Relative Accommodation Research Articles

Spatial Analysis of Sustainability Measures from Agritourism in Iberian Cross-Border Regions

This research aims to evaluate whether agritourism is a sustainable activity, comparing the profiles of accommodation, farmers, and accommodation with agricultural activities. Four specific objectives drive this study: (a) examining the cultural/landscape, economic, environmental, and social indicators of sustainability; (b) comparing indicators of sustainability between groups; (c) revealing whether there is a significant cross-correlation between spatial distribution and its impact on sustainability metrics; (d) discussing the significance of these factors for tourism development policies. The present study uses various techniques to study the degree of equilibrium in the distribution of the accommodation and farms in relation to their sustainable impact. To verify this, we use the global Moran’s I and G (d) tests proposed by Getis and Ord. As well as analyzing local contrasts, LISA (Local Indicators of Spatial Association) and Hot Spot analysis are used for mapping. The main results reveal different profiles of sustainability, highlighting the accommodation profile with the lowest contribution to sustainable development, while profiles where the relationship between agriculture and tourism is most visible seem to perform better. In general, the main results obtained suggest that there is no direct relationship between spatial distribution and sustainability inputs, excluding the potential of endogenous resources, and suggesting the existence of imbalances in the creation of agritourism products.

Results of Using Optical Simulators “Zenitsa” for the Treatment of Myopia in School Settings

Introduction. Acquired myopia (AM) is currently a growing medical and social concern as it is associated with a steadily increasing number of myopic students, early onset of its development, rapid progression and further complications. The main cause of AM is considered to be the depletion of the visual system adaptive capabilities because of too much near vision. According to the adaptation theory, it is necessary to create a high stable level of adaptive reserves of the visual system in order to normalize the process of refractive development in AM. Treatment methods of AM aimed to increase the efficacy and adaptive capabilities of eyes include optical reflex exercises. These exercises in particular using Zenitsa optical simulators compare favorably with other methods due to their physiological and pathogenetic orientation of the action mechanisms.Purpose. To study the features of using optical simulators “Zenitsa” for the treatment of acquired myopia in school settings and the dynamics of myopic process course.Material and methods. The group of 25 elementary students (50 eyes, the average age was 9.05 ± 0.72 years) with mild myopia was identified by random sampling. The study was conducted from November to December 2021. 95% of children had asthenopic complaints and 85% of students had a hereditary predisposition to it. The examination included questionnaire, visiometry, skiascopy, ophthalmoscopy, a measure of subjective refraction and relative accommodation reserves, a study of binocular stability of visual perception to hypermetropic retinal defocus. The course of treatment included 10 sessions that were carried out in school settings. We used seven simulators “Zenitsa” each of different optical strength.Results. After the treatment with the use of optical simulators, visual acuity improved on average from 0.58 to 0.67 (P < 0.01). Subjective refraction decreased from (-)1.48 ± 1.1 to 1.28 ± 1.08 D, by an average of 0.20 D (P < 0.01). Relative accommodation reserves increased from 2.33 ± 0.84 to 3.17 ± 1.07 D, by an average of 0.84 D (P < 0.01). Binocular stability of visual perception increased by an average of 1.5 D that is 15% of the initial level. The value of visual resolution increased by an average of 7.2%.Conclusion. The use of optical simulator “Zenitsa” sets significantly improves the performance of accommodation and vergence and increases the level of visual system adaptive capabilities in whole.

Long-term results of orthokeratology correction combined with 0.01 % atropine instilliations in children and adolescents with progressive myopia of various degrees

