Optometry And Vision Science[JOURNAL]
Sun
200 papers
The impact of parental myopia on refractive changes in Chinese children.
Zong C, Xu H, Pu J … +12 more , Zhou Z, Hu J, Bian S, Chen W, Yang Y, Wang D, Mi X, Fang Y, Peng C, Jin M, Zhao B, Jiao Y
Optom Vis Sci · 2026 Feb · PMID 41922923 · Publisher ↗
PURPOSE: To investigate the impact of parental myopia on refractive changes in Chinese young children over a 3-year cohort. METHODS: All data were collected in a prospective cohort study. Comprehensive eye examinations w...
PURPOSE: To investigate the impact of parental myopia on refractive changes in Chinese young children over a 3-year cohort. METHODS: All data were collected in a prospective cohort study. Comprehensive eye examinations were conducted for all participants, including assessments of refraction, ocular biometry, and questionnaires. Parental refractive categories were classified based on both the severity of myopia and the number of myopic parents. A longitudinal analysis was carried out to evaluate the relationship between the children's refractive changes and parental myopia. RESULTS: A total of 931 participants (484 boys and 447 girls) were followed annually over 3 years (mean baseline age: 4.21 ± 0.95 years). At baseline, participants' spherical equivalent refraction (SER) decreased and the prevalence of myopia increased significantly, with greater severity of parental myopia (all p < 0.0001). Over the 3-year observation period, greater severity of parental myopia was associated with lower SER, faster axial elongation, and increased axial length to corneal radius ratio in participating children. Participants with highly myopic mothers had a 12.69-fold higher risk of developing premyopia or myopia (p < 0.0001). Moreover, maternal high myopia had a more pronounced negative effect on the rate of SER decline compared to paternal high myopia (p < 0.05). Additionally, participants with highly myopic parents exhibited lower SER when their outdoor activity time was limited to 2 h or less (all p < 0.05). CONCLUSIONS: Parental high myopia was associated with lower baseline SER, accelerated refractive changes, and higher myopia incidence. Maternal high myopia has a strong influence on SER decline and myopia risk in children. Children with highly myopic parents appear more susceptible to reduced refractive power under similar lifestyle conditions.
Designing a new "turtle" optotype for use with Aboriginal and Torres Strait Islander children.
Hopkins S, Banks E, Bentley SA … +4 more , Black AA, Duthie D, Hawkins A, Wood JM
Optom Vis Sci · 2026 Feb · PMID 41922910 · Publisher ↗
PURPOSE: To evaluate whether luminance-matching of non-target elements (Study 1) and incorporating artwork (Study 2) within the newly designed turtle optotype would impact visual acuity (VA) measures. METHODS: Study 1 ev...
PURPOSE: To evaluate whether luminance-matching of non-target elements (Study 1) and incorporating artwork (Study 2) within the newly designed turtle optotype would impact visual acuity (VA) measures. METHODS: Study 1 evaluated the redesigned four alternative forced choice (4-AFC) turtle optotype to confirm whether luminance-matching of the non-target and target elements was required, through comparing VA with different turtle optotype luminance designs to the Landolt C. Study 2 evaluated whether including artwork in the turtle optotype impacted on VA as compared with the Landolt C chart. RESULTS: In Study 1 (n = 12, mean age = 34.9 ± 5.7 years), there was a significant effect of chart type (p < 0.001), where VA was significantly better in the non-luminance-matched design (M = -0.31 logMAR) compared to either of the luminance-matched designs (M = -0.09 logMAR) and the Landolt C (M = -0.13 logMAR) which were not significantly different from one another (p > 0.4). In Study 2 (n = 14, mean age = 29.1 ± 8.8 years), including the new artwork did not affect VA (p = 0.5); mean VA of the new 4-AFC turtle optotype (M = -0.10 logMAR) was not significantly different to the Landolt C (M = -0.13 logMAR). CONCLUSIONS: Findings confirmed that the optotype target needed to be luminance-matched with non-target elements and that new co-designed artwork could be incorporated without a significant effect on VA. Further work will validate the chart in children.
Measuring visual fields in children with cerebral visual impairment using Baby Vision Screener.
Thakur M, Halder T, Padmanabhan A … +1 more , Satgunam P
Optom Vis Sci · 2026 Feb · PMID 41922300 · Publisher ↗
PURPOSE: This retrospective study was undertaken to (1) determine the feasibility and reliability of Baby Vision Screener (BaViS) and (2) to test and identify visual field defects in children with cerebral visual impairm...
