Journal of Ophthalmic and Vision Research (JOVR)

Editorial – The Mystification of Multifocal IOLs Needs Unfolding

2024-06-21T11:55:22+00:00

This is an Editorial and does not have an abstract. Please download the PDF or view the article in HTML.

Effect of Computer Tasks in Straight Gaze on Corneal Topographic Indices

2024-06-21T11:55:23+00:00

Purpose: To investigate the effect of the near visual task of movie-watching in the straight gaze position on corneal topographic parameters.

Methods: Thirty myopic young adults with an average age of 25.10 ± 4.13 years were recruited for the study. The designed near visual task consisted of watching a movie in the straight gaze position at a distance of 40 cm for 30 minutes. Corneal topography was performed using Oculus Keratograph 4 (OCULUS, Wetzlar, Germany) before and immediately after watching the movie, as well as at 10, 20, and 30 minutes intervals after completing this near visual task. Zernike coefficients, asphericity indices, refractive parameters, and diagnostic indices of keratoconus were recorded for statistical analysis.

Results: Movie-watching at a close distance solely using the straight gaze position had no effect on Zernike coefficients (P > 0.130). Also, watching the movie had no effect on other corneal topography parameters including irregularities (P = 0.208), spherical eccentricity (P = 0.270), maximum decentration (P = 0.553), axis of maximum decentration (P = 0.186), peripheral astigmatism (P = 0.179), and average asphericity of the quadrants at 10 to 30º (P > 0.163).

Conclusion: The results of the present study showed that watching movies in the straight gaze position had no effect on corneal topographic parameters and did not cause errors in corneal topographic measurements.

Clinical and Visual Outcomes of Four Presbyopia Correcting Intraocular Lenses

2024-06-21T11:55:23+00:00

Purpose: To compare objective and subjective outcomes of the multifocal intraocular lenses ReSTOR SN6AD1 and Tecnis ZKB00, extended depth of focus IOL Symfony ZXR00, and trifocal IOL PanOptix TFNT00.

Methods: This study included 262 patients (524 eyes) who had phacoemulsification with IOL implantation, 128 eyes with SN6AD1, 124 eyes with ZKB00, 136 eyes with ZXR00, and 136 eyes with TFNT00. Objective outcomes included one-month postoperative uncorrected (U) and corrected (C) distance (D) and near (N) visual acuities (VA). Subjective outcomes included photic phenomena, spectacle use, and spectacle-independent visual function.

Results: Spectacle use (%) in the SN6AD1, ZKB00 ZXR00, and TFNT00 groups was 39, 64, 87, and 37 respectively (P < 0.0001). Presence of photic phenomena (%) for SN6AD1, ZKB00, ZXR00, and TFNT00 was 66, 61, and 67, and 73, respectively (P = 0.57). Spectacle-independent mean VF- 14 score (%) for SN6AD1, ZKB00, ZXR00, and TFNT00 was 89.5, 87.2, 80.9, and 83.6, respectively (P < 0.01).

Conclusion: All four IOLs provided excellent postoperative visual acuity and equally high rates of photic phenomena. SN6AD1 and TFNT00 provided the least spectacle use while ZXR00 had the highest spectacle use.

Evaluation of Intrascleral Lakes after Phaco-Viscocanalostomy using Anterior Segment Optical Coherence Tomography

2024-06-21T11:55:23+00:00

Purpose: This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary openangle glaucoma (POAG).

Methods: In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup–disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up.

Results: A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P < 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant.

Conclusion: This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm’s canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

Clinical Validation of a Handheld Deep Learning Tool for Identification of Glaucoma Medications

2024-06-21T11:55:23+00:00

Purpose: To validate a convolutional neural network (CNN)-based smartphone application for the identification of glaucoma eye drop medications in patients with normal and impaired vision.

Methods: Sixty-eight patients with visual acuity (VA) of 20/70 or worse in at least one eye who presented to an academic glaucoma clinic from January 2021 through August 2022 were included. Non-English-speaking patients were excluded. Enrolled subjects participated in an activity in which they identified a predetermined and preordered set of six topical glaucoma medications, first without the CNN and then with the CNN for a total of six sequential measurements per subject. Responses to a standardized survey were collected during and after the activity. Primary quantitative outcomes were medication identification accuracy and time. Primary qualitative outcomes were subjective ratings of ease of smartphone application use.

Results: Topical glaucoma medication identification accuracy (OR = 12.005, P < 0.001) and time (OR = 0.007, P < 0.001) both independently improved with CNN use. CNN use significantly improved medication accuracy in patients with glaucoma (OR = 4.771, P = 0.036) or VA ≤ 20/70 in at least one eye (OR = 4.463, P = 0.013) and medication identification time in patients with glaucoma (OR = 0.065, P = 0.017). CNN use had a significant positive association with subjectreported ease of medication identification (X2(1) = 66.117, P < 0.001).

