To evaluate the growth and prescribing patterns of community-based independent prescribing (IP) optometrists managing acute eye conditions in Wales between 2020 and 2024, a period that saw the introduction and subsequent commissioning of National Health Service (NHS) funded acute eye care with prescribing in primary care optometry throughout Wales. Monthly prescribing data from NHS Wales Shared Services Partnership were analysed for all IP optometrists in Wales from 1st February 2020 to 31st January 2024. Data included drug name, British National Formulary classification, quantity, cost and health board location. Descriptive and correlational statistics were used to assess prescribing activity, regional distribution and cost trends. The number of active IP optometry practices increased from eight in February 2020 to 68 in January 2024, with 20,980 prescriptions (49,162 items) issued at a total cost of £339,426. Corticosteroids, anti-infective agents and ocular lubricants were the most frequently prescribed drug classes. Ocular lubricants accounted for 34.0% of the total spend. Regional variation in prescribing activity was observed, with positive correlations between the number of active practices and both prescription volume and cost. Generic prescribing accounted for 47.0% of prescriptions, lower than national averages. NHS commissioning of IP services in Wales has significantly expanded the role of optometrists in managing acute eye conditions in primary care. The findings highlight the potential of IP optometry to reduce pressure on general medical practice and hospital eye services. Further research is needed to evaluate clinical outcomes, cost-effectiveness and the broader therapeutic use of ocular lubricants in acute care.
Retinopathy of prematurity (ROP), the leading cause of childhood blindness, is considered a vascular retinopathy; however, clinical studies have reported persistent electrophysiological dysfunctions in some ROP patients with remitted vasculopathy, resulting in severe visual impairments. Therefore, this study sought to unravel the mechanisms underlying persistent electrophysiological dysfunctions and identify a neuronal target in a murine model of oxygen-induced retinopathy (OIR), a widely used animal model for ROP. Retinal vascular morphology and leakage were examined by isolectin B4 staining and fluorescein fundus angiography in the OIR mouse model at P17 and P25. Full-field electroretinogram (ERG) was performed. Moreover, P17 retinas were analyzed with metabolomics and transcriptomics, and the results were validated by quantitative PCR (qPCR) and Western blotting (WB). Whole-cell patch clamp was used to evaluate phototransduction. Lentiviral particles carrying guanylate cyclase activator 1A (Guca1a) cDNA driven by a mouse rod opsin promoter were intravitreally injected into OIR mice, and immunofluorescence, ERG, patch clamp, cGMP measurement, and TUNEL staining were performed for assessments. Vascular lesions in OIR retinas peaked at P17 and recovered at P25. However, a wave and b wave amplitudes in dark- and light-adapted ERGs under all light intensities were deficient at both developmental stages, and electrophysiological dysfunctions persisted in P32 OIR retinas. Multiomics indicates phototransduction defects in isolated photoreceptors. QPCR and WB validated the reduced Guca1a mRNA and its encoding protein levels in P17 and P25 OIR retinas. Patch clamp demonstrated impaired light responses of single rods. Furthermore, lentivirus-mediated photoreceptor-specific expression of GUCA1A recovered electrophysiological functions, improved single rod phototransduction, increased cGMP concentration, and reduced cell death in P17 and P25 OIR retinas. The reduced GUCA1A in photoreceptors is mainly responsible for persistent electrophysiological dysfunctions in OIR mouse retinas, even after the recovery of vessel damage. The photoreceptor GUCA1A may serve as a neuronal target for ROP intervention.
Effective therapy for ischemic diseases requires not only timely restoration of perfusion but also protection of ischemic tissues from secondary insults, particularly oxidative-stress-induced injury. Here, we propose the concept of "proangiogenic nanozymes" and develop an efficient screening platform by doping angiogenic elements (Mg, Co, Cu, Zn, Sr, or Eu) into an archetypal antioxidative nanozyme, Prussian blue. Systematic assessment of catalytic activity and proangiogenic performance identified Cu-doped Prussian blue (CuPB) as the lead candidate. In addition to efficiently decomposing multiple reactive oxygen species, thereby attenuating oxidative stress, reducing apoptosis, and protecting ischemic tissues from secondary injury, CuPB nanozymes also stimulated angiogenesis, thereby accelerating tissue repair. In murine models of hind limb ischemia and myocardial infarction, CuPB conferred therapeutic benefits after both local and systemic administration, underscoring its translational potential. This proangiogenic nanozyme strategy offers an integrated and effective approach to ischemic tissue regeneration, bridging catalytic nanomedicine and vascular repair.
