British and Irish Orthoptic Journal最新文献

Introduction: Stereopsis is the ability to perceive depth through binocular vision. Artificial lighting conditions play a significant role in visual performance, yet their specific effects on stereopsis remain poorly understood. This study aimed to investigate the effect of different light sources on stereopsis.

Methodology: Forty young adults with normal binocular vision and stereoacuity better than 40 arcseconds were included. Participants were exposed to four lighting conditions [light-emitting diode (LED), incandescent, sodium vapour, and compact fluorescent lamp (CFL)] with illumination levels set at 400 lux. Stereoacuity was measured using the Randot stereo test under these lighting conditions, with the order of exposure randomised for each participant.

Results: The median stereopsis values for CFL and LED lighting were 25 arcseconds, while those for incandescent and sodium vapour lamps were 30 arcseconds. Stereoacuity was significantly worse under sodium vapour and incandescent lighting compared to CFL and LED conditions (p < 0.05). However, the stereopsis values for CFL and LED did not significantly differ from the baseline (p > 0.05). No significant differences were found between the sodium vapour and incandescent lamps (p > 0.05), nor between the CFL and LED lamps (p > 0.05).

Conclusion: Sodium vapour and incandescent lighting conditions significantly impair stereopsis, while CFL and LED lighting conditions do not adversely affect stereopsis.

Introduction: Intermittent exotropia (IXT) is a common form of strabismus in children, but the fluctuating angle of deviation and control make measuring the ocular deviation complicated. The prism cover test (PCT) is the gold standard, yet examiner dependent. We assessed whether the 2WIN-S photoscreener (2WIN plus Kaleidos corneal-reflex wand) can quantify deviation in basic IXT and whether control level modifies agreement with PCT.

Methods: Nineteen children with basic-type IXT and monocular acuity 0.1 log MAR or better were enrolled, ocular pathology or significant refractive error excluded. Control was graded (0-2 good; 3-5 fair-to-poor). PCT measured deviation at 4m, 1m and 40 cm with 5 s occlusion; 2WIN-S measured at 1 m after a 30 min rest. Analyses compared 10-20 versus > 20 prism dioptres (pd) and used Bland-Altman plots.

Results: Mean age was 10.26 ± 3.76 years. Median deviation was 25.0 pd (IQR 20-30) with PCT versus 8.5 pd (IQR 0-19.5) with 2WIN-S (z = -3.82, p < 0.001). Differences were significant in both 10-20 pd (median 11.25; z = -2.20, p = 0.028) and > 20 pd groups (median 18.0; z = -3.18, p = 0.001). In five cases, 2WIN-S reported orthophoria; four had ≥ 20 pd on PCT and good control. Good-control cases showed a 20.0 pd median difference; fair-to-poor control showed 3.5 pd within the 10 pd clinical margin. Bland-Altman mean difference was 14.13 pd with limits of agreement from -4.96 to 33.22.

Conclusion: Overall agreement between 2WIN-S and PCT was poor. Until methodological or optical refinements are made, 2WIN-S should not be used for quantifying basic-type IXT.

Background: Vision plays a critical role in a child's educational success, cognitive development, and social interaction. However, many children, particularly in low- and middle-income countries like Morocco, suffer from undiagnosed visual impairments during their school years. As teachers spend extended time with students, they are well-positioned to notice early signs of vision problems.

Objectives: This study aimed to assess the level of knowledge that Moroccan primary school teachers have about children's visual health, identify gaps in awareness of common visual disorders, explore teachers' roles in detecting signs of visual issues in the classroom, and support the development of school-based vision screening strategies.

Methods: A cross-sectional descriptive study was conducted among 271 primary school teachers across different Moroccan regions. Data were collected using a structured questionnaire covering demographic characteristics, knowledge of common visual disorders, awareness of behavioural signs, and current classroom practices. Statistical analyses were performed to examine associations between knowledge levels and variables such as gender, age, and teaching experience.

Results: The majority of participants (84.9%) reported more than five years of teaching experience, corresponding to an estimated average of approximately nine years in the profession. Teachers demonstrated a better understanding of refractive errors and strabismus compared to ocular surface diseases and behavioural signs. Teaching experience was significantly associated with higher knowledge scores (p = 0.001), whereas no significant differences were found based on gender. Although age was not directly correlated with knowledge scores, older teachers were significantly more likely to report observing academic improvement in students after correcting visual problems (p = 0.0007), a perception also more frequent among those with greater teaching experience (p = 0.004). Despite existing knowledge gaps, teachers reported supportive practices such as adjusting classroom seating (94.5%) and informing parents (52.6%).

Conclusion: The findings highlight the potential value of providing targeted training programmes to help teachers play a more active role in recognising visual problems in children. Incorporating basic eye health education into teacher training curricula may support earlier detection and contribute to better child health outcomes in school environments, though further research is recommended to validate this approach.

