The analysis of tear meniscus parameters during daily soft contact lens wear using optical coherence tomography.

PURPOSE: To evaluate tear meniscus parameters in soft contact lens wearers (SCL) using optical coherence tomography (OCT) and ImageJ software. METHODS: This prospective study included 50 soft contact lens wearers (group 1: 25 symptomatic SCL wearers (SCLW), group 2: 25 asymptomatic SCL wearers (ASCW)) and 25 healthy non-CL wearers (group 3 (NCLW)). SCLs were fitted on each eye of CL wearers, and the lower tear meniscus was imaged using OCT before CL insertion, immediately afterward, and reimaged 2, 5 and 10 h after insertion. Tear meniscus parameters, including tear meniscus height (TMH), depth (TMD), turbidity, and percentage area occupied by particles (PAOP) were measured in all groups. RESULTS: Turbidity and PAOP measurements at baseline in SCLW were significantly higher than in other groups (p < 0.05). There was no significant difference between TMH, TMD, turbidity, and PAOP parameters calculated at baseline visit and two hours after SCL insertion in all groups (p > 0.05 for 2 comparisons). The symptomatic SCL users had a significant decrease in TMH and TMD in the fifth hour. The turbidity and PAOP measurements of SCLW and ASCW at the fifth and tenth hours were significantly higher than those of NCLW (p < 0.05). CONCLUSION: TMD and height TMH decrease throughout the day in all participants; however, a significant decrease in these parameters was observed only in symptomatic SCL users at the fifth hour, at the earliest. As the duration of CL wear increases, turbidity and PAOP even in asymptomatic SCL wearers become significantly higher than those in healthy non-CL wearers. KEY MESSAGES: What Is Known • Contact lens wear is associated with an increased risk of dry eye. • Tear volume decreases gradually during contact lens wear. What Is New • Tear meniscus turbidity and particle area occupied by particles (PAOP) were higher in symptomatic contact lens wearers and they increase gradually during contact lens wear. • Tear meniscus turbidity and PAOP may be measures of how well the tear film and meniscus are functioning in contact lens wearers.

Chatbots talk Strabismus: Can AI become the new patient Educator?

BACKGROUND: Strabismus is a common eye condition affecting both children and adults. Effective patient education is crucial for informed decision-making, but traditional methods often lack accessibility and engagement. Chatbots powered by AI have emerged as a promising solution. AIM: This study aims to evaluate and compare the performance of three chatbots (ChatGPT, Bard, and Copilot) and a reliable website (AAPOS) in answering real patient questions about strabismus. METHOD: Three chatbots (ChatGPT, Bard, and Copilot) were compared to a reliable website (AAPOS) using real patient questions. Metrics included accuracy (SOLO taxonomy), understandability/actionability (PEMAT), and readability (Flesch-Kincaid). We also performed a sentiment analysis to capture the emotional tone and impact of the responses. RESULTS: The AAPOS achieved the highest mean SOLO score (4.14 ± 0.47), followed by Bard, Copilot, and ChatGPT. Bard scored highest on both PEMAT-U (74.8 ± 13.3) and PEMAT-A (66.2 ± 13.6) measures. Flesch-Kincaid Ease Scores revealed the AAPOS as the easiest to read (mean score: 55.8 ± 14.11), closely followed by Copilot. ChatGPT, and Bard had lower scores on readability. The sentiment analysis revealed exciting differences. CONCLUSION: Chatbots, particularly Bard and Copilot, show promise in patient education for strabismus with strengths in understandability and actionability. However, the AAPOS website outperformed in accuracy and readability.

Evaluation of peripheral blood inflammatory biomarkers in sickle cell disease with and without retinopathy.

BACKGROUND: The aim of this study was to evaluate the clinical significance of blood-cell associated inflammation markers in patients with sickle cell disease (SCD) and sickle cell retinopathy (SCR). METHODS: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SIII), systemic inflammation response index (SIRI), systemic inflammation modulation index (SIMI) and aggregate systemic inflammation index (AISI) were calculated. This study included 45 healthy controls (Group 1) and 100 SCD (Group 2). Patients in Group 2 were then divided into two groups: without SCR (Group 3) and with SCR (Group 4), and patients with SCR (Group 4) were further divided into two groups: non-proliferative sickle cell retinopathy (NPSCR) (Group 5) and proliferative sickle cell retinopathy (PSCR) (Group 6). RESULTS: The mean values for NLR, PLR, SIII, SIRI, AISI, and SIMI were significantly higher in Group 2 compared to Group 1 (p = 0.011 for NLR, p = 0.004 for SIII, and p < 0.001 for others). Furthermore, AISI and SIMI parameters demonstrated statistically significant discriminatory power to distinguish Group 5 from Group 6 (p = 0.0016 and p = 0.0006, respectively). CONCLUSION: Given the critical role of inflammatory mechanisms in the pathogenesis of SCD and its related complications, the assessment of blood-cell-associated inflammatory markers may present a pragmatic and advantageous approach to the clinical oversight and therapeutic intervention of SCD.

