DESIGN: Retrospective interventional case series.
PARTICIPANTS: Five patients with visual disturbances resulting from a benign, well-circumscribed orbital apex tumor (3 cases of cavernous hemangioma and 2 cases of schwannoma).
METHODS: Each patient treated with GKRS with a total radiation dose of 20 Gy in 4 sessions (5 Gy in each session with an isodose line of 50%) delivered to the tumor margin.
MAIN OUTCOME MEASURES: Best-corrected visual acuity, visual field changes, orbital imaging, tumor growth control, and side effects of radiation.
RESULTS: All patients demonstrated improvement in visual acuity, pupillary responses, color vision, and visual field. Tumor shrinkage was observed in all patients and remained stable until the last follow-up. No adverse events were noted during or after the radiosurgery. None of the patients experienced any radiation-related ocular morbidity.
CONCLUSIONS: From this experience, multisession GKRS seems to be an effective management strategy to treat solitary, benign, well-circumscribed orbital apex tumors.
METHODS: Observational study. Nonglaucomatous patients on NIPD underwent systemic and ocular assessment including mean arterial pressure (MAP), body weight, serum osmolarity, visual acuity, IOP measurement, and ASOCT within 2 hours both before and after NIPD. The Zhongshan Angle Assessment Program (ZAAP) was used to measure ASOCT parameters including anterior chamber depth, anterior chamber width, anterior chamber area, anterior chamber volume, lens vault, angle opening distance, trabecular-iris space area, and angle recess area. T tests and Pearson correlation tests were performed with P<0.05 considered statistically significant.
RESULTS: A total of 46 eyes from 46 patients were included in the analysis. There were statistically significant reductions in IOP (-1.8±0.6 mm Hg, P=0.003), MAP (-11.9±3.1 mm Hg, P<0.001), body weight (-0.7±2.8 kg, P<0.001), and serum osmolarity (-3.4±2.0 mOsm/L, P=0.002) after NIPD. All the ASOCT parameters did not have any statistically significant changes after NIPD. There were no statistically significant correlations between the changes in IOP, MAP, body weight, and serum osmolarity (all P>0.05).
CONCLUSIONS: NIPD results in reductions in IOP, MAP, body weight, and serum osmolarity in nonglaucomatous patients.
METHODS: This cross-sectional study was conducted including 34 healthy participants with a mean age of 22.26 ± 1.88 years. AA was measured using dynamic retinoscopy and the push-up, pull-away, modified push-up, and minus-lens techniques.
RESULTS: The mean AA scores for the push-up, pull-away, minus-lens, and modified push-up techniques and dynamic retinoscopy were 11.38 ± 2.03, 10.35 ± 1.64, 9.24 ± 1.18, 8.26 ± 1.44, and 7.2 ± 1.0 diopters, respectively. No AA measurements showed significant difference among ethnicities (Chinese, Malay, and Indian). This study suggested that AA obtained using push-up (p = 0.005) and pull-away (p = 0.017) methods and dynamic retinoscopy (p = 0.041) were significantly different according to sex. No significant difference was observed in AA for the minus-lens (p = 0.051) and modified push-up (p = 0.216) techniques by sex. A moderately negative correlation was found between AA and age for the push-up (r = -0.434, p = 0.010), pull-away (r = -0.412, p = 0.016), and minus-lens (r = -0.509, p = 0.002) techniques and dynamic retinoscopy (r = -0.497, p = 0.003). A weak negative correlation was found between age and AA measured using a modified push-up technique (r = -0.393, p = 0.022).
CONCLUSIONS: Mean AA was highest for the push-up technique, followed by the pull-away technique, the minus-lens technique, the modified push up technique, and dynamic retinoscopy. The push-up and pull-away methods and dynamic retinoscopy showed a significant difference in measurement of AA between sexes.
METHODS: This cross-sectional study was conducted on 171 primary angle closure patients (268 eyes). Visual acuity, refraction, and ocular biometry (central anterior chamber depth [ACD], axial length [AL], and lens thickness) were recorded. Vitreous cavity length (VL) and relative lens position (RLP) were calculated.
RESULTS: A total of 92 Primary Angle Closure Suspect (PACS), 30 Primary Angle Closure (PAC), and 146 Primary Angle Closure Glaucoma (PACG) eyes were included. Chinese ethnicity formed the majority (n = 197, 73.5%), followed by Malay (n = 57, 21.3%) and Indian (n = 14, 5.2%). There was a significant female preponderance with a female to male ratio of 1.85. Mean age was 65.7 ± 7.7 years. Mean spherical equivalent was +0.33 ± 1.29 D. Approximately half (n = 137, 51%) of the eyes were hyperopic (spherical power ≥+0.5), with PACG having the highest percentage of hyperopia (n = 69, 50.4%). Myopia and emmetropia were present in 48 (17.9) and 83 (31%) eyes, respectively. Although AL and VL in myopia patients were significantly longer than emmetropic and hyperopic eyes (p < 0.001), the ACD was not significantly different (p = 0.427). While the RLP is smaller in myopic eyes, lens thickness was increased in hyperopic eyes. PACG was significantly higher in elderly patients compared to PACS and PAC (p = 0.005). A total of 37 (13.8%) eyes were blind (vision worse than 3/60) and 19 of them (51.3%) were female patients.
