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

Purpose: To determine the incidence of keratitis and conjunctivitis associated with reusable contact lens use during ophthalmic laser procedures at an academic medical center.

Patients and methods: All laser procedures were performed at a single nonprofit academic medical center (Jacksonville, FL, USA). Data from patients that underwent neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy or selective laser trabeculoplasty (SLT) with reusable contact lenses between 2014 and 2023 was analyzed retrospectively. The post-procedure infection rate, defined as the incidence of newly diagnosed superficial keratitis and/or conjunctivitis within two weeks of the laser procedure, was calculated by dividing the total number of affected eyes by the total cohort size. A break-even analysis was conducted to evaluate the economic impact of reusable lens implementation.

Results: A total of 2285 eyes of 1363 patients were included in this study. The incidence of previous conjunctivitis in this cohort was small (0.4%) and no eyes had a prior history of keratitis. Of the 1372 Nd:YAG capsulotomy and 913 SLT procedures performed, only one eye (0.044%) developed signs of post-operative conjunctivitis and none developed keratitis. The single case of unilateral conjunctivitis occurred within one day of a Nd:YAG capsulotomy and was secondary to medicamentosa. A cost analysis showed that reusable ophthalmic laser lenses become more cost-effective than disposable lenses after approximately 86 SLT procedures and 91 Nd:YAG capsulotomies, while reducing medical waste by 79%.

Conclusion: Given the negligible rate of conjunctivitis, substantial cost savings, and significant reduction in environmental waste associated with reusable capsulotomy and trabeculoplasty lenses, the routine use of disposable ophthalmic lenses should be reconsidered.

Purpose: To investigate the consistency of intraocular pressure measurements between portable non-contact tonometer (PNCT) and Goldmann applanation tonometer (GAT).

Patients and methods: A total of 81 participants (150 eyes) who were aged ≥18 years and had no history of eye surgery within 3 months were recruited. Eyes were categorized into three IOP groups: 7-16 mmHg (n = 50, 33.3%), >16 to <23 mmHg (n = 50, 33.3%), and ≥23 mmHg (n = 50, 33.3%). All participants underwent PNCT and GAT intraocular pressure measurements in sequence, and central corneal thickness (CCT) was recorded. Pearson correlation analysis was used to evaluate the correlation between PNCT and GAT intraocular pressure results, and the intraclass correlation coefficient (ICC) and Bland-Altman method were used to evaluate the consistency. The effect of CCT on intraocular pressure measurement was further analyzed.

Results: A total of 81 subjects (150 eyes) were included. The mean intraocular pressure measured by GAT and PNCT was 21.1±7.8mmHg and 21.4±7.5mmHg, respectively, with no significant difference between the two (P>0.05). The IOP values measured by the two devices were highly positively correlated (r²=0.934, P<0.001), with an ICC of 0.933, indicating good consistency. Bland-Altman analysis showed that the mean difference between GAT and PNCT was -0.2±2.8mmHg, the limits of agreement (LoA) was +5.3 to -5.8mmHg, and 93.33% of the differences fell within ±5mmHg. CCT was significantly positively correlated with the IOP values measured by both devices, but did not significantly impact the agreement between them.

Conclusion: PNCT demonstrates high consistency with GAT and offers a reliable alternative for IOP monitoring. Its portability, non-contact operation, and automatic measurement function make it particularly suitable for home-based and long-term glaucoma management.

Purpose: To evaluate the rate of ocular prosthesis use amongst anophthalmic patients following eye removal surgery and to investigate the influence of socioeconomic factors on prosthesis acquisition.

Methods: A retrospective chart review was conducted for adults undergoing enucleation or evisceration by two surgeons at two urban trauma centers and a private practice between December 2013 and February 2024. Patients were identified using Current Procedural Terminology (CPT) codes for primary and secondary eye removal procedures. Demographic, clinical, and socioeconomic data were collected, including insurance status, employment at the time of surgery, and estimated household income by zip code. Chart data was supplemented by patient telephone interviews which assessed current prosthesis use and barriers to acquisition. Statistical analyses included chi-squared, Fisher's exact, t-tests, and multivariate logistic regression to identify factors associated with prosthesis use.

