Knowledge, perception and practice towards blue-blocking lenses among optometrists.

CLINICAL RELEVANCE: There is a lack of clinical guidelines in India for the prescription of blue-blocking lenses. Therefore, the practice trends will depend on practitioners' knowledge, attitude, and perception. BACKGROUND: Exposure to blue light with increased use of light-emitting diode (LED) lights and digital devices along with the commercial availability of blue blocking lenses has warranted the need to understand the factors that influence the prescription of blue blocking lenses among eye care practitioners. Hence, we aim to assess knowledge, perception, and practice pattern of blue blocking lenses among Indian optometrists. METHODS: This cross-sectional online survey was conducted among Indian Optometrists. The survey was distributed through various social groups of optometrists and state associations. The questionnaire had four main domains with 29 items in total. The four major domains were knowledge, practice, perception and demographic details on education. Descriptive analysis and logistic regression were performed to study the impact of these domains on the prescription of blue block lenses. RESULTS: Out of 341 responses, 247 were included for analysis as per study criteria. About 50% (n = 123) of the participants had appropriate knowledge about blue light. Blue-blocking lenses were prescribed always or most of the time by 52% (n = 130) of the participants. The odds of prescribing blue blocking lenses were higher among practitioners who considered blue light as an important factor in causing computer vision syndrome (OR 3.77, 95% CI: 1.33-10.69, P = 0.01) or if they considered there is adequate published evidence (OR 3.95, 95% CI: 1.58-9.87, P = 0.003). CONCLUSIONS: The source of evidence for prescribing blue-blocking lenses for our participants was mainly from advertisements rather than from scientific studies. Factors such as awareness, knowledge, education, and nature of practice did not play a significant role in prescribing blue-blocking lenses. This raises the need for evidence-based practice and the development of practice guidelines for prescribing blue-blocking lenses.

Oculomotor deficits in attention deficit hyperactivity disorder: a systematic review and meta-analysis.

There is equivocal evidence on the presence of oculomotor deficits among children with attention deficit hyperactivity disorder (ADHD), which can be an additional challenge in this population, especially with reading-related tasks. This study aimed to review the deficits in the oculomotor parameters among children with ADHD compared with age-matched controls. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of original research articles on various databases was done using key terms, such as "oculomotor deficit," "attention deficit hyperactivity disorder," or related terms. We included case-control studies and excluded studies in which children received medications during the test. Twelve original research studies were considered for this review. Ten studies reported data on various types of saccades, two studies reported data on fixation, and one study reported data on pursuit. Among various oculomotor deficits, the forest-plot analysis of an antisaccade task showed that children with ADHD made more direction errors compared to controls. Although independent studies report that ADHD children have poorer performance compared to control populations during oculomotor tasks, there is a lack of evidence to draw a strong conclusion. Children with ADHD are less precise in performing eye movements and need more time to complete the oculomotor tasks than those without ADHD. The overall results provide minimal evidence regarding the presence of various oculomotor deficits in ADHD.

Precision, reliability and application of the Wilkins Rate of Reading Test.

BACKGROUND: The Wilkins Rate of Reading Test (WRRT) enables rapid measurement of reading speed using text passages that have no semantic content and demand minimal word recognition skills. It is suited to applications where the primary interest is in the influence of visual and ocular motor factors on reading rate. METHODS: We obtained estimates of precision and reliability of WRRT from four data samples (A-D) collected independently by the authors: (A) n = 118 adults; (B) n = 90 adults; (C) n = 787 children; (D) n = 134 children. Each participant was asked to read aloud as quickly and accurately as possible, for 1 min, and results were recorded as number of words read correctly per minute (wcpm). RESULTS: Estimates of precision are given by the within-subjects standard deviation sw , and reliability by the intraclass correlation coefficient for single measurements r1 . For each sample these estimates were (A) sw  = 11.5 wcpm, r1  = 0.85; (B) sw  = 3.8 wcpm, r1  = 0.98; (C) sw  = 6.7 wcpm, r1  = 0.93; (D) sw  = 6.2 wcpm, r1  = 0.94. CONCLUSION: The reliability of WRRT reflects large variation in reading rate between individuals compared to within-individual variability, indicating that it is a good test for discriminating differences in reading speed between individuals. The precision of the test varies from 3.8 wcpm to 11.5 wcpm among samples, and the pooled value of 7.2 wcpm, provides a basis for setting a population-wide criterion for minimum detectable change of reading rate in individuals over time. Nevertheless, a preferable way of monitoring change in an individual would be to use a criterion determined from estimates of that individual's baseline variation in WRRT scores.

