Clinical Optometry最新文献

Introduction: Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy. Intravitreal anti-VEGF injections offer effective treatment, but they carry a risk of corneal epithelial detachment, particularly in patients who have recently undergone cataract surgery.

Case presentation: A 63-year-old male developed bilateral DME following cataract surgery with intraocular lens implantation. His best-corrected visual acuity (BCVA) was 0.15 in the right eye and 0.5 in the left eye. The patient underwent bilateral intravitreal injections of the anti-VEGF agent conbercept. During preparation for the injection in the left eye, corneal epithelial bleb formation was observed. The patient received corneal patching therapy, with complete epithelial healing observed by day 10 post-injection. This case underscores the need for vigilant corneal monitoring during and after intravitreal injections in diabetic patients with prior cataract surgery.

Conclusion: Close observation of corneal epithelial healing is crucial in diabetic patients receiving intravitreal injections, especially those with a recent history of cataract surgery. Careful pre-injection assessment and vigilant post-injection management are essential to mitigate this potential complication.

Objective: The aim of this report is to present a rare case of visually significant pseudoexfoliative deposition on an intraocular lens implant in a pseudophakic eye and describe the clinical characteristics, surgical approach, and histopathological characteristics.

Case presentation: We present the case of a 61-year-old male with a history of cataract surgery in the left eye who presented with blurry vision bilaterally. Examination of the left eye revealed a centered posterior-chamber intraocular lens implant (IOL) with extensive, visually significant pseudoexfoliative plaques growing over the entire IOL. The decision was made to perform right eye phacoemulsification and IOL implantation and left eye IOL exchange. The tissue specimens were subsequently processed using the classical histological technique of paraffin embedding. Intraocular surgery improved the visual acuity from 6/30 in the left and 6/60 in the right eye to 6/6 in both eyes at 3 months postoperative. The extracted implant was examined under a microscope and showed amyloid-positive deposits.

Conclusion: This case highlights the importance of comprehensive examination for pseudoexfoliation, even in patients with pseudophakia. Visually significant PEX deposition was first reported and should be managed with caution.

Purpose: Eye care services play an essential role in public health by addressing the needs of millions impacted by visual impairment and blindness annually. This study aimed to assess eye care services in Limpopo Province through Donabedian's framework, focusing on evaluating the availability and sufficiency of eye care infrastructure (structure), service delivery effectiveness (process), and patient outcomes.

Methods: Using an exploratory, descriptive qualitative design, data were gathered in June and July 2024, through in-depth individual interviews. Ten (10) district eye health coordinators were selected as participants using purposive sampling. Data were thematically analyzed with NVivo version 12, revealing three main themes: resources and organizational setup, service delivery and healthcare interactions, and results of care provided.

Results: The findings revealed the first theme as resources and organizational setup with sub-themes such as availability of eye care, services, resource allocation and, infrastructure, human resources and staffing. The second theme was service delivery and healthcare interactions with sub-themes such as service delivery and quality, perception, referral systems and inter-hospital coordination, health promotion and community outreach. The third theme was results of care provided with patient outcomes and satisfaction, technological advancements and patient care, challenges in achieving and public health goals as sub-themes. The findings indicate that challenges related to structure and processes significantly influence patient outcomes.

Conclusion: The study further highlights resources, service delivery efficiency, and referral timeliness as key factors essential for achieving optimal patient outcomes and contributing to the broader objective of universal eye health coverage.

