Maximal aerobic exercise and acute visual performance in females: Implications for concussion side-line testing.

PURPOSE: Many sports-related concussion (SRC) outcomes can be prevented by removing affected athletes and allowing return after full recovery. Diagnosing concussions on the side-line is challenging, as tools often rely on visual performance assessment. Since acute exercise can affect vision, it is vital to determine if exercise can mask potential brain injury if visual performance assessments are used. The aim of this study was to determine the effect of a single bout of maximal aerobic exercise on acute visual performance. METHODS: Eighty previously sedentary females were randomly assigned to an experimental group (N = 40) or control group (N = 40) and completed an identical visual task test battery. Two weeks later, participants returned to participate in the test battery, with the experimental group doing so immediately following a maximal treadmill exercise protocol. RESULTS: Significant (P < 0.05) improvements were found in accommodation facility, saccadic eye movement, speed of recognition, peripheral awareness, and hand-eye coordination (P < 0.001 for all), but not in visual memory (P = 0.556). All visual tasks, barring visual memory, loaded onto a single factor and approximated the root mean square error of approximation (RMSEA) threshold value (RMSEA = 0.112 [90 %CI: 0.047-0.182]), and a significant large main effect was found on all factors as a universal visual task performance (P < 0.001; d = 1.01). CONCLUSION: This study shows that exercise can affect performance across multiple, but not all, visual tasks and should be utilised with caution in comprehensive side-line SRC assessments. Visual memory may be more stable to the effects of acute exercise and be considered for inclusion in side-line SRC assessments.

Comparison of sweep visual evoked potential of visual acuity and Snellen visual acuity in healthy and amblyopic children / Comparação da acuidade visual por potenciais evocados visuais de varredura e pelo teste de Snellen em crianças saudáveis e ambliópicas

ABSTRACT Purpose: To evaluate the visual acuity of healthy and amblyopic children using sweep visual evoked potential and compare the results with those of Snellen visual acuity testing. Methods: A total of 160 children aged 6-17 years were included in the study. Of these, 104 (65%) were aged 7-17 years old, able to verbally communicate, and did not have any systemic or ocular pathology (Group 1). Group 2 included 56 (35%) children aged 6-17 years, able to verbally communicate, and had strabismus or anisometropic amblyopia whose best corrected visual acuity was between 0.1 and 0.8. All subjects underwent a detailed ophthalmological examination and sweep visual evoked potential measurement. Demographic characteristics, ocular findings, best corrected visual acuity, and sweep visual evoked potential results were recorded. Results: In Group 1, the mean and maximum visual acuity values for sweep visual evoked potential were lower than the Snellen best corrected visual acuity (p<0.001, for both, respectively). Bland-Altman analysis revealed that in Group 1, the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.11 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.023 logMAR. In Group 2, the mean and maximum sweep visual evoked potential visual acuity were lower than the Snellen best corrected visual acuity (p<0.001 and p=0.009, respectively). Bland-Altman analysis revealed that the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.16 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.19 logMAR. Conclusions: Sweep visual evoked potential visual acuity measurements have comparable results with Snellen visual acuity measurements. This technique is an objective and reliable method for evaluating visual acuity in children.

RESUMO Objetivo: Avaliar a acuidade visual através de po­tenciais evocados visuais de varredura em crianças saudáveis e ambliópicas, comparando-a com a acuidade visual pelo teste de Snellen. Métodos: Foram incluídas no estudo 160 crianças com idades entre 6 e 17 anos. Desse total, 104 crianças (65%) estavam entre 7 e 17 anos de idade, eram capazes de comunicação verbal e não tinham nenhuma patologia ocular ou sistêmica (Grupo 1). O grupo 2 incluiu 56 crianças verbais (35%) com idades entre 6 e 17 anos e portadoras de estrabismo ou ambliopia anisometrópica, com a melhor acuidade visual corrigida entre 0,1 e 0,8. Todos os pacientes foram submetidos a um exame oftalmológico detalhado e a uma medição do potencial evocado visual por varredura. Registraram-se as características demográficas, os achados oculares, a melhor acuidade visual corrigida e os resultados do potencial evocado visual por varredura. Resultados: No Grupo 1, os valores médios e máximos da acuidade visual pelo potencial evocado visual por varredura mostraram-se menores que a melhor acuidade visual corrigida medida através do teste de Snellen (p<0,001 para ambas as medições). Uma análise de Bland-Altman revelou que no grupo 1, a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e a média do potencial evocado visual por varredura foi de ± 0,11 logMAR, enquanto a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e o valor máximo do potencial evocado visual por varredura foi de ± 0,023 logMAR. No Grupo 2, os valores médio e máximo do potencial evocado visual por varredura mostraram-se menores que a melhor acuidade visual corrigida pelo teste de Snellen (respectivamente, p<0,001 e p=0,009). A análise de Bland-Altman revelou que a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e a média do potencial evocado visual por varredura foi de ± 0,16 logMAR, enquanto a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e o valor máximo do potencial evocado visual por varredura foi de ± 0,19 logMAR. Conclusões: As medidas da acuidade visual através do potencial evocado visual por varredura mostram resultados comparáveis às medidas da acuidade visual pelo teste de Snellen. Essa técnica é um método objetivo e confiável de se avaliar a acuidade visual em crianças.

