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Purpose To compare treatment strategies for ocular surface squamous neoplasia (OSSN), ranging from surgical excision to empiric topical interferon alpha-2b (IFN-α2b). Methods A decision model was constructed to determine which of four treatment strategies minimized expected persistence/recurrence of disease in patients with OSSN: excision followed by repeat excision for positive surgical margins, excision followed by IFN-α2b for positive margins, incisional biopsy followed by IFN-α2b for positive biopsies, and empiric treatment with IFN-α2b. Probabilities were estimated from literature published between 1983 and 2015. Expected values for the probability of recurrence could range from 0 (no persistence/recurrence) to 1 (persistence/recurrence). Sensitivity analyses were performed for each variable. Results Excision followed by IFN-α2b for positive margins was estimated to minimize persistence/recurrence of OSSN (EV 0.13 versus 0.17 for empiric IFN-α2b, 0.22 for excision-only, and 0.30 for incisional biopsy-directed IFN-α2b). The optimal strategy was sensitive to three variables: efficacy of IFN-α2b, recurrence following negative surgical margins, and accuracy of excisional biopsy. Conclusions In our decision analysis using studies published between 1983 and 2015, surgical excision followed by IFN-α2b for positive margins is the favored strategy for minimizing persistence/recurrence of OSSN. Future prospective studies would add to the certainty of these conclusions.

BackgroundRural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont.MethodsMedical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed.ResultsOf 103 patients (mean age of 45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0–50 miles) to attend screening examinations. Mean time for patients’ last effort to seek eye care was 7.1 years (range: 1–54 years).ConclusionThis study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting.

We report the case of an asymptomatic 47 year-old male patient who suffered a penetrating wound from a metallic foreign body that became embedded adjacent to the optic nerve for over thirty years, as well as the associated examination, imaging, and fundus photography. Intraorbital metallic foreign bodies can be well tolerated and may not require surgical intervention despite proximity to important structures.

Common variable immune deficiency (CVID) is one of the most commonly diagnosed primary immunodeficiencies. Generally, patients have a history of recurrent sinopulmonary infections, hypogammaglobulinemia of two or more immunoglobulin isotypes, and impaired functional antibody responses. Reports of corneal involvement associated with CVID are limited. We describe a case of corneal ulceration associated with methicillin-resistant Staphylococcus aureus in a patient with CVID that developed while on monthly intravenous immunoglobulin infusions and in which there were no common risk factors for bacterial keratitis, such as prior history of ocular surface disease, trichiasis, trauma, or contact lens wear.