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Huang Y, Ten W, Zhan B, Shen Y, Sun B, Xu H, Zhou X. Autostereoscopic 3D viewing can change the dimensions of the crystalline lens in myopes. Ophthalmic Physiol Opt 2024; 44:1309-1318. [PMID: 38980219 DOI: 10.1111/opo.13361] [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: 03/19/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three-dimensional (3D) viewing. METHODS Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two-dimensional [2D] viewing groups) to watch a 30-min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non-accommodating (static) and accommodating conditions. RESULTS In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post-3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post-3D viewing was greater in high-myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non-accommodative) condition, for 3D viewing the lens decentration decreased (-0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (-0.14 ± 0.20 mm, p = 0.006) and diameter (-0.13 ± 0.20 mm, p = 0.01) decreased. CONCLUSIONS Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non-accommodating conditions. However, its long-term effect requires further exploration.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Weijung Ten
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Biyun Zhan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Bingqing Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Haipeng Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Centre of Ophthalmology and Optometry
- Shanghai Engineering Research Centre of Laser and Autostereoscopic 3D for Vision Care
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Gilbert A, Samuel R, Cagney D, Sebag-Montefiore D, Brown J, Brown SR. The use of master protocols for efficient trial design to evaluate radiotherapy interventions: a systematic review. J Natl Cancer Inst 2024; 116:1220-1229. [PMID: 38720568 PMCID: PMC11308198 DOI: 10.1093/jnci/djae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/05/2024] [Accepted: 04/07/2024] [Indexed: 08/09/2024] Open
Abstract
The aim of this review was to highlight why the use of master protocols trial design is particularly useful for radiotherapy intervention trials where complex setup pathways (including quality assurance, user training, and integrating multiple modalities of treatment) may hinder clinical advances. We carried out a systematic review according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, reviewing the findings using a landscape analysis. Results were summarized descriptively, reporting on trial characteristics highlighting the benefits, limitations, and challenges of developing and implementing radiotherapy master protocols, with three case studies selected to explore these issues in more detail. Twelve studies were suitable for inclusion (4 platform trials, 3 umbrella trials, and 5 basket trials), evaluating a mix of solid tumor sites in both curative and palliative settings. The interventions were categorized into 1) novel agent and radiotherapy combinations; 2) radiotherapy dose personalization; and 3) device evaluation, with a case study provided for each intervention. Benefits of master protocol trials for radiotherapy intervention include protocol efficiency for implementation of novel radiotherapy techniques; accelerating the evaluation of novel agent drug and radiotherapy combinations; and more efficient translational research opportunities, leading to cost savings and research efficiency to improve patient outcomes. Master protocols offer an innovative platform under which multiple clinical questions can be addressed within a single trial. Due to the complexity of radiotherapy trial setup, cost and research efficiency savings may be more apparent than in systemic treatment trials. Use of this research approach may be the change needed to push forward oncological innovation within radiation oncology.
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Affiliation(s)
- Alexandra Gilbert
- Leeds Institute for Medical Research, University of Leeds, St James’s University Hospital, Leeds, UK
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robert Samuel
- Leeds Institute for Medical Research, University of Leeds, St James’s University Hospital, Leeds, UK
| | - Daniel Cagney
- Radiation Oncology, Mater Private Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - David Sebag-Montefiore
- Leeds Institute for Medical Research, University of Leeds, St James’s University Hospital, Leeds, UK
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah R Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Wong BM, Fung SSM, Velez FG, Perez C, Guo R, Yu F, Pineles SL. Evaluation of 3D tablet-based stereoacuity test ASTEROID in children with normal and abnormal visual acuity. J AAPOS 2024; 28:103930. [PMID: 38719139 DOI: 10.1016/j.jaapos.2024.103930] [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: 09/17/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE To assess the utility of 3D, tablet-based, glasses-free Accurate STEReotest (ASTEROID) in children compared with the Titmus test. METHODS Children aged 5-13 years were enrolled in a single-center, nonrandomized, observational comparison study and analyzed by age (5-7 vs 8-13 years) and visual acuity (20/25 or better in both eyes vs abnormal). Each participant underwent both the ASTEROID and Titmus stereoacuity tests. Stereoacuity was defined as fine (≤60 arcsec), moderate (61-200 arcsec), coarse (201-1199 arcsec), or very coarse to nil (≥1200 arcsec). Agreement between the tests was assessed using a weighted kappa (κ) statistic based on all four categories. RESULTS A total of 112 children were included: 28 aged 5-7 with normal visual acuity, 30 aged 5-7 with abnormal visual acuity, 34 aged 8-13 with normal visual acuity, and 20 aged 8-13 with abnormal visual acuity. Mean ASTEROID score was 688 ± 533 arcsec (range, 13-1200 arcsec). Agreement between ASTEROID and Titmus test scores for participants overall was moderate (κ = 0.52). By subgroup, agreement was fair for children 5-7 with abnormal visual acuity (κ = 0.31), moderate for children 5-7 with normal visual acuity (κ = 0.47) and children 8-13 with normal visual acuity (κ = 0.42), and substantial for children 8-13 with abnormal visual acuity (κ = 0.76). Where ASTEROID and Titmus score group varied, ASTEROID score was poorer in 94% (47/50) of cases. CONCLUSIONS ASTEROID is a digital, tablet-based test that evaluates global stereopsis, does not require glasses, and provides a continuum of scores. Among children, ASTEROID has good agreement with the Titmus test; however, it may be more sensitive at detecting stereovision deficits. Further study is necessary to determine which test is more accurate.
