Nataliya Ivanovna Kurysheva

Visual impairments are an important medical and social issue affecting the life quality and healthcare economy. Cataracts, glaucoma, myopia and age-related macular degeneration are the leading ophthalmologic conditions. Modifiable behavioral factors and environmental influences play a crucial role in these conditions development. The purpose of this work is to systematically analyze and synthesize current scientific data on how lifestyle affects the prevalence and pathophysiology of ophthalmologic diseases. Modifiable lifestyles correlate with increased risk for major ophthalmologic disorders, such as glaucoma. Physical inactivity, obesity, prolonged use of digital screens, and lack of exposure to natural light all contribute to glaucoma development through vascular and metabolic disturbances. Myopia is also linked to prolonged screen time and a lack of outdoor activity, particularly in children. Unbalanced diets with antioxidant deficiencies accelerate degenerative changes in ocular structures. Smoking increases the risk of cataract and age-related eye disease through oxidative stress. Lifestyle modification is a promising approach to primary prevention of eye disorders. Integrating risk factor information and implementing personalized programs tailored to genetic predispositions and behavioral patterns into clinical care and public health initiatives can significantly reduce eye disease prevalence and improve patient life quality.

Glaucoma and age-related macular degeneration are the leading causes of irreversible vision loss in individuals over 60 years of age. This review consolidates current data on the epidemiology, shared genetic factors, and pathophysiological mechanisms underpinning their coexistence, and outlines prospects for personalized prevention and therapy. Common modifiable risk factors comprise cigarette smoking, arterial hypertension, and dyslipidemia. Chorioretinal hypoperfusion, mitochondrial dysfunction, activation of the NLRP3 inflammasome, and impaired glymphatic elimination of amyloid contribute to neurodegeneration both in the macula and in the optic nerve area. Treatment prospects include comprehensive vascular and neuroprotective regimens, targeted complement modulation, and the use of polygenic risk scores for patient stratification and longitudinal monitoring.

Background . Assessing color vision in children requires a tailored approach: the tests used should be easy to understand, engaging, and quick to administer. The development of effective and practical methods for evaluating color vision in children remains an important objective in contemporary ophthalmology. Purpose : To compare the effectiveness of different methods for assessing color vision in schoolchildren. Materials and methods . A total of 532 schoolchildren (261 boys and 271 girls) with different refractive status were examined. In addition to a standard ophthalmic examination, all children underwent color vision testing using conventional methods (Rabkin pseudoisochromatic plates and the Farnsworth – Munsell Dichotomous D15 test) as well as newly developed tests (a new pseudoisochromatic plate test and a new D30 arrangement test). Results . Among boys, the prevalence of color vision deficiency was 8.1 % with the Rabkin plates, 7.7 % with both the D15 test and the new pseudoisochromatic plate test, and 9.2 % with the new D30 arrangement test. Among girls, the prevalence was 1.1 % according to all tests used in the study. The newly developed tests demonstrated adequate performance in detecting color vision deficiency. For the new pseudoisochromatic plate test, sensitivity ranged from 85.0 % to 88.9 % and specificity from 92.9 % to 99.2 % in children with different refractive status. It also had the shortest administration time across all groups. For the new D30 arrangement test, sensitivity ranged from 80.0 % to 90.9 % and specificity from 96.3 % to 99.6 %. In all groups, its administration time was shorter than that of the conventional tests. Conclusion . The findings demonstrate that the new tests provide high sensitivity and specificity while requiring less time to administer, making them advantageous for large-scale outpatient screening.

Purpose: to compare iridotrabecular contact (ITC) imaging findings of gonioscopy and anterior segment optical coherence tomography (AS-OCT) in patients with primary angle closure disease (PACD). Material and methods. Retrospective analysis of the data from 20 patients with primary angle closure and 23 with early stage primary angle-closure glaucoma aged 49 to 82 years was performed. All participants along with gonioscopy underwent AS-OCT on CASIA2 (Tomey Corporation, Nayoga, Japan) including assessment of the ITC Index and ITC Area. Results. According to gonioscopy, the average value of the number of sectors of the anterior chamber angle (ACA) of a closed and narrow profile (with a degree of opening from 0 to 2 according to Schaffer) was significantly higher than according to AS-OCT data (3.56 ± 0.65 and 2.04 ± 0.81 respectively, p = 0.02). The degree of opening of the ACA according to Shaffer differed significantly between the superior and inferior (0.06 ± 0.25 and 1.30 ± 1.22, respectively, p = 0.00), superior and nasal (0.06 ± 0.25 and 0.72 ± 1.00, respectively, p = 0.01), temporal and inferior (0.20 ± 0.51 and 1.30 ± 1.22, respectively, p = 0.04) sectors. No significant differences were found between the superior and temporal, nasal and inferior, as well as temporal and nasal sectors (all p > 0.05). According to AS-OCT data, the ITC parameters were: ITC Index = 45.4 ± 21.8% and ITC Area = 5.81 ± 3.90 mm ² . Conclusion. In PACD, gonioscopic closure of the ACA (absence of visualization of the trabecular meshwork at least 180°) does not mean the presence of an ITC, as detected by AS-OCT. The superior sector of the ACA is the most vulnerable to angle closure in patients with this pathology.

