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The Cochrane Database of Systematic... Feb 2020Glaucoma is a multi-factorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Glaucoma is a multi-factorial optic neuropathy characterized by an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although many treatments are available to manage glaucoma, patients may seek complementary or alternative medicine approaches such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (traditional Chinese concept of vital force or energy) can be managed by stimulating relevant points on the body surface.
OBJECTIVES
To assess the effectiveness and safety of acupuncture compared with other treatments, no treatment, or placebo in patients with glaucoma.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register (2018, Issue 11); Ovid MEDLINE; Embase.com; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); the Allied and Complementary Medicine Database (AMED); PubMed; Latin American and Caribbean Literature on Health Sciences (LILACS); ZETOC; the metaRegister of Controlled Trials (mRCT); ClinicalTrials.gov; the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP); and the National Center for Complementary and Alternative Medicine (NCCAM) website. We did not use any language or date restrictions in the search for trials. We last searched electronic databases on November 16, 2018, with the exception of NCCAM, which we last searched on July 14, 2010, and the metaRegister of Controlled Trials (mRCT), which we last searched on January 8, 2013. We handsearched Chinese medical journals at Peking Union Medical College Library in April 2007. We searched the Chinese Acupuncture Trials Register, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), the Chinese Biological Database (CBM), and the China National Knowledge Infrastructure (CNKI). We last searched Chinese electronic databases on November 19, 2018.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) in which one arm involved acupuncture treatment.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened results, then extracted the data and assessed risk of bias for eligible trials.
MAIN RESULTS
We included three completed trials and one ongoing trial in the 2019 update of this review. The three completed trials, conducted in Taiwan and the United States, included participants with glaucoma or intraocular hypertension. The interventions investigated varied across trials. One trial compared auricular acupressure-a non-standard acupuncture technique-with the sham procedure in 33 patients. Another trial compared transcutaneous electrical nerve stimulation (TENS) with a sham procedure in 82 patients. The third trial compared 12 sessions of acupuncture on eye-points versus on non-eye-points in 22 patients. All three trials were rated at high risk of bias for at least one domain. The certainty of evidence across all outcomes was very low due to high risk of bias in at least one contributing study; substantial clinical heterogeneity and methodological heterogeneity; and imprecision of results. One trial reported change in the visual field from baseline without any between-group comparison. Because of the quantity of missing data (50%), we did not calculate a between-group comparison, as the quantitative results are difficult to interpret. All three trials reported data for estimation of reduction of intraocular pressure (IOP). However, time points of IOP measurement varied. For the trial comparing acupressure to a sham procedure, the difference in IOP reduction (measured in mm Hg) is estimated to be -3.70 (95% confidence interval [CI] -7.11 to -0.29) for the right eye and -4.90 (95% CI -8.08 to -1.72) for the left eye at four weeks, and -1.30 mm Hg (95% CI -4.78 to 2.18) for the right eye and -2.30 mm Hg (95% CI -5.73 to 1.13) for the left eye at eight weeks. For the trial comparing TENS to sham treatment, the difference reduction is estimated to be -2.81 (95% CI -3.8 to -1.84) for the right eye and -2.58 (95% CI -3.36 to -1.80) for the left eye immediately after treatment, -2.93 (95% CI -3.72 to -2.13) for the right eye and -3.56 (95% CI -4.35 to 2.78) for the left eye 30 minutes after treatment, and finally -3.61 (95% CI -4.47 to -2.75) for the right eye and -3.61 (95% -4.47 to -2.74) for the left eye. For the trial that compared acupuncture on eye-points versus non-eye-points, 11 out of 22 (50%) participants did not complete the treatment. One trial reported data for estimation of visual acuity. When acupressure is compared to sham treatment, the difference in uncorrected visual acuity (UCVA, measured in logMAR) is estimated to be -0.01 (95% CI -0.24 to 0.22) for the right eye and -0.04 (95% CI -0.27 to 0.19) for the left eye at four months, and -0.03 logMAR (95% CI -0.27 to 0.21) for the right eye and -0.16 logMAR (95% CI -0.43 to 0.11) for the left eye at eight months. The difference in best corrected visual acuity (BCVA) is estimated to be 0.10 (95% CI -0.06 to 0.26) for the right eye and 0 (95% CI -0.14 to 0.14) for the left eye at four months, and -0.04 logMAR (95% CI -0.09 to 0.17) for the right eye and -0.04 logMAR (95% CI -0.18 to 0.10) for the left eye at eight months. One trial reported progression of optic disc damage or nerve fiber layer loss without any between-group comparison. Because of the quantity of missing data (50%), we did not calculate a between-group comparison, as the quantitative results are difficult to interpret. One trial reported adverse events in two patients (out of 22) who experienced needle sensitivity. However, the study did not report between-group comparisons. Because of the quantity of missing data (50%), we did not calculate a between-group comparison, as the quantitative results are difficult to interpret.
