PURPOSE: We used a questionnaire to explore perceptions and clinical practice patterns of Korean pediatric ophthalmologists in terms of amblyopia.METHODS: From September to November 2018, we conducted a web-based questionnaire survey of 99 specialists of the Korean Association for Pediatric Ophthalmology and Strabismus who operated ophthalmology clinics in Korea. We received 56 responses (56.57%) and retrospectively analyzed the data.RESULTS: The average specialist age was 44.0 ± 9.7 years. The mean age of treated amblyopia patients was 3 to 5 years (69.6%); the most common amblyopia was refractive anisometropic amblyopia (75.0%). On average, treatment commenced at 4 years of age (53.6%); child and parent co-operation most significantly influenced treatment success (46.4%). The preferred test was cycloplegic refraction (96.4%) and the preferred treatment occlusion therapy (100%) with glasses correction (98.2%). Occlusion therapy was most commonly performed for 2 hours/day (69.6%); the minimum age for eyeglasses prescription was 2.10 ± 1.18 years. Only three respondents (5.36%) prescribed contact lenses and only one (1.79%) performed refractive surgery.CONCLUSIONS: In Korea, amblyopia treatment is based on occlusion therapy and glasses correction. However, the time of treatment commencement, the duration of occlusion therapy, and the glasses used for correction varied. It is necessary to develop guidelines for amblyopia treatment; these should reflect current medical conditions.
Amblyopia ; Child ; Contact Lenses ; Eyeglasses ; Glass ; Humans ; Korea ; Ophthalmology ; Parents ; Practice Patterns, Physicians' ; Prescriptions ; Refractive Surgical Procedures ; Retrospective Studies ; Specialization ; Strabismus ; Surveys and Questionnaires

PURPOSE: We developed a novel method for measurement of hyperacuity and verified the utility thereof.METHODS: We developed a three-dimensional (3D) hyperacuity test using a 3D liquid crystal flat screen, a left- and right-image polarized display, and liquid crystal shutter glasses. We tested the technique in three groups: normal (n = 48), with cataracts (n = 14), and with macular disease (n = 35). We used a chart consisting of five dots and a reference line. Of the five dots, one was variably shifted from the other dots. A chart was presented to one eye and the reference line or blank image to the other eye; a subject scored positive when the dot in the unusual position was recognized.RESULTS: Hyperacuity was measured in terms of the reference line seen by the reference eye (RR), a blank image seen by the reference eye (RB), the reference line seen by the contralateral eye (CR), and a blank image seen by the contralateral eye (CB). All test scores were significantly lower when the reference line was seen than not (RR vs. RB and CR vs. CB; p < 0.01, respectively). For the RR and CR tests, no significant difference was apparent between the normal and cataracts group (p = 0.553, p = 0.494) but such differences were evident between the normal and macular disease groups (p = 0.028, p = 0.002). Also, visualization of the reference line by the reference and contralateral eyes did not differ (p > 0.05).CONCLUSIONS: Measurement of hyperacuity using our new method was not affected by media opacity but was significantly affected by macular disease. Presentation of a reference line facilitated hyperacuity assessment.
Cataract ; Eyeglasses ; Glass ; Liquid Crystals ; Methods

BACKGROUND: To objectively investigate accommodative response to various refractive stimuli in subjects with normal accommodation. METHODS: This prospective, non-randomized clinical trial included 64 eyes of 32 subjects with a mean spherical equivalent −1.4 diopters (D). We evaluated changes in accommodative power, pupil diameter, astigmatic value, and axis when visual stimuli were applied to binocular, monocular (dominant eye, non-dominant eye, ipsilateral, and contralateral), and pinhole conditions. Visual stimuli were given at 0.25 D (4 m), 2 D (50 cm), 3 D (33 cm), and 4 D (25 cm) and accommodative response was evaluated using open view binocular autorefractor/keratometer. RESULTS: The accommodative response to binocular stimulus was 90.9% of the actual refractive stimulus, while that of the monocular stimulus was 84.6%. The binocular stimulus induced a smaller pupil diameter than did the monocular stimulus. There was no difference in accommodative response between the dominant eye and non-dominant eye or between ipsilateral and contralateral stimuli. As the refractive stimuli became stronger, the absolute astigmatic value increased and the direction of the astigmatism axis became more horizontal. Pinhole glasses required 10%–15% less accommodative power compared with the monocular condition. CONCLUSION: Binocular stimuli enable more precise and effective accommodation than do monocular stimuli. Accommodative response is composed of 90% true accommodation and 10% pseudo-accommodation, and the refractive stimulus in one eye affects the contralateral eye to the same extent. This should be taken into account when developing guidelines for wearing smart glasses while driving, as visual stimulation is applied to only one eye, but far distance attention is constantly needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03557346
Astigmatism ; Eyeglasses ; Glass ; Non-Randomized Controlled Trials as Topic ; Photic Stimulation ; Prospective Studies ; Pupil ; Telescopes*

