Visual Anomalies Research Articles

TDP43 pathology in chronic traumatic encephalopathy retinas

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head trauma. Brain pathology in CTE is characterized by neuronal loss, gliosis, and a distinctive pattern of neuronal accumulation of hyper-phosphorylated tau (p-tau) and phospho-TDP43 (p-TDP43). Visual anomalies have been reported by patients with CTE, but the ocular pathology underlying these symptoms is unknown. We evaluated retinal pathology in post-mortem eyes collected from 8 contact sport athletes with brain autopsy-confirmed stage IV CTE and compared their findings to retinas from 8 control patients without CTE and with no known history of head injury. Pupil-optic nerve cross sections were prepared and stained with hematoxylin and eosin (H&E), p-tau, p-TDP43, and total TDP43 by immunohistochemistry. No significant retinal degeneration was observed in CTE eyes compared to control eyes by H&E. Strong cytoplasmic p-TDP43 and total TDP43 staining was found in 6/8 CTE eyes in a subset of inner nuclear layer interneurons (INL) of the retina, while only 1/8 control eyes showed similar p-TDP43 pathology. The morphology and location of these inner nuclear layer interneurons were most compatible with retinal horizontal cells, although other retinal cell types present in INL could not be ruled out. No p-tau pathology was observed in CTE or control retinas. These findings identify novel retinal TDP43 pathology in CTE retinas and support further investigation into the role of p-TDP43 in producing visual deficits in patients with CTE.

Accuracy and intrasession variability of noncycloplegic autorefraction of school-aged children and adolescents.

The aims of the study were (1)to compare the accuracy and intrasession variability of noncycloplegic autorefraction (AR) obtained by a photorefractor and conventional and open-field autorefractors and (2)to evaluate the impact of accommodative and binocular vision anomalies on the accuracy of autorefraction. Twenty-nine children and adolescents aged 8-18years were examined. All instruments gave more myopic results than subjective refraction (SR). Mean differences between the SR and the AR were +0.52/-0.25×96∘ for the photorefractor, +0.63/-0.31×93∘ for the conventional autorefractor, and +0.19/-0.26×94∘ for the open-field instrument. The photorefractor appeared to be the most repeatable. The impact of the examined vision anomalies on the accuracy of autorefraction was not statistically significant.

Clinical features of Sudanese patients presenting with binocular vision anomalies: A hospital-based study.

Binocular vision anomalies are major causes of asthenopia symptoms, particularly among the younger population. This study aimed to report the clinical characteristics of Sudanese patients with binocular disorders who attended the orthoptic clinic at Al-Neelain Eye Hospital. In this retrospective hospital-based study, we analyzed data from 304 patients with binocular vision anomalies who visited the orthoptic clinic between October 2020 and June 2021. We collected information on demographics, symptoms, and eye tests such as visual acuity (VA), refractive error (RE), angle of deviation, and the assessment of fusional vergence. Our findings indicated that exophoria was the most common binocular vision anomaly, affecting 79.8% of males and 71.6% of females (p=0.731). Children between 6 and 17 years old showed the highest prevalence of exophoria (75.9%) (p=0.0001). Among patients with exophoria, 100% reported itching associated with tearing during fixation, while 89.5% experienced difficulty in fixation. Refractive error varied by the type of binocular vision disorders (p=0.0001), with higher hyperopia observed in cases of unilateral esotropia and alternate esotropia (+3.571±1.238 D and +3.023±1.553 D, respectively). Positive fusional vergence (PFV) differed by types of binocular vision disorders (p=0.0001) with high PFV in esophoria (18.063±6.848∆) compared to low PFV in exophoria (12.80±5.313∆). The most common types of exophoria were convergence weakness exophoria (45.39%), followed by convergence insufficiency (20.39%). The study concluded that exophoria was the most common binocular vision anomaly among Sudanese patients, with convergence weakness and convergence insufficiency being the predominant anomalies. Headache was commonly prevalent among patients with binocular vision problems. Higher hyperopia was found in esodeviation, while low PFV was associated with exodeviation.

The diagnostic accuracy of the IFLIP system for binocular visual function anomalies assessment.

