AJO International最新文献_第4页

Optimizing glaucoma care in Ghana: a mixed-methods study of optometrists' practices, challenges, and capacity needs 优化加纳青光眼护理：验光师实践、挑战和能力需求的混合方法研究

AJO International

Pub Date : 2025-11-30 DOI: 10.1016/j.ajoint.2025.100204

Irene Nkansa-Kyeremateng , Albert Kwadjo Amoah Andoh , Eldrick Adu Acquah , Isaiah Osei Duah Junior , Beatrice Okrah , Kwadwo Owusu Akuffo

Purpose

To assess the practice patterns, challenges, and improvement strategies in glaucoma care among optometrists in Ghana.

Design

A cross-sectional study using a mixed-methods approach.

Methods

Quantitative data on demographics, clinical practices, associated factors, perceived barriers, and recommendations for improved glaucoma care were collected from 293 licensed optometrists registered with the Ghana Optometric Association using a structured questionnaire (distributed both in-person and online via Microsoft Forms), yielding a response rate of 44.1%. Qualitative insights were obtained through semi-structured interviews with nine optometrists, selected using purposive stratified sampling.

Results

Most respondents had formal training in glaucoma care through didactic courses and practical training in their completed degree programs. However, over one-third lacked standardized clinical care protocols. Clinical care centered on intraocular pressure measurement and optic nerve evaluation, with medical therapy as the primary treatment. Referrals were commonly triggered by poor treatment response (mainly based on IOP measurement) or advanced disease. The existence of clearly defined clinical protocols demonstrated a statistically significant association with increased provision of glaucoma care among optometrists (p = 0.008). Thematic analysis identified key challenges to the provision of glaucoma care, including patient noncompliance, financial barriers, and limited access to diagnostic tools. Recommended strategies for improvement included enhanced training, improved diagnostic infrastructure, and increased public education.

Conclusion

Optometrists play a vital role in glaucoma care in Ghana. However, gaps in guideline awareness, protocol use, and diagnostic capacity remain. Strengthening training, equipping clinics, and promoting public education are essential to improving glaucoma care nationwide.

目的评估加纳验光师青光眼护理的实践模式、挑战和改进策略。采用混合方法设计一项横断面研究。方法采用结构化问卷（通过Microsoft Forms当面和在线分发）收集293名在加纳验光协会注册的验光师的人口统计学、临床实践、相关因素、感知障碍和改善青光眼护理建议的定量数据，回复率为44.1%。定性的见解是通过半结构化访谈获得的9名验光师，选择使用有目的的分层抽样。结果大多数受访者在完成学位课程后，通过教学课程和实践培训接受了青光眼护理方面的正式培训。然而，超过三分之一的医院缺乏标准化的临床护理方案。临床护理以眼压测量和视神经评价为主，以药物治疗为主。转诊通常由治疗效果差（主要基于IOP测量）或疾病晚期引发。明确定义的临床方案的存在与验光师青光眼护理的增加有统计学意义的关联（p = 0.008）。专题分析确定了提供青光眼护理的主要挑战，包括患者不遵守规定、经济障碍和获得诊断工具的机会有限。建议的改进战略包括加强培训、改进诊断基础设施和增加公共教育。结论验光师在加纳青光眼护理中起着至关重要的作用。然而，在指南认识、方案使用和诊断能力方面仍然存在差距。加强培训、为诊所配备设备、促进公众教育是改善全国青光眼护理的必要条件。

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引用次数: 0

Xen45 gel stent versus trabeculectomy for glaucoma: A systematic review and meta-analysis of efficacy and safety Xen45凝胶支架与小梁切除术治疗青光眼：疗效和安全性的系统评价和荟萃分析

AJO International

Pub Date : 2025-11-19 DOI: 10.1016/j.ajoint.2025.100202

Jumanah Qedair , Konrad Schargel , Sami AlShahwan , Ibrahim AlObaida

Purpose

Although trabeculectomy is invasive, it remains the gold standard for refractory glaucoma. The XEN45 Gel Stent provides a minimally-invasive alternative; however, comprehensive data comparing its efficacy and safety to trabeculectomy remain limited. This meta-analysis evaluates outcomes between XEN45 and trabeculectomy.

Design

We conducted a systematic review and meta-analysis, following PRISMA guidelines.

Methods

We searched PubMed, Web of Science, and CENTRAL from inception to July 2025. We pooled weighted mean differences (WMDs), proportions, and odds ratios (ORs), using random-effects maximum likelihood models. Primary outcomes included intraocular pressure (IOP) reduction; complete success, qualified success, and failure rates; and risk of hyphema and hypotony.

