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Abstract Interdisciplinary scholarship and education remains elusive at modern universities, despite efforts at both the individual and institutional levels. The objective of this paper is to identify the main motivations that bring different disciplines together in joint research and identify some of the obstacles to that coming together. Here we propose that shared purpose (why do I participate?), practice (how do we interact?), and place (where do we interact?) are, in descending order, the most important drivers for what we call “undisciplinary” research in an interaction of different disciplines. Through unstructured workshops we found the choice of participants (who participates?), aspects of time (when do we interact?), and especially the research topics and focus (what are we working on?), to be less important for individual faculty engagement. Metaphor analysis obtained during a charrette-style workshop with 13 faculty from multiple disciplines suggested “inter-epistemological ways of knowing” rather than fields of study to move us from disciplinary to interdisciplinary to undisciplinary scholarship and education. Specifically, the broad intent (why do we participate?) was found to increase the impact of undisciplinary approaches that served as drivers for engagement. These lessons learned from a series of workshops were put to the test at an experimental center that clarified the importance of both synchronous and asynchronous interactions in a common space large enough to allow these and located outside the university. Despite the valuable insights gained in what undisciplinary interaction may look like in a center, it remained clear that space design must start by mapping out why and how individuals in different disciplines may want to interact at a given institution to generate buy-in and build the foundation for continuous refinement of an institutional strategy.

Parental reports suggest that difficulties related to child-feeding and children's eating behaviour are extremely common. While 'fussy eating' does not pose an immediate threat to health, over the long-term, consumption of a poor diet can contribute to the development of a range of otherwise preventable diseases. In addition, the stress and anxiety that can surround difficult mealtimes can have a detrimental impact upon both child and parental psychological wellbeing. Since parents have a great influence over what, when, and how much food is offered, feeding difficulties may be preventable by better parental awareness. The aim of this review is to describe how parental factors contribute to the development of common feeding problems, and to discuss the merits of existing interventions aimed at parents/primary caregivers to improve child-feeding and children's eating behaviour. The potential for different technologies to be harnessed in order to deliver interventions in new ways will also be discussed. [ABSTRACT FROM AUTHOR]

Measuring readiness to exercise, or exercise stage of change (ESOC), is an important first step when counseling adults about exercise. However, minimal construct validity testing of ESOC measures has been reported. With a sample of 95 adults, we estimated the construct validity of four ESOC measures with commonly used response formats (true/false, ladder, 5 choice, interview). Participants completed all four ESOC measures in random order as well as six validation measures: physical activity performed, exercise self-efficacy, decisional balance pros and cons, and behavioral and experiential processes of change. Few participants were in the earliest stage of change. The true/false measure demonstrated the strongest validity. Further studies are needed in diverse samples with more representation across the stages of change. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:254-264, 2010 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Unnecessary dietary restraint (ie in the absence of a need to lose weight) and chronic overeating are both very unhealthy activities. As a precursor to a more involved longitudinal study, we sought to identify potential early-life predictors that merit scrutiny in this context. DESIGN:: Four retrospective questionnaire studies were conducted (Study 1, N=242; Study 2, N=297; Study 3, N=175; Study 4, N=261). Female participants (18-30?y) completed measures of current dietary restraint and overeating. They also recalled experiences between 5 and 10 years of age. All were staff or students at Loughborough University (UK). RESULTS:: After considering obvious sources of systematic bias, we report evidence that (i) dietary restraint is related to memories of maternal weight and dietary behaviour, and (ii) overeating and meal-size selection are both associated with memories of receiving a high-energy diet. CONCLUSION:: The role of maternal factors in dietary restraint is consistent with previous research exploring the early onset of this behaviour. However, the relationship between childhood diet and overeating has not been suggested elsewhere. This is particularly important because it suggests a previously unreported correspondence between childhood experience and behaviours associated with obesity in adulthood.International Journal of Obesity (2005) 29, 463-474. doi:10.1038/sj.ijo.0802890 Published online 1 February 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE: The research question for the current study was: Does continuous light or continuous very light handrail support reduce oxygen uptake and/or heart rate compared with no handrail support in women during submaximal step treadmill exercise? DESIGN: Within-subject quasi-experimental. SETTING: Not given. POPULATION: The sample consisted of 15 healthy women. The mean age was 45.3 years. INTERVENTIONS: Oxygen uptake was measured during bouts of submaximal exercise on a Gauntlet step treadmill. A continuous electrocardiogram was performed during submaximal exercise bouts using a 10 lead ECG system. Women were oriented to correct techniques for mounting and dismounting the step treadmill and were oriented to using the handrail support conditions. Electrodes were applied to the anterior chest and the headgear and mouthpiece were positioned for oxygen uptake measurement. Twenty-five and 33 steps/min were chosen because these step rates are typically used by sedentary women who begin an exercise program. Three levels of handrail support were examined. Measures were obtained during 6 bouts of exercise. MAIN OUTCOME MEASURE(S): In the no handrail support condition, mean oxygen uptake and mean heart rate were greater in response to step treadmill submaximal exercise at 33 steps/min compared with 25 steps/min. This finding demonstrated that the 33 steps/min rate provided a significantly higher submaximal exercise intensity than the 25 steps/min rate. At 25 steps/min there was a significant reduction (7-8%) in mean oxygen uptake during both continuous light and continuous very light handrail support as compared with no handrail support. The current study has added important dimensions to the handrail support literature by confirming that continuous handrail support, even light or very light handrail support, attenuates oxygen uptake, and in most cases heart rate, in middle-aged women performing submaximal exercise on the step treadmill. Specifically, decreases in oxygen uptake found in the current study are consistent with previous research. RESULTS/CONCLUSIONS: Although the homogeneity of this group of women limits the generalizability of the results, the findings do provide support for discussing directions for future research, and present direction for developing handrail support protocols. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

