Journal of Optometry最新文献

Adherence plays a critical role in the success of amblyopia treatment. Traditional approaches, such as occlusion therapy, often result in poor adherence, leading to suboptimal visual outcomes. Emerging home-based digital tools, such as video games, virtual reality, and movies, offer promising alternatives by increasing patient engagement and potentially enhancing treatment efficacy. This study aimed to evaluate adherence rates associated with emerging home-based interventions, identify key factors influencing adherence, and compare their effectiveness with that of traditional approaches. A comprehensive systematic literature review was conducted across PubMed, MEDLINE, Cochrane, Scopus, and Web of Science to identify eligible studies reporting adherence rates for home-based digital amblyopia therapies. A total of 27 studies were included, involving 1.727 participants aged between 3 and 35 years. The pooled adherence rate was 74.2% ± 21.9%, with a median of 80.5% (P25 = 59; P75 = 88.1). Movies achieved significantly higher adherence (84% ± 12.3%) than video games (68.4% ± 24.4%, p = 0.038). Adherence was higher in younger participants (p = 0.023) and was reduced with longer treatment duration (p = 0.005). Higher adherence correlated with greater visual acuity improvements (p < 0.001), while the association with stereopsis was weaker and not statistically significant (p = 0.095). These results suggest that emerging amblyopia therapies achieve adherence rates exceeding 70%, higher than traditional treatments. These findings emphasize the importance of age-appropriate and engaging treatment strategies to enhance both adherence and visual outcomes.

Purpose: To characterize diurnal variations in scleral morphological parameters and assess correlations between lifestyle habits and variations in these parameters.

Methods: This prospective observational study enrolled healthy adult participants. Corneo-scleral morphology was evaluated at five standardized timepoints (9:00, 11:30, 14:00, 16:30, and 19:00) using the Pentacam HR corneo-scleral profile module. Participants completed a lifestyle questionnaire assessing sleep patterns and daily routines. Primary outcome measures included sagittal height (SH) and bulbar slope (BS), with coefficients of variation (CV) across the day calculated for each parameter.

Results: A total of 109 eyes from 55 participants (mean age: 32.6 ± 12.6 years; 37 female, 18 male) were analyzed. Repeated-measures analysis revealed no statistically significant diurnal variations in scleral parameters (all p-values ≥ 0.069). Secondary analysis identified some significant correlations between CVs of scleral parameters and specific lifestyle habits: washing face in the morning (minimum BS, p=0.007), having breakfast (minimum SH, p≤0.016), drinking coffee in the morning (SH p≤0.040), drinking coffee during the day (mean SH p=0.016), and screen exposure before bedtime (mean SH p=0.036). Statistically significant sex-related differences were observed in minimum BS of the right eye (p=0.020) and astigmatic SH (p=0.042).

Conclusions: The corneo-scleral profile of healthy eyes remains stable throughout the day, with no significant diurnal changes in SH or BS. Although certain lifestyle habits showed trends toward association with scleral variation, definitive conclusions cannot be drawn.

Purpose: To evaluate the efficacy of multifocal soft contact lenses (MFSCLs) and defocus incorporated multiple segments lenses (DIMS) to limit myopic progression in children with high myopia.

Methods: This retrospective study included 249 children (aged 8-16 years) with high myopia (non-cycloplegic spherical equivalent [SE] -6.00 to -10.00 D, astigmatism < 2.00 D). Selected participants were those treated with DIMS (N=81), MFSCLs (DISC, N=60), or single-vision spectacles (SVLs, N=108, control group). Myopic progression was assessed based on the 1-year SE change from baseline, categorized as slow (<-0.25 D), moderate (-0.25 to -0.75 D), or rapid (> -0.75 D). The multiple linear regression evaluated the association between myopic progression and characters.

Results: No significant differences in age, SE, or sex were found among the groups at baseline. At one year, the magnitude of myopic progression was significantly smaller in the DIMS (-0.47 ± 0.39 D, 33.8 %) groups and MFSCLs (-0.39 ± 0.47 D, 45.1 %) compared to the SVL group (-0.71 ± 0.54 D; P < 0.001). The proportion of slow progressors was 28.40 % (SVLs), 39.81 % (DIMS), and 51.67 % (MFSCLs). Age was associated with the myopic progression in the DIMS (β=0.108, P < 0.001) and SVLs (β=0.120, P < 0.001) group, but not in the MFSCLs (P=0.776) group. MFSCLs were preferred for children under 12 years, while DIMS and MFSCLs showed comparable efficacy for those over 12 with high myopia.

Conclusions: Both MFSCLs and DIMS have demonstrated efficacy in delaying myopic progression in children with high myopia. The MFSCLs will give children better control up to the age of 12; after that, they remain a good option.

Purpose: To develop and validate a nomogram model for predicting axial elongation in children with myopia undergoing orthokeratology (ortho-k) treatment.

