Comprehensive Eye Exam Research Articles

Effect of prisms on visual acuity, contrast sensitivity and nystagmus in patients with albinism.

To investigate the effect of using base-out prisms on nystagmus, visual acuity and contrast sensitivity in patients with albinism. In this interventional study, patients with albinism who had nystagmus were enrolled. A comprehensive eye exam was conducted, which included refraction, assessment of far and near vision acuity, and contrast sensitivity measurements. To check for the nystagmus, a videonystagmography was used. The tests were carried out in three modes: without any correction, with optical correction, and with correction using base-out prisms in three different powers, including 4, 6, and 8 prism diopters. Totally 23 patients with average age of 28.65±12.13 were examined. It was found that the use of optical correction and optical correction with prisms resulted in a statistically significant improvement in both far (at least: P<0.006) and near visual acuity (at least: P<0.001 except for prism 8; P<0.02). In addition, contrast sensitivity significantly improved at all low and medium frequencies except for correction with prism 8 in frequency 1.5 (at least: P<0.01 except for prism 4, frequency 6; P=0.04). no significant improvement was observed in the evaluation of nystagmus characteristics. Optical correction with a prism can improve visual acuity and some spatial frequencies, but failed to improve nystagmus parameters.

Cardiovascular Risk Factors as Independent Predictors of Diabetic Retinopathy in Type II Diabetes Mellitus: The Development of a Predictive Model.

Background: Diabetic retinopathy (DR) is a leading cause of blindness in patients with type 2 diabetes mellitus (T2DM). Cardiovascular risk factors, such as hypertension, obesity, and dyslipidemia, may play a crucial role in the development and progression of DR, though the evidence remains mixed. This study aimed to assess cardiovascular risk factors as independent predictors of DR and to develop a predictive model for DR progression in T2DM patients. Methods: A retrospective cross-sectional study was conducted on 377 patients with T2DM who underwent a comprehensive eye exam. Clinical data, including blood pressure, lipid profile, BMI, and smoking status, were collected. DR staging was determined through fundus photography and classified as No DR, Non-Proliferative DR (NPDR), and Mild, Moderate, Severe, or Proliferative DR (PDR). A Multivariate Logistic Regression was used to evaluate the association between cardiovascular risk factors and DR presence. Several machine learning models, including Random Forest, XGBoost, and Support Vector Machines, were applied to assess the predictive value of cardiovascular risk factors and identify key predictors. Model performance was evaluated using accuracy, precision, recall, and ROC-AUC. Results: The prevalence of DR in the cohort was 41.6%, with 34.5% having NPDR and 7.1% having PDR. A multivariate analysis identified systolic blood pressure (SBP), LDL cholesterol, and body mass index (BMI) as independent predictors of DR progression (p < 0.05). The Random Forest model showed a moderate predictive ability, with an AUC of 0.62 for distinguishing between the presence and absence of DR XGBoost showing a better performance, featuring a ROC-AUC of 0.68, while SBP, HDL cholesterol, and BMI were consistently identified as the most important predictors across models. After tuning, the XGBoost model showed a notable improvement, with an ROC-AUC of 0.72. Conclusions: Cardiovascular risk factors, particularly BP and BMI, play a significant role in the progression of DR in patients with T2DM. The predictive models, especially XGBoost, showed moderate accuracy in identifying DR stages, suggesting that integrating these risk factors into clinical practice may improve early detection and intervention strategies for DR.

