British and Irish Orthoptic Journal最新文献

Aim: To determine whether horizontal fusional vergences are comparable when measured using a prism bar and synoptophore.

Methods: Thirty two participants (18-23 years) had their blur, break, and recovery points measured for convergence and divergence amplitudes using a prism bar (6 m) and synoptophore. All participants had VA of 0.1 LogMAR or better in either eye, were heterophoric or orthophoric and had binocular single vision. The prism bar target was a 0.2 LogMAR letter. The synoptophore target was the foveal 'rabbit' fusion slides. The prism bar was placed over the dominant eye and the testing speed was two seconds per two prism dioptres (Δ), increasing to five seconds per 5Δ when the increments began to increase in 5Δ. Synoptophore testing speed was two seconds per degree.

Results: The synoptophore measured significantly higher convergence break points than the prism bar (Z = 3.37, p = 0.001). No significant differences were found between both tests for divergence break points (Z = 0.99, p = 0.32). However, both tests displayed wide limits of agreement (LoA) when measuring convergence (-24Δ to + 49.59Δ) and divergence break points (-7.70Δ to + 10.19Δ). Differences when measuring convergence and divergence blur and recovery points were not statistically significant.

Conclusion: There was a statistically and clinically significant difference when measuring convergence break points using the prism bar and synoptophore but no significant difference when measuring divergence break points. However, both tests displayed wide LoA when measuring convergence and divergence break points, indicating they should not be used interchangeably in clinic to measure horizontal fusional vergences.

Purpose: This study aimed to explore the support that UK optometrists feel they require to facilitate their engagement with myopia control intervention.

Methods: A self-administered online survey was distributed via QualtricsXM to practising optometrists in the UK via email lists and newsletters of local optical committees, social media, and optometric networks. Questions focussed on learning styles, training needs and barriers to learning.

Results: Fifty-five respondents completed the survey. Forty-eight respondents answered the question on where they get information about myopia control and learning style, 79.2% indicated that conferences offering Continuing Professional Development (CPD) material were their main source, and 20.8% preferred online learning as the preferred format of delivery. Optometrists would like to receive training in clinical assessments (78.9%), evaluating suitable interventions (76.3%), developing and implementing specific patient intervention plans (76.3%), carrying out chosen myopia control interventions (fitting/prescribing) (73.7%), and the use of pharmacological interventions (94.4%). Of the 40 respondents who answered professional development questions, 97 5% were most interested in finding, identifying and applying evidencebased practice (EBP), followed by clinical decision-making in myopia control (95.0%). When asked about barriers to learning in this field, 29.7% reported limited time to attend training as the greatest barrier.

Conclusion: Optometrists felt they need training in various aspects of myopia management, from practical skills to assessing and fitting/prescribing appropriate myopia control interventions. They were also interested in learning more on EBP and clinical decision-making related to myopia control. To improve the uptake of myopia control among optometrists, various learning methods, especially online learning, and providing sufficient time for training are crucial.

Introduction: Electronic head-mounted low vision aids (LVAs) can help children and young people (CYP) to access schoolwork and leisure activities which they would otherwise struggle to be able to do with traditional optical or hand held LVAs. SightPlus uses a smartphone mounted in a virtual reality headset controlled using a Bluetooth joystick. It offers users 0.7-24.3× magnification alongside enhanced modes to maximise vision.

Methods: Eighteen participants aged 8-16 years with reduced vision were given SightPlus to use at home for four weeks. Visual acuity was assessed with and without SightPlus along with reading performance, contrast sensitivity, functional vision and quality of life questionnaires.

Results: Clinically significant improvements in distance vision (0.633logMAR SD ± 0.359), near vision (0.411logMAR SD ± 0.368), reading acuity (0.454LlogMAR SD ± 0.406) and critical print size (0.285logMAR ± 0.360) were seen when testing with SightPlus.However, there was a mean decrease in contrast sensitivity and reading speed when using SightPlus. Despite this, nine out of the 14 patients included for analysis indicated a preference to continue to use SightPlus. Of note, younger participants were more likely to show a preference for using SightPlus. All seven CYP aged 10 or under wanted to continue to use SightPlus; in contrast, only two of the seven participants aged 11 or over wanted to continue.

Conclusions: Like the results in adult populations, SightPlus has been found to improve CYP visual functions. Older participants were less likely to want to continue to use SightPlus, potentially suggesting they have found other methods for managing sight loss.

