Ophthalmology science最新文献

Customized Evaluation of Progressive Visual Sensitivity Loss in Geographic Atrophy to Improve the Power of Clinical Trials

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-03-14 DOI: 10.1016/j.xops.2025.100763

Abera Saeed MChD , Robyn H. Guymer MBBS, PhD , Xavier Hadoux MEng, PhD , Maxime Jannaud MEng , Darvy Dang BOrth(Hons) , Lauren A.B. Hodgson MPH , Emily K. Glover OD , Erin E. Gee BAppSc(MedRad) , Peter van Wijngaarden MBBS(Hons), PhD , Zhichao Wu BAppSc(Optom), PhD

Purpose

To evaluate the effectiveness of different approaches for customizing the selection of a subset of test locations on defect-mapping microperimetry (DMP) for improving the detection of progressive visual function decline in geographic atrophy (GA).

Design

Prospective longitudinal study.

Participants

Sixty eyes from 53 participants with GA secondary to age-related macular degeneration.

Methods

Participants underwent 3-monthly DMP testing twice at each visit for up to 24 months, where the extent of deep visual sensitivity losses on each test was determined through single presentations of 10-decibel stimuli at 208 locations within the central 8° radius region. Seven outcome measures were derived, which included evaluating the proportion of locations missed (PLM; showing nonresponse to stimuli) on DMP in a subset of test locations based on their proximity to the GA margin, or to locations neighboring repeatably nonresponding points on 2 baseline tests (i.e., missed both tests at baseline). These outcome measures were compared by their coefficient of variation (CoV; reflecting performance for capturing longitudinal changes) and sample size estimates in a 2-arm trial seeking to detect a ≥30% treatment effect. Changes in GA extent and best-corrected visual acuity (BCVA) were evaluated for comparison.

Main Outcome Measures

Coefficient of variation and sample size estimates.

Results

Evaluating PLM at points immediately adjacent (<1°) to repeatably nonresponding test locations at baseline (CoV = 47%) was the best performing outcome measure on DMP testing. This measure outperformed BCVA (CoV = 188%; P < 0.001) at detecting longitudinal changes and was comparable to evaluating GA extent (CoV = 58%; P = 0.097). Sample size requirements in a 24-month trial using this outcome measure on DMP testing were lower by 46% and 94% compared with evaluating GA extent and BCVA, respectively.

Conclusions

Customized evaluation of DMP functional testing results in regions adjacent to repeatably nonresponding locations at baseline improved the detection of longitudinal changes compared with the evaluation of all test locations. These findings show that it is possible to sensitively capture progressive visual function decline with this approach, supporting its use in future GA treatment trials.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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引用次数: 0

Longitudinal Imaging of the Parafoveal Cone Mosaic in Congenital Achromatopsia

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-03-14 DOI: 10.1016/j.xops.2025.100765

Nickolas Chen MD , Katie M. Litts PhD , Danica Nikezic BS , Christopher S. Langlo MD, PhD , Brian P. Higgins BS , Byron L. Lam MD , Gerald A. Fishman MD , Frederick T. Collison OD , Mark E. Pennesi MD, PhD , Christine N. Kay MD , Sergey Tarima PhD , Joseph Carroll PhD

Purpose

To assess longitudinal changes in parafoveal cone density in individuals with congenital achromatopsia (ACHM).

Design

Retrospective longitudinal study.

Participants

Nineteen individuals (7 women and 12 men) with genetically confirmed ACHM. To be eligible, each had adaptive optics scanning light ophthalmoscope (AOSLO) images of the photoreceptor mosaic from ≥2 time points.

Methods

For each individual, follow-up AOSLO montages were aligned to their baseline montage. Notably, 100 × 100 μm regions of interest (ROIs) were extracted from the split-detection modality at locations 1°, 5°, and 10° temporal (T) from the peak cone density in each montage. All ROIs from follow-up visits were then manually aligned to their respective baseline ROI for that location. Cones were identified in each ROI by one observer, reviewed by a second observer, and confirmed together in a masked fashion. Cone density was calculated, and a linear mixed model was used to assess changes in density over time. A Wald test was performed to determine if the cone density changes were statistically significant.

Main Outcome Measures

Parafoveal cone spacing (at 1°, 5°, and 10° T) as a function of time.

