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The limitation of conventional visual acuity assessment, which primarily focuses on individual eye performance (monocular visual acuity tests). This study addresses this limitation by emphasizing the importance of binocular vision, where both eyes work together. Binocular vision provides numerous advantages, such as improved depth perception, a wider field of view, reduced visual fatigue, and binocular summation. The article introduces a new mathematical model based on the physics of constructive interference in light waves and the anatomy of visual nerves. This model yields an equation that quantifies how weakness in one eye affects the visual acuity of the other. By analyzing the correlation between the rates of visual weakness in each eye and the corresponding distances, utilizing the Snellen 6-meter test, valuable insights are gained into the complex interplay between eye deficiencies and their collective impact on overall visual acuity. The equations derived from this study can have significant implications for eye care professionals, clinicians, and patients, contributing to a more comprehensive understanding of visual impairments and enriching the field of optics and vision science. [ABSTRACT FROM AUTHOR]

To describe the clinical profile of patients presented with Acanthamoeba keratitis (AK) to a multi-tier ophthalmology hospital network in India. This cross-sectional hospital-based study included 1945339 new patients registering between September 2016 and May 2022. Patients with clinically confirmed diagnosis of AK in one or both eyes were included in the study. All the relevant data were documented using an electronic medical record (EMR) system. A total of 245 (0.013%) patients were diagnosed with AK and majority were male (62.86%) with unilateral (99.59%) affliction. The most common age group was during the fourth decade of life, 65 (26.53%) patients and predominantly were adults (95.51%). The prevalence of the infection was higher in patients from a lower socioeconomic status (43.27%) from rural geography (52.24%) and in agriculture-related work (28.16%). The most common inciting factor was injury with vegetative matter (8.98%), dust (7.76%) and contact lens wear (4.49%). The majority of the eyes had blindness (20/400 to 20/1200) in 116 (47.15%) eyes with a presenting visual acuity (logMAR) of 2.14 ± 1.04. Among the surgical interventions, therapeutic keratoplasty was performed in 41 (16.67%) eyes, penetrating keratoplasty in 22 (8.94%) eyes, and evisceration in 2 (0.81%) eyes. AK more commonly affects males presenting during the fourth decade of life from lower socio-economic status and is predominantly unilateral. A fourth of the affected eyes underwent keratoplasty and the majority had significant visual impairment at presentation. [ABSTRACT FROM AUTHOR]

The objective of our study is to understand the factors associated with non-adherence to the physician's follow-up advice by persons with glaucoma. We use a four-year panel dataset containing demographic, clinical, and intervention details and doctor's advised follow-up date for a random sample of 2,622 glaucoma patients from an Indian tertiary eye care hospital. We model this unique "advised follow-up date" in multivariate logistic regressions to identify factors associated with patients' coming early or late as against on-time. An OLS regression also examines an association between delayed follow-up and declining visual acuity. Demographic variables such as age, gender, distance to hospital, IOP, and visual acuity were not associated with delayed adherence to follow-up. Patients advised to review within 2 months (p <.001), paying patients (p <.001), and those habituated to routine follow-up (diabetes patients) (p <.01) are less likely to delay care-seeking. Patients are more likely to come on-time in visits immediately after clinical interventions relative to later ones (p <.001). Our second analysis reveals the presence of cataract and the very first post-surgery visit as factors influencing patients to come early. Our third analysis reveals that a higher proportion of delayed visits had resulted in worsening of vision in the glaucoma-affected eye. Our results suggest that active counselling by doctors, especially for routine follow-up visits, can help in better follow-up adherence and prevention of glaucoma-related visual impairment. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0–2.1), 1.6% (95% CI: 1.0–2.2) and 6.6% (95% CI: 5.5–7.7), respectively. The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia. [ABSTRACT FROM AUTHOR]

Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4– to 5-year-olds delivered in Queensland, Australia. The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores. Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services. [ABSTRACT FROM AUTHOR]

Homeless populations have lower health indicators, including in eye care. Few data exist on the levels and causes of visual impairment in Canadian homeless populations, and none in Montreal. This study aims to characterise the causes and levels of visual impairment, as well as eye care services utilisation among the Montreal homeless. Using random sampling, five homeless shelters were selected. In each shelter, 20 participants were randomly selected. After obtaining informed consent, participants completed an ocular examination, which included: presenting visual acuity (pinhole as needed), intraocular pressure, confrontation visual field, dilated fundus examination, post-dilation autorefraction and questionnaire on social determinants of health. A total of 95 participants were examined, of which 97.9% were male. The median age was 49 years old (interquartile range 38–56.5). The age-adjusted prevalence of visual impairment (presenting visual acuity <6/12) was 23.6% (95% CI 15.1–32.9) compared to 6.0% in the Canadian population (Z = 77.9, p < 0.0001). With pinhole correction, the prevalence of visual impairment dropped to 5.8% (95% CI 1.7–11.8). Prevalence was 8.2% (95% CI 3.7–15.9) for cataracts, 11.4% (95% CI 5.9–19.7) for glaucoma or suspects and 4.7% (95% CI 1.7–11.9) for diabetic retinopathy. Lastly, 18.9% of participants had an ocular examination within the last year compared to 41.4% in Canada (Z = −4.5, p < 0.0001) and 13.7% had never had a comprehensive eye examination. This sample population shows a prevalence of visual impairment which is four times that of the general Canadian population, with highly prevalent uncorrected refractive error, while accessing primary eye care twice less often. [ABSTRACT FROM AUTHOR]

This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33–2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28–1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67–2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74–3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population. [ABSTRACT FROM AUTHOR]

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

Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access. Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers. Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03–3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often. Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education. [ABSTRACT FROM AUTHOR]

To investigate the prevalence, causes and risk factors for vision impairment (VI) among the elderly population in Telangana State, India. A population-based cross-sectional study were conducted in four districts. All participants had eye examinations including visual acuity assessment for distance and near, anterior segment examination and non-mydriatic fundus imaging by trained personnel. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Individuals aged ≥60 years were considered as elderly. In total, 11,238/12,150 (92.5%) individuals aged ≥40 years were examined. Of this, the dataset of 3,640 individuals (32.4%) elderly participants was used for analysis. Among the 3,640 participants, 53.1% were women and 78.1% had no education. The mean age of the participants was 67.8 years (standard deviation: 7 years; range: 60 to 102 years). The age and gender-adjusted prevalence of VI was 32.1% (95% CI: 29.5–34.8). On multivariable analysis, the odds of VI was significantly higher in older age groups, and among those with no education. Gender and district of residence were not associated with the prevalence of VI. Cataract (54.8%) was the leading cause of VI followed by uncorrected refractive errors (37.6%). VI was common and largely avoidable in the elderly population in Telangana state in India. Elderly centric eye care including screening for vision loss, provision of cataract surgery and spectacles can be used as strategies to address VI in the elderly. [ABSTRACT FROM AUTHOR]

