Clinical Optometry Research Articles

Teaching through their eyes: effects on optometry teachers' adaptivity and students' learning when teachers see students' gaze.

Adaptive teacher support fosters effective learning in one-to-one teaching sessions, which are a common way of learning complex visual tasks in the health sciences. Adaptive support is tailored to student needs, and this is difficult in complex visual tasks as visual problem-solving processes are covert and thus cannot be directly observed by the teacher. Eye-tracking apparatus can measure covert processes and make them visible in gaze displays: visualizations of where a student looks while executing a task. We investigate whether live dynamic gaze displays help teachers in being more adaptive to students' needs when teaching optical coherence tomography interpretation in one-to-one teaching sessions and whether this fosters learning. Forty-nine students and 10 teachers participated in a one-to-one teaching session in clinical optometry. In the control condition, teachers saw the learning task of the student and could discuss it with them, whereas in the gaze-display condition, teachers could additionally see where the student looked. After the 15-minute teaching session, a test was administered to examine achievement. Furthermore, students filled in the 'questionnaire on teacher support adaptivity', and teachers rated how adaptive their support was. Bayesian analyses provide some initial evidence that students did not experience support to be more adaptive in the gaze-display condition versus the control condition, nor were their post-test scores higher. Teachers rated their provided support as being more adaptive in the gaze-display versus the control condition. Further research could investigate if live dynamic gaze displays impact adaptive teaching when used over longer periods or with more teacher training.

Smart Devices in Optometry: Current and Future Perspectives to Clinical Optometry.

There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.

The Design and Testing of an Additive Manufacturing-Obtained Compliant Mechanism for the Complex Personalisation of Lenses in Clinical Optometry

The Design and Testing of an Additive Manufacturing-Obtained Compliant Mechanism for the Complex Personalisation of Lenses in Clinical Optometry

Aspects Related to the Design and Manufacturing of an Original and Innovative Marker Support System for Use in Clinical Optometry

The compliant mechanism studied in this paper is used in the structure of an assembly necessary for the temporary mounting of visual markers on glasses frames. Proper correction of vision defects in patients is a field of study in healthcare that has grown in complexity, along with all aspects of technology, over the past decades. As such, along with better lenses and frames, including custom solutions, the devices used to determine the patient’s specific parameters need to be more complex and precise. However, this is only part of the problem: while many devices exist that take measurements such as interpupillary distance with great precision, these come at a very high cost and do not take into account aspects related to real-life usage of the lenses, such as the patient’s position, angle, etc. Given the considerations above, this paper approaches the design, simulation, realization and testing of a working model of a frame used to support markers used in the optometry process. The design proposed in this paper assumes that the system used can be used while the glasses are mounted on the patient’s face, without influencing in any way their position in front of the patient’s eyes. Furthermore, the system must allow assembly and disassembly with minimal effort, to allow the patient to perform some movements without changing the position of the frame, as well as the easy access to the markers mounted on the spectacle frame. The main scope of the paper is to design and choose the correct constructive solution of a compliant mechanism for this important clinical optometric application in terms of geometric parameters, material and technology used to obtain appropriate performances. The authors highlight how the parameters and manufacturing technology for the device were chosen, and a finite element analysis is used to simulate the mechanical behaviour of the mechanism and to choose the optimal variant in terms of the desired displacement between three proposed materials for the given application. After justifying the choice of the constructive solution, several physical models of optometric support markers were realised using Fused Deposition Modeling (FDM), and Polyethylene terephthalate glycol (PETG) or polylactic acid as materials. Furthermore, an electro-pneumatic experimental test stand was developed to simulate and test the functionality of the device and to validate the proposed model.

