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We propose a novel hybrid framework for registering retinal images in the presence of extreme geometric distortions that are commonly encountered in ultra-widefield (UWF) fluorescein angiography. Our approach consists of two stages: a feature-based global registration and a vessel-based local refinement. For the global registration, we introduce a modified RANSAC (random sample and consensus) that jointly identifies robust matches between feature keypoints in reference and target images and estimates a polynomial geometric transformation consistent with the identified correspondences. Our RANSAC modification particularly improves feature point matching and the registration in peripheral regions that are most severely impacted by the geometric distortions. The second local refinement stage is formulated in our framework as a parametric chamfer alignment for vessel maps obtained using a deep neural network. Because the complete vessel maps contribute to the chamfer alignment, this approach not only improves registration accuracy but also aligns with clinical practice, where vessels are typically a key focus of examinations. We validate the effectiveness of the proposed framework on a new UWF fluorescein angiography (FA) dataset and on the existing narrow-field FIRE (fundus image registration) dataset and demonstrate that it significantly outperforms prior retinal image registration methods in accuracy. The proposed approach enhances the utility of large sets of longitudinal UWF images by enabling: (a) automatic computation of vessel change metrics such as vessel density and caliber, and (b) standardized and co-registered examination that can better highlight changes of clinical interest to physicians.

Background: To identify vitreoretinal practice patterns in the months following the initial 2020 national shutdown due to the COVID-19 pandemic in the United States (US). Study Design: Retrospective analysis of vitreoretinal practice patterns from multiple retinal centers across the US from January 1, 2018 to December 31, 2020. Results: The lowest utilization of retina care occurred during the week of March 23, 2020, after which utilization returned to pre-pandemic levels by July 2020. Patients with retinal detachments (RDs) presented with worse visual acuity during March, April, and May 2020 compared to the same time periods of 2018 and 2019 ( P values < 0.05). However, only comparing eyes that presented in March 2018 to March 2020, was the year 1 vision significantly worse ( P = 0.008). Conclusion: The COVID-19 pandemic significantly impacted vitreoretinal care. The vision of patients with RDs may not have been affected by the delayed presentation. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:15–23.]

To describe the prevalence, management, and outcomes of rhegmatogenous retinal detachment (RRD) after incisional glaucoma filtering surgery.All patients with a history of trabeculectomy or glaucoma drainage device surgery who were subsequently diagnosed with an RRD from January 1, 2016, to January 1, 2021, at the Wills Eye Hospital were identified.Forty-six eyes met the inclusion criteria. The mean age was 60.7 ± 19.6 years, and 15 patients (32.6%) were female. Of all eyes, 34 (73.9%) were diagnosed with primary open-angle glaucoma. The mean time from most recent incisional glaucoma surgery to RRD diagnosis was 1,133 ± 1,644 days. There were 19 eyes (41.3%) with preoperative proliferative vitreoretinopathy (9 eyes [19.6%] with Grade C proliferative vitreoretinopathy) and 35 eyes (76.1%) had macula-off RRD at the time of presentation. At RRD presentation, 4 eyes (8.7%) had concomitant endophthalmitis, 5 (10.9%) had concurrent choroidal detachment, and 2 (4.7%) had concurrent vitreous hemorrhage. Primary vitrectomy was performed in most (91.3%) cases. Silicone oil tamponade was often required (71.1%). The single surgery success rate was 65.2% (30 of 46). The mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.72 ± 0.78 (Snellen acuity 20/1,050), and the mean final postoperative logarithm of the minimum angle of resolution was 1.59 ± 0.89 (20/778, P = 0.2853). Of glaucoma surgeries performed, the 5-year prevalence of RRD was 0.71% (26 of 3,664, 95% Poisson confidence interval 0.48%-1.04%).The 5-year prevalence of RRDs after trabeculectomy or glaucoma drainage device was 0.71%. Most patients presented with macula-involving detachments, often with proliferative vitreoretinopathy. Anatomical and visual outcomes were poor.

To characterize how community mobility patterns across the United States correlate with local changes in retina visits during the pandemic.Outpatient retina clinic visits were linked to population mobility by combining multiple public data sets, including the Google Community Mobility Reports and data from the Centers for Disease Control and Infection. Percentage change from baseline in daily-average number of retina visits by county and mobility were measured by county.A total of 2,159,689 patient visits were examined across 332 counties. Daily-average retina visits decreased by 7.0%, 19.0%, 5.0%, and 4.0% from Quarter 1 to 4 of 2020. This decrease was negatively correlated with increased incident of COVID-19 deaths for Quarters 1 to 3 (r = -0.13, r = -0.16, and r = -0.15, respectively, P0.001) and increased incident cases for Quarters 1 and 2 (r = -0.18, r = -0.13, respectively, P0.001). Daily-average retina visits relative to baseline were significantly lower for metropolitan counties in Quarters 1 and 2, compared with urban and rural (P0.001). The decline in retina visits had greatest association with decline in workplace visits in Quarters 1 to 3 (r = 0.27, r = 0.09, r = 0.12, respectively, P0.001 for all).This study provides insight into how regional mobility patterns may help to explain and predict patient behaviors and retina outpatient visit responses during the COVID-19 pandemic.