This study aimed to evaluate the diagnostic accuracy of the intelligent flipper (IFLIP) system in identifying binocular vision anomalies. This study comprised 70 participants aged 18 to 22. Participants underwent comprehensive eye assessments, including measurement of visual acuity, refraction, far and near cover test, stereopsis, and worth four dot test. The manual accommodation amplitude and facility, as well as the IFLIP system test, were also evaluated. The correlation between the indices of the IFLIP and manual accommodation tests was analyzed using multiple regression models, and the diagnostic ability of the IFLIP was characterized using Receiver Operating Curve (ROC) analysis. The significance level was 0.05. The mean age of the 70 participants was 20.03±0.78 years. The mean manual and IFLIP accommodation facilities were 12.00±3.70 cycle per minute (CPM) and 10.01±2.77 CPM, respectively. No correlation was found between the indices of the IFLIP system and manual accommodative amplitude. However, the regression model showed that the contraction/relaxation ratio of the IFLIP system was positively correlated to the manual accommodation facility, and the average contraction time was negatively correlated with the manual accommodation facility. The ROC analysis proposed a cut-off of 10.15 CPM monocularly for the IFLIP accommodation facility assessment. This study indicated that the parameters obtained by the IFLIP system and the manual accommodation facility were comparable, and the IFLIP system had good sensitivity and specificity in the assessment of the accommodation facility, thus may serve as a promising tool for screening and diagnosis of binocular visual function anomalies in clinical and community settings.

Posterior reversible encephalopathy syndrome in malignancy: Hypercalcemic storm?

e17559 Background: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by seizures, headaches, altered mental status and visual anomalies associated with vasogenic edema affecting the parietal-occipital lobes on brain magnetic resonance imaging. PRES is rarely described in hypercalcemia of malignancy although multiple mechanisms have been postulated in various case reports. Hence, we conducted this study to evaluate whether there is an increased risk of PRES with hypercalcemia of malignancy. Methods: We analyzed the 2016-2020 National Inpatient Sample (NIS) and extracted patient data with a diagnosis of ovarian cancer, lung cancer, multiple myeloma (MM), breast cancer, diffuse large B-cell lymphoma (DLBCL), and secondary bone cancer. Cases with a history of primary hyperparathyroidism, vitamin D intoxication and familial hypocalciuric hypercalcemia were excluded. The presence of hypercalcemia and PRES were estimated (per 10,000 cases), and their respective adjusted odds ratios (aOR) were calculated via multivariate regression analysis. Results: We identified 1,775 PRES cases in 3,781,899 cancer patients studied. Patients with breast cancers (26 per 10,000 hypercalcemia cases vs. 4 per 10,000 cases with no hypercalcemia, aOR 4.523, 95% CI 3.418-5.984, p < 0.01), ovarian cancers (41 per 10,000 hypercalcemia cases vs. 8 per 10,000 cases with no hypercalcemia, aOR 5.224, 95% CI 3.075-8.875, p < 0.010), and secondary bone neoplasms (14 per 10,000 hypercalcemia cases vs. 5 per 10,000 cases with no hypercalcemia, aOR 2.160, 95% CI 1.671-2.793, p < 0.01) exhibited a statistically significant increased outcome of PRES in association with hypercalcemia. The presence of hypercalcemia among lung cancer patients (aOR 0.755, 95% CI 0.451-1.263, p = 0.284), MM (aOR 1.005, 95% CI 0.751-1.346, p = 0.973), and DLBCL (aOR 1.393, 95% CI 0.806-2.408, p = 0.236) did not show a valid odds ratio for PRES. Conclusions: Our study found a higher association of PRES among hypercalcemia patients with ovarian cancer, breast cancer and secondary bone neoplasms. Prompt recognition of PRES and hypercalcemia-directed treatment can allay the morbidity related to PRES. While our study was limited in quantifying the cut-off values of hypercalcemia causing PRES, designated protocols entitled solely to determining serum calcium thresholds in these cancers warranting rigorous treatments are needed. PRES’s association with hypercalcemia in female-dominant cancers also paves way for further studies looking into the influences of sex hormones and hormonal therapies on the development of PRES with hypercalcemia.

