Efficacy of a new refractive multifocal contact lens for presbyopia.

This prospective single-arm study aimed to evaluate the clinical efficacy and safety of a refractive multifocal contact lens for the correction of presbyopia in 22 patients. The participants underwent clinical examinations before and 1 week after wearing a refractive multifocal contact lens (OptaCon ZOOM). The primary endpoints were the corrected distance visual acuity (CDVA) and distance-corrected near visual acuity (DCNVA). Defocus curve, contrast sensitivity, and ocular surface disease index (OSDI) were analyzed. A slit-lamp examination was performed for safety analysis. Contact lens comfort and patient satisfaction were assessed using a questionnaire. No significant difference in CDVA was observed before and 1 week after refractive multifocal contact lens use (p = 0.127), whereas DCNVA was significantly improved after 1 week (p < 0.001). The contrast sensitivity was not significantly affected at any spatial frequency under mesopic or photopic conditions. OSDI was significantly increased (p = 0.023). The patient-reported satisfaction scores were 96.2, 91.9, and 85.0 out of 100 at far, intermediate, and near distances, respectively. No significant adverse events were observed. Refractive multifocal contact lenses improved near vision while maintaining distance vision in presbyopic patients, without compromising contrast sensitivity. The study results suggest that OptaCon ZOOM can be considered safe and effective for the correction of presbyopia.

Causes of Punctal Plug Loss in Sjögren's Syndrome.

PURPOSE: To evaluate the long-term maintenance rate and associated factors of silicone punctal plugs in patients with Sjögren's syndrome (SS). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 patients with SS who underwent silicone punctal plug insertion between December 2013 and July 2021 at Severance Hospital. The status of punctal plug insertions was classified into the following three categories by the clinician: maintenance, spontaneous loss, and intended removal. Cox proportional hazards model was used to evaluate the risk factors for spontaneous loss. RESULTS: The mean maintenance period was 12.8±15.3 (median 7.07) months. The rate of spontaneous loss was 58%, and the rate of punctal plug removal by the clinician was 14%. The number of prior plug insertions was a risk factor for spontaneous loss [hazard ratio (HR) 1.055, p=0.035]. The upper eyelid punctum was at a higher risk than the lower one (p=0.042). Small-sized plugs showed a significantly higher risk for spontaneous loss than large-sized ones (HR 1.287, p=0.035). Flow-controller type plugs were more vulnerable to spontaneous loss than complete occluders [Micro Flow™ vs. EagleFlex® (HR 2.707, p=0.008) and Micro Flow™ vs. Ultraplug™ (HR 3.402, p=0.005)]. The most common reason for removal was tear overflow (5.6%). CONCLUSION: In repeated insertion, characteristics of the punctal plug, including the type and size, and location of plug insertion, influenced the spontaneous loss of plugs. The management of punctal plugs, including insertion, maintenance, and removal, requires personalized strategies for versatile situations.

Automatic measurement of mouse visual acuity based on optomotor response: SKY optomotry.

In the field of visual science study using rodents, several assessment methods have been developed for measuring visual function. However, methods such as electroretinograms tests, visual evoked potentials tests and maze tests have limitations in that they measure function of only a specific type of cells, are difficult to quantify or require sufficient training time. The method which uses an optokinetic reflex and optomotor response, a compensatory eye and head movement in response to changes in the visual scene, became the most widely used method. However, this method requires highly trained experimenters and is time consuming. We showed that measured visual acuity values are significantly different between beginner and expert. Here we suggest an automated optometry program, 'SKY optomotry', which automatically tracks rodents' optomotor response to overcome subjectivity and the lengthy scoring procedure of the existing method. To evaluate the performance of SKY optomotry using 8-12-week-old C57BL/6 mice we compared the binomial decision of SKY optomotry with a skilled expert, and the area under the curve of SKY optomotry was 0.845. Comparing the final visual acuity, the intraclass correlation coefficient value between SKY optomotry and an expert was 0.860 (95% confidence interval (CI) 0.709-0.928), whereas that between an expert and a beginner was 0.642 (95% CI 0.292-0.811). SKY optomotry showed an excellent level of performance with good inter-rater agreements based on the visual acuity measured by an expert. With the use of our application, researchers will be able to test an experimental animal's eyesight more accurately while saving time on specialized training.

Improvement in current drivability and stability in nanoscale vertical channel thin-film transistors via band-gap engineering in In-Ga-Zn-O bilayer channel configuration.

