Eye

PurposeThere is increasing evidence that microplastics exert harmful effects on human health and on the ocular surface. Recent studies have highlighted the presence of ocular surface exposure to microplastics via shedding from contact lenses. This study aims to investigate if microplastic particles are present in commonly used eyedrops in single-use plastic vials. DesignExperimental study. MethodsNine commonly used commercial tear-replacement solutions available without a doctors prescription were tested (Brands A-I). All brands of eyedrops were analysed visually using light microscopy and the number of microplastic particles were manually counted. Brands A-F were further analysed using the 8700 Agilent Laser Direct Infrared (LDIR) chemical imaging system to identify the microplastic compositions. ResultsAll eyedrops analysed contained microplastics. The number of microplastic particles identified using light microscopy ranged between 15 (Brand E) to >18,000 (Brand F). In total, nine types of microplastics were identified with LDIR - an average of 14 polyethylene, 8 polypropylene, 1 polystyrene, 2 polyvinylchloride, 21 polyethylene terephthalate, 1 polycarbonate, 19 polymethylmethacrylate, 23 polyamide and 22 polyurethane per millilitre of eyedrop were identified. ConclusionsThis is the first study that identified microplastics in commercial tear-replacement solutions. These particles may have been derived from secondary degradation of the plastic vials (polyethylene) during production, transportation, or storage, and represent a major source of exposure to the ocular surface, especially among patients who require chronic instillation of eyedrops.

Background Ocular injuries concomitantly occur among patients with head trauma because of the close anatomical relationship between the cranium and the orbit. Unfortunately, they are often overlooked during acute trauma care and may result in preventable visual loss. There is a dearth of data describing the burden and spectrum of ocular injury among head injury patients in sub-Saharan Africa. We conducted a hospital-based cross-sectional study to determine the prevalence and describe the patterns of ocular injury among adults admitted with head injury at the Accidents and Emergency Unit of Mulago National Referral Hospital, Uganda, from 1st May 2025 to 30th July 2025. Methods Consecutive patients aged 18 years and above with a confirmed head injury diagnosis underwent a structured ophthalmic evaluation comprising visual acuity testing, tonometry, slit-lamp and dilated fundus examination, pupillary and ocular motility assessment, confrontation visual fields, and review of craniofacial computed tomography. Ocular injuries were classified by anatomical site and injury type, and the prevalence was reported with a 95% confidence interval. Results Of 383 patients evaluated (mean age 32.7 {+/-} 12.3 years; 89.3% male), road traffic accidents were the leading mechanism of injury (68.9%) and most patients had mild head injury (72.3%). Overall, 268 patients (70.0%; 95% CI 65.1-74.5) sustained at least one ocular injury. Adnexal injuries were most frequent (64.0%), dominated by periorbital oedema (45.2%), subconjunctival haemorrhage (42.3%) and eyelid ecchymosis (33.2%); orbital fractures occurred in 27.4%. Closed and open globe injuries were present in 13.8% and 0.8% of patients, respectively, and abnormal confrontation visual fields in 28.2%. Conclusion Ocular injury is highly prevalent among patients admitted with head injury in this setting, with adnexal and orbital structures most commonly affected. Routine ophthalmic assessment should be integrated into the initial evaluation of all head injury patients to reduce missed injuries and prevent avoidable visual morbidity.

