Do the near computerised and non-computerised crowded Kay picture tests produce the same measure of visual acuity?

Aims: Apps have been developed to assess visual acuity (VA) on tablet computers. The aim of this study was to compare near VA scores using crowded Kay pictures on the iSight app and the printed crowded Kay picture test in amblyopic and typically developing children to determine whether the tests are clinically interchangeable. Methods: Fifty-seven participants (34 typically developing and 23 amblyopic children) aged 3–9 years had their uniocular near VA measured using computerised crowded Kay pictures on the iSight app for the iPad and the printed near crowded Kay picture test. Data were analysed to determine whether there was a significant difference between the two tests. Bland–Altman plots were constructed to assess how well the tests agreed with each other. Results: There was no significant difference between the two tests in all test conditions with the exception of the left eyes of typically developing children measured using the per line termination criteria ( p = 0.01). Bland–Altman analysis showed good agreement between the iSight app and near crowded Kay picture test. Conclusions: The results of the study indicate that near Kay pictures on the iSight app are clinically interchangeable with the traditional printed Kay pictures. These results compare well with other published studies comparing computerised vision tests with their traditional counterparts

Is the ‘Visual Fields Easy’ Application a Useful Tool to Identify Visual Field Defects in Patients Who Have Suffered a Stroke?

Aims: To determine the level of agreement between the visual Fields easy application (VFE) for iPad and a standard clinical test for assessing peripheral vision in stroke survivors. Study Design: This was a prospective cross-sectional study comparing the VFE application to the Humphrey Field Analyser (HFA) SITA Fast c30-2 program in identifying and diagnosing visual field defects post-stroke. Place and Duration of Study: The ophthalmic department at Imperial College Healthcare NHS Trust. Data collection was undertaken between January 2016 and August 2016. Methodology: A total of 50 participants with a diagnosis of stroke and a suspected visual problem were recruited to the study. Normative data was collected from 50 participants with no history of stroke or visual loss. Analysis comprised of comparing the extent of the visual field loss detected by both the VFE and HFA, and clinically assessing the results for normality. Results: Bland-Altman analysis demonstrated that with more severe visual field loss, the agreement between both modalities was found to decrease. There was a higher proportion of false negatives with the VFE compared to the HVF. The bias towards detecting more missed test locations with the VFE application compared to the HFA was 6% for the normal participants and 2% for the stroke participants. The limits of agreement between the two modalities were large; 20% and 40% for the normal and stroke participants respectively. The sensitivity of the VFE application to determine an abnormal visual field in comparison to HFA was 88% and specificity was 76% in the stroke cohort based upon a clinical impression of its findings. The majority of stroke participants (88%) found the VFE test more comfortable to perform. Conclusion: As a screening tool, the VFE application is quick and easy to administer, preferred by patients and has good sensitivity and specificity for detecting the presence of an abnormal visual field when compared to HFA. In patients with extensive visual field loss, the VFE may overestimate visual field reduction

The provision of patient information about nystagmus

Aims: The aims of this study were to evaluate the current provision of patient information about nystagmus in orthoptic clinics in the UK and Ireland and to develop a standardised information pack about nystagmus. Methods: A questionnaire was circulated to orthoptists in the UK and Ireland asking whether they had information to provide to patients with nystagmus, what was included in this information and how it could be improved. Orthoptists were also asked what should be included in a standardised information pack about nystagmus. Results: Two hundred and thirty three orthoptists completed the questionnaire. One-third of responding orthoptists did not have information to provide to patients with nystagmus. Most reported the information available to them included details of support services and physical symptoms. Including information about living with nystagmus at different ages and long-term prognosis were the most common suggestions to improve information about nystagmus. More than half of orthoptists selected all the suggested topics to be included in a standardised information pack, with support services and long-term prognosis most frequently selected. Conclusions: Only 67% of responding orthoptists had information about nystagmus to give to patients or their families. Ways to improve the current information and content considered important by orthoptists were taken into account to create a nystagmus information pack, which is now available online

Simulation of oscillopsia in virtual reality

Purpose: Nystagmus is characterised by involuntary eye movement. A proportion of those with nystagmus experience the world constantly in motion as their eyes move: a symptom known as oscillopsia. Individuals with oscillopsia can be incapacitated and often feel neglected due to limited treatment options. Effective communication of the condition is challenging and no tools to aid communication exist. This paper describes a virtual reality (VR) application that recreates the effects of oscillopsia, enabling others to appreciate the condition. Methods: Eye tracking data was incorporated into a VR oscillopsia simulator and released as a smartphone app – “Nystagmus Oscillopsia Sim VR”. When a smartphone is used in conjunction with a Google Cardboard headset, it presents an erratic image consistent with oscillopsia. The oscillopsia simulation was appraised by six participants for its representativeness. These individuals have nystagmus and had previously experienced oscillopsia but were not currently symptomatic; they were therefore uniquely placed to judge the app. The participants filled in a questionnaire to record impressions and the usefulness of the app. Results: The published app has been downloaded ~3700 times (28/02/2018) and received positive feedback from the nystagmus community. The validation study questionnaire scored the accuracy of the simulation an average of 7.8/10 while its ability to aid communication received 9.2/10. Conclusion: The evidence indicates that the simulation can effectively recreate the sensation of oscillopsia and facilitate effective communication of the symptoms associated with the condition. This has implications for communication of other visual conditions