PURPOSE This study examines the relationship between fluctuations in central subfield thickness (CST) and visual acuity (VA) in patients with diabetic macular edema (DME) using data from 2 large clinical trials. DESIGN Clinical cohort study using post hoc analysis of clinical trial databases. METHODS Standard deviation (SD) of all recorded CSTs for each patient during the study period were used to quantify the fluctuations in CST. Patients from each protocol were grouped into quartiles based on the CST SD. Eyes with at least 3 CSTs and VA at 1 year were included. The main outcome measures were VA at 1 and 2 years for each protocol, stratified by SD quartile. RESULTS A total of 1197 eyes were included in the analysis. There were significant VA differences based on CST SD quartile for both protocols while adjusting for mean baseline VA, baseline CST, lens status, hemoglobin A1c, and treatment arm. At week 52 in protocol T, the difference between the first and fourth quartiles was -1.61 Early Treatment Diabetic Retinopathy Study letters (95% confidence interval [CI] -3.52 to 0.30, P = .0986). At week 104, this difference was -3.59 letters (95% CI -6.17 to -1.00, P = .0066). In protocol V, at week 52, the difference between the first and fourth quartiles was -3.04 letters (95% CI -4.18 to -1.91, P < .0001). At week 104, this difference was -2.35 letters (95% CI -3.58 to -1.13, P = .0005). CONCLUSION Large fluctuations in CST may portend worse VA outcomes at the 2-year end point in patients with DME.

BACKGROUND AND OBJECTIVE: To characterize patient-identified barriers to care in those non-compliant with retina appointments during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS: Inclusion criteria included non-compliant patients from March 1, 2020 to May 1, 2020. Ultimately, 1,345 patients were invited to complete a 14-question survey. A retrospective chart review correlated clinical and demographic information. Univariate logistic regression, independent-samples t -test, and Pearson correlation coefficient identified differences among subgroups. RESULTS: Of the 1,345 patients, 181 (13.5%) completed the survey. The most significant barriers to care included fear of COVID (76/181; 42.0%), wait times (21/181; 11.6%), and costs (11/181; 6.1%). Patients who got their COVID information from the Centers for Disease Control and Prevention (7.8 ± 2.4) and televised news (8.0 ± 2.0) had higher levels of fear. Finally, patients with diabetic retinopathy and higher Charlson Comorbidity Index scores had greater concerns of COVID ( P = .034 and P = .047, respectively). CONCLUSION: This survey study suggests fear of COVID-19 is a prominent new barrier to retinal care. Identifying those at risk for loss to follow-up can guide practices as the pandemic continues. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:526–533.]

Swetha Davuluri,1 Nicolas A Yannuzzi,1 Amy Kloosterboer,1 Ajay E Kuriyan,2 Jayanth Sridhar1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Retina Service, Mid-Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USACorrespondence: Jayanth SridharDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USATel +1 3053266124Fax +1 3053266417Email jsridhar1@med.miami.eduPurpose: To evaluate the accuracy, quality, and readability of online information regarding the Food and Drug Administration (FDA) approved ocular gene therapy voretigene neparvovec (Luxturna, Spark Therapeutics, Philadelphia, PA, USA).Methods: Ten online resources about voretigene neparvovec were assessed in this cross-sectional study. A novel 25-question assessment was created to evaluate the information most relevant to patients. Each article was assessed by independent graders using the assessment and the DISCERN instrument. An online readability tool, Readable, was used to assess readability. Accountability was evaluated using the Journal of the American Medical Association (JAMA) benchmarks.Results: The average questionnaire score for all the articles was 33.93 (SD 11.21, CI 95% ± 6.95) out of 100 possible points with significant variation in the content accuracy and quality between the articles (P=0.017). EyeWiki achieved the highest score and MedicineNet the lowest. The mean reading grade for all articles was 12.88 (SD 1.93, CI 95% ± 1.19) with significant variation between articles (P=0.001). Wikipedia was the most readable, and the FDA website was the least. None of the articles achieved all four JAMA benchmarks, and only one of the ten articles, EyeWiki, achieved three of the four JAMA benchmarks.Conclusion: The information available online regarding this FDA-approved ocular gene therapy is generally of low quality, above the average reading level of the general population, and varies significantly between sources. The articles provide incomplete information that is not entirely accurate or easy to read, and as a result, the material would not support patients adequately in their medical decisions and questions about this new therapeutic option.Keywords: gene therapy, patient education, vitreoretinal surgery, leber congenital amaurosis, voretigene neparvovec

