Eye Clinic Research Articles

Ugandan optometry students’ experiences of their clinical training: a qualitative study

BackgroundThere is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students’ experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students’ experiences of their clinical learning environment at a national referral and teaching hospital in Uganda.MethodsBetween April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students’ clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach.ResultsTwo themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants’ experiences. Each theme had three sub themes.ConclusionTraining optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students’ experiences in lower-level health units to those in national referral hospitals.

7824 Orbital Lymphoma masquerading as Thyroid Eye Disease

Abstract Disclosure: S. Ganawa: None. S. Joseph: None. C. Anshuman: None. D. Luciane L: None. A. Sajid: None. C. Anne: None. S. Dhage: None. Thyroid eye disease (TED) is the most common extrathyroidal manifestation in Graves’ disease (GD). In this case report, we present a case of a 64 years old lady, who was initially diagnosed with thyroid eye disease about 9 years ago. However, she was clinically and biochemically euthyroid. She was offered an orbital decompression surgery by local ophthalmology team. Patient wasn’t keen on the surgery at this stage.Recently she experienced increased swelling of her eyes, with conjunctival redness, oedema, and diplopia bilaterally, more evident on the left side. She was initiated on intravenous methylprednisolone (IVMP) weekly, by local ophthalmology team and was referred to our specialist thyroid eye clinic for further management.On presentation to us, her clinical activity score (CAS) was 5/7, but she was euthyroid clinically and biochemically. She was continued on weekly IVMP and oral mycophenolate mofetil (MMF) was added on as per the latest EUGOGO guidelines published in 2021. Her treatment was reviewed after the anti thyroperoxidase (TPO) and anti-Thyroid Stimulating Hormone receptor (TSH) antibodies were reported as negative and her eyes worsened despite the treatment with IVMP and MMF.Her repeat MR orbit at this stage showed possible orbital lymphoma. Her immunosuppressive medications were discontinued at this stage. After further discussions at regional thyroid eye MDT and radiology MDT, an orbital biopsy was arranged for, which confirmed Extra nodal Marginal Zone lymphoma, with no high-grade component. She has been referred to the oncology unit for further assessment and management.This case highlights the importance of considering alternative differential diagnosis in certain patients with atypical features or those who are non-responders to the first line immunosuppressive therapies for thyroid eye disease. Details of this case and relevant literature will be reviewed in this report. Presentation: 6/3/2024

CORRIGENDUM: Optical coherence tomography angiography features in Waldenström macroglobulinemia patients without Hyperviscosity syndrome: A pilot prospective study

PurposeTo evaluate the retinal vessel density (VD) with optical coherence tomography angiography (OCTA) in asymptomatic patients affected by Waldenström macroglobulinemia (WM) without hyperviscosity syndrome (HVS) and to highlight the presence of microvascular damage in theese clinically asymptomatic WD patients. DesignProspective study. MethodsA total of 43 eyes from 43 WM patients (24 females, 19 males, mean age 55.1 ± 13.6 years) were enrolled from January 2023 to December 2023 in the Eye Clinic of the University of Naples Federico II. .Along with WM patients, 40 healthy subjects (HS) (20 females, 20 males, mean age 52.3 ± 15.6 years) with a normal ophthalmic examination and no history of intraocular surgery or retinal pathologic features were included as control group All patients and controls underwent OCTA. ResultsThe two groups were not significantly different for age and sex Visual acuity examination showed no statistically significant difference in BCVA between controls and patients Compared to HS, WD patients showed lower VD values in the SCP in the whole image (47.95 ± 5.17 % vs. 52.99 ± 2.52%; p < 0.001), as well as in the parafovea (53.01 ± 6.69 % vs. 55.30 ± 2.61%; p = 0.002), and fovea (21.38 ± 9.01 % vs. 30.31 ± 5.84 %; p < 0.001). On the other hand, in the DCP VD values were significantly higher in patients compared to controls in the whole image (55.82 ± 8.07 % vs. 50.83 ± 5.46%; p = 0.005), as well as in the parafovea (56.76 ± 6.26 % vs. 52.59 ± 5.46%; p = 0.001), and fovea (38.75 ± 8.59 % vs. 33.43 ± 8.68 %; p < 0.001). ConclusionThe finding that OCTA confirmed the presence of widespread microvascular damage in WD patients clinically silent. Thus, OCTA is a safe rapid imaging technique that could represent a valid biomarker of systemic vascular dysfunction.