A comparative study on slow down progression of myopia using atropine 0.01% in children

The aim of the study was to determine the efficacy of lower concentration of Atropine 0.01% in promoting unaided visual acuity and slowing down the progression of myopia in children over 6 months. It was a hospital-based comparative study in the outpatient department of Ophthalmology, AL, LT, ACD, PPD, SPD, PGP were taken by Lenstar and Lensometer.The Comparative study was performed on 60 children from 9 to 15 years age group with initial myopic spherical equivalence from 0.5 to 6.00 D. The children were screened for visual acuity for distance and near using Snellen’s chart. Cycloplegic Refraction was done to know the presence of Refractive Errors. This study was approved by IRB Ethical Committee. (SCAHS/IRB/2022/JULY/420).The inclusion criteria include Ammetropic children with no binocular vision anomalies and no history of ocular disease. The primary outcome was the rate of myopic progression after 6 months. The participants were instructed to use Atropine 0.01% eye drops during night times for 6 months and the rate of myopic progression and the spherical equivalence, axial length, lens thickness, anterior chamber depth, photopic and scotopic pupil diameter were re-assessed to compare the progression of myopia in the children. Sixty children enrolled for six months study in which the mean progression of myopia was found to be within 0.27D and axial elongation shows 0.23 mm changes respectively, whereas there were no significant changes in the anterior chamber depth, lens thickness, photopic and scotopic pupil diameter before and after assessment in children. Spherical power, Axial Length, Anterior Chamber Depth, Lens Thickness, Photopic Pupil Diameter and Scotopic Pupil Diameter all showed significant progression from pre to post stages, with the average post reading deviating by 0.25 from the normal limits.

Challenges of Pituitary Apoplexy in Pregnancy.

Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012-December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP/PAPP = 43/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15/43) and terguride (1/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29/43 females received the conservative approach, and 22/43 women had trans-sphenoidal surgery (TSS) (and 10/22 had the initial approach). Furthermore, 18/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26/43), with the majority of them (N = 16/26) being larger than 1 cm. A maternal-fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5/6 had no underlying pituitary adenoma; 5/6 patients were managed conservatively and 1/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample-case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal-fetal outcomes from multidisciplinary insights.

A Comparative Study to Assess the Accommodation and Vergence Relationship of Myopia in Indian Adolescent.

Accommodation and Vergence disorder are diverse visual anomalies which can interfere with a child's school performance and impair one's ability to function efficiently. Its association with refractive error and its intervention were studied less in Indian myopia children; hence, there is a need for research in such setting. One hundred and fifty Indian adolescents aged 10 to 17 years were divided into three refractive error groups (high, moderate, and low myopia). Baseline vision examination and a comprehensive binocular vision assessment were performed on all eligible adolescents. Vision therapy was provided to participants whose parents gave consent on behalf of the children. Chi-square analysis was utilized to look at the association between the groups of refractive errors. To compare the mean constants of the experimental and control groups, a two-way RM ANOVA was performed. The most common dysfunction found in low myopia (75.3%), and moderate myopia (54%) was convergence insufficiency. High myopes (62.8%) were found to have combined convergence and accommodative insufficiency followed by accommodative dysfunction (14%) and basic exophoria (6%). In moderate myopia, a significant relationship was found between this dysfunction and refractive error. The experimental group in the overall sample showed statistically significant improvement after vision therapy (P<0.001), in comparison to the control group. Refractive error is linked to accommodative and convergence insufficiency. Thus, vergence and accommodative impairment must be tested for all myopic children, and vision therapy should be advised along with spectacle prescription for efficient binocular vision.

Evaluation of Visual Skills Between Cricket Players and Sedentary Individuals

Aim: This study aims to evaluate the visual skills between cricket players and sedentary individuals of the same age group and to determine that visual skills are beneficial for both competitive sports performance and daily task activities. Settings and Design: It was a sports vision-based comparative study conducted in the outpatient department of ophthalmology for preliminary ocular examination as well as in the cricket ground for sports vision-based tests. Methods and materials: This study carries 200 subjects out of which 100 cricket players and 100 sedentary individuals (i.e individuals who are not involved in any sports activities) participated between the age group of 18 to 26. Participants underwent preliminary ocular examinations in which all those ocular diseases and binocular vision anomalies are excluded. All subjects were undergone the following sports vision test: stereopsis was measured by Randot stereo acuity chart, accommodative facility with +/- 2.00 flippers, saccadic eye movement was measured by Lang fixation stick and eye-hand coordination was recorded by Alternate hand wall toss test. Result: The cricket players exhibited better accommodative facility (p=0.05) saccadic eye movements (p=0.03) and better eye-hand coordination (p=0.01) stereopsis was good in sedentary individuals (p=0.06) confirming that basic visual skills were high in sedentary individuals. Conclusion: These findings evidence that cricket players exhibit better performance in more visual skills in comparison with a group of individuals without sporting background, suggesting an improvement in visual skills due to routine systematic activity in sports as well as daily tasks.

