Acuity Examination Research Articles

The association between sleep duration and myopia among Chinese school-age students: mediation effect of physical activity.

This study aimed to investigate the relationship between sleep duration and myopia in school-age students, as well as to observe the role of physical activity as a mediating variable in sleep duration and myopia. Using multistage stratified sampling, 26,020 school-age students in Jiangsu Province, ages 7-18, were selected for this cross-sectional survey. Each participant completed a standardized interview in which their were asked about their vision, level of physical activity and average hours of sleep per day over the past month. Visual acuity examinations were conducted by the testing team's ophthalmology professionals and they were categorized into two groups based on pre-set criteria: myopic and non-myopic. Sleep duration was classified into 3 categories: <8 h/d, 8-10 h/d, >10 h/d. The Pearson's chi-square tests were used to examine differences in the incidence of myopia among participants. Binary multifactorial logistic regression adjusted for potential confounding variables was used to examine the relationship between myopia and a variety of factors. The mediating effects of physical activity on sleep duration and myopia were analyzed using the AMOS model. In this study, the incidence of myopia was higher in females than in males, it also increased with age. Those who slept for <8 h/d had the greatest myopia rate (85.69%) compared with those who slept for≥8 h/d (p < 0.001). Sleep duration was found to be adversely correlated with myopia (sleep duration = 8-10 h/d: OR = 0.68, p < 0.01; sleep duration > 10 h/d: OR = 0.48, p < 0.01) after controlling for potential confounders like gender, age, and BMI-z score (Body Mass Index Score). Physical activity at a high intensity not moderate intensity was found to be protective factor against myopia. High-intensity physical activity also acted as a mediator in the negative association between sleep duration and myopia (a, b, c' all p < 0.05). There is a negative correlation between sleep duration and myopia in school-age students, and that high-intensity physical activity mediates the relationship between sleep duration and myopia.

Validation and optimization of smart eye camera as teleophthalmology device for the reduction of preventable and treatable blindness in Nigeria.

Limited resources and staffing hinders efforts to reduce preventable blindness, especially in low- to middle-income countries. The slit-lamp examination (SLE), which is essential for ophthalmology practices, is often unavailable in primary and secondary eye care facilities due to the high costs and lengthy training required for operation. We conducted a cross-sectional, multicentre study exploring the potential for a smart eye camera (SEC; a tele-ophthalmology handheld device developed by OUI Inc., Japan) to address the limitations of the SLE. Ocular diagnoses, visual acuity assessments and examinations of the eyes were performed independently using both a conventional SLE and a SEC. Four independent assessors (blind to the study) reviewed the images captured by the SEC and the SLE as administered by separate investigators. All analyses were performed using R version 4.2.2 for macOS at a 5% level of statistical significance. The results of the image quality analysis demonstrated that the number of higher-quality images was significantly higher (p < 0.05) for the images captured using the SEC device compared to the SLE machine. Remarkably, up to 96% accuracy of diagnosis was recorded with SEC. Evaluation of diagnostic accuracy rates derived from images obtained from both machines revealed a degree of divergence in assessments among evaluators, yielding a Fleiss's Kappa value of 0.092. The sensitivity analysis for the SEC device revealed a reasonably strong capacity to correctly identify true positive cases, with an average sensitivity score of 90%. The results of this study indicate that SEC can effectively evaluate anterior segment lesions in ophthalmology.

Primary Visual Pathway Changes in Individuals With Chronic Mild Traumatic Brain Injury

Individuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients. To determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI. This prospective, observational, case-control study was conducted between May 2018 and November 2021. The study setting was at a level 1 trauma research hospital. Participant eligibility included adult males and females with recorded best-corrected visual acuity and normal fundus examination. Individuals in the case group had a history of mild TBI; controls had no history of TBI. Exclusion criteria included a history of ocular, neurological, or psychiatric disease, moderate-severe TBI, recent TBI, metal implants, age younger than 18 years, and pregnancy. Cases and controls were sex- and age-matched. Data analysis was performed from July 2023 to March 2024. History of mild TBI in the case group. The single-session visit included the Neurobehavioral Symptom Inventory and measurements of oculomotor function, optical coherence tomography, contrast sensitivity, visual evoked potentials, visual field testing, and magnetic resonance imaging. A total of 28 participants (mean [SD] age, 35.0 [12.8] years; 15 male [53.6%]) with mild TBI and 28 controls (mean [SD] age, 35.8 [8.5] years; 19 female [67.9%]) were analyzed. Participants with mild TBI showed reduced prism convergence test breakpoint (-8.38; 95% CI, -14.14 to -2.62; P = .008) and recovery point (-8.44; 95% CI, -13.82 to -3.06; P = .004). Participants with mild TBI also had decreased contrast sensitivity (-0.07; 95% CI, -0.13 to -0.01; P = .04) and increased visual evoked potential binocular summation index (0.32; 95% CI, 0.02-0.63; P = .02). A subset of participants exhibited reduced peripapillary retinal nerve fiber layer thickness, increased optic nerve/sheath size, and brain cortical volumes. Machine learning identified subtle differences across the primary visual pathway, including the optic radiations and occipital lobe regions, independent of visual symptoms. Results of this case-control study suggest that the visual system was affected in individuals with mild TBI, even in those who did not self-report vision problems. These findings support the utility of a battery of assessments or machine-learning approaches to accurately diagnose this population.

Do diffractive intraocular lenses break the beneficial interaction between chromatic and monochromatic aberrations in the eye?

This study investigates whether a diffractive presbyopia-correcting multifocal intraocular lens disrupts the favorable interaction between chromatic and monochromatic aberrations in the eye. This is analyzed not only for distant objects but also for closer viewing distances, where the lens utilizes different diffraction orders depending on its design. We consider diffractive designs based on the zero-diffraction order for far vision and the first diffraction order for near vision (i.e., 0F/+1N design). Within the limitations of clinical visual acuity examination in various groups of subjects, our results prove that diffractive presbyopia-correcting lenses with 0F/+1N design preserve the beneficial interaction between chromatic and monochromatic aberrations at both far and near vision. The results are obtained for lenses with varying energy efficiency distributions between the far and near focal points, ranging from balanced (bifocal contact lens) to far-dominant (50% far, 30% near in a trifocal intraocular lens) configurations. These findings are specific to the 0F/+1N design and cannot be extrapolated to other diffractive lens types.

Long-term visual outcomes and histopathologic findings after cataract surgery in Ebola virus disease survivors in the Ebola virus RNA persistence in ocular tissues and fluids (EVICT) study.

Ebola virus disease (EVD) survivors develop post-acute ophthalmic sequelae, including a high prevalence of uveitis that may be complicated by vision-threatening cataract. After the non-detection of Ebola virus (EBOV) RNA in sampled ocular fluid, vision impairment due to cataract can be treated safely and effectively via manual small incision cataract surgery (MSICS). However, the long-term ocular visual outcomes and assessment of ocular tissues, including for genomic RNA, have been infrequently or not reported in Western African survivors. A cohort of EVD survivors with visually significant cataract, in whom EBOV RNA was not detected by RT-PCR testing of ocular fluid sampled prior to MSICS, were followed for a year after intraocular lens replacement. Ophthalmic outcomes, including visual acuity (VA), adverse events, and follow-up examinations, were recorded. Ocular tissue specimens obtained at MSICS underwent histopathologic examination and in-situ hybridization (ISH) targeting EBOV genomic RNA. Thirty-four EVD survivors underwent MSICS and were included for analysis. The median age of EVD survivors who underwent surgery at enrollment was 22.5 years (Interquartile range, IQR: 16.5-33) and the cohort was comprised of 20 females (58.8%). Median logMAR VA at preoperative baseline was 3 (IQR: 1-3) which improved to 0.4 (IQR: 0-0.6; n = 10; p = 0.002) and 0.6 (IQR: 0.18-0.78; n = 18; p < 0.0001) at 6- and 12-months following surgery, respectively. EBOV RNA was not detected in 7 cataract and capsular tissue specimens obtained at the time of MSICS. After MSICS, meaningful improvement in vision was maintained in EVD survivors at long-term follow-up. EBOV RNA was not detected in cataract and lens capsule specimens, providing additional reassurance of the low risk of EBOV RNA exposure during cataract surgery. Further study is needed to understand long-term ocular outcomes, including adverse events, in this population. Ebola virus disease (EVD) survivors may develop several ophthalmic sequelae including uveitis and cataract that may lead to severe vision loss if left untreated. Manual small incision cataract surgery (MSICS) has been utilized to treat cataract in EVD survivors with encouraging short-term outcomes, but the long-term visual acuity outcomes and the potential for Ebola virus RNA to reside in cataract material is unknown. In this study, we reported long-term visual acuity outcomes following MSICS in a cohort of EVD survivors along with histopathology findings from materials collected during surgery. Visual acuity improved over 12-month follow-up with encouraging safety measures. Ebola virus RNA was not detected in cataract and lens capsular tissue analyzed from EVD survivors. This study provides additional assurance regarding the safety and efficacy of cataract surgery, with potential for improved vision for EVD survivors.

