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BMJ Open Ophthalmology Nov 2023To explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy... (Meta-Analysis)
Meta-Analysis
PURPOSE
To explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy (DON).
METHODS
Studies in the literature that focused on OCT, OCTA and DON were retrieved by searching PubMed, EMBASE, Cochrane databases and Clinical Trial before 20 June 2023. The methodological quality was assessed using the Newcastle-Ottawa scale. The quantitative calculation was performed using Review Manager V.5.3.
RESULTS
Twelve studies met the eligibility criteria and were included. DON group presented lower macular ganglion cell complex in the overall, superior and inferior hemifields compared with the non-DON group. Furthermore, the ganglion cell layer and inner plexiform layer in DON group was thinner in contrast to the non-DON group. The optic nerve head vessel density was lower in the DON group than that in the non-DON group. A reduction of radial peripapillary capillary vessel density could be seen in the DON group than the non-DON group in overall, inside disc, peripapillary, superior-hemifield, temporal and nasal. Besides, the macular superficial retinal capillary layer of non-DON and DON is lower than the healthy control group.
CONCLUSIONS
This study supported the potential value of OCT and OCTA metrics as novel biomarkers of DON. Ophthalmologists should comprehensively consider the retinal structure and microvasculature in dealing with DON.
ETHICS AND DISSEMINATION
This systematic review included data from published literature and was exempt from ethics approval. Results would be disseminated through peer-reviewed publication and presented at academic conferences engaging clinicians.
PROSPERO REGISTRATION NUMBER
CRD42023414907.
Topics: Humans; Tomography, Optical Coherence; Optic Disk; Angiography; Retinal Ganglion Cells; Optic Nerve Diseases
PubMed: 37996119
DOI: 10.1136/bmjophth-2023-001379 -
International Ophthalmology Jun 2024This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in children and adults.
METHODS
A systematic search of Cochrane Central Register of Controlled Trials, Pubmed, Embase and Ovid was conducted from database inception to 22nd August 2021. Studies that reported on risks, visual and ocular biometric effects of OK in patients > 5 years of age with myopia (- 0.75 to - 6.00D) were included. Main outcomes are change in axial length and any adverse event.
RESULTS
Fourty-five papers were included in this systematic review and meta-analysis. The quality of data was variable and of moderate certainty, and selection bias likely skewed the results towards a relative benefit for OK. The rate of axial elongation in children was lower for OK treatment compared to other treatment modalities at one year (MD - 0.16 mm, 95% CI - 0.25 to - 0.07). Rate of change in axial length in children rebounded after OK discontinuation compared to participants who continued treatment (MD 0.10 mm, 95% CI 0.06 to 0.14). Adults and children wearing OK were up to 3.79 times more likely to experience an adverse event when compared with conventional contact lenses (OR 3.79, 95% CI 1.24 to ll.), though this evidence base is underdeveloped and requires additional well-designed studies for substantial conclusions to be drawn.
CONCLUSIONS
OK arrests myopia progression while in use, however, there remain unanswered questions about the optimal duration of treatment, discontinuation effects and long-term risk for adverse events.
