Eye Health Research Articles

Transformer-Enhanced Retinal Vessel Segmentation for Diabetic Retinopathy Detection Using Attention Mechanisms and Multi-Scale Fusion

Eye health has become a significant concern in recent years, given the rising prevalence of visual impairment resulting from various eye disorders and related factors. Global surveys suggest that approximately 2.2 billion individuals are visually impaired, with at least 1 billion affected by treatable diseases or ailments. Early detection, treatment, and screening for fundus diseases are crucial in addressing these challenges. In this study, we propose a novel segmentation model for retinal vascular delineation aimed at diagnosing diabetic retinopathy. The model integrates CBAM (Channel-Attention and Spatial-Attention) for enhanced feature representation, JPU (Joint Pyramid Upsampling) for multi-scale feature fusion, and transformer blocks for contextual understanding. Leveraging deep-learning techniques, our proposed model outperforms existing approaches in retinal vascular segmentation, like achieving a Mean IOU of 0.8047, Recall of 0.7254, Precision of 0.8492, F1 Score of 0.7824, and Specificity of 0.9892 for CHASEDB1 dataset. Extensive evaluations on benchmark datasets demonstrate its efficacy, highlighting its potential for automated diabetic retinopathy screening.

Impact of proxymetacaine on the dynamics of cyclopentolate in White 6- to 7-year-olds.

This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate. Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open-field autorefractometer. Data were analysed through paired t-tests, concordance analysis, linear regression, equivalence testing and Bland-Altman analysis, using the 95% limits of agreement. Mean spherical equivalent refraction (SER) (SD) in the right eye at 0-, 10-, 20- and 30-min post-instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland-Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only. Accurate autorefraction values can be obtained 20-min post-instillation of 1.0% cyclopentolate in white children aged 6-7 years, potentially reducing clinical testing times. Proxymetacaine pre-instillation allows for reliable measurements as early as 10-min post-instillation of cyclopentolate. Further research is needed to validate these findings in non-White populations and to determine the safe discharge time post-proxymetacaine instillation.

Pre-transplant Screening for MMP-9 in Allogeneic HSCT Candidates

Purpose: InflammaDry® (Quidel Eye Health, San Diego, California), an FDA-approved point-of-care commercial test, measures matrix metalloproteinase-9 (MMP-9) levels in the tear film. MMP-9 is an inflammatory biomarker that is elevated in response to ocular surface stress, particularly observed in ocular graft-versus-host disease (oGVHD). The purpose of this study is to assess the prevalence of MMP-9 positivity and a score >4 on the OSDI-6 questionnaire in patients before allogeneic hematopoietic stem cell transplant (HSCT). Methods: A prospective, observational, cross-sectional single center pilot study was conducted among 23 patients (46 eyes) undergoing planned allogenic HSCT. InflammaDry® results, OSDI-6 questionnaire results, and development of oGVHD were collected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and chi-square test were calculated. Results: InflammaDry® demonstrated high sensitivity (1.0) but low specificity (0.1429) for oGVHD development. The PPV was 0.25, while the NPV was 1.0. No statistical significance was found between InflammaDry® result and development of oGVHD (p-value> 0.05). Conclusion: InflammaDry® is not an effective tool for detecting the onset or predicting the risk of developing oGVHD. A significant percentage of patients exhibited ocular inflammation before allogeneic HSCT, suggesting that initiating prophylactic treatment could be valuable in reducing oGVHD development.

Sociodemographic Predictors of Keratoconus (Severity, Treatment, and Progression) in a Tertiary Center in New York City.

