Aaron B. Zimmerman

Validity of the convergence insufficiency symptom survey: a confirmatory study.

Purpose. The objectives of the present study were to evaluate whether investigator bias influenced the Convergence Insufficiency Symptom Survey (CISS) scores of children with normal binocular vision (NBV) in our original validation study, reevaluate the usefulness of the cutoff score of 16, and reexamine the validity of the CISS. Methods. Six clinical sites participating in the Convergence Insufficiency Treatment Trial (CITT) enrolled 46 children 9 to <18 years with NBV. Examiners masked to the child’s binocular vision status administered the CISS. The mean CISS score was compared with that from the children with NBV in the original, unmasked CISS study and also to that of the 221 symptomatic convergence insufficiency (CI) children enrolled in the CITT. Results. The mean (±standard deviation) CISS score for 46 subjects with NBV was 10.4 (±8.1). This was comparable with our prior unmasked NBV study (mean = 8.1 (±6.2); p = 0.11) but was significantly different from that of the CITT CI group (mean = 29.8 ± 9.0; p < 0.001). Eighty-three percent of these NBV subjects scored <16 on the CISS, which is not statistically different from the 87.5% found in the original unmasked study (p = 0.49). Conclusions. Examiner bias did not affect the CISS scores for subjects with NBV in our prior study. The CISS continues to be a valid instrument for quantifying symptoms in 9 to <18-year-old children. These results also confirm the validity of a cut-point of ≥16 in distinguishing children with symptomatic CI from those with NBV.

Microbial keratitis secondary to unintended poor compliance with scleral gas-permeable contact lenses.

Purpose: To report a case of neurotrophic keratitis in which scleral contact lenses improved vision from 20/100 to 20/20, however, due to poor lens care, an incident of microbial keratitis developed. Methods: A 64-year-old man with an ocular history of neurotrophic keratitis secondary to herpes simplex in each eye was successfully fit with scleral lenses. He subsequently developed microbial keratitis due to a number of risk factors. Results: The lesion was culture negative, yet was very responsive to treatment with moxifloxacin. The lesion fully healed, and the patient did not suffer additional vision loss. Conclusions: This case demonstrates the ability of scleral lenses to correct visual impairments secondary to poor epithelial integrity and illustrates the importance of the practitioner providing detailed lens care instruction.

Visual acuity and contrast sensitivity testing for sports vision.

Abstract: The building blocks of effective sports vision are visual acuity and contrast sensitivity. Proper measurement of these spatial vision attributes is necessary for repeatability in the clinic or in the laboratory. The most repeatable method of testing visual acuity is with logMAR charts-either the Bailey-Lovie chart or the Early Treatment Diabetic Retinopathy Study chart. The Pelli-Robson and the Mars are the most repeatable contrast sensitivity tests. Athletes may or may not demonstrate superior visual acuity and contrast sensitivity compared with age-matched nonathlete populations, and the optical quality of their eyes may be similar. Dynamic visual acuity in athletes and their performance are typically superior to those of nonathletes. How these differences relate to on-field performance is not known. Other changes to the visual system because of refractive surgery or contact lens wear may increase higher order aberrations and reduce low-contrast visual acuity. The ability to improve already-normal visual acuity is unclear although contrast sensitivity can improve with fast-paced video games. Tinted contact lenses help reduce discomfort glare and speed up adaptation but do not have an appreciable effect on visual acuity and contrast sensitivity. Conclusion: The use of valid and repeatable visual acuity and contrast sensitivity tests is essential for measuring the differences in visual performance among athletes and nonathletes. The development of a standardized dynamic visual acuity test is needed as are well-controlled scientific studies to evaluate the benefits of sports vision training

Multicenter Testing of a Risk Assessment Survey for Soft Contact Lens Wearers With Adverse Events: A Contact Lens Assessment in Youth Study.

