Carlos Neves
Portuguese Retina and Vitreous Group
I selected an article by an experienced researcher, focusing on vitrectomy and internal tamponade for rhegmatogenous retinal detachment (RD) in a UK-based cohort study.
O autor analisou 6377 vitrectomias com 5508 operações por falha anatómica no prazo de seis meses. Os dados recolhidos obedeceram ao RCOphth Retinal Detachment Dataset. Identificaram-se variáveis associadas a maior risco: idade <45 ou >79, roturas retinianas inferiores, descolamento total, descolamento inferior de um quadrante ou maior, óleo de silicone de baixa densidade e vitreorretinopatia proliferativa. O tamponamento C2F6, a crioterapia e a vitrectomia 25 G foram associados a um risco reduzido. Foi desenvolvido um modelo preditivo com 71,7% de exatidão, categorizando os casos de RD em baixo (54,3%), moderado (35,6%) e alto (10,1%) risco de insucesso. A taxa de insucesso anatómico primário foi de 13,9%. Os resultados oferecem informações valiosas para o aconselhamento e seleção de doentes e para futuros ensaios clínicos.
Ricardo Parreira
Portuguese Group of Pediatric Ophthalmology and Strabismus
In 2019, the PEDIG Research Group published the results of a randomized, double-blind study that compared a group of children with basic intermittent exotropia who underwent bilateral lateral rectus recoil (RBRL) with another group who underwent unilateral surgery: lateral rectus recoil and medial rectus resection (RR). In this study, after 3 years of follow-up, no statistically significant difference was found in the suboptimal surgical outcome between the two groups.
During the 42nd Meeting of the European Strabismus Association (www.esa2023.org), which took place from June 7 to 10, 2023 in Zagreb, Dr. Jonathan Holmes presented the latest results of the extension of this study. When comparing these two groups over the years, the most relevant aspect was the difference in the reoperation rate, which tended to be higher for the RBRL group (30% at 8 years) than for the RR group (11% at 8 years). According to this study, unilateral surgery may have better long-term results for basic intermittent exotropia, making it the procedure of choice for Dr. Jonathan Holmes.
Myopia Consensus Statement 2023
In March 2023, the World Society for Pediatric Ophthalmology and Strabismus published the Consensus Statement on Myopia 2023.
This document summarizes the interventions aimed at reducing the progression of myopia, which over the years have shown statistical and clinical significance, divided into two groups: those that don't work or have minimal effect, and those that seem to work. Among these, reference should be made to the ATOM 2 study, which showed in an Asian population that daily application of atropine at a dose of 0.01% was the most effective in the long term, with an estimated 50% reduction in progression after 5 years.
Interestingly, a contradictory study was published in July 2023 (https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2807117) by the PEDIG research group, which concluded that atropine at a dose of 0.01% is not superior to placebo in reducing the progression of myopia in children in the United States.
These results lead us to reflect on the efficacy of different concentrations of atropine in different populations. The trajectory of science is made up of advances and setbacks, and more studies are probably needed to clarify these and other questions that arise on this subject.
Nuno Alves
Portuguese Group of Ocular Surface, Cornea and Contactology
João Feijão
Portuguese Group of Implanto-Refractive Surgery
Prevention and management of refractive prediction errors following cataract surgery
Long gone are the days when cataract surgery was aimed solely at restoring VA.
Today, and increasingly, it is also refractive surgery. Refractive errors after cataract surgery are now poorly accepted by both surgeons and patients. These refractive errors are one of the main sources of patient dissatisfaction and one of the main causes of litigation. This article explains the precautions we should take to avoid these errors, as well as the mechanisms we have at our disposal to correct them when they do occur.
Lígia Ribeiro
Portuguese Group of Neurophthalmology
The international group of neuro-ophthalmologists from the Brain and Optic Nerve Study with Artificial Intelligence-deep learning system (BONSAI-DLS) recently published in the Journal of neuro-ophthalmology the results of a study comparing the performance of the deep learning algorithm in identifying optic disc abnormalities in photographs of the ocular fundus with that of clinicians from different fields.
