Clinical and Experimental Optometry最新文献

Clinical relevance: Non-invasive break-up time (NIBUT) has become the measurement of choice to evaluate stability of the tear film. Tear film stability is essential in the diagnosis and follow-up of dry eye disease.

Background: Instruments used to measure NIBUT have different spacing of luminous mires, but the influence of this characteristic on the measurement of NIBUT is poorly understood. This study aimed at comparing the characteristics of five different instruments used to measure NIBUT and to determine if the mire spacing had an impact on the measured NIBUT.

Methods: Mire spacing of the instruments was assessed using a calibration sphere. Two raters then measured the NIBUT of 20 participants (20 eyes) with normal ocular surfaces three consecutive times with five different instruments (Oculus Placido Disk, Keeler Tearscope Plus with the Coarse and the Fine Grid, Medmont E300 Topographer and Oculus Keratograph 5M). A two-way repeated measure analysis of variance was performed to compare the NIBUT data and correlation values (intra-class and Spearman) were computed for intra-rater agreement and test-retest reliability.

Results: The Tearscope Plus with the Fine Grid was the instrument that presented the finest mire spacing. Two instruments, the Medmont E300 and the Keratograph gave shorter NIBUTs compared to the Tearscope Plus with the Fine Grid. All instruments had good inter-rater agreement. The Medmont E300 had a less good test-retest reliability for one of the raters. Bland-Altman plots were used to compare all the instruments with the one having the finest mire spacing. A positive proportional bias between the Tearscope Plus using the Fine Grid and the Coarse Grid was found.

Conclusion: The topography-based instruments had shorter subjective NIBUT values in non-dry eye participants compared to the other instruments. Mire spacing is not the most definitive factor that impacts the NIBUT value.

Clinical relevance: Accurate and objective tools for myopia screening in children and adolescents are crucial to retard progression and avert vision-endangering complications.

Background: This study aims to investigate the diagnostic performance of the axial length/corneal radius (AL/CR) ratio for myopia in children and adolescents.

Methods: The literature search encompassed major electronic databases, key academic websites, and grey literature from inception to April 2025. Inclusion criteria were restricted to studies evaluating the diagnostic accuracy of AL/CR for myopia, with spherical equivalent (SE) ≤ -0.50 D as the gold standard for myopia diagnosis. The meta-analysis adhered to the Cochrane Handbook guidelines and PRISMA reporting standards.

Results: A total of 9 studies involving 24,030 children and adolescents were included in the meta-analysis. The summary sensitivity, specificity, and area under the curve of AL/CR for diagnosing myopia were 0.88 [95% CI: 0.86-0.90], 0.89 [95% CI: 0.86-0.91], and 0.93 [95% CI: 0.91-0.95], respectively. Meta-regression analysis revealed that the sensitivity of AL/CR remained independent of sample size, SE, myopia prevalence, age, or recruitment setting (school-based vs. hospital-based) (all p > 0.05). Notably, increased diagnostic specificity was significantly associated with older age (p = 0.01). The combination of AL/CR with non-cycloplegic autorefraction demonstrated significantly higher sensitivity and specificity in detecting myopia compared to AL/CR alone (Sensitivity: 0.93 [95% CI: 0.92-0.95] VS 0.88 [95% CI: 0.86-0.90]; Specificity: 0.94 [95% CI: 0.94-0.95] VS 0.89 [95% CI: 0.86-0.91]). AL/CR cut-off value exhibited significant correlations with age.

Conclusion: AL/CR ratio demonstrates robust diagnostic efficacy for myopia in paediatric and adolescent populations, particularly when utilised in conjunction with non-cycloplegic autorefraction. However, the selection of age-specific AL/CR cut-off points is essential to maximise diagnostic precision.

Clinical relevance: Contact lenses offer effective refractive, cosmetic, and therapeutic options; however, their safe and successful use requires addressing barriers at the practitioner, patient, and healthcare system levels. Identifying and understanding these challenges are essential to improving clinical outcomes, enhancing patient satisfaction, and supporting broader global adoption.

Background: Despite advancements in contact lens materials and designs, adoption rates in India remain constrained by discontinuation, affordability issues, and low public awareness. This study aimed to evaluate common challenges, barriers to contact lens uptake, and strategies implemented by practitioners across India.

Methods: A cross-sectional survey was conducted among contact lens practitioners across six Indian zones (North, South, East, West, Central, and North-East) between January and May 2025. A structured questionnaire, assessed challenges in contact lens practice, barriers to uptake, and improvement strategies. Responses were recorded on a 5-point numerical scale. Data were analysed, employing descriptive statistics and Kruskal-Wallis tests to evaluate regional differences.

