Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia.

SIGNIFICANCE: Among 4- and 5-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3 to 6 diopters [D]) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc). PURPOSE: To compare attention, visual motor, and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten and evaluate their associations with visual function. METHODS: Participants were 4 and 5 years of age with either hyperopia (≥3 to ≤6 D, astigmatism ≤1.5 D, anisometropia ≤1 D) or emmetropia (hyperopia ≤1 D; astigmatism, anisometropia, and myopia each <1 D), without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive, and expressive), VMI, and VP. Binocular visual acuity, stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent's/caregiver's education. RESULTS: Two hundred forty-four hyperopes (mean, +3.8 ± [SD] 0.8 D) and 248 emmetropes (+0.5 ± 0.5 D) completed testing. Mean sustained attention score was worse in hyperopes compared with emmetropes (mean difference, -4.1; P < .001 for 3 to 6 D). Mean Receptive Attention score was worse in 4 to 6 D hyperopes compared with emmetropes (by -2.6, P = .01). Hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes (-6.4, P < .001 for sustained attention; -3.0, P = .004 for Receptive Attention; -0.7, P = .006 for VMI; -1.3, P = .008 for VP). Hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes (-6.7, P < .001 for sustained attention; -3.4, P = .03 for Expressive Attention; -2.2, P = .03 for Receptive Attention; -0.7, P = .01 for VMI; -1.7, P < .001 for VP). Overall, hyperopes with better near visual function generally performed similarly to emmetropes. CONCLUSIONS: Moderately hyperopic children were found to have deficits in measures of attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.

Quality of life for amblyopic children and their parents.

AIM: To highlight the changes in the quality of life in patients with anisometric, refractive, strabic and mixed amblyopia and to assess the psychosocial implication for their family. MATERIAL AND METHODS: Prospective observational transversal study of 44 ambulatory pa- tients (88 eyes) treated in the Ophthalmology Clinic of Iasi "Sf. Spiridon" Hospital and Iasi Stereopsis Ophthalmology Clinic. Clinical parameters: visual acuity, objective refraction (autorefractometry), optical correction type, stage of binocular vision, ocular motility, strabic deviation. The patients or their attendants accepted to fill out a questionnaire comprising 46 items pertaining to 9 domains to assess patient (or parents) adherence to treatment and issues related to quality of life. RESULTS: Mean age of study patients was 8.19 ± 2.92 years (range 4-16 years) and age at first diagnosis was: 3.90 ± 2.15 years. Moderate and severe amblyopia in the right eye was present in 47.72% of cases and in the left eye in 43.18%. Right eye uncorrected visual acuity was 0.45 ± 0.31 and corrected 0.63 ± 0.31 (p < 0.0001). Left eye uncorrected visual acuity was 0.49 ± 0.33 and corrected was 0.69 ± 0.32 (p < 0.0001). No statistically significant difference between the right and left eye were found. A 46-item questionnaire focused on child health, visual acuity, binocular vision, time to occlusion or penalization, child emotions/activity, family and society integration was used. CONCLUSIONS: The first presentation to the ophthalmologist was at age 3.9091 ± 2.1597 years (range 3 months-7 years). Health promotion and education is important to determine parents to seek help from an ophthalmologist not later than age 3. The main symptoms that led the parents to seek eye care were: strabic deviation--45.45%, difficulty seeing the blackboard--11.36%, and difficulty in seeing closer--20.45%. Quality life questionnaires detect life or school problems of children with amblyopia and educate parents. In 15.91% of parents they did not knew that before treatment the child had poor school results. This study represents the first step in Romanian ophthalmologists concern for socio-professional integration of children with amblyopia, because as we know some jobs require healthy eyes and for those who do not receive appropriate treatment their dream will be denied.

Patient satisfaction and clinical outcomes with laser refractive surgery performed by surgeons in training.

