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  1. Article ; Online: Fine visuomotor skills in amblyopia: a systematic review and meta-analysis.

    Rakshit, Archayeeta / Schmid, Katrina L / Webber, Ann L

    The British journal of ophthalmology

    2023  

    Abstract: Background: Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia affects everyday task performance is important to quantifying the disease ... ...

    Abstract Background: Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia affects everyday task performance is important to quantifying the disease burden of amblyopia and can assist clinicians to understand patients' likely functional capability.
    Methods: A systematic literature search identified published studies comparing fine visuomotor performance in either children or adults with amblyopia and those with normal binocular vision. The included studies (22 studies involving 835 amblyopes and 561 controls) reported results of self-perception patient reported outcome measures, tests of motor proficiency and video recorded reaching and grasping. The outcomes of 17 studies were grouped into four meta-analyses, with pooled results reported as standardised mean difference (SMD) with corresponding 95% CI.
    Results: Regardless of the cause of amblyopia (anisometropia, strabismus, mixed, deprivation), significant reduction in self-perception of physical competence and athletic competence (SMD=-0.74, 95% CI -1.23 to -0.25, p=0.003); fine motor skills scores (SMD=-0.86, 95% CI -1.27 to -0.45, p<0.0001); speed of visually guided reaching and grasping movements (SMD=0.86, 95% CI 0.65 to 1.08, p<0.00001); and precision of temporal eye-hand coordination (SMD=0.75, 95% CI 0.26 to 1.25, p=0.003) occurred in amblyopes compared with those with normal visual development.
    Conclusion: Reports of the impact of amblyopia on fine motor skills performance find poorer outcomes in participants with amblyopia compared with those with normal vision development. Consistency in the outcome measure used to assess the functional impact of amblyopia would be valuable for future studies.
    Language English
    Publishing date 2023-09-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 80078-8
    ISSN 1468-2079 ; 0007-1161
    ISSN (online) 1468-2079
    ISSN 0007-1161
    DOI 10.1136/bjo-2022-322624
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  2. Article ; Online: The functional impact of amblyopia.

    Webber, Ann L

    Clinical & experimental optometry

    2018  Volume 101, Issue 4, Page(s) 443–450

    Abstract: Amblyopia is the most common disorder managed in paediatric ophthalmic practice in industrialised countries. Reports on the impact of amblyopia on tasks relevant to the activities of children, or on skills pertinent to their education and quality of life, ...

    Abstract Amblyopia is the most common disorder managed in paediatric ophthalmic practice in industrialised countries. Reports on the impact of amblyopia on tasks relevant to the activities of children, or on skills pertinent to their education and quality of life, is leading to greater understanding of the functional disabilities associated with the condition. This review considers the extent to which amblyopia affects the ability to carry out everyday tasks, with particular attention to studies of motor skills and reading proficiency in children. Collectively, these studies show that amblyopia results in poorer outcomes on tests of skills required for proficiency in everyday tasks and which relate to childhood academic performance. However, the relative contributions that the documented vision anomalies inherent in amblyopia contribute to various functional disabilities is not fully determined. Recent reports have demonstrated improvement following treatment in standardised measures of fine motor skills involved in practical, everyday tasks. Including measurement of functional performance skills in amblyopia treatment trials is desirable to show treatment effect on crucial, real-world activities.
    MeSH term(s) Activities of Daily Living ; Amblyopia/physiopathology ; Child ; Humans ; Quality of Life ; Vision Disorders/physiopathology ; Vision, Binocular/physiology
    Language English
    Publishing date 2018-02-26
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 639275-1
    ISSN 1444-0938 ; 0816-4622
    ISSN (online) 1444-0938
    ISSN 0816-4622
    DOI 10.1111/cxo.12663
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  3. Article ; Online: Practical use and prescription of ocular medications in children and infants.

    Webber, Ann L / Sharwood, Phillipa

    Clinical & experimental optometry

    2021  Volume 104, Issue 3, Page(s) 385–395

    Abstract: Optometrists in Australia employ ophthalmic medicines in their paediatric practice to assist clinical diagnosis and to treat ocular conditions. Prior to employing ocular medicines or initiating treatment, it is important to consider the risks versus ... ...

