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RNA-based therapies in inherited retinal diseases. 遗传性视网膜疾病的rna治疗。
IF 2.5 Pub Date : 2022-11-04 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221134602
Aniz Girach, Isabelle Audo, David G Birch, Rachel M Huckfeldt, Byron L Lam, Bart P Leroy, Michel Michaelides, Stephen R Russell, Juliana M F Sallum, Katarina Stingl, Stephen H Tsang, Paul Yang
Inherited retinal diseases (IRDs) are a genetically and phenotypically heterogeneous group of genetic eye disorders. There are more than 300 disease entities, and together this group of disorders affects millions of people globally and is a frequent cause of blindness or low-vision certification. However, each type is rare or ultra-rare. Characteristically, the impaired vision in IRDs is due to retinal photoreceptor dysfunction and loss resulting from mutation in a gene that codes for a retinal protein. Historically, IRDs have been considered incurable and individuals living with these blinding conditions could be offered only supportive care. However, the treatment landscape for IRDs is beginning to evolve. Progress is being made, driven by improvements in understanding of genotype–phenotype relationships, through advances in molecular genetic testing and retinal imaging. Alongside this expanding knowledge of IRDs, the current era of precision medicine is fueling a growth in targeted therapies. This has resulted in the first treatment for an IRD being approved. Several other therapies are currently in development in the IRD space, including RNA-based therapies, gene-based therapies (such as augmentation therapy and gene editing), cell therapy, visual prosthetics, and optogenetics. RNA-based therapies are a novel approach within precision medicine that have demonstrated success, particularly in rare diseases. Three antisense oligonucleotides (AONs) are currently in development for the treatment of specific IRD subtypes. These RNA-based therapies bring several key advantages in the setting of IRDs, and the potential to bring meaningful vision benefit to individuals living with inherited blinding disorders. This review will examine the increasing breadth and relevance of RNA-based therapies in clinical medicine, explore the key features that make AONs suitable for treating genetic eye diseases, and provide an overview of the three-leading investigational AONs in clinical trials.
遗传性视网膜疾病(IRDs)是一种遗传和表型异质性的遗传性眼病。有300多种疾病实体,这组疾病加起来影响全球数百万人,是导致失明或低视力的常见原因。然而,每种类型都是稀有或超稀有的。典型地,ird的视力受损是由于编码视网膜蛋白的基因突变导致的视网膜感光器功能障碍和丧失。从历史上看,IRDs被认为是无法治愈的,患有这些致盲疾病的个人只能得到支持性治疗。然而,候选者的治疗前景正在开始发生变化。由于分子基因检测和视网膜成像技术的进步,对基因型-表现型关系的理解得到了改善,因此正在取得进展。随着ird知识的不断扩大,当前的精准医疗时代正在推动靶向治疗的增长。这导致了首个治疗IRD的方法获得批准。IRD领域目前正在开发其他几种疗法,包括基于rna的疗法、基于基因的疗法(如增强疗法和基因编辑)、细胞疗法、视觉假肢和光遗传学。基于rna的治疗方法是精准医学中的一种新方法,已经证明是成功的,特别是在罕见疾病中。目前正在开发三种反义寡核苷酸(aon)用于治疗特定的IRD亚型。这些基于rna的疗法在ird的设置中具有几个关键优势,并且有可能为患有遗传性致盲疾病的个体带来有意义的视力益处。本文将探讨基于rna的治疗方法在临床医学中日益增长的广度和相关性,探讨使AONs适合治疗遗传性眼病的关键特征,并概述临床试验中三个领先的研究性AONs。
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引用次数: 5
Observational study of cenegermin for the treatment of limbal stem cell deficiency associated with neurotrophic keratopathy. 新胚芽素治疗神经营养性角膜病变相关角膜缘干细胞缺乏症的观察研究。
IF 2.5 Pub Date : 2022-11-04 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221134598
Alejandro Arboleda, Christopher N Ta

Background: Neurotrophic keratopathy (NK) and limbal stem cell deficiency (LSCD) have high morbidity and require aggressive management to prevent permanent vision loss. Cenegermin, a recombinant human nerve growth factor, was approved by the Federal Drug Administration in 2018 for the treatment of NK.

Objectives: To determine the efficacy and safety of cenegermin in the treatment of LSCD associated with NK.

Design: Prospective cohort study.

Methods: Patients diagnosed with LSCD and NK who had failed conventional treatment were enrolled in this prospective open-label study. Patients were treated with cenegermin for 8 weeks. The primary objective was to determine whether the area of abnormal epithelium decreased following treatment. Corneal sensation, visual acuity (VA), and LSCD severity were also evaluated.

Results: Six eyes of 5 patients were included in the study. Cenegermin significantly improved the area of abnormal corneal epithelium in 5 of 6 eyes, measuring 73% of total corneal area at the initial visit and 48% at the final visit (P = .036). Corneal sensation improved in all patients, Cochet-Bonnet aesthesiometry measured 14.7 and 26.7 mm at the initial and final visit, respectively (P = .009). VA improved in 4 out of 6 eyes, with mean initial logMAR VA of 1.67 and final logMAR VA of 1.19 (P = .045). Finally, LSCD grading improved using the Aravena scoring system; however, this difference was not statistically significant (P = .14). One patient presented with an epithelial defect at baseline, which resolved following treatment. No patient withdrew from the study due to adverse effects.

