Biomedical subjects

Jeffrey J Walline

Publications and source records attributed to Jeffrey J Walline.

12 recordsLinked to original sources

PubMed2006

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data.

PURPOSE: The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on children's self-perception. METHODS: Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Children's satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually. RESULTS: Five clinical sites enrolled 484 subjects with a mean (+/- standard deviation [SD]) age of 10.4 +/- 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (+/- SD) cycloplegic spherical equivalent autorefraction of the right eye is -2.38 +/- 1.04 D, and the average (+/- SD) axial length of the right eye is 24.32 +/- 0.77 mm. The average (+/- SD) Global Self-Worth score on the SPPC is 3.20 +/- 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (+/- SD) spectacle satisfaction is 59.1 +/- 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 +/- 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life). CONCLUSIONS: Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on children's self-perceptions.

Adolescent↗

PubMed2006

Comparison of the experience sampling method and questionnaires to assess visual activities in pre-teen and adolescent children.

AIM: A study was conducted to assess the feasibility of the experience sampling method (ESM) to quantify the daily visual tasks of children. METHODS: Thirty-one children (9-14 years old, 39% male) were randomly paged after school (four times per day) and on weekends (eight times per day) for seven consecutive days. When paged, the children completed a voicemail survey regarding the nature, duration, working distance and type of visual correction worn during the activity. Responses of the subjects were grouped into 14 categories. Before beginning the paging, each child and one parent also reported, via survey, the number of hours and working distance for several visual activities. RESULTS: The usable (complete voicemail responses) response rate was 87.1%. The most commonly reported activity category was watching television (17.8%). Other common responses included distance activities (12.5%), reading/studying (12.2%) and sports/outdoor activities (12.0%). Of the total number of responses, 25% were near work activities (reading/studying, computer use, near hobbies and playing Game Boy). The mean working distance (+/-S.D.) reported was 40.4 +/- 36.9 cm for reading/studying, 232.9 +/- 127.1 cm for watching television, 354.7 +/- 345.8 cm for distance activities and 438.5 +/- 421.0 cm for sports/outdoor activities. When comparing the ESM to surveys, the only significant difference was for the amount of time estimated to be spent in talking/conversation (p < 0.0001). No differences were found for any of the near work activities. CONCLUSIONS: The ESM provides a feasible way to quantify daily near work tasks in children.

Adolescent↗

PubMed2005

The current state of corneal reshaping.

PURPOSE: The application of contact lenses to alter the shape of the cornea and temporarily reduce or eliminate myopia is known as orthokeratology, corneal refractive therapy, or corneal reshaping. It was first introduced in the 1960s, but high oxygen permeable materials and more sophisticated designs allow patients to wear contact lenses only during sleep, while dramatically improving the predictability and rate of myopia reduction. Many studies have shown that most corneal reshaping patients achieve uncorrected visual acuity of 20/25 or better that lasts all day long in one to two weeks of nighttime wear. Treatment is primarily effective through central epithelial thinning and midperipheral epithelial and stromal thickening. Much remains to be learned about corneal reshaping contact lenses and their effects on the cornea. METHODS: The authors reviewed existing knowledge and determined what needs to be learned in order to provide patients with appropriate informed consent prior to corneal reshaping contact lens wear. RESULTS: While corneal reshaping contact lenses are effective at temporarily reducing or eliminating myopia, claims about the progress of myopia being controlled with corneal reshaping contact lenses should not be made until further studies are published in peer-reviewed literature. The incidence and prevalence of microbial keratitis related to corneal reshaping contact lens wear is not known. Any overnight wear of contact lenses increases the risk of infection, but it is not known whether the risks of microbial keratitis are greater for corneal reshaping overnight contact lens wearers than other form of overnight contact lens wear. It is also not known whether the risk of microbial keratitis is greater for children than adults, but we must determine if children are at greater risk than adults because many children are wearing corneal reshaping contact lenses. CONCLUSIONS: Finally, it is recommended that ongoing education be provided to practitioners and staff regarding safety, informed consent, and prevention of potential problems, with special emphasis on the critical need to properly and thoroughly disinfect lenses that will be worn overnight.

Child↗

PubMed2004

A randomized trial of the effects of rigid contact lenses on myopia progression.