Methodological variations in studies reporting normative data for binocular vision parameters: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the methodological variations and population characteristics of the studies that report normative data for accommodation and vergence parameters. INTRODUCTION: Accommodation and vergence are the two important parameters required for normal binocular vision. The presence of accommodation and vergence anomalies impairs the quality of life of an individual by interfering with their daily visual activities. Diagnosis of accommodative and vergence anomalies requires a series of test procedures. The test procedure or the tool used could influence the outcome measured. Different study designs and methods have been used to estimate the normative data; therefore, we aim to explore the variation in terms of population characteristics and methods used to measure accommodative and vergence parameters. INCLUSION CRITERIA: This scoping review will include published literature that assesses normative function of various binocular vision parameters with a focus on mapping the methodological differences. METHODOLOGY: JBI methodological framework for scoping reviews will be followed. The review will also be conducted in accordance with the Preferred Reporting Item for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Three-phase searches for identifying relevant articles will be conducted in the following electronic databases: PubMed, Scopus, CINAHL, Web of Science, African Journals Online, LILACS, China National Knowledge Infrastructure, and Google Scholar. The review undertakes two stages of screening: i) title/abstract screening and ii) full-text screening. The data will be extracted from the retrieved full text. The results will be tabulated and summarized descriptively.

Comparison of endpoint of subjective cycloplegic refraction with artificial aperture and post-mydriatic test among adults with refractive error.

PURPOSE: There is a need to understand the requirement for the post-mydriatic test (PMT) among adults for the final prescription of spectacles as this test increases the cost of eye care and causes inconvenience to the patient because of the additional visit to an eye care practitioner. We aim to compare the cycloplegic subjective refraction using apertures of various sizes and PMT in an adult population. METHODS: This prospective crossover study was conducted under standard settings in an eye clinic. Adult individuals between 18 and 35 years of with emmetropia and various degrees of ametropia participated in this study. Individuals with known ocular pathology were excluded. Non-cycloplegic objective refraction was performed followed by subjective refraction. Cycloplegic objective refraction was performed followed by subjective refraction with custom designed artificial apertures. After a washout period of cycloplegic, PMT was performed. The distribution of data was tested using the Kolmogorov-Smirnov test. Depending on the distribution of the data, either parametric or nonparametric test was done. RESULTS: Fifty-nine eyes of thirty individuals with a mean (±SD) age of 23(±4) years with a male: female ratio of 1:4 participated in this study. A comparison of measures of PMT and subjective refraction with 2, 3, 4, 5, and 6 mm aperture under cycloplegic effect using the Friedman test rendered a Chi square value (df = 5) of 1.92 which was not statistically different (P = 0.86). CONCLUSION: Performing subjective refraction with an appropriate spherical and cylindrical endpoint under cycloplegic effect with appropriate aperture overcomes the necessity of PMT.

Clinical Use of the Kannada and English Rate of Reading Tests.

The rate of reading test in which randomly ordered common words are read aloud has found use in optometric and educational practice as a means of assessing visual aspects of reading largely independently of comprehension. English and Kannada versions of the rate of reading test were administered to 761 children aged between 9 and 15 years. These children were recruited from four private and five state schools in Udupi Taluk that had English and Kannada, respectively, as the principal medium of instruction. The results showed that the reading rate increased with age, as expected, but depended on the language of the test and the medium of instruction. The study emphasizes the importance of using normative data based on age and the language of instruction used in school. It also suggests age-specific criteria to measure the efficacy of any visual intervention aimed at improving reading speed. The test can be used to assess (1) educational under-performance in reading and (2) the effects of optometric and educational intervention, and separate norms appropriate for each use are presented.

Android mobile applications in eye care.

Google Play Store was used to search for eye care-related applications the android simulator using various general terms related to eye care to review and categorize various interactive eye care-related applications in android platform from the details available in the application website. Data collected from application description and application developer's webpage include target audience, category of apps, estimated number of downloads, average user rating, involvement of eye care professionals in developing the application, and cost of the app. All these data were collected only from the details provided in the application website considering on online user perspective and the developers were not contacted to collect any other details. In total, 475 applications were identified and grouped into 13 categories depending on the type of service the application provide. Out of which, only 107 (22.53%) applications had mentioned about the eye care professional involvement in their design or development of the application. The applications were also stratified according to the target audience, and many had no user rating with very few downloads. The lack of evidence-based principles and standardization of application development should be taken into consideration to avoid its negative impact on the community, especially in eye care.

Reliability and validity of a Kannada rate of reading test.

