António M. G. Baptista

Norms for the developmental eye movement test for Portuguese children

Purpose. This work aims to define contemporary scores for the Developmental Eye Movement Test (DEM) for native Portuguese-speaking children (PT) and to compare these scores with three other published scores: the original norms, published in 1987 for American English-speaking children (U.S.) and two other scores published in 1995 (SP1) and 2003 (SP2) for Spanish-speaking children. Methods. A standard DEM test was administered to 695 young students ranging in age from 6 to 13 years from the region of Braga, Portugal. The mean PT scores for vertical time and adjusted horizontal time as well as the corresponding errors and ratio were calculated according to age and grade, and these results were compared with those from other studies. In addition, the clinical response types (age and grade) were obtained based on mean PT scores. Results. For several ages/grades, the scores obtained in this study were significantly different from the scores reported in other studies. A global qualitative analysis showed that PT made fewer errors and had similar ratios when compared with U.S. and SP2. However, PT were generally slower in vertical time and adjusted horizontal time in the younger age groups. When comparing PT and SP1, a higher ratio for SP1 was determined in all ages. The clinical response types signified below-normal performance scores for ages 6 to 9 and grades 1 to 5. Conclusions. The unusually large number of oculomotor and/or automaticity problems found in this normal PT population using a test based on U.S. norms highlights the need for PT-specific guidelines. It appears that DEM scores may be affected by differences in language, educational systems, and/or cultural systems. Therefore, clinicians should be aware of these findings when using the DEM test on children in countries with differing languages and cultures.

Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment

Generic instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition‐specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ‐5D‐3L and the Activity Inventory (AI).

Changes in spatial extent and peak double optical density of human macular pigment with age

The purpose of the present work was to estimate the changes in spatial distribution and optical density of macular pigment (MP) with age. A fundus imaging system with high spatial and spectral resolution was adapted to form an indirect ophthalmoscope. The double optical density at 490 nm of the MP as a function of the location in the retina was obtained for 33 healthy subjects (ages: 21-60 years). There was an increase in spatial extent and decrease in double optical density with age. Furthermore, the spatial distribution of MP showed central areas with irregular shapes and a tendency toward asymmetry.

Vision in high-level football officials

Officiating in football depends, at least to some extent, upon adequate visual function. However, there is no vision standard for football officiating and the nature of the relationship between officiating performance and level of vision is unknown. As a first step in characterising this relationship, we report on the clinically-measured vision and on the perceived level of vision in elite-level, Portuguese football officials. Seventy-one referees (R) and assistant referees (AR) participated in the study, representing 92% of the total population of elite level football officials in Portugal in the 2013/2014 season. Nine of the 22 Rs (40.9%) and ten of the 49 ARs (20.4%) were international-level. Information about visual history was also gathered. Perceived vision was assessed using the preference-values-assigned-to-global-visual-status (PVVS) and the Quality-of-Vision (QoV) questionnaire. Standard clinical vision measures (including visual acuity, contrast sensitivity and stereopsis) were gathered in a subset (n = 44, 62%) of the participants. Data were analysed according to the type (R/AR) and level (international/national) of official, and Bonferroni corrections were applied to reduce the risk of type I errors. Adopting criterion for statistical significance of p<0.01, PVVS scores did not differ between R and AR (p = 0.88), or between national- and international-level officials (p = 0.66). Similarly, QoV scores did not differ between R and AR in frequency (p = 0.50), severity (p = 0.71) or bothersomeness (p = 0.81) of symptoms, or between international-level vs national-level officials for frequency (p = 0.03) or bothersomeness (p = 0.07) of symptoms. However, international-level officials reported less severe symptoms than their national-level counterparts (p<0.01). Overall, 18.3% of officials had either never had an eye examination or if they had, it was more than 3 years previously. Regarding refractive correction, 4.2% had undergone refractive surgery and 23.9% wear contact lenses when officiating. Clinical vision measures in the football officials were similar to published normative values for young, adult populations and similar between R and AR. Clinically-measured vision did not differ according to officiating level. Visual acuity measured with and without a pinhole disc indicated that around one quarter of participants may be capable of better vision when officiating, as evidenced by better acuity (≥1 line of letters) using the pinhole. Amongst the clinical visual tests we used, we did not find evidence for above-average performance in elite-level football officials. Although the impact of uncorrected mild to moderate refractive error upon officiating performance is unknown, with a greater uptake of eye examinations, visual acuity may be improved in around a quarter of officials.

