British and Irish Orthoptic Journal最新文献

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.

Introduction: Accommodation is most commonly assessed using the RAF Rule. However, this subjective test has multiple sources of error, and an objective measurement of accommodation using Nott dynamic retinoscopy may be a more appropriate test to use. This study aimed to compare Nott dynamic retinoscopy with the RAF Rule and the Plusoptix PowerRef III (gold standard) after a period of close work, to determine whether this is a more suitable test for measuring accommodation.

Methods: Accommodation was measured in 25 students before and after 30 minutes of close work using the RAF Rule, Nott dynamic retinoscopy, and the Plusoptix. The RAF Rule measured the amplitude of accommodation when viewing N5 print. Nott dynamic retinoscopy assessed the lead/lag of accommodation using the UC Cube with N5 print at 40 cm. The Plusoptix measured objective accommodation (slope and response) in binocular and uniocular conditions.

Results: The Plusoptix and Nott dynamic retinoscopy detected accommodative lag within normal limits (under 1D), with no significant change after close work (p > 0.05). No significant change in accommodation after close work was found with the RAF Rule tested uniocularly (p > 0.05); however, a significant decrease in amplitude of accommodation from 12.85D to 11.26D was found when tested binocularly. The Plusoptix confirmed that this was not due to convergence fatigue (p > 0.05).

Discussion: The measurement variations observed with the binocular RAF Rule confirm that the subjective nature of the RAF Rule test makes it more prone to errors. Nott dynamic retinoscopy is comparable to the gold standard Plusoptix; therefore, we suggest that Nott dynamic retinoscopy should be used in the orthoptic assessment of accommodation.

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.

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: 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.

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.

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.