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Debourdeau E, Beylerian H, Nguyen V, Barthelmes D, Gillies M, Gabrielle PH, Vujosevic S, Otoole L, Puzo M, Creuzot-Garcher C, Wolff B, Daien V. Treat-and-Extend Versus Pro re nata Regimens of Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration: A Comparative Study from Routine Clinical Practice. Ophthalmol Ther 2024:10.1007/s40123-024-00983-2. [PMID: 38976148 DOI: 10.1007/s40123-024-00983-2] [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: 01/18/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION Anti-vascular endothelial growth factor (VEGF) is generally given using pro re nata or "treat-and-extend" (T&E) regimens for neovascular age-related macular degeneration (nAMD). Randomized clinical trials have reported that T&E is superior to Pro re nata (PRN), but results from clinical trials may not always be replicated in clinical practice. Real-world data comparing T&E and PRN regimens for nAMD are limited. The objective of this work was to report 24-month outcomes of PRN versus T&E regimens for ranibizumab and aflibercept to treat nAMD in routine clinical practice. METHODS We conducted a retrospective analysis of data from a prospectively designed observational outcomes registry, the Fight Retinal Blindness! Project (FRB). Treatment-naïve eyes starting nAMD treatment with at least three injections using a T&E or PRN regimen were tracked by using the FRB. The primary outcome was the mean change in visual acuity (VA) measured by the number of letters read on a logarithm of the minimum angle of resolution chart at 2 years versus baseline. The secondary outcome was the number of injections at 2 years. RESULTS From January 1, 2015 to January 31, 2019, 3313 eyes from 2948 patients with nAMD were included: 1243 eyes from 1065 patients were classified as PRN and 2070 eyes from 1935 patients started a T&E regimen. At 24 months, patients on the T&E regimen experienced significantly greater mean (95% confidence interval) improvement in VA than those on PRN (+ 4.2 [3.1, 5.2] vs. + 1.3 [0.1, 2.6] letters; p < 0.001), with more injections (14.9 standard deviation(SD) 4.3) vs. 9.8(SD 4.3); p < 0.001). CONCLUSIONS Eyes treated with a T&E regimen had better VA outcomes from VEGF inhibitors than eyes treated PRN. This large real-world data assessment supports previous data from randomized clinical trials that the T&E regimen delivers better outcomes than PRN.
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Affiliation(s)
- Eloi Debourdeau
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France.
| | - Helene Beylerian
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Louise Otoole
- Eye Centre, Mater Private Network Dublin, Dublin, Ireland
| | - Martin Puzo
- Department of Ophthalmology, Miguel Servet University Hospital, University of Zaragoza, Saragossa, Spain
| | | | - Benjamin Wolff
- Maison Rouge Ophthalmologic Center, 6 rue de L'Eglise, 67000, Strasbourg, France
| | - Vincent Daien
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Ehlers JP, McConville C, Yordi S, Cetin H, Cakir Y, Kalra G, Amine R, Whitney J, Whitmore V, Bonnay M, Reese J, Clark J, Zhu L, Luo D, Jaffe GJ, Srivastava SK. Correlation Between Blue Fundus Autofluorescence and SD-OCT Measurements of Geographic Atrophy in Dry Age-Related Macular Degeneration. Am J Ophthalmol 2024; 266:92-101. [PMID: 38719131 DOI: 10.1016/j.ajo.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To compare fundus autofluorescence (FAF) and spectral domain optical coherence tomography (OCT) measurements of geographic atrophy (GA) area and to analyze lesion area changes measured by spectral domain OCT in GATHER1. DESIGN An assessment reliability analysis using prospective, randomized, double-masked phase 2/3 clinical trial data. METHODS GATHER1 examined the efficacy and safety of avacincaptad pegol (ACP) for GA treatment. A post hoc analysis was performed to identify correlations between FAF- and OCT-based measurements of GA. GA area was measured on blue-light FAF images using semiautomatic segmentation software with support from OCT and near-infrared imaging. Machine-learning enhanced, multilayer segmentation of OCT scans were reviewed by human readers, and segmentation errors were corrected as needed. GA area was defined as total RPE loss on cross-sectional B scans. Time points included Months 0, 6, 12, and 18. Additionally, OCT-based GA-area changes between ACP and sham were analyzed. RESULTS There was a strong correlation (r = 0.93) between FAF and OCT GA area measurements that persisted through 18 months. Mean (SD) differences between OCT and FAF GA measurements were negligible: 0.11 mm2 (1.42) at Month 0, 0.03 mm2 (1.62) at Month 6, -0.17 mm2 (1.81) at Month 12, and -0.07 mm2 (1.78) at Month 18. OCT assessments of GA growth revealed a 30% and 27% reduction at Months 12 and 18, respectively, between ACP and sham, replicating FAF measurements from GATHER1. CONCLUSIONS The strong correlation between blue FAF and OCT measurements of GA area supports OCT as a reliable method to measure GA lesion area in clinical trials.
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Affiliation(s)
- Justis P Ehlers
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA.
| | - Conor McConville
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Sari Yordi
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Hasan Cetin
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Yavuz Cakir
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Gagan Kalra
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Reem Amine
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Jon Whitney
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Victoria Whitmore
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Michelle Bonnay
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Jamie Reese
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
| | - Julie Clark
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Liansheng Zhu
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Don Luo
- Iveric Bio, An Astellas Company (J.C., L.Z., D.L.), Parsippany-Troy Hills, New Jersey, USA
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University (G.J.J.), Durham, North Carolina, USA
| | - Sunil K Srivastava
- From The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA; Cole Eye Institute, Cleveland Clinic (J.P.E., C.M., S.Y., H.C., Y.C., G.K., R.A., J.W., V.W., M.B., J.R., S.K.S.), Cleveland, Ohio, USA
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Novotny J, Laidlaw DH. Evaluating Text Reading Speed in VR Scenes and 3D Particle Visualizations. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:2602-2612. [PMID: 38437104 DOI: 10.1109/tvcg.2024.3372093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
This work reports how text size and other rendering conditions affect reading speeds in a virtual reality environment and a scientific data analysis application. Displaying text legibly yet space-efficiently is a challenging problem in immersive displays. Effective text displays that enable users to read at their maximum speed must consider the variety of virtual reality (VR) display hardware and possible visual exploration tasks. We investigate how text size and display parameters affect reading speed and legibility in three state-of-the-art VR displays: two head-mounted displays and one CAVE. In our perception experiments, we establish limits where reading speed declines as the text size approaches the so-called critical print sizes (CPS) of individual displays, which can inform the design of uniform reading experiences across different VR systems. We observe an inverse correlation between display resolution and CPS. Yet, even in high-fidelity VR systems, the measured CPS was larger than in comparable physical text displays, highlighting the value of increased VR display resolutions in certain visualization scenarios. Our findings indicate that CPS can be an effective metric for evaluating VR display usability. Additionally, we evaluate the effects of text panel placement, orientation, and occlusion-reducing rendering methods on reading speeds in generic volumetric particle visualizations. Our study provides insights into the trade-off between text representation and legibility in cluttered immersive environments with specific suggestions for visualization designers and highlight areas for further research.
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Elliott DB. Red flags in submissions to Optometry and Vision Science. Optom Vis Sci 2024; 101:173-175. [PMID: 38684058 DOI: 10.1097/opx.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
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Atchison DA, Lal B, Schmid KL, Romeo B, Carkeet A. Vision screening using the Acuidrive device. Clin Exp Optom 2024:1-6. [PMID: 38350442 DOI: 10.1080/08164622.2023.2255867] [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: 07/30/2023] [Accepted: 09/01/2023] [Indexed: 02/15/2024] Open
Abstract
CLINICAL RELEVANCE Understanding devices used for vision screening, including their potential utilisation and validity, will facilitate proper utilisation of this technology. BACKGROUND The Acuidrive is a self-illuminated, hand-held, visual acuity screening device intended for use in policing, with visual acuity assessed roadside to identify drivers who may not meet vision standards for driving. The target is presented binocularly at 24 cm, and +4.00 D lenses eliminate the accommodation requirement. This study investigates its validity and applicability relative to the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. METHODS There were 36 participants, half younger adults aged 18-30 years and half older adults aged 50-70 years. The subjects underwent binocular visual acuity testing using the Acuidrive device and an ETDRS chart displayed on a monitor. Eyes were corrected for distance using lenses in a trial frame, and additional trial lenses provided four blur levels: zero, +0.50 DS, +1.00 DS and +1.50 DS. Luminances for the devices were similar at approximately 100 cd/m2. ETDRS chart measurements were conducted both with room lighting on and off. RESULTS The Acuidrive device underestimated the ETDRS visual acuity across all blur levels, with mean differences of 0.24 ± 0.07 logMAR and 0.18 ± 0.10 logMAR for room lights on and off, respectively. To predict ETDRS visual acuity of poorer than 0.34 logMAR (6/12=), a screening level of 0.50 logMAR (6/19) with the Acuidrive device provided high sensitivity and specificity (86% and 79% with lights-on, and 85% and 78% with lights-off). Visual acuity was better for the older group than the younger group by approximately 0.10 logMAR. CONCLUSION There was an offset of 0.2 logMAR (two lines) between visual acuity measures for the Acuidrive device and an ETDRS chart. The Acuidrive device has the potential to be a viable screening tool with refinement to its construction.
