Background:To examine the baseline morphological characteristics and alterations in intraretinal microvascular abnormalities(IRMAs)in response to anti-vascular endothelial growth factor(anti-VEGF)treatment,documented ...Background:To examine the baseline morphological characteristics and alterations in intraretinal microvascular abnormalities(IRMAs)in response to anti-vascular endothelial growth factor(anti-VEGF)treatment,documented by optical coherence tomography angiography(OCTA)in diabetic eyes.Methods:In this retrospective study,IRMAs were evaluated with multimodal imaging(fundus photography,fluorescein angiography,OCTA)in treatment-naïve diabetic eyes before and after anti-VEGF treatment for diabetic macular edema(DME)and/or proliferative diabetic retinopathy(PDR)and compared to diabetic control eyes with similar diabetic retinopathy(DR)severity that did not receive anti-VEGF therapy.The morphological characteristics of IRMAs on enface OCTA imaging were graded by masked readers at baseline,then after anti-VEGF therapy in treated eyes or after observation in control eyes.Characterization of interval changes in an IRMA were based on the following parameters:branching,vessel caliber and area of adjacent capillary non-perfusion.Results:The treated group included 45 IRMA foci from 15 eyes of 11 patients,while the control group included 27 IRMA foci from 15 eyes of 14 patients.Following anti-VEGF treatment,enface OCTA demonstrated that 14 foci of IRMA(31%)demonstrated regression with normalization of appearance of the capillary bed,20 IRMAs(44%)remained unchanged,six IRMAs(13%)progressed with enlargement or development of new IRMAs and five IRMAs(11%)demonstrated complete obliteration defined as IRMA disappearance with advancing capillary drop-out.In the control group,17 IRMA(63%)remained stable,8 IRMAs(29.6%)progressed and 2 experienced total obliteration(7.4%).The difference in rank order between the two groups was statistically significant(p=0.022).Conclusions:In eyes with DR status post anti-VEGF therapy,foci of IRMAs have a variable course demonstrating one of four possible outcomes:regression,stabilit,progression or complete obliteration.In contrast,none of the untreated control diabetic eyes demonstrated regression of IRMAs,consistent with known progression of DR severity in high risk eyes.Morphologic evaluation of IRMAs with OCTA may help to monitor changes in retinal blood flow as well as the response to anti-VEGF treatment.展开更多
Background:Diabetic retinopathy is a major cause of visual impairment and blindness among working-age people worldwide.The aim of our study was to investigate the effects of a carotenoid supplementation on retinal thi...Background:Diabetic retinopathy is a major cause of visual impairment and blindness among working-age people worldwide.The aim of our study was to investigate the effects of a carotenoid supplementation on retinal thickness and macular function of patients with diabetes using optical coherence tomography(OCT)and multifocal electroretinography(mfERG).Methods:A retrospective study of one hundred and twenty eyes of sixty patients age between 40 and 60 years with non-insulin dependent type 2 diabetes mellitus without diabetic retinopathy who underwent OCT and mfERG and took vitamin supplements for a period of two years.Patients received a carotenoid supplement containing lutein(10 mg),zeaxanthin(2 mg)and meso-zeaxanthin(10 mg)once a day for two years.The thickness of the fovea was evaluated using OCT and the macular function was tested by mfERG.Results:OCT showed an increase in the central foveal thickness and mfERG revealed increased retinal response density within the central 13°surrounding the fovea(rings 1 to 3)at two years after the onset of carotenoids supplement intake.Conclusion:The use of carotenoid supplements may be of benefit for improving visual function of type 2 diabetes patients.However,further study is needed to assess the treatment’s long-term efficacy.展开更多
Background:To evaluate the refractive outcomes and the optical performance as well as the quality of life in patients implanted with a new diffractive multifocal intraocular lens(IOL).Methods:Prospective,clinical stud...Background:To evaluate the refractive outcomes and the optical performance as well as the quality of life in patients implanted with a new diffractive multifocal intraocular lens(IOL).Methods:Prospective,clinical study including 41 cases of patients who underwent cataract surgery and were divided in two groups:group 1,including 20 eyes implanted with the multifocal IOL SeeLens MF(Hanita Lenses,Israel);group 2,21 eyes implanted with the Acrysof SA60AT IOL.Visual acuity,defocus curve,intraocular aberrations,contrast sensitivity function and quality of life were assessed during a follow up period of 6 months.Results:Significant improvement was observed in the uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)in both groups(p<0.02).The multifocal group showed better results in terms of uncorrected near visual acuity(UNVA)and distance-corrected near visual acuity(DCNVA)(p<0.01).Comparison of both groups showed better visual acuities for the multifocal IOL group in defocus levels from-3.0 D to-1.50 D(p≤0.01).At 6 months,there was a significant reduction of the internal higher order aberrations(p≤0.04).A significant increase in scotopic contrast sensitivity was detected for 6 cycles/°spatial frequency during follow up(p=0.04),but no significant changes were observed for the rest of spatial frequencies(p≥0.06).Visual Functioning Index(VF-14)questionnaire showed that patients reported high levels of satisfaction when performing daily tasks.Conclusions:The SeeLens MF IOL is able to successfully restore distance,near and intermediate visions after cataract surgery.It also provides functional intermediate vision with optimal intraocular optical quality.展开更多
Background:Keratoconus(KC)is a common corneal condition with an unknown gender predominance.Although numerous studies have investigated the genetic component of KC,no specific genes have yet been attributed to the con...Background:Keratoconus(KC)is a common corneal condition with an unknown gender predominance.Although numerous studies have investigated the genetic component of KC,no specific genes have yet been attributed to the condition.We recently reported posterior segment changes occurring in the eyes of KC patients.However,it is not clear whether these changes are part of KC pathogenesis or reflect changes in anatomical features of the eye manifested by changes at the cornea.Given retinal changes represent the main characteristics observed in agerelated macular degeneration(AMD)and that pleiotropy has been demonstrated between different eye diseases,we wished to assess if known AMD associated genes were also associated with KC.Methods:A total of 248 KC subjects and 366 non-KC(control)subjects were recruited from public and private clinics in Melbourne for this analysis.Nineteen single nucleotide polymorphisms(SNPs)previously associated with AMD,including rs10490924(ARMS2/HTRA1),rs10737680(CFH),rs13278062(TNFRSF10A),rs1864163(CETP),rs2230199(C3),rs3130783(IER3/DDR1),rs334353(TGFBR1),rs3812111(COL10A1),rs429608(C2/CFB),rs4420638(APOE),rs4698775(CFI),rs5749482(TIMP3),rs6795735(ADAMTS9),rs8017304(RAD51B),rs8135665(SLC16A8),rs920915(LIPC),rs943080(VEGFA),rs9542236(B3GALTL)and rs13081855(COL8A1/FILIP1L),were genotyped in this cohort.Logistic regression was applied to evaluate the association between these SNPs and KC on both genders together,as well as each gender separately.Linear regression was also applied to assess the association between SNPs and corneal curvature.Bonferroni correction was applied to adjust for multiple testing.Results:Genotyping data were available for 18 SNPs.The SNP,rs6795735(ADAMTS9)was significantly associated with KC(p=3.5×10−4)when both genders were assessed,whereas rs5749482(TIMP3)was only associated in males(p=7.7×10−4)following Bonferroni multiple correction.However,when the covariates of age and gender were included,the associations became non-significant.In addition,none of the SNPs appeared significant for corneal curvature.Conclusions:Our study suggested a potential association of rs6795735 in the ADAMTS9 gene and rs5749482 in the TIMP3 gene in KC and that different associations may be gender specific.Overall,SNPs initially identified as associated with AMD following multiple correction may be further impacted by other factors such as age or gender and further studies are needed to resolve this issue.展开更多
