Clinical and Experimental Optometry最新文献

Clinical relevance: Presbyopia rapidly progresses between 40 and 55 years of age and the amplitude of accommodation is lost around 55 years of age; however, the factors associated with presbyopia by age group in relation to ocular surface and retinal thickness have not been determined.

Background: Age and other factors are associated with presbyopia, however, factors specific to age groups have not been described.

Methods: Near add power was compared among 3000 healthy individuals grouped by age; 40s (aged 40-49 years), 50s (aged 50-59 years), and 60s (aged 60-69 years). Regression analysis and comparison of odds ratios for risk factors of presbyopia determined by near add power were conducted.

Results: The mean near add power was 1.21 ± 0.66 D in 40s, 2.16 ± 0.59 D in 50s, and 2.72 ± 0.44 D in 60s. Regression analysis of near add power and ocular parameters indicated age, astigmatic errors, intra-ocular pressure, mean deviation, thickness of ganglion cell complex (GCC) and peripapillary retinal nerve fibre layer (RNFL) were associated with near add power in 40s, whilst age, tear break-up time, and peripapillary RNFL were associated with near add power in 60s. Comparison of odds ratios for risk factors for reaching mean near add power in each age group revealed that age, astigmatic errors, mean deviation (40s only), and GCC and RNFL thickness were significant in 40s and 50s, whilst tear break-up time and RNFL thickness were significant in 60s.

Conclusions: Age and numerous other factors were significantly associated with near add power in 40s and 50s, while fewer factors were significant in 60s, suggesting age-specific management for presbyopia may be recommended.

Clinical relevance: Visual field testing is essential in the diagnosis and management of various ophthalmic diseases, particularly glaucoma. Integrating ChatGPT-4 into the interpretation of these tests has the potential to aid clinical decision making and improve efficiency and accessibility in clinical practice.

Background: This study aims to evaluate the capability of ChatGPT-4 in interpreting visual field tests.

Method: A total of 30 patient visual field printouts, either with or without defects, were included in this study. The performance of ChatGPT-4 in identifying test name, pattern, reliability indices, total deviation map, pattern deviation map and greyscale map was evaluated and compared with that of 2 experienced glaucoma consultants. The study also focused on the ability of ChatGPT to categorise tests as 'normal' or suggest diagnosis by interpreting tests accurately.

Results: The results showed that ChatGPT-4 was highly accurate in identifying test names (100%), patterns (90%) and global visual field indices (96.7%). It also accurately classified tests as reliable or unreliable (93.3%).The model provided 66.7% and 30% accurate and adequate answers in interpreting deviation and greyscale maps, respectively. In addition, in 33.3% of tests, it was able to accurately interpret the visual field test and classify it as 'normal' or suggest a diagnosis.

Conclusion: The study highlights the potential of large language models like ChatGPT-4 in assessing visual field tests. ChatGPT-4 could interpret numeric data on tests accurately. However, it was inadequate in interpreting deviation and greyscale maps and suggesting a diagnosis according to the defects.

Glaucoma is a multifactorial neurodegenerative disorder characterised by the progressive loss of retinal ganglion cells, ultimately leading to irreversible blindness worldwide. Recent research highlights metabolic dysregulation as a crucial factor in the pathophysiology of glaucoma. This review examines the intricate relationship between metabolic processes and glaucoma, with a focus on key mechanisms such as mitochondrial dysfunction, lipid metabolism, glucose metabolism, and the roles of specific metabolites. Mitochondrial dysfunction is commonly observed in glaucoma, leading to impaired energy production that compromises cellular viability. Alterations in lipid metabolism, including changes in fatty acid profiles and lipid peroxidation, contribute to cellular injury and apoptosis of retinal ganglion cells. Moreover, disturbances in glucose metabolism, such as reduced glycolytic activity, affect energy availability and neurotrophic support that are vital for retinal ganglion cells survival. The review also explores the roles of specific metabolites, including lactate and glutamate, in the context of retinal ganglion cells health, and how their dysregulation may exacerbate glaucomatous damage. Additionally, the interplay between metabolic dysregulation and elevated intraocular pressure is analysed, particularly with regard to its impact on ocular blood flow and retinal health. Understanding these metabolic mechanisms is essential for identifying potential therapeutic strategies. By deepening our understanding of the metabolic foundations of glaucoma, new avenues for effective treatments may arise, addressing the multifactorial nature of this complex disease and improving patient outcomes.

The application of eye drop is encountered with many technique errors, which can lead to decreased therapeutic response and treatment failure. Community pharmacists can play a pivotal role in providing appropriate knowledge and counselling services for the proper and effective use of eye drop. The aim of this systematic review was to assess the most important aspects of technique errors regarding eye drop application, along with the important role and impact of community pharmacist-led interventions towards the provision of patient education and counselling regarding the proper application of this topical preparation in clinical practice. PRISMA criteria were used to conduct a systematic search on the administration of eye drop through different databases, including Scopus, Web of Science, and PubMed between the years 1990 and 2023. A total of 22 articles were included in this study. Nearly three-quarters of the studies discussed the improper technique and non-adherence for eye drop instillation (77.3%). Five studies discussed the interventions by health care professionals for proper eye drop instillation technique (22.7%). Two studies discussed the intervention by community pharmacist in patient education and improved training on the correct instillation of eye drop. There are different aspects of application errors encountered by patients while using eye drop, particularly in glaucoma elderly patients, and polypharmacy. These application errors could lead to a diverse range of complications, such as poor medication, ocular infections, increased health care expenses, reduced treatment effectiveness, and lower health outcomes. There is a potential role of pharmacist-led interventions in minimising procedures associated with improper technique and application of eye drops to avoid decreased therapeutic response and treatment failure.

