1
|
Fan X, Huang H, Shi C, Jiang J, Lu F, Shen M. Changes in bulbar conjunctival microcirculation and microvasculature during short-term scleral lens wearing and their associated factors. Cont Lens Anterior Eye 2024:102159. [PMID: 38851944 DOI: 10.1016/j.clae.2024.102159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To explore the changes in microcirculation and microvasculature of the bulbar conjunctiva during the short-term wearing of the scleral lenses (ScCL). And investigate the factors affecting the microcirculation and microvasculature of the bulbar conjunctiva. METHODS In this prospective cross-sectional study, functional slit lamp biomicroscopy (FSLB) was used to image the ocular surface microcirculation and microvascular images at two different sites (under the area of ScCL and outside of the area of ScCL) before (baseline) and during the wearing of ScCL at 0 h, 1 h, 2 h and 3 h. Anterior segment optical coherence tomography (AS-OCT) (RTVue, Optovue Inc, USA) was also used to image central post-lens tear film (PoLTF) and the morphology changes of the conjunctiva under the landing zone at the same time period. The semi-automatic quantification of microcirculation and microvasculature including vessel density (Dbox), vessel diameter (D), axial blood flow velocity (Va) and blood flow volume (Q). And the morphological changes of conjunctiva and PoLTF fogging grading were evaluated manually. The changes in the microcirculation and microvasculature of the ocular surface, PoLTF fogging grade and conjunctival morphology were compared before and during the ScCL wearing at different time periods, and the relationship between them was analyzed. RESULTS Nineteen eyes (11 right eyes, 8 left eyes) were analyzed in this study. Outside of the area of ScCL, the Dbox before wearing lenses was less than that at 0 h (P = 0.041). The Q at baseline was greater than that after 1 h ScCL wearing (P = 0.026). Under the area of the ScCL, the Q at 1 h was less than that at baseline and 3 h. During the ScCL wearing, statistically significant conjunctival morphology changes were found among different time stages (baseline (0 μm), 0 h (113.18 μm), 2 h (138.97 μm), 3 h (143.83 μm) (all P <0.05). Outside the area of the ScCL, the morphology changes of the conjunctiva were negatively correlated with the changes of Va (P<0.001,r = -0.471) and Q (P = 0.003,r = -0.348),but positively correlated with the Dbox (P = 0.001,r = 0.386). Under the area of ScCL, the morphology changes of the conjunctiva were negatively correlated with the Q (P = 0.012, r = -0.291). The fogging grade was positively correlated with the Q under the area of the ScCL (P = 0.005, r = 0.331). CONCLUSIONS The microcirculation and microvasculature of the ocular surface and conjunctival morphology were changed after wearing ScCL in wearers, which indicated that the microvascular responses happened in the ScCL wearers and the severity of microvascular responses of the ocular surface related to the morphology changes of the conjunctiva. The quantification methods and findings in this study provide clues for the safety of ScCL wearing and may supervise the health of the wearer's ocular surface.
