AJO International最新文献_第8页

Features and associations of optic neuritis in the Middle East: A cross-sectional study 中东视神经炎的特征与关联：横断面研究

AJO International

Pub Date : 2024-06-08 DOI: 10.1016/j.ajoint.2024.100038

Ayah Hajjar , Anu Jacob , Scott Smith , Luai Eldweik

Background

Differences exist in the clinical profile of optic neuritis (ON) among various populations. The present study outlines the features of optic neuritis and its associations in Middle Eastern population.

Methods

In a single tertiary care neuro-ophthalmology clinic, we reviewed charts between 2016 and 2021, to identify patients with optic neuritis. Patients with at least one single episode of ON, and a follow up for at least 6 months were only included. Patients from countries outside the Middle East were not eligible. We performed a sub-analysis using data from the clinic, laboratory, and radiological findings to classify patients with optic neuritis into 4 groups: idiopathic ON, multiple sclerosis associated optic neuritis (MS-ON), neuromyelitis optica spectrum disorder associated optic neuritis (NMOSD-ON), and myelin oligodendrocyte glycoprotein associated disease optic neuritis (MOGAD-ON).

Results

77 patients met the criteria for inclusion in the study. Approximately, two thirds of the patients (64%, 95% CI [0.52–0.74]) had MS-ON, 17 patients had idiopathic ON (22.6%, 95% CI [0.13–0.33]), 6 patients were diagnosed with NMOSD-ON (8%, 95% CI [0.02–0.16]), and 4 patients had MOG-ON (5.3%, 95% CI [0.01–0.13]). More than half of patients with idiopathic ON were found to have clinically isolated syndrome (CIS) and thus to be at high risk of developing MS. Among all patients enrolled in the study, the mean age was 29.8 ± 9.53 years. Patients with MS-ON and MOG-ON were relatively younger compared to patients from other groups (P = 0.0005). There was a female preponderance among all groups except MOG-ON, where 80% were males (P = 0.11). The pre- and post-treatment logMAR visual acuity (VA) tended to be worse in NMOSD-ON than other categories (P = 0.062). Optic disc swelling was more common among patients with MOGAD-ON, and least common in patients with NMOSD (100% vs 0%, P = 0.001). 5 patients presented with simultaneous bilateral involvement, and all but one had NMOSD-ON. 29% of patients had recurrence during the time of the study with significant difference in prevalence across groups. There was no difference in the involvement of the chiasm, or the retro-chiasmal pathways across groups.

Conclusions

Our study demonstrates that multiple sclerosis (MS) is the predominant CNS demyelinating disease associated with optic neuritis (ON) in the Middle Eastern population, mirroring trends observed in Western populations. The clinical and radiological features of each subtype showed no significant divergence compared to findings from studies conducted in other regions globally. These insights contribute to a deeper understanding of ON's clinical spectrum and aid in refining diagnostic and management strategies in the Middle Eastern population.

背景不同人群的视神经炎（ON）临床特征存在差异。本研究概述了中东人群视神经炎的特征及其相关性。方法在一家三级护理神经眼科诊所，我们查阅了 2016 年至 2021 年间的病历，以确定视神经炎患者。仅纳入至少单次发病、随访至少 6 个月的视神经炎患者。来自中东以外国家的患者不符合条件。我们利用临床、实验室和放射学检查结果的数据进行了子分析，将视神经炎患者分为 4 组：特发性视神经炎、多发性硬化症相关性视神经炎（MS-ON）、神经脊髓炎视谱系障碍相关性视神经炎（NMOSD-ON）和髓鞘少突胶质细胞糖蛋白相关疾病视神经炎（MOGAD-ON）。约三分之二的患者（64%，95% CI [0.52-0.74]）患有 MS-ON，17 名患者患有特发性 ON（22.6%，95% CI [0.13-0.33]），6 名患者被诊断为 NMOSD-ON（8%，95% CI [0.02-0.16]），4 名患者患有 MOG-ON（5.3%，95% CI [0.01-0.13]）。一半以上的特发性ON患者被发现患有临床孤立综合征（CIS），因此是多发性硬化症的高危人群。在所有参与研究的患者中，平均年龄为（29.8 ± 9.53）岁。与其他组别患者相比，MS-ON 和 MOG-ON 患者相对年轻（P = 0.0005）。除MOG-ON患者80%为男性外，其他各组患者均以女性居多（P = 0.11）。NMOSD-ON患者治疗前和治疗后的logMAR视力（VA）往往差于其他组别（P = 0.062）。视盘肿胀在 MOGAD-ON 患者中更为常见，而在 NMOSD 患者中最少见（100% vs 0%，P = 0.001）。5名患者同时出现双侧受累，除一人外，其余均为NMOSD-ON。29%的患者在研究期间复发，各组患病率差异显著。结论我们的研究表明，多发性硬化症（MS）是中东人群中与视神经炎（ON）相关的主要中枢神经系统脱髓鞘疾病，这与西方人群中观察到的趋势一致。与全球其他地区的研究结果相比，每个亚型的临床和放射学特征均无明显差异。这些见解有助于加深对ON临床范围的理解，并有助于完善中东人群的诊断和管理策略。

