Lingyi Zhao, Bo Zhang, Jingjing Wang, Jinliuxing Yang, Linlin Du, Tianxiao Wang, Xun Xu, Xiangui He, Jun Chen
Aim: To evaluate the short-term effects of different sunlight exposure on fundus blood flow perfusion (BFP) after near work.
Methods: In this parallel randomised controlled trial, 81 students aged 7-15 with spherical equivalent refraction between -2.00 and +3.00 diopters were randomly assigned to either a low-illuminance (4k lux) group (N=40) or high-illuminance (10k lux) (N=41). Following 1 hour indoor reading, participants had sunlight exposure matching their group's intensity for 15 minutes. BFPs in the superficial retina, deep retina and choroid were measured at four time points: pre-reading, post-reading, 5th-minute and 15th-minute sunlight exposure.
Results: Within the initial 5 minutes of sunlight exposure, the 10k lux group showed a tendency for decreased BFP, particularly in the choroid (superficial retina: -0.2, 95% CI -0.9 to 0.5; deep retina: -0.1, 95% CI -0.6 to 0.4; choroid: -0.4, 95% CI -0.8 to 0.0), while the 4k lux group exhibited an increase (superficial retina: 0.7, 95% CI 0.1 to 1.3; deep retina: 0.3, 95% CI -0.2 to 0.8; choroid: 0.1, 95% CI -0.2 to 0.5). From 5 to 15 minutes, BFP decreased in both groups. At the 5th-minute mark, the 10k lux group exhibited a greater decrease in choroid (10k -0.4 vs 4k 0.1, p=0.051). No significant difference was observed after 15 minutes of exposure.
Conclusion: Higher illuminance sunlight exposure can restore fundus BFP more rapidly than lower; however, duration remains pivotal. To prevent myopia, continuous sunlight exposure for over 15 minutes is recommended to aid in reinstating the fundus BFP increased by near work.
Trial registration number: NCT05594732.
目的:评估不同日光照射对近距离工作后眼底血流灌注(BFP)的短期影响:在这项平行随机对照试验中,81 名球面等效屈光度在 -2.00 和 +3.00 屈光度之间的 7-15 岁学生被随机分配到低照度(4k 勒克斯)组(40 人)或高照度(10k 勒克斯)组(41 人)。在室内阅读 1 小时后,参与者接受 15 分钟与本组照度相匹配的阳光照射。在阅读前、阅读后、日光照射第 5 分钟和第 15 分钟这四个时间点测量了浅层视网膜、深层视网膜和脉络膜的 BFP:结果:在阳光照射的最初 5 分钟内,10k 勒克斯组的 BFP 呈下降趋势,尤其是脉络膜(浅层视网膜:-0.2,95% CI -0.9 至 0.5;深层视网膜:-0.1,95% CI -0.6 至 0.4;脉络膜:-0.4,95% CI -0.8 至 0.0),而 4k 勒克斯组则显示出增加(视网膜浅层:0.7,95% CI 0.1 至 1.3;视网膜深层:0.3,95% CI -0.2 至 0.8;脉络膜:0.1,95% CI -0.2 至 0.5)。从 5 分钟到 15 分钟,两组的 BFP 都有所下降。在第 5 分钟时,10k 勒克斯组的脉络膜下降幅度更大(10k -0.4 vs 4k 0.1,p=0.051)。照射 15 分钟后未观察到明显差异:结论:较高照度的日光照射比较低照度的日光照射能更快地恢复眼底BFP,但持续时间仍然至关重要。结论:较高照度的日光照射能比较低照度的日光照射更快地恢复眼底BFP,但日光照射时间的长短仍然至关重要。为预防近视,建议连续照射日光15分钟以上,以帮助恢复因近距离工作而增加的眼底BFP:NCT05594732.
