Optometry and Vision Science最新文献

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.

Significance: Evaporative dry eye disease, due to meibomian gland dysfunction, causes significant suffering for millions of people globally, yet satisfactory long-term treatment remains elusive for many. Investigation of potential therapies for meibomian gland dysfunction is therefore of high importance to clinicians and their patients.

Purpose: This study aimed to compare the efficacy of a new device for meibomian gland debridement and expression to that of the conventional way of providing this treatment.

Methods: Thirty participants (mean age, 36.4 ± 15.4 years; 77% female) fulfilling current Tear Film & Ocular Surface Society diagnostic criteria for dry eye disease and meibomian gland dysfunction were recruited (Research Registry, 10340). Fifteen participants each were randomized to receive a single treatment with either traditional debridement (using a golf-club spud), heating (10 minutes of Blepha EyeBag, Théa Laboratories, Clermont-Ferrand, France) and expression (with forceps), or the multimodal MGrx, which comprises a handheld device with heated debridement, massage, and expression attachments. Symptomatology, tear film, and ocular surface measures were assessed at baseline and at 4 and 8 weeks post-treatment.

Results: Ocular Surface Disease Index, 5-Item Dry Eye Questionnaire, and Symptom Assessment in Dry Eye symptom questionnaire scores all improved significantly with both treatments (all p<0.001), with no subsequent deterioration for at least 8 weeks. The improvement was similar between treatment groups (all p>0.05). Clinical signs, of blink rate, tear film quality and quantity, ocular surface characteristics, and meibomian gland expressibility, were all unchanged with both treatments (all p>0.05) except for noninvasive tear breakup time, which deteriorated in the conventional treatment group (p=0.006) between 4 and 8 weeks post-treatment. No adverse reactions were reported, and all participants were able to tolerate treatment.

Conclusions: A single application of meibomian gland debridement and expression resulted in sustained improvements in the symptoms of dry eye disease, in both treatment groups. The MGrx device provides a safe and effective in-office treatment for evaporative dry eye disease, and has time and space advantages compared with conventional treatment.

Significance: Topical cyclosporine A (CsA) for the treatment of dry eye disease is often associated with instillation discomfort, which may negatively influence patient adherence to therapy. This study found that refrigerating topical CsA reduced instillation discomfort compared with instillation of warm CsA. Thus, refrigerating CsA prior to instillation may improve patient experience when using CsA to manage dry eye disease.

Purpose: This study aimed to quantify instillation discomfort associated with cold or warm instillation of a 0.09% CsA.

Methods: Forty participants with symptomatic aqueous deficient dry eye were enrolled. A drop of cold (4°C) CsA was instilled in one eye, and a drop of warm (23°C) CsA was instilled in the other eye. The order and eye receiving the cold drop were randomized. Participants rated the discomfort of each eye (0, no discomfort; 10, maximal discomfort) prior to drop instillation, immediately post-instillation, and at each subsequent minute for 10 minutes. Area under the curve was used to quantify cumulative discomfort.

Results: Forty participants (39.6 ± 18.9 years old, 82% female) completed the study. A majority of participants (n = 24, 60%) experienced reduced cumulative discomfort with cold CsA, whereas the remainder experienced minimal difference (n = 10, 25%) or increased cumulative discomfort (n = 6, 15%). For those with reduced discomfort (n = 24), cumulative discomfort associated with cold instillation (median, 11.5 [2.2, 20.0]) was significantly lower (p<0.01) than cumulative discomfort associated with warm instillation (median, 17.5 [11.2, 32.2]). Cold instillation was associated with a median reduction of 1 discomfort point immediately post-instillation and at all subsequent time points (all p≤0.04, but not significant at t = 10), compared with warm instillation.

Conclusions: Up to 60% of participants found that cold instillation of CsA solution induced less discomfort than warm instillation, lasting up to 9 minutes post-instillation. In contrast, although 15% of participants found reduced discomfort with warm instillation, the magnitude of discomfort associated with warm instillation was not significantly different than cold instillation.

In this Prentice Medal Award lecture, I shall recount my career in vision science in the context of three types of inspiration-"being inspired," "personal inspiration," and "inspiring others." My research has derived inspiration from a variety of sources, such as contemporary and historical research doyens in the ophthalmic field and beyond, artists, Greek philosophers, and abstract constructs such as principles and adages. A given moment of inspiration can range from being a profound experience to a subtle realization during a quiet moment of reflection. Here I shall recount the primary research domains of vision science that have defined my academic career in the context of the three types of inspiration defined above. These research domains are ophthalmic markers of diabetic neuropathy, ocular response to contact lens wear, contact lens-induced parainflammation, contact lens-associated microbial keratitis, grading scales for contact lens complications, contact lens prescribing surveys, material properties of contact lenses, contact lens compliance, history of contact lenses, ocular thermography, and ophthalmic bibliometrics. The notions of "being inspired" and "personal inspiration" are necessarily subjective, although I have endeavored to present them here in a scientific context. Conversely, the notion of "inspiring others" can be objectively gauged, at least in part, by counting article citations or the number of times articles are read online or downloaded from a journal website. In conclusion, my research in the vision sciences has been inspired by others, derived from personal ideas, and perhaps in turn has inspired others.