Acuity In Patients Research Articles

Scleral Lens Use in the Management of Ocular Cicatricial Pemphigoid.

Symptom management in Ocular Cicatricial Pemphigoid (OCP) is challenging because of the progressive factors of dry eye, scarring, trichiasis, and vision impairment. We set out to evaluate the benefits and therapeutic effects of scleral contact lenses in the management of OCP. A retrospective review was performed over a database of 20 patients (36 eyes) fitted with scleral lenses (SL) at the Department of Ophthalmology, Emory University from May 2018 to April 2021. The fitting indications, time required for ocular surface stabilization, vision rehabilitation success, and ocular complications were evaluated. The mean age was 67.4 (range, 43-81) years, with four to one female to male predominance. The mean duration of the follow-up was 16.5 months (range, 1.5-35). The mean wearing time was 9.0±1.9 hr a day, with no overnight wear permitted. All fitted patients reported a subjective improvement in ocular comfort after initiations of SL wear. The mean keratopathy grading improved from 2.1±0.8 to 1.4±0.7 at the last documented visit. The mean visual acuity improved from 0.56±0.51 (logMAR) to 0.34±0.45; in 46% of patient eyes, visual acuity improved by two or more lines. And 96% of fitted eyes responded well to therapy and continued scleral lens wear. Patients who initially presented with fornix shortening, symblepharon, and trichiasis remained stable. SL offer ocular surface preservation, symptom relief, and improved visual acuity in patients with ocular pemphigoid. They should be strongly considered as ancillary therapy in patients with OCP.

Value of MRI-based radiomics models for predicting visual outcome in patients with MOG-optic neuritis: A preliminary study.

To investigate the predictive value of MRI-based radiomics models for the recovery of visual acuity after 12 months in patients with acute phase MOG-optic neuritis(MOG-ON). Clinical and MRI imaging data were collected consecutively from January 2021 to April 2022 from patients with acute stage MOG-ON, and the visual acuity of patients were followed up after 12 months. After stratified random sampling, patients were divided into training and test sets, and prediction models based on CE-T1WI, FS-T2WI, and combined CE-T1WI and FS-T2WI were developed. A total of 34 eyes were included, the visual acuity recovery group included 26 eyes, and the visual acuity non-recovery group included 8 eyes. The training set included 23 eyes (18 from the visual acuity recovery group and 5 from the visual acuity non-recovery group) and the test set included 11 eyes (8 from the visual acuity recovery group and 3 from the visual acuity non-recovery group). The differences in gender, age, proportion of patients with visual acuity recovery, and lesion length between the training and test sets were not statistically significant(P＜0.05). The CE-T1WI-based radiomics model had highest predictive efficacy for visual acuity recovery after 12 months in patients with MOG-ON (AUC = 0.917), followed by the combined CE-T1WI and FS-T2WI-based radiomics model (AUC = 0.838), while the FS-T2WI-based radiomics model had the worst predictive efficacy (AUC = 0.583). MRI-based radiomics models have high value in predicting visual acuity recovery after 12 months in patients with acute stage MOG-ON, especially CE-T1WI.

The Scottish Retinal Detachment Study: 10-year outcomes after retinal detachment repair.

To address the paucity of long-term data on outcomes following rhegmatogenous retinal detachment (RRD) repair we aimed to establish the 10-year best corrected visual acuity (BCVA), redetachment rate and lens status for patients from the Scottish Retinal Detachment Study. Data from patients who presented with RRD during the original study were collected from clinical records 10 years after repair. Patients were excluded if lacking 10 year follow-up data, and excluded from visual acuity analysis in the case of significant co-morbid ophthalmic disease. 103 patients had BCVA outcomes for at least 10 years post-operatively and met the inclusion criteria. 57 were macula-on and 46 were macula-off. Median10-year BCVA was 0.1 (IQR 0.3) logMAR (6/7.5). 10-year BCVA was significantly better in macula-on patients, compared to macula-off (-0.18 logMAR (p < 0.001)). There was a significant improvement in macula-off BCVA from short-term follow-up to 10-year BCVA (-0.26 logMAR, p = 0.04). 93% of macula-on patients achieved BCVA sufficient for UK driving standard compared to 65% of macula-off. There was no difference in 10-year BCVA between repair techniques. Thirty-four patients were phakic at follow-up, 65 pseudophakic, and 4 aphakic. Redetachment occurred in 14% and conferred a poorer 10-year BCVA (logMAR 0.3 IQR 0.78 (6/12)). Long-term BCVA remains excellent following successful macula-on RRD repair with almost all macula-on, and most macula-off patients achieving the UK visual acuity driving standard. We demonstrate that macula-on detachments have significantly greater long long-term visual acuity than macula-off detachments, and that re-detachment is uncommon but confers a poorer long term visual outcome. This study provides objective long-term data to guide patient and surgeon expectations following retinal detachment repair.