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Affiliation(s)
- David A Atchison
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Barsha Lal
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Katrina L Schmid
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bianca Romeo
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Andrew Carkeet
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Nandzik M, Wylęgała E, Wylęgała A, Szkodny D, Roszkowska AM, Wróblewska-Czajka E. Visual Acuity Examination Methodology in Keratoconus. J Clin Med 2023; 12:7620. [PMID: 38137688 PMCID: PMC10743794 DOI: 10.3390/jcm12247620] [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: 10/04/2023] [Revised: 11/18/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Visual acuity is one of the most important parameters for evaluating the vision of patients with keratoconus. This study reviewed 295 articles related to keratoconus published between 2017 and 2022 in which visual acuity was one of the parameters measured. The methodology of visual acuity testing in studies on keratoconus was thoroughly analyzed. The analysis showed that the most commonly indicated chart for testing visual acuity papers on keratoconus is the Snellen chart. It was shown that in 150 out of 295 articles, the authors do not describe the methodology for testing visual acuity. What is more, it was also shown that in 68 of the 295 articles which were analyzed, a procedure for converting visual acuity tested with a Snellen chart into a logMAR scale was used. In this review, we discuss the validity and reliability of such conversions. In particular, we show that insufficient description of visual acuity testing methodology and lack of information on the conversion of visual acuity results into the logMAR scale may contribute to the misinterpretation of visual acuity test results.
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Affiliation(s)
- Magdalena Nandzik
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
| | - Edward Wylęgała
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
| | - Dominika Szkodny
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
| | - Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, 98100 Messina, Italy
| | - Ewa Wróblewska-Czajka
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, 40-760 Katowice, Poland
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Torrellas B, Filloy A, Wu L, Chhablani J, Romero-Aroca P. Reply to Fernandez-Vigo et al. Comment on "Torrellas et al. Effectiveness, Safety and Choroidal Changes of a Fovea-Sparing Technique for the Treatment of Chronic Central Serous Chorioretinopathy with Yellow Subthreshold Laser. J. Clin. Med. 2023, 12, 1127". J Clin Med 2023; 12:5440. [PMID: 37685507 PMCID: PMC10488286 DOI: 10.3390/jcm12175440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
We thank the comment written by Fernández-Vigo et al. [...].
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Affiliation(s)
- Beatriz Torrellas
- Ophtalmology Department, Joan XXIII University Hospital, 43007 Tarragona, Spain
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira & Virgili University, 43204 Reus, Spain
| | - Alejandro Filloy
- Ophtalmology Department, Joan XXIII University Hospital, 43007 Tarragona, Spain
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira & Virgili University, 43204 Reus, Spain
- Clínica Oftalmològica de Tarragona (COT), 43001 Tarragona, Spain
| | - Lihteh Wu
- Asociados de Mácula, Vítreo y Retina de Costa Rica, San José 10102, Costa Rica
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Pedro Romero-Aroca
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira & Virgili University, 43204 Reus, Spain
- Ophthalmology Department, University Hospital Sant Joan de Reus, 43204 Reus, Spain
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Pant R, Ossandón J, Stange L, Shareef I, Kekunnaya R, Röder B. Stimulus-evoked and resting-state alpha oscillations show a linked dependence on patterned visual experience for development. Neuroimage Clin 2023; 38:103375. [PMID: 36963312 PMCID: PMC10064270 DOI: 10.1016/j.nicl.2023.103375] [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: 11/26/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
Persistent visual impairments after congenital blindness due to dense bilateral cataracts have been attributed to altered visual cortex development within a sensitive period. Occipital alpha (8-14 Hz) oscillations were found to be reduced after congenital cataract reversal, while participants performed visual motion tasks. However, it has been unclear whether reduced alpha oscillations were task-specific, or linked to impaired visual behavior in cataract-reversed individuals. Here, we compared resting-state and stimulus-evoked alpha activity between individuals who had been treated for dense bilateral congenital cataracts (CC, n = 13, mean duration of blindness = 11.0 years) and age-matched, normally sighted individuals (SC, n = 13). We employed the visual impulse response function, adapted from VanRullen and MacDonald (2012), to test for the characteristic alpha response to visual white noise. Participants observed white noise stimuli changing in luminance with equal power at frequencies between 0 and 30 Hz. Compared to SC individuals, CC individuals demonstrated a reduced likelihood of exhibiting an evoked alpha response. Moreover, stimulus-evoked alpha power was reduced and correlated with a corresponding reduction of resting-state alpha power in the same CC individuals. Finally, CC individuals with an above-threshold evoked alpha peak had better visual acuity than CC individual without an evoked alpha peak. Since alpha oscillations have been linked to feedback communication, we suggest that the concurrent impairment in resting-state and stimulus-evoked alpha oscillations indicates an altered interaction of top-down and bottom-up processing in the visual hierarchy, which likely contributes to incomplete behavioral recovery in individuals who experienced transient congenital blindness.
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Affiliation(s)
- Rashi Pant
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany.
| | - José Ossandón
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany
| | - Liesa Stange
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany
| | - Idris Shareef
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, 500034 Hyderabad, India; Department of Psychology, University of Nevada, 1664 N Virginia St, Reno, NV 89557, United States
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, LV Prasad Eye Institute, 500034 Hyderabad, India
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, University of Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany
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Bi H, Abrham Y, Butler PD, Hu B, Keane BP. When do contrast sensitivity deficits (or enhancements) depend on spatial frequency? Two ways to avoid spurious interactions. Eur J Neurosci 2023; 57:351-359. [PMID: 36504242 DOI: 10.1111/ejn.15887] [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: 09/28/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Studies across a broad range of disciplines-from psychiatry to cognitive science to behavioural neuroscience-have reported on whether the magnitude of contrast sensitivity alterations in one group or condition varies with spatial frequency. Significant interactions have often gone unexplained or have been used to argue for impairments in specific processing streams. Here, we show that interactions with spatial frequency may need to be re-evaluated if the inherent skew/heteroscedasticity was not taken into account or if visual acuity could plausibly differ across groups or conditions. By re-analysing a publicly available data set, we show that-when using raw contrast sensitivity data-schizophrenia patients exhibit an apparent contrast sensitivity impairment that lessens with spatial frequency, but that when using log-transformed data or when using generalized estimating equations, this interaction reversed. The reversed interaction, but not the overall contrast sensitivity deficit, disappeared when groups were matched on visual acuity. An analysis of the contrast threshold data yielded similar results. A caveat is that matching groups on acuity is probably only defensible if acuity differences arise from non-neural factors such as optical blur. Taken together, these analyses reconcile seemingly discrepant findings in the literature and demonstrate that reporting contrast sensitivity interactions with spatial frequency requires properly accounting for visual acuity and skew/heteroscedasticity.
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Affiliation(s)
- Howard Bi
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Yonatan Abrham
- Center for Visual Science, University of Rochester, Rochester, New York, USA
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York, USA
| | - Pamela D Butler
- Clinical Science Division, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Boyang Hu
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York, USA
| | - Brian P Keane
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- Center for Visual Science, University of Rochester, Rochester, New York, USA
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA
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Romano D, Bremond-Gignac D, Barbany M, Rahman A, Mauring L, Semeraro F, Cursiefen C, Lagali N, Romano V. Artificial iris implantation in congenital aniridia A systematic review. Surv Ophthalmol 2022:S0039-6257(22)00152-7. [PMID: 36379301 DOI: 10.1016/j.survophthal.2022.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Congenital aniridia is a rare, panocular disorder with a main phenotypic characteristic of a partial or complete absence of the iris existing alongside other ocular morbidities such as cataract, keratopathy, optic nerve and foveal hypoplasia, and nystagmus. The iris abnormality, however, often leads to symptoms such as photophobia, glare, and decreased visual acuity, as well as cosmetic dissatisfaction. Current management options for the iris deficit include colored iris contact lenses, corneal tattooing, and tinted contact lenses. Symptoms arising from small iris defects can be resolved with surgical management using micro-tying suture techniques such as McCannel or Siepser. Currently, larger iris defects can be treated with artificial iris implants. New prosthetic options range from colored intraocular lenses to flexible custom-made silicone iris implants. With a range of therapeutic options available and given the challenges of multiple comorbidities in aniridia, we evaluate the literature relating to the use of artificial iris implants in congenital aniridia, with a focus on the different surgical implantation techniques, the clinical outcomes achieved, complications occurred, and risk of bias of the studies included.
