Facial ageing . . . and other stories

When high quality photographs of the faces of 2700 middle aged and older participants in a longitudinal study were assessed by a panel without knowledge of their chronological age and medical history, people whose perceived age was lower than their chronological age were less likely to have osteoporosis, chronic obstructive pulmonary disease, hearing loss, or cataracts. Energy expenditure and incident type 2 diabetes Data from 90 000 participants in the UK Biobank study who wore an accelerometer for seven days reveal a linear relation between the amount of energy expended during physical activity and the subsequent incidence of type 2 diabetes—even after adjusting for body mass index. A study using data for 1.5 million prescriptions of PPIs in UK general practice found an increased risk of diagnosis of an inflammatory bowel disease in the first two years after treatment started.

Head turning is an effective cue for gaze following: Evidence from newly sighted individuals, school children and adults.

In referential communication, gaze is often interpreted as a social cue that facilitates comprehension and enables word learning. Here we investigated the degree to which head turning facilitates gaze following. We presented participants with static pictures of a man looking at a target object in a first and third block of trials (pre- and post-intervention), while they saw short videos of the same man turning towards the target in the second block of trials (intervention). In Experiment 1, newly sighted individuals (treated for congenital cataracts; N = 8) benefited from the motion cues, both when comparing their initial performance with static gaze cues to their performance with dynamic head turning, and their performance with static cues before and after the videos. In Experiment 2, neurotypical school children (ages 5-10 years; N = 90) and adults (N = 30) also revealed improved performance with motion cues, although most participants had started to follow the static gaze cues before they saw the videos. Our results confirm that head turning is an effective social cue when interpreting new words, offering new insights for a pathways approach to development.

Estimating Societal Costs Associated With Vision Loss And Delayed Cataract Surgery: The Potential Impact Of The COVID-19 Pandemic

IntroductionCataract surgery is the most commonly performed surgical procedure in the UK (approx. 472,000 annually). The suspension of interventions due to the COVID-19 pandemic, has had a devastating impact on patients' access to care. In the UK a complete cessation of elective cataract surgery during the crisis has been an unfortunate reality and encompassed a 14 week hiatus to services in the National Health Service. Patients on prolonged waiting lists may experience negative outcomes during the wait period, including vision loss, increased risk of falls, and ultimately, poorer health-related quality of life (HRQoL). The objective of this research was to estimate the potential societal costs associated with vision-loss related to prolonged waiting times for cataract surgery, as a consequence of COVID-19 in the UK.MethodsIn this analysis, we present estimates relating to two cohorts: a hypothetical cohort of 1,000 cataract surgeries and quarterly estimates of cataract surgeries in the UK. Quarterly estimates (n=122,969) were chosen to reflect a suspension of cataract surgeries for 14 weeks during the COVID-19 crisis. UK cataract surgery numbers were attained from EUROSTAT. Estimates for decreasing visual acuity for those waiting for surgery were attained from the literature, as were the cost estimates associated with cataract-related sight-loss, which were made up of direct, indirect and intangible costs. Five scenarios (at 20% intervals) were simulated for the cost estimates, assuming from 20 percent to 100 percent clearing of waiting lists.ResultsFor cohort 1 (1,000 patients), the societal costs associated patients remaining on waiting list for one year, ranged between GBP 237,765 (EUR 279,533) (20% of patients remain untreated) to GBP 1.18m (EUR 1.39m) (100% remain untreated). For cohort 2 (n=122,969) cost estimates are in the region of GBP 29.23m to GBP 146.18m (EUR 34.36m to EUR 171.73m). Estimates consist of direct (15.6%), indirect (28.7%) and intangible costs (55.6%).ConclusionsCataract surgery is a sight saving procedure and its impact on HRQoL is overwhelmingly positive. Prolonged waiting times for cataract patients due to COVID-19 is likely to be associated with significant societal costs.

Diagnostic accuracy of machine learning classifiers for cataracts: a systematic review and meta-analysis

Objective: The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Method(s): MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Result(s): Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815-0.987] and specificity was 0.960 [95% CI: 0.924-0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696-0.960] and specificity was 0.891 [95% CI: 0.807-0.942]. Conclusion(s): The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration: CRD42020219316. Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

LPL Gene Mutation in Type 1 Familial Triglyceridemia Presenting as Recurrent Pancreatitis and Complicated by COVID19

A 7-year-old girl with recurrent episodes of pancreatitis with risk factor of poorly controlled hyperglyceridemia presented with an acute episode of pancreatitis. She was managed conservatively and underwent whole exome sequencing which showed a likely pathogenic LPL gene mutation. Incidentally, she was diagnosed with COVID-19 on screening, which we hypothesize to have triggered the recent episode. On further examination, she was found to have bilateral cataracts. Her hypercholesterolemia was effectively managed with dietary therapy, high dose omega 3, and gemfibrozil. Our case report sensitizes the clinician to use a modern diagnostic tool such as whole exome sequencing in children with recurrent pancreatitis where hypertriglyceridemia is a known risk factor. This child is the first case of LPL mutation reported in India.

