Spectacle Correction Research Articles

Prescribing Yoked Prism in Patients with Autism Spectrum Disorder (ASD): A Study of Inter- and Intraexaminer Agreement Using the Kaplan Nonverbal Battery

Background Double-blind studies have reported improvements in posture, spatial awareness, and behavior in Autism Spectrum Disorder (ASD) individuals wearing yoked prism lenses. The Kaplan Nonverbal Battery (KNB) is a performance-based test used to evaluate yoked prism lenses. To date, only Kaplan has reported KNB results. This study investigates inter-examiner and intra-examiner agreement obtained in scoring the KNB in nonverbal/ minimally verbal ASD subjects. Methods Ten nonverbal/minimally verbal ASD subjects between 9 and 17 years old enrolled and completed an eye examination. All subjects adapted to spectacles, wearing refractive correction for four weeks. Subjects completed two study visits that were videotaped. At each visit, subjects completed the KNB wearing habitual spectacle correction and then wearing yoked prism lenses of five-prism diopters base up or down. Two examiners scored the KNB live and two other examiners scored the KNB via videorecording. Examiners were masked to the base direction of the yoked prism lenses and to the other examiners’ responses. Agreement between and within examiners was computed using the weighted version of Cohen’s kappa. Results Nine subjects completed both study visits. Both inter-examiner and intra-examiner agreement were markedly better when examiners scored via video. When scored by live presentation, inter-examiner agreement by the weighted Cohen’s kappa coefficient was 0.674, 0.364, 0.726 and 0.357. When scored via video, inter-examiner agreement was 0.634, 0.620,0.702 and 0.678. Intra-examiner agreement for live presentation was 0.451 and 0.579, but increased for video scoring to 0.861 and 0.875. Conclusions Examiners assessing the KNB to evaluate yoked prism lenses for nonverbal or minimally verbal ASD children consistently showed good inter-examiner and intra-examiner agreement when evaluating by video, but not by live presentation. Clinicians may improve reliability by incorporating scoring of the KNB by video presentation.

Orthokeratology lenses and myopia control

Purpose: To estimate the stabilizing effect of orthokeratology lenses (ortho-K, OK-lenses) on myopia progression by evaluating axial eye growth dynamics and clinical refraction. Material and methods. Ortho-K group consisted of 68 children (135 eyes) aged 7–17 years (mean age 12.2) with progressive myopia (initially -0.75–6.75 D). Observation period varied from 7 to 30 months (mean period 11.68±4.39). All patients used OK-lenses for overnight wear. The control group consisted of 90 patients (180 eyes) with myopia who were prescribed single vision spectacles for vision correction. Comparative analysis was performed for clinical refraction parameters as well as for axial length (AL). The data was obtained with the use of IOL-Master optical biometer (“Carl Zeiss”). Results. The parameters were stable in patients of ortho-K group: axial length, subjective and objective clinical refraction, the required power of corrective lenses. However, the parameters changed significantly in the control group during the observation period: uncorrected visual acuity (UCVA) decreased, the required power of corrective lenses increased, the indices of objective clinical refraction strengthened, annual gradient of progression (AGP) amounted to 0.26±0.19 and 0.16±0,39 mm in patients with low and moderate myopia, respectively. Conclusion. The use of OK-lenses ensures a significant deceleration of myopia progression in children. The results obtained suggest a wider use of ortho-K among pediatric ophthalmologists in their clinical practice as it is an effective preventive and therapeutic method for patients with progressive myopia.