Scleral Tattooing Complications: Surgical Management of Granulomas in a Cosmetic Procedure.

To report the surgical management and outcomes of a patient with granulomatous inflammation following scleral tattooing, emphasizing the associated risks and clinical implications. A 26-year-old woman with a history of multiple body modifications, including scleral tattooing, presented with bilateral ocular pain and discomfort. Clinical examination revealed corneal dellen and subconjunctival granulomas. The patient underwent surgical excision of the granulomas, with efforts to preserve the black conjunctival pigmentation. Histopathological analysis was performed on the excised tissue. The patient's visual acuity and ocular condition were monitored for 12 months postoperatively. Preoperative best-corrected visual acuity was 20/50 in the right eye and 20/60 in the left. Surgical excision of the granulomas was successfully performed, resulting in symptomatic relief and preservation of the black scleral coloration. Histopathological analysis confirmed the presence of exogenous pigment without hemosiderin or melanin deposits. Twelve months after surgery, the patient maintained a best-corrected visual acuity of 20/20 in both eyes, with no recurrence of granulomas or additional complications. This case highlights the serious risks associated with scleral tattooing, including granulomatous reactions and corneal complications. Surgical intervention effectively addressed the ocular issues while preserving the desired cosmetic outcome. Greater public awareness and stronger regulations are critical to prevent such complications, and to prepare ophthalmologists for managing cases of scleral tattooing-related injuries.

Suprachoroidal injection of triamcinolone acetonide as adjuvant to surgical treatment of epiretinal membrane

BackgroundTo analyse the effect of suprachoroidal injection (SChI) of triamcinolone acetonide (TA) on macular thickness (CRT), ectopic inner foveal layer thickness (EIFL-T) and best corrected visual acuity (BCVA) in pseudophakic patients undergoing vitrectomy for epiretinal membrane (iERM) compared to intravitreal injection of TA (IVTA).MethodsProspective matched comparison of patients undergoing vitrectomy for Govetto stage 3 and 4 iERM. 25 eyes receiving IVTA (G-1) were compared to 23 eyes receiving SChI-TA (G-2) during vitrectomy. Primary outcome was change in BCVA, CRT, EIFL-T before surgery and 1, 3 and 6 months after surgery. Secondary outcome was the incidence of cystoid macular edema (CME).ResultsSix months after surgery, G2 had a greater mean reduction in CRT (−222 µm vs −131 µm) and EIFL-T (−200 µm vs −104 µm) than G1. BCVA improved more in G2 than in G1 (p = 0.02). Foveal depression reformed in 43% of cases in G-2 and 16% of cases in G-1. Incidence of postoperative CME was 16% in G-1 and 4.3% in G-2.ConclusionsDuring vitrectomy for iERM, SChI-TA was more effective than IVTA in reducing CRT and EIFL-T and improving BCVA. SChI-TA was effective in preventing postoperative CME. SChI-TA treatment was safe and reproducible and did not affect postoperative IOP.Trial registration NP6289—June 18th, 2024 (retrospectively registered).

Changes of retinal ganglion cell–inner plexiform layer thickness and visual acuity in patients with diabetic macular edema treated with Aflibercept

Background Anti-vascular endothelial growth factor agents have now become the first line of treatment for diabetic macular edema (DME). Changes in the thickness of the individual retinal layers including the ganglion cell–inner plexiform layer (GC–IPL) might serve as a biomarker for the response to treatment. Aim The aim of this study was to evaluate the effect of intravitreal injections of Aflibercept on the average thicknesses of the GC–IPL in naïve eyes and on the visual acuity in patients with DME. Patients and methods This is a retrospective observational study that included 224 naïve eyes of 224 patients having DME. It compared the changes in the GC–IPL thickness at baseline and after receiving three loading doses of Aflibercept followed by as needed protocol for 12 months. All patients had optical coherence tomography imaging at baseline (with GC–IPL thickness measurement) and at the 12-month visit. The change in GC–IPL thickness was measured and was correlated with best-corrected visual acuity. Results During the study duration, a median of five injections of Aflibercept were given. There was a statistically significant decrease in the posttreatment values of the GC–IPL thickness from 89±13 to 84±14.7 µm (P=0.029). Moreover, a statistically significant association was found between the thickness reduction of the GC–IPL in the central macular area and the best-corrected visual acuity (r=0.9, P=0.005, Pearson coefficient=0.26). Conclusion The results of this study suggest that the reduction in the GC–IPL thickness can be used as a prognostic tool for the response to Aflibercept as it was associated with improved visual acuity.

