Vision related quality of life in patients with keratoconus

Impacts of keratoconus on quality of life: a qualitative study

BACKGROUND/AIMS

To identify the domains of quality of life (QoL) in people with keratoconus.

METHODS

Semi structured in-depth in person and telephone interviews were conducted with participants diagnosed with keratoconus and recruited from the Sydney Eye Hospital, Sydney, Australia. Thematic analysis of interview content was conducted using inductive and deductive processes. Data was collected until thematic saturation was obtained.

RESULTS

33 patients with keratoconus with median age 37 (range 18 to 65) years and majority male (n = 25; 75.8%) were interviewed and a total of 2551 quotes coded. Thematic analysis resulted in 7 broad themes, Driving (199 references), Career (259 references), Symptoms (647 references), Enjoyment (149 references), Relationships (250 references), Financial (104 references) and Healthcare (881 references). Most references described a negative relationship between keratoconus and these 7 domains. The diverse QoL issues expressed included frustration with treatment effectiveness, fear of disease progression, inconvenience with contact lenses, forced career changes and job loss, cost of contact lenses, and feelings of isolation and discrimination. Themes and subthemes described a complex and varied relationship between keratoconus and QoL.

CONCLUSION

Severe quality of life impairment was experienced by keratoconus patients despite treatment. Keratoconus diminishes various aspects of individual's QoL. Therapies able to improve QoL are still needed for keratoconus.

Development and validation of a health practitioner survey on ocular allergy

Survey studies have played a significant role in understanding the gaps in the knowledge and practices of health practitioners. However, there have been no such survey studies on Ocular Allergy (OA). Thus, the purpose of this study was to develop and validate a survey on OA to better understand the gaps in the diagnostic, treatment, and collaborative care approaches of health practitioners in OA. The survey is titled "Survey on Ocular Allergy for Health Practitioners (SOAHP)". SOAHP was developed in a five-stage process. First, item extraction via the use of a literature review, second, face and content validity, third, a pilot study, fourth, test-retest reliability, and fifth, finalisation of the survey. 65 items under 6 domains were initially generated in the item extraction phase. Content validity was conducted on 15 experts in the field. This was conducted twice to reach consensus whereby items and domains were added, edited, kept, or removed, resulting in 50 items under 7 domains. The pilot study was conducted on 15 participants from the five relevant health practitioner fields (Allergists/Immunologists, General Practitioners (GPs), Ophthalmologists, Optometrists and Pharmacists). This altered the survey further to 40 items under 7 domains. Test-retest reliability was conducted on 25 participants from the five health practitioner fields. Reliability was moderate to almost perfect for most (97%) investigated items. The finalised survey was 40 items under 7 domains. SOAHP is the first survey created to assess diagnostic, treatment and collaborative care approaches of Allergists/Immunologists, GPs, Ophthalmologists, Optometrists and Pharmacists on OA. SOAHP will be a useful tool in clinical research on OA.

Keratoconus disease classification with multimodel fusion and vision transformer: a pretrained model approach

OBJECTIVE

Our objective is to develop a novel keratoconus image classification system that leverages multiple pretrained models and a transformer architecture to achieve state-of-the-art performance in detecting keratoconus.

METHODS AND ANALYSIS

Three pretrained models were used to extract features from the input images. These models have been trained on large datasets and have demonstrated strong performance in various computer vision tasks.The extracted features from the three pretrained models were fused using a feature fusion technique. This fusion aimed to combine the strengths of each model and capture a more comprehensive representation of the input images. The fused features were then used as input to a vision transformer, a powerful architecture that has shown excellent performance in image classification tasks. The vision transformer learnt to classify the input images as either indicative of keratoconus or not.The proposed method was applied to the Shahroud Cohort Eye collection and keratoconus detection dataset. The performance of the model was evaluated using standard evaluation metrics such as accuracy, precision, recall and F1 score.

RESULTS

The research results demonstrated that the proposed model achieved higher accuracy compared with using each model individually.

CONCLUSION

The findings of this study suggest that the proposed approach can significantly improve the accuracy of image classification models for keratoconus detection. This approach can serve as an effective decision support system alongside physicians, aiding in the diagnosis of keratoconus and potentially reducing the need for invasive procedures such as corneal transplantation in severe cases.

Corneal Fourier and Belin-Ambrósio Enhanced Ectasia Analysis in Healthy 4-Year-Old White Children

PURPOSE

The aim of this study was to provide normative databases of Fourier analysis (FA) and Belin-Ambrósio enhanced ectasia display (BAD) in healthy White 4-year-old emmetropic children.

METHODS

FA parameters analyzed were spherical component (SRmin), spherical eccentricity (SEcc), maximal decentration (MD), regular astigmatism at the center (Astigm. C) and periphery (Astigm. P), and irregularity (I). The parameters obtained by BAD included summary indicator BAD D, anterior corneal curvature (K1 and K2, D), maximal keratometry (Kmax, D), maximal Ambrósio relational thinnest (ART max), and pachymetric and BAD indices.

RESULTS

Eighty-nine eyes of eighty-nine 4-year-old children were included. The mean values of FA parameters were the following: SRmin 7.77, SEcc 0.600, MD 0.160, Astigm. C 0.070, Astigm. P 0.050, and I 0.019. The mean K1 and K2 in our study group were 42.92 ± 1.29 D and 43.75 ± 1.41 D, with the mean BAD D value 0.42 ± 0.67. The mean PPI min 0.629 ± 0.117, PPI max 1.059 ± 0.155, PPI avg 0.847 ± 0.103, Kmax 44.10 ± 1.39, and median of ART max 515.0 were recorded. No statistically significant differences between male and female sex in any of FA or BAD parameters were found.

CONCLUSIONS

This is the first study providing large normative data on FA and BAD in 4-year-old White emmetropic children. We proposed a cutoff D value for early ectasia and clinical keratoconus in 4-year-old children.

Vision-related quality of life among patients with keratoconus: a cross sectional study

Purpose

The present study aimed to evaluate the quality of life of keratoconus patients residing in Nablus city, Palestine. Furthermore, we investigated the possible correlation between Pentacam topographic indices and the quality of life of patients with keratoconus.

Methods

This cross-sectional study evaluated keratoconus patients at An-Najah University Hospital in 2019, diagnosed through clinical examination and corneal tomography. A control group was randomly selected from non-keratoconus patients with normal tomography. The NEI-VFQ-25 questionnaire was administered during face-to-face interviews to compare both groups. NEI-VFQ-25 assesses vision-related quality of life and is a validated tool.

Results

Keratoconus patients' quality of life is significantly impacted, mainly in near and distant vision, general vision, mental health, and social health, but not in general health, ocular pain, color vision, role difficulties, or dependency. Visual acuity is significantly affected in both eyes of keratoconus patients.

Conclusion

Patients with keratoconus exhibit a decreased quality of life related to vision, with physical, emotional, and social impairments demonstrated by the NEI-VFQ-25 when compared to controls. Since keratoconus patients are typically young adults in their productive years, understanding their concerns about their future is an important public health aspect that can aid in modifying their treatments. By addressing the specific needs of this patient population, healthcare providers can better support their long-term well-being and quality of life.

