Korean journal of ophthalmology : KJO最新文献

Purpose: The purpose of this study was to evaluate economic aspect of diabetic retinopathy (DR) screening strategies in developing countries. It focused on the cost-effectiveness of artificial intelligence (AI) and telemedicine compared to standard care.

Methods: A structured literature search was conducted using PubMed, ScienceDirect, the Cochrane Library, and Google Scholar. Studies were included if they involved patients with type 1 or type 2 diabetes mellitus, conducted in low- or middle-income countries at the time of the study, compared AI or telemedicine-based intervention with standard care, and performed a health economic assessment or provided sufficient data to assess cost-effectiveness.

Results: Seven studies were identified from China, Thailand, Brazil, and India. Of these, four applied cost-utility analysis, two used cost-effectiveness analysis, and one employed both approaches. Three studies evaluated AI-based screening, three focused on telemedicine, and one examined a combined AI-assisted telemedicine model. All studies compared these interventions to standard care, with some using no screening as the comparator. Across all studies, AI and telemedicine-based screening strategies were found to be cost-effective, though the degree of economic benefit varied depending on the model, setting, and assumptions used.

Conclusions: This review supports the cost-effectiveness and feasibility of AI- and telemedicine-based DR screening in developing countries. While most strategies proved economically viable, cost savings and health gains varied. Screening frequency and patient compliance were key factors influencing successful implementation.

Purpose: To determine the correlation between electroretinography (ERG) performed using a handheld ERG device equipped with skin electrodes and postoperative best-corrected visual acuity (BCVA) in patients with vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR).

Methods: The medical records of patients who underwent vitrectomy for diabetic vitreous hemorrhage (DVH) caused by PDR at our institution between July 1, 2017, and June 30, 2023, were reviewed retrospectively. We analyzed the correlation between preoperative ERG obtained using a handheld ERG device RETevalTM (LKC Technologies, Gaithersburg, MD, USA), RETevalTM skin electrodes (Sensor strips, LKC Technologies, Gaithersburg, MD, USA), and postoperative BCVA.

Results: We evaluated the medical records of 70 eyes of 70 patients. The BCVA, which was measured in logarithm of the minimal angle of resolution (logMAR) units, improved from 1.91±0.504 preoperatively to 0.287±0.225 postoperatively (p<0.001). In the group that underwent panretinal photocoagulation before VH, the amplitudes of the b-wave in photopic ERG and 30-Hz flicker ERG were negatively correlated with the postoperative BCVA. The implicit times of the b-wave in photopic ERG and 30-Hz flicker ERG were positively correlated with the postoperative BCVA (p<0.05).

Conclusions: Photopic ERG recorded using a handheld retinal ERG device equipped with skin electrodes can aid in predicting the visual prognosis in patients with severe VH caused by diabetes mellitus.

Purpose: To evaluate real-world functional and anatomical outcomes, treatment patterns, and ocular examination trends in diabetic macular edema (DME) in Korea.

Methods: A prospective, multicenter, observational study was conducted at 17 hospitals (2017-2022) involving adults with DME. Patients were categorized into center-involving DME (CI-DME) and non-CI-DME groups based on optical coherence tomography findings. Serial changes in best-corrected visual acuity (BCVA), central subfoveal thickness (CST), and treatment and examination patterns were recorded at baseline and follow-up visits (6, 12, 18, and 24 months), and analyzed using linear mixed models and paired t-tests.

Results: A total of 209 participants (81 female patients, 38.8%; mean age, 60.2 ± 10.8 years) were enrolled. Over 24 months, 10 of 68 non-CI-DME patients (14.7%) developed CI-DME. CST significantly decreased in the CI-DME group (from 419 µm at baseline to 343 µm, p = 0.001), whereas BCVA remained unchanged in both groups. Throughout the 2-year period, the average number of anti-vascular endothelial growth factor (anti-VEGF) injections was 3.1 ± 3.6, while steroid injections averaged 0.7 ± 1.5. The CI-DME group received significantly more anti-VEGF injections compared to the non-CI-DME group (3.8 ± 3.9 vs. 2.0 ± 2.8, p = 0.004). Additionally, the CI-DME group had more frequent visits (15.8 vs. 11.3, p = 0.017) and optical coherence tomography examinations (9.7 vs. 7.4, p = 0.023). The number of anti-VEGF injections decreased in the CI-DME group over time, while the number of visits decreased in both groups.

Conclusions: In real-world clinical practice in Korea, the treatment and monitoring frequency for DME was lower than in major clinical trials, potentially contributing to suboptimal visual outcomes.

Purpose: To evaluate the long-term efficacy of home-based convergence exercises using pencil push-ups in adult patients with convergence insufficiency (CI)-type exotropia with receded near point of convergence (NPC).

Methods: This retrospective observational study included 30 adult patients diagnosed with CI-type exotropia, who were divided into two groups based on their adherence to pencil push-up exercises: pencil push-ups group (n = 20) and noncompliant control group (n = 10). Pencil push-ups were performed four times daily (15 repetitions per session) for 6 months. The outcomes were changes in the angle of exodeviation (distance and near), NPC, and stereopsis. Measurements were taken at baseline and after 6 months. Between-group comparisons were performed using parametric statistical tests.

