A survey on the willingness of outpatients to participate in fundus examination procedures conducted by ophthalmology training residents in China: A cross-sectional study.

Background and Aims: The National Standardized Training for Resident Doctors (STRD) in mainland China encounters many challenges in its implementation. To investigate whether outpatients are willing to undergo indirect ophthalmoscopy examination conducted by ophthalmology residents in the ophthalmology STRD program in China. Methods: This study conducted a cross-sectional survey at the Eye Hospital of Wenzhou Medical University between September 2021 and September 2023. A cohort of 300 initial outpatients requiring indirect ophthalmoscopy examinations were enlisted from the outpatient department. Based on whether the patients are willing to undergo an indirect ophthalmoscopy examination by resident doctors, patients were divided into two groups: Group 1 (willing) and Group 2 (unwilling), and their questionnaire responses were comparatively analyzed. Results: A total of 261/300 (87%) valid questionnaires were returned in the survey, which included 149 males and 112 females. No notable gender difference (p = 0.400) or disparity in medical expense categories (p = 0.786) was observed between the two groups. However, variables such as outpatient marital status (p = 0.002), the presence of training faculty during fundus examinations with residents and outpatients (p < 0.001), the demeanor of training residents toward patients (p < 0.001), and the quality of doctor-patient communication (p < 0.001) significantly varied between the groups. Conclusion: The level of outpatients' cooperation with ophthalmology residents during fundus examinations in the Chinese ophthalmology STRD program was observed to be low. Enhancing the presence of training faculty during examinations and enhancing the communication skills of training residents could significantly improve this situation.

Characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction.

Objectives: To investigate the characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction (PCD). Methods: In this cross-sectional study, the enrolled eyes with congenital cataract and PCD were included in the PCD group, while those with an intact posterior capsule were included in the control group. Demographic data and biometric parameters were recorded. The levels of 17 inflammatory factors in the aqueous humor collected from the enrolled eyes were detected using Luminex xMAP technology, and intergroup differences in the collected data were analyzed. Results: The PCD group comprised 41 eyes from 31 patients with congenital cataract and PCD, whereas the control group comprised 42 eyes from 27 patients with congenital cataract and an intact posterior capsule. Lens thickness was significantly thinner in the PCD group than in the control group. However, the levels of monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-ß2 (TGF-ß2), and vascular endothelial growth factor (VEGF) were significantly higher in the PCD group than in the control group. Multivariate logistic regression confirmed that lens thickness and TGF-ß2 level were independent risk factors for PCD. Conclusion: A thinner lens thickness in eyes with congenital cataract and PCD could serve as a biometric feature of these eyes. The higher levels of MCP-1, TGF-ß2, and VEGF in eyes with PCD indicated a change in their intraocular inflammatory microenvironment, which possibly led to cataract progression. Lens thickness and TGF-ß2 level are independent risk factors for PCD.

Accuracy of Ten Intraocular Lens Formulas in Spherical Equivalent of Toric Intraocular Lens Power Calculation.

INTRODUCTION: The aim of this work is to evaluate the accuracy of the Barrett Universal II (BU II), Emmetropia verifying optical (EVO) 2.0, Haigis, Hoffer Q, Hoffer QST (Savini/Taroni) (HQST), Holladay 1, Kane, Ladas Super, Sanders-Retzlaff-Kraff/theoretical (SRK/T), and T2 intraocular lens (IOL) power formulas for calculating spherical equivalent (SE) of toric IOL. METHODS: This study enrolled consecutive patients who underwent phacoemulsification and toric IOL implantation at the Eye Hospital of Wenzhou Medical University in Hangzhou from 2015 to 2022. We compared the new-generation formulas with Gaussian optics-based standard formulas, and calculated the mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ± 0.25 diopter (D), ± 0.50 D, ± 0.75 D and ± 1.00 D of the target refraction. Subgroup analyses were conducted based on the anterior chamber depth (ACD), keratometry (K), and toricity (T). RESULTS: A total of 207 eyes of 207 patients were included in this study. Overall, the Kane and EVO2.0 formulas demonstrated the lowest MedAEs. The EVO2.0 formula exhibited the highest percentage of eyes within ± 0.50 D, ± 0.75 D, ± 1.00 D. Moreover, the EVO2.0 formula showed the lowest MedAE for flat K subgroup, the highest percentage of eyes within ± 0.50 D, ± 1.00 D for shallow ACD subgroup, the highest percentage of eyes within ± 0.75 D for regular ACD, flat K, T2-T3, T4-T5 subgroups. The Kane and formula performed the lowest MedAE in the T4-T5 subgroup. CONCLUSIONS: Application of the Kane and EVO2.0 formulas significantly improved the prediction of postoperative SE outcome for toric IOL compared to the other formulas.