Purpose. To evaluate the effectiveness of control of myopia of various degrees in children and adolescents with the combined use of orthokeratology (OK) correction and ultralow-dose atropine instillations (0.01 %) over a long-term follow-up period (up to 3 years). Material and methods. Children and adolescents aged 11.0–13.5 with continuing progression of acquired myopia who wore nocturnal OK lens (OKL) were divided into three groups according to the duration of 0.01 % atropine application: group 1 comprised 58 children (116 eyes) who received the treatment for 6 months, group 2, 34 children (68 eyes), 8 months, group 3, 145 children (290 eyes), 36 months. The patients were examined before their OK-correction was supplemented by 0.01 % atropine instillations and every 6 months after it. The examination included visometry, refractometry, determination of reserves of relative accommodation reserve (RAR), objective accommodation response, pseudo accommodation (PA), measurement of axial length by optical biometry, anterior biomicroscopy, assessment of lens conditions; ophthalmoscopy under maximum mydriasis using binocular ophthalmoscope. Results. With atropine instillations, the yearly progression rate of myopia (YPR) in group 1 significantly decreased (by 1.6 times). the best effect showing in mild and moderate myopia. In group 2, after 18 months’ follow-up, YPR had significantly decreased (by 2.2 times). In group 3, after a 36 months’ observation, the maximum, 2.8-fold decrease in YPR was observed. The most marked and significant, 3.5-fold decrease in progression rate was observed in low myopia. In moderate myopia, the inhibitory effect of the combination of OKL/atropine combination showed a significant increase as the treatment duration became longer. In high myopia, progression rate fell insignificantly in the first 6 months, but over the whole period of observation, YPR showed a statistically significant, 1.6-fold decrease as compared to the initial level. RAR and PA remained at the levels they were before atropine instillations. Conclusion. OK correction combined with 0.01% atropine instillations produces a pronounced inhibitory effect in children with the most unfavourable course of myopia – progression continuing with night-time orthokeratology. The most pronounced effect was obtained in mild to moderate myopia. The longer the treatment period, the greater the effect of myopia stabilization. Over the 36 months’ period, 0.01% atropine showed no negative effect on the quality of visual functions of subjects wearing OK lenses.

Transient change in the binocular visual function after femtosecond laser-assisted in situ keratomileusis for myopia patients.

The goal of this study was to compare the difference in binocular visual function for high and low-moderate myopes before and after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Thirty-three subjects (17 males and 16 females) were divided into two groups according to their preoperative refractive errors in spherical equivalent (SE): low-moderate myopia group (SE ≥-6.00 D) and high myopia group (SE <-6.00 D). The binocular visual function including accommodative amplitude (AA), accommodative facility (AF), positive and negative relative accommodation (PRA and NRA, respectively), horizontal phoria measurement, positive and negative fusion vergence, accommodative-convergence over accommodation (AC/A) ratio, and stereopsis were assessed with the best-corrected vision before patients received FS-LASIK and 7 and 30 days after the surgery. Repeated measures analysis of variance (ANOVA) was applied to study the change in binocular visual function. The AF values in both groups were significantly reduced after 7 days of FS-LASIK (baseline vs. day 7 (mean): high myopia group: 7.85 vs. 5.62 cpm, repeated ANOVA, P = 0.01; low-moderate myopia group: 5.95 vs. 4.40 cpm, repeated ANOVA, P = 0.04). This change returned to the baseline level 30 days after the operation. In addition, the horizontal phoria values in both groups were significantly reduced for both distant (P = 0.019 and P = 0.001, respectively) and near (P = 0.003 and P = 0.049, respectively) 7 days after the operation, but they rebound to preoperative state after 30 days. A transient change in binocular visual function was noticed after 7 days of FS-LASIK operation, which could cause symptoms of asthenopia. Our data showed all the binocular visual functions returned to baseline level after 30 days of operation.

Mutual Cultural Accommodation in Relation to Northern Ireland: Reciprocity, Leadership, Tolerance, Generosity, Compromise, Respect, Listening, Inclusion and Balance

Mutual Cultural Accommodation in Relation to Northern Ireland: Reciprocity, Leadership, Tolerance, Generosity, Compromise, Respect, Listening, Inclusion and Balance

Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment

This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

Возможности коррекции оксидативного стресса в офтальмологической практике

A total of 238 patients presenting with the diagnosis of myopia or habitually excessive accommodation strain were examined and treated. It was shown that the introduction of antioxidative drugs in the combined treatment of the above disorders normalized the antioxidant properties of blood plasma and improved the blood supply to the eye which as a result increased the positive relative accommodation. The composite antioxidant drugs proved to exhibit the especially high therapeutic efficacy. Given the numerous reports of the successful use of this group of drugs in various ophthalmic pathologies, the great potential of this therapy area makes it expedient to search for new substances with antioxidant activity, as well as the best ways to administer them. Key words: ophthalmic pathology, oxidative stress, antioxidants, irrigation therapy

