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

Background: There is a lack of data evaluating the relative usability of single-dose and multi-dose containers for delivery of eye drops. This study aimed to evaluate the usability, convenience and patient preferences of eye drops in single- versus multi-dose containers.

Methods: A prospective, open-label, multicentre, cross-over study was conducted in Portugal between April and June 2017. Participants aged 50 years or older and had indications for eye lubricant use were included. The participants were allocated to use either multi-dose or single-dose containers followed by switching during the study period. The usability, convenience and patient preferences of each eye drop containers were collected using a novel questionnaire developed by the authors of this study. Descriptive statistical analyses were performed for all outcomes.

Results: A total of 114 participants completed the study. Overall, participants found the use of multi-dose containers easier than single-dose containers based on ease of container opening and ease of eye drop application. Multi-dose containers were less likely to have drops remaining in the container at disposal and had improved legibility of labels versus single-dose containers.

Conclusion: The findings suggest that multi-dose eye drop containers were associated with better handling and use compared with single-dose containers.

Purpose: To evaluate clinical tolerance to induced astigmatism in pseudophakic eyes bilaterally implanted with an extended depth of focus (EDOF) intraocular lens (AT LARA^®, Carl Zeiss Meditec). We hypothesized that small amounts of induced astigmatism may be clinically well tolerated by patients implanted with this EDOF IOL.

Methods: Prospective study including 10 patients (20 eyes) bilaterally implanted with the same EDOF IOL. Monocular defocus curves were obtained under photopic conditions after introducing cylindrical lenses of +1.00 D, +2.00 D, and +3.00 D at with-the-rule (WTR) and against-the-rule (ATR) orientations.

Results: The IOL demonstrated good tolerance up to +1.00 D of induced astigmatism, with significant reductions in visual acuity at higher magnitudes of astigmatism. Tolerance was higher for ATR astigmatism compared to WTR, consistent with axis-dependent depth-of-focus effects.

Conclusion: The AT LARA^® EDOF IOL maintained functional visual performance with up to +1.00 D of regular astigmatism, while higher magnitudes led to clinically meaningful degradation. Axis orientation modulated performance, with ATR preserving intermediate and near vision and WTR favoring distance.

Purpose: The primary aim of this study was to evaluate the level of agreement in color vision assessment between the smartphone application Farnsworth D-15 (FD-15) test and the standard FD-15 test.

Materials and methods: A cross-sectional study was conducted involving participants aged ≥ 18 years. Inclusion criteria included the ability to follow test instructions and provide informed consent. Eyes with visual acuity worse than 20/200 were excluded. Standardized score sheets were used for both tests to calculate the color confusion index (CCI). Agreement between the two tests was assessed using the Pearson correlation coefficient, adjusted R-squared (R²), calibration slope, calibration-in-the-large (CITL), and root mean square error (RMSE), and Bland-Altman plots.

Results: A total of 200 eyes from 101 participants were included in the study. The CCI data showed a strong correlation (Pearson correlation coefficient = 0.9924). The adjusted R ² of 0.9839 indicated high explanatory power. A calibration slope of 0.9861 and CITL of 0.0957 indicated minimal proportional and systematic bias, respectively. RMSE was 0.1211, within acceptable limits. The Bland-Altman analysis demonstrated limits of agreement within clinically acceptable range.

Conclusion: The smartphone application FD-15 test demonstrated high agreement with the standard FD-15 test. This study serves as a pilot validation demonstrating the potential of the smartphone-based FD-15 application for color vision screening. However, the current findings should be interpreted considering the use of a single smartphone model and the low prevalence of color vision defects. These findings support its potential utility as a practical and accessible tool for remote care and occupational health assessments.

Purpose: In Canada, accessing specialty services remains a significant challenge, leading to growing wait times for specialist care. To address this concern, the Champlain Building Access to Specialists through eConsultation (BASE) service was introduced. The Champlain BASE eConsult service is a secure web-based program that enables access to medical specialists by PCPs. The primary objective is to investigate the types of questions primary care providers (PCP) are asking ophthalmologists through the BASE service.

Patients and methods: Descriptive and retrospective analysis of 116 eConsults sent from PCPs to the ophthalmology specialty between January and December 2022, within the Champlain region, covering ~ 1.3 million people in Eastern Ontario. Using two validated taxonomies, the "content" and "type" of questions asked were coded. A closeout survey was used to determine PCP's subsequent course of action, referral outcomes, and perceived helpfulness of eConsult responses.