Comparison of Retinal Thickness betweenDiabetic Patients without Diabetic Retinopathy and Non-Diabetic Controls Using SD-OCT

Purpose: To determine retinal thickness in diabetic patients without diabetic retinopathy and non-diabetic controls using Spectral Domain Optical Coherence Tomography (SD-OCT). Study Design: Cross-sectional observational study. Place and Duration of Study: Diabetic Eye Clinic and General Eye OPD of Al-Ibrahim Eye Hospital, Karachi from July 2018 to August 2018. Methods: Patients with type 2 diabetes and non-diabetic healthy control eyes of either genderand age between 20 and 60 years were recruited. Patients with any other systemic and ocular disease affecting retinal thickness were excluded. After initial examination and informed written consent, patients were referred to ocular investigation department for detailed retinal examination and SD-OCT for measuring central retinal thickness. Data were analyzed for continuous and categorical variable using SPSS. Results: Average Central Retinal thickness was 297±21 and 315±13µmand Central Foveal Thickness was 246±16 and 249±19µmin diabetic and non-Diabetic patients respectively. Quadrant-wise evaluation revealed retinal thickness as follows; nasal 310 and 324µm), temporal (291and 304µm), superior (297and 316µm) and inferior (292and 314µm) in diabetics and non-diabetics respectively. Retinal thickness was greater at nasal and lesser at temporal regions. Conclusion: Diabetic patients without DR had thinner central retinal thickness compared to non-diabetic controls, as measured by Spectral Domain Optical Coherence Tomography (SD-OCT). Specifically, the average central retinal thickness and central foveal thickness were slightly reduced in diabetic patients. Quadrant-wise analysis revealed that the retinal thickness was consistently greater in the nasal region and lesser in the temporal region in both diabetic and non-diabetic patients.

Predictors of Posture Induced Intraocular Pressure Variations in Normal Subjects and Glaucoma Patients. Evidence from Abakaliki

Background: Intraocular pressure (IOP) is affected by factors like age, gender, body mass index (BMI), and blood pressure among others. Studies have investigated the relationship between IOP and age, gender, BMI, and refractive error (3-5). There has been conflicting results as some studies have reported a correlation between IOP and age, gender, BMI, and refractive error while results from other studies found no such association. Aim: The aim of this study was to determine the relationship between IOP and age, gender, body mass index and refractive status in the primary open angle glaucoma (POAG) and non-glaucomatous eyes. Methods: A case controlled study involving consecutive newly diagnosed POAG and non-glaucomatous patients conducted in the eye clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Demographic data included age, gender, and occupation. Height and weight were measured using a Standing Scale with calibrated metal rule. BMI was calculated as Weight (kg) / [Height (m)] 2). IOP was measured with Perkins hand-held applanation tonometer. Correlation and regression analysis was used to determine the relationship between IOP and age, gender, BMI and refractive status. Results: There was a direct relationship between age and IOP in non-glaucomatous subjects which was statistically significant (P &lt; 0.001; r = 0.8). Intraocular pressure also increased with increasing age in POAG but this was not statistically significant (P = 0.18; r =0.3). There was no statistically significant difference between mean IOP in males and females of both POAG and non-glaucoma patients, with P = 0.72 and P = 0.50 respectively. BMI had a linear relationship with intraocular pressure which was statistically significant in POAG (P = 0.01; r value = 0.3) but showed no such relationship in non-glaucomatous patients (P = 0.38; r value = 0.1). The relationship between mean IOP and refractive status was not statistically significant in non-glaucomatous (P = 0.19; r = 0.2) and POAG patients (P = 0.5; r = 0.09) respectively. Conclusion: IOP has linear correlation with increasing age in both non-glaucomatous patients and POAG. A statistically significant relationship was found between IOP and BMI in POAG but not in non-glaucomatous eyes. There was no relationship between either the gender, or refractive status and IOP in non-glaucoma and POAG subjects respectively.

