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Study protocol for a randomised controlled trial to evaluate the prophylactic efficacy of combined intense pulsed light (IPL) and low-level light therapy (LLLT) in preventing laser corneal refractive surgery-induced dry eye: the Treat Eye Before Laser ind

Por: Kerkouri · S. · Garcin · T. · Cochener · B.
Introduction

Laser corneal refractive surgery is a widely adopted approach for correcting refractive errors, but postoperative dry eye remains a common side effect. Intense pulsed light (IPL) and low-level light therapy (LLLT) are two emerging treatments that have shown potential in managing dry eye disease. However, their role as a prophylactic treatment in patients without pre-existing symptomatic dry eye undergoing refractive surgery has not been explored.

Methods and analysis

This is a single-blind, randomised controlled trial comparing the prophylactic efficacy of combined IPL and LLLT treatment versus standard care in preventing dry eye after laser corneal refractive surgery (FS-LASIK, SMILE or PRK). Eligible patients aged 18 or older scheduled for surgery will be randomly assigned in a 1:1 ratio to either the treatment or control group. The primary endpoint is the French version of Ocular Surface Disease Index score at 1 month postoperatively. Secondary outcomes include Fluorescein Break-Up Time, Schirmer I test, Oxford score and Meibomian Gland Dropout. Data will be analysed using a mixed-effects linear model adjusted for surgery type and baseline dry eye parameters. The study started in June 2023 and end in April 2025 but data have not been yet analysed.

Ethics and dissemination

The study has been approved by the Institutional Review Board Est III, France, and registered on ClinicalTrials.gov (NCT05803798). All participants will provide written informed consent. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.

Trial registration number

NCT05803798.

'Its never one size fits all: a qualitative exploration of vision-impaired patients preferences for mental health support

Por: Scott · J. A. · Gillard · J. · Vasconcelos e Sa · D. · Oliver · A. · Hawkins · R. · Pardhan · S.
Introduction

It is widely known that a diagnosis of visual impairment has significant mental health impacts. Proposed approaches to addressing these include cognitive behavioural, problem-solving and stepped care solutions.

Objectives

Limited research has focused specifically on vision-impaired patients’ preferences for mental health support following diagnosis. This study aimed to address this gap.

Design

The study was qualitative and cross-sectional, involving thematic analysis of semistructured interviews with patients diagnosed with vision impairment.

Participants

Twenty vision-impaired patients, aged from 20 to 84 years old and with a range of diagnoses, were interviewed regarding their experience of and recommendations for mental health support at the point of diagnosis and thereafter.

Results

Three main themes were identified: (1) Mapping the Journey: The Critical Role of Accessible Information, (2) Navigating the Emotional Impact: Help-Seeking Attitudes and Experiences and (3) Tailored Mental Health Support: Timing, Delivery and Preferred Providers. Each theme had three subthemes.

Conclusions

It was concluded that clear information about diagnosis, prognosis and available supports is fundamental to promoting and maintaining mental health for vision-impaired patients. Person-centred and/or peer support is highly valued. To be maximally effective, specific mental health support should be informed by knowledge of vision impairment, with standardised treatment programmes not being valued highly. The study results strongly suggest that mental health support needs to be tailored to the unique needs of each individual, and therefore, a stepped care approach may be most helpful, encompassing clear information, practical advice and ongoing peer and professional support.

Can provision of near vision glasses as an early intervention improve visual outcomes in infants at risk of perinatal brain insult? The Babies in Glasses (BiG) randomised feasibility trial

Por: Bullaj · R. · Dyet · L. · Mitra · S. · Bunce · C. · Clarke · C. S. · Saunders · K. · Dale · N. · Horwood · A. · Williams · C. · St Clair Tracy · H. · Marlow · N. · Bowman · R.
Objectives

We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.

Design

A three-arm, parallel-group, open-label randomised feasibility trial.

Setting

Tertiary neonatal intensive care in London, UK.

Participants

We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.

Interventions

At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).

Outcomes

Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.

Results

Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).

Conclusions

We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.

Trial registration numbers

ISRCTN14646770; NCT05048550.

Investigating the impact of residual refraction within {+/-}1.0 dioptre on uncorrected distance visual acuity in pseudophakic eyes: a cross-sectional study

Por: Li · D. · Zhang · J. · Jin · L. · Han · X. · Chen · L. · Liu · Y. · Cai · W. · Cao · Q.
Objectives

To investigate the impact of residual refraction within ±1.0 dioptre (D) on uncorrected distance visual acuity (UDVA) in pseudophakic eyes.

