A case of accommodation-induced lens subluxation with iris displacement causing intermittent angle closure

Purpose

To present an uncommon cause of intermittent angle closure in a young adult patient presenting with intermittent headache and blurry vision exacerbated by accommodation.

Observations

A 37-year-old man reported experiencing intermittent blurry vision, headache, and pain in both eyes associated with prolonged periods of reading beginning at age 17. Serial intraocular pressure (IOP) measurements showed an increase in IOP from 14 to 32 mmHg in the right eye and from 9 to 37 mmHg in the left eye after 145 minutes of sustained accommodation while sitting up. IOP did not normalize after laser peripheral iridotomy but did normalize after clear lens extraction.

Conclusions and importance

This case characterized a rare presentation of accommodation-induced IOP elevation in a young adult male that resolved only after clear lens extraction. The clinical takeaway was the importance of considering accommodation-associated angle closure in patients presenting with high intraocular pressures, eye strain, and/or headache with accommodative activities. Notable symptoms that should raise suspicion for this syndrome include halos, changes in visual acuity, and headache with accommodation. We suggested that patients presenting with these symptoms be followed closely, with a full glaucoma evaluation including gonioscopy and possible ultrasound biomicroscopy to assess for pediatric eversional angle closure with headache, plateau iris, angle closure glaucoma, and lens-induced angle closure.

Assessing the environmental impacts of three different types of accommodations in Portugal and Spain by using an LCA approach

The tourism industry, affected by COVID-19, must reduce greenhouse gas emissions. This study evaluated the environmental impact of three hotels in coastal and mountainous regions of Spain and Portugal using Life Cycle Assessment (LCA). Data was gathered via surveys in the Greentour tool. Results indicate that the 2-star hotel (focused on cultural-urban tourism) has the highest impacts in most categories, except for CC, FRD, and POF indicators. The 3-star hotel (beach tourism) contributes the most to CC and FRD indicators, while the hostel (nature-religious tourism) has the highest value in the POF indicator. LCA findings reveal that diesel consumption in the hostel and electricity usage in both the 2-star and 3-star hotels are major contributors to environmental impacts across various categories. Overall, evidence suggests that fossil fuel and electricity usage significantly affect tourism activities environmentally. Interestingly, this study highlights that a 2-star hotel can have a higher carbon footprint (CC indicator) compared to a 3-star hotel, challenging the notion that higher star ratings imply lower environmental impact.

BCLA CLEAR Presbyopia: Evaluation and diagnosis

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

The relationship between accommodation, binocular function and myopia progression in myopic children wearing orthokeratology lenses

PURPOSE

To determine the relationship between changes in accommodative and binocular function with myopia progression in myopic children over a two-year follow-up period, and to determine when changes in visual functions stabilized after switching from spectacles to orthokeratology (Ortho-K).

METHODS

This prospective, self-controlled study followed thirty-six participants (aged 8-14 years) for two years after they switched from spectacles to Ortho-K. Accommodative and binocular function were assessed prior to and 1, 3, 6, 12, 18 and 24 months after commencing Ortho-K. Measurements included accommodative amplitude, accommodative response, accommodative facility, accommodative convergence/accommodation (AC/A), ocular alignment, positive relative accommodation (PRA), negative relative accommodation (NRA), horizontal vergence range, reading ability and stereoacuity. Myopia progression was quantified by the change in axial length.

RESULTS

Ocular alignment, monocular and binocular accommodative facility, and PRA stabilized after 1 month. The distance blur point in the convergence range, the distance break and recovery point in the divergence range, accommodative amplitude, calculated AC/A, stereoacuity and reading ability stabilized within 6 months. After two years of Ortho-K, NRA significantly increased (p = 0.044), while it showed no significant difference after one-year of lens wear (p = 0.49). The distance break point in the convergence range showed no significant difference (p = 0.20), but significantly decreased after one-year (p = 0.005). There were no significant correlations between the change in axial length with changes in accommodative or binocular function (p > 0.05).

CONCLUSION

Accommodative and binocular function changed significantly after switching from spectacles to Ortho-K and most of the parameters stabilized within the first 6 months. There was no association between the change in accommodative or binocular function and myopia progression.

Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis

Family accommodation might play a crucial role in obsessive-compulsive disorder (OCD). Previous systematic reviews on family accommodation in OCD have focused on specific populations or variables or are outdated. We conducted a preregistered systematic review and meta-analysis on family accommodation in adults, children, and adolescents with OCD (CRD42021264461). We searched PubMed, Scopus, and Web of Science using the keywords "family accommodation" and "obsessive-compulsive disorder. One hundred-eight studies involving 8928 individuals with OCD were included. Our results indicate that levels of family accommodation in OCD are moderate, that there is a significant positive correlation between family accommodation and OCD severity (r = 0.42), that baseline family accommodation does not predict pre- to post-treatment change in OCD severity (g = -0.03), and that family accommodation decreases as a result of both individual and family-focused cognitive behavioral therapy for OCD (g = 2.00 and g = 1.17, respectively). Our findings highlight the relevance of family accommodation in OCD and may help guide assessment and treatment.

BCLA CLEAR Presbyopia: Definitions

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education.

Investigations into the anatomical location, physiological function, clinical implications, and significance of the nucleus of Perlia

BACKGROUND

The article discusses the investigations into the nucleus of Perlia (NP), a spindle-shaped nucleus located in the dorsal aspect of the oculomotor complex. However, there is still debate over its exact location and function, with conflicting findings in nonhuman primates. Therefore, the current study aimed the describe the location, function, clinical and surgical implications of NP.

METHODS

A systematic review was conducted to identify studies related to the following MeSH terms: "perlia nucleus" OR "nucleus of "perlia" OR "convergence nucleus" OR "nucleus of convergence" OR "Perlia's nucleus". The search was conducted until September 2022.

RESULTS

The location of the NP has been consistently reported in various studies, with most describing it as situated ventral to the Edinger-Westphal nucleus (EW) and dorsomedial to the oculomotor complex. The incidence of the NP in humans has been reported to range from 9 to 40%. In primates, it was observed to be absent in 77% of midbrains, while well developed in 9%. It is also noted that the NP is not a single nucleus, but rather a group of nuclei that are interconnected and involved in the coordination of eye movements that contain parasympathetic neurons.

CONCLUSIONS

The study of the NP holds clinical implications for understanding the neural mechanisms underlying the irregularities in the pupillary light reflex, such as anisocoria or abnormal responses to light, diagnosis, and treatment of neurological disorders like Horner's syndrome, and management of eye movement disorders including one-and-a-half syndrome, vertical gaze palsy, skew deviation and ptosis. The current study also highlighted the limitations of previous studies, including variations in the reported prevalence of the NP, limitations of the histological techniques, and inconsistent findings across human and animal studies.

Predictivism and avoidance of ad hoc-ness: An empirical study

Predictivism is the thesis that evidence successfully predicted by a scientific theory counts more (or ought to count more) in the confirmation of that theory than already known evidence would. One rationale that has been proposed for predictivism is that predictive success guards against ad hoc hypotheses. Despite the intuitive attraction of predictivism, there is historical evidence that speaks against it. As valuable as the historical evidence may be, however, it is largely indirect evidence for the epistemic attitudes of individual - albeit prominent - scientists. This paper presents the results of an empirical study of scientists' attitudes toward predictivism and ad hoc-ness (n = 492), which will put the debate on a more robust empirical footing. The paper also draws attention to a tension between the ad hoc-ness avoidance rationale of predictivism and the ways philosophers have spelled out the notion of ad hoc-ness.

Accommodation response and spherical aberration during 1-Year of orthokeratology lens wear and after discontinuation

BACKGROUND

To assess accommodation and spherical aberration changes during one year of orthokeratology lens wear and one month after lens cessation.

METHODS

A prospective, randomized, longitudinal study was conducted on forty-seven young healthy subjects at the Optometry Clinic of the Complutense University of Madrid (Spain). Non-cycloplegic refraction, high and low uncorrected visual acuity, high and low best corrected visual acuity, accommodative lag, horizontal near phoria, corneal topography, and high-order aberrations were performed at baseline, 1-day, 1-week, 1-, 6- and 12-months of lens wear and after one month of wash out period. p < 0.05 was considered as statistically significant.

