INTRODUCTION: The goal of this study was to investigate the efficacy and safety of therapeutic switch of intravitreal injections (IVT) from ranibizumab 10mg/mL (Lucentis®) and aflibercept 40mg/mL (Eylea®) to FYB201 (Rani...INTRODUCTION: The goal of this study was to investigate the efficacy and safety of therapeutic switch of intravitreal injections (IVT) from ranibizumab 10mg/mL (Lucentis®) and aflibercept 40mg/mL (Eylea®) to FYB201 (Ranivisio®) in exudative age-related macular degeneration (AMD). This study includes an analysis of the direct medical cost of managing exudative AMD. The data studied included the mean injection interval in the year preceding the switch and the 9 months following, the longest dry interval over this period, the change in central retinal thickness, tolerance data, the sum of visit costs, treatment costs and an estimate of transportation costs. MATERIALS AND METHODS: Fifty-nine eyes of 46 patients treated for exudative AMD were included. Twenty-one eyes were treated with Lucentis® and 38 eyes with Eylea® before being switched to Ranivisio® between February 2023 and May 2024. The primary endpoint was the change in mean inter-injection interval in the pre-switch year versus the mean inter-injection interval in the 3 to 9 months post-switch. RESULTS: Patients received a mean of 7.5 IVT of anti-VEGF per eye in the pre-switch year, with a mean inter-injection interval of 6.2 weeks in Treat-and-Extend (TaE) schedule. The switch resulted in an extension of the mean inter-injection interval to 7.1 weeks (P=0.0004) and an extension of the longest dry interval (7.5 versus 6.39, P=0.0057) in the following 3 to 9 months. A reduction in central retinal thickness was observed at 3 months (247μm versus 261μm, P=0.0067), and no adverse effects were noted. In the year prior to switch, total medical costs per patient amounted to €9,397, with €6,542.00 (70%) in medication costs, €2,035.50 (21%) in ophthalmologic follow-up costs and €819.60 (9%) in transportation costs. After the switch, with a mean Ranivisio® inter-injection interval of 7.1 weeks, the annual treatment cost per eye was estimated at €2,388.00 for 7.33 annual IVTs. DISCUSSION: This study is consistent with data in the literature demonstrating the benefits of therapeutic switches in extending inter-injection intervals and improving retinal dryness, probably due to this method being a work-around for tachyphylaxis. CONCLUSION: Switching from Eylea® and Lucentis® to Ranivisio® is effective in exudative AMD, with a good safety profile, and could help to reduce treatment costs.
INTRODUCTION: The iridocorneal angle is one of the major components of the eye. It constitutes the main pathway for aqueous humor resorption via the trabecular meshwork. The goal of this study was to investigate the irid...INTRODUCTION: The iridocorneal angle is one of the major components of the eye. It constitutes the main pathway for aqueous humor resorption via the trabecular meshwork. The goal of this study was to investigate the iridocorneal angle in black patients and to determine any anatomical variants. PATIENTS AND METHODS: This was a cross-sectional study with prospective data collection, enrolling black patients admitted to the ophthalmology departments of Burkina University Medical Centers, running from March to August 2021. The sample consisted of black patients aged 18 years or over. RESULTS: One hundred and forty-five (145) eyes of 92 patients constituted our study population. The mean age of the patients was 41 years. Males predominated, with a sex ratio of 1.3. The iridocorneal angle was open in 129 eyes (88.97%) and occludable in 16 eyes (11.03%). The lower quadrant was the most pigmented. One hundred and nineteen (82.06%) eyes had convex peripheral iris curvature. Van Herick's grade 3 test was 100% concordant with gonioscopy in the detection of open angles. There was a statistically significant relationship between iridocorneal angle depth and age (P=0.000). CONCLUSION: The iridocorneal angles in our study population were predominantly open, with low pigmentation and convex peripheral iris curvature. Good sensitivity between the Van Herick's test and gonioscopy was found in eyes of grades 3 and 4.
