Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group

PURPOSE

To estimate the frequency of convergence insufficiency (CI) and its related clinical characteristics among 9- to 13-year-old children.

METHODS

Fifth and sixth graders were screened in school settings at three different study sites. Eligible children with 20/30 or better visual acuity, minimal refractive error, no strabismus, and exophoria at near were evaluated according to a standardized protocol to determine the presence and severity of CI. These children were classified according to the presence and number of the following clinical signs: (1) exophoria at near > or =4delta than far, (2) insufficient fusional convergence, and (3) receded nearpoint of convergence. Also, children were classified as accommodative insufficient (AI) if they failed Hofstetter's minimum amplitude formula or had greater than a + 1.00 D lag on Monocular Estimate Method retinoscopy.

RESULTS

Of 684 children screened, 468 (68%) were eligible for further evaluation. Of these, 453 had complete data on CI measurements and were classified as: no CI (nonexophoric at near or exophoric at near and < 4delta difference between near and far) (78.6%); low suspect CI (exophoric at near and one clinical sign: exophoria at near > or =4delta than far) (8.4%); high suspect CI (exophoric at near and two clinical signs) (8.8%); and definite CI (exophoric at near and three clinical signs) (4.2%). CI status varied according to ethnicity and study site (p < 0.0005), but not gender. The frequency of AI increased with the number of CI-related signs. For CI children with three signs, 78.9% were classified as also having AI.

CONCLUSIONS

These findings suggest that CI (defined as high suspect and definite) is frequent (13%) among fifth and sixth grade children. In addition, there is a high percentage of CI children with an associated AI.

The presence of a magnocellular defect depends on the type of dyslexia

Previous studies have identified a magnocellular pathway defect in approximately 75% of dyslexics. Since these experiments have not classified dyslexia into subtypes, the purpose of this experiment was to determine if adult dyseidetic dyslexics or dysphoneidetic dyslexics suffer from a defect in the magnocellular pathway. Nine dyseidetic dyslexics, eight dysphoneidetic dyslexics, and nine normal readers participated in the experiment. Contrast sensitivity functions (CSF) were determined with vertically oriented sine wave gratings (0.5, 1.0, 2.0, 4.0, 8.0, 12.0 c/deg drifting at 1 and 10 Hz) by employing a two-alternative, forced-choice technique. The results of the experiment indicated that dysphoneidetic dyslexics had reduced sensitivity to low spatial frequencies at 10 Hz, whereas dyseidetic dyslexics did not have reduced sensitivity at either 1 or 10 Hz. These results suggest that the type of dyslexia influences whether losses in perception are found which are consistent with a magnocellular deficit.

Prospective comparison of convergence insufficiency and normal binocular children on CIRS symptom surveys. Convergence Insufficiency and Reading Study (CIRS) group

PURPOSE

To test the validity-related evidence of a child and a parent symptom survey developed by the Convergence Insufficiency and Reading Study (CIRS) group.

METHODS

A case comparison method was used to measure differences in symptoms between 14 school-aged children (ages 8 to 13 years) with Convergence Insufficiency (CI) and 14 children with normal binocular vision (NBV).

RESULTS

A pooled t-test indicated that CI children and their parents scored higher than the NBV children and their parents on the child's survey (p<0.001) and parent's survey (p<0.001), respectively. CI children also scored significantly higher (p<0.03) on the Conners' Rating Scale for Parents.

CONCLUSIONS

The results suggest that the CIRS symptom survey is a valid instrument for differentiating CI children from those with normal binocular vision. Additionally, children in this age group were able to respond to a broad range of symptom questions associated with CI.

Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children

PURPOSE

To compare base-in prism reading glasses with placebo reading glasses for the treatment of symptomatic convergence insufficiency (CI) in children aged 9 to <18 years.

METHODS

In a randomised clinical trial, 72 children aged 9 to <18 years with symptomatic CI were assigned to either base-in prism glasses or placebo reading glasses. Symptom level, measured with a quantitative symptom questionnaire (CI Symptom Survey-V15), was the primary outcome measure. Near point of convergence and positive fusional vergence at near were secondary outcomes.

