CLINICAL RELEVANCE: Accurate determination of refractive error is essential for optimal vision correction. However, the necessity of performing cyclo-refraction in adults remains a subject of ongoing debate.. BACKGROUN...CLINICAL RELEVANCE: Accurate determination of refractive error is essential for optimal vision correction. However, the necessity of performing cyclo-refraction in adults remains a subject of ongoing debate.. BACKGROUND: This study aimed to assess the agreement between cycloplegic retinoscopy, non-cycloplegic objective refraction methods (autorefraction and retinoscopy) and subjective refraction, in adults aged 40 to 64 years. METHODS: In this population-based cross-sectional study, a multi-stage sampling technique was employed to select the sample from this population. Measurements of uncorrected distance visual acuity, followed by autorefraction, retinoscopy, subjective refraction, and cycloplegic refraction (using cyclopentolate 1%) were performed for all participants. Cycloplegic refraction obtained through retinoscopy was established as the gold standard. RESULTS: The spherical equivalent (SE) obtained from cycloplegic retinoscopy, non-cycloplegic retinoscopy, non-cycloplegic autorefraction, and subjective refraction were + 0.07 ± 1.07, -0.21 ± 1.03, -0.28 ± 1.09, and -0.24 ± 0.99 D, respectively ( < 0.001). Cycloplegia resulted in a hyperopic shift in the spherical component ( < 0.001), with a reduction in magnitude as age increased. Subjective refraction produced the smallest absolute cylinder values (least negative) compared to all other methods ( < 0.001). In the age group of 40 to 44 years, the prevalence of hyperopia (SE ≥ +0.50 D) detected through cycloplegic retinoscopy was 42%, while the prevalence determined by non-cycloplegic autorefraction, subjective refraction, and non-cycloplegic retinoscopy was 4.9%, 2.2%, and 7.2%, respectively ( < 0.001). The prevalence of myopia (SE ≤ -0.50 D) within the same age group was 44.8%, 41.4%, 33.4%, and 34.9%, respectively ( < 0.001). The disparity in the prevalence of refractive errors identified through various refractive methods diminished progressively with advancing age. CONCLUSION: Cycloplegic refraction is essential for assessing refractive errors, especially in individuals younger than 50 years. Furthermore, subjective refraction in older adults is influenced by numerous confounding variables and should be approached with caution.
CLINICAL RELEVANCE: Visual acuity offers limited value as a clinical endpoint for evaluating functional vision deficits. Alternative measures, such as the assessment of reading efficiency, address how vision-related chal...CLINICAL RELEVANCE: Visual acuity offers limited value as a clinical endpoint for evaluating functional vision deficits. Alternative measures, such as the assessment of reading efficiency, address how vision-related challenges affect quality of life. BACKGROUND: Although oral reading speed is typically employed as the principal measure of reading performance, it fails to simulate everyday reading activities, for which silent reading is preferred. In this study, eye movements were analysed additionally to reading speed, as potentially useful clinical indicators of silent reading performance. METHODS: Silent reading performance was evaluated binocularly in 53 presbyopes (52 ± 4 years old) using the Greek IReST reading passages, displayed at 40 cm distance. Near correction was achieved with reading spectacles worn over single vision contact lenses. A subgroup of 26 participants were tested on a second visit under two conditions: (i) without best-correction for near ('blur') and (ii) following instructions for 'comprehension'. Eye movements were recorded during passage reading using video oculography. Data analysis included computation of reading speed, fixation duration, forward fixations and regressions. Frequency distributions of fixation durations were analysed with ex-Gaussian fittings. RESULTS: The strongest correlate of silent reading speed was the number of forward fixations ( = -0.86), accounting for 74% of its variance, while modest correlations were found with the percentage of regressions ( = -0.57) and the ex-Gaussian parameter τ ( = -0.59). Reading speed was significantly slower in both 'blur' and 'comprehension' conditions ( < 0.001). Comprehensive reading showed an increased number of forward fixations and regressions. Blur had a significant impact on fixation duration, ex-Gaussian parameter μ, and the number of forward fixations. CONCLUSIONS: Oculomotor behaviour during silent passage reading could complement reading speed measures to address the influence of visual (pre-cortical) vs. cognitive factors in the assessment of functional reading performance.