Keratoconus and the Impact of Treatment on Patients' Quality of Life: A Qualitative Study

INTRODUCTION

Keratoconus has a significant impact on patients' quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment.

METHODS

Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide's main themes.

RESULTS

Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: "psychological", "social life", "professional life", "financial costs" and "student life". All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary's model for patient outcomes common to all patients. This conceptual model describes the relationship between patients' characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL.

CONCLUSIONS

These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients' QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.

Impact on quality of life of keratoconus patients treated with accelerated "epi-on" corneal collagen crosslinking technique: results from the NEI VFQ-25 Questionnaire in a Romanian population

Objective: The main objective of this study was to describe vision-related quality of life (VRQoL) in a Romanian population of patients with keratoconus who underwent the accelerated "epi-on" corneal collagen crosslinking procedure and to evaluate the association with demographic data of age, gender and civil status (married, cohabitants or non-cohabitants). Method: The National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was administered to 72 patients with keratoconus who had undergone a minimally invasive procedure. Descriptive statistics and bivariate analysis were used to determine the distribution of demographic parameters and a possible association between this parameter and the scores obtained on the NEI VFQ-25 questionnaire. Results: Based on the answers to the questionnaire we calculated the mean (SD) VFQ-25 total score, which was 73,97 (15,11), whilst scores for the subscales varied from 49.93 to 84,23. No significant difference was observed between the demographic parameters and the NEI VFQ-25 items, except for one item (being with others) when comparing paired and non-paired participants. Conclusion: In a Romanian population with keratoconus being treated with accelerated "epi-on" corneal collagen crosslinking procedure, VRQoL was reported at a high baseline level. The value of this information is significant when discussing patients' expectations during treatment. The VRQoL was not affected by age or civil status.

Vision-Related Quality of Life in Patients With Rhegmatogenous Retinal Detachment Treated With Pars-Plana Vitrectomy: Impact of Gas Tamponade

PURPOSE

To investigate changes in vision-related quality of life in patients treated with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and compare groups according to the type of gas tamponade used.

METHODS

Participants in this study were 48 patients with RRD who were treated with PPV and gas tamponade (sulfur hexafluoride (SF₆) or perfluoropropane (C₃F₈)) without internal limiting membrane peeling. All participants underwent slit-lamp examination, fundoscopy, axial-length measurement, and completed the Vision Function Questionnaire-25 (VFQ-25) at month six postoperatively. We compared VFQ-25 composite and subscale scores in the SF₆ and C₃F₈ groups and investigated any correlations between age, best corrected visual acuity (BCVA), axial length, and VFQ-25 scores.

RESULTS

The demographic and clinical characteristics of the two groups (axial length, macular status, retinal detachment extent, duration of symptoms, and lens status) were comparable between the two groups. We found a statistically significant decrease in general vision (GV), ocular pain (OP), and driving (D) scores in the C₃F₈ group compared to the SF₆ group. The VFQ-25 composite score was comparable in the two groups. Similarly, all other subscales of the VFQ-25 did not differ significantly between the two groups. Age and BCVA did not significantly correlate with VFQ-25 composite and subscale scores.

CONCLUSION

Specific VFQ-25 subscales were decreased in patients with RRD treated with C₃F₈ as a gas tamponade compared to SF₆. This finding warrants further research in the tamponade agents used in PPV surgeries.

Prevalence and risk factors of keratoconus (including oxidative stress biomarkers) in a cohort study of Shiraz university of medical science employees in Iran

BACKGROUND

To determine the prevalence of keratoconus in Shiraz University of Medical Sciences Employees and the related risk factors including oxidative stress biomarkers.

METHODS

2546 subjects' mean age ± SD, 40.35 ± 6.70 (46% male) were recruited. All participants underwent objective refraction using auto-refractometer and retinoscopy, followed by subjective refraction, and bio-microscopy. Pentacam imaging was performed for the detected keratoconus patients. The prevalence of keratoconus and frequency of the visual impairment among keratoconus cases were evaluated. Potential risk factors of sex, age, family history of keratoconus, body mass index ≥ 30 kg/m², serum levels of glucose ≥ 100 mg/d, low-density-lipoprotein-cholesterol (LDL) ≥ 110 mg/dL, high-density-lipoprotein-cholesterol ≤ 40 mg/d, and triglycerides ≥ 150 mg/dL in the blood were evaluated.

RESULTS

The prevalence of keratoconus at least in one eye was 0.98% (95% CI: 0.6- 1.4%). The best corrected visual acuity in the keratoconus group was 0.06 ± 0.1 and the rest of the population was 0.01 ± 0.07 logMAR (p < 0.001). The frequency of visual impairment in the keratoconus group was zero. Odds ratios of the family history of keratoconus (21.00, 95% CI: 9.00-48.00, p < 0.001) and LDL ≥ 110 mg/dL (3.00, 95% CI: 1.20-6.40, p = 0.01) were significant.

CONCLUSIONS

Keratoconus is rare and is not considered a risk factor for visual impairment. A family history of keratoconus and elevated serum LDL levels are contributing risk factors, suggesting an inflammatory background for the disease. Serum levels of LDL ≥ 110 mg/dL in the blood increased the risk of keratoconus three folds.

Automated cornea diagnosis using deep convolutional neural networks based on cornea topography maps

Cornea topography maps allow ophthalmologists to screen and diagnose cornea pathologies. We aim to automatically identify any cornea abnormalities based on such cornea topography maps, with focus on diagnosing keratoconus. To do so, we represent the OCT scans as images and apply Convolutional Neural Networks (CNNs) for the automatic analysis. The model is based on a state-of-the-art ConvNeXt CNN architecture with weights fine-tuned for the given specific application using the cornea scans dataset. A set of 1940 consecutive screening scans from the Saarland University Hospital Clinic for Ophthalmology was annotated and used for model training and validation. All scans were recorded with a CASIA2 anterior segment Optical Coherence Tomography (OCT) scanner. The proposed model achieves a sensitivity of 98.46% and a specificity of 91.96% when distinguishing between healthy and pathological corneas. Our approach enables the screening of cornea pathologies and the classification of common pathologies like keratoconus. Furthermore, the approach is independent of the topography scanner and enables the visualization of those scan regions which drive the model's decisions.

Quality of life and tomography indices in patients with keratoconus

OBJECTIVE

Keratoconus is a corneal ectasia that leads to thinning and steepening of the corneal surface. We aimed to assess the relationship between quality of life and corneal tomography indices, irrespective of visual acuity.

METHODS

This was a cross-sectional study using a translated and validated Keratoconus Outcomes Research Questionnaire (KORQ) in Arabic language. We screened patients with keratoconus using the Belin/Ambrósio D-Index. We included the best-seeing eye in each patient with keratoconus, with a best corrected visual acuity better than 0.5. We collected variables including KORQ scores, flattest meridian keratometry, steepest meridian keratometry, mean keratometry front, maximum simulated keratometry, astigmatism front, Q value front, and thickness at the thinnest location. We performed linear regression analysis to identify predictors of the visual function score and symptom score.

RESULTS

Sixty-nine patients were included in this study, 43 (62.3%) male and 26 (37.7%) female patients, with a mean age 34.0 ± 11.50 years. The only predictor for visual function score was sex (β = 11.64, 95% confidence interval: 3.50-19.78). None of the topographic indices were related to quality of life.

