Clinical Ophthalmology

Purpose This study aimed to evaluate the long-term surgical outcomes of trabeculectomy with mitomycin C (MMC) and identify factors associated with surgical failure in Thai patients with primary and secondary glaucoma. Methods This retrospective study included 421 eyes from 397 patients with glaucoma who underwent trabeculectomy with MMC from January 1, 2012, to December 31, 2015. The patients’ demographics, baseline characteristics, ocular parameters, and postoperative outcomes were analyzed. Surgical success was classified into complete success (IOP = 4–21 mmHg without anti-glaucoma medication), qualified success (IOP = 4–21 mmHg with medication), and failure (IOP >21 mmHg or <4 mmHg). Factors associated with surgical failure were assessed using Cox regression analysis. Results The cumulative probability of complete or qualified success at 8 years was 65.9% (95% CI: 59.9%, 71.9%); however, a significantly higher success rate was observed in the primary glaucoma group (75.1%) than in the secondary glaucoma group (47.4%) (p < 0.001). The secondary glaucoma group, particularly those with secondary closed-angle glaucoma, had the lowest success rates. Preoperative IOP, number of anti-glaucoma medications, and visual acuity were significantly different between the two groups. Etiologic factors associated with surgical failure included pseudo-exfoliation glaucoma (adjusted HR 3.23), neovascular glaucoma (adjusted HR 2.87), and secondary angle closure glaucoma (adjusted HR 2.62). Late complications were more prevalent in patients with secondary glaucoma than in those with primary glaucoma and included decreased visual acuity (5.43% vs 10.29%), hypotony (0.26% vs 1.14%), corneal decompensation (1.82% vs 3.40%), and bleb-related infection (0.19%). Conclusion Trabeculectomy with MMC remains an effective surgical option for primary glaucoma, demonstrating better long-term outcomes compared to its outcomes in patients with secondary glaucoma. Risk factors for surgical failure include specific glaucoma etiologies. These findings would personalize management strategies to optimize surgical approaches based on predictive factors for surgical success.

Purpose To determine if significant correlations occur between recorded values for a) annual temperature, b) air pollution levels, and the prevalence of acute ophthalmic inflammation among patients attending an eye emergency department in an urban setting between 2011 and 2023. Patients and Methods A data bank of cases that attended an eye emergency unit (Medical University of Silesia, Katowice, Poland) between 1/1/2011 and 31/12/2023 was accessed. Cases were classified into inflammatory or noninflammatory ophthalmic groups. The former were then subdivided into subgroups for blepharitis, orbital inflammation, lacrimal system inflammation, conjunctivitis, scleritis, keratitis, uveitis with retinitis, endophthalmitis, and optic neuritis. Data on local temperatures and air pollution levels were obtained from available official publications. Results Reporting key results (p < 0.05). Total attending the emergency unit increased from 8,172 to 14,261 (8854 during pandemic lockdown in 2020), prevalence of all acute ophthalmic inflammation (y) decreased from 64.70% to 55.40% and prevalence of conjunctivitis within this group decreased from 53.96% to 36.23%. Annual average (±SD) temperature (x, °C) in Silesia increased from 8.33°C (±9.18°) in 2010 to 10.64°C (±6.83°C) in 2020 (paired t-test, p = 0.04). Curvi-linear regression revealed, y = 1.915x³-55.624x²+534.09x-1631.2, (n = 10, r²= 0.489). Prevalence of conjunctivitis was directly correlated with atmospheric concentrations of sulphur dioxide, carbon monoxide and particulate matter in suspended dust with a diameter≤10 microns. After factoring all cases of conjunctivitis, a) prevalence of endophthalmitis, uveitis with retinitis, and scleritis were negatively correlated with temperature, b) atmospheric concentrations of certain pollutants were positively correlated with the prevalence of endophthalmitis, uveitis with retinitis, scleritis and keratitis; and negatively correlated with the prevalence of orbital and lacrimal inflammation, blepharitis, and optic neuritis. Conclusion Air pollutants and temperature are linked to the prevalence of certain acute ophthalmic inflammations. Some correlations are negative suggesting some protection against the development of certain conditions. However, negative correlational effects do not necessarily imply negative causal effects.

