The effect of zonal multifocal lenses with distance and near design on visual field parameters

Aim: The aim of this article is to evaluate the visual field of healthy young subjects and determine the stability of commonly observed parameters, before and after fitting with zonal multifocal lenses with distance and near design.Materials and Methods: Thirty young subjects (20-26 years) with equal sex distribution and no eye problems were prospectively included in the study. The subjects had no need and never wore refractive correction on the tested eye (mean refraction ±0.12D). After meticulous eye examination, visual field 24-2 Threshold test (Humphrey Field Analyser 3 (HFA3) model 860 by Zeiss, version 1.3.1.2) was performed first on the fellow eye and then on the tested eye in order to gain experience. The test was repeated 3 times per eye. [AU1] Strategy was standard SITA, background 31.5 asb and III white stimulus. The test was performed 30 minutes after insertion of the zonal multifocal lens with distance design, and the methodology repeated with a near design lens [AU2] (Biofinity multifocal, Cooper Vision). The outcome measures included hemifield test (HT), visual field index (VFI), mean deviation (MD) pattern standard deviation (PSD), and total and pattern deviation (TD &PD) only for <1.0 and <0.5. The primary outcome measures were MD and PSD. Statistical analysis was performed using SPSS v.21 package.Results: Thirty eyes (equal number of left and right eyes) were tested. None of the tests presented more than one fixation loss and more than 3% false positive or negative responses. The automatic hemifield test was borderline in 10 eyes at the baseline examination and this number increased to 13 for distance design lenses and 16 for near design lenses. For the 6 cases of the last group the change was a mean of -2.91dB, and statistically significant (p=0.001). The rest of the outcome measures were with slight, not statistically significant change, except for MD which was similar to the baseline (1.29) for the distance design lenses (1.35), but significantly (p=0.003) higher for the near design multifocal lenses (1.87)

Modern Technologies for Practical Training in Medical College

Sight is our most important sense, the main source of information, and the most important prerequisite for human social life. Special diagnostic and treatment equipment should be used to examine the individual visual analyzer of а person. At the Medical College of Varna, during the past few years, practical high-tech training has actively entered into the formation of future ophthalmic personnel who are preparing to operate with such medical equipment. At this moment, the Training and Research Sector of "Medical Opticians" is one of the examples of the application of high-tech practical training. Thanks to the collaboration between the Medical College of Varna and the Specialized Hospital for Eye Diseases for Active Treatment in Varna, students have the opportunity to learn about the process of diagnosis, prevention, and treatment of eye diseases, as well as absorb experience and knowledge directly from some of the best ophthalmologists and eye specialists in the country, Europe, and the world. Devices with high technological performance, such as optical coherence tomography (OCT), computerized perimeters, corneal topographers, and the electronic platform for unification of data from previous devices FORUM® (Zeiss), are part of the daily work practice for the new eye specialists, who face even broader horizons in the field of prevention and prophylaxis of the eye health. A retrospective analysis of 23 medical scientific publications, regarding the application and advantages of using new technologies in the diagnosis of the human visual analyzer in normality and pathology, and their application in the practical training of young specialists, published between 2007 and 2022, was made. The analysis led to the conclusion that it is necessary for the eye specialist not only to acquire the necessary knowledge and skills on how to operate modern medical equipment but also to have an adequate approach towards the application of the right technology to assess the patient’s problem in a complex manner. The collaboration between eye specialists and new technologies guarantees excellent results for the prevention and prophylaxis of human eye health. Bringing together all the research of a given patient on the FORUM® platform would give wider opportunities for the treatment of serious diseases such as glaucoma, age-related macular degeneration, corneal diseases, etc. A more detailed analysis of the changes in eye health in collaboration with the ophthalmology industry will positively lead to comprehensive vision screening improvements

Early Diagnosis of Keratoconus and Morphological Analysis of Corneas with Physiologically Lower Central Thickness

