"Analysis of Macular Pigment Optical Density in Childhood: A Systematic Review".

PURPOSE: This systematic review studies the relationship between Macular Pigment Optical Density (MPOD) values and cognitive and visual function in childhood. METHODS: It included cross-sectional, observational studies or controlled clinical trials in humans between 0 and 18 years of age, analyzing MPOD values in 3 main databases: PubMed, Scopus and Web of Science. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. RESULTS: Thirteen studies were included in this systematic review. The relationship of cognitive function, visual function and diverse variables with MPOD was analyzed in 4, 4 and 5 studies, respectively. The age of the participants ranged between premature infants to 12 years. Most of the studies used Heterochromatic Flicker Photometry (HFP) with macular densitometer to obtain MPOD values. MPOD values ranged between 0 (undetectable) to 0.66 ± 0.03 d.u. Only 4 articles studied the relationship between MPOD values and dietary intake of lutein and zeaxanthin using questionnaires about diet. CONCLUSIONS: Lutein and zeaxanthin accumulation plays an important role during the maturational stage and childhood development. Although cognitive function is more strongly correlated with MPOD values, the relationship with visual function remains unclear, and further studies are required to support this relationship.

Accommodative disorders in non-presbyopic subjects with type 1 diabetes without retinopathy: A comparative, cross-sectional study.

PURPOSE: The purpose of this study was to assess accommodative function in non-presbyopic individuals diagnosed with type 1 diabetes (T1D) without any signs of retinopathy, to determine the existence of possible accommodative disorders related to this disease, and to determine the influence of T1D duration and glycosylated haemoglobin values on accommodative function. METHODS: This comparative, cross-sectional study included 60 participants between 11 and 39 years old, 30 with T1D and 30 controls, with no previous eye surgery, ocular disease or medication that could affect the results of the visual examination. Amplitude of accommodation (AA), negative and positive relative accommodation (NRA and PRA), accommodative response (AR) and accommodative facility (AF) were assessed using the tests that showed the highest repeatability. Participants were classified based on normative values into 'insufficiency, excess or normal results', and a diagnosis of accommodative disorders (accommodative insufficiency, accommodative infacility and accommodative excess) was made. RESULTS: Participants with T1D had statistically significant lower AA and AF and higher NRA values than the controls. Furthermore, AA was significantly and inversely correlated with age and the duration of diabetes; however, AF and NRA were only correlated with disease duration. In the classification by accommodative variables, a higher percentage of 'insufficiency values' was observed in the T1D group (50%) than in the control group (6%; p < 0.001). In terms of accommodative disorders, accommodative infacility was the most prevalent (15%), followed by accommodative insufficiency (10%). CONCLUSIONS: Our findings indicate that T1D affects most accommodative parameters, with accommodative insufficiency being associated with this disease.

Contrast sensitivity function under three light conditions in patients with type 1 diabetes mellitus without retinopathy: a cross-sectional, case-control study.

PURPOSE: To determine whether patients with type 1 diabetes mellitus (T1DM), without any sign of diabetic retinopathy, have any alteration in Contrast Sensitivity Function (CSF), in relation to patients without this disease, and whether CSF assessment in three different light conditions can be an effective test in the early detection of diabetic retinopathy. METHODS: A prospective, cross-sectional, case-control study was preformed including 80 patients (40 with T1DM without diabetic retinopathy and 40 controls) between 11 and 47 years old. CSF was assessed at four spatial frequencies (3, 6, 12 and 18 cycles/degree) using the CSV-1000E test, under three light conditions: high (550 lx), medium (200 lx) and low (< 2 lx). RESULTS: A lower CSF in the T1DM group was found at the three light conditions studied. The most spatial frequency affected was 18 cpd, 0.08 log units (p = 0.048) in high, 0.10 log units (p = 0.010) in medium (p = 0.010) and 0.16 log units (p < 0.001) in low-light conditions in mean CS values. The least spatial frequency affected was 3 cpd (p > 0.05 in all three light conditions). CONCLUSION: Patients with T1DM, without diabetic retinopathy, presented a loss of CS to sine-wave gratings, with respect to people with the same characteristics without the disease, mainly at medium and high frequencies, and in medium and low-light conditions.

Evaluation of Celligent® Biomimetic Water Gradient Contact Lens Effects on Ocular Surface and Subjective Symptoms.

