Subjective Refraction Research Articles

Tolerance to induced astigmatism of patients with trifocal or extended depth of focus intraocular lens implantation.

Residual astigmatism is common after cataract surgery involving implantation of an intraocular lens, yet the tolerance of presbyopia-correcting intraocular lens to astigmatism of different magnitudes and axes is poorly understood. Here we compared visual acuity and quality in the presence of induced astigmatism after implantation of a trifocal or extended-depth-of-focus (EDOF) intraocular lens, the two widely used presbyopia-correcting intraocular lenses. At least 3 months after implantation of a TFNT00 or ZXR00 intraocular lens, patients were analyzed by slit-lamp examination, non-contact tonometry, subjective refraction, iTrace aberrometry, and corneal topography. After correction of residual astigmatism, astigmatism of different magnitudes on different axes was induced using cylindrical lenses, and overall visual acuity was measured, while objective visual quality was measured using the Optical Quality Analysis System II. Subjects were also asked about subjective visual quality using the Visual Function-14 questionnaire. Comparison of 18 individuals who received a trifocal lens and 19 who received an EDOF lens showed that objective visual quality was better in the EDOF group regardless of the magnitude or axis of the induced astigmatism. In both groups, astigmatism of at least -1.00 DC influenced distant vision more severely when the axis was 45° than 0° or 90°, meanwhile astigmatism of at least -1.50 DC influenced near and intermediate vision more severely when the axis was 45° than 0° or 90°. Trifocal or EDOF intraocular lenses are less tolerant of oblique astigmatism than astigmatism with or against the rule. EDOF lenses may provide better objective visual quality than trifocal lenses in the presence of astigmatism, regardless of its magnitude or axis.

Comprehensive Primary Eye Care: A Comparison Between an In-Person Eye Exam and a Tele-Eye Care Exam.

Proper access to primary eye care is essential in addressing vision impairment, and tele-eye care examinations are a promising solution that could facilitate this access in many rural or remote areas. Even though remote eye exams are becoming increasingly frequent, comprehensive tele-eye care exams are still limited by the lack of published data. The aim of this study is to compare a comprehensive tele-eye care exam with a gold standard in-person primary eye care exam with an emphasis on refractive measurements, ocular health assessment, confidence level of the eye care providers and patient satisfaction. Sixty-six participants underwent two comprehensive eye exams performed by two eye care providers. One was a gold standard in-person exam, while the other was a remote exam performed by an eye care provider through videoconference. An overall patient satisfaction survey and a questionnaire for visual comfort with a trial frame from each modality were completed and the eye care providers scored their confidence level for each test. Exam results and diagnoses were compared between both modalities. Tele-refraction has a good to excellent agreement with in-person subjective refraction in terms of sphero-cylindrical power and best corrected visual acuity. There was no statistically significant difference for visual comfort between both modalities. The agreement between in-person and remote exams for ocular health assessment ranged from fair to almost perfect, but there was a low prevalence of ocular pathologies within the study sample. The confidence level of the eye care providers and patient satisfaction were statistically higher in-person. Tele-eye care appears to be statistically and clinically non-inferior to in-person eye exams, especially for refraction, but the low prevalence of ocular pathologies somewhat limits the comparison of its efficacy for ocular health assessment. More studies on comprehensive tele-eye care exams are needed.