PURPOSE To assess for a positive results bias in recently published randomized controlled trials in the field of vitreoretinal disease. METHODS A bibliometric analysis was conducted examining randomized controlled trials published in the field of retina between January 1, 2016, and December 31, 2019. Studies were classified as positive result or negative result based on the statistical significance of their primary outcome. Publication date and sample size were documented. These variables were compared against Journal Citation Reports Impact Factor in the year of publication. RESULTS Two hundred and eighty-eight randomized controlled trials from 64 unique journals were included and analyzed. One hundred and eighty-five (64.2%) studies were classified as positive result, and 103 (35.8%) studies were classified as negative result. There was no association between impact factor and positive result. Studies classified as positive result had larger sample sizes, and higher sample size was associated with higher impact factor. CONCLUSION These results do not support the presence of a recent positive results bias in retina randomized controlled trials. This is reassuring, although several factors could be contributing to this finding including studies that were conducted but never submitted and selective reporting of outcomes. Thus, it will be important to remain cognizant of potential publication biases moving forward.

PURPOSE To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits. METHODS A retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 and December 2017. RESULTS A total of 1,070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P = 0.01), but not TA, injections per year. Mid-career and late-career physicians performed significantly greater total injections on average compared with early-career physicians (both P < 0.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P = 0.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P < 0.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P < 0.001). CONCLUSION From 2013 to 2017, the use of DEX increased, whereas TA use remained stable. There was a positive association between DEX use and physician-industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship.

To report a case series of endophthalmitis associated with intravitreal dexamethasone injections in a single practice and to discuss the clinical findings and visual outcomes of each case.All endophthalmitis cases following intravitreal dexamethasone injections performed from January 1, 2014 to October 20, 2020 were identified using Wills Eye/MidAtlantic billing records. The diagnosis, clinical information, and microbiology were confirmed for each case. Data were analyzed using Excel (Microsoft Excel, Redmond, WA).Four cases of endophthalmitis were identified from 3,925 intravitreal dexamethasone injections in a single practice and one case was referred from an outside institution, resulting in an incidence of 0.102% (1 in 981 injections). Mean age was 82.3 years (range, 63-88 years) with a mean of 11.3 intravitreal dexamethasone injections performed (range, 2-30 injections) before endophthalmitis. Cases presented with endophthalmitis a mean (SD) of 3.6 (1.64) days after causative injection. Three cases grew gram-positive organisms. All patients responded to intravitreal antibiotics. Mean logarithm of the minimal angle of resolution visual acuity at causative injection, endophthalmitis presentation, 3 months, and last follow-up was 0.44 (20/55), 2.22 (20/3,319), 1.18 (20/303), and 1.46 (20/577), respectively.Endophthalmitis following intravitreal steroid injections may occur more frequently than other intravitreal injections. Dexamethasone-attributed endophthalmitis remains uncommon, and prompt intravitreal antibiotic treatment seems to be effective in this series.

To describe the clinical features and visual outcomes of eyes with conjunctival haptic erosion after sutureless intrascleral (SIS) fixated intraocular lens (IOL) placement.Retrospective case series.Patients experiencing haptic erosion after SIS fixation between January 1, 2013, and March 1, 2022.A multicenter, multisurgeon, retrospective review.Clinical features, visual outcomes, and treatment options following haptic erosions after SIS fixation.Nineteen eyes with haptic erosion were identified. The mean age at initial SIS fixation was 64 ± 12 years (range, 38-81 years). There were 5 (26%) eyes with a history of conjunctiva involving ocular surgery, including scleral buckle surgery and tube shunt surgery. Trocar-assisted fixation was performed in 15 (79%) eyes, whereas needle fixation was used in 4 (21%) eyes. Eighteen (95%) sets of haptics were flanged with a low temperature cautery. Seventeen (90%) sets of haptics were externalized superiorly and inferiorly, and 2 (10%) sets of haptics were externalized nasally and temporally. Haptics were covered by conjunctiva in 14 (74%) eyes and by scleral flap in 5 (26%) eyes. All patients experienced a single haptic erosion, of which 8 (43%) were located superiorly, 9 (47%) inferiorly, and 2 (10%) temporally. The mean interval between the initial SIS fixation and haptic erosion was 278 ± 437 days. After correction of the erosion, 18 (95%) eyes had a stable IOL at the last follow-up, with no recurrence of haptic erosion. In this series, there were no cases of endophthalmitis.Haptic erosion is a notable complication after SIS fixated IOL surgery but may be repaired with favorable visual outcomes. Careful evaluation of the conjunctiva should be considered before the surgery.Proprietary or commercial disclosure may be found after the references.