PURPOSE: To analyze the perioperative impact of antiseptic protocols in patients receiving intravitreal injections. METHODS: A tolerance questionnaire using visual analog pain scales was administered to patients who rece...PURPOSE: To analyze the perioperative impact of antiseptic protocols in patients receiving intravitreal injections. METHODS: A tolerance questionnaire using visual analog pain scales was administered to patients who received consecutive intravitreal injections between December 1st and 31st, 2024, across two tertiary centers. Data collected included: pathology treated, number of previous injections, current topical and systemic medications, pain experienced during the procedure, post-injection discomfort, duration and nature of symptoms, and the desire to consider an alternative antiseptic method. RESULTS: A total of 619 patients with fully completed questionnaires were included in the analysis. The mean age was 74.4 years (±11.62), with a male-to-female sex ratio of 0.48. The mean reported procedural pain was 4.2/10 (±2.7). Fifty-three percent of patients reported experiencing discomfort for at least 24h post-injection. A desire to change the antiseptic protocol was expressed in 81% of cases. DISCUSSION: Our findings across two centers are consistent with those of the IVIS study: one-third of patients reported pain greater than 6/10 following intravitreal injection. Half of the patients experienced discomfort lasting more than 24hours. This poor tolerance of a frequently repeated procedure can lead to treatment discontinuation. The fact that 81% of patients expressed a desire to switch antiseptic protocols highlights the need for alternatives, such as chlorhexidine, which is already used in other countries. CONCLUSION: The choice of antiseptic agent may become a limiting factor in intravitreal injection protocols due to poor tolerance in approximately one-third of patients. In such cases, proposing an equally effective alternative is justified. Chlorhexidine represents a viable option, though it is not currently utilized in France.
PURPOSE: Optic neuritis (ON) associated with acute retinal necrosis (ARN) has traditionally been considered a complication resulting from direct viral infiltration of the optic nerve. Although it is currently treated wit...PURPOSE: Optic neuritis (ON) associated with acute retinal necrosis (ARN) has traditionally been considered a complication resulting from direct viral infiltration of the optic nerve. Although it is currently treated with intravenous acyclovir, the appropriate dosage and duration of treatment in the pediatric population remain unclear, and no standardized effective treatment has been established in clinical guidelines. METHODS: A 14-year-old boy was referred for panuveitis in the right eye (RE), with a visual acuity (VA) of hand motions. Fundus examination revealed intense vitritis, and PCR testing was positive for HSV-2. Empirical treatment with intravenous (IV) acyclovir and intravitreal foscarnet was initiated; however, the patient developed peripheral ARN with multiple retinal detachments that required surgery, leaving silicone oil tamponade in place, and was maintained on oral valacyclovir prophylaxis. Fourteen months later, he presented with discomfort in the left eye (LE), where an active focus of ARN was identified, leading to a diagnosis of bilateral ARN. Despite urgent treatment with IV acyclovir and an intravitreal foscarnet injection, the disease progressed in the LE, and four days later, the patient developed optic neuritis associated with ARN, with VA of light perception. Since the LE was the only functional eye, high-dose intravenous methylprednisolone boluses were started. RESULTS: One month later, the optic disc edema had significantly improved, and VA had improved to counting fingers. Currently, the patient has shown a remarkable recovery, with VA improving to 20/32. CONCLUSIONS: These positive outcomes may suggest new therapeutic possibilities and highlight the possibility that HSV-2 may trigger an intense inflammatory or autoimmune response that could be the primary cause of ON, rather than direct infection of the optic nerve, as previously believed. Importantly, in our case, high-dose corticosteroid therapy was initiated at the onset of optic neuritis, after several days of antiviral therapy, which supports the safety of corticosteroid administration at this stage. To our knowledge, this case and two other cases of ON associated with herpetic encephalitis in the literature represent the first instances treated with corticosteroid boluses, all of which showed significant improvement.