With the global shortage of eye care professionals and the increasing burden of vision impairment, particularly in low- and middle-income countries, there is an urgent need for innovative solutions to bridge gaps in eye care services. Advances in artificial intelligence (AI) over recent decades have significantly impacted healthcare, including the field of optometry. When integrated into optometric workflows, AI has the potential to streamline decision-making processes and enhance system efficiency. To realize this potential, it is essential to develop AI models that can improve each stage of the patient care workflow, including screening, detection, diagnosis, and management. This review explores the application of AI in optometry, focusing on its potential to optimize various aspects of patient care. We examined AI models across key areas in optometry. Our analysis considered crucial parameters, including model selection, sample sizes for training and validation, evaluation metrics, and the explainability of the models. This comprehensive review identified both the strengths and weaknesses of existing AI models. The majority of image-based studies utilized CNN or transfer learning models, while clinical data-based studies primarily employed RF, SVM, and XGBoost. In general, AI models trained on large datasets achieved higher accuracy. However, many optometry-focused models faced limitations due to insufficient sample sizes-28% of studies were trained on fewer than 500 samples, 18% used fewer than 200 samples, and over half validated their models on fewer than 500 samples, with 38% validating on fewer than 200. Additionally, some studies that used the same data for both training and validation experienced overfitting, leading to reduced accuracy. Notably, 20% of the included studies reported accuracy below 80%, limiting their practical applicability in clinical settings. This review provides optometrists with valuable insights into the strengths and weaknesses of AI models in the field, aiding in their informed implementation in clinical settings.

Purpose: Cosmetic products, such as mascara, are known to adhere to the surface of silicone hydrogel soft contact lenses (SiHySCLs), potentially affecting lens performance and comfort. However, little is known about how different SiHySCL materials influence cosmetic adhesion. Recent reports suggest that the newly introduced lehfilcon A, a 2-week frequent replacement SiHySCL with Water Gradient and Celligent technology, may exhibit reduced lipid and cosmetic adherence. This study aimed to compare the adhesion of non-waterproof mascara to four types of 2-week frequent replacement SiHySCLs to better understand the impact of lens material properties on cosmetic contamination.

Methods: Four variants of SiHySCLs were utilized: samfilcon A, comfilcon A, senofilcon A, and lehfilcon A (with 12 lenses in each category). Non-waterproof mascara was randomly applied in a cross-pattern on the SiHySCL surface using the Latin squares method. Microscopic photography and ImageJ analysis software were employed to assess the proportion of mascara adhering to the SiHySCL surface following a one-hour soak in saline solution.

Results: The observed percentages of remaining mascara adhesion on the SiHySCL surfaces were as follows: samfilcon A (3.1±1.7%), comfilcon A (6.0±1.4%), senofilcon A (7.1±1.5%), and lehfilcon A (0.9±0.2%). Notably, lehfilcon A exhibited a significantly lower percentage of adhered non-water proof mascara compared to the other lenses (p<0.01).

Conclusion: This study demonstrates that SiHySCL material properties significantly influence mascara adhesion. Among the tested lenses, lehfilcon A showed the lowest level of mascara adherence, suggesting that its Water Gradient and Celligent technology may contribute to reduced cosmetic contamination. These findings provide valuable insights for individuals who wear makeup and use SiHySCLs, as well as for future lens material development.

Purpose: To compare vault measurement using Pentacam (Oculus, Germany) and two optical coherence tomography (OCT) instruments, Casia2 (Tomey Corporation, Japan) and RTVue (Optovue Inc. USA).

Methods: This comparative study recruited 95 eyes of 50 patients (mean age: 28.40±4.51, male/female 15/35) who underwent implantable collamer lens (ICL) implantation for myopia correction. All patients underwent a series of ophthalmic examinations at 3 and 6 months postoperatively, and the vault was measured using three instruments in the same order at both follow-ups. Intraclass coefficients (ICC) and Bland-Altman plots were used to analyze intra-equipment reproducibility and agreement between two instruments. A multivariate regression model was used to analyze the factors influencing the vault differences between the devices.

Results: The ICC values for intra-observer and inter-observer reproducibility of each piece of equipment were above 0.9. The ICC values and mean differences of vault measurement of Casia2 vs Pentacam, Casia2 vs RTVue, and RTVue vs Pentacam were 0.763 and 139.81 μm, 0.960 and -17.18 μm, 0.739 and 151.86 μm, respectively. An average of 96.2% of the points fell within the limit of agreement in the Bland-Altman plots. No difference was found in the inter-device agreement between the 3- and 6-month vaults. The difference in pupil diameter, anterior chamber depth, and anterior chamber angle could influence the vault difference between the Pentacam and the two OCT instruments.

Conclusion: All three instruments demonstrated good intra-equipment reproducibility. Casia2 and RTVue showed excellent agreement in the vault measurements. The Pentacam's vault readings were significantly lower than those measured by Casia2 and RTVue; therefore, their vault measurements were not interchangeable.