PURPOSE: This retrospective study was undertaken to (1) determine the feasibility and reliability of Baby Vision Screener (BaViS) and (2) to test and identify visual field defects in children with cerebral visual impairment (CVI). METHODS: An in-house developed device, BaViS, was used to test the visual fields. A total of 32 children (mean age: 6.3 ± 3.2 years and range: 11 months to 14 years) with CVI were included after their medical records were reviewed (from June 2021 to October 2023). Kinetic perimetry was done using BaViS in all these children to plot the visual field isopter. Different tools were used for measuring visual acuity and contrast sensitivity as appropriate. RESULTS: Most children (91%, n = 29/32) were testable, and large majority (72%, n = 21/29) had reliable visual field isopters plotted with BaViS. Of the children with reliable visual field results, 38% had visual field defects, either in isolation or with other visual function deficits. Generalized field extent reduction and inferior visual field reduction were the most common visual field defect patterns. 62% of children had visual impairment in more than one visual function domain. CONCLUSIONS: BaViS shows good potential to be used for quantifying visual fields even in younger children with CVI. About two-fifths of the children with CVI in our test cohort showed visual field defects. Measuring visual fields, along with other visual functions, will be important for managing children with CVI.
Optometry & Vision Science in 2025: Year 2 of the 3-year plan.
Elliott DB
Optom Vis Sci · 2026 Jan · PMID 41914393 · Publisher ↗
Abstract loading — click title to view on PubMed.
Invited Review: Tools to quantify environmental and behavioral risk factors for myopia.
Ostrin LA
Optom Vis Sci · 2026 Jan · PMID 41894674 · Publisher ↗
The increasing global prevalence of myopia has prompted increased efforts to identify, quantify, and modify risk factors associated with its onset and progression. Myopia risk factors can be broadly categorized into four...
The increasing global prevalence of myopia has prompted increased efforts to identify, quantify, and modify risk factors associated with its onset and progression. Myopia risk factors can be broadly categorized into four areas: (1) genetics and inheritance, (2) demographics, (3) ocular metrics, and (4) environmental and behavioral influences. Environmental and behavioral factors, including near work, screen time, light exposure, and outdoor activity, are increasingly recognized as modifiable contributors, and therefore, offer promise as prevention strategies. However, inconsistencies across studies regarding their contribution highlight the challenges of subjective data collection and population variability. This review aims to equip researchers, clinicians, and public health professionals with a comprehensive understanding of available tools to quantify myopia risk factors and their applications in research and clinical practice. Traditional and emerging methods for quantifying environmental and behavioral risk factors for myopia are critically evaluated. First, subjective methods, including questionnaires, diaries, and experience sampling, are discussed, and their practical advantages and inherent limitations, such as recall bias and low temporal resolution, are highlighted. Further, objective approaches, enabled by advances in wearable technology, including light sensors, rangefinders, and integrated devices, are explored. The capabilities and constraints of currently available tools, future directions for wearable innovations, and necessary analytical techniques are considered. Improving the precision and standardization of these measurements will enhance the ability of researchers and clinicians to detect myopia risk early, tailor interventions, and develop evidence-based guidelines for myopia control.
Compensated versus uncompensated millimeters during myopia progression: Estimating H' in children.
Holmberg DM, Mutti DO, CLEERE Study Group
Optom Vis Sci · 2026 Jan · PMID 41851068 · Publisher ↗
PURPOSE: The second principal point (H') of the eye can be used to estimate the diopters of change in refractive error that result from each millimeter of axial elongation. Calculating the location of H' requires data fr...
PURPOSE: The second principal point (H') of the eye can be used to estimate the diopters of change in refractive error that result from each millimeter of axial elongation. Calculating the location of H' requires data from phakometry, a technique not included in most myopia control clinical trials. Previous estimates have ranged from 1.602 mm (Gullstrand) to 2.1 mm. The purpose of this analysis is to develop a method for estimating the location of H' in children using more readily available biometric data. METHODS: Children (n = 4913) from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study provided the necessary biometric data to find the location of H'. Crystalline lens power was also estimated using Bennett's method. A generalized linear model was used to create an equation that could estimate the location of H' without phakometry data which was then validated against the CLEERE values. RESULTS: The average (±SD) position of H' in CLEERE children was 1.90 ± 0.15 mm posterior to the cornea. Multivariate modeling resulted in the following equation: (adjusted R = 0.60). The position of H' using this model agreed well with the position calculated using the CLEERE complete set of biometric data, with an average difference (±SD) of 0.003 ± 0.094 mm. CONCLUSIONS: Estimating the location of H' does not require phakometry. The position of H' was intermediate between the classic Gullstrand value and the value previously estimated for children. This method could be used with patients or in clinical trials to gauge the effects and effectiveness of myopia control by estimating the fraction of inhibition of eye elongation that comprises compensated elongation compared to uncompensated elongation, setting targets for slowing eye growth to the point of no net myopia progression.
Using data from both eyes of participants: Evaluating the power and Type-I error rates of common approaches to ocular data analysis via a simulation study.
Ollinger MC, Cisarik PM, Ray MA
Optom Vis Sci · 2026 Jan · PMID 41851051 · Publisher ↗
PURPOSE: The aim of this study is to evaluate and quantify model performance for commonly used statistical approaches when using data from both eyes of participants. These models highlight different methods of accounting...
