Optometry and Vision Science最新文献

Significance: In an aging population, the number of people living with neurodegenerative disease is projected to increase. It is vital to develop reliable, noninvasive biomarkers to detect disease onset and monitor progression, and there is a growing body of research into the ocular surface as a potential source of such biomarkers.

Background: This article reviews the potential of in vivo corneal confocal microscopy and tear fluid analysis as tools for biomarker development. Corneal confocal microscopy, traditionally used for studying corneal health, offers high-resolution imaging of corneal nerves and has shown promise for examining systemic diseases such as Alzheimer disease and Parkinson's disease. Complementarily, tear fluid analysis, known for its ease of collection, reflects systemic changes in neurodegenerative conditions.

Conclusion: Together, these noninvasive techniques provide insights into disease onset and progression and hold potential for advancing diagnostic and treatment strategies.

Significance: Epidemiological information about the epiretinal membrane is important for better clinical management and understanding of the nature and burden of this disease. There are some gaps in our understanding of the epidemiology of epiretinal membranes, particularly in Africa and the Middle East.

Purpose: This study aimed to determine the prevalence and risk factors of epiretinal membrane using spectral-domain optical coherence tomography (OCT) in an Iranian elderly population.

Methods: This report is a part of a population-based study conducted on the elderly population 60 years and older from Tehran, the capital of Iran, using multistage stratified random cluster sampling. Study participants underwent measurement of visual acuity, autorefraction, subjective refraction, and slit-lamp biomicroscopy. The epiretinal membranes were diagnosed by a retinal specialist from OCT images (Spectralis OCT).

Results: A total of 1298 individuals were analyzed for this report. Of these, 58.9% were female, and the mean age of the participants was 67.4 ± 6.4 years. The prevalence rates of all epiretinal membranes, primary epiretinal membrane, and secondary epiretinal membrane were 6.0% (95% confidence interval [CI], 4.6 to 7.5%), 4.7% (95% CI, 3.0 to 6.3%), and 10.1% (95% CI, 6.6 to 13.6%), respectively. According to the multiple logistic regression model, the interaction between age and diabetes (odds ratio [OR], 1.09; 95% CI, 1.01 to 1.18, p=0.048) and the presence of posterior vitreous detachment (OR, 2.89; 95% CI, 1.45 to 5.78, p=0.003) were significantly linked to a higher prevalence of primary epiretinal membrane. Additionally, a significant inverse relationship was found between the prevalence of primary epiretinal membrane and the number of years of education (OR, 0.91; 95% CI, 0.85 to 0.97; p=0.002).

Conclusions: The prevalence of primary epiretinal membrane in Tehran, Iran, was found to be lower than that reported in the majority of earlier studies. Posterior vitreous detachment, interaction between age and diabetes, and lower education level were risk factors of primary epiretinal membrane in this study.

Significance: A comprehensive falls assessment should include the assessment of key visual risk factors, namely, visual acuity, contrast sensitivity, and stereoacuity, to help prevent further falls in older adults. As a minimum, a thorough visual history and uniocular visual acuity assessment would allow appropriate onward referral for intervention.

Purpose: Falls prevention is a global public health challenge. The etiology of falls is often complex due to multiple interacting risk factors contributing to postural instability in older adults. Despite national recommendations, the assessment of visual function is often overlooked in falls management. This may be due to a lack of clear guidance on key visual functions that need assessing in this patient group, professional roles, and responsibilities. This review gives an overview of visual risk factors for falls in older adults without cognitive impairment. It focuses on visual functions that can be assessed practically using standard clinical procedures. Possible test selection for a falls clinic or inpatient setting is discussed to help inform the implementation of vision assessments in falls management.

Methods: Literature searches were conducted on Web of Science (1898 to current), MEDLINE (1946 to present), and APA PsycInfo (1887 to present) using relevant search terms and Boolean operators related to visual functions and falls. Retrospective and prospective studies including randomized controlled trials, observational, cohort, case-control, and qualitative studies were included.

Results: Visual functions decline with age due to the normal aging process and age-related pathologies. Despite considerable heterogeneity across studies, the evidence supports the association of falls with declines in visual functions, including visual acuity, binocular single vision, and the visual field, but most notably contrast sensitivity and stereopsis. Existing vision screening tools, which assess multiple visual functions, are reviewed in light of their usefulness in falls.

Conclusions: We recommend a vision assessment in the management of falls, which considers visual functions associated with falls, particularly contrast sensitivity and stereopsis. Existing vision screening tools could be adapted or developed for use in falls clinics or the inpatient setting. Eye health professionals should form part of falls multidisciplinary teams or offer training in assessing vision and help to develop intervention pathways for timely management of visual impairment.

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.

Significance: Myopia prevalence has increased over the last few decades. Studies have documented that the choroid is considered an important biomarker in myopia development. As myopia and choroidal thinning are associated with increased glaucoma risk, understanding the role of the choroid in myopia and glaucoma is imperative.

Purpose: This study investigates the effect of transiently elevated intraocular pressure on axial length, subfoveal choroidal thickness, and central retinal thickness in emmetropes, low myopes, and high myopes.