This study aimed to evaluate the non-invasive and subjective symptoms associated with Lehfilcon A water gradient silicone hydrogel contact lenses with bacterial and lipid resistance technology. A prospective, longitudinal, single-centre, self-controlled study was conducted among silicone hydrogel contact lens wearers. Non-invasive analysis of the pre-lens tear film was performed using the Integrated Clinical Platform (ICP) Ocular Surface Analyzer (OSA), and the meibomian glands were evaluated with the Cobra® HD infrared meibographer. After 30 days of contact lens wear, the subjects were re-evaluated to determine the changes in conjunctival redness, subjective dry eye disease, tear meniscus height, lipid pattern, and non-invasive break-up time. Results showed that the lipid layer thickness decreased significantly from 2.05 ± 1.53 to 0.92 ± 1.09 Guillon patterns, and the tear meniscus height decreased from 0.21 ± 0.04 to 0.14 ± 0.03. The mean pre-lens non-invasive break-up time (NIBUT) significantly increased from 15.19 ± 9.54 to 25.31 ± 15.81 s. The standard Patient Evaluation of Eye Disease (SPEED) score also decreased from 7.39 ± 4.39 to 5.53 ± 4.83. The results suggest that Lehfilcon A significantly reduced lipid and aqueous tear film volume but improved break-up time and subjective dry eye symptoms.

Tear Film Dynamics between Low and High Contact Lens Dry Eye Disease Questionnaire (CLDEQ-8) Score with a Lehfilcon A Silicone Hydrogel Water Gradient Contact Lens: A Non-Invasive Methodology Approach.

The purpose of this study is to evaluate the tear film dynamics between individuals with low and high Contact Lens Dry Eye Disease Questionnaire (CLDEQ-8) scores when wearing Lehfilcon A silicone hydrogel water gradient contact lenses. In this study, we implemented a longitudinal, single-location, self-comparison investigation. Variables measured included conjunctival redness, lipid layer thickness, tear meniscus height, first and mean non-invasive break-up time, CLDEQ-8, and standard patient evaluation of eye dryness (SPEED). In the second phase, participants were re-evaluated after 30 days of wearing the contact lenses to assess the tear film wearing the lenses. In a longitudinal comparison by group, we found that lipid layer thickness decreased 1.52 ± 1.38 (p < 0.01) and 0.70 ± 1.30 (p = 0.01) Guillon patterns degrees in the low and high CLDEQ-8 group, respectively. MNIBUT increased in 11.93 ± 17.93 (p < 0.01) and 7.06 ± 12.07 (p < 0.01) seconds. Finally, LOT increased in 22.19 ± 27.57 (p < 0.01) and 16.87 ± 25.09 (p < 0.01). In conclusion, this study demonstrates the effectiveness of Lehfilcon A silicone hydrogel water gradient contact lenses in improving tear film stability and reducing subjective dry eye symptoms in individuals with low and high CLDEQ-8 scores. However, it also led to an increase in conjunctival redness and a decrease in tear meniscus height.

Tear film layers and meibomian gland assessment in patients with type 1 diabetes mellitus using a noninvasive ocular surface analyzer: a cross-sectional case-control study.

PURPOSE: To assess the tear film layers and Meibomian glands by a noninvasive ocular surface analyzer in patients with and without type 1 diabetes mellitus (T1DM). METHODS: Eighty-eight participants were enrolled in this study: 44 patients with T1DM without diabetic retinopathy, and 44 patients as a control group, between 18 and 49 years old. Limbal and bulbar redness classification, lipid layer thickness (LLT), tear meniscus height (TMH), first and mean noninvasive tear break-up time (FNIBUT and MNIBUT, respectively), and Meibomian glands loss (MGL) were assessment through the ICP Ocular Surface Analyzer (OSA). Schirmer's I test (SIT), the fluorescein tear break-up time test (TFBUT), OSDI and SPEED questionnaires, and percentage of glycosylated hemoglobin (HbA1c) were also tested. RESULTS: The T1DM group showed higher limbal and bulbar redness (p = 0.010) and lower LLT (p < 0.001), TMH (p < 0.001), FNIBUT (p < 0.001), MNIBUT (p < 0.001), SIT (p = 0.001), and TFBUT (p < 0.001) than the control group. A higher percentage of MGL was found in the T1DM group in the upper (p = 0.097) and lower (p < 0.001) eyelids. No significant differences were found in dry eye symptoms across the OSDI and SPEED questionnaires between the two groups. CONCLUSION: Patients with T1DM without signs of retinopathy showed involvement of the mucoaqueous and lipid layers of the tear film, as well as a higher percentage of MGL, using a noninvasive analyzer. Dry eye disease in people with T1DM cannot be ruled out by anamnesis and subjective symptom questionnaires alone; therefore, these patients should undergo regular anterior pole examinations.

