Open Access Short Research Article

Comparative Analysis of Vision Screening Guidelines in the United States

Nathan J. Brown, John A. Musser VI

Ophthalmology Research: An International Journal, Page 28-32
DOI: 10.9734/or/2022/v17i330259

Aims: To assess current school vision screening guidelines of states spread across different regions of the United States to inform quality guideline parameters and help combat preventable pediatric vision loss.

Study Design:  Cross-sectional comparative analysis.

Methodology: States were first ordered alphabetically and then selected using an online random number generator (Alphabet Inc., Mountain View, California). States were selected until 13 available screening guidelines were identified. Each guideline was assessed using a 10-point multi-factorial scoring criteria detailed in Table 1. Descriptive statistics (mean and standard deviation) were calculated for each scoring criteria using Microsoft® Excel (version 16.63.1, Redmond, WA).

Results: Most state guidelines included what ages to screen (84.62%, 11/13), how to screen (84.62%, 11/13), and how to follow-up with students to arrange (92.31%, 12/13) and confirm eye care delivery (76.92%, 10/13). Sadly, only the minority of state guidelines described at least two main causes of amblyopia (46.15%, 6/13), and a less than one-third of school nurse vision screening guidelines discussed the window of time to save vision in amblyopia (30.77%, 4/12). Worse yet, very few nurse vision screening guidelines explained that subjectively a child can’t tell you if they are at risk of developing amblyopia (15.38%, 2/13), or included two treatments for amblyopia (7.69%, 1/13) in the vision screening educational program.

Conclusion: This study found that most of the assessed vision screening guidelines outlined the process of screening and follow-up but failed to emphasize why screening is important, causes, and treatment options for amblyopia. Gaps in these training guidelines may contribute to delayed recognition and treatment for amblyopia¾the leading cause of irreversible pediatric vision loss. Further improvements to vision screening guidelines are needed for school nurses and paraprofessional staff in the majority of the states evaluated.

Open Access Original Research Article

Sociodemographics and Clinical History among Primary Open Angle Glaucoma Patients on Medical Treatment in a Tertiary Hospital in Enugu, Nigeria

Gloria Chizoba Eze, Emmanuel Ifeanyi Obeagu, Amalachukwu Amanda Chime

Ophthalmology Research: An International Journal, Page 1-7
DOI: 10.9734/or/2022/v17i330256

Background: Primary Open Angle Glaucoma has been noted to be more prevalent and aggressive in blacks. Treatment of glaucoma involves lowering of intraocular pressure (IOP) to a targeted level where further glaucomatous damage is unlikely. The aim of this study was to determine sociodemographic factors and clinical history among primary open angle glaucoma (POAG) patients on medical treatment at the glaucoma clinic of Enugu State University of Science and Technology Teaching Hospital Parklane (ESUTTHP), Enugu with a view for better patient management.

Methods: The study was a hospital based cross sectional study on POAG patients on medical treatment attending the eye clinic of ESUTTHP, Enugu. Patients were selected by simple random sampling. Their socio-demographics and clinical history were obtained using an interviewer-administered questionnaire. Data analysis was done using SPSS version 20 (U.S.A). Categorical variables were presented in percentages.

Results: A total of 130 POAG patients on medical treatment were interviewed comprising of 56 males (43.1%) and 74 females (56.9%). Their age ranged between 42 and 83 years with mean age of 62.25 ± 9.002. Civil servants made up of 27.7% of the patients while 26.9% were traders, 16.2% were farmers and 9.2% were artisans. One hundred patients were on prostaglandin analogues, 90 patients were on beta blockers, 31 patients were on topical carbonic anhydrase inhibitors, 20 patients were on alpha agonist while 2 patients were on miotics. These drugs were used either singly or in combination. Ninety-five of the patients (72.1%) reported they were using their drugs regularly while 35 (26.9%) reported they were not using their drugs regularly. Out of those that do not use their drugs regularly, 62.9% reported that it was due to forgetfulness, 40.0% reported that it was due to limited finances and none of the patients reported that it was due to the side effects of the drug. Approximately, 66.2% of the patients had used drugs for 1 - 5 years with the mean duration of treatment being 4.5±3.36 years. About half (57.7%) of the patients did not have family history of glaucoma, 30% of the patients had family history of glaucoma while 17.3% were not sure of any family history of glaucoma).

Conclusion: The study revealed that greater number of the patients suffering from glaucoma were women and civil servants. Majority of the patients use their drugs regularly and higher number of the patients do not have family history of glaucoma. Women, civil servants and the entire society should check their eyes with ophthalmologists regularly to avert the danger associated with glaucoma.

