Clinical and Experimental Optometry最新文献

Clinical relevance: Effective diabetic retinopathy (DR) patient education materials (PEMs) are vital for improving patient outcomes by fostering understanding and self-management.

Background: DR is a leading cause of vision impairment and blindness among Australians with diabetes, with Indigenous populations facing higher rates of severe complications. Despite the availability of online PEMs, their understandability and actionability, especially those designed for Indigenous Australians, remains underexplored, creating a gap in effective patient education.

Methods: This descriptive study assessed online PEMs using the Patient Education Materials Assessment Tool (PEMAT). Evaluations were conducted with online search platforms for printable and audiovisual PEMs on DR. Two independent reviewers scored the PEMs for understandability and actionability, with discrepancies resolved by a third adjudicator. A 70% threshold was used to indicate acceptable scores.

Results: From 540 identified PEMs, 54 met the inclusion criteria. Indigenous-targeted PEMs achieved higher in understandability (80%) than general population PEMs (75%). However, actionability scores were lower across all formats, with printable PEMs having a mean score of 42% for general population and 53% for Indigenous PEMs, and audiovisual PEMs at 29%.

Conclusion: While most DR-related PEMs are generally understandable, their low actionability, especially audiovisual formats, indicates a need for clearer, step-by-step guidance to support patient self-management. Improving the structure and content of both printable and audiovisual PEMs can improve engagement and adherence to preventive behaviours among people living with diabetes, potentially reducing the burden of DR.

Clinical relevance: With a wide range of commercially available biometry devices, direct comparisons for agreement, interchangeability and repeatability are needed to enable correct interpretation of measured values.

Background: The purpose of this study was to evaluate the intra-device repeatability and inter-device agreement of three different ocular biometers.

Methods: This is a prospective, comparative study conducted at the University Hospital, Goethe University, Frankfurt, Germany. Included were eyes with a cataract which showed no other pathology. One eye per patient was randomly selected and 3 consecutive measurements were taken with the IOLMaster 700, Galilei G6, and Pentacam AXL. Repeatability and agreement were evaluated for simulated keratometry (simK), astigmatism (simA) and its axis, total keratometry (TC), axial length (AL), anterior chamber depth (ACD), and pachymetry (CT).

Results: simK, TC, AL, and CT show very high repeatability with an intra-class correlation (ICC) of > 0.9 and a COV < 0.5 each. Means of the measurements were significantly different between the devices for simK, AL, and TC (p < 0.05). ACD and simA also showed a high ICC, but a lower agreement between the devices. Fixed biases shown by Bland-Altman plots for simK seem to indicate that the values are not interchangeable.

Conclusion: Even though very high repeatability and agreement for most of the measured variables was observed with all three devices, fixed differences indicate that measured values are not completely interchangeable between the devices.

Corneal foreign body removal is a common office-based procedure conducted by primary eye care practitioners globally. In Australia and New Zealand, optometry is a therapeutic profession capable of removing embedded corneal foreign bodies. In Australia, it has been estimated that ocular foreign bodies account for more than 44% of eye-related presentations to a hospital emergency department. Studies have shown that the majority of these patients can be effectively managed by the community optometrist, reducing the burden on hospital admissions. Regardless of the setting, the use of standardised terminology - recently expanded based on the IGATES recommendations, is essential when describing eye injuries. This review provides a comprehensive overview of the epidemiology, classification of trauma, assessment and removal procedure, tools involved and the post-removal therapeutic management of corneal foreign bodies. It reinforces the importance of the role of the primary eye care practitioner in the provision of accessible and timely care to patients with corneal foreign bodies.

Clinical relevance: Low-luminance visual acuity and low-luminance deficit (standard visual acuity minus low-luminance visual acuity) are gaining popularity as outcome measures in clinical trials for retinal disease, demonstrating capability to detect central visual function changes earlier than standard visual acuity.

Background: The aim of this study is to explore suspected sources of low-luminance visual acuity variability, standardise the method of measurement of low-luminance visual acuity, and define a 'normal' low-luminance deficit upper limit for young adults (<55 years).

Methods: Data from three separate studies were collated. Standard visual acuity was obtained using ETDRS charts (Precision Vision, Bloomington, IL, USA) and low-luminance visual acuity was obtained with the addition of a 2.0-log neutral density filter. The effects of dark adaptation and different background luminance levels on low-luminance visual acuity results were explored. The Electronic Visual Acuity chart (M&S Technologies, Niles, IL, USA) for low-luminance visual acuity testing was also assessed.

