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Purpose: To prospectively evaluate the effectiveness of home-based computer vergence therapy for the treatment of binocular vision disorders in adults at least 3 months after an acquired brain injury., Methods: Eligibility criteria included presence of binocular dysfunction characterized by receded near point of convergence (≥6 cm break), insufficient positive fusional vergence at near (failing Sheard's criterion or <15△ blur or break), insufficient negative fusional vergence at near (<12△ blur or break), and/or reduced vergence facility at near (<15 cycles per minute with 12△BO/3△BI). Participants were prescribed 12 weeks of home-based computer vergence therapy. Phoria (cover test), negative fusional vergence, positive fusional vergence, near point of convergence, vergence facility, and symptoms (convergence insufficiency symptom survey [CISS]) were assessed at baseline and after 4, 8, and 12 weeks of prescribed therapy. ANOVA was used to evaluate change in each measure. Percentage successful was also determined., Results: Nineteen participants were enrolled (mean age 45.4 ± 12.9 years); six participants were lost to follow-up. Baseline findings were orthophoria at distance, 7.2△ exophoria at near, near point of convergence break = 17.5 cm, near point of convergence recovery = 21.8 cm, negative fusional vergence = 12.3△, positive fusional vergence blur = 8.4△, vergence facility = 3.9 cycles per minute, and CISS = 32.1. ANOVA showed a statistically significant improvement for near point of convergence break (p = 0.002) and recovery (p < 0.001), positive fusional vergence blur (p < 0.0001), break (p < 0.0001), and recovery (p < 0.0001), negative fusional vergence blur (p = 0.037), break (p = 0.003), and recovery (p = 0.006), vergence facility (p < 0.0001), and CISS (p = 0.0001). The percentage of patients who were classified as "successful" or "improved" was 69% for near point of convergence (<6 cm or decrease of ≥4 cm), 77% for positive fusional vergence (>15△ and passing Sheard's criterion or increase of ≥10△), 77% for negative fusional vergence (≥12△ or increase of ≥6△), 62% for positive fusional vergence and near point of convergence composite, and 92% for vergence facility (15 cycles per minute or increase of 3 cycles per minute)., Conclusions: The majority of participants who completed the study experienced meaningful improvements in signs and symptoms.

Purpose: To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI) and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial., Methods: This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey [CISS] score) were evaluated., Results: There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli, and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5 and 10°) appeared normal pre-OBVT and did not show any significant change after treatment., Conclusions: This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time and suggest that these measures could be used in a large-scale randomized clinical trial of concussion-related CI as outcome measures.

Purpose: To determine the frequency and types of vision disorders associated with concussion, and to determine the success rate of vision therapy for these conditions in two private practice settings., Methods: All records over an 18-month period of patients referred for post-concussion vision problems were reviewed from two private practices. Diagnoses of vergence, accommodative, or eye movement disorders were based on pre-established, clinical criteria. Vision therapy was recommended based on clinical findings and symptoms., Results: Two hundred eighteen patient records were found with a diagnosis of concussion. Fifty-six percent of the concussions were related to sports, 20% to automobile accidents, and 24% to school, work, or home-related incidents. The mean age was 20.5 years and 58% were female. Eighty-two percent of the patients had a diagnosis of an oculomotor problem [binocular problems (62%), accommodative problems (54%), eye movement problems (21%)]. The most prevalent diagnoses were convergence insufficiency (CI, 47%) and accommodative insufficiency (AI, 42%). Vision therapy was recommended for 80% of the patients. Forty-six per cent (80/175) either did not pursue treatment or did not complete treatment. Of the 54% (95/175) who completed therapy, 85% of patients with CI were successful and 15% were improved, and with AI, 33% were successful and 67% improved. Clinically and statistically significant changes were measured in symptoms, near point of convergence, positive fusional vergence, and accommodative amplitude., Conclusions: In this case series, post-concussion vision problems were prevalent and CI and AI were the most common diagnoses. Vision therapy had a successful or improved outcome in the vast majority of cases that completed treatment. Evaluation of patients with a history of concussion should include testing of vergence, accommodative, and eye movement function. Prospective clinical trials are necessary to assess the natural history of concussion-related vision disorders and treatment effectiveness.

Purpose: To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from their eye care practitioner (ECP), on the internet/telephone, or at retail (not where they were examined) to test the effect of proximity to the prescriber on SCL wear and care practices., Methods: Adult SCL wearers completed an adapted Contact Lens Risk Survey (CLRS) online that queried items related to risk factors for SCL-related complications. Responses from subjects who purchased at the ECP, via the internet/telephone, or at a retail store were compared (Chi-Square)., Results: Purchase sources were: ECP 646 (67%, 44±12 yrs, 17% male), Retail 104 (11%, 45±13 yrs, 28% male), and Internet/telephone 218 (23%, 45±12 yrs, 18% male); age (p=0.51), gender (p=0.021). Internet purchasers had fewer annual eye exams (79% ECP, 83% retail, 66% internet/telephone, p=0.007), purchased more hydrogel SCLs (34% ECP, 29% retail, 45% internet/telephone, p=0.0034), and paid for SCLs with insurance less often (39% ECP, 29% retail, 19% internet/telephone, p<0.0001). Other behaviors were similar across groups (p>0.05)., Conclusions: In this sample, the purchase location of SCL wearers had limited impact on known risk factors for SCL-related complications. Internet purchasers reported less frequent eye exams and were more likely to be wearing hydrogel SCLs. Closer access to the ECP through in-office SCL purchase did not improve SCL habits or reduce the prevalence of risk behaviors., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: This study investigated behavioral and emotional characteristics of children with convergence insufficiency (CI), before and after treatment with office-based vergence accommodative therapy (OBVAT)., Method: Parents of 44 children ages 9 to 17 years with symptomatic CI completed the Conners 3 ADHD Index and the Child Behavior Checklist (CBCL) before and after OBVAT. Pre-treatment scores were compared with normative data and post-treatment scores were compared with baseline using the Wilcoxon sign rank test., Results: Following OBVAT, CI children showed a significant mean improvement (p < .0001, effect size of 0.58) on the Conners 3 ADHD Index with the largest changes occurring in the 23 children who scored the highest at baseline. On the CBCL, anxious/depressed, somatic, and internalizing problems improved significantly (p < .001, effect sizes of -0.36, -1.15, and -0.67, respectively)., Conclusion: In an open trial, attention and internalizing problems improved significantly following treatment for CI., (© The Author(s) 2013.)

Purpose: The purpose of this study was to assess risk factors associated with soft contact lens (SCL)-related corneal infiltrative events (CIEs)., Methods: This was a single-visit, case-control study conducted at five academic centers in North America. Cases were defined as current SCL wearers with a symptomatic CIE. For each case, three age- and sex-matched controls were enrolled. Subjects completed the Contact Lens Risk Survey (CLRS), a standardized scripted medical interview, supplied a recent health history, and underwent an ocular examination. Microbial culturing of the ocular surface, SCL, and lens storage case was conducted for all cases and one of the three matched controls. Univariate and multivariate logistic regression modeling were used to assess the risk of developing a CIE., Results: Thirty cases and 90 controls 13 to 31 years of age completed the study. Corneal infiltrative event diagnosis included contact lens-associated red eye, infiltrative keratitis, and contact lens peripheral ulcer. Subjects with symptomatic CIEs were more likely to harbor substantial levels of gram-negative bioburden on the ocular surface and contact lens. Significant risk factors for developing a CIE were overnight wear of SCLs, use of multipurpose solution, rinsing SCLs with water, lens storage case older than 6 months, previous "red eye" event, use of ocular drops in the past week, and illness during the past week., Conclusions: This pilot study demonstrated feasibility of enrolling a representative pool of SCL wearers with an untreated, symptomatic CIE and assessing CIE risk factors by using standardized methods. A larger sample size is needed to determine relationships between patient-reported behaviors and exposures, microbial bioburden, and CIE development.

