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BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].

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Increasing food production in local urban and peri-urban areas is articulated as a potential way for local governments to achieve multiple sustainability outcomes (environmental, social, and human health). However, scientific judgements on localization are difficult to make because the degree of current food localization has not been systematically measured or defined across large numbers of cities. We develop new methods to quantify current local capacity for food production to meet total household agrifood demand, harmonizing bottom-up and top-down approaches to assess direct-plus-embodied agrifood demand of both fresh and processed foods. We find unique patterns of localization for different agrifoods, with 21% of U.S. metropolitan statistical areas (MSAs) currently capable of local self-sufficiency for eggs and milk equivalents embodied in diet, versus 12% and 16% of MSAs self-sufficient in fruits and vegetables, respectively. Focusing only on the direct fresh food demand, increased current local capacity (e.g., 45% MSAs self-sufficient in direct fluid milk), which also increases with production distances around cities. Overall, significant agricultural production is found to already occur in and around U.S. MSAs for these items. Multivariable analysis finds that state policies that promote urban agriculture may influence greater localization, which, interestingly, is independent of population density. Such spatial demand-production analysis is the first step in informing sustainable city or regional food policies and envisioning spatial food supply chains to urban areas.

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PURPOSE: To report the surgical management of a combined rhegmatogenous and traction retinal detachment associated with a vasoproliferative tumor secondary to sickle cell retinopathy. OBSERVATIONS: A 29 year old man from Ghana presented with unilateral vision loss, ischemic retina and sea fan neovascularization in both eyes and a retinal detachment nearby a vasoproliferative tumor (VPT) in the left eye. Hemoglobin electrophoresis led to the diagnosis of sickle cell disease. The patient underwent vitrectomy with scleral buckle surgery, resection of the tumor, and removal of subretinal membranes in the left eye. Laser photocoagulation was targeted to areas of ischemic retina in both eyes. CONCLUSIONS: and Importance: To our knowledge, this is the first report of a combined rhegmatogenous and traction retinal detachment associated with a VPT in sickle cell retinopathy managed by modern vitrectomy techniques. Prompt recognition of the condition and surgical management addressing both rhegmatogenous and tractional components can lead to improved outcome.

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PURPOSE: Vitreomacular traction (VMT) syndrome can cause symptomatic metamorphopsia and decreased visual acuity. Although it is typically treated with vitrectomy or intravitreal ocriplasmin injection, these procedures can be invasive and costly. The purpose of this retrospective, consecutive case series was to evaluate the efficacy of intravitreal expansile sulfur hexafluoride gas injection for the treatment of symptomatic VMT syndrome. METHODS: Nine eyes of 9 patients with symptomatic VMT syndrome on spectral domain optical coherence tomography received an intravitreal injection of 0.3 mL of 100% sulfur hexafluoride. The primary outcome was the number of eyes with release of VMT on spectral domain optical coherence tomography at 1 month after treatment. Secondary outcomes included change in visual acuity and central subfield thickness 1 month after treatment. RESULTS: Five patients (55.6%) had release of VMT on spectral domain optical coherence tomography by 1 month after injection. Two patients who had Stage I macular holes before injection had closure of the macular holes. Mean visual acuity at 1 month improved slightly after injection by 0.09 logMAR units, although this change was not statistically significant (P = 0.15). Central subfield thickness on spectral domain optical coherence tomography decreased by an average of 35.3 microns after injection (P = 0.004). All eyes with release of VMT had pretreatment vitreomacular adhesion of less than 521 microns and none had epiretinal membranes. One patient (11.1%) developed a peripheral retinal hole at 1 month after injection. CONCLUSION: Intravitreal injection of expansile sulfur hexafluoride gas is a low-cost and minimally invasive alternative for the treatment of symptomatic VMT syndrome. Further study is warranted.

