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An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. A total of 889 Spanish professionals answered (age, 25–62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option. [ABSTRACT FROM AUTHOR]

Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 – 47.6), hyperopia 17.1% (95% CI 16.2 – 18.1), astigmatism 39.6% (95% CI 38.4 – 40.8) and presbyopia 30.0% (95% CI 28.9 – 31.0). Some 5.9% of patients aged 0–9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 – 4.0) and for children aged 5 – 19 years, frequency was once per 4.8 years (95% CI 4.8 – 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive. [ABSTRACT FROM AUTHOR]

Despite internationally recognized guidelines, amblyopia management varies among eye care professionals worldwide. Hence, we sought to investigate the practice patterns of amblyopia management and the factors associated with the decision to treat amblyopia among optometrists in Ghana. A cross-sectional survey was conducted among registered optometrists in Ghana from January 2020 to October 2020. Data collection was done through the administration of online questionnaires via e-mail (google form). The structured questionnaires included demographic information, mode, and scope of practice, diagnostic criteria, examination procedures, treatment modalities, and prognosis. A p value of less than 0.05 was deemed statistically significant. The mean (±SD) age of all the 168 respondents was 32.6 (±6.1) years (range: 24–50 years). The majority of the optometrists (64.9%) treated amblyopia in their practice; with the most prevalent being refractive amblyopia (68.2%), followed by strabismic amblyopia (27.1%), then form-deprivation amblyopia (4.7%). Most (76.1%) amblyopic patients presented with symptomatic squinting. The most common ocular and medical history was anisometropia (90.0%), and the most common diagnostic procedures were patient history, visual acuity, and refraction. Optical correction (88.3%) was mainly prescribed for amblyopia treatment, followed by patching (58.5%). Nearly half of the respondent (45.0%) reported good prognosis after amblyopia treatment. After statistical adjustment, female optometrists were significantly associated with decreased odds of treating amblyopia (AOR = 0.36, p =.004). Refractive amblyopia is the main type of amblyopia managed by optometrists in Ghana. Hence, optical correction is the primary treatment regime. Current amblyopia management practice among optometrists adhere to recommended guidelines and our findings demonstrate uniformity in the standard of care. [ABSTRACT FROM AUTHOR]

Background/Aims: The Child Amblyopia Treatment Questionnaire (CAT-QoL) is a patient-reported outcome measure (PROM), designed to assess the impact of amblyopia treatment. The aim of this study was to compare the psychometric properties of two PROMs; the CAT-QoL instrument and Pediatric Quality of Life Inventory (PedsQLTM), a generic pediatric PROM. This work was part of a wider project to develop a condition-specific PROM for children with amblyopia. Methods: Three hundred and forty-two participants were recruited in a UK multi-center study. Quality of life data was collected using the CAT-QoL and the PedsQLTM instruments. The psychometric performance of the CAT-QoL and PedsQLTM were examined in terms of acceptability, reliability, and validity. Results: Both instruments demonstrated good reliability (CAT-QoL Cronbach's α = 0.793; PedsQLTMα = 0.872). The convergent validity of the CAT-QoL and PedsQLTM instruments was tested by comparing the instruments to each other. There was a moderate correlation between the PedsQLTM and the CAT-QoL scores, and this relationship was statistically significant (rs = −0.517, p <.000). No statistical significance was found between the level of amblyopia severity and the mean PedsQLTM score (p =.420). Conclusion: It was possible to assess the impact of amblyopia treatment using the CAT-QoL and PedsQLTM instruments. The preliminary findings from this are not conclusive, and it is not possible to advocate the use of one questionnaire over another based upon psychometric performance demonstrated here. This may be due to the sample population, as there were limited numbers of participants with severe amblyopia. Both the CAT-QoL and PedsQLTM instruments were noted to have some issues with ceiling effects at an individual item level. The CAT-QoL and PedsQLTM were reliable (as determined by Cronbach's alpha). The PedsQLTM instrument was not able to discriminate between amblyopia severity groups (discriminant validity). Further research is required to formally assess the psychometric properties of the CAT-QoL questionnaire. [ABSTRACT FROM AUTHOR]

