Spectacle Correction Research Articles

Транс-ФРК: резюме

Purpose. Based on more than 20 years of use of the excimer laser system "Profil-500" with a Gaussian broad beam, to demonstrate the expansion of the possibilities of laser correction of myopia. Material and methods. More than 10 thousand operations have been performed to correct myopia and complex myopic astigmatism. Postoperative follow-up included a survey on well-being, reaction to the exposure and the quality of the received vision. Statistical processing revealed and justified the distinctive features of the «Транс-ФРК®» methodology. Results. A reduction in the duration of postoperative pain syndrome has been achieved. Rapid and high-quality postoperative corneal epithelialization is observed, which reduces the likelihood of regression of the result obtained and the occurrence of postoperative haze. The effect of increasing the postoperative thickness of the cornea without refractive regression was revealed. The fact of unusually high visual acuity was found after the first stage of correction of very high myopia. The multifocal optical profile allows older patients to delay the need for spectacle correction of presbyopia by an average of 5 to 7 years. Conclusion. The Russian Trans-PRK technology is quite consistent with the term "breakthrough", allowing you to significantly expand the possibilities of laser correction of myopia. Methods of carrying out the operation are patented. The technique is individualized by the registration of the trademark «Транс-ФРК®». Keywords: laser correction of myopia, epithelialization, multifocality, Trans-PRK, corneal thickness, pain syndrome, spheroequivalent, visual acuity, keratotopogram.

Evaluation of Visual and Patient-Reported Outcomes, Spectacle Dependence after Bilateral Implantation with a Non-Diffractive Extended Depth of Focus Intraocular Lens Compared to Other Intraocular Lenses.

Purpose: To evaluate postoperative outcomes, spectacle dependance and the occurrence of the photic phenomena in patients after cataract surgery following the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens was compared to monofocal and multifocal lenses. Methods: We enrolled patients with bilateral cataracts who wanted to reduce their dependence on glasses in the study. They were followed for 6 months. The study group in which the EDOF lens was implanted consisted of 70 eyes in 35 patients. The control groups consisted of: 52 eyes in 26 patients in whom a multifocal was implanted and 52 eyes in 26 patients with implanted monofocal lens. After a total of 2 weeks, 2 months and 6 months post-surgery the following were evaluated: uncorrected and corrected visual acuity at 4 m, 80 cm, 40 cm, manifest refraction expressed as mean refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure. A questionnaire on independence from ocular correction, the occurrence of photic phenomena, and patient satisfaction was also completed. Results: Monocular and binocular visual acuity and MRSE 6 months after the procedure were compared between three groups. All of the main analyses, except for comparisons of uncorrected distance visual acuity (both monocular and binocular) level, were significant. Contrast sensitivity was lower among patients with multifocal lens than among patients with EDOF lens. Halo and glare after 6 months were seen more often among patients with multifocal lens than among patients with the other lens (65% of eyes with multifocal lens vs. 6% of eyes with EDOF lens and 0% of eyes with monofocal lens). Glasses were needed by 35% of patients with EDOF lens, and by 96% of patients with monofocal lens and in none of the patients with multifocal lens. Conclusions: Most patients qualify for the implantation of a non-diffractive EDOF lens. Post-operative visual acuity improves at any distance. The best monocular visual acuity for intermediate distances is provided by an EDOF lens, and for near distance by a multifocal lens. The EDOF lens definitely increases independence from spectacle correction compared to monofocal lenses; however, the greatest degree of independence from spectacles is provided by multifocal lenses. The incidence of photic phenomena is slightly higher than that of a monofocal lens, and much lower for a multifocal lens.