The model, trained and validated on 14341 photographs of normal optic discs, with papilledema or other alterations, was tested externally on a set of 1505 photographs from 5 different centers. It proved capable of detecting changes in the optic disc, with excellent performance in identifying papilledema (AUROC 0.96, sensitivity 96.4% and specificity 84.7%). In the study published in 2020, the diagnostic performance of the BONSAI-DLS was comparable to that of 2 experienced neuro-ophthalmologists, correctly classifying the optic disc in 84.7% of 800 photographs of the ocular fundus, versus 84.4% and 80.1%.
The same set of photographs was now used to compare the algorithm's results with those of 30 clinicians (6 general ophthalmologists, 6 optometrists, 6 neurologists, 6 internists and 6 emergency physicians). The DLS showed an error rate of 15.3% in classifying the appearance of the disc, outperforming clinicians from the different areas (average error rates: 24.4% general ophthalmologists, 24.8% optometrists, 38.2% neurologists, 44.8% internists and 47.9% emergency physicians). BONSAI-DLS was on average 168 times faster.
In certain clinical contexts and without access to observation by an ophthalmologist, artificial intelligence models could be useful for screening and detecting changes in the disc that have implications for patient orientation.
Nádia Lopes
Portuguese Orbit and Oculoplastic Group
COVID-19-Related Chronic Bilateral Dacryoadenitis
I would like to highlight an article that aims to draw ophthalmologists' attention to the association between infection with the SARS-CoV-2 virus and inflammatory disease of the orbit.
In this retrospective case-control study, a histological and immunohistochemical evaluation (expression of the SARS-CoV-2 nucleocapsid protein) is carried out in a patient presenting with dacryoadenitis, with a history of SARS-CoV-2 infection and in a patient with an enlarged lacrimal gland but without associated COVID-19.
The infected patient showed fibrosis, glandular necrosis and immunoreactivity for SARS-CoV-2. These alterations were not observed in the uninfected patient.
he incidence of ophthalmic diseases following infection with covid-19 ranges from 2-32%, with the most common involvement of the anterior and posterior segments and the nerve, while involvement of the orbit is rare. However, through immune-mediated mechanisms, this infection may be the cause of inflammatory disease of the orbit with manifestations in the lacrimal gland and extraocular muscles.
João Breda
Portuguese Research Group
Validation of a web-based distance visual acuity test
More and more people are talking about telemedicine. In the not too distant future, we may have self-measurements of retinal fluid or visual fields at home. In this sense, research projects could also become partially web-based. This article validates the use of a tool developed in Greece to measure visual acuity on a computer - the Democritus Digital Acuity and Reading Test (DDART). The results are very good, with excellent correlations with standard tests.
Here is the link to the tool (free) and the article.
LINK tool: https://ddart.med.duth.gr
Vanda Nogueira
Portuguese Group for Ocular Inflammation
Vaccine-Associated Uveitis after COVID-19 Vaccination: Vaccine Adverse Event Reporting System
Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma.
I selected two review articles published in 2023 on cytomegalovirus (CMV) anterior uveitis, the main ocular manifestation of this infection in immunocompetent individuals. This type of anterior uveitis is still very underdiagnosed, requiring aqueous humor analysis for confirmation. But a definite diagnosis is essential, since if appropriate antiviral treatment is not instituted, it can be complicated by severe ocular hypertension and endothelial decompensation. These articles, by two Asian groups with extensive experience in the field of ocular inflammation in general and CMV infection in particular, focus on updating clinical characterization, diagnostic criteria and treatment methods.
https://www.mdpi.com/1999-4915/15/1/185
https://www.frontiersin.org/articles/10.3389/fpubh.2023.1117412/fullll
Teresa Gomes
Portuguese Glaucoma Group
Fixed High Energy Versus StandardTitrated Energy Settings for Selective Laser Trabeculoplasty.
The increasingly evident paradigm shift in the initial therapeutic approach to Primary Open Angle Glaucoma has led me to choose an article on SLT once again.