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11
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Habitual visual acuity and visual acuity threshold demands in Nigerian school classrooms. Sci Rep 2022; 12:17816. [PMID: 36280771 PMCID: PMC9592605 DOI: 10.1038/s41598-022-21048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023] Open
Abstract
This study was designed to estimate the burden of blindness and vision impairment in school children, and to determine the proportion of students meeting the visual acuity (VA) demand for their classrooms. From 148 primary and secondary school classrooms in Edo State, Nigeria, the habitual distance and near VA of over 2000 students were measured. Values obtained were compared with the calculated distance VA demand and actual near VA demand for their classrooms. Measures used to calculate the VA demand were working distance and smallest text size on learning materials, at both distance and near. We also determined the relationship between age and calculated VA demand and the effect of factors such as school ownership and school type on the VA demand. Habitual distance vision impairment was found in 0.8% of pupils, including 2 (0.10%) who met the WHO criteria for blindness. The average VA demand at the furthest and nearest sitting position to the board was 0.21 ± 0.23 and 0.65 ± 0.33LogMAR, respectively. Near working distance of students ranged from 15.00 to 37.20 cm, and the near VA demand as well as actual near VA demand (using a 2.5 times acuity reserve) was 0.60 ± 0.17 and 0.20 ± 1.7LogMAR, respectively. LogMAR VA demand increased (size of print decreases) with increasing age, at both distance (r = - 0.549, p = 0.070) and near (r = - 0.921, p < 0.0001). The VA demand at maximum distance and the actual near VA demand differed significantly by school ownership and between primary and secondary schools. Most students had VA better, but up to 11% of students per class had VA poorer than their classroom demands. Although the majority of students had better VA than their classroom demands, for students with reduced vision, learning could be negatively impacted. It is important to continually screen students for vision impairment and ensure prompt referral and treatment. These findings have implications for managing vision problems in children, as well as enabling appropriate classroom arrangements for those with vision impairment.
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Junn S, Pharr C, Chen V, Williams K, Alexander J, Park HJ, Kraus C, Levin MR. Sensorimotor Outcomes in Pediatric Patients With Ocular Trauma in Baltimore. J Pediatr Ophthalmol Strabismus 2022; 59:303-309. [PMID: 35192378 DOI: 10.3928/01913913-20220126-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate sensorimotor outcomes following traumatic open globe injuries in the pediatric population. METHODS A retrospective cohort of 80 pediatric patients aged 0.4 to 17.7 years (mean age: 9.3 years, median age: 8.3 years) presenting with traumatic open globe injury to the Johns Hopkins and University of Maryland Medical Centers was evaluated between January 2006 and January 2020. Parameters included the mechanism of injury, length of time of visual deprivation, initial and final visual acuity, additional eye pathologies, and demographic factors such as age and sex. RESULTS Among children with more than 6 months of follow-up, 77.4% developed poor stereopsis and 50% developed strabismus. Children who developed strabismus had a lower Pediatric Ocular Trauma Score (POTS), indicating greater severity of injury, than children who did not develop strabismus (P = .005, chi-square test). A higher POTS, indicating less severe ocular injury, significantly correlated to a better stereoacuity (P = .001, chi-square test). CONCLUSIONS The findings indicate that strabismus and poor stereopsis are common in pediatric open globe injuries, occurring in more than half of children with pediatric open globe trauma. These outcomes are associated with poor presenting visual acuity, more severe ocular trauma, and a lower presenting POTS. [J Pediatr Ophthalmol & Strabismus. 2022;59(5):303-309.].
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Zhang X, Wang Y, Wang W, Hu W, Shang X, Liao H, Chen Y, Kiburg KV, Huang Y, Zhang X, Tang S, Yu H, Yang X, He M, Zhu Z. Association between dual sensory impairment and risk of mortality: a cohort study from the UK Biobank. BMC Geriatr 2022; 22:631. [PMID: 35915397 PMCID: PMC9341066 DOI: 10.1186/s12877-022-03322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Dual sensory impairment is affecting over 10% of older adults worldwide. However, the long-term effect of dual sensory impairment (DSI) on the risk of mortality remains controversial. We aim to investigate the impact of single or/and dual sensory impairment on the risk of mortality in a large population-based sample of the adult in the UK with 14-years of follow-up. METHODS This population-based prospective cohort study included participants aged 40 and over with complete records of visual and hearing functions from the UK Biobank study. Measurements of visual and hearing functions were performed at baseline examinations between 2006 and 2010, and data on mortality was obtained by 2021. Dual sensory impairment was defined as concurrent visual and hearing impairments. Cox proportional hazards regression models were employed to evaluate the impact of sensory impairment (dual sensory impairment, single visual or hearing impairment) on the hazard of mortality. RESULTS Of the 113,563 participants included in this study, the mean age (standard deviation) was 56.8 (8.09) years, and 61,849 (54.5%) were female. At baseline measurements, there were 733 (0.65%) participants with dual sensory impairment, 2,973 (2.62%) participants with single visual impairment, and 13,560 (11.94%) with single hearing impairment. After a follow-up period of 14 years (mean duration of 11 years), 5,992 (5.28%) participants died from all causes. Compared with no sensory impairment, dual sensory impairment was significantly associated with an estimated 44% higher hazard of mortality (hazard ratio: 1.44 [95% confidence interval, 1.11-1.88], p = 0.007) after multiple adjustments. CONCLUSIONS Individuals with dual sensory impairment were found to have an independently 44% higher hazard of mortality than those with neither sensory impairment. Timely intervention of sensory impairment and early prevention of its underlying causes should help to reduce the associated risk of mortality.
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Affiliation(s)
- Xinyu Zhang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
| | - Yueye Wang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wenyi Hu
- Centre for Eye Research, University of Melbourne, East Melbourne, Victoria, Australia
| | - Xianwen Shang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Huan Liao
- Neural Regeneration Group, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katerina V Kiburg
- Centre for Eye Research, University of Melbourne, East Melbourne, Victoria, Australia
| | - Yu Huang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shulin Tang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.
| | - Mingguang He
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. .,Centre for Eye Research, University of Melbourne, East Melbourne, Victoria, Australia.
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. .,Centre for Eye Research, University of Melbourne, East Melbourne, Victoria, Australia.
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Okada K, Zhou Y, Hashida N, Takagi T, Tian YS. The efficacy of Golimumab against non-infectious uveitis: a PRISMA-compliant systematic review and meta-analysis. Ocul Immunol Inflamm 2022:1-11. [PMID: 35771679 DOI: 10.1080/09273948.2022.2081584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE In this PRISMA-compliant systematic review and meta-analysis, we aimed to assess the efficacy of golimumab (GOL) against non-infectious uveitis (NIU). METHODS We included eight articles in the meta-analysis. The primary outcome was inflammation remission. Secondary outcomes were changes in the number of uveitis relapses/attacks, mean best-corrected visual acuity, central macular thickness, and systemic corticosteroid-sparing effects. RESULTS In total, eight case series with 172 patients (43.6% female) were collected. Patients had 75% (95% CI: 56-87%) of remission; 42% (0.12-0.80) of patients showed improved visual acuity. The average central macular thickness decline was 38 μm (-56.51-18.54). The pooled results showed a significant decrease in the use of systemic corticosteroids. CONCLUSION This study was limited by the use of non-RCT designs, limited sample sizes for outcomes, and heterogenetic underlying diseases. Our results suggest that GOL is effective against NIU. However, further evidence and analyses are required. (Funding: None; PROSPERO registration: CRD42021266214.).
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Affiliation(s)
- Katsuya Okada
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.,Quality Assurance Department, Nippon Ciba Geigy Co, Hyogo, Japan
| | - Yi Zhou
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Tatsuya Takagi
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Yu-Shi Tian
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
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Corneal Neurotization: A Meta-analysis of Outcomes and Patient Selection Factors. Ann Plast Surg 2022; 88:687-694. [PMID: 35502965 DOI: 10.1097/sap.0000000000003117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corneal neurotization describes reinnervation of the anesthetic or severely hypoesthetic cornea with a healthy local nerve or graft. Preliminary evidence has shown corneal neurotization to improve corneal sensation, visual acuity, and ocular surface health. Factors that improve patient selection and lead to better neurotization outcomes have yet to be elucidated, limiting ability to optimize perioperative decision-making guidelines. METHODS A systematic review with meta-analysis was performed of the MEDLINE and Embase databases using variations of "corneal," "nerve transfer," "neurotization," and "neurotization." The primary outcomes of interest were corrected visual acuity, NK Mackie stage, and central corneal sensation. Regression analyses were performed to identify the effects of surgical technique, duration of denervation, patient age, and etiology of corneal pathology on neurotization outcomes. RESULTS Seventeen studies were included. Corneal neurotization resulted in significant improvement in NK Mackie stage (0.84 vs 2.46, P < 0.001), visual acuity (logarithm of minimum angle of resolution scale: 0.98 vs 1.36, P < 0.001), and corneal sensation (44.5 vs 0.7, P < 0.001). Nerve grafting was associated with greater corneal sensation improvement than nerve transfer (47.7 ± 16.0 vs 35.4 ± 18.76, P = 0.03). Denervation duration was predictive of preneurotization visual acuity (logarithm of minimum angle of resolution scale; R2 = 0.25, P = 0.001), and older age (ß = 0.30, P = 0.03) and acquired etiology (ß = 0.30, P = 0.03) were predictive of improved visual acuity. CONCLUSIONS Corneal neurotization provides significant clinical improvement in visual acuity, NK Mackie staging, and corneal sensation in patients who experience NK. Both nerve grafting and nerve transfer are likely to yield similar levels of benefit and ideally should be performed early to limit denervation time.
