Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer.

PURPOSE: To compare the topographical tear film break-up time (T-BUT) between individuals recovering from COVID-19 and control subjects using a noninvasive and noncontact technique with a Scheimpflug-Placido disc topographer. METHODS: One-hundred and twenty-two eyes from 61 post-COVID-19 patients and 124 eyes from 62 control subjects were included in this prospective study. All participants underwent detailed ophthalmological examination including best-corrected visual acuity, intraocular pressure measurements, slit lamp examination, and fundoscopy as well as qualitative and quantitative evaluation of the noninvasive first tear film break-up time (NIF-BUT) and noninvasive average tear film break-up time (NIAvg-BUT) with T-BUT measured with a Sirius (CSO - Costruzione Strumenti Oftalmici S. r. l., Italy) corneal topography device. RESULTS: The mean NIF-BUT in post-COVID-19 and control patients was 5.2 ± 3.4 vs. 6.5 ± 3.2 sec, respectively. The mean NIAvg-BUT in the corresponding groups was 7.5 ± 3.5 vs. 8.8 ± 3.0 sec, respectively. Both NIF-BUT and NIAvg-BUT were significantly lower in the post-COVID-19 group than in controls (p = 0.004 vs. 0.020). Topographical tear film break-up at any time during the test (17 sec) was observed qualitatively in 79 eyes (64.8%) in the post-COVID-19 group and 57 eyes (46%) in the control group (p = 0.003). Moreover, temporal quadrant involvement occurred significantly more frequently in the post-COVID-19 group (p = 0.028). CONCLUSION: Tear film stability assessment based on T-BUT showed shorter NIF-BUT and NIAvg-BUT in post-COVID-19 patients as compared to the control group. Our results suggest that post-COVID-19 patients have impaired stability of tear film, and therefore require closer monitoring regarding dry eye. In addition, tear film instability in post-COVID-19 patients can be reliably detected using a noninvasive and noncontact technique that is more comfortable for both patients and physicians.

Severe COVID-19 and Retina: Are There Any Retinal Manifestations?

PURPOSE: To investigate whether there are retinal lesions associated with severe COVID-19. METHODS: We studied 232 symptomatic subjects aged 18 - 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP). RESULTS: The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the examination and imaging. CONCLUSIONS: This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may occur secondary to existing systemic diseases.

Apelin-13: A Promising Biomarker for Age-Related Macular Degeneration?

PURPOSE: To investigate the value of serum apelin-13 levels in patients with age-related macular degeneration (AMD). METHODS: Patients with dry-type AMD, patients with treatment-naïve neovascular-type AMD, and healthy controls were included in this study. Diagnoses were confirmed on detailed fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Central foveal thickness and subfoveal choroidal thickness were evaluated. Both serum apelin-13 and vascular endothelial growth factor (VEGF) levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) principle. RESULTS: A total of 84 subjects, i.e., 24 in the dry-type AMD group (group 1), 27 in the neovascular-type AMD group (group 2), and 33 in the control group (group 3) were included in the study. Mean best-corrected visual acuity (BCVA) was 76 ± 4.5, 48.4 ± 16.3, and 83.4 ± 3.09 ETDRS letters in group 1, 2, and 3, respectively. The level of serum VEGF was 44.11 ± 26.14, 56.53 ± 53.77, and 61.47 ± 41.62 pg/mL in groups 1, 2, and 3, respectively (p = 0.553, p = 0.286, and p = 0.896, respectively). The level of serum apelin-13 was 586.47 ± 167.56, 622.18 ± 324.52, and 379.31 ± 171.96 pg/mL in groups 1, 2, and 3, respectively (p = 0.847, p = 0.04, and p ≤ 0.001, respectively). There was a negative correlation between the level of serum apelin and visual acuity (VA) and choroidal thickness. CONCLUSION: Serum apelin-13 levels were higher in both dry-type and neovascular-type AMD patients than in controls. Further studies demonstrating the relationship of the level of serum apelin-13 and AMD are needed.

