Optometry and Vision Science最新文献

Significance: Acute macular neuroretinopathy (AMN) is a rare disease that causes transient or permanent visual disturbance. The exact etiology remains unknown, but vascular compromise of the deep retinal capillary plexus was postulated as the main mechanism. Retinal vascular event post-coronavirus disease 2019 (COVID-19) infection is recently highlighted during the pandemic, which includes AMN.

Purpose: To report a case of AMN post-COVID-19 infection.

Case report: A 24-year-old Indian woman presented with acute-onset painless bilateral central scotoma for a day. The symptom was preceded by a history of COVID-19 infection 3 weeks prior. Ocular examination revealed a near-normal visual acuity for both eyes. Fundus examination showed bilateral dull foveal reflex with mild scattered cotton wool spot and vascular tortuosity. Optical coherence tomography macula revealed a distinct short hyperreflective band involving the outer plexiform and outer nuclear layers nasal to the fovea. The Bjerrum perimetry test revealed central scotoma temporal to the fixation. Optical coherence tomography lesions and scotomas are identical and congruous in both eyes. Serial fundus photographs are captured showing the evolving changes of near-normal macula to pigmented wedge-shaped petaloid lesions around the fovea. The patient was diagnosed as bilateral AMN and treated with oral prednisolone. On subsequent follow-up, the central scotoma improved.

Conclusions: This case illustrates a clear temporal and possible causal relationship of COVID-19 infection with AMN. Further studies and data are required to justify its association, but the rising cases of AMN shall be anticipated as COVID-19 infections have become endemic worldwide.

Significance: This study examines a potential stress test of repeated blink refrainment and its effects on the interblink period and the rate of evaporative ocular surface cooling. Such a test could aid in the study of computer vision syndrome, in which screen users unconsciously delay blinking, leading to onset of symptoms.

Purpose: This study aimed to examine the relationship between the length of the maximum achievable interblink time and the rate of ocular surface cooling under stress test conditions of repeated refrainment from blinking for as long as possible.

Methods: Subjects acclimated to the examination room for 10 minutes before measurement and then were asked to hold the eyes open and refrain from blinking for as long as possible (the maximum blink interval), while ocular surface temperature was recorded using an infrared thermographic video camera. Subjects completed 20 trials with four successive blinks separating each trial.

Results: Fifteen subjects (8 female and 7 male subjects) completed the study. The grand mean ocular surface cooling rate was -0.027°C/s (range, -0.338 to +0.014°C/s). A faster ocular surface cooling rate was significantly related to an exponentially shorter maximum blink interval (p<0.001). An increasing number of trials was related to a clinically insignificant increase in the length of the maximum blink interval overall, and a post hoc analysis revealed subject subgroups for whom the stress test was effective or ineffective.

Conclusions: The ocular surface evaporatively cools exponentially during periods of blink refrainment. With a subgroup of subjects with initially stable tear films and normal lipid layer thickness, cumulative tear film stress from repeated, longer-term blink refrainment could contribute to tear evaporation and symptoms of computer vision syndrome.

Significance: This research contributes to the concept of cognitive overload and the association between concentration and fatigue in individuals with visual impairment (VI). Gaining more insight into these and other factors explaining cognitive overload is essential for a better understanding, prevention, and treatment of fatigue severity in individuals with VI.

Purpose: Individuals with VI need to use additional cognitive resources to compensate for their loss of vision. These cognitive demands include increased concentration, which may put an extra burden on energy levels. This study aimed to expand upon previous research on the concept of cognitive overload by exploring the relationship between concentration and fatigue severity in individuals with VI.

Methods: A cross-sectional study was conducted based on data from the eligibility screening of the E-nergEYEze trial (n = 213). Concentration problems were measured with the Checklist of Individual Strengths subscale Concentration, and fatigue severity was measured with the Checklist of Individual Strengths subscale Fatigue Severity. Linear regression analyses were performed to investigate the association between concentration problems and fatigue severity. Potential effect modifiers (i.e., sociodemographic and vision-related characteristics) were considered, and associations were corrected for confounding.