Results

The mean (± standard deviation [SD]) age at baseline was 21.6 ± 10.7 years and the mean (±SD) follow-up period was 3.83 ± 2.93 years (range, 0.46–8.66 years). At 1° T, we observed a significant decrease of 352 cones/mm² per year (P = 0.0003). At 5° T, the linear mixed model showed a nonstatistically significant decrease of 58 cones/mm² per year (P = 0.504). At 10° T, we observed a significant decrease of 139 cones/mm² per year (P = 0.0188). For a 100 × 100 μm ROI, these density changes correspond to a reduction of between about 0.5 and 4 cones per year, depending on the location.

Conclusions

Parafoveal cone density estimates in ACHM show a small decrease over time. These observed changes are within the previously reported longitudinal repeatability values for normal retinas, suggesting the observed average cone loss may not be clinically meaningful. Further studies with longer follow-up times and more genetically heterogeneous and age-diverse populations are needed to better understand factors contributing to changes in foveal and parafoveal cone structure in ACHM over time.

Financial Disclosure(s)

Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.

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引用次数: 0

Vision-Threatening Diabetic Macular Ischemia Based on Inferred Progression Pathways in OCT Angiography

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-03-12 DOI: 10.1016/j.xops.2025.100761

Miyo Yoshida MD, Tomoaki Murakami MD, PhD, Keiichi Nishikawa MD, Kenji Ishihara MD, PhD, Yuki Mori MD, PhD, Akitaka Tsujikawa MD, PhD

Purpose

To elucidate the progression pathways of diabetic macular ischemia (DMI) using OCT angiography (OCTA) images and to assess changes in visual acuity (VA) associated with each pathway.

Design

A single-center, prospective case series study.

Participants

One hundred fifty-one eyes from 151 patients with a 3-year follow-up period.

Methods

We obtained 3 × 3 mm swept-source OCTA images and conducted analyses of en face images within a central 2.5 mm diameter circle. Nonperfusion squares (NPSs) were defined as 15 × 15-pixel squares without retinal vessels. Each eye at baseline and after 3 years was embedded into a 2-dimensional uniform manifold approximation and projection space and assigned to 1 of 5 severity grades—Initial, Mild, Superficial, Moderate, and Severe—using the k-nearest neighbors method. We assessed major transitions (involving ≥4 cases) during 3 years. Subsequent probabilistic analyses enabled the construction of a graphical model, wherein directed arrows represented inferred pathways of DMI progression. From this cohort, 103 eyes of 103 patients who did not receive any ocular treatments during the follow-up period were subsequently evaluated for VA changes.

Main Outcome Measures

Inference of DMI progression pathways.

Results

In most cases, NPS counts increased in both the superficial and deep layers. The major transitions between these severity groups at 3 years displayed a unique distribution, and probabilistic analyses suggested a directed graphical model comprising 7 inferred pathways of DMI progression: Initial to Mild, Initial to Superficial, Mild to Superficial, Mild to Moderate, Superficial to Moderate, Superficial to Severe, and Moderate to Severe. Eyes of the Mild and Superficial groups had greater increases in superficial NPS within the central sector than those of the Severe group. Additionally, deep NPS counts within the central sector decreased more in the eyes of the Initial group than in those of the Superficial and Moderate groups. Notably, the eyes of the Superficial and Moderate groups exhibited greater VA deterioration at 3 years compared with those in the Initial group.

Conclusions

A directed graphical model of DMI progression may serve as a useful tool for inferring progression pathways and predicting VA deterioration.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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引用次数: 0

Deep Learning–Driven Glaucoma Medication Bottle Recognition: A Multilingual Clinical Validation Study in Patients with Impaired Vision

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-03-07 DOI: 10.1016/j.xops.2025.100758

Aidin C. Spina BS , Christopher D. Yang BS , Ayush Jain BS , Christine Ha BS , Lauren E. Chen MD , Philina Yee MD , Ken Y. Lin MD, PhD

Objective

To clinically validate a convolutional neural network (CNN)-based Android smartphone app in the identification of topical glaucoma medications for patients with glaucoma and impaired vision.

Design

Nonrandomized prospective crossover study.

Participants

The study population included a total of 20 non-English-speaking (11 Spanish and 9 Vietnamese) and 21 English-speaking patients who presented to an academic glaucoma clinic from December 2023 through September 2024. Patients with poor vision were selected on the basis of visual acuity (VA) of 20/70 or worse in 1 eye as per the California Department of Motor Vehicles' driver's license screening standard.

