Background:The rise of digital technologies has enabled vision testing via applications on phones, tablets, and computers, allowing assessments beyond clinical settings. While these tools empower parents to test their children's vision at home, little is known about the attitudes of parents in the United Kingdom (UK) toward this approach. This study examines parents perceived benefits and challenges of conducting vision tests for young children at home, either independently or with the help of a qualified clinician. Research aim:This qualitative study explores parents' perspectives on at-home remote vision testing in a paediatric population. Methodology:Data was collected via two online focus groups with parents of children aged 4-8 years old. Sessions were recorded, transcribed, and thematically coded to identify key patterns and themes. Results:Five key themes emerged: navigating trust in remote vision testing, impact of child demographics, desire for professional support, digital enablers and barriers, and appointment frequency influences desire for remote testing. Parents emphasised the need for training in remote vision testing to build confidence and skill. Potential benefits included reduced travel, time off work/school, and greater flexibility. Concerns around test accuracy, occlusion, and application use highlight the need for clear guidance and virtual supervision by professionals. Conclusion:Remote vision testing could be a reliable alternative to clinic visits, provided parents receive adequate training and support. Participants expressed concerns about the reliability of remote vision testing, particularly for younger or less cooperative children, but acknowledged benefits such as reduced travel, lower costs, and greater flexibility. While app-based testing was appealing, most preferred professional involvement, either in person or virtually, to ensure accuracy, reassurance, and follow-up support.
Background:Convergence insufficiency (CI) is a binocular vision disorder that has been linked to increasing visual demands of near tasks. As young adults routinely perform many near-work tasks, often with digital devices, this study evaluated the frequency of CI among young adults in a university population. Method:In this cross-sectional study, young adults aged 18-25 years were recruited using convenience sampling. Participants were excluded if they had any ocular pathology, clinically significant anisometropia, strabismus, accommodation insufficiency, reduced visual acuity and history of ocular conditions and vision therapy. Cover test, positive fusional vergence (PFV) and near point of convergence (NPC) were performed. The clinical diagnosis of CI was based on the CI and Reading Study group criteria. Data were analysed using descriptive and inferential statistics. Results:The mean age of the sample (n = 192) was 21.1 ± 2.0 and consisted of more females (n = 106, 55%). Overall, 151 (79%) participants did not have CI while 41 (21%) had CI. In participants with CI, low suspect CI was most common (n = 26, 63%) followed by high suspect CI (n = 10, 24%) and definite CI (n = 5, 12%). Participants with CI had significantly higher NPC break and recovery values, larger exophoria measurements at distance and near and lower PFV break and recovery values (p < 0.001). Conclusion:The findings show that CI was present in 21% of young adults in this university population. The test results, for NPC, prism cover test and PFV, in individuals with CI were significantly different from the test results in individuals without CI.
Aim:To assess the change in accommodative response between electronic devices and hardcopy text after prolonged reading. Method:There were 30 participants (N = 30), with a mean age of 24.29 ± 5.21 years. The accommodative response (lag or lead of accommodation, amplitude of accommodation, and accommodative facility) was measured before and after reading for 60 minutes from a printed book, a smartphone, and a laptop, with a 24-hour break between tasks. Secondary outcomes included comparisons of accommodative responses between hardcopy text and smartphone, smartphone and laptop, and laptop and hardcopy text. Results:Accommodative lag was initially 0.50 ± 0.00 D, with significant increases observed after 60 minutes of reading from a smartphone (1.25 ± 0.50 D), a laptop (1.75 ± 0.50 D), and a hardcopy text (1.50 ± 0.25 D). A greater lag was noted with laptop use compared to smartphone reading (P < 0.01). Accommodative facility was significantly reduced when reading from a laptop compared to both a smartphone (P < 0.01) and a hardcopy (P < 0.01). The binocular mean amplitude of accommodation was -7.50 ± 1.25 D with the laptop and -8.00 ± 1.00 D with the hardcopy, with a P-value of 0.085, indicating no statistically significant difference. Conclusion:Prolonged near work significantly affects accommodative function, with laptops inducing the greatest accommodative lag and reduction in facility. Hardcopy reading preserved accommodative facility better than digital devices, while amplitude of accommodation showed minimal change. These results suggest that sustained laptop use may lead to greater visual strain compared to smartphones or printed text.
