Oftalmoscopia indireta: melhorar a visualização do fundo ocular sem dilatação

A observação do fundo do olho é um procedimento fundamental no exame visual realizado pelo Optometrista A oftalmoscopia indireta (OI) com lâmpada de fenda (LF) é o melhor complemento e/ou alternativa à oftalmoscopia directa com algumas vantagens relativamente a esta. A OI apresenta no entanto mais desafios que vão desde a escolha da lente certa até à execução do procedimento. Neste bloco formativo iremos abordar, na primeira parte, as particularidades teóricas da OI que vão desde a direcção da imagem até à escolha da lente e, na segunda parte, colocar em prática este conceitos. Os participantes serão divididos em grupos de 3 ou 4 elementos durante a parte prática

Imagiologia ocular: potencial de cada uma das técnicas para o optometrista

A imagem ocupa um papel fundamental na forma como o Optometrista exerce a sua actividade. Em último caso, não está registado implica não ter sido visto ou não ter sido comentado. Por outro lado o registo fotográfico das observações abre caminho à troca de conhecimento e esclarecimento de questões não só entre pares, mas também entre profissionais de outras áreas como é o caso da Oftalmologia. O objectivo desta apresentação é dar uma pequena visão geral das técnicas mais populares de imagiologia em oftalmologia/optometria e referir o potencial de cada uma delas. No final espera-se que os participantes sejam capazes de entender cada uma técnicas discutidas e tenham autonomia suficiente para decidir qual o equipamento que se adequa à sua prática diária

Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso

A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation

Visual status in a Portuguese population with intellectual disability

Background: Neurosensory deprivation associated with vision is a well-known fact in people with intellectual disability (ID). This work aims to report the visual status of a population with ID in Portugal. Methods: A vision screening protocol was conducted during two Special Olympics events. The vision protocol included personal medical history, ocular health evaluation, and clinical measures, such as visual acuity (VA), binocular vision, colour vision, refractive error, and intraocular pressure. This protocol was administered to 134 subjects. Results: Half of the subjects reported that they had never attended or they did not remember having attended a previous eye exam. Additionally, 10% of them had not attended an eye exam in the immediate past three years. Half the subjects failed the VA test and 13% presented moderate Visual Impairment (VI) (VA worse than 0.5 logMAR in the best eye). Manifest ocular deviation was found in 25% of the subjects and the most common ocular health dysfunction conditions were conjunctiva hyperaemia, meibomian gland dysfunction, and lens anomalies. Refractive error correction allowed a reduction in the level of moderate VI to 3.7%. Conclusions: The population analysed showed a poor eye care attendance rate and vision-related conditions are in agreement with previous reports. The development of national strategies to promote the awareness for routine eye care in people with ID and improving accessibility to eye care services may mitigate many of the most prevalent conditions encountered.ISA -Instituto Superior de Agronomia(undefined

Accommodative and binocular vision dysfunctions in a Portuguese clinical population

Article in Press, Available online 28 November 2021Background: Several studies have suggested that accommodative and non-strabismic binocular dysfunctions are commonly encountered in optometric practice. This study aims to verify whether these findings apply to a Portuguese clinical population. Methods: This study included consecutive nonpresbyopic subjects that came to two Portuguese optometric clinics over a period of six months. A complete visual exam was conducted and included the measurement of visual acuity (VA), refraction, near point of convergence (NPC), distance and near phoria, near and distance fusional vergences, amplitude of accommodation (AA), monocular accommodative facility (MAF), relative accommodation and lag of accommodation. Results: 156 subjects with a mean age of 24.9 ± 5.3 years (from 18 to 35 years old) participated in the study. Of all subjects, 32 % presented binocular vision and/or accommodative disorders accompanied or not by refractive errors. Moreover, 21.1 % had accommodative disorders, and 10.9 % had a binocular vision dysfunction. Accommodative insufficiency (11.5 %) was the most prevalent disorder, followed by convergence insufficiency (7.1 %) and accommodative infacility (5. 8 %). Conclusions: Clinicians should be aware that about one third of the optometric clinical population could have accommodative and/or non-strabismic binocular disorders. Accommodative insufficiency was the most prevalent dysfunction presented in the studied population, followed by accommodative infacility and convergence insufficiency.This work was supported by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2019

