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Introduction Methods Results Conclusion This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP).A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management.Two rounds of voting took place and 131 statements were agreed, including that interventions should be discussed with parents/carers of all CYP who develop myopia before the age of 13 years, a recommendation for interventions to be publicly funded for those at risk of fast progression and high myopia, that intervention selection should take into account the CYP's hobbies and lifestyle and that additional training for eye care professionals should be available from non‐commercial sources. Topics for which published evidence is limited or lacking were areas of weaker or no consensus. Modern myopia management contact and spectacles are suitable first‐line treatments. The role and provision of low‐concentration atropine needs to be reviewed once marketing authorisations and funding decisions are in place. There is some evidence that a combination of low‐concentration atropine with an optical intervention can have an additive effect; further research is needed. Once an intervention is started, best practice is to monitor non‐cycloplegic axial length 6 monthly.Research is needed to identify those at risk of progression, the long‐term effectiveness of individual and combined interventions, and when to discontinue treatment when myopia has stabilised. As further evidence continues to emerge, this consensus work will be repeated to ensure it remains relevant. [ABSTRACT FROM AUTHOR]

Purpose: Uncorrected refractive error is the leading cause of vision impairment globally; however, little attention has been given to equity and access to services. This study aimed to identify and prioritise: (1) strategies to address inequity of access to refractive error services and (2) population groups to target with these strategies in five sub‐regions within the Western Pacific. Methods: We invited eye care professionals to complete a two‐round online prioritisation process. In round 1, panellists nominated population groups least able to access refractive error services, and strategies to improve access. Responses were summarised and presented in round 2, where panellists ranked the groups (by extent of difficulty and size) and strategies (in terms of reach, acceptability, sustainability, feasibility and equity). Groups and strategies were scored according to their rank within each sub‐region. Results: Seventy five people from 17 countries completed both rounds (55% women). Regional differences were evident. Indigenous peoples were a priority group for improving access in Australasia and Southeast Asia, while East Asia identified refugees and Oceania identified rural/remote people. Across the five sub‐regions, reducing out‐of‐pocket costs was a commonly prioritised strategy for refraction and spectacles. Australasia prioritised improving cultural safety, East Asia prioritised strengthening school eye health programmes and Oceania and Southeast Asia prioritised outreach to rural areas. Conclusion: These results provide policy‐makers, researchers and funders with a starting point for context‐specific actions to improve access to refractive error services, particularly among underserved population groups who may be left behind in existing private sector‐dominated models of care. [ABSTRACT FROM AUTHOR]

Purpose: Lens power profiles can provide valuable insights on the imposed optical defocus and visual experience of contact lens wearers, especially in the context of myopia control. This study measured the refractive power profiles of multifocal soft contact lenses (MFCLs) currently used or that have the potential for use in myopia control using high spatial resolution aberrometry. The instrument's repeatability for determining MFCLs power profiles was also assessed. Method: The power profiles of 10 MFCLs of various designs (centre‐distance, centre‐near and extended depth of focus) were measured using the Lambda‐X NIMOEVO, a phase shifting Schlieren‐based device. Power profiles were graphically expressed as measured power at each chord position and the maximum add power was calculated. The repeatability of the NIMOEVO was expressed as the within‐subject standard deviation at each chord position for a subset of five MFCLs. Results: The measured distance powers differed from nominal powers for more than half of the MFCLs with a definable distance zone. There were variations in the chord position of the distance and near correction zones, rate of power transitions and calculated maximum add between the MFCLs which did not depend on lens design. For half of the MFCLs, the power profile shape was inconsistent between different nominal back vertex powers of the same design. The repeatability of the NIMOEVO was dependent on the lens design, with designs featuring faster rates of power change exhibiting worse repeatability. Conclusions: Significant differences in MFCL power profiles were found which were not adequately represented in labelling. This is likely due to the small number of parameters used to define lens power characteristics. Eye health care practitioners should be aware of potential differences in power profiles between different MFCLs, which will impact the retinal defocus introduced during lens wear and the wearer's visual experience. [ABSTRACT FROM AUTHOR]

Purpose: In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14‐year period. Methods: Canadian optometrists were invited to participate in an anonymous 35‐item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item. Results: Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3–4 years in 2007 (53%) to 6–12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3‐4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4–6 years—56% 2007; 66% 2021). Conclusion: Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated. [ABSTRACT FROM AUTHOR]

Purpose: Myopia has emerged as a significant public health concern. Effective methods have now been developed to delay its onset and progression. However, this information may not be reaching parents, and they are key players in terms of implementing the necessary preventive measures. This study investigated parental awareness of myopia, its implications and the strategies available for controlling it. Methods: A self‐administered online survey was distributed to parents of children 6–16 years of age. To be eligible to respond, their child had to be myopic or at risk of developing myopia due to family history. Results: A total of 330 parents completed the survey, of which 321 were included for analysis. Sixty‐seven percent of respondents had at least one myopic son/daughter, and most were between −1.00 and −1.75 D. Among parents of myopic children, 20.9% thought that their child's myopia progressed moderately. Sixty‐seven percent of parents had a significant level of concern about the progression of the myopia and felt that it was caused mainly by the use of electronic devices and genetics. A generalised linear model showed that parental concern was significantly predicted by the perception of evolution (p < 0.001) and the number of known health‐related consequences (p < 0.001). Almost 40% of parents were unaware of the existence of myopia control strategies. Relatives and eye care practitioners are the main sources of information. The most well‐known myopia control strategy was myopia control soft contact lenses (29.2%), although the option that most parents would opt for was spectacles with peripheral defocus lenses (47.1%). The selection of a contact‐lens‐based myopia control method correlated significantly with the age of the children (p < 0.001). Conclusions: Society in general and parents in particular need more information about myopia, its consequences and the options available for its control. Eye care practitioners play an important role in this issue. [ABSTRACT FROM AUTHOR]

Purpose: To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Methods: Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age‐based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov–Smirnov cumulative distribution function test. Results: Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age‐normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5–2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Conclusion: Prescribing patterns for paediatric hyperopia vary significantly among eye care providers. [ABSTRACT FROM AUTHOR]

Purpose: Evidence supports the clinical decision‐making ability of primary care optometrists with additional qualifications in the identification of eligibility criteria for the certification of vision impairment (CVI). Welsh Government policy is driving pathway change to enable these optometrists to perform CVI. This qualitative study explores the views of people with VI due to dry age‐related macular degeneration (AMD) on this pathway change. Methods: Nine people with VI due to dry AMD, attending Macular Society support groups, participated. Individual semi‐structured interviews were conducted and analysed concurrently using thematic analysis. Results: Five major themes were identified: (1) living with dry AMD, (2) experience of eye care provision, (3) knowledge of CVI, (4) provision of information and (5) CVI in primary care. Participants consistently highlighted the need for the provision of accessible information regarding the certification pathway, dry AMD and the optometrist's role in the provision of eye health care. Information needs to be available prior to the diagnosis of an eye disease, rather than only from the point of diagnosis or where the vision reaches the level required for certification. Conclusion: The findings support the provision of CVI within primary eye care while highlighting areas of importance in pathway development. These include the provision of accessible information prior to, at the point of and following the diagnosis of an eye condition. Information provided needs to extend to the awareness of the role of the optometrist in the provision of eye care, and public health awareness of modifiable risk factors, which will influence the possibility of disease development in later life. The findings provide information that will be useful to those responsible for the provision of CVI within primary care. [ABSTRACT FROM AUTHOR]

Purpose: Research suggests that there are challenges in the accessibility of eye care for children in England. This study explores the barriers and enablers to eye examinations for children under 5 years of age from the perspective of community optometrists in England. Methods: Optometrists working in community settings were invited to participate in virtual focus group discussions using an online platform based on a topic guide. The discussions were audio‐recorded, transcribed and thematically analysed. Themes were derived from the focus group data based on the study aim and research question. Results: Thirty optometrists participated in the focus group discussions. The overarching themes identified as barriers to eye examinations for young children in a community setting were as follows: 'Time and Money', 'Knowledge, Skills and Confidence', 'Awareness and Communication', 'Range of Attitudes' and 'Clinical Setting'. The key themes for enabling eye examinations for young children were as follows: 'Improving behaviour', 'Enhancing training and education', 'Enhancing eye care services', 'Raising awareness', 'Changes in professional bodies' and 'Balancing commercial pressures and health care'. Conclusion: Time, money, training and equipment are perceived by optometrists as key factors in providing an eye examination for a young child. This study identified a need for improved training and robust governance related to eye examinations for young children. There is a need for change within eye care service delivery such that all children, regardless of age and ability, are examined regularly, and by conducting these examinations, optometrists remain confident. [ABSTRACT FROM AUTHOR]

