Adalimumab in Vogt-Koyanagi-Harada Disease Refractory to Conventional Therapy

Background: No study explores the effectiveness of adalimumab in sight-threatening Vogt-Koyanagi-Harada (VKH) patients in China.Objective: To evaluate the short-term effectiveness and safety of adalimumab (ADA) in patients with sight-threatening Vogt-Koyanagi-Harada (VKH) disease refractory to conventional therapy.Methods: Medical records of VKH patients who had been treated with systemic glucocorticoids and immunosuppressants but whose condition was poorly controlled were collected and analyzed. Primary outcomes comprised of best-corrected visual acuity (BCVA), intraocular inflammation, relapses, and glucocorticoid-sparing effects. Other outcomes included central macular thickness (CMT), intraocular manifestations and adverse events (AEs).Results: Nine refractory VKH patients with a median age of 30 (16, 43) years old were enrolled in this study and received treatment for a median of 10 (7, 11) months. Mean BCVA improved from LogMar 0.63 ± 0.50 (20/72 or 0.36 ± 0.26 in Snellen chart) at baseline to LogMar 0.50 ± 0.37 (20/82 or 0.41 ± 0.28 in Snellen chart) at final visit (P = 0.090). The anterior chamber cell grade decreased from 2 (1.75, 3)+ at baseline to 0.5 (0, 1.25)+ cell at final visit (P < 0.001). The vitritis grade decreased from 1 (1, 1) + cell at baseline to 0 (0, 1)+ cell at final visit (P < 0.001). Patients suffered a median of 1 (0, 2) relapse during treatment. CMT remained stable from 238.50 ± 144.94 μm at baseline to 219.28 ± 77.20 μm at final visit (P = 0.553). The mean prednisone dosage decreased from 21.91 ± 18.39 mg/d to 2.73 ± 4.10 mg/d (P = 0.005). No severe AEs were found during treatment.Conclusions: The outcomes indicated that ADA was an effective and safe option for VKH patients refractory to conventional therapy by controlling inflammation, preserving visual function and reducing the daily glucocorticoid dose.

Risk Factors Related to Decreased Vision in Primary School Children in Palembang

Introduction. Visual acuity is the ability of the eye to see an object clearly, and this depends on the ability of the eye to accommodate. Myopia is one of the causes of a sharp decline in vision in children aged 8-12 years. Close working distance is one of the most frequently mentioned risk factors for myopia. Head and back posture that bends forward when reading or doing other close-up tasks causes a higher prevalence of myopia. This study was conducted to describe risk factors related to decreased vision in elementary school children. Methods. The study was a descriptive research with a sample of 100 elementary school children taken by simple random sampling. Data was taken using a questionnaire and a Snellen chart. Results. A total of 100 students participated in this study. Most of the participants were aged 11 years old. Based on visual acuity, 20 students have decreased right eye vision, and 21% have decreased left eye vision. Most respondents read every day for 1 hour time as many as 58 (58%) people and had screen time for less than 2 hours (52%). In addition, based on family history, most respondents had parents' glasses (73%). Conclusion. More elementary school children had normal right and left eye vision than those with decreased vision. Most respondents have less screen time and less reading duration.

Managing solar retinopathy with suprachoroidal triamcinolone acetonide injection in a young girl: a case report

Background Solar retinopathy is a disease that causes photochemical toxicity in the retinal fovea tissues, leading to an acute decrease of vision. Case presentation This case report is an interventional case of an asymptomatic 17-year-old Caucasian female with a history of suddenly decreased vision due to solar retinopathy. The patient was managed with a custom-made needle injection of triamcinolone acetonide in the suprachoroidal space. Four months post suprachoroidal injection showed an anatomical and functional improvement in the ellipsoid zone layer through optical coherence tomography signal reappearance. In addition, the best-corrected visual acuity had improved from 0.1 to 1.0 on the Snellen chart with the disappearance of the scotoma. However, there was a mild increase in intraocular pressure after this procedure, controlled with topical hypertensive eye drops. Conclusion Suprachoroidal triamcinolone acetonide injection using a custom-made needle showed both functional and anatomical improvement of macular changes post-solar retinopathy, with acceptable safety outcomes in a young female.