Background:To compare femtosecond laser-assisted versus conventional phacoemulsification in terms of visual and refractive outcomes,cumulative dissipated energy,anterior chamber inflammation and endothelial cell loss....Background:To compare femtosecond laser-assisted versus conventional phacoemulsification in terms of visual and refractive outcomes,cumulative dissipated energy,anterior chamber inflammation and endothelial cell loss.Methods:In this retrospective cohort study,records of eyes that underwent femtosecond laser-assisted cataract surgery(FLACS)or conventional phacoemulsification(CP)were reviewed.The Victus femtosecond laser(Bausch and Lomb,Germany)was used to carry out corneal incisions,anterior capsulotomy,and lens fragmentation in FLACS procedures.Manifest refraction spherical equivalence(MRSE),uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),cumulative dissipated energy(CDE),postoperative cells and flare and endothelial cell count data were collected.Subgroup analysis of the visual acuity tests was performed based on the type of intraocular lens implanted(monofocal,monofocal toric,multifocal,multifocal toric,accommodating).Results:A total of 735 eyes were included in the study(296 eyes for the FLACS group and 439 eyes for the CP group).At one year follow-up,120 eyes comprised the FLACS group and 265 eyes for the CP group.MRSE in the FLACS group was−0.16±0.58 D and−0.20±0.52 D in the CP group(P=0.50).UDVA in the FLACS group was 20/25(mean logMAR 0.12±0.13)and 20/25(mean logMAR 0.11±0.13)in the CP group(P=0.48).CDVA was 20/20(mean logMAR 0.03±0.07)in the FLACS group and 20/20(mean logMAR 0.02±0.06)in the CP group(P=0.15).No statistically significant trend was seen for FLACS versus CP by intraocular type for visual acuity.CDE for the different cataract grades ranged from 6.97±5.74 to 29.02±16.07 in the FLACS group and 7.59±6.42 to 35.69±18.30 in the CP group.The FLACS group was significantly lower for post-operative central corneal edema(P=0.05),cells and flare(P=0.01),and endothelial cell loss(P=0.04).Conclusions:Femtosecond laser-assisted cataract surgery and conventional phacoemulsification had similar refractive and visual outcomes.Phacoemulsification energy,anterior chamber inflammation and corneal endothelial cell loss were less in the femtosecond laser group.展开更多
Keratoconus is a bilateral,non-inflammatory,degenerative corneal disease.The occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular astigmatism.With...Keratoconus is a bilateral,non-inflammatory,degenerative corneal disease.The occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular astigmatism.With the disruption of the collagen organization,the cornea loses its shape and function resulting in progressive visual degradation.Currently,corneal topography is the most important tool for the diagnosis of keratoconus,which may lead to false negatives among the patient population in the subclinical phase.However,it is now hypothesised that biomechanical destabilisation of the cornea may take place ahead of the topographic evidence of keratoconus,hence possibly assisting with disease diagnosis and management.This article provides a review of the definition,diagnosis,and management strategies for keratoconus based on corneal biomechanics.展开更多
Background:To compare the arithmetic mean(M-SIA)and the summated vector mean of surgically induced astigmatism(SVM-SIA)according to the incision site after phakic intraocular lens(Visian implantable collamer lens(ICL)...Background:To compare the arithmetic mean(M-SIA)and the summated vector mean of surgically induced astigmatism(SVM-SIA)according to the incision site after phakic intraocular lens(Visian implantable collamer lens(ICL),STAAR Surgical)implantation.Methods:This study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision.The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer.The M-SIA and the SVM-SIA were determined according to the incision site.Results:The magnitude of corneal astigmatism significantly increased from 1.23±0.59 D preoperatively to 1.46±0.72 D postoperatively in the temporal incision group(Wilcoxon signed-rank test,P<0.001),but it significantly decreased from 1.09±0.36 D preoperatively to 0.86±0.41 D postoperatively in the superior incision group(P<0.001).The M-SIA was 0.48±0.30 D,and the SVM-SIA was 0.23±0.52 D at a meridian of 82°in the temporal incision group.The M-SIA was 0.57±0.30 D,and the SVM-SIA was 0.47±0.45 D at a meridian of 1°in the superior incision group.Conclusions:ICL implantation induces the M-SIA by approximately 0.5 D,but the SVM-SIA decreased to 50%and 80%of the M-SIA in magnitude through temporal and superior incisions,respectively.The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site.It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.展开更多
Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a ...Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter.Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness(SFCT)and central retinal thickness(CRT).Anatomic(10%CRT decrease)and functional responses(best corrected visual acuity,BCVA gain≥5 letters)were assessed at 3 months and 6 months using univariate and multivariate analyses.Parameters tested were gender,duration of diabetes,HbA1c,hypertension,CRT,SFCT,BCVA,ellipsoid zone(EZ)status,subfoveal neuroretinal detachment(SND),anti-VEGF used and laser naivety.A logistic regression model was applied to find independent markers outcome.Results:BCVA increased,CRT and SFCT decreased at 3 months and 6 months.Good metabolic control(p=0.003),intact baseline EZ(p=0.030),EZ re-grading at 3 M(p<0.001)and laser naivety(p=0.001)were associated with better functional outcome.The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response,while lower baseline BCVA and intact EZ are predictors of functional response.Conclusion:The presence of SND predicts anatomic response only,while an intact EZ is critical to achieve a good functional outcome in DME.展开更多
Background:The aim of the study is to raise the awareness of the influence of coma-like higher-order aberrations(HOAs)on power and orientation of refractive astigmatism(RA)and to explore how to account for that influe...Background:The aim of the study is to raise the awareness of the influence of coma-like higher-order aberrations(HOAs)on power and orientation of refractive astigmatism(RA)and to explore how to account for that influence in the planning of topography-guided refractive surgery in eyes with coma-like-aberrations-dominant corneal optics.Methods:Eleven eyes with coma-like-aberrations-dominant corneal optics and with low lenticular astigmatism(LA)were selected for astigmatism analysis and for treatment simulations with topography-guided custom ablation.Vector analysis was used to evaluate the contribution of coma-like corneal HOAs to RA.Two different strategies were used for simulated treatments aiming to regularize irregular corneal optics:With both strategies correction of anterior corneal surface irregularities(corneal HOAs)were intended.Correction of total corneal astigmatism(TCA)and RA was intended as well with strategies 1 and 2,respectively.Results:Axis of discrepant astigmatism(RA minus TCA minus LA)correlated strongly with axis of coma.Vertical coma influenced RA by canceling the effect of the with-the-rule astigmatism and increasing the effect of the against-the-rule astigmatism.After simulated correction of anterior corneal HOAs along with TCA and RA(strategies 1 and 2),only a small amount of anterior corneal astigmatism(ACA)and no TCA remained after strategy 1,while considerable amount of ACA and TCA remained after strategy 2.Conclusions:Coma-like corneal aberrations seem to contribute a considerable astigmatic component to RA in eyes with coma-like-aberrations dominant corneal optics.If topography-guided ablation is programmed to correct the corneal HOAs and RA,the astigmatic component caused by the coma-like corneal HOAs will be treated twice and will result in induced astigmatism.Disregarding RA and treating TCA along with the corneal HOAs is recommended instead.展开更多