PURPOSE. To develop a method for individualized prediction of the rate of progression in moderate and advanced primary open-angle glaucoma (POAG). METHODS. The study included patients with confirmed moderate and advanced POAG who had been under observation for at least 36 months. Prediction of the rate of visual function loss was performed using modern machine learning methods, specifically Ranked PLS-DA, which is highly resistant to multicollinearity and allows for the ordered nature of classes to be taken into account. Two sets of input data were considered: a complete set of 34 variables and an optimized set of 20 variables, including demographic, functional, structural, and vascular indicators. For model optimization and validation, a test dataset was artificially generated using Procrustes Cross-Validation (PCV) method. Model performance was evaluated using specific metrics: sensitivity, specificity, total efficiency (TEFF), and area under the ROC curve (AUC). RESULTS. The optimized set of variables improved model sensitivity (0.93 vs 0.78) while maintaining high specificity (0.78). Total efficiency on the test dataset was 0.77 for the reduced set, with an AUC of 0.9. The model not only distinguished patients with fast, moderate, and slow progression rates but also identified «borderline» cases requiring closer monitoring. Analysis of individual variable contributions revealed key predictors influencing prognostic accuracy: age, retinal nerve fiber layer thickness and ganglion cell complex thickness, peripapillary vessel density, and parafoveal retinal thickness. These findings underscore the importance of a comprehensive approach to assessing the risk of irreversible changes in visual functions. CONCLUSION. The developed Ranked PLS-DA model demonstrated high effectiveness in stratifying patients with moderate and advanced glaucoma according to progression rate. The model may serve as a reliable basis for individualized monitoring and therapy in routine clinical practice.

Introduction. Pregnant women are objects of special attention of physicians due to two main reasons. The first one is that the fetal life depends on the health and quality of life of a future mother. The second is associated with increased load on all organs and systems of the female body, including the organ of vision. However, manifestations of dry eye syndrome (DES) in this contingent are often not given due attention and often remain untreated, which has a negative impact on the quality of life of women during this difficult period and can lead to diseases of the anterior segment of the eye. The aim of the study was to evaluate the effectiveness of a drug based on sodium hyaluronate 0.21 % in pregnant women with dry eye syndrome due to dysfunction of the meibomian glands. Рatients and methods. The study included 60 patients (120 eyes) with dry eye syndrome with an average age of 31.45 ± 5.98 years and a follow-up period of 3 months. There were 2 groups of patients: the main group (pregnant women with DES) and the control group (non-pregnant women with DES). Patients of both groups were administered a preservative-free form of 0.21 % sodium hyaluronate three times a day for 3 months. All studied patients underwent standard methods of examination, indicators of DES were assessed along with an objective valuation of tear film parameters and meibomian glands condition by digital biomicroscopy on a MediWorks slit lamp (Precision Instruments Co., Ltd., Shanghai) at the time of first visit and at 1 and 3 months of follow-up. Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups. Early diagnosis and timely correction of DES manifestations in pregnant women by administration of tear replacement therapy with preservative-free sodium hyaluronate 0.21 %, as well as eyelid hygiene can improve the quality of life of this group of patients and prevent associated with DES complications. Conclusion. The selected preservative-free tear replacement therapy with sodium hyaluronate 0.21 % (Optinol® Express moisturizing) provided a combination of ocular surface moisturizing and reducing the risk of inflammatory lesions with facilitating the release of meibomian gland secretion, contributing to the effectiveness and prolongation of therapy.