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Seeböck P, Vogl WD, Waldstein SM, Orlando JI, Baratsits M, Alten T, Arikan M, Mylonas G, Bogunović H, Schmidt-Erfurth U. Linking Function and Structure with ReSensNet: Predicting Retinal Sensitivity from OCT using Deep Learning. Ophthalmol Retina 2022; 6:501-511. [PMID: 35134543 DOI: 10.1016/j.oret.2022.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The currently used measures of retinal function are limited by being subjective, nonlocalized, or taxing for patients. To address these limitations, we sought to develop and evaluate a deep learning (DL) method to automatically predict the functional end point (retinal sensitivity) based on structural OCT images. DESIGN Retrospective, cross-sectional study. SUBJECTS In total, 714 volumes of 289 patients were used in this study. METHODS A DL algorithm was developed to automatically predict a comprehensive retinal sensitivity map from an OCT volume. Four hundred sixty-three spectral-domain OCT volumes from 174 patients and their corresponding microperimetry examinations (Nidek MP-1) were used for development and internal validation, with a total of 15 563 retinal sensitivity measurements. The patients presented with a healthy macula, early or intermediate age-related macular degeneration, choroidal neovascularization, or geographic atrophy. In addition, an external validation was performed using 251 volumes of 115 patients, comprising 3 different patient populations: those with diabetic macular edema, retinal vein occlusion, or epiretinal membrane. MAIN OUTCOME MEASURES We evaluated the performance of the algorithm using the mean absolute error (MAE), limits of agreement (LoA), and correlation coefficients of point-wise sensitivity (PWS) and mean sensitivity (MS). RESULTS The algorithm achieved an MAE of 2.34 dB and 1.30 dB, an LoA of 5.70 and 3.07, a Pearson correlation coefficient of 0.66 and 0.84, and a Spearman correlation coefficient of 0.68 and 0.83 for PWS and MS, respectively. In the external test set, the method achieved an MAE of 2.73 dB and 1.66 dB for PWS and MS, respectively. CONCLUSIONS The proposed approach allows the prediction of retinal function at each measured location directly based on an OCT scan, demonstrating how structural imaging can serve as a surrogate of visual function. Prospectively, the approach may help to complement retinal function measures, explore the association between image-based information and retinal functionality, improve disease progression monitoring, and provide objective surrogate measures for future clinical trials.
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Affiliation(s)
- Philipp Seeböck
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Vogl
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sebastian M Waldstein
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Jose Ignacio Orlando
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Yatiris Group, PLADEMA Institute, UNICEN, CONICET, Tandil, Argentina
| | - Magdalena Baratsits
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Alten
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Mustafa Arikan
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunović
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria.
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17
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Shah K, Eghrari AO, Vanner EA, O'Brien TP, Koo EH. Scheimpflug Corneal Densitometry Values and Severity of Guttae in Relation to Visual Acuity in Fuchs Endothelial Corneal Dystrophy. Cornea 2022; 41:692-698. [PMID: 35175018 PMCID: PMC8857507 DOI: 10.1097/ico.0000000000002762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association between corneal densitometry (CD) values from Scheimpflug tomography imaging, severity of guttae, and visual acuity in eyes with Fuchs endothelial corneal dystrophy (FECD). METHODS This was a retrospective, cross-sectional study. Patients with FECD were examined at the Bascom Palmer Eye Institute from January 2015 to September 2019. We extracted CD values at central annuli of 0-2, 2-6, 6-10 and 10-12 mm from Scheimpflug tomography images. We investigated the association of corrected distance visual acuity (CDVA) with CD values, severity of guttae, central corneal thickness (CCT), cataract grade, refractive error, corneal edema grade, age, and gender using multivariate generalized estimating equation regression models. RESULTS One hundred ninety-two eyes from 110 patients were included in this study. Increase in central CD values at the 0 to 2 mm zone (P < 0.001), severity of guttae (P = 0.046), age (P < 0.001), cataract grade (P < 0.001), corneal edema grade (P < 0.001), and type of refractive error (P = 0.008) were significantly associated with decreased CDVA. Central corneal thickness, sex, and the peripheral CD values (2-6, 6-10, and 10-12 mm) were not significantly associated with CDVA (P > 0.05) in the final multivariate regression model. CONCLUSIONS Our study demonstrates that central CD values at 0 to 2 mm and severity of guttae are each associated with decreased CDVA in FECD. These findings carry implications for patients with FECD considering surgical intervention for phacoemulsification alone, Descemet stripping only, or endothelial cell transplantation and provide a multifactorial perspective on vision loss in FECD.
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Affiliation(s)
- Khushali Shah
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Allen O Eghrari
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Terrence P O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Ellen H Koo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
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18
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Rosenfield M. Pharmacological treatment of presbyopia. Ophthalmic Physiol Opt 2022; 42:663-665. [DOI: 10.1111/opo.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Yao J, Peng Q, Li Y, Liang A, Xie J, Zhuang X, Chen R, Chen Y, Wang Z, Zhang L, Cao D. Clinical Relevance of Body Fluid Volume Status in Diabetic Patients With Macular Edema. Front Med (Lausanne) 2022; 9:857532. [PMID: 35492357 PMCID: PMC9039394 DOI: 10.3389/fmed.2022.857532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate body fluid status in diabetic macular edema (DME) patients and the extent to which it is affected by renal function. METHODS One hundred and thirty-two eyes from 132 patients with diabetes mellitus (DM) were prospectively collected in this cross-sectional, observational study. Thirty-five were DM patients without diabetic retinopathy (DR), 31 were DR patients without DME, and 66 were DME patients. The fluid status of each participant was quantified with extracellular water-to-total body water ratio (ECW/TBW) using a body composition monitor. Central subfield thickness (CST) and macular volume (MV) were obtained using optical coherence tomography (OCT). Urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and albumin was obtained using serum and urine laboratory data. RESULTS ECW/TBW was significantly increased in DME patients (39.2 ± 0.9, %) compared to DM (38.1 ± 0.7, %, P = 0.003) and DR patients without DME (38.7 ± 0.9, %, P < 0.001). In multilinear regression, fluid overload was positively related to DME and UACR (DME vs. DM: β = 2.418, P < 0.001; DME vs. DR: β = 1.641, P = 0.001; UACR, per 102, β = 1.017, P = 0.01). In the binary logistic regression for DME risk, the area under the receiver operating characteristic curve (AUROC) increased significantly by adding ECW/TBW along with UACR and age (AUC: 0.826 vs. 0.768). CONCLUSION DME patients had elevated body fluid volume independent of kidney functions. The assessment of extracellular fluid status may help in the management of DME.
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Affiliation(s)
- Jie Yao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Qingsheng Peng
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanhong Li
- Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Anyi Liang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianteng Xie
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuenan Zhuang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruoyu Chen
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
| | - Yesheng Chen
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zicheng Wang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- Southern Medical University, Guangzhou, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Southern Medical University, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Harbiyeli II, Gul Olke K, Erdem E, Yagmur M. Correction of moderate to high refractive astigmatism with extended range toric soft contact lenses in patients with different patterns of astigmatism. Ophthalmic Physiol Opt 2022; 42:807-813. [PMID: 35333414 DOI: 10.1111/opo.12980] [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: 08/20/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to evaluate the visual performance of extended range, toric soft contact lenses (TSCLs) in patients with keratoconus and moderate to high astigmatism with different astigmatic patterns. METHODS This was a retrospective, cross-sectional clinical study. Extended range TSCL users with astigmatism ≥3.0 D were included. Cases were categorised into three subgroups, namely regular, irregular (non-keratoconus) and keratoconic based on the topographic pattern of astigmatism. In addition, subjects were subdivided based on the degree of astigmatism. RESULTS Fifty five patients (82 eyes) were enrolled, of whom 28 (51%) were female. The mean age was 24.2 ± 7.5 (range: 8-41 years) years. Thirty-six eyes with regular astigmatism (43.9%), 34 eyes with irregular astigmatism (41.5%) and 12 eyes with keratoconus (14.6%) were included. The percentage improvement in visual acuity (VA) was significantly higher with contact lenses compared with spectacles in all groups (p < 0.001), with the highest improvement in subjects with keratoconus (p = 0.03). Twenty six (31.7%), 30 (36.6%) and 26 eyes (31.7%) had moderate (-3.0 to -4.24 D), moderate/high (-4.25 to -5.99 D) and high (≤-6.0 D) astigmatism, respectively. The percentage improvement in VA with contact lenses was statistically significantly higher than for spectacle wear in all groups (p < 0.001). CONCLUSIONS This study demonstrated that satisfactory visual outcomes can be obtained with extended range TSCLs in patients having moderate to high astigmatism with different astigmatic patterns.