Methods: A cohort of 111 myopic children who received ortho-k between 2014 and 2016 and consistently wore lenses for at least 6 years was analyzed. Right eyes were used as the model group, left eyes as the validation group. Demographic and ocular parameters were collected. A multivariable logistic regression was applied to model group data to construct the nomogram. Discriminative ability was assessed using the concordance index (C-index), calibration plots, and decision curve analysis (DCA). Statistical analysis was conducted in R version 4.2.3, with p ≤ 0.05 considered significant.

Results: Mean axial elongation in the first year was 0.14 mm (95 % CI: 0.12-0.17 mm); total elongation over six years was 0.83 mm (95 % CI: 0.75-0.91 mm). After adjusting for multicollinearity, age (β = -0.134, p < 0.001), gender (β = -0.226, p = 0.011; males as reference), baseline axial length (β = 0.950, p < 0.001), and first-year axial elongation (β = 1.714, p < 0.001) were independently associated with axial length after six years. The model yielded a C-index of 0.93 (95 % CI: 0.88-0.99) in the model group and 0.80 (95 % CI: 0.80-0.96) in the validation group. DCA showed clinical benefit.

Conclusions: Ortho-k effectively slowed axial elongation over six years. The nomogram reliably predicts whether axial length will exceed 26.0 mm after long-term ortho-k treatment.

Purpose: To assess how different corneas respond to a standardized structural weak spot in different sizes and locations using the finite element method depending on their initial geometry.

Method: The corneal meshes of 5 randomly selected emmetropic SyntEyes with different biometry and optical properties were generated using MATLAB and ANSYS. To simulate keratoconus development, a local stiffness reduction of up to 60 % of the original value was implemented in three locations (central, 1mm, and 2mm inferior) with a diameter of 2mm for each cornea. From this, tangential corneal power maps were calculated.

Results: Local weakening causes the formation of a conical deformation at the site of the weak spot and, for an inferior weak spot, a superior flattening. At the center of the weak spot, the cornea becomes thinner by 50μm, while the maximum anterior curvature increased by an average of 51.76±1.38D and the posterior curvature by an average of -7.45±0.15D for the central keratoconus. The anterior surface area increases by 0.88±0.29 mm² and 0.85±0.03 mm² for a central and inferior keratoconus, respectively. The corresponding values for the posterior surface were 1.10±0.03 mm² and 1.06±0.03 mm².

Conclusion: The shape of a keratoconic cornea is not only determined by the response to a local structural weakening, but also by its original corneal shape. This understanding may help enhance early detection and monitoring techniques for keratoconus progression.

Purpose: To assess the feasibility of a novel method for simulating a Rigid Gas Permeable Contact Lenses (RGP-CL) fitting using 3-D printed sclero-corneal surfaces (SCSs).

Methods: The experiment involved the fabrication of two resin SCSs with biconic corneal geometry and the participation of 22 optician-optometrists as observers. Participants compared the fluorescein patterns of three RGP-CL fitted on each SCS with theoretical patterns generated through computer simulation. To standardize visualization, comparisons were conducted through a multiple-choice questionnaire composed of 6 questions. Each question presented one main fluorescein pattern (either theoretical or experimental) and four additional patterns obtained using the other technique. Optometrists were required to select the fluorescein pattern more similar to the main pattern. A statistical analysis was performed to evaluate the accuracy of the comparison between the two methods.

Results: The surface quality of the printed SCSs was sufficient to produce consistent and interpretable fluorescein patterns. In all questions, at least 70 % of optometrists selected the correct pattern. In four questions, more than 90 % identified the correct pattern, and in one question accuracy reached 100 %. The correct option was always the most frequently chosen, with a significantly higher rate than the second most selected option (p = 0.05).

Conclusions: The ability of most optometrists to correctly identify patterns suggests that, even without polishing, 3-D printed SCSs can simulate fluorescein patterns closely resembling theoretical ones. This approach shows promise as a supportive tool for training in RGP-CL fitting.

Purpose: This study aimed to assess the efficacy of two formulations of lubricant eye drops, containing a gelling agent or not, compared to normal saline. This was a prospective, randomized, double-blinded, three-group, parallel, interventional single-site clinical study.

Methods: Forty-five Gazan participants with moderate to severe dry eye disease (DED) were randomized into three groups of 15 participants each. Each group received either normal saline eye drops or lubricant eye drops. For each group, one drop was applied three times a day for six weeks. All participants applied the normal saline solution for the first week. The outcomes assessed were the Arab-ocular surface disease index (Arab-OSDI) scores and clinical tests including tear break-up time test (TBUT), corneal fluorescein staining (CFS), and lissamine green conjunctival staining (LGS) at weeks 1, 3, and 6.

Results: Both formulations exhibited a significant improvement in Arab-OSDI scores from visit 2 at follow-up time points (p < 0.001). TBUT, CFS, and LGS showed an improvement in both the SH 0.15% and SH 0.38% groups (p < 0.05). SH 0.38% had a greater improvement in the proportion of evaporative dry eye from visit 2 to visit 5 (p = 0.001).

