Clinical ophthalmology (Auckland, N.Z.)最新文献

Background: The World Health Organization has declared climate change to be "the single biggest health threat facing humanity", yet there are limited studies on the impact of climate change-related air pollution on ocular health.

Objective: To explore associations between ocular surface irritation and allergy-related daily outpatient office visits with daily ambient particulate matter (PM) levels in the Denver Metropolitan Area.

Methods: Daily visit counts of ophthalmology outpatient offices were obtained from an academic health center (October 1^st, 2015 to January 27^th, 2023). Daily ambient average concentrations of PM ≤ 10 µm in diameter (PM₁₀) and 2.5 micrometers or less in diameter (PM_2.5) were obtained. Data were analyzed using distributed lag nonlinear models while accounting for the cumulative lagged effects of PM₁₀ and PM_2.5 for visits. Modifications due to temperature were assessed using stratified models.

Results: There were 144,313 ocular surface irritation and allergy visits to ophthalmic clinics during the study period. Daily visit counts increased with increasing daily ambient PM₁₀ and PM_2.5 concentrations. Five-day cumulative ambient PM₁₀ concentrations at 80, 90, 100, and 110 µg/m³ showed higher rate ratios at each level from 1.77 (95% CI: 1.71, 1.84) at concentration of 80 to 2.20 (95% CI: 2.09, 2.30) for concentration of 110 µg/m³. Similarly, the visit rate ratios increased as the daily PM_2.5 concentration increased, but this gradient effect was not significantly higher as the concentration increased. The effect of PM₁₀ was higher on days when the temperature was below the average. Temperature did not affect the association between daily visit counts and PM_2.5.

Conclusion: This study found that ambient PM increased the rate of ophthalmology visits due to ocular surface irritation and allergies. Most importantly, this association increased in magnitude with higher ambient PM concentrations. Additional studies are required to fully understand the effects of climate change-related stressors on ocular health.

Purpose: To evaluate the efficiency of a hybrid tip in removing cataract grade 3 and 4 in high and low intraocular pressure (IOP) settings.

Methods: This was a randomized, prospective, double-arm contralateral eye study. One randomized eye of each subject had phacoemulsification with high IOP settings (50 mmHg) while the other eye had phacoemulsification with low IOP settings (20 mmHg). Operative endpoints included phaco time, aspiration time, fluid use, cumulative dissipated energy (CDE), total case time, total torsional time, and total longitudinal time. Postoperative endpoints included central corneal thickness (CCT), and IOP.

Results: A total of 102 eyes (51 patients) completed the study. Phaco time in grade 3 and grade 4 cataracts were 38.4 ± 9.6 s and 44.1 ± 9.9 s in the high group, respectively, and 38.9 ± 8.6 s and 46.3 ± 11.0 s in the low group, respectively. Aspiration time in grade 3 and grade 4 cataracts were 95.3 ± 21.2 s and 111.8 ± 32.8 s in the high group, respectively, and 105.4 ± 27.0 s and 108.6 ± 23.1 s in the low group, respectively. Fluid volume used in grade 3 and grade 4 cataracts were 39.2 ± 6.8 mL and 45.2 ± 10.8 mL in the high group, respectively, and 38.3 ± 7.3 mL and 43.2 ± 8.0 mL in the low group, respectively. The CDE in grade 3 and grade 4 cataracts were 7.8 ± 2.6 and 10.2 ± 3.2 in the high group, respectively, and 7.7 ± 2.2 and 9.9 ± 4.5 in the low group, respectively.

Conclusion: Results suggest that a hybrid phacoemulsification tip was efficient in removing cataracts of grade 3 and grade 4 with high and low IOP settings.

Purpose: Compare large language models (LLMs) in analyzing and responding to a difficult series of ophthalmic cases.

Design: A comparative case series involving LLMs that met inclusion criteria tested on twenty difficult case studies posed in open-text format.

Methods: Fifteen LLMs accessible to ophthalmologists were tested against twenty case studies published in JAMA Ophthalmology. Each case was presented in identical, open-ended text fashion to each LLM and open-ended responses regarding differential diagnosis, next diagnostic tests and recommended treatments were requested. Responses were recorded and assessed for accuracy against published correct answers. The main outcome was accuracy of LLMs against the correct answers. Secondary outcomes included comparative performance on the differential diagnosis, ancillary testing, and treatment subtests; and readability of responses.

