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Eye (London, England) Mar 2024Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the... (Observational Study)
Observational Study
BACKGROUND
Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care.
METHODS
Prospective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD.
RESULTS
1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than 'PVD-only' eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05).
CONCLUSIONS AND RELEVANCE
This large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination.
Topics: Humans; Retinal Perforations; Vitreous Detachment; Prospective Studies; Retinal Detachment; Referral and Consultation
PubMed: 37798362
DOI: 10.1038/s41433-023-02779-3 -
Case Reports in Women's Health Sep 2023Prolactinomas resulting in pituitary apoplexy are an uncommon obstetrical complication. The hemorrhage can cause compression and necrosis of the pituitary gland as well...
INTRODUCTION
Prolactinomas resulting in pituitary apoplexy are an uncommon obstetrical complication. The hemorrhage can cause compression and necrosis of the pituitary gland as well as the optic chiasm, necessitating surgical intervention.
CASE
A 35-year-old woman, G0, presented for an infertility consult with a prior diagnosis of polycystic ovarian syndrome. Evaluation for oligomenorrhea found an elevated prolactin level of 69.76 ng/mL, an elevated DHEA-S of 524, and HgbA1c of 5.7%. The patient denied visual or neurological symptoms. Infertility treatment was started, and magnetic resonance imaging (MRI) of the brain was recommended; however, the patient forewent imaging. Within a few months, she was pregnant. At 27 weeks of gestation, the patient developed sudden visual field loss to the right eye and presented to her optometrist. MRI of the pituitary identified a sellar mass with suprasellar extension, consistent with a recently hemorrhaged pituitary macroadenoma or pituitary apoplexy with displacement of the optic chiasm. Due to the risks of permanent optic nerve damage, the patient underwent endoscopic endonasal transsphenoidal hypophysectomy with intraoperative fetal monitoring at 30 weeks 1 day of gestation. At 39 weeks of gestation a cesarean section was performed due to the recent procedure. Her delivery and postpartum period were without complications.
DISCUSSION
Pituitary apoplexy presenting in pregnancy is a rare and potentially life-threatening disorder due to an acute ischemic infarction or hemorrhage of the pituitary gland. Surgical management of the pituitary gland in pregnancy is rarely recommended, except in cases of severe visual disturbance and uncontrolled Cushing's disease.
PubMed: 37771424
DOI: 10.1016/j.crwh.2023.e00543 -
Microorganisms Aug 2023Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a... (Review)
Review
Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.
PubMed: 37764064
DOI: 10.3390/microorganisms11092220 -
Optometry and Vision Science : Official... Oct 2023Dry eye disease causes ocular pain, blurred vision, reduced visual quality of life, and reduced workplace performance. This disease is underreported and underdiagnosed... (Observational Study)
Observational Study
SIGNIFICANCE
Dry eye disease causes ocular pain, blurred vision, reduced visual quality of life, and reduced workplace performance. This disease is underreported and underdiagnosed despite being highly prevalent in optometric care.
PURPOSE
This study aimed to explore the vision-related quality of life of patients with dry eye disease and the potential benefits of screening for dry eye disease in Norwegian optometric practice.
METHODS
This study adopted an observational, prospective, cross-sectional design. All patients between 18 and 70 years of age who were examined between June 8 and July 5, 2018, at Erøy Optikk, Kristiansand, Norway, were invited to participate. Dry eye disease was assessed according to Tear Film & Ocular Surface Society International Dry Eye Workshop II report recommendations. Vision-related quality of life was assessed with the National Eye Institute 25-item Visual Function Questionnaire.
RESULTS
Forty-nine patients participated in the study; 29 (59%) were female, and 29 (59%) had dry eye disease. The patients with dry eye disease reported significantly more ocular pain and (vision-specific) role difficulties than the patients without dry eye disease. After adjusting for age, sex, and habitual visual acuity, dry eye disease was found to be an independent predictor of both ocular pain ( r2 = 0.328, P = .001) and (vision-specific) role difficulties ( r2 = 0.240, P = .02). Both habitual visual acuity and dry eye disease were predictors of reduced general vision, a reduced score for near activity and reduced (vision-specific) mental health.
CONCLUSIONS
Dry eye disease was an independent predictor of ocular pain (vision-specific), role difficulties, and reduced general vision, near vision, and (vision-specific) mental health. Optometrists should consider dry eye disease as a cause of reduced vision and quality of vision. Furthermore, we propose that screening for dry eye disease in Norwegian optometric practice can promote better vision and health among patients.
