Ophthalmology and Therapy最新文献

In this commentary paper, we discuss the potential of population health surveillance of retinal health in Denmark using optometrist-based opportunist retinal examination with tele-ophthalmology pathway. Using 12 months of data from 79 high-street optometrist stores, we imaged 355,818 unique individuals, which corresponds to 5.99% of the entire population of Denmark and equates to an average of 29,652 individuals each month, corresponding to 0.50% of the population. Coverage was highest among those aged 41-80 years, with coverage rates of between 8.17% and 8.68%. We also observed higher participation rates in female individuals (6.77%) than in male individuals (5.19%). Using Wilson score intervals with finite-population correction, we demonstrate that when such a large sample of the entire population is examined, prevalence estimates can be obtained with very narrow 95% confidence intervals. These results suggest that community imaging can provide stable, near real-time indicators of retinal disease at the population level. Selection bias is discussed to understand the limitations of data.

Introduction: The Collaborative Normal-Tension Glaucoma Study (CNTGS) is frequently cited as evidence that a 30% reduction in intraocular pressure (IOP) slows progression in normal-tension glaucoma (NTG). This study re-examines the statistical methodology of CNTGS to assess how its conclusions are supported by the data.

Methods: This study reviews the CNTGS design with emphasis on survival analysis methodology, including the definition of time zero, censoring rules, and intention-to-treat (ITT) versus per-protocol comparisons. Particular attention is given to the post hoc redefinition of baseline and the handling of cataract-related visual decline, assessing their impact on the reported treatment effect.

Results: CNTGS shifted the analytical baseline for the treatment group to the point of IOP stabilization, thereby excluding early progression events and introducing immortal time bias. Additionally, cataract-related visual decline, more frequent in the treatment group, was censored rather than treated as a competing risk or time-dependent covariate. These methodological choices reduced the number of counted progression events in the treatment arm. Although the adjusted per-protocol analysis yielded a statistically significant treatment effect, this effect disappeared under the original ITT analysis, which included all randomized eyes from time zero and all progression events.

Conclusion: The potential treatment benefit reported in CNTGS depended largely on post hoc analytical modifications, whereas the original ITT analysis did not support a statistically significant effect of IOP reduction. These findings highlight the importance of transparent survival analysis methods and strict adherence to ITT principles in future NTG trials. Well-designed prospective studies that avoid immortal time bias and model treatment-related events appropriately are needed to clarify the true role of IOP reduction on NTG management.

Dry eye disease (DED) is a multifactorial and prevalent condition of the ocular surface that is associated with a wide range of risk factors. In the modern world, environmental conditions and pollution have become increasingly relevant contributors. Recent findings from the Tear Film & Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) highlight the contribution of oxidative stress, inflammatory cytokines, and neurosensory alterations to environmentally associated DED. This narrative, non-systematic review aims to synthesize current evidence on the impact of climate change and exposure to pollutants on the epidemiology, pathophysiology, and management of DED, with a particular emphasis on clinical practice. A targeted search of peer-reviewed literature was conducted in PubMed and Scopus, focusing on previous reviews and original human studies evaluating environmental exposures and DED, and findings were synthesized qualitatively due to heterogeneity in study design and diagnostic criteria. Environmental influences on the ocular surface encompass a wide range of factors, including climate conditions such as temperature, humidity, wind speed, altitude, dew point, ultraviolet radiation, and allergens, as well as exposure to air pollution from gases, particulate matter, volatile organic compounds, and other airborne contaminants. Individuals living in densely populated cities, industrial zones, and dry climates are at increased risk, and emerging challenges such as wildfires and desertification warrant increasing attention due to their rising global impact. Exposure to these agents may induce or exacerbate tear film instability, epithelial damage, immune dysregulation, and ocular surface inflammation. Although most available studies are cross-sectional or observational, and therefore limited in establishing causality, environmental exposures remain a key contributor to DED and can impair occupational performance, exacerbate pre-existing health conditions, and diminish overall quality of life. Comprehensive screening, environmental risk assessment, patient counseling, and personalized management strategies are essential to the prevention and management of DED in the face of accelerating environmental change.

Despite topical ocular hypotensive treatment and selective laser trabeculoplasty being the preferred first-line treatment modalities for lowering intraocular pressure, many patients require surgery for further controlling glaucoma progression. The XEN stent is a surgical device designed for the management of glaucoma where previous medical treatments have failed, offering greater predictability and fewer vision-threatening complications compared to trabeculectomy or tube shunts. This comprehensive and narrative review aims to assess different aspects related to XEN implant, including its efficacy, patient profile, surgical technique, and the identification of potential predictors of clinical outcomes. Additionally, this paper describes the most frequently reported adverse events associated with the XEN implant, with the objective of reducing their incidence through a comprehensive understanding of their underlying pathophysiology. Moreover, the authors draw on both existing literature and their clinical experience to provide recommendations for the optimization of the use of this implant.