The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus.

PURPOSE: To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). METHODS: The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. RESULTS: The mean age was 41.25 ± 6.89 years in group 1 and 41.81 ± 5.78 years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184 cells/mm2 in group 1 and 2649 ± 315 cells/mm2 in group 2 (p = 0.843). The percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) CONCLUSION: Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality.

Systemic oxidative stress biomarkers in patients with vitreomacular traction syndrome.

PURPOSE: To evaluate whether the systemic oxidative stress biomarkers increased in patients with vitreomacular traction syndrome (VMT). METHODS: This study compared 25 patients diagnosed with VMT with 20 healthy controls. As a biomarker of systemic oxidative stress, malondialdehyde (MDA) was measured. Total oxidant status (TOS) and total antioxidant status (TAS) were measured to evaluate the systemic oxidant status. RESULTS: Serum MDA values were significantly higher among the patients (p < 0.001). The ideal cut-off value for MDA was determined to be 22.1 µmol/L, with 80% sensitivity and 75% specificity. The between-group differences were not statistically significant for TOS or TAS (p = 0.326 and p = 0.698, respectively). CONCLUSION: Increased MDA levels suggest that systemic oxidative stress may play a role in VMT.

Abnormal retrobulbar blood flow variables in central serous chorioretinopathy.

PURPOSE: To evaluate if the retrobulbar blood flow variables were deteriorated in central serous chorioretinopathy (CSC) patients. METHODS: We included 25 CSC patients and 25 healthy subjects. We used color Doppler ultrasonography to assess the ophthalmic artery (OA), the central retinal artery (CRA), and the posterior ciliary arteries (PCA) for peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI). RESULTS: Mean ages of the patients and controls were 42.3 ± 8.5 and 41.3 ± 9.4 years, respectively (P = .853). There were no significant differences between the two groups with regard to the values of PSV, EDV, and RI of CRA (P = .406, P = .627, P = .227) and PCA (P = .785, P = .403, P = .935, respectively). The PSV and EDV of OA were lower in the CSC patients (P = .005, P = .024, respectively). Whereas the RI of OA was not significantly different (P = .729). Submacular choroidal thickness (SCT) was greater in CSC patients (P < .001). There was a negative correlation between SCT and PSV of PCA (P = .022, r = -0.457) and between SCT and EDV of PCA (P = .004, r = -0.560) in CSC patients. CONCLUSION: Hemodynamic changes in OA and a negative correlation between PCA values and SCT suggest ocular circulatory dysfunction in patients with CSC.

Evaluation of the effect of combined intravitreal ranibizumab injection and sub-tenon steroid injection in the treatment of resistant diabetic macular edema.

PURPOSE: To compare sub-tenon steroid plus anti-VEGF injection with anti-VEGF injection solely in the treatment of resistant diabetic macular edema (DME). METHOD: Patients who exhibited insufficient anatomic [over 350 µm central macular thickness (CMT)] and less than 3 lines of visual gain at least six anti-VEGF injections, were randomly divided into two groups. In group I, the anti-VEGF injection was performed 10 days after the sub-tenon steroid injection [Triamcinolone acetonide (Sinakort-A®)]. And anti-VEGF was performed when needed during the follow-up period. In group II, treatment was continued with anti-VEGF only. All patients' visual acuity and CMT were followed up for 6 months. RESULTS: The baseline BCVA in group I and group II was 0.51 ± 0.667 logMAR and 0.47 ± 0.60 logMAR, respectively (p = 0.52). In group I and II, at the end of 6-month follow-up, BCVA improved to 0.38 ± 0.60 logMAR (p < 0.001) and 0.43 ± 0.60 logMAR (p = 0.20), respectively. The baseline CMT in group I and group II was 494 ± 118.32 and 438.20 ± 90.99 µm, respectively (p = 0.029). In group I and II, at the end of 6 months, CMT decreased to 302.57 ± 69.89 µm (p < 0.001) and 439.20 ± 107.6 µm (p = 0.96), respectively. CONCLUSION: Adding steroid to routine anti-VEGF treatment is an effective way of treatment method for resistant DME.

