Comparação das medidas refratométricas através da utilização do Photoscreener 2win® e da retinoscopia manual em pré-escolares assintomáticos / Comparison of refractometric measurements using 2win® Photoscreener and manual retinoscopy in asymptomatic preschoolers

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e acurácia da refratometria obtida através do aparelho photoscreener 2WIN® como método de rastreio de ametropias com indicação de prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria em crianças assintomáticas, de origem extra-hospitalar, de 6 a 36 meses de idade, e determinar se a cicloplegia influencia a capacidade de rastreio do aparelho. Métodos: Cento e setenta e oito (178) de crianças com idades entre 6 e 36 meses tiveram sua refratometria mensurada pelo método padrão-ouro, a retinoscopia manual sob cicloplegia, e pelo método em teste, o photoscreener 2WIN®, antes e após a cicloplegia. Resultados: O photoscreener 2WIN® é capaz de identificar aqueles pacientes que deveriam receber prescrição de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria com sensibilidade de 100%, especificidade de 93,18% e acurácia de 93,26%, quando comparado a retinoscopia estática. Sob cicloplegia, o 2WIN® mantém sensibilidade de 100%, porém aumenta sua especificidade para 96,59% e a acurácia para 96,63%. Conclusão: O photoscreener 2WIN® se mostrou altamente sensível, específico e acurado para uso como equipamento de triagem daqueles pacientes de 6 a 36 meses que se beneficiariam do uso de óculos pelos critérios da Sociedade Brasileira de Oftalmopediatria, com discreto aumento da especificidade e acurácia quando aplicado em pacientes cicloplegiados.

ABSTRACT Objective: Evaluate the sensitivity, specificity e accuracy of the ocular refraction measured by the 2WIN® photoscreener as a screening method to identify children in need of spectacles prescription according to the criteria published by the Brazilian Society of Pediatric Ophthalmology (BSPO) in asymptomatic children, 6 to 36 months old, and determine the impact of cycloplegia in the sensitivity, specificity and accuracy of this method. Methods: One hundred seventy-eight (178) eyes of asymptomatic children between the ages of 6 and 36 months have been submitted to ocular refraction measurements by the gold-standard method, the manual retinoscopy under cycloplegia, and the method been tested, the 2WIN® photoscreening, both before and under cycloplegia. Results: The 2WIN® photoscreener before cycloplegia was able to identify those patients in need of spectacles prescription according to the criteria published by the BSPO with 100% sensitivity, 93.18% specificity and 93.26% accuracy, when compared to the manual retinoscopy under cycloplegia. The 2WIN® photoscreener under cycloplegia maintained a sensitivity of 100%, but increased specificity to 96.59% and accuracy to 96.63%. Conclusion: The 2WIN® photoscreener before cycloplegia showed high sensitivity, specificity, and accuracy in detection of patients in need of spectacles prescription according to the criteria published by the BSPO in the tested population, with minor increase in specificity and accuracy when the measurements were performed under cycloplegia.

Anterior chamber depth and axial length affect clinical performance of Spot Vision Screener / A profundidade da câmara anterior e o comprimento axial afetam o desempenho clínico do Spot Vision Screener