A Retrospective Study of Orthoptic Students’ and Teaching Experience with the Introduction of Technology Promoting a Blended Learning Environment

Purpose: Evaluation of the students’ experience and academic achievements following the introduction of online learning. Methods and materials: In 2011, online learning activities were introduced in the teaching of the Research in Orthoptics module for final year undergraduate orthoptic students. The online learning activities were created and delivered in Moodle; an open-source online learning platform. Students from the academic year groups of 2012–13, 2013–14 and 2016–17 completed an online questionnaire. The questionnaire was divided into 6 categories (relevance, reflection, interactivity, tutor support, peer support and interpretation) with 4 questions within each category. A 5-point Likert scale was used to score each question. The sum of answers within each category ranged from 4 (negative perception) to 20 (positive perception). Student performance was assessed using the marks retrospectively for 2 years before online learning was introduced and when online learning was included. Results: Forty-two students replied to the questionnaire with a mean age of 23.0 ± 2.3 years (range 21–32). There were 38 females (90.5%) and 4 males (9.5%). Combining the 3 academic cohorts there was a significant difference between the 6 categories of the questionnaire (p < 0.0001). Three categories obtained the same high median score of 16: relevance (range 9–20), reflection (range 11–20) and tutor support (range 12–20). Peer support resulted in the lowest median score of 13. Separation of the three academic year cohorts’ revealed significant differences for tutor support (p = 0.03). The score increased from 16 in 2012–13 and 2013–14 to 18 in 2016–17. Significant differences were found between the marks for the cohorts from 2009–10 to 2016–17 (F7,245 = 5.07: p < 0.0001). The mean mark for year group 2009–2010 was significantly less compared to 2012–13 (p < 0.0001), 2014–15 (p = 0.01) and 2015–16 (p = 0.02) and year group 2011–12’s mark significantly less than 2012/13 (p = 0.001). Conclusions: Including online learning in the research module had a positive impact on the student experience, although more work needs to be done to improve peer support. Marks obtained by the orthoptic students have improved since the introduction of online learning suggesting that a mixture of teaching and learning methods is beneficial for students. However, more work needs to be done to provide teacher assistance in the design of online learning and blended learning approach

Three decades of volume change of a small greenlandic glacier using ground penetrating radar, structure from motion, and aerial photogrammetry

Glaciers in the Arctic are losing mass at an increasing rate. Here we use surface topography derived from Structure from Motion (SfM) and ice volume from ground penetrating radar (GPR) to describe the 2014 state of Aqqutikitsoq glacier (2.85 km2) on Greenland's west coast. A photogrammetrically derived 1985 digital elevation model (DEM) was subtracted from a 2014 DEM obtained using land-based SfM to calculate geodetic glacier mass balance. Furthermore, a detailed 2014 ground penetrating radar survey was performed to assess ice volume. From 1985 to 2014, the glacier has lost 49.8 ± 9.4 106 m3 of ice, corresponding to roughly a quarter of its 1985 volume (148.6 ± 47.6 106 m3) and a thinning rate of 0.60 ± 0.11 m a-1. The computations are challenged by a relatively large fraction of the 1985 DEM (∼50% of the glacier surface) being deemed unreliable owing to low contrast (snow cover) in the 1985 aerial photography. To address this issue, surface elevation in low contrast areas was measured manually at point locations and interpolated using a universal kriging approach. We conclude that ground-based SfM is well suited to establish high-quality DEMs of smaller glaciers. Provided favorable topography, the approach constitutes a viable alternative where the use of drones is not possible. Our investigations constitute the first glacier on Greenland's west coast where ice volume was determined and volume change calculated. The glacier's thinning rate is comparable to, for example, the Swiss Alps and underlines that arctic glaciers are subject to fast changes

Angiotensin II type 1 receptor antibodies in childhood kidney transplantation

Angiotensin II type 1 receptor antibodies (AT1 RAb) have emerged as non-HLA Ab present in patients with acute AMR and risk of graft loss. Furthermore, AT1 RAb have been shown to increase angiotensin II sensitivity which may play a role in the development of CVD and hypertension. Data on AT1 RAb in stable transplant recipients are lacking. The aim of this study was to analyze the levels of AT1 RAb in a cohort of stable patients after kidney transplantation (tx) in childhood. A cross-sectional study of 30 children (median age 14, range 3-19 yr, median time since tx five yr) and 28 adults who were transplanted in childhood (median age 26, range 20-40 yr, median time since tx 18 yr) transplanted between 1993-2006 and 1983-2002, respectively, was performed. Healthy controls were 51 healthy children (5-8 yr) and 199 healthy donors (median age 56.5 yr, range 42-83 yr). Plasma AT1 RAb were analyzed by immunoassay. Median total AT1 RAb IgG concentration was significantly higher in the pediatric-tx group as compared to the adult-tx group (40.0 and 10.95 U/mL, p < 0.0001). For both groups, the tx group showed higher levels: the pediatric-tx group vs. control group (40.0 vs. 13.3 U/mL, p = 0.0006) and the adult-tx group vs. adult control group (10.95 vs. 6.5 U/mL, p < 0.0001). Age was the strongest indicator of high levels of AT1 RAb IgG (p = 0.0003). AT1 RAb total IgG levels are significantly higher in a stable pediatric-tx cohort as compared to adult-tx patients and healthy controls of comparable age groups. The relevance of our findings in relation to age, time since tx, previous or future rejection, and CVD risk merits future studies