Estimation of the Prevalence of Uncorrected Refractive Error and Other Ocular Morbid Conditions in School Children of Industrial Area in a Non-metro City in India

PurposeThis study aims to estimate the prevalence of uncorrected refractive error and ocular morbid conditions in school-going children of the Pimpri Chinchwad Municipal Corporation (PCMC) industrial belt.MethodsOcular examination was done in a well-equipped mobile clinic on school premises in the presence of a school teacher using visual acuity (VA) charts, autorefractometer, retinoscope, and handheld slit lamp. For the age group of 5-6 years, Lea symbols and HOTV charts were used, and for the age group of >7 years, Snellen’s chart was used. A detailed anterior segment examination was done to see lid position, the presence of any lid swelling, conjunctival congestion, conjunctival xerosis, corneal opacity, and lens opacity, and findings of previous eye surgery were noted. Spectacle correction was given to these students if they were found to have a significant refractive error.Children requiring intervention other than refractive correction were referred to a tertiary hospital.ResultsA total of 3,054 school children were examined. Most were between the age group of 11-15 years (2,448 (80.2%)), with a mean age of 12.45 ± 2.022 years; 1,470 (48.1%) were male children. A total of 368 (12.04%) children had uncorrected refractive error. Myopia was seen in 204 (6.68%) children, hypermetropia in 16 (0.52%) children, and astigmatism in 148 (4.85%) children. On classification, simple myopic astigmatism (SMA) was found in 73 (2.39%) children, compound myopic astigmatism (CMA) in 38 (1.24%) children, simple hypermetropic astigmatism (SHA) in 13 (0.34%) children, and compound hypermetropic astigmatism (CHA) in 16 (0.52%) children. Moreover, 121 children had ocular morbid conditions. Ocular morbidity with decreased vision was seen in 52 (1.7%) children with preexisting refractive error and 12 (0.39%) with amblyopia, and strabismus was seen in eight (0.26%) children. Five (0.16%) children had lens disorder, and five (0.16%) had no improvement with glasses despite normal anterior segment.ConclusionThere was a high prevalence of uncorrected refractive error. Early detection of uncorrected refractive error and ocular morbidity will improve overall performance in school-going children.

Prevalence of Presbyopia, Spectacle Correction Coverage and Unmet Need, among Adults in Cross River State, Nigeria.

Purpose: To determine the prevalence of presbyopia, spectacle correction coverage and its unmet needs among adults 35 years and above in the study area.Methods: This cross-sectional descriptive study design used multistage cluster random sampling procedure to select the 616 adults. Data was collected using an interviewer administered semi-structured questionnaire. Visual acuity at distance and near was tested with Snellen’s chart at 6m and 40cm respectively. This was followed by eye examination. Presbyopia was defined as near visual acuity of N8 or worse. Relationship between variables were determined using chi square and multivariate analysis at 5% significant level.Results: The average age of participants was 48.1 years ± 10.4 (range, 35-88 years) and 330 (53.6 %) were males. The prevalence of presbyopia was 73.2% (95% Confidence interval [CI]: 69.5, 76.7). Multiple regression analysis showed that, female sex (Adjusted odds ratio [AOR] =1.58 (95% CI: 1.02, 2.38), older age (AOR =3.29 (95% CI: 1.02, 13.6), unemployment (β = 0.47, p = 0.016, AOR =1.59 (95% CI: 1.26, 4.55), lack of formal education (β = -3.67, p < 0.001, AOR =0.03 (95% CI: 0.007, 0.09) were significantly associated with presbyopia. The spectacle correction coverage and unmet presbyopic need were 40.8%, and 59.2% respectively.Conclusion: The Prevalence of presbyopia and unmet presbyopic correction were high among the participants. This can be addressed through awareness creation and provision of accessible and affordable primary eye care services in the communities.

Early amblyopia therapy in pediatric open globe trauma

Younger age is an independent risk factor for poor visual acuity after open globe injuries. Since ocular trauma represents an acute interruption in the development of a previously normal visual axis, amblyopia may be a factor contributing to worse outcomes. We hypothesized that preventative therapy with patching, atropine, or spectacle correction for amblyogenic refractive error early in the postoperative period may lead to improved visual outcomes after open globe injury by potentially preventing or reducing the onset of the physiologic and anatomic changes associated with amblyopia.

