Occupational Therapy Practice in Schools: National Survey in Spain.

AIMS: Interdisciplinary collaboration between health and education professionals is one of the principles of inclusive education. This study aimed to describe the practices and service delivery by pediatric occupational therapists (OTs) in schools in Spain. METHODS: Data came from a convenience sample of pediatric OTs recruited through Spanish professional colleges and associations for a web-based survey, mixed-method research study. Thirty-five respondents were excluded because they didn't meet the eligibility criteria. Ninety-two responses were obtained for data analysis. Twenty-nine OTs (31.5%) work in schools (school-OTs), and sixty-three participants (68.5%) don't work there but collaborate with schools (non-school OTs). RESULTS: Participants support students with and without a medical diagnosis. Services provided by OTs external to the educational system are mainly funded by families or only partially covered. Findings show that most participants use standardized assessments and apply several intervention approaches. They believe there are barriers to the collaboration and implementation of occupational therapy services in schools. CONCLUSIONS: This preliminary study shows a need for changes in Spain's State and Regional Education legislation and provides recommendations to improve school service delivery. Pediatric OTs are encouraged to reflect on and identify opportunities for changes to enhance school-based occupational therapy practice in Spain.

Photometric and Colorimetric Evaluation of Phototherapy Instruments for Syntonic Treatment of Visual Anomalies.

SIGNIFICANCE: Ocular light exposure therapy has been used in optometric therapies to improve binocular anomalies such as accommodative or vergence dysfunctions, amblyopia therapy or to increase the visual field. Currently, syntonic phototherapy is used worldwide by behavioral optometrists, vision trainers, or occupational therapists, among others, although these treatments are supported by only a few research studies that lack consensus on the efficacy of this approach. PURPOSE: In this article, we highlight the optical characteristics of lamps without evaluating the efficacy of their use in optometric procedures. METHODS: Our work analyzes four devices often used in clinical practice in terms of spectral power distribution, illuminance levels at the corneal plane, and both theoretical photopic and melanopic contributions to the visual system. RESULTS: First, illuminance levels reaching the corneal plane depend on the characteristics of each lamp and their distance from where the eye should be positioned; for example, delta-theta filter photopic illuminance is 13.1, 93.7, 22.7, or 41.6 lux with the four evaluated devices. Second, filters or modes named the same differ in terms of their spectral power distribution. Third, substantial difference in color appearance has been found among the same configurations. CONCLUSIONS: The spectral and iluminance characteristics of syntonic systems used for vision therapy vary widely, including variations among filters with the same identifying characteristics. This provides significant sources of variability, which limit the ability to conduct evidence-based medicine clinical trials to assess the true efficacy of syntonic therapy. This study furthers our knowledge of syntonic phototherapy from a technical perspective; however, longitudinal research examining patients' evolution pre-lighting and post-lighting treatments is required to justify and understand the effects of light exposure and its impact on optometric and ocular parameters more clearly.

Comparison of two visual-verbal tests of ocular motility using an eye-tracker.

PURPOSE: This study aims to compare eye movements monitored with an eye tracker during two visuo-verbal tests for assessing ocular motility. The study explores the potential of digital assessment and eye tracking technology in enhancing the understanding of ocular motility during these tests. METHODS: 47 healthy participants were included (20 males, 27 females), with a mean age of 21.34±1.77 years. The participants underwent optometric examinations to ensure visual health and exclude any dysfunctions or pathologies. The experimental protocol involved the digitized versions of the DEM and King-Devick tests, monitored with an eye tracker. RESULTS: The vertical subtests of DEM test showed fewer saccades, longer fixation durations, smaller saccade amplitudes, and slower saccade speeds compared to the horizontal subtest. The King-Devick test exhibited comparable fixation and saccade numbers, while fixation duration slightly increased with test difficulty. Statistically significant differences were found between the tests, but a positive correlation was observed. CONCLUSIONS: Statistically significant differences were observed between the DEM and King-Devick tests, indicating that they measure similar aspects but are not interchangeable. The DEM test offers more comprehensive information with vertical saccade assessment. Test duration correlates positively with saccade and fixation count, fixation duration, and saccade speed.

Analysis of the vergence facility test using different prismatic dioptric powers.

