Comparison of the influence of alcohol and cannabis on the dynamics of the accommodative response.

PURPOSE: To assess and compare the changes produced by the two most commonly used substances, alcohol and cannabis, on accommodation dynamics. METHODS: A total of 38 young participants (19 females) were enrolled in the study. They were assigned to two groups: a cannabis group (N = 19) and an alcohol group. Participants in the cannabis group underwent two randomized sessions: a baseline session and a session after smoking a cigarette. Participants in the alcohol group underwent three randomized sessions: a baseline session, a session after the intake of 300 ml of red wine (Alcohol 1), and other after the ingestion of 450 ml of wine (Alcohol 2). For the accommodation assessment, the open-field autorefractor WAM-5500 was used. RESULTS: The decrease of the mean velocity of the accommodative response produced by Alcohol 2 condition was significantly greater than that observed for Alcohol 1 and Cannabis (p = 0.046). The direction of the accommodation (near-distance and distance-near) had no effect on the deterioration of the accommodation dynamics following substance use. The target distance had a significant effect on the decrease of the mean velocity following substance use (p = 0.002). The decrease of the amplitude of the accommodative response was associated with a decrease of the peak velocity (p = 0.004) and the increase of the accommodative lag (p < 0.001). CONCLUSIONS: A moderate-high dose of alcohol impairs accommodation dynamics to a greater extent that lower dose of alcohol or smoked cannabis. The deterioration of the accommodation mean speed was higher for a shorter target distance.

Self-Regulation of Driving Behavior Under the Influence of Cannabis: The Role of Driving Complexity and Driver Vision.

OBJECTIVE: This study analyzed the self-regulation behaviors of drivers under the influence of cannabis and its relationship with road complexity and some driver traits, including visual deterioration. BACKGROUND: Cannabis is the illicit drug most often detected in drivers; its use results in significant negative effects in terms of visual function. Self-regulation behaviors involve the mechanisms used by drivers to maintain or reduce the risk resulting from different circumstances or the driving environment. METHODS: Thirty-one young, occasional cannabis users were assessed both in a baseline session and after smoking cannabis. We evaluated the visual function (visual acuity and contrast sensitivity) and driver self-regulation variables of both longitudinal and lateral control as the speed adaptation and standard deviation of lateral position (SDLP). RESULTS: Visual function was significantly impaired after cannabis use. Recreational cannabis use did not result in self-regulation, although some road features such as curved roads did determine self-regulation. Male participants adopted mean faster driving speeds with respect to the speed limit. Driver age also determined better lateral control with lower SDLPs. In addition, visual impairment resulting from cannabis use (contrast sensitivity) was linked with self-regulation by changes in longitudinal and lateral control. CONCLUSION: Contrast sensitivity could be a good indicator of individual visual status to help determine how drivers self-regulate their driving both in normal conditions and while under the influence of cannabis. APPLICATION: The findings provide new insights about driver self-regulation under cannabis effects and are useful for policy making and awareness campaigns.

Changes in accommodation dynamics after alcohol consumption, for two different doses.

PURPOSE: The purpose of this work was to evaluate possible changes in accommodation dynamics caused by the intake of different doses of alcohol. METHODS: A total of 20 emmetropic subjects took part in the study. This involved a baseline session, a session after consuming 300 ml of red wine, and another after consuming 450 ml of the same wine. The accommodation dynamics were characterized for two target vergences (2.5D and 5.0D) using the Grand Seiko WAM-5500 autorefractor, which provided the accommodation and disaccommodation variables. The accommodative facility was measured using flippers of ± 2.00 D. RESULTS: The mean accommodation velocities and velocity peaks were significantly lower after consuming alcohol for the higher intake, particularly for 5.0D (p < 0.05). The response time was significantly higher only for the high-intake condition for 5.0D (p < 0.05). The accommodative microfluctuations were significantly higher for both target vergences for the high-intake condition (p < 0.05). The accommodative facility was significantly impaired in both intake conditions (p < 0.05). The breath alcohol content (BrAC) was correlated with the deterioration of some variables: the accommodative facility (ρ = 0.490), and the velocity peak for 2.5D (ρ = 0.349) and 5.0D (ρ = 0.387). CONCLUSIONS: Alcohol intake affects accommodation dynamics, causing deterioration in the mean velocity, velocity peak, response time, accommodative microfluctuations, and accommodative facility, especially for the target vergence of 5.0D and high alcohol dosages.