Purpose To assess clinical outcomes after Descemet’s Membrane Endothelial Keratoplasty (DMEK) with mydriatic eye drops without peripheral iridotomy (PI-less). We performed a retrospective, observational clinical study to determine the postoperative intraocular pressure (IOP) changes and graft viability in a cohort of patients with Fuchs’ endothelial corneal dystrophy (FECD) and bullous keratopathy (BK). Patients and Methods Included in this study were 41 PI-less DMEK patients with 44 eyes (median age: 77 years; range: 53–88 years). Patients received either PI-less DMEK (group-1) or PI-less triple DMEK (group-2). The mean follow-up duration was 16 months. Eyes after standard DMEK or triple DMEK served as controls (n = 20). Included in the study were patients admitted to the hospital (securing IOP control), patients in which the tamponading agent was air or gas (SF6) and only patients with physiological air resorption, ie without routine, postoperative air/gas release (90% air/gas fill of the anterior chamber at end of surgery). Phakic eyes were not included. Postoperatively, mydriatic eye drops were administered for three days 4x/d (phenylephrine 25 mg/mL, tropicamide 5 mg/mL). The best-corrected visual acuity (BCVA), endothelial cell density (ECD), and IOP were assessed. Intra- and postoperative complications and management were recorded. Results BCVA improved significantly in both groups (group-1:0.90 ± 0.57 to 0.20 ± 0.23logMAR (p = 0.000); group-2:0.47 ± 0.23 to 0.17 ± 0.42logMAR (p = 0.0067). ECD decreased significantly: Group-1 2428±225 cells/mm² to 1810±236 cells/mm² (p = 0.005); group-2 2447 ± 178 cells/mm² to 1866 ± 229 cells/mm² (p = 0.012). After postoperative day-1 IOP decreased significantly: Group-1 p = 0.004 (10.0 ± 2.8 mmHg) and p = 0.002 (11.3 ± 3.1 mmHg); group-2 p = 0.002 (10.7 ± 3.6 mmHg) and p = 0.002 (11.4 ± 2.2 mmHg); for postoperative days 2 and 3, respectively. Postoperative adverse events included pupillary block necessitating emergency air release. Intergroup analysis did not show a significant difference in ECD, IOP (after postoperative day-1) and logMAR (after 6 months). Conclusion Patients may benefit from the promising results of the study regarding postoperative IOP developments and graft viability after DMEK using mydriatic eye drops (phenylephrine 25 mg/mL, tropicamide 5 mg/mL). PI-less triple DMEK in particular might improve accessibility, reduce surgical complexity, or lower costs, making it attractive in resource-limited settings. Close postoperative IOP monitoring is advised in PI-less DMEKs.

Introduction Visual acuity (VA) is typically measured using stationary optotypes, though real-world visual experiences involve dynamic targets. The Dyop (dynamic optotype) VA test is a computerized motion perception assessment designed to simulate daily visual experiences. With the rise of telemedicine, this study examined the feasibility and agreement between virtual online VA testing using Dyop compared to standard LogMAR optotypes in non-presbyopic and presbyopic participants. Methods After an initial online Zoom® meeting verifying inclusion criteria and technical feasibility, participants accessed the examiner’s computer using the “Anydesk” application enabling them to view the “Chart 2020” program. Monocular right eye VA was measured three consecutive times using Dyop and LogMAR optotypes in a counter-balanced design. Participants aged 18–39 yrs were considered non-presbyopic, and those 40–60 yrs were considered presbyopic. VA measurements were analyzed using the Mann–Whitney U-test, Spearman correlation coefficients, intraclass correlation coefficients (ICC), and non-parametric Bland-Altman analysis, which examined median differences and limits of agreement (LoA). Results Of the 110 participants, (70% females, mean age: 32.5 ± 13.0, range: 18–60), 73 (66%) were considered non-presbyopic (mean age: 24.1 ± 4.9, range: 18–39), and 37 (34%) were presbyopic (mean age: 49.0 ± 6.4, range: 40–60). The mean VA measured with the Dyop and LogMAR charts for the entire cohort (0.09 and 0.08), for the non-presbyopic (0.09 and 0.07) and the presbyopic (0.10 and 0.09) sub-groups was significantly positively correlated (r = 0.80, p < 0.001, r = 0.82, p < 0.001 and r = 0.72, p < 0.001, respectively), with a small mean difference (−0.01 ± 0.08, −0.02 ± 0.08, −0.01 ± 0.09 log units), for the entire cohort, the non-presbyopic, and the presbyopic, respectively. There were no significant differences between the two tests for the whole cohort (p = 0.80), for group 1 (p = 0.98) and for group 2 (p = 0.62). Conclusion This study demonstrated the feasibility of online VA measurements and that online VA measurements using Dyop and LogMAR optotypes are interchangeable in healthy non-presbyopic and presbyopic participants.

