Martin Rickert

Purpose: To quantify the impact of uncorrected astigmatism in myopic eyes fitted with dual focus (DF) myopia control contact lenses. Methods: The right eyes of 10 young adult myopes were corrected with standard single vision (SV, Proclear 1 day, CooperVision, Inc.) and DF (MiSight 1 day, CooperVision, Inc.) contact lenses. SV and DF contact lens powers were determined from SV over-refractions and any ocular astigmatism was corrected using cylindrical trial lenses. Visual acuity and subjective vision were measured through added cylindrical trial lenses (0.00DC, 0.75DC, 1.25DC, 1.75DC and 2.25DC) with spherical equivalent adjustments. With the 2.25D astigmatic lenses, spherical trial lenses were also used to focus the front edge, centre and back edge of the interval of Sturm. Data were analysed using linear mixed-effects regression models. Results: High illumination visual acuity was similar for both lens types (zero astigmatism model-estimated intercept: −0.25 logMAR for SV; −0.24 logMAR for DF), and visual acuity decreased linearly with increasing astigmatism, similarly with both SV (0.27 logMAR/D) and DF (0.23 logMAR/D) lenses. Under low room illumination and in the absence of astigmatism, SV acuity was slightly superior to DF (mean logMAR −0.03 and +0.06 for SV and DF, respectively) and the rate of visual acuity decline with increasing astigmatism was less for DF (0.21 logMAR/D) than for SV lenses (0.26 logMAR/D; p = 0.04). Subjective quality of vision ratings were higher for SV lenses compared to DF lenses (model-estimated intercept: 93 vs. 86). Quality of vision ratings decreased linearly with increasing astigmatism at nearly identical rates for both lens types (~19 rating units/D). LogMAR acuity and subjective ratings were similar when the edges or the centre of the interval of Sturm were focused. Conclusion: Uncorrected astigmatism had an almost identical impact on visual acuity and vision quality in eyes fitted with DF myopia control and SV contact lenses.

Purpose: To explore the agreement between computationally modelled point‐spread functions (PSFs) and multifocal soft contact lens wearers' descriptions of image quality. Methods: In Phase 1, participants were fitted with a single vision soft contact lens (SCL) in the left eye, and four different multifocal (MF) SCLs in the right eye in randomised order. Aberrometry measures of the MFSCL‐wearing right eye were collected while participants viewed a point source monocularly using their left eye and drew their perception of the source. The predicted right eyes' PSFs were computed from the aberrometry data using a geometrical optics PSF calculation. In Phase 2, participants completed a Likert item questionnaire designed to identify salient features in the PSFs. Consensus among the participants about these features was assessed quantitatively using Yule's Q . Participants also rated the similarity between pairs of PSFs. Non‐metric multidimensional scaling (MDS) and Procrustes transformation analyses were used to derive and compare image similarity spaces for the drawn and computed PSFs, respectively. Lastly, two observers completed an image matching task, in which they selected the best‐matching drawn PSF for each computed PSF. Results: Significant similarities between computed and hand‐drawn PSFs were demonstrated both qualitatively and quantitatively. Inter‐rater agreement for image features was statistically significant (Yule's Q = 0.63; p < 0.05). Stress values for three‐dimensional MDS configurations were p < 0.001). Conclusions: Results indicate good agreement between the PSF image quality drawn by participants and that predicted from aberrometry measures. This study has demonstrated potential for leveraging the correspondence between subjectively perceived and computationally derived representations of image quality in both clinical and contact lens research and development processes.

Purpose: To evaluate the myopic and hyperopic defocus delivered to the retina by a dual focus (DF) myopia control contact lens when myopia exceeds 6.00 D. Methods: Individuals with high myopia were fitted bilaterally with high‐powered DF lenses containing power profiles matching a Coopervision MiSight 1 day contact lens (omafilcon A) and a Coopervision Proclear 1 day single vision (SV) lens. Wavefront measurements along the primary line of sight and across the central ±20° of the horizontal retina were acquired using a pyramidal aberrometer, while subjects accommodated to high‐contrast letter stimuli (6/12 equivalent) at six target vergences (−0.25 and −1.00 to −5.00 D). Linear mixed‐effects regression models explored the relationship between the spherical equivalent refractive error (SERE) and induced defocus. Results: Thirteen teenagers and young adults (ages 13–32 years, mean [standard deviation, SD] age = 22.8 [4.9] years) with high myopia (SERE −6.50 to −9.25 D) were tested. The treatment optic zone of the DF lens shifted retinal defocus by the expected −2.00 D, with a mean (SD) difference (DF–SV) of −2.21 (0.18) D for the inner treatment ring. Inclusion of the treatment optic had no significant impact on accommodative accuracy ( p = 0.51). Accommodative lags were larger at the nearer viewing distances, with lag increasing by approximately 0.30 D for every additional dioptre of SERE. Measured retinal defocus within the annular treatment zone was approximately −2.00 D at the foveal centre, 10° nasal and temporal and 20° nasal and reduced to −1.90 (0.57) D at 20° temporal. Conclusions: Relative to eyes with lower levels of myopia, the increased accommodative lags and more prolate retinas of highly myopic eyes reduced the myopic retinal defocus from the DF myopia control lens, while the treatment optical zones generated the combined effect of reducing hyperopic and introducing myopic retinal defocus relative to an SV correction.

