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To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p =.03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p <.001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p =.04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p =.04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p =.02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p =.02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p <.001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p <.001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p <.05 for all). Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care. [ABSTRACT FROM AUTHOR]

Falls is a leading cause of injuries nationally and can lead to serious ophthalmic injuries. The purpose of this study is to examine the incidence and characteristics of ophthalmic trauma in patients with fall-related hospitalizations in the United States. Retrospective, cross-sectional study. National Inpatient Sample (NIS) was queried to identify all ophthalmic trauma associated with fall-related hospitalizations from 2000 to 2017. Patients were identified using relevant International Classification of Diseases (ICD) codes. National estimates, annual incidences and characteristics were produced from trend weights provided by the NIS sampling frame and population data from the US Census Bureau. There were 21,415,120 fall-related hospitalizations of which 425,725 (2.0%) had ophthalmic trauma. Ophthalmic injury incidence increased from 4.26 to 14.31 per 100,000 population (P <.01) from 2000 to 2017. Mean (±SEM) age was 69.2 ± 20.1 years and 56.9% were females. Of the patients with specified fall mechanism, the most common mechanisms were tripping or stumbling (48.0%), falls related to furniture (18.3%), and falls related to stairs (16.3%). The most common ophthalmic injuries were contusions of the eye and adnexa including hyphema and commotio retinae (50.1%), orbital fractures (20.7%), and eyelid lacerations (14.9%). Incidence of ophthalmic trauma in patients with fall-related hospitalizations has increased and our study provides valuable information for targeting preventive measures particularly for the elderly and falls due to tripping, stairs, and furniture related accidents. The most common associated ophthalmic injuries are contusions, orbital fractures and eyelid lacerations. [ABSTRACT FROM AUTHOR]

To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US). This retrospective cross-sectional study used National ED Sample (NEDS) (2006–2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers. An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50–32.87]). In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate artifacts in optical coherence tomography angiography (OCT-A) images of multiple sclerosis (MS) patients and healthy controls. Materials and methods: This was a prospective cross-sectional study conducted at the Department of Neurology and the Wilmer Eye Institute at Johns Hopkins Hospital. Subjects included patients with an established diagnosis of MS and healthy volunteers. OCT-A was performed using Spectralis® OCT-A prototype, OCT2 (Heidelberg, Germany). The type and frequency of artifacts, the clinical factors associated with them, and their impact on vessel density measurements were assessed. Results: Overall, 385 images from 102 participants were analyzed. The majority of images (97.1%) had some degree of artifact. The most frequent was motion artifact (96.3%), followed by blinking (51.9%), and loss of focus (25.1%). MS patients were more likely to have any artifact vs. controls (OR [95% CI], 3.83 [1.12–12.92]), and were more likely to have motion artifacts with longer disease duration (OR [95% CI], 1.11 [1.03–1.20]) or history of optic neuritis (OR [95% CI], 4.24 [1.19–15.16]). The relative area occupied by the artifact was found to underestimate vessel density measurements in both MS patients and controls. Conclusions: Artifacts are common with OCT-A imaging using this particular Spectralis® OCT-A prototype and can impact quantitative vascular density metrics. Future studies should review images for artifacts before drawing definitive conclusions [ABSTRACT FROM AUTHOR]