Objectives: To investigate factors influencing refractive error severity and visual improvement in children with unilateral high myopia and myelinated retinal nerve fibers (MRNF). Methods: Thirty-six children (12 years and younger) with unilateral high myopia (spherical equivalent [SE] <= -6.0 D) and MRNF were prospectively enrolled. Twenty-two received rigid gas-permeable (RGP) contact lenses and 14 spectacles; all underwent occlusion therapy. Myelinated retinal nerve fiber features-including optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and fovea-to-myelination distance (Df-m)-were evaluated from fundus images. Best-corrected visual acuity (BCVA) change at one year was assessed. Results: Mean age was 5.2 +/- 2.4 years. Affected eyes had a mean SE of -10.01 +/- 2.80 D and baseline BCVA of 1.33 +/- 0.35 logMAR. Spherical equivalent severity correlated negatively with myelin-over-disc ratio, MRNF area, and Df-m (P<0.05). Mean BCVA improvement at 1 year was 0.65 +/- 0.32 logMAR, positively correlated with baseline SE and final BCVA, and negatively with optic disc quadrant involvement, myelin-over-disc ratio, MRNF area, and Df-m. Patients fitted with RGP lenses achieved significantly greater visual improvement than those with spectacles (P<0.001). Conclusion: Extensive MRNF involvement predicted more severe myopia and poorer recovery. Early amblyopia therapy, particularly with RGP lenses, achieved significant visual benefits.
Achromatopsia is a rare inherited cone dysfunction characterized by reduced visual acuity, photophobia, nystagmus, impaired color discrimination, and decreased contrast sensitivity (CS). This case report describes the clinical and patient-reported outcomes of red-tinted contact lens use in a child with achromatopsia. Baseline and postlens assessments included cycloplegic refraction, visual acuity, CS, and vision-related quality of life using a Turkish questionnaire adapted from the 25-Item National Eye Institute Visual Function Questionnaire for low vision and photophobia. After lens fitting, the patient reported reduced glare, improved comfort in bright environments, and better performance in daily visual activities. Questionnaire findings also suggested improvement in distance-related tasks, outdoor functioning, reading/writing comfort, and overall visual comfort. However, CS testing showed deterioration after lens use. These findings suggest that red-tinted contact lenses may provide meaningful symptomatic and functional benefit in pediatric achromatopsia, particularly by alleviating photophobia, even when objective CS does not improve.
Objective: To evaluate the relationship of scientific publication factors to lamellar keratoplasty volume in the United States (USA). Methods: Bibliometric analysis was performed using the R package, Bibliometrix, on the Scopus citation database to analyze trends in literature regarding Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet's membrane endothelial keratoplasty (DMEK), and deep anterior lamellar keratoplasty, and compared with published reports from the Eye Bank Association of America. Results: Our search yielded 1,356 DSAEK articles published between 2004 and 2023 with an annual overall percentage growth rate of 27.65%. There were 1,622 DMEK published articles between 2006 and 2023 with an annual overall percentage growth rate of 35.64%. The most productive countries by corresponding author were the United States (388), Japan (99), and Italy (68) for DSAEK compared with Germany (310), the United States (274), and the Netherlands (133) for DMEK. Eye Bank Association of America data demonstrated relatively rapid adoption of DSAEK in the United States, while DMEK sustained a slower, steadier increase in surgeries. Conclusion: DSAEK seems to be predominantly a US-first phenomenon with rapid adoption and surgeries outpacing the rate of global publications. DMEK seems to be predominantly a European-first technique with a more diverse origin of publications which outpaced the relatively slower surgical rate in the United States.
Objectives: To evaluate the effects of scleral lens (SL) wear on intraocular pressure (IOP), retinal parameters, and choroidal metrics in habitual SL wearers with keratoconus. Methods: This cross-sectional study included 25 eyes of 25 habitual SL wearers with keratoconus and 25 eyes of 25 healthy controls. Measurements were obtained before SL wear and immediately after lens removal after 4 hr of wear. IOP, retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated. Results: Mean SL wear duration was 3.9±3.8 years. Mean IOP was 12.16±3.00 mm Hg before wear and 12.14±2.90 mm Hg after 4 hr, with a paired mean difference of 0.01 mm Hg (95% CI, −0.76 to 0.78; P =0.678). No statistically significant changes were observed in RNFL, GCC, SFCT, or CVI after 4 hr ( P =0.929, 0.094, 0.098, and 0.424, respectively). CVI did not differ between groups before or after SL wear ( P =0.114 and 0.358, respectively). Conclusions: Four hours of SL wear was not associated with statistically significant changes in IOP, RNFL, GCC, SFCT, or CVI in habitual SL wearers with keratoconus.
Objectives: To investigate current and previous mechanical ocular stimulation behaviors beyond conventional eye rubbing in patients with keratoconus. Methods: This prospective study included Japanese outpatients with a clinical diagnosis of keratoconus in at least one eye. All participants completed a structured investigator-developed questionnaire assessing current and past mechanical ocular stimulation behaviors, followed by face-to-face physician interviews. Questionnaire items included history, reasons, duration, frequency, techniques, and anatomical sites of stimulation. Results: A total of 304 patients were included, with 91.4% reporting mechanical ocular stimulation. These behaviors were typically long-standing (75.9% >10 years) and varied widely in motivation, frequency, methods, and anatomical sites. Ocular itching was the most common trigger (75.9%), although many behaviors were unrelated to itching. Finger pulp (56.1%) and knuckles (48.6%) were commonly used, and the medial canthus was the most commonly involved site (70.1%) ( P <0.05). Pressure-related behaviors, such as eye pressing or massage during fatigue, were reported by approximately one third of patients. Conclusions: The concept of mechanical ocular stimulation provides a more comprehensive framework than eye rubbing for characterizing pressure-related behaviors in patients with keratoconus. Broader assessment of current and past behaviors may improve clinical assessment and patient counseling.
