Effect of uncorrected astigmatism on vision

PURPOSE: To examine the effect of uncorrected astigmatism in older adults. SETTING: University Vision Clinic METHOD: Twenty-one healthy presbyopes, aged 58.9±2.8 years, had astigmatism of 0.0 to -4.0 x 90?DC and -3.0DC of cylinder at 90?, 180? and 45? induced with spectacle lenses, with the mean spherical equivalent compensated to plano, in random order. Visual acuity was assessed binocularly using a computerised test chart at 95%, 50% and 10% contrast. Near acuity and reading speed were measured using standardised reading texts. Light scatter was quantified with the cQuant and driving reaction times with a computer simulator. Finally visual clarity of a mobile phone and computer screen was subjectively rated. RESULTS: Distance visual acuity decreased with increasing uncorrected astigmatic power (F=174.50, p<0.001) and was reduced at lower contrasts (F=170.77, p<0.001). Near visual acuity and reading speed also decreased with increasing uncorrected astigmatism power (p<0.001). Light scatter was not significantly affected by uncorrected astigmatism (p>0.05), but the reliability and variability of measurements decreased with increasing uncorrected astigmatic power (p<0.05). Driving simulator performance was also unaffected by uncorrected astigmatism (p>0.05), but subjective rating of clarity decreased with increasing uncorrected astigmatic power (p<0.001). Uncorrected astigmatism at 45? or 180? orientation resulted in a worse distance and near visual acuity, and subjective rated clarity than 90? orientation (p<0.05). CONCLUSION: Uncorrected astigmatism, even as low as 1.0DC, causes a significant burden on a patient’s vision. If left uncorrected, this could impact significantly on their independence, quality of life and wellbeing.

Development of a questionnaire to assess the relative subjective benefits of presbyopia correction

Purpose To develop a standardized questionnaire of near visual function and satisfaction to complement visual function evaluations of presbyopic corrections. Setting Eye Clinic, School of Life and Health Sciences, Aston University, Midland Eye Institute and Solihull Hospital, Birmingham, United Kingdom. Design Questionnaire development. Methods A preliminary 26-item questionnaire of previously used near visual function items was completed by patients with monofocal intraocular lenses (IOLs), multifocal IOLs, accommodating IOLs, multifocal contact lenses, or varifocal spectacles. Rasch analysis was used for item reduction, after which internal and test–retest reliabilities were determined. Construct validity was determined by correlating the resulting Near Activity Visual Questionnaire (NAVQ) scores with near visual acuity and critical print size (CPS), which was measured using the Minnesota Low Vision Reading Test chart. Discrimination ability was assessed through receiver-operating characteristic (ROC) curve analysis. Results One hundred fifty patients completed the questionnaire. Item reduction resulted in a 10-item NAVQ with excellent separation (2.92), internal consistency (Cronbach a = 0.95), and test–retest reliability (intraclass correlation coefficient = 0.72). Correlations of questionnaire scores with near visual acuity (r = 0.32) and CPS (r = 0.27) provided evidence of validity, and discrimination ability was excellent (area under ROC curve = 0.91). Conclusion Results show the NAVQ is a reliable, valid instrument that can be incorporated into the evaluation of presbyopic corrections.

I don't see me like you see me, but is that a problem? Cultural influences on rating discrepancy in 360-degree feedback instruments

360-degree feedback from a variety of rater sources yields important information about leaders' styles, strengths and weaknesses for development. Results where observer ratings are discrepant (i.e., different) from self-ratings are often seen as indicators of problematic leadership relationships, skills, or lack of self-awareness. Yet research into the antecedents of such self-observer rating discrepancy suggests the presence of systematic influences, such as cultural values. The present study investigates the variation of rating discrepancies on three leadership skills (decision making, leading employees, and composure) in dependence of one exemplary culture dimension (power distance) on data from 31 countries using multilevel structural equation modelling. Results show that cultural values indeed predict self-observer rating discrepancies. Thus, systemic and contextual influences such as culture need to be taken into consideration when interpreting the importance and meaning of self-observer rating discrepancies in 360-degree instruments.

On the validity of subjective measures of company performance

Subjective measures of company performance are widely used in research and typically are interpreted as equivalent to objective measures. Yet, the assumption of equivalence is open to challenge. We compared the use of both types of measure in 3 separate samples. Findings were consistent in showing that: (a) subjective and objective measures of company performance were positively associated (convergent validity); (b) those relationships were stronger than those between measures of differing aspects of performance using the same method (discriminant validity); and (c) the relationships of subjective and objective company performance measures with a range of independent variables were equivalent (construct validity).