Vertical channel thin film transistors (VTFTs) have been expected to be exploited as one of the promising three-dimensional devices demanding a higher integration density owing to their structural advantages such as small device footprints. However, the VTFTs have suffered from the back-channel effects induced by the pattering process of vertical sidewalls, which critically deteriorate the device reliability. Therefore, to reduce the detrimental back-channel effects has been one of the most urgent issues for enhancing the device performance of VTFTs. Here we show a novel strategy to introduce an In-Ga-Zn-O (IGZO) bilayer channel configuration, which was prepared by atomic-layer deposition (ALD), in terms of structural and electrical passivation against the back-channel effects. Two-dimensional electron gas was effectively employed for improving the operational reliability of the VTFTs by inducing strong confinement of conduction electrons at heterojunction interfaces. The IGZO bilayer channel structure was composed of 3 nm-thick In-rich prompt (In/Ga = 4.1) and 12 nm-thick prime (In/Ga = 0.7) layers. The VTFTs using bilayer IGZO channel showed high on/off ratio (4.8 × 109), low SS value (180 mV dec-1), and high current drivability (13.6µAµm-1). Interestingly, the strategic employment of bilayer channel configurations has secured excellent device operational stability representing the immunity against the bias-dependent hysteretic drain current and the threshold voltage instability of the fabricated VTFTs. Moreover, the threshold voltage shifts of the VTFTs could be suppressed from +5.3 to +2.6 V under a gate bias stress of +3 MV cm-1for 104s at 60 °C, when the single layer channel was replaced with the bilayer channel. As a result, ALD IGZO bilayer configuration could be suggested as a useful strategy to improve the device characteristics and operational reliability of VTFTs.

Visual outcomes, spectacle independence, and patient satisfaction of pseudophakic mini-monovision using a new monofocal intraocular lens.

Modified monovision-or "mini-monovision"-is an alternative method to multifocal intraocular lenses (IOLs) for treating presbyopia. This study aimed to evaluate the clinical outcomes of patients bilaterally implanted with the new enhanced monofocal Tecnis Eyhance (ICB00) IOLs with the mini-monovision technique to improve near vision. In this retrospective case series, the medical records of 50 patients (100 eyes) who underwent bilateral cataract surgery were reviewed. Patients were divided into the Emmetropia and Mini-monovision groups based on the postoperative spherical equivalent and residual myopia. The binocular visual acuity for far (4 m), intermediate (66 cm), and near (40 cm) distances, binocular defocus curves, contrast sensitivity, visual symptoms, spectacle independence, and patient satisfaction rates were evaluated at 3 months postoperatively. The binocular uncorrected distance and intermediate visual acuities, contrast sensitivity, incidence of photic phenomena, and patient satisfaction were not significantly different between the two groups (p > 0.05). However, the binocular uncorrected near visual acuities and spectacle independence rates were significantly better in the Mini-monovision group (p < 0.001). Conclusively, the pseudophakic mini-monovision technique using enhanced monofocal IOLs may be a promising option for presbyopia correction in patients unsuitable for multifocal IOLs.

Artificial intelligence approach for recommendation of pupil dilation test using medical interview and basic ophthalmologic examinations.

Purpose: To evaluate the value of artificial intelligence (AI) for recommendation of pupil dilation test using medical interview and basic ophthalmologic examinations. Design: Retrospective, cross-sectional study. Subjects: Medical records of 56,811 patients who visited our outpatient clinic for the first time between 2017 and 2020 were included in the training dataset. Patients who visited the clinic in 2021 were included in the test dataset. Among these, 3,885 asymptomatic patients, including eye check-up patients, were initially included in test dataset I. Subsequently, 14,199 symptomatic patients who visited the clinic in 2021 were included in test dataset II. Methods: All patients underwent a medical interview and basic ophthalmologic examinations such as uncorrected distance visual acuity, corrected distance visual acuity, non-contact tonometry, auto-keratometry, slit-lamp examination, dilated pupil test, and fundus examination. A clinically significant lesion in the lens, vitreous, and fundus was defined by subspecialists, and the need for a pupil dilation test was determined when the participants had one or more clinically significant lesions in any eye. Input variables of AI consisted of a medical interview and basic ophthalmologic examinations, and the AI was evaluated with predictive performance for the need of a pupil dilation test. Main outcome measures: Accuracy, sensitivity, specificity, and positive predictive value. Results: Clinically significant lesions were present in 26.5 and 59.1% of patients in test datasets I and II, respectively. In test dataset I, the model performances were as follows: accuracy, 0.908 (95% confidence interval (CI): 0.880-0.936); sensitivity, 0.757 (95% CI: 0.713-0.801); specificity, 0.962 (95% CI: 0.947-0.977); positive predictive value, 0.878 (95% CI: 0.834-0.922); and F1 score, 0.813. In test dataset II, the model had an accuracy of 0.949 (95% CI: 0.934-0.964), a sensitivity of 0.942 (95% CI: 0.928-956), a specificity of 0.960 (95% CI: 0.927-0.993), a positive predictive value of 0.971 (95% CI: 0.957-0.985), and a F1 score of 0.956. Conclusion: The AI model performing a medical interview and basic ophthalmologic examinations to determine the need for a pupil dilation test had good sensitivity and specificity for symptomatic patients, although there was a limitation in identifying asymptomatic patients.

Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery.

Purpose: To assess the effects of femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery in the management of corneal astigmatism, compared with conventional phacoemulsification cataract surgery. Design: Retrospective comparative interventional case series. Methods: A total of 2,498 eyes of consecutive patients who presented with 3.00 diopters (D) or under of astigmatism were included. The patients were treated with conventional phacoemulsification cataract surgery (conventional group) and femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery (femtosecond group). Results: Surgically induced astigmatism (SIA) was higher in the femtosecond group than the conventional group (0.215, p < 0.001). Difference vector (DV) was lower in the femtosecond group (-0.136, p < 0.001). The cut-off value of the overcorrection in the femtosecond group was 0.752 D of target induced astigmatism (TIA). For patients with TIA 0.75 D or under, DV and the value of index of success (TIA into DV) were significantly higher in the femtosecond group (p = 0.022 and < 0.001). The overcorrection ratios were 48.8% in the conventional and 58.9% in the femtosecond group. (p < 0.001). For patients with TIA over 0.75 D, SIA and correction index (TIA into SIA) was higher in femtosecond group (0.310 and 0.250, p < 0.001 and < 0.001, respectively). Absolute angle of error was 20.612 ± 18.497 in the femtosecond group and higher than the conventional group (2.778, p = 0.010). Conclusion: Femtosecond laser arcuate keratotomy in cataract surgery was effective in SIA between 0.75 to 3.00 D of corneal astigmatism. However, the overcorrection in the lower astigmatism and angle of error in the higher astigmatism were due to the postoperative corneal astigmatism not decreasing as much as SIA. Overcoming these challenges will lead to better management of corneal astigmatism.

Patient selection for corneal topographic evaluation of keratoconus: A screening approach using artificial intelligence.

Background: Corneal topography is a clinically validated examination method for keratoconus. However, there is no clear guideline regarding patient selection for corneal topography. We developed and validated a novel artificial intelligence (AI) model to identify patients who would benefit from corneal topography based on basic ophthalmologic examinations, including a survey of visual impairment, best-corrected visual acuity (BCVA) measurement, intraocular pressure (IOP) measurement, and autokeratometry. Methods: A total of five AI models (three individual models with fully connected neural network including the XGBoost, and the TabNet models, and two ensemble models with hard and soft voting methods) were trained and validated. We used three datasets collected from the records of 2,613 patients' basic ophthalmologic examinations from two institutions to train and validate the AI models. We trained the AI models using a dataset from a third medical institution to determine whether corneal topography was needed to detect keratoconus. Finally, prospective intra-validation dataset (internal test dataset) and extra-validation dataset from a different medical institution (external test dataset) were used to assess the performance of the AI models. Results: The ensemble model with soft voting method outperformed all other AI models in sensitivity when predicting which patients needed corneal topography (90.5% in internal test dataset and 96.4% in external test dataset). In the error analysis, most of the predicting error occurred within the range of the subclinical keratoconus and the suspicious D-score in the Belin-Ambrósio enhanced ectasia display. In the feature importance analysis, out of 18 features, IOP was the highest ranked feature when comparing the average value of the relative attributions of three individual AI models, followed by the difference in the value of mean corneal power. Conclusion: An AI model using the results of basic ophthalmologic examination has the potential to recommend corneal topography for keratoconus. In this AI algorithm, IOP and the difference between the two eyes, which may be undervalued clinical information, were important factors in the success of the AI model, and may be worth further reviewing in research and clinical practice for keratoconus screening.

