Clinical and Experimental Optometry最新文献

Traumatic brain injury (TBI) is associated with impaired cognitive, psychological, and neurological functions. As an embryological extension of the central nervous system, the retina allows non-invasive assessment of cerebral pathology via optical coherence tomography (OCT). This systematic review and meta-analysis evaluated whether consistent OCT-derived retinal changes occur in TBI and their potential as biomarkers. A systematic search of five electronic databases identified studies comparing OCT parameters between individuals with TBI and controls. Retinal biomarkers included optic nerve, macular, and choroidal thickness metric. A random-effects meta-analysis was conducted, and study quality assessments were performed. Seven studies involving Olympic boxers, collision-sport athletes, rugby players, veterans, and the general population with mild-to-moderate TBI were included. Across studies, peripapillary retinal nerve fibre layer (RNFL) findings were heterogeneous, ranging from minor thickening (+1.7 µm) to pronounced thinning (-14 µm) relative to controls. RNFL thickness was significantly reduced in collision-sport athletes, especially boxers, and in veterans. Longitudinally, veterans showed faster RNFL loss (-1.47 ± 0.24 µm/year vs - 0.31 ± 0.32 µm/year; p = 0.004). The meta-analysis demonstrated a small, non-significant global effect (Hedges' g = -0.21; 95% CI -2.51 to 0.33; p = 0.84), corresponding to an estimated peripapillary RNFL thinning of approximately 1-1.5 µm in TBI cases compared with controls. Macular thickness was decreased in boxers compared to controls (p < 0.05). The ganglion cell complex was thinner in boxers (76.7 ± 2.1 µm vs 81.6 ± 0.5 µm; p = 0.02) but unchanged longitudinally. The ganglion cell layer showed localised thinning (p < 0.05) without global change. The sub-foveal choroidal thickness was reduced in patients with TBI (211 µm vs 369.5 µm; p = 0.05), while the Henle fibre layer was thicker (8.4 ± 0.9 vs 7.7 ± 1.1 pixels; p = 0.02). RNFL thinning was the most frequently examined OCT-based retinal biomarker, with variable findings across other retinal parameters. The meta-analysis revealed a non-significant effect, highlighting the need for further longitudinal research.

Clinical relevance: To meet accreditation requirements to embed Aboriginal and Torres Strait Islander health into optometry curricula, educators would benefit from access to a curated repository of high-quality resources.

Background: Since 2023, Australian and Aotearoa/New Zealand optometry programmes have been required to teach and assess students' competency to provide culturally safe care for First Nations Peoples. This study aimed to develop consensus-based guidelines for creating an online repository of Aboriginal and Torres Strait Islander health educational resources to support optometry educators.

Methods: A modified Delphi study was conducted over five months, involving up to three rounds of consensus-building. The first two rounds consisted of online surveys addressing repository content, structure, maintenance and governance. The third round was a video-conference workshop facilitated by an Aboriginal subject expert.

Results: Following round one, 66 unique responses were collated for prioritization. By the end of round three, stakeholders agreed on 12 recommendations. A key recommendation was that the repository structure align with the Optometry Aboriginal and Torres Strait Islander Health Curriculum Framework. The Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) Guide to Evaluating and Selecting Education Resources was recommended for assessing resource quality. While strengths-based resources were prioritised, deficit-based resources could be included if their purpose was clearly contextualised (e.g. to illustrate racism). Governance was recommended to include Aboriginal and Torres Strait Islander members, alongside members with teaching expertise and cultural safety training.

Conclusion: Collaboration between non-Indigenous and Aboriginal and Torres Strait Islander stakeholders, with prioritisation of Aboriginal and Torres Strait Islander voices, was critical in establishing trust and commitment. These consensus-based guidelines will support the development of an effective online repository for optometry educators.

Purpose: To describe a rare case of recurrent, reversible cystoid macular oedema (CME) associated with high-dose cytarabine therapy in a patient with acute myeloid leukaemia (AML).

Case presentation: A 39-year-old woman with AML developed recurrent bilateral visual disturbances following multiple cycles of high-dose cytarabine monotherapy. After each chemotherapy cycle, spectral-domain optical coherence tomography revealed cystoid intraretinal spaces predominantly involving the outer nuclear and outer plexiform layers. Fluorescein angiography demonstrated faint perifoveal leakage without the classic petaloid pooling pattern of CME. Macular oedema resolved spontaneously after the initial treatment cycles but showed progressively delayed regression after subsequent exposures. No systemic or ocular risk factors for CME were identified, and there was no evidence of inflammatory, vascular, or infectious retinal disease.