RESULTS

The mean (SD) CI Symptom Survey score decreased (that is, less symptomatic) in both groups (base-in prism glasses from 31.6 (10.4) to 16.5 (9.2); placebo glasses from 28.4 (8.8) to 17.5 (12.3)). The change in the CI Symptom Survey scores (p = 0.33), near point of convergence (p = 0.91), and positive fusional vergence (p = 0.59) were not significantly different between the two groups after 6 weeks of wearing glasses.

CONCLUSIONS

Base-in prism reading glasses were found to be no more effective in alleviating symptoms, improving the near point of convergence, or improving positive fusional vergence at near than placebo reading glasses for the treatment of children aged 9 to <18 years with symptomatic CI.

The role of monocular regions in stereoscopic displays

Random-dot stereograms of an object standing out from a background always contain a monocular region at the side of the foreground object. This is equivalent to the monocularly occluded part of the background in the real-life viewing of one object in front of another. The role of these monocular regions in the stereoscopic process has not been investigated previously, although it is generally assumed that they are a source of difficulty in stereoscopic resolution because of the unmatchable texture within them. The basis of the present study was a prediction that the presence of texture within these regions would facilitate rather than retard stereoscopic processing. This prediction follows from a hypothesis that stereoscopic processing is initially located at disparity discontinuities. Unmatched regions are only found at such discontinuities, and could serve to locate them.

All developmental dyslexic subtypes display an elevated motion coherence threshold

PURPOSE

Psychophysical studies indicate that many dyslexics have a motion-processing deficit. The purpose of this study was to determine whether elevated motion coherence thresholds correlate with the specific dyslexic subtypes as defined by the Boder classification scheme.

METHODS

Twenty-one dyslexics (seven dyseidetics, six dysphonetics, and eight dysphoneidetics) and 19 age- and gender-matched controls participated in the study. The dyslexics were identified by an exclusionary approach and then subtyped with the Adult Dyslexia Test or the Dyslexia Determination Test. Motion coherence thresholds were determined with random dot kinematograms composed of signal dots and noise dots. Signal dots moved either left or right on each trial, whereas noise dots moved in random directions. The percentage of dots that comprised the signal was varied randomly on each trial (0 to 21% in 3% increments). Subjects guessed the direction of signal dot motion on each trial (two-alternative forced-choice task). A 75% correct threshold was determined with a Weibull equation fit to the psychometric function.

RESULTS

All three dyslexic subtypes had elevated motion coherence thresholds (t-test; dyseidetics p = 0.01, dysphonetics p = 0.039, dysphoneidetics p = 0.048).

CONCLUSION

Motion-coherence deficits are not correlated with a specific dyslexic subtype, but, rather, are common to all subtypes. However, some individuals in each of the dyslexic subtypes were found to have normal motion coherence thresholds, suggesting that other factors must be considered to predict the motion sensitivity deficits found in dyslexia.

Tribbles homolog 3 attenuates mammalian target of rapamycin complex-2 signaling and inflammation in the diabetic kidney

The endoplasmic reticulum (ER) stress response is activated in the diabetic kidney and functions to reduce ER protein accumulation and improve cellular function. We previously showed that tribbles homolog 3 (TRB3), an ER stress-associated protein, is upregulated in the diabetic kidney. Here, we investigated whether absence of TRB3 alters outcomes in diabetic nephropathy. Type 1 diabetes was induced in TRB3 wild-type and knockout ((-/-)) mice by low-dose streptozotocin, and the mice were followed for 12 weeks. Diabetic TRB3(-/-) mice developed higher levels of albuminuria and increased expression of inflammatory cytokine and chemokine mRNA in renal cortices relative to wild-type littermates, despite similar hyperglycemia. Diabetic TRB3(-/-) mice also expressed higher levels of ER stress-associated molecules in both the renal cortices and glomeruli. This change was associated with higher renal cortical phosphorylation of AKT at serine 473 (Ser(473)), which is the AKT site phosphorylated by mammalian target of rapamycin complex-2 (mTORC2). We show in renal tubular cells that TRB3 binds to mTOR and the rapamycin-insensitive companion of mTOR (Rictor), a protein specific to mTORC2. Finally, we demonstrate in murine tubular cells that TRB3 can inhibit secretion of IL-6. Thus, TRB3 reduces albuminuria and inflammatory gene expression in diabetic kidney disease by a mechanism that may involve inhibition of the mTORC2/AKT pathway and may prove to be a novel therapeutic target.

