Difference In Visual Acuity Research Articles

The Frequency of Occurrence of Strabismus in Infants Post Lensectomy.

Purpose To identify and characterize incident cases of strabismus and interocular visual acuity among infants post lensectomy for congenital cataract. Method This was a single-centre retrospective chart review of all children aged less than 12 months who underwent lensectomy from 1st January 2014 to 1st January 2021. Cases were identified from theatre coding and electronic medical records. Cases with strabismus prior to cataract surgery were excluded. Results Seventy-five children (114 aphakic eyes) were included, 36 (48%) had unilateral cataract surgery while 39 (52%) had bilateral. The mean age at the time of cataract surgery was 3.0±2.5 months (range 1 - 10 months). The mean follow-up period was 41.2±22.8 months (range 2 -72 months). Nineteen out of 75 patients (25%) developed strabismus, most of whom (18 cases) had unilateral surgery. Out of the 19 strabismus cases recorded, esotropia was reported in 74% of the cases, followed by exotropia -16%, while esotropia associated with dissociated vertical deviation (DVD) and esotropia associated with inferior oblique each made up 5% of the population. Most children who developed strabismus [17 patients (89.5%)] had lensectomy prior to 6 months of age. A significant difference of 0.65 logMAR was recorded in the interocular visual acuity (IOVA) difference between the strabismic and non-strabismic groups, and the unilateral and bilateral lensectomy groups. Conclusion Strabismus, most commonly esotropia, is common after congenital lensectomy, particularly in those children who underwent unilateral cataract surgery, and in those less than 6 months of age.Monitoring IOVA and strabismus incidence post-cataract surgery is crucial for early intervention and amblyopia prevention.

Exploring retinal vessel density alterations in prolactinoma patients: Insights from OCTA imaging.

To investigate microvascular changes in the macular and peripapillary area in prolactinoma patients by using optical coherence tomography angiography (OCTA). A retrospective study. This study included 40 patients with treatment-naive prolactinoma and 42 healthy controls. Participants underwent comprehensive ophthalmic examinations, visual field testing, and optical coherence tomography (OCT) assessments, including retinal nerve fiber layer (RNFL) thickness, macular, and peripapillary region OCTA by using the Topcon DRI OCT Triton Swept Source-OCT system. The OCTA results were evaluated between groups and then correlated with PRL levels. The differences in best-corrected visual acuities were statistically significant among the groups. The RNFL thickness in the superior and nasal quadrants was significantly lower in the prolactinoma group. The prolactinoma group showed significant reductions in macular vessel density (VD) across all layers than the control group, except in the deep retinal capillary plexus temporal quadrants. The radial peripapillary capillary (RPC) temporal VD in the prolactinoma group was significantly lower. In patients with optic neuropathy, correlations were observed between the RPC temporal and RNFL temporal sectors (r = 0.650, P = 0.03), and between the RPC inferior and RNFL inferior sectors (r = -0.612, P = 0.045). Between PRL levels and OCTA parameters, negative correlations were observed (RPC inferior: r = -0.452, P = 0.003; DCP superior: r = -0.379, P = 0.016). Our study revealed reduced VD in the macula and RPC temporal regions in patients with treatment-naive prolactinoma. OCTA holds significant importance in detecting potential retinopathies and vasculopathies. Future research should focus on examining pre- and post-treatment changes in treatment-naive patients without ON to better understand the impact of prolactinoma.

Randomised controlled trial of HOYA One-day Multifocal Contact Lenses: – the HOMCL trial

Trial designDouble-masked crossover RCT (Research Registry: #8136) comparison of a new HOYA one-day disposable multifocal contact lens (HOMCL) with Alcon DAILIES TOTAL1® Multifocal (ADT1). MethodsSixty presbyopic participants from three countries attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way. ResultsThere were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line), better low contrast distance visual acuity with ADT1; faster Wilkins rate of reading test with HOMCL; no significant differences in near visual acuity, wearing time, or number of lenses during fitting process. Exploratory analyses were better handling scores with ADT1; and some, but not all of the dry eye data indicating better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred/performed better with each lens type. ConclusionsThe differences between the performance of the two products were small. There was a trend in some clinical measurements and the daily diary data and VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

Subclinical variability in visual function modulates visual dependence - independent of age