To identify sociodemographic factors as predictors of keratoconus severity, progression, disease outcomes, and appropriate management in a tertiary care ophthalmology institute in the New York City metropolitan area. This is a retrospective chart review. Patients with keratoconus presenting at a tertiary eye institute in an urban setting seen between 2015 and 2022 were included. Sociodemographic data including age, sex, race, ethnicity, income derived from zip code, insurance coverage, and preferred language were recorded. These sociodemographic factors were analyzed as possible predictors of keratoconus severity at presentation (Amsler-Krumeich grades III and IV): patients presenting with acute hydrops, patients receiving corneal cross-linking or corneal transplant, patients showing 1 or more diopters of increase of Kmax during their follow-up, and patients having longer time between the provider's recommendation of corneal cross-linking and the time of the procedure. The retrospective review included 634 patients with a clinical diagnosis of keratoconus. Factors associated with severe keratoconus at presentation in the multivariate analysis were non-White (P < 0.001), lowest income (Q1) (P = 0.018), Q2 income (P = 0.012), and having Medicaid/Medicare coverage (P = 0.021). Medicaid/Medicare coverage was the only factor associated with acute hydrops (P < 0.001), and younger age was the only factor associated with disease progression (P < 0.001). Younger patients and patients with commercial insurance coverage were more likely to receive corneal collagen cross-linking (P < 0.001 and P < 0.001, respectively), whereas patients with Medicaid/Medicare coverage, lowest income, and non-White race were more likely to receive corneal transplantation (P = 0.012, P = 0.062, and P = 0.028, respectively). Medicaid/Medicare was the only factor associated with delay in receiving corneal collagen cross-linking (P = 0.013). Our study demonstrates that there are sociodemographic predictors of keratoconus disease severity, progression, and the type and the time of treatment the patients received. This confirms eye health disparities among patients with keratoconus.

A Review on Multiple-Ocular Disease Detection Methodology using ML and DL Techniques

The rapid advancement in machine learning (ML) and deep learning (DL) techniques has significantly impacted the detection and diagnosis of ocular diseases, which are critical for preserving vision and overall eye health. This review aims to explore the various ML and DL methodologies applied to the detection of multiple ocular diseases, highlighting their effectiveness, limitations, and areas for improvement. The motivation behind this review stems from the increasing prevalence of ocular diseases and the need for efficient, accurate diagnostic tools. Despite the promising results of existing techniques, limitations such as data variability, the need for extensive training data, and computational resource requirements persist. The objective is to synthesize current methodologies and propose enhancements, particularly through the integration of attention mechanisms in convolutional neural networks (CNNs). This review identifies gaps in current research and suggests directions for future work to enhance diagnostic accuracy and clinical applicability.

Real-ambient PM2.5 induced corneal epithelial barrier disruption through Wnt/β-catenin signaling

Continued daily exposure to fine particulate matter (PM2.5) is linked to increasing risks of ocular surface diseases. However, further study is needed to understand how real-ambient PM2.5 disrupts the barrier function of the corneal epithelial layers and its underlying mechanism. In our study, we utilized a real-ambient PM2.5 exposure system to investigate its effects on the corneal epithelial barrier in C57BL/6Jmice over 4 and 8 weeks. The mean concentration of PM2.5 in the exposure chambers over 8 weeks was 140.18 μg/m3. Following 4 and 8 weeks of continuous PM2.5 exposure, we observed disorganized cellular arrangements in the corneal epithelium of mice. Moreover, PM2.5 exposure led to a significant loss of microvilli on the surface of corneal epithelial cells and noticeable disconnections among epithelial cell layers. Subsequent in vitro analysis revealed that 100 μg/mL PM2.5 activated the Wnt/β-catenin signaling pathway in corneal epithelium, resulting in decreased expression 1.81 fold and 2.25 fold of E-cadherin and ZO-1, respectively, ultimately impairing the corneal epithelial barrier function. Our findings provide the knowledge base for promoting eye health in the context of atmospheric pollution.