Dynamics of the accommodative response after smoking cannabis.

PURPOSE: Cannabis is the most widely consumed illicit drug worldwide. It has been suggested that cannabis could generate blurred vision during reading tasks. The goal of this study was to objectively assess the acute effects of smoking cannabis on the dynamics of ocular accommodation. The influence of other factors, including target distance and the direction of accommodation, as well as personal characteristics, were also analysed. METHODS: Nineteen young people who were occasional cannabis users participated in the study (mean age 22.53 [3.12] years). Their usage profiles were evaluated by means of the Cannabis Use Disorders Identification Test-revised (CUDIT-r). The dynamics of the accommodative response were evaluated using an open-field auto refractor (Grand Seiko WAM-5500). The participants completed two different experimental sessions, one week apart, and in random order (baseline session and after smoking cannabis). During these sessions, the amplitude of the response (D), mean velocity (D/s), peak velocity (D/s), response time (s), accommodative lag (D) and accommodation variability (D) were measured. RESULTS: The results indicated that cannabis use had a significant main effect on the mean accommodation/disaccommodation velocity (F1,13  = 7.21; p = 0.02; ηp2  = 0.396). Cannabis consumption also interacted significantly with other factors. Response time showed a significant two-way interaction between condition × target distance (F1,13  = 11.71; p = 0.005; ηp2  = 0.474) and condition × accommodation direction (F1,13  = 8.71; p = 0.01; ηp2  = 0.401). For mean velocity, two-way interactions were found between condition × age (F1,13  = 6.03; p = 0.03; ηp2  = 0.354), condition × CUDIT-r score (F1,13  = 6.03; p = 0.03; ηp2  = 0.356) and condition × target distance (F1,13  = 7.20; p = 0.02; ηp2  = 0.396). CONCLUSIONS: These findings suggest that cannabis use can alter the accommodation process, although further studies should be carried out to explore the role of attention deficits. According to these results, certain daily activities that depend on an accurate accommodative function may be affected by cannabis use.

The short-term effects of artificially-impaired binocular vision on driving performance.

Appropriate visual function is paramount to ensuring adequate driving performance and road safety. Here, we examined the influence of sudden artificially-impaired binocular vision on driving performance using a car simulator. Twenty-four young drivers (mean age 22.42 ± 3.19 years) drove under three different visual conditions (natural driving, monocular blur, and monocular occlusion) through three different traffic environments with low, medium, and high levels of complexity (highway, rural, and city, respectively). We assessed their driving performance, perceived level of task complexity, and subjectively-experienced road safety. Furthermore, as a manipulation check, we also evaluated the drivers' cardiac vagal responses, as a well-known index of task complexity. The sudden deterioration of binocular vision caused unsafe driving behaviours (distance out of the road and maximum breaking intensity) in the most complex traffic environments. Specific self-regulatory strategies (i.e. increased cardiac vagal responses) and subjective responses corroborated these results. Practitioner summary: This study provides evidence that the sudden deterioration of binocular vision has a detrimental effect on simulated driving performance. Our analysis of cardiovascular functioning shows that drivers adopt self-regulatory strategies when their binocular vision functioning is compromised. Abbreviations: VA: visual acuity; BV: binocular vision; HRV: heart rate variability; NASA: TLX: NASA-Task Load Index; SSS: Stanford Sleepiness scale; RMSSD: root mean square of successive difference; HF: high-frequency.

Prevalence of refractive errors in children in Equatorial Guinea.

