AJO International最新文献

Objective

Contact lens (CL) use for myopia correction among children and teenagers has become a focal point of global interest. Yet, spectacles remain dominant for vision correction in this age group. This study investigated the factors affecting CL uptake among myopic school-going children and teenagers attending Kenyan eye clinics.

Study Design

Cross-sectional study.

Methods

A survey conducted across 13 Kenyan eye clinics, involving myopic participants aged 8–19 years. Data collection employed a mixed-method using validated semi-structured questionnaires that also included a 3-level Likert scale to elicit responses regarding factors that influenced the uptake of CLs. Analysis techniques included descriptive statistics, chi-square, and Cramer's V.

Results

85 participants, with a mean age of 13.4 ± 2.1 years, who were more of females (54.1%) were included in the study. While CL uptake was low (17.6%), spectacles remained the preferred myopia correction method among the participants. Factors favoring CL preference were appropriate visual clarity with CL (59%), enhanced self-esteem and social acceptance (64%). Major barriers to CL uptake were fear of eye injuries (60%), limited CL knowledge (55%), and fewer CL professionals (48%). Eye care professionals were the primary CL information source. A weak association was observed between spectacles’ perceived bulkiness and CL uptake (Cramer's V: 0.223, p = 0.121). However, vision clarity (Cramer's V: 0.387, p = 0.002) and social acceptance (Cramer's V: 0.351, p = 0.005) showed stronger associations with CL uptake in children and teenagers in the study.

Conclusion

While information gaps and limited professional availability hinder CL uptake among Kenyan students, benefits like better vision clarity and improved social acceptance promote their use. Efforts to address information gaps and highlight CL advantages are recommended to foster broader acceptance.

Purpose

This study aimed to examine self-rated vision, vision concerns, and general health in individuals with and without glaucoma. Such assessments offer a broad view of a person's overall well-being and potential health issues and provide valuable insights into the characteristics of glaucoma patients.

Design

Cross-sectional.

Methods

We used questionnaire responses from Project FOREVER (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability) to evaluate self-rated vision and general health on a scale ranging from 1 (excellent), 2 (good), 3 (reasonable), 4 (poor) to 5 (very bad). Additionally, the vision concerns were rated on a scale from 1 (never), 2 (rarely), 3 (once in a while), 4 (often) to 5 (always). A glaucoma diagnosis was self-reported and obtained from the questionnaire. To investigate the strength and direction of associations, we used binomial logistic regression models including self-assessment, age, and sex as confounding variables and glaucoma status as the dependent variable.

Results

This study analyzed questionnaire data from 59,168 participants, with an average age of 55.2 years (SD 15.0), and 62.0 % being women. Of these, 900 individuals (1.5 %) reported having a glaucoma diagnosis. Individuals having glaucoma reported poorer self-ratings in vision, vision concerns and general health. Specifically, the odds ratios for the poorest ratings were 2.46 for self-rated vision (95 % CI 1.70–3.55, p < 0.001), 8.04 for self-rated vision concerns (95 % CI 5.44–11.90, p < 0.001) and 1.86 for self-rated health (95 % CI 1.16–2.98, p = 0.010).

Conclusion

Glaucoma status is associated with poorer self-assessments of vision, vision concerns, and health. This suggests that individuals with glaucoma experience more vision and health challenges than people without the disease and the three assessments can be used as tools to characterize glaucoma patients in risk profiling efforts.

Importance

There is an increasing use of artificial intelligence (AI) in ophthalmology to respond to the needs of patients to access reliable, easy-to-understand medical information.

Objective

To assess patient satisfaction with the usability of MonŒil, an AI-based platform designed for patient education in ophthalmology.

Design

This was a pilot cross-sectional study of the usability of MonŒil by patients followed for advanced age-related macular degeneration (AMD). MonŒil is based on ChatGPT-4 technology with specific ophthalmology-focused customizations and accessibility enhancements, and is freely available at monoeil.help. Patients were given 20 min of unsupervised interaction with no prior training or guidance, after which their feedback was collected.

Setting

The study was performed in the ophthalmology department at the Creteil University Hospital.

Participants

Participants included 54 patients diagnosed with advanced AMD defined presenting for follow-up. Patients had to be older than 50 years of age, capable of giving informed consent, and able to understand and interact with MonŒil. Exclusion criteria were severe visual and cognitive impairment that prevented interaction with MonŒil.

Main Outcome(s) and Measure(s)

The primary outcome was the usability of MonŒil as measured by the System Usability Scale (SUS) questionnaire.

Results

Of the 54 participants, 34 were female (62.96 %). The mean age of the cohort was 77.76±8.14 years (range 58 to 97 years). The mean SUS score was 90.23±12.04 with a median of 92.50 (range 42.50 to 100.00), indicating excellent usability. There was a positive relationship between visual acuity and SUS score (regression coefficient 0.30 (95 % CI 0.08 to 0.51), r2=0.19, p = 0.0077).