Visual function and subjective quality of life compared in subjects with acquired macular disease

PURPOSE: To determine the objective measures of visual function that are most relevant to subjective quality of vision and perceived reading ability in patients with acquired macular disease. METHODS: Twenty-eight patients with macular disease underwent a comprehensive assessment of visual function. The patients also completed a vision-related quality-of-life questionnaire that included a section of general questions about perceived visual performance and a section with specific questions on reading. RESULTS: Results of all tests of vision correlated highly with reported vision-related quality-of-life impairment. Low-contrast tests explained most of the variance in self-reported problems with reading. Text-reading speed correlated highly with overall concern about vision. CONCLUSIONS: Reading performance is strongly associated with vision-related quality of life. High-contrast distance acuity is not the only relevant measure of visual function in relation to the perceived visual performance of a patient with macular disease. The results suggest the importance of print contrast, even over print size, in reading performance in patients with acquired macular disease.

The Effect of nutritional supplementation on subjective and objective measures of visual and retinal function:a random controlled trial

In industrialised countries age-related macular disease (ARMD) is the leading cause of visual loss in older people. Because oxidative stress is purported to be associated with an increased risk of disease development the role of antioxidant supplementation is of interest. Lutein is a carotenoid antioxidant that accumulates within the retina and is thought to filter blue light. Increased levels of lutein have been associated with reduced risk of developing ARMD and improvements in visual and retinal function in eyes with ARMD. The aim of this randomised controlled trial (RCT) was to investigate the effect of a lutein-based nutritional supplement on subjective and objective measures of visual function in healthy eyes and in eyes with age-related maculopathy (ARM) – an early form of ARMD. Supplement withdrawal effects were also investigated. A sample size of 66 healthy older (HO), healthy younger (HY), and ARM eyes were randomly allocated to receive a lutein-based supplement or no treatment for 40 weeks. The supplemented group then stopped supplementation to look at the effects of withdrawal over a further 20 weeks. The primary outcome measure was multifocal electroretinogram (mfERG) N1P1 amplitude. Secondary outcome measures were mfERG N1, P1 and N2 latency, contrast sensitivity (CS), Visual acuity (VA) and macular pigment optical density (MPOD). Sample sizes were sufficient for the RCT to have an 80% power to detect a significant clinical effect at the 5% significance level for all outcome measures when the healthy eye groups were combined, and CS, VA and mfERG in the ARM group. This RCT demonstrates significant improvements in MPOD in HY and HO supplemented eyes. When HY and HO supplemented groups were combined, MPOD improvements were maintained, and mfERG ring 2 P1 latency became shorter. On withdrawal of the supplement mfERG ring 1 N1P1 amplitude reduced in HO eyes. When HO and HY groups were combined, mfERG ring 1 and ring 2 N1P1 amplitudes were reduced. In ARM eyes, ring 3 N2 latency and ring 4 P1 latency became longer. These statistically significant changes may not be clinically significant. The finding that a lutein-based supplement increases MPOD in healthy eyes, but does not increase mfERG amplitudes contrasts with the CARMIS study and contributes to the debate on the use of nutritional supplementation in ARM.

Optimizing measurement of subjective amplitude of accommodation with defocus curves

PURPOSE: To determine whether letter sequences and/or lens-presentation order should be randomized when measuring defocus curves and to assess the most appropriate criterion for calculating the subjective amplitude of accommodation (AoA) from defocus curves. SETTING: Eye Clinic, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom. METHODS: Defocus curves (from +3.00 diopters [D] to -3.00 D in 0.50 D steps) for 6 possible combinations of randomized or nonrandomized letter sequences and/or lens-presentation order were measured in a random order in 20 presbyopic subjects. Subjective AoA was calculated from the defocus curves by curve fitting using various published criteria, and each was correlated to subjective push-up AoA. Objective AoA was measured for comparison of blur tolerance and pupil size. RESULTS: Randomization of lens-presentation order and/or letter sequences, or lack of, did not affect the measured defocus curves (P>.05, analysis of variance). The range of defocus that maintains highest achievable visual acuity (allowing for variability of repeated measurement) was better correlated to (r = 0.84) and agreed best with ( 0.50 D) subjective push-up AoA than any other relative or absolute acuity criterion used in previous studies. CONCLUSIONS: Nonrandomized letters and lens presentation on their own did not affect subjective AoA measured by defocus curves, although their combination should be avoided. Quantification of subjective AoA from defocus curves should be standardized to the range of defocus that maintains the best achievable visual acuity.

