Optometry and Vision Science最新文献

Significance: Direct subjective refraction (DSR) is a novel method for refractive error measurements that uses temporal changes in defocus and a flicker minimization task. The computational models developed here are a framework for improving this clinical method.

Purpose: This study aimed to model the measurement of refractive error with the DSR method, which uses rapid changes in optical power and a bichromatic (red/blue) stimulus.

Methods: The polychromatic point spread function of the eye was used to simulate the retinal image projected in DSR method, and an image quality (IQ) metric was defined based on the spatial frequencies of the retinal image. Three tasks were modeled: blur minimization (BM), monochromatic flicker minimization (MFM), and polychromatic flicker minimization or DSR. A metric was defined for each task and studied through focus in a ±3-D range. Whereas BM was modeled using only the IQ of the projected images, MFM and DSR metrics were a function of the IQ of the average retinal image and a metric to quantify the similarity (flicker) in the image. The width of the through-focus peak was used to compare between tasks, and different values of pupil size and spherical aberration were studied.

Results: The through-focus 90% peak width was 0.48, 0.16, and 0.19 D for BM, MFM, and DSR tasks, respectively, which agreed well with previous experimental data. The 90% peak width increased for small pupils and with increasing values of spherical aberration in BM and MFM, but it remained relatively constant in DSR model.

Conclusions: The developed models explained previous experimental findings that reported a higher repeatability of the DSR compared with the traditional refraction method.

Significance: Intervention strategies for post-mild traumatic brain injury (mTBI) ocular motor disorders vary across disciplines and include watchful waiting, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical intervention. However, evidence supporting their effectiveness is limited, highlighting the need for high-quality randomized controlled trials with standardized testing, diagnostic criteria, and reassessment of ocular motor function after intervention.

Background: Ocular motor disorders occur frequently after mTBI.

Objectives: This study aimed to conduct a scoping review of interventions for mTBI-related ocular motor disorders in children and adults.

Data sources: The following electronic bibliographic databases were searched: PubMed, Embase, PEDro, OVID, Clinical Key, Google Scholar, and REHABDATA.

Study selection: Intervention studies published in English between 2003 and 2024 involving mTBI participants who had an ocular motor assessment prior to intervention were included in this study.

Data extraction and synthesis: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed for reporting. Study population, intervention, and outcomes were extracted and synthesized in tabular and graphical formats.

Results: Sixty-seven eligible studies were included, with only three (4%) judged as low risk of bias. Intervention strategies included watchful waiting (n = 31, 46%), vestibular rehabilitation (n = 13, 19%), vision rehabilitation/vision therapy (n = 10, 15%), optical intervention (n = 4, 6%), and alternative interventions or multifaceted interventions (n = 9, 14%). Among the studies providing statistically supported results, improvements in one or more ocular motor outcome domains were reported in nearly 80% of the studies on watchful waiting (19/24) and 100% of the studies on vestibular rehabilitation (4/4), vision rehabilitation/vision therapy (7/7), or optical intervention (1/1).

Conclusions and implications: Although post-mTBI ocular motor deficits improved with watchful waiting strategy, vestibular rehabilitation, vision rehabilitation/vision therapy, and optical interventions, most studies had significant risk of bias. This review emphasizes the necessity for high-quality randomized controlled trials with standardized testing protocols and diagnostic criteria and reassessment of ocular motor functions after intervention to evaluate the effectiveness of these interventions in different age groups and recovery stages.

Significance: Digital devices are ubiquitous in modern daily life. Although a high prevalence of digital eyestrain has been reported, the mechanisms underlying digital eyestrain have not been fully elucidated, and there is currently no proven treatment.

Purpose: This study aimed to evaluate the relationship between the cognitive demand of a near task, mode of presentation (digital or paper), working distance, and symptoms of digital eyestrain.

Methods: Thirty young participants completed four 30-minute reading tasks. The four conditions (performed in randomized order) entailed (1) a cognitively demanding task performed on a tablet computer and (2) a less cognitively demanding task performed on the same device. Trials (3) and (4) were identical to (1) and (2) except that the tasks were performed on paper. Subjects could hold the reading task at any distance they felt comfortable. Before and immediately following each task, subjects completed a digital eyestrain symptom survey. For all four conditions, a spectacle-mounted device (Clouclip) was used to measure the working distance objectively.

