Clinical Optometry最新文献

Background: Vision impairments are harder to diagnose among children, even though detection in childhood offers the biggest window for arresting potentially irreversible impacts on children's socioemotional and educational performance.

Purpose: This study sought to determine the prevalence of vision impairments in school-going children in Saudi Arabia and gap between the knowledge of visual impairments in school-going children and parental care-seeking practices relating to the effectiveness of school-based eye health screening programs, implementation challenges, and best practices.

Methods: The study uses a systematic review and meta-analysis conducted in December 2024 to January 2025.

Results: The present study analyzed primary 35 studies (n = 30,277). While estimates varied materially across regions and demographics, the most prevalent eye conditions affected school-going children were (un)corrected refractive errors and amblyopia. The prevalence of refractive errors, hyperopia, myopia, and astigmatism was 27.43% [18.14,39.20], 13.01% [4.00,33.00], 8.59% [3.53,19.42], and 15.35% [4.97,38.62], respectively. Amblyopia and strabismus affected 0.07 [0.04, 0.11] and 0.05[0.01,0.18] of the population, respectively. Even so, only 23.87% [10.91,44.54] of children already had glasses or contact lenses, despite more than 61.74, 95% [46.78, 74.77] of parents being open to children having glasses/lenses. Routine screening was estimated at in 38.85%, CI [28.99, 49.71.79]. Gerental awareness about eye health and specific vision impairments is inadequate, inconsistent, and broadly varied. School-based screening is equally basic or need to be officially established.

Conclusion: Children's immature ocular system offers good opportunities for intervening before reduced (or loss of) vision can materially affect quality of life, and education-work-life opportunities. With near universal primary school enrolment and continual engagements between children and education practitioners, schools offer an ideal institutional framework for early vision screening and intervention.

Purpose: To assess both the short- and long-term clinical outcomes following adjunctive treatment with shelf-stable, cryopreserved amniotic membrane (CAM) in patients with ocular surface disease (OSD).

Methods: This was a single-center, retrospective study of consecutive patients with OSD that underwent adjunctive treatment with shelf-stable CAM with 72-hour collagen shield or bandage contact lens followed by partial tape tarsorrhaphy at a single-center between January 2024 and March 2025. Corneal staining, symptoms, visual acuity (VA), and improvements in corneal sensitivity were assessed at 1 week (± 5 days) and last follow-up (12-24 weeks). Symptomatic improvement was defined as the resolution of at least one pre-treatment symptom at follow-up.

Results: A total of 29 eyes of 20 patients (mean age of 66.3 ± 9.1 years) with dry eye disease (n=14), neurotrophic keratopathy (n=5), and superficial punctate keratitis (n=10) were included in this study. At 3.9±2.9 days post-CAM placement, mean corneal staining score improved from 2.26±1.07 to 1.00± 0.91 (p<0.001), with 84.6% of eyes demonstrating improvement (mean change: 1.59 ± 0.77). Symptomatic improvement was observed in 92.3% of eyes. At 16.0 ± 2.8 weeks post-CAM, corneal staining significantly improved to 1.55 ± 1.13 (p=0.014). Trace or complete resolution of corneal staining was noted in 5/20 eyes (25.0%), and 12 eyes (60.0%) had improved staining. Symptomatic improvement was noted in 65.0% of eyes. There were no complications aside from two cases that noted irritation with collagen shield use and one case of irritation on the outer lid, which was attributed to the adhesive tape.

Conclusion: This preliminary data suggest that shelf-stable CAM may reduce both signs and symptoms of OSD as soon as four days post-treatment, with a lasting benefit observed for up to four months on average in some patients.

Background: Diabetes is a significant global health crisis, affecting approximately 828 million individuals worldwide, including 5.6 million in the UK and an estimated 212,000 in Wales. Diabetic Retinopathy (DR) is a leading cause of blindness in the UK and severely impacts the working-age population. Effective screening programs are vital for early detection and intervention, as prolonged diabetes increases the risk of developing DR. Since 2003, Diabetic Eye Screening Wales (DESW) has coordinated DR screening in Wales, but no studies have assessed grading agreement across the screening pathway.

