EAOO Abstracts Dublin 22

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Oral Presentations
Telemedicine in Optometry and Ophthalmology

Sigrid Mueller-Schotte, OD, PhD, FAAO, University of Applied Sciences in Utrecht, Netherlands
The COVID-19 pandemic challenged eye care providers to deliver eye care to patients as well as
optometric educational institutions in the way they teach clinical skills. The Optometry department
of the University of Applied Sciences in Utrecht (UASU) was faced with the need to cancel clinical
teaching and change to online education. At the same time, the Ophthalmology department of the
University Medical Center Utrecht (UMCU) with more than 85,000 appointments annually, was
forced to cancel patients with non-urgent care needs. A unique, collaboration between the two
departments of the UMCU and the UASU was born serve both needs: the TeleTriageTeam (TTT).
The presentation will describe an interprofessional approach to deliver appropriate eye care and
retain continuity of care for patients in need of physical health care in times that resources are
scarce.
From the idea, through pilot testing to implementation. Which steps were taken? Which challenges
were to overcome? What are the benefits for the optometric students? What are the limitations?
How can telehealth be used to provide eye care? What are future challenges?
Communication between Eye Care Practitioner and Parents

David Berkow, Berkow Optometrists, Haifa, Israel
Purpose:
According to Professor Ian Flitcroft, myopia has become a pandemic. We, as Eye Care Practitioners,
must either consider engaging in Myopia Management or refer to a colleague who does.
Unfortunately, most parents are not aware of the importance of treating their myopic child.
Therefore when examining a child and revealing a problem we must engage in a conversation with
the parents explaining the risks of myopia progression, the projection of the myopia progression in
the case of their child (Using the myopia calculator designed by BHVI), the importance of axial length
measurement and the different treatment interventions.
Setting/Venue:
According to Professor Ian Flitcroft, myopia has become a pandemic. We, as Eye Care Practitioners,
must either consider engaging in Myopia Management or refer to a colleague who does.
Unfortunately, most parents are not aware of the importance of treating their myopic child.
Therefore when examining a child and revealing a problem we must engage in a conversation with
the parents explaining the risks of myopia progression, the projection of the myopia progression in
the case of their child (Using the myopia calculator designed by BHVI), the importance of axial length
measurement and the different treatment interventions.
Methods:
Review Articles related to the title of my presentation
Results:
Myopia Management is a Key issue
Conclusions:
Myopia Management is very important
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Blended Learning in Optometry
Rupal Lovell-Patel, Academic Lead - Vision Sciences, School of Medicine,
University of Central Lancashire, Preston, UK
Background:
With an ageing population, the demand on the provision of eyecare is increasing globally. The world
report on vision by WHO shows that 42% of ‘blindness’ is due to uncorrected refractive error. To
reduce preventable vision loss, there needs to an increase in the resources dedicated to eyecare
provision including an increase in training and education of eyecare professionals. Optometry can
play an important role in the eyecare provision as optometrists can diagnose and correct refractive
errors in countries where the scope of practice is restricted but they can investigate, diagnose, and
treat a range of ocular conditions.
Aim:
To develop a ‘Learn as You Earn’ model of Optometry training for students who are already working
in the optical sector.
Methodology:
Based on Online teaching theories, a blended learning course for opticians working in optical
practice to develop their careers as an optometrist was designed. The blended deliver format was:
Asynchronous online weekly lectures with formative assessment and one week a month on campus
face to face clinical/practical skills teaching. Students can carry on working in the optical practice
throughout the course allowing for an experiential learning element to the course.
Conclusion:
A blended learning Optometry has been running for the past three years and students will be joining
the national professional body as fully qualified optometrists in the next few months.
This presentation will take the attendees through some of agreed principles that the academic
teaching team followed along with teaching technologies utilised to make the online theory lectures
more interactive in the development of a blended learning optometry course.
Utilising internationalisation for the Development of an International Masters Program of

Optometry at Hassadah Academic College
Liat Gantz, Hadassah Academic College, Jerusalem, Israel
Co-Authors: Y. Catalan, A. Gordon-Shaag
Purpose:
Israel’s Council of Higher Education (ICHE) is promoting internationalization of higher education so
graduates will obtain global skills, which include communication, cooperation and collaboration with
people of diverse backgrounds, cultures and ethnicities. Hadassah Academic College received a grant
from ICHE to implement internationalization throughout its departments. The grant was used in the
Masters of Optometry (M.Optom) program as a segue to the development of an international
M.Optom curriculum.
Setting/Venue:
Hadassah Academic College
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Methods:
The Pediatric Optometry, Glaucoma, Retinal Diseases, and Vision in Dyslexia courses that were
always taught in English, were offered online due to the pandemic. The grant was used to develop
infrastructure to allow international registration to these courses. Additional English courses were
developed, including Sports Vision, Treating Patients with Autism, and Optometric
Neurorehabilitation. Courses were offered in either concentrated, live, online modules, or hybrid
learning. Asynchronous lectures were supplemented with online activities ensuring comprehension
and application, as well as monthly live online sessions that were recorded to allow offline viewing.
International courses also incorporated panel discussions about optometry across the globe.
Results:
Online international courses have each attracted up to 20 participants from worldwide, including
Holland, Cyprus, Greece, Canada, USA, Philippines, Nigeria, Iceland, and the Palestinian Authority.
Registrants that return to additional courses have encouraged the development of an international
M.Optom program, currently submitted to the ICHE for accreditation. The two-year, four- semester
program will include 37 credits. Hands-on laboratories and workshops will be offered in two- 10-day
concentrated modules requiring live attendance once per academic year. Courses that are taught in
Hebrew will either be translated simultaneously or offered in Hebrew and English, alternating the
languages every other year.
Conclusions:
The successful implementation of the ICHE internationalization grant has led to the modification and
adaptation of courses in the M.Optom program to an international audience. This process is now
being further developed into a full international M.Optom curriculum.
Why Another Peer Reviewed Optometric Journal?

Timothy Wingert, Rosenberg School of Optometry, San Antonio, USA
Co-Authors: P. Freeman, W. Miller
Purpose:
Clinicians can learn something new every day in their efforts to improve the quality of peoples’ lives
by staying abreast of current developments. They may learn from a patient with a unique
presentation of an ophthalmic concern, about new materials or technologies becoming available for
patient care, or from new systems which are put into place to facilitate health care delivery. A way
to stay current is with accurate and credible information from a peer reviewed publication.
Setting/Venue:
Given the dearth of peer reviewed optometric publications, a journal which allows optometric
clinicians, researchers, and those in public health to share current information for the health and
well-being of patients is an excellent forum for worldwide sharing.
Methods:
Optometric Clinical Practice (OCP) is an online peer reviewed journal that is accessible to anyone in
the world (at no cost) and housed in the University of the Incarnate Word Rosenberg School of
Optometry library (San Antonio, Texas, USA). With an editor, two associate editors, a journal review
board which consists of faculty and practitioners from around the globe, and a statistician, it is an
excellent source of clinically relevant material for any optometrist in practice.
Results:
As of October 2021, Optometric Clinical Practice has released five issues. The Journal is the first to
publish the American Optometric Association’s Evidence-Based Clinical Guideline: Comprehensive
Pediatric Eye and Vision Examination. The AOA Evidence-Based Clinical Guidelines, which help to
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determine the standard of care for the entire profession, will continue to be part of the journal’s
offerings in future editions. Attesting to its relevance, a link to the Journal is now on the World
Council of Optometry Website.
Conclusions:
As David A Heath, OD, EdM wrote in an editorial in Optometry JAOA in August 2006, “…developing
and managing optometry’s knowledge will forever be a shared responsibility of faculty, practitioners,
and the profession’s leadership.” OCP will give all eye and health care individuals the opportunity to
do just that. This publication is designed to be written by all who have a desire to share, and read by
all who want to stay current with peer reviewed literature.
A new algorithm for Keratoconus; (Prevalence, prognosis & pathways) Langis Michaud OD FAAO
FEAOO, Professor & Dean at Université de Montréal, Canada & Tim McMahon AAO President, FAAO,
USA
This conference aims to provide an update on keratoconus by revisiting data on prevalence, the
latest knowledge in terms of etiology, and diagnostic methods. In a second part, treatment options,
including cross-linking, as well as new surgical options will be covered. Finally, an algorithm will be
suggested to help professionals select contact lenses according to the patient's parameters.
Intra-professional education in action - a review

Catherine Porter, Senior Lecturer in Optometry at the University of Manchester, UK
Abstract: A number of different healthcare practitioners are involved in delivering primary eyecare:
optometrists, GPs and pharmacists. It is only recently undergraduate students have become involved
in inter professional education. In 2015 we designed a workshop for undergraduate pharmacy and
optometry students to explore common ocular conditions, and ocular side effects of common
medications.
The three hour workshop consisted of: a jigsaw puzzle (systemic conditions, medications and ocular
side effects), and three case studies of common eye complaints that may present to pharmacists or
optometrists. The students worked in groups of ten.
For the first three years we used students’ qualitative feedback to understand their IPE learning
experience in order to develop the teaching session. In 2019 we decided to formally evaluate the
session. This talk explores how we evaluated the learning outcomes and explores the results from
the 2022 workshop.
Diagnosis & management of non-stabismic BV anomalies - why are there so many approaches?
Prof Bruce Evans, Institute of Optometry London, UK
Purpose:
To review and contrast the main approaches to diagnosing non-strabismic binocular vision
anomalies, and the main protocols for correcting and treating these anomalies. An additional
purpose is to reflect on differences in diagnosis and management between countries and
professions. Another aim is to consider the cause of variation and implications for patient care.
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Setting/Venue:
The literature search used PubMed and leading textbooks on binocular vision anomalies in the
English language.
Methods:
A literature search was undertaken to determine the main methods of diagnosing and correcting or
treating non-strabismic binocular vision anomalies. Findings from leading textbooks were compared
with research literature published in refereed journals. Evidence was also sought from studies
evaluating what actually happens in clinical practice. The data from these literature searches were
filtered by country and by profession to investigate factors that may contribute to diversity of clinical
practice.
Results:
The literature searches reveal marked variation in the methods recommended for diagnosing
binocular vision anomalies. There is agreement concerning the interventions available (refractive
correction, prisms, vision therapy). However, there are diverse opinions concerning the criteria for
determining when treatment is required. For refractive correction or prisms, the different methods
used for determining the correction required will lead to different prescriptions. To some extent, the
variation can be attributable to national differences, However, even within some countries, very
diverse diagnostic criteria and prescribing philosophies are evident. A wide variation sometimes is
present within as well as between the different eyecare professions.
Conclusions:
There is a lack of research measuring what practitioners do in everyday clinical practice. Research
with standardised patients indicates, clinical practice is likely to be different to the findings of this
review, which largely relate to what is taught. The wide variation means that even within a
country/profession, a patient may consult two practitioners and receive different diagnoses, or
dissimilar interventions. One reason for the variation is likely to be the historical influence of
prominent clinicians/teachers. Evidence-based scrutiny should be applied to old methods as well as
new. Research is required that compares different philosophies for diagnosis and prescribing.
Quality of life assessment before and after cataract surgery