Results: Three-minutes of dark adaptation and different background luminance levels (1.6 and 0.85 cd/m²) did not demonstrate clinically significant changes in low-luminance visual acuity and low-luminance deficit. Bland-Altman analyses revealed significant variability between the ETDRS physical charts and the electronic chart indicating the two cannot be used interchangeably in the presence of a luminance difference. An upper low-luminance deficit limit of 11 ETDRS letters for younger individuals was also identified.

Conclusion: Formal dark adaptation does not improve low-luminance visual acuity results since any increased sensitivity is nullified by extremely quick cone light adaptation times. Small reductions in background luminance levels are not a clinically significant source of variability. However, for consistency, the same luminance level should be maintained throughout testing. Results from electronic and physical charts are not transferrable without proper luminance calibration. A low-luminance deficit greater than 11 ETDRS letters, in younger individuals, should prompt further investigation.

Clinical relevance: Understanding myopia prevalence can improve patient education and help guide early interventions. This knowledge may enhance awareness, support better decision-making, and positively impact patients' vision and quality of life.

Background: The prevalence of myopia is increasing globally, but no published data exists for New Zealand. This study estimated myopia prevalence using New Zealand Transport Agency (NZTA) data on the number of driver licence holders with a B-condition, indicating that their unaided visual acuity was worse than 6/12 and they must wear refractive correction while driving.

Methods: A retrospective analysis of de-identified NZTA licence data (with or without a B-condition) for 2001, 2006, 2013, 2018 and 2023 was performed. Data were stratified by gender in 5-year age groups. Data from the 25-44-year age range were used to estimate myopia prevalence, assuming all B-conditions resulted from myopia. Approximately 96% of 25 to 44-year-olds in New Zealand had a driver's licence in 2023. Non-parametric, Mann-Kendall (M-K) trend analysis was used to investigate changes in myopia prevalence over time.

Results: In 2001, the proportion of 25-44-year-old drivers with a B-condition was 21.55%: n = 1,033,251 (25.32% in females, 17.78% in males). By 2023, when the 25-44-year-old group consisted of different individuals, the proportion of B-condition licences was 21.44%: n = 1,438,257 (25.39% in females, 17.71% in males). The proportion among successive independent cohorts of younger drivers (aged 25-29 years, combined female & male) remained stable from 2001 to 2023 (M-K trend, S = -8, p = 0.086) at 19.82 ± 1.71% (mean ± SD).

Conclusion: The prevalence of myopia in the New Zealand population of 25-44-year-olds remained stable from 2001 to 2023 at approximately 22% overall (with prevalence of approximately 25% in females and 18% in males).

Clinical relevance: Nerf guns can lead to significant ocular injury. Understanding the incidence and types of complications that can result can lead to improved diagnoses, management, and prevention.

Background: The intention of this study is to characterise the incidence, ocular findings, and specific visual outcomes associated with Nerf gun injuries at the Illinois College of Optometry, an academic optometric setting.

Methods: A retrospective chart review of electronic medical records at the IEI was conducted from December 2017 to December 2022. Patient charts were identified using the search options in the electronic medical system. The following words and combinations were used during the electronic medical system search: Nerf, dart, bullet, foam, projectile, rubber. Charts were reviewed for accuracy.

Results: Thirty-five patients were identified (21 females, 14 males) The average age of presentation was 24 years old (range 3-56 years). No patients were wearing protective eyewear. All injuries were unilateral. The follow-up period varied from 1 day to 1 month. Average entering best corrected visual acuity (BCVA) was 6/9, ranging between 6/6 and 6/45. All patients eventually returned to 6/6. Twenty-one patients (60%) were diagnosed with traumatic anterior uveitis. All 21 patients were treated with a topical steroid. All patients were dilated at the initial visit and at the follow-up visit. There were no findings in the intermediate and posterior segments of the eye secondary to nerf gun injuries.

Conclusion: This current study specifically focuses on Nerf gun-related ocular injuries and their definite visual outcomes in a larger study population and period in an optometric setting. Most injuries are limited to the anterior segment with limited to no visual sequalae. Poorer visual outcomes are still possible and therefore proper safety eyewear, safe play, and safe distancing when using Nerf gun-type projectiles is recommended.

Clinical relevance: To improve equity in eye care, optometry training clinics should be accessible to all population groups so that future optometrists develop skills working with different population groups.

Background: In the 2019 World Report on Vision, the World Health Organization highlighted a need to improve access to eye care globally. In Aotearoa New Zealand, a renewed focus on equity followed the 2022 health system reform. The School of Optometry and Vision Science (SOVS) at The University of Auckland has an important role in promoting equity within the eye health sector. The aim of this study was to assess whether the SOVS teaching clinics are accessible to a range of population groups.

