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Purpose The distance between an implantable collamer lens (ICL) and the crystalline lens, namely vault, is a space regulated by the interaction of the ICL and the anatomical structures of the eye. This study analysed the differences in vault size between fellow eyes with similar anterior segment biometry. Patients and methods A retrospective case series analysed 109 cases of patients bilaterally implanted with EVO-V4c. Patients were analysed pre- and postoperatively using anterior segment optical coherence tomography. The range of vault inter-eye differences was defined as the 95% confidence interval of the differences. Bivariate correlation was applied to seek for associations between vault inter-eye differences with biometric and lens parameters (angle-to-angle, anterior chamber depth, crystalline lens rise, central corneal thickness, central keratometry, ICL spherical equivalent, horizontal compression, postoperative pupil diameter and vault). Results Mean vault inter-eye differences were similar between fellow eyes (26.0 ± 122.5 µm). The 95% confidence interval range of the differences was ±240.1 µm, nearly 50% of the cases presented vault inter-eye differences higher than 100 µm. The vault of the first operated eye explained 81% of the variance in the second eye vault. Vault inter-eye differences were positively correlated with the level of horizontal compression and with vault magnitude. Conclusion Vaults measured in fellow eyes may present considerable differences, which can reach 25% of the common vault range. This reflects some degree of baseline variability in the vault. Clinically, these differences assume special relevance in cases where low or high vaults are expected.

SIGNIFICANCE The decisions taken by soccer officials are critically important to game management. Understanding the underlying processes that mediate expert performance in soccer refereeing may lead to a better standard of officiating. Vision is the dominant source of incoming information upon which officials rely to make their on-field decisions. PURPOSE We tested the hypothesis that performance on generic tests of vision and visual perception predicts domain-specific performance in elite-level soccer referees (R) and assistant referees (AR). METHODS We assessed the vision of R and AR who officiate at the highest level in Portugal. To be eligible for inclusion, R and AR had to have officiated for at least two consecutive seasons across the 2014/2015, 2015/2016, and 2016/2017 seasons. A single, rank-order list of the performance of eligible officials was created based on the rank-order list for each season that was made by the Portuguese Soccer Federation. Clinical vision measures included visual acuity and stereoacuity, and visual perception measures were gathered using the Test of Visual Perceptual Skills, Third Edition. RESULTS A total of 59 officials participated (21 R, 38 AR), 17 of whom officiated at the international level. The R and AR groups did not differ in vision or visual perception measures. We found that better stereoacuity (P < .001) and visual memory (P = .001) are associated with a higher rank order of on-field performance after adjusting for the age, experience, the national/international status, and the regional affiliation of the officials. Together, these two measures explain 22% of the variance in rank-order performance. CONCLUSIONS This is the first study to show a link between the vision of officials and their on-field performance. The origin and significance of these findings remain to be established, and further work is required to establish whether they are component skills in the domain of soccer refereeing., Fundação para a Ciência e a Tecnologia (UID/FIS/04650/2013; to AMGB)

The data used in this study can be requested by contacting the corresponding author., Background: To identify biometric and implantable collamer lens (ICL)-related risk factors associated with sub-optimal postoperative vault in eyes implanted with phakic ICL. Methods: This study reports a retrospective case series of the first operated eye in 360 patients implanted with myopic spherical or toric ICL. Preoperatively, white-to-white (WTW), central keratometry (Kc) and central corneal thickness (CCT) were measured using the Pentacam. Anterior-segment optical coherence tomography (AS-OCT, Visante) was applied preoperatively for measuring the horizontal anterior-chamber angle-to-angle distance (ATA), internal anterior chamber depth (ACD), crystalline lens rise (CLR), anterior-chamber angle (ACA) and postoperatively the vault. Eyes were divided into three vault groups: low (LVG: ≤ 250 μm), optimal (OVG: > 250 and < 1000 μm) and high (HVG: ≥ 1000 μm). Multinomial logistic regression (MLR) was used to find the sub-optimal vault predictors. Results: MLR showed that CLR, ICL size minus the ATA (ICL size-ATA), age, ICL spherical equivalent (ICLSE) and ICL size as contributing factors for sub-optimal vaults (pseudo-R2 = 0.40). Increased CLR (OR: 1.01, CI: 1.00–1.01) and less myopic ICLSE (OR: 1.22, CI: 1.07–1.40) were risk factors for low vaults. Larger ICL size-ATA (OR: 41.29, CI: 10.57–161.22) and the 13.7 mm ICL (OR: 7.08, CI: 3.16–15.89) were risk factors for high vaults, whereas less myopic ICLSE (OR: 0.85, CI: 0.76–0.95) and older age (OR: 0.92, CI: 0.88–0.98) were protective factors. Conclusion: High CLR and low ICLSE were the major risk factors in eyes presenting low vaults. In the opposite direction, ICL size-ATA was the major contributor for high vaults. This relationship was more critical in higher myopic ICLSE, younger eyes and when 13.7 mm ICL were used. The findings show that factors influencing the vault have differentiated weight of influence depending on the type of vault (low, optimal or high).