Results: Scores were normally distributed and ranged from 0-35 (with a maximum score of 60) with a mean ± standard deviation of 19 ± 9. Scores for three of the LLMs (ChatGPT 3.5, Claude Pro, and Copilot Pro) were statistically significantly higher than the mean. Two of the high-performing LLMs were paid subscription (Claude Pro and Copilot Pro) and one was free (ChatGPT 3.5). While there were no clinical or statistical differences between ChatGPT 3.5 and Claude Pro, a separation of +5 points, or 0.56 standard deviations, between Copilot Pro and the other highly ranked LLMs was present. Readability of all tested programs were above the AMA (American Medical Association) reading level recommendations to public consumers of eight grade.

Conclusion: Subscription LLMs were more prevalent among highly ranked LLMs suggesting that these perform better as ophthalmic assistants. While readability was poor for the average person, the content was understood by a board-certified ophthalmologist. The accuracy of LLMs is not high enough to recommend patient care in standalone mode, but aiding clinicians in patient care and prevent oversights is promising.

Purpose: To evaluate the subjective wearing experience of lehfilcon A toric lenses among subjects who were already satisfied with their comfilcon A toric lenses.

Methods: This was an open-label, single arm study of currently satisfied comfilcon A soft toric contact lens (Biofinity Toric, CooperVision, Pleasanton, CA) wearers that were refit with lehfilcon A soft toric lenses (Total30^® for Astigmatism; Alcon Vision LLC, Fort Worth, TX). Subjects were administered a questionnaire about satisfaction with comfort, visual performance, end of day comfort, and ease of handling with lehfilcon A toric lenses.

Results: A total of 40 subjects completed the study. After one month of wear the median and interquartile range (IQR) was 8 (2) for overall satisfaction with lehfilcon A comfort, 8 (1.25) for visual performance, 7 (3.25) for end of day comfort, 9 (2) for ease of handling, and finally 8 (2) for overall satisfaction.

Conclusion: A high proportion of subjects were satisfied with the subjective wearing experience with lehfilcon A toric lenses, including satisfaction with comfort, visual performance, end of day comfort, and ease of handling.

Purpose: To characterize the baseline characteristics and clinical outcomes of patients seen through the Free Diabetic Screening (FDS) program, a free diabetic retinopathy screening program for uninsured patients, in the ophthalmology resident clinic at the Wilmer Eye Institute.

Patients and methods: This retrospective longitudinal cohort study included uninsured patients ≥18 years with diabetes mellitus seen through the FDS clinic from 2013 to 2023. Data extraction was performed using manual chart review of the first FDS visit, and automated extraction of the data warehouse related to all other office visits. Patient demographic and clinical characteristics at presentation, treatments, and follow-ups were collected.

Results: A total of 422 patients were included in this study (mean age 52 years; 59% female; 47% Hispanic; 49% Spanish as primary language). One-third of patients had some form of diabetic retinopathy or diabetic macular edema, and 12% had vision-threatening diabetic retinopathy at presentation. In all, nearly 10% of patients were referred for further specialty care, and 71% of these patients completed at least one follow-up visit. The majority of patients (55%) returned for care as recommended and were followed for a mean length of 200 weeks and 10 office visits.

Conclusion: The FDS clinic provided much needed diabetic retinopathy screening and treatment for uninsured patients in Baltimore City and surrounding areas. This study highlights the need for strong integration between initial screening and downstream services, as nearly 10% of patients require further sub-specialty intervention or care.

Purpose: To evaluate the tolerability of utilizing Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) as a drug delivery device for preservative-free cyclosporine 0.05% for the treatment of dry eye disease.

Patients and methods: Fourteen current daily PROSE wearers were enrolled, with four screen failures and one subject that did not complete the study protocol due to burning and stinging. Nine subjects, 18 eyes completed the study protocol. All participants were instructed to instill one drop of preservative-free cyclosporine 0.05% in the PROSE reservoir and then fill the rest of the reservoir with preservative-free normal saline. After applying the PROSE and wearing for 6 hours, the PROSE was removed, and the protocol was repeated for at least another 4 additional hours of wear. Baseline, 1 week and 1 month symptom and sign data were collected.

Results: At one month, OSDI improved by an average of 3.83 ± 6.87 from baseline (p = 0.07) and there was no statistically significant change in best corrected visual acuity. Without comparing with placebo, there was statistically significant (p < 0.05) improvement in mean per subject and mean per eye corneal fluorescein staining, conjunctival lissamine staining, and conjunctival hyperemia by slit lamp examination at one-month follow-up.

Conclusion: Utilizing PROSE as a drug delivery system for non-preserved cyclosporine 0.05% was well tolerated in regard to both ocular symptoms and ocular surface signs. Results from this pilot study are suggestive of efficacy. The results of this study support progressing this protocol to a larger scale randomized controlled double blinded prospective clinical trial.