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Affiliation(s)
- Brittany M Wong
- Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Simon S M Fung
- Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Federico G Velez
- Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Claudia Perez
- Department of Medicine, Statistics Core, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Rong Guo
- Department of Medicine, Statistics Core, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Fei Yu
- Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California; Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Stacy L Pineles
- Stein Eye Institute, Department of Ophthalmology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
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Mehta J, O'Connor A. Test retest variability in stereoacuity measurements. Strabismus 2023; 31:188-196. [PMID: 37705215 DOI: 10.1080/09273972.2023.2252853] [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: 09/15/2023]
Abstract
Background: A clinician's choice of stereotest is influenced by the robustness of the measurement, in terms of sensitivity, specificity and test-retest variability. In relation to the latter aspect, there are limited data on the test-retest variability of these new tests and how they compare to the more commonly used stereotests. Therefore, the aim of the study was to determine the test-retest variability of four different measures of stereoacuity (TNO, Frisby, Lang Stereopad and Asteroid (Accurate STEReotest On a mobIle Device)) and to compare the stereoacuity measurements between the tests in an adult population. Methods: Stereoacuity was measured twice using TNO, Frisby, Lang Stereopad and Asteroid. Inclusion criteria included adult participants (18 years and older), no known ophthalmic condition and VA (Visual Acuity) equal to or better than 0.3 logMAR (Logarithm of the Minimum Angle of Resolution) with interocular difference of less than 0.2 logMAR. Bland-Altman analysis was used to assess agreement within and between stereotests. Differences in stereo thresholds were compared using signed Wilcoxon tests. Results: Fifty-four adults (male: 23 and female: 31) with VA equal to or better than 0.3 logMAR in either eye and interocular difference less than 0.2 logMAR were assessed (mean age: 38 years, SD: 12.7, range: 18-72). The test-retest variability of all the clinical stereotests, with the exception of the Lang Stereopad (p = .03, Wilcoxon signed-rank test), was clinically insignificant as the mean bias was equal or less than 0.06 log seconds of arc (equivalent to 1.15 seconds of arc). While the Asteroid test had the smallest variation between repeated measures (mean bias: -0.01 log seconds of arc), the Frisby and Lang Stereopad tests had the narrowest and widest limits of agreement respectively. When comparing results between tests, the biggest mean bias was between Frisby and Lang Stereopad (-0.62 log seconds of arc), and 64.8% and 31.5% of differences were in the medium (21-100" of arc) and larger (>100" of arc) ranges respectively. Conclusion: The TNO and Frisby tests have good reliability but measure stereoacuity over a narrower range compared to the Asteroid which shows less variation on repeated testing but has a larger testing range. The data reported here show varying degrees of agreement in a cohort of visually normal participants, and further investigation is required to determine if there is further variability when stereoacuity is reduced.