Introduction: Sampling and describing the distribution of refractive error in populations is critical to understanding eye care needs, refractive differences between groups and factors affecting refractive development. We investigated the ability of mixture models to describe refractive error distributions. Methods: We used key informants to identify raw refractive error datasets and a systematic search strategy to identify published binned datasets of community‐representative refractive error. Mixture models combine various component distributions via weighting to describe an observed distribution. We modelled raw refractive error data with a single‐Gaussian (normal) distribution, mixtures of two to six Gaussian distributions and an additive model of an exponential and Gaussian (ex‐Gaussian) distribution. We tested the relative fitting accuracy of each method via Bayesian Information Criterion (BIC) and then compared the ability of selected models to predict the observed prevalence of refractive error across a range of cut‐points for both the raw and binned refractive data. Results: We obtained large raw refractive error datasets from the United States and Korea. The ability of our models to fit the data improved significantly from a single‐Gaussian to a two‐Gaussian‐component additive model and then remained stable with ≥3‐Gaussian‐component mixture models. Means and standard deviations for BIC relative to 1 for the single‐Gaussian model, where lower is better, were 0.89 ± 0.05, 0.88 ± 0.06, 0.89 ± 0.06, 0.89 ± 0.06 and 0.90 ± 0.06 for two‐, three‐, four‐, five‐ and six‐Gaussian‐component models, respectively, tested across US and Korean raw data grouped by age decade. Means and standard deviations for the difference between observed and model‐based estimates of refractive error prevalence across a range of cut‐points for the raw data were −3.0% ± 6.3, 0.5% ± 1.9, 0.6% ± 1.5 and −1.8% ± 4.0 for one‐, two‐ and three‐Gaussian‐component and ex‐Gaussian models, respectively. Conclusions: Mixture models appear able to describe the population distribution of refractive error accurately, offering significant advantages over commonly quoted simple summary statistics such as mean, standard deviation and prevalence. [ABSTRACT FROM AUTHOR]

Purpose: To understand and compare perspectives of patients and professionals on current ophthalmologic care for high myopia, and to identify challenges and future opportunities. Methods: Self‐reported data were collected through two online questionnaires. Patient perspective was obtained from highly myopic members of a patient organisation based in the Netherlands using a 17‐item questionnaire consisting of open and multiple‐choice questions regarding personal experience with myopia care. The ophthalmologist perspective was obtained from practising Dutch ophthalmologists with a 12‐item questionnaire of multiple‐choice questions on work‐related demographics, myopia care in daily practice and need for improvement. The response rate for patients was 27% (n = 136/500) and for ophthalmologists, 24% (n = 169/716). Results: Patients were highly concerned about personal progressive loss of vision (69%) and feared their psychological well‐being (82%) in case this would happen. The quality of performance of care provided by ophthalmologists was rated as excellent or satisfactory by 64% of the patients. These ratings for multidisciplinary care and insurance reimbursement were as low as 28% and 18% respectively. The mean concern among ophthalmologists about the rise in high myopia was 6.9 (SEM 0.1) on a 10‐point scale. Sixty‐nine per cent of the ophthalmologists reported that asymptomatic myopic patients should not be examined regularly at outpatient clinics. Ophthalmologists urged the development of clinical guidelines (74%), but did report (95%) that they informed patients about risk factors and complications. This contrasted with the view of patients, of whom 42% were discontent with information provided by ophthalmologists. Conclusions: These questionnaires demonstrated that the current clinical care delivered to highly myopic patients is in need of improvement. The expected higher demand for myopia care in the near future requires preferred practice patterns, professionals specifically trained to manage myopic pathology, accurate and comprehensive information exchange and collaboration of in‐ and out‐of‐hospital professionals across the full eye care chain. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper was to present a theoretical study of how poorly measured individual parameters affect the optical performance of progressive addition lenses (PALs). Modern progressive lenses can be prescribed based on parameters such as vertex distance, pantoscopic and wrap angles. These parameters can be measured from the lens wearer using specific devices; however, not all of them can be measured with the same precision, and the impact of measurement errors on the lens performance is still unknown. Methods: Data from 1900 patients were used to simulate the performance of four PAL designs with different degrees of complexity: perfect individual design, individual design with induced errors in the individual parameters, optimised design and conventional/basic design. For each patient and design, a quality metric was calculated to describe the optical performance of the lens. Results: The design having the best performance was the perfect individual design, followed by the individual design with induced errors, the optimised design and finally the conventional/basic design. Conclusions: Individual designs with measurement errors have better optical performance than lenses with less complexity, such as the optimised or conventional designs. This knowledge is useful for the eye care professional to make informed choices when dispensing these lenses. [ABSTRACT FROM AUTHOR]

Purpose: Patient safety in eye health care is an underdeveloped field of research. A patient safety incident occurs when an unintended incident happens that could have (or did) lead to harm. To enable learning from patient safety incidents in optometry, a characterisation of commonly experienced safety incidents is needed to identify options to improve the quality of care. This study aimed to characterise eye health‐related patient safety incidents from the perspective of eye care practitioners. Methods: At a national conference in Wales, 56 eye care practitioners participated in a stakeholder workshop on eye care‐related patient safety incidents. Participants were asked to suggest patient safety incidents that have occurred, or based on their experience, could occur in optometric practice. Using the nominal group technique, participants voted on the incident they perceived could cause the most harm and the incident observed most frequently in practice. Framework analysis supported identification of themes about the nature and outcomes of incidents in eye care. Results: Diagnostic incidents were perceived to be the most severe (highest number of 'severity votes', n = 38), whilst administration‐related incidents were most frequent (highest number of 'frequency votes' n = 39). Four themes were identified which are as follows: inappropriate clinical decision‐making; delayed or missed referral of patients to general medical practitioners or ophthalmologists; compromised communication with other practitioners or patients and delays in receiving eye care. The results suggest that incidents relating to inappropriate clinical decision‐making could result in the most severe harm to patients but may not occur frequently. Conclusions: Diagnostic‐ and administrative‐related incidents pose clear challenges for improvement in quality and safety of care. The breadth of themes reflecting the nature and outcomes from unsafe eye care highlights the complexity underpinning incidents and the burden to patients. This work has informed the content of an all‐Wales incident report form for primary eye care practitioners. [ABSTRACT FROM AUTHOR]

Purpose: Treatments for myopia progression are now available, but implementing these into clinical practice will place a burden on the eye care workforce. This study estimated the full‐time equivalent (FTE) workforce required to implement myopia control treatments in the UK and Ireland. Methods: To estimate the number of 6‐ to 21‐year‐olds with myopia, two models utilising separate data sources were developed. The examination‐based model used: (1) the number of primary care eye examinations conducted annually and (2) the proportion of these that are for myopic young people. The prevalence‐based model used epidemiological data on the age‐specific prevalence of myopia. The proportion of myopic young people progressing ≥0.25 dioptres (D)/year or ≥0.50 D/year was obtained from Irish electronic health records and the recommended review schedule from clinical management guidelines. Results: Using the examination and prevalence models, respectively, the estimated number of young people with myopia was 2,469,943 and 2,235,713. The extra workforce required to provide comprehensive myopia management for this target population was estimated at 226–317 FTE at the 0.50 D/year threshold and 433–630 FTE at the 0.25 D/year threshold. Extra visits required for myopia control treatment represented approximately 2.6% of current primary eye care examinations versus 13.6% of hospital examinations. Conclusions: Implementing new myopia control treatments in primary care settings over the medium‐term is unlikely to overwhelm the eye care workforce completely. Further increases to workforce, upskilling of current workforce and tools to reduce chair time will help to ensure sustainability of the eye care workforce into the future. [ABSTRACT FROM AUTHOR]