Introduction: To determine whether classification of accommodative insufficiency (AI) based on the subjective push-up test is indicative of reduced amplitude measured objectively., Methods: Monocular subjective accommodative amplitude was measured in participants 7-24 years of age with the push-up test; a 0.9 mm letter was moved towards the eye until first sustained blur occurred. Monocular objective amplitude was measured with the same target and an autorefractor for demands from 2.5 to 30 D. The maximum response was termed the amplitude. Near point of convergence (NPC) was measured in a subset of participants. Participants were classified into groups using subjective amplitude: normal amplitude or AI (amplitude < ((15 - 0.25 × age) - 2)). Objective amplitude was plotted by age for each group and one-way ANCOVA used to evaluate differences while controlling for age. For NPC measures, a t-test compared the magnitude of the break between those with and without AI., Results: Fifty-five of 185 participants were classified as having AI. Objective amplitude decreased with age (0.20 D/year) and there was no significant difference in the age-adjusted mean amplitudes for the two groups (AI: 7.62 D, CI = 7.19, 8.04; Normal: 7.86 D, CI = 7.58, 8.15; p = 0.11). For the subset with NPC measures, participants classified as having AI had significantly more receded break values than those without AI (7.7 ± 5 vs. 3.7 ± 3 cm, p < 0.001)., Conclusions: Factors other than accommodative ability may be contributing to lower subjective amplitude findings in individuals meeting the criterion for AI., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: To assess the long-term stability of clinical measures of convergence (near point of convergence [NPC] and positive fusional vergence [PFV]) in participants enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART) who received 16 weeks of office-based vergence/accommodative therapy., Methods: A total of 310 children, 9-14 years old, with symptomatic convergence insufficiency were enrolled in CITT-ART. Some 270 completed both their 16-week primary outcome visit followed by a 1-year follow-up visit. Of those 270, 181 (67%) were randomised to the vergence/accommodative therapy. Of the 181 in the vergence/accommodative group, 121 (67%) reported not receiving any additional treatment after the 16-week primary outcome visit. The mean change in NPC, PFV and percentages of children classified by the predetermined success criteria of convergence (normal NPC [<6 cm] and/or improved by ≥4 cm; normal PFV [passing Sheard's criterion and base-out break >15Δ] and/or improved by ≥10Δ) were compared at the 16-week primary outcome visit and 1 year later., Results: Of the 121 who returned for their 1-year follow-up visit, there was no significant change in mean adjusted NPC (reduction of -0.2 cm; 95% CI: -1.0 to 0.5 cm) at 1 year. There was a statistically significant decrease in mean-adjusted PFV (-4.7∆; 95% CI: -6.5 to -2.8Δ) at 1 year. There were similar percentages of participants classified as 'normal' (p = 0.30), 'normal and/or improved' (p > 0.50) and 'normal and improved' (p > 0.14) based on NPC and PFV at the 1-year visit compared with the 16-week primary outcome visit., Conclusion: The improvements in NPC and PFV following 16 weeks of vergence/accommodative therapy (with no reported additional treatment thereafter) in children with symptomatic convergence insufficiency persisted 1-year post-treatment., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus)., Methods: Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses., Results: The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51)., Conclusions: QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition., (© 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Objectives: We investigated factors associated with job retention after developing a visual impairment in late middle adulthood. Methods: Using longitudinal survey data from the Health and Retirement Study, we identified respondents who first reported poor eyesight or legal blindness at age 44-64 years in Waves 3-14 and who were employed in the previous wave. We conducted a multiple logistic regression analysis with job retention as the dependent variable and health and socioeconomic characteristics as independent variables. Results: Women, people who were married or partnered, and people with fair or better self-reported health were more likely to retain employment after vision loss, whereas people with more chronic health conditions were less likely to retain employment. Discussion: Poor health and chronic health conditions may prompt late middle-aged adults to leave the labor force after developing vision loss. Timely vocational rehabilitation services can help employed people with vision loss retain employment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia., Methods: Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test., Results: Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years., Conclusion: Prescribing patterns for paediatric hyperopia vary significantly among eye care providers., (© 2023 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: The purpose of this study was to determine if control observers can be used as surrogates to predict visual acuity (VA) of patients with Down syndrome (DS)., Methods: Thirty adults with DS were enrolled in a clinical trial testing three refraction types: clinical refraction and two using wavefront aberration measures to optimize the metrics pupil fraction tessellated (PFSt) and visual Strehl ratio (VSX). Monocular VA was obtained through habitual refractions and each experimental refraction type. Five controls without DS viewed acuity charts simulating the retinal image produced when the corrections for each DS eye are worn, performing VA and scoring image quality of each chart. Group median VA (DS versus controls) were compared for each refraction type, and control image quality scores were compared to corresponding VA across refraction types., Results: Median VA for participants with DS ranged from 0.46 logMAR (interquartile range [IQR] = 0.32 to 0.54) with habitual correction to 0.36 logMAR (IQR = 0.28 to 0.54) with VSX, whereas controls ranged from 0.37 logMAR (IQR = 0.29 to 0.42) with habitual correction to 0.01 logMAR (IQR = -0.02 to 0.05) with VSX. Overall image quality scores were best for PFSt and VSX and showed a strong linear relationship with control VA (r = -0.91, P < 0.001), and a lesser correlation with DS VA (r = -0.33, P < 0.001)., Conclusions: Using surrogate observers to judge image quality simulations of eyes with DS did not predict actual VA, suggesting additional, non-optical factors may be limiting VA in individuals with DS., Translational Relevance: Findings may guide clinical refraction practices for patients with DS.