AUTHORS' CONCLUSIONS
At this time, it is impossible to draw reliable conclusions from available data to support the use of acupuncture for treatment of patients with glaucoma. Because of ethical considerations, RCTs comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established.
Topics: Acupuncture Therapy; Glaucoma; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Visual Acuity
PubMed: 32032457
DOI: 10.1002/14651858.CD006030.pub4 -
Graefe's Archive For Clinical and... Jun 2023Developments in image processing techniques and display technology have led to the emergence of augmented reality (AR) and virtual reality (VR)-based low vision devices...
INTRODUCTION
Developments in image processing techniques and display technology have led to the emergence of augmented reality (AR) and virtual reality (VR)-based low vision devices (LVDs). However, their promise and limitations in low vision rehabilitation are poorly understood. The objective of this systematic review is to appraise the application of AR/VR LVDs aimed at visual field expansion and visual acuity improvement in low vision rehabilitation.
METHODS
A systematic search of the literature was performed using MEDLINE, Embase, PsychInfo, HealthStar, and National Library of Medicine (PubMed) from inception to March 6, 2022. Articles were eligible if they included an AR or VR LVD tested on a sample of individuals with low vision and provided visual outcomes such as visual acuity, visual fields, and object recognition.
RESULTS
Of the 652 articles identified, 16 studies comprising 382 individuals with a mean age of 52.17 (SD = 18.30) years, and with heterogeneous low vision etiologies (i.e., glaucoma, age-related macular degeneration, retinitis pigmentosa) were included in this systematic review. Most articles used AR (53%), VR (40%), and one article used both AR and VR. The main visual outcomes evaluated were visual fields (67%), visual acuity (65%), and contrast sensitivity (27%). Various visual enhancement techniques were employed including variable magnification using digital zoom (67%), contrast enhancements (53%), and minification (27%). AR LVDs were reported to expand the visual field from threefold to ninefold. On average, individuals using AR/VR LVDs experienced an improved in visual acuity from 0.9 to 0.2 logMAR. Ten articles were classified as high or moderate risk of bias.
CONCLUSION
AR/VR LVDs were found to afford visual field expansion and visual acuity improvement in low vision populations. Even though the results of this review are promising, the lack of controlled studies with well-defined populations, use of small, convenience samples, and incomplete reporting of inclusion and exclusion criteria among included studies makes it challenging to judge the true impact of these devices. Future studies should address these limitations and compare various AR/LVDs to determine what is the ideal LVD type and vision enhancement combination based on the user's level of visual ability and lifestyle.
Topics: Humans; Middle Aged; Augmented Reality; Visual Fields; Vision, Low; Virtual Reality; Visual Acuity
PubMed: 36633669
DOI: 10.1007/s00417-022-05972-4 -
Journal of Optometry 2023To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function. (Review)
Review
PURPOSE
To analyse the scientific evidence about the efficacy of Syntonic phototherapy for producing changes in visual function.
