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Weekly review in ophthalmology: 29 October-3 November

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An end-of-week review of what happened in ophthalmology from 29 October to 3 November 2022.

Check out what Ophthalmology Times Europe shared this week:

Ophthalmology news

Assessing barriers to retinal care during a pandemic

The worldwide challenges of healthcare accessibility have been accentuated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Social distancing and population lockdowns combined with restrictions, such as the requirement for reduced time during patient visitation and decreased physical proximity within clinical settings, have created additional barriers to patient assessments.

To meet the rapidly evolving needs of patients within a pandemic setting, retinal specialists have had to innovate and look to evolving technologies and practices. It is important to examine and qualitatively assess perceptions of the digital health transformation as well as barriers to adoption and early implementation of digital services. The feedback can be used to improve patient outcomes and, ultimately, provide interventions that are accessible to both patients and clinicians.

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How to juggle simultaneous treatments for dry eye, glaucoma

Ophthalmologists are often faced with treating diseases simultaneously because 40–60% of patients with glaucoma also have dry eye, according to Dr Vatinee Bunya, the William F. Norris and George E. de Schweinitz associate professor of ophthalmology and codirector of the Penn Dry Eye and Ocular Surface Center at Penn Medicine in Philadelphia, Pennsylvania, United States.

She noted that in these cases, glaucoma treatment trumps dry eye therapy because of the threat of permanent vision loss; however, dry eye negatively affects the patient’s quality of life as well as treatment adherence.

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Identifying herpes simplex virus keratitis in keratoconus surgery patients

Nothing is perfect. Although corneal collagen cross-linking (CXL) to treat keratoconus is safe and stops the progression of disease, infections can occur. Herpes simplex virus (HSV) keratitis is one possibility, according to Dr David R. Hardten, from the Minnesota Eye Consultants in Minnetonka, Minnesota, United States.

Dr Hardten suggested that most cases of HSV keratitis associated with CXL are recurrences. He addressed the question of what causes HSV keratitis to recur and posited that the traumatic epi (epithelium)-off procedure, use of corticosteroids to reduce haze, and exposure to 30 minutes of ultraviolet light may be the culprits in re-stimulating the virus in patients with prior exposure.

He also noted that with the epi-on procedure, the epithelium is disrupted, which leaves the scene open for an HSV recurrence. “There are a number of different risk factors that can create that environment in which HSV can flourish,” he said.

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Systemic factors not predictive of VA outcomes following cataract surgery in patients with diabetic retinopathy

Dr Debora Lee from the Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, MD, and colleagues found that in patients with diabetes, systemic parameters may not be as valuable as the ocular parameters in helping to evaluate the visual acuity (VA) prognosis after cataract surgery.

The investigators evaluated VA outcomes after cataract surgery and the factors associated with good visual outcomes in a population of patients with type 2 diabetes. The patients were enrolled in The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and ACCORD-eye substudy. The study included 1,136 eyes of 784 ACCORD participants who underwent cataract surgery during a follow-up period from 2001 to 2014.

Of those eyes, 362 eyes had fundus photographs gradable for diabetic retinopathy. The main outcome measure was a postoperative VA of 20/40 or better.

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Retinal camera unlocks back-of-the-eye secrets

An adaptive optics (AO) retinal camera has been used to measure photoreceptors preoperatively and following macular hole (MH) surgery to accurately assess any changes in cone density, according to research presented by Dr Paola L. Oquendo at the 2022 Canadian Ophthalmological Society Annual Meeting and Exhibition held in Halifax, Nova Scotia, Canada.

“We hypothesised that cone density will change following macular hole closure,” said Dr Oquendo, a vitreoretinal clinical research fellow at St Michael’s Hospital Toronto and the Department of Ophthalmology and Vision Sciences at the University of Toronto in Canada. “This is because it is likely that the temporal retina stretches to close the macula hole. This could possibly result in a reduction of cone density temporally.”

Discussing MH and photoreceptor changes using high-resolution imaging with adaptive optics, Dr Oquendo described the results of a small study that used an AO retinal camera (rtx1, Imagine Eyes) and spectral-domain optical coherence tomography (SD-OCT) to evaluate the photoreceptors in patients with various morphologies of MH and the changes following surgical closure.

The study included individuals presenting to the Kensington Vision and Research Centre in Toronto with idiopathic MH needing pars plana vitrectomy and membrane peeling. Patients underwent extensive imaging before surgery and at 3 months postoperatively, according to Dr Oquendo.

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