RESULTS

Spherical equivalent refraction (SE) was -3.23 ± 1.57D at baseline and -0.36 ± 0.64D after 12-months of lens wear, while accommodative lag changed from 0.53 ± 0.39D to 0.15 ± 0.29D after one year of lens wear. No significant differences were found when comparing SE at baseline and after one month of lens cessation (p > 0.05). A high correlation was found between the accommodative lag at baseline and after 12 M of lens wear. 22 out of 25 subjects with exophoria at baseline showed a significant reduction in the deviation at 12-months (p < 0.05). Total spherical aberration increased during all visits due to the lens wear (p < 0.05) although internal spherical aberration showed a significant decrease for 1-week, 1-month and 12-month visits (p < 0,05).

CONCLUSION

Orthokeratology lenses may change the accommodative response of the patient as a reduction on accommodative lag on exophoric patients and an overall increase on the internal spherical aberrations was found during treatment but return to nearly baseline values when cessation.

Pilot Study Assessing the Safety and Acceptance of a Novel Virtual Reality System to Improve Visual Function

PURPOSE

To assess the feasibility of the clinical use of a novel Virtual Reality (VR) training software designed to be used for active vision therapy in amblyopic patients by determining its preliminary safety and acceptance on the visual function of healthy adults.

METHODS

Pilot study enrolling 10 individuals (3 men, 7 women, mean age: 31.8 ± 6.5 years) with a best-corrected visual acuity (BCVA) of ≥ .90 (decimal) in both eyes were evaluated before and after 20 minutes of exposure to the NEIVATECH VR system using the HTC Vive Pro Eye head mounted display. Visual function assessment included near (40 cm) and distance (6 m) cover test (CT), stereopsis, binocular accommodative facility (BAF), near point of convergence (NPC), near point of accommodation (NPA), accommodative-convergence over accommodation (AC/A) ratio and positive and negative fusional vergences. Safety was assessed using the VR Sickness Questionnaire (VRSQ) and acceptance using the Technology Acceptance Model ;(TAM). Changes in all these variables after VR exposure were analyzed.

RESULTS

Short-term exposure to the NEIVATECH VR system only induced statistically significant changes in distance phoria (p = .016), but these changes were not clinically relevant. No significant changes were observed in VRSQ oculo-motricity and disorientation scores after exposure (p = .197 and .317, respectively). TAM scores showed a good acceptance of the system in terms of perceived enjoyment and perceived ease of use, although some concerns were raised in relation to the intention-to-use domain.

CONCLUSION

Exposure to the NEIVATECH VR system does not seem to adversely affect the visual function in healthy adults and its safety and acceptance profile seems to be adequate for supporting its potential use in other populations, such as amblyopic patients.

'Small-scale' tourism versus traditional tourism: Which will be the new key to achieve the desired sustainable tourism?

The tourism sector after COVID-19 has raised different concerns that have lead to a development towards a more sustainable model of tourism. After the health crisis, the increase in environmental awareness of tourists has become evident. In this context, the great paradigm of 'small-scale' tourism has been developed as opposed to traditional tourism. The present work seeks to contribute to sustainable development in the Spanish tourism sector, comparing a hostel in Cantabria (considered as 'small scale' /religious tourism) and a hotel in Lloret de Mar (considered as a traditional tourism) one using the Life Cycle Assessment (LCA) methodology to verify advantages and disadvantages of both types of tourism. The functional unit (FU) used was 'per guest night with breakfast included'. The results have revealed similar results for both establishments in all impact categories, as can be seen in its contribution to Climate Change (4.41 kg CO2 eq./FU caused by the hotel and 4.78 kg CO2 eq./FU by the hostel). The electricity consumption and the impact of the breakfast in the hostel were identified as main contributors to environmental burdens (with 76.72 % of the hotel's impact to climate change and 77.36 % for the hostel); hence, improvement opportunities envisaged were focused on these critical points. On the one hand, a biomass boiler, a solar water-heating system and a hybrid solar/biomass heating are considered a more sustainable alternatives related to electricity. Natural gas and diesel Consumption, respectively. On the other hand, oatmeal, Greek yoghurt and berries are good options for a breakfast with a reduced environmental impact. It is also important to implement responsible and green practices in order to achieve more environmentally sustainable alternative and traditional accommodations. Therefore, it can be concluded by stating that LCA is a tool capable of identifying and studying the processes with the highest environmental impact in order to find out the most sustainable form of tourism.

Anterior Chamber and Retinal Morphological Changes During Accommodation in Different Age Ranges

PURPOSE

Accommodation mainly affects the lens, a structure of the eyeball that degrades with age. The aim of this work was to study the morphological changes of different ocular structures during accommodation, both in the anterior pole and the posterior pole, which may also be involved in the accommodation process.

METHODS

The study will be carried out by stimulating accommodation through lenses of -1.00, -3.00 and -5.00 D starting from the spherical equivalent (M) of each participant in different age groups, from 18 to 66 years. To obtain the M value, aberrometry was achieved, and retinal optical coherence tomography and anterior pole tomography were performed to evaluate the possible structural modifications (central and peripheral), while accommodation was progressively stimulated.

RESULTS

It showed that as the accommodative demand increased, morphological changes were produced in retinal thickness, both in the central and peripheral retina, in all age groups. A thinning of the retina was observed in the central 3 mm, while significant progressive thickening was observed closer to the periphery (up to 6 mm from the fovea) as the required accommodative power increased. A decrease in the anterior chamber depth (ACD) and anterior chamber volume (ACV) was observed with increasing lens power.

CONCLUSION

Structural changes were observed in the central and peripheral retina, as well as in the ACD and ACV, while progressively greater accommodation was stimulated, showing that these structures were modified in the accommodation process even in advanced presbyopes.

Pupillary dynamics, accommodation and vergence in concussion

Concussion, which is usually associated with head injuries, has received considerable attention in recent years because of its possible long-term cognitive and visual consequences. The review summarised the mild traumatic brain injury literature. Pupillary dynamics, which are primarily mediated by the autonomic nervous system, play an important function in regulating the amount of light entering the eye, but they can be dramatically impacted after a concussion. This can result in aberrant pupillary responses, which may have ramifications for light sensitivity, a common post-concussion symptom. In concussed individuals, accommodation and vergence - the visual processes responsible for focusing on near and distant objects - might be interrupted, potentially leading to fuzzy vision, eyestrain, and difficulty with tasks that require precise visual coordination. Understanding the delicate interplay between these three components of vision in the setting of concussions is critical for creating more targeted diagnostic and rehabilitative techniques, ultimately enhancing the quality of life for those who have had head injuries.

Endorsement of Masculine-Typed Behaviors Decreases During Middle Adolescence: The Contextualizing Role of Peer Experiences for Adolescents Living in the United States

While more research is emerging about the development of masculinity during adolescence, not much is known about how masculine-type behaviors develop over time in middle to late adolescence within the context of friendships and peer experiences. This study examined trajectories of masculine-typed behavior from ages 14 to 17. Multilevel modeling was used to account for cross-time and within-time variability in masculine-typed behavior and examined the role of positive and negative peer experiences in predicting this variability. This was done in a sample of 334 U.S. adolescents (51% boys; 50% White, 19% Black, 15% Latina/o/e). At the between-person level, boys and girls decreased in masculine-typed behavior over time. At the within-person level, negative peer experiences predicted fluctuations toward greater masculine-typed behavior, whereas friend support predicted fluctuations toward less masculine-typed behavior. Adolescence is a key period for navigating masculinity norms, and peer experiences are a key context for the development of masculine-typed behavior.

Process evaluation of the 90-90-90 targets of surge project in Addis Ababa, Ethiopia: a case study evaluation

BACKGROUND

Human Immunodeficiency Virus (HIV) is a major public health problem that continues to pose an enormous challenge to mankind's survival worldwide. In urban Ethiopia, the HIV prevalence among adults aged 15-49 years is 2.9%, while in Addis Ababa, it is 3.4%. To take the edge off, the Ethiopian government has been implementing the 90-90-90 strategy also known as the surge project, in urban cities. However, the implementation of the program has not been evaluated. Thus, we evaluated the process of the 90-90-90 targets of the surge project in Addis Ababa, Ethiopia.