{"title":"Short-term effects of sunlight exposure on fundus blood flow perfusion in children: a randomised controlled trial.","authors":"Lingyi Zhao, Bo Zhang, Jingjing Wang, Jinliuxing Yang, Linlin Du, Tianxiao Wang, Xun Xu, Xiangui He, Jun Chen","doi":"10.1136/bjo-2024-325715","DOIUrl":"https://doi.org/10.1136/bjo-2024-325715","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the short-term effects of different sunlight exposure on fundus blood flow perfusion (BFP) after near work.</p><p><strong>Methods: </strong>In this parallel randomised controlled trial, 81 students aged 7-15 with spherical equivalent refraction between -2.00 and +3.00 diopters were randomly assigned to either a low-illuminance (4k lux) group (N=40) or high-illuminance (10k lux) (N=41). Following 1 hour indoor reading, participants had sunlight exposure matching their group's intensity for 15 minutes. BFPs in the superficial retina, deep retina and choroid were measured at four time points: pre-reading, post-reading, 5th-minute and 15th-minute sunlight exposure.</p><p><strong>Results: </strong>Within the initial 5 minutes of sunlight exposure, the 10k lux group showed a tendency for decreased BFP, particularly in the choroid (superficial retina: -0.2, 95% CI -0.9 to 0.5; deep retina: -0.1, 95% CI -0.6 to 0.4; choroid: -0.4, 95% CI -0.8 to 0.0), while the 4k lux group exhibited an increase (superficial retina: 0.7, 95% CI 0.1 to 1.3; deep retina: 0.3, 95% CI -0.2 to 0.8; choroid: 0.1, 95% CI -0.2 to 0.5). From 5 to 15 minutes, BFP decreased in both groups. At the 5th-minute mark, the 10k lux group exhibited a greater decrease in choroid (10k -0.4 vs 4k 0.1, p=0.051). No significant difference was observed after 15 minutes of exposure.</p><p><strong>Conclusion: </strong>Higher illuminance sunlight exposure can restore fundus BFP more rapidly than lower; however, duration remains pivotal. To prevent myopia, continuous sunlight exposure for over 15 minutes is recommended to aid in reinstating the fundus BFP increased by near work.</p><p><strong>Trial registration number: </strong>NCT05594732.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beatrice Gallo, Rohan Hussain, Ranaa Al-Jamal, Hagar Khalid, Ian Stoker, Gordon Hay, Amit K Arora, Peter W Szlosarek, Mandeep S Sagoo
Aim: To report local tumour control, metastasis and survival rates of patients with small choroidal melanoma (CM) after treatment with ruthenium-106 (Ru-106) plaque brachytherapy.
Methods: Retrospective case series of 353 consecutive eyes with small CM (thickness ≤2.5 mm and largest basal diameter ≤16 mm) treated with Ru-106 brachytherapy at the London Ocular Oncology Service, between October 2004 and May 2019.
Results: The final cohort included 310 eyes and tumour recurrence was observed in 52 (17%) eyes. Ocular retention rate was 96%. Metastatic disease and tumour-related death occurred in 18 (5.8%) and 12 (3.9%) patients, respectively. Metastases were diagnosed after a median of 54 (54±35; range 3.6-118) months from initial treatment. Kaplan-Meier estimates for tumour recurrence, melanoma-related metastases and survival were 17% (95% CI 13.3% to 22.9%), 4.8% (95% CI 2.6% to 8.5%) and 98% (95% CI 94.4% to 99.1%) at 5 years and 26% (95% CI 18.3% to 35.3%), 16% (95% CI 8.7% to 27.7%) and 92% (95% CI 84.5% to 95.7%) at 10 years, respectively. On multivariable analysis, factors predictive for tumour recurrence included juxtapapillary location, larger plaque and final tumour thickness, and for metastasis exudative retinal detachment.
Conclusion: Small CMs treated with Ru-106 brachytherapy show recurrence and death rates of 17% and 2% at 5 years and 26% and 8% at 10 years. As small CMs have better prognosis than large tumours, early treatment is the key for better survival outcomes.
