Clinical and Experimental Optometry最新文献

Clinical relevance: Low-luminance visual acuity and low-luminance deficit (standard visual acuity minus low-luminance visual acuity) are gaining popularity as outcome measures in clinical trials for retinal disease, demonstrating capability to detect central visual function changes earlier than standard visual acuity.

Background: The aim of this study is to explore suspected sources of low-luminance visual acuity variability, standardise the method of measurement of low-luminance visual acuity, and define a 'normal' low-luminance deficit upper limit for young adults (<55 years).

Methods: Data from three separate studies were collated. Standard visual acuity was obtained using ETDRS charts (Precision Vision, Bloomington, IL, USA) and low-luminance visual acuity was obtained with the addition of a 2.0-log neutral density filter. The effects of dark adaptation and different background luminance levels on low-luminance visual acuity results were explored. The Electronic Visual Acuity chart (M&S Technologies, Niles, IL, USA) for low-luminance visual acuity testing was also assessed.

Results: Three-minutes of dark adaptation and different background luminance levels (1.6 and 0.85 cd/m²) did not demonstrate clinically significant changes in low-luminance visual acuity and low-luminance deficit. Bland-Altman analyses revealed significant variability between the ETDRS physical charts and the electronic chart indicating the two cannot be used interchangeably in the presence of a luminance difference. An upper low-luminance deficit limit of 11 ETDRS letters for younger individuals was also identified.

Conclusion: Formal dark adaptation does not improve low-luminance visual acuity results since any increased sensitivity is nullified by extremely quick cone light adaptation times. Small reductions in background luminance levels are not a clinically significant source of variability. However, for consistency, the same luminance level should be maintained throughout testing. Results from electronic and physical charts are not transferrable without proper luminance calibration. A low-luminance deficit greater than 11 ETDRS letters, in younger individuals, should prompt further investigation.

Clinical relevance: Ocular allergy (OA) is likely to be a significant problem in regional Australia and may affect quality of life.

Background: Regional locations vary markedly in the types, quantities, and seasonality of allergens compared with urban environments. The aim of this research was to investigate the effects of OA on quality of life in patients presenting to a regional Australian optometric practice.

Methods: In this 12-month cross-sectional study, 107 adults with OA were recruited from a practice in Bundaberg, Australia. Self-reported symptoms, treatments, triggers and seasonality were recorded. Ocular itch was measured using the Numerical Rating Scale-11. Conjunctival hyperaemia and papillae were graded using the Efron Grading Scales. Tear meniscus height and non-invasive tear break-up time were measured using keratography. Participants completed the mini Rhino-Conjunctivitis Quality of Life Questionnaire (mini-RQLQ). Climate data for the month prior to presentation were collected.

Results: Mean age of participants was 56 years (SD 18 years) and 67% were female. Only 33.6% initially reported ocular itch. Papillae in the most affected eye was the only OA sign that correlated with overall mini-RQLQ score, although weakly (rho = 0.194, p = 0.046). Peak OA occurred mostly between July and January. Multiple regression analysis indicated correlations between overall mini-RQLQ score and OA history (p < 0.001) and worsening degree of OA symptoms in the past year (p = 0.002). Higher average minimum (p = 0.015) and higher average maximum temperatures (p = 0.008) in the month prior to presentation were associated with a worse mini-RQLQ 'Eye Symptoms' domain score.

Conclusion: Previous history of OA symptoms was significantly associated with worse quality of life. Optometrists should be aware of and consider the negative impact of OA on quality of life in developing management plans for patients with OA.

Clinical relevance: Collaborative care models between optometry and ophthalmology can be a safe and viable way to improve patient access to paediatric eye-care services and reduce hospital paediatric load.