CLINICAL RELEVANCE: Knowledge of reliable cut-off values for screening tests can facilitate early disease identification and referral. BACKGROUND: This study compared the validity of clinical tests used to screen for ker...CLINICAL RELEVANCE: Knowledge of reliable cut-off values for screening tests can facilitate early disease identification and referral. BACKGROUND: This study compared the validity of clinical tests used to screen for keratoconus in high school students. METHODS: In this population-based, prospective, cross-sectional study, multistage cluster sampling was used to select participants who underwent visual acuity assessment, auto-refraction, retinoscopy and corneal topography. Students were classified into three groups: non-keratoconus, keratoconus suspect and keratoconus. RESULTS: A total 3051 students, mean age of 17.4 ± 1.6 years ranged from 13 to 25 years participated in this study. Of the 51 (1.7%) students diagnosed with keratoconus, one-third (31.4%) had a binocular visual acuity of ≤0.2 logMAR. The median visual acuity was worse, the spherical equivalent refractive error was more myopic and the astigmatism was higher in the keratoconus group compared to the non-keratoconus group (all values < 0.05). However, there was a considerable overlap when comparing these parameters between the three groups, making it difficult to establish a reliable cut-off. Asymmetry was a feature of a large proportion of the students with keratoconus. When using scissor reflex on retinoscopy, maximum anterior corneal curvature or astigmatism individually as referral criteria, retinoscopy yielded the highest Youden Index (0.44). However, combining the use of all three parameters where either of them is positive: a scissors reflex or maximum anterior corneal curvature > 46.5 D or astigmatism >2.50 D was the most effective (Youden index 0.46). CONCLUSION: Monocular visual acuity, retinoscopy, keratometry and refraction should be included in keratoconus screening protocols with the inclusion of corneal topography to increase effectiveness. A combined referral criterion of a scissors reflex on retinoscopy or maximum anterior corneal curvature > 46.5 D or astigmatism > 2.50 D is recommended.
CLINICAL RELEVANCE: Nutritional and immune status are emerging as systemic factors that may influence the onset and course of optic nerve disorders. Recognising their potential role in neuro-ophthalmology can enhance pre...CLINICAL RELEVANCE: Nutritional and immune status are emerging as systemic factors that may influence the onset and course of optic nerve disorders. Recognising their potential role in neuro-ophthalmology can enhance preventive strategies and support holistic patient management in clinical practice. BACKGROUND: Non-arteritic anterior ischaemic optic neuropathy (NAION) is a common cause of sudden, painless vision loss in older adults. Although vascular and systemic risk factors such as diabetes mellitus and hypertension are well-documented, emerging evidence suggests that nutritional and immune status may also play a role in its development. METHODS: A retrospective case-control study was conducted involving 50 NAION patients and 50 age-matched ophthalmologically healthy controls. The Prognostic Nutritional Index (PNI) was calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm). Controlling Nutritional Status (CONUT) scores were derived from serum albumin, total cholesterol, and lymphocyte counts. Group differences were assessed using the Mann-Whitney U and Chi-square tests. Logistic regression identified independent predictors of NAION, with significance set at < 0.05. RESULTS: PNI values were significantly lower in NAION patients than in controls (42.32 ± 5.05 vs. 46.87 ± 1.95, < 0.001), while CONUT scores were significantly higher (1.24 ± 1.62 vs. 0.22 ± 0.50, < 0.001). Both PNI (OR = 0.657, 95% CI: 0.531-0.812, < 0.001) and CONUT (OR = 3.102, 95% CI: 1.236-7.789, = 0.009) independently predicted NAION. Diabetes mellitus and hypertension were also more prevalent in the NAION group ( < 0.05). CONCLUSION: PNI and CONUT scores may serve as non-invasive, independent biomarkers for assessing NAION risk. These findings underscore the contribution of systemic nutritional and immune factors to NAION pathogenesis and support their integration into comprehensive patient evaluations. Prospective studies are needed to confirm these results and explore clinical applications.
