American Journal of Ophthalmology最新文献

Purpose: Sex bias remains a pervasive reality in academic medicine, often reflected in subtle linguistic choices, which can skew perceptions of competence and perpetuate workplace inequity. This study aims to investigate the relationship between host sex, speaker sex, and speaker introduction practices in ophthalmology grand rounds events.

Design: Cross-sectional study METHODS: Publicly accessible videos of English-language ophthalmology grand rounds and other teaching events uploaded by academic institutions in the United States and Canada from January 2019 to June 2024 were analyzed by two independent reviewers. The primary outcome was the proportion of male and female speakers introduced with the formal title "Dr." by the event host. Secondary outcomes included the proportion of male and female speakers introduced with their academic degrees, current academic appointments, awards or achievements, and research interests. Univariable and multivariable logistic regressions adjusted for the speaker's degree type(s), academic appointment, and affiliation were performed using Stata v17.0.

Results: Of 1,450 videos screened, 399 speaker introductions across 298 ophthalmology teaching sessions were analyzed. The formal title "Dr." was employed by the event host in 75.2% (n=300/399) of speaker introductions. In multivariable analysis, female speakers were significantly less likely to be introduced by their formal title (OR=0.55, 95%CI=0.25-0.78, P<.001), academic degrees (OR=0.61, 95%CI=0.35-0.97, P=.03) and their awards or achievements (OR=0.62, 95%CI=0.35-0.95, P=.04) compared to male speakers. Interaction terms between speaker and host sex were significant for formal title use (P=.03) and academic degrees (P=.04), prompting subgroup analyses by host sex. Findings were consistent when stratified by male hosts, while there was no difference in the likelihood of introducing male or female speakers with their formal titles, academic degrees, or awards/achievements when introduced by female hosts. Female speakers were significantly more likely to present on non-clinical topics compared to male speakers (OR=2.39, 95%CI=1.36-4.79, P<.001).

Conclusions: When introduced by male hosts, female speakers were less likely to be addressed using a formal title compared with male speakers, while no significant differences were observed when female hosts introduced speakers of either sex. A standardized approach to introducing speakers may be beneficial in mitigating sex biases during grand rounds and other academic events.

Purpose: To gauge the efficacy and safety of performing a one-stage endoscopic orbital decompression procedure combined with the intraoperative relaxed medial rectus muscle (MR) positioning technique as a means of treating esotropia associated with thyroid-associated ophthalmopathy (TAO).

Design: Prospective, single-blind, randomized controlled trial.

Setting: Eye Hospital of Wenzhou Medical University.

Methods: 38 TAO patients fulfilled the study requirements. The patients in Group A (n=19; mean age 52.32 ± 9.90 years; 12 males, 7 females) underwent a one-stage surgical procedure, whereas the patients in Group B (n=19; mean age 52.53 ± 8.49 years; 9 males, 10 females) underwent staged surgery. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, intraocular pressure (IOP), deviation, ocular motility, and diplopia were compared between these two groups.

Results: Of the patients in Group A, 8 (42.11%) underwent unilateral orbital decompression and 11 underwent bilateral decompression, while all 19 patients in Group B underwent bilateral decompression. Both groups exhibited significant improvements in postoperative BCVA (Group A 0.09 ± 0.15 logMAR, Group B 0.04 ± 0.08 logMAR), MD of visual field (Group A -2.73 ± 3.36 dB, Group B -1.82 ± 3.75 dB), proptosis (Group A 16.23 ± 2.58mm, Group B 17.04 ± 2.70mm), and IOP (Group A 16.23 ± 4.49mmHg, Group B 17.24 ± 4.14mmHg) when comparing postoperative values to preoperative levels, while there were no significant differences between these groups. In each group, 8 patients (42.11%) underwent surgical procedures targeting one single MR, whereas the remaining 11 in each group underwent surgery on two MRs. The respective primary motor and sensory success rates in Group A were 68.40% (13/19) and 78.95% (15/19), whereas those in Group B were 73.70% (14/19) and 84.21% (16/19), with no significant differences between these groups in terms of postoperative residual strabismus, stereoscopic vision improvements, or success rates.