Conclusion: High-dose cytarabine may rarely cause recurrent and reversible CME as a manifestation of posterior segment toxicity. The underlying mechanism is likely related to transient Müller cell dysfunction or retinal pigment epithelium impairment rather than disruption of the blood-retinal barrier. Awareness of this entity is essential to ensure prompt recognition and appropriate management, including consideration of treatment modification when clinically feasible.

Clinical relevance: Patients with seborrhoeic dermatitis frequently experience comorbid dry eye syndrome, which complicates clinical management. Identifying shared drug targets is a promising strategy for developing novel therapies that concurrently address both conditionggs.

Background: Ocular involvement is common in seborrhoeic dermatitis and frequently leads to dry eye syndrome, underscoring the importance of identifying shared drug targets for dual-pathway therapy.

Methods: A two-sample Mendelian Randomisation (MR) analysis was conducted to identify potential drug targets. Sensitivity and colocalization analyses were performed to confirm shared targets. External replication and summary-data-based MR were used to validate target accuracy. Gene enrichment analysis and drug prediction were employed to explore functional pathways and potential therapeutics.

Results: MR analysis revealed 65 plasma proteins causally associated with seborrhoeic dermatitis (P < 0.05) and 68 with dry eye syndrome (P < 0.05). Colocalization and external replication demonstrated that KRT5 exhibited significant positive causal associations with both seborrhoeic dermatitis (OR = 1.535, 95%CI: 1.092-2.159, P = 0.014) and dry eye syndrome (OR = 2.219, 95%CI: 1.267-3.887, P = 0.005). Gene enrichment analysis indicated that target genes were primarily involved in keratinisation pathways. Drug prediction identified imipenem monohydrate as a potential therapeutic candidate.

Conclusion: KRT5 is identified as a promising drug target for both conditions, with imipenem monohydrate as a potential treatment. These findings provide novel therapeutic avenues.

The global prevalence of myopia has continued to increase significantly over time. By 2050, it has been estimated that approximately half of the world's population will be myopic. Additionally, 10% of myopes will be highly myopic, which greatly increases the risk of sight-threatening ocular complications including retinal detachments and myopic maculopathies. Significant global efforts have been invested in the development of interventions and strategies to prevent myopia onset and progression. Several different myopia control treatments are now available to clinicians for this purpose. Additionally, evidence has suggested that increased outdoor time and illuminance may have protective effects against myopia progression. Recently, the use of repeated low-level red-light therapy devices has become an emerging novel intervention for myopia. While current research surrounding red light therapy, mostly occurring in China, has suggested promising results for myopia management, there is still limited long-term research into the efficacy and safety of red-light therapy. This review aims to present a comprehensive overview of the current evidence surrounding the efficacy and safety of red-light therapy as a myopia control treatment, and to highlight the importance for further global research efforts for this novel treatment.

Clinical relevance: Accurate and timely assessment of the anterior segment of the eye is vital for the early detection and management of ocular conditions, like cataracts, keratitis, and other corneal diseases.

Background: This study compares two methods for examining the anterior segment of the eye: conventional slit lamp examination, the gold standard, and a novel three-dimensional semi-automated lighting slit lamp examination. The objectives are to evaluate the correlation between grading scores of ocular signs using standardised scales and determine the sensitivity and specificity of the novel approach to diagnosis.

Methods: A randomised, prospective, and repeated-measures design was employed. Participants, candidates for cataract surgery, were recruited from an ophthalmology clinic and included pre-operative and short-term post-operative groups. The pre-operative group was assessed for cataracts and iridocorneal angles, while the post-operative group was evaluated for anterior chamber reactions, keratitis, and corneal opacities. Standardised grading scales, like Contact Lens Complications Report, Standardisation of Uveitis Nomenclature, Van Herrick grading, and Lens Opacities Classification System III, were applied to categorise ocular diseases by morbidity levels, from 1 (low) to 5 (high).