Neoplastic Disorders of Visual Apparatus: Advances and Management

Purpose: Ocular neoplasms, both primary and metastatic, may present with visual disturbance or vision loss and often are asymptomatic. Clinical examination may demonstrate leukocoria, abnormal pupillary light reflex, or a mass lesion with or without retinal detachment or hemorrhage. Retinoblastoma in children and uveal melanoma and ocular metastases in adults are the most important ocular malignant neoplasms referred for imaging to aid with diagnosis and staging. Familiarity with their common imaging appearances, the common patterns of spread, and the diagnostic findings of greatest concern to the optometrist or ocular oncologist will enhance accuracy of imaging interpretation.
 Methodology: Clinical examination and imaging using B-scan ultrasound, A-scan ultrasound, fluorescein angiography, computed tomography and magnetic resonance imaging have complementary roles in ocular tumor staging and treatment assessment.
 Findings: Ocular neoplasm tumors are relatively rare but require unique diagnostic and treatment considerations given the functional importance of the eye and periocular structures and their unique metastatic behavior. In the following paper, a major malignant tumor of the ocular adnexa including the eyelid, conjunctiva and orbit will be reviewed. Frozen section control of the margins and, in selected cases, Mohs microsurgery have decreased the recurrence rate in malignant eyelid tumors. Intraoperative cryotherapy and postoperative topical mitomycin C have similarly contributed to better surgical outcomes in conjunctival malignant tumors including squamous cell carcinoma and malignant melanoma. Immunotherapy with CD20 antibodies is a developing treatment in Ocular neoplasm lymphomas.
 Unique Contribution to Theory, Practice and Policy: Optometrists by the new advances in clinical optometry training/research, and specialists in occuloplasty/ocularistry form part of the team for a multidisciplinary approach in the clinical management of neoplastic disorders of visual apparatus.

Kongsberg Vision Meeting Abstracts 2022

Kongsberg Vision Meeting 2022: Abstracts
 Kongsberg Vision Meeting was held at the University of South-Eastern Norway in Kongsberg, for the 14th time, on November 7–9, 2022. The meeting was organised as a three-day meeting with a lighting design dayfollowed by two clinical optometry and vision research days. Rigmor C. Baraas, Sylvia Pont, Helle K. Falkenberg, Vibeke Sundling, Tove Lise Morisbakk, Gro Horgen Vikesdal, Lotte-Guri B. Steen, Trine Langaas, Randi Mork and Are Røysamb organised the three-day meeting. The theme this year was Light & Vision in a Public Health Perspective. Keynote speakers for the lighting design day was Wout van Bommel and for the research day were Bruce Moore and Vibeke Sundling. Lee Turner from the Department for Education, His Majesty’s Government, UK and Mark Mon-Williams, University of Leeds and Bradford Institute of Health Research, UK held a special session on the randomized control trial (RCT) Glasses-in-Classes, a project run in state-funded primary schools based in the Metropolitan area of Bradford (UK) to ensure that children who need eyeglasses both have access to an eye examination as well as two pairs of glasses. Teachers are informed and trained to ensure children who have been prescribed with glasses wear them at school, and that their spare pair is available if they attend school without their home pair. Preliminary results from the RCT show that wearing eyeglasses over one school year significantly improves reading and literacy skills when a child who need eyeglasses wears them as compared with those who need eyeglasses, but do not wear them. The abstracts from the other invited and contributed talks on the different days are presented in the order they were given.
 
 Received October 1, 2022. Accepted November 1, 2022.

Harnessing the potential of practice-based clinical optometry research in the United Kingdom.

Research is the core of evidence-based practice across all healthcare, in order to ensure optimum patient care. The College of Optometrists is a national standard setting institution for optometric practice in the United Kingdom. However, the standards are only as good as the available evidence, and currently there is little evidence relating directly to optometric practice. The National Institute of Health and Care Research, the General Medical Council and The College of Optometrists, amongst others, have published research strategies describing ambitious plans to expand the scope of healthcare research. The aim of this article is to raise awareness of these government initiatives and consider how they may relate to optometric practice. To improve optometrist research engagement, we need to address the barriers to research and implement strategies to overcome them. There are many opportunities to support research, with different degrees of involvement, from signposting patients to research studies, supporting recruitment or collecting data for a multicentre clinical trial, as well as undertaking an individual research project. Healthcare research is changing and there is scope for more practice-based research activities in optometry. Research should not be a solo endeavour but a multi-disciplinary effort. Greater collaborations across all stakeholders, including primary care, secondary care, academia, regulators and industry is needed to make this possible.

