Yarrow Scantling-Birch

Background: In the digital era, smartphone technology has significantly advanced ocular imaging, allowing for high-resolution anterior segment photography (ASP) to enhance referrals, decision-making, and disease monitoring within clinical workflows. Objective: This exploratory quality-improvement project aims to examine clinician experiences with 4 smartphone-based and slit-lamp–based ASP workflows used in eye casualty and corneal services. Methods: A mixed methods project was conducted at a tertiary eye hospital in England (United Kingdom) between October 21, 2024, and December 6, 2024. The full imaging setups of 4 ASP workflows were evaluated within an established clinical setting: the Magnifier app (a smartphone-based app; Apple Inc), QuikVue smartphone adapter (a smartphone-based camera lens attachment; VisuScience Meditech Co Ltd), NexYZ Slit-Lamp Adapter (a slit-lamp–based attachment; Celestron LLC), and Zeiss Slit Lamp Imaging Solution (ZSLIS; an integrated slit-lamp camera system; Carl Zeiss AG). Ophthalmology residents and corneal fellows completed nonvalidated usability surveys and participated in one-on-one interviews examining the role of ASP workflows in clinical practice. Survey data were analyzed using descriptive statistics. Interviews were transcribed and subjected to reflexive thematic analysis. Results: Among 25 survey respondents (17 residents and 8 fellows) and 12 interviewees, clinician-rated assessments of usability, cost-effectiveness, and clinical utility favored the Magnifier workflow, which received the highest ratings across these domains (19/25, 76%; 23/25, 92%; and 18/25, 72% strongly agreed, respectively). Five themes emerged from qualitative analysis: obstacles to clinical implementation, accessibility, quality and workflow, digital ethics, and innovation. Conclusions: No single ASP workflow proved superior in usability ratings and interview themes regarding clinical application. However, the use of the Magnifier workflow appeared to offer the most favorable balance of usability, cost-effectiveness, and clinical utility in clinician-rated assessments, though this reflects the full imaging workflow rather than the app alone. These findings are exploratory and require future work to examine workflow integration, data governance for smartphone imaging, and patient perspectives on ASP workflows.

We present a case series to evaluate the clinical features of acute leukemia presenting with primary orbital manifestations. We undertook a retrospective case review of primary orbital presentations of acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) over a 10-year period at two hospital sites (Hereford County Hospital and Leicester Royal Infirmary). Our case series included four patients - two with AML and two with ALL. Patients were young (mean age of four years and five months) at presentation, all with unilateral disease, and presented with orbital signs. Although there was some confusion with the diagnosis at the time of referral, a suspicion of malignancy was made rapidly once ophthalmic review was initiated. All four cases were diagnosed with the assistance of peripheral blood film and bone marrow biopsy, without the need for orbital biopsy. All four cases had resolution of the orbital mass and remain disease-free.

Smartphone apps are becoming increasingly popular in ophthalmology, one specific area of their application being toric intraocular lens (IOL) surgery for astigmatism correction. Our objective was to identify, review and objectively score smartphone apps applicable to toric IOL calculation and/or axis alignment. This review was divided into three phases. A review was conducted on four major app databases (phase I): National Health Service (NHS) Apps Library, Google Play Store, Apple App Store and Amazon Appstore. A systematic literature review (phase II) was conducted to identify studies for included apps in phase I of our study. Keywords used in both searches included: “toric lens”, “toric IOL”, “refraction”, “astigmatism”, “ophthalmology”, “eye calculator”, “ophthalmology calculator” and “refractive calculator”. Included apps were objectively scored (phase III) by three independent reviewers using the mobile app rating scale (MARS), a validated tool that ranks the quality of mobile health apps using a calculated mean app quality (MAQ) score. Phase I of our study screened 2428 smartphone apps, of which six apps for toric IOL calculation and four apps for axis marking were eligible and were selected for quantitative analysis. Phase II of our study screened 477 studies from PubMed, Medline and Google Scholar. Three studies validating two apps (toriCAM, iToric Patwardhan) in a clinical setting as adjunct tools for preoperative axis marking were identified. Phase III ranked Toric Calculator for iPhone (Apple iOS, MAQ 4.13; average MAQ 3.34 ± 0.54) as the highest-scoring toric IOL calculator, and iToric Patwardhan (Android OS, MAQ 4.13; average MAQ 3.41 ± 0.44) was the highest-scoring axis marker in our study. Our review identified and objectively scored ten smartphone apps available for toric IOL surgery adjuncts. Toric Calculator for iPhone and iToric Patwardhan were the highest-scoring toric IOL calculator and axis marker, respectively. Current literature, though limited, suggests that axis marking smartphone apps can achieve similar levels of misalignment reduction when compared to digital systems.

