Accommodation Research Articles

OSG’s Healing Cottage Design with a Cozy Retro Vintage Style

In this era of modernization, many changes have been made to humanlifestyles.The effects of modernization have had many changing impacts, one ofwhich is the dominance of the use of foreign culture in the architectural andinterior fields, both in houses, cottages, hotels and other accomm odation. Thisresearch discusses the design of cottage interior designs related to foreign culturalissues that dominate in the era of modernization. By applying OSG's healincottageconcept with a cozy retro vintage style which aims to create a comfortable andcalming room atmosphere, this design uses the concept of a combination of Osingculture because it has a variety of aesthetics and cultures that are rarely found aswell as classic concepts such as retro vintage which supports an antique andelegant impression with a few gold accents applied in various corners of the room.This design uses materials that are soft and easy to care for. The aim of thisresearch is to maintain one's own cultural traditions, but not eliminate theelements of modernization and introduce Indonesian culture to citizens both athome and abroad.

Pilot Study Assessing the Safety and Acceptance of a Novel Virtual Reality System to Improve Visual Function

ABSTRACT Purpose To assess the feasibility of the clinical use of a novel Virtual Reality (VR) training software designed to be used for active vision therapy in amblyopic patients by determining its preliminary safety and acceptance on the visual function of healthy adults. Methods Pilot study enrolling 10 individuals (3 men, 7 women, mean age: 31.8 ± 6.5 years) with a best-corrected visual acuity (BCVA) of ≥ .90 (decimal) in both eyes were evaluated before and after 20 minutes of exposure to the NEIVATECH VR system using the HTC Vive Pro Eye head mounted display. Visual function assessment included near (40 cm) and distance (6 m) cover test (CT), stereopsis, binocular accommodative facility (BAF), near point of convergence (NPC), near point of accommodation (NPA), accommodative-convergence over accommodation (AC/A) ratio and positive and negative fusional vergences. Safety was assessed using the VR Sickness Questionnaire (VRSQ) and acceptance using the Technology Acceptance Model ;(TAM). Changes in all these variables after VR exposure were analyzed. Results Short-term exposure to the NEIVATECH VR system only induced statistically significant changes in distance phoria (p = .016), but these changes were not clinically relevant. No significant changes were observed in VRSQ oculo-motricity and disorientation scores after exposure (p = .197 and .317, respectively). TAM scores showed a good acceptance of the system in terms of perceived enjoyment and perceived ease of use, although some concerns were raised in relation to the intention-to-use domain. Conclusion Exposure to the NEIVATECH VR system does not seem to adversely affect the visual function in healthy adults and its safety and acceptance profile seems to be adequate for supporting its potential use in other populations, such as amblyopic patients.

Baseline Accommodation and Binocular Vision Measures in Malay Schoolchildren Enrolled in the Myopia Control Study Using Spectacle Lenses in Kuala Lumpur.

Myopia control lenses have been shown to modify visual function; however, it is arguable if these changes are short-term or long-term. We investigated the changes in accommodative behaviour and binocular vision functions of Malay myopic children who participated in a myopia control trial utilising spectacle lenses (n = 40). This article presents baseline accommodation and binocular vision measurements. The mean (± SD) age, spherical equivalent measured by cycloplegic autorefraction, and axial length (AL) for the right eyes were 10.00 ± 1.47 years, -3.02 ± 1.20 D, and 24.42 ± 0.93 mm, respectively. All participants had good distance and near visual acuities with high-contrast charts (100%), which were significantly better than low-contrast charts (10%) (p < 0.001). The mean (± SD) accommodative lag at baseline was 1.14 ± 0.35 D, while monocular and binocular accommodative amplitudes were 15.35 ± 2.07 D and 16.82 ± 2.27 D, respectively. Malay schoolchildren in this study were more esophoric at near compared to distance, with an accommodative-convergence over accommodation (AC/A) ratio of 5.64 ± 0.66 ∆/D. A higher degree of myopia was found to be associated with a longer AL (r = -0.49, p < 0.05) and higher esophoria at near (r = -0.46, p < 0.05). These baseline measures are consistent with data from other studies showing that myopic children have a high accommodative lag, an elevated AC/A ratio, a longer AL, and are more esophoric at near. The measures reported herein will serve as a basis for examining changes that occur within 12 months of wearing myopia control spectacle lenses.