METHODS

We conducted a case study with concurrent mixed-methods evaluation. We used indicator-driven evaluation dimensions -availability and accommodation dimensions from the health services access and compliance and fidelity from implementation fidelity frameworks to test the program process theory with a total of 52 indicators. We interviewed a total of 419 clients and 210 healthcare providers and reviewed 417 clients' cards and 17 registries. We also conducted 30 key informant interviews and resource inventory. A binary logistic regression analysis was done to identify factors associated with clients' satisfaction. We transcribed and translated the qualitative data and analysed thematically. Finally, we judged the overall process of the surge project based on the pre-seated judgmental criteria as; needs urgent improvement, needs improvement and well implemented.

RESULTS

We found that 90% of the project process was as per the program process theory measured by the availability of resources (95.8%), compliance (88.0%), fidelity (84.7%), and accommodation of services (89.3%). We found a shortage of human power, test kits, and viral load testing machines. The commitment of health care providers, provider-client interaction, and clients' satisfaction with the service at card rooms were found to be poor. Moreover, being aged 15-24, being married and government government-employed were negatively associated with clients' satisfaction with antiretroviral therapy services.

CONCLUSION

The process of the surge project needs improvement. Moreover, the achievements of the first two 90-90 targets were poor. Therefore, implementers need to take intensified action for the availability of resources and to improve the commitment of healthcare providers through refreshment training.

Alterations in Lens Free Water Distribution Are Associated with Shape Deformation in Accommodation

Objective

To investigate whether a redistribution of water within the crystalline lens is associated with the shape deformation that occurs during accommodation.

Design

Observational, cross sectional study.

Subjects

Eleven young adults without presbyopia (aged 18-39 years) and 9 middle-aged adults with presbyopia (aged 40-55 years).

Methods

Magnetic resonance imaging (MRI) scans of the lens were acquired on a 3 Tesla clinical MRI scanner, without and with the presentation of a 3 Diopter accommodative stimulus. The MRIs were postprocessed using established methods to extract the geometric dimensions and spatial maps of water distribution of the lens.

Main Outcome Measures

Accommodative changes in the full 3-dimensional description of lens shape, the lens total-water distribution profile, and the lens free-water distribution profile.

Results

Viewing of an accommodative stimulus by young subjects elicited an elastic shape deformation of the lens consistent with accommodation that was associated with an elevated, smoother free-water distribution, primarily in the anterior region of the lens. In contrast, viewing of an accommodative stimulus by presbyopic subjects produced an atypical shape deformation of the lens that was instead associated with a lowered free-water distribution, primarily in the anterior region of the lens. No discernible changes to the lens total-water distribution were observed in response to the accommodative stimulus in either subject cohort.

Conclusions

The present study suggests that protein-mediated alterations in the free-water distribution of the anterior region of the lens influence the shape deformation in accommodation, presenting pharmacological modulation of free-water distribution as an attractive novel approach for treating presbyopia.

Financial Disclosures

The authors have no proprietary or commercial interest in any materials discussed in this article.

Success rates, near-response patterns, and learning trends with free-fusion stereograms

Free-fusion stereograms are routinely used for demonstrating various stereoscopic effects. Yet, untrained observers find it challenging to perform this task. This study showed that only less than 1/3rd of sixty-one pre-presbyopic adults with normal binocular vision could successfully free-fuse random-dot image pairs and identify the stereoscopic shapes embedded in these patterns. Another one-third of participants performed the task with poor success rates, while the remaining could not perform the task. There was a clear dissociation of vergence and accommodative responses in participants who were successful with free-fusion, as recorded using a dynamic infrared eye tracker and photorefractor. Those in the unsuccessful cluster either showed strong vergence and accommodation or weak vergence and strong accommodation during the task. These response patterns, however, were specific to the free-fusion task because all these participants generated good convergence/accommodation to real-world targets and to conflicting vergence and accommodative demands stimulated with prisms or lenses. Task performance of the unsuccessful cluster also improved significantly following pharmacological paralysis of accommodation and reached the performance levels of the successful cluster. A minority of participants also appeared to progressively learn to dissociate one of the two directions of their vergence and accommodation crosslinks with repeated free-fusion trials. These results suggest that successful free-fusion might depend upon how well participants generate a combination of volitional and reflex vergence responses to large differences in disparity with conflicting static accommodative demands. Such responses would require that only one direction of the vergence-accommodation crosslinks be active at any given time. The sequence of near-responses could also be learnt through repeated trials to optimize task performance.

The changes and causes of asthenopia after ICL implantation

OBJECTIVE

To detect the presence of asthenopia after implantation of Implantable Collamer Lens (ICL).

METHOD

Design: prospective observational case series. Patients with myopia and/or astigmatism who underwent ICL surgeries and completed 3-month follow-up were enrolled. Asthenopia scores, amplitude of accommodation (AA), positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), the ratio of accommodative convergence and accommodation (AC/A), Schirmer test, noninvasive breakup time (NBUT), and HOA were examined before surgeries and at 1 week, 1 month and 3 months postoperatively then statistically analyzed.

RESULTS

Symptoms of asthenopia were significantly decreased at 1 week after ICL surgeries than those before surgeries, but increased gradually as time went by, eventually recovered at 3 months postoperatively. AA, AF, AC/A decreased 1 week postoperatively, returned to the baseline at 1 month and were improved at 3 months after surgeries. NBUT at 1 week, 1 month and 3 months after surgeries were significantly decreased and was the lowest at 1 week postoperatively. PRA, NRA, Schiermer values and HOA had no significant change. Correlation analysis showed that the lower AF and NBUT after ICL surgeries, the more severe the asthenopia symptoms.

CONCLUSION

The symptoms of asthenopia aggravated transiently after ICL implantation surgeries, but improved gradually with time. AF and NBUT were important factors affecting the changes of asthenopia.

The major influence of anterior and equatorial zonular fibres on the far-to-near accommodation revealed by a 3D pre-stressed model of the anterior eye

PURPOSE

To explore the synergistic function of the ligaments in eye, the zonular fibres, that mediate change in eye lens shape to allow for focussing over different distances.

METHODS

A set of 3D Finite Element models of the anterior eye together with a custom developed pre-stress modelling approach was proposed to simulate vision for distant objects (the unaccommodated state) to vision for near objects (accommodation). One of the five zonular groups was cut off in sequence creating five models with different zonular arrangements, the contribution of each zonular group was analysed by comparing results of each specific zonular-cut model with those from the all-zonules model in terms of lens shape and zonular tensions.

RESULTS

In the all-zonular model, the anterior and equatorial zonules carry the highest tensions. In the anterior zonular-cut model, the equatorial zonular tension increases while the posterior zonular tension decreases, resulting in an increase in the change in Central Optical Power (COP). In the equatorial zonular-cut model, both the anterior and posterior zonular tensions increase, causing a decreasing change in COP. The change in COP decreases only slightly in the other models. For vitreous zonular-cut models, little change was seen in either the zonular tension or the change in COP.

CONCLUSIONS

The anterior and the equatorial zonular fibres have the major influence on the change in lens optical power, with the anterior zonules having a negative effect and the equatorial zonules contributing a positive effect. The contribution to variations in optical power by the equatorial zonules is much larger than by the posterior zonules.

A Randomized, Controlled Trial of Efficacy and Safety of Cannabidiol in Idiopathic and Diabetic Gastroparesis

BACKGROUND & AIMS

Cannabis (delta-9-tetrahydrocannabinol), a nonselective cannabinoid-receptor agonist, relieves nausea and pain. Cannabidiol (CBD), a cannabinoid receptor 2 inverse agonist with central effects, also reduces gut sensation and inflammation. We compared the effects of 4 weeks of treatment with pharmaceutical CBD vs placebo in patients with idiopathic or diabetic (diabetes mellitus) gastroparesis.

METHODS

We performed a randomized, double-blinded, placebo-controlled study of CBD twice daily (Epidiolex escalated to 20 mg/kg/d; Jazz Pharmaceuticals, Dublin, Ireland) in patients with nonsurgical gastroparesis with delayed gastric emptying of solids (GES). Symptoms were assessed by the Gastroparesis Cardinal Symptom Index Daily Diary. After 4 weeks of treatment, we measured GES, gastric volumes, and Ensure (Abbott Laboratories, Abbott Park, IL) satiation test (1 kcal/mL, 30 mL/min) to assess volume to comfortable fullness and maximum tolerance. Patients underwent specific FAAH and CNR1 genotyping. Statistical analysis compared 2 treatments using analysis of variance including baseline measurements and body mass index as covariates.

