Effect of laser eye protection devices on color perception.

Laser eye protection (LEP) devices may alter how colors are perceived in visual displays. This study investigates changes in color perception experienced by color-normal observers while wearing LEPs. Color perception with and without LEPs was measured using clinical color tests: City University Color Assessment and Diagnosis, Konan Medical ColorDx CCT-HD, and Farnsworth-Munsell 100-Hue. All LEPs induced a shift in color perception. The level of change in color perception significantly varied across LEPs. Consideration should be made when designing color displays where LEP devices are worn.

Effects of tracker location on the accuracy and precision of the Gazepoint GP3 HD for spectacle wearers.

Remote view eye-tracking systems are prone to errors when used on spectacle wearers due to reflections from the lenses and frame that result in inaccurate tracking. Traditionally, these trackers are situated below a computer monitor and the viewer's eye moments are recorded while they view the screen. Reflections may be influenced by the pantoscopic tilt of the spectacles, whereby the tilt angle causes incident light to be reflected to the camera. To overcome this problem, we propose mounting the tracker above the monitor to avoid these reflections and test the accuracy and precision of subjects with single vision spectacles, multifocals, and no correction, using both mounting positions. Experimental results showed that this alternate position had overall worse accuracy (4.06° ± 0.13) and precision (0.67° ± 0.05) compared to the standard configuration (2.15° ± 0.06 vs. 0.50° ± 0.03), with more invalid readings (5.91 vs. 19.19%) for single vision lens wearers. Multifocals performed better for the top-mounting position for the top portion of the monitor, suggesting higher-order aberrations from the bottom portion of the lens negatively impact data quality. Higher pantoscopic tilt angles displayed an improved accuracy for this alternate position (r(9) = - 0.69, p = 0.02), with superior accuracy for tilt angles greater than 14° compared to the standard configuration. This study quantifies the impact of spectacle wear on eye-tracking performance and suggests other alternate mounting positions may be viable in certain situations.

The Equivalency of the Binocular Indirect Ophthalmoscope Simulator to Peer Practice: A Pilot Study.

SIGNIFICANCE: Optometric educators are constantly looking for learning and teaching approaches to improve clinical skills training. In addition, the COVID-19 pandemic has made educators scrutinize the time allocated to face-to-face teaching and practice. Simulation learning is an option, but its use must first be evaluated against traditional learning methods. PURPOSE: The purpose of this study was to compare the training of binocular indirect ophthalmoscopy skills achieved by students and optometrists through deliberate practice on the Eyesi Indirect Ophthalmoscope simulator with deliberate practice using a peer. METHODS: Students and optometrists were randomly allocated to practice on either the simulator or a peer. Binocular indirect ophthalmoscopy performance was assessed using a peer and the simulator as the patients at different time points. Knowledge and confidence were examined before and following all practice sessions using a quiz and survey. RESULTS: Significant improvements in binocular indirect ophthalmoscopy performance using either a peer or the simulator as the patient for assessment were seen after 8 hours of student practice (P < .001) and after a half-hour practice time for optometrists (P < .001). There was no significant difference in performance overall between those practicing on a simulator and those practicing on a peer (P > .05). Confidence in ability to perform the technique was lower for students who had practiced on the simulator. CONCLUSIONS: The simulator has similar efficacy to peer practice for teaching binocular indirect ophthalmoscopy to students and maintenance of this clinical skill for optometrists. Simulation does not replace the need for peer practice but may be a useful adjunct reducing the face-to-face hours required. These findings present a need for further research regarding diverse applications of the Eyesi Indirect Ophthalmoscope simulator in the curriculum for training optometry students and as a continuing professional development offering for optometrists, given the short exposure duration required to observe a significant improvement in skill.

What do patients think about the role of optometrists in providing advice about smoking and nutrition?