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引用次数: 0

Comparison of facedown and non-facedown positions after vitrectomy with fovea-sparing internal limiting membrane peeling and air tamponade for treating myopic foveoschisis with foveal detachment: A prospective, randomized interventional study 前瞻性随机干预研究：玻璃体切割术后面朝下体位和非面朝下体位与保留眼窝内缘膜剥离术和空气填塞术治疗近视性眼底病伴眼窝脱离的比较

AJO International

Pub Date : 2024-06-02 DOI: 10.1016/j.ajoint.2024.100036

Ke Zhu , Boya Lei , Fang Song , Rui Jiang , Qing Chang , Gezhi Xu

Purpose

To compare the anatomical and visual outcomes after vitrectomy with facedown (FD) or non-FD positions for treating myopic foveoschisis (MF) with foveal detachment.

Design

Prospective, randomized interventional study.

Methods

55 eyes with MF and foveal detachment that underwent vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling and air tamponade were randomized to either the postoperative FD (26 eyes) or non-FD (29 eyes) positions. Best-corrected visual acuity (BCVA) and optical coherence tomography were assessed at baseline, 2 weeks, 3 months, and 6 months after vitrectomy with fovea-sparing ILM peeling and air tamponade with the FD or non-FD positions. Logistic and linear regression analyses were performed to study correlations between clinical factors and foveoschisis resolution and postoperative BCVA.

Results

All patients completed ≥6 months of follow-up. MF and foveal detachment were completely resolved in 22 eyes (92 %) in the FD group and 22 eyes (76 %) in the non-FD group (P = 0.160). Macular hole-associated retinal detachment occurred in one eye in the FD (4 %) and non-FD (3 %) groups. The postoperative best-corrected visual acuity (BCVA) at 6 months did not differ significantly between the two groups (P = 0.495). The BCVA improved by ≥0.3 logMAR in 14 eyes (58 %) in the FD group versus 17 eyes (59 %) in the non-FD group (P = 0.983). Central foveal thickness (CFT) and height of foveal detachment were significantly associated with foveoschisis resolution (P = 0.045 and 0.039, respectively). Better preoperative BCVA and foveoschisis resolution were significantly associated with better postoperative BCVA (P = 0.031 and 0.003, respectively).

Conclusions

The non-FD position appeared to be as effective as the FD position after vitrectomy with fovea-sparing ILM peeling and air tamponade for treating MF with foveal detachment.

