9 results for Anstice, Nicola

  • Causes of visual impairment in children referred to the Eye Department, South Auckland, NZ

    Anstice, Nicola; Abdul-Rahman, A; Spink, JS (2011)

    Conference item
    The University of Auckland Library

    Purpose: Limited data are available on the causes of visual impairment in New Zealand children. We aimed to review demographic and visual parameters in children referred to the Eye Department from preschool vision screening programs in South Auckland. Methods: Retrospective record review to determine reason for referral, findings from ophthalmic assessments, treatment received and visual acuity (VA) at final visit. The main outcome measures were cause of visual impairment and VA at the final assessment. Results: 131 children, aged 3-5, were referred from community vision screening programs to the Eye Department for further assessment. The main causes of visual impairment were refractive error (37.4%), amblyopia (22.1%) and strabismus (7.6%). Children with refractive error had good visual outcomes with an average final VA of 0.167 ± 0.077 logMAR units. In amblyopic children, refractive correction alone was the most common therapy (n=18), while 7 children also received occlusion therapy, 1 child additional atropine penalization and 3 children a combination of refractive correction, atropine and patching. Compliance with amblyopia therapy was poor with 48.3% non-compliance to the prescribed treatment regimen. Despite this, there was a significant improvement in VA in the amblyopic eye (p < 0.001) with an average final VA of 0.294 ± 0.231 logMAR (Snellen 6/12). Children with strabismus had worse visual outcomes with a final VA of 0.517 ± 0.422 in the strabismic eye. A significant number of children (n = 38) were discharged after the initial hospital assessment as false positive referrals. Conclusions: Refractive error was the most common cause of visual impairment in children referred to the Eye Department. Good acuity was achieved in the majority of children who received refractive correction and additional amblyopia therapy if required.

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  • Dual-focus inhibition of myopia evaluation in New Zealand

    Anstice, Nicola (2009)

    Doctoral thesis
    The University of Auckland Library

    Purpose: The Dual-focus Inhibition of Myopia Evaluation in New Zealand (DIMENZ) clinical trial tests the efficacy of myopic retinal defocus in slowing axial myopia progression. Methods: Dual-focus (DF) soft contact lenses were designed having a central zone correcting refractive error and peripheral treatment zones that caused 2.00D of simultaneous myopic retinal defocus. Children (12-14 yrs, n = 40, mean refractive error = -2.70D) were fitted with a DF lens in one eye and a single vision distance (SVD) lens in the fellow eye. After 10 mo. wear, lens assignment was swapped between eyes and the lenses worn for a further 10 mo. Accommodation was measured using an open-field autorefractor. Myopia was monitored using cycloplegic autorefraction and partial coherence interferrometry every 5 mo. Results: For DF lens-wearing eyes mean (± 1 SD) acuity was 99.85 ± 3.53) and for SV lens-wearing eyes 100.20 ± 2.87 (p = 0.209). After 10 months of CL wear mean (± 1 SD) increase in myopia and axial length in eyes wearing the DF lens (-0.441 ± 0.326 & 0.110 ± 0.084) were significantly less (p < 0.001) than in eyes wearing the SVD lens (-0.677 ± 0.405 & 0.218 ± 0.089). Thus, DF lenses had a 12 month adjusted treatment effect of 0.28D & 0.13 mm. Accommodative response was measured through the SVD lens and through a single vision near (SVN) lens (+2.50 D add) that reduced the accommodative demand to zero. When children changed their gaze from 4 m to 40 cm, accommodation increased by 1.80 ± 0.37 D when wearing a DF lens with a SVD lens and by 1.62 ± 0.59 with a DF and SVN contact lens (no significant difference, p = 0.21). Conclusion: Myopia progression is slowed significantly in eyes wearing DF lenses. This suggests that a myopically defocused image, even when presented to the retina simultaneously with a clear image, acts to slow myopia progression in children. DF lenses provide normal acuity and do not alter accommodative response, so provide myopic retinal defocus at distance and near.