Purpose: Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload., Methods: Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75 mm (CMT0.75) to 3 mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative/vergence therapy., Results: Sixteen subjects with AI (mean age = 17.4 years, SD = 8.0) were matched with 48 controls (mean age = 17.8 years, SD = 8.2). On average, the controls had 52-72 μm thicker ciliary muscles in the apical region at 0D than those with AI (p = 0.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8 weeks of accommodative/vergence therapy, the CMT increased by an average of 22-42 μm (p ≤ 0.04 for all), while AA increased by 7D (p < 0.001)., Conclusions: This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative/vergence therapy., (© 2023 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Significance: The U.S. Food and Drug Administration regulates contact lenses as prescription medical devices and defines daily disposable lenses for single use; however, safety comparisons between daily disposable and reusable lenses rely on the lens-wearing regimen. When inappropriately discerned, studies may erroneously report replacement regimen, resulting in inaccurate risk rates., Purpose: This study aimed to explore different measures for defining daily disposable wearers in the context of a clinical study., Methods: A secondary analysis of data from five multisite fieldings (n = 1059) from the Contact Lens Risk Survey was performed. Descriptive statistics were used to examine self-reported lens replacement, use of lens case, and manufacturer's recommended replacement frequency as defined by the participants' selection of their habitual lenses using a photographic aide. Daily disposable wearers were identified as reporting daily replacement (by self-report and lens identification) and not using a lens case. If there was a discrepancy among these three factors, the lens assignment was assessed as a majority response (two of three) or as missing if conflicting information was reported., Results: The cohort was approximately two-thirds (68.7%) female and ranged from 12 to 33 years of age. A total of 154 participants (14.5%) were classified as daily disposable wearers and 896 (84.6%) as reusable wearers. Congruence was observed among all three daily disposable assignment factors for only 106 wearers (68.8%). The greatest discrepancy among daily disposable wearers was the report of using a lens case (n = 32 [20.8%]). In contrast, reusable lens wearers were more likely to report agreement across all three factors (n = 798 [89.1%], P < .001)., Conclusions: This analysis suggests that the report of not using a lens case is a more conservative surrogate for true single-use lens wear, as one in five may be storing and reusing their daily disposable lenses., Competing Interests: Conflict of Interest Disclosure : DL: Alcon (research); BK: Alcon (research); GLM: Alcon (research); KR: Sydnexis, CooperVision, Paragon, and Euclid (consulting), and Alcon, Paragon, and Vyluma (research); BR: Alcon (research); HW: Alcon and Lentechs (research); ABZ: Alcon (research) and CooperVision (consulting)., (Copyright © 2022 American Academy of Optometry.)

