Post-Blink Blur Time-A Simple Test to Detect Dry Eye-Related Visual Disturbances.

Background: Dry eye disease (DED) stands out as one of the most common eye conditions encountered in clinical settings. This study aimed to determine the diagnostic ability and feasibility of post-blink blur time (PBBT) in detecting patients with DED symptoms. Methods: The study included 200 subjects, 100 with and 100 without DED symptoms defined by the Schein questionnaire, who underwent assessment of DED signs [visual acuity, PBBT, conjunctival hyperemia, lid-parallel conjunctival folds-LIPCOF, tear film break-up time-TBUT, fluorescein corneal staining, and meibum score]. Results: DED subjects had a lower PBBT than controls (p < 0.001), with subjective (6 (1-45) s vs. 8 (1-70) s) and objective (6 (2-33) s vs. 8 (2-50) s) PBBT measurements being similar between repeats. The correlations between subjective and objective PBBT measurements were significantly positive (R = 0.873, p < 0.001). Subjective PBBT was negatively related to the Schein questionnaire (R = -0.217, p = 0.002), conjunctival hyperemia (R = -0.105, p = 0.035), and corneal staining (R = -0.153, p = 0.031), while positively related to the TBUT (R = 0.382, p < 0.001) and meibum score (R = 0.106, p = 0.033). Logistic regression analysis showed DED symptoms were significantly associated with subjective PBBT (AOR 0.91, p = 0.001), TBUT (AOR 0.79, p < 0.001), meibum score (AOR 0.65, p = 0.008), LIPCOF (AOR 1.18, p = 0.002) and corneal staining (AOR 1.14, p = 0.028). Conclusions: Subjective self-reported PBBT is a reliable and non-invasive screening test for evaluating time-wise changes in visual acuity and detecting a tear film dysfunction.

Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence.

BACKGROUND: Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS: The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS: According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS: The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.

Short-Term Effect of Conventional Versus Accelerated Corneal Cross-Linking Protocol on Corneal Geography and Stability.

Purpose: To determine the 6-month effect of conventional (CXL30) and accelerated cross-linking with a UVA intensity of 9 mW/cm2 (CXL10) on corneal stability and to investigate whether there was a difference in ABCD grading system parameters regarding the two different procedures. Methods: Twenty-eight eyes of 28 patients with a documented keratoconus (KN) progression were included. Patients were selected to undergo either epi off CXL30 or CXL10. At the baseline and the follow-up visits after one (V1), three (V2), and six months (V3), the patients underwent complete ophthalmic examination and corneal tomography. Results: In the CXL30 group, all the parameters from the ABCD grading system significantly changed from baseline to V3; parameter A decreased (p = 0.048), B and C increased (p = 0.010, p < 0.001), and D decreased (p < 0.001). In the CXL10 group, there were no changes in parameters A (p = 0.247) and B (p = 0.933), though parameter C increased (p = 0.001) and D decreased (p < 0.001). After an initial decline after one month, visual acuity (VA) recovered on V2 and V3 (p < 0.001), and median maximal keratometry (Kmax) decreased in both groups (p = 0.001, p = 0.035). In the CXL30 group, there were significant changes in other parameters; average pachymetric progression index (p < 0.001), Ambrósio relational thickness maximum (ARTmax) (p = 0.008), front and back mean keratometry (p < 0.001), pachymetry apex (PA) (p < 0.001), and front elevation (p = 0.042). However, in the CXL10 group, there were significant changes only in ARTmax (p = 0.019) and PA (p < 0.001). Conclusion: Both epi-off CXL protocols showed similar short-term efficacy in improving VA and Kmax, halting the progression of KN, and both similarly changed tomographic parameters. However, the conventional protocol modified the cornea more significantly.

Meibomian Gland Assessment in Routine Ophthalmology Practice.