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  • Dual-focus Inhibition of Myopia Evaluation in New Zealand

    Anstice, Nicola (2009)

    Doctoral thesis
    The University of Auckland Library

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  • Review of preschool vision screening referrals in South Auckland, New Zealand

    Anstice, Nicola; Spink, JS; Abdul-Rahman, A (2012-07)

    Journal article
    The University of Auckland Library

    Background: Limited data are available on the causes of visual impairment in preschool children in New Zealand. We aimed to review demographic and visual parameters in children referred to the Ophthalmology Department, Manukau Super Clinic from vision screening programmes in South Auckland. Methods: Retrospective medical record review of 131 children, aged 3-5, referred from community-based vision screening programmes to the Ophthalmology Department for further assessment. Medical records were reviewed to determine: reason for referral, findings from ophthalmic assessments, treatment received and visual acuity at final visit. The main outcome measures were cause of visual impairment in children referred from preschool vision screening and visual acuity at final follow-up visit. Results: Thirty-eight children (29.0%) were discharged after their initial assessment as false positive referrals. Approximately half (45.5%) of children were prescribed glasses for the correction of refractive error, amblyopia or strabismus. Twenty-nine (22.1%) children were diagnosed with amblyopia with an average follow-up period of 17.5 ± 2.7 months. In general, compliance with amblyopia therapy was poor with 48.3% non-compliant to their prescribed treatment regimen. Despite this, visual outcomes were good with an average final visual acuity in the amblyopic eye of 0.294 ± 0.231 logMAR (Snellen 6/12). Conclusions: The Positive Predictive Value for the Counties-Manukau preschool vision screening programme was 47.4%, suggesting the visual acuity measurements alone produce a significant number of false positive results. In children diagnosed with amblyopia early detection and intervention showed significant improvement in vision in the amblyopic eye, with many children also showing improved binocular function.

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  • Slowing Myopia Progression with Contact Lenses

    Anstice, Nicola (2011)

    Conference item
    The University of Auckland Library

    Purpose: Limited data are available on the causes of visual impairment in New Zealand children. We aimed to review demographic and visual parameters in children referred to the Eye Department from preschool vision screening programs in South Auckland. Methods: Retrospective record review to determine reason for referral, findings from ophthalmic assessments, treatment received and visual acuity (VA) at final visit. The main outcome measures were cause of visual impairment and VA at the final assessment. Results: 131 children, aged 3-5, were referred from community vision screening programs to the Eye Department for further assessment. The main causes of visual impairment were refractive error (37.4%), amblyopia (22.1%) and strabismus (7.6%). Children with refractive error had good visual outcomes with an average final VA of 0.167 ± 0.077 logMAR units. In amblyopic children, refractive correction alone was the most common therapy (n=18), while 7 children also received occlusion therapy, 1 child additional atropine penalization and 3 children a combination of refractive correction, atropine and patching. Compliance with amblyopia therapy was poor with 48.3% non-compliance to the prescribed treatment regimen. Despite this, there was a significant improvement in VA in the amblyopic eye (p < 0.001) with an average final VA of 0.294 ± 0.231 logMAR (Snellen 6/12). Children with strabismus had worse visual outcomes with a final VA of 0.517 ± 0.422 in the strabismic eye. A significant number of children (n = 38) were discharged after the initial hospital assessment as false positive referrals. Conclusions: Refractive error was the most common cause of visual impairment in children referred to the Eye Department. Good acuity was achieved in the majority of children who received refractive correction and additional amblyopia therapy if required.

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  • Effect of Dual-Focus soft contact lens wear on axial myopia progression in children

    Anstice, Nicola; Phillips, John (2011)