Purpose: To evaluate the time course of improvements in clinical convergence measures for children with symptomatic convergence insufficiency treated with office-based vergence/accommodative therapy., Methods: We evaluated convergence measures from 205, 9- to 14-year-old children with symptomatic convergence insufficiency randomised to office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART). Near-point of convergence (NPC) and near-positive fusional vergence (PFV) were measured at baseline and after 4, 8, 12 and 16 weeks of therapy; mean change in NPC and PFV between these time points were compared using repeated measures analysis of variance. Rates of change in NPC and PFV from: (1) baseline to 4 weeks and (2) 4-16 weeks were calculated. For each time point, the proportion of participants to first meet the normal criterion for NPC (<6 cm), PFV blur (break if no blur; >15Δ and >2 times the exodeviation) and convergence composite (NPC and PFV both normal) were calculated., Results: The greatest change in NPC and PFV (7.6 cm and 12.7 Δ) and the fastest rate of improvement in NPC and PFV (1.9 cm/week and 3.2 Δ/week, respectively) were both found during the first 4 weeks of therapy, with both slowing over the subsequent 12 weeks. After 12 weeks of therapy, the NPC, PFV and convergence composite were normal in 93.2%, 91.7% and 87.8% of participants, respectively, and normalised with another 4 weeks of therapy in 4.4%, 2.0% and 4.4% of participants, respectively., Conclusion: Although the greatest improvements in NPC and PFV occurred in the first 4 weeks of therapy, most participants had weekly improvements over the subsequent 12 weeks of treatment. While most children with convergence insufficiency obtained normal convergence following 12 weeks of therapy, an additional 4 weeks of vergence/accommodative therapy may be beneficial for some participants., (© 2022 College of Optometrists.)

Objectives: To determine if targeted education can influence the behaviors and scores of soft contact lens (SCL) wearers via the Contact Lens Risk Survey (CLRS)., Methods: This was a multicenter, prospective, case-control study. Cases were symptomatic red eye SCL wearers (age, 18-39 years), and controls were age , sex, and site matched. Participants completed the CLRS and were provided targeted patient education at three time points: baseline, one, and six months. Change in scores and behaviors were analyzed using the Wilcoxon signed rank test., Results: Forty-one cases and 71 controls were analyzed. The mean risk score (mean±SE) from baseline to follow-up improved (reduced) for all participants (-1.96±0.73; P =0.01), mostly driven by the improvement among cases (-2.55±1.32; P =0.05). Case subjects reported a decrease in frequency of wearing lenses while showering (-0.32±0.07; P <0.0001), discarding lens solution (-0.13±0.06; P =0.03), and rinsing lenses with tap water (-0.19±0.08; P =0.02) after targeted education., Conclusions: Targeted patient education can influence some behaviors of SCL wearers, especially those who experienced a red eye event. Further study is needed to determine how to improve other risk behaviors and whether these changes are sustained long term., Competing Interests: There are no conflicts of interest for any of the authors that could have influenced the results of this work., (Copyright © 2022 Contact Lens Association of Ophthalmologists.)

