Predicting subjective refraction with dynamic retinal image quality analysis

The aim of this work is to evaluate the performance of a novel algorithm that combines dynamic wavefront aberrometry data and descriptors of the retinal image quality from objective autorefractor measurements to predict subjective refraction. We conducted a retrospective study of the prediction accuracy and precision of the novel algorithm compared to standard search-based retinal image quality optimization algorithms. Dynamic measurements from 34 adult patients were taken with a handheld wavefront autorefractor and static data was obtained with a high-end desktop wavefront aberrometer. The search-based algorithms did not signifcantly improve the results of the desktop system, while the dynamic approach was able to simultaneously reduce the standard deviation (up to a 15% for reduction of spherical equivalent power) and the mean bias error of the predictions (up to 80% reduction of spherical equivalent power) for the handheld aberrometer. These results suggest that dynamic retinal image analysis can substantially improve the accuracy and precision of the portable wavefront autorefractor relative to subjective refraction.The authors thanks to Dr. David Friedman (Wilmer Eye Institute, Johns Hopkins University School of Medicine) and his team for their help with study defnition and data acquisition. Eduardo Lage is funded by the Ramon y Cajal program from the Spanish Ministry of Economy, Industry and Competitivity (RYC-2016-21125). Carlos S. Hernandez, and Andrea Gil are funded by the Madrid Regional Government through IND2019/TIC-17116 and IND2020/TIC-17340 grants. Research relating to the autorefractor reported in this publication was partially support by the National Institute of Biomedical Imaging & Bioengineering and National Eye Institute of the National Institutes of Health under Award Numbers R43EB024299 and R44EY025452, respectivel

Vision difficulty and dementia: economic hardships among older adults and their caregivers

IntroductionLimited research has examined the economic impact of vision difficulty (VD) and dementia on older adults and their caregivers. We aimed to determine whether older adults with VD and/or dementia, and their caregivers, face more economic hardships than their counterparts without VD or dementia.MethodsWe used cross-sectional data from the 2015 National Health and Aging Trends Study (NHATS), a population-based survey of Medicare beneficiaries, linked to their family/unpaid caregivers from the National Study of Caregiving (NSOC). Regression models characterized the association of VD (self-report), dementia (survey and cognitive assessments), and co-occurring VD and dementia with debt, receiving financial help from relatives, government-based Supplemental Nutrition Assistance Program (SNAP), other food assistance, utility assistance, and caregiver financial difficulty.ResultsThe NHATS sample included 6,879 community-dwelling older adults (5670 no VD/dementia, 494 VD-alone, 512 dementia-alone, 203 co-occurring VD and dementia). Adults with VD and dementia had higher odds of receiving SNAP benefits (OR = 2.6, 95%CI = 1.4–4.8) and other food assistance (OR = 4.1, 95%CI = 1.8–9.1) than adults without VD/dementia, while no differences were noted for debt, financial help, and utility assistance. Adults with VD-alone had higher odds of debt (OR = 2.1, 95%CI = 1.3–3.2), receiving financial help (OR = 1.7, 95%CI = 1.1–2.5) and other food assistance (OR = 2.7, 95%CI = 1.7–4.3); while adults with dementia-alone had higher odds of debt (OR = 2.8, 95%CI = 1.4–5.5). The NSOC sample included 1,759 caregivers (995 caring for adults without VD/dementia, 223 for VD-alone, 368 for dementia-alone, and 173 for co-occurring VD and dementia). Compared to caregivers of older adults without VD/dementia, caregivers of adults with VD and dementia had higher odds of financial difficulty (OR = 3.0, 95%CI = 1.7–5.3) while caregivers of adults with VD-alone or dementia-alone did not.DiscussionWhile older adults with VD- or dementia-alone experienced increased economic hardships, disparities in food assistance were amplified among older adults with co-occurring disease. Caregivers of adults with co-occurring disease experienced more financial difficulty than caregivers of adults with a single or no disease. This study highlights the need for interventions across clinical and social services to support the economic wellbeing of our aging population and their caregivers

Investigation of the Accuracy of a Low-Cost, Portable Autorefractor to Provide Well-Tolerated Eyeglass Prescriptions: A Randomized Crossover Trial