Conclusions: Cenegermin effectively improved the cornea epithelium, VA, and corneal sensation in patients with LSCD and NK who had failed prior treatment. Further studies are necessary to better understand the anatomical changes and to confirm our results with a larger randomized control trial.

Registration: The study was registered at ClinicalTrials.gov with identifier NCT04552730 (https://clinicaltrials.gov/ct2/show/NCT04552730).

背景:神经营养性角膜病变(NK)和角膜缘干细胞缺乏症(LSCD)发病率高,需要积极治疗以防止永久性视力丧失。Cenegermin是一种重组人神经生长因子,于2018年获得美国联邦药物管理局(Federal Drug Administration)批准用于治疗NK。目的:探讨根芽素治疗NK相关性LSCD的疗效和安全性。设计:前瞻性队列研究。方法:诊断为LSCD和NK的常规治疗失败的患者被纳入这项前瞻性开放标签研究。治疗8周。主要目的是确定治疗后异常上皮的面积是否减少。角膜感觉、视力(VA)和LSCD严重程度也进行了评估。结果:5例患者6只眼纳入研究。genegermin显著改善了6只眼中5只眼的角膜上皮异常面积,首次就诊时占角膜总面积的73%,最后一次就诊时占角膜总面积的48% (P = 0.036)。所有患者的角膜感觉均有改善,初次和最后一次就诊时的Cochet-Bonnet美学测量值分别为14.7和26.7 mm (P = 0.009)。6只眼中有4只眼的VA改善,平均初始logMAR VA为1.67,最终logMAR VA为1.19 (P = 0.045)。最后,采用Aravena评分系统对LSCD评分进行改进;然而,这种差异没有统计学意义(P = .14)。一名患者在基线时出现上皮缺陷,治疗后消失。没有患者因不良反应退出研究。结论:genegermin可有效改善LSCD和NK患者先前治疗失败的角膜上皮、VA和角膜感觉。需要进一步的研究来更好地了解解剖变化,并通过更大的随机对照试验来证实我们的结果。注册:该研究在ClinicalTrials.gov注册,识别码为NCT04552730 (https://clinicaltrials.gov/ct2/show/NCT04552730)。
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引用次数: 1
The short-term effects of intravitreal bevacizumab injection on intraocular pressure, cornea, iridocorneal angle, and anterior chamber. 玻璃体内注射贝伐单抗对眼压、角膜、虹膜角膜角和前房的短期影响。
IF 2.5 Pub Date : 2022-11-02 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221133772
Gulsah Gumus, Mustafa Berhuni, Cem Ozturkmen

Background: Transient increase in intraocular pressure (IOP), changes in anterior chamber parameters, and changes in aqueous humor dynamics may occur after intravitreal injections because of intravitreal volume changes.

Objective: In this observational study, we investigated the early effects of intravitreal bevacizumab (IVB) injection on IOP, central corneal thickness (CCT), corneal volume (CV), anterior chamber depth (ACD), and iridocorneal angle (ICA).

Method: The patients who had one single-dose IVB (2.5 mg/0.1 mL) injection were included in the study. The patients underwent IOP, CCT, CV, ACD, and ICA measurements before and 1 h and 1 day after the injection. Pre-injection and post-injection values were compared.

Results: Forty-two eyes of 42 patients were included in the study, and the mean age of patients was 60.1 ± 7.4 years. The mean IOP measurements before and after injection at 1 h and day 1 were 15 ± 2.4, 17.4 ± 2.4, and 14.7 ± 2.3, respectively. The mean IOP, CCT, and CV values 1 h after injection were significantly higher than pre-injection values (p < 0.05, p < 0.05, and p = 0.02, respectively). Conversely, mean ACD and ICA values 1 h after injection were significantly lower than pre-injection values (p = 0.01 for both). There were no statistically significant differences on the first day after injection for all parameters.

Conclusion: IVB (2.5 mg/0.1 mL) injection causes transient increases in IOP and transient decreases in ACD and ICA at the first hour after injection. Related to elevation in IOP, CCT and CV may increase transiently. These changes return to baseline values on the first day after injection.

背景:由于玻璃体内体积的改变,玻璃体内注射后可能出现短暂性眼压升高、前房参数改变和房水动力学改变。目的:在这项观察性研究中,我们探讨了玻璃体内注射贝伐单抗(IVB)对IOP、角膜中央厚度(CCT)、角膜体积(CV)、前房深度(ACD)和虹膜角膜角(ICA)的早期影响。方法:选取单次注射IVB (2.5 mg/0.1 mL)的患者作为研究对象。患者在注射前、注射后1小时和1天分别测量IOP、CCT、CV、ACD和ICA。比较注射前和注射后的数值。结果:纳入42例患者42只眼,平均年龄60.1±7.4岁。注射前后1 h和第1天的平均IOP值分别为15±2.4、17.4±2.4和14.7±2.3。注射后1 h的平均IOP、CCT和CV值均显著高于注射前(p p p = 0.02)。相反,注射后1 h的平均ACD和ICA值显著低于注射前值(p = 0.01)。注射后第1天各项指标比较,差异无统计学意义。结论:注射IVB (2.5 mg/0.1 mL)可引起IOP一过性升高,ACD和ICA一过性降低。与IOP升高相关,CCT和CV可短暂升高。这些变化在注射后第一天恢复到基线值。
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引用次数: 2
Evaluation of lipid layer tear film changes after femtosecond small incision lenticule extraction. 飞秒小切口晶状体摘除后脂质层泪膜变化的评价。
IF 2.5 Pub Date : 2022-10-10 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221129534
Khalid Al Sabti, Snezhana Zechevikj, Seemant Raizada

Background: Dry eye disease is common after refractive procedures due to tear film instability. There are several causative factors for tear film instability, but the state of individual components of the tear film is not assessed much in published literature. This article quantifies the lipid layer thickness (LLT) of the tear film using surface interferometry before and after the small incision lenticule extraction (SMILE) refractive procedure.

