Intraocular lens (IOL) glistening is a relatively common phenomenon. Although most of the patients remain asymptomatic, a small percentage of patients can develop unwanted optical side effects. We report 6 symptomatic patients with IOL glistening. All patients underwent an implantation of a hydrophobic acrylic mononofocal, multifocal or toric IOL in external clinics for visually significant cataract at least 6 months prior. Patients had very reasonable corrected visual acuity (0.8-1.0 decimal), but significantly had reduced contrast sensitivity and modulation transfer function, complained of visual phenomena and expressed dissatisfaction with their visual status. Patients indicated the symptoms were not present immediately after surgery, but gradually developed postoperatively. Slit-lamp examination revealed moderate-to-severe glistening in all cases. No other pathology that would be responsible for the visual symptoms was present. Patients reported improvement in side effects with the use of edge filter (blue-light blocking) eyeglasses and polarized sunglasses with an increase in contrast sensitivity by aproximately 1 line on Pelli-Robson chart. The use of specific eyewear seems to be a promising alternative to avoid explant of an IOL in symptomatic patients with glistenings and very good visual acuity. In conclusion, we believe that long-term optical clarity is crucial for the choice of an IOL.
To test the effect of a single dose of hot peppermint consumption on the tear film in normal eye subjects. Thirty healthy male subjects aged 18-39 years (23.20±2.17 years) were enrolled. Also, an age-matched control group of 30 male subjects (19-39 years, 23.50±0.70 years) was enrolled to test the effect of the hot water. Tear meniscus height (TMH), noninvasive tear breakup time (NITBUT), and tear ferning (TF) tests were performed for each patient 30 mins before and 60 mins after they drank hot peppermint. Mean TMH measurements were higher postintervention (0.32±0.07) than preintervention (0.27±0.04 mm). Similarly, mean TF grades were significantly higher (2.07±1.20) postintervention than preintervention (0.84±0.71). By contrast, mean NITBUT was lower postintervention than preintervention (11.57±3.17 and 15.84±3.36, respectively). TMH measurements increased in 90% of the subjects. Conversely, NITBUT decreased in 96.7% of the subjects. For the control group that tests the effect of drinking hot water, the scores did not differ significantly in the three tests pre- and postintervention ( ˂0.05). TF grades increased in 93.3% of the subjects, postintervention. Tear film quality decreases significantly after peppermint beverage consumption. A similar observation has been made on the consumption of hot green tea drink.
A Nintendo 3DS™ game can reliably test monocular near acuity, stereopsis and color without the need for occlusion patches or goggles. We developed dynamic, forced-multiple choice games to measure monocular near acuity, color vision and stereopsis on the autostereoscopic barrier screen of the Nintendo 3DS gaming system. In an institutional review board-approved study, pediatric and adult patients and normal subjects performed routine patched near visual acuity, Ishahara's color test and Stereo Fly tests. Then each subject performed a two-phase orientation and testing game, "PDI Check", on a Nintendo 3DS. Forty-five patients aged 5-60 years completed the routine and Nintendo near tests, resulting in positive, consistent, discriminatory correlation functions. From ROC curves, referral criteria were determined to separate poor from fair-to-normal monocular acuity with 98% sensitivity and 100% specificity, stereoacuity with 80% sensitivity and 97% specificity, and color with 83% sensitivity and 100% specificity. The Nintendo 3DS game PDI Check can provide consistent near vision testing via a dynamic, randomized method that does not require goggles for stereo, and does not require patching to assure monocular testing.
The Antibiotic Resistance Monitoring in Ocular micRoorganisms study is an ongoing surveillance study that tracks antibiotic resistance among bacterial isolates from ocular infections across the United States. We report antibiotic resistance rates and trends from 2009 through 2016. , coagulase-negative staphylococci (CoNS), , , and from various ocular infections were obtained from participating United States centers. Isolates were sent to a central laboratory for determination of antibiotic resistance profiles. Minimum inhibitory concentrations were determined by broth microdilution according to the Clinical and Laboratory Standards Institute for drugs from more than ten antibiotic classes, and isolates were classified as susceptible or resistant based on systemic breakpoints, wherever available. Resistance rates were also evaluated based on decade of patient life and longitudinally over the 8-year time period. A total of 1,695 . , 1,475 CoNS, 474 . , 586 , and 599 . were collected from 87 sites. Resistance was high among staphylococci and pneumococci, with methicillin resistance detected in 621 (36.6%) . and 717 (48.6%) CoNS isolates. Multidrug resistance (≥3 drug classes) was observed among staphylococci, particularly in methicillin-resistant (MR) isolates (MR [MRSA]: 76.2%; MR CoNS [MRCoNS]: 73.5%). Differences in methicillin resistance among staphylococci were observed based on patient age, with higher rates observed in older patients ( <0.0001). For certain organism-antibiotic combinations, there were significant changes in resistance over time, including a decrease in methicillin resistance among (but not CoNS); no notable trends were observed for . Antibiotic resistance was prevalent among gram-positive organisms, and MR staphylococcal isolates were more likely to be multidrug resistant. Although a small decrease in methicillin resistance was observed among over time, the continued high prevalence of in vitro methicillin resistance should be considered when treating patients with ocular infections.