Purpose: Kannada, one of the Dravidian languages, is the official language of Karnataka state of India. There is a need for a test using Kannada words that can assess visual aspects of reading independently of syntactic and semantic knowledge. Methods: A test of reading rate in Kannada was developed following the design principles of the Wilkins Rate of Reading Test (RRT). Fifteen high-frequency bisyllabic Kannada words were selected. Children were recruited from state and private schools that used Kannada or English as the medium of instruction. A total of 799 children from Grade 2 to 9 participated in the study. Reading rate was measured using the English RRT and the Kannada version twice in immediate succession during the first session. In 85 children, measurements using the Kannada RRT were repeated after an interval of 15 days. Results: Pearson product moment correlation between the two immediately successive tests was 0.95 for the Kannada RRT and 0.91 for the English RRT. The correlation for the tests separated by an interval of 15 days was 0.83. When Kannada was the medium of instruction, there was little difference between test scores for Kannada and English. When English was the medium of instruction, test scores were greater in English. Scores increased as expected with age (P < 0.0001), similarly for Kannada and English tests. Conclusion: The newly developed Kannada RRT is both reliable and valid and can be used as a tool for measuring the visual aspects of reading.

Test Re-Test Reliability and Validity of Different Visual Acuity and Stereoacuity Charts Used in Preschool Children.

BACKGROUND: Preschool vision screenings are cost effective ways to detect children with vision impairments. The use of any vision tests in children must be age appropriate, testable, repeatable and valid. AIM: To compare the test re-test reliability, sensitivity and specificity of different visual acuity and stereo acuity charts used in preschool children. MATERIALS AND METHODS: Monocular visual acuity of 90 subjects (180 eyes) of age 36 to 71 months was assessed with HOTV, Lea and E-chart in a preschool located in a semi urban area, Manipal, Karnataka. After the vision assessment, stereo acuity was recorded using Frisby and Titmus stereo charts followed by comprehensive eye examination. Repeated measurements of visual acuity and stereo acuity were done one week after the initial assessment. RESULTS: Mean age of children was 53± 10 months with equal gender distribution. Intra class correlation (ICC) of Lea, HOTV, E-chart, Frisby and Titmus charts were 0.96, 0.99, 0.92, 1.0 and 1.0 respectively. The area under receiver operating curve (ROC) for Lea and E-chart was 0.892 and 0.776. HOTV was considered as the gold standard as it showed the least difference on repeated measurements. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of E-chart was 99, 15, 45, 94 and 21.8 percent, and Lea was 93, 56, 59 and 92 percent. The sensitivity, specificity, PPV and NPV of Frisby was 75, 27, 9, 92 percent were as of Titmus was 75, 13, 8 and 85 percent respectively. CONCLUSION: HOTV chart can be used as the gold standard for measuring visual acuity of pre-schoolers in a semi urban area. Lea chart can be used in the absence of HOTV chart. Frisby and Titmus charts are good screening tools, but with poor diagnostic criteria.

Normative data for near point of convergence, accommodation, and phoria.

BACKGROUND: Measurement of for near point of convergence (NPC), amplitude of accommodation (AA) and phoria are important components of diagnosing nonstrabismic binocular vision anomalies. There is a huge variation in the normative data established for orthoptic parameters because of the variation in measurement technique. There are only limited studies for normative data based on nonclinical population in Indian population. Therefore, we aim estimate the normative values for NPC, AA, and phoria measurement in Indian population using techniques, which has good repeatability and reliability. MATERIALS AND METHODS: Subjects between the age group 10-35 years participated in this prospective cross-sectional study. A self-administered symptom questionnaire was used to exclude patients with asthenopic symptoms. Clinical techniques which have good repeatability and reliability were used. NPC was measured using pen light red, green glass test. AA was measured using minus lens technique. Horizontal and vertical phoria at distance and near was measured using modified Thorington method. RESULTS: One hundred and fifty subjects participated in the study. We found that NPC receded with age, which could because of the increase in horizontal phoria at near with age. The mean normative value for objective NPC, break and recovery of subjective NPC, monocular and binocular AA, horizontal and vertical phoria at distance and near for the three age groups are reported in the study. CONCLUSION: The data presented in this study can be used as a cut-off by eye care practitioners while diagnosing convergence, accommodation related anomalies in Indian population.

Virtually controlled computerised visual acuity screening in a multilingual Indian population.

INTRODUCTION: The efficacy of tele-based (virtually monitored) visual acuity (VA) examination in a hospital-based multilingual population was assessed based on subjects from the Outpatient Department of Optometry, School of Allied Health Sciences, Manipal University and Department of Ophthalmology, Kasturba Medical College, Manipal, India. METHODS: Visual acuity measurement using a computerized VA chart (COMPlog) was done using a telemethod and face-to-face method in a randomized fashion for all subjects. Virtual (remotely operated) control of examination procedure and video-conferencing helped the optometrist positioned elsewhere (different physical location) to remotely operate the COMPlog VA chart and also interact with the subjects. The connection was facilitated using Lync software connected through local area network connections. During tele-examination, instructions were given on subject's language preference (Kannada, Malayalam or English). RESULTS: Mean age of 96 subjects (three language groups) was 40.3±14.1 years and a Bland-Altman plot showed good agreement with clinically acceptable limits of agreement. The mean difference in VA between the telemethod and face-to-face method was 0.00 logMAR (±0.16), p=0.844. Two methods had good intra-class correlation (0.912, 95% confidence interval 0.868-0.941) and had good agreement across the language groups (kappa>0.7). CONCLUSIONS: Visual acuity measurements using the telemethod along with native dialect was comparable to conventional face-to-face method in a hospital-based multilingual population. Digital VA testing systems along with communication in native dialect can be effectively integrated into a tele-eyecare model.

