Ophthalmology Clinic Research Articles

Morphometric analysis of orbital CT scan in a Jordanian sample

ABSTRACT Background Anatomical variation exists among different ethnicities in almost all body parts, including the bony skull. Researchers have found some variations between both sexes in the inner measurements of the bony orbit as well as variations related to racial differences. In this study, we assessed different parameters related to the bony orbit that are important clinically, using data collected from a random sample of the diverse population of Jordan, seeking to find out how our population correlates with the variations mentioned in the literature, and applying the results for their clinical importance for many disciplines of medicine related to ophthalmology and maxillofacial surgery, among others. Research Design and Methods This was a cross-sectional study conducted on healthy patients from the Jordan University Hospital. We randomly selected participants aged between 17 and 89, who attended the ophthalmology clinic in the Jordan University Hospital. For each patient, we obtained clinical data and computed tomography (CT) images, using four two-dimensional measurements of the orbit: D1 = distance from the orbital canal to the frontozygomatic fissure, D2 = distance from the orbital canal to the nasion, D3 = distance between the supraorbital and infraorbital canals, and D4 = distance between the nasion and the frontozygomatic fissure. Results We included a total of 161 participants, with a mean age of 54.4 (±19.3) years. They were 83 men (51.6%) and 78 women (48.4%). We found a significant difference in D3 between Jordanian males and females from various races, which might indicate a possible strong effect of sexual hormones on the orbital development. Conclusions We analyzed different measurements that are clinically relevant on a sample of Jordanian patients. These measurements can be useful for surgical decision-making and for research purposes. Our key limitations were related to concerns about the safety of CT imaging for the soft tissue of the eye and the use of two-dimensional measurements instead of three-dimensional ones.

Prevalence of dry eye and Meibomian gland dysfunction in Central and South America: a systematic review and meta-analysis

BackgroundDry eye is one of the most common ophthalmic conditions and can significantly impact quality of life. Meibomian gland dysfunction (MGD) is a major cause of evaporative dry eye.We sought to conduct a systematic review and meta-analysis to estimate the prevalence and incidence of dry eye and MGD in Central and South America and to identify factors associated with disease burden.MethodsData sources Ovid MEDLINE and Embase.Study selectionA search conducted on August 16, 2021, identified studies published between January 1, 2010, and August 16, 2021, with no restrictions regarding participant age or language of publication. Case reports, case series, case–control studies, and interventional studies were excluded.Data extraction and synthesisThe review was based on a protocol registered on PROSPERO (CRD42021256934). Risk of bias was assessed in duplicate using a risk of bias tool designed for the purposes of descriptive epidemiological studies. Data were extracted by one investigator and verified by another for accuracy. Prevalence of dry eye and MGD were grouped based on study participant characteristics.Main outcomes and measuresPrevalence and incidence of dry eye and MGD in Central and South America. Summary estimates from meta-analysis with 95% confidence intervals (CI).ResultsFourteen studies (11,594 total participants) were included. The population prevalence of dry eye was 13% (95% CI, 12%-14%) in Brazil and 41% (95% CI, 39%-44%) in Mexico based on one study each. Meta-analyses suggested that dry eye prevalence was 70% among indoor workers (95% CI, 56%-80%; I2, 82%; 3 studies), 71% among students (95% CI, 65%-77%; I2, 92%; 3 studies), and 83% in general ophthalmology clinics (95% CI, 77%-88%; I2, 88%; 2 studies). MGD prevalence ranged from 23% among indoor workers (95% CI, 16%-31%; 1 study) to 68% in general ophthalmology clinics (95% CI, 62%-72%; 1 study). No studies reported incidence of dry eye or MGD.ConclusionsThis systematic review and meta-analysis demonstrated considerable variation in the published prevalence of dry eye and MGD among the general population and subpopulations in Central and South America. Local and subpopulation estimates of dry eye disease burden may be valuable to assist needs assessments and implementation of measures to mitigate the condition.

The Evaluation of Diabetic Patients' Awareness of Diabetic Retinopathy and Its Complications in the Western Region of Saudi Arabia.