Introduction: Cerebral Visual Impairment (CVI) accounts for most visual impairment in children in the developed world. A significant proportion of children in special needs education demonstrate atypical visual function, yet referral thresholds for onward assessments are not defined. We sought to describe the elements of a visual function assessment that might indicate a threshold for referral into CVI diagnostic pathways.

Method: We undertook a retrospective analysis of 50 consecutive records of children attending a specialist visual assessment clinic. Visual ability was documented, including visual acuity, contrast sensitivity, visual field, eye movements, visual attention, accommodation, and optic disc appearance. The aim of this retrospective case note review was to examine the pattern of visual assessment outcomes that raised suspicion of CVI in a cohort of children with special needs.

Results: Atypical response to three or more testing domains was associated with a diagnosis of CVI. Mean age of children was 6.6 years (range 1-16). There was no statistical difference in the mean number of test domains completed by those with/without CVI. (7.3 vs. 8.3; p = 0.5). Children with CVI showed a statistically higher mean number of atypical responses compared with non-CVI patients (4.2 vs. 0.4; p = 0.015).

Discussion: Our findings are in keeping with other studies that indicate that detecting atypical eye movements, visual field, and/or visual attention play a key role in highlighting children who warrant comprehensive assessment for CVI. Facilitating eye health professionals to identify and refer on those children with evidence of CVI-related behaviors will further our endeavors to provide an inclusive approach to diagnosis in a high-risk group.

Background: Strabismus can have profound psychosocial impacts in addition to functional impacts. Psychosocial impacts typically stem from negative attitudes and can manifest as low self-esteem, employment discrimination, and problems forming interpersonal relationships. Evidence suggests that negative attitudes towards strabismus emerge in early childhood.The aim of this review was to investigate the age at which strabismus impacts quality of life in children.

Methods: A systematic search was conducted using online databases (MEDLINE, Embase, Emcare, and PsycINFO) from their inception until July 2024. The search strategy was derived from three topic areas: strabismus, quality of life, and children. A two-stage screening process involved screening titles and abstracts before full texts were retrieved and screened. Inclusion criteria required studies to have participants aged less than 18 years old with strabismus completing a measure of quality of life. Quality assessment was performed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

Results: From 1,014 records, a total of 10 studies were included. Most studies reported children with strabismus had significantly reduced quality of life compared to children without strabismus, across all age groups. Three studies compared scores between different age groups. One indicated a greater reduction in quality of life in older children. Conversely, two found no significant difference between different age groups.

Discussion: Findings indicated that strabismic children across all age groups experience reduced quality of life, although age-specific analysis was limited. A longitudinal study using an appropriate, validated outcome measure from diagnosis until adulthood may facilitate an age-specific analysis of quality of life.

Background: The aim of this study was to compare accommodative amplitude (AA) and accommodative facility (AF) in healthy subjects with a family history of diabetes (FHD+), individuals with diabetes mellitus (DM), and healthy controls (HC).

Material and methods: This cross-sectional, observational, comparative study was conducted among 89 subjects who attended in the age group between 30 and 40 years. The subjects were categorised into three groups: 30 healthy controls (HC) (mean age: 35.1 ± 4.5 years), 31 healthy subjects with a family history of diabetes (FHD+) (35.5 ± 3.2 years) and 28 subjects diagnosed with diabetes (DM) (36.5 ± 3.5 years). An informed consent form was obtained from subjects before conducting procedures. The amplitude of accommodation was assessed using the minus-lens technique. Additionally, accommodative facility was evaluated monocularly and binocularly using ± 1.50DS flippers. The effects of age, fasting plasma glucose levels, and glycated haemoglobin levels on accommodative parameters were examined using multiple regression analysis. One-way ANOVA with the Bonferroni post hoc test was used to test for significant differences in accommodative parameters.

Results: The mean amplitudes of accommodation for the three groups were statistically significant (Mean AA_DM: 3.4 ± 1.0; Mean AA_FHD+: 4.63 ± 0.83; Mean AA_HC: 6.25 ± 1.33; p = 0.001). Similarly, the mean monocular accommodative facility (AF) for the three groups differed significantly (mean AF_DM:4.35 ± 1.34, mean AF_FHD+: 5.95 ± 1.4; mean AF_HC:7.65 ± 1.18cpm; p = 0.001). In multiple regression, age nearly significantly affected AF in the FHD+ group, with (R² = 0.492, p = 0.040). Whereas, age and FBS were the predictors of AA in FHD+ (R² = 0.598, p = 0.001; R² = 0.400, p = 0.026).

Conclusions: Healthy subjects with a family history of diabetes who are at increased risk of developing prediabetes had reduced accommodations. The AA and AF values are notably lower than the expected value for this age group. Identifying and monitoring these individuals could provide an opportunity for early intervention, potentially delaying the progression of accommodative anomaly-like symptoms associated with DM. This observation highlights the importance of considering family history and prediabetic status when examining accommodative function.

