College Of Optometry Research Articles

Effect of customized near addition lenses on transient myopia induced by near-work

Correspondence: Bai-Chuan Jiang College of Optometry, Nova Southeastern University 3200 S. University Drive, Fort Lauderdale, FL 33328, USA Email bjiang@nova.edu Purpose: To verify whether optimal near add power can reduce near-work induced transient myopia (NITM). Methods: Eighteen subjects including nine progressive myopes (PMs) and nine stable myopes (SMs) were involved in this study. We measured the accommodative error and the near phoria at 40 cm under fully corrected conditions for each subject. These findings were then used to determine optimal near-add power for each subject based on formulae derived from a previous study. Under both with and without near-add conditions, NITM was obtained by comparing the refractions immediately before and after performing continuous computer work at 40 cm for an hour. The refraction was determined by a COAS aberrometer. Results: Using customized near-addition lenses (C-ADD) we found significantly decreased retinal defocus from 0.49 ± 0.12 (SD) D to 0.08 ± 0.11 D. The near phoria showed a significant exophoric shift from -1.84 ± 1.95 prism diopter (pd) to -5.37 ± 1.63 pd, but was still in the normal range. We also found that the differences in NITM between the two groups and between the two conditions (ie, with and without C-ADD) were both significant. Further comparisons indicated that the NITM in the SM group was significantly reduced after using C-ADD; in the PM group the reduction of NITM was not significant. Conclusions: The results suggest that C-ADD balances the load of accommodation and vergence, significantly decreasing retinal blur during the near-work, and may be able to reduce the NITM.

Scheimpflug image–processing method for accurate measurement of ocular surfaces

To develop a method to process Scheimpflug images to estimate higher-order variations in ocular surfaces. New England College of Optometry, Boston, Massachusetts, USA. Zernike polynomial functions were used rather than lower-order surface functions to fit the ocular surfaces to evaluate higher-order variations. A related ray-tracing method was developed to correct optical distortion of the Scheimpflug image. The new method to process Scheimpflug images showed higher-order variations in the posterior corneal surface. In a simulation, ignoring higher-order variations in the anterior corneal surface, as in previous studies, produced an error as high as 202% for some estimated Zernike coefficients of the posterior corneal surface. The results indicate that it is necessary to correct refractive distortion in Scheimpflug images using higher-order surface functions and that the method developed in this study can be used to process scheimpflug images for measurement of ocular wavefront aberrations.

A prospective study of different test targets for the near point of convergence

To determine whether different test targets including an accommodative target (AT), a transilluminator (TR), and a transilluminator with a red lens (RL), affect the near point of convergence (NPC) value; and to determine which test target is most sensitive to identify convergence insufficiency (CI) in young adults. Subjects were 36 optometry students from the Illinois College of Optometry, including 18 subjects with normal binocular vision (control group) and 18 subjects with CI. None of the subjects had accommodative insufficiency. The NPC break and recovery were measured by three methods: AT, TR, and RL. Each test method was administered by a different examiner and the test sequence was randomized. The mean NPC break values for AT, TR, and RL in the control group were 4.31, 3.76, and 4.08 cm respectively, compared to 10.05, 11.37 and 13.04 cm in the CI group. The mean recovery values were 6.23, 5.56, and 5.95 cm for AT, TR, and RL respectively in the control group, vs 12.21, 14.37, 16.40 cm in the CI group. Significant differences in NPC break and recovery values were detected in the CI group between RL and AT, but not between AT and TR, or TR and RL. There was no significant difference in NPC values using the three targets in the control group. For an NPC cut point of 6 cm (break) and 9 cm (recovery), RL had higher sensitivity (100%) and specificity (88.9%) as well as lower false positive (10%) and false negative (0%) values compared to AT. NPC with RL is a more sensitive method to identify abnormal findings and assist in diagnosing CI compared to using AT or TR. We recommend that NPC with RL be routinely used to evaluate patients suspected of having CI.

Efficacy of hand held, inexpensive UV light sources on Acanthamoeba, causative organism in amoebic keratitis

Efficacy of hand held, inexpensive UV light sources on Acanthamoeba, causative organism in amoebic keratitis Ivan Cometa1, Andrew Rogerson1, Scott Schatz21Department of Biology, California State University Fresno, Fresno, CA, USA; 2Arizona College of Optometry, Midwestern University, Glendale, AZ, USAAbstract: Multipurpose lens cleaning solutions (MPS) fail to consistently kill or inactivate Acanthamoeba cysts and UV irradiation, while effective at high doses, can damage contact lenses. The present study considered synergy of action between MPS and hand-held inexpensive (ie, relatively weak) UV irradiation units. Regardless of disinfection method recently formed cysts (14 days). This has important implications for future protocols on testing methods for killing amoebae. The study also showed that cysts of different strains (two tested, FLA2 and P120) are variable in their response to MPS, presumably reflecting differences in cyst wall structure and thus permeability to the disinfectant. On the other hand, the effect of UV irradiation was not wall structure dependent. A 6-hour treatment with MPS alone killed trophic amoebae but failed to kill any mature cysts. Cysts of strain FLA2 were killed after 24 hours with MPS but cysts of strain P120 survived. UV irradiation with the larger 4 W unit killed all cysts after 7 minutes and was more effective than the smaller battery-powered unit (after 10 minutes about 50% of cysts were killed). When the larger unit was used with the MPS disinfection, all trophozoites were killed using UV for 3 minutes and MPS for 1 hour. The resistant P120 cysts remained a challenge but a 2- to 4-minute UV treatment followed by MPS for 3 or 6 hours reduced mature cyst survival by about 50%. The small unit in combination with MPS was less effective but did reduce the time required to kill trophic amoebae in MPS (6 hours MPS alone versus 3 hours MPS with a 1-minute UV treatment). In short, inexpensive UV units do enhance MPS disinfection and future lens cleaning systems/protocols might capitalize on this synergistic action.Keywords: UV light sources, amoebic keratitis, MPS

Opening Remarks for Honoring Eve Symposium, 31 October 2009

Opening Remarks for Honoring Eve Symposium, 31 October 2009 H. A. Sedgwick (bio) I’m grateful to the members of the Boston University (BU) Junior Faculty Gender and Sexuality Studies Group for organizing this symposium honoring Eve and also for very kindly inviting me to be here. It’s about twenty-five years ago that Eve was on the faculty at BU, living just down the block from here in a narrow little walk-up apartment in the shadow of Fenway Park. It surprised me, thinking back, that Eve taught at BU for only two years. That time had a much larger place in her life than its brevity might suggest. Eve was very happy to be here. She had inherited $1,500 from her grandparents and used it to buy her first computer. It was the first of the “portable” computers. It had a four-inch screen, weighed twenty pounds, and looked remarkably like a portable sewing machine. From a restaurant-supply company she bought a cart on wheels—it was called a “rolling relish tray”—put the computer on it, wheeled it up to the edge of her bed, and sat propped up in bed writing Between Men. As some of you know, Eve had been scheduled to lecture at BU this past February. She was so much looking forward to visiting here that, last fall, when her illness increasingly made it seem unlikely that she would be able to travel, she canceled various engagements one after another but hung on to the possibility of the BU lecture until the very last moment, when it was inescapably clear that she simply could not do it. This symposium is, to me, a powerful way of honoring Eve’s wish to be present at BU. Present not just in our memory of her, but as she had wished to be with her lecture, present in her ongoing work. As is clear from the rich program of talks and performances that are planned for today, Eve’s work is ongoing. It continues to give us pleasure, continues to make us just a little bit smarter, and continues to give us encouragement and ideas as we develop new work of our own. [End Page 177] I want to take this opportunity to mention another effort aimed at continuing Eve’s work. Several of us are developing a website that will soon be found at EveKosofskySedgwick.net. We have several ambitions for this website. We want it to provide a guide to those who are new to Eve’s life and work and to provide an archival resource to her friends and colleagues. We also want it to be a portal to events, publications, and other websites concerned with work by and about Eve. Finally, we hope to provide a site where conversations occur—a place for developing and sharing work that draws on or intersects with hers. We’ll be exploring ways of nurturing such an online community, and we welcome suggestions, both while we’re building the website and after it’s been launched. We invite your participation. Thanks. [End Page 178] H. A. Sedgwick Hal Sedgwick lives in New York City and teaches in the Department of Vision Sciences at the State University of New York College of Optometry. He was the partner of Eve Kosofsky Sedgwick from 1968 until her death in 2009. Copyright © 2011 Wayne State University Press