Background Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia. Globally, 382 million people have diabetes mellitus, and 90% of these patients suffer from type 2 diabetes. Saudi Arabia has the second-highest prevalence of diabetes among all Middle Eastern countries. Diabetic retinopathy (DR) is a significant complication of diabetes; early detection and proper intervention are important for its management and prognosis. Aim This study aims to assess the awareness of diabetic patientsof diabeticretinopathysymptomsandcomplicationsin the western regionof Saudi Arabia. Methods This is a cross-sectionalstudy in which a convenience sampling technique was implemented for collecting data from all patients who fulfilled the inclusion criteria within the timeframe between February 2022 and October 2022 among diabetic patients at the National Guard Health Affairs in the western region. We included both type 1 and type 2 diabetic participants who are older than 18 years of age and have at least one visit to any outpatient ophthalmology clinic. Results This study involved 259 participants. The mean age of the participants is 46.69 (standard deviation {SD}: 15.59).Type 2 was more prevalent among the applicants (58.3%). A total of 242 (93%) participants were aware that diabetes could affect their eyes. Surprisingly, 130 (50.2%) do not know about diabetic retinopathy therapy options. The most significant obstacle to being examined early for ophthalmological diseases among diabetic patients was the deficient knowledge of diabetic retinopathy. Also, a significant statistical relationship was found between the year of diagnosis and the level of awareness regarding eye complications. Conclusion Despite the high level of awareness of diabetic retinopathy among diabetic patients shown in our study, it did not correspond to a high level of self-awareness on the importance of preventive measures such as annual diabetic retinopathy screening.

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.

Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients. Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation. Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR. The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

A Cross-Sectional Study on Patient Satisfaction With Healthcare Services Provided at the Ophthalmology Clinics in Saudi Arabia.

Background Saudi Vision 2030 is transforming the country's healthcare system, with efficacy, accessibility, and patient satisfaction with healthcare services serving as key indicators for assessing patient care quality. As blindness and impaired vision continue to be a rising health issue in most Eastern Mediterranean Region (EMR) nations, including Saudi Arabia, this study focused on measuring patient satisfaction with healthcare services in ophthalmology clinics. Objectives This study aimed to assess the level of patient satisfaction with healthcare services in ophthalmology clinics and its related factors in the Makkah region of Saudi Arabia in 2022-2023. Methods A cross-sectional study was conducted on a convenience sample of 553 Saudi and non-Saudi patients, aged 18 years and older, who attended private and government ophthalmology clinics in the Makkah region of Saudi Arabia during the period between November 2022 and February 2023. A self-administered questionnaire was distributed on several electronic platforms like WhatsApp, X (formerly known as Twitter), Telegram, and Snapchat to collect the data. Finally, all the data were entered and analyzed through the IBM SPSS software version 26. Results A total of 553 responses were obtained. The majority were aged between 18 and 35 years old (76.5%, n=423), with the female gender being dominant (79.7%, n=441). More than half of them (52.3%, n=289) preferred to receive ophthalmological healthcare services from governmental hospitals. The most commonly diagnosed eye disease was refractive error (43.2%, n=239). Patient satisfaction with healthcare services provided in ophthalmology clinics represented 75% (n=415). The odds of being satisfied with ophthalmology clinics are expected to decrease by at least 44% among individuals over the age of 35 (odds ratio (OR) =0.437; 95% CI=0.257-0.743; p=0.002). Moreover, those who had been married were predicted to decrease the chance of being satisfied by at least 50% compared to patients who had never been married (OR=0.538; 95% CI=0.352-0.823; p=0.004). Compared to students, patients who were currently employed were predicted to decrease the chance of being satisfied by at least 48% (OR = 0.481; 95% CI=0.270-0.856; p=0.013). Additionally, those with a higher monthly income had decreased odds of being satisfied by at least 58% (OR=0.583; 95% CI=0.381-0.893; p=0.013). In contrast, compared to patients with associated comorbidity, patients who have no comorbidity were predicted to have an increased chance of being satisfied by at least two-fold than those who had comorbidities (OR=2.023; 95% CI=1.199-3.413; p=0.008). Conclusions The study concludes that 75% of the patients attending ophthalmology clinics in the Makkah region of Saudi Arabia were satisfied with the healthcare services provided in these clinics. Most patients acknowledged the time of care, doctors' professionalism, continuity of care, comprehensive examination, and their education about their disease and management, in addition to doctors listening to them during their visits to ophthalmology clinics. Factors affecting patient satisfaction with medical services in ophthalmology clinics are patient age, occupation, marital status, monthly income, and associated comorbidities. Further studies are recommended to deeply understand patients' needs and obtain more suggestions to be fully satisfied with healthcare services in ophthalmology clinics and other different healthcare facilities.