Results: Although all four tasks induced significant symptoms, there was a significant difference between the four conditions, with the increase being greatest for the cognitively demanding task on the tablet computer. There was no significant difference in working distance for the four conditions, and all tasks showed a similar reduction in working distance (p=0.001), on average, from 31.6 to 28.9 cm, over the first 10 minutes, with the working distance remaining stable after this initial period.

Conclusions: Task-induced symptoms varied with both cognitive demand and mode of presentation. However, working distance did not vary significantly with these factors. The wording distance decreased during the first 10 minutes of each trial and was markedly closer than 40 cm for all conditions. The closer working distances being adopted should be considered during routine clinical testing.

Significance: Transference matrices are interesting tools for optical analysis of an eye alongside ray tracing. To explore possible interpretations of the ABCD entries of the transference, this article applies them to the corneal surfaces to find a surprising link to a corneal biomechanics parameter that may help with keratoconus detection.

Purpose: The transference matrix used in linear optics has four entries, dilation A, disjugacy B, divergence C, and divarication D. Entry C is the negative of the power of the system. However, the remaining three entries are somewhat difficult to relate to. This work explores how the four fundamental properties of the corneal transference relate to familiar corneal variables such as radii of curvature, thickness, surface powers, and total refractive power.

Methods: The cornea is treated as a thick lens, and a transference is obtained for the cornea at approximately 12,000 points, as well as point-by-point corneal maps of A, B, C, and D are obtained based on Scheimpflug tomography data (Pentacam HR, Wetzlar, Germany). The trace of the transference is also obtained.

Results: The four corneal maps of A, B, C, and D resemble familiar clinical maps, albeit at different scales. Pachymetry is represented by B, and total corneal power is represented by C, and A represents a new variable, resembling the corneal contribution to stress (CCS), a new variable used in detecting early keratoconus. D seems to represent a CCS-like variable applied to the posterior corneal surface. In keratoconus, the trace appears as a ring-shaped pattern around the cone.

Conclusions: The A, B, C, and D maps relate information from known clinical maps such as pachymetry, corneal power, and CCS. The trace of the transference provides a new corneal map representing the combination of CCS and a related posterior parameter that may be useful in the detection and follow-up of keratoconus.

Significance: India has a population of more than 1.40 billion with a humongous need for community eye health services. Understanding challenges faced by female optometrists in community eye care will help us address the needs and eventually improve eye and vision care services. The study also aims to give recommendations to policymakers and to leadership in hospitals that provide community eye health services and employ female optometrists.

Purpose: The study aimed to understand the challenges faced by women in optometry while delivering community eye care services.

Methods: Optometrists working in community eye health were invited to participate in this study. In-depth interviews were conducted using a semistructured questionnaire. The interviews were recorded, and the audio files were transcribed to text and analyzed using the MAXQDA-10 software. Data analysis was performed based on thematic codes and responses received from the participants.

Results: Eighteen optometrists completed the interviews, and the average age of the female optometrists who participated in the study was 36.4 ± 6.5 years. The average experiences in overall optometry work and community eye health were 14.3 ± 5.9 and 9.5 ± 5.3 years, respectively. The qualitative analysis revealed that women faced several challenges from basic logistics to gender bias, from the communities they served, and from within the organization's peers. Their work-life balance also faced challenges including their social lives. The enablers and motivating factors were job satisfaction, learning experience, and career growth.

Conclusions: The study describes several challenges faced by female optometrists in community eye health, from the lack of basic facilities to gender bias among peers and challenging work-life balance. Despite this, women are happy to contribute to community work, as they find the experience rewarding, both emotionally and professionally.

Significance: This study developed a practical screening tool to identify reduced habitual vision (RHV) in hospital rehabilitation units. This tool would enhance patient care by enabling timely interventions in resource-limited settings.

Purpose: The study aimed to develop a practical and implementable screening tool to identify patients with RHV in hospital rehabilitation units. Potential vision measures, screening questions, and demographic variables were considered to determine the optimum combination.

Methods: The cross-sectional study recruited 112 adult inpatients (aged 18+ years) from three rehabilitation units in an acute care hospital in Ontario, Canada, between October 2018 and February 2019. Data included an oral questionnaire on demographics, health status, and self-reported vision function, alongside vision assessments (distance visual acuity [VA], contrast sensitivity [CS], visual fields [VFs], and stereopsis). Univariate and multivariate logistic regression analyses were conducted to identify significant predictors of RHV, defined by VA >0.3 logMAR, CS <1.40 logCS, or any VF defect.