Results

Twelve studies (2,381 eyes [XEN45: 1,106; trabeculectomy: 1,275]) were included. Open-angle glaucoma was the predominant diagnosis (XEN45: 78.7 %; trabeculectomy: 74.7 %). Trabeculectomy showed greater IOP reduction rates (WMD: 11.9 mmHg [95 % CI: 10.2–13.7]) compared to the XEN45 Gel Stent (WMD: 9.1 mmHg [95 % CI: 7.4–10.8], p=0.02). Trabeculectomy achieved higher complete success rates (63.0 % [95 % CI: 56.0–70.0]) than XEN45 (47.0 % [95 % CI: 40.0–55.0], p=0.004), with no significant difference in qualified success (67.0 % vs. 58.0 %, p=0.44). Failure rates were significantly lower in the trabeculectomy group (10.0 % vs. 25.0 %, p=0.002). XEN45 demonstrated a superior safety profile, with significantly reduced risks of hyphema (OR: 0.34, p=0.04), hypotony (OR: 0.31, p=0.01), bleb fibrosis (OR: 0.68, p=0.01), and bleb leak (OR: 0.16, p<0.01).

Conclusion

Trabeculectomy demonstrates superior IOP control and higher complete success rates, but at the expense of a higher complication profile. XEN45 offers a relatively safer but less effective alternative. A patient-tailored approach is essential when selecting the optimal surgical intervention.

目的虽然小梁切除术是侵入性的，但它仍然是治疗难治性青光眼的金标准。XEN45凝胶支架提供了一种微创的替代方案；然而，比较其与小梁切除术的有效性和安全性的综合数据仍然有限。本荟萃分析评估了XEN45和小梁切除术之间的结果。我们按照PRISMA指南进行了系统回顾和荟萃分析。方法检索PubMed、Web of Science和CENTRAL，检索时间为建站至2025年7月。我们使用随机效应最大似然模型合并加权平均差（wmd）、比例和比值比（ORs）。主要结局包括眼内压（IOP）降低；完全成功、合格成功和失败率；还有前房积血和低血压的风险。结果纳入12项研究（2,381只眼[XEN45: 1,106；小梁切除术：1,275]）。开角型青光眼是主要诊断（XEN45: 78.7%；小梁切除术：74.7%）。与XEN45凝胶支架（WMD: 9.1 mmHg [95% CI: 7.4-10.8], p=0.02）相比，小梁切除术显示了更高的IOP降低率（WMD: 11.9 mmHg [95% CI: 10.2-13.7]）。小梁切除术的完全成功率（63.0% [95% CI: 56.0-70.0]）高于XEN45 (47.0% [95% CI: 40.0-55.0], p=0.004)，但合格成功率无显著差异（67.0%对58.0%,p=0.44）。小梁切除术组的失败率明显较低（10.0%比25.0%,p=0.002）。XEN45显示出优越的安全性，可显著降低前房积血（OR: 0.34, p=0.04）、低血液量（OR: 0.31, p=0.01）、水泡纤维化（OR: 0.68, p=0.01）和水泡渗漏（OR: 0.16, p= lt;0.01）的风险。结论小梁切除术具有良好的IOP控制和更高的完全成功率，但以较高的并发症为代价。XEN45提供了相对安全但效果较差的替代方案。在选择最佳手术干预时，患者量身定制的方法是必不可少的。

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引用次数: 0

A structure-function correlation between vessel density on OCTA and macular sensitivity on microperimetry in sickle cell retinopathy in children, adolescents, and young adults 儿童、青少年和青壮年镰状细胞性视网膜病变患者OCTA血管密度与显微视力黄斑敏感性的结构-功能相关性研究

AJO International

Pub Date : 2025-11-19 DOI: 10.1016/j.ajoint.2025.100203

Naira Ikram , Francisco Altamirano , Celine Chaaya , Hanna De Bruyn , Sandra Hoyek , Inès Fenniri , Osama Sorour , Anne Fulton , Pablo Altschwager , Efren Gonzalez , Nimesh A. Patel

Background

To identify associations between microvascular changes and functional macular sensitivity in children, adolescents, and young adults with sickle cell disease (SCD).

Methods

This analysis included patients (8–22 years) with SCD with optical coherence tomography-angiography (OCTA) and microperimetry testing between March 2023 and December 2024. Superficial (SCP) and deep (DCP) capillary plexi scans were divided into four quadrants: supero-temporal (ST), supero-nasal (SN), infero-temporal (IT), and infero-nasal (IN). Microperimetry examinations were analyzed using the 4–2 visual field method and a 68-point, 10-degree grid using the Macular Integrity Assessment (MAIA). Spearman correlation and mixed effects regression models assessed associations between vessel density (VD, measured in mm/mm²) and microperimetry sensitivity.

Results

Thirty-two eyes were included. Most were Black, non-Hispanic patients (71.9 %) with hemoglobin SS disease (62.5 %). The median age and best-corrected visual acuity (BCVA) at testing were 14.6 years (IQR, 12.2–17.5) and 0 logMAR (IQR, 0–0.1) (Snellen 20/20), respectively. Half of eyes (50 %) had some degree of sickle cell retinopathy. There were few cases of severe retinopathy (9.4 %). Median age was 14.54 (IQR, 9.34–13.61). Median VD in the SCP and DCP were lowest in the infero-temporal quadrant (27.64 and 23.80, respectively). After adjusting for covariates, microperimetry sensitivity remained positively associated with VD in the supero-temporal region, both for the SCP (β=0.44, p = 0.010) and the DCP (β =0.36, p = 0.04).