Human umbilical cord-derived mesenchymal stem cells treatment for refractory uveitis: a case series

AIM: To evaluate therapeutic outcomes of human umbilical cord-derived mesenchymal stem cells (HUC-MSCs) treatment in patients with refractory uveitis. METHODS: A retrospective and noncomparative review was performed on four patients with refractory uveitis from December 2013 to December 2017. HUC-MSCs were administered intravenously at a dose of 1×106 cells/kg. Clinical response, relapse rate, change of visual acuity, and other metrics were evaluated. RESULTS: All four patients presented with responses to HUC-MSCs treatment, with three males and one female. The numbers of uveitis attacks per year after the HUC-MSCs treatment (0, 2, 0, 0 respectively) all decreased compared with the numbers before the treatment (3, 6, 4, 4 respectively). The oral steroid and immunosuppressive agents were tapered in all patients without recrudescence of ocular inflammation, and three patients discontinued their oral medicine at the last visit. The best corrected visual acuity (BCVA) of 3 patients was improved to varying degrees, and the BCVA of 1 patient remained at 20/20 (Snellen chart) from the first to the last consultation. CONCLUSION: The study provides an effective therapy of HUC-MSCs in maintaining remission in patients affected by uveitis refractory to previous immunosuppressant treatments.

Hubungan Intensitas Cahaya dengan Ketajaman Penglihatan Penghuni Panti Asuhan

Rendahnya intensitas pencahayaan pada panti asuhan di Kota Makassar, yang penghuninya didominasi usia sekolah, dapat mempengaruhi ketajaman penglihatan penghuninya. Hal ini dapat menjadi masalah, karena dapat mengganggu fungsi penglihatan yang dibutuhkan dalam perkembangan anak usia sekolah. Penelitian ini bertujuan untuk mengetahui hubungan antara intensitas cahaya pada panti asuhan dengan ketajaman penglihatan, faktor yang terlibat di dalamnya, serta kondisi penerangan dan ketajaman penglihatan penghuni panti asuhan. Metode penelitian menggunakan analitik observasional dengan desain cross sectional. Intensitas cahaya masing-masing sampel diukur menggunakan lux meter, sedangkan ketajaman penglihatan diukur dengan snellen chart. Analisis data menggunakan Pearson’s correlation coefficient test. Jumlah sampel 47 orang yang berasal dari 7 panti asuhan di Kecamatan Manggala Kota Makassar. Hasil analisis data menunjukkan bahwa hubungan intensitas cahaya dengan visus terbaik tidak signifikan (p value 0,240) sedangkan hubungan intensitas cahaya dengan visus terburuk signifikan dengan korelasi positif (p value 0,046). Faktor yang turut mempengaruhi adalah lama paparan harian (p value 0,019) serta jarak antara mata dan bacaan (p value 0,047). Intensitas cahaya panti asuhan masih belum memenuhi standar (kurang dari 200-300 lux) dan sebagian besar penghuninya memiliki ketajaman penglihatan menurun (kurang dari 6/6). Berdasarkan data objektif dan hasil analisis, ditemukan hubungan yang signifikan antara intensitas cahaya panti asuhan dengan ketajaman penglihatan.

