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

Purpose: To evaluate retinal and choriocapillaris (CC) vascular flow changes on optical coherence tomography angiography (OCTA) associated with progression of intermediate age-related macular degeneration (iAMD) to geographic atrophy (GA) or neovascular AMD (nAMD).

Patients and methods: This retrospective, longitudinal cohort study included 68 eyes from 50 patients with iAMD at baseline who underwent OCTA and clinical examination at baseline and at 24 months. Quantitative analysis of CC flow deficits (FDs) and superficial capillary plexus vessel density (VD) was performed at baseline and after 24 months by comparing eyes that progressed to GA or nAMD to eyes that remained stable.

Results: Over 24 months, 7 eyes (10.3%) developed GA and 9 eyes (13.2%) developed nAMD, including 2 that progressed to both. Eyes that developed GA had significantly greater CC FD total area at baseline when compared with stable iAMD eyes (p=0.013) and developed significant decrease in parafoveal VD (p=0.026) and full macular VD (p=0.019) after GA onset. In contrast, eyes that developed nAMD showed no significant OCTA differences at baseline when compared to stable iAMD eyes but developed a new significant increase in CC FD total area (p=0.044) and FAZ perimeter (p=0.036) after nAMD onset (p=0.044).

Conclusion: In iAMD eyes progressing to GA, CC ischemia was detectable before GA onset, with subsequent retinal VD loss after GA development. In iAMD eyes progressing to nAMD, CC ischemia developed concurrent with neovascularization. OCTA-derived CC and retinal flow metrics may serve as non-invasive biomarkers to stratify iAMD eyes at risk for progression.

Purpose: Reporting of open-label extension data following a Phase III, randomized study examining treatment outcomes with preservative-free latanoprost eye drop cationic emulsion and preserved latanoprost in patients with open-angle glaucoma (OAG)/ocular hypertension (OHT).

Patients and methods: OAG/OHT patients were randomized 1:1 to receive preservative-free latanoprost 0.005% eye drop emulsion or preserved latanoprost 0.005% for 12 weeks. Patients entering the extension study received open-label preservative-free latanoprost eye drop emulsion from Week 12 through Month 15. Endpoints included mean (standard deviation [SD]) change from baseline (Day 1, post-washout) in peak (9:00 AM ± 1 hour) intraocular pressure (IOP), corneal fluorescein staining (CFS; modified Oxford Grade Scale) score, ocular surface disease (OSD) symptom score and adverse event (AE) reporting.

Results: Respective mean (SD) peak (9:00 AM) IOP reductions from baseline at Week 12, and Months 6, 9 and 15 were 8.9 (3.0), 8.9 (3.0), 9.0 (2.7) and 8.7 (2.3) mmHg for preservative-free latanoprost eye drop emulsion users (N=70) and 7.8 (2.6), 8.3 (2.6), 8.1 (2.7) and 7.6 (2.8) mmHg for patients switching from preserved latanoprost at Week 12 (N=66). Between-group differences for the change in IOP were statistically significant at Week 12 (-1.06; nominal p=0.029). Mean CFS and OSD symptoms scores were reduced in both groups through Month 15. No serious treatment-related AEs were reported during the study period.

Conclusion: Open-label preservative-free latanoprost eye drop emulsion treatment provided dual benefit of sustained IOP-lowering efficacy and improvements in OSD signs and symptoms over the 15-month study period. No serious treatment-related AEs were reported throughout the study period.

Purpose: To create and validate a culturally appropriate Arabic translation of the Computer Vision Syndrome Scale-17 (CVSS-17) for assessing computer vision syndrome (CVS) symptoms among Arabic-speaking populations.

Patients and methods: Following established cross-cultural adaptation guidelines, the CVSS-17 was translated into Arabic by two independent translators, then reviewed by an interdisciplinary committee and back-translated. The questionnaire was administered to 60 healthy Arabic-speaking participants (aged 18-40 years) across 2 sessions conducted 2-5 days apart. The psychometric evaluation included internal consistency and test-retest reliability.