Ophthalmology, as a high-tech, dynamic, and very interesting specialty, intertwines many sections of science, but all this requires it to be supported by the relevant equipment for diagnosis and treatment. Distinguishing a thin cornea from a mild stage of keratoconus along the curvature of the posterior corneal surface is now possible thanks to a new generation of corneal topography (Orbscan, Pentacam).The aim of the present study is to consider the Pentacam examination as the main method for distinguishing a thin cornea from a mild keratoconus stage. It also aims to analyze the results of a screening study in order to determine its significance in the diagnosis of the human visual analyzer. The subjects of the study were 32 healthy individuals (with 64 eyes) aged between 20 and 46 years without any established eye problems. 43.75% of them were women, and 56.25% were men. Their eyes were examined through corneal topography performed via an automated Oculus Pentacam test.Results: In the qualitative analysis of the corneal topography, it was found that the average radius of curvature of the cornea was analyzed in millimeters to effectively search for correlation. The cornea was found to gradually increase in thickness towards the periphery, with a mean measured value of 493.19 μm. The analysis of the results of the screening study revealed a low incidence of keratoconus among subjects, demonstrating that the Pentacam screening study could differentiate patients with a thin cornea without categorizing it as a preclinical stage of keratoconus.Conclusion: Scheimpflug-based corneal topography is a useful tool for estimating both corneal topography and corneal thickness

Contact lenses in the 21st century—advantages and challenges

IntroductionToday, with the advancement of medicine and technology, contact lenses have become extremely sophisticated and widespread throughout the world. Undoubtedly, new technological solutions such as the silicone polymers from which these lenses are made are resistant to microbial contamination, which reduces the risk of bacterial keratitis even when compared to lenses for everyday use. In the last year, the world has faced an unknown and dangerous pandemic—the Covid-19 pandemic. Some concerns of the public about easier infection with the virus as a result of the use of contact lenses were published and broadcast on social networks and on television. To date, there is no scientific evidence that wearing contact lenses during an epidemic is dangerous and can lead to disease. Intensified research and experiments are currently underway to improve contact lenses, and even more impressive innovations in the field of contactology are expected in the future.AimThe aim of the present study is to determine the level of knowledge and awareness among patients about the possibilities for correction with contact lenses, their characteristics, innovations and use.Materials and MethodsThe present study was conducted in the Department of Ophthalmology and Visual Sciences of the Medical University of Varna on the territory of the Specialized Hospital for Ophthalmology for Active Treatment, Varna and in social networks. The study included 89 patients who were surveyed over a two-month period in 2021 (from March to May). All participants were acquainted in detail with the questions and answered every question related to its correct completion. The survey included a total of 23 questions, of which 1 open and 22 structured questions. The survey data were summarized and analyzed by Google Analytics. For this purpose, special questionnaires for patients were developed, which contained multiple-choice questions and open-ended ones.ResultsThe study involved 15 men and 74 women, aged 18 to 66 years, with 55% of the patients in the study currently wearing contact lenses (CL). The majority of patients (61.2%) strictly followed the prescription for replacement of CL, 22.4% changed them in case of irritation, and 16.3% did not follow the prescription and according to them CL could be used for a longer period of time. For 50% of the participants, the maintenance of the CL was difficult, 33.9% sometimes encountered difficulties, and 16.1% considered it difficult. It turned out that 68.3% of the participants in the study did not think that infection with Covid-19 was easier because of the use of CL, 28.6% were not familiar with the topic, 3.2% were of the opinion that it was easier to get infected. Through various and numerous studies, it has been proven that CL use is wide, patients remain satisfied, but are not yet fully aware of their characteristics, maintenance, wearing mode, innovation, novelty and the risk of complications that can occur with improper maintenance. In order to avoid complicated consequences from the use of CL, some steps should be taken in the education and more active informing of the specialist and the patient.ConclusionThe analysis of the results of the survey revealed a low level of awareness of patients about the benefits of correction with CL. It has been found that most patients consult specialists before starting to use CL, but there are those who make the decision themselves and do so only by researching the Internet. It has been shown that the majority of respondents are aware that complications from the use of CL are possible and that there are concerns among patients of easier infection with Covid-19 when using CL. Health will continue to be paramount for ophthalmologists in the development of CL manufacturing technologies. Therefore, it is reasonable to refer patients to one-day and one-month CL. Millions of people around the world trust CL every day without worrying about their eyesight and appearance. The benefits of CL for patients and for the practice of the specialty are many, so the development of production technology will continue in the future

Central corneal thickness and morphological changes in the cornea after uneventful phacoemulsification

