Effectiveness of early spectacle intervention on visual outcomes in babies at risk of cerebral visual impairment: a parallel group, open-label, randomised clinical feasibility trial protocol.

INTRODUCTION: Hypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral visual impairment. It is also well recognised that early intervention for childhood visual pathology is essential, because neuroplasticity progressively diminishes during early life. This study aims to establish the feasibility and acceptability of conducting a randomised controlled trial to test the effectiveness of early near vision correction with spectacles in infancy, for babies, at risk of visual dysfunction. METHODS AND ANALYSIS: This is a parallel group, open-label, randomised controlled (feasibility) study to assess visual outcomes in children with perinatal brain injury when prescribed near vision spectacles compared with the current standard care-waiting until a problem is detected. The study hypothesis is that accommodation, and possibly other aspects of vision, may be improved by intervening earlier with near vision glasses. Eligible infants (n=75, with either HIE or <29 weeks preterm) will be recruited and randomised to one of three arms, group A (no spectacles) and two intervention groups: B1 or B2. Infants in both intervention groups will be offered glasses with +3.00 DS added to the full cycloplegic refraction and prescribed for full time wear. Group B1 will get their first visit assessment and intervention at 8 weeks corrected gestational age (B1) and B2 at 16 weeks corrected gestational age. All infants will receive a complete visual and neurodevelopmental assessment at baseline and a follow-up visit at 3 and 6 months after the first visit. ETHICS AND DISSEMINATION: The South-Central Oxford C Research Ethics Committee has approved the study. Members of the PPI committee will give advice on dissemination of results through peer-reviewed publications, conferences and societies. TRIAL REGISTRATION NUMBER: ISRCTN14646770, NCT05048550, NIHR ref: PB-PG-0418-20006.

The relationship between extremity fractures and visual impairment in childhood: A case-control study.

BACKGROUND: Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. METHODS: Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. RESULTS: The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). CONCLUSION: Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.

Variations in intraocular pressure and visual parameters before and after using mobile virtual reality glasses and their effects on the eyes.

We examined the effects of using mobile devices with immersive virtual reality for a short period on the physiological parameters of both eyes. The average age of the 50 participants (23 men and 27 women) was 17.72 ± 1.48 years, and refractive error ranged from 0 D to - 5.00 D. All the participants wore + 3.00 D glasses and underwent a 5-min relaxation adjustment through the atomization method. The participants wore immersive virtual reality (VR) glasses to watch a movie on a roller coaster for 10 min. Their relevant physiological parameters of the eyes were measured both before and after using VR glasses. Compared with before VR use, no significant difference (P > 0.05) was observed in the near-horizontal vergence and refractive error but a significant difference (P < 0.05) was observed in the amplitude of accommodation, intraocular pressure, divergence/convergence, and stereopsis after VR use. The corneal elastic coefficient was > 0.2 MPa, and we used Friedenwald's eye rigidity relationship to obtain the K value (0.065-0.09). Approximately 10% of the participants experienced cybersickness symptoms such as nausea and dizziness. The use of VR to watch three-dimensional movies reduced intraocular pressure, which may help prevent or treat glaucoma. Moreover, the binocular convergence was higher when viewing near-field objects in VR than in the real world. Therefore, individuals with convergence excess may experience symptoms. Binocular parallax is the most likely cause of cybersickness symptoms. Thus, mobile VR devices with higher quality and comfort are necessary.

A randomized controlled trial on the effects of blue-blocking glasses compared to partial blue-blockers on sleep outcomes in the third trimester of pregnancy.