Эффективность применения очковых линз stellest для контроля миопии у детей

Purpose. To study the effect of spectacle lenses Stellest™ use on refraction, axial length (AL) and accommodation parameters in children with myopia. Methods. The study included 107 children (214 eyes) aged 7 to 16 years (10.0±1.7 years) with progressive myopia from –0.5 to –7.0 D in spherical equivalent of refraction (–2.6±1.6 diopters), astigmatism from –0.75 to –4.0 D was present in 28 % of cases. Spectacle lenses Stellest™ have always been prescribed for continuous wear (at least 12 hours per day). The dynamics was studied after 6 months (in 38 children, 76 eyes) and 12 months (in 25 children, 50 eyes) from the start of wearing Stellest™. Results. The average change in cycloplegic refraction was 0.06±0.01 D. In the first 6 months, stabilization of refraction was achieved in 72 % (55 eyes), and in 22 % (17 eyes) a weakening of cycloplegic refraction (+0.5 D) was detected. During 12 months, stable cycloplegic refraction was detected in 56 % of cases (28 eyes), and its weakening (by +0.5 diopters) or strengthening (up to –0.75 diopters) was equally frequent – in 22 % (11 eyes). Myopia progression annual gradient during wearing Stellest™ was 0.1 D (p&lt;0.05). The stock of relative accommodation increased significantly to -4.0 diopters (р&lt;0.05). The initial axial length in the group as a whole was 24.5±0.1 mm. For the first 6 months, growth of the AL did not exceed 0.02 mm, for 12 months – 0.1 mm. Conclusions. Spectacle lenses Stellest™ can be recommended as a reliable means of optical correction, helping to slow down the rate of progression and stabilize myopia. Stabilization of myopia within 12 months was achieved in 78 % of patients. Key words: myopia progression; myopia in children; peripheral myopic defocus; Stellest glasses.

Short-term results of wearing spectacle lenses with embedded rings of highly aspherical lenslets Stellest™ for myopia control

Purpose: to evaluate near visual work performance of those wearing spectacles with Stellest™ lenses and the impact of their continuous wear on refraction changes, accommodation and binocular interaction after 6 months from the start of use. Material and methods. 35 children aged 8-13 with myopia of 3.15 ± 0.19 D were prescribed eyeglasses with Stellest™ lenses. 32 children with myopia of 2.68 ± 0.18 D who used monofocal glasses served as control. Visual performance, refraction, axial length (AL), accommodation and binocular interaction were assessed. Results. According to the Burdon test, the number of errors in counting letters in Stellest™ glasses was 4.5 ± 0.64, whilst in monofocal glasses it was- significantly less, 2.96 ± 0.42 (p &lt; 0.05); the rate of test progress was the same in the two groups. After 6 months from the start of wearing Stellest™ glasses, the objective cycloplegic refraction increased by 0.11 ± 0.04 D, the average year progression rate (YPR) was 0.22 ± 0.08 D. In contrast, the children wearing monofocal glasses showed an average refraction increase of 0.35 ± 0.05 D, and the average YPR value of 0.7 ± 0.09 D. In the Stellest™group, YPG drop was observed in 87 % of cases and averaged 0.95 ± 0.11 D. In the control group, YPR was found to drop in 65 % of cases and averaged 0.49 ± 0.1 D. In the Stellest™ group, AL increased by 0.04 ± 0.02 mm; in the control group, the increase in AL was 2.8 times greater — by 0.11 ± 0.02 mm (p &lt; 0.01). In the Stellest™ group, relative accommodation reserves (RAR) increased by 0.88 ± 0.14 D, which is significantly higher than in the group wearing monofocal glasses, where the increase was 0.39 ± 0.12 D (p &lt; 0.01). No differences were revealed between the groups in objective indicators of accommodation and binocular interaction. Conclusion. Wearing spectacles with Stellest™ lenses for 6 months contributes to slowing down the progression of myopia in children. Over the observation period, the refraction increase in the main group was 3.2 times lower than in the control group, whilst AL growth was 2.8 times lower than that in the control group. The children using spectacles with Stellest™ lenses showed a higher increase in RAR as compared to children wearing monofocal spectacles. The accommodation tone and objective accommodation parameters were essentially the same in both groups. Wearing Stellest™ glasses had no pronounced effect on binocular interaction.

Correlation between Eye Movements and Asthenopia: A Prospective Observational Study.

