Compliance and Appropriateness of Driver Vision Regulations in Ireland

Driving is a highly complex task which relies heavily on vision for successful execution. There are currently 2,820,528 holders of driving licences in Ireland. Holders of a driving license must meet the standards for vision as set out by the Road Safety Authority Slainte agus Tiomáint document. Visual acuity and Visual Field measurements are specified as the minimum standard. If there is reason to believe that these measurements are inadequate, it is required that the subject undergo a more detailed examination. Currently, drivers must undergo a vision screening when applying for their first license, and additional vision screening is not required until they reach 70 years of age. During this interval, licenses have 10 yearly renewal intervals. It is well known that a person’s vision changes with age. These changes may be normal and age-related, or pathological and disease related. Either Way, these changes can have a significant detrimental effect on both unaided vision and corrected acuity, and therefore their ability to meet the driving standards (either with or without refractive aides). It is our aim to assess the vision of a sample population of drivers with respect to the current vision standards for driving, and to critically evaluate the appropriateness of the standards currently in place

Upper Gastrointestinal Endoscopy in Lumbini Medical College and Teaching Hospital

  Introduction: Upper gastrointestinal (UGI) endoscopy includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum, with real time assessment and interpretation of the findings encountered. An upper endoscopy is indicated in the diagnostic evaluation of signs and symptoms of a wide variety of gastrointestinal disorders. Besides there are some therapeutic implication of the endoscopy. This study was conducted to study the spectrum of diseases found during the upper gastrointestinal endoscopy in patient presenting in Lumbini Medical College and Teaching Hospital (LMCTH).   Methods: This was a retrospective observational study carried out in LMCTH. The endoscopic record book of the patients who underwent UGI endoscopy for various reasons from February 2011 to 2013 was analysed. The risk factor of smoking and alcohol was also included and analysed in the study.   Results: All together 550 upper GI endoscopy was performed in the two years. There were 290 males (52.72%) and females were 260 (47.38%). The mean age was 45.7 years (SD=17.9). Most of the patient belonged to the age group 41 to 80 years (71%). Among total patients, 209 (38%) of them were found to be macroscopically normal. Of those who had positive endoscopic findings; 165 (48.4%) had gastritis and 36 (10.6%) had duodenal ulcer, esophageal varices was in 30 (8.8%), gastric carcinoma in nine (2.6%) of cases. Cigarette smoking was significantly associated with the presence of peptic ulcer disease (p=0.01) and malignancy of gastrointestinal tract (p=0.03). Alcohol intake was non-significantly related to peptic ulceration (p=0.07) and malignancy of gastrointestinal tract (p=0.09).   Conclusion: Upper gastrointestinal endoscopy is a safe and useful procedure for investigating patients with gastrointestinal complains. Gastritis was the most common finding among the patients who had abnormal endoscopy followed by duodenal ulcer and esophageal varices

Smartphone Use as a Possible Risk Factor for Myopia

Clinical Relevance This study demonstrates an association between myopia and smartphone data usage. Youths now spend more time participating in near tasks as a result of smartphone usage. This poses an additional risk factor for myopia development/progression and is an important research question in relation to potential myopia management strategies. Background Children are now exposed to another possible environmental risk factor for myopia-smartphones. This study investigates the amount of time students spend on their smartphones and their pattern of smartphone usage from a myopia perspective. Methods Primary, secondary and third-level students completed a questionnaire exploring patterns of smartphone usage and assessing their attitudes towards potential myopia risk factors. Device-recorded data usage over an extended period was quantified as our primary and objective indicator of phone use. Average daily time spent using a smartphone was also quantified by self-reported estimate. Refractive status was verified by an optometrist. Results Smartphone ownership among the 418 students invited to participate was over 99%. Average daily smartphone data and time usage was 800.37 (+/-1299.88)MB and 265.16 (+/-168.02)minutes respectively. Myopic students used almost double the amount of smartphone data at 1130.71 (+/-1748.14)MB per day compared to non-myopes at 613.63 (+/-902.15)MB (P=0.001). Smartphone time usage was not significantly different (P=0.09, 12% higher among myopes). Multinomial logistic regression revealed that myopic refractive error was statistically significantly associated with increasing daily smartphone data usage (odds ratio 1.08, 95% CI1.03 to 1.14) as well as increasing age (odds ratio 1.09, 95% CI1.02 to 1.17) and number of myopic parents (odds ratio 1.55, 95% CI1.06 to 2.3). 73% of students believed that digital technology may adversely affect their eyes. Conclusion This study demonstrates an association between myopia and smartphone data usage. Given the serious nature of ocular health risks associated with myopia, our findings indicate this relationship merits more detailed investigation

Prevalence of Refractive Errors in Nepalese Children and Adults: A Systematic Review With Meta-Analysis

Clinical relevance: Country-specific estimates of the prevalence of refractive errors are important to formulate national eye health policies for refractive care services. Background: The purpose of this study was to systematically synthesise available literature and estimate the prevalence of refractive errors in the Nepalese population. Methods: PubMed, Scopus, and Web of Science databases were systematically searched for articles on refractive errors and presbyopia published in English language until 27 September 2022. Population and school-based quantitative, cross-sectional prevalence studies and Rapid Assessment of Avoidable Blindness survey repository data were included. The quality of the included studies was assessed using the Newcastle Ottawa scale adapted for cross-sectional studies. Data extraction was performed with consensus among the reviewers. Meta-analysis of the prevalence was performed using the Random effects model to estimate the pooled proportions. Results: A total of 38 studies with 101 701 participants were included: 18 studies in children (n = 31 596) and 20 in adults (n = 70 105). In children, the estimated pooled prevalence of overall refractive errors was 8.4% (95% CI: 4.8 to 12.9) with myopia, hypermetropia and astigmatism prevalent in 7.1% (95% CI: 3.7 to 11.4), 1.0% (95% CI: 0.7 to 1.3) and 2.2% (95% CI: 0.9 to 3.9), respectively. In adults, the prevalence of refractive errors, uncorrected refractive errors, and uncorrected presbyopia were 11.2% (95% CI: 8.0 to 14.9), 7.3% (95% CI: 5.4 to 9.5) and 78.9% (95% CI: 69.1 to 87.3), respectively. Conclusions: The pooled prevalence of refractive errors is relatively low while uncorrected refractive errors and presbyopia are high in Nepalese population suggesting a need for better access to refractive care services in the country. The paucity of quality evidence on prevalence of refractive errors, particularly in children, indicates a need for a well-designed population-based study to accurately estimate the current prevalence of refractive errors

