Ophthalmology Clinic Research Articles

Machine learning technology for predicting intraocular lens power. Diagnostics data generalization

Backgraund. Implantation of recent IOLs allows ophthalmologists to effectively solve the problems of surgical rehabilitation of patients with cataracts. The degree of improving the patient's visual functions is directly dependent on the accuracy of the preoperative calculation of the optical power of IOLs. The most famous formulas to calculate this indicator are SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett. All of them work well for an "average patient", however, they are not adequate enough at the boundaries of input variables ranges.
 Aims. To study the possibility of using mathematical models obtained as a result of deep learning of artificial neural networks (ANN models) to generalize data and predict the optical power of modern intraocular lenses.
 Materials and methods. ANN models were trained on large-scale samples, including depersonalized data for patients of ophthalmology clinic. Data provided in 2021 by ophthalmologist K.K. Syrykh, and reflect the results of both preoperative and postoperative observation of patients. The source file used to build the ANN model includes 455 records - 26 columns of input factors and one column for the output factor - calculating IOL (diopters). To conveniently build ANN models, we used a simulator program, previously developed by the authors.
 Results. The resulting models, in contrast to the traditionally used formulas, reflect the regional specificity of patients to a much greater extent. They also make it possible to retrain and optimize the structure based on newly received data, which allows taking into account the non-stationarity of the object. A distinctive feature of such ANN models in comparison with the well-known formulas SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett, widely used in the surgical cataract treatment in ophthalmology, is their ability to take into account a significant number of recorded input quantities, which makes it possible to reduce the mean relative error in calculating the optical power of IOL from 10–12% to 3.5%.
 Conclusions. This work shows the fundamental possibility of generalizing a significant amount of empirical data on calculating the optical power of the IOL using training ANN models that have a significantly larger number of input variables than when using traditional formulas and methods. The results obtained allow, in principle, to build an intelligent expert system with a continuous flow of new data from a source and a step-by-step retraining of the ANN model.

Risk Factors for Retinopathy of Prematurity in Preterm Infants in Kerman, Iran.

Retinopathy of prematurity (ROP) is the main cause of blindness in premature infants. Despite developments in neonatal care and management guidelines, ROP is becoming increasingly prevalent worldwide. Hence, the identification of risk factors for ROP is critical to diminish the burden of the disease. This cross-sectional study included all infants with gestational age 36 weeks referred to the ophthalmology clinic at Shafa hospital, Kerman, Iran from 2014 to 2015. Ophthalmologic examinations were performed followed by demographic and ophthalmic data collection and analysis. A total of 579 preterm neonates were screened including 325 boys and 254 girls. The incidence of ROP was 17.96%. Mean birth weight (BW) and gestational age (GA) were 1668.0 grams and 31.2 weeks, respectively. The results indicated that BW, GA, duration of hospitalization and oxygen therapy were significantly related to the development of ROP, however, after multivariate logistic regression analysis, only BW and duration of hospitalization remained significant. There were no significant associations between gender, type of delivery, or assisted reproductive technologies, and ROP (P = 0.461, 0.461, and 0.826, respectively). BW and duration of hospitalization were significant risk factors for ROP in the current study. BW was also strongly associated with the need for therapy.

Surgical therapy and pathogen detection in endogenous endophthalmitis : Analysis of data from five German eye hospitals

Endogenous endophthalmitis results from hematogenous spread of bacterial or fungal infection in severely diseased patients. Specific systemic and intraocular therapy is required. The basis for this treatment is causal pathogen detection in blood culture or vitreous sample. However, functional results are limited. The current article provides practical hints for surgical therapy and pathogen detection in patients with endogenous endophthalmitis. Aretrospective analysis of anonymous data of 68male and female patients from 2018-2023 from five ophthalmology clinics in Germany was performed. Mean age of affected patients was 71.4years (31-96years). Surgical therapy included pars plana vitrectomy (ppV) and intravitreal injection (IVOM). In 44of 68patients (65%), 1-3 surgeries were performed, 4-6surgeries were required in 14/68 (21%) of patients, and 10or more surgeries were required in 4/68patients (6%). Pathogen detection was possible in 34% of vitreous specimens and in 11% of anterior chamber samples. Mean initial visual acuity was logMAR1.5. After treatment and amean follow-up of 2.5months, mean visual acuity was logMAR1.3. Preanalytical methods for specimen collection like the Freiburg endophthalmitis set to optimize pathogen detection are presented. Severe inflammatory intraocular reactions in endogenous endophthalmitis necessitate acombination of ppV and repeated IVOM. In addition to providing avitreous sample, ppV also serves to remove inflammatory fibrin membranes. Early pars plana vitrectomy with specific antibiotic or antifungal therapy should be sought in addition to the focus search and systemic therapy.