Topics: Humans; Orthokeratologic Procedures; Myopia; Refraction, Ocular; Visual Acuity; Axial Length, Eye; Contact Lenses; Child; Risk Assessment
PubMed: 38904856
DOI: 10.1007/s10792-024-03175-w -
Indian Journal of Ophthalmology Dec 2020Photorefractive keratectomy (PRK) eye surgery is widely used for patients at risk for corneal ectasia to maintain an aspheric corneal shape. Wavefront-guided (WFG)... (Meta-Analysis)
Meta-Analysis Review
Photorefractive keratectomy (PRK) eye surgery is widely used for patients at risk for corneal ectasia to maintain an aspheric corneal shape. Wavefront-guided (WFG) ablation profile was designed to reduce pre-existing higher-order aberrations (HOA). We aimed to compare the corneal aberrations and visual outcomes between WFG and Wavefront Optimized (WFO) PRK in patients with myopia. Eight randomized clinical trials were included. We searched PubMed, Scopus, Web of Science and CENTRAL at March 2020, and updated the search in September 2020 using relevant keywords, The data were extracted and pooled as Mean Difference (MD) with a 95% Confidence Interval (CI), using Review Manager software (version 5.4). Pooled results showed no significance between Uncorrected Distance Visual Acuity (UDVA) and Corrected Distance Visual Acuity (CDVA) between both groups underwent WFG and WFO PPR after three months follow up (MD = -0.03; 95% CI: [-0.06, 0.00]; P = 0.07), (MD = -0.02; 95% CI: [-0.04, 0.01]; P = 0.22) respectively. Although, no significant difference between mean manifest cylinder after three and 12 months follow up, but the total MD for mean manifest cylinder difference was significantly lower with the WFG treatment method (MD = -0.12, (95% CI: [0.23:-0.01], P = 0.03). This shows a slight advantage of the WFG over the WFO method. The visual performance showed similarity and excellent refractive outcomes in both WFO and WFG PRK. No significant statistical differences between the two approaches. On further comparison, there was a slight advantage of the WFG over the WFO method.
Topics: Corneal Wavefront Aberration; Humans; Lasers, Excimer; Photorefractive Keratectomy; Prospective Studies; Refraction, Ocular; Treatment Outcome
PubMed: 33229644
DOI: 10.4103/ijo.IJO_2921_20 -
BMC Public Health Feb 2024Computer vision syndrome has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Computer vision syndrome has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of computer vision syndrome during the COVID-19 pandemic.
METHODS
A systematic review and meta-analysis of the literature was conducted using the databases PubMed, Scopus, Web of Science, and Embase up to February 22, 2023, using the search terms "Computer Vision Syndrome" and "COVID-19". Three authors independently performed study selection, quality assessment, and data extraction, and the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate study quality. Heterogeneity was assessed using the statistical test I, and the R version 4.2.3 program was used for statistical analysis.
RESULTS
A total of 192 studies were retrieved, of which 18 were included in the final meta-analysis. The total sample included 10,337 participants from 12 countries. The combined prevalence of computer vision syndrome was 74% (95% CI: 66, 81). Subgroup analysis based on country revealed a higher prevalence of computer vision syndrome in Pakistan (99%, 95% CI: 97, 100) and a lower prevalence in Turkey (48%, 95% CI: 44, 52). In addition, subgroup analysis based on study subjects showed a prevalence of 82% (95% CI: 74, 89) for computer vision syndrome in non-students and 70% (95% CI: 60, 80) among students.
CONCLUSION
According to the study, 74% of the participants experienced computer vision syndrome during the COVID-19 pandemic. Given this finding, it is essential to implement preventive and therapeutic measures to reduce the risk of developing computer vision syndrome and improve the quality of life of those affected.
TRIAL REGISTRATION
The protocol for this systematic review and meta-analysis was registered in the international registry of systematic reviews, the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42022345965.
Topics: Humans; COVID-19; Pandemics; Prevalence; Research Design; Vision Disorders
PubMed: 38424562
DOI: 10.1186/s12889-024-17636-5 -
BMJ Open Ophthalmology Jun 2022Blindness is defined as presenting visual acuity worse than 3/60 in the better eye. Its highest proportion has been conforming to the developing countries such as... (Meta-Analysis)
Meta-Analysis Review
Blindness is defined as presenting visual acuity worse than 3/60 in the better eye. Its highest proportion has been conforming to the developing countries such as Ethiopia. So, timely information is crucial to design strategies. However, the study on the magnitude of blindness in Ethiopia was outdated which means it was conducted in 2005-2006. Therefore, this study was proposed to estimate the pooled prevalence of blindness in Ethiopia.Databases like PubMed, Cochrane library, Google Scholar and references of retrieved articles were used to search for articles. A standard data extraction approach was employed and presented using Preferred Reporting of Items for Systematic Reviews and Meta-Analyses. The Newcastle-Ottawa Scale quality assessment tool was used to evaluate the quality of studies. Analysis held using STATA V.11. The funnel plot and Egger's regression test were applied to check for the potential sources of bias. Heterogeneity among the studies was tested using I² statistics that have been calculated and compared with the standard. Meta-regression and subgroup analysis were done to identify the potential sources of heterogeneity. Estimation of blindness was carried out using Duval and Twee die's trim and fill analysis. The pooled prevalence of blindness in Ethiopia is found to be 1.18% (95% CI 0.650% to 1.706%). Blindness is among the main public health difficulties in Ethiopia. So, it demands up-to-date strategies and its implementation, preventive and curative eye care service with affordable and accessible interventions, and evidence-based advocacy. The trial Registration Number is CRD42021268448.