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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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Denkinger S, Antoniou MP, Tarello D, Levi DM, Backus BT, Bavelier D, Chopin A. The eRDS v6 Stereotest and the Vivid Vision Stereo Test: Two New Tests of Stereoscopic Vision. Transl Vis Sci Technol 2023; 12:1. [PMID: 36857068 PMCID: PMC9987163 DOI: 10.1167/tvst.12.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Purpose To describe two new stereoacuity tests: the eRDS v6 stereotest, a global dynamic random dot stereogram (dRDS) test, and the Vivid Vision Stereo Test version 2 (VV), a local or "contour" stereotest for virtual reality (VR) headsets; and to evaluate the tests' reliability, validity compared to a dRDS standard, and learning effects. Methods Sixty-four subjects passed a battery of stereotests, including perceiving depth from RDS. Validity was evaluated relative to a tablet-based dRDS reference test, ASTEROID. Reliability and learning effects were assessed over six sessions. Results eRDS v6 was effective at measuring small thresholds (<10 arcsec) and had a moderate correlation (0.48) with ASTEROID. Across the six sessions, test-retest reliability was good, varying from 0.84 to 0.91, but learning occurred across the first three sessions. VV did not measure stereoacuities below 15 arcsec. It had a weak correlation with ASTEROID (0.27), and test-retest reliability was poor to moderate, varying from 0.35 to 0.74; however, no learning occurred between sessions. Conclusions eRDS v6 is precise and reliable but shows learning effects. If repeated three times at baseline, this test is well suited as an outcome measure for testing interventions. VV is less precise, but it is easy and rapid and shows no learning. It may be useful for testing interventions in patients who have no global stereopsis. Translational Relevance eRDS v6 is well suited as an outcome measure to evaluate treatments that improve adult stereodepth perception. VV can be considered for screening patient with compromised stereovision.
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Affiliation(s)
- Sylvie Denkinger
- Psychology and Education Sciences, University of Geneva, Switzerland.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Maria-Paraskevi Antoniou
- Psychology and Education Sciences, University of Geneva, Switzerland.,Institute of Information Systems, University of Applied Sciences & Arts Western Switzerland (HES-SO) Valais-Wallis, Sierre, Switzerland
| | - Demetrio Tarello
- Psychology and Education Sciences, University of Geneva, Switzerland
| | - Dennis M Levi
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA, USA
| | | | - Daphné Bavelier
- Psychology and Education Sciences, University of Geneva, Switzerland.,Psychology and Education Sciences, University of Geneva & Campus Biotech, Switzerland
| | - Adrien Chopin
- Psychology and Education Sciences, University of Geneva, Switzerland.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
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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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8
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Clayton R, Siderov J. Differences in stereoacuity between crossed and uncrossed disparities reduce with practice. Ophthalmic Physiol Opt 2022; 42:1353-1362. [PMID: 35997266 PMCID: PMC9804356 DOI: 10.1111/opo.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Stereoacuity, like many forms of hyperacuity, improves with practice. We investigated the effects of repeated measurements over multiple visits on stereoacuity using two commonly utilised clinical stereotests, for both crossed and uncrossed disparity stimuli. METHODS Participants were adults with normal binocular vision (n = 17) aged between 18 and 50 years. Stereoacuity was measured using the Randot and TNO stereotests on five separate occasions over a six week period. We utilised both crossed and uncrossed stimuli to separately evaluate stereoacuity in both disparity directions. A subset of the subject group also completed a further five visits over an additional six week period. Threshold stereoacuity was determined by the lowest disparity level at which the subjects could correctly identify both the position and disparity direction (crossed or uncrossed) of the stimulus. Data were analysed by repeated measures analysis of variance. RESULTS Stereoacuity for crossed and uncrossed stimuli improved significantly across the first five visits (F1,21 = 4.24, p = 0.05). The main effect of disparity direction on stereoacuity was not significant (F1 = 0.02, p = 0.91). However, a significant interaction between disparity direction and stereotest was identified (F1 = 7.92, p = 0.01). CONCLUSIONS Stereoacuity measured with both the TNO and Randot stereotests improved significantly over the course of five repetitions. Although differences between crossed and uncrossed stereoacuity were evident, they depended on the stereotest used and reduced or disappeared after repeated measurements. A single measure of stereoacuity is inadequate for properly evaluating adult stereopsis clinically.