PurposeTo identify debt valuations of ophthalmology and optometry private equity-backed group (OPEG) practices, which are a proxy for financial performance. DesignRetrospective cohort study using the 2021 Business Development Company (BDC) Report and BDC quarterly/annual filings. ParticipantsBDCs holding one or more ophthalmology/optometry group debt instruments. MethodsThe 2021 BDC Report was used to identify all BDCs actively filing annual reports (Form 10-Ks) and quarterly reports (Form 10-Qs) in 2021. The public filings of BDCs lending to OPEGs were searched from inception of an OPEGs debt instrument in a BDCs portfolio, and the amortized cost and fair value of each debt instrument were tabulated. A panel linear regression was used to evaluate temporal changes in debt valuations. Main Outcome MeasuresTrends in total debt held by OPEGs, trends in valuation (premium or discount) of OPEGs. ResultsA total of 2997 practice locations affiliated with 14 unique OPEGs and 17 BDCs were identified in 2021. Debt valuations of OPEGs decreased 0.46% per quarter over the study period (95% CI: -0.88 to -0.03, P = 0.036). In the COVID-19 pre-vaccine period (March 2020 - December 2020), there was an excess (additional) 4.93% decrease in debt valuations (95% CI: - 8.63 to -1.24, P = 0.010) when compared to prepandemic debt valuations (March 2017 - December 2019). Effects of COVID-19 on valuations stabilized during the pandemic post-vaccine period (February 2021 - March 2022), with no change in excess debt valuation compared to pre-pandemic baseline (0.60, 95% CI: -4.59 to 5.78, P = 0.822). There was an increase in practices that reported average discounted debt valuations from 20 practices (1.6%) associated with 1 OPEG to 1213 practices (40.5%) (including 100% of newly acquired practices) associated with 9 OPEGs, despite stabilization of COVID-19 related excess (additional) debt. ConclusionsValuations of OPEG debt have declined significantly post-PE investment from March 2017 to March 2022. An excess (additional) decline in valuations was observed during the COVID pre-vaccine period, with trends in excess debt valuations returning to baseline pre-pandemic levels by December 2021. Declining and discounted valuations of debt raise concerns about the financial viability of many PE-backed practices.

Background Given the close anatomical proximity of the eye and its adnexae to the cranium, ocular injury frequently coexists with head trauma. However, specific factors predisposing patients with head injury to ocular involvement in Uganda remain poorly defined. Objective This study aimed to determine the factors associated with ocular injury among patients with head injury at Mulago National Referral Hospital (MNRH), a tertiary referral facility in Kampala, Uganda. Methods We conducted a cross-sectional study among 383 adult patients admitted with head injury to the Accidents and Emergency Department of MNRH from 15/05/2025 to 30/07/2025. All participants underwent a standardized ophthalmic evaluation. Bivariable and multivariable Poisson regression analyses were used to identify factors associated with ocular injury, reported as adjusted prevalence ratios (APR). Results Ocular injury was identified in 268 of 383 patients (70.0%; 95% CI: 65.1-74.5). On multivariable analysis, age 26-44 years (APR 1.18; 95% CI: 1.11-1.43; p=0.013), commercial motorcyclist (boda-boda rider) occupation (APR 1.25; 95% CI: 1.06-1.47; p=0.007), road traffic accident mechanism of injury (APR 1.19; 95% CI: 1.02-1.38; p=0.03), severe head injury (APR 1.70; 95% CI: 1.44-2.01; p<0.0001), and the presence of facial fractures (APR 1.61; 95% CI: 1.44-1.81; p<0.0001) significantly increased the likelihood of ocular injury. Conversely, intracranial hemorrhagic lesions were inversely associated with ocular injury (APR 0.80; 95% CI: 0.68-0.93; p=0.004). Conclusion Ocular injuries are common among patients with head injury. Patients aged 26 to 44 years, commercial motorcyclist occupation, road traffic injury, severe head injury, and facial fractures have a higher risk of ocular injury. We recommend prioritizing ophthalmic evaluation of for patients admitted with head injury to minimize preventable visual impairment.

