The effect of sustained eye rotation upon eye length in healthy myopic adults

AIM: The aim of the study was to determine whether ocular movement can affect the shape of the globe and lead to measurable change in axial and peripheral eye length. METHODS: Ten subjects aged 18-30 years (6 M/4 F) participated with informed consent. The mean spherical equivalent refractive error was ≤-1.00 DS with cylindrical refraction &lt;-1.25 DC. One drop of tropicamide hydrochloride 1% was instilled 20 min before measurement to induce mydriasis and mild cycloplegia. Using IOLMaster, eye length was measured centrally and temporally (25° off-axis) in four different positions. Subjects then rotated their eyes 25° in the temporal direction to fixate on a target for 10 min. After that, the same measurements were repeated. RESULTS: Before rotation, the group mean peripheral eye length was significantly shorter than the central eye length (P &lt; 0.05). There was no significant variation in central or peripheral eye length due to off-axis fixation, either after the initial eye rotation or after fixation for 10 min at the off-axis point. The difference between central and peripheral eye lengths was maintained after 10 min of temporal fixation (P &lt; 0.05). CONCLUSION: Peripheral eye length was shorter than central eye length showing the prolate shape associated with myopia. The action of the extraocular muscles on the globe has no significant effect upon the retinal shape assessed by off-axis eye length measurement in myopic subjects.</p

Research Degree Regulations

Regulations for the Award of Research Degrees by Glasgow Caledonian University including Master of Philosophy, Professional Masters, Doctor of Philosophy and Professional Doctorat

Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment

BACKGROUND: Impairment of vision is associated with a decrease in activities of daily living. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age‐matched visually normal older people. Possible interventions to reduce activity restriction and prevent falls include environmental and behavioral interventions. OBJECTIVES: We aimed to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls and improving quality of life amongst visually impaired older people. SEARCH METHODS: We searched CENTRAL (including the Cochrane Eyes and Vision Trials Register) (Issue 2, 2020), Ovid MEDLINE, Embase and eight other databases to 4 February 2020, with no language restrictions. SELECTION CRITERIA: Eligible studies were randomized controlled trials (RCTs) and quasi‐randomized controlled trials (Q‐RCTs) that compared environmental interventions, behavioral interventions or both, versus control (usual care or no intervention); or that compared different types of environmental or behavioral interventions. Eligible study populations were older people (aged 60 and over) with irreversible visual impairment, living in their own homes or in residential settings. To be eligible for inclusion, studies must have included a measure of physical activity or falls, the two primary outcomes of interest. Secondary outcomes included fear of falling, and quality of life. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included six RCTs (686 participants) conducted in five countries (Australia, Hungary, New Zealand, UK, US) with follow‐up periods ranging from two to 12 months. Participants in these trials included older adults (mean age 80 years) and were mostly female (69%), with visual impairments of varying severity and underlying causes. Participants mostly lived in their homes and were physically independent. We classified all trials as having high risk of bias for masking of participants, and three trials as having high or unclear risk of bias for all other domains. The included trials evaluated various intervention strategies (e.g. an exercise program versus home safety modifications). Heterogeneity of study characteristics, including interventions and outcomes, (e.g. different fall measures), precluded any meta‐analysis. Two trials compared the home safety modification by occupational therapists versus social/home visits. One trial (28 participants) reported physical activity at six months and showed no evidence of a difference in mean estimates between groups (step counts: mean difference (MD) = 321, 95% confidence interval (CI) ‐1981 to 2623; average walking time (minutes): MD 1.70, 95% CI ‐24.03 to 27.43; telephone questionnaire for self‐reported physical activity: MD ‐3.68 scores, 95% CI ‐20.6 to 13.24; low‐certainty of evidence for each outcome). Two trials reported the proportion of participants who fell at six months (risk ratio (RR) 0.76, 95% CI 0.38 to 1.51; 28 participants) and 12 months (RR 0.59, 95% CI 0.43 to 0.80, 196 participants) with low‐certainty of evidence for each outcome. One trial (28 participants) reported fear of falling at six months, using the Short Falls Efficacy Scale‐International, and found no evidence of a difference in mean estimates between groups (MD 2.55 scores, 95% CI ‐0.51 to 5.61; low‐certainty of evidence). This trial also reported quality of life at six months using 12‐Item Short Form Health Survey, and showed no evidence of a difference in mean estimates between groups (MD ‐3.14 scores, 95% CI ‐10.86 to 4.58; low‐certainty of evidence). Five trials compared a behavioral intervention (exercise) versus usual activity or social/home visits. One trial (59 participants) assessed self‐reported physical activity at six months and showed no evidence of a difference between groups (MD 9.10 scores, 95% CI ‐13.85 to 32.5; low‐certainty of evidence). Three trials investigated different fall measures at six or 12 months, and found no evidence of a difference in effect estimates (RRs for proportion of fallers ranged from 0.54 (95% CI 0.29 to 1.01; 41 participants); to 0.93 (95% CI 0.61 to 1.39; 120 participants); low‐certainty of evidence for each outcome). Three trials assessed the fear of falling using Short Falls Efficacy Scale‐International or the Illinois Fear of Falling Measure from two to 12 months, and found no evidence of a difference in mean estimates between groups (the estimates ranged from ‐0.88 score (95% CI ‐2.72 to 0.96, 114 participants) to 1.00 score (95% CI ‐0.13 to 2.13; 59 participants); low‐certainty of evidence). One trial (59 participants) assessed the European Quality of Life scale at six months (MD ‐0.15 score, 95% CI ‐0.29 to ‐0.01), and found no evidence of a clinical difference between groups (low‐certainty of evidence). AUTHORS' CONCLUSIONS: There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self‐reported physical activity as outcome measures of reduced activity limitation. Future research should evaluate the acceptability and applicability of interventions, and use validated questionnaires to assess the adherence to rehabilitative strategies and performance during activities of daily living

IMI – industry guidelines and ethical considerations for myopia control report

PURPOSE. To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC). METHODS. Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments. RESULTS. The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed. CONCLUSIONS. Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.</p