Association of visual impairment with cognitive decline among older adults in Taiwan

This study investigated the association between visual impairment and cognitive decline among the elderly in Taiwan. The data were obtained from a government-sponsored, annual physical examination program for elderly citizens ≥ 65 years in Taipei City during 2005–2012. Distance presenting visual acuity was measured using the Snellen chart. Visual impairment was classified into low vision and blindness. The Short Portable Mental Status Questionnaire (SPMSQ) was selected to measure cognitive decline. The confounding factors including age, sex, sociodemographic factors: living status, marital status, education level, health behaviors: smoking, alcohol consumption, betel nut chewing, and physical comorbidities: BMI, hypertension, diabetes, cholesterol and triglyceride were collected for analysis. We recruited 105,208 participants and 4542 (4.3%) have abnormal SPMSQ. The abnormal SPMSQ had significantly higher prevalence of low vision (44.52% vs 18.79%) and blindness (8.89% vs 0.93%) compared with normal SPMSQ. The hazard ratios of abnormal SPMSQ in low vision and blindness were 2.34 (95% CI 2.17–2.52), and 5.13 (95% CI 4.50–5.85), after adjustment for confounders. In conclusion, visual impairment was independently and significantly associated with greater incident cognitive decline among elderly Asian people. Prevention of visual impairment may help to reduce the incidence of cognitive decline in the aged Asian population.

Association between Refractive Error Types and Asthenopia in Primary School Students

Refractive error is a condition in which the cornea and lens fail to focus the light, resulting in reduced visual efficiency. Twelve million children are experiencing refractive errors worldwide and uncorrected refractive errors in children have been reported to cause asthenopia. This study aimed to determine the association between the types of refractive errors and asthenopia in children. This cross-sectional study was conducted on 111 students aged 10-13 years old in a public elementary school in Indonesia, SDN Penjaringan 10, in 2019. A questionnaire was used to assess asthenopia and the Snellen Chart, trial frames, and trial lenses were used for refractive errors examination. It was demonstrated that 87.4% of respondents experienced asthenopia, and 53.2% of respondents suffered from uncorrected refractive errors, mostly due to myopia. Fisher’s exact test results showed an association between refractive errors and asthenopia (p=0.019) with all myopic students experienced asthenopia. However, there was no significant association between astigmatism and asthenopia (p=0.754). In conclusion, not all types of refractive errors are associated with asthenopia.

DAMPAK PENGGUNAAN GADGET TERHADAP PENURUNAN KETAJAMAN PENGLIHATAN

Gadget merupakan barang canggih yang hampir semua orang dapat memilikinya. Gadget yang disertai berbagai macam aplikasi memberikan kemudahan mengakses berbagai hal seperti media berita, jejaring sosial, musik, bermain games, internet, foto-foto, menonton video dan masih banyak lagi yang lainnya. Penggunaan gadget di kalangan mahasiswa menjadi hal biasa, karena hampir semua kebutuhan perkuliahan dapat diakses melalui gadget. Dengan gadget mahasiswa dengan mudah mengakses literatur pengetahuan, musik, bermain games, internet, foto-foto, menonton video, transaksi perkuliahan dan lain-lain. Semua kemudahan tersebut tidak berarti tanpa masalah. Selain hal positif penggunaan gadget dapat berdampak negatif, misalnya penurunan ketajaman penglihatan. Tujuan penelitian ini adalah menganalisis dampak penggunaan gadget terhadap penurunan ketajaman penglihatan. Jenis penelitian adalah kuantitatif observasional analitik dengan desain cross sectional study. Populasi pada penelitian adalah mahasiswa, pengambilan sampel menggunakan teknik Non-Probability Sampling dengan pendekatan Accidental Sampling. Instrumen yang digunakan untuk mengukur variabel independen penggunaan gadget adalah kuesioner sedangkan variabel dependen ketajaman penglihatan menggunakan snellen chart. Pengumpulan data memperhatikan etika penelitian seperti informed consent, anonimity dan confidentiality. Jenis data adalah data primer, data sekunder dan data tersier. Data diolah dengan menggunakan program SPSS for windows versi 21.0 dengan proses editing, coding, processing dan cleaning. Data dianalisis secara univariat dan bivariat. Analisis bivariat menggunakan Uji Statistik Chi Square dengan tingkat signifikansi ?=0,05. Hasil Uji Statistik Chi Square diperoleh p value untuk mata kanan dan kiri masing-masing pkanan = 0,647 dan pkiri = 0,462. Kesimpulannya bahwa penggunaan gadget tidak berdampak signifikan terhadap penurunan ketajaman penglihatan baik pada mata kanan maupun mata kiri.