Collapse
Affiliation(s)
- Xin Fan
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huimin Huang
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ce Shi
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Jiang
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fan Lu
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Meixiao Shen
- The School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
2
|
Itokawa T, Okajima Y, Iwashita H, Koji K, Tashiro S, Suzuki T, Hori Y. Association between dryness sensation and ocular surface temperature and conjunctival blood flow in soft contact lens wearers. Cont Lens Anterior Eye 2024; 47:102166. [PMID: 38604915 DOI: 10.1016/j.clae.2024.102166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To investigate the association between dryness, ocular surface temperature (OST), and conjunctival blood flow (CBF) in soft contact lens (SCL) wearers after airflow stimulation. METHODS After recruiting 21 SCL wearers (mean age, 25.3 ± 4.2 years), subjects used two different daily disposable silicone hydrogel SCLs (narafilcon A and delefilcon A lenses). On three of four measurement days, excluding the first, OST, CBF, tear meniscus height (TMH), and non-invasive tear break-up time (NIBUT) were measured after airflow stimulation at a rate of 3 m/s for 10 min. The measurements were conducted without SCLs on the first and second days, and with different SCLs on the third and fourth days. Dryness was evaluated using the visual analogue scale (VAS). These parameters were compared between the two types of SCLs, and their association with the dryness sensation was then investigated. RESULTS Dryness was significantly weakly correlated with OST (r = -0.375, p < 0.05) and CBF (r = 0.339, p < 0.05). TMH, NIBUT, and VAS scores for dryness with the delefilcon A lens (0.15 ± 0.05 mm, 3.7 ± 01.7 s and 29.4 ± 16.9) were significantly higher, longer, and lower, respectively, than those with the narafilcon A lens (0.12 ± 0.05 mm, 2.3 ± 1.7 s and 35.9 ± 17.0; p < 0.05, p < 0.01 and p < 0.01). The changes in the OST and CBF between with and without the delefilcon A lens (-0.36 ± 0.35 °C and 0.99 ± 0.19) were significantly small compared to the narafilcon A lens (-0.60 ± 0.42 °C and 1.11 ± 0.21; p < 0.01 for both comparisons). CONCLUSION Dryness was correlated with OST and CBF, which indicates that when dryness was high, OST was low and CBF was high. These results suggest that OST and CBF assessments are effective for evaluating dryness sensation.
Collapse
Affiliation(s)
- Takashi Itokawa
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan.
| | - Yukinobu Okajima
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan; Tsunashima Eye Clinic, Yokohama, Kanagawa, Japan
| | - Hiroko Iwashita
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kakisu Koji
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Tashiro
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takashi Suzuki
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan; Ishizuchi Eye Clinic, Niihama, Ehime, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Deng M, Li M, Liu L, Shi Y, Sun L, Ma X, Zou J. Proteomic profiling of human corneal stroma from long-term contact lens wearers reveals activation of inflammatory responses. Cont Lens Anterior Eye 2023; 46:101820. [PMID: 36775668 DOI: 10.1016/j.clae.2023.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/26/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the association between proteomic changes and potential pathogenesis in the human cornea with respect to the duration of wearing soft contact lenses (SCLs). METHODS A total of 96 corneal stroma samples, obtained via small incision lenticule extraction (SMILE), were equally grouped according to the duration of wearing SCL: 0Y, did not wear SCL; 5Y, wore SCL for<5 years; 5-10Y, wore SCL for 5-10 years; O10Y, wore SCL for>10 years. Liquid chromatography-tandem mass spectrometry was used to identify and quantify protein profiles in the corneal stroma. Expression levels of CO1A1, CO4A1, NFKB1, and IL6RB were determined using western blot and immunohistochemistry analysis. RESULTS This study quantified a total of 5,668 proteins across samples and identified 2,379 differentially expressed proteins (DEPs) with significantly increased abundance in the three SCL-wearing groups compared with that in the non-SCL-wearing group. Compared with those in the 0Y group, the molecular functions of DEPs in the 5Y, 5-10Y, and O10Y groups were mainly related to translation regulator activity, antigen binding, peptidase inhibitor activity, participation in extracellular matrix (ECM) production, complement activation, and inflammatory responses. Pathway enrichment analysis of DEPs showed that the sphingolipid, phosphatidylinositol 3-kinase-protein kinase B, and hypoxia-inducible factor-1 signaling pathways were activated in the human corneal stroma after long-term SCL use. CONCLUSIONS Inflammation-related proteomic components in human corneal stroma increased after long-term use of SCL and may act as an essential factor in the molecular pathogenesis of corneal stroma damage.