Results: The pencil push-ups group showed significant improvement in both distance (from 24.65 ± 5.46 to 14.40 ± 5.71 prism diopters, p < 0.001) and near exodeviation (from 35.25 ± 5.36 to 23.85 ± 6.68 prism diopters, p < 0.001). NPC improved significantly from 22.6 ± 5.2 to 8.6 ± 3.1 cm (p < 0.001). In contrast, the noncompliant group showed no significant changes in either parameter. No measurable improvement in stereopsis was observed in either group.

Conclusions: Consistent home-based pencil push-up exercises significantly improved convergence and reduced exodeviation in adult patients with CI-type exotropia with receded NPC. Pencil push-ups may serve as an effective first-line or adjunctive therapy, particularly in motivated patients with moderate deviations.

Purpose: To investigate the characteristics of esotropia associated with hyperopia in children aged 4 to 6 years.

Methods: Medical charts of 142 patients (60 boys and 82 girls; age range, 4-6 years) with esotropia and hyperopia (≥1.5 diopters after cycloplegic refraction) were retrospectively reviewed. Patients were classified into four groups: (1) fully corrected accommodative esotropia (FCAET); (2) accommodative esotropia (AET) with residual deviation ≤8 prism diopters; (3) partially AET (PAET) with residual deviation ≥10 prism diopters; and (4) nonaccommodative esotropia (NAET). Clinical parameters, including best-corrected visual acuity, angle of esodeviation, and refractive errors, were analyzed to identify predictors of esodeviation type.

Results: Female patients were significantly more likely to achieve good control with glasses (p = 0.044). Visual acuity in the better and worse eyes and the prevalence of anisometropic amblyopia did not differ among groups (p = 0.430, p = 0.124, and p = 0.189, respectively). The hyperopia (spherical power) of the AET group was significantly higher than that of the NAET group (p = 0.028), and the spherical equivalent was also more hyperopic in the AET group compared with the NAET group (p = 0.040). Near esodeviation in the FCAET group was significantly smaller than that in the AET group (p = 0.003), whereas esodeviation at distance did not differ among groups (p = 0.115).

Conclusions: Larger angles of esodeviation and lower degrees of hyperopia were associated with a reduced likelihood of successful correction with glasses. Multiple factors should therefore be considered when predicting motor outcomes of accommodative esotropia prior to a trial of spectacle correction.

Purpose: Although numerous studies have investigated the progression of myopia, a reliable animal model for hyperopia remains undeveloped. This study aimed to evaluate whether blue light exposure can suppress emmetropization in a manner comparable to lens-induced hyperopia, thereby facilitating the development of an experimental animal model of hyperopia.

Methods: Five-day-old 24 guinea pigs were randomly assigned to four different experimental groups based on light exposure conditions. They were housed under a 12-hour light/dark cycle (lights on at 8 AM and off at 8 PM) and exposed to either white light (control) or blue light (460 ± 20 nm). To induce hyperopia, a custom-designed +10 diopters (D) lens was fabricated using a three-dimensional printer and securely attached to randomly selected one eye with hook-and-loop fasteners and tissue adhesive. Refractive errors, corneal curvature, and axial length were measured using streak retinoscopy and A-scan ultrasound, with repeated measurements to assess intereye deviation.

Results: At the end of the treatment period of 6 weeks, guinea pigs reared under blue light with an attached +10 D lens exhibited a significantly greater hyperopic shift compared to those reared under blue light without the lens. In contrast, guinea pigs raised under white light underwent emmetropization regardless of +10 D lens attachment.

Conclusions: Blue light exposure significantly suppressed emmetropization by inducing a marked hyperopic shift in guinea pigs, whereas white light conditions support normal emmetropization regardless of lens attachment. These findings suggest that blue light plays a crucial role in hyperopia induction and can be effectively utilized to establish a stable hyperopia animal model.

Purpose: To investigate the clinical characteristics and prognosis of patients with traumatic retinal detachment (TrRD) based on the mechanism of ocular injury and identify prognostic factors associated with clinical outcomes. We hypothesized that open globe injuries would demonstrate worse clinical presentations and poorer functional outcomes compared to closed globe injuries.

Methods: This retrospective study included 98 eyes of 98 patients diagnosed with TrRD who underwent surgery, followed by a minimum of 6 months of postoperative observation. The eyes were categorized into two groups based on the mechanism of ocular injury: closed and open injuries. The clinical presentations and postoperative outcomes of the two groups were evaluated, and factors associated with anatomical and functional success were identified.

Results: Of the 98 eyes, 37 (37.8%) were classified as closed injury group and 61 (62.2%) as open injury group. Patients in the open group were more likely to exhibit vitreous hemorrhage (p = 0.003), subretinal hemorrhage (p = 0.003), and retinal incarceration than those in the closed group. Although there was no difference in the anatomical outcomes between the two groups, significantly more patients achieved functional success in the closed group than those in the open group (45.9% vs. 24.6%, p = 0.043). Anatomical success was associated with the absence of giant retinal tears, retinal incarceration, and proliferative vitreoretinopathy (≥grade B). Functional success was significantly associated with better baseline best-corrected visual acuity, intraoperative intraocular lens implantation, and no retinectomy during surgery.

Conclusions: Despite the clinical presentation variations among patients with TrRD with closed and open injuries, there were no differences in anatomical outcomes between the two groups. Patients in the open group had poorer functional outcomes. By identifying specific prognostic factors associated with anatomical and functional success, this study provides evidence-based guidance for management and prognostication of patients with TrRD.