PURPOSE: To evaluate the refractive error quality of life (RQL) improvement, patient satisfaction, and clinical results of laser refractive surgery performed by residents or fellows. SETTING: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. DESIGN: Case series. METHODS: This study reviewed the clinical results of consecutive refractive surgery cases performed between March 2010 and February 2012 by ophthalmology residents or fellows. One-year postoperative analysis of the RQL and patient satisfaction in a subgroup of patients was completed using the National Eye Institute Refractive Error Correction Quality of Life-42 instrument (NEI RQL-42), and a comparison with NEI published normative data and post-refractive data was performed. RESULTS: Data were obtained from 138 eyes that had laser in situ keratomileusis and 4 eyes that had photorefractive keratectomy. The 1-year postoperative analysis of the RQL and patient satisfaction was completed in 34 patients. After 6 months postoperatively, the mean uncorrected distance visual acuity was 0.01 logMAR (95% confidence interval [CI], -0.012 to 0.023). The mean postoperative residual refractive error spherical equivalent was -0.20 diopter (D) (95% CI, -0.26 to -0.13). No eye lost corrected distance visual acuity. Equivalent or better satisfaction in the RQL was found in all but 1 of the 13 scale scores of the NEI RQL-42 compared with previously published NEI data. CONCLUSIONS: Laser refractive surgery performed by residents and fellows showed high patient satisfaction and an improved RQL 1-year postoperatively. Clinical outcomes validated the safety and efficacy of refractive surgery performed by surgeons in training. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Healthy aging for older adults with intellectual and development disabilities.

The number of older adults with intellectual and developmental disabilities (IDD) has increased rapidly in the United States as part of the general "graying"of the country. This has presented challenges in maintaining the quality of life and health for these individuals in later years. Issues including diagnostic overshadowing (the tendency to overlook symptoms of mental or physical illness as causes for decline), lack of knowledge about aging in adults with IDD, and health care disparities are discussed in this article along with recommendations for clinicians to help them meet this growing challenge.

The association between schoolchildren intelligence and refractive error.

PURPOSE: The relationship between refractory errors and intelligence and the importance of genetic, regional and environmental factors in such associations, were investigated in a group of school children. SUBJECTS AND METHODS: One hundred and thirty-seven students (34.3% boys and 65.7% girls) from two primary schools were enrolled in the study. Cycloplegic refraction was performed and a spherical equivalent (SE) > or = 0.5D were determined as hyperopia; <-0.5D myopia and <1 cyl D astigmatism. Demographic factors, parent's education level, teacher based assessment of school performance and average score were also evaluated. RESULTS: Seventy-eight (56.9%) of subjects showed a form of refractory error; 27%, 3% and 2.9% were myope, hyperope or astigmat, respectively, whereas 12.4% of them had both myopia and astigmatism and 10.2% showed hyperopia and astigmatism; 43.1% were normal. CONCLUSIONS: Although our data revealed no distinction of average score between normal group and myopia, hyperopia, astigmatism or hyperopia-astigmatism, there is a statistically significant difference between normal group and those who had both myopia and astigmatism in which the later had a lower mediocre. Our results is somehow in contrast with other parallel studies demonstrating that positive connection between school performance and myopia can be explained by the geographical or racial discrepancies as well as subjects involved in the study and divergent set of cut off limits.

[Quality of life after Lasik: part I. Validation of the French translation of the NEI-RQL-42 scale]. / Qualité de vie après Lasik : partie I. Validation de la traduction française de l'échelle NEI-RQL-42.

INTRODUCTION: The objective of this study was to bring some validation elements to a French adaptation of an American refraction-related quality of life scale, as applied to a population of Lasik patients. METHODS: The NEI-RQL-42 scale was developed in 2003 in the United States. It comprises 42 questions and 13 scores exploring quality of vision, functional symptoms, influence of refraction on daily activities and psychological impact. The authors propose here a French adaptation and elements for its validation (internal consistency, discriminating validity and external validity). These were assessed through an observational cross-sectional study, performed in one center on all patients consecutively treated with Lasik between January and March 2008. RESULTS: The study sample (307 patients) has the expected characteristics of Lasik-treated patients. The French adaptation of the NEI-RQL-42 has a good internal consistency with Cronbach's coefficients greater or equal to 0.7 for 10 scores out of 12. The discriminating validity of the scale was shown though the reference groups techniques: quality of life is generally lower in severe hyperopes compared with non-severe myopes. The scale's external validity is confirmed by the comparison of its results to those of a satisfaction questionnaire that was simultaneously sent to patients. CONCLUSION: The results obtained are favorable arguments for the validity of the proposed French adaptation of the NEI-RQL-42. This is the first scale available in French to assess refraction-related quality of life.