AI and myopia detection and control

Myopia is a major and growing health problem, particularly prevalent in Southeast Asian children. Therefore, it is crucial to design and implement screening strategies and provide timely and appropriate treatment. Early and accurate diagnosis is especially important for children, and the emergence of new AI tools holds promise for the diagnosis and treatment of myopia.Recent advances in AI applications for myopia can be summarized as follows:1. Myopia risk predictionIt is now possible to categorize children into high‐risk groups based on their risk profiles. This categorization helps identify progression patterns, which is crucial for developing suitable treatment plans. Predicting future visual outcomes enables clinicians to identify and monitor patients at risk of vision loss in advance. Researchers have developed models to predict visual acuity in patients with high myopia and evaluate children at risk of developing high myopia. An international consortium has also developed a myopia risk calculator to improve the diagnosis and management of myopia. AI models have been utilized to predict visual acuity in patients with myopic choroidal neovascularization.2. Screening, Early Detection, and Risk StratificationAI can analyze retinal images and other ocular data to detect myopic changes. Early identification of individuals at high risk allows for targeted interventions and preventive measures. Researchers have developed an AI tool to evaluate children at risk of developing high myopia. AI‐based models have been used for diagnosing and monitoring myopia without the need for cycloplegic drops during eye examinations. Deep‐learning‐based diagnostic tools have also been employed for the detection of pathological myopia. Moreover, AI‐based formulas have shown higher accuracy in calculating intraocular lens power in highly myopic eyes. The CHARM project, involving over 100,000 Chinese individuals with high myopia, aims to utilize AI in the diagnosis and treatment of myopia. Detection and classification of high myopia, pathologic myopia, and myopia‐related complications were the main application of AI in adults with myopia.3. Pathogenesis InsightsAI can help uncover complex interactions and patterns associated with myopia development by analyzing large datasets.4. Treatment OptimizationPersonalized recommendations based on individual characteristics and disease progression can enhance treatment outcomes, made possible by predictive models. Nova AI Lenses have recently been utilized for improved management of refractive errors based on each individual's unique visual preferences.5. Telemedicine IntegrationIntegrating AI into telemedicine platforms will be a new direction in myopia management, facilitating remote consultations, monitoring, and personalized care. Additionally, AI algorithms can be explored for analyzing photos taken with regular cameras, such as smartphones.6. Behavioral InterventionAI‐powered wearable devices can assist in behavioral interventions, such as monitoring screen time, outdoor activities, and other lifestyle factors.In conclusion, the role of AI in myopia management will continue to evolve, benefiting patients through early detection, personalized treatment, and improved visual outcomes. However, challenges remain in implementing these technologies into clinical practice.

Uncertainty-aware regression model to predict post-operative visual acuity in patients with macular holes

Full-thickness macular holes are a relatively common and visually disabling condition with a prevalence of approximately 0.5% in the over-40-year-old age group. If left untreated, the hole typically enlarges, reducing visual acuity (VA) below the definition of blindness in the eye affected. They are now routinely treated with surgery, which can close the hole and improve vision in most cases. The extent of improvement, however, is variable and dependent on the size of the hole and other features which can be discerned in spectral-domain optical coherence tomography imaging, which is now routinely available in eye clinics globally. Artificial intelligence (AI) models have been developed to enable surgical decision-making and have achieved relatively high predictive performance. However, their black-box behaviour is opaque to users and uncertainty associated with their predictions is not typically stated, leading to a lack of trust among clinicians and patients. In this paper, we describe an uncertainty-aware regression model (U-ARM) for predicting VA for people undergoing macular hole surgery using preoperative spectral-domain optical coherence tomography images, achieving an MAE of 6.07, RMSE of 9.11 and R2 of 0.47 in internal tests, and an MAE of 6.49, RMSE of 9.49, and R2 of 0.42 in external tests. In addition to predicting VA following surgery, U-ARM displays its associated uncertainty, a p-value of ¡0.005 in internal and external tests, showing the predictions are not due to random chance. We then qualitatively evaluated the performance of U-ARM. Lastly, we demonstrate out-of-sample data performance, generalising well to data outside the training distribution, low-quality images, and unseen instances not encountered during training. The results show that U-ARM outperforms commonly used methods in terms of prediction and reliability. U-ARM is thus a promising approach for clinical settings and can improve the reliability of AI models in predicting VA.

