Ocular Screening Research Articles

Patient Awareness of Wet Age-Related Macular Degeneration and Need for Regular Fundal Examinations

Purpose: To evaluate degree of insight, accessibility to medical care, and availability of regular ocular screening examinations before diagnosis for Korean patients with wet age-related macular degeneration.Methods: Data were collected from 95 patients by questionnaire and analyzed at Seoul National University Boramae Medical Center.Results: Although 80.0% of the patients considered themselves old, only 2.1% thought they were susceptible to wet age-related macular degeneration. Of the overall patients, 48.4% thought their disease was serious despite treatment with intravitreal injections. A majority (71.6%) thought that medical care was easily accessible, 67.4% answered that hospitals were located close by, and 90.5% answered that it was easy to make appointments and they had time to visit the hospital. However, only 15.8% answered that they had undergone regular ocular examinations before being diagnosed with wet age-related macular degeneration.Conclusions: Although most patients believed that they had easy access to medical care, only 15.8% underwent regular ocular examinations. Therefore, regular ocular examinations, including fundal examinations, are required in national health screening programs. It is also important to raise public awareness of wet age-related macular degeneration by educating the general population.

In vitro model of Reconstructed Human Corneal Epithelium for the evaluation of ocular surface desiccation and protection with Vitamin A enriched ophthalmic ointment.

The aim of this study was to evaluate the efficacy of a paraffin ointment enriched with vitamin A in the protection against severe desiccation using 2D and 3D corneal epithelial in vitro models. We used immortalized human corneal epithelial cell cultures to evaluate the efficacy of four compounds -a paraffin ointment enriched with vitamin A (vA-PFF) and its vehicle; an aqueous gel containing hydroxypropyl guar (HPG); and an aqueous gel containing sodium carboxymethylcellulose (CMC)- to preserve cell viability in an in vitro model of desiccation. WST-1 and Live/Dead assays were used to study cell viability. Protection against cell damage was evaluated using a tridimensional reconstructed human corneal epithelial stem cell model (QobuR-RhCE). Compared to CMC, the paraffin ointment produced a significant prosurvival effect and it was similar to hydroxypropyl guar (HPG). The effect of vA-PFF in the protection against cell damage in QobuR-RhCE was significantly higher than CMC and HPG.Our results suggested that reconstructed 3D human corneal epithelia are sensitive tools to evaluate the efficacy of topical formulations against chemical damage and severe desiccation, indicating that would be an alternative method to animal experimentation, valid to use in ocular drug screening. vA-PFF caused no toxicity to cells in culture and was effective against extreme desiccation and cell damage in in vitro 2 D and 3D models.

Factors that Influence Recovery From Concussion in Young Children and Preadolescents.

To examine differences in the presentation and management of concussion in younger children (aged 4-8 years) versus preadolescents (9-12 years) and identify factors that influence recovery time. Retrospective analysis of prospectively collected data. Pediatric sports medicine and orthopedics clinic. Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022. Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores. Days since injury (DSI) to initial visit, total number of visits, recovery time (days). Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery. Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.

Interconnections between diabetic corneal neuropathy and diabetic retinopathy: diagnostic and therapeutic implications.

Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus. Diabetic corneal neuropathy refers to the progressive damage of corneal nerves. Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature. However, growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit, which includes both the retinal vascular structures and neural tissues. Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening. However, diabetic corneal neuropathy is commonly overlooked and underdiagnosed, leading to severe ocular surface impairment. Several studies have found that these two conditions tend to occur together, and they share similarities in their pathogenesis pathways, being triggered by a status of chronic hyperglycemia. This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy, whether diabetic corneal neuropathy precedes diabetic retinopathy, as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy. We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.

Corneal biomechanics in patients with allergic conjunctivitis.