The ROS/AKT/S6K axis induces corneal epithelial dysfunctions under LED blue light exposure

In recent years, concerns have escalated regarding eye health problems arising from Light-emitting diode (LED), which emits high-energy blue light (BL), potentially causing corneal epithelial dysfunctions (CEpD). Nevertheless, the mechanisms underlying this damage remain poorly comprehended. This study endeavors to explore the specific mechanisms through which BL exposure induces CEpD. The study carried out diverse assays and treatments to investigate the toxicological effects of BL exposure. 48hours (h) of 440nm of BL exposure decreased the migration of human corneal epithelial cells (hCEpCs) while augmenting reactive oxygen species (ROS) production and apoptosis. RNA-Sequencing and bioinformatic analysis indicated that cellular oxidation and reduction equilibrium, wound healing, the positive regulation of the apoptotic process, and the Phosphoinositide 3-kinase (PI3K)/AKT pathway were significantly influenced by BL exposure. Treatment with N-acetylcysteine (NAC), a ROS scavenger, restored cell viability and AKT/S6 kinase (S6K) activation, suggesting the involvement of ROS in BL-induced damage. NAC also reversed BL-induced apoptosis and migration. Blocking AKT/S6K replicated detrimental effects, while pre-treatment with SC79 (SC), an AKT activator, alleviated the changes caused by BL exposure in hCEpCs. Furthermore, in mice, the combination of AKT inhibition and BL exposure led to CEpD. However, treatment with SC and NAC restored CEpD caused by BL exposure. These results imply that the regulation of the ROS/PI3K/AKT/S6K axis is implicated in BL-induced CEpD. Collectively, this study offers insights into the molecular mechanisms of BL-induced CEpD and proposes targeting the ROS/PI3K/AKT/S6K cascade as a potential therapeutic approach. The findings contribute to ocular health knowledge and establish the basis for developing interventions to safeguard the cornea from the detrimental effects of excessive BL exposure.

Evaluation of Self-vision Assessment Charts in Schools of Eastern Nepal: A Multi Method Study

Introduction: Globally, over two billion people suffer from vision impairment, almost half preventable. In Nepal, the Eastern Regional Eye Care Program introduced self-vision assessment charts in 137 schools for early eye issue detection. This study assessed the charts' use and perceived impact.Methods: A multi-method study was conducted to evaluate the use of self-vision assessment charts in schools in Eastern Nepal. Ethical approval was obtained from Institutional Review Board (Refrence number: 72-079-040). Quantitative data were collected through a questionnaire survey. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using framework analysis. Both methods were integrated to enhance understanding of participants' experiences.Results: In this study, 400 students participated in questionnaire survey, 180 in self vision assessment, and 16 teachers in in-depth interviews. Among the participants, 198 (49.50%) of students used the chart, 125 (65.78%) expressed satisfaction, 241 (60.25%) found it useful, 276 (69%) as beneficial, and 253 (63.25%) stated improved health. There were 93 (23.25%) students who felt knowledgeable about its use, with 18 (10%) using it correctly. In 162 (90%) of schools there were adequate chart placement, 23 (12.77%) provided clear signage for viewing points. Teachers recognized the chart's benefits and encouraged its use, but students lacked awareness. Regular use was viewed as beneficial for early detection of eye issues, though challenges included a need for more awareness among students and teachers and reliance on home remedies.Conclusions: Most students and teachers acknowledged self-vision assessment charts’ benefits but had low utilization and accuracy rates. Strategic interventions such as regular informational sessions, teacher motivation, and engagement with eye health experts are essential.

Orthokeratology for high myopia

Purpose. With an increasing proportion of children with myopia especially in Asia, efforts have been made to reduce chances of preventable sight loss related to high myopia in the future. Orthokeratology lens has been used as one of the modalities not just to correct myopia, but also to slow down myopic progression and axial elongation. This case report reviews a patient with clinically significantly high myopia, whose refractive errors was partially corrected with orthokeratology lens and spectacle lenses. Material and Methods. A now 14-year-old patient with a history of fast progressing myopia, was prescribed and commended orthokeratology to manage myopia, while regularly monitoring her refractive errors, axial length, binocular vision status, corneal topography, and anterior eye health was monitored regularly at the author’s practice. Results. Over a two year follow up period, a partial correction of high myopia with orthokeratology lenses and residual refractive errors with additional spectacle lenses was effective in managing this patient’s myopia, as well as slowing of axial elongation. An updated pair of orthokeratology lens with a steeper back optic zone radii were prescribed to reduce superficial corneal staining and to maintain corneal health. Conclusion. Patient commitment and adherence to close monitoring of eyes in terms refractive errors, axial length, and anterior eye health, are vital in achieving a successful orthokeratology lens wear for high myopia. A dual fitting strategy consisting of orthokeratology lens and spectacle wear can be a safe management strategy that is acceptable for patients with high myopia. It would be helpful for practitioners to be able to rely on robust evidence-based guidance when determining whether lens wear can be ceased, i.e. when further axial elongation and myopic progression are no longer likely.