Results: 116 eConsults (37 pediatric; 79 adult) were reviewed with an average patient age of 36.8 years. The most common types of questions asked related to general management (61%) and referral appropriateness (43%). The most common content questions related to other non-specified content - adults (28%), lid lesions (24%) and other non-specified content - pediatrics (12%). The ophthalmologist's median response time was 0.67 days (16.1 hours) after eConsult creation, with 84% of responses being received within seven days. PCPs received a new or additional course of action in 47% of cases. Unnecessary in-person referrals were avoided in 44% of cases. Over 88% of cases were rated at least 4/5 in value, and in 94% of eConsults, the ophthalmologists' recommendations were accepted.

Conclusion: The use of the eConsult service improves access to ophthalmologists by providing quicker, helpful, and generally accepted specialist advice while decreasing the requirement for patients to attend in-person consultations.

Purpose: To compare the efficacy and safety of topical insulin and amniotic membrane extract eye drops (AMEED) in promoting healing of corneal persistent epithelial defects (PEDs) refractory to conventional therapy.

Patients and methods: This retrospective comparative study included 27 eyes of 24 patients (mean age 61.0 ± 16.6 years) with PEDs treated with either topical insulin (1 IU/mL) or AMEED four times daily. Clinical outcomes included complete epithelial closure, rate of epithelialization, change in best-corrected visual acuity (BCVA), and occurrence of adverse events.

Results: Of 27 eyes, 18 received topical insulin and 9 received AMEED. The mean interval from diagnosis to treatment initiation was 93.4 ± 111.7 days in the AMEED group and 72.5 ± 56.1 days in the insulin group. Complete healing occurred in all eyes (100%) in the insulin group versus 44.4% in the AMEED group. The daily reduction in epithelial defect area during the first two weeks was significantly greater with insulin (P = 0.04). At final follow-up, BCVA improved significantly only in the insulin group (P = 0.006). No adverse reactions were observed in either group; one AMEED-treated eye required amniotic membrane transplantation.

Conclusion: Topical insulin and AMEED are both safe and effective for refractory PEDs, but insulin showed superior epithelial healing and visual recovery. Given its availability, low cost, and favorable safety profile, topical insulin may represent a practical alternative in the management of persistent epithelial defects.

Purpose: To evaluate the outcomes of selective laser trabeculoplasty (SLT) in Thai glaucoma patients across three treatment groups-initial, adjunctive, and replacement therapy-and to identify predictors of treatment response and durability.

Methods: This retrospective study included glaucoma patients who underwent SLT and were classified into initial, adjunctive, and replacement therapy groups. Treatment durability was analyzed using Kaplan-Meier survival methods. Predictors of non-response and shortened effects were identified using multivariable logistic regression and Cox proportional hazards models.

Results: A total of 254 eyes from 123 patients were included: 76 eyes in the initial group, 117 in adjunctive therapy, and 61 in replacement therapy. Overall, 61.1% of eyes achieved a laser response, with significant variation among groups (initial 78.9%, replacement 68.9%, adjunctive 45.3%; p < 0.001). The mean effective duration of SLT was 1.5 years, with cumulative success of 67.2% at 1 year and 14.7% at 3 years, without significant intergroup differences (p = 0.448). Retreatment with SLT was associated with a reduced risk of non-response (adjusted OR = 0.328, p= 0.023). Independent predictors of non-response included higher baseline IOP (adjusted OR = 1.118, p = 0.004), greater number of medications (adjusted OR = 1.371, p = 0.013), and acetazolamide use (adjusted OR = 5.531, p = 0.033). Shortened treatment effect within 1 year was predicted by older age (adjusted HR = 1.029, p = 0.002), higher baseline IOP (adjusted HR = 1.070; p = 0.001), and greater number of medications (adjusted HR = 1.179, p= 0.036).

Conclusion: SLT is effective and repeatable in Thai patients, particularly as initial or replacement therapy. While adjunctive therapy provides some benefit, patients with higher baseline IOP, heavier medication burden are more likely to experience non-response or shortened efficacy. Individualized selection and timely retreatment may optimize outcomes.

Purpose: To investigate the intraocular pressure (IOP) changes after cataract extraction (CE) with an acrylic hydrophobic EyeCee One versus a hydrophilic Akreos MI60 intraocular lens (IOL) implant.

Methods: All patients who underwent CE with acrylic EyeCee One IOL implant and Akreos MI60 IOL implants were included. Parameters such as age, sex, history of glaucoma or ocular hypertension (OHT), IOP, axial length (AXL), anterior chamber depth (ACD) and type of IOL implant were measured.