A second pair of eyes: Remediating formative assessment in a clinical optometry module using a video annotation tool

This paper studies how implementing video-based formative assessment using an online video annotation tool remediates an existing approach to formative assessment and exam preparation in a clinical optometry module. Using a case study methodology and an activity theoretical framework, and incorporating Engeström’s notion of expansive learning, it analyses uses of the tool and practice change among a group of 20 undergraduate students. It highlights the contextual factors that inform the development of the new activity system and the multiple contradictions inherent in it. In doing so, it contributes to the literature on student experiences of video-based formative assessment in health HE. It finds that students are likely to experience the benefits of the approach, such as supportive, objective, and contextualised feedback, if tutor and student roles are clearly communicated and tutors are flexible, adopting either more tutor-facilitated or more student-centred approaches to peer assessment to suit the needs of different peer groups. Using example videos and posts to scaffold reflection and feedback might reduce some of the affective barriers to participation and build group dynamics and interaction.Keywords: Video annotation; video-based formative assessment; self-reflection; peer feedback; health HEPart of the special issue Activity theory in technology enhanced learning research <https://doi.org/10.21428/8c225f6e.cbaae672>

Accuracy of vertical cup-to-disc ratio discrimination among clinical optometry trainees with different years of clinical experience.

Accurate evaluation of the cup-to-disc ratio is crucial for optometrists and may be influenced by their clinical experience. The study's objective was to compare the thresholds for discriminating vertical cup-to-disc ratio (VCDR) between years 2, 3, and 4 clinical optometry trainees. One hundred fundus photos with various VCDR sizes were selected from a clinic database. The median VCDR (0.43) photo was assigned as the standard, while the other 99 were assigned as the test photos. The participant's task was to discriminate using a 2-alternate-forced-choice paradigm whether the test photos' VCDR were larger or smaller than the standard VCDR. Data were fit with a Weibull function, and three discrimination thresholds were determined: the point of subjective equality (PSE), the range of VCDR uncertainty, and the ability to judge VCDR that was 0.1 unit larger than the standard photo. Year 4 trainees had better VCDR discrimination thresholds. However, the difference between the three participant groups was not statistically different for all measurements (PSE: F(2,27) = 0.43, p = 0.657; VCDR uncertainty range: F(2,27) = 0.12, p = 0.887), and thresholds for correctly discriminating VCDR 0.1 larger than the standard photo's VCDR: F(2,27) = 0.69, p = 0.512). Although Year 4 optometry trainees performed slightly better at estimating VCDR than their Year 3 and Year 2 peers, the number of years of clinical experiences did not significantly affect their VCDR discrimination thresholds when 2-dimensional fundus photos were used as stimuli.

Refractive and visual function changes in twilight conditions.

