Search Results (45)

Objectives: To determine how optometrists in Canada manage their pediatric myopia patients and to assess whether this has changed over time. Methods: In a retrospective chart review, records for children aged 6–10 years who had an eye exam between 2017 to 2021 were reviewed. Children were grouped by presenting refraction (myopes ≤ −0.50 D or pre-myopes ≤ +0.75 D). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) for each group (myopes and pre-myopes), for a maximum of 250 files per practice. Demographic information, refraction, and recommended interventions were recorded. Logistic regression was used to model the likelihood of being prescribed a myopia control intervention based on patient and optometrist characteristics. Results: A total of 2905 patients (n = 1467 (50%) female) from 15 practices across Ontario, Canada, were included, accounting for 8546 visits. Optometrists predominantly prescribed single-vision spectacle correction as a first-line intervention for myopic children, although this declined from 98.2% in 2017 to 56.7% in 2023. The use of myopia control modalities increased from 1.8% to 43.3% over this same period. Optometrists began recommending myopia control at lower myopic refractive errors over time (−2.63 DS in 2017 vs and −1.49 DS in 2020). Myopia control spectacles were the most commonly prescribed intervention, despite the observation that optometrists are not hesitant to fit contact lenses in younger children. Optometrists who had been in practice longer were more likely to prescribe older forms of myopia control (e.g., bifocals/progressives) than more recent graduates. Conclusions: While single-vision spectacle correction remains a primary approach for initial myopia management in Ontario, Canada, optometrists increasingly recommend myopia control and are initiating interventions earlier. Full article

Background: Traumatic brain injury frequently leads to visual dysfunction, affecting up to 75% of patients. These visual issues, if unrecognized, can significantly impair daily functioning. Optometrists are well-positioned to identify and manage such conditions, yet their level of preparedness is not well understood. Objective: This study aimed to assess optometrists’ knowledge, awareness, and management practices regarding TBI-related visual disorders in Saudi Arabia. Methods: A cross-sectional survey was distributed online to 411 licensed optometrists in Saudi Arabia. The 16-item questionnaire assessed demographics, awareness, confidence, knowledge, and management practices related to TBI-associated visual disorders. Results: Only 26.3% of the respondents reported receiving formal education on TBI-related visual disorders. While most recognized common symptoms, such as blurred vision and light sensitivity, comprehensive knowledge of complex visual disorders was limited. A majority (82.5%) recommended referral to other healthcare providers; however, only 16.8% demonstrated high management competency, and 31.5% fell into the low-competency category. Referral patterns and clinical decision-making were significantly associated with experience and formal training. Conclusion: The findings reveal notable gaps in optometrists’ knowledge and preparedness to manage TBI-related visual dysfunctions. Structured educational initiatives and standardized clinical protocols are essential to improve optometric care for individuals with TBI. Full article

Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 94 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings. Full article

Objectives: This study investigated the visual search behaviour of optometrists and fellowship-trained ophthalmologists when screening for diabetic retinopathy in retinal photographs. Methods: Participants assessed and graded retinal photographs on a computer screen while a Gazepoint GP3 HD eye tracker recorded their eye movements. Areas of interest were derived from the raw data using Hidden Markov modelling. Fixation strings were extracted by matching raw fixation data to areas of interest and resolving ambiguities with graph search algorithms. Fixation strings were clustered using Affinity Propagation to determine search behaviours characteristic of the correct and incorrect response groups. Results: A total of 23 participants (15 optometrists and 8 ophthalmologists) completed the grading task, with each assessing 20 images. Visual search behaviour differed between correct and incorrect responses, with data suggesting correct responses followed a visual search strategy incorporating the optic disc, macula, superior arcade, and inferior arcade as areas of interest. Data from incorrect responses suggest search behaviour driven by saliency or a search pattern unrelated to anatomical landmarks. Referable diabetic retinopathy was correctly identified in 86% of cases. Grader accuracy was 64.8% with good inter-grader agreement (α = 0.818). Conclusions: Our study suggests that a structured visual search strategy is correlated with higher accuracy when assessing retinal photographs for diabetic retinopathy. Referable diabetic retinopathy is detected at high rates; however, there is disagreement between clinicians when determining a precise severity grade. Full article

