Short Wavelength (Blue) Light Is Protective for Lens-Induced Myopia in Guinea Pigs Potentially Through a Retinoic Acid-Related Mechanism.

Purpose: To investigate the effect of short-wavelength light (SL) on guinea pigs with lens-induced myopia (LIM) and the possible retinoic acid (RA)-related mechanisms. Methods: Two-week-old guinea pigs (n = 60) with monocular -5D lenses were reared under white light (WL, 580 lux) or SL (440 nm, 500 lux). The left eyes were uncovered as control. Refractive error (RE) and axial length (AL) were measured at baseline, one week, two weeks, and four weeks after intervention. Retinal RA was measured from four guinea pigs after two and four weeks of treatment with HPLC. Two-week-old guinea pigs (n = 52) with monocular -5D lens were fed with either RA or its synthesis inhibitor citral every third day in the morning, and half from each group were reared under WL or SL conditions. RE and AL were recorded at baseline and two and four weeks after intervention. Retinal RA was measured after four weeks of intervention. Results: At the end of treatment, guinea pigs exposed to SL were less myopic than to WL (2.06 ± 1.69D vs. -1.00 ± 1.88D), accompanied with shorter AL (P = 0.01) and less retinal RA (P = 0.02). SL reduced retinal RA even after exogenous RA supplementation (P = 0.02) and decelerated LIM compared to WL (1.66 ± 1.03D vs. -3.53 ± 0.90D). Citral slowed ocular growth, leading to similar RE in W+CI and S+CI groups (3.39 ± 1.65D vs. 5.25 ± 0.80D). Conclusions: Overall, SL reduced LIM in guinea pigs, even in those supplemented with oral RA, accompanied by reduced retinal RA levels. Oral RA accelerated eye elongation, but citral equally decelerated eye elongation under SL and WL with no significant retinal RA reduction.

Components of the item selection algorithm in computerized adaptive testing / 보건의료교육평가

Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items with the difficulty level that is most relevant to each individual test taker. This paper explains the 3 components of a conventional CAT item selection algorithm: test content balancing, the item selection criterion, and item exposure control. Several noteworthy methodologies underlie each component. The test script method and constrained CAT method are used for test content balancing. Item selection criteria include the maximized Fisher information criterion, the b-matching method, the a-stratification method, the weighted likelihood information criterion, the efficiency balanced information criterion, and the Kullback-Leibler information criterion. The randomesque method, the Sympson-Hetter method, the unconditional and conditional multinomial methods, and the fade-away method are used for item exposure control. Several holistic approaches to CAT use automated test assembly methods, such as the shadow test approach and the weighted deviation model. Item usage and exposure count vary depending on the item selection criterion and exposure control method. Finally, other important factors to consider when determining an appropriate CAT design are the computer resources requirement, the size of item pools, and the test length. The logic of CAT is now being adopted in the field of adaptive learning, which integrates the learning aspect and the (formative) assessment aspect of education into a continuous, individualized learning experience. Therefore, the algorithms and technologies described in this review may be able to help medical health educators and high-stakes test developers to adopt CAT more actively and efficiently.

Ocular findings on follow-up in children who received phototherapy for neonatal jaundice.

BACKGROUND: To evaluate the ocular findings in children between 3 and 5 years of age who had received phototherapy in the neonatal period and to investigate whether they had phototherapy-related permanent ocular damage clinically. METHODS: The phototherapy group (n = 57) consisted of children who had undergone phototherapy for at least 24 h, and the control group (n = 43) comprised children who had not received phototherapy. Ophthalmic examinations consisted of assessment of visual acuity, convergence near point, ocular movements, ocular alignment, dynamic retinoscopy, cycloplegic refraction and biomicroscopic examination of anterior segment and posterior segment (using a 90 D lens in the latest). RESULTS: All children were orthophoric and had normal eye movements. A significant difference was found between the phototherapy group and control group regarding convergence near point 3.0 (2.0-5.0) vs 3.0 (2.0-5.0) (p = 0.018), right cycloplegic spherical equivalent 1.0 (0.0-3.0) vs 0.75 (0.0-4.75) (p = 0.011) and left cycloplegic spherical equivalent 1.0 (0.075-3.0) vs 0.75 (0.0-5.25) (p = 0.006).The study groups were similar according to cycloplegic spherical and cylindrical refractions. However, no significant difference was found between the groups regarding the need for eye glasses. CONCLUSION: Although there were significant differences between the phototherapy and the control groups according to the convergence near point and right and the left eye cycloplegic spherical equivalent, the similarity between the groups regarding the need for eyeglasses suggested that difference was clinically insignificant.

