Higher order aberrations in keratoconus .

INTRODUCTION: Keratoconus is a progressive disorder of the cornea that causes thinning (Sedaghat et al. in Sci Rep 11(1):11971, 2021), ectasia, and irregular astigmatism, resulting in poor visual acuity that cannot be corrected with standard sphero-cylindrical spectacle lenses. One feature distinguishing keratoconic corneas is ocular aberrations, manifesting up to five or six times the amount of higher-order aberrations than a normal, healthy eye. These aberrations can cause visual disturbances even at the very early stages of the disease. METHODS: In the past, a diagnosis was derived from clinical symptoms, but technological advances have revealed multiple pre-clinical features, allowing for the differentiation between keratoconic and normal eyes at a much earlier stage. These include anterior and posterior corneal surface elevations, the corneal pachymetry profile, corneal epithelial patterns, wavefront aberration metrics, and corneal biomechanics (Sedaghat et al. in Sci Rep 11(1):11971, 2021).This review discusses the aberrations associated with keratoconus, how to measure them, and treatment methods to minimize their negative influence. CONCLUSIONS: Early diagnosis can lead to early treatment and may allow for arresting progression, thereby improving the long-term prognosis. With the acceleration of refractive surgery, it is important to identify patients with keratoconus, as they are usually contraindicated for refractive surgery.

Applications of topical immunomodulators enhance clinical signs of vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC): a meta-analysis.

PURPOSE: This meta-analysis aimed to review the safety and efficacy of topical cyclosporine A (CsA) and topical tacrolimus in allergic eye disease. METHODS: A systematic search identified thirteen studies and a total of 445 patients for inclusion, making this the largest meta-analysis published on the subject. The current review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Thirteen randomized control trials were included in the meta-analysis. Eleven studies used CsA as the treatment, and two used Tacrolimus. In total, 445 participants were included, of whom 76.6% were male. The mean age of participants across the included studies was 14 years. All studies reported clinical signs as evaluated by an examining clinician. Signs were usually assessed by anatomical region, with the most common regions being the conjunctiva and the cornea, and the most common signs assessed were hyperemia and papillae. Three studies accounted for more than 50% of the meta-analysis's weight. Effect size (d) ranged from - 2.37 to - 0.03, negative values favoring immunomodulators. Fixed Effect Meta-Analysis returned an SMD of - 0.81 (95% CI [- 0.98, - 0.65]). However, there was significant heterogeneity (I2 = 61%, Qw = 30.76) in the outcome measure (P = 0.0021); therefore, a random-effect meta-analysis was also completed in which the pooled SMD was - 0.98 (95% CI [- 1.26, - 0.69], τ2 = 0.16). CONCLUSIONS: This study affirms the current scientific community's stance that immunomodulators effectively treat clinical signs, including blepharitis, conjunctival hyperemia, edema, papillae, and corneal damage in severe ocular allergic disease.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice.

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Assessment of the correlation of the tear breakup time with quality of vision and dry eye symptoms after SMILE surgery.

PURPOSE: It is well reported that dry eye symptoms can increase after many refractive surgery procedures. This study aims to provide a clinical understanding of the correlation of fluorescein tear film breakup time (FTBUT) with quality of vision (QoV) and dry eye symptoms following small incision lenticule extraction surgery (SMILE). METHODS: Patients electing to have SMILE surgery were subdivided into 2 groups: Group 1 included short preoperative FTBUTs of 3 to 6 seconds (s); Group 2 included long FTBUTs of ≥ 8 s. Uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction, FTBUT, QoV and Ocular Surface Disease Index (OSDI) questionnaires were recorded 1 and 6 months postoperatively. RESULTS: Thirty-nine subjects were included in each group. There was no significant difference in visual outcomes between the 2 groups at both the 1- and 6-month postoperative assessments. FTBUT remained significantly lower in group 1. Oxford staining was initially higher for group 1 at 1 month (P = 0.007), but there was no significant difference at 6 months (P = 0.180). There was no significant difference in QoV or OSDI scores between the 2 groups at both postoperative visits. CONCLUSIONS: Low preoperative FTBUT (3-6 s) does not appear to negatively affect postoperative visual outcomes or results in a greater likelihood of dry eye symptoms and poor ocular surface compared to eyes with a longer preoperative FTBUT. These results suggest that a low preoperative FTBUT does not necessarily increase the likelihood of poor visual acuity, dry eyes symptoms, or poor ocular surface outcomes following SMILE surgery.