    Abstract Optometrists in Australia employ ophthalmic medicines in their paediatric practice to assist clinical diagnosis and to treat ocular conditions. Prior to employing ocular medicines or initiating treatment, it is important to consider the risks versus benefits of ophthalmic medicines and determine the minimum dose required to safely achieve a diagnostic or therapeutic benefit. Instilling drops in infants and young children may require techniques that do not depend on full cooperation, particularly to maintain appropriate dosing and limit the rate of elimination from the eye. Diagnostic cycloplegic agents are highly recommended for the accurate determination of refractive error in infants and young children. Topical atropine is commonly prescribed in paediatric optometry practice in highly variable concentrations. 1% atropine eye drops are used for pharmacological penalisation in management of amblyopia, and, increasingly, low concentration (< 0.1%) atropine is used to manage the progression of childhood myopia. Doses of topical ocular medicines to treat inflammation, infection or glaucoma are generally identical to those use in adults; however, there is potential for increased ocular and systemic side effects with certain medications. It is, therefore, timely to present, summarise and comment on the use of ophthalmic diagnostic and therapeutic agents in children and reference where practitioners can look for more detailed information. The perspective is set in the Australian context of a collaborative approach between paediatric optometry and ophthalmology eye care practitioners for delivery of best practice care in infants and young children. Inclusion of the more complex spectrum of paediatric eye disease in a tertiary ophthalmological setting is provided to build practitioner knowledge of treatment regimens their patients may be using, even though management of these conditions lies outside their scope of practice.
    Language English
    Publishing date 2021-02-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639275-1
    ISSN 1444-0938 ; 0816-4622
    ISSN (online) 1444-0938
    ISSN 0816-4622
    DOI 10.1080/08164622.2021.1877533
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  4. Article ; Online: Ocular manifestations of systemic diseases in children.

    Chong, Cheefoong / Webber, Ann L / Dai, Shuan

    Clinical & experimental optometry

    2022  Volume 106, Issue 3, Page(s) 238–248

    Abstract: Knowledge of ocular diseases and understanding of the complex interplay between eye and systemic health have increased over the years. This knowledge is particularly important when caring for our youngest and most vulnerable paediatric patients when ... ...

    Abstract Knowledge of ocular diseases and understanding of the complex interplay between eye and systemic health have increased over the years. This knowledge is particularly important when caring for our youngest and most vulnerable paediatric patients when ophthalmic manifestations may provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Further, the visual system can be vulnerable to manifestations of known systemic disease, with vigilant ophthalmic examination generally aiding early identification of ocular complications for collaborative multidisciplinary care to prevent avoidable vision loss. The potential ocular signs and complications of the following developmental, genetic or acquired childhood systemic disorders are presented: premature birth, trisomy 21, albinism, Marfan's syndrome, Stickler's syndrome, septo-optic dysplasia, aniridia, neurofibromatosis 1, Sturge-Weber syndrome, papilloedema, juvenile idiopathic arthritis and vitamin A deficiency. Rather than providing an exhaustive list of diseases, this review offers an overview of the more commonly encountered congenital or acquired childhood systemic conditions that have associated childhood ophthalmic disorders and presents referral and ongoing surveillance recommendations.
    MeSH term(s) Humans ; Male ; Female ; Child ; Eye Diseases, Hereditary ; Ophthalmology ; Eye Diseases ; Congenital Abnormalities/genetics ; Papilledema ; Arthritis, Juvenile ; Avitaminosis
    Language English
    Publishing date 2022-03-16
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 639275-1
    ISSN 1444-0938 ; 0816-4622
    ISSN (online) 1444-0938
    ISSN 0816-4622
    DOI 10.1080/08164622.2022.2048999
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  5. Article ; Online: Vision Recovery Despite Retinal Ganglion Cell Loss in Leber's Hereditary Optic Neuropathy.

    Webber, Ann L

    Optometry and vision science : official publication of the American Academy of Optometry

    2016  Volume 93, Issue 12, Page(s) 1571–1577

    Abstract: Purpose: To report vision recovery in a single case of Leber's hereditary optic neuropathy (LHON) (mtDNA14484/ND6 mutation) with longitudinal documentation of retinal ganglion cell layer by ocular coherence tomography (OCT) that includes the pre-onset, ... ...