Podocytes express IL-6 and lipocalin 2/ neutrophil gelatinase-associated lipocalin in lipopolysaccharide-induced acute glomerular injury

Background/Aims

Acute kidney injury (AKI) contributes to significant morbidity and mortality in the intensive care unit (ICU). Plasma levels of interleukin (IL)-6 predict the development of AKI and are associated with higher mortality in ICU patients with AKI. Most studies in AKI have focused on the tubulo-interstitium, despite evidence of glomerular involvement. In the following study, our goals were to investigate the expression of IL-6 and its downstream mediators in septic-induced AKI.

Methods

Podocytes were treated in vitro with lipopolysaccharide (LPS) and mice were treated with LPS, and we evaluated IL-6 expression by real-time PCR, ELISA and in situ RNA hybridization.

Results

Following LPS stimulation, IL-6 is rapidly and highly induced in cultured podocytes and in vivo in glomeruli and infiltrating leukocytes. Surprisingly, in direct response to exogenous IL-6, podocytes produce lipocalin-2/neutrophil gelatinase-associated lipocalin (Lcn2/Ngal). LPS also potently induces Lcn2/Ngal expression in podocytes in culture and in glomeruli in vivo. Intense Lcn2/Ngal expression is also observed in IL-6 knockout mice, suggesting that while IL-6 may be sufficient to induce glomerular Lcn2/Ngal expression, it is not essential.

Conclusions

The glomerulus is involved in septic AKI, and we demonstrate that podocytes secrete key mediators of AKI including IL-6 and Lcn2/Ngal.

Not all dyslexics are created equal

BACKGROUND

Dyslexia is a common disorder that has traditionally been treated as a homogeneous condition. However, recent evidence indicates that it is a heterogenous condition with several subtypes. For example, studies of the visual system indicate that not all dyslexics have a normal visual pathway. Approximately 75% have a processing deficit in the magnocellular pathway. Our previous study indicated that dysphoneidetic but not dyseidetic dyslexics exhibit a magnocellular pathway defect.

PURPOSE

The purpose of this study was to expand our previous work by also examining dysphonetic dyslexics. Additionally, the stimulus was altered to enhance detection of a magnocellular pathway defect in any dyslexic subtype.

METHODS

Temporal contrast sensitivity functions were determined with a flickering stimulus (5, 10, 15, 20, and 25 Hz) by using a temporal, two-alternative, forced-choice technique.

RESULTS

The results indicate that the dyseidetic dyslexics do not have a magnocellular pathway defect, whereas the dysphoneidetics do. Furthermore, examination of the individual dysphonetics indicated that the more severely affected subjects also exhibited a magnocellular pathway defect.

CONCLUSION

These results suggest that treatment strategies for dyslexics may need to be modified to take into account their specific subtype.

Peroxisome proliferator-activated receptor-γ agonists repress epithelial sodium channel expression in the kidney

Thiazolidinediones (TZDs), known as peroxisome proliferator-activated receptor (PPAR) agonists, are used to treat type 2 diabetes. However, ∼5% of patients experience the treatment-limiting side effect of edema. Studies have implicated activation of the epithelial sodium channel (ENaC) as a cause of TZD-induced fluid retention, although there have been conflicting reports. The goal of this study was to resolve the role of PPARγ in control of ENaC isoforms in the kidney. Herein, we demonstrate in mice that rosiglitazone (RGZ), a PPARγ ligand, increases body weight and abdominal fat pad fluid content and reduces hematocrit. Seven days of RGZ decreases ENaCα and ENaCβ mRNA and ENaCγ protein expression in the kidney cortex, and acute treatment for 5 h with pioglitazone, another potent TZD, does not increase renal ENaC isoform mRNA or protein expression. Pioglitazone also decreases ENaCα and ENaCγ mRNA expression in a cortical collecting duct cell line. As no direct transcriptional studies had been conducted, we examined the PPARγ-dependent regulation of ENaC. Pioglitazone represses ENaCγ promoter activity, and this repression is partially relieved by inhibition of protein synthesis. Chromatin immunoprecipitation assays revealed that repression is associated with a decrease in histone H4K5 acetylation at the proximal ENaCγ promoter. In summary, TZDs do not increase ENaC mRNA expression in the kidney, and in fact repress the ENaCγ promoter via an indirect transcriptional mechanism.

