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It has been promoted that disturbance of ocular proprioception may play a role in the pathogenesis of concomitant strabismus and other types of oculomotor anomalies. The aim of the study was to obtain knowledge about how surgical foreshortening of the myotendinous region potentially affects the proprioceptors that resides in this area of the muscles and to test the hypothesis that avoiding disruption of ocular proprioceptors result in a more favorable long term postoperative result. The distal end of the lateral and medial rectus muscles from patients with manifest concomitant strabismus with a deviation of ≥15 prism diopters (PD) were collected during strabismus surgery and processed for light microscopy by standard histochemical techniques. Histological analysis served to differentiate between the tissue samples containing pure tendon, versus samples containing the myotendinous junction. Criteria for successful outcome was defined as a residual angle of deviation less than 10 PD. The binocular status of the patient was measured pre- and post-operatively at 6-months of follow-up. Tissue samples from 43 patients (median age 19 years old, range 3-58 years) were collected during surgery. Twenty-six of the samples contained pure tendon, while 17 contained muscle fibres. The evolution of the post-operative result revealed a moderate reduction in the residual angle of deviation in patient-samples containing pure tendon. In contrast, the residual angle of deviation clearly increased in patient-samples containing muscle fibres. The difference between the two groups reached statistical significance after 6 months. Successful outcome was found to be more than three times more likely in cases where surgery was performed in pure tendon, compared to muscle fibres. The current study supports the hypothesis that avoiding disruption of ocular proprioceptors, located in the distal myotendinous region, results in a more favorable postoperative result.

Imaging-defined atherosclerosis represents an intermediate phenotype of atherosclerotic cardiovascular disease (ASCVD). Genome-wide association studies (GWAS) on directly measured coronary plaques using coronary computed tomography angiography (CCTA) are scarce. In the so far largest population-based cohort with CCTA data, we performed a GWAS on coronary plaque burden as determined by the segment involvement score (SIS) in 24,811 European individuals. We identified 20 significant independent genetic markers for SIS, three of which were found in loci not implicated in ASCVD before. Further GWAS on coronary artery calcification showed similar results to that of SIS, whereas a GWAS on ultrasound-assessed carotid plaques identified both shared and non-shared loci with SIS. In two-sample Mendelian randomization studies using SIS-associated markers in UK Biobank and CARDIoGRAMplusC4D, one extra coronary segment with atherosclerosis corresponded to 1.8-fold increased odds of myocardial infarction. This GWAS data can aid future studies of causal pathways in ASCVD. Here the authors present a genome-wide study linking 20 genetic markers to coronary plaque burden, revealing differences in coronary and carotid atherosclerosis genetics. It also demonstrates and quantifies a causal link between coronary plaques and myocardial infarction.

Paduca A, Lundmark PO, Bruenech JR. Clin Ophthalmol. 2023;17:1395-1405. Page 1396, Materials and Methods, first paragraph, line 4 the text \"recession/resection surgery\" should read \"recession/resection surgery for the first time\". Page 1396, Materials and Methods, first paragraph, line 5, the text \"intermittent\" should read \"intermittent with alphabetical pattern\". The authors apologize for this error.

To compare the short-term treatment effect of low plus reading addition (ADD) and home-based vision therapy (VT) in a small group of symptomatic children with accommodative infacility (AIF) being the most significant dysfunction. Nineteen children, 8 to 12 years of age, with a first-time diagnosis of AIF were consecutively and alternately allocated to treatment with ADD (+0.50 D addition in single vision Rx) or VT (accommodation exercises using Hart Charts) for a period of 6 weeks. Accommodation facility (AF) was measured monocularly (MAF-R, MAF-L) and binocularly (BAF) with +2 D/-2 D flipper and registered in cycles per minute (cpm). Symptoms were graded using the convergence insufficiency symptom survey (CISS). Measurements were compared before and after treatment and between groups using nonparametric statistics (p < 0.05). Ten children were allocated to ADD (median age 9.0 F:5) and 9 to VT (median age 11.0 F:7). Baseline median measurements of MAF-R, MAF-L, BAF and CISS were 3.0, 3.0, 2.2 cpm, and 27.5 points, respectively, for ADD, and 2.0, 2.0, 2.0 cpm, and 27.0 points, respectively, for VT. There were no significant differences between groups at baseline. After 6 weeks of treatment, the median change of MAF-R, MAF-L, BAF and CISS was +5.0, +4.5, +4.7 cpm, and -7.5 points, respectively, for ADD and +8.0, +8.0, +10.0 cpm, and -20.0 points, respectively for VT. All changes within groups were significant. Comparison of groups showed a significantly greater effect of treatment with VT compared to ADD for BAF (p = 0.008) and CISS (p = 0.017). In children with newly diagnosed AIF, treatment with accommodation exercises for 6 weeks gives greater short-term relief of symptoms and improvement of binocular accommodative facility compared to treatment with spectacle single vision correction with a weak plus addition.

