Topographic and Clinical Characteristics of a Sample of Jordanian Students

Purpose: To screen for keratoconus (KC) and potential associated risk factors in a sample of medical students. Methods: This cross sectional study included 120 medical students studying at The University of Jordan. They were randomly selected from a total of 400 students. Participants responded by completing a self-administered questionnaire. Following initial clinical evaluation, corneal tomography images and indices were analyzed by an experienced ophthalmologist, after which the participants were classified into: normal, KC suspects and KC patients. Results: A total of 120 participants (mean age, 23.1 ±0.5 years) were included in this study, 70 (58.3%) were females and 50 (41.7%) were males. Two subjects had KC, demonstrating a prevalence of 1.7% while five (4.2%) participants showed at least two abnormal indices and were considered as KC suspects.Conclusion: the result of this study is similar to other studies conducted in the Middle East, which indicates a higher prevalence of KC than other western countries. Combined with the significantly impaired vision-related quality of life and the relatively young onset of disease, the burden of keratoconus represents a significant public health concern

Outcome of Penetrating Keratoplasty (PKP) and Redo PKP among Jordanian Population

Background: The success of penetrating keratoplasty (PKP) is determined by the duration of graft survival, which is the time to graft failure. Our study aims to identify various indications of corneal graft among our Jordanian population, their success rate as well as spotting the light on cases of re-grafting. Methods: In this study, we analyzed data for patients who had PKP as well as re-do PKP in the period from January 2014 to June 2017. For each study eye, we identified pre-operative visual acuity as well as visual acuity at six months and one year. We also focused on the specific indication for PKP, the surgical procedure and graft clarity at one year post-op. On SPSS statistical analysis software, we used repeated measure ANOVA, Pearson correlations, and Fischer’s exact test to analyze our study’s variables.Results: We included a total of 230 patients in this study with a mean age of 34.22 (±19.32). They were 112 (48.7%) males and 118 (±51.3%) females. We found a significant difference in mean age and outcome (p< 0.001), as the mean age for patients with successful PKP was 31.55 (±16.55) compared to 44.1 (±25.1) for patients with failed PKP. the success rate for patients with KC as an indication was 96.7% compared to only 58.3% for other indications. We found that failure rate in redo surgeries was significantly higher than first time surgeries.Conclusion: Among the Jordanian population, we found that Keratoconus was the main indication for PKP in our population, where we also found that it was associated with the best prognosis

Topographic characteristics of keratoconus among a sample of Jordanian patients

<b>AIM:</b>To identify topographic characteristics of keratoconus in a Jordanian sample.<b>METHODS</b>:This study characterized 210 corneas affected with keratoconus presenting to Jordan University Hospital. Patients were diagnosed based on clinical examinations and Pentacam imaging. Eyes of males (<i>n=</i>101) were of a similar proportion to females (<i>n=</i>109). All of the 111 patients were affected bilaterally. Ages ranged between 13 and 44y with a mean age of 25.2y.<b>RESULTS</b>:Results revealed significant differences between males and females at the level of the flat curvature power, basement membrane thickness and size of the anterior chamber. Eyes were arranged in three groups based on severity levels:mild, moderate and severe determined by the mean curvature power (Km). Results show that the flat (K1) and steep (K2) curvature powers, corneal asphericity coefficient (QV), thinnest point, pachy apex and basement membrane thickness are significantly different among the three groups, but not the corneal and anterior chamber volumes. Morphological analyses, based on sagittal maps, show no differences in keratometric values between eyes with different sagittal patterns except for the vertical location of the pachy apex relative to the pupil center and the thinnest point. Eyes with the island front elevation map are significantly more affected than eyes with the U shape and the ridge pattern.<b>CONCLUSION</b>:All keratometric values measured except for corneal and anterior chamber volumes vary significantly with disease severity. The vertical pachy apex location correlates well with severity levels while the horizontal location seems to have no effect. Our study also indicates that front elevation maps may be a better predictor of the severity of keratoconus than sagittal maps

The utilization of artificial intelligence in glaucoma: diagnosis versus screening