The renal-retinal connection - The eye in chronic kidney disease

Chronic kidney disease (CKD) is linked with several systemic complications, including ocular manifestations that can adversely affect quality of life. The prevalence and types of ocular changes in CKD patients, particularly their correlation with disease stages, are not well-documented. This study aims to evaluate the ocular manifestations in CKD and their association with different stages of the disease.A cross-sectional study on 70 CKD patients revealed a high prevalence of ocular abnormalities, including diabetic retinopathy, hypertensive retinopathy, and age-related macular degeneration. These conditions often worsened as CKD progressed, emphasizing the need for regular eye exams in CKD patients to prevent vision loss and address complications promptly. To investigate the prevalence and types of ocular manifestations in patients with chronic kidney disease (CKD) and to analyse their correlation with the stages of CKD. This cross-sectional, descriptive, non-interventional, hospital-based study was conducted over four months from May 2024 to August 2024 in the Department of Nephrology. Seventy patients with diagnosed CKD, aged 18 years and older, were included. Exclusion criteria were patients with reversible causes of renal failure, those who had undergone renal transplantation, and those who did not consent. A comprehensive ocular examination was performed on 140 eyes from the enrolled patients, assessing anterior and posterior segment findings, including visual acuity, eyelid conditions, conjunctival status, lens status, and fundus examination. The study included 38 males (54.3%) and 32 females (45.7%) with a mean age of 57 years. Hypertension and diabetes mellitus were the most common comorbidities, present in 71.4% and 64.3% of patients, respectively. Visual acuity deteriorated with advancing stages of CKD, with significant impairment and blindness observed predominantly in CKD stages 4 and 5. Anterior segment examination revealed that 62% of eyes had immature cataracts, and 38% were pseudophakic. Fundoscopic examination showed that 51.4% of patients had abnormal findings, including non-proliferative and proliferative diabetic retinopathy, hypertensive retinopathy, age-related macular degeneration, and glaucomatous disc changes. The severity of fundus abnormalities increased with the progression of CKD, highlighting a strong correlation between the degree of renal dysfunction and ocular health. Ocular manifestations are common in CKD patients and correlate with the severity of kidney disease. The prevalence of both anterior and posterior segment abnormalities underscores the need for regular ophthalmic evaluations in CKD patients to prevent vision loss and manage ocular complications early.

Optical coherence tomography characteristics in hydroxychloroquine retinopathy and the correlations with visual deterioration in Taiwanese.

This study aimed to investigate optical coherence tomography (OCT) characteristics in hydroxychloroquine (HCQ) retinopathy and their correlation with visual acuity among Taiwanese patients. We retrospectively recruited patients undergoing long-term HCQ treatment who had received examinations of best-corrected visual acuity and OCT scans. We observed disruptions in the ellipsoid zone (EZ) and retinal pigment epithelium (RPE) across different retinal regions. Principal component analysis (PCA) was employed to identify the most significant factors associated with visual deterioration. Among the 120 eyes included in the study, HCQ retinopathy was present in 42 eyes (35.0%). In patients with mild-to-moderate retinopathy, the pericentral pattern was predominant (75.0%), whereas no parafoveal pattern was observed. Serial examinations revealed that lesions typically progressed from pericentral to parafoveal and foveal regions. EZ disruption was observed in all affected cases, most frequently at the pericentral region (100%), followed by the perifoveal (87.4%), parafoveal (72.1%), and foveal (43.2%) regions. RPE disruption was noted in 59.5% of cases, with the highest prevalence at the pericentral (53.2%) and perifoveal (52.3%) regions, followed by the parafoveal (33.3%) and foveal (28.8%) regions. PCA identified RPE disruption at the fovea and parafoveal regions as the most strongly correlated factors for visual deterioration. In Taiwanese patients, HCQ retinopathy predominantly manifests with pericentral lesions, while isolated parafoveal lesions are rare as an initial presentation. RPE disruption, rather than EZ disruption, appears to be the primary determinant for visual deterioration in this population.

Bilateral Macular Dysplasia in Coffin-Siris Syndrome.

To report a case of bilateral macular dysplasia without pigmentary retinopathy in a patient with genetically confirmed Coffin-Siris syndrome (CSS) and a co-existing, heterozygous CNGB1 variant. Case report. A 7-year-old boy who failed his vision screening was referred for retinal consultation after his eye care provider identified bilateral macular deposits. Past medical history included developmental delay, atypical facial features, uteropelvic junction obstruction, koilonychia, and corpus callosum dysgenesis. The patient underwent whole exome sequencing, which revealed a pathogenic variant in the ARID1A gene consistent with a diagnosis of Coffin-Siris syndrome. Genetic testing also revealed a heterozygous, missense variant in the CNGB1 gene of unknown significance. Fundus examination revealed fine hypopigmented lesions in the macula with surrounding retinal pigment epithelial changes in both eyes. Spectral-domain ocular coherence tomography revealed abnormalities of the ellipsoid and interdigitation zones. The patient's best-corrected visual acuity and clinical examination remained stable for a decade since his initial examination, with persistent macular dysplasia and no pigmentary retinopathy. It is possible that the ocular findings in this case may expand the phenotypes associated with CSS.

Retinal vasculature changes in patients with internal carotid artery stenosis.

To evaluate the retinal vasculature in patient with internal carotid artery (ICA) stenosis and to highlight association between ICA stenosis severity and retinal vasculature changes. Seventy-five subjects were included in this prospective study. Twenty-five healthy subjects were included in the Group 1, 25 subjects with 1-49% ICA stenosis were included in the Group 2, and 25 subjects with 50-69% ICA stenosis were included in the Group 3. Visual acuity, intraocular pressure (IOP), and anterior and posterior segment examinations were performed. Macular superficial and deep capillary density, optic nerve head capillary density, and choroidal thickness data were measured using optic coherence tomography angiography. There was a statistically significant difference between the three groups regarding superficial vascular density, deep vascular density, vascular density of radial peripapillary capillary and choroid thickness (p < 0.05 for all). Mean parafoveal and perifoveal area vascular density of the superficial capillary plexus was significantly lower in the Group 3 than Group 1 (p < 0.05 for all). Mean whole area vascular density of the deep capillary plexus was significantly lower in Group 3 than both groups (p < 0.05 for all). Mean parafoveal area vascular density of the deep capillary plexus was significantly lower in the Group 3 than Group 1 (p < 0.05). Mean subfoveal choroid thickness in group 3 was significantly lower in the Group 3 than both groups (p < 0.05 for all). Compared to healthy controls, patients with moderate ICA stenosis revealed decreased density of superficial, deep and radial peripapillary capillary vasculature and subfoveal choroidal thickness.

