British and Irish Orthoptic Journal最新文献

Introduction: In response to the need for easily accessible, high-quality information about nystagmus, the Nystagmus Information Pack was created and made freely available online in 2017. This study was undertaken to evaluate the content and accessibility of the Nystagmus Information Pack.

Methods: Clinicians, eye clinic liaison officers (ECLOs), teachers, patients, families, and any person with an interest in nystagmus were invited to complete an online questionnaire about the content and accessibility of the Nystagmus Information Pack.

Results: One hundred and sixty respondents completed the questionnaire. Respondents who had previously accessed the Nystagmus Information Pack (n = 49, 30.6%) reported the content was appropriate (86%), of sufficient detail (94%), and easy to understand (88%). Minor suggestions were made to improve the content. Respondents who had not accessed the Nystagmus Information Pack (n = 111, 69.4%) reported not being aware of the resource (90%) but had already accessed nystagmus information from a wide range of sources. Poor vision was a barrier to accessing the resource for a small number of respondents (4.5%).

Conclusion: Some improvements to the content and accessibility of the Nystagmus Information Pack should be considered, in particular the format options in which it is available, to enable access in preferred formats and with poor vision. The availability of the Nystagmus Information Pack should be promoted and shared more widely, as the majority of respondents were unaware of the resource despite having an association with or interest in nystagmus.

Background: Abusive head trauma (AHT) is currently the accepted terminology that encompasses previously used terms such as non-accidental injury (NAI) or non-accidental head injury (NAHI) and shaken baby syndrome (SBS). It is AHT and its ocular manifestations that ophthalmologists are vital in identifying and reporting.

Objectives: To investigate whether there is a change in the incidence or severity of AHT pre- and during COVID-19 lockdown.

Participants and settings: AHT cases reported between March-June 2019 and March-June 2020. Data will be collected from ***** **** ********* NHS Foundation Trust.

Methods: A retrospective comparative study.

Main outcome measures: Comparison of total number of children reported to child protection services pre- and during lockdown.Severity of reported cases.Ophthalmic involvement.

Results: Of the pre-lockdown safeguarding referrals, 5/61 (8.19%) had confirmed AHT, and 4/40 (10%) of the during lockdown group were confirmed AHT. The absence of teachers was evident, as in the pre-lockdown group 40% (2) of referrals originated from schools compared to none during the lockdown period. Ophthalmic involvement was not present in any of the pre-lockdown cases and only 50% (2) of the during lockdown cases, with the appropriate proforma only used in one of these cases. Unfortunately, no further statistical testing was meaningful in light of the small sample size.

Conclusions: The loss of the early warning detection mechanism provided by schools and health visitors may have contributed to both the change in presentation and severity of cases during the lockdown. There is also a need for ophthalmology and paediatrics to collaborate to ensure AHT cases are thoroughly investigated and documented.

Background: Given the impact of visual acuity results on diagnosis and management, it is essential that the test is accurate, determined by factors such as test-retest variability. Standardisation improves accuracy, which can be performed via a computerised staircase methodology. Standard clinical tests with scoring of 0.02 per optotype implies an incremental score per optotype despite optotype size remaining constant on each line. The aim of this study is to establish if near continuous incremental optotype display and scoring improves test-retest variability compared to current testing methods.

Methods: A computerised three up, one down adaptive staircase was used to display Kay Picture optotypes on an LCD monitor. Three methods of visual acuity assessment were undertaken: ETDRS, Kay Pictures and computerised Kay Pictures. Tests were performed twice under standard clinical conditions.

Results: One hundred nineteen adults were tested. Test-retest variability for computerised Kay pictures was 0.01 logMAR (±0.04, p = 0.001). Good levels of agreement were observed for computerised Kay pictures in terms of test-retest variability, where the test had the smallest mean bias (0.01 logMAR compared to 0.03 and 0.08 logMAR for Kay Pictures and ETDRS respectively) and narrowest limits of agreement. Participants performed better in computerised Kay pictures than Kay Pictures by 0.03 logMAR, and better in ETDRS than computerised Kay pictures by 0.1 logMAR.