To compare the repeatability of keratometry between different instruments in patients with hyperosmolar tear film and a control group. Subjects with tear-film osmolarity of 316 mOsm/L or more in either eye or 308 m/Osm/L or lower in both eyes were assigned to the hyperosmolar and the control group, respectively. The test eye was the eye with higher osmolarity in the hyperosmolar group and randomly chosen in the control group. The repeatability of keratometry was compared between a reflectometry device (Haag-Streit Lenstar 900), a Scheimpflug device (Oculus Pentacam HR) and two optical coherence tomography (OCT) devices (Tomey Casia SS-1000 and Heidelberg Anterion), based on two measurements from each device. The study included 94 subjects (31 hyperosmolar and 63 controls). Both OCT devices had higher mean differences of average simulated keratometry (SimK) vs the Lenstar in both groups, though all differences in means were <0.07 D. The Casia had the highest mean vector difference of SimK astigmatism in the control group (differences in means <0.11 D). These differences of the instruments were statistically significant ( < 0.02), except for the Anterion in the control group. With all subjects, the coefficient of repeatability varied from 0.1 to 0.3 for average SimK (highest for both OCT devices) and from 0.4 to 0.7 for SimK astigmatism (highest for the Casia). Similar results were found for total corneal power (OCT devices compared to the Pentacam). Both OCT devices show more variability in average SimK and the Casia more variability in SimK astigmatism compared to the Lenstar and the Pentacam. However, the results suggested that repeatability was not influenced by osmolarity.

To compare the refractive predictability of ray tracing IOL calculations based on OCT data versus traditional IOL calculation formulas based on reflectometry in patients with a history of previous myopic laser vision correction (LVC). This was a prospective interventional single-arm study of IOL calculations for cataract and refractive lens exchange (RLE) patients with a history of myopic LVC. Preoperative biometric data were collected using an optical low coherence reflectometry (OLCR) device (Haag-Streit Lenstar 900) and two optical coherence tomography (OCT) devices (Tomey Casia SS-1000 and Heidelberg Engineering Anterion). Traditional post LVC formulas (Barret True-K no-history and Haigis-L) with reflectometry data, and ray tracing IOL calculation software (OKULIX, Panopsis GmbH, Mainz, Germany) with OCT data were used to calculate IOL power. Follow-up examination was 2 to 3 months after surgery. The main outcome measure, refractive prediction error (RPE), was calculated as the achieved postoperative refraction minus the predicted refraction. We found that the best ray tracing combination (Anterion-OKULIX) resulted in an arithmetic prediction error statistically significantly lower than that achieved with the best formula calculation (Barret True-K no-history) (-0.13 D and -0.32 D, respectively, adjusted = 0.01), while the Barret TK NH had the lowest SD. The absolute prediction error was 0.26 D and 0.35 D for Anterion-OKULIX and Barret TK NH, respectively, but this was not statistically significantly different. The Anterion-OKULIX calculation also had the highest percentage of eyes within ± 0.25, compared to both formulas and within ±0.50 and ±0.75 compared to the Haigis-L ( = 0.03). Ray tracing calculation based on OCT data from the Anterion device can yield similar or better results than traditional post LVC formulas. Ray tracing calculations are based on individual measurements and do not rely on the ocular history of the patient and are therefore applicable for any patient, also without previous refractive surgery.

Background Strabismus is a complex disease that has various treatment approaches each with its own advantages and drawbacks. In this context, shared decisions making (SDM) is a communication process with the provider sharing all the relevant treatment alternatives, all the benefits, and risks of each procedure, while the patient shares all the preferences and values regarding his/her choices. In that way, SDM is a bidirectional process that goes beyond the typical informed consent. Therefore, it is known a little of the extent to which SDM influences the satisfaction with the treatment outcome along with strabismus patients. To study this correlation, an SDM-Q-9 questionnaire was provided within surgical consultations where treatment decisions were made; the SDM-Q-9 aims to assess the relationship between the post-operative patient’s satisfaction and their SMD score. Methods The study is considered a prospective observational pilot study. Eligible patients were adult patients diagnosed with strabismus, who had multiple treatment options, were given at the right of choice without being driven into a physician’s preference . Ninety-three strabismus patients were asked to fill out the SDM-Q-9 questionnaire related to their perception of SDM during the entire period of strabismus treatment. After the treatment, patients were asked to rate their satisfaction level with the surgical outcome as excellent, good, fair, and poor. Descriptive statistics and the linear regression statistical tests (Spearman, Mann Whitney U, and Kriskal–Wallis) were used as analysis tools. Results The average age of the participants was 24, where 50.6% were women. The mean SDM-Q-9 score among patients was 32 (IQR = 3). The postoperative patient satisfaction was rated as being excellent by 16 (17.2%) patients, good by 38 (40.9%), fair by 32 (34.4%), and poor by 7 patients (7.5%). Data analysis by linear regression statistical tests showed a positive correlation between the SDM-Q-9 score and the patient satisfaction related to the surgery outcome (B = 0.005, p < 0.001). Criteria in assessing patients’ satisfaction were age, gender, and strabismus type. A positive correlation between SDM and real satisfaction (r = 0.834, p < 0.01) was found with age, and no significant relationship was found while taking into consideration the responder’s gender and the strabismus type. Conclusions Assessing patient satisfaction after choosing a treatment for strabismus method helped us evaluate the gaps in constructive dialogue that would lead to a positive outcome for both patient and clinician. The correlation between the SDM process and the patients’ satisfaction with surgery outcome, adjusted by age, has been established. These findings can serve as a springboard to further communicative improvements related to the SDM process and between patients and physicians, thereby consequently leading to patients’ satisfaction raise in strabismus care. The study underlines the importance of further analysis and validation of on-ground interactions among the adolescent and adult patients and the clinicians across the strabismus management trajectory. A multicentral study and its validation will follow.