To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%–1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability. [ABSTRACT FROM AUTHOR]

Background: The role of optometrists in paediatric visual assessment must compliment the role of other eye-care practitioners at all levels of care. This study was undertaken to determine if optometrists in Ghana screen, diagnose and manage paediatric ocular conditions (for example, strabismus, amblyopia), and further assessed if optometrists in Ghana have the requisite paediatric instrumentation in their practices.Methods: This was a cross-sectional descriptive survey involving optometrists in both public and private eye-care sectors in Ghana. A paediatric visual assessment questionnaire was sent to all registered optometrists in Ghana. The contents of the questionnaire evaluated areas of vision assessment, refraction, and previous diagnosis and management, which were matched with practice characteristics such as location, type of practice and type of employment. Chi-squared statistic was used to test associations between variables.Results: Responses were obtained from 140 optometrists out of the 326 registered optometrists, representing a response rate of 46 per cent. Overall, less than half of respondents (64 which represents 46 per cent) assessed themselves as practising full-scope paediatric eye care. These self-assessment views were more common among optometrists at the regional level (111: 79.3 per cent), followed by the district (20: 14.3 per cent) and sub-district levels (nine: 6.4 per cent) (χ2 = 4.774, p < 0.05), but was not influenced by type of employment, type of practice and level of training (p > 0.05). In addition, the study revealed that many respondents were more likely to assess pre-schoolers' visual acuity (VA) (121: 96.0 per cent), do refraction (109: 88.6 per cent) and perform binocular vision (BV) assessment (93: 76.9 per cent) compared to the toddlers' VA (72: 55.4 per cent), refraction (57: 46 per cent) and BV assessment (68: 56.2 per cent).Conclusion: Full-scope paediatric eye care services among optometrists in Ghana is limited. [ABSTRACT FROM AUTHOR]

Background: Among technologies targeting mobile eye care, EyeNetra is a smartphone-based subjective refraction system. This study compared the results from this system with those of professional subjective refraction. Participant visual comfort and preference of results were also measured.Methods: Thirty-six optometry-naïve participants (n = 36 eyes, aged 18-35 years), were randomly subjected to three refraction methods: professional subjective refraction, unassisted Netra (participants alone) and refined Netra (sphere results refined by a practitioner). Using a randomised, double-blind design, refraction results were mounted in a trial frame and distance logMAR visual acuities were measured. Subjective appreciation and visual comfort were assessed by questionnaire. Overall preference was ranked.Results: Unassisted Netra yielded a median myopic overcorrection of 0.60 D (interquartile range [IQR] 0.25 to 0.94) compared to professional subjective refraction. Median equivalent sphere with unassisted Netra (-1.40 D, IQR -3.10 to -0.90) was significantly more myopic than refined Netra (-0.70 D, IQR -1.60 to -0.30) and then subjective refraction (-0.80 D, IQR -1.60 to -0.30) (all p-values < 0.01). Median visual acuity with professional subjective refraction (-0.16, IQR -0.22 to -0.09) was superior than unassisted Netra (-0.08, IQR -0.20 to 0.03) (p < 0.01). Subjective refraction was ranked first in preference of trial framed results by 72 per cent of participants; median preference rank favoured professional subjective refraction to both Netra results (all p < 0.01). For all questionnaire items, visual comfort was higher with subjective refraction than with unassisted Netra (all p < 0.04).Conclusion: The Netra device - especially when used without professional assistance and compared to subjective refraction - induces significant myopic overcorrection and lower levels of visual acuity, subjective preference and visual comfort. [ABSTRACT FROM AUTHOR]

Purpose: Vision 2020 and the Global Action Plan 2013–2019 prioritise primary eye care (PEC) as an important component of reducing avoidable blindness. Studies in sub-Saharan Africa have demonstrated that current PEC provision is poor. There has been no evaluation of the current practice of PEC among primary health care workers (PHCWs) in Nepal. Methods: A mixed methods descriptive cross-sectional study with semi-structured interviews and focus group discussions (FGDs) was carried out in Eastern Nepal. Government employed PHCWs working at health posts in three districts were invited to take part in a PEC knowledge and skills assessment. Each health post was assessed for ophthalmic equipment and medications. Three focus group discussions and eight semi-structured interviews were carried out with community ophthalmic assistants, PHCWs and a district health manager. Results: 107 PHCWs in 35 health posts took part in the quantitative study. Only 8.4% had received eye care training. 27.1% PHCWs could diagnose a corneal ulcer, 83.2% conjunctivitis, 75.7% cataract and 54.2% ophthalmia neonatorum. Only 14.0% could measure visual acuity, and 5.7% of HPs had a vision chart. Ophthalmic assistants described their concern for the low level of PEC at health posts. PHCWs were keen to receive training and highlighted the need for greater government support in the provision of eye care services. Conclusion: PEC knowledge and skills among PHCWs in eastern Nepal is inadequate to provide quality PEC services. There is a pressing need for PEC training in the region, provision of ophthalmic equipment and greater government support for eye care. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical pattern of scleritis in patients ≤16 years of age at a tertiary care eye hospital in India. Methods: The medical records of 24 eyes of 20 children with scleritis were included in this retrospective study. Collected data included age, subsets of uveitis, best corrected visual acuities (BCVA), detailed laboratory investigations and treatment. Results: Mean age at presentation was 12.2 ± 2.5 years. Scleritis was unilateral in 80% patients and an equal gender distribution was observed. Posterior scleritis (41.7%) was the most common subtypes of scleritis and nodular scleritis was the most common type of anterior scleritis (33.3%). Necrotizing scleritis was seen in 16.7% eyes. Tuberculosis was the only systemic association and found in three (15%) patients. Conclusions: Clinical profile of scleritis in children can be different from that of adults. [ABSTRACT FROM AUTHOR]

