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Purpose: Controversy exists regarding the influence of peripheral visual experience on the onset and progression of childhood myopia. This longitudinal, observational study evaluated the relationship between relative peripheral refraction (RPR) and changes in refractive error and axial length (AL) over 12 months in White children aged 6–7 and 12–13 years with a range of baseline refractive errors. Methods: Cycloplegic baseline autorefraction at horizontal retinal eccentricities of 0° and ±30° were recorded with the Shin‐Nippon NVision‐K 5001 while AL was measured using the Zeiss IOLMaster 700. Measurements were repeated after 12 months on a subgroup. Refractive data were transposed into power vectors as mean spherical equivalent (M), J0 and J45. RPR was calculated by subtracting central from peripheral measurements. Participants were defined as myopic (M ≤ −0.50 D), premyopic (−0.50 D < M ≤ +0.75 D), emmetropic (+0.75 D < M < +2.00 D) or hyperopic (M ≥ +2.00 D). Results: Data were collected from 222 and 245 participants aged 6–7 and 12–13 years, respectively. Myopic eyes demonstrated, on average, more hyperopic RPR. Emmetropes and premyopes displayed emmetropic RPR, and hyperopes showed a myopic RPR. Fifty‐six 6‐ to 7‐year‐olds and seventy 12‐ to 13‐year‐olds contributed 12‐month repeated measures. Longitudinal data demonstrated a significant relationship between a more hyperopic RPR in the nasal retina and greater short‐term axial elongation in teens with myopia at baseline (β = 0.69; p = 0.04). Each dioptre of relative peripheral hyperopia in the nasal retina was associated with an additional 0.10 mm (95% CI: 0.02–0.18 mm) annual increase in AL. Conclusions: Hyperopic RPR in the nasal retina of myopic children is indicative of increased risk for rapid axial elongation and may be a useful metric to support decision‐making in myopia management. [ABSTRACT FROM AUTHOR]

