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We describe the ocular features and normal physiological parameters of the South Island takahe (Porphyrio hochstetteri), using three birds. Both eyes face slightly forward such that there is some anatomic possibility of binocular vision but with restriction particularly of the superior and posterior visual fields. The pupil is round under both dim room light and very high illumination and the centre of the pupil is displaced <= 0.5 mm nasally with regard to the corneal centre. The iris is light brown and has several areas of more prominent vascularity. Their refractive error in the distance by retinoscopy is between 0 and +1 dioptre, although they sometimes accommodate down to -1 dioptre during examination. The average intraocular pressure is 6.75 +/- 0.88 mmHg using an iCare tonometer and the average corneal thickness is 340 +/- 32 mm. The average corneal curvature is 73.63 +/- 0.82 dioptres. On B scan the eye appears flattened in its antero-posterior axis; the axial length is 13.67 +/- 0.61 mm, the width 16.36 +/- 0.30 mm. The distance from the posterior pole of the lens to the retina is 7.37 +/- 0.26 mm. The pecten is visible inferiorly but no os opticus can be identified. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate, by receiver operating characteristic (ROC) analysis, the ability of noncycloplegic retinoscopy (NCR), Retinomax Autorefractor (Retinomax), and SureSight Vision Screener (SureSight) to detect significant refractive errors (RE) among preschoolers.MethodsRefraction results of eye care professionals using NCR, Retinomax, and SureSight (n = 2588) and of nurse and lay screeners using Retinomax and SureSight (n = 1452) were compared with masked cycloplegic retinoscopy results. Significant RE was defined as hyperopia greater than +3.25 diopters (D), myopia greater than 2.00 D, astigmatism greater than 1.50 D, and anisometropia greater than 1.00 D interocular difference in hyperopia, greater than 3.00 D interocular difference in myopia, or greater than 1.50 D interocular difference in astigmatism. The ability of each screening test to identify presence, type, and/or severity of significant RE was summarized by the area under the ROC curve (AUC) and calculated from weighted logistic regression models.ResultsFor detection of each type of significant RE, AUC of each test was high; AUC was better for detecting the most severe levels of RE than for all REs considered important to detect (AUC 0.97-1.00 vs. 0.92-0.93). The area under the curve of each screening test was high for myopia (AUC 0.97-0.99). Noncycloplegic retinoscopy and Retinomax performed better than SureSight for hyperopia (AUC 0.92-0.99 and 0.90-0.98 vs. 0.85-0.94, P ≤ 0.02), Retinomax performed better than NCR for astigmatism greater than 1.50 D (AUC 0.95 vs. 0.90, P = 0.01), and SureSight performed better than Retinomax for anisometropia (AUC 0.85-1.00 vs. 0.76-0.96, P ≤ 0.07). Performance was similar for nurse and lay screeners in detecting any significant RE (AUC 0.92-1.00 vs. 0.92-0.99).ConclusionsEach test had a very high discriminatory power for detecting children with any significant RE.

Andrew W Arnold,1 Stephanie L Arnold,1 Jacob H Sprano,2 Robert W Arnold3 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Kansas City University of Osteopathic Medicine, Kansas City, MO, USA; 3Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, AK, USACorrespondence: Robert W ArnoldAlaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561 1917Fax +1 907 563 5373Email eyedoc@alaska.netObjective: Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia.Methods: Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve.Results: Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (−1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific.Conclusion: Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia.Clinical Trials Registry: NCT03668067.Keywords: hyperopia, retinoscopy, cycloplegia, skiascopy

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children. Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner. Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45). Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities.

Objective: To evaluate time of maximum cycloplegia in myopic children with brown irises and to study differences between refractive error after maximum cycloplegia measured by retinoscopy and autorefraction. Materials and Methods: The present study was a prospective descriptive study included myopic children with brown irises aged 5 to 14 years. Cycloplegic refraction was performed using cyclopentolate 1%, three times, ten minutes apart. Refractive error was measured by autorefraction before and at 30, 40, 50, 60, 70, and 80 minutes after the first instillation of cyclopentolate. Finally, retinoscopy was performed by a single examiner at 80 minutes. Time of maximum cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the mean spherical equivalent (SE) at each point and its final value at 80 minutes was reached and remained within the equivalence limit (±0.25 D). Difference between SE of retinoscopy and autorefraction was evaluated. Results: Sixty-eight children were recruited. The mean age was 10.5 years (SD 2.4). Thirty-seven children were male (54%). The time of maximum cycloplegia was 30 minutes after the first instillation of cyclopentolate. At 80 minutes, the degree of myopia measured by autorefraction was significantly higher compared to those measured by retinoscopy (p<0.001, mean difference 0.26 D). Conclusion: Time of maximum cycloplegia in myopic children with brown irises was 30 minutes after the first instillation of cyclopentolate. Even when the maximum cycloplegia was reached, the degree of myopia measured by autorefraction was higher than that measured by retinoscopy. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the refractive shift during off-the-axis retinoscopy under cycloplegic drugs in myopic patients during ocular examination.Methods: Prospective cross-sectional study was carried out among 10 myopic patients having refractive errors of -3.00 D or less. All the subjects underwent cycloplegic refraction by a single examiner at 0°, 10°, and 20°. Descriptive data were analyzed as mean and standard deviation. Paired t-test was used to compare the mean differences between on-axis (0°) and off-axis (10° and 20°) retinoscopy.Result: The mean spherical equivalent refraction of 10 myopic patients showed an increase in myopic shift with approximately 7% and 18% for 10° and 20° of eccentricity, respectively. Similarly, the mean spherical equivalent measure on axis (0°) and off axis (10° and 20°) were -2.5495, -2.737, and -3.0265, respectively. The mean spherical equivalent differences between on-axis (0°) and off-axis (10° and 20°) showed statistically significant differences with P < 0.05.Conclusion: This study concluded that a greater degree of eccentricity will induce a greater amount of errors in retinoscopy. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the sensitivity, specificity e accuracy of the ocular refraction measured by the 2WIN® photoscreener as a screening method to identify children in need of spectacles prescription according to the criteria published by the Brazilian Society of Pediatric Ophthalmology (BSPO) in asymptomatic children, 6 to 36 months old, and determine the impact of cycloplegia in the sensitivity, specificity and accuracy of this method. Methods: One hundred seventy-eight (178) eyes of asymptomatic children between the ages of 6 and 36 months have been submitted to ocular refraction measurements by the gold-standard method, the manual retinoscopy under cycloplegia, and the method been tested, the 2WIN® photoscreening, both before and under cycloplegia. Results: The 2WIN® photoscreener before cycloplegia was able to identify those patients in need of spectacles prescription according to the criteria published by the BSPO with 100% sensitivity, 93.18% specificity and 93.26% accuracy, when compared to the manual retinoscopy under cycloplegia. The 2WIN® photoscreener under cycloplegia maintained a sensitivity of 100%, but increased specificity to 96.59% and accuracy to 96.63%. Conclusion: The 2WIN® photoscreener before cycloplegia showed high sensitivity, specificity, and accuracy in detection of patients in need of spectacles prescription according to the criteria published by the BSPO in the tested population, with minor increase in specificity and accuracy when the measurements were performed under cycloplegia. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to assess the accuracy of photorefraction and wavefront-based autorefraction in children under 3 years of age. Methods: A cross-sectional study was performed with children who had no ocular abnormalities other than a refractive error and were less than 3 years old. Spot Vision Screener (Welch Allyn Inc., Skaneateles Falls, NY, USA) was used for photorefraction and SureSight Vision Screener (Welch Allyn, Skaneateles Falls, NY) was used for autorefraction. The measurements were performed with both devices before and after cycloplegia. The results were compared with those obtained using cycloplegic retinoscopy. The assessments were performed in terms of spherical equivalent (SE) values and Jackson cross-cylinder power values (J0 and J45). Results: A total of 305 children with a mean age of 15.1±10.4 months were included. The mean SE values measured with the Spot Vision and SureSight before cycloplegia were 0.43±0.75 D and 0.90±0.86 D, respectively. Following cycloplegia, the mean SE values were 1.80±1.25 D and 1.55±1.40 D, respectively. The mean SE value obtained with cycloplegic retinoscopy was 1.53±1.34 D. The mean SE values measured with both devices prior to cycloplegia were significantly lower than that measured with cycloplegic retinoscopy (p<0.001). No significant difference was observed between the cycloplegic SE values obtained with SureSight and retinoscopy (p=0.66). Spot Vision yielded significantly higher cycloplegic SE values compared with cycloplegic retinoscopy (p<0.001). Conclusion: Both devices underestimated SE values in comparison with cycloplegic retinoscopy in children under 3 years of age. Wavefront-based autorefraction performed with cycloplegia may be an alternative to cycloplegic retinoscopy, but needs confirmation. [ABSTRACT FROM AUTHOR]

