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British and Irish Orthoptic Journal
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2516-3590
Published by White Rose University Press Homepage  [4 journals]
  • Pilot Study Evaluating the Feasibility of Comparing Computer Game Play
           with Close Work During Occlusion in Children Aged 2–7 Years with
           Amblyopia

    • Abstract: Background/Aims: Computer games have been used to stimulate vision in amblyopia with varying degrees of success. The aim of this pilot study was to evaluate the feasibility of conducting a randomised controlled trial to test the effectiveness of computer game play compared to close work during occlusion treatment in children.Method: Children aged 2–7 years with amblyopia and no prior amblyopia treatment were invited to participate. Participants were randomised to a computer game group or close work group and asked to complete two hours occlusion per day, incorporating one hour of their allocated activity. LogMAR visual acuity (VA) was assessed before treatment commenced and after 7(±1) weeks. The same examiner, who was unaware of the allocated treatment, assessed the participant using the same VA test.Results: Eighteen participants (mean age of 4.2 ± 1.3 years) completed the study. After seven weeks the mean VA of the amblyopic eye in the computer game group improved by 0.147 ± 0.182 logMAR, and in the close work group improved by 0.181 ± 0.124 logMAR. The difference in VA improvement between the computer game and the close work groups was not statistically significant (F(1,32) = 3.71; p = 0.06).Conclusion: No significant difference was found in visual outcomes between the two groups, but a larger sample size would be needed to draw conclusions regarding the amblyopic population. Evaluation of the study design suggests it would be feasible to conduct a randomised controlled trial comparing computer games and close work during occlusion to determine if a significant difference in visual outcome exists. Published on 2019-07-04 11:28:48
       
  • Orthoptic Home Visits for Stroke Survivors: Results from a UK Professional
           Practice Survey

    • Abstract: Aim: Orthoptists are perhaps the only allied health profession without a standard home visits service in the UK, although it could arguably be of benefit to many orthoptic patients. The aim of this survey was to identify whether home visits are being offered, or have the potential to be offered, within the orthoptic profession.Method: A survey of the orthoptic professional body (BIOS) for the UK and Ireland was developed and data collected between January and March 2016. Descriptive analysis was used to report the quantitative findings. A thematic analysis approach was undertaken for the written responses within the free-text boxes of the survey.Results: 461 BIOS members responded to the survey (response rate of 30.7%). Ten hospital sites (3.7%) reported offering home visits, and 444 members (96.3%) reported that they do not offer home visits, with little desire or perceived need for such a service. Only certain patients reportedly meet requirements for an orthoptic home visit, including those unable to attend the hospital due to poor health, transport issues, reduced cognition, stroke and learning difficulties. Implementation barriers were reported including staff safety, assessment quality and cost.Conclusion: Home visits are infrequently conducted within the orthoptic profession. However, where offered, certain patient groups were suggested to benefit from this service when they cannot attend hospital and thus, home visits could present a viable means of providing equitable visual care. Future research is required to explore orthoptic home visits compared to other forms of rehabilitation, and address concerns from the orthoptic professional body. Published on 2019-06-27 08:59:47
       
  • Challenges of Eye Health Care in Children and Strategies to Improve
           Treatment Uptake: A Qualitative Study from the Perspective of Eye Care
           Professionals in the UK

    • Abstract: Follow up from universal vision screening at four to five years has been shown to be low in England, potentially increasing the risk of vision disorders not being treated. This study explores vision specialists’ views on the perceived barriers and facilitators encountered when engaging with parents and young children, and the strategies adopted to improve child/parent centred care. Fifteen semi-structured qualitative interviews were conducted with eye care professionals to explore perspectives on the challenges of treating children. Thematic analysis was performed to identify key barriers and the strategies eye care professionals adopt to enhance person-centred eye care when working with young children and their families. Two overarching themes were identified related to the professional-patient relationship. The first reflects the challenges which vision specialists experience when treating children, considering lack of eye health education and negative attitudes to diagnosis and treatment as major barriers. The second discusses the strategies adopted to tackle those barriers. Three strategies are proposed to enhance child-centred eye care: more eye health education, more personalised communication to enhance referral uptake and the development of better coordinated pathways of care between schools, communities and hospital services. Published on 2019-05-14 09:54:18
       