Purpose Online circular contrast perimetry (OCCP) provides perimetry on any computer or tablet without additional hardware. This study assessed the longitudinal performance and user feedback of home OCCP in an Asian population. Methods Twenty glaucoma and fifteen healthy participants underwent a comprehensive ocular examination and visual field tests in clinic, using OCCP and standard automated perimetry. Within a week, participants were asked to repeat OCCP at home. OCCP was then repeated after 3 months and 6 months at home, followed by a user-experience survey. Results No significant difference between clinic and home OCCP for test duration, false negative (FN) and fixation loss (FL) rates was found. False positive (FP) rate of home OCCP was slightly higher than that of clinic OCCP (p = 0.04). Bland-Altman plots indicated a small difference between Mean Deviation (MD) (1.26 dB, p = 0.0087) and good agreements between Pattern Standard Deviation (PSD) and Visual Index (VI) of clinic OCCP and home OCCP with insignificant difference of PSD and VI (p > 0.05). Intraclass correlation coefficient (ICC) analysis demonstrated good correlation of MD & VI and poor correlation of PSD between clinic OCCP and home OCCP. Over 6 months, home OCCP indicated moderate to excellent correlation of indices. Participants reported a positive attitude toward home OCCP; however, a high dropout rate was noted for the 3- and 6-month at-home testing. Conclusion Comparable results were observed between clinic and home OCCP at baseline. Acceptable consistency of home OCCP findings over 6 months was recognized. Patients may require additional support to achieve desired adherence to at-home monitoring protocols.

Introduction There are no available data concerning corneal parameters in patients with chronic ocular hypotony. Our purpose is to provide evidence and clinical correlation on the biomechanical corneal changes in chronic hypotonic eyes. Patients and Methods A single-center, transversal, self-controlled case series study was conducted involving patients with at least one chronic hypotonic eye (defined as an intraocular pressure ≤6.5 mmHg measured on three separate occasions for at least three months). The chronic hypotonic eye was the case and the contralateral eye the control (non-hypotonic eye). We collected data from baseline characteristic and intraocular pressure (mmHg). Biomechanical corneal parameters measured by Corvis ST: deformation amplitude ratio (mm), Ambrósio’s relational thickness (μm), stiffness parameter at first applanation (mmHg/mm), Integrated radius (mm⁻¹), stress-strain index, pachymetry (μm), and in addition macular folds were recorded as well. A descriptive and exploratory analysis was performed. Results Between November 2021 and July 2023, a total of 16 consecutive patients (7 men, 9 women; age [median (range)]: 72 (62–84)), diagnosed with chronic ocular hypotony in one eye were included: 16 chronic hypotonic eyes and 16 non-hypotonic eyes. Hypotonic versus non-hypotonic eyes [median (range)]: intraocular pressure: 4 (2–6) mmHg, 16 (8–38) mmHg; deformation amplitude ratio: 5.6 (4.3–6.6) mm, 4.7 (3.9–5.5) mm, p-value= 0.002; Ambrósio’s relational thickness: 482 (263–932) μm, 530 (210–818) μm, p-value: 0.845; stiffness parameter at first applanation: 61.5 (39–100) mmHg/mm, 113 (68–130) mmHg/mm, p-value: <0.001; Integrated radius: 10.9 mm⁻¹ (6.3–16.8), 7.9 mm⁻¹ (6.4–10.5), p-value: <0.001; stress-strain index: 0.7 (−0.2–4.9), 1.1 (−2.7–5.6), p-value: 0.034; pachymetry 509 (456–617) μm, 512 (436–775) μm, p-value: 0.637; and macular folds: 7/16, 0/16, p-value: <0.001. Conclusions Chronic hypotonic eyes (eyes with a low intraocular pressure) present biomechanical corneal changes with respect to non-hypotonic eyes, mainly in deformation amplitude ratio, stiffness parameter at first applanation, stress-strain index and Ambrósio’s relational thickness parameters. These biomechanical corneal changes could reflect softer, more elastic and deformable scleras, which at its turn can bear higher risk of hypotony maculopathy.

Purpose The primary purpose of this study is to assess the comfort and vision of Dailies Total1® for Astigmatism contact lenses in subjects dissatisfied with their previously worn toric contact lenses. Patients and Methods In this prospective, non-comparative study, subjects aged 18 to 39 years with a history of unsuccessful previous astigmatism contact lens wear were recruited. Subjects were allocated and fitted with varying astigmatism powers of the Dailies Total1® for Astigmatism contact lenses. After 30 days of wear, participants responded to a questionnaire consisting of a visual analog scale assessing overall comfort and vision and a Likert scale assessing comfort and vision throughout the day, at the end of the day (EOD), and as it pertains to real-world tasks. Results Sixty-five subjects (130 eyes) completed the study, of which 50 were female, and 15 were male, with a mean (± standard deviation) age of 29.5 ± 5 years. Overall, 87.69% of the subjects reported a positive rating for comfort and 92.31% for satisfaction with vision. 78% of respondents reported positive ratings for comfort throughout the day and 55% at the end of the day. Comfort while working on the computer and utilizing a cellphone was rated at 80% and 86%, respectively. 85% either agreed or strongly agreed that the lenses provided clear vision throughout the day, and 71% at the end of the day. Positive ratings for vision while on the computer and while using a cellphone were 87% and 91%, respectively. Of all participants, based on comfort and vision, 58% favored continuing to wear the lenses after the study. Conclusion The results suggest that Dailies Total1® for Astigmatism contact lenses offer favorable comfort and vision for individuals who had previously been dissatisfied with their toric lenses.

