Clinical Optometry最新文献

Purpose: Somalia faces a substantial burden of avoidable eye disease, while access to primary eye-care services remains uneven and optometry training capacity is limited. This rapid communication reports the pattern of ocular conditions and service needs identified in a large service-based eye-care dataset from Mogadishu and outlines a practical implementation framework for strengthening the optometry workforce in Somalia.

Methods: This study was conducted as a retrospective review of routine service data from 2,890 patients evaluated during community- and hospital-based eye-care programs at Dr. Sumait Hospital, SIMAD University, Mogadishu, Somalia, between January and October 2025. Patients underwent routine eye assessments according to program protocols, including torchlight examination, visual-acuity testing, refraction assessment, intraocular-pressure measurement, and dilated fundus examination where indicated. Diagnoses and treatment/referral decisions were recorded and analyzed descriptively using frequencies and percentages.

Results: Among 2,890 examined patients, the most common ocular condition was conjunctivitis (n=1,231; 42.6%), followed by cataract (n=644; 22.3%) and refractive error plus computer vision syndrome (n=410; 14.2%). Other ocular conditions accounted for the remaining cases (n=605; 20.9%). Comorbid conditions included glaucoma with IOP >21 mmHg (n=176; 6.1%), diabetes (n=116; 4.0%), hypertension (n=98; 3.4%), and diabetic retinopathy (n=14; 0.5%). Treatment modalities consisted of medical therapy (n=1,789; 61.9%), prescription spectacles (n=595; 20.6%), surgical procedures (n=457; 15.8%), and referrals (n=64; 2.2%).

Conclusion: The findings indicate a high burden of preventable and treatable eye conditions and support the need for a structured optometry workforce in Somalia. We propose a three-component implementation framework: (1) workforce training (optometry and optical-technician education), (2) decentralized service delivery with referral pathways, and (3) sustainable multi-sector partnerships to expand access to vision care and strengthen long-term eye-care service delivery.

Purpose: Epithelial Basement Membrane Dystrophy (EBMD)-induced irregular astigmatism can lead to unreliable biometry and suboptimal refractive outcomes in cataract surgery patients. Herein, we assessed the use of superficial keratectomy followed by placement of cryopreserved amniotic membrane (cAM) to improve the ocular surface.

Methods: This was a single-center, retrospective study of consecutive patients with EBMD that underwent superficial keratectomy with adjunctive treatment with cAM between November 2022 and March 2025. Time to complete epithelialization, visual acuity (LogMAR), higher order aberration Root Mean Square (HOA RMS), cylinder power, and IOL biometry were assessed up to two months post-treatment.

Results: A total of 27 eyes of 21 patients with EBMD were included in the study and received cAM for a mean of 3.0 ± 0.4 days. Complete re-epithelialization was noted in an average 7.0 ± 4.7 days, with 96.3% (26/27) of eyes achieved epithelialization within 10 days. At the two month follow up, LogMAR VA slightly improved from 0.34 ± 0.21 to 0.31 ± 0.23 (p=0.42). HOA RMS significantly improved from 0.68 ± 0.53 μm to 0.42 ± 0.23 μm (p=0.006), and cylinder power significantly changed from 1.38 ± 0.75 D to 1.09 ± 0.71 D (p=0.022).

Conclusion: Superficial keratectomy with cAM led to complete re-epithelialization in the majority (96.3%) of cases within 10 days, which was associated with a significant change in HOA RMS, cylinder power and IOL SE. This treatment may be considered in patients prior to cataract surgery to return the cornea to healthy state and change the biometry input for IOL selection.

Introduction: Retinoblastoma is the most common primary intraocular malignancy in childhood and is typically diagnosed prior to the age of five. Late presentation beyond this age is uncommon and is often associated with delayed recognition, misdiagnosis, or restricted access to specialized eye centers.