The prevalence of myopia is growing at an alarming rate and is associated with axial elongation of the eye. The cause of this undesirable physiological change involves multiple factors. When the magnitude of myopia approaches high levels, this accompanying mechanical effect increases the risk of developing other clinical conditions associated with permanent vision loss. Prior work has investigated how we may halt or reverse this process of axial elongation associated with myopic progression when we expose the eye to a peripheral myopic defocus stimulus. Specifically, the known, short-term response to myopic defocus stimulation is promising and demonstrates the possibility of establishing more permanent effects by regulating the axial length of the eye with specific defocus stimulation. However, how to directly convert these known, short-term effects into more long-term, permanent changes to effectively prevent these unfavourable physiological and refractive changes over time is yet to be understood. Here, we show for the first time that we can produce sustained, long-term reductions in axial length and refractive endpoints with cumulative short-term exposure to specific myopic defocus stimuli using a novel optical design that incorporates an augmented reality optical system. We believe that this technology will have the potential to improve the quality of vision in mankind., (© 2022. The Author(s).)

Purpose: To determine whether coexisting accommodative dysfunction in children with symptomatic convergence insufficiency (CI) impacts presenting clinical convergence measures, symptoms and treatment success for CI., Methods: Secondary data analyses of monocular accommodative amplitude (AA; push-up method), monocular accommodative facility (AF; ±2.00 D lens flippers) and symptoms (CI Symptom Survey [CISS]) in children with symptomatic CI from the Convergence Insufficiency Treatment Trial (N = 218) and CITT-Attention and Reading Trial (N = 302) were conducted. Decreased AA was defined as more than 2D below the minimum expected amplitude for age (15 - ¼ age); those with AA < 5 D were excluded. Decreased AF was defined as <6 cycles per minute. Mean near point of convergence (NPC), near positive fusional vergence (PFV) and symptoms (CISS) were compared between those with and without accommodative dysfunction using analysis of variance and independent samples t-testing. Logistic regression was used to compare the effect of baseline accommodative function on treatment success [defined using a composite of improvements in: (1) clinical convergence measures and symptoms (NPC, PFV and CISS scores) or (2) solely convergence measures (NPC and PFV)]., Results: Accommodative dysfunction was common in children with symptomatic CI (55% had decreased AA; 34% had decreased AF). NPC was significantly worse in those with decreased AA (mean difference = 6.1 cm; p < 0.001). Mean baseline CISS scores were slightly worse in children with coexisting accommodative dysfunction (decreased AA or AF) (30.2 points) than those with normal accommodation (26.9 points) (mean difference = 3.3 points; p < 0.001). Neither baseline accommodative function (p ≥ 0.12 for all) nor interaction of baseline accommodative function and treatment (p ≥ 0.50) were related to treatment success based on the two composite outcomes., Conclusions: A coexisting accommodative dysfunction in children with symptomatic CI is associated with worse NPC, but it does not impact the severity of symptoms in a clinically meaningful way. Concurrent accommodative dysfunction does not impact treatment response for CI., (© 2021 The Authors Ophthalmic and Physiological Optics © 2021 The College of Optometrists.)