Purpose: To compare the levels of compliance with care routines of orthokeratology (ortho‐k) wearers and their parents and to identify factors affecting compliance in a hospital setting in Chengdu, China. Methods: Patients who had worn ortho‐k lenses for at least one month were invited to participate in a survey on compliance. Wearers or their parents were required to complete a questionnaire to determine their compliance with hand hygiene, ortho‐k lenses and accessory care procedures. Results: A total of 200 wearers, 78 male wearers and 122 female wearers, median age 12 (range 8–18) years were enrolled. Except for use of lens solution, the percentage of participants reporting total compliance with all procedures did not differ significantly between lens wearers and their parents. However, compliance for some items was significantly higher when performed by parents p < 0.001–0.01). 'Eye care practitioner provided instructions' was a significant protective factor for most procedures (p < 0.001–0.04). Age and sex were significant risk factors for some items (p < 0.001–0.04; p = 0.03–0.04, respectively), with girls having higher compliance than boys. 'Parental supervision' was a significant protective factor for some items (p = 0.02–0.04) when wearers performed the procedures themselves. When parents performed lens care procedures, only 'eye care practitioner provided instructions' was a significant variable (p = 0.001–0.04). Conclusion: Some degree of non‐compliance was noted in the majority of ortho‐k wearers, particularly for the care of the lens case and suction holder. Compliance with care of some items was higher when performed by parents. Regular reinforcement of care procedures by practitioners is important, especially for older and male lens wearers. Parental supervision is necessary when children perform lens care procedures themselves, even for older wearers. [ABSTRACT FROM AUTHOR]

Purpose: The World Health Organization is developing a Package of Eye Care Interventions (PECI) to support the integration of eye health care into national health programmes. Interventions included in the PECI should be based on robust evidence where available. Refractive error is a leading cause of blindness and vision impairment and is a PECI priority condition. The aim of this study was to provide high‐quality evidence to support the development of the PECI by identifying and critically appraising clinical practice guidelines (CPGs), and extracting recommendations for refractive error interventions. Methods: We searched for CPGs on refractive error published in the last 10 years. We conducted the searches initially in February and March 2019 and repeated them in March 2020. We evaluated the quality of potentially relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Results: We identified 12 high‐quality CPGs relevant to refractive error, written by six organisations from three high‐income countries. Organisations used a variety of frameworks to assess the strength of recommendations based on available evidence, with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) being most common. Vision screening for children aged 3 to 5 years was recommended consistently. Evidence for screening and eye evaluations at other ages was weaker, although ophthalmic professional organisations consistently recommended regular evaluations. Recommendations on optical and laser correction of refractive error were limited and did not consider implications for low resource settings. Interventions for slowing myopia progression in children were recommended, but these will need regular updating as new evidence emerges. Conclusions: Current high‐quality guidelines on refractive error have been formulated in high‐income countries. Recommendations focused on prevention and treatment of refractive error in low‐and middle‐income countries are lacking. Regular updating of systematic reviews and CPGs is essential to ensure that robust evidence is promptly appraised and incorporated into recommendations for eye health care practitioners. [ABSTRACT FROM AUTHOR]

Purpose: Although urgent primary eye care schemes exist in some areas of England, their current safety is unknown. Accordingly, the aim of the present study was to quantify the clinical safety and effectiveness of a COVID‐19 Urgent Eyecare Service (CUES) across Luton, Bedford, Hull, East Riding of Yorkshire and Harrogate. Methods: Consenting patients with acute onset eye problems who had accessed the service were contacted to ascertain what the optometrist's recommendation was, whether this worked, if they had to present elsewhere and how satisfied they were with the CUES. Results: A total of 27% (170/629) and 6.3% (28/445) of patients managed virtually and in person, respectively, did not have their acute eye problem resolved. Regression analysis revealed that patients who attended a face‐to‐face consultation were 4.66 times more likely to be correctly managed [Exp (β) = 5.66], relative to those solely managed virtually. Optometrists' phone consultations failed to detect conditions such as stroke, intracranial hypertension, suspected space occupying lesions, orbital cellulitis, scleritis, corneal ulcer, wet macular degeneration, uveitis with macular oedema and retinal detachment. Of referrals to hospital ophthalmology departments, in total, 19% were false‐positives. Patients, however, were typically very satisfied with the service. Uptake was associated with socioeconomic status. Conclusion: The present study found that a virtual assessment service providing optometrist tele‐consultations was not effective at resolving patients' acute‐onset eye problems. The range and number of pathologies missed by tele‐consultations suggests that the service model in the present study was detrimental to patient safety. To improve this, optometrists should follow evidence based guidance when attempting to manage patients virtually, or in person. For example, patients presenting with acute‐onset symptoms of flashing lights and/or floaters require an urgent dilated fundus examination. Robust data collection on service safety is required on an ongoing basis. [ABSTRACT FROM AUTHOR]

Purpose: Good vision during childhood is vital for visual, educational, and social development. Previous research highlights challenges in the accessibility of eye care for children. This study investigates the accessibility of primary eye care for young children with typical development and those with autism in England. Methods: A telephone survey was conducted using four hypothetical scenarios (a child aged 1, 3, 5 years and a 13‐year‐old with autism). Four hundred community optometric practices (100 different practices for each scenario) were contacted to explore the availability of an eye examination. The caller acted as a parent, asking about the availability of an eye examination for their child and raising concerns regarding the child. Key barriers and enablers to the accessibility of primary eye care were identified through an analysis of qualitative information. Results: Of the 400 practices, only three (<1%) stated that they do not perform eye examinations on children. Fifty‐six practices (14%) stated that they would examine a child at any age, the remainder (n = 341, 85%) specifying a minimum age at which they would perform eye examinations on children. Lack of 'communication' from the child and 'equipment' were identified as barriers to accessing eye care for young children. Eye care for children with autism was enabled by factors related to adaptability and appointment time. Conclusion: Our results suggest that communication and a lack of appropriate equipment for examining children are potential barriers to accessing primary eye care. No clear barriers were identified for an older child with autism. Eye examinations are more accessible for older children in these scenarios (aged 5 with typical development and 13 years with autism) than younger children (aged 1 and 3 years old). While the UK General Ophthalmic Services (GOS) terms do not permit contract holders to exclude categories of patients from a GOS eye exam, our findings suggest this is taking place. [ABSTRACT FROM AUTHOR]

Purpose: While much is known about the psychosocial impacts of strabismus, little is known about the effects of non‐strabismic amblyopia on quality of life (QoL). The aim of this study was to explore the long‐term impacts of anisometropic amblyopia. Methods: A phenomenological qualitative investigation was carried out on a sample of adults with anisometropic amblyopia. Subjects participated in in‐depth telephone interviews and described how their eye condition affected different aspects of their life. The interviews were audio‐recorded, transcribed verbatim and analysed iteratively to form emergent themes. Results: Sixteen participants took part in the study (median age: 21.5 years; range: 18–36 years; 11 male and 5 female). Six themes emerged: (1) symptoms experienced by participants, (2) concerns and apprehensions, (3) emotional impacts, (4) activity limitations, (5) hassle and inconveniences and (6) economic and career implications. Symptoms reported by participants ranged from glare to difficulty concentrating. They were extremely concerned about the safety of their better eye and lived with several doubts and anxieties. Negative emotions such as grief and disappointment due to eye care negligence in childhood was apparent. Guilt and regretful feelings were present in those who did not comply with past treatment. Participants expressed several limitations in driving, reading, mobility (e.g., using stairs) and tasks requiring high resolution. Reported inconveniences associated with coping with their eye condition included having to travel across the country in search of a cure for their amblyopia. Economic impacts ranged from costs associated with accessing eye care and management to career choices being compromised. Conclusion: Lived experiences of people with anisometropic amblyopia indicate that the QoL impacts are multifaceted and substantial, even in the absence of strabismus. The results have the potential to influence patient‐practitioner relationship by opening newer horizons to communication and care while managing adult amblyopes. [ABSTRACT FROM AUTHOR]