Purpose: To compare patient preferences for eyeglasses prescribed using a low-cost, portable wavefront autorefractor versus standard subjective refraction (SR). Design: Randomized, cross-over clinical trial. Participants: Patients aged 18 to 40 years presenting with refractive errors (REs) to a tertiary eye hospital in Southern India. Methods: Participants underwent SR followed by autorefraction (AR) using the monocular version of the QuickSee device (PlenOptika Inc). An independent optician, masked to the refraction approach, prepared eyeglasses based on each refraction approach. Participants (masked to refraction source) were randomly assigned to use SR- or AR-based eyeglasses first, followed by the other pair, for 1 week each. At the end of each week, participants had their vision checked and were interviewed about their experience with the eyeglasses. Main Outcome Measures: Patients preferring eyeglasses were chosen using AR and SR. Results: The 400 participants enrolled between March 26, 2018, and August 2, 2019, had a mean (standard deviation) age of 28.4 (6.6) years, and 68.8% were women. There was a strong correlation between spherical equivalents using SR and AR (r = 0.97, P < 0.001) with a mean difference of −0.07 diopters (D) (95% limits of agreement [LoA], −0.68 to 0.83). Of the 301 patients (75.2%) who completed both follow-up visits, 50.5% (n = 152) and 49.5% (n = 149) preferred glasses prescribed using SR and AR, respectively (95% CI, 45.7–56.3; P = 0.86). There were no differences in demographic or vision characteristics between participants with different preferences (P > 0.05 for all). Conclusions: We observed a strong agreement between the prescriptions from SR and AR, and eyeglasses prescribed using SR and AR were equally preferred by patients. Wider use of prescribing based on AR alone in resource-limited settings is supported by these finding

Is Sensory Loss an Understudied Risk Factor for Frailty? A Systematic Review and Meta-analysis

[Abstract] Background. Age-related sensory loss and frailty are common conditions among older adults, but epidemiologic research on their possible links has been inconclusive. Clarifying this relationship is important because sensory loss may be a clinically relevant risk factor for frailty. Methods. In this systematic review and meta-analysis, we searched 3 databases for observational studies investigating 4 sensory impairments—vision (VI), hearing (HI), smell (SI), and taste (TI)—and their relationships with frailty. We meta-analyzed the cross-sectional associations of VI/HI each with pre-frailty and frailty, investigated sources of heterogeneity using meta-regression and subgroup analyses, and assessed publication bias using Egger’s test. Results. We included 17 cross-sectional and 7 longitudinal studies in our review (N = 34,085) from 766 records. Our cross-sectional meta-analyses found that HI and VI were, respectively, associated with 1.5- to 2-fold greater odds of pre-frailty and 2.5- to 3-fold greater odds of frailty. Our results remained largely unchanged after subgroup analyses and meta-regression, though the association between HI and pre-frailty was no longer significant in 2 subgroups which lacked sufficient studies. We did not detect publication bias. Longitudinal studies largely found positive associations between VI/HI and frailty progression from baseline robustness, though they were inconclusive about frailty progression from baseline pre-frailty. Sparse literature and heterogenous methods precluded meta-analyses and conclusions on the SI/TI–frailty relationships. Conclusions. Our meta-analyses demonstrate significant cross-sectional associations between VI/HI with pre-frailty and frailty. Our review also highlights knowledge gaps on the directionality and modifiability of these relationships and the impact of SI/TI and multiple sensory impairments on frailty

Vision Impairment and Cognitive Outcomes in Older Adults: The Health ABC Study.

BackgroundAn association between visual impairment and cognitive outcomes has been documented, but there is limited research examining this relationship using multiple measures of vision.MethodsParticipants included non-demented individuals in Year 3 of the Visual impairment was assessed using visual acuity, contrast sensitivity, and stereo acuity. Cognitive function was defined using the digit symbol test and the Modified Mini-Mental State Examination (3MS). Incident cognitive impairment was defined as a 3MS score <80 or a decline >5 points following Year 3. Linear mixed effects models examined longitudinal associations adjusting for year, age, sex, race, education, smoking, depression, diabetes, study site, as well as interaction terms between the vision parameters and years in study, between baseline age and years in study, and quadratic terms of baseline age and years in study. Discrete Cox regression models examined the risk of incident cognitive impairment.ResultsAnalyses included 2,444 participants (mean age = 74). Visual acuity, contrast sensitivity, and stereo acuity impairments were not associated with statistically significant changes in annual digit symbol test scores over 7 years of follow-up, as compared to those without these impairments. However, visual acuity, contrast sensitivity, and stereo acuity impairments were associated with greater declines in annual 3MS scores over 9 years. Participants with impaired visual acuity, contrast sensitivity, and stereo acuity had a greater risk of incident cognitive impairment.ConclusionsOur results suggest that visual acuity, contrast sensitivity, and stereo acuity impairments may be risk factors for cognitive decline

