BMJ Open Ophthalmology最新文献

Aims: To evaluate the efficacy of myopia control by spectacle lenses in a real-world study.

Methods: This is a longitudinal, retrospective, comparative, observational, real-world study of the French Myopia Cohort. Records of prescriptions for optical correction, gender and age were collected from 1500 opticians between 2020 and 2023. The study cohort consisted of myopic children aged 4 to 15 years who were assigned to three groups: two control groups wearing single vision lenses (SVL) and one intervention group wearing myopia control spectacles (MCS); either defocus incorporated multiple segments (DIMS, n=1786) or highly aspheric lenses (HAL, n=585). The first SVL group was matched to the MCS group for age, sex and initial refractive error (first matching), and the second SVL group was matched for the same criteria and myopia progression during the first 6 months of follow-up (second matching).The difference in myopia progression was calculated between SVL groups and the MCS group. DIMS and HAL were also compared for myopia progression.

Results: A total of 2542 children (mean age of 9.5 years and mean spherical equivalent of -2.3 D at baseline) were included in each of the three groups. The mean progression rates for MCS were by +0.59 D (95% CI +0.57 to +0.62D; p<0.001) after the first matching and by +0.30 D (95% CI +0.28 to +0.32D; p<0.001) after the second matching, in comparison to the SVL groups. Children wearing HAL spectacles showed slightly less myopia progression (difference in progression = +0.14 D, 95% CI = +0.10 to +0.18, p<0.001) compared with the DIMS group.

Conclusions: Although there are some limitations, including its retrospective design, the lack of lifestyle and environmental data and the use of SE rather than axial length, this study showed that in a real-world setting, both DIMS and HAL spectacles demonstrated efficacy in reducing myopia progression. While a statistically significant lower myopia progression rate was observed in the HAL group, this difference was not clinically meaningful. This study also showed that DIMS and HAL reduce myopia progression among younger children aged 4 to 6 years.

Background: Orbital malignant tumours seriously affect the quality of life of patients; however, there is currently no quality-of-life questionnaire for patients with orbital malignant tumours.

Objective: To develop and evaluate a quality-of-life questionnaire for patients with orbital malignant tumours.

Methods: A pool of items was generated through a literature search, expert meeting and patient interview. Pre-survey and scale evaluation were performed, the quality-of-life questionnaire for patients with orbital malignant tumours (QLQ-OT) was modified, and the scale was evaluated by measuring the quality of life of 46 patients with orbital tumours.

Results: The effective rate of QLQ-OT was 97.4%, the Cronbach's alpha coefficient was >0.6, and the test-retest reliability Intraclass Correlation Coefficient was >0.7, suggesting good internal consistency and test-retest reliability. The Pearson correlation coefficients were >0.8 between individual domain scores; > 0.6 between items and their own domains in the QLQ-OT; and >0.6 between domains and their corresponding domains in Quality of Life Center Questionnaire, thereby indicating good content, convergent and criterion-related validity. Ten principal components (the initial eigenvalues >1) were abstracted from 38 items of the general by factor analysis, accounting for 81.0% of cumulative variance.

Conclusions: QLQ-OT has good compliance, reliability, validity and responsiveness and can be used to measure the quality of life of patients with orbital malignant tumours.

Purpose: Some patients with neovascular age-related macular degeneration (nAMD) have persistent signs of exudation under treatment with intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents. We examined the real-world anatomical responses among patients with suboptimal response and switched to faricimab using artificial intelligence (AI)-based retinal fluid quantification.

Methods: A retrospective, multicentric, cohort study of patients in France with exudative signs and switched to faricimab without a new loading phase, maintaining the same prior injection interval. The RetInSight Fluid Monitor AI software quantified subretinal (SRF) and intraretinal (IRF) fluid on spectral domain optical coherence tomography. The primary outcome was change in SRF and IRF volumes in the central 1 and 6 mm retinal areas after one and two injections of faricimab.

Results: 74 patients (74 eyes) were included (mean age: 81.5±8.4 years, 49% male). Significant reductions were observed in mean 1 mm IRF (-2.9±18.3 nl; p=0.002), mean 6 mm IRF (-17.7±71.1 nl; p<0.001) and mean 6 mm SRF (-24.8±156.3 nl; p<0.001) volumes after one injection. The proportion of dry eyes (<5 nl for SRF and IRF in the 1 and 6 mm areas) increased from 0% at baseline to 32.4% after one injection and 48.4% after two injections. Lower baseline SRF volumes were predictive of dry response after one injection (_adjOR 0.965; p=0.028) and lower baseline IRF volumes were predictive of dry response after two injections (_adjOR 0.373; p=0.051).

Conclusion: Nearly half of patients achieved a dry response after two injections. AI-assisted fluid quantification provided objective monitoring, identifying lower baseline SRF and IRF as predictive factors for good response. Limited patient inclusion means longer-term and larger prospective studies are now required using automated retinal fluid quantification to further refine the baseline characteristics of good switch responders to better adapt switch protocols.

