Week in Review: Patient Mail-in Tests for Cataract Surgery Triage, Health Care Visits for Eye Pain, Melatonin and AMD

A weekly roundup of ophthalmic news from around the web.

A blast from the past: Using snail mail for cataract surgery waiting list triage. Researchers in the United Kingdom investigated a low-tech approach to managing cataract surgery assessment waiting lists, involving mailing pen-and-paper contrast sensitivity (CS) tests to 233 randomly selected people on the waiting list of a single secondary care center. Patients were asked to complete 2 SpotCheck CS tests, one for each eye, and return them to the care center; 108 of the patients returned the tests. In general, the CS test scores were able to predict which eyes were most in need of surgery (area under the receiver operative curve 0.69). These results were correlated with findings from in-office tests, including biometry. The authors note that these results indicate that low-cost, low-tech CS tests could feasibly have widespread use, and “complements a wider trend, both in ophthalmology and beyond, towards using ‘asynchronous testing’ to augment more conventional methods of patient assessment.” Eye (London)

In the United States, eye pain is a common reason for health care visits, according to a retrospective, cross-sectional study of 2008–2019 data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. During that time period, there were an estimated 5.6 million visits annually for eye pain, accounting for approximately 0.39% and 0.61% of all outpatient and emergency department (ED) visits, respectively. The most common outpatient visit diagnosis, per ICD-10 codes, was ocular pain, while the most common ED visit diagnosis was injury of the conjunctiva and corneal abrasion without foreign body. Sixteen percent of outpatient visits and 10% of ED visits had a systemic or neurologic diagnosis related to eye pain (e.g., migraine). Most diagnoses were related to non–vision-threatening conditions. JAMA Ophthalmology

Melatonin could have a protective effect against AMD development or progression. A retrospective cohort study used data from the US-based TriNetX federal health network database to assess potential associations between melatonin use and risk of new-onset age-related macular degeneration (AMD) or AMD progression. Of the 121,523 AMD-naïve patients aged ≥50 years included in the study, 4848 were found to be taking prescription melatonin. The melatonin cohort had less risk of being diagnosed with AMD than the non-melatonin cohort (relative risk 0.62), regardless of age. Analysis of a separate population of 66,253 patients with diagnosed nonexudative AMD, 4350 of whom were taking prescription melatonin, found that the risk of progression to exudative AMD was also lower for the melatonin cohort. This was an exploratory study with several limitations and more studies are needed, but the authors conclude that one potential takeaway from the study is that “the protective influence of melatonin on [retinal pigment epithelium] cells and its ability to reduce oxidative stress and resulting [vascular endothelial growth factor] overexpression may contribute to its promising role in AMD management.” JAMA Ophthalmology