Convergence insufficiency symptom survey: A tool to evaluate convergence excess in young adults.

PURPOSE: To determine the effectiveness of the Convergence Insufficiency Symptom Survey (CISS) in evaluating visual symptoms in young adults with convergence excess (CE). METHODS: A cross-sectional study was performed based on a population of optometry students. Comprehensive binocular vision tests including cover test, near point of convergence, fusional vergence and accommodative amplitude, were performed. Participants were categorised into three groups: normal binocular vision (NBV), CE and CE + accommodative insufficiency (AI) (i.e., CE + AI). The CISS was administered to each participant. An analysis of variance with Bonferroni correction was performed to compare clinical measures among the three groups. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of CISS to differentiate CE from the NBV population. RESULTS: A total of 181 participants were enrolled, including 96 in the NBV group, 66 in the CE group and 19 in the CE + AI group. A significant difference in CISS score was detected between the three groups (p < 0.001). Post-hoc tests showed significantly higher CISS scores in the CE group (16.7 ± 10.8) and the CE + AI group (19.7 ± 10.9) compared with the NBV group (12.2 ± 7.8) (p = 0.01 and p = 0.005, respectively), with no difference between the CE and the CE + AI groups (p = 0.52). The ROC curve showed the CISS poorly (but significantly) differentiated CE from NBV (area under the curve = 0.62, p = 0.01). The optimal cutoff value for a CISS score to differentiate CE was 16, with sensitivity and specificity of 52% and 72%, respectively. CONCLUSIONS: Young adults with CE had significantly higher CISS scores than those with NBV. Although using the CISS solely for diagnosing CE is not recommended, it can be used to provide a measure of symptoms in individuals identified as having CE based on clinical measurements.

Application of the Convergence Insufficiency Symptom Survey in Oculomotor Dysfunction and Accommodative Insufficiency.

SIGNIFICANCE: This study confirmed the application of the Convergence Insufficiency Symptom Survey (CISS) in distinguishing children with oculomotor dysfunction (OMD) from those with normal binocular vision (NBV) but not in distinguishing children with accommodative insufficiency (AI). PURPOSE: The purpose of this study was to determine the application of the CISS for quantifying symptoms in children aged 9 to 18 years with AI or OMD. METHODS: All participants (aged 9 to 18 years) underwent comprehensive binocular vision tests including visual acuity, cover test, near point of convergence, fusional vergence, accommodative amplitude, and the Developmental Eye Movement test to ascertain the presence of any vision conditions. According to the examination outcomes, participants were divided into four groups: NBV group, AI group, OMD group, and a group with both AI and OMD (AI-OMD). The CISS was individually administered to each participant. An ANOVA and a receiver operating characteristic curve were performed to evaluate the ability of the CISS to quantify symptoms in AI and OMD. RESULTS: A total of 82 participants were qualified for this study, with 18 in the NBV group, 21 in AI, 16 in OMD, and 27 in AI-OMD group. The mean CISS score was significantly different among the four groups (F = 4.19, P = .008). Post hoc tests showed significantly higher CISS scores in the OMD group than the NBV (P = .01) and the AI (P = .03) groups, but no differences were detected among other groups. Receiver operating characteristics curve showed a significant effect of the CISS score on predicting an OMD (area under curve = 0.78, P = .006). Using a CISS score of ≥15, good discrimination of OMD was obtained. CONCLUSIONS: Children with OMD (Developmental Eye Movement type II or IV) had higher CISS scores than ones with NBV. Using the CISS, children with AI did not report worse symptoms than children with NBV.

The impact of multimorbidity on severe COVID-19 outcomes in community and congregate settings.

Purpose: This study examined the impact of multimorbidity on severe COVID-19 outcomes in community and long-term care (LTC) settings, alone and in interaction with age and sex. Methods: We conducted a retrospective cohort study of all Ontarians who tested positive for COVID-19 between January-2020 and May-2021 with follow-up until June 2021. We used cox regression to evaluate the adjusted impact of multimorbidity, individual characteristics, and interactions on time to hospitalization and death (any cause). Results: 24.5% of the cohort had 2 or more pre-existing conditions. Multimorbidity was associated with 28% to 170% shorter time to hospitalization and death, respectively. However, predictors of hospitalization and death differed for people living in community and LTC. In community, increasing multimorbidity and age predicted shortened time to hospitalization and death. In LTC, we found none of the predictors examined were associated with time to hospitalization, except for increasing age that predicted reduced time to death up to 40.6 times. Sex was a predictor across all settings and outcomes: among male the risk of hospitalization or death was higher shortly after infection (e.g. HR for males at 14 days = 30.3) while among female risk was higher for both outcome in the longer term (e.g. HR for males at 150 days = 0.16). Age and sex modified the impact of multimorbidity in the community. Conclusion: Community-focused public health measures should be targeted and consider sociodemographic and clinical characteristics such as multimorbidity. In LTC settings, further research is needed to identify factors that may contribute to improved outcomes.