Design

Cross-sectional study.

Setting

This study was based on retrospectively collected electronic refraction records from a tertiary care academic ophthalmology centre in southern China between May 2022 and July 2025.

Participants

Patients aged ≥40 years who underwent uneventful phacoemulsification cataract surgery with in-the-bag monofocal intraocular lens implantation and achieved a postoperative corrected distance visual acuity (CDVA) of ≤0.1 logarithm of the minimum angle of resolution were enrolled. They were stratified by astigmatism subtypes: minimal astigmatism (

Outcomes measures

Postoperative evaluation (≥1 month) included spherical equivalent (SE) refraction, UDVA and CDVA. UDVA was compared across eyes with SE intervals of 0.50 D within ±1.0 D. ORs were calculated to assess the relative risk of failing to achieve a UDVA of 0.1 or better for postoperative SE within ±1.0 D, using 0.00 D as the reference.

Results

The study included 1333 eyes from 1333 patients (mean (SD) age, 66.1 (8.96) years; 532 male (39.9%)). Overall, and particularly in the minimal astigmatism (

Conclusions

The impact of refractive errors (≤1.0 D) on UDVA was associated with the magnitude and type of astigmatism. Residual astigmatism of ≥0.50 D exerted a significant negative effect on UDVA. A plano SE (0 D) was optimal for minimum and WTR astigmatism, whereas slight hyperopia yielded superior UDVA in ATR and oblique astigmatism.

Transcorneal electrical stimulation for the treatment of visual field defects in patients with open-angle glaucoma: a monocentric, randomised, double-masked, sham-controlled pilot study: the TES-GPS study protocol

Por: Lorenz · K. · Schuster · A. · Michel · H. M. · Ruckes · C. · Kronfeld · K. · Schippert · R. · Stett · A. · Beck · A.
Introduction

Glaucoma is one of the leading causes of irreversible blindness and is characterised by progressive loss of retinal ganglion cells. While therapies to lower intraocular pressure slow the progression of the disease in most patients, a significant subset still shows progression despite treatment. Transcorneal electrical stimulation (TES) may potentially activate neuroprotective pathways and slow the progression of visual field defects. The OkuStim 2 System is a medical device for TES which was originally developed for the treatment of retinitis pigmentosa and similar retinal dystrophies and shall now be tested for the treatment of glaucoma. Stimulation of the diseased retina with weak currents can activate signalling pathways and the release of substances that have a protective effect on the retinal cells. This neuroprotective effect might preserve physiological functions of the retina for longer and slow down its gradual degeneration. Long-term use is required to maintain this effect. The TES-GPS study is investigating the safety and efficacy of TES in open-angle glaucoma.

Methods and analysis

TES-GPS (short title for glaucoma pilot study) is a prospective, randomised, double-blind, sham-controlled, single-centre pilot study at the University Medical Center Mainz. 50 patients with progressive visual field loss due to open-angle glaucoma will be randomised 1:1 to receive either TES with the OkuStim 2 System or sham stimulation. The primary endpoint is the change in visual field sensitivity (Humphrey mean deviation) after 18 months. Secondary endpoints include changes in visual acuity, intraocular pressure, optical coherence tomography (OCT) parameters and quality of life (National Eye Institute Visual Function Questionnaire 25, NEI-VFQ 25). The intervention consists of weekly 30 min TES sessions, which are conducted in the patient’s home after initial training in the clinic. The study comprises up to 13 scheduled visits over 18 months.

Ethics and dissemination

The study is conducted in accordance with ISO14155, Medical Device Regulation (EU) 2017/745, International Council for Harmonisation Good Clinical Practice and the Declaration of Helsinki. Approval was obtained from the Ethics Committee of the Landesaerztekammer Rheinland-Pfalz in Mainz and from Bundesinstitut fuer Arzneimittel und Medizinprodukte. Results will be published in peer-reviewed journals and presented at scientific conferences.

Trial registration number

NCT06682962.

Clinical application of dynamic visual acuity for detection of eye diseases: a scoping review protocol

Por: Tagoh · S. · Kwarteng · M. A. · March De Ribot · F.
Introduction

Many eye diseases are asymptomatic in their early stages; thus, timely detection is essential for improved outcomes. Dynamic visual acuity (DVA)—the ability to perceive moving targets—has been reported as a valuable screening tool for early disease detection. However, unlike static visual acuity, DVA is not routinely assessed in the eye clinic, perhaps due to a lack of standardised measurement protocols and limited understanding among clinicians of its physiological and diagnostic relevance. This scoping review aims to assess the evidence on DVA; provide insight into its physiological basis, measurement techniques and potential for early detection of disease; and identify research gaps to inspire future studies.