Purpose: This study assessed the clinical and economic burden of geographic atrophy (GA) using real-world data from elderly patients with Medicare Advantage plans in the United States.

Patients and methods: A retrospective cohort design of patients with GA only, GA + visual impairment (GA + VI), GA + blindness (GA + B), and patients without GA were identified using administrative healthcare claims data from Optum Clinformatics Data Mart. Inverse probability of treatment weighting controlled for confounding when comparing patients with GA only vs without GA, GA + VI vs GA only, and GA + B vs GA only. Endpoints included all-cause and ophthalmic condition-related healthcare resource utilization (HRU), injurious falls, and healthcare costs. HRU and injurious falls were assessed per-person-per-year and per 100 person-years, respectively. Cohorts were compared using rate ratios, 95% confidence intervals (CIs), and p-values from weighted Poisson regression models. Healthcare costs were evaluated per-person-per-year using mean cost differences, 95% CIs, and p-values from weighted linear regression.

Results: The study included 18,119 patients with GA only, 2,285 with GA + VI, 1,716 with GA + B, and 72,476 patients without GA. Higher rates of all-cause hospitalizations (RR [95% CI]: 1.08 [1.03, 1.12]), outpatient visits (1.08 [1.05, 1.10]), other visits (1.14 [1.08, 1.21]), and falls with head injuries (1.24 [1.05, 1.45]) were observed in patients with GA vs without GA (P<0.05). GA was associated with higher annual all-cause total healthcare costs, spending an average of $1,171 more after adjustment (P<0.05). Progression to GA + VI and GA + B was associated with a more pronounced burden.

Conclusion: The clinical and economic burden of GA is substantial and escalates as the disease advances. These findings suggest early intervention aimed at slowing GA progression may help to mitigate the healthcare burden associated with advancement of GA to visual impairment and blindness.

The preservative-free fixed-dose combination formulation of 0.0015% tafluprost and 0.5% timolol (PF tafluprost/timolol FC) is among the topical intraocular pressure (IOP)-lowering therapies commonly used second-line for the management of ocular hypertension (OHT) and open-angle glaucoma (OAG), according to recommended treatment pathways. A growing body of evidence has developed in recent years regarding efficacy, safety and tolerability outcomes with PF tafluprost/timolol FC in both randomized controlled trials (RCTs) and real-life studies. This review aims to summarize key evidence from published Phase IV trials and real-life studies to highlight those data that complement RCT findings and support implementation of evidence-informed clinical practice. Real-life efficacy and safety outcomes are discussed through the lens of common clinical scenarios that ophthalmologists may encounter in the management of OHT/OAG. Phase IV studies conducted to date have demonstrated that the majority of OHT/OAG patients insufficiently controlled on topical prostaglandin or beta-blocker monotherapy may achieve IOP reductions of ≥20% following a switch to PF tafluprost/timolol FC therapy. Statistically significant IOP reductions were reported from 4 weeks and maintained through 6 months. Real-life studies and case series data also indicated that patients with poor IOP control on maximal/complex topical regimens benefited from a step down to PF tafluprost/timolol FC therapy, achieving significant and sustained IOP reductions. A number of studies have shown improvements in tolerability and the signs and symptoms of ocular health with PF tafluprost/timolol FC therapy, both in patients stepping up from monotherapy and in those simplifying their topical regimen. Clinicians reported better treatment adherence with PF tafluprost/timolol FC compared with prior treatments, which may have been associated with enhanced patient experience regarding treatment tolerability and is likely to have contributed to the long-term IOP-lowering efficacy outcomes observed. Real-life safety data for PF tafluprost/timolol FC reflect outcomes reported in published RCTs.

Background: Dry eye disease is one of the most common disorders we see in practice today. Perfluorohexyloctane (PFHO) ophthalmic solution (MIEBO®) (©Bausch + Lomb) is a novel, non-aqueous, single entity, preservative-free ophthalmic drop recently approved by the FDA for treatment of the signs and symptoms of dry eye disease.

Purpose: While the safety and efficacy of PFHO has been demonstrated in non-contact lens wearers, its safety and potential benefits in habitual contact lens wearers have not been explored. This report presents the results of a trial designed to evaluate the safety of PFHO and its effect on contact lens comfort, specifically in established contact lens wearers.

Patients and methods: The study included 47 patients who were adjusted contact lens wearers with a best corrected visual acuity of 20/25 or better at distance. All the patients were healthy contact lens wearers with no dry eye symptoms.

Results: A significant improvement in comfort scoring was observed without any significant changes in osmolarity, meibography scores, and total fluorescein staining.

Conclusion: These findings suggest that PCHO is safe for contact lens wearers to use and shows promise to reduce contact lens dropout.