Effects of brightness variations on a smartphone-based version of Radner reading charts.

OBJECTIVE: The purpose of this study was to evaluate the equivalence of smartphone-based measurements of near visual acuity under different screen brightness conditions with a standard near visual acuity test. METHODS: On a sample of 85 participants, we have evaluated near visual acuity with a smartphone-based version of the Radner reading chart at three distinct screen brightness levels. Results have been compared with those obtained with classical Radner paper charts. RESULTS: We have found that, when a sufficient screen brightness is employed, the smartphone-based version of the Radner reading chart produces results that are in line with the paper Radner charts while low brightness levels lead to a significant underestimation of reading acuities. This result was consistent across different refractive conditions. CONCLUSIONS: In conclusion, we have shown that handheld devices, such as smartphones, can be potentially exploited for remote measurements of near visual acuity provided a correct control of brightness screen is employed.

Translation and validation of convergence insufficiency symptom survey to Italian: Psychometric results

Purpose This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). Methods The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. Results The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting –0,81 logits but also some evidence of multidimensionality. Conclusions The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly...(AU)

Viewing distance and character size in the use of smartphones across the lifespan.

The use of smartphones has seen an extraordinary growth in recent years, thus the understanding of visual habits associated with the use of such devices across the lifespan is becoming important. In the present study we measured viewing distance and character size in a group of non-presbyopes (n = 157) and a group of presbyopes (n = 60) while participants read a simple text message on their smartphone. Results showed that non-presbyopes use shorter viewing distances as compared to presbyopes, a behavior causing a significantly higher accommodative demand. Presbyopes also use larger character sizes and this behavior is more evident whenever difficulties in near vision emerge in the Near Activity Visual Questionnaire (NAVQ, Italian version). Nevertheless, the two groups did not differ in the measurement of angular size subtended by the smallest detail of the letters. Overall, our data reveal that non-presbyopes and presbyopes have different visual habits when using a smartphone. These differences should be considered when determining the best near correction.

Translation and validation of convergence insufficiency symptom survey to Italian: Psychometric results.

PURPOSE: This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). METHODS: The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. RESULTS: The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting -0,81 logits but also some evidence of multidimensionality. CONCLUSIONS: The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly. The CISS_I can help in interpreting and monitoring convergence insufficiency symptoms in already identified subjects, but it is not suitable for screening a general population of young adults.

Self-reported symptoms of mask-associated dry eye: A survey study of 3,605 people.

PURPOSE: During the COVID-19 pandemic, the widespread use of face masks was recommended as a key measure against the spread of SARS-CoV-2. A marked increase in dry eye symptoms among regular mask users was reported, but the prevalence of this condition has not been described in the literature yet. The aim of this observational, descriptive, and cross-sectional study was to measure self-reported symptoms of mask-associated dry eye in the general population and to identify factors influencing this condition. METHODS: An anonymous online survey was distributed using Google Forms through different social media platforms. RESULTS: A total of 3,605 surveys were analysed. Of the 2,447 having symptoms, 658 (26.9 %) participants reported their symptoms were exacerbated when wearing a mask, thus 18.3 % of all participants experienced mask-associated dry eye. There was no significant association between perceived mask-associated dry eye and age, refractive correction, and pre-existing ocular discomfort, while a positive association was observed with female sex and retail work. CONCLUSIONS: Although the results of this survey showed that most people reported no change in ocular symptoms while wearing a face mask, a significant proportion reported an increase in ocular discomfort when wearing a face mask. As face masks are necessary to slow down the spread of COVID-19, it is important not to underestimate all symptoms that could discourage the population from using them. Eye care professionals should verify the presence of clinical signs in all patients complaining about mask-induced eye discomfort, and suggest methods to mitigate this condition.

Italian translation, validation, and repeatability of Standard Patient Evaluation of Eye Dryness (SPEED) Questionnaire.

PURPOSE: The assessment of symptoms of dry eye disease using a questionnaire is an effective and simple method of quantifying symptoms. The aim of this study was to translate the SPEED questionnaire and adapt it for the Italian language and verify the main psychometric performance of the translated version, including repeatability and agreement. METHODS: The SPEED questionnaire was translated into Italian following a standard methodology. The resulting questionnaire was administered to 206 adult participants in order to perform a validation analysis. A subgroup of 82 participants was retested after one week to give a repeatability and agreement assessment. RESULTS: Internal consistency showed an alpha of 0.852 (95% CI 0.818-0.881) and no unnecessary items. The factor analysis showed a saturation for three main factors related to (i) Dryness and Soreness, (ii) Fatigue, and (iii) Burning. Repeatability was high, with a CCC of 0.896 (95% CI 0.844-0.931). Agreement analysis showed no significant bias between sessions and an interval of agreement of 5 points for SPEED score. CONCLUSION: The translation and adaptation of the SPEED questionnaire for the Italian language have demonstrated good psychometric properties for the translated questionnaire, confirming and expanding the original psychometric characteristics. Consequently, the SPEED questionnaire could be used to measure the presence of symptoms of dry eye quantitatively.