MATERIAL AND METHODS
A systematic review was performed to obtain studies on the effects of Syntonic phototherapy on vision. A search in health science databases (Medline, Scopus, Web of Science and PsycINFO) for studies published between 1980 and 2022 was conducted in accordance with the principles of Cochrane approach. The search identified 197 articles. Only clinical studies which used the Syntonic phototherapy as a vision therapy for any visual condition were included. Clinical cases and case series were excluded. Following the inclusion criteria, 8 clinical studies met inclusion, 5 of them being pseudo-experimental studies with an equivalent control group and 3 pre-post pseudo-experimental studies. GRADE tool was used to assess the certainty of the evidence of the studies. The GRADE evidence profile for the studies through the Soft table was made to analyse data.
RESULTS
The studies analysed seven outcomes: visual symptoms, functional visual fields, visual acuity, contrast sensitivity, deviation (phoria/tropia), stereopsis and reading abilities. Finding table about results (Soft Table) showed that for all outcomes reviewed, all studies yielded very low certainty of evidence. Results revealed a lack of scientific evidence of the efficacy of Syntonic optometric phototherapy to produce changes in the visual function.
CONCLUSION
This systematic review found no consistent evidence for the efficacy of Syntonic phototherapy to cause changes in visual function. There is no scientific evidence to support its clinical use for treating any type of visual anomalies.
Topics: Humans; Phototherapy; Visual Acuity; Vision Disorders; Contrast Sensitivity; Vision, Low
PubMed: 37230932
DOI: 10.1016/j.optom.2023.03.002 -
Frontiers in Endocrinology 2022Changes in fundus signs and loss of visual acuity are an important basis for screening and treating diabetic patients with retinopathy, and conventional Western medicine... (Meta-Analysis)
Meta-Analysis
Effect of Chinese herbal compounds on ocular fundus signs and vision in conventional treated-persons with non-proliferative diabetic retinopathy: A systematic review and meta-analysis.
BACKGROUND
Changes in fundus signs and loss of visual acuity are an important basis for screening and treating diabetic patients with retinopathy, and conventional Western medicine is moderately effective in treating diabetic retinopathy(DR),To systematically evaluate the effectiveness and safety of Chinese herbal compounds(CHCs) in the combined treatment of diabetic retinopathy.
METHOD
Six electronic databases, including PubMed, were searched to screen eligible literature. Randomized controlled trials of non-proliferative diabetic retinopathy(NPDR) were included, in which the control group was treated with conventional Western-based drugs or retinal laser photocoagulation, and the intervention group was treated with CHCs in combination based on the control group.The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the literature, and the RevMan 5.4 software was used for statistical analysis.
RESULTS
Compared with Conventional group alone,CHCs group was superior at improving clinical efficacy [RR=1.29, 95%CI=(1.23, 1.36),P<0.01] and best corrected visual acuity(BCVA) [MD=0.10,95%CI=(0.09,0.12),P<0.01],it was also superior at reducing the number of microangiomas [MD=-2.37, 95%CI=(-3.26, -1.49),P<0.01], microangioma volume [MD=-4.72, 95%CI=(-5.14, -4.29), P<0.01], hemorrhagic spots [MD=-2.05, 95%CI=(-2.51,-1.59), P<0.01], hemorrhagic area [MD=-0.76, 95%CI=(-1.06, -0.47), P<0.01], hard exudates [MD= -1.86, 95%CI=(-2.43, -1.28), P<0.01], cotton lint spots [MD= -0.93, 95%CI= (-1.31, -0.55), P<0.01], central macular thickness(CMT) [SMD=-1.52, 95%CI=(-1.85, -1.19),P<0.01], Chinese medicine evidence score [SMD=-1.33,95%CI=(-1.58, -1.08),P<0.01], fasting blood glucose (FBG) [SMD=-0.47, 95%CI=(-0.61,-0.33),P<0.01], 2h postprandial blood glucose(2hPBG) [SMD=-0.87, 95% CI=(-1.06, -0.67), P<0.01], glycosylated hemoglobin (HbAlc) [SMD=-0.76, 95%CI=(-1.16, -0.3),P<0.01], total cholesterol(TC) [SMD=-0.33,95%CI=(-0.51,-0.16),P<0.01],and CHCs group with less adverse events occurred [RR=0.46, 95%CI=(0.29, 0.74),P<0.01].