Methods: The demographics and travel distances of patients accessing the SOVS teaching clinics within the five-year period immediately prior to the New Zealand health system reform (2017-2021) were assessed. The representativeness of patients accessing the main teaching clinic was compared to the wider New Zealand population.

Results: Information describing patient ethnicity was not available for 82% of the 18,981 patients. Compared to the New Zealand population, people who accessed the main teaching clinic were more likely to live in areas with low levels of deprivation, and those who lived in areas of high deprivation travelled the furthest (all p < 0.01). Compared to patients accessing the main teaching clinic, a person accessing care at a fully subsidised community-based clinic was 27 times more likely to live in an area with the highest level of deprivation.

Conclusions: Due to its location, the teaching clinic where New Zealand optometrists are trained is less accessible to people who live in areas with high levels of deprivation, and greater focus on collecting patient ethnicity information is required. Funding for routine, community outreach services would address inequities and embed a culture of equity into optometry education.

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: Pupillary light reflex testing via mobile apps offers a low-cost, and accessible method for assessing eye and neurological function. Its use may enable rapid screening and monitoring of eye disease, brain injury and neurological disorders, supporting early detection, telemedicine applications, and clinical decision-making in and outside clinical environments.

Background: Rapid advances in technology have made it possible to assess human brain health with personal handheld devices through quantification of visual reflexes such as the pupillary light reflex (PLR). The study examined the effectiveness of a cutting-edge smartphone application, Ocula AI (Equinox), to capture and quantify the PLR compared to an established clinical-standard device, the PLR-3000 pupillometer (NeurOptics).

Methods: Both Ocula AI and the PLR-3000 device captures the PLR waveform providing estimates of key metrics such as latency, maximum and minimum pupils, and constriction and dilation velocities. The ability of Ocula AI to capture the PLR was assessed under different indoor illumination conditions (indicated by illuminance levels ranging from 0 to 1000 lux) in 16 healthy young adults and key metrics were compared to the outputs of the PLR-3000 device.

Results: Ocula AI was capable of capturing the PLR up to approximately 1000 lux, at which point the pupils are maximally constricted. Comparison and Bland-Altman plot analyses showed that Ocula AI captured the PLR and estimated key metrics of the PLR waveform to a similar standard (and were not significantly different) to the PLR-3000 device.

Conclusions: The present study provided preliminary evidence demonstrating that nascent technologies now available on mobile devices are capable of providing accurate and easy estimation of the PLR. The development of such technologies offers a cost-effective solution and expands the scope of PLR testing (as a measure of neural function) to a range of environments and situations not limited to laboratory or clinical settings.

Clinical relevance: Quantitative analysis of macular capillary plexuses using optical coherence tomography angiography (OCTA) may improve diagnosis and monitoring of glaucoma. Identifying vascular patterns linked to localised and global visual field loss could enhance clinical decision-making and understanding of disease mechanisms.

Purpose: To investigate the relationship between macular vessel density, measured by OCTA, and visual field loss quantified by pattern standard deviation and mean deviation; and to determine whether perfusion metrics from the superficial and deep capillary plexus correlate with functional deficits using OCTA and visual field analysis.

Methods: This cross-sectional study included 114 participants: 38 with glaucoma, 38 glaucoma suspects, and 38 healthy controls. Macular vessel density of the superficial and deep capillary plexus was measured using 6 × 6 mm OCTA scans, while functional loss was assessed with Humphrey visual field parameters including pattern standard deviation, mean deviation, and the visual field index. Linear regression was performed to analyse associations between vascular metrics, visual field indices, and structural measures such as retinal nerve fibre layer and ganglion cell complex thickness.

Results: Deep capillary plexus vessel density showed strong correlations with global functional loss (mean deviation, R² = 0.88, p < 0.001) and focal loss (pattern standard deviation, R² = 0.83, p < 0.001). Superficial capillary plexus vessel density was significantly associated with pattern standard deviation (R² = 0.51, p < 0.001). Glaucoma eyes showed higher pattern standard deviation (7.87 ± 3.11) than suspects (2.76 ± 1.45) and controls (2.37 ± 0.67) (p < 0.001), along with reduced macular perfusion in both plexuses.

Conclusion: Macular vessel density, particularly in the deep capillary plexus, is strongly associated with focal and global visual field loss in glaucoma. Superficial plexus metrics show a moderate but significant correlation with focal loss, supporting OCTA as a non-invasive biomarker for early glaucoma detection and monitoring.