Birmingham and Midland Eye Centre

Introduction Dry eye disease (DED) is a multifactorial condition affecting up to 14.

A systematic review and meta-analysis evaluating the accuracy of DL models in pterygium detection and severity assessment against clinical experts. Deep learning (DL) has made significant progress in diagnosing various ophthalmological conditions. However, its diagnostic performance for pterygium remains elusive and requires further investigation. We systematically searched EMBASE, MEDLINE and other clinical registries between 1974 and February 2025. Relevant peer-reviewed clinical studies examining the diagnostic performance of AI algorithms for diagnosing or grading pterygium were deemed eligible. Risk of bias was assessed using QUADAS-2, and diagnostic accuracy was analyzed using bivariate random-effects models. The protocol is publicly available at the Open Science Framework (https://osf.io/ytpb3). Out of 406 studies identified, 20 studies (45,913 anterior segment photographs from >4460 patients) were included, of which 13 were case-control and seven were cross-sectional. No studies provided external validation data, and one study directly compared DL performance with expert ophthalmologists, which showed similar diagnostic accuracy for diagnosis and grading of pterygium. Most studies had high risk of bias in patient selection (65%) and index test (100%) domains. Based on 14 internal validation studies (8094 images), the summary estimates (95% CI) of sensitivity and specificity for diagnosing pterygium were 98.1% (96.4-99.1) and 99.1% (98.0-99.6). For severity grading (8 studies; 1631 images), summary sensitivity and specificity estimates were 91.2% (87.7-93.7) and 92.9% (88.4-95.8). DL models appear to have high accuracy for diagnosing and grading pterygium and may have comparable performance to clinical experts. However, these findings need to be interpreted with caution due to methodological limitations, including lack of external validation, case-control study designs, lack of pre-specified decision thresholds, and image-based analysis that did not account for within-individual correlation. Future studies should prioritize transparent reporting, prospective designs, external validation, and direct comparisons with clinicians to facilitate the translation of DL technologies for pterygium into clinical practice.

The effect of pre-triage visual acuity (VA) measurement on triage accuracy in a busy ophthalmic casualty department was investigated as a possible means to improve triage quality. All 576 patients attending the accident and emergency department (A&E) at the Birmingham and Midland Eye Centre (BMEC) over a period of 4days were included in this prospective cross-sectional study. Patients were assigned to two groups: those who underwent a VA measurement prior to triage (n = 242) and a control group who did not have a VA measurement (n = 234). Clinicians who were masked from the allocation also assessed whether they agreed with the triage decision after assessing each patient. Triage outcomes were recorded for 469 (81%) patients. Those with a pre-triage VA measurement were more likely to be assessed as more urgent (p = 0.005) and less likely to be discharged (p = 0.04). 248 (43%) patients had clinician response with corresponding triage records, of which 136 (55%) had prior VA measurement and 112 (45%) were in the control group. Clinicians responded that patients with VA measurement prior to triage were more accurately triaged than the control group (66% and 54%; p = 0.03). VA measurement prior to triage can help improve triage accuracy and allow better allocation of resources at an overcrowded eye-dedicated emergency department. However, waiting times may increase due to longer triage duration and more patients to be triaged into urgent pathway. Greater staffing resources may be necessary to complement the proposed change to avoid undermining triage efficiency.

Background/ObjectivesTo examine the clinical characteristics, risk factors and outcomes of contact lens-related bacterial keratitis (CLBK) in a large UK tertiary referral centre.Subjects/MethodsA retrospective analysis of all patients who presented to the Queen’s Medical Centre, Nottingham, UK, with suspected CLBK between October 2015 to September 2022 (a 7-year period) was performed. Relevant data on demographic factors, CL wear behaviour, causes, clinical characteristics, and outcomes were analysed.ResultsWe included 138 patients with CLBK; the mean age was 42.0 ± 17.8 years and 74 (53.6%) patients were male. Most CLBK were related to soft CL wear (94.5%), particularly monthly disposable (42.5%) and daily disposable (24.4%) CLs. Poor CL wear behaviour/hygiene was documented in 57.1% cases. Among the 64 (46.4%) microbiological-positive cases (n = 73 organisms), Pseudomonas aeruginosa (36, 49.3%) and Staphylococcus spp. (16, 21.9%) were most commonly identified. Six (4.3%) cases were polymicrobial. Most (97.0%) patients were successfully treated with topical antibiotics alone, with 80.6% achieving good final corrected-distance-visual-acuity (CDVA) of ≥ 0.30 logMAR. Poor visual outcome (final CDVA < 0.30 logMAR) was significantly associated with presenting CDVA < 0.6 logMAR (p = 0.002) and central ulcer (p = 0.004). Poor corneal healing (complete healing of > 30 days from initial presentation) was significantly associated with age > 50 years (p = 0.028), female gender (p = 0.020), and infiltrate size >3 mm (p = 0.031).ConclusionsPoor CL wear behaviour/hygiene is commonly observed in CLBK, highlighting the importance of improved counselling and awareness regarding CL use and hygiene. When presented early and managed appropriately, most patients are able to achieve good clinical outcomes with medical treatment alone.

Introduction: We report a rare case of an aggressive large-cell neuroendocrine lung tumour, which presented with ocular metastasis. Case Presentation: A 70-year-old lady presented with a 4-week history of left eye pain and photophobia. Ocular examination revealed left-sided episcleritis and she was treated with topical lubricants and steroids. However, she re-presented 6 months later with recurrent left eye symptoms and was found to have an iris stroma amelanotic lesion, posterior synechiae, 360-degrees rubeosis iridis, raised intraocular pressure, and trace vitreous inflammation. Ultrasound biomicroscopy revealed a left thickened iris with an associated ciliary body lesion. Sarcoid-related ocular inflammation was suspected, but a computed tomography (CT) scan of the lung revealed an incidental right upper lobe lesion. Histology from a transcorneal iris biopsy showed a high-grade neuroendocrine carcinoma, and the diagnosis of metastatic lung large-cell neuroendocrine carcinoma was confirmed via high-resolution CT scan, positron emission tomography scan, and CT-guided lung biopsy. She was given multiple courses of different chemotherapy regimens along with palliative radiotherapy. However, the tumour and its metastases continued to progress and she passed away 4 years after her initial presentation. Conclusion: Ocular metastatic large-cell neuroendocrine carcinoma is rare, and the first presentation with ocular metastasis is even rarer. This case highlights the importance of early detection of ocular metastases in order to hasten oncological treatment. A low threshold for systemic investigations and ophthalmology referral in cases of unexplained, refractory ocular symptomatology is essential, given the heterogeneous presentation, rarity, and poor prognosis of these tumours, even with maximal treatment.