The utilization of artificial intelligence in glaucoma: diagnosis versus screening.

With advancements in the implementation of artificial intelligence (AI) in different ophthalmology disciplines, it continues to have a significant impact on glaucoma diagnosis and screening. This article explores the distinct roles of AI in specialized ophthalmology clinics and general practice, highlighting the critical balance between sensitivity and specificity in diagnostic and screening models. Screening models prioritize sensitivity to detect potential glaucoma cases efficiently, while diagnostic models emphasize specificity to confirm disease with high accuracy. AI applications, primarily using machine learning (ML) and deep learning (DL), have been successful in detecting glaucomatous optic neuropathy from colored fundus photographs and other retinal imaging modalities. Diagnostic models integrate data extracted from various forms of modalities (including tests that assess structural optic nerve damage as well as those evaluating functional damage) to provide a more nuanced, accurate and thorough approach to diagnosing glaucoma. As AI continues to evolve, the collaboration between technology and clinical expertise should focus more on improving specificity of glaucoma diagnostic models to assess ophthalmologists to revolutionize glaucoma diagnosis and improve patients care.

Looking beyond blurred margins

A 60-year-old man presented to an outside ophthalmology clinic with 1 month of progressive vision loss in the right eye (OD). Right optic disc edema was noted. Brain and orbit magnetic resonance imaging revealed right optic nerve and left occipital lobe enhancement. He was seen initially by neurology and neurosurgery and subsequently referred to neuro-ophthalmology for consideration of optic nerve biopsy. He was seen 3 months after his initial symptom onset where vision was light perception OD and a relative afferent pupillary defect with optic nerve edema. OS was unremarkable. A lumbar puncture with flow cytometry was negative for multiple sclerosis and lymphoma. At his oculoplastic evaluation for optic nerve biopsy, his vision was noted to be no light perception OD. Optic nerve biopsy demonstrated non-caseating granulomatous inflammation consistent with neurosarcoidosis. The patient was started on high-dose oral steroids with improvement of disc edema, as well as significant improvement in optic nerve and intracranial parenchymal enhancement, although his vision never improved.

Naevi Characterization Using Hyperspectral Imaging: A Pilot Study

Purpose The prevalence of choroidal naevi is common and has been found to be up to 10%. Little is known regarding the optical properties of choroidal naevi. A novel hyperspectral eye fundus camera was used to investigate choroidal naevi’s optical density spectra in the retina. Methods In an ophthalmology clinic setting, patients with choroidal naevi were included in the study. Visual acuity and pressure were tested. Following mydriatics, optical coherence tomography and fundus photography were taken as a reference, after which a hyperspectral image with 12 nm spectral resolution at 450–700 nm was taken. The optical density spectra was measured across the area of the naevus. Results Nine patients with 11 naevi were examined. The visual acuity was not affected by any of the naevi. All the naevi were flat as measured either with the optical coherence tomography and/or on inspection, and only one naevi had a risk factor (orange pigmentation). The Wasserstein distance between the background and the naevi was higher at 695 nm compared to 555 nm (p = .002). The naevi could be grouped into three clusters based on the extracted optical density spectra. Conclusion Choroidal naevi are better visible in longer wavelengths compared to shorter wavelengths. This finding can be used to contour and follow choroidal naevi. Choroidal naevi expose different optical density spectra that can be grouped into three different clusters. One of these clusters has an optical density spectra resembling the absorption spectra of lipofuscin, which may indicate the content of this pigment.

Comparison of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve implantation.