Purpose: Association of asthenopia with multiple professions involving prolonged near work is well-established but asthenopia is under-reported in postgraduate surgical trainees. The purpose of this study was to determine the prevalence of asthenopia in surgical trainees and determine the associated risk factors. Methods: This study was an institute-based observational study, conducted between July 2024 and September 2024. Out of 107 surgical trainees, 102 responded to a structured asthenopia questionnaire. Detailed ophthalmic evaluation was performed in 43 trainees who consented and presented voluntarily. Visual acuity (Snellen), cover test (near and distance), positive (PFV) and negative fusional vergence (using a prism bar at near and distance), stereoacuity (Randot), near point of convergence, near point of accommodation and accommodative amplitude (using the Royal Air Force rule) were measured. Statistical analysis was performed using SPSS 22. Results: The prevalence of asthenopia was found to be 67.6%. The highest prevalence was found in Ophthalmology trainees. Out of 43 who presented for orthoptic assessment, 11 were advised to pursue refractive correction. PFV near was significantly lower in trainees with asthenopia (mean = 10.1 PD) compared to those without asthenopia (mean = 15.1), p = 0.03. Conclusion: Asthenopia among surgical trainees was high. The visual precision needed for surgical procedures, lack of sleep and the extensive academic curriculum may contribute to asthenopia in surgical trainees. Routine ophthalmic and orthoptic testing may help alleviate symptoms.
Aim: Progressive supranuclear palsy (PSP) is an atypical Parkinsonian disorder which, like other atypical Parkinsonian disorders, displays neurological motor and oculomotor signs at different stages along the disease course. The overlap in presenting signs between the disorders presents a diagnostic challenge for the clinician, particularly early on. Here we audit the role of orthoptic oculomotor and eye-tracker assessment for atypical Parkinsonian patients. Method: A retrospective analysis was conducted for 26 patients with atypical Parkinsonian signs, referred to orthoptics for oculomotor assessment. Orthoptic diagnoses were made after reviewing oculomotor range, doll’s head manoeuvre, saccadic velocity, vergence, eyelid signs and fixation results. The orthoptic diagnoses were compared with the final neurology/neurosurgery diagnosis for consistency. Results: Of the 19/26 cases who were diagnosed with ‘suspected PSP’ after orthoptic assessment, 14/19 (73.68%) had a final diagnosis of ‘suspected PSP’ by neurology/neurosurgery. In 5/19 cases (26.32%) the patients demonstrated PSP-like signs in orthoptics but later received alternative diagnoses. The orthoptic diagnosis was consistent with the final neurology/neurosurgery diagnosis for ‘suspected non-PSP’ in all seven cases. Conclusion: Suspected diagnoses after orthoptic assessment were consistent with the final neurology/neurosurgery department diagnoses in 80.77% of patients. We conclude that early orthoptic oculomotor and eye tracker assessment of atypical Parkinsonian patients is clinically effective for ruling PSP in or out of the clinical picture.
Aim:To determine the role of different levels of illumination on various binocular vision parameters. Settings and design:An experimental study was conducted from October 2024-June 2025. Methods:Thirty-four participants aged between 17 to 25 years with a mean age of 19.7 ± 2.4 years were included. Under different lighting conditions, i.e., low illumination (50 lux), medium illumination (100 lux), and high illumination (150 lux), the participants were instructed to perform reading tasks. The vergence and accommodative parameters for near were evaluated. Results:Observed changes in binocular vision parameters were associated with varying illumination levels. At 50 lux, the binocular accommodative facility (BAF) was 6.97 ± 0.86 cpm; at 150 lux, it was 10.55 ± 1.04 cpm. Higher illumination significantly enhanced vergence facility (VF), near point of accommodation (NPA), and near point of convergence (NPC). Brighter illumination enhanced both positive and negative fusional vergence (PFV and NFV) values, while MEM retinoscopy demonstrated decrease of accommodative lag. Conclusions:Binocular vision parameters were higher significantly with high illumination which can enhance visual performance. Proper lighting is essential for eye exams, digital device use, and workspace design.
