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Eye Infections

Author/s: 
Marlene L Durand, Miriam B Barshak, Lucia Sobrin

Eye infections are an important cause of vision loss worldwide. Patients with these infections are commonly seen by primary care providers, internists, emergency medicine specialists, hospitalists, and ophthalmologists. Each year in the United States alone, conjunctivitis accounts for more than 550,000 visits to emergency departments1 and many more visits to outpatient offices, keratitis is diagnosed at more than 1 million office and emergency department visits,2 exogenous endophthalmitis complicates up to 0.1% of the more than 7 million cataract surgeries and intravitreal injections performed,3-5 and thousands of patients are admitted to general hospitals to treat vision-threatening eye infections such as endogenous endophthalmitis and infectious uveitis. This review summarizes the epidemiology, diagnosis, and treatment of eye infections. Figure 1 illustrates eye anatomy as it relates to eye infections. Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org, summarizes the microbiologic features, clinical characteristics, and treatment of these infections.

Keywords 
eye infection eyes Ophthalmologists Ophthalmology

Visual Acuity Assessment and Vision Screening Using a Novel Smartphone Application

Author/s: 
Zhao, L, Stinnett, SS, Prakalapakom, SG

OBJECTIVES:

To evaluate a smartphone-based application's (Peek Acuity) ability to assess visual acuity and screen for ocular conditions in children, we compared visual acuity assessment between Peek Acuity and the pediatric ophthalmology examination and evaluated Peek Acuity's ability to identify children with referable ocular conditions.

STUDY DESIGN:

We prospectively recruited 111 children age 3-17 years, presenting to a pediatric ophthalmology clinic, who could follow instructions. Monocular visual acuity assessments by Peek Acuity and standard clinical methods were performed in randomized order. We compared visual acuity assessments between methods using intraclass correlation coefficient (ICC) and evaluated Peek Acuity's ability to identify children with referable ocular conditions.

RESULTS:

ICC comparing visual acuity assessed between methods was 0.88 (95% CI 0.83-0.92) for first and 0.85 (95% CI 0.78-0.89) for second eyes examined. ICC among 3 to 5-year-olds (preschool-age children) was 0.88 (95% CI 0.77-0.94) for first and 0.45 (95% CI 0.13-0.68) for second eyes examined. Peek Acuity had a sensitivity of 83%-86% for decreased vision and 69%-83% for referable ocular disease. Sensitivity was highest among 3 to 5-year-olds with decreased vision, 93%-100%.

CONCLUSIONS:

Overall, Peek Acuity visual acuity assessment correlated well with visual acuity assessed by standard clinical methods, though preschool-age children appeared more susceptible to examination fatigue. Peek Acuity performed adequately as a screening tool and had the greatest sensitivity among those with decreased vision and preschool-age children.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT03212222.

Keywords 
peek acuity preschool-age children school-age children vision screening
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