Methods and analysis

The review will follow the Joanna Briggs Institute guidelines and will involve all relevant articles, including reviews and original studies published in online databases such as PubMed, Medline, Web of Science, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Global Health and ScienceDirect. Also, a reference list of relevant articles will be searched, and insight from expert consultations and information from grey literature will be included in the review. Studies conducted with human subjects and in English, irrespective of the year of publication or study design, will be reviewed. Two independent reviewers will screen identified articles, with a third reviewer confirming findings. The data extraction tool will be tested in a pilot review, and the findings will be presented using tables and visual summaries.

Ethics and dissemination

No ethical approval is required. Findings will be presented at national and international conferences and published in peer-reviewed journals.

Comparing community-based monitoring to hospital-based care of patients with quiescent age-related macular degeneration: a qualitative study of patient and practitioner perspectives on acceptability and access

Por: Vougioukalou · S. · Read · S. M. · Csontos · J. K. · Jones · A. · Jaber · A. · Sharma · A. · Balaskas · K.
Objectives

This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD).

Design

Qualitative process evaluation was conducted as part of a randomised controlled trial.

Setting

Six hospitals and six community-based practices.

Participants

25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring.

Intervention

The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings.

Results

Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care.

Conclusions

The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that non-medical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.

Trial registration number

NCT03893474.

Knowledge, attitude and practice towards glaucoma among ophthalmic inpatients: a cross-sectional study in Hunan, China

Por: Zhao · Y. · Wu · P. · Liao · L. · Zhang · J. · Zhou · D. · Sun · W. · Dong · F. · Ye · C. · Duan · X.
Objectives

Glaucoma is an optic neuropathy caused by the gradual degeneration of retinal ganglion cells. This study aimed to investigate the knowledge, attitude and practice (KAP) towards glaucoma among ophthalmic inpatients.

Design

A web-based questionnaire.

Setting

Local hospital.

Participants

Ophthalmic inpatients (n=1238).

Primary and secondary outcome measures

The primary outcome was the patients’ KAP.

Results

Multivariable logistic regression analysis showed that rural residence (OR=0.488, 95% CI 0.313 to 0.762, p=0.002), college education or above (OR=4.996, 95% CI 2.942 to 8.483, p

Conclusions

Ophthalmic inpatients might have moderate knowledge and attitude, but a proactive practice towards glaucoma. A history of glaucoma, previous glaucoma surgery, education level, residency and alcohol consumption were potentially associated with knowledge and attitudes towards glaucoma among ophthalmic inpatients.

Global, regional and national burden of glaucoma from 1990 to 2021 and projections to 2050: a retrospective cross-sectional study

Por: Peng · Y. · Han · L. · Jiang · Q. · Liu · J. · Liu · X. · Jiang · G. · Li · Z. · Qin · S. · Zhuo · Y. · Su · W.
Objectives

This study assessed the global burden of glaucoma using data from the Global Burden of Disease (GBD) 2021 study. The analysis of epidemiological trends aimed to inform future public health prevention strategies.

Design

Retrospective cross-sectional study.

Participants

None.

Methods

Analysis of 1990–2021 GBD data on glaucoma prevalence, disability-adjusted life years (DALYs), age-standardised prevalence rates (ASPR), and age-standardised DALY rates (ASDR). Estimated annual percentage changes (EAPC) were calculated, Joinpoint regression identified trend changes, and Autoregressive Integrated Moving Average (ARIMA) modelling projected the burden for the year 2050.

Results

Globally, the number of prevalent glaucoma cases increased from 4 072 106.59 (95% uncertainty interval (UI) 3 489 888.7 to 4 752 867.3) in 1990 to 7 587 672.9 (95% UI 6 522 906 to 8 917 725.4) in 2021. Concurrently, DALYs increased from 467 600.4 (95% UI 323 490.5 to 648 641.6) in 1990 to 759 900.2 (95% UI 530 942.9 to 1 049 127.2) in 2021. In contrast, the ASPR and ASDR declined to 90.1 per 100 000 population (95% UI 77.8 to 105.5) and 9.1 per 100 000 population (95% UI 6.3 to 12.5) in 2021, respectively. During the COVID-19 pandemic period (2019–2021), the slowest growth rates in crude case numbers and overall disease burden were observed, accompanied by the most pronounced decline in annual percentage change of ASPR. The highest estimates for both case counts and DALYs were identified in the 70–74 age group, with males demonstrating higher prevalence rates than females. Furthermore, regions with lower Sociodemographic Index (SDI) values bore a disproportionately higher burden of glaucoma.

