Pediatric Central Retinal Artery Occlusion Attributed to a Patent Ductus Arteriosus.

This report presents a rare case of a central retinal artery occlusion in an eight-year-old girl attributed to an undiagnosed patent ductus arteriosus (PDA). Despite intensive treatment, the patient's eyesight failed to improve. Cases of central retinal artery occlusion may occur in patients with undiagnosed, small PDA, with only symptomatic treatment being available.

No End in Sight; Assessing the Impact of Internet Gaming Disorder on Digital Eye Strain Symptoms and Academic Success.

BACKGROUND: Internet Gaming Disorder (IGD) has been associated with symptoms of Digital Eye Strain (DES) and poor academic performance among adolescent students. The purpose of this study is to assess whether a student's achievement of a specific academic goal within a short period of time can be directly predicted by symptoms of IGD and DES. METHODS: This is a cross-sectional survey of 140 high school graduates who received an examination of visual acuity as a pre-requisite for entering the written admission examinations of law enforcement and military academies. The students completed the Digital Eye Strain Questionnaire (DESQ) and the Ten-Item Internet Gaming Disorder Test (IGDT-10) and stated their own evaluation of their chances for success. They were contacted following their admission examinations, and their success or failure to be admitted was recorded. RESULTS: The students with IGD symptomatology were more likely to present with symptoms of DES. They were also more pessimistic about their chances of success in the subsequent written admission examinations; none succeeded, while the rest of the students recorded an expected rate of success. A combination of IGD and complaints related to the prolonged fixation of the upper body in a specific viewing position was the best predictor variable set for future success in admission examinations. CONCLUSIONS: IGD is associated with a failure to achieve academic success. Combining a factor for physical discomfort during prolonged sessions of gaming with the typical criteria for IGD may expand the predictive validity of the construct of gaming disorder.

Bipolar Disorder and Gaming Disorder-Compatible or Incompatible Diagnoses?

Gaming Disorder (GD) is one of the latest additions in the psychiatric taxonomy, following its official inclusion in the latest revision of the International Classification of Diseases (ICD-11). This narrative review examines the rationale of an exclusion criterion for the diagnosis of GD, that of disordered gaming being limited exclusively during an episode of elevated mood in bipolar disorder. The history of the formulation of diagnostic criteria for the disorder and all relevant published studies are examined critically, and conclusions are drawn as to the potential validity and usability of the exclusion criterion. Suggestions are offered for future research to elucidate not only the relevance of the exclusion criterion but also the differential diagnosis of GD with pathological gambling (PG).

A Psychoanalytic Approach to Internet Gaming Disorder.

BACKGROUND: Internet Gaming Disorder (IGD) is now an official diagnosis and significant public health challenges have been already identified regarding the provision of appropriate care to patients of all ages and the preparedness of mental health professionals to manage the disorder. Despite the existence of psychotherapeutic treatment modalities available for some time now, there is a paucity of any psychoanalytically driven treatments and the disorder is widely regarded and classified as being 'behavioral'. This has profound implications for patients with long-standing character pathology and psychiatric comorbidities, who are underserved by the provision of health services that could efficiently address their issues. METHODS: This study presents a psychoanalytic perspective on IGD, based on Kohut's Self Psychology as applied in the treatment of other addictions. An outline of the theory, assessment and treatment modalities is presented with two case reports that illustrate its application. RESULTS: The presentation outlines the challenges in treating IGD, expanding on the concept of guided imagery, resistance to treatment, selfobject transference and comorbidity with marijuana use and bipolar disorder. CONCLUSIONS: A psychoanalytically driven protocol can be effective in treating IGD, especially in cases with marked character pathology and low motive to engage in other treatment modalities.

Validation of the Greek version of the contact lens dry eye questionnaire-8 (CLDEQ-8).