PURPOSE: Tobacco smoking and nutrition are key lifestyle factors with long-term effects on eye health. However, little is known about patients' perceptions and experiences in these areas in relation to the care received from optometrists. The main aim was to survey patients' perceptions and prior experience regarding the role of optometrists in enquiring and providing advice about tobacco smoking and nutrition. METHODS: An anonymous, paper-based survey was distributed to a convenience sample of 225 adults attending the University of Melbourne eye care clinic. Respondents provided demographic and other information (age, sex, length of time since last eye examination, country of most recent eye examination, smoking status and intake of nutritional supplements) and indicated their level of agreement (using a five-step Likert scale) with a series of statements relating to the care provided by optometrists in the areas of health, smoking and nutrition. The statements were designed to assess the perceived scope of practice of optometrists and the extent to which patients expect, and feel comfortable, discussing these issues with their optometrist. RESULTS: 220 completed surveys were returned. Most respondents (>80%) agreed that they visit their optometrist to quantify their refractive error and to examine their eye health. About two-thirds of respondents indicated that they expect their optometrist to ask about their general health, with almost half expecting their optometrist to communicate with their general medical practitioner. Approximately one-third of respondents indicated having been routinely questioned about their smoking status, diet and nutritional supplement intake by their optometrist. This was despite about half expecting their optometrist to question them about these factors and almost three out of four respondents indicating that they felt comfortable talking with their optometrist about these lifestyle behaviours. CONCLUSIONS: This study provides novel insight into patients' perceptions and experience with optometric practice in the areas of tobacco smoking and nutrition. The majority of respondents expected their optometrist to examine their eye health, ask them about their smoking and diet habits, and indicated feeling comfortable discussing these topics with their primary eye care provider. These findings suggest that brief advice interventions relating to tobacco use and diet are likely to be acceptable to deliver in optometry practice.

Optometrists who leave the profession in Australia: 2011 to 2019.

CLINICAL RELEVANCE: The number, demographics, registration status and geographic distribution of optometrists in Australia who do not renew their registration is reported. BACKGROUND: The size of the optometry workforce in Australia is determined by the number of new entrants to the profession and the number of optometrists leaving it. Limited attention has been paid to the latter. METHODS: A dataset obtained from the Australian Health Practitioner Registration Agency about registered optometrists during the period 1 January 2011 to 31 December 2019 was analysed. It included registrants' first year of registration, gender, year of birth (in five-year bands), optometry qualification; and annual collection of registration type and postcode of principal place of practice. RESULTS: Data for 6,595 registrants were analysed. Over the study period, 626 optometrists left the register. When those leaving the register were examined by year of birth bands, two main groups emerged - optometrists aged in their fifties or older, and optometrists who were under forty years of age and disproportionately male. Registration type had a significant effect on whether a registrant left or remained on the register (p < 0.05). Those holding Non-practising Registration or Limited Registration were more likely to leave the register. Registrants with an optometry qualification from an overseas institution, including from New Zealand, were more likely to leave the register (p < 0.05). Optometrists whose registration was not endorsed were more likely to leave the register (p < 0.05). No significant difference was found when the geographic location of optometrists who left the register was compared with those who remained. CONCLUSION: Optometrists who left the register fell into two main groups - late-career and early-career. An unanticipated finding was that younger optometrists who left the register were disproportionately male. What motivates optometrists in Australia to leave the register is worthy of future research.

Programmatically Localizing Diabetic Retinopathy Features in 45-Degree Retinal Photographs Using Anatomical Colocation.

Background: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. Methods: This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen-Dice coefficients were calculated to compare the location of different features. Results: Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. Conclusions: Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening.

Demographics and distribution of the optometry profession in Australia: 2011 to 2019.