Refractive status of Chinese with laser-treated retinopathy of prematurity.

PURPOSE: To analyze changes in myopia, astigmatism, and anisometropia after laser treatment of retinopathy of prematurity (ROP), including aggressive posterior retinopathy of prematurity (APROP), in Mainland Chinese children. METHODS: This was a retrospective study of children who had laser treatment for threshold or type 1 prethreshold ROP between January 2004 and October 2012 and age-matched control subjects with spontaneously regressed type 2 prethreshold ROP. One hundred fifteen eyes of 60 patients were included as the laser-treated group, which were further subdivided into APROP and non-APROP groups. Thirty-seven eyes of 20 patients who were diagnosed during the same period were included as the control group. Between 12 and 36 months postnatal age (PA) (mean [±SD], 22.9 [±8.1] months), cycloplegic retinoscopy was performed to measure refractive outcomes. A general linear model was used to analyze refractive changes among different groups at each PA. RESULTS: After adjusting for PA and the correlation between right and left eyes, the magnitude and proportion of astigmatism (p = 0.04 and p = 0.004, respectively) and myopia (p < 0.0001 and p = 0.006, respectively) were greater in the laser-treated group than in the control group. The differences in myopia were even greater in children with APROP than those with non-APROP, whereas the differences in astigmatism were not. Eyes with APROP had higher prevalence of high myopia and spherical anisometropia than the control (p = 0.002 and p = 0.02, respectively) and the non-APROP groups (p < 0.0001 and p = 0.04, respectively). CONCLUSIONS: Children with laser treatment for ROP, including APROP, tended to have higher myopia, astigmatism, and anisometropia, which may progress to amblyopia. These findings highlight the need for regular refractive screening after laser treatment of ROP.

The Youngest Patient with Bilateral Keratoconus Secondary to Chronic Persistent Eye Rubbing.

We present the case of a four-year-old girl with bilateral keratoconus secondary to chronic persistent eye rubbing. She was referred to our clinic with intractable ocular itching and low vision. According to her family, she was generally rubbing her eyes. On slit-lamp biomicroscopic examination, bilateral papillary reactions were seen on the upper tarsal conjunctiva. Clinical examination and corneal topography were compatible with keratoconus. The patient's visual acuity was not evaluated because of cooperation difficulties. Systemic examination was normal. In fact, trauma may be the common underlying factor in eye rubbing and may cause development of keratoconus, even in the early years. To the best of our knowledge, this is the youngest patient with bilateral keratoconus secondary to chronic persistent eye rubbing in the literature. Keratoconus should be kept in mind in patients with severe ocular itching, even in small children.

Successful treatment of central retinal artery thromboembolism with ocular massage and intravenous acetazolamide.

A 67-year-old woman presented with left-sided headache and blurred vision, worse during hypertensive episodes. CT angiography showed a 4 mm left internal carotid artery (ICA) aneurysm incorporating the ophthalmic artery. She passed a test balloon occlusion, so the aneurysm was coil occluded, without immediate complication. Four days postprocedure she experienced sudden loss of vision in the left eye and funduscopy showed central retinal artery occlusion secondary to emboli from the coiled aneurysm. She was treated promptly with intravenous acetazolamide and ocular massage and regained full visual acuity. Thromboembolism to the eye during or after neurointerventional treatment is a relatively rare but devastating complication. This report demonstrates the effectiveness of combined intravenous acetazolamide and ocular massage in dealing with this complication when delivered promptly.

[Development and first results of fast and cost-effective examination methods for an ophthalmological screening within the National Cohort]. / Entwicklung und erste Anwendungserfahrungen einer schnellen und kostengünstigen ophthalmologischen Untersuchung für die Nationale Kohorte.