Comprehensive Teleoptometry Exams in Canada: A Proposed Clinical Framework

Purpose: Many high-income countries like Canada are faced with unmet needs regarding the availability of access to eye care, especially in rural, remote, or northern areas. Teleoptometry has the potential to improve access to primary eye care and help prevent, detect, diagnose and treat uncorrected refractive error and sight-threatening eye diseases. Given the rapid adoption of technology for virtual care during the COVID pandemic, the existing teleoptometry guidelines in Canada are limited in scope and may lead to uncertainty for optometrists practicing remote care. The purpose of this paper is to build a scaffold that highlights the similarities and differences between an in-person comprehensive eye examination and one that is delivered through comprehensive teleoptometry in Canada. This proposed clinical framework draws from both the existing published literature and the clinical experience of the authors. This paper discusses issues for teleoptometry including patient consent, efficiency, delegation, training and the patient pathway including referral protocols when indicated. Results: Comprehensive teleoptometry eye exams are very similar to in-person eye exams, but they depend more on the assistance of an in-person technician/optometric assistant. The exams include delegated tests performed by an optometric assistant and tests controlled remotely by the optometrist like refraction. However, other tests that require clinical judgment to execute or interpret should be performed by the optometric assistant under the direct supervision of the remote optometrist using live video. The remote optometristbe able to repeat any test during videoconferencing. Conclusion: Teleoptometry is a tool optometrists can use to reach patients that struggle to access an in-person eye exam. This evidence-informed, draft framework provides a point of reference for discussion by the Federation of Optometric Regulatory Authorities of Canada and the provincial regulatory authorities to protect the public and increase access through the delivery of remote primary eye care in Canada.

Body mass index, diet, and outdoor activity linked with meibomian gland abnormalities in children.

Dry eye disease is frequently underdiagnosed in pediatric patients. Meibomian gland morphology abnormalities (atrophy and tortuosity) may be associated with dry eye. This study examined risk factors for gland morphology abnormalities in children. This study aimed to characterize meibomian gland morphological abnormalities (atrophy and tortuosity) and identify risk factors for the same in children. A total of 160 children, primarily African American and Hispanic, aged 5 to <18 years underwent a comprehensive eye exam including slit-lamp examination to evaluate the meibomian glands, conjunctival papillae, and tear film. Infrared photography was performed including assessment of noninvasive tear film breakup time and tear meniscus height. Meibomian gland atrophy and tortuosity were assessed. A modified Ocular Surface Disease Index survey was administered along with surveys on screen time, diet, and outdoor activity. Linear multiple regression was performed to determine risk factors for meibomian gland abnormalities. The average age of participants (76 male, 84 female) was 10.9 ± 3.0 years. Severe meibomian gland atrophy (score ≥2) was found in 31.0% of participants in at least one eyelid. Severe meibomian gland tortuosity (score ≥2) was found in 84.0% of participants in at least one eyelid. The median symptom score was 9.8 (range, 0 to 71), with 16.9, 8.8, and 12.5% of the children having mild, moderate, and severe dry eye symptoms, respectively. Elevated body mass index (p<0.001), reduced outdoor activity (p=0.02), and unhealthy diet (p=0.01) were found to be risk factors for meibomian gland abnormalities. Screen time, symptom score, age, gender, and race/ethnicity were not associated with gland abnormalities (all p values >0.05). This study determined that meibomian gland morphological abnormalities were commonly found in children aged 5 to <18 years. Risk factors for these abnormalities include elevated body mass index, an unhealthy diet, and reduced outdoor activity.

LONGITUDINAL ADAPTIVE OPTICS SCANNING LASER OPHTHALMOSCOPY REVEALS REGIONAL VARIATION IN CONE AND ROD PHOTORECEPTOR LOSS IN STARGARDT DISEASE.

To investigate the temporal sequence of changes in the photoreceptor cell mosaic in patients with Stargardt disease type 1, using adaptive optics scanning laser ophthalmoscopy. Two brothers with genetically confirmed Stargardt disease type 1 underwent comprehensive eye exams, spectral-domain optical coherence tomography, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy imaging 3 times over the course of 28 months. Confocal images of the cones and rods were obtained from the central fovea to 10° inferiorly. Photoreceptors were counted in sampling windows at 100- µ m intervals of 200 µ m × 200 µ m for cones and 50 µ m × 50 µ m for rods, using custom cell marking software with manual correction. Photoreceptor density and spacing were measured and compared across imaging sessions using one-way analysis of variance. Adaptive optics scanning laser ophthalmoscopy revealed the younger brother had a 30% decline in foveal cone density after 8 months, followed by complete loss of foveal cones at 28 months; the older brother had no detectable foveal cones at baseline. In the peripheral macula, cone and rod spacings were greater than normal in both patients. The ratio of the cone spacing to rod spacing was greater than normal across all eccentricities, with a greater divergence closer to the foveal center. Cone cell loss may be an early pathogenetic step in Stargardt disease. Adaptive optics scanning laser ophthalmoscopy provides the capability to track individual photoreceptor changes longitudinally in Stargardt disease.