AbstractParadoxically visual dependence is reported to increase with age, contributing to falls risk, whereas visual function typically declines. This study assesses the relationship between age, objective and subjective measures of visual function and visual dependence, in healthy young and older adults. Forty-four healthy Young (YA; n = 32; 18 males, aged 26.2 ± 5.3 yrs.) and Older (OA; n = 12; 3 males, aged 62.4 ± 6.7 yrs.) adults were assessed for objective (visual acuity, contrast sensitivity, depth perception, and lower peripheral vision), and subjective visual function (VFQ-25) along with motion sickness susceptibility. Subjective Visual Vertical (SVV) and induced nausea and vection were assessed using the Rod and Disc Test (RDT). Groups were compared using Mann-Whitney U, whilst determinants of SVV variability were evaluated using Multiple regression modelling. Visual acuity (p &lt; 0.01) and contrast sensitivity (p = 0.04) were lower in OA. Visual dependence (SVV tilt errors) was not associated with ageing (p = 0.46). YA experienced greater RDT-induced vection (p = 0.03). Visual acuity and contrast sensitivity accounted for modest proportions of variance in SVV tilt errors (VA; R2 = 0.14, F(1,42) = 8.00, p &lt; 0.01; β = 6.37) and (CS; R2 = 0.06, F(1,42) = 3.93, p = 0.05; β = −4.97), respectively. Our findings suggest that subclinical differences in visual acuity and contrast sensitivity contribute to SVV tilt error variability, among both healthy young and older adults. Further studies are needed to define the inter-relationship between age-related visual function, non-visual factors (including vestibular and somatosensory fidelity, activity levels, fear of falling and cognitive function) and visual dependence.

Clinical Evaluation of Violet Light Filtration and High-Resolution Lathing on a Diffractive Extended Depth of Focus IOL.

This study is a prospective, randomized, subject/evaluator-masked clinical trial in a single-center clinical setting. The purpose of the study is to compare the clinical performance of Tecnis Symfony Optiblue IOL (models ZXR00V and ZXW150) with violet light filter (VLF) and manufacturing improvements versus Tecnis Symfony IOL (models ZXR00 and ZXT150) with ultraviolet light filter (UVF) in patients undergoing cataract surgery. Patients with cataracts aged ≥ 22years were randomly assigned 1:1 to bilateral implantation with ZXR00V/ZXW150 (VLF group) or ZXR00/ZXT150 (UVF group). Key endpoints at 6months postoperative included patient reported nighttime dysphotopsia symptoms, 25% low contrast visual acuity with glare, and patient satisfaction. Sixty patients were implanted with ZXR00V/ZXW150 (30) or ZXR00/ZXT150 (30). At 6months, the VLF group did not show a statistically significant differences in mean monocular photopic uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA) (40cm), or distance-corrected near visual acuity (DCNVA) (40cm) compared to the UVF group. At 1month, patients in the VLF group reported significantly less difficulty due to halo (p = 0.016) and starburst (p = 0.028) symptoms. By the 6months, dysphotopsia complaints were no longer significantly different between the groups. Although the VLF group trended toward better low contrast visual acuity and patient satisfaction, statistical significance was not reached. Managing the patients' expectations is key to achieving success. At the 1-month visit the patients who reported dysphotopsia complaints in the VLF group had significantly less difficulty with starbursts and halos as compared to the UVF group. By the 6-month visit, there was no significant difference between the two groups in the difficulty with starbursts and halos. ClinicalTrials.gov identifier, NCT06567834.

The Effect of Glucagon-like-Peptide-1 Receptor Agonists on Diabetic Retinopathy Progression, Central Subfield Thickness, and Response to Intravitreal Injections.