Previous research has been limited in the comprehensive study of associations between the use of individual antiseizure medications (ASMs) in pregnancy and specific groups of birth defects, and systematic reviews and meta-analyses on the topic are limited by pooled samples and study designs. This study investigated birth defects related to ASM use in pregnancy in children born to women with epilepsy in Sweden over 20 years. We used data from Swedish national registers to follow a cohort of 17,996 children born to women diagnosed with epilepsy any time before conception in Sweden from 1996 to 2016, following them through 2017. We examined maternal-reported use of the 4 most commonly reported ASMs: lamotrigine (n = 2,148, 11.9%), carbamazepine (n = 1,940, 10.8%), valproic acid (n = 1,043, 5.80%), and levetiracetam (n = 587, 3.26%). We identified birth defects using diagnoses recorded at the time of discharge from the hospital and inpatient and outpatient diagnoses recorded in the first year of life. Models were estimated in a stepped fashion: unadjusted, adjusted for covariates, among a subcohort born to women diagnosed 10 years before conception (n = 14,586), and restricted to monotherapy. Valproic acid use in pregnancy had the strongest and most widespread associations with birth defects in children, with carbamazepine also having links to several birth defects, including respiratory system and genital organ defects. Lamotrigine use in pregnancy was associated with cleft lip/palate and chromosomal abnormalities. Levetiracetam was most often used with other ASMs and preliminarily associated with many birth defects. Our findings support avoidance of valproic acid use in pregnancy whenever possible. Lamotrigine and carbamazepine may be safer alternatives. However, these medications were also associated with certain birth defects, including some not reported previously. We are among the first to examine the possible effects of levetiracetam use in pregnancy, though more research is needed to investigate this further.

Introduction: Previous literature has indicated an association between participant‐reported perceptions (e.g., ratings) of comfort, dryness and vision quality during soft contact lens wear. However, these reports do not account for participant‐ and lens‐specific factors which may impact the interpretation of these results. The purpose of this project was to quantify the association between these participant‐reported ratings while accounting for both participant‐ and lens‐specific factors. Methods: Participant‐reported ratings (scale 0–100) of comfort, dryness and quality of vision for 675 soft contact lens wearers (1207 eyes) were aggregated across 31 studies completed at Indiana University. Linear mixed‐effects regression modelling was performed on each outcome rating individually. Covariate‐adjusted models incorporated both participant‐ (e.g., age, sex) and lens‐related (e.g., lens material, edge and optics) factors. The models were statistically adjusted for the duration of lens wear in hours and cumulative days of exposure. Results: Consistent with estimates from covariate‐adjusted regression models, pairwise Spearman correlations [95% CI] between dryness and comfort ( r _s = 0.71, [0.69, 0.74]), vision quality and comfort ( r _s = 0.53, [0.49, 0.57]) and vision quality and dryness ( r _s = 0.49, [0.42, 0.54]) were all positive and had p < 0.001. Average participant‐reported ratings of comfort, dryness and vision quality decreased by ( b _s [95% CI]) = −0.81 [−1.15, −0.46] −0.34 [−0.67, 0.0005] and −0.90 [−1.19, −0.60] rating units, respectively, for each hour of lens wear. Conclusions: Significant positive associations were found between participant‐reported measures of comfort, dryness and vision quality during soft contact lens wear. The associations between these ratings and the participant‐ and lens‐related factors that drive them should be considered by clinicians and manufacturers when fitting and designing soft contact lenses.

