Welcome to the Ophthalmology Journal News page! This page will showcase the latest news from the world of Ophthalmology, as published by The British Journal of Ophthalmology (BMJ).
For the British Ophthalmology Journal Archives, please visit http://bjo.bmj.com/ .
These news items are mainly specific study results that are relevant to the layman.
We have also added another news page with more ‘general’ Opthalmogy news here: Opthamologist News.
Furthermore, we have added a page with general news articles about Eye Health here: Eye Problems Articles , which is a good read for both patients and Ophthalmologists alike.
Ophthalmology Journal News:
The targeted delivery of drugs or genes into corneal endothelial cells (ECs) during eye banking could help improve graft quality and quantity. Physical methods raising less safety concerns than viral ones, we previously adapted, for in vitro ECs, a recent innovative technique of drug delivery based on the activation of carbon nanoparticles (CNPs) by a femtosecond laser (fsL). The aim of the present pilot study was to adapt this method to enable molecule delivery into the intact endothelium of ex vivo human corneas.
ECs from 40 organ-cultured corneas were perforated by photoacoustic reaction induced by irradiation of CNPs by a fsL. This enabled intracellular delivery of Alexa Fluor 488 dextran, a 4000 Da fluorescent macromolecule. The influence of increasing laser fluences (15, 20, 30 and 40 mJ/cm2) and of protective additives (ROCK inhibitor and poloxamer 407) on delivery and mortality rates was quantified using ImageJ.
No dextran was delivered with a fluence lower than 20 mJ/cm2. Dextran was delivered into 3% (range 0%–7%) of cells at 20 mJ/cm2, 7% (range 2%–12%) at 30 mJ/cm2 and reaching a median 13% (range 3%–24%) for 40 mJ/cm2, showing that dextran uptake by ECs increased significantly with fluence. Induced mortality varied from 0% to 53% irrespective of fluence, but likely to be related with the endothelial status (EC density and morphometry, donor age, storage duration and presence of Descemet's folds). ROCK inhibitor slightly increased uptake efficiency, unlike poloxamer. However, none of them decreased the mortality induced by laser.
This study shows that a macromolecule can be delivered specifically into ECs of a whole organ-cultured human cornea, using fsL-activated CNPs. The delivery rate was relatively high for a non-viral method. Further optimisation is required to understand and reduce variability in cell mortality.
To report a case series of patients with persistent temple-related problems following lateral wall rim-sparing (LWRS) orbital decompression for thyroid-related orbitopathy and to discuss their management.
Retrospective review of medical records of patients referred to two oculoplastic centres (Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK and Moran Eye Center, University of Utah, Salt Lake City, USA) for intervention to improve/alleviate temple-related problems. All patients were seeking treatment for their persistent, temple-related problems of minimum 3 years’ duration post decompression. The main outcome measure was the resolution or improvement of temple-related problems.
Eleven orbits of six patients (five females) with a median age of 57 years (range 23–65) were included in this study. Temple-related problems consisted of cosmetically bothersome temple hollowness (n=11; 100%), masticatory oscillopsia (n=8; 73%), temple tenderness (n=4; 36%), ‘clicking’ sensation (n=4; 36%) and gaze-evoked ocular pain (n=4; 36%). Nine orbits were also complicated by proptosis and exposure keratopathy. Preoperative imaging studies showed the absence of lateral wall in all 11 orbits and evidence of prolapsed lacrimal gland into the wall defect in four orbits. Intervention included the repair of the lateral wall defect with a sheet implant, orbital decompression involving fat, the medial wall or orbital floor and autologous fat transfer or synthetic filler for temple hollowness. Postoperatively, there was full resolution of masticatory oscillation, temple tenderness, ‘clicking’ sensation and gaze-evoked ocular pain, and an improvement in temple hollowness. Pre-existing diplopia in one patient resolved after surgery while two patients developed new-onset diplopia necessitating strabismus surgery.
This is the first paper to show that persistent, troublesome temple-related problems following LWRS orbital decompression can be surgically corrected. Patients should be counselled about the potential risk of these complications when considering LWRS orbital decompression.