Purpose: Barriers to health care present complex challenges to improving eye health in the U.S., yet few studies have quantitatively measured the impact of these barriers. This study investigated the time elapsed since a person's most recent eye examination (TLEE) as a measure of barriers to eye care. Methods: Participants (N = 1699) from mobile clinic vision health screenings completed demographic and subjective visual function questionnaires, and then underwent comprehensive eye exams. Associations between demographics, subjective visual function, and visual acuity were analyzed with respect to TLEE. Results: Many Hispanic (34.9%) and uninsured (28.6%) participants had no previous eye exam. Although most Caucasians had a previous eye exam, 40.2% did not have an exam in the previous four years. The majority of participants with diabetes were non-compliant with recommendations of annual eye examinations. Conclusion: These results describe barriers that are specific to subpopulations, providing useful information for efforts to improve eye care access. [ABSTRACT FROM AUTHOR]

Background: Visual acuity is known to be poorer in children with Down's syndrome than in age-matched controls. However, to date, clinicians do not have access to norms for children with Down's syndrome that allow differential discrimination of healthy from anomalous visual development in this population.Methods: The Down's Syndrome Vision Research Unit at Cardiff University has been monitoring visual development in a large cohort of children since 1992. Cross-sectional data on binocular visual acuity were retrospectively analysed for 159 children up to 12 years of age in order to establish binocular acuity norms. Longitudinal binocular acuity data were available for nine children who were seen regularly over the 12 years age-range. Monocular acuity was successfully recorded less often in the cohort, but analysis of scores for 69 children allowed assessment of inter-ocular acuity differences and binocular summation.Results: In comparison with published norms for the various acuity tests used, binocular acuity was consistently poorer in children with Down's syndrome from the age of three years and stabilised at around 0.25 logMAR from the age of four years. Inter-ocular acuity difference and binocular summation were both 0.06 logMAR, which is similar to the reported values in children without Down's syndrome.Conclusions: The study provides eye-care practitioners with the expected values for binocular acuity in children with Down's syndrome and demonstrates the visual disadvantage that children with Down's syndrome have when compared with their typically developing peers. The results emphasise the responsibility that practitioners have to notify parents and educators of the relatively poor vision of children with Down's syndrome, and the need for classroom modifications. [ABSTRACT FROM AUTHOR]

Purpose: To compare the surgical outcomes of glued intraocular lens (GIOL) and sutured scleral fixated intraocular lens (SFIOL) implantation.Methods: A retrospective, interventional case series of 60 patients (68 eyes) who underwent GIOL (28 eyes: 11 primary; 17 secondary) and SFIOL (40 eyes: 24 primary; 16 secondary) in a tertiary eye care institute was done. The main outcome measures were complications, time taken for surgery, postoperative refractive outcomes, and final best-corrected visual acuity (BCVA).Results: The mean final BCVA was 0.42 (20/40) (+/- SD 0.29) in the GIOL group and 0.57 (20/50) (+/- SD 0.48) in the SFIOL group (p=0.08). The time taken for primary GIOL (mean+/- SD: 66+/-19 minutes) was significantly lower than primary SFIOL (means+/-SD: 94+/-34 minutes) (p=0.006). The complications were comparable between the GIOL (25%) and SFIOL (15%) groups (p=0.30). The most common complication noted was transient vitreous hemorrhage (GIOL 17%, SFIOL 5%). The only sight-threatening complication seen was retinal detachment, with one eye in each group. The mean follow-up was 20 (GIOL) and 20.4 weeks (SFIOL).Conclusion: Both glued intraocular lens and sutured scleral fixated intraocular lens are safe and effective procedures in cases of insufficient capsular support. In view of the shorter surgical time with similar outcomes, primary GIOL can be considered as a preferred surgical option over primary SFIOL. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the degree of visual acuity in workers with intellectual disabilities and the impact of vision on their working conditions.Methods: We recruited 224 workers (mean age 43.77 years, SD ± 12.96; range, 19-72 years) from a workshop for those with intellectual disabilities, to participate in a vision examination program. The assessment consisted of objective refraction, visual acuity, ocular motility, near-point of convergence, cover/uncover test, stereo acuity and colour perception. Individuals with vision deficits were fitted with spectacles following the screening program.Results: Within the past three years, 38.9 per cent of the participants received eye care, 14.3 per cent of participants had not received eye care in more than three years, and 6.7 per cent had not received any eye care. As many as 39.7 per cent of participants did not know whether they had ever received eye care. Entering visual acuity for far vision was 0.52 dec (-0.29 logMAR) and 0.42 dec (-0.38 logMAR) for near vision. Only 14.9 per cent, 11 of all participants aged ≥50 years, owned spectacles for near vision before the examination. After subjective determination of refraction, best corrected visual acuity for far vision was 0.61 dec (-0.22 logMAR) and 0.56 dec (-0.25 logMAR) for near vision (in both cases with p < 0.001). After the examination, 44.6 per cent (33) of all workers aged ≥50 years received a recommendation for reading or bifocal spectacles. In 46 per cent of workers, the threshold of stereopsis was higher than 63 arc seconds, and some form of colour vision deficiency was measured in 12.5 per cent of participants.Conclusions: Workers with intellectual disabilities are often unaware of their visual deficits. We found that some of their abnormalities can be solved by appropriate optical means and that they could benefit from regular eye care. These workers should be encouraged to be tested and to improve their vision with appropriate lenses. [ABSTRACT FROM AUTHOR]

Background: To determine the spectacle reassessment rates of dissatisfied patients returning to the optical services department of a tertiary eye centre in India over a period of six years.Methods: A total of 169,567 spectacles were dispensed from the optical services department between January 2010 and December 2015. The spectacle reassessment forms of dissatisfied patients who returned to the optical services department with their spectacles were analysed.Results: A total of 797 spectacle reassessment forms were analysed. The overall spectacle reassessment rate during the study period was found to be 0.5% (95% CI: 0.467-0.472). The mean age of patients returning back for spectacle reassessment was 48 years (SD 19.9, range 3-97 years). Error in refractive correction measurement was found to be the most common reason for spectacle reassessment (54.7%), followed by dispensing error (21.1%), documentation errors while writing the prescription from the medical records in the tertiary eye care centre (12.7%), transcription error occurring at the optical services department (10.8%) and ocular pathologies (0.8%). No statistically significant difference was observed in the year-wise spectacle reassessment rates during the study period (p = 0.14).Conclusions: The frequency of spectacle reassessment rate in a tertiary eye care centre was low, with errors in measuring refractive errors contributing the most to the reassessment and reorder of spectacles. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. Methods: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. Results: The fieldwork was conducted over 13 months in 2013–2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. Conclusion: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older. [ABSTRACT FROM AUTHOR]

