Hypertension is the leading risk factor of cardiovascular disease and has profound effects on both the structure and function of the microvasculature. Abnormalities of the retinal vasculature may reflect the degree of microvascular damage due to hypertension, and these changes can be detected with fundus photographs. This study aimed to use deep learning technique that can detect subclinical features appearing below the threshold of a human observer to explore the effect of hypertension on morphological features of retinal microvasculature. We collected 2012 retinal photographs which included 1007 from patients with a diagnosis of hypertension and 1005 from normotensive control. By method of vessel segmentation, we removed interference information other than retinal vasculature and contained only morphological information about blood vessels. Using these segmented images, we trained a small convolutional neural networks (CNN) classification model and used a deep learning technique called Gradient-weighted Class Activation Mapping (Grad-CAM) to generate heat maps for the class “hypertension”. Our model achieved an accuracy of 60.94%, a specificity of 51.54%, a precision of 59.27%, and a recall of 70.48%. The AUC was 0.6506. In the heat maps for the class “hypertension”, red patchy areas were mainly distributed on or around arterial/venous bifurcations. This indicated that the model has identified these regions as being the most important for predicting hypertension. Our study suggested that the effect of hypertension on retinal microvascular morphology mainly occurred at branching of vessels. The change of the branching pattern of retinal vessels was probably the most significant in response to elevated blood pressure.

AIM: To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients. METHODS: A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis. RESULTS: Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment. CONCLUSION: Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.

The prevalence of contact lens related dry eye (CLDE) is high and can lead to ocular discomfort, reduced quality of vision and life. The aim of this study was to assess the efficacy of intense pulsed light (IPL) treatment in alleviating signs and symptoms of CLDE. Prospective, randomised, examiner masked study. This prospective study was conducted on 152 eyes of 76 patients (IPL group, n = 76 eyes; control group, n = 76 eyes) wearing contact lens (CL) and experiencing CLDE for more than 1 year. The IPL treatment group underwent two IPL treatment sessions at 3-week intervals while the control group received sham IPL treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), non-invasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, fluorescein staining (FS), meibum gland (MG) quality and expression, endothelial cell count (ECC) and intraocular pressure (IOP) were assessed at baseline (D-0), day-21 (D-21) and day-42 (D-42) after IPL treatment. The mean age of treatment group and control group was 28.47 ± 5.16 years (21 females, 28 %) and 28.58 ± 4.33 years (23 females, 30 %) respectively. IPL treatment group had clinically and statistically significant improvement in mean NITBUT was observed at D14 (5.24 s, P<0.001) and D28 (6.08 s, P<0.001). OSDI, TFLL score and MG quality and expressibility all improved significantly (P<0.001) at D-42, whereas BCVA, ECC and IOP showed no significant changes at D-21 and D-42 in IPL treatment group. The control group showed no significant improvement in all parameters at D-21 and D-42. Our findings suggest that CL related DE can be safely alleviated with IPL treatment as it reduced the severity of symptoms, improved the overall tear film stability and reduced artificial tear use in participants with CLDE.

Purpose: Diquafosol ophthalmic solution (DQS) stimulates P2Y2 receptors on the ocular surface, which enhances mucin secretion from goblet cells. Therefore, tear film stability and hydration of the ocular surface can be achieved independent from lacrimal gland function. Methods: This prospective, open-label pilot study included 60 eyes of 30 diabetic patients diagnosed with dry eye disease (DED) and were randomly assigned to either DQS ( n = 30 eyes) or hyaluronate (HA) group ( n = 30 eyes). Participants in the DQS group received 3% diquafosol ophthalmic solution, whereas HA group received 0.1% sodium HA preservative-free artificial tears. The dosage for both drugs was 1 drop, 6 times per day for 4 weeks. Tear film lipid layer (TFLL), noninvasive breakup time (NITBUT), corneoconjunctival staining (CS) score, meibomian gland (MG), conjunctival hyperemia [redness score (RS)], ocular surface disease index (OSDI) was assessed and compared at baseline, day 14, and day 28. Results: Comparing baseline and day 28 measurements revealed that both groups found significant improvements in NITBUT, CS, MG quality, MG expressibility, and OSDI scores significantly ( P < 0.05), in addition TFLL improvements were only found in the DQS group. At day 28, the magnitude of change in mean NITBUT was 1.74 (DQS) versus 0.31 (HA), 1.16 (DQS) versus 0.37 (HA) point grade reduction in corneoconjunctival staining score and 9.80 (DQS) versus 4.80 (HA) point grade in mean OSDI score. Conclusion: Three percent diquafosol ophthalmic solution treatment demonstrated the ability to improve the tear film dry eye parameters and clinically reduced sign and symptoms of DED in diabetic dry eye patients. Clinical Trials.gov ID: NCT04980144.

To compare the 12-month postoperative quality of vision and visual performance of 2 different refractive rotationally asymmetric multifocal intraocular lenses (IOLs). Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom. Retrospective case series. Refractive lens exchange (RLE) patients were divided into 2 groups. Group A comprised eyes receiving a Lentis Mplus LS-312 MF30 IOL and Group B, eyes receiving a Lenstec SBL-3 IOL. Refraction, uncorrected (UDVA) and corrected distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, distance-corrected intermediate and near (DCNVA) visual acuities, and quality of vision were evaluated preoperatively and up to 12 months postoperatively. Each group comprised 90 eyes. Both groups had a high level of quality of vision 12 months postoperatively with no significant difference between the 2 groups (P = .919). There was no significant between-group difference in mean monocular and binocular UDVA, monocular UIVA, or monocular UNVA. Group B had statistically significantly better mean monocular DCNVA (P = .049), binocular UNVA (P = .011), and binocular DCNVA (P = .035). Group B had a higher percentage of complete spectacle independence. Both refractive rotationally asymmetric multifocal IOLs provided an excellent level of quality of vision 12 months postoperatively. Both IOL models restored distance, intermediate, and near visual function; however the IOLs in Group B provided better near visual performance.

Introduction Laser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE . Aim The purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE. Methods The final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2). Results Following the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference. Conclusion Post-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.