Purpose: To analyze the correlation between eye movements and asthenopia so as to explore the possibility of using eye-tracking techniques for objective assessment of asthenopia. Methods: This prospective observational study used the computer visual syndrome questionnaire to assess the severity of asthenopia in 93 enrolled college students (age 20−30) who complained about asthenopia. Binocular accommodation and eye movements during the reading task were also examined. The correlations between questionnaire score and accommodation examination results and eye movement parameters were analyzed. Differences in eye movement parameters between the first and last reading paragraphs were compared. The trends in eye movement changes over time were observed. Results: About 81.7% of the subjects suffered from computer visual syndrome. Computer visual syndrome questionnaire total score was positively correlated with positive relative accommodation (p < 0.05). In the first reading paragraph, double vision was positively correlated with unknown saccades (all p < 0.05). Difficulty focusing at close range was positively correlated with total fixation duration, total visit duration, and reading speed (all p < 0.05). Feeling that sight was worsening was positively correlated with regressive saccades (p < 0.05). However, visual impairment symptoms were not significantly correlated with any accommodative function. In a total 20 min reading, significantly reduced eye movement parameters were: total fixation duration, fixation count, total visit duration, visit count, fixation duration mean, and reading speed (all p < 0.01). The eye movement parameters that were significantly increased were: visit duration mean and unknown saccades (all p < 0.001). Conclusion: Eye tracking could be used as an effective assessment for asthenopia. Among the various eye movement parameters, a decrease in fixation duration and counts may be one of the potential indicators related to asthenopia.

Accommodation Response Variations in University Students under High Demand for Near-Vision Activity.

The objective of this study was to investigate accommodation changes and visual discomfort in a university student population after a period of high demand for near-vision activity. A total of 50 university students aged between 20 and 22 years were recruited. The tests performed involved positive relative accommodation (PRA), negative relative accommodation (NRA), accommodation amplitude (AA), and monocular and binocular accommodative facility (MAF and BAF). Visual discomfort was measured on a scale involving a visual discomfort questionnaire (VDQ). All accommodative variables underwent changes during the exam period; specifically, regarding NRA and PRA, 30.4% and 15.1% of the studied population, respectively, appeared to be below average. Moreover, 42.3% of the population exhibited values below average in the second measure of AA. On the other hand, a small percentage of the population was below average in MAF and BAF measurements: 3% in the monocular right eye test, 6% in the left eye test, and 9.1% in the binocular facility test. Finally, the VDQ score did not reveal a statistically significant difference between the two measurements. Prolonged near-distance work, such as a university exams period, changed all accommodation systems (amplitude of accommodation, relative accommodation, and accommodation facility). These changes influence an accommodation excess that results in blurred vision, headache, and problems with focusing.

Сравнительная оценка эффективности рефракционной лазерной коррекции и контактной коррекции в лечении нарушений аккомодации у детей с гиперметропической анизометропией и амблиопией

Purpose. А comparative study of accommodation disorders during the treatment of amblyopia in children with hyperopic anisometropia and amblyopia after femtolaser-assisted laser intrastromal keratomileusis (FS-LASIK) and children with contact correction. Material and methods. All of the patients were divided into two groups: I group consisted of 20 children who had FS-LASIK, performed according to indications in the amblyopic eye and II group consisted of 12 children who had contact correction. Results. After one year, the objective accommodative response (OAR) of the amblyopic eye was –1.8 ± 0.2 diopters in the 1st group and –1.42 ± 0.55 diopters in the 2nd group (рm-u = 0.04). At the end of the period, the first and second groups' objective reserves of relative accommodation (ORRA) were –1.5 ± 0.3 and –1.4 ± 0.4, respectively. The accommodogram coefficients also increased. The coefficient of accommodative response (CAO) in the first group was 0,1 ± 0,06 conv. units and microfluctuations coefficient (CMF) was 63,5 ± 4,1µF/min. CAO in the second group was within 0,0 ± 0,1 conv. units (рm-u = 0.12), CMF was 60.6 ± 4.0µF/min (рm-u = 0.05). Conclusion. The use of a soft contact lens in children provides a complete correction and improves amblyopic eye accommodation, resulting in an increase in OAR, ORRA and CMF. At the same time, the increase in OAR, CMF and CAO in children after femtosecond laser intrastromal keratomileusis in situ is more effective (p &lt; 0.05). The improvement of these indicators is associated with the provision of permanent full correction of the amblyopic eye. Keywords: anisometropia, hypermetropia, FS-LASIK, contact correction

Changes in accommodation and convergence function after refractive surgery in myopic patients.

