Smartphone ophthalmoscopy: patient and student practitioner perceptions

It can take several years to become proficient at direct ophthalmoscopy; the instrument’s single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient’s perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method

Shape of the posterior vitreous chamber in human emmetropia and myopia

PURPOSE: To compare posterior vitreous chamber shape in myopia to that in emmetropia. METHODS: Both eyes of 55 adult subjects were studied, 27 with emmetropia (mean spherical error [MSE] ≥ -0.55; <+0.75 D; mean +0.09 ± 0.36 D) and 28 with myopia (MSE -5.87 ± 2.31 D). Cycloplegic refraction was measured with a Shin Nippon autorefractor and anterior chamber depth and axial length with a Zeiss IOLMaster. Posterior vitreous chamber shapes were determined from T2-weighted magnetic resonance imaging (3.0-T) using procedures previously reported by our laboratory. Three-dimensional surface model coordinates were assigned to nasal, temporal, superior, and inferior quadrants and plotted in two dimensions to illustrate the composite shape of respective quadrants posterior to the second nodal point. Spherical analogues of chamber shape were constructed to compare relative sphericity between refractive groups and quadrants. RESULTS: Differences in shape occurred in the region posterior to points of maximum globe width and were thus in general accord with an equatorial model of myopic expansion. Shape in emmetropia is categorized distinctly as that of an oblate ellipse and in myopia as an oblate ellipse of significantly less degree such that it approximates to a sphere. There was concordance between shape and retinotopic projection of respective quadrants into right, left, superior, and inferior visual fields. CONCLUSIONS: Prolate ellipse posterior chamber shapes were rarely found in myopia, and we propose that spherical shape in myopia may constitute a biomechanical limitation on further axial elongation. Synchronization of quadrant shapes with retinotopic projection suggests that binocular growth is coordinated by processes that operate beyond the optic chiasm

The Effects of Severe Myopia on the Properties of Sampling Units in Peripheral Retina

SIGNIFICANCE: Poor peripheral visual acuity in myopia may reflect, in part, photoreceptor misalignment with the exit pupil of the eye. We speculate that if such misalignment causes sufficient visual deprivation and/or disrupts retinal feedback processes, it may influence eye growth itself. PURPOSE: It is known that myopic eyes have a reduced peripheral resolution acuity relative to emmetropic eyes, though it remains unclear how mechanical stretching of the retina in myopia impacts on peripheral visual performance. Our aim was to determine how retinal stretching affects the properties of sampling units in peripheral vision. METHODS: Three-dimensional magnetic resonance imaging provided a depiction in vivo of ocular shape, allowing the inter-eye ratio of retinal image surface areas and the relative alignment of surfaces to be determined in our observer, who was unique in having severe myopia in the right eye (~21 D) but only modest myopia in the left (~3 D). Visual performance was assessed for the detection and direction discrimination of drifting sinusoids positioned 40° in the temporal retina. Applying the sampling theorem to our measures, we estimated the density and cut-off frequency of the underlying sampling units. RESULTS: The retinal image surface area of the right eye was 40% larger than that of the left and was rotated 8.9° anticlockwise relative to the left eye's image surface. In agreement with a linear stretch model of myopia, the sampling density of the right eye was reduced by approximately the same ratio as that predicted from the inter-eye MRI data, namely, 1.18. However, the cut-off frequency (cycles/mm) of the right eye was approximately half that of the left, a reduction that cannot be explained solely by a linear areal expansion of retinal sampling units. CONCLUSIONS: Poor peripheral acuity in severe myopia may be caused, at least in part, by receptoral misalignment with the exit pupil

Evaluating a new objective grading software for conjunctival hyperaemia

Background/ Aims: Standardised numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. We investigated the intra- and inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales as well as a new Advanced Ophthalmic Systems (AOS) software which uses an objective approach to grading conjunctival hyperaemia. Methods: One experienced observer graded n = 30 bulbar and n = 26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomised images was undertaken for all three methods, on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer. Results: There were no statistically significant differences (P > 0.05) between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperaemia was improved using the AOS grading method (R2 = 0.998; Coefficient of Repeatability CoR 0.10–0.13), compared to Efron (R2 = 0.926; CoR 0.62) and CCLRU (R2 = 0.885–0.911; CoR 0.50–0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (> 0.995) versus subjective methods (0.853–0.959). Conclusion: These subjective and objective grading methods are not interchangeable. Due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provides a more consistent approach when grading ocular abnormalities and may achieve greater reliability in record keeping and clinical monitoring in the future

