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Duelund N, Nisted I, Jørgensen ME, Heegaard S, Jensen H. Vision screening and refraction of Greenlandic schoolchildren. Acta Ophthalmol 2024. [PMID: 39004821 DOI: 10.1111/aos.16740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To estimate the prevalence of amblyopia and refractive errors among 6-year-old children in Greenland and to assess the impact of incorporating autorefraction, stereoacuity and near visual acuity testing into vision screening. METHODS In this cross-sectional study, 517 children (238 girls and 279 boys) from 21 locations in Greenland were screened using HOTV charts for distance and near visual acuity (VA), stereoacuity test and non-cycloplegic autorefraction. Referral criteria for further ophthalmological examination included a VA of ≥0.2 logMAR on the worse-seeing eye or an interocular VA difference of ≥2 lines. RESULTS Initial screening identified amblyopia (defined as VA of ≥0.3 logMAR) in 7% (unilateral) and 3% (bilateral) of children. However, subsequent ophthalmological examinations confirmed amblyopia in under 40% of referrals. Significant interocular VA differences were found in 9%. The prevalence of refractive errors at the screening was 3% for myopia (≤-0.5 dioptres), 10% for hyperopia (>+2.0 dioptres) and 14% for astigmatism (≤-1.00 dioptres), while the corresponding prevalences at the ophthalmological examination were 4% for myopia, 8% for hyperopia and 6% for astigmatism. Combining screening measurements increased the positive predictive values, thereby enhancing screening accuracy. Specifically, the incorporation of autorefraction or stereoacuity with distance VA demonstrated to be the most effective combination. Six percent of the children were prescribed glasses after the screening procedure. CONCLUSION This study provides the first visual profile of Greenlandic schoolchildren. Incorporating autorefraction, stereoacuity and near visual acuity in vision screenings enhanced the efficacy of detection of vision anomalies. Although this may lead to more false positives, accurate screening is crucial in regions with limited ophthalmological resources.
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Affiliation(s)
- Nick Duelund
- Queen Ingrids Healthcare Center, Nuuk, Greenland
- Greenland Center of Health Research, Institute of Health and Nature, Ilisimatusarfik University of Greenland, Nuuk, Greenland
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Ivan Nisted
- Danish College of Optometry and Vision Science, Dania Academy, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marit Eika Jørgensen
- Greenland Center of Health Research, Institute of Health and Nature, Ilisimatusarfik University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
- University of Southern Denmark, Odense, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Hanne Jensen
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Birch EE, Duffy KR. Leveraging neural plasticity for the treatment of amblyopia. Surv Ophthalmol 2024:S0039-6257(24)00046-8. [PMID: 38763223 DOI: 10.1016/j.survophthal.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Amblyopia is a form of visual cortical impairment that arises from abnormal visual experience early in life. Most often, amblyopia is a unilateral visual impairment that can develop as a result of strabismus, anisometropia, or a combination of these conditions that result in discordant binocular experience. Characterized by reduced visual acuity and impaired binocular function, amblyopia places a substantial burden on the developing child. Although frontline treatment with glasses and patching can improve visual acuity, residual amblyopia remains for most children. Newer binocular-based therapies can elicit rapid recovery of visual acuity and may also improve stereoacuity in some children. Nevertheless, for both treatment modalities full recovery is elusive, recurrence of amblyopia is common, and improvements are negligible when treatment is administered at older ages. Insights derived from animal models about the factors that govern neural plasticity have been leveraged to develop innovative treatments for amblyopia. These novel therapies exhibit efficacy to promote recovery, and some are effective even at ages when conventional treatments fail to yield benefit. Approaches for enhancing visual system plasticity and promoting recovery from amblyopia include altering the balance between excitatory and inhibitory mechanisms, reversing the accumulation of proteins that inhibit plasticity, and harnessing the principles of metaplasticity. Although these therapies have exhibited promising results in animal models, their safety and ability to remediate amblyopia need to be evaluated in humans.
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Affiliation(s)
- Eileen E Birch
- Crystal Charity Ball Pediatric Vision Laboratory, Retina Foundation, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Kevin R Duffy
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Paul ME, Frempong T. Treatment rate of strabismus and amblyopia is associated with the location of pediatric ophthalmologists in the United States. J AAPOS 2024; 28:103868. [PMID: 38458596 DOI: 10.1016/j.jaapos.2024.103868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE To determine whether the geographic density of pediatric ophthalmologists is associated with the rate of children treated for strabismus and amblyopia. METHODS This cross-sectional study included children treated for strabismus and amblyopia 0-17 years of age with commercial insurance who were included in the Vision and Eye Health Surveillance System. Additionally, pediatric ophthalmologists by state were determined using the American Association for Pediatric Ophthalmology and Strabismus website. Unadjusted linear regression was used to compare the geographic density of pediatric ophthalmologists and the rate of children treated for strabismus and amblyopia by state in 2016. This was repeated using multivariable linear regression, controlling for race, poverty, non-English-speaking children, and insurance coverage for children by state. RESULTS New York and Mississippi had the highest and lowest rates of treatment of strabismus and amblyopia, with 3.97 and 0.83 children treated per 100 children, respectively. The geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in unadjusted analyses (β = 0.62, P < 0.001). Further, the geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in adjusted analyses (β = 0.61, P < 0.001). CONCLUSIONS The geographic density of pediatric ophthalmologists by state was positively associated with the rate of children treated for strabismus and amblyopia.