To evaluate seasonal and environmental variations on the incidence and outcomes of postinjection endophthalmitis.A single-center, retrospective cohort study was conducted including all patients diagnosed with post-injection endophthalmitis between 2013-2018. Associations between climate variables and endophthalmitis incidence were evaluated.Of 423,297 injections administered, seasonal distribution in spring, summer, autumn, and winter was 26%, 27%, 25%, and 22%, respectively. Of 171 cases of endophthalmitis identified, seasonal distribution over the spring, summer, autumn, and fall was 25%, 23%, 26%, and 26%, respectively. Endophthalmitis incidence was not correlated with monthly precipitation (In contrast to previous work on postcataract endophthalmitis, seasonal and weather factors were not associated with post-injection endophthalmitis risk or bacterial species isolated. Visual outcomes at initial endophthalmitis presentation were correlated with precipitation, and worse visual outcomes were seen in patients who developed endophthalmitis in the spring.

Purpose: To explore physician gender, industry payments, and prescribing habits of anti-vascular endothelial growth factor (VEGF) agents.Methods: Retrospective review of U.S. ophthalmologists prescribing and receiving industry payments for aflibercept and/or ranibizumab (brand anti-VEGF injections) between August 2013 to December 2017.Results: Men receiving industry payments were older and had longer post-residency experience than women (both P 5 payments (P = .003), and receive payments totaling >$1000 (P = .008). Men administered more injections on average than women when receiving >3 industry payments (P $100 (P

PURPOSE: To assess content, readability, and accountability of online information for patients regarding epiretinal membranes (ERMs). METHODS: Cross-sectional study evaluating nine major medical websites on ERMs. Fifteen questions assessed patient-relevant content. Four indices estimated U.S. grade literacy level of the text. JAMA benchmarks (authorship, attribution, disclosure, currency) evaluated website accountability. RESULTS: Average content score was 36.78 (SD 13.91, CI 95% ±0.64) from a possible maximum of 60, with significant variability between websites (H=22.68, p=0.004). Mean reading grade level was 12.29 (SD 2.30, CI 95% ±1.50). No website achieved all JAMA benchmarks; only one website fulfilled three of the four. Content score did not correlate with Google rank (order of listed websites, r=−0.23, p=0.55) or JAMA benchmarks (r=0.19, p=0.62) but significantly correlated with mean reading grade (r=0.67, p=0.05). CONCLUSION: Online information regarding ERMs varies significantly, may not adequately answer common patient questions, and is written at too complex a literacy level for the average patient.

Purpose To compare the relative number of retinal pixels and retinal area imaged using the Optos P200DTx (Optos PLC) and Zeiss Clarus 500 (Carl Zeiss Meditec AG) ultra-widefield (UWF) fundus cameras. Design Single-center retrospective cross-sectional analysis. Participants Seventy-eight eyes of 46 patients. Methods Eyes were imaged with Optos P200DTx, single-capture, and Zeiss Clarus 500, 2 capture montages when possible, UWF fundus cameras. Relative number of pixels encompassing all foveal-centered retinal quadrants were measured. Retinal area was measured with Zeiss Clarus 500 images that were registered to the Optos P200DTx images. Patients and technicians were asked for preferences between the machines. Imaging session times were recorded. Main Outcome Measures Relative number of retinal pixels and retina area captured by each fundus camera. Results Optos P200DTx consistently captured more relative pixels compared with Zeiss Clarus 500: 510.4 versus 355.6 (P Conclusions In the current study, the Optos P200DTx captured statistically significantly more retinal area in all 4 quadrants compared with the Zeiss Clarus 500. No statistically significant difference was found in patient or technician preference or image acquisition time between devices.

IMPORTANCE: One of the top ten causes of disability in the United States is vision loss, primarily due to age-related eye diseases such as age-related macular degeneration. With an aging population, the number of people affected by this condition is expected to rise. Patients increasingly turn to the internet for health-related information, but no standard exists across published websites. OBJECTIVE: To assess the quality, content, accountability and readability of information found online for age-related macular degeneration. DESIGN: This cross-sectional study analyzed 12 freely available medical sites with information on age-related macular degeneration and used PubMed as a gold standard for comparison. Thirty-four questions were composed to include information most relevant to patients and each website was independently evaluated by one vitreoretinal surgeon, two vitreoretinal fellows and one ophthalmology resident. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the accountability of each site. SETTING: Freely available online information was used in this study. RESULTS: The average questionnaire score for all websites was 90.23 (SD 17.56, CI 95% ±9.55) out of 136 possible points. There was a significant difference between the content quality of the websites (P=0.01). The mean reading grade for all websites was 11.44 (SD 1.75, CI 95% ±0.99). No significant correlation was found between content accuracy and the mean reading grade or Google rank (r=0.392, P=0.207) and r=0.133, P=0.732 respectively). Without including PubMed, only one website achieved the full 4 JAMA benchmarks. There was no correlation between the accuracy of the content of the website and JAMA benchmarks (r=0.344, P=0.273). The interobserver reproducibility was similar among 3 out of 4 observers (r=0.747 between JS and NT, r=0.643 between JS and NP, r=0.686 between NP and NT, r=0.581 between JS and NY; P≤0.05 CONCLUSION AND RELEVANCE: The freely available information online on age-related macular degeneration varies by source but is generally of low quality. The material presented is difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme we used to support the patient in making medical decisions.

