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Background: Ophthalmology consultation on inpatients is often important to optimise eye care and provide information for referring teams. Inpatient consultation may constitute a not-insignificant workload however. This study reports on the nature and necessity of ophthalmology inpatient consults in a large Irish hospital.

Methods: Retrospective analysis of all consecutive ophthalmology inpatient consultations over a 12-month period.

Results: In total, 359 consult requests were received primarily from adult medicine (57.9%), surgery (22%) and paediatric teams (18.4%). The most common reasons for referral were loss of vision (23.7%); visual field testing (15%); diplopia or abnormal eye movements (11.4%); and screening for ocular features of systemic disease (10.6%). Presumptive diagnoses by referring teams were correct in 29.5% of cases. The majority had normal eye examinations (53.2%) or non-sight-threatening features (16.8%), while a minority had acute eye pathology (30%). Most patients (80.4%) required no intervention. A minority required medical (12.5%), orthoptic (4.6%) or surgical (2.4%) intervention. The majority of patients (81%) were fit for transfer to the eye clinic and did not require bedside examination.

Conclusions: Our study found a high proportion of ophthalmology inpatient consultations had normal eye exams and required no intervention. The quality of referrals was variable suggesting that clearer guidelines and more ophthalmology education is needed for referring teams.

Background

To compare the visual and anatomical outcomes of pneumatic displacement (PD) combined with anti-vascular endothelial growth factor (VEGF) therapy versus anti-VEGF monotherapy in treatment-naive eyes with submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Methods

In a retrospective comparative interventional study of 57 eyes, the changes in logMAR visual acuity (VA), and SMH height and area at baseline at months 1, 3 and 12 were compared between the PD and non-PD groups.

Results

There was no significant difference in mean VA in the PD versus non-PD group at month 12 (1.1 versus 0.7, p = 0.09). At baseline, the PD group, compared to the non-PD group, had significantly larger SMH area (35.9 versus 26.9 mm², p = 0.04) and SMH height at the fovea (733.7 versus 503.6 µm, p < 0.01). The greatest reduction in SMH height and area occurred between baseline and month 1 in the PD group, which was faster than between month 1 and month 3 in the non-PD group, with similar findings in the matched pair analysis matched for SMH height and area. In the multivariable analysis, only baseline VA was associated with VA outcomes (month 1: β = −0.46, 95% [confidence interval] CI = −0.78 to −0.14, p = 0.006; month 3: β = −0.52, 95% CI = −0.86 to −0.18, p = 0.004; and month 12: β = −0.78, 95% CI = −1.16 to −0.39, p < 0.001).

Conclusions

The visual outcome of SMH at month 12 in nAMD and PCV is poor regardless of whether PD is performed in addition to anti-VEGF therapy, although a more rapid resolution of SMH can be expected.

Background/objectives

To determine normal macular vessel density (VD) and foveal avascular zone (FAZ) values using optical coherence tomography angiography (OCTA) analysis in healthy adults.

Subjects/methods

As part of the Prospective Epidemiological Research Studies in Iran (PERSIAN) Organizational Cohort study at Mashhad University of Medical Sciences (POCM), we conducted a cross-sectional study using 3 × 3 and 6 × 6 mm OCTA scans to evaluate the VD of the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and the FAZ area in healthy adults.

Results

The study included 792 participants, with a mean age of 39.8 ± 6.8 years. There were 359 males with a mean age of 39.9 ± 7.8 years and 440 females with a mean age of 39.4 ± 6 years. The mean values of various parameters were measured, including the right eye whole image SCP and DCP VDs, FAZ area, FAZ perimeter, and fovea VD in a 300 µm wide zone around FAZ (FD). These values were found to be 45.9 ± 2.6%, 50.2 ± 3%, 0.3 ± 0.1mm², 2.1 ± 0.4 mm, and 50.4 ± 3.3%, respectively. Females and younger participants had significantly higher mean values of whole image SCP and DCP VDs. Additionally, all FAZ parameters had significantly higher values in females, while younger participants had significantly higher mean FD values. Simple linear regression analyses showed that age was negatively correlated with right eye SCP and DCP VDs.