CONCLUSION

In this study, quality of life in patients with keratoconus was not related to specific tomography indices and might be related to visual acuity itself.

Impact of corneal collagen cross-linking on vision-related quality of life measured with the keratoconus outcomes research questionnaire (KORQ) in patients with keratoconus

PURPOSE

To assess the impact of corneal collagen cross-linking on self-reported vision-related quality of life (VR-QoL) in keratoconus patients by means of the Keratoconus Outcomes Research Questionnaire (KORQ), a new disease-specific patient reported outcomes measures (PROMs) tool.

METHODS

Patients with progressive keratoconus undergoing corneal collagen cross-linking were consecutively enrolled. Patients completed the KORQ before and after the treatment, at 1, 3 and 6 months. Data were collected regarding the visual acuity and the topographic, aberrometric and pachymetric parameters of both eyes. Patients were also asked to quantify their eye rubbing behavior on a Visual Analogue Scale (VAS) from 0 to 10, before and 6 months after treatment. The KORQ scores were associated with the visual acuity, topographic, aberrometric and pachymetric data by means of the Spearman correlation coefficient.

RESULTS

The Activity Limitation (AL) subscale score was higher after surgery. Preoperatively, negative correlations were observed between the KORQ AL score and Best Corrected Visual Acuity (logMAR), maximum keratometry, flattest keratometry, steepest keratometry, symmetry index front and higher order aberrations (HOA) of the treatment eye. Postoperatively, we observed a shift toward the fellow eye, with stronger correlation of the KORQ scores with the fellow eye parameters. The Symptoms subscale score correlated with the aberrometric parameters of both eyes at various time points. Statistically significant correlations were observed between the change in KORQ scores and the change in aberrometric parameters. A statistically significant reduction in the eye rubbing behavior was detected (p < 0,0001).

CONCLUSIONS

These results suggest that the corneal cross-linking treatment is effective both in improving the subjective perception of the disease by the patient and in stabilizing the objective indicators of disease progression. Keratometric, aberrometric and visual acuity values showed a significant impact on self-reported VR-QoL. Corneal cross-linking, by halting the worsening of these parameters, may bear a beneficial effect on VR-QoL.

Vision-Related Quality of Life in Patients With Keratoconus: A Nationwide Study in Saudi Arabia

PURPOSE

To evaluate the impact of keratoconus (KC) on quality of life and assess visual performance via the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) in the Saudi population.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted using the NEI-VFQ-25 to evaluate the vision-related quality of life among previously diagnosed KC patients. An online questionnaire was used to distribute the validated survey through various social media networks. The data were extracted, reviewed, coded, and then analyzed using the Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY).

RESULTS

A total of 429 patients completed the questionnaire. The overall score of NEI-VFQ-25 was 58.6 (SD: 18.0). The visual performance was worse in females than males (with a score of 55.1), especially in patients aged less than 30 years. Visual function improved with the use of low-vision aids (spectacles and contact lenses) compared with those who did not use them.

CONCLUSION

Our study confirms the functional impairment in patients with KC, especially in females, patients aged less than 30 years, and those with no low-vision aids. Moreover, it suggests a significant role of these vision aids (spectacles and contact lenses) in improving the quality of life in patients with KC.

Risk Factors Associated with Keratoconus in an Iranian Population

Purpose

To determine associated factors for keratoconus (KCN) in the Iranian population.

Methods

In this retrospective case-control study, 100 KCN patients and 200 age- and sex-matched individuals, who were either candidates for photorefractive keratectomy or healthy referrals from the Torfeh Eye Hospital, were included as the case and control groups, respectively. KCN patients were all registered at the Iranian National Registry of Keratoconus (KCNRegⓇ). Demographic characteristics, patients' symptoms and their habits, as well as systemic and ocular disorders were documented. Clinical examinations included best corrected visual acuity (BCVA) and refractive error measurements, biomicroscopic examination, and corneal imaging.

Results

In this case group, the frequency of mild, moderate, and severe KCN was 38%, 28%, and 34%, respectively. Parental consanguinity (odds ratio [OR] = 1.758, P = 0.029), positive familial history in patients' first degree (OR = 12.533, P < 0.001) and second degree (OR = 7.52, P < 0.001) relatives, vernal keratoconjunctivitis (OR = 7.510, P = 0.003), severe eye rubbing (OR = 10.625, P < 0.001), and systemic diseases including migraine, hypertension, and thyroid disease (OR = 6.828, P = 0.021) were found as associated factors for KCN. Lesser frequency of KCN was observed in patients with Fars ethnicity (OR = 0.583, P = 0.042), with higher levels of wealth indices (OR = 0.31, P < 0.001) and higher levels of education (OR = 0.18, P = 0.024).

Conclusion

Severe eye rubbing, vernal keratoconjunctivitis, parental consanguinity and positive familial history of KCN, low socioeconomic status, and low levels of education were significantly associated with KCN in our study population.

Prevalence of keratoconus in Ghana: A hospital-based study of tertiary eye care facilities

PURPOSE

To estimate the prevalence of keratoconus in tertiary eye care facilities in Ghana.

METHODS AND ANALYSIS

In this hospital-based retrospective cohort study, medical records of patients from tertiary/referral eye care facilities in Ghana were reviewed. Included in the study were records of individuals who visited the eye care facilities and were diagnosed of keratoconus within the period of January 2016 to December 2019 inclusive. Data on patients' demographics, severity of keratoconus, mode of diagnosis, treatment, and visual acuity outcomes were analysed.

RESULTS

Out of the total of 142,209 records reviewed, 75 patients were diagnosed of keratoconus in at least one eye (127 eyes; 86.8% bilateral cases), representing a prevalence estimate of 53 per 100000 (95% confidence interval (CI): 41 to 65 per 100000). The mean ± SD age of patients at the time of diagnosis was 21.1 ± 9.5 years (66.2% males). The mean ± SD keratometry in keratoconus patients was 52.1 ± 7.0: majority (76.5%) of the cases were moderate to severe keratoconus. The main primary treatment regimen was corneal transplant (58.8%) followed by spectacles (25.0%), crosslinking (8.8%) and rigid contact lens (7.3%). There was a significant association between post-treatment visual acuity outcomes and treatment type (p < 0.001).

CONCLUSION

Our study represents the first prevalence estimate of keratoconus in Ghana. The prevalence of keratoconus estimated in our study is lower than that reported in countries with tropical climates. This could be due to lower uptake of referrals, underdiagnosis and/or misdiagnosis of the condition in lower-level health facilities.

Optometric practices and attitudes in keratoconus patient management in Latin America

CLINICAL RELEVANCE

To explore optometric practices and attitudes in the management of keratoconus patients in LatinAmerica and how they are influenced by eye-care technology will help to minimise disease progression and their impact on patients' quality of life in Latin America.

BACKGROUND

Keratoconus is a progressive, bilateral and asymmetric corneal disorder that requires a multidisciplinary approach, the use of different eye assessment technology, and different management approaches; mainly contact lenses and surgery.

METHODS

Self-reported answers to an online survey (adapted to primary eye care) distributed via a newsletter emailed by various professional organisations across 15 Latin American countries were assessed and compared with those previously reported in three European countries.