Purpose: To identify the contact lens-related modifiable and nonmodifiable factors associated with corneal inflammatory events (CIEs) in a university eye care center., Methods: Contact lens-wearing undergraduate and graduate/professional students (age range, 18 to 36 years) with CIEs and contact lens wearers without complications (non-CIEs) were surveyed about their age, education level, overnight wear, brand of lens, brand of care solution, storage case age, topping-off, and lens replacement. Logistic regression was used to assess the impact of participant characteristics (demographic and behavior) and contact lens factors on the risk of a CIE., Results: There were 160 participants enrolled, with 76 presenting with a CIE. Age was significant in the multivariate model (p < 0.001) as was an interaction between disinfectant and wearing schedule (p = 0.027). When daily wear (DW) and disinfectant were compared, polyquaternium-1/myristamidopropyl dimethylamine (PQ-1/MAPD) was associated with a greater risk of CIE versus peroxide (adjusted odds ratio [aOR], 18.4; 95% confidence interval [95% CI], 1.9-173.9) and versus polyhexamethylene biguanide or polyaminopropyl biguanide (PHMB) (aOR, 15.0; 95% CI, 4.5-50.0). For PHMB users only, extended wear (EW) compared with DW increased CIE risk (aOR, 10.0; 95% CI, 2.0-51.2). There was no difference in risk between EW and DW for PQ-1/MAPD (aOR, 0.8; 95% CI, 0.2, 2.6)., Conclusions: The multivariate analysis suggests that younger age and the use of PQ-1/MAPD, particularly in DW, increase the risk of acquiring a CIE with soft contact lens wear in college-aged students. For PHMB users, EW compared with DW increases the risk of a CIE; but for PQ-1/MAPD users, there is no difference between EW and DW.

Objective: To describe the design and methodology of the Convergence Insufficiency Treatment Trial: Attention and Reading Trial (CITT-ART), the first randomized clinical trial evaluating the effect of vision therapy on reading and attention in school-age children with symptomatic convergence insufficiency (CI)., Methods: CITT-ART is a multicenter, placebo-controlled, randomized clinical trial of 324 children ages 9 to 14 years in grades 3 to 8 with symptomatic CI. Participants are randomized to 16 weeks of office-based vergence/accommodative therapy (OBVAT) or placebo therapy (OBPT), both supplemented with home therapy. The primary outcome measure is the change in the Wechsler Individual Achievement Test-Version 3 (WIAT-III) reading comprehension subtest score. Secondary outcome measures are changes in attention as measured by the Strengths and Weaknesses of Attention (SWAN) as reported by parents and teachers, tests of binocular visual function, and other measures of reading and attention. The long-term effects of treatment are assessed 1 year after treatment completion. All analyses will test the null hypothesis of no difference in outcomes between the two treatment groups. The study is entering its second year of recruitment. The final results will contribute to a better understanding of the relationship between the treatment of symptomatic CI and its effect on reading and attention., Conclusion: The study will provide an evidence base to help parents, eye professionals, educators, and other health care providers make informed decisions as they care for children with CI and reading and attention problems. Results may also generate additional hypothesis and guide the development of other scientific investigations of the relationships between visual disorders and other developmental disorders in children.

Contact lenses provide safe and effective vision correction for many Americans. However, contact lens wearers risk infection if they fail to wear, clean, disinfect, and store their contact lenses as directed. Over the past decade, CDC has investigated several multistate outbreaks of serious eye infections among contact lens wearers, including Acanthamoeba keratitis. Each investigation identified frequent contact lens hygiene-related risk behaviors among patients. To guide prevention efforts, a population-based survey was used to estimate the number of contact lens wearers aged ≥18 years in the United States. A separate online survey of contact lens wearers assessed the prevalence of contact lens hygiene-related risk behaviors. Approximately 99% of wearers reported at least one contact lens hygiene risk behavior. Nearly one third of contact lens wearers reported having experienced a previous contact lens-related red or painful eye requiring a doctor's visit. An estimated 40.9 million U.S. adults wear contact lenses, and many could be at risk for serious eye infections because of poor contact lens wear and care behaviors. These findings have informed the creation of targeted prevention messages aimed at contact lens wearers such as keeping all water away from contact lenses, discarding used disinfecting solution from the case and cleaning with fresh solution each day, and replacing their contact lens case every 3 months.

Background: Understanding the factors associated with myopic progression is critical to properly recruit subjects into clinical trials for control of myopia. The purpose of this study is to describe the rate of change in soft contact lens (SCL) power and the associated predictive factors in a young clinical population from the Contact Lens Assessment in Youth study., Methods: Data from a retrospective chart review of myopic SCL wearers aged eight to 22 years were analysed for rate of progression of myopia and associated characteristics using multivariate methods., Results: Myopic subjects (n = 912) with at least six months of follow-up were observed (4,341 visits, mean follow-up 25 months, 37 per cent hydrogel and 63 per cent silicone hydrogel SCLs). During observation, 36 per cent of subjects experienced a change in soft contact lens power of -0.50 D or more. Significant predictors of future increase in minus lens power were: ages eight to 13 years, shorter time to the first increase in minus power and hydrogel soft contact lens material. The mean annualised increase in minus decreased with age (-0.31D per year for eight to 13 year olds to -0.10 D per year for 20 to 22 year olds, p < 0.0001). Increases in minus were less common among users of silicone hydrogel materials than hydrogel daily disposable lenses after controlling for age (p = 0.039)., Conclusion: In this retrospective chart review of young soft contact lens wearers, the mean annualised rate of increase in minus soft contact lens power decreased with age, longer time to first increase in power and was greater with hydrogel soft contact lenses. The rates observed were similar to progression rates in prospective myopia clinical trials that employed cylcoplegic autorefraction., (© 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.)

Purpose: To compare testability of vision and eye tests in an examination protocol of 9- to 17-year-old patients with autism spectrum disorder (ASD) to typically developing (TD) peers., Methods: In a prospective pilot study, 61 children and adolescents (34 with ASD and 27 who were TD) aged 9 to 17 years completed an eye examination protocol including tests of visual acuity, refraction, convergence (eye teaming), stereoacuity (depth perception), ocular motility, and ocular health. Patients who required new refractive correction were retested after wearing their updated spectacle prescription for 1 month. The specialized protocol incorporated visual, sensory, and communication supports. A psychologist determined group status/eligibility using DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria by review of previous evaluations and parent responses on the Social Communication Questionnaire. Before the examination, parents provided information regarding patients' sex, race, ethnicity, and, for ASD patients, verbal communication level (nonverbal, uses short words, verbal). Parents indicated whether the patient wore a refractive correction, whether the patient had ever had an eye examination, and the age at the last examination. Chi-square tests compared testability results for TD and ASD groups., Results: Typically developing and ASD groups did not differ by age (p = 0.54), sex (p = 0.53), or ethnicity (p = 0.22). Testability was high on most tests (TD, 100%; ASD, 88 to 100%), except for intraocular pressure (IOP), which was reduced for both the ASD (71%) and the TD (89%) patients. Among ASD patients, IOP testability varied greatly with verbal communication level (p < 0.001). Although IOP measurements were completed on all verbal patients, only 37.5% of nonverbal and 44.4% of ASD patients who used short words were successful., Conclusions: Patients with ASD can complete most vision and eye tests within an examination protocol. Testability of IOPs is reduced, particularly for nonverbal patients and patients who use short words to communicate.

Purpose: Previous studies have reported that the risk of corneal infectious and inflammatory events (CIEs) with soft contact lens (SCL) wear is highest in late adolescence and early adulthood. This study assesses the associations between patient age and other factors that may contribute to CIEs in young SCL wearers., Methods: After ethics approvals and informed consent, a nonclinical population of young SCL wearers was surveyed in five US cities. Data from 542 SCL wearers aged 12-33 years were collected electronically. Responses were analyzed by age bins (12-14, 15-17, 18-21, 22-25, 26-29, and 30-33 years) using chi-square test., Results: The cohort was 34% male and balanced across age bins. There were several significant associations between survey response and age (in bins). Wearers aged 18-21 years reported more recent nights with less than 6 hours of sleep (p < 0.001), more colds/flu (p = 0.049), and higher stress levels (p < 0.001). Wearers 18-21 and those 22-25 years were more likely to wear SCLs when showering (p < 0.001) and also reported more frequent naps with SCLs (p < 0.001). They reported sleeping in SCLs after alcohol use (p = 0.031), when traveling (p = 0.001), and when away from home (p = 0.024). Lower rates of regular hand washing before lens application (p = 0.054) was also associated with these groups. In addition, the relationship between reactive replacement and recommended replacement was dependent on age (p < 0.0001)., Conclusions: Patient age influences lens wearing behaviors, environmental exposures, and other determinants of health that may contribute to increased CIEs in younger wearers. Targeted, age-specific education should be considered for both new and established SCL wearers.