Efficacy and Safety of CSF-1 (0.4% Pilocarpine Hydrochloride) in Presbyopia: Pooled Results of the NEAR Phase 3 Randomized, Clinical Trials

PurposeThis study was undertaken to evaluate the safety and efficacy of CSF-1 (0.4% pilocarpine hydrochloride ophthalmic solution) for use in individuals with presbyopia. MethodsTwo Phase 3 multicenter, randomized, double-masked, vehicle-controlled, parallel-group clinical trials were conducted in 35 private ophthalmology clinics in the United States from October 2020 to February 2022. Key inclusion criteria were the following: (1) age 45–64 years, (2) distance-corrected near visual acuity (DCNVA) at 40 cm ≥0.40 and ≤0.90 logarithm of the minimum angle of resolution (logMAR, approximately 20/50–20/160 Snellen) in at least 1 eye, (3) manifest refraction (MR) between –4.50 and +2.00 diopter (D) sphere in each eye with ≤2.00D difference between eyes, (4) <2.00D of cylinder MR in each eye, (5) ≤0.04 logMAR (20/20–2 or better) corrected distance visual acuity (CDVA) at 4 m in each eye. Key exclusion criteria were the following: (1) >0.14 logMAR (7 letters) improvement in post-vehicle treatment in monocular DCNVA in either eye at visit 1, (2) introcular pressure (IOP) <9 or >22 mm Hg, (3) average dark-adapted pupillometry <3.5 mm in either eye, (4) prior refractive surgery or intraocular lens (IOL) implantation. Participants applied CSF-1 or vehicle twice per day for 2 weeks. Efficacy and safety assessments were performed at several times on days 1, 8, and 15. Response was defined as ≥3-line gain in DCNVA without loss of ≥1-line in CDVA in the study eye under mesopic room lighting conditions. The primary efficacy endpoint was measured 1 hour post-dose 1 on day 8. Key secondary endpoints were 2 hours post-dose 1, and 1 and 2 hours post-dose 2, also on day 8. Safety endpoints were ocular and non-ocular treatment-related adverse events (TRAE), conjunctival redness, drop comfort, slit-lamp biomicroscopy, intraocular pressure, indirect fundoscopy, and CDVA at 4 m. FindingsSix hundred thirteen participants were randomized to CSF-1 (n = 309) or vehicle (n = 304). Participants were predominantly White (80.8%) and female (62.0%), with mean age (standard deviation) of 54.7 (4.8). CSF-1 met the primary and key secondary endpoints. At the primary endpoint, 40.1% of the CSF-1 group achieved response versus 19.1% of the vehicle group (P < 0.0001). The percentage of responders was significantly greater in CSF-1 compared with vehicle at all tested times. Changes from baseline in all safety endpoints were comparable between groups. Most adverse events (AEs) were mild and transient. Neither serious nor severe AEs were reported with CSF-1. ImplicationsCSF-1, a low-dose pilocarpine ophthalmic solution, demonstrated superiority to vehicle in improving near vision in individuals with presbyopia without compromising distance vision. CSF-1 demonstrated a favorable safety profile. ClinicalTrials.gov identifier: NCT04599933 (NEAR-1), NCT04599972 (NEAR-2).