RESULTS

Answers from 977 eye care practitioners (60%) with >10 years of experience (396 in Latin America and 581 in Europe) were assessed. A total of 65.9% of Latin American responders prescribed rigid corneal lenses (RCL), although more than half of the respondents (54.0%) would fit more RCL if they underwent further training in RCL fitting. A majority of Latin American practitioners (74.0%) considered that RCL fitting is more difficult in keratoconus, requiring more diagnostic lenses (4.6 ± 2.7; median 4; range 1-10) than are necessary for healthy eyes. Low availability of corneal topography was reported in Latin America (23%), although practitioners with topographers are more likely to prescribe RCL (92.3%) and detect more new patients with keratoconus per year (83.5%). A minority of respondents referred keratoconus patients to another optometrist (25.8%) or (40.4%) participated in comanagement with ophthalmologists.

CONCLUSION

This study provides initial evidence regarding keratoconus management in Latin America and suggests that actions are necessary to improve RCL training, facilitate eye-care technology accessibility and encourage comanagement between eye care practitioners to minimise disease progression and their impact on patients' quality of life in Latin America.

Evaluation of corneal topography, pachymetry and higher order aberrations for detecting subclinical keratoconus

PURPOSE

To compare corneal topography, pachymetry and higher order aberrations in keratoconic and normal eyes; to investigate their association in keratoconic eyes; and to determine their diagnostic ability for detecting subclinical keratoconus in a Nepalese population.

METHODS

Ninety-six eyes of 48 keratoconus patients and 50 normal eyes of 50 control subjects were included in this study. The eyes of keratoconus patients were classified into four different study groups: subclinical, stage 1, stage 2 and advanced stage keratoconus. In each eye, corneal topography, pachymetry and corneal aberrometry indices were measured using a Sirius corneal tomographer. The study parameters of keratoconic eyes were compared with normal eyes, and the possible association of corneal aberrometry with topography and pachymetry indices was investigated. The area under curve (AUC) of receiver operating characteristic (ROC) curves along with optimal cutoff values with best sensitivity and specificity were also determined for each index to detect subclinical keratoconus.

RESULTS

All the indices except average keratometry measurements (K_avg and mm_avg ) and spherical aberration (SA) were found to be significantly different in subclinical keratoconus compared to the control group (p < 0.05). In keratoconic eyes, all corneal aberrations were significantly correlated with the topography and pachymetry indices (range of ρ: -0.25 to 0.96; all p < 0.05) except for trefoil and minimum corneal thickness (Thk_min ). All the indices except K_avg , mm_avg and SA showed excellent diagnostic ability (AUC > 0.90) in detecting subclinical keratoconus. The cutoff values proposed for the asymmetry index of the corneal back surface (SI_b ), Strehl ratio of point spread function (PSF), coma and Baiocchi-Calossi-Versaci index of corneal back surface (BCV_b ) each showed excellent sensitivity (100%) and specificity (≥97%).

CONCLUSIONS

Corneal higher order aberrations were found to be significantly elevated in subclinical keratoconus compared to healthy controls. SI_b , PSF, coma and BCV_b were identified as the most powerful Sirius indices for the detection of subclinical keratoconus.

Assessing the quality of life in age-related macular degeneration patients: a cross-sectional study in Kazakhstan

AIM

The goal of this study was to assess Vision-Related Quality of Life (VRQoL) in patients with Age-Related Macular Degeneration (AMD) and identify its significant predictors.

METHODS

458 AMD patients from four eye clinics in three major cities of Kazakhstan were recruited for this study. Data were collected using a structured questionnaire on sociodemographic and visual information and the National Eye Institute-Visual Function Questionnaire-39 (NEI-VFQ-39).

RESULTS

The study sample included 181 male patients who were 64.9 years on average (SD±8.4), and 277 female patients who were 68.7 years on average (SD±10.7). The majority of patients had stage 2 (43.7%) or stage 3 (40.2%) AMD according to the Age-Related Eye Disease Study (AREDS) classification. The mean (SD) NEI-VFQ-39 total score was 58.0 (23.8), range (9.8 - 100). The multiple linear regression model showed that the VRQoL of AMD patients correlated with the AMD stage according to the AREDS classification, age of the patients, visual acuity, number of years since the AMD diagnosis, and the city of residence.

CONCLUSIONS

AMD causes severe vision impairment and daily functioning problems, reducing the quality of life of patients. To diagnose and treat degenerative eye disorders at an early stage, it is essential to inform patients about regular ophthalmological checkups to diagnose and treat degenerative eye disorders at an early stage.

Corneal Scheimpflug topography values to distinguish between normal eyes, ocular allergy, and keratoconus in children

To identify and compare keratometric, corneal thickness, and elevation parameters and indices among healthy children, ocular allergy, and keratoconus using the OCULUS Pentacam Scheimpflug topography system. This study included healthy children, children with ocular allergy (OA) without keratoconus, and children with keratoconus (KC). The study design consisted of a prospective evaluation and review of medical records from a Brazilian ophthalmology department. The exclusion criteria were inability to undergo the ocular exam, other ocular diseases, contact lens wear, and topographic corneal ectasia. The effect of each corneal parameter was evaluated using univariate and multivariate logistic regression models adjusted for sex and age, and ROC curves were used to assess the ability each variable to discriminate among groups. A total of 182 subjects were included: healthy children (n = 99), children with OA (n = 32), and children with KC (n = 51). Groups differed in terms of sex, with more males in the OA group (73.2%) and the KC group (67.7%) than in the control group (40.9%). All corneal parameters studied differed significantly between the control and KC groups, and between the OA and KC groups; they also differed significantly between the three groups in terms of astigmatism, q-value, CCT, TP, BAD-D, and ARTmax values. We present the first study to describe and compare corneal tomographic parameters in healthy children, OA, and KC. Keratometry indices, ACD, ARTmax, AETP, and PETP were found to be the most useful for differentiating between healthy and KC children.IBR registry number: CAAE 54921916.9.0000.5404.

Lighting Standards Revisited: Introduction of a Mathematical Model for the Assessment of the Impact of Illuminance on Visual Acuity

Purpose

Primary objective of present study is to introduce a contemporary methodology for the lighting standards update addressing both normophakic and pseudophakic patients.

Methods

For the sake of our study, we theoretically estimated the intraocular-to-crystalline lens iIluminance ratio (ICIR) and the intraocular lens (IOL) luminous efficiency function V_IOL(λ) as a new lighting benefit metric. Then, in a sample of 24 pseudophakic patients (38 eyes) implanted with the trifocal diffractive IOL Panoptix (SG) and in a control group (CG) of 28 normophakic participants (50 eyes), uncorrected distance visual acuity (UDVA) was measured at illuminance of 550lx (optimal UDVA). Following dark adaptation, illuminance was gradually raised from 20 lx until illuminance level that the patient reached his/her optimal UDVA. This measured illuminance at this point was defined as the minimum required illuminance level (MRIL). MRIL and UDVA for illuminance levels between 20 and 550lx in SG were compared with the corresponding values in CG. MRIL calculation allowed the construction of a predictive mathematical model that estimates the impact of environmental lighting on UDVA.