Managing elevated intraocular pressure in a patient with optic nerve hypoplasia

Managing elevated intraocular pressure in a patient with optic nerve hypoplasia Karina Marcovitch, Joseph SowkaNova Southeastern University, College of Optometry, Davie, FL, USABackground: Optic nerve hypoplasia (ONH) is a congenital optic disc anomaly, often manifesting with visual deficits.Case: A 51-year-old woman with a history of bilateral amblyopia was referred for glaucoma evaluation due to elevated intraocular pressure. The patient demonstrated the classic nerve head appearance of bilateral ONH with “double ring sign” and indistinguishable cupping. Despite demonstrating functional and structural measurements consistent with glaucomatous optic neuropathy, it was felt that these deficits were more likely longstanding and secondary to ONH. Additionally, in the absence of any amblyogenic factors, it was also concluded that the patient’s bilateral “amblyopia” was the result of ONH. In that the patient presented with a significant and modifiable risk factor for glaucomatous development and pre-existing retinal nerve fiber layer and visual field defects, the patient was treated with topical glaucoma medications. Conclusion: Diagnosing glaucoma in patients with concurrent anomalies is a clinical conundrum. This report provides a review of ONH with emphasis on the common misdiagnosis of amblyopia in these patients as well as presenting a strategy for diagnosing and managing glaucoma in patients with preexisting, confounding conditions. Keywords: optic nerve hypoplasia, glaucoma, visual field loss, scanning laser polarimetry, threshold automated perimetry

Comparison of two artificial tear formulations using aberrometry

Background: This study investigates the effect of artificial tears of different viscosities on aberrations of healthy eyes.Methods: We recruited subjects from the student population of the Northeastern State University Oklahoma College of Optometry. Using the Complete Ophthalmic Analysis System (COAS), aberrometry measurements were taken every second for 60-seconds with a blink every 10-seconds. We made measurements of the naked eye, then after instillation of TheraTears non‐preserved drops, and after instillation of SystanePF, a more viscous formulation. Zernike coefficients up to the sixth order were recorded and analysed. We evaluated changes in spherical and astigmatic dioptric powers and coma‐like, spherical aberration‐like and total higher‐order aberration (HOA) RMS values as a function of time.Results: Both drops yielded significantly higher values than the naked eye for HOA RMS and cylindrical power as well as a hyperopic shift in spherical equivalent (p < 0.001, paired t‐test). SystanePF, the more viscous tear, showed significantly higher values than TheraTears in HOA RMS and cylinder in all inter‐blink periods (p < 0.001, paired t‐test).Conclusions: This study shows artificial tears can have a measurable and significant impact on aberrations of healthy eyes. This effect is sustained for at least one minute and its magnitude appears to be related to the viscosity of the tear formulation.

