Does the subjective response during the measurement of fusional reserves affect the clinical diagnosis?

INTRODUCTION: Fusional reserves differ with the method of measurement. The goal of this study was to compare the subjective and objective responses during the measurement of positive and negative fusional reserves using both step and ramp methods. METHODS: A haploscopic system was used to measure fusional reserves. Eye movements were recorded using an EyeLink 1000 Plus eye tracker (SR Research). The stimulus disparity was changed to either mimic a prism bar (steps) or a Risley prism (ramp). Subjective responses were obtained by pressing a key on the keyboard, whereas objective break and recovery points were determined offline using a custom algorithm coded in Matlab. RESULTS: Thirty-three adults participated in this study. For the ramp method, the subjective and objective responses were similar for the negative (break and recovery points (t(32) = -0.82, p = 0.42) and (t(32) = 0.42, p = 0.67), respectively) and positive fusional reserves (break and recovery points (U = -1.34, p = 0.18) and t(19) = -0.25, p = 0.81), respectively). For the step method, no significant differences in positive fusional reserves were observed when measured subjectively and objectively for the break (t(32) = 1.27, p = 0.21) or the recovery point (U = -2.02, Bonferroni-adjusted p = 0.04). For the negative fusional reserve, differences were not significant for either the break or recovery points (U = -0.10, p = 0.92 and t(19) = 1.17, p = 0.26, respectively). CONCLUSION: Subjective and objective responses exhibited good agreement when measured with the ramp and step methods.

Can viewing a 3D movie improve visual function in children with a history of amblyopia and neurotypical children?: A pilot study.

PURPOSE: The aim of this pilot study was to determine whether viewing an immersive 3D movie with large disparities in a cinema resulted in improved visual acuity (VA), stereoscopic depth perception (ST), and improved eye alignment in residual amblyopic children and children without amblyopia. METHODS: A total of 24 children aged between 5 and 12 years with a history of anisometropic and/or strabismic amblyopia, that had been previously treated and who currently have residual amblyopia (N = 14), and in children with typical development without amblyopia (N = 10) viewed the movie in 3D Sing 2 in a cinema for 110 minutes. Visual acuity, stereoacuity and ocular deviation were assessed before viewing the movie, and three months later. Stereoacuity and ocular deviation were also measured immediately after viewing the movie. RESULTS: We observed an improvement in visual acuity in the non-dominant (amblyopic) eye 3 months after viewing the movie in the amblyopic group (P<0.001). Stereopsis improved immediately after viewing the movie (P = 0.02), and after 3 months by ≈ 40% (P = 0.01). Moreover, improvements in stereopsis were also observed in children without amblyopia (P = 0.04). No significant changes in ocular deviation were observed in either group. CONCLUSIONS: These pilot results suggest that brief exposure to large disparities by viewing a 3D movie in a cinema can help to improve stereopsis and visual acuity in children aged 5‒12 years with previously treated amblyopia, and provide a rationale for a randomized clinical trial.

Influence of trajectory and contrast on dynamic visual acuity in elite team sports players.

Dynamic visual acuity (DVA) is considered an essential component for studying the visual function, especially in challenging environments like team sports. Beyond frequent comparative studies, much information is still lacking about the mechanisms underlying DVA and possible differences in stimulus presentation. It is crucial to understand the performance of DVA under different conditions of contrast and trajectories to achieve more specific data and better ecological validity of measurements. Fifty-five top professional male Spanish athletes, including 23 soccer, 14 basketball, and 18 water polo players were selected. Static visual acuity (SVA) was evaluated at 5 m. DVA was determined at 2 m under combined conditions of velocity (52°/s), three trajectories (horizontal, diagonal 45° and 135°) and two contrasts (99.7% and 13%). Significant differences in most DVA conditions measurements show that the best scores correspond to horizontal, over diagonal trajectories, and high contrast. The correlation between SVA and DVA showed a different relationship depending on the contrast conditions. Professional soccer, basketball, and water polo players have similar characteristics with reference to all the DVA evaluated conditions.

Impact of strabismus and binocular dysfunctions in the developmental eye movement test and test of visual perception skills: A multicentric and retrospective study

Purpose: To compare the performance in the Developmental Eye Movement test (DEM) and the Test of Visual Perceptual Skills (TVPS) between three groups: individuals with strabismus and amblyopia, patients with binocular and accommodative dysfunctions, and subjects with normal binocular and accommodative function. Methods: A multicentric, retrospective study including 110 children aged 6–14 years old was conducted to investigate the potential impact of strabismus, amblyopia, and different binocular conditions in DEM results (adjusted time in vertical and horizontal parts) and TVPS (percentiles in the seven sub-skills). Results: No significant differences were found in the different subtests of the vertical and horizontal DEM and all the sub-skills in the TVPS between the three groups of the study. We found high variability of performance in the DEM test between participants with strabismus and amblyopia compared with binocular and accommodative problems. Conclusion: DEM and TVPS scores have not been found to be influenced by the presence of strabismus with or without amblyopia, nor by binocular and accommodative dysfunctions. A slightly correlation tendency with horizontal DEM and degree of exotropia deviation was observed. (AU)

Global visual attention SPAN in different video game genres.

