Clinical Optometry最新文献

Purpose: To investigate the wearing pattern and awareness about contact lens care among secondary school students in Kuala Lumpur.

Patients and methods: This is a cross-sectional study using self-administered validated questionnaires. A total of 2500 questionnaires were distributed to secondary school students (aged 13 to 18 years) from 5 selected schools in Kuala Lumpur. Descriptive statistics were used to analyze the results.

Results: A total of 987 completed questionnaires were returned and analyzed. The response rate was 39.5%. Mean age of respondents was 15.5±2.5 years with 54.6% females. Around 9.9% of the respondents were contact lens wearers with female majority (78.6%) and the main reasons for wearing contact lenses were cosmesis (42.8%) and comfort (32.7%). Majority (92.2%) were soft contact lens wearers and daily wear (monthly disposable) is the preferred modality. Nevertheless, 42.4% purchased their lenses from unlicensed vendors and 18.4% rinsed their lenses using tap water. Regarding contact lens care, more than 50% of the respondents were not aware about the correct way of handling contact lenses.

Conclusion: Soft contact lens wear is popular among the secondary school students in Kuala Lumpur but the level of practice and knowledge about CL care are unsatisfactory. Thus, health communication strategies and aggressive public ocular health education that can influence behavior changes in teenagers are needed to overcome these issues.

Purpose: To report the use of miniscleral contact lenses (MSCLs) with diameter of 14.7 mm for Asian eyes to improve vision in patients after penetrating keratoplasty (PKP) surgery.

Methods: Two patients with high corneal astigmatism post-PKP were evaluated for a contact lens fitting. Visual acuity, slit lamp, and anterior segment OCT findings before and after fitted the lens of 14.7 mm diameter were recorded.

Results: A Kmax of case 1 and 2 were 52.8 D and 76.9 D, respectively at the first visit. Both patients were successfully fit with MSCLs, showing adequate corneal clearance of over 250 μm with no corneal touch on OCT and sufficient limbal clearance and edge alignment. MSCLs use resulted in improved comfort and visual acuity of 20/30 or better.

Conclusion: MSCLs with diameter of 14.7 mm can be considered a safe and effective option for patients with highly steep corneas post-PKP surgery in Asian eyes.

Introduction: Worldwide, amblyopia prevalence among children is in the range of 0.13% to 12.9%. However, there are no known community-based data regarding amblyopia prevalence and its associated factors among school age children in Ethiopia. The aim of this study was to determine the prevalence of amblyopia and to identify factors associated with amblyopia among school age children in Bahir Dar city, northwest Ethiopia.

Methods and materials: A cross-sectional study among a school age community of Bahir Dar city was conducted from April 1 to May 29, 2018. Data were collected using a pretested structured questionnaire and checklist through interview and physical examination. Bivariable logistic regression was done, and variables with p value <0.2 were entered to multivariable logistic regression using SPSS 20. Variables with p value of <0.05 in the multivariable binary logistic regression were considered as significant predictors.

Results: In total 601 (94.8%) subjects participated. Amblyopia was prevalent in 6.5% of school age children in Bahir Dar city. The odds of being amblyopic among participants who had anisometropia >2D were about 9.3 times (AOR=9.35, CI: 2.86-30.60) more as compared to those who had no anisometropia. The odds of being amblyopic among participants having a refractive error >+5D hypermetropia were about 22 times (AOR=21.77, CI: 7.15-66.34) more as compared to participants who had no hypermetropia.

Conclusion: The prevalence of amblyopia among school age children at Bahir Dar city is higher than the World Health Organization cut point. Having anisometropia greater than 1 diopter, anisometropia >2 diopter, having anisometropia less than 1 diopter, having a history of strabismus, having a hyperopia of > +5 diopter, > +2 diopter, having a positive history of visual deprivation and having a positive history of strabismus in the family were the significant factors positively associated with amblyopia.

Introduction: Classification of color deficiency has required substantial time and expense with the static Farnsworth-Munsell and Innova Rabin tests. Therefore, dynamic color tests were developed for the Nintendo 3DS.

Methods: Fifteen color deficient patients and 17 age-matched normals performed Rabin color test in addition to PDI Check dynamic color games resembling Farnsworth-Munsell presentation (version 0.2.8) and 3-color iso-luminance gray (version 0.2.13).

