Effects of scleral contact lenses for keratoconus management on visual quality and intraocular pressure

Purpose: To evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. Methods: In a prospective case series a comparison was made between visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann Applanation Tonometer (GAT) before and after scleral CL wear. Results: The mean logMAR visual acuity improved from 0.2±0.25SD with glasses and 0.1 ±0.02SD with RGP, to -0.002±0.041SD when using the scleral CL (p<0.05). The mean IOP value before scleral CL wear was 12.93mmHg±2.20SD when measured with GAT and 7.85mmHg±2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg±2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ±2.40SD and the mean IOP measured with DT was 7.66mmHg±1.88SD. Therefore, during scleral CL wear, it was evidenced a small but statistically significant increase of the mean IOP value (1.01mmHg; p<0.01), with a reversion to values prior to application when scleral CL was removed. Conclusion: Scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. Even if it was evidenced a small increase of the mean IOP value during their wear, it may not be significant in otherwise healthy eyes. Statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap, that should be taken into account when there is a need to relate the DT values to the reference ones

Relational variables and psychological well-being in lesbian, gay, bisexual and transgender elders: A critical review

Only recently the psychological literature started paying more attention to lesbian, gay, bisexual and transgender (LGBT) elders, partly because of the methodological challenges that characterise the study of this population. This paper aims to research in depth the relational life of older LGBT adults and its impact on several fundamental processes such as coming-out and isolation, which in turn influence psychological well-being and physical health. When it comes to LGBT elderly, one of the main risk factors concerns the invisibility and marginalization in dealing with social and health care. On the other hand, the presence of a social support and care network is an important protective factor

Queer generativity in lesbian, gay, and bisexual older adults: Personal, relational, and political/social behaviours

Lesbian, gay, and bisexual (LGB) older adults may have had the opportunity to reflect on and process stressful life experiences, and they may be more inclined to practice queer generative behaviours aimed at strengthening sexual minority identities and supporting the sexual minority community. The present study explored the unique patterns of generativity practiced by 27 Italian LGB older adults (60 years and older) through semi-structured interviews. Using a constructive grounded theory approach, we identified three main forms of queer generativity: (a) personal, involving the reception of generativity from others, the redefinition of religious values, and adjustment to parenting styles according to one's LGB identity, motivated by a desire for personal growth; (b) relational, involving the provision of resources and the pursuit of a career that supports the LGBT+ community, motivated by a desire to care for others; and (c) political/social, involving the creation of new LGBT+ contexts and the transmission of knowledge and experiences to younger LGBT+ persons and allies, motivated by a desire to fight for LGBT+ rights. Queer generativity emerged as a community resilience strategy practiced by LGB older adults to cope with heterosexist and/or ageist social contexts. Implications for policy and community practice are discussed. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement

The Coming-Out Process in Family, Social, and Religious Contexts Among Young, Middle, and Older Italian LGBQ+ Adults

The coming out (CO) process is fundamental for identity integration among LGBQ+ people, and its impact can vary greatly depending on personal and contextual factors. The historical, cultural, and social contexts in which LGBQ+ people develop their sexual identity can mediate the relationship between CO and health outcomes. The present study aimed at clarifying the CO process in three generations of Italian LGBQ+ people (young adults: aged 20–40 years; middle adults: aged 41–60 years; older adults: aged 61–80 years) by providing data on: (a) sexual orientation milestones, such as age of first awareness, age of first self-label, and age of first CO, as well as the rate of disclosure during different life stages; (b) the rate and average age of CO to significant others; and (c) CO within the religious context and its effect on participants’ minority stress experiences. A total of 266 Italian LGBQ+ people participated in the study, with ages ranging from 20 to 80 years (M = 41.15, SD = 16.13). Findings indicated that, on average, the older adult group became self-aware, self-labeled, and disclosed their sexual identity at a significantly older age than the other groups. Older adults were also more Catholic and had CO more frequently to their Catholic community, relative to young and middle adults. CO within the Catholic context was associated with distal and proximal minority stressors, such as discrimination, vigilance, and internalized sexual stigma. Catholic community reactions to participants’ CO were distinguished through thematic analysis in three main types: unconditional acceptance, invitation to change, and open rejection. The present research extended current knowledge on CO and minority stress experiences in different generations of LGBQ+ people. Several differences emerged between generational groups on sexual orientation milestones, highlighting the potential impact of historical and cultural contexts in determining sexual minorities’ experiences related to sexual identity. It is recommended that mental health professionals working with LGBQ+ clients implement targeted interventions based on their clients’ multiple salient aspects, including age and religious background. Clinicians should also be aware of the potentially detrimental effects of CO within an unsupportive context, rather than encouraging CO tout court