SUBCLINICAL OPTIC NEURITIS.

Acute optic neuritis is often associated with multiple sclerosis. It is considered to be the most common ocular symptom of multiple sclerosis. In addition to acute optic neuritis, in patients with multiple sclerosis, subclinical optic neuritis is also described. It is characterized by slow progression and bilateral involvement, thus being unnoticed by the patient. The purpose of the present study was to assess vision impairment in multiple sclerosis patients without a history of acute optic neuritis, using a number of functional tests including visual field testing by Octopus 101 perimetry N1 program, contrast sensitivity testing by Pelli Robson chart, and color vision by Ishihara pseudoisochromatic plates. The study included 35 multiple sclerosis patients aged 18-50 years, without subjective signs of vision impairment and visual acuity 1.0 according to Snellen. Visual field defects were found in 28 patients. The most common defects of visual fields were retinal sensitivity depression in peripheral zone and nerve fiber bundle defect. Reduced contrast sensitivity was found in 30 (86%) patients. Study results indicated multiple sclerosis patients free from signs of optic neuritis to suffer vision function impairment, as demonstrated by Octopus perimetry and contrast sensitivity testing with Pelli Robson charts.

Corrigendum: Using a Computerised Staircase and Incremental Optotype Sizes to Improve Visual Acuity Assessment Accuracy.

[This corrects the article DOI: 10.22599/bioj.271.].

Predicción del Síndrome Informático Visual mediante la adicción a videojuegos en estudiantes chinos y españoles / Prediction of computer vision syndrome by video game addiction in Chinese and Spanish students

Introducción: El uso de los videojuegos, por la extensión que ha llegado a alcanzar durante la pandemia de la COVID-19, es una variable relevante de estudio, especialmente por sus interacciones con aspectos de la salud mental y visual. Objetivo: predecir el nivel de Síndrome informático visual a partir de un índice optimizado sobre el nivel de adicción en estudiantes universitarios de dos poblaciones: española y china. Material y Métodos: Se administró un cuestionario online con tres instrumentos validados: un cuestionario para evaluar el juego con videojuegos (CHCVI), un cuestionario para evaluar la adicción a los videojuegos (CERV) y un cuestionario para detectar el síndrome visual por ordenador (CSQ). Los tres cuestionarios se aplicaron a una muestra de 253 estudiantes, tanto de universidades chinas como españolas. Para establecer las predicciones, se construyeron índices robustos basados en el análisis factorial de los instrumentos administrados. Finalmente, se aplicó una regresión logística para obtener un modelo matemático útil para predecir el Síndrome Informático Visual. Resultados: Los resultados mostraron un mayor síndrome informático visual y apetito por los videojuegos en los estudiantes españoles, y menores puntuaciones de síndrome informático visual pero una mayor alteración de la vida cotidiana en los estudiantes chinos debido a este tipo de ocio. Además, se comprobó que los estudiantes de la muestra china tenían un menor riesgo de padecer el síndrome informático visual, y que tener mayores niveles de adicción implicaba 1,4 veces más probabilidades de sufrir dicho síndrome. Conclusiones: Los presentes hallazgos demuestran una relación hasta ahora inexplorada entre la adicción a los videojuegos y los síntomas visuales relacionados con el abuso del ocio electrónico.