RESULTS

Among 44 patients (32 idiopathic, 6 diabetes mellitus type 1, and 6 diabetes mellitus type 2), 5 patients did not tolerate full-dose escalation; 3 withdrew before completing 4 weeks of treatment (2 placebo, 1 CBD); 95% completed 4 weeks of treatment and diaries. Compared with placebo, CBD reduced the total Gastroparesis Cardinal Symptom Index score (P = .008), inability to finish a normal-sized meal (P = .029), number of vomiting episodes/24 hours (P = .006), and overall symptom severity (P = .034). Patients treated with CBD had a higher volume to comfortable fullness and maximum tolerance and slower GES. FAAH rs34420 genotype significantly impacted nutrient drink ingestion. The most common adverse events reported were diarrhea (14 patients), fatigue (8 patients), headache (8 patients), and nausea (7 patients).

CONCLUSIONS

CBD provides symptom relief in patients with gastroparesis and improves the tolerance of liquid nutrient intake, despite slowing of GES.

CLINICALTRIALS

gov NCT #03941288.

Introducing Dynamic Stimulation Aberrometry: Binocular Objective Accommodation versus Subjective Measures

Purpose

The objective measurement of binocular accommodation remains a challenge. The dynamic stimulation aberrometry (DSA) system uses wavefront measurements to dynamically assess accommodation. In this study, we sought to introduce this method in a large number of patients of varying age and compared it with the subjective push-up method as well as the historical results of Duane.

Design

This study is an evaluation of diagnostic technology.

Subjects

Ninety-one patients aged 20 to 67 years (70 healthy, phakic eyes and 21 myopic eyes after phakic intraocular lens implantation) were enrolled at a tertiary eye hospital.

Methods

All patients underwent DSA measurements; the accommodative amplitude of 13 patients chosen at random was additionally examined using the subjective push-up method introduced by Duane. DSA measurements were also compared with Duane's historical results.

Main Outcome Measures

Accommodative amplitude, dynamic parameters of accommodation, and near pupil motility.

Results

Dynamic stimulation aberrometry allowed objective measurement of binocular accommodation, which decreased with age (e.g., 30-39 years vs. > 50 years; 3.8 ± 0.9 diopters [D] and 0.1 ± 0.4 D, respectively). Dynamic parameters, such as time delay of the commencement of accommodation after near target presentation, increased with age (0.26 ± 0.14 seconds for 20-30 years vs. 0.43 ± 0.15 seconds for 40-50 years, P = 0.0002). The objective accommodative amplitude was significantly smaller than Duane's historic results (P = 0.001) as well as the subjective push-up method. Dynamic stimulation aberrometry records pupil motility dynamically in parallel to wavefront measurements. Maximum pupil motility during accommodation significantly decreased with age (P = 0.0002). Maximum pupillary speed did not correlate significantly with age.

Conclusions

Dynamic stimulation aberrometry allows objective, dynamic, binocular measurement of accommodation and pupil motility with high time resolution in subjects with accommodative amplitudes up to 7 D. This article introduces the method in a large study population and may serve as a control for further studies.

Financial Disclosures

Proprietary or commercial disclosure may be found after the references.

Changes in pupil size, ocular wavefront aberrations, and accommodation in healthcare workers using FFP3 masks

PURPOSE

To evaluate changes in pupil size, ocular wavefront aberrations (WA), and accommodation in healthcare workers after 4-h usage of Filtering Facepiece class 3 (FFP3) masks.

MATERIAL AND METHODS

This prospective study included 22 healthy healthcare workers. Pupil size, ocular WA, and accommodation changes before and after FFP3 mask usage were evaluated using a Hartmann Schack aberrometer. Accommodative responses to stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were assessed. Ocular high-order aberrations (HOAs) were recorded at baseline and at every accommodative stimulus. Oxygen saturation (SpO2) was measured by pulse oximetry before and after the mask usage.

RESULTS

The mean age was 36.6 ± 8.5 years. The SpO2 significantly decreased from 98.95 to 97.95% after usage of the FFP3 mask (p < 0.001). The mean pupil size did not significantly differ before (6.22 ± 0.75 mm) and after (6.38 ± 0.83 mm) the 4-h mask usage (p = 0.093). The mean total RMS of the total HOAs was 0.36 ± 0.17 before and 0.39 ± 0.15 after the mask usage (p = 0.071). Post-mask accommodation showed a significant decrease at the 2 D (p = 0.041), 2.5D (p = 0.022), and 3 D (p = 0.025) stimuli.

CONCLUSION

The present study shows that after 4 h-usage of FFP3 mask, both SpO2 and accommodative response to increasing stimuli might be significantly decreased.

The evolution of mechanism of accommodation and a novel hypothesis

Myopia and presbyopia are two major optometry problems facing the whole society. The mechanism of accommodation is strongly related to the treatments of myopia and presbyopia. However, the key mechanism of accommodation has puzzled us for over 400 years and is still not clear at present, leading to the stagnation of prevention and treatment of myopia and presbyopia. With the continued development of experimental technologies and equipment, the approaches to elucidate accommodation's intricacies have become more methodological and sophisticated. Fortunately, some significant progress has been made. This article is to review the evolution of the mechanism of accommodation. Helmholtz proposed a classical theory of "zonules relax during accommodation." In contrast, Schachar put forward a theory of "zonules taut during accommodation." Those hypotheses are relatively complete, but either do not fully explain everything about the accommodation mechanism or lack sufficient experimental and clinical evidence to support them. Then, some contentious issues are discussed in detail to find the truth. Finally, we proposed our hypothesis about accommodation based on the anatomy of the accommodative apparatus.

Family Accommodation in Pediatric Obsessive-Compulsive Disorder: Investigating Prevalence and Clinical Correlates in the NordLOTS Study

Family accommodation (FA) involves the actions taken by family members, particularly parents, to accommodate a child´s obsessive-compulsive disorder (OCD) symptoms, reducing distress or impairment. This behavior may maintain compulsive and avoidant behavior, preventing corrective learning or habituation. This study aims to investigate the prevalence and factors influencing FA in a large Scandinavian sample of children with OCD. We assessed 238 children using standardized diagnostic interviews, OCD symptom severity assessments and questionnaires evaluating functional impairment and internalizing and externalizing symptoms. FA was measured using the Family Accommodation Scale, a 12-item clinician-rated interview. Our results confirmed a high frequency of accommodation, with approximately 70% of primary caregivers reporting some accommodation daily and 98% at least once per week. FA was associated with increased OCD symptom severity, contamination/cleaning symptoms, internalizing and externalizing behavior, and functional impairment. Linear regression analysis showed that high levels of FA are specifically associated with lower age, higher OCD symptom severity, parent-reported impairment, internalizing, and externalizing symptoms. A path analysis revealed that FA partially mediated the relationship between OCD severity, externalizing symptoms, and child's age, highlighting the role of FA in the progression of OCD and related symptoms. The findings emphasize the importance of evaluating FA before initiating treatment and specifically addressing it during the therapeutic process.

The Job Leeway Scale: Initial Evaluation of a Self-report Measure of Health-Related Flexibility and Latitude at Work

Purpose Evidence suggests that workers manage health-related challenges at work, in part, by using available leeway to perform work differently. The purpose of this study was to evaluate the reliability and validity of the Job Leeway Scale (JLS), a new 18-item self-report questionnaire designed to assess worker perceptions of available flexibility and latitude to manage health-related challenges at work. Methods Workers seeking assistance for workplace difficulties due to chronic medical conditions (n = 119, 83% female, median age = 49) completed the JLS along with other workplace and health measures. Construct validity was assessed using exploratory factor analysis (EFA), and concurrent validity was assessed by associations with related measures. Results Mean item scores ranged from 2.13 to 4.16 within a possible range of 0-6. The EFA supported three underlying factors: organizational leeway (9 items), task leeway (6 items), and staffing leeway (3 items). Internal consistency (alpha) ranged from 0.78 to 0.91 for subscale scores and 0.94 for the total score. The JLS showed moderate correlations with other work outcome measures including work fatigue, self-efficacy, engagement, and productivity. Conclusion The JLS is a promising new measure with initial support for its reliability and validity to assess worker beliefs of available flexibility to manage health symptoms at work, and this construct may have organizational implications for worker support and accommodation.