In recent years, with the gradual maturation of myopia correction surgery, the changes in binocular visual function after surgery have attracted widespread attention. The accommodation of facility, the amplitude of accommodation, relative accommodation, and accommodation convergence/accommodation assembly are essential parameters for assessing binocular visual function. The changes in these parameters are significant for guiding patients in the design of the preoperative surgical approach and alleviating postoperative visual fatigue. This paper aims to guide the preoperative assessment, design, and postoperative visual training of refractive surgery in myopic patients from the perspective of changes in binocular visual function before and after myopia and surgery, which can improve accommodation and convergence function in patients after refractive surgery.

Ортокератология как компонент функционального и патогенетического лечения прогрессирующей миопии

Purpose. To study the effect of orthokeratological correction (OK-correction) on the indicators of accommodation function and the gradient of myopia progression. Material and methods. We observed 100 patients (200 eyes) aged 6 to 18 years, wearing OK lenses. Patients were divided into subgroups by age: from 6 to 12 years and from 12 to 18 years old. In all patients the reserve of relative accommodation (RRA), the volume of absolute accommodation (VAA) were determined, as well as the eye length by optical biometry. These studies (except for OBM) were performed before fitting the OK-lenses, in 1 month and in 3 months of wearing lenses. OBM was performed on the IOL-Master device (Carl Zeiss, Germany) before the selection of lenses and after 1 year of using them. Results. All patients showed an improvement in the function of the accommodative apparatus and a decrease in the annual gradient of myopia progression: after 1 month of wearing OK-lenses, there was an increase in the RRA value in both age groups at all degrees of myopia. In 3 months of wearing OK-lenses, the RRA value reached the level of the age norm, regardless of the magnitude of the initial ametropia. The vast majority of patients showed an increase in the axial length of the eye. The annual progression gradient in patients of all groups was significantly less than in patients without OK-correction. Conclusions. Orthokeratology is an effective technique that contributes to the correction of functional disorders of accommodation in myopia and reduces the rate of its progression in children and teenagers. Keywords: orthokeratology, myopia, annual gradient of progression, peripheral defocus, optical biometry, accommodation.

Clinical features and treatment of near-work-related acquired esotropia.

To investigate the characteristics of near-work-related esotropia and the clinical efficacy of botulinum toxin type A (BTXA) injection therapy on it. A total of 107 patients aged 15-57y with near-work-related esotropia were taken as the BTXA-treated group, and 30 other peers without near-work-related esotropia were included in the control group. All participants were refractive corrected to analyse the clinical characteristics of near-work-related esotropia. All subjects were examined including Worth4 spot examination, stereoscopic vision, strabismus angle, accommodative convergence to accommodation ratio (AC/A), far and near positive and negative convergence, positive and negative fusion range, positive and negative relative accommodation. Clinical efficacy was evaluated at a period of 10mo follow-up. The distant and near stereopsis were found in 84.9% and 77.5% of patients in the BTXA-treated group, respectively. In the control group, all patients had distant and near stereopsis. The incidence of taking off one's glasses to see close objects was significantly higher in the BTXA-treated group than in the control group (P<0.05). The BTXA-treated group showed a smaller range of in-fusion (9.84±5.72)° than the control group (22.04±8.71)° (P<0.05). The near esotropia angle of the BTXA-treated group (17.08±11.98)Δ was significantly smaller than the distant esotropia angle (19.07±11.68)Δ (P<0.05). Ten months after injection, the diplopia and esotropia of most patients underwent improvements after treatment (P<0.05). This study reveals that the accommodation function and the habit of near work without wearing spectacles are associated with near-work-related esotropia, while the length of time for near work and the onset time are independent of near-work-related esotropia. Additionally, BTXA injection therapy plays a vital role in relieving diplopia and restoring eye position.

Low-intensity red-light therapy in slowing myopic progression and the rebound effect after its cessation in Chinese children: a randomized controlled trial.