To ascertain the impact of altering cylinder (cyl) power and axis on vision in astigmatism. In a prospective, randomized, participant-masked, crossover clinical trial, 28 astigmatic participants were tested for the following conditions on different days: full sphero-cyl correction and undercorrection by 0.25, 0.50, and 0.75 DC while maintaining spherical equivalence. Axis was also misaligned between -30° and +30°, in 10° steps. For each configuration, monocular high- and low-contrast visual acuities (HCVA, LCVA) were measured at 6 m, and participants rated vision clarity (1-10), vision satisfaction (1-10), and vision acceptability (yes/no). Linear mixed models were used to compare visual performance in the overall group and in low, medium, and high cyl subgroups. Undercorrecting cyl power affected all groups equally ( ≥0.073). Undercorrection by 0.75 DC was significantly different to full cyl power for all variables ( ≤0.007), while 0.25 DC undercorrection did not cause any significant decreases ( >0.05). Undercorrection by 0.50 DC was significantly different to full cyl power for HCVA ( =0.006, however not clinically significant) and vision acceptability ( =0.034). Axis misalignment affected the cyl groups differently ( 0.001), with the greatest impact in the high cyl group, followed by the medium then the low-cyl group. Misalignment by ±30° caused significant decreases in almost all cases ( ≤0.003), while misalignments by ±10° or ±20° caused significant decreases for some cyl groups and test variables. Undercorrection of cyl by ≤0.50 DC while maintaining spherical equivalence has no significant effect on HCVA, LCVA, vision clarity, and vision satisfaction, while the amount of axis misalignment that can be tolerated is dependent on the cyl power. These results may have practical ophthalmic applications, such as reducing the total number of stock keeping units of toric contact lenses.
Microbial keratitis is a potentially blinding condition for those who do not receive rapid and proper treatment. The case of a healthy 26-year-old man who has worn extended-wear hydrogel soft contact lenses and developed a unilateral central corneal ulcer with underlying dense stromal infiltrates surrounded by subepithelial and superficial stromal opacity in a reticular pattern along with several complications is reported.
and are two mites which infest the human eye and which may, in excess, lead to a wide range of anterior segment findings. mites have been implicated in anterior and posterior blepharitis, blepharoconjunctivitis, blepharokeratitis, and beyond. Due to significant overlap with other anterior segment conditions, infestation remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash sampling, and the most common mode of treatment is with tea tree oil in varying concentrations. This article summarizes elements of pathogenesis, diagnosis, and management critical to clinical care of this common condition.
The purpose of this evaluation was to compare the experience of habitual contact lens wearers with that of nonwearers when fitted with a novel toric nesofilcon A contact lens (Biotrue ONEday for Astigmatism lens; Bausch & Lomb Incorporated, Rochester, NY, USA), for wearer comfort, vision, and satisfaction in a real-world setting. Participating eye care practitioners (ECPs) prescribed toric nesofilcon A lenses to their astigmatic patients as part of their routine clinical practices. Accordingly, 1,253 patients successfully completed the evaluation; of these, 51% wore contact lenses habitually, 41% wore eyeglasses, and 8% had no prior vision correction. All wore the lenses for at least 4 days, and 74% wore them for an average of 9 hours or more per day. After at least 4 days of wear, each patient completed an online survey to evaluate his or her level of satisfaction regarding comfort and vision. As this postmarket evaluation was observational, data were analyzed to determine whether more patients than not agreed with individual statements regarding lens performance, and whether there was any difference in response between habitual contact lens wearers and nonwearers. As a measure of general satisfaction, 96% of patients indicated that their overall opinion of the toric nesofilcon A lens was good to excellent. Further, more patients than not agreed that the lens performed well with regard to all aspects of vision and comfort queried ( <0.001). There was no difference in response between habitual contact lens wearers and nonwearers. All astigmatic patients with spherical contact lenses, other toric lenses, or eyeglasses, as well as those who had no prior correction, who had converted to the toric nesofilcon A lens expressed a high level of satisfaction with vision and comfort. ECPs should expect high success rates when converting astigmatic patients to the novel toric nesofilcon A lens.
