Ophthalmic and Physiological Optics最新文献

Purpose: The objective was to predict proliferative diabetic retinopathy (PDR) in non-Hispanic Black (NHB) and Latino (LA) patients by applying machine learning algorithms to routinely collected blood and urine laboratory results.

Methods: Electronic medical records of 1124 type 2 diabetes patients treated at the Bronxcare Hospital eye clinic between January and December 2019 were analysed. Data collected included demographic information (ethnicity, age and sex), blood (fasting glucose, haemoglobin A1C [HbA1c] high-density lipoprotein [HDL], low-density lipoprotein [LDL], serum creatinine and estimated glomerular filtration rate [eGFR]) and urine (albumin-to-creatinine ratio [ACR]) test results and the outcome measure of retinopathy status. The efficacy of different machine learning models was assessed and compared. SHapley Additive exPlanations (SHAP) analysis was employed to evaluate the contribution of each feature to the model's predictions.

Results: The balanced random forest model surpassed other models in predicting PDR for both NHB and LA cohorts, achieving an AUC (area under the curve) of 83%. Regarding sex, the model exhibited remarkable performance for the female LA demographic, with an AUC of 87%. The SHAP analysis revealed that PDR-related factors influenced NHB and LA patients differently, with more pronounced disparity between sexes. Furthermore, the optimal cut-off values for these factors showed variations based on sex and ethnicity.

Conclusions: This study demonstrates the potential of machine learning in identifying individuals at higher risk for PDR by leveraging routine blood and urine test results. It allows clinicians to prioritise at-risk individuals for timely evaluations. Furthermore, the findings emphasise the importance of accounting for both ethnicity and sex when analysing risk factors for PDR in type 2 diabetes individuals.

Purpose: This investigation examined the image and vision quality of two commercially available daily disposable myopia control soft contact lenses.

Methods: Wavefront errors were measured with an SHS Ophthalmic aberrometer for two myopia control soft contact lenses: a coaxially designed dual-focus lens (omafilcon A, CooperVision MiSight® 1 day, MS1d) and a design employing multiple add powers that included non-coaxial optics in annular add zones (senofilcon A, Johnson & Johnson Vision ACUVUE® Abiliti™ 1-Day, AB). Geometric optics ray tracing generated point-spread functions and wave optics were used to compare modulation transfer functions (MTFs) and simulated letter images. Twenty-six myopic children completed a randomised, non-dispensing, contralateral double-masked clinical trial. After 1 h of wear, right and left eye visual acuity (VA), subjective vision quality and lens preference (Likert) were assessed while viewing monocularly.

Results: The lens containing non-coaxial optics employed a small central zone with approximately +10.00 D of added power and two annular rings with a power gradient typical of non-coaxial optics. The coaxial design contained a centre zone with a distance correction and two annular zones with a fixed add power of approximately +2.00 D. MTFs and simulated images were better with small pupils, which was most noticeable with the coaxial design. Distance VA was -0.02 ± 0.04 with MS1d and 0.09 ± 0.08 with AB, p < 0.01. The majority of participants (77%) reported a preference for one lens; 54% preferred the MS1d and 23% preferred the AB lens.

Conclusions: Myopia control contact lenses employing coaxial or a mixture of coaxial and non-coaxial optics both reduced retinal image contrast but successfully imaged high spatial frequencies and provided high quality of vision. Image and vision quality were slightly superior in the lens employing coaxial optics alone.

Aim: To evaluate the repeatability of pupil size measurements obtained with four different devices under varying lighting conditions and to assess the agreement between them.

Methods: This prospective study included 80 healthy participants with a mean age of 27.5 ± 8.8 years (range 19-58). Pupil size was measured under mesopic (4 lux) and low photopic (50 lux) conditions using two open-field devices (tabletop and handheld PowerRefractors) and two closed-field devices (MS-39 and NIDEK Tonoref III). Three consecutive measurements were taken per eye for each device. Repeatability was analysed using the repeatability limit (R Limit), while the agreement was assessed with Bland-Altman analysis.

Results: All devices demonstrated R Limits lower than 1 mm under both low photopic and mesopic conditions. The NIDEK Tonoref III had the best repeatability under low photopic conditions (R Limit = 0.52 mm), while the tabletop PowerRefractor had the best R Limit under mesopic conditions (0.68 mm). The agreement analysis under mesopic conditions revealed smaller mean differences and narrower limits of agreement (LoA) (approximately 2 mm) among devices with similar designs (tabletop with handheld PowerRefractor and MS-39 with NIDEK Tonoref III), while combinations of designs exhibited wider variability. Mesopic conditions yielded more consistent LoA across all device pairs.