Objectives: Determining the accuracy of cycloplegic refractive error measurements made with the Spot Vision Screener (SVS, Welch Allyn Inc, Skaneateles Falls, NY, USA) is important for refractive assessment of uncooperative patients during optometric examinations. This study compared cycloplegic refractive errors measured by SVS and tabletop autorefractometer to cycloplegic retinoscopy in children., Materials and Methods: Eighty-eight eyes of 44 subjects were examined in the study. Refractive error measurements were obtained under cycloplegia using retinoscopy, SVS, and Nidek ARK-530 tabletop autorefractometer (ARK-530, Nidek, Japan). Spherical and cylindrical values, spherical equivalents (SE), and Jackson cross-cylinder values at axes of 0° (J0) and 45° (J45) were recorded. Correlations between methods were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman analysis., Results: The mean age was 7 years (range: 6 months-17 years). Sixteen (36%) of the subjects were female and 28 (64%) were male. For SE there was excellent agreement between retinoscopy and SVS (ICC: 0.924) and between retinoscopy and tabletop autorefractometer (ICC: 0.995). While there was a moderate correlation between retinoscopy and SVS for cylindrical values (ICC: 0.686), excellent correlation was detected between retinoscopy and autorefractometer (ICC: 0.966). J0 and J45 crosscylinder power values were not correlated between retinoscopy and SVS (ICC: 0.472) or retinoscopy and tabletop autorefractometer (ICC: 0.442). Retinoscopy was correlated with both SVS and tabletop autorefractometer for all parameters within ±1.96 standard deviations in Bland-Altman analysis., Conclusion: Cycloplegic retinoscopy is the gold standard for refractive error measurement in the pediatric population. However, it requires time and experienced professionals. This study revealed moderate to good agreement between SVS and retinoscopy, with better agreement in spherical errors than cylindrical errors. Although the SVS is intended for screening programs, it may also be useful in the pediatric eye office to estimate spherical refractive error in uncooperative patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2024 by the Turkish Ophthalmological Association / Turkish Journal of Ophthalmology published by Galenos Publishing House.)

Purpose: In 1-12 years old children, we assessed correlation, regression, and agreement between spherical equivalents (SE) obtained on Mohindra's near retinoscopy (MNR) and the post cycloplegic refraction (PCRef), performed 72 h after a cycloplegic refraction (CRef) using cyclopentolate 1% drops.Methods: In this prospective comparative study, Mohindra's near retinoscopy (MNR) was performed on 202 eyes of 101 children, from 50 cm with a streak retinoscope, in a dimly lit room, subtracting 1.25 from the trial lens used for neutralization, to obtain the final refraction. Subsequently we undertook CRef, half-hour after instilling 1% cyclopentolate, with a PCRef 72 h later. All refractive data were converted to SE for evaluation. We compared the SEs using correlation, linear regression, and agreement (Bland-Altman graphic analysis) and paired t-test. Significance was set at P ≤ 0.05.Results: The mean SE on MNR was 1.71 ± 2.49 D compared to 1.43 ± 2.42 D on PCRef. A significant correlation with r = 0.97 (r2= 0.94, P < 0.001) existed. Agreement analysis suggested that MNR overestimates hypermetropia and underestimates myopia each by 0.3 D than the standard procedure of CRef-PCRef. The regression analysis suggested that SE on PCRef is 95% of that on MNR, less 0.20.Conclusion: Our study suggests that MNR offers single point refraction very similar to CRef-PCRef, and may be considered as a viable option more often. [ABSTRACT FROM AUTHOR]

AIM: To compare the changes of corneal shape and astigmatism before and after surgery in children with congenital ptosis in different degrees and different ages, and to provide a certain clinical basis for the timing of ptosis surgery and the time of refractive correction. METHODS: The study consisted of 83 patients(114 eyes, 52 cases in one eye and 31 cases in both eyes)who were diagnosed with congenital ptosis and received frontalis muscle aponeurosis in our hospital from September 2015 to August 2016. The corneal topography and retinoscopy results were collected before and 1, 3, and 6mo after surgery. Corneal topography and 10g/L atropine ophthalmic gel retinoscopy were performed on all subjects, and the changes in the amount of astigmatism before and after surgery were compared between different degrees, different age groups, and different follow-up periods. RESULTS: The corneal astigmatism measured by corneal topography after moderate to severe ptosis was not statistically different from that before the operation(P>0.05). In the 3 to less than 5 year old age group, cases with moderate to severe ptosis was observed after 6mo of Cyl, C value decrease compared with preoperative. In 5 to less than 12 year old age group, Cyl increased at first then decreased gradually 1mo after surgery compared with preoperative in patients with moderate ptosis, and decreased lower after surgery in 6mo, but C value increased compared with preoperative. In patients with severe ptosis, Cyl values showed a gradual decline after a significant increase in 1mo postoperatively, no significant changes compared with before surgery at 6mo, but the C value increased compared with preoperative. CONCLUSION: Patients with congenital ptosis with 3 to less than 5 years of age undergo surgical treatment. The postoperative astigmatism has a large decrease, which is a suitable age for operation. The early astigmatism changes greatly after ptosis and it is recommended to increase the follow-up frequency and perform refractive correction in time.

