This is a cross-sectional exploratory analysis of publicly available Internet data to examine compliance to web content accessibility guidelines (WCAG) on patient education social media posts in ...ophthalmology. WCAG ensures web content accessibility for those with disabilities (including visual impairment). A total of 100 social media posts were sampled from ten ophthalmology patient education social media pages and ten non-ophthalmology (cardiopulmonary) pages as the comparison group. Three independent graders evaluated the selected posts based on the WCAG 2 checklist by WebAIM, a non-profit affiliated with Utah State University, after its adaptation for social media posts. Validated accessibility standard labels: "0" for not meeting any standards, "1" or "A" for meeting bare minimum accessibility requirements, "2" or "AA" for meeting legal accessibility requirements, or "3" or "AAA" for exceeding accessibility requirements. There was not enough evidence to detect a difference in WCAG scores between ophthalmology and non-ophthalmology posts (p = 0.80). Forty-nine percent of scores for ophthalmology social media posts showed no compliance with any WCAG. The most common reasons that ophthalmology posts failed to meet criteria were due to color and contrast issues (39%). Most ophthalmology social media posts had low WCAG scores, indicating poor compliance to WCAG. Because social media is highly visual, reduced compliance to WCAG may create barriers for low vision individuals to successfully access patient education social media content.
Purpose To report a surgical technique for aqueous misdirection refractory to medical treatment consisting of combined pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy. Design ...Noncomparative case series. Methods The charts of 5 pseudophakic patients who sought treatment for aqueous humor misdirection refractory to medical treatment from May 2008 trough February 2009 were reviewed. All 5 patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy with an anterior vitrector through a pars plana incision. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination results, and fundus findings. Results Five female patients (age range, 23 to 89 years) had increased intraocular pressure and shallowing of the anterior chamber after cataract extraction or trabeculectomy, and none responded to conventional medical therapy. After surgery, prompt resolution of the aqueous misdirection was achieved in all cases. The follow-up was 7.6 months (range, 1 to 13 months). Conclusions Aqueous misdirection refractory to medical treatment can be treated successfully with surgery consisting of partial pars plana vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy.
January consultation #9 Bitrian, Elena
Journal of cataract and refractive surgery,
2021-Jan-01, 2021-01-00, 20210101, Letnik:
47, Številka:
1
Journal Article
To explore the association of angiographic nonperfusion with anterior segment and posterior segment neovascularization in central retinal vein occlusion (CRVO).
An imaging database at one institution ...was searched for the diagnosis of central retinal vein occlusion. Ultra wide field fluorescein angiograms were graded for image quality, the presence of retinal neovascularization, and the quantity of nonperfusion; an ischemic index (ISI) was calculated. Charts were reviewed to exclude eyes with previous treatment and to determine which eyes had anterior segment or posterior segment neovascularization on the day of the angiogram. Time from onset to presentation could not accurately be ascertained.
In a 39-month period, there were 69 eyes that met inclusion criteria. The mean ISI was 25% (SD, 26%; range, 0-100%), and 15 eyes (21%) with neovascularization had a mean ISI of 75% (range, 47-100%) compared with eyes without neovascularization that had an ISI of 6% (range, 0-43%). Ischemic index significantly correlated to neovascularization, and eyes that had evidence of neovascularization had an ISI >45% (P < 0.0001).
Ultra wide field fluorescein angiography provides visualization of nonperfusion in eyes with central retinal vein occlusion. Eyes with neovascularization on the day of the angiogram were found to have significantly larger areas of retinal nonperfusion compared with eyes without neovascularization. A prospective study is indicated to know if early treatment of peripheral retinal nonperfusion in CRVO improves outcomes.
To explore whether pointwise rates of visual field progression group together in patterns consistent with retinal nerve fiber layer (RNFL) bundles.
Three hundred eighty-nine eyes of 309 patients from ...the Advanced Glaucoma Intervention Study with ≥6 years of follow-up and ≥12 reliable visual field exams were selected. Linear and exponential regression models were used to estimate pointwise rates of change over time. Clustering of pointwise rates of progression was investigated with hierarchical cluster analysis using Pearson's correlation coefficients as distance measure and an average linkage scheme for building the hierarchy with cutoff value of r > 0.7.
The average mean deviation (±SD) was -10.9 (±5.4). The average (±SD) follow-up time and number of visual field exams were 8.1 (±1.1) years and 15.7 (±3.0), respectively. Pointwise rates of progression across the visual field grouped into clusters consistent with anatomic patterns of RNFL bundles with both linear (10 clusters) and exponential (six clusters) regression models. One hundred forty-four (37%) eyes progressed according to the two-omitting pointwise linear regression model.
ointwise rates of change in glaucoma patients cluster into regions consistent with RNFL bundle patterns. This finding validates the clinical significance of such pointwise rates. The correlations among pointwise rates of change can be used for spatial filtering purposes, facilitating detection or prediction of glaucoma progression.
