Clinical Optometry最新文献

Purpose: To investigate and compare the degradation of visual acuity (VA) in myopic presbyopes due to lens-induced astigmatism at near and at far distance.

Patients and methods: Fourteen corrected myopic presbyopes were recruited. VA (logarithm of the minimum angle of resolution) was measured binocularly for different conditions of lens-induced astigmatism: cylindrical powers of -0.25, -0.50, -0.75, -1.00, -1.50, and -2.00 diopters (and positive spherical power of half the cylindrical power) with two axis orientations (with-the-rule WTR and against-the-rule ATR) were added to their optical correction. Measurements were carried out at far and near distance both in photopic and mesopic conditions, and for high and low contrast (HC/LC) stimuli. The paired Wilcoxon signed-rank statistics test was used to evaluate difference between conditions.

Results: The measured VA as a function of the lens-induced astigmatism was described by regression lines in all investigated experimental conditions. The angular coefficients (slopes) of these lines represent the VA degradation, ie, the variation in logMAR corresponding to the addition of 1.00 diopters of cylindrical power. In photopic HC conditions, the VA degradation is significantly more pronounced at far distance than at near distance (0.22±0.06 diopters^-1 vs 0.15±0.05 diopters^-1, p = 0.0061 in WTR conditions; 0.18±0.06 diopters^-1 vs 0.12±0.05 diopters^-1, p = 0.0017 in ATR conditions), although VAs at near and at far with zero cylinder were similar (-0.14±0.10 vs -0.14±0.08, p = 0.824).

Conclusion: The better tolerance to lens-induced astigmatism blur at near than at far distance in photopic conditions with HC stimuli is tentatively attributed to a possible experience-mediated neural compensation associated to the tendency of the eye toward an inherent astigmatism at near.

Background: Glaucoma is one of the leading cause of global irreversible blindness if left untreated. Satisfaction is a multifaceted outcome based on sufficient information and encouragement from the practitioner and based on the medications' nature. Determining patients' satisfaction is essential to increase their courage in their long-time follow-up of medical care.

Objective: To assess Patients' satisfaction with topical anti-glaucoma medications and associated factors among glaucoma patients at Gondar University Tertiary Eye Care and Training Center, Northwest Ethiopia.

Methods: Hospital-based cross-sectional study was conducted from June 30 to August 27, 2021, among 395 glaucoma patients at Gondar University Tertiary Eye Care and Training Center. Data was entered into Epi info version 7 and exported to SPSS version 26 software for analysis. A Binary logistic regression model was used to determine factors associated with satisfaction with topical anti-glaucoma medications. Statistical significance was considered when p-value < 0.05.

Results: A total of 395 study subjects participated in the study with a response rate of 93.38%. The overall satisfaction with topical anti-glaucoma medication was 62.5% with 95% CI: (57.5-67.8%). The absence of ocular side effects (AOR=5.39, 95% CI: 2.35-12.37) and the absence of ocular surface diseases (AOR=4.12, 95% CI: 1.69-10.09) were significantly associated with patient satisfaction.

Conclusion: More than half of the study participants were satisfied with topical anti-glaucoma medications. The absence of ocular side effects and absence of Ocular surface diseases were significantly associated with patient satisfaction with anti-glaucoma medication.

Background: Late detection of ocular diseases negatively affects patients' quality of life (QoL), encompassing health status, psychological, financial, and social aspects. However, the early detection of eye conditions leads to rapid intervention and avoiding complications, thus preserving the QoL. This study assessed the impact of ocular diseases late detection on patients' QoL at multi-eye clinics based on questionnaire responses.

Methods: We developed an original Arabic-English questionnaire to assess the QoL of patients with ocular diseases referred from primary and secondary healthcare centers to tertiary hospitals. It covered preliminary data, patient perspectives on having lately detected ocular disease and treatment costs, and the impact of late detection on finances, social life, psychology, health status, and awareness of current initiatives. Logistic regression analysis was used to explore the associations between patient perspectives on having ocular diseases detected at a late stage and its impact on different domains. Multivariate logistic regression was applied with impact types of health status, psychological, financial, and social (dependent variables) and age, income levels, and hospital type (independent variables).