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Affiliation(s)
- Robin Clayton
- Centre for Vision across the Life Span, Department of Optometry and Vision SciencesUniversity of HuddersfieldHuddersfieldUK
| | - John Siderov
- Centre for Vision across the Life Span, Department of Optometry and Vision SciencesUniversity of HuddersfieldHuddersfieldUK
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9
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Exogenous attention generalizes location transfer of perceptual learning in adults with amblyopia. iScience 2022; 25:103839. [PMID: 35243224 PMCID: PMC8857599 DOI: 10.1016/j.isci.2022.103839] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Visual perceptual learning (VPL) is a behavioral manifestation of brain neuroplasticity. However, its practical effectiveness is limited because improvements are often specific to the trained conditions and require significant time and effort. It is critical to understand the conditions that promote learning and transfer. Covert endogenous (voluntary) and exogenous (involuntary) spatial attention help overcome VPL location specificity in neurotypical adults, but whether they also do so for people with atypical visual development is unknown. This study investigates the role of exogenous attention during VPL in adults with amblyopia, an ideal population given their asymmetrically developed, but highly plastic, visual cortex. Here we show that training on a discrimination task leads to improvements in foveal contrast sensitivity, acuity, and stereoacuity. Notably, exogenous attention helps generalize learning beyond trained spatial locations. Future large-scale studies can verify the extent to which attention enhances the effectiveness of perceptual learning during rehabilitation of visual disorders. Contrast sensitivity (CS)-based VPL in amblyopes improves CS, acuity and stereoacuity Similar improvement in trained amblyopic eye and untrained fellow eye Exogenous spatial attention facilitates location transfer of VPL in amblyopic adults
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10
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Jia Y, Ye Q, Zhang S, Feng L, Liu J, Xu Z, Zhuang Y, He Y, Zhou Y, Chen X, Yao Y, Jiang R, Thompson B, Li J. Contrast Sensitivity and Stereoacuity in Successfully Treated Refractive Amblyopia. Invest Ophthalmol Vis Sci 2022; 63:6. [PMID: 34989762 PMCID: PMC8742522 DOI: 10.1167/iovs.63.1.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia. Methods A retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues. Results Statistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test. Conclusions Full recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.
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Affiliation(s)
- Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye and Vision Research, 17W Science Park, Hong Kong
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shenglan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Benjamin Thompson
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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11
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Wang T, Thielen H, De Preter E, Vangkilde S, Gillebert CR. Encouraging Digital Technology in Neuropsychology: The Theory of Visual Attention on Tablet Devices. Arch Clin Neuropsychol 2021; 36:1450–1464. [PMID: 33621327 DOI: 10.1093/arclin/acab007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Visual attention helps us to selectively process relevant information and is crucial in our everyday interactions with the environment. Not surprisingly, it is one of the cognitive domains that is most frequently affected by acquired brain injury. Reliable assessment of attention deficits is pivotal to neuropsychological examination and helps to optimize individual rehabilitation plans. Compared with conventional pen-and-paper tests, computerized tasks borrowed from the field of experimental psychology bring many benefits, but lab-based experimental setups cannot be easily incorporated in clinical practice. Light-weight and portable mobile tablet devices may facilitate the translation of computerized tasks to clinical settings. One such task is based on the Theory of Visual Attention (TVA), a mathematical model of visual attention. TVA-based paradigms have been widely used to investigate several aspects of visual attention in both fundamental and clinical research, and include measures for general processing capacity as well as stimulus-specific attentional parameters. METHODS This article discusses the benefits of TVA-based assessments compared with frequently used neuropsychological tests of visual attention, and examines the reliability of a tablet-based TVA-based assessment in 59 neurologically healthy participants. RESULTS Pearson's correlations indicate that the tablet-based TVA assessment and the conventional lab-based TVA assessment have a comparable parallel-form (range: .67-.93), test-retest (range: .61-.78), and internal reliability (range: .56-.97). CONCLUSION Our results suggest that tablet-based TVA assessment may be a promising tool to acquire clinical measures of visual attention at low cost at the bedside of the patient.
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Affiliation(s)
- Tianlu Wang
- Department of Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Hella Thielen
- Department of Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Erik De Preter
- Department of Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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12
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Portela-Camino JA, Martín-González S, Ruiz-Alcocer J, Illarramendi-Mendicute I, Garrido-Mercado R. An Evaluation of the Agreement Between a Computerized Stereoscopic Game Test and the TNO Stereoacuity Test. CLINICAL OPTOMETRY 2021; 13:181-190. [PMID: 34267572 PMCID: PMC8275165 DOI: 10.2147/opto.s308445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Stereo-anomaly is commonly associated with amblyopia. An investigation was conducted to determine whether the measurements of stereoacuity obtained with the stereoacuity reference test (TNO Test) show an agreement with a computer stereoscope video game. METHODS Thirty-two subjects (mean age 9.37±2.00 years) with an amblyopia history were selected for a blind and randomized study of stereoacuity improvement through a new random dot game. A masked examiner measured the stereoacuity three times per subject using the TNO test (at the beginning, at the end and after 6 months of the treatment). A second masked examiner measured stereoacuity using the new computerized game after the TNO masked evaluation. RESULTS The Pearson's correlation coefficient one test against the other was r2 = 0.767 and the Bland-Altman plot was r2= 0.069 (mean difference -0.03 log sec). Using three categories: poor (840-300 seconds of arc), coarse (480-210 seconds of arc) and moderate-fine stereoacuity (210-30 seconds of arc). Positive predictive values were 89.5% for moderate-fine; 72.7% for coarse; and 90.0% for poor stereoacuity. In addition, the agreement was evaluated using the Kappa coefficient (K= 0.743) with a 0.95 confidence interval and lower and upper Kappa limits were (0.628 and 0.858), respectively. Kappa coefficient and limits were still good when analyzing data before (K =0.663, 0.420 and 0.906) and after the treatment (K= 0.765, 0.632 and 0.899). CONCLUSION The Computerized Stereoscopic Game test allows the measure of stereoacuity. It can be used for both the purpose of detecting stereo vision deficits or tracking stereo vision development.
