Clinical and Experimental Optometry最新文献

Clinical relevance: Advancements in optometric education are essential for addressing the global burden of visual impairment by ensuring a well-trained workforce capable of delivering quality eye care services.

Background: The number of optometry schools in Sub-Saharan Africa has significantly increased since 2000, reflecting a growing awareness of the role of optometry in addressing the burden of vision impairment. This report provides a comprehensive overview of the current status, challenges, and opportunities within optometry education in the region.

Methods: A cross-sectional survey was conducted from April 28 to 31 May 2024. Data were collected from 32 out of 39 optometry schools across 12 Sub-Saharan African countries, yielding a response rate of 82.1%. Heads of optometry schools provided information on student enrolment, graduates, academic staffing, curriculum, and technological resources through a standardised Excel spreadsheet.

Results: Over 75% of the schools were established post-2000, with Nigeria accounting for over 40% of them. Student enrolment numbers ranged from 50 students in Zimbabwe to 3,945 in Nigeria. The curricula varied significantly from 3-year Bachelor degrees (BSc) to 6-year Doctor of Optometry (OD) degrees, with five countries offering postgraduate training. Key challenges included inadequately qualified academic staff, low staff-to-students ratio, and a lack of government recognition and regulation. The use of Learning Management Systems (LMS) was inconsistent, with Moodle being the most commonly used platform.

Conclusion: The expansion of optometry education in Sub-Saharan Africa represents a positive development, enhancing the eye health workforce. However, to fully realise the potential of these developments, the implementation of standardised educational frameworks, enhanced regulatory support, and increased investment in developing faculty and technological resources are essential. Collaboration and knowledge-sharing across countries can further strengthen optometric education and practice, thereby reducing the burden of visual impairment in the region.

Clinical relevance: Accommodation is crucial for clear near vision and is predominantly affected by presbyopia. The ability to modulate accommodative function with eye drops could offer a pharmacological approach to manage presbyopia.

Background: To investigate the effects of different concentrations of pilocarpine eye drops on ocular accommodation in young volunteers.

Methods: In this prospective study, healthy volunteers with mild or moderate myopia with corrected visual acuity of no less than 20/20 were recruited. Participants underwent four visits for baselining and administration of low (0.75%), medium (1.00%), and high (1.25%) concentrations of pilocarpine eye drops respectively. One eye of each participant was chosen and analysed. Ophthalmologic examinations included objective and subjective refraction, corrected distance visual acuity, intraocular pressure, and pupil size. Accommodation was assessed using the WAM-5500 binocular autorefractor. Accommodation facility and the defocus curve were measured.

Results: Volunteers (n = 24, mean age 23.7 ± 1.5 years) with a mean spherical equivalent of -2.91 ± 1.54 dioptres (D) were recruited. No serious adverse events occurred. All pilocarpine concentrations showed similar pupil constriction without significant intraocular pressure changes (p > 0.05). Pilocarpine induced greater objective refraction changes with higher concentrations (-1.12 ± 1.07D, -1.56 ± 1.38D, -1.68 ± 1.60D for low, medium, and high concentrations, respectively; p < 0.01). Subjective refraction showed a similar dose-response. Accommodative response decreased significantly at the 20 cm stimulus for medium and high concentrations (p < 0.05). Corrected distance visual acuity improved beyond -1.00D to + 0.50D defocus after all three pilocarpines. Accommodative facility improved more by 1.25% than 0.75% (p = 0.04).

Conclusions: Pilocarpine eye drops are effective in improving ocular accommodation, with higher concentrations leading to greater accommodative changes. Pilocarpine has potential for managing presbyopia.

Clinical relevance: Hyperopia is a common refractive error in young children and has the potential to affect their visual, educational and general development. Management of childhood hyperopia presents significant intra-and inter-professional differences partly because evidence-based guidelines to inform when and how to prescribe for hyperopia are insufficient.

Purpose: This study investigated the prescribing philosophy in childhood hyperopia among optometrists in Ghana and the challenges faced in managing childhood hyperopia.