Background/Objectives: To analyze the macular pigment optical density (MPOD) values in a child population and to evaluate the relation between MPOD and adherence to the Mediterranean diet using a validated questionnaire specially created for children. Eighty-eight children were included in this cross-sectional study from two primary education schools of Seville (Spain). Methods: MPOD values were measured using Macular Pigment Screener II ^®. Lutein and Zeaxanthin intake was evaluated by KIDMED questionnaire, which classifies children according to adherence to the Mediterranean diet. A whole ocular exam with slit-lamp biomicroscopy was conducted by a specialized optometrist. Results: The mean age ranged between 6 and 8 years. The mean MPOD value was 0.46 ± 0.18. The mean score of the KIDMED questionnaire was 7.19 ± 1.85. No statistically significant differences were found as a function of gender or among Mediterranean diet adherence groups. No significant differences in MPOD values between answers were found in any KIDMED questions. No correlations were found for MPOD with several variables, such as Mediterranean diet adherence and KIDMED score. Conclusions: MPOD levels in children could not be correlated with Mediterranean Diet adherence and, thus, good dietary habits. Genetic characteristics, mother’s diet habits, oxidative stress, and body fat composition in children could be the main factors influencing MPOD levels. Full article

Objectives: We aimed to investigate how optometrists in Hong Kong are managing myopic and “pre-myopic” children. Methods: Clinical files for children aged 6 to 10 years old who had eye examinations from 2017 to 2021 were retrospectively reviewed. Children were grouped by the initial spherical equivalent refractive error (SER) as myopes or pre-myopes. The demographic data, refractive error, and myopia management recommended by the optometrists were analyzed. Results: A total of 1,318 children (859 myopes and 459 pre-myopes) from ten clinics in Hong Kong were included. Over 5 years, myopia management recommendations shifted significantly (p < 0.001). In 2017, only 18.4% of children were recommended to pursue myopia control (MC), increasing to 42.8% by 2021. The use of MC spectacle lenses increased from 7.3% in 2017 to 36.8% in 2021, becoming the most recommended option. Orthokeratology, MC contact lenses, and atropine remained stable at less than 5% over this period. Children recommended for MC approaches had significantly more myopia than those recommended single-vision lenses or monitoring (p < 0.05). Age of the first visit significantly correlated with SER change from the first visit to the next recommendation update for pre-myopes (r = 0.27, p = 0.013) but not for myopes. Conclusions: From 2017 to 2021, myopia management patterns in Hong Kong shifted significantly, with more children being recommended for myopia control. MC spectacle lenses emerged as the most commonly recommended method. Younger pre-myopes at their first visit were more likely to have earlier management updates. Full article

Singapore’s national myopia prevention efforts have largely focused on school vision screening and public education on outdoor activities in the past two decades. Given the emergence of evidence-based myopia interventions, this policy review and analysis investigates the potential benefits and drawbacks of optometrist prescribing privileges as it has been proposed to reduce the barriers to access effective interventions, such as combined therapy (e.g., orthokeratology treatment and low-dose atropine therapy). In this policy analysis, two policy options were identified to be feasible based on evidence from a systematic literature search and they were analysed along with status quo using the Centers for Disease Control and Prevention (CDC) Policy Analysis Framework. This includes independent prescribing and supplementary prescribing, where the former entails autonomous clinical decision making, and the latter entails co-management with ophthalmological supervision. The policy review and analysis found independent prescribing the most favourable and concluded that this should be implemented in view of its benefits for the community. Public health impact is expected to be substantial due to increased patient access, reduced treatment costs, early interventions, improved treatment compliance, and reduced wait times and inconvenience. It is feasible because treatment processes can be streamlined, and it can be implemented based on existing collaborative prescribing frameworks. Economical and budgetary impact is also substantial given the direct savings generated, which can consequently help to reduce the disease burden. Full article

Background: Since accommodation may be a source of error affecting the inter-optometrist repeatability of subjective refraction, this study investigated whether the use of cycloplegia could improve this repeatability. Methods: A randomized cross-sectional study was conducted on 42 young hyperopes (18.2 ± 7.7 years, range 6 to 31 years). Subjective refraction was performed by two different optometrists in two measurement sessions: one day without cycloplegia and, on a different day, with cycloplegia, in random order. The inter-optometrist repeatability of all refractive variables (M, J0, and J45) was analyzed, selecting one eye randomly, in terms of the 95% confidence interval of repeatability (r). Results: No statistically significant differences were found between the optometrists for any refractive variable, both with and without cycloplegia (p ≥ 0.05). Furthermore, no correlation was found between participants’ age and the refractive differences between optometrists under both cycloplegic conditions (p ≥ 0.05). However, the use of cycloplegia improved the inter-optometrist repeatability of M (r = 0.37 D) compared to the non-cycloplegic measurements (r = 0.62 D). Conclusions: These results suggest that accommodation in young hyperopes is likely a primary source of error that could explain the discrepancies in subjective refraction between optometrists. Full article

