RESUMEN
PURPOSE: To investigate the gender gap in first/last authors in vision science and whether gender affects manuscript review times. DESIGN: Observational retrospective database study. METHODS: First/last author's gender and country were assigned to 30 438 PubMed records (data derived from Q1-Q2 Ophthalmology journals for 2016-2020). Using mixed models, the influence of First Author Female (FAF) and Last Author Female (LAF) were evaluated on the manuscripts' review timeline. This analysis was performed globally and in predefined subgroups (English names, Asian names, specific topics). Additionally, the gender GAP was explored by country, journal, and research topics. RESULTS: The percentages of FAF/LAF were unevenly distributed by country; in the top 30 ophthalmology journals, FAF accounted for 40.0%±6.7% of the publications whereas LAF accounted for 27.1%±4.9%. Overall, FAF/LAF papers underwent significantly longer times to be reviewed (up to +10 days) and accepted (+5 days). These differences persisted when only English names-easily recognizable worldwide-were considered, but not for Asian names. Delays >1 month to get published were found for FAF in 3 of 4 topics analyzed (eg, amblyopia). CONCLUSIONS: Significant differences were found in both review and acceptance times for FAF or LAF papers. The causes for this are likely multifactorial and could be explained by a combination of gender bias and by women's concerns with being held to higher standards, something that has been previously documented, thereby perhaps delaying the rebuttal to reviewers. Increased awareness of this source of potential bias may assist in the implementation of preventive and corrective measures.
Asunto(s)
Oftalmología , Edición , Autoria , Femenino , Humanos , Masculino , Revisión de la Investigación por Pares , Estudios Retrospectivos , SexismoRESUMEN
PURPOSE: To present a descriptive system for the elliptic demarcation area seen in keratoconus densitometry maps (obtained with a Scheimpflug tomographer) and to evaluate its suitability for clinical practice. METHODS: The subjects were 30 keratoconus patients at different stages and 20 healthy subjects. The averaged densitometry maps ('two-layers' scan, with fixed layers 120 µm and endothelium) were analysed using a system of four categories (termed 'Brightness', 'Contrast', 'Decentration' and 'Octants surrounded by a dark line') that we created to characterise the demarcation area. Four examiners (three corneal specialists and one junior resident) used the system to classify the maps. The inter-rater agreement was calculated for two subgroups: (1) clinical keratoconus patients and (2) both healthy patients and forme fruste keratoconus patients. Intra-rater agreement was also determined. RESULTS: Inter-rater agreement on classification was higher when analysing clinical keratoconus, reaching levels of substantial agreement. Despite this, only low levels of agreement were found in 'Decentration', penalized due to the skewness in the distribution of this descriptor. Almost perfect intra-rater agreement was obtained for all descriptors in the first subgroup of clinical keratoconus, whereas the agreement was generally moderate within the second subgroup of normal and forme fruste eyes. Agreement was slightly lower with the less experienced observer. At least three observers agreed on four forme fruste keratoconus eyes presenting abnormalities in the images. The observers reported that the 'Brightness' descriptor was subjective and redundant with 'Contrast'. CONCLUSIONS: The description of the area was repeatable and reproducible, and may be a valuable supplement when documenting clinical keratoconus stage and progression in daily practice. However, a minor learning curve was noticed and agreement was higher among the more experienced observers. Since the descriptor 'Brightness' was found to be subjective and redundant, it was excluded from the final proposed classification.
Asunto(s)
Queratocono , Córnea , Topografía de la Córnea , Densitometría , Humanos , Queratocono/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
Within the COVID-19 pandemic context, the WHO has proposed a list of medicines to treat patients with severe acute respiratory syndrome (SARS-CoV-2). An analysis of their ocular side effects was performed. Only chloroquine and hydroxychloroquine were found to have an ocular impact in the medium and long-term. Detailed search strategies were performed in EMBASE, MEDLINE, SCOPUS and WOS Core Collection. Additionally, the worldwide ongoing clinical trials including chloroquine or hydroxychloroquine were evaluated, and their proposals of drug administration and exclusion criteria analyzed. In general, high maximum cumulative doses of chloroquine or hydroxychloroquine are being used for a short period in 135 currently underway clinical trials (to 21st April 2020). Typically, the doses were 2 to 5 times greater than the AAO recommendation (adjusted to weight) to avoid toxic retinopathy, the most undesirable ocular side effect. Maximum cumulative doses up to 12,000 mg for chloroquine and 18,000 mg for hydroxychloroquine were found. In prophylaxis clinical trials, 72,000 mg and 22,500 mg were the maximum cumulative doses for hydroxychloroquine and chloroquine respectively. Only 48% of the clinical trials considered retinal impairment as an exclusion criterion, and just one referred to an ophthalmic examination previous to study inclusion. How chloroquine and hydroxychloroquine treatment affect patients with a previous retinal condition is still poorly understood. A comprehensive ophthalmological examination 6 months after treatment is recommended in this subgroup. This review provides an overview of this topic and sheds light on the challenges visual caregivers may face regarding these repurposed drugs.