CHOROIDAL THICKNESS IN PATIENTS WITH STARGARDT DISEASE.

PURPOSE: To investigate the relationship between choroidal thicknesses (CT), central foveal thicknesses, multifocal electroretinography (mf-ERG) responses, and best-corrected visual acuity levels in patients with Stargardt disease (STGD). METHODS: A total of 30 eyes of 30 patients with STGD, and 30 age- and sex-matched healthy controls were included in the study. All participants underwent detailed ophthalmic examination including best-corrected visual acuity and spectral domain optical coherence tomography measurements, and also patients with STGD were performed mf-ERG. RESULTS: The mean subfoveal CT values were 271.95 ± 85.57 µm in patients with STGD and 355.73 ± 87.41 µm in the control group (P < 0.001). The mean central foveal thickness values were 223.56 ± 61.38 µm in patients with STGD and 272.46 ± 27.52 µm in the control group (P < 0.001). The mean central and paracentral mf-ERG responses (45.71 ± 26.60 and 16.47 ± 10.75 Nv/deg respectively) in patients with STGD were significantly lower from the normal ranges (66.6-130.8 Nv/deg and 30.9-77.7 Nv/deg, respectively; P < 0.001 for both). There was a statistically significant correlation between subfoveal CT and best-corrected visual acuity levels (P = 0.012, r = -0.452), and between parafoveal CT and inner retinal thickness and paracentral mf-ERG responses (P = 0.043, r = +0.372 and P = 0.049, r = +0.363, respectively). Paracentral mf-ERG responses were also correlated with outer retinal thickness values (P = 0.005, r = +0.503). CONCLUSION: Patients with STGD have a thinner CT, which may be responsible for some of the clinical findings. The pathophysiological significance of these findings needs further study.

Assessment of focal laser photocoagulations' early effect on polypoidal choroidal vasculopathy with optical coherence tomography angiography.

Polypoidal choroidal vasculopathy (PCV) is seen with polypoidal lesions and branching vascular networks (BVNs) (Spaide et al. in Retina 15(2):100-110, 1995; Yannuzzi et al. in Retina 10(1):1-8, 1990). There are reports about laser photocoagulation for PCV (Yuzawa et al. in Japan J Ophthalmol 47(4):379-384, 2003; Lee et al. in Eye 23(1):145-148, 2009); however, all these reports are about final vision and frequent relapses. Therefore, this treatment merits rigorous scrutiny using optical coherence tomography angiography (OCTA).

The Short-Term Effect of 1% Tropicamide Drop on Pupillary Diameter and Intraocular Pressure Change in Patients With Pseudoexfoliation Material.

PRCIS: In this study, in patients with pseudoexfoliation syndrome (PXS) or glaucoma, changes in intraocular pressure (IOP) and pupil size after 1% tropicamide used for pupil dilation, compared with healthy patients were quantitatively demonstrated up to 4 hours after dilation. PURPOSE: The purpose of this study was to evaluate pharmacological dilatation with one drop of 1% tropicamide on pupillary diameter and IOP changes in patients with PXS and glaucoma (PXG). MATERIALS AND METHODS: Eighty-two patients with PXS, 78 Patients with PXG, and 35 healthy subjects were included in the study. PXG and PXS were diagnosed based on IOP assessment, corneal pachymetry, optic disc examination, visual field testing, and peripapillary retinal nerve fiber analysis. IOP and the diameter of pupil size were measured before dilatation and at postdilatation first, second, and fourth hours. RESULTS: The mean pupillary diameter values at postdilatation second and fourth hours were statistically significantly different between the patients with PXS and PXG ( P <0.001, for each). Also, there were significant differences between the PXS group and the control group in terms of the mean pupillary diameter values at predilatation and postdilatation at the first hour and postdilatation second hour ( P =0.007, <0.001, respectively). The mean pupillary diameter at all times was statistically significantly different between PXG and control groups ( P <0.001 for each). Significant IOP increases were observed in all groups after dilatation. The mean IOP at predilatation and postdilatation fourth hour was statistically significantly different between PXG and PXS groups ( P =0.042, <0.001, respectively). Whereas the mean IOP at predilatation, postdilatation first hour, postdilatation second hour, and postdilatation fourth hour were statistically significantly different between PXG and control group ( P <0.001 for each). CONCLUSIONS: Significant IOP increases have been observed in our study with 1% tropicamide in the PXG and PXS groups, with the peak effect at the second hour in the postdilatation period. Furthermore, the mean pupil diameter was found to be significantly lower in PXG patients compared with the control group.