Conclusion

These findings underscore the need to strengthen early screening and treatment of glaucoma, particularly in ageing populations, male groups and low SDI regions. We urge cautious interpretation of COVID-19 related data and vigilance against potential post-pandemic surges in burden. Critical strategies include enhanced screening and intervention for high-risk groups, targeted prevention measures and integration of ophthalmic care into public health emergency frameworks to alleviate the disease burden.

Indicators for effective glaucoma care coverage in adults: protocol for a scoping review

Por: Matayan · E. Y. · Burn · H. · Gordon · I. · Evans · J. · Toews · I. · Ramke · J. · Burton · M. J. · Philippin · H. · Mtuy · T. · Hu · V. H.
Introduction

Glaucoma is the leading cause of irreversible blindness worldwide and the number of people with glaucoma is expected to increase to more than 112 million by the year 2040, making it a disease of public health interest. However, there is no consensus on public health indicators to monitor glaucoma care coverage. This scoping review aims to summarise published indicators for monitoring effective glaucoma care coverage globally, focusing on care needs, use of care services and outcomes achieved.

Methods and analysis

We will include studies that report the development and use of public health indicators for effective glaucoma care coverage in patients aged 18 years and older. Studies published from 1 January 2000, in all languages, will be included, provided they can be accurately and easily translated into English using Google Translate. Searches will be conducted by an information specialist on MEDLINE, Embase, Global Health and CENTRAL in the Cochrane Library. Two reviewers working independently will screen the search results, select studies for inclusion and extract data; any disagreements will be discussed with or resolved by a third reviewer. Data will be presented in tabular form, followed by a narrative synthesis based on the review objectives.

Ethics and dissemination

Ethical approval is not required as the review will use published data. Results will be published in a peer-reviewed journal, and summarised results will be available and contribute to the development of standardised glaucoma care indicators.

Registration

OSF registration on 19 May 2025: https://osf.io/zsyw9/

Assessing uptake of the macular degeneration core outcome set in clinical trials: a cross-sectional study

Por: Oldham · E. · Hall · R. H. · Jones · G. · Modi · J. · Ward · S. · Magee · T. · Fitzgerald · K. · Magana · K. · Hughes · G. · Ford · A. I. · Vassar · M.
Purpose

Establishing comparability between measured outcomes in clinical trials poses a significant obstacle for systematic reviewers. Core outcome sets (COSs) were developed to address this issue. The macular degeneration (MD) COS is designed to standardise outcome measurement across clinical trials for MD. This study investigates the uptake of the MD COS in standardising outcome measurement across clinical trials.

Design

Cross-sectional analysis

Methods

We conducted a search on ClinicalTrials.gov to locate MD clinical trials that were registered 5 years prior to COS publication through the search date of 26 June 2023 and obtained a pool of 2152 registered studies. After applying various inclusion and exclusion criteria, we analysed 159 trials. We then analysed the COS uptake using an interrupted time series analysis (ITSA) and performed performed analyses of variance (ANOVAs) and Pearson correlations to evaluate associations between trial characteristics and outcome measurement.

Results

ITSA showed no significant change in uptake following the MD COS (2016): mean percentage of completion of the COS increased by 0.24% per month before publication (p=0.27) and by 0.07% per month after publication (p=0.62), indicating no meaningful post-publication slope change in COS use. For context, visual acuity was most commonly measured, while several patient-reported and disutility domains were infrequently captured.

Conclusion

No discernible patterns in COS usage for MD trials were observed. We recommend further collaboration between regulators and COS developers to help with COS uptake. Additionally, we suggest that further studies analyse adherence to COSs in respect to regulatory recommendations.

