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

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.

Purpose: To assess the short-term impact of different types of contact lenses on accommodation in the same group of myopic children compared with single-vision spectacle lenses.

Methods: Thirty myopic children aged 10.2 ± 1.5 years were enrolled. Each participant was corrected with four different modalities in following sequence: single-vision spectacles (SVSP), single-vision soft contact lens (SVSCL), a high-addition multifocal soft contact lens (MFSCL), and orthokeratology lenses (OKL). Measurements included the dynamic accommodative stimulus-response curve (ASRC), distance accommodative facility (DAF), negative relative accommodation (NRA), and positive relative accommodation (PRA). Repeated-measures analysis of variance with Bonferroni correction was performed.

Results: The accommodative parameters differed among the four modalities except for the slope of ASRC ( F = 1.700, P = 0.173). Single-vision spectacle lens exhibited the highest accommodative lag area (10.08 ± 1.65 D 2 ) and the lowest objective accommodative amplitude (7.72 ± 0.93 D) and PRA (-2.51 ± 0.62 D) (all P < 0.05). Multifocal soft contact lens, OKL, and SVSCL showed no significant differences in accommodative lag area (8.93 ± 1.78, 7.98 ± 2.33, 8.44 ± 2.20 D 2 ), NRA (2.23 ± 0.33, 2.23 ± 0.38, 2.39 ± 0.33 D), PRA (-3.05 ± 0.78, -3.43 ± 1.05, 3.00 ± 1.02 D), or DAF (23.8 ± 6.99, 26.0 ± 8.23, 23.3 ± 7.07 D); however, OKL (8.68 ± 1.08 D) induced greater objective accommodative amplitude than SVSCL (8.26 ± 0.97 D) ( P = 0.010).

Conclusions: Single-vision spectacles exhibited worse accommodative function than the other three modalities. However, no significant changes in accommodation were detected when using OKL or high-addition MFSCL compared with SVSCL, except higher objective accommodative amplitude with OKL than SVSCL.

Purpose: To evaluate the demographics of limbal stem cell deficiency (LSCD) and to report the prevalence, identifiable etiologies, and treatment outcomes as described in the literature.

Methods: A literature review performed by querying published studies evaluating the demographics and/or epidemiology of LSCD. Three large retrospective studies from the University of Minnesota (UMN), Cincinnati Eye Institute (CEI), and LV Prasad Eye Institute (LV Prasad) were compared.

Results: Average age at diagnosis for the UMN and CEI cohorts was 53.2 and 42.9 years old, respectively, whereas the median age was much younger at 24 years old in the LV Prasad cohort. The LV Prasad cohort revealed a 2:1 male predominance. Both the LV Prasad and UMN cohorts reported similar rates of unilateral vs. bilateral LSCD, whereas the CEI cohort reported bilateral LSCD in 70% of their cases. The leading cause of LSCD was ocular burns (53.7%) in the LV Prasad cohort, congenital aniridia (30.9%) in the CEI cohort, and chemical/thermal burns (18.7%) in the UMN cohort. Only the UMN study reported a disease prevalence rate, which was 4.25%.

Conclusions: There is great regional variability in the demographics of patients with LSCD. This may contribute to the difficulty in establishing accurate disease prevalence rates.

Purpose: To present the long-term visual outcomes and factors affecting treatment success in children with congenital cataract surgery in infancy followed by optical correction by contact lens (CL).

Methods: We retrospectively analyzed data from 30 eyes of 26 pediatric aphakic patients followed by visual habilitation primarily by CL between 2004 and 2023. The patients were evaluated for factors affecting final best-corrected visual acuity (VA), need for additional surgery, and adherence to CL and occlusion therapy.

Results: The study included 16 eyes with idiopathic congenital cataract, 12 eyes with congenital cataract associated with persistent fetal vasculature, and two eyes with concomitant retinopathy of prematurity. Adherence to CL use was evaluated as poor in 13.3%, moderate in 40%, and good in 46.7% of the eyes, while adherence to occlusion therapy was poor in 33.3%, moderate in 20.8%, and good in 45.8% of the eyes. Final VA was 20/50 or better in 50% of the eyes, between 20/50 and 20/400 in 16.7% of the eyes, and 20/400 or worse in 33.3% of the eyes. There was no statistically significant relationship between the presence of strabismus and final VA, whereas the need for additional surgery; the presence of posterior segment pathologies, nystagmus, and glaucoma; and poor treatment adherence were associated with significantly lower final VA.

Conclusions: Good long-term visual outcomes can be achieved with effective CL and occlusion therapy in cases of infantile aphakia not accompanied by glaucoma, severe anterior and posterior segment pathologies, or the need for additional surgery.

Abstract: A 20-year-old female patient with a long-standing history of severe atopic disease was referred to our department because of bilateral gradual blurry vision. She had undergone treatment with daily application of topical tacrolimus ointment 0.03% (Protopic, Fujisawa, Munich, Germany) for a period of 5 years. Slit-lamp examination revealed inferior corneal thinning with conjunctivalization and superficial neovascularization respecting both eyes. A diagnosis of bilateral inferior limbal stem cell deficiency (LSCD) was made. After the tacrolimus ointment discontinuation, symptoms, visual acuity, and objective clinical examination improved during the follow-up period of 6 months. This case suggests that LSCD is possible after prolonged use of topical tacrolimus ointment 0.03%. In this context, it is imperative to monitor patients continuously to evaluate the safety of its chronic use.