The attitude of visual impaired students towards STEM: a pilot study

Understanding and gathering information about the attitudes of visual impaired students concerning sciences, technology, engineering and mathematics (SSTEM) is an important issue for the school and for the teachers when planning inclusive classrooms in STEM context. With the purpose of accessing the way visual impaired students relate to S-STEM, a questionnaire was applied in two samples of students from Portugal and Greece. The influence of sex, academic level, country and type of vision impairment was evaluated as main factors using a factorial ANOVA. The analysis of the questionnaires showed that the academic level was the single factor with statistically significant effect on S-STEM. This drives to the conclusion that visual impaired students generally have a similar attitude towards S-STEM when comparing with other students.This work was partially funded and supported by ERASMUS+ Programme; School Education Strategic Partnership – KA201 Agreement Number: 2020-1-PT01-KA201- 078451. This work was partially funded and supported by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UIDB/04650/2020

Posterior chamber phakic intraocular lenses for the correction of myopia: factors influencing the postoperative refraction

Posterior chamber phakic intraocular lens implantation is a refractive technique for the correction of myopia. This study aimed to identify those factors contributing to variability in postoperative refraction. Methods: This retrospective study evaluated 73 eyes (one eye per patient) implanted with myopic implantable collamer lenses (ICL). Eyes were divided into two groups, the low myopic group (LMG) (ICL > −9.5 DS) and the high myopic group (HMG) (ICL ≤ −9.5 DS), to compare the predictability, efficacy index, and postoperative refraction between groups. The association of postoperative refraction with anatomical, demographic, and optical features was assessed through correlation analysis and investigated using ray-tracing. Results: Postoperative refraction at 3 months for the whole group was close to emmetropia at −0.02 ± 0.37 DS, the LMG tended toward myopia and the HMG, toward hyperopia. The results showed that 65% and 54% of the eyes had postoperative refraction of within ±0.25 DS, respectively, in the LMG and HMG, and in both groups, 100% were within ±1.00 DS. ICL implantation had a higher efficacy index in the HMG (1.13 ± 0.15) than in the LMG (1.04 ± 0.15). Postoperative refraction was positively associated with the vault (R = 0.408) and negatively correlated with ICL power (R = −0.382). Conclusion: The predictability and effectiveness of ICL implantation is high in a wide range of myopias. Considering the expected vault and including accurate vertex measurements would contribute to improving the predictability of the results

Biometric and ICL-related risk factors associated to sub-optimal vaults in eyes implanted with implantable collamer lenses