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OBJECTIVES: To describe a patient with dyskeratosis congenita (DC) who developed retinal neovascularization (RNV) and discuss this novel association. METHODS: A 10-year-old boy with DC was referred for evaluation of possible retinal vascular disease. He underwent ophthalmologic examination, as well as fluorescein angiography. RESULTS: Fluorescein angiography demonstrated proliferative retinopathy with capillary nonperfusion in the temporal retina of both eyes. The patient underwent further evaluation with an examination with anesthesia and indirect ophthalmoscopic laser photocoagulation to areas of capillary nonperfusion. CONCLUSION: Although various ocular complications of both acquired aplastic anemia and inherited aplastic anemia due to DC have been previously described, to the authors' knowledge, this is the first reported case of either disease to exhibit RNV consistent with proliferative retinopathy. Ophthalmologists need to be aware of this potential complication in DC that could threaten vision, to provide prompt laser photocoagulation therapy.

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PURPOSE: To evaluate the visual prognosis in eyes with branch retinal artery occlusion (BRAO). DESIGN: Retrospective, observational, consecutive case series. METHODS: Retrospective medical record review of 52 consecutive eyes of 52 patients with BRAO seen at two vitreoretinal practices in Birmingham, Alabama. Only eyes with decreased central macular perfusion on fluorescein angiography (FA) were included. Eyes with anterior segment or optic nerve disease, lack of retinal whitening or a delay in arterial filling on FA, central retinal artery occlusion, and cilioretinal artery occlusion were excluded. The main outcome measure was presenting best-corrected visual acuity (BCVA) and its relationship to final BCVA. RESULTS: On presentation, 54% of eyes with BRAO had BCVA of 20/40 or better. At the mean 14-month visit, 60% of all eyes had visual acuity (VA) of 20/40 or better. VAs of 20/40 or better were retained by 89% of eyes with baseline BCVA of 20/40 or better. Only 14% of eyes with 20/100 or worse BCVA improved to 20/40 or better. Neither visible emboli (P > or = .244) nor the region of macular involvement (P = .142) were significant with respect to visual improvement. CONCLUSIONS: Visual prognosis after BRAO seems to be correlated to presenting VA. Eyes with initial VA of 20/40 or better usually remained at 20/40 or better. Individuals with poor VA of 20/100 or worse generally did not show the significant improvement reported in previous studies.

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PURPOSE: To evaluate the clinical efficacy of transluminal YAG laser embolysis (TYE) for patients with severe vision loss secondary to a newly diagnosed branch retinal artery occlusion (BRAO) with visible emboli. METHODS: Five eyes of five patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli and retinal whitening were prospectively examined, enrolled, and underwent visual acuity testing, ophthalmic examination, color photography, and fluorescein angiography. Each patient was offered TYE and the potential risks of the treatment were explained. Follow-up examinations were undertaken post-procedure day 1 and subsequent follow-up depended on the clinical course. RESULTS: In our five patients baseline best-corrected visual acuity (BCVA) was found to be 5/400, count fingers at 3 feet, count fingers at 5 feet, 20/800, and 20/200. All five of our patients showed improvement in BCVA 1 day after TYE. Fluorescein angiography showed immediate and dramatic restoration in flow past the obstructed arteriole in all patients. Patient 2 developed subretinal hemorrhage, which after vitrectomy and associated procedures the acuity improved to 20/25 at 22 days after the TYE. Final BCVA was 20/30, 20/25, 20/40, 20/30, and 20/40. CONCLUSION: TYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus. The risks of TYE must be weighed against the possibility of severe and permanent loss of vision secondary to BRAO.

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PURPOSE: To report the use of intravitreal bevacizumab (Avastin) as an adjunctive treatment for proliferative diabetic retinopathy (PDR). DESIGN: Retrospective case review. METHODS: Institutional review board approval to review patient data was obtained for this retrospective study. Three patients underwent intravitreal injection of bevacizumab as part of their treatment for PDR after informed consent was signed. Each patient also underwent fundus photographs before the bevacizumab injection and then one to three weeks after. RESULTS: All three patients showed complete regression of their neovascularization elsewhere (NVE) and neovascularization of the disk (NVD) between one and three weeks after injection. CONCLUSIONS: The speed and degree of neovascular regression after the injection of intravitreal bevacizumab may make this procedure an important adjunctive treatment in the management of selected cases with severe PDR.

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