PURPOSE: The aim of this study is to evaluate and quantify model performance for commonly used statistical approaches when using data from both eyes of participants. These models highlight different methods of accounting for interocular correlation. METHODS: We simulated a continuous outcome variable, a predictor variable measured per-eye (two correlated values per subject - termed bivariate), and a predictor measured once per subject (termed univariate). Both the outcome and the bivariate predictor shared the same correlation level in all simulations. Correlations were varied 0-0.9 in 0.1 steps, with sample sizes of 50, 100, and 150. Two thousand datasets were simulated under each correlation-sample size combination. The datasets were modeled using single-eye, averaged-eye, and assumed-independent two-eye approaches within linear regression, along with a mixed effects model and a generalized estimating equation (GEE). RESULTS: Mixed effects models, modeling one eye per subject, and averaging eyes within subjects all controlled Type-I error at 0.05 across simulated conditions. GEEs slightly inflated Type-I error, especially with smaller sample sizes. Modeling both eyes independently inflated Type-I error as high as 0.194 in high correlation scenarios. This inflation increased with increasing correlation. For univariate predictors, GEEs, mixed effects modeling and averaging eyes within subjects attained similar power across scenarios. Single-eye modeling resulted in lower power, particularly in low correlation scenarios. For bivariate predictors, mixed effects modeling and GEEs yielded greater power than single-eye or averaged-eye modeling across scenarios. CONCLUSIONS: Mixed effects models and GEEs out-perform other approaches when the predictor of interest is bivariate and correlated, assuming correlations are similar for the predictor and outcome. For univariate predictors, averaging the outcome across eyes within each subject performs similarly to mixed effects modeling. Treating correlated measurements as independent (such as when using data from both eyes without averaging or factored into a model) inflates Type-I error rates and yields inappropriately high power, especially as correlation increases; this modeling approach leads to inference errors and should be avoided.
Trends in optometrist burnout in the Veterans Health Administration.
Kim S, Rogers S, Mohr DC
Optom Vis Sci · 2026 Jan · PMID 41848197 · Publisher ↗
PURPOSE: To characterize the burnout trends among Veterans Affairs (VA) optometrists. METHODS: A repeated cross-sectional analysis using individual-level data from the VA All Employee Survey during 2018-2024 and system-l...
PURPOSE: To characterize the burnout trends among Veterans Affairs (VA) optometrists. METHODS: A repeated cross-sectional analysis using individual-level data from the VA All Employee Survey during 2018-2024 and system-level data. Burnout was assessed using two items from the Maslach Burnout Inventory. One item represented emotional exhaustion and asked, 'I feel burned out from my work' and another item represented depersonalization asked, 'I worry this job is hardening me emotionally.' RESULTS: We identified 4574 responses from VA optometrists. Mean burnout rates were 36.9% in 2018 and increased to 47% for 2022-2024. Females and supervisors/managers reported higher rates of burnout. Optometrists between 30 and 39 years of age, those working in medical centers in rural areas, and in regions other than the Northeast US were more likely to report burnout. CONCLUSIONS: The prevalence of burnout reported among VA optometrists is increasing. Interventions are required from an organizational level to target and address burnout among VA optometrists, especially females and those practicing in rural areas. Successful improvement in burnout rates among VA Optometrists could result in improved mental health of optometry providers and improved care to veterans.
Risk factor ranking of retinopathy of prematurity using classification and regression tree analysis.
Gildea N, Wang J, Ploysangam P … +3 more , Hartman O, Hendricks DH, Jin J
Optom Vis Sci · 2026 Jan · PMID 41848196 · Publisher ↗
PURPOSE: Numerous risk factors for ROP have been identified, with gestational age and birth weight being the most established. Ongoing improvements in neonatal care may change the critical thresholds for these factors as...
PURPOSE: Numerous risk factors for ROP have been identified, with gestational age and birth weight being the most established. Ongoing improvements in neonatal care may change the critical thresholds for these factors associated with ROP development. We applied a classification and regression tree (CART) analysis to predict the likelihood of developing ROP using a contemporary database. METHODS: This cross-sectional study included 1296 premature infants who completed ROP screening by pediatric ophthalmologists from a children's hospital. Relevant infant and maternal parameters were obtained from medical records. CART analysis with the recursive partitioning package was used to predict ROP incidence, treatment need, and plus disease. The dataset was randomized, with 80% for training and 20% reserved for testing the model's accuracy. A 10-fold cross-validation was conducted to assess the model's generalizability. RESULTS: The mean gestational age was 27.7 ± 2.5 weeks, and the birth weight was 1017 ± 346.9 g; 538 infants developed ROP. The CART analysis produced a predictive model for ROP incidence with a mean absolute error of 0.25. The critical thresholds identified for ROP development were gestational age <27.2 weeks and birth weight <775 g. Two models for ROP progression showed that age <25 weeks and weight <569 g were linked to the need for ROP treatment, and age <24 weeks and non-Black maternal race were associated with plus disease. CONCLUSIONS: Our CART analysis provides updated clinical thresholds for ROP development and progression in a modern U.S. preterm population. Prospective validation across diverse populations will further enhance the model's utility and generalizability.