ABSTRACT Purpose: The aim of this study was to evaluate the effect of anterior chamber depth and axial length on clinical performance of the Spot Vision Screener in detecting amblyopia risk factors in children aged 3-10 years. Methods: A total of 300 eyes from 150 patients aged 3-10 years were prospectively tested with Spot Vision Screener (firmware version 3.0.02.32, software version 3.0.04.06) and a standard autorefractometer (Nidek ARK-1). The anterior chamber depth and axial length were measured with an optical biometer (Nidek AL-Scan). The sensitivity and specificity values for detecting significant refractive errors using the referral criteria of the American Association for Pediatric Ophthalmology and Strabismus were determined. Pearson's correlation analysis was employed to evaluate the relationship between the Spot Vision results and the anterior chamber depth and axial length. Results: Compared with the standard autorefractometer results, the Spot Vision Screener's sensitivity and specificity was 59% and 94%, respectively. The differences between the cycloplegic autorefractometer and the Spot Vision Screener spherical equivalents were negatively correlated with anterior chamber depth (r=-0.48; p<0.001) and axial length (r=-0.45; p<0.001). Conclusion: The Spot Vision Screener has moderate sensitivity and high specificity, using the criteria of the American Association for Pediatric Ophthalmology and Strabismus. The anterior chamber depth and axial length affect the Spot Vision results.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o efeito da profundidade da câmara anterior e do comprimento axial sobre o desempenho clínico do Spot Vision Screener, na deteção de fatores de risco para a ambliopia em crianças de 3 a 10 anos de idade. Métodos: Um total de 300 olhos de 150 pacientes de 3-10 anos de idade foram prospectivamente testados com o Spot Vision Screener (firmware: 3.0.02.32, software: 3.0.04.06) e com autorefratómetro padrão (Nidek ARK-1). Todas as medições de profundidade e comprimento axial da câmara anterior dos pacientes foram realizadas através de Nidek AL Scan. A sensibilidade e especificidade para a deteção de erros refrativos significativos foram determinadas de acordo com os critérios de referência da Associação Americana de Oftalmologia e Estrabismo Pediátricos. A análise da Correlação de Pearson foi utilizada para avaliar a correlação entre os resultados do Spot Vision e a profundidade ou comprimento axial da câmara anterior dos pacientes. Resultados: Em comparação com os resultados do autorefratómetro padrão, a sensibilidade do Spot foi de 59% e a especificidade de 94%. As diferenças entre os equivalentes esféricos do autorefratómetro cicloplégico e o Spot Vision Screener foram correlacionados negativamente com a profundidade (r=-0,48; p<0,001) e o comprimento axial (r=-0,45; p<0,001) da câmara anterior dos casos. Conclusão: O Spot Vision Screener possui uma sensibilidade moderada e uma especificidade elevada utilizando os critérios da Associação Americana de Oftalmologia Pediátrica e Estrabismo; a profundidade da câmara anterior e o comprimento axial dos pacientes afetam os resultados do Spot Vision.

Neurite óptica secundária a infecção pelo Chikungunya Vírus / Optic neuritis secondary to chikungunya virus infection

RESUMO Apresentamos um caso de um paciente de 46 anos, sexo masculino com diagnóstico de neurite ótica em olho direito associado a infecção aguda por Chikungunya. Os sintomas iniciais eram dor e baixa acuidade visual em olho direito associado a febre e poliartralgia simétrica há uma semana. Ao exame a acuidade visual era de 20/60 em olho direito e 20/20 em olho esquerdo, fundoscopia evidenciou edema de papila à direita. Foi iniciado imediatamente pulsoterapia com metilprednisolona por 7 dias e foi observada melhora do quadro de neurite no seguimento de 1, 3 e 12 meses, porém melhora parcial da acuidade visual, Dentre as causas investigadas identificou-se sorologia anti Chikungunya IgM positivo.

ABSTRACT We present a case of optic neuritis secondary to Chikungunya virus infection. Male, 46 yo, initial symptoms were pain and low visual acuity in the right eye associated to fever and symmetrical polyarthralgia one week ago. At the examination the visual acuity was 20/60 in the right eye and 20/20 in the left eye, fundoscopy showed papillo edema on the right eye. Immediately initiated pulse therapy with methylprednisolone for 7 days and improvement of the neuritis was observed in the follow-up of 1, 3 and 12 months, but partial improvement of the visual acuity. Among the investigated causes, Chikungunya IgM positive serology was identified.

