Clinical Optometry最新文献

Purpose: Investigate the correlation between retinal vascular oxygen saturation and red blood cell parameters, hemorheology parameters in healthy adults.

Methods: The study recruited 120 healthy volunteers, and their elbow venous blood was drawn for examination of RBC parameters and hemorheology. The retinal oximeter measured the retinal vascular oxygen saturation, including retinal arteriolar oxygen saturation (SaO₂), venous oxygen saturation (SvO₂) and arteriovenous oxygen saturation Difference (AVD). The Pearson Correlation and Spearman's Correlation methods were used to analyze the correlation between the SaO₂, SvO₂, AVD and the red blood cell parameters,hemorheology parameters.

Results: The analysis yielded a statistically significant correlation between SaO₂ and BMI (r=0.184, P=0.044). SvO₂ was associated with Gender (r=-0.227, P=0.013), HGB (r=-0.190, P=0.038), HCT (r=-0.236, P=0.009), RDW-CV (r=0.228, P=0.012), WBRIH (r=0.019, P=0.037), WBVL 1/s (r=-0.194, P=0.034), WBVM 50/s (r=-0.206, P=0.024), WBVH 150/s (r=-0.211, P=0.021) and WBVH 200/s (r=-0.222, P=0.015). AVD was associated with Gender (r=-0.318, P=0.000), BMI (r=0.269, P=0.003), RBC (r=0.282, P=0.002), HGB (r=0.263, P=0.004), RBCSI (r=0.187, P=0.041), WBRIH (r=0.289, P=0.001), WBRVH (r=0.247, P=0.006), WBVL 1/s (r=0.220, P=0.016), WBVL 10/s (r=0.289, P=0.001), WBVM 50/s (r=0.323, P=0.000), WBVH 150/s (r=0.320, P=0.000) and WBVH 200/s (r=0.320, P=0.000). Gender (β=-0.297, P=0.005), BMI (β=0.208, P=0.023), PV (β=-0.304, P=0.000) were independent predictors of AVD.

Conclusion: Retinal vascular oxygen saturation is correlated with many RBC parameters and hemorheology parameters, indicating that RBC and rheological characteristics of peripheral blood may affect the transport and metabolism of retinal oxygen and are closely related to retinal microcirculation.

Translational relevance: The relationship between retinal blood oxygen saturation and red blood cell and hemorheology parameters confirmed the close correlation between ocular microcirculation and systemic blood circulation, which provided a prospective diagnosis and treatment strategy for microcirculatory-related eye diseases.

Purpose: To report on the development, evaluation, and acceptability of a simulated patient resource designed for teaching and assessment in low vision rehabilitation. The findings aim to inform possible future integration of this method into optometric education.

Methods: In response to COVID-19 restrictions, a simulated patient resource was developed to allow students undertaking the practical elements of postgraduate modules in low vision practice at Cardiff University to complete their training. Using a mixed methods case study approach, the evaluation examined perspectives from students, assessors, and simulated patients, to establish if there was a consensus of opinion on its use. The study did not seek to demonstrate educational impact or validate SiP against existing methods.

Results: Five assessors, five simulated patients and seven students completed evaluations. Both assessors and students broadly accepted the method for both teaching and assessment, with mean scores across all groups ranging from 7.3 to 9.6 on a 1-10 scale (where 1 indicated very poor acceptance and 10 excellent acceptance). The discussion and establishing magnification elements of the encounter were the least well accepted. Simulated patients found the level of preparation for the role adequate. There were no significant differences between Likert scores between assessors and students in both the teaching and assessment sessions. Thematic analysis of free text comments showed in the main positive responses, with all groups highlighting the benefits of detailed scenarios and pre-session training. The method was acceptable to the professional governing and accrediting body, the College of Optometrists.

Conclusion: Implementing a guideline-compliant simulated patient resource for high-stakes assessment requires significant time and resources. Our single cohort analysis indicates broad acceptance amongst assessors and students. Further research is needed to evaluate its educational impact across a wider range of scenarios and competencies while also further assessing its validity. Though simulated patients offer a viable alternative for teaching and assessing low vision practice, real patient encounters remain preferable.

Purpose: Factors including age, refractive error, and luminance can affect pupil size and may influence the performance of multifocal contact lenses (MFCLs). This post-hoc analysis aimed to investigate correlations between pupil size and vision performance of a 3-Zone Progressive™ design, daily disposable silicone hydrogel (kalifilcon A) MFCL.