Purpose: To report anti‐viral therapy and outcomes for patients with herpes simplex keratitis (HSK) in a quaternary centre in Sydney, Australia. Methods: A retrospective case review of patients who received anti‐viral medications for any form of HSK was conducted. Cases were identified from pathology results, pharmacy records and hospital coding data from 2012 to 2013. Clinical details including initial anti‐viral treatment and outcome were collated from the medical records. Outcome was determined from when initial anti‐viral treatment was stopped or changed, and classified as either clinically resolved, partially resolved or worsened for therapeutic indication; or as either success or failure for prophylaxis. Results: Anti‐viral therapy was given for therapeutic and prophylactic indications at presentation in 252 (85%) and 44 patients (15%), respectively. Topical aciclovir five times daily and valaciclovir in doses ranging from 500 mg to 1 g, one to three times daily were the preferred anti‐viral therapies. One hundred and fourteen patients (n = 114/296, 38.5%) also received topical corticosteroids. An outcome was determined for 210/296 (71%) patients. For therapeutic indication, half of the patients (90/174) partially resolved within 8 days, with best outcomes achieved for endothelial HSK (8/11, 73%) and keratouveitis (21/36, 58%). Adverse events, observed in 20% (35/174) of patients, included corneal perforation (n = 8) and secondary bacterial keratitis (n = 6). Prophylaxis with antiviral therapy was successful in two‐thirds of patients after 6 months. Conclusions: Clinical and visual outcomes varied with the type of HSK and prescribed therapies. Diverse initial anti‐viral therapies were identified; standardising them may improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Evidence‐based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence‐based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. Recent findings: PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. Summary: The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to predict myopia prevalence in urban Indian children and to describe the generational effect of myopia in different age groups over the next three decades from the year 2020. Methods: A systematic review of myopia prevalence in India was performed using the Preferred Reporting Items for the Systematic Reviews and Meta‐analysis (PRISMA) guidelines and included eight studies with 28 600 participants, which were published in the period 1 January 1999 to 31 December 2019. The best fit for the prediction model was assessed with the baseline prevalence data plotted against different years and fitted with multiple mathematical regressions (linear, second‐order polynomial, third order polynomial and exponential). Based on the quality of the fit assessed by the coefficient of determination (R2) values, the sum of squared residuals and statistical significance, final predictions for myopia prevalence in the 5 to 15‐year‐old urban Indian children was estimated using the aptly suited linear regression model. To describe the generational effect on myopia prevalence over the next three decades, the prevalence of myopia in both children and adults, based on the available literature (1999 to 2020) was plotted against age, as the baseline. Results: The prevalence of myopia in 5 to 15‐year‐old urban children increased from 4.44% in 1999 to 21.15% in 2019. Our predictions, based on the slope of 0.8% every year (4.05% for every 5 years) indicate that the prevalence of myopia will increase to 31.89% in 2030, 40.01% in 2040 and 48.14% in 2050. Due to the generational effect (caused by the nature of the condition lasting a lifetime once developed), there will be an overall increase in myopia prevalence across all age groups of 10.53% in the next three decades (2020 to 2050). Conclusion: The estimates of myopia prevalence across all age groups indicate the possible future epidemic of myopia in India within a few decades, similar to the situation in East Asian countries, unless active intervention to prevent myopia and changes in lifestyle are instigated to counteract myopia in India. Meticulously designed eye care services with focussed anti‐myopia strategies are needed to control the rising myopia prevalence in India. [ABSTRACT FROM AUTHOR]

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD‐19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID‐19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID‐19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of depression in people with low vision is high and often goes undiagnosed. There is the potential for those who provide low vision services to perform concurrent depression screening. However, prior training in depression identification and suitable referral pathways is required. The aims of this study were: (1) to assess the impact of a training programme on practitioners' confidence and behaviour in addressing depression in patients with low vision, and (2) to review the training programme and identify areas for further development. Methods: A convergent mixed methods approach was used. Questionnaires were completed by practitioners pre‐, immediately post‐ and 6 months post‐ training (n = 40) to assess practitioner confidence in approaching depression in patients with low vision. Qualitative interviews were performed with a subset of practitioners 6 months post‐training (n = 9). Additionally, routine data from the Low Vision Service Wales (LVSW) database was used to determine the change in the number of practitioners identifying depression in patients, and the change in the number of patients identified at risk of depression 6 months post‐training. Results: Of the 148 practitioners who completed low vision assessments pre‐ and post‐training, 28 (18.9%) documented risk of depression in their patients pre‐training, which increased substantially to 65 (43.9%) post‐training (p < 0.0001). Mixed methods analysis confirmed increased documentation of depressive symptoms by practitioners. Practitioner confidence increased following training, with 92.3% feeling more confident to approach emotional issues with patients and 92.2% intending to use the recommended screening tool to identify depression. Interviews provided insight into areas where confidence was still lacking. Quantitative questionnaires revealed that training content was considered appropriate by 91% of participants. Interviews confirmed these findings while expanding upon possibilities for programme improvement. Conclusions: Training for depression screening was found to be time‐efficient and acceptable for LVSW practitioners and shown to increase practitioner confidence in the identification of depression. Additionally, the programme changed behaviour, resulting in an increase in the identification of depression in patients with low vision. However, this is a complex topic and ongoing development is required to embed depression screening as an integral part of low vision services. [ABSTRACT FROM AUTHOR]

Purpose: Many dry eye questionnaires are available, but these may not be suitable for paediatric eye care. The feasibility of use and repeatability of symptom questionnaires administered to children was examined. Methods: Participants aged 6‐15 years (n = 62; 25M:37F; 40% male) completed six questionnaires twice in random order at a single visit: Symptoms assessment in dry eye (SANDE), ocular surface disease index (OSDI), numerical rating scale (NRS), ocular comfort index (OCI, n = 30), dry eye questionnaire 5 (DEQ‐5) and the instant ocular symptoms survey (IOSS). Completion time and need for assistance were recorded and relationships with age examined (Pearson correlation, independent t‐test). The number of participants requiring assistance and with which items were compared (linear mixed model, pairwise test). Repeatability (coefficient of repeatability (CoR), limit of agreement, bias) and intraclass correlation coefficient (ICC) were examined. Results: Completion time was ≤2 min for each individual questionnaire. Younger participants took longer to complete (r = −0.43 to −0.60, p ≤ 0.01), and required more assistance (p ≤ 0.001). Forty‐eight participants required assistance with at least one questionnaire. Older children (13–15 years) only required assistance with OSDI (p ≤ 0.004) and NRS (p ≤ 0.003). Participants required more assistance with SANDE, OSDI and NRS than with DEQ‐5 and IOSS (p ≤ 0.02) and with gritty (OSDI, 77% of participants; OCI, 100%) and foreign body sensation (NRS, 92%) items. CoR was similar for all questionnaires with no evidence of a learning effect (p > 0.05). ICC was moderate to excellent. Conclusions: Dry eye questionnaires can be used reliably in paediatric eye care; more time and assistance may be required for younger children. The DEQ‐5 and IOSS are recommended for use in younger age children. [ABSTRACT FROM AUTHOR]

Purpose: The 2019 American Optometric Association (AOA) clinical practice guideline intends to assist optometrists in providing evidence‐based eye care for people with diabetes. This technical report evaluated the methodological and reporting quality of the guideline. Methods: Four independent reviewers appraised the 2014 and 2019 versions of the AOA's guideline using the AGREE II instrument. Average scaled scores across the six domains of the AGREE II and an overall independent score were calculated based on the formula provided. Results: The 2019 guideline scored high (range: 75–93%) in all domains except for the domain of applicability (34%). In the domain of rigour of development, significant improvements were noted in the 2019 guideline (median score: 7.0, interquartile range (IQR): 6.0–7.0) compared to the 2014 guideline (median: 5.0, IQR: 4.0–6.0) (p < 0.0001). The appraisal of the guideline also identified room for further improvements, especially in relation to implementing the guideline. Conclusion: The overall and domain specific quality of the AOA 2019 guideline was high, however, improvement in its applicability domain is required. The findings of this study will aid uptake of the guideline and inform improvement efforts for other international optometric guidelines. [ABSTRACT FROM AUTHOR]