The data used in this study can be requested by contacting the corresponding author.Background: To identify biometric and implantable collamer lens (ICL)-related risk factors associated with sub-optimal postoperative vault in eyes implanted with phakic ICL. Methods: This study reports a retrospective case series of the first operated eye in 360 patients implanted with myopic spherical or toric ICL. Preoperatively, white-to-white (WTW), central keratometry (Kc) and central corneal thickness (CCT) were measured using the Pentacam. Anterior-segment optical coherence tomography (AS-OCT, Visante) was applied preoperatively for measuring the horizontal anterior-chamber angle-to-angle distance (ATA), internal anterior chamber depth (ACD), crystalline lens rise (CLR), anterior-chamber angle (ACA) and postoperatively the vault. Eyes were divided into three vault groups: low (LVG: ≤ 250 μm), optimal (OVG: > 250 and < 1000 μm) and high (HVG: ≥ 1000 μm). Multinomial logistic regression (MLR) was used to find the sub-optimal vault predictors. Results: MLR showed that CLR, ICL size minus the ATA (ICL size-ATA), age, ICL spherical equivalent (ICLSE) and ICL size as contributing factors for sub-optimal vaults (pseudo-R2 = 0.40). Increased CLR (OR: 1.01, CI: 1.00–1.01) and less myopic ICLSE (OR: 1.22, CI: 1.07–1.40) were risk factors for low vaults. Larger ICL size-ATA (OR: 41.29, CI: 10.57–161.22) and the 13.7 mm ICL (OR: 7.08, CI: 3.16–15.89) were risk factors for high vaults, whereas less myopic ICLSE (OR: 0.85, CI: 0.76–0.95) and older age (OR: 0.92, CI: 0.88–0.98) were protective factors. Conclusion: High CLR and low ICLSE were the major risk factors in eyes presenting low vaults. In the opposite direction, ICL size-ATA was the major contributor for high vaults. This relationship was more critical in higher myopic ICLSE, younger eyes and when 13.7 mm ICL were used. The findings show that factors influencing the vault have differentiated weight of influence depending on the type of vault (low, optimal or high)

Vault differences in eyes implanted with spherical and toric implantable collamer lenses: an inter-eye analysis

Purpose To determine the influence of implantable collamer lenses (ICL) geometry, i.e. spherical and toric on the vault, and report the refractive and visual outcomes of patients bilaterally implanted with the two ICL geometries. Methods: This retrospective case series analysed 41 patients implanted with a spherical ICL (sICL) in one eye and an equal sized toric ICL (tICL) in the fellow eye. The anatomical and ICL-related parameters were assessed using anterior-segment optical coherence tomography (AS-OCT Visante, Zeiss Meditec AG) and optical tomography (Pentacam, OCULUS). The influence of the anatomical and ICL-related parameters on the vault was determined using generalised estimating equations (GEE) to incorporate inter-eye correlations. Results: Postoperative spherical equivalent was within ± 0.50D in 66% and 83% of the eyes, respectively implanted with sICL and tICL. The efficacy index in the sICL group was 1.06 and 1.14 in the tICL group. The mean inter-eye vault difference was -1.46 µm, anatomical and ICL-related parameters showed similar associations with the vault for sICL and tICL. The GEE identified the ICL size minus the anterior chamber width, the ICL spherical power and ICL central thickness as significant factors influencing the vault. Conclusions: Spherical and toric ICL showed good efficacy for the correction of myopia and astigmatism. Patients implanted bilaterally with sICL and tICL tend to present similar vaults. The vault produced by both types of ICL was mainly regulated by the oversizing of the ICL. This suggests that the ICL geometry (spherical vs toric) is a factor with limited influence on the vault, thus the sizing method of a sICL and tICL should be similar

The influence of age, sex and visual dysfunction on reading ability in school-children

t. Binocular and accommodative dysfunctions affect the efficiency and coordination of the eyes, and this may impair reading performance. Reading can be evaluated using accuracy and speed measures. In this study, we searched for evidence that dysfunctions of accommodation (i.e. accommodation insufficiency, IA) and binocular vision (i.e. convergence insufficiency, CI) and also hyperopia have impact on reading ability. A sample of 292 children read a text following vision screening. The sample was composed of control children and children with the conditions: AI; CI and hyperopia. Multilinear regression analysis was used to evaluate the influence of variables sex, age and visual condition (control, AI, CI and hyperopia) on reading accuracy and speed. The results showed that ~7% of the variation in reading accuracy was explained by a model where age (p=0.001), and presence of AI (p<0.001) and hyperopia (p=0.019) were statistically significant. On the other hand, ~38% of the variation in the index of speed was explained by age alone (p<0.001). These results confirm the importance of age on children’s ability to read, and suggests that AI and hyperopia, but not CI may affect reading accuracy. Reading speed does not appear to be affected by the presence of binocular or accommodative dysfunction.This work was supported by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UID/FIS/04650/2013