Results: Concentration problems were directly and positively associated with fatigue severity (β = 0.47; R2 = 0.10; 95% confidence interval, 0.28 to 0.66; adjusted model: β = 0.52; R2 = 0.16; 95% confidence interval, 0.32 to 0.72). No relevant effect modifiers were identified. However, other factors that were not included in this study were involved in this association.

Conclusions: This study contributes to understanding the cognitive overload as experienced by adults with VI and highlights the importance of the association of concentration problems, as a reflection of the cognitive burden and perceived fatigue. It is recommended to identify and address concentration difficulties through suitable awareness and treatment strategies to prevent and reduce severe fatigue in this population.

Significance: Vitamin E could be used as a coating with commercial silicone hydrogel lenses to extend the release of various ophthalmic drugs. This concept could provide a promising approach to improve overall ocular therapeutic outcomes for topical ocular drugs.

Purpose: This study aimed to develop a contact lens-based ocular drug delivery system using vitamin E as a diffusion barrier to extend the release duration of ciprofloxacin.

Methods: Five commercial lenses were soaked for 24 hours in various concentrations of vitamin E dissolved in ethanol (0.0125 to 0.2 g/mL). The lenses were loaded with ciprofloxacin for 24 hours in 3 mL of 3 mg/mL of ciprofloxacin/acetic acid solution. The drug release was evaluated in 3 mL of phosphate-buffered saline solution. At t = 0.5, 1, 2, 4, 6, 8, 12, 16, and 24 hours, the amount of ciprofloxacin released was measured using a UV-VIS spectrophotometer at 270 nm.

Results: There was a decrease in ciprofloxacin loading with increasing amounts of vitamin E loaded into the silicone hydrogel lenses. For each lens type, there was an optimal amount of vitamin E loaded that extended the release duration of the drug from 1 hour (without vitamin E) to as long as 16 hours. In contrast, vitamin E loaded into hydrogel lenses had no effect on the amounts of drugs loaded or the release duration.

Conclusions: Vitamin E can be used as a diffusion barrier with commercially available silicone hydrogel lenses to provide sustained release of ciprofloxacin. The results suggest that vitamin E may form blockages in channels within a silicone hydrogel lens material, thereby forcing a longer path for drugs to diffuse into and out of the lens material. There is an optimal amount of vitamin E that needs to be loaded to extend the release duration, and this is lens material dependent.

Purpose: This study aimed to compare and analyze the efficacy of repeated low-level red-light therapy and orthokeratology lenses for myopia control in children.

Methods: Exactly 138 participants were enrolled in this retrospective study. Comprehensive eye examinations were performed prior to treatment. The repeated low-level red-light therapy and orthokeratology lenses groups comprised 67 and 71 patients, respectively. The age range was between 6 and 14 years, with myopia of ≤-0.50 D and astigmatism of ≤2.50 D after cycloplegia. Follow-up data were collected during the initial visit and the treatment period. Changes in axial length over a 2-year period and associated factors were analyzed.

Results: Over the 2-year period, the repeated low-level red-light therapy group exhibited significantly less axial length growth compared with the orthokeratology lenses group (0.17 ± 0.40 vs. 0.50 ± 0.27 mm, p<0.001). In the first year, the axial length growth in the repeated low-level red-light therapy group was significantly less than that in the orthokeratology lenses group (0.03 ± 0.22 vs. 0.28 ± 0.18 mm, p<0.001), with no significant difference observed in the second year (0.14 ± 0.29 vs. 0.21 ± 0.14 mm, p=0.06). The repeated low-level red-light therapy group showed a 55% reduction in axial length after 1 month and a 42% reduction after 1 year, compared with 4% and 3% reductions in the orthokeratology lenses group, respectively. Linear mixed-effects model analysis indicated that the annual axial length change rate in the repeated low-level red-light therapy group was 0.10 mm (95% confidence interval [CI], 0.07 to 0.14), compared with 0.25 mm in the orthokeratology lenses group (95% CI, 0.24 to 0.27), with an average difference of 0.15 mm (95% CI, -0.17 to -0.12, p<0.001).

Conclusions: Repeated low-level red-light therapy demonstrated slightly superior efficacy in controlling myopia progression in children compared with orthokeratology lenses.

Significance: Evaluating the visual challenges and refractive correction solutions of presbyopic orienteers identifies features of relevance to optometric management of the visual needs of active presbyopes.