Collapse
Affiliation(s)
- Manli Deng
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Min Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Lin Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuehui Shi
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Lina Sun
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyun Ma
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
| |
Collapse
|
4
|
Progress of Bulbar Conjunctival Microcirculation Alterations in the Diagnosis of Ocular Diseases. DISEASE MARKERS 2022; 2022:4046809. [PMID: 36072898 PMCID: PMC9441399 DOI: 10.1155/2022/4046809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022]
Abstract
Bulbar conjunctival microcirculation is a microvascular system distributed in the translucent bulbar conjunctiva near the corneal limbus. Multiple ocular diseases lead to bulbar conjunctival microcirculation alterations, which means that bulbar conjunctival microcirculation alterations would be potential screening and diagnostic indicators for these ocular diseases. In recent years, with the emergence and application of a variety of noninvasive observation devices for bulbar conjunctiva microcirculation and new image processing technologies, studies that explored the potential of bulbar conjunctival microcirculation alterations in the diagnosis of ocular diseases have been emerging. However, the potential of bulbar conjunctival microcirculation alterations as indicators for ocular diseases has not been exploited to full advantage. The observation devices, image processing methods, and algorithms are not unified. And large-scale research is needed to concrete bulbar conjunctival microcirculation alterations as indicators for ocular diseases. In this paper, we provide an update on the progress of bulbar conjunctival microcirculation alterations in the diagnosis of ocular diseases in recent five years (from January 2017 to March 2022). Relevant ocular diseases include contact lens wearing, dry eye, conjunctival malignant melanoma, conjunctival nevus, and diabetic retinopathy.
Collapse
|
5
|
Xu Y, Xu Z, Shu X, Liu Q, Wang Y, Xia J, Li Y, Qu J, Hu L. Dynamic Changes of Ocular Surface in First-Time Contact Lens Wearers and the Effective Factors of Contact Lens Discomfort. Front Med (Lausanne) 2022; 9:833962. [PMID: 35360725 PMCID: PMC8962650 DOI: 10.3389/fmed.2022.833962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of the study is to investigate the dynamic changes in ocular surface indicators in first-time contact lens (CL) wearers and identify the most influential factors in CL discomfort (CLD). Methods A total of 26 healthy non-CL wearers (26 eyes) were recruited and fitted monthly with disposable hydrogel CLs. Each participant underwent a full ocular surface evaluation, which include Efron grading, tear film breakup time, Schirmer's I test, corneal dendritic cell (DCs) imaging by in vivo confocal microscopy (IVCM), and conjunctival microvasculature evaluation by functional slit-lamp biomicroscopy. CLD was assessed using the Ocular Surface Disease Index questionnaire at baseline, 1 week, 1, 3, and 6 months after wearing it and another 6 months after discontinuing it. Results Clinical signs and CLD were significantly increased in the first week (p < 0.05). The microvascular response and DC activation peaked at the 1-month interval (p < 0.05). During CL wear, CLD is positively correlated with corneal staining (B = 0.238, p = 0.002), papillary conjunctivitis (B = 0.245, p < 0.001), and microvascular blood flow velocity (B = 0.353, p < 0.001). After discontinuation, only DC activation remained elevated at 6 months, whereas the other signs recovered. Conclusions The first week of CL wear was the main period for the appearance of ocular surface clinical signs, and the first month was the main period for the activation of subclinical inflammation. Corneal staining and conjunctival microvascular response are the main factors affecting CLD. Even if the clinical signs recover after discontinuing wear, subclinical inflammation may persist.
Collapse
Affiliation(s)
- Yangyang Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiqiang Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Xupeng Shu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Qiaoli Liu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yuzhou Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jiahui Xia
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Yong Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- *Correspondence: Liang Hu
| | - Liang Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Jia Qu
| |
Collapse
|
6
|
Sánchez-Tena MÁ, Martinez-Perez C, Villa-Collar C, Alvarez-Peregrina C. Long-term effect of contact lens wear: A citation network study. Cont Lens Anterior Eye 2021; 45:101527. [PMID: 34732300 DOI: 10.1016/j.clae.2021.101527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/10/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Contact lenses can cause complications in 2/3 of the total population, but in most cases, they are mild and easy to manage. However, most of the studies are short-term. The aim of the study was to analyze the publications on the long-term effects of contact lens wear to understand the current research landscape through the analysis of dating networks as well as determining the different research areas and the most cited publications. METHODS The Web of Science database was used to perform the publication search, looking for the terms "Long-term" AND "contact lens wear" within the period between 1977 and January 2021. The CitNetExplorer and CiteSpace software were then used to conduct the publication analysis. To obtain the graphics, the VOSviewer software was used. RESULTS A total of 721 publications were found with 2999 citations generated within the network. The year 2010 was singled out as a "key year", considering the number of publications that emerged in that year and increase in adaptations of contact lens worldwide. The most widely cited publication was "Effects of long-term extended contact lens wear on the human cornea", an article by Holden et al., which was published in 1985. By using the clustering function, we were able to establish three clusters that encompassed the different research areas within this field: morphological changes, the loss of corneal sensitivity, tear film characteristics and longitudinal changes in ocular physiology. CONCLUSIONS The main research topic in this field focuses on the morphological changes that take place in the corneal endothelial cell layer.