Comparison of two different contrast sensitivity devices in young adults with normal visual acuity with or without refractive surgery.

This study investigated the reliability and correlation of two contrast sensitivity test (CST) devices in young adults with normal visual acuity, with or without refractive surgery. 57 patients aged 20-39 years who received both manual (OPTEC-6500) and automated CST (CGT-2000) examinations from June 19 to July 24, 2021 were retrospectively enrolled. Patients with corrected visual acuity under 20/20 or history of ocular surgery other than refractive surgery were excluded. 82 eyes of 41 patients (40 eyes with and 42 without history of refractive surgery) were enrolled. Mean time taken to complete each examination was 396.4 ± 20.4 and 286.8 ± 2.3 s using manual and automated CST, respectively (P < 0.001). Patients who underwent refractive surgery had significantly decreased area under the log contrast sensitivity formula (AULCSF) in mesopic compared with photopic conditions in automated CST examinations (AULCSF difference 0.415 vs. 0.323 in patients with and without refractive surgery, P < 0.001), but there was no significant difference in manual CST examinations. Patients who reported decreased subjective night vision had significantly decreased AULCSF in automated CST examinations, but there was no significant difference in manual CST examinations. Compared with manual CST, automated CST was quicker and correlated well with decrease in subjective night vision.

De Novo L509P Mutation of the TGFBI Gene Associated with Slit-Lamp Findings of Lattice Corneal Dystrophy Type IIIA.

Background: Mutations of the transforming growth factor-ß-induced (TGFBI) gene produce various types of corneal dystrophy. Here, we report a novel de novo L509P mutation not located in a known hot spot of the transforming growth factor-ß-induced (TGFBI) gene and its clinical phenotype, which resembles that of lattice corneal dystrophy type IIIA (LCD IIIA). Case presentation: A 36-year-old man (proband) visited our clinic due to decreased visual acuity with intermittent ocular irritation in conjunction with painful recurrent erosions in both eyes for 10 years. Molecular genetic analyses revealed a TGFBI L509P mutation (c.1526T>C) in the proband and one of his sons. Interestingly, neither TGFBI mutations nor corneal abnormalities were detected in either of the proband's biological parents, indicating the occurrence of a de novo L509P mutation. Clinical examinations, including slit-lamp retro-illumination and Fourier-domain anterior segment optical coherence tomography (FD-OCT), revealed gray deposits in the anterior stroma and deeper refractile lines extending from limbus to limbus in both corneas of the proband, consistent with a diagnosis of LCD IIIA. Superficial diffuse haze and surface irregularity were observed in conjunction with corneal erosions and visual impairment, necessitating phototherapeutic keratectomy (PTK). A 60 µm PTK of the Bowman layer and anterior stroma of the proband's left eye was performed following the removal of the epithelium in order to remove superficial corneal opacities. His BCVA improved from 20/400 to 20/50 at postoperative week 8 and was maintained for 45 months. Pinhole-corrected VA was 20/20 at the last visit, and corneal opacities had not recurred. Conclusions: An inheritable de novo mutation of L509P in the TGFBI gene can produce severe LCD IIIA, which can be successfully treated with OCT-guided PRK.

Artificial Intelligence for the Estimation of Visual Acuity Using Multi-Source Anterior Segment Optical Coherence Tomographic Images in Senile Cataract.

