Search

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

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

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.

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.

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

Background and Objectives: (1) To assess the quality of life (QoL) in patients with glaucoma by (a) clinical assessment, (b) subjective (Visual Functioning Questionnaire-25 [VFQ-25]), and (c) objective (Assessment of Disability Related to Vision [ADREV]) tests and (2) to find out the relationship between glaucoma stages and QoL. Materials and Methods: This cross-sectional study includes 100 patients attending the glaucoma clinic of a tertiary institution in Kerala. Best-corrected visual acuity, baseline intraocular pressure, slit-lamp and fundus examination, gonioscopy, and visual field examination were carried out. Patients were categorized as early, moderate, and advanced on the basis of disc damage likelihood scale (DDLS) and modified Hodapp–Parrish–Anderson criteria. QoL was assessed subjectively using VFQ-25 and objectively by ADREV test by assessing the ability to perform activities of daily living. Contrast sensitivity and stereopsis were the other parameters assessed. Results: Of the 100 patients, 50 (50%) were POAG, 46 (46%) were PACG, and 4 were secondary glaucoma. Based on the DDLS and Anderson criteria, there were 33 early, 34 moderate, and 33 advanced glaucoma cases. The mean ADREV/VFQ scores were as follows: early, 56.9/81.1; moderate, 54.9/75; and advanced, 45.8/52.6. In ADREV tasks, the lowest mean score was for motion detection (5.1) and maximum score was for ambulation (6.1) in the study population. Patients with advanced glaucoma have difficulty in detecting motion (4.1), recognizing street signs (4.3), and color matching (4.8). Stereopsis was seen in 60% of patients with early, 29% of moderate, and 6% of advanced glaucoma. Contrast sensitivity was also reduced with glaucoma progression. Conclusion: ADREV (objective) scores correlate significantly with VFQ (subjective) scores in all the three categories of glaucoma. ADREV (objective test) scores correlate better with the severity and stages of glaucoma and degree of impairment patients experience than VFQ-25 (subjective test). With respect to QoL, patients with glaucoma faced difficulty in performing fine tasks. However, even advanced glaucoma cases were able to carry out their daily activities without much help. Stereopsis and contrast sensitivity were the most affected with advancement of disease.

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

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

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

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

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

We 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.

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.

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.

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

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.

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

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.]

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

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

PURPOSE: To 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.

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.

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

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 Femtosecond-assisted thin flap, laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) are the two most common refractive surgical procedures used to enhance visual capability in the U.S military. The purposes of the study were to examine effects on quality of vision following LASIK and PRK-MMC using a novel computer-based quick contrast sensitivity function (qCSF) test. Materials and Methods This prospective clinical study included 58 active duty U.S. military service members who elected LASIK (n = 29) or PRK-MMC (n = 29) refractive surgery for myopia (nearsightedness) treatment. Monocular photopic and mesopic quality of vision of the right eyes in spectacle correction preoperatively and unaided right eyes at four postoperative follow-up visits (1 week, 2 weeks, 1 month, and 3 months) were examined using the qCSF device. Two qCSF parameters, area under a log CSF (AULCSF) between 1.5 and 18 cycles per degree, and CSF cutoff acuity (CSF Acuity), were collected using a 50-trial setting at a 4-m testing distance. General linear model (GLM) Repeated-measures Analysis of Covariance was used to examine effects on quality of vision following LASIK and PRK-MMC. Post hoc testing with Bonferroni correction was used for pairwise comparisons, and preoperative cylinder refraction was used as a covariate. Two-tailed independent t-test was used to compare preoperative and postoperative parameters between LASIK and PRK-MMC. Pearson’s correlation, Bland–Altman plots, and multiple linear regression were used to examine the relationship among the qCSF and other vision tests. Results Quality of vision, AULCSF, and CSF Acuity returned to the preoperative baseline at postoperative 2 weeks under mesopic condition and at postoperative 1 month under photopic condition after PRK-MMC. In comparison, photopic and mesopic quality of vision were not significantly different from the baseline at any of the four postoperative visits following LASIK. Changes of CSF Acuity from the baseline after LASIK were significantly better under photopic than mesopic condition by 0.067 ± 0.014 logarithm of the minimum angle of resolution (logMAR); P Conclusion Quality of vision recovers at postoperative 1 week after LASIK and at postoperative 1 month after PRK-MMC. The standard black-on-white high-contrast, chart-based visual acuity test is weak in predicting quality of vision. The qCSF detects mild-to-moderate visual changes and is suitable for quality of vision assessment following refractive eye surgery.