目的比较采用面朝下（FD）或非FD体位进行玻璃体切除术治疗近视性眼窝裂孔（MF）伴眼窝脱离后的解剖学和视觉结果。方法55只眼患MF伴眼窝脱离并接受了玻璃体切除术，同时进行了保留眼窝的内层限界膜（ILM）剥离和空气填塞，这些眼被随机分配到术后FD体位（26只眼）或非FD体位（29只眼）。最佳矫正视力（BCVA）和光学相干断层扫描分别在玻璃体切割术后基线、2周、3个月和6个月进行了评估，并采用FD或非FD体位进行了保留眼窝的ILM剥离和空气填塞。对临床因素与眼窝裂解和术后BCVA之间的相关性进行了逻辑和线性回归分析。在 FD 组和非 FD 组中，分别有 22 只眼睛（92%）和 22 只眼睛（76%）的 MF 和眼窝脱离完全消除（P = 0.160）。在 FD 组（4%）和非 FD 组（3%）中，有一只眼睛发生了黄斑孔相关性视网膜脱离。两组患者术后 6 个月的最佳矫正视力（BCVA）无显著差异（P = 0.495）。FD组有14只眼睛（58%）的BCVA提高了≥0.3 logMAR，而非FD组有17只眼睛（59%）的BCVA提高了≥0.3 logMAR（P = 0.983）。中心眼窝厚度（CFT）和眼窝脱离高度与眼窝裂解显著相关（P = 0.045 和 0.039）。结论在进行玻璃体切除术，同时进行疏通眼窝的ILM剥离和气囊填塞术治疗伴有眼窝脱离的MF时，非FD体位似乎与FD体位一样有效。

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引用次数: 0

Investigating the impact of tadalafil on progression of age-related macular degeneration: a health insurance claims database analysis 调查他达拉非对老年性黄斑变性进展的影响：医疗保险索赔数据库分析

AJO International

Pub Date : 2024-06-01 DOI: 10.1016/j.ajoint.2024.100037

Tracy Z. Lang , John R. O'Fee , Khristina I. Lung , David S. Boyer , Andrew A. Moshfeghi , Brian C. Toy

Purpose

To assess the effect of tadalafil use on progression of early/intermediate to advanced exudative or non-exudative age-related macular degeneration (AMD) in a real-world population.

Design

Retrospective cohort study utilizing Optum's de-identified Clinformatics® Data Mart Database (CDM).

Methods

Patients were included from January 2015 to December 2020 aged 55 and older with an index International Classification of Diseases, Tenth Revision (ICD-10) diagnosis of early or intermediate AMD who had a 2-year period of continuous enrollment prior to the index diagnosis date (lookback period), 5 years of continuous follow-up, and who did not meet any exclusion criteria (claims for a phosphodiesterase-5 (PDE-5) inhibitor other than tadalafil during the study, diagnosis of advanced non-exudative or exudative AMD, or claims for exudative AMD treatment during the lookback period). Treated patients with claims for tadalafil during the study period were matched 1:1 to untreated controls by age, sex, race, and smoking status. We assessed the effect of any tadalafil use, high (≥2700 mg) cumulative dose tadalafil vs. matched untreated controls, high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil, and the 2-year cumulative dose of tadalafil (per 100 mg) as a continuous variable on incidence of progression to exudative or advanced non-exudative AMD during the 2-year follow-up.

Results

There was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the control vs treated groups (OR = 0.802, 95% CI (0.558–1.152), p = 0.233; OR = 1.326, 95% CI (0.757–2.323), p = 0.323). High (≥2700 mg) cumulative dose tadalafil was not associated with a significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when compared to the matched controls (OR = 0.455, 95% CI (0.202–1.025), p = 0.057; OR = 1.000, 95% CI (0.318–3.142), p = 1.000). There was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil (OR = 0.590, 95% CI (0.296–1.177), p = 0.134; OR = 1.039, 95% CI (0.440–2.460), p = 0.931). Lastly, there was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when assessing the 2-year cumulative tadalafil dose (per 100 mg) as a continuous variable (OR = 1.000, 95% CI (1.000–1.000), p = 0.305; OR = 1.000, 95% CI (1.000–1.000), p = 0.878).

Conclusion

In a retrospective cohort study of a large nationwide health insurance claims database, tadalafil use was not associated with progression of AMD.

