Clinical and Experimental Optometry最新文献

Myopia control, as opposed to myopia correction, is emerging as the new standard of care for clinical management of paediatric myopia by optometrists. The prevalence of myopia, and high myopia, is increasing worldwide, while the prevalence of pathologies associated with myopia increases with increasing axial length. With increasing global prevalence, preventing the axial elongation and pathologies associated with higher levels of myopia is therefore of paramount importance. Pharmacological management with atropine is one of the key myopia control options available to practitioners. Management with 1% atropine shows positive control effects but induces significant visual side effects in paediatic patients due to cycloplegia and mydriasis. The initial studies on the efficacy of low-dose atropine (<0.1%) have led to a significant increase in both publications (50% of all atropine myopia control papers having been published in the past 4 years) and practitioner prescribing. In this review, the advantages and disadvantages of low-dose atropine are explored to provide practitioners with an evidence-based approach to use in their practice.

Clinical relevance: The theoretical basis and evidence-based clinical practice of optometry and vision science are expressed primarily in refereed journals of academic and professional repute. These journals serve as the reference and access point for advances and innovations in the field of optometry.

Background: Africa has the highest global burden of visual impairment, yet the contribution of African optometry researchers to ophthalmic research has not been assessed. This study examines the scholarly output and publication outlets of the leading African optometry academics to evaluate their contribution to ophthalmic literature.

Methods: A bibliometric analysis was undertaken using Scopus-indexed publications authored by the leading African optometry researchers. The Scopus records for each of the fifty scholars were extracted and deduplicated, yielding metadata on document types, language, citation counts, journal titles, and metrics (h-index, Impact Factor, Cite Score). The Bibliometrix package in R was used to analyse the research output and publication trends. The Kruskal-Wallis and Mann-Whitney U tests were used to assess the associations between African contributions and global journal metrics.

Results: African optometry researchers published 1319 papers across 341 journals, accumulating 86,218 citations with an overall h-index of 72. Original research articles comprised 84.4%. Though open access articles had a higher volume (58.7%), subscription-based articles (41.3%) showed a higher citation impact than open access articles (mean rank:641.18 vs 686.73; U = 225,481.50, p = 0.032). Publications were concentrated in 27 core journals. No significant correlations were found between African-authored article counts and Impact Factor (r_s = -0.069, p = 0.738) or between African h-index and journal quartile (χ² (2) = 4.58, p = 0.101).

Conclusions: African optometry researchers have demonstrated increasing productivity and contribution to ophthalmic research. However, relevance and accessibility drive journal selection more than impact metrics alone, highlighting the need to bridge the gap between research visibility and global recognition.

Clinical relevance: Diabetic macular oedema (DME) is a leading cause of visual impairment worldwide. Real-world evidence is essential for understanding treatment effectiveness and guiding practical decision-making in routine clinical care.

Background: The aim of this work is to evaluate the cost-effectiveness of early versus late switching to intravitreal aflibercept or ranibizumab in eyes with DME refractory to intravitreal bevacizumab loading treatment.

Methods: This multicentre retrospective study included treatment-naïve refractory DME eyes that initiated bevacizumab between 2021 and 2023. Eyes were divided into three groups: no switch, early switch (3-6 months), and late switch (after 6 months). Public healthcare costs from 2021-2023 were used to calculate the cost per 0.1 improvement in best-corrected visual acuity (BCVA) and per 100 μm reduction in central macular thickness. Cost-effectiveness ratio and incremental cost-effectiveness ratio analyses were performed.

Results: A total of 229 eyes in the no-switch group, 328 eyes in the early-switch group, and 63 eyes in the late-switch group were analysed. At month 12, the greatest BCVA gain was observed in the early-switch group (p = 0.02). Mean injection numbers were 5.7 ± 1.4 (no-switch), 7.2 ± 1.5 (early-switch), and 6.6 ± 1.4 (late-switch) (p < 0.001). Cost-effectiveness ratio for visual acuity improvement was €4,838, €10,395, and €10,848 for the no-switch, early-switch, and late-switch groups, respectively. Incremental cost-effectiveness ratio analysis showed additional costs of €15,654 for early switching and €54,856 for late switching compared with no switching. Central macular thickness reduction was greatest in the no-switch group and lowest in the late-switch group (p = 0.05).

Conclusion: Although early switching yields the greatest visual improvement and faster rehabilitation, it incurs higher costs. The no-switch strategy provided modest visual improvement at the lowest cost, resulting in the most favourable cost-effectiveness ratio. Late switching produced limited benefit at high cost, rendering it an unfavourable option. Treatment decisions should balance clinical efficacy and cost-effectiveness on an individual basis.

