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Review: update on performance assessment and monitoring systems for ophthalmologists

Annals of eye Science 2024年第1期9卷 24-33页

作者： Heather G.Mack centre for eye research Australia University of MelbourneMelbourneAustralia

Performance assessment and monitoring systems are the process by which ophthalmologists demonstrate they are fit to continue practicing.Revalidation is the process by which licensed doctors are legally required to demonstrate to medical regulators that they are up to date and fit to practice in order to maintain their medical license,and began in the United Kingdom(UK)in 2012 following well-publicized events.Recertification is a different process which began in North America and demonstrates doctors have maintained competence,without involvement of external stakeholders.Arguments for and against the concept of performance assessment are reviewed.Stakeholders in performance assessment,whether part of the process or not,are doctors themselves,peers and other health care providers,patients,hospitals and health systems,medical regulators,and health policy makers.Early models of performance assessment included portfolios,credit accumulation,and closed-book examinations.Models are in evolution with the value of formative rather than summative assessments,and the need for methods of assessing procedural competency increasingly recognized.Emerging methods of performance assessment of practicing ophthalmologists include use of performance indicators,simulation,and workplace-based assessments.Alternate methods of assuring the public by improved detection of outliers are discussed.Despite weak evidence supporting performance assessments in demonstrating continuing competency to practice,the process is gradually being accepted worldwide.Further research into optimum methods of performance assessment and monitoring processes is required,along with cost-benefit analysis.

关键词： Performance assessment revalidation recertification maintenance of competency relicensure

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Clinical associations of corneal neuromas with ocular surface diseases

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Neural Regeneration research 2024年第1期19卷 140-147页

作者： Charmaine Jan Li Toh Chang Liu Isabelle Xin Yu Lee Molly Tzu Yu Lin Louis Tong Yu-Chi Liu Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore Singapore eye research Institute Singapore Department of Cornea and External eye Disease Singapore National Eye CentreSingapore Ophthalmology and Visual Sciences Academic Clinical Program Duke-NUS Medical SchoolSingapore

Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.

关键词： cornea corneal diseases corneal nerve corneal neuropathy in vivo confocal microscopy microneuroma neuroma ocular surface diseases

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Does HSP27 injection induce glaucoma damage in mice?

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Neural Regeneration research 2024年第11期19卷 2347-2348页

作者： Stephanie C.Joachim Sabrina Reinehr Experimental eye research Institute University Eye HospitalRuhr-University BochumBochumGermany

In a further aging society,excellent eyesight is an integral part of overall well-being and quality of life.Preserving good vision is crucial to maintaining mobility,independence,and mental health.There can be several reasons for visual impairment in elderly people,these include age-related macular degeneration,the leading cause of vision loss among older adults,cataract,glaucoma,diabetic retinopathy,retinal detachment,and others.

关键词： HSP27 injection damage

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Two become one:combination of two risk factors in a new glaucoma animal model

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Neural Regeneration research 2024年第5期19卷 982-983页

作者： Nils Kluge Sabrina Reinehr Experimental eye research Institute University Eye HospitalRuhr-University BochumBochumGermany

Glaucoma is a group of eye diseases characterized by progressive loss of retinal ganglion cells(RGCs)and optic nerve degeneration.During this process,the visual field is reduced,and blindness may ultimately occur.Worldwide,glaucoma is the second leading cause of blindness,with about 80 million people affected.Glaucoma is a multifactorial disease and due to its complexity,the exact pathomechanisms are not fully understood yet.However,different risk factors,such as elevated intraocular pressure(IOP),age,or myopia,have been identified to date(EGS,2021).

关键词： elevated exact glaucoma

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Treatment of uveitis and scleritis patients in Malaysia

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International Journal of Ophthalmology(English edition) 2024年第3期17卷 518-527页

作者： Sieng Teng Seow Iqbal Tajunisah Fei Yee Lee Pooi Wah Lott Sagili Chandrasekhara Reddy Department of Ophthalmology University Malaya Eye Research Centre(UMERC)Faculty of MedicineUniversiti MalayaKuala Lumpur 59100Malaysia Clinical research centre Selayang HospitalMinistry of Health MalaysiaSelangor 68100Malaysia Department of Ophthalmology Faculty of Medicine and Defence HealthNational Defence University of MalaysiaKuala Lumpur 57000Malaysia