Case presentation: Here, we document a case of an 8-year-old male child who presented with leukocoria, exotropia, and progressive deterioration of vision in his left eye. Initially, he was misdiagnosed with congenital cataract at a rural primary healthcare center, which delayed proper referral and management. Subsequent clinical examination and imaging revealed a significant intraocular mass with calcification, highly indicative of advanced Group D intraocular retinoblastoma. A differential diagnosis was conducted to rule out conditions that may mimic retinoblastoma. The affected eye was enucleated, and histopathology confirmed the diagnosis, demonstrating Homer Wright rosettes without optic nerve or extraocular spread. Because no high-risk features were found, additional therapy was not necessary.

Conclusion: This case report emphasizes the importance of maintaining awareness of retinoblastoma even in older children, as atypical or delayed presentations may occur. It also highlights the significance of timely recognition, successful referral, and comprehensive imaging with histopathological confirmation in guiding management and improving prognosis.

Digital eye strain is a cross-system condition that arises from interactions between visual physiology and digital displays. As the use of screens has grown in work, education, and everyday life, researchers have sought to describe this condition through symptom questionnaires (CVS‑Q, CVSS17, DESQ), measurements of the ocular surface and blinking, tests of accommodation and vergence, and, in related visual fatigue studies, neurophysiological methods such as electromyography and electroencephalography (EEG). Nevertheless, these methods have usually examined individual mechanisms separately. Interventions-ranging from lubricating the ocular surface and filtering blue light to ergonomic changes, task‑specific refractive correction, and scheduled micro‑breaks-have seldom been guided by a unified mechanistic framework. This review compiles evidence from 128 studies to identify six mechanistic domains relevant for clinical assessment. These include ocular surface and blink dynamics, accommodation and vergence, musculoskeletal load, device-related optical stress, cognitive load, and neural markers. A systematic search of PubMed/MEDLINE, Embase, Scopus, and Web of Science was carried out through September 30th, 2025, in accordance with PRISMA guidelines. Eligible studies included randomized trials, controlled interventions, cohort studies, and laboratory experiments, with methodological quality evaluated using the Mixed Methods Appraisal Tool. Results across pediatric, adolescent, working‑age, and presbyopic groups indicate that cognitive load reduces blinking and destabilizes accommodation. Binocular incongruence links visual effort with trapezius activation, and EEG markers can precede subjective fatigue. Interventions aligned with these mechanisms-such as ocular surface care, accommodative/vergence correction, ergonomic optimization, and micro‑break scheduling-are supported across all domains. The review proposes a mechanism‑based triage model to assist clinicians in prioritizing interventions based on the patient's exposure profile, breaking neuro‑ocular feedback loops, and preserving functional performance in individuals exposed to screens. The framework provides an actionable, mechanism‑first triage checklist for optometric practice.

Purpose: The aim of this study was to determine sex differences in preferred refraction for presbyopic correction in daily life, determined by the power of prescribed contact lenses.

Patients and methods: Near add power and preferred contact lens power were examined in participants aged from 20 to 79 years who were divided into three age groups (20-39, 40-59, and 60-79 years). The difference (Δ) in lens power (preferred corrective power of contact lens - full correction power) was compared between both sexes in each age group. Regression analysis was conducted to explore the relationship between Δ lens power and ocular parameters.

Results: A total of 768 men and 2314 women were enrolled in the study. Sex differences were prominent in the 40-59 year age group; namely Δ lens power was larger (P < 0.05) and visual acuity with contact lenses was lower in women than men (P < 0.05), whilst astigmatic errors and anisometropia were greater in men than women. Mean near add power was similar between both sexes in all age groups. Ocular surface parameters were worse in women compared with men, except for the Shirmer test. The results of regression analyses indicated that Δ lens power for women was associated with myopic spherical equivalent, astigmatic errors, anisometropia, near add power, contact lens power, and visual acuity with contact lenses. For men, Δ lens power was associated with myopic spherical equivalent, astigmatic errors, visual acuity with contact lenses, and tear break-up time. Age was not a significant factor for either sex.