Abstract Background Phacoemulsification and intraocular lens (IOL) implantation during cataract surgery in horses occur with increasing frequency. To reduce the postoperative refractive error it is necessary to determine the proper IOL power. In the present study retinoscopy, keratometry and ultrasonographic biometry were performed on 98 healthy equine eyes from 49 horses. The refractive state, corneal curvature (keratometry) and the axial location of all optical interfaces (biometry) were measured. The influences of breed, height at the withers, gender and age on values obtained and the comparison between the left and right eye were evaluated statistically. Corresponding IOL power were calculated by use of Binkhorst and Retzlaff theoretical formulas. Results Mean ± SD refractive state of the horses was + 0.32 ± 0.66 D. Averaged corneal curvature for Haflinger, Friesian, Pony, Shetland pony and Warmblood were 21.30 ± 0.56 D, 20.02 ± 0.60 D, 22.61 ± 1.76 D, 23.77 ± 0.94 D and 20.76 ± 0.88 D, respectively. The estimated postoperative anterior chamber depth (C) was calculated by the formula C = anterior chamber depth (ACD)/0.73. This formula was determined by a different research group. C and axial length of the globe averaged for Haflinger 9.30 ± 0.54 mm and 39.43 ± 1.26 mm, for Friesian 10.12 ± 0.33 mm and 42.23 ± 1.00 mm, for Pony 8.68 ± 0.78 mm and 38.85 ± 3.13 mm, for Shetland pony 8.71 ± 0.81 mm and 37.21 ± 1.50 mm and for Warmblood 9.39 ± 0.51 mm and 40.65 ± 1.30 mm. IOL power was calculated with the Binkhorst and Retzlaff theoretical formulas. Calculated IOL power for the several breeds ranged from 18.03 D to 19.55 D. The mean value across all horses was 18.73 D determined with Binkhorst formula and 18.54 D determined with Retzlaff formula. Conclusions Mean result of this study is: an 18.5 D IOL seemed to be the most appropriate to achieve emmetropia after IOL implantation in horses. Cataract surgery without IOL implantation results in hyperopic and visual compromised horses. Retinoscopy, keratometry and ultrasonographic biometry should be performed on every affected horse and postoperative visual outcome should be determined.

Purpose: To determine repeatability and agreement of the ARK-30 handheld autorefractor with retinoscopy under cycloplegic and noncycloplegic conditions in children. Methods: Three consecutive autorefractor measurements (with and without cycloplegia) and retinoscopy were performed and compared in 30 randomized eyes of 30 children (mean age of 6.7 ± 2.7 years with spherical equivalent [SE] refraction from ‒4.01 to +7.38 D) in a cross-section and masked study. Bland–Altman analysis of autorefractor measurements (with and without cycloplegia) and agreement with retinoscopy were calculated with conventional notation (sphere [Sph] and cylinder [Cyl]) and vector notation (SE, J0, and J45coefficients). Results: ARK-30 measurements without cycloplegia were lower than under cycloplegic conditions (Sph: ‒0.52 ± 2.37 D vs + 0.86 ± 2.60 D, P < 0.01; Cyl: ‒0.83 ± 0.80 D versus ‒0.78 ± 0.77 D, P = 0.37; and SE: ‒0.94 ± 2.19 D vs + 0.47 ± 2.44 D, P < 0.01, respectively) and statistically different (P < 0.03) from retinoscopy (Shp: +0.83 ± 2.66 D; Cyl: ‒0.71 ± 0.87 D; SE: +0.51 ± 2.49 D). Without statistical differences were in J0and J45coefficients. Cyloplegic autorefraction measures were not found to be statistically significantly different to retinoscopy measures. ARK-30 under cycloplegia shows better repeatability with lower limits of agreement (LoA) in Sph (LoA: ‒0.66 to +0.69 D), and SE (LoA: ‒0.66 to +0.65 D) than without cycloplegia (LoA: ‒1.45 to +1.77 D, and ‒1.38 to +1.74 D, respectively). Conclusion: Under noncycloplegic conditions, ARK-30 autorefractor has low repeatability and a tendency toward minus over correction in children. However, repeatability and agreement with retinoscopy under cycloplegic conditions allow use of ARK-30 in children to estimate refraction but not to substitute gold standard retinoscopic refraction.

Purpose: Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM. Methods: Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements. Results: In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 ± 13.04 μ) compared to the non-VM eyes (249.25 ± 53.70 μ) and refractive error-matched controls (264.62 ± 12.53 μ). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed. Conclusion: Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.

A 57 years old patient underwent uneventfully 23-gauge pars plana vitrectomy (PPV) surgery containing perfluorocarbon liquid (PFCL) injection, endolaser retinopexy, fluid-air exchange, and silicone-oil implantation due to rhegmatogenous retinal detachment. The patient has admitted to the clinic due to decreased visual acuity caused by subfoveal retained PFCL detected with optical coherence tomography (OCT) 4 weeks after surgery. The patient underwent a reoperation to remove the residual subfoveal PFCL partially with a new technique. [ABSTRACT FROM AUTHOR]

It has been shown that in order to increase the sensitivity of ultrasonic noncontact shadow testing of products made of polymer composite materials (PCMs), it is necessary, along with the well-known techniques (increasing the amplitude of the probing signal, using radio technical signal processing methods, employing highly sensitive electroacoustic transducers), to optimize the parameters of noncontact testing. Criteria have been established for choosing air gaps between the emitting transducer and the test object and between the test object and the receiving transducer, as well as criteria for choosing the duration of probing signals. Methods for increasing the reliability of testing the border regions of small-thickness PCM products are proposed. The results of automatic noncontact scanning of PCM products in the shadow mode using an adaptive measuring complex that allows the testing parameters to be adapted to each new tested product are presented. [ABSTRACT FROM AUTHOR]