Components of the item selection algorithm in computerized adaptive testing / 보건의료교육평가

Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items with the difficulty level that is most relevant to each individual test taker. This paper explains the 3 components of a conventional CAT item selection algorithm: test content balancing, the item selection criterion, and item exposure control. Several noteworthy methodologies underlie each component. The test script method and constrained CAT method are used for test content balancing. Item selection criteria include the maximized Fisher information criterion, the b-matching method, the a-stratification method, the weighted likelihood information criterion, the efficiency balanced information criterion, and the Kullback-Leibler information criterion. The randomesque method, the Sympson-Hetter method, the unconditional and conditional multinomial methods, and the fade-away method are used for item exposure control. Several holistic approaches to CAT use automated test assembly methods, such as the shadow test approach and the weighted deviation model. Item usage and exposure count vary depending on the item selection criterion and exposure control method. Finally, other important factors to consider when determining an appropriate CAT design are the computer resources requirement, the size of item pools, and the test length. The logic of CAT is now being adopted in the field of adaptive learning, which integrates the learning aspect and the (formative) assessment aspect of education into a continuous, individualized learning experience. Therefore, the algorithms and technologies described in this review may be able to help medical health educators and high-stakes test developers to adopt CAT more actively and efficiently.

Primeiros 5 anos de Implementação do Programa de Rastreio de Retinopatia Diabética no Centro Hospitalar do Porto / First 5 years of Implementation of Diabetic Screening Program in Centro Hospitalar do Porto

Resumo Objetivo: Caracterizar a população de diabéticos referenciados à consulta de Oftalmologia do Centro Hospitalar do Porto (CHP) através do programa de rastreio da ARS Norte, avaliar este tipo de método de rastreio e perceber o impacto do mesmo na dinâmica de um Serviço de Oftalmologia. Métodos: Avaliação retrospectiva dos processos clínicos dos utentes diabéticos referenciados à consulta de Rastreio de Retinopatia Diabética (RD) do CHP através do programa de rastreio da ARS Norte, entre Janeiro de 2012 e Dezembro de 2016. As variáveis analisadas foram: dados demográficos, duração e tipo de Diabetes Mellitus (DM), seguimento prévio em consulta de oftalmologia, tipo de retinopatia diabética e orientação subsequente. Resultados: Dos 613 doentes diabéticos observados nesta consulta 2.6% tinham DM tipo 1 e 97.4% tinham DM tipo 2, com duração média da doença de 15.8 anos e 6.6% não apresentava lesões de RD em qualquer um dos olhos; lesões de RD não proliferativa estavam presentes em 90.7% dos doentes, sendo bilaterais em 83.7% dos casos e 2.7% apresentava lesões de RD proliferativa em ambos os olhos. No momento da consulta, 31.9% apresentava maculopatia, em pelo menos um dos olhos. 51,1% dos doentes tinha no momento da consulta indicação para tratamento; 15.2% integraram a consulta de diabetes ocular do CHP por necessidade de vigilância e 33.7% tiveram alta para reintegrarem este programa de rastreio. Conclusões: O programa de rastreio de RD apresenta-se como uma ferramenta útil e necessária no diagnóstico precoce e tratamento atempado das lesões de RD.

Abstract Purpose: To characterize the population of diabetics referred to the Ophthalmology Department of the Centro Hospitalar do Porto (CHP) from the screening program of ARS Norte, to evaluate this type of screening method and to perceive the its impact in the dynamic of an Ophthalmology Department. Methods: Retrospective evaluation of the clinical processes of diabetic patients referred to the CHP Diabetic Retinopathy (DR) Screening Consultation from the ARS Norte screening program, between January 2012 and December 2016. The variables analyzed were demographic data, duration and type of Diabetes Mellitus (DM), previous follow-up in ophthalmology consultation, type of diabetic retinopathy and subsequent orientation. Results: Of the 613 diabetic patients observed in our Department referred from this program, 2.6% had type 1 DM and 97.4% had type 2 DM, with a mean illness duration of 15.8 years. 6.6% had no lesions of DR in any of the eyes. Non-proliferative DR lesions were present in 90.7% of the patients, being bilateral in 83.7% of the cases and 2.7% had proliferative DR lesions in both eyes. At the time of the consultation, 31.9% had maculopathy in at least 1 of the eyes. 51.1% of the patients had indication for treatment at the time of the referral. 15.2% were integrated in ocular diabetes section of CHP due to the need for surveillance and 33.7% were discharged to reintegrate this screening program. Conclusions: The DR screening program is a useful and necessary tool for the early diagnosis and early treatment of DR lesions.