Purpose: To investigate an artificial intelligence (AI) model performance using multi-source anterior segment optical coherence tomographic (OCT) images in estimating the preoperative best-corrected visual acuity (BCVA) in patients with senile cataract. Design: Retrospective, cross-instrument validation study. Subjects: A total of 2,332 anterior segment images obtained using swept-source OCT, optical biometry for intraocular lens calculation, and a femtosecond laser platform in patients with senile cataract and postoperative BCVA ≥ 0.0 logMAR were included in the training/validation dataset. A total of 1,002 images obtained using optical biometry and another femtosecond laser platform in patients who underwent cataract surgery in 2021 were used for the test dataset. Methods: AI modeling was based on an ensemble model of Inception-v4 and ResNet. The BCVA training/validation dataset was used for model training. The model performance was evaluated using the test dataset. Analysis of absolute error (AE) was performed by comparing the difference between true preoperative BCVA and estimated preoperative BCVA, as ≥0.1 logMAR (AE≥0.1) or <0.1 logMAR (AE <0.1). AE≥0.1 was classified into underestimation and overestimation groups based on the logMAR scale. Outcome Measurements: Mean absolute error (MAE), root mean square error (RMSE), mean percentage error (MPE), and correlation coefficient between true preoperative BCVA and estimated preoperative BCVA. Results: The test dataset MAE, RMSE, and MPE were 0.050 ± 0.130 logMAR, 0.140 ± 0.134 logMAR, and 1.3 ± 13.9%, respectively. The correlation coefficient was 0.969 (p < 0.001). The percentage of cases with AE≥0.1 was 8.4%. The incidence of postoperative BCVA > 0.1 was 21.4% in the AE≥0.1 group, of which 88.9% were in the underestimation group. The incidence of vision-impairing disease in the underestimation group was 95.7%. Preoperative corneal astigmatism and lens thickness were higher, and nucleus cataract was more severe (p < 0.001, 0.007, and 0.024, respectively) in AE≥0.1 than that in AE <0.1. The longer the axial length and the more severe the cortical/posterior subcapsular opacity, the better the estimated BCVA than the true BCVA. Conclusions: The AI model achieved high-level visual acuity estimation in patients with senile cataract. This quantification method encompassed both visual acuity and cataract severity of OCT image, which are the main indications for cataract surgery, showing the potential to objectively evaluate cataract severity.

Femtosecond laser-assisted cataract surgery after corneal refractive surgery.

Cataract is the leading cause of blindness worldwide, and advanced cataract techniques such as femtosecond laser-assisted cataract surgery (FLACS) have been commercially available. Corneal refractive surgery (CRS) is one of the most popular surgeries for the correction of refractive errors. CRS changes the cornea not only anatomically but also pathophysiologically. However, there has been no clinical research analyzing the refractive and safety outcomes of FLACS after CRS. The aim of this retrospective chart review and comparative study is to evaluate the effect and safety of FLACS after CRS comparing with conventional PCS. Participants with a previous CRS history who underwent FLACS or conventional PCS were included in this study. The visual outcomes and the refractive outcomes including refractive, corneal, and ocular residual astigmatism were compared. The safety outcomes were then studied intraoperatively and postoperatively. A total of 102 patients with age-related cataract were enrolled. At 3 months postoperatively, UCVA, BCVA, and predictive error were not significantly different between the FLACS and conventional PCS groups. Reduction of refractive astigmatism was higher in FLACS. Postoperative ORA was significant lower in FLACS. Reduction of ORA was higher in FLACS. The intraoperative and postoperative complications were also not significantly different between the two groups. FLACS could effectively change refractive astigmatism and ORA; without more complications than conventional PCS. FLACS' competitive edge in postoperative ORA may provide better visual quality than conventional PCS in patients with a previous history of CRS.

Analysis of keratometric measurements in accordance with axial length in an aged population.

To investigate keratometric measurements according to axial length in an aged population. Patients requiring cataract surgery with keratometric measurements from four different ophthalmic devices (autorefractor/keratometer, Scheimpflug imaging, corneal topography/ray-tracing aberrometry, and partial coherence interferometry) between January 2016 and March 2021 were reviewed retrospectively. Cases for which four ophthalmic devices were deployed in the same order a day were included in this investigation. The corneal curvature of the flattest and steepest meridian, mean corneal curvature, corneal astigmatism, steepest axis location, and axial length were evaluated. In total, 250 eyes (137 patients) were included in the analysis. A negative correlation was found between mean corneal curvature and axial length, with correlation coefficients of 0.587, 0.592, 0.588, 0.591, 0.588, and 0.562 for autorefractor/keratometer, Scheimpflug imaging, corneal topography/ray-tracing aberrometry, partial coherence interferometry, total corneal refractive power of Scheimpflug imaging, and simulated keratometry of corneal topography/ray-tracing aberrometry measurements, respectively. No statistically significant differences were found for corneal astigmatism according to axial length. In axial length group of less than 26.0 mm, negative correlation was found between axial length and mean frontal corneal curvature while no correlation was found between axial length and corneal astigmatism. All four ophthalmic devices showed good inter-device reliability for mean corneal curvature but not corneal astigmatism.

Effects of meibomian gland dysfunction and aqueous deficiency on friction-related disease.

