Purpose: This study describes the implementation of an electronic medical record (EMR)-based initiative aimed at reducing the number of patients with glaucoma-related diagnoses lost to follow-up (LTF) and reviews its short-term outcomes.Design: Retrospective, comparative case series.Participants: Patients with glaucoma-related diagnoses seen 1 year prior at the Lahey Medical Center and who had not returned within the 6-month period between January 1, 2020, and June 30, 2020, which spanned the outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in the United States.Methods: An EMR-based tool was designed to identify patients suspected of being LTF with glaucomarelated diagnoses. Providers were enlisted to review the EMR for each of these patients and re-engage them, as appropriate. One month later, the initiative was evaluated by means of a retrospective chart review. Binary logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with being LTF.Main Outcome Measures: Patients who completed a telemedicine or in-person appointment, or had a future scheduled or ordered return appointment, were considered re-engaged.Results: Of the 3551 patients seen during the study period, 384 patients were identified as LTF (11%), with 60 identifying COVID-19 as the reason for canceling their visit (16%). Patients who lived farther from the eye clinic (P < 0.001) or who had a history of canceling or missing an appointment (P < 0.001) were more likely to be LTF. Patients with open-angle glaucoma (P ¼ 0.042) or who had completed a visual field (P < 0.001) or ophthalmic imaging (P < 0.001) within the past year were less likely to be LTF. One month after the re-engagement initiative, 124 LTF patients (32%) had been re-engaged (40% through telemedicine), 238 patients (62%) had future scheduling orders in place, and 22 patients (6%) had no active plan for future follow-up.Conclusions: An EMR-based tool is an effective method for identifying patients at risk of being LTF and provides an opportunity for providers to recall and re-engage patients. Use of telemedicine to recontact LTF patients shows promise of improving the management of glaucoma, enhancing clinical productivity, and documenting treatment plans, thereby potentially reducing medicolegal liability. Ophthalmology
Purpose: This work describes a case of Cutibacterium acnes (formerly Propionibacterium acnes) endophthalmitis following a posterior-chamber, phakic, Implantable Collamer Lens (ICL) surgery. Methods: A 34-year-old previously healthy woman presented with chronic unilateral iritis 8 months after bilateral ICL surgery. Original testing revealed no cause for the iritis with normal culture, serology, and autoimmune testing results. Results: Follow-up revealed C acnes by polymerase chain reaction on vitrectomy samples. Complete resolution of symptoms was achieved following removal of the implant, lensectomy, and intravitreal antibiotics. Conclusions: We believe this is the first reported case of postphakic ICL C acnes endophthalmitis. It highlights the utility of polymerase chain reaction in cases of chronic uveitis.
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