Objectives: This study aimed to evaluate the effects of femtosecond SMILE on the postoperative stability of the LLT of the tear film.

Design: This was a prospective, interventional, non-case-control study.

Methods: A total of 160 eyes of 80 patients were enrolled in the study. The follow-up period was 6 months after surgery. A noninvasive surface interferometer was used to measure the thickness of the lipid layer before surgery and was repeated at 3 and 6 months after surgery. The main outcome measure was the change in average LLT at 3 and 6 months after SMILE and its statistical significance.

Results: There were 48 women and 32 men. Age ranged from 21 to 42 years (mean = 27 ± 6.4). Mean LLT at baseline was [oculus dextrus (OD) = 53.38 (±7.24) nm; oculus sinister (OS) = 52.21 (±6.95) nm], at 3 months [OD = 54.38 (±5.75) nm; OS = 53.26 (±5.70)], and at 6 months [OD = 53.31 (±5.66) nm; OS = 52.39 (±5.94)]. Mean LLT showed mild improvement at 3 months after surgery (OD = 53.38-54.38 mm, p = 0.0417; OS = 52.21-53.26 mm, p = 0.0398). There was no significant change in LLT from the baseline before surgery to levels 6 months after surgery (p = 0.8914 OD; p = 0.7368 OS).

Conclusion: The SMILE refractive procedure did not alter the LLT that remained stable and adequate at 6 months postoperative follow-up.

背景:由于泪膜不稳定,屈光手术后干眼症很常见。造成泪膜不稳定的原因有很多,但在已发表的文献中,对泪膜各组分的状态评估并不多。本文采用表面干涉法对小切口晶状体提取(SMILE)屈光手术前后泪膜脂质层厚度(LLT)进行定量分析。目的:本研究旨在评价飞秒SMILE对泪膜术后LLT稳定性的影响。设计:这是一项前瞻性、干预性、非病例对照研究。方法:80例患者共160只眼纳入研究。术后随访6个月。术前采用无创表面干涉仪测量脂质层厚度,术后3、6个月重复测量。主要观察指标为SMILE术后3个月和6个月平均LLT的变化及其统计学意义。结果:女性48例,男性32例。年龄21 ~ 42岁,平均= 27±6.4岁。基线时平均LLT为右旋眼(OD) = 53.38(±7.24)nm;眼周(OS) = 52.21(±6.95)nm, 3个月时[OD = 54.38(±5.75)nm];操作系统= 53.26(±5.70)],在6个月(d = 53.31(±5.66)海里;Os = 52.39(±5.94)。术后3个月平均LLT轻度改善(OD = 53.38 ~ 54.38 mm, p = 0.0417;OS = 52.21 ~ 53.26 mm, p = 0.0398)。从术前基线到术后6个月的LLT水平无显著变化(p = 0.8914 OD;p = 0.7368 OS)。结论:SMILE屈光手术未改变LLT,在术后6个月的随访中保持稳定和适当。
{"title":"Evaluation of lipid layer tear film changes after femtosecond small incision lenticule extraction.","authors":"Khalid Al Sabti,&nbsp;Snezhana Zechevikj,&nbsp;Seemant Raizada","doi":"10.1177/25158414221129534","DOIUrl":"https://doi.org/10.1177/25158414221129534","url":null,"abstract":"<p><strong>Background: </strong>Dry eye disease is common after refractive procedures due to tear film instability. There are several causative factors for tear film instability, but the state of individual components of the tear film is not assessed much in published literature. This article quantifies the lipid layer thickness (LLT) of the tear film using surface interferometry before and after the small incision lenticule extraction (SMILE) refractive procedure.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effects of femtosecond SMILE on the postoperative stability of the LLT of the tear film.</p><p><strong>Design: </strong>This was a prospective, interventional, non-case-control study.</p><p><strong>Methods: </strong>A total of 160 eyes of 80 patients were enrolled in the study. The follow-up period was 6 months after surgery. A noninvasive surface interferometer was used to measure the thickness of the lipid layer before surgery and was repeated at 3 and 6 months after surgery. The main outcome measure was the change in average LLT at 3 and 6 months after SMILE and its statistical significance.</p><p><strong>Results: </strong>There were 48 women and 32 men. Age ranged from 21 to 42 years (mean = 27 ± 6.4). Mean LLT at baseline was [oculus dextrus (OD) = 53.38 (±7.24) nm; oculus sinister (OS) = 52.21 (±6.95) nm], at 3 months [OD = 54.38 (±5.75) nm; OS = 53.26 (±5.70)], and at 6 months [OD = 53.31 (±5.66) nm; OS = 52.39 (±5.94)]. Mean LLT showed mild improvement at 3 months after surgery (OD = 53.38-54.38 mm, <i>p</i> = 0.0417; OS = 52.21-53.26 mm, <i>p</i> = 0.0398). There was no significant change in LLT from the baseline before surgery to levels 6 months after surgery (<i>p</i> = 0.8914 OD; <i>p</i> = 0.7368 OS).</p><p><strong>Conclusion: </strong>The SMILE refractive procedure did not alter the LLT that remained stable and adequate at 6 months postoperative follow-up.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/ff/10.1177_25158414221129534.PMC9554113.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A comparison of iStent combined with phacoemulsification and endocyclophotocoagulation (ICE2) with the PreserFlo MicroShunt and XEN-45 implants. iStent联合超声乳化和内腔光凝(ICE2)与PreserFlo MicroShunt和XEN-45种植体的比较。
IF 2.5 Pub Date : 2022-10-10 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221125697
Umair Qidwai, Lee Jones, Gokulan Ratnarajan