Purpose: To assess the correlation between tear osmolarity readings and symptoms of dry eye in a nonclinical convenience sample and to determine how well symptoms and osmolarity correlate with the self-assessment of dry eye., Methods: Two hundred forty-nine attendees in the exhibit hall at an optometric educational meeting agreed to participate in a dry eye study. Contact lens wearers were excluded. Volunteers supplied demographic information and completed a 5-item Dry Eye Questionnaire (DEQ-5) and answered the question "Do you think you have dry eye" with a yes or no response. Osmolarity testing was done using the TearLab instrument on the right eye, then on the left eye. Pearson correlation analyses were performed to determine the relationship between variables., Results: There was no correlation between DEQ-5 scores and average tear osmolarity (correlation coefficient, 0.02) and highest osmolarity (correlation coefficient, 0.03). The mean DEQ-5 score was significantly higher among subjects who self-reported dry eye (mean, 11.3; p < 0.0001) compared with those who did not (mean, 5.4; p < 0.0001). No differences were observed between the yes and no self-reported dry eye groups and average osmolarity (p = 0.23) and highest osmolarity (p = 0.14)., Conclusions: In this nonclinical population, there was no significant correlation between tear osmolarity and ocular symptoms as reported or between tear osmolarity and the self-assessment of dry eye.

Objectives: This was a secondary analysis of an existing dataset of soft contact lens wearers age 8-33 years, who received eye care outside of a clinical trial. The aim was to identify geographical and temporal factors associated with interruptions to contact lens wear., Methods: Data from six academic centers in North America captured 522 events in 3549 patients. Cases were analyzed overall and in subcategories of allergic, and serious and significant adverse events. General estimating equations were used to model the effect of geographic (Northwest, West, Central, Northeast, Southeast) and temporal (season, month, day of the week) factors, along with previously identified risk factors associated with interruptions in lens wear (patient age, contact lens material, overnight wear, lens care system, replacement schedule, and years of contact lens wear)., Results: After controlling for established risk factors, both region and temporal factors disrupted the patients' ability to maintain contact lens wear. About 4% of all visits had complications that led to an interruption in wear. Allergic events were highest in the Central region. Serious and significant adverse events peaked in the Southeast during the Autumn and Winter months (September, October, December). Day of the week was not significant in any model., Conclusions: This study provides evidence of seasonal and regional challenges to contact lens wear. As the use of soft contact lenses expands for both cosmetic and medical reasons, practitioners must examine ways to maintain continuous, safe, and healthy use of contact lenses across all patients., (Published by Elsevier Ltd.)

Purpose: The percentage of children who are symptomatic has been shown to increase with the number of signs of convergence insufficiency (CI). Our goal was to investigate whether there is a relationship between the severity of the clinical signs of CI and symptom level reported in children with a three-sign symptomatic CI., Methods: The Convergence Insufficiency Treatment Trial enrolled 221 children with symptomatic CI from ages 9 to 17 years. Inclusion criteria included the following three signs of CI: (1) exophoria at near at least 4Δ greater than at distance, (2) insufficient positive fusional vergence (PFV) at near, and (3) a receded near point of convergence (NPC) of 6 cm break or greater. The relationships between the severity of each sign of CI (mild, moderate, and severe) and the level of symptoms as measured by the Convergence Insufficiency Symptom Survey (CISS) at baseline were evaluated., Results: Mean CISS scores were not significantly different between mild, moderate, and severe exophoria (p = 0.60), PFV blur (p = 0.99), Sheard's criterion (p = 0.89), or NPC break (p = 0.84). There was also no difference between the frequency of subjects scoring at mild, moderate, or severe levels on the CISS and the severity of each sign of CI. Correlations between individual clinical signs and the CISS score were very low and not statistically significant., Conclusions: Among symptomatic children with a CISS score of 16 or higher and three clinical signs of CI, there is no further association between the severity of the clinical signs and their level of symptoms.

Purpose: Both between-session and within-session repeatability were determined for measurement of corneal thickness with the following techniques: ultrasound pachymetry (UP), confocal microscopy (CS), Orbscan pachymetry (ORB), spectral oscillation interferometry (SOI), and optical coherence tomography (OCT)., Methods: The right eyes of 20 normal subjects were tested on 2 different days. For each session, 2 central corneal thickness measurements were determined using the ConfoScan 3 microscope, the Orbscan system, and the Stratus OCT system; 5 measurements were found with the Sonogage ultrasound pachymeter; and between 2 and 10 measurements were found with the SOI system., Results: This study showed that SOI had the best repeatability, whereas CS had the worst repeatability for both within-session and between-session repeatability. Based on 95% limits of agreement (LoA), the within-session repeatability can be ranked as: (1) SOI; (2) UP; (3) OCT; (4) Orbscan pachymetry; and (5) CS. SOI had a bias of 0.13 and 95% LoA of -1.07 to 1.33, whereas UP had a bias of -0.98 and 95% LoA of -7.35 to 5.40. The between-session repeatability of the instruments can be ranked as: (1) SOI; (2) OCT; (3) UP; (4) Orbscan pachymetry; and (5) CS. Of the optical methods, SOI had the best repeatability with a bias of 1.26 and 95% LoA of -6.14 to 8.66, followed by OCT with a bias of 0.75 and 95% LoA of -16.22 to 17.27., Conclusions: Of the 4 instruments that are commercially available, the UP was the most repeatable for within sessions, and the OCT was the most repeatable for between sessions.

Purpose: To describe age and other risk factors for corneal infiltrative and inflammatory events (CIEs) in young, soft contact lens (SCL) wearers and to model the age-related risk., Methods: A multicenter, retrospective chart review of 3549 SCL wearers (8-33 years at first observed visit, +8.00 to -12.00D, oversampling <18 years) captured CIEs from January 2006 to September 2009. The review noted age, sex, SCL worn, use of lens care products, and SCL wearing history. Event diagnoses were adjudicated to consensus by reviewers masked to wearer identity, age, and SCL parameters. Significant univariate risk factors for CIEs were subsequently tested in multivariate generalized estimating equations., Results: Charts from 14,305 visits observing 4,663 SCL years yielded 187 CIEs in 168 wearers. Age was a significant nonlinear risk factor, peaking between 15 and 25 years (P < 0.008). Less than 1 year of SCL use was protective versus longer years of wear (P < 0.0003). Use of multipurpose care products (2.86×), silicone hydrogels (1.85×), and extended wear (2.37×) were significantly associated with CIEs in the multivariate model (P < 0.0001 each)., Conclusions: Patient age, years of lens wear, use of multipurpose care products, silicone hydrogels, and extended wear were all significantly associated with CIEs with SCL wear. Use of SCLs in young patients aged 8 to 15 years was associated with a lower risk of infiltrative events compared with teens and young adults. In terms of safety outcomes, SCLs appear to be an acceptable method of delivering optics designed to manage myopia progression in children and young teens in the future.

Purpose: To investigate visual activities before and after the onset of juvenile myopia., Methods: The subjects were 731 incident myopes (-0.75 D or more myopia on cycloplegic autorefraction in both meridians) and 587 emmetropes (between -0.25 and +1.00 D) in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Parents supplied visual activity data annually. Data from myopic children 5 years before through 5 years after myopia onset were compared to data from age-, sex-, and ethnicity-matched models of children who remained emmetropic., Results: Hours per week spent reading or using a computer/playing video games did not differ between the groups before myopia onset; however, hours per week for both activities were significantly greater in myopes than in emmetropes at onset and in 4 of the 5 years after onset by 0.7 to 1.6 hours per week. Hours per week spent in outdoor/sports activities were significantly fewer for children who became myopic 3 years before onset through 4 years after onset by 1.1 to 1.8 hours per week. Studying and TV watching were not significantly different before myopia onset., Conclusions: Before myopia onset, near work activities of future myopic children did not differ from those of emmetropes. Those who became myopic had fewer outdoor/sports activity hours than the emmetropes before, at, and after myopia onset. Myopia onset may influence children's near work behavior, but the lack of difference before onset argues against a major causative role for near work. Less outdoor/sports activity before myopia onset may exert a stronger influence on development than near work.

Purpose: To investigate whether relative peripheral hyperopia is a risk factor for either the onset of myopia in children or the rate of myopic progression., Methods: The risk of myopia onset was assessed in 2043 nonmyopic third-grade children (mean age ± SD = 8.8 ± 0.52 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study between 1995 and 2007, 324 of whom became myopic by the eighth grade. Progression analyses used data from 774 myopic children in grades 1 to 8. Foveal and relative peripheral refractive error 30° in the nasal visual field was measured annually by using cycloplegic autorefraction. Axial length was measured by A-scan ultrasonography., Results: The association between more hyperopic relative peripheral refractive error in the third grade and the risk of the onset of myopia by the eighth grade varied by ethnic group (Asian children odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.06-2.30; African-American children OR = 0.75, 95% CI = 0.58-0.96; Hispanics, Native Americans, and whites showed no significant association). Myopia progression was greater per diopter of more hyperopic relative peripheral refractive error, but only by a small amount (-0.024 D per year; P = 0.02). Axial elongation was unrelated to the average relative peripheral refractive error (P = 0.77), regardless of ethnicity., Conclusions: Relative peripheral hyperopia appears to exert little consistent influence on the risk of the onset of myopic refractive error, on the rate of myopia progression, or on axial elongation.

