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SIGNIFICANCE Paralympic judo currently requires all athletes to compete against each other in one class irrespective of their level of vision impairment (VI). Recent evidence suggests that multiple classes are required to enhance fairness, yet it remains unclear how many classes are necessary and what vision tests should be used to define those classes. PURPOSE The aim of this study was to quantify the relationship between vision and performance in judo for individuals with VI. The results were expected to inform the development of evidence-based criteria to structure Paralympic judo competition. METHODS The visual function of 53 elite VI judokas was assessed using a test battery that included tests of visual acuity (VA), contrast sensitivity, light sensitivity, depth perception, motion perception, visual search, and central visual field. Performance was assessed by measuring the ratio of fights won across all competitions the participants took part in in the 2 years before and after vision testing. Pearson correlation coefficients and decision tree analyses were used to determine the relationship between vision and performance. Partial correlations were also conducted to determine the unique ability of each measure of visual function to predict judo performance. RESULTS Visual acuity was the best predictor of judo performance and remained the only visual function related to performance when controlling for correlations between VA and other visual functions. Decision tree analyses suggested to split athletes into two groups for more legitimate competition, using a cutoff point around 2.6 logMAR. Within each of the two resulting subgroups, no correlations remained between any of the visual functions and performance. CONCLUSIONS The results of this study suggest that VI judo competition should be split into separate categories for partially sighted and functionally blind athletes. The inclusion of visual functions in addition to VA does not improve the ability to predict performance in VI judo.

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).

BackgroundDriving is a visually intensive task. In Cameroon, where the burden of road traffic deaths is high, visual assessment is not universally performed before the issuance of driver licenses. This study aims to assess the visual status of commercial drivers (CDs) in the southwestern region of Cameroon, and to find its relation to road traffic crashes (RTCs).MethodsThis work was a cross-sectional community-based study on CDs in Limbe and Buea. Questionnaires were used to assess sociodemographic parameters, the incidence of RTCs, and self-reported visual status. Visual acuity (VA) was measured using a standard Snellen chart at 6 m. Statistical analysis was performed using descriptive methods: frequencies, the paired Student’s t-test, and the chi-square test.ResultsTwo hundred seven CDs were enrolled in this study, all of which were male, with a mean age of 41.8 ± 12.1 years. A total of 15.0% had undergone an eye exam prior to licensure, and 3.4% had undergone an eye exam within the past 10 years. The VA in the better-seeing eye of participants was less than 6/9 and 6/12 in 14.1 and 10.6% of CDs, respectively. Seventy-five percent of CDs with self-reported poor vision and 95% of CDs with VA p p ConclusionsA large proportion of CDs did not undergo a visual assessment before the issuance or renewal of their driver licenses. A substantial number of CDs had poor vision in their better-seeing eye and suffered from RTCs and related injuries, which suggests that the visual status of CDs in Cameroon is related to the gruesome number of road traffic crashes and deaths in the country. Therefore, concerned authorities should consider making vision tests a necessary requirement for the obtention of driver licenses.

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.

SIGNIFICANCE:\ud \ud The Delphi analysis presented here highlights the need for a sport-specific evidence-based classification system for track athletics for athletes with a vision impairment (VI). This system may differ for different race distances. Further research is required to develop a useful test battery of vision tests for classification. The issue of intentional misrepresentation during classification needs particular attention.\ud \ud PURPOSE:\ud \ud At present, athletes with VI are placed into competition classes developed on the basis of legal definitions of VI. The International Paralympic Committee Athlete Classification Code states that all sports should have their own classification system designed to reflect the (visual) demands of that individual sport. This project gathered expert opinion on the specific requirements for an evidence-based sport-specific classification system for VI track athletics and to identify any particular issues within track athletics that require further research into their impact on sport performance.\ud \ud METHODS:\ud \ud A three-round Delphi review was conducted with a panel of 17 people with expertise in VI track athletics.\ud \ud RESULTS:\ud \ud The panel agreed that the current classification system in VI track athletics does not completely minimize the impact of impairment on competition outcome, highlighting the need for improvements. There was clear agreement that the existing measures of vision may fail to adequately reflect the type of vision loss that would impact running performance, with additional measures required. Intentional misrepresentation, where athletes “cheat” on classification tests, remains a serious concern.\ud \ud CONCLUSIONS:\ud \ud The panel has identified measures of vision and performance that will inform the development of an evidence-based classification system by better understanding the relationship between VI and performance in track athletics. Issues such as the use of guides and whether the current class system was equitable gave rise to differing opinions within the panel, with these varying across the different running distances.