PURPOSE: To assess the 1-year efficacy and safety of the XEN 45® gel stent (XEN) and its impact on glaucoma medication-related costs. METHODS: This retrospective study included patients with open-angle glaucoma who under...PURPOSE: To assess the 1-year efficacy and safety of the XEN 45® gel stent (XEN) and its impact on glaucoma medication-related costs. METHODS: This retrospective study included patients with open-angle glaucoma who underwent XEN implantation. We evaluated the ability of the procedure to reduce intraocular pressure, the amount of glaucoma medications required, complications and re-interventions over a 12-month follow-up period. The main outcome measures were: (1) probability of success (intraocular pressure<18mmHg with no medications, complications, or re-interventions) at 1 year; and (2) monthly cost of glaucoma medications during follow-up. We also evaluated the visual field at baseline and month 12. RESULTS: The study population consisted of 130 patients (mean [± standard deviation] age: 66.5±12.2 years). We observed 36.2% and 90.0% reductions in the mean intraocular pressure and number of medications, respectively (P<0.001 for both analysis). Mean (± standard deviation) monthly medication costs per patient decreased from 69.16±13.67 dollars at baseline to 5.18±14.70 dollars at month 12, a 92.5% reduction. The probability of success was 63.8%. No visual field worsening or vision-threatening complications were observed. CONCLUSION: The XEN procedure resulted in a significant reduction in intraocular pressure, number of medications, and glaucoma medication-related costs while achieving stability of the visual field over a 1-year period.
PURPOSE: To evaluate and compare ocular surface findings in rheumatoid arthritis (RA) patients on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). MATERIALS AND METHODS: The files of adult patient...PURPOSE: To evaluate and compare ocular surface findings in rheumatoid arthritis (RA) patients on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). MATERIALS AND METHODS: The files of adult patients (≥18 years of age) diagnosed with rheumatoid arthritis (RA) according to the 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis were reviewed retrospectively. RA disease activity was evaluated according to the DAS-28 score, and patients with similar severity of disease were enrolled. Patients who received hydroxychloroquine, methotrexate, and leflunomide treatments were defined as groups 1, 2, and 3, respectively. Ocular surface evaluation, Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test, tear break-up time (TBUT), Oxford scoring according to corneal and conjunctival fluorescein staining (CFS), conjunctival impression cytology (CIC) and the presence of posterior blepharitis were noted and statistically compared between the groups. RESULTS: The mean age of the 49 RA patients was 57.9±10.2 years; 39 were female, and 10 were male. The mean follow-up period for RA was 12.1±7.8 years. The patients numbered 19, 15, and 14 in groups 1, 2, and 3, respectively. The median OSDI questionnaire scores for the groups were 31.3 (19.2-68.75), 33.4 (19.7-69.7), and 49 (21.1-67.1), respectively (P>0.05). The median Schirmer 1 test was 9mm (2-14mm) in group 1, 8mm (4-20mm) in group 2, and 7mm (5-15mm) in group 3 (P>0.05). Tear film BUT was measured at 7 s (3-10 s), 5.5 s (2-10 s), and 5 s (2-10 s) in the groups, respectively (P>0.05). A statistically significant difference was not found in terms of the Oxford score, which evaluates staining of the ocular surface with fluorescein (P>0.05). According to the Nelson grading of CIC, a statistically insignificant difference was observed between the groups (P>0.05). The presence of posterior blepharitis differed statistically significantly among groups (P=0.003). CONCLUSION: Although a grade 3 CIC score was observed at a higher rate in the leflunomide group, this difference was not statistically significant. In addition, posterior blepharitis was observed more frequently in patients on methotrexate.
PURPOSE: This study aimed to compare the outcomes between the bag-in-the-lens (BIL) and the lens-in-the-bag (LIB) techniques for cataract surgery in children. MATERIALS AND METHODS: This retrospective study was conducted...PURPOSE: This study aimed to compare the outcomes between the bag-in-the-lens (BIL) and the lens-in-the-bag (LIB) techniques for cataract surgery in children. MATERIALS AND METHODS: This retrospective study was conducted between 2003 and 2024. All children who underwent cataract surgery with intraocular lens implantation with a minimum follow-up duration of one year were included in two groups according to the technique used: LIB and BIL. The primary outcome measure was the occurrence of amblyogenic visual axis opacification. RESULTS: A total of 64 eyes were included in the BIL group and 50 eyes in the LIB group. Visual axis opacification was found in 9.4% of eyes in the BIL group compared to 30% in the LIB group (P=0.01). The rate of all-cause surgical reinterventions was also lower in the BIL group (17.1%) compared to the LIB group (38%) (P<0.01). The final visual acuity was measured at 0.4 LogMAR for the BIL group versus 0.6 LogMAR for the LIB group (P=0.08). CONCLUSION: The rate of surgical reinterventions, particularly for visual axis opacification, was significantly lower with the BIL technique, with no detrimental effect on visual outcomes.