Zane Jansone-Langina, University of Latvia, Riga, Latvia
Co-Authors: A. Solomatin, R. Truksa, M. Solomatins, M. Jurjane, I. Solomatins
Purpose:
Cataract is an opacity in the lens or lens capsule of the eye which progressively reduces visual
functioning. In the daily life patients feel visual acuity changes in the far and near distances, increase
glare, reduced contrast vision and changes color vision. But sometimes for ophtalmologists and
optometrists it is hard to understand if the cataract surgery gave improvement of life quality.
Objective data can show better results (visual acuity, contrast vision test, refraction) but patient's
subjective responses are not that positive. Or aim was to evaluate changes in patients' quality of life
before and after cataract surgery.
Setting/Venue:
In our research participated 200 patients with cataract (mean age 64+/-6). All the patients were
divided in 4 groups depending on cataract type (nuclear (n=75), cortical(n=70) , posterior
subcapsular (n=55). The cataract removal surgery was permormed with Femto-Laser. The research
was done at the Dr.Solomatin eye center. Patient with additional eye diseases (glaucoma, diabetic
rethinopathy, AMD) were excluded from research.
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Methods:
The patients were interviewed before and 2 weeks after cataract surgery. We used Visual Function
Index (VF-14) questionnaire to determine if there were any subjective changes in quality of life. We
analyzed addition tests as visual acuity (decimal units) in the far and near distances, average
refraction in far and near distances.
Results:
The mean VF-14 was 47.0 before and 94.1 after cataract removal surgery. Statistically the biggest
difference was absorbed in reading abilityes (score before: 2,3+/-2,1; after 3,75+/-1,5;p=0,03).
Cataract surgery gave subjectively bigger improvement in cortical cataract patients (mean VF-14
score before 42,7+/-6,1, after: 78,9+/-8,1), but objective measurements did not showed statistically
significant difference (p=0,08). The mean improvement of the distance visual acuity change after the
surgery was 0,32+/-0,2 decimal unit; improvement of near vision visual acuity - 0,25 +/-0,30 decimal
units.
Conclusions:
2 weeks after cataract removal surgery patients experience statistically significant improvement in
life quality. Cortical cataract patients experience the bigger subjective life quality improvement then
nuclear or posterior sucpapsular patients.
Vision and reading: why we need to go beyond “20/20” - an evidence-based approach

Dr. Patrick Quaid, MCOptom(UK), FCOVD(USA), PhD (CAN)
Founder & Director of Optometric Services, VUE Cubed Vision Therapy Clinics
Immediate Past President, College of Optometrists of Ontario (Regulatory Board)
Executive Board, COVD International (College of Optometrists in Vision Development)
In this lecture, Dr. Quaid will outline the vital importance of a much more in-depth assessment that a
routine eye examination on children with reading and spelling-based learning difficulties. He will
highlight key visual skills “other than simple 20/20 acuity” such as tracking skills, visual memory skills
and vergence / accommodation functional skills to name but a few. Research pertaining to reading
and vision will be presented (2013, Graefes Archives of Clinical & Experimental Ophthalmology
publication) in addition to a model of reading. A discussion of how Optometric Vision Therapy and
Speech & Language interventions interleave will be discussed in addition to how issues like ADHD
and visual issues overlap. Dr. Quaid has published in peer reviewed journals and medical textbooks
to re-enforce that the myth of “20/20 is perfect vision” must be dismissed. Videos of real-life cases
will also be shown, something that Dr. Quaid insists be in all his lectures to really make the messages
in his lectures “human” and hit home.
At the end of the day, a child ability to succeed in our modern age is critically linked to their ability to
learn effectively. We do not teach children how to read to be clear, but as a profession we must
ensure that the visual skills are present and intact to facilitate the reading reflex emerging in the
“orchestra” required for reading skills to develop in children. If visual skills are not optimal, this
success is severely limited. These visual skills can be remediated in the vast majority of cases and this
is the message that Dr. Quaid really wishes to hammer home today. There is something we can all do
for these children, and we need to step up as educators, parents, and healthcare professionals.
Neuro-visual rehabilitation (a.k.a. Optometric Vision Therapy) put quite simply “teaches developing
brains how to use eyes”. We need to stop over-complicating BV/VT and use this simplified message
when educating the public and our colleagues on how we can help children especially with
dyseidetic reading-based learning difficulties.
Goals of presentation:
1. To give research background on how vision affects reading and the difference between
dysphonetic reading issues and dyseidetic reading issues.
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2. Discuss research published clearly showing associations between several impaired oculomotor
metrics and poor reading skills when measured objectively.
3. Make it clear that as a profession, Optometry is in the driving seat with these cases from a visual
standpoint and to encourage the profession to engage with these cases using the backing of
evidence-based research.
Impact of BV anomalies, accommodation disorders and ocular surface disease on the accuracy of
autorefraction
Justyna Kiermasz, Faculty of Physics, University of Warsaw, Warsaw, Poland
Co-Authors: M. Sobol, J. Pniewski
Purpose:
The purpose of the study was to evaluate if binocular vision anomalies, accommodation disorders,
and ocular surface diseases influence the differences between automated refraction (AR) and
subjective refraction (SR). We also analyzed if the technology of autorefractors (open- or and closed-
field) causes this effect. We also analyzed the short-term refractive state variations in orthogonal
three-dimensional space to verify if any disorders can determine the specific patterns of refractive
state variation.
Setting/Venue:
Autorefractors are often used to give a starting point for successive optometric procedures and in
screening programs, therefore they must provide reliable results. Many studies confirmed the
reliability of non-cycloplegic autorefraction, however in some cases the autorefractors failed and the
difference between subjective refraction and autorefraction exceeds 1,00 diopter.
Methods:
64 subjects (38 females) aged 23–60 (mean 37.5 ± 10.8) took part in the study. A closed-field auto-
refracto-keratometer Nidek ARK-510A and an open-field auto-refracto-keratometer Shin-Nippon
NVision-K 5001 were used to obtain non-cycloplegic refractive error measurements. Comprehensive
optometric examinations were carried on, and Ocular Surface Disease Index (OSDI) was assessed. AR
and SR results were analyzed in the negative cylindrical form. The results were transformed from
conventional notation (FS/FC×α) to h-vectors, according to Harris (1991). The statistical analysis was
performed using Statistica Software, and scatter plots presenting short-term refractive state
variation were made using Mathworks Matlab Software.
Results:
The mean differences between AR and SR of RE were 0.38/–0.12×92°, and 0.06/–0.12×92° for ARK
510, and NVision-K, respectively. 17 subjects demonstrated differences between AR and SR bigger
than 1,00 diopter, from whom only one did not demonstrate any of the analyzed abnormalities. In
most cases, changes of refractive state during autorefraction appeared in the sphere power, which
indicates accommodative state changes. 30 subjects demonstrated at least one outlier and/or
polymodality of refractive state distributions. The study showed that binocular vision anomalies
affected results from open-field autorefractor, whereas the accommodative disorders impacted
closed-field refraction measurements. However, the influence was weak.
Conclusions:
The study showed that short-term refractive state variation depends on the target type and viewing
conditions. The presence of accommodative disorders or binocular vision anomalies might increase
the range of short-term refractive state variation and reduce the accuracy of autorefraction. The
automatic mode used typically in autorefractors with 3 to 5 readings may not accurately represent
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the refractive state of the eye when averaged due to polymodal distribution of the readings and the
presence of outliers.
Evaluation of a New 1-Day SiH Contact Lens

Purpose:
To evaluate practitioner and patient acceptability of a new one day disposable contact lens
(sorafilcon A).
Setting/Venue:
Community optometric practices in Hungary, Finland, Netherlands, and UK.
Methods:
Following ethical approval, 138 patients who were already wearing one day spherical contact lenses
for myopia were refitted with a new one day silicone hydrogel lens (sorafilcon A). At the fitting, the
practitioner completed a questionnaire using visual analogue scales (VAS) to grade vision and fit and,
if these were acceptable, issued 10 pairs of sorafilcon lenses. After 10 days of wear the patient
completed a VAS questionnaire describing lens performance and asking participants the “bottom
line” question, whether they would change to sorafilcon if the same price as their habitual lenses.
Results:
Participants (aged 18-69 years; 61% female) were wearing a broad range of brands of daily
disposable lenses. Practitioners judged fit and vision acceptable in 96.4% and 98.5% of cases,
respectively. The VAS gradings were scored 0-100, higher indicating better performance with
sorafilcon. Mean participant gradings for comfort were 69.7 (CI, 66.1-73.4) and for 60.9%, gradings
favoured sorafilcon over habitual lenses. The mean grading for vision was 75.8 (72.9-78.7) and for
73.9% the grading favoured sorafilcon. For 72.5% lens handling gradings favoured sorafilcon. For the
“bottom line” question, 48.6% preferred sorafilcon, 26.8% preferred their habitual lenses, and 24.6%
could not decide.
Conclusions:
Further analyses indicate, those whose habitual lenses were hydrogel (N=44) reported significantly
more improvement on changing to sorafilcon in both comfort (t-test, p=0.01) and handling (t-test,
p=0.003). For all wearer questionnaire responses, the broad range from 5th to 95th percentile
responses shows that clinicians should never assume that a patient’s current lenses are optimal. In
summary, a new one day disposable contact lens, sorafilcon, performs well in comparison to popular
brands of one day lenses, and is particularly likely to be favoured by patients wearing hydrogel
lenses.
Glaucoma - going beyond IOP

In this lecture, Dr. Quaid will outline research published in Investigative Ophthalmology & Vision
Science (IOVS, #1 impact journal world-wide in ophthalmology) which stemmed from a simple
clinical observation at the University of Waterloo School of Optometry & Vision Science (UW) in
2012; namely “why did every NTG patient tend to be female and have ice-cold hands when greeted”.
This simple clinical observation led to 2 years of tracking 122 patients labelled “suspected OAG” at
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the UW Ocular Health clinic to see what factors better predicted progression between IOP, CCT, and
BP. The findings will surprise you, but the metrics attained, paying strict attention t quality of
imaging, led to a useful clinical formula than can be “applied tomorrow in clinic. This is the true value
of research – when it becomes solid “clinical translational research” in that the results can be
immediately applied to improve patient care. Being born in Limerick and leaving Ireland at 18 years
old (and yes, getting an A1 in Honours Level Gaeilge) to receive an education in both the UK and
Canada and having served as the President of the largest regular in Canada, has always been firmly
rooted in “practical approaches”. Sometimes we do not have to “build a spaceship to cross the road.
Good old fashioned common sense and clinical observation can change the landscape of patient
care. Dr. Quaid hopes you enjoy the story behind his journey into Optometry though this lecture
topic!
1. Give research background on blood pressure and how it pertains to primary open angle glaucoma.
2. Allow understanding of how IOP and DBP interact to affect perfusion and what to pay attention
to.
3. How to make an educated decision on “Target IOP” for effective treatment to give best chance for
stability for POAG cases.
Concussion and Vision: More Than Checking Pupils!

Dr. Quaid will present an overview of vision and oculomotor dysfunction in traumatic brain injury in
addition to a review of current published research literature on this topic illustrating why many
other facets of vision are problematic in brain injury other than simple “visual acuity on an
eyechart”. These oculomotor deficits and visual perceptual deficits will also be discussed in terms
functional implications, symptomatology on presentation in addition to therapy-based interventions
that can often substantially improve dynamic visual skills, mobility, and quality of life.
Visual skills deficits can lead to issues such as headaches, tracking problems, double vision, gait
issues, intolerance of screens and scrolling on screens, photophobia and poor ability to handle
visually busy environments. These symptoms are quite prevalent in post-concussion syndrome (PCS)
cases and can present in both adult and pediatric cases. How vision can impact gait will also be
discussed in addition to how lenses, prisms and tints can be used effectively to significantly reduce
symptomatology and how the involvement of neuro-visual rehabilitation can be invaluable to the
rehab strategy overall.
A medical textbook chapter, recently published in mid-2019 and authored by both Dr. Quaid and Dr.
Eric Singman (MD PhD, then Head of Neuro-Ophthalmology at Johns Hopkins) with over 230 peer-
reviewed references, will be discussed. This landmark textbook has over 35 chapters, with each
chapter delving in-depth on topics related to functional issues often seen in brain injured patients.
Real life clinical video recordings of patients will also be shown with an anatomy-based explanation
as to how the functional improvement was attained in such a short period of time.
1. To give research background on visual rehabilitation and how it pertains to brain injury.
2. Allow understanding of how the visual system interacts with vestibular function and
proprioception, and what can happen when this interaction is affected in brain injury.
3. Show real life patient cases to demonstrate the usefulness of neuro-visual rehab overall.
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The Enigmatic Vitreous: Look at it and not Through it
Prof John Nolan, Ireland & Dr Emmanuel Ankamah, Nutrition Research Centre Ireland, Waterford
Institute of Technology, Ireland
Purpose:
Vitreous describes the homogenous gel that fills the posterior segment of the eye. Degeneration of
this exquisite gel is ubiquitous during life and leads to the entoptic phenomenon, vitreous floaters or
myodesopsia. Emerging evidence have shown that symptomatic vitreous degeneration impact
negatively on both quality of life and visual function of sufferers.
Setting/Venue:
Further, the treatment options for floaters, pars plana vitrectomy and laser vitreolysis, are
accompanied by sight-threatening complications and are not readily proffered to patients unless the
benefits far outweigh the risks. It follows from the foregoing that a low-risk yet effective therapy is
warranted for the management of symptomatic vitreous degeneration.
Methods:
Recently, targeted dietary intervention with selected micronutrients has been pursued as a plausible
strategy for managing vitreous floaters.
Results:
This talk is aimed at, first, exploring the evidence regarding the impact of vitreous degeneration on
visual function, specifically contrast sensitivity, and its relevance for optometric practice. Next, the
evidence regarding the impact of vitreous degeneration on quality of life will also be discussed.
Furthermore, the evidence-based treatment options for vitreous floaters will be examined.
Conclusions:
Aside these, the micronutrients present within the human vitreous that contribute to the integrity of
the vitreous will be discussed. Lastly, the results of the Floater Intervention Study (FLIES;
ISRCTN15605916) will be presented, and its implications for eyecare will be highlighted.
Hoya Keynote
Myopia control in children wearing DIMS spectacle lens: 6 years results