The impact of corrected and uncorrected refractive error on visual functioning: the Singapore Malay Eye Study.

PURPOSE: To determine the impact of corrected and uncorrected myopia and hyperopia on visual functioning in an urban Malay population. METHODS: The Singapore Malay Eye Study is a population-based, cross-sectional study of Singaporean Malays aged 40 to 80 years. Myopia was defined as spherical equivalence (SE) 1.0 D, and emmetropia as SE -0.5 to 1.0 D in the better eye. Uncorrected myopia and hyperopia were defined as at least a 2-line difference between habitual and best corrected VA in persons with myopia or hyperopia, respectively. Visual functioning was assessed with the VF-11 scale. RESULTS: Of 2912 participants, 441 (15.1%) and 213 (7.3%) had corrected or uncorrected hyperopia and 333 (11.4%), and 131 (4.5%) had corrected or uncorrected myopia, respectively. Of those, 249 (8.6%) participants were considered emmetropic with a >2-line difference between habitual and best corrected vision, and 1543 (53.1%) participants had a

[Treatment strategy for the organ of vision in patients with somatic diseases in relation to the psychological status].

Two hundred and fifty patients aged 25 to 50 years were examined. Arterial hypertension (AH) was diagnosed in 144 persons; its mean history was 4.35 +/- 0.5 years. Insulin-independent diabetes mellitus (IIDM) and AH were observed in 71 patients; the mean history of IIDM was 3.43 +/- 0.3 years. The patients were diagnosed as having eye diseases: mild myopia and hyperopia, first- and second-degree hypertensive angioretinopathy, and diabetic angiopathy. The purpose of the study was to assess treatment compliance for eye diseases in patients with AH and IIDM in relation to the psychological status. Treatment compliance for eye diseases in patients with AH and IIDM was found to be poor. Mild depression had no significant impact on treatment compliance for eye diseases. The patients with IIDM and diagnosed eye abnormalities without signs of depression were ascertained to take drugs to stabilize visual functions more frequently than those with eye abnormalities and AH.

Hyperopia and emergent literacy of young children: pilot study.

PURPOSE: To compare emergent literacy skills in uncorrected hyperopic and emmetropic children. METHODS: "Hyperopes" (>or=2.00 D sphere along the most hyperopic meridian; n=13; aged 67+/-13 mo) and "emmetropes" (

Could personality traits modify the response to uncorrected high hyperopia?

PURPOSE: We aimed to measure temperament and investigate personality in children with high hyperopia considering that these could modify the individual response to uncorrected high hyperopia. METHODS: Fifteen children (age range, 5 to 12 years) with orthotropia and ametropic amblyopia in the presence of uncorrected high hyperopia were identified (group 1). Among the children with refractive accommodative esotropia, 15 children (age range, 5 to 12 years) were enrolled to form group 2. We measured the temperament by using the Children's Behavior Questionnaire (CBQ) Short Form. The Children's Apperception Test (CAT-H) was also administered to all subjects. RESULTS: Regarding the temperament scales measured by CBQ, themes of discomfort, fear, and shyness were more dominant in group 2; high-intensity pleasure and smiling-laughter were dominant in group 1. However the difference was statistically significant only for fear scale (P = 0.045). CAT-H results revealed that aggression toward the parents was the most commonly encountered behavioral pattern in both groups. The children in group 1 were more likely to express passive-aggressive behavioral pattern. Obstinacy and anal period characteristics dominate in the children in group 2. Themes of narcissistic injury was more frequently expressed by these children. CONCLUSION: The temperament scales and personality traits could play a role in the modification of the individual response to uncorrected high hyperopia. This finding deserves more research in a larger study group.

Hyperopia and educational attainment in a primary school cohort.