To determine patient preoperative anatomical features and the parameters of implantable collamer lenses (ICLs) relevant in explaining vault variability., Manuscript Draft

Background: Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal. Methods: A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects. Results: Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%. Conclusions: The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered., ISA -Instituto Superior de Agronomia(undefined)

t. Binocular and accommodative dysfunctions affect the efficiency and coordination of the eyes, and this may impair reading performance. Reading can be evaluated using accuracy and speed measures. In this study, we searched for evidence that dysfunctions of accommodation (i.e. accommodation insufficiency, IA) and binocular vision (i.e. convergence insufficiency, CI) and also hyperopia have impact on reading ability. A sample of 292 children read a text following vision screening. The sample was composed of control children and children with the conditions: AI; CI and hyperopia. Multilinear regression analysis was used to evaluate the influence of variables sex, age and visual condition (control, AI, CI and hyperopia) on reading accuracy and speed. The results showed that ~7% of the variation in reading accuracy was explained by a model where age (p=0.001), and presence of AI (p, This work was supported by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2013.

In pseudophakia, the eye is unable accommodate so proximal objects can be properly focused. Achieving functional vision levels relies on individual anatomical features, notably, the pupil size. This study measured the range of pupil sizes found in a population of pseudophakes, for an object placed at different distances, and modeled the optical quality associated to pupil variation. The pupil size of 58 pseudophakic eyes (age mean ± standard deviation: 70.5 ± 11.3 years) was measured using a binocular eye-tracker. The participants observed on a monitor a circular white patch subtending 5° with a cross on its center. The object was placed at 3.0, 1.0, 0.66, 0.5, 0.4, 0.33 m. The pupil size variation as a function of object distance was modelled using a linear mixed effects model. The mean and 95% confidence interval (CI) were calculated for a far object and the slope of the function, indicative of the proximal myosis. The effect of object distance on the image quality was modeled using a pseudophakic model eye for the pupil size data. The mean distance pupil sizes were 4.45 (95%CI: 2.74, 6.17) mm and the mean proximal myosis was -0.23 (95%CI: -0.53, -0.08) mm/D. The VA estimation for a distance object ranged from -0.1 logMAR for the smallest pupil to 0.08 logMAR and the near VA when mean myosis was considered ranged from 0.28 logMAR to 0.65 logMAR. These results support the importance of distance pupil size measurement for the prediction of visual performance in pseudophakia, while suggesting that myosis has a negligible impact in VA variability.

The visual system takes time to respond to visual stimuli, neurons need to accumulate information over a time span in order to fire. Visual information perceived by the peripheral retina might be impaired by imperfect peripheral optics leading to myopia development. This study explored the effect of eccentricity, moderate myopia and peripheral refraction in temporal visual integration. Myopes and emmetropes showed similar performance at detecting briefly flashed stimuli in different retinal locations. Our results show evidence that moderate myopes have normal visual integration when refractive errors are corrected with contact lens; however, the tendency to increased temporal integration thresholds observed in myopes deserves further investigation., Parts of these results have been presented at ARVO 2012 annual meeting. We would like to acknowledge Associação de Profissionais Licenciados em Optometria (APLO) for their financial support and Inês Sousa PhD for her help with the statistics. REFERENCES, info:eu-repo/semantics/publishedVersion

The pseudophakic eye lacks the ability to produce a refractive change in response to object proximity. Thus, individual anatomical features such as the pupil size play an important role in achieving functional vision levels. In this work, the range of pupil sizes at varying object distance was measured in pseudophakic participants. Furthermore, the impact of the measured values on eye optical quality was investigated using a computer simulation model. A binocular eye-tracker was used to measure the participants&rsquo, pupil sizes at six object distances, ranging from 0.33 m (i.e., vergence of 3.00 D) to 3.00 m (i.e., vergence of 0.33 D), while observing a Maltese cross with a constant angular size of 1 ∘ . In total, 58 pseudophakic participants were enrolled in this study (age mean &plusmn, standard deviation: 70.5 &plusmn, 11.3 years). The effects of object distance and age on pupil size variation were investigated using linear mixed effects regression models. Age was found to have a small contribution to individual variability. The mean infinite distance pupil size (intercept) was 4.45 ( 95 % CI: 2.74, 6.17) mm and the mean proximal miosis (slope) was &minus, 0.23 ( 95 % CI: &minus, 0.53, 0.08) mm/D. The visual acuity (VA) estimation for a distant object ranged from &minus, 0.1 logMAR (smallest pupil) to 0.04 logMAR (largest pupil) and the near VA ( 0.33 m) when mean proximal miosis was considered ranged from 0.28 logMAR (smallest pupil) to 0.42 logMAR (largest pupil). When mean distance pupil was considered, proximal miosis individual variability produced a variation of 0.04 logMAR for the near object and negligible variation for the distant object. These results support the importance of distance pupil size measurement for the prediction of visual performance in pseudophakia, while suggesting that proximal miosis has a negligible impact in VA variability.