비정시의 원점거리 측정을 이용한 자각적굴절검사의 유용성

비정시의 원점거리 측정을 이용한 자각적굴절검사의 유용성

COMPARISON BETWEEN AUTOREFRACTION AND RETINOSCOPY FOR SUBJECTIVE CORRECTION IN CHILDREN

The study's objective was to compare the accuracy of retinoscopy and autorefraction for subjective correction in children. The study was conducted in the Department of Ophthalmology at Nishtar Medical Hospital from June 2021 to May 2022, and it was a prospective study. The study included 60 children aged between 6 to 15 years who had asthenopic symptoms and blurring of vision. The children were given cyclopentolate 1% eyedrops thrice at intervals of 10 minutes to achieve cycloplegia. After an hour of instilling eye drops, cycloplegic retinoscopy, and autorefractometry were performed. Three values of each technique were recorded, and the average was calculated. After three days, binocular and monocular subjective refraction was performed until the best-corrected visual acuity (BCVA) was achieved. Results showed that 40.8% (49 eyes) were hypermetric, and 50% (60 eyes) were myopic based on subjective refraction. Comparison of spherical error by subjective refraction and retinoscopy showed that myopic eyes had a mean of -1.36 ± .98 and -1.08± .82 on subjective correction and retinoscopy, respectively (P=.07), and hypermetropic eyes had a mean of 2.5± .22 and 2.45± .22 on subjective correction and retinoscopy, respectively (P=0.07). Comparison of spherical error by subjective refraction and autorefractometer showed myopic eyes had a mean value of -1.51 ± 1.3 on autorefraction (P=.0001) while hypermetropic eyes had a mean of 2.39± .37 on autorefraction (P=0.0001). Mean cylindrical error values by retinoscopy were -.0729± .304, and by the subjective method, were -.167± .384 (P =0.0007). Mean cylindrical error values by autorefraction were .207± .487 compared to -.167± .384 by the subjective method (P =0.0088). In conclusion, conventional retinoscopy is the most accurate and reliable method for estimating the refractive status. However, autorefraction also has acceptable accuracy and can be used for cylindrical correction.

Red and green defocus curves and duochrome test in different age groups

PurposeTo compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups. Methods12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white. ResultsThe DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p= 0.012) and -0.11±0.12 D (YG, p= 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p= 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance. ConclusionBoth age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.

Agreements' profile of Scheimpflug-based optical biometer with gold standard partial coherence interferometry.

To determine the agreement of ocular biometric indices including axial length, keratometric readings, anterior chamber depth, and horizontal corneal diameter between the Pentacam AXL and IOL Master 500. The study was a large cross-sectional population-based study (Tehran Geriatric Eye Study) conducted from Jan 2019 to Jan 2020. A total of 160 clusters were randomly selected proportional to size (each cluster contained 20 individuals) from 22 strata of Tehran city. All people aged 60y and above were invited to participate in the study. For all participants, preliminary ocular examinations were performed including the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, anterior and posterior segment examinations. All participants underwent an ocular biometry using the Pentacam AXL and IOL Master 500. The 95% limits of agreement (LoA) between the two devices were -0.13 to 0.19, -0.15 to 0.17, and -0.13 to 0.19 in normal, pseudophakic, and cataractous eyes, respectively. With increasing the axial length, the difference between the two devices significantly increased in all three groups of normal, pseudophakic, and cataractous eyes (P<0.001). The 95% LoAs between the two devices regarding the mean keratometry shows that the best LoAs were seen in cataractous (-0.33 to 0.81) and followed by normal eyes (-0.36 to 0.86) and the pseudophakic eyes (-0.48 to 0.90) had the widest LoA. The 95% LoAs for horizontal corneal diameter measurements were -0.08 to 0.86, -0.03 to 0.83, and -0.07 to 0.87 in normal, pseudophakic, and cataractous eyes, respectively. The 95% LoAs of anterior chamber depth measurements between the two devices was -0.39 to 0.19 and -0.37 to 0.13 in normal eyes and cataractous, respectively. The Pentacam AXL has excellent agreement with the gold standard, IOL Master 500 in measuring axial length. In eyes with cataracts, the difference between the two devices is more scattered. With the increasing of axial length, the difference between the two devices increased, which should be considered when using Pentacam AXL.

Dietary intake and its association with myopia in children in Goa

Myopia is a multifactorial condition. Myopia is largely influenced by hereditary and environmental variables. Vitamins D, E, and C, omega-3 fatty acids, and antioxidants have been noted as essential for preserving healthy eye function and possibly reducing the development of myopia. : This study was conducted to compare dietary consumption between myopes and emmetropes.: A cross-sectional study was conducted in the outpatient department of ophthalmology in the state of Goa, India. Children aged between 7 and 15 years were included. Children with visual acuity of less than 0.1 logMAR later underwent objective evaluation using retinoscopy and subjective refraction. The spherical equivalent (SE), and myopia were defined as SE 0.5 D in at least one eye. Children with logMAR visual acuity of 0.1 in both eyes, no glasses, or an ophthalmic history were classified as emmetropic (SE&amp;#60; 0.50D). A daily intake interview was taken using a 24-hour dietary recall, and a detailed interview of the subject's food consumption was taken.: A total of 60 children who visited the outpatient department of ophthalmology were included in the analysis. The sample consisted of 31 emmetropes and 29 myopes The mean age of the sample was 10 ± 2.29 years. Almost half the population was male (32 children [53.33%]). The mean refractive error in myopic children was -2.02 ± 1.449 D. The mean axial length in emmetrope children was 22.84 ± 0.972 mm, and in myopic children it was 23.81 ± 0.91mm (P = 0.629). Emmetropes showed higher dietary nutritional consumption than myopes in all dietary components, but the results were not statistically significant. In our study, we could not link Diet and myopia statistically. Although there is a clear indication that emmetropes demonstrated better dietary consumption compared to myopes.

