Bradley Coffey

Randomized Trial of the Effect of Contact Lens Wear on Self-Perception in Children

Purpose. To determine whether contact lens wear affects children’s self-perceptions. Methods. The Adolescent and Child Health Initiative to Encourage Vision Empowerment Study was a randomized, single-masked trial conducted at five clinical centers in the United States. Subjects were 8- to 11-year-old myopic children randomly assigned to wear spectacles (n = 237) or soft contact lenses (n = 247) for 3 years. The primary endpoint was the Self-Perception Profile for Children Global Self-Worth scale. Secondary outcomes included the Physical Appearance, Athletic Competence, Scholastic Competence, Behavioral Conduct, and Social Acceptance Self-Perception Profile for Children scales. Results. Global self-worth was not affected by contact lens wear [analysis of variance (ANOVA), difference = 0.06; 95% CI, −0.004 to 0.117]. Physical appearance (ANOVA, difference = 0.15; 95% CI, 0.07 to 0.22), athletic competence (ANOVA, difference = 0.08; 95% CI, 0.01 to 0.15), and social acceptance (ANOVA, difference = 0.10; 95% CI, 0.03 to 0.17) were all greater for contact lens wearers. Conclusions. Although contact lens wear does not affect global self-perceptions of 8- to 11-year-old myopic children their physical appearance, athletic competence, and social acceptance self-perceptions are likely to improve with contact lens wear. Eye care practitioners should consider the social and visual benefits of contact lens wear when choosing the most appropriate vision correction modality for children as young as 8 years of age.

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data.

Purpose. The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on childrens self-perception. Methods. Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Childrens satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually. Results. Five clinical sites enrolled 484 subjects with a mean (± standard deviation [SD]) age of 10.4 ± 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (± SD) cycloplegic spherical equivalent autorefraction of the right eye is –2.38 ± 1.04 D, and the average (± SD) axial length of the right eye is 24.32 ± 0.77 mm. The average (± SD) Global Self-Worth score on the SPPC is 3.20 ± 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (± SD) spectacle satisfaction is 59.1 ± 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 ± 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life). Conclusions. Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on childrens self-perceptions.

Treatment options in intermittent exotropia: a critical appraisal.

Clinical opinions regarding treatment of intermittent exotropia (IXT) vary widely and there is controversy as to which treatment modality is most successful. This paper reviews the clinical literature related to five different treatment modalities used for IXT: overminus lens therapy, prism therapy, occlusion therapy, extraocular muscle surgery, and orthoptic vision therapy. Based upon review of 59 studies of treatment of IXT, and using each authors stated criteria for success, the following pooled success rates were revealed: overminus lens therapy (N=215), 28%; prism therapy (N=201), 28%; occlusion therapy (N=170), 37%; extraocular muscle surgery (N=2530), 46%; and orthoptic vision therapy (N=740), 59%. Success rates for IXT surgery differed depending upon whether a functional (43%) or cosmetic (61%) criterion was used to evaluate treatment success. These pooled success rates must be viewed carefully because nearly all the studies suffer from serious scientific flaws such as small sample sizes, selection bias, inadequately defined treatments and success criteria, absence of statistical analysis, and results reported in a manner that makes interpretation difficult. These problems indicate the need for a careful, circumscribed, and well controlled clinical trial to study the efficacy of different treatment modalities in remediating IXT.

Vision specific quality of life of pediatric contact lens wearers.

Purpose. Several studies have shown that children are capable of wearing and caring for contact lenses, but it is not known whether the benefits outweigh the risks associated with contact lens wear. The purpose of this article is to compare the vision-related quality of life benefits of children randomized to wear spectacles or contact lenses for 3 years using the Pediatric Refractive Error Profile. Methods. The Pediatric Refractive Error Profile was administered to 484 children who wore glasses at baseline. The children were then randomly assigned to wear contact lenses (n = 247) or spectacles (n = 237) for 3 years. The survey was administered at the baseline examination, at 1 month, and every 6 months for 3 years. Results. During 3 years, the overall quality of life improved 14.2 ± 18.1 units for contact lens wearers and 2.1 ± 14.6 units for spectacle wearers (p < 0.001). In all scales except the visual performance scales (Distance Vision, Near Vision, and Overall Vision), the quality of life improved more for older subjects than younger subjects. The three scales with the largest improvement in quality of life for contact lens wearers were Activities, Appearance, and Satisfaction with Correction. Conclusions. Myopic children younger than 12 years of age report better vision-related quality of life when they are fit with contact lenses than when they wear glasses. Older children, children who participate in recreational activities, children who are motivated to wear contact lenses, and children who do not like their appearance in glasses will benefit most.

A comparison of spectacle and contact lens wearing times in the ACHIEVE study

Purpose:  The aim was to compare vision correction wearing time between myopic children and teenagers in a clinical trial of contact lenses and spectacles.