Topics: Female; Humans; Male; Cross-Sectional Studies; Dry Eye Syndromes; Norway; Pain; Prospective Studies; Quality of Life; Surveys and Questionnaires; Vision, Low; Adolescent; Young Adult; Adult; Middle Aged; Aged
PubMed: 37751404
DOI: 10.1097/OPX.0000000000002058 -
Scientific Reports Sep 2023This study aimed to understand the profile of hydroxychloroquine-treated patients, referral patterns, and dosing and to assess the adherence of eye care providers to the...
This study aimed to understand the profile of hydroxychloroquine-treated patients, referral patterns, and dosing and to assess the adherence of eye care providers to the latest 2016 screening guidelines provided by the American Academy of Ophthalmology. Patients were identified using electronic health records (EHR) taking hydroxychloroquine and were seen by optometrists, retinal specialists, and non-retinal ophthalmologists. Review of EHR data includes demographic characteristics, indications, and dosing profile of hydroxychloroquine use, eye care provider managing the patient, and imaging modalities performed. A total of 166 patients were included in the study. The most common indications for screening were systemic lupus erythematosus and discoid lupus (52.4%) followed by rheumatoid arthritis (18.7%) and Sjögren's syndrome (9.6%). Ninety-two (55.4%) patients were on a higher-than-recommended dose of > 5 mg/kg/day. Patients who weighed less (mean 63.9 kg) were taking a higher-than-recommended dose (vs. 81.5 kg, p < 0.001). Although retinal specialists adhered best to the use of all three recommended imaging modalities, visual field testing was done appropriately for only 8.3% of Asian and 71.1% of non-Asian patients. In conclusion, there is substantial variability in screening by ophthalmic providers and prescribing practices compared with the current recommendations. In particular, there is a marked deficiency in correct visual field testing in Asian patients. These findings are important to highlight potential interventions to improve screening for hydroxychloroquine toxicity.
Topics: Humans; Hydroxychloroquine; Arthritis, Rheumatoid; Lupus Erythematosus, Systemic; Academies and Institutes; Retina
PubMed: 37730825
DOI: 10.1038/s41598-023-42816-5 -
Medicine Sep 2023This retrospective study investigated the effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia (JPM). In this retrospective study, we...
This retrospective study investigated the effect of auricular acupressure combined with acupuncture for juvenile pseudomyopia (JPM). In this retrospective study, we collected and analyzed a total of 66 eligible records of subjects with JPM. They were allocated into a treatment group (n = 33) and a control group (n = 33). All participants in both groups received auricular acupressure. Additionally, children in the treatment group also underwent acupuncture. The primary outcome was naked visual acuity (VA). It was performed using a standard E visual acuity chart. The secondary outcome was visual fatigue symptoms, as assessed by the College of Optometrists in Vision Development Quality of Life (COVD-QoL) questionnaire. All outcomes were analyzed before and after treatment. There were no significant differences regarding the naked VA and COVD-QoL scores before and after treatment between the 2 groups. However, there were significant differences regarding on naked VA (P < .01) and COVD-QoL scores (P < .01) within 2 groups compared before and after treatment. The findings of this study showed that both APP plus acupuncture and APP alone benefit children with JPM.
Topics: Child; Humans; Quality of Life; Acupressure; Retrospective Studies; Acupuncture Therapy; Control Groups
PubMed: 37713874
DOI: 10.1097/MD.0000000000035018 -
Medical Hypothesis, Discovery &... 2023Keen vision is one of the most important qualities required of athletes. It enables players to perform sports-related drills and apply decision-making skills. To... (Review)
Review
BACKGROUND
Keen vision is one of the most important qualities required of athletes. It enables players to perform sports-related drills and apply decision-making skills. To accurately measure the visual ability of athletes, it is important to first identify the variety of visual skills involved in the particular sport. The objectives of this novel review are to identify the most important visual skills required for rugby, and to create a reference point for further studies to include visual skills essential to rugby players.
METHODS
We conducted an electronic search with various combinations of relevant keywords using the following databases: Sport Discuss, Ovid's Evidence-Based Medicine Reviews, PubMed/MEDLINE, Current Contents, Science Direct, the National Research Council's Canada Institute for Scientific and Technical Information, Cochrane Database of Systematic Reviews, Google Scholar, and international electronic catalogues to assess the scientific literature related to the visual skills required for rugby. Only the records published in English were included. We extracted data on the relationship between vision and match performance, the defined problem or purpose of the study, and the inclusion of theoretical definitions of tactical behaviors.
RESULTS
Our search yielded 80 records, 51 of which fulfilled the inclusion criteria. The most important visual skills in rugby are classified based on whether they meet the requirements for visual hardware or visual software skills. Visual hardware skills include visual acuity, depth perception, fusion flexibility, and contrast sensitivity; visual software skills include eye tracking, hand-eye coordination, eye focusing, peripheral vision, speed and span of recognition, visual response time, and visual memory.
