Review of vision screening referrals in children

Background: Childhood vision screening is aimed at the detection of reduced vision due to amblyopia, thus enabling early diagnosis and timely intervention. The purpose of the study was to review the demographics and visual parameters of children referred to the ophthalmologist at Community Health Centre Ljubljana from Slovenian community-based vision screening program and define the visual outcome after treatment in children with amblyopia. Methods: Retrospective medical records review of children referred from community-based vision screening program for further assessment. Medical records were reviewed to determine findings from ophthalmic assessments, treatment received, and visual acuity at the final visit. The main outcome measures were the cause of visual impairment and the visual acuity at the final follow-up visit. Results: From 439 children (mean age 7.3 +/- 3.7 years) referred from community-based vision screening program, 75 children (17%; mean age 5.3 +/- 2.6 years) had amblyopia and received treatment. They had amblyogenic refractive error (3.67 +/- 2.44 diopters of sphere and 1.86 +/- 1.23 diopters of astigmatism) with uncorrected visual acuity on average 0.32 +/- 0.28 logMAR in the worse eye. Visual outcomes after treatment were good with a visual acuity of 0.04 +/- 0.07 logMAR in the worse eye, 60% of them had a visual acuity of 0.00 logMAR (40/40). Conclusion: Children with amblyopia in the presented clinical sample were mostly diagnosed and treated before the school-age. These children showed significant improvement in visual acuity in the amblyopic eye.

The Impact of Study-at-Home During the COVID-19 Pandemic on Myopia Progression in Chinese Children

Background: To assess the impact of study-at-home during the COVID-19 pandemic on myopia development in Chinese schoolchildren.Methods: This historical cohort involved two groups with a total of 154 children. The exposed group was formed from 77 children aged 8 to 10 years who studied at home in the 7-month period during the COVID-19 pandemic (follow-up period: January – August 2020) and did not study at home in the 7-month period before the COVID-19 outbreak (baseline period: July 2019 – January 2020). Seventy-seven children who did not undergo study-at-home (baseline period: 7 months in 2015, follow-up period: 7 months in 2016) were included in the control group. Cycloplegic refraction, axial length and uncorrected visual acuity were measured 3 times. The questionnaire mainly focused on collecting visual habits.Results: Myopia progression was similar between the two groups in the baseline period. However, in the follow-up period the exposed group had a greater change in refraction toward myopia (−0.83 ± 0.56 D) than the control group (−0.28 ± 0.54 D; p < 0.001). In addition, the exposed group exhibited a significantly greater change in refraction toward myopia in the follow-up period (−0.83 ± 0.56 D) than in the baseline period (−0.33 ± 0.46 D; p < 0.001). Difference-in-difference analysis indicated that study-at-home accelerated the change in refraction toward myopia (t = −0.567; p < 0.001).Conclusions: During the COVID-19 pandemic study-at-home accelerated the change of refraction toward myopia in children.

The effectiveness of hyperopia correction by wearing contact lenses in school-age children in the long-term follow-up

Background. Glasses and correction by wearing contact lenses are well tolerated by children with mild to moderate ametropia. In ametropia of high degree, an improvement of mo­nocular visual acuity with a contact lens compared to correction by glasses is 3.8 times higher. Materials and methods. The study included 56 children (112 eyes) aged 6 to 16 years with hypero­pic refraction and astigmatism, who used soft silicone hydrogel contact lenses to correct ametropia. In these patients, visual acui­ty, objective and subjective clinical refraction, axial length of the eye, corneal thickness and diameter, keratometry indicators were investigated, as well as phorometric data (accommodation, vergence, disparity areas of the oculomotor system and their inte­raction) in the early and late observation periods. Results. When using contact lenses for correction in school-age children with hyperopia and hyperopic astigmatism, after 3 years of observation there was a statistically significant increase in uncorrected visual acuity by 85 % (t = 7.9; p < 0.01), corrected visual acuity by 7 % (t = 7.4; p < 0.01), keratometry indicator in the weakest meridian by 1 % (t = 6.1; p < 0.01), in the strongest meridian by 1 % (t = 8.9; p < 0.01), central corneal thickness by 4 % (t = 4.6; p < 0.01), as well as a decrease in the spherical equivalent by 38 % (t = 3.1; p < 0.01), the amplitude of accommodation by 20 % (t = 5.8; p < 0.01), the negative relative accommodation by 20 % (t = 3.0; p < 0.01), the positive relative accommodation by 18 % (t = 3.5; p < 0.01), excessive accommodative response by 64 % (t = 7.2; p < 0.01), near phoria by 33 % (t = 4.4; p < 0.01), distance phoria by 22 % (t = 2.8; p < 0.01), the accommodation convergence to accommodation ratio by 18 % (t = 3.1; p < 0.01).

Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism.

Two-stage treatment of ametropia in patients with keratoconus and cataracts

Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus.