Predictive factors of final visual outcome in patients with leber hereditary optic neuropathy treated with lenadogene nolparvovec gene therapy

Aims/Purpose: To identify the predictive factors of final best‐corrected visual acuity (BCVA) in patients with Leber hereditary optic neuropathy (LHON) due to the m.11778G &gt; A MT‐ND4 mutation who received lenadogene nolparvovec gene therapy in clinical studies.Methods: The following covariates were studied to identify those that might influence final BCVA: age, gender, timing of treatment, baseline BCVA value and baseline optical coherence tomography (OCT) parameters. Univariate analyses were performed from three phase 3 studies (RESCUE, REVERSE and REFLECT), using BCVA at 1.5 years post‐treatment as the dependent variable. In RESCUE and REVERSE, ND4‐LHON patients received an injection of gene therapy in one eye and a sham injection in the other. In REFLECT, the first‐affected eye received gene therapy, while the other eye was randomly injected with gene therapy or placebo.Results: In 290 untreated/treated eyes, the covariates statistically significantly associated with an improvement in final BCVA were a longer time from vision loss to treatment (p &lt; 0.05), and thicker optical coherence tomography (OCT) parameters at baseline: ganglion cell layer (GCL) temporal outer segment, GCL superior outer segment, GCL nasal outer segment, and GCL inferior outer segment at ETDRS analysis, and retinal nerve fiber layer (RNFL) inferior quadrant, RNFL nasal quadrant and RNFL superior quadrant (p &lt; 0.05). The greatest effects [95% confidence interval] were observed for the thickness of the inferior and superior outer GCL segments at baseline (‐0.1 [‐0.163; ‐0.037] and ‐0.09 [‐0.146; ‐0.033], respectively; both p = 0.002). A worse baseline BCVA was associated with a worse final BCVA (p &lt; 0.0001).Conclusions: Timing of treatment administration, baseline BCVA value and baseline thickness of OCT parameters are predictive of the BCVA 1.5 years after treatment in patients with MT‐ND4 LHON who received lenadogene nolparvovec.

Clinical characteristics of post‐refractive surgery corneal ectasia

Aims/Purpose: The aim of this study was to explore the clinical characteristics, visual acuity (VA), and topographic patterns in patients who developed corneal ectasia (CE) following myopic laser vision correction (LVC).Methods: We conducted a retrospective review of medical records for patients diagnosed with CE after laser vision correction between 2009 and 2023 at a tertiary hospital in Korea. We collected various data, including patient demographics, medical history, the type of refractive surgery and postoperative periods., VA at their initial and final visits, refractive errors, and topographic biometric data.Results: In total, 36 eyes of 28 patients (13 females and 15 males) were included, and 8 (28.5%) cases were bilaterally involved. The most common type of surgery was LASIK (24 patients, 85.7%), while the remaining patients underwent LASEK (3 patients, 10.7%) or PRK (1 patient, 3.6%). In unilaterally involved eyes (20 eyes), VA, spherical equivalent (SE), and astigmatism of CE‐affected eyes were significantly different from those of eyes with uninvolved eyes (all p &lt; 0.001). In eyes with over 12 months of follow‐up observation (12 eyes of 9 patients), no significant progression was noted in VA (p = 0.392), SE (p = 0.675), astigmatism (p = 0.737), and topographic parameters.Conclusions: CE can develop even after comprehensive preoperative screening following LVC. This condition can significantly impact patients' quality of life by substantially reducing VA. Moreover, considering the spectrum of diseases that keratoconus represents, there is a possibility that CE may cease to progress after a certain age. Further investigations are required to understand the progression of CE concerning age in affected patients.