PURPOSE: Contact lens discomfort (CLD) has been cited as one of the prime reasons for discontinuing contact lens wear. The CLDEQ-8 was created in 2008 to reflect status of and change in overall opinion of soft contact lenses. The purpose of this study is to examine the validity and reliability of a Greek version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8), using Rasch statistical analysis. METHODS: This an observational prospective study of 150 consecutive patients who received soft contact lenses and were followed through with a single follow-up appointment up to a year following their initial one. The patients filled in the Greek versions of the CLDEQ-8, the Ocular Surface Disease Index (OSDI) and a self-report item on their experience of contact lens use. The CLDEQ-8 was analyzed with Rasch analytic methodology. RESULTS: The original scoring system of the CLDEQ-8 had to be altered regarding the response categories collapsing in fewer options in items b, 2b, 3b and item 5 of the original scale. The revised scoring system proved more psychometrically valid and the CLDEQ-8 had good measurement precision, category threshold order, targeting and differential item functioning for gender. Two alternative result indexes are proposed, a symptom intensity index and a symptom frequency index to address dimensionality issues that are evident with the items relating to symptom intensity versus the rest. Results from the CLDEQ-8 correlated with the OSDI total score and the self-reported experience of contact lens use. CONCLUSIONS: The Greek version of the CLDEQ-8 is a psychometrically valid and reliable assessment tool for contact lens discomfort in Greek-speaking populations.

The Effect of Statins on Ocular Disorders: A Systematic Review of Randomized Controlled Trials.

AIM: Statins have been established in the market not only due to their ability to lower plasma cholesterol levels but also due to their pleiotropic effects. In the literature, there is a controversy regarding the role of statins in ophthalmology. We aimed to systematically address the possible effect of statin therapy on ocular diseases and to identify if there is a beneficial relationship. METHODS: We searched PubMed and Cochrane Library databases up to 31 December 2022 for studies evaluating the effect of statins on ocular diseases. We included all relevant Randomized Control Trials (RCTs) that have been conducted in the adult population. PROSPERO registration number: CRD42022364328. RESULTS: Nineteen RCTs were finally considered eligible for this systematic review, with a total of 28,940 participants. Ten studies investigated the role of simvastatin, suggesting a lack of cataractogenic effect and a possible protective role in cataract formation, retinal vascular diseases, and especially diabetic retinopathy, age-related macular disease progression, and non-infectious uveitis. Four studies investigated lovastatin, showing no cataractogenic effect. Three studies examined atorvastatin, revealing conflicting results regarding diabetic retinopathy. Two studies examined rosuvastatin, indicating a possibly harmful effect on lenses and a significant protective effect on retinal microvasculature. CONCLUSIONS: Based on our findings, we believe that statins have no cataractogenic effect. There are indications that statins may have a protective role against cataract formation, AMD, diabetic retinopathy progression, and non-infectious uveitis. However, our results were insufficient for any robust conclusion. Future RCTs, with large sample sizes, on the current topic are therefore recommended to provide more solid evidence.

Spotlight on Digital Eye Strain.

Digital Eye Strain (DES) is a clinical syndrome manifested with visual disturbances and/or ophthalmic dysfunction related to the usage of screen-enabled digital equipment. This term is gradually replacing the older term computer vision syndrome (CVS) that focused on the same symptoms found on personal computer users. DES is encountered more frequently during the past years due to the explosive increase in the usage of digital devices and subsequent increase in time in front of any screens. It presents with a series of atypical symptoms and signs stemming from asthenopia, dry eye syndrome, preexisting untreated vision issues and poor screen ergonomics. This review summarizes research data to date to determine whether the concept of DES has been conclusively defined and demarcated as a separate entity and if sufficient guidance is offered on professionals and the lay public. The maturity of the field, grouping of symptoms, examination techniques, treatment and prevention modalities are summarily presented.

The Multifarious Effects of Various Glaucoma Pharmacotherapy on Corneal Endothelium: A Narrative Review.