Introduction: The importance of the use of contrast sensitivity (CS) tests in orthoptic practice is well established. However, despite the clinical relevance the implementation within clinical care is known to be variable. There are no known studies that investigate the use of CS tests in Orthoptic clinics in the UK, therefore the aim of this study is to gather information from Orthoptists in the UK on their opinion of CS and use of CS testing in clinical practice, now and in the future.

Methods: An online survey was distributed via JISC to the British and Irish Orthoptic Journal newsletter three times over a period of four weeks in June 2021 inviting practising orthoptists in the United Kingdom to complete. The questionnaire comprised of a series of questions regarding current use with free text responses for additional information.

Results: There were 84 responses to the survey. The preferred test for adult and children testing is Pelli Robson with 50% reporting use of this test. 56% felt there is a need for a new CS test for young children, 12% said no and 32% were unsure. The highest percentage (57.1%) of participants were confident to some degree that their preferred test gave them useful clinical information.

Conclusion: The result of the survey demonstrates the variability of CS testing currently in orthoptic practice in the UK. It also highlights the lack of currently available tests for children for CS testing, which may be addressed by the addition of the new Double Happy CS test.

Introduction: It is well documented that socioeconomic disadvantage adversely affects general health and ocular health worldwide. Within orthoptics, while clinicians recognise a relationship between socioeconomic situation and treatment outcome, no previous literature review was found to address this issue. Neither was a UK-specific literature review found to address the same issue for ophthalmology as a whole.

Aim: This literature review evaluates evidence for an association between socioeconomic situation and ophthalmic/orthoptic conditions and their treatment outcomes, specifically within the UK.

Methods: Keyword searches were conducted on Google Scholar and the University of Liverpool library catalogue. Results for the main analyses were limited to full papers, specific to the UK, written in English. Literature was only included from pre-2000 if more recent evidence was insufficient.

Results: There is evidence of socioeconomic disadvantage being associated with the following: reduced visual acuity; reduced attendance at diabetic retinopathy screening appointments; and delayed presentation of glaucoma, cataracts, and diabetic retinopathy. However, evidence linking socioeconomic disadvantage to AMD is mixed. There is limited evidence of the increased prevalence of amblyopia and subsequent barriers to its treatment for socioeconomically underserved children. There is also evidence of a reduction in quality of life for socioeconomically underserved adults with strabismus.

Conclusions: Health inequalities within ophthalmology and orthoptics are reported, but with confounding results for some conditions. Further research should explore the reasons behind the inequalities that are found and identify methods of reducing them.

Background & aim: The optometrist is often one of the professionals patients consult when they have headaches. The limitations inherent in previous studies on the topic limit the utilization of their findings. Therefore, the aim of conducting the present study was to explore correlations between headache and refractive errors in a clinical setting using extended classification criteria.

Methods: The study design was cross-sectional, and sample comprised (headache group = 1062; non-headache group = 1095) participants aged 10-40 years who attended an optometry practice. During case-history taking, participants were classified as headache and non-headache group. Refraction, ocular health examinations, accommodative and vergence tests were performed. Headaches were sub-classified according to the anatomic location such as temporal, frontal, occipital, or diffuse, based on where pain was felt.

Results: Temporal and temporo-frontal headaches were most frequent. Participants in the headache group numbered 1062 with mean age 25.1 ± 8.6; females 841 (79.1%) and males 221 (20.8%) while those in the no headache group numbered 1095 with mean age 25.3 ± 8.7; females 648 (59.1%). Low amount spheres and cylinders (p = 0.003) as well as hyperopic, and against-the-rule astigmatism (p = 0.012) and (p = 0.03) respectively were significantly more frequent in the headache group.

Conclusion: Temporal headaches were most frequent. Patients with low spheres and cylindrical errors as well as hyperopic and against-the-rule astigmatism were significantly more prone to headaches. This study provides findings, which have not been reported. Findings have implications for clinical practice and highlights the need to compensate for low ametropia. A standard study protocol is recommended.

Aims: To survey orthoptists' confidence in communicating with patients with communication impairments and to investigate resources orthoptists are currently using to aid assessment and management and to explore future resources that may be beneficial.

Methods and procedures: Practicing orthoptists (n = 63; median age range: 31-35 years old) completed an online survey with quantitative and qualitative questions which investigated approaches to adult and paediatric patients with communication impairments and any communication tools used. Analysis of quantitative survey responses was conducted using IBM SPSS v27. Content analysis of qualitative responses was done.

