Resident Heart Rate Variability During Cataract Surgery

Purpose: To evaluate ophthalmology resident anxiousness and cardiovascular response by tracking resident heart rate (HR) when performing cataract surgery during their last year of residency. Methods: A prospective analysis of 31 cataract cases, completed by three residents (two females and one male), at the Kresge Eye Institute in August and September 2020 was performed. Inclusion criteria for cases included all cataract cases performed by PGY-4 residents at the Kresge Eye Institute who downloaded the Heart Graph app supported by iOS. Residents with android mobile devices were excluded from the study. Informed consent was obtained from all residents who utilized the MOOFIT tracker and no incentives or penalties were utilized by the department during this study. Results: Residents were divided by gender. Total HR mean(SD) was significantly elevated for female residents with a HR of 107.4(13.0) for females and 81.4(11.5) for males (P0.05). Conclusion: Our study shows a significant difference in peak and sustained HR response between female and male ophthalmology residents while performing cataract surgery. The cumulative effect of high HR on the overall health of residents, training in the surgical specialty of ophthalmology, needs further investigation

Assessment of the Nanodropper Eye Drop Adaptor for Glaucoma Medications

Assessment of the Nanodropper Eye Drop Adaptor for Glaucoma Medications Nicholas Pryde, BS1; Parker J. Williams, DO 1; John-Michael Guest, MD1; Bret A. Hughes, MD1; Faisal Ridha MD1 1Kresge Eye Institute and Wayne State University Department of Ophthalmology, Detroit, MI, USA Purpose: To determine the dispensed volume change for seven medications with and without the Nanodropper adaptor. Methods: Sequentially, 100 µL of each medication was dispensed by micropipette into a 1.5 mL Eppendorf tube, and mass without the tube was determined with a precision balance (Practum, Germany). The mean mass was calculated following five serial measurements of 100 µL, and density was calculated by dividing mean mass (mg) by 100 µL. This procedure was repeated with and without the Nanodropper adaptor to provide the mean volume per drop. The means and standard deviations were calculated, with and without the adaptor. An unpaired student T-test was used for statistical analysis. Tested medications included brimonidine tartrate 0.2% (Alphagan P, Allergan), dorzolamide HCL (Hi-Tech), travoprost (Travatan Z, Alcon) timolol malate (Sandoz), netarsudil/latanoprost (Rocklatan, Aerie), netarsudil (Rhopressa, Aerie), and pilocarpine 1.25% (Vuity, Allergan). Results: The mean volume reduction across all medications was 62.3% (range 55.2% - 69.7%). The volume of Alphagan P decreased from 43.2 ±1.6 µL to 17.1 ±1.8 µL (60.4% reduction) with the adaptor. The volume of dorzolamide HCL decreased from 39.9 ±1.6 µL to 14.2 ±1.1 µL (64.4% reduction). The volume of Travatan Z decreased from 30.8 ±1.6 µL to 12.3 ±1.4 µL (60.1% reduction). The volume of timolol malate decreased from 28.6 ±2.2 µL to 12.8 ±1.6 µL (55.2% reduction). The volume of Rocklatan decreased from 40.2 ±2.2 µL to 12.2 ±1.1 µL (69.7% reduction). The volume of Rhopressa decreased from 33.5 ±1.4 µL to 12.2 ±1.3 µL (63.6% reduction). The volume of Vuity decreased from 32.1±1.08 µL to 11.9 ± 0.9 µL (62.9% reduction). All p-values were less than 0.0001. Discussion: It is reported that the optimal eye drop volume is between 5-15 µL.1 The Nanodropper adaptor produced statistically significant volume reductions near this range for all tested medications with excellent reproducibility. All drop volumes measured between 10-20 µL with the adaptor. Conclusions: The novel eye drop adaptor reliably reduced eye drop volumes to a level between 10.0-20.0 µL. The mean volume reduction across all medications was 62.3% (range 55.2% - 69.7%). This may decrease the financial burden on patients and reduce the risk of systemic side effects, as long as efficacy is maintained. Future studies could target differences in the reduced final volumes and the clinical efficacy of volume reduction for various medications. References: Van Santvliet, L., & Ludwig, A. (2004). Determinants of eye drop size. Survey of ophthalmology, 49(2), 197-213

Central Corneal Thickness: A Retrospective Comparison of Handheld Ultrasound Pachymetry and Optical Biometric Analysis Measurements

