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Indian Journal of Ophthalmology Aug 2022Research and awareness on refractive solutions for presbyopia, commonly known as the "Curse of the 40's," is essential as a large population in the world suffer from...
BACKGROUND
Research and awareness on refractive solutions for presbyopia, commonly known as the "Curse of the 40's," is essential as a large population in the world suffer from vision impairments. Population-based surveys have shown that one billion people in the world are in presbyopic age.
PURPOSE
Many structural and physiological changes occur in the eye with the onset of presbyopia, including the decrease in amplitude of accommodation. At present, various static and dynamic techniques have been attempted to give presbyopes good vision at near-, intermediate-, and far-viewing distances. The aim of the video is to familiarize the modern-day ophthalmologists to these modalities.
SYNOPSIS
In this video, we tried to summarize the indications and contraindications of presbyopic laser. Preoperative investigations like dominance testing and micro monovision testing are described. The role of neuroadaptation and patient counselling is emphasized. Static techniques described in the video include spectacles, contact lenses, surgical options like corneal inlays and onlays, corneal laser ablation, conductive keratoplasty, corneal implant lenses, INTRACOR and IOLs. Dynamic presbyopia correction (accommodative) is always surgical. This is split into lenticular (accommodating IOLs, piggyback, lens refilling, lentotomy) and scleral treatment (laser-assisted presbyopia reversal and scleral expansion bands).
HIGHLIGHTS
The types of corneal laser ablation, which is otherwise very confusing, is elaborated in a step-wise manner here. The difference in approach of PresbyLasik (Nidek), Presbyond (Zeiss) - Laser Blended Vision, PresbyMax (Schwind), INTRACOR (Technolas) are explained with examples. Each approach has its pros and cons. Our challenge as a surgeon is to identify the best combination for the patient. This video illustrates the treatment options which can help break the curse of presbyopia.
ONLINE VIDEO LINK
https://youtu.be/rTxMIqMrgaw.
Topics: Accommodation, Ocular; Contact Lenses; Eyeglasses; Humans; Presbyopia; Vision Tests
PubMed: 35919011
DOI: 10.4103/ijo.IJO_1086_22 -
Romanian Journal of Ophthalmology 2020Idiopathic Intracranial Hypertension (IIH) is a disease of elevated intracranial pressure without any known cause. Visual dysfunction is the major morbidity of this...
Idiopathic Intracranial Hypertension (IIH) is a disease of elevated intracranial pressure without any known cause. Visual dysfunction is the major morbidity of this disease but not much is known about the way the contrast sensitivity (CS) function is affected. This prospective, interventional study attempted to evaluate the change in central and peripheral contrast sensitivity, after treatment in patients diagnosed with IIH. Twenty eyes of 10 IIH patients underwent an internet based, Spaeth Richman Contrast Sensitivity (SPARCS) test. Average and quadrant wise SPARCS scores were compared at presentation (treatment naïve), 1-month post treatment and 3 months post treatment. The average SPARCS scores pre-treatment, 1-month post-treatment and at 3 months post treatment were 68.8 + 10.16, 74.45 + 11.17 and 75.7 + 10.81 respectively. At 3 months visit, the average SPARCS score was nearly comparable to the average score in normal Indian subjects, observed in a previous study of ours. Quadrant wise change in contrast sensitivity from first visit to third visit was significant in superonasal (p=0.003), inferonasal (p=0.029) and inferotemporal (p= 0.007) quadrants. Effect of IIH on visual system is still a relatively unexplored area, especially in the Indians. Not many studies have concentrated on its impact on central as well as peripheral CS. Previous studies have hinted at a possible role of CS as a better indicator of visual dysfunction than other parameters. IIH affects both central and peripheral contrast sensitivity and therapy results in the improvement of contrast deficit. Poor contrast can possibly be explained by relatively more involvement of Magnocellular pathway over the Parvocellular pathway. IIH = Idiopathic Intracranial Hypertension, CS = Contrast Sensitivity, SPARCS = Spaeth Richman Contrast Sensitivity Test, BMI = Body Mass Index, MC = Magnocellular pathway, PC = Parvocellular pathway.
Topics: Adult; Contrast Sensitivity; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Pseudotumor Cerebri; Vision Tests; Visual Acuity; Visual Fields; Young Adult
PubMed: 33367175
DOI: 10.22336/rjo.2020.59 -
Nigerian Journal of Clinical Practice Mar 2022To determine the prevalence and pattern of uncorrected refractive error among staff of a Nigerian university.
AIMS AND BACKGROUND
To determine the prevalence and pattern of uncorrected refractive error among staff of a Nigerian university.