BACKGROUND: For an implemented ophthalmological screening within a German long-term cohort study (National Cohort) simple and effective methods for an examination of visual acuity and for non-mydriatic retina photografies should be evaluated. Furthermore standard operating-procedures (SOP) should be developed. METHODS: In the years 2011 and 2012 pinhole visual acuity measurements and automated retina photographies (DRS, CenterVue S. p. a., Padua, Italy) were made at three different epidemiological study centers within Germany. Furthermore, anterior segment images were taken by the camera. Standard operating procedures (SOP) regarding the ophthalmological screening were developed and evaluated within the study. The main question was whether it is possible to implement the screening methods within the National Cohort. Further main outcomes were quality and interpretability of the taken images. RESULTS: 457 subjects (914 eyes) were examined within the investigation. Median VA was 0.8 for right and left eyes (p > 0.42). Image quality of the photographies was good in 491 cases (54 %), fair in 239 cases (26 %) and bad in 179 cases (20 %). The usability of the images was without limitations in 686 cases (75 %), limited in 152 cases (17 %) and not given in 71 cases (8 %). Increasing age of the subjects was slightly correlated with decreasing image quality (r = 0.26) and decreasing image usability (r = 0.2). Anterior segment photographies were usable in 176 eyes (56 %). CONCLUSION: The developed screening method fulfilled the specifications of the National Cohort. The used pinhole visual acuity examination was fast and cheap. Image quality and usability of the retina photographies could be improved with prolonged pupil recovery times. The quality of the anterior segment images could not fulfill the expectations and were taken out of the further examinations of the ophthalmological screening. The written SOP showed good acceptance within the investigators' daily routine. The ophthalmological screening within the National Cohort generates information (e. g., pathologies of the vessels or of the retina) which are useful not only from an ophthalmological point of view.

Protective effects of taurine against alloxan-induced diabetic cataracts and refraction changes in New Zealand White rabbits.

The present study examined the protective effects of taurine on alloxan-induced diabetic cataracts and lens damage in male New Zealand White rabbits. The animals were randomly divided into three treatment groups: (1) normal control (vehicle administration); (2) diabetes (100 mg/kg alloxan administration); and (3) diabetes + taurine (1% [w/v] taurine dissolved in drinking water and alloxan administration). The results showed that alloxan-induced diabetes caused significant (p < 0.05) hyperglycemia, hyperopic refraction shifts, cataract formation and lens damage compared with the normal control group. In contrast, the administration of taurine for 24 weeks significantly ameliorated the alloxan-induced elevated levels of blood glucose, level of hyperopic refraction error shifts in the eyes and progression of diabetic cataract formation in the lens in rabbits. Moreover, histopathology showed that the taurine supplement reduced the incidence of lens lesions induced by hyperglycemia. Overall, the studies demonstrate that taurine exhibits potent protective effects against alloxan-induced diabetic cataracts and refraction changes in rabbits.

Effect of osteopathy in the cranial field on visual function--a pilot study.

CONTEXT: The effects of osteopathy in the cranial field on visual function-particularly on changes in the visual field and on the binocular alignment of the eyes-have been poorly characterized in the literature. The authors examined whether osteopathy in the cranial field resulted in an immediate, measurable change in visual function among a sample of adults with cranial asymmetry. STUDY DESIGN: Randomized controlled double-blinded pilot clinical trial. SUBJECTS: Adult volunteers between ages 18 and 35 years who were free of strabismus or active ocular or systemic disease were recruited. Inclusion criteria were refractive error ranging between six diopters of myopia and five diopters of hyperopia, regular astigmatism of any amount, and cranial somatic dysfunction. INTERVENTION: All subjects were randomly assigned to the treatment or control group. The treatment group received a single intervention of osteopathy in the cranial field to correct cranial dysfunction. The control group received light pressure of a few ounces of force applied to the cranium without osteopathic manipulative treatment. MEASUREMENTS: Preintervention and postintervention optometric examinations consisted of distant visual acuity testing, Donder push-up (ie, accommodative system) testing, local stereoacuity testing, pupillary size measurements, and vergence system (ie, cover test with prism neutralization, near point of convergence) testing. Global stereoacuity testing and retinoscopy were performed only in preintervention to determine whether subjects met inclusion criteria. Analysis of variance (ANOVA) was performed for all ocular measures. RESULTS: Twenty-nine subjects completed the trial-15 in the treatment group and 14 in the control group. A hierarchical ANOVA revealed statistically significant effects within the treatment group and within the control group (P <.05) in distance visual acuity of the right eye (OD) and left eye (OS), local stereoacuity, pupillary size measured under dim illumination OD and OS, and near point of convergence break and recovery. For the treatment group vs the control group, a statistically significant effect was observed in pupillary size measured under bright illumination OS (P <.05). CONCLUSIONS: The present study suggests that osteopathy in the cranial field may result in beneficial effects on visual function in adults with cranial asymmetry. However, this finding requires additional investigation with a larger sample size and longer intervention and follow-up periods. (ClinicalTrials.gov number NCT00510562).

