The correlation between migraine headache and refractive errors.

Purpose. A literature review reveals historical references to an association between migraine headache and refractive errors, but a lack of scientific evidence relating to these claims. Methods. In a masked case-controlled study, we investigated the four aspects of refractive errors that have been implicated in the literature as correlated with migraine: spherical refractive error, astigmatic refractive error, anisometropia, and uncorrected ametropia. We also compared the calculated scalar value of refractive error, aided and unaided visual acuity, and spectacle use in migraine and control groups. We then investigated the relationship between refractive components and key migraine headache variables. Results. Compared with the control group, the migraine group had higher degrees of astigmatic components of refractive error assessed both objectively (C, p = 0.01; C0, p = 0.01; C45, p = 0.05) and subjectively (C, p = 0.03; C0, p = 0.03; C45, p = 0.05), uncorrected astigmatic components of refractive error (C0, p = 0.02; C45, p = 0.04), and anisometropia (p = 0.06). Conclusions. Perhaps the historical literature is indeed correct that low degrees of astigmatism and anisometropia are relevant in migraine. Our most significant finding was of higher degrees of astigmatism in the migraine group. This study does indicate that people who experience migraine headaches should attend their optometrist regularly to ensure that their refractive errors are appropriately corrected

Perimetry and migraine--deficits may not implicate glaucoma.

We read with interest the paper by Yenice et al. [5] regarding short wave length automated perimetry (SWAP) in patients with migraine. Yenice et al. studied 15 participants with migraine and 18 controls and suggest a link between migraine variables and glaucoma visual field indices. There remains debate about the vascular interaction at the optic disc in people with migraine and the evidence on the issue of co-morbidity, as Yenice et al. acknowledge, is conflicting. Yenice et al. used inclusion criteria that included no demonstrable glaucomatous optic disc characteristics and their participants had intra-ocular pressure between 10 and 15 mmHg. To find glaucomatous field losses in this group would be surprising

Frequency doubling technology perimetry and standard automated perimetry in migraine.

The literature suggests that visual field defects may be more common in people who experience migraine. The Humphrey frequency doubling (FDT) visual field instrument selectively examines the magnocellular visual pathway, but has not previously been used to investigate visual function in migraine. In a masked controlled study we compared Humphrey FDT and Humphrey Swedish Interactive Threshold Algorithm fields of 25 migraine sufferers with 25 age- and gender-matched controls. Although both mean deviation and pattern standard deviation were a little worse in the migraine group, these differences did not reach statistical significance. There were no inter-eye visual field differences in the migraine group compared with controls. Comparing the mean of all the contrast thresholds in each hemisphere, there were no more inter-hemifield visual field differences in the migraine group compared with controls. There was no significant difference between the migraine and control groups in intra-ocular pressures. The visual field parameters were not correlated with the interval since the last migraine headache, the severity of migraine headache, the duration of migraine headache or the number of migraine headaches per annum. In our data, there was no evidence of visual field deficits, a magnocellular deficit, or indications of glaucomatous pathology

The optometric correlates of migraine

Migraine is a common, chronic, multi-factorial, neuro-vascular disorder typically characterised by recurrent attacks of unilateral, pulsating headache and autonomic nervous system dysfunction. Migraine may additionally be associated with aura; those focal neurological symptoms that may precede or sometimes accompany the headache. This review describes the optometric aspects of migraine headache. There have been claims of a relationship between migraine headaches and errors of refraction, binocular vision anomalies, pupil anomalies, visual field changes and pattern glare. The quality of the evidence for a relationship between errors of refraction and binocular vision and migraine is poor. The quality of the evidence to suggest a relationship between migraine headache and pupil anomalies, visual field defects and pattern glare is stronger. In particular the link between migraine headache and pattern glare is striking. The therapeutic use of precision-tinted spectacles to reduce pattern glare (visual stress) and to help some migraine sufferers is described

Adherence, underperformed and overperformed test rates – Novel metrics for reporting compliance to clinical guidelines