BACKGROUND: Transthyretin amyloidosis (ATTR) is a disorder characterized by amyloid fibril deposits in various tissues, leading to dysfunction of one or multiple organs. Ocular manifestations include keratoconjunctivitis...BACKGROUND: Transthyretin amyloidosis (ATTR) is a disorder characterized by amyloid fibril deposits in various tissues, leading to dysfunction of one or multiple organs. Ocular manifestations include keratoconjunctivitis, secondary glaucoma, vitreous deposits, and amyloid choroidopathy. This study aims to describe the angiographic findings in 40 patients with either hereditary (ATTRv) or wild-type (ATTRwt) transthyretin amyloidosis, analyze the 3-year progression of choroidal involvement, and correlate these findings with neurological and cardiac involvement. PATIENTS AND METHODS: We retrospectively analyzed 79 eyes of 40 patients who underwent a comprehensive ophthalmological examination, including fluorescein angiography and indocyanine green angiography (ICGA), between 2018 and 2021. A neurological assessment (SFN-SIQ questionnaire, PND, FAP, and NIS scores) and cardiology evaluation (NYHA, LVEF) were systematically performed. RESULTS: A total of 25 men and 15 women with a mean age of 65.8±16.8 years were included. Seventy-five percent had ATTRv, mostly with the Val30Met (p.Val50Met) mutation (35%). In 61.1% of cases, hyperfluorescent lesions were observed on ICGA. Only Val30Met (p.Val50Met) patients exhibited firework-like patterns on ICGA. There was no progression of choroidal involvement over 3 years. Ninety-five percent of patients showed neurological involvement. Diffuse choroidal involvement is associated with higher SFN-SIQ questionnaire value (P=0.02), FAP score (P=0.017) and NIS score (P=0.046). In contrast, no relationship was found between cardiac involvement and choroidal involvement. CONCLUSION: ICG may be used as a marker for neural components of the choroid in this disease. A prospective longitudinal study is needed to evaluate the progression of hyperfluorescent lesions on ICGA in choroidal neuropathy under treatment over time in ATTR.
Secretory carcinoma is a histological type mostly found in salivary gland tumors, but also in breast and skin tumors. These tumors share pathological characteristics and the presence of an ETV6-NTRK3 gene fusion. Secreto...Secretory carcinoma is a histological type mostly found in salivary gland tumors, but also in breast and skin tumors. These tumors share pathological characteristics and the presence of an ETV6-NTRK3 gene fusion. Secretory lacrimal gland carcinoma is even rarer. Our case is a middle-aged man who presented with a left orbital tumor with proptosis, diplopia and mass effect on the globe. Multimodal imaging revealed a heterogeneous tumor enhanced with gadolinium. There were no granulomatous foci. Total excision was preferred over diagnostic biopsy because of the intense vascularization of the tumor. Histopathology revealed a secretory carcinoma of the lacrimal gland. The FISH study showed ETV6 gene fission in 90% of enumerated cells. After consultation, it was decided not to irradiate because of the risk of xerophthalmia, cataract and meningioma. After eighteen months, follow-up imaging showed local recurrence, treated then by surgery and stereotactic radiation therapy. During follow-up, chemotherapy was added when a second recurrence at the orbital site occurred. To support our diagnostic approach, we found only two other cases of secretory carcinoma of the lacrimal gland in the medical literature, both treated by isolated excision. The characterization of histological subtypes of carcinomas has direct implication in the therapeutic approach with the use of targeted therapies. Thus, tyrosine kinase inhibitors can provide valuable options in the treatment of secretory carcinomas.
