Optometry & Visual Performance 

Abstract: This paper is a review of the literature surrounding the potential impact of undiagnosed and untreated refractive vision problems on reading development in the early years of primary school. Despite pre-school screening programmes, it is still possible for children to enter school with undiagnosed or uncorrected refractive vision problems. This paper generally discusses correlations between refractive errors and poor reading development. However, the relationships reported remain complex. Myopia is noted to correlate to high reading ability in some studies, but a correlation does not necessarily imply causation. Previous research in the field and deficiencies in the current literature base are discussed. Recommendations for the nature of research that explores whether refractive error is the cause of poor reading development for some children in school are suggested.

Abstract: Background: The purpose of this study was to investigate the effect of a combined visual efficiency and perceptual-motor training programme on the handwriting performance of Chinese children aged 6 to 9 years with handwriting difficulties (HWD). Methods: Twenty-six children with HWD were assigned randomly and equally into two groups. The training programme was provided over eight consecutive weeks with one session per week. The perceptual-motor group received training only on perceptual-motor functions, including visual spatial relationship, visual sequential memory, visual constancy, visual closure, graphomotor control and grip control. The combined training group received additional training components on visual efficiency, including accommodation, ocular motility, and binocular fusion. Visual efficiency, visual perceptual skills, and Chinese handwriting performance were assessed before and after the training programme. Results: The results showed statistically significant improvement in handwriting speed after the training in both groups. However, the combined training gave no additional benefit on improving handwriting speed (ANCOVA: F=0.43, p=0.52). In terms of visual efficiency, participants in the combined training group showed greater improvement in amplitude of accommodation measured with right eye (F=4.34, p<0.05), left eye (F=5.77, p<0.05) and both eyes (F=11.08, p<0.01). Conclusions: Although the additional visual efficiency training did not provide further improvement in the handwriting speed of children with HWD, children showed improvement in their accommodation amplitude. As accommodative function is important for providing sustainable and clear near vision in the process of reading and word recognition for writing, the effect of the combined training on handwriting performance should be further investigated.

Abstract: Background: The use of objective eye movement measuring devices, such as the Visagraph or ReadAlyzer, has gained popularity in patients with acquired brain injury (ABI) in order to address their common complaints of reading difficulty. Based on our clinical experience, we have found a specific recording pattern in these patients, where the duration of fixation is increased proportionally greater than other test findings. Methods: A retrospective research study was conducted to determine the characteristics of Visagraph/ReadAlyzer results in 36 patients with ABI. Results: Our results show that out of 36 patients, 75% showed a pattern where the duration of fixation was increased, and a reduction of at least two grade levels as compared to the second-lowest component of the recording was present. Conclusion: It is common to see increased duration of fixation in patients with a history of ABI. This may indicate a reduction in information processing. Tachistoscopic activities, as a part of a vision rehabilitation program, will be beneficial for these patients in order to improve their reading ability further.

Abstract: Purpose: Ocular and/or vision defects are one of the most common reasons for the referral of young children to the hospital. Vision disorders are the fourth most common disability of children and the leading cause of handicapping conditions in childhood. In preschool-age children, amblyopia and amblyogenic risk factors, such as strabismus and significant refractive errors, are the most prevalent and important visual disorders. The purpose of this pilot study was to determine the prevalence of visual disorders in preschool children in Kathmandu Valley, Nepal. Methods: Four hundred and eighty-four children attending eight preschools in Kathmandu Valley underwent detailed optometric examination. Visual acuity was assessed with either Sheridan Gardiner or Kay Picture chart monocularly. Binocularity was assessed with cover test and prism bar neutralisation. Refraction was carried out in all children. In most instances this was done without the use of a cycloplegic agent. Stereopsis was assessed with the Lang stereo test. Anterior and posterior segment abnormalities were assessed by using a pen light, hand-held slit lamp, and direct ophthalmoscope. Results: Refractive error was the most common visual disorder. Considering our criteria of refractive error for myopia ≥ 0.50 D, hyperopia ≥ 1.50 D, astigmatism ≥ 1.00 D, and anisometropia ≥ 1.00 D, the overall prevalence of refractive error in our study was 31.82%. The overall prevalence of myopia, hyperopia, and astigmatism was 24.17%, 2.48%, and 5.17%, respectively. Anisometropia was present in 1.65% of the participants, and 2%, 1.4%, and 0.2% had strabismus, amblyopia, and nystagmus, respectively. Conclusion: The relatively high prevalence of refractive error in our studied population needs more attention. The results suggest that there is a need for a large-scale community-based preschool screening program in Nepal so that affected children can be identified early and appropriate treatment can be started promptly.