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Affiliation(s)
| | - Santiago Martín-González
- Department of Construction and Manufacturing Engineering, University of Oviedo, Oviedo, Asturias, Spain
| | - Javier Ruiz-Alcocer
- Department of Optometry and Vision Science, Complutense University of Madrid, Madrid, Spain
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13
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Evaluation of stereoacuity with a digital mobile application. Graefes Arch Clin Exp Ophthalmol 2021; 259:2843-2848. [PMID: 33907883 PMCID: PMC8380567 DOI: 10.1007/s00417-021-05195-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose Stereopsis is a fundamental skill in human vision and visual actions. There are many ways to test and quantify stereoacuity: traditional paper and new digital applications are both valid ways to test the stereoacuity. The aim of this study is to compare the results obtained using standard tests and the new Stereoacuity Test App developed by the University of Bergamo. Methods A group of 497 children (272 males), aged between 6 and 11 years old, were tested using different tests for the quantification of stereopsis at near. These tests were TNO, Weiss EKW, and the new developed Stereoacuity Test App. Results A one-way repeated measure ANOVA showed that the three tests give different thresholds of stereoacuity (p < 0.0001). Post hoc analyses with Bonferroni correction showed that all tests showed different thresholds (p < 0.0001). The lower threshold was obtained by Titmus Stereo Test followed by Stereoacuity App, Weiss MKW, and TNO. Conclusion The stereoacuity based on global stereopsis showed that the better values were obtained in order by Stereoacuity Test App, TNO, and Weiss EKW. However, the clinical significance of their values is similar. The new digital test showed a greater compliance by the child, showing itself in tune with the digital characteristics of today’s children.
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14
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Read JCA, Wong ZY, Yek X, Wong YX, Bachtoula O, Llamas-Cornejo I, Serrano-Pedraza I. ASTEROID stereotest v1.0: lower stereo thresholds using smaller, denser and faster dots. Ophthalmic Physiol Opt 2020; 40:815-827. [PMID: 32989799 DOI: 10.1111/opo.12737] [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: 03/03/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE In 2019, we described ASTEROID, a new stereotest run on a 3D tablet computer which involves a four-alternative disparity detection task on a dynamic random-dot stereogram. Stereo thresholds measured with ASTEROID were well correlated with, but systematically higher than (by a factor of around 1.5), thresholds measured with previous laboratory stereotests or the Randot Preschool clinical stereotest. We speculated that this might be due to the relatively large, sparse dots used in ASTEROID v0.9. Here, we introduce and test the stereo thresholds and test-repeatability of the new ASTEROID v1.0, which uses precomputed images to allow stereograms made up of much smaller, denser dots. METHODS Stereo thresholds and test/retest repeatability were tested and compared between the old and new versions of ASTEROID (n = 75) and the Randot Circles (n = 31) stereotest, in healthy young adults. RESULTS Thresholds on ASTEROID v1.0 are lower (better) than on ASTEROID v0.9 by a factor of 1.4, and do not differ significantly from thresholds on the Randot Circles. Thresholds were roughly log-normally distributed with a mean of 1.54 log10 arcsec (35 arcsec) on ASTEROID v1.0 compared to 1.70 log10 arcsec (50 arcsec) on ASTEROID v0.9. The standard deviation between observers was the same for both versions, 0.32 log10 arcsec, corresponding to a factor of 2 above and below the mean. There was no difference between the versions in their test/retest repeatability, with 95% coefficient of repeatability = 0.46 log10 arcsec (a factor of 2.9 or 1.5 octaves) and a Pearson correlation of 0.8 (comparable to other clinical stereotests). CONCLUSION The poorer stereo thresholds previously reported with ASTEROID v0.9 appear to have been due to the relatively large, coarse dots and low density used, rather than to some other aspect of the technology. Employing the small dots and high density used in ASTEROID v1.0, thresholds and test/retest repeatability are similar to other clinical stereotests.