Comparison of postoperative morphological changes and retinal displacement in diabetic and idiopathic epiretinal membranes.

PURPOSE: To compare the postoperative retinal displacement by optical coherence tomography (OCT) in idiopathic epiretinal membranes (iERM) and diabetic epiretinal membranes (dERM). METHODS: This retrospective study included 36 iERM and 22 dERM cases. In cross-sectional OCT images (B-scan) the presence of foveal pit, subfoveal fluid, cotton ball sign (CBS), intraretinal cystic changes (ICC), disorganization of retinal inner layers (DRILs) and ectopic inner foveal layer (EIFL) were recorded. Central macular thickness (CMT) and EIFL thicknesses were calculated. Retinal displacement was quantified using infrared image of OCT approach consisting of the fovea to disc margin, interarcade distance and perimacular distances. RESULTS: The presence of subfoveal fluid (p = 0.014) and DRIL (p = 0.02) was significantly higher in the dERM group. CMT decreased significantly in both groups (p˂0.001). The EIFL was significantly thicker in the iERM group compared to the dERM group (p = 0.049), and it decreased significantly in the iERM group postoperatively. In the iERM group, while the fovea-disc margin distance decreased, the interarcade and perimacular distance increased significantly (p˂0.001). In the dERM group, the disc-fovea distance change was not significant (p = 0.082). Significant visual improvement was achieved with vitrectomy in both groups (p˂0.001). In the dERM group, the presence of DRIL was associated with lower pre and post-op visual acuity (VA) (r = 0.596 and p = 0.004 for pre-operative and r = 0.567 and p = 0.007 for post-operative). CONCLUSION: Significant retinal displacement occurs after vitrectomy in both iERM and dERM. The low VA in the dERM group may be related to the presence of DRILs.

Evaluation of the lamina cribrosa in different stages of diabetic retinopathy.

PURPOSE: To evaluate the relationship of the peripapillary retina nerve fiber layer (RNFL) and lamina cribrosa (LC) with diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) cases. STUDY DESIGN: Prospective comparative study. METHODS: This study included 50 non-DR (Group 1), 55 non-proliferative diabetic retinopathy (NPDR) (Group 2), 28 DM cases with proliferative diabetic retinopathy (PDR) (Group 3) and 45 healthy volunteers (Group 4). All participants were evaluated with visual acuity, intraocular pressure (IOP) with Goldman applanation tonometry, anterior segment biomicroscopy, 24 - 2 visual field testing, and dilated fundus examination. Retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT) and anterior lamina cribrosa depth (ALCD) were examined by spectral-domain optical coherence tomography (OCT). RESULTS: There was no difference between the groups in terms of age and gender. Visual acuity (p < 0.001) was significantly different between the groups, while IOP (p = 0.068) was similar. Mean (p = 0.010), superior-temporal (p = 0.024), and superior-nasal (p = 0.011) RNFL thickness decreased significantly in correlation with the stage of DR. LCT decreased significantly as the stage of DR progressed in both vertical and horizontal radial OCT scans (p < 0.001). ALCD was not different between groups (p = 0.954 for horizontal scan, p = 0.867 for vertical scan). CONCLUSION: Peripapillary RNFL and LCT significantly decreases as the DR stage progresses. The biomechanical effects of the LC may also be responsible for diabetes-induced neurodegeneration.

