Expert Review of Ophthalmology最新文献

{"title":"Can artificial intelligence be used to improve the quality of vision in patients with amblyopia? The first digital pill in medicine administered under AI","authors":"R. Hess, B. Thompson","doi":"10.1080/17469899.2023.2248393","DOIUrl":"https://doi.org/10.1080/17469899.2023.2248393","url":null,"abstract":"We live in an ever-increasing digital world, digital applications and diagnostics are part and parcel of everyday clinical practice, particularly in Ophthalmology. All previous digital applications have been directed to improving our diagnostic capabilities but now, for the first time there is a digital pill. This is not a digitally activated/tracked pharmaceutical [1], this is a digital treatment per se, one designed to recover visual function in later life that had been lost in childhood. The neural substrate for this is residual neural plasticity present after the early critical period for visual development. There appear to be two pathways, a bottom-up one that is reliant on the appropriate dichoptic stimulation [2] while the other is a top-down one from higher brain areas that involves attention [3–5]. Treatment efficacy depends on activation of both pathways and there is an important role for AI in ensuring that attention is fully engaged for the duration of the bottom-up stimulation which is administered on a videogaming platform suitable for engaging young children.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"223 - 225"},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49067560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in dry eye","authors":"J. Aquavella, Esteban Santiago, J. Zavislan","doi":"10.1080/17469899.2023.2258285","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258285","url":null,"abstract":"The ‘Dry Eye’ definition has matured and evolved over time motivated by advances in technology, knowledge, and understanding of the disease. When TFOS DEWS first presented a definition in 2007, it was defined as a ‘multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface.’ In 2017, the same group added to the definition the concept of ‘loss of homeostasis of the tear film,’ ‘hyperosmolarity,’ ‘inflammation,’ and ‘neurosensory abnormalities.’ All these made a more complete definition of this complex and multifactorial condition [1]. In 2017, the Asia Dry Eye Society (ADES) describes and emphasizes the concept of ‘unstable tear film’ in their definition of dry eye creating a simpler classification oriented to creating a simpler diagnosis and management of these patients [2]. Nowadays, thanks to proliferative research and hard work of different societies to try to bring clarity to a disorder with a high level of complexity, the multifactorial characteristic of Dry Eye Disease is better understood, as is the concept of the lacrimal functional unit (LFU) and its role in the production and maintenance of a healthy ocular surface tear film [3,4].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"31 1","pages":"231 - 234"},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current advances in the management of optic disc pit maculopathy","authors":"D. Shukla, Jay Kalliath, A. Dhawan","doi":"10.1080/17469899.2023.2258284","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258284","url":null,"abstract":"ABSTRACT Introduction Although we have been familiar with optic disc pits for a long time, the diagnosis and management of maculopathy remain unclear. Better imaging has improved the diagnosis of this subtle pathology. A recent update on the natural history of optic pit maculopathy marks a paradigm shift in the understanding and management of this condition. There is renewed scope for non-surgical management and less urgency for vitrectomy, which remains the definitive treatment. Areas covered This perspective highlights and critiques the updates on diagnostic imaging, natural history, indications and prognosis for surgery, non-surgical alternatives, and surgical adjuncts. We searched the Medline database using the keywords optic pit AND maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the salient articles. Expert commentary There has been no major change in the surgical options and outcomes for optic pit maculopathy in recent times, except a greater clarity on the role of vitrectomy without any adjuvants as the primary surgical procedure. The key updates are on better imaging for diagnosis and prognosis, and less urgency for surgery in view of the favorable natural history.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"31 1","pages":"249 - 259"},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The vicious cycle of dry eye disease: a look into promising novel drug therapies","authors":"Giulia Coco, A. Taloni, V. Scorcia, G. Giannaccare","doi":"10.1080/17469899.2023.2258279","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258279","url":null,"abstract":"ABSTRACT Introduction Dry eye disease (DED) is a very common ocular condition with a considerable socioeconomic impact affecting patient’s visual function and quality of life. Currently, thanks to the better knowledge on DED pathophysiology, therapeutical approaches are focused on the primary core mechanisms of DED. Furthermore, new drugs and compounds are being explored in the light of recent findings concerning unique disease-related pathways. The purpose of this review is to stress DED pathogenesis, addressing its vicious cycle, and highlighting the cutting-edge drug therapy approaches under development. Areas covered A literature search on the PubMed and Scopus databases was carried out. The database search strategy was formulated around the term ‘dry eye disease’ and other terms regarding its pathophysiology and therapeutic strategy. Additional search was conducted on ClinicalTrials.gov for unpublished results and ongoing clinical trials. Expert opinion The primary approaches used for DED include lifestyle, environmental changes, tears supplementation, and control of the eyelids and ocular surface inflammation. In selected cases, medical therapy could benefit by technological device-based management. Due to the complexity of DED and the continuous growth of disease prevalence and patients’ unmet needs, new therapeutic approaches focused on its pathogenesis are currently under investigation, while others are pending approval.