BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

Human ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Ophthalmologists

Asia ; COVID-19 ; Humans ; Ophthalmologists ; Perception ; SARS-CoV-2

Objective: To determine the knowledge, attitudes, and practice patterns of ophthalmologists practicing in the Philippines on the diagnosis and management of dry eye disease through a survey using an online questionnaire. Methods: A simple online survey was designed to determine the knowledge of ophthalmologists practicing in the Philippines on the definition, symptoms, diagnostics, as well as their management of dry eye disease. Respondents also provided information regarding setting and characteristic of practice, years of practice, field of practice, and number of new dry eye patients weekly. Results: A total of 148 ophthalmologists responded to the survey with a 16% response rate. Most believed dry eye disease was associated with symptoms of ocular discomfort (99%), tear deficiency (98%), and tear film instability (97%). Symptoms believed to be associated with dry eye were dryness (97%), burning sensation (94%), foreign body sensation (93%), and discomfort/pain (93%). Most ophthalmologists diagnosed dry eye based on patient symptoms (99%), tear break-up time (93%), and fluorescein staining (91%). Very few tested for tear osmolarity to diagnose dry eye (6%). Only few used dry eye questionnaires (27%) and lissamine staining (32%). The most valuable tests included tear break-up time (92%), fluorescein staining (88%), Schirmer test (85%), and meibomian gland evaluation (83%). Treatments most commonly used were artificial tear supplements (100%), lid hygiene (94%), environmental modification (92%), and work and lifestyle modification (88%). Artificial tear supplements were the most valuable treatment (100%), followed by lid hygiene (89%) then environmental modification (85%). The most common first-line medications were carboxymethylcellulose (89%), propylene glycol (85%), and hypromellose (83%). Very few ophthalmologists classified dry eye by type (19%) and by severity (35%), but 80% tailored their treatment to the severity of the dry eye. Conclusion Dry eye disease is a common yet frequently underrecognized clinical condition whose etiology and management challenge clinicians and researchers alike. This study showed that ophthalmologists practicing in the Philippines who answered the survey lacked awareness on the new definition of dry eye disease, the newer diagnostic tests, and therapeutics available for diagnosing and managing dry eye disease.
Dry Eye Syndromes ; Surveys and Questionnaires ; Attitude ; Philippines ; Ophthalmologists

No abstract available.
Physical Phenomena ; Prostatitis ; Helicobacter Infections ; Helicobacter pylori ; Central Serous Chorioretinopathy ; Diabetes, Gestational ; Ophthalmologists ; Phosphatidylinositol 3-Kinases ; Diagnosis, Differential ; Physicians ; Writing ; Speech ; Thinking ; Prognosis ; Otolaryngology ; Internal Medicine ; Pelvic Pain ; Polyneuropathies ; Korea

INTRODUCTIONPerioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.

METHODSThis was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.

RESULTSA total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).

CONCLUSIONThe current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.

Adult ; Anesthesia, Local ; methods ; Anesthesiologists ; statistics & numerical data ; Blood Glucose ; analysis ; Cataract Extraction ; Cross-Sectional Studies ; Diabetes Mellitus ; blood ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Ophthalmologists ; statistics & numerical data ; Perioperative Care ; methods ; Singapore ; epidemiology ; Surveys and Questionnaires

OBJECTIVE: The aim of the study was to determine the prevalence of diabetic patients seeking an ophthalmic evaluation for diabetic retinopathy. Specific objectives were to describe the prevalence and risk factors for diabetic retinopathy (DR) in a group of diabetic patients referred for retinal evaluation from different internists in Laguna by screening using digital retinal photography.

METHODS: The study was a hospital-based mixed method study involving two portions: quantitative (cross-sectional) and qualitative. The cross-sectional portion involved patients diagnosed with type 2 diabetes by internists from San Pablo Colleges Medical Center referred for retinal evaluation using a non-mydriatic retinal camera. Retinal photographs were categorised for the presence and severity of diabetic retinopathy according to the international clinical DR severity scales recommended by the Global Diabetic Retinopathy Project Group. The qualitative portion involved a focus group discussion among diabetic patients and a short key informant interview with the referring internists.

