Journal articles: 'Dilated eye exam adherence'

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Winters, David, Robin Casten, Barry Rovner, Ann Murchison, Benjamin E. Leiby, Julia A. Haller, Lisa Hark, David M. Weiss, and Laura T. Pizzi. "Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes." American Journal of Medical Quality 32, no. 6 (November 24, 2016): 661–67. http://dx.doi.org/10.1177/1062860616680290.

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Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.

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Corrao, Giovanni, Federico Rea, Mirko Di Martino, Adele Lallo, Marina Davoli, Rossana DlE PlALMA, Laura Belotti, et al. "Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations." International Journal for Quality in Health Care 31, no. 6 (July 1, 2019): 464–72. http://dx.doi.org/10.1093/intqhc/mzy186.

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Abstract Objective To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes. Design A retrospective cohort study was carried out from 2010 to 2015. Setting Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens. Participants The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort. Interventions Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded. Main outcomes measures A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. Results Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6–24%) and 20% (7–28%) were observed for those who adhered to just some and almost all recommendations, respectively. Conclusions Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.

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Cooper, Blake. "Ten Key Elements of a Diabetes-Related Eye Examination." ADA Clinical Compendia 2022, no. 3 (2022): 4–7. http://dx.doi.org/10.2337/db20223-4.

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Diabetes-related eye examinations focus on detecting the impact of diabetes on ocular health, including diabetes-related retinal disease (DRD), diabetes-related macular edema (DME), glaucoma, and cataracts. Screening and early treatment can often halt or reverse the level of DRD and protect eyesight. This chapter reviews the 10 key elements of a diabetes-related eye exam: history, visual acuity, intraocular pressure, pupils, extraocular motility, visual field, external examination, slit-lamp examination, dilated funduscopic examination, and diagnostic testing. By its conclusion, readers should understand the basics of a diabetes-related eye exam and how to prepare people for their visits to an eye care professional (ECP).

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Martinez-Hollingsworth, Adrienne, Theodore Friedman, and Mohsen Bazargan. "Connecting Patient and Provider Burnout to Eye Exam Frequency among Latinx Older Adults with Diabetes Mellitus." Innovation in Aging 5, Supplement_1 (December 1, 2021): 625. http://dx.doi.org/10.1093/geroni/igab046.2383.

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Abstract Among Latinx older adults, our current understanding of barriers to eye exam often fails to consider the impact of patient and provider burnout which can decrease treatment adherence and recommendation receptivity in this group. The purpose of this study was to examine correlates of eye exam frequency among Latinx older adults in South Los Angeles and explore associations reflecting patient and/or provider burnout. Data analysis was informed by the Secret Self-Management Loop and the Burnout Dyad conceptual models. This secondary analysis used data collected from a convenience sample of non-institutionalized Latinx adults 55+ in South LA (n=165) and used multinomial regression analysis. Outcome variable is recency of eye exam, independent variables are self-reported health, including diabetes mellitus diagnosis, and either patient or provider burnout (that are functions of grouped demographic or quality of care variables). Variables associated with Provider Burnout, appear to represent a larger influence on eye examination frequency then variables associated with Patient Burnout, with the most influential factor being provider recommendation. A surprising finding was the number of participants who had never received this recommendation from a provider (21%). One-third (32%) of participants with diabetes mellitus had not had an eye examination within 12 months and almost one-fifth (13%) of participants with diabetes who had received this recommendation had not received the exam. Further exploration is needed to support a better understanding of how both patient and provider burnout impacts adherence to eye examination and other preventive care recommendations for diabetes mellitus among Latinx older adults.

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Zhang, Wenlan, Peter Nicholas, Stefanie Gail Schuman, Michael John Allingham, Ambar Faridi, Tushar Suthar, Scott William Cousins, and Sasapin Grace Prakalapakorn. "Screening for Diabetic Retinopathy Using a Portable, Noncontact, Nonmydriatic Handheld Retinal Camera." Journal of Diabetes Science and Technology 11, no. 1 (July 11, 2016): 128–34. http://dx.doi.org/10.1177/1932296816658902.

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Background: Diabetic retinopathy (DR) is a leading cause of low vision and blindness. We evaluated the feasibility of using a handheld, noncontact digital retinal camera, Pictor, to obtain retinal images in dilated and undilated eyes for DR screening. We also evaluated the accuracy of ophthalmologists with different levels of training/experience in grading these images to identify eyes with vision-threatening DR. Methods: A prospective study of diabetic adults scheduled to have dilated eye exams at Duke Eye Center from January to May 2014 was conducted. An imager acquired retinal images pre- and postdilation with Pictor and selected 1 pre- and 1 postdilation image per eye. Five masked ophthalmologists graded images for gradability (based on image focus and centration) and the presence of no, mild, moderate, or severe nonproliferative DR (NPDR) or proliferative DR (PDR). Referable disease was defined as moderate or severe NPDR or PDR on image grading. We evaluated feasibility based on the graders’ evaluation of image gradability. We evaluated accuracy of identifying vision-threatening disease (severe NPDR or PDR documented on dilated clinical examination) based on the graders’ sensitivity and specificity of grading referable disease. Results: Images were gradable in 86-94% of predilation and 94-97% of postdilation photos. Compared to the dilated clinical exam, overall sensitivity for identifying vision-threatening DR was 64-88% and specificity was 71-90%. Conclusions: Pictor can capture retinal images of sufficient quality to screen for DR with and without dilation. Single retinal images obtained using Pictor can identify eyes with vision-threatening DR with high sensitivity and acceptable specificity compared to clinical exam.

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Gediminas, Raila, Liseckienė Ida, Jarusevičienė Lina, and Leonas Valius. "Guideline Adherence and the Factors Associated with Better Care for Type 2 Diabetes Mellitus Patients in Lithuanian PHC: Diabetes Mellitus Guideline Adherence in Lithuania PHC." Open Medicine Journal 6, no. 1 (August 30, 2019): 50–57. http://dx.doi.org/10.2174/1874220301906010050.

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Background: Type 2 diabetes mellitus is one of the most common chronic conditions, which requires appropriate management and care at PHC level, which is described in guidelines. However, guideline adherence at the international arena is insufficient and little is known about the reasons for guideline non-adherence. Objective: The aim of the survey was to analyse to what extent the Lithuanian family practitioners adhere to diabetes guidelines in order to compare to international data and to discover the factors associated with better diabetes care. Methods: The present study is a part of EUPRIMECARE Project, which sets out to develop a framework aiming at the analysis of PHC across Europe. The sample strategy was based on an unequal probability sampling design. An audit of 4 public and 6 private PHC medical records of the year 2011 was carried out in Kaunas region, clinical records of 382 diabetes type 2 patients were reviewed. Demography, diseases and diabetes performance indicators data were collected using a uniform template. Binary and multivariable logistic regression analyses were used in the investigation of the factors related to better diabetes guideline adherence. Results: Three guideline adherence levels were identified: high performance (performed in more than 90% cases) - BP measurement and HbA1c exam; good performance (performed in more than 50% cases) - ECG examination and serum creatinine check; insufficient performance (performed in less than 50% of cases) - annual endocrinologist consultation, eye fundus and foot examinations, LDL check and BMI calculation. Insufficient glycaemic control was positive associated with increased endocrinologist consultation and foot exam rates, elevated BP demonstrated the positive effect to creatinine check rate, multimorbidity had positive association to the annual eye, ECG, creatinine check rates; frequent FP attendance showed no positive effect on process indicators. Rural patients have a negative association to foot and ECG exam rates compared to urban patients. In a stepwise logistic regression model, 3 dependent variables had statistically significant impact on overall diabetes care indicator performance: negative - rural location of patients (OR 0.4, 95% CI 0.2-0.8), elevated mean BP (OR 0.6, 95% CI 0.4-0.9); positive - multimorbidity (OR 2.0, 95% CI 1.2-3.4). Conclusion: Guideline adherence for T2DM is not optimal in Lithuanian PHC. The best are BP and HbA1c checks. Suboptimal are BMI and LDL annual checks. The situation with these is almost the same as in other European countries. The better guideline adherence has been observed in urban (foot exam, ECG exam), multimorbidity (eye, ECG, creatinine exams), controlled by means of BP patients (serum creatinine test).

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An, Jaejin, Craig Cheetham, Fang Niu, Yamina Rajput, and Adam Turpcu. "Dilated Eye Exam Compliance for Persons With Diabetes Mellitus in a Managed Care Setting." Journal of Patient-Centered Research and Reviews 2, no. 2 (April 30, 2015): 105. http://dx.doi.org/10.17294/2330-0698.1115.

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Cai, Cindy X., Yixuan Li, Scott L. Zeger, and Melissa L. McCarthy. "Social determinants of health impacting adherence to diabetic retinopathy examinations." BMJ Open Diabetes Research & Care 9, no. 1 (September 2021): e002374. http://dx.doi.org/10.1136/bmjdrc-2021-002374.

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IntroductionThis study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methodsThis was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment.ResultsOf the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment.ConclusionsA multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.

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Budhram, Gavin. "Acute Glaucoma after Dilated Eye Exam in a Patient With Hyphema, Retinal Detachment, and Vitreous Hemorrhage." Academic Emergency Medicine 16, no. 1 (January 2009): 87–88. http://dx.doi.org/10.1111/j.1553-2712.2008.00277.x.

