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Introduction: Uncorrected refractive errors pose a significant challenge globally, particularly in remote regions of low-middle income countries where access to optometric care is often limited. Telerefraction, which involves refraction by a trained technician followed by real-time consultation with remote optometrist, is a promising approach for such remote settings. This study aimed to evaluate the accuracy of this model. Methods: This prospective study, conducted in New Delhi, compared tele-refraction to in-person examinations. Trained technicians used a simple device, Click-check, to perform objective refraction and a tele-refraction platform to enter the findings of objective refraction. Final prescription was made after consulting a remote optometrist on that platform. Masked face-to-face optometrists served as the gold standard. The study involved refraction in 222 patients and 428 eyes. Results: Tele-refraction demonstrated a strong agreement with in-person optometry, achieving 84.6% in spherical correction and 81% conformity in spherical equivalent. The mean difference of spherical equivalent between the two arms was only 0.11 D. The consultation with a remote optometrist improved conformity of spherical equivalent by 14.8% over objective refraction. 82 percent eyes matched in best corrected visual acuity and 92 percent were within 0.1 logMAR difference. For cylindrical axis, 74% eye were within acceptable 10 degrees of difference. The mismatch amongst the individual trained technicians, in terms of difference between the tele-refraction arm and the face-to face optometrist arm was found to be significant for cylindrical axis and not for spherical power and spherical equivalent. Conclusion: Our study found tele-refraction by a trained technician comparable to refraction done by face-to-face optometrist. Tele-refraction, coupled with remote optometrist guidance can address the optometry resource gap in underserved areas. Thus, this model offers a transformative approach to enhancing the accessibility and quality of eye care services, which can significantly contribute to our efforts in achieving the global targets set by the World Health Organization for effective refractive error coverage. More standardized training for these technicians on ClickCheckTM for detecting the cylindrical axis with better accuracy, can improve this model further. [ABSTRACT FROM AUTHOR]

Purpose: To report the types of keratoplasty and analyze trends over a period of two decades in central and northern India. Methods: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and north India from 2005 to 2021. The indications and various keratoplasty procedures were compared between 2005–2012 and 2013–2021 to analyze the trend. Results: A total of 13,223 corneal grafts were performed, of which therapeutic penetrating keratoplasty (TPK) (5719, 43.3%) was the most common procedure, followed by optical penetrating keratoplasty (OPK) (5528, 41.8%), Descemet stripping endothelial keratoplasty (DSEK) (1279, 9.7%), deep anterior lamellar keratoplasty (DALK) (376, 2.8%), Descemet membrane endothelial keratoplasty (DMEK) (215, 1.6%), patch grafts (75, 0.6%), and keratoprostheses (31, 0.2%). Overall, OPK procedures decreased (−14.1%, P < 0.001), but TPK (+3.1%, P < 0.019), DSEK (+7.1%, P < 0.001), and DMEK (+1.9%, P < 0.001) procedures increased. Although there was an increasing trend in the use of DALK (+0.8%, P < 0.083) and keratoprostheses (+0.3%, P = 0.074) procedures, the trends were not statistically significant. Conclusion: In keeping with worldwide trends, an increasing trend in lamellar keratoplasties was observed in central and northern India during the past decade. The trend was significant for DSEK. However, as corneal ulcers and scars were the major indications for keratoplasty, TPK and OPK remained the most common procedures. [ABSTRACT FROM AUTHOR]

BACKGROUND: First-line treatment of acute urticaria with an intravenous (IV) antihistamine in emergency departments had previously been limited to first-generation diphenhydramine, which can cause sedation and anticholinergic effects. IV cetirizine, a second-generation antihistamine, was approved in October 2019 by the US Food and Drug Administration for the treatment of acute urticaria. In a phase 3 clinical trial, IV cetirizine demonstrated comparable efficacy in treating acute urticaria based on reduction in 2-hour patient-reported pruritus scores, with shorter duration of emergency department visits and fewer return visits, compared with IV diphenhydramine. OBJECTIVE: To assess the budget impact of treating patients with acute urticaria with IV cetirizine compared with IV diphenhydramine from an emergency department perspective by modeling clinical, facility, and cost parameters for hospital formulary considerations. METHODS: Using data from the pivotal phase 3 clinical trial, federal health agencies, and peerreviewed literature, our model evaluated a hypothetical emergency department with 50,000 (Case 1) and 100,000 (Case 2) all-cause visits per year with a nationally representative payer mix and age distribution. RESULTS: In Case 1, an estimated 204 visits per year were attributed to acute urticaria. With IV diphenhydramine as the treatment, the estimated annual net revenue to the emergency department was $56,768 (emergency department revenue of $131,056 minus a cost of $74,289). In the scenario with IV cetirizine, the estimated net revenue was $84,644 (emergency department revenue of $196,295 minus a cost of $113,080). Altogether, the adoption of IV cetirizine had a positive net impact on annual budget of $27,876. In Case 2, we found a larger net positive budget impact of $55,752. CONCLUSION: Adoption of IV cetirizine for acute urticaria treatment in the emergency department setting resulted in a positive budget impact. This outcome was driven by the shorter duration of visits, fewer 24-hour return visits, and higher drug revenue associated with IV cetirizine, compared with IV diphenhydramine. [ABSTRACT FROM AUTHOR]