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

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.

Objectives: To investigate the effect of cataract surgery on visual acuity, stereoacuity, balance, and falls in patients with senile cataract.

Methods: Prospective, cross-sectional study. The patients were divided into group 1 if the first surgery was performed on the dominant eye and group 2 on the nondominant eye. After a complete ophthalmologic examination, all patients underwent stereoacuity tests (Titmus and TNO test); Berg Balance Scale and the number of falls in the last 36 months were recorded. All assessments were performed at three time points: the preoperative period, 6 months after the first surgery (primary endpoint), and 24 months after the second surgery (secondary endpoint).

Results: The mean number of falls was 4.95±2.6/year in the preoperative period and 1.43±0.59/year in the postoperative period. The incidence of falls after the second surgery decreased by 53.15% compared with the preoperative period. The number of falls and preoperative stereoacuity were negatively and moderately correlated (r=-0.546) ( P =0.033). In univariate and multivariate analysis, only low preoperative corrected distance visual acuity in the dominant eye was associated with poor stereoacuity ( P =0.001) and a high number of falls ( P <0.001) in the preoperative period.

Conclusion: Cataract surgery in patients with senile cataracts not only improves visual acuity but also increases stereoacuity level, improves balance, and decreases falls. These effects should be further studied in multicenter, large-participant studies.

Abstract: The design of the prosthetic replacement of the ocular surface ecosystem (PROSE) device allows it to serve as a novel drug delivery system. In this article, we describe the off-label administration of amphotericin B and cenegermin by instillation in the PROSE device reservoir for the treatment of Candida keratitis in the setting of a persistent epithelial defect.

Objective: To determine if scleral fittings that occur before corneal cross-linking (CXL) are still successful after the procedure.

Methods: This prospective study included seven patients with keratoconus or post-laser-assisted in situ keratomileusis (LASIK) corneal ectasia who were fitted with scleral lenses then underwent CXL. Four patients (six eyes) had keratoconus and three patients (five eyes) had post-LASIK ectasia. Topographic and refractive parameters, as well as uncorrected visual acuity, best spectacle-corrected visual acuity, and scleral lens-corrected visual acuity were collected preoperatively and compared with values 1 and 3 months postoperatively.

Results: Ten eyes had no significant change in refractive parameters from baseline to 3 months ( P >0.05). Nine eyes had no significant change in Km (mean keratometry), K2 (steep keratometry), Kmax (maximal corneal curvature), or pachymetry from baseline to 3 months ( P >0.05). On average, there was no significant difference regarding scleral lens or topographic measurements preoperatively versus postoperatively ( P >0.05).

Conclusion: On average, no significant differences were observed between preoperative and postoperative corneal measurements or refractive correction. These findings suggest that scleral fittings could be introduced before CXL to expedite the process of lens prescription and future acquisition. Safe scleral lens use with a lens fit before surgery could resume 1 month postoperatively.

Objectives: To compare intraoperative and postoperative effects of applying a viscosurgical device versus balanced salt solution (BSS) during cataract surgery.

Methods: Single-center retrospective case-control pilot study. Reviewed 27 patients who received Viscoat (Alcon Laboratories, Inc. Fort Worth, TX) or BSS on the cornea during uncomplicated cataract surgery. Surgeries were analyzed for time when the microscope light reflection was indistinct on the cornea while instruments were in the eye. Postoperative data included patient pain ratings, National Eye Institute score, and Ocular Surface Disease Index (OSDI) scores.

Results: Compared with BSS, Viscoat application resulted in a significant increase in time with a clear light reflex during surgery ( P <0.001). With BSS, average time without a clear light reflex while instruments were in the eye was 82.69±50.14 sec, or 17.56%±12.00% of the surgery, compared with 0% with Viscoat. There was no significant difference in postoperative pain and National Eye Institute score between groups. However, OSDI score two about grittiness was significantly lower with Viscoat application ( P =0.01) and approaching significance for OSDI score three, about painful or sore eyes ( P =0.09).

Conclusions: Viscoat provided greater optical clarity during surgery with a single application and was associated with less sensation of grittiness compared with BSS.