TFOS Lifestyle: Impact of the digital environment on the ocular surface

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as “the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing”. Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not ‘diagnostic’ of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Nexus of ocular motility and dry eye.

To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Thirty-two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty-nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8-40) to 12 (5-26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3-33) to 6 (5-14) (P value 0.004) with VT. Thirty-one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms.

Designing Recolorization Algorithms to Help People with Color Vision Anomalies

The problem of perception of visual information by people with color vision anomalies remains quite relevant, as evidenced by the interest in studying this problem not only in medicine, but also in the field of medical technology. Researchers around are working on the task to create algorithms and software that can transform images and videos in accordance with their correct perception by people with color blindness. However, today there are no algorithms that allow people with any type, form, and degree of color vision anomaly to correctly perceive the visual information surrounding them. Based on the considered advantages and disadvantages of existing algorithms, conclusions were drawn about the requirements for the designed recoloring algorithms, which are planned to be implemented in software to help people with color perception issues. Such algorithms will not only allow correct video conversion for people with dichromacy and monochromacy but will also enable users with any degree of anomalous trichromacy to perceive the world around them most accurately. In addition, these algorithms will be distinguished by the high speed of the recolorization process, and the “naturalness” of the colors obtained in the process of transformations.

Assessing the reliability of web-based measurements of visual function

Many behavioural phenomena have been replicated using web-based experiments, but evaluation of the agreement between objective measures of web- and lab-based performance is required if scientists and clinicians are to reap the benefits of web-based testing. In this study, we investigated the reliability of a task which assesses early visual cortical function by evaluating the well-known ‘oblique effect’ (we are better at seeing horizontal and vertical edges than tilted ones) and the levels of agreement between remote, web-based measures and lab-based measures. Sixty-nine young participants (mean age, 21.8 years) performed temporal and spatial versions of a web-based, two-alternative forced choice (2AFC) orientation-identification task. In each case, orientation-identification thresholds (the minimum orientation difference at which a standard orientation could be reliably distinguished from a rotated comparison) were measured for cardinal (horizontal and vertical) and oblique orientations. Reliability was assessed in a subsample of 18 participants who performed the same tasks under laboratory conditions. Robust oblique effects were found, such that thresholds were substantially lower for cardinal orientations compared to obliques, for both web- and lab-based measures of the temporal and spatial 2AFC tasks. Crucially, web- and lab-based orientation-identification thresholds showed high levels of agreement, demonstrating the suitability of web-based testing for assessments of early visual cortical function. Future studies should assess the reliability of similar web-based tasks in clinical populations to evaluate their adoption into clinical settings, either to screen for visual anomalies or to assess changes in performance associated with progression of disease severity.

A védőnők szerepe a gyermekkori látásproblémák felismerésében

The children's physical and mental health is determinative for the whole society. Parents, teachers, district nurses, and doctors share the duty to ensure their uninterrupted visual development. District nurses compose key elements in connecting families and health care providers, since they have the chance to detect any visual anomalies, and to refer the children to a pediatrician, ophthalmologist, or a neurologist. Their team work yields advantages to the whole community as beyond preserving good vision, children get a real chance of right physical and mental development. Our aim was to recollect district nurses' areas of activity and to collect data about their present status in visual screening programs. Furthermore, to assess their screening methods and circumstances, and to reshape their continuous learning programs linked to the universities. Questionnaires were sent online anonymously to district nurses in practice, in order to collect data referring to their focuses during the visual screening methods. Administration of online parental tutorials was assessed, and measures of professional support in nurses' education was debated. Visual screening among infants looks for potential strabismus, and among school-age children looks for potential refractive errors. Vision tests and stereo tests are usually available as screening tools, but pen lights are underused. Only a few nurses suggest online tutorials to enhance patient education, but nurses are highly motivated in postgraduate courses about vision screening. Our results reflect good adherence to the screening protocols but there is some uncertainty in some fields. In harmony with the results, adequate technical and educational support and specific training were compiled for postgraduate district nurses. Coaching and training in visual screening (in the form of seminars or e-learning) should be available in spring 2023. Orv Hetil. 2023; 164(3): 88-95.

