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International Journal of Environmental... Feb 2022Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the second most common cause of optic nerve-related permanent visual loss in adults. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is the second most common cause of optic nerve-related permanent visual loss in adults.
AIM
We aimed to analyze the efficacy of the noninvasive and minimally invasive therapeutic options of NAION.
METHODS
We performed a systematic literature search in MEDLINE, EMBASE, and CENTRAL from inception to 10 June 2019 to identify the studies that report on the effect of different therapies on visual acuity (VA) and visual field (VF). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for these outcomes. The efficacy of steroids was investigated in quantitative, oxygen, steroid plus erythropoietin (EPO), levodopa/carbidopa, memantine, and heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) therapies and other therapeutic modalities in qualitative synthesis.
RESULTS
Thirty-two studies were found to be eligible. We found that steroid therapy compared to control did not improve VA ( = 0.182, WMD = 0.14, 95% CI: -0.07, 0.35) or VF ( = 0.853, WMD = 0.16, 95% CI: -1.54, 1.86). Qualitative analysis could be performed for oxygen, steroid plus EPO, and HELP as well, however, none of them showed VA and VF benefit. Two individual studies found memantine and levodopa beneficial regarding VA.
CONCLUSION
Our systematic review did not reveal any effective treatment. Further investigations are needed to find therapy for NAION.
Topics: Adult; Humans; Levodopa; Memantine; Optic Neuropathy, Ischemic; Oxygen; Steroids; Visual Acuity
PubMed: 35270411
DOI: 10.3390/ijerph19052718 -
Frontiers in Public Health 2022The COVID-19 pandemic has made many countries adopt restrictive measures like home quarantine. Children were required to study at home, which made parents worried about... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The COVID-19 pandemic has made many countries adopt restrictive measures like home quarantine. Children were required to study at home, which made parents worried about the rapid myopic progression of their children. To compare myopia progression during the COVID-19 pandemic home quarantine with the time before it and risk factors of myopia progression, we conducted this study.
METHODS
We searched PubMed, Embase, the Cochrane Library, and Web of Science to find literature from December 2019 to March 2022 related to COVID-19 pandemic home quarantine and children's myopia progression. Outcomes of myopia progression included axial length and spherical equivalent refraction. Factors of digital screen device time and outdoor activity time were analyzed.
RESULTS
Ten studies were included in this meta-analysis. Compared to the same period before the COVID-19 pandemic, spherical equivalent refraction decreased (OR = -0.27; 95% CI = [-0.33, -0.21]; Z = 8.42; < 0.00001). However, the subgroup analysis showed that there were no significant differences in spherical equivalent refraction between the two groups in higher-grade school-aged children (grades 4 and above, 11 to 18 years old) (OR = 0.01; 95% CI = [-0.05, 0.07]; Z =0.4; = 0.69). The outcome of axial length showed no significant difference (OR = 0.06; 95% CI = [-0.31, 0.44]; Z = 0.34; = 0.74). As for risk factors, the forest plots showed that digital screen device time (OR = 4.56; 95% CI = [4.45, 4.66]; Z = 85.57; < 0.00001) and outdoor activity time (OR = -1.82; 95% CI = [-2.87, -0.76]; Z = 3.37; = 0.0008) were risk factors of myopia progression.
CONCLUSION
Compared with the time before the COVID-19 pandemic, myopia progression in children during COVID-19 pandemic home quarantine was accelerated, especially in younger children. Increased digital screen device and decreased outdoor activity times were risk factors. When home quarantine eases, more time on outdoor activities and less time on digital screen devices are needed for children.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/logout.php.