Multitasking, such as listening while balancing, relies on integrated processing in the sensory, cognitive, and motor systems; systems that often decline with age. Hearing loss is linked to increased risks of both falls and cognitive decline. Improving cognitive processing through executive function (EF) training may support balance, especially in older adults with hearing loss. This randomized controlled study conducted across age groups and hearing abilities, examined the effects of a 12-week EF training program on postural outcomes (center of pressure (COP)) using an auditory-cognitive-postural dual-task paradigm. Sixty-five participants including middle-aged adults with normal hearing (MA; n = 19), older adults with normal hearing (OA; n = 23), and older adults with hearing loss who used hearing aids (OAHL; n = 23) were randomly assigned within each age group to an EF training condition or a control condition. Primary outcome measures were auditory-cognitive reaction time on an auditory 2-back working memory task and postural measures (COP path length variability), which were collected in single- and dual-task conditions. Secondary analyses examined whether sensory, cognitive, and mobility performance, as evaluated by baseline standardized assessments, predicted training-related outcomes. Across MA, OA, and OAHL groups, cognitive performance generally improved following EF training and transfer of these training effects were observed during experimental postural tasks and auditory-cognitive tasks, but differed depending on age, pure-tone hearing thresholds, and cognitive abilities. Specifically, for postural outcomes, performance improved after training, but only for older adults with better hearing, while those with poorer hearing at any age did not improve. For auditory-cognitive task performance, older adults with the poorest hearing and cognition benefited the most from training. EF training may support balance and cognition in older adults, although its benefits for balance may be limited by severe hearing loss, underscoring the value of early intervention. Registry Name: ClinicalTrials.gov. Registration/Trial number: NCT05418998. Trial URL: https://clinicaltrials.gov/ct2/show/NCT05418998.
Training medical vision-language models (VLMs) typically demands millions of image-text pairs to achieve versatility and reasoning, posing significant challenges in data acquisition. We propose ConceptVLM, a novel data-efficient fine-tuning paradigm that transforms general-domain VLMs into specialized medical ones with minimal labeled data, integrating medical knowledge without disrupting the model's existing general capabilities. Central to our approach is a key concept-aware training strategy, building a structured medical concept dictionary and employing masked attention to guide the model's focus toward essential clinical concepts. This focused fine-tuning enhances domain-specific comprehension while preserving the model's reasoning abilities and response diversity. Experiments across multimodal medical benchmarks show ConceptVLM achieves state-of-the-art results using only 1% of the original training data, outperforming traditional methods reliant on large-scale QA datasets. These findings challenge the prevailing reliance on extensive annotated corpora, demonstrating key concept-guided tuning as a viable path to developing cognitively capable medical VLMs.
Background: Corneal sensitivity is a key indicator of ocular surface health. This prospective, cross-sectional study evaluated agreement between corneal sensitivity thresholds obtained from equivalent stimulus settings on a contemporary, enhanced dual-temperature non-contact corneal aesthesiometer (NCCA) and a previously validated (standard) device. Methods: Central corneal sensitivity thresholds were measured in the right eyes of healthy participants using both devices. Participants with previous ocular surgery, laser treatment, trauma, contact lens wear, diabetes, or peripheral neuropathy were excluded. Sensitivity thresholds were determined using a forced-response, double-staircase protocol. Inter-device agreement was assessed using Bland-Altman analysis, and consistency was assessed using intraclass correlation coefficients. Results: Median corneal sensitivity thresholds in 51 healthy participants (32 female, 19 male; mean age: 33 ± 14 years) did not differ between enhanced (0.23 [0.18 to 0.38]) and standard (0.25 [0.15 to 0.35]) NCCA instruments (p = 0.73). Bland-Altman analysis demonstrated moderate inter-device agreement, with a mean difference of -0.01 mbar (95% limits of agreement: -0.41 to 0.39 mbar). Linear regression analysis identified greater measurement discrepancies at higher thresholds (p < 0.05), indicating greater variability in individuals with reduced corneal sensitivity. Conclusions: The enhanced NCCA yields reliable corneal sensitivity measures for a room-temperature stimulus and acceptable agreement with the existing (standard) model.