Keratorefractive lenticule extraction (KLEx) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the treatment of myopia and compound myopic astigmatism: study protocol of a randomised clinical trial in Mexico

Introduction

Kerato-lenticule extraction (KLEx) is a refractive surgery technique that, in contrast with femtosecond laser-assisted in situ keratomileusis (FS-LASIK), does not require the creation of a flap to correct refractive defects. The potential advantages of this technique are related to the absence of a flap and its complications. On the other hand, FS-LASIK is the most widely practised refractive surgery worldwide, as it offers excellent visual outcomes and is currently the gold standard of refractive surgery. The objective of this study is to compare the effectiveness and safety of KLEx versus FS-LASIK as a treatment option in patients with myopia or myopic astigmatism.

Methods and analysis

This double-masked, parallel-group, single-centre randomised clinical trial will enrol 80 eyes from adults with myopia or compound myopic astigmatism within the ranges sphere –0.50 to –12.00 D and cylinder –0.50 to –6.00 D, recruited at the Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico. Participants will be allocated to KLEx or FS-LASIK and assessed at baseline and 1 day, 1 week, 1, 3, 6 and 12 months postoperatively. The primary outcome is uncorrected visual acuity at all postoperative visits. Secondary outcomes include postoperative spherical equivalent, best-corrected visual acuity (BCVA), loss of ≥2 BCVA lines, the proportion of eyes within ±0.50 D of the refractive target, corneal aberrations over a 5 mm pupil, epithelial changes and adverse events. Participants and outcome assessors will be masked to the assigned surgical technique.

Ethics and dissemination

Participant confidentiality will be maintained with the publication of results. This study was approved by the research and ethics committee of the Instituto de Oftalmología Fundación de Asistencia Privada Conde Valenciana (CI-017-2024). The study results will be disseminated in scientific articles published in peer-reviewed journals and presented through research posters at national and international conferences.

Trial registration number

ClinicalTrials.gov registry (NCT06477081).

Psychosocial adjustment in patients with diabetic retinopathy in northeastern Iran: a qualitative study based on the transactional stress theory

Por: Salehnezhad · A.-S. · Sedghi · F. · Mahdizadeh · M. · Jamali · J. · Shoeibi · N. · Vahedian-Shahroodi · M.
Objectives

This study aimed to explore the psychosocial adaptation processes and coping methods among patients with diabetic retinopathy (DR), emphasising the importance of understanding their lived experiences.

Design

A qualitative study using semi-structured interviews.

Setting

A tertiary eye hospital in northeastern Iran.

Participants

The participants comprised patients with DR, their families and healthcare professionals.

Methods

Qualitative data were analysed based on transactional stress theory using deductive thematic analysis to identify psychosocial adaptation concepts.

Results

65% of participating patients had DR for more than 5 years. Analysis of 49 patient and 14 healthcare professional interviews revealed 6 key themes encompassing 15 categories and 33 subcategories: primary appraisal (threat perception, motivational assessment, self-blame), secondary appraisal (perceived control over disease outcomes, perceived control over emotions, self-efficacy), coping efforts (problem management, emotional regulation), meaning-based coping (positive reassessment, reinforcement of religious beliefs, constructive approach), moderators (seeking information, all-encompassing assistance) and adaptation (emotional health, individual-social functioning).

Conclusions

The analysis revealed that deficits in disease awareness, financial and systemic barriers and emotional distress significantly impeded adaptive coping. Conversely, self-efficacy, social and organisational support, and meaning-based coping strategies were key facilitators. Our findings suggest that facilitating positive psychosocial adjustment in patients with DR may require interventions that address these specific barriers and leverage these facilitators, such as providing comprehensive disease knowledge and constructing robust support systems. This study highlights the potential value of a holistic care approach that integrates medical treatment, targeted patient education and psychological support to improve the overall quality of life for these patients.

Burden and predictors of age-related macular degeneration among old age patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia: a multicentre cross-sectional prospective study

Por: Shumye · A. F. · Desalegn · G. K. · Tegegn · M. T. · Worku · E. M. · Lorato · M. M. · Bogale · Z. M. · Tegegne · M. M. · Alimaw · Y. A. · Mengistu · H. G. · Bekele · M. M. · Bayabil · A. Z. · Birhan · G. S. · Eticha · B. L.
Objective

This study aims to assess the burden and predictors of age-related macular degeneration (AMD) among older age patients with diabetes attending comprehensive specialised hospitals in Northwest Ethiopia.

Design

A multicentre cross-sectional study was conducted among older patients with diabetes using a systematic random sampling technique.

Setting

The study was conducted at five comprehensive specialised hospitals in Northwest Ethiopia from 8 May to 8 June 2023.

Participants

The study included 832 diabetic individuals aged 40 years and above.