Officiating in football depends, at least to some extent, upon adequate visual function. However, there is no vision standard for football officiating and the nature of the relationship between officiating performance and level of vision is unknown. As a first step in characterising this relationship, we report on the clinically-measured vision and on the perceived level of vision in elite-level, Portuguese football officials. Seventy-one referees (R) and assistant referees (AR) participated in the study, representing 92% of the total population of elite level football officials in Portugal in the 2013/2014 season. Nine of the 22 Rs (40.9%) and ten of the 49 ARs (20.4%) were international-level. Information about visual history was also gathered. Perceived vision was assessed using the preference-values-assigned-to-globalvisual-status (PVVS) and the Quality-of-Vision (QoV) questionnaire. Standard clinical vision measures (including visual acuity, contrast sensitivity and stereopsis) were gathered in a subset (n = 44, 62%) of the participants. Data were analysed according to the type (R/AR) and level (international/national) of official, and Bonferroni corrections were applied to reduce the risk of type I errors. Adopting criterion for statistical significance of p, FCT -Fundação para a Ciência e a Tecnologia(UID/FIS/04650/2013), info:eu-repo/semantics/publishedVersion

Goldmann applanation tonometry (GAT) is considered the gold standard technique for tonometry. It is a procedure involving administration of topical anaesthetic (a drug which could have several side effects). This prevents a large number of vision care practitioners from using GAT, due to legal restrictions regarding the use of these ophthalmic drugs. The purpose of this study was to establish whether the discomfort experienced during non-anaesthetic Goldmann Applanation Tonometry (NAGAT) would be acceptable to subjects. The intensity of pain inflicted by GAT, NAGAT, Non-Contact Tonometry (NCT) and Schirmer test was assessed on thirty-one subjects enrolled in the study using the Numerical Rating Scale (NRS) to assess pain. The GAT was performed on one eye and the other three procedures were carried out in random order on the fellow eye. Initially, each subject was asked to score their Maximum Pain Without Complaint (MPWC). The MPWC and the Schirmer test were used as references to grade the pain levels. The scores for the five procedures were registered using the NRS (0-10) and compared using a non-parametric statistical analysis (Friedman test and a post-hoc analysis). In addition, IOP results for GAT and NAGAT were also compared using the t-test. The scores obtained on the NRS ranged from 0-4, 0-5, 0-8, 0-7 and 3-8 with a median of 1, 1, 2, 2, and 5, respectively for NCT, GAT, NAGAT, Schirmer and MPWC. A statistically significant difference (p = 0.01) was found between the MPWC and the four clinical tests but no difference was found between the clinical tests. There was no statistically significant difference (p = 0.71) between the IOP results for GAT and NAGAT, 14.0 ± 2.0 mmHg and 13.8 ± 2.0 mmHg (mean ± 1S.D.) respectively. The Goldmann Applanation Tonometry without anaesthetic (NAGAT) can be performed with an acceptable level of discomfort for the majority of subjects and should be performed identically to a traditional GAT, informing the subjects about the possibility of feeling a small discomfort.

Introduction It is widely perceived that participation rates in epidemiologic studies have declined in recent years. High nonparticipation levels have a harmful effect in all studies, especially in those in which the underlying causes of such a phenomenon are associated with the epidemiologic area of interest. Thus, it is important to look into this matter more deeply. Purpose The aim of this study was to investigate the profile of the individual …

The aim of the study is to test if EQ-5D, a more generic instrument, and Activity Inventory, a more specific instrument to the visual condition, produce consistent results when considering the different levels of visual impairment. By assessing how these instruments reflect visual status in a sample of patients with visual impairment, we will help to understand how they can work in cultural context and population in which they were never tested before.Method is based on Multivariate Analysis of Variance, in which the levels of visual impairment (slightly, moderate, severe/blindness) are defined through the visual acuity values, and the utility values derived from EQ-5D and the Activity Inventory.Participants were recruited in 3 public hospitals as a part of an ongoing study of prevalence and costs of visual impairment in Portugal. Patients attending outpatient appointments in these hospitals with acuity in the better eye of 0,30logMAR or worse and/or visual field in the better eye Poster presentation