Methods: An online questionnaire was distributed to optometrists in Ghana to evaluate the prescribing philosophy in childhood hyperopia. The questionnaire assessed factors, which could influence prescribing patterns in participants including age, symptoms, emmetropisation, and magnitude of hyperopia in patients. Challenges encountered in the management of childhood hyperopia in children were also investigated.

Results: Ninety-one optometrists responded to the questionnaire with the mean age of participants being 32.3 ± 5.6 years. Most participants (67,(74%)) surveyed reported using some clinical guidelines in the management of childhood hyperopic refractive errors. The magnitude of bilateral hyperopia that practitioners were willing to prescribe decreased with increasing age of the patient (p < 0.0001). Most participants preferred modification of the amount of bilateral hyperopia found during cycloplegic refraction and also indicated a preference for prescribing a lesser amount of astigmatism. Lack of instrumentation for paediatric assessment was the main challenge reported in the management of hyperopic refractive errors.

Conclusion: The spectacle prescribing philosophies in childhood hyperopia amongst optometrists in Ghana largely follow existing clinical guidelines, although, in some instances, there were mismatches between the existing guidelines and their preferred pattern. Regular continuing professional development, which highlights emerging evidence on prescribing in childhood hyperopia, would be desirable.

Clinical relevance: Although laser refractive surgeries and multifocal intraocular lens implantation are generally avoided in patients with diabetic retinopathy, a substantial proportion of well-glycaemic-controlled type 2 diabetes mellitus patients are considered for these procedures. Pupil dynamics play a significant role in determining postoperative satisfaction in these patients.

Background: To evaluate pupillary dynamics in patients with and without diabetes following uneventful phacoemulsification surgery.

Method: This retrospective study involved 86 patients with type-2 diabetes and 41 non-diabetic patients undergoing phacoemulsification. Pupillary measurements were performed using the Sirius Topographer (CSO, Firenze, Italy) preoperatively and at the 1-month and 3-month postoperatively. Diabetic patients were categorised into non-diabetic retinopathy (without diabetic retinopathy), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) subgroups based on the presence and severity of diabetic retinopathy. Baseline and postoperative pupillometric values were then evaluated for all groups.

Results: Preoperatively, baseline scotopic, mesopic, and photopic pupil diameters, and pupil redilation velocity were smaller in the NPDR and PDR subgroups compared to the control group (p < 0.05, for all). At 1-month postoperatively, pupil diameters in all lighting conditions significantly decreased in both the control and non-diabetic retinopathy groups (p < 0.05, for all), while pupil dilation rate increased (p = 0.011 and p = 0.002, respectively). In the PDR group, a significant increase in photopic pupil diameter was observed at 1 and 3 months postoperatively (p = 0.018 and p = 0.030, respectively). The PDR and NPDR groups showed a significant decrease in postoperative first- and third-month scotopic pupil diameter (p < 0.05, for all).

Conclusion: Pupil diameter was smaller in diabetic patients compared to controls pre-and postoperatively. Patients with non- diabetic retinopathy and NPDR, who already exhibited smaller pupil diameters in all lighting conditions than the controls (in mesopic condition, 3.54 cf. 3.66, and 3.11 cf. 3.66 mm, respectively), experienced a further reduction in pupil size following phacoemulsification.

Clinical relevance: The prevalence of male androgenetic alopecia is increasing worldwide. Evaluation of dry eye parameters and meibomian glands of male androgenetic alopecia patients may help to better understand the effect of this disease on dry eye and to provide appropriate treatment for these patients.

Background: The aim of this work is to evaluate the relationship between male androgenetic alopecia, dry eye, and meibomian gland function.

Method: A total of 80 eyes of 80 patients, 40 eyes of 40 patients diagnosed with male androgenetic alopecia, and 40 eyes of 40 healthy men were included. The presence of dry eye was evaluated with the Schirmer I test, invasive tear film break-up time (TBUT), Oxford scale scoring (cornea and conjunctiva staining), and the Ocular Surface Disease Index score. Evaluation of the eyelid meibomian glands was performed using the LipiScan System, and the descending meibomian glands for each eyelid were scored proportionally.