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Affiliation(s)
- Jenny C A Read
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Zhen Yi Wong
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Xinye Yek
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ying Xin Wong
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Omar Bachtoula
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Ignacio Serrano-Pedraza
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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15
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Rodriguez-Lopez V, Dorronsoro C, Burge J. Contact lenses, the reverse Pulfrich effect, and anti-Pulfrich monovision corrections. Sci Rep 2020; 10:16086. [PMID: 32999323 PMCID: PMC7527565 DOI: 10.1038/s41598-020-71395-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Interocular differences in image blur can cause processing speed differences that lead to dramatic misperceptions of the distance and three-dimensional direction of moving objects. This recently discovered illusion-the reverse Pulfrich effect-is caused by optical conditions induced by monovision, a common correction for presbyopia. Fortunately, anti-Pulfrich monovision corrections, which darken the blurring lens, can eliminate the illusion for many viewing conditions. However, the reverse Pulfrich effect and the efficacy of anti-Pulfrich corrections have been demonstrated only with trial lenses. This situation should be addressed, for clinical and scientific reasons. First, it is important to replicate these effects with contact lenses, the most common method for delivering monovision. Second, trial lenses of different powers, unlike contacts, can cause large magnification differences between the eyes. To confidently attribute the reverse Pulfrich effect to interocular optical blur differences, and to ensure that previously reported effect sizes are reliable, one must control for magnification. Here, in a within-observer study with five separate experiments, we demonstrate that (1) contact lenses and trial lenses induce indistinguishable reverse Pulfrich effects, (2) anti-Pulfrich corrections are equally effective when induced by contact and trial lenses, and (3) magnification differences do not cause or impact the Pulfrich effect.
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Affiliation(s)
- Victor Rodriguez-Lopez
- Institute of Optics, Spanish National Research Council (IO-CSIC), Madrid, Spain
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carlos Dorronsoro
- Institute of Optics, Spanish National Research Council (IO-CSIC), Madrid, Spain
- 2Eyes Vision SL, Madrid, Spain
| | - Johannes Burge
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
- Neuroscience Graduate Group, University of Pennsylvania, Philadelphia, PA, USA.
- Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA, USA.
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16
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McCaslin AG, Vancleef K, Hubert L, Read JCA, Port N. Stereotest Comparison: Efficacy, Reliability, and Variability of a New Glasses-Free Stereotest. Transl Vis Sci Technol 2020; 9:29. [PMID: 32879785 PMCID: PMC7442860 DOI: 10.1167/tvst.9.9.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/15/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To test the validity of the ASTEROID stereotest as a clinical test of depth perception by comparing it to clinical and research standard tests. Methods Thirty-nine subjects completed four stereotests twice: the ASTEROID test on an autostereo 3D tablet, a research standard on a VPixx PROPixx 3D projector, Randot Circles, and Randot Preschool. Within 14 days, subjects completed each test for a third time. Results ASTEROID stereo thresholds correlated well with research standard thresholds (r = 0.87, P < 0.001), although ASTEROID underestimated standard threshold (mean difference = 11 arcsec). ASTEROID results correlated less strongly with Randot Circles (r = 0.54, P < 0.001) and Randot Preschool (r = 0.64, P < 0.001), due to the greater measurement range of ASTEROID (1–1000 arcsec) compared to Randot Circles or Randot Preschool. Stereo threshold variability was low for all three clinical stereotests (Bland–Altman 95% limits of agreement between test and retest: ASTEROID, ±0.37; Randot Circles, ±0.24; Randot Preschool, ±0.23). ASTEROID captured the largest range of stereo in a normal population with test–retest reliability comparable to research standards (immediate r = 0.86 for ASTEROID vs. 0.90 for PROPixx; follow-up r = 0.68 for ASTEROID vs. 0.88 for PROPixx). Conclusions Compared to clinical and research standards for assessing depth perception, ASTEROID is highly accurate, has good test–retest reliability, and measures a wider range of stereo threshold. Translational Relevance The ASTEROID stereotest is a better clinical tool for determining baseline stereopsis and tracking changes during treatment for amblyopia and strabismus compared to current clinical tests.