Evaluation of the diagnostic parameters of the amblyopia and risk factors for amblyopia screening protocol in 3-year-olds according to recommendations from the French Association for Pediatric Ophthalmology and Strabismus (AFSOP) compared with reference ophthalmological examination: the ORTHOPHTALMO study

ABSTRACT Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560. Number: NCT04395560.

Suprachoroidal Umbilical Cord-Derived Mesenchymal Stem Cell Transplantation for the Regeneration of Glaucomatous Optic Neuropathy: A Preliminary Investigation

Objective: This preliminary research presents clinical findings from patients with advanced Glaucomatous Optic Neuropathy (GON) who underwent transplantation of Umbilical Cord-Derived Mesenchymal Stem Cells (UCMSCs) into the suprachoroidal space. Methods: This prospective, single-center study included 17 eyes of 17 patients diagnosed with GON, who received suprachoroidal UCMSC implantation. Patients were registered if their visual acuity and/or Visual Field (VF) deteriorated despite maintaining good intraocular pressure control with anti-glaucomatous treatments. Evaluations were conducted at baseline, on the first postoperative day and at 1 month, 6 months and 1 year after surgery. Best Corrected Visual Acuity (BCVA), anterior segment and fundus examination, color photography, Optical Coherence Tomography (OCT), Retinal Nerve Fiber Layer (RNFL) analysis, VF testing and Pattern Visual Evoked Potential (PVEP) assessments were performed at baseline and during follow-up visits. Results: All 17 participants completed the 12-month follow-up period. No systemic or serious ocular complications were recorded. The study showed significant improvements in BCVA, VF results, RNFL measurements and PVEP amplitudes at the end of the follow-up period. Conclusion: Although the sample size is limited, suprachoroidal UCMSC therapy appears to be safe, with encouraging improvements. Further studies with larger patient groups and longer follow-up periods are required to assess the impact of stem cell delivery on visual acuity and quality of life in glaucoma patients.

Evaluation of the Safety and Tolerability of Lumify Eye Illuminations Cosmetic Products.

Cosmetic products applied to the periocular area can cause skin sensitivity reactions, and manufacturers routinely test the safety and tolerability of products in development. This research was sponsored by Bausch + Lomb to evaluate three Lumify Eye Illuminations products: a lash and brow serum, a hydra-gel eye cream, and a micellar water eye makeup remover. A cumulative irritation test (CIT) study and a repeated insult patch test (RIPT) study enrolled adult males or females with no known sensitivities to cosmetic products. Three clinical safety studies enrolled adult females with self-reported characteristics targeted by each product, which was applied in a manner consistent with expected use for 8 or 12weeks. In CIT (n=34) and RIPT (n=201) studies, faint/minimal erythema reactions were observed in 0% to 2.9% of participants; there were no moderate or severe reactions. No safety signals were observed in participants who completed clinical safety studies for lash and brow serum (n=66 enrolled, n=55 completed [83%]), eye cream (n=61 enrolled, n=52 completed [85%]), or eye makeup remover (n=80 enrolled, n=68 completed [85%]). No clinically relevant changes in visual acuity or ophthalmologic slit-lamp examination findings were noted. No participants reported ocular sensations of burning/stinging, foreign-body sensation, or soreness. At the final clinical safety study assessment, mild cutaneous erythema (as graded by the investigator) was reported for one participant (eye cream study); no other prespecified signs of cutaneous irritation (eg, edema, dryness) were observed. A treatment-related adverse event that led to study discontinuation was experienced by one participant in the eye makeup remover study (bilateral periorbital swelling). Findings from rigorously conducted irritation testing and clinical safety studies indicated that these products were safe and well tolerated. Increased availability of data regarding ocular and cutaneous safety of cosmetic products can inform consumer decision-making and eye care provider recommendations.

