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To identify normative near point of convergence (NPC) data for healthy high-school-aged athletes (13-19 years old) and determine the percentage of individuals with NPC scores that fall outside the currently accepted clinical cutoff value of 5 cm. Another objective was to determine the relationship between sex, concussion history, and attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) with NPC scores, if any.Case series.High-school sports medicine clinic.Near point of convergence was assessed in 718 high-school student athletes (141 females and 577 males) with an average age of 15.96 ± 1.16 years.None.An accommodation convergence ruler was used to measure NPC. Near point of convergence scores were repeated a total of 3 times and the mean used for all statistical analyses.The NPC scores for all participants averaged 3.58 cm, and the intraclass correlation coefficient for the 3 repeated measurements was 0.956. Approximately 20% of mean NPC scores were above the accepted upper limit of 5 cm. Although a statistically significant effect for sex was identified, the difference between them was considered clinically insignificant. No relationship between NPC and history of concussion or ADD/ADHD was identified.Results indicate that in high-school-aged subjects, approximately 20% of individuals may have NPC values that fall outside the current critical cutoff value and may lead to incorrect diagnosis of ocular dysfunction. In addition, NPC does not seem to be affected by the history of concussion or a diagnosis of ADD/ADHD.

This study investigates the directions of structural failures and toppling near Point Reyes Station during the 1906 San Francisco earthquake (Mw 7.9). We examined archives of the Jack Mason Museum of West Marin History and other historical sources for photographs and other evidence relevant to the dynamics of the 1906 rupture in this area. Using historical maps, site investigations, and previously unpublished photographs, we determined the precise locations and orientations of several structures, including a correction to the orientation of the train that was the subject of previous studies. Based on the photographic evidence and written accounts, we estimate the direction of toppling or collapse of each structure. Nearly all objects found were thrown in a direction approximately parallel to the right-lateral San Andreas fault, and in the same direction as the static ground displacement. This suggests that fault-parallel accelerations may have been stronger than fault-normal accelerations, and that the slip on the fault may have begun slowly and stopped more suddenly.

Near-point-of-care (POC) testing for early infant diagnosis (EID) and viral load expedites clinical action and improves outcomes but requires capital investment. We assessed whether excess capacity on existing near-POC devices used for TB diagnosis could be leveraged to increase near-POC HIV molecular testing, termed integrated testing, without compromising TB services.Preimplementation/postimplementation studies in 10 health facilities in Malawi and 8 in Zimbabwe.Timeliness of EID and viral load test results and clinical action were compared between centralized and near-POC testing using Somers' D tests (continuous indicators) and risk ratios (RR, binary indicators); TB testing/treatment rates and timeliness were analyzed preintegration/postintegration.With integration, average device utilization increased but did not exceed 55%. Despite the addition of HIV testing, TB test volumes, timeliness, and treatment initiations were maintained. Although few HIV-positive infants were identified, near-POC EID testing improved treatment initiation within 1 month by 57% compared with centralized EID [Malawi RR: 1.57, 95% confidence interval (CI) 0.98-2.52], and near-POC viral load testing significantly increased the proportion of patients with elevated viral load receiving clinical action within 1 month (Zimbabwe RR: 5.26, 95% CI 3.38-8.20; Malawi RR: 3.90, 95% CI 2.58-5.91).Integrating TB/HIV testing using existing multidisease platforms is feasible and enables increased access to rapid diagnostics without disrupting existing TB services. Our results serve as an example of a novel, efficient implementation model that can increase access to critical testing services across disease silos and should be considered for additional clinical applications.

The Harvest Oil Platform, near Point Conception, California, has long served as the NASA prime verification site for the TOPEX/POSEIDON and Jason series of reference altimeter missions. In this brief review article, we provide a short history of the platform verification experiment dating to the site selection in 1989. We describe the evolution of the verification data record over the past three decades, and demonstrate how the results have informed the development of a stable and accurate climate data record of sea level change from satellite altimetry.

Our purpose was to compare the clinical and injury characteristics of concussion patients with a receded near point of convergence (NPC) vs those without a receded NPC. Concussion patients were seen within 14 days of injury. We compared those with receded a NPC (>6 cm) break point distance and those with a normal NPC distance on symptom, behavioral, and clinical assessments. We also compared NPC break points between those who did/did not recover within 28 days of injury. 123 patients completed the assessment. 77/123 (63%) of participants demonstrated a receded NPC when tested within 14 days of injury. Those with receded a NPC break point (n = 77; mean = 14.9, SD = 1.5 years; 47% female) were significantly younger than those with a normal NPC break point (n = 46; mean = 15.7, SD = 1.7 years; 46% female). The receded NPC break point group had a significantly greater proportion of patients reporting headaches (86% vs. 61%), as well as significantly greater cognitive (mean = 13.4, SD = 8.7 vs. mean = 8.8, SD = 8.6), somatic (mean = 10.0, SD = 5.9 vs. mean = 6.9, SD = 6.6), and overall (mean = 23.7, SD = 13.6 vs. mean = 15.8, SD = 14.4) symptom severity. Our multivariable model indicated among all potential predictor variables, more severe somatic symptoms were significantly associated with a greater NPC break point (β = 0.26; 95% CI = 0.01, 0.52). The group who went onto experience persistent symptoms had a significantly greater NPC break point at initial evaluation than those without persistent symptoms (mean = 9.7, SD = 7.5 cm vs. mean = 7.0, SD = 4.0 cm). Those with a receded NPC break point at initial evaluation showed an increased symptom burden, most notable with somatic symptoms, compared with those without a receded NPC break point.

