British Journal of Ophthalmology最新文献

{"title":"Semi-automated screening reveals patients with glaucoma-induced blindness missing out on social support: a cross-sectional study of certificate of visual impairment allocation","authors":"Arun James Thirunavukarasu, Nikhil Jain, Helmut C Y Yu, George Nishimura, Ansh Tandon, Hamid Butt, Rohan Sanghera, Rupert R A Bourne","doi":"10.1136/bjo-2024-326745","DOIUrl":"https://doi.org/10.1136/bjo-2024-326745","url":null,"abstract":"Background/aims Many countries provide social support to patients with severe sight impairment (blindness). In the UK, these benefits require a certificate of visual impairment (CVI) which requires referral by a consultant ophthalmologist. Many eligible patients do not receive a CVI due to personal choice or lack of consideration or communication by their doctor. This study investigated the frequency and reasons for missed certification in glaucoma. Methods A retrospective cross-sectional survey was undertaken of all patients with glaucoma attending a tertiary referral clinic over a 12-month period. Semi-automated screening using objective visual acuity and perimetry parameters was facilitated by a web application, GFDC (Glaucoma Field Defect Classifier). CVI-eligible patients’ records were analysed to determine the reasons for missed registration, including incorrect screening classification. Results Of 5620 individual patients consulted, 919 were classified as sight impaired, and 64 were classified as severely sight impaired (blind). Of the patients classified as blind, 7 (11%) were misclassified, and 36 (56%) were on the CVI register already. 21 of 57 eligible patients with glaucoma-induced blindness (37%) were unregistered. Reasons for missed registration included administrative failure (23.8%), lack of consent (9.5%), reversible visual impairment (19.0%), frailty and comorbidity (71.4%), and mental health diagnoses (38.1%). Conclusion A semi-automated algorithm can be used to screen large numbers of patients for CVI eligibility due to blindness. Many eligible patients are not registered, with risk factors including frailty, comorbidity and reversible causes of visual impairment. This algorithm could be used to prompt ophthalmologists to consider registration or used as an alternative referral mechanism. Screening for CVI-eligible patients with an objective algorithm may ameliorate the inequity associated with subjective and variable decision-making. Data are available upon reasonable request. Available upon request to the corresponding author.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with diplopia before and after orbital blowout fracture reconstruction","authors":"Hiroaki Oku, Akihide Watanabe, Saul N Rajak, Tomomichi Nakayama, Akiko Yoneda, Kengo Yoshii, Chie Sotozono","doi":"10.1136/bjo-2025-327299","DOIUrl":"https://doi.org/10.1136/bjo-2025-327299","url":null,"abstract":"Background/Aims To ascertain factors associated with persistent diplopia after orbital fracture reconstruction. Methods In this retrospective study, we reviewed 798 cases with depressed fragment fracture at the Department of Kyoto Prefectural University of Medicine Hospital between January 2009 and November 2023. The restriction of extraocular movements and diplopia was assessed using the Hess area ratio (HAR). The factors for HAR% ≥85% before surgery and 6 months after surgery were assessed. Results Of the 798 cases in this study, 437 cases (54.8%) had an HAR% of ≥85%, and 361 cases (45.2%) had an HAR% of <85% before surgery. Age ≤18 years old (p=0.017), orbital tissue herniation volume <median (p=0.001), absence of extra-ocular muscle deviation (p<0.001) and medial wall (vs medial wall and orbital floor with strut fracture; p<0.001) were found to be associated with HAR% ≥85% before surgery. Of the 332 cases treated with surgery, 272 cases (81.9%) were HAR% ≥85%, and 60 cases (18.1%) were HAR%<85% after surgery. Age ≤18 years old (p=0.011), male (p=0.014), absence of extra-ocular muscle deviation (p=0.002) and medial wall (vs medial wall and orbital floor with strut fracture; p=0.002) were found to be associated with HAR% ≥85% at 6 months post surgery. Conclusion Patients of younger age, male and those with absence of extraocular muscle deviation have better eye movements in the affected eye (increased HAR%) 6 months after surgery. Data sharing not applicable as no datasets generated and/or analysed for this study. No data are available.