PurposeWe investigated the effect of luminance on refraction and visual function under twilight conditions.MethodsTwenty young adults (mean age 20.5 ± 0.5 years) without ocular diseases and 20 eyes were included in the study. Subjective and objective spherical equivalent power (SE), logMAR, pupil diameter, ocular aberration, and ocular axial length were evaluated. Measurements were conducted in a light room with high luminance (300 cd/m2) targets (photopic), in a dark room with low luminance (10 cd/m2) targets (twilight), and a dark room after 15 min of adaptation to low luminance (10 cd/m2) targets (after adaptation: AA). Differences between the three conditions were analyzed using the Friedman test and Scheffe’s multiple comparisons.ResultsThe results of logMAR were -0.20 ± 0.07, -0.08 ± 0.08, and -0.11 ± 0.08 in photopic, twilight, and AA, respectively, with significant differences between photopic and twilight (p < 0.001) and between photopic and AA (p < 0.001). Then subjective SE were -3.58 ± 2.04 D, -3.75 ± 2.08 D, and -3.74 ± 2.04 D in photopic, twilight, and AA, respectively, with significant differences between photopic and twilight (p = 0.007) and photopic and AA (p = 0.023). However, none of the other objective SEs produced a significant difference (p = 0.63). The pupil diameter and ocular aberration changed significantly in all conditions (p < 0.001).ConclusionsSubjective myopic refraction increased and visual resolution decreased in younger subjects. However, this change in refraction is less than one level (±0.25 D) in clinical optometry, so fully corrected eyeglasses are important when assuming refraction in twilight, and there is no need for additional correction.

Kongsberg Vision Meeting Abstracts 2021

Kongsberg Vision Meeting was held at the University of South-Eastern Norway in Kongsberg, for the 13th time, on November 16–18, 2021. The meeting was organised as a three-day meeting with a clinical day, a research day and a lighting design day. Rigmor C. Baraas, Eilin Lundanes, Ann Elisabeth Ystenæs, Ellen Svarverud, Klaus Sjøhaug and Are Røysamb organised the three-day meeting. The theme this year was Speciality Contact Lenses and Architectural Lighting Design. Keynote speakers for the clinical optometry day and the research day were Eef van Der Worp, Nicola Logan, Fabrizio Zeri and Daddi Fadel. The keynote speakers for the lighting day were Sylvia Pont and Manuel Spitschan. The abstracts from invited and contributed talks on the different days are presented in the order they were given.

Recollections of former editors of Clinical and Experimental Optometry

Recollections of former editors of Clinical and Experimental Optometry

Webcams as a tool for teaching in Optometry training

Clinical Optometry lab training is devoted to develop the students skills needed in eye healthcare professional practice. Nevertheless, students always find difficulties in the management of some optometric instruments and in the understanding of the evaluation techniques. Moreover, teachers also have problems in explaining the eye evaluation tests or making demonstrations of instruments handling. In order to facilitate the learning process, webcams adapted to the optometric devices represent a helpful and useful tool. In this work we present the use of webcams in some of the most common clinical test in Optometry as ocular refraction, colour vision test, eye health evaluation with slip-lamp, retinoscopy, ophthalmoscopy and contact lens fitting. Our experience shows that with this simple approach we can do things easier: show the instrument handling to all the students at the same time; take pictures or videos of different eye health conditions or exploratory routines for posterior visualization with all the students; recreate visual experience of the patient during optometric exam; simulate colour vision pathologies; increase the interactions between students allowing them to help and correct each other; and also record the final routine exam in order to make possible its revision with the students.

Descripción y análisis de las tecnologías diagnósticas OCT, HRT y GDx en glaucoma: un enfoque para la optometría clínica

&lt;p align="justify"&gt;&lt;em&gt;Objetivo&lt;/em&gt;: describir y analizar, por medio de una revisión bibliográfica, las tecnologías diagnósticas OCT (tomografía de coherencia óptica), HRT (tomógrafo de Heidelberg) y GDx (analizador de fibras nerviosas) en glaucoma, como un enfoque para la optometría clínica. &lt;em&gt;Materiales y métodos&lt;/em&gt;: se realizó una búsqueda sistemática de literatura primaria en bases de datos como Pubmed, Medline, Cochrane y Elsevier; además, se incluyeron textos literarios relacionados con el tema, escritos en inglés, español y portugués. La información seleccionada estuvo dentro de un periodo de publicación comprendido entre 2007 y 2014. &lt;em&gt;Conclusión&lt;/em&gt;: la OCT utiliza una longitud de onda de 820 nm, valora la retina y determina la aparición de la enfermedad; el HRT funciona con un láser diodo de 670 nm y genera imágenes en tercera dimensión del nervio óptico, lo que lo convierte en la tecnología diagnóstica más específica para valorar glaucoma; el GDx emplea un láser polarizado de 780 nm y evalúa el nervio óptico, por lo cual es ideal para realizar seguimiento de la enfermedad, ya que determina cambios mínimos. Estos equipos tienen aplicabilidad favorable para la detección y el seguimiento del glaucoma; sin importar cuál instrumento se emplee, es fundamental que el profesional tenga la competencia de interpretar los resultados y realizar una correlación con examen clínico.&lt;/p&gt;