Results

ICIR for Panoptix eyes ranged from 54.00% to 55.99%. Both groups had significantly higher UDVA at 550lx compared to 20lx (p < 0.05). CG had significantly higher UDVA than SG at 20lx (7.20 letters, p = 0.045), while no significant difference was detected at 550lx (0.40 letters, p = 0.883). SG required significantly more illuminance than CG to maintain their UDVA (MRIL_SG= 191.05lx, MRIL_CG= 122lx, p = 0.007). Our predictive model suggests suboptimal UDVA in a series of lighting directives for normophakic and Panoptix eyes.

Conclusion

This is the first study to introduce the V_IOL(λ) as a new lighting benefit metric and a mathematical model that quantifies the impact of illuminance on UDVA in normophakic and pseudophakic patients.

Clinicaltrials.gov Identifier

NCT04263636.

Referral pattern and co-management of keratoconus patients in primary eye care: A survey of three European countries

PURPOSE

To explore current primary care practices in keratoconus management in Portugal and compare with previous reported results in two European countries (the UK and Spain), with a special focus on interdisciplinary collaboration and referral practice patterns.

METHODS

An online survey adapted to European professional practice was distributed (via newsletters) by the Portuguese Optometrist Association to explore keratoconus patient management and referral practice patterns among Portuguese practitioners.

RESULTS

Responses of 119 optometrists were compared with previous reported of 464 eye-care practitioners (126 in the UK and 338 in Spain). Most respondents (79% in Portugal, 71% in the UK and 76% in Spain; p = 0.31) had < 5 new keratoconus patients each year. No accepted referral criterion was found (p < 0.01) because small number of the respondents (14%) in Portugal referred out at initial diagnosis (50% in the UK and Spain); 32% referred out when progression was detected (17% in the UK and 30% in Spain); and a minority (10% in Portugal, 9% in the UK, and 6% in Spain) referred out when visual acuity was affected. A majority of respondents (83%) in Portugal reported no co-management with ophthalmologists (60% in the UK and 73% in Spain; p < 0.01).

CONCLUSION

The results of this study suggest that it is necessary to encourage interdisciplinary collaboration between practitioners to improve referral of patients with suspected keratoconus to an ophthalmology specialist to change the course of this disease, to reduce keratoconus progression and visual acuity impairment and to minimize the impact of this disease on patients' quality of life.

Two-Year Follow-up of Intracorneal Ring Segments Implantation in Adolescent Patients With Keratoconus

PURPOSE

To evaluate the visual, refractive, topographic, and aberrometric outcomes after intracorneal ring segments (ICRS) implantation in adolescent patients with keratoconus.

METHODS

A retrospective longitudinal study was undertaken with a total of 61 eyes from 47 patients with keratoconus, aged between 13 and 18 years, implanted with a Ferrara-type ICRS. Topography (flattest keratometry, steepest keratometry, and asphericity), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error (sphere and cylinder), and aberrometric measurements (spherical aberration and vertical coma) were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery.

RESULTS

UDVA exhibited a statistically significant increase at all times from 1 month to 2 years postoperatively (P < .001), whereas CDVA showed a statistically significant improvement at 1 month, 6 months, and 2 years (P < .002), but dropped in significance at 1 year postoperatively (P = .097). The refractive error analysis showed no variation in statistical significance in the sphere (P = .712) after 2 years. The cylinder presented a statistically significant decrease in diopters at all times from preoperatively to 2 years postoperatively (P < .007). Steepest keratometry manifested a statistically significant decrease in steepness at all times after surgery (P < .001), whereas flattest keratometry lost significance at 1 year (P = .298) and 2 years (P = .053) postoperatively. There was no statistically significant change in the spherical aberration at any of the measured times. The vertical coma was only significantly different at 2 years postoperatively (P = .001).

CONCLUSIONS

ICRS implantation is a safe and effective treatment for improving visual and corneal morphological parameters as shown at 2 years of follow-up in adolescent patients with keratoconus. It is a good option to flatten and regularize the cornea and to temporarily improve the quality of life of young patients and delay the need for keratoplasty. [J Refract Surg. 2021;37(2):91-97.].

Correlation of Visual Quality of Life With Clinical and Visual Status in Friedreich Ataxia

BACKGROUND

The primary objective was to determine the association of patient-reported vision-specific quality of life to disease status and visual function in patients with Friedreich's ataxia (FRDA).

METHODS

Patients with FRDA were assessed with the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) along with measures of disease status (ataxia stage) and visual function (low- and high-contrast letter acuity scores). The relations of NEI-VFQ-25 scores to those for disease status and visual function were examined.

RESULTS

Scores for the NEI-VFQ-25 were lower in patients with FRDA (n = 99) compared with published disease-free controls, particularly reduced in a subgroup of FRDA patients with features of early onset, older age, and abnormal visual function.

CONCLUSIONS

The NEI-VFQ-25 captures the subjective component of visual function in patients with FRDA.

Contrast sensitivity and higher-order aberrations in Keratoconus subjects

This study analyzes the relationship between contrast-sensitivity and higher-order aberrations (HOA) in mild and subclinical-keratoconus in subjects with good visual-acuity (VA). Keratoconus group (including subclinical-keratoconus) and controls underwent autokeratometry, corneal-tomography, autorefraction and HOA measurement. Contrast-sensitivity was tested using a psychophysical two-alternative forced-choice Gabor patches in three blocks (6, 9, 12 cycles/deg). Controls were compared to the keratoconus group and to a keratoconus subgroup with VA of 0.00 LogMar group ("keratoconus-0.00VA"). Spearman correlation tested association between HOA and contrast-sensitivity. Twenty-two keratoconus subjects (38 eyes: 28 keratoconus, 10 subclinical-keratoconus, 20 keratoconus-0.00VA) and 35 controls were included. There was a significant difference between control and keratoconus, and between control and keratoconus-0.00VA, for keratometry, cylinder, thinnest and central corneal thickness (p < 0.001). Controls showed lower HOA and higher contrast-sensitivity for all spatial-frequencies (p < 0.001). Most HOA were negatively correlated with contrast-sensitivity for all spatial-frequencies for keratoconus group and for 9 and 12 cycles/deg for keratoconus-0.00VA. Keratoconus subjects with good VA showed reduction in contrast-sensitivity and increased HOAs compared to controls. HOA and contrast-sensitivity are inversely correlated in subjects with mild keratoconus despite good VA. This suggests that the main mechanism underlying the decreased vision quality in keratoconus is the increase of HOA.

Vision related quality of life of patients with keratoconus after keratoplasty at a Tertiary Eye Hospital in Saudi Arabia

PURPOSE

To assess the vision-related quality of life (VQoL) for patients with advanced keratoconus (KC) after primary keratoplasty.

METHODS

This was a cross-sectional study, undertaken at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, in December 2015. Adults (aged 22-75 years) were interviewed via telephone with regard to their VQoL, on the average, 5 years after undergoing primary keratoplasty for advanced KC. VQoL was measured using the Visual Functioning Index (VF-14, Arabic version). The relationship between VQoL and different demographic and clinical factors was evaluated using linear regression.