To compare the efficacy and complications of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve (AGV) implantation. This retrospective study included 44 refractory glaucoma patients (44 eyes) who underwent AGV implantation from 2017 to 2020 in the Ophthalmology Clinic of Eskişehir Osmangazi University Hospital and attended regular postoperative follow-ups. The patients were divided based on whether they underwent Tenon duplication technique (group 1: n = 20) or dura mater covering technique (group 2: n = 24) during surgery. The patients' age, gender, systemic diseases, glaucoma type, pre-op intraocular pressure (IOP), and ocular surgeries were recorded. The groups were compared for IOP level control, early and late complications, postoperative antiglaucomatous medication requirements, glaucoma surgery requirements, presence of postoperative hypertensive phase (HP), and surgical success which was defined as an IOP ≥5 and ≤21 mmHg, with or without antiglaucoma medication. By the end of the mean follow-up (22.6 ± 10.6 months), the success rates were 95% (group 1) and 96% (group 2). The groups showed no differences in postoperative complications, postoperative antiglaucomatous drugs' onset time, additional glaucoma surgery, need for needling, presence of HP at 6 months postoperatively, and relationship between the glaucoma type and success rates ( P values: 0.86, 0.9, 0.48, 0.12, 0.36, and 0.8, respectively). The IO P values at the last follow-up were 15.2 ± 4.1 in group 1 and 14.7 ± 4.8 in group 2. The IOP reduction rates showed no significant differences. Since success and complications are similar in both Tenon duplication and dura mater covering technique, unique grafting materials may not be needed in AGV implantation surgery, except in special cases.

Adverse reactions of cycloplegic and mydriatic eye drops in routine ophthalmologic examination of pediatric patients in Saudi Arabia: A retrospective study and survey of pediatric ophthalmologists.

The purpose of this study was to explore the side effects of using cycloplegic eye drops at ophthalmology clinics at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Moreover, to have an insight into physicians' attitude towards the management of these side effects. A retrospective cross-sectional study where medical records of pediatric patients who attended ophthalmology clinics at KSMC. Subjects were selected after reviewing their files and based on their reaction to the ocular drops. In addition, the response of ophthalmologists was obtained through a questionnaire distributed through electronic channels. A total of 111 patients' medical records were included in this study. The most reported cycloplegic agents that caused side effects were cyclopentolate 1%, tropicamide 1%, and phenylephrine 2.5%. Fifty-three percentage of physicians reported that changing their way of administering cycloplegic drops in practice plays a role in reducing some side effects. The most reported side effects of using cycloplegic eye drops were facial flushing 68%, followed by fever 46%, and irritability 38% of cases. Few children who experienced side effects needed medical intervention. Side effects caused by cycloplegic agents are usually mild and rarely severe. There are some systemic side effects such as hallucinations, psychosis, or seizures. Proper parental counseling before administering cycloplegic agents and proper clinical management in case of severe side effects is crucial. Prophylactic measures to reduce the incidence of these side effects are advisable.

Aflibercept 5+PRN with retinal laser photocoagulation is more effective than retinal laser photocoagulation alone and aflibercept 3+PRN with retinal laser photocoagulation in patients with high-risk proliferative diabetic retinopathy and diabetic macular edema: a 12-month clinical trial.

