Purpose To investigate bacterial dispersion with patient face mask use during simulated intravitreal injections. Design Prospective cross-sectional study MethodsSetting Single-center Study Population Fifteen healthy subjects were recruited Intervention Each participant was instructed not to speak for 2-minutes, simulating a “no-talking” policy, while in an ophthalmic examination chair with an blood agar plate secured to the forehead and wearing various face masks (no mask, loose fitting surgical mask, tight-fitting surgical mask without tape, tight-fitting surgical mask with adhesive tape securing the superior portion of the mask, N95 mask, and cloth mask). Each scenario was then repeated while reading a 2-minute script, simulating a talking patient. Main Outcome Measures Number of colony-forming units (CFU) and microbial species. Results During the “no-talking” scenario, subjects wearing a tight-fitting surgical mask with tape developed fewer CFUs compared to subjects wearing the same mask without tape (difference, 0.93CFU; 95%CI, 0.32–1.55; P =.003). During the speech scenarios, subjects wearing a tight-fitting surgical mask with tape had significantly fewer CFUs compared to subjects without a face mask (difference, 1.07CFU; P =.001), subjects with a loose face mask (difference, 0.67; P =.034), and subjects with a tight face mask without tape (difference, 1.13; P <.001). There was no difference between those with a tight-fitting surgical mask with tape and an N95 mask in the “no-talking” ( P >.99) and “speech” ( P =.831) scenarios. No oral flora was isolated in “no-talking” scenarios, but was isolated in 8/75 (11%) cultures in speech scenarios ( P =.02). Conclusion Addition of tape to the superior portion of a patient’s face mask reduced bacterial dispersion during simulated intravitreal injections, and had no difference in bacterial dispersion compared to wearing N95 masks.

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The coronavirus disease 2019 (COVID-19) pandemic has drastically changed how comprehensive ophthalmology practices care for patients. OBJECTIVE To report practice patterns for common ocular complaints during the initial stage of the COVID-19 pandemic among comprehensive ophthalmology practices in the US. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, 40 private practices and 20 university centers were randomly selected from 4 regions across the US. Data were collected on April 29 and 30, 2020. INTERVENTIONS Investigators placed telephone calls to each ophthalmology practice office. Responses to 3 clinical scenarios-refraction request, cataract evaluation, and symptoms of a posterior vitreous detachment-were compared regionally and between private and university centers. MAIN OUTCOMES AND MEASURES The primary measure was time to next appointment for each of the 3 scenarios. Secondary measures included use of telemedicine and advertisement of COVID-19 precautions. RESULTS Of the 40 private practices, 2 (5%) were closed, 24 (60%) were only seeing urgent patients, and 14 (35%) remained open to all patients. Of the 20 university centers, 2 (10%) were closed, 17 (85%) were only seeing urgent patients, and 1 (5%) remained open to all patients. There were no differences for any telemedicine metric. University centers were more likely than private practices to mention preparations to limit the spread of COVID-19 (17 of 20 [85%] vs 14 of 40 [35%]; mean difference, 0.41; 95% CI, 0.26-0.65; P < .001). Private practices had a faster next available appointment for cataract evaluations than university centers, with a mean (SD) time to visit of 22.1 (27.0) days vs 75.5 (46.1) days (mean difference, 53.4; 95% CI, 23.1-83.7; P < .001). Private practices were also more likely than university centers to be available to see patients with flashes and floaters (30 of 40 [75%] vs 8 of 20 [40%]; mean difference, 0.42; 95% CI, 0.22-0.79; P = .01). CONCLUSIONS AND RELEVANCE In this cross-sectional study of investigator telephone calls to ophthalmology practice offices, there were uniform recommendations for the 3 routine ophthalmic complaints. Private practices had shorter times to next available appointment for cataract extraction and were more likely to evaluate posterior vitreous detachment symptoms. As there has not been a study examining these practice patterns before the COVID-19 pandemic, the relevance of these findings on public health is yet to be determined.