CLINICAL RELEVANCE: A substantial proportion of mild coronavirus disease 2019 survivors exhibit persistent systemic manifestations despite clinical recovery. Investigating associated vascular biomarkers may provide novel...CLINICAL RELEVANCE: A substantial proportion of mild coronavirus disease 2019 survivors exhibit persistent systemic manifestations despite clinical recovery. Investigating associated vascular biomarkers may provide novel monitoring strategies and elucidate the underlying pathophysiological mechanisms of post-viral sequelae. BACKGROUND: The aim of this work is to assess the diagnostic efficacy of vascular reactivity in the retina and compare it with vascular density in the evaluation of systemic damages. METHODS: This observational cross-sectional study included 42 eyes of 24 patients who recovered from mild coronavirus disease 2019 and 18 healthy control volunteers. Optical coherence tomography angiography was used to assess the retinal vessel density. Vasoreactivity was defined as the change from baseline in vessel density after hyperoxia test. Analysis of covariance compared the ratio of intrasubject vessel density change induced by hyperoxia from baseline between the two groups. Retinal layer-specific and region-specific analyses of vasoreactivity were performed. RESULTS: Vessel density showed no difference between groups. Vasoreactivity of recovered participants was significantly lower than that of controls at the inner retinal level in peripapillary (-0.09 ± 0.04 vs -0.14 ± 0.06, = 0.005) region. Vasoreactivity exhibited strong diagnostic values ( < 0.05) whereas vessel density did not. Vasoreactivity in deep capillary plexus layer was most prominent after hyperoxic stimulation in peripapillary regions. CONCLUSION: The retinal vasoreactivity to hyperoxia is a more reliable indicator of systemic health risks compared to the structural parameters of retinal vessel density. Additionally, retinal vascular reactivity demonstrates spatial heterogeneity regarding region and layer.
CLINICAL RELEVANCE: Refractive errors, including myopia, hyperopia, and astigmatism, are common causes of vision impairment worldwide. In aviation, visual acuity is important for flight safety, as any visual impairment c...CLINICAL RELEVANCE: Refractive errors, including myopia, hyperopia, and astigmatism, are common causes of vision impairment worldwide. In aviation, visual acuity is important for flight safety, as any visual impairment can affect the ability of pilot to perform essential tasks. BACKGROUND: The aim of this work is to investigate the prevalence of refractive errors and the usage of corrective tools among civil aviation pilots and students. METHODS: A total of 2069 participants (596 aviation students and 1473 pilots) aged 18-65 were examined during their periodic medical assessments between February 2023 and February 2025. Visual acuity was assessed using Snellen charts, and keratometric measurements were obtained using an auto-refractometer. Corrective tool usage, including spectacles and contact lenses, was recorded. RESULTS: The study found that 37.3% of participants were myopic, 50.3% were emmetropic, and 12.4% were hypermetropic. Myopia was more common in students (46.5%) compared to pilots (33.6%). In total, 43% of participants required corrective tools for distance vision, with a higher proportion of students (48.2%) using corrective tools compared to pilots (40.9%). Among those requiring corrective tools, 91.2% preferred spectacles, while 8.8% preferred contact lenses. A significant gender difference was noted in corrective tool preferences, with men more likely to use spectacles. Additionally, 41.9% of pilots aged 40-65 required near-vision correction due to presbyopia. CONCLUSION: This study highlights the importance of visual health management in aviation. The higher prevalence of myopia in aviation students and the increased need for near-vision correction in older pilots underscore the necessity for proactive visual health monitoring. Early screening and appropriate corrective measures, particularly for students, are essential for ensuring flight safety. The findings also suggest the need for tailored vision care strategies in the aviation sector to address age- and gender-specific differences in visual health.
CLINICAL RELEVANCE: Preventable visual impairment and blindness represent significant global public health challenges. Expanding access to high-volume eye care services in underserved areas may reduce visual impairment a...CLINICAL RELEVANCE: Preventable visual impairment and blindness represent significant global public health challenges. Expanding access to high-volume eye care services in underserved areas may reduce visual impairment and blindness. BACKGROUND: Visual impairment negatively impacts quality of life, education, and employability, but is often treatable with management following a basic eye examination. Access to basic eyecare in Zambia is limited. Vision Action, a UK-based non-governmental organisation, facilitates eyecare services in Zambia to reduce rectifiable visual impairment by supporting government outreach clinics in underserved communities. This study examines the frequency of presenting visual impairment, uncorrected refractive error, and ocular pathology among outreach clinic attendees in Zambia. METHODS: A retrospective analysis of outreach clinic records between 2012 and 2015 was performed. The available data include patient demographics, presenting symptoms, presenting level of vision, and classification of any ocular pathology present. Levels of visual impairment were categorised according to the World Health Organization's classification for blindness and visual impairment. RESULTS: Data from 5809 patients were collected (58.5% female, mean age = 41.9 years, SD = 20.7 years). Presenting vision, in the better eye, was classified as 'moderate visual impairment' in 14.2% ( = 766), 'severe visual impairment' in 0.3% ( = 15) and 'blind' in 4.3% ( = 234) of individuals. Uncorrected refractive error was responsible for 62.4% and 57.0% of blindness and severe visual impairment, respectively. Cataract, corneal scarring, and glaucoma were the most common non-refractive ocular pathologies associated with visual impairment. CONCLUSION: Uncorrected refractive error is the leading cause of blindness and visual impairment in patients presenting to outreach clinics in Zambia and is particularly significant in a predominantly working-age population. Outreach clinics are an effective method of detecting and treating correctable visual impairment in this population. However, there is a need to expand and enhance primary eyecare services to reduce the burden of visual impairment, through management of uncorrected refractive error.