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"51 1","pages":"235 - 247"},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior segment optical coherence tomography in iris and ciliary body tumors: a systematic review","authors":"I. Mirzayev, A. Gündüz, Ö. Gündüz","doi":"10.1080/17469899.2023.2224565","DOIUrl":"https://doi.org/10.1080/17469899.2023.2224565","url":null,"abstract":"","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41816819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomegalovirus anterior uveitis: how does it compare to the characteristics of other anterior uveitides to provide unique management opportunities","authors":"I. Halkiadakis, Dimitrios S. Ladas, K. Chatzistefanou, N. Markomichelakis","doi":"10.1080/17469899.2023.2245147","DOIUrl":"https://doi.org/10.1080/17469899.2023.2245147","url":null,"abstract":"Anterior uveitis (AU) is the commonest type of uveitis [1,2]. Most cases (48–70%) are considered idiopathic. HLA-B27-associated spondyloarthritis is the most common systemic disease associated with adult AU. It was reported in 18–32% of patients with AU in Western countries and in 6–13% of patients with AU in Asia [3]. AU in children is also frequently associated with juvenile idiopathic arthritis. Several other causes of AU have been described in the literature including herpes family virus, syphilis, tuberculosis, sarcoidosis, tubulointerstitial nephritis and uveitis syndrome, and Adamantiades–Bechet’s disease (ABD) [4]. In terms of disease duration, AU has been divided into acute, recurrent, and chronic. A chronic course is defined as episode duration over 3 months or relapses within less than 3 months of treatment cessation [5]. Chronic AU has been linked to an increased risk for loss of vision from serious complications such as glaucoma, cataract, band keratopathy, cystoid macular edema, and phthisis bulbi [4]. Prompt identification of possible infectious causes or systemic associations may prevent complications and loss of vision and can positively affect the overall visual prognosis and the patient’s quality of life [6]. For example, in patients with juvenile idiopathic arthritis (JIA)-associated chronic AU, the use of immunosuppression reduces the risk of vision loss by ~ 40% [7] and an early identification of herpetic AU may significantly reduce the risk of glaucoma and cataract formation [8].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"155 - 157"},"PeriodicalIF":0.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44476930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical ocular local anaesthetics as an adjunctive measure in the day-1 treatment of bacterial keratitis","authors":"J. Pearce, B. Rai","doi":"10.1080/17469899.2023.2245145","DOIUrl":"https://doi.org/10.1080/17469899.2023.2245145","url":null,"abstract":"ABSTRACT Introduction The day-1 topical antibiotic treatment for bacterial keratitis (BK) can have a significant impact on treatment outcomes. Symptoms associated with this condition (pain, photophobia, blepharospasm and increased lacrimation) may compromise the effectiveness of topical antibiotic treatment by reducing the antibiotic contact time with the cornea. Topical ocular local anaesthetics (TOLAs) have the potential to alleviate these symptoms and thus potentiate the effect of the antibiotic drops instilled. Areas covered The literature on possible ocular side-effects of TOLAs was searched using Google and PubMed databases (Filters: Humans, English, abstract available), with no filters applied for date of publication. Relevant papers were reviewed, and possible barriers to their use on day-1 in the treatment of BK were identified, examined, and either found to be not applicable to short term use or strategies were identified to resolve any barriers. Published evidence to support the possible potentiation of antibiotic effect via the use of TOLAs was also reviewed. Expert opinion Perceived barriers to the short-term use of TOLAs in BK are not supported by the literature, and there is evidence to suggest that higher corneal antibiotic concentrations may be achieved by using TOLAs in conjunction with topical antibiotic drops in BK on day-1.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"159 - 166"},"PeriodicalIF":0.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41349439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical presentation of ischemic optic neuropathies","authors":"N. Miller, A. Arnold","doi":"10.1080/17469899.2023.2237193","DOIUrl":"https://doi.org/10.1080/17469899.2023.2237193","url":null,"abstract":"ABSTRACT Introduction Ischemic optic neuropathies (IONs) are the leading cause of sudden, permanent optic nerve-related visual loss. Areas covered There are three types of anterior and posterior (retrobulbar) IONs: nonarteritic, perioperative, and arteritic. In this review, we discuss the clinical manifestations, management, and prognoses – visual and systemic – of each type. A literature search was conducted via MEDLINE (PubMed) 1 January 1973 to 1 April 2023. Expert opinion There is no consistently beneficial treatment for the nonarteritic IONs. Patients who have experienced either spontaneous nonarteritic anterior ION (NAION) or an acute optic neuropathy following uncomplicated cataract surgery should be warned that they may have an increased risk of a similar event in their fellow eye if they undergo cataract surgery in that eye. Early recognition of perioperative ION after non-ocular surgery is crucial so that anemia and hypotension can be corrected as soon as possible, hopefully resulting in visual improvement. Finally, arteritic ION requires early recognition and timely treatment with systemic corticosteroids to prevent subsequent visual loss in the fellow eye as well as the many other complications of giant cell arteritis. The interleukin-6 inhibitor tocilizumab can be used to reduce both the dose of steroids and the duration steroids are needed.