Topics: Adolescent; COVID-19; Child; Humans; Myopia; Pandemics; Quarantine; Refraction, Ocular
PubMed: 35937221
DOI: 10.3389/fpubh.2022.835449 -
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 -
Scientific Reports Nov 2022We investigated and characterized the prevalence of dry eye disease (DED) in Parkinson's disease (PD). PubMed and EMBASE databases were searched for relevant studies... (Meta-Analysis)
Meta-Analysis
We investigated and characterized the prevalence of dry eye disease (DED) in Parkinson's disease (PD). PubMed and EMBASE databases were searched for relevant studies between January 1, 1979 and March 10, 2022. Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Study-specific estimates were combined using the DerSimonian-Laird random-effects model. Prevalence of subjective DED symptoms in patients with PD and mean differences in blink rate, corneal thickness, tear film breakup time, and tear secretion volume on Schirmer test I were compared to those in controls. Of 383 studies, 13 (1519 patients with PD) and 12 were included in qualitative and quantitative syntheses, respectively. Meta-analysis revealed a 61.1% prevalence of subjective DED symptoms in PD and that, compared with controls, patients with PD had significantly lower blink rate, thinner corneal thickness, shorter tear film breakup time, and lower tear secretion volumes on Schirmer test I, without and with anesthesia.
Topics: Humans; Tears; Prevalence; Parkinson Disease; Dry Eye Syndromes; Blinking
PubMed: 36319814
DOI: 10.1038/s41598-022-22037-y -
Optometry and Vision Science : Official... Aug 2023Dry eye is a common condition with serious implications worldwide. The unique composition of autologous serum (AS) eye drops has been hypothesized as a possible...
BACKGROUND
Dry eye is a common condition with serious implications worldwide. The unique composition of autologous serum (AS) eye drops has been hypothesized as a possible treatment.
OBJECTIVES
This study aimed to review the effectiveness and safety of AS.
DATA SOURCES
We searched five databases and three registries up to September 30, 2022.
STUDY ELIGIBILITY
We included randomized controlled trials (RCTs) comparing AS with artificial tears, saline, or placebo for participants with dry eye.
STUDY APPRAISAL AND SYNTHESIS METHODS
We adhered to Cochrane methods for study selection, data extraction, risk-of-bias assessment, and synthesis. We used the Grading of Recommendations Assessment, Development and Evaluation framework to evaluate the certainty of evidence.
RESULTS
We included six RCTs with 116 participants. Four trials compared AS with artificial tears. We found low-certainty evidence that AS may improve symptoms (0- to 100-point pain scale) after 2 weeks of treatment compared with saline (mean difference, -12.00; 95% confidence interval, -20.16 to -3.84; 1 RCT, 20 participants). Ocular surface outcomes (corneal staining, conjunctival staining, tear breakup time, Schirmer test) were inconclusive. Two trials compared AS with saline. Very low-certainty evidence suggested that Rose Bengal staining (0- to 9-point scale) may be slightly improved after 4 weeks of treatment compared with saline (mean difference, -0.60; 95% confidence interval, -1.11 to -0.09; 35 eyes). None of the trials reported outcomes of corneal topography, conjunctival biopsy, quality of life, economic outcomes, or adverse events.
LIMITATIONS
We were unable to use all data because of unclear reporting.
CONCLUSIONS
The effectiveness of AS is uncertain based on current data. Symptoms improved slightly with AS compared with artificial tears for 2 weeks. Staining scores improved slightly with AS compared with saline, with no benefit identified for other measures.
IMPLICATIONS OF KEY FINDINGS
High-quality, large trials enrolling diverse participants with varying severity are needed. A core outcome set would allow for evidence-based treatment decisions consistent with current knowledge and patient values.
Topics: Humans; Lubricant Eye Drops; Dry Eye Syndromes; Serum; Tears; Saline Solution
PubMed: 37410855
DOI: 10.1097/OPX.0000000000002042 -
Ophthalmic & Physiological Optics : the... May 2022The World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes.... (Review)
Review
Identification and critical appraisal of evidence for interventions for refractive error to support the development of the WHO package of eye care interventions: a systematic review of clinical practice guidelines.
PURPOSE
The World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes. Interventions included in the PECI should be based on robust evidence where available. Refractive error is a leading cause of blindness and vision impairment and is a PECI priority condition. The aim of this study was to provide high-quality evidence to support the development of the PECI by identifying and critically appraising clinical practice guidelines (CPGs), and extracting recommendations for refractive error interventions.
METHODS
We searched for CPGs on refractive error published in the last 10 years. We conducted the searches initially in February and March 2019 and repeated them in March 2020. We evaluated the quality of potentially relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.