Purpose: To compare real‐world measures of illumination obtained with the Actiwatch‐2 and Clouclip‐M2 with 'gold standard' photometry measures and to evaluate the ability of Actiwatch‐2 to correctly identify photometer‐defined conditions: scotopic (≤0.01 lux), mesopic (0.02–3 lux), indoor photopic (>3–1,000 lux) and outdoor photopic (>1,000 lux); and Clouclip to correctly identify photometer‐defined conditions within its operating range (>1 lux). Inter‐device reliability of Clouclip for illumination and viewing distance measures was also investigated. Methods: A Hagner‐S2 photometer was used as reference. Measures of illumination were obtained from a range of real‐world conditions. To investigate inter‐device reliability, five Clouclips were simultaneously exposed to varied light conditions and object distances. Results: Strong correlations existed between illumination measured with the photometer and both Actiwatch‐2 (ρ = 0.99, p < 0.0001) and Clouclip (ρ = 0.99, p < 0.0001). However, both devices underestimated illumination compared to the photometer; disparity increased with increasing illumination and was greater for Actiwatch‐2 than Clouclip measures. Actiwatch‐2 successfully categorised illumination level (scotopic, mesopic, indoor and outdoor photopic) in 71.2% of cases. Clouclip successfully categorised illumination levels as scotopic/mesopic (≤3 lux) and indoor and outdoor photopic in 100% of cases. Mean differences and limits of agreement (LOA) were 430.92 ± 1,828.74 and 79.35 ± 407.33 lux, between the photometer and Actiwatch‐2 and photometer and Clouclip, respectively. The Intra‐class Correlation Coefficients for illumination and viewing distance measured with five Clouclips were 0.85 and 0.96, respectively. Conclusion: These data illustrate that different Clouclip devices produce comparable measures of viewing distance and illumination in real‐world settings. Both Actiwatch‐2 and Clouclip underestimate illumination in the field compared to gold standard photometer measures. The disparity increases at higher levels of illumination and the discrepancy was greater for Actiwatch‐2 measures. For researchers interested in categorising light exposure, Clouclip classifies illumination levels >2 lux more accurately than Actiwatch‐2 but cannot discriminate between scotopic and low mesopic light. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic and non‐cycloplegic retinoscopy and whether age, refractive error, habitual spectacle wear and accommodation influence the relationship. Methods: A single examiner carried out cycloplegic and non‐cycloplegic retinoscopy on 128 children stratified into four age groups (6–7, 8–9, 10–12 and 12–13 years). Cycloplegia was achieved using 1% cyclopentolate and retinoscopy carried out after 30 min. The examiner was masked to the lenses used and to habitual spectacle wear. Accommodation was assessed using dynamic retinoscopy prior to cycloplegia. Results: Cycloplegic and non‐cycloplegic sphere differed significantly (z = −9.18, p < 0.0001). Although the difference decreased significantly as age increased (χ2 = 16.57, p = 0.0009), cycloplegic retinoscopy revealed more hyperopia than non‐cycloplegic retinoscopy in all age groups (p < 0.0001). The difference between cycloplegic and non‐cycloplegic results was greater where 'high' hyperopia (≥+2.50DS) was present (F1,6 = 12.86, p = 0.0005), and as hyperopia increased the difference increased (Spearman's ρ = 0.55, p < 0.0001). Neither spectacle wear (p = 0.74) nor accommodation (p = 0.08) influenced the difference between spherical measures. Measures of astigmatic error did not differ significantly (z = −1.59, p = 0.11). A non‐cycloplegic sphere ≥+1.50DS was relatively sensitive (87%) and specific (96%) at indicating clinically significant hyperopia (≥+2.50D) as revealed by cycloplegic retinoscopy. Conclusions: Cyclopentolate 1% does not impact the cylindrical component of the retinoscopy result, but reveals significantly more hyperopia in the spherical component, both statistically and clinically in children aged 6–13 years. Differences between cycloplegic and non‐cycloplegic sphere increase significantly with increasing hyperopia, independent of spectacle wear and accommodation. A non‐cycloplegic retinoscopy result of ≥+1.50DS may be used by practitioners wishing to identify children aged 6–13 years at risk of clinically significant hyperopia (≥+2.50DS), but cycloplegia is required to accurately ascertain the full spherical error. [ABSTRACT FROM AUTHOR]

Purpose: To survey a large number of UK‐based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. Methods: One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. Results: Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre‐school children (aged 2–4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5–7 years: 25% vs 47%, 8–11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann‐Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non‐strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. Conclusions: This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK‐based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence‐based resources to inform their decision‐making relating to use of cycloplegia in paediatric examination. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the intra- and inter-examiner repeatability of cycloplegic retinoscopy in young children aged 4-5 years old. Methods Examiner 1 refracted all children in the first sample ( n = 108); firstly with masked loose lenses, then using unmasked loose lenses (intra-examiner repeatability). Examiners 1 and 2 refracted all children in the second sample ( n = 97) using unmasked loose lenses, blind to the child's refractive error, presence/magnitude of habitual spectacle correction and to each other's findings (inter-examiner repeatability). Refractions were performed on one eye chosen at random. Mean differences, 95% limits of agreement ( LOAs) and confidence intervals were calculated for intra- and inter-examiner repeatability of sphere, cylinder and spherical equivalent refraction ( SER). Results Participants had a wide range of refractive errors (−1.50 DS to +7.25 DS; ≥4.50 DC). Mean differences (95% LOAs) were small for both intra- and inter-examiner repeatability [Intra: Sphere 0.00D (−0.85, +0.85D), Cylinder −0.03D (−0.68, +0.62D), SER −0.06D (−0.90, +0.78D); Inter: Sphere −0.08D (−0.92, +0.76D), Cylinder −0.08D (−0.75, +0.59D), SER −0.13D (−0.95, +0.69D). A statistically significant proportional bias was present for intra-examiner repeatability of cylinder (ρ = 0.20, p = 0.04) and SER measurement (ρ = 0.19, p = 0.049). Proportional bias was not present for any other measure ( p > 0.12). Examiners agreed on cylinder axis within ±20° in 71% of refractions where astigmatism of −0.75D or higher was present. 80% of intra- and inter-examiner measures fell within ±0.50D for spherical and cylindrical components. Conclusions Differences of ±1.00D and ±0.75D or more for spherical and cylindrical measures respectively can be considered significant when performing cycloplegic retinoscopy on young children. [ABSTRACT FROM AUTHOR]