This review presents the extent to which engagement in research and new developments in clinical practice alike have contributed to the establishment and development of the primary vision care profession in New Zealand that is Optometry. Many notable changes have occurred in the scope of practice of the profession over the past three decades and an important role of visual neuroscience, neurobiology and pharmaceuticals allowed the introduction of therapeutic prescribing responsibilities to a previously optics dominated profession. Scientific, optometric, medical and clinical research are factors leading the changes in scope of practice of Optometrists. These advancements have significantly expanded the scope of practice since Optometry training began in the 1960s, and has been supported by close working relationships with other health professionals in New Zealand. This article describes the history of Optometry in New Zealand from early practitioners, to the establishment of a degree programme at the University of Auckland. Along with undergraduate teaching, a strong tradition of vision science research has established New Zealand as a centre of internationally recognised expertise in a range of areas including myopia and visual neuroscience. The Optometry profession has developed to deliver primary eye care at a community level across the country in a range of areas of special interest. [ABSTRACT FROM AUTHOR]

Aim: Amplitude of accommodation (AoA) can be determined clinically using different methods. Some methods are known to be more reliable than others for measuring AoA in different age categories. The purpose of this study was to compare Hofstetter’s age-expected norms with five recommended methods of measuring AoA in order to determine age-appropriate techniques for a Ghanaian population. Materials and methods: AoA was measured using four subjective methods (push-up, push-down, minus lens, and modified push-up) and one objective method, the modified dynamic retinoscopy. The amplitudes obtained by each technique were compared to each other and also compared to the age-expected amplitudes as predicted by Hofstetter’s equations. Results: 352 non-presbyopes aged 10-39 years were included in this study. All five methods except the push-up (p = 0.089) and modified push-up (p = 0.081) differed significantly from Hofstetter’s data, while the modified dynamic retinoscopy recorded the strongest agreement with Hofstetter’s average (ICC = 0.78, p ˂ 0.001). With reference to Hofstetter’s expected AoA, the minus lens, push-down, modified dynamic retinoscopy, and modified push-up methods underestimated AoA by −4.18D, −1.99D, −0.48D, and −0.43D, respectively. As age increased, underestimated AoA values by the minus lens (10-19 years: −5.57D, 20-29 years: −3.50D, 30-39 years: −2.39D), modified push-up (10-19 years: −1.51D, 20-29 years: +0.40D, 30-39 years: +0.56D), and push-down (10-19 years: −2.90D, 20-29 years: −1.07D, 30-39 years: −1.46D) methods decreased but the modified push-up in relation to Hofstetter’s expected was most accurate for the older age. The push-up, on the other hand, overestimated accommodation in all age categories by +0.42D (10-19 years: +0.01D, 20-29 years: +0.82D, 30-39 years: 0.67D). Thus, the push-up method became more accurate as age decreased. Conclusion: This study suggested that Hofstetter’s formulae could be used to predict the amplitudes of Ghanaian non-presbyopes aged 10-39 years using the push-up and modified push-up. With regard to Hofstetter’s data, the push-up method was more accurate for the younger age-group 10-19 years while the modified push-up was more accurate for the older age-group 20-39. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of strabismus and amblyopia, and the distribution of the near point of convergence (NPC), in a population of children aged 4 to 6 years. Methods: In this cross-sectional study, preschoolers in Mashhad were sampled using a random multistage cluster sampling approach. Examinations were done after obtaining parental consent. All participants had measurements of uncorrected visual acuity, corrected visual acuity, and non-cycloplegic refraction, and they had near and far cover tests to determine tropia and phoria. Results: Of the 3765 selected children, 3701 participated in the study. The prevalence of tropia was 1.21% (95% confidence interval [CI]: 0.86–1.57). Near and near/far tropia was observed in 0.83% (95% CI: 0.53–1.12) and 0.39% (95% CI: 0.18–0.59), respectively. Tropia was significantly more prevalent in boys (P=0.005). The most common type of tropia was esotropia, 0.22% (95% CI: 0.07–0.37). Among participants, 63.92% (95% CI: 62.36–65.48) had phoria; prevalence of far, near, and near/far phoria was 0.22% (95% CI: 0.07–0.37), 60.47% (95% CI: 58.88–62.07), and 3.22% (95% CI: 2.65–3.8), respectively. Mean NPC was 5.1 cm (95% CI: 5.05–5.14). NPC increased by 0.08 cm per month of age (P=0.033) and was 0.10 cm higher in boys compared to girls (P=0.027). Based on NPC, 61.58% (95% CI: 59.99–63.17) were symptomatic. The prevalence of amblyopia was 0.41% (95% CI: 0.20–0.61). The type of amblyopia was anisometropic, strabismic, and isoametropic in 75%, 11.1%, and 8.5%, respectively. Conclusion: The prevalence of amblyopia in this study population was not high; however, the prevalence of tropia was average compared to previous studies in Iran. Describing NPC in a 4- to 6-year-old Iranian population for the first time, we found that NPC increased with age in this sample. [ABSTRACT FROM AUTHOR]