Purpose: The phenomenon of chromostereopsis, where colours are perceived at different depths due to the eye’s optics, creates a potential conflict during accommodation. This prospective, cross-sectional study aimed to investigate the effect of different chromostereoscopic stimuli on the objective accommodative response and subjective user comfort. Methods: Thirty young, healthy adults (mean age 19.83 ± 1.18 years) read text passages presented on an iPad at a 50 cm viewing distance. Stimuli included red, green, blue, yellow, and mixed-colour text on a black background, compared to a standard black-on-white baseline. Accommodative lag was measured objectively using an open-field autorefractor, while subjective ratings of perceived depth and screen readability were collected via questionnaire. Results: A significant main effect of stimulus colour on accommodative lag was found (p < .001). The short-wavelength (blue) stimulus induced the greatest mean accommodative lag (0.61 D). Conversely, the long-wavelength (red) stimulus produced the smallest lag (0.18 D), indicating the most accurate accommodative focus. Subjective data strongly corroborated these findings, with blue being perceived as most distant and most difficult to read (76.67% and 73.33% of participants, respectively), while red was perceived as closest and yellow was perceived as the easiest to read (53.33%). Conclusion: Colour is a critical factor in visual ergonomics for dark-themed interfaces. A pure blue stimulus on a black background acts as a poor driver for accommodation, leading to significant focusing errors and a diminished perceptual experience. These findings provide a physiological basis for user interface design guidelines, suggesting that the use of short-wavelength, saturated text for reading tasks should be avoided to optimize visual comfort and performance.
Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a neurological, autoimmune, demyelinating disorder. Clinical phenotypes differ between adults and children, and MOGAD is more commonly observed in the paediatric population compared to the adult population. Cases of isolated cranial nerve palsies as initial clinical phenotypes of MOGAD are rarely reported in the literature. Here, we report a child who presented with an isolated left sixth cranial nerve palsy as the initial sign of anti-myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). Method: In this case study, we report on a three-year-old female known to the orthoptic and paediatric ophthalmology services due to an intermittent exotropia. The same child later develops an acute convergent deviation of the left eye preceded by a viral illness with no other systemic symptoms. This case reports on the clinical findings and treatment over a five-year period. Results: Immunological investigations revealed positive oligoclonal bands in CSF but negative in serum. Serology was positive for MOG antibodies. Magnetic Resonance Imaging (MRI) showed acute demyelination in the pons and cerebellum with accompanying lesions in cerebral white matter bilaterally and incidental band heterotropia. The symptomatic lesion was found to be a small plaque in the left lower pons in the intrinsic course of the left sixth cranial nerve, suggestive of acute demyelination. The patient completed a five-day course of intravenous methylprednisolone 30 mg/kg daily, followed by a reducing course of oral prednisolone. Follow up discussion: Although brain stem involvement in MOGAD is common, isolated cranial palsies are rare and are not commonly reported as presenting symptoms in children (Barr et al., 2000). Patients with MOG positive antibodies have relatively favourable outcomes. Here, we highlight the importance of considering MOGAD in the differential diagnosis of isolated cranial nerve palsies, particularly in the paediatric population.
Introduction:Cerebral visual impairment (CVI) is an umbrella term that describes a broad range of brain related visual problems and it is now the most common cause of visual impairment (VI) in children in the developed world. Early assessment, management and support are essential to minimise the risk of lifelong negative consequences. Currently there are no internationally agreed clinical guidelines for the investigation and diagnosis of CVI, with variation in existing models of care resulting in potential service health inequities for this population. Objective:The objective of this scoping review is to identify and describe the components of existing service delivery models of care in relation to the detection, care, and management of children with CVI. Methods:We will search multiple databases to include MEDLINE, CINAHL, Embase, APA PsycINFO, and The Cochrane Library for English language publications from OECD countries. Supplementary searches will also be conducted to locate grey literature. We will include any study that describes or assesses service delivery for children (0-17 years) with CVI in health and social care, and education settings. Stakeholder engagement:We consulted with a broad range of stakeholders including subject experts and patient and public representatives during the planning and will continue during the conduct, reporting and dissemination of this scoping review.