Purpose: Most school vision screenings test only visual acuity. There is a need for a valid, easily administered test that screens for a wider variety of learning-related vision problems. Visual Efficiency RAting (VERA) is a software program designed for schools to detect both routine vision problems and visual skill problems. The purpose of this study was to compare the VERA visual skills screening with the optometric assessment of binocular, accommodative, and ocular motor skills., Methods: One hundred fifty-four children from grades 3 through 5 were evaluated using the VERA visual skills screening, a clinical battery of visual skills testing, the Convergence Insufficiency Symptom Survey, and 2 reading tests., Results: The sensitivity of VERA in detecting visual skills problems was 45%, and the specificity was 83%. Sensitivity increased to 64% and specificity to 100% in smaller groups of children when overlays of symptoms, classroom behaviors, and reading skills were included., Conclusions: VERA has fairly good sensitivity and very good specificity in detecting visual skills problems. Given that the majority of visual skill deficits currently go undetected, VERA can be considered a reasonably effective method of in-school visual skills screening., (Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the repeatability of the alternate cover test between experienced and inexperienced examiners and the effects of dissociation time and examiner bias., Methods: Two sites each had an experienced examiner train 10 subjects (inexperienced examiners) to perform short and long dissociation time alternate cover test protocols at near. Each site conducted testing sessions with an examiner triad (experienced examiner and two inexperienced examiners) who were masked to each other's results. Each triad performed the alternate cover test on 24 patients using both dissociation protocols. In an attempt to introduce bias, each of the paired inexperienced examiners was given a different graph of phoria distribution for the general population. Analysis techniques that adjust for correlations introduced when multiple measurements are obtained on the same patient were used to investigate the effect of examiner and dissociation time on each outcome., Results: The range of measured deviations spanned 27.5 prism diopters (Δ) base-in to 17.5Δ base-out. The absolute mean difference between experienced and inexperienced examiners was 2.28 ± 2.4Δ and at least 60% of differences were ≤2Δ. Larger deviations were measured with the long dissociation protocol for both experienced and inexperienced examiners (mean difference range = 1.17 to 2.14Δ, p < 0.0001). The percentage of measured small deviations (2Δ base-out to 2Δ base-in) did not differ between inexperienced examiners biased with the narrow vs. wide theoretical distributions (p = 0.41). The magnitude and direction of the deviation had no effect on the size of the differences obtained with different examiners or dissociation times., Conclusions: Although inexperienced examiners differed significantly from experienced examiners, most differences were <2Δ suggesting good reliability of inexperienced examiners' measurements. Examiner bias did not have a substantial effect on inexperienced examiner measurements; however, increased dissociation resulted in larger measured deviations for all examiners.

Purpose: To evaluate the effectiveness of the Convergence Insufficiency Treatment Trial (CITT) placebo therapy program in maintaining masking of patients randomized to the office-based treatment arms, determine whether demographic variables affect masking, and determine whether perception of assigned treatment group was associated with treatment outcome or adherence to treatment., Methods: Patients (n = 221, ages, 9-17 years) were randomized to one of four treatment groups, two of which were office-based and masked to treatment (n = 114). The placebo therapy program was designed to appear to be real vergence/accommodative therapy, without stimulating vergence, accommodation, or fine saccades (beyond levels of daily visual activities). After treatment, patients in the office-based groups were asked whether they thought they had received real or placebo therapy and how confident they were in their answers., Results: Ninety-three percent of patients assigned to real therapy and 85% assigned to placebo therapy thought they were in the real therapy group (P = 0.17). No significant differences were found between the two groups in adherence to the therapy (P >or= 0.22 for all comparisons). The percentage of patients who thought they were assigned to real therapy did not differ by age, sex, race, or ethnicity (P > 0.30 for all comparisons). No association was found between patients' perception of group assignment and symptoms or signs at outcome (P >or= 0.38 for all comparisons)., Conclusions: The CITT placebo therapy program was effective in maintaining patient masking in this study and therefore may have potential for use in future clinical trials using vergence/accommodative therapy. Masking was not affected by demographic variables. Perception of group assignment was not related to symptoms or signs at outcome (ClinicalTrials.gov number, NCT00338611).

Many women with elevated blood pressure who seek exercise opportunities require a flexible program with systematic follow-up. The study framework included motivational readiness (exercise stage of change) from the Transtheoretical Model and self-efficacy theory. This pilot study, which used a one-group repeated measures design, tested the feasibility of a stage-specific education/counseling intervention aimed at improving exercise outcomes in women with elevated blood pressure. Forty women completed a 2.5-hour session including prescription for moderate-vigorous exercise on their own, practice on equipment, maintenance of an exercise diary, and contracting; three follow-up calls (Weeks 1, 2, 3); a visit (Week 4); and a final call (Week 5). After the intervention, 85% of women moved to or remained in the action or maintenance stages of change, the highest levels of readiness; none relapsed. Exercise self-efficacy and benefits increased and barriers decreased (P<.05); 70% of participants increased exercise performance. The intervention was feasible. Further testing is warranted using larger samples and including a control group.

Background: Measurement of stereopsis is important in assessing a patient's binocular status. Several measurement methods are available, most commonly using polarized targets. Recently, less expensive red/green targets have become available. In this study, we compare polarized versus red/green methods, using random dot and contour targets., Methods: Sixty children with no strabismus, amblyopia, or high refractive error and normal ocular health were recruited. Stereopsis measurements were taken using the red/green and polarized versions of the Random Dot Letter "E"/RDE Test, Random Dot Butterfly/Stereo Butterfly Test, Stereo Circles/Wirt Circles, Stereo Numbers, and Stereo Animals tests. Observed agreement was used to assess agreement between results. Wilcoxon signed-rank tests were used to compare an individual's response with both targets., Results: There was greater than 95% agreement using any of the Random Dot-based tests and the Stereo Animals tests. However, agreement was less than 60% with the Stereo Numbers test and less than 35% with the Stereo Circles/Wirt Circles test., Conclusion: The red/green versions of the Random Dot-based tests and the Stereo Animals test appear to be a cost-effective alternative to their polarized equivalents. Our data, however, show that the red/green versions tend to underestimate the level of stereopsis when using the Stereo Numbers and Stereo Circles/Wirt Circles tests compared to their polarized equivalents.

Purpose: To assess the stability of dryness symptoms after refitting patients wearing low-Dk/t hydrogel contact lenses with high-Dk/t silicone hydrogel contact lenses and to determine whether early dryness symptoms were predictive of discontinuation in the 3-year study., Methods: Two hundred seventy-eight hydrogel lens wearers were refitted with lotrafilcon A silicone hydrogel contact lenses for continuous wear of up to 30 nights. Self-administered questionnaires at baseline, 1 week, and 3 years captured the frequency and intensity of dryness symptoms during the day and at the end of the day. One-week and 3-year responses were compared to baseline by a Bowker test of symmetry and median change in response with Wilcoxon signed rank test., Results: Frequency of during-the-day and end-of-day dryness decreased from baseline to 1 week and 3 years (during the day, frequency > or = "sometimes" 57.1% vs. 33.1% after 1 week and 58.5% vs. 28.8% after 3 years; end of day, 61.1% vs. 41.0% after 1 week and 64.0% vs. 35.9% after 3 years [P<0.0001 for all comparisons]). After refitting, the proportion of subjects with dryness symptoms was stable. After 1 week, the presence of frequency of at least "sometimes" and severity of at least "moderate" during-the-day and end-of-day dryness were significantly associated with study discontinuation (during-the-day frequency [P=0.007] and severity [P=0.017]; end-of-day frequency [P=0.002] and severity [P=0.003])., Conclusions: Dryness symptoms improved after 1 week of refitting with lotrafilcon A and remained stable through 3 years. The presence of dryness after 1 week was associated with discontinuation from contact lens wear. Refitting with silicone hydrogel lenses reduced the frequency and severity of dryness symptoms seen with hydrogel lens wear for many subjects.

