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BackgroundSeasonal outbreaks of infectious conjunctivitis remain a public health issue. Determination of outbreak etiologies in the context of a worldwide pandemic may provide useful information to guide public health strategies. The aim of this study was to identify pathogens associated with outpatient infectious conjunctivitis during the COVID-19 Delta surge.MethodsThis prospective study was conducted from April 2021 to September 2021. All outpatients presenting to the Aravind Eye Center (Madurai, India) with signs and symptoms consistent with acute infectious conjunctivitis were eligible. Three swabs were obtained from each participant: one from each conjunctiva and one from the anterior nares. Samples were processed for metagenomic RNA deep sequencing (RNA-seq).ResultsSamples from 106 study participants were sequenced. The most common presenting symptoms were tearing (86%) and itching (71%). Preauricular lymphadenopathy was present in 38% of participants. 20% of participants had close contacts with similar symptoms. Systemic symptoms such as coughing, runny nose, vomiting or diarrhea were uncommonly reported. 60% of all participants used some medicated eye drops upon enrollment. 75% of study participants demonstrated infection with human adenovirus D (HAdV-D). 11% of conjunctivitis was associated with SARS-CoV-2. 15% had no definitive pathogen detected. 8% of all participants had codetection of more than one pathogen on RNA-seq.ConclusionsDuring the COVID-19 Delta surge in India, HAdV-D was the most common pathogen associated with infectious conjunctivitis. SARS-CoV-2 was the second most common associated pathogen. Seasonal surveillance may be necessary for the determination of emerging and reemerging pathogens responsible for infectious conjunctivitis.

The objective of this study was to compare the sensitivity and specificity of handheld fundus cameras in detecting diabetic retinopathy (DR), diabetic macular edema (DME), and macular degeneration. Participants in the study, conducted at Maharaj Nakorn Hospital in Northern Thailand between September 2018 and May 2019, underwent an ophthalmologist examination as well as mydriatic fundus photography with three handheld fundus cameras (iNview, Peek Retina, Pictor Plus). Photographs were graded and adjudicated by masked ophthalmologists. Outcome measures included the sensitivity and specificity of each fundus camera for detecting DR, DME, and macular degeneration, relative to ophthalmologist examination. Fundus photographs of 355 eyes from 185 participants were captured with each of the three retinal cameras. Of the 355 eyes, 102 had DR, 71 had DME, and 89 had macular degeneration on ophthalmologist examination. The Pictor Plus was the most sensitive camera for each of the diseases (73-77%) and also achieved relatively high specificity (77-91%). The Peek Retina was the most specific (96-99%), although in part due to its low sensitivity (6-18%). The iNview had slightly lower estimates of sensitivity (55-72%) and specificity (86-90%) compared to the Pictor Plus. These findings demonstrated that the handheld cameras achieved high specificity but variable sensitivities in detecting DR, DME, and macular degeneration. The Pictor Plus, iNview, and Peek Retina would have distinct advantages and disadvantages when applied for utilization in tele-ophthalmology retinal screening programs.

PurposeThis article illustrates multiple atypical manifestations of ocular toxoplasmosis masquerading as acute retinal necrosis and vitreoretinal lymphoma.MethodsTwo case presentations are discussed, and the body of pertinent literature is reviewed and discussed.ResultsIn these cases, an extensive workup and attention to history lead to the correct diagnosis and management.ConclusionsAggressive cases of ocular toxoplasmosis may present in a variety of phenotypes that may mimic other vision- and potentially life-threatening conditions, particularly in a milieu of inadequate endogenous and exogenous antimicrobial defenses.