Purpose: To describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications., Methods: Psychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity., Results: Participants needed 11-12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach's α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18-25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779., Conclusion: The CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Significance: This pilot study compared subjective and objective vision of children wearing single-vision and +2.00, +3.00, and +4.00 D add power soft multifocal contact lenses to determine whether the higher add power-thought to provide better myopia control-resulted in visual compromise., Purpose: This study aimed to determine the maximum add power children wearing center-distance soft multifocal contact lenses could accept objectively and subjectively., Methods: Myopic children were assigned in random order to wear omafilcon A single-vision or multifocal "D" contact lenses with +2.00, +3.00, or +4.00 D add power for 1 week each. High-contrast distance and near visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured at each visit along with a quality of vision questionnaire to assess their vision. The Friedman test was performed to evaluate the impact of add power on all outcome measures., Results: Eleven subjects were enrolled, and nine subjects completed the study. The median age of completed subjects was 11 years. Median logMAR low-contrast distance visual acuity was reduced in the +3.00 (+0.20) and +4.00 (+0.28) D add lenses compared with the +2.00 (+0.16) D add and single-vision lenses (+0.10, P < .001). All three multifocal lenses resulted in reduced contrast sensitivity (+1.35 to +1.40) compared with single-vision lenses (+1.60, P < .001). In general, +3.00 and +4.00 D add lenses resulted in worse glare/starbursts, ghost images, computer vision, changing fixation distance, and overall vision, but results varied. There were no differences among the lenses with respect to subjective assessments of distance vision, near vision, strain or tiredness, contact lens comfort, or sporting activities., Conclusions: The +3.00 D and higher add powers result in more objective and subjective vision-related issues than single-vision lenses, but the +2.00 D add multifocal lenses were well tolerated., Competing Interests: Conflict of Interest Disclosure: KMB and JJW received material support from CooperVision for this study and Bausch + Lomb for another study, but the sponsors had no role in the study design, conduct, analysis and interpretation, or writing of the report. GLM has no financial conflict of interest., (Copyright © 2021 American Academy of Optometry.)

Significance: Clinicians can better diagnose and manage vision problems of autism spectrum disorder (ASD) children by establishing a standard of care for this population. Results also reinforce the importance of a comprehensive binocular vision evaluation in all patients with ASD., Purpose: The purposes of this study were to compare near-point and ocular motility test findings in ASD children and typically developing (TD) peers and to compare findings among ASD children by level of verbal communication., Methods: Sixty-one children and adolescents (ASD, 34; TD, 27) aged 9 to 17 years completed an eye examination protocol including tests of distance and near phoria, near point of convergence, near fusional convergence and divergence, accommodative response, and Northeastern State University College of Optometry oculomotor testing. Testing was completed through refractive correction. Parents of ASD children provided information regarding subjects' verbal communication level (nonverbal, uses short words, verbal)., Results: Distance phoria did not differ significantly between groups. Near phoria of ASD subjects was more exophoric (difference, 2.8 prism diopters). Mean near point of convergence break and recovery were 7.0 and 8.02 cm, respectively, in ASD subjects and 2.19 and 3.99 cm in TD subjects. Near fusional divergence and convergence showed no significant difference. Autism spectrum disorder subjects had significantly poorer stereoacuity (P < .0001) and, on Northeastern State University College of Optometry Oculomotor Testing, reduced fixation, poorer accuracy and stamina/ability, and increased head and body movement. Monocular estimation method retinoscopy results did not differ significantly between ASD and TD subjects. No significant differences in phoria, near point of convergence, and near fusional divergence or convergence were observed between ASD subgroups (nonverbal, uses short words, verbal)., Conclusions: Autism spectrum disorder children are more likely to show receded near point of convergence, poor fixation, inaccurate saccades, erratic pursuits, and exophoric posture. These differences occur, regardless of reported verbal communication level., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Optometry.)

Purpose: To test the Contact Lens Assessment in Youth Contact Lens Risk Survey (CLRS) scoring algorithm in soft contact lens (SCL) wearers presenting with SCL-related adverse events and healthy matched controls., Methods: This prospective case-control study compared CLRS responses in SCL wearers presenting with symptomatic red eyes (Cases) with age-, sex- and site-matched healthy SCL wearers (Controls) at six locations across North America. Responses to individual questions from Cases and Controls were analyzed using either the Pearson, Mantel-Haenszel chi-square, or Fisher's exact test. Differences in the CLRS scores were compared using t-tests., Results: A total of 171 SCL wearers were enrolled (n = 57 Cases, 114 Controls). Cases were adjudicated to consensus and classified as contact lens-related serious and significant (S&S) or non-serious events. S&S Cases scored significantly higher on the CLRS (56.1 ± 11.1) than either their matched Controls (44.3 ± 11.1) (P <  0.001) or the non-Serious Cases (44.8± 12.8 P =  0.002). Scores of non-serious Cases were not significantly different than scores of their Controls (43.4 ± 10.7, P = 0.33) CONCLUSIONS: The CLRS scoring algorithm discriminated between SCL wearers presenting with S&S CL-related adverse events from healthy SCL wearers and those with non-serious events. This survey and scoring system could help practitioners identify patients at greatest risk for CL-related adverse events and support targeted interventions aimed at reducing risk behaviors., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction., Methods: We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group., Results: From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001)., Conclusion: Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction., (© 2020 The Authors Ophthalmic & Physiological Optics © 2020 The College of Optometrists.)

