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

Purpose: To evaluate tear secretory response using a novel device, the i-Onion, which stimulates lacrimal gland activity with concentrated CO 2 bursts.

Methods: The i-Onion device delivers a controlled CO 2 burst to the ocular surface, stimulating the lacrimal gland's tear production response. We studied 120 participants: 40 with glaucoma, 40 with cataracts (some followed postsurgery), and 40 controls. Basal tear volume (BTV) was measured using a 3-min unanesthetized the Schirmer test. Stimulated tear volume was then recorded over another 3 min after a 3-second i-Onion stimulus. Tear reserve volume (TRV), the study's primary outcome, was calculated as the difference between stimulated tear volume and BTV.

Results: Participants' mean age was 60.5 years; 78% male, 59% White. No significant differences in TRV were found among the groups (glaucoma: 9.3 mm; cataract: 8.3 mm; control: 7.9 mm, P =0.67) but BTV was significantly lower in patients with glaucoma and cataract compared with controls (glaucoma: 13.6 mm; cataract: 14.1 mm; control: 19.0 mm, P =0.03). Basal tear volume also decreased with age (r=-0.2, P =0.01). Presurgical TRV in patients with cataract showed a nonsignificant negative correlation with postsurgical ocular symptoms (r=-0.23, P =0.2).

Conclusion: The i-Onion device demonstrated that TRV was preserved in elderly individuals with glaucoma and cataract, despite decreased BTV with age and disease.

Objectives: To investigate the effect of overnight orthokeratology (OOK) on ocular surface and blinking patterns in children and adolescents.

Methods: A prospective cohort study was conducted including 27 eyes of 27 children from Beijing Tongren Hospital who received OOK correction and 31 eyes of 31 spectacle wearing children. Tests were performed before and at 3 and 6 months after OOK wear. Ocular surface assessment included tear meniscus height, noninvasive tear breakup time, lipid layer thickness, number of incomplete blinks, number of total blinks, and fluorescein tear breakup time.

Results: Before treatment, there were no statistically significant differences in various indicators between the two groups. After wearing OOK for 3 months and 6 months, there were no significant differences between the tear meniscus height, noninvasive tear breakup time, lipid layer thickness, number of incomplete and total blinks, fluorescein tear breakup time groups, and upper and lower lid meibomian gland atrophy rate ( P >0.05). However, the corneal fluorescein staining scores in the OOK group were significantly higher than those in the spectacle group ( P <0.001).

Conclusions: Short-term use of OOK in children and adolescents has a relatively minor impact on ocular surfaces and is considered relatively safe to use. However, it significantly increases corneal fluorescein staining scores, which may suggest the presence of corneal epithelial damage.

Abstract: Vernal keratoconjunctivitis (VKC) is a seasonally recurring form of allergic conjunctivitis that leads to bilateral inflammation of the cornea and conjunctiva. Symptoms may include itching, foreign body sensation, discharge, and conjunctival hyperemia. Severe cases may result in corneal complications including erosions, shield ulcers, plaques, microbial keratitis, corneal scarring, limbal stem cell deficiency, and keratoconus. Epidemiological data reveal that it mainly affects children and young adults, with male predominance and a higher prevalence in warmer climates. The etiology is multifactorial, involving triggers from environmental allergens. Both type I and type IV hypersensitivity reactions have been implicated. Vernal keratoconjunctivitis may significantly impact visual acuity and quality of life, especially in school-aged children. Management strategies include allergen avoidance, topical treatments, and immunomodulators. Despite therapeutic advances, VKC remains a significant cause of morbidity, highlighting the need for prompt diagnosis and treatment to mitigate long-term impacts on vision and quality of life.

Purpose: To evaluate the outcomes of patients with corneal neovascularization treated with intrastromal injection of bevacizumab and corneal fine needle diathermy (FND).

Methods: This is a retrospective case series of six patients with at least 6 months follow-up after intrastromal injection of bevacizumab and FND. The main outcome measures include change in best-corrected visual acuity (BCVA) and regression of corneal neovascularization at follow-up. Slitlamp photographs were taken pre and post procedure.

Results: The mean age of the patients was 64.2 years, and the baseline BCVA ranged from 20/40 to 20/100. At postoperative months 1 and 6, all patients had improvement in corneal neovascularization, with 67% (4/6) showing total resolution while 33% (2/3) had residual deep fine vessels. Best-corrected visual acuity improved in two patients and remained stable in four patients. Two patients had improvement in lipid keratopathy at 6 months.