Purpose The purpose of this study was to investigate compliance with post-operative eye drops following cataract surgery among a rural Ghanaian population. Patients and Methods This cross-sectional, single-site survey is a study of patients undergoing cataract surgery at the Eastern Regional Hospital in Koforidua, Ghana during October 2022. A survey was administered 1 week post cataract surgery to assess literacy level, eye drop adherence, instillation technique, eye drop frequency, and perceived understanding of post-operative instructions. Results There were 59 patients included in the analysis. Fifty-nine (100%) patients believed they administered the eye drops at the correct time and the correct method outlined by their doctor. Fifty-six (94.9%) patients noted the tip of the drop container never touched their eye, 2 (3.38%) noted it did more than twice and 1(1.69%) noted it did once or twice. Forty-five (76.3%) patients never forgot to wash their hands prior to eye drop administration, 6 (10.15%) patients noted they did not more than twice, and 7 (11.9%) did not once or twice. There was a statistically significant different in patients forgetting to administer eyedrops (p=0.018) and forgetting to wash hands prior to eye drop instillation (p=0.0005) among patients with different literacy levels. Conclusion Although all patients perceived their method of eye drop administration to be correct, some had forgotten to wash hands prior to eye drop use and had the tip of the eye drop container touch their eye. Patient education regarding eyedrop administration can be beneficial in improving eyedrop technique and adherence. The self-reported data utilized for the study serves as a limitation. Further investigation includes supplementing subjective, self-reported data with objective observations of patients.

Introduction Ophthalmic medications administered via standardized eyedrop bottles have an average drop size of 40 µL, but absorption is limited to the conjunctival sac volume of 7–10 µL. The Nanodropper is a commercially available eyedrop bottle adapter capable of consistently delivering 10 µL aliquots. We hypothesized that the Nanodropper would supply a sufficient medication dose for mydriasis that is non-inferior to the standard eyedrop bottle. Material and methods Adult patients scheduled for routine bilateral eye dilation were selected. Exclusion criteria included anisocoria, use of mydriatic agents, and unilateral pseudoexfoliation. One eye was randomly selected and dilated with the Nanodropper, and the fellow eye dilated with the standard bottle with a 50/50 mixture of 1% tropicamide and 2.5% phenylephrine. Pre- and post-dilation pupil sizes were objectively measured with a pupillometer and compared between fellow eyes with a noninferiority margin of 0.5mm. Results A total of 54 patients (108 eyes, 54 pairs) were included in the study. Pre-dilation pupil sizes were similar in the Nanodropper eye compared to the fellow eye. There was no difference in post-dilation pupil size between fellow eyes with a noninferiority margin of 0.5mm (95% CI [−0.09, 0.15], p = 0.67). Discussion This study demonstrates that small volume eye drops using the Nanodropper adapter are as efficacious as standard volume drops for mydriasis. This may provide many clinical, practical, and economic advantages such as reducing medication excess, toxicity, and material costs. Conclusion The Nanodropper is non-inferior to the standard eyedrop bottle for pupillary dilation. Small volume eyedrops may reduce medication waste and side effects and improve affordability and patient compliance.

Purpose To compare the performance of an enhanced and conventional monofocal IOL in eyes with early and intermediate age-related macular degeneration (AMD). Methods This retrospective study compared one-month postoperative outcomes of patients bilaterally implanted with TECNIS Eyhance IOL (ICB00 group) or TECNIS Monofocal IOL (ZCB00 group). All patients underwent cataract surgery with pre-existing early or intermediate dry AMD. Outcome measures were monocular and binocular uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity, monocular corrected distance visual acuity (CDVA), and refractive outcomes. Monocular visual acuities and refractive predictability were calculated for the dominant eye of each patient. Results The ICB00 group comprised 143 eyes of 143 patients, while 164 eyes of 164 patients were included in the ZCB00 group. Preoperative characteristics were comparable between the two groups. There was no significant difference in postoperative refractive predictability, with 87.4% and 89.6% of eyes within 0.50 D of emmetropia in the ICB00 and ZCB00 groups, respectively (p=0.54). No difference was found in postoperative UDVA or CDVA between the groups. Both monocular and binocular UIVA were significantly better in the ICB00 group (monocular UIVA: 0.32±0.19 vs 0.42±0.22 logMAR, p<0.001; binocular UIVA: 0.25±0.18 vs 0.36±0.17 logMAR, p<0.001). Postoperative UNVA was also better with the ICB00 IOL (monocular UNVA: 0.58±0.16 vs 0.69±0.20 logMAR, p<0.001; binocular UNVA: 0.50±0.16 vs 0.63±0.17 logMAR, p<0.001). Conclusion ICB00 IOL enhanced intermediate and near vision in patients with AMD while achieving the same level of corrected and uncorrected distance visual acuity.