CONCLUSION: A decrease in RLP is predictive of angle closure disease in myopic eyes, whereas increased lens thickness contributes to angle closure disease in hyperopic eyes.
Methods: A new Hindi visual acuity chart was designed to logMAR specifications using Hindi optotypes experimentally selected to have similar relative legibility under equivalent spherical and cylindrical defocus. The chart calibration study was carried out in a large clinical setup in India. Participants who were literate in English and Hindi participated in the study. Visual acuity was measured with the new Hindi logMAR chart and a modified ETDRS (m-ETDRS) logMAR chart. The method of presentation was randomized between the charts. Repeat visual acuity was measured on a subsequent day with a second version of the Hindi logMAR chart.
Results: The Hindi logMAR chart correlated highly with the m-ETDRS logMAR chart (r2 = 0.92); however, the mean visual acuity difference (Hindi logMAR-m-ETDRS logMAR) was nearly one and half lines (0.13 logMAR, 95% confidence interval [CI] = ±0.15 logMAR). The Hindi logMAR chart also proved to be highly repeatable (r2 = 0.99; mean difference 0.005, 95% CI = ±0.04 logMAR).
Conclusion: This study reports the first standardized visual acuity chart developed in Hindi incorporating equal letter legibility and logMAR chart design features. The Hindi logMAR visual acuity chart provides a valid and repeatable tool for the measurement of visual acuity in native Hindi language speakers. Future use of the new Hindi chart should incorporate an increase in optotype size of 0.13 logMAR.
METHODS: The records of 126 eyes from 54 male and 72 female eyes were studied retrospectively, ranging from 6 months to 3 years post-PRK. Refractive errors ranged from low to high myopia and astigmatism, and proper and careful preoperative selection of patients was made. A single standard ablation zone (AZ) of 6.00 mm and transition zone (TZ) of 7.00 mm was made in all cases.
RESULTS: The study population showed a high degree of accuracy in visual outcome. In simple myopia, 92.3% of female eyes and 84.1% of male eyes had a visual acuity of more than 6/9 or better. In myopia with astigmatism, 83.05% of female and 65.9% of male eyes had a visual acuity of 6/9 (20/40) or better. However, despite the residual myopia, whether with or induced astigmatism, post PRK visual acuity seemed to be less influenced by it, than as in the pre-PRK status.
CONCLUSION: This study showed an accuracy in visual outcome of > 90% for females and > 80% for males. The Nidek EC-500 was satisfactory for its purpose.
METHODS: A 45-year-old man who had undergone LASIK 5 years previously presented with blurred distance vision. Unaided vision in the right eye was 20/329-2) and 20/20 in the left eye. He enrolled for NeuroVision treatment (NeuroVision Pte Ltd, Singapore), a computer-based interface in which a repetitive set of visual excerises is performed for 10 to 12 weeks.
RESULTS: After 35 sessions, unaided visual acuity in the right eye was 20/16(-3) and 20/20(-1) in the left eye, representing 2.8 lines of improvement in the right eye and 1.6 lines in the left eye.
CONCLUSIONS: NeuroVision, a noninvasive treatment based on the concept of perceptual learning, is a benefit in cases in which surgical enhancement is not recommended.
METHODS: This was a 24-month, phase 4, open-label, single-arm, prospective, observational study conducted at 20 specialised retinal centres in Japan. Participants were 209 patients with DME and impaired VA, not previously treated with either intravitreal or systemic anti-vascular endothelial growth factor (anti-VEGF) agents, who initiated ranibizumab 0.5 mg per investigator discretion. Following ranibizumab administration, patients were treated per routine clinical practice. Other treatments were allowed. The main outcome measure was the mean change in best-corrected VA (BCVA) in logarithmic minimum angle of resolution (logMAR) from baseline to month 12. An exploratory objective was to assess patients' psychological status using the Hospital Anxiety and Depression Scale (HADS).
RESULTS: The mean ± standard deviation BCVA at baseline was 0.43 ± 0.39 logMAR. The mean number of injections of ranibizumab and anti-VEGF agents from baseline to month 11 was 3.2 ± 2.0 and 3.6 ± 2.4, respectively. The BCVA change from baseline to 12 months was - 0.08 ± 0.34 logMAR (p = 0.011), showing a significant improvement; the HADS-anxiety score also decreased significantly (p = 0.001) and the depression score decreased numerically (p = 0.080).