Introduction: The use of video games, due to the extent that it has reached during the COVID-19 pandemic, is a relevant study variable especially because of its interactions with aspects of mental and visual health. Objective: to predict the occurrence of computer vision syndrome according to the level of addiction to video games in university undergraduates during a particular period of uncertainty due to health and mobility restrictions imposed by governments as a result of the COVID-19 pandemic. Material and Methods: To accomplish this objective, an online questionnaire was administered with three validated instruments: a questionnaire to assess playing video games (CHCVI), a questionnaire to evaluate video games addiction (CERV), and a questionnaire to detect computer vision syndrome (CSQ). The three questionnaires were applied to a sample of 253 students from both Chinese and Spanish universities. To establish the predictions, robust indexes were constructed based on the Factor Analysis of the instruments administered. Finally, logistic regression was applied to predict computer vision syndrome. Results: The results showed greater computer vision syndrome and appetite for video games in Spanish students, and lower computer vision syndrome scores but a greater alteration of daily life in chinese students due to this type of leisure. Moreover, it was found that students from the Chinese sample entailed a lower risk of suffering from computer vision syndrome, and that having higher levels of addiction involved 1,4 times more likelihood of suffering from such syndrome. Conclusions: The present findings demonstrate a previously unexplored relationship between video games addiction and visual symptoms related to screen exposure.

Using a Computerised Staircase and Incremental Optotype Sizes to Improve Visual Acuity Assessment Accuracy.

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.

Validación del instrumento "Computer Vision Syndrome Questionnaire (CVS-Q)" para la evaluación del síndrome visual informático en personal de salud de Lima

Objetivos: Determinar la validez y confiabilidad del instrumento "Computer Vision Syndrome Questionnaire (CVS-Q)" en la medición del Síndrome Visual Informático en personal de salud de Lima. Material y métodos: Estudio observacional, descriptivo y de corte transversal, de tipo evaluación de cuestionario, realizado en 82 trabajadores de salud. La validez de contenido se evaluó mediante juicio de expertos con método estadístico de V de Aiken; Validez de constructo, mediante análisis factorial; validez discriminante, a través de la curva operador-receptor (ROC) contrastada con el cuestionario CSSV17; confiabilidad de consistencia interna, con alfa de Cronbach; confiabilidad test - re-test (con 7 días de diferencia); con Rho de Spearman y Coeficiente de Correlación Intraclase (CCI), con intervalos de confianza (IC) del 95%. Se empleó para el procesamiento el software SPSS versión 20.0 para Windows con licencia de prueba. Resultados: El V de Aiken obtuvo un valor de 100%. El análisis factorial extrajo 3 componentes principales que explicaron el 69,455% de la varianza total. El área bajo la curva ROC fue 0,889 [(0,845-0,934); IC=0,95] (p=0,000), sensibilidad 72,22% y especificidad 100%. El alfa de Cronbach fue 0,939, Rho de Spearman 0,884 (p=0,000) y CCI 0,856 [(0,777 - 0,907); IC=0,95] (p=0,000). Conclusiones: El Cuestionario CVS-Q es válido y confiable para ser aplicado sobre el grupo ocupacional de profesionales de la salud con buenas propiedades psicométricas.

SUMMARY Objectives: To determine the validity and reliability of the instrument "Computer Vision Syndrome Questionnaire (CVS-Q)" in the measurement of the Computer Visual Syndrome in health personnel in Lima. Methods: A quantitative, observational, descriptive, cross-sectional and questionnaire study was carried out in 82 health workers. Content validity was evaluated by expert judgment with the Aiken V statistical method; construct validity, through factor analysis; discriminant validity, through the receiver operating characteristic curve (ROC) curve contrasted with the CSSV17 questionnaire; internal consistency reliability, with Cronbach's alpha; reliability test - re-test (7 days apart); with Spearman's Rho and Interclass Correlation Coefficient (ICC) with 95% CI. The SPSS software version 20.0 for Windows with a trial license was used for its processing. Results: The V of Aiken obtained a value of 100%. The factor analysis extracted 3 main components that explain 69.455% of the total variance. The area under the ROC curve was 0.889 [(0.845-0,934); CI=0.95] (p=0.000), sensitivity 72.2% and specificity 100%. Cronbach's alpha was 0.939, Spearman's Rho 0.884 (p=0.000) and ICC 0.856 [(0.777 - 0.907); CI=0.95] (p=0.000). Conclusions: The CVS-Q questionnaire is valid and reliable to be applied in the health professionals' occupational group with good psychometric properties.