PurposeTo evaluate the feasibility of anterior segment optical coherence tomography (AS-OCT) for measuring anterior chamber (AC) cells in children with uveitis and to compare different AS-OCT acquisition modes.DesignValidity and reliability analysis.MethodsWe enrolled children younger than 18 years who had uveitis involving the anterior segment and children without eye disease as controls. All underwent clinical grading of AC cells. AC images of each eye were obtained using the Optovue Avanti RTVue XR AS-OCT. Two acquisition modes were used: a single cross-sectional line scan and an 8-line radial scan in an asterisk pattern. Two independent, masked graders counted cells manually on AS-OCT images. Rater agreement was assessed using intraclass correlation (ICC).ResultsIncluded were 30 children (59 eyes) with uveitis (median age 13.0 years, range 3-17 years) and 20 control children (40 eyes, median age 10.5 years, range 4-17 years). The number of eyes assigned each clinical grade of cells were as follows: none, 32 (54%); 0.5+, 12 (20.3%); 1+, 5 (8.5%); 2+, 8 (13.6%); 3+, 2 (3.4%). ICC of graders for line and radial scan protocols were 0.87 and 0.90. There was no significant difference between acquisition modes for pooled grader results (95% CI for difference: -0.04 to 0.14). ICC of cell counts between line and radial scan protocols was 0.85 (95% CI: 0.69-0.90). No control eyes had cells on AS-OCT images.ConclusionsQuantification of AC cell in children with uveitis is feasible with AS-OCT and has excellent reliability between different graders and acquisition modes.

Purpose  This study characterizes the current landscape of uveitis specialists and their practice settings in the United States. Methods  An anonymous Internet-based survey with questions pertaining to training history and practice characteristics was distributed via REDCap to the American Uveitis Society and Young Uveitis Specialists listservs. Results  Forty-eight uveitis specialists in the United States responded to the survey out of 174 uveitis specialists that identify as practicing in the United States. Twenty-five of 48 respondents (52%) completed an additional fellowship. These additional fellowships ranged from surgical retina (12/25, 48%), cornea (8/25, 32%), and medical retina (4/25, 16%). Two-thirds of uveitis specialists managed their own immunosuppression, while one-third comanaged immunosuppression with rheumatologists. Thirty-three of 48 (69%) maintained a surgical practice. Conclusion  This is the first survey of uveitis specialists across the United States to provide understanding into training and practice characteristics. These data will provide insight into career planning, practice building, and assist in resource allocation.

BackgroundThe impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.MethodsSurvey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.Findings12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514).InterpretationPeople with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.FundingAmerican College of Rheumatology.

BackgroundImmunomodulatory therapy (IMT) is often considered for systemic treatment of non-infectious uveitis (NIU). During the evolving coronavirus disease-2019 (COVID-19) pandemic, given the concerns related to IMT and the increased risk of infections, an urgent need for guidance on the management of IMT in patients with uveitis has emerged.MethodsA cross-sectional survey of international uveitis experts was conducted. An expert steering committee identified clinical questions on the use of IMT in patients with NIU during the COVID-19 pandemic. Using an interactive online questionnaire, guided by background experience and knowledge, 139 global uveitis experts generated consensus statements for IMT. In total, 216 statements were developed around when to initiate, continue, decrease and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with NIU. Thirty-one additional questions were added, related to general recommendations, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine.ResultsHighest consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, and for using local over systemic corticosteroid therapy in patients who are at high-risk and very high-risk for severe or fatal COVID-19. While there was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients, there was no consensus in starting hydroxychloroquine in any risk groups.ConclusionConsensus guidelines were proposed based on global expert opinion and practical experience to bridge the gap between clinical needs and the absence of medical evidence, to guide the treatment of patients with NIU during the COVID-19 pandemic.

PurposeThe purposes of this study were to assess the reproducibility of a novel standardized technique for capturing corneal subbasal nerve plexus images with in vivo corneal confocal microscopy and to compare nerve metrics captured with this method in participants with dry eye and control participants.MethodsCases and controls were recruited based on their International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnoses. Participants completed the following 3 ocular symptom questionnaires: the Ocular Surface Disease Index, Neuropathic Pain Symptom Inventory, and Dry Eye Questionnaire 5. A novel eye fixation-grid system was used to capture 30 standardized confocal microscopy images of the central cornea. Each participant was imaged twice by different operators. Seven quantitative nerve metrics were analyzed using automated software (ACCmetrics, Manchester, United Kingdom) for all 30 images and a 6-image subset.ResultsForty-seven participants were recruited (25 classified as dry eye and 22 controls). The most reproducible nerve metrics were corneal nerve fiber length [intraclass correlation (ICC) = 0.86], corneal nerve fiber area (ICC = 0.86), and fractal dimension (ICC = 0.90). Although differences were not statistically significant, all mean nerve metrics were lower in those with dry eye compared with controls. Questionnaire scores did not significantly correlate with nerve metrics. Reproducibility of nerve metrics was similar when comparing the entire 30-image montage to a central 6-image subset.ConclusionsA standardized confocal imaging technique coupled with quantitative assessment of corneal nerves produced reproducible corneal nerve metrics even with different operators. No statistically significant differences in in vivo corneal confocal microscopy nerve metrics were observed between participants with dry eye and control participants.