目的:报告小型脉络膜黑色素瘤(CM)患者接受钌-106(Ru-106)斑块近距离放射治疗后的局部肿瘤控制率、转移率和存活率:回顾性病例系列:2004年10月至2019年5月期间,在伦敦眼肿瘤学服务机构接受Ru-106近距离治疗的353例小型脉络膜黑色素瘤(厚度≤2.5毫米,最大基底直径≤16毫米)患者:最终队列包括310只眼睛,观察到52只眼睛(17%)肿瘤复发。眼部保留率为96%。分别有18名(5.8%)和12名(3.9%)患者出现转移性疾病和肿瘤相关死亡。转移瘤是在初始治疗后的中位数54(54±35;范围3.6-118)个月后确诊的。肿瘤复发、黑色素瘤相关转移和生存率的卡普兰-梅耶估计值分别为:5年17%(95% CI 13.3%至22.9%)、4.8%(95% CI 2.6%至8.5%)和98%(95% CI 94.4%至99.1%);10年26%(95% CI 18.3%至35.3%)、16%(95% CI 8.7%至27.7%)和92%(95% CI 84.5%至95.7%)。多变量分析显示,预测肿瘤复发的因素包括并乳头位置、较大的斑块和最终肿瘤厚度,而预测转移的因素包括渗出性视网膜脱离:采用Ru-106近距离放射治疗的小肿瘤在5年内的复发率和死亡率分别为17%和2%,在10年内的复发率和死亡率分别为26%和8%。由于小肿瘤的预后比大肿瘤好,因此早期治疗是获得更好生存结果的关键。
{"title":"Local tumour control and patient survival after ruthenium-106 brachytherapy for small choroidal melanoma.","authors":"Beatrice Gallo, Rohan Hussain, Ranaa Al-Jamal, Hagar Khalid, Ian Stoker, Gordon Hay, Amit K Arora, Peter W Szlosarek, Mandeep S Sagoo","doi":"10.1136/bjo-2023-324687","DOIUrl":"https://doi.org/10.1136/bjo-2023-324687","url":null,"abstract":"<p><strong>Aim: </strong>To report local tumour control, metastasis and survival rates of patients with small choroidal melanoma (CM) after treatment with ruthenium-106 (Ru-106) plaque brachytherapy.</p><p><strong>Methods: </strong>Retrospective case series of 353 consecutive eyes with small CM (thickness ≤2.5 mm and largest basal diameter ≤16 mm) treated with Ru-106 brachytherapy at the London Ocular Oncology Service, between October 2004 and May 2019.</p><p><strong>Results: </strong>The final cohort included 310 eyes and tumour recurrence was observed in 52 (17%) eyes. Ocular retention rate was 96%. Metastatic disease and tumour-related death occurred in 18 (5.8%) and 12 (3.9%) patients, respectively. Metastases were diagnosed after a median of 54 (54±35; range 3.6-118) months from initial treatment. Kaplan-Meier estimates for tumour recurrence, melanoma-related metastases and survival were 17% (95% CI 13.3% to 22.9%), 4.8% (95% CI 2.6% to 8.5%) and 98% (95% CI 94.4% to 99.1%) at 5 years and 26% (95% CI 18.3% to 35.3%), 16% (95% CI 8.7% to 27.7%) and 92% (95% CI 84.5% to 95.7%) at 10 years, respectively. On multivariable analysis, factors predictive for tumour recurrence included juxtapapillary location, larger plaque and final tumour thickness, and for metastasis exudative retinal detachment.</p><p><strong>Conclusion: </strong>Small CMs treated with Ru-106 brachytherapy show recurrence and death rates of 17% and 2% at 5 years and 26% and 8% at 10 years. As small CMs have better prognosis than large tumours, early treatment is the key for better survival outcomes.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To investigate the association of floor area ratio (FAR), an indicator of built environments, and myopia onset.