The Effect of an Eyelid Speculum on Intraocular Pressure Measurement in Newborns.

PURPOSE: To evaluate the effect of an eyelid speculum on intraocular pressure (IOP) measurements in newborns. METHODS: A total of 54 eyes of 27 newborns were involved in the study. The IOP measurements were obtained under topical anesthesia with the Icare PRO (Icare Finland Oy) before and after inserting the infant type of Barraquer wire eyelid speculum. A paired t test was used to compare the measurements. RESULTS: The mean IOP without the eyelid speculum was 9.04 ± 2.13 mm Hg (range: 6.00 to 13.20 mm Hg) in the right eye and 9.26 ± 1.59 mm Hg (range: 7.10 to 13.00 mm Hg) in the left eye. With the eyelid speculum in place, the mean IOP was 11.91 ± 2.23 mm Hg (range: 9.10 to 15.80 mm Hg) in the right eye and 11.70 ± 1.89 mm Hg (range: 8.40 to 14.50 mm Hg) in the left eye (P ≤ .001). The mean differences in IOP between measurements with and without the eyelid speculum were 2.87 ± 2.23 mm Hg (range: 0.20 to 5.20 mm Hg) in the right eye and 2.44 ± 1.48 mm Hg (range: 0.00 to 4.90 mm Hg) in the left eye. The mean difference in IOP between measurements with and without the eyelid speculum for all eyes was 2.65 ± 1.89 mm Hg (range: 0.00 to 5.20 mm Hg). There was no correlation between the difference in IOP after the placement of the eyelid speculum and postconceptual age or weight at the examination (r = 0.11, P = .41, r = 0.32, P = .14, respectively). CONCLUSIONS: The Barraquer wire eyelid speculum caused an increase in IOP in newborns under topical anesthesia without a significant difference between postconceptual age and sex in both eyes. The average IOP rise after the eyelid speculum was inserted was 2.65 mm Hg. This effect should be considered when interpreting IOP measurements in newborns. [J Pediatr Ophthalmol Strabismus. 2022;59(1):13-16.].

Evaluation of choroidal thickness in light-coloured eyes.

OBJECTIVE: The aim of this study was to determine whether iris colour is related to the choroidal thickness of healthy individuals. METHODS: Healthy participants were divided into two groups. Group 1 had light-coloured eyes (blue and green), and group 2 had dark-coloured eyes (brown). The main outcome measures were iris thickness, subfoveal choroidal thickness and nasal and temporal choroidal thicknesses 500 µm away from the fovea. RESULTS: Group 1 comprised 31 subjects with light-coloured eyes, and group 2 had 31 subjects with dark eyes. The mean ages of groups 1 and 2 were 26.7 ± 7.5 years and 24.1 ± 5.8 years, respectively (p = 0.14). The choroidal thicknesses of the subfoveal, nasal and temporal regions were 336.3 ± 52.1 µm, 321.9 ± 43.6 µm and 318.4 ± 49.2 µm, respectively, in group 1 and 396.5 ± 76.9 µm, 372 ± 79.3 µm and 379.6 ± 82.4 µm, respectively, in group 2. All the values in group 1 were statistically lower than those in group 2 (p = 0.001, p = 0.001 and p = 0.003, respectively). The iris thickness in group 1 (493.73 ± 95.44 µm) was thinner than in group 2 (524.61 ± 69.74 µm) but not statistically significant (p = 0.141). CONCLUSION: The results showed that a thinner choroid can be seen in disease-free light-coloured eyes. The iris colour should be considered among the factors affecting the choroidal thickness, such as age, sex, race and refractive error.

