Hypo-accommodation responses in hypermetropic infants and children

Aims: Accommodation to overcome hypermetropia is implicated in emmetropisation. This study recorded accommodation responses in a wide range of emmetropising infants and older children with clinically significant hypermetropia to assess common characteristics and differences. Methods: A PlusoptiXSO4 photorefractor in a laboratory setting was used to collect binocular accommodation data from participants viewing a detailed picture target moving between 33cm and 2m. 38 typically developing infants were studied between 6-26 weeks of age and were compared with cross-sectional data from children 5-9 years of age with clinically significant hypermetropia (n=15), corrected fully accommodative strabismus (n=14) and 27 age-matched controls. Results: Hypermetropes of all ages under-accommodated compared to controls at all distances, whether corrected or not (p<0.00001) and lag related to manifest refraction. Emmetropising infants under-accommodated most in the distance, while the hypermetropic patient groups underaccommodated most for near. Conclusions: Better accommodation for near than distance is demonstrated in those hypermetropic children who go on to emmetropise. This supports the approach of avoiding refractive correction in such children. In contrast, hypermetropic children referred for treatment for reduced distance visual acuity are not likely to habitually accommodate to overcome residual hypermetropia left by an under-correction.

Environmental quality and the productive workplace

A good working environment will help to provide the user with a good sense of wellbeing, inspiration and comfort. The main advantages of good environments is in terms of reduced upgrading investment, reduced sickness absence, an optimum level of productivity and improved overall satisfaction. Individuals respond very differently to their environments and research suggests a correlation between worker productivity and well-being, environmental, social and organisational factors. Research shows the occupants who report a high level of dissatisfaction about their job are usually the people who suffer more work and office environment related illnesses which affect their wellbeing, but not always so. Well-being expresses overall satisfaction. There is a connection between dissatisfied staff and low productivity; and a good sense of well-being is very important as it can lead to substantial productivity gain. If the environment is particularly bad people will be dissatisfied irrespective of job satisfaction. This paper describes research showing how environment affects productivity.

Pervasive technologies for workplace management

Purpose – Facilities managers have less visibility of how buildings are being used due to flexible working and unpredictable workers. The purpose of this paper is to examine the current issues in workspace management and an automatic solution through radio frequency identification (RFID) that could provide real time information on the volume and capacity of buildings. Design/methodology/approach – The study described in this paper is based on a case study at a facilities management (FM) department. The department is examining a ubiquitous technology in the form of innovative RFID for security and workspace management. Interviews and observations are conducted within the facilities department for the initial phase of the implementation of RFID technology. Findings – Research suggests that work methods are evolving and becoming more flexible. With this in mind, facilities managers face new challenges to create a suitable environment for an unpredictable workforce. RFID is one solution that could provide facilities managers with an automatic way of examining space in real time and over a wider area than currently possible. RFID alone for space management is financially expensive but by making the application multiple for other areas makes more business sense. Practical implications – This paper will provide practicing FM and academics with the knowledge gained from the application of RFID in this organisation. While the concept of flexible working seems attractive, there is an emerging need to provide various forms of spaces that enable employees' satisfaction and enhance the productivity of the organisation. Originality/value – The paper introduces new thinking on the subject of “workspace management”. It highlights the current difficulties in workspace management and how an RFID solution will benefit workspace methods.

Variability of the accommodation response in early onset myopia

Purpose. Hyperopic retinal defocus (blur) is thought to be a cause of myopia. If the retinal image of an object is not clearly focused, the resulting blur is thought to cause the continuing lengthening of the eyeball during development causing a permanent refractive error. Both lag of accommodation, especially for near targets, and greater variability in the accommodative response, have been suggested as causes of increased hyperopic retinal blur. Previous studies of lag of accommodation show variable findings. In comparison, greater variability in the accommodative response has been demonstrated in adults with late onset myopia but has not been tested in children. This study looked at the lag and variability of accommodation in children with early onset myopia. Methods. Twenty-one myopic and 18 emmetropic children were tested. Dynamic measures of accommodation and pupil size were made using eccentric photorefraction (Power Refractor) while children viewed targets set at three different accommodative demands (0.25, 2, and 4 D). Results. We found no difference in accommodative lag between groups. However, the accommodative response was more variable in the myopes than emmetropes when viewing both the near (4 D) and far (0.25 D) targets. Since pupil size and variability also varied, we analyzed the data to determine whether this could account for the inter-group differences in accommodation variability. Variation in these factors was not found to be sufficient to explain these differences. Changes in the accommodative response variability with target distance were similar to patterns reported previously in adult emmetropes and late onset myopes. Conclusions. Children with early onset myopia demonstrate greater accommodative variability than emmetropic children, and have similar patterns of response to adult late onset myopes. This increased variability could result in an increase in retinal blur for both near and far targets. The role of accommodative variability in the etiology of myopia is discussed.

Receding and disparity cues aid relaxation of accommodation

Purpose. Accommodation can mask hyperopia and reduce the accuracy of non-cycloplegic refraction. It is, therefore, important to minimize accommodation to obtain a measure of hyperopia as accurate as possible. To characterize the parameters required to measure the maximally hyperopic error using photorefraction, we used different target types and distances to determine which target was most likely to maximally relax accommodation and thus more accurately detect hyperopia in an individual. Methods. A PlusoptiX SO4 infra-red photorefractor was mounted in a remote haploscope which presented the targets. All participants were tested with targets at four fixation distances between 0.3 and 2 m containing all combinations of blur, disparity, and proximity/looming cues. Thirty-eight infants (6 to 44 weeks) were studied longitudinally, and 104 children [4 to 15 years (mean 6.4)] and 85 adults, with a range of refractive errors and binocular vision status, were tested once. Cycloplegic refraction data were available for a sub-set of 59 participants spread across the age range. Results. The maximally hyperopic refraction (MHR) found at any time in the session was most frequently found when fixating the most distant targets and those containing disparity and dynamic proximity/looming cues. Presence or absence of blur was less significant, and targets in which only single cues to depth were present were also less likely to produce MHR. MHR correlated closely with cycloplegic refraction (r = 0.93, mean difference 0.07 D, p = n.s., 95% confidence interval +/-<0.25 D) after correction by a calibration factor. Conclusions. Maximum relaxation of accommodation occurred for binocular targets receding into the distance. Proximal and disparity cues aid relaxation of accommodation to a greater extent than blur, and thus non-cycloplegic refraction targets should incorporate these cues. This is especially important in screening contexts with a brief opportunity to test for significant hyperopia. MHR in our laboratory was found to be a reliable estimation of cycloplegic refraction. (Optom Vis Sci 2009;86:1276-1286)