Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)最新文献

{"title":"Author's reply.","authors":"Paul Chamberlain, Mark A Bullimore","doi":"10.1111/opo.12872","DOIUrl":"https://doi.org/10.1111/opo.12872","url":null,"abstract":"We thank Drs. Saunders and McCullough for their interest in our article, Axial length targets for myopia control. We regret not citing their important work, although it was published only just before our manuscript's submission. McCullough et al. present axial growth data for young emmetropes along with incident and progressing myopes from the Northern Ireland Childhood Errors of Refraction (NICER) study, which they expand upon in their letter to the editor. We are pleased to see that their data support our recent work. In particular, it is encouraging to see that the 3year progression among 10yearold myopes in NICER is close to that observed in the MiSight clinical trial, and in other recent clinical trials of predominantly nonEast Asian children. What is equally valuable are the corresponding NICER data for emmetropes, which also agree with the predictions used in our paper. Large studies of emmetropic children are rare, and it is sometimes unclear if incident myopes are included in growth data. We could have extracted growth rates form the published figures and used them for comparison. The NICER data plotted by McCullough et al. reflect the growth observed at years 3 and 6 of the study. At the start of this period, the NICER cohort had a mean age of 10.1 years, and 13.1 at the 3year mark. Data were averaged for the 6and 7yearold population at baseline and then eye growth over the 3year intervals are reported. Indeed, it is fortuitous that even though the NICER sample was examined once every three years, one of these visits featured children with a very similar mean age to the MiSight cohort. However, we chose a more nuanced approach, creating virtual cohorts reflecting the actual age distribution of our original trial— between 8 and 12 years at baseline— thereby accounting for both the age distribution of subjects and the nonlinear relationship between axial elongation and age. We would not have been able to use the NICER data for this approach. Drs. Saunders and McCullough go on to recommend criteria for clinical decision making about the efficacy of any treatment, with growth of >0.60 mm over 3 years in 10yearolds representing a lack of success. We caution against this blanket application of mean or median data to individual eyes, although 85% of the MiSighttreated eyes elongated by less than this criterion over 3 years. For example, an eye with slow underlying growth may appear to be experiencing successful treatment but may be nonresponsive. The converse is true for an inherently fastgrowing eye, where a 3year growth of 0.60 mm may represent some relative slowing. However, this is where percentile curves, as proposed by McCullough et al. and others should prove valuable to a clinician. Drs. Saunders, McCullough and colleagues are to be applauded for their ongoing and important work. We look forward to additional contributions, including an expansion of the data, perhaps including annualized axial elongation data in emmetropes and persiste","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1384"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/opo.12872","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39319306","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":"Investigating the discrepancy between MAIA and MP-1 microperimetry results.","authors":"Lixing Xu,&nbsp;Zhichao Wu,&nbsp;Robyn H Guymer,&nbsp;Andrew J Anderson","doi":"10.1111/opo.12877","DOIUrl":"https://doi.org/10.1111/opo.12877","url":null,"abstract":"<p><strong>Purpose: </strong>Previous work has suggested that sensitivities measured on the iCare MAIA and Nidek MP-1 microperimeters differ systematically, although it is unclear whether one or both devices are inaccurate. Here, we assess the discrepancy between these two instruments as well as with a rigorous reference standard.</p><p><strong>Methods: </strong>Fifteen healthy participants underwent visual field testing on the MAIA and MP-1 microperimeters. Results were compared to a reference measure of increment thresholds on a laboratory-based, calibrated computer monitor system using the same background luminance and target size. Discrepancies were assessed as a function of eccentricity along the vertical meridian. Differences in decibels (dB) due to differences in the maximum stimulus luminance between devices were accounted for mathematically.</p><p><strong>Results: </strong>The mean sensitivity measured with the MAIA was <1 dB lower than laboratory-based measures, which was statistically significant but of limited clinical importance. In contrast, the mean sensitivity measured with the MP-1 was >8 dB lower than the laboratory measures. The difference was greater for an eccentric superior retinal location, in contrast to what would be predicted if the discrepancy was due to a ceiling effect caused by the MP-1's limited dynamic range.