Allergic conjunctivitis (AC) comprises a group of conditions triggered by environmental allergens, substantially diminishing the quality of life, particularly among children and adolescents. The mechanical impact of eye rubbing in patients with AC is known to induce biomechanical alterations in the cornea. Modern instruments enable the detection and quantification of these corneal biomechanical changes. The ocular response analyzer and CorVis ST have become standard tools for assessing corneal biomechanical properties. We conducted a review of studies that have investigated corneal biomechanics in patients with AC using both devices to elucidate the association between corneal biomechanical changes and early ectasia development. Our analysis highlights significant findings regarding the tomographic biomechanical index parameter in corneal biomechanics among patients with AC. These findings underscore the importance of ocular screening for all patients to promptly detect subclinical keratoconus changes, thereby improving disease management and outcomes.

Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study.

There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. RR2-10.2196/40446.

Universal eye screening: perinatal risk factors and ocular abnormalities in 1795 newborns not meeting retinopathy of prematurity criteria.

This prospective cohort study aimed to investigate the ocular outcomes of universal eye screening in newborns and assess the relationship between different perinatal risk factors and various ocular abnormalities in infants who do not meet the criteria for retinopathy of prematurity (ROP) screening. An universal eye screening questionnaire was utilised to screen newborn babies who did not meet the ROP screening criteria within 72 h of birth at a public and private hospital between June 2016 and April 2018. The questionnaire covered demographic characteristics, neonatal history, and eye examination findings. A trained retina specialist conducted comprehensive anterior and posterior segment examinations utilising a binocular indirect ophthalmoscope. Out of the 1795 newborns screened, 55.2% were male, and 44.8% were female. The most prevalent ocular abnormality observed was retinal haemorrhage (RH), with a prevalence of 10.64% (95% CI: 9.25-12.16%). The prevalence of non-RH abnormality was 7.5% (95% CI: 6.34-8.84%). The retinal haemorrhages were associated with normal vaginal deliveries (OR: 9.91; 95% CI: 6.71-14.64, p-value < 0.001), while non-RH abnormalities were associated with pre-term babies (OR: 4.87; 95% CI: 3.03-7.83, p < 0.001), consanguinity (OR: 2.20; 95% CI: 1.28-3.8, p < 0.001), low birth weight (OR: 0.22; 95% CI: 0.14-0.34, p < 0.001) and systemic abnormalities (OR: 3.08; 95% CI: 1.94-4.91, p < 0.001). Sight-threatening ocular pathology in newborns may be linked to perinatal risk factors such as preterm birth, low birth weight, consanguinity, and systemic abnormalities. Accordingly, it may be prudent to consider specialized ocular screening protocols for neonates within this high-risk cohort in future prospective studies.

Challenges and prospects in the application of artificial intelligence for ocular disease screening and diagnosis

In recent years, artificial intelligence (AI) technologies have experienced substantial growth across various sectors, with significant strides made particularly in medical AI through advancements such as large models. The application of AI within the field of ophthalmology can enhance the accuracy of eye disease screening and diagnosis. However, the deployment of AI and its large models in ophthalmology still encounters numerous limitations and challenges. This article builds upon the transformative achievements in the medical AI sector and discusses the ongoing challenges faced by AI applications in ophthalmology. It provides forward-looking insights from an ophthalmic perspective regarding the era of large models and anticipates research trends in AI applications in ophthalmology, so as to foster the continuous advancement of AI technologies, thereby significantly promoting eye health.

Effect of high intensity, intermittent exercise on EyeGuide Focus smooth pursuit assessments in amateur female rugby union athletes