Functional impairment with minimal macular damage in femtosecond laser plasma injury: case report

Uma paciente de 26 anos foi examinada 24 horas apos observar a formacao de plasma induzido por laser em um processo de producao de nanoparticulas, referindo escotoma central bilateral. A avaliacao oftalmologica incluiu observacao dilatada da retina, angiofluoresceinografia e tomografia de coerencia optica (OCT). Na primeira avaliacao, a acuidade de 20/20 no olho direito e 20/25 no olho esquerdo. A avaliacao oftalmologica revelou mudancas de coloracao da regiao macular de ambos os olhos. A tomografia de coerencia optica mostrou uma interrupcao central da camada de fotorreceptores em ambos os olhos, e a angiografia fluoresceinica foi normal. Nas consultas subsequentes a acuidade sempre foi 20/20 em ambos os olhos. Os achados da tomografia de coerencia optica anormais desapareceram em menos de cinco meses, mas as queixas subjetivas de escotoma no olho esquerdo permaneceram. Cuidado extra deve ser tomado para este tipo de experiencia, por exemplo, reduzindo o tempo em que a retina e diretamente exposta a radiacao de plasma.A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

Evaluation of discomfort of Goldmann tonometry without anaesthetic

Goldmann applanation tonometry (GAT) is considered the gold standard technique for tonometry. It is a procedure involving administration of topical anaesthetic (a drug which could have several side effects). This prevents a large number of vision care practitioners from using GAT, due to legal restrictions regarding the use of these ophthalmic drugs. The purpose of this study was to establish whether the discomfort experienced during non‐anaesthetic Goldmann Applanation Tonometry (NAGAT) would be acceptable to subjects. The intensity of pain inflicted by GAT, NAGAT, Non‐Contact Tonometry (NCT) and Schirmer test was assessed on thirty‐one subjects enrolled in the study using the Numerical Rating Scale (NRS) to assess pain. The GAT was performed on one eye and the other three procedures were carried out in random order on the fellow eye. Initially, each subject was asked to score their Maximum Pain Without Complaint (MPWC). The MPWC and the Schirmer test were used as references to grade the pain levels. The scores for the five procedures were registered using the NRS (0–10) and compared using a non‐parametric statistical analysis (Friedman test and a post‐hoc analysis). In addition, IOP results for GAT and NAGAT were also compared using the t‐test. The scores obtained on the NRS ranged from 0–4, 0–5, 0–8, 0–7 and 3–8 with a median of 1, 1, 2, 2, and 5, respectively for NCT, GAT, NAGAT, Schirmer and MPWC. A statistically significant difference (p = 0.01) was found between the MPWC and the four clinical tests but no difference was found between the clinical tests. There was no statistically significant difference (p = 0.71) between the IOP results for GAT and NAGAT, 14.0 ± 2.0 mmHg and 13.8 ± 2.0 mmHg (mean ± 1S.D.) respectively. The Goldmann Applanation Tonometry without anaesthetic (NAGAT) can be performed with an acceptable level of discomfort for the majority of subjects and should be performed identically to a traditional GAT, informing the subjects about the possibility of feeling a small discomfort.

An exploratory study of temporal integration in the peripheral retina of myopes

The visual system takes time to respond to visual stimuli, neurons need to accumulate information over a time span in order to fire. Visual information perceived by the peripheral retina might be impaired by imperfect peripheral optics leading to myopia development. This study explored the effect of eccentricity, moderate myopia and peripheral refraction in temporal visual integration. Myopes and emmetropes showed similar performance at detecting briefly flashed stimuli in different retinal locations. Our results show evidence that moderate myopes have normal visual integration when refractive errors are corrected with contact lens; however, the tendency to increased temporal integration thresholds observed in myopes deserves further investigation.

