Clinical and Experimental Optometry最新文献

Clinical relevance: Optometrists play a key role in the provision of diabetic eye care. Timely and accurate diagnosis and management of the ocular complications of diabetes mellitus can ensure optimal patient outcomes and minimise vision loss.

Background: Diabetes mellitus is a global public health concern. Diabetic retinopathy is a complication of diabetes mellitus and the leading cause of vision impairment globally, particularly in low- and middle-income countries. Despite optometrists playing a critical role in diabetic eye care, their clinical practices remain underreported in South Africa. The objective of this study was to determine practice patterns of South African optometrists towards diabetic eye care.

Methods: In this cross-sectional study conducted in South Africa, a validated online questionnaire was distributed to optometrists to explore their self-reported practice patterns towards diabetic eye care.

Results: The sample comprised 254 participants. Most participants were confidence in grading (62.2%) and managing (74.8%) diabetic retinopathy while some were confident in detecting (45.7%) and managing (47.3%) diabetic macular oedema. The majority of participants had fundus cameras (90%) but only 25.2% had optical coherence tomography devices and of these 85% found them useful for diabetic macular oedema detection. Many participants (54%) used classification systems and guidelines for diabetic retinopathy with a significant association between routine use of these tools and confidence level (p = 0.02). Approximately 52% felt that current clinical guidelines should be reviewed and revised.

Conclusion: There exists a need for greater access to optical coherence tomography, standardised national guidelines, and diabetic focused clinical training in South Africa. This will enhance diagnostic confidence, streamline referrals and reduce vision loss associated with diabetic eye disease.

Clinical relevance: Clear, evidence-based guidelines support optometrists in diagnosing and managing age-related macular degeneration, a leading cause of vision loss in older adults. This condition is an increasing focus of clinical care due to expanding treatment options and evolving imaging technologies.

Background: Clinical practice guidelines support consistent, evidence-based care in optometry and play a critical role in guiding the diagnosis and management of chronic eye diseases. This paper discusses the methodological approach used to develop age-related macular degeneration guidelines, emphasising the modified Delphi approach used to refine and formally establish recommendations.

Methods: Recommendations were developed from a literature review and draft guideline. An expert working group of optometrists (n = 9) participated in a three-round Delphi process, rating their agreement with the draft recommendations using a 6-point Likert scale across two survey rounds, followed by a virtual meeting to discuss and re-vote on unclear or contentious items. Quantitative and qualitative measures during the first two rounds of the Delphi survey guided recommendation refinement and inclusion for discussion in round 3. Consensus for inclusion was defined as a mean score ≥5 and ≥80% agreement.

Results: Out of 37 initial recommendations, 25 (68%) were accepted and included in the final guideline. Consensus was achieved for recommendations concerning clinical classification, assessment and management strategies. Round 3 discussions helped resolve uncertainties and refine recommendations wording, particularly regarding nutritional supplements and clinical biomarkers for progression. Adoption of the Delphi approach demonstrated the value of both quantitative and qualitative feedback.

Conclusion: The feasibility and value of using a modified Delphi method to develop optometric clinical practice guidelines is demonstrated. The process supported the inclusion or exclusion of recommendations in a systematic way with the final guideline offering contemporary, practice-relevant guidance for the diagnosis and management of age-related macular degeneration.

Clinical relevance: Age-related macular degeneration can lead to significant visual impairment in older individuals. These can significantly impact their day-to-day life, and understanding these limitations is crucial for healthcare providers.

Background: The aim of this work is to determine impairment of activities of daily living secondary to visual impairment caused by age-related macular degeneration in a South Indian population.

Methods: In this prospective cross-sectional study, the instrumental activities of daily living questionnaire was administered to participants with uniocular or binocular visual impairment due to age-related macular degeneration, and controls who did not have any significant ocular or retinal pathology.

Results: The study recruited 90 participants in each arm, where those with age-related macular degeneration were older. More participants with age-related macular degeneration (92.2%) had impairment with one or more activities of daily living as compared to controls (55.6%,p < 0.001). The age-related macular degeneration group faced a median of 4 (IQR 2-8) impairments and could perform 53.3% with difficulty, 39.4% with assistance and 7.3% activities could not be completed. In the age-related macular degeneration group, those with unilateral disease had 8.95-fold (p < 0.001) greater level of impairment, while those with bilateral disease has a 10.72-fold (p = 0.001) greater level of impairment as compared to controls.