PURPOSE: The aim of this work is to evaluate the epidemiological aspects of the refractive errors in school-aged children in Malabo (Island of Bioko), Equatorial Guinea (western-central Africa). METHODS: A total of 425 schoolchildren (209 male subjects and 216 female subjects, aged between 6 and 16 years) were examined to evaluate their refraction errors in Malabo, Equatorial Guinea (western-central Africa). The examination included autorefraction with cycloplegia, measurement of visual acuity (VA) for far vision, and the curvature radii of the main meridians of the anterior surface of the cornea. RESULTS: A low prevalence of myopia was found (≤-0.50 diopters [D] spherical equivalent), with unilateral and bilateral myopia being 10.4 and 5.2%, respectively. The prevalence of unilateral and bilateral hypermetropia (≥2.0 D spherical equivalent) was 3.1 and 1.6%, respectively. Astigmatism (≤-0.75 D) was found in unilateral form in 32.5% of these children, whereas bilateral astigmatism was found in 11.8%. After excluding children having any ocular pathology, the low prevalence of high refractive errors signified good VA in these children. Significant differences were found in the distribution of the refractive errors by age and type of schooling (public or private) but not by sex. In general, the radii of the anterior of the cornea did not vary significantly with age. CONCLUSIONS: The mean refractive errors found were low and therefore VA was high in these children. There was a low prevalence of myopia, with significantly higher values in those who attended private schools (educationally and socioeconomically more demanding). Astigmatism was the most frequent refractive error.

A visual test based on a freeware software for quantifying and displaying night-vision disturbances: study in subjects after alcohol consumption.

BACKGROUND: In this work, we propose the Halo test, a simple visual test based on a freeware software for quantifying and displaying night-vision disturbances perceived by subjects under different experimental conditions, more precisely studying the influence of the alcohol consumption on visual function. METHODS: In the Halo test, viewed on a monitor, the subject's task consists of detecting luminous peripheral stimuli around a central high-luminance stimulus over a dark background. The test, performed by subjects before and after consuming alcoholic drinks, which deteriorate visual performance, evaluates the influence that alcohol consumption exerts on the visual-discrimination capacity under low illumination conditions. Measurements were made monocularly and binocularly. Pupil size was also measured in both conditions (pre/post). Additionally, we used a double-pass device to measure objectively the optical-quality of the eye and corroborate the results from the Halo test. RESULTS: We found a significant deterioration of the discrimination capacity after alcohol consumption, indicating that the higher the breath-alcohol content, the greater the deterioration of the visual-discrimination capacity. After alcohol intake, the graphical results showed a greater area of undetected peripheral stimuli around the central high-luminance stimulus. An enlargement of the pupil was also observed and the optical quality of the eye was deteriorated after alcohol consumption. CONCLUSIONS: A greater influence of halos and other night-vision disturbances were reported with the Halo test after alcohol consumption. The Halo freeware software constitutes a positive contribution for evaluating nighttime visual performance in clinical applications, such as reported here, but also in patients after refractive surgery (where halos are present) or for monitoring (time course) some ocular pathologies under pharmacological treatment.

The Relationship between Anxiety, Visual Function, and Symptomatology in University Students.

Mental health concerns have emerged at the university level, with the psychological well-being of students being increasingly affected. This cross-sectional study investigated the proportion of university students having anxiety, and its effects on their visual function and symptomatology. We included 41 students (26.1 ± 4.8 years), and their visual function was assessed through several tests to produce a general visual performance index (VPI). The visual symptomatology was studied using the Conlon Visual Discomfort Survey and the Quality of Vision (QoV) questionnaire. The students were classified into two groups according to the Generalized Anxiety Disorder Screener (GAD-7) test ("no anxiety" and "anxiety" groups). The visual function evaluation indicated significantly worse VPI in the anxiety group (p = 0.047). These students also showed significantly higher scores in the Conlon survey (p = 0.004) and two subscales of the QoV questionnaire: symptom severity (p = 0.041) and symptom bothersomeness (p = 0.013). Moreover, the multiple linear regression model showed a significant association between visual discomfort according to the Conlon questionnaire and the level of anxiety (r = 0.405; R2 = 0.164; B = 0.405; p = 0.012). It is important to study the influence of psychological factors on vision, not only for refractive error, but also for binocular and accommodative disorders.

Effects of alcohol consumption on driving performance in the presence of interocular differences simulated by filters.