Introduction: Small group teaching is widely used in healthcare education. Few studies have specifically focused on small group teaching in optometry. This study investigated the effects of small group clinical teaching combined with case-based learning (CBL) on final-year optometry students' knowledge in the assessment, diagnosis and management of accommodation and convergence anomalies.

Methods: Students took part in a tutorial session involving the assessment of accommodation and convergence. A total of 89 final-year optometry students were randomly divided into two groups (control and intervention) prior to attending a binocular vision tutorial. Before undergoing the tutorial, the control group completed 20 multiple-choice questions (sets A and B), whilst the intervention group answered 10 questions (set A) before and the remaining 10 questions (set B) after the tutorial. Non-parametric statistics were employed to investigate the differences in Set A and B scores within and between the groups.

Results: There was no significant difference in set A scores between the control (48.18%, ±17.16) and intervention (43.81%, ±13.43) groups (p = 0.27). The intervention group had significantly higher set B scores (60.71%, ±17.02) than the control group (50.68%, ±17.84) (p = 0.01).

Conclusion: Small group teaching combined with CBL significantly enhances optometry students' knowledge of the diagnosis and management of accommodation and convergence anomalies. This teaching and evaluation methodology has the potential to be applied across all healthcare disciplines.

Myopia is one of the leading causes of visual impairment worldwide, typically beginning during the school-age years. Several factors contribute to its development, including environmental influences, excessive use of digital devices, and limited outdoor activities. The objective of this study was to assess the prevalence of myopia and associated factors among school-aged children and adolescents in rural areas of southern Morocco. A cross-sectional study was conducted between November 2022 and January 2023, involving 342 participants, with a majority of boys (54.4%) and a mean age of 13 years. Data were collected using a questionnaire that gathered sociodemographic and vision-related information, followed by a vision test to determine myopia status using cycloplegic autorefraction. The results revealed a relatively low prevalence of myopia (11%, 95% CI: 7.8%-14.4%). Multivariate logistic regression showed that a screen-watching distance less than 35 cm was significantly associated with an increased risk of myopia (OR = 1.89; 95% CI: 1.02-3.47; p = 0.042). The majority of participants (98%) reported spending at least two hours outdoors daily, and the average daily use of digital devices was 30 minutes. Interestingly, the majority of participants (72%) maintained a screen viewing distance of ≥35 cm, which was found to be associated with myopia (p = 0.04). This may reflect a behavioral adaptation rather than a direct causal relationship. Overall, the study suggests that the low prevalence of myopia in this population may be attributed to high exposure to daylight and limited use of digital devices. These findings underscore the potential protective role of outdoor activities and highlight the need for further research to better understand the factors influencing myopia development in rural populations.

Aim: This study aims to assess the prevalence of binocular vision anomalies and refractive errors among secondary school students in Southern Trinidad.

Methods: A cross-sectional school-based study was conducted in two schools in southern Trinidad. Participants were randomly selected using an online spinner wheel. Refractive errors and binocular vision anomalies were assessed using handheld autorefractor and prism cover test respectively. Data on demographic information, refractive errors, and binocular vision were collected. The collected data were entered into Microsoft Excel and subsequently analysed using the Statistical Package for Social Sciences (SPSS). Descriptive statistics were computed using Pearson's Chi-Squared test to analyse categorical variables, while Spearman's rank correlation coefficient was used to assess the relationship between variables, with a significance level set at p < 0.05.

Results: The study included 95 students, with 49 males (51.6%) and 46 females (48.4%), aged 12-18 years. The prevalence of binocular vision anomalies was 13.7% (13/95), with convergence insufficiency being the most common anomaly at 6.2%. Refractive errors were observed in 64.2% (61/95). of the participants, with myopia being the predominant type, affecting 54.2% of students. Spearman's rank correlation test revealed no statistically significant correlation between binocular vision anomalies and refractive errors.

Conclusion: The study identified a prevalence of 13.7% for binocular vision anomalies and 64.2% for refractive errors among secondary school students in Southern Trinidad. There is a need for a more comprehensive screening of binocular vision anomalies and refractive error for high school children in Trinidad.

As a response to increasing pressures on hospital eye services, the Royal College of Ophthalmologists (RCOphth) has started exploring the integration of physician associates (PAs) into ophthalmology as a means of expanding the ophthalmic workforce while maintaining high standards of care. However, the proposal has sparked a discussion within the ophthalmic community regarding the role of PAs in a specialty that already benefits from a well-established and specialized multidisciplinary team. Concerns have been raised about their short generalist training, which may not fully prepare them for the complexities of ophthalmic care, as well as the high cost of their integration compared to other healthcare professionals. Given these issues, upskilling existing allied health professionals and leveraging digital health innovations could be more effective solutions in addressing workforce shortages. The Royal College of Ophthalmologists (RCOphth), having endorsed the pilot scheme, bears the burden of proof to demonstrate the efficacy and value of PAs in this specialized field, ensuring that any workforce expansion aligns with the high standards expected in ophthalmic care.