Background:It is unclear whether multifocal soft contact lenses(MFSCLs)affect visual quality when they are used for myopia control in juvenile myopes.The aim of this study was,therefore,to investigate the effect of MF...Background:It is unclear whether multifocal soft contact lenses(MFSCLs)affect visual quality when they are used for myopia control in juvenile myopes.The aim of this study was,therefore,to investigate the effect of MFSCLs on visual quality among juvenile myopia subjects.Methods:In a prospective,intervention study,thirty-three juvenile myopes were enrolled.Visual perception was assessed by a quality of vision(QoV)questionnaire with spectacles at baseline and after 1 month of MFSCL wear.At the one-month visit,the high(96%)contrast distance visual acuity(distance HCVA)and low(10%)contrast distance visual acuity(distance LCVA)were measured with single vision spectacle lenses,single vision soft contact lenses(SVSCLs)and MFSCLs in a random order.Wavefront aberrations were measured with SVSCLs,with MFSCLs,and without any correction.Results:Neither distance HCVA(p>0.05)nor distance LCVA(p>0.05)revealed any significant difference between MFSCLs,SVSCLs and single vision spectacle lenses.The overall score(the sum of ten symptoms)of the QoV questionnaire did not show a statistically significant difference between spectacles at baseline and after 1 month of MFSCL wear(p=0.357).The results showed that the frequency(p<0.001),severity(p=0.001)and bothersome degree(p=0.016)of halos were significantly worse when wearing MFSCLs than when wearing single vision spectacle lenses.In contrast,the bothersome degree caused by focusing difficulty(p=0.046)and the frequency of difficulty in judging distance or depth perception(p=0.046)were better when wearing MFSCLs than when wearing single vision spectacle lenses.Compared with the naked eye,MFSCLs increased the total aberrations(p<0.001),higher-order aberrations(p<0.001),trefoil(p=0.023),coma aberrations(p<0.001)and spherical aberrations(SA)(p<0.001).Compared with the SVSCLs,MFSCLs increased the total aberrations(p<0.001),higher-order aberrations(p<0.001),coma aberrations(p<0.001)and SA(p<0.001).The direction of SA was more positive(p<0.001)with the MFSCLs and more negative(p=0.001)with the SVSCLs compared with the naked eye.Conclusions:Wearing MFSCLs can provide satisfactory corrected visual acuity(both distance HCVA and distance LCVA).Although the lenses increased the aberrations,such as total aberrations and higher-order aberrations,there were few adverse effects on the distance HCVA,distance LCVA and visual perception after 1 month of MFSCL use.展开更多
Erratum After publication of the original article[1]it was brought to our attention that author Jorge L.Aliówas incorrectly included as Jorge Luciano Alió.The correct name is included in the author list of t...Erratum After publication of the original article[1]it was brought to our attention that author Jorge L.Aliówas incorrectly included as Jorge Luciano Alió.The correct name is included in the author list of this erratum and has been updated in the original article.展开更多
Background:The Primary Eyecare Acute Referral Service(PEARS)and the Wales Eye Health Examination(WEHE)operate as enhanced optometry services for patients residing in Wales,enabling the examination of a patient present...Background:The Primary Eyecare Acute Referral Service(PEARS)and the Wales Eye Health Examination(WEHE)operate as enhanced optometry services for patients residing in Wales,enabling the examination of a patient presenting with an acute eye problem(PEARS)or the examination of patients at higher risk of eye disease(WEHE).The purpose of the study is to assess the demographics of patients accessing these services,referral patterns and clinical management in one Health Board in Wales(Aneurin Bevan University Health Board).Methods:Information from 2302 patients accessing the services was prospectively collected.The following information was obtained:type of examination(PEARS or WEHE),patient age,gender,self-referral or general practitioner(GP)referral and clinical management(no further action,monitor by optometrist or ophthalmic medical practitioner[OMP],refer to the Hospital Eye Service[HES],or refer to GP).Results:There were 1791(77.8%)PEARS examinations and 511(22.2%)WEHE.There were 1379(59.9%)females with a mean age of 58.61(±19.75)and 923(40.1%)males with a mean age of 56.11(±20.42).The majority of patients were self-referrals compared to GP-referrals(1793[77.9%]versus 509[22.1%]respectively).Sub-analysis indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only(297[58.1%]versus 214[41.9%]respectively)but greater numbers of self-referrals for the PEARS examinations only(1496[83.5%]versus 295[16.5%]respectively).For management,75%of patients were monitored by their optometrist or OMP,17%required referral to the HES and 8%required referral to their GP.Conclusions:Higher numbers of females accessed both PEARS and WEHE services and the majority of patients self-referred.These findings have important implications for public health campaigns both for targeting specific groups(e.g.male patients)and increasing awareness among GPs.展开更多
Background:To investigate the topographic measurements and densitometry of corneas in Wilson's disease(WD)patients with or without a Kayser-Fleischer ring(KF-r)compared to healthy individuals.Methods:This cross-se...Background:To investigate the topographic measurements and densitometry of corneas in Wilson's disease(WD)patients with or without a Kayser-Fleischer ring(KF-r)compared to healthy individuals.Methods:This cross-sectional study included 20 WD patients without a KF-r(group I),18 WD patients with a KF-r(groupⅠ),and 20 age-matched controls(group Ⅱ).The Pentacam high-resolution imaging system is used to determine corneal topographic measurements and densitometry.Results:Mean age for groups Ⅰ,Ⅱ and Ⅲ was 25.40±6.43 years(14-36 years),25.38±6.96 years(16-39 years),and 23.60±6.56 years(17-35 years),respectively(P=0.623).There was no significant difference between the groups in terms of the anterior corneal densitometry values(P>0.05),while the 6-10 mm and 10-12 mm midstroma and the 2-6 mm,6-10 mm,and 10-12 mm posterior corneal densitometry values in group Ⅱ were significantly higher than those in groups Ⅰ and Ⅱ(for all values,P<0.05).However,the 10-12 mm posterior corneal densitometry values in group Ⅰ were also significantly higher than those in group Ⅲ(P=0.038).The central corneal thickness(CCT),thinnest corneal thickness(tCT),and corneal volume(CV)values in groups Ⅰ and Ⅱ were significantly lower than those in group Ⅱ(for CCT values,P=0.011 and P=0.009;for tCT values,P=0.010 and P=0.005;for CV values,P=0.043 and P=0.029).Conclusion:In WD patients with a KF-r,corneal transparency decreased in the peripheral posterior and midstromal corneal layers;for these patients,corneal transparency may be impaired not only in the peripheral cornea but also in the paracentral cornea.展开更多
Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane librar...Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and Wang,Koch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.展开更多
Background:The goal was to characterize retinal vasculature by quantitative analysis of arteriole-to-venule(A/V)ratio and vessel density in fundus photos taken with the PanOptic iExaminer System.Methods:The PanOptic o...Background:The goal was to characterize retinal vasculature by quantitative analysis of arteriole-to-venule(A/V)ratio and vessel density in fundus photos taken with the PanOptic iExaminer System.Methods:The PanOptic ophthalmoscope equipped with a smartphone was used to acquire fundus photos centered on the optic nerve head.Two fundus photos of a total of 19 eyes from 10 subjects were imaged.Retinal vessels were analyzed to obtain the A/V ratio.In addition,the vessel tree was extracted using deep learning U-NET,and vessel density was processed by the percentage of pixels within vessels over the entire image.Results:All images were successfully processed for the A/V ratio and vessel density.There was no significant difference of averaged A/V ratio between the first(0.77±0.09)and second(0.77±0.10)measurements(P=0.53).There was no significant difference of averaged vessel density(%)between the first(6.11±1.39)and second(6.12±1.40)measurements(P=0.85).Conclusions:Quantitative analysis of the retinal vasculature was feasible in fundus photos taken using the PanOptic ophthalmoscope.The device appears to provide sufficient image quality for analyzing A/V ratio and vessel density with the benefit of portability,easy data transferring,and low cost of the device,which could be used for pre-clinical screening of systemic,cerebral and ocular diseases.展开更多