As Arbo and Benneworth (2007) have alerted us, higher education institutions are now expected not only to conduct education and research, but also to play an active role in the development of their economic, social and cultural surroundings. They call this the ‘regional mission’ of HEIs. This paper is concerned with cultural engagement. Research on universities’ cultural engagement in their regions and the impact of that engagement is still in its infancy, partly because there are different understandings of ‘culture’ and of what ‘engagement’ entails. In this paper, qualitative data from the reports of mixed teams of academics and regional administrators involved in a large international project designed to improve universities’ regional engagement are analysed and discussed. The on-going study — PASCAL Universities' Regional Engagement (PURE) — investigates the role of HEIs in their regions across in a variety of fields such as the economy, community development, the environment and others. This article analyses the data from the study to identify the different perspectives universities and regions have of cultural engagement. The aim here is to demonstrate the value of PURE in facilitating the development of mutual understanding both between universities through a common language and between universities and their regions in respect of mutual expectations. For example, particularly difficult to de-construct is universities’ engagement with disadvantaged communities (Doyle, 2007) but Powell's (2009) work suggests that universities might engage more broadly and effectively ‘through better knowledge sharing and co-creation with business and community partners’ to become ‘real drivers of creative change in developing socially inclusive projects’. Others have written about the educational role of universities in developing a ‘lifelong learning culture’ in their region (European Universities’ Charter on Lifelong Learning, 2008). [ABSTRACT FROM AUTHOR]

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]

Background: Changes of choroidal vasculature in the eye have been reported in Alzheimer's disease (AD) and this is positively correlated with declining cognitive status. Patients with Down's syndrome (DS) are at a high risk of developing AD and also show signs of premature ageing. Both AD and ageing have been associated with thinner choroid, measured on optical coherence tomography (OCT) scans, however, there are currently no studies in the literature to evidence whether choroidal thinning occurs in DS. Our study, for the first time, investigated choroidal thickness (CT) in DS using OCT imaging. Method: 21 DS and 9 controls (Ctrl) were imaged using Enhanced Depth Imaging Spectral Domain OCT (Heidelberg). The choroid was manually segmented, and thickness values calculated using conventional grading grid (ETDRS). Statistical analysis was conducted in SPPS using only the right eye. The analysis was controlled for age, image quality, refractive error and time of the scan as covariates. Result: OCT imaging in DS proved to be challenging due to some participants having difficulties maintaining the fixation for an extended period. In this preliminary cohort the DS group was older than the Ctrl group (39.5±6.9 vs 31.2±6.0 years, p=.004) but there was no difference in gender (χ2=0.7, df=1, p=.376). Sub‐foveal (SF) and Superior‐inner (SI) CT was significantly increased in DS compared to Ctrl (SF: 363.2µm±25.9µm vs 237.3µm±45.8µm, p=.046; SI: 381.8µm±26.2µm vs 253.6µm±46.3µm, p=.044) but no differences were found in other sectors of the ETDRS grid. Increase in SF CT showed a moderate, positive correlation with cognitive status in the 14 participants whose cognitive score was available (ρ=.539, p=.047). Suprachoroidal space (SCS) as a hypo‐reflective band at the choroidal scleral interface, was only visible in DS in 13 (61.9%) out of the 21 participants. Those with SCS were older than those without (41.9±1.7 vs 35.6±2.2 years, p=.040). Conclusion: In this study we found that there is an increase in choroidal thickness in DS which is in contrast to the thinning observed in AD; this might be an anatomical feature of DS or may reflect inflammation. The increased prevalence of SCS in DS is likely to be associated with the accelerated ageing. [ABSTRACT FROM AUTHOR]