Modern Methodological Approaches to the Correction of Astenopia in Patients with Visual-Intensive Work

The authors consider presented in the literature tested new approaches to diagnosis, prevention and correction of symptoms of asthenopia in persons visually-intense work related to theoretical aspects of asthenopia in fact, the selection of spectacle correction and application of a multidisciplinary approach. Determines the pattern of allocation in the traditional classification of asthenopia (accommodative, muscular, sensory) classification criterion is the presence or absence of phenomena of psychological maladjustment. Along with this, it is established that the astigmatic component correction of complex myopic astigmatism, it is advisable to perform in the range of 60–75 % of the required (according to cycloplegics examination of refraction). At the same time, the level of visual performance (in the most difficult conditions of presentation of test information of the type “choice of signal from several — evaluation of the signal — response ratio”) with incomplete (60–75 %) correction by 12.7–20.4 % (p < 0.05) is higher than with partial (75–85 %) and complete, taking into account minor differences in the achieved visual acuity (0.04–0.08, p > 0.05). In addition, the practical expediency of applying a multidisciplinary approach to the correction of asthenopia, based on the complex effects of specific and non-specific methods of stimulation of vision. It was found that the combined use of multidirectional technologies of physical impact (low-energy laser radiation, cranial osteopathic effects and special training of the cervical-thoracic spine) provides effective correction of accommodation disorders, which is confirmed by a pronounced, statistically significant positive dynamics of clinical and functional, ophthalmic-ergonomic and subjective indicators of the visual system after a course of therapeutic and restorative measures.

Evaluation of eye-related parameters and adverse events of rigid gas permeable contact lens and spectacles correction in infants with monocular aphakia after congenital cataract surgery: a retrospective clinical study

BackgroundCongenital cataract is currently one of the leading blindness-causing eye diseases in children. Surgical treatment only opens the visual pathway for children. The postoperative recovery of visual function is also dependent on effective optical correction and visual function training. In this study, we analyzed the changes in eye-related parameters, adverse events and the annual cost of rigid gas permeable contact lens (RGPCL) and spectacles correction in infants with monocular aphakia after congenital cataract surgery.MethodsTo analyze the postoperative visual acuity, strabismus, nystagmus, myopic shift, globe axial length growth, adverse events, patient adherence to patching, and annual cost for patients with unilateral congenital cataract who underwent cataract surgery. Rigid gas permeable contact lenses or spectacles were used to correct aphakia after congenital cataract.ResultsOf the 49 patients, 20 patients with unilateral aphakia who used RGPCL were in group 1. Group 2 comprised 14 patients with persistent fetal vasculature (PFV) who used RGPCL, and there were 15 patients with spectacles in group 3. In group 1, there were important improvements in visual acuity, strabismus and nystagmus. In groups 2 and 3, there were no significant improvements in visual acuity, strabismus or nystagmus. Patients with a good adherence to patching had better visual acuity after the operation than patients who did not, in groups 1 and 3. There were no significant differences in myopic shift or rate of globe axial length growth among the 3 groups. No patients in group 1 had ocular disease that affected visual acuity. The mean annual expenses of the RGPCL group was 3965 yuan, and the mean annual cost of spectacles was 1140 yuan to 2500 yuan.ConclusionRGPCL is a safe and effective optical correction method for patients with monocular aphakia after congenital cataract surgery. Spectacles are not an ideal optical correction. Using RGPCL to correct patients with PFV, the final visual acuity improved, but the difference was not statistically significant. There were no improvements in strabismus or nystagmus in patients with PFV.

Visual Impairment in Fungal Versus Bacterial Corneal Ulcers 4 Years After Successful Antimicrobial Treatment

PurposeTo compare longitudinal outcomes of visual acuity after fungal corneal ulcers with those of bacterial ulcers. DesignProspective cohort study. MethodsThis study was conducted in a tertiary eye hospital in South India. The population consisted of 100 of 152 individuals whose fungal or bacterial keratitis had been diagnosed 4 years prior and had been enrolled in 1 of 2 concurrent randomized trials. Causative organisms of infectious keratitis were either bacterial or fungal. Presenting visual acuity consisted of best spectacle corrected visual acuity (BSCVA) and hard contact lens-corrected visual acuity (CLVA). ResultsFifty study participants with prior fungal keratitis and 50 with prior bacterial keratitis were enrolled. Four years after treatment for keratitis, participants' presenting vision in the better eye was worse than 20/60 for 12 individuals (24.0%) in the fungal group and 10 individuals (20.0%) in the bacterial group. Median BSCVA in the affected eye at the 4-year visit in the fungal group was similar to that in the bacterial group (Snellen equivalent, 20/32 for each), although vision worse than 20/400 was more common in the fungal ulcer group after spectacle correction (odds ratio [OR] 4.19; 95% confidence interval [CI], 1.11-15.8) and contact lens correction (OR, 5.74; 95% CI, 1.37-24.1). ConclusionsIn this South Indian population with a previous episode of fungal or bacterial keratitis, correctable bilateral visual impairment was common. Although long-term visual outcomes were, on average, similar between fungal and bacterial ulcers, fungal ulcers were more likely to produce severe visual impairment.