Background:The accommodation has considerable interactions with the pupil response,vergence response and binocularity.The transformation of visual reception processing and the changes of the binocular cooperation duri...Background:The accommodation has considerable interactions with the pupil response,vergence response and binocularity.The transformation of visual reception processing and the changes of the binocular cooperation during the presbyopia development are still poorly studied.So,the regularities of visual system violation in the presbyopia formation need to be characterized.This study aims to reveal the transformation of visual reception processing and to determine the role of disturbances in binocular interactions in presbyopia formation.Methods:This study included 60 people with emmetropic refraction,uncorrected distance visual acuity 1.0 or higher(decimal scale),normal color perception,without concomitant ophthalmopathology.The first group consisted of 30 people(from 18 to 27 years old)without presbyopia,the second cohort comprised 30 patients(from 45 to 55 years old)with presbyopia.The eyeball anatomy and optics were evaluated using ultrasound biomicroscopy,aberrometry,and pupillometry.The functional state of the visual system was investigated under monocular and binocular conditions.The registration of the disparate fusional reflex limits was performed by the original technic using a diploptic device which facilitated investigation of the binocular interaction under natural conditions without the accommodation response,but with the different vergence load.The disparate fusional reflex was analyzed using the proximal and distal fusion borders,and the convergence and divergence fusion borders.The calculation of the area of binocularity field was performed in cm2.Results:The presbyopia formation is characterized by a change in an intraocular anatomy,optics,visual processing,and binocularity.The processes of binocular interaction inhibition make a significant contribution to the misalignment of the visual perception.The modification of the proximal,distal and convergence fusion borders was determined.It was revealed that 87%of the presbyopic patients had binocularity shortage,whereas the reduction of binocularity field area in extreme grade was seen in 6%of cases.Conclusions:The presbyopia formation is accompanied by a significant reorganization of the visual system activity and by the creation of the new visual processing interactions.These data may be useful in presbyopia surgery.展开更多
BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-b...BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer.MethodsThis study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group);(b) 19 Miniwell;(c) 24 LENTIS Mplus LS-313 MF30;(d) 33 LENTIS Mplus LS-313 MF15;(e) 17 AkkoLens Lumina;(f) 31 AT LISA Tri 839MP;(g) 20 Precizon Presbyopic;(h) 20 AcrySof IQ PanOptix;(i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer.ResultsAT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10;P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001).ConclusionsFar distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.展开更多
Symptoms of dryness discomfort in soft contact lens wearers frequently lead to discontinuation from wear.The negative influence of pre-fitting tear dysfunctions appears likely to be exacerbated by the challenges to te...Symptoms of dryness discomfort in soft contact lens wearers frequently lead to discontinuation from wear.The negative influence of pre-fitting tear dysfunctions appears likely to be exacerbated by the challenges to tear homeostasis caused by contact lenses.The corneal mechanisms for symptoms in contact lens wearers are different to those for dry eye disease because the cornea is insulated by the lens from ambient conditions as well as from lid wiper friction during blinking.Symptoms of dryness discomfort might be the consequence of increased lid wiper friction during blinking when the lens front surface becomes soiled and dry and exhibits very rapid tear break up.It is possible that some cases of contact lens intolerance and discontinuation could be a function of lid wiper neuropathy.In relation to the possibility of corneal neuropathy,a stagnant post-lens tear pool with the possibility of increased concentrations of metabolic by-products,cellular debris,and bacterial exotoxins,might have the potential to disturb the corneal epithelial and sub-basal nerves.Contributions by contact lens-induced inflammation to any neuropathic changes may partly depend on the degree to which inflammatory mediators are concentrated in a stagnant post-lens tear pool.It does not appear to be known if corneal neuropathic changes could develop under these conditions.The chances of neuropathic involvement may be greater if discomfort develops after a significant period of successful wear and there is a history of comorbid pain conditions.Esthesiometry and in vivo confocal microscopy in discontinued contact lens wearers may support a diagnosis of contact lens-related corneal neuralgia.展开更多
Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents...Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throughout the 8-year follow-up.Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.展开更多
Background:Type 2 Peters anomaly is a rare anterior segment disorder characterized by central corneal leukoma with keratolenticular adhesion and cataract.Performing cataract surgery without corneal tissue transplantat...Background:Type 2 Peters anomaly is a rare anterior segment disorder characterized by central corneal leukoma with keratolenticular adhesion and cataract.Performing cataract surgery without corneal tissue transplantation in patients of type 2 Peters anomaly is extremely rare and challenging.We present a case of type 2 Peters anomaly treated by peeling off the adhesion without penetrating keratoplasty(PKP),in which restoration of corneal transparency is observed.Case presentation:An 11-month-old female infant of type 2 Peters anomaly presented with bilateral corneal opacity with distinct demarcation,keratolenticular adhesion and cataract,which was first noted at the age of 3 months.By peeling off the adhesion from corneal endothelium combined with lensectomy and vitrectomy,there was a gradual reduction in corneal opacity and improvement in visual acuity after surgery over a 2-year period.Her visual acuity had improved from light perception preoperatively to 20/50 at the latest follow-up.No sight-threatening postoperative complications were noted.Conclusion:It is safe and effective to peel off the keratolenticular adhesion in patients of type 2 Peters anomaly presented with distinctly demarcated corneal opacity.展开更多
文摘Background:To examine the baseline morphological characteristics and alterations in intraretinal microvascular abnormalities(IRMAs)in response to anti-vascular endothelial growth factor(anti-VEGF)treatment,documented by optical coherence tomography angiography(OCTA)in diabetic eyes.Methods:In this retrospective study,IRMAs were evaluated with multimodal imaging(fundus photography,fluorescein angiography,OCTA)in treatment-naïve diabetic eyes before and after anti-VEGF treatment for diabetic macular edema(DME)and/or proliferative diabetic retinopathy(PDR)and compared to diabetic control eyes with similar diabetic retinopathy(DR)severity that did not receive anti-VEGF therapy.The morphological characteristics of IRMAs on enface OCTA imaging were graded by masked readers at baseline,then after anti-VEGF therapy in treated eyes or after observation in control eyes.Characterization of interval changes in an IRMA were based on the following parameters:branching,vessel caliber and area of adjacent capillary non-perfusion.Results:The treated group included 45 IRMA foci from 15 eyes of 11 patients,while the control group included 27 IRMA foci from 15 eyes of 14 patients.Following anti-VEGF treatment,enface OCTA demonstrated that 14 foci of IRMA(31%)demonstrated regression with normalization of appearance of the capillary bed,20 IRMAs(44%)remained unchanged,six IRMAs(13%)progressed with enlargement or development of new IRMAs and five IRMAs(11%)demonstrated complete obliteration defined as IRMA disappearance with advancing capillary drop-out.In the control group,17 IRMA(63%)remained stable,8 IRMAs(29.6%)progressed and 2 experienced total obliteration(7.4%).The difference in rank order between the two groups was statistically significant(p=0.022).Conclusions:In eyes with DR status post anti-VEGF therapy,foci of IRMAs have a variable course demonstrating one of four possible outcomes:regression,stabilit,progression or complete obliteration.In contrast,none of the untreated control diabetic eyes demonstrated regression of IRMAs,consistent with known progression of DR severity in high risk eyes.Morphologic evaluation of IRMAs with OCTA may help to monitor changes in retinal blood flow as well as the response to anti-VEGF treatment.