Change in retinal vessel diameter and choroidal thickness in patients with severe COVID-19: Change In Retinal Parameters In Patients With Severe COVID-19.

PURPOSE: To compare the differences in retinal vascular structure and choroidal thickness between the active disease and post-recovery periods in COVID-19 patients and healthy controls. MATERIAL AND METHODS: This prospective, cross-sectional study included 30 eyes from 30 patients with severe COVID-19 and 30 eyes of 30 sex-matched healthy controls. Central macular thickness (CMT), subfoveal choroidal thickness (CT) and retinal vascular changes of patients were measured after positive polymerase chain reaction (PCR) (where the patient had COVID-19-related symptoms) and then three months after two negative PCRs. Laboratory parameters, including C-reactive protein and d-dimer levels, were also recorded. RESULTS: The mean age of the patients was 47.90 ± 9.06 years in patients group, 49.07 ± 8.41 years in control goups (p = 0.467). In terms of choroidal thicknesses subfoveal, nasal and temporal region were significantly higher in the active disease period than control group (p = 0.019, p = 0.036, p = 0.003, respectively). When the after recovery period was compared with the control group in terms of choroidal thickness, although the choroidal thickness was higher in all regions, this difference was not found statistically significant. There was no statistically significant difference in CMT between groups (p = 0.506).The mean venous and arterial wall thicknesses were significantly higher in the active period than after recovery (p = 0.023, p = 0.013, respectively) but there were no differences between after recovery and control groups in the pairwise comparison (p = 0.851, p = 0.715, respectively). CONCLUSION: In patients with severe COVID-19, there are changes in thickness of the choroid and retinal vessel walls. While vascular wall thickness increases due to inflammation, the absence of lumen changes may be associated with hemodynamic variables.

Assessment of Inflammation Biomarkers in Diabetic Macular Edema Treated with Intravitreal Dexamethasone Implant.

Purpose: To evaluate inflammation biomarkers in diabetic macular edema (DME) treated with intravitreal dexamethasone implant (Ozurdex®). Methods: This retrospective single-center study investigated 64 eyes of 64 patients with DME who were nonresponsive to prior antivascular endothelial growth factor and treated with intravitreal Ozurdex. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio were calculated. Visual acuity and optical coherence tomography markers, including hyper-reflective dots and subretinal fluid (SRF), were determined, and central retinal thickness was also evaluated monthly for 3 months. Results: The average age was 64.06 ± 7.81 (48-84) years. The baseline NLR and MLR were significantly higher in patients with better visual outcomes (P = 0.029 and P = 0.048, respectively). Better anatomical outcomes were observed in the presence of SRF (P = 0.027). No significant differences were observed in the rates of the presence of SRF and hyper-reflective points about the better functional outcome (P > 0.05). Conclusions: SRF as an imaging biomarker, and NLR and MLR as blood biomarkers, stand out as markers of inflammation and were found to be associated with better response to Ozurdex implantation in DME.

Accommodative amplitudes and high-order aberrations in patients with multiple sclerosis with optic nerve involvement.