Purchase of Journal Portfolios by Research Libraries is not Cost-Effective and May Lead to Normalization of Collections

Purchase of Journal Portfolios by Research Libraries is not Cost-Effective and May Lead to Normalization of Collections

Objective accommodation measurements in pseudophakic subjects using an autorefractor and an aberrometer

To compare objective measures of accommodation with the WR-5100K autorefractor and iTrace aberrometer to subjective push-down and defocus tests in normal phakic subjects and pseudophakic subjects with standard monofocal intraocular lenses (IOLs). University of Houston, College of Optometry, Houston, Texas, USA. The push-down test and defocus curves were used to stimulate and measure accommodation subjectively in pseudophakic subjects. For objective testing, a near target was pushed up and refraction measured objectively. For comparison, the same objective measurements were performed in phakic subjects. Calibration tests were performed with soft contact lenses in phakic subjects with varying refractive error and in pseudophakic subjects. Fifteen phakic subjects (mean age 28.9 years+/-5.52 [SD]) and 10 pseudophakic subjects (mean age 66.2+/-11.23 years) participated. Subjectively measured accommodative amplitude in the pseudophakic group was 3.28+/-1.11 diopters (D) in the right eye and 3.64+/-1.38 D in the left eye. Defocus curves in the pseudophakic group had a range of 2.00 D for distance-corrected visual acuity of 20/40 or better. Objective measurements in the pseudophakic group were 0.11+/-0.50 D with the autorefractor and 0.10+/-0.47 D with the aberrometer. Contact lens calibrations showed good agreement with the 1:1 line. The subjective tests overestimated accommodative amplitude relative to the objective measures. The autorefractor and aberrometer were accurate, reliable, and appropriate for objective accommodation measurements in pseudophakes. Objective accommodation measurements such as these can be used to evaluate the performance of accommodating IOLs.

Comprehensive vision care in urban communities: The pediatric outreach program

Background The Illinois College of Optometry's (ICO) Pediatric Outreach Program (POP) provides comprehensive vision care for high-risk children from birth to approximately 5 years of age in partnership with early intervention programs throughout the city of Chicago. Grant funds assisted in the ability to deliver vision services and spectacles to uninsured children. This report describes the structure and organization of the POP and presents the visual data. Methods Comprehensive eye examinations were performed on 4,298 children ages birth to approximately 5 years at 76 early intervention program sites. All of the children evaluated were enrolled from early intervention/Head Start programs. Visual acuity determination (by Lea method), assessment of binocular status, stereopsis evaluation, cycloplegic retinoscopy, and ocular health evaluations were performed. As necessary, eyeglasses were prescribed. Amblyogenic risk factors, strabismus, and ocular pathology were identified. Results Of the 4,298 children examined, 49% were boys and 51% were girls. Two percent were younger than 12 months old, 6% were 1.1 to 2 years old, 12% were 2.1 to 3 years, 30% were 3.1 to 4 years, 35% were 4.1 to 5 years, 14% were 5.1 to 6 years, and 1% were older than 6 years. Hyperopia and emmetropia were the most common refractive classifications among the children examined. Approximately 6.5% had risk factors for isometropic amblyopia, and 2.3% had risk factors for anisometropic amblyopia. Approximately 1% of the children had strabismus. Less than 1% of the children examined were identified with ocular pathology. Spectacles were dispensed to 16.6% of the children examined. Conclusions The Pediatric Outreach Program provides early identification and treatment of abnormal visual conditions, ensuring that children have maximal visual acuity and visual function. The educational aspects of the program have also contributed to its successes. Education for parents and early intervention agency staff promote the importance of comprehensive vision examinations for children 5 years of age and younger.

Importance of fixation, pupil center, and reference axis in ocular wavefront sensing, videokeratography, and retinal image quality

