The child self-refraction study results from urban Chinese children in Guangzhou

OBJECTIVE: To compare visual and refractive outcomes between self-refracting spectacles (Adaptive Eyecare, Ltd, Oxford, UK), noncycloplegic autorefraction, and cycloplegic subjective refraction. DESIGN: Cross-sectional study. PARTICIPANTS: Chinese school-children aged 12 to 17 years. METHODS: Children with uncorrected visual acuity ≤ 6/12 in either eye underwent measurement of the logarithm of the minimum angle of resolution visual acuity, habitual correction, self-refraction without cycloplegia, autorefraction with and without cycloplegia, and subjective refraction with cycloplegia. MAIN OUTCOME MEASURES: Proportion of children achieving corrected visual acuity ≥ 6/7.5 with each modality; difference in spherical equivalent refractive error between each of the modalities and cycloplegic subjective refractive error. RESULTS: Among 556 eligible children of consenting parents, 554 (99.6%) completed self-refraction (mean age, 13.8 years; 59.7% girls; 54.0% currently wearing glasses). The proportion of children with visual acuity ≥ 6/7.5 in the better eye with habitual correction, self-refraction, noncycloplegic autorefraction, and cycloplegic subjective refraction were 34.8%, 92.4%, 99.5% and 99.8%, respectively (self-refraction versus cycloplegic subjective refraction, P<0.001). The mean difference between cycloplegic subjective refraction and noncycloplegic autorefraction (which was more myopic) was significant (-0.328 diopter [D]; Wilcoxon signed-rank test P<0.001), whereas cycloplegic subjective refraction and self-refraction did not differ significantly (-0.009 D; Wilcoxon signed-rank test P = 0.33). Spherical equivalent differed by ≥ 1.0 D in either direction from cycloplegic subjective refraction more frequently among right eyes for self-refraction (11.2%) than noncycloplegic autorefraction (6.0%; P = 0.002). Self-refraction power that differed by ≥ 1.0 D from cycloplegic subjective refractive error (11.2%) was significantly associated with presenting without spectacles (P = 0.011) and with greater absolute power of both spherical (P = 0.025) and cylindrical (P = 0.022) refractive error. CONCLUSIONS: Self-refraction seems to be less prone to accommodative inaccuracy than noncycloplegic autorefraction, another modality appropriate for use in areas where access to eye care providers is limited. Visual results seem to be comparable. Greater cylindrical power is associated with less accurate results; the adjustable glasses used in this study cannot correct astigmatism. Further studies of the practical applications of this modality are warranted. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Episodic Future Thinking in 4-Year-Olds, Poster Symposium: The who, what, where and when of episodic foresight development

The ability to project oneself into the future to pre-experience an event is referred to as episodic future thinking (Atance & O’Neill, 2001). Only a relatively small number of studies have attempted to measure this ability in pre-school aged children (Atance & Meltzoff, 2005; Busby & Suddendorf, 2005ab, 2010; Russell, Alexis, & Clayton, 2010).Perhaps the most successful method is that used by Russell et al (2010). In this task, 3- to 5-year-olds played a game of blow football on one end of a table. After this children were asked to select tools that would enable them to play the same game tomorrow from the opposite, unreachable, side of the table. Results indicated that only 5-year-olds were capable of selecting the right objects for future use more often than would be expected by chance. Above-chance performance was observed in this older group even though most children failed the task because there was a low probability of selecting the correct 2 objects from a choice of 6 by chance.This study aimed to identify the age at which children begin to consistently pass this type of task. Three different tasks were designed in which children played a game on one side of a table, and then were asked to choose a tool to play a similar game on the other side of the table the next day. For example, children used a toy fishing rod to catch magnetic fish on one side of the table; playing the same game from the other side of the table required a different type of fishing rod. At test, children chose between just 2 objects: the tool they had already used, which would not work on the other side, and a different tool that they had not used before but which was suitable for the other side of the table. Experiment 1: Forty-eight 4-year-olds (M = 53.6 months, SD = 2.9) took part. These children were assigned to one of two conditions: a control condition (present-self) where the key test questions were asked in the present tense and an experimental condition (future-self) where the questions were in the future tense. Surprisingly, the results showed that both groups of 4-year-olds selected the correct tool at above chance levels (Table 1 shows the mean number of correct answers out of three). However, the children could see the apparatus when they answered the test questions and so perhaps answered them correctly without imagining the future. Experiment 2: Twenty-four 4-year-olds (M = 53.7, SD = 3.1) participated. Pre-schoolers in this study experienced one condition: future-self looking-away. In this condition children were asked to turn their backs to the games when answering the test questions, which were in the future tense. Children again performed above chance levels on all three games.Contrary to the findings of Russell et al. (2010), our results suggest that episodic future thinking skills could be present in 4-year-olds, assuming that this is what is measured by the tasks. Table 1. Mean number of correct answers across the three games in Experiments 1 and 2Experimental Conditions (N=24 in each condition)Mean CorrectStandardDeviationStatistical SignificanceExp. 1 (present-self, look) – 2 items2.750.68p < 0.001Exp. 1 (future-self, look) – 2 items 2.790.42p < 0.001Exp. 2 (future-self, away) – 2 items 2.330.64p < 0.001Exp. 3 (future-self away) – 3 items1.210.98p = 0.157