This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept 5+PRN in patients with both high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Overall, 170 patients with high-risk PDR and DME (170 eyes from 170 patients) who visited our ophthalmology clinic from December 2018 to December 2020 were divided into the PRP (n=58), aflibercept 5+PRN with PRP (n=53), and aflibercept 3+PRN with PRP (n= 59) groups. General information, such as age, sex, and eye category, was obtained. Moreover, best-corrected visual acuity (BCVA), baseline central macular foveal thickness (CFT), microaneurysm (MA), area of neovascularization (NV), area of hard exudate (HE), and cytokine levels in atrial fluid before and after treatment, were assessed. The χ2 test was used for comparison between groups for statistical data. Analysis of variance was used for the statistical description of measurement data, independent samples were analyzed using Student's t-test, and Student-Newman-Keuls test was used for group comparisons. Differences were considered statistically significant at P < 0.05. After treatment, no significant improvement in the BCVA (logMAR) of patients in the PRP group was observed. The BCVA (log MAR) decreased from 0.72 ± 0.17 and 0.74 ± 0.17 to 0.50 ± 0.13 and 0.53 ± 0.17 in PRP with aflibercept 5+PRN and PRP with aflibercept 3+PRN groups, respectively, with a statistically significant difference compared to those in the PRP group (P<0.05 in all cases). However, no statistically significant difference was observed between the combined treatment groups (P>0.05). The CFT in the PRP-only group decreased slightly from 361.80 ± 36.70 μm to 353.86 ± 40.88 μm, with no statistically significant difference (P>0.05), whereas the CFT in the aflibercept 5+PRN with PRP and aflibercept 3+PRN with PRP groups decreased from 356.57 ± 37.57 μm and 358.17 ± 44.66 μm to 284.87 ± 31.52 μm and 303.19 ± 37.00 μm, respectively, with statistically significant differences before and after treatment (P<0.05 for both groups). Statistically significant differences were observed in CFT between the three groups after treatment (P<0.05 in all cases). The number of MA (pcs) in the PRP, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups decreased from 118.34 ± 27.96, 118.60 ± 33.34, and 116.59 ± 28.95 to 92.95 ± 29.04, 44.60 ± 20.73, and 54.26 ± 25.43, respectively. The two-way comparison of the three groups revealed statistically significant differences in MA (P<0.05 in all cases). In the three groups, NV decreased from 1.00 ± 0.21 mm², 1.01 ± 0.18 mm², and 0.98 ± 0.20 mm² before treatment to 0.49 ± 0.17 mm², 0.31 ± 0.16 mm², and 0.38 ± 0.14 mm², respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, 13, 18, and 18 patients had reduced HE area in the PRP-only, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups, respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, vascular endothelial growth factor, monocyte chemoattractant protein-1, and glial fibrilliary acidic protein levels (pg/mL) in the aqueous humor decreased in both combined treatment groups compared with that at baseline, with statistically significant differences; however, no significant difference was observed between the two combined treatment groups (P>0.05). Aflibercept 5+PRN combined with PRP was safe and effective in treating patients with high-risk PDR and DME, and was more effective than PRP-only and aflibercept 3+PRN with PRP in improving CFT and MA.

Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis

PurposeTo assess disparities in initial disease severity among open-angle glaucoma (OAG) patients. DesignCross-sectional study. MethodsIn this analysis of Epic Cosmos, an aggregated electronic health record dataset encompassing >213 million patients, OAG patients examined in ophthalmology or optometry clinics between January 1, 2013 and June 1, 2023 were evaluated. OAG severity at presentation was classified as mild, moderate, or severe using International Classification of Disease-10 codes. Demographics, Social Vulnerability Index (SVI) scores, and Rural-Urban Commuting Area codes were evaluated as predictors of disease stage using ordinal logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. ResultsOf 245,669 patients, 38.1% had mild, 32.5% moderate, and 29.3% severe disease at presentation. In multivariable analyses, significant determinants of worse severity included older age (OR: 1.23 per decade, 95% CI: 1.22-1.23), male sex (OR: 1.37, 95% CI: 1.35-1.39), Black race (OR: 1.61, 95% CI: 1.58-1.65), Hispanic ethnicity (OR: 1.15, 95% CI: 1.11-1.18), non-commercial insurance or uninsured status (OR: 2.53, 95% CI: 2.33-2.74), secondary OAGs (e.g., pseudoexfoliative glaucoma – OR: 1.65, 95% CI: 1.58-1.72), and higher socioeconomic SVI scores (OR: 1.25 for highest versus lowest quartile, 95% CI: 1.22-1.28). Black and Hispanic patients were diagnosed at younger ages compared to White patients (mean ages: 67.8±12.3 and 68.1±12.8 vs. 73.3±11.8 years respectively, p<0.001). ConclusionsWorse OAG at presentation was associated with older age, male sex, Black race, Hispanic ethnicity, non-commercial insurance or uninsured status, secondary OAGs, and greater socioeconomic vulnerability in this nationwide cohort. These findings can help tailor screening programs towards vulnerable populations.