Dynamic Changes of Capsular-Intraocular Lens Adhesion in Plate-Haptic Hydrophilic and Loop-Haptic Hydrophobic Eyes.

INTRODUCTION: The aim of this work is to investigate the dynamic changes of capsular-intraocular lens (IOL) adhesion in plate-haptic hydrophilic and loop-haptic hydrophobic eyes. METHODS: Cataract eyes that met the inclusion criteria were randomly assigned to receive implantation of a plate-haptic hydrophilic or loop-haptic IOL. The anterior capsular adhesion, posterior capsular adhesion, and the configurations of the capsular bend were evaluated using swept-source optical coherence tomography at 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS: In total, 66 eyes of 66 patients were eligible for the analysis: 33 in the plate-haptic group and 33 in the loop-haptic group. The contact between the anterior capsule and IOL in the plate-haptic group was earlier than that in the loop-haptic group upon comparing the measurements taken at 1 day and 1 week (p = 0.001, p = 0.003, respectively). The complete attachment of the posterior capsule and IOL in the plate-haptic group was significantly greater at 1 week, 1 month, and 3 months (p = 0.001, p = 0.000, p = 0.001, respectively). The capsular bend index of the plate-haptic group was significantly greater than that of the loop-haptic group at each time points except at 1 day (p = 0.007, p = 0.049, p = 0.005, respectively). Furthermore, a new type of capsular bend, "cocked adhesion," was observed in the plate-haptic eyes. CONCLUSIONS: The plate-haptic IOL demonstrated excellent capsular adhesion compared to the loop-haptic IOL, which was probably attributed to haptic compressibility. A special cocked configuration of the capsular bend in plate-haptic IOL was observed for the first time. Further studies are warranted to confirm the effect of the new type of capsular bend.

Postoperative complications and axial length growth after bilateral congenital cataract surgery: eyes with microphthalmos compared to a comparison group.

PURPOSE: To investigate the postoperative clinical outcomes and axial length (AL) growth of infants with congenital cataracts and microphthalmos following first-stage cataract surgery. DESIGN: Retrospective case-control study. METHODS: Setting: Single centre. Infants with congenital cataract that met the inclusion criteria were classified into two groups: the microphthalmos and comparison groups. All infants underwent a thorough ophthalmologic examination before surgery, and one week, 1 month, 3 months, and every 3 months after surgery. RESULTS: This study enrolled 21 infants (42 eyes) in the microphthalmos group and 29 infants (58 eyes) in the comparison group. More glaucoma-related adverse events were observed in the microphthalmos group (7 eyes, 16.7%) than in the comparison group (0 eyes, 0%) (p < 0.001). At each subsequent follow-up, the comparison group had a greater AL than the microphthalmos group (all p < 0.001), and AL growth was significantly higher in the comparison group than in the microphthalmos group (all p = 0.035). Visual acuity improvement in the microphthalmos group was similar to that of the comparison group. CONCLUSION: Early surgical intervention improves visual function in infants with congenital cataracts and microphthalmos although with a higher incidence of glaucoma-related adverse events. After cataract removal, the AL growth of microphthalmic eyes is slower than that of normally developed eyes.

Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery.

PURPOSE: To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length. SETTING: Eye Hospital of Wenzhou Medical University at Hangzhou. DESIGN: Prospective self-controlled trial. METHODS: Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination. RESULTS: 21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively ( P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively ( P < .05); at 12 months postoperatively, there was a significant difference in ACOA ( P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint ( P > .05). CONCLUSIONS: For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.

Clinical usefulness of the baby vision test in young children and its correlation with the Snellen chart.

AIM: To investigate the efficacy of a new visual acuity (VA) screening method, the baby vision test for young children. METHODS: A total 105 eyes of 65 children aged 2-8y were included in the study. Acuity testing was conducted using a standardized recognition acuity chart (Snellen visual chart: at 3 m) and the baby vision model assessment. The baby vision device includes a screen, a near infrared camera and a computer. Children were seated at a measured distance of 33-40 cm from a display for testing. VA was estimated according to the highest resolution the children could follow. Decimal VA data were converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. The VA results for each child were recorded and analyzed for consistency. RESULTS: The mean VA measured using the Snellen visual chart was 0.62±0.32, and that assessed using the baby vision test was 0.66±0.27. The 95% limit of agreement was -0.609 to 0.695, with 95.2% (100/105) plots within the 95% limits of agreement. VA values of the baby vision test were significantly correlated with those of the Snellen chart (R=0.274, P=0.005). CONCLUSION: The baby vision test can be used as a relatively reliable method for estimating VA in young children. This new acuity assessment might be a valid predictor of optotype-measured acuity later in preverbal children.

Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography.