Background: Minimally invasive glaucoma surgery (MIGS), including minimally invasive bleb surgery (MIBS), is a rapidly evolving area of research and clinical interest in ophthalmology. The growing number of devices has necessitated evaluations to identify subtle differences in outcomes between treatments.

Objectives: To compare clinical effectiveness and safety outcomes of iStent combined with endoscopic cyclophotocoagulation (ICE2) with bleb forming PreserFlo MicroShunt (PMS) and XEN-45 gel implant in a 24-month retrospective review.

Design: A retrospective review of patient records.

Methods: We compared outcomes of 247 patients undergoing one of three glaucoma procedures (ICE2 = 162; PMS = 48; XEN-45 = 37) at a single facility in the United Kingdom. Clinical records were reviewed retrospectively between July 2016 and May 2020. Pairwise comparisons and within group analyses were performed to assess intraocular pressure (IOP), best-corrected LogMAR visual acuity (BCVA), the Humphrey visual fields and antiglaucoma medication outcomes across the three treatment groups.

Results: No statistically significantly differences in IOP between the groups at day 7, 6 months, 12 months and 24 months. PMS had statistically significantly change in IOP between baseline and day 7 compared with ICE2 (p = 0.003). BCVA was statistically significant different at 24 months between the ICE2 compared with PMS group (0.12 versus 0.33 LogMAR; p = 0.002). PMS group achieved the largest decline in medication usage between baseline a 24-month follow-up (2.9 versus 0.9; p < 0.001), with no statistically significant difference in the number of antiglaucoma medications being used between groups at 24 months. Postoperative complications in all three groups were transient and could be resolved with office-based interventions.

Conclusion: Real-world outcomes after 24 months were similar between patients undergoing MIGS and MIBS procedures.

背景:微创青光眼手术(MIGS),包括微创水泡手术(MIBS),是眼科一个快速发展的研究领域和临床兴趣。越来越多的设备需要评估,以确定治疗之间结果的细微差异。目的:通过24个月的回顾性研究,比较iStent联合内镜下循环光凝(ICE2)与形成泡的PreserFlo MicroShunt (PMS)和XEN-45凝胶植入的临床疗效和安全性。设计:对患者记录进行回顾性研究。方法:我们比较了247例接受三种青光眼手术之一的患者的结果(ICE2 = 162;pms = 48;XEN-45 = 37)在英国的一个设施。回顾性回顾了2016年7月至2020年5月期间的临床记录。通过两两比较和组内分析来评估三个治疗组的眼压(IOP)、最佳矫正LogMAR视力(BCVA)、Humphrey视野和抗青光眼药物治疗结果。结果:第7天、第6个月、第12个月、第24个月各组IOP差异无统计学意义。与ICE2相比,PMS患者的IOP在基线和第7天之间有统计学意义上的变化(p = 0.003)。与PMS组相比,ICE2组24个月时的BCVA差异有统计学意义(0.12 vs 0.33 LogMAR;p = 0.002)。经前综合症组在基线和24个月随访期间药物使用下降幅度最大(2.9 vs 0.9;结论:接受mis和MIBS手术的患者在24个月后的实际结果相似。
{"title":"A comparison of iStent combined with phacoemulsification and endocyclophotocoagulation (ICE2) with the PreserFlo MicroShunt and XEN-45 implants.","authors":"Umair Qidwai,&nbsp;Lee Jones,&nbsp;Gokulan Ratnarajan","doi":"10.1177/25158414221125697","DOIUrl":"https://doi.org/10.1177/25158414221125697","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive glaucoma surgery (MIGS), including minimally invasive bleb surgery (MIBS), is a rapidly evolving area of research and clinical interest in ophthalmology. The growing number of devices has necessitated evaluations to identify subtle differences in outcomes between treatments.</p><p><strong>Objectives: </strong>To compare clinical effectiveness and safety outcomes of iStent combined with endoscopic cyclophotocoagulation (ICE2) with bleb forming PreserFlo MicroShunt (PMS) and XEN-45 gel implant in a 24-month retrospective review.</p><p><strong>Design: </strong>A retrospective review of patient records.</p><p><strong>Methods: </strong>We compared outcomes of 247 patients undergoing one of three glaucoma procedures (ICE2 = 162; PMS = 48; XEN-45 = 37) at a single facility in the United Kingdom. Clinical records were reviewed retrospectively between July 2016 and May 2020. Pairwise comparisons and within group analyses were performed to assess intraocular pressure (IOP), best-corrected LogMAR visual acuity (BCVA), the Humphrey visual fields and antiglaucoma medication outcomes across the three treatment groups.</p><p><strong>Results: </strong>No statistically significantly differences in IOP between the groups at day 7, 6 months, 12 months and 24 months. PMS had statistically significantly change in IOP between baseline and day 7 compared with ICE2 (<i>p</i> = 0.003). BCVA was statistically significant different at 24 months between the ICE2 compared with PMS group (0.12 <i>versus</i> 0.33 LogMAR; <i>p</i> = 0.002). PMS group achieved the largest decline in medication usage between baseline a 24-month follow-up (2.9 <i>versus</i> 0.9; <i>p</i> < 0.001), with no statistically significant difference in the number of antiglaucoma medications being used between groups at 24 months. Postoperative complications in all three groups were transient and could be resolved with office-based interventions.</p><p><strong>Conclusion: </strong>Real-world outcomes after 24 months were similar between patients undergoing MIGS and MIBS procedures.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/06/10.1177_25158414221125697.PMC9554128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33514322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Assessing optometric care delivered by telehealth during the COVID-19 public health emergency. 评估COVID-19突发公共卫生事件期间远程医疗提供的验光服务。
IF 2.5 Pub Date : 2022-09-29 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221123526
Justine H Pidgeon, Mahesh K Bhardwaj, Patrick Titterington, Karen Latulippe, Shiyoung Roh, David J Ramsey