Performance data indicate summation for pictorial depth-cues in slanted surfaces

Over recent years much has been learned about the way in which depth cues are combined (e.g. Landy et al., 1995). The majority of this work has used subjective measures, a rating scale or a point of subjective equality, to deduce the relative contributions of different cues to perception. We have adopted a very different approach by using two interval forced-choice (2IFC) performance measures and a signal processing framework. We performed summation experiments for depth cue increment thresholds between pairs of pictorial depth cues in displays depicting slanted planar surfaces made from arrays of circular 'contrast' elements. Summation was found to be ideal when size-gradient was paired with contrast-gradient for a wide range of depth-gradient magnitudes in the null stimulus. For a pairing of size-gradient and linear perspective, substantial summation (> 1.5 dB) was found only when the null stimulus had intermediate depth gradients; when flat or steeply inclined surfaces were depicted, summation was diminished or abolished. Summation was also abolished when one of the target cues was (i) not a depth cue, or (ii) added in conflict. We conclude that vision has a depth mechanism for the constructive combination of pictorial depth cues and suggest two generic models of summation to describe the results. Using similar psychophysical methods, Bradshaw and Rogers (1996) revealed a mechanism for the depth cues of motion parallax and binocular disparity. Whether this is the same or a different mechanism from the one reported here awaits elaboration.

Quality performance rating

This Thesis reports on the principles and usefulness of Performance Rating as developed by the writer over a number of years. In Part one a brief analysis is made of the Quality scene and its development up to the present. The need is exposed for Performance Rating as a tool for all areas of management*. At the same time a system of Quality Control is described which the writer has further developed under the title of 'Operator Control'. This system is based on the integration of all Quality control functions with the creative functions required for Quality achievement. The discussions are mainly focussed on the general philosophy of Quality, its creation and control and that part of Operator Control which affects Performance Rating. Whereas it is shown that the combination of Operator Control and Performance Rating is both economically and technically advantageous, Performance Rating can also usefully be applied under inspection control conditions. Part two describes the principles of Area Performance Rating. *The need for, and the advantages of, Performance Rating are particularly demonstrated in Case study No.1. From this a summation expression is derived which gives the key for grouping of areas with similar Performance Rating (P). A model is devised on which the theory is demonstrated. Relevant case studies, carried out in practice in factories are quoted in Part two, Chapter 4, one written by the Quality manager of that particular factory. Particular stress is laid in the final conclusions on management's function in the Quality field and how greatly this function is eased and improved through the introduction of Area Performance Rating.