Introduction: Habitual viewing behaviour is widely believed to be an important contributing factor to the onset and progression of myopia and may be task dependent. The purpose of this study was to quantify the habitual viewing distance of children performing five different tasks on a smartphone digital device. Methods: The real‐time viewing distance in 38 children with their habitual correction was measured using software (MyopiaApp) on a handheld (Google Pixel 3) device. Five tasks were performed in a randomised sequence: playing a game, watching video in a light (680 lux) and dark (5.5 lux) environment and reading small (8 pt) and large (16 pt) text. ANCOVA statistical analysis was used to evaluate the effect of task, group (myope vs. non‐myope) and arm length on the median relative viewing distance. Results: Arm length was not correlated with viewing distance in any of the tasks, and there was no significant difference in viewing distance between any of the tasks. Specifically, a two‐way mixed ANCOVA indicated that task, refractive group (myopic vs. non‐myopic), age and arm length, as well as all two‐way interactions were not significantly associated with viewing distance. Overall, 60% of the total variance in viewing distance was accounted for by individual differences. Conclusions: The average handheld viewing distance was similar across a variety of everyday tasks in a representative sample of myopic and emmetropic children. Neither arm length, age nor refractive group were associated with viewing distance in any of the tasks. Importantly, myopic children of a given size did not hold the smartphone digital device at a different distance for any task than their equally sized non‐myopic peers. However, both groups exhibited high inter‐individual variability in mean viewing distance, indicating some subjects performed all tasks at further distances while other subjects used at nearer distances.

Objective To determine whether children born to women who use antiseizure medications (ASMs) during pregnancy have higher risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) independent of confounding factors. Methods We used Swedish register data (n = 14,614 children born 1996–2011 and followed up through 2013) to examine associations in children of women with epilepsy, using the largest sample to date and adjusting for a range of measured confounders. We examined maternal-reported first-trimester use of any ASM (22.7%) and the 3 most commonly reported individual drugs (valproic acid 4.8%, lamotrigine 6.8%, and carbamazepine 9.7%). We identified ASD with ICD-10 diagnoses and ADHD with ICD-10 diagnoses or filled prescriptions of ADHD medication. Results Examination of individual drugs revealed that after adjustment for confounding, use of valproic acid was associated with ASD (hazard ratio [HR] 2.30, 95% confidence interval [CI] 1.53–3.47) and ADHD (HR 1.74, 95% CI 1.28–2.38). Whereas a small, nonstatistically significant association with ASD (HR 1.25, 95% CI = 0.88–1.79) and ADHD (HR 1.18, 95% CI 0.91–1.52) remained for reported use of carbamazepine, confounding explained all of the associations with lamotrigine (HR_ASD 0.86, 95% CI 0.67–1.53; HR_ADHD 1.01, 95% CI 0.67–1.53). Conclusions We found no evidence of risk related to exposure to lamotrigine, whereas we observed elevated risk of ASD and ADHD related to maternal use of valproic acid. Associations with carbamazepine were weak and not statistically significant. Our findings add to a growing body of evidence that suggests that certain ASMs may be safer than others in pregnancy.

Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes using a large population-based dataset, multiple definitions of POA exposure, and several methods to evaluate the influence of both measured and unmeasured confounding factors. We obtained data by linking information from several Swedish registers and conducted a retrospective cohort study on a population-based sample of 620,458 Swedish births occurring between 2007 and 2013 (48.6% female; 44.4% firstborn). We evaluated associations between prenatal POA exposure and risk for preterm birth (PTB; p < 0.001). This association was attenuated when we compared POA-exposed infants with acetaminophen-exposed infants (OR = 1.18, 95% CI 1.07–1.30, p < 0.001), infants born to women who used POAs before pregnancy only (OR = 1.05, 95% CI 0.96–1.14, p = 0.27), and unexposed siblings (OR = 0.99, 95% CI 0.85–1.14, p = 0.92). We also evaluated associations with short-term versus persistent POA use during pregnancy and observed a similar pattern of results, although the magnitudes of associations with persistent exposure were larger than associations with any use or short-term use. Although short-term use was not associated with SGA (adjusted OR_{single-trimester} = 0.95, 95% CI 0.87–1.04, p = 0.29), persistent use was associated with increased risk for SGA (adjusted OR_{multiple-trimester} = 1.40, 95% CI 1.17–1.67, p < 0.001) compared with unexposed infants. The association with persistent exposure was attenuated when we used alternative comparison groups (e.g., sibling comparison OR = 1.22, 95% CI 0.60–2.48, p = 0.58). Of note, our study had limitations, including potential bias from exposure misclassification, an inability to adjust for all sources of confounding, and uncertainty regarding generalizability to countries outside of Sweden. Our results suggested that observed associations between POA use during pregnancy and risk of PTB and SGA were largely due to unmeasured confounding factors, although we could not rule out small independent associations, particularly for persistent POA use during pregnancy.