Abortion, Brain Death, and Coercion

A "universalist" policy on brain death holds that brain death is death, and neurologic criteria for death determination are rightly applied to all, without exemptions or opt outs. This essay argues that advocates of a universalist brain death policy defend the same sort of coercive control of end-of-life decision-making as "pro-life" advocates seek to achieve for reproductive decision-making, and both are grounded in an illiberal political philosophy. Those who recognize the serious flaws of this kind of public policy with respect to abortion must apply the same logic to brain death.

Death pluralism: a proposal

The debate over the determination of death has been raging for more than fifty years. Since then, objections against the diagnosis of brain death from family members of those diagnosed as dead-have been increasing and are causing some countries to take novel steps to accommodate people's beliefs and preferences in the determination of death. This, coupled with criticism by some academics of the brain death criterion, raises some questions about the issues surrounding the determination of death. In this paper, we discuss some of the main approaches to death determination that have been theoretically proposed or currently put into practice and propose a new approach to death determination called "weak pluralism" as a reasonable ethical and political alternative to respect diversity in death determination.

Near work symptoms and measures of accommodation in children

CLINICAL RELEVANCE

Some children experience significant symptoms while doing near work, and accommodative deficits can be a contributory factor. However, studies investigating near work symptoms in children are sparse.

BACKGROUND

To investigate the association between clinical and objective measures of accommodation and near point symptoms.

METHODS

Twelve asymptomatic and 14 symptomatic children (mean age = 11.1 and 11.8 years, respectively) based on their Convergence Insufficiency Symptom Survey scores participated in the study. The clinical measures of accommodation were monocular amplitude of accommodation, monocular accommodative facility, and monocular estimation method. Objective measurements of the accommodative stimulus response function were recorded with a WAM-5500 autorefractor for two consecutive minutes at five viewing distances (0.33, 2, 3, 4, and 5 Dioptres [D]). Accommodative findings were compared between the groups using the Mann-Whitney U-tests. Spearman's rank correlation coefficient was used to assess the association between symptoms and clinical and objective measures of accommodation.

RESULTS

The mean CISS scores were 32.8 and 7.3 for the symptomatic and asymptomatic groups, respectively (p = <0.001). The symptomatic group showed a reduced accommodative functions compared to the asymptomatic group (p = 0.002 for accommodative facility, p = 0.04 for accommodative amplitude, p = 0.029 and 0.01 for objective measures of accommodation at 4D and 5D viewing distance, respectively). Clinical tests of accommodative amplitude and facility (correlation coefficient = -0.407 and -0.54, respectively) showed the highest correlation with the CISS scores, compared to the objective measures of accommodation.

CONCLUSION

Clinical tests of accommodation showed a greater association with symptoms than objective measures of accommodation in children aged 8-16 years. In children presenting with visual discomfort symptoms, measurement of accommodative amplitude and facility should be considered.

Influence of a long-distance optical imaging workbench on accommodation and choroidal response in myopic children

CLINICAL RELEVANCE

Optical approaches to modulating near work may be beneficial in arresting the progression of myopia.

BACKGROUND

To explore whether a long-distance optical image workbench (LOIW) can replace traditional near-distance reading and has beneficial influences on accommodation and choroidal parameters.

METHODS

This self-control study included two sessions. In session 1, an open-field autorefractor measured sustained accommodative response and pupil diameter when participants viewed virtual images from 3.42 m away through LOIW with + 0.50 D over-correction lenses (3.42 m/+0.50 D), LOIW with full-correction lenses (3.42 m/FC), or the visual target at a given distance of 0.33 m with + 0.50 D over-correction lenses (0.33 m/+0.50 D), with full-correction lenses (0.33 m/FC). In session 2, swept-source optical coherence tomography angiography assessed subfoveal choroidal thickness (SFChT), choroidal volume (CV), and choriocapillaris flow void percentage (FV%) at baseline and before and after reading via LOIW with + 0.50 D over-correction lenses (Far/+0.50 D) or in habitual near distance with full-correction (Near/FC) for a sustained 30-min period.

RESULTS

Thirty-five myopic (mean spherical equivalent refraction: -1.11 ± 0.78 D) children (median [range] age: 8.36 [8-10] years) were analysed. Children viewing virtual images in 3.42 m/+0.50 D exhibited mild-degree accommodative leads (-0.54 ± 0.17 D), much smaller pupil diameter (3.39 ± 0.63 mm) and microfluctuations (0.13 ± 0.04 D); accommodative lags (0.88 ± 0.04 D), larger pupil diameter (5.05 ± 0.75 mm) and microfluctuations (0.88 ± 0.16 D) were observed in 0.33 m/+0.50 D, and the microfluctuations were unstable (F = 2.185, p = 0.038). Compared with baseline data, SFChT, CV, and FV% changed by 13.40 ± 4.71 μm, 0.26 ± 0.21 mm³, and - 0.14%±3.66% in Far/+0.50 D, respectively, while changes under Near/FC were - 10.19 ± 7.48 μm, -0.15 ± 0.22 mm³ and 1.95%±2.92%, respectively. All changes differed significantly between these two conditions (all p < 0.001).

CONCLUSION

The long-distance working mode may exert beneficial effects on accommodative and choroidal parameters in myopic children compared with traditional near work.

Direct or indirect energy savings in food and beverage services? Visitors' preferences in hotel restaurants

Food processing in hotels is one of most energy-intensive activities in the tourism industry. There is an urgent need to reduce energy consumption in hotels to limit their environmental impact. This research aims to assess tourists' preferences for the provision of food that require low energy preparation and to compare them with tourists' preferences for other indirect energy saving options. A quantitative survey with 944 tourists visiting six tourist sites across the Czech Republic was used for primary data collection. Data were analyzed using linear regression models. Our findings signal that direct energy savings tend to be perceived differentially and surprisingly as the least preferred option among tourists. Those who support direct energy savings in food processing are rather older respondents and also respondents who declare stronger pro-environmental everyday behaviour and subjective norms. We claim that as tourists show highly diverse preferences for various ways of energy savings, we need to ensure that multiple energy saving options are offered so that tourists contribute to reducing the ecological footprint of hotels. At the same time, it has to be highlighted that only few surveyed tourists voluntarily accepted reduction of comfort in the food and beverage provision. There is room for many technological and social innovations and raising environmental awareness among tourists to overcome this contradiction.

Short partial doffs of release/relock sockets may effectively stabilize limb fluid volume in prosthesis users with transtibial amputation

BACKGROUND

A challenge often faced by people with lower extremity amputation is management of prosthetic socket fit due to changes in fluid volume within their residual limb. Prior research suggests that intermittently doffing the prosthetic socket may help stabilize daily residual limb fluid volume.

METHODS

To assess the effects of partial doff duration on residual limb fluid volume retention, participants with transtibial amputation were tested by walking on a treadmill in a controlled, laboratory setting under three conditions. An automated system to release the locking pin and enlarge the socket was used to produce the partial doffing. Percent limb fluid volume changes after partial doffing for 4 min (Short Rest) and for 10 min (Long Rest) were compared with no partial doffing (No Release). Limb fluid volume was monitored using bioimpedance analysis.

FINDINGS

Mean percent fluid volume changes in the posterior region were  -1.2% for No Release, 2.7% for Short Rest, and 1.0% for Long Rest. Short and Long Rests had larger increases than No Release (P = 0.005 and 0.03, respectively); Short and Long Rests were not statistically different (P = 0.10). Eight of the thirteen participants experienced a higher percent fluid volume gain for both release protocols while four experienced a higher percent fluid volume gain for only one release protocol.

INTERPRETATION

A partial doff duration as short as 4 min may be an effective strategy to stabilize limb fluid volume in prosthesis users with transtibial amputation. Trials in at-home settings should be pursued.

A Comparative Study to Assess the Accommodation and Vergence Relationship of Myopia in Indian Adolescent

Background

Accommodation and Vergence disorder are diverse visual anomalies which can interfere with a child's school performance and impair one's ability to function efficiently. Its association with refractive error and its intervention were studied less in Indian myopia children; hence, there is a need for research in such setting.