Clinical relevance: Geographic atrophy is a leading cause of severe vision loss and is estimated to affect around 100,000 people in Australia alone. This survey is topical for clinical optometrists as the first treatment for geographic atrophy has just been approved by the Australian Therapeutics Goods Administration and may soon become available in Australia.

Background: Considering that treatments for geographic atrophy secondary to age-related macular degeneration are likely imminent, a survey of Australian optometrists was conducted to gauge their readiness in caring for people with geographic atrophy.

Methods: The Royal Australian and New Zealand College of Ophthalmologists age-related macular degeneration referral guidelines working group determined 26 survey questions relating to management of geographic atrophy. Strength of agreement questions utilised a 5-point Likert scale. Optometrists answered anonymously during January to March 2024.

Results: There were 101 survey responses. Almost all (97%) respondents have access to colour fundus photography, three-quarters (74%) to optical coherence tomography, and almost half (44%) to fundus autofluorescence. Almost all (97%) see patients with GA regularly, with 73% seeing at least two geographic atrophy patients per month and the majority reviewing them every 6 months. Around half were confident in differentiating geographic atrophy from inherited retinal disease (49%) and confident in identifying early signs of atrophy (44%). Around half (46%) nominated that they would refer over 50% of their current geographic atrophy patients to ophthalmology for assessment of their suitability for new treatments. Eighty-three percent would refer a patient with good vision (6/12 or better) to initiate treatment to save encroachment on the fovea. Respondents were keen to receive more education about diagnosis (88%) and new treatments (93%).

Conclusion: Optometrists are preparing for changes in the clinical management of geographic atrophy and are keen to receive further education to ensure optimal patient-centric care as new treatments become available.

Clinical relevance: Meibomian gland dysfunction (MGD) is a major contributor to dry eye disease, affecting a large proportion of the population and leading to significant discomfort and ocular surface complications. Understanding trends in MGD research, including advancements in diagnostic technologies, therapeutic approaches, and interdisciplinary collaborations, is critical for improving clinical practices.

Background: This study aims to perform a bibliometric analysis on MGD to assess the current international status of meibomian gland dysfunction research and identify the most influential contributors (journals, countries, authors) and research topics in this field.

Methods: Data from studies on MGD were obtained using the Web of Science Core Collection on Science Citation Index Expanded database. Information regarding journals, titles, text, keywords, references, citations, author names, author institutions, and countries was recorded for each publication. The data were analysed using features of the Web of Science Core Collection website and the VOSviewer visualisation tool.

Results: A total of 1313 articles published between 1980 and 2024 were identified. The number of articles published in the last 10 years was found to be 3.01 times greater than in all previous years combined. The United States and China were the most productive countries, with the highest number of articles and citations. The most productive institutions were located in the United States and Japan. The most prolific author was Reiko Arita. The most frequently cited article was titled 'The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the Meibomian Gland'. Recent and emerging keywords include 'intense pulsed light', 'meibography', 'lipiflow', 'artificial intelligence', 'meibogenesis', 'lipidomics' and 'human meibomian gland epithelium', reflecting current trends in MGD research.

Conclusions: This study provides an overview of the current status and trends in MGD research, which may help clinicians and researchers better understand this field and predict its future directions.

Vision impairment is a global public health concern affecting 1.1 billion people worldwide. The coronavirus disease or COVID-19 outbreak caused by the SARS-CoV-2 virus in 2019 affected many aspects of everyday life and prompted various preventative health measures. Persons with visual impairment face multiple challenges daily, and with the onset of the COVID-19 pandemic, these challenges were likely worsened. With various studies conducted globally to explore the experiences of persons with visual impairment, this scoping review aims to provide an overview of the impact of the COVID-19 pandemic on persons with visual impairment within a global context. The five-step framework by Arksey and O'Malley was applied, involving a literature search across nine electronic databases, with specific search terms formulated from the research question. Data were screened for eligibility by the three reviewers using pre-decided study criteria. Of the 263 articles identified from December 2019 to October 2022, 49 were included in this review. More than 80% of the articles were published in the early years of the pandemic (2020 and 2021), and 77.5% of the studies had persons with visual impairment as participants. The themes identified included psychosocial, access to COVID-19 information and technology, healthcare, everyday activities, education, economic situation, adherence to regulations, and support. Overall, the COVID-19 pandemic worsened the challenges faced by persons with visual impairment, especially those affecting their independence and daily routines. Governments and stakeholders should make more efforts to address the challenges experienced by persons with visual impairment, as this will directly impact their quality of life.

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.