BackgroundPreprinting, is the sharing of non-peer reviewed, unpublished scholarly manuscripts. Across many fields of medicine, an exponential rise of manuscripts being posted to preprint servers has been observed. This has exploded during the COVID19 pandemic where early dissemination of information was critical, or where COVID19 priority disrupted the publication dynamics and priorities in other areas. We examined the characteristics of ophthalmology related preprints in this study. MethodsWe searched the bioRxiv and medRxiv servers for preprints relating to field of ophthalmology. Preprints were screened by title and abstract to ensure they were related to the field of ophthalmology. Outcomes included number of tweets, upper bound followers of tweeters, number of citations, news outlets reports and dates posted/published. If a preprint was published the same outcomes were collected for the published version to allow for comparisons, as well as journal publisher and cite score. ResultsAfter screening, a total of 720 preprints met our inclusion criteria. 420 of the preprints went on to be published. The publication rate of the preprints was 58.3%. The median number of tweets received on preprints was 3.5, IQR 5.5. 98.75% of preprints were tweeted about. Citation rate was 40.14%. The average number of days from date posted on server to date published was 180.5{+/-}124 days. Regression analysis revealed that tweets as a preprint predicts tweets as a published article, P=0.0135. citations as a preprint predicts citations as a published article, P<0.001. The average cite score was 8.5{+/-}6.2 among those preprints that we published in journals. 16.66% of papers were published by Elsevier (n = 70). 3.19% of preprints were COVID19 related, with significant differences found between them and non-COVID19 preprints in terms of number of tweets and number of citations. ConclusionsOphthalmology preprints are increasing across preprint servers. This maybe to bypass publication times and allow early dissemination of work, as well as increase visibility and citations. We identified that preprint citations and tweets predict published version citation and tweets.

PurposeThe aim of this clinical investigation was to evaluate the safety and effectiveness of iota-carrageenan (I-C) eye drops in the treatment of mild-to-moderate dry eye disease (DED). MethodsIn this prospective, single arm, open label clinical investigation, thirty adult participants with mild-to-moderate DED applied I-C eye drops three times daily for four weeks. Before start and after end of treatment, participants rated DED symptoms (foreign body sensation, burning/stinging, itching, pain, sticky feeling, blurred vision and photophobia), both after exposure to a normal controlled environment (NCE) and to an adverse controlled environment (ACE). Additional endpoints were changes in ocular surface disease index (OSDI), Change in Dry Eye Symptoms Questionnaire (CDES-Q), corneal and conjunctival surface damage, tear film break-up time, tear evaporation and production. Tolerability was assessed by participants at start and end of treatment. Safety, including visual acuity and intraocular pressure, was monitored throughout the investigation. ResultsAfter four weeks of treatment with I-C eye drops, the mean total DED score after ACE was significantly reduced by -11.89 points (95% CI: -15.11, -8.67), p<0.001. The mean score reduction between baseline and final visit after NCE was slightly less pronounced, with -8.07 points (95% CI: -10.71; -5.43), p<0.001. The vast majority of participants (93% after ACE and 89% after NCE exposure) recorded a reduction in total DED score between baseline and final visit. Mean OSDI score significantly decreased by -7.75 points (95% CI: -10.85, -4.63), p<0.001. ACE-induced deterioration of tear film stability as well as corneal and conjunctival damage were reduced following treatment. All adverse events were mild and transient in nature. 93% of the patients described I-C eye drops as well or very well tolerated. Treatment did not negatively impact any of the safety parameters. ConclusionI-C eye drops are effective, safe and well tolerated. Treatment with I-C eye drops alleviates DED symptoms, stabilizes tear film and protects the ocular surface in patients with mild-to-moderate DED even under adverse environmental conditions. Trial RegistrationNCT06262100.

PurposeTo characterize retinal tears (RTs) and calculate the economic burden of RTs that present to the emergency department (ED) in the US. MethodsWe used a large national ED database to retrospectively analyze RTs that presented to the ED from 2006 to 2019. Using extrapolation methods, national estimates of RT incidence, demographics, comorbidities, disposition, inpatient (IP) costs, and ED costs were calculated. ResultsDuring the time period between 2006 and 2019, 15,841 patients presented to the ED with RT as the primary diagnosis. RT incidence was stable at 8.2 per million US population (95% Confidence Interval (CI): 5.3 - 21.0) in this time period. Most patients were males, Caucasian, paid with private insurance, and admitted to EDs in the Northeast. The most common comorbidities were hypertension (19%), a history of cataracts (15%), and diabetes (7.2%). During this time period, RTs costs added up to more than $79 million and $33 million in the ED and IP settings, respectively. Mean per-patient ED and IP costs increased by 145% (p=0.0008) and 86% (p=0.0047), respectively. ConclusionDespite the stable incidence of RTs, RTs place a significant economic burden to the healthcare system, which increases yearly. We recommend physicians and policy makers to work together to pass laws that could prevent the increasing healthcare costs.