Purpose: To study the risk factors, microbiologic characteristics, clinical course, and outcomes of patients with Purpureocillium keratitis at a tertiary eye care center in south Florida.Materials and Methods: All medical records during a seven-year period starting January 1, 2007, were reviewed. Twenty-eight culture-proven Purpureocillium keratitis cases with complete medical records presenting to our institution were included in this retrospective, observational case series. Data collected included predisposing factors, therapeutic interventions, treatment duration, and visual outcomes.Results: Twenty patients (71.4%) had a history of soft contact lens use, with only two for therapeutic use. Other identified risk factors were trauma and immunosuppression. Fifteen patients (53.6%) received topical corticosteroid treatment prior to the diagnosis of fungal keratitis. Thirteen patients (46.4%) were on Natamycin treatment prior to Purpureocillium identification. As a group, the average best-corrected visual acuity (BCVA) at presentation was 1.1 logMAR; upon the final evaluation, it was 1.0 logMAR. The BCVA on last evaluation for the eight patients presenting to our institution within two weeks of onset of symptoms was 0.3 log MAR, and all patients in this group responded to medical management. The final BCVA for 20 patients presenting two weeks after onset of symptoms was 1.2 logMAR. There was a significant difference in the final BCVA between Group 1 and Group 2 (p = 0.004), but no difference in steroid use or previous treatments. Previous steroid use tended to extend time to presentation and was significantly associated with a worse final visual outcome (1.2 versus 0.6 logMAR; p = 0.0474). Previous Natamycin use was significantly associated with a worse final visual outcome (1.4 versus 0.6 logMAR; p = 0.014).Conclusion: Purpureocillium keratitis can have devastating consequences to visual function and even lead to enucleation. Physicians should make every effort to arrive at an earlier microbiological diagnosis, as this is associated with better outcomes and less need for surgical intervention. The first line use of voriconazole is recommended, and steroid use should be avoided, as their previous use is associated with worse visual outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To identify the referral pattern and identify causes of missed referrals to low-vision services in a tertiary eye care center. Methods: A retrospective review of all the hospital records of patients seen from September-December 2012 was done to identify patients with visual impairment. Low vision was defined as has a best-corrected visual acuity (BCVA) in the better eye of <20/60 to light perception (as per WHO definition); or a visual field of <20° from the point of fixation. The frequency of referrals in this database was used to identify referral patterns of physicians and also causes for missed referrals for these patients. Results: Of 14,938 hospital medical records reviewed during the period, 499 patients missed low-vision services with a mean age of 46 ± 18.2 years, including 158 females. Among those missed, 12.07% were in the age group 0-15 years, while 30.9% of the patients were >60 years, with 157 requiring rehabilitative services and training. Causes for missed referrals were clear misses or non-referrals by the physician (39%), non-acceptance of services by the patient (53%), loss from appointment desks (4.5%), and loss to follow-up (3.5%). Conclusion: Missed referral to low-vision services in tertiary centers can be considerable; these need to be identified for optimal utilization and delivery of these services to patients with low vision. [ABSTRACT FROM AUTHOR]

Purpose: To investigate aqueous flare change patterns in retinal vein occlusions (RVO) following intravitreal application of dexamethasone implant. To evaluate the correlations between central macular thickness (CMT), best corrected visual acuity (BCVA) and aqueous flare values. Methods: This prospective, interventional pilot study included 40 eyes of 40 patients with macular edema associated with RVO. All patients received intravitreal injection of dexamethasone implant at baseline visit. Full ophthalmologic examination, CMT and aqueous flare measurements were performed prior to injection and repeated at months 1, 3, and 5. Aqueous flare, BCVA and CMT changes between visits were assessed. Further statistical analysis was performed to investigate correlations between these three parameters. Results: The patients consist of 23 (57.5%) men and 17 (42.5%) women with a mean age of 65.7 ± 6.2 years. Of the 40 eyes, 24 (60%) had branch retinal vein occlusion and 16 (40%) had central retinal vein occlusion. BCVA (log MAR) was significantly correlated with aqueous flare at each visit (r = 0.436,p  = 0.005;r = 0.349,p = 0.027;r = 0.357,p = 0.024;r = 0.551,p = 0.000, respectively). Flare values were also correlated with CMT measurements in 3rd and 5th months (r = 0.324,p = 0.042;r = 0.556,p = 0.000, respectively). Comparing the percentage change in CMT and flare values over time, the change in CMT from baseline to 3rd and 5th months (r = 0.441,p = 0.004,r = 0.448,p = 0.004), from 1st month to 3rd and 5th months (r = 0.441,p = 0.004;r = 0.461,p = 0.003) and from 3rd month to 5th month were directly correlated with aqueous flare changes (r = 0.584,p = 0.000). Twenty-two eyes (55%) required second dexamethasone implant application at 5th month. Conclusion: Considering the inflammatory base of RVO, dexamethasone implants effectively decreased the flare values in the anterior chamber. The CMT change was directly correlated with aqueous flare values. [ABSTRACT FROM AUTHOR]

Purpose: To determine how people attending outreach eye care clinics in Papua New Guinea (PNG) perceive eye health and eye health services. Methods: An interview-based questionnaire was administrated to a convenience sample of 614 adult participants across four provinces and perceptions of eye health and eye health services were recorded. Presenting and near visual acuity were measured and cause of visual impairment (VI) determined. Results: In this sample, 113/614 participants (18.4%) presented with distance VI, 16 (2.6%) with distance blindness, and 221 (47.6%) with near VI. Older participants and those with near VI were more likely to indicate that it is hard to have an eye examination due to travel time, lack of transport and transport costs. Female participants and those from underserved areas were more likely to report shame and fear of jealousy from others when asked about their attitudes towards spectacles. Participants reporting that they were willing to pay higher amounts for testing and spectacles/treatment also reported higher education levels, higher household incomes and were more likely to be male. A quarter of participants (25.9%) indicated that they did not like having an eye examination because their reading and writing was poor. Conclusions: People attending outreach eye care clinics in PNG reported finding it difficult to attend eye health services due to transport difficulties and anticipated high costs. Negative attitudes towards spectacles were also prevalent, and negative perceptions appeared more frequently among older participants and those with less education. [ABSTRACT FROM AUTHOR]