Applications and implications for extended reality to improve binocular vision and stereopsis.

Extended reality (XR) devices, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) devices, are immersive technologies that can swap or merge the natural environment with virtual content (e.g., videogames, movies, or other content). Although these devices are widely used for playing videogames and other applications, they have one distinct feature that makes them potentially very useful for the measurement and treatment of binocular vision anomalies-they can deliver different content to the two eyes simultaneously. Indeed, horizontally shifting the images in the two eyes (thereby creating binocular disparity) can provide the user with a compelling percept of depth through stereopsis. Because these devices are stereoscopic, they can also be used as high-tech synoptophores, in which the images to the two eyes differ in contrast, luminance, size, position, and content for measuring and treating binocular anomalies. The inclusion of eye tracking in VR adds an additional dimension to its utility in measuring and treating binocular vision anomalies, as well as other conditions. This paper describes the essential requirements for testing and treating binocular anomalies and reviews current studies in which XR devices have been used to measure and treat binocular vision anomalies.

CORRELATION BETWEEN MIGRAINE &amp; REFRACTIVE ERRORS IN YOUNG POPULATION

One of the major public health problems is headache. To evaluate refractive errors we can compare subjects with migraine headache with healthy subjects. Retinoscopy and subjective refraction can be done to find out anisometropia and type of refractive errors; myopia, hypermetropia and astigmatism. The incidences of sporadic headache, chronic primary headache are the causes for chief complaints from patients. Obviously the young adults contribute a vital role in economic and social aspects of the society, so headaches causes less work efficiency and personal too. Acute glaucoma, optic neuritis has been found to be responsible to be linked with headache. It was also reported the higher prevalence of headache in subjects with binocular vision anomalies and uncorrected refractive errors, not all the studies consistent with this theory. The criteria for the migraine connected with refractive errors include: (1) uncorrected refractive errors or wrongly corrected refractive errors; (2) mild pain in eyes and frontal lobe; (3) pain that is relieved by resting but get worse by doing visual tasks at the distance or angle for a long time when visual acuity is impaired. Purpose: To compare the prevalence of refractive errors in the young adults with headaches

Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists

Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia.&#x0D; Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department.&#x0D; Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected.&#x0D; Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parameters- NPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near.&#x0D; Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms.

Prevention campaign for amblyopia and other eye disorders among schoolchildren

AbstractPurpose: This is a retrospective longitudinal observational study to detect amblyopia and other visual anomalies (refraction, strabismus, pathologies…) in 3, 4 and 5‐year‐old schoolchildren. Amblyopia is a disorder of sight in which the brain fails to fully process input from one eye and over time favours the other eye. It results in decreased vision in an eye that typically appears normal in other respects. Early detection improves treatment success. There is currently an early detection program but according to a recently published study, does not have good compliance or appropriate material.Methods: The study was carried out with children aged 4–6 years from 4 different schools, collecting 491 children with the corresponding informed consent of their parents. The study was divided into two phases, first an optometrist performed an external examination, red reflex, pupillary examination, ocular motility, cover test and photoscreening with a portable autorefractometer. And if any anomaly is detected in the second phase, it would be explored by an ophthalmologist who would also perform stereopsis tests, visual acuity, dilated refraction, eye fundus, and diagnosis and treatment.Results: 491 children were included in this study, visual anomalies were detected in 96, of which 60 were studied in our center. It was detected 47% who had refractive problems, 5% strabismus and 0% opacities. Extrapolating it to the total number of patients seen, 9% had refractive problems and 1% strabismus.Conclusions: Amblyopia has a prevalence of 6% in the population. Its treatment is relatively simple with glasses and patches at a low cost. There is a prevalence of 5%–7.5% of amblyopia in &lt;6 years, 1%–3% strabismus in &lt;6 years as well as 1 of 3 school failure is caused by visual problem.Paediatric check‐up or other check‐ups that these schoolchildren do not detect this type of condition. Therefore, the Campaign for the Prevention of Amblyopia and Other Visual Anomalies idea should be implemented in all the Autonomous Communities.Reference1. Eileen E Birch. Amblyopia and binocular vision. Prog Retin Eye Res. 2013; 33: 67–84.

