Grace Sun

Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

PURPOSE To compare the speed of retinopathy of prematurity (ROP) diagnosis using standard indirect ophthalmoscopy with that of telemedicine. DESIGN Prospective, comparative study. METHODS Three study examiners (2 pediatric retinal specialists [R.V.P.C., T.C.L.] and 1 pediatric ophthalmologist [M.F.C.]) conducted ROP diagnosis via standard indirect ophthalmoscopy and telemedicine. Each examiner performed: 1) standard ophthalmoscopy on 72 to 150 consecutive infants at his respective institution and 2) telemedical diagnosis on 125 consecutive deidentified retinal image sets from infants from an at-risk population. Time for ophthalmoscopic diagnosis was measured in 2 ways: 1) time spent by the examiner at the infants bedside and 2) mean total time commitment per infant. Time for telemedicine diagnosis was recorded by computer time stamps in the web-based system. For each examiner, nonparametric statistical analysis (Mann-Whitney U test) was used to compare the distribution of times for examination by ophthalmoscopy vs telemedicine. RESULTS Mean (+/- standard deviation [SD]) times for ophthalmoscopic diagnosis ranged from 4.17 (+/- 1.34) minutes to 6.63 (+/- 2.28) minutes per infant. Mean (+/- SD) times for telemedicine diagnosis ranged from 1.02 (+/- 0.27) minutes to 1.75 (+/- 0.80) minutes per infant. Telemedicine was significantly faster than ophthalmoscopy (P < .0001). The total time commitment by ophthalmologists performing bedside ophthalmoscopy for ROP diagnosis, including travel and communication with families and hospital staff, was 10.08 (+/- 2.53) minutes to 14.42 (+/- 2.64) minutes per infant. CONCLUSIONS The ophthalmologist time requirement for telemedical ROP diagnosis is significantly less than that for ophthalmoscopic diagnosis. Additional time requirements associated with bedside ROP diagnosis increased this disparity. Telemedicine has potential to alleviate the time commitment for ophthalmologists who manage ROP.

Global Health Training in Ophthalmology Residency Programs

PURPOSE To assess current global health education and international electives in ophthalmology residency programs and barriers to global health implementation in ophthalmology resident education. METHODS A web-based survey regarding participation in global health and international electives was emailed to residency program directors at 116 accredited ophthalmology residency programs via an Association of University Professors in Ophthalmology (AUPO) residency program director listserv. RESULTS Fifty-nine (51%) ophthalmology residency program directors responded. Thirty-seven program directors (63%) said global health was important to medical students when evaluating residency programs. Thirty-two program directors (55%) reported developing international electives. Reported barriers to resident participation in international electives were: 1) insufficient financial support, 2) inadequate resident coverage at home, and 3) lack of ACGME approval for international electives. Program directors requested more information about resident international electives, funding, and global ophthalmology educational resources. They requested ACGME recognition of international electives to facilitate resident participation. More than half (54%) of program directors supported international electives for residents. CONCLUSIONS This survey demonstrates that program directors believe global health is an important consideration when medical students evaluate training programs. Despite perceived barriers to incorporating global health opportunities into residency training, program directors are interested in development of global health resources and plan to further develop global health opportunities.

Association between assisted reproductive technology and advanced retinopathy of prematurity.

Purpose To investigate the associations between assisted reproductive technology (ART) and severe retinopathy of prematurity (ROP) requiring treatment. Methods Retrospective analyses of inborn preterm infants screened for severe ROP at the Weill Cornell Medical Center Neonatal Intensive Care Unit at the New York-Presbyterian Hospital by single factor logistic regression and multifactor models. Results Of 399 ethnically diverse infants, 253 were conceived naturally and 146 by ART. Eight (3.16%) patients conceived naturally, and 11 (7.53%) with ART required laser treatment. In multifactor analyses, significant risks for severe ROP requiring treatment included both gestational age (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.23–0.52; P < 0.001) and ART ([OR] 4.70; [CI], 1.52–4.57; P = 0.007). Conclusions ART is associated with severe ROP requiring treatment in this cohort. This is the first report that demonstrates a statistically significant association between ART and severe ROP requiring treatment in infants in the US.