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Affiliation(s)
- Megan E Paul
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Tamiesha Frempong
- Icahn School of Medicine at Mount Sinai, New York, New York; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear, Eye and Vision Research Institute, New York, New York
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Piñero DP, Bataille L, Martínez-Plaza E, Molina-Martín A. Professional perspective and practice patterns of vision therapy in Spain. Clin Exp Optom 2024; 107:341-348. [PMID: 37218547 DOI: 10.1080/08164622.2023.2215383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
CLINICAL RELEVANCE An analysis of the professional perspective of vision therapy (VT) by eye care professionals allows understanding the current controversies about this therapeutic option of which aspects can be improved for its correct application in clinical practice. BACKGROUND The aim of the current study was to analyse the perception of VT and the clinical protocols in this context followed among optometrists and ophthalmologists in Spain. METHODS A cross-sectional survey among Spanish optometrists and ophthalmologists. Google Forms tool was used to collect data via an online questionnaire divided into 4 sections (40 questions): consent to participate, demographic characteristics, opinion of the professional perspective of VT, and protocols. Only one submission from each email address was permitted by the survey tool. RESULTS A total of 889 Spanish professionals answered (age, 25-62 years): 848 optometrists (95.4%) and 41 ophthalmologists (4.6%). VT was considered as a scientifically-based procedure by 95.1% of participants, but its recognition and prestige was considered as low. The main cause reported for this was bad reputation or perception of placebo therapy (27.3%). The main indication of VT according to the surveyed professionals was convergence and/or accommodation problems (72.4%). Significant differences were found in the perception of VT among optometrists and ophthalmologists (p ≤ 0.027). A total of 45.3% of professionals reported performing VT in their current clinical practice. A combination of training sessions in office and home was regularly prescribed by 94.5% of them, but with significant variability in the duration of such sessions. CONCLUSIONS VT is perceived by Spanish optometrists and ophthalmologists as a therapeutic option with scientific basis, but with limited recognition and prestige, although with more negative perception among ophthalmologists. A great variability was found in the clinical protocols followed between specialists. Future efforts should be focused on creating internationally recognised evidence-based protocols for this therapeutic option.
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Affiliation(s)
- David P Piñero
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- Advanced Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Laurent Bataille
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
- University of Valladolid, Valladolid, Spain
| | - Ainhoa Molina-Martín
- Group of Optics and Visual Perception (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Visutrain project, Science Park of the University of Alicante, Alicante, Spain
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Aremu OO, Ugalahi MO, Olusanya BA, Oluleye TS. Functional Vision of Pseudophakic Children Attending a Pediatric Ophthalmology Clinic in Southwest Nigeria. J Pediatr Ophthalmol Strabismus 2024; 61:138-146. [PMID: 37882184 DOI: 10.3928/01913913-20231005-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE To determine the functional vision of pseudophakic children attending a child eye health tertiary facility in southwest Nigeria. METHODS A hospital-based descriptive study of pseudophakic children attending the Pediatric Ophthalmology outpatient clinic of a tertiary facility in southwest Nigeria was conducted between June and November 2021. Details of demography and clinical examination findings were obtained using a semi-structured questionnaire. Information about functional vision was obtained using the Pediatric Eye Questionnaire (PedEyeQ). Data obtained from the PedEyeQ were entered into a Rasch-calibrated PedEyeQ Excel response data sheet. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 22 (SPSS, Inc). RESULTS A total of 196 pseudophakic children were recruited. Their ages ranged from 2 to 16 years with a mean of 9.8 ± 3.4 years and there was a male-to-female ratio of 2.2:1. The median functional vision score of pseudophakic children across all age groups was 90.0. The functional vision scores were associated with the laterality of cataract, type of cataract, presence of comorbidities, visual acuity (distance and near) in the better eye, and number of surgeries. CONCLUSIONS The functional vision scores of pseudophakic children were low. Significant predictors of low functional vision scores include surgery for congenital cataract, low average family income, longer duration of time between surgery and recruitment into the study, and poorer best corrected visual acuity in the better eye. The routine assessment of functional vision should be considered an important aspect of pseudophakic children's eye care with a view toward optimizing psychological and social well-being. [J Pediatr Ophthalmol Strabismus. 2024;61(2):138-146.].