文摘Background:Diabetic retinopathy is a major cause of visual impairment and blindness among working-age people worldwide.The aim of our study was to investigate the effects of a carotenoid supplementation on retinal thickness and macular function of patients with diabetes using optical coherence tomography(OCT)and multifocal electroretinography(mfERG).Methods:A retrospective study of one hundred and twenty eyes of sixty patients age between 40 and 60 years with non-insulin dependent type 2 diabetes mellitus without diabetic retinopathy who underwent OCT and mfERG and took vitamin supplements for a period of two years.Patients received a carotenoid supplement containing lutein(10 mg),zeaxanthin(2 mg)and meso-zeaxanthin(10 mg)once a day for two years.The thickness of the fovea was evaluated using OCT and the macular function was tested by mfERG.Results:OCT showed an increase in the central foveal thickness and mfERG revealed increased retinal response density within the central 13°surrounding the fovea(rings 1 to 3)at two years after the onset of carotenoids supplement intake.Conclusion:The use of carotenoid supplements may be of benefit for improving visual function of type 2 diabetes patients.However,further study is needed to assess the treatment’s long-term efficacy.
基金This study is supported in part by a grant from the Spanish Ministry of Health,Instituto Carlos III,Red Temática de Investigación Cooperativa en Salud“Patología ocular del envejecimiento,calidad visual y calidad de vida”,Subproyecto de Calidad Visual(RD07/0062).
文摘Background:To evaluate the refractive outcomes and the optical performance as well as the quality of life in patients implanted with a new diffractive multifocal intraocular lens(IOL).Methods:Prospective,clinical study including 41 cases of patients who underwent cataract surgery and were divided in two groups:group 1,including 20 eyes implanted with the multifocal IOL SeeLens MF(Hanita Lenses,Israel);group 2,21 eyes implanted with the Acrysof SA60AT IOL.Visual acuity,defocus curve,intraocular aberrations,contrast sensitivity function and quality of life were assessed during a follow up period of 6 months.Results:Significant improvement was observed in the uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)in both groups(p<0.02).The multifocal group showed better results in terms of uncorrected near visual acuity(UNVA)and distance-corrected near visual acuity(DCNVA)(p<0.01).Comparison of both groups showed better visual acuities for the multifocal IOL group in defocus levels from-3.0 D to-1.50 D(p≤0.01).At 6 months,there was a significant reduction of the internal higher order aberrations(p≤0.04).A significant increase in scotopic contrast sensitivity was detected for 6 cycles/°spatial frequency during follow up(p=0.04),but no significant changes were observed for the rest of spatial frequencies(p≥0.06).Visual Functioning Index(VF-14)questionnaire showed that patients reported high levels of satisfaction when performing daily tasks.Conclusions:The SeeLens MF IOL is able to successfully restore distance,near and intermediate visions after cataract surgery.It also provides functional intermediate vision with optimal intraocular optical quality.
基金supported by the Australian National Health and Medical Research Council(NHMRC)project grant GNT1104700Senior Research Fellowship(1138585 to PN Baird)+1 种基金the Angior Family Foundation and a Lions Eye Foundation Fellowship(SS)The Centre for Eye Research Australia(CERA)receives Operational Infrastructure Support from the Victorian Government.
文摘Background:Keratoconus(KC)is a common corneal condition with an unknown gender predominance.Although numerous studies have investigated the genetic component of KC,no specific genes have yet been attributed to the condition.We recently reported posterior segment changes occurring in the eyes of KC patients.However,it is not clear whether these changes are part of KC pathogenesis or reflect changes in anatomical features of the eye manifested by changes at the cornea.Given retinal changes represent the main characteristics observed in agerelated macular degeneration(AMD)and that pleiotropy has been demonstrated between different eye diseases,we wished to assess if known AMD associated genes were also associated with KC.Methods:A total of 248 KC subjects and 366 non-KC(control)subjects were recruited from public and private clinics in Melbourne for this analysis.Nineteen single nucleotide polymorphisms(SNPs)previously associated with AMD,including rs10490924(ARMS2/HTRA1),rs10737680(CFH),rs13278062(TNFRSF10A),rs1864163(CETP),rs2230199(C3),rs3130783(IER3/DDR1),rs334353(TGFBR1),rs3812111(COL10A1),rs429608(C2/CFB),rs4420638(APOE),rs4698775(CFI),rs5749482(TIMP3),rs6795735(ADAMTS9),rs8017304(RAD51B),rs8135665(SLC16A8),rs920915(LIPC),rs943080(VEGFA),rs9542236(B3GALTL)and rs13081855(COL8A1/FILIP1L),were genotyped in this cohort.Logistic regression was applied to evaluate the association between these SNPs and KC on both genders together,as well as each gender separately.Linear regression was also applied to assess the association between SNPs and corneal curvature.Bonferroni correction was applied to adjust for multiple testing.Results:Genotyping data were available for 18 SNPs.The SNP,rs6795735(ADAMTS9)was significantly associated with KC(p=3.5×10−4)when both genders were assessed,whereas rs5749482(TIMP3)was only associated in males(p=7.7×10−4)following Bonferroni multiple correction.However,when the covariates of age and gender were included,the associations became non-significant.In addition,none of the SNPs appeared significant for corneal curvature.Conclusions:Our study suggested a potential association of rs6795735 in the ADAMTS9 gene and rs5749482 in the TIMP3 gene in KC and that different associations may be gender specific.Overall,SNPs initially identified as associated with AMD following multiple correction may be further impacted by other factors such as age or gender and further studies are needed to resolve this issue.