To identify baseline ocular and systemic factors associated with central subfield thickness (CST) fluctuations in patients with diabetic macular edema (DME) using data from Diabetic Retinopathy Clinical Research Protocols T and V.Post hoc analysis of clinical trial databases.Patients in Protocols T and V.The standard deviation (SD) of all recorded CSTs for each patient during each Protocol's study period was calculated. The CST SD (corresponding to CST fluctuations) for each patient was analyzed against baseline ocular and systemic factors using linear regression analyses. Each Protocol was analyzed separately.Factors associated with CST fluctuations.A total of 1197 eyes of 1197 subjects were included. In Protocol T (559 eyes, mean CST SD was 56.4 ± 35.1 microns), using multivariate linear regression analysis, baseline urine albumin/creatine ratio (for every 1000 mg/g, CST point estimate 3.50, 95% confidence interval [CI] 0.58 to 6.43,Worse visual acuity at baseline, baseline renal disease, hypertension, female gender, type 1 diabetes, and delayed anti-VEGF treatment may be associated with increased CST fluctuations in patients with DME. Addressing these parameters may limit CST fluctuations and help identify patients requiring more frequent monitoring or treatment.

To report the anatomic and functional outcomes of retinectomy without lensectomy in eyes with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR).Retrospective, noncomparative, and interventional case series.One hundred twelve eyes of 112 patients with RRD complicated by PVR who underwent retinectomy without lensectomy.Retrospective review of patients treated with vitrectomy and retinectomy without lensectomy from January 1, 2015, to January 1, 2020.The primary outcome was the final attachment rate and single surgery anatomic success (SSAS) at 3 and 6 months after retinectomy. Secondary outcomes included predictors of final visual acuity (VA), the mean number of subsequent operations required for complete retinal reattachment, cataract surgery, and the number of eyes that ultimately had successful silicone oil removal.Complete final retinal reattachment was achieved in 111 of 112 (99.1%) patients, with a mean (standard deviation [SD]) follow-up of 29 (14) months (range, 8-62 months) after retinectomy. The SSAS was achieved in 84 of 112 (75%) patients at 3 months and 73 of 112 (65.2%) patients at 6 months. The final VA improved or stabilized in 76 of 112 (67.9%) eyes. Silicone oil removal was performed in 72 of 112 patients (64.3%) at a mean (SD) of 6.6 (3.3) months, and cataract surgery was performed on 101 (90.2%) eyes before the last follow-up visit.Retinectomy without lensectomy to repair RRDs complicated by PVR showed acceptable anatomic and functional results. This study suggests that removing the lens when there is no significant cataract may not be necessary in these cases to obtain reasonable outcomes.

Purpose This systematic review examined the relationship between industry funding and the presence of spin in high-impact studies evaluating intravitreal corticosteroid therapy for diabetic macular edema. Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE and Embase were systematically searched from inception through July 16, 2018, for randomized controlled trials and meta-analyses investigating the treatment of patients with diabetic macular edema using intravitreal corticosteroid therapy. Only studies published in English journals with an impact factor greater than 2 as per the Clarivate Analytics 2017 Journal Citation Report were included. The authors independently assessed study quality, funding source and the presence of reporting bias using a standardized datasheet. Results Title and abstract screening were completed on 7158 unique hits and full-text review yielded 44 included studies. Overall, there was correspondence between the wording of abstract conclusions and study results in 41/44 (93%) articles. Correspondence between abstract conclusions and significance of main outcome was present in 14/14 (100%) industry-funded and 27/30 (90%) nonindustry-funded studies. The odds ratio of industry funding being associated with noncorrespondence was 0.27 (95% CI: 0.01–5.61, p=0.54). The most common reason for noncorrespondence was the failure to mention rates of steroid-related intraocular pressure elevation. Conclusion The results of this systematic review indicate that biased abstract outcome reporting is rare in published randomized controlled trials and meta-analyses of intravitreal corticosteroid therapy for diabetic macular edema. Biased reporting was not associated with the presence of industry funding or a conflict of interest.

Purpose: This review details the rationale behind recommendations recently published by the American Society of Retina Specialists (ASRS) and outlines best practices for safety of vitreoretinal surgeons and staff while performing vitreoretinal surgery during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The Committee for ASRS Best Practices for Retinal Surgery During the COVID-19 Pandemic reviewed existing evidence and information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and risk factors during vitreoretinal surgery. Recommendations were based on best available published data, cumulative clinical experiences, and recommendations and policies from other organizations. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the strength of recommendations and confidence in the evidence. These serve as interim recommendations that will be routinely updated given the current gaps of knowledge and lack of high-quality data on this evolving subject. Results: Relevant existing literature related to methods of transmission and ocular manifestations of SARS-CoV-2 are summarized. The data and clinical experiences driving recommendations for preoperative, intraoperative, and postoperative surgical considerations and anesthesia choice as well as considerations for intravitreal injections are provided. Conclusions: Recommendations are provided with the goal of protecting vitreoretinal surgeons and associated personnel from exposure to SARS-CoV-2 during interventional vitreoretinal procedures. This is a rapidly evolving topic with numerous remaining gaps in our current knowledge. As such, recommendations will evolve and the present article is intended to serve as a foundation for continued dialogue on best practices.