Psychophysical Impact of COVID-19 Pandemic and Same-Sex Couples’ Conflict: The Mediating Effect of Internalized Sexual Stigma

Research on the effects of the COVID-19 pandemic on same-sex relationships is limited. The present study aimed at analyzing the association between the psychophysical impact of the COVID-19 pandemic and same-sex couples’ conflict, also considering the potential mediating effect of internalized sexual stigma (ISS). For this purpose, psychophysical challenges and couples’ conflict during the COVID-19 pandemic, ISS, age, biological sex, sexual orientation, relationship duration, religiosity, involvement in lesbian, gay, and bisexual (LGB) associations, sexual satisfaction, and interpersonal partner violence were assessed in an Italian sample of 232 LGB people engaged in a same-sex relationship (aged 18–45 years; Mage = 28.68, SD = 6.91). The results indicated that the psychophysical impact of the COVID-19 pandemic was significantly associated with couples’ conflict, and ISS mediated this relationship. Among the covariates considered, only sexual satisfaction was associated with couples’ conflict. The findings suggest that ISS, over and above the adverse effects of the COVID-19 pandemic on psychophysical health, triggered conflict within same-sex relationships. Studying the role of ISS in various relational and social contexts is important, as ISS may have an adverse effect on the mental health of sexual minority people. We recommend that more efforts be made to improve research on the LGB population during the public health response to the COVID-19 emergency, because the paucity of studies underlines the invisibility of this population in many domains, including the domain of romantic relationships. Implications and directions for future research are discussed

Sports as a risk environment: Homophobia and bullying in a sample of gay and heterosexual men

Research on bullying and homophobic bullying has mainly focused on school contexts, with little research in sports-related contexts. This study used a sample of 88 gay males and 120 heterosexual males between 18 and 36 years of age to examine the frequency of bullying experiences in Italian sports-related contexts. The results showed that gay men reported more frequent bullying and homophobic bullying than heterosexual men. Gay men reported dropping out of sports more frequently due to a fear of being bullied and greater familial pressure to conform to masculine-type sports. It is necessary to promote safer sports-related contexts for people who self-identify as a sexual minority

Coming-Out to Family Members and Internalized Sexual Stigma in Bisexual, Lesbian and Gay People

Coming out has been described as an essential component in the lesbian, gay, and bisexual identity development process and in the mental health of sexual minority people. This study investigated the coming out to family members in lesbian, gay, and bisexual people and analyzed the potential predictors associated to the choice to come out. For this purpose, disclosure of sexual orientation to family members, internalized sexual stigma (evaluated through an adapted short version of the internalized sexual stigma for lesbians, gay men, and bisexual people, measure of the internalized sexual stigma for lesbians, gay, and bisexual), gender, age, sexual orientation, background information, current romantic relationship and the wealth of social network with sexual minority people were assessed on an Italian sample of 291 adolescents and young adults (206 lesbian/gay men and 85 bisexual people). Hierarchical multiple regression showed that higher scores of coming out to family were associated with gay/lesbian identity, liberal political orientation, higher education level, presence of a stable romantic relationship, higher number of lesbian, gay, and bisexual contacts, and lower levels of internalized sexual stigma. Results suggest that bisexual people encounter major difficulties regarding the coming out to family members, respect to lesbian/gay people and indicate that internalized sexual stigma is strongly associated with concealing one’s sexual orientation. Clinical implications for the present findings are discussed