PATIENT AND METHODS
A cross-sectional study of consecutive staff of the University of Nigeria, Nsukka, Nigeria who presented for a 10-day free eye screening program. Demographic data and data on eye care awareness and knowledge were obtained with a combination of self-administered and interviewer-administered questionnaires in the English language. Clinical examinations included visual acuity taken at 6 m with Snellen's chart; noncontact tonometry; pen-torch eye examination; and direct ophthalmoscopy; autorefraction and subjective refraction.
RESULTS
One thousand and eighty-three subjects aged 18-82 years (mean = 44.1 ± 12.15 years) comprising 568 females (52.4%) and 515 males (47.6%) were screened. Eighty-nine subjects (8.3%) were visually impaired and five subjects (0.5%) were blind. Three hundred and fifty-six subjects were diagnosed with refractive error (356/1083; 32.9%), out of which 149 subjects (41.9%) were uncorrected. The prevalence of uncorrected refractive error in this study population was 13.8%. Astigmatism was the commonest refractive error, whereas hypermetropia and hypermetropic astigmatism were the commonest spherical and astigmatic errors, respectively.
CONCLUSION
A significant proportion of the staff of this Nigerian university still lives with uncorrected refractive error with its attendant consequences. Regular eye checks should be done by the staff of our universities and effort should be intensified in eye care awareness creation among the populace, including the apparently enlightened communities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Refractive Errors; Universities; Vision Tests; Visual Acuity; Young Adult
PubMed: 35295061
DOI: 10.4103/njcp.njcp_1603_21 -
International Journal of Environmental... Nov 2021Driving is the main mode of transportation in many countries, and visual safety depends largely on good visual health. The objective of this study is to analyze the...
BACKGROUND
Driving is the main mode of transportation in many countries, and visual safety depends largely on good visual health. The objective of this study is to analyze the visual health of Spanish drivers; as well as analyze the difference between professional and non-professional drivers.
METHODS
A visual screening was carried out in Spanish drivers from all over Spain, in which the following tests were performed: monocular visual acuity in distance and near vision, visual field, stereopsis, contrast sensitivity, intraocular pressure and balance test binocular. Subsequently, a questionnaire was carried out on the patient's driving data and ocular antecedents.
RESULTS
74.5% of the drivers used glasses to drive, of which 61.5% used progressive glasses. However, 39.4% reported having difficulties seeing well. The mean visual acuity in the distance and near was 0.93 ± 0.13 and 0.94 ± 0.13, respectively. Significant differences have been found in accident risk based on visual acuity ( < 0.001). But no significant differences have been found in terms of visual field, stereopsis, contrast sensitivity, binocular balance and intraocular pressure ( > 0.05).
CONCLUSION
Vision appears to play a key role in driving and a good visual assessment is recommended for early detection of visual problems that may affect road safety. A study with a larger sample size would be necessary to confirm the results of this pilot study.
Topics: Accidents, Traffic; Automobile Driving; Humans; Pilot Projects; Vision, Ocular; Visual Acuity
PubMed: 34831870
DOI: 10.3390/ijerph182212116 -
Optometry and Vision Science : Official... Jan 2023There are limited treatment options for myopia management of patients with moderate to high astigmatism. This work directly compares toric orthokeratology and soft toric... (Randomized Controlled Trial)
Randomized Controlled Trial
SIGNIFICANCE
There are limited treatment options for myopia management of patients with moderate to high astigmatism. This work directly compares toric orthokeratology and soft toric multifocal lenses to show differences in visual acuity and patient satisfaction that could impact clinical care. Toric orthokeratology caused reduced visual acuity but was preferred subjectively for vision and overall.
PURPOSE
This study aimed to quantify objective and subjective clinical differences between toric orthokeratology and soft toric multifocal contact lenses in the same cohort of myopic wearers with moderate to high astigmatism.
METHODS
Thirty adults with refractive myopia (plano to -5.00 D) and astigmatism (1.25 to 3.50 D) were fitted empirically with both toric orthokeratology and soft toric multifocal contact lenses. Participants wore lenses for 10 days in random order, separated by a 14-day washout period. High-contrast visual acuity, low-contrast visual acuity, and glare logMAR visual acuity were measured. Surveys ascertained subject preference for comfort, vision, handling, and cost. Friedman, Wilcoxon signed rank, and χ2 tests were performed.
RESULTS
A subset of participants (n = 17) who achieved good vision with both lens types was analyzed. High-contrast and glare acuity with toric orthokeratology were reduced by one line compared with soft toric multifocal lenses (both 0.00 vs. -0.10, P ≤ .003). Participants preferred toric orthokeratology for vision ( P ≤ .03) but soft toric multifocal lenses for handling ( P ≤ .006). When forced to choose between lens types, participants preferred toric orthokeratology for vision and overall (both P ≤ .007).
