Myths in Myopia Epidemiology and Treatment.

This Viewpoint discusses common myths about myopia and educational strategies for bringing clinical practice better in line with evidence.

Association between dietary inflammation index and cataract: a population-based study from NHANES 2005-2008.

Importance: Various studies have widely explored the association between index of dietary inflammation (DII) and occurrence of diseases. Accumulating evidence have revealed that a lower DII seems to be protective against a variety of diseases. Nevertheless, the association between DII and age-related cataract remains unclear. Objective: To investigate the correlation between DII and age-related cataract in a representative sample of the American population. Design setting and participants: This cross-sectional population-based study comprised 6,395 participants from the National Health and Nutrition Examination Survey (NHANES) conducted in cycles from 2005 to 2008. DII was calculated using dietary recall information, with higher scores indicating greater inflammatory potential of the diet. Age-related cataract was evaluated using cataract surgery as a surrogate measure. Covariates included sociodemographic factors, lifestyle factors, physical measures, and comorbidities. Logistic regression models were employed to assess the association between DII and cataract. The presence of a non-linear relationship was examined using restricted cubic spline analysis. Subgroup analysis was conducted to explore potential interaction effects. Data analysis was performed from September 1 to December 30, 2022. Main outcomes and measures: Age-related cataract assessed through cataract surgery information obtained from a self-reported questionnaire. Results: A total of 6,395 participants were included, with a mean (standard deviation, SD) age of 48.7 (15.3) years. Of these, 3,115 (48.7%) were male, 3,333 (52.1%) were non-Hispanic white, and 683 (10.7%) had cataract. The mean (SD) DII was -4.78 (1.74). After adjusting for all included covariates, DII showed a positive association with cataract, both as a continuous variable (odds ratio (OR): 1.054, 95% confidence interval (CI): 1.007-1.103, p = 0.023) and in quartiles, with the highest quartile compared to the lowest (OR: 1.555, 95% CI: 1.233-1.967, p < 0.001). Restricted cubic spline analysis revealed no evidence of a non-linear relationship (p for non-linearity 0.085). Subgroup analysis indicated no interaction effects among the studied covariates. Conclusions and relevance: These findings suggest that a pro-inflammatory diet serves as a risk factor for the occurrence of cataracts.

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis.

Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.

Fragility and Tendency to Crystallization for Structurally Related Compounds.

The present study was designed to investigate the physical stability of three organic materials with similar chemical structures. The examined compounds revealed completely different crystallization tendencies in their supercooled liquid states and were classified into three distinct classes based on their tendency to crystallize. (S)-4-Benzyl-2-oxazolidinone easily crystallizes during cooling from the melt; (S)-4-Benzylthiazolidine-2-thione does not crystallize during cooling from the melt, but crystallizes easily during subsequent reheating above Tg; and (S)-4-Benzyloxazolidine-2-thione does not crystallize either during cooling from the melt or during reheating. Such different tendencies to crystallize are observed despite the very similar chemical structures of the compounds, which only differ in oxide or sulfur atoms in one of their rings. We also studied the isothermal crystallization kinetics of the materials that were shown to transform into a crystalline state. Molecular dynamics and thermal properties were thoroughly investigated using broadband dielectric spectroscopy, as well as conventional and temperature-modulated differential scanning calorimetry in the wide temperature range. It was found that all three glass formers have the same dynamic fragility (m = 93), calculated directly from dielectric structural relaxation times. This result verifies that dynamic fragility is not related to the tendency to crystallize. In addition, thermodynamic fragility predictions were also made using calorimetric data. It was found that the thermodynamic fragility evaluated based on the width of the glass transition, observed in the temperature dependence of heat capacity, correlates best with the tendency to crystallize.

Corneal biomechanical characteristics in myopes and emmetropes measured by Corvis ST: a meta-analysis.

