Ophthalmic Assessment Research Articles

Brain MRI and Ophthalmic Biomarkers of Intracranial Pressure.

To evaluate the utility of brain MRI and ophthalmic biomarkers for the prediction of intracranial hypertension, we have studied the association between 6 biomarkers and 24-hour intracranial pressure (ICP) monitoring results in 45 patients. This single-center observational study includes patients who underwent 24-hour ICP monitoring, brain MRI (within 3 months), and ophthalmic assessment (during ICP monitoring). Six biomarkers were investigated: pituitary gland shape, vertical tortuosity of the optic nerve, distension of the optic nerve sheath, optic disc protrusion (MRI), papilledema (slit lamp biomicroscopy), and spontaneous venous pulsations (SVP, infrared video recordings). Forty-five patients (mean age 39 ± 14 years, 38 women) met the inclusion criteria. All 6 biomarkers had a significant association with 24-hour ICP. Concave pituitary gland was observed with moderately elevated median ICP. Protrusion of the optic disc (MRI), papilledema, and absence of SVP were associated with the highest median ICP values. Twenty patients had raised ICP (median 24-hour ICP >5.96 mm Hg, cutoff obtained through Youden index calculation). Patients with all normal biomarkers had normal median ICP in 94% (standard error 6%) of the cases. All patients with ≥3 abnormal biomarkers had intracranial hypertension. The combination of at least 1 abnormal biomarker in MRI and ophthalmic assessments was highly suggestive of intracranial hypertension (area under the curve 0.94, 95% confidence interval 0.93-0.94) CONCLUSIONS: Brain MRI and ophthalmic biomarkers can noninvasively guide the management of patients with suspected CSF dynamics abnormalities. Patients with multiple abnormal biomarkers (≥3) or a combination of abnormal MRI and ophthalmic biomarkers are likely to have intracranial hypertension and should be managed promptly.

Evaluation of Shared Genetic Susceptibility to High and Low Myopia and Hyperopia

Uncertainty currently exists about whether the same genetic variants are associated with susceptibility to low myopia (LM) and high myopia (HM) and to myopia and hyperopia. Addressing this question is fundamental to understanding the genetics of refractive error and has clinical relevance for genotype-based prediction of children at risk for HM and for identification of new therapeutic targets. To assess whether a common set of genetic variants are associated with susceptibility to HM, LM, and hyperopia. This genetic association study assessed unrelated UK Biobank participants 40 to 69 years of age of European and Asian ancestry. Participants 40 to 69 years of age living in the United Kingdom were recruited from January 1, 2006, to October 31, 2010. Of the total sample of 502 682 participants, 117 279 (23.3%) underwent an ophthalmic assessment. Data analysis was performed from December 12, 2019, to June 23, 2020. Four refractive error groups were defined: HM, -6.00 diopters (D) or less; LM, -3.00 to -1.00 D; hyperopia, +2.00 D or greater; and emmetropia, 0.00 to +1.00 D. Four genome-wide association study (GWAS) analyses were performed in participants of European ancestry: (1) HM vs emmetropia, (2) LM vs emmetropia, (3) hyperopia vs emmetropia, and (4) LM vs hyperopia. Polygenic risk scores were generated from GWAS summary statistics, yielding 4 sets of polygenic risk scores. Performance was assessed in independent replication samples of European and Asian ancestry. Odds ratios (ORs) of polygenic risk scores in replication samples. A total of 51 841 unrelated individuals of European ancestry and 2165 unrelated individuals of Asian ancestry were assigned to a specific refractive error group and included in our analyses. Polygenic risk scores derived from all 4 GWAS analyses were predictive of all categories of refractive error in both European and Asian replication samples. For example, the polygenic risk score derived from the HM vs emmetropia GWAS was predictive in the European sample of HM vs emmetropia (OR, 1.58; 95% CI, 1.41-1.77; P = 1.54 × 10-15) as well as LM vs emmetropia (OR, 1.15; 95% CI, 1.07-1.23; P = 8.14 × 10-5), hyperopia vs emmetropia (OR, 0.83; 95% CI, 0.77-0.89; P = 4.18 × 10-7), and LM vs hyperopia (OR, 1.45; 95% CI, 1.33-1.59; P = 1.43 × 10-16). Genetic risk variants were shared across HM, LM, and hyperopia and across European and Asian samples. Individuals with HM inherited a higher number of variants from among the same set of myopia-predisposing alleles and not different risk alleles compared with individuals with LM. These findings suggest that treatment interventions targeting common genetic risk variants associated with refractive error could be effective against both LM and HM.