PURPOSE: To compare levels of isoenzymes of glutathione S-transferase (GST) and mammalian target of rapamycin (mTOR) in pterygium and normal conjunctival tissues. METHODS: This study included 28 patients who had presente...PURPOSE: To compare levels of isoenzymes of glutathione S-transferase (GST) and mammalian target of rapamycin (mTOR) in pterygium and normal conjunctival tissues. METHODS: This study included 28 patients who had presented to our clinic between January 2018 and June 2018 for primary pterygium, without recurrence or history of prior eye surgery, as well as 20 age-matched control patients scheduled for strabismus surgery and having no history of prior eye surgery. The entire population was of European ancestry. Brown staining of epithelial cell cytoplasm and/or nuclei was considered positive for GST isoenzymes and the mTOR protein. The intensity of staining was evaluated as follows: grade 0 (negative), grade 1 (weak), grade 2 (moderate), and grade 3 (heavy). RESULTS: The mean age was 53.7±1.3years in the pterygium group and 44.6±2.4years in the control group. There was no significant difference between the two groups in terms of age or sex (P>0.05). Among the 28 pterygium tissue samples, 10 (35.7%) were positive for the isoenzyme GST-Z, 15 (53.6%) for GST-S, and 10 (35.7%) for GST-K. Expression of mTOR was positive in 22 samples (75.5%). Compared to the control group, there was no statistically significant difference in levels of expression of GST-Z, GST-K or mTOR (P=0.751, P=0.749, P=1.00 respectively). No statistically significant correlation was found between the size or stage of the excised pterygium tissue and levels of expression of glutathione S-transferase sigma (GST-S) (P=0.76 and P=0.73 respectively). CONCLUSION: We believe that the significant increase in expression of GST-S in pterygium serves to maintain antioxidant function against the formation of free radicals in response to exposure to ultraviolet and other factors.
Axenfeld-Rieger syndrome/anomaly (ARS) is a rare genetic disorder with an autosomal dominant inheritance pattern, characterized by dysgenesis of the anterior segment of the eye. It may present with systemic anomalies (Ax...Axenfeld-Rieger syndrome/anomaly (ARS) is a rare genetic disorder with an autosomal dominant inheritance pattern, characterized by dysgenesis of the anterior segment of the eye. It may present with systemic anomalies (Axenfeld-Rieger syndrome) or without (Axenfeld anomaly) and may sometimes be associated with multiple congenital malformations. The estimated prevalence ranges from 1 in 50,000 to 1 in 200,000 live births, with an approximate rate of 1 in 100,000, but no epidemiological studies have been conducted to date. A clinical diagnosis of Axenfeld-Rieger syndrome requires the presence of both Axenfeld and Rieger ocular anomalies, accompanied by extraocular systemic features. Ocular manifestations include iris abnormalities, posterior embryotoxon, juvenile-onset glaucoma (a common complication), and dysgenesis of the iridocorneal angle with iridocorneal adhesions. The most commonly observed systemic anomalies include: umbilical defects; craniofacial dysmorphism; dentofacial abnormalities, such as Class III malocclusion due to maxillary hypoplasia, oligodontia, dental malformations (taurodontism, root dysplasia), microdontia, hypodontia, and anodontia; hearing impairment (partial or complete sensorineural hearing loss); and cardiac anomalies, including non-congenital heart disease and mitral valve insufficiency. Additional anomalies may include hypospadias in males, anal stenosis, endocrine disorders (notably growth retardation) secondary to pituitary dysfunction, psychomotor delay, and various neurological malformations such as Dandy-Walker malformation, mega cisterna magna, posterior fossa cysts, cerebellar vermis hypoplasia, ventriculomegaly, aprosencephaly, cerebral atrophy, microcephaly, arteriovenous malformations (AVM), and digital anomalies such as camptodactyly. Diagnosis is typically made in infancy, based on iris anomalies such as corectopia (displacement of the pupil), polycoria (multiple pupils), and iris hypoplasia. Posterior embryotoxon is frequently observed upon slit-lamp examination. Given the clinical variability, a comprehensive pediatric assessment is essential to identify systemic anomalies and distinguish Axenfeld-Rieger syndrome from the isolated Axenfeld anomaly.