Purpose: To validate automated counts of presumed anterior chamber (AC) cells in eyes with histories of uveitis involving the anterior segment using swept-source (SS) anterior segment optical coherence tomography (AS-OCT) against manual counts and compare automated counts against Standardized Uveitis Nomenclature (SUN) criteria. Methods: Eyes were imaged with the ANTERION SS AS-OCT device (Heidelberg Engineering). A fully automated custom algorithm quantified the number of hyper-reflective foci (HRF) in line-scan images. Automated and manual counts were compared using interclass correlation (ICC) and Pearson correlation coefficient. Automated counts were compared to SUN grades using a mixed-effects linear regression model. Results: 90 eyes (54 participants) were included; 67 eyes (41 participants) had histories of uveitis, while 23 eyes (13 healthy participants) served as controls. ICC comparing automated to manual counts was 0.99 and the Pearson correlation coefficient was 0.98. Eyes at each SUN grade with corresponding median HRF (interquartile range [IQR]) were: Grade 0, 42 eyes, 2 HRF (0,4); 0.5+, 10 eyes, 10 HRF (8,15); 1+, 9 eyes, 22 HRF (15,33); 2+, 3 eyes, 27 HRF; 3+, 2 eyes, 128 HRF; 4+, 1 eye, 474 HRF. For every 1-step increase in grade, automated count increased by 38 (p < 0.001) or 293% (Pearson correlation coefficient 0.80, p < 0.001). Automated counts differed significantly between clinically inactive eyes (2 HRF [0,4]) and controls (0 HRF [0,1], p = 0.02). Conclusions: Our algorithm accurately counts HRF when compared to manual counts, with strong correlation to SUN clinical grades. SS AS-OCT offers the advantage of imaging of the entire AC and may allow detection of subclinical inflammation in eyes that appear clinically inactive. [ABSTRACT FROM AUTHOR]

Purpose: To describe remarkable choroidal thickness fluctuations corresponding to episodes of recurrent anterior uveitis with subretinal fluid development when exceeding a choroidal thickness threshold. Methods: A patient with pachychoroid pigment epitheliopathy and unilateral acute anterior uveitis of the left eye was evaluated over a period of 3 years with multimodal retinal imaging including optical coherence tomography. Longitudinal changes in subfoveal choroidal thickness (CT) were measured and correlated with episodes of recurrent inflammation. Results: Over the course of five recurrent episodes of inflammation in the left eye treated with oral antiviral and topical steroid therapy, subfoveal CT increased as much as 200 mm or more. By contrast, subfoveal CT in the fellow quiescent right eye was within normal limits and minimally changed throughout the follow-up. Increased CT occurred with each episode of anterior uveitis and decreased by 200 mm or more during periods of quiescence in the affected left eye. Subretinal fluid and macular edema developed with a maximum CT of 486 mm and spontaneously resolved when CT decreased after treatment. Conclusion: In eyes with pachychoroid disease, anterior segment inflammation may lead to marked increases in subfoveal CT and the development of subretinal fluid at a threshold thickness value. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses readability, suitability, and accountability of online uveitis patient education materials (PEMs). Methods: Two uveitis specialists reviewed the top 10 websites on Google for keyword "uveitis," with a PubMed review control. Readability was assessed using an online calculator, suitability using the Suitability Assessment of Materials (SAM) tool, and accountability using JAMA benchmarks. Results: The mean SAM score was 21.05, indicating that websites were on average adequately suitable to educate patients. WebMD Uveitis website scored the highest at 25.5, while allaboutvision.org scored the lowest at 18.0. The average Flesch Reading Ease (FRE) score was 44.0 (95% CI: 34.2, 53.8). The average reading grade score was 11.0 (95% CI: 9.4, 12.6). WebMD Uveitis page scored highest on readability. The average accountability score among sites was 2.36 out of 4. Conclusions: Uveitis websites are only adequately suitable as PEMs, and all are above the recommended reading level. Uveitis specialists should advise patients on quality of online PEMs. [ABSTRACT FROM AUTHOR]