Methods: This prospective cohort study recruited 136 753 children aged 6-10 years from 108 schools in Shenzhen, China at baseline (2016-2017). Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school.
Results: Of 101 624 non-myopic children (56.3% boys; mean (SE) age, 7.657±1.182 years) included in the study, 26 391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p<0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p<0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95% CI 1.3% to 2.6%, p<0.001).
Conclusions: Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.
{"title":"Shaping school for childhood myopia: the association between floor area ratio of school environment and myopia in China.","authors":"Danqi Zeng, Yahan Yang, Yang Tang, Lanqin Zhao, Xun Wang, Dongyuan Yun, Wenben Chen, Yuanjun Shang, Andi Xu, Huipeng Liao, Xingying Zhang, Duoru Lin, Haotian Lin","doi":"10.1136/bjo-2024-325448","DOIUrl":"https://doi.org/10.1136/bjo-2024-325448","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the association of floor area ratio (FAR), an indicator of built environments, and myopia onset.</p><p><strong>Methods: </strong>This prospective cohort study recruited 136 753 children aged 6-10 years from 108 schools in Shenzhen, China at baseline (2016-2017). Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school.</p><p><strong>Results: </strong>Of 101 624 non-myopic children (56.3% boys; mean (SE) age, 7.657±1.182 years) included in the study, 26 391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p<0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p<0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95% CI 1.3% to 2.6%, p<0.001).</p><p><strong>Conclusions: </strong>Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Theni district, India, based on current utilisation of eye care services and prevalence of vision impairment, a 5-year goal of eliminating vision impairment would require that the annual cataract surgical workload increase by 11.5%. Studies of this kind may have considerable value in planning service delivery in other locations. Using the axial length of the fellow eye in eyes with retinal detachment results in a clinically significant reduction of predictability of the postoperative refraction. Therefore, rather than combined phako-vitrectomy, a two-step procedure should be favoured, if possible, in which vitrectomy is undertaken first and measurements for IOL selection performed after reattachment of the retina. Deep-learning models trained with both fundus images and 15 features from the clinical information showed excellent diagnostic abilities in predicting glaucoma progression in glaucoma suspect patients with normal intraocular pressure. Opportunistic detection of glaucoma on fundus photographs in national diabetic retinopathy screening found 9% of patients had glaucoma. Referring patients with vertical-cup-to-disc ratio of 0.65 showed moderate sensitivity but low specificity and …
{"title":"At a glance","authors":"Frank Larkin","doi":"10.1136/bjo-2024-325908","DOIUrl":"https://doi.org/10.1136/bjo-2024-325908","url":null,"abstract":"In Theni district, India, based on current utilisation of eye care services and prevalence of vision impairment, a 5-year goal of eliminating vision impairment would require that the annual cataract surgical workload increase by 11.5%. Studies of this kind may have considerable value in planning service delivery in other locations. Using the axial length of the fellow eye in eyes with retinal detachment results in a clinically significant reduction of predictability of the postoperative refraction. Therefore, rather than combined phako-vitrectomy, a two-step procedure should be favoured, if possible, in which vitrectomy is undertaken first and measurements for IOL selection performed after reattachment of the retina. Deep-learning models trained with both fundus images and 15 features from the clinical information showed excellent diagnostic abilities in predicting glaucoma progression in glaucoma suspect patients with normal intraocular pressure. Opportunistic detection of glaucoma on fundus photographs in national diabetic retinopathy screening found 9% of patients had glaucoma. Referring patients with vertical-cup-to-disc ratio of 0.65 showed moderate sensitivity but low specificity and …","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141430483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clara Bertret, Juliette Knoeri, Loic Leveziel, Tristan Bourcier, Françoise Brignole-Baudouin, Lilia Merabet, Nacim Bouheraoua, Vincent Michel Borderie
Aims: To report an epidemiological update of bacterial keratitis (BK) in a tertiary ophthalmology centre over 20 months compared with a previous study on the same timeframe from 1998 to 1999.