Noninvasive brain stimulation of the left frontal eye field alters fixational control but leaves visually guided saccades unchanged.
Sharma A, Upadhyaya S
Optom Vis Sci · 2026 Jan · PMID 41848195 · Publisher ↗
PURPOSE: To investigate the effects of anodal transcranial direct current stimulation (tDCS) over the left frontal eye field (left frontal eye field) on oculomotor functions in visually normal adults, focusing on saccade...
PURPOSE: To investigate the effects of anodal transcranial direct current stimulation (tDCS) over the left frontal eye field (left frontal eye field) on oculomotor functions in visually normal adults, focusing on saccades, fixation stability, vergence stability, stereopsis, and fixational eye movements. METHODS: Nineteen right-handed adults with normal vision participated in a randomized single-blind crossover study involving both sham and anodal tDCS. Stimulation (0 μA for sham, 2000 μA for anodal) was applied for 25 min over the left frontal eye field with 20-s fade-in/out. Eye movements were recorded using the Eyelink 1000plus system at 1000 Hz. Tasks included 15-s fixation on a 0.5° target, visually guided saccades at ±5°, ±10°, ±15°, and a stereopsis test using random dot stereograms. Measurements were taken at baseline, 10, and 30 min post-stimulation. Data were analyzed using general linear model repeated measures analysis and post hoc tests. RESULTS: There were no significant changes in saccadic latency, saccadic gain, or stereopsis across time points for either condition. Fixation stability and vergence stability also showed no substantial difference in both the sham and anodal conditions. However, fixational saccade amplitude significantly increased following anodal stimulation (Pillai's Trace = 0.005, F(1, 18) = 43.84, p < 0.001), corresponding with a significant increase in fixational saccade peak velocity (Pillai's Trace = 0.003, F(1, 18) = 9.70, p = 0.006). Both amplitude and peak velocity significantly decreased after sham stimulation. CONCLUSIONS: Anodal tDCS over the left frontal eye field did not significantly affect gross oculomotor metrics but did modulate fixational saccade dynamics. These findings suggest that miniature eye movements may be more sensitive to neuromodulation than overt saccades, highlighting their potential as biomarkers for cortical excitability. Further research is needed to explore these effects in clinical populations and optimize stimulation protocols for targeted oculomotor modulation.
Does order matter? Evaluating the impact of binocular vision test sequence.
Kang P, Asper L, Chan A … +2 more , Tang A, Watt K
Optom Vis Sci · 2026 Jan · PMID 41848191 · Publisher ↗
PURPOSE: To assess the repeatability of common clinical tests of accommodative and vergence function and evaluate the impact of sequence of testing on outcomes. METHODS: Participants underwent a series of accommodative a...
PURPOSE: To assess the repeatability of common clinical tests of accommodative and vergence function and evaluate the impact of sequence of testing on outcomes. METHODS: Participants underwent a series of accommodative and vergence function tests under associated and dissociated conditions over 3 study visits. At the first study visit, participants were randomized to undergo associated or dissociated tests first. The testing order was reversed at the second visit (to evaluate sequence of testing), and the third visit replicated the order of testing of the first visit (to evaluate intersession repeatability). Associated tests (in order) included binocular modified push-in/out amplitude of accommodation, Fused Cross Cylinder, negative and positive relative accommodation, and binocular ±2.00 D lens flippers to assess accommodation, and Randot Stereo Test to measure local stereoacuity and fixation disparity. Dissociated tests (in order) were monocular modified push-in/out amplitude of accommodation, distance and near phorias measured with the Howell Phoria card and Modified Thorington test to assess vergence function, and monocular ±2.00 D lens flippers to assess accommodation. RESULTS: There were no significant differences in binocular vision function measures when associated or dissociated tests were conducted first (all p < 0.003). Additionally, there were no significant differences in mean measures tested across the first and third study visits where testing sequence remained consistent. Push-in/out methods to measure binocular and monocular accommodative amplitudes, ±2.00 D lens flippers to measure binocular and monocular accommodative facilities, horizontal distance and near phoria measured with the Howell Phoria card, and near phoria with the Modified Thorington test had ICC >0.75 indicating good intersession repeatability. All other tests had ICC <0.75 indicating poor repeatability of repeated measurements. CONCLUSIONS: The sequence of testing of associated and dissociated techniques did not influence outcomes. Additionally, when the testing sequence was kept consistent between the first and third study visits, there were no statistically significant differences in accommodative and vergence function measures obtained with investigated methods. The generally high variability of some measurements across sessions suggests that individual techniques alone may not reliably detect clinically meaningful changes in accommodation or vergence function and a battery of tests is likely needed for monitoring binocular vision disorders.