Aim:This work summarises research on the convergence accommodation to convergence (CA/C) ratio, including the methods used to measure it in both laboratory and clinical settings. It explores the role of the CA/C ratio in the diagnosis and treatment of binocular and accommodative dysfunctions, considers its potential association with myopia, discusses age-related differences, examines its relationship with the accommodative convergence to accommodation (AC/A) ratio and reviews established normative values. Methods:A literature-based narrative review was carried out on the CA/C ratio and/or convergence accommodation, vergence accommodation and vergence interaction. Results:Research to date indicates that the CA/C plays an important physiological role in binocular vision, as well as in binocular and accommodative dysfunctions. It declines with age, does not appear to be related to the onset of myopia, and has a normative value (for adults) of 0.08 ± 0.02 D/Δ, 95% confidence interval (CI) of (0.07, 0.08). Conclusions:This literature review highlights the complexity of measuring the CA/C ratio, its potential value in visual assessment and its relevance to binocular and accommodative dysfunctions. Although it is not commonly measured in clinical practice, current evidence suggests that the CA/C ratio plays an important role in visual diagnosis and management. To support its clinical integration, future research should focus on developing standardised protocols for its evaluation.
Background:Cycloplegic agents are essential for paediatric refraction examinations due to strong accommodative power in children. Accurate cycloplegia is crucial to avoid misdiagnosis of refractive errors such as latent hyperopia or pseudomyopia. Prior studies indicate that dark irises may require higher doses and exhibit a prolonged onset compared to lighter irises. Given that most Indonesians have brown irises, a comparative study of cycloplegic agents is necessary to optimise clinical application. Methods:This randomised, double-blind, controlled non-inferiority trial compared the residual accommodation amplitude (AA) following two drops of 1% Tropicamide (TRP1%) or 1% Cyclopentolate (CYC1%), administered 5 min apart. Each participant underwent both regimens in separate sessions one week apart. AA was measured using the NIDEK ARK-1s autorefractor, and side effects were assessed through interviews. Results:Seventy children (median age: 11 [9-12] years) participated. Both eyes were analysed separately. The eyes analysed were mostly myopic (70%) and emmetropic (26.43%). AA analysis showed no significant differences between TRP1% and CYC1% at 20, 30, and 40 min post-administration (p > 0.05), with maximum cycloplegic effect achieved before 20 min. Side effects were significantly higher with CYC1% than TRP1% (53.33% vs. 23.33%, p < 0.001). Conclusion:Tropicamide 1% is non-inferior to cyclopentolate 1% for cycloplegia in Indonesian children with brown irises. Given its comparable efficacy and lower incidence of side effects, Tropicamide 1% may serve as a safer alternative for paediatric cycloplegic refraction. Further studies with larger samples are warranted to refine dosing strategies and enhance clinical outcomes.
Objectives:To assess the prevalence of symptoms of depression and anxiety, as well as associated factors in myopes. Methods:Relevant studies were sourced from PubMed, Scopus, and Web of Science. A meta-analysis was conducted to determine the prevalence of symptoms of depression and anxiety in myopes. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were used to compare psychological symptoms between myopic and emmetropic groups. Results:A total of six studies assessing the symptoms of depression and anxiety in myopes were included. Prevalence of symptoms of depression and anxiety in myopes are 22.99% (95% CI 16.81% to 30.61%; I 2 = 96.6%) and 26.81% (95% CI 15.62% to 42.01%; I 2 = 98.4%), respectively. Myopes are approximately 46% more likely to suffer from symptoms of depression [OR: 1.46 (95% CI 0.98 to 2.19), I 2 = 72.4%] and are 65% more likely to suffer from symptoms of anxiety [OR: 1.65 (95% CI 1.10 to 2.49), I 2 = 70.4%], as compared to emmetropes. Myopes aged less than 40 years are about 12% more likely to suffer from symptoms of depression [OR: 1.12 (95% CI 0.83 to 1.50), I 2 = 1.5%] and 26% more likely to suffer from symptoms of anxiety [OR: 1.26 (95% CI 1.11 to 1.43), I 2 = 72.5%] than age-matched emmetropes. Myopes aged 40 years and older are almost twice as likely to suffer from symptoms of depression than age-matched emmetropes [OR: 2.02 (95% CI 1.61 to 2.51), I 2 = 0.0%]. Conclusion:Integrated eye care approaches are advocated for and should consider the psychological impact of visual impairment. As myopia prevalence rises globally, understanding and mitigating its mental health effects will be crucial for public health.