CLINICAL RELEVANCE: An assessment of the total number, demographics and geographic distribution of optometrists in Australia may inform policy to address the maldistribution of the workforce. BACKGROUND: Concerns have been expressed about the growth of the optometry workforce in the context of, in the last decade, the establishment of four new optometry programs in addition to the three long-standing programs. METHODS: This paper analysed data obtained from the Australian Health Practitioner Regulation Agency about registered optometrists during the period 1 January 2012 to 31 December 2019. The de-identified dataset included information about registered optometrists in Australia: their first year of registration, gender, year of birth (in five-year bands), optometry qualification, registration type including endorsement for therapeutic practice and the postcode of the principal place of practice. RESULTS: Data for 6,596 registrants were obtained over the study period during which the number of female optometrists increased significantly. The age profile of the profession shifted, with younger age bands becoming a significantly greater proportion of the profession. The majority of the profession comprised optometrists with a qualification from one of the three long-standing Australian optometry programs. Graduates of those programs accounted for 75.1% of registered optometrists in 2019, while 14.3% held a qualification from an overseas institution. The proportion of optometrists practising in major Australian cities was greater than the proportion of the population in those locations. A concomitant low proportion of optometrists, relative to population size, was found in regional and remote areas. CONCLUSION: Optometrists practising in Australia can be generalised as mostly female graduates of one of the three long-standing optometry programs holding general registration with a therapeutic endorsement, and with a principal place of practice located in a major Australian city. A significant maldistribution of the workforce was found that did not change significantly during the study period.

A guide to optometrists for appraising and using artificial intelligence in clinical practice.

Artificial intelligence systems are becoming increasingly available as diagnostic aids for optometric practice. These perform well but are often 'black-box' systems offering little or no insight into how a decision was reached. While there is potential for artificial intelligence to improve patient outcomes, clinicians without training in computer science may find it difficult to ascertain whether these technologies are suitable for their practice, or how they should be used. This review provides an overview of how artificial intelligence systems work in optometry, their strengths, weaknesses, and regulatory considerations. A checklist is provided for appraising a system, covering regulatory approvals, ascertaining what the system can and cannot do, how it can be used in practice, whether it is suitable for the clinical population, and whether the outputs can be explained. Artificial intelligence has the potential to improve accuracy and efficiency in many areas of optometry if used correctly, and should be embraced by clinicians as an assistive tool.

Demographics and distribution of new entrants to the optometry profession in Australia.

CLINICAL RELEVANCE: An assessment of the total number, demographics and geographic distribution of new entrants to the optometry profession in Australia can assist planning for workforce requirements. BACKGROUND: Over the past decade, the number of registered optometrists in Australia has increased by 30.1 per cent, a rate that is greater than the population growth of the country (12.1 per cent). Concerns have been expressed about the size of the optometry workforce in a context of increasing numbers of graduating optometrists. This paper analyses data obtained from the Australian Health Practitioner Regulation Agency (AHPRA) about new entrants to the profession and their initial practice location during the period 1 July 2010 to 30 June 2018. METHODS: A de-identified dataset was obtained from AHPRA that revealed the following characteristics of new entrants: qualification, gender, year of birth (in five-year bands), registration type, registration endorsement and principal place of practice including its Remoteness Area classification. RESULTS: Data for 1,680 entrants were eligible for analysis; 80 per cent graduated from an Australian university, 12 per cent graduated from the optometry program in New Zealand, and seven per cent were graduates of an overseas university. The remaining two per cent registered via the Trans-Tasman Mutual Recognition Agreement, although the dataset did not include the qualification. The United Kingdom and Republic of Ireland provided the majority of overseas entrants (60 per cent). Most (75 per cent) entrants commenced practice in a major Australian city. Graduates of Australian universities tended to commence practice in the state in which they trained or an adjacent state or territory. Juxtaposed on the data outlined above is the high proportion (42 per cent) of overseas-trained optometrists commencing practice in Western Australia. CONCLUSION: Coincident with the newer optometry programs producing graduates is the increased number of optometrists entering the Australian workforce over the past decade, with the majority commencing practice in major cities. Australia-trained optometrists tend to commence practice in the state where their training was undertaken. New entrants to the optometry profession can be generalised as graduates of an Australian optometry program, female, aged in their early-mid 20s and qualified for therapeutic practice.

Knowledge, perspectives and clinical practices of Australian optometrists in relation to childhood myopia.