Sensor-based systems and virtual reality (VR) technologies provide new opportunities for the objective, technology-driven assessment and training of visuomotor performance in applied contexts such as sport. This study examined the effects of an integrated visual training program combining stroboscopic stimulation, VR-based vergence exercises, and instrumented reaction-light tasks in adolescent handball players. Twenty-eight adolescent handball players (under-18 competitive level) completed two baseline assessments separated by six weeks, followed by a six-session training program (approximately 15 min per session) integrated into regular team practice. The intervention targeted visuomotor reaction speed, accommodative dynamics, and peripheral visual responsiveness using sensor-based and virtual reality-assisted stimuli. Compared with both baseline measurements, the intervention produced selective improvements in accommodative facility (cycles per minute, cpm)-particularly near-far focusing speed-and in multiple reaction-time conditions (milliseconds, ms) involving manual and decision-based responses. Specific peripheral-field locations showed increased response scores, whereas binocular alignment, AC/A ratio, near phoria, and stereoscopic acuity remained unchanged. These findings indicate that technology-supported visual training protocols incorporating sensor-based reaction systems and VR stimuli were associated with measurable adaptations in dynamic visuomotor processing while preserving fundamental binocular vision parameters.
To investigate whether intravitreal vasoactive intestinal peptide (VIP) attenuates form-deprivation myopia (FDM) in a dose-dependent manner in guinea pigs and to determine whether this effect is mediated through regulation of the scleral Wnt/β-catenin signaling pathway. A customized latex-balloon facemask was used to induce monocular FDM by covering the right eye, with the left eye remaining uncovered and serving as an internal self-control (SC). Fifty-four 3-week-old guinea pigs were randomly assigned to FDM without injection, FDM with intravitreal VIP (six subgroups receiving 0.1-10000pmol VIP), or FDM with intravitreal saline. Refraction and axial length were measured at baseline and at weeks 2 and 4 to establish dose-response relationships and identify the optimal VIP concentration. Using the same FDM protocol, 45 additional 3-week-old guinea pigs were allocated to three groups: FDM, FDM + intravitreal VIP (100pmol), and FDM + saline. Ocular biometric measurements were obtained at baseline and at weeks 2 and 4 during follow-up. Eyes were then enucleated for hematoxylin-eosin histological analysis of the retina, choroid, and sclera, as well as immunohistochemical assessment of β-catenin expression. Primary scleral fibroblasts were isolated to evaluate VIP-induced changes in Wnt3 and β-catenin expression using immunofluorescence and qRT-PCR. Both refractive error and axial length demonstrated a clear VIP dose-dependent response. Form deprivation induced aberrant activation of the scleral Wnt/β-catenin signaling pathway, which was significantly suppressed by VIP treatment. Moreover, VIP administration partially restored the disrupted collagen fibril organization characteristic of myopic sclera. VIP effectively slows the progression of FDM by downregulating aberrant Wnt/β-catenin signaling.
