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Objective We investigated cross-sectional gender-specific associations with vision, hearing, and both (dual) impairment with depression and chronic anxiety using a large representative sample of Spanish adults. Methods The present study utilized data from the Spanish National Health Survey 2017. A total of 23,089 adults (15-103 years, 45.9% men) participated in this survey. Participants self-reported whether they had suffered depression and/or anxiety, and also whether they experience vision, hearing and both vision/hearing (dual) impairment. Multivariable logistic regression analyses were conducted to assess the associations between the three types of sensory impairment and anxiety or depression, in men and women. Results Across the whole sample (n = 23,089) the prevalence of depression and anxiety was between 2.00 and 2.56 times higher in women compared to men. Dual sensory impairment (hearing and vision) was associated with higher levels of depression (odds ratio [OR] = 2.980, 95% confidence interval [CI]: 2.170-4.091) and anxiety (OR = 2.636, 95% CI: 1.902-3.653) compared to single sensory impairment. Stratified associations by gender showed higher odd ratios for women with dual sensory loss (3.488 for depression and 3.478 for anxiety) compared to men (2.773 for depression and 1.803 for anxiety). Conclusions Dual sensory impairment (hearing and seeing) is are associated with increased depression and anxiety. Women with dual sensory impairment showed stronger associations compared to men among adults in Spain. Interventions are needed to address vision and/or hearing impairment in order to reduce anxiety and depression especially in women.

Aims-\ud \ud Several modifiable risk factors have been meta-analysed for diabetic retinopathy (DR), such as physical activity and vitamin D status. To date, these factors have not been systematically aggregated and the credibility of evidence assessed. Therefore, the aim of this umbrella review was to aggregate all modifiable risks of DR and assess the credibility of the evidence.\ud \ud Methods-\ud \ud An umbrella review of meta-analyses was undertaken. For each meta-analytic association, random-effects effect size, 95% confidence intervals (CIs), heterogeneity, small-study effects, excess significance bias and 95% prediction intervals were calculated. The credibility of significant evidence (p < 0.05) was graded from I to IV, using pre-defined criteria.\ud \ud Results-\ud \ud After initial searches, 13 studies were included covering 34 independent outcomes (total participants = 824,372). Positive associations were found between insulin usage and diabetic macular oedema (RR = 4.5; 95% CI 3.1–6.6), and DR risk (RR = 2.3; 95% CI 1.4–3.9) in people with type 2 diabetes. Vitamin D deficiency was associated with DR risk (OR = 2.8; 95% CI 1.1–7.1), as was obesity (RR = 1.34; 95% CI 1.06–1.68) and sedentary behaviour (RR = 1.22; 95%CI 1.03–1.44). Intensive blood pressure targets (RR = 0.8 95%CI 0.8–1.0), and moderate physical activity (RR = 0.69; 95%CI 0.53–0.91) yielded significant protective associations with DR.\ud \ud Conclusions-\ud \ud People with type 2 diabetes on insulin have a high risk of macular oedema and DR. Vitamin D deficiency yielded almost three times greater odds of DR, while intensive blood pressure control reduces DR risk by 20% and moderate physical activity by 31%. Healthcare professionals should use this evidence to identify those people most at risk to ensure that proper treatment and healthy lifestyles are recommended.

