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Frequent replacement contact lenses made from the etafilcon A hydrogel lens material were introduced onto the market over 30 years ago, and etafilcon A remains the most widely used hydrogel lens material today. Although the prescribing of silicone hydrogel lenses is increasing, millions of lens wearers globally have been wearing hydrogel lenses for many years and exhibit a physiologically-stable 'quiet eye', with a low profile of adverse events. Hydrogel lenses are demonstrated to maintain a low inflammatory response and infection risk profile during daily wear, which in the case of etafilcon A, may be related to its low modulus, and the naturally-protective, anti-microbial, non-denatured lysozyme absorbed into the lens from the tear fluid. Although improved corneal physiology from decreased hypoxia with silicone hydrogel lenses is well accepted, equivalent levels of corneal oxygenation are maintained during daily wear of low to medium powered hydrogel lenses, which do not impede the daily corneal de-swelling process, and do not induce clinically significant changes in ocular health. Therefore, hydrogel lenses remain an important alternative for daily wear in modern contact lens practice., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Daily disposable (DD) contact lenses first came to the market approximately 25 years ago and eye care professionals (ECPs) started prescribing silicone hydrogel (SiH) contact lenses, primarily for extended or continuous wear, approximately 20 years ago. It has now been over ten years since SiH DD contact lenses have been available, and while SiH materials are routinely prescribed by ECPs for reusable daily wear, hydrogel materials are still frequently selected for the DD modality of contact lens wear. This article reviews the evidence to support the benefits of both a DD modality and SiH materials and how patients' needs may be met with SiH DD contact lenses, with respect to clinical performance, health outcomes, satisfaction, compliance and convenience. Factors which may enable or constrain ECPs from prescribing SiH DD contact lenses, as opposed to hydrogel DD and reusable contact lenses, for more of their patients are discussed with the objective of providing ECPs with a greater understanding of the advantages that can be afforded by prescribing SiH DD contact lenses to both their new and existing contact lens wearers., Competing Interests: Declaration of Competing Interest Anna Sulley is an employee of CooperVision Inc. Dr. Kathy Dumbleton is a paid consultant of CooperVision Inc., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the efficacy and safety of femtosecond laser-assisted in situ keratomileusis (FemtoLASIK) to correct the residual refractive error after Descemet membrane endothelial keratoplasty (DMEK)., Methods: This case series study included 7 eyes that underwent FemtoLASIK after a DMEK surgery. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography (Sirius, CSO, Italy), and anterior segment optical coherence tomography (Visante, Carl Zeiss-Meditec AG, Jena, Germany) were registered at each postoperative follow-up visit., Results: All surgeries were uneventful, with no intraoperative or postoperative complications. The follow-up time after DMEK (before FemtoLASIK surgery) ranged from 18 to 36 months. The post-FemtoLASIK follow-up period ranged from 12 to 60 months. All cases experienced a significant improvement in UDVA after FemtoLASIK, all of them reaching a postoperative UDVA value ≥20/32. None of the eyes lost lines of CDVA, and 1 case showed a gain of lines of CDVA. In all cases, the refractive error, UDVA, and CDVA values remained stable at their respective postoperative follow-up visits. Furthermore, all topographic and pachymetric parameters were stable at the different postoperative follow-up visits., Conclusions: Our findings suggest that the residual refractive error after DMEK surgery can be safely and effectively treated with FemtoLASIK.

Purpose: To study the light distortion effects of soft multifocal contact lenses and the influence of different pupil size and shape., Methods: A total of 14 eyes of 7 healthy contact lens users (mean age 28.6 ± 8.5 years) were recruited. The "Light Disturbance Analyser" device was employed for light characterization. The selected lenses were the monthly disposable "Biofinity multifocal" (CooperVision, CA, USA), both centre-distance and centre-near designs (addition power +2.50 D). Two circular pupils of 3 mm and 5 mm of diameter, and an elliptical shape (3 horizontal and 5 vertical mm) were used. Metrics such as the light distortion index (LDI), best-fit circle radius and its irregularity were analysed, among others., Results: The LDI was generally higher with multifocal lenses, varying from 3.7 ± 0.3 % of the single vision lens to 6.1 ± 3.3 % of the multifocal centre-distance design and the 5-mm pupil. Larger pupils gave higher LDI values, changing from 4.5 ± 2.0 % (3 mm) to 6.1 ± 3.3 % (5 mm) with the centre-distance design. The elliptical pupil produced the largest discrepancy in the distortion size between the vertical and horizontal directions. The centre-distance and centre-near designs behaved similarly in terms of light distortion., Conclusions: The multifocal contact lenses of the study increased light distortion effects under low light conditions, especially with larger pupils. The shape of the distortion pattern is associated with the shape of the pupil. It seems that not all, but a big percentage of light distortion would be produced by the presence of the out-of-focus images given by a multifocal lens., Competing Interests: Declaration of Competing Interest José Manuel González-Méijome has a proprietary interest in the LDA device., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Laser corneal refractive surgery has become an important treatment to correct ametropia in recent years. Rational medication in the perioperative period is essential to ensure the success of the surgery and to reduce complications. However, in this area there has been no consistent understanding and unified application guide across the world. Experts in Refractive Surgery Group, Ocular Microcirculation Branch of Chinese Society of Microcirculation who are specialized in keratology and optometry had initiated extensive and rigorous discussions and reached a consensus on appropriate medication before, during and after the refractive surgeries. The consensus covers a broad spectrum of commonly used ophthalmic solutions, provides recommendations of routine and enhanced medication on prevention and management of adverse reactions and complications related to the laser corneal refractive surgeries. We hope the consensus serves as a standard perioperative medication regimen for ophthalmologists, helps to ensure the safety and effectiveness of laser corneal refractive surgeries, and improves the quality and outcome of the refractive surgeries.

Background: The aim of this study was to explore the differences in terms of tear film and meibomian glands (MGs) between young Asian soft contact lens (CL) wearers and non-wearers., Methods: A prospective, cross-sectional observational study was conducted using 148 subjects (63 non-wearers, and 85 soft CL wearers who had been wearing CLs for more than 1 year) recruited from a clinic in Tianjin, China. All subjects first responded to an Ocular Surface Disease Index (OSDI) questionnaire and then underwent a standardized dry eye examination, which included measuring tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and corneal fluorescein staining (CFS). The MGs were evaluated via ImageJ, distorted MG count and the MG dropout were recorded., Results: Compared to the control group (non-wearers), the CL group recorded higher OSDI and CFS scores, lower TMH and NITBUT values, a larger distorted MG count, and larger MG dropout (all P < 0.05). Pearson correlation analysis found a correlation between MG dropout and the duration of CL use (r = 0.440, P < 0.001), OSDI (r = 0.298, P = 0.006), and CFS scores (r = 0.442, P < 0.001)., Conclusion: CL wearers showed higher MG dropout and reduced TMH and NITBUT, which likely contributes to severe CL-related dry eye symptoms. CL use may lead to a higher MG dropout rate, and the extent of the MG dropout presumably influences the tear film status in CL wearers.