Vision impairment is increasingly recognised as a complex condition shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors that influence participation and quality of life. In line with the United Nations Convention on the Rights of Persons with Disabilities and the International Classification of Functioning, Disability and Health, contemporary vision rehabilitation frameworks adopt a biopsychosocial perspective that extends beyond treatment of the eye condition alone toward holistic support to improve the lives of individuals with vision loss. An overview of the effectiveness and future directions of multidisciplinary vision rehabilitation in clinical practice is presented, and a summary of the findings concerning the international standards of vision rehabilitation, focusing on adults. Furthermore, some examples of achievements in emerging fields are presented, such as neuroplasticity and visual system recovery, technological interventions and psychosocial support, including their future directions. Multidisciplinary models are widely supported but remain difficult to implement because of limited resources, workforce constraints and differences in culture and health policy. Overcoming these barriers is critical to expanding and strengthening multidisciplinary vision rehabilitation. The evidence highlights the need for implementation-focused research, closer collaboration across disciplines and core outcome measures that capture participation, mental health and quality of life, not just impairment. The overview also points to the importance of structured models that integrate neurorehabilitation (artificial intelligence-based) technology and mental healthcare while adapting to regional and cultural contexts. Embedding multidisciplinary vision rehabilitation within health systems is both a clinical necessity and a prerequisite for advancing global commitments to inclusion and equity for people with vision impairment. As population ageing and global demographic change are expected to increase the absolute numbers of adults with vision loss, strengthening collaboration between research, clinical practice and service delivery will be essential to further improve the quality of life of individuals with vision loss.
The prison population in England and Wales exceeds 88,000, with a high turnover - 47% of sentenced admissions in 2023 served less than 12 months. Transitions from prison to the community are recognised as high-risk periods for medication-related harm, driven by complex health needs, short custodial stays, and fragmented healthcare systems. While national and international guidance exists to support safe medication management, implementation during prison-community transitions remains inconsistent, and evidence on both the drivers of unsafe medication practices and potential solutions is limited. This study explored the human, organisational, and environmental factors influencing medication safety during transitions from prison to the community, as well as potential solutions for improvement, from the perspective of staff involved in these transitions. Qualitative semi-structured interviews were conducted with 12 staff members working in roles relevant to transitions from prison to the community, including general practitioners, pharmacists, and prison officers. Participants were recruited through professional networks and snowball sampling. Data were thematically analysed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Five main factors impacting medication safety during transitions were identified: release practices, care coordination and communication issues, staffing shortages, IT system limitations, and patient-related factors. Key findings highlighted risks associated with immediate releases, discontinuity in medication regimens, insufficient staffing for discharge planning, and poor information transfer between prison and community healthcare providers. These challenges were further compounded by patient-level issues such as low health literacy, substance use, and housing instability. Staff proposed several improvements to enhance medication safety during prison-to-community transitions, including electronic prescribing for timely access to medication, improved information transfer, dedicated discharge teams to ensure medication follow-up, early discharge planning to address medication needs, and multi-disciplinary meetings to coordinate complex care. Medication safety during transitions from prison to community healthcare requires coordinated efforts to address organisational challenges, including short-notice releases and inadequate information transfer, as well as human factors such as communication barriers and staffing constraints. Improvements that clarify roles, enhance processes and technology, and foster cross-system collaboration are essential to ensuring continuity of care and medication safety. Two people, one with lived experience of care transitions and one carer, contributed to study design, recruitment strategies, participant materials, and the analysis plan through quarterly input. Findings were shared with a wider group of lived experience representatives, carers, professionals, and policy makers, who informed interpretation and dissemination. While PPI members did not directly participate in coding or analysing the data, their input ensured that the study design and interpretation were informed by real-world perspectives.
Mitochondrial dysfunction plays a critical role in glaucomatous trabecular meshwork (TM) degeneration, whereas increasing intracellular nicotinamide adenine dinucleotide (NAD+) levels can restore mitochondrial homeostasis, offering therapeutic benefits for glaucoma. We propose that intracellular NAD+ can be boosted by promoting NAD+ biosynthesis through the co-delivery of nicotinamide (NAM), an NAD+ precursor, and the gene encoding nicotinamide mononucleotide adenylyltransferase 1 (Nmnat1), the rate-limiting enzyme for NAD+ biosynthesis that consumes NAM. To achieve high gene transfection efficiency, the Nmnat1 gene was encapsulated in a multifunctional lipid nanoparticle (Nmnat1-LNPs). The combination of Nmnat1-LNPs and NAM synergistically reversed mitochondrial dysfunction in primary human trabecular meshwork cells (HTMCs) model. We then developed a new annular sector-shaped microneedle patch (AS-MNs), enabling localized delivery of Nmnat1-LNPs and NAM to the TM. Following application, Nmnat1-LNPs and NAM dual-loaded AS-MNs (Dual@AS-MNs) significantly enhanced the bioavailability of both the Nmnat1 gene and NAM in the TM tissue, leading to a marked reduction in intraocular pressure and alleviation of TM fibrosis in a dexamethasone-induced mice model of glaucoma, highlighting its therapeutic potential. This study presents the first development of an annular sector-shaped microneedle patch as a targeted TM drug delivery platform, and offers a promising new combinatorial strategy for glaucoma treatment.
