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Vision screening occurs once in United Kingdom (UK) children on school entry, but has recently been withdrawn in some areas. Consequently, significant refractive error and/or vision problems may go undetected. School-led vision checking, where school staff assess vision, is increasingly advocated by the International Agency for the Prevention of Blindness. This study investigates the accuracy of school-led vision checking in UK school students. School personnel were trained to conduct vision checks on their students. These involved external observation of the eyes for obvious abnormalities, as well as monocular distance (3 m) and near vision assessments (33 cm), equivalent to 0.2 logMAR. Equipment required to complete the checks was provided to schools. Optometrists repeated the assessments on average within 3 weeks to determine the accuracy of the school-led checks. Failure criteria were habitual vision >0.20 logMAR (<4 of 5 letters correct) in one or both eyes, at distance or near, and/or the presence of any ocular abnormality. One thousand and one children (45.7% female) from eight primary (6-8 years n = 233) and three secondary (11-13 years n = 768) schools participated. Overall sensitivity and specificity of distance vision and ocular abnormality checks were 87.2% and 88.9%, respectively. Corresponding values for sensitivity and specificity were 95.8% and 88.1% for primary schoolchildren and 84.3% and 89.2% for secondary schoolchildren. High negative predictive values in both primary (99.3%) and secondary (97.4%) schools indicate school staff correctly identified most children with distance vision problems. With near vision results included, sensitivity and specificity reduced to 80.6% and 82.2%, respectively, in the whole cohort (87.1% and 83.2% in primary schoolchildren and 78.5% and 81.6% for secondary schoolchildren) because of an increase in false positives. The vision screening assessment battery utilized within this study requires refinement; however, school-led vision screening is feasible and can correctly identify UK school children with and without vision problems with sensitivity and specificity of >80%.
The purpose of this study was to validate DEQ-5 and mOSDI in children using Rasch analysis and determine the optimal cutoff value for DEQ-5 to differentiate dry eye symptoms defined by mOSDI in children aged 6-17 years. In addition, the repeatability of mOSDI and DEQ-5 were investigated in children. A total of 225 children were recruited. Both DEQ-5 and mOSDI were administered to participants in a randomized sequence. Retests of the two questionnaires were performed after 30 min in 72 participants. A receiver operating characteristic (ROC) curve was generated to determine the sensitivity and specificity of the DEQ-5 questionnaire for diagnosis of dry eye symptoms. Repeatability of both questionnaires was evaluated using coefficient of repeatability (CoR) and 95% limits of agreement. The median of mOSDI score was 11.4 (Inter-quartile range: 4.5-20.5). The median DEQ-5 score was 4.0 (Inter-quartile range: 2.0-7.0). The area under the curve of the ROC curve for DEQ-5 was 0.78 (p < 0.0001). A DEQ-5 threshold of 4.5 yielded maximum sensitivity (72.2%) and specificity (66.1%) to differentiate dry eye symptoms in children. Females had significantly higher OSDI scores than males. CoR was ±4.8 for DEQ-5 and ±16.6 for mOSDI. The 95% limits of agreement were 5.5 to -4.2 for DEQ-5 and 16.5 to -16.7 for modified OSDI. Rasch analysis demonstrated that the five-level response scales in both the mOSDI and DEQ-5 produced disordered item thresholds. Collapsing the response scales from five to three categories improved overall model fit. Although we identified a DEQ-5 cutoff value of ≥5 for differentiating dry eye symptoms in children, which is different from that used in adults (≥6), the five-level response scales of both the mOSDI and DEQ-5 may not be optimal for the pediatric population and certain items might not be adequate to measure dry eye symptoms, thus we do not recommend using DEQ-5 in children to measure dry eye symptoms. This underscores the need to develop a dry eye questionnaire specifically designed for children to ensure more accurate assessment.