BACKGROUND: The aim was to investigate the understanding of Australian optometrists in relation to myopia, its natural history and associations with vision-threatening ocular disease, self-reported clinical diagnosis and management approaches for childhood myopia, engagement with adult caregivers, and utilisation of information to guide practice. METHODS: An online survey was distributed to Australian optometrists (n = 4,124). Respondents provided information about their demographics (for example, gender, age, practice location and modality), myopia knowledge, self-reported practice behaviours relating to childhood myopia, the information and evidence base used to guide their practice, and perceived extent of adult caregiver engagement in making management decisions for myopic children. RESULTS: Completed surveys were returned by 239 optometrists (six per cent completed response rate). Most respondents demonstrated knowledge of the association between high myopia and retinal breaks, retinal detachment and primary open-angle glaucoma. Optometrists used a range of techniques to diagnose childhood myopia, with a preference for non-cycloplegic refractive measures. The most common approaches to management were single-vision distance and progressive addition spectacle lenses, despite most optometrists identifying orthokeratology, low-dose (0.01%) topical atropine and soft peripheral defocus contact lenses as three potentially more effective therapeutic interventions for modifying childhood myopia progression. Almost 90 per cent of respondents considered increasing time spent outdoors to be beneficial for reducing the rate of myopia progression. The main sources of information used to guide clinical practice were continuing education conferences and events, systematic reviews, and personal experience. Respondents perceived adult caregivers to generally be involved in myopia management decisions, and considered all aspects of myopia education as important. CONCLUSION: Current optometric practices reflect the inconclusive nature of several key aspects of the evidence for childhood myopia management. Australian optometrists appear aware of emerging evidence, but are not routinely adopting measures that have not yet received regulatory approval for modulating childhood myopia progression. Clinical guidelines may be of value for assisting practitioners in making clinical decisions based upon the current, best-available research evidence.

Visual Search in Behavioral Variant Frontotemporal Dementia.

BACKGROUND: Changes to visual search have shown specific patterns in a number of dementia subtypes. The cortical regions involved in the control of visual search overlap with the regions affected in behavioral variant frontotemporal dementia (bvFTD). Previous literature has examined visual search in bvFTD with smaller array sizes. OBJECTIVE: To examine the pattern of behavior shown by bvFTD patients while undertaking visual search in the presence of larger numbers of distractors to model increased cognitive load. METHODS: 15 bvFTD and 17 control participants undertook three visual search tasks: color, orientation, and conjunction searches. A wide range of array sizes was used, from 16 to 100 items arranged as a square. Behavior was quantified using accuracy, response time, and eye movements. RESULTS: BvFTD participants displayed a reduction in accuracy and an increased response time across all task types. BvFTD participants displayed an increase in number of objects examined and number of fixations made for color and conjunction tasks. Fixation duration was increased for orientation and conjunction (the more difficult tasks) but not color search. Results indicated the increase in time to response to be due to an increased intercept, with no significant difference in slope for the different tasks. CONCLUSION: BvFTD participants display a pattern of visual search behavior consisting of a decrease in accuracy, an increase in response time, and a corresponding increase in the number and length of eye movements made during visual search. The pattern seen corresponds to studies of frontal lobe damage, while differing in pattern from that seen in a range of other cognitive conditions.

Behavioral Variant Frontotemporal Dementia Performance on a Range of Saccadic Tasks.

BACKGROUND: Saccadic paradigms display changes across a number of degenerative conditions reflecting changes in the oculomotor pathway which in some conditions have been linked to disease presentation. OBJECTIVE: To examine a novel range of saccadic paradigms in behavioral variant frontotemporal dementia (bvFTD). METHODS: Prosaccade, predictive, self-paced, memory-guided, and anti-saccade tasks were examined in bvFTD patients and controls. RESULTS: A significant increase in latency for the bvFTD group was seen in all tasks. Self-paced saccades are reduced in number, memory-guided saccades display an increase in errors. Predictive saccades show an increased latency that does not remain when prosaccade latency changes are accounted for. While changes were seen across a range of paradigms, no individual task completely separated bvFTD from control participants. CONCLUSION: bvFTD patients as a group display a number of changes on saccadic testing which may reflect the frontal lobe changes seen in this condition.