●AIM:To determine the common causes and visual outcome after treatment among uveitis and scleritis patients.●METHODS:This is a retrospective cohort observational study.All consecutive clinical records of patients with newly diagnosed uveitis and scleritis over a 4-year period,from Jan.1,2017 to Dec.31,2020,were analysed.Data was collected at the presentation and included a follow-up period of one year.●RESULTS:A total of 288 patients were recruited during the study period.Anterior uveitis was the most common anatomical diagnosis(50.0%)followed by panuveitis(25.0%),scleritis(13.5%),posterior uveitis(6.9%),and intermediate uveitis(4.5%).Viral Herpes was the most common cause of infectious cases,while Vogt-Koyanagi-Harada(VKH)disease and human leucocyte antigen(HLA)B27 spondyloarthropathy were the leading causes of identifiable non-infectious cases.Majority of patients presented with unilateral,non-granulomatous uveitis with an absence of hypopyon.Anatomical locations like posterior uveitis and panuveitis,and visual acuity worse than 3/60 at presentation were the factors associated with poor visual outcomes(P<0.05).About 60%of patients had an identifiable cause for the uveitis and scleritis,with nearly equal distribution of infectious(n=85,29.5%)and noninfectious causes(n=84,29.2%).About 14.5%of patients were clinically blind at 1y of follow-up.The most common complication in our uveitis patients was glaucoma(47.5%),followed by cystoid macula oedema(18.9%)and cataract(13.9%).●CONCLUSION:Uveitis and scleritis are important causes of ocular morbidity.They are potentially blinding diseases which can have a good outcome if diagnosed and treated early.

关键词： uveitis scleritis ocular morbidity blindness aetiology

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NLRP3 inflammasome plays a vital role in the pathogenesis of age-related diseases in the eye and brain

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Neural Regeneration research 2024年第7期19卷 1425-1426页

作者： Jack Jonathan Maran Odunayo Omolola Mugisho Buchanan Ocular Therapeutics Unit Department of OphthalmologyNew Zealand National Eye CentreUniversity of AucklandAucklandNew Zealand

Key points:With aging,there is increased nucleotide-binding oligomerization domain-(NOD-)like receptor(NLR) protein-3(NLRP3) activation in neural and ocular tissues.Activation of the NLRP3 inflammasome appears to be a common denominator in the pathogenesis of age-related diseases of the eye and brain.Pharmacological inhibition of the NLRP3 inflammasome may be a potent therapy for preventing the development and progression of age-related eye and brain diseases.

关键词： NLRP3 pathogenesis inflam

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Neuroprotective effects of acteoside in a glaucoma mouse model by targeting Serta domain-containing protein 4

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International Journal of Ophthalmology(English edition) 2024年第4期17卷 625-637页

作者： Hui-Jie Hao Ya-Hong Li Bo Yu Xun Liu Yan Zhang Xiao-Li Xing Tianjin Key Laboratory of Retinal Functions and Diseases Tianjin Branch of National Clinical Research Center for Ocular DiseaseEye Institute and School of OptometryTianjin Medical University Eye HospitalTianjin 300384China

AIM:To explore the therapeutic effect and main molecular mechanisms of acteoside in a glaucoma model in DBA/2J mice.METHODS:Proteomics was used to compare the differentially expressed proteins of C57 and DBA/2J mice.After acteoside administration in DBA/2J mice,anterior segment observation,intraocular pressure(IOP)monitoring,electrophysiology examination,and hematoxylin and eosin staining were used to analyze any potential effects.Immunohistochemistry(IHC)assays were used to verify the proteomics results.Furthermore,retinal ganglion cell 5(RGC5)cell proliferation was assessed with cell counting kit-8(CCK-8)assays.Serta domain-containing protein 4(Sertad4)mRNA and protein expression levels were measured by qRT-PCR and Western blot analysis,respectively.RESULTS:Proteomics analysis suggested that Sertad4 was the most significantly differentially expressed protein.Compared with the saline group,the acteoside treatment group showed decreased IOP,improved N1-P1 wave amplitudes,thicker retina,and larger numbers of cells in the ganglion cell layer(GCL).The IHC results showed that Sertad4 expression levels in DBA/2J mice treated with acteoside were significantly lower than in the saline group.Acteoside treatment could improve RGC5 cell survival and reduce the Sertad4 mRNA and protein expression levels after glutamate injury.CONCLUSION:Sertad4 is differentially expressed in DBA/2J mice.Acteoside can protect RGCs from damage,possibly through the downregulation of Sertad4,and has a potential use in glaucoma treatment.

关键词： glaucoma acteoside Serta domaincontaining protein 4 proteomics mice

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Construction and validation of a neovascular glaucoma nomogram in patients with diabetic retinopathy after pars plana vitrectomy

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World Journal of Diabetes 2024年第4期15卷 654-663页

作者： Yi Shi Yan-Xin Zhang Ming-Fei Jiao Xin-Jun Ren Bo-Jie Hu Ai-Hua Liu Xiao-Rong Li Surgical Retina Tianjin Key Laboratory of Retinal Functions and DiseasesTianjin Branch of National Clinical Research Center for Ocular DiseaseEye Institute and School of OptometryTianjin Medical University Eye HospitalTianjin 300384China Glaucoma Tianjin Key Laboratory of Retinal Functions and DiseasesTianjin Branch of National Clinical Research Center for Ocular DiseaseEye Institute and School of OptometryTianjin Medical University Eye HospitalTianjin 300384China Ocular Trauma Tianjin Key Laboratory of Retinal Functions and DiseasesTianjin Branch of National Clinical Research Center for Ocular DiseaseEye Institute and School of OptometryTianjin Medical University Eye HospitalTianjin 300384China