Conclusion: Our CNN-based smartphone application is efficacious at improving glaucoma eye drop identification accuracy and time. This tool can be used in the outpatient setting to avert preventable vision loss by improving medication adherence in patients with glaucoma.

Effect of Pulsed Low-Level Lasers on Adult versus Neonatal Human Retinal Pigment Epithelial Cells: An In-vitro Study

2024-06-21T11:55:23+00:00

Purpose: To investigate the short-term effects of low-level lasers (LLLs; also known as low-power laser therapy) on the structure, genetic, and phenotype of cultured human retinal pigment epithelial (hRPE) cells from both adult and neonatal sources.

Methods: Cultivated adult and neonatal hRPE cells were irradiated with two types of LLL (630 nm and 780 nm), 1 min daily for five consecutive days.

Results: An increase in doubling time was observed in 630 nm-irradiated adult hRPE cells (P = 0.032). The gene expression profile revealed increased expression of retinoid isomerohydrolase RPE65 (RPE65) (P < 0.01 for 630 nm laser, P < 0.001 for 780 nm laser) and nestin (NES) (P < 0.01 for 630 nm laser) in neonatal hRPE cells, upregulation of RPE65 (P < 0.001 for 780 nm laser) and paired box 6 (PAX6) (P < 0.001 for 780 nm laser) genes in adult hRPE cells, and reduced expression of actin alpha 2 (ACTA2) in 780 nm-irradiated adult hRPE cells (P < 0.001). Except for the significant increase of

Visual and Ocular Characteristics of Anisometropic Children

2024-06-21T11:55:24+00:00

Purpose: To compare the demographic and ocular characteristics of patients with low and high levels of anisometropia compared with non-anisometropic individuals.

Methods: This cross-sectional study was conducted on 1803 individuals (age range, 1 to 30 years) examined at strabismus clinics between January 2019 and December 2020. Of these, 203 subjects had anisometropia (11.2%); 66 cases were excluded due to the history of prior ocular surgery except from strabismus surgery. Finally, data from 137 subjects were analyzed. Spherical or cylindrical differences of 1.50 or 3.00D between the two eyes were defined as low or high anisometropia, respectively, and isometropic subjects (n = 1600) served as controls.

Results: No significant difference was observed between cases and controls regarding age (10.25 ± 8.41 vs. 9.2 ± 1.7 years; P = 0.133) and sex (P = 0.051). History of ocular surgery was present in 33% of anisometropic patients versus 0.8 % of isometropic cases. The rate of amblyopia was 83% and 2.3% in anisometropic and non-anisometropic groups, respectively. Best corrected visual acuity (BCVA) was comparable in amblyopic eyes in both study groups, while BCVA of nonamblyopic eyes of non-anisometropic subjects was better (non-anisometropic: 0.01 ± 0.01 vs. anisometropic: 0.06 ± 0.17 LogMAR; P = 0.001). Eye deviation was significantly more prevalent among anisometropic patients (36.5% vs. 3.25%, P < 0.001) and exotropia was the common type of deviation. Anisohyperopia and anisomyopia were the most common refractive errors under low and high anisometropia categories, respectively. Simultaneous manifestation of amblyopia and strabismus were observed in 30.6% of anisometropic cases, while only 0.7% of subjects with isometropia had a similar status (P < 0.001).

Conclusion: High rates of amblyopia and strabismus in anisometropic subjects, especially with higher degrees of anomaly, indicate the necessity of early visual acuity and refractive error screening to improve detection and enhance the outcomes of treatment.

Extraocular Muscle Transplantation Surgery for Primary Treatment of Extra Large-angle Squint

2024-06-21T11:55:24+00:00

Purpose: Large-angle horizontal ocular deviations will commonly require bilateral surgery to correct the primary ocular deviation. However, considering the need for full correction with one surgical procedure and patients’ reluctance to be operated on the good eye, such large horizontal ocular deviations may be managed with true muscle transplantation. The authors present a case series of patients who underwent this procedure and develop a surgical table to guide management.

Methods: Patients with horizontal squints measuring 80 prism diopters (PD) or larger in all age groups who underwent extraocular muscle transplantation surgery between January 2019 and June 2022 in Nigeria were included. Preoperative deviation of the squint, sensory evaluation, surgical dosage, and outcomes were documented. Part of the resected muscle was transplanted to give additional recession in the antagonist muscle. Success was defined as deviation corrected by 60% or more or postoperative ocular alignment within 10 PD or less, six weeks postoperatively.