Results: Tests of red, green and blue cone-deficient with the v0.2.8 had sensitivity/specificity/PPV of 92%/86%/92% protanopes, 78%/90%/88% deutanopes and 87%/50%/93% tritanopes. Version 0.2.13 had sens/spec/PPV of 78%/83%/78% red-cone, 100%/85%/80% green cone and 67%/78%/33% blue cone. Corresponding IntraClass Correlation (ICC) utilizing v0.2.8 were red-cone 0.22 (-0.02-0.60), green-cone 0.34 (-0.10-0.67) and blue-cone 0.38 (0.12-0.75). ICC for v0.2.13 was higher with protanope 0.62 (-0.07-0.87), deuteranope 0.64 (-0.09-0.88) and tritanope 0.31 (-0.07-0.70). The PDI Check color game took 65 seconds compared to 197 seconds for Innova Rabin.

Conclusion: The PDI Check color game quickly identifies patients with inherited color deficiencies.

Introduction: Eye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown.

Purpose: To investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant.

Methods: From PEI physician billing database, we identified all patients with an ocular diagnosis from 2010-2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients' residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown.

Results: Compared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9-14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7-23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3-9.3%) versus Charlottetown (4.1%, 95% CI 3.8-4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4-42.9%) versus Charlottetown (56.3%, 95% CI 55.6-57.1%). Similar trends remained throughout 2010-2012.

Conclusion: When optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation.

Trial registration: Not applicable.

Objective: To assess the agreement between retinoscopy and autorefractometry and between subjective refraction and both retinoscopy and autorefractometry in Congolese children.

Patients and methods: Fifty-four children (6-17 years old) were enrolled consecutively in this cross-sectional study. Refraction was evaluated before and after cycloplegia (1% cyclopentolate) with retinoscopy and autorefractometry. Readings were compared (paired t-test) and agreement assessed with Bland-Altman plots. Subjective refraction was compared with the two methods to determine which one provides better reference estimates for subjective refraction.

Results: Under cycloplegia, the spherical power was comparable between retinoscopy and autorefractometry (1.12 ± 1.37 D vs 1.22 ± 1.06D, P = 0.70), cylinder power was significantly more myopic on retinoscopy than autorefractometry (0.80 ± 1.10D vs -0.62 ± 0.66, P = 0.019), and SE was greater on autorefractometry than retinoscopy (0.91 ± 1.10D vs 0.72 ± 1.00D, P = 0.014). Retinoscopy and autorefractometry overestimated the power of spherical (P = 0.022 and 0.002, respectively) and cylindrical components (all P < 0.001). There was an agreement between retinoscopy and autorefractometry in measuring spherical (bias: 0.09 ± 0.16D; limit of agreement, LoA: -0.40 to 0.22D) and cylindrical power (bias: -0.18 ± 0.20D; LoA: -0.57 to 0.21D). Subjective refraction agreed with cycloplegic retinoscopy for determining SE power (bias: 0.11D; LoA: -0.51 to 0.73D).

Conclusion: Retinoscopy and autorefractometry can be used interchangeably in children for determining the power of spherical and cylindrical components. Cycloplegic retinoscopy is better than autorefractometry to obtain SE reference values for subjective refraction in children.

Purpose: This study aimed to observe intraoperative changes in macular hole (MH) form using intraoperative optical coherence tomography (iOCT).

Methods: A total of 10 eyes from 10 patients with MH who underwent vitrectomy using iOCT from May 2015 to October 2015 at the Yamagata University Hospital were retrospectively evaluated. Accordingly, 25-gauge pars plana vitrectomy using iOCT with internal limiting membrane (ILM) peeling and sulfur hexafluoride gas tamponade was performed on each patient. During surgery, MHs were observed using iOCT over four points, namely, before posterior vitreous detachment (PVD) formation, after PVD formation, after ILM peeling, and after fluid-gas exchange. Thereafter, basal MH diameter and minimum aperture MH diameter were postoperatively analyzed.

Results: Before PVD formation, after PVD formation, after ILM peeling, and after fluid-gas exchange, the mean basal MH diameters were 690.7 ± 268.4, 683.3 ± 274.2, 683.7 ± 269.5, and 668.3 ± 261.4 μm, while the mean minimum aperture MH diameters were 278.3 ± 165.2, 283.0 ± 170.2, 257.0 ± 127.8, and 188.0 ± 105.0 μm, respectively. The mean minimum aperture MH diameter decreased significantly after fluid-gas exchange (one-way repeated measures ANOVA, p < 0.05). None of the patients exhibited intraoperative closure of the MHs. However, MH closure was confirmed in all patients after the surgery.

Conclusion: None of the patients demonstrated intraoperative MHs closure. Accordingly, the minimum aperture MH diameter was the first change formation to close after fluid-gas exchange.

Introduction: Strabismus is a manifest deviation of the eye that exceeds the control of the fusional mechanism so that the eyes are misaligned under binocular conditions. Its prevalence reaches from 0.7% to 5% globally and 1.5% to 17.9% in Ethiopia.