Results: A total of 95 participants (72.17 ± 7.62 years; 59% F, 41% M) were included, with 43% in the pre-operative (phakic) and 57% in the post-operative (pseudo-phakic) patients. The intra-class correlation coefficient demonstrated good to excellent correlation (≥0.75) for most clinical findings, with moderate correlation (0.5 to 0.75) for the iridocorneal angle. Sensitivity ranged from 65% to 67% for low-morbidity diseases and 87% to 95% for moderate-morbidity diseases. Specificity was high for low-morbidity diseases (96% to 100%) and moderate for moderate-morbidity diseases (73% to 87%).

Conclusion: A good to great correlation exists between the two methods, and the novel method shows potential as a reliable alternative to the conventional method, with good sensitivity to moderate diseases and high specificity across all conditions.

Clinical relevance: Visual performance plays a fundamental role in sports, contributing to decision-making, spatial awareness, and object tracking. Establishing normative values for key visual functions supports performance assessment and training optimisation in athletes.

Background: This study aimed to evaluate visual acuity, refractive error, binocular function, and Visuo-cognitive abilities in professional football players to establish normative visual performance standards across different levels of athletic ability.

Methods: Visual assessments included static and dynamic visual acuity, refractive error, binocular vision (phoria, fusional vergence, vergence facility, and accommodative facility), and stereopsis. Visuo-cognitive abilities, such as multiple object tracking, reaction time, and peripheral perception, were also evaluated. The results were classified into five performance levels: Elite (10th percentile), Proficient (25th percentile), Average (50th percentile), Insufficient (75th percentile), and Dysfunctional (90th percentile). Statistical analyses were performed to determine normative thresholds and identify significant differences across these performance levels.

Results: A total of 262 male professional football players (mean age 24.6 ± 4.8 years) were assessed. Visual acuity averaged 1.09 ± 0.20, with Elite-level performance at 1.26 (6/4.8) and Dysfunctional-level at 0.90 (6/6.7). Dynamic visual acuity was 0.72 ± 0.17, with thresholds at 0.62 (6/9.5) (insufficient) and 0.52 (6/11.5) (Dysfunctional). Refractive error showed minimal anisometropia (0.20 ± 0.41D). Phoria status was orthophoric at distance (0.0 ± 2.1Δ) and exophoric at near (2.2 ± 4.7Δ). Accommodative facility averaged 11.7 ± 4.6 cpm. Stereopsis at distance averaged 1.85 ± 0.16 log arcsec, with Elite performance at 1.78 log arcsec and Dysfunctional at 2.00 log arcsec. Peripheral span averaged 40.7 ± 11.9, while multiple objects tracking and visual reaction time averaged 1623.3 ± 430.5 ms and 327.4 ± 37.8 ms, respectively.

Conclusion: Normative visual data is provided for male professional football players, including visual acuity, binocular vision parameters, and visuo-cognitive skills, offering a reference for assessing and optimising performance in football.

A systematic review and meta-analysis were conducted to understand the extent to which saccadic latency is impacted by different types of aetiologies. Nine studies were included in the meta-analysis, from 232 amblyopes and 140 controls. Longer saccadic latencies occurred in amblyopes compared to controls. A large and significant effect size (ES) was found when viewing with the amblyopic eye (g = 1.17, I² = 43.69%, p < 0.0001), followed by binocular viewing (g = 0.70, I² = 25.87%, p < 0.0001). However, no significant ES was found with fellow eye viewing (g = 0.12, I² = 42.86%, p = 0.320). Largest ES was noted for mixed amblyopia in the amblyopic eye (g = 1.79, I² = 0%, Q = 0.05, 95% CI = 1.70 to 1.87), followed by strabismic and anisometropic amblyopia, indicating that deficits in saccadic latency are dependent on the amblyopia type (p < 0.001). A positive association was found between saccadic latency and increasing hyperopic refractive error for the amblyopic eye (p = 0.004). A significant increase in saccadic latency ES with age was found for the fellow eye (p = 0.048) and binocular viewing (p = 0.004) conditions, but not for the amblyopic eye viewing (p = 0.077). Saccadic latency is most delayed in the amblyopic eye, particularly in mixed amblyopia, with smaller delays under binocular viewing condition. An increase in saccadic latency is observed with higher levels of hyperopia and as age progresses. These findings highlight the utility of measures of saccadic latency as a way of distinguishing between different types and severities of amblyopia, which may be useful in its diagnosis and treatment.