INTRODUCTION: The ocular manifestations of rickettsial diseases are polymorphic. The goal of our work was to characterize the ocular manifestations of rickettsial diseases and to determine the contribution of ophthalmic...INTRODUCTION: The ocular manifestations of rickettsial diseases are polymorphic. The goal of our work was to characterize the ocular manifestations of rickettsial diseases and to determine the contribution of ophthalmic examination to the diagnosis. METHODS: We conducted a retrospective descriptive analysis including consecutive patients with ocular involvement from confirmed rickettsial disease after ruling out other infectious or inflammatory etiologies. Demographic, clinical, multimodal imaging (fluorescein angiography, optical coherence tomography [OCT]), and therapeutic intervention data were systematically analyzed. RESULTS: This study included 24 patients with serologically confirmed rickettsial ocular involvement (mean age 40 years; range 16-67). Presentation with ophthalmologic symptoms occurred in 54.2% (n=13), demonstrating unilateral (58.4%, n=14) or bilateral (41.7%, n=10) ocular involvement, totaling 34 affected eyes. Posterior uveitis predominated (70.5%, 24 eyes), while other significant ophthalmologic signs included fine keratic precipitates (17.6%, 6 eyes), retinitis (64.7%, 22 eyes), retinal vasculitis (20.6%, 7 eyes), and neuroretinitis (8.8%, 3 eyes). Systemic manifestations featured febrile episodes with cutaneous eruptions in 70.8% (n=17). All patients received antibiotic treatment. Oral corticosteroid therapy was added in 12.5% (n=3). Complete resolution of inflammation occurred after a mean follow-up of 3 months. CONCLUSION: In our series, ocular manifestations in rickettsial infections presented symptomatically in only half of cases, with retinitis and retinal vasculitis emerging as the predominant findings. These observations highlight the importance of systematic posterior segment examination in suspected rickettsial cases to facilitate prompt diagnosis and therapeutic intervention.
BACKGROUND: Pediatric-type follicular lymphoma is a rare entity, predominantly involving lymph nodes in the head and neck of children and young adults. Ocular adnexal involvement, particularly of the conjunctiva, is exce...BACKGROUND: Pediatric-type follicular lymphoma is a rare entity, predominantly involving lymph nodes in the head and neck of children and young adults. Ocular adnexal involvement, particularly of the conjunctiva, is exceptionally uncommon in this age group. CASE PRESENTATION: An 11-year-old boy presented with a painless, salmon-colored mass on the nasal bulbar conjunctiva of the left eye, which had been progressively enlarging over several months. The lesion was firm, mobile, well-defined, broad-based, and non-transilluminating on clinical examination. INVESTIGATIONS: An excisional biopsy was performed. Histopathological analysis revealed features suggestive of follicular lymphoma. Immunohistochemistry supported this diagnosis. Fluorescence in situ hybridization (FISH) identified an IGH gene rearrangement. Additional molecular studies, including B-cell clonality assessment and next-generation sequencing (NGS), confirmed the presence of an IgkA gene rearrangement. DIAGNOSIS: The combined histopathological, immunophenotypic, and molecular findings confirmed the diagnosis of pediatric-type follicular lymphoma of the conjunctiva, in accordance with the 2016 WHO classification. CONCLUSION: Pediatric-type follicular lymphoma of the conjunctiva is a rare and often under-recognized presentation of orbital adnexal lymphoma in children. Due to its nonspecific clinical features, a high index of suspicion is necessary when evaluating salmon-colored conjunctival lesions. Histopathological and molecular analyses are essential for accurate diagnosis. This case represents the 10th reported instance in the medical literature, highlighting the importance of multidisciplinary evaluation in such rare presentations.
INTRODUCTION: Amblyopia can be a cause of visual impairment in children. There is no nationally organized vision screening for children in France. The French Association of Strabismology and Pediatric Ophthalmology (AFSO...INTRODUCTION: Amblyopia can be a cause of visual impairment in children. There is no nationally organized vision screening for children in France. The French Association of Strabismology and Pediatric Ophthalmology (AFSOP) has published guidelines for vision screening in preschool children. Our study aims to evaluate the feasibility and performance of the AFSOP vision screening protocol. METHODS: This was an interventional prospective feasibility and comparative study with a cluster randomization of the AFSOP vision screening protocol compared to the PARIS school health service protocol for preschool children. The main outcome measure was sensitivity compared to ophthalmologic examination with cycloplegia (gold standard). RESULTS: Ninety-five preschool children were included - 50 in the AFSOP protocol and 45 in the PARIS protocol. Sensitivity was higher in the AFSOP protocol (90% vs. 62%). Referral rate was 58% in the AFSOP group protocol. CONCLUSION: AFSOP 3-dimensional visual screening is feasible with a high sensitivity. The main limitation is the specificity, resulting in a high referral rate. Revision of visual acuity thresholds would appear to be a way to improve specificity. Visual acuity screening is encouraged in recent French health policies. Larger studies might assist in refining performance and thresholds.