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Affiliation(s)
| | - Kubra Gul Olke
- Department of Ophthalmology, Seyhan State Hospital, Adana, Turkey
| | - Elif Erdem
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Meltem Yagmur
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Gui H, Tseng B, Hu W, Wang SY. Looking for low vision: Predicting visual prognosis by fusing structured and free-text data from electronic health records. Int J Med Inform 2022; 159:104678. [PMID: 34999410 PMCID: PMC8792365 DOI: 10.1016/j.ijmedinf.2021.104678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Low vision rehabilitation improves quality-of-life for visually impaired patients, but referral rates fall short of national guidelines. Automatically identifying, from electronic health records (EHR), patients with poor visual prognosis could allow targeted referrals to low vision services. The purpose of this study was to build and evaluate deep learning models that integrate EHR data that is both structured and free-text to predict visual prognosis. METHODS We identified 5547 patients with low vision (defined as best documented visual acuity (VA) less than 20/40) on ≥ 1 encounter from EHR from 2009 to 2018, with ≥ 1 year of follow-up from the earliest date of low vision, who did not improve to greater than 20/40 over 1 year. Ophthalmology notes on or prior to the index date were extracted. Structured data available from the EHR included demographics, billing and procedure codes, medications, and exam findings including VA, intraocular pressure, corneal thickness, and refraction. To predict whether low vision patients would still have low vision a year later, we developed and compared deep learning models that used structured inputs and free-text progress notes. We compared three different representations of progress notes, including 1) using previously developed ophthalmology domain-specific word embeddings, and representing medical concepts from notes as 2) named entities represented by one-hot vectors and 3) named entities represented as embeddings. Standard performance metrics including area under the receiver operating curve (AUROC) and F1 score were evaluated on a held-out test set. RESULTS Among the 5547 low vision patients in our cohort, 40.7% (N = 2258) never improved to better than 20/40 over one year of follow-up. Our single-modality deep learning model based on structured inputs was able to predict low vision prognosis with AUROC of 80% and F1 score of 70%. Deep learning models utilizing named entity recognition achieved an AUROC of 79% and F1 score of 63%. Deep learning models further augmented with free-text inputs using domain-specific word embeddings, were able to achieve AUROC of 82% and F1 score of 69%, outperforming all single- and multiple-modality models representing text with biomedical concepts extracted through named entity recognition pipelines. DISCUSSION Free text progress notes within the EHR provide valuable information relevant to predicting patients' visual prognosis. We observed that representing free-text using domain-specific word embeddings led to better performance than representing free-text using extracted named entities. The incorporation of domain-specific embeddings improved the performance over structured models, suggesting that domain-specific text representations may be especially important to the performance of predictive models in highly subspecialized fields such as ophthalmology.
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Affiliation(s)
- Haiwen Gui
- Stanford University School of Medicine, Stanford, United States
| | - Benjamin Tseng
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States
| | - Wendeng Hu
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States
| | - Sophia Y Wang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, United States.
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22
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Defocus curves: Focusing on factors influencing assessment. J Cataract Refract Surg 2022; 48:961-968. [PMID: 35137697 DOI: 10.1097/j.jcrs.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Defocus curve assessment is used to emulate defocus over a range of distances and is a valuable tool that is used to differentiate the performance of presbyopia-correcting intraocular lenses. However, defocus curves are limited by a lack of standardization, and multiple factors can impact their generation and interpretation. This review discusses key factors that influence the assessment of defocus curves, including pupil size, level of contrast, sphere versus cylinder defocus, viewing distance, monocular versus binocular assessment, use of Snellen versus logarithm of the minimum angle of resolution charts, and diopter range and step size. There are also different methods to analyze defocus curves, including the direct comparison method, range-of-focus analysis, and area under the curve analysis, which can impact result interpretation. A good understanding of these factors and standardization of the methodology are important to ensure optimal cross-study comparisons.
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Refractive Outcomes after Cataract Surgery. Diagnostics (Basel) 2022; 12:diagnostics12020243. [PMID: 35204334 PMCID: PMC8870878 DOI: 10.3390/diagnostics12020243] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 01/19/2023] Open
Abstract
A post-operative manifest refractive error as close as possible to target is key when performing cataract surgery with intraocular lens (IOL) implantation, given that residual astigmatism and refractive errors negatively impact patients’ vision and satisfaction. This review explores refractive outcomes prior to modern biometry; advances in biometry and its impact on patients’ vision and refractive outcomes after cataract surgery; key factors that affect prediction accuracy; and residual refractive errors and the impact on visual outcomes. There are numerous pre-, intra-, and post-operative factors that can influence refractive outcomes after cataract surgery, leaving surgeons with a small “error budget” (i.e., the source and sum of all influencing factors). To mitigate these factors, precise measurement and correct application of ocular biometric data are required. With advances in optical biometry, prediction of patient post-operative refractory status has become more accurate, leading to an increased proportion of patients achieving their target refraction. Alongside improvements in biometry, advancements in microsurgical techniques, new IOL technologies, and enhancements to IOL power calculations have also positively impacted patients’ refractory status after cataract surgery.
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Bilateral visual acuity decline in males with choroideremia: a pooled, cross-sectional meta-analysis. BMC Ophthalmol 2022; 22:29. [PMID: 35034620 PMCID: PMC8762852 DOI: 10.1186/s12886-022-02250-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroideremia is a rare inherited retinal disease that leads to blindness. Visual acuity (VA) is a key outcome measure in choroideremia treatment studies, but VA decline rates change with age. An accurate understanding of the natural deterioration of VA in choroideremia is important to assess the treatment effect of new therapies in which VA is the primary outcome measure. We conducted a meta-analysis of data on individuals with choroideremia to determine the rate of VA deterioration between the better- and worse-seeing eye (BSE and WSE, respectively). METHODS Data were collected from the prospective Natural History of the Progression of Choroideremia (NIGHT) study (613 eyes, baseline data only), studies included in a recent meta-analysis, and studies identified in a targeted literature search performed on March 25, 2020, including individual best-corrected VA (BCVA) and age data in male individuals with choroideremia. Best-corrected VA decline rates (measured by logMAR units) by age and trends in BCVA decline rates in the BSE and WSE were evaluated. RESULTS: Data from 1037 males (1602 eyes; mean age, 41.8 years) were included. Before and after an age cutoff of 33.8 years, BCVA decline rates for the WSE were 0.0086 and 0.0219 logMAR per year, respectively. Before and after an age cutoff of 39.1 years, BCVA decline rates for the BSE were 0.00001 and 0.0203 logMAR per year, respectively. Differences in absolute BCVA and decline rates increased between the 2 eyes until age ~ 40; thereafter, differences in absolute BCVA and decline rates were similar between eyes. CONCLUSIONS Using the largest choroideremia data set to date, this analysis demonstrates accelerated BCVA decline beginning between 30 and 40 years of age. Disparate interocular progression rates were observed before the transition age, with similar interocular progression rates after the transition age.
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Teran E, Ramírez-Jaime R, Martínez-Gaytán C, Romo-García E, Costela FM. Refractive Error of Students (15- to 18-year-olds) in Northwest Mexico. Optom Vis Sci 2021; 98:1127-1131. [PMID: 34629438 DOI: 10.1097/opx.0000000000001779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE We assessed the prevalence of refractive error in a sample of children of Northern Mexico using the Refractive Error Study in Children protocol of the World Health Organization, which allows for the comparison with other global studies. PURPOSE Uncorrected refractive error is the main cause of visual impairment in children. The purpose of this study was to assess the refractive error and visual dysfunctions of students (15 to 18 years old) in the upper-middle school system of Sinaloa, Mexico. METHODS A total of 3468 students in Sinaloa's high school system participated in the study from 2017 to 2019. Optometrists and student clinicians from the Optometry Program of the Autonomous University of Sinaloa conducted the testing. Tests included visual acuities and static retinoscopy. We did not use a cycloplegic agent. RESULTS The results showed a high prevalence of uncorrected refractive errors. Myopia, defined as a refractive error ≤-0.50 D, had a prevalence of 36.11% (95% confidence interval, 33.47 to 38.83%); hyperopia, defined as a refractive error ≥+2.00 D, had a prevalence of 1.49% (95% confidence interval, 0.09 to 2.33%); and astigmatism, defined as a refractive error with a cylinder ≥0.75 D, had a prevalence of 29.17% (95% confidence interval, 26.60 to 31.76%). We found a significant effect of sex on visual acuity. CONCLUSIONS Our results are consistent with a high prevalence of myopia reported in adolescents worldwide and in Mexico's northern regions. The results suggest that students attending high school and entering universities should be required to have an optometric eye examination. Additional studies are needed to investigate the prevalence of refractive errors in children in Mexico.
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Affiliation(s)
| | - Rosalía Ramírez-Jaime
- Department of Optometry, Center for Research and Teaching in Health Sciences, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | - Carlos Martínez-Gaytán
- Department of Optometry, Center for Research and Teaching in Health Sciences, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | - Efrain Romo-García
- Department of Ophthalmology, Center for Research and Teaching in Health Sciences, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | - Francisco M Costela
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Lonial S, Nooka AK, Thulasi P, Badros AZ, Jeng BH, Callander NS, Potter HA, Sborov D, Zaugg BE, Popat R, Degli Esposti S, Byrne J, Opalinska J, Baron J, Piontek T, Gupta I, Dana R, Farooq AV, Colby K, Jakubowiak A. Management of belantamab mafodotin-associated corneal events in patients with relapsed or refractory multiple myeloma (RRMM). Blood Cancer J 2021; 11:103. [PMID: 34039952 PMCID: PMC8155129 DOI: 10.1038/s41408-021-00494-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022] Open
Abstract
Belantamab mafodotin (belamaf) demonstrated deep and durable responses in patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM) in DREAMM-2 (NCT03525678). Corneal events, specifically keratopathy (including superficial punctate keratopathy and/or microcyst-like epithelial changes (MECs), eye examination findings with/without symptoms), were common, consistent with reports from other antibody–drug conjugates. Given the novel nature of corneal events in RRMM management, guidelines are required for their prompt identification and appropriate management. Eye examination findings from DREAMM-2 and insights from hematology/oncology investigators and ophthalmologists, including corneal specialists, were collated and used to develop corneal event management guidelines. The following recommendations were formulated: close collaboration among hematologist/oncologists and eye care professionals is needed, in part, to provide optimal care in relation to the belamaf benefit–risk profile. Patients receiving belamaf should undergo eye examinations before and during every treatment cycle and promptly upon worsening of symptoms. Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity. Treatment decisions, including dose modifications, should be based on the most severe finding present. These guidelines are recommended for the assessment and management of belamaf-associated ocular events to help mitigate ocular risk and enable patients to continue to experience a clinical benefit with belamaf.