Pseudomembranous Conjunctivitis following Exposure to Arisaema ringens Sap: A Case Report

Plants of the Araceae family exude a sap containing calcium oxalate, a toxic substance that causes dermatitis. However, ocular injury due to exposure to Araceae sap has rarely been reported. Herein, we present a case of severe pseudomembranous conjunctivitis following exposure to Arisaema ringens, an Araceae species and popular houseplant in Japan. A 67-year-old man presented with pain in his right eye after exposure to the sap of A. ringens. At presentation, the best corrected visual acuity and intraocular pressure in the right eye were 20/800 and 15 mm Hg. Slit-lamp examination showed strong hyperemia, conjunctival chemosis, and corneal edema with many pseudomembranes, and fluorescein staining revealed corneal epithelial defects in the central area of the cornea. We washed the ocular surface with saline and initiated treatment with topical instillations of 1.5% levofloxacin and 0.1% betamethasone, combined with ofloxacin eye ointment. After repeatedly removing the pseudomembranes and increasing the frequency of the topical instillations, pseudomembranous conjunctivitis and corneal erosion gradually improved. One week following the injury, the corneal epithelial defects were no longer detectable, and the patient’s best corrected visual acuity recovered to 20/25. It is important for ophthalmologists and primary care physicians to be aware of the ocular toxicity of A. ringens and should counsel their patients accordingly. Moreover, preventative measures, such as the use of protective eyewear, should be taken when cutting this houseplant.

Cataracts in setting of multisystem inflammation after COVID-19 vaccination.

Purpose: To describe a unique case of bilateral cataract formation in the setting of multisystem inflammation after the 1st dose of the BNT162b2 mRNA COVID-19 vaccination. Observations: A previously healthy 20-year-old male developed intumescent bilateral cataracts leading to visual decline from 20/20 to 20/300-20/400 in each eye, likely from systemic inflammation after vaccination. Conclusion and importance: This is the first reported case of cataract formation following a COVID-19 vaccine. While ocular adverse effects associated with COVID-19 vaccination are rare, it is important to raise awareness of these entities amongst medical providers as the COVID-19 pandemic continues and vaccinations become widespread.

Reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic.

Purpose: To analyze the reasons for delay in cataract surgery in patients with advanced cataracts during the COVID-19 pandemic. Methods: This was a prospective, cross-sectional, multicenter questionnaire study which included patients with mature cataract, nuclear sclerotic cataract grade IV, and cataracts with best corrected visual acuity (BCVA) <5/60, during the COVID-19 pandemic from December 2020 to April 2021. Reasons for delay in presentation to the hospital were analyzed. Results: One thousand four hundred seventy two patients were recruited with advanced cataracts. Absence of ophthalmic care nearby (44.2%), lack of awareness regarding elective surgeries (42.6%), lack of public transportation (37%), fear of contracting COVID-19 (23.4%), and waiting for outreach camps (20.4%) were found to be the reasons behind the delay in cataract surgery. 53.7% of the patients had worsening of defective vision and 55.3% of them had difficulty in carrying out activities of family living. 30.8% of the patients faced difficulty in commuting and 8.4% of the patients suffered a fall during this pandemic due to worsening of the visual acuity. Conclusion: The lockdown imposed during the pandemic has created a significant backlog of patients who are progressing to advanced cataracts due to lack of ophthalmic care nearby, lack of awareness regarding elective surgeries, lack of public transportation, and no outreach camps. Proactive measures to deal with this backlog are of utmost need to prevent blindness due to cataract.

Three-Year Follow-up of a 2-Year-Old Patient with Scleral-Fixated Carlevale Intraocular Lens Implantation

According to the patient's history, the child had an earlier lens extraction with IOL implantation procedure in another center due to unilateral congenital cataract. In our opinion, the acrylic material and the elastic architecture of the haptics permit them to stretch or compress without causing significant stress to the scleral and conjunctival tissue. [...]despite the lens being manufactured and used for adults as previously mentioned, it could also be a great option for use in cases in children. [...]concerning visual acuity, the patient had a BCVA of 0.17 decimal with glasses with refraction correction of +5.00 sphere and −2.00 cylinder × 60°.

A Retrospective Study on the Eye-Related Quality of Life, Functional Vision, and Their Determinants Among Children Following Congenital and Developmental Cataracts Surgery and Its Impact on Their Families Using the PedEyeQ.

