Background Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States. Objectives To evaluate the feasibility and impact of implementing naloxone prescription to patients prescribed opioids for chronic pain. Design 2-year non-randomized intervention study. Setting 6 safety net primary care clinics in San Francisco. Participants 1985 adults receiving long-term opioids for pain. Intervention Providers and clinic staff were trained and supported in naloxone prescribing. Measurements Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review. Results 38.2% of 1,985 patients on long-term opioids were prescribed naloxone. Patients on higher doses of opioids and with a past 12-month opioid-related emergency department (ED) visit were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month six months after the receipt of the prescription (IRR=0.53, 95%CI=0.34–0.83, P=0.005) and 63% fewer visits after one year (IRR=0.37, 95%CI=0.22–0.64, P<0.001), compared to patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone compared to those who did not (IRR 1.03, 95% CI 0.91–1.27, P = 0.61). Limitations Results are observational and may not be generalizable beyond safety net settings. Conclusion Naloxone can be co-prescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients on opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits such as reducing opioid-related adverse events. Funding Source National Institutes of Health grant R21DA036776

New advances in anterior segment optical coherence tomography (OCT) technology development allow visualizing the anterior chamber angle of the eye with high speed and high resolution. Fourier-domain (FD) OCT instruments working at 840 nm can reliably identify fine angle structures such as the Schwalbe's line. This paper demonstrates quantitative angle assessment with 840 nm FD-OCT and provides diagnostic cutoff values for occludable angle detection. This is useful for angle closure glaucoma diagnosis and management. Moreover, 840 nm FD-OCT is a useful tool for postsurgical evaluation in glaucoma patients.

PURPOSE To evaluate interface quality of different corneal lamellar–cut depths with the femtosecond laser and determine a feasible range of depth for femtosecond laser–assisted lamellar anterior keratoplasty. SETTING Casey Eye Institute, Portland, Oregon, USA. DESIGN Experimental study. METHODS Full lamellar cuts were made on 20 deepithelialized human cadaver corneas using the femtosecond laser. The cut depth was 17% to 21% (100 μm), 31%, 35%, 38% to 40%, and 45% to 48% of the central stromal thickness. Scanning electron microscopy images of cap and bed surfaces were subjectively graded for ridge and roughness using a scale of 1 to 5 (1 = best). The graft–host match was evaluated by photography and optical coherence tomography in a simulated procedure. RESULTS The ridge score was correlated with the cut depth (P = .0078, R = 0.58) and better correlated with the percentage cut depth (P = .00024, R = 0.73). The shallowest cuts had the least ridges (score 1.25). The 31% cut depth produced significantly less ridges (score 2.15) than deeper cuts. The roughness score ranged from 2.19 to 3.08 for various depths. A simulated procedure using a 100 μm host cut and a 177 μm (31%) graft had a smooth interface and flush anterior junction using an inverted side-cut design. CONCLUSIONS The femtosecond laser produced more ridges in deeper lamellar cuts. A depth setting of 31% stromal thickness might produce adequate surface quality for femtosecond laser–assisted lamellar anterior keratoplasty. The inverted side-cut design produced good edge apposition even when the graft was thicker than the host lamellar–cut depth.

Purpose. To evaluate Fourier-domain optical coherence tomography (FD-OCT) as an adjunct to traditional slit lamp examination of donor corneas with suspected Anterior Stromal Opacities. Methods. Seven corneas suspected of having anterior stromal opacities by slit lamp examination were evaluated with FD-OCT. Each cornea was evaluated to confirm the presence of opacity and, if present, the depth of opacity was measured. Results. The opacity depth ranged from 82 μm to 624 μm. The initial slit lamp impressions of five of the seven corneas were confirmed by OCT. In two corneas, the OCT findings were different from the initial slit lamp impressions. Slit lamp examination of the first cornea gave the impression of anterior stromal scarring, but OCT showed that the opacity was limited to the epithelium. Slit lamp examination of the second cornea suggested opacity limited to the epithelium, but OCT identified significant sub-Bowman's scarring. In all cases, the Eye Bank Technicians reported that the location and depth of corneal opacity were more sharply defined by OCT than by slit lamp. Conclusion. The high resolution of OCT makes it easier to determine the location of corneal opacities compared to slit lamp examinations. This enhanced visualization can improve decisions regarding transplant suitability of donor corneas.

Purpose To evaluate the DSAEK graft deturgescence in preservation medium after microkeratome cut using Fourier-domain optical coherence tomography (FD-OCT). Methods The central and peripheral thickness of DSAEK graft was measured by FD-OCT immediately after microkeratome cuts as well as 1 hour, 2 hours, 3hours, and 4 hours afterwards. All measurements were taken when the grafts were stored in 4°C preservation medium. The hourly change in central graft thickness and graft shape (peripheral – central graft thickness) was calculated and tracked over time. Results Five DSAEK grafts were measured. The average central graft thickness was 188.7 μm ± 44.4μm (range: 146μm ~ 255μm) immediately after microkeratome cuts. The average central graft thickness was 147.5 μm ± 33.0 μm (range: 116μm ~ 190μm) after 4 hours in preservation medium (p < 0.001). The average hourly change in central graft thickness was -30.5 μm (p = 0.0051), -8.6 μm (p = 0.055), -2.0 μm (p = 0.42) and 0.0 μm (p = 0.93) at 1 hour, 2 hours, 3hours, and 4 hours after microkeratome cuts. The average hourly change in graft shape was insignificant. Conclusion DSAEK grafts become thinner after microkeratome cut and stabilize at about 2 hours. Therefore, DSAEK graft thickness should be measured at 1.5 – 3 hours after microkeratome cut.