Background: Diabetic retinopathy (DR), a microvascular complication of diabetes mellitus (DM), is a leading cause of vision loss worldwide. There is limited national data to inform about the prevalence of DM and DR and its associated factors, which led to the basis of conducting this survey, which would guide us for the same as part of the Rapid Assessment of Avoidable Blindness (RAAB) survey conducted across Nepal.

Methods: A population-based cross-sectional RAAB survey was conducted using multistage cluster random sampling. RAAB+DR methodology was conducted between June 2019 and February 2021 among individuals aged≥50 years across selected provinces. Diabetes was diagnosed based on treatment history and random blood glucose test with level>200 mg/dL, while DR was graded by trained ophthalmologists. All relevant data were imported into the RAAB software to determine the prevalence of DM, DR and associated factors.

Results: Among the 13 510 participants examined, the prevalence of DM was found to be 6.1% which was higher in Bagmati province at 9.4% (95% CI: 8.2% to 10.7%). Prevalence of DM was higher among females, but DR was more common in males in rural areas and females in urban areas. Untreated diabetes was most common in Madhesh (35.1%). DR prevalence was highest in Bagmati (15.9%; 95% CI: 12.7% to 19.1%), and 2.5% (95% CI: 1.2% to 3.8%) of those patients had sight-threatening DR. In Bagmati, 24.1% of diabetics had never undergone an eye examination.

Conclusion: The limited coverage of DR screening underscores the need for enhanced community-based DR screening and referral programmes. Our study lacked the use of plasma blood glucose level measurement to diagnose DM, proper slit lamp examination for diabetic retinopathy grading and diagnosis, and inclusion of a younger population providing a better representation. Strengthening these initiatives can prevent vision-threatening complications in underserved populations.

Objective: Retinoblastoma is the most common paediatric intraocular malignancy, originating in neural retina germ cells. Early diagnosis is crucial for survival and eye preservation. This study analyses gene expression and specific microRNAs (miRNAs) in patients with retinoblastoma to enhance early diagnosis, prognosis and treatment strategies.

Methods: This study examined gene and miRNA expression in 18 patients with retinoblastoma and 10 healthy individuals. Peripheral blood samples were collected from all participants, and patient demographics were recorded. The analysis was performed using real-time PCR targeting the RB1 and N-MYC genes, along with the miRNAs miR-125-5p, miR-221-3p and miR-519-3p.

Results: The patient group consisted of 18 participants (9 males, 9 females), aged between 2 and 6 years (mean±SD: 4.8±1.33 years), with a mean diagnosis age of 3.01±1.37 years. All participants were followed for 3 years, with no fatalities. The control group comprised 10 participants (4 males, 6 females), aged 2-8 years (mean±SD: 5.01±1.77 years). 11 patients underwent enucleation due to tumour progression: 3 right eyes and 8 left eyes. Gene expression analysis showed significant downregulation of miR-125-5p, miR-519-3p and NMYC in the retinoblastoma group. RB1 downregulation and miR-221-3p upregulation were noted in most patients, but without significant associations.

Conclusion: miRNAs, along with RB1 and N-MYC genes, may serve as predictive and prognostic biomarkers in retinoblastoma. While previous studies have highlighted the impact of certain miRNAs on survival and clinical outcomes, our study is limited by a small sample size and lack of strong statistical correlations. Large-scale studies are needed to validate these preliminary findings and clarify their clinical significance. Understanding the role of miRNAs in cancer biology could improve retinoblastoma mechanism insights and patient care.

Objective: Early identification of cerebral visual impairment (CVI) is important in providing timely educational support. This study explores the feasibility of early years teachers (EYT) administering in-nursery assessments of visual function.

Methods and analysis: EYT within six nursery settings were recruited and underwent training and supervision in visual acuity and tablet-delivered visuoperceptual testing (children's visual impairment test; CVIT 3-6). Binocular visual acuity was recorded at 1.5 m and 33 cm. A crowding ratio was calculated if visual acuity was poorer than 0.3 logMAR. Engagement scores were completed to offer insights into areas of testing children found easiest/hardest to engage with.

Results: Four nursery settings completed training and the families of 37 children aged 3-4 years consented to participate; 97% of participants completed acuity testing (mean testing time 5 min) and 86% participants underwent CVIT 3-6 testing (mean testing time 15 min). Mean CVIT 3-6 score was 54.6/70, (expected 10th centile score for age=53). Only 55% children completed all 14 CVIT 3-6 domains. The subtests with poor performance in all three areas (pass rate, completion rate and engagement score) were 'structure from motion', 'missing part' and 'coherent motion'.

Conclusion: Training EYT to administer visual function testing is feasible, in that some elements can be conducted in all children with a reasonably short test time. Further studies are required to identify which visuoperceptual testing domains offer the highest sensitivity/specificity for CVI-related visual dysfunction in this age group.

Objective: Optometric practices increasingly use ocular imaging as part of routine eye care. Alongside the increase in e-referral systems, the use of such images provides an opportunity for more accurate triaging of referrals, to ensure the most appropriate use of limited hospital resources. To encourage the incorporation of images into anterior eye pathology referrals, an NHS commissioner for Calderdale and Kirklees (West Yorkshire, UK) provided slit lamp mountable cameras to 20 local optometric practices. This study qualitatively explored the outcomes from this pilot study, identifying barriers and enablers for incorporating similar technology more widely.