RESULTS

Ninety-five adults participated in the study (54.7 % males; mean age at the interview = 32.05 ± 7.18 years). Eighty-seven (91.6%) of them had undergone PKP. The overall mean VF-14 score was 86.19% (SD: 12.91). VF-14 score was significantly lower for individuals with higher log average K (beta coefficient, -28.32; 95% confidence interval [CI], -55.59 to -1.04; p = 0.042) and hazy graft (beta coefficient, -12.76; 95% CI, -21.16 to -4.36; p = 0.003) adjusting for the effect of keratoplasty technique and BCVA in the better eye at the last follow up.

CONCLUSION

This study suggests that most patients with advanced keratoconus had satisfactory VQoL after primary keratoplasty. Certain subgroups may benefit less substantially than others and would need a particular attention.

A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China

China is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.

Psychiatric morbidity of patients with keratoconus: A cross-sectional study

BACKGROUND

This study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group.

MATERIALS AND METHODS

This cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed.

RESULTS

The patients' mean age was 23.9 ± 4.8 (range, 18-40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores.

CONCLUSIONS

There was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.

Quality of Life among Patients with Retinal Vein Occlusion: A Case-Control Study

Purpose: The purpose of this study was to evaluate health-related quality of life in patients with retinal vein occlusion (RVO) and investigate the possible risk factors for poor quality of life in patients with RVO.Methods: Participants in the study were 67 patients with RVO, 42 male and 25 female, mean-aged 73.1 ± 10.9 years, and 70 sex- and age-matched controls. Demographic data, lifestyle factors and medical history were recorded. All patients underwent best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography. All participants completed two questionnaires assessing quality of life (EQ-5D, NEI VFQ-25). Risk factors for health-related quality of life in RVO patients were investigated.Results: Patients with RVO exhibited significantly lower composite score for VFQ-25 compared to controls (74.1 ± 3.8 vs. 91.7 ± 3.9 for patients and controls, respectively, p < .001). In addition, RVO patients had significantly lower EQ-5D Index score compared to controls (0.88 ± 0.15 vs. 0.92 ± 0.12 for patients and controls, respectively, p = .043). Risk factors associated with quality of life in patients with RVO were found the alcohol consumption, the presence of thyroidopathy, coagulation disorders, visual acuity in the eye with RVO, central retinal thickness, the type of edema, the presence of ischemia and the condition of external limiting membrane. In multivariate analysis, only alcohol consumption and visual acuity in the eye with RVO were found to be independent risk factors, affecting quality of life in RVO patients.Conclusions: Patients with RVO presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and their early detection may improve quality of life in such patients and lead to targeted health policies.

Quality of life in stable and progressive 'early-stage' keratoconus patients

PURPOSE

To analyse the vision-related quality of life (vr-QoL) in stable and progressive keratoconus (KC) patients with a still good visual acuity.

METHODS

Combined prospective/cross-sectional study design. The Refractive Status and Vision Profile (RSVP) and the National Eye Institute Visual Functioning - 25 (NEI-25) questionnaire were used in 16 emmetropic, 32 myopic and 56 KC patients, whereby KC patients with a stable (n = 26) and patients with a progressive stage (n = 30) and some of them before and after corneal cross-linking (CXL; n = 10) were included. All patients had a DCVA in at least one eye of ≥0.7 (decimal chart).

RESULTS

The analyses revealed a minor decline of the vr-QoL from emmetropes to myopes to early KC patients with a stable disease. Nonetheless, sociological subscales (i.e. 'social functioning', 'role difficulties' and 'dependency') did not display statistically significant differences comparing these groups. In progressive KC, we could demonstrate a statistically significant decline also of these sociological subscales, which did not improve after CXL.

CONCLUSION

Due to a still high and almost unaffected vr-QoL in early KC patients and the distinct decline after progression without rehabilitation after CXL, a reconsideration of current strategies to perform CXL only after a progression is diagnosed should be re-evaluated.

APPLICATION OF MODIFIED NEI VFQ-25 AFTER RETINAL DETACHMENT TO VISION-RELATED QUALITY OF LIFE

PURPOSE

We examined the postoperative visual recovery and quality of life after retinal detachment (RD) surgery.

METHODS

In addition to a baseline clinical examination, patients filled out the National Eye Institute Visual Functioning Questionnaire at three time points: preoperatively and 1 and 3 months postoperatively (M1 and M3, respectively). We analyzed the composite score and short-form scores (socioemotional scale [SFSES] and visual functioning scale [SFVFS]).

RESULTS

One hundred ninety-four patients were enrolled in this study; 47 (26 macula-ON RD and 21 macula-OFF RD) returned all three questionnaires. The best corrected visual acuity was Snellen equivalent 20/25, 20/25, and 20/20 at the preoperative, M1, and M3 assessment, respectively. At M3, we found a positive correlation between SFSES and best corrected visual acuity measures among macula-OFF patients (P < 0.001, R2 = 0.58). A significant correlation with the best corrected visual acuity among macula-ON patients was observed only at M3 with the SFVFS score (P < 0.001, R2 = 0.41).

CONCLUSION

The quality of life differs between ON and OFF RD in regard to the composite score and especially SFSES and SFVFS. We found a transient decrease in the quality of life at M1 for macula-ON patients, whereas the quality of life improved throughout follow-up among macula-OFF patients. These data may help improve the management of patients' expectations after RD surgery.

Update on Contact Lens Treatment of Keratoconus

Keratoconus (KC) is a progressive disease that leads to a decrease in visual acuity and quality and impairs vision-related quality of life. Contact lens (CL) application has a primary place and importance in the correction of the optic problems due to the disease. The corneal changes and increased irregular astigmatism that occur with KC progression necessitate special CL designs and fitting methods. In addition to disease stage, the patient's lens tolerance also plays a role in the application of CLs in KC patients. With recent advances in materials and design technology, the CLs used in the treatment of KC have developed considerably and there are various types available. In this review, we discuss the wide range of CLs, including rigid and soft lenses, hybrid and scleral lenses, and even custom lens designs, in light of recent scientific advances.

Stress and vision-related quality of life in acute and chronic central serous chorioretinopathy

BACKGROUND

To compare vision-related quality of life (VRQOL) between acute and chronic Central serous chorioretinopathy (CSC) and correlate this with Cohen's Perceived Stress Scale (PSS) questionnaire.

METHODS

Patients who were diagnosed with both acute and chronic CSC were recruited in this study. Vision-related quality of life (VRQOL) was assessed with Rasch revised National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ25) and perceived stress with Cohen's PSS questionnaire in 118 subjects with either acute or chronic CSC. The quality of life score was compared between patients with acute and chronic CSC. Correlations between the functional score and visual acuity (VA), stage of CSC, and stress were studied.

RESULTS

There was no significant difference in VRQOL between Acute and Chronic CSC. In Acute CSC, affected eye VA correlated significantly with near vision question of the visual function subscale. Better eye VA correlated significantly with distance vision, social function, role limitation and dependency of the socioeconomic subscale. In chronic CSC, affected eye VA correlated with social function question of the socioemotional subscale and the better eye VA correlated with driving and distance vision of the visual function subscale. No other significant correlations with VA were noted. No correlations were observed between outcome of Cohen's PSS questionnaire and NEI-VFQ25 scores of acute and chronic CSC.

CONCLUSION

The VRQOL is similar between acute and chronic CSC. Perceived stress was not found to influence the VRQOL in CSC.