Introduction: The aim was to assess the incidence of dry eye disease (DED) and determine the cut-off value for non-invasive keratography tear break-up time (NIKBUT) in patients of European descent with cataracts and without significant comorbidities and to test the diagnostic agreement between invasive and non-invasive protocols.

Methods: DED symptoms and signs were evaluated preoperatively, including the SPEED II questionnaire, fluorescein break-up time (FBUT), ocular surface staining (OSS), and NIKBUT first (NIKBUT-f) and average (NIKBUT-avg). DED diagnosis was based on a SPEED score > 5 and FBUT ≤ 5 s or OSS > 1. The receiver-operating characteristic curves were determined for NIKBUT's detection of DED. The established NIKBUT-f cut-off was used instead of FBUT for alternative DED diagnostic protocols.

Results: Out of 715 patients, 217 were eligible, with a mean age of 70.9 ± 7.9 years. Thirty per cent of patients manifested both signs and symptoms of DED; 21% had symptoms only and 22% signs only. Forty-five per cent of asymptomatic patients presented abnormal FBUT and/or OSS. FBUT was shorter than NIKBUT-f (p < 0.001, Wilcoxon) with a mean difference of 2.5 s and narrower limits of agreement for shorter BUT. The optimal diagnostic cut-off for NIKBUT-f was 7.3 s, with 69.7% sensitivity and 62.3% specificity. Replacing FBUT with the optimised NIKBUT-f threshold resulted in 2% false negatives and the highest (91%) agreement compared with other studied protocols. The fully non-invasive protocol based on SPEED and NIKBUT alone resulted in 9% of patients not being assigned to DED diagnosis.

Conclusions: To maximise the agreement with eye care professional diagnosis and to minimise the number of false negatives, it is recommended to decrease the standard NIKBUT-f cut-off value of 10 s for patients with cataracts. A fully non-invasive approach will result in fewer patients being referred for preoperative eye surface treatment. Ocular staining should not be omitted from the DED diagnosis.

Introduction: Diabetic retinopathy (DR) often causes vision loss and functional impairment. Standard low vision rehabilitation improves visual function but many patients cannot access it because of cost, travel, and limited specialist availability. We aimed to compare a home-based digital vision rehabilitation program to standard in-clinic rehabilitation in patients with DR.

Methods: We conducted a retrospective matched cohort study at a tertiary eye center in China. Adults with moderate to severe visual impairment from DR were included. A total of 380 patients were analyzed after 1:1 propensity score matching (190 per group). One group underwent a 12-week home-based digital physiotherapeutic vision training program delivered via a mobile app with daily exercises and weekly telehealth supervision, while the other group received standard in-person low vision rehabilitation over 12 weeks. The primary outcome was change in visual functional status measured by the Veterans Affairs Low-Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes included visual acuity, vision-related quality of life, depressive symptoms, mobility, metabolic control, and cost. Outcomes were assessed at baseline, 12, 24, and 48 weeks.

Results: Both the home-based digital training and standard in-clinic rehabilitation groups achieved substantial improvements in vision-specific functional status over 48 weeks. VFQ-48 scores increased by 22-26 points in each group, indicating clinically meaningful gains, and the digital program's improvement was comparable to standard care (demonstrating non-inferiority for the primary outcome). All secondary outcomes improved comparably in both groups, with no significant between-group differences. The digital intervention cost 7791 Chinese yuan (CNY) per patient over 48 weeks compared to 10,305 CNY with standard care, providing a net savings of 2514 CNY per patient. Both approaches were well tolerated, with no major safety concerns.

Conclusions: Home-based digital rehabilitation was non-inferior to standard in-clinic rehabilitation in improving functional vision, while substantially reducing costs and maintaining safety. These findings support implementing home-based or hybrid telerehabilitation models to broaden access to vision rehabilitation services.

Level of evidence: Level III retrospective cohort study.

No current treatments are curative for age-related macular degeneration (AMD), and preventing disease progression is challenging. Dietary factors play a role in the course of macular degeneration, and management of AMD commonly includes nutraceuticals (e.g., supplementation with a combination of antioxidant vitamins and minerals). This commentary summarizes the existing literature, emerging evidence, and upcoming research on the role of B vitamins in both preventing the development of AMD and slowing its progression.

Introduction: Patients frequently report visual sensations during ophthalmic surgery; however, data in uveitic eyes remain limited. Patients with Uveitis  represent a unique population group because of the chronic inflammatory course, systemic associations, and prolonged pharmacologic exposure, which may influence intraoperative perception and anxiety. This study aimed to characterize the nature and impact of intraoperative subjective visual experiences in patients with uveitis undergoing intraocular surgery or intravitreal injection and to evaluate the association of these experiences with uveitic activity, preoperative anxiety, and intraoperative physiological fluctuations.