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Roohipourmoallai, Ramak, Samaneh Davoudi, Seyed Majid Hosseinian Benvidi, and Siva S. R. Iyer. "Peripheral Retinal Neovascularization in a Patient with Sarcoidosis and Cocaine-Associated Autoimmunity." Case Reports in Ophthalmological Medicine 2021 (June 1, 2021): 1–4. http://dx.doi.org/10.1155/2021/9923260.

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A 63-year-old African-American female with history of sarcoidosis (lymph node biopsy proven) and cocaine abuse for 8 years was referred to us because of new floater. Her ocular history was unremarkable except for vague complaints of visual disturbance during a hospital admission in 2016. On presentation, her visual acuity was 20/400 in the right eye and 20/30 in the left eye. Dilated fundus exam and multimodal imaging showed thick epiretinal membrane (ERM) superior to optic nerve head causing a lamellar macular hole and intra retinal edema in the right eye, a full thickness macular hole, and peripheral neovascularization in the left eye. Peripheral vasculitis was appreciated in both eyes and peripheral neovascularization in the left eye on fluorescein angiography. The patient underwent laser therapy, and the new vessels regressed in the left eye without any changes in systemic medications. Multiple factors may contribute to retinal vasculitis and neovascularization including sarcoidosis, cocaine abuse, and other undiagnosed systemic vasculitis, which makes this case a mystery.

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Eppley, Sarah E., Steven L. Mansberger, Saras Ramanathan, and Eugene A. Lowry. "Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes." Ophthalmology 126, no. 11 (November 2019): 1492–99. http://dx.doi.org/10.1016/j.ophtha.2019.05.033.

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Mendez, Isabel, Elizabeth A. Lundeen, Magon Saunders, Alexis Williams, Jinan Saaddine, and Ann Albright. "Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices." Science of Diabetes Self-Management and Care 48, no. 1 (January 13, 2022): 23–34. http://dx.doi.org/10.1177/26350106211065378.

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Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

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Lee, Bonny, Lydia Breskin, Laya Reddy, Alessandro Iliceto, Deborah Ashcraft, George Pankey, Jonathan Nussdorf, and Julia Garcia-Diaz. "Ocular Candidiasis in Patients with Candidemia at a Large Tertiary Care Center." Open Forum Infectious Diseases 4, suppl_1 (2017): S85. http://dx.doi.org/10.1093/ofid/ofx163.034.

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Abstract Background Bloodstream infections (BSI) caused by Candida sp. have a high mortality rate and have been increasing in recent years. Ocular candidiasis (OC) is one systemic manifestation of Candida infection; either chorioretinitis or endophthalmitis, and may lead to vision loss. Therefore, IDSA recommends an ophthalmology exam for all patients with Candida BSI. However, reported incidence of OC varies from 1 to 25%, questioning routine eye exams in these patients. The purpose of this study was to evaluate the number of patients who undergo ophthalmological exams and those diagnosed with OC at Ochsner Medical Center, New Orleans (OMC-NO). Methods One hundred and forty-four patients were identified from January 2013 to December 2015 with at least one positive blood culture for Candida sp. (only albicans, glabrata, and parapsilosis were included). Records were reviewed through the EPIC system. Results Of the 144 patients, 65 were females and 79 males; average age 58 years old. Seventy-six (52.8%) had an ophthalmological exam at Ochsner; excluding one patient who refused an exam, one patient who was excessively combative, and one patient in whom exam was deferred due to medical condition. Three patients (3.9%) showed Candida chorioretinitis; none endophthalmitis. Conclusion OC can have devastating consequences if left untreated and early diagnosis is imperative. Our analysis reveals that OC is present in 3.9% of ophthalmology exams, but this may be biased towards patients who are cooperative and can tolerate a dilated eye exam. Critical patients with multiple co-morbidities may be at higher risk for OC. A weakness of our study is that it is limited to ophthalmology records at Ochsner, and there may be records at outside facilities. Further data is required to make recommendations in patients with Candida BSI. Disclosures All authors: No reported disclosures.

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Nguyen, Liem Hieu, and Edward H. Jaccoma. "Pediatric Chalazion Case Report." Journal of Dry Eye Disease 1, no. 1 (December 28, 2018): e28-e31. http://dx.doi.org/10.22374/jded.v1i1.8.

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Background and Objectives A chalazion, also known as a stye, is a common and chronic inflammatory problem of the eyelids where one or more Meibomian glands are blocked. Previous studies have shown that a chalazion is a sign of Meibomian Gland Dysfunction (MGD) and evaporative dry eye disease. The prevalence of chalazia in the pediatric population has recently been noted. In this report, we will describe two pediatric cases of chalazion that are associated with MGD and related dry eye disease. Methods This is a case report of non-genetically related 7-year-old and 16-year-old patients as they were each seen for newly developed chalazia. Results External exam in both patients showed chalazia, waxy plugs and poor Meibomian gland expression. Meibography showed shorten, truncated, and dilated Meibomian glands with rapid tear break-up times leading to the diagnosis of evaporative dry eye disease due to MGD. Conclusion These cases serve to confirm an increase in the prevalence of MGD in the pediatric population and to emphasize the need for early screening for dry eye disease. Key Words: Chalazion - Meibomian gland dysfunction - Pediatric Dry Eye Disease

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Chetrit, Sally. "A presentation of aids-related ophthalmic disease in a severely immunocompromised patient." Canadian Journal of Optometry 72, no. 2 (April 1, 2010): 19. http://dx.doi.org/10.15353/cjo.72.629.

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Background: Human immunodeficiency virus (HIV) retinopathy is the most common ocular manifestation of the acquired immunodeficiency syndrome (AIDS), serving as an important marker for patients with significantly compromised immune status who are at risk for developing severe and visionthreatening ocular opportunistic infections. This case report describes a presentation of HIV retinopathy and cytomegalovirus (CMV) retinitis, and reviews the current management options. Case Report: A 40-year-old black male presented for a comprehensive eye exam to rule out HIV-related ophthalmic disease. At his initial visit, a dilated fundus examination revealed HIV retinopathy of the left eye. Upon subsequent examinations and as his immune status diminished, the patient developed CMV retinitis of the right eye. The patient was treated successfully with a course of highly active antiretroviral therapy (HAART) and oral valgancyclovir. Conclusion: CMV retinitis is the most common ocular opportunistic infection associated with AIDS. Treatment with systemic HAART and concomitant anti-CMV therapy leads to reconstitution of the immune system and regression of the retinitis.

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Huq, Madiha, Neha Sanan, Phuong Daniels, and Robert Hostoffer. "Posner-Schlossman Syndrome in Common Variable Immunodeficiency." Case Reports in Ophthalmological Medicine 2020 (October 15, 2020): 1–3. http://dx.doi.org/10.1155/2020/8843586.

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Introduction. Posner-Schlossman syndrome (PSS) is a rare glaucomatocyclitic crisis with clinical features including recurrent episodes of unilateral elevated intraocular pressure. Autoimmune and infectious causes have been proposed as potential etiologies of PSS. We report the first case of PSS in the setting of common variable immunodeficiency (CVID). Case Report. A sixty-two-year-old Caucasian female with a medical history of CVID and ulcerative colitis presented to the emergency room with complaints of acute right-sided vision changes. She reported image distortion, blurriness, and loss of central vision. Physical exam was significant for mildly injected right conjunctiva, visual acuity of 20/70 in right eye, and 20/25 in left eye. The right intraocular pressure was measured at 34 mmHg and left at 12 mmHg. The gonioscopy and dilated fundus examination were unremarkable. Cup to disc ratio was within normal limits, and no afferent pupillary defects were recorded. The patient was acutely treated with three rounds of dorzolamide/timolol and 0.2% brimonidine which decreased the right eye intraocular pressure to 24 mmHg. On follow-up exam with an ophthalmologist, anterior uveitis including an elevated pressure of 41 mmHg on the right and 18 mmHg on the left eye was noted and a PSS diagnosis was confirmed. Conclusion. PSS remains a rare condition with uncertain etiology and no associated systemic conditions. PSS has been postulated to be linked to autoimmune conditions. CVID is associated with many autoimmune disorders including Sjogren’s, rheumatoid arthritis, and colitis. There have been a few reported CVID-associated ocular diseases including granulomatous uveitis and conjunctivitis, chronic anterior uveitis, and birdshot retinopathy. We describe the first case of PSS in a patient with CVID.

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Deitz, Galia A., Adam R. Sweeney, and Hoon C. Jung. "Posterior Wall Collapse in High Myopia following Cataract Surgery." Case Reports in Ophthalmology 9, no. 1 (March 2, 2018): 167–71. http://dx.doi.org/10.1159/000487077.

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Purpose: We report a case of posterior globe collapse of an eye after initial recovery from uncomplicated cataract surgery in a patient with high myopia and discuss the course of management involving recognition and emergent air injection with globe reformation. Case Report: A 64-year-old functionally monocular male with a history of high myopia presented for follow-up after uncomplicated cataract surgery. Uncorrected distance visual acuity (UCDVA) at postoperative day 1 was 20/150 with an intraocular pressure (IOP) of 19 mm Hg. At the week 1 visit, UCDVA had decreased to 20/200 with an IOP at 9 mm Hg. After preliminary exam, the keratome site suture was removed, after which the patient reported vision changes. A dilated fundus exam was performed revealing posterior scleral wall collapse. A clinical diagnosis of hypotony was made and a pars plana injection of 1 mL air was performed. This resulted in immediate subjective improvement of vision. Exam the next day revealed UCDVA 20/50 with pinhole improvement to 20/30 and IOP 15 mm Hg. Conclusion: This case demonstrates postoperative hypotony in a patient with pathologic myopia, following cataract surgery. Pathologically myopic eyes may have greater propensity to collapse in the setting of reduced IOP.