Can listening provide a useful clinical estimate of low vision reading parameters?

PURPOSE: The purpose of this study was to determine whether a clinician can assess critical print size (CPS) and/or reading fluency by listening to a visually impaired patient reading aloud across a range of print sizes on an MNREAD chart, rather than needing to plot and analyse reading speed data as a function of print size. METHODS: Fifty-six low vision participants were audio-recorded reading an MNREAD chart under standard conditions. Two experienced raters listened to the recordings and made judgments of the CPS (logMAR), and of the level of reading fluency achieved at large print sizes on a 4-point rating scale. Reading times were plotted as a function of print size to determine the CPS as the smallest print size that supported the participant's maximum reading speed (MRS) by inspection, and the MRS as the mean reading speed across print sizes including, and larger than, the CPS. RESULTS: Listened CPS judgments made for each rater were slightly larger than the CPS values obtained by inspection (mean differences 0.04logMAR (p = 0.06), 0.08logMAR (p < 0.01); limits of agreement (LoA) ±0.28logMAR, ±0.39logMAR, respectively). CPS judgments were consistent both between raters (mean difference 0.04logMAR [p = 0.18]; LoA ±0.42logMAR) and between two judgments made by each rater (mean differences 0.00logMAR (p = 1.0), 0.03logMAR (p < 0.05); LoA ±0.23logMAR, ±0.17logMAR). Reading fluency could be categorised as 'functional' (MRS > 80 wpm) or 'non-functional' (MRS < 80 wpm) with a sensitivity of 88%-90% and a specificity of 100%. CONCLUSIONS: Experienced raters listening to a patient reading an MNREAD chart can determine a clinically useful estimate of critical print size and can discriminate maximum reading speeds that are above and below that likely to provide sustained reading ability. Listening to a patient reading an MNREAD chart is an option for the low vision clinician's armoury of assessments.

Is patient identification of 'comfortable' print size a useful clinical parameter for low vision reading assessment?

PURPOSE: The purpose of this study was to determine what a person with vision loss considers a 'comfortable' print size to read, and examine whether this reflects any of three currently used parameters for identifying print size required for sustained reading tasks: minimum size to achieve maximum reading speed (the critical print size (CPS)); minimum size for functional reading at 80 wpm and/or a size that is double the reading acuity (representing an acuity reserve of 2:1). METHODS: Forty-seven participants entering low vision rehabilitation (mean age 77 years, 24 with macular degeneration) were assessed using MNREAD charts to determine reading acuity, maximum reading speed, CPS and the minimum size allowing functional (80 wpm) reading. Comfortable print size was assessed by asking participants to identify 'the smallest print size that you would find comfortable using' on the MNREAD chart. RESULTS: There was little difference between comfortable print size and CPS (mean difference 0.05 logMAR (SD 0.18); p = 0.08, limits of agreement ±0.35 logMAR), and no trend for the difference between values to differ across the functional range. Size for functional reading could only be assessed for 41 participants, and the difference between this and comfortable print size varied across the functional range. Comfortable print size was consistently smaller than twice the reading acuity size (mean difference 0.11 logMAR (SD 0.17); p < 0.001), with an average acuity reserve of 1.74:1. CONCLUSIONS: Asking people with visual impairment to identify a print size that is comfortable to read provides a print size similar to the CPS. This can be used as a guide in selecting magnification for sustained reading without having to undertake further analyses. Identification of perceived comfortable print size may offer a time-efficient clinical method of estimating magnification requirements, and be relevant for undertaking effective remote consultations.