A Cross-Sectional Evaluation of Publication Bias in the Plastic Surgery Literature

BACKGROUND

Publication bias (PB) is the preferential publishing of studies with statistically significant results. PB can skew findings of systematic reviews (SRs) and meta-analyses (MAs), with potential consequences for patient care and health policy. This study aims to determine the extent to which SRs and MAs in the plastic surgery literature evaluate and report PB.

METHODS

This cross-sectional study assessed PB reporting and analysis from plastic surgery studies published between January 1, 2015, and June 19, 2020. Full texts of SRs and MAs were assessed by two reviewers for PB assessment methodology and analysis. Post hoc assessment of studies that did not originally analyze PB was performed using Egger regression, Duval, Tweedie trim-and-fill, and Copas selection models.

RESULTS

There were 549 studies evaluated, of which 531 full texts were included. PB was discussed by 183 studies (34.5%), and formally assessed by 97 studies (18.3%). Among SRs and MAs that formally assessed PB, PB was present in 24 studies (10.7%), not present in 52 (23.1%), and inconclusive in eight (3.6%); 141 studies (62.7%) did not report the results of their PB assessment. Funnel plots were the most common assessment method [ n = 88 (39.1%)], and 60 studies (68.2%) published funnel plots. The post hoc assessment revealed PB in 17 of 20 studies (85.0%).

CONCLUSIONS

PB is inadequately reported and analyzed among studies in the plastic surgery literature. Most studies that assessed PB found PB, as did post hoc analysis of nonreporting studies. Increased assessment and reporting of PB among SRs and MAs would improve the quality of evidence in plastic surgery.

Detecting learning-related visual problems in the primary care setting

BACKGROUND

School-aged children with learning problems are frequently encountered by optometrists. Current research indicates a link between learning problems and certain visual factors that are referred to as learning-related visual problems. As a result, the primary care vision doctor should identify children with learning-related visual problems within the context of a primary care examination. We will present a diagnostic strategy for identifying children with learning-related visual problems. The use of appropriate case history questions and a few additional tests will allow the primary care vision doctor to detect or diagnose the majority of learning-related visual problems within the context of a primary care examination.

Management of the Pulfrich phenomenon secondary to pigmentary glaucoma

BACKGROUND

The Pulfrich phenomenon can cause annoying symptoms for a patient due to a difference in interocular optic nerve conduction. There are very few reports that describe the successful use of tinted lenses as a treatment modality, while the majority of cases in the literature describe the condition without any reference to treatment. Although there are two previous reported cases of the Pulfrich phenomenon secondary to glaucoma, this article relates the first case of a patient with this phenomenon with glaucoma treated by tinted lenses.

CASE REPORT

A 42-year-old woman, who was previously diagnosed with asymmetric pigmentary glaucoma, reported dramatic changes in visual perception-especially with driving and motion-related tasks. The evaluation showed asymmetric optic nerve function and a spontaneous Pulfrich phenomenon. The effects of different grades of neutral-density filters over the better eye were quantified by means of the Pulfrich phenomenon, subjective brightness comparison, and the visual-evoked potential. Relief of some of the symptoms from the Pulfrich phenomenon was achieved using an ophthalmic tint.

CONCLUSION

The majority of patients (89%) reported in the literature who are symptomatic of the Pulfrich phenomenon received no treatment. This report illustrates that the traditional optometric tool of tinted lenses can be dramatically effective in relief of the motion-related symptoms secondary to the Pulfrich phenomenon in a patient with pigmentary glaucoma.