Contextual Factors Influencing Screening for Diabetic Eye Disease in Alabama: Provider Perspectives.

Introduction/Objectives: Comprehensive eye exams are recommended at least every 2 years for people with diabetes for early identification and treatment of diabetic eye disease, but screening rates remain suboptimal. Our objective was to qualitatively assess barriers and facilitators to completing recommended eye exam screening for patients with diabetes among providers and practice staff. Methods: As part of a larger initiative, we conducted discussion groups with healthcare providers and practice staff to evaluate factors related to referral and screening for diabetic eye disease at 2 sites, a safety-net healthcare system and a specialty clinic. Discussions were audio-recorded and transcribed. Combined inductive, deductive thematic content analysis was conducted, applying the Practical Robust Implementation and Sustainability Model to organize themes and subthemes. Results: Two discussion groups with 28 participants were conducted in August 2023. Themes included existing processes for referrals, scheduling, and tracking; patient-level determinants including transportation and financial barriers and other competing demands to receiving recommended eye screening; clinic or system-related factors, and considerations for process improvement for eye exam referrals and appointments. Conclusions: These findings can be applied to determine the most effective strategies to improve the rates of recommended eye exam referral and screening rates in people with diabetes.

Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions

IntroductionThe study's purpose is to assess the prevalence of comprehensive eye examinations (CEE) in multi-ethnic preschool children, including children with visually significant eye conditions, and identify factors associated with CEE. MethodsA sample of 9,197 African American (AA), Hispanic (HS), Asian American (AS), and non-Hispanic White (NHW) 6- to 72-month-old children was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003-2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of CEE. The proportion of children with previous CEE and the proportion with undetected amblyopia or strabismus were measured. ResultsCEE prevalence was 6.3% overall, and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior CEE were more likely to have undetected amblyopia or strabismus than those with CEE history (Ps<0.001). CEE prevalence was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of NHW, AS, AA, and HS children having had prior CEE, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all associated with a relatively higher CEE prevalence in multivariable analyses (P≤0.003 for all). ConclusionsCEE was uncommon among preschool children, including those with treatable vision disorders. Interventions, like parent education and vision insurance, are needed to improve CEE access and utilization for at-risk preschool children.

Newborn and infant vision screening in primary care: A clinical review.

Newborn and infant vision screening is an essential component of the health promotion visit, where the provider screens for ocular risk factors and abnormalities that may cause future impairment or vision loss. Providers may underestimate the importance of screening or find neonatal vision assessments difficult due to poor patient cooperation or time-consuming exams, but the reversibility of vision impairment in infants makes early detection paramount to proper treatment. This article provides a clinical review of evidence-based, practical guidance to providers who care for infants from birth through 6 months of age in the primary care setting. The comprehensive eye exam in infants should include a thorough history and physical examination of eye structures, visual acuity, evaluation of extraocular movements and alignment, and assessment of the red reflex. Recommended exam maneuvers differ with age as visual acuity improves and development advances through infancy. Early detection of ocular pathology is critical to avoid permanent vision loss, serious morbidity, and even mortality. The seemingly complex vision screening exam can be completed with little to no cooperation from the patient when a competent pediatric healthcare provider prioritizes opportunistic exam maneuvers. The opportunistic exam allows providers to maximize efficiency while maintaining thorough technique during vision exams and screenings.

Comprehensive Primary Eye Care: A Comparison Between an In-Person Eye Exam and a Tele-Eye Care Exam.

Proper access to primary eye care is essential in addressing vision impairment, and tele-eye care examinations are a promising solution that could facilitate this access in many rural or remote areas. Even though remote eye exams are becoming increasingly frequent, comprehensive tele-eye care exams are still limited by the lack of published data. The aim of this study is to compare a comprehensive tele-eye care exam with a gold standard in-person primary eye care exam with an emphasis on refractive measurements, ocular health assessment, confidence level of the eye care providers and patient satisfaction. Sixty-six participants underwent two comprehensive eye exams performed by two eye care providers. One was a gold standard in-person exam, while the other was a remote exam performed by an eye care provider through videoconference. An overall patient satisfaction survey and a questionnaire for visual comfort with a trial frame from each modality were completed and the eye care providers scored their confidence level for each test. Exam results and diagnoses were compared between both modalities. Tele-refraction has a good to excellent agreement with in-person subjective refraction in terms of sphero-cylindrical power and best corrected visual acuity. There was no statistically significant difference for visual comfort between both modalities. The agreement between in-person and remote exams for ocular health assessment ranged from fair to almost perfect, but there was a low prevalence of ocular pathologies within the study sample. The confidence level of the eye care providers and patient satisfaction were statistically higher in-person. Tele-eye care appears to be statistically and clinically non-inferior to in-person eye exams, especially for refraction, but the low prevalence of ocular pathologies somewhat limits the comparison of its efficacy for ocular health assessment. More studies on comprehensive tele-eye care exams are needed.