Brazilian guidelines on the frequency of ophthalmic assessment and recommended examinations in healthy children younger than 5 years / Diretrizes brasileiras sobre avaliação oftalmológica de crianças saudáveis menores de 5 anos: exames recomendados e frequência

ABSTRACT Purpose: To provide guidance on the frequency and components of eye examinations for healthy children aged 0 to 5 years. Methods: These guidelines were developed based on the medical literature and clinical experience of an expert committee. PubMed/Medline searches were performed, with selected publications not restricted to systematic reviews, randomized controlled trials, or observational studies. The Grading of Recommendations Assessment, Development, and Evaluation profile was applied when suitable, and for issues without scientific evidence, recommendations were based on expert consensus. Recommendations by the American Academy of Pediatrics, American Association of Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, Royal College of Ophthalmologists, and Canadian Ophthalmological Society were also reviewed. The final guideline document was approved by the Brazilian Pediatric Ophthalmology Society and by the Brazilian Pediatric Society. Results: Newborns must undergo the red reflex test and inspection of the eyes and adnexa by a pediatrician within 72 hours of life. The red reflex test should be repeated by the pediatrician during childcare consultations at least three times per year during the first 3 years of life. If feasible, a comprehensive ophthalmologic examination may be performed between 6 and 12 months of age. Until 36 months of age, the pediatrician should assess the infant's visual development milestones, age-appropriate assessment of visual function, ocular fixation, and eye alignment. At least one comprehensive ophthalmologic examination should be performed at 3 to 5 years of age. The examination should minimally include inspection of the eyes and adnexa, age-appropriate visual function assessment, evaluations of ocular motility and alignment (cover tests), cycloplegic refraction, and dilated fundus. Conclusions: Guidelines concerning the frequency of ophthalmic assessment are important tools for directing physicians regarding best practices that avoid treatable vision problems that affect children's development, school, and social performance and cause unnecessary permanent vision loss.

RESUMO Objetivo: Fornecer orientações sobre a frequência e os componentes dos exames oftalmológicos para crianças saudáveis de 0 a 5 anos. Métodos: Essas diretrizes foram desenvolvidas com base em revisão bibliográfica e experiência clínica de um comitê de especialistas. Foram realizadas buscas PubMed/Medline; documentos selecionados não se restringiram a revisões sistemáticas, ensaios clínicos randomizados e estudos observacionais. Quando adequado, o perfil GRADE foi aplicado para graduá-los e o consenso de especialistas foi usado nos tópicos sem evidência científica. Também foram revisadas as recomendações pela Academia Americana de Pediatria, Associação Americana de Oftalmologia Pediátrica e Estrabismo, Academia Americana de Oftalmologia, Royal College of Ophthalmologist e Sociedade Canadense de Oftalmologia. O documento final foi aprovado pela Sociedade Brasileira de Oftalmologia Pediátrica e Sociedade Brasileira de Pediatria. Resultados: Os recém-nascidos devem ser submetidos ao teste do reflexo vermelho e inspeção dos olhos e anexos pelo pediatra dentro de 72 horas de vida ou antes da alta da maternidade. O teste do reflexo vermelho deve ser repetido pelo pediatra durante as consultas de puericultura pelo menos três vezes ao ano durante os primeiros 3 anos de vida. Se factível, um exame oftalmológico completo pode ser feito entre 6 a 12 meses de vida. Até os 36 meses de idade, os marcos visuais, função visual apropriada para a idade, fixação e alinhamento ocular também devem ser avaliados pelo pediatra ou médico da família. Pelo menos um exame oftalmológico completo deve ser realizados entre 3 e 5 anos de idade. O exame deve conter pelo menos inspeção dos olhos e anexos, avaliação da função visual apropriada para a idade, avaliação da motilidade e alinhamento ocular (testes de cobertura), refração sob cicloplegia e avaliação do fundo de olho dilatado. Conclusões: As diretrizes sobre a frequência da avaliação oftalmológica são ferramentas importantes para orientar os médicos sobre a melhor prática a fim de evitar problemas visuais tratáveis na infância, que poderiam comprometer seu desenvolvimento social, escolar e global, além de causar perda permanente da visão.

Vision care among school-aged children with autism spectrum disorder in North America: Findings from the Autism Treatment Network Registry Call-Back Study.

LAY ABSTRACT: Children with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6-17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child's vision was tested with pictures, shapes, or letters in the past 2 years; (2) child's vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care.

Evaluation of Tablet-Based Tests of Visual Acuity and Contrast Sensitivity in Older Adults.