Conclusion: These results demonstrate that a one-stage surgical procedure can simultaneously alleviate proptosis and diplopia while achieving outcomes comparable to those achieved through staged surgery. This treatment strategy can thus provide patients with greater therapeutic convenience, decreasing the overall number of surgical procedures and their attendant risks.

Purpose: Growing interest in microperimetry (MP) or fundus-controlled perimetry (FCP) as targeted psychometric testing method in geographic atrophy (GA) is warranted due to the disease subclinical/extra-foveal appearance or preexisting foveal loss with visual acuity becoming unreliable. We provide comprehensive pointwise test-retest repeatability reference values on the most widely used MP devices and combine them with targeted testing in areas of retinal pigment epithelium (RPE) as well as photoreceptor (PR) integrity loss, guiding the interpretation of sensitivity loss during the long-term follow-up of GA patients.

Design: Prospective reliability study METHODS: Patients with GA underwent consecutive testing on CenterVue (iCare) MAIA and NIDEK MP3 devices. Obtained PWS measurements were spatially co-registered to an optical coherence tomography (OCT) volume scan acquired during the same visit. Areas with RPE and PR integrity loss, drusen and PR thickness as well as the volume of hyperreflective foci (HRF) where identified and quantified using a set of validated deep learning-based algorithms. Test-retest repeatability was assessed according to areas defined by biomarker-specific morphologic changes using Bland-Altmann coefficients of repeatability (CoR). Furthermore, the inter-device correlation, the repeatability of scotoma point detection as well as any potential effects on fixation stability were assessed.

Results: 900 stimuli per device from twenty subjects were included. Identical overall PWS test-retest variance could be detected for MAIA (±6.57) and MP3 (±6.59). PR integrity loss was associated with a higher test-retest variance on both devices (MAIA: p=0.002; MP3: p<0.001). Higher CoR for stimuli in areas presenting RPE loss (±10.99 vs ±5.34) or HRF (±9.21 vs ±6.25) could only be detected on MP3 examinations (p<0.001 and p=0.01, respectively). An excellent intra-device correlation (MAIA: 0.94[0.93-0.95] MP3: 0.94[0.94-0.95]) and a good mean inter-device correlation (0.84[0.53-0.92]) could be demonstrated. The chosen device, run order or absence of foveal sparing had no significant effect on fixation stability.

Conclusion: Areas presenting automatically quantified PR integrity loss with and without underlying RPE loss are associated with higher test-retest variance for both MAIA and MP3. These findings are crucial for an accurate interpretation of GA progression during long-term follow-up and the planning of future trials with microperimetry testing as functional study endpoint.

Purpose: To compare 7 AI-based IOL power calculation formulas in extremely long eyes DESIGN: : Retrospective accuracy and validity analysis.

Methods: SETTING: Kyiv Clinical Ophthalmology Hospital Eye Microsurgery Center, Ukraine STUDY POPULATION: : Patients with highly myopic eyes, who underwent uneventful phacoemulsification OBSERVATION PROCEDURES: Prior to cataract surgery IOL power was calculated. The power of the implanted IOL was randomly selected from the outcomes of SRK/T, Holladay 2 or Barrett Universal II. Three months after phacoemulsification, refraction was measured. Post-surgery IOL power calculations were performed utilizing the following formulas: Hill-RBF 3.0, Kane, PEARL-DGS, Ladas Super Formula AI (LSF AI), Hoffer QST, Karmona and Zhu-Lu.

Main outcome measures: root mean square absolute error (RMSAE), median absolute error (MedAE) and percentage of eyes with prediction error (PE) within ±0.50 D RESULTS: : Forty eight eyes with axial length exceeding 30.00 mm were studied. Hill-RBF 3.0 yielded the lowest RMSAE (0.788) with statistical superiority only over Karmona (0.956, p=0.021). In terms of MedAE, outcomes obtained by Hoffer QST (0.442) and Hill-RBF (0.490) were statistically significant vs LSF AI (0.800, p=0.013, p=0.008, respectively). The highest percentage of eyes with PE within ±0.50 D was achieved by Hill-RBF 3.0, Kane and Hoffer QST (54.17% each) statistically significant as follows: both Hill-RBF and Kane vs LSF AI (27.08%) and Karmona (39.58%), and Hoffer QST vs LSF AI.

