CLINICAL RELEVANCE:Understanding factors that influence refractive stability and postoperative complications after corneal refractive surgery is important for improving patient selection, risk assessment, postoperative management, and long-term visual outcomes. BACKGROUND:Gender-related differences in healing responses after corneal refractive surgery may influence rates of myopic regression and corneal haze, but evidence remains inconsistent. METHODS:This retrospective cohort study was conducted at a tertiary refractive surgery center of Harbin medical university and included patients undergoing LASIK, PRK, or SMILE. A total of 376 patients (752 eyes) with at least 12 months of follow-up were analysed. Myopic regression was defined as a ≥0.50 D myopic shift between 3- and 12-month postoperative refraction. Corneal haze was graded using the Fantes scale, and ectasia was diagnosed based on clinical and tomographic criteria. Multivariate logistic regression was performed to adjust for confounding variables. RESULTS:The cohort included 212 females (56.4%) and 164 males (43.6%) with a mean age of 28.9 ± 6.7 years. Baseline refractive and keratometric parameters were comparable between groups, although females had significantly thinner corneas. Myopic regression occurred in 18.2% of eyes and was significantly more frequent in females (20.5% vs. 15.3%, p = 0.048), with greater regression magnitude (-0.46 ± 0.33 D vs. -0.37 ± 0.29 D, p = 0.031). Corneal haze developed in 6.9% of eyes and was also more common in females (8.4% vs. 4.9%, p = 0.041), while persistent haze remained rare. Postoperative ectasia occurred in 0.53% of eyes with no sex-based difference (p = 0.62). Multivariate analysis identified younger age, higher preoperative myopia, PRK surgery, and high myopia as significant predictors of regression, whereas female sex was not independently associated (adjusted OR: 1.27, p = 0.174). . CONCLUSION:These findings suggest that clinical and surgical characteristics, rather than sex alone, should guide risk assessment and postoperative counselling.
CLINICAL RELEVANCE:Adult-onset foveomacular vitelliform dystrophy (AFVD) is a rare, slowly progressive disorder that shares features with other macular diseases. A thorough analysis of its structural and vascular characteristics is increasingly important for understanding its aetiology and distinguishing it from others. BACKGROUND:Structural retinal changes of AFVD are well documented; the relationship between vascular alterations and disease mechanisms remains unclear. This study aimed to compare the clinical, structural, and vascular characteristics of AFVD patients and healthy controls. METHODS:This cross-sectional study included 48 patients with AFVD and 40 healthy controls. Participants underwent assessment of demographic and functional characteristics with structural and vascular density measurements, using optical coherence tomography (OCT) and OCT- angiography. Data were compared between the AFVD and control groups and among AFVD subgroups. RESULTS:The mean best-corrected visual acuity of AFVD patients was 0.29 ± 0.18 logMAR, and there was no significant difference among the subgroups. The mean central macular thickness in the AFVD group was higher than in the controls (282 ± 55 vs 251 ± 27 µm; p = 0.003). The pseudohypopyon subgroup had the highest mean central thickness (303 ± 27 µm) and lesion base measurements (1212 ± 375 µm). There was a positive correlation between age and lesion height and lesion base among AFVD patients, while there was a negative correlation between visual acuity and choroidal thickness (r = -0.468 and r = -0.600). Vessel density of the superficial parafovea and fovea, the deep parafovea, the outer-retinal fovea, and all choriocapillaris regions, as well as some FAZ parameters measured by OCT-A, in eyes with AFVD, were significantly lower than those in the controls. CONCLUSION:AFVD is characterised by reduced visual acuity, age-related lesion enlargement, and decreased macular and choriocapillaris vessel density. Advanced longitudinal multimodal imaging may contribute to understanding the disease aetiopathogenesis.