OBJECTIVE: To compare the effects of rigid gas-permeable contact lenses (RGPs) and soft contact lenses (SCLs) on myopia progression in children. METHODS: We randomly assigned 116 subjects to wear RGPs or SCLs. Subjects underwent cycloplegic autorefraction, keratometry, and A-scan ultrasonographic axial length measurements at each annual visit. All analyses were conducted according to the original randomization assignment. The primary outcome measure was the 3-year change in spherical equivalent cycloplegic autorefraction. RESULTS: The mean +/- SD spherical equivalent cycloplegic refractive error progressed -1.56 +/- 0.95 diopters (D) for RGP wearers and -2.19 +/- 0.89 D for the SCL wearers during the 3 years of the study (analysis of covariance [ANCOVA], P<.001). The axial growth of the eyes was not significantly different between treatment groups (ANCOVA, P = .57). The steep corneal meridian of the RGP wearers steepened 0.62 +/- 0.60 D, and that of the SCL wearers steepened 0.88 +/- 0.57 D during the 3 years (ANCOVA, P = .01). CONCLUSIONS: The RGP wearers' myopia progressed less than that of the SCL wearers. The corneal curvature of the SCL wearers steepened more than that of the RGP wearers, but the axial growth was not significantly different between the groups. Most refractive error treatment effect was limited to the first year of the trial. The results of the study provide information for eye care practitioners to share with their patients, but they do not indicate that RGPs should be prescribed primarily for myopia control.

Child↗

PubMed2004

Quality of life in keratoconus.

PURPOSE: Keratoconus is a chronic, noninflammatory disease of the cornea with onset in early adulthood. As these years are important to financial and social health, keratoconus may have more severe impact on quality of life than would be expected given its clinical severity. We examined the vision-related quality of life of patients in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. DESIGN: Cross-sectional study. METHODS: The National Eye Institute-Visual Function Questionnaire (NEI-VFQ) was administered to 1166 CLEK Study patients at their first annual follow-up examination. Associations between clinical and demographic factors and NEI-VFQ scale scores were evaluated. RESULTS: Binocular entrance visual acuity worse than 20/40 was associated with lower quality of life scores on all scales except General Health and Ocular Pain. A steep keratometric reading (average of both eyes) >52 diopters (D) was associated with lower scores on the Mental Health, Role Difficulty, Driving, Dependency, and Ocular Pain scales. Scores for CLEK patients on all scales were between patients with category 3 and category 4 age-related macular degeneration (AMD) except General Health, which was better than AMD patients, and Ocular Pain, which was worse than AMD patients. CONCLUSIONS: Keratoconus is a disease of relatively low prevalence that rarely results in blindness, but because it affects young adults, the magnitude of its public health impact is disproportionate to its prevalence and clinical severity.

Adult↗

PubMed2004

Variables affecting rigid contact lens comfort in the collaborative longitudinal evaluation of keratoconus (CLEK) study.

PURPOSE: To identify factors associated with rigid contact lens comfort in keratoconus. METHODS: Baseline data from the 16 Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study clinical sites were analyzed for all patients wearing a rigid contact lens in their more severely keratoconic eye (as determined by steep keratometry). Corneal transplant patients, patients who did not wear a rigid contact lens in either eye, patients who did not wear a rigid lens in their worse eye, and patients with missing contact lens comfort data were excluded from the sample. A total of 751 eyes were included. Variables assessed included measures of disease severity, visual acuity through the patients' habitual rigid contact lenses, contact lens wearing time, the apical fitting relationship of the contact lens, the degree of peripheral clearance, and the presence of corneal scarring and staining. Comfort was measured by asking the patients "In general, how comfortable are your contact lenses?" (1 = very comfortable through 5 = very irritating). RESULTS: Measures of disease severity (steep keratometry and the first definite apical clearance lens) were not associated with lens comfort. There was no difference in self-reported contact lens comfort between patients fitted with apical touch vs. apical clearance. Patients with a peripheral clearance rating of "minimal unacceptable" (more common among patients with milder keratoconus) were approximately half as likely to report good contact lens comfort compared with patients with "average" peripheral clearance (unadjusted odds ratio, 0.39; 95% confidence interval, 0.19 to 0.79). There was no association between contact lens comfort and the other peripheral clearance ratings compared with ratings of average. CONCLUSIONS: There does not appear to be an association between decreasing patient-reported rigid lens comfort and increasing disease severity as measured by steep keratometry or first definite apical clearance lens in this sample. The apical fitting relationship (flat vs. steep) does not appear to be associated with patient-reported comfort. Minimal peripheral clearance may contribute to decreased rigid contact lens comfort in keratoconus.