Cancer-associated retinopathy as an initial presentation of gynecologic small-cell carcinoma

Abstract: A 56-year-old female presented with bilateral progressive blurred vision over 1 month. She has no known malignancy before her initial visit to our ophthalmologic clinic. Her best-corrected visual acuity decreased to hand motion from 30 cm in both eyes. Optical coherence tomography exhibited parafoveal thinning of outer retinal layers bilaterally. Fluorescein angiography and indocyanine green angiography disclosed hypofluorescent spots in late phase in both eyes. The suspicion of cancer-associated retinopathy (CAR) prompted us to investigate and refer for further systemic disease including occult malignancy. The patient was diagnosed with small-cell carcinoma of the endometrium or cervix, which is an extremely rare and aggressive neuroendocrine tumor. The patient was treated with oral prednisone with improved visual acuity. The patient expired from sepsis 2 months after her initial visit to our ophthalmologic clinic. In selected cases, CAR may present before the diagnosis of primary cancer. It is essential to recognize its ophthalmic manifestation for early discovery of primary malignancy.

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.Abbreviations: Visual acuity (VA), Visual acuity without correction (AVSC), Visual acuity with correction (AVCC), Refractive sphere (ER), Refractive cylinder (CR), Intraocular lens (IOL), Dioptres (D).

Physical, Psychosocial, and Practical Burden of Patients Receiving Care for Age-Related Macular Degeneration in Canada: A Mixed-Methods Qualitative Study.

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Documentation of the disease's description and treatment experience of Canadian patients is limited but of interest given the aging population and resultant implications for healthcare systems. A mixed-methods study was conducted to understand the challenges experienced by patients living in Canada with AMD to identify areas of need and for potential reform. Canadian residents with wet or dry AMD were eligible for participation in an online survey and one-on-one telephone interview regarding their disease experience. Participants were recruited via a not-for-profit stakeholder organization and an ophthalmology clinic. Surveys were completed from January-June 2020 and interviews were conducted from November-December 2020, with findings reported using descriptive statistics and thematic analysis, respectively. Findings from 303 survey responses and 20 interviews were analyzed. Most participants indicated their vision loss negatively impacts their ability to conduct daily activities (eg, self care, driving) and leads to constant worry, loneliness, and/or isolation. Participants frequently reported requiring caregiver support, often for eye appointment travel or everyday tasks. Regardless of AMD type, participants reported having several appointments each year, and that time spent travelling to/from and waiting at appointments and related costs were considerable. Although participants receiving anti-vascular endothelial growth factor injections valued treatment, the experience added additional burden related to anxiety, fear, pain, and even greater reliance on caregivers. Many participants indicated they felt poorly informed about their disease and treatment options, particularly at diagnosis, which increased their emotional burden. Patients with AMD living in Canada experience a significant and persistent mental, physical, and financial burden as a direct result of their disease. Improvements to provision of disease-related information, support of daily activities and appointment attendance, and the overall treatment experience could substantially enhance outcomes among the growing population of patients with AMD.

Risk Factors and VEGF, hs-CRP, and ESR in Central Serous Chorioretinopathy.

This study aimed to investigate the risk factors associated with central serous chorioretinopathy (CSC) and analyze the relationship between vascular endothelial growth factor (VEGF), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and CSC. A total of 109 patients diagnosed with CSC (CSC group) at our ophthalmology clinic from February 2017 to February 2021 were included, with 103 volunteers from our hospital's health examination center serving as the control group. Additionally, the new multimodal imaging classification of 109 CSC patients was further divided into simple CSC (57 cases) and complex CSC (52 cases). Demographic data, underlying diseases, medical history, and medication history were collected. Levels of VEGF, hs-CRP, and ESR were measured, and multifactorial logistic regression analysis was performed to identify factors influencing CSC. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic value of VEGF, hs-CRP, and ESR in CSC. The CSC group showed a higher proportion of males, smoking history, alcohol consumption, comorbid obstructive sleep apnea, hypothyroidism, renal disease, Helicobacter pylori infection, steroid use, and shift work compared to the control group (P < 0.05). VEGF, hs-CRP, and ESR levels were significantly higher in the CSC group than in the control group (P < 0.05). The levels of VEGF, hs-CRP, and ESR in the complex CSC group were higher than those in the simple CSC group (P < 0.05). Male gender, shift work, Helicobacter pylori infection, hypothyroidism, elevated VEGF, hs-CRP, and ESR were identified as risk factors for CSC (P < 0.05). The combined diagnostic value of VEGF, hs-CRP, and ESR (area under the ROC curve: 0.886) was higher than that of individual markers (0.722, 0.728, and 0.703, respectively) (P < 0.05). Male gender, shift work, Helicobacter pylori infection, hypothyroidism, and elevated levels of VEGF, hs-CRP, and ESR are risk factors for CSC. The combined use of VEGF, hs-CRP, and ESR demonstrates higher diagnostic efficiency in identifying CSC.