Exercise stage of change (ESOC), or readiness to exercise, has been measured using at least 13 instruments and 4 interviews, yet no comparison studies are available to determine optimal measures for use by health care providers. This pilot study compares ESOC classification between 3 instruments (scale-ladder, scale-true/false, and scale-5 choice); explores the feasibility of using a face-to-face structured interview; compares classification between instruments and interview; and examines the influence of sex, age, and education level on stage classification. Thirty healthy adults completed ESOC instruments in random order and then the interview. Scale-ladder and scale-true/false instruments exhibited almost perfect agreement (weighted kappa, 0.897). All instruments exhibited substantial agreement with interview (weighted kappa, 0.620-0.790). Stage classification did not differ significantly by sex, age, or education level. The authors recommend word clarification revision of the scale-5 choice instrument and further testing of the interview.

Purpose: To identify whether parental history of myopia and/or parent-reported children's visual activity levels can predict juvenile-onset myopia., Methods: Survey-based data from Orinda Longitudinal Study of Myopia subjects from 1989 to 2001 were used to predict future myopia. Univariate and multiple logistic regression analyses were performed, and receiver operator characteristic (ROC) curves were generated. Differences among the areas under the ROC curves were compared using the method of multiple comparison with the best., Results: Of the 514 children eligible for this analysis, 111 (21.6%) became myopic. Differences in the third grade between eventual myopes and nonmyopes were seen for the number of myopic parents (P < 0.001) and for the number of sports and outdoor activity hours per week (11.65 +/- 6.97 hours for nonmyopes vs. 7.98 +/- 6.54 hours for future myopes, P < 0.001). Analysis of the areas under the ROC curves showed three variables with a predictive value better than chance: the number of myopic parents, the number of sports and outdoor activity hours per week, and the number of reading hours per week. After controlling for sports and outdoor hours per week and parental myopia history, reading hours per week was no longer a statistically significant factor. The area under the curve for the parental myopia history and sports and outdoor activities model was 0.73. A significant interaction in the logistic model showed a differential effect of sport and outdoor activity hours per week based on a child's number of myopic parents., Conclusions: Parental history of myopia was an important predictor in univariate and multivariate models, with a differential effect of sports and outdoor activity hours per week based on the number of myopic parents. Lower amounts of sports and outdoor activity increased the odds of becoming myopic in those children with two myopic parents more than in those children with either zero or one myopic parent. The chance of becoming myopic for children with no myopic parents appears lowest in the children with the highest amount of sports and outdoor activity, compared with those with two myopic parents.

Purpose: To evaluate refractive error, axial length, and relative peripheral refractive error before, during the year of, and after the onset of myopia in children who became myopic compared with emmetropes., Methods: Subjects were 605 children 6 to 14 years of age who became myopic (at least -0.75 D in each meridian) and 374 emmetropic (between -0.25 D and +1.00 D in each meridian at all visits) children participating between 1995 and 2003 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Axial length was measured annually by A-scan ultrasonography. Relative peripheral refractive error (the difference between the spherical equivalent cycloplegic autorefraction 30 degrees in the nasal visual field and in primary gaze) was measured using either of two autorefractors (R-1; Canon, Lake Success, NY [no longer manufactured] or WR 5100-K; Grand Seiko, Hiroshima, Japan). Refractive error was measured with the same autorefractor with the subjects under cycloplegia. Each variable in children who became myopic was compared to age-, gender-, and ethnicity-matched model estimates of emmetrope values for each annual visit from 5 years before through 5 years after the onset of myopia., Results: In the sample as a whole, children who became myopic had less hyperopia and longer axial lengths than did emmetropes before and after the onset of myopia (4 years before through 5 years after for refractive error and 3 years before through 5 years after for axial length; P < 0.0001 for each year). Children who became myopic had more hyperopic relative peripheral refractive errors than did emmetropes from 2 years before onset through 5 years after onset of myopia (P < 0.002 for each year). The fastest rate of change in refractive error, axial length, and relative peripheral refractive error occurred during the year before onset rather than in any year after onset. Relative peripheral refractive error remained at a consistent level of hyperopia each year after onset, whereas axial length and myopic refractive error continued to elongate and to progress, respectively, although at slower rates compared with the rate at onset., Conclusions: A more negative refractive error, longer axial length, and more hyperopic relative peripheral refractive error in addition to faster rates of change in these variables may be useful for predicting the onset of myopia, but only within a span of 2 to 4 years before onset. Becoming myopic does not appear to be characterized by a consistent rate of increase in refractive error and expansion of the globe. Acceleration in myopia progression, axial elongation, and peripheral hyperopia in the year prior to onset followed by relatively slower, more stable rates of change after onset suggests that more than one factor may influence ocular expansion during myopia onset and progression.

Purpose: The purpose of this study was to determine the effects of static (without blinking) and dynamic (with blinking once every 5 seconds) wear of piggyback contact lens systems on corneal oxygen uptake., Methods: Corneal oxygen uptake rates were measured on the right eyes of 11 human subjects by using a polarographic electrode. Measurements were made for the normal open eye and after 5 minutes of wear of 4 rigid lens materials (Dk/t 0-82.5), 4 soft lens materials (Dk/t 13-122), and 16 combinations of rigid and soft lens materials. The piggyback systems were worn under both static and dynamic conditions. Repeated-measures analysis of variance was used to compare oxygen uptake rates associated with the wear of the rigid lens components, soft lens components, piggyback systems, and static versus dynamic wearing conditions. Spearman correlation coefficients and regression analyses were used to examine relationships between corneal oxygen uptake rates., Results: Measurable differences were found among oxygen uptake rates associated with the rigid lens components, soft lens components, and piggyback systems. Blinking resulted in no reduction in corneal oxygen uptake with the piggyback systems. Corneal oxygen uptake associated with the wear of the piggyback systems could not be predicted from those associated with the rigid and soft lens components of the systems., Conclusions: Piggyback combinations of rigid and soft lens components with the highest transmissibilities resulted in the least increase in corneal oxygen uptake beyond that of the normal open eye.

Purpose: The effects of sequencing of test conditions, in this case contact lens thicknesses, on the measurement of the oxygen shortfall of human corneas were studied., Methods: Corneal oxygen uptake rates were measured with a Clark-type polarographic electrode on the central, unanesthetized right corneas of 14 human subjects. Measurements were made under the following conditions: (1) the normal open eye; (2) after 5 min of static (without blinking) wear of each of seven rigid gas permeable lenses of seven center thicknesses (0.18, 0.12, 0.16, 0.20, 0.24, 0.28, and 0.32 mm); (3) after 5 min of static wear of a polymethylmethacrylate (PMMA) contact lens. Lens thicknesses were randomly assigned numbers, which were sequenced in seven cycles. Two subjects were assigned to each sequencing cycle, and each subject participated in two identical sessions., Results: The interaction of order x thickness was determined to be insignificant (F=0.99; p=0.5101). The effect of lens order was also insignificant (F=0.76; p=0.6239), indicating that the order of lens placement did not affect the measured corneal oxygen shortfall. Not surprisingly, the analysis indicated a significant effect of lens thickness on corneal oxygen shortfall (F=3.94; p=0.0032)., Conclusions: The sequencing of lenses of various thicknesses on the cornea does not affect the measurement of corneal oxygen shortfall.

After we consume a novel food an association can form between its sensory characteristics (e.g., taste properties) and the effect it has on the body (rewarding). Associations of this kind underpin much of our everyday dietary behavior because they mediate both the affective quality of food (flavor-preference learning) and the amount that we choose to consume (learning satiation). Notwithstanding this fact, very few studies have successfully demonstrated the process of dietary learning in human adults. In addition, based on evidence from related research, we explored whether learning is less likely to occur in individuals who have high scores on a measure of dietary restraint. Female participants (N = 44) consumed two differently flavored desserts. Each was presented three times on separate days. One was formulated with a high-energy content (1882 kJ) and the other with a low-energy content (226 kJ). After training, we found little evidence for learned satiation. However, we did observe flavor-preference learning. Specifically, participants acquired a greater liking and desire-to-eat the dessert flavor that was paired with a higher energy density during training. Further analysis revealed that this effect on liking is qualified by dietary restraint. As predicted, unrestrained eaters demonstrated greater differential responding to the two desserts than did restrained eaters. These data provide further evidence for flavor-nutrient learning in adults and they highlight a hitherto unexplored and potentially important difference between restrained and unrestrained eaters.