Prof. Carly Lam, The Center for Myopia Research, Hong Kong
DIMS spectacle lens is found to be effective in slowing myopia control in a 2-years randomized
clinical trial. The efficacy was around 60% less in myopia progression and axial elongation when
compared to the subjects wearing single vision lenses.
We followed these children for a period of 6 years and evaluate the changes in refraction and axial
length. Myopic children who had completed the 2-year randomized clinical trial of DIMS lens were
included in this follow-up study. Their cycloplegic refraction and axial length (AL) were measured up
to 6 years. Children who changed to other myopia control methods were excluded. Ninety children
completed the data collection at for a period of 6 years. The children (n=36) who had worn DIMS
lenses throughout the study had -0.92 ± 1.15D of myopia progression and 0.60 ± 0.49mm of axial
elongation. The mean annual changes were 0.15D and 0.10mm.
When these children continued to wear the DIMS lens for a period of 6 years, the myopia control
effect was sustained that both annual myopia progression and the axial length changes were similar
to the findings in the 2 years RCT.
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Childhood myopia: diagnosis and therapy
Birte Graff, M.Sc., Ophthalmic Optics and Psychophysics, Internationale Innovative
Ophthalmochirurgie, Germany
This talk gives an overview of different kinds of treatment options and its individual characteristics.
Own experiences with the MiYOSMART lenses are shared. The importance of measuring ocular
biometry when performing myopia therapy will be highlighted and questions concerning myopia
therapy itself will be addressed: What is the specific goal of myopia therapy? When should an
additional therapy be considered?
Assessing the School Age Child for Accommodative Problems

Christine Allison, Illinois College of Optometry, Chicago, USA
Purpose:
The surge in screen time and overall near work in children since the COVID pandemic has increased
concerns about the accommodative systems of school-aged children. It is important to understand
the questions to ask during the case history, and the tests to do during the exam that will fully assess
the accommodative system. Once the accommodative system is fully examined, appropriate
diagnoses must be made in order to properly manage these conditions to keep children comfortable
and symptom-free on a daily basis.
Setting/Venue:
The pediatric patients this lecture will be based on are from the clinical experience of a large urban
clinic with patients from a lower socioeconomic group. The majority of the patients in this clinic are
covered by the public aid system in Chicago, IL, USA.
Methods:
This lecture will address the types of questions to ask during the case history of a school-aged child,
including questions regarding screen time, the type of screens used, as well as overall performance
in reading and school-work, in general. The accommodative testing that will be discussed will
emphasis accommodative amplitudes, accommodative lag, and accommodative facility testing. The
way the accommodative system works with both the oculomotor and vergence systems will be
addressed, as well.
Results:
After addressing the common diagnoses of Accommodative Insufficiency, Accommodative Excess,
Accommodative Infacility, and Accommodative Spasms, we will discuss the managment options for
these patients. When to use treatments such as decreased screen time, the use of plus lenses in
reading only or bifocal form, and vision therapy will be addressed. The importance of prescribing
refractive error appropriately for patients with symptoms of distance blur when the actual problem
is a near accommodative issue will be stressed.
Conclusions:
School-aged children throughout the world are spending more and more time with near work and
computerized devices. It is important that when they have their vision assessments that the
accommodative system is thoroughly investigated in relation to their symptoms. Mis-managment of
accommodative problems can cause further visual discomfort in these patients in the future if not
fully addressed in the present."
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Why Visual Optics is Important in the Clinic or Things I Forgot that I Should Remember
Dinah Paritzky, Hadassah Academic College Jerusalem, Israel
Purpose:
Optics is defined as a science that deals with the genesis and propagation of light, the changes light
undergoes, and other closely associated phenomena. Visual optics is a branch of optics relating to
the eye and is typically studied during the first year of optometry studies. The principles of visual
optics are often forgotten over the years, although they are very relevant in the optometric clinic.
This presentation will cover optical principles that influence the optometric examination
Methods:
Content: This presentation will deal with four major topics: visual acuity and blur, anisometropia and
aniseikonia, reading with contact lenses vs reading with glasses, and the effect of pupil size on visual
acuity. For each topic the essential optical principles will be explained, and compared and contrasted
to results from clinical research. Cases will be presented in which understanding of visual optics is
essential for patient care.
Results:
Conclusion: Visual optics is one of the basic sciences from which optometry is derived. It is as
important to be familiar with these optical principles as it is to be familiar with clinical research, and
this knowledge may well affect the day-to-day clinical practice of optometrists.
Conclusions:
Conclusion: Visual optics is one of the basic sciences from which optometry is derived. It is as
important to be familiar with these optical principles as it is to be familiar with clinical research, and
this knowledge may well affect the day-to-day clinical practice of optometrists.
Anisometropic Amblyopia: Influence of Variations in Axial Length and Macular Parameters

Ana Díaz, Hospital Sant Joan de Déu (Barcelona) / Universidad Politécnica de Catalunya (UPC)
Spain
Co-Authors: C. González, J.C. Ondategui, S. Font, J. Prat
Purpose:
To determine the influence of axial length in patients with amblyopia anisometropic and possible
macular variations.
Setting/Venue:
This is an observational, cross-sectional and prospective study of non-consecutive cases performed
with pediatric patients from the ophthalmology service of the Pediatric Hospital Sant Joan de Déu in
Barcelona.
Methods:
21 pediatric patients (mean age: 7.86 ± 1.91 years) with anisometropic amblyopia were examined in
the amblyopia unit of the Ophthalmology Department of Sant Joan de Déu Hospital (Barcelona). All
patients underwent an optometric examination stipulated by the amblyopia unit of the Hospital. The
statistically analysed variables are: visual acuity (VA), refractive error (Rx), axial length (AL) (using IOL
Master 500 optic biometer) and average macular thickness (MT) and its layers (using the DRI OCT
Triton device).
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Results:
In sound eyes, a mean and standard deviation of 22.25 ± 0.95mm for AL, 0.86±1.21 for Rx and
0.94±0.11 for VA have been found. For MT: 286.11±14.21µm in macula, 37.35±5.30µm (RNFL),
72.61±6.75µm (GLC+), 109.97±9.78µm (GLC++), and 265.86±50.31µm (choroid). In amblyopic eyes, a
mean and standard deviation of 22.17±1.50mm for AL, 1.42±3.92D for Rx and 0.77±0.18. for VA. For
MT: 287.69 ±15.83µm in macula, 36.68±6.50µm (RNFL), 72.64±6.76µm (GCL+), 109.04 ±10.70µm
(GCL++) and 279.56±54.80µm (choroid). Statistically significant correlations have been found
between AL and Rx (r=‐0.876, p=0.000), and between AL and ET (r=‐0.609, p=0.003).
Conclusions:
AL increases both in amblyopic and sound eyes with age and influences Rx in anisometropic
amblyopia during childhood. There is a relationship between AL and some retinal structures. Finally,
the severity of amblyopia and axial length are not related. It is necessary to increase the number of
patients to achieve more strong results."
Computer Vision Syndrome

David Berkow, Berkow Optometrists, Haifa, Israel
Summary:
Computer Eye Syndrome is a common phenomenon amongst computer users.It is also known as
digital eye strain or visual fatigue. This phenomenon includes symptoms resulting from hours in front
of the computer screen which are associated with visual symptoms, eye surface irregularities, eye
fatigue, pain in the eye or related areas around the eye, blurred vision and headaches. There are
solutions to these symptoms which include multiple possibilites including treating the ocular surface,
the vision, residual astigmatism, accommodation and issues of convergence. One must also change
the position of the computer screen relative to the viewing angle and more.
Computer Eye Syndrome is a common phenomenon amongst computer users. It is also known as
digital eye strain or visual fatigue. This phenomenon includes symptoms resulting from hours in front
of the computer screen which are associated with visual symptoms, eye surface irregularities, eye
fatigue, pain in the eye or related areas around the eye, blurred vision and headaches. There are
solutions to these symptoms which include multiple possibilites including treating the ocular surface,
the vision, residual astigmatism, accommodation and issues of convergence. One must also change
the position of the computer screen relative to the viewing angle and more.
Optometric Practice & Research - What Colour Vision Test Should I use
Ben Evans, University of London, UK
Co-Authors: M. Rodriguez-Carmona, J. Barbur
Purpose:
Small changes in chromatic sensitivity are often the earliest signs of retinal and/or systemic disease
and colour plays a vital role in a range of occupational and clinical environments. As such, the
diagnosis and detection of colour vision deficiencies is an important element of optometric practice
and research. Colour vision tests are sometimes selected based upon familiarity rather than
suitability, despite fundamental limitations of some commonly used tests. The purpose of this study
was to produce reliable colour assessment outcomes to examine the efficacy of commonly used
methods of colour vision assessment.
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Setting/Venue:
The colour research laboratory and Advanced Vision and Optometric Tests (AVOT) clinic at City,
University of London.
Methods:
Data for 1827 participants were abstracted from anonymized records collected through the AVOT
clinic service at City, University of London. The sample included 350 normal trichromats, 1012
deutans and 465 protans with ages ranging from 10 to 65 years. Colour vision was assessed using the
Ishihara and American Optical Hardy-Rand-Rittler (AO HRR) pseudoisochromatic plates, Farnsworth
Munsell D-15 (D-15), City University (2nd Edition), computerised Colour Assessment and Diagnosis
(CAD), and Nagel anomaloscope tests.
Results:
Eighty-one per cent of normal trichromats and less than 1% of those with congenital colour vision
deficiency pass the Ishihara test when no errors are accepted. 93% of normal trichromats, 4% of
those with congenital colour vision deficiency, and no individuals with acquired loss pass the AO-HRR
when no errors are accepted. The D-15 and City University tests pass all normal trichromats, 50% of
participants with congenital colour vision deficiency, and between 16% to 25% of those with
acquired loss.
Conclusions:
The results reveal the trade-off between sensitivity/specificity. The potential sensitivity of
pseudoisochromatic plate tests is high, but this advantage is severely diminished due to the tests
failing many normal trichromats. The D-15 and City University tests fail to reliably dichotomise
participants based upon the severity of colour vision loss - many participants who fail are found with
more reliable tests to exhibit less severe loss than others who pass. A good understanding of the
capabilities and limitations of any test, particularly those used in the assessment of colour vision, is
required to maximise their efficacy in optometric practice and research.
The Challenges of Unexplained Vision Loss in Three Young Patients