Results: A total of 193 eyes of 193 patients were included. Of them, 115 eyes underwent CE with EyeCee One IOL, while 78 eyes underwent CE with Akreos MI60 IOL. Mean age (± SD) was 76.1 (± 9.4). A preoperative diagnosis of open-angle glaucoma (OAG) and ocular hypertension (OHT) was found in 10.9% and 3.6%, respectively. Mean pre-operative IOP was 16.8 ± 4.1. Mean IOP reduction at 2 months follow-up after CE was 2.8 ± 3.7 mmHg in the Akreos group and 0.3 (± 4.3) in the Eye Cee One group (<0.001). Five patients who underwent EyeCee One IOL implant had IOP rise ≥ 10 mmHg at 2 months follow-up, whereas none of the patients in the Akreos MI60 group had IOP spikes. Age and type of IOL implant were associated with greater IOP reduction in both univariable and multivariable analyses.

Conclusion: CE with acrylic hydrophobic EyeCee One IOL implant was associated with more IOP spikes compared to the acrylic hydrophilic Akreos MI60 IOL implant. Further studies are warranted to clarify the association between IOP and IOL implants.

Purpose: To compare the refractive predictive accuracy of three intraocular lens (IOL) power calculation formulas (SRK/T, Barrett Universal II, and Haigis) in patients aged 90 years and older.

Methods: This retrospective observational study included 62 eyes of 62 patients aged ≥90 years who underwent cataract surgery between April 2021 and March 2023. All procedures were performed by a single surgeon using a single IOL model (HOYA XY1). Preoperative biometry was performed using the IOL Master 700. The accuracy of each formula was evaluated by comparing the predicted spherical equivalent to the manifest refraction at 3 months postoperatively. The primary outcome was the mean absolute error (MAE) and root mean square absolute error (RMSAE), with secondary outcomes including the percentage of eyes within ±0.5 D and ±1.0 D of the predicted refraction.

Results: The mean age of the patients was 92.2 ± 2.0 years. The MAE was 0.504 ± 0.363 D for SRK/T, 0.441 ± 0.339 D for Barrett Universal II, and 0.503 ± 0.388 D for Haigis. The RMSAE was 0.607 ± 0.552 D for SRK/T, 0.532 ± 0.463 D for Barrett Universal II, and 0.565 ± 0.496 D for Haigis. No statistically significant difference in MAE and RMSAE was found among the three formulas (p = 0.12, p = 0.54). The proportion of eyes within ±0.5 D of the predicted refraction was highest for the Barrett Universal II formula at 64.5%. Multivariate logistic regression analysis found no biometric parameters to be significant predictors of achieving a refractive error within ±0.5 D.

Conclusion: In patients aged ≥90 years, the SRK/T, Barrett Universal II, and Haigis formulas demonstrated comparable refractive accuracy. In this demographic, overall refractive outcomes may be more influenced by the reliability of biometric measurements and the minimization of intraoperative risks than by the choice of formula.

Introduction: A standardized multidisciplinary treatment protocol for NVG was developed in 2020 at the University of Chicago and has been termed Salvaging the Conventional Outflow Pathway in Neovascular Glaucoma (SCOPING). We describe 9 eyes with anterior segment neovascularization and at least partially open angles that underwent the SCOPING protocol to suppress the underlying neovascular drive, control intraocular pressure, and medically or surgically salvage the angle whenever possible.

Methods: Nine eyes from 8 patients with first-time anterior segment neovascularization, at least partially open angles, and normal or elevated IOP were treated with 6 serial monthly intravitreal bevacizumab injections interspersed with pan-retinal photocoagulation.

Results: Five eyes with completely open angles without any peripheral anterior synechiae and each achieved and/or maintained physiologic IOP without requiring surgery. The other 4 eyes presented with partially open angles. Three out of these 4 eyes required subsequent IOP-lowering surgery. None of the 9 eyes developed recurrence of anterior segment neovascularization during the treatment protocol.

Discussion: This protocol may be utilized to salvage the conventional outflow pathway for patients with partially or completely open angles. The etiology and diagnosis of neovascular glaucoma have been established. Current treatment strategies include reduction of neovascular drive including panretinal photocoagulation, intravitreal injections, intraocular pressure lowering medications, and filtration surgery. However, a protocol has not been developed to treat neovascular glaucoma (NVG). Our SCOPING protocol may be helpful for glaucoma specialists in treating patients with neovascular glaucoma.