Background: To assess the general knowledge and attitude of refractive error correction methods among female Saudi university students., Methods: One thousand, one hundred and sixty-five female university students, between 17 and 32 years of age were randomly interviewed using self-administered questionnaires with open and closed-ended questions. The questions collected information on demographics (gender, age, educational status, college of study, and occupation), addressed general knowledge/perception of the difference between the professions of ophthalmology and optometry, and attitudes toward spectacle, contact lens (CL) usage, including coloured prescription CLs, and refractive surgery for correcting refractive errors., Results: The response rate was 90 per cent (1,052/1,165). Fifty-two per cent had never had an eye examination and only 28 per cent correctly identified the difference between an 'ophthalmologist' and 'optometrist'. Eighty-one per cent knew that CLs instead of spectacles (81.8 per cent), and coloured CLs (89.7 per cent) can be used for correcting refractive errors. Concerning refractive surgery, although a majority (90 per cent) knew that the technique corrects refractive error and reduces dependency on spectacles/CLs, only five per cent had experienced refractive surgery. Approximately, 46 per cent and 47 per cent used spectacles and CLs, respectively, and while the optometrist was the main source of CL prescriptions (41 per cent), most people visited the ophthalmologist for their eye examination (68 per cent). Surprisingly, 52 per cent had never had an eye examination, or had only had one or two eye examinations (50 per cent) in their lifetime. While 23 per cent of spectacle wearers chose to continue with spectacles at the end of the study, 64 per cent and 12 per cent preferred refractive surgery and CLs, respectively, for refractive correction. Lack of information and fear of complications, but not cost, hindered most people from uptake of CLs and refractive surgery., Conclusion: The students demonstrated high levels of knowledge and awareness of refractive correction methods, especially for refractive surgery. Although many consulted the optometrist or ophthalmologist for their eye examinations and corrective devices, many remain uncorrected and unaware of the main difference between both professions. The lack of information about correction methods and fear of complications may have affected their interest in uptake of eye services and should be addressed to increase uptake and prevent avoidable vision loss., (© 2019 Optometry Australia.)

Background: Primary objective of this review was to measure compliance with spectacle use in children with refractive errors. Secondary objective was to understand the reasons for non-compliance., Methods: The databases searched were Ovid, EMBASE, CINAHL and Pubmed. All studies up to March, 2018 were included. The search terms were- ((((((Compliance [Title/Abstract]) OR Adherence [Title/Abstract]) OR Compliant [Title/Abstract]) OR Adherent [Title/Abstract])) AND (((Spectacle [Title/Abstract]) OR Spectacles [Title/Abstract]) OR Eye Glasses [Title/Abstract])) AND ((((Child [Title/Abstract]) OR Children [Title/Abstract]) OR Adolescent [Title/Abstract]) OR Adolescents [Title/Abstract]). Two researchers independently searched the databases and initial screening obtained 33 articles. The PRISMA guidelines were followed for conducting and writing the systematic review. Two reviewers assessed data quality independently using the Quality Assessment tool for systematic reviews of observational studies (QATSO). Poor quality studies were those, which had a score of less than 33% on the QATSO tool. Sensitivity analysis was done to determine if poor quality studies effected compliance. Galbraith plot was used to investigate statistical heterogeneity amongst studies. A random effects model was used to pool compliance., Results: Twenty-three studies were included in the review, of which 20 were included in the quantitative analysis. All the studies were cross sectional. The overall compliance with spectacle use was 40.14% (95% CI- 32.78-47.50). The compliance varied from 9.84% (95% CI = 2.36-17.31) to 78.57% (95% CI = 68.96-88.18). The compliance derived in sensitivity analysis was 40.09%. Reasons for non-compliance were broken/lost spectacles, forgetfulness, and parental disapproval., Conclusion: Appropriate remedial measures such as health education and strengthening vision care services will be required to address poor compliance with spectacle use among children.

Purpose: To determine the correlation between higher-order aberrations (HOAs) and best-corrected visual acuity (BCVA) recovery speed after spectacles treatment using iDesign measurements in refractive amblyopic children., Methods: This is a prospective case series. Children aged from 3 to 7 years with refractive amblyopia (Landolt C equivalent < 0.8) were recruited. All participants were followed for at least 6 months after full correction of the refraction error by spectacles. The HOAs were measured using iDesign before and after cycloplegia at first visit and at 3-month intervals. Then correlation between BCVA recovery after treatment for 6 months and HOAs was determined., Results: We analyzed 24 eyes of 12 children (mean age, 4.5 years). Baseline mean BCVA was logarithm of minimal angle of resolution (logMAR) 0.335 (Landolt C equivalent 0.46), which improved to logMAR 0.193 (Landolt C equivalent 0.64) after treatment with full-correction spectacles for 6 months. The amblyopic eye BCVA recovery was negatively correlated with tetrafoil with/without cycloplegia (P = 0.006 and 0.022, respectively) and trefoil with cycloplegia (P = 0.049)., Conclusions: trefoil and tetrafoil measured with iDesign negatively correlates with the BCVA recovery speed of refractive amblyopic eyes after spectacles treatment in this pilot study. The current study results may aid in further investigation for diagnosis and treatment of refractory refractive and idiopathic amblyopia., Competing Interests: The authors have declared that no competing interests exist.

Objective: To assess the impact of eyeglass administration after a vision-screening program on standardized testing scores in school-aged children., Design: Retrospective study of children who participated in a vision-screening program that provided free eyeglasses where indicated., Participants: Students in kindergarten through grade 5 in a large urban school district in North America., Methods: Children in kindergarten through grade 3 were administered the Developmental Reading Assessment (DRA), and children in grades 3 through 5 were administered the Pennsylvania System of School Assessment (PSSA). Classroom teachers completed eyeglass adherence questionnaires., Results: A total of 4523 children participated in the vision-screening program. Eyeglasses were worn most of the time (>75%) by 67.4% of the children and never or rarely worn (<25%) by 18.6% of children. DRA results were available for 2226 children. When eyeglasses were prescribed and worn, initially high reading performances (DRA level 3) were less likely to decline (odds ratio [OR] = 4.36, p < 0.001). Improvement was not observed for children who initially scored DRA level 1 or 2 (OR = 0.29, p < 0.001 and OR = 1.00, p = 0.986, respectively). PSSA reading results were available for 847 children. When eyeglasses were prescribed and worn, Asian children were more likely to score higher PSSA reading levels (OR = 2.53, p = 0.004). This trend was also observed in black and Hispanic children without reaching statistical significance (OR = 1.70, p = 0.061; OR = 2.67, p = 0.067, respectively)., Conclusions: In some children, wearing eyeglasses was associated with maintenance in standardized reading scores. High adherence to wearing eyeglasses suggests that children perceive a benefit, perhaps beyond that which these standardized test results were able to document., (Copyright © 2019 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose : To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India. Methods : Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics set-up in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants. Result : The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62-0.81), 0.67 (95% CI: 0.54-0.77), 0.63 (95% CI: 0.48-0.74) and 0.70 (95% CI: 0.58-0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55-0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84-0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92-0.96). Conclusion : All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards 'healthy aging' in India.