Purpose: To evaluate the ability of swept-source optical coherence tomography angiography (SS-OCTA) to assess lid margin vascularity. Methods: This prospective, cross-sectional trial enrolled 125 participants, including 15 control subjects and 110 meibomian gland dysfunction (MGD) patients. Lid margin blood flow density (LMBFD) was obtained using SS-OCTA. LMBFD was assessed for repeatability in 54 of 125 participants and for reproducibility in 23 of 125 participants. The efficacy of LMBFD was validated in the 125 participants, who were divided into mild (n = 46), moderate (n = 42), and severe groups (n = 37) according to the lid margin vascularity severity shown in the slit-lamp photographs. Correlations between LMBFD and MG-related parameters, such as ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), cornea fluorescein staining (CFS), lid margin score (LMS), and meibomian gland expressibility (ME), were analyzed in all 125 participants. Results: Repeatability and reproducibility coefficients were satisfactorily high in the scan mode with a scan area of 6 mm × 6 mm (intraclass correlation coefficient [ICC] repeatability = 0.905; ICC reproducibility = 0.986) and a scan area of 9 mm × 9 mm (ICC repeatability = 0.888; ICC reproducibility = 0.988). The LMBFD gradually increased in the mild, moderate, and severe groups (P < 0.001). LMBFD was significant correlated with OSDI (r = 0.290, P = 0.001), FTBUT (r = -0.195, P = 0.030), CFS (r = 0.352, P < 0.001), ME (r = 0.191, P = 0.033), and LMS (r = 0.370, P < 0.001). Conclusions: LMBFD may be a noninvasive, repeatable, reproducible, and efficient index for the quantitative evaluation of eyelid margin vascularity in the future. Translational Relevance: We demonstrated that SS-OCTA has the potential to evaluate the eyelid margin vascularity in MGD patients and guide future treatment strategies in clinics.

Accuracy of Modern Intraocular Lens Formulas in Highly Myopic Eyes Implanted With Plate-Haptic Intraocular Lenses.

PURPOSE: To evaluate the predictive accuracy of modern intraocular lens (IOL) formulas and axial length (AL) adjusted traditional IOL formulas, including Wang-Koch and Cooke-modified AL (CMAL) method, in long eyes with plate-haptic IOLs, and to compare refractive prediction error variances with C-loop IOLs. DESIGN: Retrospective consecutive case series study. METHODS: Data from 391 eyes with Zeiss 509 M and 302 eyes with Alcon SN6CWS implants in highly myopic patients, following cataract surgery from January 2019 to November 2023, were collected. One eye per patient was selected. Predictive outcomes of 15 modern formulas (Barrett Universal II (BU II), Cooke K6 (K6), Emmetropia Verifying Optical (EVO) 2.0, Hoffer-QST, Kane, Karmona, Ladas AI, Naeser 2, Olsen, Pearl-DGS, Radial Basis Function (RBF) 3.0, T2, VRF-G, Zhu-Lu, and Z-Calc) and 4 traditional IOL formulas (Haigis, Hoffer Q, Holladay 1, and SRK/T) with AL adjusted methods, were evaluated. The mean prediction error, mean absolute prediction error (MAE), root-mean-square absolute prediction error (RMSAE) and the proportions of eyes with PEs within ±0.25 Diopter (D), ±0.50 D, ±0.75 D, and ±1.00 D were analyzed. Top 10 RMSAE-ranked formulas underwent further subgroup analysis based on AL, anterior chamber depth (ACD), and keratometry (K). RESULTS: For the 509 M group, RMSAE ranking for the top 10 IOL formulas were the RBF 3.0 (0.432), Zhu-Lu (0.436), Olsen (0.436), EVO 2.0 (0.437), Pearl-DGS (0.447), K6 (0.452), VRF-G (0.454), Naeser 2 (0.464), Haigis-CMAL (0.465) and Karmona (0.477). Karmona and Naeser 2 showed poorer performance in the extremely long AL and steep K subgroups, respectively (p ≤ 0.042). Haigis-CMAL accuracy was significantly lower in shallow ACD and flat K subgroups (P ≤ .045). The SN6CWS group showed significantly lower MAE and RMSAE compared to the 509 M group for the BU II, EVO 2.0, Hoffer-QST, Kane, Pearl-DGS, and Zhu-Lu formulas (P ≤ .024). CONCLUSIONS: In long eyes with plate-haptic IOLs, RBF 3.0 performed best, closely followed by Zhu-Lu, Olsen, and EVO 2.0; Karmona and Naeser 2 are discouraged for extreme AL and steep K conditions, respectively; Haigis-CMAL is not suggested for shallow ACD and flat K cases. Refractive outcomes in eyes implanted with a C-loop design IOL were more accurate than for those implanted with a plate-haptic design, for most tested formulas.