Optometry and Vision Science最新文献

Significance: Perspectives on eye care barriers differ between low-income patients and vision care providers. Comparing these views provides valuable insight into strategies for addressing disparities in underserved communities, especially in regions with significant income inequality and opportunity gaps.

Purpose: The aim is to identify obstacles that prevent individuals who are unhoused, have low income, or are publicly insured in Santa Clara County from accessing basic refractive eye exams and corrective glasses.

Methods: Patients aged ≥18 years with low income presenting to a free vision care clinic in Northern California (n = 15) and vision care providers who primarily work with underserved patients in Santa Clara County, California (n = 11) participated in one-on-one phone interviews. Interviews were transcribed and analyzed.

Results: Most participants (87% patients and 82% providers) say that basic vision care (refractive eye exam and eyeglasses) in Santa Clara County is unaffordable and that in-person eye exams can be physically inaccessible (67% patients and 91% providers) due to busy work schedules or limited access to transportation. However, patient and provider perspectives on intrinsic barriers to accessing eye care diverge. In total, 73% of providers stated that limited health literacy contributed to lower utilization of routine vision care, while 47% of patients cited limited empathy from providers as responsible for their negative experiences and dissatisfaction with care.

Conclusions: In Santa Clara County, patients with low income and their providers both identify similar external barriers to basic vision care: high costs, inadequate insurance coverage, and limited services. However, patients and providers may disagree on intrinsic barriers to accessing care. Suggestions for improving access to vision care include more help from healthcare coordinators, better information about affordable services, improved vision insurance, and mobile healthcare options.

Significance: Our survey found that clinical imaging is widely utilized by many Australian eyecare practitioners for detecting and monitoring choroid nevus and highlighted knowledge gaps for risk factors and features of choroid nevus and early primary eye melanoma. Continuing education related to early detection could improve multidisciplinary management of these patients.

Purpose: The aim is to survey Australian primary eyecare practitioners on their management of patients with choroidal nevus.

Methods: A random sample of optometrists and ophthalmologists registered to practice in Australia was surveyed using a purpose-designed questionnaire including demographics, types of imaging techniques used, and practitioner choroid nevus knowledge (K), attitude (A), and practice (P).

Results: Ninety-three optometrists and 82 ophthalmologists responded. More than 50% practiced independently, most in metropolitan centers (n = 113/175). Multiple imaging techniques were used to detect and monitor choroidal nevus; >72% of practitioners routinely used optical coherence tomography and color fundus photography. KAP scores indicated moderate knowledge about choroid nevus risk factors and clinical features (mean = 5.2/9, standard deviation [SD] = 1.8). Clinical mnemonics that summarized signs of risk for nevus-to-melanoma transformation were used by <50% of practitioners overall. Scores indicated a very positive attitude to nevus management (mean = 6.5/8, SD = 1.2) but a moderate practice score (mean = 13.9/25, SD = 2.9). A significant difference between optometrists and ophthalmologists was found for knowledge, but not for attitude or practice scores. Choroid nevus patients were referred to a specialist ophthalmologist by ~30% of all practitioners.

Conclusions: The majority of Australian primary eyecare practitioners used multiple imaging techniques to detect and monitor choroidal nevi. There were, however, gaps in knowledge associated with identifying risk factors for choroidal nevus growth. Our findings align with recent UK studies that highlight the importance of diligent screening and review, timely referral for potential melanoma-related risks, and encourage multidisciplinary care for choroidal nevus patients.

Significance: Identifying potential modifiable risk factors for keratoconus progression is crucial for better outcomes. This study suggests that sleeping position may contribute to interocular asymmetry in keratoconus, providing an actionable target for patient education and clinical management and underscoring the importance of sleep posture in slowing disease progression.

Purpose: This study aimed to investigate whether the preferred sleeping position can contribute to interocular asymmetry of keratoconus.