Conclusions and Relevance

MonŒil demonstrated excellent usability and satisfaction in a sample population of elderly patients with advanced AMD. These results suggest that AI-based tools like MonŒil can enhance patient education with minimal oversight in a complex field like ophthalmology, supporting its use as an adjunct to the physician-patient discussion. Further studies may be necessary to establish the applicability of MonŒil to a broader user base, and to assess its usefulness and clinical impact on patient outcomes such as patient knowledge and vision-related quality of life.

Purpose

To report the clinical outcomes of orbital radiotherapy (ORT) with combined intravenous methylprednisolone (IVMP) and mycophenolate mofetil (MMF) in thyroid eye disease (TED) patients with restrictive myopathy.

Design

Prospective comparative case series of patients managed at The Chinese University of Hong Kong from 2015 to 2021.

Methods

The primary outcome was the change in Gorman diplopia score at 52 weeks. Secondary outcomes were the changes in extraocular muscle motility (EOMy), area of extraocular muscle (EOM) on MRI, exophthalmos, and marginal reflex distance (MRD) 1 and MRD2 at 52 weeks.

Results

A total of 40 (29 females) TED patients, medium age 56 years, were treated with the double regimen: combined IVMP and MMF (17) or triple regimen: IVMP, MMF, and ORT (23). The triple group has a higher age (P = 0.028). Sex, smoking history, thyroid, and pre-treatment orbital status were comparable between the 2 groups. EOMy improved more after the triple regimen(P = 0.026). Nine patients from the triple group showed a significant reduction in the size of the inferior rectus (both eyes: P < 0.05), while five from the double group showed no significant reduction of any EOM on MRI. The improvement of CAS, diplopia score, exophthalmos, MRD1, and MRD2 were similar. No patient reported any severe or organ-threatening side effects from IVMP, MMF, or ORT requiring discontinuation of treatment.

Conclusion

The triple regimen demonstrates better structural and functional outcomes in TED-related restrictive myopathy. Future randomized clinical trials are warranted to clarify the adjuvant role of ORT in this specific indication of TED management.

Purpose

To compare outcomes of augmented deep sclerectomy surgery (DS) with mitomycin C.(MMC) between pseudoexfoliative glaucoma (PEXG) and primary open angle.glaucoma (POAG) patients..

Design

Retrospective cohort study

Methods

Retrospective review of patients undergoing DS surgery at the University Eye Hospital Bonn, Germany, from 04/2021 to 09/2022. We performed a matched-pair analysis.between eyes with PEXG (group 1, n = 45) and eyes with POAG (group 2, n = 45).

Results

90 eyes of 85 patients were included. Complete and qualified success rates for Groups.1 and 2 at one year were 55.6 % and 86.7 % (p = 0.002) and 91.1 % and 93.3 % (p = 0.78).for ≤21 mmHg, and 55.6 % and 86.7 % (p = 0.002) and 88.9 % and 93.3 % (p = 0.53) for.≤18 mmHg respectively..Mean preoperative IOP decreased from 21.11 mmHg in group 1 and 19.64 mmHg in.group 2 (p = 0.31) to 13.64 mmHg and 11.42 mmHg after surgery, respectively, whilst it.was significantly lower in eyes with POAG (p = 0.01). The number of pressure-lowering.drops was also significantly lower in eyes with POAG after 12 months (PEXG: 0.58;.POAG: 0.18; p = 0.01). Eyes with PEXG had a significantly higher rate of Nd:YAG laser.goniopuncture (PEXG: 64.4 %, POAG: 40 %, p = 0.02)..Postoperative complications occurred in 6 eyes (6.7 %) with no vision-threatening.sequelae in either group.There were no significant differences between complication.rates in the two groups (p = 0.18)

Conclusions

DS is a safe and effective procedure for lowering IOP in eyes with both POAG and PEXG, with lower overall IOP levels being achieved in eyes with POAG. Significantly more postoperative laser goniopunctures were needed in eyes with PEXG.

Purpose

To investigate genotype-phenotype correlations in ABCA4-associated retinopathy and further validate a recently proposed genotype-phenotype correlation model.

Design

Multicentric, cross-sectional cohort study.

Methods

Consecutive patients with genetically confirmed ABCA4-associated retinopathy from three Portuguese centres were included. Patients were categorized into distinct phenotype groups according to the degree of hypoautofluorescence and retinal background appearance in ultra-widefield fundus autofluorescence (UW-FAF) imaging. Genotype classification was performed using two criteria: one according to the presence of the p.Gly1961Glu variant, a hypomorphic variant, at least one moderate variant, or two biallelic severe/PVS1 variants (genotype classification A, which corresponds to the newly described criteria); and another one based on the number of null variants identified (genotype classification B). Associations between clinical data and phenotype and genotype groups were analysed.

Results

A total of 50 patients were included. Significant correlations between age of onset, best-corrected visual acuity (BCVA), and both phenotype and genotype groups were found, with patients in more severe phenotype and genotype categories exhibiting earlier disease onset and poorer visual function (p < 0.001; p < 0.001; p < 0.001; p < 0.001, p < 0.001; and p = 0.004, respectively). Genotype classification A better predicted phenotype severity on UW-AF imaging, demonstrating milder genotypes in patients with less severe phenotypes and more severe genotypes in those with advanced disease (p < 0.001). A genotype-phenotype correlation matrix was constructed based on the classification of the two disease-causing variants and their corresponding phenotypic staging.