Collapse
Affiliation(s)
- Miguel Ángel Sánchez-Tena
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; ISEC LISBOA - Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal.
| | - Clara Martinez-Perez
- ISEC LISBOA - Instituto Superior de Educação e Ciências, 1750-179 Lisboa, Portugal; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón Madrid, Spain.
| | - Cesar Villa-Collar
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón Madrid, Spain
| | - Cristina Alvarez-Peregrina
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón Madrid, Spain.
| |
Collapse
|
7
|
Fang M, Airen S, Jiang H, Wang J. Ocular surface microvascular response and its relation to contact lens fitting and ocular comfort: an update of recent research. Clin Exp Optom 2021; 104:661-671. [PMID: 33689669 DOI: 10.1080/08164622.2021.1878867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This review examines vascular responses in the ocular surface to contact lens wear and its relation to lens fitting characteristics and contact lens-related discomfort. A search of PubMed was performed to find original research in English, within the past 10 years, that studied the ocular surface, including lid-wiper vascular responses to the lens. The interaction between the lens and ocular surface triggers vascular responses, impacting the lens fitting and contact lens-related discomfort. Contact lens-related discomfort is a multifactorial event, which is affected by lens characteristics. Overall, contact lenses with low modulus and a relatively tight fit produce significant ocular comfort. If an appropriate lens fit is achieved, lens fitting characteristics may not play a critical role in contact lens-related discomfort. On the other hand, the pathogenic and vascular changes of lid-wiper vascular responses appear to play an essential role in developing contact lens-related discomfort, in concert with reactions of the cornea (compression and staining) and conjunctiva (indentation and staining). Robust evaluation of lid-wiper changes at the cellular and microvascular level may hold the key to better understanding the mechanism of contact lens-related discomfort and reveal strategies for eliminating lid wiper epitheliopathy and improving ocular comfort in contact lens wearers.
Collapse
Affiliation(s)
- Min Fang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, Guangdong, China.,School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA
| | - Shriya Airen
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Hong Jiang
- School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA.,Department of Neurology, School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Jianhua Wang
- School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA
| |
Collapse
|
8
|
Zhang T, Li M, Xiao W, Ye H, Chen R, Yuan J, Yang H. Bulbar Conjunctival Microvascular Alterations in Thyroid-Associated Ophthalmopathy Patients with Different Activities. Curr Eye Res 2021; 46:943-948. [PMID: 33719776 DOI: 10.1080/02713683.2020.1849729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose: To evaluate the morphologic and hemodynamic changes of bulbar conjunctival vessels in thyroid-associated ophthalmopathy (TAO) patients and the correlations with the activity.Methods: Patients diagnosed as TAO with different clinical activity scores (CAS) and healthy participants were recruited. All subjects underwent a complete ophthalmic examination and functional slit-lamp biomicroscope. Vascular variables including the vessel density, vessel complexity, average diameter, blood flow velocity and blood flow rate in microvascular networks were measured. The correlations among microvascular parameters, CAS and exophthalmos were analyzed. Areas under the receiver operating characteristic curves (AUROCs) were applied to evaluate the diagnostic accuracy of microvascular alterations for active TAO.Results: A total of 46 eyes were enrolled in our study. The vessel complexity and blood flow velocity increased in the active TAO group significantly compared with the inactive group and healthy controls (P < .05). Meanwhile, the vessel complexity and blood flow rate were positively correlated with CAS (r = 0.641 and r = 0.526). Bulbar conjunctival microvascular parameters performed a good ability in distinguishing the active stage of TAO (AUROC = 0.793).Conclusions: Increasing bulbar conjunctival vessel complexity and blood flow were evident in TAO with severe inflammation. The measurements of bulbar conjunctival microvasculature could be a reference to evaluate activity in TAO.