Methods: A clinical cross-sectional study was conducted on 50 patients (100 eyes) with grade I and II keratoconus (Amsler-Krumeich) and 40 individuals (80 eyes) without keratoconus. Corneal tomographic parameters from the Galilei G6 (keratometry plus curve [Steep K], mean keratometry [Sim K], thinner corneal thickness, central corneal thickness, Cone Location and Magnitude Index, dioptric asymmetry between the inferior and superior corneal hemispheres, and vertical coma) were obtained to assess interocular asymmetry. All participants answered a questionnaire about their preferred sleeping position. The eye positioned lower during sleep has been referred to as the dependent eye, and the eye positioned higher was classified as the nondependent eye, regardless of the sleeping position (lateral or ventral).

Results: There were no significant differences between dependent and nondependent eyes regarding the evaluated tomographic variables among individuals without keratoconus. However, in individuals with keratoconus, statistically significant differences were observed between dependent and nondependent eyes for the following parameters: Steep K (47.89 vs. 45.78 D, p=0.0047), Sim K (46.54 vs. 44.42 D, p=0.0016); thinnest corneal thickness (445.84 vs. 460.34 μm, p=0.0057), central corneal thickness (463.03 vs. 477.6 μm, p=0.0125), vertical coma (-1.98 vs. -1.41 μm, p=0.0448), and total coma (1.60 vs. 1.22 μm, p=0.0495).

Conclusions: This study suggests that in individuals with keratoconus, the preferred sleeping position may contribute to keratoconus asymmetry in the dependent eye, regardless of whether the sleeping position is lateral or ventral.

Significance: School-based vision programs can improve children's access to vision care in underserved areas. Little is known about the need for eyeglasses among students not wearing them compared with the need for prescription updates. A greater understanding of prescription trends will help identify gaps in care and inform resource allocation.

Purpose: We aim to describe the baseline eyeglasses-wearing status and the need for new and updated eyeglasses prescriptions for students participating in a large school-based vision program.

Methods: This cross-sectional analysis examined retrospective data from the 2016-2022 operations of the Helen Keller Intl's United States Vision Program. Included students were pre-kindergarten to grade 12 and had received a school-based eye examination after a failed vision screening. Data extracted included student demographics, self-reported eyeglasses-wearing status, lensometer measurement, refractive error, and eyeglasses prescription. Multivariate logistic regression models were implemented to understand the factors associated with eyeglasses prescription and prescription change, defined as at least 0.50 D spherical equivalent change or 0.75 D cylindrical change between lensometer measurement and final prescription.

Results: Of the 97,069 students included in the analysis, 27.3% of students were self-reported current wearers of eyeglasses, 30.5% were inactive wearers of eyeglasses, and 42.2% were nonwearers. Overall, 72,784 (75%) students were prescribed eyeglasses. Among them, 48,600/72,784 (67%) were not current wearers. On multivariate logistic regression, students were more likely to be prescribed eyeglasses if they were in higher grade levels (grades 11 to 12 compared with grades 1 to 2, odds ratio: 2.39, 95% confidence interval: 2.17 to 2.64) and were current wearers (odds ratio: 8.82, 95% confidence interval: 8.24 to 9.43). Among current wearers, students with at least 6 D myopia and at least 3 D astigmatism had the greatest likelihood of spherical equivalent and cylindrical prescription change, respectively.

Conclusions: Within a large sample of students enrolled in a school-based vision program, more than half reported having eyeglasses. However, two in three students who needed eyeglasses were not wearing them. The need for eyeglasses was notable across all age groups, especially among higher grade levels and those with more severe refractive error. Most students who failed a vision screening while wearing eyeglasses needed an eyeglasses prescription update.

Significance: Abnormalities or irregularities in the cornea, whether it is from scarring or an ectatic disease like keratoconus can significantly affect vision. Correcting such eyes with rigid gas-permeable (RGP) contact lenses can help regularize the cornea and improve vision. However, some aberrations persist despite wearing the best RGP contact lens correction.