The effects of accommodations and curriculum modifications on academic performance and perceived inclusion: a prospective longitudinal study among students in Switzerland

ABSTRACT Although inclusion generally affects students with special educational needs positively, it remains unclear whether specific integrative school measures have beneficial or detrimental effects on their academic performance and perceived inclusion. Unlike previous studies, the present paper differentiates between various types of integrative school measures, such as curriculum modifications (i.e. reduced individual learning objectives; RILO) and accommodations (AC). It explores their effects on academic performance and perceived inclusion. Analyses are based on a prospective longitudinal study of 1123 students (baseline at fifth/sixth grade, mean age 12.4 years old, and follow-up at eighth/ninth grade, mean age 15.3). Propensity-score-matching based on potential confounders was used to estimate relative changes in similar students’ academic performance and perceived inclusion, with and without RILO or AC. RILO had significant negative effects on maths and overall academic performance. AC, however, had significant positive effects on academic performance and no negative side effects on perceived inclusion. School teachers and educational professionals should consider the opportunities and risks of different integrative school measures and use RILO in an inclusive, non-stigmatising manner.

Assessing the linkages among tourism industry, economic output, energy consumption, and environmental quality

The prior empirical studies indicate torusim sector as an engine of economic growth worldwide. However, the activities linked with the tourism industries create several environmental problems as they require massive energy consumption. This study empirically explores the influence of tourism sub-sectors, i.e., accommodation (ACC), travel (TSP), food and drinks services (FDS), and shopping and entertainment (SAE) on the environmental quality in China measured by different greenhouse gasses emission and air pollutants. The bound testing ARDL approach has been employed to analyze the relationships for the data from 2001 to 2019. We also account for globalization (GLBN), economic growth (RGDP), and energy consumption (ENG), to normalize the tourism-linked sub-sectors’ environmental effects. The findings revealed that greenhouse gas emissions, especially N2O and CH4, are highly caused by FDS activities related to tourism, whereas CO2 emission is mostly caused by the TSP sector in long-term. Likewise, FDS is the highest causing factor of air pollutants except for PM2.5, and the SAE sector is highly responsible for N2O and CH4 in long-term. Furthermore, all the tourism-related sub-sectors are positively affecting economic growth and energy consumption in long-term, while TSP and SAE sectors contribute higher to the energy consumption and economic growth, respectively. Surprisingly, globalization has been seen to be a significant cause of decreasing greenhouse gases and air pollutants. Finally, the causality analysis outcomes revealed that most of the tourism sub-sectors are significantly causing air pollutants and greenhouse gases. As evidenced by the empirical results, numerous policy measures are proposed for policy initiatives for China to promote its environmental quality.

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.

Использование геоинформационных технологий для анализа влияния открытых пространств на психическое состояние человека

The paper presents the possibilities of using digital elevation and terrain models to assess the impact of open spaces on the psychophysical state of a person. An approach to assessing the impact of the visible boundaries of the surrounding space is described, allowing the construction of virtual reality full-scale models of terrain with predetermined properties for personalization of psychotherapeutic scenarios. The first steps have been taken towards the creation of a methodology for assessing the aesthetic value of the landscape, from the standpoint of its direct influence on the psychophysical state of the observer. Thus, for three territories, fundamentally different in landscape conditions (high-rise buildings in New York, the highlands of the Alps and the gentle-hilly plain of the Central Russian Upland), the shape factor of the perceived space was calculated. It was done considering the surface curvature and the surface area of buildings using digital models of terrain and elevation in GIS. Through the coefficient of accommodation (AC), which compares the space form factor with a similarly calculated brain surface coefficient, the comfort of the environment for a particular person was assessed. In both examples of natural landscapes, AC takes values &gt;0, which indicates comfortable conditions. Spaces with dense high-rise buildings (AC&lt;0), have a more negative impact on the psycho-emotional state of the person. Although the changes in the accommodation coefficient of the perceived space along the route of observer’s movement depending on changes of volumetric area of visibility area was performed. It was found that the more varied the terrain, the more contrasting will be the response to the observer’s condition. The use of GIS-technology and 3D-modeling opens up the prospects of a new approach to the design of virtual reality, allowing to optimize and create personalized VR-programs of psycho-physiological correction.