Collapse
Affiliation(s)
- Te Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Meng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
Chen Q, Jiang H, Wang J. Conjunctival Vascular Adaptation Related to Ocular Comfort in Habitual Contact Lens Wearers. Am J Ophthalmol 2020; 216:99-109. [PMID: 32247776 DOI: 10.1016/j.ajo.2020.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE We sought to investigate the bulbar conjunctival vascular responses in habitual contact lens (HCL) and non-contact lens (NCL) wearers after short-term lens wear and their relationships with ocular comfort. DESIGN A prospective, comparative before-and-after study. METHODS Twenty-seven subjects (13 HCL and 14 NCL wearers) were enrolled. Microvasculature and microcirculation on the temporal bulbar conjunctiva were imaged at baseline and 0.5 and 6 hours after wearing contact lenses (1-Day Acuvue TruEye; base curve, 8.5 mm; power, -0.50 diopters) on both eyes. The measurements included vessel diameter (D), axial (VA), and cross-sectional (VS) blood flow velocities, blood flow volume (Q), and vessel density (Dbox) and complexity (D0). A Contact Lens User Experience (CLUE) questionnaire was used to assess ocular comfort. RESULTS No significant change (P > .05) was observed in D, VA, VS, Q, Dbox, and D0 in the HCL wearers after contact lens wear. By contrast, VA, VS, Q, Dbox, and D0 increased significantly after lens wear (after 0.5 and 6 hours) in NCL wearers compared with baseline (P < .05). Moreover, the changes from the baseline to 0.5 hours (VA, VS, and Dbox) and 6 hours (VA, VS, Q, Dbox, and D0) after contact lens wear in NCL wearers were significantly greater than that in HCL wearers (P < .05). The CLUE score 6 hours after lens wear was higher in HCL wearers than in NCL wearers (P < .05). It was also significantly correlated with VA, VS, and D0 after 6-hour lens wear in HCL wearers (P < .05). CONCLUSIONS This is the first study to reveal the relationship between ocular comfort and conjunctival vascular responses in habitual contact lens wearers.
Collapse
Affiliation(s)
- Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
| |
Collapse
|
10
|
Deng Y, Chen W, Xiao P, Jiang H, Wang J, Chen W, Li S, Zhong J, Peng L, Wang Q, Yuan J. Conjunctival microvascular responses to anti-inflammatory treatment in patients with dry eye. Microvasc Res 2020; 131:104033. [PMID: 32615134 DOI: 10.1016/j.mvr.2020.104033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study characterized conjunctival microvascular morphological and haemodynamic responses after anti-inflammatory treatment in dry eye (DE). MATERIALS AND METHODS Twenty-five patients with moderate DE (17 females and 8 males aged 48 ± 16 years) who underwent anti-inflammatory therapy (0.1% fluorometholone) and 25 healthy subjects (20 females and 5 males aged 48 ± 17 years) recruited as controls were enrolled. The conjunctival blood flow rate (BFR), blood flow velocity (BFV) and vessel diameter were measured by functional slit-lamp biomicroscopy (FSLB). DE symptoms and signs were assessed. All measurements were performed at baseline and at 30 and 60 days after commencement of treatment. RESULTS At baseline, the conjunctival BFR, BFV, and vessel diameter were higher in the DE group than in the control group (p < 0.05). The BFR, BFV and corneal fluorescein staining (CFS) scores decreased at 60 days after therapy compared to at baseline and 30 days (all pcorrected < 0.05); Ocular surface diseases index (OSDI), the hyperaemia index (HI) and vessel diameters only showed significant decreases at 30 days. Moreover, significant increases in the noninvasive tear film break-up time (NI-BUT) and Schirmer I test score (ST) were observed. The CFS score correlated positively with BFV (r = 0.46), BFR (r = 0.58) and vessel diameter (r = 0.47). CONCLUSION This study characterized conjunctival microvascular responses to anti-inflammatory treatment in DE patients. The results suggest that conjunctival BFV and BFR can be used as dynamic markers for treatment efficacy in DE.