Dorothy Thompson, Sight and Sound Centre, Great Ormond Street Hospital for Children, London, UK
Co-Author: E. O'Neill
Purpose:
Unexplained or non-organic visual loss, malingering, or visual conversion reactions are ways of
saying we don’t believe a patient's vision is as bad as they report. This aim of this presentation is to
describe what can be done next if test room tricks don’t detect positive proof of vision.
Setting/Venue:
Children's hospital eye department (Great Ormond Street Hospital for Children, London, UK)
Methods:
A retrospective case series followed three girls with striking visual complaints and asymmetric vision
loss profoundly affecting one eye who were referred by optometrists to paediatric ophthalmologists.
On further examination the eyes were reported to be structurally normal and the vision loss
considered unexplained. The children went on to have visual electrophysiology tests to objectively
test retinal and visual pathway function.
Results:
1. In a 10 year old under the care of mental health services, vision loss in one eye had been
attributed to stress. 2. A 14 year old girl reported profoundly reduced vision in one eye. Healthcare
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professionals suspected the visual loss was simulated/exaggerated to attain para-Olympic eligibility.
3. A 15 year old girl reported gradual bilateral visual loss over 2y. She then complained of profound
unilateral visual loss. Visual electrophysiology (pattern ERG, pattern VEP) findings showed their
complaints were genuine by identifying retinal ganglion cell and optic nerve dysfunction, associated
with hereditary optic nerve disease, birth trauma and restricted diet respectively.
Conclusions:
Unexplained visual loss can be psychogenically created by the patient...or inadvertently by the
clinician jumping to conclusions. Visual electrophysiology can identify the cause of a child's visual
loss and provide explanations for symptoms which may be otherwise remain unexplained. Avoidant
restrictive food intake disorder in children can cause insidious vision loss and asking about diet when
taking the clinical history can be helpful.
Study Design of a Double-masked Randomised Controlled Crossover Trial of Precision Tinted

Lenses for Visual Stress
Co-Authors: B. Evans, Z. Khan, A. Wilkins, P. Allen
Purpose:
In 2016 two literature reviews of visual stress (VS) were published. One concluded that VS may
affect 1 in 5 people with reading difficulties and can be alleviated with individually prescribed
precision tinted lenses (PTL). The other attributed the benefit from filters to placebo/Hawthorne
effects. Both reviews recommended a large RCT using the Intuitive Colorimeter to control for
placebo effects. The authors have designed such an RCT to help resolve the issue. The purpose of
this presentation, as recommended by the CONSORT statement, is to detail the proposed protocol
to encourage peer review and feedback on the study design.
Setting/Venue:
Clinics that receive referrals of patients for an ophthalmic assessment for one or more of the
following reasons: the patient is struggling to learn, reports symptoms on viewing text, or is
suspected of having a visual problem that may be impacting on the perception or comfort of text.
Methods:
Participant selection criteria: aged 9-18y; diagnosis of VS (Evans et al., 2017, Journal of Optometry,
p.161); no clinically significant refractive, binocular, accommodative or ocular health anomalies; not
previously used precision tinted lenses. For each participant, the Intuitive Colorimeter will be used to
determine two precision tint colours, optimal and sub-optimal. Participants will randomly receive
optimal or sub-optimal precision tinted spectacles first. Participants and researchers will be masked.
After one month, the first pair of tinted spectacles will be taken from the participant for a one-
month washout period. Then, participants will crossover to receive spectacles tinted with the other
colour.
Results:
VS is thought to be a neuro-optometric condition causing symptoms when reading which may
impact reading indirectly (discomfort deterring reading) or directly (via visual perceptual distortions).
The primary outcome measure of the research therefore will be symptom diaries. The secondary
outcome variable will be a reading test that isolates visual aspects of reading (Wilkins Rate of
Reading Test). An additional outcome variable will be parent and teacher surveys of academic
behaviours. Analysis will use an intention-to-treat basis and attrition will be minimised by a formal
agreement at the outset and frequent contact from the researchers throughout the study.
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Conclusions:
The CONSORT (2010) statement stipulates that trial protocols should be readily available.
Increasingly, reputable conferences encourage presentation of protocols before a study is
commenced for peer review and feedback. The presentation will include full details of the protocol,
including a sample size calculation, and invite critical appraisal of the study design and methods. An
adequately powered study with minimal attrition will make a significant contribution to the evidence
base on this important clinical question. This will further delineate the role of the optometrist in
improving the academic outcome for children who are in their prime years of education.
Contrast Sensitivity - Obscure Lab-style Measurement or a Useful Tool in Modern Practice