Modeling the effects of slope of the psychometric function and the lapse rate on QUEST estimates of thresholds for preschool visual acuity measurement.
Suwal R, Hopkins S, Carkeet A
Optom Vis Sci · 2026 Jan · PMID 41848179 · Publisher ↗
PURPOSE: To develop a model investigating the effects of the psychometric function's slope and lapse rate on QUEST visual acuity (VA) thresholds for preschool children. METHODS: Monte Carlo simulations of QUEST (16 trial...
PURPOSE: To develop a model investigating the effects of the psychometric function's slope and lapse rate on QUEST visual acuity (VA) thresholds for preschool children. METHODS: Monte Carlo simulations of QUEST (16 trials) measurements of VA were performed using an underlying ideal observer model for a range of Ideal Thresholds, Slopes, and Lapse Rates for 10- and 4-alternative forced choices (AFC). Ideal Slopes (in probit size) were varied from steep to flat, 0.05 to 0.20 logMAR. Ideal Lapse Rates were varied from 0.01 to 0.50 (at Ideal Probit Size of 0.10 logMAR). Thresholds were estimated using three different techniques: (i) QUEST's maximum likelihood estimate (75% correct), and probit analysis of logMAR value (55% correct) with (ii) fixed-slope probit (probit size = 0.10 logMAR) or (iii) floating-slope probit (probit size = 0.02-0.29 logMAR). An index, Gain-Corrected Standard Deviation, was developed to assess how sensitive a technique was for detecting a change in VA. A smaller Gain-Corrected Standard Deviation indicates a technique is more sensitive to change. RESULTS: Measured VA thresholds from QUEST, floating-slope probit, and fixed-slope probit are linearly related to Ideal Threshold from -0.20 to 0.80 logMAR. Flat slopes and higher lapse rates result in an increased Gain-Corrected Standard Deviation for all threshold measurement techniques (higher when thresholds were estimated with probit fitting than with QUEST Maximum likelihood), with the increase in Gain-Corrected Standard Deviation being slightly higher for 4AFC compared to 10AFC across the range of Ideal Slopes and Lapse Rates. For 4AFC, the Gain-Corrected Standard Deviation range for varied lapse rates (0.01-0.50) was QUEST, 0.062-0.567; floating-slope probit, 0.079-0.623; and fixed-slope probit, 0.079-0.626 logMAR. CONCLUSIONS: QUEST maximum likelihood outputs should be used instead of fitting probit functions in preschool children when there are limited numbers of trials. Flat slopes and high lapse rates can significantly decrease the precision of QUEST estimates of VA in preschool children.
Optimal stimulus demands for objective measurement of monocular accommodative amplitude.
Parks SM, Mitchell GL, Kulp MT … +1 more , Anderson HA
Optom Vis Sci · 2025 Oct · PMID 41838946 · Publisher ↗
SIGNIFICANCE: Accommodative amplitude is commonly measured in the clinical setting using subjective measures that overestimate true accommodative ability. This study identifies optimal near demands for objective measurem...
SIGNIFICANCE: Accommodative amplitude is commonly measured in the clinical setting using subjective measures that overestimate true accommodative ability. This study identifies optimal near demands for objective measurement of amplitude in children and young adults with the goal of developing ways to accurately and efficiently measure amplitude in a clinical setting. PURPOSE: This study aims to determine the optimal physical stimulus demands to objectively measure the accommodative ability of the eye that will elicit maximum accommodative amplitude for the majority of children and young adults. METHODS: 100 participants aged 5 to 24 years underwent monocular measures of accommodation with an open-field autorefractor at 13 stimulus positions (40cm to 3.3cm = 2.5 to 30D) while viewing a 0.9mm "E." The greatest accommodative response was identified as the accommodative amplitude. Quadratic plateau models of accommodative response by demand for four age bins (5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) identified demands or combinations of demands most likely to elicit maximum amplitude. Comparison of accommodative response found by different combinations of demands was made to accommodative amplitude identified by the 13 stimulus position protocol. The locations identified were then applied to two previously published cohorts (n = 143) tested with the same methodology to validate the use of fewer stimulus demands. RESULTS: Stimulus positions 10.5 and 12D combined identified the highest percentage of participants within 1D of true accommodative amplitude; 80% for 5 to 9, 96% for 10 to 14, 96% for 15 to 19, and 92% for 20 to 24. The 5 to 9 year bin had the largest number of participants who were not identified (5), followed by the 20 to 24 bin (2), and the 10 to 14 and 15 to 19 bins (1 each). The average difference from true amplitude for participants not correctly identified was -1.52D (SD = 0.3), -1.24D (SD = 0.1), -1.84D, and -1.23D, respectively. Comparison with two previous cohorts showed good success in the identification of true amplitude within 1D for each age bin using the 10.5 and 12D stimulus positions: 84% for 5 to 9, 88% for 10 to 14, 86% for 15 to 20, and 84% for 21 to 24. CONCLUSIONS: Utilizing accommodative response measures at 10.5 and 12D stimulus demands combined identifies true accommodative amplitude in the majority of individuals from 5 to 24 years old.