To investigate the effect of low-intensity red-light (LRL) therapy on myopic control and the response after its cessation. A prospective clinical trial. One hundred two children aged 6 to 13 with myopia were included in the LRL group (n = 51) and the single-focus spectacles (SFS) group (n = 51). In LRL group, subjects wore SFS and received LRL therapy provided by a laser device that emitted red-light of 635nm and power of 0.35 ± 0.02 mW. One year after the control trial, LRL therapy was stopped for 3months. The outcomes mainly included axial length (AL), spherical equivalent refraction (SER), subfoveal choroidal thickness (SFCT), and accommodative function. After 12months of therapy, 46 children in the LRL group and 40 children in the SFS group completed the trial. AL elongation and myopic progression were 0.01mm (95%CI: - 0.05 to 0.07mm) and 0.05 D (95%CI: - 0 .08 to 0.19 D) in the LRL group, which were less than 0.39mm (95%CI: 0.33 to 0.45mm) and - 0.64 D (95%CI: - 0.78 to - 0.51 D) in the SFS group (p < 0.05). The change of SFCT in the LRL group was greater than that in the SFS group (p < 0.05). Accommodative response and positive relative accommodation in the LRL group were more negative than those in the SFS group (p < 0.05). Forty-two subjects completed the observation of LRL cessation, AL and SER increased by 0.16mm (95%CI: 0.11 to 0.22mm) and - 0.20 D (95%CI: - 0.26 to - 0.14 D) during the cessation (p < 0.05), and SFCT returned to baseline (p > 0.05). LRL is an effective measure for preventing and controlling myopia, and it may also have the ability to improve the accommodative function. There may be a slight myopic rebound after its cessation. The effect of long-term LRL therapy needs to be further explored. Chinese Clinical Trial Registry: Chinese Clinical Trails registry: ChiCTR2100045250. Registered 9 April 2021; retrospectively registered. http://www.chictr.org.cn/showproj.aspx?proj=124250.

Measures of accommodative function in secondary school year 9 and year 13: a 4-year longitudinal study.

PurposeTo characterize accommodative function in secondary school children in year 9 and year 13 and assess the possible relationship between daily working conditions (number of near work hours and distances) and accommodation variables related to accommodative excess.MethodsThis was a prospective study. Participants were 43 subjects who were first examined in year 9 and then again when they were in year 13. The accommodation variables measured in each session were as follows: accommodation amplitude (AA), accommodative response (AR), monocular and binocular accommodation flexibility (MAF and BAF), negative relative accommodation (NRA), and positive relative accommodation (PRA). Other data recorded were the number of hours spent working at near vision tasks and the distances used for these tasks. Participants were classified as those with accommodation variables within the normal range (NA) and those with variables suggesting accommodative excess (AE).ResultsSeveral accommodative function variables were below normative values in both year 9 and year 13. The number of subjects classified as having AE went from 27.9% in year 9 to 58.1% in year 13 according to AR (p < 0.005) and from 23.3 to 46.5% according to MAF (p = 0.024). More near work was reported in year 13 (44.6 h/week) than year 9 (32.7 h/week) (p < 0.001). It emerged that subjects in year 13 spent more hours working at near if they had AE than if they were assigned to the NA group. No differences were detected in near work distances used by subjects in the NA and AE groups in both years.ConclusionsIn both school years, values outside the norm were detected in several accommodative function measures. Also, devoting more hours to near work was linked to a greater extent of accommodative excess. We would therefore recommend regular accommodative function assessment in secondary school children.