Collapse
Affiliation(s)
- Yuqing Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China; Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Saiqun Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lulu Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qian Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
11
|
Shu X, Wang J, Hu L. A review of functional slit lamp biomicroscopy. EYE AND VISION 2019; 6:15. [PMID: 31139665 PMCID: PMC6528339 DOI: 10.1186/s40662-019-0140-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
Functional slit lamp biomicroscopy (FSLB) is a novel device which consists of a traditional slit-lamp and a digital camera. It can quantitatively assess vessel diameter, blood flow velocity, and blood flow rate and can create noninvasive microvascular perfusion maps (nMPMs). At present, FSLB is mainly used in contact lens (CL) and dry eye disease (DED) studies to advance our understanding of ocular surface microcirculation. FSLB-derived blood flow and vessel density measures are significantly altered in CL wearers and DED patients compared to normal people. These subtle changes in the ocular surface microcirculation may contribute to the monitoring of potential diseases of the body and provide a new way to diagnose dry eye disease. Therefore, this may also indicate that FSLB can be more widely applied in the study of other diseases to reveal the relationship between changes in ocular surface microcirculation and systemic diseases. The purpose of this paper is to summarize the functions of FSLB and the related studies especially in CL and DED.
Collapse
Affiliation(s)
- Xupeng Shu
- 1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| | - Jianhua Wang
- 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Liang Hu
- 1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, 325027 China
| |
Collapse
|
12
|
Shi C, Jiang H, Gameiro GR, Wang J. Microcirculation in the conjunctiva and retina in healthy subjects. EYE AND VISION 2019; 6:11. [PMID: 30993144 PMCID: PMC6451216 DOI: 10.1186/s40662-019-0136-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/18/2019] [Indexed: 01/15/2023]
Abstract
Background The aim was to determine the relationship between bulbar conjunctival microcirculation and retinal microcirculation in a healthy population. Method A functional slit-lamp biomicroscope (FSLB) was used to measure blood flow velocity (BFV) and blood flow rate (BFR) in the conjunctiva while a retinal function imager (RFI) was used to measure macular BFV and BFR in the retina. One eye of each subject of 58 self-reported healthy subjects was imaged in the same session on the same day. Results The mean BFV in the venules of the conjunctiva was 0.49 ± 0.13 mm/s, which was significantly slower than that in the retinal arterioles (3.71 ± 0.78 mm/s, P < 0.001) and retinal venules (2.98 ± 0.58 mm/s, P < 0.001). The BFR in the conjunctiva (0.09 nl/s) was also significantly lower than that in the retina (arterioles = 0.81 nl/s, venules = 0.68 nl/s, all P < 0.001). The BFVs and BFRs were not related between the conjunctiva and retina (r ranged from − 0.17 to − 0.05, all P > 0.05). Conclusion The microcirculation in the retina appeared to be different from that in the conjunctiva.