Contact lens education for the practitioners of the future.

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD-19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future.

Factors That Influence the Success of Contact Lens Fitting in Presbyopes: A Multicentric Survey.

OBJECTIVES: To evaluate the key factors behind successful and unsuccessful wear of contact lenses (CLs) for patients with presbyopia. METHOD: A multicenter survey was conducted using a questionnaire, in eight CL centers, among two groups of presbyopes: successful wearers (SWs), who were presbyopic and wearing CLs successfully, and unsuccessful wearers (UWs), who tried unsuccessfully to wear CLs to manage their presbyopia and had stopped wearing CLs. RESULTS: A total of 237 completed questionnaires were returned; 178 from SWs and 59 from UWs. Successful wearers used CLs 5.8±1.5 days a week and additional reading spectacles were never used by half of the SWs. Among SWs, the most important reason to continue wearing CLs was convenience (61%), whereas among UWs, the most important reason to discontinue wearing CLs was poor vision (80%). A logistic regression analysis showed that the absence of astigmatism (P<0.05), a higher subjective satisfaction (P<0.05), a better subjective perceived vision at distance (P<0.01), and a lower subjective loss of visual contrast (P<0.05) were able to predict the success of CL use for presbyopia. CONCLUSIONS: This study explores the predictors for determining successful or unsuccessful CL wear in presbyopes. Among ophthalmic, demographic, lifestyle, and subjective variables, the latter seems to be of greater importance in determining the success of CL wear. Therefore, it is necessary that subjective variables are taken into account by the CL practitioner when approaching presbyopic CL fitting in practice.

Immediate cortical adaptation in visual and non-visual areas functions induced by monovision.

KEY POINTS: Monovision is an optical correction for presbyopes that consists of correcting one eye for far distance and the other for near distance, creating a superimposition of an in-focus with a blurred image. Brain adaptation to monovision was studied in unexperienced observers by measuring visual evoked potentials from 64-channels. The first clear effect of monovision on visual evoked potentials was the C1 amplitude reduction, indicating that the unilateral blurring induced by monovision reduces feed-forward activity in primary visual area. Monovision led also to an increased amplitude of the P1 and pP1 components, with the latter originating in prefrontal regions. This effect probably works as an attentional compensatory activity used to compensate for the degraded V1 signal. ABSTRACT: A common and often successful option to correct presbyopia with contact lenses is monovision. This is an unbalanced correction across the two eyes where one eye is corrected for far vision and the other eye is corrected for near vision. Monovision is therefore a form of acquired anisometropia that causes a superimposition of an in-focus image with a blurred image. In spite of this visual anisometropia, monovision has been successfully used for many decadesl however the brain mechanism supporting monovision is not well understood. The present study aimed to measure the visual evoked potentials with a high-density electrode array (64-channel) in a group of presbyopes and to provide a detailed spatiotemporal analysis of the cortical activity after a short period of adaptation to monovision with contact lenses. When compared with a balanced eye near correction, monovision produced both a clear reduction of the earliest visual evoked potential components, the C1 and the N1, and an amplitude increase of the P1 and pP1. These results indicate that the unilateral blurring induced by wearing monovision contact lenses reduces feed-forward activity in the primary visual area and feedback activity in extrastriate areas (C1 and N1 reduction). Interestingly, other brain activities in both extrastriate visual areas (the P1 component) and in the anterior insula (the pP1 component) appear to compensate for this dysfunction, increasing their activity during monovision. These changes confirm the presence of fluid brain adaptation in visual and non-visual areas during monocular interferences.

How accurate is an LCD screen version of the Pelli-Robson test?

PURPOSE: To evaluate the accuracy and repeatability of a computer-generated Pelli-Robson test displayed on liquid crystal display (LCD) systems compared to a standard Pelli-Robson chart. METHODS: Two different randomized crossover experiments were carried out for two different LCD systems for 32 subjects: 6 females and 10 males (40.5 ± 13.0 years) and 9 females and 7 males (27.8 ± 12.2 years), respectively, in the first and second experiment. Two repeated measurements were taken with the printed Pelli-Robson test and with the LCDs at 1 and 3 m. To test LCD reliability, measurements were repeated after 1 week. RESULTS: In Experiment 1, contrast sensitivity (CS) measured with LCD1 resulted significantly higher than Pelli-Robson both at 1 and at 3 m of about 0.20 log 1/C in both eyes (p < 0.01). Bland-Altman plots showed a proportional bias for LCD1 measures. LCD1 measurements showed reasonable repeatability: ICC was 0.83 and 0.65 at 1 and 3 m, respectively. In Experiment 2, CS measured with LCD2 resulted significantly lower than Pelli-Robson both at 1 and at 3 m of about 0.10 log 1/C in both eyes (p < 0.01). Bland-Altman plots did not show any proportional bias for LCD2 measures. LCD2 measurements showed sufficient repeatability: ICC resulted 0.51 and 0.65 at 1 and 3 m, respectively. CONCLUSIONS: Computer-generated versions of Pelli-Robson test, displayed on LCD systems, do not provide accurate results compared to classic Pelli-Robson printed version. Clinicians should consider that Pelli-Robson computer-generated versions could be non-interchangeable to the printed version.