Video games, specifically action video games, have been demonstrated to be a useful tool in improving certain visual aspects in the general population. Visual attention span, the ability to simultaneously process multiple distinct visual elements during a single fixation, has been shown to improve among action video game players. The goal of this study was to verify that visual attention span is better not only in action video games, but also in other video game genres such as sports simulators or role-playing games. A total of 41 participants, aged 18 to 40 years old, were asked about the type of video games they were playing, name and genre, and the frequency of play. Visual attention span was assessed in all participants. Participants were divided into 4 groups according to the genre of video game they played. The total percentage of letter identification in the visual attention span was not significantly different between groups. A significant difference was found in the sixth position letter, and the right hemifield performance between groups, especially in sports simulators and action video game participants who showed a better performance. The action video game group showed a significant correlation between visual attention span performance and weekly hours played. Playing regularly different genres other than action video games can contribute to raise visual attention resources.

Accuracy of a Large Language Model as a new tool for optometry education.

CLINICAL RELEVANCE: The unsupervised introduction of certain Artificial Intelligence tools in optometry education may challenge the proper acquisition of accurate clinical knowledge and skills proficiency. BACKGROUND: Large Language Models like ChatGPT (Generative Pretrained Transformer) are increasingly being used by researchers and students for work and academic assignments. The authoritative and conversationally correct language provided by these tools may mask their inherent limitations when presented with specific scientific and clinical queries. METHODS: Three sets of 10 queries related to contact lenses & anterior eye, low vision and binocular vision & vision therapy were presented to ChatGPT, with instructions to provide five relevant references to support each response. Three experts and 53 undergraduate and post-graduate students graded from 0 to 10 the accuracy of the responses, and the references were evaluated for precision and relevance. Students graded from 0 to 10 the potential usefulness of ChatGPT for their academic coursework. RESULTS: Median scores were 7, 8 and 6 (experts) and 8, 9 and 7.5 (students) for the contact lenses & anterior eye, low vision and binocular vision & vision therapy categories, respectively. Responses to more specific queries were awarded lower scores by both experts (ρ = -0.612; P < 0.001) and students (ρ = -0.578; P = 0.001). Of 150 references, 24% were accurate and 19.3% relevant. Students graded the usefulness of ChatGPT with 7.5 (2 to 9), 7 (3 to 9) and 8.5 (3 to 10) for contact lenses & anterior eye, low vision and binocular vision & vision therapy, respectively. CONCLUSION: Careful expert appraisal of the responses and, particularly, of the references provided by ChatGPT is required in research and academic settings. As the use of these tools becomes widespread, it is essential to take proactive steps to address their limitations and ensure their responsible use.

The Relationship between Fixation Stability and Retinal Structural Parameters in Children with Anisometropic, Strabismic and Mixed Amblyopia.

(1) Background: Amblyopia is an ocular condition leading to structural and functional changes. The relationship between these changes is complex and remains poorly understood. (2) Methods: Participants included 31 children aged 5 to 9 years with strabismic (n = 9), anisometropic (n = 16) and mixed (n = 6) unilateral amblyopia, and 14 age-matched non-amblyopic children. The 95% and 63% Bivariate Contour Ellipse Area (BCEA), axial length, Foveal Avascular Zone (FAZ) area, center macular thickness and volume were assessed. The relationship between these parameters was explored. (3) Results: Statistically significant differences were found among the four groups in best corrected distance visual acuity (BCVA) (p < 0.001), BCEA 95% (p = 0.002) and BCEA 63% (p = 0.002), but not in the FAZ area, central macular thickness, central macular volume and axial length. Eyes with amblyopia had poorer BCVA and larger fixation instability than controls. Inter-ocular differences were more significant in patients with strabismic amblyopia, particularly in BCVA (p = 0.003), central macular thickness (p < 0.001) and central macular volume (p = 0.002). In amblyopic eyes, BCEA 95% and 63% were correlated with BCVA, but not with the FAZ area. (4) Conclusion: Amblyopia is associated with a reduction in fixation stability and BCVA, although there is a general lack of correlation with structural changes, suggesting a complex interaction between anatomy and function in amblyopia.