Collapse
Affiliation(s)
- Ce Shi
- 1School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China.,2Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Hong Jiang
- 2Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Giovana Rosa Gameiro
- 2Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Jianhua Wang
- 2Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| |
Collapse
|
13
|
Wang J, Hu L, Shi C, Jiang H. Inter-visit measurement variability of conjunctival vasculature and circulation in habitual contact lens wearers and non-lens wearers. EYE AND VISION 2019; 6:10. [PMID: 30984795 PMCID: PMC6442401 DOI: 10.1186/s40662-019-0135-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/11/2019] [Indexed: 01/06/2023]
Abstract
Background The inter-visit variation of measuring bulbar conjunctival microvasculature and microcirculation needs to be considered when the results from multiple visits are interpreted. This study examined the inter-visit variability of measuring conjunctival microvasculature and microcirculation in habitual contact lens (HCL) wearers and non-contact lens (NCL) wearers. Methods Twenty-eight subjects were recruited including 13 HCL wearers (10 females and 3 males; mean age ± standard deviation, 25.8 ± 4.6 years) who had worn contact lenses on a daily basis for at least 3 years and 15 NCL wearers (10 females and 5 males, age 25.5 ± 4.0 years) were recruited. The temporal bulbar conjunctiva was imaged using a functional slit-lamp bio-microscope (FSLB) imaging system. FSLB imaging was performed in the morning when the HCL wearers did not wear their lenses. The measurements included conjunctival vessel diameter, vessel density, blood flow velocity and flow volume. In addition, conjunctival microvasculature was analyzed using monofractal (Dbox, representing vessel density) and multifractal (D0 representing vessel complexity) analyses. The repeated measurement was conducted at least one week after the first visit and both eyes of each participant were imaged. The coefficient of variation (CV) was calculated as the standard deviation of the differences between test and re-test then divided by the mean of the measurements. The intra-class correlation coefficient (ICC) was also calculated. Results No significant differences of all vascular measurements in both the right and left eyes were found between two groups (P > 0.05). Between two measurements on two different visits, the CV was from 2.4% (vessel density D0) to 63.5% (blood flow volume Q) in HCL wearers and from 3.4% (D0) to 40.6% (blood flow volume) in NCL wearers. The ICC was from 0.60 (vessel diameter) to 0.81 (axial blood flow velocity VA) in HCL wearers and from 0.44 (Q) to 0.68 (cross-sectional blood flow velocity VS) in NCL wearers. Conclusions The measurement variability of the vessel density of the bulbar conjunctiva appeared to have the smallest inter-visit variation. The measurement variability of the vasculature and circulation in HCL wearers were similar to that in NCL wearers.
Collapse
Affiliation(s)
- Jianhua Wang
- 1Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Liang Hu
- 1Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA.,2School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ce Shi
- 1Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA.,2School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hong Jiang
- 1Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| |
Collapse
|
14
|
Hu L, Shi C, Jiang H, Shi Y, Sethi Z, Wang J. Factors Affecting Microvascular Responses in the Bulbar Conjunctiva in Habitual Contact Lens Wearers. Invest Ophthalmol Vis Sci 2018; 59:4108-4114. [PMID: 30098199 PMCID: PMC6088803 DOI: 10.1167/iovs.18-24216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To investigate the factors affecting microvascular responses in the bulbar conjunctiva of habitual contact lens (HCL) wearers. Methods A functional slit-lamp biomicroscope (FSLB) was used to image the temporal bulbar conjunctiva of habitual contact lens (HCL) wearers and non-contact lens (NCL) wearers. The vessel diameters and blood flow velocities (BFVs) were measured. Fractal analysis using Dbox as vessel density and D0 as vessel complexity were used to quantitatively analyze the microvascular network. One eye each of 91 NCL wearers and 75 HCL wearers was imaged. Results The BFV of NCL wearers was 0.50 ± 0.14 mm/s, which was negatively correlated with age (r = -0.22, P < 0.05). The BFV, vessel diameter, Dbox, and D0 of HCL wearers was significantly higher than NCL wearers (P < 0.05). In these HCL wearers, BFVs were positively correlated with contact lens (CL) hours of wear per day and CL days of wear per week. BFV, Dbox, and D0 were not related to CL years of wear, CL power, CL base curve, and CL diameter (P > 0.05). Conclusions Vascular responses on the bulbar conjunctiva occurred in HCL wearers and appeared to be unrelated to sex or age, CL years of wear, and lens parameters, indicating that wearing a CL itself may be the predominant factor inducing these responses.