Въведение:По време на неусложнена факоемулсификация корнеалният ендотел може да бъде увреден от редица фактори. Ендотелът представлява монослой хексагонални клетки, които са загубили способността си за делене. Той поддържа относителната дехидратация на роговицата и допринася за нейната прозрачност. Поради това, предпазването на най-вътрешния слой на корнеята е важна задача при операция на катаракта и е от съществено значение за постоперативното възстановяване и добър зрителен резултат. Преходният корнеален оток, който може да се обясни с умерената загуба или травма на хексагоналните клетки, е описан в редица публикации, но данните за средната ендотелноклетъчна загуба (ECL), промяната в централната роговична дебелина (CCT), както и времето за възстановяване на предоперативните стойности варират в широки граници.ЦелДа се оценят промените в ендотелноклетъчната гъстота (ECD) и централната роговична дебелина (CCT) след неусложнена операция на катаракта.Материали и методиВ проучването са включени пациенти със сенилна катаракта, планирани за оперативно лечение. Всички са оперирани от един опитен хирург чрез стандартна факоемулсификация с имплантиране на интраокуларна леща (ИОЛ) под местна анестезия. Изключващите критерии са: предшестващи очни операции или травми, друга очна патология и случаи с усложнения. Централната роговична дебелина е измерена чрез предносегментна оптична томография (AS-OCT), a ECD е изследвана чрез in vivo конфокална микроскопия (IVCM). Всички субекти са изследвани предоперативно и при три следоперативни визити (1, 7 и 30 ден). Статистическият анализ на данните е извършен с SPSS statistics software package (v22.0). При разпределение на резултатите, различаващо се от нормалното се приложиха методи на непараметричен анализ и данните са представени с техните медианни стойности.РезултатиПроследени са 60 пациенти на средна възраст 70.56 години (SD=8.01), от които 29 мъже и 31 жени. Предоперативно CCT е 552 m (480-659 m), a ECD е 2398 кл./мм2 (SD=1025-2965 кл./мм2). 24 часа след операцията се установи значително увеличение на CCT (Z=-6.792, p<0.001). Ендотелноклетъчната гъстота е 2302 кл./мм2 (945-2902 кл./мм2), с ендотелноклетъчна загуба от 89 кл./мм2 (3.91%), в сравнение с предоперативните стойности. През първата седмица CCT е намаляла със 7.01% спрямо първата следоперативна визита, докато ECD продължава да намалява. До тридесетия следоперативен ден почти са достигнати предоперативните стойности на CCT (566 m), a общата ендотелноклетъчна загуба е изчислена на 108 кл./мм2 (5.2%).ЗаключениеУвреждането на роговичния ендотел се смята за важен параметър на хирургичната травма и основен фактор за оценката сигурността на оперативната техника. За него индиректно може да се съди по корнеалната дебелина, но модерните методи за ултраструктурно изследване на роговицата, като OCT и IVCM, предоставят допълнителна информация за подлежащите морфологични промени и могат да допринесат за намирането на най-подходящия терапевтичен подход според индивидуалните особености на всеки пациент.Introduction: Corneal endothelium can be altered during uneventful cataract surgery due to numerous factors. The endothelium is a monolayer of hexagonal cells, which have lost their replication ability, that maintain the dehydration of cornea, assuring its transparency. For this reason, corneal endothelium protection is a major concern during cataract surgery and is of significant importance for postoperative recovery and visual outcome. Transient increase in corneal thickness, which could be explained with moderate loss of endothelial cells, has been reported in several publications. However, results in terms of mean endothelial cell loss, change of central corneal thickness, and time for reaching baseline measurements, vary widely.AimThe aim of this article is to evaluate changes in endothelial cell density (ECD) and central corneal thickness (CCT) following uncomplicated cataract surgery.Materials and Methods Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction under local anesthesia was used. Patients with previous ocular surgery or trauma, or other ocular pathology, as well as cases with complications, were not included in the study. Optical pachymetry of central cornea was performed using anterior segment optical coherence tomography (AS-OCT) (Topcon 3D SD OCT 2000). ECD and endothelial cell loss (ECL) in the central cornea were estimated using in vivo confocal microscopy (IVCM). All subjects were examined preoperatively and at three postoperative visits: day 1, day 7, and day 30. Statistical analysis was performed using SPSS statistics software package (v22.0) for Windows (IBM SPSS Inc., Chicago, IL,). Since the data were not normally distributed with the exception of patients` age they are presented with their medians with nonparametric analyses being conducted.ResultsA total of 60 patients with a mean age of 70.56 years (SD=8.01), 29 men and 31 women were enrolled. Preoperatively CCT was 552 µm (range 480-659) and ECD was 2398 cells/mm2 (SD=1025-2965). A considerable rise in CCT was noted 24 hours after surgery (Z=-6.792, p<0.001). Endothelial cell count was 2302 cells/mm2 (range 945-2902); the decrease of cell density was 89 cells/mm2 (3.91%) compared to baseline. During the first week CCT decreased by 7.01% in comparison to the first postoperative visit, while ECD continued to decrease. Nearly preoperative values of CCT (566 µm, range= 481-807) were reached by the 30th postoperative day. The overall ECL compared to baseline was 108 cells/mm2 (5.2%).ConclusionEndothelial alteration is considered an important parameter of surgical trauma and essential for estimating the safety of the surgical technique. It can be roughly assessed measuring corneal thickness but modern technology for ultrastructural examination, such as OCT and IVCM, provides further information about the underlying morphological changes and could help choose the best approach according to the individual corneal characteristics of every patient