Tear meniscus particle analysis with anterior segment optical coherence tomography in keratoconus.

PURPOSE: To perform tear meniscus particle analysis using anterior segment spectral domain-optical coherence tomography (SD-OCT) and ImageJ software in keratoconus patients. METHODS: A total of 76 participants (76 eyes) were included in the study. A comprehensive analysis of tear meniscus parameters, including tear meniscus height (TMH), tear meniscus depth (TMD), tear meniscus turbidity (TMT), and percentage of area occupied by particles (PAOP) within the meniscus, was performed in kerataconus patients and healthy controls. RESULTS: TMT was significantly higher in the keratoconus group, while PAOP was significantly lower (P < 0.05). However, TMH and TMD did not show significant differences between the two groups (P > 0.05). There was a negative correlation observed between TMT and PAOP. In binary logistic regression analysis, TMT and Schirmer score were found to be the most influential factors in predicting keratoconus (odds ratio [OR] = 0.995, P = 0.039 and OR = 1.143, P = 0.021, respectively). CONCLUSION: This study revealed novel findings on analysis of the tear film in keratoconus patients, with higher TMT and lower POAP levels in the keratoconus group compared to the healthy control group.

Pitfalls of social media for aesthetic eye surgery patients: assessing YouTube's aesthetic canthoplasty content.

PURPOSE: YouTube, a popular source for diverse information, hosts a wealth of content on aesthetic canthoplasty. Yet, concerns linger about the accuracy and reliability of these videos, with potential for inaccuracies, biases, or misleading information. This study aims to evaluate the quality and reliability of YouTube content on this sought-after facial enhancement procedure. METHODS: The study employs four distinct scoring tools: the Global Quality Score (GQS), the Medical Quality Video Evaluation Tool (MQ-VET), the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), and the Video Power Index (VPI). RESULTS: Analysis of a total of 173 YouTube videos relevant to aesthetic canthoplasty revealed scores that were primarily indicative of poor quality and reliability.(Mean score ± SD, PEMAT A/V: 30.75 ± 28.8, MQ-VET: 28.57 ± 12.6, GQS: 1.7 ± 1) Notably, these videos were predominantly uploaded by healthcare professionals (82.1%), and they focused more on advertisements (46.2%) than on scientific or educational information. Their elevated viewership and engagement metrics (likes, comments, and shares) attest to their significant popularity and influence. (Mean VPI score: 176.6 ± 635.8). CONCLUSION: YouTube's influence on aesthetic eyelid surgery is undeniable, shaping patient choices and expectations. However, unrealistic beauty ideals, heightened body dissatisfaction, and social comparisons lurk within its content, potentially harming psychological well-being and surgical decisions. Prioritizing qualified medical guidance and critical evaluation of online information are crucial for patients. Authors and platforms must act responsibly: authors by producing high-quality content, platforms by tackling misinformation.

The Performance of Chatbots and the AAPOS Website as a Tool for Amblyopia Education.