Background: The emergence of coronavirus disease 2019 (COVID-19) forced many eye care providers to implement telehealth services while in-person visits were reserved for essential and/or emergency eye care.

Objective: This study documents how an optometry group successfully implemented telehealth to care for patients during the outbreak of the COVID-19 pandemic in the United States.

Design: Retrospective, comparative case series.

Methods: Records were reviewed for patients seen in an academic optometry clinic from 23 March through 7 April 2020, the period of the Massachusetts stay-at-home advisory issued in response to COVID-19. Patients who completed telehealth visits were compared with those who received in-person care. Services delivered by telehealth included a check of symptoms, medication refills, health education, and assurance of future follow up. The study took into account the reason for each visit, as well as the rate of scheduled and completed follow-up appointments. Patient satisfaction with in-person care was evaluated by Press Ganey patient experience surveys.

Results: Out of 855 patients scheduled, 421 patients completed telehealth encounters (49%), and 46 patients completed in-clinic visits (5.4%). A further 272 patients canceled appointments (32%), 123 patients were unable to be contacted (14%), and 8 patients declined care offered by telehealth (0.94%). Most patients who were cared for by telehealth returned to see optometrists (88%). By contrast, most patients who required in-person visits during this period were subsequently seen by ophthalmologists (58%, p < 0.001). Patient satisfaction remained high for in-person visits that took place during the COVID-19-related emergency, with improvements noted in patient satisfaction regarding 'information about delays' (47 % versus 100%, p = 0.007) and 'concern for questions or worries' (76% versus 100%, p = 0.037) compared with the same period 1 year prior.

Conclusion: Optometrists rapidly embraced telehealth to deliver eye care to their patients during the COVID-19 public health emergency. Most eye issues were able to be addressed through telehealth; urgent eye problems were triaged and referred to the optometry clinic, when appropriate.