Results: Three hundred and eighty-eight responded, with 50% experiencing psychological effects, 27% health issues, 23% social impacts, and 23% financial burdens. Two hundred seventeen patients (56%) reported having ocular condition detected in late stage. Logistic regression analysis showed positive association with health status, social well-being, and financial effects (p < 0.05). Multivariate analysis revealed pronounced effects in patients ≤ 50 years, with income < 5000 SAR, and those visiting private clinics (p < 0.05). The social impact was greater in patients visiting private hospitals. Ninety percent of all patients emphasized the importance of increasing awareness for better QoL.

Conclusion: Significant associations were found between the late detection of eye diseases and their impact on QoL. Therefore, early detection and increasing patients' awareness of ocular diseases and treatment are essential.

Purpose: To develop a novel Vision Quality of Life (QoL) survey that emphasizes the amount of time a visual activity can be performed before symptoms occur.

Methods: The Vision Quality of Life with Time (VisQuaL-T) survey was developed with 10 daily activities and a list of common visual symptoms. Participants were recruited from a university campus. Participants were not excluded based on binocular impairments to obtain a normative dataset. Participants were instructed to denote when they first experience symptoms within certain time ranges. If participants did not engage in one of the 10 activities, they were instructed to denote "N/A". A composite score (range 0-3) was determined by only accounting for the questions that were answered.

Results: The normative data cohort had a sample size of 376 participants and the repeatability cohort had 54 participants. The normative, test, and retest datasets had a mean composite score of 2.47±0.54, 2.69±0.42, and 2.67±0.49 and 95% confidence interval of 2.38-2.71, 2.58-2.81, 2.54-2.80, respectively. There was good reliability and high correlation between the test and retest timepoints with an ICC of 0.825 and a Pearson correlation coefficient of 0.839 in the repeatability cohort. The normative data cohort showed good internal consistency with a Cronbach's alpha value of 0.803. Test and retest timepoints showed no statistical significance among the individual questions (p > 0.1).

Conclusion: A lower bound score of 2.4 can potentially be used to differentiate visually normal and symptomatic participants. Statistical analysis showed the survey is repeatable and reliable. Using time as a metric for assessing symptomology could be a useful method for identifying patients with QoL issues and for assessing effectiveness of binocular vision, accommodative, and eye movement treatments.

Purpose: To investigate the knowledge, attitudes, and practice towards Demodex blepharitis among optometrists in India.

Methods: The study was conducted in the form of an online survey using Research Electronic Data Capture (REDCap). The survey link was distributed via direct e-mail and social media platforms, and it was comprised of 20 questions divided into two sections. The first section focused on the practitioners' demographics and their views on the general health of the eyelid. The second section of the survey was specific and aimed at obtaining information on identifying and treating Demodex blepharitis, and was only completed by those respondents who looked for Demodex mites.

Results: The survey was completed by 174 optometrists. The prevalence of blepharitis in the general population was judged by the respondents to be 40%, whereas the prevalence of Demodex mites was estimated to be 29%. Interestingly, the prevalence of Demodex mites in people with blepharitis was estimated to be 30%. This estimated prevalence was substantially lower than that reported in the literature on the subject. 66% of participants believed Demodex mites to be a significant cause of ocular discomfort, whereas only 30% of participants would intervene to diagnose and manage Demodex blepharitis in their patients. Optometrists differed in their preferred method of diagnosis and management of Demodex infestation in eyelids.

Conclusion: The result of this survey suggests that Demodex blepharitis is a highly under-diagnosed condition in India, with nearly 30% of surveyed optometrists managing this condition. The study also observed a lack of awareness and consensus among surveyed optometrists with regards to diagnosis and appropriate treatment methods to control Demodex infestation in eyelids.

Purpose: Determining IOL power is an important step in achieving the desired postoperative refractive target, but this determination remains challenging, as currently the used formulas were developed using IOL power calculations derived from adults.

Patients and methods: This is a retrospective analytical study with the period of June 2018 to May 2019. All of the data were taken from medical records in referral tertiary eye hospital in Indonesia. All type of cataracts underwent uncomplicated surgeries and in-the-bag IOL implantation were included in this study, while aphakia, secondary IOL implantation, primary sulcus implantation, and history of ocular disorders were excluded. The data were analyzed using Wilcoxon sign-rank, paired t, and Kruskal-Wallis tests.