PURPOSE: To evaluate the clinical features of unilateral amblyopia with myopic anisometropia at a tertiary center. METHODS: The medical records of 102 children wearing spectacles due to myopic anisometropia with an interocular difference in spherical equivalent (SE) ≥ 1.00 diopters (D) with a follow-up ≥ 1 year were reviewed. Patients were classified into mild or severe groups according to an interocular SE difference ≥ 3.00D. The frequency of amblyopia (interocular difference ≥ two lines of visual acuity [VA]) and response to patching, the magnitude of anisometropia, and the frequency of combined ocular or systemic disorders except refractive errors were compared between the two groups. The VA and refractive errors were measured four months and one year after spectacle correction and at the last follow-up. RESULTS: In all, 61 patients with mild myopic anisometropia and 41 patients with severe myopic anisometropia started to wear spectacles at a mean age of 5.2 years old and were followed-up during a mean period of 34.6 months. The frequency of amblyopia decreased more prominently in the mild group: 82.0% in the mild group vs. 92.7% in the severe group four months after spectacle correction and 45.9% in the mild group vs. 87.8% in the severe group at the last follow-up. At baseline, the mild group had anisometropia of 1.42 ± 0.66D, while the severe group had anisometropia of 5.47 ± 2.09D. The magnitude of anisometropia tended to increase by 0.42D but not significantly: +0.78D in the mild group and −0.02D in the severe group. More than half of the patients had combined disorders: 57.4% in the mild group and 53.7% in the severe group. CONCLUSIONS: Severe myopic anisometropic amblyopia at a tertiary center showed little improvement and the magnitude of anisometropia did not change.
Amblyopia ; Anisometropia ; Child ; Eyeglasses ; Follow-Up Studies ; Humans ; Medical Records ; Refractive Errors ; Visual Acuity

BACKGROUND: This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children. METHODS: A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7–11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates. RESULTS: Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores. CONCLUSIONS: VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.
Anesthesia, Local ; Anxiety ; Child ; Dental Anxiety ; Eyeglasses ; Glass ; Heart Rate ; Humans ; Needles ; Pain Perception ; Prospective Studies ; Pulpectomy ; Tooth Extraction ; Visual Analog Scale

OBJECTIVE: To determine whether the use of unique customized spectacles provided with modified side arms may be helpful in reducing benign essential blepharospasm (BEB) in patients describing periocular sensory tricks (ST). METHODS: A prospective descriptive study of patients with BEB with positive periocular or temporal region ST phenomenon response under the care of the Botox Clinic at Moorfields Eye Hospital, London, UK. Nine consecutive patients with BEB describing ST were recruited, and the disease frequency and severity were assessed with the Jankovic Rating Scale (JRS) and the Blepharospasm Disability Index (BSDI) before and after the use of the sensory trick frames (STF). RESULTS: A reduction in the score was noted in both severity (p = 0.0115) and frequency patterns (p = 0.0117) in the JRS in patients using the STF. A significant reduction of the BSDI score was also observed (p = 0.0314). CONCLUSION: All the patients selected and fitted with the STF had a reduction in spasms and related symptoms. This new device may be helpful in some selected BEB patients who previously responded positively to periocular pressure alleviating maneuvers.
Arm ; Blepharospasm ; Botulinum Toxins ; Dystonic Disorders ; Eyeglasses ; Humans ; Prospective Studies ; Spasm ; Temporal Lobe