Purpose: This investigation looks into improving contact lenses by designing a customized mask on the contact lens plane. The image quality of keratoconic eyes can be improved by blocking light rays that stray too far from the best focus using a binary mask.

Methods: Corneal tomography and biometry data of 20 keratoconic SyntEyes were generated using a stochastic eye model and the best toric RGP contact lens corrections were calculated and applied to these eyes. Custom MATLAB software was used to perform ray tracing through the eye and determine ray coordinates on the retinal plane. Circular zones with radii of 0.015, 0.025, 0.05, and 0.1 mm were created on the image plane that acted as a virtual pinhole. Finally, masks in four regions were designed to block light rays that did not converge inside these virtual pinholes.

Results: A region 4 mask significantly reduces the average root-mean-square wavefront error from 1.82 ± 0.50 to 0.32 ± 0.06 µm ( t test, p<0.05), while blocking 53.87 ± 4.68% of the incoming light. For masks of regions 3, 2, and 1, the root-mean-square wavefront error increases to 0.51 ± 0.01, 1.25 ± 0.36, and 1.81 ± 0.50 μm, respectively, and the amount of blocked light decreases to 30.35 ± 5.09, 8.49 ± 3.70, and 0.47 ± 0.63%, respectively.

Conclusions: Contact lens masks designed to filter out skewed light rays can increase the image quality in contact lens-corrected keratoconic eyes, but this must be balanced with minimal light loss.

Significance: To determine basal tear-production rates from low tear-producing patients, we present a prewetted modified Schirmer's tear test (PW-MSTT). The improved method is an extension of the MSTT that provides a reliable method to investigate the relation between dry-eye symptoms and basal tear production rates.

Purpose: The MSTT quantifies basal tear-production rates from patients. However, the existing test does not allow measurement of basal tear-production rates from patients that do not wet past the 5-mm mark on the Schirmer strip within 5 minutes. We extended the MSTT with a prewetting technique to allow quantification of basal tear-production rates from patients that do not adequately wet the Schirmer strip within 5 minutes of strip insertion.

Methods: An in-vitro study was conducted with sheathed Schirmer strips to determine the volume of sterile nonpreservative saline solution necessary to prewet the Schirmer strip before insertion. This assessment determined that 1.6 µL of prewetting saline wets the Schirmer strip to 5.2 mm of the Schirmer strip, enough to allow basal tear production rate determination from subjects that do not adequately wet the Schirmer strip out to the 5-mm mark. Then, a clinical study was conducted with sheathed Schirmer strips with the prewetting technique to determine the basal tear-production rate from subjects that could not wet sufficiently to determine their basal tear-production rate.

Results: Eleven subjects completed the study; the basal tear production rates from these low tear-producing subjects were determined. The mean (SD) of the measured basal tear-production rate was 0.40 µL/min (0.28 µL/min) compared with normal subjects at 1.19 µL/min.

Conclusions: The developed PW-MSTT successfully quantifies basal tear production rates from subjects that do not adequately wet the Schirmer strip without the new prewetting technique. The determined basal tear-production rate from these low tear-producing subjects was three times less than that of those from a previous study where the subjects could adequately wet the Schirmer strip past the 5-mm line. Our improved methodology for low tear-producing patients sheds insight into how basal tear production rate is related to aqueous-deficient dry-eye symptoms.

Significance: Contact lens wettability is potentially correlated with friction, which is linked to lens comfort. However, measuring wettability can be highly variable. This study assessed wettability using three techniques for a more accurate profile.

Purpose: To evaluate the wettability of contemporary daily disposable contact lenses after 16 hours on an in vitro model using the sessile drop, captive bubble, and a novel in vit ro noninvasive keratograph breakup time (NIKBUT) method.