Purpose To compare the quality of optic nerve photographs from three different handheld fundus cameras and to assess the reproducibility and agreement of vertical cup-to-disk ratio (VCDR) measurements from each camera. Methods Adult patients from a comprehensive ophthalmology clinic and an intravitreous injection clinic in northern Thailand were recruited for this cross-sectional study. Each participant had optic nerve photography performed with each of 3 handheld cameras: the Volk iNview, Volk Pictor Plus, and Peek Retina. Images were graded for VCDR in a masked fashion by two photo-graders and images with > 0.2 discrepancy in VCDR were assessed by a third photo-grader. Results A total of 355 eyes underwent imaging with three different handheld fundus cameras. Optic nerve images were judged ungradable in 130 (37%) eyes imaged with Peek Retina, compared to 36 (10%) and 55 (15%) eyes imaged with the iNview and Pictor Plus, respectively. For 193 eyes with gradable images from all 3 cameras, inter-rater reliability for VCDR measurements was poor or moderate for each of the cameras, with intraclass correlation coefficients ranging from 0.41 to 0.52. A VCDR ≥ 0.6 was found in 6 eyes on iNview images, 9 eyes on Pictor Plus images, and 3 eyes on Peek images, with poor agreement between cameras (e.g., no eyes graded as VCDR ≥ 0.6 on images from both the iNview and Pictor Plus). Conclusions Inter-rater reliability of VCDR grades from 3 handheld cameras was poor. Cameras did not agree on which eyes had large VCDRs. [ABSTRACT FROM AUTHOR]

BACKGROUND:The use of social media in ophthalmology remains largely unknown. Our aim was to evaluate the extent and involvement of ophthalmology journals, professional associations, trade publications, and patient advocacy and fundraising groups on social networking sites. METHODS:An archived list of 107 ophthalmology journals from SCImago, trade publications, professional ophthalmology associations, and patient advocacy organizations were searched for their presence on Facebook, Twitter, and LinkedIn. Activity and popularity of each account was quantified by using the number of "likes" on Facebook, the number of followers on Twitter, and members on LinkedIn. RESULTS:Of the 107 journals ranked by SCImago, 21.5% were present on Facebook and 18.7% were present on Twitter. Journal of Community Eye Health was the most popular on Facebook and JAMA Ophthalmology was most popular on Twitter. Among the 133 members of the International Council of Ophthalmology, 17.3% were present on Facebook, 12.8% were present on Twitter, and 7.5% were present on LinkedIn. The most popular on Facebook was the International Council of Ophthalmology, and the American Academy of Ophthalmology was most popular on Twitter and LinkedIn. Patient advocacy organizations were more popular on all sites compared with journals, professional association, and trade publications. Among the top ten most popular pages in each category, patient advocacy groups were most active followed by trade publications, professional associations, and journals. CONCLUSION:Patient advocacy groups lead the way in social networking followed by professional organizations and journals. Although some journals use social media, most have yet to engage its full potential and maximize the number of potential interested individuals.

To report the availability and activity of online uveitis support groups. An online search was conducted for support groups for uveitis. Member count and activity were recorded. Posts and comments were graded along five themes: emotional or personal story sharing, information seeking, offer of outside information, emotional support, and expressions of gratitude. An online search resulted in 32 support groups for uveitis. Across all groups, there was a median membership of 725 (IQR 1410.5). Of the 32 groups, five were active and accessible at the time of study. In these five groups, 337 posts and 1406 comments were made within the past year. The most prevalent theme in posts consisted of information seeking (84%) while the most prevalent theme in comments consisted of emotion or personal story sharing (65%). Online uveitis support groups provide a unique space for emotional support, information sharing, and community building.Abbreviations: OIUF – Ocular Inflammation and Uveitis Foundation. [ABSTRACT FROM AUTHOR]

This article analyzes the responses of ChatGPT, an artificial intelligence tool developed by OpenAI, to patient-oriented questions about common ophthalmic procedures. The study aimed to assess the reproducibility and quality of ChatGPT's responses. The analysis found that ChatGPT provided moderately reproducible answers, with narrative content being more reproducible than numerical information. While responses to questions on cataract surgery showed moderate overlap with patient-facing literature and a consensus statement, ChatGPT frequently listed irrelevant or non-existent references. The study highlights the potential utility and limitations of ChatGPT, emphasizing the need for cautious review of its generated content. [Extracted from the article]