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Affiliation(s)
- Sagar Lonial
- Emory University, Winship Cancer Institute, Atlanta, GA, USA.
| | - Ajay K Nooka
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Ashraf Z Badros
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Douglas Sborov
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Brian E Zaugg
- Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Rakesh Popat
- University College London Hospitals, NHS Foundation Trust, London, UK
| | - Simona Degli Esposti
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | | | | | | | - Ira Gupta
- GlaxoSmithKline, Upper Providence, PA, USA
| | - Reza Dana
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Asim V Farooq
- University of Chicago Medical Center, Chicago, IL, USA
| | - Kathryn Colby
- New York University Grossman School of Medicine, New York, NY, USA
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Campo Dall'Orto G, Facchin A, Bellatorre A, Maffioletti S, Serio M. Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability. JOURNAL OF OPTOMETRY 2021; 14:133-141. [PMID: 33139229 PMCID: PMC8093539 DOI: 10.1016/j.optom.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Digital or computerised eye charts are becoming standard in the examination of visual acuity. Each instrument allows the selection of different optotypes, presentation modalities, and crowding. The aim of this study was to examine the differences in visual acuity (VA) measurement using a digital eye chart, comparing different optotypes and procedures, together with an evaluation of the repeatability of the measurement. METHODS Two groups of 52 participants aged between 18 and 31 years participated in the study. In the first experiment, VA thresholds were measured using LEA Symbols, Tumbling E, and Landolt Rings in monocular and binocular conditions using single line presentation and QUEST presentation. In the second experiment, we have compared all modalities of presentation together with a paper eye-chart and test the repeatability. RESULTS The results showed that thresholds for LEA Symbols are low. The modality of presentation affects these thresholds. For Landolt Rings and Tumbling E, the QUEST procedure gave significantly better thresholds than line presentation, while this difference was absent for LEA Symbols. In comparing all modalities of presentation, single letter and line presentation showed similar values, slightly better than block presentation. Paper eye-charts showed better values of VA. Repeatability and agreement were good for all presentations, but best for QUEST. CONCLUSIONS The QUEST modality of presentation provides a better threshold than line presentation except for LEA Symbols. Examiners using digital eye charts must take into account that not all modalities of presentation and optotypes are equivalent and give different VA thresholds. Specific thresholds need to be used for each optotype and presentation modality.
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Affiliation(s)
| | - Alessio Facchin
- Department of Psychology, University of Milano Bicocca, Milano, Italy; Optics and Optometry Research Center, University of Milano Bicocca, Milano, Italy; Institute of Research and Studies in Optics and Optometry, Vinci, Italy.
| | | | - Silvio Maffioletti
- Degree Course of Optics and Optometry, University of Torino, Italy; Institute of Research and Studies in Optics and Optometry, Vinci, Italy
| | - Marina Serio
- Degree Course of Optics and Optometry, University of Torino, Italy; Department of Physics, University of Torino, Italy
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Ferdi A, Nguyen V, Kandel H, Tan JCK, Arnalich-Montiel F, Abbondanza M, Watson S. Predictors of progression in untreated keratoconus: a Save Sight Keratoconus Registry study. Br J Ophthalmol 2021; 106:1206-1211. [PMID: 33785509 DOI: 10.1136/bjophthalmol-2020-317547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/08/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
AIMS We set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy. METHODS Patients were divided into 'progressors' and 'stable' patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression. RESULTS There were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA; p<0.001) and steeper baseline Max-K (HR 1.07 per 1D increase; p<0.001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older; p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT; p<0.001), (HR 1.03 per 1D increase; p=0.02) and (HR 0.98 per year younger; p=0.01), respectively. CONCLUSIONS Steeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.
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Affiliation(s)
- Alex Ferdi
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Himal Kandel
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
| | - Jeremy C K Tan
- Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | | | - Stephanie Watson
- The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
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Cheung CMG, Pearce E, Fenner B, Sen P, Chong V, Sivaprasad S. Looking Ahead: Visual and Anatomical Endpoints in Future Trials of Diabetic Macular Ischemia. Ophthalmologica 2021; 244:451-464. [PMID: 33626529 DOI: 10.1159/000515406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
Diabetic macular ischemia (DMI) is a common complication of diabetic retinopathy that can lead to progressive and irreversible visual loss. Despite substantial clinical burden, there are no treatments for DMI, no validated clinical trial endpoints, and few clinical trials focusing on DMI. Therefore, generating consensus on validated endpoints that can be used in DMI for the development of effective interventions is vital. In this review, we discuss potential endpoints appropriate for use in clinical trials of DMI, and consider the data required to establish acceptable and meaningful endpoints. A combination of anatomical, functional, and patient-reported outcome measures will provide the most complete picture of changes that occur during the progression of DMI. Potential endpoint measures include change in size of the foveal avascular zone measured by optical coherence tomography angiography and change over time in best-corrected visual acuity. However, these endpoints must be supported by further research. We also recommend studies to investigate the natural history and progression of DMI. In addition to improving understanding of how patient demographics and comorbidities such as diabetic macular edema affect clinical trial endpoints, these studies would help to build the consensus definition of DMI that is currently missing from clinical practice and research.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Elizabeth Pearce
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Beau Fenner
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Piyali Sen
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
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Rosenfield M. Editorial: I'm done with 2020. Ophthalmic Physiol Opt 2020; 41:1-2. [PMID: 33222228 DOI: 10.1111/opo.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maaswinkel IM, van der Aa HPA, van Rens GHMB, Beekman ATF, Twisk JWR, van Nispen RMA. Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study. BMC Psychiatry 2020; 20:461. [PMID: 32972387 PMCID: PMC7513319 DOI: 10.1186/s12888-020-02853-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less 'in control' and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment have only marginally been investigated. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health. METHODS A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA), collected between 2001 and 2012. A community-based population of 2599 older adults were included, who were randomly selected from population registers. Outcomes of interest were the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies - Depression scale and the Hospital Anxiety Depression Scale - Anxiety subscale. Linear mixed models were used to establish the association between visual acuity and mental health over time. RESULTS Mean age was 72 years, 56% was female and 1.2% qualified as having low vision. Visual impairment was associated with a lower sense of mastery (β = - 0.477, p < 0.001), lower self-esteem (β = - 0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated by self-esteem (25%) and sense of mastery (79%). CONCLUSIONS Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.
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Affiliation(s)
- I. M. Maaswinkel
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - H. P. A. van der Aa
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.414480.d0000 0004 0409 6003Elkerliek Hospital, Ophthalmology, Helmond, The Netherlands
| | - A. T. F. Beekman
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, The Netherlands
| | - J. W. R. Twisk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Espensen CA, Kiilgaard JF, Appelt AL, Fog LS, Herault J, Maschi C, Caujolle JP, Thariat J. Dose-Response and Normal Tissue Complication Probabilities after Proton Therapy for Choroidal Melanoma. Ophthalmology 2020; 128:152-161. [PMID: 32574763 DOI: 10.1016/j.ophtha.2020.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Normal tissue complication probability (NTCP) models could aid the understanding of dose dependence of radiation-induced toxicities after eye-preserving radiotherapy of choroidal melanomas. We performed NTCP-modeling and established dose-response relationships for visual acuity (VA) deterioration and common late complications after treatments with proton therapy (PT). DESIGN Retrospective study from single, large referral center. PARTICIPANTS We considered patients from Nice, France, diagnosed with choroidal melanoma and treated primarily with hypofractionated PT (52 Gy physical dose in 4 fractions). Complete VA deterioration information was available for 1020 patients, and complete information on late complications was available for 991 patients. METHODS Treatment details, dose-volume histograms (DVHs) for relevant anatomic structures, and patient and tumor characteristics were available from a dedicated ocular database. Least absolute shrinkage and selection operator (LASSO) variable selection was used to identify variables with the strongest impact on each end point, followed by multivariate Cox regressions and logistic regressions to analyze the relationships among dose, clinical characteristics, and clinical outcomes. MAIN OUTCOME MEASURES Dose-response relationship for VA deterioration and late complications. RESULTS Dose metrics for several structures (i.e., optic disc, macula, retina, globe, lens, ciliary body) correlated with clinical outcome. The near-maximum dose to the macula showed the strongest correlation with VA deterioration. The near-maximum dose to the retina was the only variable with clear impact on the risk of maculopathy, the dose to 20% of the optic disc had the largest impact on optic neuropathy, dose to 20% of cornea had the largest impact on neovascular glaucoma, and dose to 20% of the ciliary body had the largest impact on ocular hypertension. The volume of the ciliary body receiving 26 Gy was the only variable associated with the risk of cataract, and the volume of retina receiving 52 Gy was associated with the risk of retinal detachment. Optic disc-to-tumor distance was the only variable associated with dry eye syndrome in the absence of DVH for the lachrymal gland. CONCLUSIONS VA deterioration and specific late complications demonstrated dependence on dose delivered to normal structures in the eye after PT for choroidal melanoma. VA deterioration depended on dose to a range of structures, whereas more specific complications were related to dose metrics for specific structures.