Adult↗

PubMed2004

A survey of clinical prescribing philosophies for hyperopia.

BACKGROUND: Prescribing philosophies for hyperopic refractive error in symptom-free children vary widely because relatively little information is available regarding the natural history of hyperopic refractive error in children and because accommodation and binocular function closely related to hyperopic refractive error vary widely among children. We surveyed pediatric optometrists and ophthalmologists to evaluate typical prescribing philosophies for hyperopia. METHODS: Practitioners were selected from the American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Section; the College of Vision Development; the pediatric and binocular vision faculty members of the colleges of optometry; and the American Association for Pediatric Ophthalmology and Strabismus. Surveys were mailed to 314 participants: 212 optometrists and 102 ophthalmologists. RESULTS: A total of 161 (75%) of the optometrists and 59 (57%) of the ophthalmologists responded. About one-third of optometrists surveyed prescribe optical correction for symptom-free 6-month-old infants with +3.00 D to +4.00 D hyperopia, but fewer than 5% of ophthalmologists prescribe at this level. Most eye care practitioners prescribe optical correction for symptom-free 2-year-old children with +5.00 D of hyperopia, and this criterion for hyperopia decreases with age. Most ophthalmologists (71.4%) prescribe the full amount of astigmatism and less than the full amount of cycloplegic spherical component, and most optometrists (71.6%) prescribe less than the full amount of both components. When prescribing less than the full amount of astigmatism, eye care practitioners do not tend to prescribe a specific proportion of the cycloplegic refractive error. CONCLUSION: Pediatric eye care providers show a lack of consensus on prescribing philosophies for hyperopic children.

Data Collection↗

PubMed2004

Daily disposable contact lens wear in myopic children.

PURPOSE: To determine whether 8- to 11-year-old myopic children are able to wear daily disposable contact lenses. METHODS: Subjects were examined for eligibility and fitted with 1-Day Acuvue contact lenses at the baseline visit. They underwent noncycloplegic manifest refraction, keratometry, slitlamp biomicroscopic examination, contact lens fitting, standardized visual acuity measurement, and contact lens application and removal training. The subjects attended visits 1 week, 1 month, and 3 months after the initial dispensing visit. At each of these visits, the subjects underwent spherical over-refraction, keratometry, slitlamp examination, and standardized visual acuity measurement, and they completed surveys about contact lens wear. The contact lens with the base curve that exhibited the most appropriate amount of movement and centration or the contact lens with the flatter base curve, if the movement and centration of the two contact lenses were similar, was dispensed. RESULTS: Ten of the 12 subjects completed the 3-month investigation. One subject decided not to wear contact lenses before the 1-week visit, and one subject moved from the area after the 1-month visit. At the 3-month visit, 6 (60%) of the 10 subjects wore the 9.0 mm base curve contact lens, and 6 (60%) of the 10 subjects required one power change to optimize vision. At the 3-month visit, all subjects but one reported that their vision was "pretty good" or "perfect." All subjects also reported that their eyes were "always comfortable" or "usually comfortable." Eighty percent of the subjects reported that they "never had a problem" or "usually did not have a problem" putting on their contact lenses. All subjects reported that they "usually did not have a problem" or "never had a problem" taking out their contact lenses, and 90% of the subjects reported that they "usually did not have a problem" or "never had a problem" handling their contact lenses. CONCLUSION: Eight- to 11-year-old subjects are able to independently care for daily disposable contact lenses and wear them successfully. Daily disposable contact lenses eliminate the need for cleaning and disinfecting contact lenses, so they should be strongly considered as a contact lens treatment option for children.

Child↗

PubMed2004

Study design issues in a corneal reshaping contact lens myopia progression study.

Advances in contact lens design have led to corneal reshaping contact lenses that can be worn at night to temporarily reduce myopia so that patients can see clearly without glasses or contact lenses. Children are able to wear corneal reshaping contact lenses, but we do not know how they may affect the progression of myopia. A myopia control study with corneal reshaping contact lenses poses study design problems that other studies do not encounter because they temporarily reduce the refractive error. A discussion of the choice of primary outcome and control group will highlight some of these unique study design issues.