Contrast Sensitivity Assessment in Early Diagnosis of Diabetic Retinopathy: A Systematic Review.

INTRODUCTION: The purpose of this systematic review was to study whether contrast sensitivity assessment in people with diabetes could be a reliable test in early detection of diabetic retinopathy. A systematic search based on population, intervention, comparison, and outcome strategy was performed. METHODS: PubMed, Scopus, and Web of Science were searched for English articles of human patients with type 1 and type 2 diabetes and contrast sensitivity measurements as domain studied. RESULTS: Twentyone comparative cross-sectional studies were included. All of them showed significant loss of contrast sensitivity in people with diabetes and diabetic retinopathy regarding control patients of the same age, regardless of the method used. However, those without diabetic retinopathy, involve a loss of contrast sensitivity, although not always significant. CONCLUSION: Changes in contrast sensitivity suggest that there is damage to the retina prior to the vascular ones and that they could be detected by this test.

Choroidal thickness assessment in keratoconus patients treated with cross-linking compared to healthy population.

PURPOSE: To analyze the choroidal thickness between patients with keratoconus undergoing cross-linking treatment and a healthy population, as well as to determine the factors that influence choroidal thickness. METHODS: This was an observational, analytical, case-control study that was conducted from February 2021 to June 2021. Choroidal thickness was measured at different locations, including the subfoveal, nasal (1000 µm), temporal (1000 µm), superior (1000 µm) and inferior (1000 µm) locations using a Spectral-domain optical coherence tomography with enhanced depth imaging, which allowed us to obtain horizontal and vertical B-scans centered on the fovea. RESULTS: This study included 21 patients with keratoconus (mean age, 21.86 ± 5.28 years) and 28 healthy patients (mean age, 24.21 ± 4.71 years). Choroidal thickness was significantly greater in patients with keratoconus than in healthy patients in each of the following measured locations: subfoveal (P < 0.001); nasal (1000 µm) (P < 0.001), temporal (1000 µm) (P < 0.001), superior (1000 µm) (P < 0.001) and inferior (1000 µm) (P < 0.001) locations. Variables such as age (ρ = - 0.09; P = 0.50) and refraction (ρ = 0.14; P = 0.34) were not found to be associated with choroidal thickness. In a stepwise multiple linear regression, the group was the single variable correlated with choroidal thickness (ß = 0.88; P < 0.001). CONCLUSION: Choroidal thickness is thicker in keratoconus patients treated with cross-linking than in the healthy population. This finding could be associated with inflammatory choroidal mechanisms in keratoconus patients, but more studies are needed. Age and refractive error do not seem to influence choroidal thickness.

Pre-Lens Tear Meniscus Height, Lipid Layer Pattern and Non-Invasive Break-Up Time Short-Term Changes with a Water Gradient Silicone Hydrogel Contact Lens.

To evaluate pre-lens tear film volume, stability and lipid interferometry patterns with a silicone hydrogel water content contact lens, a novel, noninvasive, ocular-surface-analyzer technology was used. A prospective, longitudinal, single-center, self-control study was performed in daily or monthly replacement silicone hydrogel contact lens wearers. A tear film analysis was achieved with the Integrated Clinical Platform (ICP) Ocular Surface Analyzer (OSA) from SBM System. The subjects were reassessed, with the contact lens, after 30 min of wearing to quantify the volume, stability and lipid pattern of the short-term pre-lens tear film. Lipid layer thickness decreased from 2.05 ± 1.53 to 1.90 ± 1.73 Guillon patterns (p = 0.23). First pre-lens NIBUT decreased from 5.03 ± 1.04 to 4.63 ± 0.89 s (p = 0.01). Mean pre-lens NIBUT significantly increased from 15.19 ± 9.54 to 21.27 ± 11.97 s (p < 0.01). Lid opening time significantly increased from 26.36 ± 19.72 to 38.58 ± 21.78 s (p < 0.01). The silicone hydrogel contact lens with water gradient technology significantly increased the mean pre-lens NIBUT and lid opening time. Lehfilcon A suggested an improvement in contact lens wearers with tear film instability or decreased subjective symptoms of dry eye disease.