Asunto(s)
Antimaláricos/toxicidad , Tratamiento Farmacológico de COVID-19 , Cloroquina/toxicidad , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Hidroxicloroquina/toxicidad , Enfermedades de la Retina/inducido químicamente , SARS-CoV-2/efectos de los fármacos , Cuidadores , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Personal de Salud , Humanos , Oftalmólogos , Retina/efectos de los fármacos , Enfermedades de la Retina/diagnósticoRESUMEN
PURPOSE: To report an observation made while performing Scheimpflug densitometry analysis on the corneal region affected in keratoconus (KC) that seems to delineate the base of the cone. METHODS: Scheimpflug densitometries of 20 healthy subjects and 90 patients with KC were examined. Corneal densitometry was analyzed using both "1-layer" and "2-layer" approaches. The first considers the corneal transparency layer by layer at different depths, whereas the second averages densitometry between 2 corneal layers selected by the examiner. Fixed layers, 120 µm depth, and endothelium were selected. Repeated same-day scans and longitudinal series of scans were also evaluated to see whether the findings evolved over time. RESULTS: Eighty-eight of 90 KC cases displayed a bright area on the densitometry map that corresponded to the cone location. The area's characteristics, such as its brightness, contrast, and the presence of a delimiting arc correlated with KC severity and was more noticeable in advanced cases. No similar marks were found in any of the normal subjects. The shape, location, and extent of the mark were consistent over consecutive measures taken on the same day. Changes over time were also seen in eyes with known clinical progression but was also seen in eyes considered clinically stable. CONCLUSIONS: The densitometry mark seems to correspond with the zone most affected by KC and could be a supplementary tool for documenting KC stage, alongside conventional parameters. Further studies are required to ascertain whether it could prove useful in KC detection, to determine progression, and to relate it to corneal biomechanical behavior.
Asunto(s)
Córnea/patología , Topografía de la Córnea/métodos , Densitometría/métodos , Queratocono/diagnóstico , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Queratocono/clasificación , Masculino , Reproducibilidad de los Resultados , Tomografía , Adulto JovenRESUMEN
PURPOSE: To develop a stable and low-cost computer aided diagnosis (CAD) system for early keratoconus detection for clinical use. METHODS: The CAD combines a custom-made mathematical model, a feedforward neural network (FFN) and a Grossberg-Runge Kutta architecture to detect clinical and suspect keratoconus. It was applied to retrospective data of 851 subjects for whom corneal elevation and thickness data was available. These data were divided into four groups: a control group (312 eyes) with bilateral normal tomography, keratoconus suspect (77 eyes) with a clinically diagnosed keratoconus in one eye and a normal fellow eye, mild keratoconus (220 eyes), and moderate keratoconus (229 eyes). The proposed framework is validated using 10-cross-validation, holdout validation and ROC curves. RESULTS: The CAD detects suspect keratoconus with an accuracy of 96.56% (sensitivity 97.78%, specificity 95.56%) versus an accuracy of 89.00% (sensitivity 83.00%, specificity 95.00%) for Belin/Ambrosio Deviation (BADD), and an accuracy of 79.00% (sensitivity 58.00%, specificity 99.70%) for Topographical Keratoconus Classification (TKC). For the detection of mild to moderate keratoconus CAD shows nearly similar accuracies as previously described methods, with an average accuracy of 99.50% for CAD, versus 99.46% for BADD and 96.50% for TKC. The proposed algorithm also provides a 70% reduction in computation time, while increasing stability and convergence with respect to traditional machine learning techniques. CONCLUSION: The proposed algorithm is highly accurate and provides a stable screening platform to assist ophthalmologists with the early detection of keratoconus. This framework could potentially be set up for any Scheimpflug tomography system.
Asunto(s)
Topografía de la Córnea , Diagnóstico por Computador , Queratocono/diagnóstico por imagen , Aprendizaje Automático , Redes Neurales de la Computación , Adulto , Femenino , Humanos , MasculinoRESUMEN
PURPOSE: To study the corneal and internal astigmatism and the age-related changes underlying the known refractive shift with-the-rule (WTR) towards against-the-rule (ATR) astigmatism. METHODS: Refractive and corneal biometry data were collected for a total of 1195 healthy Caucasian subjects, recruited by ophthalmological centres across Europe. After conversion of refractive and corneal surface astigmatism to power vectors J0 and J45 , the total corneal and internal astigmatism were calculated. RESULTS: Both refractive power vectors had leptokurtic distributions with a narrow peak at zero, and a broader, secondary distribution at its base, corresponding to eyes without balanced components. This may be fitted with a bigaussian function (J0 : r² = 0.87; J45 : r² = 0.98). Statistically significant changes in these distributions are seen with age: for refractive J0 the narrow peak shortens progressively, while the broad peak shifts positive from to negative values, corresponding to increased astigmatism and a shift from with-the-rule towards against-the-rule. For J45 the narrow peak shortens with age as well, while the broad peak flattens. These changes in refractive J0 result from statistically significant negative shifts in both the corneal and internal components with age (Kruskal-Wallis, p < 0.05). CONCLUSION: In young participants corneal and internal astigmatism partially cancel each other out. This balance between both is gradually lost after age 50, leading to larger amounts of refractive astigmatism, as well as a reorientation of the axis. Given the small amplitude of these changes, they are unlikely to have repercussions for long term stability toric cataract or refractive surgery outcomes.