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Comer-HaGans, DeLawnia, Shamly Austin, Zo Ramamonjiarivelo, and Alicia K. Matthews. "Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities." Diabetes Educator 46, no. 1 (December 24, 2019): 94–107. http://dx.doi.org/10.1177/0145721719896262.

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Purpose The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. Methods We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. Results Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. Conclusions Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.

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Zhou, Yifan, Xiaowen Li, Qinglei Sun, Jin Wei, Haiyun Liu, Keyan Wang, and Jianfeng Luo. "Adherence to Annual Fundus Exams among Chinese Population with Diagnosed Diabetes." Journal of Clinical Medicine 11, no. 22 (November 21, 2022): 6859. http://dx.doi.org/10.3390/jcm11226859.

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Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range of data every 2 years, including demographic, socioeconomic, medical and lifestyle-related information. The adherence rates to annual fundus exams across four waves (2011–2018) were assessed. Univariate and multivariable logistic regressions were used to determine factors associated with adherence. The adherence rates to annual fundus examinations of ou study population were 23.6% in 2011, 15.3% in 2013, 17.5% in 2015 and 21.5% in 2018, respectively. Consistent results over four waves showed that non-adherent patients had a relatively lower educational level, insufficient diabetes medication use, fewer non-medication treatments and irregular physical examination compared to those who were adherent to the annual fundus exam (all p values < 0.05). These variables were further identified as factors associated with adherence according to univariate and multivariate logistic regression analyses (all p values < 0.05). The present study provides explicit evidence that the adherence rate to annual fundus examinations among Chinese population with diabetes is worryingly low. Insufficient educational attainment, especially specific diabetes education, has a negative impact on patients’ adherence to clinical guideline for eye health.

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Leisy, Heather, Meleha Ahmad, and R. Theodore Smith. "Photopsias during Systemic Bevacizumab Therapy." Case Reports in Ophthalmological Medicine 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/1926178.

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Background.The authors describe a case of recurrent photopsias in a 56-year-old woman following repeat treatments with systemic intravenous bevacizumab for stage IV ovarian cancer. To our knowledge, this is the first report of photopsias following systemic bevacizumab treatments in a patient with a normal eye exam.Case Presentation.A 56-year-old Caucasian female complained of onset of floaters and flashes in the temporal peripheral field of the right eye 1 day after receiving intravenous of 30 g of 25 mg/mL of systemic bevacizumab for treatment of stage IV ovarian cancer. Ophthalmic examination, including dilated fundus exam, spectral domain optical coherence tomography (SD-OCT) of the optic nerve head, and enhanced depth imaging SD-OCT of the macula, revealed no significant abnormalities. Possible mechanisms are reviewed.Conclusion.We propose that patients who undergo intravenous bevacizumab treatments are questioned for any ocular symptoms and that more systematic evaluations of retinal nerve fiber layer and choroidal effects are obtained in those patients who are on long-term treatment at high doses.

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Lohfeld, Lynne, Christine Graham, Anne Effiom Ebri, Nathan Congdon, and Ving Fai Chan. "Parents’ reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria—A descriptive qualitative study." PLOS ONE 16, no. 11 (November 18, 2021): e0259309. http://dx.doi.org/10.1371/journal.pone.0259309.

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Background Uncorrected refractive error (URE) is a major cause of vision impairment in children worldwide. Cases are often detected through a school-based vision screening program and then treated in a follow-up appointment. This requires parents or guardians (‘parents’) to adhere to referrals for the eye exam and care plan. We aim to understand the reasons for parents’ referral non-adherence in Cross River State, Nigeria, using qualitative methods. Methods Ten focus groups were held with parents who had not adhered to the referral for a follow-up eye examination. Participants were recruited with help from staff in schools hosting the vision screening programme. Interviews were conducted using a semi-structured interview guide, audio taped and transcribed verbatim. After identifying relevant quotes, the researchers labelled each one with a descriptive code/subcode label. Then they clustered the data into categories and overarching themes. Results Forty-four parents participated in 10 focus group discussions with 28 women and 16 men. Three themes and participated in the focus group discussions with 28 women (63%). Twelve themes were generated. The three megathemes were Modifiable Factors (with 4 themes), Contextual Factors (with 6 themes), and Recommendations (with 2 themes). Conclusion Participants identified modifiable barriers that make it difficult for parents to adhere to a referral for a follow-up eye exam. These include not believing their child has a vision problem or the screening test, and issues with the referral letter. They also described important contextual factors such as poverty, logistical problems, parental attitudes towards their children and beliefs about appropriate care. Many of these issues could be addressed by following their recommendation to educate the public on the importance of child eye care and correct parents’ misconceptions. These themes will be used by the Nigerian government to enhance and scale up its child eye health programme.

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Karadzic, Jelena, Natalija Jakovic, and Igor Kovacevic. "Unilateral Adie's tonic pupil and viral hepatitis: Report of two cases." Srpski arhiv za celokupno lekarstvo 143, no. 7-8 (2015): 451–54. http://dx.doi.org/10.2298/sarh1508451k.

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Introduction. Adie?s (tonic) pupil is a neuro-ophthalmological disorder characterized by a tonically dilated pupil, which is unresponsive to light. It is caused by damage to postganglionic fibers of the parasympathetic innervation of the eye, usually by a viral or bacterial infection. Adie?s syndrome includes diminished deep tendon reflexes. Outline of Cases. We report data of a 59-year-old female with unequal pupil sizes. She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis. On exam, left pupil was mydriatic and there was no response to light and at slit lamp we saw segments of the sphincter constrict. We performed 0.125% pilocarpine test and there was a remarkable reduction of size in the left pupil. The second case is a 55-year-old female who was referred to the University Eye Clinic because of a headache and mydriatic left pupil. She had diabetes mellitus type 2, as well as hepatitis A virus 20 years earlier. On exam, the left pupil was mydriatic, with no response to light. Test with diluted pilocarpine was positive. Neurological examinations revealed no abnormality in either case so we excluded Adie?s syndrome. Conclusion. Adie?s tonic pupil is benign neuro-ophthalmological disorder of unknown etiology. Most patients commonly present no symptoms and anisocoria is noticed accidentally. Although the etiology is unknown, there are some conditions that cause tonic pupil. It may be a part of a syndrome in which tonic pupil is associated with absent deep tendon reflexes.

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Sunderji, Farrah F., and Catherine Heyman. "An unusual case of myopic shift post acquired brain injury." Canadian Journal of Optometry 74, no. 2 (March 20, 2012): 39. http://dx.doi.org/10.15353/cjo.74.567.

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Background Ocular and visual problems are frequent consequences of an acquired brain injury (ABI). The literature suggests that many patients demonstrate a myopic shift in refractive error after a traumatic brain injury (TBI), a form of an ABI. Three reported courses are suggested. Most commonly the myopia resolves under cycloplegic conditions, secondly the shift is transient, and least commonly the myopia increases over time. This case report, although not due to a TBI, is an example of the least common subgroup. Case Report The patient, a 63 year-old male, presented with a history (15 months prior to initial evaluation) of an excised right frontal temporal lobe tumour. The history included dexamethasone 4mg QD pre- and post-surgery which caused blood glucose levels to fluctuate between 5.72-22.2 mmol/l; a stroke occured postsurgery causing hemiparesis on his left side; and shunt surgery to decrease swelling to the area of excision and the optic nerves. Medications included: Cartia, lisinopril, Toprol XL, prednisone, Reglan, and Temodar. The patient was receiving chemotherapy to treat remnants of the tumour. His last eye exam in 2004 indicated a refractive error of -2.50-1.25X080 in his right eye and -3.000.75X080 in his left eye with visual acuity of 6/7.5 in both the right and left eye. He presented to our clinic with an aided visual acuity of 8/100 (6/110) in both the right and left eye and a left homonymous hemianopsia on finger counting fields. Cycloplegic retinoscopy revealed -6.003.00X090 in his right eye and -6.002.00X090 in his left eye. Dilated fundus exam showed mild swelling of both optic nerves. The patient reported blood glucose levels of 103-140. At a one-month follow-up, his best corrected visual acuity at a distance improved to 6/60 in both the right and left eye through the new prescription. His cycloplegic retinoscopy did not show any change in myopia or astigmatism and the disk edema was resolved. Conclusion This case illustrates an unusual presentation of myopic shift post ABI. The patient’s condition continued to deteriorate eventually taking his life. It remains unclear whether the myopia and astigmatism continued to increase or remained stable. Although, the cause of this change is not fully understood and needs further investigation, providing appropriate optical correction did improve the patient’s quality-of-life.

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Malerbi, Fernando Korn, Nilson Hideo Matsudo, Adriano Biondi Monteiro Carneiro, and Claudio Luiz Lottenberg. "Retinal diseases in a reference center from a Western Amazon capital city." Einstein (São Paulo) 13, no. 4 (December 2015): 530–34. http://dx.doi.org/10.1590/s1679-45082015ao3538.

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ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.

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Johnson, Steven, Thomas Ryan, Amro Omari, Samantha Schneider, and Amit Bahl. "Valsalva Retinopathy Masking as a Retinal Detachment on Point-of-care Ocular Ultrasound: A Case Report." Clinical Practice and Cases in Emergency Medicine 6, no. 2 (March 7, 2022): 125–28. http://dx.doi.org/10.5811/cpcem.2022.1.55173.