Conclusion

In children, adolescents, and young adults with sickle cell disease, loss of vessel density in the supero-temporal region of the SCP and DCP was associated with decreased sensitivity on microperimetry. This may support a structure-function correlation, compelling further investigation of the impact of impaired retinal perfusion on subclinical vision loss.

背景：研究镰状细胞病（SCD）儿童、青少年和青年患者微血管变化与黄斑功能性敏感性之间的关系。方法分析2023年3月至2024年12月间行光学相干层析血管造影（OCTA）和显微视野检查的8-22岁SCD患者。浅表（SCP）和深层（DCP）毛细血管丛扫描分为四个象限：颞上（ST）、鼻上（SN）、颞下（IT）和鼻下（IN）。显微镜检查采用4-2视野法和黄斑完整性评估（MAIA）的68点10度网格进行分析。Spearman相关和混合效应回归模型评估了血管密度（VD，单位为mm/mm²）和显微测量灵敏度之间的关系。结果纳入32只眼。大多数是黑人，非西班牙裔患者（71.9%）患有血红蛋白SS病（62.5%）。测试时的中位年龄和最佳矫正视力（BCVA）分别为14.6岁（IQR, 12.2-17.5）和0 logMAR (IQR, 0 - 0.1) （Snellen 20/20）。一半的眼睛（50%）有一定程度的镰状细胞视网膜病变。严重视网膜病变病例较少（9.4%）。中位年龄为14.54岁（IQR, 9.34-13.61）。颞下象限的中位VD最低，分别为27.64和23.80。在调整协变量后，显微测量灵敏度与颞上区VD呈正相关，无论是SCP （β=0.44, p = 0.010）还是DCP （β= 0.36, p = 0.04）。结论在患有镰状细胞病的儿童、青少年和青壮年患者中，SCP和DCP颞上区血管密度降低与显微视野测量灵敏度降低有关。这可能支持结构-功能相关性，进一步研究受损视网膜灌注对亚临床视力丧失的影响。

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引用次数: 0

Paracentral acute middle maculopathy and hemodynamically significant patent foramen ovale 旁中央急性中黄斑病变和血流动力学显著的卵圆孔未闭

AJO International

Pub Date : 2025-11-13 DOI: 10.1016/j.ajoint.2025.100201

Chiara Muzio , Federica Fossataro , Stefano Erba , Stefano De Angelis , Manuela Mambretti , Marco Pisaniello , Marco Nassisi , Giuseppe Casalino , Francesco Viola

Purpose

To report a possible association between paracentral acute middle maculopathy (PAMM) and hemodynamically significant patent foramen ovale (PFO), and to propose a cardiovascular screening strategy for patients with unexplained isolated PAMM.

Design

Retrospective multicenter case series.

Methods

Electronic medical records and multimodal retinal imaging findings of consecutive patients with PAMM and hemodynamically significant PFO presenting at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Ophthalmic Hospital, ASST Fatebenefratelli Sacco between January 2019 and December 2024. Initial spectral domain optical coherence tomography (SD-OCT) showed a band-like hyperreflective lesion at the inner nuclear layer (INL) in all cases.

Results

A total of five patients (three males; mean age 62 years, range 54–71) with PAMM were found to have a hemodynamically significant PFO. Four out of five had isolated PAMM and were included in this series. In three cases the PFO was discovered after the cardiologist referral; one patient was known for PFO and Factor V Leiden mutation. In all cases PFO was the only embolic source identified after an extensive workup. Management included surgical or percutaneous closure or antithrombotic therapy. Over a mean 12-month follow-up (range: 6–21), SD-OCT showed progressive attenuation and thinning of the INL; visual acuity improved or remained stable. None of the patients experienced recurrent retinal or cerebral ischemic events during follow-up.

Conclusions

Our series suggests that isolated PAMM is possibly linked to hemodynamically significant PFO, supporting the need for a targeted cardiovascular assessment, including bubble contrast echocardiography.

目的报道中央旁性急性中黄斑病变（PAMM）与血流动力学意义显著的卵圆孔未闭（PFO）之间的可能关联，并提出原因不明的孤立性PAMM患者的心血管筛查策略。设计回顾性多中心病例系列。方法对2019年1月至2024年12月在意大利国立大医院眼科医院和意大利国立眼科医院就诊的PAMM和血流动力学显著的PFO患者的电子病历和多模式视网膜成像结果进行分析。所有病例的初始光谱域光学相干断层扫描（SD-OCT）均在内核层（INL）显示带状高反射病变。结果5例PAMM患者（3例男性，平均年龄62岁，54 ~ 71岁）均出现血流动力学意义显著的PFO。5例中有4例分离出PAMM，并被纳入本系列。三例PFO是在心脏病专家转诊后发现的；1例患者已知PFO和因子V Leiden突变。在所有病例中，PFO是经过广泛检查后确定的唯一栓塞源。治疗包括手术或经皮缝合或抗血栓治疗。在平均12个月的随访（范围：6-21）中，SD-OCT显示INL逐渐衰减和变薄；视力改善或保持稳定。随访期间，所有患者均无复发性视网膜或脑缺血事件。sour系列研究表明，孤立性PAMM可能与血流动力学意义显著的PFO有关，支持有针对性的心血管评估的需要，包括超声造影。