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Affiliation(s)
- Charlotte A Espensen
- Department of Oncology, Section of Radiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens F Kiilgaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Ane L Appelt
- Leeds Institute of Medical Research at St. James's, University of Leeds, and Leeds Cancer Centre, St. James's University Hospital, Leeds, United Kingdom
| | - Lotte S Fog
- Department of Physical Sciences, The Peter MacCallum Cancer Centre, Melbourne, Australia; Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
| | - Joel Herault
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, Nice University Hospital, Nice, France
| | | | - Juliette Thariat
- Department of Radiation Oncology, Centre Francois Baclesse, Caen, France; Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN, Caen, France; University of Caen Normandy, Caen, France
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Wolff B, Macioce V, Vasseur V, Castelnovo L, Michel G, Nguyen V, Daien V, Mauget‐Faÿsse M, Gillies M. Ten‐year outcomes of anti‐vascular endothelial growth factor treatment for neovascular age‐related macular disease: A single‐centre French study. Clin Exp Ophthalmol 2020; 48:636-643. [DOI: 10.1111/ceo.13742] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Valerie Macioce
- Clinical Research and Epidemiology Unit CHU Montpellier, University of Montpellier Montpellier France
| | - Vivien Vasseur
- Maison Rouge Ophthalmologic Centre Strasbourg France
- Research Department Rothschild Foundation Paris France
| | | | | | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School The University of Sydney Sydney Australia
| | - Vincent Daien
- Department of Ophthalmology Gui de Chauliac Hospital Montpellier France
- Inserm, U1061 Montpellier France
| | | | - Mark Gillies
- The Save Sight Institute, Sydney Medical School The University of Sydney Sydney Australia
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Stulova AN, Semenova NS, Akopyan VS. [Visual acuity assessment: historical overview and current trends]. Vestn Oftalmol 2020; 135:141-146. [PMID: 32015319 DOI: 10.17116/oftalma2019135061141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article reviews the evolution of visual acuity assessment and gives comparison of the visual acuity charts (Snellen vs. ETDRS) widely used in research and clinical practice.
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Affiliation(s)
- A N Stulova
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27/1 Lomonosov Av., Moscow, Russian Federation, 119991
| | - N S Semenova
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27/1 Lomonosov Av., Moscow, Russian Federation, 119991
| | - V S Akopyan
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, 27/1 Lomonosov Av., Moscow, Russian Federation, 119991
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Jolly J, Wagner S, Martus P, MacLaren R, Wilhelm B, Webster A, Downes S, Charbel Issa P, Kellner U, Jägle H, Rüther K, Bertelsen M, Bragadóttir R, Prener Holtan J, van den Born L, Sodi A, Virgili G, Gosheva M, Pach J, Zündorf I, Zrenner E, Gekeler F. Transcorneal Electrical Stimulation for the Treatment of Retinitis Pigmentosa: A Multicenter Safety Study of the OkuStim® System (TESOLA-Study). Ophthalmic Res 2019; 63:234-243. [DOI: 10.1159/000505001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/24/2019] [Indexed: 11/19/2022]
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Elliott DB. How to get your paper published in OPO. Ophthalmic Physiol Opt 2019; 39:313-315. [PMID: 31506981 DOI: 10.1111/opo.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David B Elliott
- School of Optometry & Vision Science, University of Bradford, Bradford, UK
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Bunce C, Stratton IM, Elders A, Czanner G, Doré C, Freemantle N. Ophthalmic statistics note 13: method agreement studies in ophthalmology-please don't carry on correlating…. Br J Ophthalmol 2019; 103:1201-1203. [PMID: 31320382 PMCID: PMC6709765 DOI: 10.1136/bjophthalmol-2018-313759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Catey Bunce
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK
| | | | - Andrew Elders
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gabriela Czanner
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Caroline Doré
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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Radner W, Benesch T. Age-related course of visual acuity obtained with ETDRS 2000 charts in persons with healthy eyes. Graefes Arch Clin Exp Ophthalmol 2019; 257:1295-1301. [PMID: 30989362 DOI: 10.1007/s00417-019-04320-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/25/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the age-related course of best-corrected visual acuity in healthy eyes. METHODS Two hundred participants (400 eyes) 25 to 74 years of age (114 females, 86 males) were investigated, 20 per 5-year age group. Best-corrected visual acuity was measured monocularly with the ETDRS 2000 charts at a distance of 4 m (Precision Vision, Woodstock, IL, USA). Strict exclusion and termination criteria were used. RESULTS Visual acuity did not change between ages 25 and 54 years (mean of the better eyes, - 0.18 ± 0.05 logMAR). A significant age-related break-point in visual acuity was found at the ages of 55-59 years. For all age groups, the overall mean visual acuity was - 0.15 ± 0.06 logMAR for the better eyes and - 0.13 ± 0.06 logMAR for the worse eyes. There was no difference between the right and left eyes (- 0.14 ± 0.06 logMAR). The visual acuity was better in the right eye in 29% (n = 58) of the participants, better in the left eye in 32% (n = 64), and the same in both eyes in 39% (n = 78). From ages 25 to 64 years, neither the better nor the worse eye had a visual acuity worse than 0.0 logMAR. CONCLUSION Best-corrected visual acuity was constantly high until the age of 54 years. An age-related break-point appeared at 55 to 59 years of age. Until age 64, a minimal angle of resolution smaller than 1 min of arc (visual acuity better 0.0 logMAR) can be expected in healthy eyes.
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Affiliation(s)
- Wolfgang Radner
- Austrian Academy of Ophthalmology, Mollgasse 11, 1180, Vienna, Austria. .,Department of Ophthalmology, University Hospital St. Pölten, Karl Landsteiner University for Health Sciences, Dunant-Platz 1, 3100, St. Pölten, Austria.
| | - Thomas Benesch
- Department of Development Studies, Sensengasse 3, 1090, Vienna, Austria
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Facchin A, Maffioletti S, Martelli M, Daini R. Different trajectories in the development of visual acuity with different levels of crowding: The Milan Eye Chart (MEC). Vision Res 2019; 156:10-16. [DOI: 10.1016/j.visres.2019.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023]
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Guo MY, Cheng J, Etminan M, Zafari Z, Maberley D. One year effectiveness study of intravitreal aflibercept in neovascular age-related macular degeneration: a meta-analysis. Acta Ophthalmol 2019; 97:e1-e7. [PMID: 30030923 DOI: 10.1111/aos.13825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
The current body of evidence on the efficacy and safety of aflibercept for age-related macular degeneration (AMD) is steadily growing as large clinical trials and observational studies are continually completed. Our aim was to analyse 1-year visual acuity (VA) outcomes in response to aflibercept therapy and identify factors affecting treatment response using evidence generated from a pooled analysis of current studies. A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) revealed 12 studies meeting inclusion and exclusion criteria for statistical analysis. Treatment posology, baseline patient characteristics, study type, sample size and 12-month change in VA were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and posology in subgroup analyses. A meta-regression was conducted to regress 12-month VA change against posology, baseline VA and age. Users of aflibercept experienced an overall increase of 7.37 letters (95% confidence interval: 6.27-8.48, p heterogeneity: <0.001) in VA at 12 months of follow-up. In subgroup analyses, mean VA change was higher for randomized control trials and cohorts following regular posology (>7 injections/year) compared to observational studies and irregular posology. The meta-regression showed larger VA gains with regular posology compared to an irregular posology, and decreased effect size as age increased. This meta-analysis strongly suggests improved VA outcomes at 12 months in patients with wet AMD for 2.0 mg aflibercept, comparable to but slightly lower than landmark trials. Increased injection frequency and younger age demonstrates a trend with improved outcomes.
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Affiliation(s)
- Michael Y. Guo
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Jasmine Cheng
- Faculty of Medicine; University of British Columbia; Vancouver BC Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
| | - Zafar Zafari
- University of Maryland School of Pharmacy; Baltimore MD USA
| | - David Maberley
- Department of Ophthalmology and Visual Sciences; University of British Columbia; Vancouver BC Canada
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Mataftsi A, Kappos N, Riga P, Kokkali S, Malamaki P, Brazitikos P, Haidich AB. Use of log-scaled crowded visual acuity charts in clinical studies regarding amblyopia. Graefes Arch Clin Exp Ophthalmol 2019; 257:639-644. [DOI: 10.1007/s00417-018-04235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/12/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022] Open
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Vargas V, Radner W, Allan BD, Reinstein DZ, Burkhard Dick H, Alió JL. Methods for the study of near, intermediate vision, and accommodation: an overview of subjective and objective approaches. Surv Ophthalmol 2019; 64:90-100. [DOI: 10.1016/j.survophthal.2018.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
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Guo MY, Etminan M, Cheng JZ, Zafari Z, Maberley DAL. One-Year Effectiveness Study of Intravitreous Ranibizumab in Wet (Neovascular) Age-Related Macular Degeneration: A Meta-Analysis. Pharmacotherapy 2018; 38:197-204. [PMID: 29286545 DOI: 10.1002/phar.2079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of wet (neovascular) age-related macular degeneration (wAMD). METHODS A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to find randomized controlled trials (RCTs) and observational studies that reported changes in VA while patients with wAMD were on ranibizumab. Study factors analyzed were baseline patient characteristics, study type, sample size, and 12-month change in VA. Data were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and a meta-regression was conducted to assess 12-month VA change against baseline VA and age. RESULTS A total of 42 studies were included for analysis. An overall increase of 5.58 letters (95% confidence interval [CI]: 4.42-6.75; p heterogeneity, < 0.001) was shown with use of ranibizumab compared to baseline. Improvements in VA were larger for RCTs, at 7.71 letters (95% CI: 6.66-8.76; p heterogeneity, 0.013), compared to observational studies, at 4.85 letters (95% CI: 3.32-6.38; p heterogeneity, < 0.001). The meta-regression showed a significant decrease in effect size between baseline VA and 12-month VA change. CONCLUSION This meta-analysis suggests visual improvements at 12 months of 0.5-mg ranibizumab use in patients with wAMD. A higher gain in VA was observed when pooling results from RCTs compared to those in observational studies.
