Developmental eye movement test: What is it really measuring?

Purpose. The Developmental Eye Movement (DEM) test is commonly used as a clinical visual-verbal ocular motor assessment tool. However, while the DEM test ratio has been reported to correlate with horizontal saccadic eye movements, there have been no published comparative studies of the DEM test and objective eye movement measures. The aim of this study was to compare DEM test performance with explicit quantification of saccadic eye movements, reading performance, symptomatology and visual processing speed, to assess the validity of the DEM test in clinical practice. Methods. One hundred fifty-eight children aged 8 to 11 years completed the DEM test and a battery of eye movement tasks, recorded by a Microguide 1000 infrared eye tracker. All subjects completed a symptomatology survey. Reading performance and visual processing data was collected for 77 and 75 children, respectively. Results. One hundred twenty-nine of the 158 subjects (81.65%) passed the DEM test. There was no significant correlation between any component of DEM test performance and quantitative eye movement parameters (gain, latency, asymptotic peak velocity, and number of corrective saccades) or symptomatology. There were significant correlations between DEM test outcome and reading performance, and with visual processing speed. Conclusions. DEM test performance does not correlate with saccadic eye movement skills or symptomatology. However, it is related to reading performance and visual processing speed. This study suggests that although DEM test times may not correlate directly with eye movement parameters, they do correlate with aspects of reading performance and thus may serve a diagnostic role in clinical practice. © 2009 American Academy of Optometry

Papua New Guinea vision-specific quality of life questionnaire: A new patient-reported outcome instrument to assess the impact of impaired vision

Background: The aim of this study was to develop and validate a new vision-specific quality of life (VS QoL) instrument and to assess the impact of vision impairment and eye disease on the quality of life of adults in Papua New Guinea (PNG). Design: This study was designed as community based cross-sectional. Participants: Six hundred fourteen adults aged 18 and above were included in this study. Methods: Focus groups and interviews guided development of a 41-item instrument. Two valid subscales of the instrument were obtained using pilot data after an iterative item reduction process guided by Rasch-based parameters. The person measures (in logits) of 614 participants were used to assess quality of life using univariate and multivariate regression analysis. Main Outcome Measures: Rasch logits. Results: Rasch analysis confirmed a 17-item instrument containing an 8-item activity limitation subscale and a 9-item well-being subscale. Both subscales were unidimensional and demonstrated good fit statistics, measurement precisions and absence of significant differential item functioning. A consistent deterioration in vision-specific quality of life was independently and significantly associated with levels of vision. Severity of vision impairment and ocular morbidity were independently associated with activity limitation and emotional well-being. Participants with refractive error had lower quality of life score than those with no ocular abnormality but higher score than those with cataract and other eye diseases. Conclusions: The 17-item PNG-VS QoL instrument is a valid and reliable instrument for the assessment of impact of impaired vision on quality of life in PNG. Vision-specific quality of life was significantly worse among participants who were older and less-educated, had lower income and have had ocular morbidities

Utility and uncorrected refractive error

Purpose: To investigate utility (a preference-based quality of life [QoL] measure) associated with uncorrected refractive error (URE). Design: Cross-sectional study. Participants: A cohort of 341 consecutive patients 40 to 65 years of age with refractive error and no ocular disease impairing vision worse than 20/25 (0.1 logarithm of the minimum angle of resolution [logMAR] units) in the better eye. Without vision correction, 30 had no vision impairment, 65 had only distance vision impairment (DVI), 97 had only near vision impairment (NVI), 112 had moderate amounts of both distance and near vision impairment (DNVI), and 37 had severe impairment (distance or near worse than 20/200 [>1.0 logMAR]) in the better eye. Methods: All participants underwent a comprehensive eye examination with refraction, aided and unaided visual acuity (VA) at 6 m and 40 cm, and ocular health assessment. Utilities were elicited for a number of scenarios using a standardized, face-to-face time trade-off (TTO) interview method. Main Outcome Measures: The main outcome measure was TTO utility for the participant's own uncorrected vision state. Utilities ranged from 0 to 1, where 0 = death and 1 = perfect vision, and were scaled to account for comorbidities so that 1 = perfect health (adjusted utility). Results: Unaided VA was 0.50±0.24 logMAR at distance in the DVI group, 0.43±0.17 logMAR at near in the NVI group, and 0.72±0.36 and 0.56±0.29 at distance and near, respectively, in the DNVI group. Adjusted utilities for the 3 groups were 0.82±0.16 in the DVI group, 0.81±0.17 in the NVI group, and 0.68±0.25 in the DNVI group. The DVI and NVI group utilities (adjusted and unadjusted) did not differ significantly (P = 0.73 and P = 0.77, respectively). The DNVI utility was significantly worse than that of the DVI and NVI groups (adjusted and unadjusted, P<0.01). Conclusions: The URE is associated with measurable reductions in utility (and therefore QoL). Reductions are similar regardless of whether near or distance vision is impaired, but worse when both are impaired. The results underscore the significance of the effect of URE on QoL, particularly with respect to uncorrected presbyopia, which has been a relatively neglected area in research and policy. The utility figures in this study can be used as inputs for cost-effectiveness studies relating to URE to assist resource allocation decisions. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology

Potential Lost Productivity Resulting from the Global Burden of Myopia: Systematic Review, Meta-analysis, and Modeling

Purpose: We estimated the potential global economic productivity loss resulting from vision impairment (VI) and blindness as a result of uncorrected myopia and myopic macular degeneration (MMD) in 2015. Clinical Relevance: Understanding the economic burden of VI associated with myopia is critical to addressing myopia as an increasingly prevalent public health problem. Methods: We estimated the number of people with myopia and MMD corresponding to critical visual acuity thresholds. Spectacle correction coverage was analyzed against country-level variables from the year of data collection; variation in spectacle correction was described best by a model based on a human development index, with adjustments for urbanization and age. Spectacle correction and myopia data were combined to estimate the number of people with each level of VI resulting from uncorrected myopia. We then applied disability weights, labor force participation rates, employment rates, and gross domestic product per capita to estimate the potential productivity lost among individuals with each level and type of VI resulting from myopia in 2015 in United States dollars (US$). An estimate of care-associated productivity loss also was included. Results: People with myopia are less likely to have adequate optical correction if they are older and live in a rural area of a less developed country. The global potential productivity loss associated with the burden of VI in 2015 was estimated at US$244 billion (95% confidence interval [CI], US$49 billion–US$697 billion) from uncorrected myopia and US$6 billion (95$2 billion—US$17 billion) from MMD. Our estimates suggest that the Southeast Asia, South Asia, and East Asia Global Burden of Disease regions bear the greatest potential burden as a proportion of their economic activity, whereas East Asia bears the greatest potential burden in absolute terms. Conclusions: Even under conservative assumptions, the potential productivity loss associated with VI and blindness resulting from uncorrected myopia is substantially greater than the cost of correcting myopia

IMI impact of myopia

The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden

Improving population-level refractive error monitoring via mixture distributions

Introduction: Sampling and describing the distribution of refractive error in populations is critical to understanding eye care needs, refractive differences between groups and factors affecting refractive development. We investigated the ability of mixture models to describe refractive error distributions. Methods: We used key informants to identify raw refractive error datasets and a systematic search strategy to identify published binned datasets of community-representative refractive error. Mixture models combine various component distributions via weighting to describe an observed distribution. We modelled raw refractive error data with a single-Gaussian (normal) distribution, mixtures of two to six Gaussian distributions and an additive model of an exponential and Gaussian (ex-Gaussian) distribution. We tested the relative fitting accuracy of each method via Bayesian Information Criterion (BIC) and then compared the ability of selected models to predict the observed prevalence of refractive error across a range of cut-points for both the raw and binned refractive data. Results: We obtained large raw refractive error datasets from the United States and Korea. The ability of our models to fit the data improved significantly from a single-Gaussian to a two-Gaussian-component additive model and then remained stable with ≥3-Gaussian-component mixture models. Means and standard deviations for BIC relative to 1 for the single-Gaussian model, where lower is better, were 0.89 ± 0.05, 0.88 ± 0.06, 0.89 ± 0.06, 0.89 ± 0.06 and 0.90 ± 0.06 for two-, three-, four-, five- and six-Gaussian-component models, respectively, tested across US and Korean raw data grouped by age decade. Means and standard deviations for the difference between observed and model-based estimates of refractive error prevalence across a range of cut-points for the raw data were −3.0% ± 6.3, 0.5% ± 1.9, 0.6% ± 1.5 and −1.8% ± 4.0 for one-, two- and three-Gaussian-component and ex-Gaussian models, respectively. Conclusions: Mixture models appear able to describe the population distribution of refractive error accurately, offering significant advantages over commonly quoted simple summary statistics such as mean, standard deviation and prevalence

