July 14, 2021

The most important ophthalmology research updates, delivered directly to you.

5G Technology for Real-Time Teleretinal Laser Photocoagulation in Diabetic Retinopathy

JAMA Ophthalmology

Can 5G networks help ophthalmology zoom into the future? Although teleophthalmology has demonstrated great diagnostic potential, relatively few studies have explored its role in the treatment of eye disease. The increased bandwidth and decreased latency of fifth-generation cellular network technology (5G) may broaden the scope of remote services that can be offered to patients. To explore this possibility, 6 participants (9 eyes) with proliferative or severe non-proliferative diabetic retinopathy were enrolled in a prospective, proof-of-concept study conducted between two Chinese hospitals located 1200 km apart. A retina specialist located in one hospital performed laser photocoagulation treatment on the eyes of patients located at the other, using videoconferencing and remote desktop software to conduct and monitor the treatment. Photocoagulation itself was performed by automated equipment according to parameters remotely set by the retina specialist with supervision throughout the procedure. All of the remote treatments were successful with no adverse events. Network latency throughout the procedure was 20 milliseconds, with no buffering or pixilation of the video throughout. At one month, 7 eyes from 4 participants showed no significant changes in visual acuity. Follow-up for the remaining 2 eyes from 2 participants was delayed due to COVID and showed decreased visual acuity in the setting of poor glycemic control. These findings are an early demonstration of remote treatment options made possible by 5G cellular network technology.
The Lens has expanded into the podcast world! The Lens Pod is an educational podcast created by medical students in collaboration with experts in Ophthalmology. Our first episode features Dr. Thomas Oetting, comprehensive ophthalmologist and residency program director at the University of Iowa, who shares with us what medical students should know before their first experience in comprehensive ophthalmology. Find us on Spotify or our website. Happy listening!

Pseudomonas Aeruginosa Keratitis in Contact Lens vs. Non-Contact Lens Wearers

American Journal of Ophthalmology

Which SketchyMicro character is gram negative, loves to infect corneas, and has the most enigmatic smile in the universe? Answer: Pseudo-Mona Lisa. 👩🏻‍🎨🎨 Pseudomonas Aeruginosa is the most common organism found in bacterial keratitis in contact lens wearers, and produces severe cases of keratitis. In this retrospective cohort study, Enzor et al. sought to compare outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs). They found that although PAK was more common in CLWs, outcomes were significantly poorer in non-CLWs. The final logMAR visual acuity during PAK was 0.76±0.83 (Snellen ~20/125) in CLWs and 1.82±0.87 (Snellen ~20/1200) in non-CLWs (P < .0001).  Among these cases more non-CLWs than CLWs (48.6% vs 11.0%) had light perception or no light perception vision even at resolution of infection. In addition, PAK in non-CLWs required a higher rate of surgical intervention and experienced higher rates of corneal perforation compared with CLWs. In summary, although CLWs are more commonly infected by Pseudomonas aeruginosa, non-CLW patients were found to have more advanced clinical presentations, more challenging treatment courses, and worse final visual acuity. These findings should encourage providers to lower the threshold for more aggressive treatment and even hospital admission in non-CLWs with PAK, if warranted.

OAHFAs as biomarkers for tear film dynamics


While The Weeknd is no ophthalmologist, he might be right in singing “save your tears for another…” mass spectrometer! The precorneal tear film (PCTF) is a thin layer of tear fluid that protects our eyes but can undergo excessive thinning due to evaporative loss, a key trigger for dry eye disease (DED). The PCTF is composed of a complex mixture of lipids primarily derived from the meibomian gland. While it has been established that meibomian gland dysfunction and PCTF thinning are contributors to DED, the correlation between PCTF composition and DED has been unexplored. Researchers investigated this correlation by analyzing meibum and tear film-derived samples from 195 eligible subjects (age 18-84, 62.6% female). The samples were processed for mass spectrometry analysis for (O-Acyl)-omega-hydroxy fatty acids (OAHFAs) and evaluated for the association between OAHFAs and PCTF thinning rates. While increased concentrations of most OAHFAs had an inverse relationship with thinning rate, one OAHFA (18:2/18:1) was found to be positively correlated with PCTF thinning rate (r = 0.48, P = 0.006). This study provides first evidence that there is a relationship between meibum-derived OAHFAs and evaporation-induced PCTF thinning. These lipid molecules could serve as an important biomarker for PCTF stability and tear film dynamics in the future.