Purpose: To examine gender, ethnic, and socioeconomic differences in access to eye care services in marine fishing communities in Karachi, Pakistan. Methods: The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on three islands and in four coastal areas were enrolled. Participants underwent a detailed interview regarding sociodemographics, eye problems and eye care service use, testing of presenting and best-corrected visual acuity with a reduced logMAR chart, and detailed eye examination. Results: A total of 700 people were planned to be included in the study; 638 (91.1%) were interviewed and examined. Most participants were extremely poor and had no formal education. Only 45.3% (95% confidence interval, CI, 41.4–49.2%) of participants reported having had an eye examination in the past; 12.1% (95% CI 9.5–14.6%) and 30.9% (95% CI 27.3–34.5%) had seen an eye doctor within the last year or prior 5 years, respectively. In the multivariable analysis, ethnicity was the strongest independent predictor of eye care service use, followed by self-reported eye problems and diabetes. Ethnic Bengalis were 4.2 times less likely (adjusted odds ratio 0.24, 95% CI 0.15–0.38;p < 0.001) to have had an eye examination in the past than Kutchis. Conclusions: Despite a high prevalence of visual impairment and blindness, levels of eye care examinations in fishing communities, especially among ethnic Bengalis, are disappointingly low. Such communities deserve particular attention in Vision 2020 and other national and international strategies and plans. [ABSTRACT FROM AUTHOR]

Purpose: To assess the use of eye care services in a rural population in North China and to analyze the factors associated with underuse of these services. Methods: In a cross-sectional population-based study, demographic, health and vision-related information including use of eye care services were determined during a face-to-face interview. A single visit to an eye care provider qualified as 'use' of eye care services. Results: Of 6612 participants, 754 (11.4%, 95% confidence interval, CI, 8.7-14.1%) had used eye care services. The most common reason cited for not seeing an eye care provider was 'no need' ( n = 5754). Of the 5754 who thought that there was no need to see an ophthalmologist, 3458 (60.1%) were found to have one or more type of eye disease, including glaucoma (56, 1.0%), cataract (1056, 18.4%), age-related macular degeneration (AMD; 164, 2.9%) and refractive error (3048, 53.0%). Also, 74 (1.3%) and 409 (7.1%) of the 5754 participants had visual impairment (<20/60) according to best-corrected visual acuity and presenting visual acuity, respectively. In a multiple regression model, participants who had glaucoma (adjusted odds ratio, OR, 4.0, 95% CI 3.0-5.4), AMD (adjusted OR 1.6, 95% CI 1.2-2.3) or refractive error (adjusted OR 1.4, 95% CI 1.1-1.8), were more likely to visit an eye care provider. Conclusion: A high proportion of the Chinese rural population had never used eye care services although three fifths had eye diseases. Further efforts towards better education of the general population about common eye problems as well as increasing the number of ocular health providers would be necessary in future. [ABSTRACT FROM AUTHOR]

Purpose: To explore the effect of demographic characteristics on the outcomes of cataract surgery in terms of visual acuity and patient satisfaction, and gender role in the uptake of postoperative care. Methods: Comprehensive ocular examinations were performed on 478 subjects (558 eyes) over the age of 50 years who underwent surgery for age-related cataract at the largest eye hospital in Iran. Demographic characteristics were obtained and surgical records were reviewed. Results: Male subjects had significantly better outcomes in terms of uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (mean difference 0.12 and 0.13 logMAR; p = 0.004 and p < 0.001, respectively). Women were significantly less satisfied than men (73.2% vs. 83.6%; p = 0.011). Postoperative UCVA and BSCVA were better in patients with higher levels of education (both p < 0.001). Age had an inverse association with UCVA ( p = 0.004) and BSCVA ( p < 0.001). Women were twice as likely to need capsulotomy ( p = 0.002). Men's uptake of postoperative refractive care was 4-fold that of women's (31% vs. 7%). In multivariable analyses, age, sex, education, presence of ocular comorbidity and need for capsulotomy, spectacle prescription and other care were associated with postoperative UCVA (all p < 0.05; adjusted R2 = 0.256). Conclusion: Female patients were shown to be at a clear disadvantage in cataract surgery; outcomes of the procedure and postoperative care were both poorer. Older age, lower level of education, ocular comorbidity and unmet postoperative need were also associated with a poorer outcome. [ABSTRACT FROM AUTHOR]

Purpose: Type 2 idiopathic macular telangiectasia (MacTel) is a progressive retinal disease associated with a slow deterioration of visual acuity, starting in the fifth to seventh decades of life. The etiology and pathogenesis of the disease are little known, and no effective therapy is available. We aimed to estimate the prevalence and describe the phenotype of type 2 MacTel in two African populations. Methods: From two population-based cross-sectional surveys conducted nationally in Nigeria and in the Nakuru district of Kenya, patients with fundus features of type 2 MacTel were selected. Diagnosis was based on color fundus images, grading performed according to the MacTel Study protocol and staged using the Gass and Blodi system. Disease phenotype and clinical characteristics of affected participants were assessed. Results: Of 8599 total participants, five showed a phenotype compatible with type 2 MacTel. Prevalence was estimated as 0.06% (95% confidence interval [CI] 0.02-0.21%) in Kenya, 0.06% (95% CI 0.01-0.17%) in Nigeria, and overall at 0.06% (95% CI 0.02-0.14%). Mean age was 62 years (SD 5 years), four of five affected participants were female, and none had a history of diabetes. Median corrected visual acuity was 6/12 in the better eye and 6/69 in the worse eye. Conclusions: The estimated prevalence and phenotype of type 2 MacTel in the African populations examined were similar to those in predominantly white populations. All data published so far are based on the analysis of color fundus images only and are thus likely to underestimate the true prevalence of this disease. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the 2010 prevalence and causes of blindness and low vision among Timor-Leste adults aged ≥40 years, and compare these to the results of a survey conducted 5 years previously. Method: A population-based cross-sectional survey used multistage cluster random sampling proportionate to size to identify 50 clusters of 45 people each. Cause of vision loss was determined for each eye with presenting visual acuity worse than 6/18. Results: A participation rate of 89.5% (n == 2014) was achieved. The gender-age-domicile adjusted prevalence was 7.7% (95% confidence interval [CI] 6.5, 8.8) for 6/60, and 3.6% (95% CI 2.7, 4.4) for 3/60 blindness (better eye presenting vision worse than 6/60 and 3/60, respectively) among Timorese aged ≥40 years. Cataract caused most blindness (69.3% at 6/60). The population prevalence of low vision (better eye presenting vision of 6/60 or better, but worse than 6/18) was 13.6% (95%CI 12.1, 15.1), most caused by uncorrected refractive error (57.4%) or cataract (39.5%). The prevalence and causes of blindness were unchanged compared with 5 years earlier, but low vision was less common. Conclusion: Unusually for a developing country, Timor-Leste has initiated a cycle of evidence-based eye care in which, although with limitations, population data are periodically available for monitoring and planning. [ABSTRACT FROM AUTHOR]