Background: Diabetic retinopathy, hypertensive retinopathy, glaucoma, and contrast-related eye diseases are well-recognized conditions resulting from high blood pressure, rising blood glucose, and elevated eye pressure. Later-stage symptoms usually include patches of cotton wool, restricted veins in the optic nerve, and buildup of blood in the optic nerve. Severe consequences include damage of the visual nerve, and retinal artery obstruction, and possible blindness may result from these conditions. An early illness diagnosis is made easier by the use of deep learning models and artificial intelligence (AI). Objectives: This study introduces a novel methodology called CAD-EYE for classifying diabetic retinopathy, hypertensive retinopathy, glaucoma, and contrast-related eye issues. Methods: The proposed system combines the features extracted using two deep learning (DL) models (MobileNet and EfficientNet) using feature fusion to increase the diagnostic system efficiency. The system uses fluorescence imaging for increasing accuracy as an image processing algorithm. The algorithm is added to increase the interpretability and explainability of the CAD-EYE system. This algorithm was not used in such an application in the previous literature to the best of the authors’ knowledge. The study utilizes datasets sourced from reputable internet platforms to train the proposed system. Results: The system was trained on 65,871 fundus images from the collected datasets, achieving a 98% classification accuracy. A comparative analysis demonstrates that CAD-EYE surpasses cutting-edge models such as ResNet, GoogLeNet, VGGNet, InceptionV3, and Xception in terms of classification accuracy. A state-of-the-art comparison shows the superior performance of the model against previous work in the literature. Conclusions: These findings support the usefulness of CAD-EYE as a diagnosis tool that can help medical professionals diagnose an eye disease. However, this tool will not be replacing optometrists. Full article

Background: Individuals with congenital color vision defects (CVDs) are at greater risk of misidentifying colors, necessitating an investigation into their ability to distinguish colors accurately. This study aimed to assess how individuals with CVDs perceive the colors in the Worth four-dot (W4D) and duochrome tests. It also explored whether individuals with CVDs require more detailed instructions from optometrists and eye care providers during these tests. Method: Thirty-two participants with congenital CVDs were recruited for this study. Participants with ocular diseases were excluded based on a brief questionnaire. The participants underwent a W4D test to determine the colors of four circles and the duochrome test without using filters. Result: All the participants correctly identified the W4D colors, except for five participants (15.62%). Furthermore, among all the participants, two (one with deuteranopia and one with protanopia) failed to identify the colors correctly in the duochrome test (6.25%). Conclusions: The findings suggest that in the context of optometric assessment, it could be essential for optometrists to incorporate a preliminary inquiry into a patient’s ability to identify colors prior to performing diagnostic tests such as the W4D or duochrome tests. Incorrect responses from patients with CVDs might mislead optometrists regarding the proper outcomes of the test. Full article

Background/Objectives: Glaucoma is the leading cause of irreversible blindness, with a significant proportion of cases remaining undiagnosed globally. The interpretation of optic disc and retinal nerve fibre layer images poses challenges for optometrists and ophthalmologists, often leading to misdiagnosis. AI has the potential to improve diagnosis. This study aims to validate an AI system (a convolutional neural network based on the Inception-v3 architecture) for detecting glaucomatous optic neuropathy (GON) using colour fundus photographs from a UK population and to compare its performance against Australian optometrists. Methods: A retrospective external validation study was conducted, comparing AI’s performance with that of 11 AHPRA-registered optometrists in Australia on colour retinal photographs, evaluated against a reference (gold) standard established by a panel of glaucoma specialists. Statistical analyses were performed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Results: For referable GON, the sensitivity of the AI (33.3% [95%CI: 32.4–34.3) was significantly lower than that of optometrists (65.1% [95%CI: 64.1–66.0]), p < 0.0001, although with significantly higher specificity (AI: 97.4% [95%CI: 97.0–97.7]; optometrists: 85.5% [95%CI: 84.8–86.2], p < 0.0001). The optometrists demonstrated significantly higher AUROC (0.753 [95%CI: 0.744–0.762]) compared to AI (0.654 [95%CI: 0.645–0.662], p < 0.0001). Conclusion: The AI system exhibited lower performance than optometrists in detecting referable glaucoma. Our findings suggest that while AI can serve as a screening tool, both AI and optometrists have suboptimal performance for the nuanced diagnosis of glaucoma using fundus photographs alone. Enhanced training with diverse populations for AI is essential for improving GON detection and addressing the significant challenge of undiagnosed cases. Full article