Purpose: To compare wear of standard, adjustable, and ready-made glasses among children., Design: Randomized, controlled, open-label, noninferiority trial., Participants: Students aged 11 to 16 years with presenting visual acuity (VA) ≤6/12 in both eyes, correctable to ≥6/7.5, subjective spherical equivalent refractive error (SER) ≤-1.0 diopters (D), astigmatism and anisometropia both <2.00 D, and no other ocular abnormalities., Methods: Participants were randomly allocated (1:1:1) to standard glasses, ready-made glasses, or adjustable glasses based on self-refraction. We recorded glasses wear on twice-weekly covert evaluation by head teachers (primary outcome), self-reported and investigator-observed wear, best-corrected visual acuity (BCVA) (not prespecified), children's satisfaction, and value attributed to glasses., Main Outcome Measure: Proportion of glasses wear on twice-weekly covert evaluation by head teachers over 2 months., Results: Among 379 eligible participants, 127 were allocated to standard glasses (mean age, 13.7 years; standard deviation [SD], 1.0 years; 54.3% were male), 125 to ready-made (mean age, 13.6; SD, 0.83; 45.6%), and 127 to adjustable (mean age, 13.4 years; SD, 0.85; 54.3%). Mean wear proportion of adjustable glasses was significantly lower than for standard glasses (45% vs. 58%; P = 0.01), although the adjusted difference (90% confidence interval [CI], -19.0% to -3.0%) did not meet the prespecified inferiority threshold of 20%. Self-reported (90.2% vs. 84.8%, P = 0.64) and investigator-observed (44.1% vs. 33.9%, P = 0.89) wear did not differ between standard and adjustable glasses, nor did satisfaction with (P = 0.97) or value attributed to study glasses (P = 0.55) or increase in quality of life (5.53 [SD, 4.47] vs. 5.68 [SD, 4.34] on a 100-point scale, P > 0.30). Best-corrected visual acuity with adjustable glasses was better (P < 0.001) than with standard glasses. Change in power of study lenses at the end of the study (adjustable: 0.65 D, 95% CI, 0.52-0.79; standard, 0.01 D; 95% CI, -0.006 to 0.03, P < 0.001) was greater for adjustable glasses, although interobserver variation in power measurements may explain this. Lens scratches and frame damage were more common with adjustable glasses, whereas lens breakage was less common than for standard glasses., Conclusions: Proportion of wear was lower with adjustable glasses, although VA was better and measures of satisfaction and quality of life were not inferior to standard glasses., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: Eye-glasses wear compliance is found to be low among children in school-based eye screening programs who are provided spectacles free of charge., Methods: Thirty-six schools from school visual acuity screening program in Nepal were randomly selected to receive no follow-up (standard) or follow-up by an optometry team at 3 months. In the intervention group (that received the follow-up), ophthalmic personal made unannounced visits to the schools at 3 months to determine spectacle compliance .Direct examination to determine compliance with spectacle wear 6 months was done. The primary reason for noncompliance from a list of possibilities was identified using a questionnaire., Results: Among 297 (145 control and 152 intervention) students that received glasses in the 36 schools, 128/152 (84%) were available for examination at 3 months in the intervention group. A total of 216/297 (73%) students were available for examination at 6 months (73 % and 72% of the control and intervention groups, respectively). Within the intervention group, 51% of children at 3 months and 57% at 6 months were wearing glasses during the unannounced visits. The main source of refractive error was myopia. Out of 66 children with astigmatism, 24 (36%) were wearing glasses. There was no statistically significant difference in compliance (p=0.85) between private and public schools, but compliance correlated better with the educational status of careers., Conclusion: A follow-up visit to the school by eye care personnel did not improve spectacle wear compliance among children .Other factors may also be responsible for poor compliance., (© NEPjOPH.)

Corneal refractive surgery is one of the most common approaches for correction of refractive errors. Combined corneal refractive surgery and corneal cross-linking (CXL) has been proposed as a method to achieve better refractive stability and to prevent iatrogenic corneal ectasia. However, there are concerns regarding its indications, surgical safety, standardization of protocols and long-term effect on corneal tissue. This review article aims to discuss the current knowledge and recent updates on combination of CXL and refractive surgery., (© 2019 Royal Australian and New Zealand College of Ophthalmologists.)

Background: Uncorrected refractive errors contribute enormously to the burden of avoidable visual impairment worldwide. There is a huge disparity in different parts of the globe in context to spectacle coverage for distance vision. This study was undertaken with objectives of determining prevalence of spectacle coverage, unmet needs and associated factors among adults in a rural community of north India., Methods: A community-based cross-sectional study was carried out within selected clusters of Jhajjar district of Haryana. All participants aged > 15 years underwent visual acuity assessment by LogMAR "E" screening chart. Participants with presenting visual acuity < 6/12 in any eye and all current spectacle users underwent detailed ophthalmic examination and refraction. Additional details about spectacles, barriers for their use and willingness to pay for them were collected. Participants with met and unmet need for spectacle use at visual acuity > 6/12 was computed. These are reported as proportions with 95% confidence intervals. Associated factors with unmet need were determined using bivariable and multivariable logistic regression analysis., Results: A total of 6910 participants were examined. The current spectacle use was 7.5% (95% Confidence Interval CI: 6.5, 8.7). The spectacle coverage was found in 33.3% (95% CI: 30.0, 36.7) participants among those in need. The unmet need was found in 10.8% of participants (95% CI: 10.1, 11.6). On multivariable analysis, odds of unmet need was associated with age, gender, level of education and marriage status. The most common barrier for refractive correction was lack of perceived need for refraction and its correction., Conclusion: There is substantial unmet need for distance vision spectacles in this population. It is imperative that multi-component intervention be implemented to improve spectacle coverage in this rural north Indian setting.

Background/aim: To quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children., Methods: A prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1-15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7., Results: Among 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (p<0.001), presenting VA (p<0.01), age (p<0.001), quality of life (p<0.05) and parental education (p<0.001) and myopia (either: p<0.05; both: p<0.05) remained significantly associated with better ninth grade scores., Conclusions: In this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Significance: Contemporary soft contact lenses do not affect mechanical sensitivity of the cornea, whereas conjunctival sensitivity is increased compared with nonwearers. Orthokeratology lens wear, however, reduces corneal sensitivity. The effects of contact lenses on lid margin sensitivity are unclear, and the link between ocular surface sensitivity and discomfort requires further exploration.Although up to 50% of contact lens wearers experience discomfort with varying severity, impact, and frequency, the relationship between ocular surface sensitivity and ocular surface discomfort experienced during contact lens wear is unclear. The purpose of this review is to examine and summarize the current evidence for the impact of both historical and contemporary contact lens wear on ocular surface sensitivity, the etiology of changes in ocular surface sensitivity, contact lens wear-related factors associated with changes in ocular surface sensitivity, and the relationship between sensitivity and discomfort. Despite minimal effects on mechanical corneal sensitivity with contemporary soft contact lens wear, orthokeratology reduces corneal sensitivity through pressure-related effects. This review addresses the relevance of conjunctival and potentially lid margin sensitivity in tolerance and discomfort with contemporary lens wear and the impact of instrument and stimulus characteristics. Less invasive techniques particularly for lid margin sensitivity measurements are required. Given the potential interactions between a contact lens and the varied types of ocular surface nociceptors, instruments that allow for exploration of cold and chemical sensitivity particularly may better allow the effects of lens wear to be elucidated compared with those that explore high-threshold mechanical sensitivity alone. A better understanding of the relationships between lens wear and ocular surface sensitivity may result in improved management of contact lens discomfort.