Corneal endothelium is a single cell layer that is mainly responsible for maintaining corneal clarity. Endothelial damage secondary to toxicity, stress, or genetic predisposition are common and in conjunction with the low regenerative ability of the cells, making their preservation critical for maintaining visual acuity. Patients with glaucoma, who are estimated to be close to 80 million worldwide, have a plethora of reasons for developing endothelial damage, being exposed to a spectrum that extends from various medical and surgical interventions to the disease itself. The wide spectrum of glaucoma pharmacotherapy that has been recently extended by addition of newer classes of medications has been the focus of extensive research on its effects on corneal endothelium. Both basic and clinical research have attempted to shine a light on the complex mechanisms associated with the effects of glaucoma medication on corneal endothelium and to answer the important question as to whether these findings are clinically significant. The aim of this review is to summarize and present current literature of the various findings, both from in vivo and in vitro studies that have focused on the complex relationship between different classes of glaucoma medication and their effect on corneal endothelium.

Correction of Presbyopia Alone Does Not Adequately Protect against Digital Eye Strain from Handheld Devices.

SIGNIFICANCE: The use of screen-enabled handheld devices has increased exponentially during the last few years among the older adults. Up until now, a general suggestion for preventing symptoms of digital eye strain with large screen use was to address any existing refractive error, including presbyopia. It is unclear whether this advice is of consequence in the case of smaller handheld devices. PURPOSE: The aim of this study was to examine whether correcting presbyopia ameliorates the negative effect on digital screen use, examining handheld devices where these issues are expected to be more acute with presbyopic individuals. METHODS: This is a cross-sectional study of 120 consecutive participants who had received correction for presbyopia during the past month and returned for a routine follow-up examination. The participants filled in a demographics questionnaire, questions on time spent online and using devices with digital screens, data on their eye complaints, and the validated Digital Eye Strain Questionnaire (DESQ). RESULTS: The DESQ factor scores and total score correlated with the near addition ( P < .001). Higher DESQ scores were associated (by order of magnitude) with higher near addition and a lower amount of time spent using a handheld screen-enabled device ( P < .001) while controlling for age and type of corrective lenses. CONCLUSIONS: Results indicate that older adults are at an additional disadvantage while using handheld screen-enabled devices compared with younger adults: they are more likely to be presbyopes and need higher near addition, yet increasing near addition does not guarantee greater comfort in the use of smartphones but rather increase the likelihood of experiencing digital eye strain symptoms.

Association of Cyberbullying and Internet Use Disorder.

Purpose of Review: The purpose of this review is to critically assess the published studies on the relationship between cyberbullying and internet use disorder (IUD), and propose directions for further study. Recent Findings: There were only four prospective studies out of thirty-two reviewed studies conducted since 2004, with only one prospective study conducted during the past 5 years. The field of study has been stagnant during the past 5 years with the vast majority of studies conducted on primary or secondary education and failing to address cyberbullying and IUD in social media and online gaming. Summary: Cyberbullying and IUD have been described since the nineties, yet there are still significant issues with their definition and research. Lately, both these problematic behaviors are sharing the same environments in social media and online gaming. This critical appraisal of published research examined thirty-two published peer-reviewed studies carried out since 2004. Findings indicate a number of significant issues including an overreliance on cross-sectional study design, near-exclusive focus on primary and secondary education students, widespread employment of unstandardized measures for cyberbullying and IUD, and lack of assessment for objective measures of psychological distress. Directions for future research are offered.

A Review on Pathogens and Necessary Diagnostic Work for Bleb-Related Infections (BRIs).

At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.

Drop in well-being of ARMD patients under treatment with anti-VEGF injections during the COVID-19 pandemic.