Ocular Dominance and Handedness in Golf Putting.

PURPOSE: In golf, the impact of eye-hand dominance on putting performance has long been debated. Eye-hand dominance is thought to impact how golfers judge the alignment of the ball with the target and the club with the ball, as well as how golfers visualize the line of the putt when making decisions about the force needed to hit the ball. Previous studies have all measured ocular dominance in primary gaze only, despite golfers spending a significant amount of their time in a putting stance (bent at the hips, head tilted down). Thus, the purpose of this study was to assess ocular dominance in both primary gaze (aligning the ball with the target) and putting gaze (addressing the ball and aligning the club). METHODS: This study investigated measuring pointing ocular dominance in both primary and putting gaze positions on 31 golfers (14 amateur, 7 club professionals, and 10 top professionals). All players were right-handed golfers, although one reported having no hand dominance and one reported being strongly left hand dominant. RESULTS: The results showed that (1) primary and putting gaze ocular dominances are not equal, nor are they predictive of each other; (2) the magnitude of putting ocular dominance is significantly less than the magnitude of primary gaze ocular dominance; (3) ocular dominance is not correlated with handedness in either primary or putting gaze; and (4) eye-hand dominance is not associated with increased putting skill, although ocular dominance may be associated with increased putting success. CONCLUSIONS: It is important that coaches assess golfers' ocular dominance in both primary and putting gaze positions to ensure they have the most accurate information upon which to base their vision strategy decisions.

Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis.

OBJECTIVE: To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication. DESIGN: Randomized, masked clinical trial. PARTICIPANTS: Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen. INTERVENTION: Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control. MAIN OUTCOME MEASURES: Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour. RESULTS: Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014). CONCLUSIONS: After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.

Effect of a commercially available warm compress on eyelid temperature and tear film in healthy eyes.

PURPOSE: To evaluate eyelid temperature change and short-term effects on tear film stability and lipid layer thickness in healthy patients using a commercially available warm compress (MGDRx EyeBag) for ophthalmic use. METHODS: Eyelid temperature, noninvasive tear film breakup time (NITBUT), and tear film lipid layer thickness (TFLLT) of 22 healthy subjects were measured at baseline, immediately after, and 10 minutes after application of a heated eyebag for 5 minutes to one eye selected at random. A nonheated eyebag was applied to the contralateral eye as a control. RESULTS: Eyelid temperatures, NITBUT, and TFLLT increased significantly from baseline in test eyes immediately after removal of the heated eyebag compared with those in control eyes (maximum temperature change, 2.3 ± 1.2 °C vs. 0.3 ± 0.5 °C, F = 20.533, p < 0.001; NITBUT change, 4.0 ± 2.3 seconds vs. 0.4 ± 1.7 seconds, p < 0.001; TFLLT change, 2.0 ± 0.9 grades vs. 0.1 ± 0.4 grades, Z = -4.035, p < 0.001). After 10 minutes, measurements remained significantly higher than those in controls (maximum temperature change, 1.0 ± 0.7 °C vs. 0.1 ± 0.3 °C, F = 14.247, p < 0.001; NITBUT change, 3.6 ± 2.1 seconds vs. 0.1 ± 1.9 seconds, p < 0.001; TFLLT change, 1.5 ± 0.9 vs. 0.2 ± 0.5 grades, Z = -3.835, p < 0.001). No adverse events occurred during the study. CONCLUSIONS: The MGDRx EyeBag is a simple device for heating the eyelids, resulting in increased NITBUT and TFLLT in subjects without meibomian gland dysfunction that seem to be clinically significant. Future studies are required to determine clinical efficacy and evaluate safety after long-term therapy in meibomian gland dysfunction patients.

BCLA CLEAR Presbyopia: Definitions.

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education.