背景:2019冠状病毒病(COVID-19)的出现迫使许多眼科保健提供者实施远程医疗服务,而亲自就诊则保留用于基本和/或紧急眼科护理。目的:本研究记录了在美国COVID-19大流行爆发期间,验光组如何成功实施远程医疗来护理患者。设计:回顾性,比较案例系列。方法:回顾了2020年3月23日至4月7日在一家学术验光诊所就诊的患者的记录,这段时间是马萨诸塞州为应对COVID-19而发布的居家咨询期间。完成远程医疗访问的患者与接受现场护理的患者进行了比较。远程保健提供的服务包括检查症状、补充药物、健康教育和保证今后的随访。这项研究考虑了每次就诊的原因,以及安排和完成后续预约的比率。通过Press Ganey患者体验调查评估患者对亲自护理的满意度。结果:在855名患者中,421名患者完成了远程医疗就诊(49%),46名患者完成了门诊就诊(5.4%)。另有272名患者取消预约(32%),123名患者无法联系(14%),8名患者拒绝远程保健提供的护理(0.94%)。大多数接受远程医疗护理的患者(88%)返回看验光师。相比之下,与一年前同期相比,在此期间要求亲自就诊的大多数患者随后都得到了眼科医生的诊治(58%,p = 0.007),并“关心问题或担忧”(76%对100%,p = 0.037)。结论:在COVID-19突发公共卫生事件期间,验光师迅速接受了远程医疗,为患者提供眼科护理。大多数眼部问题都能通过远程医疗得到解决;紧急眼科问题进行分类,并在适当的时候转介到验光诊所。
{"title":"Assessing optometric care delivered by telehealth during the COVID-19 public health emergency.","authors":"Justine H Pidgeon,&nbsp;Mahesh K Bhardwaj,&nbsp;Patrick Titterington,&nbsp;Karen Latulippe,&nbsp;Shiyoung Roh,&nbsp;David J Ramsey","doi":"10.1177/25158414221123526","DOIUrl":"https://doi.org/10.1177/25158414221123526","url":null,"abstract":"<p><strong>Background: </strong>The emergence of coronavirus disease 2019 (COVID-19) forced many eye care providers to implement telehealth services while in-person visits were reserved for essential and/or emergency eye care.</p><p><strong>Objective: </strong>This study documents how an optometry group successfully implemented telehealth to care for patients during the outbreak of the COVID-19 pandemic in the United States.</p><p><strong>Design: </strong>Retrospective, comparative case series.</p><p><strong>Methods: </strong>Records were reviewed for patients seen in an academic optometry clinic from 23 March through 7 April 2020, the period of the Massachusetts stay-at-home advisory issued in response to COVID-19. Patients who completed telehealth visits were compared with those who received in-person care. Services delivered by telehealth included a check of symptoms, medication refills, health education, and assurance of future follow up. The study took into account the reason for each visit, as well as the rate of scheduled and completed follow-up appointments. Patient satisfaction with in-person care was evaluated by Press Ganey patient experience surveys.</p><p><strong>Results: </strong>Out of 855 patients scheduled, 421 patients completed telehealth encounters (49%), and 46 patients completed in-clinic visits (5.4%). A further 272 patients canceled appointments (32%), 123 patients were unable to be contacted (14%), and 8 patients declined care offered by telehealth (0.94%). Most patients who were cared for by telehealth returned to see optometrists (88%). By contrast, most patients who required in-person visits during this period were subsequently seen by ophthalmologists (58%, <i>p</i> < 0.001). Patient satisfaction remained high for in-person visits that took place during the COVID-19-related emergency, with improvements noted in patient satisfaction regarding 'information about delays' (47 % versus 100%, <i>p</i> = 0.007) and 'concern for questions or worries' (76% versus 100%, <i>p</i> = 0.037) compared with the same period 1 year prior.</p><p><strong>Conclusion: </strong>Optometrists rapidly embraced telehealth to deliver eye care to their patients during the COVID-19 public health emergency. Most eye issues were able to be addressed through telehealth; urgent eye problems were triaged and referred to the optometry clinic, when appropriate.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/4b/10.1177_25158414221123526.PMC9527121.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33490859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tubercular DNA PCR of ocular fluids and blood in cases of presumed ocular tuberculosis: a pilot study. 假定的眼结核病例中眼液和血液的结核DNA PCR:一项初步研究。
IF 2.5 Pub Date : 2022-09-18 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221123522
Rohan Chawla, Mithalesh K Singh, Lata Singh, Pooja Shah, Seema Kashyap, Shorya Azad, Pradeep Venkatesh, Seema Sen

Background: The definitive diagnosing of ocular tuberculosis (TB) is difficult; therefore, there is a need of better understanding of investigating TB DNA in presumed ocular TB patients.

Objectives: The aim of this study is to correlate tubercular DNA PCR of aqueous/vitreous and blood in cases of presumed ocular TB.

Design: A prospective study.

Methods: DNA was extracted from aqueous of cases of choroidal tuberculoma (group 1) and serpiginous choroiditis (group 2) and from vitreous of cases of vasculitis (group 3) and macular hole/retinal detachment (group 4). Gel-based PCR and real-time PCR amplification were performed using IS6110 primer on ocular fluids. The same was also performed on the blood samples of cases in which tubercular DNA was detected in the ocular fluids.

Results: Overall, 31 cases were analysed in our study. Tubercular DNA was detected in ocular fluids of seven cases: group 1, two cases (67%); group 2, one case (17%); group 3, four cases (27%); and no case of group 4. Blood samples of six of these seven patients were positive for tubercular DNA. Of these six patients, four had evidence of systemic TB and were on ATT. Two cases had no evidence of active systemic TB, yet PCR was positive from blood and ocular fluids.

Conclusion: Tubercular DNA detected from ocular fluids may possibly be due to bystander DNA and may not indicate primary ocular tubercular infection. Thus, caution must be exercised prior to labelling a case of uveitis as being tubercular based on the results of molecular assays on ocular fluids alone. The results of PCR on ocular fluids should be correlated with PCR on blood and systemic findings.

