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Purpose To determine the diagnostic accuracy of potential screening tests for moderate to advanced glaucoma. Design Prospective diagnostic test accuracy study. Participants The study enrolled a consecutive series of patients aged ≥50 years who presented to a glaucoma clinic in South India without ever having received automated visual field testing. Methods All participants underwent 8 index tests: OCT of the peripapillary retinal nerve fiber layer, optic disc photography, Moorfield’s Motion Displacement Test (MDT), frequency doubling technique perimetry, noncontact tonometry, pneumatonometry, presenting visual acuity, and best-corrected visual acuity. Participants also underwent stereoscopic photographs and Humphrey visual fields, which were used by 2 ophthalmologists to arrive at the reference standard diagnosis of moderate to advanced glaucoma. Main Outcome Measures Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Results A total of 217 people were enrolled; 321 eyes from 180 participants had all tests performed. Of these, 127 eyes (40%) were classified as having moderate to advanced glaucoma. Among the 8 tests, OCT best optimized sensitivity (84%, 95% confidence interval [CI], 76–90) and specificity (75%, 95% CI, 68–81). Moorfield’s Motion Displacement Test was the best perimetric test, with a sensitivity of 91% (95% CI, 85–96) and specificity of 53% (95% CI, 44–61). Pressure and vision tests were not sensitive (e.g., sensitivity of 16%, 95% CI, 9–23 for noncontact tonometry and 23%, 95% CI, 15–31 for best-corrected visual acuity). Moorfield’s Motion Displacement Test identified 16 of 127 eyes (13%) with glaucoma that were not captured by OCT, but also had false-positive results in 65 of 194 eyes (34%) without glaucoma that OCT correctly classified as negative. Conclusions OCT had moderate sensitivity and fair specificity for diagnosing moderate to advanced glaucoma and should be prioritized during an initial assessment for glaucoma.

Tiffany A Chen,1 Jonathan Li,1 Julie M Schallhorn,1,2 Catherine Q Sun1,2 1Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 2F.I Proctor Foundation, University of California San Francisco, San Francisco, CA, USACorrespondence: Catherine Q SunF.I. Proctor Foundation, University of California San Francisco, Box 0944, 490 Illinois Street, San Francisco, CA, 94143, USAEmail catherine.sun@ucsf.eduPurpose: To evaluate the agreement of a home vision screening test compared to standard in-office technician-measured Snellen visual acuity to allow for remote screening and triaging of patients.Patients and Methods: In this prospective study, English-speaking patients with in-office ophthalmology appointments from May to August 2020 and visual acuity better than 20/125 were asked to complete a home vision test one week before their scheduled in-office appointment. The home vision test was a modified ETDRS chart displayed in a PDF document that could be printed or viewed on a monitor. The primary outcome was the mean difference between office-based and home visual acuity.Results: Eighty-two eyes of 45 patients were included in the study with 45 study eyes analyzed. The mean difference between office-based and home visual acuity was − 0.02 logMAR (SD 0.15, P=0.28) among study eyes. Of these eyes, 91% demonstrated agreement between the two methods within 0.2 logMAR of the mean difference, and 60% had agreement within 0.1 logMAR of the mean difference. There were no significant demographic or ocular risk factors leading to a greater difference between the tests.Conclusion: There was good agreement between the home and in-office Snellen tests for patients with vision better than 20/125. The home vision test can be used to remotely determine if there is a significant vision change of > 0.2 logMAR or approximately 2 lines of visual acuity.Keywords: telemedicine, tele-ophthalmology, home vision test, vision screening

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening ( OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening ( OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

Purpose Preschool children in New Zealand undergo vision screening to detect amblyopia at 4-5 years of age. The current test, the Parr vision test, does not meet international visual acuity chart guidelines and has not been validated against other commonly used paediatric vision tests. New Zealand vision screening protocols are also not targeted for detecting other eye conditions such as uncorrected refractive error, which may affect school performance. We compared the Parr vision test with the single crowded Lea symbols and the Spot vision screener for detecting ocular pathology, refractive error and amblyopic risk factors in preschool children. Methods A cross-sectional diagnostic accuracy study recruited children aged 4-5 years via convenience sampling from the University of Auckland Optometry Clinic and through primary schools in Auckland, New Zealand. Participants received vision screening with the three different instruments administered by a lay screener. Comprehensive eye examinations were completed by a paediatric optometrist to determine the presence of vision disorders. Results Of 197 children who received a comprehensive eye examination, 14 (7.1%) had amblyopic risk factors and 43 (21.8%) had significant refractive error (15.7% with astigmatism, 9.1% with hyperopia). The sensitivity for detecting any ocular condition did not differ significantly between the tests (50.0% for Parr, 43.5% for Lea, 42.5% for Spot). Specificity was significantly lower for the Parr vision test (80.8%) than for the Lea symbols (93.4%) and Spot vision screener (98.0%). Adding the Spot vision screener to measurements of visual acuity significantly improved sensitivity in detecting any ocular condition with the Parr vision test (67.5% for Parr/Spot vs 50% for Parr alone), but not with the Lea symbols (52.5% for Lea/Spot vs 43.5% for Lea alone). Conclusion The sensitivity of the Parr vision test for detecting ocular conditions in preschool children does not vary significantly from that achieved by the Lea symbols or the Spot vision screener. However, current New Zealand vision screening protocols could be improved by expanding the target conditions to include significant refractive error and incorporating the use of the Spot vision screener to increase the accuracy with which children with refractive error are identified. Future research should include longitudinal studies to determine the effect of preschool vision screening on later ocular and academic outcomes.

To determine whether a newly modified capsular tension ring (CTR) is effective at preventing toric intraocular lens (TIOL) rotation and misalignment.John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.Experimental study.Ten human cadaver eyes were used to test the ease or difficulty of TIOL rotation in the capsular bag under 3 experimental conditions: a TIOL alone, a TIOL with a standard CTR, or a TIOL with a newly modified CTR with indentations in a sinusoidal pattern. Scores for the ease of IOL rotation were compared by using the nonparametric Friedman analysis of variance test. In addition, both anterior and posterior Miyake-Apple views were filmed to observe the rotational stability of TIOLs in the capsular bag under the 3 test conditions.In the ten eyes of five patients, the rotational stability improved with a standard CTR, but further improvement was statistically observed (P.05) with the newly modified CTR under all test conditions. This was true for both IOLs used (AcrySof and TECNIS toric IOLs), with or without ophthalmic viscosurgical device, and for either clockwise or counterclockwise rotations.A newly designed CTR prototype represents a new technology for improving the rotational stability of a TIOL in the capsular bag. Under all test conditions, the prototype performed significantly better than a standard CTR. The results support the use of this new CTR design to improve the accuracy and refractive success of TIOLs.

One core question in studies of language processing is the extent to which interlocutors engage in real-time communicative perspective-taking. Current evidence suggests that both children and young adult listeners are able to draw on common ground (shared knowledge) to guide referential interpretation. However, less is known about older listeners, who are often described as experiencing age-related cognitive declines that could affect their capacity to integrate perspective cues online. In the present study, we examined the extent to which younger and older listeners used common ground to guide the interpretation of temporarily ambiguous descriptions. Participants followed instructions from a Director to click on displayed objects. The target object (e.g., hat with blue feathers) was accompanied by a competitor (e.g., hat with pink feathers) or a control object (e.g., stapler). We manipulated whether the competitor/control was mutually visible (common ground) or not (privileged ground). The results revealed that, although listeners used perspective information to differentiate the target from the competitor in the common ground condition, this pattern was notably weaker in older adults. Whereas measures of executive function showed significant group differences in inhibitory control and working memory, no differences were found in theory of mind. Thus, age-related changes in communicative perspective-taking are not likely due to general declines in mentalizing ability. Furthermore, strict screening criteria for vision and hearing ability allowed us to rule out explanations involving age-related sensory decline. Together, the results advance our understanding of how younger and older adults integrate common ground during real-time referential processing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Aim: This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians. Methods: Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ2 and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer’s V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance. Results: In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33–41) years (ranges 18–81). Patients with invasive OSSN were more likely to present with pain (p = 0.007), redness (p = 0.034), excessive tearing (p = 0.0001), discharge (p = 0.011), bleeding (p = 0.007), reduced vision (p = 0.0001), fungating lesion (p = 0.001), and blindness (p = 0.005); location at temporal limbus (p = 0.0001), inferior limbus (p = 0.0001), or circumlimbal (p = 0.001); and extension to cornea (p = 0.006) and forniceal palpebral conjunctiva (p = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (p = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; p = 0.0001; phi: 0.237 [p = 0.0001]). Conclusion: OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.