Accommodation Response Variations in University Students under High Demand for Near-Vision Activity.

The objective of this study was to investigate accommodation changes and visual discomfort in a university student population after a period of high demand for near-vision activity. A total of 50 university students aged between 20 and 22 years were recruited. The tests performed involved positive relative accommodation (PRA), negative relative accommodation (NRA), accommodation amplitude (AA), and monocular and binocular accommodative facility (MAF and BAF). Visual discomfort was measured on a scale involving a visual discomfort questionnaire (VDQ). All accommodative variables underwent changes during the exam period; specifically, regarding NRA and PRA, 30.4% and 15.1% of the studied population, respectively, appeared to be below average. Moreover, 42.3% of the population exhibited values below average in the second measure of AA. On the other hand, a small percentage of the population was below average in MAF and BAF measurements: 3% in the monocular right eye test, 6% in the left eye test, and 9.1% in the binocular facility test. Finally, the VDQ score did not reveal a statistically significant difference between the two measurements. Prolonged near-distance work, such as a university exams period, changed all accommodation systems (amplitude of accommodation, relative accommodation, and accommodation facility). These changes influence an accommodation excess that results in blurred vision, headache, and problems with focusing.

Multipurpose Lens Care Systems and Silicone Hydrogel Contact Lens Wettability: A Systematic Review.

PURPOSE: To provide a relationship between materials developed for silicone hydrogel contact lenses and multipurpose care solutions to identify improvements in wettability, for prelens noninvasive break-up time and subjective score. METHODS: This systematic review was completed according to the updated PRISMA 2020 statement recommendations and followed the explanation and elaboration guidelines. The PubMed, Web of Science, and Scopus scientific literature databases were searched from January 2000 to November 2021. RESULTS: A total of four clinical trials published between 2011 and 2017 were included in this investigation. All included studies were randomized clinical trials. The success of contact lenses is related to the comfort of their use and therefore to the stability of the tear film and the wettability of its surface. The relationship between these parameters and changes in the ocular surface and inflammatory and infectious processes has been demonstrated. CONCLUSION: Hyaluronan and propylene glycol multipurpose solution (MPS) wetting agents achieved slightly higher prelens noninvasive break-up times than poloxamine. Polyquaternium-1 achieved better wettability and patient comfort than polyhexamethylene biguanide in medium-term studies. Short-term studies did not demonstrate differences between MPSs in their effect on contact lens wettability.

Dry eye disease and tear film assessment through a novel non-invasive ocular surface analyzer: The OSA protocol.

We describe the role of OSA as a new instrument in the study of dry eye, and we recommend a protocol for conducting the tests as well as describe the advantages and disadvantages compared with other instruments. A comparison with other ocular surface devices (Tearscope Plus, Keratograph 5M, anterior-segment ocular coherence tomography, Easy Tear View-Plus, LipiView, IDRA, and LacryDiag) were presented due to manual or automatic procedure and objective or subjective measurements. The purpose of this study was to describe the OSA as new non-invasive dry eye disease diagnostic device. The OSA is a device that can provide accurate, non-invasive and easy-to-use parameters to specifically interpret distinct functions of the tear film. This OSA protocol proposed a lesser to higher non-invasive ocular surface dry eye disease tear film diagnostic methodology. A complete and exhaustive OSA and OSA Plus examination protocol was presented within the subjective questionnaire (Dry Eye Questionnaire 5, DEQ5), limbal and bulbar redness classification (within the Efron grade Scale, interferometry lipid layer thickness (LLT) (according to Guillon pattern), tear meniscus height (manually or automatic), first and mean non-invasive break up time (objective and automatic) and meibomian gland (MG) dysfunction grade and percentage (objective and automatic). The OSA and OSA Plus devices are novel and relevant dry eye disease diagnostic tools; however, the automatization and objectivity of the measurements can be increased in future software or device updates. The new non-invasive devices supposed represent a renewal in the dry eye disease diagnosis and introduce a tendency to replace the classic invasive techniques that supposed less reliability and reproducibility.

Efficacy of 0.1% crosslinked hyaluronic acid, coenzyme Q10 and vitamin E in the management of dry eye disease in menopause patients receiving antidepressants.