John Nolan, Macular Pigment Research Group at Waterford IT, Ireland & Martin O’Brien, Chair of
Education & CPD at Optometry Ireland, Optometrist.
Abstract: In both the eye examination and dispensing of corrective appliances the main goal is to
improve vision. What is vision and how do we measure it? The Snellen Chart has been the mainstay
of measuring visual acuity for generations of eyecare practitioners. However, the limitations of the
Snellen chart are well recognised. But vision is far more than reading letters on a chart, the world is
far more than black targets on a white background. Do we as eyecare practitioners have to do more
to assess the quality of how our patients see.
Contrast sensitivity is another tool to assess quality of vision, but what is this and why is this tool not
more widely utilised. Professor John Nolan and Martin O'Brien will debate the topic and invite
feedback from the floor. One of the keystones of reflective practice in terms of CPD, is to see
whether their is an impact on your practice. Will you change how you approach assessment of your
patients vision as a result of this session (or on reflection, decide that no change is necessary)?
Ellen Svarverud is Assistant Professor at the National Centre for Optics, Vision and Eye Care at
University College of Southeast Norway, where she is doing research as well as teaching and
supervising optometry students. Her broad optometric background includes clinical practice,
education, research and development of the optometric profession. She and has been a Fellow of
the EAOO since 2015.
XR (eXtended Reality) technologies such as VR (Virtual Reality) and AR (Augmented Reality) have
become increasingly commonplace. This is exciting from a visual function perspective because
people have to rely on their vision when using 3D XR technologies. We know that having two good
and cooperating eyes is necessary to take full advantage of using these technologies, which means
that it is imperative to have fully functional stereo vision, good oculomotor control and corrected
refractive errors. Further, in 3D displays, the visual system has to work differently from in the
physical world, because the neurological link between vergence and accommodation is broken
(vergence-accommodation conflict). Many studies have shown how visual cues can be used and
manipulated in all types of visual displays, demonstrating how important it is to understand vision
for optimal utilization of XR technologies. Nevertheless, not many papers on utilization and usage of
XR technologies have acknowledged that the person’s vision and potential vision problems affect
comfort, performance and the ability to work over longer time periods. As these technologies
continue to be more widespread, it is important for optometrists and vision scientists to understand
what challenges and benefits XR displays pose for the visual system.
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Poster Abstracts
Title: Tear osmolarity, its measurement and correlation with other tests for dry eye examination
Presenter
Petr Veselý, Masaryk University, Medical Faculty, Kamenice 5, 625 00, Brno, Czech Republic
Purpose:
To determine the values of osmolarity of tears of the right and left eye in individual probands.
Setting/Venue:
In our study, we had data from 20 probands, whose average age was 23.5 years.
Methods:
We presented the DEQ-5 questionnaire to the probands. Each proband underwent tear osmolarity
using a TearLab instrument.
Results:
The average value of tear osmolarity in the right and left eye of all probands was 300.35 and 293.70
mOsmol/l.
Conclusions:
The results of our study show that there is no correlation between non-invasive break time test
(nBUT) and tear osmolarity (difTL8, R = 0.23 at p = 0.32).
Title
Low Vision Therapy in the Czech Republic
Presenter
Pavel Beneš, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
Purpose:
The aim of this poster is to inform about Low Vision therapy in the Czech Republic.
Setting/Venue:
As in other countries, also our low vision therapist are focused on many types of visual exercises,
methods and support of rehabilitation and compensatory aids to improve clients´ visual
impairments.
Methods:
The therapy of the visually impaired is long-term process of developing and maintaining the visual
potential for obtain new information from the client environment.
Results:
During the training, we use a lot of special methods and tests.
Conclusions:
Low vision therapy is very important in cooperation in all helping professions.
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Title
Validation of the Cobra HD Meibographer
Authors
R. Ifrah, L. Quevedo, L. Gantz
Presenter
Reut Ifrah, Hadassah academic college, Jerusalem, Israel
Purpose
Non-contact infrared meibography is a diagnostic technique that allows in vivo evaluation of the
meibomian glands (MGs). MG loss is quantified in percentages, that are graded on a scale
representing the severity of the loss progressing in steps of a minimum of 10%. This study examined
the within-subject (intra-test), inter- examiner, and inter-session repeatability of the Cobra HD
meibographer (bon Optic VerttiebsgmbH, Italy).
Setting/Venue
Hadassah Academic College Optometry Clinics, using the Cobra HD meibographer.
Methods
61 participants (mean age: 23.1 ±4.6 years, range: 19-43, 48 female) and 42 participants (mean age:
23.0 ±3.4 years, range: 19-37, 30 female) were recruited for the inter-session and inter-examiner
experiments, respectively. Their upper and lower right eyelids were imaged with the Cobra
meibographer three consecutive times, by two different examiners to calculate the percentage of
the MG loss. Intra-test repeatability was assessed using standard deviations and the within subject
standard deviation (Sw). Inter-examiner and inter-session repeatability was assessed using
correlation and Bland and Altman (mean difference, and 95% confidence intervals- CI) analyses.
Results
Mean upper and lower eyelid MG loss and Sw was 12.5 ± 8.5%, 6.4 ± 4.9%, 9.5% and 12.0± 7.4%,
8.1± 6.4%, 7.6% for the two examiners, respectively. Inter-session measurements were significantly
correlated (both R: 0.9) and not significantly different (P=0.8, P=0.5). The inter-session Sw and mean
difference was 8.5%, 0.09±3.2% (95%CI: -6.0-6.2) and 4.9%, -0.03±2.1% (95%CI: -4.1-4.0), in the
upper and lower eyelids, respectively. Inter-examiner measurements were significantly correlated
(upper R:0.9; lower R:0.7) and not significantly different (P=0.2), with Sw and mean difference of
3.9% -0.76±4.2% (95%CI: -8.9- 7.4), and 4.3% and -0.66±4.2% (95%CI: -8.9-7.6), respectively.
Conclusions
The differences in consecutive measurements of the same patient, the differences in measurements
between the examiners and between two different sessions were all lower than 10%. Therefore, the
Cobra HD meibographer demonstrates good repeatability and reproducibility.
19
Title
Ocular aberration detection by a photopolymer-based analog holographic wavefront sensor
Authors
E. Branigan, S. Martin, M. Sheehan, K. Murphy
Presenter
Emma Branigan, Centre for Industrial and Engineering Optics, School of Physics & Clinical &
Optometric Sciences, TU Dublin, Ireland
Purpose
Aberrations or optical anomalies of a wavefront cause deviations from the ideal. The result of these
wavefront anomalies is usually a degradation in the quality of the in-focus retinal image. The role of
the wavefront sensor (WFS) is to detect the magnitude and type of the aberrations present in an
incident wavefront and, for many years, has been used as an assistive technology for procedures
such as laser refractive surgery. The construction and experimental testing of a rapid and efficient
holographic WFS for the detection of these optical aberrations is presented here. The targeted
aberrations were defocus and spherical aberration.
Setting/Venue
The Shack-Hartmann WFS (SHWFS) is widely used in routine human eye measurements for detecting
ocular aberrations. However, the size, computational overhead necessary for wavefront fitting, and
cost of these instruments often restrict their use to specialist clinics. Therefore, it is advantageous to
construct an efficient, inexpensive solution for wavefront sensing.
Methods
The analog holographic wavefront sensor (AHWFS) is a highly-efficient and cost-effective alternative
to the SHWFS. Optical aberrations, described by a set of modes, were recorded as holograms in a
photosensitive medium. A minimum and maximum phase delay associated with each mode was
recorded as a pair of multiplexed holograms. When a wavefront containing arbitrary aberration
modes was incident on the sensor, they were optically decomposed into a set of paired diffracted
beams for each mode. A normalised ratio of intensities at an array of photodetectors determined
the magnitude of the aberration, while the angular position determined the aberration type.
Results
A biconvex-refractive lens was recorded holographically in an acrylamide-based photopolymer. The
holographic optical element (HOE) was multiplexed with a maximum and minimum amount of the
defocus mode, over a wide detectable range of ±15.0D. The result was the separate recording of a
holographic converging lens and a holographic diverging lens (i.e. able to detect both myopia and
hyperopia). Four amounts of defocus: +9.0D, +7.1D, +4.9D, and 0D were introduced to verify the
detection accuracy of the sensor. All were successfully classified, within a percentage error of ~5%,
by measuring the normalised intensity ratio (NIR) produced when incident on the HOE.
Conclusions
An AHWFS was fabricated in an acrylamide-based photopolymer for the first time using only
refractive elements in the recording process. This was achieved for a defocus aberration by
multiplexing a maximum and minimum phase delay of a lens at two different carrier spatial
frequencies. The measurement and classification of a test beam with defocus (i.e.
myopia/hyperopia), within an error of ~5%, is encouraging for the future success of the AHWFS as a
cost-effective solution to wavefront sensing for ophthalmic practice. Current work on the sensor will
20
allow for the detection of spherical aberration, while future work will incorporate astigmatism
sensing.
Title
Influence of sleep habits in the development of myopia in Spanish children
Authors
C. Martínez Pérez, M.Á. Sánchez-Tena, C. Villa-Collar, M. González-Pérez, A. González-Abad, C.
Alvarez-Peregrina
Presenter
Clara Martínez Pérez, Institute of Education and Sciences, Portugal
Purpose
Sleep habits and the circadian rhythm may have a role in the development of myopia, especially
during childhood. This study aims to analyze and compare the quality of sleep between myopic and
non-myopic Spanish children.
Setting/Venue
Data collection has been carried out in 107 optical centers belonging to the Alain Afflelou
Foundation in all the autonomous communities of Spain.
Methods
Multicenter pilot study, carried out in September 2021. The study population were children aged
between 5 and 7 years, who underwent an optometric examination consisting of uncorrected
distance visual acuity (AV), objective and subjective refraction, cover test, Worth test,
accommodative delay, ocular motility and near point of convergence. In addition, the “Children’s
Sleep Habits questionnaire” was conducted. For the quantitative definition of myopia, the value of
the spherical equivalent (SE) was used. So, children were classified as myopic if SE≤-0.50. Statistical
analysis was performed using the SPSS 27.0 software (SPSS Inc., Chicago, Illinois).
Results
A total of 1027 children were examined, of which 35 were excluded as they did not meet the
inclusion criteria (children between 5 and 7 years old) or the histories were incomplete. Non-myopic
children rarely (0-1 times/week) wake up in a negative mood (p=0.042) and usually (5-7 times/week)
fall asleep in their bed (p=0.029) compared to myopic children. However, non-myopic children
usually have more problems sleeping away (p=0.007).
The spherical equivalent becomes more negative in children who usually have hard time getting out
of bed (p=0.006) and who sometimes (2-4 times/week) sleep in their brother's bed (p=0.029).
Conclusions
Myopic children have a more variable sleep than non-myopic children. The spherical equivalent
becomes more negative with poor sleep. A multivariate study with a longer follow-up is necessary to
assess whether there is a relationship with lifestyles.
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Title
Characterization of the corneal profile in keratoconic eyes by means of Scheimpflug images and
elevation data. Comparative analysis.
Authors
M. Larrosa, J. Gispets, N. Lupón
Presenter
Manel Larrosa, Universitat Politècnica de Catalunya, Violinista Vellsolà 37, 08222, Terrassa, Spain
Purpose
To describe and compare corneal sagittal heights obtained from both Scheimpflug images and
elevation maps provided by Oculus Pentacam. To gain a better understanding of the topography of
the cornea in keratoconus, including the periphery, and assist practitioners in the selection and
fitting of large diameter contact lenses.
Setting/Venue
We used images and data obtained wiht the Pentacam HR instrument iin the Optics and Optometry
School of Terrassa (UPC, Spain).
Methods
Twenty eyes with keratoconus at different stages according to the Amsler-Krumeich classification
were included in the study. The sagittal heights were manually measured on the Scheimpflug images
at six different points located on three different meridians, and they were also determined from the
data of elevation maps. In addition, the slopes and the angles in the peripheral zone were calculated
from the two sets of data. The comparison was performed using a Bland-Altman diagram.
Results
The sagittal heights, the peripheral slopes and the angles obtained from direct measures on
Scheimpflug images were, in general, slightly higher than the ones obtained from the elevation
maps. The values of the difference ranged from -1.6 to 108 microns (mean 53.5±28 microns), for the
sagittal height, from -0.005 to +0.06 (mean 0.03±0.017), for the peripheral slope, and from -0.1 to
2.8 degrees (mean 1.3±0.7 degree) for the peripheral angles. In all three comparisons the differences
were clinically unsignificant, in terms of CL parameter calculation for eyes affected of keratoconus.
Conclusions
Clinically insignificant differences were found in the two sets of measurements, supporting the idea
that both measuring approaches may be used for parameter calculation of a novel CL design for
keratoconus.
Title
The Impact of Type 1 Diabetes Mellitus on Ocular Lens Density
Presenter
Klaudia Kalinayová, Masaryk university Faculty of Medicine, , Kamenice 5, 62500, Brno, Czech
Republic
Purpose
The main objectives of the research are as follows: (1) to elucidate the impact of type I diabetes on
the ocular lens density of patients participating in the study, (2) to determine the lens density values
in the right and left eye of patients with type I diabetes and non-diabetic patients, by using the
22
Pentacam HR device, (3) to compare the values of lens densitometry measurements in both
examined groups and find out whether the values differ.
Setting/Venue
The thesis deals with problems of type I diabetes and its impact on the ocular lens density.
Methods
The research part of the thesis is devoted to the measurement of ocular lens density by using the
Pentacam HR in samples from the experimental and control group of patients. The age, duration of
type I diabetes mellitus and the glycosylated hemoglobin levels were recorded. The research has
established three main hypotheses.
Results
The patients with type I diabetes had statistically higher lens density values than subjects in control
group. The value of lens densitometry measurements in right and left eye differ with every patient.
Conclusions
The patients with type I diabetes mellitus have higher lens density values than patients without
diabetes. It is reasonable to think that these differences in the lens density values between
experimental and control group are caused by type I diabetes mellitus.
Title
Anisoaccommodation in patients using spectacle correction
Authors
A. Gregarová, P. Beneš
Presenter