Objectives: To evaluate the eye-related quality of life (ER-QOL), functional vision, and their determinants in children following congenital and developmental cataract surgery, as the impact on their families, using the Pediatric Eye Questionnaire (PedEyeQ). Materials and Methods: This was a retrospective cross-sectional study involving 107 children (aged 0-11 years) with congenital and developmental cataracts who had undergone surgery, as well as 59 visually healthy controls (aged 0-11 years). One parent for each child completed either the Proxy 0-4 PedEyeQ, the Proxy 5-11 PedEyeQ, or the Parent PedEyeQ, depending on their child's age. Mann-Whitney U and Kruskal-Wallis tests were then conducted to compare the differences between groups and to analyze their determinants. Results: PedEyeQ scores were found to be lower in postoperative children with congenital and developmental cataracts compared with the control group across all study domains. The PedEyeQ Proxy 0 to 4 years' greatest mean difference was 27 points worse in the Functional Vision domain (95% CI -34 to -19; p < 0.001). We also found that the occurrence of nystagmus (p < 0.005) and strabismus (p < 0.005) were the major factors affecting participants' functional vision. The PedEyeQ Proxy 5 to 11 years' greatest mean difference was 23 points worse in this same domain (95% CI -30 to -15; p < 0.001), with nystagmus (p < 0.05) being the main determinant herein. Parent PedEyeQ 0 to 4 years' greatest difference was 46 points worse on the Worry about their Child's Eye Condition domain (95% CI -57 to -36; p < 0.001). Similarly, parents of children with ophthalmologic abnormalities, including nystagmus (p < 0.001) and strabismus (p < 0.05), were significantly more worried about their children's eye condition. Parent PedEyeQ 5 to 11 years' greatest difference was also found to be 30 points worse on the Worry about their Child's Eye Condition domain (95% CI -43 to -17; p < 0.005). Conclusions: Children who have undergone congenital and developmental cataract surgery experience a lower quality of life and reduced functional vision. Their families are also significantly and adversely affected herein. Thus, more attention is needed on these groups, with more focused measures being administered to both children and their families.

A Deep Learning Ensemble Method to Visual Acuity Measurement Using Fundus Images

Visual acuity (VA) is a measure of the ability to distinguish shapes and details of objects at a given distance and is a measure of the spatial resolution of the visual system. Vision is one of the basic health indicators closely related to a person’s quality of life. It is one of the first basic tests done when an eye disease develops. VA is usually measured by using a Snellen chart or E-chart from a specific distance. However, in some cases, such as the unconsciousness of patients or diseases, i.e., dementia, it can be impossible to measure the VA using such traditional chart-based methodologies. This paper provides a machine learning-based VA measurement methodology that determines VA only based on fundus images. In particular, the levels of VA, conventionally divided into 11 levels, are grouped into four classes and three machine learning algorithms, one SVM model and two CNN models, are combined into an ensemble method in order to predict the corresponding VA level from a fundus image. Based on a performance evaluation conducted using randomly selected 4000 fundus images, we confirm that our ensemble method can estimate with 82.4% of the average accuracy for four classes of VA levels, in which each class of Class 1 to Class 4 identifies the level of VA with 88.5%, 58.8%, 88%, and 94.3%, respectively. To the best of our knowledge, this is the first paper on VA measurements based on fundus images using deep machine learning.

Changing trend in the morphology of cataracts at a tertiary eye care centre in South India due to COVID-19-pandemic related national lockdown.

Purpose: To study the changing trends in the morphology of cataracts at a tertiary eye care center in South India due to COVID-19 pandemic-related national lockdown. Methods: A retrospective study conducted at a tertiary eye care center in Andhra Pradesh state of South India, which included 1724 patients (1753 eyes) who underwent cataract surgery at our center during April 2019-July 2019 (1298 eyes of 1271 patients) and April 2020-July 2020 (455 eyes of 453 patients). Factors studied included preoperative lens status, associated phacodonesis or subluxation, pupil size, other eye lens status, associated retinal problems, glaucoma, and complications during surgery. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal clarity, intraocular pressure (IOP), and disc status at postoperative day 1, 1 week, and 1-month visits were compared. Results: A significantly lower proportion of nuclear sclerosis (decreased from 83.2% in last year before lockdown to 55.2% during lockdown) and significantly higher proportions of mature, brown, or black cataract and phacomorphic, phacolytic, or Morgagnian cataract (increased from 15.5% in last year before lockdown to 43.8% during lockdown) were observed. The proportion of small-incision cataract surgery decreased significantly (from 63.2% to 57.4%), whereas the proportion of phacoemulsification increased significantly (from 35.9% to 41.5%) during lockdown as compared to last year. A significantly higher proportion of eyes with small pupils and association with retinal pathology were also observed during the lockdown. Conclusion: During the national lockdown, there was a shift from nuclear sclerosis grade toward mature, brown, black grade of cataracts. In addition, the proportion of small-incision cataract surgery decreased significantly whereas the proportion of phacoemulsification increased significantly during the lockdown. More number of cataracts with small pupils and associated retinal pathology were observed during the lockdown.

Orbital infarction syndrome secondary to rhino-orbital mucormycosis in a case of COVID-19: Clinico-radiological features.

Orbital infarction syndrome is an uncommon pathology with devastating consequences. It is frequently secondary to atherothrombotic phenomena in the internal carotid artery. We report a case of a 66-year-old male with uncontrolled diabetes and use of systemic steroids for COVID-19, who presented with a sudden loss of vision in the left eye, with total ophthalmoplegia and diffuse opacification of the retina. On imaging, he was found to have features of rhino-orbital cellulitis with ischemia of the orbital tissue secondary to isolated ophthalmic artery obstruction (OAO) with a patent internal carotid artery. KOH mount of deep nasal swab was confirmatory of mucor. This is the first reported case of orbital infarction syndrome in the setting of COVID-19.