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 evaluated surgical outcomes of bilateral rectus (BLR) recession in patients with intermittent exotropia who underwent diagnostic monocular occlusion. Records of patients with intermittent exotropia who were preoperatively examined one-hour monocular occlusion and underwent BLR recession were reviewed retrospectively. Patients were classified into two groups based on change in exodeviation angle: responders (≥5 change in prism diopters [PD] after occlusion) or non-responders (

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.

Background This study aimed to compare long-term postoperative quality of life and satisfaction differences between SMILE and FS-LASIK for myopia correction. Methods This cross-sectional study enrolled patients under the age of 39 years, who chose to undergo SMILE or FS-LASIK surgery to both eyes 3 years previously. Patients completed a common vision test and Quality of Life Impact of Refractive Correction (QIRC) questionnaire, together with the surgical satisfaction, adverse symptoms subjective survey. Patients with preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity of 20/20 or greater were included. Propensity score matching (PSM) was used to match the preoperative and postoperative spherical equivalent, age, and designed optical zones of the left and right eyes between the two groups. Results Forty-nine patients were included in each group after PSM from 188 patients. No significant difference in the total QIRC score was found between the SMILE and FS-LASIK groups (45.89 ± 5.91 vs 45.09 ± 5.65, p = 0.492). There were no differences in surgical satisfaction between the groups (p = 0.178). Compared to the SMILE group, the FS-LASIK group had more glare (2.12 ± 2.25 vs 3.22 ± 2.54, p = 0.026) and severe dryness (1.80 ± 1.98 vs 2.79 ± 2.19, p = 0.021). Conclusion Postoperative quality of life is similar after SMILE or FS-LASIK. Dry eye symptoms and glare were milder in the SMILE group than in the FS-LASIK group.

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: 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 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.

ObjectiveZika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.DesignCohort study.SettingPublic health centres in Grenada, West Indies.Patients384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measuresThe INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.ResultsA total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.ConclusionsOverall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.

Purpose: To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. Methods: These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Results: Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant’s visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Conclusions: Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children’s development, school, and social performance and cause unnecessary permanent vision loss. RESUMO Objetivo: Fornecer orientações sobre a frequência e os componentes dos exames oftalmológicos para crianças saudáveis de 0 a 5 anos. Métodos: Essas diretrizes foram desenvolvidas com base em revisão bibliográfica e experiência clínica de um comitê de especialistas. Foram realizadas buscas PubMed/Medline; documentos selecionados não se restringiram a revisões sistemáticas, ensaios clínicos randomizados e estudos observacionais. Quando adequado, o perfil GRADE foi aplicado para graduá-los e o consenso de especialistas foi usado nos tópicos sem evidência científica. Também foram revisadas as recomendações pela Academia Americana de Pediatria, Associação Americana de Oftalmologia Pediátrica e Estrabismo, Academia Americana de Oftalmologia, Royal College of Ophthalmologist e Sociedade Canadense de Oftalmologia. O documento final foi aprovado pela Sociedade Brasileira de Oftalmologia Pediátrica e Sociedade Brasileira de Pediatria. Resultados: Os recém-nascidos devem ser submetidos ao teste do reflexo vermelho e inspeção dos olhos e anexos pelo pediatra dentro de 72 horas de vida ou antes da alta da maternidade. O teste do reflexo vermelho deve ser repetido pelo pediatra durante as consultas de puericultura pelo menos três vezes ao ano durante os primeiros 3 anos de vida. Se factível, um exame oftalmológico completo pode ser feito entre 6 a 12 meses de vida. Até os 36 meses de idade, os marcos visuais, função visual apropriada para a idade, fixação e alinhamento ocular também devem ser avaliados pelo pediatra ou médico da família. Pelo menos um exame oftalmológico completo deve ser realizados entre 3 e 5 anos de idade. O exame deve conter pelo menos inspeção dos olhos e anexos, avaliação da função visual apropriada para a idade, avaliação da motilidade e alinhamento ocular (testes de cobertura), refração sob cicloplegia e avaliação do fundo de olho dilatado. Conclusões: As diretrizes sobre a frequência da avaliação oftalmológica são ferramentas importantes para orientar os médicos sobre a melhor prática a fim de evitar problemas visuais tratáveis na infância, que poderiam comprometer seu desenvolvimento social, escolar e global, além de causar perda permanente da visão.

