Purpose: Develop a paradigm to map binocular perceptual visual distortions in adult amblyopes and visually normal controls, measure their stability over time, and determine the relationship between strength of binocular single vision and distortion magnitude.
Methods: Perceptual visual distortions were measured in 24 strabismic, anisometropic, or microtropic amblyopes (interocular acuity difference e 0.200 logMAR or history of amblyopia treatment) and 10 controls (mean age 27.13 ± 10.20 years). The task was mouse-based target alignment on a stereoscopic liquid crystal display monitor, measured binocularly five times during viewing dichoptically through active shutter glasses, amblyopic eye viewing cross-hairs, fellow eye viewing single target dots (16 locations within central 5°), and five times nondichoptically, with all stimuli visible to either eye. Measurements were repeated over time (1 week, 1 month) in eight amblyopic subjects, evaluating test?retest reliability. Measurements were also correlated against logMAR visual acuity, horizontal prism motor fusion range, Frisby/Preschool Randot stereoacuity, and heterophoria/heterotropia prism cover test measurement.
Results: Sixty-seven percent (16/24) of amblyopes had significant perceptual visual distortions under dichoptic viewing conditions compared to nondichoptic viewing conditions and dichoptic control group performance. Distortions correlated with the strength of motor fusion (r = ?0.417, P = 0.043) and log stereoacuity (r = 0.492, P = 0.015), as well as near angle of heterotropic/heterophoric deviation (r = 0.740, P < 0.001), and, marginally, amblyopia depth (r = 0.405, P = 0.049). Global distortion index (GDI, mean displacement) remained, overall, consistent over time (median change in GDI between baseline and 1 week = ?0.03°, 1 month = ?0.08°; x-axis Z = 4.4256, P < 0.001; y-axis Z = 5.0547, P < 0.001).
Conclusions: Perceptual visual distortions are stable over time and associated with poorer binocular function, greater amblyopia depth, and larger angles of ocular deviation. Assessment of distortions may be relevant for recent perceptual learning paradigms specifically targeting binocular vision.
Piano ME, O'Connor AR, Simmers AJ (2012) The Impact Of Degrading Binocular Single Vision Upon Fine Motor Skill Tasks, Investigative Ophthalmology & Visual Science53pp. 1777-1777
Background: Net survival rates for cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer care of cancer survivors - individuals living with and beyond cancer - to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and healthcare professionals, is an important contributor to this evolving model of care and may offer additional benefits to cancer survivors. Telehealth is a complex intervention and understanding patient experiences of it is important in evaluating its impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth have yet to be synthesised.
Objective: Systematically identify, appraise and synthesise qualitative research evidence on the experiences of adult cancer survivors participating in telehealth intervention(s), to characterise the patient experience of telehealth interventions for this group.
Methods: Medline (PubMed), PsychINFO, CINAHL (Cumulative Index for Nursing and Allied Health Professionals), Embase and Cochrane Central Register of Controlled Trial were searched on 14th August 2015 and 8th March 2016 for English-language papers published between 2006 and 2016. Inclusion criteria were: adult cancer survivors aged 18 and over; cancer diagnosis; experience of participating in a telehealth intervention (defined as remote communication and/or remote monitoring with a healthcare professional(s) delivered by telephone, internet, or hand-held/mobile technology); reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) Checklist for Qualitative Research was used to assess paper quality. The results section of each included article was coded line by line and all papers underwent inductive analysis, involving comparison, re-examination and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies.
Results: 22 papers were included. Three analytical themes emerged, each with three descriptive subthemes:
1. Influence of telehealth on the disrupted lives of cancer survivors a. Convenience b. Independence c. Burden
2. Personalised care in a virtual world a. Time b. Space c. The human factor
Piano M, O'Connor AR, Newsham D (2014) Use of Atropine Penalization to Treat Amblyopia in UK Orthoptic Practice, Journal of pediatric ophthalmology and strabismus51(6)pp. 363-369
Purpose: To compare clinical practice patterns regarding
atropine penalization use by UK orthoptists to the
current evidence base and identify any existing barriers
against use of AP as first-line treatment.
Methods: An online survey was designed to assess current
practice patterns of UK orthoptists using atropine
penalization. They were asked to identify issues limiting
their use of atropine penalization and give opinions on
its effectiveness compared to occlusion. Descriptive statistics
and content analysis were applied to the results.
Results: Responses were obtained from 151 orthoptists
throughout the United Kingdom. The main perceived
barriers to use of atropine penalization were inability to
prescribe atropine and supply difficulties. However, respondents
also did not consider atropine penalization
as effective as occlusion in treating amblyopia, contrary
to recent research findings. Patient selection criteria
and treatment administration largely follows current
evidence. More orthoptists use atropine penalization as
first-line treatment than previously reported.
Conclusions: Practitioners tend to closely follow the
current evidence base when using atropine penalization,
but reluctance in offering it as first-line treatment
or providing a choice for parents between occlusion
and atropine still remains. This may result from concerns
regarding atropine?s general efficacy, side effects,
and risk of reverse amblyopia. Alternatively, as demonstrated
in other areas of medicine, it may reflect the inherent
delay of research
Piano M, Newsham D (2015) A pilot study examining density of suppression measurement in strabismus, Strabismus23pp. 14-21
Piano MEF, Knox PC, O?connor A (2010) Grapheme-colour synaesthesia and the orthoptist, British and Irish Orthoptic Journal6pp. 34-39
Piano M, Simmers A, Bex P, Jeon S (2013) Perceptual visual distortions in amblyopia and their stability over time, Perception ECVP abstract42pp. 75-75
Piano M, O?Connor AR (2011) Conservative management of intermittent distance exotropia: a review, American Orthoptic Journal61(1)pp. 103-116
Background and Purpose: Intermittent distance exotropia is difficult to conservatively manage, with techniques varying widely between institutions. This review aims to examine current literature on conservative management for intermittent distance exotropia, investigate its impact upon current clinical practice, and identify areas for further research.