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Affiliation(s)
- Michael Y Guo
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmine Z Cheng
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zafar Zafari
- Mailman School of Public Health, Columbia University, New York, New York
| | - David A L Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Radner W, Benesch T. Age-related changes in baseline reading acuity and speed as measured using RADNER Reading Charts in healthy eyes with best corrected ETDRS distance acuity. Br J Ophthalmol 2018; 103:1518-1523. [PMID: 30573497 DOI: 10.1136/bjophthalmol-2018-313384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess age-related differences in baseline measures of reading performance obtained from the RADNER Reading Charts in healthy eyes with best corrected (ETDRS) distance acuity. METHODS Cross-sectional study of participants (n=200) aged 25-74 years (n=20 per 5 years age group). Best corrected distance visual acuity was measured monocularly with ETDRS 2000 Charts. Reading performance was evaluated binocularly with the RADNER Reading Charts. Reading acuity (RA), reading acuity score (RA score), mean reading speed (MEAN-RS), maximum reading speed, reading speed with a long paragraph, critical print size (CPS) and the logMAR/logRAD ratio were analysed. RESULTS RA, RA score, CPS-1 (last logRAD with normal reading speed) and ETDRS acuity did not change significantly between age 25 and 54 years. Overall, the mean RA was -0.091±0.07 logRAD, and the RA score was -0.069±0.07 logRAD. The mean difference between the RA and best ETDRS acuity was 0.0603±0.055 logMAR (r=0.62; p<0.05). The logMAR/logRAD ratio was 87.75%±11.23%. The MEAN-RS ranged from 189±21.9 words per minute (wpm) for the group aged 70-74 years to 236±22.5 wpm for the group aged 40-44 years and correlated well with the long paragraph results (r=0.87). CONCLUSION Best corrected RA, reading speed and ETDRS distance acuity were constant until the age of 54 years. An age-related break point was found between the groups aged 50-54 years and 55-59 years; for reading speed, the break point can be assumed to be within the age range of 50-54 years.
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Affiliation(s)
| | - Thomas Benesch
- Department of Development Studies, University of Vienna, Vienna, Austria
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45
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Cann M, Ramanan AV, Crawford A, Dick AD, Clarke SLN, Rashed F, Guly CM. Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J 2018; 16:51. [PMID: 30081917 PMCID: PMC6080499 DOI: 10.1186/s12969-018-0266-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. METHODS Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. RESULTS Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. CONCLUSION One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data.
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Affiliation(s)
- Megan Cann
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Andrew Crawford
- 0000 0004 1936 7988grid.4305.2BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew D. Dick
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfield Eye Hospital, London, UK ,0000000121901201grid.83440.3bUniversity College London Institute of Ophthalmology, London, UK
| | - Sarah L. N. Clarke
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Fatima Rashed
- Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Catherine M. Guly
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Poorer Visual Acuity Is Associated with Declines in Cognitive Performance Across Multiple Cognitive Domains: The Maine-Syracuse Longitudinal Study. J Int Neuropsychol Soc 2018; 24:746-754. [PMID: 29926789 PMCID: PMC6108908 DOI: 10.1017/s1355617718000358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Prior studies have found associations between visual acuity (VA) and cognitive function. However, these studies used a limited range of cognitive measures and did not control for cardiovascular disease risk factors (CVD-RFs) and baseline function. The primary objective of this study was to analyze the associations of VA and cognitive performance using a thorough neuropsychological test battery. METHODS This study used community-dwelling sample data across the sixth (2001-2006) and seventh (2006-2010) waves of the Maine-Syracuse Longitudinal Study (n=655). Wave 6 VA as measured by the Snellen Eye Test was the primary predictor of wave 6 and wave 7 Global cognitive performance, Visual-Spatial Organization and Memory, Verbal Episodic Memory, Working Memory, Scanning and Tracking, and Executive Function. Additionally, VA was used to predict longitudinal changes in wave 7 cognitive performance (wave 6 performance adjusted). We analyzed these relationships with multiple linear and logistic regression models adjusted for age, sex, education, ethnicity, depressive symptoms, physical function deficits in addition to CVD-RFs, chronic kidney disease, homocysteine, continuous systolic blood pressure, and hypertension status. RESULTS Adjusted for demographic covariates and CVD-RFs, poorer VA was associated with concurrent and approximate 5-year declines in Global cognitive function, Visual-Spatial Organization and Memory, and Verbal Episodic Memory. DISCUSSION VA may be used in combination with other screening measures to determine risk for cognitive decline. (JINS, 2018, 24, 746-754).
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47
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Elliott DB. What is the appropriate gold standard test for refractive error? Ophthalmic Physiol Opt 2018; 37:115-117. [PMID: 28211178 DOI: 10.1111/opo.12360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- David B Elliott
- Ophthalmic & Physiological Optics and Professor of Clinical Vision Science, University of Bradford, Bradford, UK
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48
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Davey CJ, Slade SV, Shickle D. A proposed minimum data set for international primary care optometry: a modified Delphi study. Ophthalmic Physiol Opt 2017; 37:428-439. [PMID: 28470770 DOI: 10.1111/opo.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify a minimum list of metrics of international relevance to public health, research and service development which can be extracted from practice management systems and electronic patient records in primary optometric practice. METHODS A two stage modified Delphi technique was used. Stage 1 categorised metrics that may be recorded as being part of a primary eye examination by their importance to research using the results from a previous survey of 40 vision science and public health academics. Delphi stage 2 then gauged the opinion of a panel of seven vision science academics and achieved consensus on contentious metrics and methods of grading/classification. RESULTS A consensus regarding inclusion and response categories was achieved for nearly all metrics. A recommendation was made of 53 metrics which would be appropriate in a minimum data set. CONCLUSIONS This minimum data set should be easily integrated into clinical practice yet allow vital data to be collected internationally from primary care optometry. It should not be mistaken for a clinical guideline and should not add workload to the optometrist. A pilot study incorporating an additional Delphi stage prior to implementation is advisable to refine some response categories.
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Affiliation(s)
- Christopher J Davey
- Academic Unit of Public Health, University of Leeds, Leeds, UK.,Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Sarah V Slade
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | - Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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49
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Carkeet A, Bailey IL. Slope of psychometric functions and termination rule analysis for low contrast acuity charts. Ophthalmic Physiol Opt 2017; 37:118-127. [PMID: 28211180 DOI: 10.1111/opo.12357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess whether the slopes of psychometric functions for measuring low contrast letter acuity were different from those for measuring high contrast letter acuity. METHODS Ten participants, wearing their best spectacle correction, were assessed monocularly. Stimuli were logarithmic progression charts, generated on a computer monitor, with nine rows of five randomised Sloan letters generated in either high contrast format (Weber contrast 99.2%) or low contrast format (Weber contrast 18.7%). For each participant, psychometric functions were generated by probit analysis of the data on each of 16 attempts at a low contrast chart and 16 attempts at a high contrast chart. Each of these probit fits yielded an estimate of Probit Size which provided information about how steep or flat the psychometric function was, along with an estimate of Probit Acuity Threshold. RESULTS Probit Size was significantly larger (p < 0.001) for low contrast charts than for high contrast charts, indicating that psychometric functions were flatter for low contrast charts. Mean Probit Sizes in logMAR were 0.099 (SEM 0.022) for low contrast charts and 0.071 (SEM 0.009) for high contrast charts if a guess rate of 1/26 was assumed, or were 0.086 (SEM 0.019) for low contrast charts and 0.064 for high contrast charts if a guess rate of 1/10 was assumed. Monte Carlo analysis showed that these means were likely to be biased estimates, with true Probit Size probably being larger (i.e. slightly flatter fits) by 0.016-0.019 logMAR. As expected, Probit Acuity Thresholds were poorer for low contrast charts than for high contrast charts (p < 0.001). CONCLUSION Our Monte Carlo modelling showed that such differences in acuity psychometric functions would be expected to give greater intra-subject variability in low contrast letter-by-letter acuity thresholds than for high contrast letter-by-letter acuity thresholds, and that this difference would depend on the termination rule used when measuring acuity. Likewise the variation in letter-by- letter acuity thresholds with termination rule will be different for high and low contrast charts. For low contrast and high contrast Sloan letter charts in a standard logarithmic format, a termination rule of four mistakes on a row, will give close to optimum sensitivity-to-change.
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Affiliation(s)
- Andrew Carkeet
- School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ian L Bailey
- School of Optometry, University of California, Berkeley, USA
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