目的评估在现实世界人群中使用他达拉非对早期/中期渗出性或非渗出性老年性黄斑变性（AMD）进展的影响。方法纳入 2015 年 1 月至 2020 年 12 月期间 55 岁及以上、国际疾病分类第十次修订版（ICD-10）诊断为早期或中期 AMD 的患者，这些患者在诊断日期（回溯期）之前有 2 年的连续注册期、连续随访 5 年，且不符合任何排除标准（在研究期间申请使用除他达拉非以外的磷酸二酯酶-5 (PDE-5) 抑制剂、诊断为晚期非渗出性或渗出性 AMD 或在回溯期内申请渗出性 AMD 治疗）。在研究期间报销了他达拉非的治疗患者与未治疗的对照组按年龄、性别、种族和吸烟状况进行了 1:1 的配对。我们评估了使用任何他达拉非、高剂量（≥2700 毫克）他达拉非累积剂量与匹配的未治疗对照组、高剂量（>2700 毫克）与低剂量（≤2700 毫克）他达拉非累积剂量以及他达拉非 2 年累积剂量（每 100 毫克）作为连续变量对 2 年随访期间进展为渗出性或晚期非渗出性 AMD 的发生率的影响。结果对照组与治疗组发展为渗出性AMD或晚期非渗出性AMD的几率无明显差异（OR = 0.802，95% CI (0.558-1.152)，p = 0.233；OR = 1.326，95% CI (0.757-2.323)，p = 0.323）。与匹配对照组相比，高累积剂量（≥2700 毫克）他达拉非与进展为渗出性老年黄斑病变或晚期非渗出性老年黄斑病变的几率无显著差异（OR = 0.455，95% CI (0.202-1.025)，p = 0.057；OR = 1.000，95% CI (0.318-3.142)，p = 1.000）。高累积剂量（>2700 毫克）与低累积剂量（≤2700 毫克）他达拉非相比，进展为渗出性老年黄斑病变或晚期非渗出性老年黄斑病变的几率没有明显差异（OR = 0.590，95% CI (0.296-1.177)，p = 0.134；OR = 1.039，95% CI (0.440-2.460)，p = 0.931）。最后，将 2 年的他达拉非累积剂量（每 100 毫克）作为连续变量进行评估时，进展为渗出性 AMD 或晚期非渗出性 AMD 的几率没有明显差异（OR = 1.000，95% CI (1.000-1.000)，p = 0.134）。结论在一项大型全国性健康保险索赔数据库的回顾性队列研究中，他达拉非的使用与AMD的进展无关。

{"title":"Investigating the impact of tadalafil on progression of age-related macular degeneration: a health insurance claims database analysis","authors":"Tracy Z. Lang , John R. O'Fee , Khristina I. Lung , David S. Boyer , Andrew A. Moshfeghi , Brian C. Toy","doi":"10.1016/j.ajoint.2024.100037","DOIUrl":"10.1016/j.ajoint.2024.100037","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the effect of tadalafil use on progression of early/intermediate to advanced exudative or non-exudative age-related macular degeneration (AMD) in a real-world population.</p></div><div><h3>Design</h3><p>Retrospective cohort study utilizing Optum's de-identified Clinformatics® Data Mart Database (CDM).</p></div><div><h3>Methods</h3><p>Patients were included from January 2015 to December 2020 aged 55 and older with an index International Classification of Diseases, Tenth Revision (ICD-10) diagnosis of early or intermediate AMD who had a 2-year period of continuous enrollment prior to the index diagnosis date (lookback period), 5 years of continuous follow-up, and who did not meet any exclusion criteria (claims for a phosphodiesterase-5 (PDE-5) inhibitor other than tadalafil during the study, diagnosis of advanced non-exudative or exudative AMD, or claims for exudative AMD treatment during the lookback period). Treated patients with claims for tadalafil during the study period were matched 1:1 to untreated controls by age, sex, race, and smoking status. We assessed the effect of any tadalafil use, high (≥2700 mg) cumulative dose tadalafil vs. matched untreated controls, high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil, and the 2-year cumulative dose of tadalafil (per 100 mg) as a continuous variable on incidence of progression to exudative or advanced non-exudative AMD during the 2-year follow-up.</p></div><div><h3>Results</h3><p>There was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the control vs treated groups (OR = 0.802, 95% CI (0.558–1.152), <em>p</em> = 0.233; OR = 1.326, 95% CI (0.757–2.323), <em>p</em> = 0.323). High (≥2700 mg) cumulative dose tadalafil was not associated with a significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when compared to the matched controls (OR = 0.455, 95% CI (0.202–1.025), <em>p</em> = 0.057; OR = 1.000, 95% CI (0.318–3.142), <em>p</em> = 1.000). There was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD in the high (>2700 mg) vs. low (≤2700 mg) cumulative dose tadalafil (OR = 0.590, 95% CI (0.296–1.177), <em>p</em> = 0.134; OR = 1.039, 95% CI (0.440–2.460), <em>p</em> = 0.931). Lastly, there was no significant difference in odds of progression to exudative AMD or advanced non-exudative AMD when assessing the 2-year cumulative tadalafil dose (per 100 mg) as a continuous variable (OR = 1.000, 95% CI (1.000–1.000), <em>p</em> = 0.305; OR = 1.000, 95% CI (1.000–1.000), <em>p</em> = 0.878).</p></div><div><h3>Conclusion</h3><p>In a retrospective cohort study of a large nationwide health insurance claims database, tadalafil use was not associated with progression of AMD.</p></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 2","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950253524000376/pdfft?md5=7877785fb274c73ead16d562c34f658d&pid=1-s2.0-S2950253524000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing contact lenses uptake among school-going children and teenagers with myopia attending selected eye clinics in Kenya 影响肯尼亚选定眼科诊所就诊的近视儿童和青少年接受隐形眼镜的因素