The purpose of this assessment is to evaluate the accuracy of autorefraction compared with cycloplegic retinoscopy in children. Literature searches were last conducted in October 2019 in the PubMed and the Cochrane Library databases for studies published in English. The combined searches yielded 118 citations, of which 53 were reviewed in full text. Of these, 31 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologists. Four articles were rated level I, 11 were rated level II, and 16 were rated level III articles. The 16 level III articles were excluded from this review. Thirteen of the 15 studies comparing cycloplegic autorefraction with cycloplegic retinoscopy found a mean difference in spherical equivalent or sphere of less than 0.5 diopters (D); most were less than 0.25 D. Even lower mean differences were found when evaluating the cylindrical component of cycloplegic autorefraction versus cycloplegic retinoscopy. Despite low mean variability, there was significant individual measurement variability; the 95% limits of agreement were wide and included clinically relevant differences. Comparisons of noncycloplegic with cycloplegic autorefractions found that noncyloplegic refraction tends to over minus by 1 to 2 D. Cycloplegic autorefraction is appropriate to use in pediatric population-based studies. Cycloplegic retinoscopy can be valuable in individual clinical cases to confirm the accuracy of cycloplegic autorefraction, particularly when corrected visual acuity is worse than expected or the autorefraction results are not consistent with expected findings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the accuracy and effectiveness of noncycloplegic and cycloplegic autorefraction using two types of autorefractors (ARs) compared with retinoscopy in children and adolescents.Methods: This cross-sectional study included 308 students (6-17 years old) from eastern Taiwan. Noncycloplegic and cycloplegic refractive measurements were obtained using open-field AR (Shin-Nippon NVision-K 5001), closed-field AR (Topcon KR-800), and cycloplegic retinoscopy. Three optical components emerged from the measurements: spherical equivalent (M) and two Jackson cross-cylinder values (J0 and J45). Agreement between both ARs and retinoscopy was evaluated using intraclass correlation coefficient. Measurement discrepancies from retinoscopy among different ARs and cycloplegic status were compared using repeated measures ANOVA and receiver operating characteristic curve analysis.Results: Compared with retinoscopy, measurements obtained before and after cycloplegia with both ARs showed excellent reliability for evaluating M and J0 and fair to good results for J45. More myopic results were obtained using KR-800 before cycloplegia; more hyperopic results were obtained using KR-800 and NVision-K 5001 after cycloplegia(all p < 0.05). J45 data obtained using NVision-K 5001 were closest to those obtained by retinoscopy; J0 data obtained using both ARs were comparable with retinoscopy after cycloplegia. NVision-K 5001 outperformed KR-800 in refractive measurements, particularly in hyperopia diagnosis among younger children.Conclusions: Both autorefractors showed great agreement with retinoscopy. Results obtained using NVision-K 5001 without cycloplegia were most similar to those by retinoscopy, especially for oblique astigmatism and hyperopia detection in younger children. For large vision screening in elementary school, Shin-Nippon NVision-K 5001 might be a more suitable autorefractor. [ABSTRACT FROM AUTHOR]

Objective: To determine the difference of refraction measured by cycloplegic retinoscopy (CR) and non-cycloplegic subjective refraction (NS). Materials and Methods: The present descriptive study included normal children aged 6 to 15 years with refractive error. The refractive status was measured by CR and cycloplegic autorefractometer (CA) at the initial visit. At 2-week follow-up, the refraction was measured with non-cycloplegic autorefractometer (NA) and NS. The spherical equivalent (SE) from participants' right eye was used in the data analyses. Results: Forty-four participants were included in this study with a mean age of 9±3 years and 22 (50%) were male. Overall, the median (Q1, Q3) of SE by CR, CA, NS, and NA were -1.00 (-2.50, 0.25), -1.63 (-2.63, -0.50), -1.63 (-2.50, -1.00), and -1.88 (-2.88, -1.13) diopters (D), respectively. The SE by CR was 0.56 D more than NS (p<0.001), and 0.38 D more than CA (p<0.001). The SE by NS was 0.25 D more than NA (p=0.008). By using the CR method, 11 (25%) participants were classified in the hyperopic group (positive SE) and 33 (75%) in the myopic group (negative SE). In the hyperopic group, the median (Q1, Q3) of SE by CR and NS were 0.75 (0.50, 1.75) and -0.63 (-1.00, 1.38) D, respectively. The refraction by CR was 1.50 D more than by NS (p=0.003). In the myopic group, the median (Q1, Q3) of SE by CR and NS were -1.50 (-2.50, -0.75) and -2.00 (-3.25, -1.50) D, respectively. The refraction by CR was 0.50 D more than NS (p<0.001). Conclusion: The refraction in children aged 6 to 15 years measured by CR was significantly more than NS in the participants. The authors should decrease the number of refractions obtained from CR when prescribing glasses to hyperopic children. [ABSTRACT FROM AUTHOR]

A shadow-test approach to the calibration of field-test items embedded in adaptive testing is presented. The objective function used in the shadow-test model selects both the operational and field-test items adaptively using a Bayesian version of the criterion of D s -optimality. The constraint set for the model can be used to hide the field-test items completely in the content of the test as well as to deal with such practical issues as random control of their exposure rates. The approach runs on efficient implementations of the Gibbs sampler for the real-time updating of the ability and field-test parameters. Optimal settings for the proposed algorithms were found and used to demonstrate item calibration with smaller than traditional sample sizes in runtimes fully comparable with conventional adaptive testing. [ABSTRACT FROM AUTHOR]

Purpose: Infantile cataracts are among the important conditions that cause amblyopia related visual impairment in childhood. There are difficulties of obtaining accurate measurements of aphakic corrections in babies after cataract extraction. For infant aphakia, when measurements cannot be taken, there are some recommendations for using contact lenses of +32.00 D for babies up to 6 months and +29.00 D for babies of 6-12 months. A study was conducted to test the accuracy of these recommendations and it was intended to make some recommendations for the development of rehabilitation of infantile aphakia. Material and Methods: The fi les of the babies, younger than 12 months, whom cataract extraction was performed and retinoscopic values were determined, between May 2010 and April 2013, were reviewed. Results: Of the 36 patients, whose fi les were accessed, 24 were male and 12 were female; the mean age was 5 months and ages ranged from 1 month to 11 months. The retinoscopic values of the patients were between +7.25 D and + 21.50 D; mean and standard deviation of spherical equivalents were + 16.38±2.92 for right eyes; and + 16.26±3.03 for left eyes. Considering the vertex correction and visual spheres of the patients, the majority of the contact lens values were ranged between +18.00 and +28.00 D. Conclusion: The recommendations of correction of infantile aphakia with +32.00 D contact lenses up to 6 month infants and +29.00 D for 6-12 months infants are inappropriate. If these recommendations are applied, up to +10.00 D of different correction might be found in the patients in the research group. Although the standard degree of contact lenses could be used in cases where measurements cannot be taken; accurate contact lens measurement should be performed in the earliest possible time and best possible contact lens degrees should be prescribed to the aphakic infants. [ABSTRACT FROM AUTHOR]