Bilateral macular oedema is an uncommon side-effect of paclitaxel administration in oncological patients. We report the case of a 64-year-old man who presented with decreased visual acuity due to bilateral macular oedema after paclitaxel administration for lung cancer. Optical coherence tomography scans of both eyes revealed cystoid macular oedema. Fluorescein angiography demonstrated the unusual finding of the absence of localised retinal capillary leakage. Ketorolac eye drops and acetazolamide tablets were prescribed and one month later the cystoid macular oedema resolved with subsequent improvement in visual acuity. This case illustrates the unusual presentation of cystoid macular oedema induced by paclitaxel. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the efficacy of custom-made reverse geometry rigid gas permeable (RGP) contact lenses in the control of symptoms related to increased wavefront aberrations after LASIK correction of myopia. Materials and Methods: Twenty-eight myopes treated with LASIK were assessed for post-LASIK symptoms (declined night vision, glare, halos and/or monocular diplopia) and corneal topography. A set of RGP contact lenses was selected as trial lenses based on the matching between the lens and the patient’s corneal topography. If the fluorescein pattern between the trial lens and the corneal surface showed a central alignment, a mid-peripheral bearing and peripheral clearance and if the patient felt comfortable with the lens wear, a duplicated lens was ordered for the patient. Otherwise, a lens satisfied with corneal topography of the patient and clinical judgment was used. Visual acuity (VA) and wavefront aberrations were measured after the lens wear. Results: The custom-made lenses well matched the host cornea with no dislodgment in all subjects. The post-LASIK eyes showed an increase of 1 Snellen line in VA (from 0.90 ± 0.33 to 1.11 ± 0.24) and a significant improvement in all symptoms after the lens wear. The total higher-order aberration is significantly reduced after the lens wear with at least 70% reduction in either spherical aberration, coma, third or fourth aberration but only 33% reduction in the fifth aberration. Conclusions: Reverse geometry RGP lenses with the design based on individual topographic data can improve visual performance of post-LASIK eyes by reducing higher order aberrations. [ABSTRACT FROM AUTHOR]

Background: It is generally believed that the clinical performance of the original Czechoslovakian hydrogel contact lenses was poor but historical reviews provide very little explanation regarding their failings. There is a lack of information in the literature about their dimensions and, in particular, thickness, which is essential for the calculation of oxygen transmissibility. Until now no measurements on Czechoslovakian lenses have been reported. Methods: A literature search on Czechoslovakian lenses was made that spanned the first decade of their use and included peer-reviewed journals, non-refereed publications and a number of archived documents. In addition, the water content and dimensions of five Geltakt and four Spofa lenses were measured. Results: Lens packaging, lens lifetime, hygienic care, visual acuity, nominal lens dimensions, flexure, failure to correct astigmatism, corneal oedema, oxygen transmissibility, complications and wearing time are reviewed. Measurements on Czechoslovakian lenses indicate that the total diameter was similar to that of the cornea, the back optic zone radius was steep and the centre thickness was large. Conclusion: Problems associated with the Czechoslovakian lenses included packaging and an initial failure to require daily disinfection. Few complications of lens wear were reported, probably due to the comparatively small number of patients fitted and the limited wearing time that they achieved. Delayed disclosure of lens dimensions handicapped the development of a fitting technique. An acceptable visual acuity was attained in selected cases, while reduced acuity may sometimes have been due to uncorrected astigmatism or to poor lens quality. The most serious disadvantage was the very low oxygen transmissibility that could result in marked corneal oedema. [ABSTRACT FROM AUTHOR]

Objectives: To assess the cost-effectiveness of screening for refractive error and fitting with glasses in India. Methods: We populated a decision tree with the costs of screening and spectacles, prevalence of varying levels of presenting and best corrected visual acuity (BCVA) from two studies, and sensitivity and specificity of screening. We calculated dollars spent per disability adjusted life year (DALY) averted separately in urban and rural areas for school-based screening (SBS) and primary eye care (PEC) programs that fit spectacles to individuals presenting for care. We conducted a series of univariate and probabilistic sensitivity analyses. An intervention was inferred to be highly cost-effective if the incremental cost-effectiveness ratio (ICER) was less than the gross domestic product (GDP) per capita and moderately cost-effective if the ICER was less than three times this level. Results: Compared with no screening, urban SBS was highly cost-effective; rural SBS was moderately cost-effective for ages 5–15 and highly cost-effective for ages 7–15. Both urban and rural PEC were moderately cost-effective in comparison to SBS. Probabilistic sensitivity analysis suggested that SBS is likely the most cost-effective solution for refractive error in India if the 5–15 year old age group is targeted; primary eye care is the best choice if a high value is placed on DALYs and the 7–15 year old age group is targeted. Conclusion: Both SBS and PEC Interventions for refractive error can be considered cost-effective in India. Which is the more cost-effective depends on the choice of targeted age group and area of the intervention. [ABSTRACT FROM AUTHOR]