Currently, there are neither guidelines for school-based vision program operations nor a registry of programs that exist in the United States. We aim to describe the characteristics of school-based vision programs across the United States through a survey. We identified 10 organizations that operated one or more school-based vision programs during the 2022-2023 school year. We developed and distributed an online survey form to collect information on program demographics, program components, and protocols for vision screenings and eye exams, as well as procedures for obtaining consent, dispensing glasses, and funding resources. Organizations were asked to complete a survey for each school district in which they operated, which we defined as an individual program. Programs that did not complete the survey were excluded. We used descriptive statistics to describe program characteristics. We compared grade levels that received vision screening by school-based vision programs and their respective screening mandate in the state where the programs operated. Seven organizations participated and provided data about 184 unique school-based vision programs. These programs operated in 19 states and the District of Columbia. All 184 programs provided vision screenings, eye exams, and eyeglasses. 94.6% of programs included instrument-based screening, with 46.7% using it exclusively. School-based vision programs most frequently screened elementary school grades. For eye exams, 81% of programs utilized opt-out consent; 21.7% of programs included dilation. Vision screenings were mostly conducted by program staff (164/184, 89.1%), and eye exams were performed by optometrists (183/184, 99.5%). Nine programs (5.0%) reported providing additional care beyond eyeglasses provision, while 135 (73.4%) reported having an established relationship with community eye care providers for students referred for additional evaluation and care. Many school-based vision programs operate in the United States. These programs focus on vision screening, eye exams, and eyeglasses provision. Establishing a registry of programs would help to disseminate lessons learned and track outcomes data. Future programs will benefit from guidelines to ensure they are operating according to best practices.
As artificial intelligence (AI) tools become increasingly integrated into optometric practice, higher education providers must adapt to these technological advancements and integrate teaching about AI into the optometry curriculum. Before AI can be taught in the optometry curriculum, educational priorities must be established. Therefore, this research aimed to explore a range of stakeholder views on the integration of AI into optometry education. Semi-structured interviews were conducted with a purposive sample of eyecare practitioners, students, educators, regulators, and AI technology experts. Interviews were conducted online, transcribed verbatim, and thematic analysis was conducted. Three themes emerged: (1) Curriculum design and delivery; (2) Facilitators and barriers to teaching; (3) AI as an educational tool. AI topics for inclusion in the optometry curriculum were explored, with "Interpreting outputs of AI tools," "Foundational understanding," "Ethical Considerations" and "Integrating AI into clinical workflows" most commonly identified as important to teach. Barriers to teaching were identified including lack of access to AI devices, funding and time constraints, and rapid developments in AI necessitating frequent curriculum updates. AI tools were already being used by some students as an aid to their studies. However, many participants felt that higher education providers held a negative view of AI and discouraged its use. Participants identified potential risks associated with AI usage within education including plagiarism and reduced critical thinking. The multidisciplinary participants of this study expressed perspectives on a range of issues relating to the integration of AI into optometry education. This research aimed to aid optometry higher education providers as they explore integrating AI literacy into their curricula. However, further research is required to test the implementation of these recommendations in real-world settings. Additionally, although the potential benefits of AI as an educational tool are vast, the long-term cognitive costs of using these tools are not yet known and require further study.
To evaluate the visual performance of a new daily wear presbyopia contact lens (Deseyne contact lens for presbyopia with extended depth of focus). This was a randomized, crossover, and nondispensing clinical trial. Seventy-eight presbyopic (45-70 years, mean = 53.9 years) habitual soft contact lens wearers were recruited with spherical refractive errors between -6.00 and +4.00 D and less than 1.25 D astigmatism. Subjects were fitted bilaterally with the Deseyne lens and a control monofocal contact lens and randomized as to which of the study lenses would be tested first. Effectiveness measures included monocular lens-induced depth of focus testing-the primary effectiveness measure-and monocular distance, intermediate, and near visual acuity. Contrast sensitivity was also measured at mesopic luminance with and without glare. Mean monocular distance visual acuity was 0.00 ± 0.07 and -0.07 ± 0.07 logMAR with the Deseyne and control lens, respectively. The corresponding mean monocular intermediate visual acuity was +0.02 ± 0.11 and +0.16 ± 0.14 logMAR and monocular near visual acuity was +0.20 ± 0.11 and +0.35 ± 0.17 logMAR. Mean depth of focus was 2.22 ± 0.78 D with the Deseyne lens and 1.44 ± 0.67 D with the monofocal control. The mean extended depth of focus (95% CI) was thus 0.78 (0.63, 0.93) D. Contrast sensitivity was significantly lower with the Deseyne lens at 3, 6, and 12 cycles per degree with and without glare. The Deseyne contact lens for presbyopia with extended depth of focus extends the depth of focus of the eye and thus improves intermediate and near visual acuity.
