Optometry and Vision Science最新文献

Significance: Machine learning random forest algorithms were used to predict objective refractive outcomes after cycloplegic refraction using noncycloplegic clinical data. A classification model predicted post-cycloplegic myopia and could be useful in screening, and a second regression model predicted post-cycloplegic refractive and could provide a useful objective starting point in noncycloplegic subjective refractions.

Purpose: A classification model sought to predict post-cycloplegic myopia using noncycloplegic clinical data to enhance myopia screening accuracy, whereas the regression model looked to predict objective refraction outcomes after cycloplegia for use as a starting point for noncycloplegic subjective refraction.

Methods: A cross-sectional study included data from 2483 eyes. Pre-refraction measurements, such as uncorrected visual acuity, axial length, and corneal curvature radius, were recorded. After cycloplegia, the spherical equivalent was measured. Random forest-based classification and regression models were established with input variables including age, gender, axial length, corneal curvature radius, axial length-to-corneal curvature radius ratio, spherical equivalent, and uncorrected visual acuity. Model performance was assessed using various metrics.

Results: The random forest classification model achieved high out-of-bag validation accuracy (92%), cross-validation accuracy (93%), external validation accuracy (94%), and precision (95%). The external validation sensitivity was 93%, and specificity was 95%. The regression model internal validation showed an out-of-bag validation R2 of 0.86, root mean square error (RMSE) of 0.66, and mean absolute error of 0.49. The 10-fold cross-validation R2 was 0.87, the RMSE was 0.64, and the mean absolute error was 0.48. In the external validation, R2 was 0.88, the RMSE was 0.63, and the mean absolute error was 0.48.

Conclusions: By analyzing noncycloplegic clinical data, the classification model enables earlier detection of myopia, supporting timely intervention and management. The regression model aims to accurately predict post-cycloplegia myopic corrections, providing reliable initial data for subjective refraction. This could help optometrists perform noncycloplegic subjective refraction more efficiently and is particularly relevant in China, where retinoscopy is not yet fully popularized and many school students decline cycloplegic refraction due to academic pressures and limited free time, primarily because it requires a follow-up the next day.

Significance: Although human adenoviruses are the leading cause of acute viral conjunctivitis, there is a lack of data surrounding the efficacy of contact lens care products against these viruses.

Purpose: This study investigates the antiviral activity of several commercially available contact lens care solutions against human adenovirus type 5 (Ad5).

Methods: Six contact lens care solutions (Biotrue, Boston Simplus, OPTI-FREE Puremoist, Clear Care, cleadew, and cleadew GP) were investigated. Quantitative suspensions tests were conducted on Ad5 solutions after interaction with the different contact lens care solutions for 4 or 6 hours. For the hydrogen peroxide solution (Clear Care), interaction times of 0, 2, 4, and 6 hours prior to neutralization were also investigated. Finally, the impact of rubbing and rinsing of Ad5 contaminated contact lenses with the solutions was studied.

Results: Solutions based on povidone-iodine demonstrated a more than 3-log reduction in virus after 4 and 6 hours of incubation. In contrast, hydrogen peroxide only demonstrated a 0.52-log reduction after 6 hours of incubation. Increasing the contact time with hydrogen peroxide increased Ad5 inactivation, with a 2.18-log reduction after 6 hours of incubation with the solution prior to neutralization. Nonoxidative systems did not demonstrate a significant log reduction after 4 hours of incubation. However, rubbing and rinsing of contact lenses using the nonoxidative systems reduced the virus counts from contaminated contact lenses to below the limit of quantification.

Conclusions: Povidone-iodine solutions have a significant effect on reducing the viability of Ad5. Hydrogen peroxide care solutions are effective only if unneutralized contact time is increased. Nonoxidative systems can be effective in combating contaminated lenses only with the addition of a rub-and-rinse step.

Background: Cyclopentolate 1% is considered the drug of choice for effective cycloplegic refraction in clinical population, although tropicamide 1% is also reported to have similar effects with better tolerability.

Objectives: The objective of this meta-analysis was to evaluate the efficacies of tropicamide 1% and cyclopentolate 1% for cycloplegic refraction.

Data sources: MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched for articles published until March 20, 2024.

Study eligibility criteria, participants, and interventions: Randomized controlled trials that compared tropicamide 1% with cyclopentolate 1% in terms of differences in spherical equivalent refractive errors were included. The meta-analysis included only nonstrabismic participants with no restriction to age.

Study appraisal and synthesis method: The included studies were appraised using the Cochrane Risk of Bias Tool-2. The meta-analysis was conducted using the random-effects model with restricted maximum likelihood estimation method.

Results: Of 17 full-text reviews from 2555 identified studies, 4 randomized controlled trials were included in quantitative synthesis. The meta-analysis included 171 eyes of 171 participants (age range, 4 months to 50 years), in each group, with all types of refractive errors. The results showed no statistically significant differences in mean spherical equivalent refractive error values between the two groups (mean difference, -0.05; standard error, 0.16; p=0.774). There was no heterogeneity observed between the studies ( I2 = 0.00%, p=0.93). The outcome did not change when only children were included in the meta-analysis (age range, 4 months to 16 years; mean difference, -0.14; standard error, 0.21; p=0.51). In the risk-of-bias assessment, generally all studies were judged to have low risk of bias, but only one was judged to have low risk of bias across all seven domains.