The assessment of visual impairment using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, requires a thoughtful ophthalmologic evaluation and careful application of the functional vision tests and arithmetic criteria provided in Chapter 12, The Visual System, and other chapters, as applicable. The interpolation of the multiple dimensions of the visual system into the enumeration of a single impairment percentage may involve complex mathematical manipulations. Properly enumerated, the value can be utilized rigorously in impairment evaluations, functional evaluations, and even for academic research.

Introduction: This study analyzed 39 data collection tools used by teachers of students with visual impairments when completing functional vision assessments (FVAs). Methods: In 2017, teachers of students with visual impairments submitted data collection tools used in the FVA process. These tools were then compared with the 23 FVA components suggested by two established resources, Erin and Paul and D’Andrea and Farrenkopf. Results: The most commonly assessed skills and abilities were near visual acuity, distance visual acuity, and color perception. Only five of the submitted data collection tools contained at least 80% of the FVA components identified by the established resources. Fewer than 25% of the tools incorporated an orientation and mobility (O&M) screening. Discussion: There was considerable variation in the background information, medical data, and visual skills information that was collected. Variability in the data collected during the FVA process may impact a teacher’s recommendations, including referrals for specialized evaluations such as O&M and clinical low vision evaluations. Implications for practitioners: Since FVA reports are used by Individualized Education Program teams, it is essential that data collection tools used during the assessment process are complete and address key areas such as near visual acuity and color perception. Teachers should carefully review their tools to determine whether the data collected are sufficient to make informed recommendations regarding accommodations, goals, and referrals. If the data collected are not sufficient, then the tools should be revised or additional data should be collected.

Purpose : This study is to investigate the effect of night glare on myopia.Methods : Forty eight myopic eyes aged 20 to 30 year old were under the indoor illumination 1 lx or less for 5 minutes for the mesopic adaptation. Subjects were grouped by the equivalent spherical refraction -3.25 D. The group 1 with the refraction under -3.25 D and the group 2 with over -3.25 D were compared and analyzed. Two 100 Watt bulbs were placed by the side of the target whose illuminance at the position of subject's pupil was measured. The disability glare (contrast visual acuity and contrast sensitivity) was measured at 2, 5, and 10 lx and the discomfort glare was quantified by Deboer glare scale. The contrast acuity was measured by Reverse- Contrast chart at 100%, 25% and 10% of contrast LogMAR chart and the contrast sensitivity using the iPad program Clinic CSF 2.0 was measured at 3, 6, 12 and 18 cycles per degree.Results : The contrast acuity and contrast sensitivity of disability glare were both high in the group 1. The contrast acuity showed a significant difference after glare occurred (p 0.05).Conclusion : Considering the trend of higher nighttime activity in Korea, it is thought that not only a standard vision test for the night and the prescription to intervene the glare is needed regardless of age.

SIGNIFICANCE This review summarizes the main factors of refractive error after silicone oil removal combined with cataract surgery.The post-operative refractive results of silicone oil removal combined with cataract surgery are closely related to the patient's future vision quality. This report summarizes the factors that influence the difference between the actual post-operative refractive power and the pre-operatively predicted refractive power after silicone oil removal combined with cataract surgery, including axial length, anterior chamber depth, silicone oil, commonly used tools for measuring intraocular lens power, and intraocular lens power calculation formulas, among others. The aim of the report is to assist clinical and scientific research on the elimination of refractive error after silicone oil removal combined with cataract surgery.

Introduction: Within the field of visual impairment, there is no set of standards that guide teachers of students with visual impairments as they conduct, report, and share functional vision assessment (FVA) results with other educational team members, and university instructors vary in how they teach the assessment process to preservice teachers. Methods: In parallel, a group of teachers of students with visual impairments and a group of university instructors completed three rounds of a Delphi study. After providing background information in Round 1, they rated 84 statements about the FVA process. The level for consensus was set at 80%. Results: Of the 84 statements, consensus was reached for 45 statements regarding the level of importance by both groups. Participants rated 11 of 22 visual skills (e.g., near acuity, distance acuity) as extremely important to include in the FVA process. Discussion: There continues to be a need to build consensus on when FVAs should be conducted, what visual skills should be included when conducting them, what should be included in reports, and with whom assessment information should be shared. The importance of conducting such assessments for all students, including students under the age of 5 years and those with additional disabilities, needs to be recognized by the field of visual impairment. Implications for practitioners: University personnel need to work together to develop consistent curricula that focuses on the FVA process. Future studies that examine the FVA practices of individual teachers are necessary.

Ophthalmic examinations of developmentally delayed/autistic children are challenging. Oral midazolam may be a viable alternative to general anaesthesia for this indication. Single-centre retrospective cohort study (January 2018–March 2020). Oral midazolam (0.5 mg/kg, max 15 mg). Metrics included: patient demographics, examination completion rate, duration of stay and adverse events. 50 oral midazolam examinations were performed (45 patients). Mean age was 79.12 months. All had developmental delay (66.67% autism). Time to ophthalmic examination was 60.31 minutes. Eye examination was successfully completed in 98%. No adverse events were reported. Mean stay was 3.35 hours. Oral midazolam (0.5 mg/kg, max 15 mg) is associated with safe, successful completion of ophthalmic examinations in children previously unexaminable in clinic.

Background: Refractive error is one of the most common causes of the visual impairment and second leading cause of treatable blindness. The objective of the study was to determine the mag­nitude of refractive errors in children. Methods: This was a hospital based cross-sectional study conducted on 254 children attending Ophthalmology OPD of Manipal Teaching Hospital, Pokhara. The children whose visual acuity was worse than 6/6 but improved with pinhole were included in this study. Vision test, retinoscopy and subjective refraction was done in all subjects and cycloplegic refraction was done when needed. Statistical analysis was carried out using Epi-info version 7. Results: The commonest type of refractive error was astigmatism (46.06%) followed by myopia (42.31%). Majority of children had low grade of refractive errors (46.85%). Among the children, “with the rule astigmatism” was maximum (27.56%). Majority of children were in the age between 11 to 15 years (77.95%). The refractive error was seen more in female (63.78%). Among the chil­dren of refractive errors, 29.13% had family history, 33.46% had given the history of wearing spec­tacles and 10.24% children had amblyopia. There was statistically significant association between refractive errors and age groups, history of wearing spectacles, amblyopia and grading of refractive errors. However, there was no statistically significant association of refractive error with gender, residence and family history. Conclusions: Astigmatism was the common type of refractive error followed by myopia. This study emphasizes the importance of detection of refractive error in children.