Ocular assessment tools provide insights into neurological functioning when diagnosing sport-related concussions (SRCs). Emerging technologies such as EyeGuide Focus have attempted to improve on pre-existing clinical tools however the reliability of the tool is currently uncertain and it is unclear if physical exertion may affect the validity of the device as seen with similar ocular assessments. The aim of this study was to determine if EyeGuide Focus accuracy is affected by high-intensity, intermittent exercise. Seven amateur female rugby union athletes were recruited (Mean age [± SD] = 23 ± 5 years; stature = 172 ± 4 cm, mass = 87 ± 20 kg). Athletes completed baseline testing on the unit which included two to four familiarisation trials and three official tests on the unit measured in arbitrary units (AUs). Testing was completed in a dark room free from distraction, and participants wore noise-cancelling headphones (BOSE QC45) during assessment. The athlete then performed a brief warmup before beginning the exercise protocol by Whyte et al. (2022, Phys Therapy Sport, 58, 126-133) which involves repeated circuits of acceleration, deceleration, backpedalling, change of direction, jumping, and side shuffling. This protocol has previously displayed significant effects on Vestibular Ocular Motor Screening testing. Athletes repeated circuits until they reported 17-18/20 on the Borg Scale with 30s between each circuit. Athletes then completed three more trials at five- and 10-mins post-exercise cessation. Data were exported to Microsoft Excel and Statistical Packages for the Social Sciences for analysis. Athletes completed an average of 03:15 ± 23 s total work in circuits. Significant differences existed between athlete’s heart rate at rest and post-warmup, post individual circuits, and five mins post-test (P &lt; 0.05) but not 10 mins post-test (P &gt; 0.05). Mean EyeGuide Focus scores were 23443.29 ± 8082.18, 35684.04 ± 13279.40, and 22927.64 ± 6377.61 AUs at baseline, 5 mins post-test, and 10 mins post-test respectively. Scores were significantly different between baseline and 5 mins post-test (P &lt; 0.001), and between 5- and 10-mins post-test (P &lt; 0.001), but not baseline and 10 mins post-test (P &gt; 0.848). Three mins of high-intensity, intermittent exercise was sufficient to induce significant changes in amateur female athletes’ EyeGuide Focus scores, returning to baseline after 10 mins of rest. The findings indicate that physical activity can impact on EyeGuide Focus scores and thus sufficient rest is required when assessing athletes for SRCs. Future research should investigate if sport-related contact or collisions also impact scoring on this device.

Screening for ocular toxicities of immunotherapy in a real-world population.

e24125 Background: Nivolumab, Pembrolizumab, and Ipilimumab have revolutionized the treatment of melanoma. However, patients receiving these treatments risk immunotherapy-related adverse events (IRAEs). IRAEs can occur in any organ system, are treated with steroids or immunosuppressive medications, and may require treatment delay or discontinuation. Ocular IRAEs, which are caused by off-target reactions with ocular immune mechanisms, are often identified after significant damage to the eye. Ocular IRAEs are rare in the literature with an approximate prevalence of 3.3%. After observing intraocular inflammation (uveitis) with uveal depigmentation (pigment release) in some patients receiving immunotherapy, we hypothesized that the rate of such events in a real-world population may be higher than previously reported. We predict ophthalmic screening and early intervention may prevent severe and potentially permanent ocular IRAEs. Methods: Patients starting immunotherapy for melanoma were referred to an ocular screening clinic at the Cancer Centre of Southeastern Ontario (Queen’s University, Kingston, Canada) for baseline ocular assessments. Repeat assessments occurred every three months (single agent) or at every cycle (dual immunotherapy). Intake visits included examination by an attending ophthalmologist, including examination for uveitis and anterior chamber free pigment under high-powered field. Intraocular inflammation (IOI) was defined as the presence of endothelial deposits and/or anterior chamber cell and/or pigment that was not present at baseline. Ocular findings were monitored alongside other IRAEs during treatment. Results: 28 patients (17 male, 11 female) receiving adjuvant (46.4%) or palliative (53.6%) immunotherapy for melanoma were evaluated. 9 of these patients received dual immunotherapy (Ipilimumab/Nivolumab) and 19 received single agent immunotherapy. IOI was identified in 11 patients (39.2%), while only 4 presented with symptoms. None of the patients had overt signs of anterior segment inflammation such as erythema, conjunctival injection, and chemosis. IOI developed in 54.5% of dual immunotherapy-treated patients. Patients with ocular IRAEs were treated with topical/systemic steroids or other immunosuppressive medications. None required discontinuation of immunotherapy. The development of IOI was more common in metastatic patients whose cancer was responding to immunotherapy, and many of these patients sustained IRAEs in other organ systems. Conclusions: Our findings suggest IOI related to ocular IRAEs are quite common and develop in a third of patients receiving immunotherapy for melanoma. Ocular screening for IOI identified early, often asymptomatic toxicities that could progress to permanent visual disability. Further evaluation of dedicated ocular screening is indicated in patients receiving immunotherapy.

