BMJ Open Ophthalmology最新文献

Objective: Keen interest exists in the relationship between carotid atherosclerosis and primary open-angle glaucoma (POAG), with prior studies yielding inconsistent findings. This study aims to quantify the association between carotid intima-media thickness (CIMT) and POAG using data from a large cohort.

Methods and analysis: In this cross-sectional analysis, we used data from 47 595 participants in the UK Biobank. CIMT was assessed using carotid ultrasound, while POAG was diagnosed based on health records and self-reported information. Logistic regression was used to detect CIMT-POAG association, after adjusting for potential confounders. Additionally, relationships with POAG-related endophenotypes, including intraocular pressure (IOP), macular retinal nerve fibre layer (mRNFL) thickness, macular ganglion cell-inner plexiform layer thickness and retinal vascular features, were examined through linear regression.

Results: A greater CIMT, evaluated per SD increment, was associated with a 10% increased risk of POAG (OR 1.10, p=0.004). The CIMT-POAG relationship exhibited an approximately linear pattern (p non-linear=0.797). This association was more pronounced in women (OR 1.18, p=0.003) and in individuals with a high genetic predisposition to POAG (OR 1.14, p=0.004). Furthermore, higher CIMT was significantly correlated with increased IOP (β=0.14, p=0.007) and decreased mRNFL thickness (β=-0.16, p=0.030). Additionally, higher CIMT was found to co-occur with retinal vascular impairments, including a decrease in fractal dimension, an increase in vessel tortuosity and a narrower central retinal arteriole (all false discovery rates<0.05).

Conclusion: This study observes an association between increased CIMT and POAG, especially in women and individuals with genetic susceptibility. These findings suggest that CIMT may be a useful biomarker with potential clinical relevance and propose possible vascular mechanisms underlying disease progression.

Objective: Cataracts are the leading cause of poor vision in Japanese adults. As Japan's population is rapidly ageing, the demand for cataract surgery will continue to increase. Despite this, quantitative research evaluating both supply and demand of cataract surgery is lacking. The objective of this study was to forecast future cataract surgery demand and the supply of ophthalmologists in Japan by region and evaluate the cataract surgery demand-supply balance considering regional differences in demographics and medical resources.

Methods and analysis: Based on the Ministry of Health, Labour and Welfare's 'NDB Open Data', age-specific and sex-specific cataract surgery rates were calculated from the number of billed procedures. These rates were applied to the Ministry of Internal Affairs and Communications' 'Population Estimates' and National Institute of Population and Social Security Research's 'Future Population Projections' to estimate demand for 2030, 2040 and 2050. Future supply of ophthalmologists was estimated using linear regression based on data from the 'Survey of Physicians, Dentists, and Pharmacists'. The demand-supply ratio (demand divided by supply) was calculated for each prefecture. The demand-supply ratio multiplier for each year was calculated using 2022 as the base year.

Results: The estimated number of cataract surgeries was 1 929 848 in 2030, 2 373 260 in 2040 and 2 863 733 in 2050, with a significant increase projected for individuals in their 70s and aged 80+. Although most prefectures were expected to see a gradual increase in ophthalmologist numbers, a decrease was projected for some regional areas. Consequently, the demand-supply ratio was projected to increase nationwide, with a larger increase in regional areas, suggesting a widening disparity between regional and metropolitan areas.

Conclusion: Demand for cataract surgery would continue to rise, potentially increasing demand-supply imbalances, particularly in regions with ageing populations. Re-examination of the regional allocation of medical resources is necessary to correct disparities in access to treatment. These projections are subject to limitations related to the use of publicly available data and assumptions based on past trends, which may not fully reflect regional practice variation or future changes in surgical capacity.

Background/aims: Childhood myopia is a growing global concern, associated with significant burdens. This study aimed to identify evidence gaps and unmet needs in childhood myopia management through a European Delphi panel involving eye care professionals (ECPs) with expertise in childhood myopia management and payers (ie, individuals with experience in health technology assessment, healthcare funding, drug pricing and/or reimbursement decisions).

Methods: A modified Delphi method was employed, involving two rounds of online questionnaires followed by a final virtual workshop. The panel included 12 ECPs and 13 payers from seven European countries. Consensus was defined as ≥70% agreement among panellists.

Results: Consensus was achieved on all 37 statements across six categories: disease background, clinical burden, psychosocial/humanistic burden, economic burden, treatment options and unmet needs. Key findings included recognition of ethnicity and age as crucial factors in evaluating childhood myopia, as well as the minimal clinically important difference for progression reduction. The panel emphasised the need for long-term studies on the efficacy and safety of myopia treatments, especially their impact on reducing future complications. The impact of high myopia on quality of life and economic burden was also highlighted. Regarding unmet needs, despite some known factors, the exact mechanisms behind myopia development remain unclear. There is a need for comprehensive epidemiological data on European childhood myopia and regulatory-approved pharmacological treatments in Europe.