Should Optometry & Vision Science be a hybrid or fully open access journal?
Elliott DB
Optom Vis Sci · 2025 Oct · PMID 41838945 · Publisher ↗
Abstract loading — click title to view on PubMed.
Explaining the need for recovery in workers with and without visual impairment.
Daniels R, Khazal D, Twisk J … +2 more , Hoving JL, van Nispen RM
Optom Vis Sci · 2025 Dec · PMID 41342727 · Publisher ↗
SIGNIFICANCE: Fatigue represents a substantial and frequently under-recognized burden for individuals with visual impairment. The need for recovery after work (NFR), a validated concept for occupational fatigue, is routi...
SIGNIFICANCE: Fatigue represents a substantial and frequently under-recognized burden for individuals with visual impairment. The need for recovery after work (NFR), a validated concept for occupational fatigue, is routinely employed to quantify this burden and has been linked to work-related stress and a spectrum of adverse health outcomes. PURPOSE: The aim was to explore the association and potential underlying mechanisms between visual status and NFR for workers with and without visual impairment, that is, whether this association was influenced by person and work-related factors. METHODS: Cross-sectional data on NFR and sociodemographic, work- and health-related factors were obtained with validated questionnaires. Interaction and mediation analysis were used to explore hypothesized relationships and (in)direct pathways contributing to work-related fatigue in a group of workers with (n = 58) and without (n = 189) visual impairment. In addition, predictors for NFR were identified in the subsample with visual impairment workers. RESULTS: Linear regression analysis showed that visual status (β: 23.34, standard error: 4.39, p<0.001) was associated with NFR. Explorative analysis through interaction and mediation analysis revealed that this association was mediated by depressive symptoms and hindrance in daily activities. Depressive symptoms were also the only predictor in the subsample analysis with visual impairment workers (β: 16.91, standard error: 4.99, p=0.001). CONCLUSIONS: This study showed that NFR after work is associated with visual impairment. However, experiencing depressive symptoms and hindrance in daily activities seem to be the underlying mechanisms in this association. Furthermore, depressive symptoms predict NFR in visual impairment. These insights provide us with new possibilities to identify and support workers with visual impairment who are at risk of developing higher NFR.
Heath components of objective accommodative responses for convergence insufficiency participants compared with those with binocularly normal vision.
Fine SN, Rutkowski T, Santos EM … +4 more , Gohel S, Hajebrahimi F, Scheiman M, Alvarez TL
Optom Vis Sci · 2025 Dec · PMID 41252526 · Full text
SIGNIFICANCE: Understanding the deficits in accommodative responses in convergence insufficiency compared with binocularly normal vision participants can guide targeted therapies to improve accommodative function. PURPOS...
SIGNIFICANCE: Understanding the deficits in accommodative responses in convergence insufficiency compared with binocularly normal vision participants can guide targeted therapies to improve accommodative function. PURPOSE: The first objective is to evaluate the Heath components (defined as blur, disparity, and proximal cues that elicit accommodative responses) in convergence insufficiency participants. This is achieved by analyzing objective accommodative responses to step stimuli, assessing the pre-programmed and feedback mechanisms through peak velocity and final amplitude, respectively. The second objective is to compare these pre-programmed and feedback components of the accommodative system between participants with convergence insufficiency and those with normal binocular vision. METHODS: Accommodative responses to isolated and combinatory Heath visual cues were assessed in 28 convergence insufficiency participants and 31 binocular normal vision participants. Blur, disparity, and proximal cues, stimulated in isolation, paired, or all three, lead to seven movement types. The peak velocity and final amplitude of each response were measured for each movement and participant. Comparison among the seven movement response types for the convergence insufficiency group was assessed using one-way analysis of variances. Linear Mixed Models assessed the main interaction of participant type by visual cue effects, and post-hoc tests evaluated pairwise differences. RESULTS: When assessing the Heath components of the convergence insufficiency group, significant differences were observed for peak velocity and final amplitude in focus and defocus responses for the cue combinations (p<0.001). When blur and disparity were stimulated, the final amplitude reached the intended target. When blur or disparity were stimulated, there was a significant reduction in final amplitude and peak velocity compared with responses when blur and disparity were both presented. The proximal-only responses had the slowest peak velocity and reduced final amplitude compared with the other response types. Significant differences were observed in peak velocity and final amplitude for focus and defocus responses between the convergence insufficiency and normal binocular vision groups for certain visual cues (p<0.02). CONCLUSIONS: The accommodative responses of the convergence insufficiency group were more accurate when both blur and disparity were present, compared with other visual stimulus combinations. The convergence insufficiency and binocular normal vision groups were significantly different for the blur and disparity cues.
