Joan K. Portello

Do progressing myopes show reduced accommodative responses

Refractive error and accommodative responsivity were monitored at 4-month intervals over a 1-year period to determine whether an increased lag of accommodation either precedes or accompanies the development of myopia. Accommodation was measured for stimulus levels of 2.5, 3, 4, and 5 D, and both the slope of the stimulus-response function and accommodative error were computed. Almost all subjects exhibited accommodative stimulus-response gradients close to unity, although a lower gradient was observed in subjects who were myopic upon entry into the study and whose ametropia remained stable. These stable myopes also exhibited the largest lag of accommodation. These findings do not support the proposal that the development of myopia in young adults is accompanied by a reduced accommodative response during nearwork.

Computer‐related visual symptoms in office workers

Citation information: Portello JK, Rosenfield M, Bababekova Y, Estrada JM & Leon A. Computer‐related visual symptoms in office workers. Ophthalmic Physiol Opt 2012, 32, 375–382. doi: 10.1111/j.1475‐1313.2012.00925.x

Comparison of Clinical Techniques to Assess the Near Accommodative Response

Assessment of the accommodative response (AR) is an essential part of the optometric examination. This study compared a number of clinical procedures for determining the AR with the findings of an objective infrared autorefractor. First, the AR to a 2.5 D binocular stimulus was measured by dynamic retinoscopy (neutralization being obtained both with lenses and by varying the working distance), dynamic cross-cylinder (with and without fogging lenses), and a near red-green duochrome test. Second, the response to a monocular 2.5 D stimulus was examined using dynamic retinoscopy (neutralizing with lenses), dynamic cross-cylinder, and the red-green duochrome. Third, the monocular AR was examined with both red-green and blue-yellow near duochrome tests. Under binocular conditions, the mean ARs for all the tests were clinically equivalent. However, comparison with the findings from the objective autorefractor indicated that dynamic retinoscopy (where neutralization was obtained by varying the working distance) showed the closest agreement, whereas the two dynamic cross-cylinder procedures exhibited the greatest variability. For the monocular condition, the mean lag of accommodation observed with the autorefractor was significantly less than that observed with dynamic retinoscopy, the dynamic cross-cylinder, or the red-green duochrome. However, the blue-yellow near duochrome test did not provide a valid estimation of the AR. It is concluded that the technique of dynamic retinoscopy where the working distance is varied to obtain a neutral reflex should be the method of choice for the clinical assessment of the AR, because this procedure does not require the introduction of supplementary lenses, which may themselves alter the AR.

A comparison of symptoms after viewing text on a computer screen and hardcopy.

Citation information: Chu C, Rosenfield M, Portello JK, Benzoni JA & Collier JD. A comparison of symptoms after viewing text on a computer screen and hardcopy. Ophthalmic Physiol Opt 2011, 31, 29–32.

Blink Rate, Incomplete Blinks and Computer Vision Syndrome

Purpose Computer vision syndrome (CVS), a highly prevalent condition, is frequently associated with dry eye disorders. Furthermore, a reduced blink rate has been observed during computer use. The present study examined whether post task ocular and visual symptoms are associated with either a decreased blink rate or a higher prevalence of incomplete blinks. An additional trial tested whether increasing the blink rate would reduce CVS symptoms. Methods Subjects (N = 21) were required to perform a continuous 15-minute reading task on a desktop computer at a viewing distance of 50 cm. Subjects were videotaped during the task to determine their blink rate and amplitude. Immediately after the task, subjects completed a questionnaire regarding ocular symptoms experienced during the trial. In a second session, the blink rate was increased by means of an audible tone that sounded every 4 seconds, with subjects being instructed to blink on hearing the tone. Results The mean blink rate during the task without the audible tone was 11.6 blinks per minute (SD, 7.84). The percentage of blinks deemed incomplete for each subject ranged from 0.9 to 56.5%, with a mean of 16.1% (SD, 15.7). A significant positive correlation was observed between the total symptom score and the percentage of incomplete blinks during the task (p = 0.002). Furthermore, a significant negative correlation was noted between the blink score and symptoms (p = 0.035). Increasing the mean blink rate to 23.5 blinks per minute by means of the audible tone did not produce a significant change in the symptom score. Conclusions Whereas CVS symptoms are associated with a reduced blink rate, the completeness of the blink may be equally significant. Because instructing a patient to increase his or her blink rate may be ineffective or impractical, actions to achieve complete corneal coverage during blinking may be more helpful in alleviating symptoms during computer operation.

Blink patterns: reading from a computer screen versus hard copy.