Objectives: To examine the effects of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) on diabetic retinopathy (DR) progression, visual acuity (VA), central subfield thickness (CST), and response to intravitreal injections (IVIs) in the Hadassah ophthalmological cohort. Methods: Of 4500 Hadassah patients with DR, 146 had a documented first course of GLP1-RA treatment lasting at least a year along with ophthalmological follow-up. Of these, 35 underwent at least two optical coherence tomography (OCT) exams with a one-year interval. These 35 GLP1-RA-naïve patients were compared to a control group of 31 patients with DR who did not receive GLP1-RA treatment. We compared demographics, medical records, ocular data, and OCT characteristics between the two study groups. Results: At baseline, patients who received GLP1-RA treatment had a significantly higher prevalence of retinal detachment and vitreous hemorrhage, as well as a higher (though not statistically significant) prevalence of cardiovascular comorbidities compared to the control group. At the end of the follow-up period, the GLP1-RA group had a higher prevalence of DR progression compared to controls (3/19 vs. 0/20, respectively; p = 0.106, Fisher's exact test), but also showed a better response to IVIs (27/35 vs. 17/31, respectively; unadjusted OR: 2.78, p = 0.058; 95% CI: [0.963, 8.020], Pearson's chi-square test). However, vitreous hemorrhage and hyperreflective retinal foci were confounding factors (adjusted IVI response OR: 1.76, p = 0.229, 95% CI: [0.553, 5.650], logistic regression). No significant differences were observed between the two groups in terms of change in visual acuity (-0.135 vs. -0.063 logMAR, respectively; p = 0.664, Student's t-test) or CST (-13.49 vs. -30.13 μm; p = 0.464, Student's t-test). Conclusions: This study presents preliminary findings showing no significant differences in DR progression, visual acuity, and CST between patients treated with GLP1-RA and control patients. Moreover, GLP1-RA therapy was not significantly associated with improved IVI response, with ocular parameters acting as confounding factors.

Virtual Follow-Up after Cataract Surgery: A Systematic Review.

To examine the association between virtual postoperative follow-up care and patient outcomes after cataract surgery. Cataract surgery is a safe and commonly performed surgery. Follow-up visits are used to monitor for complications. It is uncertain whether virtual follow-up provides a safe alternative to in-person review. Medline, Embase and CINAHL were searched from inception to October 2023 for relevant articles containing original data. Studies that: 1) included patients that were seen in a virtual follow-up (i.e., telephone or video call) for postoperative appointments after cataract surgery, and 2) reported patient outcomes were included. Risk of bias was assessed using the Newcastle-Ottawa and ROB2 assessment tools. Descriptive statistics were used to summarize findings. The review was registered in PROSPERO (registration number, CRD42023477207) and PRISMA guidelines were followed. The search yielded 1710 records with seven studies included in this review. The seven studies reported on 2113 cataract surgeries in 1994 patients. The studies ranged between 2004 and 2020. Most of the studies (5/7) included only patients with uncomplicated cataract surgery. Virtual follow-ups were all conducted by telephone. The follow-up calls were made at varying timepoints including postoperative day 1 (n= 3), day 7 (n=2) and day 14 (n=1). Two observational studies directly compared patients who had a telephone follow-up to a control group who had an in-person follow-up. There were no significant differences in complication rates (p=0.22) or visual acuity (p=0.28) between these follow-up groups. None of the studies reported serious adverse outcomes from replacing in-person follow-up with telephone follow-up. One study used virtual follow-up in conjunction with in-person visits for elderly patients and found that additional telephone follow-up was associated with decreased surgical recovery time and decreased patient anxiety. Three studies reported on patient perceptions about telephone follow-up. A common theme was that patients preferred telephone reviews and found them to be more convenient than in-person follow-up. For patients with uncomplicated cataract surgery, virtual follow-ups seem to be a safe alternative to in-person visits and were preferred by patients. These conclusions are preliminary given the limited literature base, and further study is needed.

Endothelial Keratoplasty Following Glaucoma Filtration Surgery: A UK Tertiary Eye Care Referral Centre Experience.

Purpose: To compare the postoperative complications and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma filtering surgery. Methods: In this retrospective comparative case series, we analysed postoperative visual acuity and intraocular pressure, graft survival, rate of graft detachment and/or dislocation, number of rebubbling and/or graft repositioning procedures, and graft rejection or failure (primary and secondary). Results: Sixteen eyes with DMEK and 80 eyes with DSAEK with previous glaucoma surgery were studied. The results were recorded at 3 and 12 months postoperatively. No statistically significant differences in postoperative visual acuity were found between the two groups at any stage of the follow-up. Intraocular pressure was lower in the DMEK group at the follow-up stage of 3 (p = 0.0022) and 12 months (p = 0.0480). Visually significant graft detachment was recorded in 31.3% and 22.5% of DMEK and DSAEK cases, respectively (p = 0.4541). All DMEK detachments (n = 5) were managed with slit-lamp rebubbling. Out of 18 graft detachments in the DSAEK group, 2 grafts were observed due to small graft detachment, 6 large graft detachments underwent rebubbling performed in the operating theatre, and 10 eyes needed primary graft repositioning for graft dislocation. Conclusions: DMEK is a feasible option to treat endothelial failure in complex eyes with previous glaucoma surgery. In the DMEK group, visual acuity outcomes and possibly postoperative intraocular pressure control were better compared with the DSAEK group.

