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- The potential of current polygenic risk scores to predict high myopia and myopic macular degeneration in multi-ethnic Singapore adultsPublication . Kassam, Irfahan; Foo, Li-Lian; Lança, Carla; Xu, Ling Qian; Hoang, Quan V.; Cheng, Ching-Yu; Hysi, Pirro; Saw, Seang-MeiPurpose: To evaluate the trans-ancestry portability of current myopia polygenic risk scores (PRS) to predict high myopia (HM) and myopic macular degeneration (MMD) in an Asian population. Design: Population-based study. Subjects: A total of 5,894 (2,141 Chinese, 1,913 Indians, and 1,840 Malays) adults from the Singapore Epidemiology of Eye Diseases (SEED) study were included in the analysis. The mean age was 57.0 (standard deviation, SD = 9.31) years. A total of 361 adults had HM (spherical equivalent, SE <-5.00D) from refraction measurements, 240 individuals were diagnosed with MMD graded by the Meta-PM criteria from fundus photographs, and 3,774 individuals were controls without myopia (SE >-0.5D). Methods: The PRS, derived from 687,289 HapMap3 SNPs from the largest genome-wide association study of myopia in Europeans to date (n = 260,974), was assessed on its ability to predict HM and MMD versus controls. Main outcome measures: The primary outcomes were the area under the receiver operating characteristic curve (AUROC) to predict HM and MMD. Results: The PRS had an AUROC of 0.73 (95% CI: 0.70, 0.75) for HM and 0.66 (95% CI: 0.63, 0.70) for MMD versus no myopia controls. The inclusion of the PRS with other predictors (age, sex, educational attainment (EA), and ancestry; age-by-ancestry; sex-by-ancestry and EA-by-ancestry interactions; and 20 genotypic principal components) increased the AUROC to 0.84 (95% CI: 0.82, 0.86) for HM and 0.79 (95% CI: 0.76, 0.82) for MMD. Individuals with a PRS in the top 5% had 4.66 (95% CI: 3.34, 6.42) times higher risk for HM and 3.43 (95% CI: 2.27, 5.05) times higher risk for MMD compared to the remaining 95% of individuals. Conclusion: The PRS is a good predictor for HM and will facilitate the identification of high-risk children to prevent myopia progression to HM. In addition, the PRS also predicts MMD and will help to identify high-risk myopic adults who require closer monitoring for myopia-related complications.
- Rendimiento escolar e tipos de errores en la lectura en los niños con alteraciones de la función visualPublication . Lança, Carla; Serra, Helena; Prista, JoãoSe desarrolló un estudio descriptivo con el objetivo de evaluar el rendimiento escolar así como tipos de errores en la lectura en niños con alteraciones de la función visual. En el estudio participaron 672 niños del Municipio de Lisboa (7.69±1.19 años): grupo de control (función visual normal=562) y grupo experimental (alteraciones da función visual=110). Se cuestionaron 34 profesores acerca del rendimiento escolar y lectura a través de un cuestionario validado. Para la evaluación en la lectura se empleó la prueba de lectura de 34 palabras sueltas. Los niños con la función visual alterada mostraron niveles más bajos de rendimiento escolar. Estaban en el nivel "negativo" del 10,9% de los niños con la función visual alterada y sólo del 5,3% de los niños con la función visual normal. Estos niños comenten más errores en la lectura (p<0,001) con un mayor número de no palabras (3,09±5,20) en comparación con los niños con la función visual normal (1,44±3,09). Comenten también más omisiones y adiciones de letras y confusiones de grafema, teniendo dificultades en el análisis global de la palabra. Se propone un modelo de orientación para los profesores.
- Estrabismo, acuidade visual e erro refrativo não corrigido na criança em idade escolarPublication . Lança, CarlaPreventable visual loss in children is an important public health problem. The critical period of susceptibility to deprivation or abnormal visual experience has been identified since the early 1970s. Preventable visual loss caused by amblyopia (0.3%–4%) and its risk factors such as strabismus (2.1%–4.6%) and uncorrected refractive errors (5%–7.7%) represent an important public health problem. Thus the primary justification for preschool vision screening is the detection of amblyopia or amblyogenic refractive, strabismic, or ocular disease conditions. However in Portugal there has been little investigation regarding prevalence of visual anomalies among school-age children. Data on the prevalence are lacking but are needed for planning vision services. Aims: 1) Determine the prevalence of strabismus; 2) Determine the prevalence of decreased visual acuity; 3) Determine the prevalence of uncorrected refractive error.