To examine the impact of the location of the fixation target, pupil center, and reference axis of ophthalmic aberrometers and videokeratographers on the measurement of corneal aberrations relevant to vision. Clinical Research, Visual Optics Institute, College of Optometry, University of Houston, Houston, Texas, USA. The design features of a generic aberrometer and videokeratographer and their interaction with the eye were examined. The results provided a theoretical framework for experimental assessment of pupil translation errors on corneal aberrations relevant to vision and their correction in 129 eyes. Two key principles emerged. First, the aberrometer's measurement axis must coincide with the eye's line-of-sight (LoS). Second, the videokeratographer's measurement axis (the vertex normal) must be parallel with the eye's LoS. When these principles are satisfied, the eye will be in the same state of angular rotation and direct comparison of measurements is justified, provided any translation of the pupil from the vertex normal is taken into account. The error incurred by ignoring pupil displacement in videokeratography varies between eyes and depends on the type of aberration and amount of displacement, with the largest residual correction root-mean-square wavefront error being 1.26 mum over a 6.0 mm pupil, which markedly decreases retinal image quality. Translation of the pupil center with respect to the vertex normal in videokeratography should not be ignored in the calculation of the corneal first-surface, internal aberrations of the eye relevant to vision, or the design of refractive corrections based on videokeratography.

Performance of Wavefront-Guided Soft Lenses in Three Keratoconus Subjects

To examine whether custom wavefront-guided soft contact lenses provide visual and optical performance equivalent to habitual gas permeable (GP) corrections in three keratoconus subjects. Custom wavefront-guided soft contact lenses were produced and evaluated at the Visual Optics Institute, College of Optometry, University of Houston for three habitual GP-wearing keratoconus subjects. Photopic high and mesopic low contrast logarithm of minimum angle of resolution visual acuity (logMAR VA) and residual second to tenth order optical aberrations experienced with these custom soft lenses were recorded and compared with the subjects' habitual GP correction. All three subjects wearing custom soft lenses reached the established exit criterion of photopic high contrast (HC) logMAR VA equal to or better than values recorded with their habitual GP lens. HC logMAR VA for GP and custom soft lens correction was 0.01 +/- 0.05 and 0.00 +/- 0.02 for KC1, 0.20 +/- 0.02 and 0.14 +/- 0.02 for KC2, and 0.04 +/- 0.09 and -0.05 +/- 0.05 for KC3, respectively. In addition, KC2 reached the exit criterion of high-order aberration levels equal to or less than values with their habitual GP lens (GP lens: 0.394 +/- 0.024 microm, custom lens: 0.381 +/- 0.074 microm). Custom wavefront-guided soft contact lenses have been demonstrated to provide equivalent photopic HC logMAR VA to that achieved with habitual GP correction in three keratoconus subjects. Future emphasis will be placed on surpassing habitual GP performance and reaching a normal age-matched criterion for both VA and aberration measures. Achieving these goals may require a more thorough understanding of the relationship between visual performance and residual aberration experienced during custom lens wear through the use of image quality metrics predictive of visual performance.

Affiliations of community health centers with the accredited schools and colleges of optometry in the states and territories of the United States

Background In 2006, the American Optometric Association Community Health Center Committee surveyed schools/colleges of optometry in the United States and its territories to assess collaborations between community health centers and optometric institutions. Methods The survey investigated the number and structure of affiliations that existed between Federally Qualified Health Centers and schools/colleges of optometry in the United States. The survey reached the schools through the American Optometric Association Faculty Relations Committee or personal contact (Inter-American University of Puerto Rico). Results The survey showed wide variation in affiliations of community health centers with optometry programs. Six schools had no affiliations, whereas the remaining 11 ranged from 1 to 14. Information relating to 37 community health centers was reported. Results showed that schools utilized community health centers for fourth-year students in 5 schools, and both third- and fourth-year students in the remaining 6 schools. Schools vary regarding how precepting is managed with either full-time faculty (64.9%) or adjunct faculty. Business models also vary between schools. Conclusion Affiliations between school/colleges of optometry and community health centers differ considerably. Optometric affiliations with community health centers can result in increased access to eye care for underserved populations and increased clinical experience for optometry students and residents. Opportunities exist to establish additional affiliations. Educational benefits and costs associated with affiliations should be explored before entering into a collaborative model of eye care delivery.