Objective: To examine the current status of research, identify key areas of interest, and explore emerging frontiers in the field of scleral lenses (SL) with the goal of informing and advancing further research in this field.

Methods: Bibliometric methods were utilized to retrieve SL-related literature published in the Web of Science and Scopus database from 2014 to 2024. Elements such as authors, country/region, institution, journal, and keywords were analyzed using CiteSpace information visualization and analysis software and Bibliometrix R package.

Results: A total of 506 articles were included. Among 117 countries/regions, the United States ranked first in the number of publications, followed by Spain and Australia. The distribution of research institutions showed that the Queensland University of Technology had the largest number of publications. Prof. Schornack, MM from Mayo Clinic had the highest number of articles. The research literature on SLwas published in 184 journals, of which Contact Lens & Anterior Eye and Eye & Contact Lens: Science and Clinical Practice were the most influential. Keyword clustering mainly included corneal topography, dry eye, limbal stem cell deficiency, ocular surface disease.

Conclusion: SL has emerged as a prominent area of investigation in the field of ophthalmology. In this study, the research field of SL from 2014 to 2024 was visualized and analyzed, providing a visualization of the development status of SL and revealing the trends and cutting-edge hotspots of SL-related research. SL exhibits a broad spectrum of applications and demonstrates considerable potential for enhancing both visual acuity and overall quality of life in patients afflicted with diverse ocular conditions. This study offers a comprehensive overview of current state of knowledge and understanding on SL for researchers and clinicians.

Purpose: To (1) assess rates of burnout in Fellows of the American Academy of Optometry and (2) assess associations among perceptions of workplace wellness support with lifestyle behaviors and health and wellness indicators (ie, anxiety, depression, stress, burnout, mattering to the workplace, and workplace is not stressful).

Methods: A survey collected sample characteristics and outcomes of interest from 321 Fellows.

Results: Thirty-two percent reported burnout. Females and those working in academia were significantly more likely to report being burned out at work. Compared to Fellows with low perceptions of workplace wellness support, Fellows with high perceptions of support were significantly more likely to report mattering to their workplace, a non-stressful workplace environment, and no burnout.

Conclusion: Promoting workplace wellness support may improve perceptions of mattering, stressful workplace environments, and rates of self-reported burnout in optometrists.

Purpose: Dry eye disease (DED) causes discomfort and potential damage to the surface of the eye, commonly managed with artificial tears. We assessed symptom relief, tolerability, and patient experience of a novel carboxymethyl-cellulose-based artificial tear formulation with trehalose and sodium hyaluronate (ABBV-444) in patients with DED.

Methods: This open-label, single-arm, single center study enrolled adult patients with baseline Ocular Surface Disease Index (OSDI) scores of ≥18 and ≤65. Patients were instructed to use ABBV-444 as often as needed but at least twice a day for 30 days. The primary endpoint was change from baseline in OSDI score at Day 30. Secondary endpoints were onset of action (change from baseline in current symptom survey [CSS] visual analog scale [VAS] scores over 5 minutes post administration on Day 1) and patients' experience (change from baseline in Patient Eye Drop Experience [PEDE] survey VAS scores at Day 30). Outcomes were assessed in the per-protocol (PP) population using descriptive statistics. A paired t-test was performed to calculate P-values.

Results: A total of 34 patients were included in the PP population. DED severity, measured by OSDI, significantly decreased by a mean (standard deviation; SD) score of 6.8 (15.0) points from baseline to Day 30 (P=0.006). Patients showed significant symptom improvement as early as 30 seconds after application, with mean (SD) CSS changes from baseline of -3.3 (10.3) points at 30 seconds (P=0.03) and -10.1 (10.6) points at 5 minutes post-dose (P<0.001). No adverse events were reported. PEDE scores averaged between 76.4 (36.7) and 85.7 (21.0) at Day 30.

Conclusion: Continuous daily treatment with ABBV-444 reduced DED symptom severity over 30 days and demonstrated rapid onset of action within 30 seconds post administration. These results suggest that ABBV-444 is a viable therapy for DED symptoms and support further investigation of longer-term treatment in multicenter trials.