Collapse
Affiliation(s)
- Liang Hu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Ce Shi
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Yingying Shi
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Zubin Sethi
- School of Business Administration, University of Miami, Miami, Florida, United States
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| |
Collapse
|
15
|
McMonnies CW. An Amplifying Cascade of Contact Lens-Related End-of-Day Hyperaemia and Dryness Symptoms. Curr Eye Res 2018; 43:839-847. [PMID: 29630423 DOI: 10.1080/02713683.2018.1457163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
End-of-day (EOD) symptoms of dryness are too often the cause of poor soft contact lens (SCL) tolerance and abandonment of wear. This review examines an amplifying cascade model for these symptoms, which involve thin tear layers on contact lens (CL) front surfaces being susceptible to evaporation-related short tear breakup (TBU) times. Susceptibility to faster tear loss by evaporation may be exacerbated by other forms of tear instability, such as lipid and mucin deficiencies as well as lens surface soiling. Bulbar and palpebral conjunctival hyperaemia and associated faster evaporation of warmer pre-conjunctival tears could also contribute to evaporative dry eye EOD symptoms. In CL wearers, a cascade of increasing hyperaemia toward the end of day, associated increasing tear temperature and evaporative loss, shortened TBU times (TBUTs) and increased osmolarity, all elevate the risk of higher symptom levels according to progressive amplification of this cascade. Chronic wound healing responses to SCL wear, perhaps related to limbal conjunctival trauma, stem cell deficiency and persistent epitheliopathy, as well as one or more immune responses, may contribute directly or indirectly to inflammation and the amplifying evaporative dryness cascade. A diurnal cycle that culminates in EOD symptoms appears to involve a process of recovery from causal mechanisms after lens removal, which allows lenses to be worn comfortably, at least initially the next day. Possible recovery processes are discussed in this review as are procedures that may help de-amplify an inflammatory, evaporative dryness cascade and alleviate EOD symptoms. Evidence of an accrual of adverse responses over long periods of more or less successful lens wear indicate an incremental failure to recover from EOD hyperaemia. Such incremental failure could help explain how SCL wear too often needs to be abandoned after many years of comfortable wear.
Collapse
Affiliation(s)
- Charles W McMonnies
- a School of Optometry and Vision Science , University of New South Wales , Kensington , Australia
| |
Collapse
|
16
|
Chen W, Deng Y, Jiang H, Wang J, Zhong J, Li S, Peng L, Wang B, Yang R, Zhang H, Li M, Yuan J. Microvascular abnormalities in dry eye patients. Microvasc Res 2018; 118:155-161. [PMID: 29601875 DOI: 10.1016/j.mvr.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 11/19/2022]
Abstract
This study was conducted to evaluate conjunctival blood flow velocities and microvascular network density in patients with dry eye disease (DED). Twenty-five patients with DED and 25 healthy controls were recruited. The microvasculature and microcirculation of the temporal bulbar conjunctiva of the right eyes were assessed using a functional slit-lamp biomicroscope. Vascular variables included blood flow velocity (BFV), blood flow rate (BFR), microvascular network density and vessel diameter. A fractal analysis was performed using the box counting method to measure the fractal dimension (Dbox) representing the vessel density. The bulbar BFV was 0.59 ± 0.09 mm/s in the DED group and 0.47 ± 0.12 in the control group (P < 0.001). BFR was 169.5 ± 1.8 in the DED group compared to the control group (107.2 ± 49.6) (P < 0.001). Dbox was higher in DED patients (1.65 ± 0.04) than controls (1.60 ± 0.07, P < 0.05). Moreover, the vessel diameter was larger in the DED group (21.8 ± 1.8 μm) compared with controls (17.9 ± 2.2 μm, P < 0.001). Dbox was positively related with ocular surface disease index (OSDI) in patients with DED (r = 0.54, P = 0.008). Microvascular alterations were found in the bulbar conjunctiva of DED patients, including increased blood flow velocity, higher vessel density and larger vessel diameter.
Collapse
Affiliation(s)
- Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuqing Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Department of Neurology, University of Miami, Miami, FL, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
| | - Jing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Saiqun Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lulu Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bowen Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruhui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Henan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|