Relationship between ophthalmic artery Doppler and maternal cardiovascular function.

In mid-gestation, the finding of an increase in the ophthalmic artery second to first peak of systolic velocity ratio (PSV ratio) provides useful prediction of subsequent development of pre-eclampsia (PE). The objective of this study of an unselected population at 19-23 weeks' gestation was to gain a better understanding of the factors that influence ophthalmic artery Doppler by examining the possible association between the PSV ratio and maternal cardiovascular function. This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries and assessment of maternal cardiovascular function. The following nine cardiovascular indices were examined: E/A ratio; E/e' ratio; myocardial performance index; global longitudinal systolic strain; left ventricular ejection fraction; peripheral vascular resistance; left ventricular cardiac output; left ventricular mass indexed for body surface area; and mean arterial pressure. The ophthalmic artery PSV ratio and the nine cardiovascular indices were converted to either log10 multiples of the median (MoM) values or deviations from the median (deltas) values after adjustment for maternal characteristics and elements of medical history. Regression analysis was then used to examine the significance of the association between PSV ratio delta and MoM or delta values of each cardiovascular index in the total population and in the subgroup that developed PE. The study population of 2853 pregnancies contained 76 (2.7%) that developed PE. In the total population, there were significant but weak associations between the PSV ratio and most of the cardiovascular indices, with r-values of < 0.1, except for mean arterial pressure with r = 0.178. In the subgroup that developed PE, a moderately strong association between the PSV ratio and left ventricular mass indexed for body surface area was noted (r = 0.308). The findings of this study suggest that Doppler assessment of PSV ratio in the ophthalmic artery provides information about peripheral vascular status. The increase in PSV ratio in women who develop PE is associated with increased afterload and an increase in left ventricular thickness. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Ophthalmic Assessment in Patients With Darier Disease

To assess the prevalence of ophthalmic findings in patients with Darier disease, an autosomal dominant genetic skin disorder, in an effort to evaluate the need for eye examinations in the management of the disease. Prospective observational case series. Thirty-six individuals with Darier disease were evaluated by both ocular assessment questionnaire and a comprehensive ophthalmic examination (visual acuity, refraction, external examination, and slit-lamp examination) with emphasis on the eyelids, conjunctiva, and cornea. In addition, questionnaire-based medical interview and skin examination were conducted. According to the medical questionnaire, 39% of patients reported eye problems, 36% dry eye, and 42% eye fatigue after prolonged reading. Ocular examination revealed Darier disease lesions on the eyelids in 55% of the patients, blepharitis in 44%, conjunctival hyperemia in 28%, and short tear film break-up time in 83%. There was no significant relationship between any of these ophthalmic findings and systemic retinoid therapy, sex, or age. The high prevalence of blepharitis and dry eye highlights the importance of ophthalmologic evaluation of patients with Darier disease.

Retrospective analysis of ophthalmology referrals during the COVID-19 pandemic compared to prepandemic

ObjectiveThis study was conducted to analyse emergency ophthalmology referrals to a Canadian tertiary academic centre during the current coronavirus disease 2019 (COVID-19) pandemic in comparison to prepandemic referrals. DesignThis was a retrospective chart review looking at emergency referrals seen by the ophthalmology service between March 18 to April 17, 2020 (representing the COVID-19 period), and March 18 to April 17, 2019 (representing the pre-COVID-19 period). MethodsData gathered from referral records included patient demographics, timing and site of referral, and ophthalmic diagnosis. Referrals were categorized as urgent or nonurgent, with urgent indicating the need for ophthalmic assessment within 24 hours. ResultsThe total number of referrals decreased by 54.2% in the COVID-19 period versus the pre-COVID-19 period. There was a similar bimodal age distribution in both periods, with fewer patients over 65 years of age presenting during the pandemic. Tertiary hospital referrals decreased by 62% in the pandemic period, while nontertiary emergency department referral trends varied and outpatient clinic referrals increased by 16%. Overall, there was a significant shift in the distribution of referral sites (p = 0.04). The proportion of urgent referrals increased by 14% during the pandemic; this was not statistically significant. There was no significant change in the timing of referrals or in the distribution of diagnostic segments. ConclusionsThis study offers insight into the impact of the COVID-19 pandemic on ophthalmology referral patterns in a Canadian context. Moving forward, it helps to guide resource allocation and public education on the importance of seeking necessary eye care.