PURPOSE: Patients with age-related macular degeneration (ARMD) are required to follow a treatment protocol that requires regular follow-ups. The COVID-19 pandemic has created an additional burden for patients with ARMD under treatment with anti-vascular endothelial growth factor (anti-VEGF) injections, since patients face a congestion of the health system and closing of the outpatient services. This study examines the impact of the uncertainty regarding patients' treatment on their sense of well-being. METHODS: This is a longitudinal cohort study of eighty patients who were followed during the year following the outbreak of the COVID pandemic. Patients reported their sense of well-being with the WHO-5 questionnaire and their perception and fears for the impact of the pandemic on their ongoing ARMD treatment. RESULTS: There was a significant drop in mental well-being during the pandemic that paralleled the self-reported impact of the pandemic on ARMD treatment. Patients who reported a higher impact of COVID-19 on their treatment had experienced a higher drop in mental wellbeing compared to those who hadn't, with female gender being an additional risk factor. Objective measurements of visual acuity did not factor in the drop of sense of well-being. CONCLUSIONS: The high initial level of uncertainty regarding ARMD patients' long-term course was further exacerbated when exposed to additional uncertainties during the pandemic regarding their standard of care. Planning ahead for continuation of services and close contact with patients during similar health emergencies is of paramount importance.

Blue Light Blocking Treatment for the Treatment of Bipolar Disorder: Directions for Research and Practice.

Recent results from a small number of clinical studies have resulted in the suggestion that the process of blocking the transmission of shorter-wavelength light ('blue light' with a wave length of 450 nm to 470 nm) may have a beneficial role in the treatment of bipolar disorder. This critical review will appraise the quality of evidence so far as to these claims, assess the neurobiology that could be implicated in the underlying processes while introducing a common set of research criteria for the field.

Validation of the Digital Eye Strain Questionnaire and pilot application to online gaming addicts.

INTRODUCTION: 'Digital eye strain' (DES) is a clinical syndrome with eyesight symptoms related to continuous engagement in front of a screen-enabled digital device. With use of these devices constantly on the rise, the related symptoms have become prominent, even in younger ages. This study describes the process of validating the Digital Eye Strain Questionnaire (DESQ), a thirteen-item self-report scale in a yes-no format designed to offer a measure of complaints related to digital eye strain syndrome (DES). METHODS: The validation process included 150 outpatients with no long-standing eye disease who were examined for various eye complaints and 50 outpatients who were diagnosed with gaming addiction according to WHO ICD-11 clinical criteria. All participants filled in a demographics questionnaire, the DESQ, the Computer Vision Syndrome Questionnaire (CVS-Q) and the Problematic Internet Use Questionnaire-9 (PIUQ-9). RESULTS: Principal component analysis of categorical variables confirmed the proposed three-factor DES structure with a total of 61.02% of explained variance and Cronbach's alpha equal to.94. Concurrent validity was assessed by comparing the results of the DESQ to the CVS-Q while convergent validity was assessed by examining correlations of the DESQ with results from the PIUQ-9 questionnaire. In all cases the DESQ demonstrated excellent reliability and validity. CONCLUSIONS: Results indicate that the DESQ questionnaire can be employed to reliably measure the symptomatology of digital eye strain in clinical populations who present either with eye issues or with excessive use of the gaming and screen-enabled devices in general.

Personality of patients with central serous chorioretinopathy.

INTRODUCTION: Central serous chorioretinopathy (CSC) is a disease of the retina that is a frequent cause of mild to moderate visual impairment. The disease can be precipitated by psychosocial stress and hypercortisolism while full remission will often be spontaneous within a few months. Risk factors have included male gender, increased plasma cortisol due to other conditions or steroid use and Type A behavior. METHODS: This is a cross-sectional study comparing three research groups that included 100 CSC patients, 200 healthy volunteers, and 200 patients with other ophthalmic disease on their results in the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). RESULTS: CSC patients differed from the other subjects on increased high Neuroticism-Anxiety, low Sociability, and high Aggression-Hostility. CONCLUSIONS: Since high Neuroticism is related to increased cortisol levels only in males, and high Aggression-Hostility is related to increased cortisol response, these findings point to the possibility of a robust neurobiological background to the etiopathogenesis of CSC that merits further research. The association of Type A behavior with CSC may be a spurious one and its widespread reference in ophthalmology texts should be re-examined.

