Clinical and Experimental Optometry最新文献

Clinical relevance: Retinoscopy is an important ophthalmic technique for objectively assessing refractive errors and detecting ocular abnormalities, especially in patients unable to undergo subjective refraction. The development and standardisation of retinoscopy rubrics foster a more equitable and consistent learning experience for trainees, ultimately leading to improved patient care.

Background: Retinoscopy is an essential skill in ophthalmic examination. Despite the use of various rubrics in eye care, standardised rubric for retinoscopy is still unavailable. This study aims to develop and validate a comprehensive rubric for retinoscopy, addressing the lack of standardised assessment tools in optometric and ophthalmic education.

Methods: The authors developed a retinoscopy rubric, which was assessed for face and content validity by an international group of optometry educators. Cohen's alpha was calculated to determine interobserver reliability.

Results: The final rubric consists of 19 individual items for performance criteria. The revised rubric demonstrated face validity, with an overall percentage of agreement of 95.71%. The content validity index (S-CVI/Ave) was 0.99. Most of the individual rubric items showed moderate to strong interobserver reliability.

Conclusion: The retinoscopy rubric, a validated evaluation tool for objective refraction, demonstrates strong validity and reliability. It holds significant potential to enhance ophthalmic education by providing a consistent and effective framework for assessing retinoscopy skills.

Clinical relevance: Presbyopia, an age-related decline in near vision, significantly impacts daily functioning and work performance in visually demanding professions. Understanding occupational factors influencing presbyopia is crucial for optimizing vision screening and management strategies.

Background: This study aimed to compare the prevalence and progression of presbyopia in civilian pilots aged 40 and above with an age-matched control group lacking aviation experience.

Methods: A retrospective cross-sectional study involved 1124 participants (159 females, 965 males). The study group comprised civilian aviators aged 40+ with at least five years of flying experience, while controls had no aviation history. Comprehensive visual assessments were performed.

Results: Civilian aviators exhibited significantly lower near addition values compared to controls (mean +0.59 ± 0.71 D vs. +1.61 ± 0.71 D; p < 0.01). Gender-specific analysis revealed a more pronounced difference in female pilots versus female controls (p < 0.01).

Conclusion: Civilian pilots aged 40 and above may experience delayed onset or slower progression of presbyopia. These findings suggest that aviation-related visual demands and proactive ocular health practices might mitigate presbyopia development. Further research is needed to validate these findings and assess long-term occupational visual influences.

Clinical relevance: Radiation retinopathy is a common cause of visual impairment following ocular radiotherapy, and systemic inflammatory activity may contribute to retinal vascular damage. Understanding inflammatory mechanisms may support earlier identification of patients at risk and improve clinical monitoring strategies.

Background: Radiation retinopathy is a vision-threatening complication of radiotherapy for uveal melanoma and has traditionally been considered a localised microvascular disorder. However, the potential contribution of systemic inflammation to its development remains unclear.

Methods: A retrospective review was undertaken of hospital records of patients diagnosed with radiation retinopathy after stereotactic photon radiotherapy for uveal melanoma. Demographic characteristics, tumour features, and systemic inflammatory blood parameters were evaluated before and after the onset of retinopathy.

Results: A total of 97 patients were included, with 52.6% female participants. Most tumours were classified as T1 or T2. The median time to retinopathy diagnosis was 24 months. All systemic inflammatory blood parameters showed significant increases after the development of radiation retinopathy (all p < 0.05).

Conclusion: It is concluded that radiation retinopathy is associated with systemic inflammatory activation, suggesting that inflammatory processes may extend beyond localised retinal injury, and therefore may serve as accessible biomarkers for disease monitoring.

Clinical relevance: Vision plays an important role in the normal motor development of children. Increased understanding of this relationship is important for providing appropriate advice in a clinical setting.

Background: Growing evidence indicates that vision anomalies are associated with reduced motor performance in children. This study investigated whether feedback loop noise, induced by common vision anomalies, adversely affects sensorimotor processing in children aged 7 to 16.

Methods: Sensorimotor function was measured in 409 children aged 7-8, 10-11, and 15-16 years as part of an annual school vision programme. The vision programme included assessment of visual acuity, binocular vision and refraction. Aiming and steering sensorimotor performance were measured using a validated tool that utilised a stylus on a tablet computer. Analysis of covariance models tested whether visual function (binocular near visual acuity, amplitude of accommodation, near point of convergence) and refractive error, along with age, contributed to the variance in aiming and steering performance.

Results: Sensorimotor performance showed considerable variation within each age group. The simplest models that captured aiming variance included age and refractive error (R² = 0.42, F[3, 402] = 99.04, p < 0.001), whilst age and accommodative function contributed towards steering variance (R² = 0.22, F[3, 400] = 38.72, p < 0.001).

Conclusion: Hyperopic refractive errors and reduced accommodative function affect the ability to perform sensorimotor transformations, negatively impacting age-expected manual control skill levels. Longitudinal research is needed to test whether correcting hyperopia can: (i) improve the development of sensorimotor processing; (ii) produce beneficial changes in motor skill abilities.

Clinical relevance: Convergence insufficiency is a common binocular vision anomaly among college students, and its impact on routine near work activities of students needs to be assessed.

Background: This study assessed the reading, writing, and typing speed of young college students with convergence insufficiency and age-matched controls.

Methods: A case-control study was conducted among 50 students with convergence insufficiency and 50 control students aged 18 to 25 years. All subjects underwent visual examinations including refractive assessments and evaluations of accommodative and binocular vision parameters. Reading and writing speeds were assessed using the International Reading Speed Texts (IReST) charts while typing speed was measured using the Psychology Experiment Building Language (PEBL) software. Reading, writing and typing speeds were compared between the two groups; and their correlation with clinical parameters related to convergence insufficiency was examined. Additionally, speeds were compared among symptomatic and asymptomatic students, assessed using the Convergence Insufficiency Symptomatic Survey (CISS) scale.