CLINICAL RELEVANCE:Quantitative evaluation of lens transparency may aid the clinical assessment of normal and abnormal lenticular changes during childhood. BACKGROUND:Scheimpflug imaging enables objective measurement of crystalline lens light backscatter. While age-related increases in lens densitometry are well documented in adults, normative paediatric data remain limited. Because lens development in childhood differs fundamentally from adult cataractogenesis, age-stratified reference standards are required. METHODS:This cross-sectional study included 188 eyes from 188 participants aged 4-18 years. Scheimpflug imaging (Pentacam HR) was used to measure global and zone-specific lens densitometry (nucleus 0-2 mm, anterior cortex, posterior cortex, annulus 2-4 mm, annulus 4-6 mm). Demographic and biometric parameters, including visual acuity, refraction, keratometry, anterior chamber depth, lens thickness, and pupil diameter, were recorded. RESULTS:The mean age was 12.5 ± 3.6 years (range 4-18), with 53.2% male. Mean global lens density declined from 7.98 ± 0.41 in children aged 4-9 years, to 7.93 ± 0.21 in those aged 10-13 years, and further to 7.72 ± 0.50 in adolescents aged 14-18 years (p < 0.001). Nuclear density showed the steepest decrease, from 8.53 ± 0.57 to 8.23 ± 0.28 and then 7.89 ± 0.29 across the three age groups (p < 0.001). Anterior cortical density increased slightly (7.25 ± 0.77 → 7.20 ± 0.58 → 7.53 ± 0.73, p = 0.028), while posterior cortical density rose modestly (4.63 ± 0.76 → 4.46 ± 0.69 → 4.83 ± 0.65, p = 0.005). Annulus 2-4 mm and 4-6 mm values progressively decreased from childhood to adolescence (p < 0.001 for both). CONCLUSIONS:Lens density decreases across childhood, most markedly in the nucleus, reflecting physiologic maturation.
CLINICAL RELEVANCE:Wearable technologies may enable eyecare practitioners to assess visual function, behaviour, environmental exposure, and treatment needs beyond the clinic. However, most applications require stronger clinical validation, usability evaluation, and evidence of patient benefit before routine implementation. BACKGROUND:Wearable devices may extend ophthalmic assessment and support beyond episodic clinic visits by capturing visual behaviour, environmental exposure, task performance, and ocular or periocular physiological signals. METHODS:This scoping review mapped English-language publications from 2018 to 2025 concerning wearable device classes, ophthalmic applications, the analytical roles of artificial intelligence, evidence maturity, and barriers to translation. RESULTS:Database searches identified 465 records; 310 remained after duplicate removal and were screened, 100 full-text articles were assessed, and 35 studies were included. Evidence was strongest for objective exposure monitoring in myopia research, headset-based assessment of visual function, and assistive technologies for people with low vision or blindness. Artificial intelligence was used mainly for temporal signal interpretation, multimodal integration, and real-time assistive feedback rather than autonomous diagnosis. CONCLUSION:Most systems remain at the technical validation or early clinical feasibility stage. Broader implementation requires stronger analytical and clinical validation, patient-centred outcomes, regulatory planning, usability evidence, and safeguards for privacy and interoperability.
CLINICAL RELEVANCE:Systemic inflammatory-nutritional biomarkers are readily accessible potential indicators of anti- vascular endothelial growth factor (antiVEGF) treatment outcomes in diabetic macular oedema; however, their independent clinical value remains uncertain. BACKGROUND:Systemic inflammatory indices have been associated with diabetic retinopathy and anti-VEGF treatment outcomes. This study evaluated whether composite inflammatory-nutritional biomarkers, particularly haemoglobin, albumin, lymphocyte, and platelet (HALP) score and prognostic nutritional index, are associated with anatomical and visual outcomes following bevacizumab treatment in diabetic macular oedema. METHODS:This retrospective study included 77 eyes of 77 patients with diabetic macular oedema treated with three consecutive intravitreal bevacizumab injections. Anatomical response was defined as a ≥ 50-µm reduction in central macular thickness from baseline. Systemic inflammatory-nutritional biomarkers were evaluated between responders and non-responders. Multivariable logistic regression was performed for anatomical response, while multivariable linear regression was used to evaluate visual improvement, adjusting for relevant ocular and systemic covariates. RESULTS:Anatomical response was observed in 24 eyes (31.2%). None of the evaluated inflammatory-nutritional indices differed significantly between responders and non-responders. In multivariable analysis, neither HALP nor prognostic nutritional index was independently associated with anatomical response, whereas higher baseline central macular thickness was independently associated with response (OR = 1.022, 95% CI: 1.010-1.034; p < 0.001). Neither HALP nor prognostic nutritional index was independently associated with best corrected visual acuity, whereas baseline best corrected visual acuity was significantly associated with visual improvement (β = 0.511; p < 0.001). CONCLUSION:HALP and prognostic nutritional index were not independently associated with anatomical or visual outcomes following bevacizumab treatment in diabetic macular oedema. Baseline ocular characteristics, particularly central macular thickness and best corrected visual acuity, showed stronger associations with treatment outcomes than systemic inflammatory-nutritional indices.