Dissociated vertical deviation: Simplified

Abstract Dissociated vertical deviation (DVD) is not a well-understood ocular motility disorder. It is defined as an intermittent anomaly of a non-fixing eye consisting of upward excursion, ex-cyclotorsion, and lateral deviation. It can present as latent or manifest deviation. It is usually bilateral, asymmetrical, and often associated with latent nystagmus and infantile esotropia. In unilateral cases, it can be associated with amblyopia. Binocular vision is usually absent in these patients. There are huge variations in the measurements of DVD, as it becomes visible only with one eye covered, hence making quantification of its magnitude difficult. Therefore, choosing an adequate management option is difficult. Management options include both conservative as well as surgical treatment. Conservative management is done with spectacles correction to encourage fusion. Surgical management is indicated in large, frequent DVD or with anomalous head posture. Surgical options commonly adopted are superior rectus recession with or without posterior fixation sutures. Different surgical approaches to DVD are currently being used but no recommended guidelines are available, hence is based on the amount of deviation and experience of a surgeon.

Meridional ocular magnification after cataract surgery with toric and non-toric intraocular lenses

BackgroundOverall ocular magnification (OOM) and meridional ocular magnification (MOM) with consequent image distortions have been widely ignored in modern cataract surgery. The purpose of this study was to investigate OOM and MOM in a general situation with an astigmatic refracting surface.MethodsFrom a large dataset containing biometric measurements (IOLMaster 700) of both eyes of 9734 patients prior to cataract surgery, the equivalent (PIOLeq) and cylindric power (PIOLcyl) were derived for the HofferQ, Haigis, and Castrop formulae for emmetropia. Based on the pseudophakic eye model, OOM and MOM were extracted using 4 × 4 matrix algebra for the corrected eye (with PIOLeq/PIOLcyl (scenario 1) or with PIOLeq and spectacle correction of the residual refractive cylinder (scenario 2) or with PIOLeq remaining the residual uncorrected refractive cylinder (blurry image) (scenario 3)). In each case, the relative image distortion of MOM/OOM was calculated in %.ResultsOn average, PIOLeq/PIOLcyl was 20.73 ± 4.50 dpt/1.39 ± 1.09 dpt for HofferQ, 20.75 ± 4.23 dpt/1.29 ± 1.01 dpt for Haigis, and 20.63 ± 4.31 dpt/1.26 ± 0.98 dpt for Castrop formulae. Cylindric refraction for scenario 2 was 0.91 ± 0.70 dpt, 0.89 ± 0.69 dpt, and 0.89 ± 0.69 dpt, respectively. OOM/MOM (× 1000) was 16.56 ± 1.20/0.08 ± 0.07, 16.56 ± 1.20/0.18 ± 0.14, and 16.56 ± 1.20/0.08 ± 0.07 mm/mrad with HofferQ; 16.64 ± 1.16/0.07 ± 0.06, 16.64 ± 1.16/0.18 ± 0.14, and 16.64 ± 1.16/0.07 ± 0.06 mm/mrad with Haigis; and 16.72 ± 1.18/0.07 ± 0.05, 16.72 ± 1.18/0.18 ± 0.14, and 16.72 ± 1.18/0.07 ± 0.05 mm/mrad with Castrop formulae. Mean/95% quantile relative image distortion was 0.49/1.23%, 0.41/1.05%, and 0.40/0.98% for scenarios 1 and 3 and 1.09/2.71%, 1.07/2.66%, and 1.06/2.64% for scenario 2 with HofferQ, Haigis, and Castrop formulae.ConclusionMatrix representation of the pseudophakic eye allows for a simple and straightforward prediction of OOM and MOM of the pseudophakic eye after cataract surgery. OOM and MOM could be used for estimating monocular image distortions, or differences in overall or meridional magnifications between eyes.

A STUDY OF REFRACTIVE ERRORS IN CHILDREN AND UNMET NEED OF SPECTACLES IN THEM

AIM– to study causes of vision impairment in school going children, with focus on refractive errors and to study the unmet need of spectacles in them. Prospective analysis of 500 children (up to 14METHOD– years of age) visiting a tertiary care teaching Institute in Ahmedabad who were willing to comply with the procedure of the study were enrolled in the study. Refractive error was the main cause in 58.6% of eyes with vision impairment, amblyopia inRESULTS– 15.2% while other causes in 4.3%. Out of which, maximum number of children had astigmatism (200), followed by Myopia (160) and Hypermetropia (70). In the performed study, more than half of those in need of corrective spectacles were without them. Among different types of refractive error, the greatest likelihood for an unmet need was found with myopia followed by hyperopia, while the association with astigmatism, although signicant, was the weakest. There was a benetCONCLUSION– of spectacles in 70% (unmet need) of those who had visual acuity 6/12 or worse in the better eye at the initial examination. Only 18.6% of the children having refractive error were wearing appropriate glasses.