Three-dimensional ophthalmic artery model reconstruction and assessment captured by computed tomographic angiography in non-arteritic anterior ischemic optic neuropathy patients.

BackgroundThe ophthalmic artery (OA) was first reconstructed using computer software. The structural differences of ophthalmic arteries in non-arteritic anterior ischemic optic neuropathy (NAION) and normal eyes, in addition to hemodynamic alterations, were assessed.MethodsThirty-one NAION eyes, 19 uninvolved eyes with NAION, and a control group of 26 healthy eyes were retrospectively included. Computed tomographic angiography data were recorded, and corresponding three-dimensional OA models were constructed. Initial OA and internal carotid artery (ICA) diameters and the angle between them were analyzed. Three different OA models were used to evaluate hemodynamic performance. The statistical relationships between the initial diameters of the OA and ICA and the angle between the OA and ICA were described.ResultsOA diameters in NAION eyes were significantly smaller than those in both uninvolved and healthy eyes (P<0.05). There was no significant difference between uninvolved and healthy eyes (P=0.31). The initial ICA diameter and the angle between the OA and ICA did not significantly differ among the three groups. In the three models, the blood flow velocity in the initial ophthalmic arteries of uninvolved eyes was higher than that in the NAION eyes. The mass flows of the right and left ophthalmic arteries, accounting for the ipsilateral ICA in the control model, were 0.57%. However, these values in uninvolved and NAION eyes were 1.36% and 0.25%, respectively.ConclusionsNAION is associated with a smaller initial OA diameter, which may be related to hypoperfusion. To our knowledge, this is the first pilot study to analyze hemodynamic alterations using OA models.

Relationships between retinal layer thickness and brain volumes in the UK Biobank cohort.

Background and purposeCurrent methods to diagnose neurodegenerative diseases are costly and invasive. Retinal neuroanatomy may be a biomarker for more neurodegenerative processes and can be quantified in vivo using optical coherence tomography (OCT), which is inexpensive and noninvasive. We examined the association of neuroretinal morphology with brain MRI image‐derived phenotypes (IDPs) in a large cohort of healthy older people.MethodsUK Biobank participants aged 40 to 69 years old underwent comprehensive examinations including ophthalmic and brain imaging assessments. Macular retinal nerve fibre layer (mRNFL), macular ganglion cell‐inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and total macular thicknesses were obtained from OCT. Magnetic resonance imaging (MRI) IDPs assessed included total brain, grey matter, white matter and hippocampal volume. Multivariable linear regression models were used to evaluate associations between retinal layers thickness and brain MRI IDPs, adjusting for demographic factors and vascular risk factors.ResultsA total of 2131 participants (mean age 55 years; 51% women) with both gradable OCT images and brain imaging assessments were included. In multivariable regression analysis, thinner mGCIPL, mGCC and total macular thickness were all significantly associated with smaller total brain (p < 0.001), grey matter and white matter volume (p < 0.01), and grey matter volume in the occipital pole (p < 0.05). Thinner mGCC and total macular thicknesses were associated with smaller hippocampal volume (p < 0.02). No association was found between mRNFL and the MRI IDPs.ConclusionsMarkers of retinal neurodegeneration are associated with smaller brain volumes. Our findings suggest that retinal structure may be a biomarker providing information about important brain structure in healthy older adults.

Surgical Transplantation of Human RPE Stem Cell-Derived RPE Monolayers into Non-Human Primates with Immunosuppression.