Intervention

Enrolled subjects participated in a medication identification activity in which they identified a set of 6 topical glaucoma medications presented in a randomized order. Subjects first identified half of the medications without the CNN-based app. They then identified the remaining half of the medications with the app. Responses to a standardized ease-of-use survey were collected before and after using the app.

Main Outcome Measures

Primary quantitative outcomes from the medication identification activity were accuracy and time. Primary qualitative outcomes from the ease-of-use survey were subjective ratings of ease of smartphone app use.

Results

The CNN-based mobile app achieved a mean average precision of 98.8% and recall of 97.2%. Identification accuracy significantly improved from 27.6% without the app to 99.2% with the app across all participants, with no significant change in identification time. This observed improvement in accuracy was similar among non-English-speaking (71.6%) and English-speaking (71.4%) participants. The odds ratio (OR) for identification accuracy with the app was 319.353 (P < 0.001), with substantial improvement in both non-English-speaking (OR = 162.779, P < 0.001) and English-speaking (no applicable OR given 100% identification accuracy) participants. Survey data indicated that 81% of English speakers and 30% of non-English speakers found the app “very easy” to use, with the overall ease of use strongly associating with improved accuracy.

Conclusions

The CNN-based mobile app significantly improves medication identification accuracy in patients with glaucomatous vision loss without increasing the time to identification. This tool has the potential to enhance adherence in both English- and non-English-speaking populations and offers a practical adjunct to daily medication management for patients with glaucoma and low VA.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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引用次数: 0

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IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-03-01 DOI: 10.1016/S2666-9145(25)00044-2

引用次数: 0

Sickle Cell Trait or Sickle Cell Disease Associated with Increased Diabetic Retinopathy Risk

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-02-28 DOI: 10.1016/j.xops.2025.100756

Christina M. Ambrosino BS , Jacinta A. McDonald MD , Ximin Li ScM , Ann Nampomba MSc , Adrienne W. Scott MD

Objective

This study aimed to understand the impact of sickle cell disease (SCD) or sickle cell trait (SCT) on diabetic retinopathy and retinopathy treatment burden.

Design

Cross-sectional study.

Subjects and Controls

Utilizing the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight), 3742 patients with comorbid diabetes mellitus (DM) and either SCD or SCT were included in the analytic sample. A race-stratified group of 3742 patients with DM and no known SCD was included as controls.

Methods

Data analysis was performed using R (R Project 4.2.0). Descriptive statistics summarized demographic data among patients with comorbid SCD or SCT and among controls. Chi-square tests compared clinical outcomes (proliferative diabetic retinopathy [PDR], diabetic macular edema [DME]) and ocular procedure frequency across patients with DM and SCD or SCT and across controls. Multivariate logistic regression models examined the likelihood of clinical outcomes and ocular procedures across patients with and without comorbid SCD or SCT while adjusting for insurance, smoking status, and demographic factors.

Main Outcome Measures

Frequency of clinical outcomes and ocular procedures.

Results

All measured clinical outcomes were more frequently documented among patients with DM and either SCD or SCT as compared with those with DM alone. Of the 7 ocular procedures studied, 5 were more common among the DM with SCT or SCD group as compared with controls (P < 0.001). On regression analysis, DM patients with comorbid SCD or SCT had 7.36 and 4.22 times greater odds of PDR and DME, respectively (confidence interval for PDR: 6.36–8.54, confidence interval for DME: 3.68–4.85).

Conclusions

This analysis suggests that DM patients with comorbid SCD or SCT have an increased likelihood of DM-related microvascular pathology and a higher ocular treatment burden. Prospective studies are needed to further characterize the relationship between DM and SCT or SCD.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

