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- Visual function and impact of visual therapy in children with learning disabilities: a pilot studyPublication . Martins, Ana R.; Nunes, Amélia Fernandes; Jorge, ArmindaUndetected visual dysfunctions affect performance. Thus it’s e-essential the implementation of programs for visual evaluation/intervention in schoolchildren. [...]
- Tear meniscus height agreement and reproducibility between two corneal topographers and spectral-domain optical coherence tomographyPublication . Soares, Ivo; Ramalho, Eva; Brardo, Francisco M.; Nunes, Amélia FernandesClinical relevance: Tear meniscus height (TMH) is an important clinical marker in dry eye diagnosis and management. Purpose: To evaluate the reproducibility and agreement of TMH measurements in non-clinical participants using the Oculus Keratograph 5 M, Medmont Meridia, and Spectral-domain optical coherence tomography (Spectralis SD-OCT). Methods: Fifty-six participants (mean 43.8 ± 22.4 years) were recruited for this cross-sectional study. Image acquisitions were performed on the three devices, sequentially and randomized. The repeatability and reproducibility of inter-observer and inter-device analysis were performed. Repeated measures ANOVA and Bland-Altman Plots were used to evaluate the agreement between devices. Results: The mean TMH with the Oculus Keratograph 5 M, Medmont Meridia and Spectralis SD-OCT were 0.29 ± 0.16 mm, 0.24 ± 0.09 mm and 0.27 ± 0.16 mm, respectively. There were no significant inter-observer differences (paired t-tests, p < 0.001). All the devices exhibited good inter-observer reliability (ICC ≥ 0.877), and good repeatability (CV ≤ 16.53%). Inter-device reliability is moderate (ICC = 0.621, p < 0.001). Repeated measures ANOVA revealed that TMH measurements given by the Spectralis SD-OCT are not significantly different from the Oculus Keratograph 5 M (p = 0.19) and the Medmont Meridia (p = 0.38). TMH measurements from Oculus Keratograph 5 M were significantly higher than those from Medmont Meridia (p = 0.02). Correlations between the mean TMH and the difference in the TMH measurements were positive for Oculus Keratograph 5 M and Medmont Meridia (r2 = 0.62, p < 0.001), negative for Medmont Meridia and Spectralis SD-OCT (r2 = -0.59, p < 0.001), and not significant for Oculus Keratograph 5 M and Spectralis SD-OCT (r2 = 0.05, p = 0.74). A strong correlation was found for TMH measured with all devices (r2 = 0.55 to 0.81, p < 0.001). Conclusions The Oculus Keratograph 5 M, Medmont Meridia, and Spectralis SD-OCT provide reliable and reproducible inter-observer TMH measurements. Inter-device reliability is moderate, with a close correlation between Spectralis SD-OCT and the Oculus Keratograph 5 M. Oculus Keratograph 5 M and Medmont Meridia are repeatable devices appropriate for the measurement of TMH, but they are not interchangeable in clinical practice.
- Frequency of anisometropia in children in the Médio TejoPublication . Nunes, Amélia; Fernandes, Duarte José Gaião; Tuna, Ana Rita; Gonçalves, A.; Calado, R.; Monteiro, PedroAnisometropia is a difference in refractive error in the two eyes of an individual. It is often associated with amblyopia, both in the presence of and in the absence of strabismus. Its revalence depends on several factors, different values being found in different geographical areas of the world and in different age groups. [...]
- Eye discomfort at close work in Portuguese university students: A comparative analysis between the pre-COVID and confinement periodPublication . Nunes, Amélia Fernandes; Leitão, Mara Filipa Antunes; Nunes, António; Monteiro, PedroBackground Many individuals experience visual symptoms associated with near work. The level of discomfort appears to increase with the amount of digital screen use. Objective To study the eye discomfort with near tasks in university students in the pre-COVID period and in the period of confinement due to the pandemic. Methods Two independent samples of students, aged between 18 and 35 years, were used to assess symptomatic behaviour with the Convergence Insufficiency Symptom Survey (CISS) questionnaire. In the pre-COVID period the sample had 342 participants, 64.6% females and in the COVID period 322 students participated, 71.4% females. The study of differences was carried out by the Mann-Whitney U test. The interpretation of the statistical inference was performed for a significance level≤0.05. Results There was an increase in the number of symptomatic cases in the COVID period without statistical evidence of differences in the frequency of symptoms reported in the two periods. The dimensions "somatic sensations" and "cognitive performance" were the typology of symptoms that most contributed to visual complaints with near vision. There was a significantly different symptomatic behaviour between genders in the period of confinement (p = 0.001), worsening in females and improving in males. Conclusion These findings suggest that females and males exposed to digital environments, over time, may exhibit different symptomatic behaviour. Our results suggest that boys adapt more quickly than girls. Factors that predispose to these changes, aetiology and potential intervention actions still need further study.