OBJECTIVE: Sleep disturbances are common in pregnancy. Blocking blue light has been shown to improve sleep and may be a suitable intervention for sleep problems during pregnancy. The present study investigated the effects of blue light blocking in the evening and during nocturnal awakenings among pregnant women on primary sleep outcomes in terms of total sleep time, sleep efficiency and mid-point of sleep. METHODS: In a double-blind randomized controlled trial, 60 healthy nulliparous pregnant women in the beginning of the third trimester were included. They were randomized, using a random number generator, either to a blue-blocking glass intervention (n = 30) or to a control glass condition constituting partial blue-blocking effect (n = 30). Baseline data were recorded for one week and outcomes were recorded in the last of two intervention/control weeks. Sleep was measured by actigraphy, sleep diaries, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale. RESULTS: The results on the primary outcomes showed no significant mean difference between the groups at posttreatment, neither when assessed with sleep diary; total sleep time (difference = .78[min], 95%CI = -19.7, 21.3), midpoint of sleep (difference = -8.9[min], 95%CI = -23.7, 5.9), sleep efficiency (difference = -.06[%], 95%CI = -1.9, 1.8) and daytime functioning (difference = -.05[score points], 95%CI = -.33, .22), nor by actigraphy; total sleep time (difference = 13.0[min], 95%CI = -9.5, 35.5), midpoint of sleep (difference = 2.1[min], 95%CI = -11.6, 15.8) and sleep efficiency (difference = 1.7[%], 95%CI = -.4, 3.7). On the secondary outcomes, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale the blue-blocking glasses no statistically significant difference between the groups were found. Transient side-effects were reported in both groups (n = 3). CONCLUSIONS: The use of blue-blocking glasses compared to partially blue-blocking glasses in a group of healthy pregnant participants did not show statistically significant effects on sleep outcomes. Research on the effects of blue-blocking glasses for pregnant women with sleep-problems or circadian disturbances is warranted. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (NCT03114072).

Allergic contact dermatitis from dyes used in the temple of spectacles.

BACKGROUND: We observed an increasing number of patients who presented with facial or retro-auricular dermatitis after skin contact with plastic spectacles or plastic covered temples. OBJECTIVES: To identify the allergens in plastic spectacles that may cause allergic contact dermatitis. METHODS: All patients with suspected allergic contact dermatitis to eyewear were tested with Solvent Orange 60 (SO60), four additionally with Solvent Yellow 14 (SY14), and five with scrapings from their own spectacles. In one case, a chemical analysis of the spectacles was performed to uncover the causative allergen. RESULTS: Three patients were allergic to SO60, two patients to SY14, and two patients were allergic to both SO60 and SY14. CONCLUSION: Patients with suspected allergic contact dermatitis from spectacles should be tested with SO60 and SY14, and based on findings from previous reports, also with Solvent Red 179.

Myopia-correcting lenses decrease eye fatigue in a visual search task for both adolescents and adults.

The steady, world-wide increase in myopia prevalence in children over the past decades has raised concerns. As an early intervention for axial-length-related myopia, correcting lenses have been developed (such as Defocus Incorporated Multiple Segment (DIMS) lenses), which have been shown to be effective in slowing myopia progression. Beyond this direct effect, however, it is not known whether such lenses also affect other aspects important to the wearer, such as eye fatigue, and how such effects may differ across age, as these lenses so far are typically only tested with adolescents. In the present work, we therefore investigated perceived fatigue levels according to lens type (normal vs DIMS) and age (adolescents vs adults) in a demanding visual search task ("Finding Wally") at two difficulty levels (easy vs difficult). Whereas age and difficulty did not result in significant differences in eye fatigue, we found a clear reduction of fatigue levels in both age groups when wearing the correcting lenses. Hence, the additional accommodation of these lens types may result in less strain in a task requiring sustained eye movements at near viewing distances.