Purpose To determine if the measure of central cornea thickness among suspected and confirmed glaucomatous patients is significantly influenced by instrument device. Methods We retrospectively examined the charts of all patients having a central corneal thickness (CCT) measured with both ultrasound pachymetry and IOL Master 700 at the Kresge Eye Institute within the past year. Intraocular pressure and demographic data including age and race, were also collected. Significant corneal disease such as Fuchs corneal dystrophy, other corneal dystrophies, corneal transplant, and corneal edema were excluded. Statistical analysis of the paired CCT measurements were performed with a paired t-test and regression analysis. Results The total number of patients having a CCT measured with both ultrasound pachymetry and IOLMaster700 was 59. Mean CCT measured with ultrasound pachymetry was 539.38 ± 49.56 µm (n=118). Mean CCT measured with IOLMaster700 was 536.83 ± 42.52 µm (n=112). The intraparticipant mean of differences between the ultrasound pachymetry and the IOLMaster700 was 3.16 ± 25 µm. Analysis with a paired t-test did not find a significant difference between the two groups (p=0.19). A regression analysis of the paired CCTs yielded an R2 value of 0.74. Conclusion There is no significant difference between CCT measurements taken with handheld ultrasound pachymetry compared to the IOL Master 700. More data is warranted to confirm, but the IOL Master 700 may yield lower variability and a lower mean CCT, possibly due to greater instrument precision and increased likelihood of a central measurement. In practice, the IOL Master 700 may provide a more reliable measure of central cornea thickness when compared with ultrasound pachymetry

Long-Term Outcomes of Bleb Needling Following Primary Glaucoma Filtering Surgery in Primary Open Angle Glaucoma

Purpose: To determine the long-term success rate of bleb needling in a predominantly African American population and to identify factors associated with success. Methods: We conducted a retrospective, observational clinical study in patients with primary open angle glaucoma. Patients who underwent a primary trabeculectomy, with or without an express shunt placement, and then subsequently had a bleb needling procedure were selected for this study. Patients were followed every three months for a period of two years. Failure criteria included achieving an intraocular pressure (IOP) of greater than 20 mmHg or greater than 80% of the pre-needling value on two subsequent visits, an increase in the number of prescribed medications relative to pre-needling quantity, and the occurrence of other complications. Kaplan-Meier survival curves were used to calculate bleb needling success rates and variables associated with failure were analyzed using multivariate Cox regression analysis. Results: Seventy-four eyes from 71 patients were included in the study, with the majority of eyes from African Americans. The overall success rate at 12 months and two years was 28.1% and 14.3%, respectively. However, the complete success rate (completely weaned off of medications) was 12.7% and 5.1% at 12 months and 2 years, respectively. The most frequent reasons for failure included increased number of glaucoma medications (40%), surgical revision (31.7%), and IOP that exceeded threshold (21.7%). Conclusions: The two-year bleb needling success rate reported in our study is lower than that reported in other studies, possibly due to the increased severity of glaucoma in our patient population

Post-operative Day 1 versus Day 0 follow-up for Uncomplicated Cataract Surgeries: A comparison of post-operative outcomes and managements

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1). Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery, or did not complete two follow up visits within 14 days of surgery. Results: The pre-operative demographic data between patients seen on POD 0 (n=119) versus POD1 (N=414) were equally distributed. By unpaired t-test, the average VA of patients seen on POD 1 was significantly better than those seen on POD 0 (P0.50). Conclusion: There was no significant difference in management between POD 0 and POD 1 patients having undergone uncomplicated cataract surgeries. Therefore, surgeons can safely consider POD 0 or POD 1 evaluations for uncomplicated cataract surgeries and improve healthcare cost efficiency for CEIOL

Factors Associated With 5-Year Glaucomatous Progression In Glaucoma Suspect Eyes: A Retrospective Longitudinal Study

Purpose: To study the association of 5-year glaucomatous progression with several demographic, clinical, visual field and optical coherence tomography (OCT) variables in glaucoma suspect eyes. Methods: A retrospective chart review of 365 eyes of 288 patients were included (323 eyes with suspicious cup-to-disc ratio and 42 eyes with ocular hypertension). The study subjects were divided into two groups: eyes that progressed to glaucoma and those that did not. We calculated the percentage of glaucoma suspect eyes that progressed to glaucoma within 5 years. The inclusion criteria were glaucoma suspect eyes (i.e., suspicious cup-to-disc ratio and/or intraocular pressure \u3e21 mm Hg), age ≥ 30 years old, follow-up time of 5 years, best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. We excluded eyes with any significant retinal or neurological disease, and glaucoma which was determined by at least 2 consecutive reliable visual field tests regardless of the appearance of the optic disc. Results: Bivariate analysis showed eyes that progressed to glaucoma had significantly worse mean deviation, higher pattern standard deviation (PSD), less visual field index, thinner average, superior, and inferior retinal nerve fiber layer thickness (RNFL), and more severe average, superior, and inferior RNFL damages (i.e., color grading scale) at baseline. Logistic regression analysis showed only PSD and severe inferior RNFL damage (i.e., red color) were significantly associated with 5-year glaucomatous progression. Conclusions: Segmental RNFL damage and PSD are associated with 5-year glaucomatous progression in glaucoma suspect eyes