CONCLUSION
CHCs combined with conventional medicine for NPDR has better clinical efficacy and higher safety, but the above findings need further validation in more large sample, multicenter, and low-bias RCTs due to the limitation of the quality and quantity of included literature.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022342137.
Topics: Blood Glucose; China; Diabetes Mellitus; Diabetic Retinopathy; Humans; Laser Coagulation; Multicenter Studies as Topic; Visual Acuity
PubMed: 36034416
DOI: 10.3389/fendo.2022.977971 -
Archivos de La Sociedad Espanola de... Jan 2017To evaluate recent evidence concerning the relationship between the exposure to organic solvents and the impairment of colour vision. (Review)
Review
OBJECTIVE
To evaluate recent evidence concerning the relationship between the exposure to organic solvents and the impairment of colour vision.
METHODS
A bibliographic search was conducted for scientific papers published in the last 15 years, in the LILACS, PubMed, Science Direct, EBSCO, and Cochrane databases that included observational studies assessing the relationship between impairment in colour vision and exposure to organic solvents.
RESULTS
Eleven studies were selected that were performed on an economically active population and used the Lanthony D-15 desaturated test (D-15d), measured the exposure to organic solvents, and included unexposed controls. It was found that there is a statistically significant relationship between the exposure to organic solvents and the presence of an impairment in colour vision.
CONCLUSIONS
The results support the hypothesis that exposure to organic solvents could induce acquired dyschromatopsia. The evaluation of colour vision with the D-15d test is simple and sensitive for diagnosis. More studies need to be conducted on this subject in order to better understand the relationship between impaired colour vision and more severe side effects caused by this exposure.
Topics: Air Pollutants, Occupational; Color Perception Tests; Color Vision Defects; Humans; Meta-Analysis as Topic; Observational Studies as Topic; Occupational Diseases; Occupational Exposure; Organic Chemicals; Solvents
PubMed: 27422480
DOI: 10.1016/j.oftal.2016.05.008 -
Graefe's Archive For Clinical and... Nov 2009This systematic review evaluates the diagnostic accuracy of preschool vision screening tests for the detection of amblyopia and its risk factors. (Review)
Review
AIM
This systematic review evaluates the diagnostic accuracy of preschool vision screening tests for the detection of amblyopia and its risk factors.
METHODS
The literature searches were conducted in nine bibliographic databases. No limitation to a specific study design, year of publication or language was applied. Studies were included if they compared a vision screening test with a reference test (gold standard) in children from the general population. In addition, the studies had to provide sufficient data to calculate diagnostic accuracy (sensitivity and specificity). Full-text articles were assessed for studies that satisfied the inclusion criteria using the "Quality of Diagnostic Accuracy Studies (QUADAS)" checklist.
RESULTS
Two studies with a longitudinal design and 25 cross-sectional studies met the inclusion criteria. One of the longitudinal studies compared a screening programme in children between 1 and 2 years of age with a re-examination at the age of 8. The sensitivity for the screening programme was 86% (range: 64-97%) and the specificity 99% (range: 98-99%). The second longitudinal study compared screening examinations at 8, 12, 18, 25 and 31 months, with a re-examination at the age of 37 months. In this study, the sensitivity of the screening examination increased with age, while the specificity remained unchanged. The cross-sectional studies evaluated different screening settings, visual acuity tests, auto- or photorefractors and stereo tests. A large variety of reference tests, differing criteria for defining amblyopia and its risk factors and methodological limitations of the studies prevented a valid data interpretation.
CONCLUSION
Diagnostic test accuracy of preschool vision screening tests can only be sufficiently investigated after establishing age-related values defining amblyopia, refractive errors and binocular disorders. To address these questions, we recommend a controlled longitudinal study design.