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Introduction: Approximately two million people present to the emergency department (ED) with eye-related complaints each year in the United States. Differentiating pathologies that need urgent consultation from those that do not is imperative. For some physicians, ocular ultrasound has eclipsed the dilated fundoscopic exam as the standard posterior segment evaluation in the ED. Case report: A 60-year-old female presented with sudden onset visual disturbance in her right eye. Point-of-care ultrasound showed a hyperechoic band in the posterior segment concerning for a retinal detachment. Ophthalmology was consulted and diagnosed the patient with a condition known as Valsalva retinopathy. The patient was discharged from the ED with expectant management. Conclusion: This case highlights an important differential diagnosis that should be considered when ocular ultrasound demonstrates a hyperechoic band in the posterior segment. While previous literature has demonstrated that emergency physicians are able to accurately identify posterior segment pathology using ultrasound, there is limited information regarding their ability to differentiate between pathologies, some of which may not require urgent consultation. We highlight the important differentials that should be considered when identifying posterior segment pathology on point-of-care ultrasound and their appropriate dispositions.

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Tandlich, Michael, and Kelly Williamson. "Bilateral Central Retinal Vein Occlusion as a First Presentation of Multiple Myeloma: A Case Report." Clinical Practice and Cases in Emergency Medicine 6, no. 3 (July 27, 2022): 232–35. http://dx.doi.org/10.5811/1/cpcem.2022.4.55710.

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Introduction: Acute presentation of multiple myeloma in the emergency department (ED) is an uncommon yet life-threatening clinical entity. Case Report: A 42-year-old male presented to the ED with severe generalized fatigue and vision changes most notable in his left eye. Bilateral central retinal vein occlusion (CRVO) was diagnosed on dilated fundus exam in the ED. Conclusion: The most common cause of CRVO in adults over age 50 is vascular disease, but in younger adults, conditions of systemic inflammation or hyperviscosity must be considered. Diagnosis of CRVO requires emergent ophthalmology consultation and further treatment with phototherapy, steroids, and potentially anti-vascular endothelial growth factor. Ultimately, patients require hematology/oncology and ongoing management of acute hyperviscosity syndrome. We present this case to increase awareness surrounding this diagnosis among emergency physicians. Multiple myeloma should be considered in young patients who present to the ED with bilateral CRVO, acute renal failure, and symptomatic anemia.

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Speckert, Matthew, Andrei-Alexandru Szigiato, Jeanne zielonka, Kathleen Hollamby, Eugene Ng, Filiberto Altomare, Michael Sgro, and Rosane Nisenbaum. "THE EFFECT OF EYEMASKS ON REDUCING DISTRESS ASSOCIATED WITH THE RETINOPATHY OF PREMATURITY EXAM." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e24-e24. http://dx.doi.org/10.1093/pch/pxy054.060.

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Abstract BACKGROUND Retinopathy of prematurity (ROP) is a disorder of retinal development in the low birthweight preterm infant. Eye screening is routinely performed for infants at risk of developing this disorder. While these examinations help prevent blindness, they can be physiologically stressful for infants, with changes in oxygen saturation, blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24–48 hours period afterward. The cause of these increased apneic episodes is not currently known. OBJECTIVES To evaluate the effect of decreasing light simulation during mydriasis on the frequency of stressful episodes after ROP screening. DESIGN/METHODS Multi-centre randomized study. This study was approved by hospital ethics boards at all sites. After informed consent was obtained, infants with a birthweight <1500g or gestational age of ≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation, in addition to routine care. Dilated retinal exams were performed by retinal surgeons and fellows. The primary outcome was the frequency of any desaturation, bradycardic event, or apneic event 12 hours following the examination, compared to a baseline rate 12 hours prior to the exam. Heart rate, respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline. RESULTS A total of 51 infants were enrolled; 28 randomized to the masked group and 23 to the control group. 10 and 13 infants were on ventilator support at the time of examination in each group, respectively. There was a 57.7% decrease in the total number of all stressful events in the masked group compared to controls in the 12 hour post exam period (Rate Ratio 0.42, 95% CI 0.2–0.9, P=0.024). There was a 61.3% decrease in the number of bradycardic events in the masked group compared to controls (RR 0.39, 95% CI 0.2–1.0, P=0.042). Heart rate was significantly higher in both groups after the exam (Effect by time P=0.04), with no difference in between groups (Effect by group P=0.31). There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline. Risk factors that were associated with increased stress included: younger gestational age (RR=1.32 95%CI [1.2–1.5] per week), lower birthweight (RR=1.39 [1.2–1.5] per 100g), ventilator support around the time of exam (RR=2.67 [1.3–5.6]), diagnosis of intraventricular hemorrhage (RR=3.78 [1.9–7.3]), and hyponatremia (RR=3.42 [1.8–6.6]). No adverse events occurred while using eye masks. CONCLUSION The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity, particularly lower episodes of bradycardia.

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Alam, Mustafa, Baha Abdelrahim, and Mohamed Hosam Horani. "ODP482 Graves Orbitopathy Secondary to Alemtuzumab Infusion for Multiple Sclerosis." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A766—A767. http://dx.doi.org/10.1210/jendso/bvac150.1582.

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Abstract Presentation: This is a 51-year-old male with a history of Graves disease who presented to the ED with worsening proptosis and 10/10 eye pain. He reported being unable to shut his eyes, photophobia, decreased vision, and extreme eye sensitivity to touch. He was initially diagnosed with Graves disease 3 months ago, after which he was started on Methimazole 15mg 3x a day. Patient has a history of multiple sclerosis treated with an Alemtuzumab infusion 6 months ago. He additionally reports a history of depression, smoking, and alcoholism. Hospital Course: The patient presented with stable vitals signs with T: 36.5 C, HR: 97, BP: 117/68, O2 Sat 98% on RA. Physical exam was notable for Va: 20/100 OD, 20/200 OD with near card Sc. The R pupil was dilated Nr OU. EOM exam was notable for restricted ductions in all fields of gaze OU. IP was 20 mmHg OD and 22mmHg OS with Toponen 95%. Significant Proptosis OS more than OD with resistance to retropulsion. Bilateral conjunctival erythema with clouded corneas. Labs were significant for Hgb 12.2, MCV 80, Plt 342, ANC 12.1, Creatinine 0.69, albumin 2.8, Alk Phos 158, CK 41, FT4 0.53, TSH 0.318, and FT3 1.63. An US of the thyroid was significant for thyromegaly and a 5mm right thyroid nodule. A CT Orbit/Sella was significant for thyroid associated orbitopathy with greater exophthalmos on the left and maxillary sinusitis. The patient received 1000mg Rituximab infusion and IV Decadron every 4 hours with referral for possible thyroidectomy, orbital decompression as per ophthalmology, and continued multiple sclerosis management as per neurology. Discussion This complex case highlights worsening Graves orbitopathy as a rare side effect of Alemtuzumab. This orbitopathy persisted despite high dose methimazole. Urgent IV Decadron with orbital decompression should be considered in the acute setting with thyroidectomy for symptom resolution. Presentation: No date and time listed

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Victor, Andi Arus. "Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in Central Retinal Vein Occlusion : Are Loading Dose Necessary ?" Ophthalmologica Indonesiana 45, no. 1 (April 18, 2019): 6. http://dx.doi.org/10.35749/journal.v45i1.171.

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Background : Ranibizumab (anti-VEGF) given monthly for six doses, is effective in central retinal vein occlusion (CRVO). However, the cost and adherence to complete Ranibizumab regiment is a burden for developing countries. Aim : To present two CRVO cases with satisfactory outcome after partial regiment of ranibizumab injections. Case presentation : A 52-year old male came with sudden, painless visual decline of the left eye (LE). Best corrected visual acuity (BCVA) was 0.4. Relative afferent pupillary defect (RAPD) was positive on LE. Anterior segment was normal. Fundus examination revealed a cup-disc ratio (CDR) of 0.4, macular edema (ME), scattered hemorrhages, dilated and tortuous retinal veins. Patient was diagnosed with CRVO and was given two monthly injections before stopping treatment. Patient came with worsened VA, was then given another injection. After 6 months, his BCVA was 0.8. Similarly, a 32- year old male came with sudden painless decline of vision of LE (BCVA 0.15). Anterior segment was normal. Fundus examination showed CDR of 0.3, ME, multiple scattered pre-retinal hemorrhages, dilated and tortuous retinal veins. Patient was similarly diagnosed with CRVO of LE and given two monthly injections. Final BCVA after six months follow-up was 0.9. Conclusion : Both cases showed improvement in VA despite having partial regiment of ranibizumab injections.

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Bussan, Katherine A., Whitney L. Stuard, Natalia Mussi, Won Lee, Jess T. Whitson, Yacine Issioui, Ashley A. Rowe, Katherine J. Wert, and Danielle M. Robertson. "Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer." PLOS ONE 17, no. 6 (June 30, 2022): e0266483. http://dx.doi.org/10.1371/journal.pone.0266483.

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Purpose Obstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity. Design Single center cross-sectional study. Methods Sixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance. Results No significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping. Conclusions OSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

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Schreiberová, Zuzana, Oldřich Chrapek, and Juraj Šimičák. "Ocular Complications of Diabetes Mellitus in Pregnancy – Case Report." Czech and Slovak Ophthalmology 76, no. 4 (November 1, 2020): 166–70. http://dx.doi.org/10.31348/2020/26.