Prevention of Ocular Toxicity Using Protective Contact Lenses in Multiple Myeloma Patients Receiving Belantamab Mafodotin, Pomalidomide and Dexamethasone: A Sub-Study of the Cmrg-007 Trial

Background: Belantamab mafodotin (belamaf) is a monomethyl auristatin-F containing antibody drug conjugate that targets BMCA on myeloma cells. Single agent belamaf has shown clinical meaningful activity in relapsed/refractory multiple myeloma (RRMM) but ocular adverse events (AEs) affect 53-72% of trials'participants. In DREAMM-2, prophylactic corticosteroid eye drops did not effectively reduce the risk of keratopathy. It is therefore imperative that strategies to mitigate corneal AEs be explored. This 2-part study is designed to evaluate belamaf and pomalidomide/dexamethasone (Pd) in RRMM. Here we report the efficacy and ocular AEs of patients (pts) receiving 2.5 mg/kg (maximum tolerated dose) or 1.92 mg/kg IV belamaf and administrated on various schedules aimed to define the optimal balance of efficacy and tolerability. We also present results of an ocular sub-study exploring the use of bandage contact lens (BCLs) to reduce the risk and severity of belamaf-associated ocular AEs. Methods: Eligibility: &amp;gt; 1 prior lines of therapy (LoT), lenalidomide, proteasome inhibitors exposed, and refractory to the last LoT. Pd was administered per standard of care and belamaf (1.92 or 2.5 mg/kg) Q4W or 2.5 mg/kg Q8W, Q12W or SPLIT equally on days 1 and 8, Q4W. Pts enrolled on the ocular sub-study received the recommended part two dose (RP2D): 2.5 mg /kg Q8W. A BCL (Bausch and Lomb Pure Vision) was placed in the right (R) eye for the 1st 2 doses of belamaf with the left (L) eye serving as control. Subsequently, BCLs were placed in both eyes. Pts wore BCLs for up to 28 days after each belamaf dose. Evaluation by an eyecare specialist for a comprehensive eye exam and BCL placement occurred every 15-28 days during BCLs use and prior to each belamaf dose. Corneal findings were graded (Gr) by the keratopathy and visual acuity (KVA) scale and findings of local infection were reported. Keratitis prophylaxis during BCLs use included gatifloxacin 0.3% or tobramycin 1.3% eye drops. Results: This analysis comprises 92 pts including 14 on the ocular sub-study. Baseline best corrected visual acuity (BCVA) and ocular comorbidities were similar across all cohorts: with median 20/20 BCVA 46.7% R and 50% L eye. Abnormal fundoscopy was 21.7% in R and 16.3% in L eye. There was a trend to lower incidence and less severity of ocular AEs for the 1.92 mg/kg dose (Table 1). Gr 3-4 keratopathy, decrease in BCVA and subjective Gr &amp;gt;2 blurred vision by CTCAE were 33.3% (4/12), 41.7% (5/12) and 25% (3/12) for the 1.92 mg/kg and 75% (9/12), 75% (9/12) and 33.3% (4/12) for 2.5 mg/kg Q4W cohorts. Preliminary data indicated superior clinical efficacy (ORR, &amp;gt;VGPR rate and mPFS) for the 2.5 mg/kg dose, 100% (12/12), 91.7% (11/12) and 25.1 months (11.8-NYR) versus 66.7% (8/12), 63.6% (7/12) and 16.9 months (5.3-19.7) for the 1.92 mg/kg dose (Table 2). To preserve efficacy but reduce ocular AEs additional cohorts exploring 2.5 mg/kg dosed every 8 and 12 weeks were included. Extended dosing schedules showed lower rates of Gr 3-4 keratopathy, decrease in BCVA, and Gr ≥2 blurred vision: 58.3% (7/12), 91.7% (11/12) and 16.7% (2/12) of pts treated Q8W; and 58.3%, 58.3% and 16.7% (2/12) of pts treated Q12W versus the Q4W schedule. Importantly, the efficacy was preserved with ORRs of 91.7% (11/12) and 100% (11/11), &amp;gt;VGPR rates of 83.3% (10/12) and 63.6% (7/11) and mPFS of 18.3 months (95% CI: 10.1-NYR) and 22.5 (95% CI: 8.9-NYR) for Q8W and Q12W groups, respectively. In the ocular sub-study, assessment of R and L eye during the first 2 belamaf doses showed a significant delay in onset of BCVA decrease in the R eye (p&amp;lt;0.0001) compared to the L. Comparing pts treated at the RP2D, moderate to severe (Gr ≥2) keratopathy and decrease BCVA were significantly lower (p=0.0004 and 0.010), in the BCL cohort versus no-BCL group. Further there was a trend towards less symptomatic blurred vision (p=0.256). BCL pts were able to complete 90% of the pre-planned belamaf cycles compared to 70% in the RP2D no-BCL group (p=0.029). No cases of infectious keratitis were reported in the BCL cohort. Conclusions: Our data suggest that extended dosing intervals may be a significant step forward in mitigating corneal AEs of belamaf. This preliminary report on the efficacy of BCLs in 14 pts demonstrates a decrease in moderate to severe corneal AEs and reduction in dose holds for corneal AEs, noting however a short follow up at this time. The data support the further evaluation of BCLs in preventing belamaf associated ocular toxicities.