Purpose: The purpose of this study is to determine the effects of rigid gas-permeable contact lens thickness, base curve radius, and material permeability on corneal hypoxic stress., Methods: Corneal oxygen uptake rates were measured with a Clark-type polarographic electrode on the right eye of 10 human subjects for the normal open eye (air) and after 5 minutes of static wear of rigid contact lenses of four cornea-to-contact lens base curve fitting relationships: 0.2 mm steeper-than-K (STK), 0.1 mm STK, on K, and 0.1 mm flatter-than-K (FTK). There were also four materials (polymethylmethacrylate [Dk=0], lotifocon B [OP-2, Dk=15.9], lotifocon A [OP-3, Dk=30], lotifocon C [OP-6; Dk=60]) and three center thicknesses (0.14, 0.28, and 0.53 mm for the OP-6 lenses and 0.14 mm for all other materials) with all other parameters being constant. Each subject participated in two identical sessions. A repeated-measures analysis of variance was performed to compare the mean response across lens materials/thicknesses and the four curvature values., Results: Significant differences were found only for lens material/thickness (p<0.0001). Although OP-2 and OP-6 (0.53 mm) were manufactured to have the same Dk/t, post hoc comparisons showed that the oxygen uptake rate with OP-6 (0.53 mm) was significantly lower. The same is also true for OP-3 and OP-6 (0.28 mm), with OP-6 (0.28 mm) having a significantly lower oxygen uptake rate., Conclusions: In contrast to past studies with PMMA, cornea-to-contact lens base curve fitting relationship, with the lens materials and designs studied here, did not affect corneal hypoxic stress, and thick, high Dk lenses resulted in less change in corneal response than did thin, lower Dk lenses of the same Dk/t. This is attributed to the lens reservoir effect that has been previously described.

Two experiments explored the hypothesis that distraction causes a reduced sensitivity to the physiological and sensory cues that signal when to terminate a meal. In Experiment 1, eighty-eight females ate five 'Jaffa Cakes' either while distracted by a computer game or while sitting in silence. Analysis of the difference in rated hunger, fullness and desire to eat (pre- to post-intake) revealed that distracted participants experienced smaller changes in their desire to eat and fullness than did non-distracted participants. Experiment 2 assessed whether changes in ratings are attenuated because sensory-specific satiety (or a related process) fails to develop. Using a similar procedure, eighty-four females provided desire to eat, pleasantness and intensity ratings for Jaffa Cakes and for two 'uneaten' foods, both before and at three time-points after consuming five Jaffa Cakes. Non-distracted participants reported a reduction in their desire to eat the eaten food relative to the uneaten food (food-specific satiety), whereas distracted participants maintained a desire to eat all foods. Moreover, this difference between distracted and non-distracted participants was evident 5 and 10 min after the eating episode had terminated. The present findings invite speculation that distraction attenuates the development of sensory-specific satiety, and that this effect persists (at least for a brief period) after the distractor has terminated. More generally, this kind of phenomenon warrants further scrutiny because it holds the potential to contribute towards overeating, either by prolonging an eating episode or by reducing the interval between meals.

Purpose: The etiology of dry eye disease is poorly understood, and a significant percentage of the population reports experiencing frequent and burdensome symptoms. Recent evidence from other disciplines has shown a relation between self-rated mood and symptom reporting, and the purpose of this work was to explore the relation between self-rated mood and dry eye symptoms., Methods: A cross-sectional/nested case-control study was used to examine factors associated with self-reported dry eye disease. Logistic and linear regression analyses were used to examine the relation between self-reported dry eye and positive and negative affect. All models included age, sex, education, income, race, and marital status, when appropriate., Results: Four hundred fifteen individuals were enrolled in the study. Two thirds were women, and the average age was 30.6 +/- 11.2 (SD) years. Two hundred fifteen (51.8%) self-reported dry eye. The average positive-affect scores were 34.6 +/- 5.9 and 34.9 +/- 6.0 (t = 0.58, P = 0.56) for those self-reporting dry eye and not reporting dry eye, respectively. The average negative-affect scores were 19.4 +/- 6.0 and 18.6 +/- 5.7 (t = -1.38, P = 0.17) for the dry eye and non-dry eye groups, respectively. After controlling for age, neither logistic regression nor linear regression showed a relation between positive or negative affect and self-reported dry eye., Conclusion: Preliminary analyses suggest that self-reported mood is not related to dry eye status in contact lens wearers. Although symptoms are a hallmark of dry eye disease, they may not be significant enough such that they relate to affective states in the way they do for other symptomatic diseases with more associated pain (eg, arthritis).

Purpose: The Study of Progression of Adult Nearsightedness (SPAN) is a 5-year observational study to determine the risk factors associated with adult myopia progression. Candidate risk factors include: a high proportion of time spent performing near tasks, performing near tasks at a close distance, high accommodative convergence/accommodation (AC/A) ratio, and high accommodative lag., Methods: Subjects between 25 and 35 years of age, with at least -0.50 D spherical equivalent of myopia (cycloplegic autorefraction), were recruited from the faculty and staff of The Ohio State University. Progression is defined as an increase in myopia of at least -0.75 D spherical equivalent as determined by cycloplegic autorefraction. Annual testing includes visual acuity, noncycloplegic autorefraction and autokeratometry, phoria, accommodative lag, response AC/A ratio, cycloplegic autorefraction, videophakometry, ultrasound, and partial coherence interferometry (IOLMaster). Participants' near activities were assessed using the experience sampling method (ESM). Subjects carried a pager for two 1-week periods and were paged randomly throughout the day. Each time they were paged, they dialed into an automated telephone survey and reported their visual activity at that time. From these responses, the proportion of time spent performing near work was estimated., Results: Three-hundred ninety-six subjects were enrolled in SPAN. The mean (+/- standard deviation) age at baseline was 30.7 +/- 3.5 years, 66% were female, 80% were white, 11% were black, and 8% were Asian/Pacific Islander. The mean level of myopia (spherical equivalent) was -3.54 +/- 1.77 D, the mean axial length by IOLMaster was 24.6 +/- 1.1 mm, and subjects were 1.7 +/- 4.0 Delta exophoric. Refractive error was associated with the number of myopic parents (F = 3.83, p = 0.023), and the number of myopic parents was associated with the age of myopia onset (chi2 = 13.78, p = 0.001). In a multivariate analysis, onset of myopia (early vs. late) still had a significant effect on degree of myopia (F = 115.1, p < 0.001), but the number of myopic parents was no longer significant (F = 0.65, p = 0.52). For the ESM, the most frequently reported visual task was computer use (mean, 18.9%; range, 0-60.0%) and, overall, subjects reported near work activity 34.1% of the time (range, 0-67.3%)., Conclusions: The design of SPAN and the baseline characteristics of the cohort have been described. Parental history of myopia is related to the degree of myopia at baseline, but this effect is mediated by the age of onset of myopia.

Purpose: To assess the reliability of a lissamine green grading scale for conjunctival images., Methods: A 20-second video clip of the right eye of 288 contact lens-wearing individuals was recorded using a digital slip-lamp camera after instilling liquid lissamine green. A single nasal and temporal still image were selected. A masked reader used the Oxford grading scale to grade the images on two occasions whereas a second masked reader graded each image on 1 occasion. kappa statistics and 95% confidence intervals (CIs) were used to determine the within- and between-grader reliability overall and when the sample was stratified by age, sex, contact lens type, and disease severity., Results: There was substantial within-grader reliability for both the nasal (kappasimple = 0.69, 95% CI, 0.63-0.75) and temporal (kappasimple = 0.73, 95% CI, 0.67-0.79) images. There was moderate between-grader reliability for both the nasal (kappasimple = 0.51, 95% CI, 0.44-0.58) and temporal (kappasimple = 0.51, 95% CI, 0.44-0.58) images. Age, sex, and contact lens type did not affect within- or between-examiner reliability. There may have been an influence of disease severity on within-examiner reliability, because grading of the temporal images was significantly less reliable in the images with more significant staining., Conclusion: Within- and between-grader reliability of lissamine green staining seems to be at least substantial to moderate. Because the extent of conjunctival staining may influence reliability, this should be considered when studies may include patients with significant staining.

Purpose: The purpose of this study is to determine the effect of corneal refractive therapy (CRT) on refractive error-specific quality of life., Methods: The National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) was administered to 20 myopic patients (mean spherical equivalent -3.11 D +/- 0.96 D) between the ages of 21 and 37 years both before and 1 month after being successfully fit with Paragon CRT lenses. High- and low-contrast best-corrected visual acuity (BCVA) and higher-order aberrations were also measured. Scores for the 13 NEI RQL-42 subscales were calculated and a Wilcoxon sign rank test was used to determine whether there was a significant change in each of the subscale scores. Post hoc power analyses were also performed., Results: Statistically significant changes were found in three of the 13 NEI RQL-42 subscales. Significant improvements in subscale score were found for the symptoms (mean +/- standard deviation, 10.18 +/- 10.57, p = 0.0007) and dependence on correction (43.13 +/- 27.42, p < 0.0001) subscales. A significant reduction was found in the glare subscale (-32.50 +/- 35.22, p = 0.001). No significant changes were found in the clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limitations, worry, suboptimal correction, appearance, or satisfaction with correction subscales., Conclusions: CRT may improve a patient's perception of their visual independence, decrease the amount of ocular symptoms they report, and increase symptoms of glare. A larger, well-controlled clinical trial is necessary to verify these results. An increase in patient-reported glare is likely the result of measured increases in higher-order aberrations after CRT, especially spherical aberration under mesopic and scotopic conditions.