AJO International

Pub Date : 2024-05-31 DOI: 10.1016/j.ajoint.2024.100033

Gellause Kololi , Emmanuel E. Okenwa-Vincent , Tecla Jerotich Sum

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.

目的在儿童和青少年中使用隐形眼镜（CL）矫正近视已成为全球关注的焦点。然而，在这一年龄组中，眼镜仍是矫正视力的主要手段。本研究调查了在肯尼亚眼科诊所就诊的近视学龄儿童和青少年中影响隐形眼镜使用率的因素。数据收集采用混合方法，使用经过验证的半结构式问卷，其中还包括一个 3 级李克特量表，以征求对影响接受 CL 的因素的回答。分析技术包括描述性统计、卡方差和克莱默 V。结果85 名参与者参与了研究，平均年龄为 13.4 ± 2.1 岁，女性占多数（54.1%）。虽然 CL 的使用率较低（17.6%），但眼镜仍是参与者首选的近视矫正方法。选择角膜塑形镜的因素包括角膜塑形镜带来的适当视觉清晰度（59%）、增强的自尊和社会接受度（64%）。接受角膜塑形镜的主要障碍是担心眼睛受伤（60%）、角膜塑形镜知识有限（55%）和角膜塑形镜专业人员较少（48%）。眼科护理专业人员是接受角膜接触治疗的主要信息来源。眼镜的厚重感与 CL 使用率之间存在微弱联系（Cramer's V：0.223，p = 0.121）。然而，视力清晰度（Cramer's V：0.387，p = 0.002）和社会接受度（Cramer's V：0.351，p = 0.005）与儿童和青少年对 CL 的接受程度有更密切的关系。建议努力消除信息差距，突出角膜塑形镜的优势，以促进更广泛的接受。

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引用次数: 0

Glaucoma is associated with poorer self-rated vision, vision concerns and health: Results from 59,168 questionnaire responses 青光眼与自我视力、视力问题和健康状况较差有关：59 168 份问卷调查结果

AJO International

Pub Date : 2024-05-27 DOI: 10.1016/j.ajoint.2024.100035

Jens Rovelt , Josefine Freiberg , Marcel Reimann , Marianne Benn , Christian Torp-Pedersen , Miriam Kolko , FOREVER consortium

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.