This study was conducted to validate a recently described technique for measuring the rates of visual field (VF) decay in glaucoma.
A pointwise exponential regression (PER) model was used to ...calculate average rates of faster and slower deteriorating VF components, and that of the entire VF. Rapid progressors had a faster component rate of >25%/year. Mean deviation (MD) and visual field index (VFI) forecasts were calculated by (1) extrapolation of linear regression of MD and VFI, and (2) calculation de novo from the PER-predicted final thresholds.
The mean (± SD) years of follow-up and number of VFs were 9.2 (± 2.7) and 13.7 (± 5.8), respectively. The median rates of the decay were -0.1 and 3.6 (%/year) for the slower and the faster components, respectively. The "rapid progressors" (32% of eyes) had a mean decay rate of 52.2%/year. In comparison with actual values, the average absolute difference and the mean squared error for MD forecasts with linear extrapolation of indices were 3.58 dB and 31.91 dB(2), and with the de novo recalculation from PER predictions were 2.95 dB and 17.49 dB(2), respectively. Similar results were obtained for VFI forecasts. Comparisons of the prediction errors for both the MD and VFI favored the PER forecasts (P < 0.001).
PER for measuring rates of VF decay is a robust indicator of rates across a wide range of disease severity and can predict future global indices accurately. The identification of "rapid progressors" identifies high-risk patients for appropriate treatment.
Reply Bitrian, Elena
American journal of ophthalmology,
02/2015, Letnik:
159, Številka:
2
Journal Article
Recenzirano
...the use of a patch graft at the time of bleb revision did not eliminate the risk of subsequent revision surgery in our series or the one described by Halkiadakis and associates.1,2 We thank Dr ...Pazos and colleagues for the opportunity to further discuss the surgical techniques described in our manuscript.
Introduction: To report a case of angle closure and corneal decompensation requiring surgical intervention secondary to BrightOcular cosmetic iris implantation in a patient with a history of ...congenital bilateral iris coloboma. Patient and Clinical Findings: A 40-year-old male patient with a history of bilateral congenital coloboma presented to the emergency department with reduced visual acuity to count fingers and moderate pain in the left eye 4 months after bilateral BrightOcular iris implant surgery in Mexico. Intraocular pressure (IOP) was 70 mm Hg with little response to maximal medical therapy. Gonioscopy revealed dense pigment obstructing angle inferiorly. Diagnosis, Interventions, and Outcomes: The patient was diagnosed with angle closure, pigment dispersion syndrome, and corneal decompensation secondary to bilateral cosmetic iris implants. IOP stabilized after emergency Ahmed valve and Baerveldt shunt placement. Corneal decompensation addressed first with endothelial keratoplasty, however ultimately failed leading to penetrating keratoplasty in the left eye. Fellow eye required glaucoma shunt placement 4 years after initial presentation due to persistent glaucoma not controlled with laser and medical therapy. Conclusions: The use of iris implants for cosmetic reasons can have serious ocular morbidity in patients with iris coloboma. Close monitoring and explantation should be strongly recommended at the earliest sign of complication.
Purpose To detect potential differences in the phenotypes between Western normal-tension glaucoma (NTG) and Korean NTG. Design A retrospective, cross-sectional study. Methods One hundred eighty-four ...NTG eyes of 71 patients of the Jules Stein Eye Institute, University of California, Los Angeles, and 113 patients of the Seoul National University Hospital, Seoul, Korea, were studied after reviewing medical charts retrospectively. All eligible patients from both institutions who were evaluated between July 2007 and June 2008 were included. The groups were matched for stage of glaucoma severity based on the visual field mean deviation value. All patients underwent a complete ophthalmic examination, Humphrey perimetry, Heidelberg Retina Tomography, Stratus optical coherence tomography, and pachymetry. Structural and functional parameters between the 2 groups were compared. Results There were no statistically significant differences in the baseline intraocular pressure, disc area, frequency of disc hemorrhage, or peripapillary atrophy ( P > .05). Cup-shape measure (by Heidelberg Retina Tomography), average RNFL thickness (by Stratus optical coherence tomography), and central corneal thickness were significantly different ( P < .002). The eyes of Korean NTG patients showed higher values for cup-shape measure, higher average RNFL thicknesses, and thinner central corneal thicknesses than Western NTG patients. The difference was significant ( P < .001) while controlling for age, sex, disc area, mean deviation, pattern standard deviation, and spherical equivalent with multivariate analysis. Conclusions Korean NTG patients showed steeper cup shapes, thicker RNFL thickness, and thinner central corneal thickness compared with Western NTG patients with similar amounts of visual field loss. This result may help clinicians understand the clinical characteristics of NTG patients and points to the heterogeneous character of the glaucomas.