PURPOSE: To evaluate the understandability, actionability, and readability of responses provided by the website of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), ChatGPT-3.5, Bard, and Bing Chat about amblyopia and the appropriateness of the responses generated by the chatbots. METHOD: Twenty-five questions provided by the AAPOS website were directed three times to fresh ChatGPT-3.5, Bard, and Bing Chat interfaces. Two experienced pediatric ophthalmologists categorized the responses of the chatbots in terms of their appropriateness. Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL), and Coleman-Liau Index (CLI) were used to evaluate the readability of the responses of the AAPOS website and chatbots. Furthermore, the understandability scores were evaluated using the Patient Education Materials Assessment Tool (PEMAT). RESULTS: The appropriateness of the chatbots' responses was 84.0% for ChatGPT-3.5 and Bard and 80% for Bing Chat (P > .05). For understandability (mean PEMAT-U score AAPOS website: 81.5%, Bard: 77.6%, ChatGPT-3.5: 76.1%, and Bing Chat: 71.5%, P < .05) and actionability (mean PEMAT-A score AAPOS website: 74.6%, Bard: 69.2%, ChatGPT-3.5: 67.8%, and Bing Chat: 64.8%, P < .05), the AAPOs website scored better than the chat-bots. Three readability analyses showed that Bard had the highest mean score, followed by the AAPOS website, Bing Chat, and ChatGPT-3.5, and these scores were more challenging than the recommended level. CONCLUSIONS: Chatbots have the potential to provide detailed and appropriate responses at acceptable levels. The AAPOS website has the advantage of providing information that is more understandable and actionable. The AAPOS website and chatbots, especially Chat-GPT, provided difficult-to-read data for patient education regarding amblyopia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Association of Retinal Vein Occlusion With Serum Osmolality and Hydration Status.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate serum osmolality and hydration status in patients with retinal vein occlusion (RVO). PATIENTS AND METHODS: This cross-sectional study consisted of 79 patients with RVO and 81 age- and sex-matched peers without ocular disease. Data were collected from patient records and included a comprehensive ophthalmological examination, laboratory data of fasting blood test results, and internal medicine outpatient examination. Complete blood count and levels of fasting glucose, sodium, blood urea nitrogen (BUN), creatinine, triglyceride, low-density lipoprotein, high-density lipoprotein, HbA1c, and serum osmolality were evaluated. BUN/creatinine ratios were calculated. RESULTS: Mean serum sodium and serum osmolality levels were 142.53 ± 2.13 and 139.74 ± 2.16 mEq/L and 286.58 ± 4.40 and 280.57 ± 4.39 mOsmol/kg H2O in the RVO and control groups, respectively. Serum osmolality and serum sodium levels, and BUN/creatinine ratio were significantly higher in the RVO group than in controls (P < 0.05 for all). CONCLUSIONS: We found that serum osmolality, sodium levels, and the BUN/creatinine ratio increased significantly in the RVO group. The results suggest dehydration status may affect the genesis of vessel occlusion in RVO. [Ophthalmic Surg Lasers Imaging Retina 2024;55:130-135.].

Assessment of vision-related quality of life and depression in patients with age-related macular degeneration.

PURPOSE: To evaluate the effect of age-related macular degeneration (AMD) on vision-related quality of life (VRQOL) and depression levels. METHODS: This cross-sectional study included 143 patients who are being followed up with a diagnosis of AMD. The Turkish versions of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and Geriatric Depression Scale-15 (GDS-15) were directed to the patients. The questionnaire results were analyzed based on the severity, treatment procedures for AMD, and sociodemographic characteristics of patients. RESULTS: The subscale scores obtained from the NEI VFQ-25 ranged from 47.54 for "near activities" to 84.02 for "color vision." Of the patients, 59.4% (85/143) were compatible with depression according to the GDS-15 questionnaire. There was no significant difference in the NEI VFQ-25 subscale scores between the gender groups (P > 0.05), whereas females were statistically significantly more depressive than males (P < 0.05). There were no significant differences between the injection (anti-vascular endothelial growth factors [anti-VEGF]) group and the non-injection group in terms of subscales of the NEI VFQ-25 questionnaire (P > 0.05). The depression ratio in the non-injected group was statistically significantly higher (P < 0.05). CONCLUSION: According to the present study, the association between depression and AMD is a fact that should be highlighted. Patients with depression had lower scores on the quality of life (QOL) test. Previous intravitreal injection did not affect NEI VFQ-25 scores. Female patients with AMD had higher rates of depression and lower visual acuity levels.

Impaired brachial flow-mediated dilation may predict choroidal and retinal nerve fibre layer thickness changes in people with obesity.