Innovation Competence of the Mathematics Teacher

У статті проаналізовано погляди вітчизняних та зарубіжних науковців на поняття «інноваційна компетентність учителя»; визначено поняття «інноваційна компетентність учителя математики» як складову загальної професійної компетентності та необхідну умову формування математичної компетентності, зміст якої зумовлюється особливостями інноваційної діяльності, її суспільною значимістю, творчим характером та спрямованістю на неперервне творення нового, розвиток особистісного й професійного потенціалу педагога; виділено концептуальні положення щодо аналізу структури та змісту цього поняття; виокремлено компоненти інноваційної компетентності вчителя математики та запропоновано напрями її набуття у процесі викладання дисциплін математичного циклу.The article analyzes the views of native and foreign scientists on the concept «innovation competence of the teacher», the concept «innovation competence of the mathematics teacher» is defined, the conceptual provisions concerning the analysis of the structure and content of this concept are described, the components of the innovation competence of the mathematics teacher are outlined and the directions of their formation in the teaching disciplines of mathematical cycle are proposed. The formation of future teachers of mathematics readiness to innovative pedagogical activity is an objective process of purposeful preparation for the creation, implementation and dissemination of educational innovations, which is based on: 1) the adaptation of students to higher education, the implementation of the principle of continuity between the older and the higher school, the formation of motivation of the students for professional activities; 2) maximum use of innovative techniques in the study of the disciplines of mathematical cycle, giving the educational process of students the creative, innovative character; 3) deepening integration of psycho-pedagogical and professional knowledge of future teachers of mathematics; application of innovative information technologies in the educational process; 4) the use of the system principle of training of future specialists in the design, development and partial validation of models of mathematics teacher’s work in the form of a common scheme or plan activities in the implementation of the educational process, based on the predominant activity of students, organized and created by the teacher; 5) the development and application of «prognostic acmeological training» of future teachers of mathematics to innovative pedagogical activity. The predictability of this preparation means its orientation to the school of the future taking into account the main trends in the development of technologies for teaching mathematics. Its implementation on a contextual basis provides a consistent use of all types of preparation of future teachers of mathematics. The innovative competence of teachers of mathematics is seen as part of general professional competence and the necessary condition for the formation of mathematical competence, the content of which is determined by the peculiarities of innovative activity, its social significance, creative nature and focus on continuous creation of something new, development of personal and professional potential of the teacher

Memory and Confusion Complaints in Visually Impaired Older Adults: An Understudied Aspect of Well-Being

Objective: To determine the prevalence of cognitive (memory or confusion) complaints in older adults with visual impairment (VI). Method: We assessed the relationship between VI (corrected visual acuity [VA] < 20/40) and self-reported confusion or problems with memory among participants aged 60 years to 85 years in the 1999-2006 cycles of National Health and Nutrition Examination Survey ( n = 5,795). Prevalence estimates of cognitive complaints were calculated using Current Population Surveys. Results: Memory/confusion complaints were reported in 22% of the VI group and 11% of the no VI group ( p < .001). In individuals aged ≥ 80 years, 30% of those with VI reported cognitive complaints, as compared with 19% with no VI ( p = .003). In fully adjusted models, individuals with VI were more likely (OR = 1.3, p = .049) to report cognitive complaints as compared with those without VI. Conclusion: Subjective reports of memory or confusion are highly prevalent in older individuals with VI

Comparison of self-refraction using a simple device, USee, with manifest refraction in adults

<div><p>Background</p><p>The USee device is a new self-refraction tool that allows users to determine their own refractive error. We evaluated the ease of use of USee in adults, and compared the refractive error correction achieved with USee to clinical manifest refraction.</p><p>Methods</p><p>Sixty adults with uncorrected visual acuity <20/30 and spherical equivalent between –6.00 and +6.00 diopters completed manifest refraction and self-refraction.</p><p>Results</p><p>Subjects had a mean (±SD) age of 53.1 (±18.6) years, and 27 (45.0%) were male. Mean (±SD) spherical equivalent measured by manifest refraction and self-refraction were –0.90 D (±2.53) and –1.22 diopters (±2.42), respectively (p = 0.001). The proportion of subjects correctable to ≥20/30 in the better eye was higher for manifest refraction (96.7%) than self-refraction (83.3%, p = 0.005). Failure to achieve visual acuity ≥20/30 with self-refraction in right eyes was associated with increasing age (per year, OR: 1.05; 95% CI: 1.00–1.10) and higher cylindrical power (per diopter, OR: 7.26; 95% CI: 1.88–28.1). Subjectively, 95% of participants thought USee was easy to use, 85% thought self-refraction correction was better than being uncorrected, 57% thought vision with self-refraction correction was similar to their current corrective lenses, and 53% rated their vision as “very good” or “excellent” with self-refraction.</p><p>Conclusion</p><p>Self-refraction provides acceptable refractive error correction in the majority of adults. Programs targeting resource-poor settings could potentially use USee to provide easy on-site refractive error correction.</p></div

Distribution of age, gender, handedness, ethnicity, and race among study participants (N = 60).

<p>Distribution of age, gender, handedness, ethnicity, and race among study participants (N = 60).</p

Distribution of visual acuity before and after refraction.

<p>Distribution of visual acuity before and after refraction.</p