Cortical dynamics in visual areas induced by the first use of multifocal contact lenses in presbyopes.

A common non-spectacle strategy to correct presbyopia is to provide simultaneous images with multifocal optical designs. Understanding the neuroadaptation mechanisms behind multifocal devices usage would have important clinical implications, such as predicting whether patients will be able to tolerate multifocal optics. The aim of this study was to evaluate the brain correlates during the initial wear of multifocal contact lenses (CLs) using high-density visual evoked potential (VEP) measures. Fifteen presbyopes (mean age 51.8 ±â€¯2.6 years) who had previously not used multifocal CLs were enrolled. VEP measures were achieved while participants looked at arrays of 0.5 logMAR Sloan letters in three different optical conditions arranged with CLs: monofocal condition with the optical power appropriate for the distance viewing; multifocal correction with medium addition; and multifocal correction with low addition. An ANOVA for repeated measures showed that the amplitude of the C1 and N1 components significantly dropped with both multifocal low and medium addition CL conditions compared to monofocal CLs. The P1 and P2 components showed opposite behavior with an increase in amplitudes for multifocal compared to monofocal conditions. VEP data indicated that multifocal presbyopia corrections produce a loss of feedforward activity in the primary visual cortex that is compensated by extra feedback activity in extrastriate areas only, in both early and late visual processing.

Myopia management -A survey of optometrists and ophthalmologists in Israel.

PURPOSE: Myopia management is practiced by ophthalmologists and optometrists. This study evaluated the approach and standard of myopia management among eye-care practitioners (ECPs) in Israel. The findings may ultimately affect the quality of care. METHODS: A questionnaire was sent to 954 optometrists and 365 ophthalmologists, including demographic questions; whether they owned any devices to monitor myopia progression; the lowest progression they considered significant; various questions pertaining to myopia management and treatment methods. RESULTS: Responses from 135 optometrists and 126 ophthalmologists were collected, the majority practicing more than five years; 94% of optometrists, and 64% of ophthalmologists. Around 53% of optometrists and 27% of the ophthalmologists proclaimed to practice myopia management. ECPs primary parameters influencing risk assessment for progression were age, genetic background and history of progression. Time outdoors, during daylight hours, is advised by ophthalmologists (97%) and optometrists (78%). Limiting screentime is encouraged by 87% of ophthalmologists and 69% of optometrists. Myopia progression of 0.50D-0.75D after six months is regarded to require intervention by 93% of ophthalmologists and 83% of optometrists. Optometrists selected multiple myopia management treatments, primarily optical (ophthalmic myopia management lenses 40%, multifocal ophthalmic lenses 24%, peripheral blur contact lenses 38%, orthokeratology 11%), while 95% of ophthalmologists chose atropine and only 3-11% selected any additional treatments to consider. CONCLUSION: This study highlighted ECPs' agreement on the principles, importance of, and timeline of intervention with myopia management. The disconnect between the two professions lies in management methods. Genuine dialogue and co-management should be encouraged for maximum implementation, benefit and effectiveness of available patient treatments.

The effect of non-ablative thermomechanical skin treatment (Tixel®) on dry eye disease: A prospective two centre open-label trial.

PURPOSE: To determine the effects of a thermo-mechanical action-based peri-orbital fractional skin treatment (Tixel®) on dry eye disease. METHODS: This prospective, controlled, open labelled study was conducted at two study centres: Midland Eye, Solihull, UK, and Vallmedic Vision, Andorra. Participants were screened at the baseline visit (visit-1), received three Tixel® treatments at 2-weeks intervals including further assessment (visits 2, 3 and 4). Participants were followed up for three months post-treatment (visit 5). Vision, intraocular pressure (IOP), dry eye symptomatology were assessed, including the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NIBUT) and tear osmolarity as well as detailed ophthalmic assessments. RESULTS: Seventy-four participants (41 in Birmingham and 33 in Andorra) with periorbital wrinkles and moderate to severe dry eye disease (DED) were enrolled. The mean age was 59.3 ± 13.3 years and 57 were females. No adverse events, no change in vision (p = 0.310) or IOP (p = 0.419) were observed. Tixel treatment was associated with clinically and statistically significant improvement in the DED symptoms, which was supported by a reduction of 21.40 ± 15.08 (P < 0.001) of the OSDI index. Non-invasive tear break-up time improved by 2.10 ± 0.91 s (p < 0.001) in the Birmingham cohort and 6.60 ± 2.13 s (p < 0.001) in the Andorra cohort. Tear osmolarity reduced from 299.8 ± 13.3 mOsm/L to 298.8 ± 15.6 mOsm/L following the Tixel treatment (p = 0.271). CONCLUSIONS: Thermo-mechanical action-based peri-orbital fractional skin treatment Tixel® could be an attractive, safe and effective treatment for DED. This treatment is associated with high clinical and statistically significant improvement in DED signs and symptoms with no adverse events.