Methods: Habitual MFCL wearers aged ≥40 years were enrolled in a 3-week, single-arm, bilateral, open-label study to assess near, intermediate, and distant vision performance. Pupil sizes were recorded at dispensing, along with binocular high-contrast visual acuity (VA) by logMAR. VA was assessed at 1- and 3-weeks' follow-up for distance, intermediate, and near vision, and participants rated vision performance using a 0-100 scale (100=most favorable) at both these follow-ups. Responses with score ≥50 were considered favorable. Pearson correlation coefficient (r) was used to determine the correlation significance.

Results: Pupil size ranged from 2.0 mm to 7.0 mm. Mean logMAR VA was -0.009, 0.046, and 0.114 (1 week), and -0.012, 0.046, and 0.115 (3 weeks) for distance, intermediate, and near vision, respectively. Statistical analysis of the VA distribution found no significant correlation between VA and pupil size after 1 week of MFCL wear for distance or near vision (r²=0.003 and 0.006, respectively; both p≥0.05), and a weak but statistically significant correlation between intermediate VA and pupil size (r²=0.017; p<0.05). No correlations were observed after 3 weeks for any distance (all p≥0.05). Participants rated subjective vision highly (84.0±19.9, 89.2±11.8, and 82.5±18.5, respectively at 1 week, and 84.6±18.0, 89.3±12.6, and 84.2±17.9, respectively at 3 weeks). Responses were favorable at both visits (p<0.05). Correlations between vision rating and pupil size were not significant at either visit (p≥0.05).

Conclusion: The kalifilcon A daily disposable silicone hydrogel MFCL delivers stable VA and significantly favorable (p<0.05) ratings at all distances for patients with a wide range of pupil sizes.

Introduction: Anxiety and depression in optometry students are becoming acknowledged as critical concerns, especially given the rigorous demands of their academic curricula. This study aimed to identify the severity of anxiety and depression and their association with socio-demographic, academic, and clinical variables among optometry students in South Africa.

Methods: This study was a descriptive, quantitative, and cross-sectional study involving 171 optometry undergraduate students at a university in South Africa. Data was gathered using the Generalized Anxiety Disorder (GAD-7) scale, the Patient Health Questionnaire (PHQ-9), and a questionnaire encompassing socio-demographic, student, and clinical variables. Students who agreed to participate and provided written consent were recruited to participate in this study. The association between socio-demographic, student, and clinical variables with total GAD-7 and PHQ-9 scores was determined using the Mann-Whitney U-test and Kruskal-Wallis test where applicable.

Results: More than half of the participants were female (n=63; 63.2%), identified as belonging to the Pedi ethnic group (n=96; 56.1%), single (n=118; 69%), and lived with both parents (n=94; 55.0%). Over half (51.4%; n=88) of the participants reported high levels of anxiety, while two-thirds (n=141; 67.8%) exhibited high levels of depression. Variables such as academic level, receipt of financial bursary, and prior professional psychological support had a significant (p < 0.05) association with total GAD-7 and PHQ-9 scores. Correlation analysis revealed a strong positive correlation between total GAD-7 and PHQ-9 scores (r = 0.77, p < 0.001).

Conclusion: Addressing the high levels of anxiety and depression among optometry students necessitates a comprehensive strategy that encompasses the augmentation of mental health resources, fostering resilience, and creating supportive environments. By implementing these strategies, educational institutions can enhance the mental health and well-being of optometry students, ultimately leading to improved academic outcomes and professional readiness.

Purpose: Contact lens dropout is known to occur frequently in presbyopic patients. The purpose of this study was to assess the rate of patient-reported success, defined by willingness to continue lens wear after the study, when fitting previous presbyopic contact lens dropout patients with a single-use multifocal contact lens.

Methods: Presbyopes who had previously discontinued contact lens wear due to poor vision were recruited and fit with delefilcon A multifocal contact lenses. Participants were prescribed lenses following the fitting guide, wore lenses for 1 week to allow for adaptation, and returned for a follow-up visit. After confirmation of optimized lens powers, lenses were dispensed for one month of wear. A final visit was completed to assess vision and respond to survey questions, including 0-100 visual analog scale (VAS) surveys of lens wear experiences. Participants also scored their likelihood of continuing with study lenses upon study completion and whether the participant would recommend the study lenses to a friend. Success with fitting the study lenses was defined as those participants who selected "very likely" or "likely" to continue wearing the study lenses after the conclusion of the study.

Results: Twenty-five participants completed all study visits. Median (Interquartile range) binocular LogMAR acuity with the study lenses was -0.10 (0.16) at distance (20/16 Snellen acuity equivalent) and 0.00 (0.12) at near (20/20 Snellen acuity equivalent). The median (IQR) satisfaction score was 84 (29.75) on a scale of 0-100. Eighty percent of the participants said they were very likely or likely to continue wearing the multifocal lenses after the conclusion of the study. All twenty-five of the participants said they would recommend the study lenses to a friend.