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Liang X, Zheng D, Young CA, Ma Y, Ling L, Zou M, Liu S, Zhang X, Jin G. Evaluation of functional vision and eye-related quality of life in children with congenital ectopia lentis: a prospective cross-sectional study. BMJ Open 2023; 13:e075222. [PMID: 38135313 DOI: 10.1136/bmjopen-2023-075222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES This study aims to evaluate the effect of congenital ectopia lentis (CEL) on functional vision and eye-related quality of life (ER-QOL) in children and their families using the Paediatric Eye Questionnaire (PedEyeQ). DESIGN A questionnaire survey administered via in-person interviews of patients with CEL and their parents. PARTICIPANTS 51 children with CEL and 53 visually normal controls accompanied by 1 parent completed the survey questionnaires for the study from March 2022 to September 2022. OUTCOME MEASURES PedEyeQ domain scores. Functional vision and ER-QOL of children and their families were evaluated by calculating and comparing the Rasch domain scores of the PedEyeQ. RESULTS PedEyeQ domain scores were significantly worse with CEL compared with controls (p<0.01 for each), with the exception of the Proxy Social domain among children aged 0-4 years (p=0.283). Child PedEyeQ greatest differences were in the functional vision domain (5-11 years, -20 points (95% CI -27 to -12)) and frustration/worry domain (12-17 years, -41 (95% CI -37 to -6)). Proxy PedEyeQ greatest differences were in the functional vision domain (0-4 years, -34 (95% CI -45 to -22)) and frustration/worry domain (5-11 years, -27 (95% CI -39 to -14); 12-17 years, -37(95% CI (-48 to -26))). Parent PedEyeQ greatest difference was in the 'worry about child's eye condition' (-57 (95% CI (-63 to -51))). CONCLUSIONS In this study, children with CEL had reduced functional vision and ER-QOL compared with controls. Parents of children with CEL also experience reduced quality of life.
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Affiliation(s)
- Xiaolin Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | | | - Yiyuan Ma
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lirong Ling
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Siyuan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xinyu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Nowik M, Perna F, Dahlmann-Noor A, Stern J, Malkowski JP, Weisberger A, Webber A. Amblyopia-A novel virtual round table to explore the caregiver perspective. Ophthalmic Physiol Opt 2023; 43:1571-1580. [PMID: 37515472 DOI: 10.1111/opo.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE A survey aimed to capture the caregiver's perspective on the impact of amblyopia and its treatment on the child and family, as well as caregivers' views on the design and feasibility of clinical trials investigating dichoptic binocular therapies for amblyopia. METHODS Parents of amblyopic children, patient advocates and healthcare professionals took part in a moderated, structured discussion on a novel virtual advisory-board platform. RESULTS Seven parents of children with amblyopia, two patient organisation representatives, one ophthalmologist and one optometrist participated in the survey. A total of 645 posts were entered on the platform over a 14-day period in September 2021. There was widespread agreement that the management of amblyopia poses more of a burden on the child and family than the condition itself, with treatment burden accentuated when treatment is unsuccessful. Parents expressed uncertainty and frustration in relation to the duration of patching, success of patching and alternative treatment options, and felt there was inadequate readily available, easy-to-understand information on the condition. Parents reported that a new treatment for amblyopia, such as dichoptic binocular therapy using video games, should be safe, non-invasive and engaging compared with an eye patch. Treating at home, potentially for a shorter treatment duration, and with an entertaining game were the main reasons parents would join a clinical study with this type of novel therapy. However, due to a limited critical period treatment window, parents would feel more comfortable joining a clinical trial if traditional therapies were offered in conjunction with those under investigation. CONCLUSION Patient perspectives and the role of caregivers in the acceptance of any interventional treatments are increasingly recognised. Understanding how amblyopia and its treatment impacts a child and family should be an important premise to guide therapy and evaluate treatment value, both in clinical trials and in routine medical practice.
