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Background: The purpose of this study was to identify the knowledge of and perceived barriers to providing low vision services among eye care practitioners in Goa. Methods: A pretested and predesigned questionnaire was sent to 72 eye care practitioners, which included the optometrists and ophthalmologists working in Goa, through offline and online (social media like WhatsApp, Instagram, etc.) platforms. Information was collected to understand the barriers that restrict eye care practitioners from providing low vision services. Results: Seventy-two participants took part in this study, of which 26.39% (n=19) were ophthalmologists and 73.61% (n=53) were optometrists. From the practitioner's point of view, lack of awareness (70.83%, n=51) and training (68.06%, n=49) were the major barriers to providing low vision services. Conclusion: A lack of awareness and training facilities among eye care practitioners acts as a barrier to providing low vision services. [ABSTRACT FROM AUTHOR]

Background: Current research in the realm of teleoptometric examinations is largely focused on the refractive and ocular health components of the exam. The purpose of this study was to evaluate the validity of binocular vision and accommodative testing in a tele-optometric examination compared to an in-person examination. Methods: Thirty students, ≥18 years old, at the Illinois College of Optometry were recruited to participate in this study. A teleoptometric examination was completed using the DigitalOptometrics platform, followed by a standard in-person examination. The following tests were performed in both examinations: near horizontal heterophoria by von Graefe, near negative and positive fusional vergences (NFV and PFV, respectively) by Risley prism, and accommodative testing with fused cross-cylinder (FCC). Results: The mean near horizontal heterophoria by von Graefe was 2.09Δ ± 6.73∆ exophoria in the tele-optometric examinations and 2.07Δ ± 6.54∆ exophoria in the in-person examinations, with no statistically significant difference between the two examinations (p=0.98). The mean NFV break and recovery in the tele-optometric examination were 10.85∆ ± 3.17∆ and 7.08∆ ± 3.03∆, respectively, and 23.40∆ ± 7.71∆ and 15.38∆ ±7.31∆, respectively, in the in-person examination, with a statistically significant difference (for both, p<0.0001). The mean PFV break and recovery in the tele-optometric examination were 13.50Δ ± 4.24Δ and 9.36Δ ± 4.68Δ, respectively, and 25.86Δ ± 10.48Δ and 16.54Δ ± 7.18Δ, respectively, in the inperson examination, with a statistically significant difference (break: p=0.001, recovery: p=0.004). Agreement of NFV and PFV between the two examinations was poor. The average FCC in the tele-optometric versus in-person examination was +0.67 D ± 0.51 D and +0.96 D ± 0.33 D, respectively, with a statistically significant difference between the two examinations (p=0.012). Conclusions: The tele-optometric and inperson examinations had fair agreement on near heterophoria but poor agreement on break and recovery values of NFV and PFV. Accommodative testing with FCC was not equivalent between the two exams. [ABSTRACT FROM AUTHOR]

Background: Congenital aniridia and oculocutaneous albinism impair ocular development and frequently present with overlapping signs and symptoms. Similar manifestations include foveal hypoplasia, optic nerve hypoplasia, iris abnormalities, congenital nystagmus, strabismus, and decreased visual acuity, which hinder quality of life in affected individuals. Case Report: We present a case of a six-yearold male with both familial congenital aniridia and oculocutaneous albinism yielding secondary visual impairment. His low vision optometric care included refractive error correction, photophobia control, low vision device evaluation, strabismus and amblyopia treatment, ocular health examination and management, and functional vision assessment. The patient's specialty care team included a low vision optometrist, a pediatric glaucoma specialist, a strabismus specialist, a teacher of the visually impaired, an orientation and mobility specialist, and an occupational therapist. Conclusions: The unique contributions of each member of the care team facilitate the holistic development of pediatric low vision patients. Appropriate management, including a multifaceted and multidisciplinary approach to care, is critical to maximize quality of life and visual potential. [ABSTRACT FROM AUTHOR]

Just as the COVID19 virus evolves and continues to affect the lives of billions of people around the globe, neuro-developmental optometric physicians are constantly monitoring, making changes, and updating their offices, as well as the treatment and care of their patients, to keep both patients and staff safe. Each day, more and more information is becoming available about COVID. We now know more about its transmission, which steps help reduce its transmission, and which steps do not. As we learn more about COVID and adapt to the safety precautions necessary to keep our communities safe, we adapt our protocols. The following article will discuss COVID protocols instituted at the Vision & Conceptual Development Center due to COVID, what has been updated, and what policies may be maintained even when the pandemic ends. [ABSTRACT FROM AUTHOR]