Evaluation of topical bromfenac as an adjunctive treatment with intravitreal ranibizumab in the management of diabetic macular edema

Background and purpose Intravitreal injection of anti- vascular endothelial growth factor medications has transformed the therapy of diabetic macular edema (DME). The purpose of this study was to evaluate the safety and efficacy of topical bromfenac as an adjunctive therapy to intravitreal ranibizumab injections in patients diagnosed with DME. Study design Prospective, randomized, controlled clinical trial. Patients The study included 40 eyes of patients with DME, divided into two groups: group I (20 eyes) received intravitreal ranibizumab injections and adjunctive topical bromfenac twice daily; group II (20 eyes) received only intravitreal ranibizumab injections. Methods All patients underwent assessments for best corrected visual acuity (BCVA), intraocular pressure, anterior segment, and fundus examination. Optical coherence tomography of the macula was repeated at 1, 3, and 6 months after the last injection. Results At 6 months, group I demonstrated significantly worse BCVA compared with group II (P=0.021). In group II, the 6-month change in central macular thickness from baseline was significantly greater in patients aged less than or equal to 60 years compared with those greater than 60 years (median = –170.5 μm vs. −40 μm, respectively; P=0.001) and in females compared with males (median = –75 μm vs. −23.4 μm; P=0.012). No significant differences were observed concerning the duration of diabetes (P=0.238), HbA1c levels (P=0.315), or laterality (P=0.792). Conclusion Topical bromfenac, when combined with intravitreal ranibizumab, showed some efficacy in the management of DME over a 6-month follow-up period, although the results were not statistically significant.

Long-Term Evaluation of Patients with Neurotrophic Keratopathy Undergoing Staged Keratoplasty After Corneal Neurotization

Purpose Corneal neurotization (CN) is a novel, potentially curative surgical procedure for the treatment of neurothophic keratopathy (NK). Patients with severe NK can present with corneal opacification requiring optical keratoplasty, which would likely fail without a proper trophic support of corneal nerves in the recipient cornea. Methods This is a pilot study on 4 patients undergoing keratoplasty after CN. Pre- and postoperative data at 12, 24 months and at the last follow-up were collected for the examination of (i) best corrected visual acuity (BCVA), (ii) slit lamp examination and photograph acquisition with and without fluorescein staining, (iii) corneal aesthesiometry, (iv) in vivo confocal microscopy of the central cornea. Neurophysiological study of the corneal reflex before corneal graft and at last follow up was performed. Results Four female patients (47.25 ± 5.06 y.o.) underwent keratoplasty after CN (3 penetrating keratoplasty, 1 deep anterior lamellar keratoplasty). The mean interval between CN and keratoplasty was 22 (± 12) months. The mean graft survival time was 42 (± 25) months. Graft follow-up ranged from 72 to 132 months. At the final follow-up, BCVA was improved in 2 out of 4 patients. The mean corneal sensitivity was 11.9 ± 8.3 mm at last follow-up. In vivo confocal microscopy confirmed the presence of functioning nerves at the last follow-up in all patients. NK-related complications occurred in 3 eyes (2 persistent epithelial defect, 1 corneal melting). The former complication was successfully treated by autologous serum eye drops while the latter required repeated keratoplasty. Conclusions Keratoplasty is a viable strategy to improve visual acuity in patients with corneal opacity who underwent CN for the treatment of NK. Even in the presence of functioning corneal nerves before keratoplasty, surgeons should be aware of the increased rate of NK-related complications that could require the need for repeated procedure.

Association Between Dry Eye Disease with Anxiety and Depression Among Medical Sciences Students in Qassim Region: Cortisol Levels in Tears as a Stress Biomarker.