The aim of this study is to ascertain whether the quantity and quality of tear and eye subjective comfort are influenced by the temperature, humidity and oral Contraceptives Taking or Non-taking (CTNT). Forty-one students, females, from the University of Minho, Braga, Portugal, aged (mean±1standard deviation) of 21.51±1.85 years, ranging from 20 to 30 years, participated in this study. The McMonnies Questionnaire (MMQ), Break Up Time (BUT) and Phenol Red Test (PRT) were accessed between 14-17 hours in four sets of visits throughout the year: Visit 1, Visit 2, Visit 3 and Visit 4. The PRT and BUT values (mean±1standard deviation) for Visit 1, Visit 2, Visit 3 and Visit 4 were respectively 23.88±6.50mm, 22.29±8.00mm, 23.61±6.75mm, 22.88±7.00mm and 6.02±1.58s, 5.62±1.22s, 5.23±0.88s, 5.53±1. 42s. The MMQ scores for Visit 1, Visit 2, Visit 3 and Visit 4 ranged from 2-13, 2-15, 1-14 and 2-14 with medians of 6, 7, 6 and 6, respectively. The influence of temperature, humidity and CTNT on PRT, BUT and MMQ were evaluated using generalized linear mixed model. For BUT and MMQ statistical significant effects were found regarding temperature and humidity. The temperature and humidity influenced the tear quality and subjective comfort but did not influence the tear quantity. The CTNT did not influence tear quantity, quality or subjective eye comfort.

Purpose. The photostress recovery time test (PSRT) has been widely reported as a helpful screening clinical tool. However, the poor standardization of its measurement technique remains to be a limitation among clinicians. The purpose of this study is to apply a recommended clinical technique to measure the PSRT in some of the most commons eye diseases to ascertain whether these diseases affect the PSRT values. Methods. One hundred and one controls and 105 patients, with diagnosed diabetes (without visible signs of diabetic retinopathy), primary open angle glaucoma (POAG) or cataracts underwent photostress testing. The test was performed with a direct ophthalmoscope for illuminating the macula for 30 seconds. Participants belonged to three age classes: A, B and C; and were divided into four groups: control, diabetic, POAG and cataract. The age range for A, B and C classes were respectively 43-54, 55-64 and 65-74 years. The groups were also further compared within each age class. In addition, the influence of age on PSRT was evaluated using the control group. Results. Results demonstrate that PSRT changes with age (p

A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

The topic of ophthalmic use of cocaine in clinical practice has a long history; nevertheless, the possible influence and pathways of action of inhaled cocaine in the human eye remain unknown. This study evaluates the effect of snorted cocaine in the eye tear of 22 occasional cocaine users using the Schirmer Test I (ST1). The tear amount without the subjects being under the effect of cocaine was (mean +/- standard deviation) 22.50 +/- 12.85 mm ranging from 5-55 mm. Under the effect of cocaine, 17 in 22 eyes had a decrease in the tear amount, averaging 16.52 +/- 10.13 mm ranging from 1-38 mm, representing a statistical significant decrease (paired t-test, one-tailed p = 0.0024) of about 27% between the previous conditions. The large majority of the subjects under the effect of cocaine present a decrease in ST1 determining a global statistical significant decrease in ST1. That suggests a relationship between snorted cocaine and a reduction in tear amount. The identification of the tear cocaine effect and the pathway of action cannot be overlooked in the research for a comprehensive characterization of inhaled cocaine action in the central and peripheral nervous system.

Purpose. This work aims to define contemporary scores for the Developmental Eye Movement Test (DEM) for native Portuguese-speaking children (PT) and to compare these scores with three other published scores: the original norms, published in 1987 for American English-speaking children (U.S.) and two other scores published in 1995 (SP1) and 2003 (SP2) for Spanish-speaking children. Methods. A standard DEM test was administered to 695 young students ranging in age from 6 to 13 years from the region of Braga, Portugal. The mean PT scores for vertical time and adjusted horizontal time as well as the corresponding errors and ratio were calculated according to age and grade, and these results were compared with those from other studies. In addition, the clinical response types (age and grade) were obtained based on mean PT scores. Results. For several ages/grades, the scores obtained in this study were significantly different from the scores reported in other studies. A global qualitative analysis showed that PT made fewer errors and had similar ratios when compared with U. S. and SP2. However, PT were generally slower in vertical time and adjusted horizontal time in the younger age groups. When comparing PT and SP1, a higher ratio for SP1 was determined in all ages. The clinical response types signified below-normal performance scores for ages 6 to 9 and grades 1 to 5. Conclusions. The unusually large number of oculomotor and/or automaticity problems found in this normal PT population using a test based on U.S. norms highlights the need for PT-specific guidelines. It appears that DEM scores may be affected by differences in language, educational systems, and/or cultural systems. Therefore, clinicians should be aware of these findings when using the DEM test on children in countries with differing languages and cultures.