Findings from an opt-in eye examination service in English special schools. Is vision screening effective for this population?

Our objective was to present the findings of an opt-in, school-based eye care service for children attending 11 special schools in England and use these findings to determine whether a vision screening programme would be appropriate for this population. Data from eye examinations provided to 949 pupils (mean age 10.7 years) was analysed to determine the prevalence and aetiology of visual deficiencies and reported eye care history. For 46.2% (n = 438) of pupils, a visual deficiency was recorded. 12.5% of all the children seen (n = 119) had a visual deficiency that was previously undiagnosed. Referral for a medical opinion was made for 3.1% (n = 29) of pupils seen by the service. Spectacle correction was needed for 31.5% (n = 299) of pupils; for 12.9% (122) these were prescribed for the first time. 3.7% (n = 11) of parents/carers of pupils needing spectacles chose not to use the spectacle dispensing service offered in school. Eye care history was available for 847 pupils (89.3%). Of the pupils for whom an eye care history was available, 44% (n = 373) reported no history of any previous eye care and10.7% (n = 91) reported a history of attending a community optical practice/opticians. Only one pupil from the school entry 4–5 age group (0.6% of age group n = 156) would have passed vision screening using current Public Health England screening guidelines. Children with a diagnosis of autism were significantly less likely to be able to provide a reliable measurement of visual acuity. This study supports previously published evidence of a very high prevalence of visual problems in children with the most complex needs and a significant unmet need in this group. It demonstrates routine school entry vision screening using current Public Health England guidelines is not appropriate for this group of children and very low uptake of community primary eye care services.

Safety assessment of using collamer phakic implants in the correction of refractive errors

An increasing number of patients with refractive visual impairments, in whom the correction using spectacles or contact lenses does not meet expectations, consider the possibility of undergoing refractive surgery. Phakic implants are an alternative for patients who are not eligible for laser correction. The aim of the study is to assess the safety of using collamer phakic implants in the correction of vision defects during the annual follow-up. The study included 24 eyes in 12 patients who were implanted with Visian ICL phakic posterior chamber lenses in order to correct myopia. The examinations carried out before the surgery were as follows: objective refractometry, the assessment of distant visual acuity with the best correction, intraocular pressure measurement, evaluation of the endothelium, corneal topography, and depth of the anterior chamber measurement. The final examinations included visual acuity, refraction, intraocular pressure, implant placement, endothelial microscopy, and funduscopic examination. Mean objective refraction was: sphere -7.77 ±3.55 diopters and cylinder 1.18 ±0.87 diopters. Spectacle correction produced the mean visual acuity of 0.91 ±0.20 (Snellen). During the period of 1-year follow-up, the mean spherical power was 0.475 ±0.39 diopters, cylinder 0.46 ±0.27 diopters and the visual acuity after the procedure 1.05 ±0.22 (Snellen). The results of the 12-month evaluation showed a statistically significant greater improvement in patients using phakic implants compared to those subjected to spectacle correction (p < 0.05). The preand post-operative evaluation demonstrated no significant differences in endothelial cell density (p < 0.05). No complications were reported both during the surgery and the entire follow-up period. The results of the safety assessment of using properly implanted ICL phakic lenses show good tolerance of collomer implants in the posterior chamber. They do not have a negative effect on the structures located in the anterior segment of the eye, including the corneal endothelium and the lens.

