Robert P. L. Wisse

The intraoperative optical coherence tomography (iOCT) is recently introduced in Descemet membrane endothelial keratoplasty (DMEK) surgery, which aims to increase clinical performance and surgery safety. However, the acquisition of this modality is a substantial investment. The objective of this paper is to report on the cost‐effectiveness of an iOCT‐protocol in DMEK surgery with the Advanced Visualization in Corneal Surgery Evaluation (ADVISE) trial. This cost‐effectiveness analysis uses data 6 months postoperatively from the multicentre prospective randomized clinical ADVISE trial. Sixty‐five patients were randomized to usual care ( n = 33) or the iOCT‐protocol ( n = 32). Quality‐Adjusted Life Years (EQ‐5D‐5L), Vision‐related Quality of Life (NEI‐VFQ‐25) and self‐administered resources questionnaires were administered. Main outcome is the incremental cost‐effectiveness ratio (ICER) and sensitivity analyses. The iOCT protocol reports no statistical difference in ICER. For the usual care group compared with the iOCT protocol, respectively, the mean societal costs are €5027 compared with €4920 (Δ€107). The sensitivity analyses report the highest variability on time variables. This economic evaluation learned that there is no added value in quality of life or cost‐effectiveness in using the iOCT protocol in DMEK surgery. The variability of cost variables depends on the characteristics of an eye clinic. The added value of iOCT could gain incrementally by increasing surgical efficiency, and aiding in surgical decision‐making.

Purpose To investigate the agreement between an online nurse‐assisted eye‐screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. Methods Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye‐screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye‐screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. Results A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye‐screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye‐screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye‐screening tool, although remarks for further improvements were made. Conclusions The eye‐screening tool is promising for nurse‐assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye‐screening tool in practice, cost‐effectiveness needs to be investigated.