Many patients undergoing ophthalmic surgery are elderly with comorbidities requiring antiplatelet therapy to prevent thromboembolic or atherothrombotic events. The use of antiplatelet therapy has expanded over the years, predisposing these patients to hemorrhagic complications perioperatively. The risk of hemorrhagic complications must be weighed against the risk of thromboembolic events with cessation of antiplatelet therapy. The decision to continue or interrupt antiplatelet therapy in the setting of ophthalmic surgery is based upon various factors, including the type of surgery and each patient’s comorbidities. This review examines the risks of thrombotic complications versus hemorrhagic complications in different types of ophthalmic surgeries with the use of antiplatelet medications and provides evidence-based recommendations regarding perioperative management of antiplatelet therapy

Rates of diabetic retinopathy (DR) and diabetic macular edema (DME), a common ocular complication of diabetes mellitus, are increasing worldwide. There is a substantial burden concerning the detection and management of this condition, particularly in low-resource settings, due to limitations such as the time, cost, and labor associated with current screening and treatment methods. Artificial intelligence (AI) is a modality of pattern recognition that has the potential to combat these limitations in a reliable and cost-effective way. This review explores the various applications of AI on the screening, management, and treatment of DR and DME. AI applications for detecting referable DR and DME have been the most thoroughly researched applications for this condition. While some studies exist using AI to stratify DR patients based on the risk of progression, predict treatment outcomes to anti-VEGF therapy, and explore the utilization of AI for clinical trials to develop new treatments for DR, further validation studies on larger datasets are warranted.

Purpose To examine the relationship between industry funding and "spin" in randomized controlled trials (RCTs) and meta-analyses investigating use of ocriplasmin for patients with vitreomacular traction (VMT) and macular hole (MH). Methods In this study, we examined all PubMed and Ovid MEDLINE RCTs and meta-analyses published in journals with impact factor ≥2 investigating effectiveness of ocriplasmin use for VMT and MH. The main outcome measure was correspondence between the studies' main statistical outcome and their abstract conclusion wording. Each article was reviewed by three independent observers and was evaluated for source of funding, industry co-authorship, study methodology, statistical significance of main outcome measure, correspondence between results of main outcome measure and abstract conclusion, and journal impact factor. Funding was determined by public disclosure. Discrepancies were resolved by consensus. Results Twelve studies met inclusion criteria, of which 11 were industry funded and 1 was non-industry funded; 11 (91.67%) showed correspondence between outcome and abstract conclusion, without difference between industry-funded and non-industry funded publications or between publications in journals with high impact factor (≥3) versus low impact factor (≥2 and Conclusion In RCTs and meta-analyses of ocriplasmin for VMT and MH, our results suggest that neither industry funding nor journal impact factor affected the rate of "spin" in study conclusions. This study helps physicians understand what challenges they face when learning about a newer, less-established drug.

To report factors affecting the retinal redetachment rate after silicone oil removal (SOR) following rhegmatogenous retinal detachment (RRD) repair.Retrospective cohort study from December 1, 2014, to March 1, 2020, of 205 consecutive patients treated for RRD with silicone oil (SO) tamponade and subsequent SOR with at least 6-month follow-up. Primary outcome measure was the rate of retinal redetachment after SOR.The retinal redetachment rate after SOR was 18.5%. Preoperative macula and lens status, proliferative vitreoretinopathy, previous retinectomy, retinal detachment size, concomitant phacoemulsification, previous scleral buckling, and endolaser during SOR did not affect the redetachment rate after SOR. Previous SO exchange was associated with increased redetachment (OR 2.53, 95% CI [1.11-5.80], P = 0.0278). Twelve months of SO tamponade had lower redetachment rates compared with 3 months (OR 0.25, 95% CI [0.04-0.09], P = 0.048). Shorter SO tamponade (3 vs. 12 months) had better final visual outcomes after SOR (0.80 ± 0.61 vs. 1.41 ± 0.66, P0.0001).No preoperative or intraoperative factors in this analysis influenced the risk of redetachment after SOR except duration of SO tamponade and previous SO exchange. Although longer SO tamponade duration may be associated with lower rates of redetachment, visual outcomes may be worse.

Subjects in diabetic macular edema clinical trials in the United States are disproportionately White and male, compared with the population undergoing treatment for diabetic macular edema.