Contact Lenses↗

PubMed2004

The Children's Overnight Orthokeratology Investigation (COOKI) pilot study.

PURPOSE: Innovations in contact lens materials and designs allow patients to wear contact lenses during sleep to flatten the cornea and temporarily to reduce myopic refractive error and improve unaided visual acuity. We conducted the Children's Overnight Orthokeratology Investigation (COOKI) pilot study, a case series, to describe the refractive error and visual changes, as well as the slitlamp observations associated with overnight orthokeratology in children, over a period of 6 months. METHODS: Twenty-nine 8- to 11-year-old children with myopia between -0.75 and -5.00 D and <-1.50 D corneal toricity were fitted with corneal refractive therapy contact lenses (Paragon Vision Sciences, Mesa, AZ). They were examined within 1 hour of awakening and about 6 hours later at 1 day, 1 week, 2 weeks, 1 month, 3 months, and 6 months after the first night of contact lens wear. At each visit, the logarithm of the minimum angle of resolution (logMAR) visual acuity, manifest refraction, slitlamp examination, and corneal topography were performed. RESULTS: Twenty-three subjects completed the 6-month study. Three subjects decided not to wear contact lenses, two did not achieve acceptable fits, and one moved from the area. At the 6-month afternoon visit, the mean +/- SD uncorrected high-contrast visual acuity was +0.08 +/- 0.15 logMAR (Snellen equivalent, 20/24), and the mean +/- SD spherical equivalent refraction was -0.16 +/- 0.66 D. The corneas of three-fifths of the subjects showed mild staining at the morning visit, and one-third of the patients showed mild corneal staining at the afternoon visit. The most common type of stain was central punctate staining. No subjects experienced lasting adverse visual effects from cornea-reshaping contact lens wear during the study period. CONCLUSIONS: Overnight cornea-reshaping contact lenses are efficacious for young myopic patients, and no children experienced a serious adverse event during the study.

Child↗

PubMed2003

Use of a run-in period to decrease loss to follow-up in the Contact Lens and Myopia Progression (CLAMP) study.

Rigid gas permeable (RGP) contact lenses are initially less comfortable to wear than spectacles. In previous studies evaluating the use of RGP contact lenses to control myopia, more subjects randomly assigned to wear RGP contact lenses have been lost to follow-up than spectacle wearers. Previous rigid contact lens myopia control studies have lost 44% and 47% of the rigid contact lens wearers. This unequal loss to follow-up may compromise the results of the study, so we conducted a run-in period prior to randomized treatment-group assignment to ensure that all participants could adapt to RGP contact lens wear. We enrolled 147 children ages 8-11 years with myopia in the run-in period. Of the 147 subjects, 116 (78.9%) were able to wear RGP contact lenses for at least 40 hours per week and reported that they were "usually comfortable" or "always comfortable." After 3 years, no subjects were lost to follow-up. The run-in period greatly reduced the loss to follow-up suffered by previous RGP contact lens myopia progression studies and may help provide more definitive answers regarding myopia control with RGP contact lenses.

Child↗

PubMed2003

Are we nearsighted when it comes to myopia treatment?

PURPOSE: The purpose of this article is to highlight the current research on myopia treatment and to speculate about the future of myopia treatment. METHODS: A review of the literature on myopia treatment in humans was performed using Medline, CRISP, and a variety of web pages. A summary of the research is presented in the article. RESULTS: Most of myopia research can be categorized into three areas: control, treatment, and prevention. Most of independent myopia research currently conducted is in the area of control. Great advances in the myopia treatment are constantly being practiced, but few independent investigations are conducted. Methods of predicting the future onset of myopia are being investigated to some day allow us to apply preventive agents before myopia occurs. CONCLUSION: Two randomized clinical trials are scheduled for completion within the next year, and they should offer answers about mechanisms of myopia control. Treatments for myopia are moving beyond questions of safety and efficacy and on to reductions of complications and refinement of vision to produce super vision. At least one eye drop, pirenzepine, is being investigated for myopia control and may show promise for prevention of myopia in the future.

Biomedical Research↗