Objective To investigate the differences in ocular biometry between cataract patients with and without systemic diseases and assess relationships between ocular biometry and demographic factors in Thai cataract patients. Methods A cross-sectional study was conducted from November 2020 to May 2023 at Rajavithi Hospital, Thailand. Ocular biometry was measured using the IOL Master 700, and demographic data were extracted from medical records. Pearson’s and Spearman correlations assessed relationships between ocular biometry and demographic/systemic factors. Univariate and multivariate regression analyses identified associated factors. Results The study included 6,330 participants. The most common systemic disease was diabetes (25.7%), followed by hypertension (6.9%), dyslipidemia (5.4%), and chronic kidney disease (CKD) (3.0%). Age correlated positively with lens thickness and negatively with axial length (AL), anterior chamber depth (ACD), and central corneal thickness (CCT). Multivariate analysis showed AL decreased with age (β = −0.012, p < 0.001) and was shorter in females (β = −0.193, p < 0.001) and diabetics (β = −0.130, p < 0.001). ACD was shallower with age (β = −0.008, p < 0.001) and in CKD patients (β = −0.079, p = 0.013), while females had shallower ACD (β = −0.159, p < 0.001). LT increased with age (β = 0.018, p < 0.001) and was greater in diabetics (β = 0.044, p = 0.012), CKD patients (β = 0.162, p < 0.001), and females (β = 0.070, p = 0.001). CCT decreased with age (β = −0.279, p < 0.001) but was higher in diabetics (β = 4.905, p < 0.001) and dyslipidemia (β = 6.881, p = 0.003). Conclusion Ocular biometry varies significantly with gender, systemic diseases (diabetes, dyslipidemia, CKD), and demographic factors among Thai cataract patients. These findings highlight the importance of incorporating systemic disease management into preoperative planning to optimize cataract surgery outcomes.

Purpose To examine the association between refraction, ocular biometry and a child’s behavioral disorder using the Conners’ Parent Rating Scale. Materials and Methods This cohort study recruited 139 children aged 6–9 years old. Their legal guardians completed the Conners’ Parent Rating Scale [the revised-long version (CPRS-R-L)], and the individual responses were entered into the software scoring program, resulting in 14 scores for behavioral disorders. Cycloplegic refraction and ocular biometry were performed. Correlation analyses among the 14 behavioral scores, refraction, and biometry were performed. The analyses were performed for three refractive groups: hyperopia, emmetropia, and myopia. Results Children (N = 93) with mean age of 7.2 ± 1.2 y were included. Spherical equivalent (SE) of the refractive groups were +3.46±1.71 diopters (D), 0.61 ± 0.41 D and −1.76 ± 2.15 D (p < 0.0001). The CPRS-R-L subscale scores positively correlated with sphere, SE, and negatively correlated with cylinder. With the exception of oppositional behavioral subscale that had higher than mean score, 13 CPRS-R-L scores fell within the normal range, regardless of refraction. CPRS-R-L subscale scores negatively correlated with axial length. Axial length shorter than 22.5 mm had CPRS-R-L 95th percentile, some of which surpassed the normal range score of CPRS-R-L, and indicate the presence of ADHD concerns. Conclusion Refraction, astigmatism, and axial length were associated with Conners’ behavioral subscales and warrant additional studies to clarify any cause–effect relationship.

Purpose To validate an efficient and reliable instrument for measuring postoperative performance and satisfaction in refractive cataract surgery. Methods A 10-question survey was designed to assess patient satisfaction and functional outcomes in refractive cataract surgery. The survey included seven questions rated on a 1–10 scale and three yes/no questions. Internal consistency was evaluated using Cronbach’s alpha. Correlations between survey responses and objective visual acuity measurements (binocular uncorrected distance visual acuity [BUDVA] and binocular uncorrected near visual acuity [BUNVA]) were analyzed. Factor analysis explored the constructs assessed by the survey. Results A total of 477 eyes from 240 patients were included, including 234 AcrySof PanOptix, 53 AcrySof IQ Vivity, 88 TECNIS Eyhance, 102 AcrySof Aspheric Monofocal intraocular lenses (IOLs). Cronbach’s alpha (0.785) indicated acceptable moderate to strong internal consistency. Significant correlations were found between visual acuity and satisfaction ratings for distance (r = 0.256; p < 0.001) and near vision (r = 0.195; p < 0.001). A significant model was found (R² = 0.350, F(7, 474) = 35.86, p < 0.001) with quality of near vision (β = 0.188, p < 0.001), quantity of glasses independence (β = 0.116, p < 0.05), and lens choice (β = 0.434, p < 0.001) being significant predictors for IOL selection. Conclusion The Refractive Cataract Surgery Survey (RCSS) is an efficient, reliable tool for assessing patient satisfaction and performance in refractive cataract surgery. The quality of near vision and the level of glasses independence were significant predictors of lens choice satisfaction.