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Affiliation(s)
| | | | | | - Jude Stern
- c/o International Agency for the Prevention of Blindness (IAPB), Sydney, New South Wales, Australia
| | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Randhawa S, Griffiths N, O'Brien P, Panter C, Boparai K, Harrad R, Khuddus N, Webber A, Bouchet C, Felizzi F. Qualitative Exploration of the Visual Function Impairments and Health-Related Quality of Life Impacts of Amblyopia in Adult and Pediatric Populations. Ophthalmol Ther 2023; 12:2505-2528. [PMID: 37356087 PMCID: PMC10441976 DOI: 10.1007/s40123-023-00751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION Amblyopia is a reduction in vision in one or both eyes due to impaired development of the visual pathway. This study explored the experience of amblyopia and treatment from the patient, caregiver, and clinician perspectives. METHODS A targeted literature review, including a review of social media listening (SML) studies, was conducted. Next, qualitative interviews were conducted with amblyopia patients, caregivers of children with amblyopia, and ophthalmologists with experience treating patients with amblyopia. The findings informed the development of a disease model. Amblyopia clinical experts provided input at key stages. RESULTS Twelve data sources were reviewed, including qualitative studies in the literature and SML studies. Overall, 133 patients/caregivers were interviewed (23 adults, 16 adolescents, 47 child-caregiver dyads), plus 10 ophthalmologists from the United States, France, and Germany. Reduced visual acuity, impaired depth perception, impaired peripheral vision, and double vision were the most frequently reported symptoms. Amblyopia impacted daily activities (reading, using digital devices), the ability to move around, school/work (productivity, seeing the board in class), emotional well-being (frustration, sadness), and social functioning (difficulty socializing). Treatments, including patching and corrective lens, also impacted daily activities (using digital devices, sports/leisure), mobility (bumping into things), and work/school (tasks taking longer) as well as emotional well-being (embarrassment), and social functioning (bullying/stigma). CONCLUSION The findings contribute valuable insights into the adult and pediatric experience of amblyopia from a multi-stakeholder perspective. The findings were used to critically assess existing clinical outcome assessments and supported the development of patient- and observer-reported outcome measures for use in amblyopia clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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Simon-Martinez C, Antoniou MP, Bouthour W, Bavelier D, Levi D, Backus BT, Dornbos B, Blaha JJ, Kropp M, Müller H, Murray M, Thumann G, Steffen H, Matusz PJ. Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial. BMC Ophthalmol 2023; 23:220. [PMID: 37198558 DOI: 10.1186/s12886-023-02944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children. METHODS The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up. DISCUSSION The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills. TRIAL REGISTRATION This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024).
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Affiliation(s)
- Cristina Simon-Martinez
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland.
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland.
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland.
| | - Maria-Paraskevi Antoniou
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Walid Bouthour
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Daphne Bavelier
- Faculty of Psychology and Education Sciences, University of Geneva, Geneva, Switzerland
| | - Dennis Levi
- Herbert Wertheim School of Optometry & Vision Science, Helen Wills Neuroscience Institute, University of California Berkley, Berkley, CA, USA
| | - Benjamin T Backus
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - Brian Dornbos
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - James J Blaha
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - Martina Kropp
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Henning Müller
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
| | - Micah Murray
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Institute of Health Sciences, School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Laboratory for Investigative Neurophysiology, Department of Radiology, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Heimo Steffen
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Pawel J Matusz
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
- Institute of Health Sciences, School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Laboratory for Investigative Neurophysiology, Department of Radiology, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Gong L, Yu X, Wei L, Zhang R, Cao S, Xiong Y, He Z, Xu M, Yu H, Yu X, Lu F, Qu J, Zhou J. Translating and evaluating the Chinese version of Pediatric Eye Questionnaire (PedEyeQ-CN) for children. Eye (Lond) 2023; 37:1397-1404. [PMID: 35760903 PMCID: PMC10169794 DOI: 10.1038/s41433-022-02157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the reliability and validity of Chinese version of the Pediatric Eye Questionnaire (PedEyeQ-CN) by testing ophthalmic patients in China. METHODS The PedEyeQ (standard English version) was translated by local researchers. Children were asked to complete the Child section, and their parents the Proxy and Parent sections. 160 children (32 normal controls, 77 with refractive error, 48 with strabismus/amblyopia, 3 with other eye conditions) aged 5-11 years old, and one parent of each child were recruited. Cronbach's α and intraclass correlation coefficient were calculated to examine the reliability and test-retest reliability; the score differences between controls and patients were compared to examine the validity. RESULTS The internal consistency (Cronbach's α ≥ 0.76) and test-retest reliability (r > 0.80) of PedEyeQ-CN were robust. Children with eye conditions had lower scores compared with children with normal vision (refractive error: 10 out of 13 domains, P ≤ 0.021; strabismus/amblyopia: all domains, P ≤ 0.015). Children with strabismus/amblyopia had lower scores compared with children with refractive error (two domains, P = 0.048, P = 0.001). Visual acuity was significantly correlated with functional vision (P = 0.005), but not significantly correlated with the eye-related quality of life (ER-QOL). CONCLUSIONS The PedEyeQ-CN is a valuable tool for assessing the functional vision and ER-QOL of Chinese children and help us increase our understanding about the impact of eye conditions on children and their families.
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Affiliation(s)
- Ling Gong
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xi Yu
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lili Wei
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ran Zhang
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Suqi Cao
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yue Xiong
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhifen He
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiping Xu
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huanyun Yu
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinping Yu
- Zhongshan Ophthalmic Center, Sun Yat-Sun University, Guangzhou, Guangdong, China.
| | - Fan Lu
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Qu
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiawei Zhou
- School of Ophthalmology and Optometry, Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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11
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Birch EE, Kelly KR. Amblyopia and the whole child. Prog Retin Eye Res 2023; 93:101168. [PMID: 36736071 PMCID: PMC9998377 DOI: 10.1016/j.preteyeres.2023.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
Amblyopia is a disorder of neurodevelopment that occurs when there is discordant binocular visual experience during the first years of life. While treatments are effective in improving visual acuity, there are significant individual differences in response to treatment that cannot be attributed solely to difference in adherence. In this considerable variability in response to treatment, we argue that treatment outcomes might be optimized by utilizing deep phenotyping of amblyopic deficits to guide alternative treatment choices. In addition, an understanding of the broader knock-on effects of amblyopia on developing visually-guided skills, self-perception, and quality of life will facilitate a whole person healthcare approach to amblyopia.