Purpose: To report the demographics, types of visual/ocular pathology, and ability to achieve a comprehensive examination at a university-based outpatient clinic for individuals of all ages with disabilities., Methods: The medical records for all patients with disabilities examined from January 2014 through December 2016 at our monthly clinic staffed by a pediatric ophthalmologist were reviewed retrospectively. Descriptive statistics were calculated for demographics, visual acuity, ocular diagnoses, nonocular diagnoses, refractive error, and achievable examination data. Ocular diagnoses were categorized as treatable or nontreatable and noted if newly diagnosed., Results: A total of 178 patients with disabilities were examined at 281 visits; 119 patients (66.9%) were nonverbal. Of the 178, 140 patients (78.7%) had pathology or refractive error requiring glasses; 126 had pathology and 14 had no pathology. Of the 126 patients with pathology, 113 had treatable ocular diagnoses and 13 had only nontreatable diagnoses. Of the 113 with treatable conditions, 56 (49.6%) were newly diagnosed. Cycloplegic refraction was attained in 168 patients (94.4%); 85 had a significant refractive error, 66 of whom had another treatable ocular diagnosis. Lack of cooperation precluded slit-lamp examination in 1 patient, cycloplegic refraction in 3 (1.7%), dilated fundus examination in 4 (2.2%), and iCare or Goldmann intraocular pressure measurement in 28 (15.7%)., Conclusions: Patients with disabilities in our cohort had a high prevalence of ocular pathology, which was often treatable and previously unrecognized. Refractive errors were common and frequently accompanied by other treatable conditions. A thorough ophthalmic examination was achievable in most individuals with disabilities., (Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

A 35-year-old man presented with decreased vision in his left eye following small incision lenticule extraction (SMILE) surgery. The refractive error after surgery was nearly twice his preoperative refractive error in the left eye. The patient was diagnosed as having a retained lenticule after SMILE surgery, which was folded on itself and was successfully managed by conversion to a flap. Postoperatively, the patient maintained good uncorrected visual acuity and a low refractive error, with the best spectacle corrected acuity of 20/20., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Albinism degrades visual function due to developmental disorders of the eye and visual pathways, larger refractive errors, absent binocularity and poor fixation control. Reading spectacles is commonly prescribed in our clinic and well tolerated. The purpose was to evaluate whether the accommodative response is typical or affected in comparison to a reference group., Methods: Twenty-two children with albinism (median: 13.5 years) and 12 controls (median: 13 years) underwent a full optometric examination and an objective accommodation measurement (WAM-5500 @ 6 Hz; Grand Seiko) in response to minus-lens-blur (-1, -2 and -3 D) and to a prolonged near viewing task (20 cm) for 5 min., Results: Children with albinism displayed less accommodation to minus lens-blur and during sustained near viewing (p < 0.001) compared to the reference group. Higher visual acuity correlates with a better accommodative response (r ≥ 0.5; p ≤ 0.04). The subjective and objective measures of accommodation did not correlate. The habitual reading distance was always closer than the point towards which the subjects with albinism seemed to accommodate according to the measurements at 20 cm., Conclusion: Children with albinism benefits from reading spectacles due to a combination of close habitual reading distance and a poor accommodation. Objective recording of accommodation is not critical for a correct judgement of near visual function. Children already wearing reading spectacles were those with least accommodative response., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Introduction: This article describes the implementation of a novel technology tool to capture demographic distribution and clinical presentation of patients in rural vision centers using the eyeSmart electronic medical record (EMR) app in a three-tier eyecare network in India., Methods: A two-year retrospective review of all patients who presented to the rural vision centers of LV Prasad Eye Institute (LVPEI) eyecare network was performed from September 2016 to August 2018 using an in-house developed eyeSmart EMR app., Results: A total of 501 771 patients were captured on the eyeSmart EMR app across the LVPEI network. The ratio of males (n=273 985, 54.60%) and females (n=227 786, 45.40%) presenting to the rural vision centers was 1.2:1. The most prevalent ocular disorder was refractive errors (n=273 720, 44.32%)., Conclusions: This study details the demographic distribution and prevalence of ocular disorders in a large cohort of Indian patients and demonstrates the potential for real-time analytics through the use of EMR systems. This provides rigorous evidence for the community and eyecare providers that the use of a web application/tablet app (eyeSmart) aids in providing better eyecare services in rural areas. It helps in creating government policies and improves the treatment strategies for various preventable ocular disorders in India.

Purpose: A market research survey was conducted to assess the impact of offering complimentary contact lenses (CLs) to spectacle-only wearing patients during frame selection with regards to their in-office experience, the transaction amount for their eyewear purchase and the likelihood of proceeding with a comprehensive contact lens fitting., Methods: Five optometry offices in the US participated. An initial interviewing phase served as a control during which optometrists treated spectacle-only wearing patients in the usual manner for frame selection. After this, the offices transitioned into a test phase where patients were offered the opportunity to wear CLs while selecting new spectacle frames. Only patients 18 or older who had not expressed an interest in CLs were invited to participate. A brief survey was completed on an iPad following the visit by all patients in both control and test phases., Results: 410 patients (205 test, 205 control) participated. 63% of the test group elected to wear CLs (40% spherical, 20% toric, 35% multifocal, 5% monovision). Patients wearing CLs spent more on their eyewear purchase ($708 vs $593, p = 0.04), were greater than 2.5X more likely to have received or scheduled a CL fit (p = 0.01), and were greater than 3X more likely to consider scheduling a CL fitting in the future (p = 0.0003). Additionally, 93% reported that they were highly satisfied with the experience and 86% said they would wear CLs to select frames again (86%)., Conclusions: Offering CLs to spectacle-only patients positively impacts eyewear selection and purchase and can grow the overall CL business., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Precis: Glaucoma suspect was the most prevalent category in this study followed by glaucoma associated with acquired ocular anomaly and juvenile open-angle glaucoma. Primary congenital glaucoma was diagnosed in only 3% of the population studied., Purpose: To describe the prevalence and clinical characteristics of childhood glaucoma diagnosed over a 10-year period among patients aged 18 years or below who were seen at a tertiary care children's hospital using the new Childhood Glaucoma Research Network classification system., Methods: Medical records of all patients aged 18 years or below (n=108) who were diagnosed with glaucoma between January 1, 2008 through September 30, 2018 were reviewed. Data collected included demographics (age at diagnosis, sex, and family history of glaucoma), intraocular pressure, disc-to-cup ratio, retinal nerve fiber layer thickness, and refractive errors. Clinical characteristics of each patient were evaluated according to the criteria established by Childhood Glaucoma Research Network. Categorical distributional equivalence comparisons were performed using the Pearson χ test. A P-value <0.05 was defined as statistically significant., Results: A total of 108 patients with a diagnosis of childhood glaucoma or glaucoma suspect were included in this study. Sixty-four percent of these patients were males (P<0.0001). The mean age at the time of diagnosis was 7.07±5.4 years. "Glaucoma suspect" was the most prevalent category (46%, P=0.0002), followed by glaucoma associated with the acquired ocular anomaly (20%) and juvenile open-angle glaucoma (16%). Primary congenital glaucoma represented 3% and all these patients were males. Sixty-nine percent of the patients had bilateral involvement (P=0.0073). The highest intraocular pressure recorded in the study was 57 mm Hg, the largest cup-to-disc ratio was 0.96, and the lowest retinal nerve fiber layer measurement was 39 μm. Ninety-two percent of the patients had refractive errors and 85% of them had astigmatism., Conclusions: Establishing a pattern and the associated clinical characteristics of childhood glaucoma at tertiary care children's hospitals will help in developing collaborative research efforts and effective treatment/management strategies for children with these rare groups of disorders.