CLINICAL RELEVANCE:Non-arteritic anterior ischaemic optic neuropathy may occur following exposure to glucagon-like peptide-1 receptor agonists, although a causal relationship has not been established. BACKGROUND:Recent evidence has raised concern regarding a possible association between glucagon-like peptide-1 receptor agonists and non-arteritic anterior ischaemic optic neuropathy. We describe an illustrative case occurring in a younger patient without diabetes mellitus or hypertension. METHODS:A 37-year-old woman with obesity and insulin resistance developed painless unilateral visual loss following three once-weekly doses of semaglutide, all administered before symptom onset. Clinical examination, multimodal ophthalmic imaging, visual field testing, neuroimaging, and laboratory investigations were performed. RESULTS:The right eye showed optic disc oedema, a dense inferior altitudinal visual field defect, and marked peripapillary retinal nerve fibre layer thickening, supporting a diagnosis of non-arteritic anterior ischaemic optic neuropathy. Investigations excluded alternative inflammatory, demyelinating, infectious, arteritic, compressive, and pseudopapilloedema-related causes. At three months, the optic disc oedema had resolved with residual pallor, while the visual field defect persisted. CONCLUSIONS:Although causality cannot be established from a single case, recent glucagon-like peptide-1 receptor agonist exposure may be relevant when evaluating atypical optic neuropathy in younger patients.
CLINICAL RELEVANCE:A thorough understanding of the challenges involved in practising in long-term care communities is essential to enhance optometric engagement with this sector. BACKGROUND:Vision impairments are common among older adults living in long-term care communities. However, significant gaps in access and utilisation of eyecare services exist in this setting. This study explored the barriers and enablers faced by optometrists to provide domiciliary eyecare services in long-term care. METHODS:A qualitative descriptive approach was adopted. Twenty-seven Australian optometrists (16 with long-term care experience) participated in interviews or focus groups, guided by the theoretical domains framework. The sessions were audio recorded, transcribed, coded deductively and inductively, and analysed iteratively to form themes. RESULTS:Five themes emerged, highlighting several barriers at macro/ system-level (e.g. regulatory gaps, workforce shortage), meso/ organisational level (e.g. environment, poor care coordination) and micro/ practitioner-patient-family level (e.g. capabilities, competing priorities). Enablers included positive beliefs about socio-professional responsibilities, experience managing complex conditions, confidence in clinical skills and practising in non-traditional settings, knowledge of referral practices, and job satisfaction. Recommendations to overcome barriers included financial incentives, peer-support, and mentoring opportunities, an enabling environment in aged care, centralised health records, and collaborative models of care involving aged care staff, health professionals, and families. CONCLUSION:Multifaceted challenges hinder eyecare in long-term care. The findings highlight the need for advocacy and a systems-thinking approach to build capacity, enhance care coordination, and optimise funding for domiciliary optometry to improve eye and health outcomes for people in long-term care. The study recommendations align with the Integrated People-Centred Health Services framework of the World Health Organization, offering opportunities for further development.
CLINICAL RELEVANCE:Reliable ocular biometry and refraction measurements are essential for monitoring paediatric myopia in routine practice and school screening. Integrated instruments may improve clinical workflow, but measurement differences between devices can influence longitudinal interpretation. BACKGROUND:Accurate assessment of biometric and refractive parameters is essential for paediatric myopia management. The aim was to evaluate the agreement and repeatability of a multifunctional ocular biometer, the SW-9000ARK, compared with established instruments for ocular biometry and refraction. METHODS:This prospective cross-sectional study included 361 children (mean age 10.7 ± 2.5 years; 49.0% girls). All subjects underwent non-cycloplegic measurements with the SW-9000ARK, IOLMaster 700, and Topcon KR-800 in random order, followed by subjective refraction (SR). Agreement was assessed using Bland-Altman analysis. Repeatability in 211 right eyes was assessed using within-subject standard deviation, test-retest repeatability, coefficient of variation and intraclass correlation coefficient (ICC). RESULTS:The SW-9000ARK showed excellent agreement with the IOLMaster 700 for axial length (mean difference -0.01 mm; 95% LoA -0.08 to +0.05 mm), central corneal thickness (+5.19 µm; 95% LoA -9.57 to +19.96 µm), anterior chamber depth (-0.03 mm; 95% LoA -0.11 to +0.05 mm), lens thickness, and keratometry, with ICC values ≥ 0.96. Spherical equivalent exhibited strong agreement with the Topcon KR-800 (+0.08D; 95% LoA -0.65 to +0.81D) and SR (+0.35D; 95% LoA -0.43 to +1.13D). Repeatability was high across all parameters (Sw = 0.018 mm for AL; ICC ≥0.94). CONCLUSION:The SW-9000ARK provides highly agreeable and repeatable measurements of ocular biometry and non-cycloplegic refraction in paediatric ametropia, supporting its use as a reliable single-platform tool for myopia management and large-scale screening.
