Virtual reality training improves accommodative facility and accommodative range.

Objective: To evaluate the short-term effect of dexmethylphenidate (D-MPH) on visual acuity (VA), pupil size, anterior chamber depth, and accommodation-convergence reflex in children treated with D-MPH for attention-deficit/hyperactivity disorder (ADHD). Method: Prospective cohort study including 15 patients aged 8-16 (11.58 ± 2.39) treated with D-MPH for ADHD. Patients were questioned for subjective complaints such as blurred vision and photosensitivity. An ophthalmic evaluation was performed twice; before and 1.5 hours after D-MPH administration. The examination included evaluation of best corrected visual acuity at distance and near, accommodation range, convergence range, 3D vision test (stereopsis), and anterior segment optical coherence tomography. Results: A significant association between change in pupil diameter and D-MPH treatment dose was demonstrated (p = 0.01). In addition, a positive correlation between complaints about blurred vision and pupil's size change was found (p < 0.05). There were no significant changes in VA, convergence range, stereopsis, accommodation range, or anterior chamber measures. Conclusions: Our findings provide support for the effect of stimulants on pupil diameter in a dose-dependent manner. No clinically significant differences in visual functions were found 1.5 hours after consumption of D-MPH. Institutional review board clinical trial refference no. 0122-17-TLV.

PurposeStereoscopic viewing has an impact on ocular dynamics, but its effects on accommodative functions are not fully understood, especially for autostereoscopic viewing. This study aimed to investigate the changes in dynamic accommodative response, accommodative amplitude, and accommodative facility of myopes after autostereoscopic visual training.MethodsWe enrolled 46 adults (men = 22 and women = 24; age = 21.5 ± 2.5 [range = 18–25] years, spherical equivalent: −4.52 ± 1.89 [−8.88 to −1.75] diopters [D]) who visited the Eye & ENT Hospital of Fudan University. The study population was randomly divided into three-dimensional (3D) and two-dimensional (2D) viewing groups to watch an 11-minute training video displayed in 3D or 2D mode. Dynamic accommodative response, accommodative facility, and accommodative amplitude were measured before, during, and immediately after the training. Accommodative lag and the variability of accommodation were also analyzed. Visual fatigue was evaluated subjectively using a questionnaire.ResultsAccommodative lag decreased from 0.54 ± 0.29 D to 0.42 ± 0.32 D (P = 0.004), whereas accommodative facility increased from 10.83 ± 4.55 cycles per minute (cpm) to 13.15 ± 5.25 cpm (P < 0.001) in the 3D group. In the 2D group, there was no significant change in the accommodative lag (P = 0.163) or facility (P = 0.975), but a decrease in accommodative amplitude was observed (from 13.88 ± 3.17 D to 12.71 ± 2.23 D, P = 0.013). In the 3D group, the accommodative response changed with the simulated target distance. Visual fatigue was relatively mild in both groups.ConclusionsThe immediate impact of autostereoscopic training included a decrease in the accommodative lag and an increase in the accommodative facility. However, the long-term effects of autostereoscopic training require further exploration.

Preliminary visual outcomes following three-dimensional conformal radiation therapy for optic nerve sheath meningioma

To investigate how refraction and visual acuity may vary in patients with diabetes under routine care. Fifty-three eyes of 53 patients with various degrees of diabetic retinopathy were examined prospectively on four different occasions within a month. Refraction, best-corrected visual acuity (expressed as logMAR score) and blood glucose were measured on each occasion. Intraindividual variability was calculated as the range between the highest and lowest measurements. Associations between blood glucose levels and each of the other variables were tested by linear regression analysis for each patient. Refraction was completely stable in 43 patients and changed only slightly in 10, in whom the mean intraindividual variability of the spherical equivalent was 0.4 dioptres. Visual acuity test results were also highly reproducible. Mean intraindividual variability in visual acuity was 0.08 logMAR. Mean haemoglobin A1c (HbA1c) was 7.3 ± 1.5% but individual blood glucose levels ranged from 2.8 to > 22.2 mmol/l. Intraindividual variability ranged from 0.5 to 18.1 mmol/l, with a median of 6.0 mmol/l for the entire group. There were no associations between refraction or visual acuity and blood glucose levels or inter- or intraindividual glucose variations. Refraction and visual acuity test results were highly reproducible and stable in patients with reasonably well controlled diabetes but variable blood glucose levels under routine care.