Calidad de vida y visual en pacientes con implante de lente intraocular fáquico / Visual acuity and quality of life of patients undergoing phakic intraocular lens implantation

RESUMEN Los errores refractivos altos son difíciles de corregir óptica y quirúrgicamente. Los pacientes que los padecen se encuentran incómodos con las gafas, ya que la calidad de su visión es deficitaria. Las lentes de contacto proporcionan mejor agudeza visual; sin embargo, en ocasiones requieren diseños especiales para ser adaptadas y pueden asociarse a complicaciones severas. La cirugía refractiva como subespecialidad busca mejorar la agudeza visual no corregida y disminuir la dependencia a gafas o lentes de contacto. Las opciones van desde los procedimientos queratorrefractivos hasta el implante de una lente intraocular, ya sea con la extracción del cristalino transparente o en un ojo fáquico. Este último ofrece ventajas al mantener la acomodación, obtener una mejor calidad óptica y cierta reversibilidad. En el mundo se han realizado múltiples trabajos en pacientes con lentes fáquicos de diferentes modelos y estos han demostrado que son seguros y confiables, aunque no son muchos los estudios sobre la calidad de vida a largo plazo; de ahí la motivación para realizar una búsqueda actualizada de diversos artículos publicados, con el objetivo de describir los resultados visuales y la calidad de vida en pacientes con implante de lentes fáquicos. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

ABSTRACT High refractive errors are difficult to correct both optically and surgically. Patients suffering from them feel uncomfortable with their eyeglasses, since their visual quality is poor. Contact lenses provide better visual acuity, but they sometimes require special designs to be adjusted and may be associated to severe complications. The subspecialty of refractive surgery seeks to improve uncorrected visual acuity and reduce dependence on eyeglasses or contact lenses. Options range from keratorefractive procedures to intraocular lens implantation, be it with removal of the transparent crystalline lens or in phakic eyes. The latter provides the advantages of maintaining accommodation, obtaining better visual quality and affording a certain degree of reversibility. A great many studies have been conducted worldwide of patients with phakic lenses of various models, and these have proved to be safe and reliable. However, not many studies are available about long-term quality of life. Hence the motivation to perform an updated search for published papers about the subject, with the purpose of describing the visual results and quality of life of patients with phakic lens implants. Use was made of the Infomed platform, particularly the Virtual Health Library with all its search engines(AU)

Prevalence and risk factors to Demodex folliculorum infection in eyelash follicles from a university population of Mexico.

Demodex folliculorum shows a high occurrence in the general population, however, its pathologic relevance is still controversial. In this prospective study, we evaluated the prevalence of D. folliculorum on eyelashes from 8,033 subjects of a university population (including 7,782 students, and 251 academics). Additional information on some risk factors to infection by the mites was evaluated, as well. A prevalence of 1.47% was found, where 118 individuals were positive for D. folliculorum; and, among them, 63 (53.4%) were women and 55 (46.6%) were men. Results showed a negative correlation with the age (r = -0.45), the highest prevalence was found in individuals between 19 and 22 years of age (2.1%, 84 patients). The number of D. folliculorum mites did not differ between the right and left eye; however, the use of cosmetics or facial cream, contact lens, hair removers, were factors present in patients infected with D. folliculorum. Although Demodex prevalence did not increase in line with weight, we found significantly higher prevalence in the 51-60 kg and 71-80 kg weight groups, and a particularly high prevalence in the over 81 kg weight group (2.6%). In conclusion, it was observed that the main population positive to infection consisted of young adults; this is in contrast with the international evidence reporting a high rate of infection in older adults. Besides, our results suggest that items of daily use such as cosmetics, facial cream, eyeliner, glasses, or contact lenses may be some of the main culprits of the infection by D. folliculorum.

Evaluating the myopia progression control efficacy of defocus incorporated multiple segments (DIMS) lenses and Apollo progressive addition spectacle lenses (PALs) in 6- to 12-year-old children: study protocol for a prospective, multicenter, randomized controlled trial.