Purpose: To evaluate near point of convergence (NPC), near point of accommodation (NPA), and accommodative facility (AF) in order to determine their normative data in a rural population.Methods: The target population for this population-based, cross-sectional study was people living in rural areas. Each subject underwent extensive optometric and ophthalmic examinations, including the measurement of visual acuity, refraction, NPA, NPC, and AF.Results: The data of 1113 individuals was analyzed of whom 58.8% (n = 576) were women. The mean age of the participants was 15.26 ± 7.38 years (range: 6-30 years). The mean spherical equivalent of the subjects was 0.16 ± 0.63 D. The prevalence of myopia, hyperopia and astigmatism was 16.28% (13.97-18.58), 5.97% (4.49-7.44), 11.93% (9.91-13.95) in this study, respectively The mean and 95% confidence interval of NPC, NPA, and binocular accommodative facility (BAF) was 6.99 cm (6.84-7.15), 9.91 cm (9.71-10.11), and 9.84 cpm (9.63-10.06), respectively. A significant correlation was found between age and the parameters such that all evaluated parameters worsened significantly with age (P < .001).Conclusion: The results of the present study showed the normal ranges of NPA, NPC, and BAF in a 6-30 year-old population living in rural areas of northern Iran. These parameters changed significantly with age.

Background: Near point of convergence (NPC) assesses the vergence ability of the visuo-oculomotor system; however, little is known regarding: the extent and duration exercise impacts NPC and the be...

Effects of home-based convergence insufficiency vision therapy on accommodation among school going children Wekesa Andrew1, Wanzala Maximilla1 1Masinde Muliro University of Science and Technology Kakamega, Kenya. Abstract Background: Convergence and accommodation are always yoked together and any adjustment on the former affects the later. The most effective treatment for convergence insufficiency (CI) is vision therapy. Aim/Purpose: To determine the effects of home-based vision therapy on accommodation in school-going with CI attending the Masinde Muliro University Academic Vision Center in Kenya. Methods: A clinical experimental design involving 23 participants with the mean age of 14±2.4 years, were recruited into the study, however, only 18 were assessed after the therapy. The study took 9 weeks thus majority lost contact while others moved out of the town. Home-based vision therapy which is undertaken at home using a pencil or broke strings. During the therapy, accommodative values were monitored which were; negative relative accommodation, positive relative accommodation, dynamic accommodation, accommodative facility and near point of accommodation. Paired t-test used to compare mean values before and after the therapy. Results: The mean value of negative relative accommodation (NRA) before (mention what the mean values were here) and after (mention what the mean values were here) home-based therapy was statistically significant (p=0.01). However, the mean values before and after home-based therapy for the near point of accommodation (NPA), dynamic (Lag), relativity (PRA) and facility (MAF) showed no difference (p> 0.05). The mean value of the NRA before and after office-based vision therapy was statistically significant (p=0.01). Conclusion: The use of home-based vision therapy for the patients with CI had significant effects on accommodation changing from a lower limit to average after the therapy. Keywords: Convergence insufficiency, Accommodation, Home-based vision therapy.

Aim: To evaluate safety and efficacy of reconstituted atropine 0.01% eye drops for Indian children with myopic progression. Methods: Fifty children with progressive myopia with their spherical equivalent increasing at least 0.75 D in 6 months (0.75 to 1.50 D) were put on reconstituted atropine 0.01%. Ocular examination, including near vision, near point of accommodation (NPA), pupil size and axial length, was done. Subjective symptoms of glare and photophobia were noted. Systemic side effects were documented. Analysis was done using Microsoft Excel 2010. Results: The average age of patients was 9.5 years (range 5 to 14 years) and they were followed up for 1 year. Average mesopic and photopic pupil size was 5 and 4 mm, respectively. Average NPA was 9 cm. Mean increase in spherical equivalence was 0.18 D over 6 months. Average increase in axial length was 0.12 ± 0.11 mm over 6 months and 0.2 ± 0.29 mm over 1 year. Average increase in spherical equivalent over 6 months was 0.07 ± 0.19 D and over 1 year was 0.32 ± 0.29 D. No systemic side effects were recorded. Conclusion: Reconstituted atropine 0.01% eye drops is safe and efficacious in slowingthe progression of myopia in Indian children.

Purpose : To evaluate changes in accommodative function after near works in young myopes with accommodative infacility fitted with center-near multifocal soft contact lenses. Methods : Thirty-one soft contact lens wearers were participated and divided into the accommodative infacility group and normal group according to the accommodative facility. Subjects were fitted with single vision contact lenses (SVCLs) and center-near mid-add multifocal soft contact lenses (MFCLs). In case of MFCLs wearing, accommodative functions were measured after more than 7 days of adaptation. The amplitude of accommodation, near point of convergence, accommodative facility and vergence facility were measured after watching video using a smartphone for inducing accommodative burden for 30 minutes. Results : Among the subjects, twenty-four were normal in accommodative facility and seven were accommodative infacility. In young adults group with accommodative infacility, the near point of accommodation after watching video, was significantly increased with SVCLs(p=0.012) and no difference with MFCLs compared with before watching video. And the near point of convergence with MFCLs after watching video was significantly shorter than that with SVCLs, and shorter than before watching video(p=0.009), and accommodative facility with MFCLs was statistically significant increased compared with SVCLs, and higher than that of before video watching(p=0.004). Conclusion : The med-add center-near MFCLs enhance accommodative function that could be effective to alleviated accommodative burden for the young adults with accommodative infacility.

