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PURPOSE: To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Prospective, randomized, double-blind study. METHODS: Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. RESULTS: The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application ( P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI ( P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application ( P < .001). CONCLUSIONS: Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.

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BACKGROUND: Ophthalmology practice entails many hours of physical inactivity, a potential long-term health hazard. This study aims to perform a pedometer-based evaluation of the physical activity (PA) levels of ophthalmologists at work. METHODS: This is a prospective observational study. Ophthalmologists from a single tertiary medical center were monitored with electronic pedometers during six morning sessions in the ophthalmology clinics. Working hours and the number of patients seen per clinic session were retrieved. The age and body mass index (BMI) of participants were documented. Step number per working hour (SPH) was calculated for all participants. Comparisons between males and females, practicing ophthalmologists (attendings) and ophthalmology residents (residents), and sub-specialties were performed. Correlations between SPH and age, BMI, and patients seen per clinic session were computed. FINDINGS: Pedometer readings for a total of 673 working hours were analyzed for 24 ophthalmologists, 17% female, 17 attendings, mean age 44.2 years (standard deviation (SD = 9.8). The average number of SPH for all participants was 359.7 (SD = 166.7). The mean PA level of residents was significantly higher than that of attendings (410.17 SPH vs. 338.95 SPH, respectively, p = .019). Oculoplastic surgeons demonstrated significantly higher step counts per hour than cornea specialists (439.90 SPH vs. 245.55 SPH, respectively, p = .002). A negative correlation was observed between SPH and the number of patients seen per clinic session (ρ = -0.274, p = .001). CONCLUSIONS/APPLICATIONS TO PRACTICE: Low number of SPH for ophthalmologists in this study indicates ophthalmology to be a highly sedentary medical occupation. PA levels of ophthalmologists in the workplace may indicate a personal health care challenge.

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PURPOSE: To assess the impact of COVID-19-related delay in intravitreal injection timing on macular structure and visual acuity (VA) among patients treated for neovascular age-related macular degeneration (nvAMD). METHODS: We reviewed demographic and clinical data and macular ocular computerized tomographic images of 34 patients (48 eyes, group A) who did not follow their injection schedule during the first wave of COVID-19 and compared them to 46 patients (71 eyes, group B) who did. Functional worsening was defined as a loss of at least 0.1 in decimal VA. Anatomic worsening was defined as new or increased subretinal/intraretinal fluids or new hemorrhage. RESULTS: The planned mean ± standard deviation intervals between the intravitreal injections were 5.7 ± 2.7 weeks for group A and 5.5 ± 2.4 weeks for group B (P = 0.60). The actual intervals were 13.6 ± 6.8 (7.9 ± 5.2 weeks' delay) and 5.3 ± 2.4 weeks (no delay), respectively (P < 0.001). The best corrected visual acuity worsened in 23 group A eyes (47.9%) and in 6 group B eyes (8.5%) (odds ratio [OR] 9.97, P < 0.001). Anatomic features indicative of nvAMD worsening were detected in 31 group A eyes (64.6%) and in 16 group B eyes (22.5%) (OR 5.73, P < 0.001). A new macular hemorrhage was observed in 4 group A eyes (8.3%) and in no group B eyes (P = 0.09). CONCLUSION: Delay in timely retinal care during the COVID-19 restrictions period resulted in short-term negative outcomes, including macular bleeding, in nvAMD patients.