PURPOSE: This study aimed to investigate and compare the changes in corneal aberrations and accommodative amplitudes between patients with multiple sclerosis and normal individuals. METHODS: We included 20 patients who were previously diagnosed with multiple sclerosis with optic nerve involvement (multiple sclerosis group) and 20 healthy sex- and age-matched individuals (control group). We only selected those who were under 40 years old because accommodation in individuals over 40 years old significantly deteriorates. We measured the accommodative amplitude in diopters by minus lens test and evaluated the higher-order aberrations by using the iDesign aberrometer. Then, we compared the accommodative amplitude and the root mean square of higher-order aberrations between the groups. RESULTS: The mean age of the multiple sclerosis and control groups were 35.25 ± 4.52 and 32.28 ± 6.83 years, respectively (p=0.170). The accommodative amplitude was 4.05 ± 1.25 D in the multiple sclerosis group and 6.00 ± 1.03 D in the control group, with a statistically significant difference (p<0.001). Meanwhile, the root mean square of higher-order aberrations was not significantly different between the groups (multiple sclerosis group, 0.44 ± 0.22; control group, 0.43 ± 0.10, p<0.824). Moreover, aberration changes had no statistically significant differences between the two groups at baseline and at 5 D stimulus. CONCLUSIONS: The accommodative amplitude was decreased in patients with multiple sclerosis, suggesting the possible cause of transient visual impairments in these patients. However, this accommodative amplitude did not demonstrate a significant difference in terms of higher-order aberration change during accommodation between such patients and the controls.

Relationship of Obesity and Related Disorders with Ocular Parameters in Children and Adolescent.

PURPOSE: To evaluate the effect of obesity and obesity-related high blood pressure (BP) on the retinal nerve fiber layer (RNFL) and macula in children and adolescents. MATERIALS AND METHODS: Thirty-two obese patients followed up in the pediatrics endocrinology clinic between 2018 and 2019 were evaluated in the ophthalmology clinic. The results were compared with 25 healthy subjects, matched for age and sex. Anthropometric measurements, and systolic and diastolic BP were measured. The study consisted of three groups: Group 1, patients with obesity; Group 2, those with obesity and associated hypertension (obesity-related HT); and Group 3, healthy controls. A complete ophthalmologic examination was performed. Macular and RNFL thicknesses were determined using spectral domain optical coherence tomography (SD-OCT). RESULTS: There were no statistically significant differences between the groups in terms of gender, age, and intraocular pressure (p > .05). The inferior RNFL thickness and central foveal thickness were statistically thinner in the obesity-related HT group (p < .001 and p = .040). The systolic and diastolic BP and fasting glucose values were significantly higher in the obesity-related HT group than the other groups (p < .001; p < .001; p = .026, respectively). In linear regression modeling in obese and obesity-related HT groups, a significant assocation was found between diastolic BP and temporal RNFL thickness (p = .027) as well as between the systolic BP and triglyceride values and the nasal RNFL thickness values (p = .016 and p = .025, respectively). CONCLUSIONS: Inferior RNFL thickness and central foveal thickness were significantly thinner in patients with obesity-related HT. The effects of obesity-related HT on the retina should be evaluated using SD OCT, since no signs were found in a routine ocular examination.

The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients.

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.

Determination of Neurodegeneration in Polycystic Ovary Syndrome with Retinal Segmentation Analysis.

Purpose: To compare the thickness of each retinal layer in patients with polycystic ovary syndrome (PCOS) versus healthy, age-matched controls by using retinal segmentation analysis.Methods: In our cross-sectional study, 37 patients with PCOS (i.e., patient group) and 35 healthy individuals (i.e., control group) underwent spectral-domain optical coherence tomography imaging. Using built-in automatic retinal segmentation software to analyze the images collected, we compared the thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, photoreceptor layer (PRL), retinal pigment epithelium (RPE), inner retinal layers, and outer retinal layers between the groups. To analyze the measurements, we used a traditional Early Treatment Diabetic Retinopathy Study (ETDRS) grid.Results: In ETDRS subfields, 6-mm nasal RNFL thickness; 3- and 6-mm nasal GCL thickness; 3-mm superior and 6-mm nasal IPL thickness; 1-mm central, 3-mm nasal, superior, and inferior, and 6-mm nasal and inferior PRL thickness; and 6-mm inferior RPE thickness were significantly thinner in patients with PCOS than that of healthy controls.Conclusion: The results of our retinal segmentation analysis indicate that patients with PCOS tend to have thinner GCL, IPL, and PRL than healthy, age-matched controls due to neurodegeneration likely caused by insulin resistance, or subclinical retinal inflammation.