Anna Gregarová, Masaryk University, Komenského nám. 220/2, 662 43, Brno, Czech Republic
Purpose
The aim of this paper is to compare amplitudes of accommodation of the right and left eye without
correction and amplitudes of accommodation of the right and left eye with habitual correction and
to find out the occurrence of anisoaccommodation (hypothesis 1). The second hypothesis aims to
determine whether the size of habitual correction-corrected anisometropia influences the size of
anisoaccommodation. The objective of the third hypothesis is to verify the difference between the
amplitudes of accommodation of the right and left eye when using the best tolerated correction
performed with binocular accommodative balance test.
Setting/Venue
Data are measured in 21 probands, the mean age is 20.8 ± 0.6 years. Nine probands are myopes, one
hypermetrope and eleven have astigmatism. The small number of hypermetropes is due to the age
of group of probands, in the third decade there is usually no manifestation of hypermetropia yet.
Methods
The anamnestic questionnaire focuses mainly on subjective asthenopia. Digital focimeter is used to
determine the optical power of spectacle lenses of habitual correction of probands. The best
possible tolerated correction with binocular accommodation balance is performed. The refraction is
performed using standard test frame and set of test lenses. The amplitudes of accommodation are
measured separately in the right and left eye, first with habitual correction, then with natural vision
23
and lastly with the best possible correction using accommodative ruler of the RAF type and the
method of choice is the push-up and pull-away method.
Results
The first hypothesis – spectacle correction reduces anisoaccommodation, was confirmed. With
habitual correction anisoaccommodation decreased in 14 probands out of 21, ie in 66.7% of cases.
The second hypothesis – differences between the amplitudes of accommodation of the right and left
eye with habitual correction will be more significant with increasing anisometropia, was also
confirmed. The correlation coefficient R is 0.77, which indicates a high degree of linear dependence
of these quantities. The third hypothesis – after performing binocular balancing, there will be a
reduction in anisoaccommodation, was also confirmed. The reduction of anisoaccommodation
occured in 62% of cases.
Conclusions
The aim of the research was to determine effect of current spectacle correction on
anisoaccommodation. The issue of anisoaccommodation should not be neglected in optometry
practice, particularly in anisometropic patients it can be a source of asthenopia. Furthermore,
finding of unequal accommodation may be crucial in determining correct addition of presbyopic
correction. A suitable solution for unequal accommodation is, above all, the prescription of the best
tolerated correction with the implementation of binocular balancing. As proved in the first and third
hypotheses, the prescription of such correction of refractive error reduces anisoaccommodation.
Another option for therapy of anisoaccommodation is visual training.
Title
Objective and Subjective Evaluation of Novel Soft MiniScleral Contact Lenses for Keratoconus
Authors
L. Gantz, E. Gal, J. Gispets, M. Zyroff, E. Netanya
Presenter
Eyal Gal, Hadassah Academic College, 37 Haneviim St., 91010001, Jerusalem, Israel
Purpose
This prospective case series examined the objective and subjective visual quality of a new soft mini
scleral contact lenses for keratoconus (miniScK, Cooper Vision, Israel).
Setting/Venue
Patients were fit with contact lenses in the clinics at Hadassah Academic College, and wore their
lenses for two weeks. They were re-examined in the clinics after two weeks of wear.
Methods
Twenty one eyes of 11 keratoconic patients (8 females), with a mean age 38 ± 13 (range: 18-65)
were fit with a miniScK. Physiological fit was assessed with a slit lamp and Efron grading scale. Low
and high contrast distance and near Snellen visual acuity (VA), higher order aberrations (HOA),
tomography (vx130 Wavefront aberrometer, Visionix Luneau, France), and Pelli-Robson contrast
sensitivity (CS)were measured with the habitual and the miniScK. Participants reported daily hours
of wear and graded visual quality and visual comfort on a scale 1 to 5. Results were compared using
Mann-Whitney U tests.
24
Results
Participants reported a mean daily wear time of 6.44±3.24 hours. Visual quality and comfort scored
a mean of 3.9±0.9 and 2.9±0.9, respectively. Itchy, dry eyes and secretions were reported. All Efron
grading scale scores were lower than 1.2. Compared to the habitual correction, the lenses did not
significantly improve the low contrast VA, but did significantly improve the high contrast VA (low:
0.37 to 0.39, p=0.35, high: 0.55 to 0.83 Snellen decimal, p<0.0001). The mini ScK lenses significantly
improved the total RMS (4.7±1.6 to 2.0±0.7, p<0.001) but not total HOA (1.3±0.6 to 0.8±0.5, p=0.08)
or CS (1.2±0.5 to 1.5±0.2, p=0.23).
Conclusions
The lenses provided acceptable visual acuity with a mean wear duration of six hours and good
subjective visual quality. However, lens comfort should be improved, with the majority experiencing
itchy eyes and an overall score 2.9/5.
Title
Correlation between refractive errors and migraine
Presenter
Veronika Koňaříková, Masaryk University Faculty of Medicine, Brno, Czech Republic
Purpose
The main aims of the study are: (1) Patients with headaches and migraines have higher levels of
astigmatism compared to control subjects. (2) After proper correction is established, the frequency
of migraine disorders is reduced. (3) Anisometropia is found in migraine patients.
Setting/Venue
Refractive errors and headaches are common and well represented in the population. Significant
errors in the correction of refractive errors can cause problems associated with headaches.
Methods
Assessment of the client's subjective problems based on the questionnaire, which may be associated
with refractive error and its correction. Distribution of clients according to age, gender, type of
correction and subjective difficulties. Also according to the type of refractive error - spherical error,
astigmatic error, uncorrected ametropia and anisometropia. Determination of the correct
correction. After a certain period of time, the client is contacted for feedback.
Results
Based on research, I expect to see a reduction in the frequency of headaches and migraines in
patients. Patients with difficulties will have higher degrees of astigmatism than the control group.
Anisometropia is present in patients with frequent headaches.
Conclusions
Ophthalmologists and optometrists often meet clients who suffer from migraines and headaches. A
possible relationship between the presenting headache and migraine and visual anomalies is still
being sought.
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Title
Solving Problems Caused by Aniseikonia
Authors
E. Machynková, P. Veselý
Presenter
Eliška Machynková, Masaryk University, Faculty of Medicine, Department of Optometry and
Orthoptics, Komenského nám. 220/2, 66243, Brno, Czech Republic
Purpose
Research focuses on measuring the degrees of aniseikonia and the subjective difficulties of
anisometropes. I have identified the following as the objectives of the research. Determine the
magnitude of the anisometropia. Then using the questionnaire to determine whether the patient is
experiencing some of the subjective problems related to the anisometropia. Further to monitor
whether using size-lens reduces aniseikonia and eliminates subjective problems. I have established
three hypotheses. Hypothesis 1: Subjective problems in anisometropia increase with the size of the
aniseikonia. Hypothesis 2: Using size-lens will result in a reduction in aniseikonia. Hypothesis 3: Using
size-lens will reduce subjective problems.
Setting/Venue
A total of 35 probands took part in the measurement. Based on gender, the examined group is
divided into 27 women and 8 men with an average age of 26 years. The criterion for inclusion in the
research is anisometropia >0.75 D.
Methods
Based on the questionnaire, the occurrence of subjective problems associated with aniseikonia of
the probands is evaluated first. The magnitude of anisometropia is determined using objective and
subjective refraction. The degree of aniseikonia with a habitual distance correction is measured
using the Aniseikonia Inspector computer software. The suppression of the aniseikonia in patients
experiencing various degrees of aniseikonia was achieved by using size-lenses. This was followed by
verification of the remission of subjective difficulties using a questionnaire. All measured data are
mathematically processed in Microsoft Excel and compared with research on the same thopic.
Results
The first hypothesis was evaluated using a score of 1 point for each present symptom. This score was
then plotted depending on the size of the anisometropia and backed up by the correlation
coefficient R = 0.77. Consequently, first hypothesis was confirmed. The second hypothesis – using
size-lens will result in a reduction in aniseikonia, was also confirmed. Overall, a reduction in
aniseikonia was achieved in 84 % of those tested using size-lenses. Third hypothesis was also
confirmed – using size-lens reduced subjective problems. The average score of symptoms with
habitual correction was 4.66, after size-lens use it was 1,66.
Conclusions
The purpose was to demonstrate the relation of size of aniseikonia on the size of present subjective
symptoms of anisometropes, than to verify the effect of size-lenses on decreasing the size of
aniseikonia and reducing these subjective problems. Based on the measurements, it was found out
that the number of present symptoms increases with increasing anisometropia. Size of aniseikonia
was suppressed in most of those tested using size-lenses. The use of size-lens also reduces the
subjective problems related to aniseikonia by more than half.
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Title
The impact of the COVID-19 pandemic optometric and contact lens practice in Poland
Authors
A. Sawczuk, S. Kropacz-Sobkowiak, A. Przekoracka- Krawczyk
Presenter
Aleksandra Sawczuk, Adam Mickiewicz University, , Uniwersytetu Poanańskiego 2, 61-614, Poznań,
Poland
Purpose
The study aimed to assess the impact of the COVID-19 pandemic on everyday optometric and
contact lens practice in Poland. The impact of the COVID-19 pandemic on the scope of procedures
performed during and after different lockdown periods and pandemic waves, compared to the scope
of practice before the pandemic. Another objective was to examine the sense of safety in the
workplace and willingness to receive the COVID-19 vaccination by optometrists in Poland.
Setting/Venue
The study was conducted from March till May 2021. The survey was created and conducted online
using a Google Forms.
Methods
The internet survey among 103 optometrists consisted of 15 questions. Optometrists were asked
about practice procedures before the pandemic and during the pandemic. The study distinguished
four different periods with different restrictions and government recommendations. Additionally,
respondents were asked about the frequency of personal protective equipment use, disinfection,
and willingness to receive the COVID-19 vaccine. They were also asked about safety in the workplace
and the possible positive effects of the pandemic on optometrists' profession in the future.
Respondents were also asked about their level of education and number of years of experience as an
optometrist.
Results
The analysis showed that the highest percentage of the respondents were optometrists with 1-3
years of experience. Optometrists with extensive experience practically did not cease their services
during pandemic. 35% of optometrists limited their work with the elderly, children, people with
disabilities and vision therapy. The highest decrease due to the pandemic was noted in the
percentage of practitioners who performed contact lens fitting (from 86% to 20%). Over 85 % of
respondents used a face mask in the office most of the time. 78% of respondents were already
vaccinated or answered that they plan to be vaccinated soon.
Conclusions
Despite the lack of clear guidelines on the use of procedures during an optometric examination in
Poland, most respondents have made significant modifications to their practice. Many practitioners
have reduced the scope of services, particularly for procedures requiring longer chair time.
27
Title
Beyond COVID-19: The Future of Humanitarian Eye Care
Presenter
Jeffrey L. Weaver, VOSH/International, USA
Purpose
One of the overlooked consequences of the COVID-19 pandemic is its impact on humanitarian
missions. Organizations such as Volunteer Optometric Services to Humanity International
(VOSH/International) saw their operations completely curtailed. Globally, in eye and vision care
alone, millions of individuals in underserved populations did not receive needed care. It is hoped
that humanitarian teams can soon resume normal operations.
This study reviews the effect of the COVID-19 pandemic on five optometry groups involved in
humanitarian activity. As the world emerges from this crisis, each of the groups projects their vision
of the future of humanitarian aid in the post-pandemic era.
Setting/Venue
Interview of leaders of optometric organizations.
Methods
The authors reached out to leaders across and beyond the eye and vision aid sector to understand
the full impact of the pandemic on operations and the populations served. Further, the leaders were
asked to describe their visions for the future of humanitarian missions in eye care.
Results
As expected, there was a paucity of activity among the eye care groups during the COVID-19
pandemic. Only those who had transitioned from episodic to some level of sustained care in their
humanitarian service had maintained some level of activity. Each of the groups has hope that
normalcy will return during 2022. Most are looking at the benefit of sustained operations for
improved long term care of chronic conditions.
Conclusions
The COVID-19 pandemic had a huge impact on humanitarian care, including those providing
optometric services. Despite the curtailment of operations for two years, organizations are resuming
operations with a new passion toward sustained care as an approach to chronic conditions and to
combat the vision pandemic of myopia.
Title
Normative Reference Ranges for the Macula and Retinal Layer Thickness in Spanish Healthy Children
Authors
S. Font Armadans, A. Díaz Cortés, J.C. Ondategui-Parra
Presenter
Sara Font Armadans, Spain
Purpose
Create a normalized database reference ranges for macula and retinal layer thickness in Spanish
healthy children using Optical Coherence Tomography (OCT). In order to avoid misinterpretations, it
is necessary to define a normalized database that provides a reliable analysis, taking into account
28
variables such as age, spherical equivalent and axial length of the patient, where it has been
observed that they may have a direct relationship with the obtained results.
Setting/Venue
Children were enrolled during a routine ophthalmological examination through primary health care
centers: Hospital Sant Joan de Déu Barcelona and ALTHAIA, Xarxa assistencial universitària de
Manresa (Barcelona, Spain). All subjects underwent a comprehensive ocular examination, that
concluded that they are healthy eyes.
Methods
Prospective cross-sectional and descriptive study of non-consecutive cases. A total of 92 children (55
girls and 37 boys) aged 3-17 years were included in this study. Participants underwent a
comprehensive ocular examination that included measurement of the best-corrected visual acuity
(BCVA) of at least 0.2 log MAR, assessment of ocular motility and alignment. Following, macular
scanning was performed using a DRI OCT Triton (Swept Source OCT, Topcon, Oakland, NJ) and Axial
Length (AL) measurement using optical biometer AL-scan (NIDEK). Central and average macular
thickness were recorded and related with age, spherical equivalent (SE) and axial length.
Results
The global mean age of the subjects was 9.33±3.24 years with a global mean of SE -0.10±1.74D, and