Results: A total of 338 (96.5%) out of 350 practitioners completed the survey. Limited availability of trial lenses and high material costs were the most frequently reported challenges (median score: 3/5, IQR: 2.0-4.0). Key barriers to contact lens uptake included lack of awareness (median: 3/5, IQR: 2.0-4.0), discomfort-related dropout (median: 3/5, IQR: 2.0-4.0), and unsupervised online purchases (median: 3/5, IQR: 2.0-5.0). High consensus was observed for improvement strategies, with practitioner education, patient awareness initiatives, affordability, and proactive contact lens recommendations scoring a median of 4/5, IQR: 3.0-5.0. No statistically significant regional differences were found (p > 0.05).

Conclusions: Indian contact lens practitioners face consistent challenges nationwide, with affordability, trial lens availability, and public awareness identified as primary concerns. Practitioner-driven education, patient counselling, and affordability measures are essential to enhancing contact lens practice and promoting the safe and wider adoption of contact lenses in India.

Age-related macular degeneration (AMD) is a common condition that causes vision impairment in the elderly, significantly impacting their physical and psychosocial well-being. Historically, treatment options to slow or prevent atrophic AMD progression have been limited but are recently increasing in number. This scoping review aims to provide an overview of the research (both preclinical and clinical) on non-neovascular AMD (including early, intermediate, and geographic atrophy) treatments published in the past decade. Our study protocol was prospectively registered on the Open Science Framework.Searches were conducted on MEDLINE, Embase, ProQuest, and CINAHL for studies investigating treatments for atrophic AMD (including early, intermediate, and geographic atrophy stages) published between 1 January 2014 and 14 July 2024, the search date. Data screening, full-text review, and extraction were independently performed by two researchers. Study characteristics and outcomes were summarised, and the results were synthesised narratively. The search identified 1,211 studies, of which 132 were included in this review. Studies were most often conducted in the United States (n = 92, 68.7%) or Europe (n = 25, 18.5%) and most frequently investigated antioxidant or anti-inflammatory treatments (n = 30, 22.7%) or complement pathway inhibitors (n = 25, 18.9%) as potential therapies. Over three quarters (n = 101, 76.5%) of the included studies reported positive outcomes. Across the decade, the number of studies published increased at an annual rate of 24.0%.This review highlights the growing body of research on atrophic AMD treatments over the past decade, with antioxidant and anti-inflammatory treatments emerging as prominent, promising avenues. However, more phase III human clinical trials are needed to ensure that future therapies effectively serve the global AMD population.

Clinical relevance: Vitamin B12 deficiency can affect macular and choroidal vasculature. Optical coherence tomography angiography (OCTA) and enhanced depth imaging OCT (EDI-OCT) are essential for early detection and monitoring of these microvascular changes, helping to prevent potential visual impairment.

Background: This study aimed to assess the impact of vitamin B12 deficiency on the vascular structures of the macula and choroid by using OCTA and EDI-OCT.

Methods: This prospective cross-sectional study included 34 individuals with vitamin B12 deficiency and 36 healthy participants as the control group. Macular vascular parameters, including superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular densities, and foveal avascular zone (FAZ) metrics, were measured using OCTA. The choroidal structure was assessed using EDI-OCT to calculate the total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI).

Results: Compared with the control group, patients with vitamin B12 deficiency showed significantly higher vascular densities in the SCP of the parafoveal superior quadrant, as well as in the DCP of the parafoveal superior hemi and superior quadrants (p = 0.03, p = 0.04, and p = 0.01, respectively). The remaining OCTA parameters did not exhibit any statistically significant variation between the groups. Choroidal assessment showed notable decreases in TCA, LA, SA, and central subfoveal choroidal thickness. Moreover, patients with vitamin B12 deficiency showed a significant increase in the CVI (all p ≤ 0.01).

Conclusion: Vitamin B12 deficiency is associated with complex alterations in macular and choroidal vascularity, including localised increased macular capillary densities and a paradoxical increase in the CVI despite decreased choroidal thickness.

Retinopathy of prematurity (ROP) is a vasoproliferative blinding disorder of the retina, unique to premature infants and a leading cause of preventable childhood blindness globally. Screening of premature babies aims to identify disease reaching a threshold for treatment needed in 6-10% of babies screened. Current screening criteria are based on birth weight (BW) and gestational age (GA) with an additional third criteria for babies deemed at risk by the neonatologist due to an unstable postnatal course or prolonged use of oxygen. These lack specificity and could potentially miss babies at risk. With increased survival rates of premature and extreme premature babies, ROP screening numbers are rising with associated clinical and economic burden. Several alternative algorithms have been proposed based on postnatal weight gain and in this review, the application and pitfalls of these will be discussed as well as the potential role of artificial intelligence in improving accuracy, efficiency, and equity in Australasia and low-middle-income countries.

Clinical relevance: Early diagnosis, close monitoring, and timely intervention in patients with unilateral primary angle closure disease is necessary to prevent visual loss due to glaucoma.

Background: The aim of this study is to investigate the biometric parameters of eyes in patients with asymmetric primary angle closure disease and to determine the biometric differences that can predispose to Primary Angle Closure Glaucoma (PACG).