APPLICATIONS OF MULTIMODAL GENERATIVE ARTIFICIAL INTELLIGENCE IN A REAL-WORLD RETINA CLINIC SETTING.

This study evaluates a large language model, Generative Pre-trained Transformer 4 with vision, for diagnosing vitreoretinal diseases in real-world ophthalmology settings. A retrospective cross-sectional study at Bascom Palmer Eye Clinic, analyzing patient data from January 2010 to March 2023, assesses Generative Pre-trained Transformer 4 with vision's performance on retinal image analysis and International Classification of Diseases 10th revision coding across 2 patient groups: simpler cases (Group A) and complex cases (Group B) requiring more in-depth analysis. Diagnostic accuracy was assessed through open-ended questions and multiple-choice questions independently verified by three retina specialists. In 256 eyes from 143 patients, Generative Pre-trained Transformer 4-V demonstrated a 13.7% accuracy for open-ended questions and 31.3% for multiple-choice questions, with International Classification of Diseases 10th revision code accuracies at 5.5% and 31.3%, respectively. Accurately diagnosed posterior vitreous detachment, nonexudative age-related macular degeneration, and retinal detachment. International Classification of Diseases 10th revision coding was most accurate for nonexudative age-related macular degeneration, central retinal vein occlusion, and macular hole in OEQs, and for posterior vitreous detachment, nonexudative age-related macular degeneration, and retinal detachment in multiple-choice questions. No significant difference in diagnostic or coding accuracy was found in Groups A and B. Generative Pre-trained Transformer 4 with vision has potential in clinical care and record keeping, particularly with standardized questions. Its effectiveness in open-ended scenarios is limited, indicating a significant limitation in providing complex medical advice.

Ocular Imaging Challenges, Current State, and a Path to Interoperability: A HIMSS-SIIM Enterprise Imaging Community Whitepaper.

Office-based testing, enhanced by advances in imaging technology, is routinely used in eye care to non-invasively assess ocular structure and function. This type of imaging coupled with autonomous artificial intelligence holds immense opportunity to diagnose eye diseases quickly. Despite the wide availability and use of ocular imaging, there are several factors that hinder optimization of clinical practice and patient care. While some large institutions have developed end-to-end digital workflows that utilize electronic health records, enterprise imaging archives, and dedicated diagnostic viewers, this experience has not yet made its way to smaller and independent eye clinics. Fractured interoperability practices impact patient care in all healthcare domains, including eye care where there is a scarcity of care centers, making collaboration essential among providers, specialists, and primary care who might be treating systemic conditions with profound impact on vision. The purpose of this white paper is to describe the current state of ocular imaging by focusing on the challenges related to interoperability, reporting, and clinical workflow.

Response predictors of a topical corticosteroid-based regimen for dry eyes: A real-life study.

To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting. Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (NMG) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression. A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), NMG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (ΔOSDI, ΔDEQ5, ΔOSS, ΔFBUT, ΔNMG, ΔMQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, NMG, MQ). The remaining tests did not show statistically significant changes. Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study.

Intravitreal therapy in neovascular age-related macular degeneration-adapting to increasing demand and changing times.