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.

Purpose To explore whether subtle changes in visual quality can be detected using different measures of visual function against the quick contrast sensitivity function test (quick CSF). Methods Sixty participants, aged 17 to 34 years, were enrolled. Participants' vision was degraded by 0.25 D undercorrection (0.25 D), 60% neutral density filter brightness reduction (60% ND), and 0.8 Bangerter foil optical diffusion (0.8BAN). Visual function tests including visual acuity and contrast sensitivity (CSV-1000E and quick CSF) were measured with participant's best-corrected vision and under simulated visual degradation conditions. Test sensitivities in detecting differences were compared. Results Statistically significant visual acuity degradation was observed in the 0.8BAN condition only (Pcorrected < 0.001). With CSV-1000E and outliers removed, significant CS degradation was observed in all spatial frequencies, area under log CSF (AULCSF) in the 0.8BAN condition (Pcorrected < 0.001 for all), medium and high spatial frequencies and AULCSF in the 60%ND condition (Pcorrected,6cpd = 0.002, Pcorrected,12cpd = 0.005, Pcorrected,18cpd = 0.001, Pcorrected,AULCSF < 0.001) and the 0.25 D condition (Pcorrected,6cpd = 0.011, Pcorrected,12cpd = 0.013, Pcorrected,18cpd = 0.015, Pcorrected,AULCSF < 0.001). With the quick CSF, significant CS degradation was observed in all simulated visual conditions in all spatial frequencies, cutoff frequency and AULCSF (Pcorrected < 0.001 for all). Test-retest reliability of the quick CSF method was high; coefficient of repeatability ranged from 0.14 to 0.18 logCS. Conclusions Compared with visual acuity and chart-based CS tests, the quick CSF method provided more reliable and sensitive measures to detect small visual changes. Translational Relevance The quick CSF method can provide sensitive and reliable measures to monitor disease progression and assess treatment outcomes.

This report evaluates the role of the combined visual abilities of acuity, contrast sensitivity and presentation time on plate discipline and baseball batting performance. A visual function test (EVTS) was performed on 585 professional baseball players. The results were compared to several common plate-discipline measures. The EVTS test provides a single measure combining target size, contrast and presentation time. Correlations (statistically significant) were found between this measure and several plate discipline metrics (InzoneSwingPct, inzoneFbSwingPct, ChasePct, FbChasePct, BBperPa). Years of major league service did not appear to be related to visual ability. When comparing the best and worst 20% groups based on visual ability, statistically significant improvements ranging from 11.6% in BBperPa to 3.5% in inzoneSwingPct were noted in the better visual function group. Effect sizes ranged from 0.278 to 0.387. These results demonstrate the relationship between basic visual function and batting performance. These are the first results, on a large group at the professional level, to demonstrate this relationship statistically. These results may aid player selection, indicating that batters with better visual function are more likely to be successful when batting and more productive for their team.

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.]

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.

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.]

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.

To identify risk factors for axial length (AL) elongation and incident school myopia.Population-based prospective birth-cohort study.Four thousand seven hundred thirty-four children examined at 6 and 9 years of age from the Generation R Study in Rotterdam, The Netherlands.Axial length and corneal radius (CR) were measured with an IOLMaster 500 and daily life activities and demographic characteristics were obtained by questionnaire. Three thousand three hundred sixty-two children (71%) were eligible for cycloplegic refractive error measurements. Linear regression models on AL elongation were used to create a risk score based on the regression coefficients resulting from environmental and ocular factors. The predictive value of the prediction score for myopia (≤-0.5 diopter) was estimated using receiver operating characteristic curves. To test if regression coefficients differed for baseline AL-to-CR ratio, interaction terms were calculated with baseline AL-to-CR ratio and environmental factors.Axial length elongation and incident myopia.From 6 to 9 years of age, average AL elongation was 0.21±0.009 mm/year and myopia developed in 223 of 2136 children (10.4%), leading to a myopia prevalence at 9 years of age of 12.0%. Seven parameters were associated independently (P0.05) with faster AL elongation: parental myopia, 1 or more books read per week, time spent reading, no participation in sports, non-European ethnicity, less time spent outdoors, and baseline AL-to-CR ratio. The discriminative accuracy for incident myopia based on these risk factors was 0.78. Axial length-to-CR ratio at baseline showed statistically significant interaction with number of books read per week (P0.01) and parental myopia (P0.01). Almost all predictors showed the highest association with AL elongation in the highest quartile of AL-to-CR ratio; incidental myopia in this group was 24% (124/513).Determination of a risk score can help to identify school children at high risk of myopia. Our results suggest that behavioral changes can offer protection particularly in these children.