- A influência do computador na integridade da visão binocularPublication . Plácido, Susana; Neves, Carolina; Francisco, Vanessa; Marques, Sónia; Ceia, Susana; Oliveira, Manuel; Lança, CarlaComputer Vision Syndrome (CSV): 1) Conjunto de complicações desencadeadas com o acto de fixação para perto, que são experimentadas durante ou após o uso do computador; 2) Distúrbio caracterizado pelo esforço repetitivo de perto traduzindo-se em sintomas oculares e não oculares. Pertinência do estudo: os trabalhadores de telecomunicações desempenham actividades prolongadas de fixação para perto, o que pode originar queixas de fadiga visual devido ao stress exercido sob a convergência acomodativa. Objectivos do estudo: 1) Identificar quais os parâmetros da visão binocular que são mais influenciados pelo uso prolongado do computador; 2) Comparar a visão binocular em dois grupos de indivíduos com e sem sintomatologia ocular.
- Binocular function years after surgeryPublication . Reich-d'Almeida, F.; Lança, Carla; Reich-d'Almeida, IsabelPurpose - To demonstrate that in surgically treated infantile esotropia patients, with no previous signs of binocularity, it is possible after a very long therapy with medical and orthoptic regular follow up, to achieve functional rehabilitation well above the conventionally accepted age for sensorial recovery.
- Myopia: public health challenges and interventions [editorial]Publication . Iribarren, Rafael; Grzybowski, Andrzej; Lança, CarlaMost school myopia results from an excessive eye axial length that develops in childhood. In the past three decades, there have been significant increases in the prevalence of childhood myopia. By 2050, half of the world's population is expected to have myopia, a 2-fold increase compared to the year 2000. In the last years, the achievements made by scientists have been exceptional, leading to major advancements in the treatment of myopia progression. This Research Topic comprises 14 studies including original research articles and reviews covering several aspects of myopia. Myopia has become one of the fastest-growing eye health challenges of the twenty-first century, with a disproportionate burden on urban Asia regions. Shi et al. conducted a study on temporal and spatial characterization of myopia in China. The authors showed that there was an increase in the prevalence of myopia in children aged 7–18 years old from 1995 to 2014. The study results also showed a shift of myopia to the southeast, identifying the existence of high-risk areas. Those results are important for targeted myopia prevention.
- Abordagens pedagógicas no ensino da ortóptica e ciências da visão na ESTeSLPublication . Lança, CarlaDigital strategy in higher education institutions: advances in knowledge have resulted in an increasing use of technology for personal and educational purposes; online learning is the delivery of a learning, training or education program by electronic means; a range of online learning management system software is available for educators such as Moodle, Blackboard, and Canvas; the use of online learning is growing in medical education. Digital strategy IN the BSc Orthoptic degree: in 2011, online learning activities were introduced in the teaching of the research in orthoptics module for final year undergraduate orthoptic students (4-year program) at ESTeSL. A research study undertaken at ESTeSL (n=42) from 2012/13, 2013/14 and 2016/17 cohorts showed that the majority of the students used the Moodle platform only to submit and download learning materials. Conclusions: Rating the tutor support higher than peer support could reflect that the students are still very dependent on the lecturer. Although e-learning is an effective approach in many medical schools, it should not replace traditional learning.
- Competências dos ortoptistas no rastreio visual infantilPublication . Lança, CarlaA identificação das competências profissionais do Ortoptista no contexto do rastreio visual infantil não se encontra suficientemente suportada em estudos de investigação. Que relação existe entre as competências e a prática destes profissionais? Qual a relação entre a aquisição das competências e a sua exequibilidade no contexto de trabalho? Que guias de orientação e que competências essenciais no campo de acção do rastreio visual infantil? Objectivo do estudo: analisar a relação entre as competências profissionais e a prática do Ortoptista no Rastreio Visual Infantil.