Influence of high altitude on choroid thickness, retinal thickness, and myopia: A cross-sectional study comparing adolescents in Shanghai and Tibet.

This study aimed to explore the influence of high altitude on myopia, macular choroidal thickness (mCT), and macular retinal thickness (mRT) in adolescents. Two schools, one in Shanghai (at sea level) and one in Shigatse, Tibet (more than 4000 m above sea level), were selected. Refractive error was measured by an autorefractor instrument and subjective refraction, and mCT and mRT were measured at three concentric circles by optical coherence tomography. Student's t -test, Chi-square test, and multiple linear regression analyses were used to analyze the data. A total of 1114 participants (657 and 457 in Shanghai and Tibet, respectively) were enrolled in this cross-sectional study. The average age of the participants was 18.81 ± 1.10 years, and 44.34% were males. The spherical equivalent (SE) of adolescents in Shanghai was significantly lower than that of adolescents in Tibet (-4.14 ± 2.37 D and -2.12 ± 1.87 D, P < 0.01). The prevalence of myopia and high myopia among adolescents in Shanghai (94.52%, 19.48%) was significantly higher than those among adolescents in Tibet (44.74%, 2.41%) ( P < 0.01). The mCT of Tibetan adolescents was significantly thicker than that of Shanghai adolescents (295.80 ± 62.46 μm and 218.71 ± 61.42 μm, P < 0.01), especially the central mCT. The mRT of Tibetan adolescents was also thicker than that of Shanghai adolescents (301.42 ± 23.26 μm and 281.04 ± 12.24 μm, P < 0.01). Compared with Shanghai adolescents, the choroid of Tibet adolescents is thicker, and the myopia prevalence is lower. It is speculated that increased altitude is associated with the thickening of mCT and a low myopia prevalence.

Subjective behavioral measures in myopic and pre-myopic children before and after the COVID lockdown.

There are environmental factors that may contribute to the onset of myopia. This study aims to evaluate the children's lifestyle changes before and after the COVID-19 lockdown and how they can influence their vision. The same questionnaire was administered to children aged between 5 and 7 in Spain every year in September before (2017-2019) and after the COVID-19 lockdown (2020-2021). All the children also passed a vision exam consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. Children were classified as myopes, pre-myopes, or hyperopes. The cut-off points to define the refractive error were established according to the value of the spherical equivalent (SE): hyperopia (SE > +0,75D), myopia (SE ≤ -0,5D), or pre-myopia (-0.5D < SE ≥ +0.75D). Data analysis is performed with the SPSS 27.0 software (SPSS Inc., Chicago, Illinois). In the pre-COVID period, the pre-myopes were the ones who spent the longest time outdoors, and after the COVID lockdown, there were no differences between groups. There neither were any differences in the time spent doing near-work activities between the groups in both periods (p > 0.05). Regarding the spherical equivalent, in the pre-COVID period, the mean value was 0.75 ± 2.09D and after the COVID lockdown, it was 0.47 ± 1.88D (p < 0.001). Pre-myopes spent more time outdoors than myopes in the pre-COVID period, while myopes spent more time using digital devices. All these differences do not exist after the COVID lockdown, with a general increase in the time spent outdoors and a decrease in the use of digital devices. Further studies are needed to know if these lifestyle changes remain and how they influence the onset of myopia.

Ametropia detection using a novel, compact wavefront autorefractor.