Changes in corneal biomechanical parameters in keratoconus eyes with various severities after corneal cross-linking (CXL): A comparative study.

OBJECTIVES: To compare changes in corneal biomechanical parameters one year after corneal cross-linking (CXL) in keratoconus (KCN) eyes of different severities. METHODS: Seventy-five eyes with mild, moderate, and severe grades of KCN (n = 24, 31, and 20 eyes, respectively) that were treated with CXL, based upon the standard Dresden protocol, were included. The corneal biomechanical assessment was performed using Corvis ST and Ocular Response Analyzer (ORA). Changes in Corvis's dynamic corneal response (DCR) parameters and ORA's derived parameters (corneal hysteresis (CH), and corneal resistance factor (CRF)) were assessed whilst the corneal thickness and intraocular pressure were considered as covariates. RESULTS: There was no statistically significant difference in the corneal biomechanical parameters obtained using both devices after surgery separately in different KCN grades, except for the deformation amplitude (DA) in the severe KCN group (P = 0.017). Changes in the classic parameters of the highest concavity phase of Corvis ST (peak distance, radius, and DA) were more positive and in the newer parameters (integrated inverse radius (IIR), deformation amplitude ratio (DAR)) more negative in the severe group compared to the other groups. Also, the mean change in CH (P = 0.710), and CRF (P = 0.565), showed a negative shift in higher grades of KCN; however, there was no significant difference in the mean changes of all parameters between different groups. (P > 0.05). CONCLUSIONS: Similar changes in the Corvis ST and ORA parameters in mild, moderate, and severe KCN indicate biomechanical stability and the effective role of CXL in stopping the progressive nature of keratoconus in eyes of varying severities one year after CXL.

Evidence-based teaching in contact lenses education: Teaching and learning strategies.

INTRODUCTION: Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education? METHOD: An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education. RESULTS: Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes. CONCLUSION: There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

Translation and validation of convergence insufficiency symptom survey to Italian: Psychometric results.

PURPOSE: This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). METHODS: The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. RESULTS: The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting -0,81 logits but also some evidence of multidimensionality. CONCLUSIONS: The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly. The CISS_I can help in interpreting and monitoring convergence insufficiency symptoms in already identified subjects, but it is not suitable for screening a general population of young adults.

Italian translation and validation of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8).

PURPOSE: To translate and validate an Italian version of the CLDEQ-8 (CLDEQ-8_IT). METHODS: The study was carried out in two phases. In the first phase, a cross-cultural adaptation of CLDEQ-8 to Italian was performed by forward and backward translation in sequence. In the second phase, a multi-centre study was conducted for the validation of the questionnaire. Validity CLDEQ-8_IT was evaluated against three gestalt questions: overall opinion of soft contact lenses (CLs), global self-assessments of eye sensitivity and eye dryness. Reliability was evaluated by test-retest assessment in a subgroup of subjects. Finally, the psychometric properties of CLDEQ-8_IT were explored by Rasch analysis. RESULTS: Two hundred and forty soft CL wearers, fluent Italian speakers (73 males and 167 females), between 18 and 70 years of age were enrolled. A significant correlation was found between CLDEQ-8_IT and each of the three Gestalt questions. The cutoff score of 12 points demonstrated the best balance between sensitivity and specificity in differentiating wearers grading their CLs as "Excellent/Very good" from those reporting their overall opinion as "Good/Fair/Poor". The Intraclass Correlation Coefficient between test and retest was 0.88 (95% CI: 0.81-0.92). Finally, infit and outfit statistics using Rasch analysis for the 8 items were in a good range, however Principal Components Analysis revealed a certain degree of multi-dimensionality of the instrument. Also, item 8 analysis could be computed after merging the last two response categories. CONCLUSION: The CLDEQ-8_IT showed very good validity and reliability in measuring symptoms of CL wearers, comparable to the original English language version. A cut-off of 12 was confirmed as yielding the best balance between sensitivity and specificity in detecting CL wearers who could benefit from clinical management of their CL-related symptoms. Collapsing of the response options 5 and 6 in the last item of questionnaire could optimise its functioning.

TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface.

Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.