CLINICAL RELEVANCE:Vergence assessment is a fundamental component of binocular vision evaluation, enabling clinicians to detect and monitor conditions such as convergence insufficiency. Accurate and repeatable clinical tests are essential for reliable diagnosis and for tracking patient progress over time. BACKGROUND:The Near Point of Fixation Disparity (NPFD), associated positive fusional vergence (APFV) range, and associated negative fusional vergence (ANFV) range are polarised Nonius-based tests designed to evaluate vergence system integrity. However, their repeatability remains uninvestigated, limiting clinical utility. This study is the first to assess intraexaminer and interexaminer repeatability of these tests in symptomatic and asymptomatic participants. The NPFD test is commercially available from Vision Assessment Corporation, Rolling Meadows, IL, USA. METHODS:This prospective, cross-sectional study enrolled 64 university students (32 symptomatic, 32 asymptomatic; aged 18-27 years) from King Saud University, Riyadh, Saudi Arabia. Symptom status was classified using the Convergence Insufficiency Symptom Survey (CISS; score ≥21 = symptomatic). Two trained optometrists performed all measurements across two sessions separated by two weeks. Repeatability was assessed using mean difference, 95% confidence intervals, intraclass correlation coefficient, coefficient of repeatability, and Bland-Altman analysis. RESULTS:Intraexaminer repeatability of the NPFD test ranged from moderate to good with intraclass correlation coefficient 0.47-0.86, with the strongest agreement observed in asymptomatic participants. The APFV and ANFV ranges demonstrated poor intraexaminer repeatability, with limits of agreement frequently exceeding 10-15 prism dioptres. Interexaminer repeatability was poor across all three tests in both groups, with negative intraclass correlation coefficient values in several comparisons and limits of agreement exceeding 20 prism dioptres. CONCLUSION:Although the NPFD test can achieve acceptable intraexaminer repeatability, its interexaminer reliability remains poor, raising concerns about its use as a diagnostic tool across different examiners. Vergence assessments should be performed by the same examiner, and changes of less than 10-15 prism dioptres should be interpreted with caution. Standardisation of testing protocols is strongly recommended to improve the clinical applicability of these tests.
CLINICAL RELEVANCE:Understanding accommodative mechanisms across refractive errors is essential for improving the clinical assessment and management of refractive errors. BACKGROUND:Dynamic accommodative assessment may improve detection of functional differences in refractive errors that are not evident in conventional clinical testing, where accommodative differences across refractive groups remain not fully understood. This study analysed dynamic accommodative behaviour and ocular optical quality during stimulus and post-stimulus phases in emmetropes, hyperopes, and myopes. METHODS:The root-mean-square (RMS) of high-order aberrations (HOA), accommodative response, residual accommodation after stimuli, microfluctuations, and response times were assessed in 75 participants (36 emmetropes, 24 myopes, 15 hyperopes), with a mean age of 23.04 ± 3.67 years. Measurements were obtained in the relaxed state and during/after 1.00 D, 2.45 D, and 4.73 D stimuli using a real-time Shack-Hartmann aberrometer. RESULTS:Accommodative responses did not differ significantly between refractive groups at any stimulus level (p > 0.05). Hyperopes showed significantly higher residual accommodation after the 2.45 D (p = 0.001) and 4.73 D (p = 0.003) stimuli, and myopes exhibited significantly higher residual accommodation after the 4.73 D stimulus (p = 0.03). Myopes demonstrated increased microfluctuations at 2.45 D (p = 0.013) and after removal of the 4.73 D stimulus (p < 0.01), relative to baseline, indicating greater accommodative instability. Hyperopes showed significantly higher RMS HOA in the relaxed state than emmetropes (p = 0.028) and myopes (p = 0.009), and after removal of the 4.73 D stimulus than myopes (p = 0.009). No significant differences were found in accommodative or disaccommodative response times. CONCLUSION:Although accommodative responses during stimulation were similar across refractive groups, hyperopes and myopes showed incomplete accommodative relaxation after higher demands, and myopes exhibited greater instability during and after accommodation. Residual accommodation and microfluctuations provide valuable insights into dynamic accommodative behaviour across refractive errors.