Conclusion: The current results revealed sex differences in the preferred power of contact lenses for presbyopic correction for optimal daily living. The magnitude of under-correction was significantly greater in women than men aged 40 to 59 years.

Background: Tobacco use is a leading cause of preventable death worldwide, linked to various health issues, including cancers, cardiovascular diseases, and respiratory illnesses. It also adversely affects ocular health, increasing the risk of conditions like Age-Related Macular Degeneration and cataracts. The socioeconomic burden of smoking in the UK is significant, costing the National Health Service between £2.7 and £5.2 billion annually. Smoking cessation improves health outcomes and reduces healthcare costs. Optometrists are well positioned to identify smoking behaviours and offer cessation advice, yet evidence on current practice in Wales is limited.

Methods: This cross-sectional study used an anonymous online questionnaire to assess smoking-related practice behaviours among optometrists providing National Health Service optometry services in Wales. The survey captured demographic characteristics, training history, current approaches to smoking status identification and cessation advice, confidence levels, and perceived barriers to discussing smoking with patients.

Results: A total of 778 optometrists participated, with 96.3% reporting routine assessment of patients' smoking status. Most respondents felt confident discussing the impact of smoking on health; however, barriers like time constraints and perceived patient reluctance were common. Notably, those with longer professional tenures were more likely to view patient reluctance as a barrier (OR 1.46, 95% CI, 0.026-0.050, p < 0.001).

Conclusion: The findings suggest generally positive engagement with smoking cessation among optometrists in Wales, though barriers to patient engagement persist. While training appears to support more proactive practice, further work is needed to understand how optometric interventions influence smoking cessation outcomes and to explore why some practitioners perceive patients as hesitant to discuss health behaviours.

Purpose: The purpose of this study is to compare the macular thickness, foveal thickness, and retinal nerve fiber layer (RNFL) thickness in amblyopic eyes with those of fellow non-amblyopic eyes using spectral-domain optical coherence tomography (OCT).

Methods: A cross-sectional, observational study was conducted with amblyopic subjects from August 2022 to December 2024. A pilot study was carried out using simple random sampling technique. The study involved OCT-based measurement of macular, foveal, and RNFL thickness in amblyopic and non-amblyopic eyes using standardized imaging protocols. Data were analysed using appropriate statistical tests (paired and independent t-tests) based on normality results to compare values across eye types and gender.

Results: The results showed significantly higher macular, foveal, and RNFL thickness in amblyopic eyes compared to non-amblyopic eyes (p < 0.05), with no significant differences between anisometropic and mixed amblyopia subtypes. Gender had no significant effect on retinal thickness, except for superior RNFL thickness, which was higher in the anisometropic group of non-amblyopic eyes.

Conclusion: This study confirms that amblyopia involves both functional and structural retinal changes, notably in the macula and RNFL, regardless of type or gender. OCT proves valuable in detecting these changes, and future studies should focus on axial length correction and post-treatment outcomes.

Background: Dry eye disease (DED) is increasingly prevalent among young adults, largely driven by prolonged digital screen exposure. This study evaluated changes in ocular surface-related parameters following carboxymethyl cellulose (CMC) use in a young population with high digital screen exposure and explored baseline factors associated with anatomical change.

Methods: This prospective, single-arm interventional study enrolled 76 patients (120 eyes) aged 20-40 years with symptomatic DED and high screen time. Participants used preservative-free 0.5% CMC artificial tears four times daily for one month. Primary outcome was the change in central corneal epithelial thickness (CET) measured by Fourier-domain optical coherence tomography (OCT). Secondary outcomes included changes in non-invasive tear break-up time (NIBUT), central corneal thickness (CCT), and an analysis of predictors of anatomical improvement.