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.

Progressive spectacle correction in patients with ametropia and primary open-angle glaucoma

Purpose: To determine the role that progressive spectacle lenses play in intraocular pressure compensation and stabilization of the glaucomatous process in patients with primary open-angle glaucoma (POAG) combined with presbyopia and refractive errors. Material and methods. 29 patients (53 eyes) aged 43 to 67 years with I-II stage POAG and a certain type of refractive error were enrolled into study. All patients had intraocular pressure (IOP) compensated to the target level on medication. Patients of the main group (17 people, 32 eyes) used universal progressive spectacle lenses with optimized surface. The patients of the control group (12 people, 21 eyes) used separate monofocal glasses for near and distance vision as a method of ametropia correction. Visual acuity test, refractometry, pneumotonometry, tonography, automated static perimetry were applied for monitoring the patients. The measurements were taken before spectacle correction and a year after its prescription. Results. A decrease of IOP (p=0.01) and an increase of the aqueous humor outflow coefficient (p&lt;0.01) were determined after one year use of the recommended type of vision correction in the main group, whereas in the control group there was an increased level of IOP (p&lt;0.05) and a reduced aqueous humor outflow coefficient (p&lt;0.2). Conclusion. The use of progressive spectacle lenses as a method of permanent vision correction reliably reduces IOP and improves the aqueous humor outflow in patients with early-stage POAG. The absence of negative visual field dynamics indicates the stabilization of the glaucomatous process.

Visual rehabilitation of patients with irregular cornea

Purpose: To estimate the possibility of optical correction of an irregular surface of a cornea at primary ectasia (keratoconus) and secondary ectasia (a consequence of radial keratotomy (RKT) and Keratoplasty) for improvement of the maximum of visual acuity. Material and methods: In the study the scleral gas-permeable lenses (SGCL) were fitting by the 60 patients, it was 45 men and 15 women from them. The 46 patients had various stage of keratoconus and 14 patients had the keratectasia after RKT. On the 5 eyes of the patients was carried out keratoplasty earlier. Criteria of successful selection of SGCL considered achievement of steadily high visual acuity, comfort of carrying and the optimal clearance in apical zone, in the limbal and landing zone on the conjunctiva also. The results: In the course of the study, the maximum visual acuity in all patients was achieved with mini-SGKL correction irrespective of type of keratoektasia. All patients observed visual comfort compared with spectacle correction or correction with other types of contact lenses. Conclusion: Scleral gas-permeable contact lenses are the main method of correction at patients with irregular corneas and provide the best visual acuity.

Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review.

Purpose:The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ≥30 years in India.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision <N8 improving with correction in the absence of distance URE.Results:Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2–68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9–14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0).Conclusion:This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.

Evaluation of amblyopia in school going children

Background and objective: Amblyopia is the most common cause of monocular vision loss in children and as amblyopia is a major preventable and treatable cause of pediatric low vision, early detection and treatment of amblyopia is very important to reduce the prevalence of amblyopia. This study was done to determine the prevalence of amblyopia in school going children in the age group of 5-15 years in and around Jaipur and also to detect the types of amblyopia in these children. Materials and methods: Cross sectional and time bound study, in which 4020 school children in the age group of 5-15 years underwent screening. Amblyopia was diagnosed in eyes with reduced best corrected visual acuity in the absence of any other cause. Results: Amblyopia was diagnosed in 44 children. Prevalence of amblyopia in our study was found to be 1.1 %. The underlying amblyogenic causes assessed were anisometropia (29.5%), strabismus (25%), combined mechanism amblyopia (15.9%), meridional amblyopia (13.6%), ametropic amblyopia (11.6%), and the least was that of visual deprivation amblyopia being 4.5%. No statistically significant associations were found in the geographical distribution, or in the gender distribution. The most frequent pattern of strabismus was exotropia. A higher percentage of moderate degree of amblyopia (64%) and more of unilateral cases of amblyopia (26) were detected. There were an equal number of hypermetropes and myopes, majority were given spectacle correction. All 44 amblyopes were prescribed occlusion therapy. Conclusion: Prevalence of amblyopia was found to be 1.1% in our study. The results indicate the importance of screening school going children for amblyopia and the importance of early detection and treatment.