Methods: 354 patients with BK documented by microbiological corneal scraping or resolutive under antibiotics treatment from January 2020 to September 2021 were analysed retrospectively.
Results: One or several risk factors were found in 95.2% of patients: contact lens wear (45.2%), ocular surface disease (25.0%), systemic disease (21.8%), ocular trauma (11.9%) and ocular surgery (8.8%). The positivity rate of corneal scrapings was 82.5%, with 18.2% polybacterial. One hundred seventy-five (59.9%) bacteria were Gram-negative, and 117 (40.1%) were Gram-positive. The most common bacteria were Pseudomonas aeruginosa (32.5%), Moraxella spp (18.1%) and Staphylococcus aureus (8.2%). Final visual acuity (logarithm of the minimum angle of resolution) was associated with age (r=+0.48; p=0.0001), infiltrate size (r=+0.32; p<0.0001), ocular surface disease (r=+0.13; p=0.03), ocular trauma (r=-0.14; p=0.02) and contact lens wear (r=-0.26; p<0.0001). Gram-negative bacteria were responsible for deeper (r=+0.18; p=0.004) and more extensive infiltrates (r=+0.18; p=0.004) in younger patients (r=-0.19; p=0.003). Compared with the previous period, the positivity rate of corneal scrapings and the proportion of Gram-negative bacteria, especially Moraxella spp, increased. All P. aeruginosa and Moraxella spp were sensitive to quinolones, and all S. aureus were sensitive to both quinolones and methicillin.
Conclusion: Contact lens wear remained the leading risk factor. The bacteria distribution was reversed, with a predominance of Gram-negative bacteria and increased Moraxella spp.
{"title":"Predisposing factors, clinical and microbiological insights of bacterial keratitis: analysis of 354 cases from a leading French academic centre.","authors":"Clara Bertret, Juliette Knoeri, Loic Leveziel, Tristan Bourcier, Françoise Brignole-Baudouin, Lilia Merabet, Nacim Bouheraoua, Vincent Michel Borderie","doi":"10.1136/bjo-2024-325261","DOIUrl":"https://doi.org/10.1136/bjo-2024-325261","url":null,"abstract":"<p><strong>Aims: </strong>To report an epidemiological update of bacterial keratitis (BK) in a tertiary ophthalmology centre over 20 months compared with a previous study on the same timeframe from 1998 to 1999.</p><p><strong>Methods: </strong>354 patients with BK documented by microbiological corneal scraping or resolutive under antibiotics treatment from January 2020 to September 2021 were analysed retrospectively.</p><p><strong>Results: </strong>One or several risk factors were found in 95.2% of patients: contact lens wear (45.2%), ocular surface disease (25.0%), systemic disease (21.8%), ocular trauma (11.9%) and ocular surgery (8.8%). The positivity rate of corneal scrapings was 82.5%, with 18.2% polybacterial. One hundred seventy-five (59.9%) bacteria were Gram-negative, and 117 (40.1%) were Gram-positive. The most common bacteria were <i>Pseudomonas aeruginosa</i> (32.5%), <i>Moraxella</i> spp (18.1%) and <i>Staphylococcus aureus</i> (8.2%). Final visual acuity (logarithm of the minimum angle of resolution) was associated with age (r=+0.48; p=0.0001), infiltrate size (r=+0.32; p<0.0001), ocular surface disease (r=+0.13; p=0.03), ocular trauma (r=-0.14; p=0.02) and contact lens wear (r=-0.26; p<0.0001). Gram-negative bacteria were responsible for deeper (r=+0.18; p=0.004) and more extensive infiltrates (r=+0.18; p=0.004) in younger patients (r=-0.19; p=0.003). Compared with the previous period, the positivity rate of corneal scrapings and the proportion of Gram-negative bacteria, especially <i>Moraxella</i> spp, increased. All <i>P. aeruginosa</i> and <i>Moraxella</i> spp were sensitive to quinolones, and all <i>S. aureus</i> were sensitive to both quinolones and methicillin.</p><p><strong>Conclusion: </strong>Contact lens wear remained the leading risk factor. The bacteria distribution was reversed, with a predominance of Gram-negative bacteria and increased <i>Moraxella</i> spp.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sadi Can Sonmez, Mertcan Sevgi, Fares Antaki, Josef Huemer, Pearse A Keane
The rapid advancements in generative artificial intelligence are set to significantly influence the medical sector, particularly ophthalmology. Generative adversarial networks and diffusion models enable the creation of synthetic images, aiding the development of deep learning models tailored for specific imaging tasks. Additionally, the advent of multimodal foundational models, capable of generating images, text and videos, presents a broad spectrum of applications within ophthalmology. These range from enhancing diagnostic accuracy to improving patient education and training healthcare professionals. Despite the promising potential, this area of technology is still in its infancy, and there are several challenges to be addressed, including data bias, safety concerns and the practical implementation of these technologies in clinical settings.