Background/Objectives: Stroke survivors often experience various visual consequences that impact their daily life and may benefit from visual interventions. However, some of these usually go unaddressed as optometrists are rarely included in the post-stroke care pathway. Yet, optometrists are interested in contributing to the care of these patients. This survey evaluated the readiness of optometrists in diagnosing and managing visual disorders specific to stroke survivors. Methods: A questionnaire was developed by the researchers, pilot tested by 5 research optometrists and 15 community optometrists, and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, the US, Hong Kong, India, and the UK. Results: Most respondents displayed strong knowledge, but 61.6% indicated that enhancing their knowledge would be helpful. The majority (87%) agreed that stroke is related to an increased incidence of falls. Participants’ knowledge regarding the natural history of post-stroke visual disorders was poorer. There were also inconsistencies regarding what optometrists considered ideal interventions and what they undertook in practice. More than 50% of respondents reported that the quality of published evidence on post-stroke visual consequences was low or nonexistent. Conclusions: Overall, survey respondents displayed sufficient knowledge. However, there are areas of uncertainty in their knowledge, which in many cases correspond to real gaps in the available evidence. There is a need to identify and remediate these gaps to enable optometrists to deliver quality optometric care as collaborative members of the post-stroke professional team, which would eventually improve the rehabilitation of stroke survivors. Full article

Aim: Among the severe organ complications occurring in patients with Turner syndrome (TS), ophthalmic dysmorphia and visual impairment are usually marginalized. There are only a few studies that take into account the prevalence of ophthalmic disorders in female patients with TS. Material and methods: Articles in PubMed, Scholar, and Website were reviewed, considering the prevalence of various ocular disorders in patients with X chromosome deficiency. Current standards for the management of patients with TS in the context of the prevalence of ophthalmic disorders were also analyzed. Results: Identification of visual impairment in people is important because it significantly impairs quality of life (QoL) along with other health problems. QoL affects cognitive and behavioral functioning and significantly increases self-esteem, acceptance of treatment, and, consequently, physical and mental health. Low self-esteem makes patients feel helpless and unable to plan their social development. Patients with TS are relatively more frequently diagnosed with various eye defects compared to the healthy population. Therefore, special attention should be paid to the early assessment of the visual system in people with TS to eliminate any factors that could potentially impair their QoL. Conclusions: Patients with TS should be referred to specialist ophthalmologists, pediatricians, or optometrists for preventive care or early treatment of visual impairment. The authors point out the need for comprehensive ophthalmological examinations as standard management in patients with TS. Full article

Determining the axial length (AL) of the eye is of significant interest in the management of myopia. However, the devices that allow this value to be obtained are either expensive, for example, optical biometers, or inconvenient for use in pediatric population, such is the case with ultrasound biometers. Therefore, this study aimed to develop a mathematical model for estimating the AL value based on easily obtainable variables, with the novel addition of body height to the analysis. A total of 170 eyes of 85 myopic volunteers (mean age of 10.8 ± 1.45 years, ranging from 7 to 14 years) were included in the analysis. Participants underwent anamnesis, keratometry by NVISION-K 5001, subjective refraction by an optometrist, AL measurement by the Topcon MYAH biometer, and body height measurement. Spearman’s correlation test was employed to analyze the relationships between AL and keratometry, spherical equivalent, body height (Sperman’s correlation, all r ≥ 0.267, all p < 0.001), and age (Spearman’s correlation, p = 0.081). Subsequently, multiple regression analysis was conducted on the variables that demonstrated a previous correlation. The mathematical model obtained permits the estimation of AL based on average keratometry, spherical equivalent, and body height. This model is significant (p < 0.001) and explains 82.4% of AL variability. Full article

Purpose: This study aims to investigate the disposal practices of optical materials in Portuguese Optical Centers. Methods: This study, conducted in the Portuguese Optical Centers across 18 districts and 308 municipalities, divided the country into 4 regions for analysis. Utilizing Google Forms^®, a survey targeting Optical Center managers and related professionals was disseminated via email from February to May 2023, comprising 30 questions across 6 sections, including optical and contact lenses, maintenance solutions, eyeglass frames, and recycling participation. Data analysis employed IBM SPSS^® Statistics v.27, using non-parametric tests for variable distribution. Ethical standards and privacy policies were strictly observed throughout the research process. Results: Findings indicated that there were significant differences in the final treatment of organic and mineral lenses. Organic lenses were placed in the yellow recycling bin (22.2%), while mineral lenses were placed in the green recycling bin (37.9%). In the case of contact lenses, regardless of the type (RGP, scleral lenses, conventional hydrogels, and silicone hydrogel lenses), the majority (>50%) were disposed of in general trash. Regarding eyeglass frames, there were no significant differences between mass and metal frames, mostly being discard in general waste (~30.0%). Conclusion: Approximately half of the surveyed Portuguese Optical Centers were not actively involved in recycling. This represents a missed opportunity for optometrists to play a role in enhancing recycling rates through patient education. Full article