A new experimental setup for any standard Video Display Unit (VDUET) with dichromatic glasses was developed for fixation disparity (FD) accessing. A computer software produce a dark field with white targets for central and peripheral fusion and two lines colors red and green for dissociated vision with the use of red and green filters. These lines can be moved right or left by the subject, until are seen apparently aligned. The real displacement between the lines is then recorded. The fixation curve (FC) is obtained by the interposition of prisms before one or both eyes, as in a regular commercial FD test. A comparison for FD and measurement time between this experimental setup and two commercially available methods, Wesson and Saladin cards, was performed in thirty-two university students. The means slope, x-intercept and y-intercept were 0.13, -0.22 and -5.63 for Saladin; 0.01, -2.29 and -1.88 for Wesson; and 0.61, -1.33 and -2.46 for VDUET. The mean measurement test time was 582.3 s, 501.3 s and 444.8 s for Saladin, Wesson and VDUET. The FC measured by these three methods was different but not statically significant (ANOVA one-way, Tukey post-hoc test) with the exception of the slope between Wesson test and VDUET (p

The aim of this method is to determine the thickness of a transparent medium, close to the corneal thickness, using the angle at the first and second Purkinje images are aligned for a specific optical slit width. An optical slit is projected in an oblique angle relatively to the transparent medium, producing two different reflections in each medium surface (first and second Purkinje images). The slit is then moved until the first and second Purkinje images of the slit are aligned in such a way, that look as if they were a continuous slit. The slit width, the angle between the illumination and observation, and the medium index are used, then, to calculate the medium thickness. This method was implemented in a slit lamp and the central thicknesses (CT) of nine gas-permeable contact lenses (CL) were measured, with this method and a mechanical gauge and the results were compared. The mean CT difference ± standard deviation, between the two methods was 0.004 ± 0.008 mm with minimum and maximum absolute values of 0.002 and 0.019 mm. This technique showed good precision to measure the CT of CL and should be tried in human corneas.

The establishment and development of optometry in Portugal resulted from the committed work of many individuals and institutions. These efforts have had good results in terms of raising the public's awareness of the major role played by optometrists in primary eye care. Back in the late 80's higher education in optometry was started. Ten years ago the results of scientific research on the topic first became available and are now also contributing to the success of optometry in Portugal. In regard to the optometry profession, specific regulations are to be discussed in the national parliament. The Associacao de Profissionais Licenciados de Optometria (APLO), as the professional organization representing optometrists in Portugal, has been critically important in this process. This article will present an overview of the history of optometry in Portugal, of change in the foreseeable future and of the APLO's experience and activities.

© Springer-Verlag Berlin Heidelberg 2016, Objective: To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics. Methods: Three investigators searched the CRD York, Tufts CEA Registry, and MEDLINE databases through 2015. We reviewed all potentially relevant titles and abstracts, and screened full-text articles, according to inclusion criteria. We established a quality score for each study based on a 35-item list. Results: A total of 295 studies were identified, of which 20 were included. The average quality score was 0.720 on a 0–1 scale. All studies were performed in high- and middle-income countries, using a 3rd-party payer perspective and randomized clinical trials to measure effectiveness. Sitagliptin, saxagliptin and vildagliptin had an ICER below 25,000 €/QALY, as second-line and as add-ons to metformin, in comparison to sulfonylureas. When compared with sitagliptin, liraglutide (GLP-1 receptor agonist) had an ICER of up to 22,724 €/QALY for the 1.2-mg dosage, and up to 32,869 €/QALY for the 1.8-mg dosage. Insulin glargine was dominant when compared with sitagliptin. Conclusions: According to the WHO threshold applied to the country and year of each study, DPP-4 inhibitors were highly cost-effective as second-line, as add-ons to metformin, in comparison with sulfonylureas. More recent therapies (GLP-1 receptor agonists and insulin glargine) were highly cost-effective in comparison to DPP-4 inhibitors. These results were obtained, however, on the basis of a limited number of studies, relying on the same few clinical trials, and financed by manufacturers. Further independent research is needed to confirm these findings.