This cross-sectional study aimed to investigate the connection between meibomian gland (MG) excreta quantity and quality after MG expression (MGX), dry eye disease (DED) symptoms, and objective DED signs and to clarify the relationship between dry eye and MG function in DED pathophysiology. The study included 200 subjects, 100 with and 100 without dry eye symptoms. Schein questionnaire was used to determine the severity of dry eye symptoms and self-reported skin type for facial skin dryness self-evaluation. Objective dry eye signs were assessed by monitoring conjunctival hyperemia, lid parallel conjunctival folds (LIPCOF), tear break-up time (TBUT), fluorescein surface staining and digital MGX. Subjects with DED symptoms had significantly lower MG quantity scores than healthy controls (p < 0.001). Meibum quality and quantity scores significantly correlated with female gender (p = 0.002), Schein questionnaire score (p < 0.001), fluorescein corneal staining score (p = 0.019), self-reported skin type (p < 0.001), TBUT (p < 0.001) and LIPCOF (p = 0.041). After adjustment for age and gender in a logistic regression analysis, dry eye was independently and significantly associated with self-reported skin type (OR 0.73, p < 0.001), LIPCOF (OR 1.04, p < 0.001), fluorescein corneal staining (OR 1.05, p = 0.019), TBUT (OR 0.77, p < 0.001) and meibum quantity score (OR 0.59, p < 0.001). Dry eye symptoms and objective signs correlated well in this study. MGX discriminated between the subjects with and without DED symptoms and was associated with other objective DED signs. Results showed a significant association between meibum quality and quantity, MG function, DED and facial skin dryness self-perception. This paper established a correlation between dry eye symptoms caused by MG dysfunction and dry skin, which can help general health practitioners consider dry eye as a cause of chronic eye complaints with patients who report dry skin.

The medication adherence among glaucoma patients during the coronavirus disease 2019 pandemic in Croatia.

PURPOSE: This study aimed to evaluate the level of treatment adherence and identify predictors of adherence in glaucoma patients during the coronavirus disease 2019 (COVID-19) pandemic in Zagreb, Croatia. METHODS: The cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, University Hospital Centre Zagreb, between 1st April 2020 and 1st April 2021. The sociodemographic data, clinical, and drug information were recorded. The treatment adherence was assessed through a self-administered questionnaire, the Culig Adherence Scale (CAS). Statistical analyses were performed using TIBCO Statistica™ 14.0.0. RESULTS: 113 POAG patients (48M/65F) with a mean age of 65.89 ± 8.53 years were included in this study. According to the CAS, only 39.8% of patients adhered to topical glaucoma treatment. Educational level was positively related to adherence to treatment (p = 0.022). The main predictors for adherence were the patients' positive attitude towards the drug's effect, family support, and good relationship with the healthcare providers (p < 0.05, respectively). The majority of patients stated forgetfulness as the main reason for skipping drug dosing. CONCLUSIONS: Non-adherence to treatment was prevalent among patients with POAG during the COVID-19 pandemic in Zagreb, Croatia. Personal beliefs and attitudes towards treatment, family support, and patient-healthcare provider relationship were significant predictors of adherence. Special consideration should be given to the whole health system-level strategies targeting the adherence to treatment, especially in crises, in order to achieve positive therapeutic outcomes.The study protocol was registered in the DRKS - German Clinical Trials Register, DRKS-ID: DRKS00022081.

Tolerability in Glaucoma Patients Switched from Preserved to Preservative-Free Prostaglandin-Timolol Combination: A Prospective Real-Life Study.

Purpose: To evaluate the effect of switching from preserved prostaglandin analog-timolol fixed combinations (PG-timolol FCs) to preservative-free latanoprost-timolol FC (PF-LT) on intraocular pressure (IOP), ocular surface health, and tolerability in glaucoma and ocular hypertension (OH) patients with the concurrent ocular surface disease (OSD). Methods: This was a longitudinal, prospective, interventional, real-life study among 42 patients. Up to 3 visits were planned, at baseline, 30, and 90 days to assess efficacy on IOP decrease and local tolerance. The severity of OSD symptoms [Ocular Surface Disease Index (OSDI) questionnaire], subjective drug tolerability [visual analog scale (VAS)], conjunctival hyperemia (McMonnies scale), and tear break-up time (TBUT) were the main parameters assessed. Results: Data from 36 patients were available for statistical analysis. IOP was significantly reduced at day 30 and day 90 compared to baseline (16 vs 14 vs 14 mmHg, p < 0.001). Significant improvement was demonstrated in OSD symptoms, signs, and VAS scores from the baseline to the second and third visits. Median OSDI (27.1 vs 9.6 vs 4.2, p < 0.001), conjunctival hyperemia (2 vs 1 vs 1, p < 0.001), corneal surface staining (p < 0.001), and conjunctival staining scores (p < 0.001), and the percentage of patients with eyelid and periocular hyperemia (61.1 vs 12.5 vs 2.8%, p < 0.001), significantly decreased. TBUT (4 vs 5 vs 6 s, p < 0.001) and VAS score regarding tolerability (5 vs 2 vs 1, p < 0.001) significantly increased. Conclusion: A switch from preserved PG-timolol FCs to PF-LT improved tolerability and optimized IOP control, providing better adherence with greater chances of treatment success.