{"title":"Sickle Cell Trait or Sickle Cell Disease Associated with Increased Diabetic Retinopathy Risk","authors":"Christina M. Ambrosino BS , Jacinta A. McDonald MD , Ximin Li ScM , Ann Nampomba MSc , Adrienne W. Scott MD","doi":"10.1016/j.xops.2025.100756","DOIUrl":"10.1016/j.xops.2025.100756","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to understand the impact of sickle cell disease (SCD) or sickle cell trait (SCT) on diabetic retinopathy and retinopathy treatment burden.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects and Controls</h3><div>Utilizing the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight), 3742 patients with comorbid diabetes mellitus (DM) and either SCD or SCT were included in the analytic sample. A race-stratified group of 3742 patients with DM and no known SCD was included as controls.</div></div><div><h3>Methods</h3><div>Data analysis was performed using R (R Project 4.2.0). Descriptive statistics summarized demographic data among patients with comorbid SCD or SCT and among controls. Chi-square tests compared clinical outcomes (proliferative diabetic retinopathy [PDR], diabetic macular edema [DME]) and ocular procedure frequency across patients with DM and SCD or SCT and across controls. Multivariate logistic regression models examined the likelihood of clinical outcomes and ocular procedures across patients with and without comorbid SCD or SCT while adjusting for insurance, smoking status, and demographic factors.</div></div><div><h3>Main Outcome Measures</h3><div>Frequency of clinical outcomes and ocular procedures.</div></div><div><h3>Results</h3><div>All measured clinical outcomes were more frequently documented among patients with DM and either SCD or SCT as compared with those with DM alone. Of the 7 ocular procedures studied, 5 were more common among the DM with SCT or SCD group as compared with controls (<em>P</em> < 0.001). On regression analysis, DM patients with comorbid SCD or SCT had 7.36 and 4.22 times greater odds of PDR and DME, respectively (confidence interval for PDR: 6.36–8.54, confidence interval for DME: 3.68–4.85).</div></div><div><h3>Conclusions</h3><div>This analysis suggests that DM patients with comorbid SCD or SCT have an increased likelihood of DM-related microvascular pathology and a higher ocular treatment burden. Prospective studies are needed to further characterize the relationship between DM and SCT or SCD.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100756"},"PeriodicalIF":3.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Telangiectatic Capillaries in Retinal Vein Occlusion: Incidence, Topography, and Risk Factors

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-02-27 DOI: 10.1016/j.xops.2025.100754

Paolo Forte MD , Jennifer Cattaneo MD , Vincenzo Fontana BSc , Bénédicte Dupas MD , Giovanni Forte MD , Daniela Castro-Farías MD , Giuseppe Querques MD, PhD , Michel Paques MD, PhD , Chiara Maria Eandi MD, PhD

Purpose

To investigate the incidence, timing, dimensional features, and spatial characteristics of telangiectatic capillaries (TelCaps) in retinal vein occlusion (RVO) patients treated with anti-VEGF monotherapy.

Design

Prospective nonconcurrent cohort study.

Participants

One hundred thirty-eight eyes of 138 patients with treatment-naive RVO treated with anti-VEGF monotherapy for a minimum of 24 months.

Methods

Telangiectatic capillaries were identified using multimodal imaging, including indocyanine green angiography (ICGA), OCT, and color fundus photography. Recurrence of venous occlusive events was defined by new onset of retinal hemorrhages accompanied by worsening of macular edema. Cox regression modeling was used to assess risk factors for TelCap development.

Main Outcome Measures

Telangiectatic capillaries' incidence, dimensional features, spatial distribution, and association with RVO recurrence events.

Results

Over 4.4 ± 2.6 years of follow-up, TelCaps developed in 15/138 eyes (10.9%) after 26 ± 16 months. Telangiectatic capillaries in hemispheric and central RVO showed larger diameters compared with branch RVO (277 ± 44 μm vs. 196 ± 43 μm, P = 0.005) and preferential localization along the temporal horizontal raphe (y-axis coordinates: 0.4 ± 0.6 mm vs. 0.9 ± 0.7 mm, P = 0.017). The recurrence of RVO during follow-up was significantly associated with TelCap development (hazard ratio = 8.74, 95% confidence limit = 2.92–26.2, P < 0.001). At 5-year follow-up, the risk of developing TelCaps was ∼9% in patients without recurrence and ∼55% in those patients with recurrence.