Dry eye disease (DED) is an ocular surface ailment with a high prevalence in the current era. One of the management principles involves the treatment of the underlying ocular surface inflammation. Topical Cyclosporine therapy is an effective treatment option. However, achieving an adequate drug concentration at the site of action and minimising the associated adverse drug effects, such as stinging and burning sensations at the site of instillation, are the biggest challenges. A preservative-free formulation of Cyclosporine 0.05% (Cyclisis-PF, Intas Pharmaceuticals, India) was studied in 50 patients with mild to moderate DED in a prospective interventional study. Eye drops were prescribed twice daily in addition to conventional treatment. At 12 weeks follow-up, the tear film stability was better in terms of improved tear break up time (TBUT) (p < 0.01), non-invasive break up time (NIBUT) (p < 0.001), Schirmer’s test (p < 0.01), lipid layer thickness (LLT) (p = 0.006), tear meniscus height (TMH) (p < 0.01), corneal staining score (p < 0.01), and ocular surface disease index (OSDI) score (p < 0.01) at the three-month follow-up. Only five of the 50 (10%) patients had mild adverse drug effects in the form of mild stinging. However, none of the patients discontinued this drug. In conclusion, preservative free cyclosporine is a safe, effective and well tolerated treatment modality in cases of mild to moderate DED.

Purpose To compare real-world outcomes in subjects who underwent treatment with intravitreal avacincaptad pegol (IVA) or intravitreal pegacetacoplan (IVP) for geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Methods This study was undertaken as a retrospective, comparative assessment of subjects who underwent IVA or IVP treatment for GA secondary to AMD at two community-based ophthalmology practices. All subjects included in the study had a visual acuity of ≥20/200 at baseline, a total GA lesion area of ≥1.5 mm² and ≤17.5 mm²at baseline, and follow-up of 12-months following IVA or IVP initiation. The primary outcome was change in GA lesion size at 12 months. Secondary outcomes were change in logMAR vision at 12 months, total number of complement injections administered over 12 months, and the incidence of exudation at 12 months. Results A total of 112 subjects were analyzed. There were no significant differences in baseline characteristics between treatment groups. There were no significant differences between IVA and IVP in change in total GA lesion size [1.19 (±0.33) mm² versus 1.28 (±0.37) mm²; p = 0.61], change in visual acuity [−0.1 (−0.04 to −0.16) logMAR versus −0.09 (−0.05 to −0.13) logMAR; p = 0.57], or exudation (p = 0.66) over the 12 month study period, respectively. However, the IVA cohort received more injections compared to the IVP group at 12 months (9.05 (±1.06) versus 5.96 (±2.01); p < 0.01). Conclusion This real-world study reports that treatment with IVA and IVP have similar visual and anatomic outcomes at 12-months, although subjects undergoing treatment with IVP may receive fewer injections to obtain these outcomes. Further studies comparing the safety and efficacy of IVA and IVP are warranted.

Purpose To determine the characteristics of normal tension glaucoma referrals at a tertiary care center and risk factors associated with unilateral versus bilateral disease. Patients and Methods Medical records were reviewed of patients who were referred to a single glaucoma provider at a tertiary care center and were given a presumptive diagnosis of normal tension glaucoma (NTG) between the years 2018 and 2021. Data collected included demographics, medical and family history, ophthalmic history, ophthalmic examination findings, neuro-ophthalmology referrals, and magnetic resonance imaging (MRI) results. Results A total of 98 patients were included in this study. The majority of patients (82%) had bilateral disease at initial presentation. Most patients (65%) had a history of systemic disease, including hypertension (32%), cardiovascular disease (19%), diabetes (12%), obstructive sleep apnea (10%), or orthostatic hypotension (4%). Conditions associated with vascular dysregulation were identified in 24% of patients. Sixty six percent of patients had a family history of glaucoma, while nearly half (49%) were myopic. Of patients with unilateral disease, 39% had workup or consideration of other neuro-ophthalmic diagnoses compared to 13% of patients with bilateral disease (P = 0.01). Conclusion Patients referred for NTG commonly present with disc changes in both eyes. Clinicians should assess for the presence of systemic diseases associated with vascular dysregulation, myopia, and a family history of glaucoma. Patients with unilateral disease consistent with NTG may benefit from additional workup including neuroimaging or a neuro-ophthalmic evaluation.