Purpose: To evaluate a substantially improved wavefront acquisition technique (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany) for selective wavefront-guided aberration correction to improve satisfaction after implantation of trifocal intraocular lenses (IOLs)., Methods: Of 213 eyes from 108 consecutive patients receiving cataract surgery with multifocal IOL implantation (FineVision; PhysIOL, Liége, Belgium), 56 eyes (26%) of 42 dissatisfied patients were treated with selective wavefront-guided laser in situ keratomileusis (LASIK) (Amaris 1050; SCHWIND eye-tech-solutions) free of cost with a follow-up of 12 months. Selective wavefront-guided ablation corrected for all aberrations except spherical aberrations to preserve the apodization and therefore to enhance the multifocal effect. The degree of satisfaction after trifocal IOL implantation, its increase after selective wavefront-guided LASIK, and the refractive error (spherical equivalent, refractive astigmatism) before and after selective wavefront-guided LASIK were evaluated., Results: Refractive astigmatism of greater than 0.50 diopters (D) was the most frequent residual refractive error (63%), followed by myopia (45%), hyperopia (20%), and increased ocular higher order aberrations (13%). After selective wavefront-guided LASIK, the refractive target (±0.50 D) was achieved in 98% and refractive astigmatism was 0.50 D or less in 93% of the eyes operated on. The overall satisfaction score in dissatisfied patients increased from 2.1 ± 0.8 preoperatively to 3.6 ± 0.8 (out of 4). Eighty-eight percent of initially dissatisfied patients would choose this procedure again., Conclusions: Selective wavefront-guided LASIK reduced refractive errors and significantly increased spectacle independence and satisfaction, which may lead to a better acceptance of trifocal IOLs. [J Refract Surg. 2019;35(6):346-352.]., (Copyright 2019, SLACK Incorporated.)

Significance: Self-adjustable spectacles are increasingly being used in refractive service delivery programs in developing countries. Despite the success of self-refraction as a refraction technique, compliance with actual wear of adjustable spectacles has not been evaluated. Findings in this study have significant programmatic implications for the effectiveness and sustainability of this mode of correction in developing countries., Purpose: The purpose of this study was to assess compliance with wearing of adjustable spectacles and factors associated with compliance in pre-teen schoolchildren at 6 months after spectacles were dispensed., Methods: A cohort of 86 children aged 6 to 12 years with presenting vision worse than or equal to 6/12 in the better eye that could be improved to better than or equal to 6/7.5 by subjective refraction and who were identified from a randomized sample of 18 primary schools in the coastal areas of Cape Coast in Ghana received free FocusSpecs adjustable spectacles after successfully completing self-refraction and cycloplegic subjective refraction. Follow-up examination to assess compliance and to determine reasons for noncompliance was conducted at 6 months after spectacle provision. Logistic regression models assessed factors associated with spectacle wear compliance (95% confidence intervals [CIs])., Results: Spectacle wear compliance was 33.7% (95% CI, 31.3 to 36.1%); an additional 29% had their spectacles with them but were not wearing them. The major reasons given by the children for noncompliance were "loss" (32%; 18/57) and "breakage" (23%; 13/57). Modest compliance (49%) was observed among the poorer children who attend public schools. Attending public school was the only predictor of compliance to spectacle wear (odds ratio, 3.096; 95% CI, 1.228 to 7.805; P = .02)., Conclusions: Despite accurate self-refraction by most children, only a small proportion was compliant with actual wear of the spectacles. Loss and breakage were the major reasons for noncompliance. The poorer children who attend public schools, who stand to benefit most from the technology, were the ones more likely to be compliant with wear.

Children with craniofacial malformations frequently require spectacles but have difficulty finding an acceptable fit with current offerings of pediatric spectacle frames. We describe a novel method for creating custom 3D-printed spectacle frames based on a 3D reconstruction of a prior computed tomography scan. This method offers the ability to create better-fitting spectacles to children who are not served by "off the rack" frames., (Copyright © 2019 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: Children with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance-correcting unifocal glasses in children with DS., Methods: A total of 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova., Results: Treatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short-term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1-year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged., Conclusion: After one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals., (© 2018 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Importance: Data on the incidence of presenting vision impairment (PVI) and spectacle coverage rate (SCR) in urban China is limited., Background: To estimate the 6-year incidence and risk factors for PVI and the SCR in urban Southern China., Design: Population-based cohort study., Participants: A total of 1817 participants aged ≥35 years were identified from Guangzhou in 2008 at baseline and 1427 attended follow-up examination in 2014., Methods: Presenting visual acuity (PVA) was measured using the ETDRS chart with habitual spectacles. Participants with PVA ≤20/40 underwent subjective refraction at the follow-up visit. Incidence of PVI was calculated using the WHO and US criteria, respectively. The met-need SCR was defined as the percentage of participants with PVA <20/40 that had been improved to ≥20/40 after correction., Main Outcome Measures: Incidence of PVI and SCR., Results: Incidence of PVI was 8.3% (95%CI, 6.9-9.8) and 12.2% (95%CI, 10.5-14.0) based on the WHO and US definition, respectively. Older age, female, lower education level, more myopic spherical equivalent and worse PVA at baseline were significantly related to a higher PVI incidence based on the WHO criteria, with similar associations identified using the US criteria except for gender. The overall met-need SCR was 42.5%, and was lower among the elderly, more hyperopic participants or participants with lower education level., Conclusions and Relevance: The incidence of PVI is high in urban Southern China and spectacle wearing is available in less than half of those in need. This highlights the needs to promote spectacle coverage even in the urban population., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To determine the repeatability of refractive values measured using the Spot vision screener in healthy children and children with refractive errors. Methods: This cross-sectional study included 170 eyes of 85 healthy children (normal group), and 50 eyes of 25 children wearing spectacles for refractive errors (spectacles group). The spherical equivalent value, cylindrical value, and inter-ocular differences in the spherical equivalent values were analyzed. The repeatability of the refractive values measured using the Spot vision screener was determined using intra-class correlation coefficients (ICCs) and 95% limits of agreement. Results: In the normal group, ICC values for the spherical equivalent value, cylindrical value, and amount of anisometropia were 0.77, 0.80, and 0.64, respectively. In the spectacles group with spectacles they were 0.89, 0.67, and 0.78, respectively. In the spectacles group without spectacles they were 0.96, 0.78, and 0.97, respectively. The 95% limits of agreement between consecutive measurements for the spherical equivalent value, cylindrical value, and amount of anisometropia were within ±1.00 D in the normal group and the spectacles group with spectacles, and over ±1.00 D in the spectacles group without spectacles. Conclusions: The Spot vision screener can ensure better than moderate repeatability with and without spectacles.