Purpose: Infantile cataracts are among the important conditions that cause amblyopia related visual impairment in childhood. There are diffi culties of obtaining accurate measurements of aphakic corrections in babies after cataract extraction. For infant aphakia, when measurements cannot be taken, there are some recommendations for using contact lenses of +32.00 D for babies up to 6 months and +29.00 D for babies of 6-12 months. A study was conducted to test the accuracy of these recommendations and it was intended to make some recommendations for the development of rehabilitation of infantile aphakia. Material and Methods: The fi les of the babies, younger than 12 months, whom cataract extraction was performed and retinoscopic values were determined, between May 2010 and April 2013, were reviewed. Results: Of the 36 patients, whose fi les were accessed, 24 were male and 12 were female; the mean age was 5 months and ages ranged from 1 month to 11 months. The retinoscopic values of the patients were between +7.25 D and + 21.50 D; mean and standard deviation of spherical equivalents were + 16.38±2.92 for right eyes; and + 16.26±3.03 for left eyes. Considering the vertex correction and visual spheres of the patients, the majority of the contact lens values were ranged between +18.00 and +28.00 D. Conclusion: The recommendations of correction of infantile aphakia with +32.00 D contact lenses up to 6 month infants and +29.00 D for 6-12 months infants are inappropriate. If these recommendations are applied, up to +10.00 D of different correction might be found in the patients in the research group. Although the standard degree of contact lenses could be used in cases where measurements cannot be taken; accurate contact lens measurement should be performed in the earliest possible time and best possible contact lens degrees should be prescribed to the aphakic infants. [ABSTRACT FROM AUTHOR]

Purpose: To calculate the mean difference of visual acuity as measured by auto refraction and subjective refraction. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Ophthalmology, Services hospital Lahore from November 2013 to April 2014. Material and Methods: Using non-probability consecutive sampling 300 eyes of 300 patients fulfilling inclusion criteria were recruited through OPD registration slip. Demographic data including age and gender was recorded. Complete ophthalmic examination was performed. This included measurement of refractive error by autorefraction as well as subjective refraction. Detailed anterior segment examination with slit lamp and dilated fundus examination with indirect ophthalmoscopy was performed. The collected data was analyzed by using software SPSS version 17. Results: The mean age of patients was 34.71 ± 7.45 years. There were 156 (52%) males and 144 (48%) females. There were 263 (87.69%) patients who had visual acuity of 6/6 and 37 (12.33%) had 6/9. Mean spherical auto-refraction and subjective refraction was 0.0290 ± 2.58 and -0.2842 ± 2.37 D with mean difference of -0.3133 ± 1.27 D. The mean cylindrical auto and subjective refraction in this study was -.9742 ± 0.78 D and -0.7500 ± 0.81 D and mean difference was 0.2242 ± 0.74 D. The mean cylindrical axis of auto and subjective refraction was 114.88 ± 49.75 and 115.60 ± 49.70 with mean difference as 0.72 ± 3.02 D (p-value < 0.05). Conclusion: Difference of spherical, cylindrical and cylindrical axis in auto and subjective refraction was significantly different. [ABSTRACT FROM AUTHOR]

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We have combined methods from volume visualization and data analysis to support better diagnosis and treatment of human retinal diseases. Many diseases can be identified by abnormalities in the thicknesses of various retinal layers captured using optical coherence tomography (OCT). We used a support vector machine (SVM) to perform semi-automatic segmentation of retinal layers for subsequent analysis including a comparison of layer thicknesses to known healthy parameters. We have extended and generalized an older SVM approach to support better performance in a clinical setting through performance enhancements and graceful handling of inherent noise in OCT data by considering statistical characteristics at multiple levels of resolution. The addition of the multi-resolution hierarchy extends the SVM to have "global awareness." A feature, such as a retinal layer, can therefore be modeled.

Recent developments in Fourier domain-optical coherence tomography (Fd-OCT) have increased the acquisition speed of current ophthalmic Fd-OCT instruments sufficiently to allow the acquisition of volumetric data sets of human retinas in a clinical setting. The large size and three-dimensional (3D) nature of these data sets require that intelligent data processing, visualization, and analysis tools are used to take full advantage of the available information. Therefore, we have combined methods from volume visualization, and data analysis in support of better visualization and diagnosis of Fd-OCT retinal volumes. Custom-designed 3D visualization and analysis software is used to view retinal volumes reconstructed from registered B-scans. We use a support vector machine (SVM) to perform semiautomatic segmentation of retinal layers and structures for subsequent analysis including a comparison of measured layer thicknesses. We have modified the SVM to gracefully handle OCT speckle noise by treating it as a characteristic of the volumetric data. Our software has been tested successfully in clinical settings for its efficacy in assessing 3D retinal structures in healthy as well as diseased cases. Our tool facilitates diagnosis and treatment monitoring of retinal diseases.

A fast and efficient method for quantifying photoreceptor density in images obtained with an en-face flood-illuminated adaptive optics (AO) imaging system is described. To improve accuracy of cone counting, en-face images are analyzed over extended areas. This is achieved with two separate semiautomated algorithms: (1) a montaging algorithm that joins retinal images with overlapping common features without edge effects and (2) a cone density measurement algorithm that counts the individual cones in the montaged image. The accuracy of the cone density measurement algorithm is high, with >97% agreement for a simulated retinal image (of known density, with low contrast) and for AO images from normal eyes when compared with previously reported histological data. Our algorithms do not require spatial regularity in cone packing and are, therefore, useful for counting cones in diseased retinas, as demonstrated for eyes with Stargardt's macular dystrophy and retinitis pigmentosa.