CONCLUSION: MERCURY study data confirm the effectiveness of real-world treatment initiated with ranibizumab in Japanese patients with DME. In addition, treatment was able to positively influence anxiety via VA improvement.
METHODS: Multi-centre retrospective cohort study of RP patients at initial presentation. Disease severity was scored using ellipsoid zone (EZ) width on SD-OCT and logistic regression used to determine risk factors for advanced disease at presentation.
RESULTS: A total of 146 unrelated RP patients were included. Median age at onset and presentation was 40.5 (range 1-74) and 50.1 (range 3.9-81.8), respectively. Severe disease (<5° of remaining EZ width) was present in 28.1% of cases at presentation. Patients with family history of RP had greater odds of severe disease (OR 3.29, 95% CI 1.56, 6.95; p = 0.002), while male gender, race, age, syndromic features, and socioeconomic status did not. Patients with affected siblings (median EZ width 6.2°; p = 0.01), but not affected parents (median EZ width 9.4°; p = 0.99), presented with severe EZ loss compared to patients without family history (median EZ width 13.1°). Patients with affected siblings had delayed presentation (≥5 years; OR 5.76, 95% CI 1.817, 18.262; p = 0.003) compared to patients without family history.
CONCLUSIONS: Family history influences the stage of disease at which RP patients initially seek ophthalmology review. This has implications for patient counselling and the number of patients who may benefit from future therapies.
METHODS: Both eyes of patients with myopic MNV diagnosed with fluorescein angiography (FA), SD OCT and OCTA were assessed by unmasked investigators. The images were deidentified and randomised before graded by masked investigators, who determined the presence of active myopic MNV by using SD OCT together with OCTA without FA and by FA alone, respectively. The findings of masked investigators were compared with unmasked investigators.
RESULTS: 213 eyes of 110 patients comprising 499 imaging episodes were eligible for grading. For diagnosing new-onset myopic MNV without FA, combined use of SD OCT and OCTA had a sensitivity of 0.94, specificity of 0.84 and area under the curve (AUC) of 0.92. FA had a sensitivity of 0.52 (p<0.01), specificity of 0.80 (p=0.38) and AUC of 0.66 (p<0.01). For recurrent myopic MNV, the combination of SD OCT and OCTA had a sensitivity of 0.98, specificity of 0.78 and AUC of 0.88. FA had a sensitivity of 0.50 (p=0.04), specificity of 0.76 (p=0.85) and AUC of 0.63 (p=0.01). Myopic traction maculopathy was more frequently associated with recurrent myopic MNV (p<0.01).
CONCLUSION: SD OCT with dense volumetric scan was highly sensitive for diagnosing myopic MNV. The addition of OCTA improved the diagnostic specificity without FA. Monitoring of the longitudinal changes on SD OCT and judicious use of FA is a reliable surveillance strategy for myopic MNV.
METHODS: This was a cross-sectional observational study on patients with Type II diabetes mellitus from October 2020 to May 2021. Data collected include systolic/diastolic blood pressure, visual acuity, glycated hemoglobin, and central macular thickness. Diabetic retinopathy severity was categorized using the Early Treatment Diabetic Retinopathy Study classification. Photoplethysmography signals were acquired using pulse-oximeter modules (OEM-60; Dolphin Medical, Inc) measured for 90 seconds at 275 Hz sampling rate and 16-bit resolution, which records photoplethysmography fitness index, vascular risk prediction index, and vascular age.
RESULTS: One hundred and forty-one patients were equally distributed into six DR categories. Mean age was 58.8 ± 9.9 years, with female-to-male ratio of 1.27. There were significant differences in mean systolic (125.5 ± 10.0 mmHg, P = 0.007) and diastolic blood pressure (80.0 ± 8.8 mmHg), mean glycated hemoglobin (7.6 ± 1.9%, P = 0.005), median log unit of minimal angle of resolution (0.3, interquartile range: 0.2-0.5, P < 0.001), and central macular thickness ( P = 0.003) across DR severity. Significant differences were also seen in photoplethysmography fitness index ( P = 0.001), vascular risk prediction index ( P < 0.001), and vascular age ( P = 0.001), with poorer values in severe compared with mild/moderate DR. After adjusting for age, blood pressure, and glycated hemoglobin, photoplethysmography fitness reduces by 3.3% (regression coefficient, b = -3.27, P < 0.001), vascular age increases by 2.5 years ( b = 2.54, P = 0.002), and vascular risk prediction index increases by 3.1 ( b = 3.08, P < 0.001) with every DR worsening.
CONCLUSION: More severe DR stages were associated with poorer photoplethysmography vascular markers.