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"22 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the effect of physical activity on intraocular pressure using a novel implanted telemetric pressure sensor","authors":"Vincenzo Pennisi, Jacqueline J O N van den Bosch, Anna Neustaeter, Angela Ehmer, Hagen Thieme, Michael B Hoffmann, Lars Choritz","doi":"10.1136/bjo-2023-324034","DOIUrl":"https://doi.org/10.1136/bjo-2023-324034","url":null,"abstract":"Background Due to technical limitations of commonly used tonometry devices, the effects of physical exercise on intraocular pressure (IOP) have never been studied during exercise. This study continuously monitored IOP variations in patients with glaucoma during physical exercise using an implanted IOP microsensor. Methods In total, 10 participants (six male and four female) with open-angle glaucoma (age range: 67–79), previously implanted with an IOP sensor, were included. We monitored IOP telemetrically during a 10 min session on a bicycle ergometer with a stepwise power increase from 0 to 75 W, in 25 W increments, at 2 min intervals. We also recorded IOP during the 2 min resting period after the exercise compared with resting baseline before exercise. Results The average IOP increased from 15.4±1.3 mm Hg at rest to 18.0±1.3 mm Hg at 75 W and returned to 14.4±1.0 mm Hg during the resting period after exercise. During the resting period after the activity, average IOP reduced below baseline in 8 out of 10 patients (ΔIOP=−0.98±0.57 mm Hg, p=0.12). Both systolic blood pressure and heart rate were highly correlated with IOP during the exercise (R²=0.997, p=0.002 and R²=0.986, p=0.007, respectively). Conclusions In our study, IOP, heart rate and blood pressure increased and decreased with physical intensity, suggesting these parameters are closely linked and potentially driven by a common mechanism during aerobic exercise. Further studies with larger patient groups are warranted to better understand the mechanisms involved. Data are available upon reasonable request. Not applicable.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At a glance","authors":"Frank Larkin","doi":"10.1136/bjo-2025-327610","DOIUrl":"https://doi.org/10.1136/bjo-2025-327610","url":null,"abstract":"Statistically significant worsening of myopia progression was observed in children after COVID-19 home confinement. Elementary school age children demonstrated the greatest increase in myopia prevalence. Low myopia patients demonstrated the greatest change in mean spherical equivalent. Using handheld swept source optical coherence tomography, markers of foveal immaturity, including shallower foveal angle, higher inner retinal fovea/parafovea ratio, and larger retinal cross-sectional area, were associated with more severe retinopathy of prematurity. This study proposes a standard framework to assess quality of OCT images of the lacrimal gland, highlighting the impact of dry eye disease and intraocular pressure on image quality. Conjunctival flap surgery followed by staged …","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"42 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of mental health comorbidities on the effect of cataract surgery on dementia risk: a real-world retrospective cohort study","authors":"Shih-Kai Kao, Ming-Pei Yueh, Huan-Jui Yeh, Hui-Chen Cheng","doi":"10.1136/bjo-2025-327134","DOIUrl":"https://doi.org/10.1136/bjo-2025-327134","url":null,"abstract":"Background Cataract surgery has been shown to reduce the risk of developing dementia in the future; however, its impact on different dementia subtypes, including vascular dementia, remains unknown. Moreover, its dementia-protecting effect among cataract patients with common mental disorder (CMD) remains unclear. Methods Patients aged 65 or older diagnosed with cataract between 2012 and 2021 were included and grouped based on whether they underwent cataract surgery within 1 year of diagnosis. Propensity-score matching was used to balance baseline characteristics, and Cox proportional hazards models were applied to assess dementia incidence within 5 years post-cataract between groups. Subgroup analyses were performed based on CMD status. Results After propensity-score matching, 75 757 patients were included in both surgery and control groups. Cataract surgery significantly reduced dementia risk (HR=0.677, 95% CI =0.638 to 0.719, p<0.001), particularly for Alzheimer’s disease (HR=0.643, 95% CI=0.576 to 0.716, p<0.001), with no significant effect on vascular dementia (HR=0.968, 95% CI=0.851 to 1.101, p=0.621). Subgroup analyses showed a significant reduction in dementia risk for patients without CMD (HR=0.666, 95% CI=0.624 to 0.710, p<0.001), but no protective effect in those with CMD, regardless of CMD status. Conclusion Cataract surgery is linked to a lower risk of dementia, especially Alzheimer’s disease, in patients with cataract. However, this protective effect is diminished in those with CMD. The data supporting this study are available from the corresponding author upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"25 