With advancements in the implementation of artificial intelligence (AI) in different ophthalmology disciplines, it continues to have a significant impact on glaucoma diagnosis and screening. This article explores the distinct roles of AI in specialized ophthalmology clinics and general practice, highlighting the critical balance between sensitivity and specificity in diagnostic and screening models. Screening models prioritize sensitivity to detect potential glaucoma cases efficiently, while diagnostic models emphasize specificity to confirm disease with high accuracy. AI applications, primarily using machine learning (ML) and deep learning (DL), have been successful in detecting glaucomatous optic neuropathy from colored fundus photographs and other retinal imaging modalities. Diagnostic models integrate data extracted from various forms of modalities (including tests that assess structural optic nerve damage as well as those evaluating functional damage) to provide a more nuanced, accurate and thorough approach to diagnosing glaucoma. As AI continues to evolve, the collaboration between technology and clinical expertise should focus more on improving specificity of glaucoma diagnostic models to assess ophthalmologists to revolutionize glaucoma diagnosis and improve patients care

The Effect of Visual Impairment and Its Severity on Vision-Related and Health-Related Quality of Life in Jordan: A Comparative Cross-Sectional Study

Purpose: To assess the effect of visual impairment (VI), its severity, and ocular diseases on vision-related and health-related quality of life (QoL) in Jordan. Patients and Methods: A comparative, cross-sectional, hospital-based study was conducted among a group of 278 patients with VI aged ≥ 18 years, and age and sex-matched control group of 278 individuals with no VI. An interviewer administered the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) to all participants. Results: All the mean VFQ-25 subscales scores, physical component scale (PCS) and the mental component scale (MCS) of the SF-12 were significantly lower in patients with VI compared to controls with no VI. The VFQ-25 subscales (except general health and ocular pain), PCS, and MCS scores significantly decreased with more severity of VI. In the adjusted multivariate analysis, lower level of education (p=0.013), male sex (p=0.016), and the presence of cerebrovascular disease (p=0.019) were significantly associated with lower VFQ-25 composite scores in visually impaired patients compared to controls. Ocular disease duration of >5 years and progressive VI were significantly associated with lower VFQ-25 composite scores (p= 0.026 and p<0.001) respectively, in patients with VI. Glaucoma had a significantly larger reduction in mean scores of all the VFQ-25 subscales, and the PCS of the SF-12 compared to all other ocular diseases. Conclusion: Both VI and increasing severity of impairment were associated with reduced vision-related and health-related quality of life in adult Jordanians. Glaucoma patients and less educated people were particularly affected. Routine assessment of QoL in visually impaired patients and improving referral protocols to vision rehabilitation services is recommended to improve the QoL in those patients.This work was funded by the deanship of research, Jordan University of Science and Technology, Grant No: [20210196]

Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor

Purpose To assess the impact of Jordanian's Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions. Patients and Methods This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown. Results One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (±9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (±24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045). Conclusion The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome

Extending the spectrum of CLRN1‐ and ABCA4‐associated inherited retinal dystrophies caused by novel and recurrent variants using exome sequencing

Abstract Background Inherited retinal dystrophies (IRDs) are characterized by extreme genetic and clinical heterogeneity. There are many genes that are known to cause IRD which makes the identification of the underlying genetic causes quite challenging. And in view of the emergence of therapeutic options, it is essential to combine molecular and clinical data to correctly diagnose IRD patients. In this study, we aimed to identify the disease‐causing variants (DCVs) in four consanguineous Jordanian families with IRDs and describe genotype–phenotype correlations. Methods Exome sequencing (ES) was employed on the proband patients of each family, followed by segregation analysis of candidate variants in affected and unaffected family members by Sanger sequencing. Simulation analysis was done on one novel CLRN1 variant to characterize its effect on mRNA processing. Clinical evaluation included history, slit‐lamp biomicroscopy, and indirect ophthalmoscopy. Results We identified two novel variants in CLRN1 [(c.433+1G>A) and (c.323T>C, p.Leu108Pro)], and two recurrent variants in ABCA4 [(c.1648G>A, p.Gly550Arg) and (c.5460+1G>A)]. Two families with the same DCV were found to have different phenotypes and another family was shown to have sector RP. Moreover, simulation analysis for the CLRN1 splice donor variant (c.433+1G>A) showed that the variant might affect mRNA processing resulting in the formation of an abnormal receptor. Also, a family that was previously diagnosed with nonsyndromic RP was found to have Usher syndrome based on their genetic assessment and audiometry. Conclusion Our findings extend the spectrum of CLRN1‐ and ABCA4‐associated IRDs and describe new phenotypes for these genes. We also highlighted the importance of combining molecular and clinical data to correctly diagnose IRDs and the utility of simulation analysis to predict the effect of splice donor variants on protein formation and function