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Optometry & Vision Science - Published Ahead-of-Print
Sat, 04 Feb 2012 00:22:33 -0600
Purpose. To evaluate the use of lower tear meniscus measurements obtained with anterior segment Spectral Optical Coherence Tomography (OCT) in quantitative tear evaluation and diagnosis of dry eye syndrome. To verify sensitivity and specificity of different tear meniscus parameters in diagnosis of dry eye syndrome. Methods. A total of 111 eyes in consecutive patients, mean age 34.35 years (SD, 11.17), were enrolled. Each patient completed a standard Ocular Surface Disease Index questionnaire and general ophthalmic examination. Lower tear meniscus was evaluated using Spectral OCT (RTVue, Optovue) with cornea-anterior segment lens short. Three parameters were measured: tear meniscus cross-section area (TMA, mm2), tear meniscus height (TMH, mm), and tear meniscus depth (TMD, mm). Break-up time and Schirmer tests after instillation of topical anesthetic drops were also evaluated. Results. The highest correlation with Schirmer test results was found with TMA, followed by TMH and TMD. Respective Spearman correlation coefficient values were 0.54, 0.52, and 0.3, respectively. TMA, TMH, and TMD measurements were significantly lower in dry eyes than in controls. Sensitivity and specificity for dry eye diagnosis were 80.56% and 89.33% for TMH, 86.11% and 85.33% for TMA, and 77.78% and 52.7% for TMD, respectively. There was a significant negative correlation between both TMA and TMH and Ocular Surface Disease Index questionnaire scores. Conclusions. Lower tear meniscus parameters measured with Spectral OCT correlate well with the Schirmer test, break-up time, and subjective symptoms. TMA and TMH measurements have high sensitivity and specificity for the diagnosis of dry eye syndrome. (C) 2012 American Academy of Optometry
Purpose. Previous studies suggest that the refractive status of the peripheral retina may influence the progression of myopia. Our aim was to investigate peripheral refractions in human eyes with high myopia when corrected with a conventional soft spherical contact lens (CL). Methods. Ten young adults with high myopia (over -6.00 D) were investigated. An open-field auto-refractor was used to measure on- and off-axis refractions in primary gaze, with and without a CL, every 5[degrees] out to 20[degrees] horizontally in nasal and temporal retina. Results were analyzed as mean sphere (M) and astigmatic (J0 and J45) vector components. Partial coherence interferometry measures of eye size were also made on- and off-axis at 10 and 20[degrees] in nasal and temporal retina. Results. Subjects (mean age, 22 years; range, 20 to 26 years) had an average on-axis spherical refractive error of -8.31 +/- 2.10 D and an average on-axis eye length of 27.39 +/- 1.18 mm. Mean sphere exhibited a significant shift from hyperopic relative peripheral refraction (RPR) in the uncorrected state to myopic RPR on correction, in both nasal and temporal retina. Mean RPR of all subjects across all eccentricities was hyperopic when uncorrected (M = +0.20 +/- 0.49 D: mean +/- 1 SEM) becoming myopic when corrected (M = -0.45 +/- 0.56 D: p = 0.0003, reaching -1.21 +/- 0.82 D at 20[degrees] in the temporal retina). Peripheral J0 astigmatism also became significantly more negative on correction (p = 0.002), whereas J45 astigmatism remained unchanged. On- and off-axis measures of eye length indicated a relatively prolate retinal contour. Uncorrected off-axis mean sphere refractive error reduced with eccentricity, and this was accurately predicted (R2 > 0.98) by the measured retinal contour. Conclusions. Correcting the foveal refractive error in high myopia with standard spherical soft CLs can result in significant absolute myopic defocus in the peripheral retina. If peripheral refraction does indeed influence myopia progression, then our results suggest that in high myopia, standard soft CLs may be beneficial in reducing myopia progression. (C) 2012 American Academy of Optometry
Purpose. The purpose of this case report is to report a rare, bilateral, choroidal metastases from a primary esophageal melanoma. Case Report. A 44-year-old white female presented to the ocular oncology clinic in February 2010 on urgent referral from her ophthalmologist for evaluation of an elevated mass in each eye. The patient presented with best-corrected visual acuities of 20/25 in both eyes. Fundus examination displayed creamy white choroidal infiltrates located in the superior temporal arcade of the right eye and temporally in the left eye. The patient was diagnosed with bilateral choroidal metastatic melanoma from known primary esophageal melanoma. External beam radiation therapy was administered and complete resolution of the lesions occurred. Final visual outcome was 20/20 in both eyes. Nine months after diagnosis of choroidal metastases, the patient died from complications related to the extensive systemic metastatic involvement. Conclusions. Choroidal metastases are the most common intraocular malignancy. However, metastatic melanoma is a rare finding and has only been reported from cutaneous and primary choroidal melanoma. Therefore, to the best of the authors' knowledge, this is the first reported case of bilateral choroidal metastasis from a primary esophageal malignant melanoma. (C) 2012 American Academy of Optometry