Main outcome measures

Data were collected using a pretested structured questionnaire and physical examinations.

Result

In this study, a total of 832 participants were involved, with a response rate of 96.85%. The burden of AMD was 15.4% (95% CI 13.0% to 18.0%). Male sex (adjusted OR (AOR) 2.04, 95% CI 1.17 to 3.56), older age (AOR 6.91, 95% CI 3.17 to 15.08), diabetes duration of 10 and more years (AOR 3.00, 95% CI 1.91 to 4.69), higher body mass index (AOR 2.56, 95% CI 1.15 to 5.71), presence of hypertension (AOR 2.45, 95% CI 1.56 to 3.85) and family history of diabetes mellitus (DM) (AOR 2.29, 95% CI 1.40 to 3.76) were positively associated with AMD.

Conclusions

This study found that the prevalence of AMD among patients with diabetes was 15.4%. Older age, male sex, longer DM duration, higher body mass index, presence of hypertension and family history of DM were significantly associated with AMD. Targeted screening of at-risk individuals for AMD, public health awareness campaigns focusing on these factors and further research to understand the burden and underlying mechanisms of these associations with AMD are recommended.

At the epicentre: a qualitative study of how parents of a child with de novo retinoblastoma experience the diagnostic process and primary treatment

Por: Lou · S. · Carstensen · K. · Mikkelsen · P. A. · Jensen · P. S. · Hogild · M. L. · Christensen · R. T. · Overgaard · J. · Urbak · S. F. · Staffieri · S. E. · Gregersen · P. A.
Objective

To explore how parents of children with de novo retinoblastoma (RB) experience the diagnostic process and acute treatment phase, and to identify factors that may support parental coping and adaptation.

Design

A qualitative interview study using reflexive thematic analysis.

Setting

National Retinoblastoma Unit at Aarhus University Hospital, Denmark.

Participants

Thirty-one parents (21 mothers, 10 fathers) of 21 children diagnosed with de novo RB were recruited via hospital follow-up clinics and a support group day.

Results

For most parents, the diagnostic process was short. In cases of diagnostic delay, parents described frustration and guilt due to missed symptoms. Receiving the RB diagnosis was described as a surreal experience, accompanied by feelings of shock, grief and loss of control. Parents faced challenges in adapting to rapid medical decisions and the unfamiliar demands of hospital protocols. However, meeting the clinical experts was a relief, as parents felt they were in capable hands, experiencing empathetic communication and a clearly framed treatment plan. Parents emphasised the importance of support systems, including family, healthcare professionals and the child’s resilience, as crucial for coping with and managing the diagnosis.

Conclusions

Parents faced a sudden and disruptive transition from symptom recognition to life-altering diagnosis and treatment. While professional care and communication were experienced as supportive, they did not eliminate the emotional impact. Clinical pathways should prioritise early validation of parental concerns and provide transparent communication, both prior to referral and throughout treatment. Future research should examine longer-term parental adjustment and identify interventions that support emotional resilience beyond the acute phase.

Using retinal diagnostics as a biomarker for neurodegenerative diseases: protocol for a systematic review

Por: Sahin-Lodge · Z. · Pisani · S. · Nderitu · P. · Guu · T.-W. · Aarsland · D. · Jackson · T. L. · Ffytche · D. · Venkataraman · A. V.
Introduction

Retinal neurodegeneration has recently been shown to occur in tandem with neurodegenerative disease. In the expectation that disease-modifying treatments for Alzheimer’s disease (AD) and Parkinson’s disease (PD) will soon become available, it will be important to have clinically useful biomarkers for neurodegenerative disease subtyping to guide early diagnosis, inform on prognosis and stratify subgroups for treatment. Understanding differences in detectable retina changes in individuals with different neurodegenerative disease subtypes is therefore fundamental. The emerging field of oculomics posits that systemic and neurodegenerative disease can be characterised using detectable ocular biomarkers within retinal diagnostics. The aim of this review is to compare the performance of common retinal imaging modalities in neurodegenerative disease detection and subtyping.