Comparison of keratometric values and anterior segment parameters measured using Scheimpflug Sirius topography and Lenstar biometry.

This study aimed to evaluate the consistency of preoperative keratometric values, anterior segment, and intraocular lens (IOL) power measurements in patients with cataract and no comorbidities using the Sirius topography device (CSO, Italy) and Lenstar LS 900 (Haag-Streit AG, Köeniz, Switzerland). Patients with grade 2 and 3 cataracts who applied to Ophthalmology Clinic of Dışkapı Yıldırım Beyazıt Education and Research Hospital, University of Health Sciences and planned for cataract surgery were included the study. Forty eyes with cataract from 40 patients were taken in the study. All patients underwent preoperative assessment using a combined Scheimpflug-Placido disc-based tomography device (Sirius) and Lenstar before cataract surgery. Keratometric measurements, such as flat keratometry (K1), steep keratometry (K2), and maximum keratometry (Kmax), and anterior segment parameters, white-to-white (WTW) distance, IOL power, astigmatism (AST), anterior chamber depth (ACD), aqueous depth (AD), and central cornea thickness (CCT), were recorded. There were significant differences between K1Lenstar and K1Sirius, K2Lenstar and K2Sirius, KmaxLenstar and KmaxSirius, WTWLenstar and WTWSirius, and IOL powerLenstar versus IOL powerSirius. However, there were insignificant differences between ASTLenstar and ASTSirius, ACDLenstar versus ACDSirius, ADLenstar and ADSirius, and CCTLenstar and CCTSirius variables. Furthermore, it was found that Sirius measured significantly higher than Lenstar, especially in terms of IOL power. Significant differences were observed between Lenstar and Sirius in terms of keratometric values, WTW distance, and IOL power. The IOL power value measured with Sirius was found to be higher than the IOL power value measured with Lenstar.

Prevalence and Characteristics of Glaucoma Among Patients Presenting to Ophthalmology Clinics in a Tertiary Hospital in the Kingdom of Bahrain.

Introduction The aim of this study was to determine the prevalence and characteristics of glaucoma in patients presenting to the ophthalmology department in a tertiary hospital in Bahrain for the first time. Methods A retrospective study was conducted at the Salmaniya Medical Complex, Manama, Bahrain. The medical records of all patients who presented for the first time to an eye clinic between January and December 2019 were reviewed. Patients who were diagnosed with glaucoma were included in this study. Data regarding age, sex, ethnicity, type of glaucoma, previous treatment, best corrected visual acuity, cup-to-disc ratio, intraocular pressure, central corneal thickness, optical coherence tomography (OCT) retinal nerve fiber layer (RNFL), and visual field findings were collected. Results Of a total of 18,238 new patients in 2019, 173 patients (0.97%) had glaucoma. The mean age of patients with glaucoma was 59.6 ± 11.3 years and approximately 60% of them were males (n=103, 59.5%). In 93% of the cases, glaucoma involved both eyes (n=161). Primary open-angle glaucoma (n=97, 56.1%), normal tension glaucoma (n=28, 16.2%), and chronic angle closure glaucoma (n=15, 8.7%) were the most frequently encountered types of glaucoma. Approximately 16.76% (n=29) of the patients were blind in one or two eyes at the time of presentation. Conclusion There seems to be a low prevalence of glaucoma among the encountered cases on the first visit to ophthalmology clinics in Bahrain, with primary open-angle glaucoma being the most common type.