History of community health center affiliations with The New England College of Optometry

Background Since the 1970s, The New England College of Optometry (NECO) has been a leader in community-based educational programming. This was accomplished through the development of affiliation agreements with health care facilities that care for the underserved, notably community health centers (CHCs). The college's clinical system, the New England Eye Institute (NEEI), develops CHC programs, manages professional services agreements, initiates teaching affiliation agreements, and leads staff recruitment and retention efforts. Overview CHC collaborations, which effectively address disparities in access to health care and visual health status, represent a significant component of the college's primary care clinical training venues. Since their inception in 1972, these CHC academic–community partnerships have provided more than 650,000 eye examinations to the underserved and have trained more than 3,200 graduates in community-based eye care, interdisciplinary care management environment, clinical prevention strategies, and population health. Conclusions This report describes NECO's longstanding success with CHCs, explains the scope of practice at CHCs, explains how students are involved in the CHCs' eye care services, and discusses the various management and business arrangements. The benefits and challenges of CHC affiliations with optometry schools and colleges are also discussed.

Orthokeratology practice in children in a university clinic in Hong Kong*

Purposes: The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho‐k) and to investigate patients’/parents’ perspective on ortho‐k via telephone interviews.Methods: Clinical records of children undergoing ortho‐k from a university optometry clinic were reviewed and the effects of ortho‐k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients’/parents’ perspective of the treatment.Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (±SD) pre‐treatment refractive sphere was ‐3.56 ± 1.49-D and the median refractive cylinder was ‐0.50-D (range zero to ‐4.25-D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho‐k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho‐k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho‐k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment.Conclusion: Under close monitoring, overnight ortho‐k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.

Objective accommodation measurements in prepresbyopic eyes using an autorefractor and an aberrometer

To test the repeatability of the iTrace wavefront aberrometer (Tracey Technologies, Inc.) and the WR-5100K autorefractor (Grand Seiko Co., Ltd.) and to measure accomodation in young and phakic prepresbyopic subjects. University of Houston, College of Optometry, Houston, Texas, USA. This study comprised 30 young adults and 15 prepresbyopic subjects. Accommodation was stimulated with near charts presented at various distances. Measurements were repeated 3 times for each target distance with both instruments. For test-retest reliability, the entire protocol was repeated on 3 additional days in 3 prepresbyopic subjects as well as twice on the same day in the young adults. The mean age was 25.5 years +/- 3.25 (SD) (range 21 to 31 years old) in the young adult group and 41.2 +/- 2.98 years (range 38 to 49 years) in the prepresbyopic group. Bland-Altman analysis of repeated measures of the young subjects had limits of agreements (LoA) of 1.58 diopters (D) or less for each instrument and when compared between instruments. Normalized mean stimulus response functions in the prepresbyopic group were similar for the 2 instruments. Bland-Altman analysis of the accommodation measurements between the 2 instruments showed a mean difference of 0.07 D and an LoA of 0.70 D. Repeated measures of 3 prepresbyopic subjects had a range of standard deviations from 0.07 to 0.51 D. The accommodative responses measured with the 2 instruments were not significantly different, and testing showed both instruments to be suitable for objective measurement of accommodation in a phakic prepresbyopic population with low accommodative amplitudes.

Effect of Flap Thickness on Higher Order Wavefront Aberrations Induced by LASIK: A Bilateral Study

To investigate the effect of flap thickness on wavefront aberrations induced by LASIK. LASIK was performed on 56 eyes of 28 patients with refraction errors that were well matched between the right and left eyes. For each patient, a planned 160-microm flap was created for one randomly selected eye using the Moria M2 microkeratome (130-microm head; thick flap group), and a 110-microm flap was created for the contralateral eye with the same microkeratome (90-microm head; thin flap group). Flap thickness was measured using ultrasonic pachymetry. Wavefront aberrations were measured in the anterior cornea using the Orbscan II (Bausch & Lomb) and in the whole eye using the Wavefront Supported Custom Ablation (WASCA) aberrometer (Carl Zeiss Meditec) preoperatively and at 1 month and 1 year postoperatively. Mean flap thickness was 155 +/- 13 microm in the thick flap group and 112 +/- 11 microm in the thin flap group. Mean root-mean-square of higher order wavefront aberrations were changed for the different test times in the cornea (F = 29.9, P < .0001) and the whole eye (F = 48.0, P < .0001). There was no significant difference between the two flap groups for the cornea (F = 0.76) or for the whole eye (F = 0.07). Similar results were observed for higher order Zernike aberrations such as spherical aberration and comas. The results suggest higher order wavefront aberrations induced by LASIK are independent of flap thickness. Complications in visual outcome for patients with different flap thickness should be attributed to factors other than aberrations.