Conclusion: Lubricant eye drops are beneficial for alleviating the symptoms of dry eye. There was no noticeable difference in the effectiveness of these formulations in relieving symptoms and changing any of the objective signs that were assessed. Improved EDE outcomes occurred with SH 0.38% eye drops, observed between visit 2 and visit 5.

Purpose: Playing videogames involves prolonged screen exposure, potentially leading to ocular discomfort and altered eye blink behavior. However, until date, only action video game genres have been considered for their effects on blink rate and amplitude, compared to non-action video games. This study explored blink rate, amplitude, and regularity across video game genres and the influence of specific in-game scenes on blinking.

Methods: Twenty casual gamers (mean age 26.2 ± 4.6 years) were enrolled in the study. Blink parameters were recorded using the Pupil Core eye tracker while watching and playing three video games in random order: Call of Duty (Action), Sackboy (Adventure), and FIFA 19 (Sports). Blink rate, amplitude and regularity were analyzed during baseline, gameplay viewing and active play sessions. Blink parameters during high- and low-dynamic in-game scenes were examined.

Results: Blink rate significantly decreased during both gameplay viewing and active play compared to baseline (p < 0.001). The lowest blink rate was observed in action video games, but differences among genres did not reach statistical significance. No significant differences were found in incomplete blinks across conditions. Blink regularity was significantly different between game genres, with sports games showing the highest irregularity. Participants blinked less frequently during high-dynamic scenes across all genres (p = 0.007).

Conclusions: Blink rate was similarly reduced in all gameplay situations, although action games had the largest impact on blink irregularity. Incomplete blinks did not differ between genres. Blinks tended to occur less during high-dynamic in-game scenes across videogame genres, with potential implications on ocular discomfort and dryness.

Purpose: A novel combination device for objective and subjective refraction was assessed regarding repeatability, reproducibility, validity, vision quality, and timing for experienced and untrained examiners.

Methods: Six examiners (each three trained optometrists and untrained examiners) examined 33 healthy participants for objective and subjective refraction. The ZEISS VISUCORE 500 (VC) objective and subjective refraction combination device with an algorithm-based guided and regular custom mode was compared to a conventional control procedure (wavefront aberrometer and phoropter).

Results: For the objective measurement of spherical equivalent refractive error (SE), VC shows good repeatability (≤ ±0.29 D) and reproducibility (≤ ±0.28 D) across all examiners versus control (±0.34 D and ≤ ±0.30 D, respectively), measured only by trained examiners. VC measures slightly negative objective refractions for SE with a mean difference (MD) and 95% limits of agreement (LoA) of -0.07 ± 1.24 D analyzed for a trained examiner. Subjective refraction for VC guided and custom mode showed good repeatability (≤ ±0.64 D) and reproducibility (≤ ±0.59 D) regarding SE for the examiner level. The results were similar to control (±0.54 D and ±0.51 D, respectively) with MD and LoA of +0.12 ± 0.67 D and +0.14 ± 0.66 D for VC guided and custom for trained examiner level. No significant differences were observed in best-corrected visual acuity across the three refraction workflows (all p > 0.05). The VC guided procedure was the most time-efficient, requiring less than 5 min of chair time.

Conclusions: The tested combination refraction device provides reliable and efficient objective and subjective refraction measurements across trained and untrained examiners.

Purpose: Acanthamoeba keratitis (AK) is a sight-threatening disease, commonly associated with contact lens use. Early diagnosis is challenging due to its varied clinical presentation. This study aimed to describe the clinical characteristics of AK and evaluate the utility of corneal scraping for early diagnosis.

Methods: This retrospective study included 14 eyes from 13 AK patients diagnosed by detecting Acanthamoeba cysts in corneal scrapings between July 2019 and August 2023. Clinical history, presentation, treatment, and outcomes were analyzed.

Results: The mean age of the 13 patients was 28 ± 13 years. Ten patients used soft contact lenses and 3 patients used orthokeratology lenses. The mean time from symptom onset to diagnosis was 18.2 ± 12.9 days. The most common sign was elevated superficial punctate keratitis (SPK), followed by dot infiltrates, radial perineuritis, pseudodendrites, stromal edema, and ring infiltrates. Nine eyes were treated with polyhexamethylene biguanide (PHMB) eye drops, while the remaining five eyes received a combination of two or three anti-amoebic agents. Thirteen eyes improved with treatment, but one eye-initially misdiagnosed and treated with steroids-required therapeutic keratoplasty. LogMAR visual acuity in eleven eyes improved from an initial 0.51 ± 0.44 to 0.11 ± 0.10 after treatment.

Conclusion: Elevated SPK is the most frequent early feature of AK and may mimic contact lens-related sterile keratitis. Corneal scraping is a valuable diagnostic tool that enables earlier detection and improved outcomes. PHMB monotherapy is effective in early AK, while delayed diagnosis and prior steroid use may lead to disease progression and necessitate surgical intervention.