Loss of Blink Regularity and Its Impact on Ocular Surface Exposure.

(1) Background: Changes in blink parameters have been found to influence ocular surface exposure, eliciting symptoms of dry eye and ocular signs. The aim of the study was to highlight the relevance of including blink regularity as a new parameter to fully characterize blinking; (2) Methods: A novel characterization of blink parameters is described, including spontaneous eyeblink rate (SEBR), percentage of incomplete blinks, and blink regularity. A pilot study was designed in which tear film break-up time (TFBUT), blink parameters, and the time percentage of ocular surface exposure were determined in eight subjects (52.0 ± 16.6 years, 4 females) in three experimental conditions (baseline, reading a hard-copy text, and reading from an electronic display). Blink parameters were monitored through asynchronous image analysis of one minute video segments; (3) Results: All blink parameters were influenced by experimental conditions. A trend was observed in which both reading tasks resulted in an increase in ocular surface exposure, mainly related to a combination of reduced SEBR, increased percentage of incomplete blinks, and loss of blink regularity; (4) Conclusions: A complete characterization of blink parameters is relevant to better understand ocular dryness related to surface exposure and to advice patients towards a reeducation of their blinking habits.

Impact of strabismus and binocular dysfunctions in the developmental eye movement test and test of visual perception skills: A multicentric and retrospective study.

PURPOSE: To compare the performance in the Developmental Eye Movement test (DEM) and the Test of Visual Perceptual Skills (TVPS) between three groups: individuals with strabismus and amblyopia, patients with binocular and accommodative dysfunctions, and subjects with normal binocular and accommodative function. METHODS: A multicentric, retrospective study including 110 children aged 6-14 years old was conducted to investigate the potential impact of strabismus, amblyopia, and different binocular conditions in DEM results (adjusted time in vertical and horizontal parts) and TVPS (percentiles in the seven sub-skills). RESULTS: No significant differences were found in the different subtests of the vertical and horizontal DEM and all the sub-skills in the TVPS between the three groups of the study. We found high variability of performance in the DEM test between participants with strabismus and amblyopia compared with binocular and accommodative problems. CONCLUSION: DEM and TVPS scores have not been found to be influenced by the presence of strabismus with or without amblyopia, nor by binocular and accommodative dysfunctions. A slightly correlation tendency with horizontal DEM and degree of exotropia deviation was observed.

Feasibility of measuring fusional vergence amplitudes objectively.

Two tests to measure fusional vergence amplitudes objectively were developed and validated against the two conventional clinical tests. Forty-nine adults participated in the study. Participants' negative (BI, base in) and positive (BO, base out) fusional vergence amplitudes at near were measured objectively in an haploscopic set-up by recording eye movements with an EyeLink 1000 Plus (SR Research). Stimulus disparity changed in steps or smoothly mimicking a prim bar and a Risley prism, respectively. Break and recovery points were determined offline using a custom Matlab algorithm for the analysis of eye movements. Fusional vergence amplitudes were also measured with two clinical tests using a Risley prism and a prism bar. A better agreement between tests was found for the measurement of BI than for BO fusional vergence amplitudes. The means ± SD of the differences between the BI break and recovery points measured with the two objective tests were -1.74 ± 3.35 PD and -1.97 ± 2.60 PD, respectively, which were comparable to those obtained for the subjective tests. For the BO break and recovery points, although the means of the differences between the two objective tests were small, high variability between subjects was found (0.31 ± 6.44 PD and -2.84 ± 7.01 PD, respectively). This study showed the feasibility to measure fusional vergence amplitudes objectively and overcome limitations of the conventional subjective tests. However, these tests cannot be used interchangeably due to their poor agreement.

Regularly Playing First-person Shooter Video Games Improves Dynamic Visual Acuity.

SIGNIFICANCE: This study investigated the dynamic visual acuity (DVA) in young adults who play action video games regularly compared with nonaction video game players and those without regular experience in video game play. The results indicate better performance in some measurements of DVA in action video game players. PURPOSE: This study aimed to provide new insights into performance on DVA assessments in young adults who play action video games regularly. METHODS: A cross-sectional study was conducted between action video game and nonaction video game players with 47 participants ranging in age from 20 to 30 years. Dynamic visual acuity with two different angular velocities, 57 and 28.5°/s, and three different contrasts, 100, 50, and 10%, were evaluated. A second analysis with 33 participants compared DVA between action video game players and nonexperienced video game players or those spending less than 1 h/wk in gaming. RESULTS: Dynamic visual acuity in the first analysis revealed a nonstatistical significance between groups in all the experimental conditions with 57 and 28.5°/s in three different contrasts. The second analysis with 33 participants revealed a statistical significance in DVA at 57 and 28.5°/s with contrast at 100% ( P = .003 and P < .001, respectively). CONCLUSIONS: Dynamic visual acuity seems to have better performance in young adults spending more than 5 h/wk with action video games, mostly first-person shooter games.