This study aimed to investigate the relationships between anxiety, depression, and ocular surface health. Cortisol levels were detected in human tears, and their relationship with anxiety levels was determined using a validated questionnaire. In total, 112 participants were recruited for this study. All participants were healthy medical students at the Qassim University. Each participant signed an informed consent form after receiving detailed information about the study. Visual acuity examination, TBUT, Shirmer1 test were performed. Participants were asked to fill out three questionnaires: Taylor Manifest Anxiety Scale, Beck Depression Inventory, and The Ocular Surface Disease Index. Tear samples were extracted from the Schirmer strips and cortisol level was measured using ELISA kits. A total of 112 college students were included in the study, 58.9% of whom were females. The mean age was 21.9 ± 1.7 years. Subjective reported symptoms of anxiety levels were significantly correlated with depression scores, the OSDI, and reduced Schirmer test measurements. Moreover, cortisol levels detected in tears were positively associated with higher anxiety scores (r=0.328, P<0.05). Ocular surface health is associated with symptoms of anxiety and depression. The use of tears to measure cortisol levels could be an interesting way to serve as an anxiety biomarker.

Ocular manifestation of systemic tuberculosis in children at tertiary pediatric hospital in North India

Background: Tubnerculosis is Characterised by the presence of granuloma formation. The mode of spread of pulmonary tuberculosis is via airborne aerosol. This bacteria enters the lungs and leads to latent infection in susceptible hosts. Diagnosis is mostly presumptive in ocular tuberculosis. There is lack of uniform diagnostic criteria. Despite of vast developments in diagnostic tools, evidence of systemic tuberculosis disease along with suggestive clinical ocular findings is considered the major diagnostic criterion for ocular tuberculosis. Aim: This study aims to evaluate ocular findings in diagnosed cases of pulmonary and extrapulmonary tuberculosis in children. Methods: The study included children with various type of pulmonary and extra pulmonary tuberculosis. All these children referred to ophthalmology department to rule out ocular manifestations were evaluated on the basis of visual acuity, anterior segment and dilated posterior segment examination. Results: A total of 90 children were diagnosed with tuberculosis, of whom 30 (33.3%) were male and 60 (66.7%) were female, The mean age of presentation is 4±7 years. 30 (33.7 %) were a diagnosed case of pulmonary kochs, 52 (58.4 %) had tubercular meningitis (TBM), remaining 7 (7.8%) had other extrapulmonary kochs. The most common anterior segment finding was lateral rectus palsy in 14 (15.5%) children, the most common posterior segment finding was papilledema in 20 (22.2%) children. Conclusion: Tuberculosis is one of those pandemic in the world that can affect each and every organ of the body. A timely diagnosis of ocular findings can prevent these children from permanent ocular morbidity and blindness.

Study of Blood Lipid Levels and C-Reactive Protein in Patients with Pseudoexfoliation Syndrome

Aim: To evaluate the relationship between the level of blood lipids and inflammatory reaction protein and pseudoexfoliation syndrome. Methods: The research sample included 75 patients with pseudoexfoliation deposits that were discovered during the examination of the anterior sections of the eye on the slit lamp, attending the general eye clinic at Tishreen University Hospital in Lattakia during the time period 2022-2023, who investigated the inclusion criteria in the research, in addition to a control sample consisting of 75 patients as well. All participants underwent a detailed clinical history and ophthalmological examination including visual acuity examination and slit-lamp examination before and after mydriasis, after which the following laboratory tests were performed: CRP, LDL, HDL, TC, and TG on peripheral blood samples drawn after a 12-hour fast. Results: By comparing the patient group with the control group, our study found that there were no statistically significant differences between the two research groups according to demographic variables, as it was (P-value=0.6) for gender and (P-value=0.1) for age. We also noted with this comparison that there were no statistically significant differences between the two research groups according to the average values of the inflammatory reaction protein (CRP) (P = 0.06), total cholesterol (TC) (P = 0.5), triglycerides (TG) (P = 0.4), and low-density lipoprotein. (LDL) (P=0.6) and high-density lipoprotein (HDL) (P=0.8) Conclusion: We did not find an increase in the level of lipids in the blood, nor even in the level of CRP, in PEX patients attending the eye clinic at Tishreen University Hospital in Lattakia. These findings raise doubts about the possible relationship between PEX and vascular disease. Because the results of our and other studies are inconclusive, the causes and correlates of PEX remain unexplained and more studies on this topic are needed.

