Bilkhu PS, Wolffsohn JS, Naroo SA, Robertson L, Kennedy R
Objective: To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication.
Intervention: Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control.
Main Outcome Measures: Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour.
Results: Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014).
Conclusions: After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.
British Journal of Ophthalmology, bjophthalmol-2013
Wong TY, Zheng Y, Jonas JB, Flaxman SR, Keeffe J, Leasher J, Bourne RR
Aims To describe the prevalence and causes of visual impairment and blindness in East Asia in 1990 and 2010.
Method Data from population-based studies conducted from 1980 to 2012 were identified, and eligibility for inclusion was assessed. Data on prevalence of blindness (presenting visual acuity <3/60 in the better eye) and moderate to severe visual impairment (MSVI; presenting visual acuity <6/18 to 3/60 in the better eye) and causes were extracted.
Results The age-standardised prevalence of blindness was 0.7% (95% CI 0.6 to 0.9) in 1990 and 0.4% (95% CI 0.3 to 0.5) in 2010, while that of MSVI was 3.6% (95% CI 2.3 to 4.4) and 2.3% (95% CI 1.7 to 2.8), respectively. These prevalence estimates were lower than those of other countries globally. The absolute numbers affected by blindness and MSVI in 2010 were 5.2 million and 33.3 million, respectively, and were higher among women than men. Cataract was the leading cause of blindness, whereas uncorrected refractive error was the leading cause of MSVI.
Conclusions There has been a significant reduction in prevalence of blindness in East Asia, but a substantial absolute number of people remain blind and visually impaired, largely caused by cataract and uncorrected refractive error.
Journal of Cataract & Refractive Surgery, 2014;40(1):20-28.
Nagy ZZ, Takacs AI, Filkorn T, Kránitz K, Gyenes A, Juhász É, Slade S
Purpose: To analyze complications of femtosecond lasers used for cataract surgery.Setting: Department of Ophthalmology Semmelweis University, Budapest, Hungary
Design: Retrospective analysis.
Methods: Intraoperative complications of the first 100 femtosecond laser–assisted (Alcon-Lensx, Inc.) cataract surgeries were collected. Possible complications of femtosecond capsulotomies and their management were also assessed.
Results:The complications were as follows: suction break (2%), conjunctival redness or hemorrhage (34%), capsule tags and bridges (20%), anterior tear (4%), miosis (32%), and endothelial damage due to cut within the endothelial layer (3%). There were no cases of capsule blockage or posterior capsule tear. During the learning curve, there was no complication that would require vitrectomy. All complications occurred during the first 100 cases.
Conclusions: Femtosecond laser cataract surgery had a learning curve during the first 100 cases. With cautious surgical technique, the complications can be avoided. The femtosecond laser–assisted method was efficient and safe for cataract surgery.
Background:Uveitis is a diverse group of intraocular inflammatory disease and is a significant cause of visual loss worldwide.
Background: Uveitis is a diverse group of intraocular inflammatory disease and is a significant cause of visual loss worldwide. Recent studies have identified various endogenous immune mechanisms and genetic factors that are involved in the pathogenesis of uveitis. This review provides an overview on the role of genetics in the development and clinical course of uveitis.
Methods: PUBMED was used for literature search, and articles published from 1970 to 2012 that evaluated the genetic associations and mechanisms involved in the development and clinical features of uveitis were included.
Results: Studies have demonstrated associations between various genetic factors and the development and clinical course of intraocular inflammatory conditions. Genes involved included genes expressing interleukins, chemokines, chemokine receptors, and tumor necrosis factor and genes involved in complement system, oxidation, and other intracellular molecular pathways.
Conclusion: Multiple genetic factors play important roles in the pathogenesis of uveitis and may influence the clinical course of uveitis. Further studies to investigate the genetic mechanisms of uveitis might identify additional genetic associations and might have the potential for identifying novel therapeutic targets in the treatment of intraocular inflammation.
Katz T, Frings A, Linke SJ, Richard G, Druchkiv V, Steinberg J
Background: This study examined the refractive and visual outcome of wavefront-optimized laser in situ keratomileusis (LASIK) in eyes with low myopia and compound myopic astigmatism ≤ 0.75 diopter (D).