Cycloplegic Refraction in Hyperopic Children: Effectiveness of a 0.5% Tropicamide and 0.5% Phenylephrine Addition to 1% Cyclopentolate Regimen

PURPOSE: To evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children. METHODS: The medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens. RESULTS: A total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia. CONCLUSIONS: The Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.

The impacts of computer adaptive testing from a variety of perspectives / 보건의료교육평가

Computer adaptive testing (CAT) is a kind of tailored testing, in that it is a form of computer-based testing that is adaptive to each test-taker's ability level. In this review, the impacts of CAT are discussed from different perspectives in order to illustrate crucial points to keep in mind during the development and implementation of CAT. Test developers and psychometricians often emphasize the efficiency and accuracy of CAT in comparison to traditional linear tests. However, many test-takers report feeling discouraged after taking CATs, and this feeling can reduce learning self-efficacy and motivation. A trade-off must be made between the psychological experiences of test-takers and measurement efficiency. From the perspective of educators and subject matter experts, nonstatistical specifications, such as content coverage, content balance, and form length are major concerns. Thus, accreditation bodies may be faced with a discrepancy between the perspectives of psychometricians and those of subject matter experts. In order to improve test-takers' impressions of CAT, the author proposes increasing the target probability of answering correctly in the item selection algorithm even if doing so consequently decreases measurement efficiency. Two different methods, CAT with a shadow test approach and computerized multistage testing, have been developed in order to ensure the satisfaction of subject matter experts. In the shadow test approach, a full-length test is assembled that meets the constraints and provides maximum information at the current ability estimate, while computerized multistage testing gives subject matter experts an opportunity to review all test forms prior to administration.

Accuracy of three common optometry methods in examination of refraction in juveniles / 中南大学学报(医学版)

OBJECTIVE@#To compare the results of the three methods of Suresight handheld autorefractor, table-mounted autorefractor and retinoscopy in examination of juveniles patients with or without cycloplegia.
@*METHODS@#Firstly, 156 eyes of 78 juveniles (5 to 17 years old) were examined by using WelchAllyn Suresight handheld autorefractor and NIDEK ARK-510A table-mounted autorefractor with or without cycloplegia; secondly, retinoscopy was performed with cycloplegia.
@*RESULTS@#The spherical power measured by methods without cycloplegia were significantly greater than those measured with cycloplegia (P0.05). These results were highly consistent, suggesting a tendency towards a short sight. However, the spherical power and cylindrical power measured by table-mounted autorefractor was significantly different (P<0.05); with cycloplegia, there was significant difference in spherical power between Suresight handheld autorefractor and retinoscopy (P<0.05).
@*CONCLUSION@#Cycloplegic retinoscopy is necessary for juvenile refraction examination. Under natural pupil situation, Suresight handheld autorefractor is better than table-mounted autorefractor, though both show a myopia tendency. Nevertheless, table-mounted autorefractor can be taken as a recommendation for the prescription of lens trial. As a strong reference for subjective optometry, retinoscopy should be the gold standard for measuring refractive errors.

Oil Droplet Cataract: Cause of Decreased Vision of Unknown Etiology

PURPOSE: To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology. METHODS: We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated. RESULTS: Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher. CONCLUSIONS: Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs.

Comparison of Manifest Refraction and Cycloplegic Refraction Using Retinoscopy or an Autorefractor in Children