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"167 - 176"},"PeriodicalIF":0.7,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42992168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under pressure: keratoconus and intraocular pressure elevation evidence","authors":"Otavio Azevedo Magalhaes","doi":"10.1080/17469899.2023.2216931","DOIUrl":"https://doi.org/10.1080/17469899.2023.2216931","url":null,"abstract":"I read with great interest the review article recently published by McMonnies [1] regarding eye rubbing-related intra-ocular pressure (IOP) elevation in the development and progression of keratoconus (KC). Although we congratulate the author for highlighting the importance of eye rubbing and KC pathogenesis, some important points that support the primary role of IOP elevation in the context of eye rubbing still need to be considered. First, the relationship between KC and the onset and progression of primary open angle glaucoma (POAG) cannot be observed in a clinical setting [2]. If elevated IOP during rubbing is so relevant in terms of corneal bulging, rubbing would also be expected to damage the optic nerve and retinal fiber layer. In addition, in very asymmetric cases, an eye with severe KC would present an increased cup-to-disc ratio compared to mild or form frustre contralateral eye. Again, this finding has not been observed [3]. The concept of corneal bulging/distention due to IOP forces needs to be investigated. The concept invokes the notion of an increase in surface area occurs via a stretching process [4]. However, this idea is not exactly an accurate description of the morphology of the keratoconic cornea. A true bulge would necessarily dictate an increase in surface area of the cornea, such as in keratoglobus in which the surface expands [5]. In contrast, surface area tends to be conserved to the same degree as in corneas with KC, promoting an isometric type of distortion or warping in the majority of cases. Hence, the flattening seen in the periphery of keratoconic corneas (increased prolateness) corresponds to a coupling effect that compensates for the increase in curvature in the cone region [6]. What happens to a young patient’s cornea when he is subject to constantly elevated IOP? It has been reported that cases of childhood glaucoma corneas have flatter keratometry, greater diameter, and relatively thicker corneas than normal corneas [7,8]. Only a statistically significant increase in posterior corneal elevation in eyes with childhood glaucoma, both unoperated and operated, was found, although no significant difference in anterior corneal elevation and pachymetry was observed [9]. Finally, I agree with the author that eye rubbing is the most important risk factor for KC development and progression (perhaps sine qua non) and causes substantial transient IOP elevation. However, the lack of relationship between KC, POAG, and childhood glaucoma in addition to the morphology of corneal deformation questions the importance of IOP elevation in KC pathogenesis. Funding","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"151 - 151"},"PeriodicalIF":0.7,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43186222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pathogenesis of KERATOCONUS","authors":"C. McMonnies","doi":"10.1080/17469899.2023.2216932","DOIUrl":"https://doi.org/10.1080/17469899.2023.2216932","url":null,"abstract":"The editor, I appreciate the opportunity to respond to Dr Gatinel’s comments as they address some key issues in relation to the pathogenesis of keratoconus (KC). In regard to links between KC and primary open angle glaucoma, Hashemi and coauthors reviewed the associations between KC and posterior segment structures and reported extensive evidence of morphological and functional changes in the retina, optic nerve head and choroid being found in KC patients [1]. These changes included significantly larger disc and cup areas and deeper cup depth in KC patients than in non-KC individuals [1]. It is possible that exposure to rubbing-related or other mechanisms for episodes of elevated intraocular pressure (IOP) might be involved in the development of posterior segment changes observed in KC patients [2]. For instance, increased tissue hydrostatic pressure and ubiquitination processes that could occur during episodes of IOP elevation may help explain both retinal and corneal cellular changes seen in KC patients [2]. Accordingly, increased hydrostatic pressure in corneal stroma may damage keratocytes and reduce their collagen maintenance functions. Poorly maintained collagen may increase the possibility of thinning and reduced resistance to IOP distending forces with associated increased susceptibility for bulging responses during episodes of IOP elevation [2]. In regard to the notion of bulging corneal responses due to IOP forces and an expected increase in corneal surface area: in the earlier stages of KC development, it appears that stromal fibrils/lamellae may not significantly stretch in response to IOP distending forces. That the corneal surface area is conserved can be explained by the concepts of biomechanical coupling [3] or curvature transfer [4]. These explanations involve steepening/bulging/protrusion of a central/para-central/pre-cone corneal area that is less resistant to IOP, which is compensated for by a flattening of curvature in a diametrically opposed area. The lamellae length required to form the bulge is provided by reduced curvature in the flattened zone. Thus, at least in the earlier stages of KC development, corneal surface area is not significantly changed despite a localized steepened area of bulge response. Colour topographical maps of early KC will sometimes very clearly show the compensating flatter peripheral area diametrically opposed to a steeper/bulging/pre-cone central or para-central area. Correction with rigid contact lenses appears to alter corneal topography such that this observation is not often apparent subsequently. KC corneas assume a conical shape in the most advanced cases [5]. and stretching/elongation of stromal fibrils and lamellae may be part of cone formation as well as an increase in corneal surface area. As far as rubbing being the sine qua non mechanism for KC pathogenesis, there is the need to consider patients who don’t have abnormal rubbing habits. For these patients KC development/progression may ","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":"18 1","pages":"153 - 154"},"PeriodicalIF":0.7,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43156077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}