Conclusions: Tropicamide 1% and cyclopentolate 1% showed similar efficacies for cycloplegic refraction in nonstrabismic children and adults. Considering patient tolerability and drug safety, it may be practical to use tropicamide 1% in routine cycloplegic refractions.

Significance: Visual acuity (VA) depends on many factors. When the goal is to assess retinal health rather than performance, then using a 3-mm pupil reduces unwanted wavefront aberrations. The axis of astigmatism can still potentially change with age.

Purpose: When VA measurements are intended to quantify the status of the retina, extraneous optical aberrations can make the measured VA worse and introduce variability, particularly in aging eyes. Our study quantifies wavefront aberrations for a 3-mm pupil, which is similar to the theoretical optical size for best VA, versus a 5-mm pupil.

Methods: The wavefront aberrations of normally sighted adults (N = 39; age, 41.9 ± 16.3 years) were measured for a 3- and 5-mm pupil setting without pupil dilation, using a commercially available and semiautomatic instrument (Pentacam AXL WAV; Oculus Optikgeraete GmbH, Wetzlar, Germany). The mean wavefront errors from the average of three measurements with three samples each were computed for each Zernike term orders 1 to 6 and correlated with age. The difference of measurement 1 and measurement 2 provided the test-retest values.

Results: Each 3-mm pupil measurements had a reduced average aberration for all 26 aberrations Zernike values, and 21 of 26 were statistically significant (p<0.05). The variability of the Zernike values was less for the 3-mm pupil than for the 5-mm pupil for all 26 measured aberrations pooled (Zernike orders 1 to 6), which was statistically significant ( F = 54.625, p<0.001). Most mean aberrations did not vary significantly with age for a 3-mm pupil, except for vertical astigmatism, horizontal coma, spherical aberration, and vertical quadrafoil. Against-the-rule astigmatism was more common in subjects >60 than <40 years old (p=0.05).

Conclusions: The findings of this study indicate that measurements of VA to assess retinal health could be made less dependent on unrelated and unwanted anterior segment factors by using a 3-mm pupil, because the wavefront aberrations for a 3-mm pupil were less than those for a 5-mm pupil. The change with age in vertical astigmatism more than oblique is consistent with the expected increase in proportion of against-the-rule astigmatism.

Background: The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes.

Aim: This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals.

Methods: We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care.

Results: Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents.

Conclusions and implications: This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

Significance: Several studies indicate that dual sensory loss (DSL) is related to cognitive impairment. However, there are still no conclusive data on the role of each individual deficit on cognitive performance when both co-occur in the same person.

Purpose: This study aimed to analyze the possible association between sensory deficit and cognitive impairment in a sample of older adults and whether this association differs in subjects with DSL compared with those with single or no sensory impairment.

Methods: Participants of this study were older adult users of gerontological centers in an urban area of Galicia (Spain). All subjects underwent visual and auditory screening tests to detect the presence of DSL. The Spanish version of the Mini-Mental State Examination test was used to identify cognitive impairment. Hearing loss was defined according to Ventry and Weinstein's criteria. Visual impairment was defined as a binocular presenting visual acuity <0.5 (20/40). The presence of DSL was established on the basis of the definitions of the single deficits.

Results: A total of 534 subjects were examined. Older adults with DSL had the worst results in the Mini-Mental test, and those without sensory impairment had the best. The likelihood of cognitive impairment was greater in older adults with DSL than in those without sensory impairment (odds ratio, 6.06 [3.14 to 11.65]). When only visual impairment was present, the likelihood of cognitive impairment was 3.73 times higher (0.95 to 3.09) than that of subjects with no sensory impairment. Hearing loss alone seems not to be significantly associated with a higher risk of cognitive impairment.

Conclusions: The results of this study highlight the importance of continuing research in DSL for the prevention of cognitive impairment, the design of intervention plans, and the optimization of health resources.

Purpose: There is evidence that wearing multifocal glasses increases the risk of falls in older people, especially when walking on stairs and in unfamiliar settings. However, it is not clear whether all types of multifocal glasses are equally associated with falls. This study comprised a secondary analysis of data from the VISIBLE randomized controlled trial to determine whether fall rates differ among older bifocal, trifocal, and progressive addition lens glasses wearers.

Methods: Two hundred eighty-one regular wearers of multifocal glasses (mean age, 80.3 years; standard deviation, 6.8 years) who were at increased risk of falls and used multifocal glasses three or more times per week participated in the study. Participants were classified into three groups: bifocal (n = 170), trifocal (n = 33), and progressive addition lens glasses wearers (n = 78). Participants underwent assessments of vision, sensorimotor function and balance (assessed with the Physiological Profile Assessment), Timed Up and Go performance, and activity levels and were then followed up for falls for 13 months.

Results: Two hundred sixty-eight participants (95.4%) were followed up for falls for 6+ months over the following 13 months: 51 bifocal glasses wearers (31.5%) suffered multiple falls compared with 15 trifocal glasses wearers (46.9%) and 33 progressive addition lens glasses wearers (44.6%) (p=0.071). When adjusting for established fall risk factors, participants wearing progressive addition lens glasses had over twice the odds of suffering multiple falls compared with bifocal glasses wearers (odds ratio, 2.23; 95% confidence interval, 1.08 to 4.58).

Conclusions: These findings suggest that progressive addition lens glasses increase the risk of falls more than bifocal glasses possibly due to visual distortions and reduced awareness of blurred distant objects in the lower visual field. Education of the risks posed by progressive addition lens glasses and training in optimal glasses use may help protect older people from falls.