Conclusion: Visual impairment due to age-related macular degeneration has a significant impact on activities of daily living. The patients often need assistance in completing their activities. Care in age-related macular degeneration needs to involve rehabilitation and help in carrying out daily activities in addition to treatment for visual benefits.

Clinical relevance: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, serious, long-term complication of neurotoxic chemotherapy that alters nerve fibre morphology, and is one of the most common dose-limiting factors. Detection is challenging and usually occurs after significant symptoms. Thus, early and accurate detection is crucial.

Background: CIPN accounts for the main dose-limiting factor in cancer treatment. Its early detection however is challenging and often occurs only after the development of significant symptoms. In-vivo corneal confocal microscopy may be a potential method of detecting early changes in CIPN. The aim of this study was to determine whether corneal nerve parameters enable early detection of CIPN, to report any dose-dependent effects of treatments used, and to observe longitudinally corneal nerve changes during and after treatment.

Methods: Fifteen individuals receiving taxane-based chemotherapy for breast, gynaecological, or prostate cancers were recruited and compared to an oxaliplatin-treated group (n = 18). Corneal nerve measurements were taken at the beginning, middle, and end of treatment, and up to 12 months post-treatment. Central corneal and inferior whorl nerve fibre images were obtained with an in-vivo laser scanning confocal microscope.

Results: A dose-dependent reduction in corneal nerves was observed for every 100 mg/m² of neurotoxic chemotherapy, especially in taxane-treated participants (p = 0.02). The average nerve fibre length, which refers to both the central cornea and inferior whorl, showed significant changes earlier in the treatment course. After treatment, especially in the taxane-treated group, CIPN participants had lower corneal nerve fibre length at the middle and end of treatment compared to those without persistent neuropathy (p = 0.02 and p = 0.006, respectively).

Conclusion: Average nerve fibre length loss may have clinical utility as an early marker of CIPN progression. Imaging a wider area of the sub-basal corneal nerve plexus including the inferior whorl region may be more beneficial for monitoring early neuropathic changes.

Clinical relevance: Understanding the link between visual system parameters and visuo-cognitive abilities can enhance strategies to optimise visual performance in daily and professional tasks.

Background: To investigate the relationship between visual system parameters - such as visual acuity, refractive error, binocular vision (including phoria, fusional vergences, vergence and accommodation facility, and stereopsis) - and visuo-cognitive abilities, including perception span, multiple object tracking, and visual reaction time.

Methods: All measurements were conducted by the same specialist in a single session, starting with visual acuity assessment, followed by refractive error evaluation, binocular vision assessments, including phoria (cover test and Thorington test), fusional vergence, vergence facility, accommodative facility, and stereopsis, and concluding with visuo-cognitive tests, namely perception span, multiple object tracking, and reaction time. Data were analysed using Pearson's correlation test, with a statistical significance set at p < 0.05.

Results: The study involved 218 elite male football players with a mean age of 24.6 ± 4.8 years. The perception span correlated positively with monocular (r = 0.185, p = 0.003) and binocular (r = 0.176, p = 0.005) visual acuity and negatively with anisometropia (r = -0.115, p = 0.045), near esophoria (r = -0.347, p = 0.010), and near stereopsis (r = -0.178, p = 0.004). Weak positive correlations were observed with positive fusional vergence at distance (r = 0.126, p = 0.032) and multiple object tracking (r = 0.207, p = 0.001). Multiple object tracking correlated negatively with horizontal phoria at both distance (r = -0.141, p = 0.019) and near (r = -0.141, p = 0.019) and with stereopsis at distance (r = -0.255, p = 0.024) and near (r = -0.142, p = 0.018), with more pronounced correlations in participants with esophoria. Visual reaction time correlated positively with emmetropia (r = 0.141, p = 0.019), distance horizontal phoria (r = 0.121, p = 0.037), and distance negative fusional vergence break (r = 0.124, p = 0.034).

Conclusion: Binocular vision, vergence, and phoria may influence visuo-cognitive performance in elite football players. Effective binocular coordination and minimal refractive error appear beneficial, whereas esophoria was linked to reduced performance. Although correlations were weak, the findings highlight the multifactorial nature of visuo-cognitive function in sport.