{"title":"Paracentral acute middle maculopathy and hemodynamically significant patent foramen ovale","authors":"Chiara Muzio , Federica Fossataro , Stefano Erba , Stefano De Angelis , Manuela Mambretti , Marco Pisaniello , Marco Nassisi , Giuseppe Casalino , Francesco Viola","doi":"10.1016/j.ajoint.2025.100201","DOIUrl":"10.1016/j.ajoint.2025.100201","url":null,"abstract":"<div><h3>Purpose</h3><div>To report a possible association between paracentral acute middle maculopathy (PAMM) and hemodynamically significant patent foramen ovale (PFO), and to propose a cardiovascular screening strategy for patients with unexplained isolated PAMM.</div></div><div><h3>Design</h3><div>Retrospective multicenter case series.</div></div><div><h3>Methods</h3><div>Electronic medical records and multimodal retinal imaging findings of consecutive patients with PAMM and hemodynamically significant PFO presenting at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Ophthalmic Hospital, ASST Fatebenefratelli Sacco between January 2019 and December 2024. Initial spectral domain optical coherence tomography (SD-OCT) showed a band-like hyperreflective lesion at the inner nuclear layer (INL) in all cases.</div></div><div><h3>Results</h3><div>A total of five patients (three males; mean age 62 years, range 54–71) with PAMM were found to have a hemodynamically significant PFO. Four out of five had isolated PAMM and were included in this series. In three cases the PFO was discovered after the cardiologist referral; one patient was known for PFO and Factor V Leiden mutation. In all cases PFO was the only embolic source identified after an extensive workup. Management included surgical or percutaneous closure or antithrombotic therapy. Over a mean 12-month follow-up (range: 6–21), SD-OCT showed progressive attenuation and thinning of the INL; visual acuity improved or remained stable. None of the patients experienced recurrent retinal or cerebral ischemic events during follow-up.</div></div><div><h3>Conclusions</h3><div>Our series suggests that isolated PAMM is possibly linked to hemodynamically significant PFO, supporting the need for a targeted cardiovascular assessment, including bubble contrast echocardiography.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Workforce distribution and cataract surgical rates in the eastern mediterranean (EMR) and middle east north Africa (MENA) regions 东地中海（EMR）和中东北非（MENA）地区的劳动力分布和白内障手术率

AJO International

Pub Date : 2025-11-08 DOI: 10.1016/j.ajoint.2025.100200

Fatma Shakarchi , John Buchan , Allen Foster

Purpose

This study analyses the distribution of ophthalmic human resources in countries of the Eastern Mediterranean Region (EMR) and the Middle East North Africa (MENA), and their productivity in relation to cataract surgery.

Design

Cross-sectional, secondary data analysis.

Methods

The analysis compiled secondary data available in the public domain, on the ophthalmic workforce and Cataract Surgical Rate (CSR), defined as the number of cataract surgeries performed annually per million population, using the International Agency for the Prevention of Blindness (IAPB) Vision Atlas and the Rapid Assessment of Avoidable Blindness (RAAB) Repository. We included data from 25 countries (n = 25 data points), and performed a segmented linear correlation to account for the correlation between CSR and ophthalmologist density.

Results

The density of ophthalmologists per million population ranged from <1 per million population in Somalia and South Sudan to 70 per million in Saudi Arabia. There was a positive correlation between the number of ophthalmologists per million and CSR up to approximately 20 ophthalmologists/million, after which the association was not found. On average, ophthalmologists performed <1 to 22 cataract surgery per week in countries of the region. Iran and Pakistan showed the highest CSR values and CSRs per ophthalmologist/week among the countries analysed.

Conclusions

There are wide variations in the availability and productivity of ophthalmic personnel in terms of cataract surgeries/ophthalmologist/week between countries in the region. These findings highlight the need to strengthen efficiency, equitable access, and data quality across eye care systems in the region. Wider adoption of newer indicators, particularly the effective cataract surgical coverage (eCSC), would provide additional information on equity and quality of cataract services.