CLINICAL RELEVANCE:Uveitic macular oedema (uveitic macular oedema) is an important cause of visual morbidity in patients with uveitis, highlighting the clinical importance of understanding factors associated with treatment response. BACKGROUND:To identify clinical factors and optical coherence tomography features associated with macular oedema regression and best-corrected visual acuity improvement at 3 months after dexamethasone implant (dexamethasone implant) treatment for non-infectious uveitic macular oedema. METHODS:This retrospective cohort study included patients with non-infectious uveitic macular oedema treated with dexamethasone implant. Baseline demographics and clinical characteristics were collected, including best-corrected visual acuity, central retinal thickness, and intraocular pressure at pre-injection and at 1 and 3 months post-injection. uveitic macular oedema regression was defined as the absence of intraretinal and subretinal fluid on spectral-domain optical coherence tomography at 3 months. The best-corrected visual acuity improvement was defined as a decrease of ≥ 0.1 logMAR, with a ≥ 0.2-logMAR threshold evaluated in a sensitivity analysis. Mixed-effects logistic regression models were used to evaluate associated factors, and first-injection sensitivity analyses were performed to assess the robustness of the findings. RESULTS:A total of 85 dexamethasone implant injections in 48 eyes of 38 patients were analysed. uveitic macular oedema regression at 3 months occurred after 54 injections (63.5%). Higher pre-injection central retinal thickness was independently associated with reduced odds of regression (adjusted odds ratio [OR] per 100-µm increase: 0.362; 95% confidence interval [CI]: 0.194 - 0.675, p = 0.002). Ellipsoid zone disruption was associated with reduced odds of ≥ 0.1-logMAR improvement after adjustment for pre-injection best-corrected visual acuity (adjusted OR: 0.261; 95% CI: 0.084-0.815; p = 0.021). Using the 0.2-logMAR threshold, longer uveitic macular oedema duration and ellipsoid zone disruption remained significant. CONCLUSION:Dexamethasone implant treatment provided favourable short-term anatomical and visual outcomes in patients with non-infectious uveitic macular oedema, although repeat treatment was frequently required. Baseline clinical and optical coherence tomography characteristics were associated with treatment response and may help characterise the expected outcomes following dexamethasone implant treatment.
CLINICAL RELEVANCE:Optical coherence tomography can enhance preoperative evaluation in patients with epiretinal membranes, improve surgical planning, and provide patients with more detailed information about potential visual outcomes. BACKGROUND:Investigate the morphological and functional changes in idiopathic and diabetic epiretinal membrane. METHODS:All participants underwent optical coherence tomography preoperatively and 6 months postoperatively. Foveal contour, retinal segmentation, external limiting membrane and ellipsoid zone integrity, subfoveal fluid, disorganisation of inner retinal layers, and ectopic inner foveal layer were evaluated with optical coherence tomography. Associations between optical coherence tomography parameters and visual acuity were analysed. RESULTS:This study included 34 idiopathic epiretinal membrane and 31 diabetic epiretinal membrane cases. In the idiopathic epiretinal membrane group, preoperative foveal pit presence was associated with better visual acuity (p = 0.030). In the diabetic epiretinal membrane group, the preoperative subfoveal fluid, disorganisation of inner retinal layers, ectopic inner foveal layer, cystic changes and advanced stage were associated with lower preoperative visual acuity (p = 0.008; p = 0.001; p = 0.021; p = 0.043; p = 0.01; respectively). In the postoperative period the persistence of subfoveal fluid, ectopic inner foveal layer and advanced stage were associated with lower postoperative visual acuity in the diabetic epiretinal membrane group (p = 0.002; p = 0.016; p = 0.018, respectively). external limiting membrane integrity was better preserved preoperatively in the idiopathic epiretinal membrane group (p = 0.022). Ellipsoid zone integrity was better preserved in the idiopathic epiretinal membrane group compared to the diabetic epiretinal membrane group, both preoperative and postoperative period (p = 0.010 and p = 0.022, respectively). In multivariable linear regression analysis, the presence of preoperative subfoveal fluid was independently associated with poorer postoperative visual acuity. The inner retinal layers were significantly thinned in both groups, while the outer layers remained unchanged. CONCLUSION:Although most retinal segmentation parameters showed similar postoperative changes in both idiopathic epiretinal membrane and diabetic epiretinal membrane, diabetic epiretinal membrane eyes demonstrated greater impairment of outer retinal biomarkers. Preoperative subfoveal fluid may be associated with postoperative visual outcomes in diabetic epiretinal membrane and warrants further investigation in larger prospective studies. Vitrectomy yielded beneficial anatomical and functional results in both groups.