Results: Sixty-seven patients (106 eyes) were found to meet the inclusion criteria, average age was 7.35 ± 4.61 years (1.00 to 17.00 years). Average targeted refraction was 1.69 ± 2.06 D (-0.38-+6.99 D), and spherical equivalent (actual postoperative refraction) was -0.90 ± 1.45 D (-4.38 to +2.75 D). There was statistically significant difference between preoperative targeted refraction and actual postoperative refraction (p < 0.001). Mean absolute prediction error (APE) in general was 1.34 ± 1.18 D, 1.22 ± 0.88 D (in short eyes), 1.52 ± 1.37 D (in moderate eyes), and 0.69 ± 0.52 D (in long eyes) (p = 0.202). Mean APE in age group <7 years old was 1.27 ± 1.18 D and ≥7 years-old was 1.42 ± 1.19 D (p = 0.429).

Conclusion: SRK/T formula is fairly accurate in calculating IOL power in pediatric cataract surgery. Mean APE in this study was within the range of accurate mean APE in pediatric patients despite differentiated axial length and age.

Purpose: Uncorrected refractive errors after cataract surgery contribute to visual impairments. The aim of this study was to investigate the spectacle coverage rate (SCR) following cataract surgery and its relationship with socioeconomic factors in an urban city in Indonesia.

Patients and methods: This population-based cross-sectional study was conducted in 2015 in Jakarta. The former participants of the Rapid Assessment of Avoidable Blindness (RAAB) survey had a history of cataract surgery and met either of the following criteria: (1) wore spectacles with presenting visual acuity (PVA) 6/12 or (2) had PVA less than 6/12 regardless of spectacle use but achieved the best visual acuity (BVA) 6/12 with pinhole correction.

Results: Of the 2998 participants of the RAAB survey, 173 (5.6%) (252 eyes) had a history of cataract surgery, among whom 53 (86 eyes) met our inclusion criteria. The SCR was 69.8% and was associated with age group, household income level, education level, and physicians' recommendation of spectacle wear. Participants who were of nonproductive age (80%), had the highest household income level (88.2%), the highest level of education (87.5%), and had been recommended for spectacle use by their physicians (80.9%) demonstrated higher SCR. Participants with the highest household income had the highest SCR. Patients who had received a physician's recommendation showed a higher SCR and were 26 times more likely to wear spectacles (odds ratio [OR] 25.99, 95% CI 2.59-260.10).

Conclusion: There is an unmet need for refractive errors after cataract surgery. Factors such as household income levels and physician recommendations were predictive of spectacle wear.

Purpose: This project aims to describe the characteristics of patients with visual impairment referred from a tertiary academic hospital in Jordan for a comprehensive low vision evaluation and to study its impact on their functional needs.

Methods: A retrospective analysis of the records of 108 patients from the ophthalmology clinic at Jordan University Hospital over the period from January 2014 to December 2018 was performed. Gathered information included age, gender, clinical diagnosis, family history of ocular disease, and type of low vision aid prescribed and its impact on patients' functional needs.

Results: The mean age was 44.64 years (range 4-88). Most participants were in the 19-60 years age group (50.0%). Fifty percent of the participants were the offspring of consanguineous marriages. The main cause of visual impairment in this cohort was retinitis pigmentosa, followed by diabetic retinopathy. The majority of low vision aids were prescribed for near distance tasks, and reading spectacles were the most prescribed visual aid. Eighty-nine percent of patients reported functional improvement and retained their visual aids upon follow-up.

Conclusion: Retinitis pigmentosa was the main cause of visual impairment in this cohort of patients referred from a tertiary academic hospital for low vision assessment. We report a consanguinity rate of 50%. The overwhelming majority of patients reported functional improvement and retained their visual aids upon follow-up. Awareness and integration of low vision services into a multidisciplinary approach and improving referral protocols is essential to better address the needs of patients with visual impairment. Familial counselling regarding consanguineous marriages and emerging research to treat inherited retinal diseases should be pursued.