Although amniotic membrane transplantation (AMT) has long been used as an essential surgical technique for ocular surface reconstruction, its role continues to evolve and expand. In the management of numerous ocular surface disorders, ranging from inflammatory to infectious, traumatic to neoplastic, the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist. The purpose of this paper is to provide ophthalmologists with an updated, evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction, reviewing its common and even experimental applications known to date. The methods of amniotic membrane preservation, the available commercial amniotic membrane products to date, and future directions for amniotic membrane use, including amniotic membrane extract eye drops (AMEED), are also discussed. It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic. By familiarizing the general ophthalmologist with its diverse applications, we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice, or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease. We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects. Technique description and retrospective interventional case series. The reconstruction technique was used by an experienced oculoplastics surgeon (ASL) in 3 adults with malignant lesions involving the lateral upper eyelid margin, resulting in a post-excision 50% full-thickness defect between November 2017 and June 2020. The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap. The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle. Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases. One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants. In all patients, the final eyelid contour and symmetry were adequate, with only minimal scarring, evident already 3 to 4 months postoperative. There were no major complications or need for revisions. The technique described herein highlights the utility of the blepharoplasty flap for lateral, full-thickness upper eyelid defects. This logical variation enables the reconstruction of significant defects using only local tissue, obeying the “like with like” principle, and helps avoid the need for a bridging flap. We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour, together with a fast recovery of appropriate eyelid function.

Abstract: Acute retinal arterial ischemia, which includes transient monocular vision loss (TMVL), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and ophthalmic artery occlusion (OAO), is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery, heart or aortic arch, leading to partial or complete occlusion of the central retinal artery (CRA) or its branches. Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency. Patients with acute retinal arterial ischemia are at a high risk of having further vascular events, such as subsequent strokes and myocardial infarctions (MIs). Therefore, prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up (such as brain magnetic resonance imaging with diffusion weighted imaging, vascular imaging, and cardiac monitoring and imaging) and potential treatment of an urgent etiology (e.g., carotid dissection or critical carotid artery stenosis). Since there are no proven, effective treatments to improve visual outcome following permanent retinal arterial ischemia (central or branch retinal artery occlusion), treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.

Background: Dementia is a syndrome that affects a person’s ability to understand and express information. The higher prevalence of vision and/or hearing losses among persons with dementia in long-term care (LTC) facilities interferes with the ability of nurses to provide optimal care because communication is compromised. Therefore, the detection and screening for sensory impairment is of the utmost importance in LTC facilities; however, there is currently no agreement among nursing professionals on how to best identify such losses for the purpose of further referral, and the need for a validated screening measure suitable for nurses in LTC facilities is clear. The present project aims to close this gap by investigating the screening recommendations of vision- and hearing-care professionals working with clients affected by dementia.

Methods: Eleven experts in audiology, optometry, deafblindness, and technology participated in individual semi-structured interviews on the topic of tools and strategies that can be used to screen individuals with dementia for sensory loss. Interview transcripts were coded by two evaluators using verbal agreement and consensus building.

Results: Three main themes emerged from the interviews with experts: barriers, facilitators, and strategies. Barriers to sensory screening were often mentioned, particularly impaired communication and lack of staff cooperation. Facilitators consisted uniquely of people, such as family members, intervenors, and nurses. Strategies for sensory screening in this population consisted of improving communication through repetition and encouragements; considerations based on familiarity; and inferring an impairment on the basis of patient behaviour. Few of our interviewees were knowledgeable on the topic of screening apps.

Conclusions: Our findings, to be integrated with a similar environmental scan conducted among LTC nurses, can inform the administration of sensory impairment screening tests among a population with dementia in order to optimize care.

Abstract: Complications of myopia have become an important public health issue with serious socio-economic burdens. Prevention and treatment are both important. The Taiwan Student Vision Care Program (TSVCP) promoted by Ministry of Education (MOE) has been carried out for 3 decades in Taiwan. The myopia prevalence has increased rapidly to a high level and therefore myopia prevention has continued to be the most important item in the program. Therefore, TSVCP aims to decrease the prevalence of myopia, in order to decrease the high myopia related blindness in the future. Recently, outdoor activity has been found to be an important protective factor for myopia and was implemented in TSVCP since 2010. Afterwards, the nationwide vision impairment rate (uncorrected vision 20/25 or less) of elementary school students declined unprecedentedly and continuously in recent years. Evidence-based protective and risk factors for myopia are now clearer. Widespread acknowledgement of myopic disease, preventing the onset of myopia, prompt diagnosis, and early treatment to control progression are all important.

Abstract: Retinopathy of prematurity (ROP) is an emerging cause of childhood blindness in the developing countries. The low and middle-income countries are facing common challenges in the midst of the ‘third epidemic’ of ROP. Improvement in neonatal care facilities has increased survival of preterm babies. Lack of awareness and non-uniform standards of care in the ever-increasing number of neonatal intensive care units (NICUs) and special newborn care units (SNCUs) has resulted in this surge of ROP. Apart from low birth weight and the degree of prematurity, use of unblended supplemental oxygen, sepsis, anemia and blood transfusion are important risk factors associated with ROP in developing countries. Atypical forms of aggressive posterior ROP (APROP) are seen in heavier birth weight babies in the developing countries. Prevention of ROP by good quality neonatal care, timely diagnosis by mandatory ROP screening in NICUs and training manpower for laser treatment of ROP requires close collaboration between the neonatologists, ophthalmologists and the policy makers. Team approach and inter-disciplinary co-ordination are keys in a nation’s drive to fight this preventable cause of blindness.

Abstract: The teaching of professionalism, a key aspect of medical competence that regulates physician’s behavior towards patients, colleagues, society, and self, should be included in the curriculum of every training program. Studies suggest a variety of formats to teach and evaluate professionalism in residents, being role modeling, reflection, case discussions, and 360-degree assessments the most commonly used. However, little is published about the need to train faculty for teaching and evaluating professionalism, or how to improve institutional culture, so that principles that are indicated to teach in theory are also fulfilled in practice.