Сравнительная оценка пространственной контрастной чувствительности у пациентов с миопией на фоне очковой и ортокератологической коррекции

Сравнительная оценка пространственной контрастной чувствительности у пациентов с миопией на фоне очковой и ортокератологической коррекции

REHABILITATION POSSIBILITIES OF SOFT CONTACT CORRECTION IN POST-TRAUMATIC AND CONGENITAL PATHOLOGY OF CHILDREN

Objective. To analyze the results of the use of contact correction in the rehabilitation of children with post-traumatic and congenital abnormalities. Material and methods. 424 patients, aged between 3 months and 17 years, using soft contact lenses using traditional and special methods of examination. Results and discussion. It was established that in the overwhelming number of children who were assigned to wear, the post-traumatic pathology prevailed - 341 (79.1%) patients; congenital abnormality was 83 cases (20.9%). Contact lenses were made individually according to the developed technologies from a hydrogel material by turning using biocompatible paint, which allows combining several color zones of different diameters, while achieving optimal functional and cosmetic results. Proved a significant increase in visual acuity compared with spectacle correction and correction of transparent contact lenses in 86.4% of children. Thus, the use of soft contact lenses, performing corrective, diaphragmatic and cosmetic function is a method of preventing the development of amblyopia, strabismus, contributing to the full development of the visual analyzer in children.

"Attitude of Female Undergraduates Towards Spectacle Correction of Refractive Errors"

"Attitude of Female Undergraduates Towards Spectacle Correction of Refractive Errors"

Preliminary Clinical Exploration of Scleral Lens Performance on Normal Eyes

Abstract&#x0D; Objectives: The purpose of this study was to evaluate the performance (i.e. vision, comfort and fit) of spherical and front-surface toric scleral lenses in subjects with regular, healthy corneas.&#x0D; Methods: Scleral lenses were fitin the eyes (n = 16) of healthy subjects (n = 9) with regular corneas, absent of pathology, and studied using an observational, multi-visit design. Lens fit was objectively evaluatedby an experienced practitioner.Following 1 month of successful lens wear, participants completedsubjective satisfaction surveys regarding the scleral lens wearing experience.&#x0D; Results: According to participant surveys, scleral lenses were subjectively preferred over soft toric or gas permeable contact lenses in 88% of eyes, including in all eyes fit with a front-surface toric scleral lens (n = 3). Seventy-five percent (75%) of eyes achieved visual acuity of 0.1 logMAR or better, while all eyes with prior spectacle wear achieved visual acuity with a scleral lens within 1 Snellen line of spectacle correction. Seventy-five percent (75%) of eyes achieved good subjective comfort with a scleral lens. No participants reported poor subjective vision and/or comfort.&#x0D; Conclusions: Our findings suggest that subjects preferred the performance of a scleral lens (spherical or front-surface toric) compared to a soft toric or gas permeable contact lens. Moreover, scleral lenses may provide a viable, alternative contact lens modality option for patients considering discontinuation of traditional soft toric and/or rigid contact lens wear; so long as the factors associated with hypoxia remain minimized.&#x0D; Key Words: scleral lens; scleral contact lens; front-surface toric scleral lens; lens performance; normal eyes; healthy eyes

Customised spectacles using 3‐D printing technology

BackgroundThis study describes a novel method of customised spectacles prototyping and manufacturing using 3‐D printing technology.MethodsThe procedure for manufacturing customised spectacles using 3‐D printing technology in this study involved five steps: patient selection; using surface topography; 3‐D printing of the phantom model; 3‐D designing of the spectacles; and 3‐D printing of the spectacles.ResultsThe effective time required for 3‐D printing of the spectacles was 14 hours. The spectacles weighed 7 g and cost AUD$160.00 to manufacture. The 3‐D‐printed spectacles fitted precisely onto the face and were considered to provide a superior outcome compared with conventional spectacles. Optical alignment, good comfort and acceptable cosmesis were achieved. One month after fitting, the 3‐D‐printed spectacles did not require further changes.ConclusionCustomised 3‐D‐printed spectacles can be created and applied to patients with facial deformities. As a significant number of children with facial deformities require spectacle correction, it is essential to provide appropriate frames for this group of patients. The 3‐D printing technique described herein may offer a novel and accurate option. It is also feasible to produce customised spectacles with this technique to maximise optical alignment and comfort in special conditions.