Introduction:Vision problems are common in patients with acquired brain injury (ABI). Inpatient eye care is ad hoc in the UK, and once patients with ABI are discharged from hospital care, community eye care provision is typically non-standardised and frequently leads to substantial unmet needs and health inequalities for patients. Objective:The objective of this scoping review is to identify and describe the components of existing service delivery models of care in relation to the detection, care and management of visual impairment for adults and children with ABI. This is a protocol; no results will be published in this manuscript. Methods:We will search multiple databases to include MEDLINE, CINAHL, Embase, APA PsycINFO and The Cochrane Library for English language publications from the Organisation for Economic Co-operation and Development (OECD) countries. Supplementary searches will also be conducted to locate grey literature. We will include any study that describes or assesses service delivery for adults and children with visual impairment following ABI in health and social care and education settings. Stakeholder Engagement:We consulted with a broad range of stakeholders, including subject experts from health and education sectors and patient and public representatives during the planning, and will continue the same during the conduct, reporting and dissemination of this scoping review.
Introduction:Stereopsis is the ability to perceive depth through binocular vision. Artificial lighting conditions play a significant role in visual performance, yet their specific effects on stereopsis remain poorly understood. This study aimed to investigate the effect of different light sources on stereopsis. Methodology:Forty young adults with normal binocular vision and stereoacuity better than 40 arcseconds were included. Participants were exposed to four lighting conditions [light-emitting diode (LED), incandescent, sodium vapour, and compact fluorescent lamp (CFL)] with illumination levels set at 400 lux. Stereoacuity was measured using the Randot stereo test under these lighting conditions, with the order of exposure randomised for each participant. Results:The median stereopsis values for CFL and LED lighting were 25 arcseconds, while those for incandescent and sodium vapour lamps were 30 arcseconds. Stereoacuity was significantly worse under sodium vapour and incandescent lighting compared to CFL and LED conditions (p < 0.05). However, the stereopsis values for CFL and LED did not significantly differ from the baseline (p > 0.05). No significant differences were found between the sodium vapour and incandescent lamps (p > 0.05), nor between the CFL and LED lamps (p > 0.05). Conclusion:Sodium vapour and incandescent lighting conditions significantly impair stereopsis, while CFL and LED lighting conditions do not adversely affect stereopsis.
Background:Isolated inferior rectus weakness (IRW) has historically been reported as a possible presenting sign of myasthenia gravis (MG). Orthoptists often identify IRW, prompting further investigations. This service evaluation aims to determine whether patients with IRW or other symptoms were subsequently diagnosed with MG. Methods:A retrospective review of patient case notes was conducted. The cohort included consecutive patients who presented to the adult strabismus service and received acetylcholine receptor antibody (ACR) testing between 2010 and 2023 at a tertiary referral centre in Sheffield. Results:Sixty-two patients were included in the analysis. Patients were grouped based on isolated IRW, suspicion of thyroid eye disease, or the presence of MG characteristics. These characteristics included variable diplopia, ocular motility and ptosis; fatigue on elevation; Cogan's lid twitch; MG-like fatigue; and breathing or swallowing difficulties.Ten patients (16.13%) were diagnosed with MG. Of these, six (60%) had ocular MG (OMG). No patients in the isolated IRW group were found to have MG. All MG patients exhibited weakness of multiple extra-ocular muscles (EOM), ranging from 2 to 12 different muscles affected. Each had one or more characteristic MG symptoms or signs, with variability observed in 80% (n = 8). Conclusion:No cases of MG were identified in patients with isolated IRW. All MG diagnoses were associated with characteristic signs or symptoms. This highlights the importance of detailed clinical history and orthoptic assessment when MG is suspected and poses further questions of whether isolated IRW needs further MG investigative testing.