The effect of action and casual video games on visual reaction time and accommodation in non-gamers

Aim: To understand the effect of video games on non-gamers’ visual reaction time (VRT) and Accommodation. Methodology: A cross sectional study was conducted to evaluate the effect of video games on VRT and Accommodation in non-gamers. Subjects between the age of 18-28 years with BCVA 0.0 LogMAR; 0.63M were enrolled in this study. A written consent was obtained. Subjects having binocular vision anomalies, systemic diseases, learning disabilities, and dry eyes were excluded from the study. All subjects underwent a comprehensive eye exam. In addition, VRT and Accommodation were measured pre and post exposure to video games. VRT was assessed with PEBL (Psychology Experiment Building Language) and WAM open field autorefractor was used to measure Accommodation. Result: 17 subjects (15 females and 2 males) participated in the study with the mean age of 21 ± 1.70 years. In the action video game group, mean VRT decreased significantly from 362.56±31.68ms to 348.75±31.35ms post video game exposure (p&lt;0.05). The mean VRT in casual video game group pre video game exposure was 358±29.56ms and post was 353.89±26.8ms (p&gt;0.05). The accommodative response exhibits a significant change, with pre-exposure mean of -0.98D and post exposure mean of -1.20D (p&lt;0.05). Conclusion: Action video games were found to enhance VRT significantly, making them a potential tool for activities requiring rapid reactions. While casual video games also improved VRT, the changes were not statistically significant. Moreover, both types of video games had a significant impact on accommodative responses, which could be clinically relevant for individuals with accommodation related issues.

The impact of having a free community eye clinic located inside a homeless shelter: a retrospective analysis of patient demographics

Worsening vision is a life-altering process that affects individuals in many aspects of daily life. While worsening vision can be caused by normal physiological processes that occur with age, there can be underlying systemic or ocular diseases that may be the root cause. Routine eye exams can screen for disease as well determine the degree of vision correction required to attain acceptable vision. Access to an eye exam ordinarily requires vision insurance and one must consider the added expense of glasses if they are recommended. While this can be a life-improving visit for many, there are several socioeconomic barriers that discourage homeless and low-income individuals from being able to access this service. The lack of resources to access regular eye exams and the resulting inadequate eye care may lead to underdiagnosis of serious ocular pathology. The Kansas City Free Eye Clinic is located inside a homeless shelter and, therefore, provides a convenient location for homeless and low-income individuals to receive comprehensive eye exams as well as prescription glasses at no cost. In this paper, we discuss the unique setup and demographics of this student-run eye clinic and the ways in which it has served the Kansas City population and how its integration into a homeless shelter could serve as a role model for free community eye clinics.