Glaucoma is a common blinding eye disease characterised by chronic and progressive degeneration of the optic nerve. Recent studies have increasingly shown that the pathological process of glaucoma involves not only tradi...Glaucoma is a common blinding eye disease characterised by chronic and progressive degeneration of the optic nerve. Recent studies have increasingly shown that the pathological process of glaucoma involves not only traditional factors such as elevated intraocular pressure (IOP) but also significant changes in the immune microenvironment surrounding the optic nerve. Immune cells within this microenvironment, including macrophages, microglia, and T cells, play crucial roles in the pathogenesis of glaucoma. The activation and infiltration of these immune cells, along with the accompanying neuroinflammatory responses, may exacerbate damage to retinal ganglion cells (RGC) through the release of pro-inflammatory cytokines and chemokines. The dysregulation of these immune factors not only promotes RGC apoptosis but also affects the outflow pathways of aqueous humour, leading to further elevation of IOP. This review summarises recent advances in the study of the immune microenvironment in glaucoma, explores its role in the disease pathogenesis, analyzes the immune regulatory networks associated with glaucoma, and discusses potential therapeutic strategies based on immune modulation. These studies offer new insights into the complex pathological mechanisms of glaucoma and provide novel targets for future treatments.
CLINICAL RELEVANCE: The goal of low vision rehabilitation is to help patients make the most of their remaining vision with the use of low vision devices so they can lead independent lives. Vision rehabilitation is an eff...CLINICAL RELEVANCE: The goal of low vision rehabilitation is to help patients make the most of their remaining vision with the use of low vision devices so they can lead independent lives. Vision rehabilitation is an efficient way to improve the remaining vision of people with low vision due to retinitis pigmentosa. BACKGROUND: Retinitis pigmentosa is a common inherited retinal disease causing vision impairment and blindness. This study aimed to investigate the role of low-vision devices in managing low vision associated with retinitis pigmentosa. METHODS: This retrospective cross-sectional study included 50 consecutive retinitis pigmentosa cases assessed for low vision rehabilitation in a tertiary care hospital between January 2022 and June 2024. Each participant underwent a thorough ocular examination, including history, visual acuity assessment, and evaluation for low vision devices (LVDs). The paired samples T-test, with a significance level of < 0.05, was used to look for statistical differences between visual acuity before and after the provision of LVDs. RESULTS: Of the 50 participants, 68% ( = 34) were male. The mean age was 26.10 (±12.96) years. At the time of presentation, the mean visual acuity of the better-seeing eye was 1.04 ± 0.46 (range: 0.10 to 1.60) log MAR for distance and 3.60 ± 2.46 (1.00-12.00) M for near. There was a significant improvement of 0.27 ± 0.25 logMAR in the mean best corrected visual acuity after careful refraction ( < 0.001). The mean visual acuity was improved to 0.77 ± 0.46 logMAR for distance 1.46 ± 1.25 M for near with LVDs. Monocular telescopes were the most common LVDs for distance vision, and Fonda glasses (high plus up to + 10.00D with base-in prisms) for near vision. Fifteen (30%) of participants needed more than one type of LVD for different tasks. CONCLUSION: The use of low vision devices can enhance the functional independence of people with low vision associated with retinitis pigmentosa by maximising residual vision according to their specific needs.
Children who struggle with learning to read, and those who experience reading discomfort, are faced with varied and conflicting opinions regarding appropriate interventions. They commonly present to eye care practitioner...Children who struggle with learning to read, and those who experience reading discomfort, are faced with varied and conflicting opinions regarding appropriate interventions. They commonly present to eye care practitioners for an examination and advice, often after a referral from school. Eye care practitioners have a responsibility to understand and to convey the current state of evidence about any proposed treatment plan to affected individuals who find themselves vulnerable due to a lack of expertise. Non-beneficial therapies for reading difficulty and discomfort may contribute to the delay of appropriate interventions, a critical issue for children learning to read, and one which may have health, economic and educational implications. This perspective and review examines the historical context, proposed causal theories, and current state of the evidence regarding the use of coloured filters for children with reading difficulties, and people of all ages with reading discomfort, and concludes that such use cannot be recommended or promoted based on literature published to date.