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Affiliation(s)
- Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Krista R Kelly
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA; Vision and Neurodevelopment Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA.
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12
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Bui Quoc E, Kulp MT, Burns JG, Thompson B. Amblyopia: A review of unmet needs, current treatment options, and emerging therapies. Surv Ophthalmol 2023; 68:507-525. [PMID: 36681277 DOI: 10.1016/j.survophthal.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Amblyopia is a global public health issue with extensive, multifaceted impacts on vision and quality of life (QoL) for both patients and families. Geographical variation exists in the management of amblyopia, with traditional mainstay treatments, optical correction, and fellow eye occlusion most successful when implemented at an early age. In recent years, however, studies demonstrating meaningful improvements in older children and adults have challenged the concept of a complete loss of visual processing plasticity beyond the critical period of visual development, with growing evidence supporting the potential efficacy of emerging, more engaging, binocular therapies in both adults and children. Binocular approaches aim to restore deficits in amblyopia that extend beyond monocular visual acuity impairment, including binocular fusion and visuomotor skills. In view of this, incorporating outcome measures that evaluate the visual performance and functional ability of individuals with amblyopia will provide a clearer understanding of the effect of amblyopia on QoL and a more comprehensive evaluation of amblyopia therapies.
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Affiliation(s)
- Emmanuel Bui Quoc
- Ophthalmology Department, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
| | | | | | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Canada; Centre for Eye and Vision Research, Hong Kong
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13
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Yang T, Hu R, Tian W, Lin Y, Lu Y, Liang X, Zheng D, Zhang X. Comparison of Functional Vision and Eye-Related Quality of Life between Myopic Children Treated with Orthokeratology and Single-Vision Spectacles in Southern China. J Ophthalmol 2023; 2023:7437935. [PMID: 37089412 PMCID: PMC10118901 DOI: 10.1155/2023/7437935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Objective To compare eye-related quality of life between Chinese children wearing orthokeratology (OK) contact lenses and single-vision spectacles (SVS) using the Pediatric Eye Questionnaire (PedEyeQ) and to evaluate the impact of different myopia correction methods on children and their parents. Methods Children aged 12-17 years and their parents/legal guardians were recruited. The children's myopia ranged from -0.50 to -5.00 diopters (D), and their astigmatism was <1.50 D. They had all been wearing OK contact lenses or SVS for at least 12 months. The children completed the Child PedEyeQ. One of their parents (or a legal guardian) completed the Proxy PedEyeQ and the Parent PedEyeQ. Rasch-calibrated PedEyeQ scores were calculated for each domain and were converted to a scale from 0 to 100 for statistical analysis. Results A total of 50 children wearing OK contact lenses, 43 children wearing SVS, and their parents/legal guardians completed the questionnaires. The scores of all Child, Proxy, and Parent PedEyeQ domains in the OK contact lens group were higher than those in the SVS group (all P < 0.05). In the mild and moderate myopia subgroups, the Child, Proxy, and Parent PedEyeQ scores in the mild myopia OK contact lens subgroup were higher than those in the mild myopia SVS group (all P < 0.05) except functional vision and bothered by eyes/vision domains for the proxy PedEyeQ. Similarly, the Child, Proxy, and Parent PedEyeQ scores in the moderate myopia OK contact lens subgroup were higher than those in the moderate myopia SVS subgroup (all P < 0.05) except impact on parent and family domain for the parent PedEyeQ. In the subgroup analysis of glasses type, no significant score difference of any Child, Proxy, and Parent PedEyeQ domain was detected between mild and moderate myopia in either the OK contact lens group or the SVS group (all P > 0.05). Conclusion Compared with children wearing SVS, children wearing OK contact lenses have better functional vision and eye-related quality of life. Moreover, OK contact lens has a better correction effect, higher acceptance rates, and less impact on parents and families than SVS.
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Affiliation(s)
- Tingting Yang
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Rongsheng Hu
- Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Wen Tian
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Ying Lin
- Qingyuan Aier Eye Hospital, Qingyuan, China
| | - Yamei Lu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Xiaolin Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xinyu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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14
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Le T, Örge F. Treatment compliance in amblyopia: A mini-review and description of a novel online platform for compliance tracking. Surv Ophthalmol 2022; 67:1685-1697. [PMID: 35970235 DOI: 10.1016/j.survophthal.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
Patient compliance with amblyopia therapies, including eye patching and atropine drops, is crucial for optimal visual acuity outcomes. Studies utilizing objective measures of compliance measurement have consistently shown that a majority of patients receive significantly less treatment than prescribed. We review the subjective and objective compliance rates reported in the literature, assess possible explanations for poor compliance and describe studies of interventions to improve compliance. Additionally, we report our experience implementing Inside Out Care, a novel online platform designed to improve monitoring of amblyopia patient compliance, in our clinics. We have found that this platform, which is accessible via both computer and smartphone, has improved monitoring of amblyopia patient patching compliance, as well as allowed for enhanced doctor-patient communication.