</p><p><strong>Conclusions: </strong>While MAIA measurements showed low bias compared with our rigorously determined reference standard, the MP-1 showed large discrepancies that could not be explained purely by the limited dynamic range of the instrument. MAIA and MP-1 sensitivity values cannot be compared directly, and caution is advised when assessing absolute sensitivities or eccentricity effects in the extensive MP-1 literature.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1231-1240"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/opo.12877","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39366329","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":"Cone photoreceptor density in the Copenhagen Child Cohort at age 16-17 years.","authors":"Christina Eckmann-Hansen,&nbsp;Mathias Hvidtfelt Hansen,&nbsp;Poul Pedersen Laigaard,&nbsp;Birgit Agnes Sander,&nbsp;Inger Christine Munch,&nbsp;Else Marie Olsen,&nbsp;Anne Mette Skovgaard,&nbsp;Michael Larsen","doi":"10.1111/opo.12889","DOIUrl":"https://doi.org/10.1111/opo.12889","url":null,"abstract":"<p><strong>Purpose: </strong>To examine cone density in relation to gestational and morphological parameters in the Copenhagen Child Cohort (CCC2000).</p><p><strong>Methods: </strong>The macula was imaged using adaptive optics in 1,296 adolescents aged 16-17 years. Axial length and distance visual acuity were determined. Absolute and angular cone photoreceptor density were analysed for an 80 × 80-pixel area, 2 degrees temporal to the fovea. Association with axial length was analysed with linear regression. Correlation with visual acuity was described with a Pearson correlation coefficient. Associations of cone density with gestational parameters, maternal smoking, sex and age were analysed using multiple regression adjusted for axial length.</p><p><strong>Results: </strong>Mean absolute cone density was 30,007 cones/mm² (SD ± 3,802) and mean angular cone density was 2,383 cones/deg² (SD ± 231). Peri- and postnatal parameters, sex and age had no statistically significant effect on cone density (p > 0.05). Absolute cone density decreased with longer axial length (-2,855 cones/mm² per mm or -9.7% per mm, p < 0.0001). For angular density, which included a correction for the geometrical enlargement of the eye with axial length, a decrease with axial length was detectable, but it was small (-20 cones/deg² per mm or -0.84% per mm, p = 0.009).</p><p><strong>Conclusions: </strong>The decrease in cone density per unit solid angle with increasing axial length was small, less than 1 percent per mm, indicating that expansion of the posterior pole during the development of refraction takes place without a clinically significant loss of cones. Perinatal parameters, within the spectrum presented by the study population, had no detectable effect on cone density.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1292-1299"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39445795","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":"Comparison between estimated and measured myopia progression in Hong Kong children without myopia control intervention.","authors":"Yajing Yang,&nbsp;Sin Wan Cheung,&nbsp;Pauline Cho,&nbsp;Stephen J Vincent","doi":"10.1111/opo.12895","DOIUrl":"https://doi.org/10.1111/opo.12895","url":null,"abstract":"<p><strong>Purpose: </strong>To compare myopia progression estimated by the Brien Holden Vision Institute (BHVI) Myopia Calculator with cycloplegic measures in Hong Kong children wearing single-vision distance spectacles over a 1- and 2-year period.</p><p><strong>Methods: </strong>Baseline age, spherical equivalent refraction (SER) and ethnicity of control participants from previous longitudinal myopia studies were input into the BHVI Myopia Calculator to generate an estimate of the SER at 1 and 2 years. Differences between the measured and estimated SER (116 and 100 participants with 1- and 2-year subjective refraction data, respectively, and 111 and 95 participants with 1- and 2-year objective refraction, respectively) were analysed, and the measured SER compared with the 95% confidence interval (CI) of the estimated SER.</p><p><strong>Results: </strong>In children aged 7-13 years, 36% progressed within the 95% CI of the Myopia Calculator's estimate, whereas 33% became less myopic than predicted (range 0.31 to 1.92 D less at 2 years) and 31% became more myopic than predicted (range 0.25 to 2.33 D more myopic at 2 years). The average difference between the estimated and measured subjective or objective SER at 1 and 2 years of follow-up was not clinically significant (<0.25 D).