PurposeWe determined the receiver operating characteristic (ROC) curves for Peristat online perimetry at detecting varying degrees of glaucoma and the correlation between Peristat online perimetry and Humphrey visual field.MethodsA prospective, comparative study of Peristat online perimetry (an achromatic static computer threshold testing program) and Humphrey visual field (HVF) 24-2 SITA standard testing was performed by 63 glaucoma patients and 30 healthy controls in random order. The number of total adjacent abnormal test points were identified for each test, and compared with Spearman correlation. Receive operating characteristic curves were generated for Peristat online perimetry detection of mild and moderate-severe glaucoma patients using contrast sensitivity thresholds of −16.7, −21.7, and −26.7 dB.ResultsThe area under the ROC curve for glaucoma detection ranged from 0.77 to 0.81 for mild disease (mean deviation [MD], >−6 dB on HVF) and 0.85 to 0.87 for moderate to severe disease (MD, <−6 dB on HVF) depending on contrast threshold. Peristat online perimetry and Humphrey visual field abnormal points were highly correlated with Spearman rank correlations ranging from 0.55 to 0.77 (all P < 0.001).ConclusionsPeristat online perimetry exhibits a reasonable ROC curve without specialized equipment and exhibited significant correlation with the conventional 24° Humphrey visual field test.Translational RelevanceLow cost widely available internet-based visual fields may complement traditional office-based visual field testing.

IMPORTANCEEye health in the homeless population is important, yet follow-up to referral appointments in this population remains low.OBJECTIVE To investigate the association of health coaching and transportation vouchers with follow-up rates at a free ophthalmology homeless shelter clinic. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study was conducted from January 9, 2019, to March 4, 2020, among all 71 patients evaluated at a free ophthalmology clinic at a single homeless shelter in San Francisco, California.EXPOSURES If indicated, patients were referred for advanced ophthalmologic care at a county hospital and free eyeglasses from a nonprofit organization. MAIN OUTCOMES AND MEASURESThe primary outcome was follow-up rates to referral appointments. The secondary outcomes were prespecified baseline variables hypothesized to be associated with follow-up. The intervention began September 4, 2019. Follow-up rates were compared between the preintervention (n = 37) and postintervention (n = 34) groups. The hypothesis was formulated before data collection. RESULTS Among the 71 patients, 50 (70.4%) were men, and the mean (SD) age was 51.9 (12.4) years. A total of 28 patients (39.4%) were referred for free eyeglasses, 14 (19.7%) to the county hospital for advanced care, and 7 (9.9%) to both. Of those referred, the difference in follow-up from the postintervention to preintervention groups was 53.8% (95% CI, 39.8%-67.9%; P < .001). Compared with patients who did not follow up, those who did had a mean difference of 59 more days at the shelter (95% CI, 39-80 days; P = .003). Among patients with a visual acuity of 20/40 or worse in the better-seeing eye, the mean difference between those who did not follow up and those who did was 61% (95% CI, 44%-78%; P = .003). The mean difference in follow-up between patients who were born in the US and patients not born in the US was 89% (95% CI, 79%-98%; P = .02). Of those in the postintervention group, the difference in presentation to follow-up for patients with a high school diploma compared with those without was 59% (95% CI, 37%-81%; P = .001). CONCLUSIONS AND RELEVANCEThis study suggests that a health coaching and bus token intervention improved follow-up rates at a free ophthalmology homeless shelter clinic by at least 39.8%; this improvement supports considering implementation of this intervention when developing public assistance programs if independent corroboration is provided. Barriers to follow-up included a shorter duration of stay at the homeless shelter, visual acuity better than 20/40, not being born in the US, and lower educational level, although the size of this study does not permit determining if some or all of these are associated with one another.

Problem Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools’ curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education. Intervention A multidisciplinary clinician and non-clinician faculty team partnered with a cardiology outpatient clinic to design a nine-month clerkship for first-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013–2014, eight trainees participated in educational seminars, research activities, and nine-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students’ detailed field notes. Context The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the U.S. All educational activities took place at the university’s medical school and at the medical center’s cardiology outpatient clinic. Outcome Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients’ experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented. Lessons Learned The Action Research Program is a small pilot project that demonstrates an innovative pairing of experiential and didactic training in systems-based practice. Lessons learned include the need for dedicated time and faculty support for students’ improvement projects, which were the least successful aspect of the program. We recommend that future projects aiming to combine clinical training and quality improvement projects designate distinct blocks of time for trainees to pursue each of these activities independently. In 2014–2015, the University of California, San Francisco School of Medicine incorporated key features of the Action Research Program into the standard curriculum, with plans to build upon this foundation in future curricular innovations.

The results suggested that the -2518 GG genotype and G allele of MCP-1 are associated with an increased risk of PDR in the Chinese Han population. This polymorphism may influence the expression of the MCP-1 gene, which may play an important role in the pathogenesis of DR.

Patients who received a Retisert implantation had lower IOP and used fewer glaucoma eye drops compared with control eyes at 1-year post-Ahmed valve surgery. This study suggests that long-term, slow-release corticosteroid medication from Retisert (fluocinolone acetonide) may improve the surgical outcome for patients with an Ahmed valve implantation and/or Retisert helps control uveitis in patients with uveitic glaucoma receiving Ahmed valves.