The Clareon Vs AcrySof PanOptix Trifocal IOL: A Comparative Study of Patient Satisfaction and Visual Performance.

To evaluate patient-reported outcomes of cataract surgery using the Clareon Panoptix and Panoptix Toric trifocal lenses and to compare these to the data collected previously for the AcrySof Panoptix and Panoptix Toric. Prospective, open-label, multicenter analysis of satisfaction, spectacle independence, presence of unwanted side effects, and best-corrected visual acuity among patients undergoing cataract surgery who had been implanted at least 1 month previously with the Clareon PanOptix or PanOptix Toric trifocal IOL bilaterally. Results were compared to outcomes measured two years ago from a similar study with the AcrySof version of the same lens. No significant differences in patient satisfaction rates were reported between the two cohorts. Spectacle independence was similar with 88% of Clareon Panoptix and 83% of AcrySof Panoptix patients having no need for any corrective lenses. Quality of vision was not statistically different with 7% of Clareon vs 15% of AcrySof patients reporting "very much" or more of glare/halo severity. Significantly more AcrySof (66%) than Clareon (42%) patients achieved a spherical equivalent outcome within 0.25 D of target. Best corrected distance visual acuity differences were not statistically significant, and no safety concerns were reported. The Clareon PanOptix trifocal lens provides similar satisfaction and spectacle independence and has a similar side effect profile and BCVA outcome to the identical lens made of the predecessor AcrySof lens.

High variability phonetic training facilitates categorical perception of Mandarin lexical tones in L2 older adults: A link to auditory processing

The current study investigated the facilitatory effects of High Variability Phonetic Training (HVPT) in second language (L2) categorical perception (CP) of Mandarin lexical tones. It also explored whether and how individual differences in auditory processing predicted gains from such training. The participants were 32 native English-speaking adults aged over 60 years who were learning Mandarin Chinese as their L2. They were randomly divided into the HVPT group (HG) ( n = 16) and the control group (CG) ( n = 16). Their L2 CP performance was assessed through an identification task and discrimination task before training, immediately after training, and two months later. Auditory processing tests were also conducted to measure the participants’ ability to encode spectral and temporal details of sounds. Linear mixed-effects (LME) models showed that, compared to the CG, the HG exhibited a more pronounced improvement in tonal categorization. Furthermore, regression analysis confirmed that individual differences in perceptual acuity significantly predicted gains from training in L2 CP of Mandarin lexical tones.

Comparison of objective visual quality between SMILE and FS-LASIK in moderate-to-high myopia.