Conclusions: Consensus was reached among European ECPs and payers on the evidence gaps and unmet needs in childhood myopia management. These findings can guide future research to establish the best strategies for childhood myopia management and mitigate the burden.

Background/aims: The emotional response to Charles Bonnet Syndrome (CBS) (visual hallucinations in individuals with sight loss) is associated with negative affect, suggesting a link between psychological measures and hallucination characteristics. This study set out to investigate whether the association extends to a broader range of hallucination attributes and psychological measures, taking into account clinical factors likely to influence such associations.

Methods: 70 participants with self-reported CBS completed an online survey assessing hallucination attributes of frequency, duration, emotional valence, distress, level of control over hallucinations and impact on quality of life (QoL). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale while loneliness was assessed using the University of California Los Angeles (UCLA) Loneliness Scale. All three measures were combined as a mental health factor. Regression models tested relationships between hallucination attributes and mental health, controlling for age, sex assigned at birth, years of sight loss, years experiencing hallucinations, presence of migraine and visual field loss.

Results: All visual hallucination attributes except level of control were associated with the mental health factor; higher factor scores were associated with more frequent, longer lasting, more unpleasant and more distressing hallucinations and also with a more negative impact of hallucinations on QoL. These associations were independent of years of sight loss and CBS.

Conclusion: Mental health measures are linked to a wider range of CBS attributes than previously recognised, with greater clinical attention required to identify people with CBS who are experiencing psychological difficulties to help provide appropriate treatment and support.

Limitations: The study did not include a control group of visually impaired participants without hallucinations and has an uneven representation across age and gender with a small sample size for the sub-group analysis. The study relied on self-reported online data without clinical assessment; details of participants' medication use were not collected.

Background: Vitreomacular interface disorders are known to reduce vision-related quality of life (VR-QoL). This is due to both reduced visual acuity and metamorphopsia. In clinical practice, visual acuity is measured routinely, but quantitative measurements of metamorphopsia are less frequent. We conducted a scoping literature review to determine whether metamorphopsia or visual acuity has the greatest effect on VR-QoL.

Methods: A literature review, of studies published in English, and indexed in Medline or Embase, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 65 studies were identified. 55 were excluded as they did not meet the inclusion criteria.

Results: Of the 10 publications, six studied epiretinal membrane, two studied full-thickness macular hole, one studied vitreomacular traction with or without macular hole and one included both macular hole and epiretinal membrane. A variety of different methods were used to measure metamorphopsia and VR-QoL. Of the eight studies reporting the association between preoperative metamorphopsia and VR-QoL, five found a significant correlation. Six studies examined the association between post-operative metamorphopsia and VR-QoL, five of which found a significant correlation. Five studies looked for any link between reduction in metamorphopsia and improvement in VR-QoL. All five found a significant association. In contrast, only two of eight studies found any association between preoperative vision and VR-QoL, and none found any relationship between improvement in visual acuity and improvement in VR-QoL.

Conclusions: Although the published evidence is limited, it appears that metamorphopsia may be a better predictor of preoperative and postoperative VR-QoL than visual acuity. Further research is necessary to confirm this, but metamorphopsia should be measured when assessing vitreomacular interface disorders.

ObjectiveTo study the properties of different ophthalmic viscosurgical devices (OVDs) with respect to their ability to create and maintain high intraocular pressure (IOP) during the creation of a continuous curvilinear capsulorhexis (CCC) by comparing the drop in IOP before and after creation of the CCC.

Methods and analysis: The study included 174 eyes in four groups using two different OVDs (hyaluronic acid (HA) and hydroxypropylmethylcellulose (HPMC)) and two different instruments (utrata forceps (UF) and 26G cystotome (RN)). IOP was measured using rebound tonometry with sterilised probes immediately before the beginning of the CCC and immediately afterwards during cataract surgery.

Results: The drop in IOP during capsulorhexis was measured at 52.1±10.7 mm Hg with the combination HA/RN, 62.4±11.5 mm Hg with HA/UF, 60.5±10.0 mm Hg with HPMC/RN and 68.7±14.1 mm Hg with HPMC/UF. The variance in IOP reduction between HA and HPMC did not reach statistical significance (p=0.100).

Conclusion: The lack of a noticeable difference in IOP levels, despite the use of different OVDs with unique properties, indicates that IOP may not be the main factor influencing the notable differences in tactile feedback perceived by surgeons during capsulorhexis procedures conducted with varying OVDs. To elucidate these sensations, additional characteristics such as viscosity, elasticity, pseudoplasticity and cohesion will have to be explored.

Aims: To investigate retinal vascular geometric alterations following intraocular pressure (IOP)-lowering surgery in patients with primary angle closure disease (PACD) and determine associations between IOP reduction magnitude and retinal vascular parameters.