Online e-learning during the COVID-19 lockdown in Trinidad and Tobago: prevalence and associated factors with ocular complaints among schoolchildren aged 11-19 years.

BackgroundThe increase in online learning during the pandemic has been linked to various ocular complaints. This study determined the prevalence and factors associated with ocular complaints among schoolchildren aged 12–19 years during the COVID-19 lockdown in Trinidad and Tobago (T&T).MethodsA cross-sectional study was conducted between January and May 2021, during the COVID-19 lockdown in T&T among secondary school students studying remotely. A two-stage cluster sampling method was employed. A modified web-based Computer Vision Syndrome questionnaire was administered to students. Data on demography, duration of digital device use, and ocular complaints were collected, and multilevel logistic regression was used to determine factors associated with ocular complaints among school children, 12–19 years of age in T&T.ResultsA total of 435 schoolchildren (mean age, standard deviation, 15.2 ± 1.9 years range 12–19 years) responded to the questionnaire. The prevalence of self-reported symptoms of headache, blurred vision, dry eyes, itchy eyes, and double vision were 75.0%, 65.1%; 56.8%; 46.4%; and 33.5%, respectively. Schoolchildren aged 18–19 years, those that used spectacles for correction of their refractive errors, and spent more than 6 h on average on digital devices, reported a high prevalence of any ocular complaints. Analysis also revealed that age (14–15 years) was associated with dry eyes, blurred vision, and headaches, while gender (more prevalently females) was associated with blurred vision and headache. Those that had an eye examination in the last year and schoolchildren that took action to resolve ocular complaints were more likely to experience nearly all ocular complaints.ConclusionsDuring the COVID-19 lockdown, over three in four students in T&T reported ocular complaints from digital devices for online learning. Tailored interventional messages to reduce all forms of ocular complaints should target older students, particularly females, those who laid down when learning online via their devices and people who regularly examine their eyes.

Refractive errors among commercial drivers.

Purpose:To determine the pattern of refractive error among commercial drivers in north India.Methods:Descriptive study with convenient sampling conducted among commercial drivers of north India.Results:A total of 213 (75.8%) heavy-vehicle and 68 (24.2%) light-vehicle drivers were screened for eye diseases. Refractive error for distance was reported in 44 (15.7%; 95% CI: 11.6–20.4) drivers. Hyperopia was reported in 23 (8.2%; 95% CI: 5.2–12) drivers, followed by myopia in 15 (5.3%; 95% CI: 3–8.6) drivers and astigmatism in six (2.1%; 95% CI: 0.7–4.5) drivers. Presbyopia was reported in 157 (55.8%) drivers. Dry eye was reported in 70 (24.9%), stereo deficiency in 77 (27.4%), and color vision deficiency in 11 (3.9%) drivers. Three drivers were diagnosed with cataract, and two were referred for retina evaluation.Conclusion:Hyperopia in both eyes was the most common refractive error. Dry eye disease and color vision deficiency were also reported. Most of the drivers were not using spectacles for refractive error correction. Due to their mobile nature, drivers with cataract and retina diseases did not turn up for follow-up.

Binocular Visual Function Changes After Corneal Collagen Cross-linking in Patients With Keratoconus.