Functional impairment with minimal macular damage in femtosecond laser plasma injury: case report Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso

Uma paciente de 26 anos foi examinada 24 horas apos observar a formacao de plasma induzido por laser em um processo de producao de nanoparticulas, referindo escotoma central bilateral. A avaliacao oftalmologica incluiu observacao dilatada da retina, angiofluoresceinografia e tomografia de coerencia optica (OCT). Na primeira avaliacao, a acuidade de 20/20 no olho direito e 20/25 no olho esquerdo. A avaliacao oftalmologica revelou mudancas de coloracao da regiao macular de ambos os olhos. A tomografia de coerencia optica mostrou uma interrupcao central da camada de fotorreceptores em ambos os olhos, e a angiografia fluoresceinica foi normal. Nas consultas subsequentes a acuidade sempre foi 20/20 em ambos os olhos. Os achados da tomografia de coerencia optica anormais desapareceram em menos de cinco meses, mas as queixas subjetivas de escotoma no olho esquerdo permaneceram. Cuidado extra deve ser tomado para este tipo de experiencia, por exemplo, reduzindo o tempo em que a retina e diretamente exposta a radiacao de plasma.A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso

Uma paciente de 26 anos foi examinada 24 horas apos observar a formacao de plasma induzido por laser em um processo de producao de nanoparticulas, referindo escotoma central bilateral. A avaliacao oftalmologica incluiu observacao dilatada da retina, angiofluoresceinografia e tomografia de coerencia optica (OCT). Na primeira avaliacao, a acuidade de 20/20 no olho direito e 20/25 no olho esquerdo. A avaliacao oftalmologica revelou mudancas de coloracao da regiao macular de ambos os olhos. A tomografia de coerencia optica mostrou uma interrupcao central da camada de fotorreceptores em ambos os olhos, e a angiografia fluoresceinica foi normal. Nas consultas subsequentes a acuidade sempre foi 20/20 em ambos os olhos. Os achados da tomografia de coerencia optica anormais desapareceram em menos de cinco meses, mas as queixas subjetivas de escotoma no olho esquerdo permaneceram. Cuidado extra deve ser tomado para este tipo de experiencia, por exemplo, reduzindo o tempo em que a retina e diretamente exposta a radiacao de plasma.A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation.

The influence of humidity, temperature, and oral contraceptive in tear

The aim of this study is to ascertain whether the quantity and quality of tear and eye subjective comfort are influenced by the temperature, humidity and oral Contraceptives Taking or Non-taking (CTNT). Forty-one students, females, from the University of Minho, Braga, Portugal, aged (mean±1standard deviation) of 21.51±1.85 years, ranging from 20 to 30 years, participated in this study. The McMonnies Questionnaire (MMQ), Break Up Time (BUT) and Phenol Red Test (PRT) were accessed between 14-17 hours in four sets of visits throughout the year: Visit 1, Visit 2, Visit 3 and Visit 4. The PRT and BUT values (mean±1standard deviation) for Visit 1, Visit 2, Visit 3 and Visit 4 were respectively 23.88±6.50mm, 22.29±8.00mm, 23.61±6.75mm, 22.88±7.00mm and 6.02±1.58s, 5.62±1.22s, 5.23±0.88s, 5.53±1. 42s. The MMQ scores for Visit 1, Visit 2, Visit 3 and Visit 4 ranged from 2-13, 2-15, 1-14 and 2-14 with medians of 6, 7, 6 and 6, respectively. The influence of temperature, humidity and CTNT on PRT, BUT and MMQ were evaluated using generalized linear mixed model. For BUT and MMQ statistical significant effects were found regarding temperature and humidity. The temperature and humidity influenced the tear quality and subjective comfort but did not influence the tear quantity. The CTNT did not influence tear quantity, quality or subjective eye comfort.