Zusammenfassung Einführung Special Olympics Deutschland (SOD) ist die deutsche Organisation der weltweit größten Sportbewegung für Menschen mit geistiger und mehrfacher Behinderung: Viele Landesverbände von SOD bieten mittlerweile alle 4 Jahre Sommerspiele für diese Klientel an, an denen Kinder und Erwachsene aus dem jeweiligen Bundesland teilnehmen. Während der Landessommerspiele von SO Baden-Württemberg in Offenburg im Jahr 2017 konnten die Athletinnen und Athleten im Rahmen des Gesundheitsprogramms „Opening Eyes – Besser Sehen“ an einem augenärztlichen Screening teilnehmen. Methoden Optiker und Optometristen erhoben die Anamnese und Refraktion, prüften auf Farbfehlsichtigkeiten, Sehschärfe (Ferne und Nähe) sowie den orthoptischen Status. Insgesamt 4 erfahrene Ärzte in Weiterbildung und Fachärzte der Klinik für Augenheilkunde des Universitätsklinikums Freiburg führten Spaltlampenuntersuchungen, Funduskopie und Augendruckmessungen durch. Bei Bedarf wurde eine Funduskopie in Mydriase bzw. eine OCT-Untersuchung angeschlossen. Ergebnisse Insgesamt wurden 166 Personen untersucht (48% weiblich = 80; 52% männlich = 86). Der Abdecktest war in etwa 45% der Fälle in der Ferne und in 47% der Fälle in der Nähe auffällig. Sechs bzw. 11% der Patienten gaben Doppelbilder an (9/156; 17/156; jeweils Ferne und Nähe). Eine auffällige Farbsehprüfung mit weniger als 9 von 9 erkannten CVTM-Testtafeln (Color Vision Testing Made Easy nach Waggoner) wurde bei 8% (11/143) dokumentiert. Fundusauffälligkeiten sahen wir in 13% der Fälle (16/125). 41% (48/118) benötigten eine neue Brillenverschreibung. 29% (45/157) gaben eine Überempfindlichkeit gegenüber Licht an. Jeder 2. Teilnehmer hatte in den letzten 3 Jahren einen Augenarzttermin wahrgenommen; dennoch ergab die Erhebung in 10% (16/160), dass noch kein Augenarztbesuch stattgefunden hatte. In 4% der Fälle wurde eine notfallmäßige Vorstellung beim niedergelassenen Augenarzt empfohlen (z. B. im Falle eines akuten Keratokonus oder aufgrund eines erhöhten Augeninnendrucks). Eine optionale Behandlung (z. B. wegen eines Trockenen Auges) wurde in 40% der Fälle (66/166) empfohlen. Diskussion Menschen mit geistiger Behinderung beklagen allgemeine Probleme mit den Augen oder neu aufgetretene Sehprobleme nicht zwangsläufig und unmittelbar. Zusätzlich besteht möglicherweise ein eingeschränkter Zugang zur augenärztlichen Versorgung im Vergleich zu Menschen ohne geistige Behinderung. Aufgrund der 4% behandlungsbedürftiger Diagnosen sowie der 53% der Teilnehmer mit nicht optimalem Refraktionsausgleich erscheint eine augenärztliche Begleitung von Special Olympics sinnvoll, sollte verstetigt und mit öffentlichen Mitteln unterstützt werden.

To clarify the changing characteristics of choroidal thickness over time within different age ranges and among different refractive statuses of children aged 6 to 18 years.Prospective cohort study.Data of axial length, cycloplegic refraction, and choroidal thickness (using swept-source optical coherence tomography) were collected at baseline and at a 1-year follow-up for 756 participants. One-year change in choroidal thickness and its association with age and refraction were analyzed.Significantly greater attenuation of choroidal thickness was observed in younger children aged 6-9 years for all participants (-9 ± 25 μm) and for those with a myopic shift (-12 ± 25 μm), whereas there was a larger increase in adolescents aged 10-13 years for those without a myopic shift (9 ± 23 μm). There was a marked decrease in the choroidal thickness for newly developed myopic patients compared with persistent-nonmyopic patients and persistent-myopic patients (P.01). The association between changes in axial length and choroidal thickness was less strong in persistent-myopic patients (β = -15.4, P = .022) than that in persistent-nonmyopic patients (β = -30.4, P.001) and newly developed myopic patients (β = -33.7, P = .001), whereas among the persistent-myopic patients, the association was less strong in the baseline mild-myopic patients (β = -10.4, P = .193) than that in the baseline moderate-to high-myopic patients (β = -31.4, P = .026).Changes in choroidal thickness varied by age. There was an increased rapid thinning of the choroid among newly developed myopic patients, and a nonsignificant association between changes in choroidal thickness and axial length in the early stages of myopia.

WE sought to evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOLs) with plate-haptic, c-loop haptic, and a rhexis-fixated lens were compared.Retrospective, multicenter, comparative case series.The study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic, or a novel rhexis-fixated IOL. Biometry and refraction measurements were conducted preoperatively and 3 months postoperatively. Lens constant optimization was performed.Seventy eyes of 56 subjects were included. ELP for rhexis-fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis-fixated IOL and both plate-haptic (P = .001) and c-loop haptic IOL (P = .000). Anterior chamber depth adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P.05). For the rhexis-fixated IOL the differences in refraction ranged from -0.039 diopters (D) for the Hill-Radial Basis Function to -0.096 D for Haigis. The other 2 lenses showed mean differences in refraction between +0.046 D for Hill-Radial Basis Function and +0.097 D for Haigis.The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.

To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes.Retrospective case series review at 10 IATS sites.The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS.Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010.Visual acuity (VA), strabismus, adverse events (AEs), and reoperations.One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%).Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.

Visual impairment and blindness is a global concern. Poor awareness and late detection are the significant factors contributing to the large number of visually impaired people worldwide. The ubiquitous use of smartphone devices will enable the public to access various eye care services provided. We are developing this application based on the need for early detection to avoid further vision loss. The simple algorithm and user-friendly features will promote any layperson to use it with minimal training. This pilot study revealed the application is highly potential to be a valid and reliable tool for vision screening in the community.Keywords: mobile application; vision screening; visual impairment; blindnesseISSN: 2514-7528 © 2020 The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/jabs.v5i15.340

Objective The purpose of this study was to determine if there is an association between Perceptual Ability Test (PAT) results and color vision deficiency (CVD). Methods Three consecutive classes of first-year dental students (n = 291) voluntarily participated in the study. The Farnsworth-Munsell 100 Hue Color Vision test (FM-100) was administered to students beneath a Macbeth Judge II viewing booth that provided ideal lighting conditions to ascertain CVD. Results of FM-100 test were recorded as total error scores (TES). Color acuity was scored as superior (TES 0-16), average (TES 20-100), or poor (TES > 100). Additional information of age, sex, ethnicity, and time to complete the FM-100 was obtained. Multiple linear regression was used to determine the association between PAT and CVD while adjusting for age, sex, ethnicity, and time to complete the FM-100 test. Results TES ranged from 0-244. There were 132 students with superior color acuity, 161 with average, and eight with poor acuity. Females performed better than males on the FM-100 test. Time to complete the FM-100 test ranged from 3:40 minutes to 25:12 minutes. There was a strong relationship between PAT scores and CVD (P = 0.0003). A 1-unit increase in PAT scores was found to result in a 9% decrease in TES; indicating that students with higher PAT scores are less likely to have CVD. Conclusion The PAT may be a preliminary screening instrument to identify students who may have CVD. The FM-100 test can then confirm the presence of CVD. Students with CVD may desire to improve dental shade matching skills through targeted training and education.

Purpose The use of monochromatic light in the assessment of intraocular lenses (IOLs) has been criticized for not representing the real-world situation. This study aimed to measure and compare the image quality of 3 extended depth-of-focus (EDOF) IOL models in monochromatic and polychromatic light. Setting David J Apple Laboratory, Heidelberg, Germany. Design In vitro study. Methods An optical metrology instrument was used to study image quality metrics of diffractive IOLs with chromatic aberration correction (Symfony and AT Lara) and a refractive lens (Mini Well). The modulation transfer function (MTF) was measured in green and polychromatic light at a 2.0 mm, 3.0 mm, and 4.0 mm aperture. The EDOF IOL's tolerance to defocus was tested against a monofocal lens. Results The mean MTF of the EDOF IOL at far distance was decreased in polychromatic compared with monochromatic light. The largest effect was found in the refractive lens; however, at intermediate distance, only small differences occurred. In their tolerance to defocus, the EDOF IOLs were superior to the monofocal IOL. The diffractive IOL had higher MTFs than that of the refractive IOL at 2 primary foci, the refractive IOL's optical quality varied less with defocus at 3.0 mm. The refractive lens was the most susceptible to changes in aperture size. Conclusion The diffractive EDOF IOL was more resistant to chromatic effects than the refractive IOL. The EDOF IOLs provided an extended through-focus performance compared with the monofocal IOL, but differences in optical design, particularly pupil dependency, should be considered when refining IOL selection for patients.