There is a rapid increase in the number of individuals with high-functioning autism (HFA). Research on motion perception in HFA has shown deficits in processing motion information at the higher visual cortical areas (V5/middle temporal). Several hypotheses have been put forth to explain these deficits as being due to enhanced processing of small details at the expense of the global picture or as a global integration abnormality. However, there is a lot of variability in the results obtained from experiments designed to study motion in adults with autism. These could be due to the inherent diagnostic differences within even the same range of the autism spectrum and/or due to comparison of different experimental paradigms whose processing by the same visual neural areas could be different. In this review, we discuss the various results on motion processing in HFA, as well as the theories of motion perception in autism.
Simon Berry,1 Victoria Ship2 1Simon Berry Optometrist, Durham, UK; 2Dove Medical Press Ltd, Macclesfield, UK We are pleased to announce that Clinical Optometry has recently been accepted for indexing with PubMed. This is an exciting and important leap forward for this journal that began with humble beginnings as a sister journal to Clinical Ophthalmology when some of the articles submitted were more suited to an optometric audience. All articles published in Clinical Optometry are now available through PubMed and PubMed Central (Clin Optom (Auckl)), the Emerging Sources Citation Index (Web of Science), Scopus, Directory of Open Access Journals, OAIster, as well as through Dove Medical Press and Internet search engines such as Google. It is heartening that the scientific quality of these articles, and the peer review process, has been proven to be of a high enough standard for archiving.
The purpose of this study is to investigate and compare spectacle and contact lens (CL) prescription trends, with an emphasis on astigmatic refractive error prescribing differences for patients who purchase spectacles or CLs in South Korea. A retrospective study of patient records of a major optical chain in South Korea was conducted. De-identified data of age, gender, power of prescribed spectacles and/or CLs were extracted from the practice database. Inclusion criteria were being within the first 10,000 purchasers of spectacles or CLs or both. The first 10,000 purchases comprised spectacles (59%) and CLs (41%) (male:female ratio 4:6). The proportion of purchasers who were female was significantly higher for CLs (88% female, 12% male) than spectacles (43% female, 57% male) (χ =4480.36, =1, <0.0001). There was a significant difference in the proportions of purchases by age group for spectacles and CLs (χ =3246.69, =3, <0.0001). Spherical power distribution of prescribed lenses was similar between the groups; however, cylinder power and axis were significantly different ( <0.0001). CL astigmatic powers were more likely to be 1.00 DC or greater, whereas the majority of spectacle lenses had astigmatic power of 0.75 DC or less. In total, 90% of toric CLs were prescribed ×180 and 9% other meridians, unlike spectacles where 50% were prescribed ×180, 14% ×90 and 40% at oblique meridians. There is scope for providing increased toric lens correction amongst CL wearers and increasing the proportion of wearers who are male. The estimated gap for toric lens prescription amongst CL wearers who have clinically significant astigmatism ≥0.75 DC is about 59%.
Alan G Kabat Pennsylvania College of Optometry, The Eye Institute, Salus University, Philadelphia, PA, USAI read with great interest the recent manuscript entitled "Demodex blepharitis: clinical perspectives" by Fromstein et al in Clinical Optometry.1 I wish to commend the authors on a thorough and well-written review of the subject. However, I feel compelled to point out one very controversial point that I believe is erroneous and unfounded. Authors' replyStephanie R Fromstein, Jennifer S Harthan, Jaymeni Patel, Dominick L OpitzDepartment of Clinical Education, Illinois College of Optometry, Chicago, IL, USAThe work by Dr Kabat is of particular interest to us as this is the first study comparing the kill time of commercially available Cliradex® (Bio-Tissue, Inc, Miami, FL, USA) containing 4% terpinen-4-ol to commercially available Avenova® (NovaBay Pharmaceuticals, Inc, Emeryville, CA, USA) containing 0.01% hypochlorous acid, and 100% mineral oil. His work demonstrated statistically significant kill time with Cliradex® compared to Avenova®, but we found it particularly interesting that 21% of Demodex mites treated with Avenova® were killed within 90 minutes of exposure to Avenova® and that none of the mites exposed to mineral oil were killed.View the original paper by Fromstein and colleagues.