Comitant strabismus etiology: extraocular muscle integrity and central nervous system involvement-a narrative review.

Strabismus is not a condition in itself but the consequence of an underlying problem. Eye misalignment can be caused by disease, injury, and/or abnormalities in any of the structures and processes involved in visual perception and oculomotor control, from the extraocular muscles and their innervations to the oculomotor and visual processing areas in the brain. A small percentage of all strabismus cases are the consequence of well-described genetic syndromes, acquired insult, or disease affecting the extraocular muscles (EOMs) or their innervations. We will refer to them as strabismus of peripheral origin since their etiology lies in the peripheral nervous system. However, in most strabismus cases, that is comitant, non-restrictive, non-paralytic strabismus, the EOMs and their innervations function properly. These cases are not related to specific syndromes and their precise causes remain poorly understood. They are generally believed to be caused by deficits in the central neural pathways involved in visual perception and oculomotor control. Therefore, we will refer to them as central strabismus. The goal of this narrative review is to discuss the possible causes behind this particular type of eye misalignment and to raise awareness among eyecare professionals about the important role the central nervous system plays in strabismus etiology, and the subsequent implications regarding its treatment. A non-systematic search was conducted using PubMed, Medline, Cochrane, and Google Scholar databases with the keywords "origins," "causes," and "etiology" combined with "strabismus." A snowball approach was also used to find relevant references. In the following article, we will first describe EOM integrity in central strabismus; next, we will address numerous reasons that support the idea of central nervous system (CNS) involvement in the origin of the deviation, followed by listing several possible central causes of the ocular misalignment. Finally, we will discuss the implications CNS etiology has on strabismus treatment.

Vergence and Accommodation Cues in Stereo-Localization during the Small-In Large-Out (SILO) Effect.

A typical procedure in vision therapy is the use of Quoits vectograms to train fusional vergence ranges by improving stereo-localization, which is the ability to correctly locate the target stimulus in space. With this procedure, the Small-In Large-Out (SILO) effect is usually reported in patients with normal binocular vision and accommodation. In this study, the influence of vergence and accommodation cues, as determined with the accommodative-convergence over accommodation (AC/A) ratio, to correctly locate the Quoits vectograms in space was investigated. Twenty participants, aged 29.2 ± 2.8 (mean ± standard deviation) years, without amblyopia or strabismus, were recruited. A geometrical formula was obtained to calculate the theoretical distance to the target stimulus for different vergence demands. Theoretical values were compared with measured distances to the perceived stimuli and stereo-localization accuracy was determined. Stereo-localization accuracy was significantly worse at 10∆ Base In vergence demand (p < 0.001). A statistically significant positive correlation was found between AC/A ratio and stereo-localization accuracy (i.e., worse accuracy) at 10Δ Base Out vergence demand (rho = 0.446, p = 0.049). These findings highlight that AC/A ratio may be a secondary cue for stereo-localization when using vectograms in which the SILO effect is manifest. These results assist in the understanding of the physiological basis of vision therapy procedures.

Functional connectivity of brain networks with three monochromatic wavelengths: a pilot study using resting-state functional magnetic resonance imaging.

Exposure to certain monochromatic wavelengths can affect non-visual brain regions. Growing research indicates that exposure to light can have a positive impact on health-related problems such as spring asthenia, circadian rhythm disruption, and even bipolar disorders and Alzheimer's. However, the extent and location of changes in brain areas caused by exposure to monochromatic light remain largely unknown. This pilot study (N = 7) using resting-state functional magnetic resonance shows light-dependent functional connectivity patterns on brain networks. We demonstrated that 1 min of blue, green, or red light exposure modifies the functional connectivity (FC) of a broad range of visual and non-visual brain regions. Largely, we observed: (i) a global decrease in FC in all the networks but the salience network after blue light exposure, (ii) a global increase in FC after green light exposure, particularly noticeable in the left hemisphere, and (iii) a decrease in FC on attentional networks coupled with a FC increase in the default mode network after red light exposure. Each one of the FC patterns appears to be best arranged to perform better on tasks associated with specific cognitive domains. Results can be relevant for future research on the impact of light stimulation on brain function and in a variety of health disciplines.

Topical Review: Optometric Considerations in Sports Versus E-Sports.