文摘Background:To compare femtosecond laser-assisted versus conventional phacoemulsification in terms of visual and refractive outcomes,cumulative dissipated energy,anterior chamber inflammation and endothelial cell loss.Methods:In this retrospective cohort study,records of eyes that underwent femtosecond laser-assisted cataract surgery(FLACS)or conventional phacoemulsification(CP)were reviewed.The Victus femtosecond laser(Bausch and Lomb,Germany)was used to carry out corneal incisions,anterior capsulotomy,and lens fragmentation in FLACS procedures.Manifest refraction spherical equivalence(MRSE),uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),cumulative dissipated energy(CDE),postoperative cells and flare and endothelial cell count data were collected.Subgroup analysis of the visual acuity tests was performed based on the type of intraocular lens implanted(monofocal,monofocal toric,multifocal,multifocal toric,accommodating).Results:A total of 735 eyes were included in the study(296 eyes for the FLACS group and 439 eyes for the CP group).At one year follow-up,120 eyes comprised the FLACS group and 265 eyes for the CP group.MRSE in the FLACS group was−0.16±0.58 D and−0.20±0.52 D in the CP group(P=0.50).UDVA in the FLACS group was 20/25(mean logMAR 0.12±0.13)and 20/25(mean logMAR 0.11±0.13)in the CP group(P=0.48).CDVA was 20/20(mean logMAR 0.03±0.07)in the FLACS group and 20/20(mean logMAR 0.02±0.06)in the CP group(P=0.15).No statistically significant trend was seen for FLACS versus CP by intraocular type for visual acuity.CDE for the different cataract grades ranged from 6.97±5.74 to 29.02±16.07 in the FLACS group and 7.59±6.42 to 35.69±18.30 in the CP group.The FLACS group was significantly lower for post-operative central corneal edema(P=0.05),cells and flare(P=0.01),and endothelial cell loss(P=0.04).Conclusions:Femtosecond laser-assisted cataract surgery and conventional phacoemulsification had similar refractive and visual outcomes.Phacoemulsification energy,anterior chamber inflammation and corneal endothelial cell loss were less in the femtosecond laser group.
文摘Keratoconus is a bilateral,non-inflammatory,degenerative corneal disease.The occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular astigmatism.With the disruption of the collagen organization,the cornea loses its shape and function resulting in progressive visual degradation.Currently,corneal topography is the most important tool for the diagnosis of keratoconus,which may lead to false negatives among the patient population in the subclinical phase.However,it is now hypothesised that biomechanical destabilisation of the cornea may take place ahead of the topographic evidence of keratoconus,hence possibly assisting with disease diagnosis and management.This article provides a review of the definition,diagnosis,and management strategies for keratoconus based on corneal biomechanics.
文摘Background:To compare the arithmetic mean(M-SIA)and the summated vector mean of surgically induced astigmatism(SVM-SIA)according to the incision site after phakic intraocular lens(Visian implantable collamer lens(ICL),STAAR Surgical)implantation.Methods:This study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision.The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer.The M-SIA and the SVM-SIA were determined according to the incision site.Results:The magnitude of corneal astigmatism significantly increased from 1.23±0.59 D preoperatively to 1.46±0.72 D postoperatively in the temporal incision group(Wilcoxon signed-rank test,P<0.001),but it significantly decreased from 1.09±0.36 D preoperatively to 0.86±0.41 D postoperatively in the superior incision group(P<0.001).The M-SIA was 0.48±0.30 D,and the SVM-SIA was 0.23±0.52 D at a meridian of 82°in the temporal incision group.The M-SIA was 0.57±0.30 D,and the SVM-SIA was 0.47±0.45 D at a meridian of 1°in the superior incision group.Conclusions:ICL implantation induces the M-SIA by approximately 0.5 D,but the SVM-SIA decreased to 50%and 80%of the M-SIA in magnitude through temporal and superior incisions,respectively.The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site.It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.
基金Grant by the Portuguese Foundation for Science and Technology, StrategicProject (UID/NEU/04539/2013) and COMPETE-FEDER (POCI-01-0145-FEDER007440)EJC was financially supported by the FCT Postdoctoral FellowshipSFRH/BPD/93672/2013, through European Union and National funds and cofunded by Human Capital Operating Program (Programa Operacional do Capital Humano, POCH)JM was financially supported by an unrestricted grantfrom Novartis.
文摘Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter.Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness(SFCT)and central retinal thickness(CRT).Anatomic(10%CRT decrease)and functional responses(best corrected visual acuity,BCVA gain≥5 letters)were assessed at 3 months and 6 months using univariate and multivariate analyses.Parameters tested were gender,duration of diabetes,HbA1c,hypertension,CRT,SFCT,BCVA,ellipsoid zone(EZ)status,subfoveal neuroretinal detachment(SND),anti-VEGF used and laser naivety.A logistic regression model was applied to find independent markers outcome.Results:BCVA increased,CRT and SFCT decreased at 3 months and 6 months.Good metabolic control(p=0.003),intact baseline EZ(p=0.030),EZ re-grading at 3 M(p<0.001)and laser naivety(p=0.001)were associated with better functional outcome.The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response,while lower baseline BCVA and intact EZ are predictors of functional response.Conclusion:The presence of SND predicts anatomic response only,while an intact EZ is critical to achieve a good functional outcome in DME.
文摘Background:The aim of the study is to raise the awareness of the influence of coma-like higher-order aberrations(HOAs)on power and orientation of refractive astigmatism(RA)and to explore how to account for that influence in the planning of topography-guided refractive surgery in eyes with coma-like-aberrations-dominant corneal optics.Methods:Eleven eyes with coma-like-aberrations-dominant corneal optics and with low lenticular astigmatism(LA)were selected for astigmatism analysis and for treatment simulations with topography-guided custom ablation.Vector analysis was used to evaluate the contribution of coma-like corneal HOAs to RA.Two different strategies were used for simulated treatments aiming to regularize irregular corneal optics:With both strategies correction of anterior corneal surface irregularities(corneal HOAs)were intended.Correction of total corneal astigmatism(TCA)and RA was intended as well with strategies 1 and 2,respectively.Results:Axis of discrepant astigmatism(RA minus TCA minus LA)correlated strongly with axis of coma.Vertical coma influenced RA by canceling the effect of the with-the-rule astigmatism and increasing the effect of the against-the-rule astigmatism.After simulated correction of anterior corneal HOAs along with TCA and RA(strategies 1 and 2),only a small amount of anterior corneal astigmatism(ACA)and no TCA remained after strategy 1,while considerable amount of ACA and TCA remained after strategy 2.Conclusions:Coma-like corneal aberrations seem to contribute a considerable astigmatic component to RA in eyes with coma-like-aberrations dominant corneal optics.If topography-guided ablation is programmed to correct the corneal HOAs and RA,the astigmatic component caused by the coma-like corneal HOAs will be treated twice and will result in induced astigmatism.Disregarding RA and treating TCA along with the corneal HOAs is recommended instead.