Purpose: To assess national endophthalmitis prophylaxis practice patterns during phacoemulsification surgery in Pakistan. Study Design: Cross sectional survey. Place and Duration of Study: Eye units registered with the British Pakistani Ophthalmic Society (BPOS) between September and November 2020. Methods: A survey-based cross sectional study was conducted in Pakistan between September and November 2020. A proforma was designed using a survey client (Survey Monkey) and distributed to the eye units registered with the British Pakistani Ophthalmic Society (BPOS). The survey explored demographic factors, current antibiotic prophylaxis practice during cataract surgery and audit practice in Pakistan. Results: A total of 339 respondents completed the survey. The survey was representative of ophthalmic surgeons working in the major provinces of Pakistan. A small majority of ophthalmic surgeons provided some form of routine antibiotic prophylaxis (n = 140, 53.8%). Povidone iodine 5% (PVP-I) solution on skin and in the conjunctival sac proved the most popular protocol (n = 163, 66.3%). This was followed by immediate postoperative topical antibiotics (n = 101, 41.1%). Intracameral antibiotic prophylaxis accounted for less than half of current antibiotic practice during cataract surgery in Pakistan (n=99, 40.3%). Most of the respondents did not conduct any audit regarding endophthalmitis (n = 119, 55.6%). Conclusion: Our survey provides an up-to-date view on the state of antibiotic prophylaxis during cataract surgery in Pakistan and highlights several areas for improvement. This includes policy changes to increase adherence to gold standard antibiotic prophylaxis guidelines, improvement in transparency of surgical outcomes and to audit current postoperative outcomes. Key Words: Acute postoperative endophthalmitis, Surgical wound infection, Antibiotic, Cataract, Pakistan.

Introduction: Reforms in the postgraduate and undergraduate curriculum have resulted in a lack of surgical teaching. By tailoring educational objectives to learning needs of junior doctors, we assessed the perceptions and knowledge transfer of our 2-phase surgical teaching programme. Method: A perception questionnaire was distributed amongst junior doctors to establish confidence levels in surgical topics. Junior doctors were invited to attend (1) a local surgical techniques workshop and (2) an online national webinar. Perception questionnaire and knowledge tests were delivered before and after each session. Result: 87.5% (n = 14) participants were not confident assessing an unwell surgical patient when on-call. Mean confidence gain before and after the practical session was 4.18 (W = 91.0, p = 0.0002). 106 participants attended the online webinar. 61.3% (n = 65) were quite confident in assessing a sick surgical patient and 56.6% (n = 60) were quite confident managing a sick surgical patient. The majority (97.2%, n = 103) deemed the session to be useful to very useful. Mean knowledge gain before and after the session was 32.8% (t = 4.67, p = 0.009). Conclusions: Improvement in confidence and knowledge in surgical topics amongst juniors can be feasible by implementing blended learning tools, such as online webinars.

Lower respiratory infections are often caused or precipitated by viruses and are a leading cause of global morbidity and mortality. Mutations in these viral genomes can produce highly infectious strains that transmit across species and have the potential to initiate epidemic, or pandemic, human viral respiratory disease. Transmission between humans primarily occurs via the airborne route and is accelerated by our increasingly interconnected and globalised society. To this date, there have been four major human viral respiratory outbreaks in the 21st century. Healthcare workers (HCWs) are at particular risk during respiratory epidemics or pandemics. This is due to crowded working environments where social distancing, or wearing respiratory personal protective equipment for prolonged periods, might prove difficult, or performing medical procedures that increase exposure to virus-laden aerosols, or bodily fluids. This review aims to summarise the evidence and approaches to occupational risk and protection of HCWs during epidemic or pandemic respiratory viral disease.

Purpose: Simulation provides a realistic environment to learn technical and non‐technical skills for surgical trainees, without compromising patient safety. Glaucoma surgery is intricate and complex, demanding the highest order of manual dexterity and skill. Mastering the array of glaucoma procedures takes time and practice. High‐fidelity simulation offers a solution to learn this effectively in an artificial environment before operating on patients. The purpose of this study was to summarise the literature and identify simulation training models available to learn glaucoma surgery.Methods: PubMed, Embase, Medline and Cochrane Library were systematically searched using keywords and MeSH terms: simulation, training, education, learning, glaucoma surgery, filtering surgery, shunting surgery and MIGS. The search yielded 148 articles, these were filtered by abstract and/or title by two independent reviewers.Results: A total of 6 articles published in English with full text available were identified. All studies used high‐fidelity simulators, a trainee cohort and tested technical skills. No study examined non‐technical skills. Three studies described wet‐lab simulators for MIGS and three studies described a mix of wet and dry‐lab simulators for trabeculectomy surgery. Three studies used human cadaveric eyes, two studies adopted pig eyes and one study employed fruit. Only one study used a validated instrument in assessing technical skills of trainees.Conclusions: Simulation provides an immersive scenario for both trainees and seniors to practice procedural techniques that increase expertise, reduce cognitive load and improve patient safety. There is a limited number of models for simulation training in glaucoma surgery, impeding the ability of trainees to learn evolving surgical techniques. Further work is required in producing high‐fidelity, but cost‐effective simulators in glaucoma surgery to train technical and non‐technical skills.