Background/Aims: Neovascular glaucoma (NVG) is a severe, secondary glaucoma. This study aimed to identify factors associated with vision, intraocular pressure (IOP), and ocular pain outcomes. Methods: The cohort included all patients diagnosed with NVG during 2008-2024 at Helsinki University Hospital, Finland. Linear mixed-effects models used pre-specified covariates, whereas machine learning was given the full longitudinal data with biomicroscopic findings as an exploratory approach. Results: 626 patients were analysed. Worse baseline vision and a closed angle were associated with worse follow-up vision. Treatments were associated with lower IOP and less pain rather than better vision. Age, sex and comorbidity were largely not associated with the outcomes. Glaucoma drainage devices showed the greatest initial IOP reduction (-10.2 mmHg, 95% confidence interval, CI -11.9 to -8.6 mmHg), followed by transscleral cyclophotocoagulation (TSCPC, -4.7 mmHg, 95% CI -5.8 to -3.7 mmHg) and peripheral retinal cryotherapy (-2.2 mmHg, 95% CI -3.1 to -1.4 mmHg). TSCPC and cryotherapy were also associated with reduced pain (odds ratio 0.51 and 0.46). Pan-retinal photocoagulation and anti-VEGF showed smaller IOP reductions, with a pain reduction for pan-retinal photocoagulation only. Both methods agreed, and machine learning added no novel clinical findings. Conclusions: Vision in this cohort was largely set by the state of the eye at diagnosis. IOP control and pain relief therefore remain realistic goals even when sight cannot be saved. Peripheral retinal cryotherapy stood out, linked to both lower IOP and less pain, seldom reported in NVG. These associations from a large, unselected cohort identify treatments worth comparing prospectively.

IntroductionOcular surface disorders are prevalent, impacting millions worldwide and causing significant morbidity. Conventional treatments often fall short in addressing refractory cases. Topical insulin has emerged as a potential therapeutic option. ObjectiveThis systematic review aimed to evaluate the safety and efficacy of topical insulin for ocular diseases. MethodsWe conducted a systematic review in major databases including the PubMed, MEDLINE, and EMBASE for studies published from (1976 Jan - 2024 Feb) investigating topical insulin for ocular conditions. Studies were screened and selected based on predefined inclusion/exclusion criteria. Data on safety and efficacy were extracted and analyzed. ResultsTen studies (1 case-control, 3 randomized prospective, 3 retrospective, and 3 double-blind designs) met the inclusion criteria. Studies explored various indications, including neurotrophic corneal ulcers, persistent epithelial defects, recurrent epithelial erosions, dry eye disease, and postoperative corneal wound healing in diabetic patients. Overall, findings suggested promising outcomes with topical insulin: promoting healing of refractory neurotrophic corneal ulcers, accelerating reepithelialization in persistent epithelial defects, reducing recurrence of recurrent epithelial erosions, improving symptoms and reducing corneal staining in dry eye disease, enhancing postoperative corneal epithelial wound healing in diabetic patients. Adverse events were minimal and primarily reported as transient stinging or discomfort. ConclusionThis review provides encouraging evidence for the therapeutic potential of topical insulin in diverse ocular diseases. While methodological limitations exist, particularly in non-randomized studies, the current body of literature suggests topical insulin may offer a safe and effective treatment option for patients with refractory corneal disorders.

TikTok has recently emerged as a rapidly growing global phenomenon that is becoming popular among medical professionals and patients alike. The use of other social media platforms such as Instagram and Twitter by ophthalmologists is well-documented, but the prevalence of ophthalmologists on TikTok is not well understood. We sought to analyze the scope of popular ophthalmology content on TikTok.