Purpose To examine the feasibility of saccadic vector optokinetic perimetry (SVOP), an automated eye tracking perimeter, as a tool for visual field (VF) assessment in infants. Methods Thirteen healthy infants aged between 3.5 and 12.0 months were tested binocularly using an adapted SVOP protocol. SVOP uses eye tracking technology to measure gaze responses to stimuli presented on a computer screen. Modifications of SVOP for testing infants included adjusting the fixation target to display a short animation, increasing the stimulus size to equivalent to Goldmann V, and introducing a tiered test pattern strategy. Binocular, single-quadrant confrontation VF testing and Keeler preferential looking cards visual acuity testing was also performed. Results Using multiple test attempts when required, all but the youngest infant (12 of 13 [92.3%]) successfully completed a 4-point screening test. Seven infants (53.8%) successfully completed the 12-point test, four (30.8%) successfully completed the 20-point test, and three (23.1%) successfully completed the 40-point test. The effect of multiple test attempts and the complexity of the test pattern (number of test points) on performance was investigated, including test completion rate, percentage of correctly seen stimuli, and average time per tested stimulus. Conclusions The modified SVOP test strategy allowed successful assessment of binocular VFs in healthy infants. Future data collection from larger cohorts of infants is needed to derive normative limits of detection and assess accuracy in detecting and monitoring infant VF abnormalities. Translational relevance Eye tracking perimetry may provide a useful method of automated VF assessment in infants.

The SpeedWheel (SW) test is an objective test of visual acuity (VA) using suppression of the optokinetic nystagmus (OKN). Here, we established prediction intervals of the SW measures compared to Snellen acuity in adults and children.In this prospective, single center study, subjects aged at least 4 years underwent testing of VA with SW, Landolt-C, and Tumbling-E symbols (Freiburg acuity test: FrACT-C, FrACT-E). Prediction intervals were established for SW compared to FrACT-C or -E and for FrACT-E compared to FrACT-C. Mixed linear effect models were applied for statistical analysis.From 241 subjects, 471 eyes were included: median age 36 years, range 4 - 88 years, 43.6% male, 56.4% female. Eyes included were either healthy or had various underlying ophthalmic conditions. Prediction intervals for SW to estimate FrACT-C or -E acuity showed a similar range compared to the prediction interval of FrACT-C for the estimation of FrACT-E acuity. For each acuity step, there was no influence of age. Up to an SW acuity of 0.7 logMAR, 80% of the subjects had a FrACT-C acuity that was at most 1.6 logMAR lines below, and for an SW acuity of 1.0 logMAR, FrACT-C acuity was not worse than 4 logMAR lines. Prediction intervals for eyes with refractive error, cataract, visual field loss and retinal disease did not differ significantly from healthy eyes in contrast to eyes with amblyopia or multiple ophthalmic disorders. SW correlated well to FrACT tests and results of a previous study fell within our prediction estimates.Our prediction intervals for SW acuity may be used to estimate Snellen acuity (FrACT-C and -E) in the clinic in adults and children unable to cooperate in other acuity testing.Der SpeedWheel-Test (SW-Test) ästimiert die Sehschärfe mittels Suppression des optokinetischen Nystagmus (OKN). Wir erhoben Vorhersageintervalle für SW verglichen mit dem Snellen-Visus für Erwachsene und Kinder.In dieser prospektiven Studie wurde die Sehschärfe bei Probanden ab 4 Jahren mittels SW, FrACT-C, FrACT-E (Freiburg Acuity Test) erhoben. Vorhersageintervalle für den SW-Visus wurden im Vergleich zu FrACT-C und FrACT-E und für FrACT-E im Vergleich zu FrACT-C erstellt. In der statistischen Analyse kamen lineare gemischte Modelle zur Anwendung.471 Augen von 241 Probanden wurden eingeschlossen: Altersmedian 36 Jahre (4 – 88 Jahre), 43,6% männlich, 56,4% weiblich. Die Probandengruppe beinhaltete neben gesunden Augen auch solche mit vorbestehenden ophthalmologischen Erkrankungen. Die Vorhersageintervalle des SW im Vergleich zu den FrACT-Tests war vergleichbar mit dem Vorhersageintervall des FrACT-E-Tests bezogen auf den FrACT-C-Test. Für die verschiedenen Visusstufen ließ sich kein signifikanter Einfluss des Alters nachweisen. Für einen SW-Visus bis 0,7 logMAR war der FrACT-C-Visus bei 80% nicht schlechter als 1,6 logMAR-Zeilen und bei einem SW-Visus von 1,0 logMAR nicht schlechter als 4 logMAR-Zeilen. Augen mit refraktiven Fehlern, Katarakt, Gesichtsfeldeinschränkungen oder retinalen Krankheiten zeigten, im Unterschied zu Amblyopen oder Augen mit mehreren Augenkrankheiten, keinen signifikanten Unterschied zu Gesunden. SW korrelierte gut mit den FrACT-Tests. Daten einer Vorgängerstudie lagen innerhalb unserer Vorhersageintervalle.Unsere Vorhersageintervalle für SW können bei Erwachsenen und bei Kindern mit unzureichender Kooperation für einen subjektiven Sehtest helfen, um die Snellen-Sehschärfe (FrACT-C bzw. FrACT-E) zu ästimieren.