Methods: The wettability of six contemporary silicone hydrogel contact lens materials (verofilcon A, delefilcon A, senofilcon A, kalifilcon A, stenfilcon A, and somofilcon A) and two conventional hydrogel materials (nesofilcon A and etafilcon A) were evaluated using an in vitro blink model at t = 0 and 16 hours. The blink rates of the eye model were 20 blinks per minute. Sessile drop and captive bubble angles were analyzed using the Optical Contact Analyzer. NIKBUT was assessed on a blink model in combination with the OCULUS Keratograph 5M.

Results: There were no significant differences in wettability for any lens types between 0 and 16 hours when assessed using the captive bubble or NIKBUT methods (p>0.05). For the sessile drop method, verofilcon A had the lowest contact angle values (36.5 ± 2.9°), and all lenses except for etafilcon A had similar wettability after 16 hours. All the lenses had similar wettability when assessed using the captive bubble method, suggesting that they had similar wettability under optimal wetting conditions. For NIKBUT, delefilcon A had the longest NIKBUT values (9.0 ± 1.0 s) after 16 hours.

Conclusions: The sessile drop technique produced the most measurable differences in wettability between different lens types, whereas the captive bubble technique was not able to provide any measurable differences between lenses. NIKBUT measurements may provide a better measure of on-eye wettability, but variability in the results using the current eye model still needs to be addressed in future studies for improved repeatability. Although the contact lenses showed different contact angles and NIKBUT results, their in vitro wettability did not significantly change over the 16 hours of simulated wear in terms of the captive bubble or NIKBUT values.

Significance: Toric orthokeratology lenses show potential in slowing myopia progression in adolescents with moderate to high astigmatic myopia. These findings support the broader application of toric orthokeratology in managing challenging refractive conditions and mitigating myopia-related complications.

Purpose: This study seeks to probe the efficacy of toric orthokeratology lenses in controlling moderate to high astigmatic myopia in adolescents and to analyze the risk factors influencing treatment outcomes.

Methods: One hundred adolescent patients with moderate to high astigmatic myopia who were treated at our medical facility from January 2022 to January 2023 were randomly selected as the study subjects. All patients were allocated to either the experimental group (n = 50) or the control group (n = 50) using a random number table method. The control group was subjected to treatment with spherical orthokeratology lenses, whereas the experimental group was treated with toric orthokeratology lenses. Changes in uncorrected visual acuity, axial length, cylinder diopters, sphere diopters, and average corneal curvature before treatment and after 12 months of treatment were compared between the two groups. The logistic regression analysis was conducted to identify the factors influencing the efficacy of toric orthokeratology lenses in controlling moderate to high astigmatic myopia in adolescents.

Results: Both cohorts showed substantial improvements in uncorrected visual acuity, axial length, sphere, and average corneal curvature compared with their pre-treatment values, with the experimental cohort showing greater improvements than the control cohort (p=0.01, 0.03, 0.00, 0.00). There were no significant differences in cylinder between the two groups after treatment (p=0.56). Univariate analysis unraveled significant differences in age, baseline sphere, average corneal E value, baseline axial length, and central corneal thickness (p=0.00, 0.03, 0.04, 0.02, 0.05). Receiver operating characteristic curve analysis displayed that the area under the curve for the logistic regression model attained 0.82, with a 95% confidence interval of (0.69, 0.95), sensitivity of 88%, specificity of 72%, and a Youden index of 0.61.

Conclusions: Toric orthokeratology lenses demonstrate potential efficacy for adolescents with moderate to high astigmatic myopia by slowing myopia progression. Patients who are older, severely nearsighted, and have longer baseline axial length experience more significant control over myopia progression.

Significance: This 7-year clinical study assessed the impact of age and number of years of myopia control treatment with MiSight 1 day (omafilcon A; CooperVision, Inc., Pleasanton, CA) dual-focus contact lenses on post-treatment eye growth and myopia progression. Growth and progression after treatment were ceased and returned to age-normal levels retaining prior accrued treatment gains.