Methods: This retrospective study analysed data from January 2021 to December 2023, involving 762 eyes from 486 patients referred across different grading levels. The RxMx system was used to classify retinopathy and maculopathy. The agreement between primary graders (DESW) and secondary graders (community optometrists) was compared, along with that between secondary and tertiary graders (hospital eye services). Percentage agreement and weighted Cohen's Kappa were calculated to assess interobserver reliability.

Results: The percentage agreement was 60.4% (weighted Cohen's Kappa of 0.423, indicating moderate agreement) between primary and secondary graders for retinopathy. For maculopathy, the agreement was 69.6% (weighted Cohen's Kappa of 0.42). Between secondary and tertiary graders, the percentage agreement for retinopathy was 61.5% (Kappa of 0.634, indicating substantial agreement), while for maculopathy, it was 75.0% (Kappa of 0.618).

Conclusion: The findings show fair agreement between primary and secondary graders and a substantial agreement between secondary and tertiary graders. These results highlight concerns regarding the reliability of current screening practices and suggest incorporating optical coherence tomography (OCT) to enhance grading accuracy. Additionally, implementation of personalised risk-based screening may help reduce the burden of DR on healthcare services, although consideration is necessary to prevent exacerbating existing health inequalities. An electronic system for shared imaging data could further improve screening reliability and grader competency assessment.

Purpose: Many ocular conditions that lead to blindness or visual impairment are preventable or treatable with early diagnosis and timely access to eye care. However, individuals in low-income areas often encounter significant barriers. This study assessed eye care management strategies and facility availability for patients in the uMgungundlovu district.

Methods: A cross-sectional, descriptive, quantitative, and retrospective study was conducted using an online questionnaire and record card reviews to assess management strategies in selected public eye care facilities in uMgungundlovu from January to December 2022. Cluster sampling across 27 facilities was employed. Data were analyzed with the Statistical Package for the Social Sciences (SPSS), with descriptive statistics presented in graphs and tables. Significant differences in optometrist prescribing patterns were identified, with a p-value of less than 0.05 considered statistically significant.

Results: A total of 1397 record cards were reviewed from seven facilities. Most patients received spectacles (n = 741, 53%), but 12.5% (n = 174) took six months or longer to receive them, and 12% (n = 167) did not receive them at all. Primary facilities occasionally supplied eye drops, requiring referrals to secondary hospitals for ongoing treatment. Statistically significant differences in optometrist prescribing patterns were found for spectacles (p = 0.039) and pharmaceutical treatments (p < 0.001) between primary and secondary care levels. Six out of seven representatives (85.7%) indicated that facilities lacked adequate ophthalmic equipment and qualified professionals. None of the facilities conducted data analysis, resulting in insufficient evidence-based information for planning.

Conclusion: The district faces healthcare access and management gaps. With 84% of the population relying on public services, a comprehensive eye care model (CEC) is essential for equitable access.

Purpose: This study evaluated the effects of orthokeratology (Ortho-K) lenses on corneal endothelial morphology, anterior segment health, myopia progression, and potential complications in children over 12 months, compared with single vision spectacles (SVS).

Methods: Seventy healthy myopic children aged 6-12 years, with 45 subjects in the Ortho-K group and 25 in the SVS group. Ortho-K lenses (Menicon Z) were worn overnight, while the SVS group wore single vision spectacles. Unaided VA, Spherical Equivalent (SE), axial length (AL), corneal curvature (FK), intraocular pressure (IOP), corneal endothelial morphology (endothelial cell density ECD, hexagonal cell percentage HEX, coefficient of variation COV), and central corneal thickness (CCT), Tear Break Up Time (TBUT) and corneal staining were assessed at baseline, 6 months, and 12 months.

Results: The Ortho-K group demonstrated significant improvements in unaided VA and reductions in SE at 12 months (p < 0.05). At 12 months, corneal curvature and axial length decreased significantly in the Ortho-K group but increased in the SVS group (p < 0.05). Corneal endothelial morphology remained stable in both groups over 12 months. Mild corneal staining and occasional infections were more frequent in the Ortho-K group, though not statistically different from the SVS group.