ANÁLISIS TOPOGRÁFICOS EN PACIENTES ADAPTADOS CON LENTES DE CONTACTO BLANDOS ESFÉRICOS HIDROGEL DE SILICONA

Objetive: Identify changes in patients tomographic patterns in soft lens wearers silicone hydrogel contact in clinical optometry at the Universidad of Santo Tomas Bucaramanga in 2014.Methods: A study of experimental quantitative masked randomized clinical trial was conducted in which the analysis of topographic changes of the cornea in patients who have adapted them two types of soft contact lenses silicone hydrogel spherical silvers. For the execution of this study, a composite of ten (10) participants shows, who were asked monitored monthly for 3 months, in which visual acuity, among other things features such as topographic indices were evaluated, is used.Results: According to the results, it was found that there were no clinically significant changes during the three months of lens wear, because the curvature and corneal thickness remained within the parameters of normality, even though there was a slight thinning and corneal edema.Conclusions: Although from the beginning some indexes such as the index offset by lifting index vertical asymmetry and asymmetry index elevation was found altered it should be noted that during the study with the use of contact lenses these rates remained the same, in some improved as in the case index by lifting runout.

What do clinical optometrists like about their job?

BackgroundThere are few publications describing what optometrists like about clinical work. The purpose of this paper is to explore what optometrists in practice find satisfying with their work and what they find stressful.MethodsSixty Australian optometrists participated in a 30‐minute semi‐structured telephone or face‐to‐face interview during the period August 2009 to March 2010. The interviews covered a range of topics related to ergonomics and physical comfort, including three questions related to satisfaction with clinical optometry, job satisfaction and self‐perceived work‐stress. These data were subject to qualitative and quantitative analysis.ResultsParticipants reported that they liked clinical optometry because of work‐related factors (for example, clinical challenge) (n = 47, 78 per cent), people‐related factors (e.g. helping people) (n = 29, 48 per cent) and relationships with patients (n = 28, 47 per cent). Clinical freedom was the most frequently cited reason for participants liking their current job (n = 18, 30 per cent). Self‐employed participants were more likely to value relationships with their patients (Chi‐square, p < 0.01). Employee and locum participants were more likely to value relationships with staff (Chi‐square, p < 0.05) and colleagues (Chi‐square, p < 0.05). There were 32 participants (53 per cent) who perceived their work as stressful, most commonly related to clinical issues (n = 25, 42 per cent), workload demands (n = 20, 33 per cent) and management tasks (n = 15, 25 per cent). Clinical issues were a stressor for employee and locum participants (Chi‐square, p < 0.01) and urban practitioners (Chi‐square, p < 0.05). Management tasks were a stressor for independently practising participants (Chi‐square, p < 0.01).ConclusionUnderstanding what clinical optometrists like and find stressful about their work is important for employers, industry and the profession, as these are key elements of employment satisfaction. The information presented in this paper can be used as a basis for developing quantitative tools for assessing job satisfaction and job stress more extensively in the optometric profession.