a global mean of AL 23.00±1.06mm. Significant correlation was found between age of participants
and axial length (r=0.449, p<0.001), and normalized database reference for axial length was defined
by age and SE. An accurate relation was observed between SE and average thickness with a trend of
increasing thickness on retina, ganglion cell layer +, ganglion cell layer + and choroid with the chance
to conclude that a minimum value should be registered on different SE group, defined as
pathological biomarker.
Conclusions
To conclude, the present study defines the normative healthy biomarkers in Spanish children using
SS DRI-OCT Triton plus, that can be useful for early detection of retinal abnormalities on that range
population. Contrary to expectations, a strength association was observed between average macular
thickness with SE and AL, and less relevant association with age. The obtained information can
provide the relevance of AL and ocular magnification on the analysis, and evidence that the issue has
not yet been resolved by OCT manufacturers, so we must continue investigating to obtain a reliable
database considering the patient’s variables.
Title
Modern Spectacle Lenses to Myopia Control: Acceptance, Efficacy and Visual Performance
Authors
S. Escandón García, D. Lopes - Ferreira
Presenter
Santiago Escandón García, GrandVision Spain, Carrer Numancia 46, 5ª Planta, 08029, Barcelona,
Spain
Purpose
Recently arrived to market new spectacle lenses designed to prevent myopia progression. The aim of
this work was to provide a compilation of most recent clinical trials evaluating different spectacle
29
lenses at level of myopia retention efficacy and also visual performance, accommodation facility and
binocular function in children.
Methods
A search was performed using PubmedCentral and including all randomized clinical trials (RCT) that
were found in search by “spectacle lenses to myopia control”. Results were filtered and only the
results from the last 10 years were included. Results including bifocals, orthokeratology, atropine or
progressive addition lenses (PALS) reports were excluded.
Results
Total of 9 articles and 3 types of lenses designed to prevent myopia progression were identified:
Peripheral Defocus Management(PDM) commercialized by CarlZeiss as MyoVision, Defocus
Incorporated Multiple Segments (DIMS) commercialized by Hoya as MiYOSMART and Highly
Aspheric Lenslets (HAL) commercialized by ESSILOR® as Stellest. At this time, duration of studies
varies between 1 (HAL) and 3 years (DIMS). The efficacy in myopia retention determined by
refractive error was 15%, 52% and 63% respectively using PMD, DIMS and HAL. Not verified
significant differences in distance and near VA high and low contrast, binocular function and
accommodation between DIMS, HAL and SV.
Conclusions
DIMS and HAL are the most recent and efficient spectacle lenses designed to avoid myopia
progression. Despite positive tolerance and acceptance by children with DIMS, HAL demonstrated
lower impact on both Visual Acuity and Contrast Sensitivity.
Title
Using Humanitarian Missions to Improve Cultural Competency
Authors
T. Wingert, W. Miller
Presenter
Timothy Wingert, Rosenberg School of Optometry, 9725 Datapoint Dr, 78229-2384, San Antonio,
USA
Purpose
The recent Summit on Optometric Education showed a concern from all countries for improving the
cultural competency of optometrists. The literature contains numerous articles on the benefits of
humanitarian missions as a vehicle for Interprofessional Education and Collaborative Practice.
However, these trips also enhance the student’s cultural competency by being exposed to patients
from many diverse backgrounds. The University of the Incarnate Word Rosenberg School of
Optometry has faculty and students participate in multidisciplinary mission trips to numerous
underserved areas. These trips are part of a larger effort to demonstrate cultural respect and
establish good rapport with patients.
Setting/Venue
The Rosenberg School of Optometry is in San Antonio, Texas. Students participate in humanitarian
missions within the city and state as well as in numerous other countries. Partnerships with other
programs have students working alongside those with different worldviews.
30
Methods
After each trip, students are requested to write a reflection piece on their experience. This is
designed to have the student look back on the experience and contemplate how it fits into their
other educational experiences. In particular, they are asked to consider the cultural aspects of the
trip, the care they provided and its impact, and the interprofessional experience they had during the
trip. They are also asked to discuss what they learned apart from health care. Conversations with
students from other programs exposes them to a different expectation and approach to patient
care.
Results
In addition to the enriching experience of seeing a different set of clinical conditions, students also
learned by interacting with patients and providers from other cultures. Their understanding of
different expectations in the interaction expanded their perspective. They also reported favorably on
what they were able to assimilate by interacting with health care students from other programs
while providing patient care. They reported a greater understanding of how these different
approaches could benefit patients they see in their normal clinical environment and an appreciation
of the people they treated.
Conclusions
These experiences have shown that moving the care to an environment in which the clinicians have
no familiarity reduces the desire to conduct their practice as usual and opens their professional
minds to finding ways to cooperate and interact with others. Students and faculty return more open
to approaching patients in a fresh manner and considering the care they provide in a more holistic
way. Professional interactions with those trained in another school allow them to realize that
alternatives to their worldview do exist and may prove to be beneficial.
Title
Academic Readiness Program: Aligning the Future for Underrepresented Minorities.
Authors
W. Miller, T. Wingert
Presenter
William Miller, Rosenberg School of Optometry, 9725 Datapoint Dr, 78229-2384, San Antonio, USA
Purpose
The Academic Readiness Program (ARP) is intended to be a pre-matriculation "boot-camp" for
academically ‘at risk’ Latino and non-Latino students to prepare for the rigors of a challenging health
professions program. Many of our Latino students are the first to go to college (First Generation) and
thus the first to attend a health professions program. As such, the first semester tends to be
challenging for these students and many have academic difficulties especially at the beginning of the
semester.
Setting/Venue
The ARP experience was conducted at the University of the Incarnate Word, Rosenberg School of
Optometry from 2017 to the present. University of the Incarnate Word is an Hispanic Serving
Institution and is defined under United States federal law as having an Hispanic student enrollment
of at least 25 percent.
31
Methods
The goal of ARP is to provide a 4-week intense program before the start of a matriculating student’s
first academic year to give them exposure to the rigor of their first semester. This was supplemented
with faculty mentorship as well as non-formal events such as "Pastries with the Profs" and "Donuts
with the Deans". The program ends with a capstone exam, encompassing material from each
discipline taught during ARP. Sixty percent of faculty members teaching in the ARP were Latino, who
provided mentorship and coaching. ARP was intended to increase success during the most
challenging semester for an entering student.
Results
Four courses (Basic Optometry, Optics, Anatomy & Physiology and Clinical Physiology) are taken
during ARP representing the most difficult of the first semester. These courses typically present a
challenge to academically ‘at risk’ students. Data indicates that ARP students perform at or above
non-ARP students in all Academic Readiness courses. Final course grades for ARP students were
within 2 percentage points of non-ARP students. They tended to perform higher on the first few
exams with the effect decreasing by final examination. A student survey post-ARP demonstrated an
overall positive response in preparing them for their first semester of optometry school.
Conclusions
What is generally shown is that those taking ARP, both Latino and non-Latino, are helped in the first
few exams of the fall semester by the Academic Readiness Program. This effect tends to decrease as
you reach the final exam and thus the final course grade. However, the increased general
performance during the first two exams provides confidence and an academic buffer before the final
exam for those students not accustomed to a rigorous academic program. ARP represents a
preparatory step in transitioning students from undergraduate to an unfolding future in a rigorous
optometry program.
Title
Online e-learning during the COVID-19 Lockdown in Trinidad and Tobago: Prevalence and Associated
Factors with Ocular complaints among schoolchildren aged 11-19 years.
Authors
K. Ekemiri, N. Ezinne, K. Kamalodeen, K. Pierre, B. Lalla, U. Osuagwu
Presenter
Kingsley Ekemiri, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
Purpose
Before the COVID-19 lockdown, schoolchildren in Trinidad and Tobago (T&T) learnt in a typical
classroom setting where students engaged in in-person, face-to-face activities, with minimal class
time spent on digital devices (DD) during the school day. The increase in online learning during the
pandemic has been linked to various ocular complaints, however, no data exist on the impact of
internet use for online learning on the visual system of schoolchildren in the Caribbean and T&T in
particular. This study determined the prevalence and factors associated with ocular complaints
among schoolchildren aged 11-19 years during the COVID-19 lockdown in T&T.
Setting/Venue
There are 134 government-owned secondary schools in T&T, 124 (92.5%) of which are in Trinidad
and are spread across the seven districts (Lochan & Barrow, 2008). The study population were
32
selected through a two-stage cluster sampling. A simple random sampling was used to select seven
schools from Trinidad's seven districts.
Methods
A cross-sectional study was conducted between January and May 2021, during the COVID-19
lockdown in T&T among secondary school students studying remotely. A two-stage cluster sampling
method was employed. A modified web-based Computer Vision Syndrome questionnaire was
securely administered to students and their parents (students below 18 years). Data on
demography, duration of digital device use, and ocular complaints were collected, and multilevel
logistic regression was used to determine factors associated with ocular complaints among school-
aged 11-19 years in T&T.
Results
The prevalence of headache, blurred vision, dry eyes, itchy eyes, and double vision were 75.0%,
65.1%; 56.8%; 46.4%; and 33.5%, respectively. Schoolchildren aged 11-18 years, those that used
spectacles as treatment and spent more than 6 hours on average on DD, reported a high prevalence
of any ocular complaints. The analysis also revealed that age (14 years) was associated with dry eyes,
blurred vision, and headaches, while gender (girl) was related to blurred vision and headaches.
Those who recently had an eye checkup and took action to resolve ocular issues were more likely to
report almost all ocular complaints.
Conclusions
During the COVID-19 lockdown, over three in four students in T&T reported ocular complaints from
digital devices for online learning. Tailored interventional messages to reduce all forms of ocular
complaints should target older students, particularly girls who regularly examine their eyes. The
appropriate sitting positions should be encouraged among schoolchildren working online while
ensuring proper ergonomic practice with the devices. Since the post-pandemic era will likely see
many schools continue to provide remote learning or adopt a hybrid pattern, this can increase the
prevalence of these visual problems further and lead to more severe convergence issues among
schoolchildren.
Title
Eye care services utilization in an underserved community in the South-East, Nigeria
Authors
N.E. Ezinne, K. Ekemiri, S.C. Ojukwu, I. Chukwuma
Presenter
Ngozika E Ezinne, Optometry Unit, Department of Clinical Surgical Sciences, University of the West
Indies, St Augustine Campus, Trinidad and Tobago
Purpose
Accessing eye care services has been a major problem in many developing countries including
Nigeria due to many barriers hindering the effective use of eye care services. This study was done to
determine the utilization of eye care services in an underserved community in the South-East Nigeria
Setting/Venue
This descriptive cross-sectional survey was conducted in Ugbawka a rural community in Nkanu East
Local Government Area of Enugu State in the South-East of Nigeria. Ugbawka is a clan with seven
33
rural communities including Isigwe, Ovuorie, Amuzam, Amafor, Imeama, Akpaa and Umuisu. The
Igbos are the major ethnic group, and the predominant religion is Christianity (90%), but there are a
sizable number of traditionalists as well as Muslims, making up about 5% each of the population. The
communities have an agriculture-based economy with farming, fishing and wine tapping as their
main occupation and there is only one health care facility.
Methods
A community-based cross-sectional study was done among adults ≥18 years in Ugbawka community
in Enugu State. Multistage sampling technique was used to select 700 participants. A structured
questionnaire was used to collect the data and utilization of eye care service was considered within
the last two years. The collected data was analysed with Statistical Package for Social Science (SPSS)
version 24. Pearson chi-squared test was used to assess variables correlations with eye care service
utilization and P-value < 0.05 were considered statistically significant.
Results
A total of 500 adults with a mean age of 48±10 years and a response rate of 71.4% (500/700)
participated in the study. Out of the 500, 328 (65.6%) were females and a good proportion (n= 149,
29.8%) were between 18 to 30 years of age. Eye care service utilization rate within the last two years
was 18%. Females (68.5%) utilized eye care services more than males though not statistically
significant (P>0.05). Utilization of eye care service was found to be associated with age, religion,
occupation, marital status, monthly income, family history of ocular disease and history of ocular
disease
Conclusions
Utilization of eye care service in this study is low when compared with other studies. Financial
constraint is a big barrier to utilization of eye care services in this community; there is a need to
make eye care services affordable and accessible to reduce socio-economic cost of blindness.
Title
Awareness, Knowledge and Attitude of Trinidad and Tobago Optometrists towards prescribing Blue-
Light Blocking Lenses.
Authors
N.E. Ezinne, A. Rampersad, L. Joseph, K. Ekemiri
Presenter
Ngozika E Ezinne, University of the West Indies, St Augustine Campus, Trinidad and Tobago
Purpose
Blue light-blocking lenses are used to reduce the amount of blue-light reaching the eyes. The recent
increase in the amount of harmful blue light, from the visible spectrum, exposed to the eyes is
believed to lead to sleep deprivation, retinal damage and digital eye strain. The use of these lenses
to prevent dangers caused by the overexposure to blue light, is posed to be a controversial topic
among optometrists due to the lack of high-quality evidence. This study was done to determine
awareness, knowledge and attitude of optometrists in Trinidad and Tobago towards prescribing
blue-light filtering lenses.
Setting/Venue
This study was done among optometrists in Trinidad and Tobago, a twin island n the southernmost
part of the Caribbean. Trinidad is the larger of both islands and contains the majority of optical
offices. There are 114 practicing optometrists in both public and private sectors.
34
Methods
All (114) registered optometrists in Trinidad and Tobago were invited to participate in this study. A