High-order aberrations (HOAs) have been demonstrated to profoundly affect both visual acuity and stereoacuity in patients with keratoconus. Corneal collagen cross-linking (CXL) has been proven to significantly lower HOAs in keratoconus. Yet, to the present date, no evaluation of the effect of the procedure on stereopsis has been performed. The purpose of the study was to assess differences in binocular visual performance in patients with keratoconus before and after CXL. Patients with keratoconus undergoing standard Dresden protocol epi-off CXL in the ophthalmology department of Policlinico Universitario Agostino Gemelli Hospital received slitlamp examination, uncorrected distance visual acuity and corrected distance visual acuity assessment, corneal tomography, Lang stereotest, TNO stereoacuity assessment, distance and near cover test, and Irvine test before surgery and 6 months after CXL. Stereopsis tests were performed with spectacle correction. The analysis included 30 patients (mean age 24.63 ± 3.49 years). The Lang test improved after treatment ( P 0.027), with 6 of 30 patients (20%) showing a positive Lang test before CXL compared with 16 of 30 patients (53.3%) after treatment. Moreover, TNO stereoacuity increased after treatment ( P 0.043), and 14 of 30 patients (46.7%) manifested an improvement of at least 250″ at the TNO test after CXL. In this subgroup of patients, total root mean square values decreased after treatment ( P < 0.001), whereas patients who did not manifest a clinically significant improvement in stereoacuity did not show a reduction in total root mean square values after CXL ( P = 0.11). The results of cover test and Irvine test did not vary after CXL. Patients with keratoconus showing a reduction of HOAs after CXL also manifest a significant improvement in stereoacuity after the treatment.

Outcomes of corneal transplantation in Australia, in an era of lamellar keratoplasty.

Widespread adoption of modern lamellar procedures has altered the pattern of practice of corneal transplantation. Herein, we describe recent findings from the Australian Corneal Graft Registry and place these data into an international context. The total number of grafts reported to the Registry has doubled over the past decade. Deep anterior lamellar keratoplasty is increasingly used for keratoconus, while endokeratoplasty has displaced penetrating keratoplasty for Fuchs endothelial dystrophy. Graft survival and visual outcomes for modern lamellar procedures have shown improvement over time. First deep anterior lamellar and penetrating grafts for keratoconus show comparable survival and long-term best-corrected visual acuity is equivalent. Penetrating grafts for Fuchs endothelial dystrophy exhibit significantly better survival than do endokeratoplasties, largely because the latter undergo more early graft failures. However, visual rehabilitation is swifter in surviving endokeratoplasties. Significantly fewer recipients of a deep anterior lamellar graft or endokeratoplasty require spectacle or contact lens correction, compared with penetrating keratoplasty.

Prevalence, Causes, and Risk Factors of Visual Impairment in Emiratis and Non-Emiratis of Dubai: A Subnational Population-Based Cross-Sectional Survey.

Purpose To study the prevalence, causes, and risk factors of visual impairment (VI) among the Dubai Emiratis and non-Emiratis. Methods The survey was a population-based cross-sectional eye health study conducted 2019-2020. Cluster sampling was used to randomly select local (Emirati) and expatriate (non-Emirati) Dubai residents aged 40 years and older. Ocular examinations were conducted in selected eye clinics to determine the visual acuity (VA) and cause(s) of VI if any. Trained nurses, optometrists, and ophthalmologists did the examinations. VA was measured using ETDRS visual chart. The World Health Organization VI and blindness definitions and classifications for the cause(s) of VI were used. Results A total of 892 participants were included in the final analysis. The mean age [SD] was 52.09 [9.48] years, with 55.8% as males. Prevalence of presenting mild, moderate, and severe VI was 4.7% (2.94–7.11%), 1.8% (0.78–3.5%), and 0% for Emiratis, and 3.6% (2.06–5.76), 1.6% (0.63–3.21), and 0% for non-Emiratis, respectively. Four Emirati participants were blind, with a prevalence of 0.9% (0.25%–2.28%). Men had lower likelihood of VI than women (odds ratio [OR] (95% CI): 0.42 (0.24–0.77)) after adjustment for covariates. Diabetes (OR (95% CI): 1.91 (1.04–3.52)) was an independent risk factor for VI. Higher education level was associated with a lower likelihood of VI (OR (95% CI): 0.34 (0.13–0.89). Leading causes of VI among Emiratis were uncorrected refractive error (52%) and cataract (17.2%). Glaucoma, optic atrophy, and absent globe were the causes of blindness. Conclusions Prevalence of VI is comparably low with leading causes readily treatable. An effective strategy to improve spectacle correction and cataract services would reduce the VI burden.

Prevalence and Distribution of Refractive Errors among Ophthalmic Patients in Madang Province, Papua New Guinea.