Influences of examiner position and effective prism power on nearpoint alternate cover test

BACKGROUND This study was designed to resolve uncertainty concerning whether the position of the examiner is associated with variability in the results of the nearpoint alternate cover test (NACT). Two previous studies have shown that when the examiner is positioned to the side of the patient, rather than directly in front of the patient, the NACT shows greater exophoria in the range of 1.3 to 4.4 prism diopters. In the current study, we sought to determine if proximal cues or effective prism power might be the source of the apparent exo shift associated with examiner position. METHODS Three conditions of the NACT were performed on 52 young adults with normal visual function. Two measurements using the method of limits were made in each condition and averaged. In all conditions, the fixation target remained on the subjects midline at a distance of 40 cm. RESULTS Our results showed a small significant increase in measured exophoria when the examiner administered the NACT from a position to the side of the subject. The magnitude of the increase, 0.98 prism diopter, was less than in the previous studies, probably due to the control for proximal effect that was used. Intentionally rotating the measuring prism had a nominal effect on the measured phoria value, consistent with error induced due to effective prism power. DISCUSSION It appears that examiner position does affect the outcome of the NACT, but that the magnitude of the effect is not clinically significant. A change in proximal cues may contribute to the effect.

Influence of ocular gaze and head position on 4 m heterophoria and fixation disparity.

Four-meter heterophoria and fixation disparity measurements were taken from a sample of 40 young adults in primary gaze, 33° left and right lateral gaze, and in 2 head/gaze positions related to golf putting. Comparisons using analysis of variance were made between the mean values in each gaze position and between the test-retest range of values in each gaze position. Mean heterophoria was more eso (p < 0.05) in the two head/gaze positions related to golf putting than in other gaze positions, whereas mean fixation disparity was more eso (p < 0.05) in rightward than in primary gaze. Phoria test-retest range was less (p < 0.05) in all nonprimary gaze positions than in primary gaze. One of the putting-related gaze positions showed smaller (p < 0.05) fixation disparity ranges than the primary or leftward position of gaze. All measures were highly variable among subjects. Trends present in the data suggested greater esophoria and eso fixation disparity mean values, and lesser heterophoria and fixation disparity test-retest range values in all nonprimary positions relative to primary gaze. The behavior of exophoric and esophoric subjects differed only in regard to changes in heterophoria associated with left and right lateral gaze. These data indicate differences in oculomotor postural tendencies relative to position of gaze. Relevance of the results to athletes is discussed.

EFFECT OF MONOVISION CONTACT LENSES ON READING EYE MOVEMENTS, READING SPEED AND COMPREHENSION.: 3:00 - 3:15

Purpose. To extend our knowledge about how monovision contact lenses may affect reading eye movements, reading speed and reading comprehension. Methods. A sample of 21 presbyopes was selected based on stringent inclusion criteria. Six trials of the Ober2 Visagraph were performed on each subject within hours of initiating monovision Rx. In three of the trials, the subject wore a distance vision contact lens correction with near reading spectacles; in the other three trials, the subject was tested wearing a monovision contact lens correction. Results. Reading eye movements, reading speed and reading comprehension were measured by the Ober2 Visagraph. The Ober2 results indicated no difference in reading efficiency between the two conditions. Monovision and distance vision correction with near spectacles showed no significant differences in reading eye movements, reading speed or reading comprehension. Conclusion. Monovision contact lens correction is a convenient modality for presbyopic correction and does not negatively influence reading efficiency as measured by the Ober2 when first worn. Further studies are needed to determine the effect of long-term monovision contact lens wear on reading.

COMPARISONS OF EYE MOVEMENTS BEFORE AND AFTER A SPEED READING COURSE: Poster # 23 (BV-309)

BACKGROUND The techniques of speed reading are widely used and generally accepted, but few studies have investigated whether- and how-speed reading actually improves reading ability in the typical reader. METHODS Using the Ober2, an infrared monitoring device that accurately tracks eye movements, we measured the eye movements of 59 students. The Ober2 calculates reading speed, number of fixations per 100 words, number of words seen in each fixation, number of regressions per 100 words, and duration of fixation. Comprehension was assessed with ten detailed true or false questions. RESULTS One group of the students (n = 25) participated in a speed reading class; the other group (n = 34) did not. After completion of the course, all 59 were re-measured on the Ober2. The speed-reading group improved significantly in five of the six aspects tested. Comprehension for the speed reading group showed an insignificant decrease. CONCLUSIONS We conclude that measurable changes in reading eye movements accompany successful completion of a speed-reading course.

VERTICAL-HORIZONTAL DIFFERENCES IN VISUAL SPACE RECOGNITION OF AMERICANS AND JAPANESE: 2:00 pm (BV-305)

This study compared two different written language groups, Americans and Japanese. Interestingly, Japanese can be written and read ether vertically or horizontally, but English can be done only horizontally. Since vision is a learned process, especially skilled reading is highly automated process, we suspected that Japanese would have more effective vertical visual recognition process than would Americans. In order to examine our hypothesis, three tasks were designed as follows. Card task 1 was oral reading task. Card task 2 was searching and counting task without vocalization process. Computer task was letter recognition on a computer monitor. All three tasks had two types of trials, vertical and horizontal. 25 American and 28 Japanese subjects were involved in this study. The results of card task 2 supported our assumption that Japanese had more effectiveness in vertical task and Americans had more effectiveness in horizontal task with significant difference.