Patients’ perceptions on reluctance to undergo cataract surgery in Sedibeng district hospital, Gauteng province

Background: Over 50 million people are blind, and 135 million people suffer from severe visual impairments, with cataracts contributing to 51% of global blindness cases. Despite efforts to promote cataract surgery (CS), many patients remain hesitant, underscoring the importance of understanding their perspectives.Aim: This study aimed to explore and describe patients’ perceptions regarding reluctance to undergo CS to improve awareness and increase surgery uptake.Setting: The research was conducted in the Sedibeng District, Gauteng province, South Africa.Methods: A qualitative descriptive phenomenological design was employed to capture the lived experiences of patients through face-to-face, individual semi-structured interviews with 15 patients aged 38 – 72 years prior to their CS. Purposive sampling was used to select participants, and Colaizzi’s seven-step analysis was used for data analysis.Results: The findings highlight several barriers perceived by participants, including long waiting times; fear; lack of knowledge; limited financial, material and human resources; power outages; uncontrolled blood sugar levels; and coronavirus disease 2019 (COVID-19) pandemic restrictions. Nevertheless, some view it positively as a means to avert blindness and enhance vision.Conclusion: To address the challenges, the study recommends boosting the number of eye health care professionals, prioritising budget allocation, addressing electricity interruptions and conducting community outreach educational programmes to improve access to CS in the district.Contribution: The insights gained from this study can help health care providers and policymakers optimise care and support for CS patients through policy formulation and education. Addressing these knowledge gaps will likely increase surgery uptake and improve patients’ quality of life.

Reduction of screen induced myopia by parental interventions

Abstract Background Excessive use of digital devices, including smartphones and tablets, has been shown to increase the risk of myopia in children. Gaps persist in understanding parental attitudes towards handheld screen use and effective interventions guiding eye health policies. This study examined the associations between parental behavior related to myopia and children’s handheld screen use. Methods Data obtained from 395 parents of pre-adolescents (Mean age 10.63; SD 1.09) were used, collected from an online community panel. Parents reported on various behavioral determinants related to myopia and their child’s screen time: knowledge, attitude, risk perception and self-efficacy. They reported on their child’s frequency and amount of screen use. Logistic regression analysis was used to assess associations between variables, using parental efforts to reduce screens as outcome measure. Results Of the 395 participating 9-12 year-olds, 73.4% of the children spent up to two hours a day on recreational handheld screens, 26% more than two hours. Of the parents surveyed, 28.1% perceived the risk of screen-induced myopia as significant, prompting 62.6% of them to take active measures to minimize screen time. The more knowledge parents had on child myopia the more they attempted to reduce screen time (OR = 2.57; 95% CI [1.57-4.19], p = &amp;lt;.001). Moreover, a more negative attitude towards screens was significantly related to attempting to reduce screen time (OR = 1.26; 95% CI[1.17-1.35],p = &amp;lt;.001). Key messages • These findings emphasize a need to address parental knowledge and attitude towards myopia and screen time reduction. • We recommend increasing knowledge, influencing attitude and searching for alternatives as a part of behavioral change strategies.

Caffeine and Vision: Effects on the Eye.