Results: The average age of patients with androgenetic alopecia and the control group is 41.93 ± 6.65 and 40.75 ± 7.32 years, respectively (p = 0.413). The mean Schirmer I test score was statistically significantly lower in the androgenetic alopecia group (p = 0.001), and the mean Ocular Surface Disease Index score was significantly higher in the androgenetic alopecia group compared to the control group (p = 0.001). In the androgenetic alopecia group, mean TBUT was lower (p = 0.001) and mean Oxford scale score was higher (p = 0.009). Total, upper, and lower meibomian gland scores were statistically significantly higher in the androgenetic alopecia group (p = 0.001, p = 0.001, and p = 0.001, respectively).

Conclusion: There may be an association between male androgenetic alopecia and dry eye and meibomian gland dysfunction. Male individuals with androgenetic alopecia should be closely followed for dry eye and meibomian gland dysfunction.

Clinical relevance: Interprofessional education and collaborative working are known to improve patient outcomes. The evidence to support this approach in optometry is lacking.

Background: There is no published evidence into the effectiveness of interprofessional education for pharmacy and optometry students. This study aimed to evaluate the effectiveness of an interprofessional case-based learning session that took place between third year pharmacy students and final year optometry students at the University of Manchester.

Methods: Students worked together in a 1.5-hour workshop to help each other gain an understanding of common ocular conditions that may present to primary care. Students were randomised into two groups; the control group answered all the pre and post questions before the teaching session. The intervention group answered the pre questions at the beginning and the post questions immediately after the teaching session. Nonparametric statistics were employed to look for differences in the two groups.

Results: The control groups of pharmacy and optometry students did not significantly differ in their pre and post test scores (p = .069 pharmacy and p = .082 for optometry). The post scores for the intervention group were significantly higher than the control group. For pharmacy students the control group post score average was 44.9% (±20.5) and the intervention group was 63.2% (±15.9). For optometry students the control group post score average was 35% (±21.2) and the intervention group was 57.5% (±19.9).

Conclusion: Interprofessional education is a useful way to increase student knowledge of the management of authentic clinical cases in primary care.

Clinical relevance: When selecting an intervention for myopia management, parental inquiries centre around the comparative efficacy of orthokeratology versus myopic defocus spectacle lenses. This prompts an intriguing investigation into the nuanced differences between these two treatment methods.

Background: This study aimed to compare the efficacy of spectacle lenses with highly aspherical lenslets (HAL) versus orthokeratology (Ortho-k) in controlling axial length elongation.

Methods: Electronic medical records of children aged 8 to 14 years who were prescribed either spectacle lenses with HAL or one of the four Ortho-k brands were reviewed. The standardised axial length changes within one year were compared between HAL lenses and Ortho-k lenses with analysis of variance and multivariable regression analysis, adjusting for age, gender, and baseline spherical equivalent.

Results: A total of 308 subjects were included in the analyses. The mean (standard error) of the standardised one-year changes in axial length was 0.12 ± 0.02 mm for HAL, 0.17 ± 0.02 mm for Dreamlite, 0.22 ± 0.02 mm for Alpha, 0.21 ± 0.02 mm for Lucid, and 0.18 ± 0.02 mm for Euclid user cohorts. After adjusting for covariates, the mean differences in axial length growth between HAL and both Alpha and Lucid cohorts were estimated at 0.11 mm (95% CI, 0.03 to 0.19 mm and 95% CI, 0.03 to 0.20 mm). The differences between HAL and Dreamlite or Euclid lenses were not statistically significant. Baseline spherical equivalent demonstrated a significant positive association with axial length growth in Lucid and Euclid lens users.

Conclusions: Spectacle lenses with HAL design exhibited comparable or superior efficacy in mitigating axial length growth compared to conventional Ortho-k lenses. Furthermore, orthokeratology showed greater efficacy in controlling axial length elongation among individuals with greater baseline myopia.