RESULTS
We identified 12 high-quality CPGs relevant to refractive error, written by six organisations from three high-income countries. Organisations used a variety of frameworks to assess the strength of recommendations based on available evidence, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) being most common. Vision screening for children aged 3 to 5 years was recommended consistently. Evidence for screening and eye evaluations at other ages was weaker, although ophthalmic professional organisations consistently recommended regular evaluations. Recommendations on optical and laser correction of refractive error were limited and did not consider implications for low resource settings. Interventions for slowing myopia progression in children were recommended, but these will need regular updating as new evidence emerges.
CONCLUSIONS
Current high-quality guidelines on refractive error have been formulated in high-income countries. Recommendations focused on prevention and treatment of refractive error in low-and middle-income countries are lacking. Regular updating of systematic reviews and CPGs is essential to ensure that robust evidence is promptly appraised and incorporated into recommendations for eye health care practitioners.
Topics: Child; Child, Preschool; Humans; Delivery of Health Care; Refractive Errors; Vision Screening; World Health Organization; Practice Guidelines as Topic
PubMed: 35191063
DOI: 10.1111/opo.12963 -
Eye (London, England) Jan 2023The purpose of this project was to systematically review and meta-analyse studies assessing the diagnostic accuracy of optical coherence tomography angiography (OCTA)... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
The purpose of this project was to systematically review and meta-analyse studies assessing the diagnostic accuracy of optical coherence tomography angiography (OCTA) and optical coherence tomography (OCT) for myopic choroidal neovascularisation (mCNV). Fluorescein angiography (FA) was accepted as the reference standard.
METHODS
PUBMED and EMBASE were searched from inception to March 2021 for studies evaluating the test accuracy of OCTA and/or OCT for diagnosing mCNV. The Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Test Accuracy Studies guideline was followed, and the Grading of Recommendations, Assessment, Development and Evaluation approach was used to frame clinical recommendations. Pooled estimates of test accuracy were obtained using a bivariate model.
RESULTS
Of 410 studies assessed for eligibility, 3 studies were identified that compared OCTA to FA and 3 studies were identified that compared spectral domain (SD) OCT to FA. All studies had at least one major methodological flaw leading to an overall high risk of bias. On meta-analysis, the pooled sensitivity of OCTA was 0.89 (95% CI 0.78-0.94) and pooled specificity was 0.93 (95% CI 0.79-0.98). The pooled sensitivity of SD-OCT was 0.99 (95% CI 0.91-1.00). Due to uncertainty in individual studies, the pooled specificity of SD-OCT could not be estimated.
CONCLUSIONS
OCTA can reliably diagnose mCNV in clinically suspected patients, however, SD-OCT may not reliably establish a positive diagnosis of mCNV. Future large, prospective studies with improvements in conduct and reporting are needed to strengthen these clinical recommendations.
Topics: Humans; Tomography, Optical Coherence; Prospective Studies; Choroidal Neovascularization; Fluorescein Angiography
PubMed: 36456704
DOI: 10.1038/s41433-022-02227-8 -
Travel Medicine and Infectious Disease 2023Orthohantaviruses are zoonotic diseases transmitted mainly by rodents, particularly mice and rats, associated with multiple outbreaks in different continents. Despite... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Orthohantaviruses are zoonotic diseases transmitted mainly by rodents, particularly mice and rats, associated with multiple outbreaks in different continents. Despite its epidemiological relevance, there is a lack of systematic reviews and meta-analyses.
OBJECTIVE
To determine the combined global prevalence of Orthohantavirus infection in rodents.
METHODS
A systematic literature review was carried out in six databases (Web of Sciences, Scopus, PubMed, SciELO, Lilacs, Google Scholar) to evaluate the proportion of rodents infected with Orthohantavirus, defined by molecular and immunological techniques. The meta-analysis used a random effects model for the pooled prevalence and 95% confidence intervals (95%CI). Heterogeneity measures, Cochrane's Q, the I index and the tau-squared test were estimated.