目的本研究旨在调查青光眼患者和非青光眼患者的自评视力、视力问题和总体健康状况。这些评估能广泛反映一个人的整体健康状况和潜在的健康问题，并能为了解青光眼患者的特征提供有价值的信息。方法我们利用 FOREVER 项目（发现眼科风险和评估眼科检查的价值及其预测可靠性）的问卷调查来评估自评视力和一般健康状况，评分标准从 1（极好）、2（好）、3（一般）、4（差）到 5（非常差）不等。此外，视力问题的评分标准为 1（从不）、2（很少）、3（偶尔）、4（经常）到 5（总是）。青光眼的诊断是通过自我报告和问卷调查获得的。为了研究两者关联的强度和方向，我们使用了二项式逻辑回归模型，将自我评估、年龄和性别作为混杂变量，将青光眼状态作为因变量。结果这项研究分析了 59 168 名参与者的问卷数据，参与者的平均年龄为 55.2 岁（SD 15.0），女性占 62.0%。其中有 900 人（1.5%）被诊断出患有青光眼。患有青光眼的人在视力、视力问题和一般健康方面的自我评分较低。具体而言，视力自评最差的几率为 2.46（95 % CI 1.70-3.55，p <0.001），视力问题自评最差的几率为 8.04（95 % CI 5.44-11.90，p <0.001），健康自评最差的几率为 1.86（95 % CI 1.16-2.98，p = 0.010）。这表明，青光眼患者比非青光眼患者面临更多的视力和健康挑战，这三种评估可用作风险分析工作中描述青光眼患者特征的工具。

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引用次数: 0

Pilot study evaluating the usability of MonŒil, a ChatGPT-based education tool in ophthalmology 评估基于 ChatGPT 的眼科教育工具 MonŒil 可用性的试点研究

AJO International

Pub Date : 2024-05-19 DOI: 10.1016/j.ajoint.2024.100032

Claudio XOMPERO, Walid BENETTAYEB, Eric H. SOUIED, Carl-Joe MEHANNA

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.

重要性人工智能（AI）在眼科领域的应用越来越广泛，以满足患者获取可靠、易懂的医疗信息的需求。目的评估患者对MonŒil（一个基于人工智能的眼科患者教育平台）可用性的满意度。MonŒil以ChatGPT-4技术为基础，针对眼科进行了专门定制并增强了可访问性，可在monoeil.help上免费获取。研究在克里特大学医院的眼科进行。参与者包括 54 名被诊断为晚期 AMD 的患者，他们都是来复诊的。患者年龄必须在 50 岁以上，能够做出知情同意，能够理解 MonŒil 并与之互动。排除标准是有严重视力和认知障碍，无法与MonŒil互动。主要结果和测量指标主要结果是MonŒil的可用性，通过系统可用性量表（SUS）问卷进行测量。平均年龄为（77.76±8.14）岁（58 至 97 岁）。平均 SUS 得分为 90.23±12.04，中位数为 92.50（范围为 42.50 至 100.00），表明可用性极佳。视力与 SUS 分数之间存在正相关关系（回归系数为 0.30（95 % CI 0.08 至 0.51），r2=0.19，p = 0.0077）。这些结果表明，像MonŒil这样基于人工智能的工具可以在像眼科这样复杂的领域以最小的监督加强患者教育，支持将其作为医患讨论的辅助工具。可能有必要开展进一步研究，以确定MonŒil是否适用于更广泛的用户群，并评估其实用性及其对患者知识和视力相关生活质量等患者结果的临床影响。

{"title":"Pilot study evaluating the usability of MonŒil, a ChatGPT-based education tool in ophthalmology","authors":"Claudio XOMPERO, Walid BENETTAYEB, Eric H. SOUIED, Carl-Joe MEHANNA","doi":"10.1016/j.ajoint.2024.100032","DOIUrl":"https://doi.org/10.1016/j.ajoint.2024.100032","url":null,"abstract":"<div><h3>Importance</h3><p>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.</p></div><div><h3>Objective</h3><p>To assess patient satisfaction with the usability of MonŒil, an AI-based platform designed for patient education in ophthalmology.</p></div><div><h3>Design</h3><p>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 <em>monoeil.help</em>. Patients were given 20 min of unsupervised interaction with no prior training or guidance, after which their feedback was collected.</p></div><div><h3>Setting</h3><p>The study was performed in the ophthalmology department at the Creteil University Hospital.</p></div><div><h3>Participants</h3><p>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.</p></div><div><h3>Main Outcome(s) and Measure(s)</h3><p>The primary outcome was the usability of MonŒil as measured by the System Usability Scale (SUS) questionnaire.</p></div><div><h3>Results</h3><p>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, <em>p</em> = 0.0077).</p></div><div><h3>Conclusions and Relevance</h3><p>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.</p></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"1 2","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950253524000327/pdfft?md5=0d565968f77c687abb04b1d701e28a80&pid=1-s2.0-S2950253524000327-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Orbital radiotherapy with combined intravenous methylprednisolone and mycophenolate mofetil in moderate-to-severe thyroid eye disease 中重度甲状腺眼病患者的眼眶放疗与甲基强的松龙和霉酚酸酯静脉注射联合疗法

