Off the Cuff: Hubble…Is the End Finally in Sight for Rubble?

Digital eye strain encompasses a range of ocular and visual symptoms across all age groups. Recently, symptoms associated with accommodative or binocular vision stress have become a major problem, especially in young individuals. The purpose of this prospective, single-blinded study was to objectively quantify the accommodative response and visual performance of low-add soft contact lenses (CLs) in young non-presbyopic individuals. A daily disposable low-add bifocal design lens (low-add CL) was tested. It employs a center-distance optical zone and peripheral zone with the added power of +0.50D to support near vision. Sixteen subjects ages 20 to 39 years were enrolled in the study. Refractive state and accommodation were measured using an open-field autorefractor with three target vergences, namely, -0.20D, -2.5D and -4.0D. Binocular visual acuity at high (100%) and low (40%, 20%) contrast and reading ability were assessed. Monofocal soft CLs were used as controls.

Accommodative response with low-add CLs was significantly smaller than those with two monofocal CL wearing conditions, i.e., at 40cm (2.5D of stimulus) and 25cm (4D of stimulus). The 20% contrast visual acuity at distance was significantly better with low-add CLs and second-time monofocal CLs compared with first-time monofocal CLs. The reading ability was not significantly different.

Quantification of accommodative response and visual performance demonstrated that using low-add CLs alleviated the accommodation under the near-vision condition, without sacrificing distance vision, in non-presbyopes.

Standardized numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. Researchers investigated the intra- and inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales, as well as a new Advanced Ophthalmic Systems (AOS) software that uses an objective approach to grading conjunctival hyperemia. One experienced observer graded n=30 bulbar and n=26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomized images was undertaken for all three methods on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer.

There were no statistically significant differences between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperemia was improved using the AOS grading method (R2=0.998; Coefficient of Repeatability CoR 0.10 to 0.13), compared with Efron (R2=0.926; CoR 0.62) and CCLRU (R2=0.885 to 0.911; CoR 0.50 to 0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (>0.995) vs. subjective methods (0.853 to 0.959).

These subjective and objective grading methods were not interchangeable. Researchers wrote that, due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provided a more consistent approach when grading ocular abnormalities and might achieve greater reliability in record keeping and clinical monitoring in the future.

This retrospective, single-center case series was conducted to update the literature on the current trends of viral conjunctivitis infections in Sydney, Australia, to find correlations between viral and patient characteristics on disease outcomes, and to assess the rates of antibiotic and steroid use in patients with viral conjunctivitis prior to and after assessment by ophthalmology trainees. A total of 368 eyes of 224 patients diagnosed with viral conjunctivitis at the Sydney Eye Hospital from Jan. 1 to March 31, 2017, were identified from hospital records or polymerase chain reaction results and included in the study.

The median patient age was 35.3 (range, 7 to 82) and 59.8% males. A total of 152 (67.9%) patients presented already on antibiotic treatment. Most (83.5%) had no previous ocular history aside from 35 (15.6%) who were regular contact lens wearers. PCR was performed in 170 (75.9%) patients, with 92 (54.1%) positive for adenovirus, and seven (4.1%) positive for HSV. The average duration of symptoms prior to presentation was 6.3 days. A total of 177 (78%) patients presented within one week of symptom onset, and these patients were more likely to be adenovirus positive on PCR (OR=2.37). Patients with symptoms of longer duration were more likely to have photophobia (OR=2.96) and have had steroid treatment (OR=3.80).

Patients with viral conjunctivitis typically presented within a week of symptoms onset, with bilateral disease and on topical antibiotics. Pseudomembranes and a palpable preauricular lymph node were not common. Investigators suggested that, as treatments emerge for viral conjunctivitis, patients should be encouraged to present earlier.