Effect of fatigue on consumers' advertising processing

Huge advertising budgets are invested by firms to reach and convince potential consumers to buy their products. To optimize these investments, it is fundamental not only to ensure that appropriate consumers will be reached, but also that they will be in appropriate reception conditions. Marketing research has focused on the way consumers react to advertising, as well as on some individual and contextual factors that could mediate or moderate the ad impact on consumers (e.g. motivation and ability to process information or attitudes toward advertising). Nevertheless, a factor that potentially influences consumers’ advertising reactions has not yet been studied in marketing research: fatigue. Fatigue can yet impact key variables of advertising processing, such as cognitive resources availability (Lieury 2004). Fatigue is felt when the body warns to stop an activity (or inactivity) to have some rest, allowing the individual to compensate for fatigue effects. Dittner et al. (2004) defines it as “the state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.’’ It signals that resources will lack if we continue with the ongoing activity. According to Schmidtke (1969), fatigue leads to troubles in information reception, in perception, in coordination, in attention getting, in concentration and in thinking. In addition, for Markle (1984) fatigue generates a decrease in memory, and in communication ability, whereas it increases time reaction, and number of errors. Thus, fatigue may have large effects on advertising processing. We suggest that fatigue determines the level of available resources. Some research about consumer responses to advertising claim that complexity is a fundamental element to take into consideration. Complexity determines the cognitive efforts the consumer must provide to understand the message (Putrevu et al. 2004). Thus, we suggest that complexity determines the level of required resources. To study this complex question about need and provision of cognitive resources, we draw upon Resource Matching Theory. Anand and Sternthal (1989, 1990) are the first to state the Resource Matching principle, saying that an ad is most persuasive when the resources required to process it match the resources the viewer is willing and able to provide. They show that when the required resources exceed those available, the message is not entirely processed by the consumer. And when there are too many available resources comparing to those required, the viewer elaborates critical or unrelated thoughts. According to the Resource Matching theory, the level of resource demanded by an ad can be high or low, and is mostly determined by the ad’s layout (Peracchio and Myers-Levy, 1997). We manipulate the level of required resources using three levels of ad complexity (low – high – extremely high). On the other side, the resource availability of an ad viewer is determined by lots of contextual and individual variables. We manipulate the level of available resources using two levels of fatigue (low – high). Tired viewers want to limit the processing effort to minimal resource requirements by making heuristics, forming overall impression at first glance. It will be easier for them to decode the message when ads are very simple. On the contrary, the most effective ads for viewers who are not tired are complex enough to draw their attention and fully use their resources. They will use more analytical strategies, looking at the details of the ad. However, if ads are too complex, they will be too difficult to understand. The viewer will be discouraged to process information and will overlook the ad. The objective of our research is to study fatigue as a moderating variable of advertising information processing. We run two experimental studies to assess the effect of fatigue on visual strategies, comprehension, persuasion and memorization. In study 1, thirty-five undergraduate students enrolled in a marketing research course participated in the experiment. The experimental design is 2 (tiredness level: between subjects) x 3 (ad complexity level: within subjects). Participants were randomly assigned a schedule time (morning: 8-10 am or evening: 10-12 pm) to perform the experiment. We chose to test subjects at various moments of the day to obtain maximum variance in their fatigue level. We use Morningness / Eveningness tendency of participants (Horne & Ostberg, 1976) as a control variable. We assess fatigue level using subjective measures - questionnaire with fatigue scales - and objective measures - reaction time and number of errors. Regarding complexity levels, we have designed our own ads in order to keep aspects other than complexity equal. We ran a pretest using the Resource Demands scale (Keller and Bloch 1997) and by rating them on complexity like Morrison and Dainoff (1972) to check for our complexity manipulation. We found three significantly different levels. After having completed the fatigue scales, participants are asked to view the ads on a screen, while their eye movements are recorded by the eye-tracker. Eye-tracking allows us to find out patterns of visual attention (Pieters and Warlop 1999). We are then able to infer specific respondents’ visual strategies according to their level of fatigue. Comprehension is assessed with a comprehension test. We collect measures of attitude change for persuasion and measures of recall and recognition at various points of time for memorization. Once the effect of fatigue will be determined across the student population, it is interesting to account for individual differences in fatigue severity and perception. Therefore, we run study 2, which is similar to the previous one except for the design: time of day is now within-subjects and complexity becomes between-subjects

The effects of a lutein-based supplement on objective and subjective measures of retinal and visual function in eyes with age-related maculopathy - a randomised controlled trial

Lutein and zeaxanthin are lipid-soluble antioxidants found within the macula region of the retina. Links have been suggested between increased levels of these carotenoids and reduced risk for age-related macular disease (ARMD). Therefore, the effect of lutein-based supplementation on retinal and visual function in people with early stages of ARMD (age-related maculopathy, ARM) was assessed using multi-focal electroretinography (mfERG), contrast sensitivity and distance visual acuity. A total of fourteen participants were randomly allocated to either receive a lutein-based oral supplement (treated group) or no supplement (non-treated group). There were eight participants aged between 56 and 81 years (65·50 (sd 9·27) years) in the treated group and six participants aged between 61 and 83 years (69·67 (sd 7·52) years) in the non-treated group. Sample sizes provided 80 % power at the 5 % significance level. Participants attended for three visits (0, 20 and 40 weeks). At 60 weeks, the treated group attended a fourth visit following 20 weeks of supplement withdrawal. No changes were seen between the treated and non-treated groups during supplementation. Although not clinically significant, mfERG ring 3 N2 latency (P= 0·041) and ring 4 P1 latency (P= 0·016) increased, and a trend for reduction of mfERG amplitudes was observed in rings 1, 3 and 4 on supplement withdrawal. The statistically significant increase in mfERG latencies and the trend for reduced mfERG amplitudes on withdrawal are encouraging and may suggest a potentially beneficial effect of lutein-based supplementation in ARM-affected eyes. Copyright © 2012 The Authors.

