Ophthalmology最新文献

Purpose: Prevalence of myopia and vision impairment due to myopic macular degeneration and myopia-related optic neuropathies have markedly increased worldwide. We evaluated whether myopia is associated with other ocular disorders.

Design: Population-based studies conducted in Russia, China, and India.

Participants: The Russian Ural Eye and Medical Study (UEMS) and the Beijing Eye Study (BES) included 5899 individuals and 4439 individuals (all aged 40+ years), respectively, and the Central India Eye and Medical Study (CIEMS) consisted of 4711 individuals aged 30+ years. The studies were conducted in rural and urban regions in Bashkortostan/Russia, Nagpur/India, and Beijing/China.

Methods: The participants underwent a series of ophthalmological and general medical examinations.

Main outcome measures: Axial length as a surrogate for myopia and prevalence of diabetic retinopathy (DR), age-related macular degeneration (AMD), angle-closure glaucoma (ACG), and open-angle glaucoma (OAG).

Results: In the UEMS, DR prevalence (odds ratio [OR], 0.73), AMD prevalence (OR, 0.85), and ACG prevalence (OR, 0.72) decreased, and OAG prevalence (OR, 1.65) increased with longer axial length in multivariable analyses. In the CIEMS, lower AMD prevalence (OR, 0.81) and lower ACG prevalence (OR, 0.55), and higher OAG prevalence (OR, 1.45) were associated with longer axial length. Diabetic retinopathy prevalence (0.33%) was too low for statistical analysis in the CIEMS. In the BES, prevalence (OR, 0.64) and 10-year incidence of DR (OR, 0.48) and prevalence (OR, 0.83) and 5-year incidence of AMD (OR, 0.996) decreased, and prevalence (OR, 1.35) and 10-year incidence of OAG (OR, 1.40) increased with longer axial length. In all 3 studies, the association between higher OAG prevalence and longer axial length was nonlinear with a slight increase for the moderate myopia range and a steep increase in the highly myopic range.

Conclusions: Myopia is associated with a lower prevalence of DR, AMD, and ACG and a lower incidence of DR and AMD, whereas high myopia more than moderate myopia is associated with a higher prevalence and incidence of OAG. Future studies may assess whether in myopia (in particular, in moderate myopia), the myopia-related advantages, that is, lower prevalence of DR, AMD, and ACG, may outweigh the increased risks for OAG and other myopia-related disorders.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Topic: Development of evidence-based guidelines for keratorefractive lenticule extraction (KLEx).

Clinical relevance: KLEx refers to various corneal refractive procedures involving removal of refractive lenticules of intrastromal corneal tissue, typically through a small incision, thereby eliminating creation of a corneal flap. This technique has rapidly gained popularity as a possible alternative to flap-based procedures; however, no clinical practice guidelines exist for KLEx.

Methods: These evidence-based guidelines were developed following the WHO guidebook, utilizing the AGREE II tool, and adhering to the RIGHT statement. The body of evidence was drawn from eight literature databases, five clinical guideline databases, and two academic organizations. Recommendations were developed via a Delphi consensus of 44 global experts in refractive surgery, corneal diseases, retinal diseases, glaucoma, and optometry. The certainty of evidence, balance of benefits and harms, patient preferences and values, and economic evaluations were fully considered. The GRADE approach was employed to assess evidence quality and recommendation strengths.

Results: From 385 initial clinical questions, 15 were identified, prompting a review of 250,717 studies, with 609 included for conducting and updating 26 and 2 systematic reviews, respectively. Subsequently, consensus was reached on 38 recommendations for preoperative screening, candidate selection, intraoperative quality control, operating principles, postoperative monitoring, and complication management. For KLEx, an effective and accurate refractive correction is attributed to various factors such as corneal thickness, degree of myopia, treatment nomogram, and optical zone. For KLEx-related complications that could affect vision, comprehensive and effective management strategies were proposed, particularly for wrong-plane dissection and difficult lenticule removal, suction loss, and perioperative infection. Customized surgical planning protocols and operative techniques were analyzed. Among all recommendations, 29 (76%) were labelled as "strong", each externally reviewed. The assessment of corneal biomechanical properties may help improve safety and predictability, though needing further validation. The development process also revealed several research gaps for enhancing KLEx safety.

Conclusions: These guidelines provide evidence-based recommendations for KLEx in clinical practice, such as on preoperative screening for keratoconus, surgical planning, managements and prevention of complications and infection. The guidelines are expected to improve the safe and effective application of KLEx procedures and achieve more satisfactory visual correction.

Purpose: To determine the pattern(s) of onset, variation, and progression of retinopathy in patients with Mucopolysaccharidosis (MPS).

Design: Prospective, longitudinal, observational study.

Participants: Between November 2015 and March 2023, individuals with MPS were recruited from Ophthalmology clinics at the Manchester Royal Eye Hospital, United Kingdom.

Methods: Participants underwent assessment of visual acuity, corneal clouding, intraocular pressure, along with fundoscopy, ultra-widefield (UWF) colour fundus photography, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT), and electroretinography (ERG), where feasible.