Purpose: To assess changes in the pattern of eye care utilization among older Australians with correctable visual impairment, identified in an eye survey. Methods: The Blue Mountains Eye Study (BMES) examined 3654 Australians aged ≥ 49 years at baseline (BMES-I). Five-year follow-up examinations were attended by 2334 participants, 75.0% of survivors (BMES-II). Interviewers collected data on eye care utilization at each visit. Habitual (presenting) and best-corrected visual acuity were assessed using a LogMAR chart. Survey reports, including visual acuity and recommendations were sent to participants after each visit. Those with under-corrected refractive error were informed that they could benefit from a new distance prescription. Eye care utilization was compared before and after the BMES-I survey. Results: Of 2152 participants with data from both examinations, 26 had non-correctable and 115 had correctable visual impairment at BMES-I. The proportion of the 115 participants with correctable visual impairment who reported seeing an eye care provider during the previous 2 years increased from 55% at BMES-I to 64% at BMES-II. Comparing the data collected at BMES-II with that at BMES-I, a higher proportion of reported optometric visits in the previous 5 years was evident for all participants regardless of their correctable visual impairment status. Among those with correctable visual impairment at BMES-I, 58% improved to no visual impairment at BMES-II, and the proportion who subsequently wore distance correction increased from 57% to 71%. Conclusions: We observed modest increases in eye care utilization by older persons after an eye survey, particularly those with correctable visual impairment. [ABSTRACT FROM AUTHOR]

In this article, the authors describe the self-reported eye conditions, eyecare history, and eye safety practices of migrant farmworkers in eastern North Carolina. The authors administered interviews to 79 farmworkers recruited at migrant clinics. Data collected included eye-related complaints and diagnoses, self-assessed visual acuity, eye symptoms, use of protective gear during work, and attitudes toward eye protection gear. Fair or poor eyesight was reported by 21.3%. Only 4 (5.1%) reported wearing glasses or contact lenses. More than 11% reported difficulty in recognizing a friend across the street, and 19.5% reported difficulty in reading. About 20% reported each of several eye symptoms. Fewer than 1 in 10 wore eye protection at work. Of all, 38% reported never having visited any eyecare professional. Farmworkers have a high level of unmet need for both routine preventive eye care and treatment or correction of vision problems. [ABSTRACT FROM AUTHOR]

The purpose of the work was to assess the contrast sensitivity function of individuals wearing gas permeable (GP) multifocal contact lenses, soft bifocal contact lenses, and GP monovision lenses. Twenty-six females and six males between the ages of 42 and 65 participated in this study. The study included subjects wearing monovision (N = 8), the Acuvue Bifocal (Johnson & Johnson) (N = 8), Essential GP Multifocal (Blanchard) lenses (N = 8) and progressive addition spectacle lenses (PAL) (N = 8), with PAL wearers forming the control group. Measurements of binocular contrast sensitivity were obtained using the VISTECH 6500 system. Thresholds for each spatial frequency were fit to the equation CS(k) = ak exp(-bk) [1 + c exp(bk)]-1/2, to describe the human contrast sensitivity function. The area under the contrast sensitivity function (CSF) curve was calculated for all four groups and compared. An index of performance was obtained, which was defined as the ratio of CSF with the contact lens correction to the CSF with spectacles. Of the contact lens wearing groups, GP multifocal contact lens wearers had the highest contrast sensitivity at all the spatial frequencies. Soft bifocal contact lens wearers exhibited higher contrast sensitivity than monovision wearers at all spatial frequencies. Subjects wearing GP multifocals had the largest area under the CSF; followed by those wearing soft bifocals, with monovision wearers having the smallest area. GP multifocals have the best visual function at 0.98, soft bifocals have an index of 0.65 and monovision has an index of 0.59. This study quantifies the visual performance of the three lens systems by measuring the area under the CSF curve. In addition, it provides indices of visual function with the contact lenses that will be helpful for analyses and comparisons in future studies. [ABSTRACT FROM AUTHOR]

Purpose: To determine the awareness, use, and barriers to use of eye services in Fiji's Central Province. Methods: A cross-sectional survey study design with random clusters of households was used. Semi-structured interviews were conducted (152 females and 22 males). For 267 household members, presenting distance and near visual acuities were measured, and the perception of and satisfaction with their vision were recorded. Results: Most (86%; 150/174) respondents were aware of at least one conventional eye care service. However, only 66% (121/183) of household members with previous eye problems had consulted one of these; the proportion was even lower for those in the older age groups (p < 0.01). Rural dwellers expressed satisfaction with their vision, despite being more likely to regard it as limiting their activities and being less likely to seek conventional care. A higher proportion of females were reported to have (or have had) eye problems (60:40) and were found to have bilateral visual impairment (60:40). Despite this, females and males attended the hospital eye clinic (47:53) or sought treatment from conventional services (51:49) nearly equally. The reasons given for not seeking conventional care were “fatalistic attitude” (“did not bother”, “could manage”, or accepted the condition: 57%), expense (12%), and fear (8%). Conclusion: Central Province Fijians, particularly the old, rural, and female, under-utilise conventional eye care services. As in developing countries elsewhere, fatalistic attitudes to visual impairment are a significant contributor to this. To improve eye health, planning and implementation of eye care services must overcome under-utilisation by addressing local barriers to uptake through community participation in education and affirmative action. [ABSTRACT FROM AUTHOR]

Recent progress in several fields has radically changed the expectations of low vision individuals. These changes augment existing prescription eye-care and electronic reading machines to improve recovery of visual function. Companies are reporting incidences of multi-line gains in visual acuity as their products for macular degeneration move through FDA approval stages. Funding for this research is rapidly increasing. The range of suitable lighting products and their sphere of application is expanding, facilitating gains in functional vision under more flexible conditions. There is mounting evidence that the use of electronic readers not only solves reading problems but fosters gains in visual capacity, providing significant improvement in reading stamina and confidence. [ABSTRACT FROM AUTHOR]

Introduction: Adults with learning disabilities find it difficult to access conventional eye care services. The result is that refractive errors remain uncorrected, treatable pathology goes undetected and visual acuities are suboptimal. Impaired vision limits independence and impacts significantly on quality of life. Methodology: The demographic and visual characteristics of 95 adults with learning disabilities attending a specialist multi-professional visual assessment clinic within a day centre in Belfast were examined and issues relating to co-operation, access and communication addressed. Results: Of the 95 patients assessed, 51(53.7%) were male and the mean age was 38.13 ± 10.71 years (range: 19–65 years). In 43.2% (n = 41) of cases, there had been no previous visual assessment. Only 30.6% of those requiring spectacles had an adequate correction. A total of 25.3% (n = 24) could be classified as visually impaired. Onward referral for treatable ocular pathology was recommended in 5.3% (n = 5) of patients and 11.6% (n = 11) benefited from assessment by a rehabilitation worker. Experience suggests that with the use of appropriate preparatory material, 86.9% can undertake a complete eye examination. The results of the assessment need to be made available in an easy-to-understand format to the individual and to those involved in their care, so that recommendations can be implemented. Conclusion: Key elements to a successful eye examination with adults who have learning disabilities are utilising a multi-professional approach, preparing patients beforehand, carrying out assessments in a familiar environment and ensuring the outcomes are communicated effectively. [ABSTRACT FROM AUTHOR]