Purpose:To assess the prevalence and distribution of refractive errors in Madang Province, Papua New Guinea (PNG).Methods:A retrospective hospital-based study was conducted at Madang Provincial Hospital Eye Clinic. It is a free eye clinic and spectacle costs are further subsidized by a nongovernmental organization. Nonprobability purposive sampling was used to retrieve patients' records at the eye clinic from January to December 2016. Only demographic and clinic data on the patients' first visit to the eye clinic were recorded and these included their age, gender, location, presenting visual acuity (VA), and refractive correction.Results:One thousand and one hundred eighty-four patients' records were retrieved, of which 622 (52.53%) had refractive error. The mean age of refractive error presentation was 49.68 ± 16.29 years with a range of 9–86 years. There were more males (55%) than females. About a quarter of the patients (21.2%) presented with moderate visual impairment. There was a statistically significant relationship between visual impairment and age group (P < 0.001). Myopia (53.1%) was the most common type of refractive error followed by hyperopia (32.5%) and astigmatism (14.4%). The uptake of spectacle correction was very high (95.3%) among the patients. More than one-tenth of the patients (12.5%) reported from other provinces. Almost one-third of the patients (31.4%) could not obtain a VA of 6/6 after refraction. About one-fifth (17.0%) of the patients were suspected of functional amblyopia.Conclusions:Uncorrected refractive error (URE) is a significant cause of visual impairment in PNG. There is a need for the integration of eye care services into primary health care for early detection, treatment, and prevention of visual impairment caused by UREs.

Frequency of Eye Diseases in Residents of Nursing Homes - 1-Year Results of a Novel Telemedicine Service in Switzerland.

For the elderly in nursery homes, a visit to the ophthalmologist is a burden, which might lead to undertreatment. We have recently started offering a novel ophthalmological service combining onsite examination and telemedical interpretation for patients with limited access to ophthalmological care. This study summarises the frequency of findings of treatable eye diseases after the first year of operation in participants who dropped out from regular ophthalmological control. Participants' clinical characteristics, frequency of service utilisation, and findings were extracted from the system and analysed. Of 1946 residents approached, 540 (27.7%; 1080 eyes) signed up for the service. A complete examination was possible in 412 persons (813 eyes) and partially possible in the remaining 128. The mean age of the examined participants mean age was 83.9 years (SD 9.7), and they were predominantly female (69.8%). The majority had a diagnosis of dementia (54.5%) and 20.2% had diabetes mellitus requiring treatment. The median care level (ranging from 0 - 12) was 7(interquartile range 6 - 9), corresponding to a care need of 121 - 140 min/d. The mean best-corrected decimal visual acuity was 0.55 (SD 0.24). For 164 eyes (15.2%), the current spectacle correction was insufficient. An untreated cataract was present in 145 eyes (13.4%), 89 eyes (8.2%) were receiving glaucoma treatment, and 7 eyes had a decompensated glaucoma. Dry age-related macular degeneration (AMD) appeared in 276 eyes (25.6%), 12 eyes (1.1%) had wet AMD, and 24 eyes (11.0%) among patients with diabetes showed signs of diabetic retinopathy. Other pathologies were uncommon. Residents of nursery homes, who are unable to attend regular ophthalmological control, show various treatable ophthalmological conditions, including cataracts, glaucoma, and retinal pathologies. Screening with a novel telemedicine service allows for the identification of treatable conditions and careful planning and referral of patients to appropriate clinics having the necessary infrastructure for this particular population.

The impact of scleral contact lenses correction of keratoconus on wave-front and accommodation parameters

