Spectacle Wear Research Articles

Comparison of four different orthokeratology lenses in controlling myopia progression

PurposeTo compare axial length (AL) elongation in myopic children with four Orthokeratology (OrthoK) lenses and spectacles. MethodsThe medical records of 266 patients (532 eyes) who were fitted with OrthoK lenses or spectacles (control group) were reviewed. Data collection included baseline age, gender, baseline objective sphere and cylinder, baseline flat and steep corneal meridian power, corneal asphericity coefficient (Q value), AL at baseline and after 1-year, and 2-years of OrthoK or spectacle wear analyzed using analysis of repeated measures data ANOVA. Stepwise linear regressions between the changes in AL after 2 years relative to baseline parameters were calculated for the OrthoK and control groups separately. ResultsThe baseline subject parameters for each of the four OrthoK lenses were not statistically different. Statistically significant differences between time points were found between 12- and 24- months (all P < 0.05). AL growth was slower in all OrthoK groups than in the control group (all P < 0.05). AL grew 0.081±0.034 mm per year slightly less than average with Essence compared to the Mouldway OrthoK group (P = 0.019). The coefficient of regression weakly expressed between the increases in AL over 2-years study period and baseline spherical equivalent refraction was 0.065 in Essence, 0.079 in Euclid and 0.087 in Mouldway. The coefficient of regression was also weakly between age and the increases AL over 2-years study period and baseline age in all groups. ConclusionDifferent OrthoK lenses differ minimally in slowing axial elongation effectively in myopic children during 2-years lens wear.

Contact lens and eye glass wearers with and witouth ocular symptoms: differences in corneal sensitivity, blinking, tearing and corneal surface temperature

AbstractPurposeTo analyze corneal sensitivity, blink frequency (BF), tearing rate (TR), TBUT, and corneal surface temperature (CST) in young contact lens (CLs) and eye glass (EGs) wearers with and without ocular discomfort symptoms.MethodsEGs (n = 18) and CLs (n = 23) young subjects (18–40 years old, both sexes) participated voluntarily. CLs were classified as asymptomatic (A) or symptomatic (S) depending on their OSDI score (&lt; 13 or ≥ 13, respectively). Corneal sensitivity to mechanical and chemical air puffs (3s duration, applied with a gas esthesiometer) and cold (4°C) saline drops was explored. Sensations evoked by each stimulus was scored with 0 to 10 VAS. BR (1 min at rest or during a task), TR (mm of wet phenol red threads, 15 s), TBUT (s), and CST (IR video thermography) were also measured.ResultsVAS values of irritation sensation evoked by mechanical and chemical stimulation (p &lt; 0.05) were higher in CLs than in EGs while VAS values of cold sensation evoked by saline drops were similar in both groups. Although CST and TR were similar in EGs and CLs, TBUT was significantly shorter (p &lt; 0.001) and BR was higher in CLs both at rest (p &lt; 0.001) and during a visual task (p &lt; 0.01). Although VAS values scored to corneal mechanical, chemical and cold stimulation were lower in CL‐S than in CL‐A, no differences were found in BR at rest or during the task, TR, TBUT and CST. Corneal sensitivity and CST were also similar in EG‐A and EG‐S, although TR (p &lt; 0.05) and BF at rest (p &lt; 0.05), but not during the task, were higher in EG‐S.ConclusionsResults show a reduced corneal sensitivity in symptomatic CL wearers, which suggests that corneal sensory nerve activity must be altered in a different degree in asymptomatic and symptomatic individuals, thus leading to changes in tearing and blinking regulation.Support: AEI‐ERDF SAF‐2017‐83674‐C2‐1‐R and 2‐R

Mixed-methods study of behaviours and attitudes to vision correction of spectacle and contact lens wearers

Mixed-methods study of behaviours and attitudes to vision correction of spectacle and contact lens wearers

Quantification of Gender Representation Bias in Commercial Films based on Image Analysis