Background People of Black and Asian ethnicities have a higher infection rate and mortality as a result of COVID‐19. It has also been reported that vitamin D deficiency may play a role in this, possibly because of the multi‐gene regulatory function of the vitamin D receptor. As a result, increased dietary intake and/or supplementation to attain adequate 25‐hydroxyvitamin D (25(OH)D) levels could benefit people in these ethnicities. The present study aimed to review the literature examining the changes in 25(OH)D in different types of vitamin D supplementation from randomised controlled trials in this population. Methods This systematic review was conducted using the PRISMA guidelines. Electronic databases were systematically searched using keywords related to vitamin D supplementation in Black and Asian ethnicities. Results Eight studies were included in the review. All the included studies found that supplementation of vitamin D (D2 and D3), regardless of dosage, increased 25(OH)D levels compared to a placebo. All trials in which participants were vitamin D deficient at baseline showed increased 25(OH)D levels to a level considered adequate. Two studies that used food fortification yielded smaller 25(OH)D increases compared to similar studies that used oral supplementation (10.2 vs. 25.5 nmol L−1, respectively). Furthermore, vitamin D2 supplementation yielded significantly lower 25(OH)D increases than vitamin D3 supplementation. Conclusions Oral vitamin D supplementation may be more efficacious in increasing 25(OH)D levels than food fortification of Black and Asian ethnicities, with vitamin D3 supplementation possibly being more efficacious than vitamin D2. It is recommended that people with darker skin supplement their diet with vitamin D3 through oral tablet modes where possible, with recent literature suggesting a daily intake of 7000–10,000 IU to be potentially protective from unfavourable COVID‐19 outcomes. As a result of the paucity of studies, these findings should be treated as exploratory., Highlights Oral vitamin D supplementation could be more efficacious than food fortification in Black and Asian populations.Vitamin D3 is more efficacious than vitamin D2.It is recommended that people with darker skin supplement their diet with vitamin D3.

Objective:\ud \ud We investigated cross‐sectional gender‐specific associations with vision, hearing, and both (dual) impairment with depression and chronic anxiety using a large representative sample of Spanish adults.\ud \ud Methods:\ud \ud The present study utilized data from the Spanish National Health Survey 2017. A total of 23,089 adults (15–103 years, 45.9% men) participated in this survey. Participants self‐reported whether they had suffered depression and/or anxiety, and also whether they experience vision, hearing and both vision/hearing (dual) impairment. Multivariable logistic regression analyses were conducted to assess the associations between the three types of sensory impairment and anxiety or depression, in men and women.\ud \ud Results:\ud \ud Across the whole sample (n = 23,089) the prevalence of depression and anxiety was between 2.00 and 2.56 times higher in women compared to men. Dual sensory impairment (hearing and vision) was associated with higher levels of depression (odds ratio [OR] = 2.980, 95% confidence interval [CI]: 2.170–4.091) and anxiety (OR = 2.636, 95% CI: 1.902–3.653) compared to single sensory impairment. Stratified associations by gender showed higher odd ratios for women with dual sensory loss (3.488 for depression and 3.478 for anxiety) compared to men (2.773 for depression and 1.803 for anxiety).\ud \ud Conclusions:\ud \ud Dual sensory impairment (hearing and seeing) is are associated with increased depression and anxiety. Women with dual sensory impairment showed stronger associations compared to men among adults in Spain. Interventions are needed to address vision and/or hearing impairment in order to reduce anxiety and depression especially in women.

INTRODUCTION: Within the Canadian competency‐based medical education system, entrustable professional activities (EPAs) are used to assess residents on performed clinical duties. This study aimed to determine whether implementing a bundle of two interventions (a case‐based discussion intervention and a rotation‐based nudging system) could increase the number of EPA assessments that could occur for our trainees. METHODS: The authors designed an intervention bundle with two components: 1) a case‐based workshop where trainees discussed which EPAs could be assessed with multiple cases and 2) a nudging system wherein each trainee was reminded of EPAs that would be useful to them on each rotation in their first year. We conducted a retrospective program evaluation to compare the intervention cohort (2019) to two historical cohorts using similar EPAs (2017, 2018). RESULTS: Data from 22 trainees (seven in 2017, eight in 2018, and seven in 2019) were analyzed. There was a marked increase in the total number of EPA assessments acquired in the 2019 cohort (average per resident = 285.7, 95% confidence interval [CI] = 256.1 to 312.3, range = 195–350) compared to the two other years (2018 [average = 132.4, 95% CI = 107.5 to 157.02, range = 107–167] and 2017 [70.1, 95% CI 45.3 to 91.0, range = 49–95]), yielding an effect size of Cohen's d = 4.02 for our intervention bundle. CONCLUSIONS: Within the limitations of a small sample size, there was a strong effect of introducing two interventions (a case‐based orientation and a nudging system) upon EPA assessments with PGY‐1 residents. These strategies may be useful to others seeking to improve EPA assessment numbers in other specialties and clinical environments.

Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

Introduction:\ud \ud Obesity has been associated with poor vascular health, but not in a Spanish population. Therefore, the study aimed to investigate associations between obesity and cataract, wearing glasses or contact lenses, and trouble seeing in a large representative sample of the Spanish adult population.\ud \ud Methods:\ud \ud Cross‐sectional data from the Spanish National Health Survey 2017 were analyzed. Body mass index (BMI) was calculated and obesity was defined as BMI ≥ 30 kg/m2. Ocular health included three dichotomous variables (presence vs absence): self‐reported cataract, wearing glasses or contact lenses, and trouble seeing. Multivariable logistic regressions were used to assess associations between obesity (independent variable) and ocular health outcomes (dependent variables). Covariates included in the analysis were sex, age, marital status, education, smoking, alcohol, and diabetes.\ud \ud Results:\ud \ud A total of 23 089 participants were included (54.1% female; mean [SD] age = 53.4 [18.9] years). After adjusting for sex, age, marital status, education, smoking, alcohol, diabetes, and wearing glasses or contact lenses (for the trouble seeing analysis only), obesity was found to be a risk factor for cataract (odds ratio [OR] = 1.22; 95% confidence interval [CI], 1.09‐1.37) and trouble seeing (OR = 1.20; 95% CI, 1.09‐1.32) but not for wearing glasses or contact lenses (OR = 0.99; 95% CI, 0.91‐1.08). These findings were corroborated in participants ≥64 years.\ud \ud Conclusions:\ud \ud In this large representative sample of Spanish adults, we found that obesity was a risk factor for cataract and trouble seeing. Lifestyle interventions aiming at the reduction of obesity in this population may indirectly improve ocular health. Such lifestyle interventions are important to implement considering the rising trend of obesity in Spain.

Importance: The change in the anatomical dimensions over time and the effect on diurnal intraocular pressure following laser peripheral iridotomy is poorly understood. Background: To evaluate change over time in anterior chamber angle anatomy following laser peripheral iridotomy (LPI) in patients with primary angle closure compared to control eyes. Additionally, the effect of LPI on diurnal intraocular pressure (DIOP) fluctuation was investigated. Design: Longitudinal, prospective, double-randomised research study. Participants: Adults with suspected angle closure or angle closure diagnosis referred to hospital services in the United Kingdom. Methods: Thirty-nine patients newly diagnosed with bilateral primary angle closure/suspects (PAC/PACS) received LPI to one eye and changes in angle morphology were measured over 8 sections with swept source AS-OCT. The other eye acted as control with intraocular pressure (IOP) measured hourly. Main outcome measures: Angle opening distance (AOD), trabecular–iris angle (TIA), angle recess area (ARA), and trabecular–iris space area (TISA) at 500 m and 750 m from scleral spur Results: There was an increase in all angle parameters following LPI, which was maintained for 6 months (e.g inferotemporal segment AOD500 0.041mm (p=0.008) at 1 week and 0.039mm (p=0.003) at 6 months) following LPI. Greatest effect at 6 months post-LPI was observed opposite the iridotomy site in the inferior/inferotemporal sections (AOD500 0.039mm, p=0.003 and AOD750 0.075mm, p=0.002). There were no statistically significant differences for the overall DIOP fluctuation values in the treated group at 6 months post-LPI compared to baseline. Conclusions and Relevance: LPI widened all angle sections with maximum effect observed in the site opposite the iridotomy. Angle changes were maintained up to 6 months after LPI treatment without any statistically significant change in DIOP fluctuation.

