Eye & Contact Lens-Science and Clinical Practice最新文献

Objective: To identify systemic conditions associated with dry eye disease (DED) symptoms, signs, and their discordance in a clinically diagnosed DED cohort.

Methods: In this prospective cross-sectional study, participants with DED were assessed for systemic conditions through self-reported history, health records, and specialist referrals. Dry eye disease symptom and sign scores were transformed to a 0 to 1 scale using linear transformation. A discord score (symptom score-sign score) was calculated. Associations between systemic conditions and DED parameters were analyzed using linear regression.

Results: The study included 371 DED participants (mean age: 52.9±14.0 years; 226 women). No significant correlation was observed between signs and symptoms (Spearman rho = -0.08; P=0.08). Increasing age (β = -0.005; P<0.001) and longer DED duration (β = -0.003; P<0.001) were associated with higher signs than symptoms. Atopy, chronic gastrointestinal disorders, psychological disorders, and hormonal replacement therapy use were associated with more severe DED symptoms than signs (all P≤0.03). Female sex, graft-versus-host disease, Sjögren disease, and rheumatoid arthritis were associated with more severe DED signs and a symptom-sign discordance (all P≤0.04).

Conclusion: Systemic conditions significantly affect how DED presents and may cause symptom-sign mismatch, highlighting the need for thorough systemic history and evaluation in DED.

Purpose: To evaluate the diagnostic and management practices of optometrists in Trinidad and Tobago (T&T) for keratoconus (KC), and to identify barriers affecting clinical care.

Methods: A cross-sectional survey was conducted between July and December 2023 among registered optometrists in T&T using a validated questionnaire. Data were collected on diagnostic approaches, treatment strategies, referral behaviors, and perceived challenges. Descriptive statistics and chi-square tests were used for analysis, with significance set at P <0.05.

Results: Of the 108 respondents, 57.4% were women and 50.0% identified as Indo-Trinidadian. While 64.8% reported diagnosing at least five KC cases annually, only 17.6% had access to corneal topography. Most practitioners (78.7%) relied on clinical examination and patient-reported symptoms for the diagnosis of KC. Rigid gas permeable (RGP) lenses were seldomly used for KC management, as 66.7% reported they did not fit RGP lenses, with cost identified as the main barrier (53.7%) to RGP use. Only 36.1% reported co-managing KC cases with ophthalmologists. Regression analysis revealed that Optometrists with ≥5 years of experience were significantly more likely to diagnose KC more frequently compared to those with less than 5 years of practice experience (OR: 4.74; 95% CI: 1.99-11.31; P = 0.001).

Conclusions: Optometrists in T&T play a crucial role in KC care despite resource limitations. The development of national guidelines is urgently needed to standardize diagnosis, management, and referral pathways.

Objective: l -cysteine graphene oxide (CysGO) was synthesized and deposited onto the hydrogel and silicone hydrogel contact lenses (CLs) to study the surface characterization.

Methods: A cysteine graphene oxide composite was synthesized, characterized, and deposited on commercially available soft CLs. Characterization techniques such as FESEM, Fourier Transform Infrared, Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), and Ultraviolet-Visible spectroscopy were employed to analyze CysGO deposited lens surface characterisation. Swelling and transmission percentages were calculated.

Results: Raman spectra revealed an increased I d /I g ratio of 2.5 for CysGO compared with GO (2.25), indicating reduced layer stacking due to cysteine interaction. IR spectra confirmed the presence of amide groups, and XPS spectra exhibited a distinct s2p peak at 164eV and N2 spectrum at 399 eV exclusively in CysGO, confirming its deposition on the lens substrate. The deposited CLs showed a uniform coating of CysGO, an increase in the swelling percentage ( P <0.001), and no difference in transmittance percentage when compared with the control.

Conclusion: This study presents the inaugural investigation of CysGO deposition applied to CL, revealing its advantageous properties, including uniformity and enhanced wettability. The potential of this coating extends beyond these characteristics, prompting further exploration of its diverse properties and applications in subsequent studies.