基金This study was supported by the Health Department of Zhejiang Province(Medical and health projects of Zhejiang 2018KY542).
文摘Background:It is unclear whether multifocal soft contact lenses(MFSCLs)affect visual quality when they are used for myopia control in juvenile myopes.The aim of this study was,therefore,to investigate the effect of MFSCLs on visual quality among juvenile myopia subjects.Methods:In a prospective,intervention study,thirty-three juvenile myopes were enrolled.Visual perception was assessed by a quality of vision(QoV)questionnaire with spectacles at baseline and after 1 month of MFSCL wear.At the one-month visit,the high(96%)contrast distance visual acuity(distance HCVA)and low(10%)contrast distance visual acuity(distance LCVA)were measured with single vision spectacle lenses,single vision soft contact lenses(SVSCLs)and MFSCLs in a random order.Wavefront aberrations were measured with SVSCLs,with MFSCLs,and without any correction.Results:Neither distance HCVA(p>0.05)nor distance LCVA(p>0.05)revealed any significant difference between MFSCLs,SVSCLs and single vision spectacle lenses.The overall score(the sum of ten symptoms)of the QoV questionnaire did not show a statistically significant difference between spectacles at baseline and after 1 month of MFSCL wear(p=0.357).The results showed that the frequency(p<0.001),severity(p=0.001)and bothersome degree(p=0.016)of halos were significantly worse when wearing MFSCLs than when wearing single vision spectacle lenses.In contrast,the bothersome degree caused by focusing difficulty(p=0.046)and the frequency of difficulty in judging distance or depth perception(p=0.046)were better when wearing MFSCLs than when wearing single vision spectacle lenses.Compared with the naked eye,MFSCLs increased the total aberrations(p<0.001),higher-order aberrations(p<0.001),trefoil(p=0.023),coma aberrations(p<0.001)and spherical aberrations(SA)(p<0.001).Compared with the SVSCLs,MFSCLs increased the total aberrations(p<0.001),higher-order aberrations(p<0.001),coma aberrations(p<0.001)and SA(p<0.001).The direction of SA was more positive(p<0.001)with the MFSCLs and more negative(p=0.001)with the SVSCLs compared with the naked eye.Conclusions:Wearing MFSCLs can provide satisfactory corrected visual acuity(both distance HCVA and distance LCVA).Although the lenses increased the aberrations,such as total aberrations and higher-order aberrations,there were few adverse effects on the distance HCVA,distance LCVA and visual perception after 1 month of MFSCL use.
文摘Erratum After publication of the original article[1]it was brought to our attention that author Jorge L.Aliówas incorrectly included as Jorge Luciano Alió.The correct name is included in the author list of this erratum and has been updated in the original article.
文摘Background:The Primary Eyecare Acute Referral Service(PEARS)and the Wales Eye Health Examination(WEHE)operate as enhanced optometry services for patients residing in Wales,enabling the examination of a patient presenting with an acute eye problem(PEARS)or the examination of patients at higher risk of eye disease(WEHE).The purpose of the study is to assess the demographics of patients accessing these services,referral patterns and clinical management in one Health Board in Wales(Aneurin Bevan University Health Board).Methods:Information from 2302 patients accessing the services was prospectively collected.The following information was obtained:type of examination(PEARS or WEHE),patient age,gender,self-referral or general practitioner(GP)referral and clinical management(no further action,monitor by optometrist or ophthalmic medical practitioner[OMP],refer to the Hospital Eye Service[HES],or refer to GP).Results:There were 1791(77.8%)PEARS examinations and 511(22.2%)WEHE.There were 1379(59.9%)females with a mean age of 58.61(±19.75)and 923(40.1%)males with a mean age of 56.11(±20.42).The majority of patients were self-referrals compared to GP-referrals(1793[77.9%]versus 509[22.1%]respectively).Sub-analysis indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only(297[58.1%]versus 214[41.9%]respectively)but greater numbers of self-referrals for the PEARS examinations only(1496[83.5%]versus 295[16.5%]respectively).For management,75%of patients were monitored by their optometrist or OMP,17%required referral to the HES and 8%required referral to their GP.Conclusions:Higher numbers of females accessed both PEARS and WEHE services and the majority of patients self-referred.These findings have important implications for public health campaigns both for targeting specific groups(e.g.male patients)and increasing awareness among GPs.
文摘Background:To investigate the topographic measurements and densitometry of corneas in Wilson's disease(WD)patients with or without a Kayser-Fleischer ring(KF-r)compared to healthy individuals.Methods:This cross-sectional study included 20 WD patients without a KF-r(group I),18 WD patients with a KF-r(groupⅠ),and 20 age-matched controls(group Ⅱ).The Pentacam high-resolution imaging system is used to determine corneal topographic measurements and densitometry.Results:Mean age for groups Ⅰ,Ⅱ and Ⅲ was 25.40±6.43 years(14-36 years),25.38±6.96 years(16-39 years),and 23.60±6.56 years(17-35 years),respectively(P=0.623).There was no significant difference between the groups in terms of the anterior corneal densitometry values(P>0.05),while the 6-10 mm and 10-12 mm midstroma and the 2-6 mm,6-10 mm,and 10-12 mm posterior corneal densitometry values in group Ⅱ were significantly higher than those in groups Ⅰ and Ⅱ(for all values,P<0.05).However,the 10-12 mm posterior corneal densitometry values in group Ⅰ were also significantly higher than those in group Ⅲ(P=0.038).The central corneal thickness(CCT),thinnest corneal thickness(tCT),and corneal volume(CV)values in groups Ⅰ and Ⅱ were significantly lower than those in group Ⅱ(for CCT values,P=0.011 and P=0.009;for tCT values,P=0.010 and P=0.005;for CV values,P=0.043 and P=0.029).Conclusion:In WD patients with a KF-r,corneal transparency decreased in the peripheral posterior and midstromal corneal layers;for these patients,corneal transparency may be impaired not only in the peripheral cornea but also in the paracentral cornea.
基金supported by the Technology Foun dation of Tianjin Municipal Health Bureau of China(Grant No.2014KY37)the Natural Science Foundation of the Tianjin Science and Technology Committee of China(Grant No.18JCZDJC36400).
文摘Background:To compare the accuracy of intraocular lens power calculation formulae after laser refractive surgery in myopic eyes.Methods:We searched the databases on PubMed,EMBASE,Web of Science and the Cochrane library to select relevant studies published between Jan 1st,2009 and Aug 11th,2019.Primary outcomes were the percentages of refractive prediction error within±0.5 D and±1.0 D.Results:The final meta-analysis included 16 studies using seven common methods(ASCRS average,Barrett True-K no history,Double-K SRK/T,Haigis-L,OCT formula,Shammas-PL,and Wang-Koch-Maloney).ASCRS average yielded significantly higher percentage of refractive prediction error within±0.5 D than Haigis-L,Shammas-PL and Wang,Koch-Maloney(P=0.009,0.01,0.008,respectively).Barrett True-K no history also yielded significantly higher percentage of refractive prediction error within±0.5 D than Shammas-PL and Wang-Koch-Maloney(P=0.01,P<0.0001,respectively),and a similar result was found when comparing OCT formula with Haigis-L and Shammas-PL(P=0.03,P=0.01,respectively).Conclusion:The ASCRS average or Barrett True-K no history should be used to calculate the intraocular lens power in eyes after myopic laser refractive surgery.The OCT formula if available,can also be a good alternative choice.