Conclusions

Telangiectatic capillaries occur in approximately 10% of RVO cases undergoing intravitreal anti-VEGF monotherapy, with distinct characteristics based on RVO subtype. The strong association with disease recurrence suggests episodes of increased venous obstruction contribute to TelCap formation. Extended follow-up and vigilant screening are recommended; when TelCaps are suspected, ICGA can confirm the diagnosis and guide adjunctive targeted treatment.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的研究接受抗血管内皮生长因子单药治疗的视网膜静脉闭塞（RVO）患者毛细血管扩张（Telangiectatic capillaries，TelCaps）的发生率、时间、尺寸特征和空间特性。方法使用多模态成像技术，包括吲哚青绿血管造影术（ICGA）、OCT 和彩色眼底照相术，识别远端毛细血管。静脉闭塞事件复发的定义是新出现视网膜出血并伴有黄斑水肿恶化。结果在 4.4 ± 2.6 年的随访中，有 15/138 只眼睛（10.9%）在 26 ± 16 个月后出现了 TelCap。半球和中央 RVO 中的远端毛细血管与分支 RVO 相比直径更大（277 ± 44 μm vs. 196 ± 43 μm，P = 0.005），且更倾向于沿颞水平剑突定位（y 轴坐标：0.4 ± 0.6 mm vs. 0.9 ± 0.7 mm，P = 0.017）。随访期间，RVO 的复发与 TelCap 的发展显著相关（危险比 = 8.74，95% 置信限 = 2.92-26.2，P <0.001）。结论在接受玻璃体内抗 VEGF 单药治疗的 RVO 病例中，约有 10% 的病例会出现远端毛细血管扩张，并且根据 RVO 亚型的不同而具有不同的特征。这种现象与疾病复发密切相关，表明静脉阻塞的加剧是导致泰勒帽形成的原因之一。建议延长随访时间并提高筛查的警惕性；当怀疑有TelCap时，ICGA可以确诊并指导辅助性靶向治疗。

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引用次数: 0

Prevalence and Associations of Epiretinal Membrane by OCT in a Japanese Population-Based Cohort: Tohoku Medical Megabank Organization Eye Study

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-02-26 DOI: 10.1016/j.xops.2025.100752

Akihiko Shiraki MD , Atsushi Hirayama MD, MPH , Nobuo Fuse MD, PhD , Ryo Kawasaki MD, PhD , Satoko Fujimoto MD, PhD , Tomoyuki Okazaki MD , Susumu Sakimoto MD, PhD , Takatoshi Maeno MD, PhD , Makiko Taira MD, PhD , Tomo Saito MS , Tomohiro Nakamura PhD , Soichi Ogishima PhD , Atsushi Hozawa MD, PhD , Kengo Kinoshita PhD , Masayuki Yamamoto MD, PhD , Kohji Nishida MD, PhD

Purpose

To examine the prevalence of epiretinal membrane (ERM) according to the OCT-based severity scales, and to describe associations focusing on the impact of smoking and axial length of the globe.

Design

Cross-sectional study.

Participants

The baseline examination cohort comprised participants from the Tohoku Medical Megabank community cohort recruited from 2013 to 2017.

Methods

In total, 38 118 eyes of 19 486 participants were classified with ERM staging. The characteristics of ERM severity were analyzed, and the association between the prevalence of ERM and ocular and systemic parameters was investigated using logistic regression models. Cubic spline models were constructed to visualize the relationships with lifetime smoking exposure and axial lengths. Regarding ERM severity, the associations between stage 1 and stage 2 or more were analyzed with multivariate analysis.

Main Outcome Measures

Epiretinal membrane prevalence at each stage determined via OCT and factors associated with ERM presence and severity.

Results

The prevalence of ERM was 2.3% per eye (3.6% per person), with a predominance at stage 1. The presence of severe ERM stages was higher in older individuals. The multivariate logistic analysis revealed that older age, female sex, and long axial length were associated with a higher prevalence of ERM. In a multivariate analysis stratified by sex, glaucoma was also identified as a significant factor associated with the prevalence of ERM in women. In the cubic spline model, no consistent trend was observed between smoking and ERM prevalence. However, a U-shaped relationship was indicated between axial length and ERM prevalence. Epiretinal membrane severity highlighted older age, alcohol consumption, and very long axial length as significantly associated compared with stage 1.

Conclusions

Epiretinal membrane prevalence was significantly associated with older age, female sex, and long axial length.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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引用次数: 0

Additive Effect of Highly Aspherical Lenslet Target Spectacles to Children Inadequately Controlled by Atropine Monotherapy

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-02-26 DOI: 10.1016/j.xops.2025.100753

Bryan Xiangrong Sim MMed, FRCOphth , Kai Lyn Loh MMed, FAMS , Hla Myint Htoon PhD , Yudah Sri , Maithily Balakrishnan , Pauline Chan Poh Lin , Ralene Zi Hui Sim MMed, FRCOphth , Crystal Shue Wen Lam BSc , Audrey Wei Lin Chia PhD, FRANZCO

Purpose

Myopia progression in children, especially in East Asia, is a significant public health concern. This study evaluated the efficacy of combining myopia control spectacle lenses with Highly Aspherical Lenslet Target (HALT) technology and atropine in children who continued to progress on low-dose atropine (LDA).