</p><p><strong>Conclusions: </strong>On average, the BHVI Myopia Calculator estimated SER was in close agreement with measured cycloplegic SER after 1 and 2 years of follow-up (mean differences < 0.25 D). However, the measured myopia progression only fell within the 95% CI of the estimated SER for 32%-38% of children, suggesting that the BHVI 'without management' progression data should be interpreted with caution. The inclusion of additional data, modified to include axial elongation, from longitudinal studies of longer duration with larger sample sizes and a range of racial backgrounds may improve the Calculator's ability to predict future myopia progression for individual children.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1363-1370"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/c4/OPO-41-1363.PMC9291478.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39476842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is myopia prevalence related to outdoor green space?","authors":"Brian An Peng,&nbsp;Thomas John Naduvilath,&nbsp;Daniel Ian Flitcroft,&nbsp;Monica Jong","doi":"10.1111/opo.12896","DOIUrl":"https://doi.org/10.1111/opo.12896","url":null,"abstract":"<p><strong>Purpose: </strong>Rapid urbanisation and lifestyle changes have been associated with a huge increase in myopia across many parts of the world. There is strong evidence that environmental factors including time outdoors and urbanisation can influence the development of myopia, particularly in school-aged children. The aim of this study is to determine whether there is a relationship between the prevalence of myopia and the amount of vegetation/green spaces across different regions of the world, as a risk factor for myopia development.</p><p><strong>Methods: </strong>The prevalence of myopia in the 15 to 19-year age group in Australia, Brazil, China, Finland, India, Iran, Japan, Oman, Singapore, South Africa and the UK was obtained from a meta-analysis by Holden et al. Normalised Difference Vegetation Index (NDVI) was used to quantify green space exposure based on Landsat 7 Enhanced Thematic Mapper Plus (ETM+) satellite data. Green space was measured in locations specific to 15 studies that reported myopia prevalence. Simple linear regression was used to analyse yearly data, and a mixed effects model was applied to assess the significance of green space when study was a random effect.</p><p><strong>Results: </strong>Myopia prevalence increases significantly when green space was <-0.2, but the effect was less apparent for values >-0.1. When a mixed effects model was used, the effect of green space was found to be significantly associated with myopia prevalence (p = 0.05).</p><p><strong>Conclusions: </strong>There was evidence of a weak but significant non-linear relationship between myopia and green space, with the effect most apparent at low levels of green space. A larger data sample, along with further investigations into the utilisation of green spaces, are required to understand whether increasing the amount of green space can reduce myopia incidence and progression impact.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1371-1381"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39485702","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":"Do rectus muscle parameters vary between emmetropes and myopes?","authors":"Ashish Vasudeva,&nbsp;Rohit Dhakal,&nbsp;Kiran Kumar Vupparaboina,&nbsp;Pavan K Verkicharla","doi":"10.1111/opo.12890","DOIUrl":"https://doi.org/10.1111/opo.12890","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the thickness, area, and insertion site of the medial (MR) and lateral (LR) rectus muscles in individuals with emmetropia and different degrees of myopia.</p><p><strong>Methods: </strong>Swept-source optical coherence tomography images of the MR and LR muscles in 80 participants including emmetropes (spherical equivalent refractive error [SER] ±0.50 D, N = 14) and myopes (≤ -0.75 D, N = 66), were analysed. Custom-designed, semi-automated software was used to measure parameters such as insertion distance from limbus, muscle thickness at every 1 mm interval to 3 mm periphery and muscle area from insertion site to 3 mm.</p><p><strong>Results: </strong>The median (Q1, Q3) SER error and axial length were -6.00 D (-13.25, -2.12) and 25.78 mm (23.78, 28.61), respectively. The MR was significantly thinner (mean ± SE: 137.7 ± 8.9 vs. 159.7 ± 8.9 µm, p < 0.01) and occupied less area than the LR (0.35 ± 0.01 vs. 0.42 ± 0.01 mm² , respectively, p < 0.01). The thickness of the MR gradually increased from the insertion site to a 3 mm peripheral eccentric location (106.5 3.8 µm at 1 mm, 135.5 ± 4.5 µm at 2 mm and 156.1 ± 5.9 µm at 3 mm, p < 0.01). The overall median thickness of the MR was significantly less in myopes (129 µm [111.5, 152.2]) than emmetropes (158.1 [134.3, 167.7] µm, p = 0.03). However, no such trend was seen in the LR muscle. Muscle area and insertion distance were not different between emmetropes and myopes in both horizontal rectus muscles.