To compare the accuracy of self-obtained, partner-obtained and trainer-obtained measurements using the handheld Icare Home rebound tonometer with Goldmann applanation tonometry (GAT), and to evaluate the acceptability to subjects of Icare Home measurement.
76 subjects were trained to use Icare Home for self-measurement using a standardised protocol. A prespecified checklist was used to assess the ability of a subject to perform self-tonometry. Accuracy of Icare Home self-measurement was compared with GAT using one eye per subject, randomly selected. Bland-Altman difference analysis was used to compare Icare Home and GAT intraocular pressure (IOP) estimates. Acceptability of self-tonometry was evaluated using a questionnaire.
56 subjects (74%, 95% CI 64 to 84) were able to correctly perform self-tonometry. Mean bias (95% limits of agreement) was 0.3 mm Hg (–4.6 to 5.2), 1.1 mm Hg (–3.2 to 5.3) and 1.2 mm Hg (–3.9 to 6.3) for self-assessment, partner-assessment and trainer-assessment, respectively, suggesting underestimation of IOP by Icare Home tonometry. Differences between GAT and Icare Home IOP were greater for central corneal thickness below 500 µm and above 600 µm than data points within this range. Acceptability questionnaire responses showed high agreement that the self-pressure device was easy to use (84%), the reading was quick to obtain (88%) and the measurement was comfortable (95%).
Icare Home tonometry can be used for self-measurement by a majority of trained subjects. IOP measurements obtained using Icare Home tonometry by self-assessment and third party-assessment showed slight underestimation compared with GAT.
To assess the differences in the neuroretinal rim area (NRA) and ocular haemodynamic parameters in patients with normal-tension glaucoma (NTG) with differing intracranial pressure (ICP) values.
40 patients (11 males) with NTG (age 61.1 (11.5)) were included in the prospective study. Intraocular pressure (IOP), non-invasive ICP, retrobulbar blood flow (RBF) and confocal laser scanning tomography for optic nerve disc (OND) structural parameters were assessed. Non-invasive ICP was measured using a novel two-depth Transcranial Doppler device. RBF was measured using colour Doppler imaging in the ophthalmic artery (OA). The patients were divided into two groups, ICP ≥ and <8.3 mm Hg, based on the statistical median of ICP. p Values <0.05 were considered statistically significant.
Patients with NTG had mean ICP 8.8 (2.5) mm Hg, IOP 13.6 (2.1) mm Hg, OND size 2.3 (0.6) mm2, NRA 1.2 (0.4) mm2. Lower ICP was correlated with decreased NRA (r=0.51, p=0.001). Patients with NTG having lower ICP (N=20) had significantly lower NRA 1.0 (0.3) mm2, than patients with NTG having higher ICP (N=20) 1.3 (0.3) mm2, p=0.002, although there were no significant differences in OND size (accordingly, 2.2 (0.5) and 2.3 (0.6) mm2, p=0.55) and IOP (accordingly, 13.5 (2.4) and 13.7 (1.8) mm Hg, p=0.58). Patients with NTG having lower ICP had significantly lower OA blood flow velocities (peak systolic volume (PSV) 28.7 (8.0), end-diastolic volume (EDV) 6.9 (3.0) cm/s), compared with patients with NTG having higher ICP (PSV 35.5 (10.2), EDV 9.4 (4.1) cm/s), p<0.04.
Patients with NTG having lower ICP have decreased neuroretinal rim area and OA blood flow parameters compared with patients having higher ICP. Further longitudinal studies are needed to analyse the involvement of ICP in NTG management.
To determine if Humphrey visual field (HVF) testing induces anxiety and how anxiety relates to visual field parameters of reliability and severity.
A prospective cohort study at a university affiliated private ophthalmic practice.
137 consecutive age-matched and gender-matched patients with glaucoma undergoing either HVF testing only (n=102) or Heidelberg retinal tomography (HRT) only (n=35) were enrolled.
