Ophthalmic and Physiological Optics最新文献

Purpose: The aim of this study was to investigate changes in the light-adapted (LA) electroretinogram (ERG) associated with paediatric amblyopia.

Method: A total of 220 eyes from 81 postoperative paediatric cataract patients and 29 healthy children were enrolled in four groups, namely controls, unilaterally amblyopic eyes, non-amblyopic fellow eyes and bilaterally affected eyes. Differences in LA ERG variables (peak time and amplitude of a- and b-waves and photopic negative response [PhNR]) were compared across groups, as well as their associations with visual acuity and changes in axial length.

Results: The peak time of both the a-wave (p < 0.001) and b-wave (p < 0.001), as well as the amplitude of the b-wave (p < 0.001) and the PhNR (p = 0.04) differed significantly across groups. Compared to controls, affected eyes in both unilateral and bilateral groups showed significantly lower b-wave amplitude and longer a- and b-wave peak times (p < 0.008, Bonferroni-corrected). Additionally, fellow eyes in the unilateral group exhibited significantly longer b-wave peak times (p = 0.008). For all eyes, poorer visual acuity was associated with a longer peak time for both the a- (p = 0.006) and b-waves (p = 0.003), as well as lower amplitudes of the b-wave (p = 0.006) and PhNR (p = 0.02).

Conclusions: Changes in LA ERG components suggest alteration of retinal physiology in deprivation amblyopia. Thus, the LA ERG may provide additional information to help understand the mechanisms underlying deprivation amblyopia.

Purpose: To assess the repeatability of lipid layer thickness (LLT) measurement using the LipiView® interferometer after daily disposable contact lens (CL) wear and correlation with ocular comfort in soft contact lens wearers.

Methods: A prospective study was conducted over two consecutive months, wherein CL wearers (n = 20) wore either Somofilcon A or Verofilcon A daily disposable CLs in a crossover design, switching lenses after 1 month. The pre-corneal tear film LLT was measured at the end of each month after CLs had been worn for at least 6 h. Using the LipiView® interferometer, three measurements of the LLT (average, maximum and minimum) were recorded. Subjects' symptoms were evaluated with the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and correlations sought between post-lens pre-corneal tear film LLT and symptoms.

Results: The average, maximum and minimum intraclass correlation coefficients (ICC) of LLT measurements at baseline were 0.57, 0.39 and 0.66, respectively, indicating poor (ICC < 0.4) to moderate (≥0.4, <0.75) repeatability. Coefficients of repeatability (CR) were 20.4, 24.8 and 20.8, respectively. After daily disposable CL wear, the ICC values were 0.66, 0.72 and 0.63 (indicating moderate repeatability), with CR values of 25.7, 32.0 and 23.3, respectively. Although all the ICC values of the pre-corneal LLT increased after daily disposable lens wear indicating improved repeatability, the CR values also increased, indicating larger spread of data. However, in both cases, these increases were not significantly different from baseline. There were no significant differences in pre-corneal LLT between the two lens types and no significant correlation with comfort scores (baseline: r = -0.11, p = 0.67; Verofilcon A lenses: r = 0.19, p = 0.45; Somofilcon A lenses r = 0.13, p = 0.62) for either lens.

Conclusions: The repeatability of average, maximum and minimum LLT measurements performed by LipiView remained stable during CL wear. There was no significant correlation between LLT and comfort scores.

Purpose: Myopia, a leading cause of correctable visual impairment, is projected to affect nearly 50% of the global population by 2050, posing a significant public health challenge. Understanding its prevalence and associated factors, particularly in children, is crucial for devising prevention and intervention strategies. This study aims to determine the proportion of myopia in school-aged children in Portugal and to examine the correlation between myopia occurrence and various environmental and genetic factors.

Methods: A cross-sectional epidemiological study was conducted on children aged from 5 to 17 years from nine schools in Lisbon, Portugal, between September 2020 and May 2021. It included optometric assessments to evaluate refractive status and binocular vision, as well as questionnaires about their lifestyles and parental myopia.

Results: Out of 1992 participants enrolled, 12.7% of the children were found to be myopic. The proportion of myopia increased with age and was higher in girls. A significant association was observed between myopia and parental history, with the likelihood being higher if one or both parents were myopic. Engaging in outdoor activities was associated with a lower likelihood of myopia.