Design

Prospective cohort.

Subjects

Children aged 6–11 years with ≥0.5 diopters (D) myopia progression over 6 months on LDA (0.01% or 0.025%) were recruited.

Methods

All participants used HALT (Essilor Stellest) spectacle lenses while maintaining their LDA dose. The changes in spherical equivalent (SE) and axial length (AL) were tracked for 6 months before and 6–12 months after starting combination treatment.

Main Outcome Measures

Progression of SE and AL.

Results

Fifty children (mean age 8.9 ± 1.1 years) were separated into group A (on 0.01% atropine daily, n20) and group B (on 0.01% atropine twice daily, n5 and 0.025% atropine nightly, n25). Most (86%) were ethnic Chinese. The baseline SE and AL showed no significant intergroup differences, with prior myopia progression (0.60D/0.24 mm) over 6 months. After adding HALT lenses, progression slowed to −0.06D/0.06 mm at 6 months and −0.15D/0.14 mm at 12 months. A hyperopic shift in AL was seen in 11 children (24%). However, the progression of >0.5D was noted in 20%, with 18% and 40% progressing by >0.3 mm and >0.15 mm, respectively. Univariate analysis suggested that children who progressed >0.10 mm over 6 months were more likely to be younger, whereas multivariate analysis suggested that change in AL was associated with smaller pupil size (possibly from poor compliance or absorption of atropine) at 6 months and younger age at 12 months, after controlling for sex, race, and baseline SE and AL. There were no complaints of glare, near, or peripheral blur in children after starting combination treatment.

Conclusions

The addition of HALT spectacle lenses significantly reduced myopia progression in children, aged 6–11 years, who were poorly controlled on LDA alone demonstrating a potential synergistic effect with LDA. These findings supported combination therapy for managing challenging myopia cases.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的儿童近视的发展是一个重大的公共卫生问题，尤其是在东亚地区。本研究评估了在使用低剂量阿托品（LDA）后近视度数继续加深的儿童中，将高非球面小镜靶点（HALT）技术的近视控制眼镜片与阿托品相结合的疗效。方法所有参与者在保持 LDA 剂量不变的情况下使用 HALT（依视路 Stellest）眼镜片。结果50名儿童（平均年龄8.9 ± 1.1岁）被分为A组（每天服用0.01%阿托品，20人）和B组（每天两次服用0.01%阿托品，5人；每晚服用0.025%阿托品，25人）。大多数（86%）为华裔。基线SE和AL在组间无明显差异，6个月内近视度数有所加深（0.60D/0.24 mm）。添加 HALT 镜片后，近视度数在 6 个月和 12 个月分别减缓至-0.06D/0.06 mm 和-0.15D/0.14 mm。11名儿童（24%）出现了AL远视偏移。然而，有20%的儿童视力下降了0.5D，分别有18%和40%的儿童视力下降了0.3毫米和0.15毫米。单变量分析表明，6个月内瞳距增加0.10毫米的儿童年龄更小，而多变量分析表明，在控制了性别、种族、基线SE和瞳距后，6个月时瞳距的变化与瞳孔变小（可能是由于顺应性差或阿托品的吸收）和12个月时年龄更小有关。结论对于单用 LDA 控制不佳的 6-11 岁儿童，添加 HALT 镜片可显著降低近视度数的加深，这表明 HALT 镜片与 LDA 有潜在的协同作用。这些发现支持将联合疗法用于管理具有挑战性的近视病例。

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引用次数: 0

A Novel Bluetooth-Based Automated Flipper for Measuring Accommodative Facility: a Comparison with Conventional Manual Flipper

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science

Pub Date : 2025-02-25 DOI: 10.1016/j.xops.2025.100750

Hongxi Wang MD , Peiting Guo MD , Riping Zhang MD , Kunliang Qiu MD, PhD , Dongfeng Zhao BS , Liqiong Zhu BS , Mingzhi Zhang MD

Purpose

To evaluate the diagnostic accuracy of a Bluetooth-based automated flipper for measuring accommodative facility (AF) in children.

Design

A cross sectional study with crossover design.

Participants

Children aged 8 to 12 years were enrolled and randomly divided into 2 groups (A and B).