PURPOSE: To comprehensively identify the corneal biomechanical differences measured by Corvis ST between different degrees of myopia and emmetropia. DESIGN: Systematic review and meta-analysis. METHODS: Electronic databases, including PubMed, Embase, and Web of Science, were systematically searched for studies comparing the corneal biomechanics among various degrees of myopes and emmetropes using Corvis ST. The weighted mean differences and 95% confidence intervals were calculated. Meta-analysis was performed in high and non-high myopes and in myopes and emmetropes, respectively. RESULTS: Eleven studies were included in this study. The meta-analysis among myopes and emmetropes included 1947 myopes and 621 emmetropes, and 443 high myopes and 449 non-high myopes were included in the meta-analysis among high and non-high myopia. Myopes showed the cornea with significantly longer time at the first applanation (A1t) and lower length at the second applanation (A2L) than emmetropes. High myopes showed significantly greater A1t, velocity at the second applanation (A2v), deformation amplitude at the highest concavity (HC-DA), and peak distance at the highest concavity (HC-PD) and decreased time at the second applanation (A2t) and radius of the highest concavity (HC-R). CONCLUSIONS: Corneal biomechanics is different in myopia, especially in high myopia. Compared with non-high myopes, the corneas of high myopes deformed slower during the first applanation, faster during the second applanation, and showed greater deformation amplitude, indicating greater elasticity and viscidity.

Crossover to PDT after the unsuccessful micropulse laser treatment of central serous chorioretinopathy.

Purpose: Subthreshold micropulse laser (SML) and photodynamic therapy (PDT) are among the most effective therapeutic modalities applied to central serous chorioretinopathy (CSCR). This study aimed to evaluate the efficacy and durability of PDT in CSCR cases unresponsive to at least two SML treatments. Methods: The study included 26 consecutive eyes of 24 patients (21 males and three females) with chronic CSCR. In all cases, a lack of reduction in subretinal fluid (SRF) levels was noted after at least two consecutive SML sessions. The parameters of best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were evaluated at baseline and 1, 3 and 12 months post-PDT. Results: The mean duration of symptoms in the group was 53.81 ± 39.48 months, the mean age of the patients was 49.26 ± 12.91 years, and the mean subfoveal choroidal thickness (SFCT) was 572.11 ± 116.21 mm. Complete resorption of SRF was observed in 21 out of 26 eyes (80.77%) at 1 month and sustained in 18 cases (69.23%) at 12 months. At 12 months, in the sustained group, BCVA improved significantly from 0.39 ± 0.18 to 0.19 ± 0.2 logMAR (P = 0.01), central subfoveal thickness (CST) reduced from 316.44 ± 75.83 mm to 197.67 ± 22.99 mm (P < 0.0001), and SFCT reduced from 579.28 mm to 446.78 mm (P < 0.0001). Conclusions: PDT provides the opportunity for the successful treatment of CSCR unresponsive to SML treatment. Improvements are possible even in cases with a long duration of symptoms and significant alterations in retinal morphology. Thus, PDT should be considered for patients with prominently increased choroidal thickness.

Association of sleep traits with myopia in children and adolescents: A meta-analysis and Mendelian randomization study.

PURPOSE: The association between sleep and myopia in children and adolescents has been reported, yet it remains controversial and inconclusive. This study aimed to investigate the influence of different sleep traits on the risk of myopia using meta-analytical and Mendelian randomization (MR) techniques. METHODS: The literature search was performed in August 31, 2023 based on PubMed, Embase, Web of Science, and Cochrane library. The meta-analysis of observational studies reporting the relationship between sleep and myopia was conducted. MR analyses were carried out to assess the causal impact of genetic pre-disposition for sleep traits on myopia. RESULTS: The results of the meta-analysis indicated a significant association between the risk of myopia and both short sleep duration [odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.08-1.42, P = 0.003] and long sleep duration (OR = 0.75, 95% CI = 0.66-0.86, P < 0.001). MR analyses revealed no significant causal associations of genetically determined sleep traits with myopia, including chronotype, sleep duration, short sleep duration and long sleep duration (all P > 0.05). CONCLUSIONS: No evidence was found to support a causal relationship between sleep traits and myopia. While sleep may not independently predict the risk of myopia, the potential impact of sleep on the occurrence and development of myopia cannot be disregarded.

Acta Ophthalmologica 100 years-Overview of selected articles during Acta Ophthalmologica history.

We selected and discussed 10 articles in Acta Ophthalmologica since 1923 that changed clinical ophthalmology and treatment protocols, or provided novel findings and perspectives. We are aware that the selection of articles may be debatable and we invite readers to suggest other significant Acta articles. For historians, the article archive of Acta Ophthalmologica is located in Copenhagen.