Patients with mild traumatic brain injuries (mTBI) often report difficulties in motor coordination and visuo-spatial attention. However, the consequences of mTBI on fine motor and visuo-motor coordination are still not well understood. We aimed to evaluate whether mTBI had a concomitant effect on fine motor ability and visuo-motor integration and whether this is related to visual perception and visuo-spatial attention impairments, including patients at different symptoms stage. Eleven mTBI patients (mean age 22.8 years) and ten healthy controls participated in the study. Visuo-motor integration of fine motor abilities and form recognition were measured with the Beery-Buktenica Developmental Test of Visual-Motor Integration test, motion perception was evaluated with motion coherence test, critical flicker fusion was measured with Pocket CFF tester. Visuo-spatial was assessed with the Ruff 2 & 7 Selection Attention Test. mTBI patients showed reduced visuo-motor integration, form recognition, and motor deficits as well as visuo-spatial attention impairment, while motion perception and critical flicker fusion were not impaired. These preliminary findings suggest that the temporary brain insults deriving from mTBI compromise fine motor skills, visuomotor integration, form recognition, and visuo-spatial attention. The impairment in visuo-motor coordination was associated with speed in visuo-attention and correlated with symptoms severity while motor ability was correlated with time since concussion. Given the strong correlation between visuomotor coordination and symptom severity, further investigation with a larger sample seems warranted. Since there appeared to be differences in motor skills with respect to symptom stage, further research is needed to investigate symptom profiles associated with visuomotor coordination and fine motor deficits in mTBI patients.

Clinical relevance: Ocular biometry is key to understanding the determinants of ocular development and pathology changes, especially for the thriving myopic population in Asia. Investigating biometric data in highly myopic eyes within a wide age spectrum is therefore of high importance.Background: To report the magnitude of change in spherical equivalent for each unit of change in the ocular biometry parameters in a highly myopic population in China.Methods: Highly myopic patients aged 7 to 70 years were recruited from the Zhongshan Ophthalmic Center, China. Each patient had a cycloplegic refraction and a measurement of ocular biometry.Results: Data from 823 right eyes were available for analysis, with a mean age of 22.7 years and a median spherical equivalent of -8.88 D. Axial length and lens thickness increased with age, while anterior chamber depth (ACD) decreased in older subjects. There was a significant trend of increasing axial length, lens thickness, vitreous chamber depth (VCD) and decreasing ACD and calculated lens power over spherical equivalent quartiles (all p