- Systematic review and meta-analysis on the impact of COVID-19 pandemic-related lifestyle on myopiaPublication . Li, Mijie; Xu, Lingqian; Tan, Chuen-Seng; Lança, Carla; Foo, Li-Lian; Sabanayagam, Charumathi; Saw, Seang-MeiPurpose: To conduct a systematic review and meta-analysis to assess the effects of coronavirus disease 2019 (COVID-19) pandemic–related lifestyle on myopia outcomes in children to young adults. Methods: A systematic search was conducted on PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases (with manual searching of reference lists of reviews). Studies included assessed changes in myopia-related outcomes (cycloplegic refraction) during COVID and pre-COVID. Of 367 articles identified, 7 (6 prospective cohorts; 1 repeated cross-sectional study) comprising 6327 participants aged 6 to 17 were included. Quality appraisals were performed with Joanna Briggs Institute Critical Appraisal Checklists. Pooled differences in annualized myopic shifts or mean spherical equivalent (SE) during COVID and pre-COVID were obtained from random-effects models. Results: In all 7 studies, SE moved toward a myopic direction during COVID (vs pre-COVID), where 5 reported significantly faster myopic shifts [difference in means of changes: −1.20 to −0.35 diopters per year, [D/y]; pooled estimate: −0.73 D/y; 95% confidence interval (CI): −0.96, −0.50; P<0.001], and 2 reported significantly more myopic SE (difference in means: −0.72 to −0.44 D/y; pooled estimate: −0.54 D/y; 95% CI: −0.80, −0.28; P<0.001). Three studies reported higher myopia (SE ≤−0.50 D) incidence (2.0- to 2.6-fold increase) during COVID versus pre-COVID. Of studies assessing lifestyle changes, all 4 reported lower time outdoors (pre-COVID vs during COVID: 1.1–1.8 vs 0.4–1.0 hours per day, [h/d]), and 3 reported higher screen time (pre-COVID vs during COVID: 0.7–2.8 vs 2.4–6.9 h/d). Conclusions: This review suggests more myopic SE shifts during COVID (vs pre-COVID) in participants aged 6 to 17. COVID-19 restrictions may have worsened SE shifts, and lifting restrictions may lessen this effect. Evaluations of the long-term effects of the pandemic lifestyle on myopia onset and progression in large studies are warranted to confirm these findings.
- An exploratory study of orthoptic student satisfaction in a blended learning environmentPublication . Lança, CarlaPurpose: To describe orthoptic student satisfaction in a blended learning environment. Methods: Blended learning and teaching approaches that include a mix of sessions with elearning are being used since 2011/2012 involving final year (4th year) students from an orthoptic program. This approach is used in the module of research in orthoptics during the 1 semester. Students experienced different teaching approaches, which include seminars, tutorial group discussions and e-learning activities using the moodle platform. The Constructivist OnLine Learning Environment Survey (COLLES ) was applied at the end of the semester with 24 questions grouped in 6 dimensions with 4 items each: Relevance to professional practice, Reflection, Interactivity, Tutor support, Peer support and Interpretation. A 5-point Likert scale was used to score each individual item of the questionnaire (1 - almost never to 5 – almost always). The sum of items in each dimension ranged between 4 (negative perception) and 20 (positive perception). Results: Twenty-four students replied to the questionnaire. Positive points were related with Relevance (16.13±2.63), Reflection (16.46±2.45), Tutor support (16.29±2.10) and Interpretation (15.38±2.16). The majority of the students (n=18; 75%) think that the on-line learning is relevant to students’ professional practice. Critical reflections about learning contents were frequent (n=19; 79.17%). The tutor was able to stimulate critical thinking (n=21; 87.50%), encouraged students to participate (n=18; 75%) and understood well the student’s contributions (n=15; 62.50%). Less positive points were related with Interactivity (14.13±2.77) and Peer support (13.29±2.60). Response from the colleagues to ideas (n=11; 45.83%) and valorization of individual contributions (n=10; 41.67%) scored lower than other items. Conclusions: The flow back and forth between face-to-face and online learning situations helps the students to make critical reflections. The majority of the students are satisfied with a blended e-learning system environment. However, more work needs to be done to improve interactivity and peer support.