Open Access Original Research Article

Ocular Hypotony after Glaucoma Surgery

Heba Mohammed Ghobashy, Ahmed Fekry Elmaria, Ahmed Mohammed Ghoneim, Tarek El Mohammadi Eid

Ophthalmology Research: An International Journal, Page 8-15
DOI: 10.9734/or/2022/v17i330257

Background: Postoperative hypotony is associated with choroidal effusion, suprachoroidal haemorrhage, aqueous misdirection syndrome (malignant glaucoma), choroidal folds and hypotony maculopathy, anterior chamber (AC) shallowness or loss and subsequent failure of the original filtration of procedure. This work aimed to study the causes, risk factors, adverse effects, and management plans of ocular hypotony after different glaucoma surgeries.

Methods: This retrospective study was carried out on 205 eyes underwent glaucoma surgery with follow up for more than 3 months. Patients were divided into two groups: 30 cases were diagnosed with post-operative hypotony, 175 eyes were without hypotony. Patients were subjected to glaucoma diagnosis, type of glaucoma operation and recorded IOP for 3 months at least.

Results: CPC, Visco-Trab, Phaco Visco-Trab Visco and express valve were significantly different between the two groups (P=0.049, P=0.012, P=0.043 and P<0.001 respectively) and other types of operation were insignificantly different between the two groups. IOP was significantly decreased at first diagnosis of hypotony and at last follow up compared to before operation (P value <0.001). IOP at last follow up was significantly increased compared to first diagnosis of hypotony (P value <0.001). Criteria of hypotony eyes were insignificantly different between patients needed surgical intervention and no surgical intervention.

Conclusions: Postoperative hypotony was most common in pseudo-exfoliative glaucoma cases compared to other glaucoma types. While the most type of glaucoma surgery that was associated with postoperative hypotony was viscocanalostomy combined with express shunt. The adverse effects reported in our study were choroidal effusion and hypotony maculopathy.

Open Access Original Research Article

Persistent Intraocular Residue with the Use of Dexycu® in Cataract Extraction: A Case Series

Ryan T. Wallace, Annika M. Hansen, John A. Musser VI, Anthony P. Mai, Craig J. Chaya

Ophthalmology Research: An International Journal, Page 16-27
DOI: 10.9734/or/2022/v17i330258

Purpose: The objective of this article is to report 8 cases of persistent IOL residue associated with the use of Dexycu® in the context of cataract surgery and then to subsequently describe each patients clinical course.

Observations and Presentation: Between 2020-2021, persistent residue was noted in 8 eyes of 7 patients who received Dexycu® implants after cataract surgery. The residue was identified an average of 1.63 months after surgery (range 0.20-4.23). A subsequent procedure removed the residue from the intraocular lens; the average time to the follow-up procedure after surgery was 4.71 months (range 1.90-11.20).

Conclusions and Importance: The Bausch and Lomb intraocular lenses seem to be predisposed to a Dexycu® persistent opacification, however correlation does not equate with causation. This article documents cases of persistent IOL residue with the use of Dexycu® and the MX60 lenses and its toric varieties. Further evaluation is necessary to elucidate the mechanism and risk factors for this occurrence.

Open Access Original Research Article

Reassessment of the Clinical Significance of the Demarcation Line in the Corneal Stroma in Crosslinking

I. M. Kornilovskiy

Ophthalmology Research: An International Journal, Page 33-41
DOI: 10.9734/or/2022/v17i330260

Purpose: To consider the clinical significance and features of the formation of a demarcation line in the corneal stroma with various methods of corneal crosslinking.

Materials and Methods: Literature data on the evaluation of the effectiveness of various methods of crosslinking by the demarcation line in the corneal stroma were analyzed. The formation of a demarcation line during prophylactic and therapeutic excimer laser crosslinking was studied after various photorefractive operations, keratoconus and other pathologies of the cornea (168 operations).

Results: With various methods of crosslinking, including prophylactic and therapeutic excimer laser corneal crosslinking, the depth of the demarcation line in the stroma varied from 1/3 to 2/3 of the corneal thickness. It was noted that the saturation of the corneal stroma with a 0.25% solution of riboflavin is accompanied by a large increasing effect of the optical density in the stroma above the demarcation line at a shallower depth of its occurrence. The severity of the aseptic inflammatory reaction after corneal crosslinking affected the optical density, shape, intensity, and depth of the demarcation line in the stroma. In some cases, the formation of a demarcation line in the stroma was noted when the stroma was saturated with riboflavin immediately after refractive keratoablation without additional UV irradiation. The demarcation line in the stroma was revealed during inflammatory processes in the corneal stroma without the participation of riboflavin and its activation by UV radiation.  The study showed that the assessment of corneal crosslinking by the depth of the demarcation line is not an indicator of the photochemical process and the number of crosslinks formed in the corneal stroma.

Conclusion: Based on the severity, shape and depth of the demarcation line, it is not possible to judge the density of crosslinks in the corneal stroma, which predetermine its strength properties after one or another method of corneal crosslinking.