Purpose: To test the ability of responses to the Contact Lens Assessment in Youth (CLAY) Contact Lens Risk Survey (CLRS) to differentiate behaviors among participants with serious and significant (S&S) contact lens–related corneal inflammatory events, those with other events (non-S&S), and healthy controls matched for age, gender, and soft contact lens (SCL) wear frequency. Methods: The CLRS was self-administered electronically to SCL wearers presenting for acute clinical care at 11 clinical sites. Each participant completed the CLRS before their examination. The clinician, masked to CLRS responses, submitted a diagnosis for each participant that was used to classify the event as S&S or non-S&S. Multivariate logistic regression analyses were used to compare responses. Results: Comparison of responses from 96 participants with S&S, 68 with non-S&S, and 207 controls showed that patients with S&S were more likely (always or fairly often) to report overnight wear versus patients with non-S&S (adjusted odds ratio [aOR], 5.2; 95% confidence interval [CI], 1.4–18.7) and versus controls (aOR, 5.8; CI, 2.2–15.2). Patients with S&S were more likely to purchase SCLs on the internet versus non-S&S (aOR, 4.9; CI, 1.6–15.1) and versus controls (aOR, 2.8; CI, 1.4–5.9). The use of two-week replacement lenses compared with daily disposables was significantly higher among patients with S&S than those with non-S&S (aOR, 4.3; CI, 1.5–12.0). Patients with S&S were less likely to regularly discard leftover solution compared with controls (aOR, 2.5; CI, 1.1–5.6). Conclusions: The CLRS is a clinical survey tool that can be used to identify risky behaviors and exposures directly associated with an increased risk of S&S events.

Is purchasing lenses from the prescriber associated with better habits among soft contact lens wearers

PURPOSE To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from their eye care practitioner (ECP), on the internet/telephone, or at retail (not where they were examined) to test the effect of proximity to the prescriber on SCL wear and care practices. METHODS Adult SCL wearers completed an adapted Contact Lens Risk Survey (CLRS) online that queried items related to risk factors for SCL-related complications. Responses from subjects who purchased at the ECP, via the internet/telephone, or at a retail store were compared (Chi-Square). RESULTS Purchase sources were: ECP 646 (67%, 44±12 yrs, 17% male), Retail 104 (11%, 45±13 yrs, 28% male), and Internet/telephone 218 (23%, 45±12 yrs, 18% male); age (p=0.51), gender (p=0.021). Internet purchasers had fewer annual eye exams (79% ECP, 83% retail, 66% internet/telephone, p=0.007), purchased more hydrogel SCLs (34% ECP, 29% retail, 45% internet/telephone, p=0.0034), and paid for SCLs with insurance less often (39% ECP, 29% retail, 19% internet/telephone, p<0.0001). Other behaviors were similar across groups (p>0.05). CONCLUSIONS In this sample, the purchase location of SCL wearers had limited impact on known risk factors for SCL-related complications. Internet purchasers reported less frequent eye exams and were more likely to be wearing hydrogel SCLs. Closer access to the ECP through in-office SCL purchase did not improve SCL habits or reduce the prevalence of risk behaviors.

A Method to Monitor Eye and Head Tracking Movements in College Baseball Players

Purpose This study had two purposes. The first was to develop a method to measure horizontal gaze tracking errors (based on synchronized eye and head tracking recordings) as subjects viewed many pitched balls. The second was to assess horizontal eye, head, and gaze tracking strategies of a group of Division 1 college baseball players. Methods Subjects viewed, but did not swing a bat at, tennis balls projected by a pneumatic pitching machine. Subjects were to call out numbers and the color of these numbers (black or red) on the balls. The trajectory of each pitch was very predictable. Eye and head movements were monitored with a video eye tracker and an inertial sensor, respectively, and these movements were synchronized with ball position using an analog recording device. Data were analyzed for 15 subjects. Results Eye rotation, head rotation, gaze errors (GEs), and unsigned gaze errors (UGEs) were calculated at various elapsed times. On average, subjects tracked the pitched ball with the head throughout the pitch trajectory, while the eye was moved very little until late in the pitch trajectory. On average, gaze position matched the target position throughout the pitch trajectory. There was some variability in the mean amplitudes of head and eye movement between subjects. However, the eye and head were related by a common rule (partial rotational vestibulo-ocular reflex suppression) for all subjects. Although the mean amplitudes of the GE and UGE varied between subjects, these means were not consistent with anticipatory saccades for any subject. Conclusions On average, Division 1 college players tracked the pitched ball primarily with the head and maintained gaze close to the ball throughout much of the pitch trajectory. There was variability between subjects regarding the head and eye movement amplitudes and GEs, but, overall, all subjects maintained gaze close to the ball throughout the pitch trajectory despite the fact that these individuals were not batting.