Methods: This study involved 29 young adults (23 ± 1 years), including 10 emmetropes (-0.50 D < SE < +0.50 D), 10 low myopes (-6.00 D < SE ≤ -0.50 D), and 9 high myopes (SE ≤ -6.00 D). Participants were fitted with modified swimming goggles for 5 minutes to transiently change intraocular pressure. Noncontact tonometry, optical biometry, and optical coherence tomography were used to measure intraocular pressure, axial length, central retinal thickness, and subfoveal choroidal thickness, respectively. Measurements were taken at before, during goggle wear, immediately after, and 3 minutes after goggles removal. Repeated-measures analysis of variance with Bonferroni adjustment was used to assess the effect of transiently changed intraocular pressure and to elucidate any differences between refractive groups in response to the intraocular pressure change.

Results: Intraocular pressure increased by 1.7 ± 2.1 mmHg (p=0.002) from baseline, accompanied by axial elongation of 14 ± 21 μm (p = 0.012) and subfoveal choroidal thinning of 13 ± 15 μm (p=0.01). However, central retinal thickness did not change significantly (p>0.05). Most of the changes in the axial length were due to changes in the choroidal thickness. Observed changes returned to baseline immediately following goggles removal. There was no significant difference between refractive error groups' changes associated with the transient increase in intraocular pressure (p>0.05).

Conclusions: Transiently increased intraocular pressure caused temporary axial elongation and subfoveal choroidal thinning, with no significant differences between refractive groups. Further studies are required to assess the impact of long-term increased intraocular pressure on ocular components.

Significance: Optimal meibography utilization and interpretation are hindered due to poor lid presentation, blurry images, or image artifacts and the challenges of applying clinical grading scales. These results, using the largest image dataset analyzed to date, demonstrate development of algorithms that provide standardized, real-time inference that addresses all of these limitations.

Purpose: This study aimed to develop and validate an algorithmic pipeline to automate and standardize meibomian gland absence assessment and interpretation.

Methods: A total of 143,476 images were collected from sites across North America. Ophthalmologist and optometrist experts established ground-truth image quality and quantification (i.e., degree of gland absence). Annotated images were allocated into training, validation, and test sets. Convolutional neural networks within Google Cloud VertexAI trained three locally deployable or edge-based predictive models: image quality detection, over-flip detection, and gland absence detection. The algorithms were combined into an algorithmic pipeline onboard a LipiScan Dynamic Meibomian Imager to provide real-time clinical inference for new images. Performance metrics were generated for each algorithm in the pipeline onboard the LipiScan from naive image test sets.

Results: Individual model performance metrics included the following: weighted average precision (image quality detection: 0.81, over-flip detection: 0.88, gland absence detection: 0.84), weighted average recall (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.80), weighted average F1 score (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.81), overall accuracy (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.80), Cohen κ (image quality detection: 0.60, over-flip detection: 0.62, and gland absence detection: 0.71), Kendall τb (image quality detection: 0.61, p<0.001, over-flip detection: 0.63, p<0.001, and gland absence detection: 0.67, p<001), and Matthews coefficient (image quality detection: 0.61, over-flip detection: 0.63, and gland absence detection: 0.62). Area under the precision-recall curve (image quality detection: 0.87 over-flip detection: 0.92, gland absence detection: 0.89) and area under the receiver operating characteristic curve (image quality detection: 0.88, over-flip detection: 0.91 gland absence detection: 0.93) were calculated across a common set of thresholds, ranging from 0 to 1.

Conclusions: Comparison of predictions from each model to expert panel ground-truth demonstrated strong association and moderate to substantial agreement. The findings and performance metrics show that the pipeline of algorithms provides standardized, real-time inference/prediction of meibomian gland absence.

Significance: Artificial tears remain the cornerstone for managing dry eye disease. The current study's real-world efficacy test of carboxymethylcellulose (CMC), polyethylene glycol (PEG) 400, or sodium hyaluronate (SH)-based lubricants highlights their similar effects on noninvasive tear film parameters over the short term. However, patients reported better relief with SH-based lubricants.

Purpose: This study aimed to compare the short-term impact of different artificial tear formulations on tear film in moderate dry eye disease patients.

Methods: A prospective, double-masked, controlled study randomly allocated moderate dry eye disease patients into five groups of artificial tears: 0.5% CMC, 1% CMC, 0.1% SH-trehalose, 0.4% PEG 400-0.3% propylene glycol (PG), and 0.1% SH-0.4% PEG 400-0.3% PG. Noninvasive tear breakup time (NIBUT), tear meniscus height, and bulbar redness (Keratograph 5M; OCULUS Optikgeräte, Wetzlar, Germany) were assessed (in a controlled environment chamber 68 to 70°F; 35% relative humidity) at baseline and every 15 minutes for 1 hour after a drop instillation in the left eye. The right eye was an internal control. At 1 hour, subjects were asked for a change in subjective symptomatology (scales 0 to 4). A linear mixed-effect model was used for analysis.

Results: Each artificial tear group had 20 patients (100 patients). All groups had similar dry eye disease types and durations, baseline ocular surface disease index scores, and tear film parameters. All artificial tears showed significant improvement in NIBUT values at all time points from baseline compared with contralateral eyes. The change in NIBUT values was similar between different artificial tears at all time points. Bulbar redness scores and tear meniscus height showed no significant change in either eye with time or artificial tears. All patients reported improvement in dry eye disease symptomatology, with significant differences observed between 1% CMC and SH-PEG-PG (p=0.01), 0.5% CMC and SH-PEG-PG (p<0.0001), and 0.5% CMC and 0.1% SH-trehalose (p=0.01), where SH-based tear drops performed better.

Conclusions: Tear film stability improves following a single drop of CMC, SH, and PEG-based artificial tears, although these artificial tears do not differ in their short-term effect.