Twitter at the 2014 and 2015 Annual Meetings of the American Academy of Ophthalmology

The use of social media within medicine has increased dramatically in recent years, as physicians, academic journals, professional societies, and industry groups now use social media platforms such as Facebook and Twitter to share information. Founded in 2006, Twitter is an online service that enables users to send and read short messages of 140 characters called “tweets.” By searching for a specific hashtag, such as #ophthalmology, a user can selectively view only tweets inclusive of this hashtag, creating a filtered list of solely ophthalmology-related tweets. Similarly, professional societies such as the American Academy of Ophthalmology (AAO) encourage participants at its meetings to tweet using a designated hashtag such as #AAO2015 to promote the meeting and enable Twitter users worldwide to engage in a discussion related to content shared at the meeting. The use of Twitter at medical conferences has been reported in the literature of several specialties, including emergency medicine, general surgery, oncology, radiology, and urology. However no study has examined the use of Twitter by ophthalmologists at a large ophthalmology conference. The aim of this report is to document the quantity, impressions, content, and demographics of tweets published during the 5 days of the 2014 annual meeting of the AAO in Chicago, Illinois, and the 2015 meeting in Las Vegas, Nevada. Given the public availability of data, this report was exempt from full institutional review board review. All tweets that included the designated conference hashtag, #AAO2014 or #AAO2015, were collected using commercially available services (Symplur.com, Upland, CA). A total of 1067 users published 4539 tweets during the 2014 meeting and 924 users published 5065 tweets during the 2015 meeting. Approximately 50% of all tweets (48% in 2014 and 51% in 2015) were original tweets, with the remainder categorized as retweets (52% in 2014 and 49% in 2015). Tweets were categorized as original tweets if containing new or original content, or as retweets, wherein a user forwards a previously published tweet to his or her followers without the addition of new content. A total of 348 and 403 individuals published original tweets at the 2014 and 2015 meetings, respectively. The number of Twitter “impressions” generated during the 2014 and 2015 meetings was compared. “Impressions” quantify the number of tweets delivered to Twitter users, and serve to measure the number of potential views. Tweets with the hashtag #AAO2014 generated 23 696 564 impressions, increasing to 24 524 044 impressions for tweets published during the 2015 meeting. By means of comparison with other specialties, the nearly 23.7 million impressions generated during AAO 2014 was >7.5 times the impressions generated (3.12 million) at a large international emergency medicine conference, despite a similar number (4692) of tweets. Essential to the hypothesis of Twitter as a tool to share information at ophthalmology conferences is analysis of the type of content shared. In this analysis, we used a previously published methodology to categorize the content of each tweet into the following categories: meeting, social, logistical, or advertising. When this methodology failed to clearly distinguish between categories, such as if a tweet contained both meeting and logistical content, additional clarifying criteria were added to create the improved methodology seen in Table 1 (available at www.aaojournal.org). Using this modified methodology, we found the majority of original tweets by ophthalmologists contained content related to the meeting (79% in 2014 and 66% in 2015), followed by content categorized as social (15% and 19%), logistical (4% and 12%), or advertising (2% and 3%). Table 2 (available at www.aaojournal.org) displays the results of tweet categorization by both ophthalmologists and nonophthalmologists. To evaluate the specific contribution of ophthalmologists to the Twitter discussion, we used Twitter profile data, Internet searches (Google, Inc., Mountain View, CA), and the AAO member directory to identify any ophthalmologists who published original tweets. During the 2014 meeting, 60 ophthalmologists published 502 original tweets, and during the 2015 meeting, 86 ophthalmologists published 522 original tweets, reflecting an annual increase of 43% in the number of ophthalmologists tweeting. Nonophthalmologists contributing to the Twitter discussion included professional societies, digital/print publications, academic/private practices, pharmaceutical/industry representatives, and marketing/public relations firms. The majority of ophthalmologists who published original tweets practice in North America (62% in 2014 and 64% in 2015), with decreasing percentages from Europe (23% and 14%), Asia (7% and 9%), South America (7% and 12%), and Australia (1% and 1%), very similar to a 2014 study describing Twitter use at radiology’s largest international meeting. Finally, we found that approximately 60% of tweeting ophthalmologists (55% in 2014 and 63% in 2015) were either currently in residency/ fellowship or 10 years of practice (Fig 1), consistent with social media trends by young adults, and suggesting social media will be used increasingly in ophthalmology as young ophthalmologists progress in their careers. Few published studies describe the use of social media within ophthalmology, despite a recent increase in research about the role of social media in medicine. A 2012 study highlighted several ways Twitter could be used within ophthalmology, including by academic journals to publicly share peer-reviewed publications, by professional societies to communicate with their members, by advocacy groups to share issues of legislative interest, and by ophthalmologists to educate the public on ophthalmology-related topics. There are several recognizable limitations to this report. First, only tweets published during the 5 days of each meeting with the hashtags #AAO2014 or #AAO2015 were analyzed; thus, tweets published before or after the meeting or tweets published during the meeting but without the designated hashtags were not captured. Second, as reported in prior studies, Twitter participants

Acute retinal necrosis and cystic encephalomalacia in a premature neonate.