The balance of responses between the ON and OFF pathways is believed to play an important role in myopia. This pilot study compared the difference in visual acuity under two contrast polarities between myopic children (corrected and uncorrected) and emmetropic children. Two groups of children aged 8-12 years were enrolled: a myopic group (spherical equivalent [SEQ] between -0.75 D and -6.00 D, N = 11) and a normal control group (N = 16). Visual acuities were measured using an Early Treatment Diabetic Retinopathy Study program, which presented either white letters against a black background or black letters against a white background. Visual acuity (corrected and uncorrected for the myopic group) under both polarities was tested in randomized order and repeated after a 30-min interval. Visual acuities were reported as letter scores. The ON/OFF ratios of visual acuity scores under the two polarity conditions were calculated and correlated with SEQ. When uncorrected, white-letter visual acuity was significantly better than black-letter visual acuity (p < 0.001) for the myopic group, with a difference of 6 letters (equivalent to 0.12 logMAR). No significant differences in visual acuity scores between the two polarities were found when the myopic group was corrected or in the control group. This suggests that uncorrected myopic eyes have greater difficulty in resolving the spatial resolution of black letters as compared to white letters. The ON/OFF ratio in the uncorrected myopic group was significantly higher than in the corrected myopic group and the control group (1.14 ± 0.09 vs. 0.99 ± 0.04, 1.00 ± 0.03, p < 0.001). When uncorrected, the ON/OFF ratio correlated with SEQ (R = 0.38, t = -2.4, p = 0.02), indicating that the ON/OFF imbalance increases with the magnitude of uncorrected myopic blur. Children with uncorrected myopic eyes had more difficulty in recognizing black letters compared to white letters, and the ON/OFF imbalance was correlated with the magnitude of uncorrected myopic blur.
To examine if clusters of colocated damaged locations repeatedly found during prior SITA-Standard (SS) visual field tests are not replicated in a subsequent SITA-Faster (SFR) test. Visual field series from the Lions Eye Institute, Perth, Australia were extracted if they had at least 4 SS fields followed by a SFR field and all fields had false positive rates and fixation losses less than 15%. Clusters of damaged locations were defined as either an isolated location with no damaged neighbors or a group of connected 24-2 points (not crossing the horizontal) that all had Pattern Deviation (PD) probability values below 1% of normal in all 3 SS tests immediately preceding the SFR test. For each cluster, the number of locations that were damaged in the SFR field that overlapped the established and repeatable SS clusters was computed and reported. We compare this proportion of overlap against the same calculations using the last SS as the final field. We also examine the effect of relaxing the PD criteria for damage in the final field on the proportion of overlap. 2519 eyes were included. For established, repeatable, and clusters of size 1, 2, 3, and 4 locations, the follow-up SFR field completely missed 46%, 26%, 11%, and 14% of the clusters whereas SS missed significantly less 26%, 11%, 4% and 1% (t-test with mixed paired and unpaired observations and p < 0.05). Relaxing the criteria for damage in the final field to PD < 5% reduced the miss rates for both methods, but SFR was still significantly worse than SS (SFR: 24%, 8%, 3%, and 6% vs. SS: 13%, 3%, 1%, and 1%). SITA-Faster tends to miss established clusters of damaged locations of size 4 or fewer locations in follow up visits at a higher rate than SITA-Standard.