SummaryRecent trials of retinal pigment epithelium (RPE) transplantation for the treatment of disorders such as age-related macular degeneration have been promising. However, limitations of existing strategies include the uncertain survival of RPE cells delivered by cell suspension and the inherent risk of uncontrolled cell proliferation in the vitreous cavity. Human RPE stem cell-derived RPE (hRPESC-RPE) transplantation can rescue vision in a rat model of retinal dystrophy and survive in the rabbit retina for at least 1 month. The present study placed hRPESC-RPE monolayers under the macula of a non-human primate model for 3 months. The transplant was able to recover in vivo and maintained healthy photoreceptors. Importantly, there was no evidence that subretinally transplanted monolayers underwent an epithelial-mesenchymal transition. Neither gliosis in adjacent retina nor epiretinal membranes were observed. These findings suggest that hRPESC-RPE monolayers are safe and may be a useful source for RPE cell replacement therapy.

Topiramate-induced ocular side effects in Egyptian patients, idiosyncratic versus dose-dependent effect, a prospective study

BackgroundTo test the nature of the ocular side effects induced by topiramate (TPM) whether dose dependent or idiosyncratic, and to test various predictors that might influence the occurrence of those side effects.MethodsTwenty patients treated with TPM were included in this study. Patients underwent ophthalmic assessment before and after 4 weeks of treatment by stable doses of oral TPM. We examined non-cycloplegic refraction (RF) in diopters, best corrected visual acuity (BCVA), intraocular pressure (IOP) in mmHg, and anterior chamber depth (ACD) in mm.ResultsThere were no statistically significant differences between baseline and follow-up assessments in all tested ophthalmological parameters including errors of RF, ACD, IOP, and the BCVA. One case suffered from painful drop of vision in both eyes with elevated IOP and decreased ACD, and evident myopic shift 1 week after treatment with small dose of TPM. There was no significant effect of age, TPM dose, disease, and gender on all tested variables.ConclusionTPM can induce idiosyncratic, but not dose dependent, ocular side effects, namely myopic shifts and angle closure glaucoma. Those side effects were not disease, age, or gender dependent. However, ethnicity might play a role in induction of those side effects.

Sickle cell retinopathy: Patient awareness, mode of presentation, and treatment modalities in Ibadan, South-West Nigeria

Background: Sickle cell retinopathy is a recognized complication of sickle cell disease (SCD) which may lead to visual impairment or blindness. Despite this, many patients with SCD hemoglobinopathy SC and SS are unaware of their genotype, hence resulting in only occasional or no eye checks with possibilities of getting blind. Purpose: The purpose of this study was to describe the genotype awareness, pattern of presentation, and treatment of sickle cell retinopathy in Ibadan. Methods: This was a retrospective review of the case notes of 64 patients with the diagnosis of sickle cell retinopathy seen over two years (January 2018 to December 2019). Sociodemographic characteristics, clinical data, ophthalmic assessment, and treatment performed on patients were extracted onto pro forma. Information obtained included age, sex, sickle cell genotype, genotype awareness from their medical history, retinal findings using Goldberg classification, and treatment modalities for the patients. Data analysis was performed using the IBM SPSS software version 22. Analysis was done using proportions and percentages. Results: Medical records of 64 patients were reviewed. The mean age of the patients was 39.05 ± 10.48 (range: 20–65) years, with a male-to-female ratio of 1.8:1. Sixty (93.8%) patients had genotype SC. Forty-six (71.8%) patients were aware of their genotype. Fifty-six patients presented with Proliferative sickle cell retinopathy (PSR) in the right eye, while 55 had PSR in the left eye. These spanned all the different grades of PSR. Treatment offered at the first visit included laser photocoagulation, intravitreal anti-vascular endothelial growth factor (bevacizumab), vitrectomy, and scleral buckle. At subsequent follow-up visits, detailed ocular examination on patients was done to look out for new/active lesions. If any of these lesions were found, repeat or additional treatment was offered to help stabilize and/or improve the best-corrected visual acuity of patients. Conclusion: This study has demonstrated high genotype awareness among the studied patients. Despite this high awareness, majority of our patients presented with varying stages of proliferative sickle cell retinopathy. While our patients had more than one type of treatment, some defaulted due to lack of funds. Therefore, to improve the quality of life of SCD patients, it is essential for health-care providers and other stakeholders to design policies for sustainable and accessible eye care programs to avoiding needless blindness from sickle cell retinopathy.