{"title":"Generative artificial intelligence in ophthalmology: current innovations, future applications and challenges.","authors":"Sadi Can Sonmez, Mertcan Sevgi, Fares Antaki, Josef Huemer, Pearse A Keane","doi":"10.1136/bjo-2024-325458","DOIUrl":"https://doi.org/10.1136/bjo-2024-325458","url":null,"abstract":"<p><p>The rapid advancements in generative artificial intelligence are set to significantly influence the medical sector, particularly ophthalmology. Generative adversarial networks and diffusion models enable the creation of synthetic images, aiding the development of deep learning models tailored for specific imaging tasks. Additionally, the advent of multimodal foundational models, capable of generating images, text and videos, presents a broad spectrum of applications within ophthalmology. These range from enhancing diagnostic accuracy to improving patient education and training healthcare professionals. Despite the promising potential, this area of technology is still in its infancy, and there are several challenges to be addressed, including data bias, safety concerns and the practical implementation of these technologies in clinical settings.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clara Pak, Nathan Hall, Demissie Tadesse Bekele, K H Martin Kollmann, Tesfaye Tadele, Redda Tekle-Haimanot, Tarik Taye, Babar Qureshi, Wubante Yalew, Emily W Gower, John H Kempen
Background/aims: Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.
Methods: Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest.
Results: A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT.
Conclusion: Our results indicate a significant reduction in the risk of PTT after experienced surgeons' participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.
{"title":"Impact of refresher training on the outcomes of trachomatous trichiasis surgery.","authors":"Clara Pak, Nathan Hall, Demissie Tadesse Bekele, K H Martin Kollmann, Tesfaye Tadele, Redda Tekle-Haimanot, Tarik Taye, Babar Qureshi, Wubante Yalew, Emily W Gower, John H Kempen","doi":"10.1136/bjo-2022-322497","DOIUrl":"10.1136/bjo-2022-322497","url":null,"abstract":"<p><strong>Background/aims: </strong>Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1-22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.</p><p><strong>Methods: </strong>Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest.</p><p><strong>Results: </strong>A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT.</p><p><strong>Conclusion: </strong>Our results indicate a significant reduction in the risk of PTT after experienced surgeons' participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41117290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christoph Lwowski, Klemens Paul Kaiser, Julian Bucur, Philipp Schicho, Thomas Kohnen
Purpose: Evaluate whether the axial length of the fellow eye can be used to calculate the intraocular lens (IOL) in eyes with retinal detachment.
Design: Retrospective, consecutive case series.
Methods: Our study was conducted at the Goethe University and included patients who underwent silicone oil (SO) removal combined with phacoemulsification and IOL implantation. Preoperative examinations included biometry (IOLMaster 700, Carl Zeiss). We measured axial length (AL) of operated eye (OE) or fellow eye (FE) and compared mean prediction error and mean and median absolute prediction error (MedAE) using four formulas and AL of the OE (Barrett Universal II (BUII)-OE). Additionally, we compared the number of eyes within ±0.50, ±1.00 and ±2.00 dioptre (D) from target refraction.