Purpose. To describe the visual recovery after intravitreal injections of the antivascular endothelial growth factor, bevacizumab, in a case of vaso obliteration from idiopathic retinal vasculitis, aneurysm, and neuroretinitis (IRVAN). The name IRVAN was given to the condition to highlight the key findings present in the disease. IRVAN is a severe, sight threatening condition that can lead to peripheral capillary non-perfusion and vision loss from the ischemic sequelae of vascular occlusion. Panretinal photocoagulation (PRP) is the current standard of care for IRVAN but visual outcome is poor if PRP is initiated after neovascularization develops. Intravitreal bevacizumab has success at treating neovascularization from other ischemic retinopathies and inflammatory retinal conditions that have similar characteristics to IRVAN. Case Report. This case report describes a patient with decreased vision in the OS. The patient presented with best-corrected visual acuity of 20/20 in the OD and count fingers at 4 ft in the OS. Evaluation revealed findings consistent with an advanced stage of IRVAN. Anterior and posterior neovascularization had developed from extensive capillary non-perfusion in both retinas. A dense vitreous hemorrhage blocked vision OS. Bilateral intravitreal injections of bevacizumab and extensive PRP were given in the area of retinal ischemia for treatment. After 4 months, the patient's vision had improved from count fingers in the OS to 20/40. Conclusions. IRVAN has favorable outcomes when treated with a combination of PRP and intravitreal injections of antivascular endothelial growth factor. This case demonstrates the effectiveness of this combination treatment in a case of IRVAN with both posterior and anterior neovascularization. (C) 2012 American Academy of Optometry
Purpose. The goal of this study was to explore binocular coordination during fixation in patients with age-related macular degeneration (AMD) and to investigate whether there is a shift in eye position when the viewing condition changes from binocular to monocular. Methods. Sixteen people with normal vision and 12 patients with AMD were asked to look at a 3 deg fixation target with both eyes and with each eye individually while the fellow eye was covered by an infrared filter. Fixational eye movements were recorded for both eyes with an EyeLink eye-tracker in all conditions. The shift in eye position at the end of every fixation period was calculated for each eye. Results. All people with normal vision as well as the majority of patients had good binocular coordination during fixation in the binocular viewing condition. When the viewing condition changed from binocular to monocular, three patients (25%) had atypical shifts in their eye position. The shift was related to (1) loss of fixational control when the better eye was covered and the worse eye viewed the target or (2) a slow drift of the viewing eye that was associated with a large phoria in the covered eye. Conclusions. Patients with AMD have good binocular ocular motor coordination during fixation. A change in viewing condition from binocular to monocular can lead to disturbances in ocular motor control for some patients, especially in the worse eye. (C) 2012 American Academy of Optometry
Purpose. Bacterial contamination of the contact lens surface has been demonstrated to cause corneal infiltrative events. A reduction in the rate of bacterially driven corneal infiltrative events associated with lens wear is one of the major goals of the contact lens industry. There is a concern over the potential of any antimicrobial strategy that there will be unwanted changes to the ocular microbiota or the development of resistance to the antimicrobial. The aim of this study was to investigate the effect of prophylactic topical antibiotic instillation during continuous wear of silicone hydrogel lenses on the normal ocular microbiota, the throat microbiota, and the ocular physiology. Methods. Forty-two male subjects were dispensed with lotrafilcon A silicone hydrogel contact lenses for a 3-month, 30 night continuous wear, monthly replacement trial. Subjects were randomized into either tobramycin 0.3% (test) or saline (control) drop group. Two drops were instilled into each eye on waking and before sleep. At monthly visits, lenses were collected aseptically, and ocular and throat swabs were performed, followed by standard microbial recovery and identifications. Any corneal infiltrative event at scheduled or unscheduled