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Affiliation(s)
- Tinh Le
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute
| | - Faruk Örge
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute.
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15
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O’Connor A, King C, Milling A, Tidbury L. Using a Computerised Staircase and Incremental Optotype Sizes to Improve Visual Acuity Assessment Accuracy. BRITISH AND IRISH ORTHOPTIC JOURNAL 2022; 18:93-100. [PMID: 35938054 PMCID: PMC9306677 DOI: 10.22599/bioj.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Given the impact of visual acuity results on diagnosis and management, it is essential that the test is accurate, determined by factors such as test-retest variability. Standardisation improves accuracy, which can be performed via a computerised staircase methodology. Standard clinical tests with scoring of 0.02 per optotype implies an incremental score per optotype despite optotype size remaining constant on each line. The aim of this study is to establish if near continuous incremental optotype display and scoring improves test-retest variability compared to current testing methods. Methods: A computerised three up, one down adaptive staircase was used to display Kay Picture optotypes on an LCD monitor. Three methods of visual acuity assessment were undertaken: ETDRS, Kay Pictures and computerised Kay Pictures. Tests were performed twice under standard clinical conditions. Results: One hundred nineteen adults were tested. Test-retest variability for computerised Kay pictures was 0.01 logMAR (±0.04, p = 0.001). Good levels of agreement were observed for computerised Kay pictures in terms of test-retest variability, where the test had the smallest mean bias (0.01 logMAR compared to 0.03 and 0.08 logMAR for Kay Pictures and ETDRS respectively) and narrowest limits of agreement. Participants performed better in computerised Kay pictures than Kay Pictures by 0.03 logMAR, and better in ETDRS than computerised Kay pictures by 0.1 logMAR. Conclusion: Computerised Kay pictures exhibited a low test-retest variability, demonstrating it is reliable and repeatable. This repeatability measure is lower than the test-retest variability of the ETDRS and Kay Pictures tests.
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Hatt SR, Leske DA, Wernimont SM, Bothun ED, Birch EE, Holmes JM. Applying Normal PedEyeQ Thresholds to Assess Eye-related Quality of Life among Children with Strabismus. J Binocul Vis Ocul Motil 2022; 72:92-96. [PMID: 35104205 PMCID: PMC9050854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
PURPOSE To determine proportions of children with strabismus with below-normal Pediatric Eye Questionnaire (PedEyeQ) scores. METHODS Ninety-eight children with strabismus (70 aged 5-11 years; 28 aged 12-17 years) were evaluated. Children completed the Child 5-11 or 12-17 PedEyeQ (Functional Vision, Bothered by Eyes/vision, Social, and Frustration/worry domains). Parents completed the Proxy (same domains plus Eye Care) and Parent PedEyeQ (Impact on Parent and Family, Worry about Child's Eye Condition, Worry about Child's Self-perception and Interactions, and Worry about Functional Vision domains). Previously published normal (5th percentile) thresholds were applied to calculate proportions with below-normal scores for each domain. RESULTS For the Child PedEyeQ more than 20% of 5- to 11-year-olds scored below normal, on all but the Social domain, whereas more than 50% of 12- to 17-year-olds scored below normal on all domains. On the Proxy PedEyeQ, more than 50% scored below normal on all domains when parents reported on 5- to 11-year-olds and 12- to 17-year-olds. For the Parent PedEyeQ, more than 50% of the parents of both 5- to 11-year-olds and 12- to 17-year-olds scored below normal on all domains. CONCLUSIONS The majority of children with strabismus have below-normal PedEyeQ scores, particularly children aged 12-17 years.