BACKGROUND: Myopia is increasing in prevalence and is currently recognized as a significant public health issue worldwide, particularly in China. Once myopia develops, appropriate clinical interventions need to be prescribed to slow its progression. Currently, several publications indicate that myopic defocus (MD) retards eye growth and myopia progression. However, no clinical trials have compared the outcomes of different MD spectacle lenses in the same observational group, especially in mainland China. The aim of the present study is to compare the myopia control efficiency of two different MD spectacle lenses: defocus incorporated multiple segments (DIMS) lenses and Apollo progressive addition lenses (PALs). METHODS: The trial is designed as a 3-year, prospective, randomized, multicenter clinical trial of schoolchildren treated with DIMS lenses and PALs. A total of 600 Chinese primary school children aged 6-12 years will be recruited, and each group is intended to include 300 subjects. The inclusion criteria are myopia between - 1.00 and - 5.00 diopters and astigmatism ≤ 1.50 diopters. The follow-up time points will be 1 month (m), 3 m, 6 m, 12 m, 18 m, 24 m, 30 m, and 36 m. The primary outcome will be determined by the difference between the two groups in cycloplegic spherical equivalent refraction between baseline and the last follow-up visit. The secondary outcome is the axial length, and the exploratory outcomes include ocular biometric measures, peripheral refraction, binocular vision, accommodation, compliance, and the results of questionnaires related to wearing experiences. DISCUSSION: The present study will be the first randomized controlled trial in myopic primary school children treated with DIMS lenses and PALs in China. The results will indicate whether and how much different MD mechanisms retard myopia progression and axial elongation. In addition, the comparison will provide information on the clinical efficacy and safety of DIMS lenses and PALs, including information related to wearing experiences and visual function. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900025645. Registered on 3 September 2019. http://www.chictr.org.cn/showproj.aspx?proj=42927.

Retinal control of lens-induced astigmatism in chicks.

PURPOSE: Astigmatism is a refractive error due to meridional differences in refractive powers of lens or cornea. The resulting failure to focus image points in a single plane causes blurred vision at all distances. In this study, using an animal model of lens-induced astigmatism, we tested the hypothesis that induced astigmatism is due to processing of astigmatic retinal image information by the brain, which causes distorted growth in the anterior segment via centrifugal neural projections. METHODS: To induce astigmatism, +4.00DS/-8.00DC crossed-cylinder-lens goggles were affixed over the right eyes of 7-day-old chicks (P7), with the -8.00DC axis oriented vertically (at 90°) or horizontally (180°) (n = 12 each); the left eyes were without goggles (non-goggled). For all experiments, refractive errors of both eyes were measured by streak retinoscopy, before and after 1 week of lens wear. To test whether neuronal pathways between retina and brain are required, axonal conduction within the eye was blocked by intravitreal injections of tetrodotoxin (TTX; 7 µL of 10-4M) in phosphate-buffered saline (PBS), or of PBS alone (7 µL); fellow open eyes received PBS alone. Pupillary light reflex (PLR) and optokinetic response (OKR) were measured, to assess the efficacy and duration of TTX action. To test whether retinal circuitry is required, groups of chicks (n = 12 each) were treated at P7 by intravitreal injection of 20 µL of mixed excitotoxins (2 µmol N-methyl-D-aspartate, 0.2 µmol quisqualic acid, 0.2 µmol kainic acid; in water) into goggled or non-goggled eyes, to compromise retinal circuitry needed for emmetropization. RESULTS: Crossed-cylinder goggles reliably induced refractive astigmatism. Maximum astigmatic error was induced when the cylindrical axis was oriented at 90° (vertically). TTX effectively blocked nerve conduction within the eye for 48 h after injection. Goggled eyes developed astigmatism after treatment with TTX or PBS, but not after excitotoxins. CONCLUSION: Our hypothesis was rejected. In this model, the compensatory astigmatism induced by crossed-cylinder lenses is intrinsic to the eye, and mediated by visual processing in the retina.

Regulatory roles of differentially expressed MicroRNAs in metabolic processes in negative Lens-induced myopia Guinea pigs.