Low utility of ocular screening in sarcoidosis in Finland.

Systematic ocular screening is recommended in sarcoidosis, because of a high rate of ocular involvement. The purpose of this study was to determine whether ocular screening is useful in sarcoidosis in a Finnish university hospital population with 0.5 M inhabitants. Patient charts of patients with sarcoidosis, without a history of ocular sarcoidosis, without ocular inflammatory symptoms, and with a comprehensive eye exam from January 2014 to January 2021 at Tays Eye Centre, Tampere, Finland, were studied. Five of 262 patients (2%) were diagnosed with asymptomatic uveitis. No other types of ocular sarcoidosis were found. Anterior uveitis without complications was present in three patients, unilaterally in two and bilaterally in one patient. Posterior uveitis was present in two patients, a unilateral choroidal granuloma requiring treatment in one and bilateral punched-out chorioretinal lesions in the other patient. With this low rate of ocular involvement requiring treatment in sarcoidosis, systematic screening for asymptomatic ocular sarcoidosis does not seem useful in a Finnish population. In Tays Eye Centre, systematic screening of ocular sarcoidosis was discontinued in 2021.

Acute Retinal Necrosis: Experience in a Reference Center in Santander – Colombia

ABSTRACT Introduction Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. Objective We present an ARN case series showcasing treatment experience and results. Methodology Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. Results Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. Conclusions Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. Abbreviations ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.

Effect of Moringa Olifera Leaves on Intraocular Pressure and Blood Pressure

Moringa exhibits many antioxidant, antihypertensive, and anticancer effects. A significant source of therapeutic medicines for reducing ocular and systemic hypertension is herbal remedies. Objectives: To assess the impact of moringa on blood pressure and intraocular pressure and to evaluate various moringa doses that affect IOP and BP. Methods: Quasi Experimental study was conducted at MTH, Faisalabad from September 2022 to April 2023. Sampling technique was non-probability purposive sampling. Emmetropes, age 20-35 years, IOP range 11-22 mmHg, BP 120/80 mmHg was included. After comprehensive eye exam, 60 subjects were divided into two groups. IOP and BP were evaluated before and after intake at 30, 60, 90, and 120 minutes. Data were analyzed with SPSS software. Repeated Measure ANOVA was used for statistical analysis. Results: Out of 60 subjects, mean age was 22.5 ± 1.31. Baseline IOP in group 1 was 19.40 ± 3.19 and BP 113.67 ± 9.27/81.00 ± 8.03 while in group 2 IOP 19.42 ± 4.11 and BP 116.33 ± 10.08/83.17 ± 8.75. There was significant Change in IOP at 90minutes and BP at 60minutes. IOP was 18.54 ± 3.19 and 17.56 ± 4.25 in group 1, 2 respectively. BP was 101.33 ± 7.76/72.67 ± 8.97 and 101.50 ± 9.92/72.50 ± 8.68 in both groups respectively. There were significant Changes as compared to 30, 60, 120minutes. IOP and BP return to its baseline at 120 minutes. Conclusions: Moringa Oleifera has significant effect on lowering IOP and BP. Effect of dose on the reduction rate was directly proportional to the amount of dose administered.

Pediatric Eye Care Treatment Rates and Community Compliance to a Spectacle Provision Program in an Underserved School District in San Diego, CA.