Topics: Amblyopia; Child, Preschool; Humans; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Vision Screening
PubMed: 19669781
DOI: 10.1007/s00417-009-1150-2 -
Medicine Aug 2022The purpose of the study was to conduct a meta-analysis about the effect of the combined application of orthokeratology and single-vision spectacles on slowing the... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of the study was to conduct a meta-analysis about the effect of the combined application of orthokeratology and single-vision spectacles on slowing the progression of high myopia.
METHODS
The literature was searched in PubMed, EMBASE, the Cochrane Library, Wang Fang Data, CNKI and sinoMed. The Cochrane Handbook was used to evaluate the quality of the included randomized clinical trials, and the Newcastle-Ottawa Scale was used to evaluate the included case-control or cohort studies. The results were analyzed by Revman 5.3.
RESULTS
Five studies (2 randomized clinical trials, 2 case-controls, and 1 cohort study) with a total of 360 patients were included in this meta-analysis. The follow-up time was at least 1 year. Combined application of orthokeratology and single-vision spectacles were used in the experimental group. The control group used single-vision spectacles only. The pooled estimates indicated that the standardized mean difference between the 2 groups was -1.46 mm (95% confidence interval: -1.88 to -1.05; P < .05) for axial length elongation and -1.85D (95% confidence interval: -2.40 to -1.31; P < .05) for change in spherical equivalent refraction. No serious adverse events were reported in all studies.
CONCLUSION
The combined application of orthokeratology and single-vision spectacles is more effective than single-vision spectacles only on slowing the progression of high myopia.
Topics: Axial Length, Eye; Cohort Studies; Eyeglasses; Humans; Myopia; Orthokeratologic Procedures; Randomized Controlled Trials as Topic; Refraction, Ocular
PubMed: 35984116
DOI: 10.1097/MD.0000000000030178 -
Journal of Cataract and Refractive... Sep 2023In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift... (Meta-Analysis)
Meta-Analysis
In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift and an overview of reasons for refractive shift after DMEK are provided. The PubMed library was screened for articles containing the terms "Descemet membrane endothelial keratoplasty," "DMEK," "Descemet membrane endothelial keratoplasty combined with cataract surgery," "triple-DMEK" combined with "refractive outcomes," "refractive shift," and "hyperopic shift." The refractive outcomes after DMEK were analyzed and compared using a fixed and random effects model. The overall mean change of the spherical equivalent outcome when compared with the preoperative value in cases of DMEK or when compared with the preoperative target refraction in cases of DMEK combined with cataract surgery was +0.43 diopters (D) (95% CI, 0.31-0.55). When DMEK is combined with cataract surgery, a target refraction of -0.5 D is recommended to achieve emmetropia. Changes in the posterior corneal curvature are identified as the main cause of the refractive hyperopic shift.
Topics: Humans; Visual Acuity; Descemet Stripping Endothelial Keratoplasty; Refraction, Ocular; Hyperopia; Cataract; Retrospective Studies; Fuchs' Endothelial Dystrophy; Descemet Membrane; Endothelium, Corneal
PubMed: 37144644
DOI: 10.1097/j.jcrs.0000000000001212 -
Stem Cell Research & Therapy Oct 2023Stem cell therapy is a promising therapeutic approach for inherited retinal diseases (IRDs). This study aims to quantitatively examine the effectiveness and safety of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Stem cell therapy is a promising therapeutic approach for inherited retinal diseases (IRDs). This study aims to quantitatively examine the effectiveness and safety of stem cell therapy for patients with IRDs, including retinitis pigmentosa and Stargardt disease (STGD).
METHODS
We searched PubMed, EMBASE, Web of Science, Cochrane Library databases, and the ClinicalTrials.gov website. The latest retrieval time was August 20, 2023. The primary outcomes were rates and mean difference (MD) of best-corrected visual acuity (BCVA) improvement. Subgroup analyses were conducted according to administration routes and stem cell types. This study was registered with PROSPERO (CRD42022349271).