Conclusion: All tested formulas demonstrated comparable trueness, with Hill-RBF 3.0 being more accurate than Karmona (RMSAE), and LSF AI being less accurate than Hoffer QST and Hill-RBF 3.0 (MedAE).

Purpose: To highlight innovations in ophthalmic oncology through histiocytosis advancements.

Design: Perspective and retrospective review.

Methods: The literature outlining the recent advancements in histiocytosis and ocular oncology were reviewed and combined with trial data and personal recollection. Intersections between these two fields were discussed.

Results: The understanding of genetic mutations in disease-both in which cells they occur and the timing of mutation development-has expanded in tandem for the fields of ophthalmic oncology and histiocytosis. Similarly, advancements in diagnostic and treatment technology in one field can help patients in the other. For example, in one study, cell-free DNA testing reliably detected mutations in 14 of 18 (78%) patients with suspected histiocytosis. This technique has also been used in ophthalmic oncology as an alternative to invasive biopsy to avoid the risk of tumor externalization, vision impairment, and other side effects. These and other advancements, have allowed both fields to utilize targeted agents to successfully treat diseases with an actionable mutation; or deliver more targeted chemotherapy via the intraarterial technique.

Conclusions: The explosion of molecular genetics technology and targeted therapies has revolutionized cancer treatment, including histiocytosis and ophthalmic oncology. Recent progress in both fields has shown how these seemingly disparate areas have many intersections, and this speaks to the collaborative spirit that is inherent in clinical research.

Purpose: This study aimed to evaluate the humanistic burden of non-infectious uveitis (NIU).

Design: Systematic review and meta-analysis.

Methods: A comprehensive search was conducted across Medline, Embase, and Scopus databases from inception to March 2023. Studies pertaining to the health-related quality of life (HRQoL) of patients with NIU in both adult and pediatric populations were included. Identified studies were critically appraised and assessed for bias using the Joanna Briggs Institute Critical Appraisal tools.

Results: A total of 68 studies involving 8,403 participants met the inclusion criteria, and 10 studies were included in the meta-analysis. Across 14 HRQoL instruments used across the studies, Visual Function Questionnaire 25 (VFQ-25) was the most frequently used (n=35), followed by the 36-Item Short Form Survey (SF-36) and 8-Item Short Form Survey (SF-8) (n=30), EuroQol 5-Dimensions (EQ-5D) (n=8) and Pediatric Quality of Life (PedsQL) (n=8). Thirteen studies assessed pediatric populations (19%), 12 studies compared NIU and systemic disease (18%), 14 studies assessed QoL outcomes with different treatment modalities (21%), and 4 studies explored QoL outcomes through qualitative exploratory methods (6%). Patients with JIA-U had poorer HRQoL scores than non-uveitic JIA by 5.26 (95% CI -7.24, -3.28; P < .05) on the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire and the Childhood Health Assessment Questionnaire (CHAQ). Adults with NIU with systemic disease scored notably lower on both Mental Component Summary (MCS) (mean difference (MD): -5.63; 95% CI -9.37, -1.88; P < .01) and Physical Component Summary (PCS) (MD: -4.99; 95% CI -11.71, 1.73; P < .01) segments of the 36-Item Short Form Survey (SF-36) compared to healthy controls. Overall, the studies were of moderate to high quality.

Conclusion: NIU poses a significant QoL impact from a physical health, mental health, daily functioning, and caregiving perspective. Patients with NIU experience significant declines in QoL, particularly those with comorbid conditions and systemic diseases, highlighting the need for validation of uveitis-specific patient-reported outcome measures(PROMs). Future studies should develop interventions and explore QoL impacts on diverse geographic regions.