This study aims to detail the frequency of peripheral retinal findings seen in pediatric patients in a primary care optometry clinic, and evaluate the relative frequency of abnormal and pathological peripheral retinal findings based on myopia magnitude. An observational retrospective cross-sectional study analyzed records for 874 patients aged 6-17 years who received routine eye exams at an academic eye care clinic in Memphis, TN between January 2020 and July 2023. Demographic data, refractive error, and peripheral retinal findings, both pathological and non-pathological, were evaluated. Overall frequencies of retinal findings were assessed, and further contrasted between levels of myopia. Abnormal retinal findings were present in 177 participants (20.2%). Pathology was diagnosed in a total of 55 participants (6.3%). The frequency of abnormal peripheral retinal findings increased with myopia severity, with nearly half (44.8%) of patients with 3 or more diopters of myopia having at least one abnormal finding. Significant associations were found between myopia category and the presence of abnormal retinal findings (p < 0.0001), and between myopia category and retinal pathology (p < 0.0001), suggesting that children with 3 or more diopters of myopia have an elevated risk of peripheral retinal pathology detection compared to children with no myopia (odds ratio of 11.5, 95% CI: 4.8-27.8). These findings highlight the notable frequency of retinal findings in pediatric primary eye care patients. Peripheral retinal pathology is more common in pediatric patients with 3 or more diopters of spherical equivalent myopia, and present across all refractive error statuses. These results underscore the importance of a comprehensive dilated retinal evaluation in children, particularly those with myopia.
To determine the effect of +2.50 D add multifocal soft contact lenses (MFSCLs) compared to +1.50 D add and single vision contact lenses (SVCLs) on the relationship between axial elongation and myopia progression. Individual estimates of D/mm were derived from the CLEERE Study, then applied to data from 289 participants in the BLINK Study to determine the portion of axial elongation that either contributed (uncompensated elongation) or did not contribute to myopia progression (compensated elongation). BLINK participants had myopia between -0.75 D and -5.00 D and were 7-11 years of age when enrolled in a 3-year clinical trial of multifocal contact lens myopia control. Cycloplegic refractive error was measured under tropicamide cycloplegia with the Grand Seiko WAM-5500 Binocular Autorefractor/Keratometer and axial length was measured using the Lenstar LS 900. The majority of the inhibition of axial elongation during myopia control with +2.50 D add MFSCLs was inhibition of uncompensated elongation. Over 3 years, axial elongation was less in +2.50 D add MFSCLs (0.39 mm) compared to SVCLs (0.62 mm) by 0.23 mm (95% CI: 0.14, 0.33), split between 0.17 mm (95% CI: 0.091, 0.26) of uncompensated elongation and 0.055 mm (95% CI: 0.013, 0.097) of compensated elongation. Inhibition of compensated elongation only occurred in the first year of the study. Total axial elongation over 3 years would need to be reduced to 0.17 mm (0.45 mm less than 0.62 mm) to result in no myopia progression. Optical myopia control with multifocal contact lenses has a small but significant effect on the compensation for elongation from changes in the optical components of the eye. As a result, myopia control must set an aggressive therapeutic target if the goal is slowing axial elongation to the point of no net myopia progression.
The purpose of this pilot study was to assess the effect of 0.05% low-dose atropine on ocular accommodation (amplitude and accuracy) and how its effect changed throughout the day. Sixteen children aged 6-16 years using 0.05% atropine and 16 controls not using atropine were enrolled. Monocular accommodative amplitude was measured objectively using a Grand Seiko WAM-5500 open field autorefractor (formerly manufactured by RyuSyo Industrial Co.) and subjectively using the push-up method. Accuracy of accommodation was measured using monocular estimation (MEM) retinoscopy. All measures were taken at three study visits over a single day to assess change over time. Measures of accommodative amplitude and accuracy were compared using a 2-way analysis of variance (ANOVA). Nonparametric analyses were performed to compare MEM retinoscopy using the Mann-Whitney U-test and Friedman's test. Objectively measured accommodative amplitude was significantly lower in the 0.05% atropine group (morning: 5.99 ± 2.28D, midday: 6.17 ± 2.06D, afternoon: 7.08 ± 1.82D) compared to the control group (morning: 7.68 ± 1.59D, midday: 7.62 ± 1.93D, afternoon: 7.63 ± 1.48D) at the morning and midday visits (p = 0.01, 0.03). There was no difference between groups at the afternoon visit (p = 0.40). In the 0.05% atropine group, objectively measured amplitudes were greater at the afternoon visit compared to those of the morning and midday visits (p < 0.01). There were no significant differences throughout the day in the push-up amplitude of accommodation or MEM retinoscopy. When measured objectively, accommodative amplitude in children using 0.05% low-dose atropine was reduced compared to controls during the morning and midday visits and increased over the day reaching a level comparable to that of the control group by the afternoon visit. Common clinical measures of accommodative ability, including subjective amplitude of accommodation using the push-up test and accommodative accuracy using MEM retinoscopy, did not demonstrate these same differences.