Background: Many people who have suffered a stroke can experience lasting effects that can impact their ability to partake in daily routines. Research supports that the visual system can be affected in many ways after enduring a stroke, which can ultimately limit independent function. In the optometric world, there are numerous ways to rehabilitate visual symptoms that restore the ability to participate in activities of daily living. Case Report: A 34-year-old wheelchair-bound Caucasian female presented for a vision therapy evaluation two years after an idiopathic left-sided cerebral vascular accident (CVA). The CVA affected her in many ways, such as: ability to move the right side of her body, capability to articulate language, and dysfunction of her binocular vision system. A multidisciplinary team was already established, which included physical, equine, and speech therapists to assist in her recovery process. Ocular examination findings revealed diagnoses of internuclear ophthalmoplegia, nystagmus, and convergence insufficiency. Vision therapy was initiated to rehabilitate visual issues, particularly diplopia, nystagmus, and helping her left eye to appear more opened. Throughout vision therapy, activities were modified in order for the patient to appreciate the same visual experiences as others not bound by a wheelchair. After completing 45 sessions of vision therapy, she only experienced diplopia in extreme right and left gazes, and she was able to stand with some assistance. Her multidisciplinary team were all on board to work towards her goal of being able to walk again independently. Conclusion: Enduring a stroke can affect a multitude of systems within an individual, which requires a multidisciplinary approach to regain useful function. Undesirable visual symptoms resulting from a stroke can cause valid concerns, including limitations to independence. Early treatment is recommended to help rehabilitate visual barriers. Slight modifications in vision therapy activities can offer the same visual experiences for those bound by a wheelchair as for those not so bound. [ABSTRACT FROM AUTHOR]

Increased computer use has changed the visual demands of today's society based on aspects such as the angle of viewing, the working distance, and the types of eye movements required. However, the effects of screen light are not fully understood. Blue-light blocking lenses are promoted not only to reduce digital eye strain, but also to prevent the decline of ocular health - specifically photochemical retinal damage. Blue light is suggested to impact scotopic vision and circadian rhythm. Hard evidence is lacking in determining whether these lenses are effectively designed and are performing as advertised. Many of the studies are not long-term, lack a control for the placebo effect, or are poorly controlled. The effects of blue light remain unclear. There have not been any reported negative consequences to blue-blocking lenses, but the objective data for them is still lacking and inconclusive. It is known that light impacts our visual comfort, circadian rhythm, and ocular health (if at high levels). Note that even the more popular lenses on the market may not be blocking as much light as advertised, and the patient may be better off changing their work environment and screen to "night mode" if they are interested in completely removing all blue light exposure. All this being said, this is the first time period in which screens have become such an integral part of our lives at such a young age, so it is an important body of work to pay attention to so we can best direct our patients. This literature review examines 5 studies in the area of blue-light blocking lens technology. [ABSTRACT FROM AUTHOR]

Deaf patients represent a subset of the population that may present to primary care optometrists. Deaf patients have a heightened need to maximize visual function due to their pre-existing sensory deficit. This clinical procedures manuscript aims to identify special considerations in the provision of eye care to deaf patients before, during, and after the exam encounter. Traditional methods of healthcare communication may need to be adjusted, and deaf cultural sensitivity is paramount. Specific examination strategies are discussed with the intent to equip the primary care optometrist with a particular skill set and additional resources in order to examine deaf patients efficiently and effectively. [ABSTRACT FROM AUTHOR]

Background: Aniseikonia is a condition in which there are different image sizes in the two eyes. Post-surgical anisometropia from corneal transplant, cataract surgery, or epiretinal membrane peel continues to be the primary cause and sometimes is large enough to remain symptomatic even after contact lens (CL) correction. Clinical measurement of aniseikonia is rare and uses obsolete instrumentation long out of production. This case report details the diagnosis and treatment of a symptomatic patient with significant anisometropia, pseudophakia OS, and post-penetrating keratoplasty OU secondary to keratoconus. Treatment included using size lenses and common clinical equipment. Case Report: A 62-year-old female presented with diplopia and blurry vision. Due to her irregular astigmatism, the manifest refraction was unreliable. The patient was fit with a large-diameter corneal gas-permeable CL OD (-11.50 DS) and a scleral CL OS (-2.50 DS) to correct her irregular astigmatism OU. Best-corrected acuities were 20/20 OD and 20/30 OS. After contact lens correction, the patient noted poor depth perception, clumsiness, and non-specific asthenopia. Using the Brecher test, aniseikonia was diagnosed. Aniseikonia was measured at 6% larger retinal image OS using plano magnifiers (size lenses). A 6% size lens was prescribed for the OD with a 2 prism diopter base-in correction. A 10 D base curve (BC) spectacle lens in CR-39 (n=1.498) and standard 1.5 mm center thickness was prescribed OD, matching the BC of the plano magnifier accepted on trial framing over the patient's contact lens correction for residual post-surgical aniseikonia. The following year, the aniseikonia measured at 7%, but the patient preferred the thinner 6% magnifier since it still allowed fusion. Horizontal prism correction was changed to 4 prism diopters base out. Conclusions: The Brecher test combined with a size lens set, lens clock, and specialty CL can be used to diminish or to eliminate aniseikonia without requiring additional mathematical calculation of spectacle base curve or center thickness. [ABSTRACT FROM AUTHOR]