This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator.Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders.The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47-0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35-0.78, p 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48-0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.

Introduction: We investigated the frequency of granulomatous lung diseases (GLD) in patients with granulomatosis ocular pathologies who referred to our clinic for differential diagnosis. Methods: Diagnosis of sarcoidosis or definitive tuberculosis was made with microbiological and/or histopathological findings. Patients who did not respond to immunosuppressive treatments, and had latent tuberculosis infection proven with PPD and/or Quantiferon-TB test were considered as possible ocular tuberculosis and antituberculosis treatments were given to these patients. Treatment response was evaluated with vision tests and clinical response. Results: Totally 200 patients (58% female, 42% male, age:46±3.9years) included. Ocular pathologies were uveitis in 65.6%, choroiditis in 20%, vascular pathologies in 6.5% and others 8%. Immunosuppressive treatment were given to 132 (66%) cases; 56 (41%) of them received steroid treatment. PPD performed in 173 patients (PPD:16.6±7mm) and PPD was ≥15mm in 125 of them. Quantiferon-TB test was positive in 85.5% of 166 cases. Sarcoidosis was diagnosed histopathologically in 7.5% (n=15/200), tuberculosis was diagnosed microbiologically or pathologically in 2% (n=4/200). Eighty-nine cases were considered as possible tuberculosis with clinical-radiological findings and the presence of latent tuberculosis. Antituberculosis treatment was given to these patients and 50 of them (56%) responded well. Conclusion: Only 9.5% of cases with ocular granulomatosis disease diagnosed definitively tuberculosis or sarcoidosis. In cases who do not respond to immunosuppressive treatments and have latent tuberculosis infection; initiating anti-tuberculosis treatment can provide good results.

Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care. Lay Abstract Children with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child’s vision was tested with pictures, shapes, or letters in the past 2 years; (2) child’s vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care.

IMPORTANCE: There is substantial socioeconomic and individual burden from uncorrected refractive error (URE) and chronic ocular disease. Understanding the association of visual acuity (VA) reduction with URE and the adults most likely to benefit from refraction may help support clinical decision-making in ophthalmologic care and maximize patient outcomes. OBJECTIVES: To assess the magnitude of VA improvement associated with URE among adults under ophthalmic care who obtain low vision rehabilitation (LVR) services and identify the characteristics of the patients who are most likely to experience improvement. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series assessed patients 20 years or older who were new to the LVR clinics from August 1, 2013, to December 31, 2015, and who had habitual VA between 20/40 and counting fingers (not including) and underwent refraction. Data analysis was performed from April 4, 2018, to December 20, 2019. EXPOSURES: Patient demographics and clinical data, including habitual and refraction VA, refraction, and disease diagnosis. Habitual VA was categorized as mild (VA worse than 20/40 and at least 20/60), moderate (VA worse than 20/60 and better than 20/200), severe (VA 20/200 or worse and better than 20/500), and profound (VA 20/500 or worse) vision impairment (VI). MAIN OUTCOMES AND MEASURES: At least 2-line VA improvement and any VA improvement (≥1-line) by refraction. RESULTS: Among the 2923 patients new to LVR clinics, 1773 (mean [SD] age, 70 [18.2] years; 1069 [60.3%] female) were included in these analyses. The mean habitual VA was 20/100 (mean [SD], 0.67 [0.36] logMAR). At least 2-line improvement was observed in 493 patients (27.8%), and any VA improvement was seen in 1023 patients (57.7%). At least 2-line improvement was observed in 54 patients (34.8%) with corneal disorders and was more likely seen among patients aged 40 to

SIGNIFICANCE Laser refractive surgery procedures are efficacious at correcting myopia, but they result in long-term deterioration of optical quality that affects monocular and binocular visual performance. The study shows that the optical quality of the two eyes needs to be similar to optimize binocular visual performance after surgery. PURPOSE This study aimed to systematically analyze longitudinal changes in optical quality, high- and low-contrast logMAR acuity and random-dot stereoacuity before and after three refractive surgery procedures for correcting myopia. METHODS A total of 106 subjects (laser-assisted in situ keratomileusis, 40; photorefractive keratectomy, 26; small-incision lenticule extraction, 40) with myopia and astigmatism ≤1.5 D participated in this prospective cohort-based study. All aforementioned outcome variables were measured in both eyes pre-operatively and 1 week and 1, 3, and 6 months post-operatively. RESULTS Pre-operative myopic spherical equivalent of refraction (median [25th to 75th interquartile range], -6.4 D [-8.0 to -4.2 D] for laser-assisted in situ keratomileusis, -4.3 D [-5.0 to -3.5 D] for photorefractive keratectomy, -5.5 D [-6.5 to -4.3 D] for small-incision lenticule extraction) was corrected to within ±0.75 D of emmetropia in all cohorts up to 6 months post-operatively (P < .001). Higher-order wavefront aberrations, uncorrected high- and low-contrast logMAR acuity, and stereoacuity all worsened and remained so up to 6 months post-operatively, relative to pre-operative values (P < .001). Stereoacuity worsened with both interocular average and difference in the magnitude of higher-order aberrations, whereas logMAR acuities worsened only with interocular average of these aberrations (r ≥ 0.40; P < .01 for all). CONCLUSIONS Although the refractive surgery procedures tested here correct myopia, they result in a sustained (up to 6 months) loss of optical quality and spatial and depth-related visual functions post-operatively. Both interocular average and difference in the eye's optical quality seem to impair binocular visual functions after refractive surgery for myopia.