    Abstract Purpose: To report vision recovery in a single case of Leber's hereditary optic neuropathy (LHON) (mtDNA14484/ND6 mutation) with longitudinal documentation of retinal ganglion cell layer by ocular coherence tomography (OCT) that includes the pre-onset, acute, and chronic stages of vision loss.
    Case report: We report LHON in a 16-year-old male patient with Type 1 diabetes and known and documented family history of LHON. The patient presented with best-corrected visual acuities of right eye 20/150 and left eye 20/25-. His retinal nerve fiber layer had thickened compared with baseline measures obtained 19 months before the onset of vision loss. Vision rapidly reduced to "hand movements" vision in each eye over the following 2 months. Despite OCT-documented significant recalcitrant loss of ganglion cell layer, visual acuity remarkably recovered to right eye 20/40+ left eye 20/50+ 16 months after onset of neuropathy.
    Conclusions: A selective loss of ganglion cells and nerve fiber layer can be documented in LHON. Significant recovery of visual acuity can occur without apparent structural recovery.
    MeSH term(s) Adolescent ; Humans ; Male ; Optic Atrophy, Hereditary, Leber/pathology ; Optic Atrophy, Hereditary, Leber/physiopathology ; Recovery of Function ; Retinal Ganglion Cells/pathology ; Visual Acuity/physiology
    Language English
    Publishing date 2016-12
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1001706-9
    ISSN 1538-9235 ; 1040-5488
    ISSN (online) 1538-9235
    ISSN 1040-5488
    DOI 10.1097/OPX.0000000000000991
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  6. Article ; Online: A pragmatic approach to amblyopia diagnosis: evidence into practice.

    Webber, Ann L / Camuglia, Jayne E

    Clinical & experimental optometry

    2018  Volume 101, Issue 4, Page(s) 451–459

    Abstract: Amblyopia is a common cause of reduced vision in children. The clinical diagnosis is complicated and requires consideration of the severity of vision loss relative to the characteristics of the disrupting amblyogenic factor. Added to the challenge of a ... ...

    Abstract Amblyopia is a common cause of reduced vision in children. The clinical diagnosis is complicated and requires consideration of the severity of vision loss relative to the characteristics of the disrupting amblyogenic factor. Added to the challenge of a thorough examination of very young children, is the weight of consequence if the amblyogenic factor is not identified and treated appropriately within clinically recommended time frames. Further, the poor visual function may be a symptom of more sinister underlying pathology impacting the visual pathway. This review presents an evidence-based, pragmatic approach to the diagnosis of amblyopia, as a means for guiding best practice for the care of children who present with reduced vision.
    MeSH term(s) Amblyopia/classification ; Amblyopia/diagnosis ; Child ; Child, Preschool ; Evidence-Based Practice ; Humans ; Infant ; Physical Examination ; Vision Disorders/diagnosis
    Language English
    Publishing date 2018-02-26
    Publishing country Australia
    Document type Journal Article ; Review
    ZDB-ID 639275-1
    ISSN 1444-0938 ; 0816-4622
    ISSN (online) 1444-0938
    ISSN 0816-4622
    DOI 10.1111/cxo.12662
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  7. Article ; Online: The paediatric optometry alignment program - a model of interprofessional collaborative eyecare.

    Webber, Ann L / McKinlay, Lynne / Newcomb, Dana / Dai, Shuan / Gole, Glen A

    Clinical & experimental optometry

    2022  Volume 106, Issue 2, Page(s) 178–186

    Abstract: Clinical relevance: Collaboration  between hospital-based ophthalmology and community-based optometry could pave the way to improve access to paediatric eyecare services.: Background: The Paediatric Optometry Alignment Program (POAP) began in 2016 as ...

    Abstract Clinical relevance: Collaboration  between hospital-based ophthalmology and community-based optometry could pave the way to improve access to paediatric eyecare services.
    Background: The Paediatric Optometry Alignment Program (POAP) began in 2016 as a proof-of-concept pilot project that aimed to improve access to specialist paediatric ophthalmology services. If found to be effective at improving patient access, and the quality of care acceptable to patients and professionals then the strategic intent was to upscale the programme to  serve as a model for paediatric eye care in the community.
    Methods: Temporal observational trend analysis was used to review ophthalmology clinic appointment waitlists prior and post POAP pilot project commencement. Family satisfaction with post-discharge care was surveyed in a purposive sample of 30 patients.  Aligned optometrists in the program pilot (n = 97) were invited to complete an online survey (response rate 46%; n = 45).
    Results: The percentage of children waiting longer than clinically recommended fell from 72% to 36%. Sixty-seven percent  of surveyed families had attended a community optometrist as recommended, and all rated the optometry experience from good to excellent.  Participating optometrists reported high levels of satisfaction with involvement in the program, and increased confidence and involvement in paediatric eye care delivery. The need to improve formal transfer  of clinical information was identified.
    Conclusion: Facilitated integrated care between community-based optometrists and a hospital-based ophthalmology department can improve access for tertiary care services, with high satisfaction for families and participating community-based optometrists.
    MeSH term(s) Humans ; Aftercare ; Ophthalmology ; Optometrists ; Optometry ; Patient Discharge ; Pilot Projects
    Language English
    Publishing date 2022-11-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639275-1
    ISSN 1444-0938 ; 0816-4622
    ISSN (online) 1444-0938
    ISSN 0816-4622
    DOI 10.1080/08164622.2022.2141561
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  8. Article ; Online: Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program.