Despite the well-known reproducibility issues of subjective refraction, most studies evaluating autorefractors compared differences between the device and subjective refraction. This work evaluated the performance of a novel handheld Hartmann-Shack-based autorefractor using an alternative protocol, which considered the inherent variability of subjective refraction. Participants underwent an initial measurement with a desktop autorefractor, two subjective refractions (SR1 and SR2) and a final measurement with the QuickSee Free (QSFree) portable autorefractor. Autorefractor performance was evaluated by comparing the differences between the QSFree and each of the subjective refractions with the difference between the subjective refractions (SR1 vs. SR2) using Bland-Altman analysis and percentage of agreement. A total of 75 subjects (53 ± 14 years) were enrolled in the study. The average difference in the absolute spherical equivalent (M) between the QSFree and the SR1 and SR2 was ±0.24 and ±0.02 D, respectively, that is, very similar or smaller than the SR1 versus SR2 difference (±0.26 D). Average differences in astigmatic components were found to be negligible. The results demonstrate that differences between QSFree and both subjective refractions in J0 and J45 were within ±0.50 D for at least 96% of the measurements. The limits of agreement (LOAs) of the differences between QSFree and SR1, as well as QSFree and SR2, were higher than those observed between SR1 and SR2 for M, J0 and J45 . A protocol was designed and validated for the evaluation of a refractive device to account for the variability of subjective refraction. This protocol was used to evaluate a novel portable autorefractor and observed a smaller difference between the device and subjective refractions than the difference between the two subjective refraction measurements in terms of mean bias error, although the standard deviation was higher.

Clinical practice patterns for assessing children with learning difficulties: survey of eye health care professionals

ABSTRACTClinical relevanceUnderstanding what aspects of vision or binocular vision may affect learning, and how these are assessed, is important for the eye health care professional assessing children with learning difficulties. It is vital that visual dysfunction is identified or excluded in these patients to ensure targeted and timely intervention.BackgroundThe aim of this study was to investigate similarities and differences between eye care professionals in the knowledge, attitudes and practice patterns, when evaluating children with learning difficulties.MethodsThis study was a cross-occupational, cross-sectional, predominantly quantitative internet-based survey. Ophthalmologists, optometrists, and orthoptists working in Australia were eligible to participate. A questionnaire comprising of 31 multiple-choice questions with up to 19 additional branching questions was distributed using REDCap in September 2022.ResultsA total of 130 responses were analysed (6 ophthalmologists, 84 orthoptists and 40 optometrists of whom 9 were practicing behavioural vision care). Most respondents assessed distance visual acuity (95%), near stereoacuity (85%), presence of strabismus (88%) and ocular movements (91%). Near vision was assessed less often (65%). Optometrists were most likely to measure colour vision (p < 0.002), accommodation and undertake a subjective refraction (each p < 0.001). Ophthalmologists were least likely to measure convergence (p = 0.041) but more likely to undertake a cycloplegic refraction (p = 0.044). More optometrists practicing behavioural vision care reported testing binocular vision (p = 0.026), fusional vergence (p < 0.001), saccades (p = 0.066), and smooth pursuit (p = 0.050) than other professions. There was a positive correlation between frequency and confidence level when assessing children with learning difficulties (ρ = 0.64). Respondents referred to paediatricians (39%), speech pathologists (30%), educational psychologists (29%) and general practitioners (29%).ConclusionDespite similarities across occupations, there were differences in testing the vision and binocular functions of children with learning difficulties. Future research should aim to establish minimum standards for assessing this patient cohort to ensure consistent and relevant assessment.

Visual Performance of Two Designs of Myopia Management Soft Contact Lenses Compared with a Monofocal One in Young Adults.

To compare the visual performance of two distinct types of soft contact lenses (CL) aimed at slowing down myopia progression with the performance of a monofocal soft CL. In a prospective double-masked, crossover trial, 18 myopic adults (aged 18-30 years old) were fitted in a randomized order with three types of disposable CL: MiSight (dual-focus), Mylo (extended depth of focus -EDOF-), and Clariti (single distance vision). Measurements were taken after wearing the CL for five days with five days off in between at two different optometry centers. High contrast distance visual acuity (VA) with spectacles and for each of the different CL, subjective refraction, slit lamp exam, aberrometry, stereopsis, monocular and binocular amplitude of accommodation and accommodative facility, and horizontal phorias were measured. The high contrast distance VAwas better for the single vision CL compared to the myopia control CL. No significant differences were observed between the r two myopia control CL. The overall root mean square (RMS) was higher for the double focus CL (RMS = 1.18 0.29 µm), followed by the EDOF CL (RMS = 0.76 0.35 µm) and then the single vision CL (RMS = 0.50 0.19 µm). The primary spherical aberration (SA) mean value was low for all of the three CL, without statistical differences among them. No other significant differences were detected. The overall RMS resulted in a higher value for the dual-focus than the EDOF CL, but no differences in high contrast distance VA and binocularity were detected between them. The monofocal CL's performance was better than the myopia control CL.