PURPOSE: To compare the measurements between manifest refraction and cycloplegic refraction using retinoscopy or an autorefractor in children and to investigate factors affecting the difference. METHODS: A total of 388 children with a mean age of 7.4 ± 3.6 years were examined using retinoscopy and a Grand Seiko GR-3500KA autorefractor before and after cycloplegia. We compared the difference in spherical and cylindrical components between refractions and analyzed the results according to gender, age, type of refractive error, amblyopia, strabismus, and neuro-developmental disorder. A difference in refractions of ±0.50 D or more was considered as a significant discrepancy. RESULTS: Before cycloplegia, the spherical portion of the refractive error via autorefractor measurement was more myopic than for the retinoscopic measurement in 47.2% of patients, and the cylindrical portion was greater in 37.1%. The spherical discrepancies were more common in children aged < 7 years, with hyperopia, or amblyopia (respectively, p = 0.002, p < 0.001, and p = 0.033). After cycloplegia, the spherical component of the refractive error by auto-refraction differed from retinoscopic measurement in 29.4% of patients, and the cylindrical portion differed in 30.7%. However, the difference was not significant and there was no difference according to clinical features. More than half of the children with discrepancies in the spherical component between retinoscopic refractions before and after cycloplegia had a discrepancy between auto-refraction and retinoscopic refraction before cycloplegia, and the two discrepancies had a significant correlation. CONCLUSIONS: Auto-refraction after cycloplegia can estimate retinoscopic values partially. Nevertheless, 30% of the children still showed a discrepancy. The discrepancy of manifest refraction or auto-refraction compared to retinoscopic refraction with cycloplegia should be considered in younger children, cases with hyperopia or amblyopia, and cases with a difference in auto-refraction and retinoscopic refraction before cycloplegia.

Comparison of the Refractive Measurements with Hand-held Autorefractometer, Table-mounted Autorefractometer and Cycloplegic Retinoscopy in Children

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.

Comparison of the Refractive Measurements with Hand-held Autorefractometer, Table-mounted Autorefractometer and Cycloplegic Retinoscopy in Children

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.

Reliability and Usefulness of Refractive Measurements by PlusoptiX S09 in Children

PURPOSE: To compare the refractive measurements obtained using a photorefractor (PlusoptiX S09, PlusoptiX GmbH, Germany) with those obtained using cycloplegic refraction in children. METHODS: We assessed the refractive status of 268 eyes in 134 children. The values acquired via photorefraction with a PlusoptiX S09 device were compared with those obtained by cycloplegic retinoscopy. Hyperopia (> or =+3.5 D), myopia (> or =-3.0 D), with the rule or against the rule astigmatism (> or =-1.5 D), and oblique astigmatism (> or =-1.0 D) were set as diagnostic criteria for refractive amblyopia risk factors (RARFs). The difference in the detection of RARFs by the two methods was the main outcome measure. RESULTS: The average spherical refractive power was -0.81 +/- 1.68 D for PlusoptiX S09 versus -0.26 +/- 2.00 D for cycloplegic retinoscopy (average difference -0.54 +/- 0.61 D; p < 0.001). The average spherical equivalent was -1.20 +/- 1.62 D for PlusoptiX S09 versus -0.64 +/- 1.94 D for cycloplegic retinoscopy (average difference -0.56 +/- 0.62 D; p < 0.001). The average cylinder power was -0.79 +/- 0.93 D for PlusoptiX S09 versus -0.76 +/- 0.94 D for cycloplegic retinoscopy (average difference -0.03 +/- 0.33 D; p = 0.135). Even though cycloplegic retinoscopy is considered the gold standard, the sensitivity and specificity for detecting RARFs with the PlusoptiX S09 were 88.0% and 96.3%, respectively. CONCLUSIONS: PlusoptiX S09 is a relatively useful method for detecting RARFs, but the device tends toward myopic shift compared to cycloplegic refraction, and hyperopia is underestimated.

Precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial / Accuracy limits of retinoscopy without neutralising lenses for evaluation of experimental hypermetropia in a model eye

OBJETIVO: Avaliar a acurácia e a precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial. MÉTODOS: Observação da projeção da faixa do retinoscópio em olho artificial preparado para apresentar hipermetropias de +1,00 D a +8,00 D. A movimentação da faixa é feita simultaneamente com a variação da sua largura, deslocando a luva do retinoscópio até a obtenção da neutralização do movimento. O retinoscópio foi preparado para dois modos de medida: com escala milimétrica sob a luva e com acoplamento a potenciômetro ligado a multímetro de leitura digital em ohms (Ù). Oito médicos oftalmologistas realizaram 1200 retinoscopias em cada modo de medida, num total de 2400. Calculou-se a média e o desvio padrão das observações. Para comparar os resultados em mm e em ohms (Ù) calculou-se o coeficiente de variação (CV) a partir dos desvios padrão das observações em cada modo. RESULTADOS: Pelos modos descritos foi possível estimar hipermetropias até +4,00 dioptrias. CONCLUSÃO: A acurácia e a reprodutibilidade experimentais foram boas na identificação de hipermetropias até +4 ,00 D.