BACKGROUND Neovascular glaucoma(NVG)is likely to occur after pars plana vitrectomy(PPV)for diabetic retinopathy(DR)in some patients,thus reducing the expected benefit.Understanding the risk factors for NVG occurrence and building effective risk prediction models are currently required for clinical research.AIM To develop a visual risk profile model to explore factors influencing DR after surgery.METHODS We retrospectively selected 151 patients with DR undergoing PPV.The patients were divided into the NVG(NVG occurrence)and No-NVG(No NVG occurrence)groups according to the occurrence of NVG within 6 months after surgery.Independent risk factors for postoperative NVG were screened by logistic regression.A nomogram prediction model was established using R software,and the model’s prediction accuracy was verified internally and externally,involving the receiver operator characteristic curve and correction curve.RESULTS After importing the data into a logistic regression model,we concluded that a posterior capsular defect,preoperative vascular endothelial growth factor≥302.90 pg/mL,glycosylated hemoglobin≥9.05%,aqueous fluid interleukin 6(IL-6)≥53.27 pg/mL,and aqueous fluid IL-10≥9.11 pg/mL were independent risk factors for postoperative NVG in patients with DR(P<0.05).A nomogram model was established based on the aforementioned independent risk factors,and a computer simulation repeated sampling method was used to internally and externally verify the nomogram model.The area under the curve(AUC),sensitivity,and specificity of the model were 0.962[95%confidence interval(95%CI):0.932-0.991],91.5%,and 82.3%,respectively.The AUC,sensitivity,and specificity of the external validation were 0.878(95%CI:0.746-0.982),66.7%,and 95.7%,respectively.CONCLUSION A nomogram constructed based on the risk factors for postoperative NVG in patients with DR has a high prediction accuracy.This study can help formulate relevant preventive and treatment measures.

关键词： Diabetic retinopathy Retinopathy Neovascular Glaucoma Risk factors Nomogram

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Glycolysis and glucose metabolism as a target for bioenergetic and neuronal protection in glaucoma

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Neural Regeneration research 2024年第8期19卷 1637-1638页

作者： Pete A.Williams Robert J.Casson Department of Clinical Neuroscience Division of Eye and VisionSt.Erik Eye HospitalKarolinska InstitutetStockholmSweden Ophthalmic research Laboratories Discipline of Ophthalmology and Visual SciencesUniversity of AdelaideAdelaideAustralia

Vision is arguably our most valued sense,yet approximately 340 million people globally suffer blindness or moderate visual impairment,highlighting the need to further develop and advance treatments for ophthalmic diseases.Glaucoma refers to a group of ocular disorders united by a clinically characteristic optic neuropathy with associated retinal ganglion cell loss.

关键词： metabolism glaucoma globally

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Effect of low-degree astigmatism on the objective visual quality

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International Journal of Ophthalmology(English edition) 2024年第6期17卷 1086-1093页

作者： Ling-Ying Ye Shu-Feng Li Jing-Jing Zuo Jin Li Hui-Xiang Ma National Clinical research Center for Ocular Diseases Eye HospitalWenzhou Medical UniversityWenzhou 325027Zhejiang ProvinceChina

AIM:To evaluate the effect of low-degree astigmatism on objective visual quality through the Optical Quality Analysis System(OQAS).METHODS:This study enrolled 46 participants(aged 23 to 30y,90 eyes)with normal or corrected-to-normal vision.The cylindrical lenses(0,0.5,0.75,1.0,and 1.25 D)were placed at the axial direction(180°,45°,90°,and 135°)in front of the eyes with the best correction to form 16 types of regular low-degree astigmatism.OQAS was used to detect the objective visual quality,recorded as the objective scattering index(OSI),OQAS values at contrasts of 100%,20%,and 9%predictive visual acuity(OV100%,OV20%,and OV9%),modulation transfer function cut-off(MTFcut-off)and Strehl ratio(SR).The mixed effect linear model was used to compare objective visual quality differences between groups and examine associations between astigmatic magnitude and objective visual quality parameters.RESULTS:Apparent negative relationships between the magnitude of low astigmatism and objective visual quality were observed.The increase of OSI per degree of astigmatism at 180°,45°,90°,and 135°axis were 0.38(95%CI:0.35,0.42),0.50(95%CI:0.46,0.53),0.49(95%CI:0.45,0.54)and 0.37(95%CI:0.34,0.41),respectively.The decrease of MTFcut-off per degree of astigmatism at 180°,45°,90°,and 135°axis were-10.30(95%CI:-11.43,-9.16),-12.73(95%CI:-13.62,-11.86),-12.75(95%CI:-13.79,-11.70),and-9.97(95%CI:-10.92,-9.03),respectively.At the same astigmatism degree,OSI at 45°and 90°axis were higher than that at 0°and 135°axis,while MTFcut-off were lower.CONCLUSION:Low astigmatism of only 0.50 D can significantly reduce the objective visual quality.

关键词： low-degree astigmatism objective visual quality Optical Quality Analysis System

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