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Pregnancy is associated with increased risk of progression of diabetic retinopathy (DR), the greatest risk of worsening occurs during the second trimester of pregnancy and persists as long as one year after the childbirth. The risk factors include duration of the diabetes, insufficient metabolic control, severity of DR at the time of conception and presence of coexisting vascular disease, such as arterial hypertension, and pregnancy itself. The recommendations for retinopathy screening in pregnancy vary significantly. A dilated fundus exam should be done in the beginning of pregnancy, the next follow-up throughout pregnancy depends on the severity of ocular findings. The cooperation of multi-disciplinary team consisting of ophthalmologist, obstetrition and endocrinologist is essential to provide the best health care. The authors present a case report of a pregnant woman with type 1 diabetes mellitus (DM), who had a progression of DR and diabetic macular edema (DME) in both eyes during pregnancy. She has had DM for 24 years and has been treated with insulin. The patient was examined at the 23rd week of the second pregnancy (first pregnancy was terminated because of missed miscarriage). The diagnosis of advanced proliferative DR and advanced DME in both eyes was made so we performed panretinal laser photocoagulation of the retina of both eyes. Despite that the ocular findings got worse and we found vitreous haemorrhage in the left eye. We performed pars plana vitrectomy (PPV) of the left eye at the 28th week of pregnancy, nevertheless the DME got worse in both eyes, so we recommended to terminate the pregnancy at the 31st week because of the risk of loss of vision. The visual acuity of the left eye improved, but suddenly there was vitreous haemorrhage in the right eye after the delivery. We indicated PPV of the right eye, the outcome of the surgery was satisfying. We still take care about this patient.

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LoBue, Stephen A., Fukutaro Mano, Erin Schaefer, and Thomas D. LoBue. "Unilateral Multifocal Intraocular Lens Implantation in a Patient with Adie’s Pupil." Case Reports in Ophthalmology 9, no. 2 (August 9, 2018): 369–74. http://dx.doi.org/10.1159/000492106.

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Purpose: To report a case of a patient with unilateral Adie’s pupil who underwent bilateral cataract extraction with multifocal and monofocal posterior chamber intraocular lens (IOL) implantation. Methods: A 74-year-old woman presented to our institution complaining of worsening near vision. Gross examination revealed a 6-mm fixed pupil on the right eye (OD) and a 5-mm pupil reacting to 3 mm with light on the left eye (OS). Slit lamp examination revealed a tonic pupil with an exaggerated pupillary constriction to dilute pilocarpine OD. Dilated exam revealed 2–3+ nuclear and cortical lens changes bilaterally. The patient’s active lifestyle, personality, and biometry measurements made her a good candidate for multifocal IOL (MfIOL) implantation OS. Femtosecond laser-assisted cataract extraction with a ReSTOR +3 ADD (SN60D1) implantation was performed OS. Monofocal lens implantation (SN60WF) was performed OD 6 months later. Results: One year postoperatively, our patient had an uncorrected visual acuity (VAsc) of 20/15 for distance and J10 for near OD. Her VAsc was 20/25 +1 for distance and J1 for near OS. Visual acuity when using both eyes was 20/15 for distance and J1 for near. Conclusion: Optimizing success for MfIOL implantation is a multifactorial process. Large pupils preoperatively are of particular concern, as this may lead to increased dysphotopsia with pupil-dependent MfIOLs. Thus, patients with unilateral mydriasis, such as Aide’s pupil, may have a beneficial outcome combining multifocal-monofocal implantation after bilateral cataract extraction, especially if they are not a candidate for monovision but desire spectacle independence.

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Adil, Munazir, Samreen Siddiqui, Swati Waghdhare, Amit Bhargava, and Sujeet Jha. "Awareness of retinal screening in patients with Type 2 diabetes mellitus: Are we meeting standards of care?" Asian Journal of Medical Sciences 8, no. 6 (November 1, 2017): 9–12. http://dx.doi.org/10.3126/ajms.v8i6.18058.

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Background: Since diabetic retinopathy is a silent, but progressive complication of diabetes, and comprises 4.8% of the global causes of blindness, it is imperative that it is detected early and treated in a timely fashion.Awareness about retinopathy amongst patients with diabetes is an important aspect in the management of diabetes.Aims and Objective: To understand the level of awareness of retinal screening in North Indian patients with diabetes mellitus (DM), attending a tertiary care hospital.Materials and Methods: This was an observational, cross-sectional questionnaire based study, conducted over a 6 month period at a tertiary care hospital in North India. Patients above the age of 18, having an underlying diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM), were included in the study. The Unpaired or independent student t-test were used for the comparison of the mean value of two groups, and the Chi-square test for the comparison of categorical variables. The p-value was taken as significant when less than 0.05 (p<0.05). A Confidence interval of 95% was used.Results: The mean age of the study subjects was 53.78±11.24 years, with a mean age of diagnosis of 46.50±10.7 years, and a mean duration of having diabetes of 7.4±7.61 years. Glycemic control was sub-optimal, with the mean HbA1c of the cohort at 9.55%. Of 100 responders, 33% reported being unaware of the ocular complications of diabetes. Only 48% stated that their healthcare provider had advised them that they need a routine yearly dilated eye exam. Despite 62% of the cohort reporting decreased visual acquity, 52% did not have an eye exam in the preceding year.Conclusion: The majority of our patients remains unaware of the complications of their diabetes, and hence may not be engaged in its management. More longitudinal studies are needed to understand what factors are affecting health literacy in the population. Better sustainable and patient-centric education models need to be developed, that will serve to increase health literacy, and improve patient care.Asian Journal of Medical Sciences Vol.8(6) 2017 9-12

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Wallace, Scott A. "Spontaneous Vitreous Hemorrhage in a Naval Aviator." Aerospace Medicine and Human Performance 91, no. 11 (November 1, 2020): 904–7. http://dx.doi.org/10.3357/amhp.5666.2020.

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BACKGROUND: Spontaneous vitreous hemorrhage is uncommon in the general population. Of cases, 1020% are idiopathic or due to occult causes and a majority of the remainder are associated with diabetic disease. The evaluation and disposition of an aviator has not been reported previously. This case will document the work-up and safe return to flight of a patient.CASE REPORT: A 33-yr-old male MH-60R pilot presented with acute blurred vision in the left eye and eye pain which began at his desk. His review of systems was otherwise negative. His medical history was noncontributory. On initial examination his vital signs and external ocular exam were normal. He was immediately referred to the optometry clinic, where a dilated funduscopic examination (DFE) with scleral depression demonstrated a large floater OS composed of streaks of blood and tobacco dust. His DFE was otherwise normal with no retinal tears or vitreous detachments. On repeated DFEs, his intraoccular pressures remained normal and his hemorrhage resorbed without decreased visual acuity or field deficits. A hematologic work-up was negative. After 4 mo of observation, the patient was returned to flight status without further recurrence.DISCUSSION: No known associations exist between aeronautical duties and spontaneous vitreous hemorrhages. The stressors aviators are subjected to, such as high vibrations and increased g forces, may make them more likely to suffer intraocular microvascular damage that could lead to retinal detachment, vitreous detachment, and bleeding. Further reports are needed to determine the risks of recurrence in aviators and their differences from typical spontaneous vitreous hemorrhage patients.Wallace SA. Spontaneous vitreous hemorrhage in a naval aviator. Aerosp Med Hum Perform. 2020; 91(11):904907.

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White, Cameron, Peter Pappas, and Todd P. McCarty. "1173. Ocular Candidiasis in Patients with Candidemia Diagnosed by Blood Culture Versus T2Candida® Assay." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S612. http://dx.doi.org/10.1093/ofid/ofaa439.1359.

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Abstract Background Ocular candidiasis (OC) is a serious complication of candidemia. Current guidelines recommend dilated fundoscopic exam (DFE) in all patients with candidemia. In this study, we examined characteristics and outcomes of patients at UAB Medical Center with candidemia diagnosed by blood culture (BC) or T2Candida® rapid diagnostic assay (T2C) who were found to have evidence of fungal disease on ophthalmologic exam. Methods Patients from 2016-2019 with either 1) at least one positive BC for Candida species or 2) positive T2C assay and negative or no paired BC were identified and retrospectively reviewed. Patients with additional positive BC or T2C within 60 days were excluded from the analysis. Data collected included risk factors for candidemia, causative Candida species, and whether DFE was performed after diagnosis. Patients with evidence of OC by exam were compared by type of ocular involvement (chorioretinitis vs. vitritis), whether visual symptoms were present, and whether intravitreal injection was performed. Results A total of 360 episodes of candidemia diagnosed by BC and 288 by T2C alone were included. Of those who underwent DFE, 33 BC patients (12.9%) had findings concerning for OC compared to 18 (8.9%) T2C patients (p=0.177) (Table 2). T2C patients with OC were younger, were more likely to have a prolonged ICU stay and to be mechanically ventilated, and were less likely to be on TPN compared to the BC group. Identification of C. parapsilosis was significantly more common in T2C patients (Table 1). There were no significant differences in presence of visual symptoms, type of ocular involvement, need for intravitreal injection, or 30-day mortality (Table 3). Table 1. Demographics and risk factors Table 2. Episodes of candidemia and ocular candidiasis by year Table 3. Ocular findings and outcomes Conclusion The frequency of ocular disease was similar between groups. Significantly more T2C patients had candidemia due to C. parapsilosis, and the groups differed in terms of risk factors for candidemia. There were no differences in frequency of intravitreal injection, severity of eye disease, or mortality. Despite recent concerns about the necessity of DFE in asymptomatic patients with candidemia, we believe these results emphasize the importance of performing DFE in candidemic patients and also support the practice of doing so in patients with positive T2C even in the absence of positive blood cultures. Disclosures Peter Pappas, MD, SCYNEXIS, Inc. (Consultant, Advisor or Review Panel member, Research Grant or Support) Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)

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Guo, Fangjian, Yu-Li Lin, Mukaila Raji, Bruce Leonard, Lin-Na Chou, and Yong-Fang Kuo. "Processes and outcomes of diabetes mellitus care by different types of team primary care models." PLOS ONE 15, no. 11 (November 5, 2020): e0241516. http://dx.doi.org/10.1371/journal.pone.0241516.