    Journal article
    The University of Auckland Library

    Purpose: To test the efficacy of an experimental Dual-Focus (DF) soft contact lens in reducing myopia progression. Design: Prospective, randomized, paired-eye control, investigator-masked trial with cross-over. Participants: Forty children, 11–14 years old, with mean spherical equivalent refraction (SER) of 2.71 1.10 diopters (D). Methods: Dual-Focus lenses had a central zone that corrected refractive error and concentric treatment zones that created 2.00 D of simultaneous myopic retinal defocus during distance and near viewing. Control was a single vision distance (SVD) lens with the same parameters but without treatment zones. Children wore a DF lens in 1 randomly assigned eye and an SVD lens in the fellow eye for 10 months (period 1). Lens assignment was then swapped between eyes, and lenses were worn for a further 10 months (period 2). Main Outcome Measures: Primary outcome was change in SER measured by cycloplegic autorefraction over 10 months. Secondary outcome was a change in axial eye length (AXL) measured by partial coherence interferometry over 10 months. Accommodation wearing DF lenses was assessed using an open-field autorefractor. Results: In period 1, the mean change in SER with DF lenses ( 0.44 0.33 D) was less than with SVD lenses ( 0.69 0.38 D; P 0.001); mean increase in AXL was also less with DF lenses (0.11 0.09 mm) than with SVD lenses (0.22 0.10 mm; P 0.001). In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the DF lens relative to that wearing the SVD lens. Similar reductions in myopia progression and axial eye elongation were also observed with DF lens wear during period 2. Visual acuity and contrast sensitivity with DF lenses were not significantly different than with SVD lenses. Accommodation to a target at 40 cm was driven through the central distance-correction zone of the DF lens. Conclusions: Dual-Focus lenses provided normal acuity and contrast sensitivity and allowed accommodation to near targets. Myopia progression and eye elongation were reduced significantly in eyes wearing DF lenses. The data suggest that sustained myopic defocus, even when presented to the retina simultaneously with a clear image, can act to slow myopia progression without compromising visual function. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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  • Effect of Dual-Focus soft contact lens wear on axial myopia progression in children

    Anstice, Nicola; Phillips, John (2010)

    Conference item
    The University of Auckland Library

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  • Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years.

    McKinlay, Christopher; Alsweiler, Jane; Ansell, JM; Anstice, Nicola; Chase, JG; Gamble, Gregory; Harris, Deborah; Jacobs, Robert; Jiang, Yannan; Paudel, N; Signal, M; Thompson, Benjamin; Wouldes, Trecia; Yu, TY; Harding, Jane (2015-10)

    Journal article
    The University of Auckland Library

    BACKGROUND: Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. METHODS: We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. RESULTS: Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P=0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P=0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. CONCLUSIONS: In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).

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  • Global Motion Perception in 2-Year-Old Children: A Method for Psychophysical Assessment and Relationships With Clinical Measures of Visual Function

    Yu, TY; Jacobs, Robert; Anstice, Nicola; Paudel, Nabin; Harding, Jane; Thompson, Benjamin; CHYLD Study Team (2013-12)

    Journal article
    The University of Auckland Library

    Purpose. We developed and validated a technique for measuring global motion perception in 2-year-old children, and assessed the relationship between global motion perception and other measures of visual function. Methods. Random dot kinematogram (RDK) stimuli were used to measure motion coherence thresholds in 366 children at risk of neurodevelopmental problems at 24 ± 1 months of age. RDKs of variable coherence were presented and eye movements were analyzed offline to grade the direction of the optokinetic reflex (OKR) for each trial. Motion coherence thresholds were calculated by fitting psychometric functions to the resulting datasets. Test–retest reliability was assessed in 15 children, and motion coherence thresholds were measured in a group of 10 adults using OKR and behavioral responses. Standard age-appropriate optometric tests also were performed. Results. Motion coherence thresholds were measured successfully in 336 (91.8%) children using the OKR technique, but only 31 (8.5%) using behavioral responses. The mean threshold was 41.7 ± 13.5% for 2-year-old children and 3.3 ± 1.2% for adults. Within-assessor reliability and test–retest reliability were high in children. Children's motion coherence thresholds were significantly correlated with stereoacuity (LANG I & II test, ρ = 0.29, P < 0.001; Frisby, ρ = 0.17, P = 0.022), but not with binocular visual acuity (ρ = 0.11, P = 0.07). In adults OKR and behavioral motion coherence thresholds were highly correlated (intraclass correlation = 0.81, P = 0.001). Conclusions. Global motion perception can be measured in 2-year-old children using the OKR. This technique is reliable and data from adults suggest that motion coherence thresholds based on the OKR are related to motion perception. Global motion perception was related to stereoacuity in children.

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