Methods: 153 eyes from 153 consecutive myopic patients (74 male, 79 female; mean age at surgery 40.4 ± 10.4 years) who had a preoperative refractive cylinder ≤ 0.75 D and a manifest sphere between -0.25 D and -2.75 D, and who had completed 4-month follow-up. Three subgroups defined by the magnitude of preoperative manifest refractive cylinder (0.25, 0.50, and 0.75 D) were formed. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and postoperatively. The astigmatic changes achieved were determined using the Alpins vector analysis.
Results: After 4 months (120.0 ± 27.6 days) of follow-up, a mean uncorrected distant visual acuity of 0.07 ± 0.11 logMAR and a mean manifest refraction spherical equivalent of -0.06 ± 0.56 D were found. There was no statistically significant difference in efficacy and safety between the preoperative cylinder groups. Astigmatic overcorrection for preoperative cylinder of ≤ 0.50 D was suggested by the correction index, the magnitude of error, the index of success, and the flattening index.
Conclusions: Low myopic eyes with a preoperative cylinder of ≤ 0.50 D were significantly overcorrected with regard to cylinder correction when combined with low myopic LASIK. Accordingly, we are cautious in recommending full astigmatic correction for eyes with low myopia and manifest cylinder of ≤ 0.50 D.
Contact Lens & Anterior Eye. February 2014;37(1):16-19
Vivian A. Phan Yoon Hee Kim,Catherine Yang,Barry A. Weissman
Purpose
The purpose of this study was to evaluate the complexity and effectiveness of fitting bitoric rigid gas permeable contact lenses (RGPCLs), compared to spherical RGPCLS, when used in the correction of high amounts of post-penetrating keratoplasty astigmatism.
Journal of Neuro-Ophthalmology. December 2013; 33 (4):344-348
Altpeter EK, Blanke BR, Leo-Kottler B, Nguyen XN, Trauzettel-Klosinski S
Background: Leber hereditary optic neuropathy (LHON) is characterized by progressive loss of central vision leading to impaired reading ability. The aim of this study was to evaluate sensory adaptation and reading ability in LHON patients.
Methods:This prospective pilot study included 12 male patients with a clinical diagnosis and a positive genetic analysis of LHON, who matched the inclusion criteria of a central scotoma on visual field testing and the use of magnifying aids to read. Examination included best-corrected visual acuity, magnification need, reading speed, and evaluation of fixation by corneal reflexes and by Rodenstock scanning laser ophthalmoscope (SLO). Central scotoma was assessed by conventional perimetry (Tübingen Automated Perimeter) and microperimetry (NIDEK MP1).
Results:Mean magnification need was 13.2 ± 7.3-fold (range: 2- to 25-fold). Mean reading speed was 53 ± 18 words per minute (WPM) (range: 24–85 WPM). With automated perimetry, all patients showed central scotomas with a mean radius of 13° ± 7° (range: 1°–30°) in the better eye. Microperimetry in all patients showed fenestrated central scotomas. Eccentric fixation with a preferred retinal locus (PRL) was detected with SLO examination and microperimetry correlated well in 11 of 12 patients. The SLO results showed no systematic pattern in the placement of the PRL; however, 7 of 12 patients (58%) placed their PRL in an unfavorable location left or below the fovea. In 8 of 12 patients, fixation was unstable. Between reading speed and central scotoma size, there was a statistically significant negative correlation (P = 0.021, r = −0.65).
Conclusions:The percentage of unfavorable PRL locations was extremely high compared with other disorders with central scotomas. Unstable fixation and fenestrated central scotomas led to difficulties in reading. Early rehabilitation and, if necessary, eccentric viewing training should be considered in LHON patients.
PURPOSE:To investigate whether patients with primary open-angle glaucoma combined with high myopia (POAG-HM) have short-term intraocular pressure (IOP) fluctuations at resting conditions over 24 hours and after dynamic exercise.
CONCLUSIONS: High-tension POAG patients with high myopia on only pharmacological glaucoma therapy have significantly greater IOP fluctuations after moderate and heavy exercise and do not have greater 24-hour IOP fluctuations at resting conditions.
Los objetivos generales del Grupo son: 1. Crear producción científica de la Asociación. Ésta podrá ser entre otras: 1.1 Publicación de artículos en revistas de alto factor de impacto. 1.2 Presentación de ponencias en congresos nacionales e internacionales. 2. Acercar la investigación a los asociados.