Caffeine, commonly found in coffee and tea, affects various aspects of eye health as it blocks adenosine receptors, impacting tear production, intraocular pressure, macular perfusion, and choroidal thickness. However, its connection with eye conditions like glaucoma and cataracts remains uncertain due to conflicting research findings. Some studies suggest potential benefits for cataracts, while others warn against frequent caffeine intake in glaucoma and surgical scenarios due to possible increases in intraocular pressure. Conflicting evidence also exists regarding its effects on dry eye, macular degeneration, myopia/hyperopia, diabetic retinopathy, retinopathy of prematurity, and central serous retinopathy. Caffeine does not seem to be a risk factor for dry eye, although studies have shown that caffeine may offer protection against wet age-related macular degeneration, and the metabolite 7-methylxanthine could be a more promising treatment for myopia. Moreover, caffeine can potentially cause tremors and might hinder surgical performance, especially in less experienced surgeons. Recommendations from experts vary, highlighting the need for further research to fully understand how caffeine affects the eye. Individuals genetically predisposed to glaucoma should be cautious due to the possibility of clinically significant elevations in intraocular pressure with caffeine consumption. For delicate procedures like microsurgery, where tremors can be detrimental, caution should be exercised with caffeine. This review underscores the importance of additional studies to provide clearer insights and prudent recommendations regarding caffeine's impact on eye health.

Eyestrains among smartphone users while watching videos in Taipei MRT carriages: a comparison between sitting and standing postures

In MRT carriages, more passengers are watching videos on their smartphones during daily commutes, yet the impact of these viewing conditions on visual strain remains unexplored. This study examined eyestrain in 24 male and 24 female participants while watching videos on smartphones in two postures (sitting and standing) and over two durations (15 min and 30 min) in Taipei MRT carriages. We measured critical flicker fusion frequency (CFF) reduction, visual fatigue scale (VFS) scores, and viewing distance (VD) for each trial. Results revealed significant effects of sex, posture, and viewing duration on visual strain, with notable two-way interactions (sex × posture and posture × time) influencing most outcomes. Women showed greater CFF reduction while sitting compared to standing (3.47 Hz vs. 1.90 Hz, p < 0.001) and maintained shorter VDs while seated (25.5 cm vs. 34.3 cm, p < 0.001). However, they reported higher VFS scores when standing (8.94 vs. 4.60, p < 0.001), indicating increased discomfort while standing in the moving MRT carriage. Men exhibited higher CFF reduction (2.81 Hz) than women while standing (1.90 Hz) (p < 0.01), but this difference was not observed while sitting. Eyestrain indicators significantly worsened after 30 min of viewing compared to 15 min, with stronger effects on VFS scores and VDs. This finding supports the recommendation to take breaks after 20 min of smartphone use, even in MRT carriages. Although subjective eyestrain is not always recognized, watching videos on smartphones while seated can result in unexpectedly high levels of objective visual fatigue, indicated by CFF reduction. Our findings suggest that eyestrain patterns in MRT carriages differ from those reported in previous studies. Seated passengers, particularly females with shorter VD, may experience unrecognized eyestrain that could impact eye health, while standing passengers may face greater discomfort. These results highlight the need for increased awareness and preventive measures to mitigate eyestrain in digital public transportation environments.

Selected Trace Elements and Their Impact on Redox Homeostasis in Eye Health

Oxidative stress plays a crucial role in the pathogenesis of various ocular degenerative diseases, leading to structural and functional changes in eye tissues. This imbalance between reactive oxygen species (ROS) and antioxidants significantly contributes to conditions such as age-related macular degeneration, diabetic retinopathy, cataracts, and glaucoma. Both enzymatic and nonenzymatic antioxidants are vital for maintaining ocular health by neutralizing ROS and restoring cellular redox balance. Essential trace elements, including iron, zinc, copper, and selenium, are fundamental for the proper functioning of these antioxidant systems. Iron is indispensable for enzymatic activity and cellular energy production, zinc supports numerous proteins involved in visual functions and antioxidant defense, copper is essential for various enzymatic reactions preventing oxidative stress, and selenium is critical for the activity of antioxidant enzymes such as glutathione peroxidase (GPX) and thioredoxin reductase (TrxR). This review summarizes current research on the complex interactions between oxidative stress and trace elements in ocular diseases, highlighting the therapeutic potential of antioxidant supplementation to mitigate oxidative damage and improve eye health. By integrating insights from studies on oxidative stress, trace elements, and eye physiology, this article underscores new diagnostic and therapeutic strategies that could lead to more effective prevention and treatment of ocular diseases, aiming to enhance clinical outcomes and guide future research in optimizing therapeutic strategies for eye health.