Purpose: The purpose of this study was to assess visual performance and patient satisfaction with two presbyopic soft contact lens modalities., Methods: A crossover study of 38 patients with presbyopia was conducted. Patients were randomized first into either multifocal (Bausch & Lomb SofLens Multifocal) or monovision (SofLens 59) for 1 month. Visual performance was measured with high- and low-contrast visual acuity at distance and near and near stereoacuity. Patients' satisfaction was measured by the National Eye Institute Refractive Error Quality of Life Instrument questionnaire and by recording the patient's final lens preference., Results: Patients maintained at least 20/20 binocular vision with both multifocal (MF) and monovision (MV) contact lenses under high-contrast conditions at distance and near. Under low-contrast conditions, patients lost less than a line of vision from the best spectacle correction to either multifocal or monovision contact lens correction at distance (pMF = 0.001, pMV = 0.006). Under low-contrast conditions at near, multifocal wearers lost five to six letters and monovision wearers lost two letters of vision (pMF < 0.001, pMV = 0.03, pMF/MV = 0.005). The average stereoacuity decreased by 79 s arc with monovision vs. multifocal contact lenses (p = 0.002). On the NEI-RQL, patients reported worse clarity of vision (pMF = 0.01, pMV < 0.001), more symptoms (pMF = 0.09, pMV = 0.01), and an improvement in their appearance with contact lens wear (pMF < 0.001, pMV < 0.001). Seventy-six percent of patients reported that they preferred multifocal contact lenses, and 24% preferred monovision contact lenses (p = 0.001)., Conclusion: The majority of our patients preferred multifocals to monovision, most likely because the Bausch & Lomb SofLens Multifocal provides excellent visual acuity without compromising stereoacuity to the same degree as monovision.

Purpose: To evaluate accommodative lag before, during the year of, and after the onset of myopia in children who became myopic, compared with emmetropes., Methods: The subjects were 568 children who became myopic (at least -0.75 D in each meridian) and 539 children who were emmetropic (between -0.25 D and +1.00 D in each meridian at all visits) participating between 1995 and 2003 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Accommodative lag was measured annually with either a Canon R-1 (Canon USA., Lake Success, NY; no longer manufactured) or a Grand Seiko WR 5100-K (Grand Seiko Co., Hiroshima, Japan) autorefractor. Subjects wore their habitual refractive corrections while viewing a letter target accommodative stimulus of 4 D (either in a Badal system or at 25 cm from the subject, designated Badal and near, respectively) or of 2 D (Badal only). Refractive error was measured with the same autorefractor in subjects under cycloplegia. Accommodative lag in children who became myopic was compared to age-, gender-, and ethnicity-matched model estimates of emmetropic values for each annual visit from 5 years before, through 5 years after, the onset of myopia., Results: In the sample as a whole, accommodative lag was not significantly different in children who became myopic compared with model estimates in emmetropes in any year before onset of myopia for either the 4-D or 2-D Badal stimulus. For the 4-D near target, there was only a greater amount of accommodative lag in children who became myopic compared with emmetropes 4 years before onset (difference, 0.22 D; P = 0.0002). Accommodative lag was not significantly elevated during the year of onset of myopia in any of the three measurement conditions (P < 0.82 for all three). A consistently higher lag was seen in children after the onset of their myopia (range, 0.13-0.56 D; P < 0.004 for all comparisons). These patterns were generally followed by each ethnic group, with Asian children typically showing the most, African-American and white children showing the least, and Hispanic children having intermediate accommodative lag., Conclusions: Substantive and consistent elevations in accommodative lag relative to model estimates of lag in emmetropes did not occur in children who became myopic before the onset of myopia or during the year of onset. Increased accommodative lag occurred in children after the onset of myopia. Elevated accommodative lag is unlikely to be a useful predictive factor for the onset of myopia. Increased hyperopic defocus from accommodative lag may be a consequence rather than a cause of myopia.

Previously, it has been demonstrated that overeating can occur when an individual engages in a cognitive task during a meal. One possibility, therefore, is that task performance can provide a measure of attention to dietary control. To explore this idea we measured performance on an otherwise irrelevant task during a meal. In two experiments, we compared intake and performance across five groups of females; dieters, and four groups of non-dieters, each with contrasting high and low scores on the restraint scale of the Dutch Eating Behaviour Questionnaire and the disinhibition scale of the Three-Factor Eating Questionnaire. Our analysis suggests that a correspondence can exist between task performance and intake (Experiment 1) and this might be influenced by the extent to which foods are regarded as forbidden (Experiment 2). However, aspects of our data are difficult to reconcile with the idea that task performance reflects a simple measure of attention to dietary control. Instead, one possibility is that individuals differ in the way that they choose to allocate attention during a meal. In relation to this idea, we discuss the possibility that some individuals choose to avoid food-related cognition by engaging strategically with other aspects of their cognitive environment.

Purpose: To evaluate scores from the National Eye Institute Refractive Error Quality of Life instrument (NEI-RQL) relative to refractive surgery outcomes in myopic patients., Setting: Large institutional ophthalmic practices., Methods: Patients seeking refractive surgery (n = 59) self-administered the NEI-RQL before and 6 months after surgery; the comparison group of myopes and emmetropes (n = 72) not seeking refractive surgery also completed the NEI-RQL. Myopic patients seeking refractive surgery had bilateral, same-day laser in situ keratomileusis (LASIK) treatment. Regression analyses were conducted to compare survey scores in the LASIK treatment group before surgery with those in the myopic sample who were not seeking refractive surgery and to compare the survey scores in the post-LASIK treatment group (surgical emmetropes) to those in the naturally emmetropic group. Logistic regression was used to determine NEI-RQL subscales that were related to myopic patients seeking refractive surgery and myopic patients not seeking refractive surgery., Results: Myopes seeking LASIK reported greater expectations for vision improvement (P < .0001), greater activity limitations (P < .0001), suboptimal correction (P = .04), worse appearance (P < .0001), and lower satisfaction (P < .0001) than myopes not seeking refractive surgery. Logistic regression showed that worse self-perceived appearance (odds ratio 20.71), more dissatisfaction with current correction (odds ratio 8.28), and higher expectations for "optimal" correction (odds ratio 6.41) were independently associated with myopes seeking LASIK, while better perceived "clarity of vision" (odds ratio = 0.20) was associated with myopes not seeking surgery. Overall, surgical emmetropes were similar to natural emmetropes in terms of refractive-error-specific quality of life (clarity of vision, near vision, far vision, diurnal fluctuations) and clinical measures of visual function, yet they reported significantly better appearance (P = .02) and greater satisfaction (P < .0001) than natural emmetropes., Conclusion: The NEI-RQL demonstrated vision-related quality-of-life differences when comparing patient samples associated with refractive surgery.

Adults who attempt to restrict their dietary intake also tend to perform worse on a range of cognitive tasks. However, the extent to which this finding generalises to children has remained unclear. Following studies involving adults, we asked 44 girls (mean age = 10.1 years) to complete a simple reaction-time task and the Tower of London task. This group was selected from a local community school in the East Midlands (UK). Dietary restraint was measured using a version of the Dutch Eating Behaviour Questionnaire that had been adapted for use by children. Our results indicate that children with high restraint scores have longer reaction times and they also tend to perform worse on the TOL task. Other aspects of our data also suggest the dietary restraint may be correlated negatively with a measure of academic ability. We discuss reasons why restraint and performance might be related causally and we conclude that this issue warrants further scrutiny.