In film directing, a bias towards the representation of a particular gender can cause the audience to form a distorted stereotype of the gender role. The Bechdel test has been widely used to objectively judge the existence of such bias in films. However, because its analysis is based solely on the script of a film, the Bechdel test is incapable of considering the broad spectrum of bias that films can have as a visual medium. This study proposes a more comprehensive analysis system that quantifies the degree of bias in the visual representations of female and male characters in commercial films. By analyzing the image frames of a movie using the latest image analysis techniques, a total of 40 films were analyzed based on 8 quantitative indices. The result demonstrates that there exists a statistically significant difference in the visual representation of female and male characters. Specifically, female characters showed lower values in emotional diversity, spatial occupancy, and temporal occupancy compared to male characters in commercial films. Further, female characters were less likely to wear eyeglasses and also appeared more in static scenes, such as indoors.

Association Between Polygenic Risk Score and Risk of Myopia

Myopia is a leading cause of untreatable visual impairment and is increasing in prevalence worldwide. Interventions for slowing childhood myopia progression have shown success in randomized clinical trials; hence, there is a need to identify which children would benefit most from treatment intervention. To examine whether genetic information alone can identify children at risk of myopia development and whether including a child's genetic predisposition to educational attainment is associated with improved genetic prediction of the risk of myopia. Meta-analysis of 3 genome-wide association studies (GWAS) including a total of 711 984 individuals. These were a published GWAS for educational attainment and 2 GWAS for refractive error in the UK Biobank, which is a multisite cohort study that recruited participants between January 2006 and October 2010. A polygenic risk score was applied in a population-based validation sample examined between September 1998 and September 2000 (Avon Longitudinal Study of Parents and Children [ALSPAC] mothers). Data analysis was performed from February 2018 to May 2019. The primary outcome was the area under the receiver operating characteristic curve (AUROC) in analyses for predicting myopia, using noncycloplegic autorefraction measurements for myopia severity levels of less than or equal to -0.75 diopter (D) (any), less than or equal to -3.00 D (moderate), or less than or equal to -5.00 D (high). The predictor variable was a polygenic risk score (PRS) derived from genome-wide association study data for refractive error (n = 95 619), age of onset of spectacle wear (n = 287 448), and educational attainment (n = 328 917). A total of 383 067 adults aged 40 to 69 years from the UK Biobank were included in the new GWAS analyses. The PRS was evaluated in 1516 adults aged 24 to 51 years from the ALSPAC mothers cohort. The PRS had an AUROC of 0.67 (95% CI, 0.65-0.70) for myopia, 0.75 (95% CI, 0.70-0.79) for moderate myopia, and 0.73 (95% CI, 0.66-0.80) for high myopia. Inclusion in the PRS of information associated with genetic predisposition to educational attainment marginally improved the AUROC for myopia (AUROC, 0.674 vs 0.668; P = .02), but not those for moderate and high myopia. Individuals with a PRS in the top 10% were at 6.1-fold higher risk (95% CI, 3.4-10.9) of high myopia. A personalized medicine approach may be feasible for detecting very young children at risk of myopia. However, accuracy must improve further to merit uptake in clinical practice; currently, cycloplegic autorefraction remains a better indicator of myopia risk (AUROC, 0.87).

Safety of soft contact lenses in children: retrospective review of six randomized controlled trials of myopia control.

To examine the rate and types of ocular adverse events among children wearing soft contact lenses. This study is a retrospective review of ocular adverse event data from six randomized controlled trials among a total of 581 myopic children (aged 7-15years at baseline) administered daily disposable hydrogel contact lenses (etafilcon A). During 816 patient years of contact lens wear, no significant or serious ocular adverse events were reported. A total of 86 non-significant ocular adverse events occurred in 53 children. The crude rate of ocular adverse events was 10.6 per 100 patient years with the estimated pooled incidence being 8.9 per 100 patient years (95% CI: 4.5-17.4). Two asymptomatic corneal infiltrative events were reported (both non-significant), which is an incidence of 0.3 (95% CI: 0.1-0.9) per 100 patient years. The most common ocular adverse events (n) were slit-lamp findings of Grade 2 or less requiring treatment (26), unspecified conjunctivitis (14), and allergic conjunctivitis (13). No cases of microbial keratitis were observed. Of the 86 adverse events, 37 were classified as highly likely or possibly lens-related, giving a crude incidence of 4.5 per 100 patient years for contact lens-related events. The crude incidence of ocular adverse events among spectacle wearers was 1.8 per 100 patient years. These data suggest that daily disposable soft contact lenses can be safely worn by children. Additional studies will be needed to precisely quantify the adverse event rate of soft contact lenses in normal clinical practice.

Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit

ObjectivesThis study reports the prevalence of persistent amblyopia (post-traditional treatment age) in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive...

Measurement of saccadic eye movements by electrooculography for simultaneous EEG recording

Eye movements are an important index of the neural functions of visual information processing, decision making, visuomotor coordination, sports performance, and so forth. However, the available optical tracking methods are impractical in many situations, such as the wearing of eyeglasses or the presence of ophthalmic disorders, and this can be overcome by accurate recording of eye movements by electrooculography (EOG). In this study we recorded eye movements by EOG simultaneously with high-density electroencephalogram (EEG) recording using a 128-channel EGI electrode net at a 500-Hz sampling rate, including appropriate facial electrodes. The participants made eye movements over a calibration target consisting of a 5×5 grid of stimulus targets. The results showed that the EOG methodology allowed accurate analysis of the amplitude and direction of the fixation locations and saccadic dynamics with a temporal resolution of 500 Hz, under both cued and uncued analysis regimes. Blink responses could be identified separately and were shown to have a more complex source derivation than has previously been recognized. The results also showed that the EOG signals recorded through the EEG net can achieve results as accurate as typical optical eye-tracking devices, and also allow for simultaneous assessment of neural activity during all types of eye movements. Moreover, the EOG method effectively avoids the technical difficulties related to eye-tracker positioning and the synchronization between EEG and eye movements. We showed that simultaneous EOG/EEG recording is a convenient means of measuring eye movements, with an accuracy comparable to that of many specialized eye-tracking systems.

Comparison of retinoscopy results with and without 1% cyclopentolate in school-aged children.

This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic and non-cycloplegic retinoscopy and whether age, refractive error, habitual spectacle wear and accommodation influence the relationship. A single examiner carried out cycloplegic and non-cycloplegic retinoscopy on 128 children stratified into four age groups (6-7, 8-9, 10-12 and 12-13years). Cycloplegia was achieved using 1% cyclopentolate and retinoscopy carried out after 30min. The examiner was masked to the lenses used and to habitual spectacle wear. Accommodation was assessed using dynamic retinoscopy prior to cycloplegia. Cycloplegic and non-cycloplegic sphere differed significantly (z=-9.18, p<0.0001). Although the difference decreased significantly as age increased (χ2 =16.57, p=0.0009), cycloplegic retinoscopy revealed more hyperopia than non-cycloplegic retinoscopy in all age groups (p<0.0001). The difference between cycloplegic and non-cycloplegic results was greater where 'high' hyperopia (≥+2.50DS) was present (F1,6 =12.86, p=0.0005), and as hyperopia increased the difference increased (Spearman's ρ=0.55, p<0.0001). Neither spectacle wear (p=0.74) nor accommodation (p=0.08) influenced the difference between spherical measures. Measures of astigmatic error did not differ significantly (z=-1.59, p=0.11). A non-cycloplegic sphere ≥+1.50DS was relatively sensitive (87%) and specific (96%) at indicating clinically significant hyperopia (≥+2.50D) as revealed by cycloplegic retinoscopy. Cyclopentolate 1% does not impact the cylindrical component of the retinoscopy result, but reveals significantly more hyperopia in the spherical component, both statistically and clinically in children aged 6-13years. Differences between cycloplegic and non-cycloplegic sphere increase significantly with increasing hyperopia, independent of spectacle wear and accommodation. A non-cycloplegic retinoscopy result of ≥+1.50DS may be used by practitioners wishing to identify children aged 6-13years at risk of clinically significant hyperopia (≥+2.50DS), but cycloplegia is required to accurately ascertain the full spherical error.