Optical coherence tomography (OCT), a non-invasive method, was used for qualitative assessment of fetal retinal sheet transplants by non-invasive imaging. Rhodopsin-mutant S334ter-line-3 rats with fast retinal degeneration (28-37-day old) were transplanted with fetal retinal sheets from embryonic day (E) 18-19 pigmented normal rats. Retinal thickness measurements from transplanted (n = 51), no surgery control (n = 8), and normal pigmented rat eyes (n = 6) were obtained using a Zeiss stratus OCT-3 scanning instrument. Frozen retinal sections were stained with hematoxylin/eosin. S334ter-line-3 rats showed significant reduction in OCT retinal thickness (p

Objective: To evaluate refractive state outcomes following phacoemulsification and implantation of 3 different intraocular lenses (IOLs)., Animals: A prospective, randomized, controlled study was conducted on 43 client-owned dogs undergoing phacoemulsification with IOL implantation., Methods: Eyes were randomized to receive either an-vision Fo-X (n = 26), an-vision MD8 (18), or I-MED I-LENS (24) IOL. Refraction was measured 1 week, 1 month, and 3 months postoperatively using streak retinoscopy by 2 examiners masked to each other's results., Results: Postoperative refractive outcomes were highly correlated and not significantly different between 2 examiners for all time points (r = 0.97, 0.98, and 1.00; P = .76, .94, and .98, respectively). One week postoperatively, the refractive errors (mean ± SD) for Fo-X, MD8, and I-LENS were -0.14 ± 2.02 diopters (D), 0.97 ± 2.01 D, and 0.15 ± 2.55 D, respectively. One month postoperatively, the refractive errors were 0.35 ± 2.04 D, 0.06 ± 2.41 D, and -0.82 ± 2.20 D, respectively. Three months postoperatively, the refractive errors were -0.16 ± 2.67 D, 1.60 ± 2.99 D, and 0.59 ± 1.51 D, respectively. There were no significant differences in refractive error outcomes between Fo-X, MD8, and I-LENS at 1 week, 1 month, and 3 months postoperatively (P = .16; F(df=2,66)- = 1.89). However, the Fo-X was the only IOL to yield nearly emmetropic outcomes (±0.50 D) at all 3 time points., Clinical Relevance: The postoperative refractive states of dogs were not statistically different when comparing 3 types of IOLs at 3 postoperative time points, though the Fo-X was the only IOL to yield nearly emmetropic outcomes at all 3 time points.

To compare and validate the accuracy and ease of use of handheld autorefractors against retinoscopic refraction by an ophthalmologist for assessing the visual acuity of older adults in India. 190 patients were enrolled at the Sankara Eye Hospital in Bangalore, India, to undergo refraction using three different handheld devices—Retinomax (Nikon Inc., Japan), Netra (Eyenetra, Inc., USA), and QuickSee (PlenOptika, Inc., USA)—and the results were compared with cycloplegic retinoscopy and refraction done by an ophthalmologist. We analyzed the mean, standard deviation (S.D.), and Bland-Altman comparison of dioptric (D) power accuracy. The difference between the handheld devices and subjective refraction for each device was: Retinomax (N = 186), mean -0.41 D, S.D. 2.14; Netra (N = 179), mean 0.61 D, S.D. 2.20; and QuickSee (N = 182), mean -0.05 D, S.D. 1.04. The QuickSee and the Retinomax may be used successfully as refraction screening tools in epidemiologic studies of adults in India and as diagnostic tools in low-resource settings. [ABSTRACT FROM AUTHOR]

Purpose: To compare refractive measurements of noncycloplegic photoscreener Plusoptix S12R with cycloplegic retinoscopy, noncycloplegic autorefractor, and cycloplegic autorefractor in children.Methods: The study population (200 eyes of 100 children) was divided into two groups: Group 1 (age 3-7 years) and Group 2 (age 8-15 years). In Group 1, Plusoptix was compared with cycloplegic retinoscopy. In Group 2, Plusoptix was compared with cycloplegic retinoscopy and autorefraction. The second group was made because the younger group was found to be uncooperative for autorefraction. Paired t-test and Pearson's correlation were used for statistical analysis.Results: The mean difference in sphere (DS), spherical equivalent (DSE), and cylinder (DC) between cycloplegic retinoscopy and Plusoptix in Group 1 was 0.68 ± 0.55 (P < 0.001), 0.77 ± 0.61 (P < 0.001), and 0.18 ± 0.28 (P < 0.001), respectively. In Group 2, DS, DSE, and DC between cycloplegic retinoscopy and Plusoptix were 0.86 ± 0.49 (P < 0.001), 0.97 ± 0.51 (P < 0.001), and 0.23 ± 0.28 (P < 0.001); between cycloplegic autorefractor and Plusoptix were 0.69 ± 0.47 (P < 0.001), 0.74 ± 0.49 (P < 0.001), and 0.10 ± 0.31 (P = 0.002); and between noncycloplegic autorefractor and Plusoptix were - 0.25 ± 0.39 (P < 0.001), -0.19 ± 0.41 (P < 0.001), and 0.11 ± 0.31 (P < 0.001), respectively. Pearson's correlation coefficients of S, SE, and C between Plusoptix and cycloplegic retinoscopy were 0.948, 0.938, and 0.924 in Group 1 and 0.972, 0.972, and 0.946 in Group 2, and these values were statistically significant. Bland-Altman plots showed good agreement between cycloplegic retinoscopy and Plusoptix in both groups. Plusoptix gave axis values within 10° of cycloplegic retinoscopy in 81.56% of eyes in Group 1 and in 71.44% of eyes in Group 2.Conclusion: Plusoptix photoscreener can be used for prescription of axis of cylinder in children; however, other refractive measurements must be refined by cycloplegic retinoscopy. [ABSTRACT FROM AUTHOR]