Purpose: Orienteering is a unique sport requiring visual clarity at a range of viewing distances and has a high proportion of presbyopic participants. This study evaluates the vision corrections used by presbyopic orienteers, specifically aiming to characterize the prevalence of different vision correction options used and to explore the strengths and limitations of different vision correction solutions.

Methods: Orienteers 40 years or older completed an online questionnaire consisting of multiple-choice questions covering personal demographics, orienteering participation, and visual corrections worn in everyday life and for orienteering. Free-text questions asked for further information about the corrections used and advice received from eye care practitioners were analyzed using content analysis.

Results: There were 469 respondents (195 women, 274 men; median age category, 55 to 59 years). For the 187 people without distance refractive correction, the most frequent corrections for orienteering were "off the shelf" reading spectacles (n = 95) or use of a compass magnifier (n = 24), and for the 277 people with distance refractive correction, they were progressive addition spectacles (n = 96) and monovision contact lenses (n = 63). The main visual challenges faced by orienteers were seeing map detail, lens obstruction from fogging and rain, and difficulty orienteering in low light in the daytime. An ideal correction needed to provide visual clarity for both map and terrain. No visual correction type consistently addressed all challenges. Orienteers valued personalized discussion with eye care practitioners to address their needs.

Conclusions: Optimal visual corrections for presbyopic orienteers are individual, but higher reading additions to clarify map detail, contact lenses to avoid lens obstruction, additional light, and solutions that provide clear vision at all viewing distances while avoiding the reading add blurring the ground at the orienteer's feet should be considered. Personalized care is necessary to optimize visual correction solutions.

Purpose: This study aimed to identify baseline factors associated with greater myopia progression and axial elongation in children with myopia.

Methods: This study performed a post hoc analysis of data from a 30-month randomized trial of atropine 0.01% versus placebo in children 5 to <13 years old with baseline spherical equivalent refractive error (SER) of -1.00 to -6.00 D, astigmatism of ≤1.50 D, and anisometropia of <1.00 D SER. Data from atropine 0.01% and placebo groups were pooled given outcomes were similar. Baseline factors of age, SER, axial length, race, sex, parental myopia, and iris color were evaluated for association with changes in SER and with changes in axial length at 30 months (24 months on treatment and then 6 months off) using backward model selection.

Results: Among 187 randomized participants, 175 (94%) completed 30 months of follow-up. The mean change in SER was greater among younger children (-0.19 D per 1 year younger; 95% confidence interval [CI], -0.25 to -0.14 D; p<0.001) and children with higher myopia (-0.14 D per 1 D more myopia at baseline; 95% CI, -0.23 to -0.05 D; p=0.002). The mean change in axial length was also greater among younger children (0.13 mm per 1 year younger; 95% CI, 0.10 to 0.15 mm; p<0.001) and children with higher baseline myopia (0.04 mm per 1 D more myopia; 95% CI, 0.002 to 0.08; p=0.04).

Conclusions: Younger children with higher myopia had greater myopic progression and axial elongation over 30 months than older children with lower myopia. Developing effective treatments to slow the faster myopic progression in younger children should be a target of further research.

Significance: Low vision is a public health priority disability condition. People with this condition face multiple types of discrimination in a society that is not accustomed to diversity.

Purpose: This study aimed to describe the life experience of people with low vision from an intersectional perspective in Medellín, Colombia.

Methods: A qualitative ethnographic case study was conducted, considering the intersectional perspective as an analytical element to comprehend the everyday experience of people with low vision. Twenty-nine interviews were conducted with 10 participants, along with 16 participant observation exercises in their daily lives, with prior informed consent.

Results: Participants experienced discrimination due to their visual condition, which had negative implications for the development of their life projects. Three categories emerged: Discrimination in everyday contexts: ocularcentrism, gender challenges in the lives of people with low vision, and challenges in seeking vision rehabilitation services.

Conclusions: The results of the study show that people experience discrimination, exclusion, and stigmatization in their daily activities, which vary according to the traditionally assigned roles of gender, social class, age, and educational level, among others. Given the complexity of the experience, it is important for health and visual rehabilitation professionals to broaden their perspective and transition toward vision rehabilitation models that address the various dimensions affected by this condition.