Results: Fourteen patients with extra-large-angle strabismus were operated. Male/female ratio was 0.6:1. Mean preoperative deviation of 89.6 ± 9.3 collapsed to 6.6 ± 1.8 PD at six weeks and continued to improve to a mean deviation of 2.5 PD at six months postoperatively. When the subgroup of patients who were <18 years were analyzed, the outcome was equally successful; preoperative deviation of 89.4 PD collapsed to 1.4 PD, six months postoperatively. There were equal success rates when those with sensory strabismus were compared with those with binocular vision; preoperative deviation of 92.5 PD in the sensory group and 88.5 PD in the binocular group collapsed to 5.9 PD and 1 PD, respectively, six months after surgery.

Conclusion: A viable alternative for treating extra-large-angle strabismus in adults and children in developing countries was described with good postoperative outcome. In addition, a new expanded surgical dosage table for muscle transplantation surgery corrections of up to 130 PD was developed.

Effect of Induced Myopia on the Vestibulo-ocular Reflex Evaluated by Ocular Vestibular Evoked Myogenic Potential

2024-06-21T11:55:24+00:00

Purpose: The possible effects of refractive errors on vestibulo-ocular reflex (VOR) has been a conflicting issue. The aim of this study was to evaluate the effects of induced myopia on VOR using the ocular Vestibular Evoked Myogenic Potential (oVEMP).

Methods: In this cross-sectional quasi-experimental study, 35 emmetropic and normal subjects with the mean age of 23.89 ± 3.93 (range, 20–40 years) without any ocular, nervous system, and vestibular disorders, underwent the oVEMP test in the comprehensive rehabilitation center of Mashhad University of Medical Sciences. The oVEMP was performed under five different conditions of testing binocularly, monocularly, and when myopia was induced with the use of spherical lenses of +1.00, +3.00, and +5.00 diopters, respectively. There were 2 to 5 min of rest with closed eyes after each condition to avoid adaptation, fatigue, and any other sources of bias. Mean latencies of oVEMP waves (N1 and P1) and amplitudes of N1–P1 complex were measured.

Results: There was no significant difference between the right and left sides (P > 0.05). The induced myopia significantly increased the N1 and P1 latencies using lenses of +1.00, +3.00, and +5.00 diopters but the amplitudes of N1–P1 complex were not influenced by the different amounts of induced myopia. There was no significant difference among the different conditions of induced myopia either (P > 0.05).

Conclusion: Induced myopia could affect the VOR due to prolonging the latencies of oVEMP waves. However, the amplitudes were not affected and the effects of multiple degrees of induced myopia were not significantly different.

Elevated Smooth Pursuit Gain in Collegiate Athletes with Sport-related Concussion Immediately Following Injury

2024-06-21T11:55:24+00:00

Purpose: Although there is evidence that sport-related concussion (SRC) affects oculomotor function and perceptual ability, experiments are often poorly controlled and are not replicable. This study aims to test the hypothesis that there are decreased values when assessing oculomotor impairment indicating poorer performance in SRC patients.

Methods: Fifteen DI athletes presenting with SRC (7 females, 8 males) and 15 student volunteers (CON) (12 females, 3 males) completed a dynamic visual acuity (DVA) task that involved answering the direction of a moving stimulus (Landolt C) while wearing a head-mounted binocular eye tracker. There were 120 trials total with 60 trials presenting at 30º per second and 60 presenting at 90º per second. Various eye movement measurements, including horizontal smooth pursuit eye movements (SPEM) gain and saccadic peak velocity, were analyzed between groups using univariate ANOVAs. Saccade count in SPEM trials, accuracy, and vision were analyzed using Kruskal–Wallis tests.

Results: There was no statistical difference in saccadic peak velocity: SRC = 414.7 ± 42º/s, CON = 406.6 ± 40.6º/s. A significant difference was found between SRC patients and healthy controls in horizontal SPEM gain (SRC = 0.9 ± 0.04, CON = 0.86 ± 0.03, F(1,28) = 7.243, P = 0.012) indicating that patients demonstrated compensatory eye movements when tracking the target. There were significantly more saccades in all SPEM trials (P = 0.001).

Conclusion: SRC oculomotor deficits manifest as elevated horizontal SPEM gain when assessed within 48 hours of injury and compared to healthy controls within the same age range. SRC demonstrates altered oculomotor ability. While accurate in tracking a stimulus, SRC patients may conduct less controlled eye movements.

Oculoplastic Conditions in Covid-19 Patients: Case Series and Literature Review

2024-06-21T11:55:24+00:00

Purpose: To investigate oculoplastic conditions in patients diagnosed with coronavirus disease 2019 (COVID-19) seen at ophthalmology departments of three tertiary referral centers in the United Kingdom and the United States, and review of the literature.