Purpose: To describe estimation dynamic distance direct ophthalmoscopy (eDDDO) and compare it with the monocular estimation method of dynamic retinoscopy (eDR) for the assessment of accommodation in children.Methods: In this prospective observational cohort study, an ophthalmologist performed eDDDO followed by eDR in children with normal eyes, and then under the partial effects of cyclopentolate and tropicamide to assess performance of eDDDO with eDR under the condition of pharmacologically induced accommodation failure. Only one eye of each child was recruited in the study. To study the inter-observer variation, two masked pediatric ophthalmology fellows performed eDDDO in the similar manner.Results: For the comparison of eDDDO with eDR, 60 eyes of 60 patients were recruited. The mean age of the patients was 10.4 years. The mean accommodation on eDDDO was 3.0D, 5.1D, 9.8D, and 11.3D at 40 cm, 25 cm, 10 cm, and 8 cm, respectively and 3.0D, 5.0D, 9.5D, and 11.0D on eDR. The eDDDO overestimated accommodation by a mean 0.17D (95% CL 0-0.48D, P = 0.5). The correlation of eDDDO with eDR was excellent (Pearson r 0.98, T value 76.0). The inter-observer difference with eDDDO was not significant (mean 1D, 95% CL 0-2.6D, P = 0.9) and the correlation between two observers was excellent (Pearson r 0.9, T value 12.7). The eDDDO and eDR were also performed on 12 eyes of 6 children with a mean age of 8.5 years (range 8-12 years) under the partial effect of cyclopentolate and tropicamide, where eDDDO overestimated the accommodation by a mean 0.3D (95% CL 0- 1.2D, P = 0.7) and the correlation was excellent (Pearson r 1.0, T value 45).Conclusion: eDDDO is a simple, reliable, quantitative, and objective technique of accommodation assessment for children. Further studies with larger sample are required to assess its performance in disorders of accommodation affecting younger children and in children with ocular comorbidities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the refractive outcome and influencing factors following atropine 0.5% eye-drops applied twice daily during 2 ½ days at home and two drops of cyclopentolate 1% (C+C) and one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T) applied in an outpatient clinic, in hypermetropic children with a dark iris. Methods: Double-blind randomized study including 67 3–6-year-old children receiving C+C in one eye and C+T in the other eye. Two weeks later followed by atropine 0.5% in both eyes. Primary outcome measures were: spherical equivalent (SEQ) following C+C, C+T and atropine, and secondarily SEQ with respect to sex, ethnicity, skin pigmentation (light, medium, dark) and crying. Data on atropine are divided in those with C+C (CC) or C+T (CT) as a first intervention. Results: Mean SEQ±SD for C+C, C+T, atropine-(CC) and atropine-(CT) was +1.74 ± 1.35, +1.77 ± 1.34, +2.15 ± 1.43 and +2.10 ± 1.38 diopter (D). Atropine 0.5% revealed significantly more hypermetropia than C+C and C+T; +0.41 ± 0.43, 95%CI +0.31 to +0.52D and +0.33 ± 0.39, 95%CI +0.24 to +0.34D. No significant difference was present between C+C and C+T; −0.03 ± 0.56, 95%CI −0.16 to +0.11D. Ethnicity and skin-color were strongly associated (r = 0.84, p <.001). Sex was not affecting outcomes (p =.101). Ethnicity was borderline significant (p =.049). Skin-color was a highly significant factor (p =.002). A statistical model combining intervention and skin-color, with light-pigmented subjects receiving atropine-(CC) as reference group (mean SEQ +2.61 ± 1.46D), indicated borderline significantly less hypermetropia in atropine-(CC)-dark: mean decrease (95%CI): −0.81 (−1.66 to +0.05)D and atropine-(CT)-dark −0.87 (−1.70 to −0.03)D, furthermore significantly less hypermetropia in C+C-dark: −1.15 (−1.97 to −0.32)D; C+T-dark: −1.21 (−2.03 to −0.39)D, C+C-medium: −1.02 (−1.81 to −0.24)D and C+T-medium: −0.86 (−1.64 to −0.08)D. Adding crying to the model significantly less hypermetropia was found for subjects crying in all interventions; −0.53 (−0.98 to −0.09)D. Within the interventions, with light-pigmented non-crying subjects as reference group (mean SEQ in atropine, C+C, respectively, C+T: +2.62 ± 1.41, +2.33 ± 1.20 and +2.32 ± 1.20D), showed significantly less hypermetropia in dark-pigmented crying subjects in each individual intervention: atropine −1.10 (−2.01 to −0.19), C+C −1.28 (−2.14 to −0.42) and C+T −1.34 (−2.20 to −0.48)D. For medium pigmented crying subjects this was present in atropine: −0.82 (−1.61 to −0.03)D and C+C: −0.86 (−1.68 to −0.04)D, but not in C+T: −0.58 (−1.25 to +0.09)D. Conclusions: Atropine 0.5% revealed a slight significantly higher hypermetropia. A dark-pigmented skin, especially when crying upon application, resulted in lower hypermetropia in all interventions. C+T provided clinically better results in medium pigmented crying subjects compared to C+C, and equal results compared to atropine 0.5%. [ABSTRACT FROM AUTHOR]

Silicone oil (SO) is used mainly when managing complex retinal detachments, commonly with proliferative vitreoretinopathy, as well as a hemostatic agent in proliferative diabetic retinopathy. Combined lens exchange and pars plana vitrectomy remains preferred by many surgeons; however, sequential surgery might be advantageous to minimize the postoperative anterior chamber inflammatory response, particularly in proliferative diabetic retinopathy or retinal detachment. The aim of the study was to evaluate the optimal method of intraocular lens (IOL) calculation in eyes filled with SO. Different techniques are employed for axial length assessment in eyes filled with SO, including preoperative A-scan applanation or immersion biometry, partial coherence interferometry (PCI), or less commonly computed tomography, magnetic resonance imaging, or intraoperative retinoscopy/biometry after SO removal. PCI might provide better refractive outcomes compared to ultrasound measurements, however, the quality of presented evidence is low. Bias in calculation may be a result of limited vitreous base removal during vitrectomy, partial filling of the vitreous chamber with SO and measurements in supine position, macular edema or detachment, selection of an inappropriate IOL calculation formulas and sulcus IOL placement. Clinicians should consider that even when employing optical biometry and correct calculation formulas only a third of eyes filled with silicone oil might achieve ± 1.0 D of target refraction, compared to 97.2% of normal eyes. We would recommend performing optical biometry before the application of SO; if this is impossible, measurement of the second eye or biometry after SO removal is an alternative. Implantation of a convex-plano monofocal polymethyl methacrylate or foldable hydrophobic acrylic IOL with large optic diameter is advised in these patients. [ABSTRACT FROM AUTHOR]

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

Objectives: To describe preliminary use of a forced‐choice preferential looking task for the clinical assessment of vision in dogs. Materials and Methods: The vision of 18 pet dogs was investigated in two separate studies using a forced‐choice preferential looking task: multiple observers watched eye, head and body movements on video recordings to identify cues suggesting when a dog had seen the feature of interest. Human observer reliability was determined using eight dogs and computer‐generated stimuli. Visual acuity was assessed using computer‐generated grating stimuli: in real‐time, an observer watched each dog's eye movement patterns and behaviour to decide whether each grating was seen. Stimuli were presented in a step‐wise manner and were controlled by the observer. Acuity was estimated as the highest spatial frequency the dog was determined to have seen. Results: Median estimated visual acuity was better at 1 m compared to that at 3 m. Average test time was longer at a 3‐m distance than at 1 m. Inter‐ and intra‐observer reliability was better from 1 m than from 3 m. Clinical Significance: Preliminary use of a forced‐choice preferential looking task for measurement of visual acuity in dogs has potential use as a clinical tool for the assessment of vision in dogs. [ABSTRACT FROM AUTHOR]