Purpose: To explore the relationship between ocular position control ability and stereopsis recovery in children with intermittent exotropia, and to analyze the influencing factors of distance stereopsis recovery. Methods: In this retrospective study, 78 children with small angle intermittent exotropia received vision training for 3 months. All patients were examined for distance stereopsis with the synoptophore and for near stereopsis with the Titmus stereogram before and after the training. The patients were divided into low and high Newcastle Control Score (NCS) groups. The stereopsis of the two groups was compared. Logistic regression analysis was used to analyze the influencing factors of distance stereopsis recovery. Results: Among 78 children with intermittent exotropia, 33 had near stereopsis (42.3%) and 22 had distance stereopsis (28.2%); the difference was significant ( P < .05). After 3 months of training, there were statistically significant differences between distance and near stereopsis in the low NCS group and the high NCS group (chi-square = 7.127, P = .008; chi-square = 13.005, P < .001). The number of children with distance and near stereopsis in the low NCS group increased significantly compared with before training (chi-square = 13.471, P < .001; chi-square = 22.244, P < .001). Multivariate logistic regression analysis showed that age of onset (odds ratio [OR] = 3.768, P = .001), near point of convergence (OR = 0.347, P = .002), and NCS (OR = 0.142, P = .002) were risk factors that affected stereopsis recovery in children with small angle intermittent exotropia. Conclusions: Control ability is one of the important indicators to assess the severity of intermittent exotropia. The worse the control ability, the more difficult the recovery of stereopsis. Age of onset, near point of convergence, and NCS are risk factors that affect the recovery of distance stereopsis. [ J Pediatr Ophthalmol Strabismus . 2021;58(6):350–354.]

PURPOSE To examine the association between Post-Concussion Symptom Scale (PCSS) scores, Convergence Insufficiency Symptom Survey (CISS) scores, and oculomotor deficits post-concussion. METHODS Records of adolescent patients examined in a multidisciplinary concussion clinic between July 2014 and May 2019 were reviewed. PCSS and CISS scores, results of eye examination and oculomotor assessment, concussion history, and demographics were abstracted. RESULTS One hundred and forty patient records (median age, 15.3 years; 52 males, presented 109 days (median) from their most recent concussion) met inclusion criteria. Mean total scores on PCSS and CISS were 46.67 ± 25.89 and 27.13 ± 13.22, respectively, and were moderately correlated with each other (r = 0.53, p

BACKGROUND In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants

Individuals with Parkinson's disease and convergence insufficiency were assigned vergence training. After two months, average positive fusional vergence increased and average near point of convergence decreased. Vergence can be improved with training in persons with Parkinson's disease who also have convergence insufficiency.

Oculomotor dysfunction is a common symptom of post-concussion syndrome (PCS). By use of a retrospective analysis approach, the efficacy of Vision Therapy (VT) for the treatment of PCS related symptoms of the visual system was investigated. Overall, 56 patients were selected for inclusion in this study, all of which presented with clinical impairment of at least one measure of oculomotor functioning. Activities related to VT were wide-ranging and case-dependent, but all aimed to improve one of the five main areas of visual function. Following completion of VT, all patients demonstrated statistically or clinically significant improvements, as defined by use of Morgan’s Norms, in at least one measure of oculomotor functioning related to PCS. In general, improvements in measures of oculomotor functioning were greatest for near point of convergence, vergence facility and accommodative facility. Patients receiving 20 sessions of VT had improved and less variable outcomes when compared to those receiving 5-10 sessions of VT. In addition, VT was found to improve symptoms of visual discomfort in patients presenting with PCS. Results of this retrospective analysis demonstrate significant improvements in measured outcomes for all patients receiving VT and support VT as a treatment option for symptoms of PCS.

Objectives: This study examined the effect of hydrostatic test practice on the mechanical properties of steel pipeline used in the oil and gas industry. Method/analysis: The method involves subjecting a 76.2 mm (3-inch) and 101 mm (4-inch) pipeline spools to predetermined maximum allowable operating pressures and designed hydrostatic pressures at designated data points. Thereafter, the spools were cut and samples prepared for experimental tests and analysis. Findings: The results showed that there is a significant change in the mechanical properties like fatigue strength and ultimate tensile strength. The result also showed a progressive increase in the fatigue strength from the control specimens to the hydrostatic pressure-tested specimens. The control specimens also exhibited a reduced fatigue strength compared to the maximum allowable operating pressure (MAOP)-tested specimens. Thus, since the hydrostatic pressure-tested specimens exhibited the highest fatigue strength, this could be reasonably attributed to the strain-hardening behaviour. Novelty/improvement: The hydrostatic pressure-testing procedure, at least, is not detrimental to the integrity of the pipeline. At best, it is beneficial since it increases the strain-hardening of the material.Keywords: Hydrostatic Testing, Service Pressures, Near Point, Far Point, Mechanical Properties, Integrity

Purpose To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. Design Retrospective cross-sectional study. Methods Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. Results Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits. Conclusion A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.

Background: The Convergence Insufficiency Symptom Survey (CISS) is being utilized as an assessment measure following concussion despite minimal research. This study explored the sensitivity and specificity of the CISS in identifying receded near point of convergence (NPC) post-concussion. Methods: Prospective study of 130 patients post-concussion aged 11-25, classified into normal NPC (n = 94) and CI (n = 36) groups (i.e., NPC >5 cm), completed the CISS, VOMS, and PCSS. Sensitivity and specificity identifying receded NPC were explored with published CISS cutoff score (>16). ROC with AUC analysis was conducted to determine an alternate CISS cutoff score to yield optimal sensitivity and specificity in patients with concussion. Results: Utilizing the published cutoff score, the CISS demonstrated adequate sensitivity (.78 [95% CI = .60-.89]) but poor specificity (.35 [95%CI = .26-.46]). ROC curve demonstrated that CISS score was significant (P = .01) in predicting a positive test result (i.e., NPC >5) with AUC of .65 (95%CI .54-.76). An alternative cutoff score (CISS>23) maximized sensitivity (.70) and specificity (.53) for identifying receded NPC. Conclusions: Both the previously published CISS cutoff and our sample-based cutoff score yielded a high rate of false positives for receded NPC. CISS scores post-concussion may help the clinician understand difficulties with visual tasks but is not a suitable diagnostic tool in this patient population.