CLINICAL RELEVANCE: The vergence facility (VF) test is important in a complete optometric examination, but there is still controversy over which prismatic power combinations to use according to the patient age, especially in children. BACKGROUND: The aim of this work is to study the VF test using three different prismatic power combinations in four age groups, with a view to determine the best prismatic power for performing the test. METHODS: The VF of 122 healthy subjects was evaluated using three prismatic flippers with different powers: 8∆ base-in with 8∆ base-out (8BI/8BO∆), 3BI/12BO∆ and 5BI/15BO∆. The number of cycles per minute (cpm) was counted. RESULTS: The participants were divided into four age groups. The mean age of group 1 was 6.69 ± 0.65 years, that of group 2 was 9.36 ± 0.87 years, that of group 3 was 12.08 ± 0.79 years and that of group 4 was 28.67 ± 8.11 years. The mean cpm value in VF was higher for near vision than in distance vision. The lowest cpm values were observed in the youngest group (group 1) (far vision: 8BI/8BO∆: 2.32 cpm, 3BI/12BO∆: 2.68 cpm and 5BI/15BO∆: 1.59 cpm; near vision: 8/8∆: 6.59 cpm, 3BI/12BO∆: 7.77 cpm and 5BI/15BO∆: 5.27 cpm). The cpm values increased progressively with age, with group 4 achieving the highest cpm values (far vision: 8BI/8BO∆: 3.61 cpm, 3BI/12BO∆: 8.56 cpm and 5BI/15BO∆: 5.28 cpm; near vision: 8BI/8BO∆: 10.22 cpm, 3BI/12BO∆: 12.28 cpm and 5BI/15BO∆: 10.89 cpm). CONCLUSIONS: VF increased with age. The youngest children achieved the lowest cpm values, which progressively increased until the highest cpm values were achieved in adults. The best results were found with 3BI/12BO∆ in all groups in near and far vision. Higher cpm values were achieved in near vision than in far vision with all flippers in all groups.

Hess Lancaster Screen Test with Eye Tracker: An Objective Method for the Measurement of Binocular Gaze Direction.

BACKGROUND: To objectively measure with an eye tracker both eye movement conjugacy and gaze direction in different positions when performing the Hess Lancaster Screen Test (HLST) in a sample of control subjects without binocular dysfunction and compare the results with those of the traditional subjective HLST performance. METHODS: The sample was selected avoiding subjects who suffered from suppression of one of the two eyes, visual acuity less than 20/25 on the Snellen chart in each eye, strabismus, or any symptom of binocular dysfunction that could alter the results. While performing the HLST, the examiner wrote down each of the points on a template in a traditional way while the eye tracker (Tobii Pro Fusion, Tobii AB, Danderyd, Sweden), placed in front of the subject, took objective measurements of the position of both eyes at each point. Of the 29 subjects recruited in this study, 13 subjects between 18 and 27 years old underwent the complete optometric examination and the HLST wearing anaglyph glasses; meanwhile, 16 people were excluded because of binocular or accommodative dysfunctions or because they didn't give reliable eye-tracking results. Additionally, a specific program called Etracker Parse Video (University of Zaragoza, Zaragoza, Spain) was developed to analyse the prismatic deviation between both eyes at each evaluated point. RESULTS: Similar horizontal prismatic deviations of visual axes were obtained in the different gaze positions with the Maddox rod, the manually annotated HLST, and the eye-tracker measurement. Variations were found in the magnitude of the deviation between methods but not in the direction. On the other hand, vertical deviations were more difficult for the examiner to detect and quantify, especially those with small magnitudes; more exact values were obtained when measuring objectively with the eye tracker. CONCLUSION: The HLST is very useful and allows the amount of heterophoria or heterotropia to be recorded in the patient's medical record in all the main gaze positions. This test is complementary; by itself, it is not diagnostic and does not replace a complete examination of binocular vision. The eye tracker is an objective method with which we can evaluate the HLST in patients with no binocular problems, obtaining more accurate results than when it is performed in the traditional manner.

Eye-Tracker Study of the Developmental Eye Movement Test in Young People without Binocular Dysfunctions.

BACKGROUND: The purpose of this study was to evaluate ocular motility in normal young adults when performing the Developmental Eye Movement (DEM) test using an infrared eye-tracker in a sample of young subjects without visual dysfunctions. METHODS: An optometric evaluation was carried out on 52 participants with a mean age of 21.00 ± 3.22 years to verify they did not have any binocular dysfunction, by completing a computerized version of the DEM test while their eye movements were recorded with an eye-tracker. A custom-written software was developed to analyse some specific parameters of ocular motility while performing each subtest (Test A, Test B and Test C) of the complete DEM test. RESULTS: The mean duration of the fixations was shorter in Test C (243.56 ± 46.18 s) than in Test A (493.52 ± 171.41 s) and Test B (484.20 ± 156.59 s). The mean adjusted horizontal (AdjHT: 35.24 ± 6.68 s) and vertical (VT: 33.58 ± 5.56 s) times were at the 45th and at the 40th percentile, respectively. In Test C, there was a high positive significant correlation between the saccadic speed (cc: 0.77; p < 0.001) and the saccadic length (cc: 0.74; p < 0.001) of both eyes. CONCLUSIONS: The eye-tracker is an objective method to evaluate the DEM test in subjects without binocular dysfunctions, measuring and quantifying ocular motility parameters that are impossible with the traditional subjective method. The eye movements of both eyes are conjugated in each subject, having saccades of the same length and speed.