Methods

Initially, group A participants used the manual flipper to measure monocular (MAF) and binocular (BAF) AF, whereas participants in group B used the automated flipper. Subsequently, the groups underwent a crossover, exchanging the methods to measure AF. The diagnostic accuracy of the automated flipper was evaluated against gold standard, which defined inadequate AF as <7 cycles per minute (cpm) for MAF and <5 cpm for BAF, as measured with the manual flipper.

Main Outcome Measures

Accommodative facility measured using automated and manual flipper. Area under the receiver operating characteristic curve for automated flipper; sensitivity and specificity at the optimal cutoff (maximal Youden index).

Results

The average age of the 129 participants was 10.50 ± 1.42 years. The MAF and BAF values obtained using automated flipper were significantly correlated with those from the manual flipper (correlation coefficients of 0.819 and 0.813, respectively, both P < 0.001). The mean MAF and BAF measured with the automated flipper were 9.30 ± 2.30 cpm and 9.13 ± 2.34 cpm, respectively, significantly higher than the manual flipper's measurements (8.53 ± 2.16 cpm and 8.33 ± 2.22 cpm, respectively), even after adjusting for the learning effect associated with multiple measurements using analysis of variance for crossover design. The area under the curve for the automated flipper in diagnosing inadequate MAF and BAF was 0.911 (cutoff value = 9 cpm, sensitivity = 71.11%, specificity = 97.44%) and 0.920 (cutoff value = 7 cpm, sensitivity = 85.34%, specificity = 84.62%), respectively.

Conclusions

The automated flipper showed a strong correlation with the manual flipper, and demonstrated satisfactory sensitivity and specificity in diagnosing inadequate AF. It is recommended that the Bluetooth-based automated flipper be adopted as a novel tool to enhance the accuracy of AF testing in children.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

{"title":"A Novel Bluetooth-Based Automated Flipper for Measuring Accommodative Facility: a Comparison with Conventional Manual Flipper","authors":"Hongxi Wang MD , Peiting Guo MD , Riping Zhang MD , Kunliang Qiu MD, PhD , Dongfeng Zhao BS , Liqiong Zhu BS , Mingzhi Zhang MD","doi":"10.1016/j.xops.2025.100750","DOIUrl":"10.1016/j.xops.2025.100750","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic accuracy of a Bluetooth-based automated flipper for measuring accommodative facility (AF) in children.</div></div><div><h3>Design</h3><div>A cross sectional study with crossover design.</div></div><div><h3>Participants</h3><div>Children aged 8 to 12 years were enrolled and randomly divided into 2 groups (A and B).</div></div><div><h3>Methods</h3><div>Initially, group A participants used the manual flipper to measure monocular (MAF) and binocular (BAF) AF, whereas participants in group B used the automated flipper. Subsequently, the groups underwent a crossover, exchanging the methods to measure AF. The diagnostic accuracy of the automated flipper was evaluated against gold standard, which defined inadequate AF as <7 cycles per minute (cpm) for MAF and <5 cpm for BAF, as measured with the manual flipper.</div></div><div><h3>Main Outcome Measures</h3><div>Accommodative facility measured using automated and manual flipper. Area under the receiver operating characteristic curve for automated flipper; sensitivity and specificity at the optimal cutoff (maximal Youden index).</div></div><div><h3>Results</h3><div>The average age of the 129 participants was 10.50 ± 1.42 years. The MAF and BAF values obtained using automated flipper were significantly correlated with those from the manual flipper (correlation coefficients of 0.819 and 0.813, respectively, both <em>P</em> < 0.001). The mean MAF and BAF measured with the automated flipper were 9.30 ± 2.30 cpm and 9.13 ± 2.34 cpm, respectively, significantly higher than the manual flipper's measurements (8.53 ± 2.16 cpm and 8.33 ± 2.22 cpm, respectively), even after adjusting for the learning effect associated with multiple measurements using analysis of variance for crossover design. The area under the curve for the automated flipper in diagnosing inadequate MAF and BAF was 0.911 (cutoff value = 9 cpm, sensitivity = 71.11%, specificity = 97.44%) and 0.920 (cutoff value = 7 cpm, sensitivity = 85.34%, specificity = 84.62%), respectively.</div></div><div><h3>Conclusions</h3><div>The automated flipper showed a strong correlation with the manual flipper, and demonstrated satisfactory sensitivity and specificity in diagnosing inadequate AF. It is recommended that the Bluetooth-based automated flipper be adopted as a novel tool to enhance the accuracy of AF testing in children.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100750"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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