Introduction: The aging population has been rapidly growing in the United States (U.S.). In line with this trend, older adults’ mobility and transportation safety are an increasing priority. Many states have implemented driver licensure laws specific to older adults to limit driving among the elderly with driving skill decline. Evaluations of these laws have primarily focused on their safety benefits related to older drivers’ fatal crash rate or injury rate. However, very few studies investigated licensure law effects on older adults’ mobility. Objective: The objective of our study is to evaluate the association between older driver licensure laws and older adult daily traveling and passenger exposure. Methods: The 2003–2017 American Time Use Survey (ATUS) data were linked with statewide driver licensure law provisions. Adults aged 55–64 years were used as the reference group to control for the effects of non-licensure-law factors (e.g., economic trend). We used modified Poisson regressions with robust variance to estimate the relationships between licensure law provisions and the likelihoods of older men and women’s daily traveling and passenger behaviors. Results: Laws requiring a vision test at in-person renewal were associated with increased daily traveling likelihood for women aged 75 years or older, primarily as a passenger. Laws requiring a knowledge test were related to a reduced daily overall traveling likelihood for women aged 75 years or older. Conclusions: In general, licensure law provisions are not strongly related to older adults’ mobility, in particular for older male adults. Older female adults’ daily mobility may be more likely to be influenced by the change of licensure laws than older male adults. The existence of gender-based disparities in responding to licensure laws requires future studies to account for the gender difference in estimating the effects of those traffic policies on older adults’ mobility and traffic safety.

IMPORTANCE: Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. OBJECTIVES: To evaluate the repeatability of visual acuity measured using the Home Acuity Test (HAT) and the agreement between the HAT and the last in-clinic visual acuity. DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study was conducted from May 11 to 22, 2020, among 50 control participants and 100 adult ophthalmology outpatients who reported subjectively stable vision and were attending routine telemedicine clinics. Bland-Altman analysis of corrected visual acuity measured with the HAT was compared with the last measured in-clinic visual acuity on a conventional Early Treatment Diabetic Retinopathy Study logMAR chart. MAIN OUTCOMES AND MEASURES: For control participants, repeatability of the HAT and agreement with standard logMAR visual acuity measurement. For ophthalmology outpatients, agreement with the last recorded in-clinic visual acuity and with the International Classification of Diseases and Related Health Problems, 11th Revision visual impairment category. RESULTS: A total of 50 control participants (33 [66%] women; mean [SD] age, 36.0 [10.8] years) and 100 ophthalmology patients with a wide range of diseases (65 [65%] women; mean [SD] age, 55.3 [22.2] years) were recruited. For control participants, mean (SD) test-retest difference in the HAT line score was −0.012 (0.06) logMAR, with limits of agreement (LOA) between −0.13 and 0.10 logMAR. The mean (SD) difference in visual acuity compared with conventional vision charts was −0.14 (0.14) logMAR (range, −0.4 to 0.18 log MAR) (−7 letters) in controls, with LOA of −0.41 to 0.12 logMAR (−20 to 6 letters). For ophthalmology outpatients, the mean (SD) difference in visual acuity was −0.10 (0.17) logMAR (range, −0.5 to 0.3 logMAR) (1 line on a conventional logMAR sight chart), with the HAT indicating poorer visual acuity than the previous in-clinic test, and LOA of −0.44 to 0.23 logMAR (−22 to 12 letters). There was good agreement in the visual impairment category for ophthalmology outpatients (Cohen κ = 0.77 [95% CI, 0.74-0.81]) and control participants (Cohen κ = 0.88 [95% CI, 0.88-0.88]). CONCLUSIONS AND RELEVANCE: This study suggests that the HAT can be used to measure visual acuity by telephone for a wide range of ophthalmology outpatients with diverse conditions. Test-retest repeatability is relatively high, and agreement in the visual impairment category is good for this sample, supporting the use of printed charts in this context.