Medications prescribed to brain injury patients: A retrospective analysis

Background The purposes of this study were to retrospectively evaluate the frequency of medications used by individuals with either traumatic brain injury (TBI) or cerebrovascular accident (CVA) and to consider the possible relationship between vision symptoms and diagnoses in this sample and the established visual and ocular side effects of the prescribed medications. Methods Charts of patients examined in the Raymond J. Greenwald Rehabilitation Center at the SUNY State College of Optometry from the years 2000 to 2003 were reviewed. Only TBI (n=160) or CVA (n=60) patients were included. Prescribed medications from 12 possible categories were identified. Patients experiencing blurred vision, diplopia, asthenopia, poor depth perception, and/or light sensitivity were identified. Patients with accommodative dysfunction, vergence dysfunction, versional dysfunction, dry eyes, and/or ptosis were also identified. Results The 4 most common medication categories taken by TBI patients were anti-anxiety/antidepressants (42.5%), anticonvulsants (26.9%), opiate/combination analgesics (23.8%), and cardiac/antihypertensives (23.1%). For the CVA patients, the medications were cardiac/antihypertensives (66.7%), anti-anxiety/antidepressants (31.7%), vitamins/mineral supplements (26.7%), and anticonvulsants (23.3%). Frequency of vision symptoms and diagnoses in the TBI and CVA patients appeared not to be related to medication use in most cases. Conclusions Anti-anxiety drugs, antidepressants, and anticonvulsants were the overlapping medication categories between the TBI and CVA groups. Medication intake did not affect the frequency of the reported vision symptoms and diagnoses in most cases, suggesting the symptoms and diagnoses were primarily related to either the TBI or CVA itself.

A Randomized Controlled Trial of Corneal Collagen Cross-linking in Progressive Keratoconus: Preliminary Results

This prospective, randomized, controlled trial aims to provide evidence in relation to the efficacy and safety of corneal collagen cross-linking (CXL) in the management of progressive keratoconus. Eligible eyes were separately randomized into either treatment or control groups. Collagen crosslinking was performed using 0.1% riboflavin (in 20% dextran T500) and ultraviolet A (UVA) irradiation (370 nm, 3 mW/cm2, 30 min) in accordance with a previously published protocol. At each review, a full clinical ophthalmic examination was performed including endothelial cell count and confocal microscopy. To date, 66 eyes of 49 patients with documented progression of keratoconus have been enrolled and randomized. Interim analysis of treated eyes showed a flattening of the steepest simulated keratometry value (K-max) by an average of 0.74 diopters (D) (P = .004) at 3 months, 0.92 D (P = .002) at 6 months, and 1.45 D (P = .002) at 12 months. A trend toward improvement in best spectacle-corrected visual acuity was also observed. In the control eyes, mean K-max steepened by 0.60 D (P = .041) after 3 months, by 0.60 D (P = .013) after 6 months, and by 1.28 D (P < or = .0001) after 12 months. Best spectacle-corrected visual acuity decreased by logMAR 0.003 (P = .883) over 3 months, 0.056 (P = .092) over 6 months, and 0.12 (P = .036) over 12 months. No statistically significant changes were found for spherical equivalent or endothelial cell density. Preliminary results of this randomized controlled trial suggest a temporary stabilization of all treated eyes after CXL.

Provision of eye care: Commissioning change

Provision of eye care: Commissioning change