Acute Eye-Tracking Changes Correlated With Vestibular Symptom Provocation Following Mild Traumatic Brain Injury.

To quantify norms and changes in eye-tracking proficiency, and determine vestibular symptom correlations in varsity college athletes following acute mild traumatic brain injury (mTBI). We hypothesized that mTBI impacts central coordination between the vestibular and oculomotor systems with resultant changes in eye-tracking proficiency that are correlated with vestibular symptom provocation. Retrospective cohort study. Sports medicine care at a single institution. One hundred and nineteen college athletes diagnosed with mTBI by a physician between 2013 and 2019. N/A. Standard deviation of tangential error, standard deviation of radian error, mean phase error, and horizontal gain from virtual reality-based, circular eye-tracking goggles used at baseline and within 72 hours post-mTBI. Headache, dizziness, nausea, and fogginess provocation after the Vestibular Ocular Motor Screening (VOMS) smooth pursuits subtest compared with pretest baseline, assessed within 72 hours post-mTBI. One hundred and nineteen college athletes (N = 56 women and 63 men) aged 18 to 24 years sustained a total of 177 mTBI. Forty-four percent of athletes displayed abnormal eye-tracking on at least 1 eye-tracking measure following acute mTBI compared with their baseline. From the VOMS, horizontal gain showed medium-sized to large-sized positive correlations with headache ( r = 0.34) and dizziness ( r = 0.54), respectively. Mean phase error showed a medium-sized negative correlation with nausea ( r = -0.32) on the VOMS. Eye-tracking proficiency was impaired and correlated with vestibular symptom provocation following acute mTBI in college athletes. Future research should examine eye-tracking proficiency testing in other acute care settings to support mTBI diagnosis.

AvaGen Genetic Testing versus Ocular Screening Assessments Including the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS) in Refractive Surgery Candidates.

To determine whether the AvaGen (AG) Genetic Eye Test provided additional information for screening for the presence of keratoconus (KC) and assessing KC risk in refractive surgery candidates, as compared to the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS). This retrospective study analyzed patients seeking refractive surgery at an eye clinic in the United States between January 2022 and July 2023. The inclusion criteria encompassed those with a family history of KC, positive KC indices, or both. Corneal evaluations and demographic information were recorded and analyzed. KSS and ERSS criteria were utilized to evaluate postoperative KC and ectasia risk, respectively. Patients were categorized on how the AG genetic test compared to KSS and ERSS criteria. Clinicians assessed topographic indices, criteria scoring, and AG testing to deliver a definitive surgical recommendation. Among the 19 patients evaluated for ectasia risk, AG testing showed lower KC risk than ocular screening in three patients (15.8%), equal risk in three patients (15.8%), and higher risk in 13 patients (68.4%). The mean AG scores were 45.7 ± 7.0, 49.0 ± 3.46, and 61 ± 13.0 for these respective categories. The most frequently identified KC risk genes were ADAMTS18, COL2A1, and COL4A1. The AG test modified the physician's recommendation for refractive surgery in nine cases (47.4%). Despite the promising application of AG testing for assessing KC risk, further research and development are needed to enhance its applicability for screening refractive surgery candidates, in addition to standard ocular screening approaches.

Ocular screening for chronic graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplant

ObjectiveThis study investigates ocular manifestations of graft-versus-host disease in patients following allogeneic hematopoietic stem cell transplantation (HSCT) at the University of Texas Medical Branch (UTMB). Preferred practice pattern guidelines are proposed for ocular graft-versus-host disease (oGHVD) detection. MethodsThe Epic electronic medical record database at UTMB was screened using International Classification of Diseases, Tenth Revision (ICD-10), codes for bone marrow transplants, stem cell transplants, and complications of bone marrow transplants and stem cell transplants. We identified 50 patients with the ICD-10 codes that were seen at UTMB between 2000 and 2021. Patients who received an HSCT and follow-up care with UTMB were included in this study. Thirty-eight patients met the inclusion criteria, whereas 12 patients were excluded because they had no diagnosis of HSCT or did not follow-up with UTMB. ResultsOf the 38 patients in our cohort, 23.7% (n = 9) were noted to have oGVHD. As many as 89% of the patients with oGVHD presented with an ocular surface disease including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome. Systemic GVHD also was found in 44% of the patients with oGVHD. Only 29% (n = 11) of the study population had referrals to ophthalmology. Most referrals (55%) were made within 1 year of getting the HSCT. None of the patients in our cohort received an ocular screening before HSCT. ConclusionsMany post-HSCT patients lack routine ophthalmic care. Regularly assessing post-HSCT patients for early signs and symptoms of oGVHD may limit adverse outcomes. Management of oGVHD should involve a multidisciplinary team approach.