Conclusion

Our study established standard SCP and DCP VD values influenced by age and gender. Age correlates negatively with both, DCP VDs correlate negatively with height and weight, and SCP VDs correlate positively with diastolic blood pressure.

Purpose

To determine the associations between the demographic factors (age and sex) and physiological dynamic iris changes and explore the associated factors for iris cross-sectional area (IA) change in healthy Chinese individuals.

Methods

This cross-sectional study included individuals aged ≥40 years with an open angle and underwent anterior segment optical coherence tomography under light and dark conditions from the follow-up cohort of the Handan Eye Study. Ocular data from the right eye were analyzed. The Pearson correlation coefficient was used to assess the relationship between age and iris parameters, including iris thickness (IT), IA, and iris curvature (IC), as well as the pupil diameter (PD) in the dark, and their changes from light to dark conditions. Linear regression analysis was performed to identify the potential factors associated with IA change.

Results

The final analysis included 465 healthy individuals. PD in dark, IA change and PD change decreased with age (P < 0.001), whereas IC increased with age (P < 0.001). IT and IT change were smaller, and IC was larger in women than that in men (P = 0.021, 0.007, and 0.010, respectively). Older age (P = 0.041), larger lens thickness (P = 0.013), larger IC change (P < 0.001), and smaller PD change (P < 0.001) were significantly associated with a smaller IA change.

Conclusions

Our study demonstrated the associations of static and dynamic iris parameters in healthy Chinese individuals. The findings provided a possible explanation for the higher prevalence of primary angle closure disease in elderly and female populations.

Reference to original article:

Campochiaro, P. A., Marcus, D. M., Awh, C.C. et al. The port delivery system with ranibizumab for neovascular age-related macular degeneration: results from the randomized phase 2 ladder clinical trial. Ophthalmology, 126(8), 1141–1154.

We have read with great interest the recent article by Tao et al. [1] which provides the reader with a concise overview regarding the neuro-ophthalmic manifestations of herpes zoster and their management. However, we would like to make a comment regarding what in our opinion is a clinical misinterpretation of Hutchinson’s sign as a predictor of neuro-ophthalmic disease.

In 1866, Sir Jonathan Hutchinson documented “My cases [n = 13] are as yet too few in number to authorize a confident statement, but thus far I have never seen the whole side of the nose affected without also witnessing inflammation of the eye and I have never seen the eye inflame unless the side of the nose showed vesicles.” [2]. A prospective study carried out by Adam et al. [3] did not find any statistical significance between Hutchinson’s sign (nasociliary nerve involvement) and herpes zoster ophthalmicus (p = 0.184). However, statistical significance was approached when Hutchinson’s sign coexisted with blepharitis and conjunctivitis (p = 0.067). Furthermore, supratrocheal nerve involvement showed greater statistical significance (pvalue = 0.0004) for the development of herpes zoster ophthalmicus, whilst having a positive predictive value of 0.6 and a negative predictive value of 0.89 for associated eye involvement [3].

Diabetic retinopathy is a serious condition that can lead to diabetic macular oedema or vision loss. In 2020, approximately 103·12 million diabetic patients worldwide were affected by retinopathy. This number is projected to increase to 129·84 million and 160·50 million in 2030 and 2045, respectively. Regions most impacted by diabetic retinopathy are anticipated to be the Western Pacific, Middle East and North Africa, and North America and Caribbean [1].

Whilst anti-vascular endothelial growth factor treatment has improved visual outcomes for patients with diabetic retinopathy, reports indicate that some do not achieve complete resolution of diabetic macular oedema, and most require multiple injections and prolonged treatments. These limitations have spurred interest in novel agents with more effective control of diabetic retinopathy [2].