Background: Compliance to guidelines ensures evidence-based care, critical to optimal patient outcomes. There is currently no common and comprehensive method of reporting compliance to guidelines across multiple ocular conditions. Moreover, IP optometrist activity has yet to be evaluated in this manner. This paper presents novel metrics to promote the standardised reporting of compliance to clinical guidelines. Methods: Three novel metrics were developed; adherence (A), overperformed test rate (OP), and underperformed test rate (UP). These metrics were used to evaluate 822 first patient appointments collected over the course of a year (Nov 2018 - Oct 2019) by four specialist IP Optometrists (Acute Primary Care Ophthalmology Service, Kent). Compliance across 76 quality indicators (recommended tests) covering history and symptoms, clinical signs, management, and prescribing decisions was measured against the College of Optometrists’ Clinical Management Guidelines. Results: The metrics (mean and range) are as follows. History and symptoms, A: 78.9% (range: 48–98%), OP: 6.9% (range: 0-13.7%) and UP: 14.2% (range: 1.2-4.5%). Clinical signs (tests undertaken), A: 93.8% (61-99%), OP: 2.8% (range: 0-14%) and UP: 3.4% (range: 0-28%). Management decisions, A: 69.6% (range: 61-100%), OP: 3.1% (0-12%) and UP 27.3% (range: 0-57%). Prescribing decisions, A: 92.1% (range: 61-100%), MOP: 0.9% (range: 0-5%) and UP: 7.1% (range: 0-35%). Conclusion: The three novel metrics provide a comprehensive method of reporting compliance to guidelines. IP optometrist activity appears largely compliant against CMG recommendations across 48 anterior ocular conditions. Further work is being undertaken to explore the relationship between clinical observations and decisions made by IP optometrists

Translational Learning with Orange Data Mining

Abstract for the e-NATCONPH 2021 (International Conference) TRANSLATIONAL LEARNING WITH ORANGE DATA MINING Raqib F 1, Dunne MCM 1*, Gurney JC2, Harle DE 3, Sivapalan T 2, Sabokbar N 2, Bhogal-Bhamra GK 1 1 Ophthalmic Research Group, Optometry School, Aston University, Birmingham, UK 2 Acute Primary Care Ophthalmology Service, West Kent CCG, Aylesford, UK 3 Acute Primary Care Ophthalmology Service, West Kent CCG, Tonbridge, UK *Corresponding author’s email ID: [email protected] BACKGROUND. Health Education England’s Topol Review has recommended preparation of clinicians for a digital future. Orange Data Mining software enables hands-on exposure of machine learning to practitioners that traditionally lack this training. PURPOSE. This case study presents a translational learning approach, used for teaching undergraduate optometrists, that includes (a) gathering clinical evidence (b) learning from the clinical evidence and (c) translation to evidence-based teaching and practice. METHODOLOGY In this approach, students are taught about research ethics before creating an Orange Data Mining canvas containing widgets to upload clinical data (File), remove missing data (Impute), assign variables (Select columns), carry out machine learning (Naïve Bayes and Logistic Regression), master cross validation and hyperparameter tuning (Test and score) before gaining new knowledge and clinical decision support (Nomogram). This is demonstrated with 1351 real clinical cases for determining the relative importance of clinical data, recommended by the College of Optometrists’ Clinical Management Guidelines, for investigating an anterior eye disease (uveitis). RESULTS. Students discover that Naive Bayes has higher informedness (96%) than tuned Logistic Regression (90%). The Naïve Bayes nomogram reveals the relative importance of the clinical symptoms and signs while the Logistic regression nomogram indicates possible redundancy. A presentation of acute unilateral discomfort and visual disturbance with mild red eye and anterior chamber inflammation results in 90% and 68% probabilities of uveitis according, respectively, to Naïve Bayes’ and Logistic Regression nomograms. CONCLUSION. Our students enjoy this translational learning approach and we ask if it might also be useful for training other health scientists. Key Words: Education, Health Sciences, Translational learnin

Technical note: A comparison of a novel direct ophthalmoscope, the Optyse, to conventional direct ophthalmoscopes.

Despite the current popularity of binocular indirect ophthalmoscopy, direct ophthalmoscopes are still commonly used by clinicians for fundus examination. They are considered to be expensive, however, and it has been suggested that this cost can prevent their use by healthcare professionals in developing countries. The OptyseTM Lens Free Ophthalmoscope is a novel direct ophthalmoscope, without a lens focus system, that allows for comparatively inexpensive manufacture and supply. We compared the clarity of view with the OptyseTM to that with standard direct ophthalmoscopes, over a sequential cohort of patients with a variety of refractive errors and ocular conditions. The grade of clarity of view with the OptyseTM Lens Free Ophthalmoscope was less than conventional ophthalmoscopes (Wilcoxon signed rank test, p < 0.0001). This grade of clarity of view was not associated with the ametropia of the ophthalmoscopic observation (Spearman r ≤ 0.03, p ≥ 0.28) but was with the presence of cataracts (χ2 test, p < 0.0001) with both the OptyseTM and the conventional ophthalmoscopes. Despite its limitations, the retinal view with OptyseTM was often within acceptable clinical limits suggesting that this relatively inexpensive ophthalmoscope may have a place when cost prohibits any other type of ophthalmoscope use