Objective Macular edema and retinal thickening after cataract surgery can lead to poor vision in patients, especially in the presence of high glucose. Blood glycosylated hemoglobin (HbA1c) concentration plays an important role in assessing diabetic control and is closely related to cataract surgery prognosis. The aim of this study was to investigate the correlation between postoperative HbA1c levels and postoperative cystoid macular edema (CME) and central macular thickness (CMT) in diabetic cataract patients. Methods Retrospective analysis was conducted on 80 patients with diabetic cataracts from December 2018 to December 2023. The enrolled cases were divided into 2 groups according to the blood glucose control: 56 cases (56 eyes) in the intensive treatment group (HbA1c ≤ 7.0%) with insulin combined with oral hypoglycemic agents; and 24 cases (24 eyes) in the standard treatment group (HbA1c > 7.0%). The Student’s t-test or paired t-test was used to compare the changes in CMT between the two groups at each preoperative and postoperative time period. The chi-square test was used to compare the incidence of CME at each postoperative time period. Pearson or Spearman correlation was used to analyse the relationship between HbA1c levels and CMT or CME at each postoperative time period. Predictive efficacy was analyzed using ROC curves. Results Patients who went through the standard treatment showed significant CMT thickening and CME at 3 and 6 months postoperatively. HbA1c levels were positively correlated with CME and CMT at 1, 3, and 6 months postoperatively, with good predictive efficacy. Conclusion Postoperative HbA1c levels have a strong correlation with CME and CMT thickening and may be reliable and valid biomarkers.

Purpose In the absence of a measured posterior keratometry input, toric intraocular lens power formulae in patients with a history of myopic laser keratorefractive surgery (M-LVC) predict the posterior corneal astigmatism. These formulae assume that the posterior corneal curvature is essentially unchanged post M-LVC and hence its characteristics in this demographic of patients would be the same as virgin eyes. We aim to describe astigmatism measured by a swept-source optical coherence tomography biometer in such patients. Patients and Methods Retrospective consecutive case review of eyes with prior M-LVC, followed by subsequent cataract surgery. Pre-operative biometric data was collected using the IOLMaster 700 (Carl Zeiss Meditec). Magnitude and orientation of the steep and flat meridian of standard keratometry (SK), posterior keratometry (PK) and total keratometry (TK) were recorded. Relationships between corneal astigmatism, age, and gender were assessed. Statistical analysis was performed using linear regression, Mann Whitney U-test and Chi squared test. Results A total of 341 eyes (218 patients) were studied. Mean SK was 39.65D ± 2.16D. Mean PK was −5.82D ± 0.24D. Mean TK was 39.15D ± 2.34D. SK astigmatism (SKA) was predominantly vertical (57.8%, n = 197 eyes) with a mean magnitude of 0.85D ± 0.47D. Posterior corneal astigmatism (PCA) was predominantly vertical (91.5%, n = 312 eyes) with a mean magnitude of 0.29D ± 0.14D. TK astigmatism (TKA) was predominantly vertical (42.2%, n = 144 eyes) with a mean magnitude of 0.83D ± 0.47D. There was a positive correlation between magnitude of TKA with SKA and PCA (P < 0.001). A negative correlation between age and magnitude of SKA, PCA and TKA was noted (P < 0.001). No statistically significant relationship with gender was noted. Conclusion PCA orientation of post M-LVC eyes is similar to published data of virgin eyes. This reinforces the assumption made in toric intraocular lens power formulae that posterior corneal astigmatism in these eyes share the same characteristics as virgin eyes.

Purpose To investigate the relationships among postoperative metamorphopsia and postoperative macular morphological changes and the duration from the onset of visual field disturbance to surgery (DVD) in patients who underwent surgery for macula-off rhegmatogenous retinal detachment (RRD). Patients and Methods We retrospectively reviewed 33 eyes of 33 patients who underwent pars plana vitrectomy (PPV) for macula-off RRD with known onset of symptoms of visual field disturbance at Niigata University Medical and Dental Hospital or Saiseikai Niigata Hospital and were followed up for at least 6 months postoperatively. Optical coherence tomography images of the macula obtained at 6 months postoperatively and DVD were analyzed, and the associations of the DVD with vertical metamorphopsia (vM) and horizontal metamorphopsia (hM) at 6 months postoperatively were evaluated using M-CHARTS. Results vM was significantly correlated with the DVD and ellipsoid zone (EZ) disruption (P = 0.004 and P = 0.008, respectively), while hM was significantly correlated only with the DVD (P = 0.018). vM was significantly smaller in eyes with a DVD ≤ 7 days (0.34 ± 0.35)) than in eyes with a DVD ≥ 8 days (0.69 ± 0.32) (P = 0.005). In the multivariate analyses, postoperative vM was significantly associated with EZ disruption and the DVD (≤ 7 or ≥ 8 days) (P = 0.012 and P = 0.014, respectively). Conclusion Metamorphopsia after PPV for macula off RRD was associated with the DVD and EZ disruption.