To investigate factors associated with good visual acuity (VA) following repair of rhegmatogenous retinal detachments (RD) with proliferative vitreoretinopathy (PVR) undergoing retinectomy.Interventional, retrospective, case-control study.This single-institution study evaluated patients who underwent retinectomy during repair of RD with PVR from January 1, 2015 to December 31, 2019. A good VA cohort was identified based on a final VA ≥20/70. A 2:1 age-matched and gender-matched poor VA cohort with VA20/70 was subsequently identified. Metrics compared between the two cohorts included time from primary and recurrent RD diagnosis to surgery, lens status, initial RD size, macula involvement, PVR grade, and size of retinectomy.A total of 5355 eyes were diagnosed with primary RD during the study period, of which 345 had PVR and underwent retinectomy. The good VA cohort included 62 eyes with a mean final logMAR VA of 0.32 [Snellen 20/42], while the poor VA cohort included 119 eyes with a mean final logMAR VA of 1.54 [Snellen 20/693; P.0001]. On multivariate analysis, smaller initial RD size (P = .0090), fewer surgeries (P = .0002), shorter time between recurrent RD diagnosis and subsequent surgeries (P = .0006), better preoperative VA (P = .0276), and pseudophakia at final visit (P = .0049) remained significant predictors of good vision.Eyes undergoing retinectomy during repair of RD with PVR can achieve good VA outcomes. The primary modifiable factor associated with better VA was shorter delay between redetachment diagnosis and surgery, particularly in the absence of silicone oil tamponade.

This prospective survey study demonstrates a lack of retina clinic patient knowledge about appropriate stem cell therapy applications for retinal disease.

Objective This study aimed to evaluate the experiences and preferences of ophthalmology fellowship applicants utilizing a virtual interview format. Design Present study is a cross-sectional study. Subjects All fellowship applicants to Wills Eye Hospital during 2020 to 2021 application cycle were included. Methods A nonvalidated, online survey was conducted, and surveys were distributed at the conclusion of the interview process after rank list submission. Main Outcome Measures Applicant demographics, application submissions, interview experiences, financial considerations, and suggestions for improvement of the virtual interview process were the primary outcomes of this cross-sectional study. Results Survey responses were received from 68 fellowship applicants (34% response rate). Thirty (44%) applicants preferred in-person interviews, 25 (36%) preferred virtual interviews, and 13 (19%) would like to prefer the option to choose either. Fifty-five of 68 (80%) applicants attended the same range of interviews for which they received interview invitations. Reduced costs were reported as the highest ranked strength of virtual interviews in 44 (65%) applicants, with a majority of respondents (68%) spending less than U.S. $250 throughout the entire process. The highest ranked limitation for virtual interviews was limited exposure to the culture/environment of the program in 20 (29%) respondents. On a scale of 0 to 100, the mean (standard deviation [SD]) satisfaction level with the fellowship application process was 74.6 (18.3) and mean (SD) perceived effectiveness levels of virtual interviews was 67.4 (20.4). Conclusion Respondents were generally satisfied with virtual interviews and noted reduced costs and increased ability to attend more fellowship interviews as the strengths of the virtual interview format. Limited exposure to the culture/environment of the program was cited as the most important limitation.

We report a case series of 12 eyes that underwent retinal detachment (RD) repair after secondary implantation of Akreos AO60 intraocular lens (IOL) with a subset experiencing the complication of IOL opacification. Major predisposing risk factors for retinal detachment included trauma (42%), prior vitrectomy (33%), and ectopia lentis (17%). Opacification developed in two eyes with gas tamponade and three with silicone oil tamponade. Two eyes required explantation of the IOL. Permanent visually significant Akreos AO60 lens opacification is a possible complication weeks after retinal detachment repair and can occur regardless of tamponade agent.

Purpose “Cell therapy” is becoming increasingly available to the public via online direct-to-consumer advertisement within the United States (U.S.). The current study investigates the scope of “cell therapy” clinics across the U.S. that advertise and offer “cell therapy” for ocular conditions based on information provided on their websites. Design Cross-sectional study. Participants The study included companies that are U.S.-based, participate in direct-to-consumer online marketing, have websites that can be data-mined with content analysis, and advertise therapy for ocular conditions. Methods Using a systematic, extensive keyword-based Internet search, content analysis of company websites was utilized to identify, document, and analyze U.S. businesses marketing “cell therapy” for ocular conditions as of September 16, 2017. Main Outcome Measures Clinic locations, source of stem cells used, route of administration, marketed ocular conditions, and cost of treatment. Results Forty companies with 76 clinics use “cell therapy” to treat ocular conditions. California (23), Florida (12), and Illinois (10) contain the most clinics. All 40 companies specified sources of cells, which included autologous adipose-derived stem cells (35; 67%), autologous bone marrow–derived stem cells (8; 15%), amniotic stem cells (2; 4%), peripheral blood–derived stem cells (2; 4%), umbilical cord blood stem cells (2; 4%), allogenic bone marrow–derived stem cells (1; 2%), placental stem cells (1; 2%), and xenocells (1; 2%). The most commonly marketed ocular conditions included macular degeneration (35), optic neuritis (18), retinitis pigmentosa (17), and diabetic retinopathy (16). The most common routes of administration were intravenous (22) and “unspecified” (12); however, other companies listed more ocular-specific routes such as intravitreal injections (2), retrobulbar injections (2), eye injections (2), retrofundal injection (1), sub-Tenon injection (1), intraocular injection with vitrectomy (1), and eye drops (1). The cost of advertised “cell therapy” ranged from $4000 to $10 500. Conclusions “Cell therapy” for ocular conditions is readily available via direct-to-consumer marketing strategies across the United States. The “cells” are harvested from numerous sources and administered through different methods for multiple ocular conditions at these “cell therapy” clinics. Limited data for these treatments necessitates advocating caution to physicians and patients about treatments offered at commercial “cell therapy” clinics.

Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in diabetic retinopathy (DR), recognition of prognostic biomarkers in the peripheral retina may prove invaluable toward optimizing the management and reducing the societal burden of this blinding disease. Following a bibliographic review using Pubmed, OVID Medline, Embase, and the Cochrane Library, the current review systematically examined 13 studies that compared UWFI to conventional screening techniques such as seven standard field (7SF) Early Treatment In Diabetic Retinopathy Study (ETDRS) and non-mydriatic multifield fundus photography (NMFP), as well as their scientific level of evidence. Overall, UWFI had good agreement with 7SF ETDRS and NMFP, and moderate agreement with dilated fundus examination. Seven additional studies were examined that considered the significance of peripheral lesions found on UWFI. These studies demonstrated that UWFI captured additional DR pathology in the peripheral retina that may not be evident if evaluation is limited to the posterior pole and may be relevant to patient outcomes. Future directions include but are not limited to the potential of UWFI to track the progression of DR with treatment. [ Ophthalmic Surg Lasers Imaging Retina. 2019;50:639–648.]

Purpose:This article aims to determine preferences and demographics for listeners of an ophthalmology podcast, since podcasts are gaining favor for medical education.Methods:The present study used a cross-sectional, online survey as well as Podtrac, Inc and Squarespace, Inc platform analytics to examine perceived educational usefulness of podcasts for listeners.Results:Quarterly episode downloads increased from 684 in first-quarter 2017 to 16 016 in third-quarter 2018. A total of 102 participants completed the survey: 82 (80.4%) men and 68 (66.7%) retina attending physicians or fellows. Most respondents listened to “stay up to date” or “learn more about the field of retina” (67; 65.7% each). Most respondents agreed that podcasts are useful for medical education and result in changes in practice, but not that podcasts have surpassed traditional educational methods. For respondents, there was no difference in perceived usefulness between podcasts and peer-reviewed journals, textbooks, continuing medical education lectures, or national conferences; these did not differ with respondent listening histories.Conclusions:Podcasts are valuable adjuncts for distributing clinically relevant material.

To compare thickness and reflectance of retinal layer findings in patients with idiopathic epiretinal membranes (ERMs) before and after surgery with those of normal controls.Retrospective study.Patients with ERMs before and after surgery and healthy controls.Spectral-domain (SD) OCT imaging of eyes with ERMs before and after surgery and of healthy eyes were analyzed for morphologic appearance and using a customized algorithm to measure retinal layer reflectance and thickness. Findings were correlated with visual acuity outcomes.Retinal layer thickness and reflectance.Thirty-four ERM and 12 healthy eyes were identified. Mean preoperative best-corrected visual acuity (BCVA) improved from 0.53±0.31 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/68) to 0.41±0.25 logMAR (Snellen equivalent, 20/51) after surgery (P = 0.030). Differences in reflectance and thickness of retinal layers were identified among the preoperative ERM, postoperative ERM, and healthy eyes. High preoperative reflectance of the internal limiting membrane (ILM) to outer plexiform layer (OPL) was correlated with better postoperative BCVA (r = -0.451; P = 0.007). A larger improvement in BCVA was correlated with preoperative thick measurements of the outer nuclear layer (r = 0.514; P = 0.002), high reflectance of the group of layers from the ILM to the OPL (r = 0.426; P = 0.012), and low reflectance of the photoreceptor layer (r = -0.453; P = 0.007). Using linear regression analysis, better postoperative BCVA was associated with better preoperative vision (standardized regression coefficient, 0.553; P = 0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.526; P = 0.001). A larger improvement in BCVA was associated with worse preoperative BCVA (standardized regression coefficient, -0.539; P0.001) and high reflectance of the group of layers from the ILM to OPL (standardized regression coefficient, -0.428; P = 0.001).Quantitative differences in reflectance and thickness among preoperative, postoperative, and normal SD OCT imaging allow assessment of retina layer changes secondary to ERMs. High reflectance of the ILM to OPL correlated with and was associated with better postoperative BCVA and improvement in BCVA.