Purpose: to evaluate the wave-front and accommodation changes in various stages of keratoconus corrected by scleral contact lenses.Material and methods. 20 patients (39 eyes) aged 18–37 with keratoconus of various stages (8 eyes with stage I, 3 eyes with stage II, 12 eyes stage II/III and 16 eyes with stage III wore OneFit or OneFitMed scleral lenses, made of hard gas-permeable material Contamac (Great Britain) with Dk 100 and mean thickness of 200–220 μm. All patients were examined using refractometry before and after cycloplegia, tested for uncorrected and best corrected visual acuity, relative accommodation reserve (RAR), binocular and monocular accommodation response (with Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K, Japan) for full spectacle correction and scleral contact lens correction. 17 patients (34 eyes) were tested for corneal aberrations with OPD Scan III aberrometer (Nidek) without correction and with scleral contact lenses.Results. Patients with keratoconus demonstrated a manifest form of refraction -5.26 ± 0.45 D (by sphere equivalent) and a cycloplegic refraction of -4.75 ± 0.33 D. Uncorrected visual acuity averaged 0.26 ± 0.05, increasing with full spectacled correction to 0.54 ± 0.07 and with scleral contact lenses correction to 0.95 ± 0.08. Keratoconus patients demonstrated binocular accommodative response (BAR) of +4.5 to -6.12 D averaging -1.43 ± 0.34 D with full spectacled correction diopters and of -0.5 to -8.13 D averaging - 2.83 ± 0.23 D with scleral contact lenses, р ≤ 0.01. We could not measure the BAR in 3 patients with keratoconus stage III. Monocular accommodative response (MAR)with a full correction with glasses averaged -0.98 ± 0.33 D (from + 6.0 to -5.0 D) with full spectacled correction and -2.41 ± 0.27 D (from +1.25 to -5.5 D) with scleral contact lenses, р ≤ 0.02. At the same time monocular accommodative response of 4 patients with keratoconus of the third stage of disease was not available to assess. So, accommodative response significant increased with scleral contact lenses. Positive relative accommodation with a full correction with glasses averaged 1.50 ± 0.35 D, with scleral contact lenses – 2.25 ± 0.29 D, р ≤ 0.01. The level of all aberrations, from lower to higher orders was significantly increased. With scleral contact lenses that correct the shape of the anterior surface of the cornea, the level of all corneal aberrations dropped to nearly normal values, while the coefficient of asphericity dropped below normal values, and the point spread function parameter (PSF) increased by fifteen times (to reach 0.06).Conclusions. Patients with keratoconus demonstrated a generally lower objective accommodative response as compared to normal values, but with the scleral lenses it increases to the normal level. Scleral contact lenses normalize corneal aberrations and increase the quality of vision. All of the above justifies the recommendation to use scleral contact lenses for optical correction of keratoconus to increase the vision, the accommodation response and visual comfort, including that of near-visual work.

Visual impairment in children with multiple disabilities in schools for children with special needs in South India.

Purpose:To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting.Methods:Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps.Results:Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVIConclusion:Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision-related problems in children with multiple disabilities.

Spectacle correction in the complex of therapeutic measures for primary angle closure glaucoma. Preliminary report

PURPOSE. To improve the effectiveness of primary angle closure glaucoma (PACG) treatment in the initial stage in patients with hyperopia.MATERIAL AND METHODS. The study observed 18 patients (36 eyes) with the initial stage of PACG who also had low (8 subjects, 16 eyes) or moderate (10 subjects, 20 eyes) hyperopia. Study patients were divided into two groups: the main group — 12 patients (24 eyes) aged 43–67 years (mean age 55.6±1.1 years); the control group — 6 patients (12 eyes) aged 48–60 years (mean age 56.4±2.4 years). Prescribed treatment in the main group: selection and application of universal progressive correction, then laser iridecotomy (LIE) and management without pilocarpine instillations. Prescribed treatment in the control group: selection and application of monofocal correction for near vision, then LIE and instillations of 1% pilocarpine solution 3 times a day. All patients underwent visometry with correction, refractometry, ophthalmoscopy, tonometry, tonography, gonio-scopy, optical coherence tomography of the anterior eye segment, ultrasound biometry. Indicators of hydrodynamics and parameters of the anterior chamber were recorded before using spectacles correction, after the start of correction, after LIE, and 1 month after the start of all therapeutic measures.RESULTS. The use of progressive spectacle correction led to a significant decrease of true intraocular pressure (IOP) (p&lt;0.001), an improvement of aqueous humor outflow (p&lt;0.05) and an increase in the size of anterior chamber angle (p&lt;0.001). Performing LIE in patients of the main group did not significantly change these indicators. The results obtained in this group made it possible to abandon the use of pilocarpine. In patients of the control group, the improvement in aqueous humor outflow (p&lt;0.001) and increase in the size of anterior chamber angle (p&lt;0.002) were more significant after LIE than after prescription of adequate monofocal correction for near vision (p&lt;0.02–0.05 and p&lt;0.2, respectively).CONCLUSION. The use of progressive spectacle correction in patients with hyperopia and initial stage of PACG before LIE leads to normalization of hydrodynamic parameters and an increase in the magnitude of anterior chamber angle without the use of miotic drugs. Prescription of progressive spectacle correction is advisable in these patients as a part of the complex of therapeutic measures aimed at normalizing ocular hydrodynamics.