Significance This study presents the relationship between distance visual acuity and a range of uncorrected refractive errors, a complex association that is fundamental to clinical eye care and the identification of children needing refractive correction. Purpose This study aimed to analyze data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study to describe the relationship between distance uncorrected refractive error and visual acuity in children. Methods Subjects were 2212 children (51.2% female) 6 to 14 years of age (mean ± standard deviation, 10.2 ± 2.1 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study between 2000 and 2010. Uncorrected distance visual acuity was measured using a high-contrast projected logMAR chart. Cycloplegic refractive error was measured using the Grand Seiko WR-5100K autorefractor. The ability of logMAR acuity to detect various categories of refractive error was examined using receiver operating characteristic curves. Results Isoacuity curves show that increasing myopic spherical refractive errors, increasing astigmatic refractive errors, or a combination of both reduces distance visual acuity. Visual acuity was reduced by approximately 0.5 minutes of MAR per 0.30 to 0.40 D of spherical refractive error and by approximately 0.5 minutes of MAR per 0.60 to 0.90 D of astigmatism. Higher uncorrected hyperopic refractive error had little effect on distance visual acuity. Receiver operating characteristic curve analysis suggests that a logMAR distance acuity of 0.20 to 0.32 provides the best balance between sensitivity and specificity for detecting refractive errors other than hyperopia. Distance acuity alone was ineffective for detecting hyperopic refractive errors. Conclusions Higher myopic and/or astigmatic refractive errors were associated with predictable reductions in uncorrected distance visual acuity. The reduction in acuity per diopter of cylindrical error was about half that for spherical myopic error. Although distance acuity may be a useful adjunct to the detection of myopic spherocylindrical refractive errors, accommodation presumably prevents acuity from assisting in the detection of hyperopia. Alternate procedures need to be used to detect hyperopia.

Significance In intermediate AMD, a simple, clinically feasible vision test of sensitivity to radial deformation is significantly more impaired in eyes with hyperpigmentation than in eyes with large drusen but normal retinal pigmentation, consistent with the former's increased risk of progression to advanced AMD. This ongoing longitudinal study will determine whether this vision measure is predictive of progression to advanced AMD. Purpose This study aimed to determine whether simple, clinically feasible psychophysical measures distinguish between two levels of intermediate AMD that differ in their risk of progression to advanced AMD: eyes with large macular drusen and retinal pigment abnormalities versus eyes with large macular drusen without pigment abnormalities. Abnormal pigmentation in the presence of large drusen is associated with a higher risk of development of advanced AMD. Methods Each eye of 39 individuals with the same form of intermediate AMD in both eyes was tested monocularly on a battery of vision tests. The measures (photopic optotype contrast sensitivity, discrimination of desaturated colors, and sensitivity to radial deformation [shape discrimination hyperacuity]) were compared for both dominant and nondominant eyes. ANOVA with eye (dominant or nondominant) as a within-subject factor and retinal status (pigmentary abnormalities present or absent from the macula) as a between-subject factor was used to determine statistical significance. Results Sensitivity to radial deformation was significantly reduced in eyes with large drusen and pigment changes compared with eyes with large drusen and normal retinal pigmentation (-0.40 ± 0.04 vs. -0.61 ± 0.02, respectively; F = 13.31, P = .001). Conclusions In the presence of large macular drusen, performance on a shape discrimination task is related to the presence versus absence of abnormal retinal pigmentation, being poorer in the higher-risk group, supportive of the measure's potential to predict progression to advanced AMD.

Introduction Vision problems affect academic performance, social and mental health. Most traditional vision screening methods rely on human expert assessments based on a set of vision tests. As technology advances, new instruments and computerised tools are available for complementing vision screening. The scoping review based on this protocol aims to investigate current technologies for vision screening, what vision tests can be complemented by technologies, and how these can support vision screening by providing measurements. Methods and analysis The planned review will utilise the PRISMA extension for Scoping Reviews (PRISMA-ScR) tool. Electronic search will be performed in databases, including Web of Science, MEDLINE (Ovid), Scopus, Engineering Village, Cochrane and Embase. We will perform a systematic search in selected reference databases without the limitation on publications dates, or country of studies. Reference management software, like EndNote and DistillerSR, will be used to remove duplicate entries. Two authors will independently analyse the studies for inclusion eligibility. Conflicts will be resolved by discussion. We will extract the types of technologies, types of vision tests they complement and the measurements for the included studies. Overall findings will be synthesised by thematic analysis and mapping to the logic model. Ethics and dissemination Ethical approval is not required for this review, as it will only summarise existing published data. We will publish the findings in an open access, peer-reviewed journal. We expect that the review results will be useful for vision screening experts, developers, researchers, and policymakers.