This study aims to compare the changes in the corneal wavefront aberrations and the objective visual quality resulting from two types of eye surgery-small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK)-in patients with moderate-to-high myopia. A prospective analysis was performed on 98 eyes of 51 patients who underwent SMILE. Additionally, 88 eyes of 45 patients who underwent FS-LASIK were analyzed. All patients underwent ocular examination preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal aberrations and objective visual quality were measured using the Optical Quality Analysis System II (OQAS II) and Optical Path Difference Scan III (OPD-Scan III). At postoperative 1 day and 1 week, there was a statistically significant difference in uncorrected distance visual acuity (UDVA) between SMILE and FS-LASIK (P < 0.05). Postoperative spherical (S), cylinder (C) and spherical equivalent refraction (SE) were similar between the two groups (P > 0.05). In both groups, the absolute magnitude of total higher-aberrations (tHOA), piston, vertical tilt, vertical coma, and spherical aberration (SA) increased after surgery compared to preoperative values (P < 0.05). There was no significant difference in Δhorizontal tHOA, Δhorizontal tilt, Δhorizontal coma, and Δhorizontal trefoil between the two groups (P > 0.05), and the FS-LASIK had higher Δvertical trefoil and ΔSA (P < 0.05) but lower Δpiston, Δvertical tilt, and Δvertical coma than the SMILE group (P < 0.05). There was a rise in objective scattering index (OSI) and a decline in both modulation transfer function (MTF) cutoff and Strehl ratio (SR) after surgery compared to preoperative values in both groups (P < 0.05). There was a statistically significant difference in the OSI at 1 day and 3 months between the two groups (P < 0.05). Postoperative MTF cutoff and SR were similar between the two groups (P > 0.05). Postoperative OSI was positively correlated with corneal tHOA (0.261 ≤ R ≤ 0.483, P < 0.05) and was negatively correlated with vertical tilt and vertical coma (-0.315 ≤ R ≤ -0.209, P < 0.05) in both groups. While both SMILE and FS-LASIK can effectively correct moderate-to-high myopia, there is an increase in corneal aberrations and a postoperative delay in objective visual quality. The cornea may require a longer recovery period in the SMILE. OPD-Scan III combined with OQAS II is a useful supplementary inspection for assessing the optical quality following refractive surgery.

The effect of different potency glucocorticosteroids treatments on tear inflammatory factors and corneal optical density after femtosecond-assisted laser in situ keratomileusis.

To assess the impact of glucocorticosteroids with varying potencies on inflammatory mediators in tears and corneal optical density after femtosecond-assisted laser in situ keratomileusis (FS-LASIK). In a prospective study, 110 patients (220 eyes) who underwent FS-LASIK were divided into 2 groups: 55 patients (110 eyes) received dexamethasone, and another 55 patients (110 eyes) received fluorometholone. Visual acuity, intraocular pressure, and corneal optical density were measured before, 1 week, and 1 month after surgery. Tear fluid samples were also collected to assess expression levels of TNF-α, IL-1α, IL-6, and TGF-β1. One week after the procedure, the dexamethasone group exhibited elevated intraocular pressure (IOP) levels (P > .05) and a decreased expression of TNF-α in tears (P < .001) compared to the fluorometholone group. Within the 0 to 2 mm range from the corneal apex, the anterior corneal layer's optical density in the fluorometholone group surpassed that of the dexamethasone group (P < .05). At 1 month post-surgery, the IOP in the fluorometholone group was higher than that in the dexamethasone group (P < .05). In both the 0 to 2 mm and 2 to 6 mm intervals from the corneal apex, the optical density of the anterior corneal layer was significantly higher in the fluorometholone group compared to the dexamethasone group (P < .05). There was no statistically significant difference in visual acuity between the 2 groups at any postoperative time point. Short-term use of potent corticosteroids after FS-LASIK can swiftly address ocular surface inflammation, enhance corneal wound healing, reduce corneal edema, and accelerate the restoration of corneal transparency, in contrast to prolonged use of milder corticosteroids post-surgery.

Efficacy of Foldable Capsular Vitreous Body Implants Filled With Light or Heavy Silicone Oil in the Treatment of Silicone Oil-dependent Eyes.

The purpose of this study was to compare the clinical efficacy of foldable capsular vitreous body (FCVB) filled with either light or heavy silicone oil and the incidence of complications after their implantation for the treatment of severe ocular trauma and silicone oil-dependent eyes. FCVB filled with either light (n = 16) or heavy (n = 8) silicone oil was implanted in 24 patients. During the 12-month follow-up period, the intraocular pressure, final best-corrected visual acuity, retinal reattachment condition, position of the FCVB, and complications were assessed. All surgeries were performed without issue. There was no significant difference in preoperative and postoperative best-corrected visual acuity between the two groups. A significant improvement in the intraocular pressure was observed after surgery in both the light silicone oil (P = 0.029) and heavy silicone oil (P = 0.035) groups. None of the patients developed displacement or prolapse of the FCVB. The most common early and late postoperative complications were postoperative hemorrhage (33.3%) and corneal opacification (50%), respectively. FCVB filled with heavy silicone oil can be used as a supplemental therapy for patients who have lost the anterior segment of their eye, have lesions of the inferior retina, or cannot maintain the prone position for various reasons. Implantation of FCVB combined with heavy silicone oil compensates for the shortcomings of this with light silicone oil, providing patients with more personalized treatment.

