Ophthalmic and Physiological Optics最新文献

Purpose: To examine the influence of aperture size (corneoscleral data coverage) on extrapolated scleral sagittal height data generated by the Pentacam HR derived from the Corneo Scleral Profile (CSP) software, by comparing measurements obtained during natural and retracted eyelid positions.

Methods: Corneoscleral topography of the left eye of 20 young (age: 22 [3] years) healthy adults with normal corneas was measured using the Pentacam HR CSP with the eyelids in their natural primary gaze resting position and during eyelid retraction with a wire speculum. The measured and extrapolated sagittal height data were exported from the instrument and analysed over a range of chord diameters (10.0, 12.5, 15.0 and 17.5 mm) and locations (superior, inferior, nasal and temporal) using customised software.

Results: Eyelid retraction increased data coverage (% of available data points within 360°) for the 12.5 and 15.0 mm chord diameters (by 25% and 35%, respectively, p < 0.001), but by less than 10% for the 10.0 and 17.5 mm chord diameters. Significant differences in extrapolated sagittal height data were observed between the natural and retracted eyelid positions with respect to chord diameter and location (both p < 0.001), with the greatest difference observed superiorly for a 17.5 mm chord diameter (mean extrapolated sagittal height difference, retracted minus natural: -447 ± 401 μm, p < 0.0001).

Conclusions: Eyelid retraction substantially increased data coverage for the 12.5 and 15.0 mm chord diameters. Significant differences in the extrapolated sagittal height data generated from measurements obtained during natural and retracted eyelid positions were observed for the superior location (12.5, 15.0 and 17.5 mm chord diameters) and inferior and nasal locations (17.5 mm chord diameter). Extrapolated sagittal height values obtained during the natural eyelid position were typically greater than those obtained with eyelid retraction, most likely due to the amount of measured data available for extrapolation.

Purpose: To investigate seasonal variations in changes of axial length (AL) among myopic children wearing orthokeratology (ortho-K) lenses.

Methods: The data of 600 children receiving ortho-K treatment, aged 7-13 years, were collected retrospectively. Data were classified as 'summer' or 'winter' based on the midpoint of the 6-month period between visits. For each interval, AL from the right eye was used for statistical analysis. Paired sample t-tests were used to compare the seasonal differences in AL. Furthermore, the relationship between seasonal differences in AL, age and initial AL was analysed using Pearson correlation and multiple regression analysis, respectively.

Results: The AL at 1 year after the initial ortho-K treatment was 24.96 ± 0.85 mm, representing an increase of 0.19 ± 0.15 mm. The semi-annual axial elongation was 0.07 ± 0.09 and 0.12 ± 0.09 mm for the summer and winter, respectively (p < 0.001). Linear regression analysis revealed that the control of axial growth in the summer was better than in the winter (β = -0.05, p < 0.001). A similar seasonal pattern was found among children aged 7-12 years as well as for those with an initial AL < 26 mm (but not in children aged 13 years).

Conclusions: The inhibition of axial growth by ortho-K treatment in the summer months is superior to that seen in the winter. Seasonal differences decrease with age and the initial AL.

Purpose: To investigate the repeatability of optical coherence tomography angiography (OCTA) parameters in participants with different severities of glaucoma.

Methods: Subjects with open-angle glaucoma were enrolled prospectively and categorised into mild (mean deviation [MD] of 24-2 visual field test ≥ -6 dB), moderate to advanced (-6 > MD ≥ -20 dB) and severe glaucoma groups (MD < -20 dB). OCTA was performed three times within a single visit to obtain superficial and deep macular vessel density (VD) and peripapillary vessel and capillary density. The association between the coefficient of variation (CoV) and intraclass correlation coefficient (ICC) of these OCTA parameters and glaucoma severity (MD, the thickness of the retinal nerve fibre layer and the ganglion cell complex) was analysed, along with factors associated with the CoV of OCTA parameters.

Results: A total of 57 mild, 92 moderate to advanced and 39 severe glaucomatous eyes were included. CoV for superficial (p < 0.001) and deep macular VD (p < 0.001) and peripapillary VD (p = 0.004) increased with glaucoma severity. Greater CoV for superficial and deep macular VD and peripapillary VD was associated with worse MD and scan quality index in multivariable analysis. The association between a higher CoV of superficial and deep macular VD and worse MD was only noticeable in participants with a scan quality index <7. The relationship between the CoV of peripapillary VD and MD was consistent across varying image qualities.

Conclusion: The intrasession variability of OCTA parameters was greater in glaucoma participants with advanced disease, especially in those with suboptimal scan quality.

Purpose: Wearable electronic low vision enhancement systems (wEVES) improve visual function but are not widely adopted by people with vision impairment. Here, qualitative research methods were used to investigate the usefulness of wEVES for people with age-related macular degeneration (AMD) after an extended home trial.

Methods: Following a 12-week non-masked randomised crossover trial, semi-structured interviews were completed with 34 participants with AMD, 64.7% female, mean age 80.2 (±6.0) years, mean distance visual acuity 0.81logMAR (±0.32). Reflexive thematic analysis was used to analyse the data.

Results: Four themes were developed: (i) early positivity and potential; (ii) you're not good enough: performance barriers of the device; (iii) you're annoying: practicality barriers of the device and (iv) we can fix this together. First, participants expressed joy in an aesthetically appealing device perceived as potentially enabling, different and complementary to their current solutions. Imagined usefulness included not only reading, shopping and television but also resuming abandoned hobbies. The second theme captured performance barriers that restricted numerous activities but were most acutely noted with manipulation tasks. Barriers included image quality, screen size and short-lived adverse effects. The third theme conveyed the multiple practical challenges that caused annoyance, preventing imagined usage even when performance appeared superior to other solutions. Slow start-up times and the inability to use wEVES dynamically prevented integration within users' lifestyles. The final theme reflected that wEVES remained a desirable concept, but future iterations require inclusive design methodology to ensure development is directed by consumers' needs.

