British and Irish Orthoptic Journal最新文献

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.

Purpose: To evaluate the impact of gaming on ocular accommodative parameters.

Methods: A comparative and experimental study was conducted among non-orthoptic university students for a duration of six months from September 2023 to March 2024. After a half-hour of gaming, the subjects' accommodative parameters were examined and compared. The accommodative parameters before and after iPad gaming were compared.

Results: The study included 80 participants (mean age 22.96 ± 2.23 years; 50 males, 30 females). Post gaming near-point of accommodation decreased (right eye: 10.75D to 7.15D, p < 0.001), Negative Relative Accommodation (NRA) increased from 2.64 ± 0.23 DS to 2.92 ± 0.37 DS, whereas Positive Relative Accommodation (PRA) decreased from -2.46 ± 0.41 DS to -1.78 ± 0.31 DS. The Monocular Estimation Method (MEM) values showed accommodative lag (right eye: +0.46 ± 0.15 DS to +1.24 ± 0.26 DS, p < 0.001). Monocular Accommodative Facility (MAF) and Binocular Accommodative Facility (BAF) exhibited decrease in facility (MAF; right eye: 10.34 to 4.54 cpm, BAF: 10.65 to 4.90 cpm, p < 0.001).

Conclusion: This study shows 30 minutes of gaming using digital devices leads to decrease in accommodative parameters, potentially causing ocular fatigue and binocular vision anomalies in young individuals.

Background: Patching therapy is the most common treatment for amblyopia (lazy eye) and is unsuccessful for approximately 40% of patients, leaving them with life-long unilateral visual impairment and increased risk of bilateral visual impairment later in life. Poor adherence to patching therapy is a major contributing factor in treatment failure yet we lack real-world understanding as to why this is a problem outside of controlled research studies.

Methods: In collaboration with patient contributors, we developed an online survey for past patients, parents/carers of children with amblyopia, health professionals, and schoolteachers. The survey included questions about when and where is best for children to wear the patch, the design of the patch, and facilitators and barriers to patching therapy.

Results: We received 631 responses to the survey (259 health professionals, 213 parents/carers, 110 people who patched as a child, 7 teachers, and 42 people matched to multiple categories). Healthcare professionals thought weekday (54.4% versus 14.3% preferring weekend and 31.3% no difference) and school (54.4% versus 21.6% preferred home and 23.9% no difference) patching was more successful. Past patients (52.4%) favoured 'force' as a technique to encourage patching; more than both health professionals (7.7%) and parents or carers (19.7%). Patients rated 'people making fun' of them as an important barrier to patching.

Conclusions: We describe surprising differences in stakeholders' responses to the survey questions about barriers to successful patching treatment. We suggest these differences are used as a guide for further work to explore stakeholder's social experience of patching.

Objective: Vision screening programs in children aged 4-5 years aim to address visual issues before they start school, supporting children's educational, developmental, emotional, and social well-being. This study evaluates attendance rates and barriers to attendance for children requiring follow-up in an urban hospital eye service after their initial screening visit.

Methods and analysis: Retrospective data on attendance, visual acuity, refractive errors, and presence of additional support needs (ASN) were collected from the National Database for preschool screening and the hospital electronic record system. Caregivers of children with missed appointments were invited for a telephone survey.

Results: First-time hospital attendance rate was 61%. Children with ASN were 1.8× more likely to miss two hospital appointments and had more incomplete tests compared to children without ASN. In children receiving a spectacle prescription, vision improved by 0.07 LogMAR in the better eye and 0.16 LogMAR in the worse eye. Barriers for attendance included being unaware of the appointment, ASN, hospital environment, scheduling and transport issues. Parents recommended information with the appointment letter in an accessible language for the child and caregiver, an appointment reminder text message and options for vision tests in the community or at school.

Conclusion: Whilst the initial uptake of vision screening is high, there is a significant proportion of children with incomplete screening tests or missed follow-up appointments. Greater attention should be placed on improving accessibility of the service for children with ASN, as they may be at greater risk of missing out on appropriate eye care.

Introduction: Clinical placements in allied health are crucial for students to develop skills in real-world settings. However, these environments can expose students to incidents of incivility, bullying, or harassment. Whilst much research has explored bullying in medicine and nursing, little is known about the rate or effect of bullying in smaller allied health professions. This study aimed to investigate the frequency of bullying incidents among final year orthoptic students and assess the consequential effects of this experience.

Methods: In this cross-sectional study, final year orthoptic students and graduates who had completed placements in the preceding year were invited to complete an online survey. The survey instrument was adapted from the Clinical Workplace Learning Negative Acts Questionnaire-Revised. Information on demographics, placement attributes, bullying experiences, and their effects was gathered. The data were analysed using descriptive statistics.

Results: A total of 20 individuals responded to the survey; 12 (60%) final year students and 8 (40%) graduates. Almost all participants (95%) reported experiencing at least one negative act whilst on placement, with 10 (50%) indicating they experienced bullying. Of these 10, all reported feeling humiliated by the incidents, and 90% reported a loss of confidence. Almost all students (90%) did not report the behaviour when it happened, with most students also being unaware of bullying and harassment policies of the university or health facility.

Conclusion: Bullying and incivility pose challenges for orthoptic students during placements. This study highlights gaps in policy implementation and underscores the need for effective measures to address this issue.

Purpose: In 2022, the General Optical Council initiated a call for evidence concerning the Opticians Act. This consultation aimed to gather input and evidence relevant to potential modifications to the Opticians Act. One piece of research that was commissioned aimed to investigate the role of orthoptists in refraction.

Method: We invited a range of eye care practitioners to participate in an online virtual focus group. Focus group discussions were audio-recorded, transcribed, and thematically analysed.

Results: Two focus group discussions involving sixteen eye care professionals were completed. Findings confirm some orthoptists are already performing refraction tasks within the hospital eye service, primarily with young children using cycloplegic retinoscopy. Participants indicated that, at present, orthoptists refract on behalf of ophthalmologists who issue spectacle prescriptions based on the findings of the orthoptist's refraction. Potential benefits of orthoptists undertaking refraction responsibilities were discussed including the ability to conduct retinoscopy in hospital paediatric clinics where services are in high demand and there is often a shortage of refraction appointments. This shift could lead to decreased NHS waiting times, fewer patient appointments, improved clinical decision-making, and facilitate the assessment of accommodative dysfunction. Overall, the group were positive towards orthoptists conducting refractions and issuing optical prescriptions but with specific conditions: limited to hospital settings, necessitating adequate postgraduate training, supervision by a hospital eye service consultant, and regular ocular health assessments.

Conclusion: This study assessed the involvement of orthoptists in present and prospective refraction services, including their potential to legally issue optical prescriptions. The research outlined both the potential benefits and mitigating strategies to address concerns if orthoptists could issue optical prescriptions.