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Background Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs). Methods We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition. Results Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices. Conclusion The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.

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Ingley, Megan, Patrick Quebedeaux, Kristen Schmidbauer, Idris Ali Amghaiab, and Jacqueline Chan. "PMON315 Hyperglycemia Dilemma: Concomitant Type 1 Diabetes Mellitus and Cushing's disease." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A624—A625. http://dx.doi.org/10.1210/jendso/bvac150.1295.

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Abstract Introduction Type 1 diabetes (T1DM) is an autoimmune condition causing destruction of insulin-producing pancreatic beta cells. About a third of patients present with DKA at diagnosis. Insulin is mainstay therapy to achieve glucose control. Glucose hemostasis is affected by several factors. Conditions including acute illness or endocrinopathy such as Cushing's disease can cause hyperglycemia. We present a case of a pediatric patient with T1DM and difficult to control hyperglycemia due to concomitant hypercortisolism. Case The patient is an eleven-year-old male, who first presented in DKA at the age of 10. HgA1c at diagnosis was 17.9%. GAD65 and IA2 antibodies were positive. Compliance to medications as well as post-hospital follow-up has been an issue. At his initial follow-up visit, 8 months after diagnosis, they reported adherence to prescribed insulin regimen although his A1c was 11.3%. Insulin dose was adjusted based on current A1c level and documented glucose monitor readings. 3 months after, improvement of A1c was documented at 10.7%. He however complained of eye swelling and noted to have elevated blood pressure. Due to concerns of nephrotic syndrome he was referred to nephrology. His renal function test and urine micro-albumin came back normal. He was started on Lisinopril 5mg daily but eventually switched to amlodipine 5mg daily to control his blood pressure. In the following 14 months, nephrology noted that his hypertension was difficult to control in spite of optimizing medications. He was eventually admitted for severe headache. Significant exam on admission revealed moon facies, buffalo hump, striae on his extremities. A CT scan revealed pituitary macroadenoma 1.1×2cm. TSH was slightly low, FT4 normal. Growth hormone was also elevated. ACTH was 38 pg/ml (n 7.2-63 pg/ml)and serum cortisol was 7.1mcg/dl (n 3-22 mcg/dl). 24hr urine cortisol sent but was still pending. The rest of the pituitary work up was normal. Patient was scheduled for transsphenoidal surgery. A repeat 24-hour urine cortisol was again sent prior to surgery assuming initial test was lost. Interestingly, the initial 24-hour Urine free cortisol came back significantly elevated at 1,304 mcg (normal 2.3-37mcg) and urine free cortisol is . Pathology came back as pituitary apoplexy. 24-hour urine cortisol right before surgery came back undetectable confirming this. Conclusion Non-adherence to medication is a common reason for persistent hyperglycemia in T1DM but providers should be vigilant of other possible etiologies. Continued follow-up and detailed physical exam to check for clues such as hypertension, striae, buffalo hump, and bruising can lead to unmasking a secondary etiology. We present the first reported case of type 1 diabetes and Cushing's disease from a functional pituitary macro-adenoma that subsequently develop pituitary apoplexy. It is important to note that 24 urine cortisol remains the gold standard for diagnosis regardless of normal serum cortisol levels. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

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Swiston, Cole J., K. S. Hu, A. Simpson, E. Burton, B. J. Brintz, and A. Lin. "Prevention of Exposure Keratopathy in the Intensive Care Unit: Evaluation of an EMR-Based Lubrication Order Protocol for Ventilated Patients." Journal of Academic Ophthalmology 14, no. 02 (July 2022): e141-e146. http://dx.doi.org/10.1055/s-0042-1750020.

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Abstract Purpose In this pilot study, we aimed to investigate the efficacy of an electronic medical record (EMR) order set for lubricating ointment (four times daily) in the prevention of exposure keratopathy in ventilated patients in the intensive care unit (ICU) at the University of Utah. We attempted to capture the magnitude of morbidity, cost, and care burden in ventilated patients, as well as the utility of a systematic EMR-based preventative lubrication protocol in the ICU setting. Methods After implementation of the order set, a retrospective chart review was performed to capture all ventilated ICU patients pre- and postintervention. Three separate study periods were used: (1) Six months prior to coronavirus disease 2019 (COVID-19) and prior to the ocular lubrication intervention; (2) the subsequent 6-month period including COVID-19 patients but prior to any intervention; and (3) the subsequent 6-month period postintervention, including COVID-19 patients. The primary endpoint of ointment use per day was analyzed with a Poisson regression model. Secondary endpoints including rates of ophthalmologic consultation and exposure keratopathy were compared with Fisher's exact test. A poststudy survey of ICU nurses was included. Results A total of 974 ventilated patients were included in the analysis. Ointment use per day increased by 155% (95% confidence interval [CI] 132–183%, p < 0.001) following the intervention. Rates also increased 80% (95% CI 63–99%, p < 0.001) during the COVID-19 study period but prior to intervention. The percentage of ventilated patients requiring a dilated eye exam for any indication was 3.2, 4, and 3.7% in each of the study periods, respectively. There was an overall down trend in the rate of exposure keratopathy which was diagnosed in 33.3, 20, and 8.3% of those receiving ophthalmologic consultation, though these rates were not statistically significant. Conclusion These preliminary data show a statistically significant increase in the rates of lubrication in mechanically ventilated patients using an EMR-based order set in the ICU setting. There was no statistically significant decrease in the rates of exposure keratopathy. Our preventative protocol with lubrication ointment was of minimal cost burden to the ICU. Further longitudinal and multicenter studies are needed to better assess the efficacy of such a protocol.

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Estepp, Jeremie H., Mary Ellen Hoehn, Matthew Smeltzer, Jane S. Hankins, Winfred C. Wang, and Banu Aygun. "The Impact of Hydroxyurea Therapy on the Prevalence of Retinopathy in a Pediatric Sickle Cell Cohort." Blood 118, no. 21 (November 18, 2011): 1057. http://dx.doi.org/10.1182/blood.v118.21.1057.1057.

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Abstract Abstract 1057 Introduction: Approximately 15–17% of children with HbSS and 11% of those with HbSβ0thalassemia (HbSβ0thal) develop sickle retinopathy (SR) by 18 years of age. Sickle retinopathy is a spectrum of vascular lesions that insidiously evolve as a result of ischemia from vaso-occlusion of capillary and precapillary arterioles in the peripheral retina. These lesions are usually clinically silent but can progress to spontaneous vitreous hemorrhage or retinal detachment and lead to blindness. Therefore, periodic screening retinal exams are recommended for children and adults with sickle cell disease (SCD). Prior reports from Jamaica identified low fetal hemoglobin (HbF) concentration as a potential risk factor for retinopathy in HbSS patients. Hydroxyurea (HU), an increasingly utilized treatment in children with HbSS/HbSB0thal, increases %HbF levels. However, there are no reports describing the effects of HU therapy on the prevalence of retinopathy in children with SCD. In our institution, all children with SCD are referred to ophthalmology for a screening dilated fundoscopic exam (DFE) beginning at 10 years of age and then every 2 years. Objective: Define the prevalence of retinopathy in children with HbSS/HbSβ0thal and analyze the effects of treatment with HU and %HbF levels on the prevalence of retinopathy. Methods: After IRB approval, a retrospective chart review was performed on children with HbSS/HbSβ0thal who received a DFE without fluorescein angiography at St Jude Children's Research Hospital between 2003 and 2010. Children who received chronic transfusion therapy or hematopoietic stem cell transplantation were excluded from analysis. Records of DFEs were reviewed for a diagnosis of non-proliferative or proliferative SR. Laboratory data were collected at multiple time points from patients' electronic medical records, including: prior to initiation of HU, following two years of therapy with HU, and immediately prior to diagnosis of retinopathy. Time of observation was defined as birth to diagnosis of SR or to date of last DFE. Summary statistics are reported and the HU and non-HU groups are compared with the Wilcoxon-Mann-Whitney Exact test. Results: Of 182 children referred to ophthalmology, 142 (78%; 126 HbSS, 16 HbSβ0thal) received an initial DFE at a median age of 13.1 ± 3.3 years (range: 1.6–18.7 years). The median number of DFEs per patient was 1.7 ± 1.4 (range: 1–12) during the time of observation. Sickle retinopathy was diagnosed in 9.9% (14/142) of children, at an average age of 15 ± 2.5 years. Of the children who received a DFE, 63% (90/142) had initiated HU therapy at an average age of 9.8 ±4.8 years. The average age at initial DFE was not different in patients receiving HU (13.1 ± 3.2 years) and those who did not (13 ± 3.5 years). The total number of DFEs performed in both groups was also similar (1 ± 1.2 in HU-treated group vs. 1 ± 1.6 in untreated group). Retinopathy was diagnosed in 7.8% (7/90) of children who received HU and 13.5% (7/52) of children who did not (p=0.27). The median age at diagnosis of SR was similar for patients treated with HU (15.4 ± 2.5 years, range: 11.3–18.2 years) compared to untreated children (14.6 ± 2.6 years, range: 10.8–17.3 years; p=0.6). Among patients receiving HU, those who developed retinopathy started treatment at a later age, however the difference was not statistically significant (12.2 ± 5 years vs. 9.3 ± 4.5 years; p=0.23). Among the HU treated group, %HbF following 2 years of HU therapy was similar in those who developed SR (16.1 ± 7.7%) and those who did not (20.0 ± 6.8%; p=0.24). Conclusion: Although the average age at diagnosis with retinopathy in these children with HbSS/HbSβ0thal was similar to previously reported untreated pediatric cohorts, the overall prevalence of retinopathy was lower. Treatment with HU did not affect the development of retinopathy nor did %HbF levels in those treated with HU. More studies are necessary to analyze the effects of HU treatment on development of SR. In the meantime, continued adherence to screening guidelines for ophthalmology evaluations are necessary for children with HbSS and HbSβ0thal being treated with hydroxyurea. Disclosures: Off Label Use: Use of hydroxyurea in children with sickle cell anemia.