Corrective surgery improves visual motor and visual perception skills in children with intermittent exotropia.
Yang Y, Lou J, Hou J … +4 more , Tan S, Chang S, Yuan Y, Yu X
Optom Vis Sci · 2025 Nov · PMID 41212121 · Publisher ↗
SIGNIFICANCE: This study reveals that children with intermittent exotropia (IXT) demonstrate subtle but measurable impairments in visual motor and visual perceptual skills. Importantly, strabismus surgery may yield funct...
SIGNIFICANCE: This study reveals that children with intermittent exotropia (IXT) demonstrate subtle but measurable impairments in visual motor and visual perceptual skills. Importantly, strabismus surgery may yield functional gains in these domains, providing clinical insights beyond ocular alignment outcomes. PURPOSE: To assess visual motor and visual perception skills in children with IXT compared with matched controls, and evaluate post-operative changes after surgical intervention. METHODS: Prospective longitudinal case-control study. Visual motor and visual perception were evaluated using the Beery Visual Motor Integration 6th ed. and the Test of Visual Perception Skill, 4th ed. A 1-year post-operative follow-up was conducted for the IXT group. RESULTS: A total of 61 children with basic-type IXT (mean age: 9.6 ± 1.9 years; 38 boys) and 40 age-and sex-matched controls (mean age: 9.6 ± 1.7 years; 23 boys) were included. Among the IXT cohort, 27 underwent strabismus surgery and 34 were observed. One-year follow-up was completed by 22 surgical patients, 18 observation patients, and 28 controls. At baseline, children with IXT scored significantly lower than controls on visual motor integration (106.4 ± 11.9 vs. 112.4 ± 9.4, p=0.01), motor coordination (104.8 ± 10.7 vs. 112.4 ± 9.4, p=0.001), and perceptual subtests including form constancy (109.8 ± 12.0 vs. 115.5 ± 11.4, p=0.01) and visual closure (109.1 ± 11.5 vs. 116.6 ± 10.4, p=0.001). At 1-year follow-up, the surgical group showed significant improvements in visual motor integration (mean change: +8.7, p=0.01), motor coordination (+3.7, p=0.04), and form constancy (+6.5, p=0.04), while no changes were observed in the observation or control groups. Analysis of covariance, using the 1-year change from baseline as the outcome, revealed significant group differences in visual motor integration (p=0.02), visual discrimination (p=0.04), and sequential memory (p=0.002), with the surgical group demonstrating greater improvement in visual motor integration compared with the observation group (p=0.03). CONCLUSIONS: Children with IXT exhibit functional deficits in the visual motor and perceptual domains. Surgical alignment may lead to improvements in select functions beyond ocular correction, supporting its potential role in enhancing visual cognitive development.
Axial length as a function of age, sex, and ethnicity: Results from the CLEERE study.
Mutti DO, Sinnott LT, Cotter SA … +6 more , Jones-Jordan LA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K, CLEERE Study Group
Optom Vis Sci · 2025 Nov · PMID 41129327 · Full text
SIGNIFICANCE: Axial length is emerging as the primary outcome variable used for assessing myopia control efficacy, in both clinic and clinical trials. This report provides a model of axial length as a function of age, se...
SIGNIFICANCE: Axial length is emerging as the primary outcome variable used for assessing myopia control efficacy, in both clinic and clinical trials. This report provides a model of axial length as a function of age, sex, and race/ethnicity, in addition to percentiles of axial length across age in childhood. PURPOSE: To model axial length in juvenile-onset myopia and children in general as a function of age, sex, race/ethnicity, parental history of myopia, diopter-hours of near work, and hours of outdoor/sports activities. METHODS: Axial length from the time of myopia onset was modeled using quadratic fits as a function of age, sex, race/ethnicity, and other covariates. Myopic participants were 590 children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study with at least three annual visits: one without myopia, an onset visit 1 year later (spherical equivalent at least -0.75 D), and another visit after myopia onset. Percentiles for axial length from the entire CLEERE sample were determined using 23,154 observations from 4877 children. RESULTS: Axial elongation in myopic children was greatest at younger ages, slowing with age in a quadratic trajectory between 6 and 14 years. The average rate of elongation at a given age, however, was independent of the age of myopia onset. In the general sample of children, axial length percentiles at age 6 years were similar across racial/ethnic groups, but Asian American children had the steepest increases in axial length with age, followed by Native American and Hispanic children. The shallowest increases occurred in Black and White children. Females had shorter axial lengths than males by 0.4 to 0.5 mm, but a higher probability of being myopic for a given age and axial length percentile. Parental history of myopia, time spent reading, and time spent in outdoor/sports activity were not significant factors for axial length in multivariate models. CONCLUSIONS: The models of axial length as a function of age, sex, and race/ethnicity, along with their percentiles, may prove useful in sample size planning for clinical trials, for judging efficacy of myopia control in individual children, and for comparison to more recent datasets.
