Clinical and Experimental Optometry最新文献

Entrustable professional activities (EPAs) are increasingly being adopted as an assessment tool by medicine and other health professions in a bid to enhance competency-based health professional education. EPAs are well-defined professional activities that can be entrusted to students to perform with varying levels of supervision. They were introduced to overcome some of the limitations of traditional assessment methods of competency such as individual skills assessment or Direct Observation of Procedures and Objective Structured Clinical Examinations. Could EPAs be beneficial in Australian and New Zealand optometric clinical education for advanced skills training and accreditation including the credentialing assessment of overseas educated practitioners? This paper discusses the historical context of how competencies were introduced and assessed in Australian optometry, the evolution of the concept of EPAs in medicine and other health professions, their design and implementation worldwide and whether EPAs could be adopted into optometric training and assessment in Australia and New Zealand.

Clinical relevance: The vestibular-ocular reflex stabilises the retinal image and maintains balance during head movement. Astigmatism is one of the common refractive errors that can reduce the quality of visual inputs.

Background: The purpose of this study was to investigate the effect of induced astigmatism on the function of the vestibular-ocular reflex.

Methods: This prospective semi-experimental study was conducted on 48 participants aged 20 to 40 years who had no history of neurological, vestibular, or eye disorders. Simple myopic astigmatism was induced using three positive cylindrical lens powers of + 0.50D, +1.50D, and + 2.50D at three axes of 180, 45, and 90 degrees in both eyes. The vestibular-ocular reflex was evaluated by the ocular Vestibular Evoked Myogenic Potential (oVEMP) through acoustic stimulation (a 500 hz tone burst at an intensity of 95 dBnHL) of the ear, with potentials recorded from the lower oblique muscle. The latency of the N1 and P1 waves and the amplitude of N1-P1 were recorded for all participants in the baseline condition (without any induced astigmatism) and under different induced astigmatism conditions.

Results: The latencies of N1 and P1 significantly increased with the increasing power of induced astigmatism; however, the powers of astigmatism had no effect on the amplitude of N1-P1. The axes of induced astigmatism did not have a significant effect on the latencies and amplitude of N1-P1.

Conclusions: Induced astigmatism due to retinal image blur can deteriorate the function of the vestibular-ocular reflex by increase in the latencies of N1 and P1 oVEMP waves.

Clinical relevance: Pseudoexfoliation syndrome (PXS) is a common age-related disorder associated with glaucoma and cataract. Despite its clinical importance, the pathogenesis of PXS is not yet fully understood.

Background: To evaluate levels of SCUBE-1 (signal peptide, CUB domain, and epidermal growth factor-like domain containing protein 1) in the serum and aqueous humour of patients with PXS in comparison with non-PXS controls.

Methods: This prospective study included patients with and without PXS undergoing phacoemulsification surgery for cataract. Patients with pseudoexfoliative glaucoma were excluded. Aqueous humour samples collected at the beginning of phacoemulsification surgery were analysed by using the sandwich enzyme-linked immunosorbent assay method (human SCUBE-1 enzyme-linked immunosorbent assay kit; Elabscience).

Results: There was a significant difference in mean aqueous humour SCUBE-1 levels between PXS patients (1.69 ± 0.41 ng/µL) and non-PXS controls (0.89 ± 0.33 ng/µL) (p = 0.012). However, the difference in mean serum SCUBE-1 levels was not significant (0.87 ± 0.36 ng/µL and 0.81 ± 0.35 ng/µL, respectively; p = 0.560). There was no significant correlation between aqueous humour and serum SCUBE-1 levels in either group (p > 0.05).

Conclusion: SCUBE-1 is an important marker of ischaemia and oxidative stress. Increased SCUBE-1 levels in the aqueous humour of patients with PXS may indicate a local effect of SCUBE-1 in the pathogenesis of PXS.

Clinical relevance: There are many recognised risk factors for retinal vein occlusions. It is plausible that musicians who play wind instruments or use their voice as their primary instrument may be at increased risk of branch retinal vein occlusions through repeated Valsalva manoeuvre.

Background: Repeated valsalva manoeuvres are commonly performed by musicians using high resistance wind instruments. This also true for singers. This case series illustrates a correlation between repeated Valsalva manoeuvres and retinal vein occlusion in three patients and explores the clinical and functional underlying mechanisms.

Methods: A retrospective review of three cases presenting to a private Ophthalmology clinic.

Results: Case 1 is an 85-year-old male, French Horn player and Case 2 is a 77-year-old male, bass-baritone singer each presented with a left-sided non-ischaemic branch retinal vein occlusion. Case 3 is a 79-year-old male Tenor presented with a left -sided ischaemic branch retinal vein occlusion. All cases were treated with intravitreal anti-vascular endothelial growth factor stabilising vision.

Conclusion: Repeated Valsalva manoeuvre as demonstrated in wind musicians and singers may play a role in pathogenies of branch retinal vein occlusions in susceptible individuals.

Clinical relevance: Vitreous floaters have been associated with depressive and anxiety symptoms. However, there is a scarcity in the literature regarding the possible impact of vitreous flashes on the psychological status of the patients.

Background: Photopsias and vitreous floaters frequently co-exist. Floaters have been accompanied by exacerbated levels of depression and anxiety. The aim of this study was to examine whether the presence of photopsias in patients suffering from vitreous floaters is accompanied by exacerbated levels of anxiety and depression.