Purpose Many subjects experience ocular and visual symptoms during computer use. Previous studies have reported a reduced blink rate during computer operation and suggested that this may account for some of the symptoms, particularly dry eye. However, these earlier investigations failed to include an appropriate control condition. To determine whether it is computer screen viewing that produces the change in blink rate, the present study compared blink patterns when reading from either a desktop computer monitor or a hard copy printed text under equivalent viewing conditions. Methods Subjects (N = 25) were required to perform a continuous 20-minute reading task from either a desktop computer screen or a printed hard copy page at a viewing distance of 50 cm. Identical text was used in the two sessions, which was matched for size and contrast. Target viewing angle and luminance were similar for the two conditions. Subjects were videotaped during the task to determine their blink rate and amplitude. Immediately after the task, subjects completed a questionnaire regarding ocular symptoms experienced during the trial. Results Mean blink rates for the computer and hard copy conditions were 14.9 and 13.6 blinks per minute, respectively (p = 0.58). However, a significantly higher percentage of incomplete blinks was observed for the computer condition (7.02 vs. 4.33%; p = 0.02). No significant correlation was found between the symptom score and the percentage of incomplete blinks. Conclusions When compared with an equivalent hard copy control condition, blink rates were not reduced during computer operation. It is proposed that the previously observed differences in blink rate are more likely to be produced by changes in cognitive demand rather than the method of presentation. However, a higher percentage of incomplete blinks was noted during computer operation, which may have been associated with visual fatigue.

Does the dynamic cross cylinder test measure the accommodative response accurately

BACKGROUND The dynamic cross cylinder (DCC) test is a standard clinical procedure used to assess the accommodative response (AR) subjectively. However, because of potential problems arising from the ambiguous stimulus conditions, it is unclear whether this test provides an accurate measure of the AR. The aim of this study was to compare clinical subjective findings with objective measurements of the AR. METHODS Subjective findings to a 2.50-diopter (D) accommodative stimulus obtained with the DCC test (without fogging lenses) were compared with objective measurements of the AR obtained with a Grand Seiko WAM 5500 optometer (RyuSyo Industrial Co. Ltd., Kagawa, Japan) in 25 young subjects. As spherical lenses were introduced to quantify the subjective finding, objective measures of the AR were also recorded through these lenses. RESULTS The mean AR recorded subjectively and objectively was 2.35 and 1.68 D, respectively (P < 0.0001). Of the 10 subjects who demonstrated a lead of accommodation subjectively, only 1 had a lead objectively. For the 8 subjects who showed a lag of accommodation subjectively, all had a lag objectively. Introducing lenses produced a significant change in the mean AR. CONCLUSION The subjective DCC test as performed here does not provide an accurate measurement of the AR to a near target in a young population. We recommend that alternative techniques such as using an objective, open-field optometer or Cross-Nott retinoscopy be adopted for determining the within-task AR.

Does prior instillation of a topical anaesthetic alter the pupillary mydriasis produced by tropicamide (0.5

Purpose:  It is common clinical practice to instill a topical anaesthetic prior to the instillation of a mydriatic agent into the eye. The main rationale for using the anaesthetic is to increase corneal permeability, so that more of the mydriatic agent reaches the receptor sites within the anterior chamber. It addition, as mydriatics generally cause stinging, prior use of an anaesthetic should reduce the degree of discomfort. The aim of the present study was to determine whether the efficacy of mydriasis produced by an antimuscarinic agent is enhanced by prior instillation of a topical anaesthetic.

Computer Vision Syndrome and Blink Rate

Wink glass to increase the blink rate while subjects read material from a computer screen. The device contains a polymer network liquid crystal film, mounted in a spectacle frame, which becomes opaque if the wearer does not blink within 5 s. The authors demonstrated that this apparatus produced a significant increase in blink rate and reduced ocular surface symptoms (light sensitivity, grittiness and pain or sore eyes) after a 20-min period of reading from a computer screen. The authors suggested that this device could reduce ocular and visual symptoms associated with computer vision syndrome (CVS). 2 In a similar experiment, we used an audible tone to stimulate voluntary blinking in 23 visually-normal subjects (mean age = 24.4 years) who read text aloud from a desktop computer screen at a viewing distance of 50 cm for a continuous 15-min period. The text comprised cognitively-demanding stories taken from the internet, presented in 12 point Times New Roman font. During the task, subjects were videotaped using a web camera to determine the mean blink rate. While the web camera was in clear view, subjects were not told that their blinks were being either monitored or recorded, since this may have produced conscious changes in this function. Subjects attended for two trials. In the first session, no instructions were given regarding blinking. In the second session, a web-based metronome program (www.webMetronome.com) was used to provide an audible beep every 4 s (i.e. 15 times/min) and subjects were instructed to blink their eyes each time they heard a beep. The order of the two sessions was randomized across the subjects. After each session, subjects completed a written questionnaire comprising 10 questions concerning the level of ocular and visual discomfort experienced during the computer

Multi‐meridional keratometry

During conventional keratometry, the two principal meridia are identified and measurements of the anterior corneal curvature determined along these orientations. However, in cases of corneal irregularity, the principal meridia may be difficult to identify. Accordingly, the present study sought to evaluate two alternative procedures which do not require identification of the principal meridia. Instead, measurements of anterior corneal curvature were determined along either three or four preselected meridia and subsequently converted into the standard format for measurements of anterior corneal curvature. The study was performed on 25 visually normal subjects and the results compared with conventional two meridian keratometry findings. No significant differences were observed between the mean findings for the three and four meridian techniques. Furthermore, both procedures gave comparable results to the conventional two meridian method. Accordingly, multi-meridional keratometry may be valuable in cases of irregular astigmatism, for example produced by keratoconus or scarred corneas, since measurements can be obtained without the necessity for identification of the principal meridia.