Optical quality and impact resistance comparisons of 2 football helmet faceshields

BACKGROUND Currently there is no standard that specifically addresses the optical and impact performance of football protective faceshields. This study compared the impact resistance and optical quality between 2 popular football faceshields. Testing was performed only on new faceshields. METHODS To test impact resistance, baseballs were propelled at the faceshields with velocities up to 66.4 m/sec. Structural integrity was evaluated after each impact. Ten visors from each of 2 companies underwent a single impact at various velocities. Two visors from each company were impacted 3 times to evaluate the effects of repeated blows. Additional visors were conditioned to -10 degrees C and impacted once. Additionally, prismatic power, refractive power, haze, visible light, and ultraviolet (UV) transmittance, and optical distortion were measured to evaluate optical quality. All testing was done with faceshields mounted to facemask and, when appropriate, to a helmet. RESULTS None of these new faceshields fractured even with impact velocities up to 66.4 m/sec. With regard to optical quality, both protectors met the optical requirements for the standards of faceshields for selected sports (ASTM F803-2003). CONCLUSIONS Both faceshields tested should protect football players from anticipated impacts while providing adequate optical quality for satisfactory visual performance.

Contact lens associated microbial keratitis: practical considerations for the optometrist

Microbial keratitis (MK) is a corneal condition that encompasses several different pathogens and etiologies. While contact lens associated MK is most often associated with bacterial infections, other pathogens (fungi, Acanthamoeba species, etc) may be responsible. This review summarizes the risk factors, microbiology, diagnostic characteristics, and treatment options for all forms of contact lens-related MK.

Intercollegiate usage schedule and the impact resistance of used football helmet faceshields

PURPOSE Although new polycarbonate helmet faceshields can withstand impacts exceeding forces of 2,400 N, repeated impacts and ultraviolet radiation degrade the structural integrity. In this study, the impact resistances of unused, solar-radiated, and of game-used faceshields were analyzed. Also, Division 1 National Collegiate Athletic Association football programs were surveyed concerning their faceshield practices. METHODS Impact resistance was tested by impacting faceshields with baseballs at velocities exceeding 67.1 m/s. Twenty-four new faceshields were exposed to southern daylight, 3 hours per day for 3 months before testing. Subsequent testing was performed on 60 game-used faceshields. Additionally, a faceshield utilization survey was distributed to 117 college programs. RESULTS Solar-irradiated shields did not fail at maximum test velocity. The survivability of nonimpacted shields was greater than game-worn shields (P = 0.0003). Fifty-nine surveys were returned with 58 programs reporting faceshield use. Approximately 21 players per program use a faceshield. The main reason reported for use was aesthetic. Only 21% of reporting programs require a faceshield for players with reduced visual acuity in 1 eye. CONCLUSION Faceshields lose impact resistance with typical use. Programs should incorporate a policy for replacement and require that players with reduced vision in at least 1 eye wear a faceshield.

Foveal Curvature and Asymmetry Assessed Using Optical Coherence Tomography

PURPOSE The aims of this study were to use cross-sectional optical coherence tomography imaging and custom curve fitting software to evaluate and model the foveal curvature as a spherical surface and to compare the radius of curvature in the horizontal and vertical meridians and test the sensitivity of this technique to anticipated meridional differences. METHODS Six 30-degree foveal-centered radial optical coherence tomography cross-section scans were acquired in the right eye of 20 clinically normal subjects. Cross sections were manually segmented, and custom curve fitting software was used to determine foveal pit radius of curvature using the central 500, 1000, and 1500 μm of the foveal contour. Radius of curvature was compared across different fitting distances. Root mean square error was used to determine goodness of fit. The radius of curvature was compared between the horizontal and vertical meridians for each fitting distance. RESULTS There radius of curvature was significantly different when comparing each of the three fitting distances (P < .01 for each comparison). The average radii of curvature were 970 μm (95% confidence interval [CI], 913 to 1028 μm), 1386 μm (95% CI, 1339 to 1439 μm), and 2121 μm (95% CI, 2066 to 2183) for the 500-, 1000-, and 1500-μm fitting distances, respectively. Root mean square error was also significantly different when comparing each fitting distance (P < .01 for each comparison). The average root mean square errors were 2.48 μm (95% CI, 2.41 to 2.53 μm), 6.22 μm (95% CI, 5.77 to 6.60 μm), and 13.82 μm (95% CI, 12.93 to 14.58 μm) for the 500-, 1000-, and 1500-μm fitting distances, respectively. The radius of curvature between the horizontal and vertical meridian radii was statistically different only in the 1000- and 1500-μm fitting distances (P < .01 for each), with the horizontal meridian being flatter than the vertical. CONCLUSIONS The foveal contour can be modeled as a sphere with low curve fitting error over a limited distance and capable of detecting subtle foveal contour differences between meridians.