RESULTS
A total of 35,706 rodents (229 studies) were evaluated for ELISA, in which 3360 were found positive, for seroprevalence of 4.9% (95%CI 4.3-5.4%) (τ = 0.001; Q = 4027.708; I = 94.339%, p < 0.001). For PCR (N = 8812, 91 studies) it was 3.2% (95%CI 2.5-3.9%) (τ = 0.001; Q = 397.483; I = 77.358%; p < 0.001). For IFA (N = 555, 7 studies) it was 18.8% (95%CI 9.4-28.2%) (τ = 0.011; Q = 51.239; I = 88.29%, p < 0.001). At the genus level, the studies evaluated Oligoryzomys (8.98%), Reithrodontomys (8.98%), Peromyscus (8.20%), Rattus (8.20%), and Akodon (6.64%).
CONCLUSIONS
The global prevalence of Orthohantavirus is worrisome, with an increase in its report in certain regions, including Latin America. In this context, rodents have a role as reservoirs. The data of the present meta-analysis showed considerable seroprevalences with great variations by years, countries and Orthohantavirus species.
Topics: Rats; Animals; Rodentia; Seroepidemiologic Studies; Hantavirus Infections; Zoonoses; Prevalence
PubMed: 36402291
DOI: 10.1016/j.tmaid.2022.102504 -
Eye (London, England) Apr 2021We performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC).
METHODS
We searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT).
RESULTS
Five randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = -0.06, 95% CI -0.15-0.02, P = 0.15, I = 86%), 3 months (WMD = -0.04, 95% CI -0.14-0.06, P = 0.44, I = 77%) and 6 months (WMD = -0, 95% CI -0.05-0.05, P = 0.92, I = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = -60.64, 95% CI -97.91 to -23.37, P = 0.001, I = 49%), SFCT (WMD = -39.15, 95% CI -52.58 to -25.72, P < 0.001, I = 0%), and CMT (WMD = -60.75, 95% CI -97.85 to -23.65, P = 0.01, I = 53%).
CONCLUSIONS
Our meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.
Topics: Central Serous Chorioretinopathy; Humans; Mineralocorticoid Receptor Antagonists; Subretinal Fluid; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity
PubMed: 33414535
DOI: 10.1038/s41433-020-01338-4 -
Ophthalmic & Physiological Optics : the... Nov 2019The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim was to compare fatigue levels between patients with visual impairment and controls with normal sight and to examine the association between fatigue and vision loss severity.
METHODS
A systematic literature search was performed using databases of PubMed, Embase, PsycINFO and Cochrane to identify observational studies with outcomes related to fatigue (e.g. vitality subscale of the Short-Form 36, Fatigue Assessment Scale). A meta-analysis was performed using standardised mean differences (SMDs) and odds ratios (OR) to quantitatively summarise the association between visual impairment and fatigue. Sources of heterogeneity were explored by subgroup and sensitivity analyses. Study quality was assessed with the Newcastle-Ottawa scale.
RESULTS
After reviewing 4477 studies, 22 studies with a total of 40 004 participants were included, of which 18 contributed to meta-analysis. Among these, eight were assessed as moderate quality studies and 10 as high quality studies. Pooled analysis involving 2500 patients and 8395 controls showed higher fatigue severity levels (S.M.D. = -0.36, 95% CI -0.50 to -0.22, 14 studies) among visually impaired patients compared to normally sighted controls. This effect size was small and persisted in sensitivity analyses that involved study quality, fatigue assessment tools and visual acuity data. Furthermore, pooled analysis of four studies including 2615 patients and 5438 controls showed a significant association between visual impairment and fatigue (OR = 2.61, 95% CI 1.69 to 4.04). Secondary meta-analysis of four studies showed no significant difference in fatigue severity (S.M.D. = 0.01, 95% CI -0.37 to 0.39) between patients with moderate visual impairment and patients with severe visual impairment or blindness.
CONCLUSIONS
Current moderate to high quality evidence suggest that patients with visual impairment experience more severe fatigue symptoms than persons with normal sight. However, a limited number of available studies indicates that fatigue is not associated with severity of vision loss. Future studies are required to determine which factors and underlying mechanisms may explain the association between visual impairment and fatigue. Discussing fatigue at an early stage and developing intervention options for vision-related fatigue should be considered within the field of low vision rehabilitation.
Topics: Fatigue; Global Health; Humans; Incidence; Observational Studies as Topic; Vision Disorders; Visual Acuity
PubMed: 31696537
DOI: 10.1111/opo.12647