CONCLUSIONS
Rugby players must use both visual hardware and software skills to reliably observe their teammates' positions, understand their opponents' actions and tactics, handle the ball, analyze the immediate circumstances, and anticipate what will occur. Further studies are needed to verify the significance of each visual skill in actual competition to determine a relationship between vision and the results of a championship.
PubMed: 37641672
DOI: 10.51329/mehdiophthal1469 -
The effectiveness of interventions for optometric referrals into the hospital eye service: A review.Ophthalmic & Physiological Optics : the... Nov 2023Ophthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department... (Review)
Review
PURPOSE
Ophthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department within the National Health Service. Recognising the need for intervention, several approaches have been trialled to tackle the high numbers of false-positive referrals initiated in primary care and seen face to face within the hospital eye service (HES). In this mixed-methods narrative synthesis, we explored interventions based on their clinical impact, cost and acceptability to determine whether they are clinically effective, safe and sustainable. A systematic literature search of PubMed, MEDLINE and CINAHL, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), was used to identify appropriate studies published between December 2001 and December 2022.
RECENT FINDINGS
A total of 55 studies were reviewed. Four main interventions were assessed, where two studies covered more than one type: training and guidelines (n = 8), referral filtering schemes (n = 32), asynchronous teleophthalmology (n = 13) and synchronous teleophthalmology (n = 5). All four approaches demonstrated effectiveness for reducing false-positive referrals to the HES. There was sufficient evidence for stakeholder acceptance and cost-effectiveness of referral filtering schemes; however, cost comparisons involved assumptions. Referral filtering and asynchronous teleophthalmology reported moderate levels of false-negative cases (2%-20%), defined as discharged patients requiring HES monitoring.
SUMMARY
The effectiveness of interventions varied depending on which outcome and stakeholder was considered. More studies are required to explore stakeholder opinions around all interventions. In order to maximise clinical safety, it may be appropriate to combine more than one approach, such as referral filtering schemes with virtual review of discharged patients to assess the rate of false-negative cases. The implementation of a successful intervention is more complex than a 'one-size-fits-all' approach and there is potential space for newer types of interventions, such as artificial intelligence clinical support systems within the referral pathway.
Topics: Humans; Ophthalmology; State Medicine; Artificial Intelligence; Telemedicine; Referral and Consultation; Hospitals
PubMed: 37632154
DOI: 10.1111/opo.13219 -
Vision (Basel, Switzerland) Aug 2023This study measured and evaluated the socioeconomic burden of people living with keratoconus in Saudi Arabia.
AIM
This study measured and evaluated the socioeconomic burden of people living with keratoconus in Saudi Arabia.
METHODS
This study employed a cross-sectional design, a Keratoconus Economic Burden Questionnaire, and a convenient sample of 89 keratoconus patients (58.4% male) drawn from multiple regions in Saudi Arabia. It was conducted using online surveys, and the data were analyzed using appropriate quantitative techniques.
RESULTS
The mean age and annual income of the participants were 33.24 (SD = 6.82) years and USD 9046.52 (SD = 16,866.48), respectively, with only 37% being employed for wages. Up to 94.4% needed glasses or contact lenses at least once a week, and 73.0% received care from optometrists. The condition forced 45.9% of the respondents to change careers or leisure activities, with a further 51.3% having to take time off work. The mean annual out-of-pocket expenses for buying and maintaining glasses or contact lenses, as well as traveling and accommodation for keratoconus-related treatment were USD 2341.76 (SD = 3053.09), with 48.32 incurring upwards of USD 3240 over the period. The treatment costs increased with disease duration, (89) = 0.216, < 0.05. Regression results showed that the existence of comorbid eye disease, changing glasses at least once a year, and wearing either glasses or contact lenses at least once a week individually had statistically significant negative effects on the total annual keratoconus treatment costs, while disease duration, utilization of optometrists, and taking time off had a statistically significant increase on the total cost ( < 0.05).
CONCLUSION
With a prevalence rate of 1 in 375, progressive debilitation, and the lifetime nature of the disease, keratoconus is a critical public health concern in Saudi Arabia. The resulting visual impairment and discomfort, as well as both direct and indirect economic burdens, have considerable impacts on the patient's quality of life.
PubMed: 37606498
DOI: 10.3390/vision7030052 -
Indian Journal of Ophthalmology Sep 2023Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII...
PURPOSE
Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software-"Bharat Protocol."
METHODS
Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany).
RESULTS
At a minimum follow-up of 6 months (range 6.2-13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen.
CONCLUSIONS
The "Bharat" Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.
Topics: Humans; Keratoconus; Pilot Projects; Eye Pain; Retrospective Studies; Cornea
PubMed: 37602609
DOI: 10.4103/IJO.IJO_295_23