Prevalence of Refractive Errors and Associated Factors in the Population of the Eye Cohort Study in Southeast Iran

Objectives: The study aims to determine the age- and sex-adjusted prevalence of refractive errors and its related factors among the adult population of southeastern Iran. Methods: The current study included 9280 individuals aged 35 to 70 years using a multistage random sample method from October 2015 to January 2019 as a part of a Persian cohort study in Zahedan. Uncorrected and corrected vision, objective noncycloplegic, and subjective refraction were measured, with all participants undergoing ophthalmoscopy, slit-lamp biomicroscopy, fundoscopy, refraction, and retinoscopy. Data were analyzed using SPSS version 23.0 statistic software and described as percentage, odds ratio, and 95% confidence interval. Comparisons between groups and relationships among risk factors and refractive errors were performed with chi-square, nominal, and multiple regression analysis. Results: The prevalence of low and moderate myopia, high myopia, low and moderate hyperopia, high hyperopia, low and moderate astigmatism, and high astigmatism was 24.2 (95% CI: 22.40 - 25.90), 1.5(95% CI: 0.00 - 3.53), 16.1(95% CI: 14.20 - 17.90), 1.3(95% CI: 0.00 - 3.30), 35.6 (95% CI: 33.90 - 37.30), and 3.8 (95% CI: 1.80 - 5.70) percent, respectively. The prevalence of refractive errors significantly varied across different age groups overall and by sex (P = 0.01). The proportion of refractive errors also significantly differed by education (P = &lt; 0.001). The prevalence of against the rule, with the rule, and oblique astigmatism was 32.8 % (95% CI: 31.10 - 34.20), 42.1% (40.50 - 43.60), and 24.9% (23.10 - 26.60), respectively. The risk of astigmatism was significantly lower in men than in women (OR = 0.75; 95 % CI: 0.60 - 0.90). Based on multiple regression, the risk of myopia (OR = 2.07; 95 % CI: 1.60 - 2.60) and hyperopia (OR = 25.38; 95 % CI: 18.70 - 34.3) was higher in the age group 65 to 75 years compared to the younger group. Conclusions: The present study provided valuable information on the prevalence of refractive errors in the adult population in south-eastern Iran. The findings underscore the need for comprehensive eye care services, particularly for older individuals and those with lower education levels. Further prospective research is warranted to explore the factors contributing to refractive errors and to develop effective strategies for its prevention and management.

Measurement Accuracy When Using Spot Vision Screener With or Without Cycloplegia in Young Adults.

There are many unclear points about the accuracy of measurement of cycloplegic refraction using the Spot Vision Screener (SVS). This study aimed to investigate the accuracy of SVS measurements with cycloplegia for myopia. Forty-nine healthy subjects were included, and refraction was measured. Objective refractions were measured by SVS, table-mounted autorefractometer (RT7000), and handheld autorefractometer (Retinomax Screeen) at noncycloplegic and cycloplegic conditions by 1% cyclopentolate. Subjective noncycloplegic refraction was obtained by a visual acuity and refraction test performed by certified orthoptists using a cross-cylinder. One-way repeated-measures analysis of variance was used to examine whether the measured refractions fluctuate due to different reflection tests. In the noncycloplegic condition, the mean (±standard deviation) spherical equivalent (SE) measured by subjective method, SVS, RT7000, and Retinomax Screeen were -2.56 ± 3.00, -2.62 ± 2.38, -3.05 ± 2.84, and -3.26 ± 2.97, respectively. The subjective SE and objective SE measured by SVS had significantly less myopic value than the objective SE measured by two autorefractometers (p < 0.001). In the cycloplegic condition, the mean (± standard deviation) SE measured by SVS, RT7000, and Retinomax Screeen were -2.07 ± 2.66, -2.62 ± 2.98, and -2.66 ± 3.02, respectively. The objective SE measured by SVS had significantly less myopic value than SEs measured using other methods (p < 0.001). In the cycloplegic condition, SVS showed a fixed error wherein the SE was more hyperopic than that with the subjective method and SVS had a proportional error. In the measurement under cycloplegic conditions, use of an autorefractometer rather than a photorefractometer such as SVS was preferable.