The aim of this study was to show the potential applicability of optical coherence tomography angiography (OCTA) for the evaluation of the peripheral fitting of fully scleral contact lenses. A pilot study was proposed fitting three different scleral contact lenses (Irregular Corneal Design [ICD]) with different sagittal heights (4200, 4800, and 5600 mm) in a healthy volunteer of 27 years old. We evaluated by means of optical coherence tomography (OCT, DRI Triton) the apical clearance achieved with each of the three lenses fitted. The impact over scleral flow was assessed with the OCTA module of the same device. The apical clearance was 310, 901, and 1680 µm with the scleral lenses of sagittal heights 4200, 4800, and 5600 µm, respectively. With OCTA, we evaluated the impact of the lens bearing on the conjunctival vascular flow, observing an area of vascular interruption of 0, 25, and 75% with the lenses of 4200, 4800, and 5600 µm of sagittal heights, respectively. The vascular interruption was induced in the perilimbar area, suggesting the need of readjusting the limbal clearance zone of the lens. Fully scleral contact lens fitting may be optimized with the use of OCTA, allowing the practitioner to perform the fitting with better control of the peripheral bearing of the lens on the conjunctival tissue, assessing the impact on vascular structures. This potential use of OCTA must be investigated further in future studies including large samples of eyes.
Soft contact lens wear is most frequently associated with morphologic changes in corneal endothelial cells, but the data are scarce in Asians. This study aimed to evaluate changes in corneal endothelial cell morphology after 6 months of wearing soft hydrogel contact lenses (SH) in young myopic adults living in Kuala Lumpur. Forty-eight subjects were included in the study, 24 were fitted with SH contact lenses (A) and the rest were prescribed with glasses (B). Refraction was conducted subjectively and standard contact lens fitting protocol was followed. Corneal endothelial cell morphology (endothelial cell density, ECD; coefficient of variation, COV; cells' hexagonality, HEX; and central corneal thickness, CCT) was evaluated using specular microscope. Data were collected at baseline and after 6 months of lens wear. Mean age of all subjects was 21.23±1.30 years. All results are shown at baseline and 6 months, respectively. Mean refraction for A was -2.16±0.97 diopter sphere (DS) and -2.05±1.03 DS ( =0.49); for B was -2.72±1.51 DS and -2.73±1.51 DS ( =0.58). Mean ECD (cell/mm ) for A: 3104.19±237.30 and 3107.23±237.51 ( =0.07); for B: 3011.56±227.95 and 2983.83±244.55 ( =0.33). COV (%) for A: 46.52±8.63 and 48.53±10.65 ( =0.06); for B: 46.93±9.31 and 46.14±10.65 ( =0.88). HEX (%) for A: 46.21±10.12 and 45.15±10.01 ( =0.08); for B: 46.21±10.12 and 45.15±10.01 ( =0.12). CCT (µm) for A: 520.33±0.04 and 525.70±0.05 ( =0.41); for B: 532.00±0.04 µm and 530.00±0.05 µm ( =0.40). This study found no significant change in corneal endothelial cell morphology after 6 months of wearing SH contact lenses. This is probably due to better oxygen permeability of the contact lens material, good compliance, and short wearing period.
Astigmatism produces meridional variations in the retinal blur pattern, thus interacting with object spatial detail and altering visual performance as the axis changes. This study investigates the influence of astigmatic axis orientation on visual acuity (VA) for four alphabets used worldwide. Visual acuity was measured monocularly in 25 Roman alphabet users (mean age: 25.6±7.5 years) using computer-presented logarithm of the minimum angle of resolution (log-MAR) charts with letters from four different alphabets (Arabic, Chinese, Roman, and Tamil). VA was assessed under the effect of four optical conditions: best distance correction and three astigmatic conditions (using a +2.00 cylindrical diopter trial case lens with its axis oriented at 180, 45, or 90 degrees). For each alphabet, single optotypes were presented on a monitor viewed from a distance of 4.0 m, and a matching technique was used to identify the letters. The degradation in VA with astigmatic defocus was influenced by the alphabet used ( <0.001) and by the astigmatic axis ( <0.001). Interactions in VA degradation between astigmatic axes and alphabet ( <0.001) showed differences within 0.10 logMAR. These interactions were more pronounced in alphabets with higher dominance of curves and vertical (Tamil) and horizontal (Arabic) detail. Interactions between alphabet and type of astigmatism indicate that the effects of meridional blur on letter discrimination differ between alphabets. These findings have relevance in the way VA is assessed in populations using different typographies, and ultimately in the impact of astigmatic axis on their visual performance.