CLINICAL RELEVANCE: Choroidal thickness and peripapillary retinal nerve fibre layer (RNFL) changes are known to occur in obesity. Endothelial dysfunction and systemic atherosclerosis may play a role in the pathophysiology of these differences. BACKGROUND: Flow-mediated dilation (FMD) is reduced in patients with endothelial dysfunction, and the ankle-brachial index is a surrogate marker for atherosclerosis. This study was conducted to examine the relationship between systemic vascular parameters (FMD, and ankle-brachial index), subfoveal choroidal thickness, and peripapillary RNFL thickness in obese individuals. METHODS: This observational, cross-sectional study involved 108 total participants who were divided into two groups. One group consisted of 54 obese subjects who each had a body mass index of 30 kg/m2 or more. The other control group contained 54 participants who each had a body mass index of 25 kg/m2 or less but higher than 20 kg/m2 . For each participant, only one eye was examined in this study. Subfoveal choroidal thickness, RNFL thickness, ankle-brachial index, and ultrasound measurement of the brachial artery FMD were performed. FMD was categorised according to receiver operating characteristic analysis, and endothelial dysfunction was defined as an FMD ≤ 7.29%. RESULTS: Subfoveal choroidal and RNFL thicknesses in the temporal quadrant were significantly lower in the obese group (p < 0.05). Lower mean values of subfoveal choroidal and RNFL thicknesses in the temporal and inferior quadrants were observed in subjects with an FMD ≤ 7.29% (p < 0.05). In people with obesity, FMD was positively correlated with subfoveal choroidal thickness (r = 0.322, p = 0.001), inferior RNFL thickness (r = 0.259, p = 0.007), and temporal RNFL thickness (r = 0.297, p = 0.002). However, the ankle-brachial index was not correlated with obesity. CONCLUSIONS: Impaired FMD was associated with reduced subfoveal choroidal and RNFL thicknesses in the temporal and inferior quadrants of people with obesity.

Talking technology: exploring chatbots as a tool for cataract patient education.

CLINICAL RELEVANCE: Worldwide, millions suffer from cataracts, which impair vision and quality of life. Cataract education improves outcomes, satisfaction, and treatment adherence. Lack of health literacy, language and cultural barriers, personal preferences, and limited resources may all impede effective communication. BACKGROUND: AI can improve patient education by providing personalised, interactive, and accessible information tailored to patient understanding, interest, and motivation. AI chatbots can have human-like conversations and give advice on numerous topics. METHODS: This study investigated the efficacy of chatbots in cataract patient education relative to traditional resources like the AAO website, focusing on information accuracy,understandability, actionability, and readability. A descriptive comparative design was used to analyse quantitative data from frequently asked questions about cataracts answered by ChatGPT, Bard, Bing AI, and the AAO website. SOLO taxonomy, PEMAT, and the Flesch-Kincaid ease score were used to collect and analyse the data. RESULTS: Chatbots scored higher than AAO website on cataract-related questions in terms of accuracy (mean SOLO score ChatGPT: 3.1 ± 0.31, Bard: 2.9 ± 0.72, Bing AI: 2.65 ± 0.49, AAO website: 2.4 ± 0.6, (p < 0.001)). For understandability (mean PEMAT-U score AAO website: 0,89 ± 0,04, ChatGPT 0,84 ± 0,02, Bard: 0,84 ± 0,02, Bing AI: 0,81 ± 0,02, (p < 0.001)), and actionability (mean PEMAT-A score ChatGPT: 0.86 ± 0.03, Bard: 0.85 ± 0.06, Bing AI: 0.81 ± 0.05, AAO website: 0.81 ± 0.06, (p < 0.001)) AAO website scored better than chatbots. Flesch-Kincaid readability ease analysis showed that Bard (55,5 ± 8,48) had the highest mean score, followed by AAO website (51,96 ± 12,46), Bing AI (41,77 ± 9,53), and ChatGPT (34,38 ± 9,75, (p < 0.001)). CONCLUSION: Chatbots have the potential to provide more detailed and accurate data than the AAO website. On the other hand, the AAO website has the advantage of providing information that is more understandable and practical. When patient preferences are not taken into account, generalised or biased information can decrease reliability.

Quaternary Knot Technique: Suture Knot Burial without Scleral Flap or Incision for Trans-scleral Fixation.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

Ocular findings and their correlation with disease severity in Fabry disease in South-East Anatolia.

PURPOSE: To evaluate the ocular findings and the relationship between these findings and the disease severity of patients with Fabry disease (FD) in South-East Anatolia. METHODS: We enrolled the 24 eyes of 24 patients with FD and the disease severity scores were obtained with FD severity scoring system (DS3). The relationship between the presence of any ocular findings and DS3 scores was evaluated. RESULTS: The mean age of the patients was 35.2 ± 8.6 years. The mean DS3 score and α-galactosidase A enzyme activity of the patients was 7.04 ± 3.71 and 1.93 ± 0.84 µmol/l/h, respectively. Of the 24 patients, 20 (83.3%) had cornea verticillate (CV), 18 (75%) had tortuous conjunctival vessels, 15 (62.5%) had tortuous retinal vessels and 3 (12.5%) had lens opacities. The ocular vascular abnormalities were associated with disease severity (p < 0.05); however, the presence of CV did not affect the DS3 scores (p > 0.05). CONCLUSIONS: According to our study, the patients with ocular vascular abnormalities associated with FD had more severe disease than those who did not have an abnormality. CV was the most common ocular finding in FD, but it has no association with disease severity.