Purpose: To describe the management and long-term outcome of patients with serpiginous choroiditis (SPC) treated with interferon (IFN) alpha-2a.Design: Prospective, non-comparative case series.Participants: Five patients (8 eyes) with active vision-threatening SPC, who failed to respond and/or presented with side effects to the combination of steroid-cyclosporin-A or chlorambucil, at a tertiary care referral center.Intervention: The patients were treated with IFN alpha-2a (4,500,000 IU, 3 times a week for the first 3 months, followed by once a week for the next 3 months). Prednisone was also given initially, then tapered and discontinued.Main Outcome Measures: Visual acuity, control of inflammation, duration of drug-free disease remission, and side effects of IFN alpha-2a therapy.Results: Argon laser photocoagulation (ALP) was applied in three eyes with extrafoveal choroidal neovascular membrane (CNM). All active lesions, including complicating subfoveal CNM in one eye, resolved within six months. The patients had no recurrences and recovered (4 out of 8; 50%) or maintained (4 out of 8; 50%) useful vision during the 16-48-month follow-up. Except for flu-like symptoms at the beginning of the therapy, no noticeable adverse reaction was observed.Conclusions: IFN alpha-2a seems to be a novel treatment option for SPC. In the five patients (8 eyes) with SPC, who were intolerant or unresponsive to the combination of steroid-cyclosporin-A or chlorambucil, IFN alpha-2a treatment prevented recurrences and stabilized the lesions during the long-term follow-up (16-48 months). These promising results support the use of this mode of therapy in controlled clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: I. To determine the causes of low vision by age and sex. II. To assess the need of spectacles and low-vision devices (LVDs) in low-vision patients attending the clinic at the Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex Peshawar. III. To determine the proportion of patients with low vision whose distance visual acuity (VA) can be enhanced to 6/18 or better in the better eye and who have the potential to discern 1 M (newspaper print) after appropriate refraction and application of low-vision devices (LVDs). Design: Hospital-based, cross-sectional study. Methods: A total of 504 individuals attending the low-vision clinic between June 2000 and June 2002 were included in the study. Of this cohort, 372 (73.8%) were male and 132 (26.2%) were female. The inclusion criterion was that the individual had VA < 6/18 in the better eye after medical or surgical treatment and/or best available correction. Results: The leading cause of low vision in age group 16 years was nystagmus 28 (16.97%). While the leading cause amongst all patients was myopic degeneration (14.48%, 95% CI). The percentages of visually impaired, severe visually impaired, and blind (using the WHO low-vision criteria) were 41% (95%CI), 22.4% (95%CI), and 36.5% (95%CI), respectively. After appropriate refraction, 19% of the patients achieved a VA of 6/18 or better. With LVDs, 86% (95%CI) achieved a VA of 6/18 or better and 90% (95%CI) achieved essentially normal near visual acuity. Spectacles were the most common devices. Conclusions: Low-vision clinics have now become an integral part of comprehensive eye-care services. Any patient with some residual vision must be referred to a low-vision clinic for the possibility of exploiting his/her visual potential through LVDs or other means. With appropriate training in their use, counseling, and medical and social support, LVDs can make a significant change in the quality of life of affected individuals. [ABSTRACT FROM AUTHOR]

Purpose: To report a patient fifteen years after anterior chamber phakic intraocular lens (AC-PIOL) implantation in one and laser in situ keratomileusis (LASIK) in the fellow eye. Methods: Case report. Results: A 56-year-old male underwent AC-PIOL implantation in one eye and LASIK in the fellow eye fifteen years ago. Preoperative uncorrected visual acuity (UCVA) was finger count in both eyes. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 (−16.75 −0.50 × 40) in the LASIK eye and 20/32 (−24.50 −0.50 × 90) in the AC-PIOL eye. Fifteen years postoperatively, UCVA was finger count in the LASIK eye and 20/200 in the AC-PIOL eye, while BSCVA was 20/32 and 20/25, respectively. Endothelial cell density (ECD) was 2020±47 in the LASIK eye and 945±22 in the AC-PIOL eye. Conclusion: Both procedures had similar visual outcomes. Furthermore, lower ECD was found in the AC-PIOL eye in comparison to the LASIK eye. [ABSTRACT FROM AUTHOR]

Background: This paper investigates viewing distances and eyestrain symptoms in young adults reading from a smartphone for 60 minutes.Methods: A survey related to common asthenopic (eyestrain) symptoms was administered to subjects before and after they read an extract from a novel on a smartphone for 60 minutes. Subjects rated their symptoms on a scale from zero (not at all) to four (extremely). The viewing distance to the smartphone was measured on a photograph taken of the subject every minute. Each subject used the same smartphone and read the same text.Results: Subjects were 18 young adults (mean age: 21.5 ± 3.3 years) with self-reported good health, normal visual acuity and no accommodative or binocular vision disorders. The mean viewing distance while using a smartphone over 60 minutes was 29.2 ± 7.3 cm. The viewing distance was significantly greater during the first, second and fifth 10-minute time periods (30.6 ± 7.2 cm, 29.7 ± 7.3 cm and 28.9 ± 8.5 cm, respectively) than during the final 10-minute time period (27.8 ± 7.7 cm) (Wilcoxon, p = 0.023, 0.02 and 0.04, respectively). The total symptom score was significantly greater post-experiment (score = 8.06) than pre-experiment (score = 3.56) (Wilcoxon, p < 0.001). Symptoms of tired eyes, uncomfortable eyes and blur increased significantly after 60 minutes of smartphone use (Wilcoxon, p < 0.05). There was a significant correlation between change in total symptom score and change in viewing distance (ρ = -0.51; p = 0.03). The only single symptom that correlated with a change in viewing distance was 'uncomfortable eyes' (ρ = -0.52, p = 0.03).Conclusion: Viewing distances are closer and eyestrain symptoms are greater after reading from a smartphone for 60 minutes. The viewing distances measured were closer than those previously reported in the literature. [ABSTRACT FROM AUTHOR]