Topics: Blindness; Ethiopia; Humans; Prevalence
PubMed: 36161856
DOI: 10.1136/bmjophth-2021-000949 -
Journal of Ophthalmic Inflammation and... Jan 2023Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity... (Review)
Review
BACKGROUND
Retinal vasculitis is a component of uveitis for which the Standardisation of Uveitis Nomenclature (SUN) working group has no standard diagnostic criteria or severity grading. Fluorescein angiography is the gold standard test to assess retinal vasculitis, but is invasive and time-consuming. Optical coherence tomography (OCT) provides non-invasive detailed imaging of retinal structures and abnormalities, including blood vessel architecture and flow with OCT angiography (OCT-A). However, use of OCT in retinal vasculitis beyond assessing macular oedema, is not well established. We conducted a systematic review to understand the features of retinal vasculitis in OCT, Enhanced-depth imaging OCT (OCT-EDI) and OCT-A imaging.
METHODS
The systematic search was done in March 2022 and updated in January 2023, through PubMed, EMBASE and the Web of Science database for studies related to OCT, OCT-EDI and OCT-A findings and retinal vasculitis. Bias assessment was assessed using JBI Critical Appraisal Checklist, and any findings associated with retinal vasculitis were extracted by qualitative analysis.
RESULTS
We identified 20 studies, including 8 articles on OCT, 6 on OCT-EDI and 6 on OCT-A. The studies included analytical retrospective studies, case-series, and a case-control study. Five OCT studies reported secondary complications could be detected, and four reported retinal thickness alteration in retinal vasculitis. Five studies explored choroidal thickness alteration in OCT-EDI, and four explored capillary density alterations in retinal vasculitis using OCT-A. The heterogeneity in the studies' analysis and design precluded a meta-analysis.
DISCUSSION
There were no clear OCT, OCT-EDI or OCT-A findings that demonstrated potential to supersede fluorescein angiography for assessing retinal vasculitis. Some signs of macular structural effects secondary to retinal vasculitis may help prognostication for vision. The OCT signs of inflamed retinal vessels and perivascular tissue is an unexplored area.
PubMed: 36715778
DOI: 10.1186/s12348-023-00327-4 -
Cancers May 2022Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have... (Review)
Review
Cervical dysplasia is a common precancerous lesion affecting 1% to 2% of women worldwide. Significant progress in the diagnosis and treatment of cervical dysplasia have been made in the last decade. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify controlled clinical trials reporting on the efficacy and safety of diagnostic and therapeutic interventions for cervical dysplasia. Data were analyzed according to PRISMA guidelines. In total, 33 studies reporting on 5935 women were identified. We recommend intravenous or intracervical lidocaine for pain reduction during colposcopically-directed cervical biopsies but not topical lidocaine, music, or video colposcopy. Monsel’s solution might be used to control bleeding after cervical biopsies. The acetic acid test should be scored 1 min after the application of acetic acid and should be followed by Lugol’s iodine test for an optimal yield of LSIL/HSIL. LEEP/LLETZ remains the standard and techniques such as SWETZ, C-LETZ, and TCBEE are not superior. LEEP/LLETZ should be performed under local anesthesia and with direct colposcopic vision. Cryotherapy and thermoablation might be used in women with LSIL, especially in women with HIV infection, but LEEP/LLETZ remains the standard for HSIL. Topical imiquimod remains an experimental procedure. In conclusion, significant progress has been made in the last decade regarding both diagnostic interventions as well as therapeutic interventions for women with cervical dysplasia. Based on >30 controlled clinical trials, we were able to formulate specific and evidence-based recommendations.