目的分析东地中海地区（EMR）和中东北非（MENA）国家眼科人力资源的分布及其与白内障手术相关的生产力。设计横断面、二次数据分析。方法利用国际防盲机构（IAPB）视力地图集和可避免盲症快速评估（RAAB）知识库，对公共领域的眼科劳动力和白内障手术率（CSR）（定义为每年每百万人口进行白内障手术的数量）的二手数据进行分析。我们纳入了来自25个国家的数据（n = 25个数据点），并进行了分段线性相关，以解释CSR与眼科医生密度之间的相关性。结果每百万人口中眼科医生的密度从索马里和南苏丹的1 /百万到沙特阿拉伯的70 /百万不等。每百万名眼科医生的数量与CSR之间存在正相关关系，最高约为20名眼科医生/百万名，之后不再存在相关关系。该地区国家的眼科医生平均每周进行1至22例白内障手术。在分析的国家中，伊朗和巴基斯坦显示出最高的社会责任值和每位眼科医生/周的社会责任比率。从白内障手术/眼科医生/周的数量来看，该地区各国眼科人员的可获得性和生产力存在很大差异。这些发现突出表明，需要加强本地区眼科保健系统的效率、公平获取和数据质量。更广泛地采用新的指标，特别是有效白内障手术覆盖率（eCSC），将提供更多关于白内障服务公平性和质量的信息。

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引用次数: 0

Retinoblastoma: Bridging the gap in diagnosis and treatment in Nigeria 视网膜母细胞瘤：弥合尼日利亚诊断和治疗方面的差距

AJO International

Pub Date : 2025-11-05 DOI: 10.1016/j.ajoint.2025.100198

Dupe S. Ademola-Popoola , Ibrahim A. Yusuf

Purpose

Retinoblastoma is generally curable and the most common intraocular childhood cancer, with a 3-year survival of 95 %-99.5 % in high-income countries compared to 80 % in MICs and 57 % in LMICs. This article highlights the gap in retinoblastoma management as well as the efforts made to improve its diagnosis and treatment in Nigeria, a case study for a LMIC.

Design

Perspective article

Methods

This perspective is based on the authors clinical and programmatic experience in developing national and regional retinoblastoma services, combined with synthesis of published evidence and collaborative inputs from African and international partners involved in retinoblastoma care.

Results

Multi-level scalable strategies, including task shifting, affordable treatment innovations, legislation, telemedicine, regional and international collaborative efforts have been implemented successfully. These efforts transformed a new service into a referral center and established a network of retinoblastoma services. Human capacity was developed to enhance early detection, improve access and delivery of essential treatments, and attract resources, thereby enabling cure within a resource-limited setting.

Conclusions

Increasing national, regional and global initiatives remain crucial not only to scale up successful programs but also to urgently address the lack universal access to care, genetic testing across many African countries, and survivorship support, providing long-term care of complications, including other non-ocular cancers, which are becoming evident, thereby closing the survival gaps and offering a model for retinoblastoma care progress

视网膜母细胞瘤通常是可治愈的，也是最常见的儿童眼内癌，高收入国家的3年生存率为95% - 99.5%，而中等收入国家为80%，中低收入国家为57%。这篇文章强调了视网膜母细胞瘤管理方面的差距，以及尼日利亚为改善其诊断和治疗所做的努力，这是一个低收入和中等收入国家的案例研究。该观点基于作者在发展国家和地区视网膜母细胞瘤服务方面的临床和规划经验，并结合已发表的证据和参与视网膜母细胞瘤护理的非洲和国际合作伙伴的合作投入。结果成功实施了任务转移、平价治疗创新、立法、远程医疗、区域和国际合作等多层次可扩展策略。这些努力将一个新的服务转变为一个转诊中心，并建立了一个视网膜母细胞瘤服务网络。发展了人的能力，以加强早期发现，改善基本治疗的获取和提供，并吸引资源，从而在资源有限的情况下实现治愈。增加国家、区域和全球倡议至关重要，不仅可以扩大成功项目的规模，还可以紧急解决许多非洲国家缺乏普遍获得护理、基因检测和幸存者支持的问题，提供包括其他非眼部癌症在内的并发症的长期护理，这些问题越来越明显，从而缩小生存差距，并为视网膜母细胞瘤治疗进展提供一个模式

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引用次数: 0

Bridging the diagnostic and therapeutic gaps in retinoblastoma: A referral center’s perspective from Southeast Asia 弥合视网膜母细胞瘤的诊断和治疗差距：东南亚转诊中心的观点

AJO International

Pub Date : 2025-11-04 DOI: 10.1016/j.ajoint.2025.100199

Thanaporn Kritfuangfoo , Duangnate Rojanaporn

Purpose

To highlight diagnostic and therapeutic disparities in retinoblastoma care and share our institutional approach to bridging these gaps in a resource-limited setting in Southeast Asia.

Design

Perspective and selected literature review.

Methods

A narrative overview of our referral center’s experience was combined with key findings from the literature. We describe evolving diagnostic resources, as well as treatment advancements such as intra-arterial chemotherapy (IAC) and high-dose intravitreal topotecan.