ImportanceDiabetic retinopathy (DR) progression significantly impacts vision and quality of life in patients with Type 2 Diabetes Mellitus (T2DM). Statins and fibrates are commonly prescribed lipid-lowering medications, but their comparative effectiveness in DR progression remains uncertain. ObjectiveTo determine whether fibrates reduce the risk of DR progression compared to statins in patients with T2DM and nonproliferative diabetic retinopathy (NPDR). Design, Setting, and ParticipantsRetrospective cohort study using the TriNetX Global Collaborative Network, a multicentered, population-based electronic medical record database. Inclusion criteria consisted of patients diagnosed with T2DM and NPDR 5-20 years prior. Patients were propensity score matched based on demographics and comorbidities. Two cohorts were defined: patients on fibrates but not statins (n = 543), and patients on statins but not fibrates (n = 60,135). After matching, each cohort included 542 patients. Main Outcomes and MeasuresPrimary outcomes: intravitreal antiVEGF injection or retinal laser procedures Secondary outcomes: progression to PDR, vitreous hemorrhage (VH), neovascularization (NV), or tractional retinal detachment (TRD) Tertiary outcomes: neovascular glaucoma (NVG) or pars plana vitrectomy (PPV). ResultsFibrate-treated patients had a 57.3% risk reduction in anti-VEGF injection (RR = 0.427; 95% CI: 0.219, 0.830; p < 0.011) and longer time-to-injection (log-rank x2 = 4.927; p < 0.027). PDR risk was reduced by 59.3% (RR = 0.407; 95% CI: 0.242, 0.684; p < 0.001) with delayed progression (log-rank x2 = 8.657; p < 0.004). Fibrate use was associated with 72.1% lower instantaneous risk of NGV (HR = 0.279; 95% CI: 0.079, 0.991, p < 0.015) and delayed onset (log-rank x2 = 4.448, p < 0.036) despite a higher survival probability in the statin group (97.08% vs 96.65%). Fibrates lowered the absolute risk of NV (-0.019; 95% CI: -0.030, -0.007; p < 0.002) but increased risk of TRD (0.018; 95% CI: 0.007, 0.030; p < 0.003); however, neither occurred in the comparison group, limiting statistical power. Conclusions and RelevanceAmong patients with T2DM and NPDR, fibrates were associated with reduced risk of antiVEGF injection, PDR progression, and NVG onset compared to statins. These findings suggest fibrates may help mitigate DR progression.

Background/Aims: To evaluate the impact of socioeconomic deprivation on clinical presentation and outcomes of bacterial keratitis (BK) in the United Kingdom. Methods: A retrospective multicentre cohort study of 320 patients with BK presenting to two UK tertiary ophthalmic centres. Demographic, clinical and microbiological data were extracted from electronic health records. Socioeconomic status was assigned using residential postcodes mapped to the 2019 English Index of Multiple Deprivation (IMD) and grouped into quintiles (Q1 most deprived; Q5 least deprived). Presenting severity and outcomes were compared across IMD quintiles. Results: The mean age was 54.0{+/-}20.9 years; 50.6% were male and 83.4% were White. Mean presenting CDVA was 1.10{+/-}1.01 logMAR and time to presentation was a median of 3 days (IQR 1-6). Most cases had a small infiltrate (<3 mm; 68.4%), small epithelial defect (<3 mm; 63.4%) and no hypopyon (72.5%). Hospitalisation was required in 50.0%, and 17.5% underwent surgery. Culture positivity was 36.3%. There were no significant differences in presenting CDVA, time to presentation, clinical severity, admission, microbiological profile, surgical intervention or final CDVA across IMD quintiles (all p>0.05). Final CDVA improved to 0.75{+/-}0.96 logMAR (p<0.001). On multivariable analysis, poorer final CDVA was associated with worse presenting CDVA, increasing age and Gram-positive organisms, but not IMD. Conclusion: Socioeconomic deprivation did not influence the clinical presentation or outcomes in BK. Clinical severity at presentation and microbiological profile were the principal determinants of outcome. In this acute, painful sight-threatening condition, deprivation-related disparities may be attenuated by prompt presentation and universal access to emergency ophthalmic care.