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

Objectives: The purpose of the study was to compare the refractive error measurements of pediatric patients performed with a Plusoptix A09 photorefractor (PO; Plusoptix AG, Nuremberg, Germany), a Retinomax K-plus 3 (RTX; Right Group, Tokyo, Japan), and the new handheld auto refracto-keratometer, the Nidek HandyRef-K (HDY; Nidek SA, Créteil, France), and to evaluate the intermethods agreement. Methods: A total of 194 eyes of 194 children were included in the study. All of the children underwent refraction measurement with the PO before cycloplegia and 2 autorefractors were used after cycloplegia: the RTX and the HDY. Results: The mean age of the patients was 16.65±10.04 months (range: 3-34 months). There were no statistically significant differences between the spherical values (SV) or cylindrical axis values (CAV) measured with the PO (SV: 1.61±1.79 diopters [D]; CAV: 94.25±72.47 D), the RTX (SV: 1.91±2.06 D; CAV: 94.3±73.44 D), and the HDY (SV: 1.89±2.04 D; CAV: 93.55±73.71 D) (p>0.05).There was a statistically significant difference in the cylindrical values (CV) assessed with the RTX (CV: -0.97±0.75 D) and the HDY (CV: -1.11±0.76 D) (p=0.003) and the HDY and the PO (CV: -0.92±0.68 D) (p=0.002), while there was no statistically significant difference between the values determined with the RTX and the PO (p>0.05). Statistically significant differences were demonstrated for spherical equivalent values (SEV) obtained with the RTX (SEV: 1.43±1.97 D) and the PO (SEV: 1.15±1.74 D) (p=0.02), and the HDY (SEV: 1.34±1.95 D) and the PO (p=0.03), but no significant difference was found between the RTX and the HDY values (p>0.05). Conclusion: No significant difference was found between the SEV measured by the RTX and the HDY, but the PO was significantly less hyperopic than the RTX and the HDY. The CV measured by HDY was higher than that of other devices. These devices can be used for screening in crowded pediatric ophthalmology clinics and may be an easier way of measuring refractive errors in children younger than 3 years of age, but high SEV and CV results should serve as an alert to physicians. It should also be kept in mind that cycloplegic retinoscopy is still the gold standard and these alternative methods can only be used for screening. The prescription of eyeglasses should not be made without cycloplegic retinoscopy. [ABSTRACT FROM AUTHOR]

A 15-year-old male patient presented with vision loss after blunt trauma to the right eye and with clinical evidence of posterior lenticonus. The posttraumatic lenticonus was eccentric (superotemporal). Irregular astigmatism with high myopia on dilated retinoscopy within the lenticonus, localized posterior convexity of peripheral capsule on ultrasound biomicroscopy, and increased higher-order aberrations (HOAs) on wavefront aberrometry compared with fellow-eye findings confirmed the diagnosis. To our knowledge, acquired peripheral posterior lenticonus representing dialysis of Weigert ligament after acute blunt trauma is a new finding. This case provides an insight into the pattern of higher HOAs associated with any type of lenticonus. [ABSTRACT FROM AUTHOR]

Background: To assess agreement between accommodative lag by monocular estimation method (MEM) retinoscopy and Nott retinoscopy compared to open-field autorefraction using spherical equivalent versus power in the 180 meridian for both children and adults.Methods: Twenty-six children aged 7-16 years (mean: 9.9 ± 2.3) and 27 adults aged 22-29 years (mean: 24.2 ± 1.7) participated. Accommodative lag was measured by examiners with autorefraction and separate examiners using MEM and Nott retinoscopy while subjects viewed 6/18 letters at 33 cm. Five measures of autorefraction were averaged with vector analysis and both power in the 180 meridian and spherical equivalent was determined. Two-factor repeated measures analysis of variance and the mean difference and 95 per cent limits of agreement were calculated.Results: Mean (standard deviation) lag for each technique was: MEM = 0.69 (0.52) D, Nott = 0.62 (0.51) D, autorefraction in 180 = 0.66 (0.50) D and autorefraction spherical equivalent = 0.60 (0.46) D. Lag did not vary across techniques (p = 0.48), but children did have smaller lags than adults (p < 0.001) and greater amounts of uncorrected astigmatism (0.61 ± 0.09 D versus 0.42 ± 0.08 D, p = 0.02). There was no significant interaction between age group and technique (p = 0.74). Mean differences between techniques were small, ranging from -0.14 to +0.06 D. Ninety-five per cent limits of agreement ranged from ±0.80 to ±1.33 around the mean with the narrowest ranges found for comparisons made to autorefraction in 180. Limits of agreement were also narrowest in children as compared to adults with similar mean differences between age groups.Conclusions: This study demonstrates the mean agreement between autorefraction and retinoscopic techniques is centred on zero (no bias) in both children and adults. The range of agreement becomes narrower when autorefraction power in the 180 is calculated, even for a sample of subjects with moderately small amounts of uncorrected astigmatism. [ABSTRACT FROM AUTHOR]

3 Mirzajani A, Vishteh RA & Khalilian M (2021): Introducing a new method for retinoscopy for refraction of infants and young children: The "Mirza" tele lens retinoscopy. Retinoscopy is one of the most important skills to learn in ophthalmology and optometry, allowing the examiner to objectively determine the refractive state of the eye. Retinoscopy was performed for each whole dioptre on the scale, from +6 to -7 D, with four different eye-to-trial lens distances: 0 cm, 5 cm, 10 cm, 15 cm and 20 cm. The retinoscopy measurements were carried out with an accuracy to the nearest 0.25 D. Great care was taken to perform the retinoscopy "on-axis", holding the trial lens perpendicular to the retinoscopic axis, as well as strictly controlling both the working distance and the eye-to-trial lens distance with each measurement. [Extracted from the article]

AIM: To compare the results of noncycloplegic photorefraction, cycloplegic photorefraction and cycloplegic refraction in preschool and non-verbal children. METHODS: One hundred and ninety-six eyes of 98 children (50 females, 48 males) were included in the study. Firstly, non-cycloplegic photorefraction was achieved with Plusoptix A09; secondly, cycloplegic photorefraction was carried out with Plusoptix A09 after 10 min cyclopentolate. Finally, 30min after instillation of twice cyclopentolate, cycloplegic refraction was obtained with autorefraction and/or standard retinoscopy. Spheric equivalent, spheric power, cylindric power and cylindrical axis measurements were statistically compared. RESULTS: The mean age was 28.8±18.5mo (range 12-72mo). The differences in spherical equivalent, spheric power and cylindrical power measured by the three methods were found statistically significant (P0.05). CONCLUSION: For the determination of refractive errors in children, the Plusoptix A09 measurements give incorrect results after instillation of cyclopentolate. Additionally, the cylindrical power measured by Plusoptix A09 with or without cycloplegia is higher. However, the non-cycloplegic Plusoptix A09 measures spheric equivalent and spheric power similar to cycloplegic refraction measurements in preschool and non-verbal children.