College of Optometrists

Abstract:

Myopia is a condition that affects approximately 1 in 6 of the world’s population and has reached epidemic proportions in some industrialized East Asian societies (e.g. Singapore), where 70% or more of young adolescents are myopic. Myopia interferes significantly with normal visual function, ranging from a simple visual hindrance to a precursor for secondary pathologies and accounts for approximately 35% of an optometrist’s workload. The significant increase in prevalence of child myopia over recent decades has initiated a global surge of research into its epidemiological characteristics and ocular biometric corollaries. The prevalence of myopia varies between countries even when subjects of similar ethnicity are compared suggesting that prevalence rates may be population specific. Research findings from recent UK studies on epidemiology of refractive error will be discussed and compared with other studies from around the world.  The nature as to how refractive error progresses during childhood will be explored along with findings from research which suggests that certain features of the environment may influence the development of myopia in childhood. ‘Is my child likely to become myopic?’ is an often asked question in optometry practice; recent research will be analysed that will assist the optometrist with responses to the question of potential myopia development.

Learning objectives:

• Appraise current epidemiology studies on refractive error in children.
•  Describe the typical progress of refractive error during infancy and childhood.
•  Extend existing knowledge of environmental and lifestyle factors that may be of significance in the onset and development of myopia.
• Develop evidence-based guidelines to advise on childhood myopia

Biography:

Nicola Logan is a lecturer in Optometry in the School of Life and Health Sciences, Aston University, Birmingham, UK. Nicola’s main teaching areas are Clinical Optometry and Paediatric Optometry for undergraduate students and Myopia to postgraduate students. Nicola’s research interests are in the epidemiology of refractive error, the development of myopia and ocular biometry. Her current main research project is the Aston Eye Study: an epidemiological, cross-sectional study to determine the prevalence of refractive error and its associated ocular biometry in a large multi-racial sample of school children from the metropolitan area of Birmingham, England.  Current collaborations include ongoing projects with Dr Alicja Rudnicka and Dr Chris Owen (St Georges, University of London), Dr Kathryn Saunders and Dr Lisa O’Donoghue (University of Ulster) and Dr Hetal Patel (University of Plymouth).
Nicola has published research papers on various aspects of myopia and also has 2 book chapters and one edited book published (Optometry: Science, Techniques and Clinical Management. Eds Rosenfield and Logan, Elsevier, Oxford, 2009).
 

Abstract:

Comfortable binocular vision, co-ordinating vergences and accommodation in the face of refractive error, heterophoria and varying target distance, usually occurs seamlessly. So why do some patients with small defects of these systems suffer such severe symptoms, while others with large objective defects seem untroubled?

This presentation will discuss the issues around deciding how much a patient’s signs and symptoms are due to a treatable binocular vision defect, then carrying on to discuss when and how to treat or refer to specialist services.

Our research at the University of Reading has made me re-address topics that as an orthoptist I thought I knew all about; in particular I will present evidence that suggests we should consider the role of disparity-driven convergence accommodation much more than that of blur-driven accommodative convergence for the majority of our patients.

Learning objectives:

• Recognise when visual symptoms are due to a BV defect
• Know which types of patients can be safely treated in the community, which should not be actively treated, and which should be referred for a specialist opinion
• Be able to reflect on the possibility of a stronger role for convergence accommodation than generally thought

Biography:

Dr Anna Horwood trained as an orthoptist in the ‘70s and taught theoretical and clinical orthoptics for many years. She worked at Moorfields Eye Hospital, London and the Royal Berkshire Hospital, Reading before moving into laboratory research at the University of Reading with Dr Patricia Riddell, studying the development of typical vergence and accommodation. Her PhD was on the topic of neonatal ocular misalignments, which enabled more accurate differentiation of typical from atypical development.
Since then, work from the Infant Vision Laboratory, funded by personal fellowships from the National Institute of Health Research and Medical Research Council has provided insights into many aspects of binocular vision, with publications covering typical development, accommodation in hypermetropia, distance exotropia,  accommodative esotropia, photorefraction and  the AC/A and CA/C relationships. Anna is a regular reviewer for a wide range of optometry and paediatric ophthalmology journals.