</p><p><strong>Conclusion: </strong>Unlike the LR, the parameters of the MR (thin and occupying less area) show significant association with myopia. While the key finding of this study indicates the possible association of MR parameters with myopia, the clinical relevance of this finding and its role in myopiogenesis/progression needs to be investigated further.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1300-1307"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39440583","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":"Retinal image size in pseudophakia.","authors":"David A Atchison,&nbsp;Jos J Rozema","doi":"10.1111/opo.12874","DOIUrl":"https://doi.org/10.1111/opo.12874","url":null,"abstract":"<p><strong>Purpose: </strong>Approaches are developed to determine relative retinal magnifications in anisometropic patients undergoing cataract surgery; these can be used to balance between full spectacle corrections with equal intraocular lens (IOL) powers and a pure IOL power correction.</p><p><strong>Methods: </strong>The analysis started from the original and pseudophakic Navarro eye models, where in the latter case an IOL replaced the natural lens. A third model was a simplified Navarro-IOL model with a single surface cornea and a thin lens. These models were manipulated by altering vitreous length, corneal power and lens position. Retinal image sizes were determined for both full IOL corrections and full spectacle corrections by raytracing and approximate equations. Relative magnification (RM) was determined as the ratio of retinal image size of an eye to that of the appropriate standard eye.</p><p><strong>Results: </strong>For raytracing and full IOL correction, vitreous length led to RM change of 5%/mm, while for corneal power and IOL position this was -0.4%/D and 1.4%/mm, respectively. For raytracing and spectacle correction, effects were 0%/D (vitreous depth), -1.6%/D (corneal power) and +1.0%/mm (IOL position). For full IOL correction, the approximate RM calculations were highly accurate. For spectacle correction, the approximate RM calculations were exact for vitreous length changes, reasonably accurate for corneal power changes but very inaccurate for changes in anterior chamber depth.</p><p><strong>Conclusion: </strong>Relative magnification approximations may be useful to assess the risk of aniseikonia in anisometropic patients targeted for postoperative emmetropia. Some of these patients would be corrected best by a combination of spectacles and IOLs.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1222-1230"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/opo.12874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39339293","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":"Should a pooled analysis of FDA trials be considered representative for a population?","authors":"Piotr Kanclerz,&nbsp;Jordan Masters","doi":"10.1111/opo.12884","DOIUrl":"https://doi.org/10.1111/opo.12884","url":null,"abstract":"To the Editor: We have read with interest the article by Wu et al., in which the authors have compared the risk of bestcorrected vision acuity (BCVA) loss associated with contact lens wear and laserassisted in situ keratomileusis (LASIK). The pooled analysis revealed that the risk of a ≥2 line BCVA loss following LASIK was equivalent to the risk of daily contact lens wear for 103 (95% CI: 103– 391) years. While it is useful to compare outcomes of LASIK to that of contact lenses, suggesting such a chasm between visual outcomes is inappropriate given the limitations of this study. To evaluate the total risk of BCVA loss following LASIK, the authors have identified randomised clinical trials published within the FDA database from 2003 to 2019. In our opinion, the pooled results of these investigations cannot be considered as representative for the population of patients undergoing LASIK. Several of these FDA studies have been conducted in patients with hyperopia; within the analyzed data, at least 36.7% of eyes (1,792 out of 4,882) were hyperopic. Importantly, the percentage of eyes with a loss of two or more BCVA lines is significantly higher in eyes treated for hyperopia than in those treated for myopia. In clinical practice, hyperopes might constitute only up to 20% of patients undergoing LASIK. In some particular groups e.g., in US Navy personnel undergoing LASIK, the proportion of hyperopes might be even lower; in the PROWL1 Study 10 out of 508 eyes (1.9%) undergoing LASIK were hyperopic, as were 14 out of 620 eyes (2.2%) in the PROWL2 Study. Moreover, microbial keratitis (MK) related to contact lens use is a more severe condition than corneal aberrations after hyperopic LASIK, while both might lead to a ≥2 line BCVA loss. It is also useful to note that the pooled studies used from the FDA database have less than 5,000 participants. Several significantly larger studies demonstrated a significantly lower risk of BCVA loss after LASIK. 