Clinical Accuracy of the Nidek ARK-1 Autorefractor

Autorefractors are commonly used by eye care practitioners worldwide as a starting point for clinical prescribing and by researchers as an instrument to study development of refractive errors and accommodation. This study demonstrates that the Nidek ARK-1 provides a reasonable and repeatable estimate of refractive error

On the Road to Sustainability? A Review of a Half-Century of Biodiversity Conservation Successes in Nepal and Some Thoughts on Future Needs

We review the history, over the past half-century, of biodiversity conservation legislation and programs in Nepal. We especially consider how they have evolved in light of some earlier concerns resulting from, for example, the strict “fines and fences” conservation approaches first implemented in the 1970s, to pressing issues that emerged over time such as park-people and wildlife-human conflicts, poaching and illegal wildlife trade. We also consider how the implementation of international conservation agreements and demographic and political changes have affected conservation programs in Nepal. We finish by discussing conservation in the context of sustainable development and conclude with some thoughts on future research and managerial needs in a rapidly-changing world

Choroidal Thickness Profiles and Associated Factors in Myopic Children

SIGNIFICANCE: This study addresses the lack of choroidal thickness (ChT) profile information available in European children and provides a baseline for further evaluation of longitudinal changes in ChT profiles in myopic children as a potential biomarker for myopia treatment and identifying children at risk of myopic progression. PURPOSE: This study aimed to investigate ChT profiles and associated factors in myopic children. METHODS: Baseline data of 250 myopic children aged 6 to 16 years in the Myopia Outcome Study of Atropine in Children clinical trial were analyzed. Choroidal thickness images were obtained using swept-source optical coherence tomography (DRI-OCT Triton Plus; Topcon Corporation, Tokyo, Japan). The macula was divided into nine Early Treatment of Diabetic Retinopathy Study locations with diameters of 1, 3, and 6 mm corresponding to the central fovea, parafoveal, and perifoveal regions. Multiple linear regression models were used to investigate determinants of ChT. RESULTS: Choroidal thickness varied across themacular Early Treatment of Diabetic Retinopathy Study locations (P \u3c .001): thickest in the perifoveal superior region (mean ± standard deviation, 249.0 ± 60.8 μm) and thinnest in the perifoveal nasal region (155.1 ± 50.3 μm). On average, ChT was greater in all parafoveal (231.8 ± 57.8 μm) compared with perifoveal (218.1 ± 49.1 μm) regions except superiorly where the ChT was greater in the perifoveal region. Longer axial length and higher myopic spherical equivalent refraction were consistently associated with thinner ChT at all locations in the multiple linear regression models. Asian race was significantly associated with thinner ChT only at parafoveal and perifoveal superior regions after Bonferroni correction (P = .004 and P = .001, respectively). CONCLUSIONS: Choroidal thickness was thinnest in the nasal macular region and varied systematically across all macular locations, with axial length and spherical equivalent refraction being the strongest determinants of ChT. Longitudinal evidence will need to evaluate whether any differences in ChT profiles are predictive of myopic progression and to determine the role of ChT measurements in identifying myopic children most in need of myopia control treatment

Flash VEP in Clinically Stable Pre-Term and Full-Term Infants

Purpose Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age. Methods Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA). Results At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00–17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83–3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (β = −2.66, p = .003). Neither GA (β = 0.21, p = .28) nor BW (β = 0.001, p = .32) showed any relationship with P2 amplitude. Conclusions Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants

SubFoveal Choroidal Imaging in High Myopic Nepalese Cohort

Current image captioning models produce fluent captions, but they rely on a one-size-fits-all approach that does not take into account the preferences of individual end-users. We present a method to generate descriptions with an adjustable amount of content that can be set at inference-time, thus providing a step toward a more user centered approach to image captioning

Agreement Between Lea Symbols and Patti Pics Visual Acuity in Children and Adults

Patti Pics (PP) and Lea Symbols (LS) are commonly used by eye care practitioners worldwide. Although the relationship between the two tests is fairly well understood, the availability of different chart designs (single optotypes, multiple optotypes, multiple optotypes with crowding box) merits futher understanding. The purpose of this study is to explore the agreement between the acuity measures obtained with Patti Pics and Lea Symbols in children and adults and compare their performance with the Sloan Letter (SL) chart in adults. Methods: Monocular visual acuity was obtained from ninety-three 3 to 5-year-old children using Patti Pics and Lea Symbols. Acuities were also obtained from 113 adults using the same tests under identical conditions. Acuity results obtained with the pediatric tests were compared with the gold-standard Sloan Letter chart in adults. The Bland-Altman method was implemented to compare the level of agreement between tests. Results: Patti Pics yielded worse visual acuity than the Lea Symbols by approximately half a logMAR line in both children (mean difference: -0.07 § 0.07 logMAR,