Comparative study between topical insulin, autologous serum, and honey-based eye drops as adjunctive treatment in resistant corneal ulcer

Background Resistant keratitis is a difficult situation faced every day in ophthalmology clinics. Resistance to healing may be attributed to many factors. Many adjunctive agents are widely used in a trial to accelerate healing and to prevent resistance to eliminate the chance of development of disabling complications. Purpose The aim of this study was to compare the effectiveness of topical insulin, autologous serum, and honey-based eye drops as adjunctive therapies in resistant corneal ulcers. Patients and methods This prospective study investigated 45 eyes of infected keratitis not responding to culture-based medical treatment for 2 weeks. The eyes were divided into three groups each of 15 eyes. The insulin group was treated with topical insulin drops, the serum group with autologous serum drops, and the honey group with honey-based drops. Culture-based medical treatment was also continued in the three groups till complete healing was achieved. The results of the three groups were compared regarding the time needed for healing and best-corrected visual acuity outcome. Results Best-corrected visual acuity improved by one or more lines in 11 (73.33%) cases in the insulin group, in 10 (66.67%) cases in the serum group, and in nine (60%) cases in the honey group, with no statistically significant difference (χ 2=1.525, P=0.822). Healing occurred in 14–28 days in 12 (80%) cases in the insulin group, in 13 (86.67%) cases in the serum group, and in 10 (66.67%) cases in the honey group, with no statistically significant difference (χ 2=1.8, P=0.407). The remaining cases in each group required amniotic membrane transplantation due to thinning. Conclusion The effects of topical insulin, autologous serum, and honey-based eye drops, when used as adjunctive methods added to the culture-based medical therapy in the management of resistant corneal ulcers, were comparable. Autologous serum gave slightly higher effect than topical insulin and honey-based eye drops but the difference was statistically insignificant.

Low vision rehabilitation program in patients with myopic macular degeneration: A case series

Aims/Purpose: Patients with pathologic myopia are at risk of developing myopic macular degeneration (MMD) that leads to vision loss and irreversible visual impairment. Working age and elderly populations are affected by loss of productivity and quality of life. Low vision services should offer specialized training programs to help patients to overcome the difficulties in daily living activities. The aim of this study was to describe the results of a low vision rehabilitation program (LVR) in patients with MMD.Methods: Five patients (8 eyes) with MMD were included in the LVR at an ophthalmology clinic in Portugal. The LVR had a length of 8 weeks and was divided into two phases. The first phase included the use of prisms for image relocation (IR) with eccentric viewing exercises to stabilize the preferred retinal locus. At the second phase, training with low vision aids was performed. Best corrected visual acuity (BCVA) for distance and near, contrast sensitivity (CS), reading speed (RS) and face recognition were compared pre and post rehabilitation.Results: Patients had MMD category 3 (patchy chorioretinal atrophy) and 4 (macular atrophy) in the best eye. Vision impairment varied between mild and severe. The IR prisms varied from 2 to 6 prism dioptres. Electronic devices were the most prescribed low vision aids. At the end of the LVR, the outcomes were good in all patients. BCVA increased by two to three lines, CS increased by two to four lines, RS increased by 40 to 60 words per minute and face recognition improved in all patients.Conclusions: The LVR was beneficial, improving visual function and functional vision outcomes in all patients. LVR programs seem to be effective in patients with pathologic myopia. Longitudinal studies are necessary to ascertain the long‐term efficacy of LVR.