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Hark, LA. "Assessing Adherence to Annual Dilated Eye Exam Recommendations in Patients with Diabetes and Erectile Dysfunction." Journal of Clinical Research and Ophthalmology, December 17, 2015, 067–71. http://dx.doi.org/10.17352/2455-1414.000025.

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Kisra, Sood, John Spertus, Faraz Kureshi, Philip G. Jones, Mikhail Kosiborod, and Suzanne V. Arnold. "Abstract 121: Testing Frequency Of Guideline-recommended Diabetes Performance Measures In A Cohort Of Post-acute Myocardial Infarction (AMI) Diabetics." Circulation: Cardiovascular Quality and Outcomes 7, suppl_1 (July 2014). http://dx.doi.org/10.1161/circoutcomes.7.suppl_1.121.

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Background: Diabetes mellitus (DM) is common among patients hospitalized with acute myocardial infarction (AMI). Although guideline-supported performance measures exist to improve care for each condition, prior work assessing the quality of care for diabetic patients after AMI has focused only on adherence to CAD performance measures. The quality of diabetic care these patients’ receive is unknown. Methods: Using data from a prospective AMI registry (TRIUMPH), we identified patients with known DM and examined whether DM-focused performance measures had been applied over the 12 months after discharge. We focused upon 3 DM guideline-supported performance measures: a dilated eye exam, detailed foot exam, and HgbA1C testing. For this analysis, we conducted univariate statistics to describe the frequencies with which diabetics reported receiving these DM performance measures and 4 CAD performance measures at their 12-month interview. Results: Among 1,343 patients with a known diagnosis of diabetes presenting with an AMI, a total of 791 (58.9%) completed the 12-month follow up interview. The mean age (SD) of the analytic cohort was 6111 years, with 60% being males and 63% Caucasian. The frequencies of reported receipt among the examined DM and CAD performance measures ranged from 57.3%- 82.2%, with ASA being the most common and a dilated eye exam being the least (Figure). Only 47% of patients reported receiving all three DM performance measures over the past 12 months, while 41.1% reported receiving either one or two, and 12% reported receiving none. Conclusion: In a large, multi-center cohort of diabetic AMI survivors we found that patient-reported receipt of 3 DM and 4 CAD performance measures is sub-optimal and there is significant room for improvement. Novel strategies and approaches for assessing the quality of care delivered to post-AMI diabetics in a multidimensional fashion remains vital for improving care and outcomes in this high-risk group of patients. Characters: 1,683 + figure 500. Limit 2,500

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Alhabshan, Rashed, and David Scales. "Multiple Evanescent White Dot Syndrome Developing Three Days following Administration of mRNA-1273 Booster Vaccine: Case Report." Case Reports in Ophthalmology, July 18, 2022, 570–77. http://dx.doi.org/10.1159/000525687.

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Little is known about the potential ocular adverse events following mRNA-1273 vaccine. We aimed to report a case of multiple evanescent white dot syndrome (MEWDS) developing 3 days following the administration of mRNA-1273 vaccine booster. A 71-year-old white myopic female presented with complaints of seeing “pulsating light” and scotoma with her left eye that started about 3 days following mRNA-1273 vaccine booster administration. The patient was found to have multiple scattered white-yellow outer retinal lesions on dilated fundus exam of the left eye. Visual symptoms and exam findings continued to improve without any intervention confirming a short-lived and self-limiting disease course. Clinical presentation was consistent with a clinical diagnosis of MEWDS. Ophthalmologists need to take detailed vaccination history in patients presenting with MEWDS.

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Ribeiro, Ana Clara Sarzedas, Rodolfo José Cavalcanti Souto, Tayrlla Polessa Rodrigues Silva, José Augusto Bastos Afonso, Carla Lopes Mendonça, Nivaldo de Azevedo Costa, Luiz Teles Coutinho, and Jobson Filipe De Paula Cajueiro. "Ultrasonographic Diagnosis of Ileal Intussusception in Calf." Acta Scientiae Veterinariae 49 (January 18, 2021). http://dx.doi.org/10.22456/1679-9216.116569.

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Background: Intussusception, characterized by invagination of an intestinal segment into the lumen of the adjacent segment, is one of the main causes of intestinal obstruction in cattle, and occurs more frequently in calves. The diagnosis of the disease is based on the history, clinical examination, and complementary exams, which are a challenge in this species, especially in calves, in which transrectal palpation is limited. As it is a non-invasive, effective, and low-cost test, ultrasonography could be an important tool in the diagnosis of intestinal obstructions, in which time is essential for the prognosis. Therefore, the objective was to report a case of intussusception in a calf diagnosed by ultrasound.Case: A 4-month-old calf, weaned at 3 months and raised intensively, was treated at the Clínica de Bovinos de Garanhuns, campus of the Universidade Federal Rural de Pernambuco (CBG/UFRPE), with a history of apathy, anorexia, and dyschezia for 3 days. On physical examination, fever, moderate dehydration, tachycardia, tachypnea with polypnea, bilaterally bulging abdomen, sound of fluid on ballottement, ruminal and intestinal hypomotility, and melena were observed. The hematological findings revealed leukocytosis due to neutrophilia (degenerate neutrophils), hypoproteinemia, and hyperfibrinogenemia. The analysis of the ruminal fluid showed compromised microbiota and increased chloride content. The transabdominal ultrasonography demonstrated, in the right ventral region, hypermotile and full small bowel loops and an increase in the volume of the peritoneal fluid. In addition, there was a segment of the small intestine which, in cross-section, showed multiple concentric rings (“onion rings”, “target pattern”, or “bull’s eye”) and adherence to adjacent loops, compatible with intestinal obstruction due to intussusception. Due to the seriousness of the clinical condition and the ultrasound findings, the animal was euthanized and the necropsy revealed focal fibrinous peritonitis and intestinal obstruction due to intussusception in ileum intestinal segments.Discussion: Intussusception has previously been reported in calves, however this is the first report of ultrasound diagnosis of the disease in Brazil. Although the etiology is rarely confirmed, the age group and recent changes in diet (weaning) were predisposing factors. The history, clinical signs, and laboratory tests were similar to those described in cattle with intussusception, however they may be present in other gastrointestinal illnesses. Other authors have also reported that the nonspecificity of the signs and the impossibility of performing transrectal palpation made it difficult to diagnose intestinal obstruction in calves without the use of other diagnostic tools. As it is a non-invasive and accurate technique, ultrasound has been used in ruminants for diagnostic purposes, including intestinal obstructions. In the present case, the main findings are described as the presence of a lesion with the appearance of multiple concentric rings, hypermotile, dilated, and full intestinal loops. The pathological findings were compatible with the ultrasound images and similar to those described by other authors, confirming the diagnosis. The use of ultrasonography as a diagnostic tool in cattle should be expanded, aiming at the early determination of diagnosis and prognosis, to reduce producer costs and animal discomfort. In cases of intussusception, late diagnosis makes treatment unfeasible.

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Tumbo, John M., and Faustin N. Kadima. "Screening of long-term complications and glycaemic control of patients with diabetes attending Rustenburg Provincial Hospital in North West Province, South Africa." African Journal of Primary Health Care & Family Medicine 5, no. 1 (April 15, 2013). http://dx.doi.org/10.4102/phcfm.v5i1.375.