To report testability and test-retest reliability of the SpotChecks contrast sensitivity (CS) test in amblyopic and nonamblyopic eyes of children with unilateral amblyopia. Children aged 3-12 years with unilateral amblyopia due to strabismus and/or anisometropia were recruited as part of a randomized trial. SpotChecks was administered twice in the left eye at 8 weeks post-randomization. This single-use paper test has a measurable CS threshold range of 0.90 to 2.09 logCS (24 lines, 1 line = 0.05 logCS). Testability was defined as the completion of a pre-test. Bland-Altman analysis was used to evaluate test-retest reliability. In children aged 3-6 years, 81% (117/145) passed the pre-test: 17 of 34 (50%) 3-year-olds, 39 of 46 (85%) 4-year-olds, 33 of 37 (89%) 5-year-olds, and 28 of 28 (100%) 6-year-olds. Fifty-four of 117 (46%) who passed the pre-test had matching test pairs for analysis. In children aged 7-12 years, all 45 passed the pre-test. Twenty-two of 45 (49%) who passed the pre-test had matching test pairs for analysis. Among 76 test-retest pairs (40 amblyopic and 36 nonamblyopic eyes), the mean difference (95% CI) was 0.01 (-0.02 to 0.03) logCS and the half-width of the 95% limits of agreement was ±0.20 (0.16-0.24) logCS. Results were similar between amblyopic and nonamblyopic eyes, as well as within age cohorts. Children aged 6-12 years were more likely to be testable. Regardless of age, half of all test-retest pairs were completed incorrectly, possibly due to examiner or participant-related factors. A greater than 4-line (0.20 logCS) change on the SpotChecks contrast sensitivity test is required to detect a change in contrast sensitivity function beyond measurement error in children 3-12 years of age with unilateral amblyopia. Clinicaltrials.Gov, registered 14 July 2022, NCT05462821.
To validate a custom smartphone application for at-home visual acuity (VA) measurement in children. A total of 452 children aged 3-17.5 years participated. Certified examiners measured in-office test-retest VA (logMAR) using gold-standard Amblyopia Treatment Study HOTV (3-to-6-year-olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7-to-17.5-year-olds, older cohort) protocols at 3-4.5 m and app-based VA at 1.5 m. Caregivers measured at-home app-based VA at 1.5 m. Comparing at-home app-based with gold-standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.04; 95% limits-of-agreement half-width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in-office app-based VA with gold-standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = -0.03, older = -0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold-standard test-retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.
This replication study sought to determine (1) the frequency of horizontal/vertical saccades, vergence jumps, and horizontal/vertical vestibulo-ocular reflexes (VORs) elicited per minute in young Indian adults using the OculoMotor and Vestibular Endurance Screening (MoVES) protocol with the OculoMotor Assessment Tool (OMAT) and (2) the association between the participant's MoVES values and routine clinical binocular vision status. Two hundred twenty-two healthy participants (17-33 years) repeatedly generated the aforesaid eye movements using the OMAT as a target for 60 s. A subset (n = 75) also underwent binocular vision assessment using standard optometric protocols. Eye movement frequency of participants with a near point of convergence ≤ 6 cm, stereoacuity ≤ 70 arcsec, and BIVSS score ≤ 31 constituted the normative cohort. Eye movement responses of 153 participants who formed the replication cohort showed a higher frequency in the last 30 s compared to the initial 30 s (p < 0.01). The overall frequency of vergence jumps was lower in those who failed these criteria, vis-à-vis, the pass cohort (p < 0.01). These values were lower than previously published data from USA (p ≤ 0.05), but the differences diminished when matched with participants in organized sports activities. The clinical binocular vision parameters did not show a strong correlation with oculomotor frequency (r ≤ 0.3). The endurance values of eye movements established here allow screening for oculomotor dysfunctions in young Indian adults. These values may be impacted significantly by the level of organized physical activity engaged by the participant. Routine binocular vision evaluation does not correlate with eye movement endurance values, reflecting the need for dedicated assessments of the latter functions using standardized techniques and tools.