Peripheral Ulcerative Keratitis: A Serious Corneal Inflammation

Abstract&#x0D; Introduction : Peripheral ulcerative keratitis (PUK) is a rare, but severe sight-threatening inflammatory condition that affects the cornea. PUK is characterized by peripheral corneal ulceration, stromal thinning, and neovascularization that can lead to corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders.&#x0D; Case Illustration : A 53-year-old woman presented to the ophthalmology clinic with complaints of redness, foreign body sensation, and blurred vision in her both eye for the past three days. On examination, slit-lamp biomicroscopy revealed a peripheral corneal ulcer. She had a history of rheumatoid arthritis for the past 2 months and was being treated with methotrexate and metylprednisolone. Laboratory investigations revealed elevated Anti-CCP IgG, which confirmed the presence of rheumatoid arthritis.&#x0D; Discussion : PUK is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis, but may also occur in individuals with infectious, degenerative or traumatic corneal injuries. Immune- mediated inflammation, complement activation, and tissue destruction are thought to be involved in the pathogenesis of PUK. The diagnosis of PUK requires a thorough ophthalmic examination, including slit-lamp biomicroscopy, and laboratory investigations for underlying autoimmune disorders.&#x0D; Conclusion : PUK is a rare but serious ocular disease that requires prompt diagnosis and management to prevent severe complications such as corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis.

Clinical Correlation of CD4 Count and Dry Eye Disease (DED) Severity Among HIV Patients: A Case Study in Voluntary Counseling and Testing Clinic Prof Ngoerah General Hospital, Bali

Abstract&#x0D; Introduction &amp; Objectives : Dry Eye Disease is a multi-factorial ocular surface and tear film instability disease. It has been reported as one of the most frequent anterior segment ocular manifestations in HIV patients, occurring late in the disease. The study aimed to investigate clinical correlation of CD4 count and severity of the disease.&#x0D; Methods : This study was a hospital based cross-sectional study where 75 HIV patients (150 eyes) aged 18-50 years old were referred to ophthalmology clinic in VCT for ocular surface related complaints and were included in the study.&#x0D; Results : The study showed significant moderate positive correlation between CD4 count with Tear Break Up Time (TBUT) (r-value=0.509;p-value=0.05) and negatively correlated with Ocular Surface Disease Index (OSDI) score (r-value=-0.252, p-value=0.035). There were a significant difference in CD4 count between mild and moderate dry eyes (p-value=0.005) and between mild and severe dry eyes (p-value=0.005), however no significant difference was observed between moderate and severe dry eyes (p value=0.435). The severity of dry eye in HIV patients also tends to differ in-between clinical stage of the disease (p value=0.513) and with the presence of co-infection (p value=0.228), although the result was not statistically significant.&#x0D; Conclusion : There is a correlation between CD4 Count and Dry Eye Disease severity among HIV patients. The lower the CD4, the higher the risk for HIV patients to get severe dry eye disease. This shows the importance of CD4 control and monitoring to prevent various ocular disease and manifestations related to HIV.

Dry Eye Disease: An Overview of Its Risk Factors, Diagnosis, and Prevalence by Age, Sex, and Race.

This short review focuses on the significance and prevalence of dry eye disease (DED) in the arena of ophthalmology. DED can be identified as one of the most common optical morbidities affecting about one-fourth of the patients visiting ophthalmology clinics. The perception of the cytology and disease evolution of DED has shown a noteworthy advancement in the last decade by recognizing two diverse mechanisms of the disease: tear desertion and deficient tear production. The role of these two components independently or concurrently in the prevalence of DED was also understood. Several studies in different parts of the world have projected that DED is more common in women as compared to men and this difference increases with ageing. Aged people, especially women in the menopausal and post-menopausal stages, are more prone to DED. This ailment is more prevalent in patients suffering from autoimmune diseases with a higher percentage of women getting affected. Various everyday activities as well as social and dietary behaviors like smoking might set off DED symptoms. Extensive visual tasking while using a computer, watching television, and doing a lot of reading also increase the risk of DED. Although DED occurs in all age groups, it is seen in very few children in comparison to adults. In fact, DED in children may be related to diverse factors such as congenial, inflammatory, and autoimmune disorders as well as environmental conditions and nutritional deficiencies. A significant relationship has also been found between DED and racial differences among individuals. A few studies have suggested that the Asian population is more susceptible to DED as compared to the Caucasian population, but this concept needs further research and investigation. Climatic conditions and environmental challenges, such as relative humidity (RH), internal atmosphere, effluence, travel by air, and intense temperatures, are equally important in the occurrence of DED. The present review aims to examine the prevalence of DED in relation to age, sex, and race by analyzing several relevant studies and also have an overview of the diagnosis and risk factors of the disease.