25-item structured online questionnaire was sent to them through their emails. Participants
provided information regarding their demographics, knowledge about effects of blue light, attitudes
towards prescribing blue-light blocking lenses and reasons why they may or may not prescribe them.
Ordinal logistic regression analysis was performed to assess the predictive factors for optometrists
prescribing blue-light blocking lenses.
Results
A total of 40 (35.1%) registered optometrists participated in the study. Twenty seven (67.5%) were
females and most (72.5%) of the participants were between the ages of 21 to 30 years. All (100%)
the participants were aware of the blue light blocking lenses and its uses. A good number (42.5%) of
them believe that blue light blocking lenses are very effective against sleep deprivation (75%), eye
pain (50%) and retinal damage (32.5%). Optometrists were significantly more likely to prescribe
blue-light blocking lenses if they considered blue light to cause sleep deprivation (odd ratio, OR 9.5
(1.12, 80.57) P = 0.04).
Conclusions
Most of the Trinidad and Tobago optometrists are aware and had good knowledge of the effect of
blue light and blue light blocking lenses. Although, the evidence to support the efficacy of blue light-
blocking lenses is still lacking, majority of the optometrists still prescribe the filtered lenses based on
the symptoms a patient portrays.
Title
Early detection of amblyopia at school age by visual screenings
Authors
M. Álvarez, C. Benedí, A. González, P. Concepción, C. Cano, J. García, M. Dosal, E. Chamorro
Presenter
Marta Álvarez, Clinical research department, Indizen Optical Technologies.SL, Madrid, Spain
Purpose
Amblyopia is a disorder of visual development that begins in childhood. Therefore, early detection
and treatment is key to avoiding irreversible vision loss in the future. Previously, vision screening of
preschool children has employed traditional methods based on subjective visual acuity to assess
visual function, but new technologies, such as photorefraction, have promoted the preliminary
detection of refractive defects in a quick and easy way in the early school years. The aim of this
study is to determine the age prevalence of amblyopia and refractive errors using a photorefractor
device.
Setting/Venue
1325 children (4-12 years old) from Madrid (Spain) participated in a transversal study, consisted of
an anamnesis and an autorefraction with PlusOptix A12 (Plusoptix GmbH, Germany).
Methods
Binocular measurements were performed on all children at one meter by a trained optometrist. To
improve the detection of the eye pupils during measurements, mesopic illumination conditions were
maintained. Two consecutive measurements were taken per child to check repeatability; if they
were differed by more than 0.50D, the measurements were taken again. Each measurement took 30
35
seconds and the total exam 5 minutes. Risk factors of the American Association for Pediatric
Ophthalmology and Strabismus (AAOPS) were considered. When refractive errors were not
corrected, they were considered as no detected potential amblyopia.
Results
Potential amblyopia was found around 20% of the population younger than 7 years old, while it was
between 10 and 20% in the elder groups. Between of 90-66% of potential amblyopic participants
younger than 8 years old hadn’t been previously detected but this percentage decreased with age up
to 53%.
Conclusions
The prevalence of uncorrected refractive errors is high among children, which in most cases leads to
the development of amblyopia. These results show that it is necessary to reinforce school health
programs to provide more information and better eye care services to improve this public health
problem.
Title
Accommodative object space and progressive lens design
Authors
Amelia González, Marta Álvarez, Clara Benedí, Pablo Concepción, Paulina Dotor, Jose Miguel Cleva,
Jose Alonso
Presenter
Amelia Gonzalez, Clinical research department, Indizen Optical Technologies.SL, Madrid, Spain
Purpose
The optimization of personalized progressive power lenses (PPLs) involves the consideration of the
prescription, the individual wearer parameters, and the object space. Traditionally, a single object
distance is assumed for each gaze direction. However, for any gaze direction, the individual can
focus a range of object points by using accommodation. The volume of points in the object space
that can be focused by the combined effect of power progression and accommodation is defined as
accommodative space. The goal of this study is to compare lenses optimized considering the whole
accommodative space vs lenses optimized for the traditional, static object space.
Setting/Venue
Evaluation of subjective visual performance was done in Madrid between August 2020 and May
2021 by means of satisfaction questionnaires in the everyday life environment of the users when
using 2 pairs of spectacles: PPL-A (AlphaH45®, DRP®, IOT®) and PPL-B (EndlessSteady®, DRP2®, IOT®).
Methods
42 presbyopic subjects with experience using PPLs participated in this observational, prospective and
double-masked trial. Users compared 2 lenses: personalized PPL optimized considering the most
common personalization parameters and static object space (PPL-A); and a personalized PPL using
the same personalization parameters but optimized in the whole accommodative space (PPL-B).
Subjects were asked to score the designs in a scale from 1-5 for different tasks after 7 days of use. In
addition, they were asked to choose the best lens for each task. Statistical analysis was performed
using Statgraphics Centurion XVI.II® software.
36
Results
The analysis of subjective satisfaction provided statistically significant differences between both
types of lenses for both questionnaires. Regarding the 7-day questionnaire, PPL-B got better score
with statistical significance at intermediate vision (PPL-A: 4.14±0.90, PPL-B: 4.45±0.67, p=0.03), and
showed a tendency to be preferred at near vision (PPL-A: 4.36±0.73, PPL-B: 4.55±0.67, p=0.06). PPL-
B was also significantly preferred by 39% of wearers at far vision (vs 17% PPL-A, p=0.03), 46% at
intermediate vision (vs 20% PPL-A, p=0.01), 51% at near vision (vs 12% PPL-A, p=0.00), and 50% in
overall satisfaction (vs 23% PPL-A, p=0.01).
Conclusions
The oblique aberration compensation that considers a dynamic accommodative object space in the
optimization of PPLs provides a greater vision satisfaction not only for near and intermediate
distances where the accommodative capacity of the user is commonly activated, but also at far
distance.
Title
The COSS (Community Ophthalmic Services Scheme) Contract: Is the contract fit-for-purpose,
according to members of Optometry Ireland?
Presenter
Martin O’Brien FCOptom, FAOI, working within the COSS and a member of Optometry Ireland
Council & Executive Committee.
Abstract
The majority of optical practices in Ireland provide services to patients remunerated under the COSS
(Community Ophthalmic Services Scheme). The contract uses open and vague terminology that does
not specify the what "tests" must be carried out by an optometrist and what "tests" are included in
the remuneration.
Methods
Optometry Ireland members were invited to participate in an online survey in relation to the COSS
contract and the results analysed.
Results
Only 3% of respondents deemed the contract to reflect modern optometric practice and to be fit for
purpose. Participants were asked to rank "Tests" as being either Basic (included in COSS), Additional
(should be remunerated as an extra item) or Exempt (not covered at all by COSS).
Conclusion
The current COSS is out of date and does not reflect the reality of optometric practice in respect of
remuneration and the additional equipment / investigative techniques in modern optometrists'
practices.
37
Title
WIVI Automated Optometric Visual Screening in a Public Hospital Pediatric Service
Authors
J.C. Ondategui Parra, A. Martínez Mejías
Presenter
Juan Carlos Ondategui Parra, Universitat Politecnica de Catalunya, Spain
Purpose
The Spanish health system is a benchmark in relation to pediatric protocols for the detection of
pathology in routine well-child check-ups. But in most of the autonomies of the Spanish territory,
these pediatric protocols for visual evaluation from the age of 7 include tests of color vision, but no
test that evaluates binocular, accommodative or visual reading abilities.
The objective of this study is to determine the prevalence of binocular dysfunctions and reading
skills including a visual screening within the protocol of the routine check-up of the well child in the
public health system.
Setting/Venue
Taking into account that children and adolescents present the highest prevalence values of binocular
dysfunctions, the inclusion of instrumentation to be able to evaluate in an automated and objective
way, allows a massive arrest of this type of alterations.
Methods
It is a prospective cross-sectional observational study of non-consecutive cases. A total of 198
individuals have been included. All of them were evaluated by the pediatric team of the Consorci
Sanitari de Terrassa (CST) performing the routine pediatric visual assessment: visual acuity, covert
test, color vision and stereoacuity and an optometric tests:visual acuity, phoria, fusional reserves,
vergence facility, stereo acuity, color vision and visual reading skills, obtained with and objective and
autonomous assessment carried out by the WIVI system (e-Health Technical Solutions). The results
of each test and the diagnostic capacity for the detection of visual dysfunctions were compared.
Results
The age (mean and standard deviation) of the sample was 10.5 2.3 years (range 6.8 to 14.4), of
which there were 75 boys (37.9%) and 123 girls (62.1%). 114 cases (57.6%) of patients with
alteration in any of the visual areas evaluated were detected, being the conditions of Inflexibility of
Vergences, Insufficiency of Convergence and Excess of Convergence the most prevalent. 4% of
patients with color alteration were detected (a value lower than that usually found in the pediatric
protocol of 6%). 60 patients (30.3%) with alterations in visual reading skills were detected.
Conclusions
The results obtained are significant enough to assess the inclusion of this type of visual tests in the
screening protocol for visual disturbances in children and young people in the health system. More
studies are needed to optimize tests and criteria for different ages. Including objective and
automated screening tests for alterations in binocularity and visual reading skills in routine in the
healthy patient visits in pediatrics improves the detection rate of this type of alterations. WIVI
system has been shown to be a useful equipment in the detection of this type of alterations in the
pediatric population.
38
Title
Clinical case neurofibromatosis type 1 in pediatric age
Authors
C. Fresno, J. Gispets
Presenter
Carlos Fresno, Hospital Sant Joan de Déu, Spain
Purpose
To make known among optometrists the importance of knowing minority diseases such as
neurofibromatosis type 1 in pediatric age.
Setting/Venue
Pediatric Hospital Sant Joan de Déu, Barcelona,Spain.
Ophthalmology service
Methods
A 4-year-old patient referred from oncology due to suspicion of poor distant vision.
AP: follow-up in oncology for multiple café au lait spots in armpits and groin.
Exploration:
Distance VA 0.6/0.7 (HOTV test)
CT Distance and Near orthotropia
Slit Lamp exam: multiple lisch nodules in both eyes
Dilated fundus eye: normal
Retinoscopy (under cycloplegia): -1,00 (VA: 1) /+0,00 (VA:0,7)
Ganglion cells OCT à RE: 100 // LE: 80
Macular OCT à RE: normal thickness and good foveal profile // LE: thickness slightly lower than RE
and good foveal profile. Hyperreflective areas with IR at the posterior pole.
Results
Cranial MRI is requested for suspected optic glioma.
Diagnosis: Neurofibromatosis type 1 with optic glioma in left Optical nerve.
Treatment: At the ocular level refraction and referred to oncology to assess chemotherapy
treatment to preserve the visual pathway.
Follow up: Visits every 3 months to check de visual acuity and the ganglions cells OCT.
Conclusions
Neurofibromatosis is the rare disease with the highest incidence. That is why as visual health
professionals we must be in constant training to know what possible visual involvement these
patients may have, as well as their prognosis. It is very important to make an early diagnosis in order
to improve the visual quality of these patients.
Title
Idiopathic Optic Neuritis Secondary to Bilateral Optic Atrophy: A Case of Low Vision.
Authors
K. Ekemiri, K. Seetaram
Presenter
Kingsley Ekemiri, The University of the West Indies, Trinidad and Tobago
39
Purpose
Optic neuritis is an inflammatory demyelinating condition of the optic nerves. It can arise alone or as
part of multiple sclerosis. Idiopathic optic neuritis (ION) occurs when no other systemic illnesses
exist. According to research, 30–50% of ION patients suffer recurring attacks. Optic neuritis is most
observed in women aged 10-50 years. The patient in this case report has ION since she was 13 years
old, and a recent exam revealed optic atrophy related to ION. This report summarizes the ION
findings and highlights the patient's goals, which were met at the end of the low vision evaluation.
Setting/Venue
A 32-year -old female presented in a Low Vision Clinic located in Trinidad and Tobago.
Methods
Chief Complaint: Glare problems, Photophobia, Night vision problems, Depth Perception and
Contrast problems.
Ocular History: Diagnosed with idiopathic optic neuritis of the OD at 13 years old at the Port of Spain
General Hospital. Patient was treated with steroids and 1 month after, her OS was dragonised with
the same condition and similar treatment was administered.
Last low vision examination if any: No previous intervention.
Medical History: DM-, HTN-, CVD-, Asthma-
Family Ocular History: Grandparents were blinded by diabetic retinopathy.
Other Salient Information: OCT & VFT was performed
Patient goals: Want to read, watch T.V and move independently.
Results
Unaided Visual acuity: Distance OD 1.34 LogMAR; OS 1.20 LogMAR
Near OD 1.30 M; OS 1.60 M
Final Prescription: OD -3.25/-0.50×165; OS -3.25/-0.50×160
BCVA: 1.10 LogMAR OD, 1.00 LogMAR OS.
Anterior Segment: Unremarkable
Posterior Segment: Optic disc pallor with undefined margins.
Colour Vision Test: Ishihara Test- Patient could not identify plates.
Amsler Grid: Patient claims to not see any issues around centre of box.
Contrast Sensitivity: Patient could not identify letters
OCT results revealed optic nerve pallor along with significant RNFL thinning OU.
VFT results revealed a significant amount of peripheral vision loss OU.
Laboratory Test: None.
Conclusions
It affects the optic nerve, which transmits vision to the brain. Optic neuritis is diagnosed based on
signs and symptoms. Steroids can be given orally or intravenously. It can damage any visual area.
Her Optic Neuritis with Bilateral Optic Atrophy was controlled, and her assessment goals were met.
Optical instruments were used for the patient's visual goals, and social information was offered.
The patient's vision was improved at a distance using a power spec and at a close range using an
illuminated handheld 8D magnifier and a contrast-enhancing Yellow Filter.
40

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1

Telemedicine in Optometry and Ophthalmology

Communication between Eye Care Practitioner and Parents

Utilising internationalisation for the Development of an International Masters Program of

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Quality of life assessment before and after cataract surgery

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Computer Vision Syndrome

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The Challenges of Unexplained Vision Loss in Three Young Patients

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L. Gantz, E. Gal, J. Gispets, M. Zyroff, E. Netanya

S. Font Armadans, A. Díaz Cortés, J.C. Ondategui-Parra

J.C. Ondategui Parra, A. Martínez Mejías

Juan Carlos Ondategui Parra, Universitat Politecnica de Catalunya, Spain

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