visits was recorded. Results. Numbers of microbes recovered from eye swabs from the tobramycin (test) group were significantly lower than the control (p = 0.01). Gram-positive cocci were recovered less frequently from the test group (p = 0.001). There were no significant differences in the numbers and types of microbes recovered from lens samples, or the contamination rate of the lenses between the two groups. There were no changes in the numbers of fungi or bacteria from throat swabs. There was no evidence of changes to resistance profile of microbes in the throat. More eye swabs from the test group (68.5%) were culture-negative than swabs from control (46.5%; p = 0.002). The test group had less corneal staining superiorly (0.0 +/- 0.0 vs. 0.3 +/- 0.4; p = 0.025) but increased bulbar redness (2.2 +/- 0.5 vs. 1.5 +/- 0.4; p < 0.001) at the 3-month visit only, compared with control group. Conclusions. Overall, there appeared to be a minimal safety risk with 3-month's prophylactic antibiotic drop use during continuous wear of silicone hydrogel lenses. Clinically, antibiotic drop use induced a mild to moderate increase in bulbar redness by the 3-month time-point. Antibiotic use reduced microbiota on lids but did not affect the microbiota of the throat or change resistance to tobramycin. (C) 2012 American Academy of Optometry
Purpose. The purpose of this study was to determine the sensitivity of madarosis as an indicator for malignancy in eyelid lesions affecting the lid margin. Methods. A retrospective medical record review was completed for patients who were diagnosed with lesions affecting the eyelid margin which were suspicious for malignancy. Suspicion was determined by considering an array of factors, including lesion characteristics, Fitzpatrick score, sun exposure history, and history of skin cancer. Presence of madarosis was assessed by clinical examination, and presence of malignancy was determined by biopsy. Results. The association between madarosis and malignancy was statistically significant (p <= 0.001). Madarosis had a sensitivity of 0.643 and a specificity of 0.882 when used as a sole indicator for malignancy. The odds of malignancy were 13.4 times higher in the presence of madarosis. Conclusions. Madarosis is more common in malignant eyelid margin lesions than benign lesions. If madarosis is present, there is a 69.23% chance that the lesion is malignant. Therefore, biopsy of any suspicious lesion that demonstrates madarosis is recommended. However, many malignant eyelid margin lesions do not demonstrate madarosis, and so the sensitivity of madarosis as a sole indicator for malignancy is poor. In the absence of madarosis, it is important to consider other factors when determining malignant potential of eyelid lesions. (C) 2012 American Academy of Optometry
Purpose. To analyze relations between upper lid (UL) and lower lid (LL) meibomian gland (MG) morphology and tear film and the MG criteria ability to predict dry eye. Methods. MG, lipid layer, and non-invasive break-up time (NIBUT) were evaluated of the OD of 20 randomly selected subjects (female = 10; median age = 44.5 years, interquartiles = 39.5 to 55 years). Subjects were grouped into nine Ocular Surface Disease Index (OSDI)- and 11 OSDI+ by the OSDI. Non-contact infrared meibography and image analysis were performed to evaluate MG loss, MG thickness, and MG bent angle. Results. MG loss (Pearson correlation; r = 0.647, p = 0.003) and MG bent angle (r = 0.489, p = 0.027) were significantly correlated between lids, but MG thickness was not (r = -0.059, p = 0.413). MG loss was significantly (t-test; p = 0.048) less in the UL (median = 26.9%; LL = 32.3%), thicker in the LL (p < 0.001) and were more bent in the LL (p = 0.001). MG loss was significantly correlated to lipid-layer thickness (r < -0.597, p < 0.003) and NIBUT (r < -0.453, p < 0.030), whereas MG thickness and bent angle of the UL only were related to NIBUT (r < -0.563, p < 0.018). Combining MG loss of both lids (linear regression analysis) resulted in the best predictive ability of OSDI+/- (area under the receiver operative characteristic curve = 0.929, p = 0.001). Conclusions. MG scores between lids were significantly different but correlated. MG loss was significantly correlated to tear film characteristics including lipid layer thickness and stability. MG thickness and bent angle of the UL were related to NIBUT. The combination of both lids' MG loss showed best predictive ability of dry eye. (C) 2012 American Academy of Optometry