Correction of astigmatism with OKVision® FUSION NEW toric soft contact lenses: Fitting algorithm

Uncorrected astigmatism is one of the most common causes of reduced visual acuity in the world population. The optical system of the eye, in which the presence of clinically significant astigmatism (more than 1.0 D) is detected, is quite common. In the absence of adequate correction or inadequate diagnosis, astigmatism significantly reduces the uncorrected visual acuity of patients, which affects their quality of life. Eyeglass and contact vision correction are the most common methods of non-surgical correction of ametropia. However, according to the data of foreign and Russian studies of the contact astigmatism correction market, the share of toric lenses fitting is only a small part among all prescriptions.This article is devoted to detailing of the fitting algorithm of new toric soft contact lenses manufactured by OKVision® Fusion NEW Toric and aims to help optometrists to fit this type of lenses more confidently, which in turn will help users to obtain full- fledged vision correction.

Intravitreal therapy for the management of diabetic retinopathy: A concise review.

Diabetic retinopathy (DR) is a serious microvascular complication of diabetes mellitus and may result in irreversible visual loss. Laser treatment has been the gold standard treatment for diabetic macular edema and proliferative diabetic retinopathy for many years. Of late, intravitreal therapy has emerged as a cornerstone in the management of DR. Among the diverse pharmacotherapeutic options, anti-vascular endothelial growth factor agents have demonstrated remarkable efficacy by attenuating neovascularization and reducing macular edema, thus preserving visual acuity in DR patients.

The Impact of the Foveal Bulge on Visual Acuity in Resolved Diabetic Macular Edema and Retinal Vein Occlusions.

The purpose of this study is to evaluate the impact of foveal bulge presence on visual acuity (VA) in patients with diabetic macular edema (DME) and retinal vein occlusion (RVO). Spectral-domain optical coherence tomography (SD-OCT) scans were conducted on 22 DME patients and 20 RVO patients. Ordinary least squares (OLS) regression was employed to analyze the association between VA and the presence of the foveal bulge, as well as factors such as sex, age, central foveal thickness, various line scans of the fovea, and the external limiting membrane (ELM). In DME patients, the β value associated with foveal bulge presence was 10.2, while the β value for ELM presence was 36.19. For RVO patients, the β value for foveal bulge presence was 18.71. In the combined analysis of DME and RVO patients, VA increased by 14.24 letters with the presence of a foveal bulge. The presence of a foveal bulge significantly enhances VA in patients with resolved DME and RVO. Our findings indicate that the increase in VA is more pronounced in RVO patients compared to those with DME. Additionally, the presence of the foveal bulge, ELM, and sex can serve as predictors for VA outcomes in these patient populations.

Utilizing Lactation Acuity to Improve Lactation Services in a U.S. Hospital.

National staffing guidelines for hospital lactation services do not account for the lactation acuity of breastfeeding patients. Higher acuity breastfeeding couplets require a higher level of knowledge and skill from lactation care providers. In these cases, a referral to an International Board Certified Lactation Consultant (IBCLC) is recommended for appropriate management. Use of a lactation acuity classification system as a clinical practice innovation was implemented at Oklahoma University Medical Center to improve the distribution of staff resources for optimal care of breastfeeding patients. Lactation service reports from this facility, a tertiary care teaching hospital, were reviewed to evaluate staffing, number of lactation consults, reason for and acuity of consults, and time spent. The review included over 10,000 lactation consults completed over a 1-year period. Once the lactation acuity system for IBCLC staff was in place, there was an increased mean direct consult time and acuity level with 85% of IBCLC time allocated to high acuity consults. Trained bedside nurses handled most low-acuity patients. The percentage of patients needing a lactation consult who received one increased along with the number of consults per patient. Data on time spent per consult were stratified by acuity, location, and reason for consult, including details on priority consults for neonatal intensive care unit patients. The productivity of the lactation team was higher with the use of a lactation acuity system compared to without it. The data reported support the use of lactation acuity in making recommendations for staffing of hospital lactation services.

Parasellar region meningiomas with optic canal (OC) invasion: Correlation between the degree of decompression of the OC and the improvement of visual acuity.