Conclusions: Combined intrastromal injection of bevacizumab and FND is an effective treatment for corneal neovascularization.

Purpose: To subject a number of areas of contention in the myopia field to evidence-based scrutiny.

Method: The 10 topics from our previous review were revisited, and nine new topics were also critiqued with emphasis on the recent peer-reviewed literature.

Results: The following observations were made: 0.01% atropine should not be considered a frontline myopia control treatment; the role of relative peripheral hyperopia in myopia development and progression remains unclear; undercorrection probably does not slow myopia progression; treatment efficacy diminishes with time; percentage is a misleading metric of efficacy; handheld digital devices have not been proven to be myopiagenic; more time outdoors may slow myopic shift to a similar extent in children with and without myopia; daylight is responsible for only part of the impact of outdoor time; all myopia, not just high myopia, carries the risk of visually threatening complications; premyopia is a real condition. Furthermore, myopia may be considered a disease; accommodation lag may be a measurement artifact; adult myopia progression is significant; past progression is a flawed indicator to initiate myopia control; fast progression does not mean nonresponse to treatment; single vision soft contact lenses are not myopiagenic; red light therapy may not be safe; contact lens wear in children may be considered safe; rebound cannot be assessed by comparing progression during and following treatment.

Conclusions: The myopia field continues to evolve with some conflicts resolved, ongoing areas of confusion, and new uncertainties emerging.

Objectives: To present an 11-year case series of pterygia.

Methods: We conducted a retrospective case review of all pterygium surgeries performed at Dartmouth Hitchcock Medical Center between April 2011 and July 2022. Eighty-six cases were identified through a chart review identifying procedures with the code «Excision of Pterygium W/Transplant» on our electronic medical record system, obtained per a protocol approved by the Dartmouth-Hitchcock Health Human Research Protection Program (IRB study 02002030).

Results: Of 86 cases, 84 were performed with conjunctival autografting (CAG) with fibrin glue, one was performed with just amniotic membrane transplant (AMT) with fibrin glue, and one was performed with both CAG and AMT with fibrin glue. No intraoperative mitomycin C or 5FU were used. Three patients with postoperative complications were identified, including two cases of postoperative conjunctival granulomas and one case of recurrent pterygium. Both conjunctival granulomas were treated with surgical excision without recurrence and sent to pathology for analysis. Histopathological findings are discussed herein. The recurrent pterygium was treated with 5FU injections, after which there were minimal symptoms and no progression at the last follow-up.

Conclusions: Although recurrence is the most commonly discussed complication of pterygium surgery, in our cases, over an 11-year span, we found that postoperative conjunctival granulomas were more common than recurrence.

Objectives: To determine the age- and gender-specific prevalence of contact lens wearers among Iranian adults aged 31 to 70 years (results from the nationwide Persian Cohort Eye Study).

Methods: This multicenter population-based cross-sectional study used a cluster sampling procedure to recruit 48,618 Iranian participants aged 31 to 70 years (mean age: 42.9±7.9 SD) from six different provinces between 2015 and 2020. Demographic characteristics and medical and ocular history of participants were gathered through the interview. All participants underwent a thorough history-taking interview and a comprehensive optometric examination in the clinic. We used logistic regression on the multilevel analysis to determine the effect of different variables on contact lens use.

Results: In total, 228 participants (0.34%, of all) used contact lenses. Among them, 141 subjects (0.22%) used corrective lenses, 82 subjects (0.13%) wore cosmetic lenses, and five subjects wore both. The mean age of the population was 42.9±7.9 SD (31-70 years). There was an inverse association between advancing age and both lens wear (adjusted ORs: 0.26, 0.15). Wearing both types of lenses was correlated with being female (adjusted ORs: 3.22, 9.03), having higher education (adjusted ORs: 7.94, 5.49), and high wealth score index (adjusted ORs: 3.64, 1.46). The mean spherical equivalent of the whole population, corrective lens, and cosmetic lens users were -1.46±2.91 D, -2.04±3.42 D, and -0.55±1.21 D, respectively. Most cosmetic lens users were emmetropes (68.75%), while myopia was the most frequent refractive error among corrective lens wearers (67.88%). There was a significant difference in usage between centers. Professional prescriptions and other unknown sources were the main purchase sources for corrective and cosmetic lens users, respectively.