Abstract Importance: Access to eye care is increasingly constrained by declining ophthalmologist workforce density, particularly in rural areas, while optometrist workforce is projected to exceed demand. Numerous state legislatures have expanded optometrist scope of practice (SOP), but the workforce effects of these policies have not been evaluated.. Objective: To evaluate changes in optometrist and ophthalmologist workforce density following state-level expansion of optometrist scope of practice. Design: This retrospective ecological study analyzed workforce density across 50 states and the District of Columbia. Between 2008 - 2019, nine states expanded SOPs for optometrists. We used interrupted time-series regression to estimate associations between these policy changes and provider density from 2010-2021, adjusting for covariates. Setting: Population-based analysis of all 50 US states and the District of Columbia, 2010 - 2021. Participants: State-level workforce data were derived from Bureau of Labor Statistics and US Census data (optometrists) and the American Medical Association Physician Masterfile (ophthalmologists). Socioeconomic covariates were obtained from the American Community Survey. Exposure: State-level legislative expansion of optometrist SOPs to allow injections beyond anti-anaphylaxis treatment, lesion removal, and/or laser procedures. SOP changes were identified through systematic review of legislative and regulatory records. Main Outcomes and Measures: Annual change in optometrist and ophthalmologist workforce density (providers per 100,000 population) following SOP expansion, adjusted for age, income, rates of vision difficulty, diabetes, poverty, and uninsured status. Results: Nine states met inclusion criteria for SOP expansion between 2008 and 2019. Analysis of national data showed that among all 50 US states and the District of Columbia, SOP expansion was associated with a non-significant change in optometrist density (-0.65 per 100,000; 95% CI, -1.87 to 0.57) and ophthalmologist density (+0.09; 95% CI, -0.10 to 0.28). Results were consistent in the 9-state subgroup (optometrists: -0.60, 95% CI -2.90 to 1.70; ophthalmologists: +0.02, 95% CI -0.13 to 0.18). Conclusions and Relevance: Our population-level data suggest that, in the US, state legislation expanding optometrist scope of practice has not been associated with increased workforce density. As numerous state legislatures continue to consider such policies, these findings can inform efforts to balance access to eye care with patient safety.

Key PointPatients with sickle cell Leg ulcers are 5.9 times more likely to develop sickle retinopathy. Leg ulcers are a common sign in Sickle Cell Disease. But to what extent are they indicative of Sickle cell eye disease in these patients? This short communication assesses to what extent leg ulcers predict the presence of sickle eye disease in Nigerian patients. This was a clinic based, comparative non-interventional study, conducted at both the Hematology Clinic and Eye clinic in Lagos University Teaching Hospital (LUTH). One hundred consecutive cases of Sickle Cell Disease (SCD) patients (HbSS and HbSC) attending the Haematology Clinic were compared with 100 age and sex matched non-SCD HbAA controls. The presence of leg ulcers was sought in both groups, and all had assessment for ocular anterior and posterior signs of SCD. Cases and controls were comparable in age and sex. Amongst 100 Cases, 85 were HbSS and 15 HbSC. Leg ulcers were present in 18 patients. Eighty-two cases had either anterior or posterior SCD related ocular manifestations. Patients with leg ulcer were found to be at higher risk of developing Conjunctival Sickle Sign, Retinal Venous Tortuosity and Proliferative Sickle Retinopathy with an increased likelihood of 22.9, 7.1 and 5.9 times respectively. We believe this is the first study to quantify this association. ConclusionsThis study suggests that sickle cell eye disease is more likely to develop in sickle cell disease patients with leg ulcers. Internists managing SCD patients are advised to refer patients with leg ulcers for early ocular assessment in order to prevent complications.