Application of Lutein in Relieving Digital Eye Fatigue in Adolescents

This paper studies the application of lutein in relieving digital eye fatigue in adolescents. Through in-depth discussion of the causes and effects of digital eye fatigue, as well as the mechanism and effect of lutein, the method of applying lutein through dietary intake and supplements was proposed. Combined with the change of living habits, the positive effect of lutein in relieving digital eye fatigue was verified by case analysis. The results show that lutein has potential value in improving the eye health of adolescents.

Visual fatigue prediction using classification model based on physiological responses of occupants under office lightings

Appropriate management of visual fatigue is crucial for eye health as it significantly impacts life quality throughout an individual's life cycle. The shift to digital tasks in modern office environments has increased occupants' exposure to visual fatigue, leading to various social problems. This study aimed to develop visual fatigue prediction models based on physiological responses and classification algorithms. Experiments were conducted to collect physiological responses and subjective visual fatigue under various lighting environments. Collected data was refined and reorganized as predictor variables by different time windows and target variables by scales. Then, visual fatigue prediction models were developed using supervised machine learning algorithms (i.e., artificial neural network, support vector machine, gradient boosting machine, and random forest). And improved by feature selection and adding subject-label variables. The resulting two-scale and three-scale visual fatigue prediction models demonstrated an average performance of 93.73 % and 94.64 % respectively. This research can contribute to reducing societal costs and enhancing productivity by proposing visual fatigue prediction models that help manage eye health in office environments.

Visual Awareness and Its Impact on Sports Performance of Basketball Players in The Maldives

Objective: This study aimed to assess the visual awareness and its impact on basketball performance among Maldivian basketball players. Material and Methods: A 16-item questionnaire about visual and ocular problems, perception towards eye health, and sports performance was distributed electronically to basketball players in the Maldives through various basketball organizations. Data collected were analyzed using descriptive statistics and the Chi-Square test in Statistical Package for the Social Sciences.Results: Eighty two Maldivian basketball players aged between 10-40 years, with sixty males, participated in this study. Data showed that only 30.5% of the respondents wore vision correction when playing basketball, none had undergone any visual training, and 20.7% never had any eye examination.Majority of those who underwent eye examination had more than two years since their last eye check-up. Visual difficulties during games were reported by 41.5% of the respondents, with blurry vision and eye injury being the most commonly reported visual symptom and ocular problem, respectively. Moreover, 70.7% of the players experienced inconsistent performance level and loss of concentration during games. There was a significant relationship between experiencing visual difficulties and inconsistent sports performance χ2 (1, N=82) =5.95, p-value=0.02. Conclusion: The visual awareness among Maldivian basketball players is generally low and this seems to be associated with their sports performance. Importance of using corrective/protective eyewear and attending regular eye examinations should be cultivated among athletes in the Maldives, aiming to improve the sports field in this country.

Challenges and Barriers to Utilizing Eye Care Services Among Urban Population Globally: A Scoping Review

Objective: Eye health is crucial for overall well-being, relying on eye care services for the prevention and treatment of vision disorders. Increasing blindness rates underscore the need for early detection. Despite known urban-rural disparities in eye care utilization, urban challenges are underexplored. This scoping review summarized and determined the challenges and barriers to utilizing eye care services specifications in urban populations globallyMaterial and Methods: A search was conducted on multiple databases such as Scopus, ScienceDirect, WOS, PubMed, and Google Scholar, covering the period of 2000 to 2023. The criteria were selected based on the PRISMA statements. The search focuses on challenges and barriers in utilizing eye care services.Results: The search identified 464 studies, and 18 were included in the final review. Person-related and service-related barriers can be distinguished from the review. The most common challenges were lack of felt need the eye care services and cost. Person-related barriers were found to be higher compared to service-related barriers among urban populations. Conclusion: The scoping review highlights significant person-related and service-related barriers to utilizing eye care services in urban populations globally. Despite the availability of services, person-related barriers were more pronounced, indicating a critical need for targeted interventions. Addressing these barriers is essential to enhance eye care services and reduce the prevalence of vision disorders in urban settings.