Evaluation of anterior chamber parameters with spectral-domain optical coherence tomography.

PURPOSE: To evaluate several anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography and to describe the repeatability and reproducibility of this method. STUDY DESIGN: Prospective clinical study. METHODS: Fifty-two eyes of 52 healthy volunteers were enrolled. Manual measurements of the anterior chamber angle (ACA500 and ACA750), angle opening distance (AOD500 and AOD750), angle-to-angle distance (ATA), anterior chamber width (ACW), and lens vault (LV) were obtained. RESULTS: The mean nasal ACA500 was 44.87 ± 12.92°; ACA750, 43.94 ± 10.41°; AOD500, 672.54 ± 270.19 µm; AOD750, 881.87 ± 290.55 µm. The mean temporal ACA500 was 41.46 ± 11.20°; ACA750, 41.27 ± 11.31°; AOD500, 603.15 ± 232.28 µm; AOD750, 823.46 ± 308.76 µm. The differences between the corresponding nasal and temporal parameters were statistically significant. The ACW was 11.97 ± 0.42 mm, the ATA was 12.10 ± 0.43 mm, and the LV was 3.71 ± 232.93 µm. The ACA was highly associated with the LV. The intraclass correlation coefficients ranged from 0.984 to 0.999 for the intraobserver repeatability and from 0.966 to 0.998 for the interobserver reproducibility. CONCLUSIONS: This study assessed anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography. This technique reveals the spatial relationships of the ocular structures, provides high-resolution images, and results in high degrees of intraobserver and interobserver repeatabilities.

Evaluation of Total Corneal Thickness and Corneal Layers With Spectral-Domain Optical Coherence Tomography.

PURPOSE: To evaluate total corneal thickness and corneal layers in healthy young adults using spectral-domain optical coherence tomography and to describe its repeatability and reproducibility. METHODS: Eighty-six eyes from 86 healthy volunteers were prospectively and consecutively enrolled. Manual measurements of central corneal thickness (CCT) and central thickness of epithelium, Bowman's layer, stroma, and the Descemet-endothelium complex were performed using Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). To assess the reliability of the repeated measurements, intraclass correlation coefficients and coefficients of variation were used. RESULTS: Mean CCT, epithelium, Bowman's layer, stroma, and Descemet-endothelium values were 555.50 ± 29.64, 54.60 ± 4.25, 16.70 ± 1.73, 467.51 ± 28.91, and 16.74 ± 1.66 µm, respectively. The intraclass correlation coefficients ranged from 0.746 (Bowman's layer) to 0.999 (CCT and stroma) and from 0.483 (Bowman's layer) to 0.995 (CCT) and 0.998 (stroma) for intraobserver repeatability and interobserver reproducibility, respectively. The measurements showed coefficients of variation lower than 11% in all cases. CONCLUSIONS: This study establishes a normal database for corneal thickness and all its layers in healthy young adults with spectral-domain optical coherence tomography. This device exhibited a high degree of intraobserver repeatability and interobserver reproducibility for all regions except Bowman's layer.

Evaluation of patient visual comfort and repeatability of refractive values in non-presbyopic healthy eyes.

AIM: To evaluate the intra-operator repeatability in healthy subjects using the WAM-5500 auto-kerato/refractometer and the iTrace aberrometer, to compare the refractive values and the subjective refraction obtained with both devices and to determine which of these three spherocylindrical corrections allows the subject to achieve the best visual comfort. METHODS: Forty-two non-presbyopic healthy eyes of 42 subjects were enrolled in this prospective study. Refractive values were compared, evaluating the repeatability, the relationship between the methods and the best visual comfort obtained. RESULTS: Sphere, cylinder and axis results showed good intraclass correlation coefficients (ICC); the highest ICC was obtained using the spherical refraction with the autorefractometer and the aberrometer, achieving levels of 0.999 and 0.998, respectively. The power vector (PV) was calculated for each refraction method, and the results indicated that there were no statistically significant differences between them (P>0.05). Direct comparison of PV measurements using the three methods showed that aberrometer refraction gave the highest values, followed by the subjective values; the autorefractometer gave the lowest values. The subjective method correction was most frequently chosen as the first selection. Equal values were found for the autorefractometer and the aberrometer as the second selection. CONCLUSION: The iTrace aberrometer and the WAM-5500 auto-kerato/refractometer showed high levels of repeatability in healthy eyes. Refractive corrections with the aberrometer, the autorefractometer and subjective methods presented similar results, but spherocylindrical subjective correction was the most frequently selected option. These technologies can be used as complements in refractive evaluation, but they should not replace subjective refraction.