Methods and analysis

This protocol has been reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. A comprehensive literature search will be conducted in PubMed, Web of Science and Scopus. Eligible studies will have reported using retinal diagnostic tools defined as optical coherence tomography (OCT), OCT angiography (OCTA), colour fundus photography (CFP) and electroretinography (ERG) in individuals with neurodegenerative diseases, including AD, PD, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and mild cognitive impairment. There will be no time restrictions placed in these searches. Studies not written in English, not peer-reviewed and grey literature will be excluded. Screening for eligible studies and data extraction will be conducted by two independent reviewers, using predefined inclusion criteria. Any disagreements between the reviewers will be settled by discussion, and if required, third senior reviewer arbitration. The systematic review primary outcome is the performance of retinal diagnostics, namely OCT, OCTA, CFP and ERG in the detection and subtyping of aforementioned neurodegenerative diseases. The secondary outcome is to evaluate the association between changes in retinal diagnostic features (eg, retinal layer thicknesses) and neurodegenerative disease subtypes. The quality of the included studies will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) tool. A narrative synthesis approach will be used to analyse the results, with meta-analysis performed if there is sufficient data.

Ethics and dissemination

Ethical approval for this manuscript is not required, as this is a protocol for a systematic review and therefore no data are to be collected. Findings for this systematic review will be disseminated as a peer-reviewed publication and presentations at national and international symposiums including International Lewy Body Dementia Conference, International Congress of Parkinson’s Disease and Movement Disorders, The Association for Research in Vision and Ophthalmology.

PROSPERO registration number

CRD42023434024.

Kaupapa Maori approaches to improve Maori eye health: a protocol for a scoping review

Por: Watene · R. · Ramke · J. · Te Ao · B. · Harwood · M. · Manuel · A.
Introduction and aim

Māori experience higher rates of disease and poorer health outcomes than non-Māori, highlighting inequities in the health system in Aotearoa New Zealand (Aotearoa). Māori eye health has historically been under-researched. Kaupapa Māori (by Māori, with Māori, for Māori) approaches to research have been recognised as critical for developing and informing equitable and inclusive health service solutions for Māori. This scoping review aims to summarise the literature on interventions to improve Māori eye health and investigate the extent to which Kaupapa Māori approaches have been used within these studies.

Methods and analysis

This scoping review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist and informed by Kaupapa Māori research and strengths-based methodologies. Electronic searches of MEDLINE (Ovid), Embase (Ovid) and Google Scholar were performed using keywords focused on Māori eye health, Kaupapa Māori and eye health interventions. The search was performed by an information specialist without language or time restrictions. Peer-reviewed and grey literature reports will be included if they report any intervention that aimed to improve eye health for Māori. Two reviewers will independently screen abstracts and full texts, followed by data charting in Covidence. Data items will include publication, study and intervention characteristics and whether a Kaupapa Māori approach was used, in which case the characteristics of the approach will be charted. The responsiveness to Māori of each included study will be assessed using the MĀORI framework and CONSIDER statement. Data will be summarised in tables, graphs, maps and text.

Ethics and dissemination

To the best of our knowledge, the scoping review is the first to investigate published and publicly accessible literature related to interventions for improving Māori eye health and Kaupapa Māori approaches. Ethical approval is not required for this review as we will include information available in the public domain. We anticipate that the findings will be useful for Hauora Māori providers, organisations, education training and research providers of eyecare services. The scoping review also informs a more extensive project examining Indigenous perspectives in optometry to achieve equitable outcomes. Dissemination will include publication of the scoping review findings in an open-access peer-reviewed journal, as well as presentations at conferences, to Māori community and service organisations, scholars and staff working in the field of Māori eye health.

Registration

Open science framework (https://osf.io/4vqaw/). On 27 February 2025.

Prevalence of eye care service utilisation and associated factors among healthcare professionals in Gondar city, northwest Ethiopia, 2024: community-based cross-sectional study

Por: Bekele · M. M. · Munaw · M. B. · Etsub · S. A. · Tegegn · M. T. · Shumye · A. F. · Alemu · D. S.
Objective

This study aimed to assess the prevalence of eye care service utilisation and associated factors among healthcare professionals in Gondar city, northwest Ethiopia.

Design

An institution-based cross-sectional study was conducted using a systematic random sampling method.

Setting

The study was conducted at public healthcare facilities in Gondar city, orthwest Ethiopia.

Participants

The study included 607 healthcare professionals who worked in public healthcare facilities in Gondar ity.

Main outcome measures

Data were collected using personal interview using a pretested and structured questionnaire.

