Investigating mental rehearsal's applicability in guiding independent E-learning (IMAGINE) of eye examination skills during the pandemic.

BACKGROUND: COVID-19's infection control policies have hindered the Deliberate Practice of clinical examinations. Guided Mental Rehearsal (GMR) may overcome this obstacle by facilitating independent, repetitive practice. Underpinned by the 'Motor Simulation Theory,' GMR reinforces similar neuro-circuit activations during physical practice and was proven effective in surgical training. METHODS: This prospective, randomized controlled study evaluated the efficacy of GMR versus 'peer-learning' of Confrontational Visual Field Examination (CVFE). Third-year medical-students without clinical Ophthalmology experience were recruited. Controls (n = 40) watched an e-learning instructional video (8-min CVFE tutorial) followed by 6-min of 'peer-learning.' GMR-students (n = 40) had 'peer-learning' replaced by a 6-min GMR audio-recording (CVFE running commentary). Pre-test and post-test MCQs were administered to determine baseline knowledge and knowledge acquisition, respectively. 28 controls and 26 GMR-students performed CVFE on simulated patients with right homonymous hemianopia. Four Ophthalmologists graded their performances using a checklist-based marking scheme. RESULTS: Both groups did not exhibit a significant difference in pre-test scores (8.550 vs. 7.947, p = 0.266); outcome of sub-group analysis of CVFE-performing candidates was similar (8.214 vs. 7.833, p = 0.561). Post-test scores were significantly higher than pre-test in both groups (all p < .001), without inter-group difference (14.000 vs. 15.000, p = 0.715). GMR-group had significantly higher scores on CVFE performance than controls (85.354 vs. 73.679%, p = .001). CONCLUSIONS: GMR improved psychomotor but not cognitive aspect of learning CVFE. This may be attributable to GMR's theoretical resemblance with physical practice, with additional expert guidance. By enabling independent learning, GMR may also reduce the demand for teaching manpower and thus education cost in the future.

Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review.

Purpose: To evaluate the visual outcomes and safety profile of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the treatment of diabetic macular edema (DME) in real-world studies in Asian countries. Methods: A systematic review of electronic literature databases (Embase, Medline, and the Cochrane Library from January 1, 2010, to March 16, 2021) was conducted to identify observational studies that reported clinical and safety outcomes of anti-VEGF treatments for DME in Asia. We analyzed baseline patient characteristics, treatment patterns, mean number of injections, best-corrected visual acuity (BCVA), retinal thickness, and safety outcomes. Results: Seventy-one studies were included in this review. Most studies reported treatment of DME with ranibizumab (n = 33), followed by aflibercept (n = 13), bevacizumab (n = 28), and conbercept (n = 9). At 12 months, the cumulative mean number of injections for ranibizumab, aflibercept, and conbercept was 5.2, 4.6, and 6, respectively. At the 12-month follow-up, the cumulative mean BCVA gain was 6.8 letters (ranibizumab), 4.6 letters (aflibercept), 4.9 letters (bevacizumab), and 8.3 letters (conbercept). The cumulative mean reduction in retinal thickness at 12 months was 116.9 µm (ranibizumab), 105.9 µm (aflibercept), 81.7 µm (bevacizumab), and 135.2 µm (conbercept). A strong positive correlation (r = 0.78) was observed between mean number of injections and change in BCVA at 12 months. A moderate positive correlation (r = 0.54) was observed between mean number of injections and mean reduction in retinal thickness at 12 months. A weak positive correlation was observed between baseline retinal thickness and visual acuity at 12 months. Baseline BCVA and mean number of injections were predictors of BCVA at 12 months. Conclusion: All anti-VEGFs were effective in the treatment of DME in Asia. The data suggest that a greater number of anti-VEGF injections was associated with better improvement in BCVA and moderate reduction in retinal thickness at the 1-year follow-up.

Case of unilateral anaemic retinopathy unmasking colorectal carcinoma.