To compare the prevalence of dry eye disease (DED) as determined by signs and symptoms in patients with a history of laser vision correction (LVC) or implantable collamer lens (ICL) implantation 5-15 years ago with a matched control group with no history of refractive surgery. This was a cross-sectional case-control study. The subject population included patients who had LVC or ICL 5 to 15 years ago. The control group was age matched. A test eye was randomly chosen. Subjects were required to have good ocular health. DED was evaluated using categorical cut-off criteria for tear film osmolarity (measured in both eyes), the subjective Ocular Surface Disease Index (OSDI), the dynamic Objective Scatter Index (OSI), non-invasive keratography tear break-up time (NIKBUT), meibography, and the Schirmer 1 test. The study included 257 subjects (94 LVC, 80 ICL, 83 control). The frequency of hyperosmolarity was significantly higher in the LVC group vs the control (73% vs 50%, p = 0.002), In contrast, the frequency of subjective symptoms tended to be lower in the LVC group than in the control group (19% vs 31%; p = 0.06). These differences were not seen between the ICL and control group. The results suggest that LVC may cause tear film instability as indicated by hyperosmolar tears up to 15 years after surgery, with few subjective symptoms of dry eye. This may have implications for IOL calculations for cataract or refractive lens exchange later in life.

The increasing demand for primary eye care due to an aging population implicates an enhanced role of optometrists in the communities. The primary objective of this study was to investigate the rate of referrals and returning medical reports between optometrists and health care professionals in Norway. The secondary objectives were to investigate the conformity of diagnoses in referrals and medical reports, the extent of optometric follow-up examinations and the use of ophthalmic diagnostic drugs in optometric practice. This study is an ongoing prospective electronic survey administered on the Internet between November 2014 and December 2017. Optometrists in private optometric practice are eligible. Participants register data for up to 1 year, including examinations and the use of ophthalmic diagnostic drugs; referrals, including International Classification of Primary Care, second edition (ICPC-2) codes; medical reports, including the ICD-10 codes; and optometric follow-up enquiries. Analysis of agreement between referred and diagnosed conditions was made possible by encoding patients' ID. Seventeen months into the study, 67 optometrists were included (Female: 60%, mean age: 41 years.). There were 49,510 registered examinations (60% general, 28% contact lens, 12% auxiliary). Diagnostic drugs were used in 4% of these and in 14% of the examinations that resulted in a referral. There were 1,779 referrals (97% to ophthalmologists). Top three diagnoses were cataract (36%), glaucoma (11%), and age-related macular degeneration (7%). There were 1,036 returned medical reports, of which 76% could be linked with registered referrals. Diagnostic agreement was observed in 80% of the cases (74% for primary diagnoses). There were only 17 registered cases of optometric follow-ups. In Norway, nearly all referrals from optometrists are to ophthalmologists. More than half of these result in a returned medical report. Nonreturned reports do not seem to trigger optometric follow-ups. The diagnostic agreement between referrals and medical reports is high. Diagnostic ophthalmic drugs are used sparsely by optometrists and mostly in relation to referrals.

A large number of genome-wide association studies have been performed during the past five years to identify associations between SNPs and human complex diseases and traits. The assignment of a functional role for the identified disease-associated SNP is not straight-forward. Genome-wide expression quantitative trait locus (eQTL) analysis is frequently used as the initial step to define a function while allele-specific gene expression (ASE) analysis has not yet gained a wide-spread use in disease mapping studies. We compared the power to identify cis-acting regulatory SNPs (cis-rSNPs) by genome-wide allele-specific gene expression (ASE) analysis with that of traditional expression quantitative trait locus (eQTL) mapping. Our study included 395 healthy blood donors for whom global gene expression profiles in circulating monocytes were determined by Illumina BeadArrays. ASE was assessed in a subset of these monocytes from 188 donors by quantitative genotyping of mRNA using a genome-wide panel of SNP markers. The performance of the two methods for detecting cis-rSNPs was evaluated by comparing associations between SNP genotypes and gene expression levels in sample sets of varying size. We found that up to 8-fold more samples are required for eQTL mapping to reach the same statistical power as that obtained by ASE analysis for the same rSNPs. The performance of ASE is insensitive to SNPs with low minor allele frequencies and detects a larger number of significantly associated rSNPs using the same sample size as eQTL mapping. An unequivocal conclusion from our comparison is that ASE analysis is more sensitive for detecting cis-rSNPs than standard eQTL mapping. Our study shows the potential of ASE mapping in tissue samples and primary cells which are difficult to obtain in large numbers.