British and Irish Orthoptic Journal最新文献

Background: Amblyopia is the most common cause of visual impairment in children, and early detection is essential, yet screening remains limited in many settings, especially where access to eye-care specialists is scarce.

Objective: To evaluate the accuracy of a web-based screening tool that combines parent-reported risk factors with AI-assisted strabismus detection for identifying children at risk of amblyopia.

Methods: This pilot study included 105 children aged 3-10 years attending a public hospital in Morocco for their first ophthalmological evaluation. Parents completed an online screening tool consisting of eight validated amblyopia risk-factor questions and an automated strabismus analysis based on a frontal smartphone photograph. The AI module combined geometric measurements of pupil-nasal root symmetry with convolutional neural network (CNN) features such as corneal light reflex and gaze vector orientation. Each child received a total score (0-9), stratified into high-risk (6-9), moderate-risk (3-6), or low-risk (0-3) categories. A comprehensive ophthalmological examination, performed by a clinician blinded to the application results, served as the reference standard.

Results: Of the 105 children screened, 32 were classified as high-risk, 62 as moderate-risk, and 11 as low-risk. The tool demonstrated perfect agreement in the high-risk category, with all 32 high-risk children clinically confirmed to have amblyopia (PPV = 100%). In the moderate-risk group, 30 of the 62 children were clinically confirmed (PPV = 48.4%). No child in the low-risk group had amblyopia (NPV = 100%). The AI-assisted strabismus module showed strong predictive accuracy in the high-risk category (96.9% confirmation). Statistical analyses showed no significant differences in diagnostic performance across age, gender, or urban/rural subgroups (p > 0.05).

Conclusions: The hybrid screening tool reliably identified children at high risk for amblyopia with complete concordance with a blinded clinical diagnosis, while safely excluding low-risk children. Although moderate-risk scores require cautious interpretation and clinical follow-up, this approach offers a low-cost, accessible, and scalable solution for paediatric vision screenings in resource-limited settings. Further large-scale community-based studies are warranted to validate generalisability.

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.

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.

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.

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: 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.

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.

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.