Results: The average age of participants was 74.5 years (±14.3 years), and RHV was present in 48.7%. Significant predictors of RHV included self-reported "happiness" with vision with current spectacles and difficulty reading a newspaper. The optimal predictive factors were VA and VF testing (96% sensitivity), but for practical implementation, the combination of three self-reported questions (happiness with vision, difficulty reading a newspaper, and difficulty distinguishing facial expressions) demonstrated 74% sensitivity.

Conclusions: The study highlights that a combination of self-reported questions can effectively identify patients with RHV, providing a feasible alternative to direct vision assessments in resource-limited settings. Implementing this screening tool could improve patient care by enabling timely adaptations and referrals for eye care, ultimately enhancing rehabilitation outcomes and reducing falls risk. Further research is needed to refine the tool's sensitivity and explore its applicability in broader hospital and primary care settings.

Significance: The study first investigated the prevalence and internal relationship of astigmatism components under cycloplegia in Tibetan children on plateau areas of China. We found a higher prevalence of refractive (RA) and corneal astigmatism (CA) in Lhasa children and certified the compensation of internal astigmatism (IA), which might be associated with myopic progression.

Purpose: This study aimed to investigate the prevalence and related risk factors of RA, CA, and IA and evaluate compensation and associated influence factors of IA in Lhasa Tibetan children.

Methods: This was a school-based cross-sectional study. Stratified random clustering was used to recruit 1751 Tibetan children with a mean age of 7.90 ± 0.48 years from schools in Lhasa, China. Cycloplegic autorefraction was conducted, and ocular biometrics were examined.

Results: The prevalence rates of RA, CA, and IA were 18.73, 72.53, and 40.72%, respectively, with the diagnosis criteria ≥1.00 D. With-the-rule was the main type of RA (70.05%) and CA (91.93%), whereas the against-the-rule was predominant in IA (79.67%). Compared with the reference group (spherical equivalent range, 0.51 to 1.00 D), mean RA and CA increased with more hyperopic and myopic refractions, and mean IA was significantly lower only in myopia and emmetropia groups. Girls had a higher incidence of CA and IA than boys. Internal astigmatism was negatively correlated with CA in the vertical/horizontal vector ( J0 ) and oblique vector ( J45 ). The majority of IA compensated for RA in different degrees (95.25% in J0 and 66.43% in J45 ) and no compensation accounted for a higher proportion in myopic children (10.47% in J0 and 5.76% in J45 ).

Conclusions: The prevalence of RA and CA in Tibetan children from Lhasa was higher than reported in most previous studies. The compensation of IA in reducing CA was prominent, and the function could decrease with the myopic progression.

Purpose: This study aimed to assess intrasession repeatability, diurnal intravisit and day-to-day intervisit reproducibility of qualitative tear film lipid layer interferometry grading obtained from the Keratograph 5M (Oculus Optikgeräte GmbH, Wetzlar, Germany), and automated quantitative layer thickness measurements obtained from the TearScience LipiView II Ocular Surface Interferometer (Johnson & Johnson Vision, Milpitas, CA), in community residents, not stratified by dry eye or blepharitis status.

Methods: Forty community residents (24 women, 16 men; age mean ± standard deviation, 36 ± 14 years) were recruited in an investigator-masked, randomized, crossover study. Participants attended two sessions 6 hours apart on the same day and a third session on a separate day. During each session, tear film lipid layer grading and thickness measurements were performed in triplicate, in a masked manner, with 10-minute intervals between each measurement.

Results: There were no significant differences in lipid layer grading and thickness measurements in all pairwise intrasession, diurnal intravisit, and day-to-day intervisit comparisons (all p≥0.19), and positive correlations were observed in all cases (all p<0.001). The weighted Cohen κ coefficients for intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility of qualitative lipid layer grading ranged from 0.670 to 0.867. The test-retest repeatability of quantitative lipid layer thickness measurements ranged from 4.5 to 11.7 nm, and the Bland-Altman biases were within the order of 3 nm in all pairwise comparisons. The intraclass correlation coefficients for lipid layer thickness measurements exceeded 0.80 for all intrasession comparisons and were between 0.60 and 0.80 for all diurnal intravisit and day-to-day intervisit comparisons.

Conclusions: Both qualitative grading and automated quantitative thickness measurements of tear film lipid layer interferometry demonstrated relatively favorable levels of intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility. The study findings would support the use of either qualitative or quantitative measurement in clinical and research settings, as a reliable tool for assessing lipid layer interferometry.