The influence of COVID-19 lockdowns on presentation with spontaneous posterior vitreous detachment to the emergency department in Italy.

The purpose of the study was to analyze the frequency of the spontaneous posterior vitreous detachment (PVD) in patients admitted to an Emergency Eye Department in Italy (EED) during the COVID-19 pandemic national lockdown in 2020 compared with the similar time period in 2019. In this retrospective observational study, patient records for ophthalmology EED patients in the month of April 2020 during the COVID-19 Italian national lockdown, were compared with those for an equivalent one-month period in 2019. Diagnoses, gender, and age were assessed. Unpaired Student t-tests were used for continuous variables. Poisson regression was used for count analysis to compare categorical variables. Chi-square test was applied to asses proportion differences. In comparison with the 2019 equivalent period, there was a significant decrease in the overall number of EED visits and in the number of patients presenting with a spontaneous PVD during the 2020 lockdown (-41.6% and -49%, respectively). During the 2020 lockdown, all diagnostic categories showed less patient admittance, however, the proportions remained stable when considering the entire cohort. The proportion of urgent visits was 90% in 2020 and 86% in 2019 (p = 0.66). The proportion of EED patients affected by spontaneous PVD was comparable between the two study periods (8.4% in 2020 vs. 9.6% in 2019, p = 0.34). Patients presenting with spontaneous PVD in both periods were significantly older when compared to patients with other pathologies (mean age of 63years in 2020 and 64years in 2019, p < 0.001). There was a significant bias in female gender (61.2% in 2019 and 60% in 2020, p < 0.05). There was a significant decrease of accesses to the EED during COVID-19 2020 lockdown. Patients affected by spontaneous PVD were about 50% less compared with the same period of 2019. Risk factors for the development of spontaneous PVD were older age and female gender. PVD represents a potentially visual function threatening condition because it can cause retinal ruptures and retinal detachment. Patients need to be educated to get urgent ophthalmic assessments in the presence of important acute signs and symptoms, like floaters and flashes, even in the presence of a lockdown.

Brazilian guidelines on the frequency of ophthalmic assessment and recommended examinations in healthy children younger than 5 years

To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

Visual Deficiency in Wallenberg’s Syndrome

The aim of this case report of a 47-year-old woman who suffered from acute right-sided medullar ischemic stroke was to define the range of visual impairment in Wallenberg’s syndrome (WS). The patient complained of unbearable environmental tilt and rotating visual perception. On examination, 11 months following the stroke, the patient manifested rightsided postural inclination and gaze ipsipulsion. The fixation in primary position was unstable, after a conjugate ipsipulsion ensued, spontaneous corrective saccades and a horizontal-rotational jerking nystagmus beating away from the side of the lesion were generated. Monocular visual acuity (right eye: 0.4 logMAR distance and 0.2 logMAR near; left eye: 0.1 logMAR distance and 0.0 logMAR near) was significantly better than binocular (0.63 logMAR distance and near). Fluent reading was impossible. Contralateral smooth pursuits were more impaired. Saccades were defective manifesting right hypermetria and left hypometria. Visual field was constricted to central 10 – 20°. A diagnosis of Wallenberg’s syndrome was made. Occlusion was prescribed. Review of literature demonstrated lack of evidence-based guidelines for ophthalmic assessment and treatment of visual impairment in WS. Oculomotor abnormalities, oscillopsia and tilt illusion cause significant impact to daily life. Early post-stroke ophthalmological evaluation is thus mandatory in order to offer timing treatment.

Ocular disorders in children with learning disabilities in a tertiary Hospital, Pondicherry