Assessment of Visual Quality in Eyes with Forme Fruste Keratoconus and Mild and Moderate Keratoconus Based on Optical Quality Analysis System II Parameters

Purpose

The study aimed to evaluate the visual quality of forme fruste keratoconus (FFK) and mild and moderate keratoconus by using an optical quality analysis system II (OQAS-II) and to explore the correlation between optical quality parameters and the disease progression.

Methods

Twenty-one normal eyes, twenty-one FFK eyes, twenty-one mild keratoconus eyes, and twenty-one moderate keratoconus eyes were included in this prospective study. The optical quality parameters, such as object scatter index (OSI), modulation transfer function cutoff (MTF cutoff), strehl ratio (SR), and OQAS-II values at contrasts of 100% (OV-100), 20% (OV-20), and 9% (OV-9), were measured by OQAS-II. The repeatability of these parameters was analyzed by intraclass correlation coefficient (ICC), repeatability coefficient (RC), and coefficient of variation (CV_w). Correlations between optical quality parameters and mean central keratometry readings (K_mean) were evaluated. The sensitivity and specificity of the parameters were analyzed using the receiver operating characteristic (ROC).

Results

All the optical quality parameters among four groups showed good repeatability (all ICC≥0.75). The MTF cutoff, SR, OV-100, OV-20, OV-9 in FFK, mild and moderate keratoconus eyes were significantly lower than those in the normal group (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all K_mean) were evaluated. The sensitivity and specificity of the parameters were analyzed using the receiver operating characteristic (ROC). r = −0.710, P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all

Conclusion

The repeatability of OQAS-II is good in measuring visual quality of normal as well as FFK, mild, and moderate keratoconus. The visual quality of the FFK, mild, and moderate keratoconus is worse than that in normal eyes. The OQAS-II has the potential value in screening FFK from normal eyes and might be a useful tool for evaluating the progression of keratoconus.

Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective

INTRODUCTION

Visual acuity (VA) and refractive error (RE) remain important parameters in the management of keratoconic (KC) patients. Despite rapid amelioration in capacity of diagnostic equipment, these remain inaccessible to the majority of practitioners in low-income countries. Notwithstanding limitations, practitioners are expected to utilize existing resources to satisfactorily manage their increasing numbers of keratoconic patients.

PURPOSE

To determine the changes in visual acuity and refractive errors with diagnostic and management options available in low-income contexts.

METHODS

A descriptive, retrospective chart analysis of medical records dating back 5 years was employed in this study. Records of patients prescribed with corneal rigid gas permeable (RGP) and scleral lenses were analyzed. Data on age, gender, stage of keratoconus, pre-, and post-visual acuities and refractive errors, mode of correction and lens parameters were evaluated.

RESULTS

A total of 124 medical records were analyzed. Males comprised 58.9% and females 41.1% of the total sample, with a mean age 20.86 ± 9.50 years. The mean unaided VA in logMAR notation was 1.0±0.19, while corrected VA was 0.18±0.17. There was a significant improvement (p=0.001) in VA with corneal RGP contact lenses (mean 0.19±0.17) as compared to unaided VA (mean 1.29±0.20). Scleral lens VA also improved from a median of 1.06 to -0.01 logMAR; p=0.001. The mean RE before RGP contact lens fitting was -9.43±2.37 diopters (D) which improved to -0.41±0.78D. RE reduced significantly (p=0.001) after fitting with both corneal RGP lenses (from a mean of -9.80±4.46D to -0.45±0.80D) and scleral lenses (from a median of -8.00D to -0.02D).

CONCLUSION

Significantly improved visual acuity and refractive error status were achieved with all KC patients. Despite the diagnostic equipment and contact lenses design limitations, practitioners in low-income contexts can fit the relatively more affordable corneal RGP lenses to positively impact the daily living experiences of their KC patients.

Keratoconus Screening Among Myopic Children

Aim

To assess the topographic corneal changes and the incidence of keratoconus among children with high myopia.

Settings

It is a prospective study, in which 174 eyes of children with high myopia were studied in the period between August 2015 and June 2018.

Methods

All patients were examined to assess the refractive error and corneal examination using Scheimpflug camera to evaluate different corneal parameters.

Results

Studied children aged between 6 and 14 years (11.05±1.98). Males represented 54% of the cases (n=94). The mean spherical error was −7.75±2.97 ranging from −6 to −13.50D. The mean cylindrical error was −4.12±1.78D (−1 to −8). Regarding corneal examination, data recorded were those about maximum K reading (k_max), thinnest location, highest anterior and posterior elevation in 4mm zone, and higher-order corneal aberrations. Analysis of the obtained data revealed 16 eyes (9.2%) with keratoconus. These eyes were considered as a separate group and compared with the remaining eyes. There was significant difference in k_max (p= 0.03), anterior elevation, and posterior elevation (p=0.01 for both). Regarding myopia or astigmatism, there were no significant differences when compared with normal eyes. But high myopia with low astigmatism were found in five eyes of them (31.2%). The main statistically different aberrations were vertical coma (−2.04±0.99) (p=0.01) and spherical aberrations (−0.9±0.78) (p=0.02). Regarding gender, there were 11 eyes in boys (68.7%), and this was statistically significant (p=0.01). Vernal keratoconjunctivitis with frequent eye rubbing was found in 6 eyes (37.5%).

Conclusion

Children with high myopia irrespective of the degree of astigmatism may have corneal abnormalities which are more pronounced in cases with vernal keratoconjunctivitis. Corneal examination should be performed for highly myopic children to detect any corneal abnormality and to treat it as early as possible.

Transcriptional profiling of corneal stromal cells derived from patients with keratoconus

Keratoconus (KC) is a multi-factorial corneal ectasia with unknown etiology affecting approximately 1:2000 people worldwide. Dysregulated gene expression, using RNA-Seq technology, have been reported in KC corneal tissue. However, the differential expression of genes, in KC corneal stromal cells have been widely ignored. We utilized mRNA-Seq to analyze gene expression in primary human corneal stromal cells derived from five non-Keratoconus healthy (HCF) and four Keratoconus (HKC) donors. Selected genes were further validated using real time PCR (RT-PCR). We have identified 423 differentially expressed genes with 187 down- and 236 up-regulated in KC-affected corneal stromal cells. Gene ontology analysis using WebGestalt indicates the enrichment of genes involved in cell migration, extracellular matrix, adherens junction, and MAPK signaling. Our protein-protein interaction network analysis identified several network seeds, such as EGFR, NEDD4, SNTA1, LGALS3BP, HSPB1, SDC2, MME, and HIF1A. Our work provides an otherwise unknown information on the transcriptional changes in HKCs, and reveals critical mechanisms of the cellular compartment. It also highlights the importance of human-based in vitro studies on a disease that currently lacks strong biomarkers and animal models.

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.

Risk Factors for Poor Quality of Life among Patients with Age-Related Macular Degeneration

PURPOSE

The purpose of this study was to evaluate the quality of life in patients with age-related macular degeneration (AMD) and compare it with that of healthy controls. Additionally, our study aims to investigate the possible risk factors for poor quality of life in AMD patients.