Outcomes and results: Simple communication strategies (e.g., eye contact and body language, repeating/rephrasing sentences) were commonly used with both adult and paediatric patients while more complex strategies (e.g., electronic visual aids, writing key words/concepts) were rarely used. Usage of communication strategies was not affected by length of work experience, workplace clinical speciality or training during their clinical degree or after graduation (p < 0.05). Most participants (71.2%) reported being unaware of resources available for orthoptists to assist in the assessment and management of patients with communication impairments.

Conclusions and implications: Orthoptists have adopted some communication strategies to improve their interactions with patients with communication impairments, despite limited resources. With proper resources, such as training in supportive communication techniques, they can provide optimal patient care, making it essential to identify what kind of resources would be most appropriate.

Aim: An audit of the effectiveness of amblyopia treatment in the Newcastle Eye Centre (NEC) to determine how current visual acuity (VA) outcomes compare to those found in the 2011-12 audit.

Methods: A retrospective database review. VA outcomes of patients who had undergone treatment for anisometropic, strabismic and mixed amblyopia; discharged between 31.08.2016 - 01.09.19, were compared with VA outcomes found in the previous audit. The previous audit reviewed patients commencing amblyopia treatment during 1.1.11-31.12.12.An unpaired T-test was used to assess if results were statistically significantly different to those found previously. Proportion of visual change from commencement to completion of treatment was calculated. The duration of episode from first visit to discharge, adverse events and percentage of patients who achieved acceptable visual outcomes following only six to eight weeks of occlusion, were also analysed.

Results: Between 31.8.16 and 01.09.19, 1,100 patients were discharged, of which 174 had completed amblyopia treatment and fit the inclusion criteria for the audit. Results show no statistically significant difference between current and previous VA outcomes for each type of amblyopia. The majority of patients (60%) achieve a VA outcome of ≤0.250 (logMAR) in the amblyopic eye. This is comparable to the previous audit where 59% of patients achieved a VA outcome of ≤0.250. Most patients still achieve a level of VA which is equal or almost equal to the fellow eye following amblyopia treatment. Treatment is still completed within a two-year period for the majority of patients (62%). There was only one adverse event and this related to atropine occlusion. Only 18 out of the 174 (10%) patients showed that occlusion could be discontinued following just six to eight weeks of treatment.

Conclusions: The treatment of amblyopia in the NEC is as successful as found in the previous audit and the current amblyopia treatment protocol remains effective. Only 10% of patients achieved the appropriate VA for amblyopia treatment to be ceased on their first return visit. This indicates that the follow-up length for patients undergoing amblyopia treatment could be extended beyond six to eight weeks without causing a detriment to VA outcome.

Purpose: Determining the correct power and orientation of prism to be prescribed for patients with symptomatic, oblique-angle strabismus can be challenging and confusing, prone more to clinician gestalt than science or methodology. The author shares a simplified, approach not previously described in the scientific literature that utilizes commercially available equipment and freely available on-line prism calculators for choosing the correct Press-On™ prism power, positioning the prism correctly on the spectacle lens, and ultimately determining the correct prism prescription to be incorporated into the patient's spectacles.

Purpose: The conversion of ocular myasthenia gravis (OMG) to generalised myasthenia gravis (GMG) is reported to differ depending on the presence of generalisation risk factors (Mazzoli et al. 2018). Thymic pathology has been recognised as a potential risk factor for generalisation in the literature (Teo et al. 2017). Thymoma and thymic hyperplasia have yet to be examined as a risk factor for generalisation of OMG independently of other risk factors in the literature. Thus, the purpose of this review is to examine the literature to identify whether thymoma and thymic hyperplasia do increase the risk of OMG progressing to GMG.

Methods: A literature search was carried out which employed a systematic approach. The search was undertaken using the following academic libraries: MEDLINE, Embase and Starplus. The search was limited to publications between the years 2001 to 2021. The search yielded 82 studies, which after the screening of titles and abstracts, left 62 studies for further analysis against the inclusion and exclusion criteria.

Results: The review found thymoma to be associated with an increased risk of GMG development. However, there was a scarce amount of literature which investigated thymic hyperplasia. Therefore, a firm conclusion could not be made with regards to thymic hyperplasia and the risk of GMG development.

Conclusions: This review provides evidence for the consideration of thymectomy early after thymomatous OMG diagnosis to prevent GMG conversion. As the review did not collect enough evidence to support the influence of thymic hyperplasia on OMG conversion, further research is required.