Schornack, Muriel M

Background: Ocular graft-versus-host disease (oGVHD) is a frequent complication after hematopoietic stem cell transplant, with dry eye being the most common presentation. Patient experience with dry eye from oGVHD may negatively affect quality of life. The purpose of this study was to evaluate patients’ perspectives on the symptoms, treatments, and care burdens associated with dry eye from oGVHD. Materials and methods: An electronic questionnaire was sent to patients with dry eye asking about their diagnoses, symptoms, treatments, and experiences associated with dry eye. Results: Of the 639 patients who responded to the questionnaire, 79 reported having dry eye from oGVHD and were included in the analysis. The mean (SD) age of these patients was 55 (10) years (range, 22–73 years; n = 75). Of the patients who reported their sex (n = 78), 32 were male, and 46 were female. The most common ocular symptom was a sandy or gritty feeling (n = 68, 86%). Patients reported a mean (SD) of nine (2) symptoms, despite using four (2) treatments. The most common initial treatment was artificial tears (n = 71, 90%). Most patients (68/75, 91%) reported receiving oGVHD care from an eye care professional (e.g., ophthalmologist or optometrist), whereas a few (4/75, 5%) received oGVHD care from a hematologist. Conclusions: Dry eye symptoms and treatments, along with the associated time and financial costs required, are a burden to patients with oGVHD. These patients should be evaluated by a knowledgeable eye care professional to best treat and manage their disease.

SIGNIFICANCE Alignment of the scleral lens haptic with the anterior ocular surface is of critical importance when fitting scleral lenses. The concept of leveraging big‐data analysis to drive lens design is explored in this study. This retrospective study evaluated fitting outcomes of a data‐driven, quadrant‐specific scleral lens design and found that most patients (76%) were successfully fit with this design. PURPOSE The purpose of this study was to evaluate clinical outcomes with a data‐driven, quadrant‐specific scleral lens design compared with traditional lens designs. METHODS For this multicenter retrospective observational study, A REDCap (Research Electronic Data Capture) survey was distributed to scleral lens practitioners who participated in β testing of a data‐driven, quadrant‐specific scleral lens design (study lens) between June 1, 2016, and January 31, 2017. Descriptive data were collected, and patient‐reported outcomes, visual acuity, and lens design outcomes achieved with the study lens were described. RESULTS Seventy‐five patients (85 eyes) were fit with the study lens design between June 2016 and January 2017. Mean patient age was 47 years (range, 17 to 77 years). Forty‐six were male, and 29 were female. Seventy‐six eyes (89%) were fit for corneal irregularity, whereas nine eyes (11%) were fit for management of ocular surface disease. Compared with habitual correction, 22% more eyes achieved 20/20 or better, and 21% more eyes achieved 20/40 or better. There was also a 60% decrease in the need for midday removal with the study lens. An average of two lenses were manufactured per eye to complete the fitting process. CONCLUSIONS Using a data‐driven, quadrant‐specific scleral lens resulted in visual improvement, a reduced need for midday removal, and an average of two lenses needed to complete the fitting process. Longer‐term clinical outcomes and the use of big‐data analysis to inform scleral lens design should be further explored.

Introduction This manuscript describes data from an original study, simulating a tele-glaucoma programme in an established clinic practice with an interdisciplinary team. This is a ‘real life’ trial of a telemedicine approach to see a follow-up patient. The goal is to evaluate the accuracy of such a programme to detect worsening and/or unstable disease. Such a programme is attractive since in-clinic time could be reduced for both the patient and provider. This study evaluates agreement between in-person and remote assessment of glaucoma progression. Methods A total of 200 adult glaucoma patients were enrolled at a single institution. The in-person assessment by an optometrist or glaucoma specialist at time of enrolment was used as the gold standard for defining progression. Collated clinical data were then reviewed by four masked providers who classified glaucoma as progression or non-progression in each eye by comparing data from enrolment visit to data from the visit immediately prior to enrolment. Agreement of glaucoma progression between the masked observer and the in-person assessment was determined using Kappa statistics. Intra-observer agreement was calculated using Kappa to compare in-person to remote assessment when both assessments were performed by the same provider ( n = 279 eyes). Results A total of 399 eyes in 200 subjects were analysed. Agreement between in-person versus remote assessment for the determination of glaucoma progression was 63%, 62%, 69% and 68% for each reader 1–4 (kappa values = 0.19, 0.20, 0.35 and 0.33, respectively). For intra-observer agreement, reader 1 agreed with their own in-person assessment for 65% of visits (kappa = 0.18). Discussion Intra-observer agreement was similar to the agreement for each provider who did not see the patient in person. This similarity suggests that telemedicine may be equally effective at identifying glaucomatous disease progression, regardless of whether the same provider performed both in-clinic and remote assessments. However, fair agreement levels highlight a limitation of using only telemedicine data to determine progression compared with clinical detail available during in-patient assessment.