Stereopsis Following Implantation of Presbyopia-Correcting Intraocular Lenses: A Narrative Review.

Recent advancements in cataract surgery have broadened its scope from mere vision restoration to include correction of refractive errors and presbyopia. This evolution has introduced multifocal and extended depth-of-focus (EDOF) intraocular lenses (IOLs), allowing enhanced vision across multiple distances. However, the influence of these advanced IOLs on stereopsis remains controversial. Factors influencing stereopsis after surgery include visual acuity, interocular differences, residual astigmatism, and the type of IOL, etc. Binocular vision integration and neuroadaptation further affect stereopsis, especially in cases of presbyopia-correcting IOLs. It is widely acknowledged that bilateral implantation of presbyopia-correcting IOLs yield superior stereopsis compared to unilateral implantation. However, there remains no consensus on whether binocular implantation of multifocal or monofocal IOLs provides superior stereopsis. Most studies suggest no significant difference in stereopsis between these two types of implants. Among different types of multifocal IOLs, refractive multifocal IOLs may offer better stereopsis than diffractive multifocal IOLs when implanted bilaterally. Emerging EDOF and hybrid multifocal-EDOF IOLs also demonstrate promising postoperative stereopsis. Additionally, a mix-and-match strategy with different types of IOLs implanted in each eye may result in interocular differences in visual acuity at certain distances, potentially affecting stereopsis. Nevertheless, with appropriate selection, most patients can achieve satisfactory postoperative stereopsis. This review synthesizes current literature on the effects of presbyopia-correcting IOLs on postoperative stereopsis recovery following cataract surgery. Studies on stereopsis outcomes with different IOLs have yielded mixed results, urging further investigation for optimized surgical strategies and patient outcomes.

Characteristics, associations, and outcomes of children with posterior segment coloboma

PurposeTo describe the clinical characteristics and outcomes of children with posterior segment coloboma (PSC). MethodsThe medical records of children (age <18 years) with PSC examined at Boston Children’s Hospital from May 1997 to May 2023 were reviewed retrospectively. The following data were collected: demographics, ocular and systemic conditions, coloboma type according to the Ida Mann (IM) classification, and best-corrected visual acuity. Rate of retinal detachment (RD) was calculated. A t test was used to compare visual outcomes by coloboma classification. Logistic regression was used to evaluate the association of CHARGE syndrome with coloboma classification and laterality. ResultsA total of 501 eyes of 343 patients were included. Differences in the mean best-corrected visual acuity of eyes with large PSC (IM type 1-3) and moderate-to-small PSC (IM type 4-7) were found at initial and final examination (both P < 0.001). RD rate was 5% per eye (95% CI, 3.25-7.28) and 7.3% per patient (95% CI, 4.77-10.57). After adjusting for covariates, children with CHARGE syndrome were at increased odds of having IM type 1, type 2, or type 3 colobomas (OR = 2.5; 95% CI, 1.4-4.8; P = 0.003) and bilateral fundus colobomas (OR = 7.0; 95% CI, 3.4-14.5; P <0.001), regardless of IM type, compared to children with PSC and no CHARGE association. ConclusionsEyes with large IM colobomas had worse visual outcomes than those with smaller defects; however, both experienced visual impairment. Children with PSC had a low rate of RD. Children with CHARGE syndrome often presented with bilateral and large IM colobomatous defects.

Mobile assessment of visual function helps to prevent Re-Injury in elderly patients with recent hip fractures