A prospective study of different test targets for the near point of convergence.

PURPOSE: To determine whether different test targets including an accommodative target (AT), a transilluminator (TR), and a transilluminator with a red lens (RL), affect the near point of convergence (NPC) value; and to determine which test target is most sensitive to identify convergence insufficiency (CI) in young adults. METHODS: Subjects were 36 optometry students from the Illinois College of Optometry, including 18 subjects with normal binocular vision (control group) and 18 subjects with CI. None of the subjects had accommodative insufficiency. The NPC break and recovery were measured by three methods: AT, TR, and RL. Each test method was administered by a different examiner and the test sequence was randomized. RESULTS: The mean NPC break values for AT, TR, and RL in the control group were 4.31, 3.76, and 4.08 cm respectively, compared to 10.05, 11.37 and 13.04 cm in the CI group. The mean recovery values were 6.23, 5.56, and 5.95 cm for AT, TR, and RL respectively in the control group, vs 12.21, 14.37, 16.40 cm in the CI group. Significant differences in NPC break and recovery values were detected in the CI group between RL and AT, but not between AT and TR, or TR and RL. There was no significant difference in NPC values using the three targets in the control group. For an NPC cut point of 6 cm (break) and 9 cm (recovery), RL had higher sensitivity (100%) and specificity (88.9%) as well as lower false positive (10%) and false negative (0%) values compared to AT. CONCLUSION: NPC with RL is a more sensitive method to identify abnormal findings and assist in diagnosing CI compared to using AT or TR. We recommend that NPC with RL be routinely used to evaluate patients suspected of having CI.

Diagnosing and managing functional visual complications after brain injury.

BACKGROUND: Brain injury caused by an arteriovenous malformation (AVM) hemorrhage is an uncommon occurrence in a teenager. An AVM is a congenital anomaly of unknown etiology, often described as a tangle of arteries and veins that may vary in length and width leading to a loss of capillary bed. The vessels can break down with time and cause hemorrhage or aneurysm. Hemorrhage occurs in a significant number of patients with AVM. Intracranial hemorrhage causes brain injury, which can lead to systemic and ocular complications, neurologic deficits, and death. CASE REPORT: A 15-year-old girl presented to our clinic with a chief complaint of horizontal diplopia while reading, lasting from seconds to 5 minutes. Nine months before the examination she had a ruptured cerebral AVM, then surgery to control the bleeding. She spent 6 weeks in a coma after surgery and woke up a hemiplegic. There were no visual problems before the bleeding. Our evaluation showed accommodative insufficiency, oculomotor dysfunction, dry eye syndrome, and a right beating latent nystagmus in both eyes. Perceptual testing showed a severe visual sequential memory deficit. The patient was given a reading prescription to aid with accommodation and was to use artificial tears and lacrilube ointment. At the follow-up examination, she reported increased efficiency and fewer episodes of diplopia while reading with bifocals and fewer dry eye symptoms since using the artificial tears. CONCLUSIONS: After a brain injury, a young adult can present with perceptual and visual efficiency problems as well as nystagmus. It is important to test all areas that may be affected by this type of event and to investigate all complaints thoroughly with continued follow-up care. A latent nystagmus was discovered during thorough near point testing. The visual perceptual testing helped to confirm the visual sequential memory deficit, which may otherwise have been overlooked. It is believed that the diplopic complaint and poor oculomotor skills were directly related to the newly acquired nystagmus.

An optometric approach to patients with sensory integration dysfunction.

BACKGROUND: Sensory integration dysfunction is a neurologic condition that can cause children to process environmental sensations in an inappropriate way. As a result, they may either seek out strong sensations or avoid even mild sensations. Some of the characteristics of these children may be hyperactivity, poor awareness of pain, high risk taking, listening to loud sounds, clumsiness, poor fine motor skills, poor gross motor skills, poor visual tracking, problems with sequencing, and problems with balance. Sensory integration dysfunction often is related to children with developmental disabilities, autism, and attention deficits. METHODS: Two children from the same family were examined for general eye examinations because of a history of sensory integration problems. J.H., an 11-year-old girl, and her 6-year-old half-brother, A.T., returned to the clinic for visual-perceptual testing: the Test of Variables of Attention (TOVA), the Developmental Eye Movement Test (DEM), and the Visagraph (Compevo AB, Stockholm, Sweden). The use of yoked prisms with these children was also explored. RESULTS: Both children showed oculomotility problems based on the DEM and Visagraph results. Whereas J.H. performed well on the visual-perceptual profile overall, A.T. showed problems in many areas such as reversals, visual spatial relations, visual sequential memory, visual form constancy, and attention. Both children were low hyperopes and showed positive postural and balance changes when tested with yoked prisms. CONCLUSIONS: Children with sensory integration dysfunction can have a number of signs and symptoms that may bring them to the optometrist's office. It is important to thoroughly test their visual, perceptual, and oculomotor systems to determine the best way to help these patients. The use of vision therapy and yoked prisms can be beneficial treatment options for many of these patients.