Soft contact lenses (SCLs) have recently been introduced as an alternative method for human tear protein sampling. However, SCLs are available in a variety of chemical compositions which affect protein binding specificity. Here we analyzed 8 different SCL materials to identify an optimal lens for tear protein sampling. Polymer contamination, mass spectrometry (MS) sample preparation method, total protein capture, individual protein specificity, and SCL cost were all assessed. Using a filter-aided sample prep (FASP) method with 4M guanidine for protein removal, only etafilcon A and verofilcon A did not have significant polymer contamination. Polymer was successfully removed using phosphate buffered saline (PBS) with S-Trap columns for all SCL materials, though yielding a slightly lower number of protein identifications per sample. Minor quantitative differences were observed between SCL materials. However, we also saw significant intersubject variation in protein abundance. Of all the assessed SCL materials, verofilcon A lenses yielded the most total protein while comfilcon A and senofilcon A had the least protein variability. As a newly released daily disposable modality (Precision 1, Alcon), verofilcon A has one of the longest predictable production schedules and one of the lowest costs per lens, making it beneficial for large-scale experiments and diagnostics. Furthermore, we demonstrate how protein binding bias with SCL tear sampling is useful for intra-experiment normalization. Overall, these experiments have led us to optimize our previous protocol for SCL tear protein sampling, highlighting important differences between SCL materials and identifying etafilcon A and verofilcon A as optimal materials for tear protein sampling. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=107 SRC="FIGDIR/small/23290135v1_ufig1.gif" ALT="Figure 1"> View larger version (25K): org.highwire.dtl.DTLVardef@11e4b0dorg.highwire.dtl.DTLVardef@1d183aeorg.highwire.dtl.DTLVardef@1c23cdorg.highwire.dtl.DTLVardef@1727b47_HPS_FORMAT_FIGEXP M_FIG C_FIG

ObjectiveTo evaluate the economic impact on the Brazilian Public Health System (SUS) of the initial treatment of glaucoma in two scenarios: (1) the traditional continuous clinical treatment with hypotensive eye drops and (2) the single treatment with Selective Laser Trabeculoplasty. MethodsEconomic impact analysis was conducted in three scenarios, from the least to the most conservative, for the two initial treatment methods for open-angle glaucoma in a hypothetical cohort of 5,000 individuals. Projections were then made based on a prevalence of 3% of the Brazilian population in 2021. ResultsAll three scenarios analyzed showed a significantly lower economic impact for Selective Laser Trabeculoplasty on the Brazilian Public Health System over one to five years, with a favorable difference of more than 8 billion US dollars over five years when considering 3% of the Brazilian population over 40 years old in 2021. ConclusionThe economic impact on the Brazilian Public Health System was lower for Selective Laser Trabeculoplasty compared to the use of latanoprost and timolol maleate eye drops as the initial treatment for primary open-angle glaucoma in all scenarios studied over one and five-year periods.

ObjectiveThis study aimed to evaluate the incidence, patterns, and determinants of ocular hypertension (OH) following Bevacizumab Intravitreal injections for various retinal diseases at KCMC Hospital, Tanzania. MethodsA prospective cohort study was conducted from August 2023 to July 2024, involving 120 participants. OH was defined as an intraocular pressure (IOP) >21 mmHg or an increase >5 mmHg from baseline. Data on demographics, injection history, ocular conditions, and systemic factors were collected. IOP was measured at baseline, immediately post-injection, and at six-week intervals during follow-up. Paired t-tests compared mean IOP differences, Nelson Allan estimator curves assessed cumulative OH risk, and Poisson regression identified associated factors. ResultsParticipants median age was 62 years, with diabetic macular edema (52.5%) being the most common indication. OH incidence was 15%, significantly associated with the number of injections (adjusted hazard ratio [AHR] 2.17, 95% CI 1.56-3.16, p < 0.001) and history of YAG laser capsulotomy (AHR 0.33, 95% CI 0.12-0.88, p = 0.028). Temporary post-injection IOP spikes normalized within 60 minutes. ConclusionThe study revealed a higher incidence of ocular hypertension following Bevacizumab injections compared to other studies. Significant factors included injection frequency and a history of YAG laser capsulotomy, with repeated injections leading to delayed normalization of intraocular pressure and increased spikes during subsequent visits.