OBJECTIVE: Evaluate accuracy and reproducibility of streak retinoscopy without neutralising lenses in experimental hyperopia of an artificial eye. METHODS: Observe a Welsh Allynretinoscope streak through the pupil of an artificial eye prepared do show hyperopia from +1,00 D to +8,00 D. The streak was moved while varying its width by sliding the sleeve upwards until neutralisation point. The retinoscope was fitted either with a millimetre scale under the sleeve or with a multimetre connected to a rheostat driven by a spool snugly fastened around the sleeve. Multimetre readings were taken in ohms (Ù). Eight ophthalmologists performed 1200 in each mode totalysing 2400 readings. Average and standard deviation of the readings in each mode were determined, as well as the variation coefficient in order to allow comparison of results in millimetre and Ù. RESULTS: Based on the proposed method it was possible to estimate hyperopia up to +4,00 D. CONCLUSION: Accuracy and reproducibility in experimental hyperopia of an artificial eye was feasible up to +4,00 D.

Síndrome de Down: epidemiologia e alterações oftalmológicas / Down syndrome: epidemiology and ophthalmologic changes

OBJETIVO: O objetivo do projeto de pesquisa é determinar a incidência das alterações oftalmológicas de crianças com a Síndrome de Down, as quais foram atendidas no Ambulatório de Especialidades Jardim Peri-Peri, no período de 7 de julho 2004 a 14 de outubro de 2009. MÉTODOS: Neste trabalho empregou-se um estudo observacional retrospectivo dos prontuários de 35 crianças com Síndrome de Down, 15 do sexo feminino e 20 do masculino, da raça branca e com 2 meses de idade. Os pacientes, no período em estudo, foram submetidos à avaliação oftalmológica que incluiu: -inspeção ocular; retinoscopia; biomicroscopia; mapeamento de Retina; teste de Milder; teste de observação da fluoresceína na orofaringe (TOFO). RESULTADOS: As crianças deste estudo foram examinadas desde 2 meses de idade e acompanhadas anualmente. As alterações oftalmológicas encontradas nas 35 crianças com a Síndrome de Down foram: fissura palpebral oblíqua em 100%, epicanto em 70%, vasos supranumerários nas arcadas ao exame de mapeamento de retina em 100%,manchas de Brushfield em 48,57% ,blefarite em 42,85%, obstrução da via lacrimal excretora em 25,71%, miopia em 14,28%, astigmatismo em 14,28%, ambliopia em 2,85%, estrabismo convergente em 11,42%, estrabismo divergente em 5,71%, nistagmo em 2,85%, ectrópio em 5,71%, catarata congênita em 2,85%. CONCLUSÃO: Neste trabalho verificou-se a alta incidência de patologias oftalmológicas em crianças com a síndrome de Down, tais como: blefarites, obstrução da via lacrimal excretora, erros refracionais, estrabismos e catarata etc. As alterações oftalmológicas são muito importantes para alertar os pais das crianças com síndrome de Down, quanto ao seu tratamento precoce proporcionando melhora na acuidade visual e no desenvolvimento neuropsicomotor dessas crianças.