AJO International

Pub Date : 2024-05-16 DOI: 10.1016/j.ajoint.2024.100031

Kenneth Ka Hei Lai , Ryan Hong Yu Fong , Fatema Mohamed Ali Abdulla Aljufairi , Jake Uy Sebastian , Karen Kar Wun Chan , Joyce Ka Yee Chin , Kenneth Chun Wai Wong , Hanson Yiu Man Wong , George Pak Man Cheng , Wilson Wai Kuen Yip , Alvin Lerrmann Young , Clement Chee Yung Tham , Chi Pui Pang , Kelvin Kam Lung Chong

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.

目的报告眼眶放射治疗（ORT）联合静脉甲基强的松龙（IVMP）和霉酚酸酯（MMF）对甲状腺眼病（TED）伴局限性肌病患者的临床疗效。方法主要结果是52周时Gorman复视评分的变化。次要结果是52周时眼外肌运动（EOMy）、MRI上眼外肌面积（EOM）、眼球外翻、边缘反射距离（MRD）1和MRD2的变化。结果共有40名（29名女性）TED患者接受了双方案治疗：联合IVMP和MMF（17名）或三方案治疗：IVMP、MMF 和 ORT（23 例）。三联疗法组患者的年龄更大（P = 0.028）。两组患者的性别、吸烟史、甲状腺和治疗前眼眶状况相当。三联方案治疗后，EOMy的改善程度更高（P = 0.026）。三联疗法组中有九名患者的下直肌明显缩小（双眼：P < 0.05），而双联疗法组中有五名患者的任何EOM在核磁共振成像上都没有明显缩小。CAS、复视评分、眼球外翻、MRD1和MRD2的改善情况相似。没有患者报告IVMP、MMF或ORT产生任何严重或危及器官的副作用而需要中断治疗。未来有必要开展随机临床试验，以明确 ORT 在 TED 治疗这一特殊适应症中的辅助作用。

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引用次数: 0

A comparison of deep sclerectomy outcomes in eyes with pseudoexfoliation versus primary open angle glaucoma 假性角膜外翻与原发性开角型青光眼眼球深部巩膜切除术效果比较

AJO International

Pub Date : 2024-05-14 DOI: 10.1016/j.ajoint.2024.100030

Constance Weber, Anna Sophia Jauch, Natalie Rieder, Frank G. Holz, Karl Mercieca

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.

目的比较假性角膜外翻性青光眼（PEXG）和原发性开角型青光眼（POAG）患者接受丝裂霉素 C（MMC）增强深巩膜切除术（DS）的疗效。我们对 PEXG 眼（第 1 组，n = 45）和 POAG 眼（第 2 组，n = 45）进行了配对分析。第 1 组和第 2 组一年后的完全成功率和合格率分别为 55.5%和 55.5%。在一年内，≤21 mmHg 的完全成功率和合格率分别为 55.6% 和 86.7% (p = 0.002) 以及 91.1% 和 93.3% (p = 0.78)；≤18 mmHg 的完全成功率和合格率分别为 55.6% 和 86.7% (p = 0.002) 以及 88.9% 和 93.3% (p = 0.53)。第一组和第二组的术前平均眼压分别从 21.11 mmHg 和 19.64 mmHg（p = 0.31）降至术后的 13.64 mmHg 和 11.42 mmHg，而 POAG 患者的眼压明显降低（p = 0.01）。12 个月后，POAG 患者的降压药滴数也明显减少（PEXG：0.58；POAG：0.18；p = 0.01）。PEXG患者的Nd:YAG激光眼球穿刺率明显更高（PEXG：64.4%；POAG：40%，p = 0.02）。术后并发症发生在6只眼睛（6.7%），两组均未出现威胁视力的后遗症。两组的并发症发生率无明显差异（p = 0.18）。结论DS是一种安全有效的降低POAG和PEXG患者眼压的手术，POAG患者的总体眼压水平较低。PEXG患者术后需要进行激光结膜穿刺的次数明显增多。