    Webber, Ann L / Toomey, Melinda / Keay, Lisa / Dai, Shuan / Gole, Glen A / Newcomb, Dana / McKinlay, Lynne

    Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists)

    2023  Volume 44, Issue 1, Page(s) 52–70

    Abstract: Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional ... ...

    Abstract Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme.
    Methods: Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey.
    Results: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist.
    Conclusion: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.
    MeSH term(s) Humans ; Child ; Optometry ; Queensland ; Cross-Sectional Studies ; Optometrists ; Learning
    Language English
    Publishing date 2023-11-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 604564-9
    ISSN 1475-1313 ; 0275-5408
    ISSN (online) 1475-1313
    ISSN 0275-5408
    DOI 10.1111/opo.13246
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  9. Article ; Online: Recognizing and Mitigating Gender Bias in Medical Teaching Assessments.

    Babal, Jessica C / Webber, Sarah / Nacht, Carrie L / Nackers, Kirstin A M / Tiedt, Kristin / Allen, Ann / Allen, Brittany J / Kelly, Michelle M

    Journal of graduate medical education

    2022  Volume 14, Issue 2, Page(s) 139–143

    MeSH term(s) Education, Medical ; Female ; Humans ; Internship and Residency ; Male ; Sexism ; Students, Medical ; Teaching
    Language English
    Publishing date 2022-04-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2578612-X
    ISSN 1949-8357 ; 1949-8357
    ISSN (online) 1949-8357
    ISSN 1949-8357
    DOI 10.4300/JGME-D-21-00774.1
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  10. Article ; Online: Suppression Rather Than Visual Acuity Loss Limits Stereoacuity in Amblyopia.

    Webber, Ann L / Schmid, Katrina L / Baldwin, Alex S / Hess, Robert F

    Investigative ophthalmology & visual science

    2020  Volume 61, Issue 6, Page(s) 50

    Abstract: Purpose: To investigate the influence of interocular suppression and visual acuity loss on stereoacuity in observers with and without abnormal vision development from strabismus or amblyopia. To determine whether stereoacuity improves in amblyopic ... ...

    Abstract Purpose: To investigate the influence of interocular suppression and visual acuity loss on stereoacuity in observers with and without abnormal vision development from strabismus or amblyopia. To determine whether stereoacuity improves in amblyopic observers when suppression is neutralized.
    Methods: Experiment 1: Visual acuity (VA), depth of suppression (contrast ratio [CR]), and stereoacuity (digital random-dot) were tested in adult amblyopic observers (n = 21; age 27 ± 11 years). Experiment 2: VA, stereoacuity, and CR were measured at baseline and through a series of monocular contrast attenuation and Bangerter filter conditions that degrade visual input in participants with normal binocular vision (n = 19; age 31 ± 13 years). Multiple regression models were used to determine relative contribution of VA and CR to stereoacuity in both groups. Experiment 3: stereoacuity was retested in a subsample of amblyopic observers (n = 7) after contrast reduction of the stimulus presented to dominant eye to neutralize suppression.
    Results: In amblyopic observers, stereoacuity significantly correlated with CR (P < 0.001), but not with interocular VA difference (P = 0.863). In participants with normal vision development, stereoacuity, VA, and CR declined with introduction of monocular Bangerter filter (P < 0.001), and stereoacuity reduced with monocular attenuation of stimulus contrast (P < 0.001). Reduction in stereoacuity correlated with both VA decrement and degraded CR. Stereoacuity significantly improved in amblyopic observers when the contrast to the dominant eye was adjusted based on the contrast ratio.
    Conclusions: Suppression rather than visual acuity loss limits stereoacuity in observers with abnormal vision development. Stereopsis can be improved when interocular sensory dominance is neutralized.
    MeSH term(s) Adult ; Amblyopia/physiopathology ; Amblyopia/therapy ; Depth Perception/physiology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sensory Deprivation ; Vision, Binocular/physiology ; Visual Acuity ; Young Adult
    Language English
    Publishing date 2020-06-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 391794-0
    ISSN 1552-5783 ; 0146-0404
    ISSN (online) 1552-5783
    ISSN 0146-0404
    DOI 10.1167/iovs.61.6.50
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