To assess the relationship between non-invasive tear break-up time (NITBUT) and maximum blink interval (MBI) values among young adults. The study was conducted at Mzuzu University and involved 98 subjects (55 females and 43 males) aged between 18 and 40 years. All subjects were screened under the slit lamp, and were also asked questions to determine their eligibility to participate in the study. NITBUT measurements were taken by checking the discontinuity of the mires on the keratometer. MBI measurements were taken by observing the time period the subject could keep their eyes open without blinking. There was a positive correlation ( =0.64, =0.418, <0.001) between NITBUT and MBI values. The relationship between NITBUT and MBI values was similar in both males and females. Furthermore, the study showed that age, as well as gender, is not correlated to NITBUT and MBI values. There is a positive significant correlation ( =0.64, =0.418, <0.001) between NITBUT and MBI values. There was no significant difference between the NITBUT and MBI values between males and females. The study has also discovered that there is no correlation between NITBUT and MBI with age and gender.
To compare the visual performance of soft contact lenses reported to reduce myopia progression. In a double-blind, randomized, crossover trial, 30 non-presbyopic myopes wore MiSight™, center-distance Proclear Multifocal (+2.00 D add), and two prototype lenses for 1 week each. High- and low-contrast visual acuities at 6 m, and 70 and 40 cm; stereopsis at 40 cm; accommodative facility at 33 cm; and horizontal phoria at 3 m and 33 cm were measured after 1 week. Subjective performance was assessed on a numeric rating scale for vision clarity, lack of ghosting, vision stability, haloes, overall vision satisfaction, and ocular comfort. Frequency of eye-strain symptoms and willingness to purchase lenses were also reported with categorical responses. Participants reported wearing times (total and visually acceptable). Linear mixed models and chi-square tests were employed in analysis with level of significance set at 5%. Theoretical optical performance of all lenses was assessed with schematic myopic model eyes (-1.00, -3.00, and -6.00 D) by comparing the slope of the edge spread function (ESF), an indicator for optical performance/resolution and the blur patch size of the line spread function, an indicator for contrast, between the lenses. Proclear Multifocal and MiSight provided the best distance acuities. However, the prototype lenses were rated significantly higher for many subjective variables, and there were no subjective variables where commercial lenses were rated significantly higher than the prototypes. Theoretical optical performance showed steeper slopes of the ESF and greater blur patch sizes of the LSP with commercial lenses, supporting the clinical findings of better visual acuities but reduced subjective performance. Participants wore prototypes longer and reported their vision acceptable for longer each day compared to MiSight. Both prototypes had the highest willingness-to-purchase rate. The prototypes were better tolerated by myopes compared to the commercial soft contact lenses currently used for slowing myopia progression.
Scleral lenses are being prescribed for the management of corneal irregularity, uncomplicated refractive error, and ocular surface disease. There are many potential therapeutic uses of scleral lenses in addition to providing similar benefits as corneal gas permeable lenses. Scleral contact lenses are a valuable therapeutic tool for patients with ocular surface disease as these lenses protect the ocular surface, provide continuous corneal hydration while providing optimal visual correction, and are often used in conjunction with other therapies.
To investigate dry eye disease in Saudi employees working in indoor and outdoor environments. A single-center randomized controlled study was carried out in an optometry clinic, to assess the ocular dryness of 24 male employees (12 indoor and 12 outdoor employees, mean age 36.4±2.5 years). The Ocular Surface Disease Index questionnaire was used to assess ocular dryness. Tear film assessment was carried out using phenol red thread (PRT), tear film osmolarity test, and fluorescein tears breakup time (FTBUT) with slit-lamp biomicroscopy. Both indoor and outdoor employees showed mild-to-moderate ocular dryness. A significant difference ( =0.004) was found for the tear quality test (FTBUT) between the indoor (8.58±4.8) and outdoor (5.54±1.3) employees. However, no significant differences for the tear quantity tests (tear osmolarity and PRT) between the indoor and outdoor employees were observed. Dry eye cases were detected in both groups. This might be due to the hot dry environment in Riyadh and the use of air conditioners commonly used indoors. A significant difference was observed for the tear film stability, which might be due to the effect of environment and/or visual display unit use.