The role of interocular differences simulated by filters (fog filter and Bangerter foil) on visual and driving performance in alcohol users was assessed. We found that the binocular visual function deteriorates significantly in terms of contrast sensitivity (from 6 to 18 cpd). Additionally, driving performance is significantly impaired under these conditions as evidenced by increased mean speed, standard deviation of the lateral position, distance traveled outside the lane, reaction time and number of collisions. Furthermore, we found that interocular differences due to intraocular scattering and straylight are directly related to an overall reduction in visual and driving performance. This provided a comprehensive perspective from which to understand the relationship between binocular visual function, interocular differences, and driving performance. In practice, our findings contribute to the understanding of the importance of limiting interocular differences, which can be common among presbyopes corrected using the monovision technique, as well as in cases of cataract or other ocular pathology affecting only one eye, or even in cases of cataract surgery of the first eye. These interocular differences can have an adverse impact on road safety, especially when combined with moderate alcohol consumption.

Theoretical analysis for spherical aberration induction with low-order correction in refractive surgery: comment.

In this paper, we reply to post-surgical corneal asphericity conclusions made by Dai [Appl. Opt.51, 3966 (2012)]. We deduced, after a theoretical analysis, that the conclusions derived from this analysis are not theoretically or experimentally sound, because the author considers only the Munnerlyn formula for ablation algorithms and not the paraxial Munnerlyn formula, which is widespread in refractive surgery [J. Cataract Refract. Surg.14, 46 (1988)]. We refer to a previous paper published by Jiménez et al. [J. Opt. Soc. Am. A21, 98 (2004)] for a complete analysis on this matter that clarifies some points of confusion in Dai's paper.

Ametropias in school-age children in Fada N'Gourma (Burkina Faso, Africa).

PURPOSE: To assess epidemiological aspects of refractive errors in school-age children in Burkina Faso (west-central Africa). METHODS: A total of 315 school children (ranging from 6 to 16 years of age and belonging to different ethnic groups) taken at random from two urban schools in eastern Burkina Faso were examined to assess their refractive error, which was determined by non-cycloplegic retinoscopy with optical fogging. The standard Refractive Error Study in Children (RESC) definitions of refractive errors were used: myopia ≤-0.5 D spherical equivalent (SE) in at least one eye, hyperopia ≥2 D SE in at least one eye, astigmatism ≤-0.75 D cylinder in at least one eye, and anisometropia ≥1 D SE difference between the two eyes. RESULTS: Unilateral myopia and bilateral myopia were found in 2.5 and 1%, respectively; unilateral hyperopia in 17.1%, bilateral hyperopia in 8.6%; astigmatism in at least one eye in 11.7%. The highest prevalence value (18.4%) of astigmatism (≤-0.75 D) in at least one eye was found in the Gourmantché ethnic group. The low prevalence of large refractive errors makes visual acuity in these children very good (visual acuity logarithm of the minimum angle of resolution -0.073 ± 0.123 SD). CONCLUSIONS: There was a low prevalence of myopia in these African school children. Clinically significant high hyperopia (≥+2 D SE) was also uncommon. There were no significant differences between the distributions of refractive errors according to gender or ethnicity. With respect to age groups, the prevalences of hyperopia and astigmatism were significantly higher in the younger age groups.

Effect of peripheral refractive errors on driving performance.

The effect of peripheral refractive errors on driving while performing secondary tasks at 40° of eccentricity was studied in thirty-one young drivers. They drove a driving simulator under 7 different induced peripheral refractive errors (baseline (0D), spherical lenses of +/- 2D, +/- 4D and cylindrical lenses of +2D and +4D). Peripheral visual acuity and contrast sensitivity were also evaluated at 40°. Driving performance was significantly impaired by the addition of myopic defocus (4D) and astigmatism (4D). Worse driving significantly correlated with worse contrast sensitivity for the route in general, but also with worse visual acuity when participants interacted with the secondary task. Induced peripheral refractive errors may negatively impact driving when performing secondary tasks.

Speed management across road environments of varying complexities and self-regulation behaviors in drivers with cataract.