Prior to testing, participants completed the State-Trait Anxiety Inventory questionnaire. A 5-point Likert scale was used to grade pretest anxiety and was repeated after testing to grade intratest anxiety. Subjective discomfort parameters were also recorded.
Anxiety scores were used to make non-parametrical comparisons and correlations between cohorts and also against visual field reliability and severity indices.
Trait anxiety (p=0.838) and pretest anxiety (p=0.802) were not significantly different between test groups. Within the HVF group, intratest anxiety was 1.2 times higher than pretest anxiety (p=0.0001), but was not significantly different in the HRT group (p=0.145). Pretest anxiety was correlated with test unreliability (Spearman's r=0.273, p=0.006), which was predictive of worse test severity (p=0.0027). Subjects who had undergone more than 10 visual field tests had significantly lower pretest and intratest anxiety levels than those who had not (p=0.0030 and p=0.0004, respectively).
HVF testing induces more anxiety than HRT. Increased pretest anxiety may reduce HVF test reliability. Increased test experience or interventions aimed at reducing pretest anxiety may result in improved test reliability and accuracy.
To compare cycloplegic autorefraction with non-cycloplegic subjective refraction across all age and refractive error groups.
In a cross-sectional study with random stratified cluster sampling, 160 clusters were chosen from various districts proportionate to the population of each district in Tehran. Following retinoscopy and autorefraction with the 0.25 D bracketing (Topcon KR-8000, Topcon, Tokyo, Japan), all participants had a subjective refraction. Then all participants underwent cycloplegic autorefraction.
The final analysis was performed on 3482 participants with a mean age of 31.7 years (range 5–92 years). Based on cycloplegic and subjective refraction, mean spherical equivalent (SE) was +0.31±1.80 and –0.32±1.61 D, respectively (p<0.001). The 95% limits of agreement (LoA) between these two types of refraction were from –0.40 to 1.70 D. The largest difference between these two types of refraction was seen in the age group of 5–10 years (1.11±0.60 D), and the smallest difference was in the age group of >70 years (0.34±0.45 D). The 95% LoA was –0.52 to 0.89 D in patients with myopia and –0.12 to 2.04 D in patients with hyperopia. We found that female gender (coefficients=0.048), older age (coefficients=–0.247), higher education (coefficients=–0.043) and cycloplegic SE (coefficients=–0.472) significantly correlated with lower intermethod differences.
The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclorefraction technique is highly recommended to exactly measure the refractive error in momentous conditions such as refractive surgery, epidemiological researches and amblyopia therapy, especially in hypermetropic eyes and paediatric cases.
Assessment of children with complex and severe learning disabilities is challenging and the children may not respond to the monochrome stimuli of traditional tests. The International Association of Scientific Studies on Intellectual Disability recommends that visual function assessment in poorly or non-cooperative children should be undertaken in an objective manner. We have developed a functional visual assessment tool to assess vision in children with complex and multiple disabilities.
The Bradford visual function box (BVFB) comprises a selection of items (small toys) of different size and colour, which are presented to the child and the response observed. The aim of this study is to establish its intertester validity in children with severe learning disability. The visual function of 22 children with severe learning disability was assessed using the BVFB. The children were assessed by experienced practitioners on two separate occasions. The assessors were unaware of each other's findings.
In 15/22 of the children, no difference was found in the results of the two assessors. The test was shown to have a good intertester agreement, weighted =0.768.
The results of this clinical study show that the BVFB is a reliable tool for assessing the visual function in children with severe learning disability in whom other tests fail to elicit a response. The need for a tool which is quick to administer and portable has previously been highlighted. The BVFB offers an option for children for whom other formal tests are unsuccessful in eliciting a response.
To determine the influence of single-vision lenses (SVLs) and progressive addition lenses (PALs) on the near vision posture of myopic children based on their near phoria.
Sixty-two myopic children were assigned to wear SVLs followed by PALs. Eighteen children were esophoric (greater than +1), 18 were orthophoric (–1 to 1) and 26 were exophoric (less than –1) at near. Reading distance, head tilt and ocular gaze angles were measured using an electromagnetic system after adaptation to each lens type.