Intraocular Lenses for Cataract Surgery

What Is the Issue?&#x0D; &#x0D; A cataract is an opacity of the lens and is the leading cause of reversible visual impairment worldwide. There are no medical treatments for cataracts but surgical procedures that replace the lens with a synthetic lens (called an intraocular lens [IOL]) have shown to be effective for restoring vision.&#x0D; Premium lenses, including lenses to correct astigmatism (called toric lenses), are available but may not be covered by public or private health plans.&#x0D; Given that there is an increased cost associated with toric lenses, there is a need to evaluate their effectiveness compared to other available corrective options, including glasses.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; To inform decisions about the appropriate use of astigmatism-correcting IOLs, CADTH sought to identify and summarize literature that evaluates the clinical effectiveness of toric lenses against other corrective options.&#x0D; An information specialist conducted a search of peer-reviewed and grey literature sources. One reviewer screened citations, and selected and critically appraised the included studies.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; One systematic review (SR), 3 randomized controlled trials (RCTs), 1 prospective nonrandomized study, and 6 retrospective nonrandomized studies were identified that evaluated the clinical effectiveness of toric versus nontoric IOLs implanted during cataract surgery, including 1 with a pediatric focus.&#x0D; Toric IOLs may be better than nontoric IOLs for postoperative astigmatism, but this may be dependent on the measurement of astigmatism evaluated (e.g., corneal astigmatism, residual refractive astigmatism, subjective refraction astigmatism, autorefraction astigmatism, spherical equivalent astigmatism, cylinder astigmatism, surgically induced astigmatism).&#x0D; Toric IOLs may be better than nontoric IOLs for postoperative uncorrected visual acuity (VA), but it is unclear if this results in a clinically meaningful difference to the patient. None of the studies reported on spectacle independence.&#x0D; Patient-centred outcomes were seldomly reported across the studies, and rarely used validated tools, making it difficult to conclude if there were patient-centred outcome differences between toric and nontoric IOLs.&#x0D; Harms were reported across the studies through intraoperative complications, postoperative complications, and adverse events. Postoperative complications were statistically higher in the toric group in the SR, but there were not statistically significant differences in harms reported in the primary studies.&#x0D; &#x0D; What Does it Mean?&#x0D; &#x0D; It is difficult to draw conclusions across the studies and outcomes due to the variation in how outcomes were reported or because few studies report on these outcomes.&#x0D; A proposed minimum set of core outcomes for cataract surgery was published in 2015. The studies included in this report did not align with this minimum set of outcomes. For example, as VA is not synonymous with improved visual functioning for patients, evaluating patient-reported visual functioning with a patient-reported outcome measure (PROM) tool is part of the minimum set of core outcomes. Future research should incorporate core outcomes, including PROMs.&#x0D; Although toric IOLs statistically improved uncorrected VA, when compared to nontoric lenses, statistical significance does not imply a difference that is clinically meaningful to a patient.&#x0D;

Refractive error prevalence among the traditional Quranic boarding schools in Al-Gezira, Sudan

Background: Uncorrected refractive error is an avoidable aetiology of visual impairment, negatively affecting children’s quality of life. There is limited evidence related to the prevalence of refractive errors among the children or adolescent population within Sudan.Aim: To determine the prevalence and types of refractive error among children enrolled in traditional Quranic boarding schools in the Al-Gezira state, Sudan.Setting: This cross-sectional, quantitative study conducted within the student population of traditional Quranic boarding schools in Al-Gezira, Sudan.Methods: A total of 551 male children from eight schools underwent subjective and objective refraction, including direct ophthalmoscopy as well as binocular vision assessment.Results: Out of the total 551 school children, the refractive error prevalence was 6.2% (n = 34). The prevalence of myopia among the participants was 5.1% (n = 28), followed by hypermetropia 1.1% (n = 6). Astigmatism was diagnosed in 3.3% (n = 18) of the study population classified as myopic astigmatism of 2.4% (n = 13) and hyperopic astigmatism 0.9% (n = 5).Conclusion: This study found the prevalence of refractive errors among the children as 6.2%. It provides baseline data about refractive error among the children in this sample, which is useful as a reference point, however further studies need to be conducted in all the Quranic schools of Sudan.Contribution: This study offers a principal information about the ametropia among the children in this community and highlights the need for further refractive errors related epidemiological studies within the region.