Evidence suggests that drivers with cataract self-regulate their driving, but there is a lack of objective information. This study compared speed behavior in older drivers with and without cataract and how the parameter is influenced by road traffic complexity and driver characteristics. The study included 15 drivers with cataract and a control group of 20 drivers. Visual status was assessed using visual acuity, contrast sensitivity, and intraocular straylight. Speed management was studied using a driving simulator. Driving difficulty and self-regulation patterns were evaluated by means of the Driver Habits Questionnaire (DHQ). The cataract group showed a significant decrease in visual function in all the parameters evaluated (p < 0.05). These drivers tended to drive at lower speeds than the control group. Road characteristics, gender, and intraocular straylight in the better eye were identified as significant predictors of speed management. Drivers with cataract experience greater driving difficulty, particularly when driving at night (p < 0.05). Drivers with cataract reduce their driving speed more than older drivers without visual impairment. The straylight parameter may be a good indicator of each driver's subjective perception of their own visual ability to drive. This work helps shed light on the mechanisms through which age-related visual impairment influences driving behavior.

Visual evaluation of different multifocal corneal models for the correction of presbyopia by laser ablation.

PURPOSE: To evaluate the visual quality of two theoretical multifocal corneal models designed to correct presbyopia by corneal photoablation. METHODS: Two theoretical multifocal corneal surfaces were analyzed by ray tracing: a central model (with a central zone for near vision and a peripheral zone for distance vision), and a peripheral model (with a central zone for distance vision and a peripheral zone for near vision). For both models, the effect of the size of the central zone and transition zone as well as the size of the pupil was evaluated. RESULTS: Our results show that a smaller transition zone favors total visual quality in both models. The optimal size of the central zone depends both on the size of the transition zone used as well as the model. However, both models responded similarly with respect to the variations in pupil size, providing the same visual quality although in an opposite way. CONCLUSIONS: This work shows that the optimal diameter of the central zone is smaller for the central model than for the peripheral model. Also, pupil size plays a fundamental role in achieving multifocality, showing that patient's pupil size should be thoroughly evaluated prior to multifocal refractive surgery.

Optical quality and visual discrimination capacity after myopic LASIK with a standard and aspheric ablation profile.

PURPOSE: To determine whether the eye's optical quality is correlated to the visual discrimination capacity of patients treated with LASIK using two different ablation algorithms. METHODS: Visual discrimination was evaluated by the disturbance index under low illumination (Halo v1.0 software, Laboratory of Vision Sciences and Applications) in two groups of patients who underwent LASIK with two different ablation algorithms using the Allegretto Wave Eye-Q 400 Hz laser (WaveLight AG). In the first group (standard group; 30 eyes), corneal ablations were performed with the standard algorithm (preoperative spherical equivalent refraction -3.20±1.70 diopters [D]). In the second group (Q-optimized group; 38 eyes; spherical equivalent refraction -3.40±1.90 D), the ablations were made with the Q-optimized (F-CAT) algorithm. Optical quality of the eye was calculated by the Strehl ratio measured with a double-pass device (OQAS, Visiometrics SL). RESULTS: After LASIK, both the Strehl ratio as well as visual discrimination capacity diminished in both groups, although the changes were significantly greater in the standard group than in the Q-optimized group. CONCLUSIONS: A high correlation was found between the Strehl ratio and the disturbance index in patients who underwent LASIK, regardless of the ablation algorithm applied. Optical and visual deterioration were greater after standard ablation.

Aggressive Driving Behaviours in Cannabis Users. The Influence of Consumer Characteristics.

This study analysed dangerous driving behaviours in twenty young occasional cannabis users through objective and self-reported data, studying the relationship between the two aspects. Visual function was assessed in a baseline session and after smoking cannabis, as well as speed-related behaviour in a driving simulator. The participants responded to questionnaires on sociodemographic factors, their consumption profile, and the incidence of dangerous behaviours (Dula Dangerous Driving Index; DDDI). After cannabis use, the results revealed a significant deterioration in visual function. In terms of speed management, they showed significantly greater acceleration force in the two different sections of the route, and they drove significantly faster. Our correlations indicate that males and heavier users display more risky speed management. Likewise, the heavier cannabis users admitted to increased dangerous driving behaviour, and an accident in the preceding year was associated with a trend towards aggressive driving behaviour according to the DDDI questionnaire. The findings of this study suggest that cannabis users adopt dangerous behaviours when driving, despite the effect this drug has on certain important functions, such as vision. The results suggest a need for awareness-raising and information campaigns.