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BACKGROUND AND OBJECTIVES: Anterior knee pain (AKP) is the most common knee pathology in athletes and occurs in 15% of army recruits of elite units during basic training. Of these, 50% are symptomatic 6 years later. Photobiomodulation (PBM) is a nonthermal red-to-near-infrared irradiation used for pain reduction of a variety of etiologies. This study was designed to determine whether addition of PBM to physiotherapy (PT) for AKP in combat soldiers is superior to PT alone. STUDY DESIGN/MATERIALS AND METHODS: In this prospective, double-blind, sham-controlled, randomized clinical trial (NCT02845869), 26 combat soldiers/policemen (male:female, 15:11; body mass index [BMI] = 24.2 ± 3.9, n = 46 knees), with AKP due to overuse/load, received 4 weeks of PT + sham (PT + Sham) or active PBM (wavelength = 660 and 850 nm, pulsing = 2.5 Hz, LED power = 50 mW/cm2 [local tissue/regional lymph nodes]; 810 nm continuous beam, laser cluster 6 W/cm2 [analgesia] and laser pointer 4.75 W/cm2 [trigger points]) (PT + PBM). The main outcome measures were subjective pain by visual analog scale (VAS) (0 [none]-100 [intolerable]) and functional disability by Kujala score (0 [worst]-100 [best]). Evaluations were carried out at baseline, end of treatments, and 3-month follow-up. RESULTS: All participants completed the treatment protocol without any reported adverse device effects. Post-treatment pain was significantly reduced in the PT+PBM group, compared with baseline and sham (Δpain, VAS, mean ± SD: PT + PBM = -19 ± 23, P = 0.002; PT + Sham = -6 ± 21, P = 0.16; between groups, P = 0.032). At 3-month follow-up, pain reduction was similar between groups; however, the Kujala score was significantly improved only in the PBM-treated group (ΔKujala: PT + PBM = 11 ± 10, P = 0.003; PT + Sham = 5 ± 7, P = 0.059). CONCLUSIONS: Addition of PBM to PT for AKP resulted in earlier reduction in pain and improved functionality, compared with PT alone. This noninvasive, nonpharmacologic, adjunctive therapeutic modality can be easily incorporated into team healthcare frameworks or end units and may lead to earlier return to competition or combat-level service. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

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PURPOSE: To assess the additive value of foveal swept-source optical coherence tomography (OCT)-based biometry to the preoperative fundus examinations for diagnosing macular abnormalities in patients scheduled for cataract surgery. DESIGN: Diagnostic testing evaluation. METHODS: Consecutive patients 50 years of age and older planned for cataract surgery from one institution were retrospectively enrolled. All patients underwent foveal swept-source OCT, and macular spectral domain (SD) OCT scans before pupil dilation as well as dilated fundus biomicroscopy examination. The effectiveness of fundus biomicroscopy examinations, foveal swept-source OCT scans, and the combination of both in identifying macular diseases was analyzed with macular spectral-domain OCT scans as reference. RESULTS: Seventy-eight of the eligible 442 eyes (442 patients) were excluded because of noninterpretable macular spectral-domain OCT OCT scans or foveal swept-source OCT scans. The remaining 364 eyes of 364 patients (mean age 73.59±9.26 years [range 49-96], 172 males) formed the study group. Fundus biomicroscopy alone vs fundus biomicroscopy with the addition of foveal swept-source OCT yielded 36% vs 63% sensitivity, 94% vs 72% specificity, 79% vs 58% positive predictive value (PPV), and 71% vs 76% negative predictive value (NPV), respectively. This diagnostic improvement was significant compared with fundus biomicroscopy alone (P = 2.98-8). CONCLUSION: Combined fundus biomicroscopy and foveal swept-source OCT scans improved the detection of macular abnormalities prior to cataract surgery but it was inferior to macular spectral-domain OCT scans. Additional studies to assess the cost-effectiveness of adding foveal swept-source OCT scan in comparison to macular spectral-domain OCT scan to the preoperative cataract evaluation are required.

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PURPOSE: To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery. SETTING: Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective case series. METHODS: Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning before cataract surgery. The scans were reviewed by a retinal specialist for macular pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed. RESULTS: Four hundred fifty-three eyes of 453 patients were enrolled in the study; 42 eyes (9.2%) were excluded because of noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 eyes (40.6%), including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 patients (26.0%) was modified because of macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopic examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes [17.8%]) and referral to a retinal specialist for consultation (34 eyes [8.3%]). CONCLUSIONS: Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopic examination. The added information could improve patient management.

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Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti-VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year's total was expected for this time period. Using this model, the 636 reported number of injections for the March-April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti-VEGF treatments.

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A 45-year-old woman, immediately after receiving a cosmetic treatment with intense focused ultrasound (IFUS) over the eyelids, developed an acute, progressive, severe cataract with a unique shape as an adverse effect of the IFUS esthetic treatment. At examination of the lens in the right eye, 4 drop-like dense lens opacities aligned consecutively in a horizontal line together with a posterior capsular opacity in a stellate-shaped fashion. It rapidly progressed into a dense posterior cataract, leaving the patient with an uncorrected distance visual acuity (UDVA), from 20/20 prior to the event, to 20/160 4 days later. Phacoemulsification and intraocular lens implantation were performed, restoring her UDVA to 20/25. Cosmetic and ophthalmic healthcare providers should be aware of the potentially damaging effect of IFUS.

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