Purpose. To compare measurements of murine ocular axial lengths (ALs) made with 780 nm partial coherence interferometry (PCI) and 1310 nm spectral domain-optical coherence tomography (SD-OCT). Methods. AL was measured at postnatal day (P) 58 in C57BL/6J mice. Repeated AL measurements were taken using a custom-made 780 nm PCI and a commercial 1310 nm SD-OCT. Intra- and interuser variability was assessed along the central optical axis and 2-degree off-axes angles with the SD-OCT. Data were collected and analyzed using Cronbach alpha ([alpha]), Bland-Altman coefficient of repeatability, agreement plots, and intraclass correlation coefficients (ICC). Results. AL measurements agreed well between the two instruments (3.262 +/- 0.042 mm for PCI; 3.264 +/- 0.047 mm for SD-OCT; n = 20 eyes). The ICC for PCI compared with SD-OCT was 0.92, confirming high agreement between the two instruments. Intrauser ICC for the PCI and SD-OCT were 0.814 and 0.995, respectively. Similarly, interuser ICC for PCI and SD-OCT were 0.970 and 0.943, respectively. Using SD-OCT, a 2-degree misalignment of the eye along the horizontal meridian produced mean differences in AL of -0.002 +/- 0.017 mm relative to the centrally aligned images, whereas similar misalignment along the vertical meridian created 0.005 +/- 0.018 mm differences in AL measurements. Conclusions. AL measurements from the 780 nm PCI and 1310 nm SD-OCT correlate well. Multiple statistical indices indicate that both instruments have good precision and agreement for measuring murine ocular AL in vivo. Although the vertical meridian had the greater variability in AL in the small mouse eye; 2-degree off-axes differences were within the SD of centrally aligned AL. (C) 2012 American Academy of Optometry
Purpose. To evaluate the association of symptomatic soft contact lens (SCL)-related corneal infiltrative events (CIEs) with SCL material, lens care products (LCPs), and other risk factors. Methods. Cases with symptomatic CIEs were identified in a retrospective, multicenter case-control study at five academic eye care centers. Each case was matched to three controls each who had received eye care near the time of the case's last full examination at that center but were not matched for demographic or other factors. Infiltrate status was established by an expert panel who were masked to sponsor, SCL, and LCP brand. Stratified analyses were conducted removing all daily disposable (DD) and all extended wear (EW) cases. Results. Clinical records from 166 patients with symptomatic CIEs and known EW status were included. Cases used >50 SCL brands and >10 LCP brands. Increased risk in univariate analysis for LCP was not significant after adjustment for other factors. In the multivariate analysis of all cases, use of reusable SCLs (4.03x; 95% C.I. 1.12 to 14.67) and EW (3.98x; 2.32 to 6.84) increased risk and patient age (per year older) was protective (0.96x; 0.94 to 0.98). Among daily wear cases (n = 102 cases), use of reusable SCLs (12.46x; 1.54 to 100.62) and silicone hydrogel (SiHy) (1.99x; 1.06 to 3.75) and age (0.95x: 0.92 to 0.97) were associated. Without DD cases (n = 162), EW (4.42x; 2.53 to 7.70), SiHy use (1.84x; 1.03 to 3.29), and patient age (0.96x 0.94 to 0.98) were significant factors. No specific SCL or LCP brands were associated with increased risk. Conclusions. In this community-based trial, younger patients were at increased risk of infiltrative events. DD lenses were protective relative to reusable lenses. Overnight use increased risk in all analyses and silicone hydrogels increased risk in daily wearers, regardless of LCP brand. Improvements in lens storage case hygiene and environment may be a mechanism for reducing risk of CIEs related to SCL use. (C) 2012 American Academy of Optometry
Purpose. The purpose of the study is to evaluate the relationship between time trade off (TTO) and standard gamble (SG) estimates of health and vision utilities in a low vision patient sample. Methods. Telephone surveys were conducted on 74 low vision patients. All study participants were administered utility questionnaires that used the TTO and SG methods as they relate to health and vision. Results. There is high between-person variability in the relationship of TTO- to SG-estimated utilities for both vision and health. However, when transformed to logits, differences between TTO and SG utilities for health are equal to differences between TTO and SG utilities for vision. These differences are symmetrically distributed around the origin. The data were consistent with a model that includes both health or vision state and personal response criteria. The model explains between-person variability in the relationship of TTO to SG utilities as idiosyncratic differences within people between response criteria for making TTO and SG judgments. Conclusions. The large between-person variability in the relation of utilities estimated from TTO to those estimated from SG can be explained by large between- and within-person variability in personal TTO and SG response criteria. However, within each person, the response criteria used to judge health state are the same as the response criteria used to judge vision state. This observation leads to the conclusion that health and vision states are in the same units when estimated from utilities. A meta-analysis of published studies that compared TTO with SG utilities for different health states confirms the conclusion of the model that average utilities across people are criterion-free estimates of average health-related states on a common logit scale. (C) 2012 American Academy of Optometry