CLINICAL RELEVANCE:Cardiometabolic disease and its treatments can influence ocular surface health. Describing ocular surface features in populations with systemic vascular disease may help generate hypotheses for future studies, but current evidence is insufficient to support changes in cardiovascular screening, optometric triage, dry eye treatment, or patient management. BACKGROUND:Links between systemic vascular disease burden and meibomian gland morphology have been suggested, but evidence is limited in cohorts where coronary artery disease severity is defined by coronary angiography. METHODS:This single-centre retrospective observational study included patients aged 50 to 80 years who underwent coronary angiography between January 2023 and January 2026 and had lower-eyelid meibography and non-invasive tear break-up time measurements within a ± 90-day window. When more than one record was available, the closest measurement to angiography was analysed (right eye only). Outcomes were meibomian gland loss, meiboscore and non-invasive tear break-up time. An age- and sex-adjusted linear regression model evaluated associations with meibomian gland loss; broader adjustment was not feasible. RESULTS:Eighty-eight patients were analysed (no coronary artery disease, 22; one to two vessel disease, 38; three-vessel disease or greater, 28). Meibomian gland loss differed between groups (median [interquartile range] 23.4 [12.8], 31.3 [19.4] and 47.5 [13.9], respectively; all pairwise comparisons significant). Meiboscore findings were less consistent, and non-invasive tear break-up time did not differ significantly. In the age- and sex-adjusted model, crude angiographic grouping and female sex were associated with lower-eyelid meibomian gland loss. CONCLUSION:This highly selected retrospective cohort showed an age- and sex-adjusted association between crude angiographic coronary artery disease grouping and lower-eyelid meibomian gland loss, whereas non-invasive tear break-up time did not differ between groups. These preliminary findings should not be interpreted as evidence that isolated lower-eyelid structural gland loss directly reflects tear film instability, mechanistic vascular injury, systemic screening value, or clinical practice relevance.
CLINICAL RELEVANCE:Undergraduate optometrists represent a substantial potential future workforce to provide low vision (LV) services. BACKGROUND:This study aimed to gain a detailed understanding of the intentions of current undergraduate optometrists to provide LV services. METHODS:Academics from 14 universities in the UK were invited to circulate an online survey to their final year undergraduate optometry students. Undergraduate optometrists rated their capabilities, opportunities and motivations to participate in LV services; their confidence in different areas of core optometric practice and in undertaking various clinical tasks; and their likelihood of undertaking postgraduate professional qualifications in different clinical areas. They described their experiences seeing patients for LV assessments and how those experiences impacted their intentions to provide LV assessments in primary care practice. RESULTS:The survey received responses from undergraduate optometrists from 12 universities (n = 163, 17.3%). Undergraduate optometrists have lower confidence in LV than in other areas of core optometric practice (p < 0.001) and they have lower confidence in tasks involved in LV service delivery than in tasks involved in routine optometric practice (p < 0.001). Undergraduate optometrists are significantly less likely to plan to undertake a postgraduate professional qualification in LV than in other subject areas (p ≤ 0.02 for all subjects) and they perceive the available opportunities to provide LV services in primary care optometry practice to be relatively low (p < 0.001). Undergraduate experiences seeing patients with a vision impairment for LV assessments largely positively impact intentions to provide LV services. CONCLUSION:There is scope to increase the confidence of undergraduate optometrists in LV before they enter the professional workforce and increasing undergraduate clinical experiences with LV patients will arguably yield important benefits. However, concurrent interventions aimed at increasing LV service provision in primary care practices appear necessary to improve student perceptions of their future opportunities to provide LV services.