- Adaptação do Questionário Standardized Patient Evaluation of Eye Dryness para Português (SPEED-Vp) numa População Não ClínicaPublication . Sanches, Ana Lúcia; Leite, Sara Gisela; Nunes, António; Caixinha, Miguel; Monteiro, Pedro; Nunes, AméliaIntrodução: O objetivo deste estudo foi traduzir e adaptar o questionário Standardized Patient Evaluation of Eye Dryness para o português europeu, bem como avaliar o desempenho psicométrico da versão traduzida, incluindo repetibilidade e concordância. Material e métodos: O questionário original Standardized Patient Evaluation of Eye Dryness - SPEED foi traduzido e adaptado para o contexto cultural português seguindo uma metodologia cientificamente válida comumente usada no processo de adaptação de instrumentos para outras culturas e línguas. O questionário resultante da tradução para o novo idioma foi sujeito a um pré-teste onde os comentários dos participantes foram escritos e considerados para a versão final do questionário. Para a validação da escala da versão final do questionário traduzido, 89 indivíduos de uma população não clínica, com idades entre 18 e 84 anos, foram convidados a responder ao questionário (61% eram mulheres). Uma semana depois, o mesmo questionário foi repetido por 63 indivíduos. A confiabilidade interna do questionário foi analisada pelo alfa de Cronbach, a estabilidade temporal pelo teste-reteste e a análise de concordância entre medidas pelo método de Bland-Altman. Resultados: A consistência interna do questionário traduzido, SPEED-vP, foi alta (α = 0,871) e todos os itens do questionário contribuíram para o aumento desse índice. Essa consistência também foi confirmada como alta no reteste (α = 0,856) e quando a amostra foi estratificada por idade e sexo. O questionário SPEED-complete também apresentou alta consistência (α = 0,88). A repetibilidade do instrumento foi alta (ICC 0,933; IC 95%: 0,899 e 0,960) e o gráfico de Bland-Altman revelou boa concordância entre as medidas. Conclusão: O Standardized Patient Evaluation of Eye Dryness in Portuguese (SPEED-vP) apresentou boas propriedades psicométricas para a população portuguesa. Portanto, a versão traduzida do questionário SPEED-vP pode ser usada para mensurar quantitativamente a presença de sintomas de olho seco na população portuguesa.
- Convergence insufficiency and accommodative insufficiency in childrenPublication . Nunes, Amélia; Monteiro, Pedro; Brardo, Francisco M.; Nunes, AntónioPurpose: Convergence and accommodative insufficiency represent the main cause of complaints during close visual work and can reduce visual performance and comfort. Knowing their prevalence among schoolchildren is fundamental to define strategies for action. The purpose of this study was to estimate the frequency of these conditions in children in 5th and 6th school years in inland Portugal and to assess the impact that each visual condition has on their quality of life, based on the level of visual symptoms. Methods: a cross-sectional study was carried out with children enrolled in the 5th and 6th school years. 372 children (192 girls) were assessed, with average ages of 10.9 ± 0.9 years. Refractive error and binocular vision assessment, integrating accommodative parameters, were used to analyse the visual condition. Symptoms were quantified using the Portuguese version of the CISS (Convergence Insufficiency Symptom Survey). Results: The prevalence of definite Convergence Insufficiency (CI) in the children assessed was 2%. A prevalence of 6,8% could be considered if clinically significant CI (high suspect and definite categories) cases are accounted. In relation to Accommodative Insufficiency (AI), a frequency rate of 10% was recorded, with 3% of the evaluated children presenting AI and CI simultaneously. The symptoms score was higher in AI than in CI. Conclusions: A frequency of approximately 10% was found for each one of the visual syndromes, and it was verified that visual discomfort is common among teenagers who carry these conditions. In cases of asthenopia, such as headaches and loss of concentration, associated with near vision activities, there is a requirement to evaluate the quality of binocular vision.
- Prevalence, sociodemographic risk factors, and coverage of myopia correction among adolescent students in the central region of PortugalPublication . Nunes, Amélia Fernandes; Cunha, Mariana; Sousa, Miguel Castelo-Branco; Godinho, Cristina AlbuquerqueBackground Knowing the prevalence of myopia at school age is essential to implement preventive measures and appropriate interventions, ensure access to vision care, promote a healthier educational environment and improve academic performance. The purpose of this study was to determine the prevalence of myopia and its associated sociodemographic risk factors, as well as to estimate the coverage of myopia correction among adolescents in center of Portugal. Methods This cross-sectional study evaluated 1115 adolescents from the 5th to the 9th year of school, with an average of 12.9 years (SD = 1.5) ranging from 10.0 to 18.0 years. Optometric evaluations were carried out in a school environment and consisted of the evaluation of distance visual acuity, assessed using a logarithmic visual acuity chart (ETDRS charts 1 and 2) at 4 m, and measured by refractive error with a pediatric autorefractometer (Plusoptix), by non-cycloplegic. Myopia was defined as spherical equivalent (SE ≤ -0.50 diopter (D)) and uncorrected visual acuity (UVA ≤ 95VAR). Adjusted logistic regression analysis was applied to investigate risk factors. Results We found a myopia rate of 21.5% and a high myopia rate of 1.4%. Higher school level and attendance at urban schools were associated with myopia, but no association was found with age or sex. Only 34.6% of myopic adolescents use the best optical correction and 26.4% do not use any type of optical correction. Conclusions Data on the prevalence of refractive problems in Portugal are scarce and heterogeneous. This study, although regional, provides a valuable contribution with a clear and reproducible methodology, following international guidelines and filling gaps in the existing literature. The results show that the rate of myopia in this age group is similar to reports from other European studies. The high rate of adolescents with uncorrected or undercorrected myopia in Portugal is a problem that deserves attention.
- Transcranial Magnetic Stimulation in Adults With AmblyopiaPublication . Tuna, Ana Rita; Pinto, Nuno; Brardo, Francisco M.; Fernandes, Andresa; Nunes, Amélia; Patto, Maria Da Assunção VazThrough transcranial magnetic stimulation (TMS) it is possible to change cortical excitability of the visual cortex, and to influence binocular balance. The main goal of our study is to assess the effect of transcranial magnetic stimulation, specifically theta burst stimulation (TBS), in a group of amblyopic volunteers measuring several visual parameters: visual acuity, suppressive imbalance, and stereoacuity.