BMJ Open Ophthalmology最新文献

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.

Objective: To determine the prevalence and risk factors for blindness at initial hospitalisation with primary angle-closure glaucoma (PACG) and proposed glaucoma surgery in China.

Methods: A multistage stratified sampling method was used to select patients with PACG (1 January 2011 to 31 December 2020) presenting for initial hospitalisation from hospitals of various levels (n=26): 2 nationally leading ophthalmic hospitals, 12 university-affiliated and provincial people's hospitals and 12 city-level hospitals. Blindness is defined according to WHO standards, with visual acuity <3/60 defined as blindness. We used separate logistic regression models to identify the risk factors for blindness in at least one eye and bilateral blindness.

Results: Among the 3957 patients with PACG included in this study, 42.7% (n=1691) and 5.33% (n=211) had either-eye and bilateral blindness, respectively. In multivariable logistic models, participants with 60-69 years (ORs=1.28, 95% CI 1.06 to 1.55), 70-79 years (OR=2.27, 95% CI 1.85 to 2.78) and >80 years (OR=4.21, 95% CI 3.09 to 5.73) had a higher risk of either-eye blindness compared with those aged 50-59, higher intraocular pressure (IOP; OR=1.06 per mm Hg, 95% CI 1.05 to 1.07), residence in rural areas (OR=1.45, 95% CI 1.24 to 1.70) and presentation to city-level hospitals (vs higher-level facilities, OR=1.53, 95% CI 1.18 to 2.00) increased risk. Similar results were obtained for bilateral blindness.

Conclusions: In China, two out of every five PACG patients presenting for initial hospitalisation experienced blindness in at least one eye. Efforts to reduce this burden should focus on improving diagnostic and treatment services at city-level facilities in rural settings while focusing on older patients presenting with higher IOP.

Purpose: Age-related macular degeneration (AMD) remains the leading cause of blindness in developed countries. There are many different intravitreal anti-vascular endothelial growth factor (VEGF) drugs available for the treatment of neovascular AMD (nAMD). Unfortunately, not all patients respond equally well to the drugs, and some show recurrences during treatment. Since 01/2024, aflibercept 8 mg represents an additional treatment option and contains a four times higher dosage than the already known aflibercept 2 mg.

Methods: To evaluate the real-world efficacy of aflibercept 8 mg in refractory nAMD patients, focusing on changes in key optical coherence tomography biomarkers over a follow-up period of the first four aflibercept 8 mg injections using a deep learning-based semantic segmentation algorithm. Inclusion criteria were: switch to aflibercept 8 mg after insufficient response to aflibercept 2 mg, marked by persistent retinal fluid or inability to extend treatment beyond 6 weeks; completion of at least 3 months (90 days) follow-up under treat-and-extend treatment regime; and no confounding conditions like intraocular infection, uveitis or other retinal diseases.

Results: 23 eyes of 21 patients with therapy-resistant nAMD were switched to aflibercept 8 mg. All patients had previously received aflibercept 2 mg, with an average of 30.7 previous anti-VEGF injections. Significant reductions in intraretinal fluid and fibrovascular pigment epithelial detachment at timepoint V3 were observed. The decrease in subretinal fluid and central retinal thickness at V3 was not significant. Treatment intervals extended significantly by 24%, from a baseline average of 34 days to 42 days. Best-corrected visual acuity remained stable throughout the study period.

Conclusions: Aflibercept 8 mg demonstrated significant efficacy and durability in reducing nAMD biomarkers and extending intervals in a real-world setting. The use of deep learning for biomarker quantification highlighted its potential for enhancing treatment monitoring and decision-making. Future studies with a larger patient cohort and prospective study setting should explore long-term outcomes and integration of artificial intelligence-driven analysis.

Topic: To develop quality indicators to be included for the certification of excellence care in glaucoma units in Spain.

Clinical relevance: The certificate of excellence in care in glaucoma units is expected to enhance clinical outcomes and patient satisfaction, but also to optimise the use of resources and promote an efficient and effective patient care system.

Methods: The Delphi methodology was used to obtain a consensus on quality indicators in glaucoma care. The scientific committee and an advisory group created a 182-item questionnaire classified by indicator type: care structure, care process and outcomes. A two-round Delphi survey was conducted among a panel of expert ophthalmologists in Spain, and a 9-point Likert-type scale was used for data analysis.

Results: After the two rounds, 39 panellists reached consensus on 166 out of 182 items (91.2%). By indicator type, consensus was reached on 38 (88.4%) indicators related to care structure, on 85 (87.6%) indicators related to care process and on all indicators 42 (100%) related to outcomes.

Conclusion: This consensus identified a set of quality indicators that will help to develop the certification of excellence in glaucoma care units. This certification will facilitate best clinical practices and better health outcomes for glaucoma patients. Limitations of the study include the consensus nature of results, potential bias from the lengthy questionnaire and the focus on experts only in Spain, limiting generalisability.

Purpose: To evaluate and compare the vision-related quality of life and efficacy between myopic children and adolescents wearing orthokeratology (OK) lens, defocus spectacle (DS) lens and single vision spectacle (SVS).

Methods: This ambispective cohort study involved 93 participants who had worn optical correction lenses (31 OK lens, 31 DS lens and 31 SVS) for 1 year. The Pediatric Refractive Error Profile questionnaire was used to compare the visual-related quality of life after 1 year of lens wear among the three groups. Changes in axial length (AL) and spherical equivalent (SE) at 6 months and 1 year of lens wear across the groups were assessed.