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引用次数: 0

Genotype-phenotype severity correlation in a multicentric portuguese cohort of ABCA4-associated retinopathy ABCA4相关视网膜病变葡萄牙多中心队列中基因型与表型严重程度的相关性

AJO International

Pub Date : 2024-05-10 DOI: 10.1016/j.ajoint.2024.100029

Catarina Cunha Ferreira , Sara Geada , Ana Marta , Pedro Carreira , Diogo Cabral , Ana Luísa Carvalho , Rufino Silva , Joaquim Murta , João Pedro Marques

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.

目的研究 ABCA4 相关性视网膜病变的基因型-表型相关性，并进一步验证最近提出的基因型-表型相关性模型。方法纳入葡萄牙三个中心经基因证实患有 ABCA4 相关性视网膜病变的连续患者。根据超宽视野眼底自发荧光（UW-FAF）成像的低自发荧光程度和视网膜背景外观，将患者分为不同的表型组。基因型分类采用两种标准：一种是根据是否存在p.Gly1961Glu变异、一个低位变异、至少一个中度变异或两个双拷贝重度/PVS1变异（基因型分类A，与新描述的标准相对应）；另一种是根据识别出的无效变异的数量（基因型分类B）。结果共纳入了 50 名患者。结果发现，发病年龄、最佳矫正视力（BCVA）与表型和基因型组之间存在显著相关性，表型和基因型分类较严重的患者发病较早，视功能较差（分别为 p < 0.001; p < 0.001; p < 0.001; p < 0.001, p < 0.001; 和 p = 0.004）。基因型分类 A 更好地预测了 UW-AF 成像的表型严重程度，显示表型较轻患者的基因型较轻，而晚期患者的基因型较重（p <0.001）。结论：我们的研究结果支持新描述的基因型分类在评估 ABCA4 相关视网膜病变表型严重程度方面的实用性，这可能对未来了解疾病遗传学和评估患者个体预后具有重要意义。

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引用次数: 0

Raised intraocular pressure after immediate sequential bilateral cataract surgery with EyeCee one intraocular lens 使用 EyeCee 一号眼内透镜立即进行双侧序贯白内障手术后眼压升高的情况

AJO International

Pub Date : 2024-05-10 DOI: 10.1016/j.ajoint.2024.100027

Emily N. Stedman, Stephanie J. Chiu, Haoyu Wang, Jennifer H.Y. Tan

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.

目的美国医药与保健品管理局（MHRA）报告了植入受影响批号的 EyeCee One 眼内人工晶体（EC1IOL）后出现高眼压（IOP）的病例。在我们医院，我们提供了使用 EC1IOL 的即刻连续双侧白内障手术（ISBCS），在此我们将对该组患者的眼压升高率、病例管理和结果进行研究。结果43眼（27名患者）在ISBCS期间植入的EC1IOL批号受影响，16名患者双眼晶状体受影响，11名患者单眼晶状体受影响。7%的患者（3 名患者的 3 只眼睛）在术后就诊时眼压飙升（平均 51.9 mmHg），据认为与 EC1IOL 有关。患者需要立即接受治疗，平均使用 3.33 种常规局部降眼压药物和 5 次门诊预约。以同侧眼睛作为对照比较，尖峰组的 3 只眼睛中有 2 只的视力改善幅度较小。结论我们发现与 EC1IOL 相关的眼压峰值率高于 MRHA 报告。出现眼压骤升的患者术后视力提高的趋势较小，但由于人数较少，无法进行有意义的统计分析。本组患者无需进行手术干预。

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引用次数: 0