Results

Significant disparities persist between high- and low-resource settings in both diagnosis and treatment of retinoblastoma. While high-income countries have access to advanced tools such as aqueous humor analysis, molecular diagnostics, and globe-salvaging therapies, many lower-resource centers must rely primarily on clinical examination and imaging, as aqueous humor testing remains unavailable in most regions. In these settings, close clinical monitoring is essential, particularly in diagnostically uncertain cases. Treatment options are also limited, with restricted access to IAC and other advanced modalities. At our center, protocol refinements, multidisciplinary coordination, and adaptation of emerging therapies have contributed to improved outcomes. In institutions without IAC capability, high-dose intravitreal topotecan may offer a feasible alternative when used in combination with other available treatments.

Conclusion

Retinoblastoma management in resource-limited settings requires tailored approaches. Institutional adaptation of IAC protocols and incorporation of emerging therapies such as high-dose intravitreal topotecan can improve outcomes, even in advanced disease. Broader access to diagnostic tools, regional training, and inter-institutional collaboration are essential to bridge global gaps in retinoblastoma care.

目的强调在资源有限的东南亚地区，视网膜母细胞瘤护理的诊断和治疗差异，并分享我们的制度方法来弥合这些差距。设计视角和选定的文献综述。方法对我们转诊中心的经验进行叙述性概述，并结合文献中的主要发现。我们描述了不断发展的诊断资源，以及治疗进展，如动脉内化疗（IAC）和高剂量玻璃体内拓扑替康。结果高资源地区和低资源地区在视网膜母细胞瘤的诊断和治疗方面存在显著差异。虽然高收入国家可以获得房水分析、分子诊断和全球挽救疗法等先进工具，但由于房水检测在大多数地区仍然无法获得，许多资源较低的中心必须主要依靠临床检查和成像。在这些情况下，密切的临床监测至关重要，特别是在诊断不确定的病例中。治疗选择也很有限，IAC和其他先进方式的使用受到限制。在我们的中心，方案的完善，多学科的协调和适应新兴疗法有助于改善结果。在没有IAC能力的机构中，当与其他可用的治疗方法联合使用时，高剂量玻璃体内拓扑替康可能是一种可行的选择。结论在资源有限的情况下，视网膜母细胞瘤的治疗需要有针对性的方法。机构调整IAC方案和结合新疗法，如高剂量玻璃体内拓扑替康，可以改善预后，即使是晚期疾病。更广泛地获得诊断工具、区域培训和机构间合作对于弥合视网膜母细胞瘤治疗方面的全球差距至关重要。

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引用次数: 0

Treatment compliance in retinoblastoma management – An approach to identifying and addressing barriers, and assessing compliance rate 视网膜母细胞瘤治疗的依从性-一种识别和解决障碍的方法，并评估依从率

AJO International

Pub Date : 2025-11-02 DOI: 10.1016/j.ajoint.2025.100197

Shirali Gokharu, Namita Kumari, Chhavi Gupta, Obaidur Rehman, Sima Das

Purpose

To identify causes of non-compliance and evaluate effectiveness of interventions in improving retinoblastoma (RB) treatment compliance.

Design

Retrospective observational analytical study.

Methods

The staging and grouping of RB were determined according to International Retinoblastoma Staging System and the International Classification of Intraocular Retinoblastoma respectively. Medical records of RB patients treated at a North Indian tertiary ocular oncology center (July 2019–June 2022) were reviewed. Compliance was defined as adherence to treatment plans and timely follow-ups. Patients in Group 1 (July 2019–Dec 2020, n = 60) received standard care, while Group 2 (Jan 2021–June 2022, n = 86) additionally received financial, logistic, and counselling support. Compliance and treatment barriers, assessed through parental interviews, were compared.

Results

Both the groups had similar demographics. Compliance improved from 67 % (Group 1) to 78 % (Group 2). Major barriers included financial constraints (69 %), refusal of enucleation (27 %), family/social issues (14 %), cultural beliefs (13 %), and COVID-19 restrictions (9 %).

Conclusion

Additional support led to better treatment compliance, though the improvement was not statistically significant. Non-compliance persisted in 22 % of patients, mainly due to advanced disease, reluctance to enucleation, and sociocultural challenges. Sustained improvements in compliance require community awareness, family education, and early detection strategies.

目的探讨视网膜母细胞瘤患者治疗依从性不佳的原因，评价干预措施对提高视网膜母细胞瘤治疗依从性的效果。设计回顾性观察性分析研究。方法分别按照《国际视网膜母细胞瘤分期系统》和《国际眼内视网膜母细胞瘤分类》对RB进行分期和分组。回顾了北印度三级眼肿瘤中心治疗的RB患者的医疗记录（2019年7月- 2022年6月）。依从性定义为遵守治疗计划和及时随访。第一组患者（2019年7月- 2020年12月，n = 60）接受标准治疗，而第二组患者（2021年1月- 2022年6月，n = 86）额外接受财务、后勤和咨询支持。依从性和治疗障碍，通过家长访谈评估，比较。结果两组的人口统计数据相似。依从性从67%（第一组）提高到78%（第二组）。主要障碍包括经济拮据（69%）、拒绝去核（27%）、家庭/社会问题（14%）、文化信仰（13%）和COVID-19限制（9%）。结论额外支持可提高患者的治疗依从性，但无统计学意义。22%的患者持续不遵规，主要是由于疾病晚期、不愿摘除和社会文化挑战。持续改善依从性需要社区意识、家庭教育和早期发现策略。