Background: Long waiting lists exist for paediatric ophthalmology services Australia-wide, yet some patients who are referred to the hospital may not require hospital-based treatment and instead can be seen in primary care. This audit assessed the safety and standard of care provided in a paediatric collaborative care model between a student-led university optometry clinic and a public ophthalmology clinic. Supervising optometrists in the optometry clinic were experienced in the care of paediatric patients. Collaborative care was provided for children with juvenile idiopathic arthritis, craniosynostosis (without strabismus/amblyopia), nasolacrimal duct obstruction or chalazion, following a co-developed care protocol.

Methods: Outcome data (throughput, re-referrals, waiting list removals) were collected through both clinics. A retrospective case note audit (randomised record selection across the four included conditions) was undertaken, assessing percentage compliance against the co-developed care model protocol. Patient satisfaction with the collaborative care clinic was assessed by patient reported experience survey for clinic attendees in a one-month period.

Results: One hundred and fifty-seven of 169 children offered the care pathway received care through the collaborative model, with 209 patients being removed or prevented from being added to the Royal Children's Hospital Ophthalmology waiting list. Collaborative care protocol compliance was 95%. Twenty-nine children were re-referred for ophthalmological intervention. Parents/guardians of 11 children completed the survey, reporting 100% satisfaction.

Conclusions: Collaborative care between hospital-based ophthalmology and university-based optometry can be effectively implemented in a student-led clinic, resulting in reduced hospital wait times, high clinician adherence to protocols and high family satisfaction.

Inherited retinal disease (IRD) refers to a heterogeneous group of genetic eye disease that causes progressive vision loss and was once regarded untreatable. However, regulatory approval for Luxturna (voretigene neparvovec-rzyl) for patients with biallelic mutation in the RPE65 gene has heralded new optimism for patients with the disease. One critical question in designing clinical trial in patients with IRD is choosing appropriate outcome measures to assess the retina, taking into consideration the slow disease progression and the inherent low vision associated with the disease. In this review, the functional and structural endpoints that have been utilised in human retinal gene therapy clinical trials in patient selection as well as measures of safety and efficacy are described. For clinicians, an appreciation of these specialised measures of eye health in a patient with IRD will enhance understanding of retinal health assessments, disease prognosis as well as facilitating discussions with patients potentially eligible for retinal gene therapy clinical trial.

Clinical relevance: Accurate measurement of refractive errors is essential for vision correction. Understanding the strengths and limitations of different refractive measurement techniques is crucial for clinical practice, particularly in managing patients with complex refractive conditions.

Background: This study compares the accuracy of the Plusoptix A16 and Vision Screener V100 photorefraction devices with the WAM-5500 open-field autorefractor and subjective refraction.

Methods: One hundred and eighty-six subjects with a mean age of 30.3 ± 20.1 years were evaluated using the Plusoptix A16, Vision Screener V100, WAM-5500 autorefractor, and subjective refraction. Measurements were taken in random order in a room with diminished ambient lighting. In subjective refraction, the best visual acuity with the maximum positive sphere hyperopic correction and the minimum negative sphere for myopic correction was used as the endpoint. Mean differences of the M, J0, and J45 parameters were analysed across all techniques, stratified by age groups (<18 years, 18-45 years, >45 years).

Results: There were significant differences in refractive error components (M and J0) across all methods, with subjective refraction yielding the most negative M values. Statistically significant differences were noted for the WAM-5500 (-0.12 ± 0.58D) and Plusoptix A16 (-0.17 ± 0.65D). Subjective refraction showed more positive J0 values, indicating greater with-the-rule astigmatism compared to Plusoptix A16 and Vision Screener V100. No significant trends were found for J45. Age-related differences were observed in M and J0 components when comparing subjective refraction with WAM-5500 and Plusoptix measurements.

Conclusion: Significant differences in refractive error measurements were observed between devices, with the Vision Screener V100 overestimating errors and the Grand Seiko WAM-5500 showing higher J0 values. Subjective refraction detected more with-the-rule astigmatism, highlighting the importance of validating autorefraction results, especially in high astigmatism cases. Age-related differences in M and J0 components highlight the need to confirm objective methods with subjective refraction.

