Tarantula Hairs as Corneal Foreign Bodies

Purpose: To report a case of tarantula hairs found in the cornea and discuss treatment. Case Report: A 16-year-old male presented with a 6-week history of right ocular irritation that began after letting his pet tarantula crawl on his face. Slit-lamp examination of the right eye revealed the presence of approximately 16 dark foreign bodies that had the appearance of small hairs. The foreign bodies were removed from the nasal region of the right cornea using Jewelers forceps, and the patient was prescribed a combination neomycin, polymyxin B, and dexamethasone ointment (Maxitrol®), given 4 times per day. Results: The patient presented for follow-up 2 weeks later, with resolution of symptoms. Conclusion: Effective treatment of keratitis caused by tarantula hairs includes taking a detailed history, conducting a careful slit-lamp examination, removal of any accessible hairs, and initiation of treatment with a topical steroid as determined by the clinical picture

Prevalence of Falls and Fall‐Related Outcomes in Older Adults with Self‐Reported Vision Impairment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147783/1/jgs15628_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147783/2/jgs15628.pd

Mastermind Mutations Generate a Unique Constellation of Midline Cells within the Drosophila CNS

Background: The Notch pathway functions repeatedly during the development of the central nervous system in metazoan organisms to control cell fate and regulate cell proliferation and asymmetric cell divisions. Within the Drosophila midline cell lineage, which bisects the two symmetrical halves of the central nervous system, Notch is required for initial cell specification and subsequent differentiation of many midline lineages. Methodology/Principal Findings: Here, we provide the first description of the role of the Notch co-factor, mastermind, in the central nervous system midline of Drosophila. Overall, zygotic mastermind mutations cause an increase in midline cell number and decrease in midline cell diversity. Compared to mutations in other components of the Notch signaling pathway, such as Notch itself and Delta, zygotic mutations in mastermind cause the production of a unique constellation of midline cell types. The major difference is that midline glia form normally in zygotic mastermind mutants, but not in Notch and Delta mutants. Moreover, during late embryogenesis, extra anterior midline glia survive in zygotic mastermind mutants compared to wild type embryos. Conclusions/Significance: This is an example of a mutation in a signaling pathway cofactor producing a distinct centra

A checklist for assessing the methodological quality of concurrent tES-fMRI studies (ContES checklist): a consensus study and statement

Background: Low intensity transcranial electrical stimulation (tES), including alternating or direct current stimulation (tACS or tDCS), applies weak electrical stimulation to modulate the activity of brain circuits. Integration of tES with concurrent functional magnetic resonance imaging (fMRI) allows for the mapping of neural activity during neuromodulation, supporting causal studies of both brain function and tES effects. Methodological aspects of tES-fMRI studies underpin the results, and reporting them in appropriate detail is required for reproducibility and interpretability. Despite the growing number of published reports, there are no consensus-based checklists for disclosing methodological details of concurrent tES-fMRI studies. Objective: To develop a consensus-based checklist of reporting standards for concurrent tES-fMRI studies to support methodological rigor, transparency, and reproducibility (ContES Checklist). Methods: A two-phase Delphi consensus process was conducted by a steering committee (SC) of 13 members and 49 expert panelists (EP) through the International Network of the tES-fMRI (INTF) Consortium. The process began with a circulation of a preliminary checklist of essential items and additional recommendations, developed by the SC based on a systematic review of 57 concurrent tES-fMRI studies. Contributors were then invited to suggest revisions or additions to the initial checklist. After the revision phase, contributors rated the importance of the 17 essential items and 42 additional recommendations in the final checklist. The state of methodological transparency within the 57 reviewed concurrent tES-fMRI studies was then assessed using the checklist. Results: Experts refined the checklist through the revision and rating phases, leading to a checklist with three categories of essential items and additional recommendations: (1) technological factors, (2) safety and noise tests, and (3) methodological factors. The level of reporting of checklist items varied among the 57 concurrent tES-fMRI papers, ranging from 24% to 76%. On average, 53% of checklist items were reported in a given article. Conclusions: Use of the ContES checklist is expected to enhance the methodological reporting quality of future concurrent tES-fMRI studies, and increase methodological transparency and reproducibility

