Effect of Visual Impairment on Teleretinal Imaging for Diabetic Retinopathy Screening.

BACKGROUND AND OBJECTIVE: To evaluate the effect of decreased visual acuity on image quality obtained by non-mydriatic retinal photography in diabetic subjects. PATIENTS AND METHODS This case-control study comprised 422 eyes (211 cases with ungradable images after non-mydriatic retinal photography, and 211 controls). All subjects underwent complete ophthalmic examination. The association between ungradable image rate and several eye factors, such as corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatism, and cataracts, was evaluated using a generalized estimating equations model. RESULTS: Visual impairment (Snellen CDVA worse than 20/40) was significantly associated with an increased likelihood of ungradable images. The odds ratio (OR) for this association was 7.79 (95% CI, 4.19-14.50; P < .0001). This relationship remained significant in the multivariable model (OR: 5.23; 95% CI, 2.82-9.71; P < .0001). Similarly, refractive error worse than -6.0 diopters (D) SE or +5.0 D SE was associated with increased risk of ungradable scans, with an OR of 13.21 (95% CI, 2.61-66.77; P = .002). CONCLUSION: Decreased visual acuity may be a predictor of inaccurate image analysis in subjects screened for diabetic retinopathy by non-mydriatic retinal photography.

Self-Reported Sleep Duration in Patients with Neovascular Age-Related Macular Degeneration.

PURPOSE: To examine the relationship between self-reported sleep duration and neovascular age-related macular degeneration (nAMD). METHODS: This case-control study comprised 165 subjects (57 patients with nAMD and 108 controls). Controls were matched to cases by age and sex. Participants completed a questionnaire that included questions about sleep duration and quality. Four categories of sleep duration were established; <6 hours, 6-7 hours, 7-8 hours and >8 hours. Association of sleep duration and nAMD was assessed by logistic regression analysis. Multiple logistic regression models were performed to control for possible confounders. RESULTS: We found a significant association between short sleep duration and nAMD (for <6 hours, odds ratio, OR, 3.29, 95% confidence interval, CI, 1.32-8.27; for 6-7 hours, OR 2.25, 95% CI 0.80-6.32; and for >8 hours, OR 1.39, 95% CI 0.53-3.73) compared with the reference category of 7-8 hours. This association remained significant after adjustment for confounders (<6 hours, OR 3.09, 95% CI 1.20-7.97). In addition, a borderline significant association was observed between self-reported very bad sleep quality and nAMD (OR 2.84, 95% CI 1.02-7.88). The highest rate of sleep medication use was found in the nAMD group (p < 0.001). CONCLUSION: Our findings provide evidence to support an association between short sleep duration and nAMD. Considering strategies to improve sleep in these patients may prevent the negative effects of sleep deficiency.

Severe keratomalacia after 12 months of continuous hydrogel contact lens wear in a psychiatric patient.

A 53-year-old cachectic patient diagnosed with major depressive disorder was referred to our department for evaluation of a visible deformation of the right eye. She had been wearing hydrogel contact lenses on a continuous basis without removal for the last 12 months, influenced by low self-esteem and social isolation. Slit-lamp examination of the right eye showed a conical cornea, extensive neovascularization, severe stromal melting with descemetocele formation and forward bulging of the iris. Examination of the left eye revealed multiple corneal opacities, deep stromal neovascularization and anterior chamber inflammation. No sign of infection was present. Vitamin A deficiency was suspected and later confirmed. The patient required evisceration of the right eye and psychiatric treatment. Inflammatory signs of the left eye resolved within 1 week of initiating treatment. This case illustrates the synergistic effect of soft contact lens abuse and vitamin A deficiency in a psychiatric patient, and emphasizes the importance of instructing vulnerable patients on appropriate lens use and care.