基金The work has been supported by NIH Center Grant P30 EY014801,NINDS 1R01NS111115–01(Wang)the Ed and Ethel Moor Alzheimer’s Disease Research Program(Florida Health,20A05,to Jiang)+3 种基金a grant from Research to Prevent Blindness(RPB)Visiting scholar activities(Haicheng Wei and Mingxia Xiao)were supported by the North Minzu University Scientific Research Projects(Major projects No.2019KJ37 and 2018XYZDX11)National Natural Science Foundation of China(No.61861001)Natural Science Foundation of Ningxia(No.2020AAC03220).
文摘Background:The goal was to characterize retinal vasculature by quantitative analysis of arteriole-to-venule(A/V)ratio and vessel density in fundus photos taken with the PanOptic iExaminer System.Methods:The PanOptic ophthalmoscope equipped with a smartphone was used to acquire fundus photos centered on the optic nerve head.Two fundus photos of a total of 19 eyes from 10 subjects were imaged.Retinal vessels were analyzed to obtain the A/V ratio.In addition,the vessel tree was extracted using deep learning U-NET,and vessel density was processed by the percentage of pixels within vessels over the entire image.Results:All images were successfully processed for the A/V ratio and vessel density.There was no significant difference of averaged A/V ratio between the first(0.77±0.09)and second(0.77±0.10)measurements(P=0.53).There was no significant difference of averaged vessel density(%)between the first(6.11±1.39)and second(6.12±1.40)measurements(P=0.85).Conclusions:Quantitative analysis of the retinal vasculature was feasible in fundus photos taken using the PanOptic ophthalmoscope.The device appears to provide sufficient image quality for analyzing A/V ratio and vessel density with the benefit of portability,easy data transferring,and low cost of the device,which could be used for pre-clinical screening of systemic,cerebral and ocular diseases.
文摘Background:The accommodation has considerable interactions with the pupil response,vergence response and binocularity.The transformation of visual reception processing and the changes of the binocular cooperation during the presbyopia development are still poorly studied.So,the regularities of visual system violation in the presbyopia formation need to be characterized.This study aims to reveal the transformation of visual reception processing and to determine the role of disturbances in binocular interactions in presbyopia formation.Methods:This study included 60 people with emmetropic refraction,uncorrected distance visual acuity 1.0 or higher(decimal scale),normal color perception,without concomitant ophthalmopathology.The first group consisted of 30 people(from 18 to 27 years old)without presbyopia,the second cohort comprised 30 patients(from 45 to 55 years old)with presbyopia.The eyeball anatomy and optics were evaluated using ultrasound biomicroscopy,aberrometry,and pupillometry.The functional state of the visual system was investigated under monocular and binocular conditions.The registration of the disparate fusional reflex limits was performed by the original technic using a diploptic device which facilitated investigation of the binocular interaction under natural conditions without the accommodation response,but with the different vergence load.The disparate fusional reflex was analyzed using the proximal and distal fusion borders,and the convergence and divergence fusion borders.The calculation of the area of binocularity field was performed in cm2.Results:The presbyopia formation is characterized by a change in an intraocular anatomy,optics,visual processing,and binocularity.The processes of binocular interaction inhibition make a significant contribution to the misalignment of the visual perception.The modification of the proximal,distal and convergence fusion borders was determined.It was revealed that 87%of the presbyopic patients had binocularity shortage,whereas the reduction of binocularity field area in extreme grade was seen in 6%of cases.Conclusions:The presbyopia formation is accompanied by a significant reorganization of the visual system activity and by the creation of the new visual processing interactions.These data may be useful in presbyopia surgery.
基金This study has been financed in part by the Network for Cooperative Research in Health“OFTARED”—Reference:RD16/0008/0012.Funded by Instituto de Salud Carlos III and co-funded by European Regional Development Fund(ERDF),Project“A way to make Europe”.
文摘BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer.MethodsThis study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group);(b) 19 Miniwell;(c) 24 LENTIS Mplus LS-313 MF30;(d) 33 LENTIS Mplus LS-313 MF15;(e) 17 AkkoLens Lumina;(f) 31 AT LISA Tri 839MP;(g) 20 Precizon Presbyopic;(h) 20 AcrySof IQ PanOptix;(i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer.ResultsAT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10;P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001).ConclusionsFar distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.
文摘Symptoms of dryness discomfort in soft contact lens wearers frequently lead to discontinuation from wear.The negative influence of pre-fitting tear dysfunctions appears likely to be exacerbated by the challenges to tear homeostasis caused by contact lenses.The corneal mechanisms for symptoms in contact lens wearers are different to those for dry eye disease because the cornea is insulated by the lens from ambient conditions as well as from lid wiper friction during blinking.Symptoms of dryness discomfort might be the consequence of increased lid wiper friction during blinking when the lens front surface becomes soiled and dry and exhibits very rapid tear break up.It is possible that some cases of contact lens intolerance and discontinuation could be a function of lid wiper neuropathy.In relation to the possibility of corneal neuropathy,a stagnant post-lens tear pool with the possibility of increased concentrations of metabolic by-products,cellular debris,and bacterial exotoxins,might have the potential to disturb the corneal epithelial and sub-basal nerves.Contributions by contact lens-induced inflammation to any neuropathic changes may partly depend on the degree to which inflammatory mediators are concentrated in a stagnant post-lens tear pool.It does not appear to be known if corneal neuropathic changes could develop under these conditions.The chances of neuropathic involvement may be greater if discomfort develops after a significant period of successful wear and there is a history of comorbid pain conditions.Esthesiometry and in vivo confocal microscopy in discontinued contact lens wearers may support a diagnosis of contact lens-related corneal neuralgia.
文摘Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throughout the 8-year follow-up.Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.
文摘Background:Type 2 Peters anomaly is a rare anterior segment disorder characterized by central corneal leukoma with keratolenticular adhesion and cataract.Performing cataract surgery without corneal tissue transplantation in patients of type 2 Peters anomaly is extremely rare and challenging.We present a case of type 2 Peters anomaly treated by peeling off the adhesion without penetrating keratoplasty(PKP),in which restoration of corneal transparency is observed.Case presentation:An 11-month-old female infant of type 2 Peters anomaly presented with bilateral corneal opacity with distinct demarcation,keratolenticular adhesion and cataract,which was first noted at the age of 3 months.By peeling off the adhesion from corneal endothelium combined with lensectomy and vitrectomy,there was a gradual reduction in corneal opacity and improvement in visual acuity after surgery over a 2-year period.Her visual acuity had improved from light perception preoperatively to 20/50 at the latest follow-up.No sight-threatening postoperative complications were noted.Conclusion:It is safe and effective to peel off the keratolenticular adhesion in patients of type 2 Peters anomaly presented with distinctly demarcated corneal opacity.