RESULTS: Sixty-seven (67) diabetic patients were evaluated for diabetic retinopathy (DR) using digital retinal photography. The overall prevalence of any DR was 26% (n=18): 55% mild NDPR, 33% moderate NDPR, 6% severe NPDR and 6% PDR. Diabetic macular edema (DME) was present in 22% of patients with any form of DR. The focus group discussion reported the following reasons for consulting an ophthalmologist: presence of blurring of vision, availability of budget, knowledge of the need for ophthalmic evaluation, and order for evaluation by the internist. Interviews among the referring internists revealed three primary reasons for referring: history of visual disturbances, uncontrolled diabetes and finances of the patient.

CONCLUSION: This study presented a lower prevalence rate of diabetic retinopathy among patients who underwent digital retinal photography compared to that of other studies published in the Philippines. Nevertheless, it is important to continue patient education with regards to diabetic complications in the eye, and improve the referral system among medical practitioners.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Diabetes Mellitus, Type 2 ; Macular Edema ; Prevalence ; Ophthalmologists ; Retina

OBJECTIVE: To determine the relationship between hypothyroidism and color vision deficiency among Filipinos ages 20-60 years
DESIGN AND METHODS: A cross-sectional study was performed on 91 biochemically hypothyroid and euthyroid patients seen at the Makati Medical Center from July to December 2013. All subjects underwent the Ishihara color test, followed by the Farnsworth-Munsell D15 test if this was positive. The patient who tested positive in the Farnsworth-Munsell D15 test was referred to an ophthalmologist to rule out any anatomic problem, and was excluded from the study if found to have any. Fisher's exact test assessed the significant correlation between hypothyroidism and color vision deficiency. A p-value less than 0.05 was considered significant.
RESULTS: Of the 91 patients that were included in the study, the average age was 42 years, majority (87%) were females, and 41% were biochemically hypothyroid. All euthyroid patients (100%) had normal color vision, while one hypothyroid patient (3.0%) tested positive for color vision deficiency (p-value 0.407).
CONCLUSION: Based on this study, the hypothyroid state of the patients had no effect on their color vision, unlike those seen in rodents, probably because mature human cones are not as easily affected by changes in thyroid hormone levels.

Human ; Male ; Female ; Middle Aged ; Adult ; Color Vision Defects ; Color Vision ; Ophthalmologists ; Retinal Cone Photoreceptor Cells ; Thyroid Hormones ; Hypothyroidism

Behcet's disease is a chronic, relapsing, inflammatory multisystem disorder characterized by recurrent oral and genital ulcerations along with eye lesions (anterior uveitis, posterior uveitis, cells in vitreous on slit lamp examination, retinal vasculitis observed by ophthalmologist), skin lesions (erythema nodosum, pseudofolliculitis, papulopustular lesions, acneiform nodules), arthralgia, central nervous system and vascular involvement, and gastrointestinal manifestations. The etiology of Behcet's disease remains unknown. We report a case of a 48-year-old male with a 25-year-history of blindness, recurrent ulcers on mucosal surfaces, and papulopustular lesions on the trunk. Dapsone is an easily available, cheap and relatively safe drug, useful particularly in the management of the mucocutaneous symptoms of Behcet's disease. Dapsone 100 mg was given daily for one month which resulted in improvement of skin and mucosal lesions. Early diagnosis and treatment of this condition is important to prevent irreversible organ damage and mandatory to reduce mortality and morbidity.

Human ; Male ; Middle Aged ; Arthralgia ; Behcet Syndrome ; Blindness ; Dapsone ; Early Diagnosis ; Erythema Nodosum ; Ophthalmologists ; Retinal Vasculitis ; Skin ; Slit Lamp Microscopy ; Ulcer ; Uveitis, Anterior ; Uveitis, Posterior

By any standard, our national hero, Jose Rizal, is one of the most interesting, brilliant, enigmatic, charismatic, and controversial figures in history. There seems to be always something new to discover about him and debates around him prevail to this day. It is no wonder, therefore, that this year 2011, the 150th anniversary of his birth, almost every columnist, every commentator, every radio and television station, has had something to say about some special “little known” facts about our national hero. During the past year, there had been numerous reports in all forms of media about Rizal as sportsman and excellent student, as someone who had prophetic dreams, as a world traveler, a romantic, an artist, a political activist, as polyglot who spoke 22 languages and dialects, and of course, as a writer and martyr. Even topics as mundane as where he tied his horse when he visited his childhood sweetheart have generated interest. The list goes on and on.
Ophthalmologists