To use volumetric analysis applied to total deviation (TD) perimetric data to characterize the presence of residual sensitivity measurable using the 10-2 in lieu of the 24-2 test grid in glaucoma (the functional vulnerability zone [FVZ]) and develop a prototype end-user application for clinical guidance. Cross-sectional study. Six hundred twenty-six pairs of Humphrey Field Analyzer 10-2 Swedish Interactive Thresholding Algorithm (SITA)-Fast and 24-2 SITA-Faster test results of 160 subjects. Total deviation values located within 10° from fixation (10-2, 68 locations; 24-2, 12 locations) were extracted. Volumetric analysis was performed to calculate the difference in TD "volume" (10-2 - 24-2) for each pair of results. Then, 24-2 test locations were interpolated across the central 10° to obtain "equivalent" 10-2 test locations used to calculate number of test locations gained (10-2 - 24-2). A positive TD volume difference and positive gain represented the presence of an FVZ. Linear regression and principal components analysis were used to identify 24-2 test features that may predict the presence of an FVZ. Volumetric differences in visual field TD as a surrogate for a FVZ. Visual field global indices and the number of central 24-2 defects predicted TD volume difference (P < 0.0001), with 24-2 mean deviation (MD) showing the highest R 2 (0.32). All parameters had low R 2 values when predicting gain. A simplified model comprising 24-2 MD and number of central 24-2 TD probability (TDP) defects (P < 0.01) provided a method for clinically identifying the likelihood of an FVZ. Principal components analysis revealed 2 principal components (24-2 global indices and pointwise probability scores) that accounted for 79.7% of the variance, with principal component 1 accounting for 69.3% and comprising 24-2 MD and number of central 24-2 TDP scores at P < 2%. The FVZ offers a data-driven approach to identifying residual dynamic range using the 10-2 test grid. A prototype model for predicting the likelihood of 10-2 utility in progression analysis is proposed. The authors have no proprietary or commercial interest in any materials discussed in this article.
Background/Objectives: Early-onset high myopia (eoHM), defined as high myopia manifesting before 10 years of age, is largely attributed to genetic defects. This study aimed to investigate the genetic underpinnings of eoHM in a cohort of Chinese patients. Methods: We recruited 64 Chinese patients with eoHM. Comprehensive clinical evaluations were performed, and whole exome sequencing (WES) was conducted to identify potential pathogenic variants. The genetic findings were analyzed and correlated with the clinical phenotypes. Results: A total of 64 unrelated Chinese patients with suspected early-onset high myopia were initially recruited. Following whole exome sequencing (WES) and variant annotation, final 37 patients with variants in known myopia-associated genes were included in the analytical cohort. The mean age of onset for the cohort was 5 years (IQR, 4-7), with a mean spherical equivalent refraction of -7 D (IQR, (-8)-(-6)). Genetic analysis revealed variants in 28 known myopia-associated genes. We identified pathogenic or likely pathogenic variants in 11 of the 37 patients (29.7%, 95%CI: 0.1737-0.4590), while the overall diagnostic yield was 17.2% (11/64, 95%CI: 0.0970-0.2839) in initial 64 recruited patients. These genes included seven well-established eoHM-related genes, such as ARR3, CACNA1F, P4HA2, TRPM1, COL11A1, COL2A1, and PAX6. Additionally, variants of uncertain significance (VUS) in seven other candidate genes were detected in patients with eoHM. Conclusions: Our findings expand the genetic spectrum of eoHM and reinforce the critical role of genetic testing in its etiological diagnosis and clinical management. Observed patterns of genotype-phenotype associations are descriptive and should be considered hypothesis-generating, requiring validation in larger cohorts. Additionally, we identify several candidate genes that may serve as prospective biomarkers, though these findings require validation in larger cohorts and functional studies.