BACKGROUND: Myopia is one of the most common vision defects worldwide. microRNAs can regulate the target gene expression, influencing the development of diseases. RESULTS: To investigate the alterations of microRNA profiling in negative lens-induced myopia (NLIM) guinea pigs and to explore the regulatory role of microRNAs in the occurrence and the development of myopia, we first established the NLIM guinea pig model after induction for 2 weeks. Further, we isolated sclera to purify total messenger RNA (mRNA) in both NLIM and NLIM fellow sclera. Using next generation sequencing technique and bioinformatics analysis, we identified the differentially expressed microRNAs in NLIM guinea pigs, performed the bioinformatics annotation for the differentially expressed microRNAs, and validated the expression of differentially expressed microRNAs. As a result, we successfully established an NLIM model in guinea pigs, identified 27 differentially expressed microRNAs in NLIM guinea pig sclera, including 10 upregulated and 17 downregulated microRNAs. The KEGG annotation showed the main signaling pathways were closely associated with PPAR signaling, pyruvate and propanoate metabolisms, and TGF-beta signaling pathways. CONCLUSIONS: Our findings indicate that the development of myopia is mainly involved in the disorder of metabolic processes in NLIM guinea pigs. The PPAR signaling, pyruvate and propanoate metabolism pathways may play roles in the development of myopia.

Commonly Held Beliefs About Myopia That Lack a Robust Evidence Base.

PURPOSE: To subject a number of commonly held beliefs or areas of confusion in the myopia field to scientific scrutiny. METHOD: A collection of statements about myopia are provided with references to demonstrate that a section of the research or clinical community supports the statement. The topics under discussion are reviewed critically with reference to the literature. RESULTS: The following statements are considered to lack sufficient supporting data to be considered as evidence-based: low-dose (0.01%) atropine slows myopia progression; relative peripheral hyperopia leads to myopia development and progression in children; undercorrection slows myopia progression; percentage treatment effect remains constant with continuing treatment; percentage treatment effect applies across the progression range; hand-held digital devices contribute to the myopia epidemic; more time outdoors slows myopia progression; the impact of outdoor activity on myopia incidence is due to daylight; subclassifications for myopia are effective; and myopia is a condition with a negative dioptric number. CONCLUSION: There are many hypotheses proposed to explain phenomena in the myopia field. Caution should be exercised in adopting conjecture until a robust evidence base is provided in support.

Evaluation of eye-related parameters and adverse events of rigid gas permeable contact lens and spectacles correction in infants with monocular aphakia after congenital cataract surgery: a retrospective clinical study.

BACKGROUND: Congenital cataract is currently one of the leading blindness-causing eye diseases in children. Surgical treatment only opens the visual pathway for children. The postoperative recovery of visual function is also dependent on effective optical correction and visual function training. In this study, we analyzed the changes in eye-related parameters, adverse events and the annual cost of rigid gas permeable contact lens (RGPCL) and spectacles correction in infants with monocular aphakia after congenital cataract surgery. METHODS: To analyze the postoperative visual acuity, strabismus, nystagmus, myopic shift, globe axial length growth, adverse events, patient adherence to patching, and annual cost for patients with unilateral congenital cataract who underwent cataract surgery. Rigid gas permeable contact lenses or spectacles were used to correct aphakia after congenital cataract. RESULTS: Of the 49 patients, 20 patients with unilateral aphakia who used RGPCL were in group 1. Group 2 comprised 14 patients with persistent fetal vasculature (PFV) who used RGPCL, and there were 15 patients with spectacles in group 3. In group 1, there were important improvements in visual acuity, strabismus and nystagmus. In groups 2 and 3, there were no significant improvements in visual acuity, strabismus or nystagmus. Patients with a good adherence to patching had better visual acuity after the operation than patients who did not, in groups 1 and 3. There were no significant differences in myopic shift or rate of globe axial length growth among the 3 groups. No patients in group 1 had ocular disease that affected visual acuity. The mean annual expenses of the RGPCL group was 3965 yuan, and the mean annual cost of spectacles was 1140 yuan to 2500 yuan. CONCLUSION: RGPCL is a safe and effective optical correction method for patients with monocular aphakia after congenital cataract surgery. Spectacles are not an ideal optical correction. Using RGPCL to correct patients with PFV, the final visual acuity improved, but the difference was not statistically significant. There were no improvements in strabismus or nystagmus in patients with PFV.