The Epstein-Barr virus BamHI C promoter is not essential for B cell immortalization in vitro, but it greatly enhances B cell growth transformation

Epstein-Barr virus (EBV) infection of B cells leads to the sequential activation of two viral promoters, Wp and Cp, resulting in the expression of six EBV nuclear antigens (EBNAs) and the viral Bcl2 homologue BHRF1. The viral transactivator EBNA2 is required for this switch from Wp to Cp usage during the initial stages of infection. EBNA2-dependent Cp transcription is mediated by the EBNA2 response element (E2RE), a region that contains at least two binding sites for cellular factors; one of these sites, CBF1, interacts with RBP-JK, which then recruits EBNA2 to the transcription initiation complex. Here we demonstrate that the B cell-specific transcription factor BSAP/Pax5 binds to a second site, CBF2, in the E2RE. Deletion of the E2RE in the context of a recombinant virus greatly diminished levels of Cp-initiated transcripts during the initial stages of infection but did not affect the levels of Wp-initiated transcripts or EBNA mRNAs. Consistent with this finding, viruses deleted for the E2RE were not markedly impaired in their ability to induce B cell transformation in vitro. In contrast, a larger deletion of the entire Cp region did reduce EBNA mRNA levels early after infection and subsequently almost completely ablated lymphoblastoid cell line (LCL) outgrowth. Notably, however, rare LCLs could be established following infection with Cp-deleted viruses, and these were indistinguishable from wild-type-derived LCLs in terms of steady-state EBV gene transcription. These data indicate that, unlike Wp, Cp is dispensable for the virus' growth-transforming activity. IMPORTANCE Epstein-Barr virus (EBV), a B lymphotropic herpesvirus etiologically linked to several B cell malignancies, efficiently induces B cell proliferation leading to the outgrowth of lymphoblastoid cell lines (LCLs). The initial stages of this growth-transforming infection are characterized by the sequential activation of two viral promoters, Wp and Cp, both of which appear to be preferentially active in target B cells. In this work, we have investigated the importance of Cp activity in initiating B cell proliferation and maintaining LCL growth. Using recombinant viruses, we demonstrate that while Cp is not essential for LCL outgrowth in vitro, it enhances transformation efficiency by >100-fold. We also show that Cp, like Wp, interacts with the B cell-specific activator protein BSAP/Pax5. We suggest that EBV has evolved this two-promoter system to ensure efficient colonization of the host B cell system in vivo

HPV vaccine knowledge, attitudes, beliefs, and behaviors among community college students: a scoping review

Background: Human Papillomavirus is the most common sexually transmitted infection in the United States. Approximately 42.5 million individuals in the U.S. are infected with disease-associated HPV and 13 million new cases occur every year. It is estimated that 85% of sexually active adults will be infected with HPV at some point during their lifetime. Most individuals infected with HPV are asymptomatic and clear the virus without any complications. However, in some individuals, the virus persists. Prolonged HPV infection has been associated with six different types of cancer and genital warts. There are approximately 37,000 cases of HPV-associated cancers diagnosed annually in the U.S. In 2006, a highly effective vaccine was approved for use in the U.S. which has been shown to be able to prevent 90% of HPV-associated cancers. Although the vaccine has displayed proven safety and efficacy, uptake of the vaccine among adolescents continues to lag. This lag in vaccination among adolescents has led to an increased need for catch-up vaccination. College students represent an ideal population to target for catch-up HPV vaccination. Previous research has examined HPV knowledge, attitudes, beliefs, and behaviors among college students; however, most of this research has occurred among students attending four-year universities. While community college students comprise 41% of all undergraduate college students in the U.S., limited HPV-related research exists among this population. Purpose: This study aims to review the current literature on knowledge, attitudes, beliefs, and behaviors around HPV and HPV vaccination among community college students in the United States. Methods: A scoping review will be conducted in accordance with the Joanna Briggs Institute methodology using published research from PubMed, Embase, PsycINFO, and CINAHL databases covering all relevant literature addressing knowledge, attitudes, beliefs, and behaviors around HPV and HPV vaccination among community college students in the United States

Diferencias intra e inter individuales en inteligencia social de estudiantes portugueses

