Purpose To investigate the effect of a + 2.00 D fogging lens on accommodative behavior during measurements with an open-view handheld wavefront autorefractor, considering refractive status and fogging duration. Methods Participants underwent six consecutive 10-second measurements per eye using an open-view autorefractor: three without and three with a fogging lens. Subjects were classified as myopic, emmetropic or hyperopic based on the mean spherical refraction of the right eye. Bland–Altman analysis assessed device repeatability and the effect of fogging (with vs without), both overall and by refractive group. The influence of acquisition time was evaluated by comparing the first 5 s with the full 10-second recordings. Results Sixty-one young adults (25.02 ± 6.16 years; spherical refraction -0.80 ± 2.21 D) were included: 34.4% myopes, 42.6% emmetropes and 22.9% hyperopes. Ten-second measurements showed excellent repeatability, with mean differences near zero and 95% limits of agreement within ±0.50 D, regardless of fogging. Shortening acquisition to 5 s maintained negligible bias but increased variability by ∼20%. The fogging lens induced heterogeneous responses across refractive groups. In myopic and emmetropic eyes, most showed no change (52% and 58%), and accommodative relaxation occurred infrequently (10% and 17%). In contrast, 43% of hyperopic eyes showed accommodative relaxation, with a mean refractive shift of 0.84 D, suggesting a clinically meaningful response. Conclusion The effect of a + 2.00 D fogging lens depends on refractive status. Routine use may provide limited additional benefits in myopic and emmetropic subjects, whereas hyperopic individuals appear more likely to benefit from its selective use.
Purpose To translate, culturally adapt, and validate the original Pediatric Refractive Error Profile (PREP) questionnaire into Spanish, enabling assessment of vision-related quality of life (VR-QoL) in children wearing spectacles. Methods The PREP was translated and adapted following a five-step protocol. A sample of 124 Spanish children aged 8–14 years with refractive errors (myopia, hyperopia, and/or astigmatism) and ≥1 year of spectacle use completed the Spanish version. Internal consistency was assessed using Cronbach’s alpha; test–retest reliability was evaluated in 18 children using intraclass correlation coefficients (ICC). Validity was examined through item–scale correlations, inter-scale correlations (construct validity), and associations with clinical visual parameters and a Visual Analogue Scale (VAS) measuring subjective experience (concurrent validity). Results All participants completed the questionnaire without difficulties. Cronbach’s alpha ranged from 0.754 to 0.918 across the 10 scales. ICC values ranged from 0.541 to 0.921, indicating moderate to excellent reliability. Item–scale correlations exceeded 0.40, and construct validity was supported by moderate to strong inter-scale associations. Significant correlations were found between visual acuity and the vision-related scales, and between VAS scores and the appearance, satisfaction, and activities scales. Children with visual acuity deficits showed significantly lower scores in several domains. Conclusions The Spanish version of the PREP questionnaire shows preliminary evidence of reliability and validity for assessing vision-related quality of life in children wearing spectacles. However, further studies are needed to confirm its psychometric properties using more comprehensive validation approaches.
PURPOSE:To evaluate the diagnostic accuracy of objective tests including Visual Evoked Potentials (VEP), pupillometry, and eye-tracking technologies in detecting ocular malingering among individuals suspected of fabricating visual impairments for secondary gain. METHODS:Following PRISMA guidelines, PubMed, Web of Science, Scopus, EMBASE, and Cochrane Library were searched until June 2025. Studies evaluating objective diagnostic methods for detecting ocular malingering that reported diagnostic accuracy metrics were included. Two reviewers performed data extraction and quality assessment using QUADAS-2. RESULTS:Ten studies from 1993 to 2017 with 20 to 222 subjects were included. Approximately half of the studies employed experimentally simulated malingering paradigms, while the remainder involved clinically suspected cases. VEP was the most frequently evaluated modality and showed high sensitivity across studies, although specificity varied. Pattern-reversal VEPs showed effectiveness in adults and military conscripts, while step VEPs demonstrated 100% specificity in paediatric cases. Pupillometry and specialised colour vision tests achieved 80-94% sensitivity and specificity rates. Most studies showed low bias risk in index test and reference standard domains. These findings suggest potential utility of objective tools as adjuncts in clinical and medico-legal settings. CONCLUSION:Objective diagnostic measures demonstrate promising utility as adjunctive tools for detecting ocular malingering and may support clinical decision making by providing reproducible assessments that bypass voluntary patient control. However, heterogeneity in study designs limits generalisability. Future research should standardise protocols and validate findings across diverse populations.