To report the outcomes of patients with neovascular age-related macular degeneration (nAMD) at Palmerston North Eye Clinic (PNEC) during 2020 and 2021, comparing time to treatment initiation based on nurse-injector availability and during COVID-19 restrictions. Data were recorded from a prospective database for patients with nAMD at PNEC. Each patient's electronic health record was reviewed to ensure the accuracy of the database and to fill in missing data points. Statistics were done using Microsoft Excel and R. One hundred and fifty-six eyes were diagnosed with nAMD during the study. Mean time from referral triage to first injection was 13.08 days across the study period. Time to treatment initiation was not statistically different by level of COVID-19 restriction but there was a significant difference in first specialist appointment to injection interval when three nurse-injectors were available compared to four. The effect seemed most evident in subsequent months after reduced nurse-injector availability began. Despite an increase in nAMD diagnoses each year, PNEC continues to meet national guidelines for interval from referral to treatment initiation through innovations in practice. As demand for intravitreal injections continues to increase, further resourcing and research into newer agents will be required to keep wait times compliant with guidelines.

Retinoscopes: Past and present.

Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills. To discuss the history of retinoscopes and examine current literature on the subject. A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term "Retinoscopy," with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)]. This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope. The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.

Demographic, Clinical, and Surgical Risk Factors of Pars Plana Vitrectomy (PPV) for Neovascular Glaucoma (NVG) Development in Type 2 Diabetes Mellitus Patients.

Neovascular glaucoma (NVG) is a severe type characterized by forming new blood vessels on the iris and the anterior chamber angle, often resulting from ischemic retinal diseases. Pars plana vitrectomy (PPV) is a standard surgical procedure for treating various retinal and vitreous conditions. Understanding the risk factors associated with NVG development following PPV is crucial for improving patient outcomes. To identify and evaluate demographic, clinical, and surgical risk factors associated with developing NVG following PPV. A prospective cohort study was conducted over two years, involving 60 type 2 diabetes mellitus (T2DM) patients (31 males and 29 females; mean age 60.48±9.63 years) who underwent PPV at the Eye Clinic and Department of Clinical Immunology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina. Patients were thoroughly informed about the study, and written informed consent was obtained. Comprehensive data collection included demographic information, medical history, preoperative and postoperative eye examinations, and intraoperative details. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Within 12 months postoperatively, 17 patients (28.3%) developed NVG. Significant preoperative risk factors for NVG included prolonged duration of T2DM (p=0.037), elevated preoperative intraocular pressure (IOP) (p=0.024), and higher levels of vascular endothelial growth factor (VEGF) (p=0.011). Intraoperative factors, such as sharp dissection (p=0.000) and operative complications (p=0.004), were also significantly associated with NVG development. Multivariate logistic regression analysis identified prolonged T2DM duration (OR 1.132, p=0.023), increased preoperative IOP (OR 1.192, p=0.029), elevated VEGF levels (OR 1.002, p=0.016), and intraoperative sharp dissection (OR 0.114, p=0.006) as independent risk factors. Multiple preoperative and intraoperative factors influence the development of NVG post-PPV. Prolonged T2DM duration, elevated preoperative IOP, high VEGF levels, and specific intraoperative techniques significantly increase the risk of NVG. These findings underscore the importance of careful preoperative assessment and tailored intraoperative strategies to mitigate NVG risk in PPV patients.

Treatment Options and Referral Pattern among Patients with Retinal Diseases Attending an Eye Clinic in a Tertiary institution, North Central Nigeria.

Objectives: The aim of the study was to determine the treatment modalities and pattern of referral of patients with retinal diseases in the eye clinic. Methods: All consenting new patients attending the eye clinic were recruited for the study and interviewed by the author. The treatment offered to the participants diagnosed with retinal disease (medical, surgical, LASER, optical or a combination) was recorded. Information on the patient’s referral for vitreoretinal consultation (this could be ‘yes’ or ‘no’) and reasons for the referral were also documented and analyzed. Results: treatment options for the 278 study participants were: medical for 100 (36%), optical for 94 (33.8%) optical correction, surgical for 24 (8.6%), LASER photocoagulation for 6 (2.2%) and a combination of LASER photocoagulation and intravitreal avastin injection for 20 (7.2%) patients. Counselling and watchful expectancy accounted for treatment of 34 (12.2%) patients. Seventy-four patients of the 278 included in the study had retinal diseases. Of these 74 with retinal diseases, 46 (62.2%) were referred to vitreoretinal units out of which 39 (84.8%) patients were referred to the vitreoretinal unit in JUTH and 7 (15.2%) were referred to vitreoretinal units elsewhere. The referrals were largely on account of unavailability of requisite equipment in 3 (42.8%) patients, surgical expertise in 2 (28.6%) patients and patient request in 2 (28.6%) cases. Conclusion: The need for establishment of standard vitreoretinal services strategically in each geo-political zone of Nigeria to cater more efficiently to the needs of patients with retinal diseases and appropriate referral cannot be overemphasized

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers

ABSTRACT Clinical relevance The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. Background Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. Methods This study included 134 patients who underwent surgery for eyelid lesions between 2021–2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. Results Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. Conclusion High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

Epidemiology and phenomenology of the Charles Bonnet syndrome in low-vision patients

BackgroundThe occurrence of visual hallucinations in visually impaired people without mental impairment is known as Charles Bonnet Syndrome (CBS). To date, the prevalence of CBS has been reported with high variance. The present study aims at evaluating the prevalence of CBS among low-vision patients.MethodsFrom March 2018 to February 2022, 194 patients with a visual acuity ≥ 0.5 logMAR approached the low vision section of the Eye Clinic Sulzbach. Of these, 50 patients were found eligible, agreed to participate in the study and were screened for CBS. The course of the disease, its phenomenology and characteristics, the circumstance of onset, the ability to manipulate and resolve the hallucinations, and the psychosocial aspects of CBS were investigated.Results26% of patients with low vision suffered from CBS. Women did not suffer from CBS significantly more often than men. Often, insight into the unreality of the images is not achieved immediately. Patterns or so-called “simple” hallucinations occurred just as frequently as other types of images such as people, body parts or faces. The most frequent images were animals. Visual hallucinations, lasting only for seconds in most cases, occurred more frequently during the day and in bright surroundings. All patients experienced the hallucinations exclusively with their eyes open. The hallucinations generally did not move with the eyes. Many sufferers did neither communicate about their hallucinations nor consult any physician.ConclusionsCBS among low-vision patients is common. Its prevalence constitutes clinical relevance. Future management of CBS may benefit from encouraging patients to share their experiences and consult a physician.

Accuracy of a commonly used mobile ophthalmology application's vision assessment tools in measuring five vision assessment parameters.

The use of mobile ophthalmology applications (MOA) is increasing, but many of these tools have not been validated. This study was performed to assess the accuracy of a popular MOA, Eye Handbook, in measuring five commonly-tested vision assessment parameters (distance visual acuity (DVA), near visual acuity (NVA), colour vision testing (CVT), contrast sensitivity (CS), and pupillary distance (PD)) was compared with traditional vision assessment methods (TVAM) [i.e. Snellen chart, Rosenbaum near card, Ishihara, Pelli Robson test, etc.] performed in the eye clinic setting. Prospective crossover clinical trial of 129 patients meeting inclusion criteria. Participants averaged significantly better DVA (p = 0.0008), NVA (p < 0.0001), and CVT (p = 0.0105) in the MOA than the TVAM, but all three MOA assessments were predictive of the TVAM values. CS was significantly better with the MOA (p < 0.0001). Linear regression and Spearman correlation tests were applied to assess the effect of CS on NVA, which showed no clear relationship between the difference in NVA and the difference in CS. PD using the two methods was in agreement with no significant difference (p = 0.2889). The studied MOA offers an effective means of measuring four common vision parameters: DVA, NVA, CVT, and PD. The MOA can potentially be used by eye care providers, health care providers, and patients, both as a screening tool with correction factor and to monitor ocular pathologies. Atypical MOA measurements should prompt testing in the clinic with formal TVAMs.

Hyperactivity of the medial thalamus in patients with photophobia-associated migraine.

To examine cerebral functional alterations associated with sensory processing in patients with migraine and constant photophobia. Migraine is a common headache disorder that presents with photophobia in many patients during attacks. Furthermore, some patients with migraine experience constant photophobia, even during headache-free intervals, leading to a compromised quality of life. This prospective, case-control study included 40 patients with migraine (18 male and 22 female) who were recruited at an eye hospital and eye clinic. The patients were divided into two groups: migraine with photophobia group, consisting of 22 patients (10 male and 12 female) with constant photophobia, and migraine without photophobia group, consisting of 18 patients (eight male and 10 female) without constant photophobia. We used 18F-fluorodeoxyglucose and positron emission tomography to compare cerebral glucose metabolism between the two patient groups and 42 healthy participants (16 men and 26 women). Compared with the healthy group, both the migraine with photophobia and migraine without photophobia groups showed cerebral glucose hypermetabolism in the bilateral thalamus (p < 0.05, family-wise error-corrected). Moreover, the contrast of migraine with photophobia minus migraine without photophobia patients showed glucose hypermetabolism in the bilateral medial thalamus (p < 0.05, family-wise error-corrected). The medial thalamus may be associated with the development of continuous photophobia in patients with migraine.

Psychometric properties and diagnostic performance of three dry eye questionnaires in Italian: OSDI, OSDI-6, and SPEED.

Psychometric questionnaires are highly valuable instruments in clinical practice as they make subjective symptoms easier to measure. Recently, a short version of the Ocular Surface Disease Index (OSDI) questionnaire was developed, named OSDI-6. This study aimed to assess the psychometric properties and compare the diagnostic criteria of three questionnaires, available in the Italian language, designed for assessing dry eye disease: Standard Patient Evaluation of Eye Dryness (SPEED), OSDI-12, and specifically the new shortened version, OSDI-6. Psychometric evaluations were conducted on 250 adult participants aged 20 to 83 years. Classic and Rasch psychometric analyses were performed on the three questionnaires. The repeatability of the questionnaires was assessed by retesting 120 participants. The exploratory factor analysis of OSDI-6 indicated saturation on two factors. Repeatability was optimal for all three questionnaires. Based on the reference OSDI-12, the cutoff for OSDI-6 was 5 points and 7 for SPEED. Rasch analysis showed that OSDI-6 and OSDI-12 present disordered response categories and thresholds. Conversely, the SPEED questionnaire shows the optimal item characteristic curve. The OSDI-12 is a reference questionnaire used in dry eye disease studies and clinics, but OSDI-6 does not represent a perfect shortened version, primarily for the absence of one factor measured and secondarily for the same problem of category response order and thresholds. Conversely, SPEED focusing only on symptoms showed better psychometric properties.

Morph-SSL: Self-Supervision With Longitudinal Morphing for Forecasting AMD Progression From OCT Volumes.

The lack of reliable biomarkers makes predicting the conversion from intermediate to neovascular age-related macular degeneration (iAMD, nAMD) a challenging task. We develop a Deep Learning (DL) model to predict the future risk of conversion of an eye from iAMD to nAMD from its current OCT scan. Although eye clinics generate vast amounts of longitudinal OCT scans to monitor AMD progression, only a small subset can be manually labeled for supervised DL. To address this issue, we propose Morph-SSL, a novel Self-supervised Learning (SSL) method for longitudinal data. It uses pairs of unlabelled OCT scans from different visits and involves morphing the scan from the previous visit to the next. The Decoder predicts the transformation for morphing and ensures a smooth feature manifold that can generate intermediate scans between visits through linear interpolation. Next, the Morph-SSL trained features are input to a Classifier which is trained in a supervised manner to model the cumulative probability distribution of the time to conversion with a sigmoidal function. Morph-SSL was trained on unlabelled scans of 399 eyes (3570 visits). The Classifier was evaluated with a five-fold cross-validation on 2418 scans from 343 eyes with clinical labels of the conversion date. The Morph-SSL features achieved an AUC of 0.779 in predicting the conversion to nAMD within the next 6 months, outperforming the same network when trained end-to-end from scratch or pre-trained with popular SSL methods. Automated prediction of the future risk of nAMD onset can enable timely treatment and individualized AMD management.