Main outcome measures: Evaluation of findings from clinical examination, retinal imaging, and electroretinogram studies, to ascertain the presence and patterns of retinopathy.

Results: Data was collected for 75 patients, including 45 MPS I, 9 MPS II, 13 MPS IVA, and 8 MPS VI, aged 3-58 years. Fundus photography was conducted in 65 patients, FAF in 61, OCT in 58, and electrodiagnostic studies in 36 participants. Retinopathy was defined as signs of retinal disease evident through retinal examination or fundus photography such as depigmentation, bone-spicule pigmentation, vascular tortuosity, retinal pigment epithelium (RPE) mottling/other changes, macular atrophy/puckering/epiretinal membranes, FAF findings such as a central hyperautofluorescent dot, hyperautofluorescent parafoveal ring, hypoautofluorescent lesions around fovea (double bull's eye), areas of hyper/hypoautofluorescence, and extrafoveal changes, OCT imaging features such as central external limiting membrane (ELM) thickening, RPE disturbance, photoreceptor layer loss, parafoveal retinal atrophy, and outer retinal/intrachoroidal cavities, or electroretinogram studies revealing rod-mediated retinopathy or rod-cone dystrophy. Retinopathy was confirmed in 32 patients, including 25 MPS I, 4 MPS II, 1 MPS IVA, and 2 MPS VI. Five participants were first diagnosed with retinopathy with clinical examination, while 31 participants were identified on UWF colour fundus photography supported by FAF and OCT. 21 patients exhibited ERG abnormalities consistent with retinopathy. Fifteen of the total 32 participants described symptoms of nyctalopia. The onset of retinopathy varied substantially, with initial detection between 2 and 53 years of age.

Conclusions: MPS patients as young as 2 may develop retinopathy, diagnosed through fundus examination, ophthalmic imaging, or ERG. Emerging treatments, including gene therapy, may prevent or stabilise retinopathy. Phenotypic data and natural history of MPS-related retinopathy are thus of paramount importance.

Objective: School-based vision programs (SBVPs) deliver vision care services directly to students at school, helping address disparities in access to pediatric vision care. We aim to evaluate the associations between SBVP outcomes and school-level characteristics.

Design: Retrospective cross-sectional data analysis PARTICIPANTS: Public schools with at least 50 SBVP-enrolled students 5 to 22 years old with complete demographic data. Schools with fewer than 60% of total grade levels served by the SBVP were excluded, resulting in a sample of 410 schools.

Methods: Vision screening and eye exam data were extracted from Helen Keller International's United States Vision Program dataset from 2016 through 2022. Individual student data were aggregated to characterize each school's SBVP outcomes and analyzed with schools' publicly available socioeconomic and demographic data (student body race and ethnicity composition, proportion of students qualifying for free and reduced-price meals [FARM%], and proportion of English Language Learners). Descriptive statistics summarized SBVP outcomes. Fractional regression models were utilized to understand associations between SBVP outcomes and school characteristics.

Main outcome measures: SBVP outcomes were rates of vision screening failure, eyeglasses prescription, and community eye care referral among each school's SBVP-enrolled students.

Results: We evaluated 151 (36.8%) elementary, 155 (37.8%) middle, and 104 (25.4%) high schools, with a median FARM% of 87.4% and a plurality of Hispanic students in 61.0% of schools. Overall median rates of vision screening failure, eyeglasses prescription, and referral were 38.4%, 25.2%, and 5.4%, respectively. High schools were associated with increased screening failure and eyeglasses prescription rates and a decrease in referral rate, compared with elementary schools. In multivariate analysis, each 10% increase in FARM% was associated with a 2.6% (95% confidence interval [CI]: 1.54-3.65), 1.8% (CI: 0.87-2.74), and 0.86% (CI: 0.36-1.36) increase in screening failure, eyeglasses prescription, and referral rates, respectively.

Conclusions: There is significant vision care demand among public schools, especially those with student populations from lower socioeconomic backgrounds. SBVPs are important in bridging the gap in pediatric vision care access in such populations. Our findings demonstrated opportunities to allocate program staffing and equipment resources according to schools' anticipated needs, thus maximizing SBVPs' impact in delivering pediatric vision care.

Purpose: To determine the risk of uveitis among e-cigarette users METHODS: The TriNetX database was used to recruit adult patients with and without a history of e-cigarette usage. The primary outcome was the incidence of new-onset uveitis.

Results: E-cigarette users were associated with an increased risk for uveitis compared to non-users (HR: 2.53, CI: 2.33-2.76). Subgroup analysis revealed an increased risk of uveitis among e-cigarette users aged 18-39 years (HR: 2.59, CI: 2.11-3.17), 40-64 years (HR: 2.20, CI: 1.95-2.48) and ≥65 years (HR: 3.15, CI: 2.72-3.64).

Conclusions: An increased risk for uveitis was seen among e-cigarette users compared to non-users.