Social intelligence is a favorable condition for career decision-making and development. The social intelligence indices of Portuguese students in school years prior to a career transition are characterized and intra and interindividual differences are analyzed. Participants were 1095 students (552, 50.4% women) with a mean age of 14.78 years (SD = 1.86), in the 8th (542, 49.5%), 10th (295, 26.9%) and 11th (258, 23.6%) grades. The Cognitive Test of Social Intelligence (PCIS) was administered at two moments, six months apart. Results indicate that the 8th grade obtained higher average scores in Problem Solving, Motivation and Self-confidence (time 1), while the 10th grade obtained better results in Problem Solving, Motivation and Familiarity (time 2). Between the assessment moments, all school years register an increase in Problem Solving and Self-confidence in social situations. These results constitute favorable psychological conditions for the promotion of ethical questioning in career guidance interventions.A inteligência social constitui uma condição favorável à tomada de decisão e ao desenvolvimento vocacional. Este trabalho visa caracterizar os níveis de inteligência social, e analisar as diferenças intra e interindividuais, em alunos portugueses em anos de pré-transição vocacional. Participaram 1095 alunos (552, 50% mulheres), com uma média de idades de 14,78 anos (DP = 1,86), do 8º, 10º, e 11º níveis escolares. Administrou-se a Prova Cognitiva de Inteligência Social (PCIS), em dois momentos (T1 e T2), com seis meses de intervalo. Os resultados indicam que o 8º ano obteve resultados médios superiores, nos índices de Resolução de Problemas, Motivação e Autoconfiança (T1), enquanto o 10º ano obteve resultados superiores, em Resolução de Problemas, Motivação e Familiaridade (T2). Entre momentos de avaliação, registra-se, para todos os níveis escolares, um aumento em Resolução de Problemas e Autoconfiança em situações sociais. Estes resultados constituem condições psicológicas favoráveis à promoção do questionamento ético nas intervenções de orientação vocacional.La inteligencia social es una condición favorable para la toma de decisiones y el desarrollo de la carrera. Se caracterizan los niveles de inteligencia social y sus diferencias intra e interindividuales en estudiantes portugueses en transición pre-profesional. Participaron 1095 estudiantes (552, 50.4% mujeres) con una edad media de 14.78 (DE = 1.86), del 8º (542, 49,5%), 10º (295, 26.9%) y 11º (258, 23.6%) años escolares. Se administró la Prueba Cognitiva de Inteligencia Social (PCIS) en dos ocasiones, con seis meses de diferencia. Los resultados indican que los estudiantes del 8º grado obtuvieron puntajes medios más altos en la Resolución de Problemas, Motivación y Confianza (T1), mientras que los del 10º grado obtuvieron mejores resultados en la Resolución de Problemas, Motivación y Familiaridad (T2). Entre momentos de evaluación se registra, para todos los años, un aumento en la Resolución de Problemas y Confianza en situaciones sociales. Estos resultados constituyen condiciones psicológicas favorables a la promoción del cuestionamiento ético en las intervenciones de orientación profesional.Project coordinated by the fourth author and co-funded by the Foundation for Science and Technology and the Compete Program - PTDC/CPE-CED/098896/200

Fast versus gradual adaptation of soft daily disposable contact lenses in neophyte wearers

Purpose Despite the widespread practice of gradually adapting all new soft contact lens wearers (neophytes), there is little evidence-based research underpinning such practice. This work determined if a gradual adaptation period is necessary for neophytes when fitted with modern hydrogel or silicone-hydrogel daily disposable contact lenses. Method At four sites, neophytes (19–32 years) were randomly assigned to an adaptation schedule: fast (10 h wear from the first day) or gradual (4 h on the first day, increasing their wear-time by 2 h on each subsequent day until they had reached 10 h) with hydrogel (n = 24 fast; n = 21 gradual) or silicone-hydrogel (n = 10 fast; n = 10 gradual) contact lenses. Masked investigators graded ocular surface physiology and non-invasive tear breakup time (NIBUT). A range of subjective scores (using 0–100 visual analogue scales) were recorded at the initial visit and after 10 h of lens wear, 4–6 days and 12–14 days after initial fitting. Subjective scores were also repeated after 7 days. Results There was no difference (p > 0.05) in ocular surface physiology between the fast and gradual adaptation groups at any time point in either lens type. NIBUT was similar at all time points for both adaptation groups in both lens types with the exception that the gradual adaptation silicone-hydrogel wearers had a slightly longer NIBUT (p = 0.007) than the fast adaptation group at 12-14 days. Subjective scores were also similar across the visits and lens types with the exception of ‘lens awareness’ and ‘ease of lens removal’ which were better (p < 0.05) in the fast compared with the gradual adaptation hydrogel lens group at day 7. Additionally, ‘end-of-day discomfort’ was better (p = 0.02) in the fast compared with the gradual adaptation hydrogel lens group at 12–14 days. Conclusion There appears to be no benefit in daily disposable soft contact lens adaptation for neophytes with modern contact lens materials