Purpose: Recent innovations in mobile technology for the measurement of vision present a valuable opportunity to measure visual function in non-clinical settings, such as in the home and in field-based surveys. This study evaluated agreement between a tablet-based measurement of distance and near acuity and contrast sensitivity as compared to gold-standard clinical tests.Methods: Participants aged ≥55 years recruited from a tertiary eye clinic underwent testing with three tablet-based and corresponding gold-standard clinical measures (ETDRS distance acuity, Pelli-Robson contrast sensitivity, and MNRead near acuity). Correlation and agreement between tablet-based and clinical tests were assessed.Results: A total of 82 participants with a mean age of 69.1 (SD = 7.6) years, and majority female (67.1%) and white (64.6%), were enrolled in this study. The mean (SD) difference between the tests (gold-standard - tablet) was -0.04 (0.08) logMAR for distance acuity, -0.11 (0.13) log units for contrast sensitivity, and -0.09 (0.12) logMAR for near acuity. 95% limits of agreement for distance acuity (-0.21, 0.12 logMAR), near acuity (-0.34, 0.14 logMAR), and contrast sensitivity (-0.36, 0.14 logCS) were also determined. The correlation between tablet-based and gold-standard tests was strongest for distance acuity (r = 0.78), followed by contrast sensitivity (r = 0.75), and near acuity (r = 0.67). The agreement between the standard and tablet-based methods did not appear to be dependent on the level of vision.Conclusions: This study demonstrates the agreement of tablet-based and gold-standard tests of visual function in older adults. These findings have important implications for future population vision health surveillance and research.

ASTEROID stereotest v1.0: lower stereo thresholds using smaller, denser and faster dots.

PURPOSE: In 2019, we described ASTEROID, a new stereotest run on a 3D tablet computer which involves a four-alternative disparity detection task on a dynamic random-dot stereogram. Stereo thresholds measured with ASTEROID were well correlated with, but systematically higher than (by a factor of around 1.5), thresholds measured with previous laboratory stereotests or the Randot Preschool clinical stereotest. We speculated that this might be due to the relatively large, sparse dots used in ASTEROID v0.9. Here, we introduce and test the stereo thresholds and test-repeatability of the new ASTEROID v1.0, which uses precomputed images to allow stereograms made up of much smaller, denser dots. METHODS: Stereo thresholds and test/retest repeatability were tested and compared between the old and new versions of ASTEROID (n = 75) and the Randot Circles (n = 31) stereotest, in healthy young adults. RESULTS: Thresholds on ASTEROID v1.0 are lower (better) than on ASTEROID v0.9 by a factor of 1.4, and do not differ significantly from thresholds on the Randot Circles. Thresholds were roughly log-normally distributed with a mean of 1.54 log10 arcsec (35 arcsec) on ASTEROID v1.0 compared to 1.70 log10 arcsec (50 arcsec) on ASTEROID v0.9. The standard deviation between observers was the same for both versions, 0.32 log10 arcsec, corresponding to a factor of 2 above and below the mean. There was no difference between the versions in their test/retest repeatability, with 95% coefficient of repeatability = 0.46 log10 arcsec (a factor of 2.9 or 1.5 octaves) and a Pearson correlation of 0.8 (comparable to other clinical stereotests). CONCLUSION: The poorer stereo thresholds previously reported with ASTEROID v0.9 appear to have been due to the relatively large, coarse dots and low density used, rather than to some other aspect of the technology. Employing the small dots and high density used in ASTEROID v1.0, thresholds and test/retest repeatability are similar to other clinical stereotests.

Stereotest Comparison: Efficacy, Reliability, and Variability of a New Glasses-Free Stereotest.

Purpose: To test the validity of the ASTEROID stereotest as a clinical test of depth perception by comparing it to clinical and research standard tests. Methods: Thirty-nine subjects completed four stereotests twice: the ASTEROID test on an autostereo 3D tablet, a research standard on a VPixx PROPixx 3D projector, Randot Circles, and Randot Preschool. Within 14 days, subjects completed each test for a third time. Results: ASTEROID stereo thresholds correlated well with research standard thresholds (r = 0.87, P < 0.001), although ASTEROID underestimated standard threshold (mean difference = 11 arcsec). ASTEROID results correlated less strongly with Randot Circles (r = 0.54, P < 0.001) and Randot Preschool (r = 0.64, P < 0.001), due to the greater measurement range of ASTEROID (1-1000 arcsec) compared to Randot Circles or Randot Preschool. Stereo threshold variability was low for all three clinical stereotests (Bland-Altman 95% limits of agreement between test and retest: ASTEROID, ±0.37; Randot Circles, ±0.24; Randot Preschool, ±0.23). ASTEROID captured the largest range of stereo in a normal population with test-retest reliability comparable to research standards (immediate r = 0.86 for ASTEROID vs. 0.90 for PROPixx; follow-up r = 0.68 for ASTEROID vs. 0.88 for PROPixx). Conclusions: Compared to clinical and research standards for assessing depth perception, ASTEROID is highly accurate, has good test-retest reliability, and measures a wider range of stereo threshold. Translational Relevance: The ASTEROID stereotest is a better clinical tool for determining baseline stereopsis and tracking changes during treatment for amblyopia and strabismus compared to current clinical tests.