Improvement in general health after cataract surgery is not limited to vision-specific function.

Cataract surgery is known to have a beneficial impact on quality of life. Recent studies claimed that disease-specific measures of functional impairment are more sensitive to preoperative functional impairment and gains from surgery than are generic measures of general health and quality of life. The purpose of this study is to ascertain whether measures of general health provide additional information on the improvement of patients following cataract surgery over measures of visual function. This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and were evaluated for changes in health-related quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) and improvement in visual-related functioning with the 14-item Visual Function test (VF-14). All of the SF-36 subscales improved post operatively with the magnitude of improvement in VF-14 significantly affecting all subscales except for the Vitality subscale. Treatment effects were significant for the SF-36 subscales 'Role limitations due to physical health', 'Role limitations due to emotional problems', 'Social Functioning' and 'General Health', while taking into account the difference in VF-14 scores pre and postoperatively (p < 0.001). The outcome of phacoemulsification surgery for cataract cannot be completely ascertained solely by the measurement of improvement on tasks related to visual functioning, leaving unaccounted a component related to self-appraisal of ability in everyday and social function, as well as the general feeling of subjective health. The concurrent use of general health measures with visual functioning measures to account for the general improvement on health status following cataract surgery is thus justified.

Examining different outcome measures for reliability in assessing the impact of cataract surgery in quality of health.

INTRODUCTION: The aim of this study was to determine a reliable combination of vision-specific measures and general health measures to assess the improvement on the patient's QoL following cataract surgery either when patients had first time surgery or had already received successful surgery in the fellow eye for cataract. METHODS: Study sample included two waves of data measurement in 150 patients undergoing uncomplicated cataract surgery who were assessed for visual acuity, vision-specific quality of life, and general health. Data were acquired pre-surgery and 2 months post-surgery. About 90 patients haven't had prior cataract surgery while 60 patients had prior successful cataract surgery in the fellow eye. RESULTS: There was considerable improvement in all outcome measures following cataract surgery. Patients who have had prior surgery presented with modestly higher scores in the vision-specific QoL measures and minimal benefit pre-operatively compared to those who haven't had any surgery in the general health measure. They also had more gains post-surgery in the vision-specific QoL measures only. CONCLUSIONS: There is a possibility that gains in QoL plateau after a certain level of visual acuity improvement. While improvement can be detected with a general health QoL measure, this measure may require additional psychometric validation to the particular population beforehand. Otherwise, a combination of vision-specific outcome measures will provide the most reliable estimate.

Patient Adherence to Glaucoma Treatment During the COVID-19 Pandemic.

Introduction In medicine, patient adherence refers to the degree to which a patient correctly follows medical advice, and it most commonly pertains to medication or drug compliance. Patient adherence to glaucoma treatment has been a frequent and serious issue that is associated with adverse long-term outcomes. The purpose of this study was to determine the factors that are associated with adherence to glaucoma treatment among patients during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods This was a cross-sectional study involving 100 consecutive glaucoma outpatients who were interviewed based on the modified version (ARMS2-COVID) of the original Adherence to Refills and Medications Scale 2 (ARMS2) that examined adherence to medication. Length of treatment and disease onset along with basic demographic details (gender, age, socioeconomic status, and educational levels) of the patients were also recorded. Results The COVID-19 pandemic has disproportionally impacted patients of older age (p=0.033) and lower educational levels (p<0.001) with regard to their ability to follow their treatment plan regardless of the duration of previous treatment. Conclusions Based on our findings, in order to ensure higher levels of patient adherence among patients of older age with limited education, more planning will be required, aided by appropriate educational interventions and proactive patient follow-ups.