IntroductionSubthreshold micropulse laser treatment with a 532 nm (532-SML) wavelength has been suggested as a treatment option for the treatment of chronic central serous retinopathy (cCSR). The objective is to present its effects and complications.MethodsWe present a retrospective cohort study of cCSR patients submitted to 532-SML. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) parameters – central macular thickness, subfoveal outer nuclear layer, external limiting membrane, ellipsoid band, interdigitation band, subretinal fluid and choroidal thickness – were evaluated before and 12 weeks after treatment. A power of 50%, a duty cycle of 5%, exposure time of 200 ms and a spot size of 160 µm were the applied laser parameters.ResultsWe included 26 eyes. Overall there were no significant changes in visual acuity (median 0.20 (IQR 0) logMAR before and after treatment) or SD-OCT parameters. However, visual benefits occurred in 42.3% (n=11) of the patients and in half of the cases, subretinal fluid was completely reabsorbed. There were no complications.ConclusionIn this study, 532-SML was overall ineffective on cCSR as it did not lead to significant changes in the overall median visual acuity and SD-OCT parameters. However, some patients may have benefited functionally and anatomically from the treatment; further investigation is necessary to understand the potential of 532-SML.

To evaluate the efficacy of treatment of diffuse diabetic macular oedema (DME) with difluprednate ophthalmic emulsion 0.05% (Durezol™) in eyes before vitrectomy. This study enrolled patients with diffuse DME for whom more than 3 months had passed since prior treatment. Nineteen eyes in 15 subjects were treated with difluprednate ophthalmic emulsion 0.05% four times daily for the first month and then twice daily for 2 months (treatment group). As a control group, 22 eyes in 11 subjects with DME were selected from subjects who underwent the steroid responder test. In the treatment group, the mean visual acuity (VA) (±SD) was 0.38 ± 0.25 logMAR and mean retinal thickness was 461.1 ± 109.9 μm at baseline. After 1 month of treatment, the mean VA had improved to 0.29 ± 0.25 (Wilcoxon rank-sum test, p = 0.30), while mean retinal thickness had decreased to 372.1 ± 70.0 μm (p = 0.006). The rate of effective improvement in retinal thickness was 42% and that of VA was 26%. In the control group, changes in neither VA nor retinal thickness were significant. Eye drop therapy using difluprednate ophthalmic emulsion 0.05% is a useful and effective treatment modality without surgical intervention or severe side-effects.

Computer vision syndrome (CVS) has become a significant issue for individuals working on computers and digital devices for extended periods. The ocular and periocular symptoms and signs associated with CVS are a major concern, affecting individuals physically and financially. Additionally, CVS has been linked to the rapid progression of myopia, exacerbating the situation. Blinking has been one of the major treatment methods for the treatment of CVS. This study presents a unique and novel randomized controlled therapeutic trial that evaluates the impact of extended blinking therapyon eyehealth and vision, along with other related parameters. Materialsandmethods: The present studyis a randomized controlled trial conducted from September 2022 to April 2024. Participants aged 18-40 with CVSand a computer vision syndrome questionnaire (CVS-Q)score of ≥6, with mild to moderate refractive error (between -6D and +4D), were included. The sample size was determined based on a pilot study, resulting in a minimum required sample size of 36 patients (18 cases and 18 controls). Participants were randomly assigned to either the case (interventional) or control (conventional) group and were followed up for six months. Cases received conventional CVS treatment plus optimized blinking exercises, while controls received conventional therapy only. Comprehensive ocular assessments were conducted bi-monthly over six months, evaluating changes in uncorrected visual acuity (UCVA), refractive error, near point of accommodation (NPA), near point of convergence (NPC), Schirmer's test, and tear film breakup time (TBUT). The study included 20 patients in the case group and 18 in the control group, primarily aged 20-29 (60.5%). Most patients used laptops for their activities (55.26%). The CVS-Q score significantly decreased in both groups following treatment, with both cases and controls showing significant improvement (p<0.001 for both groups). UCVA in the right eye (RE) and left eye (LE) of the cases improved significantly post-treatment in the interventional group (RE: p=0.002; LE: p<0.001). A significant change in refractive error, which is measured as spherical equivalent (SE), was seen among cases following treatment (RE: p<0.001; LE: p=0.021). Controls showed no significant changes in visual acuity or refractive error. The NPAin the cases improved significantly in the RE (p=0.027) but not in the left. The NPC in the intervention group showed no significant change, while controls showed considerable improvement (p=0.042). Schirmer's test results showed no significant change in either group. However, TBUTin the cases improved significantly (RE: p<0.001; LE: p<0.001). In the controls, TBUT decreased significantly, indicating a deterioration in tear film stability. Asthenopia grades improved considerably in cases, while controls showed only some improvement. Severe symptoms still remained in the control group, emphasizing the potential benefits of the blinking exercise in reducing asthenopia symptoms. Optimized blinking therapy significantly improves vision and refractive error, tear film stability, and discomfort, making it beneficial for chronic computer users to maintain ocular health and enhance productivity and quality of life.

To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.

