BMJ Open Ophthalmology最新文献

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.

Background: A few studies have reported conjunctivitis is a complication associated with acute COVID-19. It is unknown whether SARS-CoV-2 infection increases the risk of conjunctivitis post-COVID-19 long term.

Objectives: This study investigated the incidence of new-onset conjunctivitis 3.5 years post SARS-CoV-2 infection and compared it with patients without SARS-CoV-2 infection.

Methods: This retrospective study consisted of 67 702 patients who tested positive for COVID-19 (defined by a positive PCR test), and 1 391 135 COVID-19-negative patients with no prior records of conjunctivitis in the Montefiore Health System from 11 March 2020 to 31 December 2022. The study included adult patients re-presenting to our centre with conjunctivitis. Outcome was new conjunctivitis between 14 days and 3.5 years post index date. Analysis was performed with unmatched and matched cohorts. Matching was done for age, sex, race and ethnicity. Cumulative incidence and hazard ratio (HR) with and without adjustment for competitive risks were analysed.

Results: There were 1154 (2.27%) individuals with COVID-19 and contemporary 13 899 (1.57%) controls who developed new conjunctivitis. COVID-19-positive patients had a significantly higher risk of developing new incident conjunctivitis (unmatched cohort adjusted HR 1.11 (95% CI 1.04 to 1.17), matched cohort adjusted HR 1.10 (95% CI 1.02 to 1.16)) compared with COVID-19-negative patients.

Conclusions: COVID-19-positive patients had significantly higher risk of developing new conjunctivitis compared with contemporary COVID-19-negative controls. Identifying risk factors for developing new-onset conjunctivitis may draw clinical attention for careful follow-up in at-risk individuals for ocular infections.

Objective: This study aims to develop ultrasound biomicroscopy (UBM)-based artificial intelligence (AI) models for preoperative differentiation of acute angle closure (AAC) with or without zonulopathy and to compare their comprehensive diagnostic performance against ophthalmologists as a cross-sectional study.

Methods and analysis: Three AI models were developed to differentiate AAC with or without zonular laxity or lens subluxation using UBM images and ocular parameters. Their diagnostic performances were analysed, with the best-performing model then compared with two diagnostic methods used by ophthalmologists (logistic regression and UBM image analysis). Additionally, a robustness validation dataset, including images from UBM and anterior segment optical coherence tomography (AS-OCT), was used to validate the robustness of the best-performing AI model.

Results: A total of 537 eyes were included in this study. The best-performing AI model was image-based and achieved a macro-area under the curve (AUC) of 0.9046 with a diagnostic processing time of 0.03 s per image in differentiating AAC with or without zonulopathy. The manually calculated multinomial logistic regression model achieved a macro-AUC of 0.9373, requiring 1200.00 s per analysis. UBM image analysis achieved a mean accuracy and processing time of 64.17% and 20.13 s, respectively, per image. Robustness validation of the image-based AI model showed an accuracy of 66.67% and 61.11% for UBM and AS-OCT images.

Conclusions: AI models and ophthalmologists effectively differentiated AAC with or without zonulopathy. However, when evaluated in terms of both accuracy and efficiency, the AI model showed superior comprehensive diagnostic performance, demonstrating high clinical applicability for preoperative diagnosis.

Purpose: To investigate central Bowman's layer thickness (BT) in relation to central corneal thickness (CCT) and curvature, and epithelial thickness in healthy and disease corneas.

Methods: Patients with keratoconus (KC), corneal dystrophies (CD) and healthy controls (HC) were included. Linnik and Mirau versions of an ultra-high axial resolution line field spectral domain optical coherence tomography device were used to image the cornea, in addition to commercially available devices. A supervised automated segmentation process was used to extract the quasi-point thickness of Bowman's layer.

Results: 62 participants: 24 with KC, 20 with CD and 18 HC were included. Mean central BT was 15.41 µm (SD 0.49; min-max: 12.28-19.54) in HC, 14.27 µm (SD:0.43; min-max: 11.22-18.25) in KC and 15.65 µm (SD 0.64; min-max: 12.42-20.06) in CD (mainly Fuchs CD). Patients with KC had thinner central BT than those with CD (p=0.03), but not compared with HC (p=0.13). Central BT was significantly associated with CCT (p<0.01), being on average 3% of CCT. The ratio of BT to CCT was independent of diagnosis (CD 0.028, HC 0.030, KC 0.028, p=0.88), age (p=0.23), sex (p=0.67), Kmax (p=0.77) or epithelial thickness (p=0.72).

Conclusions: Over sample populations of healthy, keratoconic and dystrophic corneas, central BT was consistently associated with corneal thickness and was independent of age, sex, Kmax, and epithelial thickness.

Trial registration number: ISRCTN40558.