Results: Among 152 patients screened, 138 patients were included (mean age 52; 55.8% male; 60.1% Black), and 81 (59%) obtained a prosthesis by last follow-up. Most patients (82%) had government-sponsored insurance. Employment and longer follow-up duration were significantly associated with prosthesis use (p=0.036; p<0.001). In multivariate analysis, female sex (adjusted OR=2.06, [1.0; 4.27], P=0.052) and private insurance (adjusted OR=2.70, [0.84; 8.7], P=0.097) trended toward higher rates of prosthesis utilization but were not statistically significant. Among 41/138 (30%) interview participants, 30/41 (73%) had a prosthesis, with 26 of these 30 (87%) reporting positive impacts on quality-of-life. Cost was the most cited barrier among those without a prosthesis.

Conclusion: This study uniquely combines clinical data with direct patient interviews to provide new evidence on real-world barriers to prosthesis access among anophthalmic patients. Ocular prosthesis utilization remains limited, with fewer than 60% of anophthalmic patients obtaining prostheses despite high insurance coverage rates. Employment status and consistent follow-up care were significantly associated with prosthesis acquisition, while cost appeared as a primary barrier. Future efforts should leverage emerging technologies and integrated care pathways to improve access for all anophthalmic patients.

Purpose: This 12-month, prospective, single-arm, postmarketing study assessed efficacy, safety, and patient satisfaction for AcrySof IQ PanOptix TFNT00 intraocular lens in a Chinese population.

Patients and methods: Adults with bilateral cataracts received TFNT00 (286 eyes); visual acuity (VA) was assessed at 12 months. Manifest refraction spherical equivalent (MRSE), corrected and uncorrected distance VA (CDVA, UDVA), distance-corrected and uncorrected intermediate (DCIVA, UIVA) and near (DCNVA, UNVA) VA, and defocus curve were evaluated. Patient-reported outcomes were assessed using questionnaires. Adverse events (AEs) were evaluated.

Results: 134/144 patients (268/286 eyes) completed the study. At 12 months, MRSE was -0.06±0.36 D. Monocular and binocular CDVA ≤0.3 logMAR was achieved in 99.3% of patients. Mean±SD monocular CDVA, UDVA, DCIVA, UIVA, DCNVA, and UNVA were -0.01±0.13, 0.04±0.13, 0.076±0.14, 0.089±0.14, 0.084±0.13, and 0.096±0.13 logMAR, respectively. Binocular VA was equal to or better than 0.1 logMAR for defocus range +0.5 to -3.0 D. Most patients achieved spectacle independence for distance (94%), intermediate (90%), and near (87%) vision; 88% were "satisfied" or "very satisfied." No device-related AEs were reported. Forty eyes (14%) had posterior capsular opacity (37 were clinically nonsignificant; 1 [0.4%] required posterior capsulotomy). Five cystoid macular edema cases (1.7%) were reported. Severe starbursts, halo, and glare were reported by 15.6%, 4.4%, and 2.3% of patients, respectively, with only 1.5% of patients significantly bothered by each.

Conclusion: TFNT00 was safe and effective in a Chinese population, providing good VA at far, intermediate, and near distances, with high rates of spectacle independence and patient satisfaction.

Introduction: Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the elderly in higher-income countries. This study aimed to explore the medical and economic burden of non-exudative AMD patients living in Germany.

Methods: German claims data (AOK PLUS) were utilized in this retrospective analysis. Prevalent non-exudative AMD only patients were compared to (i) non-exudative AMD patients with a concomitant exudative AMD diagnosis and (ii) propensity score matched non-AMD controls in terms of patient characteristics and eye-related diagnostic/monitoring patterns during baseline (in 2020) as well as in terms of the healthcare resource use and associated costs during the follow-up (in 2021).