Background: Convergence insufficiency (CI) is a common binocular vision disorder which often causes symptoms when doing near work. However, the best screening test for CI is unknown. The purpose of this study was to evaluate the ability of common tests of binocular and accommodative function to identify children with CI in a school screening setting., Methods: Children aged nine to 14 were invited to participate. Positive fusional vergences, near point of convergence (NPC), accommodative amplitude, accommodative facility, Modified Thorington, and the Convergence Insufficiency Symptom Survey were evaluated., Results: Of the 282 children tested, approximately 20 per cent had 2-3 signs of CI. One half of 2-3 signs of CI and 66 per cent of three signs of CI subjects were symptomatic. Approximately 61 per cent of subjects with symptomatic 2-3 signs of CI had an accompanying low accommodative amplitude. The largest area under the receiver operating characteristic curve was obtained using NPC break measurements. NPC break ≥ 6 cm for CI and NPC break ≥ 7 cm for symptomatic CI were the cut points that maximised the sum of sensitivity and specificity., Conclusion: NPC break performed best in identifying children with CI., (© 2018 Optometry Australia.)

Background: To evaluate the impact of treatment of symptomatic convergence insufficiency using office-based vergence/accommodative therapy on reading skills in children., Methods: Children (n = 44) ages nine to 17 years with symptomatic convergence insufficiency were administered the following four reading tests: Wechsler Individual Achievement Test II; Test of Word Reading Efficiency; Test of Silent Word Reading Fluency; and the Gray Oral Reading Test, at baseline and eight weeks after completion of a 16-week program of office-based vergence/accommodative therapy. To determine whether significant change occurred with therapy, change in performance was compared to zero. Treatment response was determined using a composite score of symptoms and signs at the conclusion of treatment and at the 24-week outcome visit. Participants were classified as early responders, late responders, or non-responders based upon whether criteria for successful treatment were met at the completion of 16 weeks of treatment, at the 24-week outcome visit, or not met at either visit, respectively., Results: After treatment for convergence insufficiency, statistically significant improvements were found for reading comprehension (mean = 4.2, p = 0.009) and the reading composite score (mean = 2.4, p = 0.016) as measured by the Wechsler Individual Achievement Test at the 24-week visit. These improvements were related to the clinical treatment outcome measures (p = 0.011) with the largest improvements occurring in those who were early responders to treatment. Reading speed (words per minute) increased significantly on the Gray Oral Reading Test (p < 0.0001). No significant improvements were observed for single word reading or reading fluency as measured by the Test of Word Reading Efficiency, the Test of Silent Word Reading Fluency or the Gray Oral Reading Test., Conclusion: Improvements in reading comprehension and reading composite were found after office-based vergence/accommodative therapy, with the greatest improvements in those who responded early to treatment., (© 2018 Optometry Australia.)