Aims: The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia. Methods: Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary’s Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance. Results: Seven hundred and four patients had appointments booked at St Mary’s and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary’s and 9% at Hillingdon;P=0.75). Of the 704 patients, 533 (St Mary’s, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related. Conclusions: Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits. [ABSTRACT FROM AUTHOR]

Background The aim was to develop and validate an instrument called the ' Children's Vision for Living Scale' ( CVLS) for the assessment of vision-related quality of life in Saudi Arabian children with and without amblyopia. Methods A 43-item child self-report questionnaire was initially developed based on interviews with children with amblyopia, their parents and eye-care professionals, and a literature review. Following a process that involved the removal of redundant items, 28 items remained and were piloted on children aged five to 12 years with and without amblyopia (n = 48 amblyopic, n = 53 non-amblyopic) living in Saudi Arabia. Rasch analysis was applied to determine whether the 28-item questionnaire fitted the Rasch model. Rasch analysis was used to assess the validity and reliability of the questionnaire. Principal components analysis ( PCA) was used to check dimensionality. A 21-item questionnaire resulting from this process was administered in children with (n = 81) and without (n = 82) amblyopia in Saudi Arabia for further validation. Results The final 21-item questionnaire had good validity and reliability as demonstrated by person separation of 2.02, person reliability of 0.80 (mean square and standard deviation: infit = 1.01 ± 0.39; outfit = 1.01 ± 0.40) and item reliability of 0.93 (item infit range = 1.33 to 0.78; item outfit range = 0.78 to 1.30). The mean difference between person and item scores of 0.33 ± 0.53 logits (scale range, 2 to -2) indicates that the items are well targeted to the populations. The PCA (dimensionality measures) shows the percentage of variance explained by measures equal to 26.4 per cent (modelled 26.9 per cent) and an eigenvalue of the first contrast of 2.5, which demonstrated good stability. Conclusion The 21-item CVLS is a valid uni-dimensional child self-report instrument for the assessment of the impact of amblyopia on vision-related quality of life in children with and without amblyopia living in Saudi Arabia. [ABSTRACT FROM AUTHOR]

The visual outcomes for infants 18 months or younger with cataracts have improved dramatically over the past couple of decades. Earlier detection of infantile cataract and prompt surgical removal—with subsequent visual rehabilitation with contact lenses—mean that these patients now have a much better visual prognosis. Advances in contact lens technology have led to a significantly higher success rate with contact lenses and this has been a major factor in improving the visual outcomes for aphakic infants. This review outlines the contact lens management of infantile cataract, including a detailed analysis of the various contact lens options available and a discussion regarding the important factors that can cause issues with contact lens wear and affect the overall visual rehabilitation of the infant. [ABSTRACT FROM AUTHOR]

Introduction and Background: The Pediatric Eye Disease Investigator Group is a network of pediatric eye care providers undertaking clinical trials with National Eye Institute support. The network includes university- and community-based providers. Methods: Randomized and observation studies have involved refining the best amblyopia treatment in children from 3 to less than 18 years of age, observation of the behavior of early-onset esotropia, treatment of primary congenital nasolacrimal duct obstruction, and observation of the stability of strabismic angle in esotropia. Conclusions: To date 16 studies have been undertaken enrolling 5064 children and teens. [ABSTRACT FROM AUTHOR]

Purpose: To determine the usefulness of the Brückner test as a screening tool for detection of amblyogenic factors in developing countries. Methods: A double blind prospective study of 101 children aged I to 16 years attending the pediatric ophthalmology department of a tertiary eye care center. A trained optometrist masked to clinical findings of the subject performed the Brückner test in a dark room using a direct ophthalmoscope and compared differences in brightness of the pupillary reflex of both eyes. Subsequently, subjects underwent a complete ophthalmic examination by a pediatric ophthalmologist masked to the results of the Brückner test. Results: The optometrist identified 39 subjects as Brückner test positive and 62 as Brückner test negative. On clinical examination, 12 subjects had anisometropia of ≥1D and 20 subjects had manifest deviation of >4 *(This character cannot be converted in ASCII text). The sensitivity of the Brückner test was 87.5% and specificity 84.1%; the positive (PPV) and negative predictive (NPV) value was 71.8% and 93.6%. The false positive and false negative rates were 28.2% and 6.5%. Conclusion: Although imperfect, the Brückner test may be a low cost alternative to either screening with photo screener or to no screening for amblyogenic factors in developing countries. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including eye and vision care in children, the association between children's eye care and ethnicity, and the impact of amblyopia on monocular vision.