New England College of Optometry

To evaluate diabetic ketoacidosis (DKA) risk among new users of ertugliflozin versus sulfonylureas (SU) or thiazolidinediones (TZD) and incretin-based drugs in patients with type 2 diabetes. We used Medicare and Medicaid fee-for-service adjudicated claims within the Innovation in Medical Evidence and Development Surveillance network to identify three new-user cohorts: (1) ertugliflozin; (2) SU/TZD; and (3) incretin-based drugs. The outcome was a principal hospital discharge diagnosis for DKA. Adjusted hazard ratios (HRs) were estimated after 1:1 propensity score (PS) matching, separately for ertugliflozin vs. SU/TZD and vs. incretin-based drugs. Subgroup analyses were performed based on baseline insulin use. After PS matching, baseline characteristics were similarly distributed in each cohort. For ertugliflozin (n = 42,907) vs. SU/TZD (n = 42,907), the incidence rates of DKA per 1000 person-years (PY) were 2.95 and 1.49, respectively. For ertugliflozin (n = 42,247) vs. incretin-based drugs (n = 42,247), the incidence rates of DKA per 1000 PY were 2.76 and 1.06, respectively. For ertugliflozin vs. SU/TZD, the HR [95% confidence interval (CI)] was 1.88 [1.17-3.02]; in non-insulin users, 2.34 [1.27-4.31]; and in insulin users, 1.17 [0.54-2.52]. For ertugliflozin vs. incretin-based drugs, the HR [95% CI] was 2.40 [1.40-4.11]; in non-insulin users, 2.84 [1.42-5.66]; and in insulin users, 1.87 [0.79-4.46]. Ertugliflozin was associated with a higher risk of DKA relative to comparators. HRs were higher among new users with no-concomitant insulin use than those with concomitant insulin use. Results were consistent with prior SGLT2i data and highlighted the importance of caution by both patients and physicians.

The angle between the visual axis and the pupillary axis (angle kappa), and its approximation (angle lambda-between the line of sight and the pupillary axis), are reported to be larger in shorter eyes. However, there is only one previous study of these angles in children, and no longitudinal studies. This study evaluated angle kappa in young children over a 3-year period. Pupil barycenter measures (pupil centre relative to the corneal apex) were taken with an optical biometer and used to estimate angle kappa using the Pythagorean theorem. Both eyes of young children (6 to ≤8 years at baseline) with functional emmetropia were measured biannually for 3 years (seven visits) following complete cycloplegia. The pupil barycenter was located inferior nasal to the corneal apex in most eyes, with a median absolute angle kappa of 5.01° ± 2.54° (0.33 ± 0.15 mm). There was no significant interocular difference in this angle. Correlations of angle kappa with axial length (AXL) and refractive error at baseline were not significant (both p > 0.05), with a trend of a smaller angle kappa in longer eyes. The rate of decrease of angle kappa (slope) was significant for the right eye, as the rate of increase in AXL increased (r = 0.33, p < 0.01), but not in the left eye. The rate of change in AXL and refractive error did not show a significant correlation with the rate of change in angle kappa (p > 0.05). Angle kappa appears to be independent of AXL or refractive error in these young children with a limited range of eye sizes. However, angle kappa may decrease at a higher rate in eyes with a greater rate of increase in AXL over the course of 3 years.

SIGNIFICANCE:Despite significant evidence supporting the utility of vision screening for identifying children who need further evaluation by an eye care professional, there is considerable variability in screening guidelines along with a lack of consensus for monitoring and reporting outcomes. This article provides updated vision screening recommendations for pre-school-age children (aged 3 to <6 years) in the United States.PURPOSE:The goal of vision screening programs is to identify, refer, and help ensure eye examinations for children who may have vision disorders, such as significant uncorrected refractive errors, amblyopia, strabismus, reduced visual acuity, and other vision and eye health problems. This article provides an update to the 2015 recommendations for vision screening in pre-school-age children in the United States, which were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness.METHODS:Recommendations for vision screening for pre-school-age children were developed by the NCCVEH and published in 2015. The updated recommendations in this article were developed through a targeted literature review (PubMed and Science Direct) and expert opinion from the committee, which approved the final recommendations.RESULTS:The committee recommends that vision screening programs have follow-up systems to ensure that referred children receive comprehensive eye examinations. In addition, screening programs should consist of observation, threshold or critical line (age-specific minimal acuity line to pass) distance visual acuity, binocular critical line near visual acuity, and stereopsis, all of which should be performed annually. Instrument-based screening may be used in place of distance visual acuity and stereopsis, though additional research is needed to guide the recommendation for specific devices.CONCLUSIONS:The NCCVEH recommends that children aged 3 to <6 years have their vision screened annually to identify potential eye health and vision disorders. These updated vision screening recommendations provide lay screeners with a standardized approach for detecting vision problems and ensuring timely intervention and treatment. The NCCVEH will continue to provide vision screening updates at http://nationalcenter.preventblindness.org.

PurposeThis study aimed to assess the impact of Rhodiola rosea (RR) supplementation on the dynamics of the accommodative response and digital eye strain (DES) symptoms following 30‐min visual tasks with different levels of cognitive demand.MethodsEighteen young adults (mean age ± SD: 24.6 ± 4.0 years) participated in this placebo‐controlled, triple‐blind, balanced crossover study. Participants completed four sessions separated by 1 week in a randomised order. The sessions differed in the supplement (RR or placebo) and cognitive demand of the visual task (Stroop test or control video). The supplementation consisted of 1200 mg of RR or placebo per day for 4 days (two 300 mg capsules every 12 h) and a washout period of 3 days was allowed before the subsequent condition. The lag and variability of the accommodative response were measured at 500, 40 and 20 cm using an open‐field autorefractor, and DES symptoms were assessed using a 10‐item questionnaire.ResultsRR supplementation caused a reduction in the variability of accommodation (p = 0.007) and the perceived levels of ‘Blurred vision when looking into the distance at the end of the near task’ (p = 0.009). However, the lag of accommodation (p = 0.15) and the remainder of the DES symptoms were unaffected by the ingestion of RR (p > 0.05 in all cases). The reduction in the variability of accommodation after RR intake was observed at 40 and 20 cm (p‐values <0.001 and 0.04, respectively), but not at far distance (500 cm, p = 0.40).ConclusionsThese findings show that RR supplementation (1200 mg/day for 4 days) produced a reduction in the variability of accommodation and one of the assessed DES symptoms, suggesting that it could be considered as a potential strategy to prevent or manage DES. However, further research is needed to determine its clinical relevance and optimise dosage and timing.