  • Ten Years On – A Survey of Orthoptic Stroke Services in the UK and
           Ireland

    • Abstract: Aim: In 2007 a national orthoptic survey identified poor provision of vision assessment for stroke survivors. The purpose of this study is to report a 10-year update of this survey to identify changes in clinical practice over recent years.Methods: An online practice survey of registered orthoptists (British and Irish Orthoptic Society, BIOS) was undertaken to scope vision services for stroke survivors.Results: At the time of this survey, there were 223 orthoptic departments and 227 stroke units in the UK and Ireland. 317 responses were received representing 178 orthoptic departments – an 80% response rate for orthoptic departments. Of the respondents, 92% reported having a stroke unit in their hospital. A stroke/vision service was provided by 98% of responding orthoptic departments for 77% of stroke units but with only half providing a vision service on the stroke unit. Only 33% of vision services were funded and funding remains the primary barrier to providing a stroke/vision service. About 85% of respondents were aware of the national clinical guidelines for stroke and the BIOS extended practice guidelines for stroke.Conclusions: There has been a positive increase in awareness of stroke-related visual impairment and a steady improvement in provision of eye care for stroke survivors. However, there remains a lack of provision of specialist vision services specifically on stroke units which infers a health inequality for stroke survivors who have visual impairment. Their visual impairments can remain undetected and thus undiagnosed and unmanaged due to unsatisfactory patient care. Published on 2019-05-08 07:37:11
       
  • Arguments for the Adoption of a Nystagmus Care Pathway

    • Abstract: Pathological nystagmus is a spontaneous oscillation of the eyes. It is a complex problem with many subtypes and causes ranging from the acute neurological emergency to chronic visual disorders. There is considerable variability in clinical management and patient experience across the UK. The Nystagmus Care Pathway (NCP) is a proposal to provide an evidence-based, consistent minimum standard of care across all eye services for patients with nystagmus. The NCP coordinates expertise from the various team members with a staged approach: 1) pathway entry; 2) nystagmus identification; 3) finding underlying causes/associations; 4) managing causes/associations; 5) managing the nystagmus and its effects; 6) support for patients and families; 7) pathway exit. Orthoptists are ideally placed to coordinate the NCP as they are trained in ocular motility and visual assessment. They are accustomed to providing continuity of care, multidisciplinary working and via the British and Irish Orthoptic Society (BIOS), they can provide consistency of care across the UK. Key performance indicators are proposed. Published on 2019-04-25 12:20:43
       
  • The Effects of Anisometropic Amblyopia on the FNS and TNO Stereotest
           Thresholds in Four- to Eight-Year-Olds

    • Abstract: Purpose: To investigate the relationship between stereoacuity and factors associated with anisometropic amblyopia in children aged 4–8 years.Method: 44 participants had their stereoacuity thresholds measured using the Frisby Near Stereotest (FNS) and the TNO Randot Stereotest (TNO). Participants were divided into anisometropic amblyopes and controls (normal uniocular visual acuity (VA) with or without glasses). FNS and TNO stereoacuity thresholds were compared based on different factors, which included interocular acuity difference (IAD), VA levels, and the degree of anisometropia.Results: All 44 participants achieved better stereoacuity with the FNS compared to the TNO (p = 0.045). The control group performed significantly better on the FNS (p = 0.012) and the TNO (p = 0.009) when compared with anisometropic amblyopes. The only statistically significant correlation was found between stereoacuity – as measured with FNS – and IAD (p = 0.009). However, the TNO showed a correlation in the presence of poor VA, larger IADs and a high degree of anisometropia.Conclusion: Stereoacuity thresholds are significantly affected by poor VA, large IAD and high degrees of spherical anisometropia when trying to distinguish the resolution of a target with the TNO yet the same factors do not appear to affect ability to distinguish the disparity of a target with the FNS. Controls also performed worse on the TNO. Published on 2019-04-25 12:12:51
       