장애인 근로자 등에 대한 정당한 편의제공 의무의 법적 근거와 성격

The most direct legal basis for the obligation to provide just accommodation to employees with disabilities is the Anti-Discrimination against and Remedies for Persons with Disabilities Act(ADRPDA). ADRPDA divides discrimination into direct discrimination, indirect discrimination, and refusal to provide just accommodation. The UN Convention on the Rights of Persons with Disabilities(CRPD) has separate provisions for non-discrimination and the obligation to provide reasonable accommodation in relation to employment. CRPD is an international treaty that has been ratified and agreed to by the National Assembly and has the same effect as domestic laws, so it can serve as a legal basis for the obligation to provide accommodation. In particular, CRPD are particularly useful in areas that set a higher or more specific level of coverage than ADRPDA, such as not acknowledging reasons for defense, such as excessive burden in the area of accessibility standards, or specifying conditions for a safe and sanitary working environment. The obligation to provide accommodation to employees with disabilities can also be derived based on general anti-discrimination provisions such as the Employment Act for the Disabled, the Welfare Act for the Disabled, the Labor Standards Act, and the Equal Rights of the Constitution. This discussion has great benefits in that the provisions on the obligation to provide accommodation under ADRPDA is incomplete in several respects. The obligation to provide accommodation can be derived normatively from the concept of non-discrimination, and has essentially a legal character as a non-discrimination. The duty of accommodation originated from the United States. Under the Civil Rights Act of 1964, in the field of employment discrimination based on religion, the principle that refusal to provide accommodation constitutes discrimination was applied for the first time. After that, refusal to provide accommodation was recognized as discrimination in relation to the prohibition of discrimination in employment based on disability under the Rehabilitation Act of 1972. At the same time, the employer's obligation to provide accommodation grants the other party the right to claim the fulfillment of the obligation to provide accommodation. The duty to provide accommodation and the right to request accommodation can also be derived from contract law through the concept of the duty of consideration based on the labor contract. The above review on the legal basis and nature of the obligation to provide accommodation gives many implications to the discussion of various issues related to the obligation to provide accommodation in ADRPDA.

Development and validation of a novel nomogram for predicting the occurrence of myopia in schoolchildren: A prospective cohort study

Myopia is a major public health issue and occurs at young ages. Apart from its high prevalence, myopia results in high costs and irreversible blinding diseases. Accurate prediction of the risk of myopia onset is crucial for its precise prevention. We aimed to develop and validate an effective nomogram for predicting myopia onset in schoolchildren. School-based prospective cohort study. A total of 1073 schoolchildren were enrolled from November 2014 to May 2019 in China, and were divided into the training and validation cohorts. Myopia was defined as a spherical equivalent refraction (SER) ≤-0.5 diopters. Predictors of myopia were determined through the least absolute shrinkage and selection operator regression and multivariable Cox proportional hazard model based on the training cohort. The predictive performance of the nomogram was validated internally through time-dependent receiver operating characteristic (ROC) curves, calibration plot, decision curve analysis, and Kaplan-Meier curves. Independent predictors at baseline including gender, SER, axial length, corneal refractive power, and positive relative accommodation were included in the nomogram prediction model. This nomogram demonstrated excellent calibration, clinical net benefit, and discrimination, with all the area under the ROC curves (AUCs) between 0.74 and 0.86 in the training and validation cohorts. The Kaplan-Meier curves showed that 3 distinct risk groups stratified through X-tile analysis were well discriminated and robust among subgroups. The Harrell's C-index and net reclassification improvement demonstrated that the nomogram substantially improved compared with previous models. An online myopia risk calculator was generated for better individual prediction. The nomogram provides accurate and individual prediction of myopia onset in schoolchildren. External validation is needed to verify the generalizability of this nomogram.

Нарушения аккомодации и вергенции как причина астенопии после лазерных рефракционных операций

Purpose. To evaluate reasons and frequency of asthenopia after refractive surgery. Methods. This study prospectively evaluated 40 eyes of 20 patients. Accommodative amplitude and facility, positive and negative relative accommodation, binocular vision, near point of convergence, heterophoria measurement, AC/A, and accommodative lag were assessed before and 1 month after surgery. This study also evaluates retrospectively 200 eyes of 100 patients within 1 year after surgery. Results. There was no significant impact upon accommodation in prospective group. Asthenopia was found in 7 % of patients in 1 month after surgery and in 1 % in 1 year. It was related with convergence insufficiency in 4 %, convergence excess in 2 % and accommodative insufficiency in 1 %. Conclusions. Refractive surgery does not seem to cause asthenopia. Most problem in fact is already present prior to surgery. Patients with such non-strabismic binocular dysfunction as convergence insufficiency, convergence excess, accommodative insufficiency are in high risk of asthenopia. Preoperative assessment of refractive surgery patients should include a full binocular examination. Key words: refractive surgery; asthenopia; non-strabismic binocular dysfunction; convergence insufficiency; convergence excess; accommodative insufficiency Страница источника: 78-81 Виртуальная выставка КАТАЛОГ Продукции Каталог Продукция Производители Поставщики ОРГАНИЗАЦИИ Офтальмологические клиники, производители и поставщики оборудования