Methods: Retrospective multicenter case series studied over 18 months.

Results: A total of four patients developed eyelid, orbital, or lacrimal gland pathology within four weeks of testing positive for COVID-19. All were male, and the mean age at presentation was 49 (range, 31–58 years). Suspected diagnoses included anterior idiopathic orbital inflammation, facial angioedema, dacryoadenitis, and anophthalmic socket inflammation. Three patients recovered fully and one patient recovered partially (mean 2.7 weeks) from ocular manifestations with steroids hastening recovery.

Conclusion: Adnexal manifestations of COVID-19 include self-limiting orbital inflammation and eyelid lymphedema.

Anatomic and Functional Outcomes of Vitrectomy for Advanced Retinopathy of Prematurity: A Systematic Review

2024-06-21T11:55:25+00:00

The success of vitrectomy in the advanced stages of retinopathy of prematurity (ROP) is defined not only by anatomical results, but also by functional outcomes. Studies have indicated that vitrectomy produces better outcomes when performed at an earlier stage (stage 4 vs. stage 5 ROP). This study reviewed the outcomes of vitrectomy in advanced stages of ROP and the associated factors. PubMed, ScienceDirect, Cochrane, Wiley, and WorldCat databases were systematically searched for articles published in the last 10 years. Studies involving participants with stages 4 and 5 ROP who underwent vitrectomy were included. The final search was performed on March 24, 2023. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool. The results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Ten studies were included in the review. A total of 1179 eyes underwent vitrectomy (72% lens-sparing vitrectomy [LSV] and 28% lensectomy-vitrectomy [LV]). LSV was mainly performed in stage 4 ROP and LV in stage 5 ROP. Anatomical and functional successes were more significant in stages 4A and 4B than in stage 5. Factors that improved prognosis included no plus diseases, stage 4, prior treatments such as laser or intravitreal anti-vascular endothelial growth factor injection, and sparing the lens intraoperatively. Vitrectomy resulted in better outcomes in patients with stage 4 ROP. Early detection and a strict screening protocol are needed to prevent ROP progression into stage 5.

Presentation of Adult-onset Asthma and Periocular Xanthogranuloma with Intermediate Uveitis and Hodgkin’s Lymphoma: A Case Report

2024-06-21T11:55:25+00:00

Purpose: To report a case of adult-onset asthma and periocular xanthogranuloma (AAPOX) in a patient with intermediate uveitis and a history of Hodgkin’s lymphoma (HL).

Case Report: A 51-year-old man with a past medical history of HL presented with blurred vision, asthma, and bilateral yellowish eyelid lesions. The eyelid lesions and asthma appeared 10 years after being diagnosed with HL. Physical examination was significant for multiple subcutaneous and firm eyelid masses in addition to the presence of pre-auricular and submandibular lymphadenopathies. Ophthalmic examination revealed bilateral intermediate uveitis and mild macular edema. Further systemic evaluations, including laboratory testing and imaging, were normal. Excisional biopsy of the eyelid lesions was performed and the histopathologic examination was consistent with the diagnosis of AAPOX.

Conclusion: The presence of AAPOX in a patient with intermediate uveitis and history of HL suggests that immunological dysfunction may play a role in the pathogenesis of adult orbital xanthogranulomatous disease.

Whiplash Maculopathy Following Parachute Injury

2024-06-21T11:55:25+00:00

Purpose: To report subtle yet important macular changes following a whiplash injury.

Case Report: We report an unusual case of a healthy young male presenting with a three-month history of a drop in vision in both eyes following an accident while crash-landing from a parachute. There was no direct ocular injury. Fundus examination revealed a bilateral well-defined area of retinal pigment epithelium (RPE) alterations over the macula with no other obvious retinal abnormality. Optical coherence tomography (OCT) examination revealed outer retinal layer defects with nearly intact inner retina.

Conclusion: This case highlights the importance of fundus evaluation and reviewing patient’s visual symptoms in otherwise inapparent ocular trauma.

Combined Brilliant and Trypan Blue As Vital Dyes for Chromovitrectomy

2024-06-21T11:55:25+00:00

Brilliant blue 0.05% and trypan blue 0.1% were mixed in a proportion of 1:1 in a 1-mL syringe. This combination produced a waterfall effect with the fast sinking of the dye to the posterior pole and little diffusion through the vitreous cavity. Therefore, it can effectively stain the internal limiting membrane and the epiretinal membrane with a good contrast during surgeries for a macular hole, myopic foveoschisis, and macular pucker.

Updated Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran

2024-06-21T11:55:25+00:00

Please download the PDF or view the guidelines in HTML.