Atopic Dermatitis Associated Retinal Detachment and Retinal Vasculitis: A Case Report

Atopic dermatitis is usually associated with various ocular complications. We report a 21-year-old Chinese male who presented to our ophthalmology clinic with bilateral retinal detachment and cataracts. The patient had a clear medical history of atopic dermatitis, which had been diagnosed eight years earlier and had been treated with loratadine and pimecrolimus. Cataract surgery was performed for both eyes, combined with scleral buckling for the right eye and pars plana vitrectomy for the left eye. During postoperative follow-up, fundus fluorescein angiography showed retinal vasculitis in both eyes and macular edema in the left eye, which coincided with an exacerbation of atopic dermatitis. Macular edema improved after four months of regular dupilumab treatment in the dermatology department. The ocular condition remained stable three years postoperatively.

A comparative analysis of the effectiveness of laser correction with a mechanical and laser microkeratome for myopia.

Myopia, or nearsightedness, is one of the most common eye conditions worldwide. However, a comparison of the effectiveness of different laser-assisted interventions is lacking. Thus, we aimed to compare the efficacy and safety of LASIK and IntraLASIK in addressing myopia. The study was conducted in two ophthalmology clinics in Beijing, China, in 2022. A total of 84 patients (152 eyes) with different degrees of myopia were examined and underwent LASIK (n=46, 80 eyes) or IntraLASIK (n=38, 72 eyes). Keratometry, corneal topography, pachymetry, visual acuity evaluation, and corneal biomechanical analysis were performed before and after the intervention. IntraLASIK produced more precise flaps than LASIK, with deviations of <8 mm and 0.1 mm from the intended thickness and diameter, respectively. LASIK resulted in nonuniform flaps, with thickness deviations of 5-86 mm. IntraLASIK demonstrated a superior efficacy for patients with severe myopia and thin corneas, with a mean spherical equivalent of 0.9 D at 6 months compared to the 1.4 D for LASIK. Approximately 91% and 83% of the patients with mild to moderate and severe myopia, respectively, achieved results within ± 0.49 D from the refractive target with IntraLASIK. Corneal hysteresis and corneal resistance factor decreased with an increase in laser intensity, and they decreased faster with thinner corneas. Thus, IntraLASIK is more useful than LASIK in patients with thin corneas and severe myopia.

PAUL device implantation in paediatric glaucoma patients with LTBP2 mutation: Case reports

Purpose: Latent‐transforming growth factor beta‐binding protein 2 (LTBP2) is a fibrillin‐related extracellular matrix protein. The protein is expressed in the ciliary body, and mutations in its gene lead to primary paediatric glaucoma due to anterior segment dysgenesis. These mutations in the Greek area appear almost exclusively in Roma families. In this work, we present the surgical treatment of two patients with PAUL® device implantation, and their preoperative and postoperative course.Methods: Case Reports.Results: Case 1: A 2‐month‐old female patient, the fifth child of a Roma family with an older sister with paediatric glaucoma, presented to the Ophthalmology clinic of our hospital with microspherophakia and megalocornea, a phenotype compatible with a mutation of the LTBP2 gene. She underwent a phakectomy for lens dislocation in both eyes. At the age of 2.5 years, she was diagnosed with hypertony and started topical treatment. After two years of treatment escalation and unsuccessful management of intraocular pressure, at the age of 4.5 years it was decided to implant a PAUL® glaucoma implant in her left eye. Case 2: An 8‐month‐old male patient, child of a Roma family, similarly presented with microspherophakia and megalocornea as well as hypertony. In addition to topical treatment, he underwent peripheral iridectomies and phakectomies in both eyes. After years of treatment escalation and unsuccessful management of intraocular pressure, at the age of 6.5 years it was decided to implant a PAUL® glaucoma implant in his left eye. We describe the surgical procedures as well as their postoperative course.Conclusions: Regular monitoring of intraocular pressure is recommended in children with megalocornea, microspherophakia and/or ectopia lentis. Genetic testing of the LTBP2 gene is recommended in these patients. It is important to raise awareness in the ophthalmological community regarding the recognition of this phenotype in children of Roma families. The PAUL® device is one of the options for treating drug‐resistant paediatric glaucoma.