The role of the physiotherapist in concussion.

Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.

Preschool Vision Screening: Prevalence and Associated Factors of Amblyopia among School Going Children in Dhaka City

Background: Amblyopia is a decrease in best-corrected visual acuity in one or both eyes due to form deficiency or abnormal binocular interaction. It affects infancy and adulthood for the individual and society as a whole. Amblyopia affects academic success, career choice, visuomotor skills, social interaction, psychological development, and economic participation. Unilateral amblyopia increases the likelihood of bilateral vision loss. Ocular media opacity, strabismus, anisometropia, hypermetropia, astigmatism, myopia, and blepharoptosis are risk factors for amblyopia. Ocular screening programs in young children, primarily preschoolers, may detect amblyopia and amblyogenic risk factors like as strabismus, refractive errors, and media opacities early. It prevents and treats amblyopia. It helps children's emotional growth. Diagnosis and treatment of amblyopia at a younger age may result in a better and more stable final VA because to shorter treatment durations, faster VA improvement, and greater treatment adherence. Objective: The purpose of this study was to determine Preschool vision screening, prevalence and associated factors of amblyopia among school going children in Dhaka city. Methods and Material: Between January 1 and June 30, 2022, a cross-sectional survey of a community of Dhaka city residents in the school age range was carried out. Through interviews and physical exams, data were gathered using a pretested structured questionnaire and checklist. Using SPSS 23, descriptive and inferential analysis was performed, and variables with a p value of less than 0.2 were included into multivariate logistic regression. In the multivariable binary logistic regression, significant predictors were defined as variables with a p value of &lt; 0.05. Result: Majority of the student are of 4-5 years age, among the participant 50.8% were male and 45.8% were female. Study showed that majority of the family has 1-2 (49.5%) and 3-4 (45.3%) children. Majority of the mother .......

Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

ABSTRACT Introduction Higher perceived stress negatively impacts concussion recovery, but there are limited data examining connections between perceived stress and concussion. Additionally, higher mindfulness is associated with lower perceived stress, but there is limited research on how mindfulness impacts concussion outcomes. Therefore, this study aimed to estimate the associations among perceived stress, mindfulness, and clinical concussion outcomes. Methods This was a cross-sectional, observational study in 80 young adults with a concussion history. Participants completed a single study visit measuring the following: 1) demographics, concussion history, and current mindfulness practice; 2) perceived stress (Perceived Stress Scale); 3) mindfulness (Five Facet Mindfulness Questionnaire); and 4) clinical concussion outcomes/symptoms (Rivermead Post-Concussion Symptoms Questionnaire), balance performance (Balance Error Scoring System (BESS) and center of mass), autonomic nervous system function (heart rate variability), vestibular/ocular function (vestibular ocular motor screening), and exertion tolerance (step test). Separate multivariable linear regression models were used to determine the associations among 1) perceived stress and clinical concussion outcomes and 2) mindfulness and clinical concussion outcomes. Next, a perceived stress and mindfulness interaction term was included to test the potential moderation effect of mindfulness on clinical concussion outcomes. Results Higher perceived stress was significantly associated with higher concussion symptom severity (P &lt; 0.001) and higher number of concussion symptoms reported as worse than before injury (P &lt; 0.001). Higher mindfulness was associated with lower concussion symptom severity (P &lt; 0.001), and fewer concussion symptoms reported as worse than before injury (P = 0.002). There were no clinically significant models where the interaction effect was also significant, but the BESS parameter estimate did show statistical significance in the interaction model. Conclusions Our results provide a novel understanding of the association among perceived stress, mindfulness, and clinical concussion outcomes. These data are necessary to inform mechanistic concussion rehabilitation interventions.