Purpose: The purpose was to evaluate if there are differences between tears of contact lens (CL) wearers of different materials detectable by measuring the hydrodynamic diameter of tear components through photon correlation spectroscopy (PCS)., Methods: Tears of 59 CL wearers and tears of 39 non-wearers were collected by glass capillary. Wearers were divided into groups depending on the CL material: (i) hydrogels of II FDA group (H-II, 15 subjects), (ii) hydrogels of IV FDA group (H-IV, 13 subjects), (iii) silicone hydrogels (SH, 31 subjects). PCS analyses were performed at 25 °C on samples diluted with deionized water with tear concentration (10 ± 2)% V / W to obtain, for each subject, the average hydrodynamic diameter (d H,avg ) of tear components by analyzing intensity fluctuations in time of scattered light., Results: Means of d H,avg calculated on each group were found, on increasing order, to be 256 nm (std dev 18 nm) for non-wearers, 297 nm (std dev 45 nm) for H-II, 360 nm (std dev 76 nm) for SH, and 391 nm (std dev 85 nm) for H-IV with statistical differences between each group of wearers compared to non-wearers and between groups of wearers except between SH and H-IV., Conclusions: PCS reveals the differences between tears of CL wearers of different materials, not only between tears of wearers and non-wearers., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Contact lenses are gaining popularity in developing countries as an alternative to spectacles for the correction of refractive errors. It is needful, therefore, to generate information to guide the mode of practice, and assist the industry in developing products for the increasing contact-lenses-user population. The purpose of this study was to identify the demographic profile, as well as the knowledge, attitude to wear and care regimen of wearers of contact lenses in Ghana., Methods: In a cross-sectional study, case folders of 87 users of contact lenses were selected from the database eye contact lenses practices. The folders were reviewed for the demographic profile, type, and purpose for which the contact lenses were prescribed. Forty-two (42) contact lenses users were then randomly surveyed, using a semi-structured questionnaire to collect information on their knowledge, lens wear regimen, and attitudes regarding lens hygiene. Chi-square test was used to test associations between demographics and lens wear variables., Results: Out of the 87 cases reviewed, 46 (52.9%) were females and 41 (47.1%) males. Their ages ranged from 15 to 68 years with a mean age of 28.62 ± 9.38 years. The majority- 65 (75%) - were youthful (≤ 40 years), with the highest proportion of them - 46 (53%) - being between 20-29 years. The majority - 60 (68.9%) - had a tertiary level of education. Soft contact lenses were commonly worn by 68 (78.2%) users while 19 (21.8%) wore rigid gas permeable lenses. The purpose for wearing contact lenses included for vision correction - 46 (52.9%), followed by for cosmesis - 23 (26.4%) - and therapeutic reasons -18 (20.7%). The commonest refractive error corrected was myopia - 38 (43.7%), followed by astigmatism -19 (21.8%) and hyperopia 6 (6.9%). Among the 42 users who responded to the questionnaire, by proportion, the majority -17 users (40.5%) - were introduced to contact lenses by optometrists. All respondents reported previous symptoms associated with the use of their contact lenses, but slightly more than half, 25 (57.1%) did yearly follow-up visits., Conclusion: The majority of contact lenses used in Ghana are soft lenses, for the purpose of vision correction. The use of contact lenses was common among individuals in their early adulthood and those with tertiary education., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Significance: Provision of subsidized spectacles to schoolchildren with refractive error in Delhi was associated with increased spectacle coverage., Purpose: Studies involving free spectacle distribution and self-purchase of spectacles often report poor compliance. We assessed 1-year spectacle coverage among schoolchildren with refractive error who were provided subsidized spectacles., Methods: This was a study of a prospective cohort of 10,114 students from 20 randomly selected schools of Delhi. Children were presumed to have refractive error when unaided visual acuity was worse than or equal to 6/12 in either eye and a best-corrected visual acuity better than or equal to 6/9.5 in both eyes (n = 1503). Children with unmet need of spectacles (presenting with a visual acuity worse than 6/9.5 in the worse eye) were provided subsidized spectacles (n = 1191). Coverage was established by direct observation at baseline and after 1 year through unannounced visits., Results: Mean age of cohort was 12.0 ± 2.0 years, and 566 (37.7%) were girls. Baseline spectacle coverage was 29.3% (95% confidence interval [CI], 27.1 to 31.7%), which improved to 65.9% (95% CI, 56.0 to 61.6%) among all children (n = 1470) and 58.8% (95% CI, 56.0 to 61.6%) among children with unmet need (n = 1163) at 1 year. Uptake of the subsidized spectacles was 98.6%. On multivariate regression, the odds of spectacle use were greatest when unaided vision was poor: 55.5% when visual acuity was better than or equal to 6/9.5, 74.8% when visual acuity was 6/19 to 6/60 (adjusted odds ratio, 2.5; 95% CI, 1.7 to 3.5), and 91.5% when visual acuity was worse than 6/60 (adjusted odds ratio, 3.1; 95% CI, 1.0 to 9.5). Sex (boys, 66.3%; girls, 65.3%) and socioeconomic status (lower, 58.6%; middle, 61.8%; upper middle, 70.7%) were not associated with coverage. Increasing maternal education and baseline spectacle use were associated with coverage. However, 38.0% were wearing spectacles prescribed by the project, and 61.9% of the spectacles being used at 1 year were purchased in the open market., Conclusions: Spectacle coverage after 1 year increased through a subsidized spectacle scheme, particularly for children with poor uncorrected vision.