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semiautomated measures of foveal immaturity from handheld swept-source optical coherence tomography are associated with retinopathy of prematurity severity.","authors":"Emily K Tam, Karen E Lee, Sumner E Lawson, Tatiana R Monger, Alex T Legocki, John P Kelly, Teng Liu, Yujiao Zheng, Leona Ding, Kristina Tarczy-Hornoch, Ruikang Wang, Michelle T Cabrera","doi":"10.1136/bjo-2023-324220","DOIUrl":"10.1136/bjo-2023-324220","url":null,"abstract":"<p><strong>Background/aims: </strong>Handheld swept-source optical coherence tomography (SS-OCT) was previously used to measure foveal maturity through semiautomated methods in awake premature infants. This study assesses the relationship between foveal maturity and retinopathy of prematurity (ROP) severity.</p><p><strong>Methods: </strong>This is a prospective, observational study using handheld SS-OCT imaging of premature infants undergoing ROP screening. A semiautomated segmentation algorithm measured foveal angle, total retinal cross-sectional area, and retinal and choroid thicknesses at the fovea and parafovea, excluding significant macular oedema. Measures were correlated with ROP severity using a mixed model approach.</p><p><strong>Results: </strong>99 eye imaging sessions from 26 preterm infants were included. Average birth weight was 1057.6±324.8 g. Gestational age and postmenstrual age at imaging were 29.1±3.0 and 36.1±3.8 weeks, respectively. Stage 3 ROP occurred in 16/99 (16.2%) exams. Shallow foveal angle and higher inner retinal fovea/parafoveal (F/P) ratio correlated with more posterior ROP zone (zone 2: 119.2°±20.9° vs zone 3: 96.5°±16.7° and zone 2: 0.6±0.2 vs zone 3: 0.4±0.1, respectively, both p<0.001). Inner retinal F/P ratio was greater in eyes with higher ROP stage (stage 3: 0.6±0.2 vs stage 0 or mature: 0.4±0.2, p=0.03) but this relationship was not seen for outer retina (p=0.29). Larger retinal cross-sectional area coincided with worse ROP stage (stage 3: 1.9±0.06 mm² vs stage 0 or mature: 1.6±0.04 mm², p<0.001) and zone (zone 2: 1.6±0.04 mm² vs zone 3: 1.7±0.04 mm², p=0.01).</p><p><strong>Conclusions: </strong>SS-OCT semiautomated measurements of inner retinal F/P ratio, foveal angle and retinal cross-sectional area may serve as ROP severity biomarkers.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"549-553"},"PeriodicalIF":3.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Registry-based randomised controlled trials in glaucoma: the time is right?","authors":"Mitchell Lawlor, Catherine Q Sun, Gus Gazzard","doi":"10.1136/bjo-2025-327111","DOIUrl":"10.1136/bjo-2025-327111","url":null,"abstract":"","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"533-534"},"PeriodicalIF":3.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractive changes in children in the Chicago area during the COVID-19 pandemic: a retrospective observational study.","authors":"Eugene Kim, Magdalena Stec, Noreen Shaikh, Jonathan Huang, Hantamalala Ralay Ranaivo, Rebecca Mets-Halgrimson","doi":"10.1136/bjo-2024-325984","DOIUrl":"10.1136/bjo-2024-325984","url":null,"abstract":"<p><strong>Background: </strong>Remote learning during the COVID-19 pandemic caused behavioural changes such as increased screen time and decreased outdoor time. This study aimed to investigate myopia progression in children during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This was a retrospective observational study performed among 2064 patients ages 2-17 with cycloplegic refractions in the months of January 2019-March 2021 at a tertiary children's hospital. Exclusion criteria were a medical history of relevant connective tissue diseases, myopia control treatment, pseudophakia and aphakia.</p><p><strong>Results: </strong>The overall cohort (n=2064) had a mean spherical equivalent (SE) of 0.12±3.70 D in 2019, -0.07±3.95 D in 2020 and -0.49±3.85 D in 2021. The change in mean SE (0.42 D) from 2020 to 2021 was 2.2 times greater than the change (0.19 D) from 2019 to 2020 at baseline. In the cohort of return patients, there was a significant difference in myopic shift between years (F-ratio=14.4, p<0.00001), and a significant change from 2020 to 2021 (p=0.00008) but not from 2019 to 2020. When observing the prevalence of myopia grouped by age, 8-year-old and 17-year-old patients had the greatest increase compared with baseline. When grouped by refractive error, low myopia children (-0.5 D to -3.00 D) displayed the greatest change in mean SE 2020-2021.</p><p><strong>Conclusions: </strong>There was a substantial increase in myopia progression for children in the Chicagoland area after the period of COVID-19 changes. The behavioural changes of home confinement and online learning during the pandemic may explain these findings.