Conclusion

Our findings support the utility of the newly described genotype classification in evaluating ABCA4-associated retinopathy phenotype severity, with possible implications in future understanding of the disease genetics and assessment of individual prognosis for patients.

Purpose

The Medicine and Healthcare products Regulatory Agency (MHRA) reported cases of high intraocular pressure (IOP) after implantation of affected batch numbers of EyeCee One intraocular lens (EC1IOL). In our institution we offered Immediate Sequential Bilateral Cataract Surgery (ISBCS) with EC1IOL and here we examine the rate of raised IOP, management of cases and outcomes of this group.

Design

Retrospective case series review.

Methods

A search of our electronic patient record system identified 27 patients who had ISBCS with EC1IOL. Patients with IOP ≥30 mmHg at a post op visit were identified as the “spike” group and a case series review performed.

Results

43 eyes (27 patients) had an affected batch number of EC1IOL implanted during ISBCS, 16 patients had an affected lens in both eyes and 11 in one eye. 7% (3 eyes of 3 patients) had a post op IOP spike (average 51.9 mmHg) at a post-op visit felt to be EC1IOL related. Patients required immediate treatment, an average of 3.33 regular topical IOP lowering agents and 5 outpatient appointments. Using the fellow eye as a control comparison, 2 out of the 3 eyes in the spike group had less visual improvement. 1 eye in the spike group lost 0.2 LogMAR lines.

Conclusions

We found a greater rate EC1IOL related IOP spikes than the MRHA reports. There was a trend towards less visual gain post operatively in patients who had a spike, but due to small numbers meaningful statistical analysis cannot be performed. Surgical intervention was not required in this cohort.

This study investigates the influence of question phrasing and long wavelength cone sensitivity on red cap test responses in healthy patients. A chart review of 230 adult patients assessed responses to two different phrasings of the red cap test. Phrasing 1 asked the patient to describe the left eye relative to the right while Phrasing 2 asked the patient to name the brighter eye and provided an option for the patient to report no difference. Long wavelength cone thresholds were measured using the Konan CCT. Across both phrasings, 33 % of patients reported red saturation asymmetry, with a significant difference in positive responses between the two phrasings (43.6 % for Phrasing 1 vs. 11.3 % for Phrasing 2, (χ² = 121.694, p < .001). No significant interocular differences in long wavelength cone sensitivity were found in those patients with a positive red cap response. Phrasing contributes to the high false positive rate of the red cap test reported in healthy patients.

Objective

To demonstrate initial experience of Heads-up 3-dimensional-visualization system and integrated intra operative optical coherence tomography (iOCT) in a spectrum of complex infantile vitreoretinal surgeries.

Methods

Two different 3-D-visualization systems were used during the surgery on case-to-case basis and iOCT was used as needed. The vitrectomy system used was the same for all the surgeries. The disease spectrum included retinal disorders due to retinopathy of prematurity, familial exudative vitreoretinopathy, and retinitis.

Design

Descriptive case series of surgeries operated under 3-D visualization and conventional microscope.

Results

A total of 10 eyes of 7 patients were included; out of which 5 eyes of 4 unique cases were operated under 3-D-visualization system and remaining 5 eyes of other 3 cases under the conventional microscope. The cases present our initial experience of the 3-D visualization and iOCT system over the conventional microscope with appropriate imaging and surgical videos.

Conclusion

Infantile vitreoretinal surgeries are difficult to teach, require an ergonomic friendly surgical environment and unpredictable surgical adjustments, which are the chief advantages of the discussed technologies. Heads-up 3-D-visualization system and iOCT appeared to be powerful new tools that can be explored further for use in complex infantile vitreoretinal surgeries.

Purpose

To assess and compare accuracy of intraocular lens (IOL) power calculation performed with old generation, new generation and artificial intelligence (AI)-based formulas in eyes with flat corneas.

Design

Patients with a tomography-derived mean keratometry <42 D were retrospectively recruited among those who underwent uncomplicated phacoemulsification with intracapsular IOL implantation in two different tertiary care centers. Mean prediction error (ME), mean absolute prediction error (MAE) and incidence of MAE>0.25D were calculated for Barrett Universal II (BUII),EVO 2.0, Hoffer QST, Kane, Olsen-C, Pearl-DGS and SRK/T formulas. Linear correlation between MAE and axial length was also calculated for each formula.

Results

Eighty (80) eyes with a mean keratometry of 41.4 ± 0.6 D (range 40.6–41.9 D) were recruited. The SRK/T significantly differed from both the Olsen-C (p = 0.022) and the BUII (p = 0.048) in ME. The EVO 2.0, the Hoffer QST, the Kane and the PEARL-DGS showed a significantly lower MAE compared to all other formulas (p < 0.001) and a significant lower incidence of MAE>0.25D (p < 0.001), MAE>0.50 D (p < 0.001) and MAE>1.0 D (0.002).

Conclusion

Formulas based on AI and on the theory of vergence show superior accuracy in IOL power calculation in corneas with low mean keratometry; their MAE is not correlated to axial length.