Applications of artificial intelligence-enabled robots and chatbots in ophthalmology: recent advances and future trends.

PURPOSE OF REVIEW: Recent advances in artificial intelligence (AI), robotics, and chatbots have brought these technologies to the forefront of medicine, particularly ophthalmology. These technologies have been applied in diagnosis, prognosis, surgical operations, and patient-specific care in ophthalmology. It is thus both timely and pertinent to assess the existing landscape, recent advances, and trajectory of trends of AI, AI-enabled robots, and chatbots in ophthalmology. RECENT FINDINGS: Some recent developments have integrated AI enabled robotics with diagnosis, and surgical procedures in ophthalmology. More recently, large language models (LLMs) like ChatGPT have shown promise in augmenting research capabilities and diagnosing ophthalmic diseases. These developments may portend a new era of doctor-patient-machine collaboration. SUMMARY: Ophthalmology is undergoing a revolutionary change in research, clinical practice, and surgical interventions. Ophthalmic AI-enabled robotics and chatbot technologies based on LLMs are converging to create a new era of digital ophthalmology. Collectively, these developments portend a future in which conventional ophthalmic knowledge will be seamlessly integrated with AI to improve the patient experience and enhance therapeutic outcomes.

Subthreshold laser treatment in retinal diseases: a mini review.

PURPOSE: To summarize the mechanism and the clinical applications of subthreshold laser (STL) in retinal practice. Subthreshold or "non-destructive" laser includes all types of laser treatments that produce minimal or no damage to the tissues and no visible signs after application. METHODS: A descriptive review of articles from literature databases (PubMed, Medline, Embase, Cochrane, Web of Science) published before August 2023, which discuss current STL treatments of retinal diseases. RESULTS: This review provides evidence for STL as a treatment option for central serous chorioretinopathy, diabetic retinopathy, age-related macular degeneration, macular edema due to retinal vein occlusion, and other maculopathies. In most published reports, STL has shown a therapeutic effect without damage to the underlying tissue. CONCLUSION: Subthreshold laser treatment has shown safety and efficacy in the management of some retinal and macular diseases. Stimulation of the retinal pigment epithelium without destroying adjacent neuroretina has been shown to be sufficient in inducing retinal repair in many clinical cases. Recent research and clinical studies continue to explore the mechanisms and improving therapeutic benefits of this technology as well as extend the range of retinal disorders treatable by this modality.

Artificial intelligence in the detection of skin cancer: State of the art.

The incidence of melanoma is increasing rapidly. This cancer has a good prognosis if detected early. For this reason, various systems of skin lesion image analysis, which support imaging diagnostics of this neoplasm, are developing very dynamically. To detect and recognize neoplastic lesions, such systems use various artificial intelligence (AI) algorithms. This area of computer science applications has recently undergone dynamic development, abounding in several solutions that are effective tools supporting diagnosticians in many medical specialties. In this contribution, a number of applications of different classes of AI algorithms for the detection of this skin melanoma are presented and evaluated. Both classic systems based on the analysis of dermatoscopic images as well as total body systems, enabling the analysis of the patient's whole body to detect moles and pathologic changes, are discussed. These increasingly popular applications that allow the analysis of lesion images using smartphones are also described. The quantitative evaluation of the discussed systems with particular emphasis on the method of validation of the implemented algorithms is presented. The advantages and limitations of AI in the analysis of lesion images are also discussed, and problems requiring a solution for more effective use of AI in dermatology are identified.

Application of artificial intelligence in oculoplastics.

Oculoplastics is a subspecialty of ophthalmology/dermatology concerned with eyelid, orbital, and lacrimal diseases. Artificial intelligence (AI), with its powerful ability to analyze large data sets, has dramatically benefited oculoplastics. The cutting-edge AI technology is widely applied to extract ocular parameters and to use these results for further assessment, such as screening and diagnosis of blepharoptosis and predicting the progression of thyroid eye disease. AI also assists in treatment procedures, such as surgical strategy planning in blepharoptosis. High efficiency and high reliability are the most apparent advantages of AI, with promising prospects. The possibilities of AI in oculoplastics may lie in three-dimensional modeling technology and image generation. We retrospectively summarize AI applications involving eyelid, orbital, and lacrimal diseases in oculoplastics, and we also examine the strengths and weaknesses of AI technology in oculoplastics.