Introduction: The prescription of blue‐blocking (B‐B) filters for the management of visual symptoms and signs associated with the use of electronic devices is routinely performed by eye care specialists. However, the utility of B‐B filters is a matter of debate and discussion by the scientific community due to the lack of evidence supporting their use. Here, we aimed to determine the effects of using B‐B filters on the dynamics of the accommodative response and pupil size and perceived levels of visual discomfort, while performing a 30‐min reading task at a close distance in subjects who routinely use electronic devices. Methods: Nineteen healthy young adults (22.0 ± 2.7 years) read two 30‐min passages on a computer screen placed at 50 cm, either while using a commercially available B‐B filter or without any filter on two different days. The magnitude and variability of both the accommodative response and pupil size were dynamically measured for 60 s using the WAM‐5500 open field autorefractometer at 4–5, 9–10, 14–15, 19–20, 24–25, and 29–30 min into the trial. The perceived levels of visual discomfort were also obtained. Results: The lag and variability of accommodation were insensitive to the blue light level (p = 0.34 and 0.62, respectively). There was a time‐on‐task effect for the variability of accommodation, showing greater instability over time regardless of the blue light level. The use of the B‐B filter was associated with improved reading speed (p = 0.02), with an increase of 16.5 words per minute. However, it was not associated with any significant change in pupil dynamics or the perceived levels of visual discomfort (p> 0.05 in both cases). Conclusions: Our data showed that the use of a B‐B filter had no effect on accommodative dynamics or visual symptomatology. Based on these findings, there is no support for the prescription of B‐B filters to attenuate the visual symptoms and signs associated with the use of electronic devices in healthy young adults. [ABSTRACT FROM AUTHOR]

Purpose: Although there is a high prevalence of keratoconus in the Middle East including Israel, limited data is available describing first‐degree relatives of patients with sporadic keratoconus (KC) using Scheimpflug imaging. The purpose of this study is to accurately phenotype first‐degree relatives of patients with sporadic KC in Israel using corneal tomography, which may help determine the genetic aetiology of KC. Methods: First‐degree relatives (N = 56) of 16 KC probands participated in this prospective case‐control study. Healthy controls (N = 96) were from a previous study. Autorefraction, visual acuity, slit lamp biomicroscopy, retinoscopy, subjective refraction and Scheimpflug imaging (CSO Sirius Topographer) of keratoconus patients and their first‐degree relatives were evaluated. The worse eye was used for KC and KC suspects. The main outcome measure was prevalence of abnormal corneal topography and tomography parameters, which was compared between first‐degree relatives vs controls. p values < 0.05 were considered significant. Results: KC (N = 2) or KC suspect (N = 8) was diagnosed in 18% (95% CI 8‐28%) of the first‐degree relatives. At least one abnormal corneal parameter was evident in 34% of first‐degree relatives, while this was significantly lower for controls (14%, χ2(1, N = 152) = 8.8, p = 0.01). Qualitative analysis showed KC first‐degree relatives had significantly more abnormal anterior corneal topography patterns than controls (34% vs 17%, χ2(1, N = 152) = 5.9, p = 0.02). For first‐degree relatives, sex was not a factor influencing prevalence of corneal abnormalities (18% for both men and women, χ2(1, N = 56) = 0.0, p = 1.0). A significant correlation was found for first‐degree relatives between age and most corneal parameters, while this was not evident for the control group. Conclusions and Relevance: Eye care practitioners should consider first‐degree relatives of patients with KC at moderate risk for the disease and/or corneal abnormalities. [ABSTRACT FROM AUTHOR]

Purpose: Patients' perceptions about the functional impact of amblyopia and strabismus in daily life have not been explored extensively. Therefore, this study aimed to explore the lived experiences of adults with these conditions and understand the functional limitations they face in their day‐to‐day life. Methods: A qualitative study design was adopted. Participants over 18 years of age, with a primary diagnosis of amblyopia (with or without strabismus) were recruited from the community and various eye care practices in South Australia and Victoria, Australia. Participants took part in either focus group discussions or individual interviews and described the functional limitations they experienced in their daily life due to their eye condition. These sessions were audio recorded, transcribed verbatim, coded inductively, and analysed iteratively to form emergent themes. Results: Thirty‐seven adult participants took part in the study: 23 (62%) had strabismic amblyopia; 5 (14%) anisometropic amblyopia;, 7 (19%) combined‐mechanism amblyopia; and 2 (5%) deprivational amblyopia. Their median age was 54 years (range: 21–82 years) and 19 (51%) were female. Participants reported several challenges in performing everyday tasks such as driving (e.g. judging distances, changing lanes), reading (e.g. fine print, reading for prolonged time) and sports (e.g. catching a ball). They also articulated trouble in navigating safely (e.g. using stairs, bumping into objects), performing work‐tasks (e.g. taking longer than peers to complete tasks) and other routine tasks (e.g. chopping vegetables with care). Conclusions: Several functional limitations were encountered by adults living with amblyopia and strabismus. Participants recognised these limitations in their normal day‐to‐day life and related the challenges they faced to symptoms associated with their eye condition. By presenting rich in‐depth qualitative data, the paper demonstrates qualitative evidence of the functional impacts associated with amblyopia and strabismus. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To learn more about the perceptions and attitudes toward eye care of members of the public — in particular, their knowledge of the purpose, components and providers of eye examinations, their ability to self‐monitor ocular status and their awareness of major sight threatening eye conditions. Methods: This study used the qualitative research strategy, grounded theory. Participants were recruited via poster and social media. Two researchers, one with optometric knowledge and one without, moderated seven 60‐ to 90‐min, semi‐structured focus group discussions, which were audiotaped and transcribed. Participants also completed a short demographic questionnaire. Three researchers employed constant comparative coding strategies to identify common themes within the focus group transcripts. The number of participants represented by identified themes were tracked and themes were listed in order of decreasing frequency. Results: Focus groups included 25 participants (nine male, 16 female), ranging in age from 18 to 71 years (mean: 41.7). Five themes related to eye care awareness were identified: eye examination purpose, test procedure identification, eye care professional roles, asymptomatic eye disease awareness, and significant eye disease awareness. Perceived eye examination purposes were vision/prescription priority with some eye health knowledge, comprehensive evaluation of visual system, and vision/prescription only. Most participants who responded could correctly identify the use of an eye chart and a phoroptor; fewer were able to do the same for a direct ophthalmoscope and slit lamp biomicroscope. Less than a quarter of participants could accurately identify the roles of all three major eye care providers. Trauma was the most commonly mentioned risk for vision loss, followed by diabetes and infection. Participants’ knowledge appeared most often to have been obtained from personal experience rather than as the result of any systematic educational initiative. Conclusions: This study found notable gaps in knowledge of eye care and sight risks. If these gaps result in fewer eye examinations, they potentially contribute to increased risk of vision loss due to later stage detection. The results provide motivation for further study and development of effective public health education strategies. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Cataract shared care schemes involving community optometrists show wide variation in practice. We report on defined key performance indicators (KPIs) which improve accountability between stakeholders. Methods: In this prospective study over nine months at a UK public hospital, we evaluated the outcomes of consecutive direct cataract referrals from community optometrists against two KPIs agreed under a service‐level agreement between the Hospital Eye Service and community optometrists: (1) 85% of patients listed for cataract listing at first consultation; and (2) 90% postoperative feedback return rate on patients discharged to community optometrists. A detailed analysis on referral triage, surgical listing and postoperative form return rate is reported in this study. Results: A total of 733 direct cataract referrals were received using a designated referral form of which 86% were listed for cataract surgery. The predominant reason for not listing was a failure to reach the visual threshold set by the local clinical commissioning guidelines. Out of 569 cataract surgical episodes, 402 (71%) patients were discharged on the same day of surgery to community optometrist follow up. Completed postoperative feedback was returned from 374 patients (93%). Conclusion: Direct cataract referrals from accredited community optometrists led to a majority of patients receiving a definitive clinical decision during first consultation. Postoperative community follow up reduced hospital visits and allowed for convenient consultation closer to home following uncomplicated cataract surgery. A service‐level agreement with an accreditation scheme measured against KPIs enhances the accountability of stakeholders involved in the cataract shared care scheme. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess the effects of changing computer monitor pixel density on visual acuity measurements made using Sloan optotypes. Methods: Acuity was measured on 10 participants aged 19 to 38 years (mean 27.9 ± 7.0) measured binocularly wearing their best spectacle correction. Stimuli were eight lines of five Sloan letter optotypes in logarithmic progression, ranging in size from −0.4 to 0.3 logMAR. Test distance was varied so that pixels on the monitor ranged in size from 0.125 mins of arc to 1.97 mins of arc. Two sampling approaches were used: (1) unfiltered sampling, with each pixel rendered either black or white; and (2) filtered sampling with pixel luminance averaged across a pixel aperture, giving grey‐scale smoothing of letter edges. Results: A broken line fit was made to each data set, with acuity being stable at an asymptotic threshold VAas for small pixels sizes, with thresholds increasing linearly when pixel sizes exceeded a critical pixel size Pcrit. For unfiltered stimuli, Pcrit averaged 1.1 mins of arc and for unfiltered stimuli averaged 0.69 mins of arc. For filtered stimuli, Pcrit was 1.79xVAas, and for unfiltered Pcrit was 1.05xVAas. Conclusion: The results show that grey‐scale filtering makes acuity measurement more resistant to the effects of pixellation. Based on a conservative interpretation of these findings, we make the recommendation that charts be constructed with, for filtered optotypes, a maximum pixel size of 0.6 x of the smallest MAR used and, for unfiltered optotypes, 0.35 x the smallest MAR used. [ABSTRACT FROM AUTHOR]