The need for early identification and treatment of young children's refractive error needs has become a public health concern. The UCSD Eyemobile for Children (EyeMobile) provides vision screenings and comprehensive eye exams on the Eyemobile among a population of underserved, predominantly Hispanic preschool and elementary school children. The program also provides spectacles for children who fail eye exams due to refractive error. We performed a retrospective cross-sectional analysis of all children screened from 2011 to 2017 by the Eyemobile across 10 San Diego elementary schools. We examined demographics, distance and near visual acuity, autorefraction, stereopsis, and color vision. To measure compliance to our spectacle program, we checked if children who were prescribed spectacles were wearing them, as instructed, at the following year's screening. Differences between compliance measures with respect to school, age, ethnicity, and gender were determined using chi-square analysis, while all other measures were fit to a binary logistic regression to determine statistically significant factors. A total of 12,176 elementary school children were screened between 2011 and 2017. Of these children, 5269 (43.3%) were referred for a comprehensive eye examination. Across six years, 3163 (60.0%) of the children referred completed their eye examinations. There was a significant increase (p < 0.001) in exam completion in the successive years. Exam completion was significantly higher in ten-year-olds (p = 0.0278) and in 3 of the 10 schools (p < 0.0001, p = 0.0027, and p = 0.0309). A total of 1089 (8.9% of screened) children were prescribed spectacles. Of the 409 children that were recorded with the compliance method, 342 (83.6%) were found to be fully compliant and wearing their spectacles as prescribed. The Eyemobile program demonstrated high levels of compliance for both eye examination completion and prescribed spectacle wear in underserved populations in the San Diego region, compared to similar national programs.

The Relationship Between Eye Diseases and Toxic Thyroid Gland: A Concentrated Study

Background: When the thyroid gland becomes overactive or underactive, a variety of health issues may occur, including eye illnesses. Thyroxine (T4) and triiodothyronine (T3) are the two primary hormones produced by the thyroid gland. These hormones are essential for maintaining of proper eye function. When the thyroid gland is hyperactive, it can cause a variety of eye disorders for example Graves' ophthalmopathy. Aim: To explore the potential link between eye disorders and toxic thyroid glands, specifically how hyperthyroidism (an overactive thyroid gland) may contribute to the development of eye conditions like Graves' ophthalmopathy. . The ultimate goal is to enhance patient outcomes through better knowledge and management of these complicated illnesses. Patients and Methods: The second survey questionnaire was completed by 100 patients with thyroid disorders. Several approaches are available to assess the link between ocular problems and toxic thyroid glands. Among these methods are Thyroid Function Tests and a Comprehensive Eye Exam: Thyroid function tests include measuring the plasma levels of TSH, T3, and T4 levels to see if there is an underlying thyroid gland dysfunction which may produce abnormalities in the eyes. Results: The study included 100 patients, with 81% of them being women. Individual ocular problems are more common in male than in female patients. Exophthalmos was reported by about 70% of the men (the most frequently). Patients also frequently reported redness of the eyes (68%), edema or swelling of the eyelids (67%), and ocular dryness (61%). They were less likely to have a hazy vision, but about one-third did. Conclusion: Hyperthyroidism and Graves' disease can lead to eye problems such as bulging eyes, double vision, dry eyes, and sensitivity to light. It is important to have regular eye exams and seek medical attention if any changes occur.

Standard Amblyopia Therapy in Adults with Longstanding Amblyopia Improves Visual Acuity and Contrast Sensitivity.

Perceptual learning or dichoptic training may result in improved acuity in adult amblyopes. However, for amblyopic children (<18 years), most clinicians recommend standard part-time patching. The purpose of this study was to determine if standard amblyopia therapy results in an enhancement in vision in the amblyopic eye of adults. Fifteen amblyopes (20/30 or worse) were recruited and nine (age (SD) 32.9 (16.31)) with anisometropia or anisometropia and strabismus (ie, combined mechanism amblyopia) completed the study. Previous therapy did not exclude subjects. The subjects received a comprehensive eye exam and wore their best correction for at least four weeks prior to baseline testing. The non-amblyopic eye was patched for 2 hours per day (Amblyopia iNET training for 30 minutes and near/distance activities for 1.5 hours). The subjects had a baseline amblyopia evaluation followed by one visit per week for 12 weeks. At 12 weeks, the treatment was tapered off over one month and the subjects had a final amblyopia evaluation at 24 weeks. Contrast sensitivity was measured at baseline and 12 weeks with the Quick CSF system. The subjects had a significant improvement in visual acuity across the weeks (p < 0.001). At baseline, weeks 12 and 24, the average logMAR acuities (SE) were 0.55 (0.09), 0.41 (0.08), and 0.38 (0.09), respectively. Weeks 4 to 24 were significantly different (p < 0.001) from baseline. The average acuity improvement over the 24 weeks was 1.7 logMAR lines. There was a significant increase in the area under the log contrast sensitivity function (p = 0.002) and its estimated acuity (p = 0.036) from baseline to 12 weeks. Standard amblyopia treatment can result in an improvement in visual acuity and contrast sensitivity in adults with longstanding anisometropic or combined mechanism amblyopia even if they had prior therapy.