Refractive surprises remain one of the most challenging postoperative complications in modern cataract surgery, where precision and patient expectations for plano refractive outcomes continue to rise. Despite advances in optical biometry, intraocular lens (IOL) formula optimization, and surgical technology, postoperative refractive error still occurs in a subset of patients and may significantly affect visual satisfaction and quality of life. This review synthesizes contemporary evidence on the causes, detection, and optometric management of refractive surprises, with a practical focus on the evolving role of the optometrist in co-management. Residual refractive error most commonly results from biometric inaccuracies, keratometric misalignment, incorrect estimation of effective lens position, prior corneal refractive procedures, and anatomical extremes such as axial myopia or hyperopia. Early recognition through comprehensive postoperative assessment-including manifest refraction, keratometric stability, IOL position evaluation, corneal tomography, and retinal imaging-is critical to differentiating optical errors from pathology. Management options include spectacles and contact lenses for mild errors, while significant ametropia may require corneal refractive surgery, arcuate keratotomy, piggyback IOL implantation, or IOL exchange depending on patient factors, ocular anatomy, and refractive stability. The review further discusses algorithmic approaches to decision-making, counseling strategies for dissatisfied patients, and considerations when dealing with toric and multifocal IOLs. As optometrists increasingly serve as primary comanagers of cataract surgery patients, understanding the etiology and management of refractive surprises is essential. Improved diagnostic workflows, individualized IOL planning, and collaborative postoperative care pathways can greatly enhance refractive predictability and visual outcomes.
The aim of this study was to investigate the relationship between dry eye disease (DED) and smartphone addiction, and to explore the mediating effect of sleep disturbance on this relationship. A total of 375 participants were recruited and surveyed using demographic questionnaires, 5-Item Dry Eye Questionnaire (DEQ-5), Sleep Disturbance Scale for Children (SDSC) and Smartphone Addiction Scale-Short Version (SAS-SV). Additionally, they were assessed for DED using the Keratograph 5M and corneal fluorescein staining. Regression analysis and the bootstrap method were used to investigate the influence of sleep disturbance on the relationship between DED and smartphone addiction. Among the 375 participants, 247 (65.9%) spend less than 2 h on screens, while 66 (17.6%) spend 2-4 h and 62(16.5%) spend more than 4 h. The effects of smartphone addiction, dry eye and sleep disturbance were positively correlated with one another (all p < 0.01). Model fit indices were all within acceptable ranges, indicating an adequate fit to the data. The total effect of smartphone addiction on dry eye is significant (β = 0.30, p = 0.002). Further, smartphone addiction has a significant indirect effect on the dry eye via sleep disturbance (β = 0.04, p = 0.045). The results suggest that the severity of DED symptoms was affected by smartphone addiction directly and sleep disturbance indirectly. A significant correlation was found between DED and smartphone addiction. Moreover, sleep disturbance was a mediator of the relationship between DED symptoms and smartphone addiction, which aligns with the direct and indirect effects identified in the results.