Importance: The change in the anatomical dimensions over time and the effect on diurnal intraocular pressure following laser peripheral iridotomy is poorly understood.\ud \ud Background: To evaluate change over time in anterior chamber angle anatomy following laser peripheral iridotomy (LPI) in patients with primary angle closure compared to control eyes. Additionally, the effect of LPI on diurnal intraocular pressure (DIOP) fluctuation was investigated. \ud \ud Design: Longitudinal, prospective, double-randomised research study.\ud Participants: Adults with suspected angle closure or angle closure diagnosis referred to hospital services in the United Kingdom.\ud \ud Methods: Thirty-nine patients newly diagnosed with bilateral primary angle closure/suspects (PAC/PACS) received LPI to one eye and changes in angle morphology were measured over 8 sections with swept source AS-OCT. The other eye acted as control with intraocular pressure (IOP) measured hourly. \ud \ud Main outcome measures: Angle opening distance (AOD), trabecular–iris angle (TIA), angle recess area (ARA), and trabecular–iris space area (TISA) at 500 m and 750 m from scleral spur\ud \ud Results: There was an increase in all angle parameters following LPI, which was maintained for 6 months (e.g inferotemporal segment AOD500 0.041mm (p=0.008) at 1 week and 0.039mm (p=0.003) at 6 months) following LPI. Greatest effect at 6 months post-LPI was observed opposite the iridotomy site in the inferior/inferotemporal sections (AOD500 0.039mm, p=0.003 and AOD750 0.075mm, p=0.002). There were no statistically significant differences for the overall DIOP fluctuation values in the treated group at 6 months post-LPI compared to baseline.\ud \ud Conclusions and Relevance: LPI widened all angle sections with maximum effect observed in the site opposite the iridotomy. Angle changes were maintained up to 6 months after LPI treatment without any statistically significant change in DIOP fluctuation.

Visuo-manual interaction in visual short-term memory (VSTM) has been investigated little, despite its importance in everyday tasks requiring the coordination of visual perception and manual action. This study examines the influence of a manual action performed during stimulus learning on a subsequent VSTM test for object appearance. The memory display comprised a sequence of briefly presented 1/f noise discs (i.e., possessing spectral properties akin to natural images), wherein each new stimulus was presented at a unique screen location. Participants either did (or did not) perform a concurrent manual action (spatial tapping) task requiring that a hand-held stylus be moved to a position on a touch tablet that corresponded (or did not correspond) to the screen position of each new stimulus as it appeared. At test, a single stimulus was presented, either at one of the original screen positions, or at a new position. Two factors were examined: the execution (or otherwise) of spatial tapping at a corresponding or non-corresponding position, and the presentation of test stimuli either at their original spatial positions, or at new positions. We find that spatial tapping at corresponding positions elevates VSTM performance by more than 15%, but this occurs only when stimulus positions are matched from memory to test display. Our findings suggest that multimodal attentional focus during stimulus encoding (incorporating visual, spatial, and manual components) leads to stronger, more robust memory representations. We posit several possible explanations for this effect.

Citation information: Pardhan S, Gonzalez-Alvarez C & Subramanian A. How does the presence and duration of central visual impairment affect reaching and grasping movements? Ophthalmic Physiol Opt 2011, 31, 233–239. doi: 10.1111/j.1475-1313.2010.00819.x Abstract Purpose: To examine how subjects with central visual impairment (CVI) due to macular degeneration conduct reaching and grasping movements compared to those with normal vision and to determine whether these are influenced by the duration of the impairment. Methods: Eighteen subjects with CVI and 9 subjects of a similar age but with normal vision were recruited. Subjects were required to pick up a cylindrical object and a motion analysis system recorded and reconstructed the reaching and grasping movements in 3-D. Subjects were also divided into two groups based on the duration of their vision loss: subjects with CVI of less/greater than 10 years duration. Results: Subjects with CVI showed significant differences in some transport and grasping indices compared to age matched normal subjects (p