MEMS-based wearable eyeglasses for eye health monitoring.

A large number of world population suffer from vision related diseases/defects. Visual health supervision is important for detection, prevention and treatment of eyes disorders. Images of retina/fundus are important for diagnosis of eye diseases. In this paper we report on design and development of a wearable eyeglass type retinal imaging system using a 2D MEMS scanner for ocular health monitoring. Several wearability criteria for instance weight and size factor should be taken into account while designing a wearable health monitoring system. The 2D-MEMS scanner used in the system is small in size, that helps to fabricate an easy to use and lightweight wearable imaging device. The net weight of fabricated system including optical components is 150 g. Sensitivity of the system was estimated by measuring the signal-to-noise ratio for high and low reflectance materials. Signal-to-noise ratio was 7 for high reflectance material and about 4 for biological samples. Imaging results were obtained by scanning a model eye, ham slice and enucleated swine eye in real time by custom made LabVIEW program. The fabricated system has adequate sensitivity and resolution for the observation of retinal arteries and optic disc for detection of eye diseases.

A view to a kill? - Ambient bacterial load of frames and lenses of spectacles and evaluation of different cleaning methods.

Surfaces with regular contact with the human body are typically contaminated with microorganisms and might be considered as fomites. Despite spectacles being widespread across populations, little is known about their microbial contamination. Therefore, we swab-sampled 11 worn spectacles within a university setting as well as 10 worn spectacles in a nursing home setting. The microbial load was determined by aerobic cultivation. All spectacles were found to be contaminated with bacteria, with nose pads and ear clips having the highest density, i.e. at sites with direct skin contact. Summed over all sites, the median microbial load of the university spectacles (1.4 ± 10.7 x 10(3) CFU cm-2) did not differ significantly from the spectacles tested in the nursing home (20.8 ± 39.9 x 10(3) CFU cm-2). 215 dominant bacterial morphotypes were analyzed by MALDI biotyping. 182 isolates could be assigned to 10 genera, with Staphylococcus being the most common. On genus-level, bacterial diversity was greater on nursing home spectacles (10 genera) compared to the university environment (2 genera). Four cleaning methods were investigated using lenses artificially contaminated with Escherichia coli, Micrococcus luteus, a 1:2 mixture of E. coli and M. luteus, and Staphylococcus epidermidis (the dominant isolate in our study), respectively. Best cleaning results (99% -100% median germ reduction) were obtained using impregnated wipes; dry cleaning was less effective (85% -90% median germ reduction). Finally, 10 additional worn university spectacles were cleaned with wipes impregnated with an alcohol-free cleaning solution before sampling. The average bacterial load was significantly lower (0.09 ± 0.49 x 10(3) CFU cm-2) compared to the uncleaned university spectacles previously investigated. Spectacles are significantly contaminated with bacteria of mostly human skin origin-including significant amounts of potentially pathogenic ones and may contribute to eye infections as well as fomites in clinical environments.

Angular Vein Varix Congestion From Chronic Glasses Wear.

This is a case report of a symptomatic varicose angular vein exacerbated by chronic glasses wear. Compressing the vein in a recumbent position led to increased fullness of the medial canthal region and reproduced his symptoms. Obliteration by cauterization of the vein led to resolution of symptoms.

Retained Eyeglasses in the Orbital Cavity After Penetrating Facial Trauma.

This study describes a 68-year-old man who was presented to the emergency department with left orbital cavity penetration by his eyeglasses. The eyeglasses had entered the orbit and at presentation his eyesight could not be measured. The foreign body was extracted carefully and panfacial bone fractures were then reduced through lateral rhinotomy combined with a lip-splitting incision. When planning removal of an unusual foreign body from the orbital cavity, care should be taken not to injure the optic nerve, periorbital musculatures, or the eyeball.