OBJECTIVE Closing the knowledge gap that exists between patients and health care providers is essential and is facilitated by easy access to patient education materials. Although such information has the potential to be an effective resource, it must be written in a user-friendly and understandable manner, especially when such material pertains to specialized and highly technical fields such as neurological surgery. The authors evaluated the accessibility, usability, and reliability of current educational resources provided by the American Association of Neurological Surgeons (AANS), Healthwise, and the National Institute for Neurological Disorders and Stroke (NINDS). METHODS Online neurosurgical patient education information provided by AANS, Healthwise, and NINDS was evaluated using the LIDA scale, a website quality assessment tool, by medical professionals and nonmedical professionals. A high achieving score is regarded as 90% or greater using the LIDA scale. RESULTS Accessibility scores were 76.7% (AANS), 83.3% (Healthwise), and 75.0% (NINDS). Average usability scores for the AANS, Healthwise, and NINDS were 73.3%, 82.6%, and 82.9%, respectively, when evaluated by medical professionals and 78.5%, 80.7%, and 75.9%, respectively, for nonmedical professionals, respectively. Average reliability scores were 58.5%, 53.3%, 72.6%, respectively, for medical professionals and 70.4%, 66.7%, and 78.5%, respectively, for nonmedical professionals when evaluating the AANS, Healthwise, and NINDS websites. CONCLUSIONS Although organizations like AANS, Healthwise, and NINDS should be commended for their ongoing commitment to provide health care-oriented materials, modification of this material is suggested to improve the patient education value.

Diabetes mellitus type 1 (DM1) is a metabolic disorder affecting 2 per 1000 school-aged children in the United States. 1 With a possible increase in the prevalence of DM1, the pediatric patient population is expected to be at risk for other health care complications. Diabetic retinopathy (DR) is the leading complication and cause of blindness in the pediatric population with DM1. The presence of DR has been gradually increasing with a prevalence of 10% to 30% contingent on the study. 2 In patients with DM1 younger than 30 years of age, The American Academy of Ophthalmology recommends annual screenings between 3 to 5 years post-diagnosis of disease. 3 The greatest impact on this disease comes from early detection. According to numerous published studies, the use of telemedicine has proved its role as a valid method in diagnosing ocular pathologies. 4 Current imaging modalities, such as spectral domain optical coherence tomography (SD-OCT), have shown morphological changes seen in the retina prior to the loss of visual acuity in the diabetic eye. 5,6 Such pathologies can be associated with known risk factors such as poor glycemic control (HbA1C) and body mass index (BMI). 7 SD-OCT with a resolution of about 5 microns has become a state-of-art technique in the evaluation of diabetic pathology 603371D STXXX10.

Background: Type 1 Diabetes (T1D) Mellitus is a complex, chronic illness that affects half a million children under the age of 15 years. Complications associated with diabetic retinopathy can be prevented with continued self-management of Blood Glucose (BG) and Blood Pressure (BP) into adulthood. In this case, we present a 20-year-old man with a 15 year history of T1D who loses control of his BG and BP for 2 years. Methods: Blood pressure, visual acuity and intraocular pressures were measured at the time of visit. Non-mydriatic retinal imaging was performed using a Canon CR-2 Plus AF with a resolution of 18 megapixel. A Spectral Domain (SD)-OCT provided a 5 micron resolution of the posterior pole including the macula/fovea. Optical Coherence Tomography Angiography (OCTA) (Optovue, Inc., Fremont, CA, USA) captured 6*6 mm angiograms centered on macula. TeamViewer TM was used to perform remote tele-presence tele-ophthalmology. Results: Color Fundus Photo (CFP) of the subject in 2013 showed few hemorrhages with virtually no signs of retinopathy although his BP, last Glycated hemoglobin (HbA1c) and BG were uncontrolled (130/91 mm Hg, 13+, 421 mg/dL, respectively). Two years later, after 15 years of diabetes, his BP, last HbA1c, and BG are still uncontrolled (142/62 mm Hg, 13.5%, and 319 mg/dL, respectively). CFP and tele-consultation confirms severe Non-proliferative diabetic retinopathy (NPDR), after 131 days since last annual eye examination, with 259 retinal hemorrhages and 12 Intraretinal microvascular abnormalities (IRMAs) in his left eye. OCT was normal, but OCTA identified areas of retinal telangiectasia and micro-aneurysm formation. 21 days following NPDR diagnosis, he reduced BP to 122/78 mm Hg, HbA1c to 10%, and BG to 115 mg/dL. CFP showed 80 fewer hemorrhages and 10 IRMAs. 57 days following NPDR diagnosis, subject had BP of 107/72 mm Hg and BG of 124 mg/dL. CFP showed 180 fewer hemorrhages and 13 IRMAs. Conclusions: As BG and BP were decreased and maintained within normal levels, the subject benefited from reduction in retinopathy findings. This case identifies the role non-mydriatic retinal imaging, OCT, and OCTA may play in the assessment and follow-up of patients with long duration type 1 diabetes. Tele-ophthalmology can be an important tool in the follow-up and second opinion of screened patients. An emphasis on BP monitoring can play an important role in the better management of patients with type I diabetes. Close monitoring and maintenance of BP below 130/80, fasting BG under 120 mg/dL, and HbA1c<10% can help reduce NPDR microvascular complications and save vision.

Purpose: To report a case of asymmetric bilateral optic neuropathy in a patient receiving tacrolimus for immunosuppression after kidney transplantation with subsequent stroke-like symptoms of posterior reversible encephalopathy syndrome (PRES). Method: Case report. In a 54-year-old Hispanic male receiving tacrolimus after orthotropic kidney transplantation, serial ophthalmologic examinations, laboratory studies, and imaging were performed. Results: The patient had deterioration of vision in the left eye with subclinical optic neuropathy in the right eye, with clinical features resembling ischemic optic neuropathy. Additionally, he developed a change in mental state with weakness of extremities. After the cessation of tacrolimus, the visual loss remained but the other neurologic symptoms resolved. Conclusion: Tacrolimus may be associated with optic neuropathy and PRES at the initial presentation to an ophthalmologist.

BACKGROUND:To analyze changes over a 3-year period in ganglion cell complex (GCC) thickness in individuals with type 1 diabetes mellitus (T1DM) using spectral-domain optical coherence tomography (Optovue, Fremont, CA, USA).METHODS:Thirty-seven individuals from “Friends for Life Conference” with T1DM and a 3-year history of GCC thickness measurements were included in the study. Data analysis using SPSS 22 and Excel StatPlus was completed to note the subgroups that had a significant change.RESULTS:Significant decreases were noted in the following subgroups with slope in parenthesis. Overall: GCC superior thickness OD (−0.48)Male: GCC thickness OD (−0.86), GCC superior thickness OD (−0.735)Body mass index (BMI) 25.0–29.9: GCC thickness OD (−0.48), GCC superior thickness OS (−0.915), GCC inferior thickness OD (−0.43)Ages 10–20 years: GCC superior thickness OD (−0.635)Duration of diabetes 10–20 years: GCC thickness OD (−1.055), GCC superior thickness OD (−0.99). CONCLUSION:GCC loss was noted in individuals who were males, those with BMIs of 25.0–29.9, and those who had diabetes for 10–20 years. Ganglion cell loss was also noted before the presence of any diabetic retinopathy, suggesting onset of neuronal loss before any vasculature changes.

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Our preliminary results show that in this cohort, vegetarians had statistically significant lower levels of autofluorescence. These findings can have potential implications regarding long-term retinal health and risk for developing certain diseases over decades in subjects at risk for vision-threatening diseases.

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