Results: The participants had an average age of 20.7 ± 1.3 years (45% male, 55% female), with mean CVSS-17 scores of 34.4 ± 11.0 (range: 20-60). The Arabic CVSS-17 demonstrated excellent internal consistency (Cronbach's α = 0.904, range: 0.890-0.905) and test-retest reliability ranging from 0.50-0.93, and item-retest correlations ranging from 0.57-0.91 (p < 0.001). The floor and ceiling effects were minimal (1.7% each), indicating good discriminative ability.

Conclusion: The Arabic CVSS-17 demonstrated excellent reliability and internal consistency, highlighting its utility as a culturally appropriate screening tool for CVS symptoms in Arabic-speaking populations. The cultural adaptation of this questionnaire successfully maintains psychometric integrity and establishes a solid foundation for standardized CVS assessment research in Arabic-speaking regions.

Purpose: To determine current perioperative practice patterns for the prevention of endophthalmitis following cataract surgery in Thailand.

Design: Cross-sectional Survey Study.

Methods: An online questionnaire was distributed nationwide to certified ophthalmologists, consisting of 21 questions covering 10 preoperative, 7 intraoperative, and 4 postoperative measures for the prevention of post-cataract surgery endophthalmitis. Subgroup analyses were performed to compare practices between general ophthalmologists, retina/uveitis specialists (R/U), and other subspecialists (Non-R/U).

Results: A total of 426 responses were analyzed. Preoperative topical antibiotics (21.1%, n = 90) and oral antibiotics (4.9%, n = 21) were rarely prescribed. The most common antiseptic for skin preparation was 10% povidone-iodine (72.3%, n = 308). Intracameral antibiotics were adopted by 54.7% of respondents (n = 233). Postoperative topical antibiotics were almost universally prescribed (99.5%, n = 424). Moxifloxacin was the most preferred topical (preoperative: 45.6%, n = 41, postoperative: 46.4%, n = 197) and intracameral (57.1%, n = 133) antibiotic. Subspecialty analysis revealed that R/U specialists were more prone to use 10% povidone-iodine (relative risk ratio [RRR] 2.37, 95% CI 1.16 to 4.82) and antiseptic applied to fornix (RRR 2.62, 95% CI 1.26 to 5.46) than the general ophthalmologist group.

Conclusion: Although the majority of Thai ophthalmologists align their practices with international endophthalmitis prevention guidelines, certain practices were less frequently adopted than recommended. These findings emphasize the need for standardized national practice patterns to enhance surgical outcomes.

Purpose: This study aims to examine the geographic distribution of ocular oncologists in the United States and evaluates how social determinants of health (SDOH) and environmental factors influence access to ocular oncologists nationally and uveal melanoma (UM) outcomes locally at the University of Illinois (UI) Hospital.

Patients and methods: A national analysis mapped ocular oncologist locations using ArcGIS Pro, assessing accessibility via drive-time radii (15-60 minutes) and census tract population density. SDOH variables (income, education, and insurance) were extracted from US Census data. A retrospective chart review of 167 UM patients at UI Hospital (2010-2023) analyzed tumor characteristics, referral patterns, and SDOH/environmental factors linked to zip codes. Statistical analyses included t-tests, logistic regression, and False Discovery Rate correction.

Results: Nationally, 33.5% of the population, including 45.9% of rural residents, live beyond 60 minutes of an ocular oncologist. Areas outside of an accessible distance of an ocular oncologist were more likely to have low-income, less-educated, and uninsured populations (p < 0.001). At UI Hospital, patients outside a 60-minute radius required significantly more referrals (p = 0.046) but showed no differences in tumor stage at presentation. Trends suggested larger tumor thickness in areas with fewer naturalized citizens and more households under the Asset Limited, Income Constrained, Employed threshold. (q = 0.068 and q = 0.093, respectively). Environmental factors showed no significant associations, including Lifetime Inhalation Cancer Risk, Water Polluting Sites Environmental Justice Index, and Optometrists Per Capita.

Conclusion: There may be geographic and socioeconomic barriers that limit access to UM care, particularly in rural and underserved communities. While proximity did not affect tumor presentation at UI Hospital, referral delays and socioeconomic trends highlight systemic inequities. Multicenter studies are needed to further explore these disparities and improve equitable UM care delivery.

