Lynette Dias

Distress associated with prenatal screening for fetal abnormality

A theoretically-based, multivariate approach was used to identify factors associated with emotional distress for pregnant women undergoing maternal serum alpha fetoprotein (MSAFP or AFP) testing, used to detect abnormalities of the fetal brain and spinal cord. Participants were those who received normal results (N = 87). Study results supported the hypothesis that different factors would predict distress before and after testing. Satisfaction with information about testing predicted lower emotional distress early in the testing process; concerns about the child having other medical conditions and low-dispositional optimism predicted distress later. Study findings indicate that even in women who receive normal test results, AFP testing is associated with a modest degree of emotional disturbance which declines, but does not completely abate, after testing.

Myopia Progression in Children Wearing Spectacles vs. Switching to Contact Lenses.

Purpose. To investigate myopia progression in Correction of Myopia Evaluation Trial (COMET) participants who switched to soft contact lenses (CLs) vs. remained in spectacles after the clinical trial ended. Methods. Four hundred sixty-nine ethnically diverse, 6- to 11-year-old myopic children were randomly assigned to wear single vision lenses (SVLs) or progressive addition spectacle lenses (PALs) for 5 years as part of COMET. Afterwards they could choose another lens type, including CLs. Data in this article are from 286 participants who wore their original spectacle lenses for 6 years (n = 199) or wore CLs most or all the time between the 5- and 6-year visits (n = 87). Refractive error and axial length (AL) were measured after cycloplegia with 1% Tropicamide. The primary outcome was myopia progression between the 5- and 6-year visits. Two-year myopia progression was evaluated in a subset of 183 participants who wore the same lens type for an additional year. Myopia progression and AL were compared between the two lens groups using multiple linear regression. Results. Participants in the two groups were similar with respect to age, ethnicity, myopia at 5-years, accommodation and phoria, but more girls switched to CLs than remained in spectacles (p < 0.0001). Mean (±SD) myopia progression was higher (p = 0.003) after 1 year in the CL group [−0.28 ± 0.33 diopter (D)] than the spectacle group (−0.14 ± 0.36 D), and remained higher after 2 years in the 2-year subset (−0.52 ± 0.46 D vs. −0.25 ± 0.39 D, p < 0.0001). Results were similar after adjustment for related factors. No significant differences in AL were found between groups after adjustment. Corneal curvature remained unchanged in both groups. Conclusions. COMET children switching from glasses to CLs experienced a small, statistically significant but clinically inconsequential increase in myopia progression.

Visual activity and its association with myopia stabilisation

To evaluate the association between outdoor and nearwork activities at baseline and myopia stabilisation by age 15 in the Correction of Myopia Evaluation Trial (COMET).

The relationship between self-esteem of myopic children and ocular and demographic characteristics.

Purpose. To evaluate self-esteem and its relationship with various ocular and demographic characteristics in 469 myopic children participating in the Correction of Myopia Evaluation Trial (COMET), an ongoing, randomized, multicenter clinical trial designed to evaluate the effects of progressive addition lenses vs. single vision lenses on the progression of juvenile-onset myopia. Methods. Baseline data collection included demographic information, refractive error measurements, parent-reported myopia history, child-reported visual symptoms, and self-esteem in several areas (scholastic/athletic competence, physical appearance, social acceptance, behavioral conduct, and global self-worth) as measured by the Self-Perception Profile for Children. Univariate and multiple regression analyses were used to identify factors associated with self-esteem. Results. The Self-Perception Profile for Children is a reliable measure of self-esteem in COMET children as indicated by the high internal consistency reliabilities (0.74 to 0.81) obtained for the various domains. COMET children’s mean self-esteem scores ranged from 2.72 ± 0.69 for athletic competence to 3.36 ± 0.56 for global self-worth and were similar to normative samples. Multiple regression analyses showed that less symptomatic children had higher self-esteem in all areas (p < 0.05), except athletic competence, after adjusting for other ocular and demographic characteristics. Self-esteem also varied significantly by age, gender, and ethnicity (p < 0.05). Conclusions. Baseline self-esteem is associated with visual symptoms, age, gender, and ethnicity, but not with magnitude of refractive error. Follow-up reports will assess whether there are changes in self-esteem associated with myopia progression and lens assignment.

Myopia, contact lens use and self-esteem

To evaluate whether contact lens (CL) use was associated with self‐esteem in myopic children originally enrolled in the Correction of Myopia Evaluation Trial (COMET), that after 5 years continued as an observational study of myopia progression with CL use permitted.

Evaluating masking in a randomized, double-masked clinical trial in children with myopia.

Purposes. The purposes of this study were to evaluate the success of masking in the Correction of Myopia Evaluation Trial (COMET), a study designed as a randomized, double-masked clinical trial comparing the effect of progressive addition lenses (PALs) with single-vision lenses (SVLs) in slowing myopia progression among children and to investigate the impact of unmasking on the treatment effect. Methods. The success of masking of children and parents was assessed by questionnaires administered after the clinical trial results were reported and before families were informed of their childs lens assignment. Children and parents who correctly guessed their assignment with absolute or “pretty sure” certainty were considered as unmasked. The role of childrens age, gender, and ethnicity in unmasking was evaluated using logistic regression. The impact of unmasking on the treatment effect at 3 years was investigated using analysis of variance. The success of masking of the study optometrists was assessed by data collected at the childs follow-up visits. Results. Overall 93% (436 of 469) of the COMET children responded to the questions about lens assignment and certainty. Thirty-seven percent (163 of 436) of children met the criteria for being unmasked with similar results from the parents. The majority (91%) of the 163 “unmasked” children reported that their glasses were the main reason for lens identification. Although children 10 to 11 years at baseline became unmasked more often than did children 6 to 9 years (44% vs. 31%, p = 0.01), there was no difference between boys and girls becoming unmasked (p = 0.2). The treatment effect did not differ between the masked and unmasked children (p = 0.69). The study optometrists became unmasked for five children over the course of 3-year follow up. Conclusions. Masking was successfully maintained for the study optometrists and the majority (63%) of COMET children. Although some children were able to identify their lens assignment, the primary study outcome was not affected by unmasking.