Method

One hundred and fifty Indian adolescents aged 10 to 17 years were divided into three refractive error groups (high, moderate, and low myopia). Baseline vision examination and a comprehensive binocular vision assessment were performed on all eligible adolescents. Vision therapy was provided to participants whose parents gave consent on behalf of the children. Chi-square analysis was utilized to look at the association between the groups of refractive errors. To compare the mean constants of the experimental and control groups, a two-way RM ANOVA was performed.

Results

The most common dysfunction found in low myopia (75.3%), and moderate myopia (54%) was convergence insufficiency. High myopes (62.8%) were found to have combined convergence and accommodative insufficiency followed by accommodative dysfunction (14%) and basic exophoria (6%). In moderate myopia, a significant relationship was found between this dysfunction and refractive error. The experimental group in the overall sample showed statistically significant improvement after vision therapy (P<0.001), in comparison to the control group.

Conclusion

Refractive error is linked to accommodative and convergence insufficiency. Thus, vergence and accommodative impairment must be tested for all myopic children, and vision therapy should be advised along with spectacle prescription for efficient binocular vision.

Monocular transcorneal electrical stimulation induces ciliary muscle thickening in contralateral eye

Transcorneal electrical stimulation (TES) is used as therapy for retinal diseases such as retinitis pigmentosa (RP) and was suggested for assessing retinal sensitivity by determining phosphene thresholds, subjective luminance impressions caused by retinal stimulation. Further applications concerned the accommodation process, revealing an improved accommodative amplitude in presbyopic eyes after TES treatment. The respective changes of the ciliary muscle (CM), the structure most important for near vision, during TES are yet unknown. In a pilot study, we aimed to assess whether monocular TES leads to morphological and functional CM changes and whether central accommodation control is affected. Ten healthy, near-emmetropic adults participated in the trial (4 females, age 26.3 ± 3.6 years). Using a wavefront and a stimulus generator, a biphasic square-wave stimulus (2 s positive and 6 s negative amplitude) of 0 μA average current was produced and transferred to the eye by means of a Dawson-Trick & Litzkow electrode. Prior to the stimulation, an individual determination of phosphene thresholds served to define individual TES current amplitudes, which ranged between 60 and 100 μA. Optical coherence tomography (OCT) imaging of the right eye's temporal ciliary muscle was performed before and during ipsi-as well as contralateral monocular TES in randomized order in the morning and afternoon of the same day. During imaging, subjects fixated a target at 4 m distance and refraction was simultaneously recorded via eccentric infrared photorefraction. OCT images were assessed using previously published custom-developed software, allowing the definition of selective CM thickness (CMT) readings, and plotting of continuous CMT profiles along the muscle border. CMT profiles revealed that both stimulations, on the ipsi- and contralateral eye, induced a thickening of the CM compared to the non-stimulated state. The selective CMT readings confirmed a significant increase with ipsi- (31 ± 30 μm; p = 0.010) and contralateral (25 ± 16 μm; p = 0.001) TES. However, refraction during far vision was not significantly affected by either stimulation (ipsilateral [n = 5]: median Δ_w/-w/o = 0 D; contralateral [n = 7]: Δ_w/-w/o = 0.13 D). Pupil size on average increased during TES, but without reaching significance (ipsilateral [n = 5] median Δ_w/-w/o = 0.23 mm, contralateral [n = 7] Δ_w/-w/o = 0.39 mm). Ipsilateral CM thickening could be explained by local changes within the stimulated ciliary muscle, such as increased blood flow or interstitial fluid rise induced by TES. However, the CMT increase in the right eye when TES was performed contralaterally, on the left eye, indicates an involvement of the central control circuit of accommodation. Further possible explanations for this finding are a synchronization of neuronal activities in the visual pathway, the release of vasoactive neuropeptides, or effects on the central blood pressure regulation. Given a neuromodulation effect on the CM function, TES might have implications for children with accommodation insufficiencies and as additional therapy in myopia control management, e.g. in combination with multifocal contact lens treatment. Our study is important for the clinical application of TES, and the outcome might add crucial knowledge to the current understanding of the accommodation process and inform research and treatment of both myopia and presbyopia.

Cognitive workload affects ocular accommodation and pupillary response

SIGNIFICANCE

Cognitive involvement in reading causes variations in the tonus of autonomic nerve system. The aim of this study was to examine the effect of short-term cognitive load on accommodation and pupils' absolute values and temporal variability in test persons performing three different types of tasks.

PURPOSE

We aimed to show how cognitive tasks of different type and difficulty level affect accommodation and pupil behavior during a short time interval.

METHODS

Participants (n = 58; mean age 16.4 years, SD = 0.56) performed reading from a 10-inch LCD screen placed at 40 cm distance. Three different types of tasks (numerical, textual, and the Stroop task), each at three different levels of cognitive load were introduced. Participants had 90 s to complete each task. Accommodative and pupillary responses were measured with videoretinoscope Power Refractor 3 at 50 Hz.

RESULTS

Pupil size was largest in the Stroop task (M = 5.20 mm, SD = 0.75 mm), followed by the numerical tasks (M = 5.02 mm, SD = 0.72 mm) and textual tasks (M = 4.78 mm, SD = 0.71 mm). Accommodative fluctuations - measured as accommodation SD - were largest in the textual tasks (M = 0.67 D, SD = 0.34 D), followed by the numerical tasks (M = 0.61 D, SD = 0.40 D) and the Stroop task (M = 0.52 D, SD = 0.21 D).

CONCLUSIONS

In our experiment, short-term cognitive load was associated with altered pupillary and accommodative response to near tasks. In conflicting tasks (Stroop) or in performing continuing calculations, the pupils were larger; in tasks requiring logical reasoning, the accommodative fluctuations were greater. These effects can potentially be associated with current near-point stress and myopia growth models.

Effect of Neuromuscular Electrical Stimulation Training on Control of Involuntary Muscular Torque and Stimulation Intensity in Older Adults

The purpose of this study was to examine the effects of a 4-week neuromuscular electrical stimulation (NMES) training regimen on involuntary torque output and electrical stimulation intensity in older adults. Twelve older adults (ages: 68.4 ± 6.5 years; men: n = 6, women: n = 6; weight: 158.6 ± 27.3 lbs; height: 65.2 ± 2.1 in) received submaximal intensity NMES to the quadriceps for 4 weeks to determine training-related changes in stimulation intensity and involuntary control of muscular torque during the NMES protocol. Two-way repeated measures ANOVAs were used to compare torque parameters and stimulation intensity between days and across protocol time bins. After training, stimulation intensity and torque increased over the course of the NMES protocol, while torque decreased during the protocol pre-training. These results suggest that muscular endurance of involuntary muscle contraction is increased with NMES training, and that stimulation intensity should be increased throughout the course of training to augment muscular torque output.

Barriers and facilitators to accommodations in the workplace for adults who use augmentative and alternative communication (AAC): a systematic review

Workplace accommodations can reduce barriers to employment for people who use augmentative and alternative communication (AAC), however, the lack of accommodations continues to challenge participation in employment. This systematic review identified and analyzed barriers and facilitators to implementing workplace accommodations for adults (19 years and over) who use AAC. A systematic search of nine databases was conducted to identify relevant studies using the search terms "AAC" and "workplace accommodations" and variations of each term. Results were imported into Covidence. Seventeen studies met the inclusion criteria. Results were presented using the International Classification of Functioning, Disability, and Health (ICF) framework. The Oxford levels of evidence and Confidence in Evidence from Review of Qualitative Research (GRADE-CERQual) were used to assess the quality of the studies and confidence in findings, respectively. Environmental barriers related mainly to attitudes and technology, and personal barriers related to job qualifications, education, and work-related skills. A combination of facilitators such as personal strengths, access to technology, and supportive relationships contributed to successful implementation of accommodations. The findings of this review suggest that implementing workplace accommodations for adults who use AAC strategies is complex and further research is needed to advance practices and policies that support the implementation of workplace accommodations.