Amblyogenic risk factors and validity of vision screening using spot-screener among kindergarten children in Qassim region, Saudi Arabia.

The purpose of the study was to present the outcomes of vision and amblyogenic risk factor (ARF) screening in kindergarten children in the Qassim region, Saudi Arabia. In this cross-sectional study, an optometrist conducted first-level screening in a kindergarten using a spot screener (Welch Allyn) in 2023. Refractive status and ocular alignment were evaluated. The visual acuity of each eye was measured. Those who failed the first screening or had impaired vision were re-evaluated at the second level of screening by an optometrist and pediatric ophthalmologist. Those who failed the screening in Kindergarten were referred to a pediatric ophthalmology clinic for confirmation and management (third level of screening). We screened 222 children (mean age: 5.9 ± 0.4 years, 111 boys). A total of 59 (26.6%) children failed the spot vision screening test. A vision screening test by an optometrist identified 58 (26.1%) children with impaired vision. Refractive errors (REs) for children who failed the spot screener included hyperopia in 4 (6.7%) children, high myopia (>6.00 D) in 2 (3.4%) children, and astigmatism in 53 (89.83%) children. Compared to the evaluation by optometrists and pediatric ophthalmologists at KGs, spot screening had 0.845 sensitivity and 0.939 specificity. Validity parameters differed for RE, vision impairment, amblyopia, and strabismus. Seventy-one (31.98%) children were referred for third-level screening, but only 32 (44.4%) children attended, and among them, the prevalence of amblyopia was 25%. The high prevalence of amblyopia and undetected ARFs necessitate establishing annual vision screening among 3- to 5-year-old children in the study area.

Diagnosis of primary vitreoretinal lymphoma masquerading infectious retinitis by retinal biopsy

PurposeTo report a case of primary vitreoretinal lymphoma masquerading as infectious retinitis that was diagnosed via a retinal biopsy.ObservationsA 72-year-old female patient was referred to our ophthalmology clinic for evaluation of retinitis and vasculitis in the right eye (OD). On examination, best-corrected visual acuities (BCVAs) were hand motions OD and 20/20 in the left eye (OS). Fundus examination revealed optic disc edema and diffuse retinal whitening superior to the superotemporal arcade OD. Given the high suspicion of infectious retinitis, the patient was treated with intravitreal foscarnet, systemic acyclovir, and oral prednisone and underwent a comprehensive uveitis workup, which was unremarkable for viral and autoimmune entities. Given the patient’s history of diffuse large B cell lymphoma with cutaneous involvement, vitreoretinal lymphoma was suspected, prompting pars plana vitrectomy with a retinal biopsy. Biopsy and immunohistochemistry results were consistent with B-cell lymphoma, and the patient was treated with high-dose methotrexate and rituximab. At 5-month follow-up, BCVAs were hand motions OD and 20/30 OS, and fundus examination demonstrated disc edema with resolution of retinal whitening OD. She responded well to the treatment with regression of vitreoretinal lymphoma on examination and is being monitored closely for lymphoma recurrence.Conclusions and importanceAlthough uncommon, patients with vitreoretinal lymphoma may masquerade as infectious retinitis, and vitreoretinal lymphoma should be suspected when refractory to antiviral therapy and in the setting of a negative workup for viral etiologies. Vitrectomy with retinal biopsy may be considered to aid the diagnosis of vitreoretinal lymphoma although careful consideration of the risks and benefits is warranted.

Comparison of immunological and molecular methods for laboratory diagnosis of ocular toxoplasmosis in blood, serum and tears in Brazil.