Specific Immunoglobulin E and G to Common Food Antigens and Increased Serum Zonulin in IBS Patients: A Single-Center Bulgarian Study

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder whose pathogenesis is considered multifactorial, including abnormal gut motility, visceral hyperreactivity, psychological factors, disturbances in the brain-gut axis, leaky gut, oxidative stress, etc. We aimed to investigate serum levels of specific immunoglobulin E and G to common food antigens and zonulin and to assess their use in clinical practice for patients with IBS. Material and methods. We included 23 participants, 15 with IBS (diagnosed according to the Rome IV criteria) and 8 healthy controls. We investigated serum levels of specific IgG antibodies to 24 food antigens, specific IgE antibodies to 20 food antigens, anti-celiac antibodies, fecal calprotectin and serum zonulin by ELISA. Results. Food-specific positive IgG antibodies were significantly higher in patients with IBS than in controls (p = 0.007). IgE-mediated allergic reactions were found in five patients with IBS; no one had anti-TG antibodies. One-third of IBS patients demonstrated a low degree of chronic inflammation (positive fecal calprotectin test > 50 ng/mL) without specific bacterial infection. Serum levels of zonulin in IBS patients were higher than in healthy controls (0.378 ± 0.13 vs. 0.250 ± 0.14 ng/mL, p = 0.0315). However, no correlations between clinical symptoms and zonulin levels were found. Conclusion. The mechanisms of IgG hypersensitivity and low degree inflammation in IBS and elevated zonulin may contribute to multifactor pathogenesis in IBS

Specific Immunoglobulin E and G to Common Food Antigens and Increased Serum Zonulin in IBS Patients: A Single-Center Bulgarian Study

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder whose pathogenesis is considered multifactorial, including abnormal gut motility, visceral hyperreactivity, psychological factors, disturbances in the brain-gut axis, leaky gut, oxidative stress, etc. We aimed to investigate serum levels of specific immunoglobulin E and G to common food antigens and zonulin and to assess their use in clinical practice for patients with IBS. Material and methods. We included 23 participants, 15 with IBS (diagnosed according to the Rome IV criteria) and 8 healthy controls. We investigated serum levels of specific IgG antibodies to 24 food antigens, specific IgE antibodies to 20 food antigens, anti-celiac antibodies, fecal calprotectin and serum zonulin by ELISA. Results. Food-specific positive IgG antibodies were significantly higher in patients with IBS than in controls (p = 0.007). IgE-mediated allergic reactions were found in five patients with IBS; no one had anti-TG antibodies. One-third of IBS patients demonstrated a low degree of chronic inflammation (positive fecal calprotectin test &gt; 50 ng/mL) without specific bacterial infection. Serum levels of zonulin in IBS patients were higher than in healthy controls (0.378 &plusmn; 0.13 vs. 0.250 &plusmn; 0.14 ng/mL, p = 0.0315). However, no correlations between clinical symptoms and zonulin levels were found. Conclusion. The mechanisms of IgG hypersensitivity and low degree inflammation in IBS and elevated zonulin may contribute to multifactor pathogenesis in IBS