Method: A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1950 and the present day were considered.
Results: Intermittent distance exotropia is a difficult condition to manage because of its variability / uncertain natural history, although control scores can facilitate management decisions. Research is required to establish recommended dosages for antisuppression occlusion and determine whether other treatments such as minus lenses are more effective. Use of orthoptic exercises has declined, but recently certain exercises have been shown to improve surgical outcomes if applied preoperatively. Prisms are mainly used postoperatively. Minus lens therapy is recommended as a first line treatment, but may not always be successful.
Conclusion: Conservative management techniques for intermittent distance exotropia have their place as both an alternative and an adjunct to surgery. However, further research needs to be conducted to determine which techniques are appropriate for which patients.
Purpose.: To evaluate the impact of degrading binocular single vision (BSV) on performance of fine visuomotor skill tasks requiring speed/accuracy.
Methods.: Binocular functions (Frisby/Preschool Randot [PSR] stereoacuity, horizontal phasic prism fusion amplitudes) were measured in visually normal participants aged 18 to 40 years (n = 80). Participants performed 2-timed visuomotor tasks: water pouring (450 mL accurately into five measuring cylinders at 90 mL) and bead threading on upright needles (30 large, 22 small beads, creating two difficulty levels). Task and binocular function measures were repeated in a randomized order with monocular visual acuity (VA) reduced in three-line increments using convex spherical lenses. Analyses used were Kruskal-Wallis/Mann-Whitney U tests and linear mixed modeling.
Results.: Median Frisby stereoacuity levels were 203 arc at baseline, 553 arc when VA was degraded by 6 lines, 2103 arc by 9 lines, and unmeasurable by 12 lines (9 lines in some individuals). Task performance times deteriorated for the large bead task (7%?10% between lenses, total 37% from median baseline time of 51 seconds, P < 0.001), and small bead task (0.5%?15% between lenses, total 42% from median baseline time of 57 seconds, P < 0.001). Binocular function measures causing significant fixed effects were base-out fusional amplitudes in both bead tasks (large: P = 0.010, small: P = 0.011) and PSR stereoacuity in the small bead task (P = 0.047). Water-pouring task performance was not significantly affected by changes in any experimental parameter.
Conclusions.: Degrading motor fusion as well as stereoacuity significantly affects performance in certain fine visuomotor tasks. This impact is differentially affected by task difficulty.
Purpose: Extensive literature exists on normative stereoacuity values for younger children, but there is less information about normative stereoacuity in older children/adults. Individual stereotests cannot be used interchangeably ? knowing the upper limit of normality for each test is important. This report details normative stereoacuity values for five near/distance stereotests drawn from a large sample aged 16-40 years, across 3 studies.
Methods: Participants (n = 206, mean age 22.18 ± 5.31 years) were administered the following stereotests: TNO, Preschool Randot, Frisby, Distance Randot and Frisby-Davis 2. Medians and upper limits were calculated for each test.
Results: Upper limits for each stereotest were as follows: TNO (n = 127, upper limit = 120? arc), Preschool Randot (PSR, n = 206, upper limit = 70? arc), Frisby (n = 206, upper limit = 40? arc), Distance Randot (n = 127, upper limit = 160? arc) and Frisby-Davis 2 (FD2, n = 109, upper limit = 25? arc). Conclusions: Normative values for each stereotest are identified and discussed with respect to other studies. Potential sources of variation between tests, within testing distances, are also discussed.
Piano M, Simmers A, Bex P (2015) The impact of active shutter glasses viewing upon horizontal motor fusion amplitudes, 44pp. 352-353 SAGE PUBLICATIONS LTD
Piano M, O'Connor AR, Stephenson MG (2010) What does that mean? A review of some aspects of orthoptic terminology, British and Irish Orthoptic Journal
Piano M, Bex PJ, Simmers AJ (2016) Perceived visual distortions in juvenile amblyopes during/following routine amblyopia treatment, Investigative Ophthalmology and Visual Science
Piano MEF, Simmers AJ, Bex PJ (2014) Perceptual visual distortions in children undergoing routine amblyopia treatment, 14pp. 690-690 Association for Research in Vision and Ophthalmology
In recent years, media coverage has demonstrated instances in which families of children aged 7 and older, newly diagnosed with strabismic and/or anisometropic amblyopia through community eyecare services, were told it was ?too late? for their child to effectively respond to conventional amblyopia treatment (occlusion or atropine penalisation). Formal guidance pertaining to binocular vision anomalies from eyecare professional bodies does not specifically make reference to a child?s age, beyond stating the importance of early diagnosis and treatment of strabismus/amblyopia. However, there have been many changes in the way we view the recovery period for amblyopia, and it is well demonstrated both within literature and clinical practice that conventional treatment can improve amblyopic eye visual acuity in children beyond the age of 7 years. The occurrence of these media described cases within the community eyecare sphere would suggest it is worthwhile revisiting the literature on the subject of amblyopia treatment in older children (aged 7+ years), to address misconceptions and place in the spotlight current considerations facing clinicians when treating newly diagnosed amblyopia within this age group. This perspective review provides an evidence-based update covering the various considerations associated with treatment of amblyopia in older children, along with recent amblyopia treatment advances that could have an impact on treatment prospects for this patient group. Considerations include the risks, benefits and efficacy of treating newly diagnosed amblyopia in older children, monitoring density of suppression to mitigate intractable diplopia risk, and recent findings regarding binocular treatments for amblyopia.