Purpose: To evaluate spectacle adherence with impact-resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study., Design: Retrospective cohort analysis of randomized clinical trial data., Methods: Setting: Multicenter., Patients: One hundred and fourteen children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy., Intervention: One-week diaries completed annually and retrospective telephone interviews conducted every 3 months to age 5 years to assess spectacle adherence with impact-resistant lenses. Visual acuity was assessed by a traveling examiner at age 4.5 years., Main Outcome Measures: Spectacle adherence between ages 4 and 5 years., Results: Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, P = .034). Reported adherence to spectacle wear correlated with reported patching (r = 0.30, P = .002). Spectacle adherence did not correlate with sex, type of healthcare insurance, or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence., Conclusions: These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery during infancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Importance: Uncorrected refractive error causes 90% of poor vision among Chinese children., Background: Little is known about teachers' influence on children's glasses wear., Design: Cohort study., Participants: Children at 138 randomly selected primary schools in Guangdong and Yunnan provinces, China, with uncorrected visual acuity (VA) ≤6/12 in either eye correctable to >6/12 in both eyes, and their teachers., Methods: Teachers and children underwent VA testing and completed questionnaires about spectacles use and attitudes towards children's vision., Main Outcome Measures: Children's acceptance of free glasses, spectacle purchase and wear., Results: A total of 882 children (mean age 10.6 years, 45.5% boys) and 276 teachers (mean age 37.9 years, 67.8% female) participated. Among teachers, 20.4% (56/275) believed glasses worsened children's vision, 68.4% (188/275) felt eye exercises prevented myopia, 55.0% (151/275) thought children with modest myopia should not wear glasses and 93.1% (256/275) encouraged children to obtain glasses. Teacher factors associated with children's glasses-related behaviour included believing glasses harm children's vision (decreased purchase, univariate model: relative risk [RR] 0.65, 95% CI 0.43, 0.98, P < 0.05); supporting children's classroom glasses wear (increased glasses wear, univariate model: RR 2.20, 95% CI 1.23, 3.95, P < 0.01); and advising children to obtain glasses (increased free glasses acceptance, multivariate model: RR 2.74, 95% CI 1.29, 5.84, P < 0.01; increased wear, univariate model: RR 2.93, 95% CI 1.45, 5.90, P < 0.01), but not teacher's ownership/wear of glasses., Conclusions and Relevance: Though teachers had limited knowledge about children's vision, they influenced children's glasses acceptance., (© 2018 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To describe patient-specific outcomes of scleral lens wear utilizing a variety of lens designs across multiple practice settings as reported in an international practitioner survey., Methods: An electronic survey was administered to eye care providers who prescribe scleral lenses in which they were asked to describe their most recently examined established scleral lens patient. Data was collected on patient characteristics, lens designs, wearing schedules, care products, and visual and physiological outcomes of lens wear. Descriptive analysis of data was performed., Results: A total of 292 responses were received. Participants represented 26 countries. The most commonly reported indication for scleral lens wear was corneal irregularity (87%) followed by ocular surface disease (8%), refractive error (4%) and 1% with multiple indications. Visual acuity improved from 0.4 ± 0.4 (mean ± SD) to 0.1 ± 0.2 in eyes with corneal irregularity (p < 0.001), from 0.3 ± 0.3 to 0.1 ± 0.3 in eyes with ocular surface disease (p < 0.001), and from 0.1 ± 0.1 to 0.0± [0.1] in eye with refractive error (p = 0.01). Prior to scleral lens wear, corneal staining was present in 55% of patients; staining was present in only 35% of patients following scleral lens wear. The number of topical ophthalmic drops needed decreased from 1.7 ± 0.9 to 0.8 ± 0.8 in patients with corneal irregularity (p < 0.001) and from 3.5 ± 1.7 to 1.1 ± 1.0 in patients with ocular surface disease (p < 0.001). The number of drops used by patients with refractive error remained stable, with these patients using an average of 2.0 ± 1.0 drops prior to scleral lens wear and 1.7 ± 1.5 drops following scleral lens wear., Conclusions: Patients with corneal irregularity experienced the greatest improvement in visual acuity, but patients with ocular surface disease and refractive error also achieved better visual acuity with scleral lenses. Ocular surface condition improved in patients with both corneal irregularity and ocular surface disease; patients with ocular surface disease experienced the most dramatic improvement. Patients who wore scleral lenses to correct uncomplicated refractive error did not experience an improvement in signs or symptoms of ocular surface disease., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the visual quality results when fitting a corneo-scleral contact lens (CScL) after intracorneal ring segment (ICRS) implantation for keratoconus management., Methods: Twenty-seven eyes of 27 patients with keratoconus underwent ICRS implantation and had CScL fitted as their visual quality was unsatisfactory with their spectacles or contact lenses. Patients received a complete eye examination, refraction and visual acuity assessment, anterior eye biomicroscopy, ocular fundus examination, corneal topographic analysis, endothelial-cell count, and visual quality assessment using contrast sensitivity and aberrometry tests. A diagnostic trial set was used in the fitting process, and patients were assessed according to a standardised methodology, including subjective visual quality and comfort, and contact lens usage time. The follow-up period was one year., Results: After fitting CScL, log-MAR visual acuity values improved significantly in relation to the best spectacle-corrected vision (0.22 ± 0.17 vs 0.00 ± 0.12; p < 0.001). Total high-order aberrations decreased 33% (2.62 ± 1.31 vs 1.75 ± 1.81 μm; p < 0.009) and the spatial frequencies of contrast sensitivity all improved (all p < 0.05). Furthermore, 70.37% of patients reported high ratings of subjective visual quality (favourable and very favourable) and prolonged usage times (11.78 ± 3.93 h). After wearing CScL for one year, no adverse ocular effects or clinically relevant changes in corneal parameters, visual quality, comfort ratings or usage time were found., Conclusion: This CScL appears to be an alternative reasonable option for keratoconic eyes with ICRS placement, providing an improvement in subjective visual quality., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To analyze the relationship between corneal sagittal height and asymmetry parameters derived from Placido-videokeratoscopy with the parameters of fitted scleral lenses (ScCLs)., Methods: Corneal topographies were measured with MedmontE300 in a total of 126 eyes with irregular and regular corneas before ScCL fitting were analyzed. Measurements of sagittal height (OC-SAG) at steep and flat corneal meridians were obtained for 10 mm and 12 mm chords. Estimated Height (EHChord) parameters were taken for a chord equal to the diameter of the lens that each subject was wearing at different semi-meridians. Corneal asymmetry (difference in OC-SAG between steep and flat corneal meridians) was also assessed. These outcomes were correlated to ScCL parameters that subjects were wearing after 1 month., Results: The mean ScCL-SAG was 4696 ± 240 μm, and the mean OC-SAG ranged from 1891 μm (10 mm), 2914 μm (12 mm), and between 4162 μm and 4251 μm for EH0-180º and EH30-210º. Stronger correlations (p < 0.001) between OC-SAG and ScCL-SAG were determined for EH0-180º (r = 0.595) and EH30-210º (r = 0.618). The mean differences between OC-SAG and ScCL-SAG were between 447 ± 290 μm (EH0-180º) and 389 ± 360 μm (EH30-210º). There was no relationship between corneal asymmetry and the need to fit a ScCL with toric haptic design in irregular corneas. Orientation of flat corneal and scleral meridians were similar only in corneas with high regular astigmatism., Conclusions: EHChord attributes were the parameters that best correlated with the ScCL-SAG. The corneal asymmetry was shown to be a poor predictor for the need to fit a ScCL with toricity at landing zone in irregular corneas, but could have some predictive power in regular corneas., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the safety and therapeutic effect of a modified posterior scleral reinforcement (PSR) in treating high myopia., Methods: A total of 85 highly myopic eyes in 47 children (6.3±3.6 years of age, range from 3 years to 15 years) who underwent this modified PSR were included in this study. Axial length, refractive error, best-corrected visual acuity (BCVA), macular scans, and adverse events were recorded before the operation (as a baseline) and in postoperative reviews taken yearly for 5 years., Results: This was a 5-year research: 50% of the children (20 children, 40 eyes) participated in the 6-month review, 41% of the children (17 children, 33 eyes) participated in the 1-year review, 26% of the children (11 children, 21 eyes) participated in the 2-year review, 16% of the children (7 children, 13 eyes) participated in the 3-year review, 13% of the children (5.3 children, 11 eyes) participated in the 4-year review, and 8% of the children (3.3 children, 7 eyes) participated in the 5-year review. Compared with the baseline, axial elongation was significantly changed ( P <0.05) over the 5-year period in all of the children: 6-month ( P =0.003), 1-year ( P =0), 2-year ( P =0), 3-year ( P =0), 4-year ( P =0), and 5-year ( P =0). The axial length was extended. No significant difference was found in refractive error between measurements taken at baseline and at the 5-year postoperative visit in all of the children: 6-month ( P =0.51), 1-year ( P =0.50), 2-year ( P =0.46), 3-year ( P =0.56), 4-year ( P =0.30), and 5-year ( P =0.16). There were significant differences in BCVA between measurements taken at baseline and at the postoperative 5-year visit in all the children: 6-month ( P =0), 1-year ( P =0), 2-year ( P =0), 3-year ( P =0), 4-year ( P =0), and 5-year ( P =0). BCVA improved in 71 eyes (83.52%), remained stable in 14 eyes (16.47%), and declined in none of the children. No serious adverse events occurred before the operation and during the 5-year follow-up period., Conclusion: This modified PSR could be a therapeutic treatment for high myopia.