Conclusions: Performance and practicality barriers limit the usefulness of a device initially seen as desirable. Current devices do not align with users' requirements for flexible use, even when performance is good. Improvements in technology may solve performance barriers, but these changes must be inclusively designed and evaluated to ensure the device integrates more successfully into the lives of users with AMD.

Purpose: Little is known about the quality of optometrists' referrals to secondary care for neovascular age-related macular degeneration (nAMD), despite the need for timely intervention. We analysed the content and accuracy of optometrists' referrals for nAMD. Adherence to UK National Institute for Health and Care Excellence (NICE) guidelines and the impact of the COVID-19 pandemic were assessed as secondary measures.

Methods: Optometric referrals to a specialist macular treatment centre in Bradford, United Kingdom, between March 2019 and March 2021 were retrospectively analysed and compared with subsequent electronic medical records. Data were extracted on legibility, reason for referral, patient and optometrist demographics, visual acuity, reported signs and symptoms, patient diagnosis and patient outcomes. Binomial logistic regression models were constructed to determine whether signs or symptoms noted in the referral were associated with subsequent nAMD diagnosis in secondary care and whether optometrist gender or experience influenced nAMD referral accuracy.

Results: Across all 394 referrals analysed, 256 were for nAMD. Referral accuracy for nAMD was 39.8% (95% CI [34.0%, 45.9%]), with the most common reason for misdiagnosis being dry AMD. However, 76.8% of patients referred for suspected nAMD were either treated in secondary care or observed over multiple visits. 20% of suspected nAMD patients were seen within the NICE recommended 14-day window pre-COVID, dropping to 5% during the pandemic (p < 0.001). Visual acuity was most strongly associated with nAMD diagnosis (χ²(1) = 13.71, p < 0.001) followed by macular haemorrhage (χ²(1) = 5.89, p = 0.02). Neither optometrist gender nor experience was significantly associated with confirmed nAMD. Legibility of referrals was 91-95% for patient details and 94-97% for the referring optometrist.

Conclusions: Although the overall quality and legibility of optometrists' macular referrals to secondary care were of a high standard, the diagnostic accuracy of nAMD was below 40%. Referred visual acuity was the main sign/symptom associated with confirmed nAMD diagnosis.

Purpose: To examine the developmental patterns of refractive error and optical components in hyperopic children with infantile (onset ≤12 months of age) accommodative or late-onset (18-48 months of age) accommodative esotropia.

Methods: This prospective longitudinal study included children with infantile (n = 34) or late-onset (n = 63) accommodative esotropia. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and keratometry (K1, K2) were obtained with a Lenstar LS 900. Lenstar measures were recorded <6 months after cycloplegic spherical equivalent refraction (SER) was derived. An initial examination was conducted at 5.8 ± 1.5 years of age, with a follow-up duration of 4.8 ± 0.8 years. A linear mixed-effects model was used to estimate the rate of individual development for each ocular component and SER, and to compare the two groups.

Results: All biometric components changed with age. The rates of change with age for SER and AL were significantly different between the infantile and late-onset groups (SER: -0.18 vs. -0.12D/year, p < 0.001; AL: 0.16 vs. 0.14 mm/year, p < 0.01). The rate of change with age of the AL/CR ratio was significantly different between the infantile and late-onset groups (0.019 vs. 0.016, p < 0.001). No significant differences in the rates of change in ACD, LT, K1 or K2 were identified.

Conclusions: Major ocular biometric components in children continue to mature in both infantile and late-onset accommodative esotropia. Annual change in axial length is smaller in late-onset accommodative esotropia than for infantile accommodative esotropia, consistent with less change in the SER with age.

Purpose: Low concentration atropine is an effective treatment to slow myopia progression and axial elongation and also reduces accommodation. On-axis ocular dimensions of the eye change during accommodation; hence, this study aimed to quantify the effect of 0.025% atropine eye drops on accommodation-induced changes in ocular biometry.

Methods: Twenty-eight myopic participants with a mean (SD) age of 17.0 (6.0) years (range: 8.0-25.5 years) and spherical equivalent refraction (SER) of -2.03 (1.05) D (range: -0.75 to -4.38 D) were enrolled. Baseline ocular biometry measurements of the left eye were captured using an optical biometer (Zeiss IOLMaster 700) for 0, 2, 4 and 6 D accommodation stimuli, presented via a Badal optometer. The accommodation response (AR) was determined using wavefront aberrometry (Imagine Eyes irx3) for the same accommodation stimuli and following cycloplegia using 1% tropicamide. Participants instilled 0.025% atropine eye drops nightly for 1 week in both eyes, and ocular biometry measurements were repeated on the day after the final atropine dose.

Results: Anterior chamber depth (ACD) and corrected vitreous chamber depth (cVCD) decreased, and crystalline lens thickness (LT), anterior segment length (ASL), crystalline lens centre position (LCP) and the AR increased significantly during accommodation (all p ≤ 0.009). Accommodation-induced changes in ACD and LT were reduced following 0.025% atropine use (both p ≤ 0.01), with significant pre- and post-atropine differences for the 4 and 6 D stimuli (all pairwise comparisons, p ≤ 0.004). On average, ACD, ASL and LCP increased, while cVCD, corrected axial length (cAL), and the AR decreased following 1 week of 0.025% atropine use (all p ≤ 0.002).

Conclusions: The AR and on-axis ocular biometric changes during accommodation were reduced following 1 week of 0.025% atropine use. These findings may have implications for the association between near work and myopia, and atropine's mechanism of action in humans.