Purpose: To analyze the effect of radiotherapy timing relative to surgery on patients' survival and mortality rates in uveal melanoma (UM). Design: Retrospective cohort study using registry data from the Surveillance, Epidemiology, and End Results (SEER) database. Subjects: A total of 1,198 patients with UM were extracted from the SEER database and divided into three groups: preoperative radiotherapy, intraoperative radiotherapy (IORT), and postoperative radiotherapy. Methods: UM cases were extracted from the SEER database. Survival curves were generated based on the Kaplan-Meier method. An extended Cox regression was used to estimate the cancer-specific and all-cause mortality. Main Outcome Measures: Overall survival (including median survival) and hazard reductions for cancer-specific and all-cause mortality. Results: Preoperative radiotherapy revealed the highest median survival (4.93 years), followed by postoperative radiotherapy (4.76 years), and IORT (4.02 years). The preoperative strategy reduced the hazard of all-cause mortality by 42%, 50%, and 60% at 5-, 7-, and 10-year follow-up, respectively, compared with IORT. Findings were consistent in the cancer-specific sensitivity analysis (45%, 53%, and 62% reductions at the same time points). However, postoperative radiotherapy did not significantly reduce the cancer-specific mortality in comparison to IORT. Conclusions: Preoperative radiotherapy was associated with higher median overall survival and lower all-cause and cancer-specific mortality than IORT over 10 years of follow-up. Postoperative radiotherapy showed intermediate outcomes that did not differ significantly from IORT. Prospective studies with more detailed data on the temporal relation of radiotherapy timing and surgery are needed to confirm these findings.

AimTo capture the direct and indirect cost estimates of dry eye disease (DED), stratified by disease severity, in patients from Canada and to understand the impact of DED on quality of life (QoL) in this group. MethodsA prospective, multi-centre, observational, cross-sectional study was conducted at six optometry and ophthalmology sites across Canada. Eligible patients completed a 20-minute survey on demography, general health, disease severity, QoL, and direct and indirect costs. ResultsA total of 151 patients participated in the study and 146 were included in the analysis. Mean (standard deviation [SD]) age was 49.8 (11.4) years and most patients were female (89.7%). DED was considered moderate or severe by 19.2% and 69.2% of patients, respectively. Sjogrens syndrome was reported by 8.2% of patients. Total mean annual costs of DED were $24,331 (Canadian dollars [CAD]) per patient and increased with disease severity. Mean (SD) indirect costs for mild, moderate, and severe disease were $5,961 ($6,275), $16,525 ($11,607), and $25,485 ($22,879), respectively. Mean (SD) direct costs were $958 ($1,216), $1,303 ($1,574), and $2,766 ($7,161), respectively. QoL scores were lowest in patients with Sjogrens syndrome and those with severe DED. ConclusionsThis study provides important insights into the negative impact of DED in a Canadian setting. Patients with severe DED reported higher direct and indirect costs and lower QoL compared with those with mild or moderate disease. Increased costs and poorer QoL were also evident for patients with DED plus Sjogrens syndrome versus DED alone.

BackgroundPrimary care practices play a critical role in ensuring that patients with diabetes undergo an annual eye examination, the importance of which is underscored by the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures. Store-and-forward teleophthalmology, where ocular images are read remotely by an ophthalmologist, has the potential to facilitate this role. MethodsIn this report, we aim to measure if using a primary care-based teleophthalmology program improves access to eye examinations for diabetic patients as reflected in HEDIS measures. Over a 20-month period, non-mydriatic fundus photographs were obtained at five primary care sites in the San Francisco Bay Area from patients with a new or existing diagnosis of diabetes mellitus type 1 or 2 who needed an annual eye examination. Collected photographs were evaluated remotely by vitreoretinal specialists for diabetic retinopathy. Our primary measures were the proportion and number of annual eye exams of diabetic patients in primary care clinics that participated in the teleophthalmology program compared to clinics that did not participate. Additional measures included the number of patients with DR who were identified through the program, gradeability of fundus photographs, and characteristics of the study population. ResultsThe program screened 760 unique patients, 84 of whom were found to have DR (11.1%). The rate of ungradable photos was 9.7%, which was greater for patients who self-reported as racially non-White. For the duration of the study, including during the COVID-19 pandemic, both the proportion and number of diabetic patients receiving annual eye examination increased (17.1% increase in proportion, 14.8% increase in number). In comparison, primary care sites that did not offer the teleophthalmology service declined in these measures (2.3% decrease in proportion, 17.0% decrease in number). ConclusionsPrimary care-based teleophthalmology improves access to eye exam for diabetic patients and identifies patients with diabetic retinopathy across diverse communities.