The impact of smartphone use on accommodative functions: pilot study

Evidence about the effect of smartphone use on accommodation is limited and inconclusive. Several studies have investigated either symptoms or near triad measures following smartphone use. These suggest that, certainly for the short term, smartphones have a negative impact on the near triad and produce symptoms. In addition, there is a body of recent work reporting cases of acute acquired concomitant esotropia (AACE) that may be caused by the accommodation-vergence demand of excessive smartphone use. A pilot study was undertaken to investigate accommodative measures before and after 30 minutes of smartphone use. Participants aged 16-40 years were invited to participate. Accommodative facility (AF), near point of accommodation (NPA), and near point of convergence (NPC) before and after 30 minutes of habitual smartphone use were assessed. NPA and AF were assessed with both eyes open (BEO), right eye (RE) and left eye (LE). Accommodative facility was assessed using ±2DS flipper lenses and measured in cycles per minute (cpm). NPA and NPC were assessed using the RAF rule and measured in centimeters. Data were analyzed in StatsDirect using non-parametric statistical tests. Eighteen participants were recruited, with a mean age of 24 years (SD: 7.6yrs). AF improved by 3cpm (p= .015) for BEO, 2.25cpm for RE (p = .004) and 1.5 cpm for the LE (p =. 278) after smartphone use. NPA with BEO became worse by 2 cm (p =.0474), with the RE worse by 0.5cms (p = .0474) and the LE, worse by 0.125 cms (p = .047). Convergence worsened by 0.75 cms (p = .018). Although these appeared to represent a change in measures following smartphone use, post-hoc analysis with Bonferroni correction demonstrated that these were not statistically significant at the 0.07 significance level. This pilot study found that there was no difference in accommodative and convergence measures before and after 30 minutes of smartphone use. These results suggest evidence contrary to the existing literature. There are several limitations to this pilot study and previous work, which are discussed. Suggestions on future work to explore the effect of smartphone use on the near triad to address limitations and further knowledge, in this area, are provided.

Trajectory of Change in Parental Accommodation and Its Relation to Symptom Severity and Impairment in Pediatric OCD

Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 youth receiving a family-based intervention for early-onset OCD. FA, symptom severity and functional impairment were assessed at baseline, week 5, week 9, and post-treatment (week 14). Results suggested that changes in FA in the beginning stages of treatment preceded global symptom improvement (but not OCD specific improvement) whereas changes in functional impairment preceded changes in FA. In the latter half of treatment, changes in FA preceded improvement in global and OCD specific symptom severity as well as functional impairment. These findings highlight the importance of reducing FA, especially in the later stages of treatment, in order to optimize treatment outcomes in early-onset OCD.

A Review of Lens Biomechanical Contributions to Presbyopia

Purpose: Presbyopia-the progressive loss of near focus with age-is primarily a result of changes in lens biomechanics. In particular, the shape of the ocular lens in the absence of zonular tension changes significantly throughout adulthood. Contributors to this change in shape are changes in lens biomechanical properties, continuous volumetric growth lens, and possibly remodeling of the lens capsule. Knowledge in this area is growing rapidly, so the purpose of this mini-review was to summarize and synthesize these gains.Methods: We review the recent literature in this field.Results: The mechanisms governing age-related changes in biomechanical properties remains unknown. We have recently shown that lens growth may be driven by zonular tension. The same mechanobiological mechanism driving lens growth may also lead to remodeling of the capsule, though this remains to be demonstrated.Conclusions: This mini-review focuses on identifying mechanisms which cause these age-related changes, suggesting future work which may elucidate these mechanisms, and briefly discusses ongoing efforts to develop a non-surgical approach for therapeutic management of presbyopia. We also propose a simple model linking lens growth and biomechanical properties.

The effect of concentric and aspheric multifocal soft contact lenses on binocular vision in young adult myopes

PURPOSE

Multifocal soft contact lenses (MFCLs) are prescribed to inhibit myopia progression; these include aspheric and concentric designs. The effects of MFCLs on visual quality, accommodation and vergence in young-adult myopes were evaluated.

METHODS

Participants were twenty-six myopes (19-25 years, spherical equivalent -0.50 to -5.75D), with normal binocular vision and no past myopia control. Pupil sizes were 4.4 ± 0.9 mm during distance viewing and 3.7 ± 0.8 mm at near. In random order, participants wore four MFCLs: Proclear single vision distance, MiSight concentric dual focus (+2.00D), distance center aspheric (Biofinity, +2.50D) (CooperVision lenses), and NaturalVue aspheric (Visioneering Technologies). Testing included visual acuity, contrast sensitivity (Pelli-Robson), stereoacuity, accommodation response, negative and positive relative accommodation, horizontal phorias, horizontal fusional vergence and AC/A ratio, and a visual quality questionnaire.

RESULTS

The four lenses differed in distance (p = 0.001) and near visual acuity (p = 0.011), and contrast sensitivity (p = 0.001). Compared with the single vision lens, the Biofinity aspheric had the greatest visual impact: 0.19 ± 0.14 logMAR distance acuity reduction, 0.22 ± 0.15 log contrast sensitivity reduction. Near acuity was affected less than distance acuity; the reduction was greatest with the NaturalVue (0.05 ± 0.07 logMAR reduction). The MFCLs altered the autorefraction measure at distance and near (p = 0.001); the accommodation response was less with aspheric lenses. Negative relative accommodation reduced with the aspheric lenses (p = 0.001): by 0.9 ± 0.5D with Biofinity and 0.5 ± 0.7D with NaturalVue. Exophoric shifts were greater with aspheric lenses (1.8 ± 2.4Δ Biofinity, 1.7 ± 1.7Δ NaturalVue) than with the concentric MiSight (0.5 ± 1.3Δ).

CONCLUSIONS

MFCLs alter visual performance, refraction and vergence; two aspheric lenses had greater effect than a concentric lens.

Accommodation in allogeneic and xenogeneic organ transplantation: Prevalence, impact, and implications for monitoring and for therapeutics

Accommodation refers to acquired resistance of organs or tissues to immune or inflammatory reactions that might otherwise cause severe injury or rejection. As first observed in ABO-incompatible kidney transplants and heterotopic cardiac xenografts, accommodation was identified when organ transplants continued to function despite the presence of anti-graft antibodies and/or other reactants in the blood of recipients. Recent evidence suggests many and perhaps most organ transplants have accommodation, as most recipients mount B cell responses specific for the graft. Wide interest in the impact of graft-specific antibodies on the outcomes of transplants prompts questions about which mechanisms confer protection against such antibodies, how accommodation might be detected and whether and how rejection could be superimposed on accommodation. Xenotransplantation offers a unique opportunity to address these questions because immune responses to xenografts are easily detected and the pathogenic impact of immune responses is so severe. Xenotransplantation also provides a compelling need to apply these and other insights to decrease the intensity and toxicity of immunosuppression that otherwise could limit clinical application.

Using magnetic panels to enlarge a transtibial prosthetic socket

A novel method is described to connect a prosthetic liner to the panels of an adjustable socket to facilitate limb fluid volume stabilization in prosthesis users. Magnets are placed in the socket panels, and iron powder is embedded in the user's prosthetic liner. When the magnet is in close proximity to the liner, a firm connection is formed. The system's capability to execute panel pull on transtibial prosthesis users was tested. The backs of the panels were supported by a bracket mounted to the external surface of the socket that allowed the radial position of the panels to be adjusted. Bench testing demonstrated an optimized strength-to-weight ratio using 1.27-cm thick annular-shaped magnets supported by 0.32-cm thick backplates. Testing on four people with transtibial amputation showed that the maximum socket increase achieved using magnetic panel pull ranged from 5.3% to 13.8% of the initial (panels flush) socket volume. The results indicate that magnetic panel pull induces a meaningful increase in socket volume during sitting. The clinical relevance is a novel strategy that may help stabilize prosthesis users' limb fluid volume over the day.

The Influence of Near Vision Tasks on Intraocular Pressure in Normal Subjects and Glaucoma Patients

Purpose

To investigate the effect of static accommodative tasks on intraocular pressure (IOP) of glaucomatous and normal eyes.

Methods

Four groups of subjects categorized as primary open-angle glaucoma (POAG), primary angle-closure suspects (PACS), normal age-matched controls, and normal young adults (NYA; age < 40 years) were enrolled. The baseline IOPs were measured after the subjects were looking at a distant target for 15 min. Static accommodation was obtained by execution of near vision tasks (reading at 33 cm in daylight [300 lux] for 60 min). IOPs were measured at 15, 30, 45, and 60 min intervals while accommodating and then measured again after 15 min of relaxing accommodation while looking at a distant target.