Specifically, 19.8% fewer patients re-presented after a face-to-face ophthalmology appointment (15.7% re-present rate) and 26% fewer patients represented after a face-to-face optometry appointment (0.7% re-present rate). For example, a practitioner could record no tear/detachment for a patient presenting with flashing lights and/or floaters which, according to the records, the practitioner may appropriately decide not to refer the patient onwards for treatment. We thank Harper et al.1 for their interest in our paper.2 We agree that the safety of commissioned services is of importance, and we believe that novel services should be commissioned with inbuilt service evaluation, but we acknowledge the inherent barriers to doing this. [Extracted from the article]

Purpose Tobacco smoking and nutrition are key lifestyle factors with long-term effects on eye health. However, little is known about patients' perceptions and experiences in these areas in relation to the care received from optometrists. The main aim was to survey patients' perceptions and prior experience regarding the role of optometrists in enquiring and providing advice about tobacco smoking and nutrition. Methods An anonymous, paper-based survey was distributed to a convenience sample of 225 adults attending the University of Melbourne eye care clinic. Respondents provided demographic and other information (age, sex, length of time since last eye examination, country of most recent eye examination, smoking status and intake of nutritional supplements) and indicated their level of agreement (using a five-step Likert scale) with a series of statements relating to the care provided by optometrists in the areas of health, smoking and nutrition. The statements were designed to assess the perceived scope of practice of optometrists and the extent to which patients expect, and feel comfortable, discussing these issues with their optometrist. Results 220 completed surveys were returned. Most respondents (>80%) agreed that they visit their optometrist to quantify their refractive error and to examine their eye health. About two-thirds of respondents indicated that they expect their optometrist to ask about their general health, with almost half expecting their optometrist to communicate with their general medical practitioner. Approximately one-third of respondents indicated having been routinely questioned about their smoking status, diet and nutritional supplement intake by their optometrist. This was despite about half expecting their optometrist to question them about these factors and almost three out of four respondents indicating that they felt comfortable talking with their optometrist about these lifestyle behaviours. Conclusions This study provides novel insight into patients' perceptions and experience with optometric practice in the areas of tobacco smoking and nutrition. The majority of respondents expected their optometrist to examine their eye health, ask them about their smoking and diet habits, and indicated feeling comfortable discussing these topics with their primary eye care provider. These findings suggest that brief advice interventions relating to tobacco use and diet are likely to be acceptable to deliver in optometry practice. [ABSTRACT FROM AUTHOR]

Purpose To estimate the prevalence of visual impairment ( VI) in a sub-population of Canadian long-term care facilities, i.e. residents affected by dementia. Methods This study was conducted in the long-term care facility units at the Institut universitaire de gériatrie de Montréal. All residents ≥65 years old (y.o.), having a clinical diagnosis of dementia, and able to understand French or English, were eligible for participation in the study. All residents participating in the study received a complete eye exam by an experienced optometrist. For the purpose of the study, VI was defined as a distance visual acuity ( VA) <6/12 (0.30 log MAR, 20/40) in the better seeing eye. Results One hundred and fifty residents, 68-102 y.o. took part into the study. All participants had a diagnosis of dementia recorded in their clinical chart. VI was present in 37.3% (95% CI: 29.1-46.1%) ( n = 50) of residents in whom monocular VA could be measured. Ocular refraction for their better seeing eye improved the VA to ≥6/12 (0.30 log MAR, 20/40) in 40% ( n = 20) of those 50 residents. When VI remained after refraction, it was due in order of frequency to cataract, age-related macular degeneration, and primary open angle glaucoma. Conclusions Our data showed that an appreciable proportion (37.3%) of older residents with dementia also have VI, and that VI can be corrected in many by updating their refraction. Others could potentially be helped through cataract surgery. It is therefore important to offer regular eye care services to those residents, knowing that many are not able to express their visual needs. [ABSTRACT FROM AUTHOR]

Purpose Contact lens discomfort continues to be reported as the primary reason for soft lens discontinuation, regardless of new modalities and materials. The purpose of this analysis of comfort related data from a series of clinical studies was to review whether there was a difference between symptomatic and asymptomatic habitual lens wearers' comfort responses over the course of the day. Methods Data from five independent non-dispensing clinical studies were pooled and analysed. Participants in these studies were assigned to one of two groups depending on whether they were classified as symptomatic or asymptomatic contact lens wearers according to a modified Subjective Evaluation of Symptoms of Dryness ( SESOD) questionnaire. Masked participants were randomised to wear either a hydrogel or a silicone hydrogel contact lens and their ocular comfort was rated using a visual analogue scale on insertion and 2-hourly during an 8-hour period of a single lens wearing day. Results Data from 103 participants were used, 58 in the symptomatic group and 45 in the asymptomatic group as determined by the SESOD questionnaire. There was no effect of lens material on comfort ( p = 0.43). However, there was a significant interaction between symptoms and time. The difference in mean comfort between the symptomatic and asymptomatic group was significant at each time point ( p < 0.05). However, comfort did not vary significantly over the day for the asymptomatic group ( p = 0.87), whereas, there was a significant decline in mean comfort ratings for the symptomatic group from 84.6 ± 13.2 (S.D.) at insertion to 73.0 ± 18.5 at 8 hours ( p < 0.001). Conclusions In our study, changes in contact lens comfort over a day were independent of lens material but not symptoms. Symptomatic lens wearers reported a progressive decrease in comfort, whereas asymptomatic wearers did not. Therefore, asymptomatic wearers should not be used when measuring contact lens comfort in clinical studies. The exclusion of asymptomatic lens wearers would likely increase the sensitivity of comfort ratings as a measure in contact lens research. [ABSTRACT FROM AUTHOR]

Purpose High-quality optical coherence tomography ( OCT) macular scans make it possible to distinguish a range of normal and diseased states by characterising foveal pit shape. Existing mathematical models lack the flexibility to capture all known pit variations and thus characterise the pit with limited accuracy. This study aimed to develop a new model that provides a more robust characterisation of individual foveal pit variations. Methods A Sloped Piecemeal Gaussian ( SPG) model, consisting of a linear combination of a tilted line and a piecemeal Gaussian function (two halves of a Gaussian connected by a separate straight line), was developed to fit retinal thickness data with the flexibility to characterise different degrees of pit asymmetry and pit bottom flatness. It fitted the raw pit data between the two rims of the fovea to improve accuracy. The model was tested on 3488 macular scans from both eyes of 581 young adults (376 myopes and 206 non-myopes, mean (S.D.) age 21.9 (1.4) years). Estimates for retinal thickness, wall height and slope, pit depth and width were derived from the best-fitting model curve. Ten variations of Gaussian and Difference of Gaussian models were fitted to the same scans and compared with the SPG model for goodness of fit (by Root mean square error, RMSE), model complexity (by the Bayesian Information Criteria) and model fidelity. Results The SPG model produced excellent goodness of fit (mean RMSE = 4.25 and 3.89 μm; 95% CI: 4.20, 4.30 and 3.86, 3.93 for fitting horizontal and vertical profiles respectively). The SPG model showed pit asymmetry, with average nasal walls 17.6 (11.6) μm higher and 0.96 (0.61)° steeper than temporal walls and average superior walls 7.0 (12.2) μm higher and 0.41 (0.65)° steeper than the inferior walls. The SPG model also revealed a continuum of human foveal shapes, from round bottoms to extended flat bottoms (up to 563 μm). 49.1% of foveal profiles were best fitted with a flat bottom >30 μm wide. Compared with the other tested models, the SPG was the preferred model overall based on the Bayesian Information Criteria. Conclusions The SPG is a new parsimonious mathematical model that improves upon other models by accounting for wall asymmetry and flat pit bottoms, providing an excellent fit and more faithful characterisation of typical foveal pit shapes and their known variations. This new model may be helpful in distinguishing normal foveal shape variations by refractive status as well by other characteristics such as sex, ethnicity and age. [ABSTRACT FROM AUTHOR]