背景:眼结核(TB)的明确诊断是困难的;因此,有必要更好地了解在假定的眼结核患者中调查结核DNA。目的:本研究的目的是在假定的眼结核病例中,将水/玻璃体结核DNA PCR与血液结核DNA PCR相关联。设计:前瞻性研究。方法:从脉络膜结核瘤(1组)和丝状脉络膜炎(2组)患者的水样中提取DNA,从脉络膜炎(3组)和黄斑孔/视网膜脱离(4组)患者的玻璃体中提取DNA,用IS6110引物对眼液进行凝胶PCR和实时PCR扩增。对在眼液中检测到结核DNA的病例的血液样本也进行了同样的检测。结果:本研究共分析了31例病例。在眼液中检出结核DNA 7例:1组2例(67%);第二组1例(17%);第三组4例(27%);没有第4组的情况。这7名患者中有6人的血液样本结核DNA呈阳性。在这6例患者中,4例有全身性结核病的证据,并正在接受ATT治疗。2例没有活动性全身性结核病的证据,但血液和眼液PCR检测呈阳性。结论:从眼液中检测到的结核DNA可能是由旁观者DNA引起的,可能不是原发性眼结核感染。因此,在仅根据眼液分子测定结果将葡萄膜炎标记为结核之前,必须谨慎。眼液PCR结果应与血液和全身检查结果相关联。
{"title":"Tubercular DNA PCR of ocular fluids and blood in cases of presumed ocular tuberculosis: a pilot study.","authors":"Rohan Chawla,&nbsp;Mithalesh K Singh,&nbsp;Lata Singh,&nbsp;Pooja Shah,&nbsp;Seema Kashyap,&nbsp;Shorya Azad,&nbsp;Pradeep Venkatesh,&nbsp;Seema Sen","doi":"10.1177/25158414221123522","DOIUrl":"https://doi.org/10.1177/25158414221123522","url":null,"abstract":"<p><strong>Background: </strong>The definitive diagnosing of ocular tuberculosis (TB) is difficult; therefore, there is a need of better understanding of investigating TB DNA in presumed ocular TB patients.</p><p><strong>Objectives: </strong>The aim of this study is to correlate tubercular DNA PCR of aqueous/vitreous and blood in cases of presumed ocular TB.</p><p><strong>Design: </strong>A prospective study.</p><p><strong>Methods: </strong>DNA was extracted from aqueous of cases of choroidal tuberculoma (group 1) and serpiginous choroiditis (group 2) and from vitreous of cases of vasculitis (group 3) and macular hole/retinal detachment (group 4). Gel-based PCR and real-time PCR amplification were performed using IS6110 primer on ocular fluids. The same was also performed on the blood samples of cases in which tubercular DNA was detected in the ocular fluids.</p><p><strong>Results: </strong>Overall, 31 cases were analysed in our study. Tubercular DNA was detected in ocular fluids of seven cases: group 1, two cases (67%); group 2, one case (17%); group 3, four cases (27%); and no case of group 4. Blood samples of six of these seven patients were positive for tubercular DNA. Of these six patients, four had evidence of systemic TB and were on ATT. Two cases had no evidence of active systemic TB, yet PCR was positive from blood and ocular fluids.</p><p><strong>Conclusion: </strong>Tubercular DNA detected from ocular fluids may possibly be due to bystander DNA and may not indicate primary ocular tubercular infection. Thus, caution must be exercised prior to labelling a case of uveitis as being tubercular based on the results of molecular assays on ocular fluids alone. The results of PCR on ocular fluids should be correlated with PCR on blood and systemic findings.</p>","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2022-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/f5/10.1177_25158414221123522.PMC9485188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33477935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Intraocular lens power calculation in eyes with previous corneal refractive surgery. 既往角膜屈光手术眼的人工晶状体度数计算。
IF 2.5 Pub Date : 2022-08-30 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221118524
Philipp Anders, Lisa-Marie Anders, Adel Barbara, Nora Szentmary, Achim Langenbucher, Zisis Gatzioufas

Intraocular lens (IOL) power calculation after corneal refractive surgery (CRS) becomes an expanding challenge for ophthalmologists as more and more cataract surgeries after CRS are required. These patients typically also have high expectations as to visual performance. Conventional IOL power calculation schemes frequently provide inaccurate results in these cases. This review aims to summarize and recommend currently available IOL power calculation methods for eyes with the most common CRS methods: radial keratotomy (RK), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE). To this end, biometry measuring methods and IOL formulas will be explained and combinations of both are proposed. In synopsis, it is evident that the latest generation of vergence formulas exhibit favorable IOL power prediction accuracy in post-CRS eyes, even though the predictive precision of methods in eyes without CRS is not attained. Ray tracing computation, intraoperative aberrometry, and machine learning-based formulas hold potential to further improve refractive outcomes in post-CRS eyes.

随着角膜屈光手术(CRS)后白内障手术的增多,人工晶状体(IOL)的度数计算成为眼科医生面临的一个越来越大的挑战。这些患者通常对视觉表现也有很高的期望。在这些情况下,传统的人工晶状体度数计算方案往往提供不准确的结果。本文旨在总结和推荐目前最常见的CRS方法:径向角膜切开术(RK)、光屈光性角膜切除术(PRK)、激光原位角膜磨圆术(LASIK)和小切口晶状体摘除(SMILE)。为此,将解释生物测量方法和IOL公式,并提出两者的组合。综上所述,很明显,最新一代的会聚公式在后CRS眼中具有良好的人工晶状体度数预测精度,尽管没有CRS眼的方法的预测精度尚未达到。射线追踪计算、术中像差测量和基于机器学习的公式有可能进一步改善crs后眼睛的屈光结果。
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引用次数: 0
The effects of loading ranibizumab on vision-related quality of life in the treatment of low-risk neovascular age-related macular degeneration. 在低风险新生血管性年龄相关性黄斑变性治疗中,加载雷尼单抗对视力相关生活质量的影响。
IF 2.5 Pub Date : 2022-07-18 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221108021
Hatice Daldal

Background: The loss of central vision plays a major role in the quality of life (QoL). This study evaluates the changes in QoL in the treatment of low-risk neovascular age-related macular degeneration (AMD).

Objectives: The aim of this study was to evaluate the changes in vision-related QoL in patients receiving intravitreal ranibizumab loading dose for low-risk neovascular AMD.

Design: A prospective study.

Methods: Forty-two eyes of 42 patients receiving ranibizumab injections for neovascular AMD were included in this prospective study. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) of the patients before the treatment, and 1 month after three loading doses were evaluated. Turkish version of the National Eye Institute 25-Item Vision Function Questionnaire (NEI VFQ-25 TR) was conducted. The changes of QoL scores through the NEI VFQ-25 TR questionnaire were compared with visual acuity (VA) and CMT measurements before the injections and 1 month after the loading dose.