Methods and analysis: Six months after receiving the camera, participating optometrists were contacted to discuss their experiences via semi-structured interviews. Opinions were also sought from commissioners of the initiative. Transcripts were reviewed and coded by the research team and organised via thematic analysis.

Results: Twelve semi-structured interviews took place. Five themes were identified: practice autonomy, communication, financial and time costs, hardware and software issues, and wider application of technology. Practitioners typically reported that the device had not been used much. This was partly due to difficulties integrating the device into their routine practice and partly due to the relatively low prevalence of anterior eye pathology requiring referral. A wider remit for the technology, other than simply improving triaging efficiencies, was also identified as part of this study.

Conclusion: This study highlights the importance of conducting small pilot studies prior to significant investment of scarce NHS resources. It also highlights the importance of sharing negative findings to share best practice and avoid wastage. Limitations of this investigation included the voluntary approach of both the camera scheme and our interviews; practitioners who took part in the study were more likely to be engaged and to participate in these types of schemes compared with non-participating practitioners, and the study was unable to investigate the barriers to entry for non-participants. Nevertheless, consulting with local practitioners during service design for similar new schemes may pre-empt potential barriers and facilitate greater engagement and practice autonomy for future schemes.

Objective: This study evaluated the clinical characteristics and treatment outcomes of bigger premature infants treated for retinopathy of prematurity (ROP).

Methods: A retrospective, multicentre study analysed data from 33 ROP centres in Türkiye. Infants with gestational ages (GA) of 32-37 weeks and birth weights (BW) >1500 g who required ROP treatment were included. Patient demographics, clinical details, treatments, responses and complications were recorded. Descriptive statistics were calculated after excluding cases with missing or erroneous data.

Results: The study included 365 eyes of 365 infants. The average GA at birth was 33±1 weeks, with a mean BW of 1896±316 g. Of these, 83.6% had type 1 ROP, and 16.4% had aggressive ROP (A-ROP). Treatment-requiring ROP (TR-ROP) occurred at an average postmenstrual age of 39.0±4.6 weeks. Among 170 infants with TR-ROP at their first exam, 81.2% were screened at 4 weeks postpartum. Reactivation of ROP was observed in 5.4% of the primary laser photocoagulation (LPC) group and 23.9% of the primary anti-vascular endothelial growth factor (VEGF) group (p<0.001). Reactivation and progression to stage 4-5 were more frequent in A-ROP cases (p=0.012; p=0.008). The need for additional treatment was significantly higher in cases of A-ROP, zone 1 disease or stage 4-5 disease (p<0.001). Anti-VEGF therapy demonstrated superior single-treatment success rates in A-ROP eyes compared with laser LPC (85.7% vs 60%, p=0.03). Infants requiring additional treatments also had higher rates of respiratory distress syndrome (RDS), maternal premature rupture of membranes (PROM) and non-ophthalmological surgical interventions (p<0.05).

Conclusion: Bigger premature infants in low and middle-income countries should be screened earlier than 4 weeks after birth. A-ROP, zone 1 disease and stage 4-5 disease have higher reactivation risks. Primary anti-VEGF therapy was associated with a greater need for retreatment. Maternal PROM, RDS and surgical interventions also increase retreatment risk. Limitations include retrospective design and lack of smaller preterm comparisons, potentially limiting generalisability.

Objective: Photoreceptors can be impacted early in diabetes mellitus (DM). The primary goal of this study was to determine if having DM and no/mild diabetic retinopathy (DR) affected photoreceptor layer thickness.

Methods and analysis: Participants from the UK Biobank database who underwent fundus photographs and macula-centred spectral domain-optical coherence tomography were considered for inclusion in the study. Multivariable linear regression models were used to compare photoreceptor thickness between participants with DM (no/mild DR) and without DM after adjusting for confounders. Secondary analyses investigated factors associated with photoreceptor thickness among participants with DM (no/mild DR).

Results: 64 237 participants without DM and 3832 with DM were included. Among those with DM, 2683 had no/mild DR. The inner segment/outer segment (IS/OS) photoreceptor junction was significantly thinner in participants with DM (no/mild DR) compared with those without DM (-0.06 µm, 95% CI -0.10 to -0.03). The OS photoreceptor layer was thinner in participants with DM (no/mild DR) compared with those without DM (-0.14 µm, 95% CI -0.19 to -0.08). Among participants with DM (no/mild DR), being male was associated with thinner IS/OS (p<0.001) and higher A1c level was associated with thinner OS (p=0.02). Thicker OS layer was associated with higher high-density lipoprotein (p<0.001), male gender (p<0.001) and higher spherical equivalent (p=0.005).

Conclusions: We found photoreceptor layers to be thinner in participants with DM (no/mild DR) compared with those without DM. Limitations include the absence of additional imaging such as angiography to evaluate the retina for early vascular changes or choroidal imaging to study the potential impact of the choroid on photoreceptors. Overall, our findings suggest that changes in photoreceptors may occur prior to evidence of more than mild DR on fundus photographs.