Nonlinear speech analysis algorithms mapped to a standard metric achieve clinically useful quantification of average Parkinson's disease symptom severity

The standard reference clinical score quantifying average Parkinson's disease (PD) symptom severity is the Unified Parkinson's Disease Rating Scale (UPDRS). At present, UPDRS is determined by the subjective clinical evaluation of the patient's ability to adequately cope with a range of tasks. In this study, we extend recent findings that UPDRS can be objectively assessed to clinically useful accuracy using simple, self-administered speech tests, without requiring the patient's physical presence in the clinic. We apply a wide range of known speech signal processing algorithms to a large database (approx. 6000 recordings from 42 PD patients, recruited to a six-month, multi-centre trial) and propose a number of novel, nonlinear signal processing algorithms which reveal pathological characteristics in PD more accurately than existing approaches. Robust feature selection algorithms select the optimal subset of these algorithms, which is fed into non-parametric regression and classification algorithms, mapping the signal processing algorithm outputs to UPDRS. We demonstrate rapid, accurate replication of the UPDRS assessment with clinically useful accuracy (about 2 UPDRS points difference from the clinicians' estimates, p < 0.001). This study supports the viability of frequent, remote, cost-effective, objective, accurate UPDRS telemonitoring based on self-administered speech tests. This technology could facilitate large-scale clinical trials into novel PD treatments.

Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocular lens

Purpose - To assess clinical outcomes and subjective experience after bilateral implantation of a diffractive trifocal intraocular lens (IOL). Setting - Midland Eye Institute, Solihull, United Kingdom. Design - Cohort study. Methods - Patients had bilateral implantation of Finevision trifocal IOLs. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and manifest refraction were measured 2 months postoperatively. Defocus curves were assessed under photopic and mesopic conditions over a range of +1.50 to -4.00 diopters (D) in 0.50 D steps. Contrast sensitivity function was assessed under photopic conditions. Halometry was used to measure the angular size of monocular and binocular photopic scotomas arising from a glare source. Patient satisfaction with uncorrected near vision was assessed using the Near Activity Visual Questionnaire (NAVQ). Results - The mean monocular CDVA was 0.08 logMAR ± 0.08 (SD) and the mean binocular CDVA, 0.06 ± 0.08 logMAR. Defocus curve testing showed an extended range of clear vision from +1.00 to -2.50 D defocus, with a significant difference in acuity between photopic conditions and mesopic conditions at -1.50 D defocus only. Photopic contrast sensitivity was significantly better binocularly than monocularly at all spatial frequencies. Halometry showed a glare scotoma of a mean size similar to that in previous studies of multifocal and accommodating IOLs; there were no subjective complaints of dysphotopsia. The mean NAVQ Rasch score for satisfaction with near vision was 15.9 ± 10.7 logits. Conclusions - The trifocal IOL implanted binocularly produced good distance visual acuity and near and intermediate visual function. Patients were very satisfied with their uncorrected near vision.

Consensus on recording of gas permeable contact lens fit

Purpose: To develop a new schematic scheme for efficiently recording the key parameters of gas permeable contact lens (GP) fits based on current consensus. Methods: Over 100 established GP fitters and educators met to discuss the parameters proposed in educational material for evaluating GP fit and concluded on the key parameters that should be recorded. The accuracy and variability of evaluating the fluorescein pattern of GP fit was determined by having 35 experienced contact lens practitioners from across the world, grading 5 images of a range of fits and the topographer simulation of the same fits, in random, order using the proposed scheme. The accuracy of the grading was compared to objective image analysis of the fluorescein intensity of the same images. Results: The key information to record to adequately describe the fit of an GP was agreed as: the manufacturer, brand and lens parameters; settling time; comfort on a 5 point scale; centration; movement on blink on a ±2 scale; and the Primary Fluorescein Pattern in the central, mid-peripheral and edge regions of the lens averaged along the horizontal and vertical lens axes, on a ±2 scale. On average 50-60% of practitioners selected the median grade when subjectively rating fluorescein intensity and this was correlated to objective quantification (r= 0.602, p< 0.001). Objective grading suggesting horizontal median fluorescein intensity was generally symmetrical, as was the vertical meridian, but this was not the case for subjective grading. Simulated fluorescein patterns were subjectively and objectively graded as being less intense than real photographs (p< 0.01). Conclusion: GP fit recording can be standardised and simplified to enhance GP practice. © 2013 British Contact Lens Association.