Objective: To discuss the efficacy and safety of orthokeratology with increased compression factor (ICF) in myopia correction in children. Methods: It was a prospective cohort study. Data of the right eyes of myopic children who visited the First Affiliated Hospital of Chengdu Medical College for orthokeratology were collected continuously from May 2016 to Dec 2018. All children had low myopia (<3.00 D) or moderate myopia (≥3.00 D), and were grouped using random numbers in Excel to receive orthokeratology with ICF or conventional compression factor (CCF). The axial length (AL), spherical equivalent (SE), best corrected visual acuity (BCVA), near visual acuity (NVA), Efron grade, corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), tear film break-up time (BUT), higher-order aberrations (HOAs), accommodative amplitude (AA) and accommodative facility (AF) were compared between groups during the 1-year treatment period. The Chi-squared test was used to compare the categorical data, while the independent-sample t-test was performed to assess the measurement data. Results: After 1 year of treatment, there were no statistical differences in AL, SE, BCVA, NVA, Efron grade, CH, CRF, IOPcc, BUT, HOAs, AA and AF between the low myopia ICF group and the low myopia CCF group (all P>0.05). After 6 months of treatment, the AL increased by (0.05±0.03) mm in the moderate myopia ICF group and by (0.08±0.04) mm in the moderate myopia CCF group (t=-3.416, P=0.001). After 1 year of treatment, the AL increased by (0.12±0.04) mm in the moderate myopia ICF group and by, (0.16±0.05) mm in the moderate myopia CCF group (t=-4.017, P<0.001). The SE was (-0.16±0.40) D in the moderate myopia ICF group, significantly different from that in the moderate myopia CCF group [(-0.58±0.60) D; t=3.529, P=0.001]. There were also statistical differences in HOAs, spherical aberrations and AF (all P<0.05), but no statistical differences in BCVA, NVA, Efron grade, CH, CRF, IOPcc, BUT and AA between the two groups (all P>0.05). Conclusions: Orthokeratology with ICF safely and effectively corrected myopia in children during the observation period. It could control the progression of moderate myopia more effectively than that of low myopia.

BackgroundComputer vision syndrome is common and affects performance of visual tasks. Background illumination, light source, light compensation, position of the display, contrast and glare are environmental factors associated with computer vision syndrome. The aim of this study is to investigate the effects of reflected glare and visual field lighting on computer vision syndrome.MethodsIn a reflected glare experiment, participants performed a two‐hour visual task using a glossy, matte, or glare‐free surface display in two visual environments (normal, glare). In a visual field lighting experiment, participants performed the visual task in dim lighting, uneven supplementary lighting, or uniform supplementary lighting. Visual function parameters, including critical fusion frequency, heterophoria, amplitude of accommodation and accommodative facility were evaluated by the investigators and a visual fatigue questionnaire was completed before and after the visual task. Visual performance was also recorded. In addition, the variation of pupil size under different lighting conditions was analysed.ResultsCritical fusion frequency was the only visual function parameter which decreased significantly after the visual task. The questionnaire score was significantly higher in a glare environment and was lower when the task was performed using a glare‐free display. Visual performance was significantly worse in the glossy display group. The increment in the questionnaire score was smaller in the uniform supplementary lighting group. Visual performance was significantly worse in the dim lighting or uneven supplementary lighting group, but not in the uniform supplementary lighting group. Variation in pupil size was significantly greater in the dim lighting condition than in the supplementary lighting condition.ConclusionCritical fusion frequency is an effective indicator of computer vision syndrome. Glare‐free displays could alleviate visual fatigue and preserve visual performance. Uniform supplementary lighting could decrease variation in pupil size and prevent eye strain.

We investigated the differences in binocular vision function and visual fatigue between school-aged children with myopic anisometropia and those with myopic isometropia. It also examined the correlation between myopic anisometropia and binocular vision parameters. One hundred school-aged (ages 6–13 years) children (43 boys and 57 girls) were divided into two groups: the myopic anisometropia group (interocular spherical equivalent difference ≥ 1.50 and < 4.00 D) and the myopic isometropia group as control group (interocular spherical equivalent difference < 1.00 D). Binocular vision parameters related to accommodation were analyzed, including accommodative amplitude, flexibility, relative accommodation, and convergence flexibility. Differences in visual fatigue scores between groups were also evaluated. Patients with myopic anisometropia show significant binocular visual dysfunction, including reduced accommodation amplitude, accommodative facility, and vergence facility, with a compensatory increase in positive relative accommodation. Although negative relative accommodation was similar between groups, anisometropic patients had more severe visual fatigue (higher ASQ-11 scores). In myopic patients without anisometropia, visual fatigue was mildly negatively correlated with accommodative facility. Clinically, binocular accommodation and vergence function should be carefully assessed in myopic patients, especially those with anisometropia, and visual fatigue interventions should include training of accommodative and vergence facility to enhance visual quality.

Diurnal stability of refraction after implantation with intracorneal ring segments

Comparison of short term and long term multidrug resistant tuberculosis treatment outcomes in tertiary care settings

To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Efficacy of Macular Hole Surgery in Patients with Idiopathic Macular Telangiectasia Type 2