Clinical relevance: Rising myopia prevalence in Indian children necessitates an increase in the number of myopia practitioners across all states to effectively counteract its progression and prevent long-term visual impairment.

Purpose: There is limited information on how eye care practitioners perceive and practice myopia control treatments in India. This study aimed to assess the current knowledge, attitudes, practices, and barriers to initiating myopia management among eye care practitioners in India.

Methods: A self-administered online questionnaire was distributed through social media platforms and emails to eye care practitioners from January 8 to 23, 2022. This survey comprised a total of 12 questions to seek information related to knowledge, attitudes, practices, and barriers associated with myopia management. Basic descriptive and percentage analyses were performed.

Results: Among the 423 respondents, optometrists were 66% (n = 279/423), followed by ophthalmologists (16%, n = 68/423) and trainees involving optometrists and ophthalmologists (18%, n = 76/423). Of all, only 22% (n = 94/423) indicated practicing myopia management. They gained knowledge through scientific articles (71%, n = 300/423), conferences, and continuous professional education (62%, n = 231/423). Low-concentration atropine eye drops are widely considered for myopia control by both optometrists (57%, n = 28/49) and ophthalmologists (97%, n = 38/39), along with behavioural and lifestyle modifications (55%, n = 27/49; 74%, n = 29/39). A smaller proportion preferred to under-correct myopia (20%, n = 19/94) to counteract progression. Among myopia practitioners, combination therapy was recommended by 24% (n = 12/49) of optometrists and 23% (n = 9/39) of ophthalmologists to halt progression if a single modality was ineffective. The major barriers to initiating myopia management were lack of awareness among parents (73%, n = 68/94), lack of education (34%, n = 143/423) and training (26%, n = 112/423) among practitioners, and unavailability of treatment modalities in various regions of India (18%, n = 76/423).

Conclusion: Only 1 out of 5 practitioners was actively involved in practicing myopia management. Barriers must be minimised through various means to enable routine myopia practice in clinics.

Clinical relevance: Cretan protocol plus is a novel technique that combines corneal cross-linking with refractive procedures in patients with keratoconus. Visual improvement is not only limited to visual acuity, the optical quality may also be enhanced by the Cretan protocol.

Background: To evaluate the higher-order aberrations (HOAs) and optical quality of the cornea 1 year after the Cretan protocol plus in keratoconus patients.

Methods: The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction spherical equivalent (MRSE), and topographical analysis of the cornea were assessed. The corneal optical quality parameters, including total HOA (Z_3-8), vertical coma (Z₃^-1), horizontal coma (Z₃¹), vertical trefoil (Z₃^-3), oblique trefoil (Z₃³), and spherical aberration (Z₄⁰), modulation transfer function (MTF) and Strehl ratio of point spread function (PSF) over the 4 mm diameter pupil were recorded via Sirius dual-scanning corneal tomography. All data were analysed preoperatively, 1 month, 6 months, and 1 year postoperatively.

Results: Twenty eyes of 16 keratoconus patients with 1 year of follow-up were included. After the Cretan protocol plus, the mean UDVA, CDVA, MRSE, corneal astigmatism, simulated keratometry-1, simulated keratometry-2, and maximum keratometry (Kmax) improved significantly throughout the follow-up visits (p < 0.001). Total HOA, vertical coma, and spherical aberration were significantly reduced at 1 year compared with the preoperative values (p < 0.05). Vertical coma was decreased from preoperative to all postoperative time points (p = 0.009). Regarding optical quality, MTF 5 and MTF 10 at both the vertical and horizontal meridians were significantly increased 1 year after the Cretan protocol plus compared to preoperatively (p < 0.05). Significant improvements in the PSF occurred at all postoperative time points (p < 0.001).

Conclusions: The Cretan protocol plus is more efficient in improving optical quality while reducing corneal aberrations in keratoconus patients. Vertical coma and PSF could be objective indicators of optical performance after this procedure.