Regarding the Question of Postoperative Asthenopia

Relevance. It is well known that asthenopic complaints, such as increased visual fatigue when working at close range, lacrimation, eye pain and headache after corneal refractive operations in recent years are increasingly common at routine ophthalmological practice. They cause significant subjective discomfort in patients and reduce the satisfaction of the surgery. The pathogenesis of asthenopia is a violation of the coordinated work of the accommodation and binocular systems as a result of their overstrain with excessive visual loads.Purpose. To study the role of the lack of adequate optical correction before surgery in the development of asthenopia in patients with mild and moderate myopia after ReLEx SMILE surgery, as well as to evaluate the effectiveness of drug correction of this condition.Patients and methods. This study included 84 patients (128 eyes) who spend more than 8 hours at a computer due to their professional activity, without pathology of the visual organ that prevents keratorefractive operations, whose average age was 33.2 ± 1.9 years.Results and discussion. The ReLEx SMILE operations in all patients were carried out without complications with the achievement of uncorrected visual acuity equal to the preoperative values of the maximum corrected visual acuity in the period of 1 week and 1 month. In the group with a preoperative lack of adequate optical correction, signs of asthenopia were more often manifested than in patients using full eyeglass or contact correction before surgery. The appointment of the drug Mydrimax® allows to improve the subjective state of patients with asthenopia and leads to the normalization of functional parameters.Conclusion. Corneal refractive operations in patients with the lack of adequate correction of refractive disorders before surgery leads to a significantly significant increase in the initially impaired functional parameters compared to preoperative values, however, it does not reach normal values in most cases and is accompanied by a greater probability of developing postoperative asthenopia.

Effect of eccentricity of overnight lenses on 2-year axial growth and visual quality

AIM: To explore the effect of eccentricity of overnight orthokeratology (OK) lenses on 2-year eye axial growth and visual quality. METHODS: Based on the degree of eccentricity of OK lenses, patients were divided into three groups: a low degree of eccentricity group (degree of eccentricity ≤0.5 mm), a group of moderate eccentricity (eccentric degree >0.5-1.0 mm) and a group with a high degree of eccentricity (eccentric degree >1-1.5 mm). The degree of eccentricity of the OK lens, spherical equivalent (SE), the uncorrected visual acuity (UCVA) after wearing OK lenses, axial length (AL) before and after wearing OK lenses, total higher-order aberrations (HOA), comas, and spherical aberrations (SA) for 3 mm pupils were analyzed. The difference among the three groups for all parameters was compared using the Kruskal-Wallis H Rank-Sum test. RESULTS: The study retrospectively analyzed 75 cases (139 eyes). In the low eccentricity group (53 eyes), the mean age was 11.4±2.4y, SE was -3.24±1.48 D, and AL was 24.85±1.01 mm. In the moderate eccentricity group (53 eyes), the mean age was 11.4±2.2y, SE was -3.22±1.29 D, and AL was 25.15±0.92 mm. In the high eccentricity group (31 eyes), the mean age was 11.5±1.9y, SE was -3.54±1.43 D, and AL was 24.95±0.84mm. After two years, there was no significant difference in the changes of the axis among the three groups (P=0.089). The HOA, SA, and coma in the high eccentric group were significantly higher than in the middle eccentric group (P<0.05). The HOA, SA, and coma in the high eccentric group were also significantly higher than those in the low eccentric group (P<0.05). CONCLUSION: For OK lenses, it is unnecessary to strictly require the absolute centralization of the lens position. An unnecessary change of the lenses may delay the eye-axis control. However, the balance between axial control and visual quality should be assessed.

Comparison of Visual Acuity between Post Small Incision Cataract Surgery and Phacoemulsification in Sanjiwani Hospital

Cataracts are the second most common cause of blindness in the world at 33%. The incidence of cataracts is 0.1% of the total population, so the number of new cataract cases in Indonesia is estimated at 250,000 per year. This study aims to compare the visual acuity of post cataract surgery patients with Small Incision Cataract Surgery and Phacoemulsification techniques at Sanjiwani Hospital, Gianyar. This study was a retrospective cohort at Ophthalmologist’s Outpatient Departement of Sanjiwani Hospital, Gianyar, Bali. The sample of this study was 60 patients with 84 eyes with senile cataract. The surgical techniques performed were Small Incision Cataract Surgery (53.6%) and Phacoemulsification (46.4%). After that, an Uncorrected Visual Acuity (UCVA) examination was carried out on day 1 and day 42. The result were cataract patients at Sanjiwani Hospital, Gianyar aged 60-65 years who were male. Comparison of visual acuity after Small Incision Cataract Surgery and Phacoemulsification had the same results. On day 1 and day 42, there was no different uncorrected visual acuity result between Small Incision Cataract Surgery and Phacoemulsification statistically.

Therapeutic and Tectonic Keratoplasty with Simple Cryopreserved Remnants of Donor Corneas: An 11 Year Retrospective Case Series

This study sought to describe the use of deep-frozen donor corneal remnants preserved after keratoplasty procedures for therapeutic or tectonic keratoplasty without subsequent optical keratoplasty. This single-centre retrospective consecutive case series analyzed the electronic medical records of patients who had undergone therapeutic or tectonic keratoplasty using deep-frozen donor remains preserved in Optisol-GS, for the past 11 years at Keimyung University Dongsan Medical Center. Fifty-five surgical cases in 46 patients were included. Twenty-three surgical cases in 18 patients underwent therapeutic keratoplasty for refractory infectious corneal ulcer. Complete eradiation of primary infection was achieved in 14 patients (77.8%). Tectonic keratoplasty were performed 32 cases in 28 patients. Twenty-seven of 28 patients were ultimately able to maintain anatomical integrity (96.4%). Mean uncorrected visual acuity improved from 1.77 ± 0.94 preoperatively to 1.31 ± 0.95 at the last follow up postoperatively in the tectonic graft group by logarithm of the minimal angle of resolution (P = 0.002). There were no cases of graft rejection. Keratoplasty using cryopreserved donor tissue is a suitable surgical alternative for infectious or non-infectious corneal ulcers in elderly patients or patients with poor general condition. It could be a viable alternative to overcome the shortage of corneal donors.