Therapeutic effect of rigid permeable contact lenses on irregular astigmatism after keratoplasty

Objective: To evaluate the clinical effect of rigid permeable contact lenses (RGPCL) in the correction of irregular astigmatism after keratoplasty. Methods: Retrospective case study. From June 2012 to December 2016, 31 patients (37 eyes) who underwent corneal transplantation were tested and fitted with RGPCL. The patients' data of primary disease, interval from keratoplasty to contact lens fitting, uncorrected visual acuity, best spectacle-corrected visual acuity, best RGPCL-corrected visual acuity, contrast visual acuity before and after RGPCL wear, corneal topography and corneal endothelium parameters before and after RGPCL wear were collected, including ocular complications and comfort of contact lenses. Results: Among the 31 patients, 24 were male and 7 were female, with age of (31.3±5.8) years. The mean interval between grafting and initial contact lens fitting was (4.6±2.3) years. Uncorrected visual acuity, best spectacle-corrected visual acuity, and best RGPCL-corrected visual acuity were 0.81±0.21, 0.54±0.13, and 0.10±0.07, respectively (t=7.170, 16.617, 17.866; all P<0.05). The average astigmatism was -5.76±2.23 D and -0.83±0.47 D before and after wearing RGPCL (t=8.531, P<0.05). After wearing RGPCL, the contrast visual acuity of 100%, 25%, 10%, and 5% was increased from 0.95±0.33, 1.18±0.21, 1.40±0.00, and 1.40±0.00 to 0.12±0.15, 0.37±0.17, 0.65±0.25, and 0.96±0.29, respectively (t=5.972, 8.473, 9.243, 5.104; all P<0. 05). There were no obvious changes of corneal endothelium parameters during the observation period. No obvious corneal allograft rejection or other complications occurred, and 94.6% (35/37) of the patients felt comfortable with wearing RGPCL. Conclusions: RGPCL wear is safe and effective in correcting irregular astigmatism after corneal transplantation. We can obtain good corrected vision and improve contrast visual acuity, especially for patients who can not wear spectacles. (Chin J Ophthalmol, 2019, 55: 413-418).

The Effect of Vertically Yoked Prisms on Binocular Vision and Accommodation

Vertically yoked prisms have been used in treatment of binocular vision dysfunction despite minimal supporting evidence. In people with normal binocular vision, the impact on phorias has been assessed but not the impact on accommodation, accommodation vergence interactions, or the horopter. We found that vertically yoked prisms have minor effects during short-term wear in young adults. The purpose of this study was to determine effects of vertically yoked prisms on accommodative response and several binocular vision tasks. There were 45 participants aged 18 to 24 years. The 23 myopes wore distance-corrected soft contact lenses. In a random arrangement, each person wore spectacles containing planopower lenses with either 8 Δ base-up, 4 Δ base-up, zero, 4 Δ base-down, and 8 Δ base-down prisms. Before spectacle wear, baseline measurements of near heterophoria, accommodation response, negative and positive relative accommodations, fusional vergence, and Nonius-horopter spatial perception were taken. Measurements were repeated after a 40-minute wear, spectacles were removed, and tests were performed 20 minutes later. On a 22-participant subset, on a separate occasion, measurements of heterophoria, accommodation response, and relative accommodation were made immediately after spectacles were fitted. Most changes relative to baseline were not significant. Where effects occurred, these were nearly all associated with prism presence rather than adaptation. There were significant effects on accommodation response, but these seem to be refraction effects produced by pantoscopic tilt-induced power changes rather than perceptual effects altering accommodation. There were statistically significant effects on negative relative accommodation (P < .01), with zero prism giving more negative relative accommodation than 8 Δ base-down prisms. Tendencies were noted for prisms to move horopter limits toward the observer. Effects were small and likely not of clinical relevance. Vertically yoked prisms have minor effects on accommodation and binocular vision, at least during short-term wear in young adults with normal binocular vision.

Self-adjustable Spectacle Wearing Compliance and Associated Factors among Rural School Children in Ghana.

Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries. The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed. A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs]). Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were "loss" (32%; 18/57) and "breakage" (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02). Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

Ocular Characteristics in Contact Lens and Spectacle Wear

Ocular Characteristics in Contact Lens and Spectacle Wear

Vision screening services in special needs schools in Western Saudi Arabia.