Study of Blood Lipid Levels and C-Reactive Protein in Patients with Pseudoexfoliation Syndrome

Aim: To evaluate the relationship between the level of blood lipids and inflammatory reaction protein and pseudoexfoliation syndrome. Methods: The research sample included 75 patients with pseudoexfoliation deposits that were discovered during the examination of the anterior sections of the eye on the slit lamp, attending the general eye clinic at Tishreen University Hospital in Lattakia during the time period 2022-2023, who investigated the inclusion criteria in the research, in addition to a control sample consisting of 75 patients as well. All participants underwent a detailed clinical history and ophthalmological examination including visual acuity examination and slit-lamp examination before and after mydriasis, after which the following laboratory tests were performed: CRP, LDL, HDL, TC, and TG on peripheral blood samples drawn after a 12-hour fast. Results: By comparing the patient group with the control group, our study found that there were no statistically significant differences between the two research groups according to demographic variables, as it was (P-value=0.6) for gender and (P-value=0.1) for age. We also noted with this comparison that there were no statistically significant differences between the two research groups according to the average values of the inflammatory reaction protein (CRP) (P = 0.06), total cholesterol (TC) (P = 0.5), triglycerides (TG) (P = 0.4), and low-density lipoprotein. (LDL) (P=0.6) and high-density lipoprotein (HDL) (P=0.8) Conclusion: We did not find an increase in the level of lipids in the blood, nor even in the level of CRP, in PEX patients attending the eye clinic at Tishreen University Hospital in Lattakia. These findings raise doubts about the possible relationship between PEX and vascular disease. Because the results of our and other studies are inconclusive, the causes and correlates of PEX remain unexplained and more studies on this topic are needed.

Vessel density, macula thickness and foveal avascular zone measurements in young African adults with moderate myopia: A pilot study.

The aim of this study was to investigate the association between macula thickness and vessel density in African myopic and emmetropic eyes through the use of Spectral Domain Optical Coherence Tomography (OCT). The study population comprised African adults aged 18-35 years old. The study was conducted at a University eye clinic located in Durban, South Africa. Purposive sampling was utilised to obtain 59 participants of whom 24 were myopes and 35 were emmetropes. Vessel density (VD), foveal avascular zone (FAZ) and retinal thickness (RT) were obtained using the Heidelberg Spectralis OCT with angiography. Thereafter, a multivariate linear regression was used to investigate associations between the spherical equivalent myopic refractive error and VD, FAZ and RT for the myopic group only. Myopic participants had a mean spherical equivalent (MSE) and standard deviation (SD) of -4.79 D (1.27) while the emmetropic group had an MSE (SD) of -0.32 D (0.46). Both superficial and deep VD were significantly decreased at the central fovea (radius (r) = 0.4 mm), peri-foveal (r = 1.10-1.45 mm) and para-foveal (r = 0.75-1.10 mm) sectors in myopes when compared with emmetropes. Myopes showed a significant reduction in RT in the inner retinal layer across the inferior and temporal zones of the peri-foveal region as well as the inferior and temporal zones of the para-foveal region when compared with emmetropes. A significantly smaller FAZ was found at both the superficial and deep vascular plexuses (p < 0.001). In African myopes, significant associations were not found between MSE and VD or FAZ and macula retinal thickness. Retinal vascular and thickness reduction may occur in young African adults with moderate myopia. A broad-based study targeting VD and IRT in African myopes is proposed to confirm preclinical myopic macula disruptions in adults of African ethnicity. OCT angiography should be considered when monitoring progressive myopia.