PURPOSE: The purpose of this study is to test non-inferiority of a lower dose of crosslinked hyaluronic acid (CLHA) to a higher dose of carmellose eye drop in menopause patients receiving antidepressant treatments. METHODS: This prospective, double-blind, single-center study enrolled sixty female patients. Mean age was 63.25 ± 9.13 years. We examined patients with Schirmer I, breakup time (TBUT) and the ocular surface disease index (OSDI) at the first visit. Tear A eyedrops were formulated with crosslinked hyaluronic acid, coenzyme Q10 and vitamin E. Control tear B was formulated with carmellose sodium. Posology was two and five times, respectively. RESULTS: After 2 months of treatment, the tear A obtained 14.12 ± 7.47 score points for OSDI (t = 11.74, p < 0.01), and tear B obtained 19.46 ± 10.03 score points (t = 7.59, p < 0.01). The tear A obtained 13.77 ± 7.78 score points for Schirmer test (t = 0.88, p > 0.05), and tear B obtained 14.20 ± 8.62 score points (t = 2.92, p < 0.01). The tear A obtained 8.30 ± 2.08 s for TBUT (t = 15.50, p < 0.01), and tear B obtained 7.23 ± 2.40 s (t = 8.79, p < 0.01). CONCLUSION: Lower total daily dose of crosslinked hyaluronic acid eyedrops obtained similar efficacy results in terms of tear stability and subjective dry eye sensation than higher carmellose total daily dose. A lower total daily dose of crosslinked eyedrops was sufficient to achieve better dry eye disease management compared to carmellose.

Effect of Blue Light Filters on Tear and Contrast Sensitivity in Individuals Using Electronic Devices.

OBJECTIVES: To investigate the effect of contact lenses with blue light filters on contrast sensitivity and any alteration in tear quantity and quality. METHODS: This prospective longitudinal pilot study required three visits by each participant. Monocular visual acuity, contrast sensitivity, phenol red thread test, and tear breakup time were measured at each visit. RESULTS: There were significant differences in logarithmic contrast sensitivity between the groups. The breakup time (BUT) was significantly lower after using video display terminals than before (P<0.05). No differences in BUT were found between groups video display terminals and contact lenses having the blue filter (P>0.05). However, higher mean values were observed in the group after video display terminal use with contact lenses having the blue filter than that with standard contact lenses (P>0.05 in both groups). Furthermore, the mean value of phenol red thread test on the group after video display terminal use with contact lenses having the blue filter was lower than the group before its use (P>0.05). CONCLUSION: The results establish a possible relationship between tear stability, improved contrast sensitivity, and the use of a blue filter in contact lenses.

Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study).

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

Reflection on Telemedicine Competencies in Spanish Medicine Degrees After the COVID-19 Pandemic.

The pandemic suffered in 2020 following the appearance of the SARS-CoV-2 virus has marked a radical change in the way in which the basic pillars of international, and more specifically Spanish, society are understood. The existing social and economic model has had to adapt abruptly and urgently to the reality of what has happened. The impact that these changes will have after the pandemic is still unclear, but it may be surmised that many of them are here to stay. The use of information and communication technologies has been critical in the pandemic scenario and also in the health environment, where factors like telemedicine have come to play a key role for society. This work presents an initial analysis of how degrees in Medicine train students for telematic work with patients and provides a series of reflections based on the pandemic which may serve as a point of departure for future studies.

Plasma Rich in Growth Factors (PRGF) in Transepithelial Photorefractive Keratectomy (TPRK).

To evaluate the usage of plasma rich in growth factor (PRGF) in transepithelial photorefractive keratectomy (TPRK) in low and moderate myopia, patients who underwent myopic and astigmatism TPRK with PRGF were involved in this retrospective, observational study. Subjects underwent a surgical procedure between February 2019 and June 2019. A three-month follow-up was recorded. Pain score was assessed with a visual analogue scale (0-10) and re-epithelialization time recorded. A total of 48 eyes from 24 patients were recruited. Mean uncorrected distance visual acuity (UDVA) was 20/20.31 (0.00 ± 0.02 LogMAR). A total of 98% of eyes did not change corrected distance visual acuity (CDVA) lines. Two percent of eyes lost one line of CDVA. Preoperative spherical equivalent was -2.67 ± 1.37 D and after three months changed to -0.21 ± 0.34 D, and 2% of eyes changed 0.50 D or more between one and three months. Pain score was 3.29 ± 0.61 (3 to 6) score points at day one and 0.08 ± 0.27 score points at day seven. Finally, re-epithelialization time was 2.50 ± 1.20 days. PRGF addition to conventional refractive treatment such as TPRK seems to alleviate immediate postoperative pain and positively contribute to corneal re-epithelization time.