{"title":"Treatment compliance in retinoblastoma management – An approach to identifying and addressing barriers, and assessing compliance rate","authors":"Shirali Gokharu, Namita Kumari, Chhavi Gupta, Obaidur Rehman, Sima Das","doi":"10.1016/j.ajoint.2025.100197","DOIUrl":"10.1016/j.ajoint.2025.100197","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify causes of non-compliance and evaluate effectiveness of interventions in improving retinoblastoma (RB) treatment compliance.</div></div><div><h3>Design</h3><div>Retrospective observational analytical study.</div></div><div><h3>Methods</h3><div>The staging and grouping of RB were determined according to International Retinoblastoma Staging System and the International Classification of Intraocular Retinoblastoma respectively. Medical records of RB patients treated at a North Indian tertiary ocular oncology center (July 2019–June 2022) were reviewed. Compliance was defined as adherence to treatment plans and timely follow-ups. Patients in Group 1 (July 2019–Dec 2020, <em>n</em> = 60) received standard care, while Group 2 (Jan 2021–June 2022, <em>n</em> = 86) additionally received financial, logistic, and counselling support. Compliance and treatment barriers, assessed through parental interviews, were compared.</div></div><div><h3>Results</h3><div>Both the groups had similar demographics. Compliance improved from 67 % (Group 1) to 78 % (Group 2). Major barriers included financial constraints (69 %), refusal of enucleation (27 %), family/social issues (14 %), cultural beliefs (13 %), and COVID-19 restrictions (9 %).</div></div><div><h3>Conclusion</h3><div>Additional support led to better treatment compliance, though the improvement was not statistically significant. Non-compliance persisted in 22 % of patients, mainly due to advanced disease, reluctance to enucleation, and sociocultural challenges. Sustained improvements in compliance require community awareness, family education, and early detection strategies.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ability of the optical coherence tomography parameters to identify retinal nerve fibre layer defect in Indian eyes with mild glaucoma 光学相干断层扫描参数识别印度眼轻度青光眼视网膜神经纤维层缺损的能力

AJO International

Pub Date : 2025-10-28 DOI: 10.1016/j.ajoint.2025.100196

Flonny Sunny, Premanand Chandran, Liji Joy, Ganesh V Raman

Purpose

To compare the diagnostic ability of thickness, deviation and clock-hour map of spectral domain optical coherence tomography (OCT) to detect retinal nerve fibre layer (RNFL) defect in mild glaucoma.

Design

Cross sectional study.

Methods

Eyes with mild glaucoma and well defined photographic RNFL defect were included as cases and eyes with normal optic nerve head were included as controls. Fundus photograph and spectral domain OCT optic disc cube scan was performed in all the eyes. Thickness map, deviation map and clock-hour map of OCT were assessed for the presence of RNFL defect. Image J was used to calculate the width of the RNFL defect.

Results

127 eyes were recruited in each group. OCT RNFL thickness map was able to identify the RNFL defect in all the 127 (100 %) eyes, whereas deviation map was able to identify in 122 (96 %) eyes and clock-hour map in 114 (90 %) eyes. Average width of RNFL defect was 21⁰ (± 5.9). The width of the RNFL defect was <20° in all the eyes in which RNFL defect was missed by both deviation and clock-hour map. Narrow angular width of RNFL defect was the only risk factor for missing RNFL defect in both deviation and clock-hour map. Among the control eyes thickness map showed RNFL thinning in 3 (2.4 %) eyes, deviation map in 6 (4.7 %) eyes and clock-hour map in 7 (5.5 %) eyes.

Conclusions

Thickness map performs better than deviation map and clock-hour map in identifying RNFL defect in eyes with mild glaucoma.

目的比较光谱域光学相干断层扫描（OCT）厚度、偏差及钟时图对轻度青光眼视网膜神经纤维层（RNFL）缺损的诊断能力。设计横断面研究。方法以轻度青光眼和清晰的影像RNFL缺损为例，视神经头正常眼为对照。所有眼均行眼底照片及光谱域OCT视盘立方体扫描。评估OCT厚度图、偏差图和钟时图是否存在RNFL缺陷。图像J用于计算RNFL缺陷的宽度。结果每组共招募127只眼。OCT RNFL厚度图能识别127只眼（100%）的RNFL缺损，偏差图能识别122只眼（96%），钟时图能识别114只眼（90%）。RNFL缺损的平均宽度为21⁰（±5.9）。所有眼的RNFL缺损宽度均为20°，偏差和钟时图均未发现RNFL缺损。RNFL缺损角宽度窄是导致RNFL缺损在偏差图和钟时图上缺失的唯一危险因素。对照眼厚度图显示RNFL变薄3眼（2.4%），偏差图6眼（4.7%），钟时图7眼（5.5%）。结论厚度图对轻度青光眼RNFL缺损的鉴别效果优于偏差图和钟时图。

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引用次数: 0

Geospatial analysis of accessibility to oculofacial plastic surgery in the United States: Driving distance and sociodemographic disparities 美国眼面部整形手术可达性的地理空间分析：驾车距离和社会人口差异

AJO International

Pub Date : 2025-10-28 DOI: 10.1016/j.ajoint.2025.100192

Anne X. Nguyen , Daniel R. Chow , Mélanie Hébert , Edsel Ing , Georges Nassrallah , Navdeep Nijhawan

Purpose

To identify disparities in access to complex oculofacial plastic care by mapping American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members’ service coverage areas (SCAs) in the United States (US).