PURPOSE:To evaluate the association between Active Vision Therapy (AVT) combined with occlusion and occlusion-only therapy in task-based saccadic and pursuit visuomotor performance and visual outcomes in children with anisometropic amblyopia. METHODS:Forty children (median age=9years, IQR=7-11) with persistent anisometropic amblyopia after six weeks of spectacle adaptation were alternately assigned to AVT-occlusion (n = 23) or occlusion-only (n = 17). BCVA, stereopsis, contrast sensitivity, and task-based saccadic and smooth pursuit performance were measured at baseline, three weeks, six weeks, and three months. AVT included structured monocular and binocular exercises using Vision Training System 4 and Cheiroscope, while occlusion involved daily patching of the fellow eye. Repeated-measures ANOVA and Friedman tests evaluated changes over time, partial Spearman correlations adjusted for group examined associations between oculomotor and visual improvements. RESULTS:Both groups improved in BCVA, and task-based saccadic and smooth pursuit performance (p < 0.05) in the AVT-occlusion group. Significant time × therapy interactions were found for BCVA, task-based saccadic and smooth pursuit performance, and contrast sensitivity (p ≤ 0.03). At three months, AVT-occlusion outperformed occlusion-only in BCVA (-0.13 logMAR, p = 0.01), task-based saccadic response time (-0.78 ms equivalent, P < 0.001) and task-based smooth pursuit performance (4.68%, p = 0.03), and contrast sensitivity (0.06 log-units, p = 0.005). Greater gain in task-based saccadic (ρ=-0.43, p = 0.006) and smooth pursuit (ρ=-0.53, p = 0.001) performance correlated with BCVA improvement; faster saccadic response performance (ρ=0.35, p = 0.026) correlated with better stereopsis. CONCLUSIONS:AVT with occlusion was associated with greater improvements in functional visuomotor task performance and visual outcomes in children with anisometropic amblyopia, supporting its role as a function-oriented adjunct to conventional therapy.
PURPOSE:Short-term visually induced axial eye shortening and choroidal thickening are of interest since they may be linked to reduced myopia development. We studied whether axial eye shortening, induced by imposing positive defocus, varies throughout the day, and whether emmetropes and myopes differ in their responses. METHODS:Twenty young adults (10 emmetropes, 10 myopes) completed a daytime protocol conducted between 10:00 am and 3:00 pm, consisting of repeated 30- minute sessions of movie watching while the right eye was myopically defocused by a trial lens, imposing approximately +3D of myopic defocus at the viewing distance used. Each session was started and was followed by a washout period of 15 min. Axial length was measured in both eyes using the Lenstar LS900 biometer immediately before and after each session at five time points. RESULTS:Emmetropic eyes showed significant axial length shortening in response to imposed myopic defocus in the morning (10 am: -10.1 ± 7.8 µm, p = 0.0028, 11 am: -9.8 ± 7.0 µm, p = 0.0017) and again in the afternoon (3 pm: -11.2 ± 5.2 µm, p = 0.0001). No significant responses were observed at 1:00 pm and 2:00 pm. Different from emmetropes, myopic eyes did not exhibit significant axial length changes at any time point. CONCLUSIONS:Emmetropic eyes exhibited time-of-day-dependent variability in short-term axial length responses to myopic defocus, with stronger responses in the morning and afternoon but no responses around midday. The mechanisms underlying choroidal thickening appear to be modulated over the day. Myopic eyes showed minimal or no responses to positive defocus.