Development of Pocket Vision Screener and its effectiveness at screening visual acuity deficits.

AIM: The aim was to construct a visual acuity chart and find its effectiveness at screening visual acuity deficits. MATERIALS AND METHODS: Two phases were involved in this study.Construction of the screener: Ten Sloan letters (C, D, H, K, N, O, R, S, V, and Z) were selected and the letters were constructed and reduced to 0.2 logMAR acuity size (6.92 mm) for viewing at 3 m. The screener contains three lines with seven letters in each. Few combinations of the seven letter sequences were chosen based on the row legibility scores. Three seven letter combinations close to the median of all combinations were selected, such that maximum difficulty score difference between the lines are <1%. Finding the effectiveness of the screener: 100 literate subjects with unaided visual acuity better than or equal to 6/60 were recruited for the study. Unaided visual acuity was tested using both the newly constructed Pocket Vision Screener and a logMAR visual acuity chart and the time taken to measure the visual acuity using both the charts was noted. RESULTS: The mean age of the subjects was 43 ± 17 years. Subjects were classified as normal or deficient based on the logMAR visual acuity measurement. The screener was found to have 81% sensitivity, 94% specificity. The positive and negative predictive values were found to be 91% and 87%, respectively. A significant difference (P < 0.001) was found in the time taken to record visual acuity using both the charts. CONCLUSION: The Pocket Vision Screener can be used as a quick and accurate tool to screen subjects for visual acuity deficits, being highly sensitive, specific, and cost-effective.

Efficacy of a remote based computerised visual acuity measurement.

AIM: To determine the efficacy of a remotely operated computer-based logarithmic (logMAR) visual acuity chart. METHODS: Visual acuity was tested using a laptop or computer-based logMAR chart (COMPlog) for all subjects by two different methods. The methods differed by the physical presence and absence (remote) of an optometrist and in the mode of instructions provided. Remote access was obtained through the internet, using Teamviewer software to control the system linked to COMPlog and instructions were provided by telephone. The order of measurements and the eye to be tested was randomised. logMAR visual acuity and time taken were recorded. A questionnaire was used to assess the participant's feedback. RESULTS: Intraclass correlation for visual acuity between the two methods (α=0.964, 95% CI 0.937 to 0.979). There was no statistically significant difference (p=0.648) in the median visual acuity measurement between the two methods (median difference 0.00, IQR 0.20 logMAR). The time taken between the two methods was not statistically significant (p=0.457). There was no significant difference in the responses to the questionnaire between the study methods (p=0.119). CONCLUSIONS: Tele (remotely controlled) visual acuity measurement is as reliable as that measured with the physical presence of an optometrist.

Construction and validation of a Tamil logMAR chart.

PURPOSE: To design, construct and validate a new Tamil logMAR visual acuity chart based on current recommendations. METHODS: Ten Tamil letters of equal legibility were identified experimentally and were used in the chart. Two charts, one internally illuminated and one externally illuminated, were constructed for testing at 4 m distance. The repeatability of the two charts was tested. For validation, the two charts were compared with a standard English logMAR chart (ETDRS). RESULTS: When compared to the ETDRS chart, a difference of 0.06 +/- 0.07 and 0.07 +/- 0.07 logMAR was found for the internally and externally illuminated charts respectively. Limits of agreement between the internally illuminated Tamil logMAR chart and ETDRS chart were found to be (-0.08, 0.19), and (-0.07, 0.20) for the externally illuminated chart. The test - retest results showed a difference of 0.02 +/- 0.04 and 0.02 +/- 0.06 logMAR for the internally and externally illuminated charts respectively. Limits of agreement for repeated measurements for the internally illuminated Tamil logMAR chart were found to be (-0.06, 0.10), and (-0.10, 0.14) for the externally illuminated chart. CONCLUSIONS: The newly constructed Tamil logMAR charts have good repeatability. The difference in visual acuity scores between the newly constructed Tamil logMAR chart and the standard English logMAR chart was within acceptable limits. This new chart can be used for measuring visual acuity in the literate Tamil population.