Purpose Longitudinal chromatic aberration is present in all states of accommodation and may play a role in the accommodation response and the emmetropisation process. We study the change of the depth of field ( DOFi) with the state of accommodation, taking into account the longitudinal chromatic aberration. Methods Subjective DOFi was defined as the range of defocus beyond which the blur of the target (one line of optotypes of 0.1 log MAR shown on a black-and-white microdisplay, seen through different colour filters) was perceived as objectionable. The subject's eye was paralysed and different, previously-measured accommodative states (corresponding to the accommodative demands of 0D, 2D and 4D) were simulated with a deformable mirror. Different colour conditions (monochromatic red, green and blue and polychromatic (white) were tested. The DOFi was measured subjectively, using a motorised Badal system. Results Taking as reference the average accommodative response for the white stimulus, the blue response exhibits on average a lead of 0.45 ± 0.09D, the green a negligible lead of 0.07 ± 0.02D and red a lag of 0.49 ± 0.10D. The monochromatic DOFi, calculated by averaging DOFi over the red, green and blue colour conditions for each accommodative demand was 1.10 ± 0.10D for 0D, 1.20 ± 0.08D for 2D, and 1.26 ± 0.40D for 4D. The polychromatic white DOFi were greater than the average monochromatic DOFi by 19%, 9% and 14% for 0D, 2D, and 4D of accommodative demand, respectively. Conclusion The longitudinal chromatic aberration causes a dioptric shift of the monochromatic accommodation response. The study did not reveal this shift to depend on the accommodative demand or to have an effect on the DOFi. [ABSTRACT FROM AUTHOR]

Purpose Diseases involving the macula and posterior pole are leading causes of visual impairment and blindness worldwide and may require prompt ophthalmological care. However, access to eye-care and timely patient management may be limited due to inefficient and inappropriate referrals between primary eye-care providers and ophthalmology. Optometrists with a special interest in macular disease may be useful as a community aid to better stratify and recommend best-practice management plans for suitable patients. This study assesses such a notion by appraising the optometric referral patterns of patients with suspected macular disease to an intermediate-tier optometric imaging clinic. Methods We performed a retrospective review of patient records and referrals using patients examined at Centre for Eye Health ( CFEH) for an initial or follow up macular assessment between the 1/7/2013 and 30/6/2014 ( n = 291). The following data were analysed: patient demographic characteristics, primary reason for referral, diagnosed/suspected condition, CFEH diagnosis and recommended management plan. Results The number of referrals stipulating a diagnosis, confirmed after evaluation at CFEH was 121 of 291 (42%). After evaluation at CFEH, the number of cases without a specific diagnosis was approximately halved (reduced from 47% to 23%), while the number of cases with no apparent defect or normal aging changes rose from 1% to 15%. Overall diagnostic congruency for specified macular conditions was high (58-94%); cases were seldom (30/291, 10%) found to have a completely different macular condition. 244 of 291 (84%) patients seen at CFEH were recommended ongoing optometric care: either with the referring optometrist or through recall to CFEH. Referral to an ophthalmologist was recommended in 47 instances (16%). Conclusions More widespread adoption of intermediate-tier optometric eye-care referral pathways in macular disease (following opportunistic primary care screening) has the potential to reduce the number of cases with non-specific diagnoses and to increase those with a diagnosis of normal aging changes or no apparent disease. The majority of cases seen under this intermediate-tier model required ongoing optometric care only and did not require face-to-face consultation with an ophthalmologist. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses various reports within the issue on topics including the prevention of presbyopia, the eye care and brain imaging.

Purpose Blur adaptation occurs when an observer is exposed to continuous defocus. However, it is unclear whether adaptation requires constant defocus, or whether the effect can still be achieved when the adaptation period is interrupted by short periods of clear vision. Methods The study included 12 emmetropes and 12 myopes. All observers wore full refractive correction throughout the experiment. 1D and 3D of myopic defocus was introduced using spherical convex lenses. An automated system was used to place the blurring lens before the RE for varying periods of blurred and clear vision during adaptation. Participants watched a DVD at 3 m during each 15 min trial. Visual acuity was measured using Test Chart 2000 before and after adaptation. Results Blur adaptation occurs to varying degrees depending on the periods of incremental blur exposure. Significant improvements in defocused visual acuity occur with continuous blur, equal blur and clear periods, as well as for longer blur periods. However, longer clear periods showed reduced adaptation and this trial is significantly different to the other three trials for both defocus levels ( p < 0.001). No refractive group differences were observed for neither 1D nor 3D defocus ( p = 0.58 and p = 0.19 respectively). Conclusions Intervening periods of clear vision cause minimal disruption to improvements in defocused visual acuity after adaptation, indicating that blur adaptation is a robust phenomenon. However, when the exposure to clear vision exceeds the defocused periods, adaptation is inhibited. This gives insight into the effects of real-world tasks on adaptation to blur. [ABSTRACT FROM AUTHOR]

Purpose UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services ( EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care. Methods The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature. Results Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success. Conclusions The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness. [ABSTRACT FROM AUTHOR]

Purpose The prevalence of dementia and ocular pathology increases with age and many older individuals affected by such diseases are being institutionalised. The objectives of this systematic review are to describe the level of eye care services being offered to older institutionalised individuals, present the prevalence of visual impairment in those with dementia, and describe the interventions offered to visually impaired residents with dementia. Methods A literature review was performed in four relevant databases, limited to peer-reviewed journals published in English and French, between the years 1984 and 2014. The review targeted individuals 65 years of age or older, residing in long-term care facilities/nursing homes and affected by dementia. Only relevant articles addressing at least one of the three objectives were retained for this review. Results The literature search identified 440 abstracts that were all read by each of the authors. After consensus, 92 articles were identified as potentially relevant and read. In the end, 28 were found to address at least one of the three objectives and were kept for the review. The results indicated that eye care services for older institutionalised individuals are sub-optimal, that the prevalence of visual impairment remains high in that population, and that interventions such as optimising the ocular refraction, performing cataract surgery, providing low vision rehabilitation and adapting the environment can be beneficial to residents. Conclusions This systematic review demonstrated the benefits of providing regular eye care to long-term care facility/nursing home residents, including those at all levels of dementia. Additionally, it documented the benefits of various treatment modalities such as cataract surgery, staff training, environmental adaptations and visual rehabilitation for improving several aspects of the residents' quality of life. This review, however, has highlighted the fact that additional studies are required to strengthen the findings reported so far, and importantly, to evaluate the various treatment modalities described herein for residents in the most advanced stages of dementia. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to compare the self-reported clinical practice behaviours of optometrists in Australia and the United Kingdom ( UK) with respect to the diagnosis and management of dry eye disease ( DED). We also sought to examine whether the reported practices of clinicians in each region were consistent with current evidence-based recommendations for DED. Methods An online survey was distributed to optometrists (Australia, n = 654; UK, n = 1006). Respondents provided information about practice modality, years of optometric experience, preferred diagnostic and management strategies (stratified by DED severity) and the information/evidence base used to guide patient care. Results A total of 317 completed surveys were received (response rates, Australia: 21%, UK: 17%). Optometrists in both regions demonstrated similarly strong knowledge of tear film assessment and adopted both subjective and objective techniques to diagnose DED. Patient symptoms were considered the most important, valuable and commonly performed assessment by both Australian and UK respondents. UK practitioners valued and utilised conjunctival signs and tear meniscus height assessments more than Australian optometrists ( p < 0.05), who placed relatively greater emphasis on sodium fluorescein tear break-up time to diagnose DED ( p < 0.05). Clinicians in both locations tailored DED therapy to severity. While practitioners in both regions predominantly managed mild DED with eyelid hygiene and tear supplementation, Australian optometrists indicated prescribing topical corticosteroid therapy significantly more often than UK practitioners for moderate (14% vs 6%) and severe (52% vs 8%) disease ( p < 0.05). The major source of information used to guide practitioners' dry eye management practices was continuing education conferences. Conclusions This study highlights a range of parallels and divergences in dry eye clinical practice between Australian and UK optometrists. Our data identify both areas of strength in the adoption of evidence-based practice, as well as some potential to improve international translation of dry eye research evidence into practice. [ABSTRACT FROM AUTHOR]