Anaemic retinopathy presents commonly with bilateral retinal haemorrhages and soft exudates. Unilateral optic disc oedema in these patients has rarely been mentioned. We report a case of an atypical presentation of anaemic retinopathy with recurrent unilateral optic disc oedema and retinal haemorrhages secondary to iron deficiency anaemia from a newly diagnosed colorectal adenocarcinoma.A man in his 70s with multiple ischaemic risk factors was referred for unilateral optic disc oedema associated with a few retinal haemorrhages. Initial diagnosis was that of impending central retinal vein occlusion. The optic disc oedema initially resolved but recurred 8 months later with worsening unilateral disc oedema, 'coin-shaped' retinal haemorrhages, Roth's spots and venous tortuosity. Full blood count showed microcytic hypochromic anaemia secondary to iron deficiency and colonoscopy revealed colorectal adenocarcinoma. The patient received blood transfusions, oral iron replacement and underwent surgical resection of the tumour. The anaemia resolved, and the fundus findings resolved as well.

BISPHOSPHONATE-INDUCED BILATERAL ANTERIOR UVEITIS AND CHOROIDAL EFFUSIONS WITH SECONDARY ANGLE CLOSURE.

PURPOSE: To report a case of bisphosphonate-induced bilateral anterior uveitis and choroidal effusions with secondary angle closure in a 64-year-old female patient. METHODS: Observational case report. RESULTS: A 64-year-old woman with history of scleroderma and antiphospholipid syndrome, presented with bilateral painless blurring of vision after commencement of alendronate. Clinical examination revealed bilateral anterior uveitis and choroidal effusions with resultant secondary angle closure in the left eye. Ultrasound biomicroscopy showed bilateral anteriorly rotated ciliary bodies. There was also a -2D myopic shift in the left eye. On drug cessation, complete resolution was seen within 2 weeks. CONCLUSION: In the absence of other plausible etiologies and with recent commencement of a new drug, we postulate that the anterior uveitis and choroidal effusions are likely due to alendronate. This is further supported by complete resolution of the inflammation and effusions once alendronate was withheld.

Aqueous humor protein dysregulation in primary angle-closure glaucoma.

PURPOSE: Primary angle-closure glaucoma (PACG) is associated with increased intraocular pressure, optic nerve damage, and progressive vision loss, but the molecular mechanism that underpins retinal ganglion neuropathy in PACG remains poorly understood. To better understand the pathogenesis of human PACG, we performed the first comprehensive proteomic analysis of aqueous humor (AH) samples from PACG patients and matched control donors to study pathogenic alteration in AH composition in disease. METHODS: High-resolution, label-free, liquid chromatography-tandem mass spectrometry-based quantitative proteomic analyses were performed in AH samples collected from PACG patients and a matched control cohort of patients with cataracts. RESULTS: The AH proteome comprised of 1363 distinct proteins, of which more than 50% were differentially expressed in PACG (773 total; 501 up-regulated, 272 down-regulated). AH from PACG patients was enriched in atypical collagens and fibronectins, suggesting that the composition of the trabecular matrix is significantly altered in disease. Pathway and cluster analyses revealed that AH protein modulation in PACG is closely associated with biological processes including platelet degranulation, cellular import/export mechanisms, and control of protease activity. In addition, critical mediators of oxygen homeostasis and neuronal function in AH were significantly dysregulated in disease, strongly implicating oxidative stress responses in PACG-associated nerve damage. CONCLUSIONS: Altered AH proteome in human PACG indicated oxidative stress in the neuronal damage that preceded vision loss. Identifying key mediators of PACG pathology will yield new prognostic biomarkers and novel targets for future therapeutic interventions.

Retinal detachments in the pediatric population.

In this review, we present a concise summary of the more commonly seen types of retinal detachments (RDs) that one can encounter in pediatric patients. A spectrum of diseases from rhegmatogenous RD in Stickler syndrome, Marfan syndrome, and choroidal coloboma to exudative RD in Coats disease, to tractional RD in persistent fetal vasculature, and combined RDs in familial exudative vitreoretinopathy are described with the management pearls for each.