To investigate the association between reduced hyperopia and the increased risk of myopia onset in preschool children aged 3-6 years. This study utilized data from the Beijing Hyperopia Reserve Research (BHRR) prospective cohort, including 941 children aged 3-6 years who completed baseline and 3-year follow-up assessments (2021-2024). Cross-sectional analyses compared ocular biometry among children with different baseline refractive statuses, followed by longitudinal analyses evaluating the relationship between reduced hyperopia and myopia onset. Children were categorized into pre-myopia and hyperopia groups based on spherical equivalent refraction (SER). The predictive ability of SER for myopia onset was evaluated using receiver operating characteristic analysis, with optimal cutoffs determined by the Youden index. Age-stratified (3-6 years) analyses identified age-specific SER thresholds. The baseline cross-sectional analysis revealed that there were no significant differences in anterior chamber depth (ACD) or corneal radius (CR) in the pre-myopia group compared to the hyperopia group despite having a significantly lower SER (p < 0.001) and longer AL (p < 0.001). Over 3 years, both groups showed decreasing SER, increasing AL, and deepening anterior chambers (all p < 0.05). Furthermore, in the 5- and 6-year-old groups, the pre-myopia group demonstrated significantly higher rates of change in SER and AL compared to the hyperopia group (all p < 0.05). The optimal SER cut-off value for predicting myopia onset in preschool children was +0.90 D. This cut-off value showed a decreasing trend with age, corresponding to +1.04 D, +0.95 D, +0.87 D, and +0.82 D for children aged 3, 4, 5, and 6 years, respectively. Preschool children with lower levels of hyperopia, especially those aged 5 and 6, show a significantly higher rate of myopic drift, and AL growth compared to those with greater hyperopia. Enhanced early monitoring and interventions are essential to prevent excessive loss of hyperopia that may accelerate myopia development. The registration database and the registration number: Chinese Clinical Trial Registry: ChiCTR2000031142.
Two prior studies suggested a relationship between spatial neglect and reduced diplopia reporting. In spatial neglect with visual extinction phenomenon, the double image on the neglected side may be extinguished from perception, representing a pathological binocular suppression. We retrospectively reviewed the binocular vision testing battery routinely performed at one inpatient rehabilitation hospital vision clinic to better understand reduced diplopia reporting and look for evidence of pathological suppression. One hundred fifty-five consecutive patient charts were retrospectively reviewed. Significant predictors of denial of double vision in patients with recent stroke and strabismus (N = 55) or prism induced strabismus (N = 98) were identified with logistic regression. Additionally, three clinicians rated the likelihood (1 to 10) of suppression in each case and predictors of the rating were identified with a cumulative logit model. Cases with likelihood rating >7/10 were flagged and examined individually. Only 15 of 155 patients passed all suppression tests administered (9.7%). Fifty-three percent of patients with strabismus actively denied diplopia. When controlling for significant effects of age, patients with spatial neglect had 3.9 greater odds of denying diplopia (OR (95% CI) 3.91 (1.70, 8.96)). Inter-ocular acuity difference and hemianopia were not significant predictors. A high likelihood of suppression was associated with parietal lobe injury, (3.40 (1.22-9.30)). The side of the brain was not significant (α = 0.05). Five patients had a likelihood rating greater than 7 out of 10 and so were likely exhibiting pathological suppression. Denial of diplopia is associated with spatial neglect and age. In some cases, this likely represents a pathological suppression of binocular vision.