How much can lifestyle impact AMD?


In today’s episode of Genetics vs Lifestyle, we’re talking about age-related macular degeneration (AMD), a leading cause of vision loss in those over age 50. To elucidate the genetic and lifestyle interrelationship, investigators calculated genetic, pathway-specific, and lifestyle late AMD risk scores in the European Eye Epidemiology Consortium. They determined that genetic variants in the complement cascade and ARMS2 pathways were the top contributors of late AMD (90% of patients with late disease). However, lifestyle factors can strongly influence the outcome of genetic risk; factors such as smoking and poor nutrition increased the risk of late AMD by at least twofold. Given that lifestyle modification may improve outcomes in patients with increased genetic risk, counseling patients on healthy lifestyle choices should be the focus of late AMD management. 

Cornea & Refractive Surgery

Is dry eye disease associated with OCD?


Dry eyes? The last thing we want to do is make them drier! This prospective study from Turkey aimed to evaluate the association between dry eye disease and patients with newly diagnosed obsessive compulsive disorder (OCD). The idea for this association originates in the neutrophil-to-lymphocyte ratio (NLR), which has been proposed as a marker for inflammation in neuropsychiatric disorders, such as OCD, as well as an indicator for inflammation in dry eye disease. Treatment-naïve patients with OCD (n = 30) and controls (n = 30) were included, and a number of dry eye disease markers were measured. Patients with OCD were found to have significantly increased Ocular Surface Disease Index, corneal staining, and conjunctival staining, along with lower values in the Schirmer I test and tear breakup time. The NLR values were significantly higher in the OCD group vs. controls (2.4 ± 0.9 vs. 1.6 ± 0.4; p = 0.001). Overall, authors found a significant association between dry eyes and newly diagnosed OCD. Because psychotropic medications may also exacerbate dry eye disease, patients with OCD may benefit from lubricating treatments. 


Can you still differentiate nephritic vs nephrotic syndrome?

BMC Ophthalmology

You may have thought your days of thinking about nephrotic syndrome were done, but nephrotic syndrome will still come back to haunt us. 👻 The most common glomerulopathy in children is nephrotic syndrome (NS), and the mainstay of treatment is systemic glucocorticoids, which can lead to various systemic and ocular complications. Nakublwa et al. sought to establish a relationship between NS among pediatric patients and ocular complications in order to build a framework for adequate monitoring with ocular examinations. In this cross-sectional study based in Uganda, 100 children with NS were included and data was analyzed from questionnaires and complete eye examinations. Of the 100 children in this study, 80% had ocular abnormalities: 71% had hypertrichosis, 56% had refractive errors, 16% had elevated IOP, and 1% had cataract. In a multivariate analysis, those over age 10 years had a 37% increased risk for ocular abnormalities. This study shows the significant ocular consequences in children with nephrotic syndrome, and authors recommend baseline and regular ophthalmic follow up for children being treated for NS.

Question of the Week

An 8-year-old girl is brought to her pediatrician because of irritation and redness in her eyes for the past 3 days. She states that the symptoms began in her right eye and became bilateral the next day. She now wakes up with “sticky eyes”. Her temperature is 100.9 ℉. Upon physical exam, she has profuse tearing and preauricular lymphadenopathy. Corneal sensation is intact bilaterally. Visual acuity is 20/20 bilaterally. Slit lamp exam reveals follicles on the inferior lid, but no signs of dendritic lesions on her corneas.
Which of the following is the next best step in management? 

A.    Supportive therapy
B.    Topical erythromycin
C.    Oral acyclovir
D.    Topical moxifloxacin

Keep scrolling for answer or click here

Additional Links

Quiz Answer: A
Quiz Answer Explained
Twitter Twitter
Website Website
Share with a friend Share with a friend
Copyright © 2021 The Lens Newsletter LLC, All rights reserved.