IntroductionPatients undergoing surgery due to hip fracture face an elevated risk of a subsequent fall during rehabilitation. An important contributing factor to this risk is deteriorated visual function, often responsive to intervention. This study aims to explore differences in visual acuity (VA) and stereovision (SV) between individuals with a history of fall-related hip injuries (study group) and age-matched controls, utilizing a mobile application (EuvisionTab, ET) to distinguish age-related visual decline from pathological vision. Materials & MethodsA total of 32 and 71 participants were enrolled in the study and control groups, respectively (mean age: 74.9 years, range: 60–96). Monocular logMAR VA was measured using a tablet by means of an adaptive threshold-search algorithm. SV was assessed using low-dot density static and dynamic random dot stereograms. An age-dependent reference limit for VA was established. For ET stereotests, the number of correctly identified optotypes out of 10 random presentations served as the measure for further comparisons. Visually impaired status in the study group was determined if patients failed either the VA threshold or the SV criteria. ResultsIn the control group, an apparent but statistically nonsignificant decline in VA was observed, while stereovision remained stable and did not exhibit significant age-related variations based on ET stereotests. Conversely, the study group demonstrated significantly worse results in monocular VA (p = 0.0032) and for both stereotests (p = 0.018 for static, p = 0.036 for dynamic) according to paired samples t-test and chi-square test, respectively. Hip injuries were significantly associated with visual impairment (OR = 4.88, p = 0.0012). DiscussionThis study focuses on one possible risk factor of elderly falls, namely, vision impairment. Patients with visual decay present a higher incidence of hip injuries compared to age-matched controls. This data suggest that vision screening and, when feasible, restoration of visual function may contribute to the prevention of secondary falls, refractures, or contralateral fractures. A mobile-based screening protocol, executable as part of a postoperative bedside examination and independent of specialized eye care, can be proposed.

Pulsed corneal crosslinking in the treatment of Keratoconus: a systematic review and meta-analysis.

Corneal crosslinking (CXL) procedures are the treatment of choice in halting progressive corneal ectasia and preserving visual acuity due to keratoconus. Pulsed crosslinking (P-CXL) was developed using intermittent pulsing ultraviolet (UV) light to mitigate the depletion of oxygen levels that occurs with continuous UV exposure in standard crosslinking protocols (C-CXL). This study aimed to explore the use of P-CXL in the treatment of keratoconus and determine whether the availability of oxygen in P-CXL carries superior efficacy outcomes as an alternative to C-CXL modalities. This review was undertaken in accordance with PRISMA guidelines. A search of several databases conducted with two separate reviewers resulted in 29 papers meeting inclusion criteria for the review, 14 selected for meta-analysis. Primary outcomes assessed by the included papers included maximum keratometry (Kmax), corrected and uncorrected distance visual acuity (CDVA, UDVA), and secondary outcomes included central corneal thickness (CCT), endothelial cell count and demarcation line. Statistical analyses were carried out on Review Manager 5.4 and the meta-analysis employed a random-effects model, which estimated the weighted effect size of raw means using inverse variance weights. At 12 months P-CXL showed statistically significant reductions in Kmax (-0.75 D; p < 0.001) and improvement in CDVA (-0.10 logMAR; p < 0.001) compared to baseline. The meta-analysis of comparative studies determined that mean differences in Kmax, CDVA, UDVA, Kmean and CCT after 12 months were not statistically significant between pulsed and continuous crosslinking groups. Overall, P-CXL is effective in improving visual acuity and keratometry outcomes in keratoconus. The meta-analysis did not show a statistically significant difference in Kmax and CDVA between P-CXL and C-CXL, indicating a non-inferiority of P-CXL. However, findings of the meta-analysis are limited by the fact that different energy levels and exposure times were used for P-CXL in comparison to C-CXL in some studies, making it unsuitable to determine whether the efficacy of CXL is improved by the use of pulsed light. What is Known • Pulsed crosslinking (P-CXL) uses intermittent UV light to prevent oxygen depletion when using higher energy protocols, unlike continuous UV exposure in standard continuous crosslinking (C-CXL). • This should theoretically enhance the efficacy of the treatment by maintaining higher oxygen levels that are crucial to the cross-linking process. • There are no systematic reviews or meta-analyses directly comparing the efficacy or safety of P-CXL to C-CXL. What is New • Meta-analysis revealed differences in keratometry between P-CXL and C-CXL groups with equivalent fluence (7.2 J/cm2) at 12 months were not statistically significant (Kmax -0.04 dioptres; p = 0.84). • Meta-analysis revealed differences in visual acuity between P-CXL and C-CXL groups with equivalent fluence (7.2 J/cm2) at 12 months were not statistically significant (CDVA -0.01 logMAR letters; p = 0.57). • The use of intermittent pulsing in higher energy CXL protocols renders statistically similar outcomes as continuous light exposure at equivalent fluence (7.2 J/cm2).