Strabismus is a pathologic condition in which the eyes do not properly align with each other forming different images on the corresponding retinal points. Early diagnosis and appropriate management of strabismus in the sensitive period of visual maturation is critical for the development of normal binocular vision in children. Therefore, it is important to perform ophthalmologic examinations including cycloplegic refraction and ocular alignment as early as possible to detect risk factors for amblyopia and strabismus. Strabismus could also be a sign of intraocular pathology, brain diseases or myasthenia gravis which may require urgent treatment. Strabismus can be treated by surgical and non-surgical methods. The first step in the management of strabismus is to correct amblyogenic refractive errors and prescribe glasses if necessary. Bifocal lenses, prism glasses, occlusion therapy, and botulinum toxin injection could also be considered. Surgery is usually performed if non-surgical treatments are unsuccessful. Making an accurate diagnosis and setting practical goals and limitations of treatment is the key to success in the treatment of strabismus.
Amblyopia ; Botulinum Toxins ; Brain Diseases ; Child ; Diagnosis ; Early Diagnosis ; Eyeglasses ; Glass ; Humans ; Myasthenia Gravis ; Pathology ; Refractive Errors ; Retinaldehyde ; Risk Factors ; Strabismus ; Vision, Binocular

PURPOSE: To evaluate the clinical features of children with high hyperopia weaning with age. METHODS: The medical records of 203 children wearing spectacles due to hyperopia of +4.00 diopters (D) or greater in at least one eye based on the cycloplegic refraction and with follow-up for 3 years or more were reviewed. The patients were divided into those who showed a decrease in the spherical equivalent (SE) of 1.50 D or greater and those who maintained. The age of wearing spectacles, the magnitude of hyperopia, the angle of deviation, the ratio of accommodative-convergence to accommodation (AC/A), and the frequency of amblyopia and anisometropia were compared. RESULTS: Forty seven patients with decreased hyperopia and 156 patients with sustained hyperopia were included. The decreased-group started to wear spectacles later than the sustained-group (5.0 ± 2.3 years vs. 4.1 ± 2.4 years). The mean SE of the hyperopic eye in the decreased-group was significantly greater at the initial visit than in the sustained-group (6.29 ± 2.18 D vs. 5.47 ± 1.38 D); was identical at the 1 year follow-up (4.83 ± 1.72 D vs. 4.89 ± 1.55 D); and significantly lower at the last follow-up (3.15 ± 1.72 D vs. 4.65 ± 1.56 D). In the decreased-group, the mean hyperopia of 3.14 ± 2.02 D decreased during a mean period of 3.9 years, especially during the first year after spectacle correction. At baseline, the frequency and angle of esotropia at both distant and near with/without hyperopic correction was significantly larger in the sustained-group. The frequency of amblyopia and anisometropia and the AC/A were identical between the two groups, while the frequency of amblyopia at the last follow-up was significantly lower in the decreased-group. CONCLUSIONS: Some patients with hyperopia of +4.00 D or greater who had none or a small angle of esotropia and improved amblyopia showed a decrease in hyperopia with age.
Amblyopia ; Anisometropia ; Child ; Emmetropia ; Esotropia ; Eyeglasses ; Follow-Up Studies ; Humans ; Hyperopia ; Medical Records ; Weaning

OBJECTIVE: Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access.METHODS: In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty.RESULTS: No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P<0.01). No significant differences in the number of skin punctures or needle restrictions were observed between the groups.CONCLUSION: Our results indicate that smart-glasses may aid in ensuring ultrasound-guided peripheral venous access by reducing head movements.
Emergency Service, Hospital ; Eyeglasses ; Glass ; Head Movements ; Needles ; Pilot Projects ; Punctures ; Skin ; Ultrasonography ; Wireless Technology

This review gives an overview of the current multifocal intraocular lenses (IOLs) landscape, in terms of the technology, benefits, and limitations of different premium IOLs, as well as significant clinical outcomes. Cataract is the most common cause of visual impairment in older adults. From 1980, the number of blind and visually impaired people have decreased due to cataract surgery. As the number of surgical procedures increases every year, patient demands have also changed with many patients expecting excellent visual acuity without glasses. Multifocal IOLs can provide spectacle-independence for near, intermediate, and distant vision tasks. Multifocal IOLs can be classified into bifocal, trifocal, and extended depth of focus multifocal IOLs. The ultimate goal of multifocal lenses includes reduced incidence of photic phenomena, and improved uncorrected near, intermediate, and far visual acuities for those working with computers and smartphones, as well as no contrast sensitivity loss. Although some patients have issues with halos and glare, overall patient satisfaction and quality of life are generally high after multifocal IOL implantation. Careful patient selection should be made to satisfy different individual needs.
Adult ; Cataract ; Contrast Sensitivity ; Eyeglasses ; Glare ; Glass ; Humans ; Incidence ; Lenses, Intraocular ; Patient Satisfaction ; Patient Selection ; Presbyopia ; Quality of Life ; Smartphone ; Vision Disorders ; Visual Acuity