To evaluate the quality of existing patient-reported outcome measures (PROMs) used to assess the impact of keratitis on the quality of life (QoL). A literature search was conducted using Embase, PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. The review included PROMs used to assess the impact of keratitis on QoL. Data on the content development and psychometric properties were extracted. Quality assessment was performed using the established criteria for ophthalmic PROMs. A total of seven articles met our inclusion criteria. The study populations in the reviewed articles consist of individuals diagnosed with different types of microbial keratitis. Ten unique PROMs were reviewed. Nine were ophthalmic and one was generic. Only the impact of vision impairment PROM has undergone psychometric validation in keratitis. Although the validation indicated acceptable unidimensionality (grade B), both the eigenvalue and item-person targeting demonstrated misfit to the Rasch model. Psychometric appraisal showed that keratitis patients were not involved in PROM content development, leading to misalignment and inconsistencies between the constructs outlined by the instruments and evaluation findings. Limited available literature constrains the depth of this review. Initiating psychometric validation of the PROM in keratitis conditions is a good starting point. All evaluated PROMs lack psychometric validation and are not specific to keratitis. The findings of this review underscore the need to create a psychometrically robust, keratitis-specific PROM. The systematic review registration number is CRD42023449213.
(1) To investigate if binocular cross-correlation metrics derived from the aberrated monocular retinal images can explain the deterioration of stereoacuity following keratorefractive surgeries. (2) To investigate if the quality of binocular metrics improves with improved monocular retinal image quality and pupil miosis. High-order aberrations (HOAs) were obtained over 6 mm pupil diameter from 99 young adults undergoing photorefractive keratectomy (PRK) (n = 26), laser-assisted in situ keratomileusis (LASIK) (n = 38), and ReLEx small-incision lenticule extraction (SMILE; n = 35) for myopia correction. Point spread functions derived from HOAs were convolved with random-dot stereo pairs and cross-correlated to obtain four binocular metrics-signal width, signal height, signal-to-noise ratio, and height-to-width ratio-that signified the quality of the disparity signal. These metrics were derived pre-operatively and at 1-week, 1-month, 3-month, and 6-month after surgeries, and correlated with the subject's stereoacuity for 6 mm pupil diameters. Binocular metrics were also derived for 4 mm pupil diameters and compared with the 6 mm data. Larger interocular differences in retinal image quality led to reduced disparity signal quality and less optimal values of the binocular metrics. These trends were strongly correlated with the subject's stereoacuity across refractive surgeries (ρ ≥ 0.71; p < 0.001). Relative to pre-operative values, post-operative metrics worsened at 1-week followed by a recovery period (p < 0.001). All post-operative metrics for PRK and LASIK surgeries were similar (p ≥ 0.67), but worse than SMILE surgery (p < 0.001). The binocular metrics derived for the 4 mm pupil diameters were superior to those of the 6 mm pupil diameters (p < 0.001). Binocular cross-correlation metrics derived from the aberrated monocular retinal images signify the strength of the disparity signal, and capture much of the stereoacuity losses following keratorefractive surgeries for myopia. Binocularity may be better preserved after SMILE surgery owing to the smaller interocular mismatches in optical quality, relative to PRK and LASIK surgeries for comparable pupil diameters.
To determine whether 3 months of prescribed full-time alternate patching is more effective than observation for intermittent exotropia (IXT) in children. We enrolled 73 children aged 3 to <9 years with mean IXT distance control score (3 measures) ≥2 points (on a 0-5 [phoria constant tropia] scale) with at least one score ≥3, 4, or 5 (indicating spontaneous XT over 30-s observation) and a distance exodeviation of 15-50 prism diopters (Δ) by prism and alternate cover test (PACT), with the near deviation not exceeding the distance by > 10Δ. Children were randomly assigned to 3 months full-time patching (all waking hours, 7 days per week, alternating eyes) or observation. The primary outcome was change in mean distance IXT control at 3 months. Baseline mean (SD) distance control for children assigned to full-time patching (N = 36) and observation (N = 37) were 3.6 (0.9) and 3.6 (0.9) points; mean distance PACT was 27Δ (9) and 27Δ (8), respectively. The 3-month visit was completed by 33 (92%) of 36 and 35 (95%) of 37 children assigned to full-time patching and observation. Mean patching adherence was 4.1 h per day (95% CI: 2.8-5.5, N = 20) by participants who returned temperature sensor occlusion dose monitors and 7.4 h per day (95% CI: 5.8-8.9, N = 33) by review of at-home calendars and interviews with parent and child. At 3 months, children in the patching group had greater improvement in mean distance control than the observation group: 0.9 (1.3) versus 0.2 (1.1) points (difference = 0.62 points, 95% CI: 0.04-1.20, p = 0.04). There was also greater improvement in mean distance PACT: 6 (7) versus 2 (7) Δ, difference = 4Δ (95% CI: 1-8, p = 0.02). Three months of prescribed full-time alternate day patching improved distance control and magnitude of IXT in children 3-<9 years, despite mean adherence substantially less than the prescribed full-time regimen. Future studies should evaluate the durability of treatment effects and compare patching to other treatments. Clinicaltrials.Gov, registered 14 July 2022, NCT05462821.