Comparing the Netra smartphone refractor to subjective refraction.

BACKGROUND: Among technologies targeting mobile eye care, EyeNetra is a smartphone-based subjective refraction system. This study compared the results from this system with those of professional subjective refraction. Participant visual comfort and preference of results were also measured. METHODS: Thirty-six optometry-naïve participants (n = 36 eyes, aged 18-35 years), were randomly subjected to three refraction methods: professional subjective refraction, unassisted Netra (participants alone) and refined Netra (sphere results refined by a practitioner). Using a randomised, double-blind design, refraction results were mounted in a trial frame and distance logMAR visual acuities were measured. Subjective appreciation and visual comfort were assessed by questionnaire. Overall preference was ranked. RESULTS: Unassisted Netra yielded a median myopic overcorrection of 0.60 D (interquartile range [IQR] 0.25 to 0.94) compared to professional subjective refraction. Median equivalent sphere with unassisted Netra (-1.40 D, IQR -3.10 to -0.90) was significantly more myopic than refined Netra (-0.70 D, IQR -1.60 to -0.30) and then subjective refraction (-0.80 D, IQR -1.60 to -0.30) (all p-values < 0.01). Median visual acuity with professional subjective refraction (-0.16, IQR -0.22 to -0.09) was superior than unassisted Netra (-0.08, IQR -0.20 to 0.03) (p < 0.01). Subjective refraction was ranked first in preference of trial framed results by 72 per cent of participants; median preference rank favoured professional subjective refraction to both Netra results (all p < 0.01). For all questionnaire items, visual comfort was higher with subjective refraction than with unassisted Netra (all p < 0.04). CONCLUSION: The Netra device - especially when used without professional assistance and compared to subjective refraction - induces significant myopic overcorrection and lower levels of visual acuity, subjective preference and visual comfort.

Epidemiology of myopia and unaided visual impairment of primary and secondary school students of Han and minorities in Mangshi City in Yunnan / 中国学校卫生

Objective@#To investigate the prevalence and associated factors of unaided visual impairment and myopia among primary and secondary school students in Yunnan Province, and to provide scientific basis for myopia prevention.@*Methods@#The study was conducted among primary and secondary school students in Mangshi, Yunnan Province from March to August, 2014. All the 7 681 subjects underwent detailed eye examinations and a questionnaire survey. Myopia was defined as spherical equivalent value of less than -0.5 diopters. Unaided visual impairment was analyzed on the basis of the better and the worse-seeing eye, respectively.@*Results@#The prevalence of myopia and high myopia were 39.1% and 0.6%. The prevalence of unaided visual impairment was 11.4% based on the worse-seeing eye. Refractive errors accounted for 87.3% of the participants with unaided visual impairment. Prevalence of myopia was higher in girls than in boys (χ2=29.74, P<0.01), but there was no gender difference in high myopia (P=0.19). The prevalence of myopia and high myopia increased significantly with increasing age (χ2=351.23, 22.56, P<0.01). Besides, prevalence of myopia was 63.7% in Dai nationality students and 36.6% in Yi nationality students (χ2=78.14, P<0.01), which was higher than other ethnic minorities. After adjusting for the effects of sex, age and ethnicity, the presence of myopia was associated with increasing height (OR=1.02, 95%CI=1.01-1.03), computer use (OR=1.17, 95%CI=1.03-1.32), having a myopic father (OR=1.56, 95%CI=1.24-1.94), having a myopic mother (OR=1.33, 95%CI=1.08-1.63) and more time reading(OR=1.18, 95%CI=1.09-1.28). High myopia was found to be more prevalent in children who had a myopic father (OR=3.98, 95%CI=1.72-9.22) and using computers (OR=2.31, 95%CI=1.17-4.57).@*Conclusion@#Myopia and unaided visual impairment is prevalent in school students in rural China (Yunnan), though the prevalence is relatively lower compared with other areas in China. Attention should be paid to the formulation and input of primary eye care policies.