PURPOSE: The research project goal is to determine the incidence of ophthalmologic changes in children with Down syndrome who were attended in Peri-Peri Health Center, from july 07, 2004 to october 14, 2009. METHODS: This is an observational retrospective study of 35 children medical records with Down's Syndrome who were attended in Peri-Peri Health Center.The patients were submitted to ophthalmologic exams including: ocular inspection; retinoscopy; biomicroscopy; indirect ophthalmoscopy; fluorescein disappearance test; observation test of fluorescein in the oropharynx. RESULTS: The children of this study were examined since 2 months of age. The ophthalmologic changes found in the 35 children with Down Syndrome was: oblique eyelid in 100%, epicanto in 70%, supernumerary vessels in the arcades in the retina exam in 100%, Brushfield spot in 48.57%, blefarity in 42.85%, congenital lacrimal obstruction in 25.71%, miopy in 14.28%, astigmatismy in 22.28%, esotropia in 11.42%, exotropia in 5.71%, nystagmus in 2.85%, ectropion in 5.71% and congenital cataract in 2.85%. CONCLUSION: This study found a lot of ophthalmologic diseases in children with Down's syndrome: blefarity, congenital nasolacrimal duct obstruction, etc. Therefore the follow-up of these children is very relevant.

Dynamic distance direct ophthalmoscopy, a novel technique to assess accommodation in children.

Aim: To describe and compare dynamic distance direct ophthalmoscopy (DDDO) with dynamic retinoscopy (DR) in assessment of accommodation in children. Materials and Methods: This prospective observational study had four components. Component 1: to understand the characteristic digital images of DDDO. Component 2: to compare DDDO with DR for detection of accommodative defects in children (1–16 years). Component 3: to compare DDDO with DR for the detection of completeness of pharmacologically induced cycloplegia in children (5–16 years) and Component 4: to assess which one of the two techniques was more sensitive to detect onset of cycloplegia after instillation of 1% cyclopentolate eye drops. Results: Component 1: image analysis of DDDO on two subjects (7 years and 35 years) demonstrated superior pupillary crescent that progressively disappeared with increasing accommodation. Concurrently an inferior crescent appeared that became bigger in size with increasing accommodation. Component 2: the prevalence of defects in accommodation was 3.3% (33/1000 children). Three had unilateral accommodation failure. Sensitivity of DDDO was 94%, specificity 100%, positive predictive value 100%, negative predictive value 99%, and clinical agreement (kappa) 0.97. Component 3: in the detection of completeness of pharmacologically induced cycloplegia (n=30), the sensitivity of DDDO was 94%, specificity 96%, positive predictive value 97%, negative predictive value 93% and kappa 0.9. DR had two false positives. DDDO had one false negative. Component 4: DDDO detected onset of pharmacologically induced cycloplegia 5 min earlier than DR (n=5). Conclusion: DDDO is a novel, simple, clinical and reliable method to assess accommodation in young children. This test can assess the accommodative response of both eyes simultaneously.

Concordancia interobservadores en retinoscopía estática entre docentes y estudiantes de optometría de una institución universitaria de Bogotá, Colombia / Inter-observer agreement of a static retinoscopy study between optometry teachers and college students at an institution in Bogota, Colombia

Introducción: los docentes de optometría al evaluar estudiantes aceptan una diferencia de ±0,50D en la retinoscopía, pero no se ha valorado estadísticamente si es adecuado para ametropías bajas y altas. El objetivo fue comparar la concordancia interobservadores en retinoscopía entre docentes y estudiantes para ametropías altas y bajas. Metodología: estudio de concordancia entre 4 observadores en 40 ojos; 20 con ametropías altas y 20 con bajas, y muestreo no probabilístico por conveniencia. Análisis estadístico con coeficiente de correlación intraclase y método gráfico de límites al 95%. Resultados: concordancia en el equivalente esférico entre cuatro examinadores 0,78; defectos bajos 0,86 y altos 0,67. Margen de error entre docentes ±0,87D y estudiantes ±3,15D. En defectos bajos ±0,61D para docentes y ±0,80D para estudiantes y en defectos altos ±1,10D y ±4,22D respectivamente. Conclusión: hubo mayor confiabilidad en retinoscopía entre docentes. Se debenformular estrategias de enseñanza que permitan reducir los márgenes de errorobtenidos.