PURPOSE: To evaluate the effects of meibomian gland dysfunction (MGD) and aqueous deficiency (AD) on friction-related disease (FRD). METHODS: Cross-sectional comparative study. This study included 550 eyes (550 patients) with dry eye disease (DED). The DED subtype and dynamic tear-film parameters by automated assessments were investigated for the analysis of FRD (superior limbic keratoconjunctivitis, conjunctivochalasis, and lid wiper epitheliopathy). RESULTS: Patients with FRD had a higher proportion of moderate-to-severe MGD and AD (p < 0.001 and p < 0.001, respectively). The dropout rate of the meibomian gland was higher (30.5 ± 31.8 and 14.1 ± 25.0%, p < 0.001), tear meniscus height (TMH) was lower (227.8 ± 60.4 and 241.7 ± 55.6 µm, p = 0.008), and he first non-invasive keratographic tear break-up time (NIKBUT-1) was shorter (5.9 ± 3.5 and 7.3 ± 3.7 s, p < 0.001) in patients with FRD than in those without FRD. In the logistic regression analysis with clinical manifestation, both moderate-to-severe MGD and AD were associated with FRD (odds ratios [OR] 12.27, 95% confidence interval [CI] 7.72-19.50, and 2.31, 95% CI 1.43-3.71], p < 0.001 and p < 0.001, respectively). The dropout rate was positively associated with FRD (OR 1.017, 95% CI 1.010-1.023, p < 0.001). TMH and NIKBUT-1 were negatively associated with FRD (OR 0.995, 95% CI 0.991-0.999, and 0.90, 95% CI 0.85-0.95, p = 0.039 and p < 0.001, respectively). CONCLUSIONS: This study showed that FRD was highly associated with MGD and meibomian gland dropout rate, suggesting that FRD may be mainly affected by lipid components. AD and TMH also had a good but relatively lower association with FRD, compared to MGD and meibomian gland dropout rate.

How Long to Continue Eyelid Hygiene to Treat Meibomian Gland Dysfunction.

To determine the efficacy duration of eyelid hygiene for meibomian gland dysfunction (MGD) treatment, a total of 1015 participants with primary MGD, followed for at least 6 months, were enrolled. The participants were classified into the eyelid hygiene group and the control group. The participants who had stopped eyelid hygiene at any point in the observation period after the initial 2 months were classified into the withdrawal group. Analysis was conducted with a generalized linear mixed model. Treatment group, age, sex, ocular surface inflammation, anti-inflammatory treatments, and baseline MGD subtype were considered as fixed effects, and the individual factor was considered as a random effect. The MGD stage decreased significantly for the observational period in the eyelid hygiene group (p < 0.001). Approximately 40.1% of the participants continuously maintained eyelid hygiene throughout the observational period. The MGD stage in the eyelid hygiene group continued to decrease for 6 months and was maintained thereafter. After 4 months of stopping eyelid hygiene, the MGD stage in the withdrawal group was worse than in the eyelid hygiene group (p < 0.001) and similar to that in the control group (p = 0.762). Maintaining eyelid hygiene was significantly effective in MGD treatment. Efficacy increased with treatment for 6 months, and the efficacy duration was maintained for 4 months even after stopping eyelid hygiene. Therefore, we recommend that patients with MGD maintain eyelid hygiene, and compliance should be checked continuously.

Comparison of Treatment Modalities for Dry Eye in Primary Sjögren's Syndrome.

PURPOSE: To evaluate the effectiveness of different treatment modalities for dry eye in primary Sjögren's syndrome with their potential overlapping influences. METHODS: This study included 199 patients with newly diagnosed primary Sjögren's syndrome from 2005 to 2020. Various treatment modalities for primary Sjögren's syndrome were compared. Improvement of corneal staining based on Sjögren's International Collaborative Clinical Alliance (SICCA) scores was the primary outcome. RESULTS: The average follow-up period was 5.4 ± 3.1 (range, 2.0-14.1) years. Analysis of the individual treatments showed that punctal plug insertions in the lower and upper eyelids were strongly associated with improvement of SICCA scores (ß = 2.70 and 1.80, p < 0.001 and <0.001, respectively). With ocular surface inflammation, corneal staining scores improved significantly with steroid eye drops. Prednisolone (1%) had the strongest association with improvement of corneal staining scores (ß = 1.48, p < 0.001); this was based on the frequency of administration. Without ocular surface inflammation, diquafosol (3%), carbomer gel, and lanolin ointment were effective (ß = 1.37, 1.06, and 1.17; p = 0.003, 0.003, and <0.001, respectively). CONCLUSIONS: Punctal plug insertion, primarily targeting aqueous deficiency, is the mainstay of the treatment for dry eye in primary Sjögren's syndrome even in the presence of ocular surface inflammation. Furthermore, the effectiveness of treatment modalities for dry eye in primary Sjögren's syndrome was dependent on the presence of ocular surface inflammation.