Aim: To assess the visual function of the children with disabilities and to identify the preventable and treatable ocular abnormalities. Materials and Methods: This was a cross sectional hospital based study which included the children aged between 3 to 16 years with learning disabilities (cLDs, previously referred to as mentally challenged) who were on speech and occupational therapy sessions. After consent from parents or guardian who accompanied the child, relevant medical history was taken. Detailed ocular examination, visual acuity assessment, cycloplegic retinoscopy of all children was done. Spectacles and low vision aids were prescribed appropriately. Results: A total of 116 children with learning disabilities were enrolled. There were 79 (68.1%) males as compared to 37 (31.9%) females in the study. Eighty eight children (76%) had ocular disorder, 31 children had more than one ocular abnormality and 51 of them were not cooperative for assessment. The most common ocular disorders seen in these children were 48 (54.5%) children had refractive errors, strabismus in 17 (19.3%) children, followed by nystagmus in 15 (17%) children, Only 7 of the 48 children (14.6%) with refractive error were using spectacles. Conclusion: The prevalence of ocular abnormalities is higher among the children with disabilities than in general population. Their flawed verbal, poor communication and cooperation add on to the burden of their disabilities as the ocular abnormalities go unnoticed. Therefore there is a need for strategies regarding increasing awareness, annual comprehensive ophthalmic assessments, early detection and treatment of the ocular disorders to assist these children in their learning process. Keywords: Children with learning disabilities, Refractive error, Strabismus, Special needs.

LINC-34. OPTIC NERVE INFILTRATION: RARE MANIFESTATION OF CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA IN REMISSION

BACKGROUNDOptic nerve infiltration in acute lymphoblastic leukemia is a rare manifestation. This infiltration may appear months in advance as an isolated sign of extramedullary relapse and considered as one of the significant clinical findings of central nervous system leukemia. AIM: To describe a case of rapidly progressive optic nerve infiltration in a girl with ALL in remission. CASE: A 13-year-old girl in full remission following treatment for B-cell acute lymphoblastic leukemia presented with decreased vision and proptosis on the left eye. She completed the chemotherapy course two years before. On physical examination, we found the optic disc swelling in her left eyes. There were no signs of relapse from the hematological, cerebrospinal fluid analysis, and bone marrow aspiration. The orbital CT found a mass on the left retrobulbar (size 29x48x32 mm), suspected of optic nerve glioma. The mass has grown rapidly in a month, and she lost her left sight. The involved eye was exenterated (60x55x40 mm). The histopathology and immunohistochemistry showed the B-cell acute lymphoblastic lymphoma. Unfortunately, the patient could not come for further follow up due to the COVID-19 large-scale social distancing. Two months later, she came with pallor and pain in all of her body. The bone marrow aspiration showed leukemic relapse and she is undergoing chemotherapy.CONCLUSIONOptic nerve infiltration by leukemia requires both diagnostic certainty and urgent management. A routine ophthalmic assessment is recommended in patients with a history of acute lymphoblastic leukemia to diagnose optic nerve involvement due to leukemic infiltration.

Ocular Discomfort and Quality of Life Among Patients in the Dry Eye Assessment and Management Study.

To assess the association of severity of ocular discomfort with measures of quality of life among patients with moderate to severe dry eye disease (DED). This is a prospective, observational, cohort study within a randomized clinical trial. Patients (N = 535) in the Dry Eye Assessment and Management study with moderate to severe DED completed the Ocular Surface Disease Index on DED symptoms, the SF-36 on quality of life, and the Brief Ocular Discomfort Inventory questionnaire and had a comprehensive ophthalmic assessment by a study-certified clinician. The ocular discomfort on average over the past week was scored on an 11-point scale (0 for no discomfort and 10 for discomfort as bad as you can imagine). The average ocular discomfort scores for patients ranged from 0 to 10, with a mean of 4.28. Discomfort scores did not vary with demographic characteristics, signs of DED, self-reported depression, or self-reported nonocular pain conditions. Ocular discomfort scores did correlate moderately to strongly with total Ocular Surface Disease Index scores (Spearman correlation coefficient, rs, 0.47-0.67) and with measures of interference with activities of daily living [general activity level, mood, walking ability, ability for normal work, relations with other people, sleep, and enjoyment of life (rs = 0.39-0.65)]. Among patients in the Dry Eye Assessment and Management study, worse ocular discomfort was associated with worse overall DED symptoms and interfered to a greater degree with activities of daily living. Ocular discomfort is an important part of the assessment of patients with DED.