Introduction: optometry teachers to assess students, accept a difference of ±0,50D in the retinoscopy but have not statistically evaluated, whether it is suitable for low and high ametropias.The objective of this study was to compare the interobserver agreement between optometry teachers and students in a study of static retinoscopy for high and low refractive errors. Methods: agreement study between 4 observers in 40 eyes, 20 with high and 20 with low refractive errors. Convenience non-probability sampling was performed.Statistical analysis performed with the intra-class correlation coefficient andgraphical method of 95% limits of agreement. Results: concordance in spherical equivalent between four examiners was 0.78, 0.86 for low defects and 0.67 for high errors. Margin of error between teachers was ±0.87D and students ±3.15D. In low defects was ±0.61D for teachers and ±0.80D for students and in high defects ±1.10D and ±4.22D, respectively. Conclusions: retinoscopy reliability was higher among teachers. Teaching strategies should be formulated to allow a reduction in the obtained margins of error.

Progress of research in retinal image registration / 生物医学工程学杂志

The retinal image registration has important applications in the processes of auxiliary diagnosis and treatment for a variety of diseases. The retinal image registration can be used to measure the disease process and the therapeutic effect. A variety of retinal image registration techniques have been studied extensively in recent years. However, there are still many problems existing and there are numerous research possibilities. Based on extensive investigation of existing literatures, the present paper analyzes the feature of retinal image and current challenges of retinal image registration, and reviews the transformation models of the retinal image registration technology and the main research algorithms in current retinal image registration, and analyzes the advantages and disadvantages of various types of algorithms. Some research challenges and future developing trends are also discussed.

Accommodative spasm in siblings: A unique finding.

Accommodative spasm is a rare condition occurring in children, adolescents, and young adults. A familial tendency for this binocular vision disorder has not been reported. I describe accommodative spasm occurring in a brother and sister. Both children presented on the same day with complaints of headaches and blurred vision. Treatment included cycloplegia drops and bifocals. Siblings of patients having accommodative spasm should receive a detailed eye exam with emphasis on recognition of accommodative spasm.

Effect of rapid decompression on rat multifocal electroretinogram / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the effect of rapid decompression on rat multifocal electroretinogram (mfERG) and to explore the characteristics of the retinal function impairment due to decompression sickness at early stage.</p><p><b>METHODS</b>Twenty rats were randomly divided into 4 groups: normal control (NC) group, safe decompression (SD) group, 0 h and 6 h after rapid decompression (RD0 and RD6) groups. The treated rats in safe decompression group and each rapid decompression group were exposed in hyperbaric cabin and air pressure in the cabin rose up to 1.0 MPa in 30 s and lasted for 5.5 min. The pressure decreased to normal pressure in 55 s as for the treatment of rapid compression while air pressure of safe decompression decreased to normal pressure according to an animal safe decompression protocol. The mfERG parameters of one eye each rat were recorded by RETIscan 3.15 system.</p><p><b>RESULTS</b>Rapid decompression increased noise, delayed latent period and reduced amplitude in mfERG. The topographic map showed that the P1 wave response density in RD0 group was lower than that in NC and SD groups and higher than that in RD6 group in peripheral regions. The amplitudes of sum response density in NC, SD, RD0 and RD6 groups were (71.1 ± 7.5), (53.6 ± 9.3), (38.2 ± 13.1) and (18.4 ± 7.7) µV, respectively, and there was statistical difference among them (F = 17.313, P < 0.01). The P1 wave response densities of RD0 and RD6 groups were lower than that of NC group in 4 quadrants (P < 0.05) and the P1 wave amplitudes of RD0 and RD6 groups decreased in supranasal and supratemporal quadrants (P < 0.05). The P1 wave amplitudes of RD0 and RD6 groups were less than these of NC and SD groups in supranasal and supratemporal quadrants (P < 0.05). In 5 rings, the response densities of RD0 and RD6 groups were lower than these of NC and SD groups (P < 0.05) and the P1 and N1 wave amplitudes were less than these of NC and SD groups (P < 0.05). The P1 and N1 wave amplitudes of RD6 group were lower than those of RD0 group (P < 0.05).</p><p><b>CONCLUSION</b>Rapid decompression can cause characteristic changes of mfERG and the major involved parts are superior retina and juxtaprepapillary region.</p>