To evaluate the visual outcomes, reading performance, and patient satisfaction following bilateral implantation of a non-diffractive extended depth-of-focus (EDOF) intraocular lens (IOL) in Chinese eyes, and to compare the efficacy of emmetropia versus mini-monovision targets. This prospective, multi-center, observational study included 72 patients (144 eyes) who underwent phacoemulsification with bilateral implantation of the AcrySof IQ Vivity IOL (or Toric model). Patients were divided into two groups based on the refractive target: emmetropia (n=29) and mini-monovision (n=43). At 3 months postoperatively, binocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities were assessed. Functional outcomes were evaluated using the International Reading Speed Test (IReST), the Questionnaire for Visual Disturbances (QUVID), and the Intraocular Lens Satisfaction (IOLSAT) questionnaire. At 3 months, both groups achieved excellent binocular uncorrected distance visual acuity (emmetropia: 0.03 ± 0.06 logMAR; mini-monovision: 0.05 ± 0.06 logMAR) and uncorrected intermediate visual acuity (emmetropia: 0.12 ± 0.14 logMAR; mini-monovision: 0.13 ± 0.14 logMAR). No statistically significant differences were observed in binocular UIVA (p=0.317) or UNVA (p=0.684) between the emmetropia and mini-monovision groups, although the mini-monovision group demonstrated significantly higher rates of spectacle independence (89.2% vs. 70.4%, p = 0.049). The mean reading speed improved significantly from 172 ± 67 wpm preoperatively to 201 ± 58 wpm postoperatively (p<0.05). Regarding visual disturbances, 100% of patients in both groups reported "none to a little" for starbursts, halos, and glare. Patient satisfaction was high in both cohorts (66.7% in the emmetropia group and 79.5% in the mini-monovision group). The non-diffractive Vivity IOL provides excellent distance and intermediate vision with a favorable visual disturbance profile in Chinese eyes. While the mini-monovision strategy enhanced spectacle independence and patient satisfaction, the improvements in uncorrected near acuity were not statistically significant compared to emmetropia. These short-term findings suggest that a myopic target closer to -0.75 D or -1.00 D may need to be evaluated to maximize chart-based near vision benefits in this population.
This study investigated the relationship between form-deprivation myopia and amblyopic deficit. Five rhesus monkeys underwent monocular form-deprivation beginning at 24 ± 2 days of age. Lightweight helmets held a light-perception only Bangerter filter over the right eye and a plano lens over the left eye. Refractive error and axial length were measured biweekly using streak retinoscopy and noncontact biometry. After 135 ± 2 days of treatment, visual function in each eye was assessed under sedation by recording Visual Evoked Potentials (VEP) elicited by monocular stimulation with square wave gratings (spatial frequencies 0.25-16 cycles per degree). An Ocular Dominance Index (ODI), the difference in VEP amplitudes between form-deprived (amblyopic) eye stimulation and fellow (control) eye stimulation divided by the sum, quantified amblyopic deficits. At the end of treatment, mean spherical equivalent refraction and axial length were -0.43 ± 4.41 D and 16.66 ± 0.70 mm in form-deprived eyes and +1.75 ± 2.71 D and 16.07 ± 0.61 mm in fellow eyes, respectively. Anisometropia was highly variable, ranging from -6.13 to +2.75 D (mean -2.18 ± 3.60 D). All monkeys demonstrated a significant amblyopic deficit, with a mean ODI of -0.66 ± 0.11 (range: -0.43 to -0.81). Correlations between ODI and anisometropia and ODI and axial length were not significant in this small cohort. Monocular form-deprivation in young rhesus monkeys produced a robust amblyopic deficit as measured by VEPs, even in the absence of myopia. Findings indicate that form-deprivation induces central visual pathway deficits may not be correlated with the amplitude of form-deprivation myopia.
Precise intraocular lens (IOL) positioning is critical for optimal visual outcomes in cataract surgery, particularly with advanced IOLs. Misalignment can lead to refractive errors, astigmatism, and higher-order aberrations. This study aimed to predict postoperative anterior chamber depth (ACD), IOL tilt, and decentration using machine learning. A prospective, single-center study was conducted at the Kepler University Clinic, Linz, Austria, involving 49 patients undergoing cataract surgery with implantation of a hydrophobic single-piece IOL (Clareon CNA0T0). Preoperative biometric data were collected using swept-source optical coherence tomography. Prediction models were developed using partial least squares regression to identify key predictive variables, followed by validation with a random forest model. Postoperative outcomes were assessed 8 weeks after surgery. The mean out-of-bag (OOB) error was 0.07 mm for ACD, 1.17° for IOL tilt, and 0.02 mm for IOL decentration. Key predictive variables for ACD included preoperative ACD, axial eye length (AL), and preoperative lens tilt. IOL tilt prediction was mainly influenced by preoperative lens tilt, thickness, and decentration. For IOL decentration, preoperative lens tilt, AL, and keratometry were significant predictors. The study demonstrated excellent predictability of postoperative ACD and IOL tilt and good predictability of IOL decentration using machine learning models. These findings support the clinical applicability of predictive modeling in optimizing IOL positioning for improved visual outcomes in cataract surgery. ClinicalTrials. gov identifier, NCT06595693.