Impact of Viewing Conditions and Vision Anomalies on Accuracy and Dynamics of Noncycloplegic Autorefraction.

This study was conducted to analyze the influence of binocular vision and accommodation anomalies on refraction dynamics. Our results may help to design more accurate autorefractors and to better understand the difficulties in prescribing an optical correction or adaptation to a correction. This study aimed to verify whether viewing conditions (open- or closed-field) or vision anomalies, such as ocular surface diseases, accommodative dysfunctions, and binocular vision anomalies, influence (1) the differences between subjective refraction and autorefraction and (2) the characteristics of the short-term refractive state variation. The subjective refraction of 64 subjects aged 23 to 60 years was measured during a comprehensive optometric examination, and the Ocular Surface Disease Index questionnaire was collected. Twenty successive measurements of automated refraction of each eye were obtained using a conventional autorefractor Nidek ARK-510A and an open-field autorefractor Shin-Nippon NVision-K 5001. Conventional notation of refractive error (sphere, cylinder, axis) was transformed to h-vectors, presented in scatterplots, and analyzed statistically. The three-way analysis of variance tests showed that there is no influence of accommodation dysfunctions (P = .22 for ARK-510A), binocular vision anomalies (P = .97 for ARK-510A), and ocular surface diseases (P = .20 for ARK-510A) on differences between autorefraction and subjective refraction. The binocular vision anomalies affected the results from open-field autorefractor, whereas the accommodation impacted closed-field refraction measurements. Changes in short-term refractive state variation occurred in sphere power, indicating accommodative state changes; however, 30 subjects demonstrated at least one outlier and/or polymodality of refractive state distributions. The study showed that the presence of accommodative dysfunctions or binocular vision anomalies might increase the range of short-term refractive state variation. The impact of vision anomalies differs between viewing conditions. The polymodal distribution of refractive state variation and the presence of outliers imply that automatic modes used typically in autorefractors with three to five readings may not accurately represent the refractive state of the eye.

Objective estimation of fusional reserves using infrared eye tracking: the digital fusion-range test

ABSTRACT Clinical relevance Horizontal fusional reserves are used in the diagnosis and monitoring of common vergence disorders, such as convergence insufficiency, which can cause asthenopia and impact near work. Infrared eyetracking technology shows promise for obtaining automated and objective measurements of fusional reserves, expanding options for screening, clinical testing, and at-home monitoring/vision training. Background Current clinical tests for fusional reserves rely on subjective judgements made by patients (for diplopia) and clinicians (for eye movements). This paper describes an objective and automated “digital fusion-range test” pilot-tested in adults without current eye disease or binocular vision anomalies. This test combines a consumer-grade infrared eyetracker, a dichoptic display, and custom analyses programs to measure convergence and divergence reserves. Methods Twenty-nine adult participants completed the study. Horizontal fusional reserves at 55 cm were measured using prism bars and with our computer-based digital fusion-range test. For the digital test, observers viewed dichoptic targets whose binocular disparity modulated over time (at speeds of 0.5, 1.0, or 2.0 Δ/s) while their eye movements were continuously recorded. Subjective reports of break and recovery (by keyboard button press) were compared to objective estimates extracted from eyetracking recordings (via automated analyses). Results Objective and subjective measures of break and recovery agreed closely. Clinically small (0.3-2Δ) but statistically significant (p < 0.012) differences were found between measurement types for divergence breaks/recoveries and convergence recoveries. No significant differences were found for convergence breaks (p = 0.11). Such differences are consistent with an average 0.91 (SD 1.66) seconds delay between objective break/recovery and subjective responses. The digital test produced comparable results to the standard clinical prism bar method. Conclusion The digital fusion-range test supports an automated, reliable assessment of horizontal fusional reserves, which do not depend on subjective responses. This technology may prove useful in a variety of clinical and community-based settings.