Introdução: O uso de exercícios domiciliares para o tratamento da insuficiência de convergência tem se mostrado eficaz, porém não existe estudos com desenhos metodológicos adequados que demonstrem sua efetividade. Objetivo: Verificar a efetividade de exercícios domiciliares no tratamento da insuficiência de convergência. Metodologia: Trata-se de um estudo de série de casos clínicos, com seleção da amostra realizada por conveniência, composto por quatro individuos de ambos os sexos,realizado no Centro Universitário da Fundação Assis Gurgacz (FAG). Os desfechos incluíram os sinais e sintomas da IC através do questionário CISS, a acuidade visual através da Tabela de Snellen e o ponto próximo de convergência (PPC). Resultados: Foram avaliados e tratados quatro indivíduos, 75%do sexo feminino e 25% do sexo masculino, com média de idade de 24,25±4,5 anos. Todos relataram os sintomas de diplopia e desconfortos visuais durante atividades próximas e cefaleia.O PPC obteve média inicial de 8,7±0,5 cm e média final de 8,2±1,4cm,sem diferença estatisticamente significativa P=0,18.Os indivíduos apresentaram diminuição na pontuação do CISS, apresentando média inicial de 24,7±7,8 pontos (sintomas de IC) e média final de 16,7±13,4 pontos, com DM=8,0±6,9 pontos, sem diferenças estatisticamente significativa P=0,10, porém a terapia foi capaz de reduzir os sintomas da IC. Para acuidade visual não houveram diferenças significativas tanto monocular quanto binocular. Conclusão: Os resultados mostraram que não houve diferença estatisticamente significante para os desfechos propostos em relação aos exercícios domiciliares, porém houve redução da sintomatologia dos sujeitos.

Introduction and Purpose: The aim of this study is to evaluate binocular vision parameters such as near point of accommodation (NPA), near point of convergence (NPC), fusional vergence rang...

Objective: To determine the distribution of near point of convergence (NPC) according to age, sex, and refractive error in a rural population above 1 year of age in 2015. Methods: In this population-based cross-sectional study, multistage cluster sampling was applied to randomly select two underserved areas from the north and southwest of Iran and all individuals above 1 year living in these areas were invited to participate in the study. All participants underwent ocular examinations including visual acuity measurement, refraction, binocular vision testing including cover test and measurement of NPC, and slit lamp biomicroscopy. Results: Of 3851 who were invited, 3314 participated in the study (response rate: 86.5%). The NPC was 8.42 ± 2.94 cm in the whole population, 8.59 ± 3.07 cm in men, and 8.30 ± 2.84 cm in women. Subjects above 70 years of age had the most remote NPC (mean: 10.44 ± 3.07 cm). The mean NPC was 7.79 ± 2.93, 8.83 ± 2.72, and 9.63 ± 2.70 cm in emmetropic, myopic, and hyperopic participants, respectively. According to the results of a multiple linear regression model, NPC had a positive correlation with age (b: 0.058, p

Background: Convergence insufficiency (CI) is a common condition characterized by patient's inability to maintain binocular alignment on objects as they approach from distance to near. One study has found association between low body mass index (BMI) and CI. The purpose of this study is to find the prevalence of CI and its association with BMI among patients aged 18–35 years. Subjects and Methods: In a prospective study, we recorded convergence among individuals aged 18–35 years. We defined CI as near point of convergence of >10 cm, exophoria greater for near than distance, and positive fusional vergence of

BACKGROUND: To determine the distribution of the near point of convergence (NPC) and its related factors in an elderly population in Tehran, Iran. METHODS: This population-based cross-sectional study was conducted on the elderly population (60 years of age and over) of Tehran, Iran in 2019. The samples were selected using stratified random cluster sampling. The examinations included the measurement of uncorrected and best-corrected visual acuity, objective and subjective refraction, unilateral and alternate cover test, ocular health examination, and NPC measurement. RESULTS: The mean age of the participants was 65.90 ± 4.56 years and 59.6% of them were females. The mean (95% CI) NPC in the total sample was 7.84 cm (95% CI: 7.65–8.03). The mean (95% CI) NPC in males and females was 7.92 cm (7.63–8.21) and 7.75 cm (7.54–7.97) (P = 0.338), respectively. The mean NPC increased from 7.8 cm (95% CI: 7.55–8.05) in the age group 60–64 years to 8.83 cm (95% CI: 7.47–10.2) in the age group ≥ 80 years (P > 0.05). The mean (95% CI) NPC in emmetropic, myopic, and hyperopic individuals was 7.67 cm (95% CI: 7.33–8.02), 7.96 cm (7.56–8.37), and 7.87 cm (7.63–8.11), respectively (P = 0.378). There was no statistically significant relationship between NPC with education level, smoking, diabetes mellitus (DM), and hypertension (HT). CONCLUSIONS: The NPC values found in this study were significantly lower (less remote) than the values reported in previous studies in similar age groups. The NPC had no significant relationship with age, sex, education level, smoking, DM, and HT.