Influence of perfluorohexyloctane (Evotears®) on higher order aberrations

PurposeTo prospectively assess the effect of regular application of perfluorohexyloctane (F6H8; Evotears®) on the tear film lipid layer, higher order aberrations (HOA) and the repeatability of measurements in healthy eyes.MethodsThis prospective clinical study included 104 eyes treated with F6H8 four times daily for four weeks (group A) and 101 eyes that served as controls (group B). Measurements were performed with the WASCA aberrometer (Carl Zeiss Meditec GmbH, Jena, Germany). Main outcome measurement in addition to subjective refraction were the root mean square values of HOA measured before and after the intervention.ResultsRegular use of F6H8 over a period of four weeks significantly increases HOA in healthy eyes (p < 0.05). In addition, the repeatability of measurement increases after the application of F6H8.ConclusionF6H8 may be a suitable treatment option to improve the accuracy of refractive assessment, although it increases HOA. Further studies are needed to confirm the effect on HOA and the repeatability of measurement.

Accuracy of an objective binocular automated phoropter for providing spectacle prescriptions

ABSTRACT Clinical relevance Currently eye examinations are usually based on autorefraction followed by subjective refraction (SR) with a phoropter. An automated phoropter that can also perform autorefraction may facilitate the optometric workflow. Background The efficiency and feasibility of an objective autorefraction and correction system are assessed by comparing objective refractive measurements with SR on the same subjects and evaluating the visual acuity (VA) values obtained after the objective refractive measurement and correction. Methods Objective autorefraction and correction was performed on 41 subjects using an automated binocular phoropter system. The auto-phoropter performs autorefraction by wavefront measurement and corrects the spherical and cylindrical errors with tunable fluidic lenses while the patient looks at a visual display inside the instrument. The instrument outputs are optometric constants of spherical and cylindrical aberrations. After measurement and automated correction of the refractive errors, the VA values were assessed by having the subjects look at an integrated Snellen chart. The objective measurement results were statistically compared with their SR. Results The correlations between SR and objective autorefraction and correction spherical equivalents (M) were 0.98 (0.97–0.99) and 0.96 (0.93–0.98), the vertical Jackson cross cylinder (J0) were 0.96 (0.92–0.98) and 0.95 (0.91–0.97), and the oblique Jackson cross cylinder (J45) were 0.73 (0.55–0.85) and 0.82 (0.69–0.90), for the right and left eyes, respectively, with the 95% confidence interval (CI) values in parentheses. 89.0% of the 82 eyes had at least 6/7.5 VA. Conclusions A significant agreement between the SR and objective autorefraction and correction was observed. An all-objective refractive assessment with instantaneous verification may improve the precision of eye prescriptions and possibly reduce the procedure time.

Axial length shortening in myopic children with Stickler syndrome after repeated low-level red-light therapy.

To report the myopia-controlling effect of repeated low-level red-light (RLRL) therapy in patients with Stickler syndrome (STL), an inherited collagenic disease typically presenting with early onset myopia. Three STL children, aged 3, 7, and 11y, received RLRL therapy throughout the follow-up period of 17, 3, and 6mo, respectively after exclusion of fundus anomalies. Data on best-corrected visual acuity (BCVA), intraocular pressure, cycloplegic subjective refraction, ocular biometrics, scanning laser ophthalmoscope, optical coherence tomography, genetic testing, systemic disease history, and family history were recorded. At the initiation of the RLRL therapy, the spherical equivalent (SE) of 6 eyes from 3 patients ranged from -3.75 to -20.38 D, axial length (AL) were from 23.88 to 30.68 mm, and BCVA were from 0.4 to 1.0 (decimal notation). Myopia progression of all six eyes slowed down after RLRL therapy. AL in five out of the six eyes shortened -0.07 to -0.63 mm. No side effects were observed. Three cases of STL whose progression of myopic shift and AL elongation are successfully reduced and even reversed after RLRL therapy.

Quality of refractive error care in Pakistan: an unannounced standardised patient study

ObjectiveUndercorrected refractive errors are the primary cause of vision impairment worldwide, including in Pakistan. However, limited data exist on the quality of refractive error care. Our study assessed the quality...