Los objetivos específicos del Grupo son: 1. Proponer proyectos de investigación a la Asociación a través del Comité Científico de AEOPTOMETRISTAS 2. Desarrollar y participar en proyectos de investigación aprobados por el Comité Científico de AEOPTOMETRISTAS 3. Servir de apoyo y asesoramiento a los asociados que deseen desarrollar un trabajo de investigación. 4. Servir de apoyo y asesoramiento al Comité Científico AEOPTOMETRISTAS, emitiendo informe de opinión sobre los proyectos recibidos. 5. Promover la comunidad científica
by Diana América Chávez Cabrera: UNIVERSIDAD AUTONOMA DE VERACRUZ VILLA RICA, MPSS en CIS at Diana América Chávez Cabrera: UNIVERSIDAD AUTONOMA DE VERACRUZ VILLA RICA on Feb 23, 2010
PRINCIPALES PADECIMIENTOS CONJUNTIVALES AUTORAS: DIANA AMERICA CHAVEZ CABRERA MARILYN BERENICE PEREZ GARCIA ASIGNATURA:OFTALMOLOGIA DRA. MA. ADELAIDA LABARDINI SCHETTINO
Progress in Retinal and Eye Research. January 2014: 38; 20–42
Kanagasingam Y, Bhuiyan A, Abràmoff MD, Smith RT, Goldschmidt L, Wong TY
Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss in those over the age of 50 years in the developed countries. The number is expected to increase by ∼1.5 fold over the next ten years due to an increase in aging population. One of the main measures of AMD severity is the analysis of drusen, pigmentary abnormalities, geographic atrophy (GA) and choroidal neovascularization (CNV) from imaging based on color fundus photograph, optical coherence tomography (OCT) and other imaging modalities. Each of these imaging modalities has strengths and weaknesses for extracting individual AMD pathology and different imaging techniques are used in combination for capturing and/or quantification of different pathologies. Current dry AMD treatments cannot cure or reverse vision loss. However, the Age-Related Eye Disease Study (AREDS) showed that specific anti-oxidant vitamin supplementation reduces the risk of progression from intermediate stages (defined as the presence of either many medium-sized drusen or one or more large drusen) to late AMD which allows for preventative strategies in properly identified patients. Thus identification of people with early stage AMD is important to design and implement preventative strategies for late AMD, and determine their cost-effectiveness. A mass screening facility with teleophthalmology or telemedicine in combination with computer-aided analysis for large rural-based communities may identify more individuals suitable for early stage AMD prevention.
In this review, we discuss different imaging modalities that are currently being considered or used for screening AMD. In addition, we look into various automated and semi-automated computer-aided grading systems and related retinal image analysis techniques for drusen, geographic atrophy and choroidal neovascularization detection and/or quantification for measurement of AMD severity using these imaging modalities. We also review the existing telemedicine studies which include diagnosis and management of AMD, and how automated disease grading could benefit telemedicine. As there is no treatment for dry AMD and only early intervention can prevent the late AMD, we emphasize mass screening through a telemedicine platform to enable early detection of AMD. We also provide a comparative study between the imaging modalities and identify potential study areas for further improvement and future research direction in automated AMD grading and screening.
Top-down guidance of visual attention has classically been thought to operate in a feature-specific manner. However, recent studies have shown that top-down visual attention can also be guided by information about target–nontarget feature relations (e.g., larger, redder, brighter). Here we recommend a minimal set of cues for differentiating between relational and feature-specific attentional guidance and examine contrasting predictions for the guidance of attention by size and color stimuli in a spatial cueing paradigm. InExperiment 1 we demonstrate that in search for size, when both feature-specific and relational strategies are available, participants adopt a relational search strategy. Experiment 2 shows that when feature-specific information is the only reliable information to guide attention to the target, participants are able to adopt a feature-specific set for size information. Finally, in Experiment 3 we extend our paradigm to differentiate between feature-specific and relational strategies in search for color. Together, these experiments help to clarify the conditions under which different attentional guidance strategies will be employed, and demonstrate a useful minimum cue requirement for differentiating between these two forms of top-down guidance. Implications for current theories of attention are discussed
Abstract : Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3 weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors such as age, baseline VA, and CNV lesion size with anti-VEGF treatment outcomes. No behavioral factors such as smoking influence treatment outcomes. Based on the studies conducted so far, the evidence suggests that underlying genotype of known AMD risk associated genes or of the VEGF-A gene have a limited effect, whereas presenting clinical factors appear to be more important in determining treatment outcomes.