Introduction:Intermittent exotropia (IXT) is a common form of strabismus in children, but the fluctuating angle of deviation and control make measuring the ocular deviation complicated. The prism cover test (PCT) is the gold standard, yet examiner dependent. We assessed whether the 2WIN-S photoscreener (2WIN plus Kaleidos corneal-reflex wand) can quantify deviation in basic IXT and whether control level modifies agreement with PCT. Methods:Nineteen children with basic-type IXT and monocular acuity 0.1 log MAR or better were enrolled, ocular pathology or significant refractive error excluded. Control was graded (0-2 good; 3-5 fair-to-poor). PCT measured deviation at 4m, 1m and 40 cm with 5 s occlusion; 2WIN-S measured at 1 m after a 30 min rest. Analyses compared 10-20 versus > 20 prism dioptres (pd) and used Bland-Altman plots. Results:Mean age was 10.26 ± 3.76 years. Median deviation was 25.0 pd (IQR 20-30) with PCT versus 8.5 pd (IQR 0-19.5) with 2WIN-S (z = -3.82, p < 0.001). Differences were significant in both 10-20 pd (median 11.25; z = -2.20, p = 0.028) and > 20 pd groups (median 18.0; z = -3.18, p = 0.001). In five cases, 2WIN-S reported orthophoria; four had ≥ 20 pd on PCT and good control. Good-control cases showed a 20.0 pd median difference; fair-to-poor control showed 3.5 pd within the 10 pd clinical margin. Bland-Altman mean difference was 14.13 pd with limits of agreement from -4.96 to 33.22. Conclusion:Overall agreement between 2WIN-S and PCT was poor. Until methodological or optical refinements are made, 2WIN-S should not be used for quantifying basic-type IXT.
Background:Vision plays a critical role in a child's educational success, cognitive development, and social interaction. However, many children, particularly in low- and middle-income countries like Morocco, suffer from undiagnosed visual impairments during their school years. As teachers spend extended time with students, they are well-positioned to notice early signs of vision problems. Objectives:This study aimed to assess the level of knowledge that Moroccan primary school teachers have about children's visual health, identify gaps in awareness of common visual disorders, explore teachers' roles in detecting signs of visual issues in the classroom, and support the development of school-based vision screening strategies. Methods:A cross-sectional descriptive study was conducted among 271 primary school teachers across different Moroccan regions. Data were collected using a structured questionnaire covering demographic characteristics, knowledge of common visual disorders, awareness of behavioural signs, and current classroom practices. Statistical analyses were performed to examine associations between knowledge levels and variables such as gender, age, and teaching experience. Results:The majority of participants (84.9%) reported more than five years of teaching experience, corresponding to an estimated average of approximately nine years in the profession. Teachers demonstrated a better understanding of refractive errors and strabismus compared to ocular surface diseases and behavioural signs. Teaching experience was significantly associated with higher knowledge scores (p = 0.001), whereas no significant differences were found based on gender. Although age was not directly correlated with knowledge scores, older teachers were significantly more likely to report observing academic improvement in students after correcting visual problems (p = 0.0007), a perception also more frequent among those with greater teaching experience (p = 0.004). Despite existing knowledge gaps, teachers reported supportive practices such as adjusting classroom seating (94.5%) and informing parents (52.6%). Conclusion:The findings highlight the potential value of providing targeted training programmes to help teachers play a more active role in recognising visual problems in children. Incorporating basic eye health education into teacher training curricula may support earlier detection and contribute to better child health outcomes in school environments, though further research is recommended to validate this approach.
Introduction:Cerebral Visual Impairment (CVI) accounts for most visual impairment in children in the developed world. A significant proportion of children in special needs education demonstrate atypical visual function, yet referral thresholds for onward assessments are not defined. We sought to describe the elements of a visual function assessment that might indicate a threshold for referral into CVI diagnostic pathways. Method:We undertook a retrospective analysis of 50 consecutive records of children attending a specialist visual assessment clinic. Visual ability was documented, including visual acuity, contrast sensitivity, visual field, eye movements, visual attention, accommodation, and optic disc appearance. The aim of this retrospective case note review was to examine the pattern of visual assessment outcomes that raised suspicion of CVI in a cohort of children with special needs. Results:Atypical response to three or more testing domains was associated with a diagnosis of CVI. Mean age of children was 6.6 years (range 1-16). There was no statistical difference in the mean number of test domains completed by those with/without CVI. (7.3 vs. 8.3; p = 0.5). Children with CVI showed a statistically higher mean number of atypical responses compared with non-CVI patients (4.2 vs. 0.4; p = 0.015). Discussion:Our findings are in keeping with other studies that indicate that detecting atypical eye movements, visual field, and/or visual attention play a key role in highlighting children who warrant comprehensive assessment for CVI. Facilitating eye health professionals to identify and refer on those children with evidence of CVI-related behaviors will further our endeavors to provide an inclusive approach to diagnosis in a high-risk group.