Artificial intelligence method to classify ophthalmic emergency severity based on symptoms: a validation study.

OBJECTIVES: We investigated the usefulness of machine learning artificial intelligence (AI) in classifying the severity of ophthalmic emergency for timely hospital visits. STUDY DESIGN: This retrospective study analysed the patients who first visited the Armed Forces Daegu Hospital between May and December 2019. General patient information, events and symptoms were input variables. Events, symptoms, diagnoses and treatments were output variables. The output variables were classified into four classes (red, orange, yellow and green, indicating immediate to no emergency cases). About 200 cases of the class-balanced validation data set were randomly selected before all training procedures. An ensemble AI model using combinations of fully connected neural networks with the synthetic minority oversampling technique algorithm was adopted. PARTICIPANTS: A total of 1681 patients were included. MAJOR OUTCOMES: Model performance was evaluated using accuracy, precision, recall and F1 scores. RESULTS: The accuracy of the model was 99.05%. The precision of each class (red, orange, yellow and green) was 100%, 98.10%, 92.73% and 100%. The recalls of each class were 100%, 100%, 98.08% and 95.33%. The F1 scores of each class were 100%, 99.04%, 95.33% and 96.00%. CONCLUSIONS: We provided support for an AI method to classify ophthalmic emergency severity based on symptoms.

Clinical Characteristics and Disease Progression in Early-Stage COVID-19 Patients in South Korea.

A rapid increase in the number of patients with coronavirus disease 19 (COVID-19) may overwhelm the available medical resources. We aimed to evaluate risk factors for disease severity in the early stages of COVID-19. The cohort comprised 293 patients with COVID-19 from 5 March 2020, to 18 March 2020. The Korea Centers for Disease Control and Prevention (KCDC) classification system was used to triage patients. The clinical course was summarized, including the impact of drugs (angiotensin II receptor blockers [ARB], ibuprofen, and dipeptidyl peptidase-4 inhibitors [DPP4i]) and the therapeutic effect of lopinavir/ritonavir. After adjusting for confounding variables, prior history of drug use, including ARB, ibuprofen, and DPP4i was not a risk factor associated with disease progression. Patients treated with lopinavir/ritonavir had significantly shorter progression-free survival than those not receiving lopinavir/ritonavir. KCDC classification I clearly distinguished the improvement/stabilization group from the progression group of COVID-19 patients (AUC 0.817; 95% CI, 0.740-0.895).

The Influence of Parental Myopia on Children's Myopia in Different Generations of Parent-Offspring Pairs in South Korea.

PURPOSE: To compare the heritabilities of myopia and high myopia across three different generations in Korea. METHODS: Parent-offspring pairs of different age groups were included: two parents and their offspring aged 10-19 ("young families"), two parents and their offspring aged 20-29 ("middle-aged families"), and two parents and their offspring aged 30-45 ("older families") were selected from the 2008-2012 Korea National Health and Nutrition Examination Survey. Variance component methods were used to obtain the heritability estimates for myopia and high myopia using parent-offspring pairs from three generations. Spherical equivalents measured in the right eyes were used. RESULTS: From the 2008-2012 data, 2,716, 1,211, and 477 offspring from 1,807 young, 956 middle-aged, and 434 older families were eligible for the study, respectively. For myopia, the additive genetic portion of phenotypic variance was smaller in the younger families (74.7% in the older families, 48.1% in the middle-aged families, and 40.1% in the young families), and the non-shared environmental portion was greater in the younger families (12.4% in older families, 24.9% in middle-aged families, and 46.5% in young families). In contrast, for high myopia, the additive genetic portion remained roughly constant at approximately 60% in all three generations. CONCLUSIONS: With myopia, the environmental portion of the phenotypic variance increased and the additive genetic portion decreased as South Korea became more urbanized. With high myopia, the additive genetic portion remained roughly constant at approximately 60%, despite the urbanization.