CLINICAL RELEVANCE: A variety of training opportunities is key to ensuring optometry graduates are competent to practice optometry at its fullest scope. It is therefore important to understand how the geographic location...CLINICAL RELEVANCE: A variety of training opportunities is key to ensuring optometry graduates are competent to practice optometry at its fullest scope. It is therefore important to understand how the geographic location of placements contributes to the volume and diversity of clinical experience gained by students. BACKGROUND: Research suggests optometry students and rural-based supervisors believe that rural placements offer students exposure to a wider variety of clinical experiences compared with metropolitan placements. However, to date there has been no formal analysis of whether students on rural placement gain a more diverse experience. This study aimed to compare the clinical experience gained by optometry students on rural versus metropolitan placement. METHODS: Clinical experiences recorded in student electronic logbooks from 203 Deakin University optometry students undertaking a 26-week clinical placement were analysed. Differences between the numbers of patients seen, skills performed, and ocular conditions managed by students were compared by geographic location. RESULTS: Students experienced 12.2% more patient encounters on a rural placement than on metropolitan placement (mean ± SD, 341 ± 123 vs 304 ± 109, < 0.002). On average, during rural placement, students encountered 49.6% more patients presenting with sore eyes (56.1 ± 37.5 vs 37.5 ± 24.6, < 0.001) and 61.0% more instances of urgent, potentially sight-threatening eye conditions (8.5 ± 6.4 vs 5.9 ± 4.9, < 0.001). Students on metropolitan placement encountered 33.2% more patients presenting for reasons related to contact lenses (26.1 ± 14.7 vs 19.6 ± 11.2, < 0.001). CONCLUSION: Students encountered a greater total count of conditions on rural placement than metropolitan placements. However, there were some opportunities metropolitan placements offered which were limited on rural placements. It is important students are exposed to practice in both rural and metropolitan locations to ensure a breadth of clinical experience is encountered.
CLINICAL RELEVANCE: Binocular vision anomalies are common in individuals with keratoconus (KC) corneas and can significantly impact visual function, comfort, and quality of life. Understanding how ocular conditions influ...CLINICAL RELEVANCE: Binocular vision anomalies are common in individuals with keratoconus (KC) corneas and can significantly impact visual function, comfort, and quality of life. Understanding how ocular conditions influence accommodative and vergence parameters is essential for accurate assessment and effective management, especially in patients requiring speciality contact lenses such as scleral lenses (SL) for visual rehabilitation. BACKGROUND: The aim of this work is to evaluate the changes in binocular vision parameters in eyes with KC wearing SLs. METHODS: Binocular vision parameters (accommodative and vergence) were assessed at baseline, after 6 h and 1 month of SL wear in 16 KC participants. Convergence insufficiency symptom survey (CISS) was employed to assess binocular vision disorder-related symptoms. RESULTS: A statistically significant improvement in visual acuity was observed after 6 h and 1 month of SL wear ( < 0.05). Stereopsis showed a significant improvement after 6 h ( = 0.002) and 1 month ( = 0.001) of SL wear compared to baseline. Near point of convergence break showed significant improvement after 1 month ( = 0.002) when compared to baseline and between 6 h and 1 month ( = 0.003) SL wear. Near point of convergence recovery showed significant improvement after 1 month of SL wear ( = 0.005). Positive fusional vergence improved at distance recovery ( = 0.01) and near break and recovery ( = 0.03, = 0.01) after 6 h and 1 month of SL wear. Vergence facility at near improved significantly after 6 h and 1 month of SL wear compared to baseline ( < 0.001). Statistically significant improvement was observed for the binocular amplitude of accommodation ( = 0.009) and negative relative accommodation ( = 0.003) after 1-month SL wear. Binocular accommodative facility also showed significant improvement after 6 h ( = 0.009) and 1 month ( = 0.003) of SL wear. CISS scores significantly improved after 1 month of SL wear ( < 0.001). CONCLUSION: SLs effectively enhance vision, help maintain proper eye alignment, improve binocular function, and reduce asthenopia symptoms in KC patients. Comprehensive orthoptic examinations are crucial for addressing these issues in KC.