Chronic cigarette smoking is associated with diminished folate status, altered folate form distribution, and increased genetic damage in the buccal mucosa of healthy adults.

BACKGROUND: Smoking causes genetic damage in buccal cells and increases the risk of oral cancer. Because folate is instrumental in DNA synthesis and repair, it is a determinant of genetic stability and therefore might attenuate the genotoxic effects of smoking. OBJECTIVE: Our aim was to compare the presence of folate metabolites and select indicators of genetic damage in the mouths of chronic smokers and nonsmokers. DESIGN: Dietary, biochemical, and molecular correlates of folate status were measured in healthy smoker (n = 35) and nonsmoker (n = 21) groups of comparable age, sex, and body mass indexes. RESULTS: After correction for dietary intake, the smokers displayed lower plasma, erythrocyte, and buccal mucosal cell (BMC) folate (20%, 32%, and 50% lower, respectively; P < 0.05) and lower plasma vitamin B-12 and pyridoxal 5-phosphate (P < 0.05) than did nonsmokers. Folate in the BMCs of smokers comprised significantly greater proportions of pteroylmonoglutamate, formyltetrahydrofolate, and 5,10-methenyltetrahyrofolate than did folate in the BMCs of nonsmokers. Although the degree of genomic methylation and uracil incorporation in the buccal cells of the 2 groups were not significantly different, the BMC micronucleus index, a cytologic indicator of genetic damage, in the smokers was 2-fold that of the nonsmokers (9.57 compared with 4.44 micronuclei/1000 cells; P < 0.0001). Neither systemic nor oral folate status was an independent predictor of micronuclei. CONCLUSIONS: Chronic smoking is associated with a lower systemic status of several B vitamins, reduced oral folate, and changes in folate form distribution in the mouth. However, the cytologic damage that is evident in the mouths of smokers does not correlate with oral folate status.

A comparison of carotenoids, retinoids, and tocopherols in the serum and buccal mucosa of chronic cigarette smokers versus nonsmokers.

BACKGROUND: Cigarette smoking, a major risk factor for oropharyngeal cancer, is reported to alter oral levels of carotenoids and tocopherols. Such effects may be important because these nutrients, as well as retinoids, are putative chemoprotective agents. OBJECTIVES: To determine whether chronic smoking is associated with altered concentrations of these nutrients in serum and buccal mucosa; to distinguish whether such effects are ascribable to diet; and to determine whether oral concentrations of these nutrients correlate with a putative biomarker of oral cancer risk. METHODS: Serum and buccal mucosal cells (BMC) were analyzed for these nutrients and for BMC micronuclei in smokers (n = 35) and nonsmokers (n = 21). RESULTS: General linear regression with adjustments for dietary intake showed that smokers possess lower serum concentrations of beta- and alpha-carotene, cryptoxanthin, lutein, and zeaxanthin (P

A 10-year case report and current clinical review of chronic beta-hemolytic streptococcal keratoconjunctivitis.

BACKGROUND: Streptococcus is a common source of bacterial keratoconjunctivitis in adults. Affected patients often report decreased vision, foreign body sensation, redness, and a mucous discharge. Clinical signs reveal diffuse conjunctival injection, a conjunctival papillary response, corneal superficial punctate keratitis, and a mucopurulent discharge with corresponding visual acuity decrease. Culturing is mandatory in hyperacute cases and broad-spectrum treatment is advised until culture results are definitive. Recurrent cases may change in clinical appearance. Bacterial exotoxins may induce a severe inflammatory response as well. CASE REPORT: A case of bilateral recurrent bacterial keratoconjunctivitis in a 61-year-old man is reported, as well as a current clinical review of the literature. Aerobic culture yielded Streptococcus pyogenes, a beta-hemolytic group A streptococcus. After unsuccessful broad-spectrum antibiotic treatment with several agents, culture and sensitivity testing confirmed the diagnosis and adjustment of the treatment plan accordingly was successful. During the following 10 years, there were six episodes in the left eye and three episodes in the right eye with resultant inflammation and comeal pannus. Recent repeat culture and sensitivity testing showed that the streptococcus had changed to an atypical presentation. The university laboratory reported the findings to the State Department of Public Health, as this was a nonrespiratory isolate of group A streptococcus. CONCLUSION: Although culture is indicated in hyperacute bacterial keratoconjunctivitis, consider sensitivity testing in non-responsive cases. If the condition is recurrent and the clinical presentation appears different from previous episodes, suspect that the initial pathogen may be changing. Severe secondary inflammation may occur due to bacterial exotoxin reactions. Identification of the underlying causes is advised.