Pharmaceutical Care (PC) has emerged as a vital component of the healthcare system, involving the provision of medication therapy to achieve specific outcomes that enhance a patient's quality of life. Therefore, this study aims to evaluate PharmD interns' self-reported attitudes, perceptions of the skills required to provide PC using multiple domains (technical, psychosocial, communication, and administrative aspects) and perceived barriers to implementing PC, and recommendations. A cross-sectional study was conducted between May and December 2023, utilizing pretested questionnaires with PharmD interns at Saudi universities in Riyadh, Saudi Arabia. The questionnaire included sociodemographic information, attitudes (13 items), perceptions (24 items), importance (19 items), barriers (17 items) toward PC, and recommendations (4 items). To find out the association between variables chi-square, Analysis of Variance, and Spearman correlation were used to examine differences in perceptions and correlations between attitude and perception scores, with a P value < .05 considered statistically significant. A total of 216 PharmD interns participated, with 59.7% being male, 94.9% Saudi nationals, and a mean age of 24.08 ± 0.98 years. The majority (72.7%) were 24 years old. Participants were from public (57.9%) and private (42.1%) universities in Riyadh. The mean attitude score towards PC was 51.25 ± 9.38, and the mean perception score was 106.67 ± 16.01. Attitude scores were significantly associated with gender and university type (P < .001), while perception scores showed significant associations with gender, age, and university type (P < .01). The results of the Spearman correlation analysis indicated a moderate, statistically significant positive correlation between mean attitude and mean perception scores (R = 0.345, P < .01). Most interns agreed that pharmacists should prevent and solve medication-related problems (86.6%) and provide PC (85.7%). However, 43.5% believed that PC is not worth the additional workload. The most frequently reported barriers were lack of financial compensation (65.8%), inadequate staffing (62.5%), limited private counseling areas (60.7%). Most of the PharmD interns have a positive attitude towards PC but face structural and educational barriers to PC implementation. Future research should focus on overcoming these barriers and promoting Interprofessional healthcare courses to enhance patient outcomes.
Elevated intraocular pressure (IOP) is a risk factor for primary open-angle glaucoma, and genetic risk scores hold promise as a tool for screening for ocular hypertension. However, genetic risk scores for IOP have a nonuniform association across the range of IOP, which reduces their accuracy. To test the hypothesis that nonuniform behavior of genetic risk scores for IOP is associated with a specific type of genetic interaction. Cross-sectional, post hoc genetic association studies were performed using linear and quantile regression in a sample of UK Biobank participants. Data were analyzed from January to September 2025. Ninety-eight genetic variants associated with IOP. Tests were carried out for 98 genetic variants associated with IOP (P < 5.0 ×10-8) to examine (1) dominant or recessive genetic effects, (2) genotype × genotype interactions, (3) genotype × age interactions, and (4) genotype × sex interactions. A total of 98 235 participants (mean [SD] age, 58.1 [7.9] years; 52 168 female [53.1%]) were included in this analysis. More variants exhibited genotype × age interactions than expected by chance (14 of the 98 variants associated with IOP had at least nominal evidence of an interaction with age; P = 3.76 ×10-4). For 12 of these 14 variants, age increased rather than decreased the magnitude of the IOP vs genotype association. However, integrating age interactions into the genetic risk score construction process did not yield improved accuracy (incremental noninteraction model, R2 = 4.05; 95% CI, 3.82-4.31 and interaction model, R2 = 4.04; 95% CI, 3.80-4.27). There was little support for other types of genetic interaction. In the current work, findings show minimal evidence that nonadditive allelic effects, genotype × genotype interactions, and genotype × sex interactions contributed to the nonuniform association of genetic variants with IOP across quantiles of IOP. Although a genetic risk score for IOP was more accurate in older vs younger individuals, efforts to account for genotype × age interactions in genetic risk score construction did not improve accuracy. These findings suggest other factors, such as gene-environment interactions, contribute to the nonuniform relationship of genetic variants with IOP.