Sparing versus Removal of Epiretinal Proliferation in the Surgical Repair of Full-thickness Macular Holes.

To evaluate the efficacy of vitrectomy with epiretinal proliferation (EP) sparing for full-thickness macular hole (FTMH) accompanied by EP. A multicenter, retrospective study. Eyes were divided into two groups: the sparing group (Group S) included eyes in which the EP around the hole was peeled and preserved, whereas the removal group (Group R) included eyes in which the EP was partially or completely removed. The internal limiting membrane was peeling in all eyes. Forty-six eyes were included. Twenty-five eyes were in Group S, and 21 eyes were in Group R, with no difference in preoperative best-corrected visual acuity (BCVA) (P = 0.96). After primary surgery, MHs were closed in all eyes, and there were no complications in either group. Postoperative 12-month BCVA significantly improved in both groups (both P < 0.01), while Group S had better 12-month BCVA than Group R (P = 0.016). In the multivariable analysis, EP sparing was associated with better BCVA at 12 months (P = 0.006) after accounting for the minimal macular hole size and preoperative BCVA. EP sparing and removal were both safe and effective techniques, while EP sparing may provide a favorable outcome for eyes with FTMH and EP.

Transcranial Direct Current Stimulation in Children With Anisometropic Amblyopia.

Amblyopia is defined clinically as a difference in best-corrected visual acuity of two or more lines of acuity (0.2 logMAR) between the eyes. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that can transiently alter the excitability of targeted brain areas in a polarity-specific manner. To detect the effect of tDCS on anisometropic amblyopia. This is a randomized controlled trial conducted on 78 patients with anisometropic amblyopia from 4.5 to 12 years of age. All patients presented with monocular amblyopia. They were divided into three groups; each group received five sessions of tDCS (anodal tDCS, cathodal tDCS, and sham tDCS). The active electrode was placed over occipital midline and the reference over central midline. Pattern visual-evoked potentials and contrast sensitivity tests were conducted before, immediately after, and 1 week after tDCS. The amplitude of P100 was significantly decreased immediately after and 1 week after cathodal tDCS. The latency of P100 immediately after and 1 week after anodal tDCS was significantly decreased and increased significantly after cathodal tDCS. The amplitude of P100 and maximum and minimum contrast sensitivities were significantly increased immediately after and 1 week after anodal tDCS, and maximum contrast sensitivity was significantly decreased immediately after cathodal tDCS. Anodal tDCS is a promising noninvasive modality for improvement of anisometropic amblyopia.

Topical bromfenac in VEGF-driven maculopathies: topical review and meta-analysis

BackgroundTopical non-steroidal anti-inflammatory drugs have the potential to reduce treatment burden and improve outcomes of anti-VEGF therapy for a number of retinal disorders, including neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusions. In this review, we focused on the advantages of topical bromfenac as an adjunct to intravitreal anti-VEGF therapy in VEGF-driven maculopathies.MethodsCochrane Library, PubMed, and EMBASE were systematically reviewed to identify the relevant studies of neovascular age-related macular degeneration, diabetic macular edema, macular edema associated with retinal vein occlusion, myopic choroidal neovascularization, and radiation maculopathy which reported changes in central retinal thickness, visual acuity, and the number of anti-VEGF injections needed when anti-VEGF therapy was combined with topical bromfenac.ResultsIn total, ten studies evaluating bromfenac as an adjunct to anti-VEGF therapy were identified. Five studies were included in meta-analysis of the number of injections and five studies were included in the analysis of changes in central retinal thickness. A statistically significantly lower number of intravitreal injections (p = 0.005) was required when bromfenac was used as an adjunct to anti-VEGF therapy compared to anti-VEGF monotherapy with pro re nata regimen. At the same time, eyes receiving bromfenac as an adjunct to anti-VEGF therapy demonstrated non-inferior outcomes in central retinal thickness (p = 0.07). Except for one study which reported better visual outcomes with combined treatment, no difference in visual acuity or clinically significant adverse effects were reported.ConclusionsThis literature review and meta-analysis showed that topical bromfenac can be considered as a safe adjunct to anti-VEGF therapy with a potential to reduce the treatment burden with anti-VEGF drugs requiring frequent injections without compromising improvement of central retinal thickness or visual acuity.