Conclusion: Computerised Kay pictures exhibited a low test-retest variability, demonstrating it is reliable and repeatable. This repeatability measure is lower than the test-retest variability of the ETDRS and Kay Pictures tests.

Background: Refractive, accommodative and vergence parameters and associated anomalies cause symptoms of asthenopia. Patients consult eye care practitioners mainly due to symptoms they experience. To enhance targeted treatments from various anomalies, it is relevant to study symptoms with associating anomalies.

Aim: To determine the frequencies of refractive error, accommodative and vergence anomalies, and their associations with symptoms in sample of Black South Africans.

Method: This prospective, cross-sectional study comprised consecutive participants aged 10-40 years who attended the author's optometry practice in a Black population in South Africa. Visual acuity, refraction, accommodative and vergence tests were performed. Anomalies were classified as either single measure or syndromes based on the number of failed clinical signs.

Results: Participants (n = 254) had mean age 22.6 ± 7.22 years. Ninety-four were male (37%) and 160 were female (63%). The frequencies of syndrome anomalies were accommodative insufficiency 17 [(6.6%) 95% CI 3.9-10.5%)], accommodative infacility 32 [(12.6%)] 8.7-17.3%] and convergence insufficiency 22 [(8.6%, 5.1-12.3%)]. Frequencies of coexisting anomalies were refractive error and accommodative 150 (60.0%), refractive error and vergence anomalies 136 (54.4%) and vergence and accommodative disorders 155 (62.0%). Most patients were symptomatic (70.9%). Headache was the most frequent symptom (41.1%).

Conclusion: Accommodative anomalies were more frequent than refractive error and vergence anomalies. The high frequency of anomalies suggests a high uptake of optometric services for asthenopia. Accommodative anomalies were the most symptomatic. The study highlights the need for diagnosing visual symptoms and coexisting anomalies. Establishment of validated study protocols for all accommodative and vergence anomalies is recommended.

Aim: The aim of this study was to evaluate completed cognitive screens in stroke survivors with and without visual impairment to explore whether the presence of visual impairment impacts on completion of cognitive screening.

Materials and methods: Cognitive screening assessment was undertaken using the Oxford Cognitive Screen (OCS). Data from visual function assessments (inclusive of visual acuity, visual fields, eye movements and visual perception evaluation) were analysed to determine whether presence and/or type of visual impairment impacted on cognitive screening scores achieved. Covariates, including glasses use, gender, age at stroke onset and stroke type, were used to assess confounding impacts on scores attained during cognitive screening.

Results: 1500 stroke admissions were recruited. One hundred ninety-seven who completed the OCS, were identified from the IVIS study database. Those who reported visual symptoms performed worse statistically on all cognitive tasks except the recall recognition (p = 0.232) and executive tasks (p = 0.967). Visual symptoms did not prevent participants from completing every section of the OCS (p = 0.095). In certain tasks, those not wearing their required glasses performed worse, including the executive function (p = 0.012), broken hearts and sentence reading tasks.

Conclusions: Many tasks within cognitive screening assessment are impacted by presence of visual deficits, and adjustments, where possible (e.g. good lighting, large print) should be used to facilitate completion of cognitive screening. It is important to ensure required reading correction is worn during screening.

Introduction: Virtual reality (VR) gameplay is popular with a range of games and educational resources available. However, it puts high demands on the visual system. Current evidence shows conflicting impacts on visual parameters. Therefore, this study explores the changes to vision following VR gameplay.

Methods: The study was conducted at the School of Health Sciences, University of Liverpool. All participants had binocular vision with good visual acuity and no manifest strabismus. Participants were assessed before and after playing 15 minutes of the VR game Beat Saber, which incorporated convergence and divergence movements. Clinical assessments including near point of convergence (NPC) and near point of accommodation (NPA) using the RAF rule; accommodative convergence to accommodation (AC/A) ratio; motor fusion using the prism fusion range (at 33cm), accommodation facility using +2.00/-2.00DS flipper lenses, and stereoacuity using the Frisby stereo test were assessed before and after playing.