Results: The mean ± standard deviation age of the participants was 20.72 ± 2.00 years. The two groups did not differ in age, gender distribution, visual acuity or spherical equivalent (p > .05 for all). The median [interquartile range] reading speed was 160.34 [152.32-172.00] words per minute (WPM) in convergence insufficiency students, and 183.52 [168.34-201.36] WPM in control students (p < .001). Writing speed averaged 32.98 ± 4.31 WPM in convergence insufficiency students versus 36.48 ± 4.23 WPM in controls (p < .001). The median typing speed was 19.57 [17.57-24.73] WPM in convergence insufficiency students, and 24.15 [19.31-27.40] WPM in control students (p = .007). Correlation analysis showed none to poor correlations between speeds and clinical parameters. No significant differences were observed in speeds between symptomatic and asymptomatic students with convergence insufficiency.

Conclusion: College students with convergence insufficiency were found to have reduced reading, writing and typing speeds.

Clinical relevance: Systemic sclerosis can affect vision quality by causing fibrosis in the cornea and lens, as in all organs.

Background: The aim of this work is to evaluate corneal and lens densitometry alongside anterior segment parameters in patients with systemic sclerosis (SSc), and to assess whether subclinical structural changes are detectable using Scheimpflug-based imaging.

Methods: This prospective case-control study included 20 patients with SSc and 20 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic examination, including anterior segment imaging using the Pentacam HR system. Corneal and lens densitometry values were recorded in concentric zones and evaluated in the anterior, central, and posterior layers. Additional parameters such as central corneal thickness (CCT), anterior chamber (AC) depth, AC angle, and corneal volume were also assessed.

Results: No statistically significant differences were observed in anterior segment parameters (CCT, AC depth, AC angle, corneal volume) or lens densitometry values between SSc patients and controls (p > 0.05). However, significantly reduced corneal densitometry values were found in the anterior and central layers of the 0-2 mm and 2-6 mm zones in the SSc group (p < 0.05). No significant differences were noted in the posterior corneal layer across all zones.

Conclusion: Although anterior segment and lens parameters appeared unaffected, reduced corneal densitometry in the central optical zone suggests subtle stromal remodelling in patients with long-standing SSc. These microstructural changes may reflect chronic fibrotic remodelling and warrant further investigation.

Clinical relevance: Blinking plays a vital role in protecting the eye and maintaining ocular surface health. Understanding blink behaviour may help identify ocular surface disorders and detect blink abnormalities associated with systemic or neurological conditions.

Background: This study assessed the kinematic characteristics of spontaneous blinking versus mechanically evoked reflex blinking and explored their relationship with potentially related ocular surface characteristics.

Methods: This pilot study used high-speed infrared imaging to capture spontaneous and reflex blinking in 11 participants. A five-minute video recording of spontaneous blinking was captured while participants watched a wildlife documentary. Reflex blinking was evoked by delivering a puff of air into the right eye at random intervals. Blink velocity, completeness and duration were determined using custom semi-automated analysis software. Corneal sensitivity, subbasal corneal nerve morphology, non-invasive tear break-up time and tear meniscus height were also assessed.

Results: Spontaneous blinking was less complete than reflex blinking (p = 0.012). Closing-phase velocity was greater for reflex blinking than for spontaneous blinking (p < 0.001), whilst no significant difference was observed for opening-phase velocity (p = 0.164). Closed-phase duration was longer for reflex blinking than for spontaneous blinking (p = 0.023), whereas total blink duration did not differ significantly (p = 0.718). Exploratory analyses suggested potential associations between tear film parameters and blink dynamics.

Conclusion: Differences were found in the kinematic characteristics of spontaneous and reflex blinking. Preliminary associations between blink characteristics and ocular surface parameters warrant confirmation in larger studies. High-speed infrared imaging is a promising technique that may be used in the future to better understand how blinking is affected by ocular, systemic and neurological conditions.

Clinical relevance: A non-refractive approach for potential myopia management is introduced as spectacle films with opaque features, hypothesised to modulate retinal ganglion cell activity away from the baseline state of the eye. Visual performance of these spectacle films is currently unknown.

Background: The aim of this work is to compare the visual performance of spectacle films with opaque non-refractive features (test), MiYOSMART (control: MS), and single vision (control: SV) lenses.

Methods: This was a prospective, randomised, unmasked, cross-over study where 37 myopic adults (18-42 years) wore each lens for a minimum of 5 days. Subjective visual performance was assessed with a 1-10 numeric rating scale for clarity of vision, vision at night, vision when walking, and overall vision satisfaction and visual acuity (monocular at 6 m and binocular at 6 m and 40 cm). Willingness-to-purchase, based on vision and myopia efficacy, was assessed with a binary Yes/No response.

Results: Test and SV were rated higher than MS (p ≤ 0.005) for all subjective ratings, while SV was rated higher than test (p ≤ 0.02) for all ratings except vision when walking (p = 0.11). A higher proportion were willing to purchase both test and SV compared to MS based on vision (p ≤ 0.001), with no difference between test and SV (p = 0.20). A higher proportion were willing to purchase SV compared to MS based on myopia efficacy (p = 0.005), with no difference between test and either control (p > 0.06). SV was significantly better than MS for acuity at 40 cm (p = 0.004) with no differences between lenses for other acuity measurements (p > 0.1).

Conclusions: Test offered better subjective visual performance than MS with higher proportions of participants willing to purchase based on vision. Test offered worse subjective visual performance than SV with no differences in willingness-to-purchase questions. SV offered better visual performance than MS and higher proportions of participants willing to purchase for vision or myopia management.