Purpose: Prior studies in monofocal intraocular lenses (IOLs) suggest that larger Nd:YAG posterior capsulotomies may reduce straylight and photic phenomena, but generalizability to extended depth-of-focus (EDOF) optics is uncertain. We evaluated whether capsulotomy size affects optical quality, higher-order aberrations (HOAs), and patient-reported outcomes in eyes with EDOF IOLs.

Patients and methods: In this prospective single-center study, 106 pseudophakic eyes with visually significant posterior capsule opacification and EDOF IOLs underwent Nd:YAG laser posterior capsulotomy. Capsulotomy size was measured at the slit lamp using a calibrated reticule in the horizontal and vertical meridians; the effective diameter was defined as the mean of these two measurements. Eyes were prospectively assigned to a small opening (S group, n=47), created to slightly exceed the IOL's central diffractive zone (≈1.6-1.8 mm), or a large opening (L group, n=59), extended to the margin of the outermost diffractive ring (≈4 mm). At 1-month post-treatment, visual acuity, HOAs, defocus curves, and optical quality metrics were assessed. Subjective outcomes were evaluated using the APPLES and Catquest-9SF-CN questionnaires.

Results: Both groups showed improved visual acuity, with greater corrected distance visual acuity (CDVA) gain in the L group (-0.15 vs -0.06 logMAR; P = 0.024). Trefoil aberration increased more in the S group than in the L group (+0.15 vs +0.02; P = 0.021), while spherical aberration decreased more in the S group than in the L group (-0.20 vs -0.09; P = 0.024). The APPLES questionnaire showed a greater reduction in starburst severity and frequency in the L group (Δ -0.43 vs +0.07; P = 0.010). Multivariate analysis identified pre-treatment spherical equivalent, trefoil, mesopic pupil size, and CDVA as significant predictors of satisfaction.

Conclusion: Capsulotomy size significantly influences optical quality and patient satisfaction in eyes with EDOF IOLs. Larger openings improve CDVA and photic symptoms, while smaller ones better reduce spherical aberration but increase trefoil. Personalizing capsulotomy size may optimize outcomes.

Background: Corneal transplantation is a surgical procedure where damaged cornea is replaced with a cadaveric corneal tissue, which helps to restore the vision in people with corneal blindness. Limited availability of corneal tissue compared to the increasing burden of corneal blindness remains a critical challenge. We aim to evaluate the public knowledge, awareness, and attitudes towards corneal transplants in the Western region of Saudi Arabia.

Methods: We conducted an electronic cross-sectional survey distributed using social media platforms (Twitter and Telegram) targeting residents of the western region of Saudi Arabia during the period from October 2021- January 2022.

Results: Out of total participants, 136 (24%) were willing to donate their corneas, while 302 (53.3%) have not decided yet. A multinomial logistic regression analysis identified several factors influencing willingness to donate corneas. Awareness of the registration process significantly increased willingness (p = 0.008). Participants who believed organ donation is religiously prohibited were significantly more likely to refuse or being uncertain about donation (p < 0.001 and p = 0.038, respectively). Family objection was significantly associated with refusal of donation (p = 0.027). Younger age was associated with greater uncertainty (p = 0.015). Health care providers were the preferred source of information regarding corneal donation in 52.8% of participants. No significant associations were found with gender, nationality, or education.

Conclusion: Several social, cultural, and personal factors collectively influence the decision to donate corneal tissue. Community awareness campaigns led by healthcare providers that address social influences, clarify religious beliefs, and provide information about the registration process may help enhance public willingness to donate.

The global eye‑health agenda has shifted from service volume to effectiveness care that restores usable vision and function. This commentary proposes a pragmatic eye-care playbook for resource-limited settings: (1) complete screening‑to‑spectacles pathways for children with on‑site refraction, timely delivery, and a three‑month wear review; (2) expand cataract access while protecting outcomes by tracking a small bundle of indicators and reporting effective cataract surgical coverage (eCSC); and (3) close workforce gaps via competency‑based task‑sharing and asynchronous tele‑ophthalmology. Aligning with WHA73.4 and the WHO 2030 effective coverage targets (eCSC/eREC), the approach is human‑centered, feasible at district scale, and designed to deliver faster, fairer gains in vision. Somalia‑specific evidence illustrates unmet need (school‑age refractive error and adult blindness profiles) and real‑world delivery via outreach eye camps.