Methods: This cross-sectional study included 224 eyes of 112 patients. Eyes with PACG were grouped as group A1 and fellow eyes of the same patient with either primary angle closure suspect or primary angle closure were grouped as group A2. Controls included healthy age and sex-matched patients with no evidence of glaucoma. These patients underwent clinical and ocular biometric measurements, including axial length, anterior chamber depth, lens thickness, and keratometry. Lens axial factor and relative lens position were calculated from the above ocular parameters. The differences in ocular biometric parameters between the cases and controls were compared and analysed.

Results: There was a significant difference in the mean anterior chamber depth between the cases. Relative lens position was found to be anterior in group A1 (0.220 ± 0.012) as compared to group A2 (0.223 ± 0.013), which was statistically significant (p = 0.002). There was no statistically significant difference in the mean axial length, mean lens thickness or mean lens axial factor in cases or controls.

Conclusion: In a patient with primary angle closure disease, a relative anterior placement of the crystalline lens may predispose the eye to earlier occurrence of glaucomatous damage.

Clinical relevance: Exposure to unregulated online content may impact health beliefs. Optometrists should be aware of these digital influences and incorporate targeted education strategies to promote eyecare practices.

Background: This study investigates the effect of user-generated YouTube content on knowledge and beliefs in safe lens practices, and addresses growing concerns about the quality of unmoderated online health information and its potential impact on lens usage behaviours.

Methods: Using a pre-post experimental design, contact lens wearers viewed selected YouTube videos about lens care. Participants were randomised to watch videos containing evidence-based contact lens advice, poor advice, or a control video. Measurements of knowledge and beliefs in the importance of contact lens care practices were assessed using questionnaires before and after video viewing.

Results: A total of 154 contact lens wearers who were university students living in Australia participated in the study. Pairwise pre-post comparisons revealed better knowledge in the correct information group (62 vs 74%, p = 0.01) with improved case and lens hygiene knowledge. Belief scores improved (68 vs 73%, p = 0.005) and this was driven by case hygiene domain (80 vs 91%, p < 0.001). There were no between-group differences for overall belief score, however case hygiene belief domain was higher in the correct video (91%) compared to the incorrect (81%, p = 0.001) and control (81%, p = 0.002) groups. After adjusting for co-variates, viewing the correct video remained predictive of beliefs. Lens wearing experience and better self-reported hygiene practices were associated with better knowledge and beliefs.

Conclusion: Viewing of videos with correct information increased belief in the importance of contact lens care, particularly case hygiene, while evidence for impact on knowledge was mixed. Contact lens prescribers need to be aware that successful interventions to improve contact lens care practices may be improved by video viewing but should also include active behavioural modification strategies.

Clinical relevance: Integrating axial and anterior-segment measures, along with quadratic prediction and odds-based models, can support diagnosis, risk stratification, and management.

Background: The aim of this work is to quantify the axial length (AL) - spherical equivalent (SE) relationship in Iraqi adults, assess sex differences within refractive categories, and develop prediction and risk models.

Methods: Cross-sectional study of 2,948 eyes (18-33 years) at a university eye-care clinic (Feb - May 2025). SE was measured by non-cycloplegic autorefraction (Nidek ARK-1) and AL by SS-OCT biometry (ZEISS IOL-Master 700). Refractive groups were emmetropia (-0.50 D < SE ≤ +0.50 D), mild myopia (-0.50 to -3.00 D), and moderate myopia (-3.25 to -6.00 D). Group differences were analysed with t-tests/ANOVA. Sex-stratified, within-category SE was examined with equivalence testing (TOST; ±0.25 D). Ordinary least-squares models predicted AL from SE and SE², and SE from AL and AL², adjusting for age and sex. Logistic regression mapped AL to odds of any myopia versus emmetropia and of moderate versus emmetropia plus mild; discrimination was evaluated by the ROC/AUC.

Results: Mean SE was +0.11 ± 0.29 D in emmetropia and -3.25 ± 1.67 D in myopia; mean AL 23.33 ± 0.60 mm and 26.03 ± 1.17 mm, respectively. AL differed across categories (p < 0.001). Females had longer AL within emmetropia (≈0.57 mm) and within mild - moderate myopia (≈0.70 mm; both p < 0.001), while SE was equivalent by TOST. The AL - SE association was range dependent: strong and negative in emmetropia/mild myopia (R² ≈ 0.83) and weaker in moderate myopia (R² ≈ 0.45). Quadratic models improved prediction (adjusted R² ≈ 0.936 for AL; ≈ 0.934 for SE; RMSE 0.42 mm and 0.54 D). Longer AL significantly increased the odds of myopia after adjustment.

Conclusion: AL closely tracks refractive status with range-dependent coupling. Females show longer AL without SE shifts, implying anterior segment compensation.