Background: Medicare uses a combination of incentives and penalties to encourage health care practices to screen for tobacco use and counsel on cessation. The few studies published on success rates report cessation rates from zero to 15% in hospitals and primary care offices. This study examines the effect of screening for and counseling about tobacco use and cessation on patients of an eye care practice. Methods: Study design: retrospective cohort records review. Criteria for inclusion were: established patient with a documented history of tobacco use at previous office visit(s), received cessation counseling, and age 25 or older. Sample size: given an 18% prevalence of tobacco use in the target population, a minimal sample size of 1418 was calculated in order to detect a 1% change in tobacco use status. Consecutive records from a large multisite eye care practice were reviewed for all visits April 21-May 5, 2016. A total of 1834 established patient records were reviewed, and 193 met the inclusion criteria. Results: Twenty-eight (14.4%) of 193 patients who reported tobacco use at a previous exam and who received counseling on tobacco cessation reported no longer using tobacco at the survey visit. The demographic variables of age, gender, and health insurance carrier did not differ between former users and continuing users. Conclusions: Screening and counseling tobacco cessation in an eye care office is associated with clinically significant decreases in tobacco use. [ABSTRACT FROM AUTHOR]

Introduction: Visual consciousness is affected when the primary visual cortex is damaged. However, sighted behavior can persist within the areas of cortical blindness. This phenomenon is called blindsight, and it describes the ability to respond to visual stimuli in the absence of conscious awareness. With practice, visual awareness within a blind field can be trained through repeated visual stimulation. Case Report: A 70-year-old female with blindsight presented for a visual skills evaluation following a left-sided ischemic stroke. She perceived light in only very limited areas of her visual field, yet she was able accurately to identify colors, orientation, and the location of various visual targets presented in her blind field. Vision therapy was initiated to maximize the use of her residual vision, as well as to improve overall visual awareness. Within two months of starting therapy, her vision improved to 20/100 in the right eye and 20/125 in the left eye with near normal visual fields. Conclusions: With practice, responses to visual stimuli within the blind field can improve, perceptual learning can occur over time, and awareness can be trained. Rehabilitation of individuals with blindsight is highly recommended as it may present some therapeutic value as well as rehabilitative. [ABSTRACT FROM AUTHOR]

Background: One of the more common types of congenital synkinetic abnormalities is Marcus Gunn Jaw Winking Syndrome. It is typically a unilateral condition in which the affected superior eyelid moves with mouth movement, and the identified ptosis improves upon opening the mouth. Case Report: A ten-week-old infant presented to The Eye Center at Southern College of Optometry due to the right superior lid moving simultaneously with mouth movement. The child had been seen at eight weeks of age for the same presentation at Le Bonheur Children's Hospital, where neurological testing was found to be normal. At TEC, she was diagnosed with Marcus Gunn Jaw Winking Syndrome. Possible sequelae of this condition include, but are not limited to, binocular vision and accommodative dysfunctions and potential amblyopia of the affected eye. Conclusion: This case presentation will serve to help other eye care professionals to recognize and to understand Marcus Gunn Jaw Winking Syndrome in the pediatric patient. [ABSTRACT FROM AUTHOR]

Most optometrists are taught to determine which lens produces the best acuity. Those who practice the art and science of optometry understand that there is a range of lens powers through which a patient can see clearly. The determination of a prescription is a negotiation between the clinician and the patient. This paper will introduce the concept of Range of Clarity and demonstrate its usefulness in the examination process and in determining the stage of refractive development. [ABSTRACT FROM AUTHOR]

Background: There are epidemiological studies which suggest that the athletic population is underserved by the eye care professions. The purpose of this investigation was to compare the epidemiological and visual examination findings from a cohort of amateur athletes to a similar cohort of amateur athletes that had been tested 10 years previously. Methods: Data collected from the 2009 Amateur Athletic Union Junior Olympic Games (AAUJOG) was analyzed and compared to data gathered from the 1997 and 1998 AAUJOG. A total of 12 sports were represented by 116 athletes, ranging in age from 6 to 18 years. Protocols were similar between the two screening events and included a history and appropriate vision examinations. Performance-based testing was calculated and compared to previous research by age group and sporting activity. Results: Among the 2009 athletes, more than 29% of participants had not received eye care for >3 years, with more than 20% indicating that they had never been examined by an eye care professional. This was slightly better than the 1997/8 rates. None of the 2009 athletes used the appropriate protective eyewear to prevent ocular injuries as compared to 1% in 1997/8. The most common visual symptoms were headaches, difficulty seeing, and light sensitivity. Comparing performance between the two screening events, no significant differences were identified. Increased performance with increased age for most tests was documented. Conclusions: The results of this study indicate a continued need for optometric services within the athletic population to ensure that the visual system is not limiting athletic performance and that eye protection is used to prevent injury. [ABSTRACT FROM AUTHOR]