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Affiliation(s)
- Sarah R. Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David A. Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Eileen E. Birch
- Retina Foundation of the Southwest, Dallas, Texas
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University of Arizona-Tucson, Arizona
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17
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Gu S, Hu Y, Zhao Y, Chen L, Sun W, Chang P, Wang D, Zhao Y. A Retrospective Study on the Eye-Related Quality of Life, Functional Vision, and Their Determinants Among Children Following Congenital and Developmental Cataracts Surgery and Its Impact on Their Families Using the PedEyeQ. Front Public Health 2022; 10:788384. [PMID: 35372237 PMCID: PMC8968105 DOI: 10.3389/fpubh.2022.788384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo evaluate the eye-related quality of life (ER-QOL), functional vision, and their determinants in children following congenital and developmental cataract surgery, as the impact on their families, using the Pediatric Eye Questionnaire (PedEyeQ).Materials and MethodsThis was a retrospective cross-sectional study involving 107 children (aged 0–11 years) with congenital and developmental cataracts who had undergone surgery, as well as 59 visually healthy controls (aged 0–11 years). One parent for each child completed either the Proxy 0–4 PedEyeQ, the Proxy 5–11 PedEyeQ, or the Parent PedEyeQ, depending on their child's age. Mann-Whitney U and Kruskal-Wallis tests were then conducted to compare the differences between groups and to analyze their determinants.ResultsPedEyeQ scores were found to be lower in postoperative children with congenital and developmental cataracts compared with the control group across all study domains. The PedEyeQ Proxy 0 to 4 years' greatest mean difference was 27 points worse in the Functional Vision domain (95% CI −34 to −19; p < 0.001). We also found that the occurrence of nystagmus (p < 0.005) and strabismus (p < 0.005) were the major factors affecting participants' functional vision. The PedEyeQ Proxy 5 to 11 years' greatest mean difference was 23 points worse in this same domain (95% CI −30 to −15; p < 0.001), with nystagmus (p < 0.05) being the main determinant herein. Parent PedEyeQ 0 to 4 years' greatest difference was 46 points worse on the Worry about their Child's Eye Condition domain (95% CI −57 to −36; p < 0.001). Similarly, parents of children with ophthalmologic abnormalities, including nystagmus (p < 0.001) and strabismus (p < 0.05), were significantly more worried about their children's eye condition. Parent PedEyeQ 5 to 11 years' greatest difference was also found to be 30 points worse on the Worry about their Child's Eye Condition domain (95% CI −43 to −17; p < 0.005).ConclusionsChildren who have undergone congenital and developmental cataract surgery experience a lower quality of life and reduced functional vision. Their families are also significantly and adversely affected herein. Thus, more attention is needed on these groups, with more focused measures being administered to both children and their families.
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Affiliation(s)
- Siyi Gu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yiwen Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yinying Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Lulu Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Weijie Sun
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Pingjun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Dandan Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yune Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
- *Correspondence: Yune Zhao
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18
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Murray J, Gupta P, Dulaney C, Garg K, Shaikh AG, Ghasia FF. Effect of Viewing Conditions on Fixation Eye Movements and Eye Alignment in Amblyopia. Invest Ophthalmol Vis Sci 2022; 63:33. [PMID: 35212720 PMCID: PMC8883146 DOI: 10.1167/iovs.63.2.33] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients with amblyopia are known to have fixation instability, which arises from alteration of physiologic fixation eye movements (FEMs) and nystagmus. We assessed the effects of monocular, binocular, and dichoptic viewing on FEMs and eye alignment in patients with and without fusion maldevelopment nystagmus (FMN). Methods Thirty-four patients with amblyopia and seven healthy controls were recruited for this study. Eye movements were recorded using infrared video-oculography during (1) fellow eye viewing (FEV), (2) amblyopic eye viewing (AEV), (3) both eye viewing (BEV), and (4) dichoptic viewing (DcV) at varying fellow eye (FE) contrasts. The patients were classified per the clinical type of amblyopia and FEM waveforms into those without nystagmus, those with nystagmus with and without FMN. Fixational saccades and intersaccadic drifts, quick and slow phases of nystagmus, and bivariate contour ellipse area were analyzed in the FE and amblyopic eye (AE). Results We found that FEMs are differentially affected with increased amplitude of quick phases of FMN observed during AEV than BEV and during DcV at lower FE contrasts. Increased fixation instability was seen in anisometropic patients at lower FE contrasts. Incomitance of eye misalignment was seen with the greatest increase during FEV. Strabismic/mixed amblyopia patients without FMN were more likely to demonstrate a fixation switch where the AE attends to the target during DcV than patients with FMN. Conclusions Our findings suggest that FEM abnormalities modulate with different viewing conditions as used in various amblyopia therapies. Increased FEM abnormalities could affect the visual function deficits and may have treatment implications.
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Affiliation(s)
- Jordan Murray
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Palak Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States.,Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States
| | - Cody Dulaney
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Kiran Garg
- Case Western Reserve University, Cleveland, Ohio, United States
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States.,Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States.,Department of Neurology, Neurological Institute, University Hospitals, Cleveland, Ohio, United States
| | - Fatema F Ghasia
- Visual Neurosciences and Ocular Motility Laboratory, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.,Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, United States
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Birch EE, Kelly KR, Wang J. Recent Advances in Screening and Treatment for Amblyopia. Ophthalmol Ther 2021; 10:815-830. [PMID: 34499336 PMCID: PMC8589941 DOI: 10.1007/s40123-021-00394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA.
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Krista R Kelly
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
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20
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Quality of life study in ophthalmic practice. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov71041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The article discusses various methods for studying the quality of life in all kinds of eye diseases. General and special questionnaires used in modern ophthalmological practice are presented. The presence of a sufficiently large amount of data indicating the relationship between the quality of life and objective indicators of the visual system was established. A fairly good comparability of results obtained in the assessment of various quality of life questionnaires in a patient with ophthalmic condition was revealed.
