Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK.

OBJECTIVE: Many children with progressive myopia are still prescribed single-vision correction. An investigation into UK eyecare practitioners' (ECPs) perceptions of myopia management was carried out to ascertain factors which may be limiting its implementation and uptake within clinical practice. METHODS AND ANALYSIS: Online focus groups were held with UK ECPs. Participants were encouraged to discuss their knowledge of the available myopia management options, their perception of how myopia management is being delivered in the UK and any barriers limiting ECPs' prescribing of these management options in practice. The discussions were transcribed and analysed thematically. RESULTS: Focus groups were held with 41 ECPs from primary and secondary eyecare. ECPs felt that provision of myopia management in the UK is variable. Most ECPs believe they have sufficient knowledge, but felt a lack of confidence in decision-making and practical experience. Less experienced ECPs sought more definitive guidance to support their decision-making. ECPs desired clarity on their duty of care obligations and were concerned over possible future litigation if they had not offered, or referred for, myopia management when indicated. The greatest barrier appears to be financial-treatment is expensive and ECPs are uncomfortable communicating this to parents. Many barriers were indicative of systemic problems within UK eyecare, such as commercial pressures, inadequate National Health Service funding and poor public awareness of paediatric eyecare. CONCLUSION: Myopia management is not implemented consistently across the UK. To improve accessibility, changes are required at multiple levels, from individual ECPs through to wider stakeholders in UK eyecare provision.

Clinical Investigation of Flat Pack Toric Contact Lenses and Wearer Attitudes to Environmental Impact.

OBJECTIVES: To investigate the performance of a novel flat pack toric daily disposable contact lens compared with traditionally packaged toric lenses in a randomized, crossover study. Environmental attitudes to contact lens wear were also explored. METHODS: Habitual contact lens wearers were recruited to wear a hioxifilcon A (Miru 1 day Flat Pack Toric, Menicon, Nagoya, Japan) test lens and a control lens: either nelfilcon A (Dailies AquaComfort Plus, Alcon, Geneva, Switzerland) or etafilcon A (1-Day Acuvue Moist, Johnson & Johnson, New Brunswick, NJ). Objective lens performance was assessed at fitting, and participants wore lenses in a randomized order for three consecutive days. Subjective measures of lens performance (comfort, vision, and handling) were then assessed by a questionnaire, with further questions on overall lens preference and environmental perceptions. RESULTS: Objective measures of lens fit were similar for the test and control lenses, except for distance VA which was better with the control lenses ( P <0.05; difference of two logMAR letters). End of day comfort was greater with the test lens, but this did not reach significance. Both lenses demonstrated similar scores for overall satisfaction. 87.5% of participants indicated the environmental impact of contact lenses to be important/extremely important to them, with 100% of participants identifying the flat pack packaging as having a smaller environmental impact. CONCLUSION: Overall, the lenses used in the study performed to similar levels. Environmental credentials are important to contact lens wearers, which may contribute to overall lens preference.

Optimising the glaucoma signal/noise ratio by mapping changes in spatial summation with area-modulated perimetric stimuli.

Identification of glaucomatous damage and progression by perimetry are limited by measurement and response variability. This study tested the hypothesis that the glaucoma damage signal/noise ratio is greater with stimuli varying in area, either solely, or simultaneously with contrast, than with conventional stimuli varying in contrast only (Goldmann III, GIII). Thirty glaucoma patients and 20 age-similar healthy controls were tested with the Method of Constant Stimuli (MOCS). One stimulus modulated in area (A), one modulated in contrast within Ricco's area (CR), one modulated in both area and contrast simultaneously (AC), and the reference stimulus was a GIII, modulating in contrast. Stimuli were presented on a common platform with a common scale (energy). A three-stage protocol minimised artefactual MOCS slope bias that can occur due to differences in psychometric function sampling between conditions. Threshold difference from age-matched normal (total deviation), response variability, and signal/noise ratio were compared between stimuli. Total deviation was greater with, and response variability less dependent on defect depth with A, AC, and CR stimuli, compared with GIII. Both A and AC stimuli showed a significantly greater signal/noise ratio than the GIII, indicating that area-modulated stimuli offer benefits over the GIII for identifying early glaucoma and measuring progression.