Visual and refractive outcomes of monofocal toric intraocular lens implantation in amblyopic eyes.

To evaluate the visual and refractive outcomes of monofocal toric intraocular lens (IOL) implantation after cataract surgery in amblyopic eyes. Our center's database was used to identify patients who had undergone bilateral cataract surgery between 2016 and 2020 with the implantation of a toric IOL in their amblyopic eye. Exclusion criteria were the presence of strabismus, ocular pathologies other than cataract or intra-surgical complications. The outcomes analysed were uncorrected distance visual acuity (UDVA), subjective refraction and corrected distance visual acuity (CDVA) one month after surgery. Ninety patients were included, with a mean age of 68.96 ± 7.81years. CDVA was lower for the amblyopic eye, both before and after surgery. There was a mean improvement in CDVA of 0.23 ± 0.21 LogMAR for the dominant eye and of 0.39 ± 0.33 for the amblyopic eye, p < 0.001 in both cases. Postoperative subjective refractive cylinder was higher in the amblyopic eye (-0.24 ± 0.39 D versus -0.10 ± 0.25 D, p < 0.01), as well as mean cylinder prediction error (-0.30 ± 0.47 D versus 0.02 ± 0.42 D, p < 0.01), compared to the dominant eye. There was a statistically significant correlation between preoperative and postoperative CDVA in amblyopic eyes (Spearmańs Rho = 260, p = 0.013). Mean postoperative UCVA was 0.15 ± 0.25 for amblyopic and 0.03 ± 0.12 for dominant eyes. Only one patient required distance spectacle correction due to residual astigmatism. Cataract surgery with toric IOL implantation in amblyopic eyes leads to an improvement in visual acuity and to spectacle independence in almost all cases, even in the presence of a higher cylinder prediction error.

Eligibility for the use of ready-made spectacles among children in a school-based programme in Ghana.

Ready-made spectacles are low-cost spectacles for correcting refractive errors in children who would otherwise have their refractive errors uncorrected due to lack of availability and affordability of conventional, expensive custom-made spectacles. Thus, this study seeks to estimate the proportion of children with uncorrected refractive errors eligible for ready-made spectacles in a school-based programme. A school-based descriptive cross-sectional study was employed to screen children aged 12-15 years in eighteen public junior high schools within the Bongo district of Ghana. Children who failed the 6/9 acuity test were refracted and given spectacles. Ready-made spectacle was prescribed when visual acuity improved by ≥2 lines in at least one eye with full correction (astigmatism of ≤0.75D); spherical equivalent corrected visual acuity to ≤1 line worse than best corrected visual acuity with full correction in the better eye; and there was ≤1.00D difference between the two eyes. A total of 1,705 school children were examined. Of this number, 30 (1.8%; 95% CI: 1.2-2.5%) met the criteria for refractive correction but none had any. Twenty-six (86.7%; 95% CI: 69.7-95.3%) were found to be eligible for ready-made spectacles (power range: -1.50D to +1.00D, mean spherical equivalent ± SD = -0.27D ± 0.79D) while 4 (13.3%; 95% CI: 4.7-30.3%) were not, hence, given custom-made spectacles. A binary logistic regression analysis revealed that the odds of being eligible for one type of spectacles was similar between males and females (OR: 1.1; 95% CI: 0.1-12.7; p = 0.93). A large proportion of students who met the criteria for spectacle correction could be corrected with ready-made spectacles. There is, therefore, the need for these spectacles to be considered an appropriate alternative for refractive error correction during school eye health programmes.