The interpupillary distance in adult Caucasian subjects, with reference to ‘readymade’ reading spectacle centration

The magnitude of the far interpupillary distance (FIPD) has recognized significance within and beyond clinical optometry. Quantitative information regarding the lesser-reported near parameter (NIPD) would similarly be of interest, and could be of relevance with regard to the visual comfort obtained with 'readymade' reading spectacles. Mensuration statistics relating to the FIPD and NIPD are presented, as collated from the spectacle dispensing records of n = 1354 healthy Caucasian presbyopic subjects. The FIPD data were partitioned across 4 age bands (by decade, 41-80 years of age): the NIPD data were distributed across seven nominal reading powers (in 0.50 D steps, +1.00 to +4.00 D). The results of these analyses are considered here, along with their potential application. Consistent gender (male > female) and classification (far > near) differences in IPD (both of approximately 3 mm) were confirmed throughout these data. The magnitude of the adult FIPD is in accord with previously published results; this dimension is now supplemented by NIPD values, whose relationship with total near power is also described. This new anthropometric survey indicates that inter- and intra-gender interocular facial measurement stability is a characteristic of presbyopic subjects. It is suggested that across the anticipated range of age and total reading power requirement of Caucasian (White Northern European) wearers of 'readymade' reading spectacles, adoption of a standard optical centration distance of 61 mm would be universally appropriate.

CORRESPONDING AND OBLIQUE MOVEMENTS IN RETINOSCOPY

(1932). Corresponding and Oblique Movements in Retinoscopy. Clinical and Experimental Optometry: Vol. 14, No. 12, pp. 10-11.

A web‐based archive for topographic maps of retinal cell distribution in vertebrates

Clinical and Experimental Optometry, in conjunction with Optometrists Association Australia and Professor Shaun P Collin of the University of Queensland, announce the launch of a web‐based archive of previously published topographic maps of retinal cell distribution in vertebrates. At present, the archive boasts more than 770 different maps of the distribution of retinal neurons (for example, photoreceptors, bipolar cells, amacrine cells, horizontal cells and ganglion cells) in nearly 200 species within all vertebrate classes (Cephalospidomorpha, Actinopterygii, Sarcopterygii, Amphibia, Reptilia, Aves and Mammalia). The distribution of retinal neurons has been studied for more than 100 years and has become a powerful means of predicting the spatial resolving power of the eye and the retinal regions containing specialisations, such as areae centrales, horizontal streaks and foveae, where increased densities of neurons define the way in which a species visually samples its environment. The location of these retinal specialisations thereby identifies the part(s) of the visual field of critical importance for localising food and mates and for predator surveillance. The distribution of sampling elements even reflects the symmetry of a species' ecological habitat. The archive is a unique collection of most of the currently available retinal maps, which also presents relevant information, where known, about eye size, retinal cell density, retinal orientation, cell number, spatial resolving power and the type of specialisation, in addition to basic physical parameters of each species (body size, weight, sex and developmental stage). The archive is accessible at http://www.optometrists.asn.au/ceo/retinalsearch and will be updated regularly. The powerful database is interactive and freely available, providing the opportunity to upload both published and unpublished topographic maps. Following a review process, previously unpublished maps will be ‘published’ and available online worldwide. It is hoped that this comprehensive new resource will provide not only an up‐to‐date method of accessing maps of the distribution of retinal neurons in individual species but also allow broader evolutionary comparisons of the visual capabilities, ecology, development and the type(s) of retinal specialisations found in vertebrates.

Implementation of evidence‐based practice in optometry

Evidence‐based practice in health care requires that treatment decisions be supported by high‐quality clinical evidence, preferably involving well‐designed large‐scale clinical trials of the various treatment options. How does this relate to everyday primary‐care optometry? This article provides a background to the emergence of the ‘evidence‐based’ movement and investigates areas where the efficacy of clinical optometry might be improved by an evidence‐based approach. It is argued that evidence‐based practice is appropriate for all aspects of optometry but it may be most useful in the selection of treatments with topical therapeutic agents and in optometry’s growing public health role in the detection and management of sight‐threatening disease.