  • Stiff-Person Syndrome: A Case Report and Review of the Literature

    • Abstract: Aim: To report a case of sudden onset vertical diplopia, blurred vision, and muscle spasms.Methods: This is a case report of a 57-year-old female who presented to the accident and emergency department with a one day history of vertical diplopia and a two week history of lower limb spasticity secondary to muscle spasms.Results: The patient had no significant medical or ocular history. Orthoptic investigation initially revealed a left inferior rectus (IR) underaction. Possible diagnoses at this point were thought to be isolated IR weakness, myasthenia gravis or skew deviation. An urgent MRI scan was arranged and blood tests were taken. MRI showed no abnormalities. Blood tests were normal, however, the acetylcholine receptor antibody serum test (ACH-R) was 0.43 nmol/L, which is at the high end of normal. At the follow-up visit, the IR weakness had deteriorated and the patient had also developed gaze-evoked nystagmus. An appointment with the neurologist and neuro-ophthalmologist was expedited. When the patient returned, she reported that her neurologist had diagnosed her with stiff-person syndrome (SPS). The patient had also developed a laterally alternating skew deviation and reported that she had undergone a course of intravenous immunoglobulin (IVIG). The patient was prescribed diazepam and gabapentin. Due to the lack of recovery, persistent diplopia and oscillopsia, monthly IVIG have been prescribed.Conclusion: There is currently a paucity of literature relating to ophthalmic problems with SPS and how they are best treated. Previous reports have established that there is a link with myasthenia gravis, with many patients going on to develop myasthenia. Treatment of SPS is lacking large evidence-based studies. However, treatment with muscle relaxants and anticonvulsants has provided a good outcome for some. Further research is required to develop an evidence-based approach to treating the ophthalmological problems patients with SPS experience. This case report highlights the importance and value of orthoptists in investigating and monitoring patients with stiff-person syndrome. Published on 2019-04-16 12:27:25
       
  • The Impact of Visual Field Loss on Driving Skills: A Systematic Narrative
           Review

    • Abstract: Purpose: To review the evidence on the impact of visual field loss on skills required for driving.Methods: A literature search was undertaken using a systematic approach. Papers within scope were identified by two independent reviewers, and papers were grouped into similar themes for discussion.Key findings: Evidence suggests that both binocular and monocular visual field defects have a negative impact on driving skills. Both central and peripheral cause difficulties, but the degree of impact is dependent on the defect severity and compensation ability. Many factors that affect compensation to visual field loss and the effects of visual field loss on driving skills are discussed, including cognitive status, age and duration of visual field loss. In summary, in central visual field loss compensation, strategies include reduction of overall driving speed; whereas, in peripheral field loss, increased scanning is reported to aid adaptation.Conclusions: For driving, there is evidence that complete and/or binocular visual field loss poses more of a difficulty than partial and/or monocular loss, and central defects cause more problems than peripheral defects. A lack of evidence exists concerning the impact of superior versus inferior defects. The level of peripheral vision loss that is incompatible with safe driving remains unknown, as compensation abilities vary widely between individuals. This review highlights a lack of evidence in relation to the impact of visual field loss on driving skills. Further research is required to strengthen the evidence to allow clinicians to better support people with visual field loss with driving advice. Published on 2019-04-16 12:17:31
       
  • The Test-Retest Variability of the COMPlog System in Participants with
           Induced Non-Normal Visual Acuity