To describe characteristics and outcomes of primary rhegmatogenous retinal detachment in older adults (age $ 80).Methods: Consecutive patients with rhegmatogenous retinal detachment undergoing pars plana vitrectomy (PPV), scleral buckling (SB), or PPV/SB in the Primary Retinal Detachment Outcomes Study were evaluated. Outcome measures included single surgery anatomic success and visual acuity.Results: Of 2,144 patients included, 125 (6%) were 80 years or older. Compared with younger patients (age 40-79), older adults were more likely to be pseudophakic (P , 0.001), have macula-off detachments (P , 0.001), and have preoperative proliferative vitreoretinopathy (P = 0.02). In older adults, initial surgery was PPV in 73%, PPV/SB in 27%, and primary SB in 0%. Single surgery anatomic success was 78% in older adults compared with 84% in younger patients (P = 0.03). In older adults, single surgery anatomic success was 74% for PPV and 91% for PPV/SB (P = 0.03). The final mean logMAR was lower for older adults (0.79 [20/125] vs. 0.40 [20/40], [P , 0.001]). In older adults, the final mean logMAR for eyes that underwent PPV was 0.88 (20/160) compared with 0.50 (20/63) for PPV/SB (P = 0.03).Conclusion: Octogenarians and nonagenarians presented with relatively complex pseudophakic rhegmatogenous retinal detachments. Single surgery anatomic success and visual outcomes were worse compared with younger patients, and PPV/SB had better outcomes compared with PPV alone.RETINA 41:947-956, 2021W ith the population of older Americans expected to double by 2050, the number of elderly patients undergoing primary rhegmatogenous retinal detachment (RRD) surgery has been projected to grow substantially in the coming years. 1 In particular, the population of octogenarians and nonagenarians is expected to increase from 9.3 million in 2000 to 19.5 million in 2030. 2 These patients will be a critical segment of the population undergoing RRD repair given that the annual incidence of primary RRD is approx-imately 10 to 15/100,000 with a lifetime risk of up to 3% by the age of 85. 3,4 Previous studies have suggested that older age may be a predictor of worse anatomic and visual outcomes after RRD surgery. 5,6 These findings raise concerns about the safety and efficacy of surgical interventions in view of the unique considerations in older adults including anesthesia risks, medical comorbidities, and postoperative positioning. [7][8][9] Currently, published data on outcomes of retinal detachment surgery in older 947

Objective This study aimed to evaluate the experiences and preferences of ophthalmology fellowship applicants utilizing a virtual interview format. Design Present study is a cross-sectional study. Subjects All fellowship applicants to Wills Eye Hospital during 2020 to 2021 application cycle were included. Methods A nonvalidated, online survey was conducted, and surveys were distributed at the conclusion of the interview process after rank list submission. Main Outcome Measures Applicant demographics, application submissions, interview experiences, financial considerations, and suggestions for improvement of the virtual interview process were the primary outcomes of this cross-sectional study. Results Survey responses were received from 68 fellowship applicants (34% response rate). Thirty (44%) applicants preferred in-person interviews, 25 (36%) preferred virtual interviews, and 13 (19%) would like to prefer the option to choose either. Fifty-five of 68 (80%) applicants attended the same range of interviews for which they received interview invitations. Reduced costs were reported as the highest ranked strength of virtual interviews in 44 (65%) applicants, with a majority of respondents (68%) spending less than U.S. $250 throughout the entire process. The highest ranked limitation for virtual interviews was limited exposure to the culture/environment of the program in 20 (29%) respondents. On a scale of 0 to 100, the mean (standard deviation [SD]) satisfaction level with the fellowship application process was 74.6 (18.3) and mean (SD) perceived effectiveness levels of virtual interviews was 67.4 (20.4). Conclusion Respondents were generally satisfied with virtual interviews and noted reduced costs and increased ability to attend more fellowship interviews as the strengths of the virtual interview format. Limited exposure to the culture/environment of the program was cited as the most important limitation.

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Background/Purpose: To identify geographic and socioeconomic variables predictive of residential proximity to retinopathy of prematurity (ROP) clinical trial locations.Methods: This cross-sectional epidemiological study used census tract-level data from three national public data sets and trial-level data from ClinicalTrials.gov. Socioeconomic predictors of driving distance and time to the nearest ROP clinical trial location were identified. Primary outcomes were time .60 minutes and distance .60 miles traveled to the nearest ROP clinical trial site.Results: Multivariate analysis showed that residents were more likely to travel .60 minutes to the nearest ROP clinical trial site if they lived in census tracts that were rural (adjusted odds ratio 1.20, P = 0.0002), had higher percentages of the population living # federal poverty level (fourth quartile vs. first quartile, adjusted odds ratio 1.19, P , 0.0001), or had less education (associate vs. bachelor's degree, adjusted odds ratio 1.01, P ,0.007). By contrast, counties with higher percentages of births with birth weight ,1500 g (adjusted odds ratio 0.88, P = 0.0062) were less likely to travel .60 minutes. Similar variables predicted travel distance.Conclusion: Although counties with higher incidences of very low-birth-weight infants were closer to ROP clinical trial sites, residents living in rural and low-income census tracts had significantly greater travel burdens.