Results: One month of CMC treatment was associated with the statistically significant increase in central CET (from 52.79 ± 2.86 µm to 53.65 ± 2.92 µm; Δ = +0.86 µm, p < 0.001), with significant thickening observed across all corneal zones. Tear film stability also improved significantly, with NIBUT increasing from 6.52 ± 2.14 seconds to 7.89 ± 3.13 seconds (Δ = +1.37 seconds, p < 0.001). A strong negative correlation was found between daily screen time and baseline NIBUT (r = -0.72, p < 0.001). Binary logistic regression identified that older age within the cohort was a significant predictor of a positive anatomical response to treatment (adjusted OR = 1.15, p = 0.013).

Conclusion: In young adults with screen-time-associated DED, one month of CMC may be associated with changes in corneal epithelial thickness and tear film stability. The strong correlation with screen time underscores its role as a key risk factor.

Background: The swift development of our digital lives has led to a significant reliance on devices for everyday tasks, including education. The adverse effects of these devices on health are the subject of numerous studies and investigations. In this study, we assessed the relationship between answers to the Computer Vision Syndrome Questionnaire (CVS-Q) and the Schirmer tear test for the detection of symptoms of Dry Eye Disease (DED). Qualitative and quantitative data were combined to examine the association between electronic device use and the appearance of such symptoms in health science students in Saudi Arabia.

Methods: A cross-sectional study was conducted at King Saud bin Abdulaziz University for Health Sciences in Jeddah among 111 students from October 2023 to May 2024. DED symptoms were investigated in two steps: first, using the CVS-Q; and second, with the Schirmer tear test under topical anesthesia (1.0% tetracaine hydrochloride eye drops).

Results: The CVS-Q findings showed that a majority of students (58.9% of males and 86.8% of females) used tablets for online courses. The average distance at which the students placed their devices from their eyes was between 25cm and 45cm (58.9% of males, 65.79% of females). Most students (90.4% of men, 92.1% of women) used devices for more than five hours a day. Women reported more DED symptoms than did men, especially burning, dryness, and headache (63.16%), while the men mostly experienced dryness (47.95%). The CVS-Q indicated that 41.10% of males and 57.89% of females had dry eyes, while the Schirmer test indicated that 30.14% of males experienced greater dryness. A negative correlation was found between CVS-Q scores, Schirmer test results, and the influence of digital device use among students, by gender.

Conclusion: This study found that assessing DED-like symptoms via the link between the CVS-Q score and the Schirmer test may indicate the influence of digital device use among healthcare students.

Background: This pilot study investigates the effects of HIV and antiretroviral therapy (ART) on retinal vessel calibre in immunocompetent people living with HIV (PLHIV). Changes in vessel calibre in HIV-positive individuals may serve as biomarkers of iBRB integrity and endothelial dysfunction.

Methods: This was a cross-sectional study. Fundus photography was conducted in three groups: HIV-positive individuals on ART (HIV-ART, n=62 eyes), HIV-positive ART-naïve individuals (HIV-NART, n=20 eyes), and a comparison group of HIV-negative controls (n=82 eyes). We evaluated retinal vessel calibres (Arteriolar widths, venular widths, central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), arteriole-venule ratio (AVR) using VAMPIRE software. Association models included Multivariable regression, generalized estimated equations, and mixed effects models.

Results: The mean venular width was significantly greater among PLHIV compared to HIV-negative controls (p=0.003). Longer ART duration was associated with the narrowing of venules in the HIV-ART group, particularly affecting mean venular width (β=-1.40 μm, p=0.02) and CRVE (β=-4.44 μm, p=0.05). The generalized model showed longer ART duration was positively associated with wider arteriolar calibre (β=7.09 μm for CRAE, p=0.001). The HIV-NART group had a significantly higher odds of abnormal CRAE (OR=3.00; p=0.033) compared to controls.

Conclusion: This study provides a novel perspective on the probable link between retinal vessel calibre and systemic HIV factors, suggesting a possible relationship to systemic vascular health. All health clinicians should be aware of the potential for ART to influence retinal microvasculature. Future research should focus on larger cohorts and longitudinal studies to track changes in vessel calibre over time.