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Background: The prevalence of diabetes mellitus (DM) is increasing worldwide, with more than 90% being type 2. In South Africa, DM is common amongst all racial groups with the highest prevalence amongst the Indian population (15.8%), followed by the White (3.5%) and Black (4.8%) populations. Long-term cardiovascular, renal, neurovascular and retinal complications of type 2 DM are majorcauses of disability and mortality - hence the need for screening.Objective: To describe the screening practices of long-term complications amongst patients withtype 2 diabetes attending Rustenburg Provincial Hospital in North West Province (South Africa).Method: A cross-sectional quantitative study using patients’ clinical records was performed. A randomsample of 92 out of 1340 patients with type 2 diabetes attending the hospital in 2007 was selected. Demographic information on age, gender, body mass index, residence, level of education, durationof treatment and type of treatment was obtained. The recorded glycosylated haemoglobin (HbA1c),lipids and blood pressure levels were extracted, as well as the results of the dilated eye exam, footexamination, urine test for microalbumin, blood urea and creatinine. The data was analysed usingthe EPI Info version 6.05 software package.Results: The screening tests that were carried out consistently included: glycosylated haemoglobin (95.7%), blood pressure (100%), serum glucose (100%), serum cholesterol (79.3%) and serum creatinine (93.5%). Aspects poorly screened for were: dilated eye examination (19.5%), foot examination (20.6%), urine test for micro-albumin (1.1%), as well as HDL and LDL cholesterol (17.4%). Abnormal resultswere mainly detected in: HbA1c (69.3%), serum creatinine (30.2%), dilated eye examination (38.9%) and foot examination (52.6%). The HbA1c of 9.1% is far above the target of 6% and this predisposespatients to long-term complications.Conclusion: The screening of long-term complications of type 2 DM was poor in most patients and demonstrated a high prevalence of abnormal results. There is a need to improve screening practices.

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Tsani, Zoi, Antonios Ntafos, Victoria Toumanidou, Anna Dastiridou, Ioanna Ploumi, and Sofia Androudi. "Vision loss in a pregnant woman with nephrotic syndrome." European Journal of Ophthalmology, October 19, 2021, 112067212110547. http://dx.doi.org/10.1177/11206721211054731.

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Purpose To report acute visual acuity loss in a pregnant woman with nephrotic syndrome. Case Report A 34-year-old pregnant woman was referred to our service for acute, bilateral visual impairment, associated with bilateral below knee edema (BKE). Best-corrected visual acuity (BCVA) was hand motion in the right eye and 20/200 in the left eye. Dilated fundus exam disclosed multiple pigment epithelium detachments involving the macula in both eyes. After consultation with a nephrologist a diagnosis of nephrotic syndrome was made. Unfortunately, a week later she lost the fetus. At follow-up evaluation, 20 days after the miscarriage, BCVA improved to 20/25 in both eyes with near normal restoration of the retinal anatomy. Conclusion In nephrotic syndrome, sequestration of interstitial fluids, which leads to classic generalized edema, could be the origin of interstitial accumulation of fluids in the retinal and subretinal layers. Increased awareness by the gynaecologists and prompt treatment may prevent fetus miscarriage.

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"Amblyopia or Pathology? Diffuse Unilateral Subacute Neuroretinitis in a Pediatric Patient." Vision Development & Rehabilitation, March 30, 2018, 29–37. http://dx.doi.org/10.31707/vdr2018.4.1.p29.

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Background: Diffuse unilateral subacute neuroretinitis (DUSN) is a retinal disorder cause by a subretinal nematode. The disorder tends to affect children and young adults. It is characterized by unilateral retinal pigment epithelium changes, vitritis, retinal vessel narrowing and, in advanced stages, optic atrophy. Patients are generally asymptomatic or report a painless loss of vision. It has been described in the United States as well as Latin America, Asia and Europe. Case Report: A 9 year old female, recently adopted from the Ukraine, presented for an eye exam after failing a vision screening. Uncorrected visual acuity was 20/20 OD, 20/30 OS with hyperopia OS>OD. A dilated examination revealed pigment epithelial changes in the macula OS only. Examination by a retinal specialist included ocular coherence topography and a fluorescein angiography. Blood work and stool samples were normal. A diagnosis of DUSN was made and laser photocoagulation was performed around the suspected worm. The patient tolerated the procedure well. After treatment, and with her eyeglasses, visual acuity was 20/25 OS. Conclusion: Diffuse unilateral subacute neuroretinitis (DUSN) is a condition that can be detected on a routine exam in asymptomatic patients. Recognition of the condition and prompt treatment is important to help delay disease progression and preserve visual acuity.

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Joseph, Tina, Genevieve Hale, Cynthia Moreau, Elaina D. Rosario, Nichelle Logan, and Alexandra Perez. "Evaluating a Pharmacist-Led Intervention on Cardiovascular- and Diabetes-Related Quality Measures in a Primary Care-Based Accountable Care Organization." Journal of Pharmacy Practice, December 11, 2020, 089719002097774. http://dx.doi.org/10.1177/0897190020977740.

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Background: The Centers for Medicare and Medicaid Services (CMS) publishes quality measures to gauge performance in Accountable Care Organizations (ACOs). ACO-27 (Diabetes Mellitus: Hemoglobin A1c Poor Control) and ACO-41 (Diabetes: Eye Exam), are 2 components for the Diabetes Composite measure. ACO-42 focuses on Statin Therapy for the Prevention and Treatment of Cardiovascular (CV) Disease. There are limited studies regarding the pharmacist role in CV and Diabetes Management in the ACO primary care setting. Objective: To evaluate the impact of pharmacist-led interventions on CV- and diabetes-related CMS quality measures within a primary care-based ACO. Methods: This retrospective pre-post intervention study included 3 primary care-based ACO offices. Patients who met eligibility criteria for CMS quality measures ACO-27, -41 and -42 were included. Pharmacist interventions occurred in December 2018. The study co-primary outcomes were the percentage of patient meeting ACO-27/-41 (composite diabetes-related) and -42 (statin-related) CMS quality measures in the pre-intervention compared to the post-intervention phases. Results: Of 105 patients meeting study inclusion criteria, 77.1% were on statin therapy prior to intervention. After pharmacist intervention, the prevalence of patients on statin therapy increased to 80.0% (p = 0.083). All patients had a HbA1c less than 9% pre-intervention. Sixty-one (58.1%) patients had a documented dilated eye exam prior to intervention. Post-intervention, the prevalence of exams increased to 73.3% (p < 0.0005). Conclusions: Pharmacists can assist primary care providers in the ACO setting meet CV- and diabetes-related CMS quality measures, demonstrating the value of the pharmacist in value-based health care settings.

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Fuller, Spencer D., Jenny Hu, James C. Liu, Ella Gibson, Martin Gregory, Jessica Kuo, and Rithwick Rajagopal. "Five-Year Cost-Effectiveness Modeling of Primary Care-Based, Nonmydriatic Automated Retinal Image Analysis Screening Among Low-Income Patients with Diabetes." Journal of Diabetes Science and Technology, October 30, 2020, 193229682096701. http://dx.doi.org/10.1177/1932296820967011.

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Background: Artificial intelligence-based technology systems offer an alternative solution for diabetic retinopathy (DR) screening compared with standard, in-office dilated eye examinations. We performed a cost-effectiveness analysis of Automated Retinal Image Analysis System (ARIAS)-based DR screening in a primary care medicine clinic that serves a low-income patient population. Methods: A model-based, cost-effectiveness analysis of two DR screening systems was created utilizing data from a recent study comparing adherence rates to follow-up eye care among adults ages 18 or older with a clinical diagnosis of diabetes. In the study, the patients were prescreened with an ARIAS-based, nonmydriatic (undilated), point-of-care tool in the primary care setting and were compared with patients with diabetes who were referred for dilated retinal screening without prescreening, as is the current standard of care. Using a Markov model with microsimulation resulting in a total of 600 000 simulated patient experiences, we calculated the incremental cost-utility ratio (ICUR) of the two screening approaches, with regard to five-year cost-effectiveness of DR screening and treatment of vision-threatening DR. Results: At five years, ARIAS-based screening showed similar utility as the standard of care screening systems. However, ARIAS reduced costs by 23.3%, with an ICUR of $258 721.81 comparing the current practice to ARIAS. Conclusions: Primary care-based ARIAS DR screening is cost-effective when compared with standard of care screening methods.

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Ahmed, Yusuf, Aman Sayal, Alexander J. Kaplan, and Jonathan A. Micieli. "Monocular Temporal Hemianopia due to Acute Zonal Occult Outer Retinopathy." Case Reports in Ophthalmology, February 10, 2022, 44–49. http://dx.doi.org/10.1159/000521784.

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Retinal disease may mimic an optic neuropathy since both may result in a relative afferent pupillary defect (RAPD), and retinal abnormalities may not be evident on a clinical exam. We report a case of a young woman with a monocular temporal hemianopia respecting the vertical meridian due to acute zonal occult outer retinopathy (AZOOR). This 34-year-old woman presented with a 10-day history of left eye vision loss and was found to have a visual acuity of 20/20 in both eyes, a left RAPD, and left temporal hemianopia on Humphrey 24-2 SITA-Fast visual field testing. Dilated fundus examination showed a normal-appearing optic nerve and retina in both eyes. She had already had a normal magnetic resonance imaging of the orbits with contrast and retinal disease was suspected. Optical coherence tomography showed dropout of the ellipsoid zone in the peripapillary retina, and fundus autofluorescence showed hyper-autoflourescence in the peripapillary region of the left eye. A diagnosis of AZOOR was made, and no improvement with prednisone occurred at final follow-up. This case demonstrates the importance of multimodal imaging in patients referred for optic neuropathies since retinal disease such as AZOOR can produce visual field defects characteristic of optic nerve disease.

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Meena, Ashok Kumar, Bhushan R. Ghodke, and Gautam Singh Parmar. "Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report." European Journal of Ophthalmology, August 21, 2019, 112067211987074. http://dx.doi.org/10.1177/1120672119870740.

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Purpose: To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. Methods: An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. Results: After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Conclusion: Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.

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Journal articles on the topic 'Dilated eye exam adherence'

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