Purpose: To study the incidence and progression of refractive errors in medical students. Methods: This is a retrospective study including 200 medical students of our college during the period of July 2015 to June 2018. Examination included visual acuity testing using Snellens chart, slit lamp biomicroscopy, fund us examination with direct ophthalmoscope, indirect ophthalmoscope and refraction. Students were examined for refractive errors and findings compared with pre-admission data. Changes in spherical, cylindrical power analysed. Results: Prevalence of Myopia increased from 40% to 48%. Incidence of new refractive errors in emmetropes was 8%. Myopic change found was -0.75D to -1.0D. Conclusion: Students in medical colleges have high prevalence of myopia, high incidence of adult onset myopia and statistically significant progression. Parental history, prolonged eye strain, excessive use of electronic gadgets, decreased outdoor activity and urban background had significant association with prevalence of myopia.

Purpose Incorporating mass pediatric vision screening programs as part of a national agenda can be challenging. This review assessed the implementation strategy of the existing pediatric vision screening program. Methods A search was performed on PubMed, EBSCO host MEDLINE Complete, and Scopus databases encompassing the past ten years for mass pediatric screening practice patterns that met the selection criteria regarding their objectives and implementation. Results were analyzed from 18 countries across five continents. Results Eight countries (44%) offered screening for distance visual acuity only, where the majority of the countries (88%) used either Snellen or Tumbling E chart. High-income countries initiated screening earlier and applied a more comprehensive approach, targeting conditions other than reduced vision only, compared with middle-income countries. Chart-based testing was most commonly performed, with only three countries incorporating an instrument-based approach. Lack of eyecare and healthcare practitioners frequently necessitated the involvement of non-eyecare personnel (94%) as a vision screener including parent, trained staff, and nurse. Conclusions Implementation of a vision screening program was diverse within countries preceded by limited resources issues. Lack of professional eyecare practitioners implied the need to engage a lay screener. The limitation of existing tests to detect a broader range of visual problems at affordable cost advocated the urgent need for the development of an inexpensive and comprehensive screening tool.

Purpose Current chart-based tests of spatial contrast sensitivity (SCS) with fixed or narrow frequency ranges (≤18 cycles/°) cannot characterise the limits of spatial contrast vision. Here we present the design and validation of a chart-based measure of the spatial contrast envelope. Methods Following the principles of the standard visual acuity (Bailey-Lovie) and contrast sensitivity (Pelli-Robson) charts, a combined spatial-contrast and visual acuity chart was designed using a language-independent triangular symbol for a four-alternative forced-choice procedure plus chart rotation. Symbol frequencies ranged between 0.38 and 60 cycles/° spaced along 10 radial axes (0.55%-100% contrast). The chart was validated with reference to the Bailey-Lovie and Pelli-Robson charts; its reliability and sensitivity to changes in illumination, simulated cataract and blur was evaluated in healthy adults. Results The photopic SCS function could be measured in 5.5 ± 0.5 min; thresholding around the spatial contrast resolution limit reduced completion times to ~2 min. There was good agreement with high-contrast visual acuity (difference = 0.08 ± 0.02 logMAR) and contrast-sensitivity at 1.5 cycles/° (0.13 ± 0.06 logCS). Test-retest reliability was excellent at all spatial frequencies (ICC = 0.99). Mesopic illumination or simulated cataract caused a generalised SCS loss; myopic blur reduced high-frequency sensitivity. Spatial contrast sensitivity was independent of radial axis orientation (cardinal or oblique). Conclusions The chart provides a time-efficient, reliable and inexpensive measure of SCS with applications in research and clinic for detecting subtle deficits in early stages of ocular and neurological conditions that often manifest at higher frequencies. It is sensitive to vision changes occurring in dim lighting and with simulated cataract and blur. The chart is available open-access for self-printing; contrast variation in print can be controlled through user calibration and/or establishing normative SCS functions using the theoretical values.

Supplemental digital content is available in the text., SIGNIFICANCE Evidence supporting the contributions of near work in myopia is equivocal. Findings from this pilot study suggest that a high prevalence of myopia in ultra-Orthodox boys may be attributed to intense near work at school and learning to read in preschool at an early age. PURPOSE This study aimed to assess factors that may influence myopia in three groups of Jewish boys with different educational demands. METHODS Healthy ultra-Orthodox, religious, and secular Jewish boys (n = 36) aged 8 to 12 years participated. Refractive status, education, time spent reading and writing, and electronic device use were assessed using a questionnaire, and time outdoors and physical activity were assessed objectively using an Actiwatch. Data were analyzed with χ2 and Kruskal-Wallis tests with Bonferroni post hoc comparisons. RESULTS Ultra-Orthodox (n = 14) and religious (n = 13) children had greater myopia prevalence compared with secular children (n = 9; P = .01), despite no differences in parental myopia. Actigraph data showed that there were no differences in activity (P = .52) or time spent outdoors (P = .48) between groups. Ultra-Orthodox children learned to read at a younger age and spent more hours at school (P < .001 for both). All groups engaged in a similar amount of near work while not in school (P = .52). However, ultra-Orthodox boys had less electronic device use than did religious (P = .007) and secular children (P < .001). CONCLUSIONS This pilot study demonstrates that ultra-Orthodox, religious, and secular children have distinct educational demands but similar time outdoors, physical activity, and near work while not in school. The findings suggest that near work at school and/or learning to read in preschool at an early age may contribute to previously reported differences in refractive error between groups. However, conclusions should be confirmed in a larger sample size.

Significance The popularity of competitive video game play is growing rapidly. Little is known about the ocular characteristics of esports participants. Refractive error and binocular measures in young adult gamers were similar to population norms. However, tear breakup time was lower, and accommodative lag was higher. Purpose In a recent report, very young video game players were found to have greater levels of refractive error and heterophoria and reduced stereopsis. The purpose of this study was to assess the visual and ocular characteristics of a group of recreational esports athletes to determine if the findings in young children were similar to findings in a group of young adult video game players. Methods Vision tests were performed on 36 college students during a video game combine event. Testing included high- and low-contrast visual acuity, autorefraction at distance and at 33 cm, stereoacuity, near heterophoria, and tear breakup time. Participants also indicated their level or rank in the game Overwatch. Results Fifteen participants were myopic, and 21 did not wear vision correction. The mean local stereopsis was 31.9 seconds. The mean of the esophoric value was 3.2 prism diopters, and the mean of the exophoric value was 5.7 prism diopters. The mean lag of accommodation was 0.81 D. The mean tear breakup time was 5.8 seconds. Average hours of play did not differ between those who wore vision correction and those who did not. There were no significant relationships between the hours of play and the ocular findings. Conclusions The prevalence of refractive error and the mean heterophoria were similar to population norms, and the mean stereoacuity was normal. However, accommodative lag was slightly higher, and the tear breakup time was lower than expected. Differences in these latter values were also noted between high- and low-level Overwatch players.

Purpose Spectacle lenses containing multiple small peripheral elements have been developed for myopia control in children. It is important that their effect on vision be quantified by (i) fixation through the peripheral portion, thereby using foveal vision and (ii) by fixation through the central portion and presentation of peripheral targets. Methods The above approaches were used in five studies to evaluate two novel spectacle lens designs: spectacle lenses with Highly Aspherical Lenslets (HAL) and Slightly Aspherical Lenslets (SAL). A single vision lens served as a control. Visually normal adults participated in each study. The first two studies had subjects fixate through the periphery of the lenses. High and low (10%) contrast visual acuity was measured with the Freiburg Vision Test and reading speed for high and low contrast words measured with a sentence generator. The other three studies assessed peripheral vision while subjects fixated through the central portion of the lens. Peripheral contrast sensitivity was measured using two cycles per degree drifting Gabor stimuli. Peripheral motion perception was further evaluated using random dot stimuli. Finally, attention was measured using an established test of useful field of view with three levels of complexity. Results The periphery of the HAL lens significantly reduced low contrast visual acuity, but not high contrast visual acuity, while the effect of the SAL lens was not significant for either. Neither test lens affected reading speed for high contrast words, but the HAL lens significantly affected performance for low contrast words. Neither test lens affected peripheral motion perception or useful field of view. Conclusions Low contrast visual acuity and reading was slightly reduced while high contrast visual acuity was unaffected when fixating through the periphery of the novel lens designs. None of the peripheral measures of vision was affected by the novel lens designs.

Background: A smart vision screening instrument was applied for screening low eyesight in primary school students in Wuhan, China. We aimed to compare the differences in test results between this instrument and lamp-box visual acuity charts, assess the validity of the screening results, and perform a preliminary comparison of the cost inputs of the two approaches. Methods: In this cross-sectional study conducted in Wuhan, China in 2017, vision tests were performed on the same day among enrolled primary school students by using the two approaches. The t-test and kappa test were performed to compare the differences, and the indicators of validity were calculated and receiver operating characteristic (ROC) curves were drawn. Existing cost-input data were collected and the budget was analyzed. Results: In total, 1001 schoolchildren were included, and the prevalence of low eyesight was 21.18% (95% CI: 18.71-23.87%). The test results of the two approaches were not statistically different (t=1.929, P>0.05) and showed moderate consistency (kappa=0.519, P

With the rapid development of 5th generation mobile networks, the manufacturing industry and the Internet become more and more intimate. And as an important part of the industrial Internet, the cloud-side collaborative industrial Internet system comes into being. In this paper, in order to improve production quality and efficiency, an industrial intelligent edge computing system, named as EdgePlus, is proposed, which introduces the architecture of the industrial Internet system and expounds the deployment method of the system based on 5G. To verify the system performance, an industrial vision test for flexible smart SMT production line is then performed, which can be concluded that the proposed system can greatly improve the intelligentization of industrial production.

To describe the course of intermittent exotropia (IXT) in children followed up without treatment for 3 years.Observation arm from randomized trial of short-term occlusion versus observation.One hundred eighty-three children 3 to 10 years of age with previously untreated IXT and 400 seconds of arc (arcsec) or better near stereoacuity.Participants were to receive no treatment unless deterioration criteria were met at a follow-up visit occurring at 3 months, 6 months, or 6-month intervals thereafter for 3 years.The primary outcome was deterioration by 3 years, defined as meeting motor criterion (constant exotropia ≥10 prism diopters [Δ] at distance and near) or near stereoacuity criterion (≥2-octave decrease from best previous measure). For the primary analysis, participants also were considered to have deteriorated if treatment was prescribed without meeting either deterioration criterion.The cumulative probability of protocol-specified deterioration by 3 years was 15% (95% confidence interval, 10%-22%), but that was likely an overestimate, partly because of misclassification. Among 25 deteriorations, 2 met motor deterioration, 11 met stereoacuity deterioration, and 12 started treatment without meeting either criteria (7 for social concern, 1 for diplopia, 4 for other reasons). Among the 132 participants who completed the 3-year visit and had not been treated during the study, only 1 (1%) met motor or stereoacuity deterioration criteria at 3 years. Of the 4 participants completing the 3-year visit who met deterioration criteria previously and had not started treatment, none still met deterioration criteria. Between the baseline and 3-year examination for these 132 patients, improvement occurred in distance and near stereoacuity (mean improvement, 0.14 and 0.14 logarithm of arcsec; P ≤ 0.001 and P ≤ 0.001, respectively), distance exotropia control (mean improvement, 0.6 points; P ≤ 0.001), and distance exodeviation magnitude (mean improvement, 2.2 Δ; P = 0.002).Among children 3 to 10 years of age with IXT for whom surgery was not considered to be the immediately necessary treatment, stereoacuity deterioration or progression to constant exotropia over 3 years was uncommon, and exotropia control, stereoacuity, and magnitude of deviation remained stable or improved slightly.

PURPOSE: Clinical evaluation of the visual outcomes after implantation of a small-aperture extended depth of focus (EDOF) intraocular lens (IOL) and a segmental refractive bifocal lens. METHODS: In this prospective study, 13 patients with cataract received a small-aperture IC-8 IOL (AcuFocus, Irvine, CA) in one eye and a segmental-refractive Lentis Mplus LS-313 MF20 IOL (Oculentis, Berlin, Germany) in the fellow eye. The clinical examination included measurements of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Additionally, a defocus curve was obtained from +2.00 to −5.00 diopters (D) and a Salzburg Reading Desk was used to assess the patients' reading acuity at intermediate and near distances. A halo and glare simulator was used to evaluate the postoperative perception of dysphotopsia. RESULTS: At 5 months postoperatively, the mean binocular visual results demonstrated UDVA, UIVA, and UNVA values of −0.04 ± 0.11, 0.00 ± 0.10, and 0.11 ± 0.08 logMAR, respectively. The binocular distance-corrected reading performance test also confirmed the improved visual function, with an intermediate reading acuity of 0.12 logMAR at 69.21 cm and a near reading acuity of 0.19 logMAR at 41.63 cm. The mean halo size was 32.54 ± 22.38, mean halo intensity was 34.46 ± 21.95, mean glare size was 9.00 ± 17.47, and mean glare intensity was 9.92 ± 16.84. CONCLUSIONS: The new concept of a combined implantation of a small-aperture IOL and a segmental-refractive bifocal lens showed good results in far and intermediate distances and functional results at near distance, while causing minimal photic phenomena. [ J Refract Surg. 2019;35(9):551–558.]

The huge number of accidents makes the study of accidents causation one of the priorities in the design of roads, location of traffic signs, specifying the permitted ages for driving, improving license procedure and to provide local data to predicate the behavior. The characteristics of drivers affect results in roads. Drivers' data, vision test and reaction time of the drivers taken, head cover and spectacle considered in the drivers' abilities and accidents background involvements in the questionnaire form. Drivers' reaction time and drivers' accidents rate (accidents+1/experience) through the years of driving experience are modeled. The results revealed the negative impact of head cover and/or spectacle on vision abilities, while it didn’t show obvious effect on accidents rate The best reaction time is 0.5708 (sec) for age group (29-39) years, while the worst reaction time is 0.6974 for age (>=51) years. The maximum accident rate is 0.482 for age group (18-28) and decreases with age increase to a minimum accidents rate of 0.0808 for age group >=51.

The measurement of corneal radius of curvature is of great importance for clinical studies of patients with both healthy eyes and keratometric issues. We present here a simple design for a keratometer formed by two circular LED arrays. Based on basic geometrical ray trace, we obtain the average anterior corneal radius of curvature, the cylinder power for astigmatic correction as well as the axis of astigmatism. Our statistical results denote a 95% of confidence in the measurements obtained with calibrated steel balls, healthy eyes and astigmatic eyes. These results show that this instrument has as good precision as other more complex and expensive keratometers already in the market.

SIGNIFICANCE The present study addresses the accommodative response and its dependence on the type of optical correction used. The results are discussed relative to their possible implications for myopia progression and visual fatigue. PURPOSE The accommodative response has been investigated owing to its possible relationship with the onset and progression of myopia and visual fatigue. This study explored the influence of wearing soft contact lenses in comparison with spectacles in terms of magnitude and variability of accommodation. In addition, we analyzed the intersession and intermethod repeatability. METHODS Dynamic accommodative response was recorded during 30-second epochs, at five different distances (50, 40, 33, 25, and 20 cm), in 21 individuals (mean refractive error ± SD, -0.79 ± 1.39 D) while wearing either soft contact lenses or spectacles on two different days. To assess repeatability, a second identical intervention was conducted. RESULTS Higher lags of accommodation were obtained with the use of soft contact lenses in comparison with the spectacle condition (P =.04, partial η 2 [η p 2] = 0.204), and similarly, a higher variability of accommodation at near distances was found during the soft contact lens measurement (P

SIGNIFICANCE: Uncorrected refractive error is the leading cause of visual impairment; therefore, reducing its prevalence is important worldwide. For two decades, there has not been a comprehensive assessment of refractive error in Latin America. PURPOSE: The purpose of this study was to determine the current prevalence of refractive error, presbyopia, spectacle coverage, barriers to uptake refractive services, and spectacle correction in people 15 years and older in Bogotá, Colombia. METHODS: A cross-sectional community-based survey was conducted using 50 randomly selected clusters from 10 districts of Bogotá reflecting the socioeconomic status of the city. Respondents 15 years and older were interviewed and underwent standardized clinical eye examinations. Prevalence of uncorrected refractive error, spectacle coverage, and visual impairment were standardized to 2015 age-sex population distribution of Bogotá and further analyzed. RESULTS: A total of 2886 subjects (90% of 3206 eligible subjects) participated in the study; 39.1% were male and 60.9% were female in the age range of 15 to 96 years, with a median age of 46 years (interquartile range, 45 to 54 years). Age- and sex-standardized prevalence of visual impairment was 19.3% (95% confidence interval [CI], 17.8 to 20.8%). Prevalence of uncorrected refractive error was 12.5% (95% CI, 11.3 to 13.7%). Prevalence of presbyopia among participants 35 years and older was 55.2% (95% CI, 52.9 to 57.4%). Spectacle coverage was 50.9% for distance vision, and it was 33.9% for presbyopia. Main barrier to spectacle uptake was a limitation in affording spectacles because of economic factors (29.5%). CONCLUSIONS: This study provides a current estimate of refractive error using the Rapid Assessment of Refractive Error for Colombia and the Latin American region. The prevalence of uncorrected refractive error and presbyopia was high, and the barriers to spectacle uptake were higher in the lowest socioeconomic strata. The results obtained in the present study will help in making evidence-based decisions related to eye care service delivery in Colombia.

Aim: To evaluate the reliability and validity of the Children's Visual Impairment Test for 3‐ to 6‐year‐olds (CVIT 3–6). Method: Reliability was assessed via test–retest correlation and intraclass correlation coefficient (ICC) in typically developing children, children with cerebral visual impairment (CVI), intellectual impairment, and simulated impaired vision (validation groups n=59, mean developmental age=4y 10mo, 27 females, 32 males). Internal validity was evaluated with a confirmatory factor analysis on the normative sample (n=301, median age=4y 8mo, SD=9.7mo, 148 females, 153 males). External validity was assessed by correlating performance on CVIT 3–6 with L94, the Beery‐Buktenica Developmental Test of Visuo‐Motor Integration (Beery‐VMI), the Freiburg Vision Test, the revised Snijders‐Oomen Nonverbal Intelligence Test for children between 2 years 6 months and 7‐years‐old (SON‐R 2.5–7), and the Social Responsiveness Scale (SRS) questionnaire and by comparing performance between validation groups. Results: We observed very good test–retest reliability (r=0.82, p Interpretation: CVIT 3–6 is grounded in knowledge of visual perception. The tool specifically measures CVI‐related visual perception deficits and is not mediated by intellectual abilities or low visual acuity. What the Paper Adds: - Evidence for good test–retest reliability of the Children's Visual Impairment Test for 3‐ to 6‐year‐olds (CVIT 3–6). - Factor structure of normative data reflects CVIT 3–6's foundations in vision science. - CVIT 3–6 specifically measures visual perception impairments. - CVIT 3–6 performance is not influenced by intelligence or low visual acuity.

SIGNIFICANCE Glaucoma has been shown to impair hazard detection ability and increase crash risk compared to controls. Differences in visual search behavior of the driving scene may explain these differences; however, there has been limited investigation of this issue with inconsistent findings. PURPOSE Through eye movement tracking of older drivers with glaucoma, we explored their visual search behavior in comparison with controls while performing the DriveSafe, a slide recognition test purported to predict fitness to drive. METHODS Thirty-one drivers with glaucoma (mean age, 71.7 ± 6.3 years; average better-eye mean defect,-3 dB; average worse-eye mean defect,-12 dB) and 25 age-matched controls underwent measurements of their visual acuity, contrast sensitivity, visual fields, and useful field of view (visual processing speeds). Participants' eye movements were recorded while they completed the DriveSafe test, which consists of brief presentations of static, real-world driving scenes containing various road users (pedestrians, bicycles, vehicles). Participants reported the types, positions, and direction of travel of road users in each image; the score was the total number of correctly reported items (maximum, 128). RESULTS Drivers with glaucoma had significantly worse DriveSafe scores (P = .03), fixated on road users for shorter durations (P < .001), and exhibited smaller saccades (P = .02) compared with controls. For all participants, longer fixation times on road users (P < .001) was the eye movement measure most strongly associated with better DriveSafe scores; this relationship was not significantly different between groups. Useful field-of-view divided attention was the strongest visual predictor of DriveSafe scores. CONCLUSIONS Eye movement changes in the glaucoma group may reflect increased difficulty in identifying relevant objects in the visual scene, which may be related to their lower DriveSafe scores. Given the DriveSafe's potential utility in assessing drivers with visual impairment before on-road testing, further investigations on how DriveSafe performance and eye movement patterns compare to those during on-road driving are warranted.

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation based on standard keratometry (K) and the new Total Keratometry (TK). METHODS: A post-hoc analysis of study data based on 145 pseudophakic astigmatic eyes was conducted. The absolute prediction error (APE) of spherical equivalent (SE) and cylinder (CYL) was calculated based on K and TK (including posterior corneal surface) data recorded 6 weeks after IOL implantation. APE was calculated as the difference between the postoperative refraction and the refractive error predicted by three classic IOL calculation methods (Haigis/Haigis-T, Barrett Universal II, Barrett Toric Calculator) and two new formulas developed for TK (Barrett TK Universal II, Barrett TK Toric). For APE in SE, the Haigis-T (K versus TK) and Barrett Universal II (K) versus Barrett TK Universal II (TK) were compared. For APE in CYL, the Haigis-T (K versus TK) and Barrett Toric Calculator (K) versus Barrett TK Toric formula (TK) were compared. RESULTS: Mean APE in SE and CYL was lower based on TK values compared to K, with a mean APE difference (K − TK) of 0.011 ± 0.107 diopters (D) (SE Haigis-T; 95% confidence interval [CI]: −0.004 to infinity), 0.016 ± 0.113 D (SE: Barrett Universal II versus Barrett TK Universal II; 95% CI: 0.0005 to infinity), 0.103 ± 0.173 D (CYL: Haigis-T; 95% CI: 0.0791 to infinity), and 0.020 ± 0.148 D (CYL: Barrett Toric versus Barrett TK Toric; 95% CI: −0.0002 to infinity). APE in SE was within ±0.50 D in 86% (Barrett TK Universal II) versus 84% (Barrett Universal II) of eyes. APE in CYL was within ±0.50 D in 58% (Haigis from TK) versus 44% (Haigis from K) of eyes. CONCLUSIONS: In comparison to standard K, a higher prediction accuracy can be expected by using TK values along with the two newly developed formulas. TK values are compatible with standard IOL power calculation formulas and existing optimized IOL constants. [ J Refract Surg. 2019;35(6):362–368.]

Significance Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries. Purpose The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed. Methods A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]). Results Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were "loss" (32%; 18/57) and "breakage" (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02). Conclusions Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

Significance Well-established charts such as Early Treatment Diabetic Retinopathy Study are able to quantify visual acuity (VA) with a low cutoff of 1.6 logMAR. Below this point, nonquantitative measures, such as count fingers, hand movements, and light perception, are used. There is a need for more reproducible, comparable, and reliable ways to measure VA changes in this patient cohort. Purpose The purpose of this study was to examine and compare the ability of the Berkeley Rudimentary Vision Test (BRVT) and the Freiburg Acuity Test (FrACT) to quantify VA in low-vision patients who score nonnumerical VAs in standard charts. Methods Fifty adult participants with VA ≤1.0 logMAR in both eyes were recruited from the Oxford Eye Hospital, Oxford, United Kingdom. Correlation between FrACT and BRVT results and the correlation between VA and daily living activities were analyzed statistically. Potential predictors of differences were investigated. Results The BRVT was significantly faster to conduct (P = .002), but FrACT was able to quantify vision numerically in a greater proportion of eyes. The κ agreement between tests was 0.26. The difference increased systematically with the VA reduction (P < .0001). The Bland-Altman analysis showed a skew to measurement of lower logMAR VA indicating better vision measured on the FrACT. The only significant predictor of difference between the tests was binocular VA (coefficient, −0.445; P = .001). Conclusions Both tests are suitable for a very low-vision population. The BRVT is a faster test to administer, but FrACT provides a numerical result in more eyes. The poor intertest repeatability indicates that they cannot be used interchangeably. The BRVT generally reported poorer vision than did the FrACT. The medium of presentation, such as a computer screen or externally lit print medium, is likely to be the biggest factor in these differences and warrants further investigation.

The MNREAD chart consists of standardized sentences printed at 19 sizes in 0.1 logMAR steps. There are 95 sentences distributed across the five English versions of the chart. However, there is a demand for a much larger number of sentences: for clinical research requiring repeated measures, and for new vision tests that use multiple trials at each print size. This paper describes a new sentence generator that has produced over nine million sentences that fit the MNREAD constraints, and demonstrates that reading performance with these new sentences is comparable to that obtained with the original MNREAD sentences. We measured reading performance with the original MNREAD sentences, two sets of our new sentences, and sentences with shuffled word order. Reading-speed versus print-size curves were obtained for each sentence set from 14 readers with normal vision at two levels of blur (intended to simulate acuity loss in low vision) and with unblurred text. We found no significant differences between the new and original sentences in reading acuity and critical print size across all levels of blur. Maximum reading speed was 7% slower with the new sentences than with the original sentences. Shuffled sentences yielded slower maximum reading speeds and larger reading acuities than the other sentences. Overall, measures of reading performance with the new sentences are similar to those obtained with the original MNREAD sentences. Our sentence generator substantially expands the reading materials for clinical research on reading vision using the MNREAD test, and opens up new possibilities for measuring how text parameters affect reading.

PURPOSE: To assess early visual and optical quality recovery according to preoperative refraction after small incision lenticule extraction (SMILE) at low energy level for myopia and myopic astigmatism treatment. METHODS: This prospective study included 101 eyes of 101 patients separated into three groups: low myopia (30 eyes), with a mean spherical equivalent (SE) of −2.13 ± 0.73 diopters (D); moderate myopia (33 eyes), with a mean SE of −4.53 ± 0.86 D; and high myopia (38 eyes), with a mean SE of −6.54 ± 0.78 D. Visual acuity, contrast sensitivity, refraction, corneal higher order aberrations, modulation transfer function, Strehl ratio, and Objective Scatter Index (OSI) were measured. RESULTS: All eyes had a corrected distance visual acuity of 20/20 or better at 1 day in the low myopia group and 1 month in the moderate and high myopia groups. The contrast sensitivity preoperative values recovered at 8 days in the low myopia group and 1 month in the moderate and high myopia groups. At 1 month, the low myopia group recovered the OSI preoperative values (0.61 to 0.69) and the OSI values were slightly higher than the preoperative value in the moderate and high myopia groups (0.74 to 1.00 and 0.8 to 1.14, respectively). CONCLUSIONS: The recovery time of visual and optical quality in the first month after SMILE correlated with preoperative refraction and the amount of postoperative scattering. Patients with low myopia recovered visual acuity faster and with less ocular scattering than patients with moderate or high myopia. [ J Refract Surg . 2019;35(5):285–293.]

ObjectiveTo study if the thalamic lateral geniculate nucleus (LGN) is affected in multiple sclerosis (MS) due to anterograde degeneration from optic neuritis (ON) or retrograde degeneration from optic radiation (OR) pathology, and if this is relevant for visual function.MethodsIn this cross-sectional study, LGN volume of 34 patients with relapsing-remitting MS and 33 matched healthy controls (HC) was assessed on MRI using atlas-based automated segmentation (MAGeT). ON history, thickness of the ganglion cell–inner plexiform layer (GC-IPL), OR lesion volume, and fractional anisotropy (FA) of normal-appearing OR (NAOR-FA) were assessed as measures of afferent visual pathway damage. Visual function was tested, including low-contrast letter acuity (LCLA) and Hardy-Rand-Rittler (HRR) plates for color vision.ResultsLGN volume was reduced in patients vs HC (165.5 ± 45.5 vs 191.4 ± 47.7 mm3, B = −25.89, SE = 5.83, p < 0.001). It was associated with GC-IPL thickness (B = 0.95, SE = 0.33, p = 0.006) and correlated with OR lesion volume (Spearman ρ = −0.53, p = 0.001), and these relationships remained after adjustment for normalized brain volume. There was no association between NAOR-FA and LGN volume (B = −133.28, SE = 88.47, p = 0.137). LGN volume was not associated with LCLA (B = 5.5 × 10−5, SE = 0.03, p = 0.998), but it correlated with HRR color vision (ρ = 0.39, p = 0.032).ConclusionsLGN volume loss in MS indicates structural damage with potential functional relevance. Our results suggest both anterograde degeneration from the retina and retrograde degeneration from the OR lesions as underlying causes. LGN volume is a promising marker reflecting damage of the visual pathway in MS, with the advantage of individual measurement per patient on conventional MRI.

Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O’Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.

Tests of contrast sensitivity (CS) are not routinely performed in the clinic, although CS is reduced in many conditions, such as amblyopia or glaucoma. This may be due to perceived time constraints or unaffordability of equipment.Monocular CS functions obtained with the FACT, CSV 1000E, and Lea Symbols were compared in 19 healthy subjects aged 24 - 78 years and 24 subjects aged 5 - 16 years, 9 of whom had amblyopia.CS functions could be obtained with all three tests. The tests were equally comfortable for young and adult patients, and took less than 5 minutes to perform (one eye). All measured CSs at 3, 6, 12, and 18 cycles per degree (cpd), but the FACT included 1.5 cpd. LINEAR MIXED EFFECT MODELS: were performed. While there was no significant difference at low spatial frequencies, the Lea CS test showed a ceiling effect in that range, while the FACT showed a floor effect at high spatial frequencies. CS in amblyopic children did not differ between the contralateral and the amblyopic eye. Overall, amblyopic eyes had lower CS values than the control eyes and CS did not correlate significantly to visual acuity at distance.All three CS tests could be usefully applied in the clinic in adults as well as children over the age of 4 years. Only the CSV 1000E exhibited neither a ceiling nor a floor effect. This was also the fastest test. In children with amblyopia, CS testing offers additional information on visual function. In contrast to previous reports, we did not find that the CSV and FACT are interchangeable.Obwohl Kontrastempfindlichkeit bei vielen Augenkrankheiten wie Amblyopie oder Glaukom vermindert ist, werden Kontrastempfindlichkeitstest nicht routinemäßig durchgeführt. Der Grund dafür liegt womöglich in der Zeitknappheit oder an mangelnder Ausrüstung.Kontrastempfindlichkeitsfunktionen wurden mit 3 verschiedenen Tests: FACT, CSV-1000E und Lea Symbolen monokular bei 19 gesunden Erwachsenen (24 – 78 J) und 15 gesunden und 9 amblyopen Kindern (5 – 16 J) gemessen und miteinander verglichen.Mit allen 3 Tests konnten Kontrastempfindlichkeitsfunktionen erhalten werden. Die Tests waren vergleichbar angenehm für Jung und Alt und dauerten alle weniger als 5 Minuten (1 Auge). Während alle Tests Kontrastempfindlichkeiten bei 3, 6, 12 und 8 Zyklen pro Grad messen, werden mit dem FACT auch Werte bei 1,5 Zyklen pro Grad gemessen. Lineare Mixed-Effect-Modelle wurden erstellt. In tiefen Ortsfrequenzen ergab sich keine signifikante Differenz. Lea zeigte einen Ceiling-Effekt in den tiefen und FACT ein Floor-Effekt in den hohen Ortsfrequenzen. Bei den amblyopen Kindern bestand kein signifikanter Unterschied zwischen dem amblyopen und dem Partnerauge. Insgesamt hatten die amblyopen Augen tiefere Kontrastempfindlichkeiten als die Kontrollen und korrelierten nicht signifikant mit dem Fernvisus.Alle Tests können sowohl bei Erwachsenen als auch bei Kindern über 4 Jahren sinnvoll in der Praxis eingesetzt werden. Für Kinder mit Amblyopie liefert die Kontrastempfindlichkeit zusätzliche Informationen über die visuelle Funktion. Im Gegensatz zur Literatur waren FACT und CSV nicht austauschbar. Der CSV ließ sich am schnellsten durchführen und zeigte als einziger Test weder einen Floor- noch einen Ceiling-Effekt.