Conclusion: The objective and subjective findings of this study suggest that presbyopic contact lens dropouts can be refit with the study multifocal contact lens.

Purpose: To investigate the relationship between tear film stability and visual fatigue using two objective measurements: the non-invasive tear film break-up time (NI-BUT) and the binocular fusion maintenance (BFM) test.

Methods: Eleven young adult volunteers (age [mean ± standard deviation], 20.7 ± 1.4 years) participated in this study. The NI-BUT was determined using the distortion of the mire ring. BFM was assessed by measuring the transmittance of liquid crystals placed in front of the subject's non-dominant eye when binocular fusion was broken, and non-dominant eye was shifted to heterophoric. The volunteers were administered the NI-BUT and BFM before and after a 30-minute visual task.

Results: NI-BUT (pre vs post: 9.12 ± 1.00 s vs 5.69 ± 3.11 s) was significantly shorter in the post-visual task than in the pre-visual task (P = 0.011). BFM (0.95 ± 0.09 vs 0.75 ± 0.16) was significantly lower in the post-visual task than in the pre-visual task (P = 0.012). The change in NI-BUT was significantly and positively correlated with the change in BFM (R² = 0.385, P = 0.042).

Conclusion: These objective findings support the association between tear film stability and visual fatigue.

Objective: The purpose of this study was to compare the near add power among glaucoma patients using prostaglandin F (FP) receptor agonists and fixed combination therapies and controls.

Methods: Participants were aged from 40 to 69 years and phakic with visual acuity of 20/25 or better, and included 2200 controls, 784 patients using FP receptor agonist for primary open-angle glaucoma (FP), and 412 patients using fixed combination (Combi). Each group was further divided into three groups based on age: those aged 40 to 49 years (40s), those aged 50 to 59 years (50s), and those aged 60 to 69 years (60s), and the near add power at 30 cm and various ophthalmic factors were compared.

Results: The mean near add power for the control, FP, and Fixed combination groups were 1.21±0.66, 1.88±0.75 and 2.04±0.81 for those in their 40s, 2.16±0.59, 2.48±0.55 and 2.70±0.53 for those in their 50s, and 2.74±0.38, 2.89±0.35 and 2.97±0.17 for those in their 60s, respectively. Significant differences were found between all pairs of groups in all age groups (P<0.05, t-test). The odds ratios for near add power reaching 3.00 D were 4.8 (95% CI, 4.0-5.7) for glaucoma, 2.5 (2.1-3.0) for FP, and 6.0 (4.7-7.9) for the Fixed combination group, all of which were significant.

Conclusion: The mean near add power of the Fixed combination group was higher than that of the control and FP groups for the same ages, indicating a faster progression of presbyopia.

Drug-induced uveitis is a recognized but often underdiagnosed cause of ocular inflammation, with an increasing number of systemic and topical medications implicated. The clinical presentation is highly variable, ranging from anterior to posterior uveitis, often mimicking autoimmune or infectious etiologies. This review examines the mechanisms underlying drug-induced uveitis, including immune-mediated reactions, direct toxicity, and idiosyncratic responses. A comprehensive evaluation of specific drug classes is provided, covering topical agents (prostaglandin analogues, brimonidine), intravitreal therapies (anti-VEGF agents, triamcinolone and vancomycin), antimicrobials (cidofovir, rifabutin), bisphosphonates, tumor necrosis factor (TNF) inhibitors, immune checkpoint inhibitors, BRAF and MEK inhibitors, and vaccines. For each category, the review discusses the pathogenesis, frequency of occurrence, clinical presentation, diagnostic approach and management strategies. Diagnosing drug-induced uveitis requires a high index of suspicion and a systemic drug history. A structured approach to differentiating drug-induced uveitis from other inflammatory and infectious causes is outlined, emphasizing the key clinical and imaging features that aid in diagnosis. The expanding list of medications associated with uveitis underscores the need for heightened awareness in patients presenting with ocular inflammation. Establishing causality requires a careful balance of clinical pattern recognition, temporal correlation, and structured assessment tools. Understanding the pathogenesis of drug-induced uveitis not only informs treatment decisions, including whether to discontinue or modify therapy, but also helps refine guidelines for drug safety monitoring. As novel therapies, particularly in oncology, immunomodulation and vaccination, continue to evolve, ongoing research and robust pharmacovigilance efforts will be critical in identifying risks, improving diagnostic accuracy, and optimizing patient care.