Is serum vitamin D associated with diabetic retinopathy and its severity or with diabetes itself ?

CLINICAL RELEVANCE: Vitamin D (VitD) deficiency, which is found in approximately one-third of the population of the world, may play a role in the pathogenesis of diabetic retinopathy. Physicians following diabetes patients should be aware of this relationship and should refer patients to for ophthalmic care for control in a timely manner. BACKGROUND: Diabetic retinopathy is one of the most common complications of diabetic microvascular disease. VitD deficiency has been implicated in the pathogenesis and progression of diabetes and may have a role in development and severity of diabetic retinopathy. The aim of this study was to examine the relationship of serum VitD and some laboratory parameters with the presence of diabetes and retinopathy. METHODS: In this study, which has a retrospective epidemiological study design, comprehensive ophthalmologic examination data from the eye clinic, laboratory data from fasting blood tests, and internal medicine outpatient clinic examination data were reviewed. All participants were divided into four groups: 109 healthy controls, and 165 patients with type 2 diabetes of whom 54 did not have retinopathy, 64 had proliferative diabetic retinopathy, and 47 had non-proliferative diabetic retinopathy. Participants were also divided into four groups according to their serum VitD levels. Serum 25(OH)D, HbA1C, creatine, calcium, phosphate, triglyceride, low-density lipoprotein, and high-density lipoprotein levels were evaluated. RESULTS: In the whole study cohort, 152 (55.5%) were female and 122 (44.5%) were male. A statistically significant difference was observed in VitD between the healthy group and the diabetic and proliferative diabetic retinopathy groups (p ≤ 0.001). However, no significant correlation was observed between the presence of diabetes and retinopathy and serum VitD in logistic regression analyses (p > 0.05). CONCLUSION: Diabetic patients have lower 25(OH)D than non-diabetic patients and there is no direct relationship between 25(OH)D and the development of diabetic retinopathy.

Evaluation of the Tear Meniscus Using Optical Coherence Tomography in Meibomian Gland Dysfunction.

INTRODUCTION: This study aimed to evaluate tear meniscus parameters in meibomian gland dysfunction (MGD) using optical coherence tomography and ImageJ software. METHODS: We enrolled 66 eyes of 66 participants and measured tear meniscus parameters, including height, depth, turbidity, and percentage area occupied by particles (PAOP) in the meniscus in the MGD and control groups. RESULTS: Tear meniscus turbidity and PAOP were significantly higher in the MGD group, but tear meniscus height (TMH) and depth (TMD) did not differ significantly between groups. Tear meniscus turbidity and PAOP were positively correlated with each other and ocular surface parameters, including OSDI and ocular surface staining scores. CONCLUSION: Tear meniscus turbidity and PAOP were higher in the MGD group than in the control group; therefore, they can be used as significant non-invasive parameters in the prediction of MGD. TMH and TMD did not differ significantly between groups.

Acute Myopic Shift and Internal Limiting Membrane Folds Linked to Topiramate Use: A Case Report.

We present a case report of a 26-year-old female patient with acute visual impairment, who had been treated with 50 mg/day topiramate for 5 days for migraine prophylaxis. Ocular examination showed bilateral anterior chamber narrowing and macular striae. She had no previous ocular pathology, but her cycloplegic refraction showed a myopic shift of about 6 D. Topiramate was stopped and the patient's unaided visual level and macular stria returned to normal with topical steroid and cyclopentolate treatment. Recognition of this side effect and discontinuation of the causative drug may prevent angle closure and related vision loss.

Simple Oral Mucosal Epithelial Transplantation in a Patient With Bilateral Limbal Stem Cell Deficiency.

PURPOSE: To present management of a patient with bilateral limbal stem cell deficiency (LSCD) by using "simple oral mucosal epithelial transplantation" (SOMET) technique. METHODS: Case report. RESULTS: A 65-year-old female diagnosed with bilateral LSCD based on clinical findings. After stabilizing the ocular surface, we performed SOMET in the right eye. At 13 months postoperatively, visual acuity improved from counting fingers to 10/100 and a stable epithelium with regressed corneal vascularization was observed. CONCLUSIONS: This report showed that SOMET seems to be an alternative technique in LSCD.