PRINCIPLE OF REASONABLE ACCOMMODATION ACCORDING THE UNITED NATIONS CONVENTION ON THE RIGHTS OF THE PERSONS WITH DISABILITIES (UNCRPD)

After decades of work at 13 December of 2006 UN enacted ‘convention on right of people with disabilities’ (CRPD) which entered into force on 3 of May of 2008. CRPD is one of the most important international documents, which raised the question of disabled people’s rights and wellbeing. To protect disable people’s rights CRPD implements modern approaches. The CRPD covers an important issue such as the principle of reasonable accommodation. Convention treats denial of principles of reasonable accommodation as a type of discrimination and differs it from any other types of discrimination. Responsibility for reasonable accommodation is an integral part of social model. This article discusses a new type of discrimination - Refuse to provide reasonable accommodation in the context of CRPD. It also analyzes the form and origin of reasonable accommodation.

Vergence and Accommodation Cues in Stereo-Localization during the Small-In Large-Out (SILO) Effect.

A typical procedure in vision therapy is the use of Quoits vectograms to train fusional vergence ranges by improving stereo-localization, which is the ability to correctly locate the target stimulus in space. With this procedure, the Small-In Large-Out (SILO) effect is usually reported in patients with normal binocular vision and accommodation. In this study, the influence of vergence and accommodation cues, as determined with the accommodative-convergence over accommodation (AC/A) ratio, to correctly locate the Quoits vectograms in space was investigated. Twenty participants, aged 29.2 ± 2.8 (mean ± standard deviation) years, without amblyopia or strabismus, were recruited. A geometrical formula was obtained to calculate the theoretical distance to the target stimulus for different vergence demands. Theoretical values were compared with measured distances to the perceived stimuli and stereo-localization accuracy was determined. Stereo-localization accuracy was significantly worse at 10∆ Base In vergence demand (p < 0.001). A statistically significant positive correlation was found between AC/A ratio and stereo-localization accuracy (i.e., worse accuracy) at 10Δ Base Out vergence demand (rho = 0.446, p = 0.049). These findings highlight that AC/A ratio may be a secondary cue for stereo-localization when using vectograms in which the SILO effect is manifest. These results assist in the understanding of the physiological basis of vision therapy procedures.

Tourism subindustry level environmental impacts in the US

ABSTRACT Trends indicate that the tourism and hospitality (TH) industry is significantly contributing to the socio-economic conditions of the economies worldwide. However, TH-led economic development is attained at the cost of environmental pollution. This research explores four TH subindustries’ impacts on greenhouse gas (GHG) emissions and air pollutants in the US. We also considered energy consumption, economic growth, and globalization to normalize TH subindustries’ environmental impacts. The ARDL bounds test approach is applied on a quarterly (2005-2019) time-series data to analyze TH environmental impacts. The findings uncovered that food and drink places (FSDP) contribute higher to GHG (CO2, CH4, N2O) emissions in the long-run than the rest of the subindustries. Compared to the other subsectors, the accommodation (AC) sector contributed higher to air pollutants (CO, NH3, NOx, SO2, VOC, and PM2.5). All the four subindustries positively contribute to energy consumption; however, FSDP, amusement, gambling, and recreation (AGR) subindustries consume higher energy levels. Economic growth has mixed impacts on GHG emissions and air pollutants. Interestingly, globalization shows negative impacts on GHG emissions and air pollutants. Granger causality results show that FSDP, AC, AGR, and performing arts and sports subindustries cause PM2.5. Key implications and policy initiatives are provided.

The Effects of Consumer-grade Virtual Reality Headsets on Adult Visual Function

ABSTRACT Introduction Consumer-grade virtual reality (VR) headset is being used with increasing frequency nowadays, however, the effect on visual function is not clear. Objectives We here investigate whether using VR headset changes adults’ visual function and take into account the possible factors. Methods We compared the uncorrected distant visual acuity (UDVA), uncorrected near visual acuity (UNVA), best corrected visual acuity (BCVA), low contrast visual acuity (LCVA), glare visual acuity (GVA), refractive error (RE), amplitude of accommodation (ACC), and pupil diameter (PD) before and after using VR headset 10 mintues at a time twice per day for 2 successive weeks in 40 volunteers with a mean age of 28.6 years. Differences in these 8 parameters before vs. after VR headset use were analyzed using SPSS 22.0. Results In our study, we found that the amplitude of accommodation had significantly increased by 0.53 (F = 5.673; P = .006) after using, while visual acuity, refractive error and pupil diameter did not show statistically significant changes (P > .05). Correlation test showed that there was no significant correlation between any two parameters on visual function. Conclusion It is discovered that using a consumer-grade VR headset 10 minutes at a time twice daily for 2 weeks improved the amplitude of accommodation of adults dramatically, while neither visual acuity nor refractive error was affected. Abbreviations VR: visual reality; UDVA: uncorrected distant visual acuity; UNVA: uncorrected near visual acuity; BCVA: best corrected visual acuity; LCVA: low contrast visual acuity; GVA: glare visual acuity; RE: refractive error; ACC: amplitude of accommodation; PD: pupil diameter; 3D: three-dimensional; VDTS: visual display terminal syndrome; FOV: field of view; SEQ: spherical equivalent diopter.

Efficacy of vision therapy in impaired stereoscopic depth with intermittent exotropia (true divergence excess) with unilateral amblyopia: a case report

Divergence excess (DE) can be described clinically as exotropia at far greater than the near deviation by at least 10 prism dioptres (PD). We are reporting a rare case of 25-year-old female visited in the eye department for a routine eye check-up with a history of decreased vision in one eye. On examination, it was detected as a case of unilateral amblyopia with intermittent exotropia of true divergence excess with high accommodative-convergence over accommodation (AC/A) ratio. The patient was asymptomatic from exo-deviation due to the presence of binocular vision and good fusional reserve. The patient was started on active conventional vision therapy along with occlusion therapy. Post 16 weeks of constant therapy, a vision assessment with complete squint assessment along with binocular vision tests were performed. The result interprets to support the use of active conventional vision therapy as an integral part of the clinical treatment of amblyopia and intermittent exotropia. The rate of recovery of several monocular functions monitored during the vision therapy period provides the evidence of neural plasticity at multiple sites in the visual pathway in this adult amblyope. Therefore, if an ordered plan is being followed for the management of the patient of unilateral amblyopia and divergence excess, it can yield long-lasting improvement in visual acuity and binocular functions of any age.

FUNCTIONAL RECOVERY OF VOICE FUNCTION IN PATIENTS WITH LARYNGEAL DYSFUNCTION: OBSERVATIONAL STUDY

Introduction: Functional recovery of voice function in patients with laryngeal dysfunction is a slow and lengthy process that is associated with changes in social and economic living conditions. The serious functional damage can also lead to disorders in swallowing and respiratory function. It is believed that paresis passes into definitive if continues for more than 10-12 months due to irreversible changes in the tissues. According to literature data, spontaneous recovery in unilateral vocal cord paralysis is observed in 40% of cases. Low frequency currents with adjustable parameters are frequently used in the practice of electro diagnostics and electrical stimulation in damage of the neuromuscular system and in particular in laryngeal paresis and paralysis. In recent decades, an increase in the number of patients suffering from diseases associated with laryngeal dysfunction was noted by many authors. Interruption of nervous pulsation to laryngeal structures leads to sensory and motor disorders and development of subsequent paralysis of the muscles. Treatment depends on the cause, the severity of the symptoms and time of onset of the disease. It includes non-operative and operative treatment. Non-operative treatment is with good results and should precede surgery. Purpose: The purpose of this study is to objectify the therapeutic options of neuromuscular elektro-phonatory stimulation /NMEPS/ in patients with laryngeal dysfunction. Materials and methods: The study included 21 patients with unilateral dysfunction of n. laryngeus recurens after surgery of the thyroid gland. Patients with complete denervation were excluded from the study. Procedures are preceded by electro-diagnostic in direct laryngoscopy to establish the extent of damage of the nerve and to determin the coefficient of accommodation (ACC) and variable parameters for stimulus currents. Therapeutic session is implemented in two stages: (1) 'heating' with galvanic current, and (2) real NMEPS selective stimulation of the damaged muscle, leaving untreated antagonists or neighboring healthy muscles, accompanied by active and targeted implementation of Förster phonatoric exercises, coughing and breathing. Treatment is organized in courses for 10 days, 20 procedures per course. Results: The results before and after completion of therapeutic course by assessing changes in the coefficient of accommodation(ACC), voice quality, degree of hoarseness, coughing efficiency, presence of dysphagia are reported. After statistical processing of the obtained results a statistical dependence in relation to dysphonia before and after NMEPS therapy was established (p=0.0001), which is expressed in improvement of medium to mild dysphonia. In relation to dysphagia we found improvement from average-heavy to light form of dysphagia and absence of any symptoms of it after treatment, but there are patients with no change observed (44.4%) and statistical dependence (p=0.005) Patients with dysfunction regarding the effectiveness when coughing, before treatment they were: 16.7%, with severe dysfunction, 50.0% with moderate to severe and 33.3% with light. After NMEPS therapy improvement in the condition of patients with moderate-heavy to light form was observed. The non-parametric analysis proved statistical dependence (Z=3.58 ;p=0.0001). All patients were asked to assess the quality of their voice according to the Linkert five-point rating scale. In the beginning of the therapy 44.4% of the patients ranked their voice quality as poor, 50.0% as moderate and 5.6% as good. After treatment improvement in self-assessment of voice quality from moderate to very good and statistical dependence (p=0.0001) was observed. Conclusion: The results of the observational study prove that NMEPS therapy is effective for functional recovery in complex treatment of laryngeal dysfunction. Because of the small number of patients included in the study for better objectifying of the effects of the neuro muscular elektro-phonatory stimulation, the studies should continue.

Efficacy of myopia control by combination of orthokeratology and instillation of low-concentration atropine

Majority of reports regarding methods of myopia control are devoted to the use of orthokeratology lens¬es (OKL) or atropine. The purpose of the study was to estimate the efficacy and safety of using OKL in com¬bination with instillation of 0.01% atropine drops for myopia control in children. Material and methods. Prospective cohort study in¬cluded 34 patients (68 eyes) aged 8 to 14 years old with acquired myopia. Groups with low (17 patients, 34 eyes), moderate (12 patients, 24 eyes) and high (5 patients, 10 eyes) myopia were identified and examined prior to and 6, 12 and 18 months after adding 0.01% atropine instillations to OKL wearing. To assess the degree of pro¬gression of myopia in dynamics the following parameters were evaluated: refraction (by Huvitz MRK 3100P, axial length (AL) by IOL-Master, “Carl Zeiss”, (Germany), ampli¬tude of accommodation (AA) by Grand Seiko WRK-5100K, positive-relative accommodation (PRA), pseudoaccom¬modation (PA) and annual gradient of progression (AGP). Results. The most noticeable effect was observed in patients with low myopia. In patients with low myopia, the rate of annual progression gradient decreased by 3.4 times by 18th month of atropine use; therefore a condition close to stabilization of myopia progression occurred. The data is statistically significant. In patients with moderate myopia, despite the de¬crease of the AGP within 6-month period of atropine use by 3.7 times, the increase of APG was observed by 12th month of atropine use, which continued until 18th month of observation. In spite of this, in comparison with baseline indices, the decrease in the rate of myo¬pia progression was obtained. The data is statistically significant. In patients with high myopia, change in the AGP was not ob¬served within the 6-month period of atropine use; afterwards, a gradual decrease in the rate of myopia progression was noted: AGP decreased by 1.2 times by 12th month. By 18th month of atropine use, AGP decreased by 1.5 times compared to its initial level. The data is statistically significant. Evidently, the inhibitory effect of OKL, which is de¬termined by optical factors such as peripheral myopic defocus, even in combination with atropine, is not suf¬ficient to halt the progression of high myopia, because of structural and biomechanical changes of the sclera. Conclusion. Based on the preliminary results ob¬tained, 100% efficacy of a long-term instillation of low-concentration atropine cannot be claimed, howev¬er, the positive effect does exist and therefore the study continues.

Evaluation of binocular function among pre- and early-presbyopes with asthenopia.

PurposeIndividuals approaching presbyopia may exhibit ocular symptoms as they contend with visual demands of near work, coupled with natural age-related changes in accommodation. Therefore, accommodation and vergence of 30- to 40-year-old, myopic, soft contact lens wearing subjects with symptoms of asthenopia and no history of using multifocal lenses were evaluated.Patients and methodsIn this prospective, observational study, 253 subjects with asthenopia were evaluated by 25 qualified practitioners, each at a different clinical site. Subjects were 30–40 years in age, had symptoms of soreness, eyestrain, tired eyes, or headaches with near work, regularly performed 2–3 consecutive hours of near work, and were undiagnosed with presbyopia. Amplitude of accommodation (AC) and near point convergence (NPC) were measured with a Royal Air Force binocular gauge. Triplicate push up and push down AC and NPC measures were recorded, and average AC values were compared to those calculated using the Hofstetter formula (HF).ResultsThe average AC push up/push down value was significantly better than the HF prediction for this age range (8.04±3.09 vs 6.23±0.80 D), although 22.5% of subjects had mean AC below their HF value (5.36±0.99 D). The average NPC push up/push down value was 12.0±4.69 cm. The mean binocular AC value using the push up measure was significantly better than the push down measure (8.5±3.4 vs 7.6±3.0 D). The mean NPC value using the push up measure was significantly worse than the push down measure (13.0±5.0 vs 11.0±4.7 cm). The most frequent primary diagnosis was ill-sustained accommodation (54%), followed by accommodative insufficiency (18%), and accommodative infacility (12%).ConclusionBased upon a standardized assessment of accommodation and vergence, ill-sustained accommodation was the most frequent diagnosis among this population.

The Aging Factor in Presupposition Processing

The Aging Factor in Presupposition Processing

Analysis of Factors Related to Length of Stay Time in Patients with Back Pain at Emergency Department

Purpose: Most patients with acute low back pain visit emergency room (ER). They mostly need beds, and if their length of stay is longer, it can become difficult to ac commodate new patients at the ER. We analyzed the treatment process of patients with back pain and tried to find method for shortening of the length of stay at the ER. Methods: We retrospectively analyzed the medical records of patients with back pain who visited at our ER for one year. Patients were divided into two groups according to their length of stay at ER and were compared the charateristcs of between two groups. Results: A total of 274 patients were included in the study. Eigthy-nine patients (32.5%) were in the group with less than 3 hours and 185 patients (67.5%) were in the other group. In the comparison of the two groups according to the medical departments, the number of patients who were in group with more than 3 hours were 25 (14.0%) in the emergency department, 94 (50.5%) in neurosurgery, 66 (35.5%) in orthopedic surgery. Length of stay was significantly increased in orthopedic surgery and neuro surgery (p=0.014). In addition, the length of stay was longer when computed tomog raphy and magnetic resonance imaging examinations were performed (p=0.000). Regardless of the type of analgesic agent, the median time to the analgesic treatment was shorter in the group with less than 3 hours (p=0.034). Conclusions: In patients with back pain who visit the ER, the emergency medicine doctor will early control the pain and do not unnecessary image examination to re duce a length of stay at the ER.

Determining the relative contribution of retinal disparity and blur cues to ocular accommodation in Down syndrome

Individuals with Down syndrome (DS) often exhibit hypoaccommodation alongside accurate vergence. This study investigates the sensitivity of the two systems to retinal disparity and blur cues, establishing the relationship between the two in terms of accommodative-convergence to accommodation (AC/A) and convergence-accommodation to convergence (CA/C) ratios. An objective photorefraction system measured accommodation and vergence under binocular conditions and when retinal disparity and blur cues were removed. Participants were aged 6–16 years (DS n = 41, controls n = 76). Measures were obtained from 65.9% of participants with DS and 100% of controls. Accommodative and vergence responses were reduced with the removal of one or both cues in controls (p < 0.007). For participants with DS, removal of blur was less detrimental to accommodative responses than removal of disparity; accommodative responses being significantly better when all cues were available or when blur was removed in comparison to when proximity was the only available cue. AC/A ratios were larger and CA/C ratios smaller in participants with DS (p < 0.00001). This study demonstrates that retinal disparity is the main driver to both systems in DS and illustrates the diminished influence of retinal blur. High AC/A and low CA/C ratios in combination with disparity-driven responses suggest prioritisation of vergence over accurate accommodation.

Assessing the accommodation response after near visual tasks using different handheld electronic devices.

To assess the accommodation response after short reading periods using a tablet and a smartphone as well as determine potential differences in the accommodation response at various stimulus vergences using a Hartmann- Shack aberrometer. Eighteen healthy subjects with astigmatism of less than 1 D, corrected visual acuity of 20/20 or better, and normal findings in an ophthalmic examination were enrolled. Accommodation responses were obtained under three different conditions: accommodation system of the eye relaxed and visually stressed with a tablet and an smartphone for 10 min, at a distance of 0.25 m from the subject's eyes. Three measurements of accommodation response were monocularly acquired at stimulus vergences ranging from 0 to 4 D (1-D step). No statistically significant differences were found in the accommodation responses among the conditions. A moderate but gradually increasing root mean square, coma-like aberration was found for every condition. Conversely, the spherical aberration decreased as stimulus vergences increased. These outcomes were identified in comparison to the one-to-one ideal accommodation response, implying that a certain lag value was present in all stimulus vergences different from 0 D. The results support the hypothesis that the difference between the ideal and real accommodation responses is mainly attributed to parameters associated with the accommodation process, such as the near visual acuity, depth of focus, pupil diameter, and wavefront aberrations. The wavefront aberrations were dependent on the 3-mm pupil size selected in this study. The accommoda tion response was not dependent on the electronic device employed in each condition, and it was mainly associated with young age and level of amplitude of accommodation of the subjects.

A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes

Background: Vestibular and ocular motor impairments are routinely reported in patients with sports-related concussion (SRC) and may result in delayed return to play (RTP). The Vestibular/Ocular Motor Screening (VOMS) assessment has been shown to be consistent and sensitive in identifying concussion when used as part of a comprehensive examination. To what extent these impairments or symptoms are associated with length of recovery is unknown. Purpose: To examine whether symptom provocation or clinical abnormality in specific domains of the VOMS results in protracted recovery (time from SRC to commencement of RTP protocol). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A retrospective chart review was conducted of 167 patients (69 girls, 98 boys; mean ± SD age, 15 ± 2 years [range, 11-19 years]) presenting with SRC in 2014. During the initial visit, VOMS was performed in which symptom provocation or clinical abnormality (eg, unsmooth eye movements) was documented by use of a dichotomous scale (0 = not present, 1 = present). The VOMS used in this clinic consisted of smooth pursuits (SMO_PUR), horizontal and vertical saccades (HOR_SAC and VER_SAC), horizontal and vertical vestibular ocular reflex (HOR_VOR and VER_VOR), near point of convergence (NPC), and accommodation (ACCOM). Domains were also categorized into ocular motor (SMO_PUR, HOR_SAC, VER_SAC, NPC, ACCOM) and vestibular (HOR_VOR, VER_VOR). Cox proportional hazard models were used to explore the relationship between the domains and recovery. Alpha was set at P ≤ .05. Results: Symptom provocation and/or clinical abnormality in all domains except NPC (P = .107) and ACCOM (P = .234) delayed recovery (domain, hazard ratio [95% CI]: SMO_PUR, 0.65 [0.47-0.90], P = .009; HOR_SAC, 0.68 [0.50-0.94], P = .018; VER_SAC, 0.55 [0.40-0.75], P < .001; HOR_VOR, 0.68 [0.49-0.94], P = .018; VER_VOR, 0.60 [0.44-0.83], P = .002). The lowest crude hazard ratio was for ocular motor category (0.45 [0.32-0.63], P < .001). Conclusion: These data suggest that symptom provocation/clinical abnormality associated with all domains except NPC and ACCOM can delay recovery after SRC in youth and adolescents. Thus, the VOMS not only may augment current diagnostic tools but also may serve as a predictor of recovery time in patients with SRC. The findings of this study may lead to more effective prognosis of concussion in youth and adolescents.