Purpose To determine whether the removal of modern disposable hydrogel contact lenses may influence intraocular pressure ( IOP) measurement, and if so, how long the effect may last. Methods Twenty-five healthy experienced contact lens wearers aged 19-25 inserted their lenses at least 30 min prior to the study. Each participant was asked to remove a contact lens from one eye (control eye, selected at random) upon commencement of the study, and then to remove the lens in the other eye (lens-wearing eye) after a 30 min washout period. IOP was measured immediately in both eyes using non-contact tonometry, then repeated every 3 min for 12 min. To determine the change in IOP due to lens removal, the IOP in the lens-wearing eye was compared to the control eye using paired t-tests at each time point. Results The IOP was significantly higher in the lens-wearing eye immediately following lens removal (0.7 ± 1.0 mmHg, t(24) = 3.46, p < 0.01), but was within baseline values at 3 min (0.2 ± 1.0 mmHg, t(24) = 0.84, p = 0.41), 6 min (0.3 ± 1.1 mmHg, t(24) = 1.39, p = 0.18), 9 min (0.3 ± 1.2 mmHg, t(24) = 1.14, p = 0.27) and 12 min (−0.1 ± 0.9 mmHg, t(24) = −0.49, p = 0.63, paired t-test). Conclusions There was a slight statistically significant increase in IOP following contact lens removal, with a maximum duration of 3 min. Given the small magnitude of the change in IOP, and its transient nature, there appears to be no clinical reason to delay IOP measurements following the removal of modern disposable hydrogel contact lenses. [ABSTRACT FROM AUTHOR]

Purpose To determine the relative binocular signal strength of moving images that are peripherally viewed through a monocular field expansion prism as opposed to moving images viewed directly. We hypothesised that prism blur might make prism images predominate less than images viewed directly with the other eye. Methods We employed the binocular rivalry paradigm to measure the relative binocular effectiveness of directly viewed vs prism images. Four normally-sighted subjects tracked the rivalrous visibility of opponent-coloured targets seen dichoptically in the same part of the retinal visual field, using monocular field expansion prisms to produce the dichoptic display. We analysed the effects of external signal strength (whether or not motion was present in either image), retinal position or eccentricity of the targets, and controlled for target saturation. Results We found that prism images predominate less than directly viewed images. When both eyes were presented with pattern in the dichoptic display, direct-to-prism predominance was 51%:31%. When only the direct view was presented with pattern, direct-to-prism predominance was 74%:12%; when only the prism view was presented with pattern, direct-to-prism predominance was 25%:58%. Dominance durations followed established binocular rivalry rules. Conclusions The prism image in a monocular, peripheral field expansion prism is perceptually weaker than the corresponding direct image in the other eye. However, the prism image is still seen a significant proportion of the time, especially when no moving pattern is present in the direct view. We conclude that the rivalry ratio of the prism device is sufficiently effective for clinical applications. [ABSTRACT FROM AUTHOR]

Purpose Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners. Methods An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with individual tests being available to optometrists and their confidence in applying them. Results Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years. Conclusions Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training. [ABSTRACT FROM AUTHOR]

Purpose To evaluate an incentive-based intervention to increase time spent outdoors among children in a 9-month cluster randomised controlled trial. Methods Two hundred and eighty-five children aged 6-12 years of age were randomised to the intervention ( n = 147) or control arm ( n = 138) in the Family incentive trial ( FIT). The FIT intervention comprised of targeted education on myopia and good eye care habits, structured weekend outdoor activities and incentives for children to increase their daily steps via pedometers. The main outcome measure was outdoor time, measured by the WHO questionnaire and a 1-week diary. Results Interim analysis at 6 months showed a significant increase in mean outdoor time per week in the intervention arm (14.75 h week−1) compared to the control arm (12.40 h week−1) as measured by the questionnaire ( p = 0.04). However, greater outdoor time was not statistically significant at the end of the trial (15.95 h week−1 vs 14.34 h in the control group ( p = 0.29). Conclusions There was an increase in outdoor time for children in the incentive-based physical activity outdoor program after 6 months but not at the end of the trial. Further larger school trials with better compliance with the intervention and longer duration could be conducted to evaluate clinical outcomes such as myopic shifts. [ABSTRACT FROM AUTHOR]

Purpose To quantify the optical quality of various daily disposable contact lenses in vivo and to ascertain its variation in terms of wearing time by means of objective non-invasive determination of wavefront patterns. Methods The crx1 adaptive-optics system was used to measure the wavefront aberrations in 15 myopic eyes before and at 2-h intervals after contact lens fitting, over a 12-h wearing period. Seven types of contact lenses having different material, water content and lens design were evaluated in this study: Dailies Total1, Dailies Aqua Comfort Plus, Proclear 1 Day, 1-Day Acuvue Tru Eye, 1-Day Acuvue moist, Sof Lens daily disposable and Clariti 1-Day. The aberration data were analysed by fitting Zernike polynomials up to the 5th-order for 3 and 5-mm pupils. The optical quality under each condition and at each point in time was described by means of the Root-Mean-Square ( RMS) value of wavefront aberration, Modulation Transfer Function ( MTF), Point Spread Function and cut-off spatial frequency. Results A RMS increase was observed after contact lens fitting as well as over time, both for a 3-mm and a 5-mm pupil. Each type of lens induced a different amount of wavefront aberrations, which vary over time also in a different manner. Dailies Total1 showed the lowest RMS values both at baseline and at the end of the day. In addition, Dailies Total1 provided the best MTF out of all the contact lenses that were assessed. These observations were reflected in higher cut-off spatial frequencies and visual resolution both at baseline and after 12 h of wearing time. Conclusions Aberrometry makes it possible to analyse accurately and in vivo the optical quality of contact lenses and to assess how lenses having different characteristics - such as material or water content - behave for different wearing times. These variations across contact lenses may result in differences in visual performance. [ABSTRACT FROM AUTHOR]

Citation information: Backhouse S, Fox S, Ibrahim B & Phillips JR. Peripheral refraction in myopia corrected with spectacles versus contact lenses. Ophthalmic Physiol Opt 2012, 32, 294-303. doi: 10.1111/j.1475-1313.2012.00912.x Abstract Purpose: Previous studies suggest that the refractive status of the peripheral retina can influence the development and progression of myopia. Our aim was to compare peripheral refractions in the same cohort of human eyes corrected with spectacle lenses vs soft contact lenses. Methods: Ten young adults with moderate to high myopia (−5.00 D to −8.00 D) were investigated. Open-field autorefraction was used to measure on- and off-axis refractions with the eyes in primary gaze, when uncorrected, and when corrected with spectacles and contact lenses. Measures were made every 5° out to 30° horizontally in nasal and temporal retina and analysed as power vectors ( M, J0, and J45). Partial coherence interferometry measures of eye size were also made on-axis and off-axis at 10º and 20º in nasal and temporal retina. Results: Subjects (mean age 24; range 19-29 years) had an average on-axis mean-sphere refraction of −6.33 ± 0.31 D (mean ± 1 S.E.) and an average axial eye length of 25.99 ± 0.20 mm. The average relative peripheral refraction (RPR) for all subjects across all eccentricities was hyperopic when uncorrected (+0.90 ± 0.14 D) and also when corrected with spectacles (+1.01 ± 0.13 D) but changed to a myopic RPR when corrected with contact lenses (−1.84 ± 0.61 D). There was a highly significant effect of correction on peripheral refraction ( p < 0.0001). Peripheral J0 astigmatism also became significantly more negative (less with-the-rule) on correction with contact lenses ( p = 0.015), whereas J45 astigmatism remained unchanged. On- and off- axis eye length measures indicated a relatively prolate eye shape. Conclusions: Correcting the on-axis refractive error in moderate to high myopia with conventional spherical spectacle lenses results in hyperopic defocus in the peripheral retina. Correcting the same eyes with conventional spherical soft contact lenses results in significant myopic defocus in the peripheral retina. These results corroborate the general findings of earlier studies and the predictions of optical modelling by others. If the refractive status of the peripheral retina does influence myopia progression, then these results suggest that myopia progression should be slower with conventional contact lens wear than with conventional spectacle wear. However, previous studies comparing myopia progression with conventional spectacles and conventional contact lenses have reported no such difference. [ABSTRACT FROM AUTHOR]