Results: No significant differences were observed in academics and symptoms among the three groups (p>0.05). The OK lens group scored significantly higher in overall vision, far vision, appearance, satisfaction, activities, peer perception and overall scores than the SVS and DS lens groups (p<0.05). The DS lens group showed significantly lower scores in near vision compared with the OK lens and SVS groups (p<0.05). The OK lens group had a significantly lower handling score than the SVS group (p=0.01), with no significant difference between the OK lens and DS lens groups (p=0.184). In the 12th month, the axial length (AL) changes in the OK lens, DS lens and SVS groups were 0.18±0.08 mm, 0.27±0.08 mm and 0.36±0.09 mm, respectively (p<0.05). The OK lens group had the shortest AL elongation compared with the DS lens and SVS groups (p<0.05). The axial growth of the DS lens group was less than that of the SVS group (p<0.05). At both the 6th and 12th months, both the DS lens group and the SVS group showed an increasing trend in SE, with the SVS group exhibiting a significantly greater increase in SE compared with the DS lens group (p<0.001).

Conclusion: Although both the DS lens and OK lens can effectively control myopia, the OK lens demonstrates superior performance in improving vision-related quality of life and controlling axial elongation. This study is limited by the fact that the lens brands chosen by participants in the three groups were all commonly available brands on the market, and no single brand was selected for comparison.

Importance: This review explores the prevalence, diagnostic challenges, associated comorbidities, and potential complications of early-onset glaucoma in individuals with Stickler syndrome. By addressing these aspects, this review aims to enhance clinical awareness, improve patient outcomes and highlight research opportunities within the paediatric Stickler syndrome population.

Methods and results: Of 185 unique studies, 51 duplicates were removed, leaving 15 studies for analysis. The review included data from 679 patients, of whom 82 were reported as being diagnosed with glaucoma, yielding an overall prevalence of 12.1%. The prevalence was 7.5% in patients aged 0-10 years and remained stable through age 20. It then increased to 18% in patients aged 21-40 years, before slightly decreasing to 16.5% in those over 40. Paediatric patients with Stickler syndrome and glaucoma exhibited a higher risk of cataract (56% vs 22%, OR 4.5, p<0.05) and hearing loss (70% vs 31% OR 5.2, p<0.05) compared with those without glaucoma.

Conclusions: Early identification of clinical signs is critical for effective intervention. Paediatric patients with Stickler syndrome, particularly those with cataract or hearing loss, are at higher risk of glaucoma and, therefore, should be closely monitored, in addition to regular retinal assessments. Given the limitations of this review-including small sample sizes and variable diagnostic methods-larger standardised studies are needed to refine glaucoma prevalence estimates and clinical guidelines for Stickler syndrome.

Purpose: To assess the application of generative adversarial networks (GANs) to restore the blurred optical coherence tomography (OCT) images caused by optical media opacity in eyes.

Methods: In this cross-sectional study, a spectral-domain OCT (Zeiss Cirrus 5000, Germany) was used to scan the macula of 510 eyes from 272 Chinese subjects. Optical media opacity was simulated with an algorithm for training set (420 normal eyes). Images for three test sets were from the following: 56 normal eyes before and after fitting neutral density filter (NDF), 34 eyes before and after cataract surgeries and 90 eyes processed by algorithm. GANs of pix2pix was trained with training set and restored blurred images in test sets. Structural similarity index (SSIM) and peak signal-to-noise ratio (PSNR) were used to evaluate the performance of GANs.

Results: PSNR for test sets before and after image restoration was 18.37±0.44 and 19.94±0.29 for NDF (p＜0.01), 16.65±0.99 and 16.91±0.26 for cataract (p=0.68) and 18.33±0.55 and 20.83±0.41 for algorithm regenerated graph (p＜0.01), respectively. SSIM for test sets before and after image restoration was 0.85±0.02 and 1.00±0.00 for NDF (p＜0.01), 0.92±0.07 and 0.97±0.02 for cataract (p＜0.01) and 0.86±0.02 and 0.99±0.01 for algorithm regenerated graph (p＜0.01), respectively.

Conclusions: GANs can be used to restore blurred OCT images caused by optical media opacity in eyes. Future studies are warranted to optimise this technique before the application in clinical practice.

Aims: To determine whether peripheral retinal irradiation with low-energy red light can effectively and safely delay the progression of myopia.

Methods: The guinea pigs (age, 2 weeks) were used. The central or peripheral retina was exposed to red light for 3 min each at 9:00 AM and 5:00 PM daily. At day 28, examinations were performed to assess the condition of axial length, the cornea and lens, and the central choroid thickness. The ratio of axial length at a given time to the baseline axial length was used to assess the axial length growth.

Results: Under the same energy density mode, illuminance (energy density) on the retina layer of peripheral irradiation is less than that of central irradiation. Under myopia induction, after 4 weeks of red light irradiation, the axial length ratios of the central and peripheral irradiation groups were 1.09±0.02 and 1.07±0.02, respectively, both significantly lower than the axial length ratio of 1.11±0.01 in the group with only myopia induction. Peripheral irradiation outperformed central irradiation in delaying axial elongation (p<0.05). Under the premise of myopia induction, peripheral irradiation but not central irradiation at 0.6 mW/cm² still delayed axial elongation. Both central and peripheral irradiation increased central choroidal thickness, with peripheral irradiation having a more pronounced effect.

Conclusion: Peripheral retinal irradiation with low-energy red light can effectively and safely slow axial growth while increasing central choroidal thickness. The follow-up period for the current study is 28 days, and the long-term safety of red light therapy for myopia necessitates further investigation.