BACKGROUND: Vision screening addresses the visual impairments that impact on child development. Tests of long-sightedness are not found in most school screening programmes. The evidence linking mild-moderate hyperopia and lack of progress in school is insufficient, although strengthened by recent findings of developmental problems in infants. AIMS: To report on the relation between hyperopia and education test results in a cohort of primary school children. METHODS: A total of 1298 children, aged 8 years, were screened for hyperopia on the basis of fogging test results. School test results (NFER and SATs) were compared between groups categorised by referral status and refractive error. RESULTS: A total of 166 (12.8%) fogging test failures were referred for ophthalmic assessment. Ophthalmic tests on 105 children provided an accurate diagnosis of vision defects, for reference to their education scores. Fifty per cent of the children examined by optometrists required an intervention (prescription change, glasses prescribed, or referral). Mean (95% CI) NFER scores of children with refractive errors (summed for both eyes) >+3D (98.4, 93.0-103.8, n = 32) or >+1.25D (best eye) (99.3, 93.0-105.6, n = 26) were lower than the respective scores of children with a less positive refractive state (104.8, 100.7-108.9, n = 43) (103.6, 99.7-107.4, n = 49), the non-referred group, and total sample. The SATs results followed a similar trend. A high proportion of the fogging test failures (16%) and confirmed hyperopes (29%) had been referred to an educational psychologist, and the latter group contributed substantially to the poor education scores. CONCLUSIONS: The results of this study provide further evidence for a link between hyperopia and impaired literacy standards in children.

[Predictors of quality of life in refractive surgery]. / Les prédicteurs de qualité de vie en chirurgie réfractive.

PURPOSE: To investigate predictors of quality of life in refractive surgery: psychological status, quality of vision, visual acuity, and patient satisfaction. METHODS: In a prospective study, 143 patients were evaluated preoperatively and after the third postoperative month using the same questionnaire. Quality of vision, visual acuity, well-being, self-esteem, coping, and patient satisfaction were analyzed with 47 parameters. Refractive procedures included PRK, LASIK, and phakic IOL. Four groups of low (G1), medium (G2), and high myopia (G3) and hyperopia (G4) were individualized to compare the results. RESULTS: We noted a mean postoperative best corrected visual acuity (BCVA) of 20/25 or more for the G1, G2, and G4 groups. For the G3 group, the mean BCVA was increased, with a gain of two Snellen Lines from 20/50 to 20/32. Postoperative patient satisfaction improved, with a significant difference (p<0.05) in all groups. We noted no significant difference in all myopic groups in well-being and no significant decrease in G4. Concerning self-esteem and coping, scores improved, with a significant difference in G3 group (p<0.05). Quality of vision was directly correlated with improvement of quality of life (psychological status), satisfaction scores, and BCVA preoperatively and postoperatively in all patients, but no correlation was noted between visual acuity and patient satisfaction. CONCLUSION: In spite of good refractive results, modification of patient satisfaction depends on quality of vision and quality of life (psychological status) scores. These results give us a new tool that provides useful additional information in refractive surgery.

The influence of the Stiles-Crawford peak location on visual performance.

We investigated the influence of the Stiles-Crawford peak location on visual acuity, contrast sensitivity and phase transfer with 6 mm diameter pupils in two subjects. Apodising filters were used to move the peak. One subject (SM) had her natural peak 0.9 mm below pupil centre, and visual performance was measured for both this peak position and when the peak was moved to the same distance above pupil centre. The other subject (DAA) had a more centred peak and visual performance was measured for this peak position and when the peak was moved both 2.3 mm temporally and 2.6 mm nasally. Measurements of contrast sensitivity and phase transfer were compared with predictions based on aberration measurements. The peak position had definite influence on performance, but this was mainly noticeable when subjects were defocused e.g. SM's visual acuity was reduced by 0.13 log units under the peak-shifted condition at -2D (hypermetropic) defocus.

The relationship between moderate hyperopia and academic achievement: how much plus is enough?

BACKGROUND: There is evidence linking uncorrected hyperopia in children with academic learning problems. METHODS: This study was designed to test that hypothesis and--given supportive data--to then address a second topic: the minimal amount of uncorrected hyperopia that appears to impede elementary school performance. RESULTS: The refractive status and achievement test scores of 782 first-through-fifth grade children were compared. CONCLUSIONS: Statistical analysis indicated significantly lower achievement test scores among hyperopic children whose refractive errors exceeded 1.25 D (ANOVA F = 12.51; df = 4; p = 0.014).

Consequences of monocular diplopia for the contrast sensitivity function.