This retrospective article addresses the need to find new protocols that allow this procedure to be more effective. The parameter studied is energy. The effectiveness of a high fixed power is compared with a variable power depending on the response of the treated tissue.
and the ideal protocol had not been found, particularly in terms of the level of energy and the length of the trabeculum to be treated, the impact of the LIGHT study in terms of massifying the use of SLT led to the development of a device that allows energy to be administered via the transscleral/translimbic route: the Eagle system. This system makes treatment quicker, easier to perform as it excludes the need for a gonioscopy lens, and more comfortable for the patient. This technique is called Direct SLT (DSLT).
An RCT called "GLAUrious" is underway, with no published results yet, comparing DSLT and SLT in terms of efficacy and safety.
For a number of reasons, it is important to be attentive, prepared and constructively critical of these proposals that could radically change our approach to treating glaucoma patients.
Guilherme Castela
Portuguese Group for Oncologic Pathology and Ocular Genetics
Modern treatment of retinoblastoma: A 2020 review
Retinoblastoma is the most common malignant ocular tumor in children, with an incidence of around 1/18,000 children. In Portugal, there are around 5 new cases a year. Since the 1990s, chemotherapy has become the main therapeutic modality and, more recently, superselective chemotherapy of the ophthalmic artery and intravitreal chemotherapy are considered first line for this type of tumor. With this in mind, I would like to highlight a review article in which the most up-to-date treatment modalities are presented and a treatment algorithm is proposed.
Ana Almeida
Portuguese Group of Ergoftalmology
"My Zelda Cane": Strategies Used by Blind Players to Play Visual-Centric Digital Games
Video games are an increasingly popular entertainment activity. Unfortunately, the most popular games rely heavily on the use of vision and are rarely accessible to players with profound visual impairments.
Gonçalves D. et al. carried out a study in which they analysed a set of videos published on the YouTube platform and characterized the experiences of blind users playing popular video games. They described the various strategies used by these players in order to be able to play and characterized the accessibility barriers as well as potential measures to minimize them.
Access to the arts for people with blindness or low vision
Under the MusicAIRE label, an action co-financed by the European Union to support the music industry, the MUSICAR project is a Metropolitana initiative that runs from February to November 2023 and aims to contribute to full access to the arts for blind and deaf people by promoting the teaching of music theory and ensemble music practice in these communities. The Come make music with us workshops are aimed at blind or low-vision students over the age of 6. With free registration, these workshops will take place at Metropolitana's headquarters and offer a first approach to musical training. First, some musical instruments will be presented by Metropolitana teachers, always accompanied by professionals with experience in teaching music to these communities. The initiative will take place between mid-September and November 29th, the date of the final MUSICAR Concert to be held at the Teatro São Luiz, in which EVERYONE will be able to take part.
Diogo Hipólito
SPO Youth
First of all, we have selected and invite you to read an article that provides us with the long-term results (3 years) of controlling the progression of myopia using lenses with the technology called H.A.L.T.5, which uses a constellation of microlenses with high asphericity to create a volume of light that is focused in front of the retina. What this study shows is that during the third year, both the group that started the study with the lenses mentioned above and those who switched from other lens models to these had significantly less progression of both the spherical equivalent and the axial length, compared to patients who used so-called "normal" corrective lenses, without any technology to try to limit the progression of the associated myopia. Given the real epidemic of myopia that exists and is expected in the future, the existence of an easily applicable methodology that allows us to obtain a lower progression without affecting visual acuity is certainly very interesting.
Secondly, we would like to highlight the first published study on the new phakic lens for presbyopia correction (EVO Viva ICL, STAAR Surgical), at a time when the first randomized studies on the use of pilocarpine for presbyopic patients are also beginning to appear in the literature. This study shows that these lenses could be an alternative to consider, preserving the lens, in patients with moderate to high myopia, aged 45-55, maintaining the quality of the results in distance vision, but adding the ability to improve visual acuity for near without correction.