Ophthalmology Practice-Related Factors and Patient Loyalty: Mediating Role of Patient Satisfaction.

In the current period, competition among the healthcare sector has increased and healthcare providers try to get loyalty and satisfy the patients by establishing different strategies. : This current study aims to discover ophthalmology practice-related factors and patient loyalty and to analyze the mediating role of patient satisfaction in private ophthalmology services in various private centers in the Kingdom of Saudi Arabia. : The nature of the study is quantitative, and data is collected with a questionnaire. We used a pre-tested questionnaire that was divided into different sections assessing ophthalmology practice-related factors, patient satisfaction, and patient loyalty. These were measured using a 5-point Likert scale, focusing on financial aspects, access to facilities, staff services, and ophthalmologist services. Further, the smartPLS technique was used to extract the results by using SmartPLS. : The analysis sample size consisted of 323 participants from Saudi Arabia. The results found that ophthalmologist service has a positive relationship with patient satisfaction (β= 0.369, p = 0.000) as well as patient loyalty (β= 0.234, p = 0.004), but there are some ophthalmology practice-related factors such as financial aspects, access and facilities, and staff service, which showed no relationship with patient loyalty but a positive relationship with patient satisfaction. Further analysis found that patient satisfaction as a mediator has a positive relationship between ophthalmology practice-related factors, namely, ophthalmologist service (β= 0.228, P= 0.000), financial aspects (β= 0.102, p = 0.019), access and facilities (β= 0.109, p =0.000), and staff service (β= 0.188, p = 0.000) with patient loyalty. : The present study findings reveal the importance of focused patient satisfaction improvements in enhancing patient loyalty within ophthalmological clinic settings in Saudi Arabia. Furthermore, we recommend future exploratory prospective research to find the satisfaction and loyalty factors that change over a period of time.

Contribution of Optical Coherence Tomography in the Diagnosis and Follow-up of Primary Open-Angle Glaucoma

Objective: To study the contribution of OCT in the diagnosis and follow-up of POAG at the ophthalmological clinic of the University Hospital Center in the Suru Lere area and at the ophthalmological clinic of HIA - CHU. Method: This is a descriptive and analytical study, retrospective over a period of 7 years from 1st January 2015 to 31st December 2021. Results: We identified a total of 30 patients, i.e. 60 glaucomatous eyes, in whom at least two OCTs were performed. The average age of the patients was 51.23 ± 12.16 years with extreme values of 23 to 72 years. In our series, 17 patients were male (56.65%), i.e. an M/F sex ratio of 1.30, employees were in the majority and represented 66.67% of patients, patients with no history represented 60 %. The main risk factors were hypertension, HT0 with respectively 20%, 13.33%. Visual loss was the main reason for consultation, 56.67%. The average cup/disc ratios on clinical examination of the papilla are respectively 0.57 ± 0.19 on the right and 0.58 ±0.18 on the left. In our series, the means of the three OCTs for the C/D ratios were established respectively at 0.70, 0.71 and 0.62 for the right eye and respectively 0.70, 0.71 and 0.65 for the left eye. Regarding the mean of the per papillary RNFL, the means of the three OCTs are respectively 86.27; 83.93; 86.29 for the must eye and 89.20 respectively; 83.47; 85.07 for the left eye. For the ganglion cell complex the results were respectively 85.63; 81.73, 71.71 for the right eye and 86.07 respectively; 81.23 and 71.86 for the left eye. There was a significant correlation between fundoscopic and tomographic vertical C/D ratios. Conclusion: It appears from this work that OCT is an essential material examination and plays an important role in both the diagnosis and the follow-up of glaucomatous disease.

