Ophthalmology and Therapy最新文献

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.

Introduction: Intact corneal sensation plays a vital role in maintaining ocular surface health. Various ocular surface pathologies can present with differing levels of decreased corneal sensation, while in some cases patients may instead experience heightened sensation. This study compared corneal sensitivity with the new quantitative non-contact esthesiometer (NCE, Brill, USA) and the conventional qualitative cotton wisp (CW) test in patients with ocular surface diseases (OSD).

Methods: A retrospective, cross-sectional study was conducted, including patients with OSDs, who had both CW and NCE test results available. Descriptive analysis of one eye per patient was performed to compare the distribution of patients according to NCE and CW responses.

Results: Of 139 eyes (n = 139 patients), 129 (92.8%) were CW+ and 10 eyes were CW- (7.2%). Among these, 111 eyes responded to levels 1-3 when assessed with NCE, with 38 (34.2%) responding to level 1, 45 (40.5%) to level 2, and 28 (25.2%) to level 3. However, of CW+ eyes, 10 (7.8%) responded to level 4 and 6 (4.7%) responded to level 5 of NCE, while 2 (1.6%) had no response to any NCE stimulation (i.e., level 6), indicating varying degrees of hyposensitivity not detected by CW. Of the 10 eyes (7.2%) that did not respond to CW (CW-), 3 responded to level 4, and one to level 5 of NCE, while 4 eyes (40.0%) failed to respond to NCE (level 6). Notably, two CW- patients responded to level 1 NCE, suggesting potential hypersensitivity. Results showed high sensitivity (98.2%, 95% CI 93.8-99.8%) but low specificity (30.8%, 95% CI 14.3-51.8%) of the CW test in patients with OSD when level 4 of NCE (i.e., levels 4, 5, and 6) was used as the cutoff for defining corneal hyposensitivity.

Conclusion: Our results demonstrate that the low specificity of the qualitative CW test, combined with a broad confidence interval, indicates a high likelihood of false-positive results. This suggests that a positive CW test may not reliably rule out hyposensitivity, underscoring the need for further evaluation in the setting of a positive CW test result.

Introduction: This study investigated the effectiveness, repeatability, and safety of retreatments with micropulse transscleral cyclophotocoagulation (MP-TSCPC).

Methods: A retrospective cohort study was conducted on 76 eyes of patients with glaucoma who underwent standardized MP-TSCPC at the University Eye Clinic Maastricht between November 2016 and February 2019. Patients with at least one retreatment and a follow-up of 6 months or more were included and divided into four groups on the basis of their response to the primary treatment: nonresponder (NR), early attrition (EA), late attrition (LA), and enhancement (EH). Intraocular pressure (IOP) and IOP lowering medication use were recorded, and complications were assessed. Treatment success was defined as an IOP reduction of ≥ 20% compared with baseline or a decrease in the number of IOP-lowering medications with stable target IOP.

Results: Three months after retreatment, the NR, EA, LA, and EH groups experienced significant IOP reductions of 24.7%, 35.3%, 24.7%, and 28.2%, respectively. Significant medication reduction was observed only in the EH group. At the last follow-up, treatment success was achieved in 39.4% (NR), 33.3% (EA), 41.7% (LA), and 60.0% (EH) of the patients. Among patients receiving a second retreatment, the EH group demonstrated the most favorable and sustained outcomes. Early postoperative complications after retreatment (5.26%) were mild and reversible. A late complication of persistent hypotony developed in one patient (1.3%). Additional glaucoma surgery was required in 28.9% of the eyes.

Conclusions: Retreatment with micropulse TSCPC is a safe and effective option for (further) lowering IOP in patients with glaucoma. Especially patients who responded well to the primary treatment and patients who initially showed a good response but in whom the effect of the primary treatment has worn off have shown to be good candidates for retreatment. Repeatability and treatment success are most evident in initial responders and the primary benefit of retreatment is IOP reduction, with a less consistent effect on reducing IOP lowering medications.

Introduction: To report the 1-year efficacy of Myofix Defocus spectacles, designed to control the progression of myopia in childhood.

Methods: A total of 47 children with myopia aged 7-15 years were enrolled. Cycloplegic objective refraction (spherical equivalent refraction, SE) and axial length (AL) were measured at baseline, 6 months, and 12 months. Linear regression models were used to identify risk factors of 12-month changes in SE and AL. For comparison, two virtual control groups of children were included. Tolerance was assessed through a questionnaire at each follow-up visit.

Results: Of the initial cohort, 11 participants were lost to follow-up after 6 months due to reasons unrelated to lens design (77.1% retention rate). Over 12 months, the mean SE change in all eyes was - 0.21 ± 0.30 D, and AL change was 0.19 ± 0.13 mm. Progression was significantly different in participants who reported good compared to poor compliance (p < 0.001). At the 12-month follow-up, participants with good compliance had a mean SE progression of - 0.12 ± 0.25 D and a mean AL change of 0.17 ± 0.11 mm. In virtual controls, the mean annual SE progression was - 0.47 ± 0.36 D, and AL change was 0.26 ± 0.17 mm (both p < 0.001). In compliant participants, Myofix Defocus lens demonstrated a 75% reduction in SE and 37% reduction in AL compared to virtual controls.

Conclusions: After 1 year, Myofix Defocus spectacles slowed myopia progression in children, demonstrating comparable efficacy to other defocus-incorporated spectacle designs. Greater compliance resulted in better treatment effect. Further long-term studies are warranted to confirm these findings.

Trial registration: ClinicalTrials.gov identifier: NCT07092072. Registered retrospectively on July 29, 2025.

Introduction: Anti-vascular endothelial growth factor (VEGF) therapy suppresses neovascularization in neovascular age-related macular degeneration (nAMD) but may reduce ocular blood flow. However, its relationship with choroidal thickness remains unclear. This study evaluated 1-month outcomes after switching from intravitreal aflibercept or ranibizumab to intravitreal brolucizumab (IVBr) in patients with refractory nAMD.

Methods: This prospective, single-center study included 50 eyes of 50 patients with nAMD. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), choroidal stromal area (SA), choroidal luminal area (LA), optic nerve head (ONH) mean blur rate (MBR), and choroidal (CHOR) MBR were evaluated before and 1 month after switching to IVBr, with blood flow measured using laser speckle flowgraphy. Univariate analyses were performed to identify potential predictors of changes in CHOR-MBR, and variables with P < 0.1 were entered into a multiple regression model.

Results: BCVA was maintained. CRT decreased from 371.6 ± 118.7 to 288.8 ± 89.7 µm (P < 0.001). SFCT decreased from 231.9 ± 118.7 to 196.0 ± 117.4 µm (P < 0.001). CVI showed no significant changes, while SA and LA exhibited significant reductions. ONH-MBR and CHOR-MBR decreased (P = 0.004 and P < 0.001, respectively). The baseline SFCT was the only significant predictor of change in CHOR-MBR. Older age correlated with thinner baseline SFCT and a greater decrease in CHOR-MBR.

Conclusions: IVBr is associated with significant reductions in CRT and SFCT and may decrease choroidal blood flow, particularly in older patients and those with thinner SFCTs.

Trial registration: UMIN-CTR Registration ID, UMIN000041382.