Conclusion: Ortho-K lenses are effective in controlling myopia progression in children, leading to significant improvements in VA, reductions in corneal curvature, and slowing of AL without significant adverse effects on corneal endothelial health. Minor complications were comparable to SVS wear, and all corneal changes remained within safe, reversible limits, underscoring the safety of Ortho-K treatment.

This report a case of intermittent esotropia in an 8-year-old boy with high axial myopia, which manifested within just three months of initiating 0.01% atropine treatment, despite minimal axial elongation. After discontinuation of atropine and introduction of multifocal soft contact lenses, normal binocular visual function was restored. This case emphasizes the importance of monitoring binocular parameters during low-dose atropine treatment for myopia control.

Purpose: To evaluate the clinical performance of a novel multifocal toric contact lens design combining a pupil-optimized multifocal design with a blink stabilized toric design featuring a single cylinder power and a choice of 3 add powers in a group of presbyopic patients with low to moderate astigmatism.

Patients and methods: A total of 171 subjects (105 myopic and 66 hyperopic) with refractive astigmatism of -1.00 diopter (D) to -1.75D with axes 90±15 or 180±15 degrees were fit with the study lenses in a two-week, multi-site prospective open-label clinical trial. The test lens was a multifocal toric soft contact lens with sphere powers of -1.00D to -4.00D and +1.00D to +4.50D, and a single cylinder power of -1.00D with axes 90±10 and 180±10 degrees. Outcome measures included logMAR Visual Acuity, subjective assessments of vision, comfort and handling, and fit metrics including orientation, rotational stability and fit success.

Results: Over 96% of subjects were fit in the optimized lens power with 2 pairs of lenses or less. After 2-weeks of lens wear, the mean binocular high luminance high contrast (HLHC) logMAR visual acuities were -0.085, -0.023, and 0.083, for distance (4m), intermediate (64cm), and near (40cm), respectively. Subjective vision, comfort and handling scores established statistically higher scores for both hyperopes and myopes compared to the pre-defined margin. The percentage of eyes with absolute lens orientation error ≤10° was over 94% and rotational stability ≤5° was over 98%.

Conclusion: The multifocal toric contact lens design provided clear and consistent vision for a variety of critical distance, intermediate and near tasks across varying lighting conditions and had a high rate of lens fit success.

Purpose: Visual skills and Oculomotor function deficits are common in children with Autism Spectrum Disorder (ASD), potentially affecting their development and quality of life. This study aimed to evaluate the effectiveness of vision therapy in visual perceptual skills and oculomotor function in children with ASD.

Patients and methods: This prospective interventional study was conducted using a convenience sampling method between February and May 2025. All children with a prior diagnosis of ASD who met the inclusion criteria were included in the study and underwent 45 sessions of vision therapy guided by the Developmental, Individual-Differences, Relationship-Based (DIR) model. Visual skills and oculomotor functions were assessed before and after vision therapy using the Wachs Analysis of Cognitive Structures (WACS) and the Northeastern State University College of Optometry (NSUCO) Oculomotor test, respectively. The paired t-test with Hedge's g effect size was used to compare pre and post vision therapy outcomes for normally distributed data, while the Wilcoxon signed-rank test with effect size r was applied for non-normally distributed variables. Analysis of Covariance was used to examine the effect of ASD severity on post-therapy outcomes while controlling for age and gender.

Results: Among the 42 children with ASD enrolled in the study, 36 completed all 45 sessions of vision therapy. Significant post-therapy improvements with large effect size were observed in visual perceptual skills (WACS) and oculomotor functions (NSUCO). Children with mild to moderate ASD showed greater improvements than those with severe ASD. Analysis of covariance revealed a significant effect of ASD severity on post-therapy outcomes: WACS (F(1,32) = 36.80, p < 0.001, R² = 0.55), saccades (F(1,32) = 36.75, p < 0.001, R² = 0.54), and pursuits (F(1,32) = 35.54, p < 0.001, R² = 0.54). Age and gender showed no statistically significant effects on the outcomes.

Conclusion: This prospective study provides preliminary evidence that DIR-guided vision therapy, particularly when combined with occupational and behavioral therapy, may enhance visual perceptual and oculomotor functions in children with ASD. However, randomized controlled studies with longer follow-up are needed to confirm these results.