Ocular sarcoidosis, to screen or not to screen?

Ocular sarcoidosis most commonly presents with symptoms and is first diagnosed before systemic sarcoidosis in at least half of the patients with sarcoidosis. Prevalence of ocular involvement in sarcoidosis varies between 2-80% depending on the study setting, included ocular diseases, and studied population. In many studies, ocular involvement in sarcoidosis has been overestimated mainly because study populations have been collected from eye clinics and because the study criteria have included ocular findings or symptoms that do not require treatment or monitoring. In a screening setting, asymptomatic ocular sarcoidosis has been detected in only 2-5%. 0-1% of the screened sarcoidosis patients have required treatment. For these reasons, ocular screening in sarcoidosis seems generally of little value. Patients with sarcoidosis who present with ocular symptoms should be screened for ocular sarcoidosis in a timely manner because they are at high risk of ocular disease.

Should Ocular Hemorrhage Screening Be Conducted in Newborns with Acidosis?

Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis. Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed. Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH. Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation. · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..

STUDY OF OCULAR MANIFESTATIONS IN PATIENT WITH CHRONIC KIDNEY DISEASE IN TERTIARY CARE RURAL HOSPITAL

Purpose: To study the occurrence of various ocular manifestations exhibited by patients with Chronic Kidney Disease(CKD) and to analyse the findings. Materials and Methods: An observational, cross sectional, descriptive study was conducted at a tertiary care hospital after the approval of ethical committee for duration of 1year (July 2022- July 2023). A total of 50 patients of all age group, either sex, diagnosed with CKD irrespective of the haemodialysis statuswere evaluated. Detailed history and examination including visual acuity, anterior segment andfundus examination with direct and indirect ophthalmoscope was conducted. Result:Majority of CKD cases were noted in the age group of more than 60 years (40%) with male predominance of 66%.Out of 50 cases, 13(26%) were hypertensives, 8(16%) were diabetics and 3 patients had both.Out of 50 patients,6(12%) and 13(26%) showed signs of hypertensive and diabetic retinopathy respectively. Retinal detachment was noted in 2 patients, one had signs of pathological myopia and vitreous hemorrhage was noted in 1 patient. Conclusion:Most patients of CKD are detected in advanced stages. Hence it becomes imperative to detect CKD at an early stageand retard the progress of renal disease. Eye can be used as a window to kidney status so that necessary treatment can be given before irreversible changes occur. Thus, early ocular screening is of utmost importance in such patients.

Parallel Multi-Path Network for Ocular Disease Detection Inspired by Visual Cognition Mechanism.

Various ocular diseases such as cataracts, glaucoma, and diabetic retinopathy have become several major factors causing non-congenital visual impairment, which seriously threatens people's vision health. The shortage of ophthalmic medical resources has brought huge obstacles to large-scale ocular disease screening. Therefore, it is necessary to use computer-aided diagnosis (CAD) technology to achieve large-scale screening and diagnosis of ocular diseases. In this work, inspired by the human visual cognition mechanism, we propose a parallel multi-path network for multiple ocular diseases detection, called PMP-OD, which integrates the detection of multiple common ocular diseases, including cataracts, glaucoma, diabetic retinopathy, and pathological myopia. The bottom-up features of the fundus image are extracted by a common convolutional module, the Low-level Feature Extraction module, which simulates the non-selective pathway. Simultaneously, the top-down vessel and other lesion features are extracted by the High-level Feature Extraction module that simulates the selective pathway. The retinal vessel and lesion features can be regarded as task-driven high-level semantic information in the physician's disease diagnosis process. Then, the features are fused by a feature fusion module based on the attention mechanism. Finally, the disease classifier gives prediction results according to the integrated multi-features. The experimental results indicate that our PMP-OD model outperforms other state-of-the-art (SOTA) models on an ocular disease dataset reconstructed from ODIR-5K, APTOS-2019, ORIGA-light, and Kaggle.