How to improve influenza vaccine coverage of healthcare personnel

Abstract Influenza causes substantial morbidity and mortality worldwide each year. Healthcare-associated influenza is a frequent event. Health care personnel (HCP) may be the source for infecting patients and may propagate nosocomial outbreaks. All HCP should receive a dose of influenza vaccine each year to protect themselves and others. This commentary will discuss the study recently published in the IJHPR by Nutman and Yoeli which assessed the beliefs and attitudes of HCP in an Israel hospital regarding influenza and the influenza vaccine. Unfortunately, as noted by Nutman and Yoeli in this issue many HCP in Israel choose not to receive influenza immunization and many harbor misconceptions regarding their risk for influenza as well as the benefits of influenza vaccine. We also discuss proven methods to increase acceptance by HCP for receiving an annual influenza vaccine

An Optimized Chloroplast DNA Extraction Protocol for Grasses (Poaceae) Proves Suitable for Whole Plastid Genome Sequencing and SNP Detection

peer-reviewedBackground Obtaining chloroplast genome sequences is important to increase the knowledge about the fundamental biology of plastids, to understand evolutionary and ecological processes in the evolution of plants, to develop biotechnological applications (e.g. plastid engineering) and to improve the efficiency of breeding schemes. Extraction of pure chloroplast DNA is required for efficient sequencing of chloroplast genomes. Unfortunately, most protocols for extracting chloroplast DNA were developed for eudicots and do not produce sufficiently pure yields for a shotgun sequencing approach of whole plastid genomes from the monocot grasses. Methodology/Principal Findings We have developed a simple and inexpensive method to obtain chloroplast DNA from grass species by modifying and extending protocols optimized for the use in eudicots. Many protocols for extracting chloroplast DNA require an ultracentrifugation step to efficiently separate chloroplast DNA from nuclear DNA. The developed method uses two more centrifugation steps than previously reported protocols and does not require an ultracentrifuge. Conclusions/Significance The described method delivered chloroplast DNA of very high quality from two grass species belonging to highly different taxonomic subfamilies within the grass family (Lolium perenne, Pooideae; Miscanthus×giganteus, Panicoideae). The DNA from Lolium perenne was used for whole chloroplast genome sequencing and detection of SNPs. The sequence is publicly available on EMBL/GenBank

The evolution of rotating stars

First, we review the main physical effects to be considered in the building of evolutionary models of rotating stars on the Upper Main-Sequence (MS). The internal rotation law evolves as a result of contraction and expansion, meridional circulation, diffusion processes and mass loss. In turn, differential rotation and mixing exert a feedback on circulation and diffusion, so that a consistent treatment is necessary. We review recent results on the evolution of internal rotation and the surface rotational velocities for stars on the Upper MS, for red giants, supergiants and W-R stars. A fast rotation is enhancing the mass loss by stellar winds and reciprocally high mass loss is removing a lot of angular momentum. The problem of the ``break-up'' or $\Omega$-limit is critically examined in connection with the origin of Be and LBV stars. The effects of rotation on the tracks in the HR diagram, the lifetimes, the isochrones, the blue to red supergiant ratios, the formation of W-R stars, the chemical abundances in massive stars as well as in red giants and AGB stars, are reviewed in relation to recent observations for stars in the Galaxy and Magellanic Clouds. The effects of rotation on the final stages and on the chemical yields are examined, as well as the constraints placed by the periods of pulsars. On the whole, this review points out that stellar evolution is not only a function of mass M and metallicity Z, but of angular velocity $\Omega$ as well.Comment: 78 pages, 7 figures, review for Annual Review of Astronomy and Astrophysics, vol. 38 (2000

Single-male paternity in coelacanths

Latimeria chalumnae, a ‘living fossil,’ is of great scientific interest, as it is closely related to the aquatic ancestors of land-living tetrapods. Latimeria show internal fertilization and bear live young, but their reproductive behaviour is poorly known. Here we present for the first time a paternity analysis of the only available material from gravid females and their offspring. We genotype two L. chalumnae females and their unborn brood for 14 microsatellite loci. We find that the embryos are closely related to each other and never show more than three different alleles per locus, providing evidence for a single father siring all of the offspring. We reconstruct the father’s genotype but cannot identify it in the population. These data suggest that coelacanths have a monogamous mating system and that individual relatedness is not important for mate choice