CONCLUSIONS
Participants who achieved good vision with both lens types preferred toric orthokeratology over soft toric multifocal lenses, despite reduced high-contrast and glare visual acuity. Further research is needed to understand the relationship between visual performance and patient satisfaction.
Topics: Adult; Humans; Astigmatism; Visual Acuity; Refraction, Ocular; Myopia; Contact Lenses, Hydrophilic
PubMed: 36705710
DOI: 10.1097/OPX.0000000000001969 -
BMJ Open Sep 2021Vision problems affect academic performance, social and mental health. Most traditional vision screening methods rely on human expert assessments based on a set of...
INTRODUCTION
Vision problems affect academic performance, social and mental health. Most traditional vision screening methods rely on human expert assessments based on a set of vision tests. As technology advances, new instruments and computerised tools are available for complementing vision screening. The scoping review based on this protocol aims to investigate current technologies for vision screening, what vision tests can be complemented by technologies, and how these can support vision screening by providing measurements.
METHODS AND ANALYSIS
The planned review will utilise the PRISMA extension for Scoping Reviews (PRISMA-ScR) tool. Electronic search will be performed in databases, including Web of Science, MEDLINE (Ovid), Scopus, Engineering Village, Cochrane and Embase. We will perform a systematic search in selected reference databases without the limitation on publications dates, or country of studies. Reference management software, like EndNote and DistillerSR, will be used to remove duplicate entries. Two authors will independently analyse the studies for inclusion eligibility. Conflicts will be resolved by discussion. We will extract the types of technologies, types of vision tests they complement and the measurements for the included studies. Overall findings will be synthesised by thematic analysis and mapping to the logic model.
ETHICS AND DISSEMINATION
Ethical approval is not required for this review, as it will only summarise existing published data. We will publish the findings in an open access, peer-reviewed journal. We expect that the review results will be useful for vision screening experts, developers, researchers, and policymakers.
Topics: Humans; Mental Health; Peer Review; Review Literature as Topic; Systematic Reviews as Topic; Technology; Vision Screening
PubMed: 34475181
DOI: 10.1136/bmjopen-2021-050819 -
Indian Journal of Ophthalmology Feb 2021The objective of this study was to identify and validate smartphone-based visual acuity (VA) apps that can be used in a teleophthalmology portal.
PURPOSE
The objective of this study was to identify and validate smartphone-based visual acuity (VA) apps that can be used in a teleophthalmology portal.
METHODS
The study was conducted in three phases: A survey to investigate if the SmartOptometry App was easy to download, understand and test (phase I), an in-clinic comparison of VA measured in a random testing order with four tools namely COMPlog, Reduced Snellen near vision, Peek Acuity (Distance VA) and SmartOptometry (Near VA) (phase II) and a repeatability study on these 4 tools by measuring VA again (phase III). The study recruited the employees of our institute and adhered to the strict COVID-19 protocols of testing.
RESULTS
Phase I Survey (n = 40) showed 90% of participants used android phones, 60% reported that instructions were clear, and all users were able to self-assess their near VA with SmartOptometry App. Phase II (n = 68) revealed that Peek Acuity was comparable to COMPlog VA (P = 0.31), however SmartOptometry was statistically significantly different (within 2 log MAR lines) from Reduced Snellen near vision test, particularly for young (n = 44, P = 0.004) and emmetropic (n = 16, P = 0.04) participants. All the 4 tests were found to be repeatable in phase III (n = 10) with a coefficient of repeatability ≤0.14.
CONCLUSION
Smartphone-based apps were easy to download and can be used for checking patient's distance and near visual acuity. An effect of age and refractive error should be considered when interpreting the results. Further studies with real-time patients are required to identify potential benefits and challenges to solve.
Topics: Adult; Aged; COVID-19; Comorbidity; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mobile Applications; Ophthalmology; Pandemics; Prospective Studies; Refractive Errors; Reproducibility of Results; SARS-CoV-2; Smartphone; Telemedicine; Vision Tests; Visual Acuity; Young Adult
PubMed: 33380619
DOI: 10.4103/ijo.IJO_2333_20 -
Journal of Optometry 2021Phoria measurements form a routine part of the examination of binocular vision. Various studies have compared different methods of phoria measurement and their... (Comparative Study)
Comparative Study
PURPOSE
Phoria measurements form a routine part of the examination of binocular vision. Various studies have compared different methods of phoria measurement and their repeatability between sessions. However, no studies have accounted for within-session repeatability, and few norms have been available to date. Our aims were to assess the short-term within-session repeatability, the agreement and the comparisons between three phoria tests and the delineation of normative data.