Purpose. To describe corneal and crystalline lens dimensions before, during, and after myopia onset compared with age-matched emmetropic values. Methods. Subjects were 732 children aged 6 to 14 years who became myopic and 596 emmetropic children participating between 1989 and 2007 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Refractive error was measured using cycloplegic autorefraction, corneal power using a hand-held autokeratometer, crystalline lens parameters using video-based phakometry, and vitreous chamber depth (VCD) using A-scan ultrasonography. Corneal and crystalline lens parameters in children who became myopic were compared with age-, gender-, and ethnicity-matched model estimates of emmetrope values annually from 5 years before through 5 years after the onset of myopia. The comparison was made without and then with statistical adjustment of emmetrope component values to compensate for the effects of longer VCDs in children who became myopic. Results. Before myopia onset, the crystalline lens thinned, flattened, and lost power at similar rates for emmetropes and children who became myopic. The crystalline lens stopped thinning, flattening, and losing power within +/-1 year of onset in children who became myopic compared with emmetropes statistically adjusted to match the longer VCDs of children who became myopic. In contrast, the cornea was only slightly steeper in children who became myopic compared with emmetropes (<0.25 D) and underwent little change across visits. Conclusions. Myopia onset is characterized by an abrupt loss of compensatory changes in the crystalline lens that continue in emmetropes throughout childhood axial elongation. The mechanism responsible for this decoupling remains speculative but might include restricted equatorial growth from internal mechanical factors. (C) 2012 American Academy of Optometry
Purpose. Few studies have specifically investigated the functional effects of uncorrected astigmatism on measures of reading fluency. This information is important to provide evidence for the development of clinical guidelines for the correction of astigmatism. Methods. Participants included 30 visually normal, young adults (mean age, 21.7 +/- 3.4 years). Distance and near visual acuity and reading fluency were assessed with optimal spectacle correction (baseline) and for two levels of astigmatism, 1.00 diopter cylinder (DC) and 2.00 DC, at two axes (90 and 180[degrees]) to induce both against-the-rule (ATR) and with-the-rule (WTR) astigmatism. Reading and eye movement fluency were assessed using standardized clinical measures including the test of Discrete Reading Rate (DRR), the Developmental Eye Movement test (DEM), and by recording eye movement patterns with the Visagraph (III) during reading for comprehension. Results. Both distance and near acuity were significantly decreased compared with baseline for all the astigmatic lens conditions (p < 0.001). Reading speed with the DRR for N16 print size was significantly reduced for the 2.00 DC ATR condition (a reduction of 10%), whereas for smaller text sizes, reading speed was reduced by up to 24% for the 1.00 DC ATR and 2.00 DC condition in both axis directions (p < 0.05). For the DEM, subtest completion speeds were significantly impaired, with the 2.00 DC condition affecting both vertical and horizontal times and the 1.00 DC ATR condition affecting only horizontal times (p < 0.05). Visagraph reading eye movements were not significantly affected by the induced astigmatism. Conclusions. Induced astigmatism impaired performance on selected tests of reading fluency, with ATR astigmatism having significantly greater effects on performance than did WTR, even for relatively small amounts of astigmatic blur of 1.00 DC. These findings have implications for the minimal prescribing criteria for astigmatic refractive errors. (C) 2012 American Academy of Optometry
Purpose. An examination of studies that have assessed corneal biomechanical performance using the Ocular Response Analyzer (ORA: Reichert Ophthalmic Instruments, Depew, NY) raises some questions regarding the influence of measurement variables and the interpretation of the findings obtained with this instrument. This analysis of those questions describes additional factors which do or may contribute to the assessment of corneal hysteresis (CH). Methods. Using key words CH and ORA, English language articles relevant to this analysis were selected after a PubMed search with the addition of some articles referenced in the selected publications. Results. Corneal thickness, the level of edema, intraocular pressure, and corneal temperature as well as the area, location, rate, duration, and