High measured intraocular pressure in children with recessive congenital hereditary endothelial dystrophy.

PURPOSE: To report the phenomenon of high measured intraocular pressure in recessive congenital hereditary endothelial dystrophy. METHODS: A case series was retrospectively reviewed. RESULTS: Five infants with significant congenital corneal haze had increased measured intraocular pressure that remained high despite drug treatment and surgery to decrease intraocular pressure. The clinical diagnosis of recessive congenital hereditary endothelial dystrophy without glaucoma was made based on the absence of buphthalmos, a distinct pattern of mosaic corneal haze with significant corneal thickness, and absence of cupping in healthy-appearing optic nerve heads. CONCLUSION: Intraocular pressure can be falsely elevated in some children with recessive congenital hereditary endothelial dystrophy, leading to confusion with congenital glaucoma.

Automated retinal image analysis over the internet.

Retinal clinicians and researchers make extensive use of images, and the current emphasis is on digital imaging of the retinal fundus. The goal of this paper is to introduce a system, known as retinal image vessel extraction and registration system, which provides the community of retinal clinicians, researchers, and study directors an integrated suite of advanced digital retinal image analysis tools over the Internet. The capabilities include vasculature tracing and morphometry, joint (simultaneous) montaging of multiple retinal fields, cross-modality registration (color/red-free fundus photographs and fluorescein angiograms), and generation of flicker animations for visualization of changes from longitudinal image sequences. Each capability has been carefully validated in our previous research work. The integrated Internet-based system can enable significant advances in retina-related clinical diagnosis, visualization of the complete fundus at full resolution from multiple low-angle views, analysis of longitudinal changes, research on the retinal vasculature, and objective, quantitative computer-assisted scoring of clinical trials imagery. It could pave the way for future screening services from optometry facilities.

[Investigation of the related factors between newborn history and red reflex]. / Investigação do reflexo vermelho em recém-nascidos e sua relação com fatores da história neonatal.

The red reflex test is an important part of the newborn's ocular exam. This study investigated the relationship between red reflex in premature newborns (PN) and factors of the newborn history. It's a descriptive, exploratory, quantitative study conducted in a public maternity in Fortaleza, State of Ceará, with 114 PN between the months of April and May of 2004. For data registration was used a questionnaire, and for the ocular exam a direct ophthalmoscope. Data showed the following findings: 68% of PN had an Apgar under seven during the first minute; 112 were submitted to oxygen therapy; and 68 to phototherapy. As for the red reflex, 13 (11%) showed alterations, with significant statistical association between red reflex and the Apgar during the first minute of life (p = 0.041). The results cause concern because 10 of the 13 PN with red reflex showed retinopathy of prematurity.

[Guidelines for surgery in the treatment of rhegmatogenous detachments (buckle, pneumatic retinopexy, endosurgery)]. / Richtlinien zur Indikationsstellung bei netzhautchirurgischen Massnahmen (einfache Buckelchirurgie, pneumatische Retinopexie, Endotamponadechirurgie).

In view of diverging opinions for retinal detachment surgery (pneumatic retinopexy or buckling procedure with or without drainage versus primary vitrectomy without external buckling) pneumatic retinopexy, orbital balloon, buckling procedures (sponge, encircling band) are discussed with a short historical background and a brief description of current technology. Pros and cons of the individual technique are discussed on the basis of monographs and articles. From the repertoire of a retinal surgeon typical case examples are presented, different operation methods discussed, advantages and disadvantages of each individual technique emphasized. A goal of the work is to provide a practicable manual for the less experienced surgeon and the expert, who experiences an increasing trend to vitrectomy techniques instead of the conventional buckling procedures.