METHOD
The participants comprised 315 refractive corrected participants with a normal binocular vision, with ages between 20 and 80 years. Phoria was measured using three methods: von Graefe (VG), modified Thorington (MT) and Thorighton (TH) procedures. Each measurement was taken 3 consecutive times at far and near.
RESULTS
The repeatability between measurements was high (0.87 to 0.96), but the relationship between tests was medium (0.407 to 0.682). About the mean bias, VG show more exo values (0.02 to 0.14 at far and 0.07 to 0.14 at near) and MT and TH similar values (-0.04 to 0.08 at far and -0.1 to 0.03 at near). The best agreement between tests was for TH and MT (LoA = 2.33 at far and LoA = 4.44 at near). Normative data for non-presbyopic were provided.
CONCLUSION
Overall, there is a high agreement between MT and TH. Conversely, VG shows more exo values at near and shows large limits of agreement. We recommend that subjective measurements of phoria can best be quantified once using the MT or TH techniques in free space and the values compared with updated norms.
Topics: Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Strabismus; Vision Tests; Vision, Binocular; Young Adult
PubMed: 32763127
DOI: 10.1016/j.optom.2020.05.007 -
Eye (London, England) Jan 2024After going into the etymology of the word "optotype", this article covers some tasks in ancient times that required good visual acuity (VA). Around 300 BCE, Euclid... (Review)
Review
After going into the etymology of the word "optotype", this article covers some tasks in ancient times that required good visual acuity (VA). Around 300 BCE, Euclid formulated the existence of a visual cone with a minimal visual angle at its tip. Trials to test VA appeared AD 1754. Around that time, texts were introduced by opticians in order to be able to prescribe more reliably. In the early nineteenth century, the need for VA tests in ophthalmology resulted in German and English test charts. Numerous variants emerged after the first edition of Snellen's optotypes in 1862 in The Netherlands. However, 100 years later there was still no standard optotype to reliably test VA. Multidisciplinary approaches between ophthalmology, linguistics, psychology and psychophysics improved optotypes and VA testing, which led to the more reliable LogMAR charts. Recent advances in aids and therapies for the blind and severely visually handicapped, necessitate further development of new and standardized VA tests.
Topics: Humans; Ophthalmology; Vision Tests; Visual Acuity
PubMed: 35922542
DOI: 10.1038/s41433-022-02180-6 -
BMJ Open Ophthalmology 2022Visual performance and short-term tolerability of different designs of myopia correcting options, including therapeutically relevant bifocal contact lenses (CL) and...
OBJECTIVE
Visual performance and short-term tolerability of different designs of myopia correcting options, including therapeutically relevant bifocal contact lenses (CL) and spectacle lenses with 'defocus incorporated multiple segments (DIMS)' technology were compared.
METHODS AND ANALYSIS
In myopic volunteering subjects (n=8; spherical equivalent range: -1 to -7 D) visual acuity (VA) using Landolt C and contrast sensitivity (CS) using contrast C were assessed at three different gaze positions (-22° nasal, +22° temporal and 0° central), corresponding to a gaze through the DIMS area or the clear area of the DIMS lens design, respectively, after short-term wear of each of single vision spectacle lenses (SV), DIMS spectacle lenses (DIMS), monofocal soft CL and centre-near multifocal soft CL (MCL). Also, CS was assessed under photopic and mesopic light conditions with and without glare using sinusoidal gratings at 1.5, 3, 6, 12 and 18 cpd.
RESULTS
Mean VA (Landolt C) was -0.12 to -0.10, -0.05 and 0.10 logMAR (SV, DIMS, CL, MCL) at central gaze (0°). At nasal gaze (-22°), VA differed by 0.12, 0.33, 0.05 and 0.01, and at temporal gaze (+22°) by 0.05, 0.26, 0 and -0.08 compared with central gaze values. Mean CS (Contrast C) was 1.74, 1.73, 1.69 and 1.61 logCS (SV, DIMS, CL, MCL) at central gaze at nasal gaze, CS differed by -0.02 to -0.13, -0.01 and -0.01, and at temporal gaze by -0.02 to -0.16, -0.01 and +0.06 compared with central gaze values.
CONCLUSION
When compared with SV, MCL leads to a general decrease in VA and CS, while DIMS did not differ from SV at straight gaze (0° gaze). With DIMS, VA and CS are decreased to a similar level as with the MCL, but only at nasal and temporal gaze.
Topics: Color Vision; Contact Lenses, Hydrophilic; Humans; Myopia; Pilot Projects; Vision Tests
PubMed: 35464151
DOI: 10.1136/bmjophth-2022-000971