7","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1385-1386"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/opo.12884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39394683","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":"Attitudes of optometrists in the UK and Ireland to Digital Eye Strain and approaches to assessment and management.","authors":"Patrick A Moore,&nbsp;James S Wolffsohn,&nbsp;Amy L Sheppard","doi":"10.1111/opo.12887","DOIUrl":"https://doi.org/10.1111/opo.12887","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the attitudes and understanding of optometrists in the UK and Ireland towards Digital Eye Strain (DES), and to examine related practice patterns.</p><p><strong>Methods: </strong>An anonymous online questionnaire was developed, covering attitude and understanding of DES, examination of patients who may be experiencing DES and approaches to management options. The questionnaire was promoted to UK and Ireland optometrists via professional bodies and local and area optometric committees.</p><p><strong>Results: </strong>406 responses were included in the analysis. Most respondents agreed that DES was an important concern for optometrists (88.9%). 91.4% reported they felt confident in discussing possible symptoms of DES and management options; this was weakly and negatively associated with number of years qualified (r_s  = -0.198, p ≤ 0.001). Estimations of the proportion of patients affected by DES were lower than reports in the literature (median 25%, IQR 10%-50%). Most respondents always (60.6%) or frequently (21.9%) inquired about device usage in routine case history taking, and also asked follow-up questions, although 29.3% only asked about the presence of symptoms half the time or less. Advising on regular breaks (84.0%), lubricants (55.7%) and environment/set up (69.2%) were felt to be extremely or very important by most respondents. Advising on specialist spectacle lenses, specifically blue filtering designs, was considered extremely or very important by 34.2% and 15.2%, respectively.</p><p><strong>Conclusion: </strong>Given the agreement that DES is a significant issue causing frequent and persistent symptoms, and practitioners reported high levels of confidence in discussing DES, patients can expect to receive advice on symptoms and management from their optometrist. Simple management strategies were felt to be most important to advise on, with more uncertainty linked to specialist spectacle lenses.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1165-1175"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/8d/OPO-41-1165.PMC9291543.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39434825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transdermal anti-inflammatory therapy for aqueous deficiency.","authors":"Charles W McMonnies","doi":"10.1111/opo.12891","DOIUrl":"https://doi.org/10.1111/opo.12891","url":null,"abstract":"<p><strong>Purpose: </strong>Lacrimal gland inflammation has been identified as an important limitation on aqueous production and associated dry eye disease. Ocular surface inflammation in dry eye disease can be a downstream response to reduced quantities of warmer hyperosmotic aqueous being delivered from an inflamed lacrimal gland with high concentrations of inflammatory mediators. This review examines evidence which shows how topical applications of anti-inflammatory drugs have very limited access to the lacrimal gland and an associated limited capacity to increase aqueous flow by reducing inflammation in the main lacrimal gland.</p><p><strong>Recent findings: </strong>Using cyclosporine as an exemplar immunomodulatory drug, this review examines problems associated with the topical administration of all anti-inflammatory drugs in the treatment of dry eye disease.</p><p><strong>Summary: </strong>Limited access to the lacrimal gland for topical applications and their very short on-eye residence times are compared with the therapeutic potential of prolonged therapeutic episodes that could be achieved with transdermal applications of a drug to the skin at the site of the lacrimal gland. Poor access to the lacrimal gland for topically administered drugs is a major barrier to the treatment of aqueous deficiency. While topical inflammatory drug access to the ocular surface is direct, poor access to the lacrimal gland is partly due to drop placement being downstream to the flow of aqueous (Eye Vis 2020;7:1; Eye Vis 2019;6:1). This barrier is much greater according to the degree that reflex tear flow is stimulated by irritation associated with adverse drop temperature, and/or pH and/or tonicity for example.</p>","PeriodicalId":520731,"journal":{"name":"Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)","volume":" ","pages":"1267-1272"},"PeriodicalIF":2.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483057","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}