sequence of corneal unloading and loading may need to be considered as significant variables when assessing CH. Conclusions. CH values may be specific to measurement method and conditions rather than representing an unequivocal corneal property. Consideration of the uncontrolled variables involved may help explain some of the findings obtained with the ORA. That a CH measurement might vary with the sequence of unloading and loading suggests that the ORA CH finding may not represent the CH, but instead represents a hysteresis value better described as central, applanation-derived hysteresis, which is based on a very short unloading/loading sequence. The potential for the ORA to contribute to improved clinical management appears to be considerable but so does the need for better understanding and further development of its functions and applications. (C) 2012 American Academy of Optometry
Purpose. To report a case of multiple parallel-line endotheliitis with a possible link to herpes simplex virus. Case Report. An 89-year-old woman presented with new onset reduced vision in her left eye. Her visual acuity with pinhole was 20/120 with the affected eye and 20/30 in the right. She had a white left eye with significant corneal edema and keratic precipitates. These were arranged in a striking pattern of multiple parallel lines resembling railroad tracks. She responded very well to topical steroid and was found to have positive immunoglobulin G and immunoglobulin M titers for herpes simplex virus. Conclusions. Multiple parallel-line endotheliitis may represent a mild expression of herpes simplex keratitis. It appears to be exquisitely sensitive to topical steroid on its own suggesting that immune response has a dominant role in its pathogenesis. (C) 2012 American Academy of Optometry
Purpose. An assessment of the retinal nerve fiber layer (RNFL) provides important information on the health of the optic nerve. There are several non-invasive technologies, including spectral domain optical coherence tomography (SD OCT), that can be used for in vivo imaging and quantification of the RNFL, but often there is disagreement in RNFL thickness between clinical instruments. The purpose of this study was to investigate the influence of scan centration, ocular magnification, and segmentation on the degree of agreement of RNFL thickness measures by two SD OCT instruments. Methods. RNFL scans were acquired from 45 normal eyes using two commercially available SD OCT systems. Agreement between RNFL thickness measures was determined using each instrument's algorithm for segmentation and a custom algorithm for segmentation. The custom algorithm included ocular biometry measures to compute the transverse scaling for each eye. Major retinal vessels were identified and removed from RNFL measures in 1:1 scaled images. Transverse scaling was also used to compute the RNFL area for each scan. Results. Instrument-derived global RNFL thickness measured from the two instruments correlated well (R2 = 0.70, p < 0.01) but with significant differences between instruments (mean of 6.7 [mu]m; 95% limits of agreement of 16.0 [mu]m to -2.5 [mu]m, intraclass correlation coefficient = 0.62). For recentered scans with custom RNFL segmentation, the mean difference was reduced to 0.1 [mu]m (95% limits of agreement 6.1 to -5.8 [mu]m, intraclass correlation coefficient = 0.92). Global RNFL thickness was related to axial length (R2 = 0.24, p < 0.01), whereas global RNFL area measures were not (R2 = 0.004, p = 0.66). Major retinal vasculature accounted for 11.3 +/- 1.6% (Cirrus) or 11.8 +/- 1.4% (Spectralis) of the RNFL thickness/area measures. Conclusions. Sources of disagreement in RNFL measures between SD-OCT instruments can be attributed to the location of the scan path and differences in their retinal layer segmentation algorithms. In normal eyes, the major retinal vasculature accounts for a significant percentage of the RNFL and is similar between instruments. With incorporation of an individual's ocular biometry, RNFL area measures are independent of axial length, with either instrument. (C) 2012 American Academy of Optometry

Published monthly, Optometry and Vision Science (OVS) is the official journal of the American Academy of Optometry. It is an authoritative source for current developments in optometry, physiological optics, and vision science. Ranked 19th, and the top ranked optometry journal internationally of the top 45 journals in the Ophthalmology (eye/vision research, ophthalmology, optometry) category (JCR, 2007) with an Impact Factor of 1.638, this frequently cited scientific journal has served primary eye care practitioners for almost 80 years, promoting vital interdisciplinary exchange among optometrists, ophthalmologists and vision scientists worldwide. Anthony J. Adams, OD, PhD, FAAO is the Editor-in-Chief, Optometry and Vision Science.

 

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