Methods: One hundred and four patients complaining of floaters were included in the study; 51 experienced also photopsias and 53 did not. A comprehensive ocular examination, including funduscopy and optical coherence tomography scans was performed to every patient, while their clinical and demographic data were also assessed. Every participant completed the PHQ-9, the Zung SDS, and the HADS anxiety and depression questionnaires.

Results: The clinical and demographic data did not differ significantly between the study groups (p > 0.05).The scores of every questionnaire were significantly higher among the patients with vitreous flashes (p < 0.05 for all). After adjustment for several confounders, the values remained significantly impaired.

Conclusion: Photopsias negatively affect the psychological and mental well-being of the patients, by the terms of amplified levels of depression and anxiety. These findings underscore the necessity for a more holistic approach to managing patients presenting with vitreous flashes.

With optometrists well placed to address the challenges and opportunities faced by contemporary eye care systems, it is ever more important to understand the genesis and development of the profession, so that optometrists can continue to build on this legacy for patient benefit. While the optometry profession of optometry in the United Kingdom can arguably trace its foundation back to 1629 and the Royal Charter gifted by Charles I to the Worshipful Company of Spectacle Makers to establish the 60^th Livery Company of the City of London, the genesis of optometry as an independent profession (initially known as 'ophthalmic optics') can perhaps best be attributed to the formation of the British Optical Association in 1895. This paper reviews the current legal framework and recent changes that dictates how the optometry profession are trained and practice, along with clinical and educational innovations that are shaping the future role of the profession.

Clinical relevance: Knowledge of contact lens prescribing trends can (a) assist practitioners to benchmark their own prescribing habits, (b) help the contact lens industry understand preferred products, and (c) support academics in scholarly writings.

Background: This work aims to document contact lens prescribing trends in Australia over the past quarter of a century.

Methods: An annual survey of contact lens prescribing trends was conducted in Australia each year from 2000 to 2024, inclusive, by asking optometrists to provide information relating to 10 consecutive contact lens fits undertaken between January and March.

Results: Over the 25-year survey period, a total of 20,281 contact lens fits were reported. Lens wearers were 34.4 ± 14.7 years of age and 65% were female. Over the survey period, rigid lenses increased from 13% to 21% of all lens fits. Of all soft lens fits, silicone hydrogel lenses increased from 22% to 96%; soft torics increased from 24% to 30%; daily disposables increased from 7% to 63%; soft extended wear decreased from 16% to 5%; multifocals increased from 5% to 26%; and myopia control (first fit in 2011) reached 3% by 2024. Rigid lens extended wear (primarily orthokeratology) increased from 0.3% to 17% of rigid lens fits, primarily for myopia control. Multi-purpose lens care solutions are ubiquitous, and peroxide systems are seldom prescribed. Rigid lenses and monthly replacement soft lenses are largely worn full time, whereas daily disposables are worn full time and part time in equal measure. Australian and global prescribing trends are broadly consistent.

Conclusions: Contact lens fitting trends this century can be characterised as: soft lenses - significant increase in silicone hydrogels, daily disposables, torics and multifocals; rigid lenses - dominance of high-Dk materials, and recent resurgence in scleral and orthokeratology fits. There is little extended wear fitting. Multi-purpose care systems are ubiquitous.

Clinical relevance: Horizontal rectus muscle surgeries may cause changes in corneal and anterior segment parameters. Corneal topography is an important device for identifying these alterations.

Background: The aim of this work is to evaluate the effects of horizontal rectus muscle surgeries on corneal topography, anterior chamber parameters and corneal wavefront aberrations.

Methods: Patients who had horizontal rectus muscle surgery from a single hospital in Turkey between September 2021 and March 2022 were invited to participate. Anterior segment parameters and corneal wavefront aberrations were analysed using a Pentacam device. Axial lengths were measured with an intraocular lens biometric instrument. Tests were performed prior to surgery and 3 months after surgery and results were compared. Parameters with significant change were determined in the whole study group, single muscle and two-muscle groups. The amount of change (Δ) in all parameters was compared between the groups that underwent single muscle and two-muscle surgeries.

Results: For this prospective study, 44 eyes of 35 patients were included. The mean age was 18.10 ± 6.93 (7-28) (mean ± standard deviation (range)) years. Of the eyes, 22 (50%) underwent single muscle recession surgery. Two-muscle surgeries (recession and resection combination) were performed in 22 eyes. In the whole study group, axial length, anterior corneal surface-steep keratometry, anterior corneal astigmatism and anterior chamber volume increased significantly in the postoperative period (p = 0.002, p < 0.001, p < 0.001, and p = 0.007 respectively). Anterior corneal surface-flat keratometry decreased significantly (p = 0.002). While root mean square (RMS)-Spherical aberration increased significantly for the total corneal surface (p < 0.001), RMS-Trefoil 0° decreased (p = 0.039). Only ΔSteep keratometry and ΔMean keratometry parameters were changed significantly between the two groups.

Conclusions: Horizontal muscle surgeries may cause changes in corneal topography, anterior chamber parameters and corneal aberrations. The number of muscles operated during the surgery does not seem to greatly affect the magnitude of changes that occur.