CLINICAL RELEVANCE:Postoperative dry eye disease is a common and clinically significant complication of cataract surgery that can impair visual recovery and reduce patient quality of life. Effective management of ocular surface inflammation in this patient population remains an important challenge in clinical practice. BACKGROUND:The aim of this work is to compare the efficacy of 20% autologous serum and 0.15% preservative-free sodium hyaluronate in managing iatrogenic dry eye disease after cataract surgery, with ocular surface inflammation assessed by in vivo confocal microscopy. METHODS:This retrospective, non-randomised comparative study included 46 patients who developed dry eye disease within one month after phacoemulsification, receiving either 20% autologous serum (n = 24) or 0.15% sodium hyaluronate (n = 22) five times daily for four weeks. Outcomes included Ocular Surface Disease Index, tear break-up time, corneal fluorescein staining, tear meniscus height and area, and subbasal dendritic cell density by in vivo confocal microscopy. RESULTS:Both groups achieved significant improvements in all parameters (p < 0.05). At one month, autologous serum showed greater improvements than sodium hyaluronate in Ocular Surface Disease Index (11.4 ± 6.0 vs. 19.4 ± 8.3; p < 0.001), tear break-up time (9.98 ± 2.72 vs. 8.17 ± 2.56 s; p = 0.019), corneal fluorescein staining (0.67 ± 0.64 vs. 1.23 ± 0.53; p = 0.003), tear meniscus height (326.2 ± 50.4 vs. 284.1 ± 44.8 µm; p = 0.005), and dendritic cell density (37.9 ± 15.8 vs. 52.7 ± 18.6 cells/mm2; p = 0.003), with a greater mean reduction in dendritic cell density (-29.1 ± 6.6 vs. -14.0 ± 7.2 cells/mm2; p < 0.001). CONCLUSION:Compared with sodium hyaluronate, 20% autologous serum was associated with greater improvements in clinical outcomes and a greater reduction in dendritic cell density, providing objective microstructural evidence of reduced ocular surface inflammation. Prospective randomised studies are warranted to confirm these findings.
CLINICAL RELEVANCE:Accurate intraocular lens power calculation is a key determinant of postoperative refractive outcomes and patient satisfaction after cataract surgery. Reliable biometric measurements remain essential for achieving optimal visual outcomes across diverse clinical settings. BACKGROUND:To evaluate refractive outcomes during transition from ultrasound-based to optical biometry-guided cataract surgery in a resource-limited secondary referral centre and to identify factors associated with refractive prediction accuracy. METHODS:This retrospective observational study included 444 eyes undergoing uncomplicated phacoemulsification cataract surgery. Ultrasound biometry was performed using contact applanation technique before optical biometry became available in institutional practice. Absolute prediction error (APE), signed prediction error, refractive benchmark outcomes and factors associated with refractive accuracy were analysed. RESULTS:The mean APE was significantly lower in the optical biometry group compared with the ultrasound biometry group (0.34 ± 0.33 D vs 0.65 ± 0.60 D, p < 0.001). A significantly greater proportion of eyes measured with optical biometry achieved refractive outcomes within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D of the target refraction than eyes measured with ultrasound biometry (all p < 0.01). Signed prediction error analysis demonstrated a mild myopic shift in the ultrasound biometry group (-0.14 ± 0.88 D vs 0.10 ± 0.47 D, p = 0.029). Multiple regression analysis identified biometry method and preoperative corneal astigmatism as independent predictors of refractive prediction error. CONCLUSIONS:In this real-world study from a resource-limited clinical setting, eyes measured with optical biometry demonstrated lower prediction errors and higher refractive accuracy than eyes measured with ultrasound biometry. However, given the retrospective and non-contemporaneous nature of the study groups, these findings should be interpreted as an association rather than definitive evidence of superiority. Higher preoperative corneal astigmatism was independently associated with reduced refractive accuracy.