Epicanthoplasty: Social and historical perspectives.

The epicanthus is a fold of skin covering the inner corner of the eye which blends into the nasal skin. It is a cosmetic feature of many populations of the world. The surgical alteration of this structure was first developed for the epicanthus found in such congenital genetic conditions as Down syndrome in the West. In the past century and a half, in what may be a reaction to the Western portrayal of skin overlying the eye and of Shakespeare's descriptions of characters with epicanthic folds, surgical techniques have arisen for pure cosmetic intent to alter the Asian eyelid. These procedures have almost wholly become undertaken by patients and surgeons of East Asian descent. Since 1989, the epicanthus surgery literature has been penned predominantly by authors of East Asian descent.

How to cope with potential malfeasance using artificial intelligence: Call to action.

Just as fire and electricity can be, and in many ways are, of great benefit to humanity, and as the contributions elsewhere in this issue of Clinics in Dermatology have shown, artificial intelligence (AI) can be used for the ill and help in medicine. We offer several suggestions to counter some of the more egregious and obvious ones: AI-generated material that purports to be caused by humans and AI-generated material that purports to show actual people doing things that these people would not normally do. Both suggestions rely on methods already in existence to ensure public safety.

A History of Artificial Intelligence.

The development of the computer and what is now known as artificial intelligence (AI) has evolved over more than two centuries in a long series of steps. The date of the invention of the first computer is estimated at 1822, when Charles Babbage (1791-1871) developed his first design of a working computer on paper, based mainly on a Jacquard loom. He worked on his project together with Augusta Ada King, Countess Lovelace (née Byron) (Ada Lovelace) (1815-1852), whom he called the "Sorceress of Numbers." This work will present the profile and achievements of Charles Babbage, Augusta Ada King, Countess Lovelace, and Alan Mathison Turing (1912 - 1954), who is considered the father of computer science and artificial intelligence, and then provide an outline of the tumultuous events affecting AI up to the present.

Challenges of artificial intelligence in medicine and dermatology.

Artificial intelligence (AI) in medicine and dermatology brings additional challenges related to bias, transparency, ethics, security, and inequality. Bias in AI algorithms can arise from biased training data or decision-making processes, leading to disparities in health care outcomes. Addressing bias requires careful examination of the data used to train AI models and implementation of strategies to mitigate bias during algorithm development. Transparency is another critical challenge, as AI systems often operate as black boxes, making it difficult to understand how decisions are reached. Ensuring transparency in AI algorithms is vital to gaining trust from both patients and health care providers. Ethical considerations arise when using AI in health care, including issues such as informed consent, privacy, and the responsibility for the decisions made by AI systems. It is essential to establish clear guidelines and frameworks that govern the ethical use of AI, including maintaining patient autonomy and protecting sensitive health information. Security is a significant concern in AI systems, as they rely on vast amounts of sensitive patient data. Protecting these data from unauthorized access, breaches, or malicious attacks is paramount to maintaining patient privacy and trust in AI technologies. Lastly, the potential for inequality arises if AI technologies are not accessible to all populations, leading to a digital divide in health care. Efforts should be made to ensure that AI solutions are affordable, accessible, and tailored to the needs of diverse communities, mitigating the risk of exacerbating existing health care disparities. Addressing these challenges is crucial for AI's responsible and equitable integration in medicine and dermatology.

Artificial intelligence and the scientific method: How to cope with a complete oxymoron.

Artificial intelligence (AI) can be a powerful tool for data analysis, but it can also mislead investigators, due in part to a fundamental difference between classic data analysis and data analysis using AI. A more or less limited data set is analyzed in classic data analysis, and a hypothesis is generated. That hypothesis is then tested using a separate data set, and the data are examined again. The premise is either accepted or rejected with a value p, indicating that any difference observed is due merely to chance. By contrast, a new hypothesis is generated in AI as each datum is added to the data set. We explore this discrepancy and suggest means to overcome it.