Objective: The Randot test is a commonly used stereoacuity test with child-friendly targets; however, little has been published about its use for young children. We sought to determine the completion rate of the Randot test among young children with normal vision and to calculate normative values., Subjects and Methods: The Randot stereoacuity test was administered to 264 children whose ages ranged from 3 to 7 years. Because this was an investigation to determine the percentage of children who could complete the Randot test, children who failed a vision screening modified from the Modified Clinical Technique were excluded to minimize confounding factors (ie, a lack of measurable stereopsis due to vision problems rather than inability to understand the test). Completion rates and cumulative percentages were calculated by age., Results: A completion rate of 98.5% was found. Median Randot stereoacuities were 100 seconds of arc for the 3-year-old children, 70 seconds of arc for the 4-year-old children, 50 seconds of arc for the 5-year-old children, 40 seconds of arc for the 6-year-old children, and 45 seconds of arc for the 7-year-old children. Kruskal-Wallis testing revealed a significant change in stereoacuity with age (chi-square, 35.55; df = 4; P < .001), and pairwise comparisons (alpha = 0.05) revealed that the 3- and 4-year-old children were significantly different from the 5-, 6-, and 7-year-old children., Conclusions: Randot stereoacuity can be assessed for most preschool children and all young school-aged children. In the absence of significant refractive error, strabismus, or reduced or unequal acuity, most 4-year-old children should have a Randot stereoacuity of 70 seconds of arc or better and most young school-aged children should have a Randot stereoacuity of 50 seconds of arc.

Purpose: To compare base-in prism reading glasses with placebo reading glasses for the treatment of symptomatic convergence insufficiency (CI) in children aged 9 to <18 years., Methods: In a randomised clinical trial, 72 children aged 9 to <18 years with symptomatic CI were assigned to either base-in prism glasses or placebo reading glasses. Symptom level, measured with a quantitative symptom questionnaire (CI Symptom Survey-V15), was the primary outcome measure. Near point of convergence and positive fusional vergence at near were secondary outcomes., Results: The mean (SD) CI Symptom Survey score decreased (that is, less symptomatic) in both groups (base-in prism glasses from 31.6 (10.4) to 16.5 (9.2); placebo glasses from 28.4 (8.8) to 17.5 (12.3)). The change in the CI Symptom Survey scores (p = 0.33), near point of convergence (p = 0.91), and positive fusional vergence (p = 0.59) were not significantly different between the two groups after 6 weeks of wearing glasses., Conclusions: Base-in prism reading glasses were found to be no more effective in alleviating symptoms, improving the near point of convergence, or improving positive fusional vergence at near than placebo reading glasses for the treatment of children aged 9 to <18 years with symptomatic CI.

Purpose: To determine the impact of compositional differences in contact lens care solutions on the thickness of the tear film during contact lens wear., Methods: A randomized, crossover, investigator-masked clinical trial was conducted to compare AMO's Complete MoisturePlus to Alcon's Opti-Free Express in 31 subjects. The primary outcome of this study was a comparison of prelens tear film (PLTF) and postlens tear film (PoLTF) thickness values obtained during the first 2 hours of etafilcon A hydrogel lens wear. Each solution was used by each participant for a period of 7 days, separated by a washout period of 1 day. Alternative outcomes studied included prelens tear film thinning rates, solution preference, and dry eye-related symptom scores. Tear film thickness measurements were made using a noninvasive wavelength-dependent interferometric system., Results: The average overall PLTF thickness over the 120-minute time period after using Complete MoisturePlus was 3.02 +/- 1.07 microm, whereas the average overall PLTF thickness in this same time interval after using Opti-Free Express was 2.72 +/- 0.86 (P = 0.003). For both solutions, the PLTF could be fitted by the sum of an exponential decay plus a constant. The PLTF decay amplitudes did not statistically differ when the solutions were compared (P = 0.11). There was no difference in overall PoLTF thicknesses when the average values after using each solution were compared (P = 0.57), although there was a difference immediately after the lens was applied to the eye (Complete MoisturePlus average = 4.10 versus Opti-Free Express average = 3.48, P = 0.02). The PoLTF also demonstrated an exponential decay for both solutions. The PoLTF decay amplitudes did not statistically differ (P = 0.14). Twenty subjects (64.5%) preferred Complete MoisturePlus to Opti-Free Express (35.5%) (P = 0.11), and nearly every subject (90.3%) suggested "comfort" as their reason for preference., Conclusions: Complete MoisturePlus is associated with a thicker PLTF when compared with Opti-Free Express in contact lens wearers without dry eye symptoms, especially during the first 5 minutes following lens insertion.

Purpose: To evaluate the contribution made by the ocular components to the emmetropization of spherical equivalent refractive error in human infants between 3 and 9 months of age., Methods: Keratophakometry in two meridians was performed on 222 normal-birthweight infant subjects at 3 and 9 months of age. The spherical equivalent refractive error was measured by cycloplegic retinoscopy (cyclopentolate 1%). Anterior chamber depth, lens thickness, and vitreous chamber depth were measured by A-scan ultrasonography over the closed eyelid., Results: Both the mean and SD for spherical equivalent refractive error decreased between 3 and 9 months of age (+2.16 +/- 1.30 D at 3 months; +1.36 +/- 1.06 D at 9 months; P < 0.0001, for the change in both mean and SD). Average ocular component change was characterized by increases in axial length, thinning, and flattening of the crystalline lens, increases in lens equivalent refractive index, and decreases in lens and corneal power. Initial refractive error was associated in a nonlinear manner with the change in refractive error (R(2) = 0.41; P < 0.0001) and with axial growth (R(2) = 0.082; P = 0.0005). Reduction in hyperopia correlated significantly with increases in axial length (R(2) = 0.16; P < 0.0001), but not with changes in corneal and lenticular power. Decreases in lenticular and corneal power were associated with axial elongation (R(2) = 0.40, R(2) = 0.12, respectively; both P < 0.0001)., Conclusions: Modulation in the amount of axial growth in relation to initial refractive error appeared to be the most influential factor in emmetropization of spherical equivalent refractive error. The associations between initial refractive error, subsequent axial growth, and change in refractive error were consistent with a visual basis for emmetropization. The cornea and crystalline lens lost substantial amounts of dioptric power in this phase of growth, but neither appeared to play a significant role in emmetropization.

Previous research has indicated that flavor-flavor learning is impaired in restrained eaters. In Experiment 1 we sought to extend this finding using a larger sample and a more comprehensive assessment of dietary behavior. Participants (N=90, including 30 current dieters) sampled three novel flavors (CSs), each on 10 separate occasions, in a randomized order. Each flavor was paired with chocolate (US) either 10%, 50%, or 90% of the time. We then assessed liking for the three CSs and asked participants to complete the DEBQ-restraint and TFEQ-disinhibition sub-scales. After these CS-US parings, restrained eaters tended to prefer the 10% paired flavor whereas unrestrained eaters tended to prefer the 90% paired flavor. Differential CS liking was not evident in dieters and it was not predicted by disinhibition. Using a similar methodology, in Experiment 2 (N=76) we assessed evaluative change following picture-sweet pairings. Relative to the other CSs, the restrained eaters reported a greater increase in their liking for the 10% paired CS and the unrestrained eaters reported a greater increase in their liking for the 90% paired CS. We also discovered that evaluative change is related to the level of US devaluation that takes place during conditioning. Evidence that a sweet US can bring about a decrease in liking has not been reported previously. One interpretation is that negative beliefs and attitudes can contaminate the representation of the US during training.

Purpose: : The purpose of this article is to compare vision therapy/orthoptics, pencil pushups, and placebo vision therapy/orthoptics as treatments for symptomatic convergence insufficiency in adults 19 to 30 years of age., Methods: : In a randomized, multicenter clinical trial, 46 adults 19 to 30 years of age with symptomatic convergence insufficiency were randomly assigned to receive 12 weeks of office-based vision therapy/orthoptics, office-based placebo vision therapy/orthoptics, or home-based pencil pushups. The primary outcome measure was the symptom score on the Convergence Insufficiency Symptom Survey. Secondary outcome measures were the near point of convergence and positive fusional vergence at near., Results: : Only patients in the vision therapy/orthoptics group demonstrated statistically and clinically significant changes in the near point of convergence (12.8 cm to 5.3 cm, p = 0.002) and positive fusional vergence at near (11.3Delta to 29.7Delta, p = 0.001). Patients in all three treatment arms demonstrated statistically significant improvement in symptoms with 42% in office-based vision therapy/orthoptics, 31% in office-based placebo vision therapy/orthoptics, and 20% in home-based pencil pushups achieving a score <21 (our predetermined criteria for elimination of symptoms) at the 12-week visit., Discussion: : In this study, vision therapy/orthoptics was the only treatment that produced clinically significant improvements in the near point of convergence and positive fusional vergence. However, over half of the patients in this group (58%) were still symptomatic at the end of treatment, although their symptoms were significantly reduced. All three groups demonstrated statistically significant changes in symptoms with 42% in office-based vision therapy/orthoptics, 31% in office-based placebo vision therapy/orthoptics, and 20% in home-based pencil push-ups meeting our criteria for elimination of symptoms.