Optimizing home-based vision training for convergence insufficiency in young adults using automatic dual rotational Risley prisms: A pilot study.
Chen YY, Chen PT, Huang SY … +1 more , Tsai TH
Optom Vis Sci · 2025 Oct · PMID 41021831 · Publisher ↗
SIGNIFICANCE: Automatic dual rotational Risley prisms are a novel, mobile phone-operated device providing variable prism power for home-based visual therapy. Patients with symptomatic convergence insufficiency may experi...
SIGNIFICANCE: Automatic dual rotational Risley prisms are a novel, mobile phone-operated device providing variable prism power for home-based visual therapy. Patients with symptomatic convergence insufficiency may experience improvements in visual symptoms, near exodeviation, near point of convergence, and positive fusional vergence after this therapy. PURPOSE: To investigate the effects of automatic dual rotational Risley prisms training on symptoms and visual function in individuals with convergence insufficiency. METHODS: Prospective, interventional pilot study enrolling patients aged 19-30 years with convergence insufficiency. Eligibility criteria included a Convergence Insufficiency Symptom Survey (CISS) score ≥21, near point of convergence ≥6 cm, near exodeviation at least 4[INCREMENT] greater than distance, and positive fusional vergence ≤15[INCREMENT]. Participants (n = 14) were divided into visual training (n = 10) and control (n = 4) groups. The training group underwent visual training for 15 minutes/day, 3 times/week, for 12 weeks. Visual function and symptoms were assessed at baseline and during follow-up visits at weeks 4, 6, and 12. RESULTS: Fourteen participants (mean age: 22.9 ± 3.8 years; 64% female) completed the study. After 12 weeks, the training group showed significant improvements in CISS scores (32.9 ± 10.1 to 14.9 ± 12.5, p=0.005), near positive fusional vergence (14.0 ± 7.7[INCREMENT] to 39.0 ± 22.6[INCREMENT], p=0.005), near exodeviation (10.9 ± 4.0[INCREMENT] to 6.4 ± 5.3[INCREMENT], p=0.01), and accommodative convergence/accommodation ratio (3.1 ± 1.6 to 4.7 ± 1.7, p=0.007). Statistically significant improvements were also observed in accommodative facility (right eye: p=0.02; left eye: p=0.008) and vergence facility (p=0.007), while near point of convergence showed a nonsignificant trend (p=0.06). No significant changes were found in the control group. Between-group comparisons from baseline to 12 weeks showed greater improvements in the training group for CISS scores (p=0.02), positive fusional vergence (p=0.004), near exodeviation (p=0.04), and accommodative convergence/accommodation ratio (p=0.02). CONCLUSIONS: Preliminary results suggest that home-based automatic dual rotational Risley prisms training may improve visual symptoms, near exodeviation, near point of convergence, and positive fusional vergence in individuals with convergence insufficiency over 12 weeks. Further studies are needed to assess its long-term effects.
A comparison of head-worn versus handheld artificial intelligence implementations for people with vision loss.
Seiple WH, van der Aa HPA, Garcia-Piña F … +2 more , Greco I, van Nispen R
Optom Vis Sci · 2025 Oct · PMID 41021829 · Publisher ↗
SIGNIFICANCE: The predominantly nonsignificant differences we found between head-worn (ARx) and handheld Seeing AI (artificial intelligence) implementations provide objective evidence to the ongoing debate about the rela...
SIGNIFICANCE: The predominantly nonsignificant differences we found between head-worn (ARx) and handheld Seeing AI (artificial intelligence) implementations provide objective evidence to the ongoing debate about the relative advantages and disadvantages of form. People with vision loss must choose between these implementations based on functional needs and app accessibility, rather than form factor. PURPOSE: To compare the functionality of AI implementations in head-worn devices versus handheld smartphones by objectively quantifying performance, usability, and acceptability when acquiring information from text and in daily activities. METHODS: A cross-sectional, counterbalanced, crossover design was employed to assess performance using Seeing AI in two formats (ARx headset and on a smartphone) and to compare two head-worn formats that utilize different AI algorithms-Seeing AI and Meta AI. Completion and timing were quantified for items in two task categories: Text and Searching & Identifying. Usability was evaluated with the System Usability Scale. Data were compared with a baseline condition with no assistive technology, and performance among AI implementations was assessed. RESULTS: There was no significant difference in the number of participants who completed tasks and timing between head-worn ARx and smartphone-based Seeing AI implementations. A comparison of two AI algorithms (Seeing AI and Meta) in wearable implementations found equivalent gains in performance but significantly faster task completion times for the Meta glasses. The timing advantage of Meta derives from its ability to provide more information about most tasks more quickly, whereas Seeing AI often requires additional prompts to gather sufficient data to complete tasks. The reported acceptability and usability were statistically similar among the three AI implementations. CONCLUSIONS: We found no evidence to demonstrate an advantage in completing tasks using either head-worn (ARx and Meta glasses) or smartphone AI implementations.
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