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Affiliation(s)
| | - Kathleen Vancleef
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Luke Hubert
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Jenny C A Read
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Nicholas Port
- School of Optometry, Indiana University, Bloomington, IN, USA
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17
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Ting DSJ, Foo VH, Yang LWY, Sia JT, Ang M, Lin H, Chodosh J, Mehta JS, Ting DSW. Artificial intelligence for anterior segment diseases: Emerging applications in ophthalmology. Br J Ophthalmol 2020; 105:158-168. [PMID: 32532762 DOI: 10.1136/bjophthalmol-2019-315651] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
With the advancement of computational power, refinement of learning algorithms and architectures, and availability of big data, artificial intelligence (AI) technology, particularly with machine learning and deep learning, is paving the way for 'intelligent' healthcare systems. AI-related research in ophthalmology previously focused on the screening and diagnosis of posterior segment diseases, particularly diabetic retinopathy, age-related macular degeneration and glaucoma. There is now emerging evidence demonstrating the application of AI to the diagnosis and management of a variety of anterior segment conditions. In this review, we provide an overview of AI applications to the anterior segment addressing keratoconus, infectious keratitis, refractive surgery, corneal transplant, adult and paediatric cataracts, angle-closure glaucoma and iris tumour, and highlight important clinical considerations for adoption of AI technologies, potential integration with telemedicine and future directions.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.,Singapore Eye Research Institute, Singapore
| | | | | | - Josh Tjunrong Sia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Haotian Lin
- Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - James Chodosh
- Ophthalmology, Massachusetts Eye and Ear Infirmary Howe Laboratory Harvard Medical School, Boston, Massachusetts, USA
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore .,Vitreo-retinal Department, Singapore National Eye Center, Singapore
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18
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Casanova T, Black C, Rafiq S, Hugill-Jones J, Read JCA, Vancleef K. The impact of active research involvement of young children in the design of a new stereotest. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:29. [PMID: 32518689 PMCID: PMC7276065 DOI: 10.1186/s40900-020-00194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although considered important, the direct involvement of young children in research design is scarce and to our knowledge its impact has never been measured. We aim to demonstrate impact of young children's involvement in improving the understanding of a new 3D eye test or stereotest. METHODS After a pre-measure of understanding was taken, we explored issues with the test instructions in patient and public involvement (PPI) sessions where children acted as advisers in the test design. Feedback was collected via observations, rating scales and verbal comments. An interdisciplinary panel reviewed the feedback, discussed potential changes to the test design, and decided on the implementation. Subsequently, a post-measure of understanding (Study 1-2) and engagement (Study 3) was collected in a pre-post study design. Six hundred fifty children (2-11.8 years old) took part in the pre-measure, 111 children (1-12 years old) in the subsequent PPI sessions, and 52 children (4-6 years old) in the first post-measure. One hundred twenty-two children (1-12 years old) and unrelated adults took then part in a second series of PPI sessions, and 53 people (2-39 years old) in the final post-measure. Adults were involved to obtain verbal descriptions of the target that could be used to explain the task to children. RESULTS Following feedback in Study 1, we added a frame cue and included a shuffle animation. This increased the percentage of correct practice trials from 76 to 97% (t (231) = 14.29, p < .001), but more encouragements like 'Keep going!' were needed (t (64) = 8.25, p < .001). After adding a cardboard demo in Study 2, the percentage of correct trials remained stable but the number of additional instructions given decreased (t (103) = 3.72, p < .001) as did the number of encouragements (t (103) = 8.32, p < .001). Therefore, changes in test design following children's feedback significantly improved task understanding. CONCLUSIONS Our study demonstrates measurable impact of involvement of very young children in research design through accessible activities. The changes implemented following their feedback significantly improved the understanding of our test. Our approach can inform researchers on how to involve young children in research design and can contribute to developing guidelines for involvement of young children in research.