Ristau T, Keane PA, Walsh AC, Engin A, Mokwa N,Kirchhof B, Liakopoulos S
Purpose: Relationship between spectral domain optical coherence tomography (SD-OCT) and visual acuity (VA) in neovascular age-related macular degeneration (NVAMD).
Procedures: VA and SD-OCTs of 64 treatment-naive eyes with NVAMD were retrospectively collected at baseline and 1 year (n = 30). Retinal and subretinal spaces were manually analyzed. Volume and thickness measurements were correlated with VA.
Results: At baseline, lower VA correlated with increased volume of subretinal hyperreflective material (R = 0.4, p < 0.001) and with decreased volume of the photoreceptor layer (PRL, R = -0.4, p < 0.01). At 1 year, lower VA correlated with decreased volume of the retina (R = -0.7, p < 0.001), outer nuclear layer (R = -0.6, p < 0.05) and PRL (R = -0.7, p < 0.001). Decrease in VA after 1 year correlated with a decrease in PRL (R = 0.4, p < 0.05).
Conclusions: Quantitative analysis of SD-OCT revealed correlations between VA and retinal and subretinal morphological changes in NVAMD. Message: Atrophy of the outer retina is an important correlate for lower VA in NVAMD.
Relación entre la agudeza visual y los parámetros en la tomografía de coherencia óptica de dominio espectral de retina en la neovascularización de la DMAE
Objectives:To evaluate the visual correction and clinical performance with scleral contact lenses (CL) for the visual rehabilitation of irregular astigmatism and to report the effect of brief wearing breaks on the wearing time and success rate.
Methods: A retrospective review was performed on consecutive patients who were fitted with scleral CL because of irregular astigmatism following failure of other optical corrections. Visual acuity (VA) and wearing times were abstracted.
Results:The 97 consecutive identified patients (155 eyes) were divided according to the diagnosis: (1) keratoconus (105 eyes; 67.7%), (2) postpenetrating keratoplasty (PK) (28 eyes; 18.1%); (3) multiple diagnoses (22 eyes; 14.2%)—postradial keratotomy, keratoglobus, pellucid marginal degeneration, PK with aphakia, and iatrogenic ectasia. The mean follow-up was 34.9 ± 18.5 months (range, 2–71 months). There was a significant increase in best VA-scleral when compared with the previous best VA-prescleral (P<0.001). The best VA-scleral was similar in the 3 groups (P>0.5). Patients who took brief breaks every 4 to 5 continuous wearing hours had a significantly higher success rate (P<0.001) among all diagnosis groups. The success rate in wearing time in the keratoconus group was significantly higher than in the PK group (P<0.001). Twenty-six patients (27%) discontinued to wear scleral lenses.
Conclusion:Scleral lenses can be used successfully for visual rehabilitation and management of irregular astigmatism from various causative factors. The daily wearing time was significantly improved by taking brief breaks for replenishing the CL.
Ophthalmic and Physiological Optics. January 2014; 34(1):94–101,
Gordon‐Shaag A, Barnard S, Millodot M, Gantz L, Chiche G, Vanessa E, Shneor E
Abstract
Purpose: To determine the prevalence of choroidal naevi in a healthy population using an ultra-wide scanning laser ophthalmoscope which can capture up to a 200° field of view of the retina, without pupil dilation.
Methods: Subjects were recruited from a college population. Each subject underwent an eye examination that included retinal and choroidal imaging using the Optos scanning laser ophthalmoscope and completed a self-administered questionnaire. Univariate and multivariate regression analysis were performed to identify associated factors with choroidal naevi.
Results: The Optomap images of 406 participants (mean age 23.5 ± 4.4) were analysed. Thirty-nine subjects (10%) presented with at least one naevus in one eye, and multiple naevi were observed unilaterally in eight subjects. Drusen were noted in only one eye. The mean naevus diameter was 2.38 mm (±2.07). Prevalence was not associated with either eye colour, time spent outdoors, visual impairment, or ethnic group, but was significantly associated with male gender (OR 2.41, p = 0.009), blond/red hair colour (OR 2.42, p = 0.037), skin that neither burns nor tans (OR 2.8, p = 0.02) and habitual sunglasses use (OR 0.33, p = 0.002).
Conclusions: A higher prevalence of choroidal naevi was detected in this college population compared to other population-based studies. This is likely due to the use of an ultra-wide field scanning laser ophthalmoscope which provides up to 200° of the fundus. The naevi were associated with several factors.