Purpose: This study aimed to assess eye growth and refractive changes after cessation of prolonged myopia control treatment with a dual-focus contact lens.

Methods: Eighty-three subjects completing a 6-year clinical trial of a dual-focus myopia control contact lens (MiSight 1 day) continued into a follow-on 1-year "wash-out" phase in which all subjects were fit with a single-vision contact lens (Proclear 1 day, omafilcon A; CooperVision, Inc.). Right and left eye data were analyzed from 38 subjects with 6 years of prior treatment (T6) and 40 receiving treatment during study years 4 to 6 (T3). Axial length and cyclopleged spherical equivalent refractive errors were monitored annually for 7 years. Expected axial growth and myopia progression during years 4 to 7 if treatment had not been started were estimated by extrapolating growth of untreated myopic control eyes collected during years 1 to 3 using population-based estimates of age effects on growth rates.

Results: During the untreated year 7, annualized axial growth and refractive changes were 0.09 ± 0.09 (T3) and 0.10 ± 0.10 mm/y (T6), and -0.23 ± 0.36 (T3) and -0.21 ± 0.40 D/y (T6), respectively, each slightly greater than observed during the previous year of treatment (0.07 ± 0.12 [T3] and 0.08 ± 0.07 mm [T6], and -0.04 ± 0.34 [T3] and -0.13 ± 0.42 D [T6]). Year 7 progression was less for the older (11 to 12 at baseline, -0.17 ± 0.40 D/0.05 ± 0.07 mm) than the younger (8 to 10 at baseline, -0.26 ± 0.36 D/0.13 ± 0.10 mm) subgroup. Years in treatment (3 vs. 6) did not influence post-treatment growth or progression.

Conclusions: A cessation study following 3 or 6 years of myopia control treatment with the dual-focus myopia control contact lens found axial growth and myopia progression rates similar to those expected of untreated myopic eyes at these ages. This finding reveals that accrued treatment gains were retained and neither amplified nor diminished after cessation of treatment.

Significance: Adult onset and progression of myopia are not well understood. It is of interest to better characterize myopia progression in young adults, who are frequently subjected to risk factors, such as intense near-work demands.

Purpose: This study aimed to assess the prevalence and progression of myopia and other refractive errors in optometry students in the United States.

Methods: This study was a retrospective chart review of electronic medical records of students enrolled in the optometry program at the University of Houston College of Optometry who graduated between 2013 and 2023. For each student, refractive error was noted from the medical record for eye examinations during their time as an optometry student. Exclusion criteria were ocular disease, myopia control treatment, or refractive surgery. Prevalences of hyperopia (≥+ 0.50 D), emmetropia (>-0.50 to <+0.50 D), myopia (≤-0.50 D), astigmatism (>0.50 D), and anisometropia (≥1.0 D) were determined from spherical equivalent refraction (SER) of the right eye. Absolute and annualized differences in SER were calculated between visits.

Results: Records for 1071 students were reviewed, and 961 were included. Prevalences were 80.7% for myopia, 14.9% for emmetropia, and 4.4% for hyperopia. Additionally, 38.4% had astigmatism, and 16.1% had anisometropia. Students with one follow-up exam (n = 639) showed a significant negative change in SER of -0.05 ± 0.38 D over an average follow-up period of 1.60 ± 0.61 years (p=0.001). Myopia onset was observed in 15.7% of emmetropes at baseline. Greater negative SER change was associated with greater follow-up duration and younger age. Hyperopes and emmetropes did not demonstrate significant changes in SER. An annualized negative SER change of ≥-0.25 D was noted in 20% of the 639 students, of which 5.5% showed ≥-0.50 D.

Conclusions: Findings demonstrate a high prevalence of myopia among optometry students. A small but statistically significant myopic change in refraction was observed. These findings may implicate a role of education and near work in myopia.