Anxiety and Treatment Adherence among Glaucoma Patients during COVID-19 Pandemic and Earthquakes in Croatia.

BACKGROUND: The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort. SUBJECTS AND METHODS: This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant. RESULTS: This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p<0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228). CONCLUSION: Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.

BILATERAL SEROUS CHORIORETINOPATHY AND PIGMENTARY GLAUCOMA - WHAT IS THE ASSOCIATION?

We present a patient with concurrent pigmentary glaucoma, bilateral central serous chorioretinopathy and unilateral optic disc pit, and propose a possible association of these conditions. Comprehensive ophthalmic examination of a 36-year-old man who was complaining of blurry vision and pain in the eyes showed reduced visual acuity on the left eye, elevated intraocular pressure in the right eye, bilateral signs of pigment dispersion syndrome, and bilateral central serous chorioretinopathy, combined with optic disc pit in the left eye. Visual field and optical coherence tomography findings demonstrated functional and structural glaucoma changes. Choroidal circulation abnormalities were observed by angiographic methods. Genetic and developmental anomalies of the external layer of the optic disc cup that gives rise to many anterior and posterior eye segment structures suggest a possible association of a clinical condition characterized by the combination of pigmentary glaucoma, central serous chorioretinopathy and optic disc pit. Future research would enable to determine proper diagnostic protocols, treatment and follow-up procedures for this chronic-progressive disorder.

Bilateral juxtapapillary choroidal neovascularization secondary to Birdshot chorioretinopathy-case report.

Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misinterpreted as high myopia complications. In atypical cases, detailed examination and a thorough diagnostic workup are required to establish the proper diagnosis, which is often beyond the scope of diagnoses initially considered.

Systemic inflammation and dyslipidemia are associated with retinopathy in type 2 but not in type 1 diabetes.

The aim of this study was to investigate risk factors and role of systemic inflammation, dyslipidemia and obesity in development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and determine the differences in risk factors between these two types of diabetes. Eighty-four type 1 and 107 type 2 diabetic patients were included in this cross-sectional study. Diabetes duration, body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. C-reactive protein (CRP), fibrinogen (FIB), glycated hemoglobin (HbA1c), fasting and postprandial blood glucose (fBG, ppBG), HDL and LDL cholesterol and triglycerides (TG) were determined using routine methods. HbA1cmedian was obtained by statistical analysis of the CroDiabNet data and used as a marker of long-term glycemic control. Albumin excretion rate (AER) was measured in a 24-hour urine collection. Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. DR was positively related to diabetes duration (p < .001), HbA1cmedian (p < .001) and AER (p = .008) in type 1, and diabetes duration (p < .001), HbA1cmedian (p = .018), AER (p < .001), CRP (p = .048) and TG (p = .041) in type 2 diabetes. Regression analysis showed that diabetes duration (OR 1.20, p = .005) and HbA1cmedian (OR 6.92, p = .007) were the main predictors of DR in type 1, and diabetes duration (OR 1.17, p < .001), fBG (OR 1.45, p = .024) and TG (OR 2.08, p = .025) in type 2 diabetes. In conclusion, systemic inflammation and dyslipidemia are associated with DR in type 2 but not in type 1 diabetes.

NONINVASIVE TEAR FILM BREAK-UP TIME ASSESSMENT USING HANDHELD LIPID LAYER EXAMINATION INSTRUMENT.

The aim was to determine feasibility and reliability of noninvasive tear break-up time (NIBUT) assessment using handheld lipid layer examination instrument, and to compare it with standard tear break-up time (TBUT) test. Fifty patients were enrolled, 31 with and 19 without dry eye symptoms. Schein questionnaire was used to assess dry eye symptoms. During examination, three NIBUT measurements were performed on each eye using handheld instrument, followed by three TBUT measurements. Receiver operating characteristic curves, sensitivity, specificity and logistic regression analysis were generated. Median NIBUT values were significantly shorter in dry eye symptom group than in control group in all three measurements (9, 8 and 8 s vs. 21, 22 and 21 s; p<0.001). TBUT values showed no significant difference between the groups in the first measurement (p=0.053), but the values were significantly shorter in dry eye symptom group in second and third measurements (p=0.020). The cutoff value to distinguish patients with symptoms of dry eye from control group was 12 seconds for NIBUT and 8 seconds for TBUT, with NIBUT having significantly higher sensitivity, specificity, area under the receiver operating characteristic curve and positive predictive value. NIBUT, measured by handheld lipid layer examination instrument, was superior to TBUT in detecting dry eye.