Purpose:The aim of this study was to assess the efficacy and safety of bevacizumab in the treatment of pterygium and to mainly explore its effects on recurrence rate and complications.
Methods:We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to July 2013 for relevant randomized controlled trials that examined bevacizumab therapy for pterygium. Data concerning study design, patient characteristics, treatment, and outcomes were extracted. The methodological quality of the studies included was assessed using the Jadad score. Relative risk (RR) was calculated for recurrence rate and complications.
Results:A total of 474 patients with 482 eyes in 9 randomized controlled trials were analyzed. The pooled estimate showed that bevacizumab had no statistically significant effect on preventing pterygium recurrence [RR 0.90, 95% confidence interval (CI) 0.77–1.07, P = 0.23]. None of the subgroup analyses yielded significant results in favor of bevacizumab (surgery group: RR 0.77, 95% CI 0.50–1.18, P = 0.23; nonsurgery group: RR 0.98, 95% CI 0.86–1.11, P = 0.76; primary pterygium group: RR 0.82, 95% CI 0.53–1.26, P = 0.36; recurrent pterygium group: RR 0.95, 95% CI 0.82–1.09, P = 0.44). There were no statistically significant differences in the complications between the 2 groups (RR 1.00, 95% CI 0.73–1.37, P = 1.00). However, the bevacizumab group was associated with a higher risk of developing subconjunctival hemorrhage (RR 3.34, 95% CI 1.07–10.43, P = 0.04).
Conclusions:Topical or subconjunctival bevacizumab was relatively safe and well tolerated, but it had no statistically significant effect on preventing pterygium recurrence. A large-scale trial with a suitable dosage and a longer follow-up would be required to rule out the possibility of any treatment benefit.
Purpose : The objective was to compare retinal morphology and function following intravitreal injections of bevacizumab (Avastin) or triamcinolone (Volon A) in patients with early diabetic macular edema (DME).Patients and methods: The study was planned as a randomized, prospective, interventional clinical trial. A total of 30 diabetic patients with treatment-naïve, clinically significant macular edema were included in this study and randomized to two equal groups. One group initially received three injections of 2.5 mg bevacizumab in monthly intervals. The second group received a single injection of 8 mg triamcinolone, followed by two sham interventions. Functional and anatomic results were evaluated monthly using ETDRS vision charts and spectral-domain optical coherence tomography. According to the study protocol, retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen.Results:Baseline best corrected visual acuity (BCVA) was 0.30 logMAR and central retinal subfield thickness (CSRT) was 505 μm in the bevacizumab group and 0.32 logMAR and 490 μm CSRT in the triamcinolone group. After 3 months, BCVA improved to 0.23 logMAR (bevacizumab) and 358 μm CRST and 0.26 logMAR (triamcinolone) and 308 μm CSRT. After 12 months, BCVA further recovered in the bevacizumab group (0.18 logMAR) but slightly decreased in the triamcinolone group (0.36 logMAR).Conclusion: Intravitreal bevacizumab and triamcinolone are both equally effective in reducing CSRT in early DME. After 6 months, rehabilitation of vision was comparable in both treatment arms, whereas at the final follow-up at month 12, BCVA was superior in the bevacizumab than in the triamcinolone sample. This may be related to cataract development following steroid treatment, as well as to substance-specific mechanisms within the angiogenic versus the inflammatory cascade.
Desde la Asociación Española de Optometristas Unidos (AEOPTOMETRISTAS) nos gustaría compartir con todos vosotros la creación del Grupo de Estudios AEOPTOMETRISTAS (GEA).
Los objetivos de GEA son crear producción científica en el ámbito de las ciencias visuales, y acercar la investigación a los asociados. Se presenta como un grupo de apoyo y asesoramiento para que cualquier asociado que quiera desarrollar un proyecto de investigación, tenga una plataforma desde la cual poder desarrollar sus ideas y trabajar en un equipo de investigación, para conseguir una publicación científica de alto nivel. GEA es un grupo abierto, en el que cualquier optometrista asociado, sea cual sea su ámbito profesional y su lugar de trabajo, puede colaborar formando parte activa del mismo.
Esperamos que este proyecto, que comenzamos con mucha ilusión, produzca los frutos científicos que esperamos. Queremos aprovechar este foro para compartirlo con todos vosotros, y animaros a visitar nuestra página web (www.aeoptometristas.es) y conocernos.
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