Methods: This retrospective, self-controlled study included patients with PACD who underwent IOP-lowering surgery at Beijing Tongren Hospital. Retinal vascular parameters were quantitatively measured from fundus photographs before and after surgery using a validated deep learning-based analysis system. Main outcomes included retinal arteriolar and venular calibre, tortuosity, fractal dimension (FD), segment number (N_seg) and vascular density. Linear mixed-effects models, adjusted for age, follow-up interval and PACD subtype, assessed associations between IOP reduction magnitude and vascular parameter changes.

Results: Among 126 eyes (112 patients), surgery decreased IOP from 35.0±9.9 to 16.7±5.7 mm Hg (p<0.001). Venous FD increased from 1.52±0.06 to 1.53±0.05 (p=0.003), N_seg from 123.50 (IQR: 61.75-182.50) to 153.00 (88.50-185.00) (p=0.007), vessel area density (VAD) from 6.13±1.56 to 6.50±1.34 (p=0.006) and vessel skeleton density (VSD) from 1.24±0.35 to 1.35±0.31 (p=0.003). Vessel calibre and tortuosity showed no significant changes. IOP reduction magnitude was independently associated with changes in venous FD (p=0.023), N_seg (p=0.031), VAD (p=0.012) and VSD (p=0.030).

Conclusions: Surgical IOP reduction in PACD patients produces selective retinal venous alterations with increased complexity and density. These pressure-responsive changes may provide complementary, non-invasive information regarding vascular response after surgery.

Objective: In retrocaruncular medial decompression, the incision is small relative to the depth of the surgical space, and haemorrhage may obscure vision. Measures that minimise bleeding are most important to improve visualisation and facilitate the procedure. Despite this, there is no consensus regarding the effect of nasal packing with a vasoconstrictive agent. The aim of this study was to see if haemorrhage during external medial decompression could be reduced by nasal packing.

Methods and analysis: A randomised, non-blinded, prospective study in which patients listed for orbital medial wall decompression at St Erik Eye Hospital, Sweden, were recruited. Patients were randomised to receive either nasal packing with a 4%+0.02% Cocaine Hydrochloride-Adrenaline solution or the control group. Intraoperative bleeding was quantified by weighing the suction device before and after the procedure.

Results: A total of 46 medial orbital wall decompressions in 37 patients were included in the final analysis. The treatment group, which received nasal packing, demonstrated significantly reduced intraoperative bleeding compared with the control group (median 9.40 g vs 30.10 g, p<0.001). No surgical complications or postoperative infections were reported.

Conclusions: This study demonstrated a highly significant reduction in perioperative bleeding during retrocaruncular medial decompression when nasal packing with a vasoconstrictive agent was used (p<0.001). The main limitation of this study is the potential variability between surgeons. However, a post hoc test (p=0.75) and interaction analysis (p=0.63) did not reveal any differences between surgeons. In summary, nasal packing with a potent vasoconstrictor offers a simple, effective means to reduce intraoperative bleeding during external medial wall decompression and can thereby be an easy way to facilitate this surgical procedure and reduce the risk of complications.

Objective: Aqueous humour (AH) contains relatively high concentrations of vitamin C (ascorbate). AH drains out of the anterior chamber through the trabecular meshwork (TM) and, therefore, TM cells in vivo are routinely bathed in this antioxidant. Yet, most TM cells are cultured in vitro in media without ascorbate. In this study, we investigated molecules expressed by TM cells cultured with and without ascorbate.

Methods and analysis: Non-glaucomatous TM cell strains were grown to confluence and placed in serum-free media with or without 0.1 mM ascorbate for 3 days. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blotting were used to investigate protein levels, and some bands were analysed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) mass spectrometry. RNA was isolated and gene expression was quantified using fluorescent barcode technology. Following data normalisation, bioinformatics software was used to identify differentially expressed genes (DEGs). Quantitative PCR was used to validate results.

Results: In ascorbate-treated cells, western immunoblotting showed that several collagen chains were properly modified and secreted and LC-MS/MS identified proteins. Gene expression showed that 76 genes were significantly upregulated, and 20 genes were downregulated. Not surprisingly, antioxidative stress genes (SOD1, PRDX1, TXN2) were upregulated. Several genes involved in collagen synthesis, extracellular matrix assembly and remodelling (HSP47, MMP2, TIMP2, SERPINE1, CDH5, NCAM1, ITGA4) were also upregulated, but ITGB3 was downregulated. Genes involved with vascular endothelium growth factor (VEGF) (VEGFA, VEGFB), transforming growth factor β (SMAD2, SMAD4) and Hedgehog (PTCH1, GLI1) signalling pathways were also significantly altered by ascorbate treatment. Interestingly, many DEGs have no currently assigned role in ascorbate response.

Conclusions: This study revealed several collagens and 96 genes that are regulated by ascorbate in TM cells. Our results establish the importance of including ascorbate in culture media during the in vitro culture of TM cells. Further analysis of the function of these genes may improve our understanding of the importance of ascorbate for TM cell health.