Though the human eye generally creates a single image on the retina, the literature contains many examples showing perceptual monocular diplopia. Previously, monocular diplopia resulting from astigmatic defocus has been demonstrated to cause a notch (local minimum) in the contrast sensitivity function (CSF). We examine Verhoeff's (1900) model which explains how monocular diplopia can occur through an interaction between defocus and common ocular aberrations. From the measured ocular transverse aberration function and from the measured monocular diplopia of three cyclopleged subjects we predicted multiple notches in the CSF with hyperopic spherical defocus. Monochromatic and polychromatic CSF were measured for vertical gratings with best refraction and with simulated myopia and hyperopia. Multiple notches in CSF were observed experimentally. Notches in the polychromatic CSF were smaller and broader than those found in the monochromatic CSF. Our aberration model was successful in predicting notches in the CSF with hyperopic spherical defocus. The implications for clinical measurement of CSF are discussed.

Refractive error, IQ and reading ability: a longitudinal study from age seven to 11.

Children from a population sample whose cycloplegic refractive errors included myopia, pre-myopia and hypermetropia were compared on measures of IQ and reading with a group of children without significance refractive errors. At age 11 both those with myopia and with pre-myopia had increased verbal and performance IQ, while those with hypermetropia had slightly reduced verbal and performance IQ, in comparison with the children without refractive errors. The differences in verbal IQ were not attributable simply to earlier differences, but the differences in performance IQ were attributable to earlier differences. No significant differences in reading scores were found at either age. It is concluded that differing abilities of myopic and other children at age 11 are not fully explained by differences in family background or in pre-existing ability.

An illusion of reversed direction in hyperopes.

If a subject who is sufficiently farsighted removes his corrective, positive, lenses and looks with one eye from a distance of one or a few meters, at a small lighted area such as the (continuously "on") indicator light of an electric toothbrush, razor, or smoke detector, and if a small object such as a pin is then moved slowly from above to below the subject's eyes (in a plane close to the eye), the subject will perceive the object moving normally from above to below until it encroaches on his view of the lighted area. The object will then be seen to encroach first on the bottom of the lighted area, and as the object continues to move down it will be seen to be moving up across the lighted area, exiting the lighted area at the top. Similarly, an object moved in front of the eye from the subject's left to his right will be seen by the subject to traverse the lighted area in the reverse direction, right to left, even though the subject moves the object himself. Also, while the object is in front of the lighted area, it is perceived as an upside down silhouette having surprisingly clear and sharp edges, and it appears to be located on the lighted area rather than close to the eye where it really is.

Vision and academic performance of learning disabled children.

The purpose of this study was to assess difference in academic performance among myopic, hyperopic, and emmetropic children who were learning disabled. More specifically, myopic children were expected to perform better on mathematical and spatial tasks than would hyperopic ones and that hyperopic and emmetropic children would perform better on verbal measures than would myopic ones. For 439 learning disabled students visual anomalies were determined via a Generated Retinal Reflex Image Screening System. Test data were obtained from school files. Partial support for the hypothesis was obtained. Myopic learning disabled children outperformed hyperopic and emmetropic children on the Key Math test. Myopic children scored better than hyperopic children on the WRAT Reading subtest and on the Durrell Analysis of Reading Difficulty Oral Reading Comprehension, Oral Rate, Flashword, and Spelling subtests, and on the Key Math Measurement and Total Scores. Severity of refractive error significantly affected the Wechsler Intelligence Scale for Children--Revised Full Scale, Performance Scale, Verbal Scale, and Digit Span scores but did not affect any academic test scores. Several other findings were also reported. Those with nonametropic problems scored higher than those without problems on the Key Math Time subtest. Implications supportive of the theories of Benbow and Benbow and Geschwind and Behan were stated.

Eye classification, sex, and math anxiety in learning disabled children: behavioral observations on conservation of volume.

Benbow and Benbow suggest that myopia and maleness are advantages in mathematical giftedness; however, the influence of these biological correlates on learning disabilities is not yet as clearly defined. 29 learning disabled children (aged 7-13 yr; eye class diagnosed) performed two Piagetian tasks on conservation of volume, one using numbered blocks to rebuild an original house whose "rooms" were cued by an illogically ordered system, and one using plain blocks to recreate an unnumbered house. A modification of the Preschool Observation Scale of Anxiety was used to observe frequencies of overt physiological behavioral indicators of anxiousness during task performances. No significance was noted by eye class; however, a significant interaction of sex by task did occur. Means differed by sex significantly on the numbered tasks. Implications are discussed in terms of certainty times versus correctness and facilitative versus debilitative anxiety.