Electronic sports (e-sports) have recently emerged to become a rapidly growing form of videogame competition, requiring gamers to spend many hours in front of a visual display. The nature of this new modality raises important considerations for ocular health, and visual and perceptual functioning, compared to traditional sports. In general, sports performance has been associated with open spaces, gross motor movement, and balance, while electronic sports require visual and attentional stamina at near distances with fine motor control. From an optometric viewpoint, visual perception is specific to both the sports modality and the environment where sports take place. In this topical review, we consider e-sport optometric factors such as screen time and digital eyestrain, visual skill demands, and perceptual cognitive skills such as visual attention. We compare training considerations for traditional sports and training in gaming platforms, with recommendations for future research in this growing modality. The goal of this review is to raise awareness of the various elements to consider when providing vision care to e-sport participants.

Gamification, serious games and action video games in optometry practice / Gamificación, juegos serios y videojuegos de acción en la práctica optométrica

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Real-Time Non-Intrusive Assessment of Viewing Distance during Computer Use.

PURPOSE: To develop and test the sensitivity of an ultrasound-based sensor to assess the viewing distance of visual display terminals operators in real-time conditions. METHODS: A modified ultrasound sensor was attached to a computer display to assess viewing distance in real time. Sensor functionality was tested on a sample of 20 healthy participants while they conducted four 10-minute randomly presented typical computer tasks (a match-three puzzle game, a video documentary, a task requiring participants to complete a series of sentences, and a predefined internet search). RESULTS: The ultrasound sensor offered good measurement repeatability. Game, text completion, and web search tasks were conducted at shorter viewing distances (54.4 cm [95% CI 51.3-57.5 cm], 54.5 cm [95% CI 51.1-58.0 cm], and 54.5 cm [95% CI 51.4-57.7 cm], respectively) than the video task (62.3 cm [95% CI 58.9-65.7 cm]). Statistically significant differences were found between the video task and the other three tasks (all p < 0.05). Range of viewing distances (from 22 to 27 cm) was similar for all tasks (F = 0.996; p = 0.413). CONCLUSIONS: Real-time assessment of the viewing distance of computer users with a non-intrusive ultrasonic device disclosed a task-dependent pattern.

Blinking supervision in a working environment.

The health of the ocular surface requires blinks of the eye to be frequent in order to provide moisture and to renew the tear film. However, blinking frequency has been shown to decrease in certain conditions such as when subjects are conducting tasks with high cognitive and visual demands. These conditions are becoming more common as people work or spend their leisure time in front of video display terminals. Supervision of blinking frequency in such environments is possible, thanks to the availability of computer-integrated cameras. Therefore, the aim of the present study is to develop an algorithm for the detection of eye blinks and to test it, in a number of videos captured, while subjects are conducting a variety of tasks in front of the computer. The sensitivity of the algorithm for blink detection was found to be of 87.54% (range 30% to 100%), with a mean false-positive rate of 0.19% (range 0% to 1.7%), depending on the illumination conditions during which the image was captured and other computer­user spatial configurations. The current automatic process is based on a partly modified pre-existing eye detection and image processing algorithms and consists of four stages that are aimed at eye detection, eye tracking, iris detection and segmentation, and iris height/width ratio assessment.

Blink Rate and Incomplete Blinks in Six Different Controlled Hard-Copy and Electronic Reading Conditions.

PURPOSE: To evaluate spontaneous eye blink rate (SEBR) and percentage of incomplete blinks in different hard-copy and visual display terminal (VDT) reading conditions, compared with baseline conditions. METHODS: A sample of 50 participants (29 females, age range, 18-74 years) were recruited for this study. All participants had good ocular health and reported no symptoms of dry eye (OSDI score < 15). Face video recordings were captured while participants observed in silence a landscape picture at 2 m (baseline) and during six different, 6-minute controlled reading experimental conditions. Texts were presented in electronic (tablet and computer display at 100% and 330% zoom levels) and hard-copy (text in book position in silence and aloud and text pasted on the computer display) formats. Video analysis was subsequently conducted to assess blink parameters. RESULTS: All reading conditions resulted in a decrease in SEBR when compared with baseline conditions (all P < 0.001), with the least negative impact corresponding to reading in a 330% expanded display. The percentage of incomplete blinks was found to increase when reading was conducted on an electronic platform, in contrast to hard-copy text. CONCLUSIONS: The high cognitive demands associated with a reading task led to a reduction in SEBR, irrespective of type of reading platform. However, only electronic reading resulted in an increase in the percentage of incomplete blinks, which may account for the symptoms experienced by VDT users. Spanish Abstract.