Two case studies in the literature report on patients with infantile nystagmus (IN) who preferred to read text that is oriented vertically rather than horizontally. The current study systematically evaluated the effect of text orientation (−60 to +90 deg with respect to horizontal) on reading speed in nine individuals with IN associated with albinism at Hadassah Academic College (HAC), seven individuals with IN at the University of Houston (UH), and a total of 17 normal control observers. Observers at HAC read 40-character passages of Hebrew text from standardized 2nd grade level reading material and observers at UH read MNRead acuity chart sentences. Letter size was two to six lines larger than each observer’s measured visual acuity. In both individuals with IN and normal observers reading speed was fastest for horizontally oriented text and decreased for other orientations. However, reading speed decreased significantly more for non-horizontally orientated text in the observers with IN, compared to controls. In general, it is recommended that to achieve best reading performance patients with IN read horizontally oriented text.

PURPOSE: To evaluate the outcomes of primary topography-guided laser in situ keratomileusis (LASIK) in eyes with subjective refractive astigmatism of 2.00 diopters (D) or greater. METHODS: This was a prospective study in consecutive eyes with cylinder of 2.00 D or greater that had LASIK using the Alcon WaveLight EX500 excimer laser and T-CAT/Contoura software (Alcon Laboratories, Inc., Fort Worth, TX). The accuracy, efficacy, safety, cylinder vector analysis, higher order aberrations, and patients' subjective quality of vision were assessed. Eyes with naturally occurring topographic irregular astigmatism were not excluded. RESULTS: The mean cylinder was −2.55 D preoperatively and −0.34 D postoperatively; 81% and 95% of eyes were within ±0.50 and ±0.75 D of intended cylinder after LASIK, respectively. The correction index and index of success were 1.00 and 0.13, respectively. The efficacy and safety indexes were 0.98 and 1.04, respectively. The preoperative corneal topography irregularity index, anterior corneal higher order aberrations, and refractive astigmatism magnitude were mildly correlated to postoperative residual astigmatism. Mean ocular and corneal coma were not increased postoperatively. Patients had significant improvements after LASIK in both subjective uncorrected quality of vision and night vision disturbances compared to spectacle- and contact lens–corrected vision before LASIK. CONCLUSIONS: Topography-guided ablation using the Alcon WaveLight EX500 excimer laser and T-CAT/Contoura software results in excellent accuracy, efficacy, and safety, with improved postoperative subjective quality of vision and reduced night vision disturbances in virgin eyes with refractive astigmatism of 2.00 D or greater, including eyes with topographic naturally occurring irregular astigmatism. [ J Refract Surg. 2019;35(2):78–86.]

Reading is a foundation skill that plays a major role in a child's academic success. It is also an ability that unlocks the door of learning and success. At the same time, reading can be very challenging, especially when the materials are unfamiliar, technical, and complex. The researcher thought of a material that could alleviate reading difficulties particularly the reading rate of the learners. This material is called Color Overlays. It is a type of tinted filter and is a plastic reading sheet tinted with color and placed over text to eliminate a wide range of reading difficulties such as low reading rate, accuracy, and comprehension. This research investigated the effects of Irlen's Colored Overlays on reading rate as an intervention tool for the Grade Two Instructional Level of learners, with a class teacher initiating the study and a teacher-librarian conducting the assessment. All of the 52 learners were screened with a vision test. They were grouped into two wherein only the experimental group used the color overlays as their intervention. The result of the study implies that with or without the intervention, the reading rate of the learners is expected to increase. Therefore, color overlays made a difference in improving the reading rate of the learners.

Pediatric vision screening has been shown to reduce the prevalence of amblyopia. To assess the current local situation in the Canton of St. Gallen, a survey study was performed.A standardized questionnaire was sent to 191 general practitioners and school doctors to obtain information on the currently applied vision screening protocols for children. The questionnaire included 17 questions with multiple answers possible.Sixty-seven participants (35%) answered the survey. Overall, 61 (91%) of the repliers confirmed that some sort of vision screening exists. According to 45 (67%) repliers, a mandatory examination exists. As to the question about the person performing the examination, multiple answers were given; 39 (44%) answered that the secretary or the medical practical assistant performs the vision tests, 15 (17%) indicated the school doctor, and 25 (28%) indicated the general practitioner or the pediatrician. Most screening tests are performed in a general practitioner's practice (32; 40%), some are done in the kindergartens (17; 21%), and others are done in a pediatrician's practice (17; 21%). The majority of children are tested at the age of 5 - 6 years (58, 87%). Sixty-one (91%) of the repliers indicated that at least the children's visual acuity is measured. Acuity is assessed with different methods, mainly, with pictures (20; 30%), numbers (23; 34%), and Snellen optotypes (33; 49%).There are no consistent regulations regarding vision screening in the Canton of St. Gallen. Actually, rather different screening scenarios exist. Tests are performed by a variety of people in different locations with diverse testing procedures. A standardization of the applied screening procedures at cantonal and national levels seems reasonable.Sehscreening bei Kindern führt zu einer Reduktion der Amblyopieprävalenz. In der vorliegenden Studie wurden die lokalen Gegebenheiten mit einer Meinungsumfrage untersucht.Ein standardisierter Fragebogen mit 17 Fragen und möglichen Mehrfachantworten wurde an 191 Allgemeinmediziner und Schulärzte versandt, um die geübte Praxis des Sehscreenings bei Kindern zu erheben.Die Rücklaufquote betrug 35% (67 Teilnehmer). 61 befragte Personen (91%) bestätigten, dass ein Sehscreening durchgeführt wird. 45 der Befragten (67%) bestätigten verbindliche Richtlinien. Die Untersuchung wird von einem breiten Personenkreis durchgeführt: In 39 Fällen (44%) werden diese durch die Sekretärin oder durch medizinisches Assistenzpersonal ausgeführt, in 15 Fällen (17%) obliegt sie dem Schularzt und in 25 Fällen (28%) dem Hausarzt oder dem Pädiater. Die Untersuchung erfolgt zumeist in der Praxis des Hausarztes (32, 40%), aber auch im Kindergarten (17, 21%) und beim Kinderarzt (17, 21%). Die meisten Kinder werden im Alter von 5 – 6 Jahren getestet (58, 86%). Gemäß Umfrage wird in erster Linie der Visus erhoben (61, 91%). Die Visusprüfung erfolgt unterschiedlich; vor allem mit Snellen-Optotypen (33, 49%), Zahlen (23, 34%) und Kinderbildern (20, 30%).Einheitliche Richtlinien für das Sehscreening bei Kindern existieren im Kanton St. Gallen nicht. Das führt zu recht unterschiedlichen Szenarien bezüglich involvierter Personen, Untersuchungsorten und angewendeter Testverfahren. Die Untersuchung der Kinder erfolgt eher spät. Eine Vereinheitlichung der Screeningabläufe auf kantonaler und nationaler Ebene scheint sinnvoll.

Vision plays a key role in a child’s development. Early detection and treatment of vision abnormalities decreases future complications. Follow-up vision care is a common problem. Barriers to vision care include financial cost, lack of insurance knowledge to cover costs, and disbelief of vision results. The purpose of this evidence-based pilot project was to improve the rate of follow-up vision care obtained by school-aged children. The target population was school-aged children from kindergarten to fifth grade at an elementary school within Lake County, Ohio. The vision referral program included phone calls to families to identify and overcome barriers to obtaining vision care. Barriers identified with the target population include disbelief of vision results, lack of knowledge about vision health, and financial cost. Results indicated an increase of vision care rates during the 2017–2018 academic year by 60% above baseline rates from the previous academic year.