Effects of cannabis on visual function and self-perceived visual quality.

Cannabis is one of the most used drugs of abuse in the world. The objective of this study was to analyze the effects of smoking cannabis on vision and to relate these to those perceived by the user. Thirty-one cannabis users participated in this study. Visual function assessment was carried out in a baseline session as well as after smoking cannabis. We evaluated static visual acuity, contrast sensitivity, stereoacuity, accommodative response, straylight, night-vision disturbances (halos) and pupil size. The participants were also divided into two groups depending on whether they perceived their vision to have worsened after smoking cannabis. A logistic regression analysis was employed to identify which visual test could best predict self-perceived visual effects. The study found that smoking cannabis has significant adverse effects on all the visual parameters analyzed (p < 0.05). Self-perceived visual quality results revealed that about two thirds of the sample think that smoking cannabis impairs their vision. Contrast sensitivity, specifically for the spatial frequency 18 cpd, was identified as the only visual parameter significantly associated with self-perceived visual quality (Odds Ratio: 1.135; p = 0.040). Smoking cannabis is associated with negative effects on visual function. Self-perceived visual quality after smoking cannabis could be related to impaired contrast sensitivity.

Deterioration of binocular vision after alcohol intake influences driving performance.

In this study, we assessed the influence of moderate alcohol intake on binocular vision, vergence system and simulated driving performance by analyzing the interactions between visual deterioration and driving variables. Thirty young healthy subjects were recruited. For the analysis, we measured: visual function (visual acuity and stereoacuity), phorias and fusional reserves. Also, we checked Sheard's and Percival's criteria at near and far. The accommodative convergence/accommodation (AC/A) ratio was calculated and vergence facility was also obtained at near. A driving simulator was used to assess driving performance under natural conditions and after alcohol consumption with a breath alcohol content of 0.40 mg/l. Alcohol intake significantly reduced binocular visual performance and vergence function, except for vertical phorias, horizontal phoria at near and Sheard's and Percival's criteria at near. Driving performance parameters also presented a statistically significant deterioration after alcohol consumption. A statistically significant correlation was found between the deterioration in overall visual function and overall driving performance, highlighting the influence of the visual deterioration on the driving performance. Moderate alcohol consumption impairs binocular visual and simulated driving performances, implying a greater safety hazard. In addition, deteriorations in binocular visual function and vergence correlated with simulated driving impairment, which indicates that the deterioration of binocular vision due to alcohol consumption affects driving, thus reducing road safety.

Testing a model for excimer laser-ablation rates on corneal shape after refractive surgery.

We have tested whether a recent model [Appl. Phys. Lett.95, 174105 (2009)APPLAB0003-695110.1063/1.3254236] that considers the angular dependence of laser-ablation rates, including reflection losses and geometrical dependence of incident fluence, and the effect of plume absorption can have significant effects for refractive surgery patients. We have developed a mathematical procedure and deduced equations that show that this model can significantly influence postsurgical corneal parameters (radius and asphericity) and, thus, should be considered in ablation algorithms in order to achieve a better emmetropization and an effective correction of eye aberrations.

Characterizing corneal shape after LASIK using a reference system intrinsic to the cornea.

The reliability of using a reference system intrinsic to the cornea has been evaluated in order to characterize corneas of subjects after refractive surgery. Data on 90 eyes operated on by LASIK to correct myopia and astigmatism were considered. The corneal parameters (curvature radii and corneal asphericity) found with respect to this reference system are compared with the parameters provided directly by the corneal topographer. The corneal parameters referenced to the intrinsic main axes of the cornea allow a better characterization of the corneal geometry, showing lower variability and diminishing the dissimilarities between the different eyes. The use of these parameters reduces the discrepancies between the real experimental and the theoretically predicted values (21% mean relative error using intrinsic data versus 81% using the topographer data). To understand and reduce these differences is essential in refractive surgery.