Quantifying vitreous inflammation in uveitis: an optical coherence tomography prospective study

OBJECTIVE: To quantify vitreous inflammation in a uveitis cohort using optical coherence tomography and correlate findings to gold-standard Nussenblatt scores. DESIGN: Prospective cohort study. PARTICIPANTS: 36 eyes from 19 patients primarily with pan uveitis. METHODS: Study participants were scanned with optical coherence tomography and evaluated by 2 independent graders using open-source ImageJ software. Graders characterized the mean intensity of the vitreous in a 67 500-pixel box immediately above the internal limiting membrane and over the fovea and divided it by the mean intensity of the retinal pigment epithelial layer (RPE). The vitreous to retinal pigment epithelial layer ratio (VIT/RPE) ratios were correlated to Nussenblatt vitreous haze scores recorded by an independent uveitis specialist blinded to the graders\u27 reads. Grader 1 measured intensity a second time after a 48-hour washout period, and the intraclass correlation coefficients (2,1) were calculated for intra- and intergrader reliability. RESULTS: 21 (58.3%) eyes had a Nussenblatt score of 0, 9 (25.0%) had a score of 0.5, and the remaining 6 (16.7%) had a score ranging from 1 to 4. The r values for VIT/RPE intensity ratio regressed against Nussenblatt scores were 0.670, 0.672, and 0.660 for grader 1 read 1, grader 1 read 2, and grader 2 read 1, respectively (p \u3c 0.001 for all linear correlations). The intragrader reliability was 0.999 (p \u3c 0.001) and intergrader reliability was 1.000 (p \u3c 0.001). CONCLUSION: The VIT/RPE intensity ratio is a clinically relevant measure that reliably captures inflammation in uveitis and correlates well with gold-standard Nussenblatt scores

Persistent opioid use in cataract surgery pain management and the role of nonopioid alternatives

Cataracts are a leading cause of preventable blindness globally. Although care varies between developing and industrialized countries, surgery is the single effective approach to treating cataracts. From the earliest documented primitive cataract removals to today's advanced techniques, cataract surgery has evolved dramatically. As surgical techniques have developed, so have approaches to surgical pain management. With current cataract surgical procedures and advanced technology, anesthesia and intraoperative pain management have shifted to topical/intracameral anesthetics, with or without low-dose systemic analgesia and anxiolysis. Despite this, pain and discomfort persist in some patients and are underappreciated in modern cataract surgery. Although pain management has progressed, opioids remain a mainstay intraoperatively and, to a lesser extent, postoperatively. This article discusses the evolution of pain management in cataract surgery, particularly the use of opioids and the associated risks as well as how ophthalmology can have a positive impact on the opioid crisis

The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine

<div><p>This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p < 0.0005). Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents’ year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from “mouse click fatigue” as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.</p></div

Documentation percentage of different chart note template versions.

<p>Documentation percentage of different chart note template versions.</p

Overall average documentation by resident year.

<p>Overall average documentation by resident year.</p

Differences in documentation methods of different chart note template versions.

<p>Differences in documentation methods of different chart note template versions.</p