METHODS

Participants in the study were 114 patients with AMD, 63 male and 51 female, mean-aged 76.5 ± 6.1 years. Demographic data, lifestyle factors, and medical history were recorded. All patients underwent a routine examination for AMD, including best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography, and completed three questionnaires assessing quality of life (SF-36, EQ-5D, NEI VFQ-25). In addition, 100 controls, adjusted for gender and age, were included in the study. Risk factors for quality of life in AMD patients were investigated. Univariate analysis was performed using SPSS 22.0.

RESULTS

Patients with AMD scored lower in vision- and health-related quality-of-life questionnaires compared to controls. Risk factors associated with quality of life in patients with AMD were found to be the female gender, alcohol consumption, the presence of hypertension, diabetes mellitus, cardiovascular diseases, myosceletal problems, migraine, anxiety/depression, subretinal or intraretinal fluid, pigment epithelium detachment, previous treatment for AMD, visual acuity, the stage of the disease, and the integrity of the ellipsoid zone.

CONCLUSION

Patients with AMD presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and clinicians should thus focus on the most vulnerable subgroups.

Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

Purpose. To evaluate the visual and refractive outcomes after small incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism after penetrating keratoplasty (PKP). Design. Case-series. Methods. Ten eyes of 10 patients with previous PKP and residual myopic astigmatism for whom pentacam imaging and thickness measurements were acceptable for laser vision correction. Manifest refraction (MR), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained preoperatively and one day, one week, and one, 3, and 6 months postoperatively. Cases were operated on the VisuMax® femtosecond laser platform with 500 kHz repetition rate. Results. The mean correction ratio for spherical errors was 0.84 ± 0.19 D and for the mean refractive spherical equivalent (MRSE) was 0.79 ± 0.13 D. Vector analysis showed a mean astigmatism reduction at the intended axis of 67 ± 25.25%, a correction index of 0.81 ± 0.21, and an overall mean percentage of success of astigmatism surgery of 53 ± 37.9%. The postoperative MRSE was stable throughout the 6-month follow-up period. The efficacy index was 0.93 and the safety index was 1.12. Conclusion. SMILE for correction of post-PKP myopia and astigmatism is effective, safe, and stable with moderate accuracy and predictability. Centration of the treatment within the grafts was easily performed.

Impact of Ocular Chronic Graft-versus-Host Disease on Quality of Life

Ocular involvement can be quite symptomatic in patients with chronic graft-versus-host disease (GVHD). The prevalence of and risk factors for ocular GVHD and its impact on quality of life (QOL) in patients with chronic GVHD were studied in a prospective, multicenter, longitudinal, observational study. This study enrolled 342 patients with 1483 follow-up visits after allogeneic hematopoietic cell transplantation. All patients in this analysis were diagnosed with chronic GVHD requiring systemic treatment and enrolled within 3 months of chronic GVHD diagnosis. The symptom burden of ocular GVHD was based on the degree of dry eye symptoms, frequency of artificial tear usage, and impact on activities of daily living. Patients' QOL was measured by self-administered questionnaires. Variables associated with ocular GVHD at enrollment and subsequent new-onset ocular GVHD and the associations with QOL were studied. Of the 284 chronic GVHD patients, 116 (41%) had ocular GVHD within 3 months of chronic GVHD diagnosis ("early ocular GVHD"). Late ocular GVHD (new onset > 3 months after chronic GVHD diagnosis) occurred in 64 patients. Overall cumulative incidence at 2 years was 57%. Female gender (P = .005), higher acute GVHD grade (P = .04), and higher prednisone dose at study entry (P = .04) were associated with early ocular GVHD. For patients who did not have ocular GVHD within 3 months of chronic GVHD diagnosis, presence of prior grades I to IV acute GVHD (HR 1.78, P = .04) was associated with shorter time to late ocular GVHD, whereas female donor-male recipient (HR .53, P = .05) was associated with longer time to late ocular GVHD onset. Using all visit data, patients with ocular GVHD had worse QOL, as measured by Functional Assessment of Cancer Therapy Bone Marrow Transplantation (P = .002), and greater chronic GVHD symptom burden, as measured by the Lee symptom overall score excluding the eye component (P < .001), compared with patients without ocular GVHD. In conclusion, this large, multicenter, prospective study shows that ocular GVHD affects 57% of patients within 2 years of chronic GVHD diagnosis. Women, patients on higher doses of prednisone at study entry, and those with a history of acute GVHD were at higher risk for ocular GVHD. Strong evidence suggests that ocular GVHD is associated with worse overall health-related QOL.

Changes in vision related quality of life in patients with diabetic macular edema: ranibizumab or laser treatment?

PURPOSE

To compare the changes in vision related quality of life (VR-QoL) in patients with diabetic macular edema (DME) undergoing intravitreal ranibizumab (IVR) injection or focal/grid laser.

MATERIAL AND METHODS

In this prospective study, 70 patients with clinically significant macular edema (CSME) were randomized to undergo IVR injection (n=35) and focal/grid laser (n=35). If necessary, the laser or ranibizumab injections were repeated. Distance and near visual acuities, central retinal thickness (CRT) and The 25-item Visual Function Questionnaire (VFQ-25) were used to measure the effectiveness of treatments and VR-QoL before and after 6 months following IVR or laser treatment.

RESULTS

The demographic and clinical findings before the treatments were similar in both main groups. The improvements in distance and near visual acuities were higher in IVR group than the laser group (p<0.01). The reduction in CRT in IVR group was higher than that in laser treatment group (p<0.01). In both groups, the VFQ-25 composite score tended to improve from baseline to 6 months. And at 6th month, the changes in composite score were significantly higher in IVR group than in laser group (p<0.05). The improvements in overall composite scores were 6.3 points for the IVR group compared with 3.0 points in the laser group. Patients treated with IVR and laser had large improvements in composite scores, general vision, near and distance visual acuities in VFQ-25 at 6 months, in comparison with baseline scores, and also mental health subscale in IVR group.

CONCLUSION

Our study revealed that IVR improved not only visual acuity or CRT, but also vision related quality of life more than laser treatment in DME. And these patient-reported outcomes may play an important role in the treatment choice in DME for clinicians.

Coping style and quality of life in elderly patients with vision disturbances

Purpose. This study aims at evaluating coping style and quality of life in patients with glaucoma and cataract. Methods. The participants were patients (N = 237, 130F; mean age: M = 67,8; SD = 9,5) with low vision caused by cataract (N = 188) and glaucoma (N = 49) who answered the Quality of Life Questionnaire (QOLQ) by Schalock and Keith. The participants were divided by means of cluster analysis (k-means) according to coping styles measured by CISS (Endler and Parker) into three groups: (1) high mobilization for coping, (2) task-oriented coping, and (3) low mobilization for coping. Results. In all the group, a general quality of life was moderately lowered; however, in task-oriented group it was relatively high. Moreover, task-oriented group had significantly lower level of anxiety (STAI), hopelessness (HS), and loneliness (UCLA LS-R) and higher level of self-esteem (SES) in comparison to the patients from high mobilization and low mobilization for coping. Conclusions. In an old age, adaptive coping with vision disturbances does not necessarily mean flexibility in combining all coping styles, but rather task-oriented coping and an ability to use social support. Extreme mobilization for coping seems not adaptive similarly like low mobilization for coping because it violates balance between environmental requirements and personal resources.