Objective: (1) To compare patient- and clinician-administered measurements of near point of convergence (NPC) distance including the percentage of patients exceeding clinical cutoffs among concussed adolescents and (2) to assess the reliability of patient- and clinician-measured NPC distances. Methods: A total of 762 patients (mean = 15.51, SD = 3.09 y) within 30 days of concussion participated. The NPC distance was measured consecutively with the patient and clinician controlling the fixation target. The differences between patient (PT) and clinician (CLIN) measurements and cases exceeding cutoffs (ie, ≥5 cm) were examined with a series of t tests and chi-square tests, respectively. Intraclass correlation coefficients and unbiased estimate of reliability were performed. Results: The NPC measurements were similar, t(761) = −.26, P = .79, between the PT (mean = 3.52, SD = 3.77 cm) and CLIN (mean = 3.54, SD = 3.97 cm) conditions. The number of measurements that exceeded cutoffs was similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10), and the number of measurements classified as abnormal/invalid was also similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10). There was excellent reliability between the methods (intraclass correlation coefficients = .85, unbiased estimate of reliability = .92). Conclusion: The findings support the application of this assessment in clinical settings where the clinician may not have direct contact with their patient and rely on the patient (eg, telehealth).

Background Near point of convergence (NPC), a component of the Vestibular Ocular Motor Screening (VOMS) assessment, may be helpful in diagnosing concussion. The VOMS uses a standardized approach to measure NPC; however, methods of screening for NPC are not standardized. Purpose The purpose of this study was to determine whether four different methods of measuring NPC yielded different estimates. Study Design Descriptive within-subjects laboratory study. Level of Evidence Level 3. Methods Healthy recreational athletes participated in a comparison of 4 commonly used methods of measuring NPC: a 12-point font target, the VOMS (14-point font target), the tip of a black pen, and the Bernell VergelTM device (9-point font target). The order of the presentation of the 4 targets was randomized. Results Seventy-five participants (59 females, 16 males; mean [SD] age=21.0 [6.12] years) completed 3 trials. The mean (SD) of the 900 NPC measurements was 7.11 (3.67) cm. Measurements for all targets had excellent reliability (r=0.94 to 0.98). In a comparative analysis, participant age was associated with NPC (p, The purpose of this study was to determine whether four different methods of measuring near point of convergence yielded different estimates.

Background To evaluate the change of accommodation and ocular discomfort according to the display size, using quantitative measurements of accommodation and ocular discomfort through subjective and objective metrics. Methods Forty six subjects without any ophthalmic disease history were asked to watch the documentary movie, using two different sizes of smart devices; smartphones and tablets. Before and after using devices, the near point accommodation (NPA) and the near point convergence (NPC) were measured, and objective accommodation was measured using an auto refractometer/keratometer. The subjective ocular discomfort was assessed through a survey. Results Both devices showed a decrease in post-use NPA and NPC, and the change after use of the smartphone was significantly severe, 1.8 and 2.5 folds respectively, compared to tablet (p = 0.044, p = 0.033, respectively). Neither smartphone nor tablet showed significant changes in the accommodative response induced by dynamic accommodative stimulus of auto refractometer/keratometer (p = 0.240 and p = 0.199, respectively). Subjects showed a more severe increase in ocular discomfort after using smartphones (p = 0.035) and reported feeling tired even with shorter use times (p = 0.012). Conclusions Both devices showed significant decreases in NPA and NPC, and the larger changes were seen when using the small display smartphone. Even within 20minutes of using, subjects start to feel ocular discomfort, and it was more severe and faster after smartphones than tablets. Therefore, the smaller the display size, the greater the adverse impact on eyes, and thus, appropriate display size will need to be selected depending on the time and purpose of use.

Background and purpose The study aimed to obtain optometric findings of amyotrophic lateral sclerosis (ALS) patients in different stages of the disease, and to determine the relation between ocular data and ALS-related features; that is, functional and cognitive impairment and staging. Methods The optometric protocol included tests of the ocular motility [broad-H test and Northeastern State University College of Optometry (NSUCO) test], near point of convergence (NPC), error refraction, best-corrected visual acuity, and binocular visual alignment, and an ocular symptoms questionnaire. The functional measures included the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-r) and Milano-Torino staging (MiToS), and cognitive impairment was assessed using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Demographic and clinical features were also collected, including whether the patients used an eye-tracking communication device (ETCD). Results Two-hundred consecutive ALS patients (median age of 64 years, 118 males and 82 females) in different stages of disease were recruited. Nearly 70% of patients reported at least one ocular symptom, and the use of an ETCD was found to be significantly related to the presence of most symptoms. Moreover, the severely symptomatic group was characterized by significantly lower ALSFRS-r total and subscale scores, and higher MiToS. Abnormal NPC values were significantly related to lower ALSFRS-r total and bulbar-subscale scores. Patients with acceptable NSUCO test values exhibited significantly higher ECAS scores. Conclusions The presence of ocular alteration in patients in different stages of ALS supports the idea that this is a multisystem disorder and emphasizes the importance of optometric evaluations in multidisciplinary assessments to address ocular impairment early in the disease process.

Objectives To identify predictors of prolonged recovery (ie, >28 days) using patient demographic factors and healthy, norm-based cutoffs on a multimodal test battery in adolescents after sport-related concussions (SRCs). Design Retrospective cohort. Patients were deemed recovered after successful completion of return-to-play/school protocols and received medical clearance. Setting Community concussion clinic. Patients Male and female adolescent student athletes diagnosed with a SRC and evaluated within 1 week of injury. Independent variables Patient demographics, medical history, injury description, computerized neurocognitive testing, vestibular/ocular testing, and symptoms at initial clinical visit. Main outcome measures Performance on clinical testing to predict recovery duration, classified as normal ( 28 days). Results A total of 201 adolescent student athletes (age = 15.3 ± 1.4 years) were included (female 35%). Average recovery duration for the entire cohort was 22.3 ± 13.3 days, with 22% (n = 45) of adolescent student athletes taking >28 days to recover. The final model was 88.3% accurate in classifying normal and prolonged recovery. Predictor variables included sex, loss of consciousness, history of ocular disorder, history of concussion, performance on visual motor speed composite, visual motion sensitivity symptom provocation and near point of convergence distance, number-naming total time, and symptom count. Conclusions These findings suggest that using norm-based cutoffs from cognitive, oculomotor, and vestibulo-ocular testing and symptom reporting, clinicians can accurately predict a prolonged recovery (sensitivity = 81%) and normal recovery (specificity = 83%) in an adolescent, SRC cohort.