Conclusions: The study found that 12.7% of the children in the study sample, aged 5-17 years, were myopic, indicating a significant association with familial history and limited outdoor activities. These insights highlight the need for targeted myopia screening and prevention strategies in the paediatric population.

Purpose: To investigate the influence of axial length on different ocular parameters and create a predictive tool for refractive error progression.

Methods: Two eye models were used to simulate refractive errors, namely the Liou-Brennan and the Goncharov-Dainty. Both models were simulated using Zemax OpticStudio. Simulations were made by varying axial length and central corneal radii of curvature, with values ranging from 21.5 to 28.5 mm and 7.0 to 8.5 mm, respectively. Additionally, simulations of different lens parameters were included.

Results: Refractive error maps were produced for different ethnicities and a comparison with experimental results was undertaken. These showed the relationships between axial length and crystalline lens thickness, refractive index and curvatures of the cornea and lens.

Conclusions: The concept of refractive error maps may provide more insight into the refractive state of individuals and groups with provision for a comparative analysis. With further experimental data added, such refractive error maps could be used as a predictive tool.

Purpose: To investigate changes in fluid reservoir turbidity parameters over time and its influence on visual performance in eyes with ocular surface disorders (OSD) wearing scleral contact lenses (SL).

Methods: Thirteen eyes with OSD were assessed for corrected distance visual acuity, contrast sensitivity (CS) and fluid reservoir turbidity using anterior segment optical coherence tomography at baseline, after 5 min and 0.5, 1, 2, 3 and 4 h of SL wear on day 1 and after 1 month.

Results: A significant reduction in CS was noted at 0.5, 1, 2, 3 and 4 h of SL wear compared to 5 min (p < 0.001) and a similar trend was noted after 1 month (p < 0.001). The average number of particles on day 1 showed a significant increase over 4 h of SL wear (p < 0.001), with a same trend noted at 1 month (p = 0.001). However, the percentage of particles decreased from 88% ± 4% to 75% ± 12% (p = 0.004) after 1 month of SL wear. Average particle size showed a significant increase at all time points over 4 h compared with 5 min of SL wear (p < 0.003) and after 1 month (p < 0.001). The percentage of average particle size decreased from 73% ± 9% to 67% ± 8% after 1 month of lens wear (p = 0.003). The mean percentage turbid area increased from 0.6% ± 0.5% to 24% ± 16% over 4 h of lens wear on day 1 (p < 0.006) and from 0.7% ± 0.5% to 11% ± 8% at 1 month (p = 0.001). The mean difference in percentage turbid area at the first and follow-up visits decreased from 96% ± 3% to 89% ± 9% (p = 0.01).

Conclusions: A gradual increase in fluid reservoir turbidity parameters was noted with the reduction in CS; however, all these parameters improved after 1 month of SL wear.

Purpose: The Predicting Myopia Onset and progression (PreMO) risk indicator, developed using data generated from white children in the UK, incorporates age, spherical equivalent refraction (SER), axial length (AL) and parental myopia to stratify the likelihood of developing myopia. This study evaluated the PreMO's predictive accuracy using prospective datasets from independent samples of children in Hong Kong (HK) and an ethnically diverse cohort of children in the United Kingdom.

Methods: Non-myopic children (SER > -0.50 D) aged 6-8 and 9-10 years were scored using the PreMO risk indicator framework, integrating baseline cycloplegic SER, AL and parental myopia data. Scores were assigned risk categories as follows: 0 = no risk, 1-3 = low risk, 4-6 = moderate risk and 7-9 = high risk. SER at ≥15 years of age was used to define refractive outcomes as 'myopic' or 'not myopic'. PreMO's predictive accuracy was analysed via Receiver Operator Characteristic curves, with Youden's J-Index identifying the optimal risk score threshold. Sensitivity, specificity and area under the curve were determined and compared with those of singular predictors, that is, SER < +0.75 D and AL ≥ 23.07 mm at 6-8 years.

Results: In the cohort of children aged 6-8 years, a PreMO risk score ≥ 4 exhibited high sensitivity in predicting myopia onset in UK (0.97) and HK (0.94) children, with high specificity in UK (0.96) and moderate specificity in HK (0.64) children. In UK children aged 6-8 years, the PreMO outperformed singular predictors such as SER and AL. Among HK children aged 9-10 years, the PreMO score maintained high sensitivity (0.90) and moderate specificity (0.72).