Results: In total, 77 eyes of 77 patients met our inclusion criteria. MedAE was lowest for the BUII-OE (0.42 D) compared with Kane-FE (1.08 D), BUII-FE (1.02 D) and Radial Basis Function 3.0 (RBF3.0)-FE (1.03 D). This was highly significant (p<0.001). The same accounts for the number of eyes within ±0.50 D of the target refraction with the BUII-OE (44 eyes, 57%) outperforming the RBF3.0-FE (20 eyes, 25.9%), Kane-FE and BUII-FE formula (21 eyes, 27.2%) each.
Conclusion: Our results show a statistically and clinically highly relevant reduction of IOL power predictability when using the AL of the FE for IOL calculation. Using the AL of the SO filled eye after initial vitrectomy results in significantly better postoperative refractive results. A two-step procedure using the AL of the OE after reattachment of the retina is highly recommended.
{"title":"Accuracy of using the axial length of the fellow eye for IOL calculation in retinal detachment eyes undergoing silicone oil removal.","authors":"Christoph Lwowski, Klemens Paul Kaiser, Julian Bucur, Philipp Schicho, Thomas Kohnen","doi":"10.1136/bjo-2023-323581","DOIUrl":"10.1136/bjo-2023-323581","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate whether the axial length of the fellow eye can be used to calculate the intraocular lens (IOL) in eyes with retinal detachment.</p><p><strong>Design: </strong>Retrospective, consecutive case series.</p><p><strong>Methods: </strong>Our study was conducted at the Goethe University and included patients who underwent silicone oil (SO) removal combined with phacoemulsification and IOL implantation. Preoperative examinations included biometry (IOLMaster 700, Carl Zeiss). We measured axial length (AL) of operated eye (OE) or fellow eye (FE) and compared mean prediction error and mean and median absolute prediction error (MedAE) using four formulas and AL of the OE (Barrett Universal II (BUII)-OE). Additionally, we compared the number of eyes within ±0.50, ±1.00 and ±2.00 dioptre (D) from target refraction.</p><p><strong>Results: </strong>In total, 77 eyes of 77 patients met our inclusion criteria. MedAE was lowest for the BUII-OE (0.42 D) compared with Kane-FE (1.08 D), BUII-FE (1.02 D) and Radial Basis Function 3.0 (RBF3.0)-FE (1.03 D). This was highly significant (p<0.001). The same accounts for the number of eyes within ±0.50 D of the target refraction with the BUII-OE (44 eyes, 57%) outperforming the RBF3.0-FE (20 eyes, 25.9%), Kane-FE and BUII-FE formula (21 eyes, 27.2%) each.</p><p><strong>Conclusion: </strong>Our results show a statistically and clinically highly relevant reduction of IOL power predictability when using the AL of the FE for IOL calculation. Using the AL of the SO filled eye after initial vitrectomy results in significantly better postoperative refractive results. A two-step procedure using the AL of the OE after reattachment of the retina is highly recommended.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41232485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yanxian Chen, Andreas Mueller, Ian Morgan, Frank Larkin, Yan Wang, Junwen Zeng, Mingguang He
{"title":"Best practice in myopia control: insights and innovations for myopia prevention and control - a round table discussion.","authors":"Yanxian Chen, Andreas Mueller, Ian Morgan, Frank Larkin, Yan Wang, Junwen Zeng, Mingguang He","doi":"10.1136/bjo-2023-325112","DOIUrl":"10.1136/bjo-2023-325112","url":null,"abstract":"","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11228199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Ziyou Chen, Charlene Wong, Janice Sing Harn Lam, Chen-Hsin Sun, Yien Lai, Victor Teck Chang Koh, Yap-Seng Chong, Seang-Mei Saw, Yih-Chung Tham, Cheryl Ngo
Aims: To determine axial length (AL) elongation profiles in children aged 3-6 years in an Asian population.