Clinical characteristics of dry eye with ocular neuropathic pain features: comparison according to the types of sensitization based on the Ocular Pain Assessment Survey

BackgroundTo compare the clinical characteristics of dry eye patients with ocular neuropathic pain features according to the types of sensitization based on the Ocular Pain Assessment Survey (OPAS).MethodsCross-sectional study of 33 patients with dry eye and ocular neuropathic pain features. All patients had a comprehensive ophthalmic assessment including detailed history, the intensity and duration of ocular pain, the tear film, ocular surface, and Meibomian gland examination, and OPAS. Patients with < 50% improvement in pain intensity after proparacaine challenge test were assigned to the central-dominant sensitization group (central group) and those with ≥50% improvement were assigned to the peripheral-dominant sensitization group (peripheral group). All variables were compared between the two groups.ResultsNo significant differences were observed in age, sex, underlying diseases, history of ocular surgery, duration of ocular pain, tear film, ocular surface and Meibomian gland parameters (all p > 0.05). Ocular pain and non-ocular pain severity and the percentage of time spent thinking about non-ocular pain were significantly higher in the central group than in the peripheral group (all p < 0.05). Central group complained more commonly of a burning sensation than did the peripheral group (p = 0.01).ConclusionsPatients with central-dominant sensitization may experience more intense ocular and non-ocular pain than the others and burning sensation may be a key symptom in those patients.

Sutureless scleral fixation: comparison between 3-piece IOL and new single-piece foldable IOL.

Comparing two different sutureless scleral fixation techniques. A retrospective study of patients who underwent sutureless scleral fixation IOL from October 2013 to May 2018 at "Luigi Sacco Hospital", University of Milan. Comparison between two groups: Group 1 implanted with a 3-piece ALCON-MA60AC and group 2 implanted with a newly developed single-piece foldable IOL SOLEKO FIL-SSF. Patients underwent a complete preoperative ophthalmic assessment and post-operative evaluation at 1, 3, and 6months. Vitrectomy was performed in all cases. The two groups were compared for age, axial length, and lens status at baseline. Visual acuity, refractive results, surgical time, and post-operative complications were recorded. Thirty-one eyes were included: group 1, 15 eyes of 15 patients, and group 2, 16 eyes of 14 patients. No difference was found in visual acuity. Mean refractive error was 1D in both groups (group 1 1.01D, group 2 1.09D), but spherical equivalent was more often moved toward negative values and induced astigmatism was greater in the 3-piece group (group 1 1.91D [SD ± 2.07], group 2 0.67D [SD ± 0.88] P = 0.04). Surgical procedure was faster in group 2 (mean time difference 21', P = 0.01*). New displacement occurred in 5 cases (33%) of group 1 and in no cases of group 2 (P = 0.01*). Post-operative bleeding was registered only in group 1 (20%), but the difference was not statistically significant. The group 2 IOL gives in our sample better results due to less post-operative astigmatism and reducing dislocation and bleeding during follow-up. Surgical technique appeared easier and faster: the specifically designed IOL seems to be a feasible solution for sutureless scleral fixation.

Clinical effectiveness of intrastromal corneal ring segments among keratoconus patients

AIM: To evaluate the clinical effectiveness of intrastromal corneal ring segments (ICRS) among the patients suffering from keratoconus. METHODS: A retrospective and non-comparative interventional design had been utilized on the basis of postoperative follow-up among 56 keratoconus patients. Visual acuity was significantly assessed during complete ophthalmic examination of the patients. The femtosecond laser had been used to create the corneal tunnels in 15 eyes; whereas, the corneal tunnels were created in 72 eyes mechanically. RESULTS: The ranges and standard deviations had been used to obtain results. It had been revealed through ophthalmic assessment that the mean preoperative uncorrected visual acuity observed was 1.38±0.37 logarithm of Minimal Angle of Resolution. Moreover, a significant improvement was observed postoperatively in visual acuity by 0.58±0.32 during the 4th month. The improvement was also witnessed in the 16th month by 0.48±0.30. CONCLUSION: The implantation of ICRS is an efficient and effective surgical intervention for the treatment of keratoconus. Thus, identified intervention seems to be associated with appropriate visual outcomes and safety after the development of femtosecond as well as mechanical tunnels.

Using non-mydriatic fundus photography to detect fundus pathology in Australian metropolitan emergency departments: A prospective prevalence and diagnostic accuracy study.

To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review. Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review. A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs. Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.