Ocular toxoplasmosis (OT) is caused by protozoan T. gondii. Ophthalmological examination is considered the gold standard for OT diagnosis, and laboratory tests are used for diagnostic confirmation. However, these tests can present different results, which change depending on their basis, on sample type and on patients' clinical alteration. Thus, the aim of the present study is to assess immunodiagnostic and molecular techniques applied in blood, serum and tear fluid to diagnose T. gondii infection in patients seen at an Ophthalmology Clinic. In total, 160 patients were included in the study, 40 of them had OT with active lesions (G1); 40 had OT with healed lesions (G2), 40 had non-toxoplasmic uveitis (G3) and 40 had no ocular alterations (G4). Serum samples were subjected to Immunoenzymatic Assay (ELISA) and to Indirect Immunofluorescence Reaction (IFAT) to search for anti-T. gondii IgM and IgG. Tear fluid samples were analyzed through ELISA for IgA research. All blood and tear fluid samples were subjected to conventional polymerase chain reaction (cPCR) and in a Nested PCR model for T. gondii DNA amplification with targets B1, GRA7 and REP 529. IgG and IgM anti-T. gondii was detected in serum samples from 106 and 15 patients, respectively, when combining ELISA and IFAT results. Anti-T.gondii IgA antibodies were detected in 9.2% of the tear material. Nested PCR with GRA7 target showed higher positivity in blood samples (24.4%); Nested PCR with B1 target showed a higher frequency of positivity in tears (15%). Biological samples of patients with active lesions showed the highest positivity frequencies in all immunodiagnostic assays, as well as in most PCR models. The present results highlighted the need of associating techniques with different fundamentals to confirm OT diagnosis. Furthermore, further tear fluid analyses should be performed to validate this biological material as lesser invasive alternative for the more accurate OT diagnosis.

Clareon Intraocular Lens: Results of Cataract Surgery. Exilaser Cuenca Ophthalmological Center Ecuador June 2020 – July 2021

Objective: To analyze visual acuity, refractive cylinder, refractive sphere and complications in cataract surgery by phacoemulsification with Clareon intraocular lens. Methodology: A descriptive-observational, longitudinal study based on the review of medical records of the Exilaser Ophthalmology Clinic of 114 patients who underwent cataract surgery by phacoemulsification with a Clareon intraocular lens was carried out. Descriptive statistical techniques such as frequencies, measured percentages were used on those cases of central tendency and comparative analysis with T Student. Results: The most frequent pre-surgical visual acuity on the Snellen scale was 20/CD with 27.2%, the most frequent corrected pre-surgical visual acuity was 20/CD with 14.0%, the most frequent pre-surgical refractive cylinder value was 0 with 50.9%, the most frequent pre-surgical refractive sphere value was 0 with 28.9%. Post-surgical visual acuity was 20/30 with 20.2%, Corrected Post-surgical Visual Acuity was 20/20 with 53.5%, the most frequent post-surgical refractive sphere value was 0 with 40.4%, the most frequent Post-surgical Refractive Cylinder value was 0 with 14.0%. 99.1% did not present trans-surgical complications and 91.2% did not present post-surgical complications. Conclusions: Cataract surgery by phacoemulsification with CLAREON intraocular lens improves Visual Acuity and the Refractive Sphere, with statistically significant results, with minimal intra-surgical and post-surgical complications.

Computer-Aided Discrimination of Glaucoma Patients from Healthy Subjects Using the RETeval Portable Device.

Glaucoma is a chronic, progressive eye disease affecting the optic nerve, which may cause visual damage and blindness. In this study, we present a machine-learning investigation to classify patients with glaucoma (case group) with respect to normal participants (control group). We examined 172 eyes at the Ophthalmology Clinic of the "Elpis" General Hospital of Athens between October 2022 and September 2023. In addition, we investigated the glaucoma classification in terms of the following: (a) eye selection and (b) gender. Our methodology was based on the features extracted via two diagnostic optical systems: (i) conventional optical coherence tomography (OCT) and (ii) a modern RETeval portable device. The machine-learning approach comprised three different classifiers: the Bayesian, the Probabilistic Neural Network (PNN), and Support Vectors Machines (SVMs). For all cases examined, classification accuracy was found to be significantly higher when using the RETeval device with respect to the OCT system, as follows: 14.7% for all participants, 13.4% and 29.3% for eye selection (right and left, respectively), and 25.6% and 22.6% for gender (male and female, respectively). The most efficient classifier was found to be the SVM compared to the PNN and Bayesian classifiers. In summary, all aforementioned comparisons demonstrate that the RETeval device has the advantage over the OCT system for the classification of glaucoma patients by using the machine-learning approach.