Objectives: To compare the effect of toric versus spherical soft contact lenses on objective measures of visual performance using visual acuity and electromyography of the orbicularis oculi muscle., Methods: Current soft contact lens wearers with -0.75 to -1.75 D astigmatism in each eye were binocularly fitted with toric (1-Day ACUVUE MOIST for astigmatism) and spherical (1-Day ACUVUE MOIST) contact lenses in random order. After each fitting and at 1-week follow-up, high- and low-contrast visual acuities were measured. Electromyography was used to objectively evaluate eyestrain. Linear mixed models were used to assess differences between toric and spherical contact lenses., Results: The mean age (±SD) of the 60 participants was 27.5±5.0 years, spherical refractive error was -3.68±2.01 D, and cylinder was -1.28±0.36 D. High- and low-contrast visual acuities with toric lenses were better than with spherical lenses at both fitting (toric high-contrast: -0.065±0.078 and low-contrast: 0.133±0.103 vs. spherical high-contrast: 0.001±0.104 and low-contrast: 0.224±0.107) and follow-up (toric high-contrast: -0.083±0.087 and low-contrast: 0.108±0.107 vs. spherical high-contrast: -0.015±0.095 and low-contrast: 0.211±0.104) (all P<0.0001). Electromyography-measured eyestrain was less with toric versus spherical contact lenses at fitting (least-square ratio of toric over spherical=0.72; P=0.0019) but not at follow-up (ratio=0.86; P=0.11)., Conclusion: These results suggest that toric contact lenses provided improved objective measures of vision in a low-to-moderate astigmatic population.

Background: The aim of this study was to investigate static and dynamic visual acuity, refractive error, and the use of visual compensation of elite football players., Methods: From 2015 to 2017, 147 professional players from five teams were analysed. Screening consisted of a survey about the use of visual correction, and measurement refractive error, static visual acuity and dynamic visual acuity. Refractive error was assessed using an autorefractor. Distance static visual acuity was evaluated using a Snellen chart. Dynamic visual acuity was measured at five metres using the software COI-SV. All athletes were male with a mean age of 24.6 ± 4.1 years., Results: The mean refractive error of the athletes was -0.04 ± 0.83 D, and 16.4 per cent were myopic. Statistically significant differences were found for dynamic visual acuity (p = 0.033), based on the position occupied. Goalkeepers displayed the best dynamic visual acuity and forwards had the lowest values (0.82 ± 0.14 and 0.62 ± 0.17, respectively). The forwards presented with the highest prevalence of myopia and goalkeepers the lowest, at 22.5 per cent and 12.5 per cent, respectively. All goalkeepers who needed to use a correction for play used it, whereas only 16 per cent of the forwards who needed a correction used it., Conclusion: Dynamic visual acuity of forwards is lower than that of other players. Twenty-five per cent of players who need to use visual correction to practice sports actually use it., (© 2018 Optometry Australia.)

Objectives: To identify consumers’ tendencies regarding contact lens (CL) use in order to develop recommendations for messages to include in education for safe CL use and in public awareness campaigns., Materials and Methods: Subjects living in Ankara, Turkey who used eyeglasses and/or contact lenses due to refractive error were included in the study. CL users’ reasons for choosing CLs for vision correction, CL-related problems they encountered, and their perceptions regarding safe CL use education and regular ophthalmologic follow-up visits were evaluated using a survey completed by 917 participants., Results: In total, 836 survey forms were included in the analysis. Most of the participants were female (59.6%), university students (91.4%), and 18-30 years old (68.9%). According to the survey results, 64.6% of eyeglass users stated that they had never tried CLs, while 17.7% reported using CLs regularly. Most of the participants (61.7%) said they visit an ophthalmologist only when they needed, while 33.1% claimed to attend regular follow-up. When all participants were considered, the level of satisfaction with glasses was 3.11 out of 5, while CL users reported satisfaction of 4.15 out of 5. Most (78.6%) of the CL users said they started using CL by their own initiative, most commonly due to a dislike of eyeglasses. The most frequent complaint from CL users was dry eye and discomfort in the evening. The most common source of CL use education was ophthalmologists (55.5% of the participants), followed by opticians (28.2%)., Conclusion: Incorrect and inappropriate information on CL usage may lead to problems that can threaten eye health. The results of our study suggest that providing accurate information through concise messages in physician-supervised education and raising awareness through the media may be beneficial to public health. Therefore, we identified messages about CL usage and quality of life, safety, and the rules for proper use.

Purpose: To evaluate whether the presentation of a video within the informed consent consultation affects patient knowledge about refractive excimer laser treatment, satisfaction with the informed consent process, anxiety in respect to the planned surgery, and the consultation duration., Setting: Tertiary referral center, Lucerne, Switzerland., Design: Single-center, randomized controlled trial., Methods: Consenting eligible patients were randomly assigned to receive either a conventional face-to-face consultation (conventional group) or a conventional consultation with additional video-assisted information (interventional group). Knowledge and satisfaction with the informed consent process and anxiety regarding surgery were assessed. Differences between groups were tested with Wilcoxon-Mann-Whitney, Chi-square, and Student t tests., Results: The study comprised 113 patients (58 in the conventional group and 55 in the interventional group). There was no difference in terms of knowledge with 22/25 points (interquartile range [IQR], 3) in the conventional group versus 22/25 points (IQR, 2) in the interventional group (P = .957), satisfaction with the informed consent ("very satisfied": 47/58 versus 45/55; P = .915) and anxiety toward surgery with a median 8 (IQR, 4) versus median 9 (IQR, 3; P = .159). In the interventional group, however, the total consultation time was significantly lower than in the conventional group (-4.96 minutes; 95% CI, -9.50 to -0.43; P = .032)., Conclusion: Compared with a conventional consultation, video-assistance slightly reduced the total consultation time while maintaining patient knowledge, satisfaction with the informed consent process, and anxiety regarding the surgery on equal levels. Video-assistance could increase efficiency of clinical management on a double-digit percentage at an equal running cost compared with a conventional consultation., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)