Comparison of the pediatric vision screening program in 18 countries across five continents.

PURPOSE: Incorporating mass pediatric vision screening programs as part of a national agenda can be challenging. This review assessed the implementation strategy of the existing pediatric vision screening program. METHODS: A search was performed on PubMed, EBSCO host MEDLINE Complete, and Scopus databases encompassing the past ten years for mass pediatric screening practice patterns that met the selection criteria regarding their objectives and implementation. Results were analyzed from 18 countries across five continents. RESULTS: Eight countries (44%) offered screening for distance visual acuity only, where the majority of the countries (88%) used either Snellen or Tumbling E chart. High-income countries initiated screening earlier and applied a more comprehensive approach, targeting conditions other than reduced vision only, compared with middle-income countries. Chart-based testing was most commonly performed, with only three countries incorporating an instrument-based approach. Lack of eyecare and healthcare practitioners frequently necessitated the involvement of non-eyecare personnel (94%) as a vision screener including parent, trained staff, and nurse. CONCLUSIONS: Implementation of a vision screening program was diverse within countries preceded by limited resources issues. Lack of professional eyecare practitioners implied the need to engage a lay screener. The limitation of existing tests to detect a broader range of visual problems at affordable cost advocated the urgent need for the development of an inexpensive and comprehensive screening tool.

[Hereditary color vision deficiency: Physiology, classification, diagnosis and application to aeronautics]. / Dyschromatopsies hereditaires : physiologie, classification, diagnostic et application à l'aéronautique.

Hereditary color vision deficiency affects 9% of men and 0.5% of women. It is often unrecognized and diagnosed late, which can interfere with the professional careers of these patients. Most color vision deficiencies are related to X chromosome involvement and concern the red-green chromatic axis. They are secondary to dysfunction of an L or M cone (protanomaly or deuteranomaly) or to the absence of an L or M cone (protanopia or deuteranopia). Color vision deficiency screening and assessment can be done by confusion tests or equalization tests, but also by ergonomic tests, professional tests that assess the aptitude for a given profession.

One-year test-retest reliability of ten vision tests in Canadian athletes.

Background: Vision tests are increasingly being suggested for use in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Therefore, our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines, etc.). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.55 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccade (ICC=0.56). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.21 after removing one outlier. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Four tests had moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

Different Surgical Approaches for Treatment of Dissociated Vertical Deviation (DVD).

INTRODUCTION: DVD is a rare, poorly understood eye motility disorder of unknown etiology. In socially unacceptable deviation, surgical treatment is an option. We present patients operated with three different surgical methods. AIM: To evaluate and compare different surgical approaches for treatment of dissociated vertical deviation (DVD). METHODS: Total amount of 20 patients with DVD of ≥ 20 PD are operated with three different techniques on superior rectus (SR) muscle: Group I with preoperative angle of 20-30 PD was operated with 8 mm recession of SR, Group II with preoperative angle of ≥ 30 PD undergo 3 mm recession with posterior fixation on SR and Group III with preoperative angle of ≥ 30 PD undergo-splitting of SR muscle. Surgeries for associated horizontal deviations were performed before surgery for DVD. Follow up was three years. RESULTS: In all cases amount of DVD deviation was significantly reduced. No binocularity was gained. Although hyperdeviation of affected eye was reduced in all patients, we didn't eliminate deviation completely. Despite smaller preoperative angle, residual angle was bigger (6-12 PD) in the patients in group I where only recession of SR was performed, compared to Group II and III where postoperative angle was 4-8 PD in both groups. CONCLUSION: There are no recommended guidelines for the surgical treatment of DVD and treatment is based more on the surgeon's experience than evidence based data. In our experience recession of the SR should be method of choice in the cases of smaller deviation. SR recession combined with posterior fixation suture and Y-splitting seems to be a safe and effective method for surgical treatment of unilateral DVD with bigger deviation angles. Y splitting with less surgical complications and increasing effect with time can be a good alternative to posterior fixation surgery.