Diabetic retinopathy screenings in West Virginia: an assessment of teleophthalmology implementation

BackgroundThe prevalence of diabetes in the state of West Virginia (WV) is amongst the highest in the United States, making diabetic retinopathy (DR) and diabetic macular edema (DME) a major epidemiological concern within the state. Several challenges exist regarding access to eye care specialists for DR screening in this rural population. A statewide teleophthalmology program has been implemented. We analyzed real-world data acquired via these systems to explore the concordance between image findings and subsequent comprehensive eye exams and explore the impact of age on image gradeability and patient distance from the West Virginia University (WVU) Eye Institute on follow-up.MethodsNonmydriatic fundus images of diabetic eyes acquired at primary care clinics throughout WV were reviewed by retina specialists at the WVU Eye Institute. Analysis included the concordance between image interpretations and dilated examination findings, hemoglobin A1c (HbA1c) levels and DR presence, image gradeability and patient age, and distance from the WVU Eye Institute and follow-up compliance.ResultsFrom the 5,512 fundus images attempted, we found that 4,267 (77.41%) were deemed gradable. Out of the 289 patients whose image results suggested DR, 152 patients (52.6%) followed up with comprehensive eye exams—finding 101 of these patients to truly have DR/DME and allowing us to determine a positive predictive value of 66.4%. Patients within the HbA1c range of 9.1-14.0% demonstrated significantly greater prevalence of DR/DME (p < 0.01). We also found a statistically significant decrease in image gradeability with increased age. When considering distance from the WVU Eye Institute, it was found that patients who resided within 25 miles demonstrated significantly greater compliance to follow-up (60% versus 43%, p < 0.01).ConclusionsThe statewide implementation of a telemedicine program intended to tackle the growing burden of DR in WV appears to successfully bring concerning patient cases to the forefront of provider attention. Teleophthalmology addresses the unique rural challenges of WV, but there is suboptimal compliance to essential follow-up with comprehensive eye exams. Obstacles remain to be addressed if these systems are to effectively improve outcomes in DR/DME patients and diabetic patients at risk of developing these sight-threatening pathologies.

Choroidal Melanoma in an Asymptomatic Patient

Introduction Choroidal melanoma is considered the most common intraocular malignancy found in adults and typically presents without symptoms in the early stages. They are frequently first seen on routine dilated fundoscopic exams and appear as a pigmented or nonpigmented choroidal lesion. Case Presentation A 58-year-old Caucasian female presented for a comprehensive eye exam with a chief complaint of gradual distance blur in both eyes. On funduscopic examination of the right eye, a suspicious faint, variably pigmented large choroidal lesion was noted adjacent to the optic nerve. The patient was referred to a retinal oncologist for further workup and management. Management and Outcome The retinal oncologist performed multiple imaging tests including B-scan ultrasound, OCT, and Fundus Autofluorescence which revealed a choroidal mass with subretinal fluid, and presence of lipofuscin confirming a diagnosis of a small choroidal melanoma. Systemic workup did not reveal any metastasis of the choroidal lesion. The patient was initially treated surgically with plaque radiotherapy; however, the patient developed ocular complications ultimately leading to enucleation of the right eye. Consequently, the patient was fitted with an ocular prosthesis. Discussion Choroidal melanomas are the most common intraocular malignancy found in adults and encompass 80% of all uveal melanomas. Patients with choroidal melanoma are typically asymptomatic and are commonly first seen on routine dilated fundoscopic exams. Metastasis of choroidal melanomas are rare but can occur in 1-2% of all cases mainly to the liver, bone, and lung. A 50% mortality rate in a 10-year span has been noted for metastasized choroidal melanomas. Ancillary imaging modalities such as Optical coherence tomography, Fundus Autofluorescence, and B-scan ultrasound are useful in aiding in the diagnosis. Treatment and management are modified based on the characteristics of the tumor and patient, which can include brachytherapy, external beam radiotherapy, stereotactic radiotherapy, transpupillary thermotherapy, and enucleation. Timely detection and treatment are key in managing this sight and life-threatening illness CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/choroidal-melanoma-in-an-asymptomatic-patient) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.