Purpose: To test the ability of responses to the Contact Lens Assessment in Youth (CLAY) Contact Lens Risk Survey (CLRS) to differentiate behaviors among participants with serious and significant (S&S) contact lens-related corneal inflammatory events, those with other events (non-S&S), and healthy controls matched for age, gender, and soft contact lens (SCL) wear frequency., Methods: The CLRS was self-administered electronically to SCL wearers presenting for acute clinical care at 11 clinical sites. Each participant completed the CLRS before their examination. The clinician, masked to CLRS responses, submitted a diagnosis for each participant that was used to classify the event as S&S or non-S&S. Multivariate logistic regression analyses were used to compare responses., Results: Comparison of responses from 96 participants with S&S, 68 with non-S&S, and 207 controls showed that patients with S&S were more likely (always or fairly often) to report overnight wear versus patients with non-S&S (adjusted odds ratio [aOR], 5.2; 95% confidence interval [CI], 1.4-18.7) and versus controls (aOR, 5.8; CI, 2.2-15.2). Patients with S&S were more likely to purchase SCLs on the internet versus non-S&S (aOR, 4.9; CI, 1.6-15.1) and versus controls (aOR, 2.8; CI, 1.4-5.9). The use of two-week replacement lenses compared with daily disposables was significantly higher among patients with S&S than those with non-S&S (aOR, 4.3; CI, 1.5-12.0). Patients with S&S were less likely to regularly discard leftover solution compared with controls (aOR, 2.5; CI, 1.1-5.6)., Conclusions: The CLRS is a clinical survey tool that can be used to identify risky behaviors and exposures directly associated with an increased risk of S&S events.

Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and knowledge regarding exposure of lenses to water., Methods: The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions., Results: GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P < 0.001; storing: 33% GP, 15% SCL P < 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P < 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P < 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P < 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P < 0.0001) and GP lens wearers (P < 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses., Conclusions: Despite previously published evidence of Acanthamoeba keratitis' association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.

Purpose: The aim of this study was to use a large group of observers to test prior research findings that suggest optic disc size, clinical evaluation of the neuroretinal rim (ISNT rule), and practitioner characteristics influence the accuracy of differentiating normal from glaucomatous optic nerves., Methods: Participant observers were optometrists, optometry students, and vision scientists/researchers attending the 2013 American Academy of Optometry Annual Meeting. Each observer viewed and judged six sets of stereoscopic photographs of normal and clinically confirmed glaucomatous optic nerves of different sizes presented in random order. Observers were queried on whether each nerve was glaucomatous or normal, whether the nerve followed the ISNT rule, and whether further evaluation with advanced imaging techniques was indicated., Results: Of the 261 observers who participated, 59% were practicing optometrists, 7% were vision scientists, and 34% were residents or students. Of practicing optometrists and vision scientists, half (49%) had more than 15 years of experience, whereas 11% had less than 2 years of experience. Diagnostic accuracy differed based on optic nerve size: average-sized nerves were correctly identified by 90% of subjects, whereas small nerves and large nerves were correctly identified by 42% and 62%, respectively. Notably, only 9% of subjects correctly identified the small glaucomatous nerve, and only 34% correctly identified the large normal nerve. No practitioner characteristics were associated with diagnostic accuracy., Conclusions: Accurate identification of glaucomatous optic neuropathy was significantly influenced by optic disc size. This was particularly evident for the large normal nerve and the small glaucomatous nerve. The ISNT rule provided value for differentiating normal from glaucomatous nerves, but its subjective interpretation resulted in considerable intergrader variability. These findings agree with other studies utilizing smaller numbers of observers but larger numbers of optic nerve presentations that disc size and the ISNT rule have value for enhancing accuracy of optic nerve assessment.

Purpose: To investigate the ratio of accommodative convergence per diopter of accommodative response (AC/A ratio) before, during, and after myopia onset., Methods: Subjects were 698 children aged 6 to 14 years who became myopic and 430 emmetropic children participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error. Refractive error was measured using cycloplegic autorefraction, near work by parent survey, and the AC/A ratio by simultaneously monitoring convergence and accommodative response. The response AC/A ratios of children who became myopic were compared with age-, sex-, and ethnicity-matched model estimates for emmetropic children from 5 years before through 5 years after the onset of myopia., Results: The response AC/A ratio was not significantly different between the two groups 5 years before onset, then increased monotonically in children who became myopic until reaching a plateau at myopia onset of about 7 Δ/D compared to about 4 Δ/D for children who remained emmetropic (differences between groups significant at P < 0.01 from 4 years before onset through 5 years after onset). A higher AC/A ratio was associated with greater accommodative lag but not with the rate of myopia progression regardless of the level of near work., Conclusions: An increasing AC/A ratio is an early sign of becoming myopic, is related to greater accommodative lag, but does not affect the rate of myopia progression. The association with accommodative lag suggests that the AC/A ratio increase is from greater neural effort needed per diopter of accommodation rather than change in the accommodative convergence crosslink gain relationship.