The lens type did not influence reading distance or head tilt angle (p>0.05 for both), but ocular gaze angle decreased significantly with the PALs (F=9.25, p=0.004). With the PALs, exophoric children exhibited significantly increased head tilt angle (p=0.003) and reduced ocular gaze angle (p=0.004) compared with esophoric children. Near non-exophoric children exhibited similar eye and head postures when wearing SVLs and PALs, whereas exophoric children exhibited reduced ocular gaze angle (t=–3.18, p=0.04) with PALs compared with SVLs. Using PALs for reading, the mean addition power employed by esophoric children was significantly greater than exophoric children (p=0.04).
The lens type and the near phoria state affected near vision posture. During reading, myopic esophoric children used a lower portion of their PALs compared with exophoric children, resulting in greater addition power. These results may partially explain why myopic children with near esophoria exhibited superior treatment effects in myopia control trials using PALs.
To evaluate the outcomes of the type-I and type-II Boston keratoprostheses in a single Irish centre.
A retrospective chart review of keratoprosthesis implantations carried out in our institution from November 2002 to March 2014 was performed. All procedures were performed by a single surgeon (WP).
Thirty-four keratoprosthesis implantations were carried out in 31 patients with a mean follow-up of 42±31 months (range 2–110 months). Seventeen patients were female (54.8%) and 14 were male (45.2%). The majority of keratoprostheses implanted were type-I (31/34, 91.2%), and three were type-II (3/34, 8.8%). Twenty-nine patients (85.3%) had an improvement in distance best-corrected visual acuity (BCVA) from baseline. Fifty per cent (17/34) of patients had a best-ever BCVA of at least 6/12. Eighteen patients (64.3%) retained a BCVA of at least 6/60 at 1 year. Over the course of follow-up, six keratoprostheses were explanted from six eyes of five patients, one of which was a type-II keratoprosthesis. Twenty-six patients (76.5%) developed postoperative complications. Complications included retroprosthetic membrane (18 patients, 52.9%), an exacerbation or new diagnosis of glaucoma (6 patients, 17.6%), endophthalmitis (5 patients, 14.7%) and retinal detachment (2 patients, 5.9%).
These data demonstrate excellent visual acuity and retention outcomes in a cohort with a long follow-up period in a single centre. Complications remain a considerable source of morbidity. These outcomes provide further evidence for the long-term stability of type-I and type-II Boston keratoprostheses in the management of patients in whom a traditional graft is likely to fail.
To describe and compare clinical features, complications and outcomes in patients with granulomatosis with polyangiitis (GPA)-associated scleritis with those seen in idiopathic and other autoimmune-associated scleritis, and to further describe the features that may serve as an indicator of life-threatening systemic disease.
We retrospectively reviewed electronic health records of all patients with scleritis seen at two tertiary care centres. Of 500 patients, 14 had GPA-associated scleritis and were included in this analysis. Measures included were age, gender, laterality, visual acuity and underlying systemic or ocular diseases. Clinical features (location, pain, inflammation) and ocular complications of these patients (decrease of vision, concomitant anterior uveitis and ocular hypertension) were studied and correlated.
Fourteen of 500 patients with scleritis were GPA associated. Most of the patients with GPA-associated scleritis presented with sudden onset, bilateral, diffuse anterior scleral inflammation, with moderate-or-severe pain. Vision loss was not significantly different, and pain was more severe in these patients than in those with idiopathic scleritis. When compared with patients with other underlying autoimmune diseases, there were no significant differences found in epidemiological or clinical signs. Necrotising scleritis and corneal involvement were more commonly observed in GPA than in idiopathic scleritis and other autoimmune diseases and are often the presenting feature of the disease.
The presence of necrotising changes or corneal involvement in the setting of scleral inflammation is highly suggestive of an underlying systemic vasculitis, of which GPA is the most common. These features should alert the doctor/optometrist and prompt a thorough diagnostic approach and an aggressive treatment given that it could reveal a life-threatening disease.
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