Objective: To investigate and compare the effects of bifocal soft contact lenses, single-focus soft contact lenses, and orthokeratology lenses (OK lenses) on patients with small-angle intermittent exotropia (IXT) accompanied by myopia, providing a basis for reducing secondary surgeries in clinical practice.

Methods: A prospective, randomized, controlled study was conducted on 142 patients with small-angle IXT who had undergone IXT surgery and had concomitant myopia. Patients were randomly assigned to three groups using a computer-generated random number sequence with allocation concealment: the bifocal soft contact lens group (group A), the single-focus soft contact lens group (group B), and the OK lens group (group C). During the one-year treatment period, multiple visual function parameters were measured, including best-corrected visual acuity (BCVA), contrast sensitivity, accommodative function, eye position control ability, strabismus angle, and axial length (AL).

Results: There were no significant differences in BCVA among the three groups, indicating similar basic visual acuity correction effects. Compared with the other two lens types, defocus soft contact lenses led to reduced contrast sensitivity at high spatial frequencies. Orthokeratology lenses resulted in decreased accommodative amplitude, increased accommodative lag, and reduced accommodative facility compared with the other lenses. The strabismus angle decreased in all patients, with improved positive fusional convergence. Groups A and B showed better improvements in eye position control and strabismus angle reduction than group C. Defocus soft contact lenses and OK lenses were comparable in controlling AL growth. The strabismus angle positively correlated with near stereopsis acuity and eye position control scores and negatively correlated with near horizontal positive fusional convergence.

Conclusion: After the initial IXT surgery, patients wearing defocus soft contact lenses with a concentric bifocal design can effectively control AL growth, enhance eye position control ability, improve visual function, and achieve good subjective visual outcomes.

Objectives: To evaluate the impact of using a high-viscosity hyaluronate solution in the fluid reservoir (FR) on post-lens fluid turbidity and the settling of scleral lenses (SLs).

Methods: Forty-four eyes of 22 keratoconus patients were fitted SLs. SLs applied to the right eye were filled with preservative-free sodium hyaluronate solution, whereas those applied to the left eye were filled with preservative-free saline. After SL fitting, high- and low-contrast visual acuities (VAs) were measured at 0, 4, and 8 hr. The optical density of the post-lens fluid was calculated using Scheimpflug tomography and graded from anterior-segment optical coherence (AS-OCT) images. Central corneal clearance and lens settling were measured with AS-OCT.

Results: High-contrast VA showed no significant change over time in either group. Low-contrast VA remained stable during 8 hr of SL wear in the right eyes, but low-contrast VA decreased at 4th and 8th hours in the left eyes. AS-OCT-based turbidity grading and the optical density increased over time, with no difference between the two solutions. The rate and amount of settling did not differ between the groups.

Conclusions: High-viscosity sodium hyaluronate may sustain improved low-contrast vision in keratoconus patients compared with saline, without adversely affecting post-lens fluid turbidity or lens settling.

Objectives: To determine the factors that may affect pediatric epithelial remodeling after accelerated epi-off cross-linking (A-CXL) by examining the changes in epithelial thickness (ET) maps in pediatric keratoconus patients at the 1-year follow-up.

Methods: Seventy-one eyes of 53 patients (mean age 14.89±1.89 years) were included. Before A-CXL, the MS-39 anterior segment optical coherence tomography images were examined 3, 6, and 12 months after corneal cross-linking (CXL).

Results: Significant flattening was observed in Kmax and Ksteep values at 6 and 12 months after A-CXL ( P <0.05). No significant change was noted in mean ET, except for the 6 to 8 mm inferonasal area ( P >0.05). When max-min ET differences were examined in each region of the corneal ET map, significant improvement was detected in the central 6 mm area, in the 2 to 4 mm inferior-temporal (IT) zone, and in the 4 to 6 mm area in the IT and inferior (I) zones ( P <0.05). The change in max-min ET differences in the central 6 mm area before A-CXL and at 12 months after CXL was significantly correlated with the change in corrected distance visual acuity values, corneal keratometry, corneal astigmatism, and stromal thickness parameters ( P <0.05).