PubMed: 35681649
DOI: 10.3390/cancers14112670 -
Physiology & Behavior Oct 2022Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of... (Review)
Review
Lutein and zeaxanthin-xanthophyll carotenoids with antioxidant and anti-inflammatory characteristics-are present in the retina and the brain. High concentrations of these carotenoids have been positively related to cognitive performance. Therefore, this systematic review analyses the relationship between macular pigment density and cognitive functions. Most relevant databases were scoured for studies on healthy people relating cognitive functions to macular pigment optical density (MPOD). There were no age, sex, or race limitations. PROSPERO registration: CRD42021254833. Nineteen studies were included, seven randomized controlled trials (RCT) and eleven observational studies. The general aim of the studies was to examine the association between carotenoids (lutein, meso‑zeaxanthin and zeaxanthin) and cognitive function. Most observational studies correlates MPOD levels with cognitive function or brain activity. Besides, RCTs compared the cognitive function and/or brain activity after increasing lutein and zeaxanthin intake though dietary supplementation or avocado consumption. Dietary lutein and zeaxanthin intake increased MPOD in six of the seven clinical trials and significantly improved most of the cognitive functions studied. A wide variety of test and methodologies for measuring cognitive functions were observed. Memory, processing speed, attention and reasoning were the cognitive function significantly related to MPOD levels in adults. Brain activity also was related to MPOD, but the results were inconsistent. Only four of the eleven observational studies were based on young people and all studies showed a significant relationship between MPOD and cognitive functions. This systematic review showed a direct relationship among cognitive functions, macular pigment and the intake of lutein and zeaxanthin.
Topics: Adolescent; Adult; Cognition; Dietary Supplements; Humans; Lutein; Macular Pigment; Zeaxanthins
PubMed: 35752349
DOI: 10.1016/j.physbeh.2022.113891 -
Clinical Neurology and Neurosurgery Jun 2023Atypical symptoms of stroke, such as non-specific visual symptoms, are a challenging aspect of acute stroke diagnostics. Among patients evaluated for stroke in the... (Review)
Review
OBJECTIVE
Atypical symptoms of stroke, such as non-specific visual symptoms, are a challenging aspect of acute stroke diagnostics. Among patients evaluated for stroke in the Emergency Department, 2-28% present with stroke chameleons, and 30-43% with stroke mimics. We aimed to identify the type of visual symptoms present in typical strokes, stroke mimics, and stroke chameleons.
PATIENTS AND METHODS
By use of Preferred Reporting Items for Systematic Reviews and Meta-Analysis we searched PubMed and Embase for studies with reports of acute visual symptoms in typical strokes vs mimics or chameleons (PROSPERO protocol, ID CRD42022364749). Risk of bias was assessed by The Critical Appraisal Skills Program.
RESULTS
Thirteen papers were included, comprising data from 9248 patients evaluated for stroke. Compared to mimics, visual symptoms in stroke presented more frequently as hemianopia (28.2% vs 4.8%, 7,4% vs 2.3%, 22% vs 0%), visual loss (11.6% vs 1.8%), visual field defect (11.6% vs 4%, 24% vs 2%, 19% vs 1.7%), eye movement disorder (19.4% vs 6.4%), eye deviation (9.6% vs 0.9%), gaze palsy (32.1% vs 8.6%), oculomotor disturbance (37% vs 0%), and visual inattention (17.5% vs 4%). Compared to strokes, mimics more often presented "non-systematized visual trouble" (10% vs 3%) and blurred vision (22% vs 5%), whereas "visual disturbance" was reported more often in stroke chameleons than in typical strokes (10% vs 3%).
CONCLUSION
Detailed reports of visual symptoms were lacking in most studies, however blurred vision and "non-systematized visual trouble" were more frequent in mimics, "visual disturbance" in stroke chameleons, and negative visual symptoms such as visual field defects in typical strokes. A more systematic and detailed approach to visual symptoms may facilitate acute stroke recognition in patients with visual symptoms.