Purpose To assess the influence of capsular tension ring (CTR) on surgical outcomes of toric and multifocal intraocular lenses (IOLs) in eyes at high risk of zonular instability. Methods Fifty-five eyes of 43 patients who had undergone phacoemulsification and IOL implantation were included in the analysis. They had some risk of zonular weakness, such as pseudoexfoliation, shallow anterior chamber, high myopia, and phacodonesis, or were judged to have unstable zonules during surgery. Toric IOL was implanted in 9 eyes with CTR and 22 eyes without CTR, while multifocal IOL was used in 9 eyes with CTR and 15 eyes without CTR. Manifest refraction, refractive astigmatism, visual acuity, and degree of IOL decentration and tilt measured using swept-source anterior segment optical coherence tomography were analyzed. Axis misalignment of toric IOLs were also evaluated. Results In toric IOLs, co-implantation of CTR significantly reduced decentration and axis misalignment of IOL, resulting in better uncorrected and corrected visual acuity after surgery. In multifocal IOLs, combined use of CTR significantly prevented IOL tilt, leading to better intermediate visual acuity. Spherical equivalent and residual astigmatism were not significantly affected by the use of CTR. Conclusions CTR reduces decentration and axis misalignment of toric IOL and tilt of multifocal IOL, achieving improvement of postoperative visual function in eyes with suspected zonular instability.

Purpose: To determine the factors affecting the risk of deterioration and evaluate the refractive error change in patients with fully accommodative esotropia. Methods: Patients diagnosed as having fully accommodative esotropia (esotropic deviation that started before 7 years of age and less than 8 to 10 prism diopters [PD] of esotropia with full hyperopic correction and/or bifocals) were included in this retrospective population-based cohort study. Refractive error changes were recorded. For comparisons, patients were divided into two groups: nondecompensated fully accommodative esotropia group and decompensated fully accommodative esotropia group. Results: Two hundred and twenty-three patients met the inclusion criteria. The mean follow-up time was 5.94 ± 0.31 years (range: 5 to 8 years). The changes in spherical equivalent in the younger than 7 years, 7 to 12 years, and 12 to 17 years groups were statistically significant ( P < .001). The decrease of hypermetropia was 0.13 diopters/year between 7 and 12 years and 0.06 diopters/year between 12 and 17 years. Forty-one of 223 patients (18.4%) discontinued spectacle therapy during the follow-up period. Hyperopic error and presence of amblyopia were lower, whereas visual acuity level and presence of near-distance disparity were higher in the spectacle discontinuation group ( P < .001, .007, .01, and 0.01, respectively). Deterioration of fully accommodative esotropia occurred in 30 of 223 patients (13.5%). Boys were more likely to require strabismus surgery ( P = .32). The mean age at presentation, esotropia angle with and without refractive correction at both near and distance fixation, near distance disparity, and inferior oblique overaction were significantly higher in patients with decompensated fully accommodative esotropia. Conclusions: Hyperopic error increased from the initial level until 7 years of age, followed by a myopic shift thereafter. Few children had resolution of fully accommodative esotropia and could discontinue spectacle therapy. Children with male gender, higher esotropia angle, older age at presentation, near-distance disparity, and inferior oblique overaction experienced a greater deterioration of the fully accommodative esotropia. [ J Pediatr Ophthalmol Strabismus . 2020;57(4):217–223.]