Purpose To determine the frequency and accuracy of pseudoexfoliation syndrome (PEX) assessment in referrals from primary care optometrists before the new Swedish glaucoma guidelines were established, and to evaluate an optometrist’s ability to assess PEX. Patients and Methods We studied PEX assessments in 95 referrals (95 patients,189 eyes) with elevated intraocular pressure (IOP) from optometrists to the Skåne University Hospital in Malmö, Sweden, in 2019. We reviewed the frequency and accuracy of PEX assessments in referrals and compliance of these referrals with the new guidelines. In addition, an optometrist’s ability to identify PEX was evaluated and compared to that of an ophthalmologist specialized in glaucoma. Patients referred were examined at the hospital for PEX, first by the study’s optometrist and then by the ophthalmologist. Results PEX was present in 17% of the patients (16 patients, 19 eyes). The optometrist in this study positively assessed PEX in 12 of 19 eyes (63%) before dilatation and in 14 of 19 eyes (74%) after dilatation. Seven referrals included a PEX assessment (3 assessed PEX and 4 assessed non-PEX), all of which were confirmed as correct. Of the 16 patients with PEX, 13 did not undergo a PEX assessment before referral. According to the new Swedish guidelines, three of the 13 referrals would not have been accepted, meaning that two patients requiring treatment would have been missed, one with pseudoexfoliation glaucoma and one with ocular hypertension with PEX. Conclusion Very few referrals from primary care optometrists included a PEX assessment (7%). According to the new guidelines, necessary referrals would therefore have been rejected. Still, the study’s optometrist detected PEX in the majority of patients. The risk of missing high risk patients requiring glaucoma treatment would be reduced if primary care optometrists assess PEX before referral.

Purpose To compare the performance of a self-refraction device (EyeQue Vision Check 2, EyeQue, USA) with autorefraction (OPD-Scan III, NIDEK) and subjective cycloplegic refraction in measuring refractive errors. Methods This descriptive study included 80 eyes from 40 patients. Measurements were obtained using the portable EyeQue device, OPD-Scan III, and subjective cycloplegic refraction performed by an experienced examiner. Spherical equivalent (SE), cylindrical power, and axis values were analyzed using power vector decomposition (M, J0, J45) to improve accuracy in comparing methods. The main outcome was the agreement between self-refraction, autorefraction, and subjective refraction. Results The EyeQue device showed lower variability and greater homogeneity in spherical measurements but exhibited lower precision for cylindrical power and axis than subjective refraction. Power vector analysis revealed that EyeQue overestimated spherical equivalent (M) and produced higher J0 values, suggesting a tendency to alter cylindrical correction. Although comparable to OPD-Scan in spherical refraction, EyeQue demonstrated inconsistencies in astigmatism correction, particularly in J45 components. Conclusion The EyeQue device is a promising tool for large-scale screenings due to its affordability and portability. However, its limitations in astigmatism and axis measurements indicate that subjective refraction should complement rather than replace it. Therefore, further refinement and validation in diverse populations are recommended.

Purpose This qualitative study assessed the relationship between health literacy and perceptions surrounding fear of cataract surgery and fear of vision loss in patients presenting to a Midwestern, urban, safety-net hospital-based clinic setting. Patients and Methods Forty-two patients were recruited from the Hoxworth Eye Clinic at the University of Cincinnati Medical Center. The inclusion criteria were as follows: established patient at the clinic, age 50 or older, diagnosis of cataract by ICD-10 and/or physical exam, and no history of prior cataract surgery. Each patient completed a survey of demographic information and questions targeting their understanding and attitudes surrounding cataract pathology and treatment, and the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), a validated 7-item word recognition test assessing patient health literacy. Two-tailed t-tests assuming equal variances and chi-squared tests conducted in Excel were used in statistical analyses. Results In our cohort (n = 42), there was no association between score on the REALM-SF and fear of cataract surgery (p = 0.87), but there was a significant association between fear of cataract surgery and belief that cataract surgery would improve vision (p = 0.03). Conversely, there was no significant association between fear of vision loss and belief that cataract surgery would improve vision (p = 0.92). The factors underlying these findings may be further clarified when attitudes surrounding cataract surgery and vision are categorized based upon best corrected visual acuity (BCVA). Patients with BCVA worse than 20/40 in only one eye fear cataract surgery more than patients with BCVA more than 20/40. Conclusion In our patient population, neither health literacy nor understanding of cataract pathology was associated with fear of cataract surgery. However, given patients who feared cataract surgery were less likely to believe cataract surgery would improve vision, clarifying goals of surgery and addressing patient fears should be prioritized. Interestingly, this may be more important at earlier stages of non-visually significant cataracts for patients with good vision.