Design

Cross-sectional analysis

Methods

We analyzed US-based ASOPRS members’ practice locations in ArcGIS Pro (Esri) to define SCAs as regions within a 60-minute drive. With American Community Survey data and chi-square tests, we compared social determinants of health within and outside SCAs.

Results

Of the 322,561,852 Americans, 260,154,031 (80.7 %) lived within a 60-minute driving time from one of the 635 ASOPRS members. The population outside 60-minute SCAs was significantly more likely to be White, Non-Hispanic, without university education, receiving social security income, residing in a household below federal poverty level, and lacking health insurance, compared to the population inside SCAs (each P < 0.001). States with the most ASOPRS members were California (n = 95, 2.4 per million residents), Texas (n = 47, 1.5/million) and Florida (n = 45, 2.0/million), while none practiced in Montana, North Dakota, South Dakota, New Mexico and Wyoming.

Conclusions

Inequitable geographic distribution of ASOPRS members disproportionately affects patients in rural areas and those with lower socio-economic status. Recognizing these geographic-social obstacles can inform policies to reduce barriers to complex oculofacial plastic care access.

目的通过绘制美国眼科整形与重建外科学会（ASOPRS）会员的服务覆盖区域（sca），了解在美国获得复杂眼面部整形护理的差异。设计横断面分析方法我们在ArcGIS Pro （Esri）中分析了美国ASOPRS成员的实践地点，将SCAs定义为60分钟车程内的区域。利用美国社区调查数据和卡方检验，我们比较了社会服务中心内外的健康社会决定因素。结果在322,561,852名美国人中，260,154,031人（80.7%）与635名ASOPRS成员之一的驾车时间在60分钟内。60分钟隔离区之外的人口明显更可能是白人，非西班牙裔，没有大学教育，接受社会保障收入，居住在低于联邦贫困水平的家庭，缺乏健康保险，与隔离区内的人口相比（P < 0.001）。ASOPRS成员最多的州是加利福尼亚州（n = 95，每百万居民2.4人）、德克萨斯州（n = 47，每百万居民1.5人）和佛罗里达州（n = 45，每百万居民2.0人），而蒙大拿州、北达科他州、南达科他州、新墨西哥州和怀俄明州都没有。结论ASOPRS成员地域分布不均对农村地区和社会经济地位较低的患者影响较大。认识到这些地理-社会障碍可以为政策提供信息，以减少获得复杂的眼面部整形护理的障碍。

{"title":"Geospatial analysis of accessibility to oculofacial plastic surgery in the United States: Driving distance and sociodemographic disparities","authors":"Anne X. Nguyen , Daniel R. Chow , Mélanie Hébert , Edsel Ing , Georges Nassrallah , Navdeep Nijhawan","doi":"10.1016/j.ajoint.2025.100192","DOIUrl":"10.1016/j.ajoint.2025.100192","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify disparities in access to complex oculofacial plastic care by mapping American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members’ service coverage areas (SCAs) in the United States (US).</div></div><div><h3>Design</h3><div>Cross-sectional analysis</div></div><div><h3>Methods</h3><div>We analyzed US-based ASOPRS members’ practice locations in ArcGIS Pro (Esri) to define SCAs as regions within a 60-minute drive. With American Community Survey data and chi-square tests, we compared social determinants of health within and outside SCAs.</div></div><div><h3>Results</h3><div>Of the 322,561,852 Americans, 260,154,031 (80.7 %) lived within a 60-minute driving time from one of the 635 ASOPRS members. The population outside 60-minute SCAs was significantly more likely to be White, Non-Hispanic, without university education, receiving social security income, residing in a household below federal poverty level, and lacking health insurance, compared to the population inside SCAs (each <em>P</em> < 0.001). States with the most ASOPRS members were California (<em>n</em> = 95, 2.4 per million residents), Texas (<em>n</em> = 47, 1.5/million) and Florida (<em>n</em> = 45, 2.0/million), while none practiced in Montana, North Dakota, South Dakota, New Mexico and Wyoming.</div></div><div><h3>Conclusions</h3><div>Inequitable geographic distribution of ASOPRS members disproportionately affects patients in rural areas and those with lower socio-economic status. Recognizing these geographic-social obstacles can inform policies to reduce barriers to complex oculofacial plastic care access.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0