Results: Forty-two patients (19 females and 23 males) were included in the study, and the mean age was 72.69 ± 7.12 years. After the treatment, a statistically significant improvement in BCVA (0.98 ± 0.44, 0.76 ± 0.42 logMAR, p < 0.001) and a significant decrease in CMT (357.90 ± 71.71, 274.50 ± 58.35 μm, p < 0.001) was observed. The QoL composite score was found to be statistically significantly higher after the treatment (64.27 ± 11.47, 68.56 ± 11.39, p < 0.001). General vision (p < 0.001), ocular pain (p = 0.025), near activities (p < 0.001), distance activities (p = 0.027), vision-specific mental health (p = 0.014), vision-specific role difficulties (p < 0.001), and peripheral vision (p = 0.046) were significantly higher after the treatment.

Conclusion: NEI VFQ-25 TR is a useful questionnaire for evaluating changes in visual functions and psychosocial characteristics of low-risk neovascular AMD patients before and after the injections.

背景:中心视力的丧失对生活质量(QoL)起着重要的作用。本研究评估低危新生血管性年龄相关性黄斑变性(AMD)治疗后生活质量的变化。目的:本研究的目的是评估低风险新生血管性AMD患者接受雷尼珠单抗玻璃体内负荷剂量后视力相关生活质量的变化。设计:前瞻性研究。方法:42例接受雷尼珠单抗注射治疗新生血管性AMD的患者的42只眼睛被纳入这项前瞻性研究。观察患者治疗前及三次负荷后1个月最佳矫正视力(BCVA)、黄斑中央厚度(CMT)的变化。采用土耳其语版国家眼科研究所25项视力功能问卷(NEI VFQ-25 TR)。将NEI VFQ-25 TR问卷中生活质量评分的变化与注射前和加载剂量后1个月的视力(VA)和CMT测量值进行比较。结果:共纳入42例患者,其中女性19例,男性23例,平均年龄72.69±7.12岁。治疗后,治疗后BCVA(0.98±0.44,0.76±0.42 logMAR, p p p p = 0.025)、近距离活动(p p = 0.027)、视觉特异性心理健康(p = 0.014)、视觉特异性角色困难(p p = 0.046)的改善有统计学意义。结论:NEI VFQ-25 TR是评价低危新生血管性AMD患者注射前后视觉功能和心理社会特征变化的有效问卷。
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引用次数: 0
Nanotechnology-based formulations to amplify intraocular bioavailability. 纳米技术为基础的配方,以提高眼内生物利用度。
IF 2.5 Pub Date : 2022-07-18 eCollection Date: 2022-01-01 DOI: 10.1177/25158414221112356
Konstantinos Kagkelaris, George Panayiotakopoulos, Constantinos D Georgakopoulos

Conventional drug delivery formulations, such as eye drops and ointments, are mainly administered by topical instillation. The topical delivery of ophthalmic drugs is a challenging endeavor despite the eye is easily accessible. Unique and complex barriers, serving as protection against extrinsic harmful factors, hamper therapeutic intraocular drug concentrations. Bioavailability for deeper ocular tissues of the anterior segment of the eye is exceptionally low. As the bioavailability of the active substance is the major hurdle to overcome, dosing is increased, so the side effects do. Both provoke patient poor compliance, confining the desired therapeutic outcome. The incidence and severity of adverse reactions amplify evenly in the case of chronic treatments. Current research focuses on the development of innovative delivery strategies to address low ocular bioavailability and provide safe and convenient dosing schemes. The main objective of this review is to explore and present the latest developments in ocular drug delivery formulations for the treatment of the pathology of the anterior segment of the eye. Nanotechnology-based formulations, that is, organic nanoparticles (liposomes, niosomes/discosomes, dendrimers, nanoemulsions, nanosuspensions, nanoparticles/nanospheres) and inorganic nanoparticles, nanoparticle-laden therapeutic contact lenses, in situ gelling systems, and ocular inserts, are summarized and presented accordingly.

传统的给药配方,如滴眼液和软膏,主要是通过局部滴注给药。眼部药物的局部递送是一项具有挑战性的努力,尽管眼睛很容易接近。独特而复杂的屏障,作为对外来有害因素的保护,阻碍了治疗性眼内药物浓度。眼前段深层眼组织的生物利用度非常低。由于活性物质的生物利用度是要克服的主要障碍,剂量增加,副作用也随之增加。这两种方法都会导致患者依从性差,限制了预期的治疗结果。在慢性治疗的情况下,不良反应的发生率和严重程度均匀地扩大。目前的研究重点是开发创新的给药策略,以解决低眼生物利用度问题,并提供安全便捷的给药方案。这篇综述的主要目的是探讨和介绍眼部给药制剂治疗眼前段病变的最新进展。基于纳米技术的配方,即有机纳米颗粒(脂质体、乳质体/盘质体、树状大分子、纳米乳液、纳米悬浮液、纳米颗粒/纳米球)和无机纳米颗粒、纳米颗粒负载的治疗性隐形眼镜、原位胶凝系统和眼植入物,进行了总结和介绍。
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引用次数: 4
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Therapeutic Advances in Ophthalmology
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