Background:Strabismus can have profound psychosocial impacts in addition to functional impacts. Psychosocial impacts typically stem from negative attitudes and can manifest as low self-esteem, employment discrimination, and problems forming interpersonal relationships. Evidence suggests that negative attitudes towards strabismus emerge in early childhood.The aim of this review was to investigate the age at which strabismus impacts quality of life in children. Methods:A systematic search was conducted using online databases (MEDLINE, Embase, Emcare, and PsycINFO) from their inception until July 2024. The search strategy was derived from three topic areas: strabismus, quality of life, and children. A two-stage screening process involved screening titles and abstracts before full texts were retrieved and screened. Inclusion criteria required studies to have participants aged less than 18 years old with strabismus completing a measure of quality of life. Quality assessment was performed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results:From 1,014 records, a total of 10 studies were included. Most studies reported children with strabismus had significantly reduced quality of life compared to children without strabismus, across all age groups. Three studies compared scores between different age groups. One indicated a greater reduction in quality of life in older children. Conversely, two found no significant difference between different age groups. Discussion:Findings indicated that strabismic children across all age groups experience reduced quality of life, although age-specific analysis was limited. A longitudinal study using an appropriate, validated outcome measure from diagnosis until adulthood may facilitate an age-specific analysis of quality of life.
Background:The aim of this study was to compare accommodative amplitude (AA) and accommodative facility (AF) in healthy subjects with a family history of diabetes (FHD+), individuals with diabetes mellitus (DM), and healthy controls (HC). Material and methods:This cross-sectional, observational, comparative study was conducted among 89 subjects who attended in the age group between 30 and 40 years. The subjects were categorised into three groups: 30 healthy controls (HC) (mean age: 35.1 ± 4.5 years), 31 healthy subjects with a family history of diabetes (FHD+) (35.5 ± 3.2 years) and 28 subjects diagnosed with diabetes (DM) (36.5 ± 3.5 years). An informed consent form was obtained from subjects before conducting procedures. The amplitude of accommodation was assessed using the minus-lens technique. Additionally, accommodative facility was evaluated monocularly and binocularly using ± 1.50DS flippers. The effects of age, fasting plasma glucose levels, and glycated haemoglobin levels on accommodative parameters were examined using multiple regression analysis. One-way ANOVA with the Bonferroni post hoc test was used to test for significant differences in accommodative parameters. Results:The mean amplitudes of accommodation for the three groups were statistically significant (Mean AADM: 3.4 ± 1.0; Mean AAFHD+: 4.63 ± 0.83; Mean AAHC: 6.25 ± 1.33; p = 0.001). Similarly, the mean monocular accommodative facility (AF) for the three groups differed significantly (mean AFDM:4.35 ± 1.34, mean AFFHD+: 5.95 ± 1.4; mean AFHC:7.65 ± 1.18cpm; p = 0.001). In multiple regression, age nearly significantly affected AF in the FHD+ group, with (R2 = 0.492, p = 0.040). Whereas, age and FBS were the predictors of AA in FHD+ (R2 = 0.598, p = 0.001; R2 = 0.400, p = 0.026). Conclusions:Healthy subjects with a family history of diabetes who are at increased risk of developing prediabetes had reduced accommodations. The AA and AF values are notably lower than the expected value for this age group. Identifying and monitoring these individuals could provide an opportunity for early intervention, potentially delaying the progression of accommodative anomaly-like symptoms associated with DM. This observation highlights the importance of considering family history and prediabetic status when examining accommodative function.