Purpose: To find out the Centrality of Hirschberg reflex in young emmetropic females and to correlate it with asthenopia. Study Design: Cross-sectional study Place and Duration of Study: Outpatients department of Khalid Eye Hospital, Karachi, from January to December 2019. Methods: Six hundred young emmetropic females 10 to 25 years of age were included. We performed the Hirschberg test and Jackson cross cylinder to assess the astigmatism and observed near point of convergence to find out convergence insufficiency. Results: Out of 600 young emmetropic females only one hundred and ninety had a central Hirschberg corneal reflex along with an astigmatism of 0.25 to 0.50 which was observed in one hundred and sixty five patients. One hundred and twenty five had a receded near point of convergence. Conclusion: Acentrality of Hirschberg can be a cause of asthenopia among young emmetropic females. Key Words: Asthenopia, Astigmatism, Emmetropia, Hirschberg corneal reflex.

Purpose: To find out the frequency of convergence insufficiency in a refraction clinic of Karachi. Study Design: Cross Sectional Study. Place and Duration of Study: Al-Ibrahim Rye Hospital, Karachi from June to December 2019. Methods: A total of 150 patients were included in the study (52 males and 98 females). Patients with un-corrected visual acuity of ≥6/9 and age between 16 – 35 years were included. Patients who had received treatment for convergence insufficiency (CI), mentally retarded patients, patients with Manifest strabismus or any other ocular pathology were excluded. Near point of convergence (NPC), near phoria and positive fusional vergence (PFV) were measured for the diagnosis of CI. Results: Mean age of the patients was 23.55 years. Gender wise distribution showed that 52 (34.7%) were males and 98 (65.3%) were females. Out of 150 patients, 64 patients had CI and 42 were normal with no reduction in NPC, PFV or exophoria. Rest of the patients had only one of the three criteria of CI but did not qualify our definition of CI. Twenty-five male patients and 39 female patients had CI. CI was more common in teenagers. With increasing age, the frequency of CI was reduced. CI due to remote NPC was seen in 12 (8%) and CI due to decreased PFV was seen in 21 (14%). Conclusion: Females are affected more with CI than males especially in the younger age group. Keywords: Convergence insufficiency, near point of convergence, Positive fusional vergence.

For populations at risk of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), regular testing of multiple anatomical sites is recommended. Pooling methods that combine one patient’s anatomical site specimens can reduce cost and workflow burdens.1 2 The feasibility of such methods within a community setting is well established3 4; however, sensitivities of pooling are inferior to methodologies that test anatomical sites separately.1 5 Our group sought to improve pooling performance near the point of care within a peer-led, community-based STI testing service. Adapting a protocol described by Speers et al ,5 we previously reported3 sensitivities of 90% (95% CI 77.4% to 96.3%) and 89.7% (95% CI 74.8% to 96.7%) for the pooled detection of CT and NG, respectively, when using the Xpert CT/NG assay (Cepheid, Sunnyvale, California, USA). The Xpert CT/NG assay has not been listed by any regulatory body …

Cel pracyW odniesieniu do choroby afektywnej dwubiegunowej (ChAD), dotychczasowe prace wskazują na zaburzenia ruchów sakadycznych, głównie pod postacią wydłużenia czasu reakcji (latencji) w testach prosakad i antysakad. Dotychczas nie przeprowadzono oceny ruchów wergencyjnych gałek ocznych u osób z ChAD. Głównym celem naszego badania jest ocena parametrów konwergencji (zbieżne ruchy gałek ocznych) w tej grupie klinicznej.MetodaDo badania włączono 30 pacjentów z ChAD w stanie remisji objawowej i 23 zdrowych ochotników. Uczestników poddano badaniu optometrycznemu oceniającemu punkt bliski konwergencji przy użyciu pręta fiksacyjnego. Badanie okulometryczne przeprowadzono przy pomocy okulografu wykorzystującego promieniowanie podczerwone z dedykowanym stymulatorem wergencji.WynikiPacjenci z ChAD wykazali istotnie większy średni błąd pozycji konwergencji do celu oraz większą liczbę wtrąceń sakadycznych w porównaniu do grupy kontrolnej. Analiza składowych głównych przeprowadzona na zmiennych okulometrycznych pokazała istotne różnice między pacjentami z ChAD a zdrowymi ochotnikami. Wykazano obecność istotnych korelacji między zaburzeniami ruchów wergencyjnych a liczbą wtrąceń sakadycznych.WnioskiPacjenci z ChAD ujawnili zaburzenia ruchów wergencyjnych gałek ocznych podobne do zaburzeń opisywanych w trakcie śledzenia bodźców poruszających się w płaszczyźnie czołowej. Podczas gdy zaburzenia wergencji były opisywane w innych zaburzeniach psychicznych, nasza praca po raz pierwszy obiektywnie zmierzyła to zjawisko w ChAD.

Intraoperative monitoring of parathyroid hormone (PTH) is commonly used during parathyroidectomies. There are a number of practical challenges in achieving rapid turnaround time (TAT) for intraoperative PTH testing, whether the testing is performed point-of-care, near point-of-care, or in a central clinical laboratory. In the related research article, we analyzed a decade of data from 3025 intraoperative PTH tests on 897 unique patients. Of these, 1787 tests on 514 unique patients (375 female, 139 male) occurred while intraoperative PTH measurement was done as near point-of-care testing; the remaining 1238 tests on 383 unique patients (282 female, 101 male) occurred after a switch to intraoperative PTH measurement by the hospital central laboratory. The data in this article provides the patient age, gender, location of surgery (main operating rooms vs. ambulatory surgery center), incision to close time for surgery, and operation start to end times. For the central laboratory testing, additional data are provided for the intraoperative PTH TAT. The analyzed data is provided in the supplementary tables included in this article. Plots of operation start and end times are also included. The dataset reported is related to the research article entitled "Evaluation of Switch from Satellite Laboratory to Central Laboratory for Testing of Intraoperative Parathyroid Hormone" [D. Jacob, G. Lal, D.R. Voss, T. Bebber, S.R. David, J. Kulhavy, S.L. Sugg, A.E. Merrill, M.D. Krasowski, Evaluation of Switch from Satellite Laboratory to Central Laboratory for Testing of Intraoperative Parathyroid Hormone, Pract. Lab. Med. (2020) 22: e00176] [1].

Background To evaluate the differences of ocular abnormalities between children with attention deficit hyperactivity disorder and non-attention deficit hyperactivity disorder children using siblings of cases in Jordan. Methods A case–control study of 55 children with attention deficit hyperactivity disorder, and 55 children without the disorder as a control group using siblings of cases. Examination included visual acuity, motility, anterior and posterior segments, convergence, optical coherence tomography and corneal topography. Results Thirty-eight patients from the attention deficit hyperactivity disorder group had visual acuity better than 0.8 in both eyes; 36.4% had normal cyclorefraction, while 54.5% had mild hyperopia. Most of them did not need glasses. Tomography showed normal values with no statistically significant differences between the two groups. The near point of convergence showed significantly abnormal values in 41.9% of children with attention deficit hyperactivity disorder. Pentacam measurements showed normal values with no statistically significant differences between the two groups. Conclusions Children with attention deficit hyperactivity disorder show significant low near point convergence compared with the study control group., Highlights • ADHD is one of the most common neurodevelopmental disorders of childhood. • It is important to rule out underlying ocular conditions. • Children with ADHD show significant low near point convergence. • All children with ADHD should undergo an ophthalmological assessment.

SUMMARY The aim was to determine whether improvement of near point of convergence (NPC) and binocular vision after orthoptic exercises had any impact on children and adolescents diagnosed with attention deficit/hyperactivity disorder (ADHD) and convergence insufficiency (CI). In this clinical trial, 50 children and adolescents aged 6 to 18 years diagnosed with ADHD and CI received orthoptic therapy that included home-based exercises (pencil push-ups and stereograms) and office-based therapy on synoptophore. Binocular vision and NPC were measured before, during and after therapy. Study subjects showed significant improvement (p

Abstract Background To investigate the differences in refraction, accommodative factors, visual parameters, and subjective symptoms after using two types of virtual reality (VR) content with different depths of perception. Methods Twenty-three volunteers, who played VR games in two modes (immersive and non-immersive) for 30 min, were enrolled. Visual parameters were examined before and after using VR. Accommodative factors were measured using static and dynamic methods. Subjective symptoms were assessed using a questionnaire. Differences according to VR content were compared, and correlations between each visual parameter were analyzed. Results There were no changes in refraction or accommodative factors after use of the VR. However, there was a significant increase in the near point of accommodation (NPA), the near point of convergence (NPC), and subjective symptom scores after using the immersive mode. Correlation analysis revealed a positive correlation between baseline values of near exophoria and mean accommodative lag of the dominant eye, and also revealed a negative correlation between NPA and mean accommodative lag in the non-dominant eye. Conclusions The use of VR for 30 min increased NPA and NPC, especially after the immersive mode was used. In addition, higher exophoria and smaller NPA is associated with increased accommodative lag after using VR.

The purpose of the study was to determine the frequency of vision diagnoses after concussion in adolescents and evaluate the sensitivity and specificity of physician-administered screening for detecting convergence and accommodative disorders post-concussion. We enrolled participants 11 to 17 years old, assessed 4 to 12 weeks following a diagnosed concussion. During the initial concussion examination, a sports medicine physician measured the near point of convergence (NPC), monocular accommodative amplitude (AA), and symptoms using the Convergence Insufficiency Symptom Survey (CISS). A comprehensive oculomotor evaluation was performed by an optometrist. One hundred and thirteen adolescents were enrolled, with a mean age of 15.2 years. Seventy-nine of the 113 (70%) participants had at least one oculomotor diagnosis after concussion, with the most common problems being vergence disorders (60%) and accommodative disorders (57%). The most common vergence disorder was convergence insufficiency (35%). Among accommodative disorders, the most common problem was accommodative insufficiency (35%). In all, 47% of the participants had more than one oculomotor diagnosis following concussion. The sensitivity of physician screening using measures of NPC, AA, and CISS for detecting convergence and accommodative insufficiency was 63%, 43%, 48%, respectively. The results of this study provide additional evidence that vision problems are common in adolescents with persistent concussion symptoms in the sub-acute phase 4 to 12 weeks post-concussion, and current physician screening methods using the NPC, AA, or the CISS underperform. Thus, it is prudent that adolescents with post-concussion symptoms lasting more than 4 weeks post injury receive a comprehensive oculomotor examination.

Mycoplasma genitalium is an important sexually transmitted infection that can cause acute and/or chronic urethritis in males and females, and its prevalence is approximately 16% in females and 17% in males ([1][1]). Globally, macrolide resistance is estimated to exceed 50% in most urban centers ([1

BackgroundThe majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4-6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care.AimThis paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing.MethodsThis is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International).ResultsThe majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants' HIV status quicker, thereby shortening the stressful waiting time for results.ConclusionOur study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution.

BACKGROUND: To determine the sensitivity and specificity of school nurse screening for hypermetropia and convergence insufficiency exophoria (CIE) in schoolchildren.METHODS: Near point of convergence and distance visual acuity with +2.00D lenses were measured in 2097 children (6-15 years) during standard school nurse screening in the municipality of Randers, Denmark. One hundred and ninety-four children with positive screening results (near point of convergence >10 cm and/or distance visual acuity improved or maintained with +2.00D) and 182 controls with negative screening results received a full vision assessment, including cycloplegic refraction and orthoptic evaluation.RESULTS: Sensitivity and specificity of screening was 0.75 and 0.69 for CIE and 0.59 and 0.87 for hypermetropia (≥+2.00), respectively. While precision of screening for CIE was significantly higher for symptomatic children aged 9-15 than for younger and asymptomatic children, precision of screening for hypermetropia was independent of age and presence of visually related symptoms.CONCLUSION: While precision of screening for CIE and hypermetropia (>+2.00) was low, additional vision evaluation of children older than 9 years with asthenopic symptoms identified most children with CIE with a low absolute number of false positives.

Introduction Point-of-care (POC) technologies in resource-limited settings can circumvent challenges of centralized laboratory testing, improving clinical management. However, higher device costs and uncertain indications for use have inhibited scaling up POC modalities. To address this gap, we investigated the feasibility and cost of targeted near-POC viral load (VL) testing in 2 large HIV clinics in Lilongwe, Malawi. Methods VL testing using GeneXpert was targeted for patients suspected of treatment failure or returning to care after a previously elevated VL (>1000 copies/mL). Descriptive analysis of retrospective clinical and cost data is presented. Results Two thousand eight hundred thirteen near-POC VL tests were conducted. One thousand five hundred eleven (54%) tests were for patients for whom results and reason for the test were documented: 57% (794/1389) of tests were to confirm a previously high VL, and 33% (462/1389) were due to clinical indications. Sixty-one percent (926/1511) of patients had a high VL, of whom 78% (719/926) had a recorded clinical action: 77% (557/719) switched to second line antiretroviral therapy, and 15% (194/719) were referred for intensive adherence counseling. Eighty-two percent (567/687) of patients received a clinical action on the same day as testing. The "all-in" cost was $33.71 for a valid POC VL test, compared with an international benchmark for a centralized VL test of $28.62. Conclusion Targeted, near-POC VL testing was feasible and consistently enabled prompt clinical action. The difference between the "all-in" cost of near-POC VL and centralized testing of $5.09 could be further reduced in an optimized national program by combining targeted near-POC testing and centralized testing.

This article provides acoustic measurements data for vowel nasalization which are based on speech recorded from fifteen (8 female and 7 male) native speakers of American English in a laboratory setting. Each individual speaker's production patterns for the vowel nasalization in tautosyllabic CVN and NVC words are documented in terms of three acoustic parameters: the duration of nasal consonant (N-Duration), the duration of vowel (V-Duration) and the difference between the amplitude of the first formant (A1) and the first nasal peak (P0) obtained from the vowel (A1-P0) as an indication of the degree of vowel nasalization. The A1-P0 is measured at three different time points within the vowel –i.e., the near point (25%), midpoint (50%), and distant point (75%), either from the onset (CVN) or the offset (NVC) of the nasal consonant. These measures are taken from the target words in various prosodic prominence and boundary contexts: phonologically focused (PhonFOC) vs. lexically focused (LexFOC) vs. unfocused (NoFOC) conditions; phrase-edge (i.e., phrase-final for CVN and phrase-initial for NVC) vs. phrase-medial conditions. The data also contain a CSV file with each speaker's mean values of the N-Duration, V-Duration, and A1-P0 (z-scored) for each prosodic context along with the information about the speakers' gender. For further discussion of the data, please refer to the full-length article entitled “Prosodically-conditioned fine-tuning of coarticulatory vowel nasalization in English”(Cho et al., 2017). Keywords: Vowel nasalization, Coarticulation, Prosodic strengthening, Prominence, Boundary, Phonetic grammar

Near point of convergence (NPC) is an emerging concussion assessment tool and researchers have reported NPC scores using different administration methods which may influence assessment interpretation. The purpose of this study is to investigate the effect of different administrative methods on NPC scores in healthy, active young adults. NPC was measured using two different accommodative rulers and a fingertip, with three different placements. No significant difference in NPC score was observed between rulers. Significant differences were observed between ruler placements. Furthermore, fingertip use was significantly different compared to all ruler placements.

Purpose : The purpose of this study is to find how it influences on refractive error and visual function by intaking water soluble Perilla frutescens var. acuta (PFA) extract for 4 weeks. Method : After the permission of the institutional review board of medical devices (IRB Permission No.: DSGOH-042), This study was tested on 30 adult men and women. Two hours after PFA or placebo was taken in, smart device based VDT work had been done for 2 hours. And then, the results before and after PFA intake were compared with those in control group. Result : As a result, the PFA intake group tended to improve Spherical Equivalent Refractive Error statistically and significantly(p=0.001, p=0.000). Compared to the placebo intake group, the PFA intake group had statistically significant improvements in the near point of convergence and the near point of accommodation(p=0.007, p=0.001, p=0.001, p=0.000). According to the test on binocular accommodative facility, the PFA group showed a more significant rise after intake than before intake(p=0.021). The placebo group had no significant difference. Also, there was no significant difference between the two groups(p=0.876). After intake of PFA or placebo for 4 weeks, the safety before and after intake was evaluated. As a result, the two intake groups had no abnormal reaction. It was judged that taking in water-soluble PFA extract was safe to the human body. Conclusion : PFA increased activity of ciliary body muscles more than placebo. Therefore, it is considered to suppress a rise in refractive error and to improve convergence, accommodation, and asthenopia.