Conclusions: A-CXL is an effective treatment for preventing the progression of pediatric keratoconus and for normalizing ET changes by promoting epithelial remodeling. Epithelial remodeling may have an impact on the improvement in visual acuity after A-CXL by providing a smooth optical surface.

Abstract: This case series reports two cases of scleral lens (SL)-associated suture erosion of polytetrafluoroethylene CV-8 (Gore-Tex, Newark, DE) in scleral-sutured CZ70BD (Alcon, Fort Worth, TX) posterior chamber intraocular lens (SS-PCIOL). Suture erosion after SS-PCIOL has been reported in two of the patients who were fitted with SL for visual acuity improvement. Erosion was corrected in both cases with suture repositioning and corneal patch graft, with one patient requiring the exchange of the intraocular lens. The other patient was able to transition to an SL of a different size parameter. Scleral lens fitting should consider the position of haptic placement in relation to the suture site and be monitored for suture erosion postoperatively. A scleral flap or corneal tissue patch graft may be needed for patients who have scleral thinning from prior surgery.

Abstract: A 36-year-old man presented with a vascularized corneal epithelial hypertrophy after a persistent epithelial defect (PED) in the left eye, 1 year after undergoing retinal detachment surgery. Despite multiple interventions such as bandage contact lens, punctal occlusion, topical steroids and lubricants, tarsorrhaphy, amniotic membrane transplantation, and insulin drops, the defect progressed to a hypertrophic, elevated, and vascularized corneal lesion obstructing visual axis. A customized scleral lens (SL) was prescribed to support ocular surface healing, improve comfort, and enhance visual acuity. Over 18 months of daily SL wear, the patient experienced a marked reduction in the size, elevation, and vascularization of the epithelial hypertrophy, with gradual visual improvement from 6/36 to 6/12. The fitting complications, including lens removal difficulty and nasal quadrant impingement, were resolved through edge modification. Follow-up revealed improved ocular surface appearance, a stable fluid reservoir, and better surface wettability. This case highlights the therapeutic potential of SLs not only in promoting epithelial healing but also in remodeling chronic corneal pathologic condition such as epithelial hypertrophy and neovascularization post-PED. Scleral lens therapy, when appropriately customized and monitored, offers a safe, nonsurgical alternative for patients with complex ocular surface disorders unresponsive to conventional treatments.

Abstract: We report on the management of a patient with bilateral central toxic keratopathy (CTK) and infective keratitis in one eye after bilateral photorefractive keratectomy (PRK). A 27-year-old woman presented with bilateral central corneal opacification, thinning and reduced vision within a week of PRK. The uncorrected distance visual acuity was 20/100 in the right eye and 20/60 in the left eye. The central pachymetry was 296 μm in the right eye and 262 μm in the left eye. Clinical diagnosis of CTK was made. Initial treatment included oral doxycycline and vitamin C. Subsequent evaluation at 3 weeks post-PRK showed infiltrate in the left eye, which revealed atypical mycobacteria on microbiological tests. The left eye was treated with topical azithromycin 1% for 2 months with a favorable response. The central pachymetry in the right eye improved significantly in 3 months. At 4 months, the central pachymetry in the right eye restored to 420 μm, which was stable till the last follow-up of 1 year. The central pachymetry in the left eye improved to 373 μm in 8 months, which remained stable till 1-year follow-up. At 1 year, the best corrected visual acuity was 20/20 and 20/25 in the right and left eyes, respectively. Bilateral CTK associated with infective keratitis in one eye can be effectively treated with medical therapy. Central toxic keratopathy may be self-limiting, requiring supportive management. Prompt recognition of coexisting infection and timely management leads to good visual outcomes.