Viewing distance of smartphones in presbyopic and non-presbyopic age

Purpose: The aim of this cross-sectional observational study was to measure habitual viewing distance with smartphones in individuals of different ages, and to identify factors influencing viewing distance.MaterialGender, reading position, forearm length, ametropia, correction modality, and near vision quality were investigated as factors affecting viewing distance. Participants were asked to read a typical text message on their own smartphone, while sitting and standing. A total of 233 subjects (129 females and 104 males), aged from 16 to 90 years old, were included and divided in two groups: 131 non-presbyopes (median 21.1, range 16 − 39), and 102 presbyopes (median 54.5, range 42 − 90).ResultsMean viewing distance was 36.1 ± 7.2 cm while sitting, and 37.4 ± 6.8 cm while standing (P < 0.05), and 36.8 +/- 6.6 cm overall. The average viewing distance was 35.0 ± 6.4 cm in non-presbyopes, and 39.0 ± 6.1 cm in presbyopes (P < 0.05). The average viewing distance was 34.7 ± 6.2 cm in females, and 38.2 ± 6.3 cm in males (P <  0.001).ConclusionsSignificant differences between males and females were observed, due to the different average body size between the two gender groups. Average viewing distance with smartphones in presbyopes matched approximately to the typical near reading distance of 40 cm. In the non-presbyopic group, the accommodative demand when reading a smartphone was slightly higher than in the presbyopic group. High variability was observed in both age groups, without a statistically significant correlation with other assessed factors as reading position, ametropia, correction modality, and near vision quality. (AU)

Viewing distance of smartphones in presbyopic and non-presbyopic age.

PURPOSE: The aim of this cross-sectional observational study was to measure habitual viewing distance with smartphones in individuals of different ages, and to identify factors influencing viewing distance. MATERIAL: Gender, reading position, forearm length, ametropia, correction modality, and near vision quality were investigated as factors affecting viewing distance. Participants were asked to read a typical text message on their own smartphone, while sitting and standing. A total of 233 subjects (129 females and 104 males), aged from 16 to 90 years old, were included and divided in two groups: 131 non-presbyopes (median 21.1, range 16 - 39), and 102 presbyopes (median 54.5, range 42 - 90). RESULTS: Mean viewing distance was 36.1 ±â€¯7.2 cm while sitting, and 37.4 ±â€¯6.8 cm while standing (P < 0.05), and 36.8 +/- 6.6 cm overall. The average viewing distance was 35.0 ±â€¯6.4 cm in non-presbyopes, and 39.0 ±â€¯6.1 cm in presbyopes (P < 0.05). The average viewing distance was 34.7 ±â€¯6.2 cm in females, and 38.2 ±â€¯6.3 cm in males (P <  0.001). CONCLUSIONS: Significant differences between males and females were observed, due to the different average body size between the two gender groups. Average viewing distance with smartphones in presbyopes matched approximately to the typical near reading distance of 40 cm. In the non-presbyopic group, the accommodative demand when reading a smartphone was slightly higher than in the presbyopic group. High variability was observed in both age groups, without a statistically significant correlation with other assessed factors as reading position, ametropia, correction modality, and near vision quality.

An Italian Translation and Validation of the near Activity Visual Questionnaire (NAVQ).

PURPOSE: To validate the Near Activity Vision Questionnaire (NAVQ) in Italian to allow the assessment of presbyopia corrections in Italian-speaking patients. METHODS: An Italian version of the NAVQ was arranged through several steps: an initial forward translation (from English to Italian), a backward translation (from Italian to English), and finally a consensual version to check against the original NAVQ. This prospective study enrolled native Italian-speaking presbyopic patients with corrected distance visual acuity of 0.20 logMAR or better in each eye and free of ocular anomalies. Six different groups of patients were asked to complete the questionnaire: emerging presbyopic patients, reading spectacle users, multifocal spectacle users, multifocal contact lens (CL) wearers, monovision CL wearers, and monofocal intraocular lens patients. Subjects were asked to answer the questionnaire again 2 weeks after the first completion. RESULTS: A total of 207 subjects completed the questionnaire. Data analysis showed good internal consistency (Cronbach α = 0.93) and factorial validity with only one factor explaining 62.0% of the variance. Test-retest reliability was extremely good (ICC = 0.92) as well as discriminatory power of the questionnaire's ability to discriminate between subjects with different forms of presbyopic correction. CONCLUSIONS: The Italian version of the NAVQ matches the properties of the original English version. It is a valid instrument to evaluate near activity visual quality of presbyopic Italian speakers.

Design of short Italian sentences to assess near vision performance.

PURPOSE: To develop and validate 28 short Italian sentences for the construction of the Italian version of the Radner Reading Chart to simultaneously measure near visual acuity and reading speed. METHODS: 41 sentences were constructed in Italian language, following the procedure defined by Radner, to obtain "sentence optotypes" with comparable structure and with the same lexical and grammatical difficulty. Sentences were statistically selected and used in 211 normal, non-presbyopic, native Italian-speaking persons. The most equally matched sentences in terms of reading speed and number of reading errors were selected. To assess the validity of the reading speed results obtained with the 28 selected short sentences, we compared the reading speed and reading errors with the average obtained by reading two long 4th-grade paragraphs (97 and 90 words) under the same conditions. RESULTS: The overall mean reading speed of the tested persons was 189±26wpm. The 28 sentences more similar in terms of reading times were selected, achieving a coefficient of variation (the relative SD) of 2.2%. The reliability analyses yielded an overall Cronbach's alpha coefficient of 0.98. The correlation between the short sentences and the long paragraph was high (r=0.85, P<0.0001). CONCLUSIONS: The 28 short single Italian sentences optotypes were highly comparable in syntactical structure, number, position, and length of words, lexical difficulty, and reading length. The resulting Italian Radner Reading Chart is precise (high consistency) and practical (short sentences) and therefore useful for research and clinical practice to simultaneously measure near reading acuity and reading speed.