This literature review is devoted to one of the most challenging problems of ophthalmology — neuroprotective and neuroregenerative treatment of glaucoma and consists of two parts. The second part of the review deals with the role of glia, inflammation and autoimmunization in the pathogenesis of neuroretinal degeneration in glaucoma optic neuropathy (GON), new treatment strategies based on modern achievements of gene and immunotherapy. Special attention is paid to promising therapeutic approaches based on artificial intelligence application, usage of peptide bioregulators, immunomodulators and mixed-action drugs. Alternative methods of axonal regeneration, including gene therapy and stem cell therapy, are discussed.

Purpose. To compare the iridotrabecular contact (ITC) parameters in patients with primary angle closure disease (PACD) and primary open angle glaucoma (POAG) based on SS-OCT data, and examine their relationship with other clinical and anatomical parameters.Patients and methods. The retrospective study analyzed the data of 89 patients aged 32 to 89 years: 43 patients with PACD, 25 with POAG, and 21 controls. All participants underwent optical coherence tomography of the anterior segment of the eye using the SS-OСT “CASIA2” (Tomey Corporation, Nayoga, Japan), including assessment of the ITC Index and ITC Area. Results. ITC parameters in PACD were significantly higher than in POAG and controls. ITC Index = 45.40 ± 21.80 % and ITC Area = 5.81 ± 3.90 mm² in the POAG group versus 0.01 ± 0.03 % and 0.1 ± 0.37 mm² in POAG, respectively, and versus 0.05 ± 0.11 % and 0.56 ± 1.17 mm² in the control, respectively, all p = 0.00. The values of ITC Index, as well as ITC Area in POAG and control were comparable, p = 0.21 and p = 0.25, respectively. A relationship was found between ITC Index and ITC Area in case of PACD with the depth of the anterior chamber (r = –0.42, p = 0.01 and r = –0.43, p = 0.00, respectively), the lens vault (r = 0.35, p = 0.02 and r = 0.36, p = 0.02, respectively), its thickness (r = 0.47, p = 0.01 and r = 0.44, p = 0.01, respectively) and the number of antihypertensive drugs (r = 0.63, p = 0.01 and r = 0.68, p = 0.01, respectively). No correlations were found in the POAG and control groups.Conclusion. The high values of the parameters of the ITС and their correlation with other clinical and anatomical parameters in PACD compared with those in POAG indicate the role of the topography of the anterior segment of the eye in the formation of the leading mechanisms for the anterior angle closure.

Purpose. To determine the predictors of hypotensive efficacy of laser peripheral iridotomy (LPI) in patients with primary angle closure (PAС) based on the machine learning. Material and methods. A prospective study included 30 patients with PAС, aged 41 to 80 years, who underwent LPI. The observation period was 1 month. All subjects underwent Swept Source optical coherence tomography (SS-OCT). The analyzed parameters included 37 parameters such as spherical equivalent, corrected distance visual acuity (CDVA) and uncorrected distance visual acuity, intraocular pressure (IOP), Shaffer angle opening degree, lens opacity, choroidal thickness in the macula, axis length, anterior chamber depth (ACD), lens vault (LV), iris curvature (ICurv) and thickness (IT750), angle opening distance (AOD), iridotrabecular space area (TISA). As the success of treatment, the value of the decrease in intraocular pressure (DIOP) after the intervention relative to the initial one was taken. Along with standard methods of descriptive statistics, the machine learning method Partial Least Squares regression (PLS regression) was used. Results. After treatment, there was a significant decrease in IOP compared with baseline (from 24.6±2.1 to 19.7±0.8 mm Hg, p=0.000) against the background of a non-statistically significant decrease in the number of medicines (from 0.60±0.50 to 0.43±0.50, p=0.317). The predictors of DIOP were: advanced age (В-coefficient=0.280), presence of early cataract (B=0.277), low CDVA (B= –0.275), high preoperative IOP (B=0.291), narrow profile Shaffer angle opening degree in the superior sector (B= –0.183), high values of LV (B=0.278) and ICurv (B=0.306 in the nasal and 0.307 in the temporal sectors, respectively), as well as low values IT750 (B= –0.297 and –0.296 in similar sectors, respectively) and ACD (B= –0.178). Conclusion. Using PLS regression, predictors of the hypotensive effect of LPI were identified: the advanced age, high initial IOP and lens vault, early cataract, steep and thin iris, shallow anterior chamber, indicating the advantages of laser treatment of the pupillary block of the anterior chamber angle of the eye. This is consistent with the well-known role of LPI in the treatment of the pupillary block, as the leading mechanism for the anterior chamber angle closure. Key words: primary angle closure, SS-OCT, optical coherence tomography the anterior segment (AS-OCT), laser peripheral iridotomy, machine learning, Partial Least Squares regression