Effect of supplementation with lutein, zeaxanthin, and omega-3 fatty acids on macular pigment and visual function in young adults with long-term use of digital devices: study protocol for a randomized double-blind placebo-controlled study.

Growing evidence emphasizes the importance of xanthophyll carotenoids and omega-3 fatty acids in eye health. However, the beneficial effects of such supplementation have not been thoroughly discussed among adults with high screen exposure. Current trial evidence on lutein bioavailability is contradictory, and the interactions of dietary intervention with host-related factors remain elusive. This study aims to investigate the comparative effectiveness of supplementation with macular xanthophylls and omega-3 fatty acids on macular pigment optical density (MPOD) and visual function, access the bioavailability of free lutein and lutein ester, and explore the complex interplay between genetic variations, intestinal microbiota, and the dietary intervention in Chinese adults with long-term exposure to digital devices. The Lutein, Zeaxanthin, and Omega-3 (LZO) clinical trial is a 24-week multicenter, randomized, double-blind, placebo-controlled trial of 600 participants recruited from research centers, universities, and communities. Individuals are eligible to participate if they are aged over 18 years and use digital devices for over 8 h daily in the last 2 years, and will be randomized to six arms. A total of three visits will be scheduled at baseline, 12 and 24 weeks. The primary outcome is the change in MPOD over the 24-week intervention. The secondary outcomes are changes in visual function (visual acuity, best-corrected visual acuity, contrast and glare sensitivity, critical flicker fusion, reaction time, visuognosis persistence, symptoms and signs of dry eye, retinal thickness, and optical quality), and changes in serum lutein and zeaxanthin concentrations, and erythrocyte membrane omega-3 fatty acids. Genetic variations will be determined using genome-wide genotyping at baseline. 16S rRNA gene sequencing will be utilized to assess microbiome compositional changes before and after intervention. The trial is anticipated to establish early interventions to prevent photochemical ocular damage and delay the onset of vision impairment in young adults with long-term repeated exposure to screen-based electronic devices, and provide valuable insights for the development of precision nutrition strategies for maintaining eye health. www.clinicaltrials.in.th, Identifier, TCTR20220904002.

Compliance and Determinants of Spectacle Wear Among Moroccan Adults Residing Beni-Mellal Khénifra Region.

Ensuring a high level of adherence to wearing spectacles is essential to preserve eye health and achieve optimal vision correction. Comprehending the factors influencing adherence to wearing spectacles can inform strategies to improve eye care outcomes. This study aimed to assess the prevalence and factors influencing adherence to wearing spectacles among Moroccan adults residing the Beni-Mellal Khenifra region. A cross-sectional interview survey was conducted involving 389 adult spectacle wearers. Participants were recruited through a multilevel random sampling technique and interviewed using a structured questionnaire. This questionnaire collected data on demographics, spectacle prescription, usage patterns, and barriers to compliance. Compliance was assessed based on self-reported frequency and duration of spectacle wear according to the prescription. Possible factors influencing the wearing of spectacles were investigated using both univariate and multivariate regression models. This study revealed that 57.6% of participants adhered to the recommended use of spectacles. Factors associated with compliance were higher education level, longer duration of spectacle use, awareness about the importance of spectacle wear, absence of a family history, specific refractive error types, and increased severity of refractive errors. Participants reported various reasons for not adhering to the recommended use of spectacles, with the most common being forgetfulness, perceiving improved vision without spectacle, discomfort while wearing spectacle, difficulty adapting to spectacle, and loss of spectacle. Given the high prevalence of non-compliance to spectacle wear among adults in the Beni-Mellal Khenifra region, it is evident that additional efforts are required to improve understanding and education regarding the advantages of consistent spectacle usage. Targeted educational and awareness initiatives have the potential to substantially enhance adherence rates and consequently improve visual health outcomes in the region.