Background: There are many approaches to treating amblyopia; opaque patching is one of the most common. However, opaque patching is known to have limited patient compliance due to poor cosmesis and social stigma. Partial occlusion with translucent Bangerter foils is a viable alternative to opaque patching. Case Report: JR, a 12-year-old Caucasian male with refractive amblyopia, was referred for a vision therapy evaluation. In addition to reduced acuity of 20/50- OS, JR exhibited decreased accommodative and oculomotor skills. JR was fitted with a 0.3 Bangerter foil OD over his glasses to be worn 2-3 hours per day. JR was enrolled in weekly vision therapy and reevaluated after 10 and 20 sessions. After his 20-week progress check, JR's acuity improved to 20/30 OS. JR also reported a subjective improvement in reading ability and a decrease in frequency of headaches. Conclusion: Bangerter foils are an acceptable alternative to opaque patching for amblyopia treatment. When combined with active vision therapy, patients can see an increase in visual acuity, accommodative skills, and oculomotor control. [ABSTRACT FROM AUTHOR]

Fitting contact lenses in the pediatric population can be rewarding for both the child and practitioner. Contact lenses as an option for vision correction can have a major impact on a child's life and visual development. Progressive myopia is a detrimental and visually debilitating condition. With recent focus on the use of different contact lenses modalities, continuous progress is being made in attempting to halt myopia progression in children. Promising results have been found in early trials with use of Dual Focus lenses. With the advent of improved contact lens materials, the question of whether it is possible to fit younger children has been raised. Recent studies have found fitting children with contacts has minimal risk of adverse events, does not require more of the practitioner's time and can improve a child's self-perception. This month's review takes a look at three studies involving contact lenses and children. [ABSTRACT FROM AUTHOR]

Strabismus is a common problem encountered by eye and vision care professionals and alternating exotropia is a common diagnosis of patients with strabismus. When measuring the deviation it is often easier to elicit consistent near fixation than at distance, particularly with children and special populations. The purpose of this study was to investigate the existence of a correlation between far gaze measurements with 10° or 25° of upward gaze at near with alternating exotropia. The sample was a cross-sectional pilot study of 41 patients with a definite diagnosis of basic alternating exotropia, either intermittent or constant. The deviation was first measured at far gaze and then in an up gaze position with neck flexion of 10° and 25°, respectively. The outcome measures were correlations between exotropia measurements in far gaze and both the 10° and 25° upward near gaze measures. Measuring exotropia in upward gaze instead of far gaze offers the possibility of a more reliable method of measurement with children and noncooperative patients. [ABSTRACT FROM AUTHOR]

Abstract Experts estimate vision problems are prevalent in 25% of all schoolchildren in the United States and are one of the most prevalent handicapping conditions in childhood. However, research has shown, of children in the 9 to 15 years old age group, only 10% who needed eyeglasses actually had them. Children with undiagnosed and untreated vision problems grow up to become adults with undiagnosed and untreated vision problems. The failure to detect and treat children's vision disorders affects the rates of adult criminality, literacy and labor productivity. Children must have the vision care and vision skills required in order to perform successfully in school and workplace environments. As children progress through their school years they must be checked regularly for vision problems. These screenings or examinations should include multiple tests to identify a wider spectrum of vision problems, especially those affecting near-vision. Parents must be educated on these points so they do not defer vision care for their children. Resources should be provided for those who cannot afford eye exams or glasses for their children, as well as to make it easier for follow through. [ABSTRACT FROM AUTHOR]

Optometrists are being asked to provide vision care to increasing numbers of individuals with mild traumatic brain injury (mTBI). However, the complexity of both the vision-based, and non-vision-based symptoms and related problems, as well as the multiple levels of concurrent care provided by other health-related professionals, may make the task appear daunting. We propose a four-tiered, conceptual model of optometric care in these patients that should render the task more easily achievable. The four-tiered model includes the basic optometric examination, and analysis of ocular motor problems, non-ocular motor problems, and non-vision-based problems. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of changes in the lives and system of education of children. He argues that the importance of child development is de-emphasized and there is an assumption that testing will enhance learning. He mentions the significant role played by optometrists in changing the education system for children, like providing indicated eye and vision care for them to alleviate obstacles to their academic achievement.