Methods: This prospective cross-sectional observational study was conducted at a tertiary eye care hospital between June 2022 and July 2023. Seventy-six patients with uveitis undergoing anterior segment surgery, posterior segment surgery, or intravitreal injection were enrolled. Patients younger than 18 years, those requiring general anaesthesia, or with psychiatric/systemic disorders affecting perception were excluded. Demographic variables, uveitis type, systemic history, and visual acuity were recorded. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Intraoperative visual phenomena were evaluated postoperatively using a standardized questionnaire, while vital parameters (blood pressure, pulse rate, and SpO₂) were monitored throughout surgery.

Results: Among 76 patients (mean age 56 years; 48.7% male, 51.3% female), 60.5% underwent anterior segment surgery, 17.1% posterior segment surgery, and 22.3% intravitreal injections. All retained light perception intraoperatively. Common experiences included seeing colours (76.1% anterior; 61.5% posterior; 41.2% intravitreal), floaters (63%, 23%, 64.7%, respectively), and flashes (43.4%, 61.5%, 23.5%). Frightening perceptions occurred in 26.3% overall, significantly more in male patients (P = 0.008) and those with better preoperative visual acuity (P = 0.014). Notable intraoperative fluctuations were observed in systolic/diastolic blood pressure and pulse rate.

Conclusion: Patients with uveitis consistently experience intraoperative visual sensations irrespective of disease activity or surgical type. The occurrence of fear underscores the need for structured preoperative counselling, tailored anaesthetic management, and vigilant systemic monitoring to enhance patient comfort and surgical safety.

Trial registration no: CTRI/2022/07/043763.

Introduction: This study aimed to evaluate choroidal nevi (CN) volume as assessed by widefield optical coherence tomography (WF-OCT) and by ultrasound (US)-based mathematical approximations.

Methods: In a prospective, exploratory study, CN of consecutive patients were imaged with WF-OCT (VG 200D, Intalight Inc., San Jose, California, USA) and US (Quantel Absolu, Cournon, D'Auvergne Cedex, France). Volume was assessed by CN annotation on 64 B-scans on WF-OCT and two approximations based on US measurements (thickness, largest and perpendicular basal diameter (LBD; PBD)): (a) π/6 × thickness × LBD × PBD and (b) 2π/3 × [(LBD + PBD)/4]² × thickness.

Results: Eighteen nevi of 18 patients were included in the study. Mean volume evaluated on WF-OCT was 15.1 ± 24.1 mm³. US approximations resulted in (a) 23.0 ± 35.0 mm³ and (b) 23.5 ± 35.5 mm³. Intraclass correlation coefficients showed very good agreement between WF-OCT and US measurements (a) of 0.947 (CI 0.860-0.980) and (b) of 0.945 (CI 0.853-0.979). Stepwise backward elimination multivariable linear regression showed an association between difference of volume measurements and lesion thickness and LBD for approximations (a) and (b).

Conclusion: WF-OCT and US-based approximations show good interdevice reliability for CN volume in this exploratory study. Thickness and LBD have significant impact on discrepancy of volume measurements with a tendency that small CN are underestimated and large CN are overestimated with US. This potentially limits interchangeable use of US and WF-OCT.

Introduction: Despite refractive correction and patching, some patients have residual amblyopia. In the current study, we compared the effectiveness of daily 6-hours (6-h) intensive patching and a newly developed individualized and adaptive vision training (iAVT) protocol for residual amblyopia in children.

Methods: In a randomized clinical trial, 60 children aged 4 to under 11 years with residual amblyopia and visual acuity ranging from 0.2 to 0.8 logarithm of the minimum angle of resolution (logMAR) were assigned to receive either 50 sessions of iAVT training or 6 h of daily patching for 10 weeks.

Results: Visual acuity in the amblyopic eye improved more in the iAVT group than in the extended patching group (0.13 versus 0.07 logMAR; 95% confidence interval (CI) 0.010-0.100; p = 0.017) over 10 weeks. At 2 weeks, the iAVT group also showed a faster improvement compared with the patching group (0.09 versus 0.06 logMAR; 95% CI -0.004 to 0.067; p = 0.076). Meanwhile, no significant between-group difference was found in the area under the log contrast sensitivity function (AULCSF) change. However, the AULCSF of the iAVT group showed a marginally significant within-group improvement from base to week 10 (0.78 versus 0.89; 95% CI -0.225 to 0.001; p = 0.056), while no significant change was observed in the patching group. The iAVT group also reported higher quality-of-life scores after treatment, as monitored by the Pediatric Eye Questionnaire.

Conclusions: The iAVT provided a faster and more effective treatment for residual amblyopia compared with 6-h patching within the 10-week treatment period. These results suggest that iAVT may be an important new approach to treating residual amblyopia.

Trail registration: Chinese Clinical Trial Registry, ChiCTR2300075594. Registered on 8 September 2023-retrospectively registered.