Results: Seventy-eight participants (19-25 years old) were included in the study, with 16 males and 41 females respectively. The breakpoint of convergence reduced by 0.5 cm (p = 0.001). The binocular accommodative facility improved by 2 cycles per minute (cpm); p = 0.004. The mean, near horizontal prism fusion range (PFR) base break and recovery points both worsened by of 5.0 dioptres (p = 0.003), whereas the mean near horizontal PFR base in recovery point improved by of 4.0 dioptres (p = 0.003).

Discussion: The study validated previous findings as VR gameplay over-exercised and fatigued convergence muscles, but to a small degree. The VR experience improved the participants' ability to change focus quickly and improve accommodation, as well as the divergence function of the eye. However, as the participants were retested directly after the VR gameplay, the findings were limited to short term effects on vision.

Introduction: Nystagmus has been reported in up to 30% of people with Down Syndrome (DS), and yet is still not well understood. Our study aims to characterise the clinical features of patients with DS and nystagmus.

Methods: A retrospective medical-records review was conducted of all patients with a diagnosis of DS and nystagmus seen at Moorfields Eye Hospital over a ten-year period.

Results: Fifty-one subjects were identified, with complete data in 48. The mean age at presentation was 5.1 years (range 0-26 years). The mean binocular LogMAR visual acuity was 0.55(95%CI 0.53-0.57), mean refractive error was -1.8 Dioptre Sphere, DS (95% CI - 5.251.63) with -1.2 Dioptre Cylinder, DC (95% CI - 1.6-0.7). Ocular misalignment was found in 50% of patients. A diagnosis of Fusion Maldevelopment Nystagmus Syndrome (FMNS) was made in 6.3%, Infantile Nystagmus Syndrome (INS) in 8.4% and ABducting nystagmus/Inter-Nuclear Ophthalmoplegia (INO) in 2.1%. The descriptive term 'Manifest Horizontal Nystagmus'(MNH) was used in the majority, highlighting the difficulties in clinically differentiating the subtypes of nystagmus in DS. Eleven patients had associated cataract. Additional diagnoses unrelated to DS were made in 10.4%.

Conclusions: The most frequent type of nystagmus in our cohort was 'presumed' INS. This study highlights the importance of differentiating between FMNS and INS (with a latent component), so that further investigations can be performed as appropriate. Almost 25% had associated cataract, and a further 10% other diagnoses un-associated to DS. Despite INS being known to be associated with DS, further investigations may be required in a small subset with true INS after careful clinical assessment and use of eye movement recordings (where available).

Purpose: To describe and compare vision screening programmes and identify variance in number and type of tests used, timing of screening, personnel involved, monitoring and funding to be used as data for optimising, disinvesting or implementing future screening programmes.

Methods: A questionnaire consisting of nine domains: demography & epidemiology, administration & general background, existing screening, coverage & attendance, tests, follow-up & diagnosis, treatment, cost & benefit and adverse effects was completed by Country Representatives (CRs) recruited from 47 countries.

Results: The questionnaire was sufficiently completed for 46 Countries: 42 European countries, China, India, Malawi and Rwanda. Variation of provision was found in; age of screening (0-17 years), tests included (23), types of visual acuity (VA) test used (35 different optotypes), personnel (13), number of screens per child (median 5, range 1-32), and times VA tested (median 3, range 1-30). Infant screening is offered in all countries, whereas childhood vision screening is offered at least once in all countries, but not all regions of each country. All 46 countries provide vision screening between the ages of 3-7 years. Data on screening outcomes for quality assurance was not available from most countries; complete evaluation data was available in 2% of countries, partial data from 43%.

Conclusion: Vision screening is highly variable. Some form of VA testing is being undertaken during childhood. Data collection and sharing should be improved to facilitate comparison and to be able to optimise vision screening programmes between regions and countries.