Fundus photography plays an important role in detection and assessment of diabetic retinopathy. This study compared the detectability of diabetic retinopathy lesions on Polaroid prints and Ektachrome slides obtained with a non-mydriatic camera. The number of lesions detected with Ektachrome slides was higher compared to Polaroids. The method of viewing the Ektrach-rome slides was also shown to be important. Slides when projected onto a white screen revealed a higher number of lesions compared to the same slide viewed through a macroscope. If a non-mydriatic camera is used to screen diabetic retinopathy, judgement from a projected Ectrachrome slide is recommended

Aim To investigate how prehensile movements, such as reaching and grasping, are affected by different fields of view when both haptic and visual information are available. Methods Ten volunteers with normal vision (mean age 24.5 years) participated. Subjects picked up an object with a full monocular field of view (FOV) and with two different sizes of pinholes which simulated a central FOV of 23 degrees and 11 degrees respectively. The Vicon motion analysis system was used to record and reconstruct the 3D-kinematic data. The kinematic parameters measured were total time of the movement, maximum velocity, time to maximum velocity, deceleration time, maximum grip aperture, time to maximum grip aperture and time taken after maximum grip aperture. Results Restricting the FOV affected both the transport and grasp components of the movement. The maximum velocity decreased (p = 0.008) and the maximum grip aperture increased (p = 0.003) with both restricted FOV when compared with the full field. The execution or on-line control of both reach and grasp components were also longer (p = 0.005 and p = 0.002 respectively) for the 11 degrees FOV only. Conclusions Reducing the FOV to 11 degrees (an absence of peripheral vision) affects the planning and execution of the reach and the grasp component of the movement. Restricting the FOV to 23 degrees of central vision (with some peripheral cues present) affects only the planning of the reach and grasp component of the movement. Peripheral visual cues are therefore more important for the on-line control than for the planning of the movement. The findings of this study have important clinical implications in patients who suffer from ocular diseases in which peripheral vision gradually decreases.

Purpose: Visual short-term memory (VSTM) for briefly presented visual stimuli has been estimated at 4–6 items for real-world objects (Luck and Vogel, 1997). To measure the fundamental capacity of VSTM the use of real-world objects is undesirable, since estimates are confounded by verbal descriptors and/or long-term memory support (Olsson and Poom, 2005). The purpose of this study is to measure the accuracy and capacity of VSTM for unfamiliar, non-categorical visual stimuli. Method: Stimuli were random grayscale noise patterns subtending 2°× 2, displayed at a distance of 57 cm. A series of reference stimuli were presented sequentially at the centre of a computer display for 500 ms each. Following this, a blank interval of 500 ms, and then a test stimulus were displayed. Signal present test stimuli originated from a random index in the study series. The probability of a signal present trial was 50%. Observers were instructed to indicate, via a numeric keypad, if the test stimulus was present in the study series (yes/no). Series length was increased from 1 to 5 across blocks of trials. The number of blocks completed for each series length, S, was 2S, where each block comprised 100 trials (i.e. 3000 trials per observer were completed). Four normal/corrected-to-normal observers participated in the study. The number of objects encoded in VSTM was calculated using Cowan's formula (Cowan, 2001). Results: Across series lengths 1–5, average performance rate (pooled across observers) decreased exponentially from 95% for series length 1, to 60% for series length 5. The number of stimuli encoded in VSTM, determined using Cowan's formula, was found to be 1.52, achieved for series length 3. Beyond series length 3, the number of items encoded was found to decrease, at 0.92, 1.30, 1.52, 1.35 and 1.40 for series lengths 1–5, respectively. For series lengths > 1, large recency effects were found by analysis of the reference indices of correctly identified signal present test stimuli. Conclusions: We find that the capacity of VSTM for serially presented non-categorical visual stimuli is limited to 1.5 items, in line with VSTM capacity estimates of Olsson and Poom (2005), rather than the more commonly cited 4–6 items (Cowan, 2001; Luck and Vogel, 1997), and is seen to decrease exponentially with increases in series length or decreases in recency. A suite of related experiments are underway to construct a memory performance model under varying stimulus presentation scenarios, including parallel display and variable location.

Purpose: Binocular summation (binocular sensitivity > monocular sensitivity) and binocular inhibition (binocular sensitivity