PURPOSE To report a case of an infant born at 30 weeks gestational age (GA) who, at 37 weeks GA, presented with bilateral acute retinal necrosis (ARN) syndrome and herpes simplex virus (HSV) encephalomalacia. METHODS Observational case report. RESULTS A premature infant was found to have ARN based on dilated funduscopic examination and positive HSV serologies. Herpes simplex virus encephalomalacia was diagnosed base on magnetic resonance imaging (MRI). CONCLUSION To our knowledge, this is the youngest reported patient with ARN. This case demonstrates that neonatal ARN may present with posterior chorioretinal lesions and highlights the importance of considering HSV infection of the central nervous system with MRI findings of cystic encephalomalacia.

Retinal necrosis secondary to inadvertent intravitreal methylprednisolone acetate (depo-medrol) injection during pars plana vitrectomy.

PURPOSE Methylprednisolone acetate (Depo-Medrol, Pfizer, New York) is a depot corticosteroid that is commonly injected periorbitally to treat various ophthalmologic conditions. Accidental intravitreal injections secondary to globe perforations have resulted in rapid retinal toxicity. To their knowledge, the authors report the first case of inadvertent intravitreal methylprednisolone acetate injection during pars plana vitrectomy. METHOD Report of a case of inadvertent intravitreal injection of methylprednisolone acetate, mistaken as triamcinolone acetonide, during repeated retinal detachment repair. RESULTS The affected eye had loss of vision, afferent pupillary defect, optic nerve atrophy, retinal necrosis, retinal vascular damage, and recurrent retinal detachment. DISCUSSION Methylprednisolone acetate administered during vitrectomy causes severe retinal toxicity and complicates retinal detachment repair. It is important to use measures to avoid erroneous intravitreal injections during vitrectomy.

Eponymous women in ophthalmology: syndromes with prominent eye manifestations named after female physicians

Many eponymic syndromes were characterized when few women had entered medicine. Nearly simultaneous with the growth of women in ophthalmology has been a decreased emphasis on eponyms in favor of descriptive [1, 2] or biochemical [2–4] terminology. The decline in eponym use has been fueled by calls to eliminate the possessive form [2], concerns regarding inaccuracy as knowledge of disease pathogenesis has evolved [3, 4], worries that using different eponyms across languages stymies global scientific discussion [1], and the realization of inhumane activities by some individuals to whom eponyms were previously attributed [1, 3]. Nonetheless, it is of important historical relevance to identify and celebrate the women who distinguished themselves by helping to characterize syndromes associated with their names. For this report, we culled print and electronic media for eponymous eye syndromes named after female ophthalmologists. Public records, obituaries, images, and other resources were compared to determine gender. Only syndromes listed in OMIM were reviewed to avoid inclusion of arcane eponyms. Syndromes in which the only ophthalmicrelated features are craniofacial abnormalities, optic atrophy, and/or cortical blindness were excluded in order to focus inclusion on eye-related syndromes. Two eponymous female ophthalmologists were identified: Ester Elisabeth Gröenblad and Mette Warburg. Gröenblad-Strandberg disease is pseudoxanthoma elasticum (PXE), characterized by ectopic mineralization and fragmentation of elastic fibers primarily in the eye, skin, and cardiovascular system. Ophthalmic findings include angioid streaks, peau d’orange fundus, and choroidal neovascularization. Gröenblad, a Swedish ophthalmologist, established the syndromic association of angioid streaks with the skin findings in collaboration with dermatologist James Strandberg. Walker-Warburg syndrome causes brain abnormalities and retinal dysplasia. Neurosurgeon Arthur Earl Walker reported a case of hydrocephalus, lissencephaly, microphthalmos, and retinal dysplasia in 1942; additional authors subsequently presented cases. Warburg, a Danish ophthalmologist, suggested in 1971 that the findings represented a yet-uncharacterized syndrome. Today, the syndrome is referred to as muscular dystrophy-dystroglycanopathy with brain and eye anomalies, and genetic sequencing has led to subtype classification. During our search for eponymous ophthalmologists, we identified several female non-ophthalmologist physicians who characterized syndromes with prominent eye manifestations (Table 1). As is common among eponyms, the syndromes identified herein were not all named after the original discoverers, a phenomenon described as Stigler’s Law of Eponymy [5]. The skin and eye findings of PXE had been described before Gröenblad and Strandberg established the syndromic association. Cases of Walker-Warburg syndrome were reported by Walker and others as many as 30 years prior to Warburg’s papers, but eponymous credit is given to her due to her summative assessments of the syndrome. Warburg also described Norrie syndrome but named it in tribute after Gordon Norrie, a Danish ophthalmologist. The plethora of historical eponyms leaves open the possibility that our report is incomplete. Additionally, binary gender categories may unintentionally exclude or mischaracterize some individuals. * Sarah H. Van Tassel sjh2006@med.cornell.edu