Objectives:To evaluate the current status of vision screening services in special educational needs (SEN) schools in the western region of Saudi Arabia.Methods:This was a cross-sectional study that involved distribution of a questionnaire to all 30 SENs schools in the western region of Saudi Arabia between April and May 2018.Results:Twenty-three schools responded to the questionnaire (77% response rate). The number of pupils represented in the surveyed schools was 1831. On average, 10.8% of pupils were reported to wear eyeglasses. Approximately 60.9% of schools reported that vision screening was not offered at their schools. The percentage of students who used optical, non-optical, or high-technology low-vision aids was <2.7%. Most participants (78.3%) reported that no one in their schools had received some form of training to work with and support students with visual impairments.Conclusion:In the western province of Saudi Arabia, the vision care status of individuals with intellectual disabilities (ID) in SEN schools is poor. To better serve this underprivileged group, the necessity of implementing vision screening programs on a larger scale should be considered.

Evaluating the use of a temperature sensor to monitor spectacle compliance in warm versus cold climates

BackgroundThis study investigates the utility of a temperature sensor data logger to monitor spectacle compliance for future application in research and clinical settings. Specifically, the question of whether warm versus cold climates negatively impact accuracy of the sensor to monitor spectacle wear is investigated.MethodsFifty adults from Houston, Texas (summer) and 40 adults from Columbus, Ohio (winter) wore a thermosensor on their spectacles for one-week while keeping wear‐time logs. Temperatures during reported spectacle wear (ON) were compared to temperatures during non‐wear (OFF) between sites. Two methods to approximate wear time were evaluated by percent error with respect to subject‐reported wear time. Method 1 filtered temperatures, classifying the range of 28.4 to 35.2°C as wear. Method 2 utilised examiners interpreting temperature versus time plots. Separate analysis of periods of reported outdoor wear was performed to identify the percentage of time examiners correctly identified wear.ResultsGroup mean ON temperatures did not differ between sites (p = 0.72), but group mean OFF temperatures were significantly warmer in Houston (Houston: 24.7 ± 2.0°C, Columbus: 20.3 ± 2.1°C; p < 0.0001). Median percent error of the filtering technique to approximate subject reported wear time was 4-per cent for Houston and −8-per cent for Columbus. Median percent error for examiner 1: Houston 1-per cent, Columbus 0-per cent; median percent error for examiner 2: Houston 3-per cent, Columbus 0-per cent. Houston outdoor wear was correctly identified 88 and 97-per cent of the time by the examiners versus 79 and 81-per cent for Columbus.ConclusionDespite environmental temperature differences, measured temperatures during spectacle wear were similar across subjects and median percent error was less than 10-per cent for both wear time approximation methods. The device studied was effective for objectively monitoring spectacle wear in both warm and cold climates with the caveat that subjects spent the majority of time indoors.

Impression Formation of Male and Female Millennial Students Wearing Eye Glasses or Hearing Aids

The purpose of this study was to examine impressions of persons wearing hearing aids (HA) and glasses. A survey consisting of impression formation measures was administered to 569 participants. Factor analysis and a series of T-tests were used to examine the effect of wearing glasses and hearing aids on first impressions. T-tests indicated significant differences between the control and glasses style for both the male and female model. Male and female control models (without glasses) were rated more positively. Another series of t-tests between hearing aid styles and the control indicated significant differences for the heavier, more visible hearing aid with the control model being rated higher on every factor except “reliable”. There were almost no significant differences between the control and the light, less visible hearing aid for either the male or the female. Correlations among traits differ as a function of both stimulus person and relevance of trait. Data indicates that different types of hearing aids stimulate varying impressions. The findings have implications for advising potential HA users who are disinclined to wear a device for cosmetic reasons. Findings support other literature on impression formation and the hearing aid effect. However, the findings are encouraging, as hearing aid use has historically been associated with an impression of lower cognitive function, yet participants did not indicate a significant perceptual difference between the hearing aid user and the control, possibly indicating stronger social acceptance.

Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles

Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential. To investigate predictors of spectacle wear and reasons for nonwear in students randomized to ready-made or custom-made spectacles. In planned secondary objectives of a noninferiority randomized clinical trial, students aged 11 to 15 years who fulfilled eligibility criteria, which included improvement in vision with correction by at least 2 lines in the better eye, were recruited from government schools in Bangalore, India. Recruitment took place between January 12 and July 15, 2015, and analysis for the primary outcome occurred in August 2016. Data analysis for the secondary outcome was conducted in August 2018. Spectacle wear was assessed by masked observers at unannounced visits to schools 3 to 4 months after spectacles were distributed. Students not wearing their spectacles were asked an open-ended question to elicit reasons for nonwear. Predictors of spectacle wear and reasons for nonwear. Of 460 students recruited and randomized (52.2% male; 46 students aged 11 to 12 years and 13 to 15 years in each trial arm), 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles (no difference between trial arms). Poorer presenting visual acuity (VA) and improvement in VA with correction predicted spectacle wear. Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84; 95% CI, 1.52-5.27). Improvement of VA with correction of 3 to 6 lines or more than 6 lines had adjusted odds ratios of 2.31 (95% CI, 1.19-4.50) and 2.57 (95% CI, 1.32-5.01), respectively, compared with an improvement of less than 3 lines. The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]). Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%). Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial. Predictors of spectacle wear, poorer presenting VA, and greater improvement in VA with correction are similar to other studies. Interventions to reduce teasing and bullying are required, and health education of parents is particularly needed for girls in this setting. isrctn.org Identifier: ISRCTN14715120.

The treatment of amblyopia: current practice and emerging trends.

The purpose of this review is to provide an update on current management and recent research for amblyopia treatment. Part I will review patching, atropine penalization, and pharmacological treatments. Part II will focus on perceptual learning, video gaming, and binocular dichoptic approaches. A literature search was performed in PubMed, ClinicalTrials.gov , Google Scholar, and reference lists of retrieved articles until December 20, 2018, for all papers containing "amblyopia treatment" or "amblyopia therapy." We have included RCTs, prospective observational studies, prospective and retrospective cohort studies, pilot studies, and review articles. The mainstay of treatment for amblyopia has been based on increasing visual stimulation of the amblyopic eye by occlusion, atropine, or optical penalization of the dominant eye. It has been established that refractive adaptation alone can significantly enhance visual acuity. However, the duration of optical correction varies between studies and the effectiveness of spectacle wear over early beginning of patching is still under investigation. Additionally, by means of occlusion dose monitors, it was found that adherence to occlusion affects the outcome, as a dose-response relationship exists between adherence and visual acuity. Treatment efficiency declines with age; however, recent evidence indicates cortical plasticity beyond the "critical period" and recommends that an attempt at treatment should be offered to all amblyopic children regardless of age, including those in later childhood. Novel approaches targeted to the restoration of binocular functions, such as perceptual learning, video gaming, and dichoptic training, have shown small effects on visual acuity and have failed to demonstrate non-inferiority over standard treatments. On review, significant evidence for the successful management of amblyopia, with occlusion therapy and atropine, has been found. However, the management of amblyopia remains challenging, mainly due to compliance issues and suboptimal treatment outcomes during occlusion and atropine penalization. Recent studies have found evidence of new ways of treating amblyopia particularly in regard to binocular treatment although these remain under investigation. Further robust clinical trials on these new treatment modalities are still warranted in order to establish their role in treating amblyopia.

Association of visual acuity with educational outcomes: a prospective cohort study

Background/aimTo quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.MethodsA prospective, longitudinal, school-based study on grade...

Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study

To evaluate spectacle adherence with impact-resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study. Retrospective cohort analysis of randomized clinical trial data. Setting: Multicenter. One hundred and fourteen children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy. One-week diaries completed annually and retrospective telephone interviews conducted every 3months to age 5 years to assess spectacle adherence with impact-resistant lenses. Visual acuity was assessed by a traveling examiner at age 4.5 years. Spectacle adherence between ages 4 and 5 years. Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, P= .034). Reported adherence to spectacle wear correlated with reported patching (r=0.30, P=.002). Spectacle adherence did not correlate with sex, type of healthcare insurance, or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence. These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery duringinfancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence.