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Optometry & Vision Science:
doi: 10.1097/OPX.0000000000000215
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IN THIS ISSUE:

Hard Exudates Surrogate for CSME Screening?
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Hard exudates (HEs) have been used as a surrogate for edematous retina detection for some time, and this has been identified as a screening tool for referral of treatable clinically significant macular edema (CSME). Our authors evaluated the presence of HEs near the center of the macula by comparing two independently graded nonstereo fundus images. Clinically significant macular edema was determined during a separate dilated fundus examination using the criteria set forth by the Early Treatment Diabetic Retinopathy Study. For HE used as a surrogate, the detection of CSME sensitivity (94%) and specificity (85 to 88%) was found. This supports the screening use of HEs within a disc diameter of the center of the macula in nonstereo digital images for CSME detection. (p. 370)

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Outdoor Activity and Myopia
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After adjusting for the confounders, our authors found a significant association between outdoor time and children’s spherical equivalent (SE) refractive error in primary school (aged <12 years) Beijing children. However, they did not see this in the secondary students (aged >12 years). Interestingly, they failed to find an association of near work activity with myopic refraction in either the younger or older study groups after adjusting for the children’s gender, the outdoor activity time, and average parental refractive error. (p. 376)

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Hyperopia Greater than 3.25 D Suggests Other Vision Problems in Preschoolers
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In preschoolers (aged 3 to 5 years), what kind of associations do we expect for hyperopic refractive errors greater than 3.25 D with amblyopia, astigmatism, anisometropia, and stereoacuity? As the Vision in Preschoolers Study group shows here, screening tests of refraction perform well in detecting amblyopia and strabismus. And the association between decreased stereoacuity and greater magnitudes of uncorrected hyperopia was shown even among nonstrabismic, nonamblyopic children, perhaps indicating increasing difficulty compensating for accommodative and vergence demands. Because of the increased odds of other vision disorders associated with high hyperopia, preschool vision screenings should refer such children for full eye examinations. (p. 383)

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Astigmatism in Chinese Children Younger than 7 Years
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In a study of the prevalence and type of astigmatism in an undeveloped area in Western China, our authors found a surprising prevalence (almost 13%) of “high astigmatism” (≥1.25 D) in children younger than 7 years. Perhaps less surprising was the fact that, as the age group approached 7 years, the prevalence of high astigmatism dropped to about 8%. (p. 390)

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Reading Speed in 10-Year-Old Hyperopes
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Reading performance can be reduced without reduction in visual acuity. Our authors note that correcting hyperopia in 9- to 10-year-olds increases reading speed but only for meaningful (“genuine”), not nonsense (“nonwords”), words. They deduce that only fast recognition and not decoding of words is impacted by uncorrected hyperopia. (p. 397)

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Peripheral Myopic Defocus: The Basis of Orthokeratology Slowing Myopia?
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The authors’ study reports that subjects with higher relative corneal peripheral power, after orthokeratology lens wear, experienced slower axial length elongation. They note that, as with previous reports, their result is consistent with relative myopic defocus to the peripheral retina slowing myopia progression. More clinically, their result adds support for orthokeratology as a method of controlling myopia progression in children. (p. 404)

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Scleral Reinforcement on Young High Myopes
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A prospective and contralateral eye–controlled study demonstrated effectiveness of posterior scleral reinforcement surgery on 30 young patients with high myopia, but the effect was small. The patients, of mean age 7.5 years and mean spherical equivalent of -9.72 D, had a slower progression of myopia in the operated eyes of 0.7 D compared with the contralateral eyes during the 2.5 years of the study. (p. 412)

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Is Reported PAX6 Gene Really Controlling Myopia?
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Existing genetic association studies provide inconsistent evidence for the role of the PAX6 gene in myopia development. Our authors’ systematic review and meta-analysis of five PAX6 polymorphisms suggested only a weak association of the PAX6 SNP rs644242 with extreme and high myopia. The authors note that because myopia is a polygenic disease, PAX6 probably has only a small effect in myopia development. (p. 419)

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Contour of the Retina from Partial Coherence Interference
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The authors describe a methodology that derives two-dimensional posterior retinal contours using measures of eye length obtained with corrected partial coherence interference biometry. The method accounts for the effect of distortion and differences in indices within the eye using numerical ray tracing. It could be useful in studies to understand the effect of peripheral retinal location on myopia progression. (p. 430)

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Optics of Pseudophakic Eyes Correlates with Vision
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Our authors demonstrate that a double-pass system is clinically relevant to evaluate the optical quality in pseudophakic eyes. They measured optical quality in pseudophakic eyes. For this they used the double-pass systemand measured ocular aberrations with a ray-tracing aberrometer with a monofocal intraocular lens in place. Optical quality was correlated with visual acuity and contrast sensitivity. (p. 437)

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Compromising Astigmatism Can Improve Near Vision in Pseudophakia
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Leaving myopic astigmatism uncorrected has been suggested as a strategy for improving the near vision of pseudophakic eyes with monofocal intraocular lens implants, albeit with an expected loss in distance vision. Using objective image quality metrics analysis, the authors’ study confirmed the benefit of uncorrected astigmatism on near vision of pseudophakic eyes. As noted, this improvement came with a small but significant loss in distance image quality. (p. 444)

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Tear Collection in Primary Health Care Settings?
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In their study, the authors raise the question of whether this is feasible and useful. They concluded that tear collection using Schirmer strips is highly acceptable, and the pain score was lower than antecubital venous puncture but higher than finger prick. Participants preferred Schirmer tear collection to urine and blood collection. They feel that their study has implications for using tear collection as a method of ocular and systemic health screening in the primary health care setting. (p. 452)

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Provocative Test Identifies Relatives with Glaucoma?
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The authors argue that the darkroom prone provocative test is a safe and effective screening tool to determine angle closure glaucoma, or the risk of developing it, among first-degree relatives of primary angle closure glaucoma patients. Testing 74 family members of patients with primary angle closure glaucoma showed that 20% either had angle closure (8%) or were angle-closure suspects (12%). They also had the shallowest anterior chamber depth, thickest lens, shortest axial length, and most anteriorly positioned lenses. (p. 459)

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Vision Correction Reflects Inequalities among Occupational Social Classes in Spain
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Our authors’ cross-sectional study of a large number of individuals (86,831) in Catalonia, Spain, determined types of optical correction for refractive error in a working population. The type and purpose of refractive correction and sociodemographic variables were self-reported, and VA was measured with habitual correction. Almost 50% wore glasses, being more common among women (especially women aged 55 to 64 years). Similarly, individuals in technical, administrative, or intellectual occupations were more likely to wear optical correction than unskilled professionals. Nonmanual workers were three times more likely to be wearing glasses, reflecting inequalities in use between social classes and occupations. (p. 464)

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Should Eye Function Always Be Compared Across Eyes?
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Clinicians astutely use the difference in vision between eyes to detect abnormal vision in one eye. According to our authors, such comparisons between eyes have not been studied for either of the electrophysiological measures of pattern-evoked electroretinogram or pattern-evoked visual cortex response. Using these measurements, there is a surprising lack of correlation between eyes. Because of this finding, they caution that a between-eye difference in either of these electrophysiological measures should be viewed cautiously in trying to infer abnormality in one eye. (p. 472)

Copyright © 2014 American Academy of Optometry

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