    • Abstract: Aim: The aim of this study was to determine and compare test-retest variability (TRV) of the computerised visual acuity (VA) COMPlog system on participants with normal vision and non-normal vision induced by bangerter foils (BFs).Methods: Twenty adult volunteers with VA of 0.100 logMAR or better in each eye and no eye conditions were included. Monocular VA data using the COMPlog system under five conditions—with plain Plano glasses (visually normal condition) and four pairs of Plano glasses with BF strengths of 0.6, 0.3, 0.2 and 0.1 (induced non-normal vision conditions)—were collected on two separate visits. To reduce bias, the eye tested and order of the BFs assessed were randomised. Data comparison was analysed using 2-factor ANOVA and paired t-tests and Bland Altman analysis to assess TRV.Results: Mean VA score from the two visits was –0.072 ± 0.1 logMAR for Plano, 0.106 ± 0.1 logMAR for BF 0.6, 0.428 ± 0.1 logMAR for BF 0.3, 0.662 ± 0.09 logMAR for BF 0.2 and 0.850 ± 0.08 logMAR for BF 0.1. As BF density increased, VA score significantly worsened (p < 0.0001). Overall mean VA score from the first and second visit was 0.410 ± 0.4 logMAR and 0.379 ± 0.4 logMAR, respectively. This improvement was significant (p < 0.009). The 95% limits of agreement of the VA scores between testing conditions had a range of ±0.120 to ±0.220 logMAR.Conclusions: Increase in BF strength led to a worsened VA score. However, the COMPlog TRV under the visually normal and induced non-normal vision conditions were within a similar range (±0.120 to ±0.220 logMAR). VA significantly improved on the second visit, suggesting a possible learning effect, which could have a clinical impact. Published on 2019-04-11 12:54:39
       
  • Visual Profile of Children who Passed or Failed the UK School Vision
           Screening Protocol

    • Abstract: Background: We applied the National Screening Committee vision screening protocol [pass criterion monocular acuity ≤ 0.2 LogMAR in both eyes(BE)] to children four to five years old to investigate the visual profile of children who passed/failed. Previous studies have only evaluated those failing. The aim was to derive false positive and negative values, specificity/sensitivity of the vision screening protocol for detecting significant visual defects (strabismus and/or significant refractive error) and the utility of a ‘plus blur test’ in identifying hyperopia.Methods: Participants included 294 children (5.2 ± 0.4 yrs). In addition to the vision screening protocol (monocular acuity–3 m crowded Keeler LogMAR letters), acuities were recorded through +2.50D and +4.00D lenses and ocular alignment and cycloplegic refractive error were assessed. Using acuity measures, participants were classed as passing/failing the screening protocol. Each participant was also classed as having a strabismus and/or significant refractive error (hyperopia ≥ +4.00DS; myopia ≤ –0.50DS; astigmatism ≤ –1.50DC; anisometropia ≥ +1.50DS) or no significant visual defects.Results: Of the 284 children who completed all tests, 27.8% failed to achieve 0.2 LogMAR in BE. The acuity pass/fail criterion had a sensitivity of 70.4% and specificity of 82.2% for detecting strabismus and/or significant refractive error. Of those who failed, 51.9% (n = 41/79) had no strabismus and/or significant refractive error (false positives). Of those who passed, 7.8% (n = 16/205) had visual defects (false negatives). The ‘plus blur tests’ improved sensitivity in detecting significant refractive error (+2.50D & +4.00D 90.7%) but significantly reduced specificity (+2.50D = 65.2%; +4.00D = 60.9%).Conclusions: School-entry vision screening is reasonably sensitive and specific for detecting strabismus and/or significant refractive error. Most children with visions poorer than 0.2 LogMAR need refractive intervention, and the majority of the remainder are likely false positives for significant visual defects. One in 13 children who pass have either strabismus and/or significant refractive error (7.8%). The inclusion of a ‘plus blur test’ was not a useful addition to the vision screening protocol. Published on 2019-03-26 09:32:27
       
 
 
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