Myopia and Environmental Risk Factors: A Comprehensive Study

Background: The global rise in the prevalence of myopia calls for evidence-based strategies to be devised to reduce the incidence and delay the progression of Myopia. The aim is to determine the relationship between myopia incidence and some environmental factors. Methods: A cross-section observational study was conducted at Alzahraa Teaching Hospital from May 2023 to December 2023. Primary school students of both genders. All students were enrolled in the study after an agreement with their parents/guards. Data was collected using a pre-constructed data collection sheet (questionnaire) including three sections, the first section was sent to the families to fill and sign the consent for participation and provide the required data including the demographic variables, family history and medical history of the students, time outdoors, prolonged near work/increased study hours, high BMI, use of LED lamps for homework, less sleeping hours, low Vitamin D levels, less participation in sports and low socioeconomic status. The second part included the general examination of the students, school grades and education performance (assessed according to the student school Cards). The third section involved the ophthalmological examination, visual acuity and ophthalmoscopic examination. Results: A total of 100 students were enrolled in this study, they were equally distributed according to gender, 50 boys and 50 girls. The age of students ranged between 6 and 12 years. Only 12 students had positive past medical and surgical history. A family history of myopia was reported in 20% of the studied group, 20 children were wearing spectacles and a history of past eye complaints was reported in 9 (9%) of children. The refractive errors were 45% hypermetropia, 39% myopia and 16% astigmatism. Abnormal visual acuity was detected in 35%. Myopia was significantly higher in children with family history (p=0.007). A statistically significant relationship was found between large time outdoors and myopia (OR=4.52, p=0.02). A statistically significant relationship was found between prolonged near-work/increased study hours and myopia (OR=4.52, p=0.02). A statistically significant relationship was found between using LED lamps for homework and myopia (OR=10.33, p&lt;0.0001). A statistically significant relationship was found between fewer sleeping hours and myopia (OR=7.5, p&lt;0.0001). Conclusion: Prevention of the onset of myopia and delay in the progression of myopia can be altered by modifying the contributing environmental risk factors. Raise outdoor time with adequate sunlight exposure, rural environment, less duration of near work, use of incandescent lamp and normal sleeping rhythms with adequate regular sleeping hours can prevent the onset and progression of myopia. Myopia is associated with high BMI, watching television and playing digital devices. High socioeconomic status associated with more indoor activity, increased academic pressure, sedentary lifestyle contribute to the prevalence of myopia.

Changes in Macular Pigment Optical Density after Intravitreal Faricimab in Neovascular Age-Related Macular Degeneration: A Pilot Study.

Background: This study aimed to evaluate the effects of faricimab intravitreal injections in patients with exudative age macular degeneration (nAMD) after the loading dose using spectral domain optical coherence tomography (SD-OCT) and macular pigment optical density (MPOD). Methods: In this observational prospective study, we enlisted a total of 12 consecutive eyes of 12 patients (six females, six males; mean age 70.47 ± 2.46 years) affected by nAMD who consecutively presented to the Eye Clinic of the University of Naples "Federico II" and Monaldi Hospital of Naples, from June 2023 to December 2023. All patients received four once-monthly intravitreal injections of faricimab (6 mg/0.05 mL) (loading phase). At baseline and 1 month after the fourth faricimab monthly injection, all patients underwent assessment of best correct visual acuity (BCVA) and ophthalmic examination, including slit-lamp biomicroscopy, intraocular pressure (IOP), fundus biomicroscopy, SD-OCT, and MPOD. Results: A total of 12 eyes of 12 patients (six women, six men; mean age 70.47 ± 2.46 years) were included in this study. A statistically significant raise in BCVA and MOPD parameters was shown between baseline and after the loading phase (p < 0.001). Conclusions: Intravitreal injections of faricimab led in the short term to a significant functional and MPOD improvement along with a decrease in central macular thickness (CMT) and thus appears to be an effective treatment option without relevant adverse effects. MOPD may be considered as a prognostic factor associated with a good visual prognosis after intravitreal injections treatment.

Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease.

To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.