Higher order aberrations,refractive error development and myopia control: a review

Evidence from animal and human studies suggests that ocular growth is influenced by visual experience. Reduced retinal image quality and imposed optical defocus result in predictable changes in axial eye growth. Higher order aberrations are optical imperfections of the eye that alter retinal image quality despite optimal correction of spherical defocus and astigmatism. Since higher order aberrations reduce retinal image quality and produce variations in optical vergence across the entrance pupil of the eye, they may provide optical signals that contribute to the regulation and modulation of eye growth and refractive error development. The magnitude and type of higher order aberrations vary with age, refractive error, and during near work and accommodation. Furthermore, distinctive changes in higher order aberrations occur with various myopia control treatments, including atropine, near addition spectacle lenses, orthokeratology and soft multifocal and dual-focus contact lenses. Several plausible mechanisms have been proposed by which higher order aberrations may influence axial eye growth, the development of refractive error, and the treatment effect of myopia control interventions. Future studies of higher order aberrations, particularly during childhood, accommodation, and treatment with myopia control interventions are required to further our understanding of their potential role in refractive error development and eye growth.     

Use of the Optomap with lid retraction and its sensitivity and specificity#

Background: Optomap uses the ultra‐wide field scanning laser ophthalmoscopy to provide retinal examination. It permits fundus examination without the use of a mydriatic, which is more comfortable for the patients. This paper determines the sensitivity and specificity of the Optomap for detecting retinal signs under non‐mydriatic conditions. Methods: Fifty‐four eyes identified with retinal/choroidal signs and eight normal eyes were recruited from 31 Hong Kong Chinese subjects. Photo‐documentation of fundal changes was obtained with the Optomap under non‐mydriatic conditions before a dilated fundus examination by a clinician using standard procedures. The eyelid was retracted using a cotton bud when necessary. Dilated fundus examinations were performed by another clinician using binocular indirect ophthalmoscopy and slitlamp biomicroscopy with a fundus lens. The Optomap images were evaluated by four other investigators under masked condition. The International Classification of Disease, Ninth Revision (ICD‐9‐CM) was adopted for recording retinal features. Screening results were compared with those obtained using the dilated fundus examination as the gold standard. Results: The cotton bud method for eyelid retraction showed an improvement in the area of retina that could be visualised. The sensitivity and specificity of the Optomap averaged 76.4 and 71.9 per cent, respectively. Some fundal signs were missed by all observers in the Optomap but not with the biomicroscope. These included white‐without‐pressure, lattice degeneration, paramacular drusen and pigmentary changes at central fundus. Conclusion: Optomap serves as a reliable screening tool for fundus examination especially because it covers a much wider area of the peripheral retina than other digital instruments for fundus photography.     

A conjoint appointment involving a nursing research management role

Elliot DJ. International Journal of Nursing Practice 1997; 3: 47–52
A conjoint appointment involving a nursing research management role
Nursing conjoint appointments have taken a number of different forms and included various hospital roles such as ward manager, educator and consultant. This paper discusses an appointment trialed at a lecturer/middle manager level with a functional hospital role of Assistant Director of Nursing (research). The hospital role included activities categorized as: research consultations; research proposal reviews; committee membership; and research project involvement. The academic activities included a half-time teaching load, student clinical placement supervision and thesis/treatise student supervision.
The development and implementation of the position, including background, role structure, appointment conditions and work practices are discussed. Issues that were highlighted during the 2 year trial included: the teaching load compared to reimbursement funding; the actual activities involved in the position; the level of appointment required to be most effective in the role; and concomitant university study by the appointee.     

A shot in the dark: the use of darkness to investigate visual development and as a therapy for amblyopia

Extended periods of complete darkness have long been used among other early experiential manipulations to explore the role of visual experience in the development of the visual pathways. In the last decade, short periods of darkness have been used to facilitate the imposition of different or conflicting visual input each day to explore the manner by which processes of perinatal development controlled by gene action are refined subsequently by visual experience. Very recently, periods of complete darkness of intermediate length (10 days) have been shown to promote very fast recovery from amblyopia induced by prior monocular deprivation (MD). When imposed immediately after a period of MD, in certain circumstances, darkness appears to insulate against the development of amblyopia. It is proposed that complete darkness may reverse maturation of many of the so‐called braking molecules in the visual cortex, so that it reverts to a more juvenile state.