Results

A total of 607 study participants took part in this study with a response rate of 91.97%. The median age of the participants was 32 years (IQR 30–36; range ±6). The proportion of eye care services utilisation in this study was 27.68% (95% CI 24.11% to 31.25%). Being masters or higher degree educational status (adjusted OR (AOR)=4.81, 95% CI: 2.01, 11.46), having more than ten years of working experience in healthcare (AOR3.01, 95% CI: 1.51 to 5.99), being affiliated with general hospital (AOR 4.02, 95% CI 1.51 to 10.68) and specialised hospital (AOR 3.02, 95% CI 1.55 to 5.89), obtaining prior eye healthcare training (AOR 1.90, 95% CI 1.20 to 3.00) and having a higher monthly household income (AOR 3.59, 95% CI 1.89 to 6.81) were positively associated with eye care service utilisation.

Conclusion

This study revealed that the proportion of eye care service utilisation among study participants was low. Holding a master or higher degree, more than 10 years of working experience in healthcare, affiliation with general or specialised healthcare facility, obtaining prior eye healthcare training and higher monthly household income were significantly associated with a good level of eye care service utilisation.

Investigating the capability of deep learning models to predict age and biological sex from anterior segment ophthalmic imaging: a multi-centre retrospective study

Por: Balal · S. · Cox · L. · Khan · A. · Kandakji · L. · Leucci · M. · Keane · P. A. · Gore · D. · Pontikos · N. · Allan · B.
Objective

To assess the capability of a convolutional neural network trained by transfer learning on anterior segment optical coherence tomography (AS-OCT) images, Placido-disk corneal topography images and external photographs to predict age and biological sex.

Design

Development of a deep learning model trained on retrospectively collected data using transfer learning.

Setting

A multicentre secondary care public health trust based in London.

Participants

We included 557,468 scans from 40,592 eyes of 20,542 patients. Data were extracted from all patients who underwent MS-39 imaging within our trust from October 2020 to March 2023.

Primary and secondary outcome measures

Primary outcome measures for biological sex classification included accuracy, precision, recall, F1-score and area under the receiver operating curve (ROC-AUC). Primary outcome measures for age prediction were Pearson correlation coefficients (r), coefficients of determination (R²) and the mean absolute error (MAE) to evaluate the predictive performance. The secondary outcome was to visualise and interpret the model’s decision-making process through the construction of saliency maps.

Results

For age prediction, the MAEs for the Placido, AS-OCT and external photograph models were 5.2, 5.1 and 6.2 years, respectively. For gender classification, the same models achieved ROC-AUCs of 0.88, 0.73 and 0.81, respectively. No difference in performance was found in the analysis of corneas with pathological topography. The saliency maps highlighted the peri-limbal cornea for age prediction and the central cornea for gender discrimination.

Conclusions

Our study demonstrates that deep learning models can extract age and gender information from anterior segment images. These findings support the concept that the anterior segment, like the retina, encodes important biological information. Future research should explore whether these models can predict specific systemic conditions.

Portable devices for the diagnosis of glaucoma: a scoping review

Por: Garba · F. · Kyari · F. · Burton · M. J. · Adler · S. H. · Khan · Z. · Bello · M. · Evans · J. · Gordon · I. · Hu · V. H. · Nolan · W.
Background

Glaucoma is a leading cause of irreversible blindness worldwide. Early detection and continuous monitoring are essential to preventing vision loss, yet traditional diagnostic tools remain largely inaccessible in low-resource settings.

Purpose

This scoping review aimed to map the existing evidence on the use of portable devices for the detection, diagnosis and monitoring of glaucoma.

Methods

We conducted a scoping review in accordance with the Joanna Briggs Institute Manual and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed across major databases to identify studies that evaluated handheld tonometers, portable fundus cameras and visual field testing devices. Data were extracted on study design, population characteristics, devices used, comparators and reported outcomes.

Results

A total of 216 studies published between 1975 and 2024 were included. Most studies (90.3%) were method agreement studies, primarily focused on intraocular pressure (IOP) devices. Only two studies evaluated all three glaucoma assessment domains (IOP, visual fields and fundus imaging). Most studies were conducted in high-income countries, with a smaller number from low- and middle-income countries. Despite variability in performance, many devices demonstrated acceptable agreement with gold standard methods and were assessed in a range of clinical and community settings.

Conclusion

This review highlights the range and characteristics of portable glaucoma devices and their potential for enhancing access to diagnosis and monitoring, particularly in underserved settings. However, the predominance of method agreement studies and the limited integration of multimodal assessments point to gaps in the literature. Future research should focus on comprehensive diagnostic pathways using multiple portable tools and on expanding evaluations in low-resource settings to inform policy and service planning.

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