Objective: This study aimed to assess the prevalence of strabismus and its associated factors among school-age children living in Bahir Dar city.

Methods: A community-based cross-sectional study was conducted from April 15 to May 25, 2019, in Bahir Dar city and a total of 632 participants were recruited using a multistage sampling technique. The data were collected with a face-to-face interview, Snellen acuity, prisms, pen torch, portable slit lamp, and ophthalmoscope. The collected data were entered into Epi Info version 7 and transposed to statistical package for social science version 20 for formal statistical analysis. Frequency (percentage), mean (standard deviation), tables and graphs were used to present the summary statistics. All variables with a p-value of less than 0.2 in bi-variable logistic regression were entered into multiple logistic regression and variables with a p-value of less than 0.05 were taken as significantly associated with strabismus. The strength of association between variables was shown with an odds ratio and a 95% confidence interval.

Results: A total of 611 children participated with a response rate of 96.7% and a mean age of 12.3 (±3.25). The prevalence of strabismus was 31 (5.0%), 95% CI: (3.45, 6.97). Family history of strabismus (AOR= 3.9 (95% CI: 1.71, 11.22)), hyperopia ≥ +3.00 diopters sphere (AOR=5.3 (95% CI: 2.01, 10.77)), and not with exclusive breastfeeding (AOR= 2.9 (95% CI: 1.14, 4.71)) were the only risk factors found for strabismus.

Conclusion: The prevalence of strabismus was 5% among children living in Bahr Dar city. A family history of strabismus, not with exclusive breastfeeding, and hyperopia ≥ +3.00 diopters sphere were associated with strabismus.

Purpose: Pollen and proteins attached to soft contact lenses (SCLs) exacerbate allergic conjunctivitis. The material of SCLs may affect the pollen adhesion to the SCLs. The factors associated with the number of pollen particles that are adherent to daily disposable SCL were investigated.

Methods: Pollen particles were experimentally exposed to the contact lens surface of 12 types of SCLs for 1 hour, and the SCLs were washed and rinsed with a physiological saline (n=10 for each SCL type). A total of 120 contact lenses were used in this study. The pollen particles attached to the SCL were observed and photographed under a microscope. The influence of the materials of the SCLs on the degree of pollen adhesion were investigated.

Results: The number of residual pollen particles attached to SCLs was in the range from 0-293/area of 200×200 µm. Percentage of pollen adhesion area of the surface of the SCL was in the range from 0.01% to 3.25%. There were significant differences in both the number and adhesion area of pollen particles among the 12 types of SCLs tested (P<0.0001 and P<0.0001, respectively). The number of pollen particles adhered to SCLs was significantly higher in colored SCLs than clear SCLs (unpaired t-test, p<0.001). The portion of pollen adhesion area was the lowest in the silicone hydrogel SCLs made with delefilcon-A (0.01 ± 0.02%).

Conclusion: Pollen adhesion in daily disposable SCLs depends on the characteristics and materials of the SCLs and was high in colored SCLs and lowest in delefilcon-A silicone hydrogel SCL. These results suggest that colored SCLs are not preferred during pollen season.

Purpose: This study aimed to estimate the magnitude of blindness, identify causes and associated factors among adult patients who visited a Tertiary Eye Care Training Center in Gondar, Ethiopia.

Methods: A hospital-based cross-sectional study was done at University of Gondar Tertiary Eye Care and Training Center. 708 participants (99.02% of invited) were recruited in this study with a systematic random sampling technique. Interviewer administered questioner and physical examination were applied to collect the data. Blindness was defined as the presenting visual acuity less than 3/60 in the better eye according to the World Health Organization criterion for visual acuity. Data was entered with Epi Info 7 and imported into SPSS for coding and analysis. Descriptive and analytical statistics were performed to analyze the entered data. Adjusted odds ratio was used to show the strength of the association and variables with a P-value of < 0.05 were considered as statistically significant.

Results: The proportion of blindness in this study was 14.3% (95% CI: 11.8-16.8). Low monthly income (AOR: 4.9; 95% CI: 1.4, 17.1), aged ≥ 60-69 (AOA: 2.9, 95% CI: 1.2, 7.6), and aged ≥ 70 years (AOR: 4.8; 95% CI: 1.9, 12.2) were positively associated with blindness. In this study, the leading cause of blindness was cataract (49.5%), followed by glaucoma (18.8%) and Age-related macular degeneration (AMD) (9.9%).

Conclusion: The proportion of blindness was 14.3%. Cataract, glaucoma and AMD were the common causes of blindness. Low monthly income and older age were significantly increased the risk of blindness.