Conclusions: The prevalence of contact lens use in the older adult population of Iran is very low, highlighting an important opportunity for public health and eye care professionals. The population-based information reported in this article indicates a significant gap in public and professional awareness and attitudes toward contact lens use, emphasizing the need for targeted educational initiatives and accessibility improvements. These findings offer valuable insights for future eye care planning, policy development, and potential growth in contact lens practice and marketing in Iran.

Objective: To create a comprehensive multi-tissue molecular atlas of Sjögren's disease by using unbiased RNA sequencing to identify differentially expressed genes (DEGs) in peripheral blood and conjunctival transcriptomes, and to characterize the ocular surface and gut microbiome profiles in participants classified as Sjögren's versus non-Sjögren's disease.

Methods: This exploratory study used high-throughput RNA sequencing to analyze peripheral blood, conjunctival swabs, and rectal swabs from participants (11 classified as Sjögren's disease and four classified as non-Sjögren's) to identify DEGs and microbial profiles that could distinguish these groups.

Results: Differential gene expression analysis revealed upregulated type I interferon ( IFI44L , OASL , USP18 ) and complement pathways ( SERPING1 ) in peripheral blood, alongside activation of several novel pathways in the conjunctiva including intracellular vesicle trafficking ( HIP1, GOLIM4, FIG4 ), immunometabolism ( CERS5, HPRT1, ULK2 ), and cytoskeletal remodeling ( MARK1, IQCB1) in Sjögren's disease. In addition, distinct gut microbiome compositions were observed in Sjögren's disease participants, characterized by an increased presence of Lactobacillus reuteri species.

Conclusions: Using unbiased RNA sequencing, we confirmed the role of type I interferon and complement pathways in the peripheral blood and identified novel molecular signatures in the conjunctiva of Sjögren's disease participants. These newly identified pathways-involved in intracellular vesicle trafficking, immunometabolism, and cytoskeletal remodeling-expand our understanding of disease mechanisms beyond traditional immune pathways. In addition, we found distinct gut microbial profiles in Sjögren's disease participants, although ocular surface microbiome showed no significant differences. Such findings may suggest possible new therapeutic targets and allow for Sjögren's disease patient stratification. However, validation in larger cohorts is needed to establish clinical significance and potential applications in Sjögren's disease.

Objective: Patient sentiments of keratoconus treatment discussions on Reddit were evaluated to enhance understanding of factors affecting the subjective patient experience.

Methods: Posts were extracted from the r/keratoconus on Reddit, an anonymous social media platform. The top 200 posts from each Reddit flair were included: "contact lenses," "crosslinking," "corneal transplant," and "corneal implants," and "other laser procedures." Posts were stratified by author and topic, and Valence Aware Dictionary and Sentiment Reasoner was used to generate a compound postsentiment score. Word frequency analysis was also conducted.

Results: Of the 717 posts analyzed, most were classified as positive (60.5%). "Other Laser Procedures" posts had the highest mean score, whereas "Corneal Implant" posts had the lowest (0.47 vs 0.06; P =0.045). Lifestyle and Preoperative question posts were most positive, whereas Noncompliance and Treatment Anxieties/Validation seeking posts were the most negative (0.41 vs 0.066; P =0.02). Word frequency analysis found high use of "pain" (n=230), "insurance" (n=34), and "years" (n=35).

Conclusions: Subjective patient sentiment toward keratoconus treatment was overall positive. However, there was frequent discussion of timeline, pain, and contact lens instructions. These data suggest that addressing specific concerns, such as pain management and treatment anxieties, may improve satisfaction in keratoconus care.

Objectives: The aim of this study is to characterize the power profile of different soft contact lens designs for myopia control and assess the stability of their power parameters.

Methods: Eight different soft contact lens designs for myopia control were studied using the NIMO TR1504. A total of 96 contact lenses were measured, ranging from -0.50 D to -6.00 D in 0.50 D steps. Each power and design were measured three times.

Results: One dual focus, two extended depth of focus (EDOF), and five gradient multifocal (MF) designs were identified. The dual focus design had an optical zone diameter (OZ) of 3.23±0.07 mm and an addition of 1.99±0.30 D. The two EDOF designs had OZs of 0.93±0.38 mm and 2.21±0.11 mm, being the smallest among the eight designs. Finally, the MF designs showed the highest OZ of 3.64±0.06 mm and additions ranging from 0.69±0.14 D to 8.49±2.61 D.

Conclusions: These designs differ in characteristics such as OZ and addition. In some designs, the addition power or OZ may be influenced by the lens power. The EDOF and one MF design demonstrated the greatest stability. Further studies are needed to determine the optimal OZ and addition for myopia control.