Results: The sample comprised 25,439 patients diagnosed with non-exudative AMD only and 7,153 diagnosed with both types of AMD (mean age: 79/81 years | female: 64.3%/64.5%). The total health insurance costs for non-exudative AMD only patients were estimated to be 6,500 € per person-year (pPY), which was about 500 € pPY higher than in matched non-AMD controls. The total costs further increased by about 3,500 € pPY in the presence of concomitant exudative AMD. Also, the healthcare resources (especially related to ophthalmological care) were utilized more frequently by non-exudative AMD patients compared to non-AMD controls, and even more so by patients with concomitant exudative AMD.

Conclusion: Non-exudative AMD patients were associated with an increased medical and economic burden compared to non-AMD individuals living in Germany.

Purpose: To identify factors influencing good adherence when using different myopia management solutions, including low-dose atropine, defocus spectacle lenses (DIMS), defocus contact lenses, photobiomodulation with low-intensity red light, and combined approaches.

Design: Retrospective, observational, single-center chart review.

Patients and methods: This single center retrospective study analyzed clinical and demographic data of myopic patients younger than 17 years. Exclusion criteria were presence of systemic and ocular pathologies, significant refractive (other than myopia) or binocular vision disorders, and follow-up less than 6 months. Data on age, sex, cycloplegic refraction, myopic progression, type of myopia control treatment, and patient-reported adherence to treatment (categorized as good, fair, poor) was obtained from the medical charts.

Results: We analyzed 177 Caucasian pediatric patients (49.2% female; mean age 11.1 ± 2.78 years); 84.2% reported good adherence to treatment, 6.8% reported moderate adherence, and 9.0% reported poor adherence. In multivariate logistic regression analysis, DIMS spectacle lenses showed the strongest association with adherence (OR = 21.17, p = 0.003), followed by the combined use of DIMS spectacle lenses and atropine (OR = 4.02, p = 0.038). Higher myopia progression in spherical equivalent (SE) (OR = 0.31, p = 0.002), and older age (OR 0.78, p = 0.05) were significantly associated with lower adherence.

Conclusion: These findings suggest that younger age and lower myopia progression are associated with better adherence to treatment. Among treatment options, DIMS spectacle lenses alone or combined with atropine, were the strongest predictors of adherence, while other approaches showed no significant associations. This favors optical-based strategies when adherence is a concern and calls for enhanced counseling strategies in adolescents.

Purpose: To evaluate whether regionally customized high-density MP-3 microperimetry guided by regions of interest (ROIs) derived from standard automated perimetry (SAP) provides stronger structure-function correlations with ganglion cell layer thickness (GCLT) than conventional SAP in glaucoma.

Methods: This cross-sectional study included 85 eyes of 55 glaucoma patients. All participants underwent SAP (Octopus 900) and MP-3 microperimetry (Nidek Co. Ltd). Individual high-density grids were customized to target the quadrant of lowest mean sensitivity on SAP. Optical coherence tomography (DRI-OCT Triton) was used to measure mean GCLT in the corresponding quadrant (GCLTq). Structure-function relationships between GCLTq and visual field (VF) sensitivity indices were analyzed with linear mixed-effects models accounting for inter-eye correlation. VF sensitivities were expressed on logarithmic and linear scales. Comparative model performance was assessed using Akaike's Information Criterion (AIC), ΔAIC, and Akaike weights (w_i).

Results: All VF indices correlated significantly with GCLTq (p < 0.05). MP-3 mean sensitivity on the linear scale (MS-MP3) showed the strongest association (R² = 0.139; p = 0.003), followed by MS-MP3 in dB (R² = 0.134; p = 0.003), SAP in dB (R² = 0.111; p = 0.008), and SAP on the linear scale (R² = 0.062; p = 0.021). Model comparison indicated a better fit for MP-3 on the linear scale (ΔAIC = 8; w_i = 0.982) than SAP, while differences on the dB scale were minor (ΔAIC = 2). The ROI-guided approach provided a wider sensitivity range and stronger spatial correspondence between functional and structural damage.