Prevalence and types of refractive errors, and spectacle coverage in Sri Lankan adults: The Sri Lanka National survey of blindness and visual impairment

Introduction Uncorrected refractive errors are the commonest cause of visual impairment globally. Despite this, the proportion of affected individuals who wear spectacles can be low, particularly in low and middle- income countries. No data were available for Sri Lanka. Objectives To estimate the prevalence of refractive errors and investigate their risk factors among adults aged 40 years and above. Another purpose was to calculate spectacle coverage and identify subgroups with low coverage. Methods Cluster random sampling was used to obtain a nationally representative sample. Presenting distance visual acuity was measured using a logMAR chart, with distance spectacle correction if usually worn. All underwent autorefraction and an optician measured best-corrected visual acuity after subjective refraction. Participants who had undergone cataract surgery were excluded. Spectacle coverage was assessed amongst participants with a visual acuity of Results 5,779/6,713 (86.1%) enumerated adults were examined; 5,179 had refraction data. 67% had a refractive error: hyperopia 49.6%; myopia 17.4%. Refractive errors increased with age. Being aged 60 years and above and Sinhala ethnic group were independent risk factors. Spectacle coverage was 17.7% overall, being lower in females and the non-literate. Based on the findings, 1.66 million adults require spectacles for distance correction. Conclusions Refractive errors are very common in Sri Lankan adults, and there is a large unmet need for spectacles. Affordable services for refractive errors need to be scaled up, focusing on the most underserved subgroups in the population.

A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years

To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone. Multicenter randomized clinical trial. One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment. Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n= 69) or continued spectacle correction alone if needed (n= 69). Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P= 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively. In children aged 7 to 12 years who have received previous treatment for amblyopia otherthan spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.

Potential Lost Productivity Resulting from the Global Burden of Myopia: Systematic Review, Meta-analysis, and Modeling

We estimated the potential global economic productivity loss resulting from vision impairment (VI) and blindness as a result of uncorrected myopia and myopic macular degeneration (MMD) in2015. Understanding the economic burden of VI associated with myopia is critical to addressing myopia as an increasingly prevalent public health problem. We estimated the number of people with myopia and MMD corresponding to critical visual acuity thresholds. Spectacle correction coverage was analyzed against country-level variables from the year of data collection; variation in spectacle correction was described best by a model based on a human development index, with adjustments for urbanization and age. Spectacle correction and myopia data were combined to estimate the number of people with each level of VI resulting from uncorrected myopia. We then applied disability weights, labor force participation rates, employment rates, and gross domestic product per capita to estimate the potential productivity lost among individuals with each level and type of VI resulting from myopia in 2015 in United States dollars (US$). An estimate of care-associated productivity loss also was included. People with myopia are less likely to have adequate optical correction if they are older and live in a rural area of a less developed country. The global potential productivity loss associated with the burden of VI in 2015 was estimated at US$244 billion (95% confidence interval [CI], US$49 billion-US$697 billion) from uncorrected myopia and US$6 billion (95% CI, US$2 billion-US$17 billion) from MMD. Our estimates suggest that the Southeast Asia, South Asia, and East Asia Global Burden of Disease regions bear the greatest potential burden as a proportion of their economic activity, whereas East Asia bears the greatest potential burden in absolute terms. Even under conservative assumptions, the potential productivity loss associated with VI and blindness resulting from uncorrected myopia is substantially greater than the cost of correcting myopia.