Conclusions: All devices showed excellent repeatability. Instruments with similar measurement designs demonstrated better agreement, particularly under low photopic conditions. Significant variability existed when comparing open- and closed-field devices. These findings underscore the importance of selecting appropriate instruments for clinical and research applications, and highlight the need for further validation of pupillometry devices.

Purpose: Spectacle lenses with highly aspherical lenslets (HAL) have been shown to slow myopia progression and axial length (AL) elongation effectively. The effects of HAL on peripheral eye length (PEL) and peripheral refraction (PR) were investigated in children who continued wearing HAL or switched from single-vision spectacle lenses (SVL) or spectacle lenses with slightly aspherical lenslets (SAL) to HAL.

Methods: Fifty-two participants who had worn HAL for 2 years continued their use (HAL group), while 51 and 48 participants who had originally worn SAL or SVL for 2 years switched to HAL (SAL-HAL and SVL-HAL groups, respectively) in Year 3. A new SVL group of 56 participants, 10-15 years of age, was enrolled in Year 3 (new-SVL group). PEL and PR were measured every 10° from 30° nasal to 30° temporal and from 30° superior to 10° inferior retina.

Results: There were significant differences in the changes in AL and PEL on the temporal side among the groups (all p ≤ 0.001). All three HAL groups exhibited less elongation than the new-SVL group. PR changes in the parafoveal temporal (p = 0.002) and superior (p = 0.001) regions differed among the groups; the new-SVL group progressed more than the other three groups. The AL in the new-SVL group exhibited greater elongation than the PEL (all p < 0.02). However, there were no significant differences between the AL and PEL changes in the three HAL groups (all p > 0.05).

Conclusions: Compared with wearing SVL, switching to or continuing to wear HAL could slow central and temporal elongation of eye length. Wearing HAL could impact retinal steepness and symmetry.

Purpose: Early detection of myopia is essential to delay its onset and progression. Pre-myopia, defined by an inadequate hyperopic reserve, increases myopia risk in childhood. However, effective screening methods remain limited. This study aimed to develop practical non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-olds to support earlier interventions.

Methods: This cross-sectional study of 621 Irish schoolchildren (mean age: 7.12 ± 0.45 years; 51.8% boys) assessed uncorrected distance visual acuity (UDVA). Cycloplegic spherical equivalent refraction (SER) classified refractive status (myopia: SER ≤ -0.50D; pre-myopia: SER > -0.50 ≤ 0.75D). Pre- and post-cycloplegic SER were measured using the Welch Allyn Spot Vision Screener and Dong-Yang Rekto-ORK 11, respectively. Axial length (AL) and corneal radius (CR) were measured with the Zeiss IOLMaster and parental myopia history via questionnaire. Logistic regression and ROC curves evaluated non-cycloplegic screening methods.

Results: Pre-myopia prevalence was 24.3% (95% confidence intervals (CI): 29.3-36.2), and myopia prevalence was 3.3% (CI: 2.5-5.5). UDVA screening had an area under the curve (AUC) (CI) = 0.72 (0.59-0.86) and 0.42 (0.36-0.47) for detecting myopia and pre-myopia, respectively. For pre-myopia discrimination, non-cycloplegic SER, AL, AL/CR and parental myopia had AUCs of 0.67 (0.62-0.72), 0.67 (0.62-0.72), 0.69 (0.64-0.74) and 0.59 (0.53-0.64), respectively. The best method combined non-cycloplegic SER and AL/CR (AUC = 0.72 (0.67-0.76)). Including UDVA or parental myopia did not improve results. For myopia detection, AUCs were non-cycloplegic SER:0.84 (0.72-0.97), AL:0.88 (0.82-0.95), AL/CR:0.84 (0.75-0.94) and parental myopia:0.62 (0.48-0.75). The best method combined AL and non-cycloplegic SER 0.94 (0.90-0.99). Adding parental myopia did not improve the AUC = 0.93 (0.87-0.99) but adding UDVA achieved an AUC = 0.95 (0.90-0.99).

Conclusion: While UDVA alone provided acceptable discrimination for myopia, it was insufficient for screening pre-myopia. Non-cycloplegic SER alone had relatively poor discrimination for pre-myopia, but its performance improved when combined with the AL/CR ratio. The best results for myopia discrimination were achieved by combining non-cycloplegic SER, axial length and UDVA measures.

Purpose: This three-dimensional study investigated how different contact lens materials affect oxygen levels in the cornea. Specifically, it measured oxygen tension, flux and consumption in the epithelium, stroma and endothelium when exposed to various contact lenses. The goal was to understand how oxygen distribution within the cornea changes based on the oxygen tension at the cornea-tear interface, which is influenced by the lens's oxygen transmissibility.

Methods: To achieve this goal, a finite element analysis model was used that accounted for the axisymmetric properties of the cornea. A parametric analysis was conducted to examine how lens power and refractive index impacted oxygen distribution. This involved testing various contact lens materials with different powers (±3 and ±6D) and refractive indices.

Results: This three-dimensional model provides new insights into the flux and concentration profiles of oxygen across the epithelium, stroma and endothelium for contact lenses having different optical powers. The key findings show that contact lens thickness and refractive index, which are related to the power, significantly impact oxygen concentration within the cornea. Notably, reduced corneal oxygen consumption occurs primarily at the epithelium, where oxygen tension decreases under both open-eye and closed-eye conditions. This decrease depends on the oxygen permeability of the contact lens being worn and its power.

Conclusions: The cornea can sustain normal metabolic processes (aerobic metabolism) if the oxygen levels at the cornea-tear film interface are within approximately 60-100 mmHg. This holds true for all of the contact lenses tested here under open-eye conditions. However, when the eyes are closed, the cornea is unable to maintain normal metabolic processes, leading to a shift towards anaerobic metabolism. Prolonged exposure to these conditions can cause corneal oedema (swelling) due to an inadequate oxygen supply.

Purpose: To examine glaucoma practice patterns in Australia, focusing on visual field test uptake and antiglaucoma drug prescribing by optometrists and ophthalmologists.

Design: A serial cross-sectional study was conducted to describe visual field testing charges and compare them to changes in comprehensive eye examination charges, as well as to analyse Pharmaceutical Benefits Scheme (PBS) items for antiglaucoma prescriptions.

Methods: The study utilised Medicare Benefits Schedule (MBS) reimbursements for visual field testing from January 2003 to December 2022, along with PBS prescriptions for antiglaucoma drugs by optometrists and ophthalmologists from January 2008 to December 2022.

Results: From 2003 to 2022, rates of visual field testing per 100,000 population in Australia showed a consistent increase, except for a decline in 2020 due to COVID-19 lockdowns, particularly in Victoria. Optometry surpassed ophthalmology in conducting visual field tests in 2009. Prescription rates for antiglaucoma medications rose significantly from 2009 to 2022, following their inclusion in the optometric PBS, with prostaglandin analogues being the most prescribed. During the 2020 lockdowns, visual field testing decreased while antiglaucoma prescriptions remained stable.

Conclusions: The increase in visual field testing and antiglaucoma drug prescriptions underscores the expanding role of optometrists in glaucoma management in Australia. This rise has not impacted ophthalmology prescriptions, suggesting that the growing scope of optometric practice effectively reaches a broader patient population, especially amid the public health crisis of undiagnosed glaucoma.

Purpose: This study aimed to compare corneal aberrations and anterior segment parameters in preterm children, aged 4-8 years, with or without a history of retinopathy of prematurity (ROP).

Methods: A comparative cohort study was conducted using corneal tomography to analyse anterior segment parameters in preterm children. Four groups of children were included (n = 30 in each group): children with a history of ROP who were treated with intravitreal bevacizumab, children whose ROP regressed spontaneously and received no treatment, preterm children without ROP and age- and gender-matched full-term children.

Results: A total of 120 eyes from 120 children with a mean age of 6.63 ± 1.25 years were analysed. Mean anterior corneal curvature was significantly steeper in the treated ROP, spontaneously regressed ROP and preterm (no ROP) groups compared with full-term children (p < 0.001, p = 0.001 and p = 0.04, respectively). Similarly, posterior corneal curvature was steeper in these same groups compared with full-term children (p < 0.001, p < 0.001 and p = 0.007, respectively). Further, the treated and spontaneously regressed ROP groups exhibited narrower iridocorneal angles compared with full-term children (p = 0.02 and p = 0.002, respectively). Higher order aberrations of the anterior cornea and trefoil of the total cornea were elevated in the treated ROP group compared with preterm children (both p = 0.02). Posterior spherical aberration was significantly higher in the spontaneously regressed ROP group compared with full-term controls (p = 0.02).

Conclusion: Preterm children, regardless of their ROP status, demonstrated steeper anterior and posterior corneal curvatures than full-term children. Children with a history of ROP also exhibited narrower iridocorneal angles and increased corneal aberrations.