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.

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.

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.

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.

Development of a reliable preoperative risk stratification system for phacoemulsification.

PURPOSE: To present a statistically validated risk classification system for intraoperative complications in cataract surgery. SETTING: 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. DESIGN: Prospective observational study. METHODS: All patients underwent phacoemulsification surgery by experienced, high-volume surgeons for cases with intraoperative complications. The presence of several risk factors was statistically assessed with the help of multiple correspondence analysis to determine the more reliable rank categorization for severity and to calculate a total risk score. RESULTS: This study included 1572 consecutive patients. The proposed system had 3 risk groups and a no-risk group and had high statistical reliability. A comparison of this system against a previously asserted empirical system showed higher internal reliability. CONCLUSIONS: Previous efforts to construct a risk classification system for intraoperative complications in cataract surgery have been empirically defined and tested against practice-as-usual. The system in this study quantified risk more accurately and provided an experienced clinician with a reliable means of assessing the preoperational likelihood of intraoperative complications.

The Impact of Internet and Videogaming Addiction on Adolescent Vision: A Review of the Literature.

During the past decade, vision problems that were attributed to the use of electronic screens have gradually shifted from being a workplace health issue to a wider public health issue. "Computer vision syndrome" originally related to the few professionals exposed to long hours of work in front of a computer screen. The widespread use of digital screens in devices used throughout the day have led to the emergence of "digital eye strain" as a new clinical syndrome that affects every individual who spends a large period of time fixated on multiple screens, for work or leisure. A new subcategory, "video game vision" has been proposed to specifically address vision issues related to large periods of continuous use of screen enabled devices in order to play video games. With gaming disorder being included in the next version of the WHO classification of diseases (ICD-11), it is becoming increasingly important to have a clear idea of the impact of this disorder in general health and functioning. At the same time, a number of research studies have reported positive impact of videogame playing on the players vision. This article reviews the latest research studies on the impact of digital screen enabled devices on adolescent vision in light of the increasing reports of internet addiction and gaming disorder while referencing positive findings of videogaming on vision in order to provide a balanced approach and assist with classification, diagnosis and treatment, while providing directions for future research.

Retinal nerve fiber layer thickness in patients with exfoliation, exfoliative glaucoma, and primary open angle glaucoma.

PURPOSE: to evaluate the retinal nerve fiber layer(RNFL) profile of healthy controls, persons with exfoliation syndrome (XFS), and patients with exfoliation glaucoma (XFG) and primary open angle glaucoma(POAG). METHODS: One eye from each of 269 participants was analyzed. Fifty eyes were normal , 45 eyes had XFS, 89 eyes had POAG, and 89 had XFG. Glaucoma patients were divided according to the severity of the disease into mild and advanced groups. All participants underwent imaging with the GDx-VCC device. Measurements of the parameters TSNIT average, TSNIT SD, and nerve fiber indicator (NFI) were performed. Polametric RNFL thickness values were compared by means of Bonferroni-corrected t-tests. RESULTS: Regarding control and glaucoma groups, statistically significant differences were identified in all GDx parameters. RNFL thickness values of the control group differed significantly from the values of the XFS group. There was no statistically significant difference between RNFL thickness values for the mild POAG and mild XFG groups or for the advanced POAG and advanced XFG groups. CONCLUSIONS: Polarimetry-determined RNFL in eyes with XFS is thinner than that of healthy eyes. No differences in RNFL thickness were found when eyes with POAG and XFG of similar severity were compared.

Alkaline reflux gastritis: early and late results of surgery.

BACKGROUND: Alkaline gastritis is caused by excessive reflux of alkaline duodenal content into the stomach or gastric remnant following procedures that resect or de-functionalize/deviate the pyloric sphincter. The symptoms may be intractable and surgery may be required in a selected subgroup of patients. The goal of this study was to present our experience regarding surgical management of alkaline reflux gastritis. MATERIALS AND METHODS: During a 15-year period, 26 patients underwent surgery for the management of refractory alkaline reflux gastritis. Preoperative evaluation included a detailed history, endoscopy, and histology; alkaline reflux gastritis was characterized as mild, moderate, or severe based on the results of this evaluation. The patients underwent remedial gastric surgery when conservative management was ineffective and the patient's symptoms-despite medical treatment-persisted for at least 2 years and affected quality of life. Most patients had previously undergone subtotal gastrectomy/gastrojejunostomy (the Billroth II procedure) (22/26, 84.6%); three patients (11.5%) had vagotomy and gastrojejunostomy, and 1 patient (3.9%) had vagotomy and pyloroplasty. In most patients (14/26, 54%), symptoms appeared 1-3 years after initial gastric surgery. Epigastric pain and bilious vomiting were reported by all (26/26, 100%) and by 25/26 (96%) of patients, respectively, while anemia and weight loss were observed in 11/26 (42.3%) and 18/26 (69.2%), respectively. Severe, moderate, and mild gastritis was present in 12, 9, and 5 patients, respectively. Most patients (18/26, 69%) were treated by Roux-en-Y anastomosis, and 8 (31%) by the Tanner (Roux-19) procedure. Long-term follow-up was completed in 23 patients (mean: 7.3 years), by clinical assessment (n=18), or by questionnaire (n=5). Results were assessed by using the Visick grading. RESULTS: One patient died from massive pulmonary embolism (mortality: 3.8%). Morbidity was 57%, with the Roux stasis syndrome being the most frequent complication (n=9). Both procedures achieved good early results, particularly regarding pain relief and absence of vomiting (84% and 96%, respectively). Endoscopic findings were ameliorated 6 months following surgery, whereas histological changes remained relatively unchanged. Eleven patients (47.8%) reported excellent (Visick I), 9 (39.2%) good, and 3 (13%) unsatisfactory late results. CONCLUSIONS: Remedial gastric surgery was effective and achieved symptom relief in a significant percentage (87%) of our patients. The Roux stasis syndrome is a frequent complication following Roux-en-Y reconstruction, but quality of life is significantly improved. Careful patient selection is essential to achieve satisfactory results.