Ganglion cell loss in central serous chorioretinopathy

Aims/Purpose: The aim of the study was to determine the amount of deficit of best corrected visual acuity (BCVA) and individual retinal layers, including ganglion cells, in different types of CSCR and with the reference to its duration.Methods: The retrospective analysis included 69 eyes of patients with resolved CSCR managed in Dobry Wzrok Ophthalmological Clinic between 01.01.2019 and 30.06.2022. The diagnosis of CSCR was based on the criteria outlined by the Central Serous Chorioretinopathy International Group. The analysis included data obtained from medical history, BCVA testing, and spectral domain optical coherence tomography (SD‐OCT) measurements, with specific thickness values for individual retinal layers. The results were compared among affected eyes, unaffected fellow eyes and healthy controls.Results: BCVA values were significantly lower in acute (0.08 ± 0.12 logMAR) and chronic (0.26 ± 0.19 logMAR) versus controls (0.0 logMAR). The thickness of all retinal layers (central subfoveal thickness, CST; inner retina with ganglion cell complex, GC; outer retina, ORT; and photoreceptor outer segments, POS) and macular volume (MV) were significantly decreased in chronic eyes versus controls (p &lt; 0.01). Acute eyes had significant thinning of the outer retina and POS only compared to control eyes (p &lt; 0.01). The amount of deficit in CST, ORT, GC and MV was strongly correlated with poorer BCVA (p &lt; 0.001), and the deficit of CST, ORT and GC was correlated with disease duration (p &lt; 0.05). The subfoveal choroidal thickness was significantly greater in affected and fellow eyes versus controls (p &lt; 0.001).Conclusions: Damage to the outer retina and photoreceptors occurs early in the course of CSCR, with a deficit in ganglion cells noted adjunctively in chronic forms of the disease. Further studies are required to precisely determine correlation between visual loss in CSCR and deficits in individual retinal layers.

Para‐phenylenediamine hair dye and dry eye symptoms: A cross‐sectional study

Aims/Purpose: Para‐phenylenediamine is a common constituent in black hair dye which is well‐associated with irritant dermatitis. Ocular complications include blepharoconjunctivitis, dry eye disease and allergic eye disease (1), mostly reported in case studies. We conducted a cross‐sectional study to establish the prevalence of dry eye symptoms in black hair dye users, and its association with irritant dermatitis, sleeping position and frequency of hair dye use.Methods: This cross‐sectional study was conducted online among Facebook followers of an ophthalmology clinic based in Mauritius. 100 responses were gathered between November 2020 and May 2022. Participants included in the study were all users of black hair dye, over the age of 18 and of either sex. Patients with potential confounding causes of dry eye disease symptoms were not excluded from the study, but a separate analysis was conducted excluding them. Data was subsequently analysed using R statistical software.Results: Most participants were female (88%) and excluding those with confounding causes of dry eye disease, 57% of participants reported ocular symptoms, such as grittiness, blurry vision and red eyes. 34% of these patients also reported scalp dermatitis. Prevalence of ocular symptoms increased with duration of hair dye use. However, no association was found between either rates of irritant scalp dermatitis, sleeping position or frequency of hair dye use and ocular symptoms.Conclusions: We have found a high prevalence of dry eye symptoms among black hair dye users, compared to the prevalence previously described in the literature (28.2% by Golińska‐Zach et al.) (1), with a prolonged duration of hair dye use being a risk factor. Larger scale studies are needed to characterize the influence of para‐phenylenediamine hair dye on ocular surface disease, including assessment of tear film properties and meibomian gland dysfunction.Reference1. Golińska‐Zach A, Krawczyk‐Szulc P, Wiszniewska M, Nowakowska‐Świrta E, Świerczyńska‐Machura D, Tymoszuk D, et al. Sensitization to occupational allergens in hairdressing apprentices diagnosed already before entering vocational training. Med Pr [Internet]. 2016 [cited 2022 Apr 25]; 67(5): 567–75. Available from: https://pubmed.ncbi.nlm.nih.gov/27819696/

Glaucoma Screened at the Ophthalmology Clinic of PZaGa Hospital Androva Mahajanga, Madagascar.

Glaucoma Screened at the Ophthalmology Clinic of PZaGa Hospital Androva Mahajanga, Madagascar.