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Affiliation(s)
- Therese Casanova
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
- Present address: NHS Business Services Authority, Stella House, Goldcrest Way, Newcastle, NE5 8NY UK
| | - Carla Black
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
- Faculty of Medical Sciences, Professional Services, Newcastle University, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
| | - Sheima Rafiq
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
- Present address: Children’s Acute and Ongoing Needs Service, Salford Royal NHS Foundation Trust, Nye Bevan House, Maclure Rd, Rochdale, OL11 1DR UK
| | - Jessica Hugill-Jones
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
- Present address: York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Jenny C. A. Read
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
| | - Kathleen Vancleef
- Institute of Neuroscience, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH UK
- Present address: Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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19
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Serrano-Pedraza I, Vancleef K, Herbert W, Goodship N, Woodhouse M, Read JCA. Efficient estimation of stereo thresholds: What slope should be assumed for the psychometric function? PLoS One 2020; 15:e0226822. [PMID: 31895925 PMCID: PMC6939937 DOI: 10.1371/journal.pone.0226822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022] Open
Abstract
Bayesian staircases are widely used in psychophysics to estimate detection thresholds. Simulations have revealed the importance of the parameters selected for the assumed subject’s psychometric function in enabling thresholds to be estimated with small bias and high precision. One important parameter is the slope of the psychometric function, or equivalently its spread. This is often held fixed, rather than estimated for individual subjects, because much larger numbers of trials are required to estimate the spread as well as the threshold. However, if this fixed value is wrong, the threshold estimate can be biased. Here we determine the optimal slope to minimize bias and maximize precision when measuring stereoacuity with Bayesian staircases. We performed 2- and 4AFC disparity detection stereo experiments in order to measure the spread of the disparity psychometric function in human observers assuming a Logistic function. We found a wide range, between 0.03 and 3.5 log10 arcsec, with little change with age. We then ran simulations to examine the optimal spread using the empirical data. From our simulations and for three different experiments, we recommend selecting assumed spread values between the percentiles 60–80% of the population distribution of spreads (these percentiles can be extended to other type of thresholds). For stereo thresholds, we recommend a spread around the value σ = 1.7 log10 arcsec for 2AFC (slope β = 4.3 /log10 arcsec), and around σ = 1.5 log10 arcsec for 4AFC (β = 4.9 /log10 arcsec). Finally, we compared a Bayesian procedure (ZEST using the optimal σ) with five Bayesian procedures that are versions of ZEST-2D, Psi, and Psi-marginal. In general, for the conditions tested, ZEST optimal σ showed the lowest threshold bias and highest precision.
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Affiliation(s)
- Ignacio Serrano-Pedraza
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Kathleen Vancleef
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - William Herbert
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Goodship
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maeve Woodhouse
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jenny C. A. Read
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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Read JCA, Rafiq S, Hugill J, Casanova T, Black C, O’Neill A, Puyat V, Haggerty H, Smart K, Powell C, Taylor K, Clarke MP, Vancleef K. Characterizing the Randot Preschool stereotest: Testability, norms, reliability, specificity and sensitivity in children aged 2-11 years. PLoS One 2019; 14:e0224402. [PMID: 31697704 PMCID: PMC6837395 DOI: 10.1371/journal.pone.0224402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To comprehensively assess the Randot Preschool stereo test in young children, including testability, normative values, test/retest reliability and sensitivity and specificity for detecting binocular vision disorders. METHODS We tested 1005 children aged 2-11 years with the Randot Preschool stereo test, plus a cover/uncover test to detect heterotropia. Monocular visual acuity was assessed in both eyes using Keeler Crowded LogMAR visual acuity test for children aged 4 and over. RESULTS Testability was very high: 65% in two-year-olds, 92% in three-year-olds and ~100% in older children. Normative values: In 389 children aged 2-5 with apparently normal vision, 6% of children scored nil (stereoblind). In those who obtained a threshold, the mean log threshold was 2.06 log10 arcsec, corresponding to 114 arcsec, and the median threshold was 100 arcsec. Most older children score 40 arcsec, the best available score. We found a small sex difference, with girls scoring slightly but significantly better. Test/retest reliability: ~99% for obtaining any score vs nil. Agreement between stereo thresholds is poor in children aged 2-5; 95% limit of agreement = 0.7 log10 arcsec: five-fold change in stereo threshold may occur without any change in vision. In children over 5, the test essentially acts only as a binary classifier since almost all non-stereoblind children score 40 arcsec. Specificity (true negative rate): >95%. Sensitivity (true positive rate): poor, <50%, i.e. around half of children with a demonstrable binocular vision abnormality score well on the Randot Preschool. CONCLUSIONS The Randot Preschool is extremely accessible for even very young children, and is very reliable at classifying children into those who have any stereo vision vs those who are stereoblind. However, its ability to quantify stereo vision is limited by poor repeatability in children aged 5 and under, and a very limited range of scores relevant to children aged over 5.
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Affiliation(s)
- Jenny C. A. Read
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Sheima Rafiq
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Jess Hugill
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Therese Casanova
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Carla Black
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Adam O’Neill
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Vicente Puyat
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Helen Haggerty
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, England, United Kingdom
| | - Kathryn Smart
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, England, United Kingdom
| | - Christine Powell
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, England, United Kingdom
| | - Kate Taylor
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, England, United Kingdom
| | - Michael P. Clarke
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, England, United Kingdom
| | - Kathleen Vancleef
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, England, United Kingdom
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