Distance Visual Acuity Versus Near Visual Acuity in Amblyopia.

Purpose: To measure and compare distance and near visual acuity in amblyopic patients.Methods: This study was evaluated 167 patients with amblyopia between ages of 6 and 55 years. In all subjects, a comprehensive ophthalmic examination including visual acuity, refraction, slit lamp biomicroscopy, and funduscopy was performed. Distance visual acuity (DVA) was measured by Snellen chart at 4 m and near visual acuity (NVA) was measured by Snellen chart at 40 cm, and then DVA and NVA were compered and analyzed.Results:In our subjects, the mean distance and near visual acuity was 0.39± 0.30 log MAR and 0.30± 0.32 log MAR respectively. The mean NVA was 0.12±0.12 log MAR better than DVA and difference between them was statistically significant (P<0.001). In 40% of patients, there were no difference between DVA and NVA, and in 60% of them, NVA was 0.1 or more log MAR better than DVA. The difference between DVA and NVA was not significantly related with age (p=0.225), spherical equivalent (P=.820) and strabismus (P=.336) and type of amblyopia (P=.405). Although all of these subjects had subnormal DVA, but 43 subjects (26%) had normal NVA. In mild and moderate amblyopic groups, difference between DVA and NVA was 0.14±0.10 log MAR and 0.15±0.14 log MAR respectively, but in severe amblyopic group it was 0.03±0.08 log MAR. The difference between DVA and NVA showed a significant relation with severity of amblyopia (P<0.001). The difference between DVA and NVA was 0.16±0.11 log MAR in patients with history of amblyopia therapy and 0.07.± 0.11 log MAR in patients without treatment. This difference was statistically significant (P<0.001).Conclusion: Our results showed that near visual acuity in amblyopia especially in mild to moderate types was significantly better than distance visual acuity. More than 50% of subjects with mild amblyopia had normal near visual acuity. The difference between DVA and NVA showed no relation with age, spherical equivalent, strabismus, and type of amblyopia. Also, difference between the DVA and NVA in patients with history of amblyopia therapy was better than of it in non-treated subjects.

Development and Validation of a Mobile Visual Acuity Examination App for Universal Use, Including Remote and Rural Regions

Background: Visual refractive errors are projected to rise in the coming decades worldwide, especially in remote and rural regions. To combat this, smartphone visual acuity testing apps may allow for the early detection of refractive errors thanks to their low cost and wide availability. Hence, we developed the OcularCheck app as a free mobile vision screening tool for public health use. Objective: We sought to determine whether OcularCheck accurately measures distance visual acuity (DVA) in comparison to a standard Snellen chart (Space Saving Chart SSC-350). Methods and Results: In January 2021, we measured DVA in n=56 eyes using the OcularCheck app and a standard Snellen chart. To minimize bias, we used two separate examiners who were blinded to each other’s measurements. To assess the similarity of measurement methods, we performed a two-tailed, paired t-test and Bland-Altman analysis using the R-Project software. The t-test showed that differences in DVA between testing methods were not significant (P=0.698). Bland-Altman analysis showed that the mean difference between measurement methods was 0.01 LogMAR (95% CI -0.03 to 0.04), and the standard deviation of differences (0.139 LogMAR) was below the test-retest variability of the Snellen chart. The main limitation of the study was that we were not able to measure DVA with non-English optotypes. Conclusion: OcularCheck provides accurate DVA measurements, and it harbors the potential to expand the accessibility of DVA screening to resource-scarce regions.