This study examined the factors affecting corneal curvature change after lateral rectus recession and medial rectus resection surgery in patients with intermittent exotropia. This was a retrospective cross-sectional study in intermittent exotropia patients who underwent rectus resection surgery. The study involved 41 male and 42 female patients (mean age: 9.55 ± 5.03 years, range: 3-28 years). Corneal astigmatism analysis was performed using the Galilei G4 Dual Scheimpflug Analyzer. The values of simulated and ray tracing corneal keratometry (K) of astigmatism, including axis changes, were determined preoperatively and at 1 week and 3 months postoperatively. The factors found to affect corneal curvature change were sex, extent of surgery, and axial length. Simulated and ray tracing changes were significant preoperatively and at 1 week and 3 months after rectus resection surgery (p < 0.05); however, there were no differences in astigmatism (D) at any time. The spherical equivalent had a myopic change after rectus resection surgery with cycloplegic refraction, and in ray tracing mode, flat K was decreased at 1 week from baseline and increased 3 months later. Steep, mean K, and axis increased continuously from baseline to 1 week and 3 months. Astigmatism, in contrast, was increased at 1 week, but decreased at 3 months, with no return to baseline. Univariable linear regression analyses showed that the extent of surgery had an effect on flat K change and that sex had an effect on steep K and axis. Additionally, axial length affected steep K and astigmatism, while age had no effect on any variable. Ray tracing values were significantly different from simulated values. In ray tracing mode, rectus resection surgery may result in astigmatism shifted toward with-the-rule, and myopic changes may be caused by differences in thickness and flexibility of the sclera. Notably, age did not affect any variable.

Background: The Zika virus (ZIKV) targets neural stem cells in the developing brain. It remains unclear whether ZIKV-Exposed Children (ZEC) with no apparent neurological manifestations at birth were protected from ZIKV neurotropism during gestation or harbor subtle pathology that might disrupt neurodevelopment. In this prospective study, we tracked a cohort of normocephalic ZIKV-exposed children (NZEC) in parallel with normocephalic unexposed controls (UC) from birth to 30 months of age to determine whether NZEC show higher rates of neurodevelopmental delays relative to UC. Methods: A total of 384 pregnant women were recruited from public health centers in Grenada, West Indies and enrolled between April 2016 and March 2017, which was a period of active ZIKV transmission. Serum samples were collected from mothers during the prenatal and postnatal period and assessed for ZIKV antibodies using a plasmonic-gold platform. Infants were classified as NZEC if their mothers tested positive for ZIKV infection during pregnancy and they were normocephalic, as defined by World Health Organization Child Growth Standards. Children were classified as UC if their mothers tested negative for ZIKV infection during and following pregnancy. Outcome measures included the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, which were administered and scored by research staff blinded to participants’ exposure status. Findings: A total of 68 NZEC and 63 UC completed outcome measures between 22 to 30 months of age. There were no group differences in socio-demographics. Visual acuity deficits were apparent in NZEC in the absence of any other cognitive, motor, language, or behavioral delays. Interpretation: The presence of visual acuity deficits in NZEC suggests that the visual system may be selectively vulnerable in otherwise normally developing children. Continued neurocognitive surveillance of this cohort will address whether early vision problems place NZEC at risk for future deficits in visuo-spatial functions and learning disorders. Funding Statement: TWINDREF GSP-SRGI-18009 (KB); USAID AID-OAA-A-14-00028 (ADL), NIH R21HD093551-01 (RW, BL, MF), Stanford Maternal Child Health Research Institute (ADL). MF is supported by an Academic Clinical Fellowship in Paediatrics from the National Institute for Health Research, UK, to the University of Southampton. Declaration of Interests: None of the authors have any conflicts of interest to disclose. Ethics Approval Statement: Institutional Review Board approval was obtained at St George’s University (IRB#16061) and Stanford University (IRB#45242). Informed consent was obtained from all mothers who participated in this study. There was no financial compensation.

The purpose of this study was (1) to implement a test for binocular imbalance in a Virtual Reality headset, (2) to assess its testability, reliability and outcomes in a population of clinical patients and (3) to evaluate the relationships of interocular acuity difference, stereoacuity and binocular imbalance to amblyogenic risk factors. 100 volunteers (6 to 70 years old, mean 21.2 ± 16.2), 21 with no amblyogenic risk factors and 79 with amblyopia or a history of amblyopia participated. Participants were classified by amblyogenic risk factor (24 anisometropic, 25 strabismic and 30 mixed) and, for those with strabismus, also by refractive response (16 accommodative and 39 non-accommodative). We characterized our sample using three variables, called the 'triplet' henceforth: interocular acuity difference, stereoacuity and imbalance factor. Binocular imbalance showed high test-retest reliability (no significant difference between test and retest in a subgroup, n = 20, p = 0.831); was correlated with Worth 4 dots test (r = 0.538, p