Topics: Humans; Stroke; Vision Disorders; Visual Field Tests; Blindness; Diagnosis, Differential
PubMed: 37163931
DOI: 10.1016/j.clineuro.2023.107749 -
The Cochrane Database of Systematic... Feb 2020Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of... (Review)
Review
BACKGROUND
Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of aqueous from the anterior segment of the eye. Anti-vascular endothelial growth factor (anti-VEGF) medications are specific inhibitors of the primary mediators of neovascularization. Studies have reported the effectiveness of anti-VEGF medications for the control of intraocular pressure (IOP) in NVG.
OBJECTIVES
To assess the effectiveness of intraocular anti-VEGF medications, alone or with one or more type of conventional therapy, compared with no anti-VEGF medications for the treatment of NVG.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register); MEDLINE; Embase; PubMed; and LILACS to 22 March 2019; metaRegister of Controlled Trials to 13 August 2013; and two additional trial registers to 22 March 2019. We did not use any date or language restrictions in the electronic search for trials.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of people treated with anti-VEGF medications for NVG.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the search results for trials, extracted data, and assessed risk of bias, and the certainty of the evidence. We resolved discrepancies through discussion.
MAIN RESULTS
We included four RCTs (263 participants) and identified one ongoing RCT. Each trial was conducted in a different country: China, Brazil, Egypt, and Japan. We assessed the trials to have an unclear risk of bias for most domains due to insufficient information. Two trials compared intravitreal bevacizumab combined with Ahmed valve implantation and panretinal photocoagulation (PRP) with Ahmed valve implantation and PRP. We did not combine these two trials due to substantial clinical and statistical heterogeneity. One trial randomised participants to receive an injection of either an intravitreal anti-VEGF medication or placebo at the first visit, followed by non-randomised treatment according to clinical findings after one week. The last trial randomised participants to PRP with and without ranibizumab, but details of the study were unavailable for further analysis. Two trials that examined IOP showed inconsistent results. One found inconclusive results for mean IOP between participants who received anti-VEGF medications and those who did not, at one month (mean difference [MD] -1.60 mmHg, 95% confidence interval [CI] -4.98 to 1.78; 40 participants), and at one year (MD 1.40 mmHg, 95% CI -4.04 to 6.84; 30 participants). Sixty-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 60% without anti-VEGF medications. In another trial, those who received anti-VEGF medications were more likely to reduce their IOP than those who did not receive them, at one month (MD -6.50 mmHg, 95% CI -7.93 to -5.07; 40 participants), and at one year (MD -12.00 mmHg, 95% CI -16.79 to -7.21; 40 participants). Ninety-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 50% without anti-VEGF medications. The certainty of a body of evidence was low for this outcome due to limitations in the design and inconsistency of results between studies. Post-operative complications included anterior chamber bleeding (3 eyes) and conjunctival hemorrhage (2 participants) in the anti-VEGF medications group, and retinal detachment and phthisis bulbi (1 participant each) in the control group. The certainty of evidence is low due to imprecision of results and indirectness of evidence. No trial reported the proportion of participants with improvement in visual acuity, proportion of participants with complete regression of new iris vessels, or the proportion of participants with relief of pain and resolution of redness at four- to six-week, or one-year follow-up.
AUTHORS' CONCLUSIONS
Currently available evidence is uncertain regarding the long-term effectiveness of anti-VEGF medications, such as intravitreal ranibizumab or bevacizumab or aflibercept, as an adjunct to conventional treatment in lowering IOP in NVG. More research is needed to investigate the long-term effect of these medications compared with, or in addition to, conventional surgical or medical treatment in lowering IOP in NVG.
Topics: Endothelial Growth Factors; Glaucoma, Neovascular; Humans; Intraocular Pressure; Randomized Controlled Trials as Topic; Vascular Endothelial Growth Factor A; Visual Acuity
PubMed: 32027392
DOI: 10.1002/14651858.CD007920.pub3