To evaluate the correlation between the degrees of circumferential decompression of the optic canal (OC) and the improvement of visual acuity in patients with parasellar meningiomas (PMs) with optic canal invasion. This is a monocentric retrospective study conducted at author's institution. The visual acuity was evaluated preoperative and at 3-months after surgery with Snellen acuity test. The degree of decompression of the OC was calculated through postoperative multiplanar CT-scan reconstructions in coronal plane at intraorbital opening (IOO), intracranial opening (ICO) and middle point between them (MP). OC was then divided in two segments (anterior and posterior). 29 consecutive patients were identified. Improvement of visual acuity was observed in 18 patients (62 %). Mean decompression achieved at ICO, MP and IOO was 226.2°± 43.6° (range: 68.7°-297.1°), 217.5°± 37.2° (range: 75.3°-268.7°) and 204.6°± 41.2° (range: 67.3°-252.6°) respectively. A decompression > 90° of the anterior segment of the OC, a decompression > 180° of the posterior segment and a full-length decompression > 90° were associated visual acuity improvement at univariate analysis (p = 0.010, p = 0.002 and p < 0.001, respectively). A decompression > 180° of the posterior segment and a full-length decompression > 90° of the OC maintained statistical significance at multivariate analysis (p = 0.030 and p = 0.035, respectively). Anterior segment decompression > 90° and posterior segment decompression > 180° were associated with improvement of visual acuity at 3 months after surgery. A full-length decompression of the optic canal > 90° showed better visual outcome, while a full-length decompression > 180° did not seem to be related to significative improvements in visual acuity.

Good Initial Visual Acuity in Patients with Macular Edema due to Retinal Vein Occlusion - Management and Outcomes.

The approach to managing patients with retinal vein occlusion (RVO) and cystoid macular edema (CME) with good initial visual acuity (VA) better than 6/12 has not been investigated. This study aimed to evaluate functional and anatomical outcomes of intravitreal treatment and observation in patients with CME due to RVO, who presented with good initial VA. Methods: Multicenter retrospective cohort study. Seventy-nine eyes of 79 patients with CME secondary to RVO and initial VA better than 6/12, either treated with anti-VEGF therapy or observed. Clinical parameters and OCT measures were recorded. Main Outcome Measure: Proportion of patients losing ≥1 line of VA at 12 months. Secondary outcomes: Visual and anatomical results at 12 and 24 months, and correlation between number of injections and VA outcomes. Fifty-three percent of patients maintained VA at month 12. VA of 6/6 - 6/7.5 was maintained in 59% and 57% at 12 and 24 months, respectively. At 24 months, the number of anti-VEGF injections was strongly correlated with VA among patients with BRVO and CRVO. This study marks the first exploration of patients with RVO and initial VA better than 6/12, indicating that most patients sustained good VA, and anti-VEGF treatment maintained and improved VA.

Enhancing Predicted Visual Acuity After SmartSight Lenticule Extraction: Identifying Key Factors With Machine Learning.

To develop a predictive model aimed at assessing the likelihood of improvement in corrected distance visual acuity (CDVA) for patients undergoing lenticule extraction using the SmartSight system from SCHWIND eye-tech-solutions. This model evaluates the effectiveness and weight of various clinical and procedural parameters in predicting enhancements in visual acuity. Data from 1,262 eyes treated with the SmartSight system, encompassing 86 features, were analyzed. Regression and classification techniques were employed to estimate the probability of CDVA gain, ensuring robust results by comparing different methods. The dataset was divided into training (70%, 883 treatments) and testing (30%, 379 treatments) subsets to ensure comprehensive model evaluation using machine learning methods. Feature significance was determined via analysis of variance and principal components analysis to identify impactful parameters. Three principal components accounting for more than 70% of the data variance were identified. The first component was primarily linked to system settings, whereas the second and third components were associated with patient gender and laterality. Factors significantly influencing CDVA improvement included a higher spot-to-track distance ratio, tighter track distance, lower pulse energy, lower average laser power, larger spot distance, greater cap thickness, and lower dosage. These variables were ranked based on their impact on CDVA enhancement. Using low-energy asymmetric spacing for lenticule extraction with the SmartSight system is safe and effective. This approach improves visual outcomes for patients undergoing treatment for myopic astigmatism, offering a reliable method for predicting CDVA improvements. [J Refract Surg. 2024;40(12):e974-e984.].

Relationship between genotype, phenotype, and refractive status in patients of inherited retinal degeneration.