Conclusions: A PreMO risk score ≥ 4 is a strong predictive indicator for future myopia onset, particularly in UK children. Despite high sensitivity in both UK and HK cohorts, specificity varied, indicating the need for contextual application of the tool, particularly in pre-myopic Asian children.

Purpose: To summarise pooled estimates of the efficacies of various myopia control interventions, as drawn from published meta-analyses.

Method: PubMed, SCOPUS and Web of Science were searched from inception to February 2024 for systematic reviews and meta-analyses reporting treatment effects of various myopia control strategies. The qualities of the included meta-analyses were assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2. An intervention was defined as having a clinically significant effect if it resulted in a change in spherical equivalent refraction (SER) of ≥0.50 D/year or axial length (AL) change of ≤-0.18 mm/year.

Results: A total of 38 studies were identified. The overall respective changes in SER and AL, mean difference (95% CI) were high-concentration (≥0.5%) atropine 0.67 D (0.58-0.77) and -0.24 mm (-0.36 to -0.11); moderate-concentration (>0.05% to <0.5%) atropine 0.48 D (0.34-0.62) and -0.23 mm (-0.27 to -0.19); low-concentration (0.01%, 0.025%, 0.05%) atropine 0.33 D (0.23-0.43) and -0.14 mm (-0.19 to -0.09); orthokeratology -0.47 mm (-0.66 to -0.28); peripheral plus soft contact lenses 0.30 D (0.18-0.42) and -0.35 mm (-0.62 to -0.08); peripheral plus spectacles 0.77 D (0.40-1.14) and -0.43 mm (-0.78 to -0.08); multifocal spectacles 0.21 D (0.11-0.31); repeated low-level red light therapy 0.55 D (0.46-0.65) and -0.25 mm (-0.29 to -0.20); outdoor time 0.17 D (0.16-0.18) and -0.04 mm (-0.06 to -0.01).

Conclusion: High and moderate concentrations of atropine, orthokeratology, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing AL elongation, while high and moderate concentrations of atropine, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing SER progression.

Purpose: Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England.

Methods: Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight-tests for all contractors within each IMD decile calculated, allowing rate of sight-testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid-year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII).

Results: Overall, 12.94 million NHS sight-tests were provided by 5622 GOS contractors in England in 2022-2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight-tests, while in the most deprived decile, average NHS sight-tests per contractor was ~1100. Rate of sight-testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27-5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight-tests. Overall, SII and RII were 333.5 (95% CI 333.52-333.53) and 6.4 (95% CI 6.39-6.40), respectively, findings reflective of substantial inequality in uptake.

Conclusion: There remains substantial unwarranted variation in uptake of NHS sight-testing, with those in more affluent areas accessing sight-testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.

Introduction: To determine whether classification of accommodative insufficiency (AI) based on the subjective push-up test is indicative of reduced amplitude measured objectively.

Methods: Monocular subjective accommodative amplitude was measured in participants 7-24 years of age with the push-up test; a 0.9 mm letter was moved towards the eye until first sustained blur occurred. Monocular objective amplitude was measured with the same target and an autorefractor for demands from 2.5 to 30 D. The maximum response was termed the amplitude. Near point of convergence (NPC) was measured in a subset of participants. Participants were classified into groups using subjective amplitude: normal amplitude or AI (amplitude < ((15 - 0.25 × age) - 2)). Objective amplitude was plotted by age for each group and one-way ANCOVA used to evaluate differences while controlling for age. For NPC measures, a t-test compared the magnitude of the break between those with and without AI.

Results: Fifty-five of 185 participants were classified as having AI. Objective amplitude decreased with age (0.20 D/year) and there was no significant difference in the age-adjusted mean amplitudes for the two groups (AI: 7.62 D, CI = 7.19, 8.04; Normal: 7.86 D, CI = 7.58, 8.15; p = 0.11). For the subset with NPC measures, participants classified as having AI had significantly more receded break values than those without AI (7.7 ± 5 vs. 3.7 ± 3 cm, p < 0.001).

Conclusions: Factors other than accommodative ability may be contributing to lower subjective amplitude findings in individuals meeting the criterion for AI.