Binocular dysfunctions were more prevalent than accommodative dysfunctions or accommodative and binocular dysfunctions together in a randomised population of university students.
Purpose. To characterize the symptomatology of refractive, accommodative, and nonstrabismic binocular dysfunctions and to assess the association between dysfunctions and symptoms. Methods. 175 randomised university students were examined. Subjects were given a subjective visual examination with accommodative and binocular tests, evaluating their symptomatology. Accommodative and binocular dysfunctions (AD, BD) were diagnosed according to the number of existing clinical signs: suspect AD or BD (one fundamental clinical sign), high suspect (one fundamental + 1 complementary clinical sign), and definite (one fundamental + 2 or more complementary clinical signs). A logistic regression was conducted in order to determine whether there was an association between dysfunctions and symptoms. Results. 78 subjects (44.6%) reported any kind of symptoms which were grouped into 18 categories, with “visual fatigue” being the most frequent (20% of the overall complaints). Logistic regression adjusted by the presence of an uncorrected refractive error showed no association between any grade of AD and symptoms. Subjects with BD had more likelihood of having symptoms than without dysfunction group (OR = 3.35), being greater when only definite BD were considered (OR = 8.79). Conclusions. An uncorrected refractive error is a confusion factor when considering AD symptomatology. For BD, the more the number of clinical signs used the greater the likelihood suffering symptoms.
To develop the Symptom Questionnaire for Visual Dysfunctions (SQVD) and to perform a psychometric analysis using Rasch method to obtain an instrument which allows to detect the presence and frequency of visual symptoms related to any visual dysfunction. A pilot version of 33 items was carried out on a sample of 125 patients from an optometric clinic. Rasch model (using Andrich Rating Scale Model) was applied to investigate the category probability curves and Andrich thresholds, infit and outfit mean square, local dependency using Yen’s Q3 statistic, Differential item functioning (DIF) for gender and presbyopia, person and item reliability, unidimensionality, targeting and ordinal to interval conversion table. Category probability curves suggested to collapse a response category. Rasch analysis reduced the questionnaire from 33 to 14 items. The final SQVD showed that 14 items fit to the model without local dependency and no significant DIF for gender and presbyopia. Person reliability was satisfactory (0.81). The first contrast of the residual was 1.908 eigenvalue, showing unidimensionality and targeting was − 1.59 logits. In general, the SQVD is a well-structured tool which shows that data adequately fit the Rasch model, with adequate psychometric properties, making it a reliable and valid instrument to measure visual symptoms.
PurposeTo establish whether the cover test and von Graefe methods are interchangeable in a non-presbyopic and presbyopic population.MethodsWe performed a prospective study on a sample of 127 non-presbyopic subjects between 20 and 45 years old and 56 presbyopic between 40 and 78 years old. Distance and near vision phoria were measured using the von Graefe method (VG) and cover test (CT). We analyzed the significant differences between methods, their correlation and the agreement between them using the Bland and Altman method.ResultsFor distance vision, heterophoria values for non-presbyopic subjects were −0.61 ± 1.86Δ with CT and −0.88 ± 2.37Δ with VG, and for presbyopic subjects were −0.56 ± 1.64Δ with CT and −0.85 ± 1.94Δ with VG. For near vision, CT yielded −3.02 ± 3.97Δ, while VG achieved −3.49 ± 4.70Δ in non-presbyopic subjects. For presbyopic subjects these values were −6.05 ± 4.38Δ with CT and −6.29 ± 4.19Δ with VG, respectively. Statistically significant differences between the two methods were observed for all groups analyzed (p < 0.05), except for near vision in presbyopic subjects (p > 0.05). Coefficient of agreement for non-presbyopic was ±2.97Δ for distance vision and ±6.74Δ at near. For presbyopic patients, this coefficient was ±1.59Δ for distance and ±1.86Δ for near vision.ConclusionCover test and von Graefe methods have a high level of agreement for both distance and near vision when considering presbyopic subjects. For non-presbyopic patients, the level of agreement is very low. Both methods for measuring heterophoria can only be considered interchangeable for presbyopic patients. For clinical purposes, this implies that any method can be used for measuring heterophoria in presbyopic patients.
PurposeTo compare the thickness and stromal optical density (OD) evolution of the flap and cap after femtosecond (FS-LASIK; Visumax) and small incision lenticule extraction (SMILE), respectively, for myopia correction.MethodsA prospective study comprising 78 eyes (n=39 per group) was performed. Anterior segment optical coherence tomography (MS39) images were collected at each postoperative visit (1 day, 1 week and 1 and 3 months) and flap/cap thicknesses were measured. Using ImageJ software, three regions were defined to measure OD (in grayscale units: flap/cap stroma, residual stromal bed (RSB) and all stroma (including flap/cap-stroma, surgical interface and RSB).ResultsMean central thickness significantly increased during the 3-month follow-up in both LASIK (5.43±4.23 μm; p=0.0118) and SMILE (2.76±5.61 μm; p=0.0118), with differences between both techniques statistically significant (p=0.020). All OD values showed a statistically significant reduction during SMILE follow-up: cap 48.96±5.55 versus 44.95±5.41 (p=0.19×10−6), RSB 50.26±7.06 versus 45.42±7.53 (p=0.00005), total stroma 50.34±6.49 versus 45.46±6.96 (p=0.5×10−5) at 1 day and 3 months, respectively, whereas no statistically significant changes were found during LASIK follow-up. No significant differences were observed in OD values between both techniques at any time point, although SMILE showed a tendency for higher OD values than LASIK within the first postoperative month. Visumax presented a tendency for thicker caps than target (11.48±7.85 μm), but not for flaps (2.73±8.93 μm) (p=0.00003).ConclusionsBoth LASIK flaps and SMILE caps show a significant postoperative rethickening. SMILE corneas present higher optical densities than LASIK corneas in the early postoperative period, with a significant decrease thereafter and up to 3 months. These findings correlate with the delayed visual recovery observed after SMILE.
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