Minus Piggyback Lens Overlaying ReSTOR® Multifocal Lens in High Myopia

Background: We report the case of a 40-year-old female patient treated with implantation of the Acrysof® IQ ReSTOR® lens (Alcon, Fort Worth, Tex., USA) with overlaying Acrysof EXpand® minus piggyback lens (Alcon). Methods: The patient had high myopia and was diagnosed with presbyopia and bilateral posterior subcapsular cataract. She desired to be spectacle-free and opted to undergo bilateral placement of the ReSTOR multifocal lens. The necessary intraocular lens (IOL) power was +3.5 in the right eye and +4.0 in the left eye, though the range of commercially available ReSTOR lenses is +6.0 to +34.0 D. In order to achieve emmetropia in this case of high myopia, it was determined that an EXpand minus piggyback lens would be necessary. Results: Implantation of the ReSTOR lens with overlaying EXpand minus piggyback lens was performed successfully and without complication. At 5 months postoperatively, the patient had 20/20 uncorrected visual acuity in both eyes. She reported a high level of satisfaction and was able to return to her daily activities including reading and driving without spectacles. Conclusion: We report successful primary implantation of AcrySof EXpand minus piggyback lenses overlying the AcrySof IQ ReSTOR lens in a patient with high myopia. Long-term follow-up and further evaluation is necessary to establish piggyback IOL implantation with multifocal IOL as an accepted treatment for high myopia with presbyopia

Incident glaucoma and ocular hypertension after periocular and intravitreal steroid injections: a claims-based analysis

Background/aims This study aims to determine the incidence and risk of open-angle glaucoma or ocular hypertension (OHT) following ocular steroid injections using healthcare claims data.Methods We retrospectively reviewed deidentified insurance claims data from the IBM MarketScan Database to identify 19 156 adult patients with no prior history of glaucoma who received ocular steroid injections between 2011 and 2020. Patient demographics and steroid treatment characteristics were collected. Postinjection glaucoma/OHT development was defined as a new diagnosis of glaucoma/OHT, initiation of glaucoma drops, and/or surgical or laser glaucoma treatment. Cox proportional hazards models were used to determine the risk of glaucoma/OHT development within 5 years after first steroid injection.Results Overall, 3932 (20.5%) patients were diagnosed with new glaucoma/OHT, 3345 (17.5%) started glaucoma drops and 435 (2.27%) required a laser or surgical glaucoma procedure within 5 years of first steroid injection. Triamcinolone subconjunctival injections were associated with a lower risk of glaucoma/OHT development than retrobulbar or intravitreal steroid injections (p<0.001, HR 0.68, 95% CI 0.59 to 0.79), whereas the 0.59 mg fluocinolone acetonide intravitreal implant had the highest risk of glaucoma/OHT development (p=0.001, HR 2.01, 95% CI 1.34 to 3.02). The risk of glaucoma/OHT development was also higher for patients receiving multiple steroid injections (p<0.001), with the largest increase in risk occurring after three total steroid injections.Conclusion Patients receiving ocular steroid injections are at risk of developing glaucoma/OHT, even with no prior glaucoma/OHT diagnosis or treatment. Patients should be closely monitored for the development of glaucoma following ocular steroid injections, particularly in the setting of intravitreal and/or repeated steroid administration

Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature

There are little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the underserved Baja Verapaz region. This observational study assessing XFS/XFG and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS/XFG in Guatemala. During Moran Eye Center’s global outreach medical eye camps from 2016–2017, 181 patients age 15 years and older presented for complete eye exams. These individuals were screened for eye disease and evaluated for possible surgical interventions that could occur during the camps to improve eyesight. During the dilated exams, XFS was noted as missing or present. Of those 181, 10 had insufficient data and 18 lacked a definitive diagnosis of XFS or XFG, resulting in 153 evaluable patients; 46 XFS and 9 XFG were identified. Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history, and occupational data (only 2017 trip) were obtained for each patient. The most common occupations of these individuals were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural compared to urban settings and Mayan speaking people compared with Spanish speakers. Based on this subset of patients, with various ocular pathologies being evaluated during medical eye outreach camps, the prevalence of XFS/XFG appeared to be 36%, a high prevalence compared to other world populations. Location and higher altitude, along with a farming occupation, may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the largest study looking at the epidemiology of XFS/XFG in the Baja Verapaz region of Guatemala for those over the age of 15 years seeking eye exams and interventions

Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India

Abstract Background For patient undergoing cataract surgery in India, existing patient-reported outcome (PRO) measures are either not culturally relevant, have not been adequately validated, or are too long to be used in a busy clinical setting. We sought to develop and validate a brief and culturally relevant point-of-care PRO measure to address this need. Methods Twelve items from the Indian Visual Functioning Questionnaire (IND-VFQ) were selected based on preliminary data. Patients 18 years and older were prospectively recruited at Aravind Eye Care System in Madurai, India. Clinical and sociodemographic data were collected and the 12-item short-form IND-VFQ (SF-IND-VFQ) was administered pre- and post-operatively to 225 patients; Factor analysis and Rasch modeling was performed to assess its psychometric properties. Results One item that did not fit a unidimensional scale and had poor fit with the Rasch model was eliminated from the questionnaire. The remaining 11 items represented a single construct (no residual correlations> 0.1) and were largely unaffected by differential item functioning. Five items had disordered thresholds resolved by collapsing the response scale from four to three categories. The survey had adequate reliability (0.80) and good construct (infit range, 0.77–1.29; outfit range, 0.56–1.30) and content (item separation index, 5.87 logits) validity. Measurement precision was fair (person separation index, 1.97). There was evidence that items were not optimally targeted to patients’ visual ability (preoperatively, − 1.92 logits; overall, − 3.41 logits), though the survey measured a very large effect (Cohen’s d 1.80). In a subset of patients, the average time to complete the questionnaire was 2 min 6.3 s. Conclusions The SF-IND-VFQ is a valid, reliable, sensitive, and rapidly administered point-of-care PRO measure to assess changes in visual functioning in patients undergoing cataract surgery in India

Systematic User-centered Design of a Prototype Clinical Decision Support System for Glaucoma

Purpose: To rigorously develop a prototype clinical decision support (CDS) system to help clinicians determine the appropriate timing for follow-up visual field testing for patients with glaucoma and to identify themes regarding the context of use for glaucoma CDS systems, design requirements, and design solutions to meet these requirements. Design: Semistructured qualitative interviews and iterative design cycles. Participants: Clinicians who care for patients with glaucoma, purposefully sampled to ensure a representation of a range of clinical specialties (glaucoma specialist, general ophthalmologist, optometrist) and years in clinical practice. Methods: Using the established User-Centered Design Process framework, we conducted semistructured interviews with 5 clinicians that addressed the context of use and design requirements for a glaucoma CDS system. We analyzed the interviews using inductive thematic analysis and grounded theory to generate themes regarding the context of use and design requirements. We created design solutions to address these requirements and used iterative design cycles with the clinicians to refine the CDS prototype. Main Outcome Measures: Themes regarding decision support for determining the timing of visual field testing for patients with glaucoma, CDS design requirements, and CDS design features. Results: We identified 9 themes that addressed the context of use for the CDS system, 9 design requirements for the prototype CDS system, and 9 design features intended to address these design requirements. Key design requirements included the preservation of clinician autonomy, incorporation of currently used heuristics, compilation of data, and increasing and communicating the level of certainty regarding the decision. After completing 3 iterative design cycles using this preliminary CDS system design solution, the design was satisfactory to the clinicians and was accepted as our prototype glaucoma CDS system. Conclusions: We used a systematic design process based on the established User-Centered Design Process to rigorously develop a prototype glaucoma CDS system, which will be used as a starting point for a future, large-scale iterative refinement and implementation process. Clinicians who care for patients with glaucoma need CDS systems that preserve clinician autonomy, compile and present data, incorporate currently used heuristics, and increase and communicate the level of certainty regarding the decision. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references