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21
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Quality of life and functional vision across pediatric eye conditions assessed using the PedEyeQ. J AAPOS 2021; 25:23.e1-23.e5. [PMID: 33601046 PMCID: PMC8169574 DOI: 10.1016/j.jaapos.2020.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate eye-related quality of life (ER-QOL) and functional vision across a wide range of pediatric eye conditions, using the Pediatric Eye Questionnaires (PedEyeQ). METHODS A total of 1,037 children with an eye condition and 254 visually normal controls, across 0-4, 5-11, and 12-17 years age groups, completed the following questionnaires: Child PedEyeQ (Functional Vision, Bothered by Eyes/Vision, Social, Frustration/Worry domains), Proxy PedEyeQ (same domains plus Eye Care), and Parent PedEyeQ (Impact on Parent and Family, Worry about Child's Eye Condition, Worry about Child's Self-perception and Interactions, and Worry about Functional Vision domains). The primary eye condition was classified as amblyopia (n = 171), cataract (n = 99), cerebral visual impairment (CVI; n = 50), cornea (n = 20), eyelid (n = 35), glaucoma (n = 24), nystagmus (n = 57), orbital (n = 19), pupil/iris (n = 7), refractive error (n = 119), retina (n = 82), strabismus (n = 332), and uveitis (n = 22). RESULTS PedEyeQ domain scores (scaled 0-100) were significantly worse across eye conditions, compared with controls. Child PedEyeQ greatest differences were on the Bothered by Eyes/Vision domain (nystagmus 5-11 years, -26 points [95% CI, -39 to -12]; nystagmus 12-17 years, -45 [95% CI, -61 to -28]). Proxy PedEyeQ differences were greatest on Functional Vision (CVI 0-4 years, -45 [95% CI, -56 to -34]; CVI 5-11 years, -58 [95% CI, -72 to -43]; nystagmus 12-17 years, -50 [95% CI, -69 to -31]). Parent PedEyeQ differences were greatest on Worry about Child's Functional Vision (CVI 0-4 years, -64; 95% CI -77 to -50). CONCLUSIONS The PedEyeQ detects reduced ER-QOL and functional vision across pediatric eye conditions, and across age groups, indicating its utility for clinical practice and clinical trials.
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Birch EE, Castañeda YS, Cheng-Patel CS, Morale SE, Kelly KR, Jost RM, Hudgins LA, Leske DA, Holmes JM. Associations of Eye-Related Quality of Life With Vision, Visuomotor Function, and Self-Perception in Children With Strabismus and Anisometropia. Invest Ophthalmol Vis Sci 2020; 61:22. [PMID: 32926105 PMCID: PMC7490229 DOI: 10.1167/iovs.61.11.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/08/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate associations between eye-related quality of life (ER-QOL) assessed by the Child Pediatric Eye Questionnaire (Child PedEyeQ) and functional measures (vision, visuomotor function, self-perception) in children with strabismus, anisometropia, or both. Our hypothesis was that children with functional deficits would have lower ER-QOL, and if so, these associations would support the convergent construct validity of the Child PedEyeQ. Methods We evaluated 114 children (ages 5-11 years) with strabismus, anisometropia, or both. Each child completed the Child PedEyeQ to assess four Rasch-scored domains of ER-QOL: Functional Vision, Bothered by Eyes/Vision, Social, and Frustration/Worry. In addition, children completed one or more functional tests: visual acuity (n = 114), Randot Preschool Stereoacuity (n = 92), contrast balance index (suppression; n = 91), Readalyzer reading (n = 44), vergence instability (n = 50), Movement Assessment Battery for Children-2 manual dexterity (n = 57), and Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (n = 44). Results Child PedEyeQ Functional Vision domain scores were correlated with self-perception of physical competence (rs = 0.65; 95% confidence interval [CI], 0.35-0.96) and reading speed (rs = 0.47; 95% CI, 0.16-0.77). Bothered by Eyes/Vision domain scores were correlated with self-perception of physical competence (rs = 0.52; 95% CI, 0.21-0.83). Moderate correlations were observed between Social domain scores and vergence instability (rs = -0.46; 95% CI, -0.76 to -0.15) and self-perception of physical competence (rs = 0.43; 95% CI, 0.12-0.73) and peer acceptance (rs = 0.49; 95% CI, 0.18-0.80). Frustration/Worry domain scores were moderately correlated with self-perception of physical competence (rs = 0.41; 95% CI, 0.10-0.71) and peer acceptance (rs = 0.47; 95% CI, 0.16-0.77). Conclusions Strong and moderate correlations were observed between functional measures and Child PedEyeQ domain scores. These associations provide supporting evidence that the Child PedEyeQ has convergent construct validity.
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Affiliation(s)
- Eileen E. Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States
- Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | | | | | - Sarah E. Morale
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Krista R. Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States
- Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Reed M. Jost
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | | | - David A. Leske
- Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
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