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"543-548"},"PeriodicalIF":3.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of clinical outcomes between different combinations of hybrid multifocal, extended-depth-of-focus and enhanced monofocal intraocular lenses.","authors":"Bokyung Kim, Hyeck-Soo Son, Ramin Khoramnia, Gerd U Auffarth, Chul Young Choi","doi":"10.1136/bjo-2024-325181","DOIUrl":"10.1136/bjo-2024-325181","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes of bilateral implantation of hybrid multifocal intraocular lenses (IOLs) versus mix-and-match implantation of hybrid multifocal and extended-depth-of-focus (EDOF) versus mix-and-match implantation of hybrid multifocal and enhanced monofocal IOLs.</p><p><strong>Methods: </strong>Patients with bilateral age-related cataract were randomised in one of three groups: group 1, bilateral hybrid multifocal IOL; group 2, EDOF in the dominant eye, hybrid multifocal in the non-dominant eye; group 3, enhanced monofocal in the dominant eye, hybrid multifocal in the non-dominant eye. Assessments at 6 months postoperatively included monocular and binocular uncorrected distance visual acuity (UDVA), intermediate (UIVA) and near distance (UNVA) at 40 and 33 cm, defocus curves, contrast sensitivity (CS), reading speed and questionnaires on quality of vision and dysphotopsia.</p><p><strong>Results: </strong>75 patients (25 per group) were enrolled. There were no statistically significant differences in binocular UDVA and UNVA between groups (p>0.05); binocular UIVA was better for group 1 and 2 versus group 3 (p=0.030). Binocular uncorrected defocus curve showed better performance for group 1 compared with group 3 from -2.00 to -3.50 D. Significantly higher reading speed was measured for Jaeger 1 font in group 1. There were no differences in CS between groups, but higher incidence of starbursts in group 1 and higher need for near spectacles in group 3.</p><p><strong>Conclusion: </strong>Bilateral hybrid multifocal IOL implantation resulted in better near vision, but higher rates of photic phenomena compared with the mix-and-match groups. Combinations of IOLs may allow surgeons to fine-tune for individual patient's needs.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"565-571"},"PeriodicalIF":3.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outlier ophthalmologists in the treatment of neovascular age-related macular degeneration with intravitreal therapy.","authors":"Yohei Hashimoto, Adrian Robert Hunt, Jane M Wells, Gayatri Banerjee, Ross Ferrier, Richard Barry, Andrew Field, Justin Game, Claire Yvonne Hooper, Daniel Barthelmes, Mark C Gillies","doi":"10.1136/bjo-2024-326024","DOIUrl":"10.1136/bjo-2024-326024","url":null,"abstract":"<p><strong>Background: </strong>To compare individual ophthalmologists grouped as outliers or non-outliers based on the mean 12-month visual acuity (VA) outcomes for their patients with neovascular age-related macular degeneration (nAMD).</p><p><strong>Methods: </strong>This prospectively designed database study included treatment-naïve eyes with nAMD starting vascular endothelial growth factor inhibitors between July 2018 and April 2023 in Australia. Ophthalmologists were classified into high outliers, non-outliers and low outliers with a funnel plot of the adjusted mean 12-month VA change. The number of injections, last injection interval and proportion of visits where choroidal neovascularisation was active were compared between the groups.</p><p><strong>Results: </strong>38 ophthalmologists who treated a total of 1266 eyes (male, 35%; mean age, 81 years old) were classified into 1 high outlier, 34 non-outliers and 3 low outliers (mean VA change, 7.5, 5.1 and 2.5 letters, respectively). The high outlier gave significantly more injections than the non-outliers (mean, 8.6 vs 7.7; p<0.001), while the low outliers administered significantly fewer injections than the non-outliers (mean, 7.1 vs 7.7; p=0.009). The last injection interval was shortest in the high outlier's eyes (9.4 weeks), followed by non-outliers' (10.8 weeks; p=0.04 (vs high outlier's)) and low outliers' (11.8 weeks; p=0.22 (vs non-outliers')). The low outliers' patients had more visits with intraretinal fluid (59%) than non-outliers' (29%; p<0.001) and high outlier's patients (31%; p<0.001).</p><p><strong>Conclusion: </strong>The low outliers' eyes had fewer injections, a longer treatment interval and more visits with intraretinal fluid. Building a system through which low outliers are anonymously notified of their performance would help improve general quality of care.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"606-613"},"PeriodicalIF":3.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}