To elucidate the relationship between inherited retinal disease, visual acuity and refractive error development in Asian patients. Five hundred phakic eyes with refractive data were analysed in this retrospective cohort. Diseases were categorized by clinical phenotypes, and the prevalent genotypes identified in the Taiwan Inherited Retinal Degeneration Project were analysed. Consecutive surveys in Taiwan have provided the rates of myopia in the general population. No differences were observed among the disease phenotypes with respect to myopia (P = 0.098) and high myopia rates (P = 0.037). The comparison of refractive error between retinitis pigmentosa and diseases mainly affecting the central retina showed no difference, and the refraction analyses in diseases of different onset ages yielded no significance. Moreover, there was no difference in the myopia rate between the diseases and general population. Among the genotypes, a higher spherical equivalent was seen in RPGR and PROM1-related patients and emmetropic trends were observed in patients with CRB1 and PRPF31 mutations. Furthermore, significantly poorer visual acuity was found in ABCA4, CRB1 and PROM1-related patients, and more preserved visual acuity was seen in patients with EYS, USH2A, and RDH12 mutations. No significant differences were observed in visual acuity, refractive state and myopia rate between patients with inherited retinal disease and the general population, and different subtypes of inherited retinal disease shared similar refractive state, except for higher cylindrical dioptres found in patients with Leber's congenital amaurosis. The heterogeneity of disease-causing genes in Asian patients may lead to variable refractive state.

Impact of Lipid Parameters on Visual Acuity Change in Non-Arteritic Anterior Ischemic Optic Neuropathy.

To assess the potential influence of serum biochemical factors, specifically lipid profile parameters, on visual outcomes in patients with non-arteritic anterior ischemic optic neuropathy (NAION). All patients diagnosed with NAION at Rajavithi Hospital between 1 January 2011 and 31 December 2020 were retrospectively reviewed. The primary outcome was defined as visual recovery, measured by an improvement of at least 0.2 logarithm of the minimal angle of resolution (logMAR) in their best-corrected visual acuity (BCVA) at the 12-weeks follow-up visit compared to the initial visit and determine whether those lipid profiles parameters are predictive of 12weeks-visual outcomes. Factors of an initial poor VA were evaluated using logistic regression analysis. In this study, 84 patients with NAION were included to assess the impact of lipid parameters on visual outcomes. Majority of participants were male. The group with initial VA worse than 20/200had significantly higher mean age of 58.3±7.6 years and levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL) (all p < 0.05 respectively). Throughout 12weeks, a significant difference in change of BCVA between the two groups of initial VA was observed (p<0.001). Regarding lipid parameters on visual prognosis, lipid profile between the two groups of VA improvement of 0.2 logMAR was comparable different. The probability of VA improvement showed a weak association with TC levels. A gradual increase in probability slightly related to LDL parameter, while TG showed an inverse relationship. At elevated lipid levels, there was a greater degree of uncertainty in predicting visual outcomes. While older age and elevated lipid levels, specifically TC, TGs, and LDL, were correlated with poorer initial visual acuity in NAION patients, no significant associations were identified between lipid parameters and long-term visual recovery. Early detection for individuals with dyslipidemia (DLP) and advanced age merit attention.

Referral Time for Diabetic Retinopathy Screening and Impact on the Visual Acuity of Patients in a Tertiary Hospital

OBJECTIVE: To evaluate the referral time for the screening of diabetic retinopathy (DR) from the initial diagnosis of diabetes to retinal examination. We also compared visual results among groups screened at various duration of referral time.METHODS: This cross-sectional study was conducted retrospectively from medical records for the poorer-seeing eyes of 100 patients with type 2 diabetes from January 2021 to December 2022 at the tertiary eye center. Patients were classified based on the time duration from the initial diagnosis of diabetes to retinal examination or imaging. Visual acuity (VA) and DR stages categorized by the period of referral time were compared among each group.RESULTS: Seventy-five patients (75%) took &gt; 2 months from the first diagnosis of diabetes to DR screening performed by an ophthalmologist. Twenty-three patients (23%) were diagnosed with DR at the first ophthalmic visit; among these, 16 had a referral time of &gt; 2 months. Twelve patients were diagnosed with vision-threatening DR; six of these had diabetic macular edema. The receiver operating characteristic (ROC) curve analysis indicates that patients receiving ophthalmic examination within 91 days from the diagnosis of diabetes likely maintain a best-corrected VA of ≥ 20/50. This recommended period of referral time yielded an area under the ROC curve, sensitivity, and specificity of 70.63%, 61.90%, and 83.33%, respectively.CONCLUSION: In clinical practice, a prolonged period for the first DR screening is relatively common and may result in more patients with vision-threatening DR. Proactive and systematic work should be undertaken to create patient awareness on the importance of detection of asymptomatic and early-stage DR to prevent irreversible visual loss.