SPS-315 Pediatric Cornea | ASCRS
2020 ASCRS Virtual Annual Meeting

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Papers in this Session
Expand each tab below to view the paper abstract for each paper within this session.
Corneal Crosslinking As a Treatment of Keratoconus in Pediatric Patients
Authors
Rodrigo A. Quesada, MD
Gabriel Quesada, MD
Kevin L. Waltz, MD, OD

Purpose
Evaluate the safety and efficacy of corneal crosslinking as a treatment for progressive keratoconas in pediatric patients.

Methods
Retrospective case control series of 50 eyes in 52 patients, aged 2 to 17 years. After 6 months of observation with topographic evidence of progressive ectasia all eyes received crosslinking. Corneal crosslinking was performed with the IROC 1000 and IROC 2000 equipment, removing the epithelium and complying with the Dresden protocol. All patients have a minimum of 5 years and a maximum of 10 years of post operative follow-up with refractive measurements, visual acuity, pachymetries and serial topographies. Visual acuity, topography and manifest refractions were performed at month 1, 3.6 and 12 months and after 1 year every 6 months for a minimum of 60 months

Results
In all follow-up visits of up to 5 years, the maximum keratometry values improved significantly (mean change at 5 years -2.06 diopters (p = 0.01). - The average keratometry, uncorrected distance visual acuity and corrected stance visual acuity improved in all follow-up periods, although not always with the level of statistical significance. You need to spell this out in detail. - In 9 eyes (18%), keratoconus had progressed in terms of increased keratometry> 1.0 diopter at the last follow-up visit, despite treatment with Cross-linking.

Conclusion
Epithelium off cross-linking appears to be safe and effective in the treatment of childhood keratoconus, achieving stable long-term results out to at least 5 years. Given the typical progression of Keratoconus often observed in pediatric patients, cross-linking treatment should be performed before disease progression occurs
A Novel Epidemiological Approach to Geographically Mapping Dry Eye Disease in the United States through Google Trends
Authors
Daniel B. Azzam
Nitish Nag, MD, PhD
Julia Tran
Lauren E. Chen, MS
Kaajal M. Visnagra
Matthew Wade, MD

Purpose
Our study fills the spatiotemporal gaps in current dry eye disease (DED) epidemiology by using Google Trends as a novel epidemiological tool for monitoring DED. We provide a proof of concept analysis of how internet search intent can be extrapolated to geographically map DED in relation to environmental risk factors like temperature and humidity.

Methods
We utilized the online Google Trends dataset in order to extract DED queries as a population estimation of users’ intent from 2004 to 2019 in the United States (US). We downloaded data for a list of DED symptoms and treatments frequently encountered in clinical practice, and a list of control queries. Climate data were collected from the US National Climatic Data Center and incorporated to generate geographic heat maps for comparison of the spatial, temporal, and environmental relationships of DED search intent, temperature, and humidity across the four US census regions of West, Midwest, South, and Northeast. Statistical analysis was conducted using One-Way ANOVA and linear regression.

Results
Our results illustrated the temporal rise and spatial relationship of DED search intent across US geography, and the environmental influence on DED search volume. Localized patches of DED interest were visualized across the map, mostly along the coast. There was no significant difference in DED queries across US census regions (ANOVA, p-value=0.3543). However, temperature and humidity differed significantly between regions (ANOVA, p-value <0.0001 and <0.01, respectively), with the Northeast being the coldest and most humid. DED queries and temperature showed a moderately strong positive linear correlation (r=0.56), while DED queries and humidity showed no linear relationship (r=0.10).

Conclusion
Our study used Google Trends as a novel epidemiologic approach to geographically map DED in the US. Of note, temperature was a stronger environmental predictor of DED searches than humidity. Our work paves the way for future exploration of geographic information systems for locating dry eye and other diseases via online population disease metrics.
Observations of the Ergonomic Posture of Ophthalmologists
Authors
Alexander Knezevic, MD
Stephanie H. Noh
Kayvon A. Moin
Matthew Wade, MD

Purpose
To observe the ergonomic posture of attending ophthalmologists with a posture tracking device and survey their rates of musculoskeletal pain.

Methods
Attending ophthalmologists from a single academic institution were invited to participate in this study. Posture was recorded through a posture tracking device as “upright” or “slouched”. “Slouched” posture was defined as a 52 degree deviance from a calibrated neutral posture. Data was collected over the duration of one clinic day for each physician (11) and one operating room day for most of the physicians (8). The same participants completed a survey (adapted from the Nordic Questionnaire) recording rates of neck, shoulder, and back pain.

Results
In clinic, the mean percentage of time spent in “slouched” posture was 23.6% (n = 11) with a mean clinic day duration of 5.5 hours. In the operating room, the mean percentage of time spent in “slouched” posture was 18.1% (n = 8) with a mean operating day duration of 6.1 hours. 9 ophthalmologists completed the survey. 66.7% (6) reported neck pain, 55.6% (5) reported shoulder pain, 77.8% (7) reported upper back pain, and 77.8% (7) reported lower back pain in the past 12 months.

Conclusion
Musculoskeletal pain, particularly neck and back pain, is a common symptom of ophthalmologists. While musculoskeletal disorders (MSDs) are often multifactorial in nature, posture is an important component of practicing safe workplace ergonomics.
Improving Ergonomic Posture of Ophthalmologists with Posture Trainer Device
Authors
Stephanie H. Noh
Alexander Knezevic, MD
Kayvon A. Moin
Matthew Wade, MD

Purpose
To test if there is an improvement in posture using a posture trainer device for attending ophthalmologists while performing clinical duties.

Methods
Attending ophthalmologists from a single academic institution were invited to participate in this study. Posture was recorded through a posture tracking device as “upright” or “slouched”. “Slouched” posture was defined as a 52 degree deviance from a calibrated neutral posture. During training, the device will emit a small, non-painful vibration when the subject is in a “slouched” posture. Pre-training and post-training postures were compared.

Results
Two ophthalmologists (both cornea specialists) completed the study. The mean pre-training percentage of time spent in bad posture was 8.4%. The mean post-training percentage of time spent in bad posture was 3.7%. There was no statistically significant difference in mean percentage of time spent in bad posture when comparing pre and post training (p > 0.05).

Conclusion
Improving posture is an important component of workplace ergonomics. While our results were not statistically significant, our study would greatly benefit from increasing the sample size. Further research is needed to validate the efficacy of using a posture trainer device in improving physicians’ postures.

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