Assessment of Visual and Chromatic Functions in a Rodent Model of Retinal Degeneration.

PURPOSE: We evaluated the photoreceptor response of pigmented P23H and normal pigmented Long Evans (LE) rats over time using functional tests in variable lighting conditions. METHODS: Pigmented P23H rats were studied by optomotor testing and electroretinogram (ERG) recordings at P30, P150, and P240. Pigmented LE rats were used as a normal wild-type control. Stimuli were modified with colored filters. Neutral density filters were used to reduce luminance. RESULTS: Age-related decreases in visual acuity (VA) and contrast sensitivity (CS) were observed in P23H rats. Good correlations in measurements without filter and with green filter were observed between LE and P23H P30 rat values. Differences between groups were smaller with red and purple filters. A strong relationship with luminance was observed in LE rats (VA and CS) and with P23H P30 rats (CS). A decline in the ERG responses of P23H rats was consistent with the gradual loss of photoreceptors. Differences in a- and b-wave amplitudes with different colored filters were negligible with the exception of the red filter, which resulted in smaller responses. CONCLUSIONS: Visual function parameters decreased with age in pigmented P23H rats. Irrespective of luminance, color filter, and retinal degeneration, minimum thresholds of VA and CS were found. Smaller differences than expected were found using color filters. Responses to functional tests at long wavelengths were observed, where there is very low photoreceptor spectral sensitivity. The use of filters with functional testing could minimize light-induced retinal damage in rats.

Comparison of anterior segment measurements obtained by three different devices in healthy eyes.

PURPOSE: To assess the normal values and the repeatability of the Galilei Dual Scheimpflug Analyzer (GDSA), the biometer IOL Master, and the autokerato/refractometer WAM 5500 in anterior segment examinations. METHODS: Eighty-eight eyes from 88 healthy volunteers were prospectively and consecutively recruited. The repeatability was assessed, calculating the intraclass correlation coefficient (ICC). RESULTS: The correlations among the repeated measurements showed nearly perfect reliability (ICC > 0.81) for all of the parameters, except corneal astigmatism Galilei (0.79) and WAM (0.68). There were statistically significant differences (P < 0.001) between the values of the flat simulated keratometry (SimK) and the steep SimK measured by GDSA and the other methods; however, there were no statistically significant differences for the values obtained with the IOL Master and WAM 5500 (P = 0.302 and P = 0.172, resp.) or between the values of the ACD (P < 0.001) and WTW (P = 0.007) measured by the IOL Master and GDSA. CONCLUSIONS: The anterior segment measurements from the IOL Master and WAM 5500 were highly repeatable, comparable, and well correlated. In healthy young persons, the evaluated parameters had very good repeatability, although significant differences were found between the GDSA and IOL Master and between the GDSA and WAM 5500.

Repeatability of ocular measurements with a dual-Scheimpflug analyzer in healthy eyes.

PURPOSE: To assess the repeatability of the Galilei dual Scheimpflug analyzer (GDSA) in anterior segment examination. METHODS: Fifty-two eyes from 52 healthy volunteers were prospectively and consecutively recruited. Anatomic, axial, refractive, and instantaneous parameters were measured with GDSA to provide a complete characterization of the anterior segment. Repeatability was assessed calculating intraclass correlation coefficient (ICC), and coefficient of variation (COV). RESULTS: Correlation among repeated measurements showed almost perfect reliability (ICC>0.81) for all parameters except thinnest central corneal thickness (CCT) (0.78), corneal thickness average out (0.79), and posterior axial curvature average out (0.60). Repeatability was excellent (COV<10%) for all parameters except anterior chamber volume and, superior iridocorneal angle and eccentricities. In these last three parameters, repeatability limits were excessively high compared to the mean. CONCLUSIONS: GDSA in healthy young persons had an almost perfect correlation in measuring anatomic, axial, instantaneous, and refractive parameters with greater variability for peripheral terms. Repeatability of anatomical parameters like pachymetry, anterior chamber, or iridocorneal angle and eccentricity were limited. In healthy young persons, the other evaluated parameters had very good repeatability and their limits of agreement showed excellent clinical results for this device.