Methods: Eligible subjects were recruited from the Growing Up in Singapore Towards Healthy Outcomes birth cohort. AL measurement was performed using IOLMaster (Carl Zeiss Meditec, Jena, Germany) at 3 and 6 years. Anthropometric measurements at birth, cycloplegic refraction at 3 and 6 years, questionnaires on the children's behavioural habits at 2 years and parental spherical equivalent refraction were performed. Multivariable linear regression model with generalised estimating equation was performed to determine factors associated with AL elongation.
Results: 273 eyes of 194 children were included. The mean AL increased from 21.72±0.59 mm at 3 years to 22.52±0.66 mm at 6 years (p<0.001). Myopic eyes at 6 years had greater AL elongation (1.02±0.34 mm) compared with emmetropic eyes (0.85±0.25 mm, p=0.008) and hyperopic eyes (0.74±0.16 mm, p<0.001). The 95th percentile limit of AL elongation was 1.59 mm in myopes, 1.34 mm in emmetropes and 1.00 mm in hyperopes. Greater birth weight (per 100 g, β=0.010, p=0.02) was significantly associated with greater AL elongation from 3 to 6 years, while parental and other behavioural factors assessed at 2 years were not (all p≥0.08).
Conclusion: In this preschool cohort, AL elongates at an average length of 0.80 mm from 3 to 6 years, with myopes demonstrating the greatest elongation. The differences in 95th percentile limits for AL elongation between myopes, emmetropes and hyperopes can be valuable information in identifying myopia development in preschool children.
{"title":"Axial length elongation profiles from 3 to 6 years in an Asian paediatric population: the Growing Up in Singapore Towards Healthy Outcomes birth cohort study (GUSTO).","authors":"David Ziyou Chen, Charlene Wong, Janice Sing Harn Lam, Chen-Hsin Sun, Yien Lai, Victor Teck Chang Koh, Yap-Seng Chong, Seang-Mei Saw, Yih-Chung Tham, Cheryl Ngo","doi":"10.1136/bjo-2023-323906","DOIUrl":"10.1136/bjo-2023-323906","url":null,"abstract":"<p><strong>Aims: </strong>To determine axial length (AL) elongation profiles in children aged 3-6 years in an Asian population.</p><p><strong>Methods: </strong>Eligible subjects were recruited from the Growing Up in Singapore Towards Healthy Outcomes birth cohort. AL measurement was performed using IOLMaster (Carl Zeiss Meditec, Jena, Germany) at 3 and 6 years. Anthropometric measurements at birth, cycloplegic refraction at 3 and 6 years, questionnaires on the children's behavioural habits at 2 years and parental spherical equivalent refraction were performed. Multivariable linear regression model with generalised estimating equation was performed to determine factors associated with AL elongation.</p><p><strong>Results: </strong>273 eyes of 194 children were included. The mean AL increased from 21.72±0.59 mm at 3 years to 22.52±0.66 mm at 6 years (p<0.001). Myopic eyes at 6 years had greater AL elongation (1.02±0.34 mm) compared with emmetropic eyes (0.85±0.25 mm, p=0.008) and hyperopic eyes (0.74±0.16 mm, p<0.001). The 95th percentile limit of AL elongation was 1.59 mm in myopes, 1.34 mm in emmetropes and 1.00 mm in hyperopes. Greater birth weight (per 100 g, β=0.010, p=0.02) was significantly associated with greater AL elongation from 3 to 6 years, while parental and other behavioural factors assessed at 2 years were not (all p≥0.08).</p><p><strong>Conclusion: </strong>In this preschool cohort, AL elongates at an average length of 0.80 mm from 3 to 6 years, with myopes demonstrating the greatest elongation. The differences in 95th percentile limits for AL elongation between myopes, emmetropes and hyperopes can be valuable information in identifying myopia development in preschool children.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41111032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}