Clinical relevance: In vivo confocal microscopy (IVCM) is a pivotal imaging tool in ophthalmology, enabling the non-invasive, real-time visualisation of corneal microstructures. Its clinical importance lies in its ability to diagnose and monitor a wide range of corneal and ocular surface conditions at a cellular level, enhancing early detection and treatment outcomes.

Background: IVCM enables detailed visualisation of corneal structures and has broad applications in diagnosing and managing corneal and ocular surface diseases. Despite its widespread use, no global bibliometric analysis of IVCM research in ophthalmology has been conducted to date. This study aims to bridge this gap by identifying influential articles, authors, institutions, and emerging trends in IVCM research.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection database. Articles and reviews in the ophthalmology research area were identified by searching for 'confocal microscopy' within titles and author keywords. Sub-analyses focused on corneal nerves and immune cells. Data were visualised using VOSviewer to create overlay visualisation maps, highlighting research trends and connections.

Results: A total of 1,389 articles were identified, with 600 published in the last decade. Corneal nerve studies constituted 425 publications, with an h-index of 68 and 38.81 citations per article. Immune cell studies accounted for 182 publications, with an h-index of 36 and 25.79 citations per article. The United States, China, and Italy were the most productive countries, while Harvard Medical School and the Massachusetts Eye and Ear Department of Ophthalmology led institutional output. Emerging keywords included 'limbal stem cell deficiency', 'deep learning', and 'artificial intelligence'.

Conclusions: This study underscores the increasing impact and versatility of IVCM in ophthalmology. The findings highlight key contributors and trends, providing a roadmap for future research. The integration of artificial intelligence and novel analytical techniques will likely drive further advancements, enhancing the diagnostic and therapeutic potential of IVCM.

Clinical relevance: Since inflammation plays an important role in the pathogenesis of diabetic retinopathy, serum biomarkers and retinal imaging aimed at evaluating the presence of inflammation have emerged as useful tools to monitor the appearance and progression of diabetic retinopathy.

Background: This study aims to investigate the value of YKL-40 levels in patients with diabetes mellitus with different stages of diabetic retinopathy and without diabetic retinopathy, and to compare those findings with results from healthy individuals without diabetes mellitus.

Methods: This prospective cross-sectional study included 67 diabetic patients with or without diabetic retinopathy who underwent cataract surgery and 23 patients (control group) having no ocular and systemic disease other than senile cataract. Participants with diabetes mellitus were separated into three subgroups: the first group consisted of 26 patients without diabetic retinopathy, the second group included 21 patients with non-proliferative diabetic retinopathy and the third group included 20 patients with proliferative diabetic retinopathy. Serum and aqueous humour YKL-40 levels were analysed and compared between the groups.

Results: The mean serum (p < 0.001) and aqueous humour (p < 0.001) YKL-40 levels were statistically significantly lower in control subjects compared to patients with diabetes mellitus. The aqueous humour YKL-40 levels showed statistically significant elevations with the progression of diabetic retinopathy. Duration of diabetes mellitus was significantly correlated with aqueous humour YKL-40 levels (p = 0.001, r = 0.384).

Conclusion: Both serum and aqueous humour YKL-40 levels are higher in patients with diabetes mellitus compared to healthy subjects. Levels of YKL-40 in aqueous humour increase with the progression of diabetic retinopathy.

Clinical relevance: Resilience is a key enabler for healthcare professionals including optometrists, to cope with adversities and practice self-care. Evaluating the levels of resilience and its associated factors in optometry students can lead to the development of appropriate intervention strategies for academic and professional success.

Background: The moderately high prevalence of mental health issues and burnout among optometry students suggests a need to equip the next generation of optometrists with the necessary skills to enhance mental health. Resilience has been shown to mitigate burnout among healthcare professionals and offer personal and professional benefits. Additionally, resilience education during healthcare student training can enhance mental health and wellbeing, leading to better patient care. This study aims to evaluate resilience levels and its associated factors (self-efficacy, mindfulness, positive and negative affect, and coping strategies) in optometry students.

Methods: Students enrolled in optometry schools across eight institutions in six countries were invited to participate in an online survey within the period of April 2023 - January 2024. The survey comprised of demographic data, existing and validated questionnaires on resilience, self-efficacy, mindfulness, positive and negative affect, and coping strategies. Descriptive statistics and linear regressions were used for analysis.

Results: A total of 294 valid responses were collected. There were no significant differences in resilience scores between countries. Greater resilience (p < 0.05) was associated with older age, higher academic grades and having no financial assistance. Additional predictors of greater resilience included higher self-efficacy, mindfulness, positive affect and acceptance scores, and lower behavioural disengagement scores.

Conclusion: Identifying factors that affect resilience in optometry students provides information for targeted strategies that enhance resilience. More work is required to understand the generalisability of these results, impact of culture on resilience, and appropriate intervention methods.