RESULTS
Twenty-one prospective studies, involving 496 eyes (404 RP and 92 STGD) of 382 patients (306 RP and 76 STGD), were included in this study. For RP, the rate of BCVA improvement was 49% and 30% at 6 months and 12 months, respectively, and the BCVA was significantly improved in the operative eyes at 6 months post-treatment (MD = - 0.12 logMAR, 95% CI .17 to - 0.06 logMAR; P < 0.001), while there was no significant difference at 12 months post-treatment (MD = -0.06 logMAR; 95% CI - 0.13 to 0.01 logMAR; P = 0.10). For STGD, the rate of BCVA improvement was 60% and 55% at 6 months and 12 months, respectively, and the BCVA was significantly improved in the operative eyes at 6 months (MD = - 0.14 logMAR, 95% CI - 0.22 to - 0.07 logMAR; P = 0.0002) and 12 months (MD = - 0.17 logMAR, 95% CI - 0.29 to - 0.04 logMAR; P = 0.01). Subgroup analyses showed suprachoroidal space injection of stem cells may be more efficient for RP. Eleven treated-related ocular adverse events from three studies and no related systemic adverse events were reported.
CONCLUSIONS
This study suggests stem cell therapy may be effective and safe for patients with RP or STGD. The long-term vision improvement may be limited for RP patients. Suprachoroidal space injection of stem cells may be a promising administration route for RP patients. Limited by the low grade of evidence, large sample size randomized clinical trials are required in the future.
Topics: Humans; Prospective Studies; Visual Acuity; Retinitis Pigmentosa; Choroidal Effusions; Cell- and Tissue-Based Therapy
PubMed: 37798796
DOI: 10.1186/s13287-023-03526-x -
Strabismus Mar 2023The objective of this review was to estimate the prevalence of strabismus and amblyopia in Africa. A systematic online literature search was conducted for articles on... (Meta-Analysis)
Meta-Analysis
The objective of this review was to estimate the prevalence of strabismus and amblyopia in Africa. A systematic online literature search was conducted for articles on strabismus and amblyopia in Africa. Meta-analysis was performed, using the Freeman-Tukey double arcsine transformation, to estimate the prevalence of strabismus and amblyopia in Africa. Subgroup analyses were conducted according to age, gender, study year, and type of amblyopia. Meta-regression was used to evaluate the influence of predetermined factors on the prevalence of amblyopia. 8 (1 population-based & 7 school-based) and 21 (3 population-based & 18 school-based) studies on strabismus and amblyopia with sample sizes of 22,355 and 46,841, respectively, were included in the review. Overall prevalence of strabismus in Africa was estimated to be 0.8% (95% CI: 0.4% - 1.4%); exotropia was 0.2% (95% CI: 0.1% - 0.5%) and esotropia was 0.5% (95% CI: 0.1% - 1.2%). Overall prevalence of amblyopia was estimated to be 0.6% (95% CI: 0.3% - 0.9%); refractive and strabismic amblyopia were 1.1% (95% CI: 0.2% - 2.5%) and 0.4% (95% CI: 0.2% - 0.6%), respectively. Prevalence estimate of amblyopia in males was 1.8% (95% CI: 0.7% - 3.3%) and in females was 1.3% (95% CI: 0.4% - 2.6%). There was a significant association between the prevalence of amblyopia and the type of amblyopia (p = .007) and the study year (p = .006). Although there appears to be a relatively low prevalence of strabismus and amblyopia in Africa, there is a dearth of well-designed population-based studies on strabismus and amblyopia in Africa, resulting in the lack of epidemiological information on strabismus and amblyopia within the general African population. Information about the prevalence of strabismus and amblyopia across Africa can inform policy making and design and implementation of public health intervention program.
Topics: Male; Female; Humans; Amblyopia; Visual Acuity; Strabismus; Esotropia; Prevalence; Africa
PubMed: 36576233
DOI: 10.1080/09273972.2022.2157023