Conclusion: ROI-guided MP-3 microperimetry yielded a statistically supported yet modest improvement in structure-function correlation compared with SAP. The AIC-based analysis confirms that ROI targeting enhances the reliability and topographic accuracy of structure-function mapping in glaucoma.

Purpose: Social networking sites are an increasingly popular source of health information and a natural place for connection and support among patients and their loved ones. This study analyzes the content of a Facebook support group for congenital cataracts to understand the concerns, informational needs, and support-seeking behaviors in this community.

Methods: A qualitative evaluation was conducted on the Facebook group Children with Congenital Cataracts, the largest group for congenital cataracts on the platform. The most recent 150 discussion posts were selected for review. Posts were categorized into one of 5 themes: surgery, contact lens, disease related, tips/advice, and miscellaneous. Additional information recorded included the identity of the post's author (caregiver/patient) and level of engagement. Two investigators reviewed the posts.

Results: The majority of posters were mothers of children with congenital cataracts (142/150 or 94.67%), with two posts from adults with the condition. The average number of replies per post was 9 (range: 0-63). Posts with image attachments had more engagement in terms of reactions obtained compared to posts without images (p = <0.001). The majority of posts were questions, followed by news sharing. Discussion post topics fell under the following categories: tips/advice, surgery related, contact lens related, miscellaneous, and disease related. The most common topics within each category were questions regarding surgical complications (n=12, 8%), inserting and removing (usage of) contact lens (n=12, 8%), etiology of disease (n=3, 2%), and advice on patching (n=13, 8.67%) and glasses (n=13, 8.67%).

Conclusion: Awareness of the community and knowledge sharing in the online social space is important for pediatric cataract surgeons. Understanding parental knowledge gaps can help healthcare providers address concerns and improve patient education strategies. Community-driven resources, such as unused contact lens resale, highlight impressive grassroots efforts to assist in care.

Background: Research-grade artificial intelligence has been used to accurately diagnose strabismus from image input. OpenAI's consumer-oriented GPT-4o model can analyze images, but has shown poor accuracy for image-based diagnosis. Parents may turn to GPT-4o to support or refute visible health concerns for their children, such as strabismus. The study aims to evaluate GPT-4o's diagnostic accuracy and response quality for strabismus evaluation.

Methods: After gold-standard alternate cover exam by a clinician, 35 mobile photos of esotropia (13), pseudoesotropia (11), and exotropia (11) were selected. Images were excluded if a second "masked" examiner did not corroborate diagnosis. Images were submitted to a secure GPT-4o platform with patient-perspective prompts requesting overall evaluation (Prompt 1) and eye alignment evaluation (Prompt 2). Responses were graded by a pediatric ophthalmologist and certified orthoptist assessing for quality and safety.

Results: GPT-4o provided interpretations for 15/35 and 27/35 images after Prompts 1 and 2, respectively. Analysis of the accuracy includes a primary "intention-to-diagnose" and secondary "per-diagnosis" framework. The diagnostic accuracies in the primary and secondary analysis following prompt 1 were 14.3% (low sensitivity and specificity) and 33.3% (low sensitivity, high specificity), respectively. Following prompt 2, accuracies were 48.6% (moderate sensitivity, low specificity) and 63.0% (high sensitivity, low specificity). Overall, the mean rating for content for strabismus prompts was 4.94 ± 0.27 out of a best possible 6, and for pseudostrabismus, 5.14 ± 0.18 (p=0.638).

Conclusion: GPT-4o shows poor accuracy for image-based strabismus diagnosis. GPT-4o frequently categorized pseudoesotropia as true strabismus and true strabismus as orthophoria. While the quality of responses was rated as good overall, the quality of counseling did not match what would be provided in a pediatric ophthalmology clinic. Patients, clinicians, and AI developers should be aware of the need for specialist evaluation for strabismus.