To compare the visual performance (VP) of P.A.U.S.E. spectacle lenses (tests) against defocus incorporated multiple segments (DIMS; control). This randomized, single-masked study included 48 participants aged 18-41 years who wore five tests (T1, T2, T4, T5, T6) and DIMS. VP was assessed through the full-lens and inferior treatment zone. Full-lens visual-acuity (VA) based measurements comprised monocular high- and low-contrast VA (HCVA/LCVA) at 6 m and binocular HCVA at 6 m and 40 cm. Assessments through the treatment zone comprised HCVA at 40 cm and subjective ratings (1-10 scale) of near vision-clarity and ease-of-reading. VP was assessed after 3 days of wear (full-lens) using subjective ratings of vision-clarity, night-vision, vision-while-walking, eyestrain, overall-vision-satisfaction, and willingness-to-purchase (yes/no: based on vision and myopia management efficacy). Analyses were performed using linear mixed models and the X2 test. Significance was set at 5%. Full-lens binocular HCVA at 40 cm was significantly better with three tests (T2, T4, T5) compared to DIMS (p ≤ 0.022), whereas there were no differences between any test and DIMS for monocular or binocular HCVA at 6 m (p > 0.5). Full-lens monocular LCVA at 6 m was significantly better with DIMS compared to T4 (p = 0.0057). Through the treatment zone, four tests (T2, T4, T5, T6) were significantly better than DIMS for binocular HCVA at 40 cm (p < 0.0001), near vision-clarity (p ≤ 0.0011) and ease-of-reading (p ≤ 0.0014). T2 was rated significantly higher than DIMS for night-vision (p = 0.0085) and overall-vision-satisfaction (p = 0.0495), whereas DIMS was rated higher than T1 for vision-clarity (p = 0.0001). There were no significant differences between DIMS and any test for other subjective ratings (p > 0.07), nor willingness-to-purchase based on vision (p > 0.2) or myopia management efficacy (p > 0.6). Most of the test lenses achieved better VP through the treatment zone compared to the DIMS control. T2 showed better overall VP compared to DIMS, whereas DIMS showed better overall VP compared to T1.
Regional patterns of visual field (VF) loss may affect vision-related quality of life (QoL) differently in people with glaucoma; yet evidence across studies remains inconsistent. To identify and evaluate studies comparing vision-related QoL, measured by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), with specific regions of VF loss in glaucoma. MEDLINE, EMBASE, CINAHL, PsycINFO, and AMED were systematically searched from inception to April 2025. Eligible studies included adults with glaucoma that examined regional VF loss (e.g., central vs. peripheral, hemifield, or cluster analyses) and reported NEI-VFQ-25 outcomes. Studies using only global VF indices were excluded. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute tools. Due to heterogeneity in VF metrics and NEI-VFQ-25 scoring approaches, the findings were synthesized narratively. Nine studies (n = 2626 participants) met the inclusion criteria. Most cohorts were relatively young (mean age mid-60s) with mild-moderate glaucoma; only two included participants with advanced loss. Despite methodological variation, a consistent pattern emerged: central and inferior VF loss were most strongly associated with poorer QoL, whereas superior and peripheral loss showed weaker or domain-specific effects. Associations were generally stronger when using better-eye or integrated VF measures. The evidence base is limited by few studies, small sample sizes, predominance of mild disease, and variability in both VF and NEI-VFQ-25 methodologies. Central and inferior VF loss appear most closely linked to reduced QoL; however, conclusions are constrained by the limited number and methodological heterogeneity of available studies. Larger, standardized investigations across disease stages are needed to clarify these relationships and guide patient-centered care. PROSPERO CRD420251169334.