Results

One-hundred and eighteen eyes of 98 subjects were recruited. The study groups consisted of the following categories: 25 POAG (46 eyes), 24 PACS (47 eyes), 25 matched controls (50 eyes), and 24 NYA (48 eyes). Within all groups, the mean IOP decreased throughout the accommodation period at all time points. Maximum IOP reduction after accommodation was detected at the 30-min time among the POAG subjects, at the 45-min time in the PACS and matched control groups, and at 15 min after the relaxation of accommodation in the NYA group. IOP reduction levels showed no statistically significant difference among POAG, PACS, and the normal matched groups in their response to accommodation. However, NYA had significantly lower IOP and greater IOP reduction after the resting period (relaxation of accommodation).

Conclusion

Static accommodative tasks can significantly reduce IOP in normal, POAG, and PACS individuals. Encouraging glaucoma patients to practice periodical near vision tasks could be viewed as an adjunctive measure for glaucoma management.

Frequency and Correlates of Fathers' Accommodation in Pediatric Anxiety Disorders

Previous studies investigating family accommodation (FA) in pediatric anxiety disorders have primarily relied on mothers' reports, while data on FA by fathers remains scarce. We examined the frequency and correlates of fathers' FA of anxious children and compared fathers' and mothers' reports of FA. Participants were 69 parents of treatment-seeking children and adolescents with a primary anxiety disorder. FA was highly prevalent amongst fathers, with the majority of fathers participating in symptom-related behaviors and modifying family routines due to child anxiety. Fathers' accommodation levels were significantly correlated with fathers' reports of child internalizing symptoms, child externalizing symptoms, and fathers' own anxiety symptoms. Fathers' and mothers' reports of FA were moderately correlated, whereas their reports of their respective distress related to the need to accommodate were only weakly correlated. Fathers reported a significantly lower frequency of FA than did mothers. These findings highlight the importance of obtaining reports from both fathers and mothers when assessing FA. Results are particularly relevant to family-focused and parent-based interventions designed to address and reduce FA amongst parents of clinically anxious children.

Accommodative and binocular vision dysfunctions in a Portuguese clinical population

BACKGROUND

Several studies have suggested that accommodative and non-strabismic binocular dysfunctions are commonly encountered in optometric practice. This study aims to verify whether these findings apply to a Portuguese clinical population.

METHODS

This study included consecutive nonpresbyopic subjects that came to two Portuguese optometric clinics over a period of six months. A complete visual exam was conducted and included the measurement of visual acuity (VA), refraction, near point of convergence (NPC), distance and near phoria, near and distance fusional vergences, amplitude of accommodation (AA), monocular accommodative facility (MAF), relative accommodation and lag of accommodation.

RESULTS

156 subjects with a mean age of 24.9 ± 5.3 years (from 18 to 35 years old) participated in the study. Of all subjects, 32 % presented binocular vision and/or accommodative disorders accompanied or not by refractive errors. Moreover, 21.1 % had accommodative disorders, and 10.9 % had a binocular vision dysfunction. Accommodative insufficiency (11.5 %) was the most prevalent disorder, followed by convergence insufficiency (7.1 %) and accommodative infacility (5. 8 %).

CONCLUSIONS

Clinicians should be aware that about one third of the optometric clinical population could have accommodative and/or non-strabismic binocular disorders. Accommodative insufficiency was the most prevalent dysfunction presented in the studied population, followed by accommodative infacility and convergence insufficiency.

The Pediatric Accommodation Scale: Psychometric Evaluation of a Therapist-Report Format

Anxiety disorders are the most common mental health problem in youth, and accommodation is prevalent among youth with anxiety disorders. The Pediatric Accommodation Scale (PAS) is an interview administered by trained evaluators and a parent-report form (PAS-PR) to assess accommodation and its impact. Both have strong psychometric properties including internal consistency, inter-rater reliability, and data supporting construct validity. The present study evaluates the Pediatric Accommodation Scale - Therapist Report (PAS-TR), a therapist-reported version of the PAS-PR. Participants were 90 youth enrolled in cognitive behavioral therapy for anxiety. Therapists completed the PAS-TR over 16 therapy sessions. Internal consistency at baseline, convergent validity, divergent validity, and parent-therapist agreement were evaluated. Results suggest that the PAS-TR has mixed psychometric qualities suggesting that while not strong prior to the initiation of treatment, the PAS-TR may be a useful measure for therapists to rate accommodation as treatment progresses. Implications for assessment, treatment, and research are discussed.

Premium intraocular lenses in children

Multifocal and toric intraocular lenses (IOLs) or the so-called premium IOLs are currently widely used in adult patients as a one-step refractive solution following cataract surgery. However, the decision to implant a premium IOL in a pediatric patient involves multiple factors affecting the child's visual development and is associated with several dilemmas and surgical challenges. The purpose of this review is to summarize these factors and analyse the influence of each of them on the visual outcomes following premium IOL implantation. A review of literature was conducted using the relevant keywords from various databases until 31^st January 2022. All pertinent studies with multifocal or toric IOL implantation in children were reviewed, and relevant articles were studied in detail for age, IOL power calculation, visual outcomes (refractive outcomes, contrast sensitivity and stereopsis) and complications such as dysphotic phenomena and others. A total of 17 relevant studies (10 case series/interventional studies and 7 case reports) on the subject were included. All studies showed a favourable refractive outcome; however, the data available was significantly less. Studies with earlier models of multifocal IOLs showed a higher incidence of IOL decentration and posterior capsule opacification; however, more recent studies with newer IOL models showed much better safety profiles. Toric IOLs showed promising results in all the studies evaluated. Premium IOLs have shown promising results in the pediatric age group. However, their long-term outcomes specifically concerning refractive shift, capsular contraction and role in the management of amblyopia needs to be explored further.

Intraocular accommodative movements in monkeys; relationship to presbyopia

Our goal was to quantify the age-related changes in the dynamic accommodative movements of the vitreous and aqueous humor in iridic, aniridic, phakic and aphakic primate eyes. Six bilaterally iridic and four bilaterally iridectomized rhesus monkeys, ranging in age from 6 to 25 years, received a stimulating electrode in the midbrain Edinger-Westphal nucleus to induce accommodation, measured by a Hartinger coincidence refractometer. One of the four iridectomized monkeys underwent unilateral extracapsular and another monkey underwent intracapsular lens extraction. Eyes were imaged utilizing specialized techniques and contrast agents to resolve intraocular structures. During accommodation the anterior hyaloid membrane and the posterior lens capsule bowed backward. Central vitreous fluid and structures/strands moved posteriorly toward the optic nerve region as peripheral vitreous, attached to the vitreous zonule, was pulled forward by ciliary muscle contraction. Triamcinolone particles injected intravitreally were also observed in the anterior chamber and moved from the anterior chamber toward the cleft of the anterior hyaloid membrane and then further posteriorly into the vitreous-filled cleft between the vitreous zonule and the ciliary body pars plana. These accommodative movements occurred in all eyes, and declined with age. There are statistically significant accommodative movements of various intravitreal structures. The posterior/anterior fluid flow between the anterior chamber and the vitreous compartments during accommodation/disaccommodation represents fluid displacement to allow/facilitate lens thickening. The posterior accommodative movement of central vitreous fluid may result from centripetal compression of the anterior tips of the cistern-like structure attached to the vitreous zonule, and posterior displacement of the central trunk of the cistern during ciliary muscle contraction and centripetal muscle movement. The findings may have implications for presbyopia.

Classifying Conversational Entrainment of Speech Behavior: An Expanded Framework and Review

Conversational entrainment, also known as alignment, accommodation, convergence, and coordination, is broadly defined as similarity of communicative behavior between interlocutors. Within current literature, specific terminology, definitions, and measurement approaches are wide-ranging and highly variable. As new ways of measuring and quantifying entrainment are developed and research in this area continues to expand, consistent terminology and a means of organizing entrainment research is critical, affording cohesion and assimilation of knowledge. While systems for categorizing entrainment do exist, these efforts are not entirely comprehensive in that specific measurement approaches often used within entrainment literature cannot be categorized under existing frameworks. The purpose of this review article is twofold: First, we propose an expanded version of an earlier framework which allows for the categorization of all measures of entrainment of speech behaviors and includes refinements, additions, and explanations aimed at improving its clarity and accessibility. Second, we present an extensive literature review, demonstrating how current literature fits into the given framework. We conclude with a discussion of how the proposed entrainment framework presented herein can be used to unify efforts in entrainment research.