martphones and other handheld devices have become increasingly ingrained into daily life. 1 There is substantial potential to integrate mobile applications (apps) in clinical ophthalmology. 2,3 However, mobile apps can be published without any external testing for validity or reliability yet still may be used widely in clinical practice. 4,5 The coronavirus disease 2019 (COVID-19) pandemic illustrates the increasingly important role of telemedicine as a method of clinician-patient interaction. Given the considerable expansion in number of apps and increasing need for such apps in telemedicine during the 6,7 this study aims to assess the accuracy and usability in the context of teleophthalmology of currently available visual acuity testing apps. MethodsThe US Apple App Store was queried for mobile apps that test visual acuity from April 17, 2020, to May 5, 2020. The search terms "eye test," "Snellen," "visual acuity," "vision test," "optometry," and "letter chart" were used. Apps were downloaded if they were free, in English, and not in the category of entertainment or advertised as "eye workouts." Inclusion of a downloaded app in the analysis required that it state the distance to hold the device to measure visual acuity. Data regarding the publisher, rating, most recent update, functionalities of the app, and distance were recorded. Optotype size was manually measured on the iPhone 7, iPhone 11, 11-inch iPad Pro (second generation), and Mini 4 for visual acuity lines 20/200, 20/100, 20/40, and 20/20. The expected optotype size was calculated using the equation Height (in mm) = Inverse of Snellen Fraction × Viewing Distance (in mm) × tan (5/60) and compared with measured optotype size. Mean (SD) errors were calculated per device, and the average mean error was reported across devices. Mean (SD) errors are not available from the apps themselves. A Rosenbaum Near Vision Card was also tested to validate our methodology, with a mean (SD) error of 0.0% (3.7%). Analyses were completed with Excel version 16.16.27 (Microsoft). IMPORTANCEThe coronavirus disease 2019 pandemic illustrates the increasingly important role of telemedicine as a method of clinician-patient interaction. However, electronic applications (apps) for the testing of ophthalmology vital signs, such as visual acuity, can be published and used without any verification of accuracy, validity, or reliability. OBJECTIVE To reassess the accuracy of visual acuity-testing apps and assess their viability for telehealth. DESIGN, SETTING, AND PARTICIPANTSThe US Apple App Store was queried for apps for visual acuity testing. Anticipated optotype size for various visual acuity lines were calculated and compared against the actual measured optotype size on 4 different Apple hardware devices. No human participants were part of this study.MAIN OUTCOMES AND MEASURES Mean (SD) errors were calculated per device and across multiple devices.RESULTS On iPhones, 10 apps met inclusion criteria, with mean errors ranging from 0.2% to 109.9%. On the iPads, 9 apps met inclusion ...
To review the demographics, clinical features, and response of orbital squamous cell carcinoma treated with cemiplimab.Methods: This is a retrospective multi-institutional series. Patient characteristics, drug dosing, duration, and response to treatment were evaluated.Results: The study cohort consisted of 11 patients from 5 institutions. All patients received a regimen of 350 mg q 3 weeks and an average of 11.2 cycles (SD 5.8). No patient experienced significant side effects requiring treatment or cessation of cemiplimab. Complete response was achieved in 9 patients (82%) treated with cemiplimab.Conclusions: Immune checkpoint inhibitors, such as cemiplimab provide a globe-sparing option for the treatment of orbital squamous cell carcinoma. It is important to consider these agents especially when orbital exenteration is the alternative.
Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education, particularly for those applying to residency programs in 2020 to 2021. This study describes the challenges for potential ophthalmology residency applicants so that residency leadership can make informed decisions about changes to the process. Methods A survey was distributed electronically via social media and medical school ophthalmology interest groups from June 18, 2020 to July 2, 2020 to individuals interested in applying to ophthalmology residency in the United States. Survey questions included demographics and perceived impacts of COVID-19 on ability, confidence, intention to apply, and perceptions toward changes in the application process for the 2020 to 2021 ophthalmology residency application cycle. Results One-hundred sixteen total responses were received. Eighty-six responses (74%) were from individuals intending to apply in the 2020 to 2021 application cycle. Most respondents (86%) felt that their application would be affected by COVID-19 with 51% feeling less confident. Only four (5%) felt that they could adequately compile a rank list following a video interview, and over half (51%) anticipated applying to more programs than they originally intended. Academic plans of seven (8%) respondents were significantly altered via deferral of application or cancellation of a research year. Thirty-nine (45%) students reported delayed ophthalmology electives, with less than half (41%) feeling that they had adequate clinical exposure to be prepared for residency. Conclusion The COVID-19 pandemic has had a substantial impact on the 2020 to 2021 ophthalmology residency application cycle. As stakeholders begin to approach this cycle, these findings will help them make effective and informed decisions to create the best overall experience for all involved.
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