Dr. Tawna Roberts is an Associate Professor at Stanford University’s Byers Eye Institute. She earned her Optometry degree from Pacific University, completed a residency in Pediatrics and Vision Therapy at Southern California College of Optometry, and earned her PhD in Vision Science and Physiological Optics at University of Houston College of Optometry studying oculomotor function in children and young adults. At Stanford, she directs the National Institute of Health (NIH/National Eye Institute (NEI) and Department of Defense funded Vision Development and Oculomotor Lab investigating refractive error development, strabismus, amblyopia, and concussion-related vision disorders. Currently, Dr. Roberts is the Principal Investigator (PI) for the Department of Defense study, Abnormal Dynamic Visual Function and Associated Symptomatology in Mild Traumatic Brain Injury, and the co-PI for the NIH-funded study, ‘Vision Disorders in Adolescents Following Concussion.’ She is also a consultant for the Department of Defense Vision Center of Excellence where she serves as the co-PI for the FOCUS Study (Frequency of Oculomotor Dysfunction in Symptomatic Mild Traumatic Brain Injury). Dr. Roberts is the past co-Vice Chair of the Pediatric Eye Disease Investigator Group, an NEI-funded clinical research network of 400+ pediatric optometrists and ophthalmologists who conduct clinical studies on pediatric eye disease. She also provides direct patient care to children in the pediatric ophthalmology and concussion clinics at Stanford Children’s. She is a fellow of the American Academy of Optometry (AAO), serves as the Co-Chair of the Research Committee, and is Past-Program Chair of the Binocular Vision, Perception, and Pediatric Section. Dr. Roberts received the AAO’s 2021 Irvin and Beatrice Borish Award.

Clinical Focus

  • Optometrist
  • Pediatric Vision
  • Binocular Vision
  • Strabismus
  • Amblyopia
  • Concussion Related Vision Disorders

Academic Appointments

Honors & Awards

  • Irvin M. and Beatrice Borish Award, American Academy of Optometry (2021)
  • Walt and Lilly Disney Awardee for Amblyopia Research, Research to Prevent Blindness (2021)
  • Emerging Vision Scientist, Alliance for Eye and Vision Research (2018)

Professional Education

  • BS, Pacific University, Biology (1999)
  • OD, Pacific University College of Optometry, Optometry (2003)
  • Residency, Southern California College of Optometry, Pediatrics and Vision Therapy (2004)
  • MS, Indiana University, Vision Science (2014)
  • PhD, University of Houston College of Optometry, Vision Science and Physiological Optics (2015)

Current Research and Scholarly Interests

Our research efforts are funded by grants from the National Eye Institute, Department of Defense, and various foundations to study vision development in infants and young children as well as binocular vision disorders in adolescents and adults with concussions. Our focus is to identify underlying mechanisms that will inform clinical treatment approaches and ultimately leading to the prevention of strabismus, amblyopia, and binocular vision disorders.

All Publications

  • Vergence and accommodation deficits in paediatric and adolescent patients during sub-acute and chronic phases of concussion recovery. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Marusic, S., Vyas, N., Chinn, R. N., O'Brien, M. J., Roberts, T. L., Raghuram, A. 2024


    Visual function deficits have been reported in adolescents following concussion. We compared vergence and accommodation deficits in paediatric and adolescent patients at a tertiary medical centre in the sub-acute (15 days to 12 weeks) and chronic (12 weeks to 1 year) phases of concussion recovery.The study included patients aged 7 to <18 years seen between 2014 and 2021, who had a binocular vision (BV) examination conducted within 15 days and 1 year of their concussion injury. Included patients had to have 0.10 logMAR monocular best-corrected vision or better in both eyes and be wearing a habitual refractive correction. BV examinations at near included measurements of near point of convergence, convergence and divergence amplitudes, vergence facility, monocular accommodative amplitude and monocular accommodative facility. Vergence and accommodation deficits were diagnosed using established clinical criteria. Group differences were assessed using nonparametric statistics and ANCOVA modelling.A total of 259 patients were included with 111 in the sub-acute phase and 148 in the chronic phase of concussion recovery. There was no significant difference in the rates of vergence deficits between the two phases of concussion recovery (sub-acute = 48.6%; chronic = 49.3%). There was also no significant difference in the rates of accommodation deficits between the two phases of concussion recovery (sub-acute = 82.0%; chronic = 77.0%).Patients in both the sub-acute and chronic phases of concussion recovery exhibited a high frequency of vergence and accommodation deficits, with no significant differences between groups. Results indicate that patients exhibiting vision deficits in the sub-acute phase may not resolve without intervention, though a prospective, longitudinal study is required to test the hypothesis.

    View details for DOI 10.1111/opo.13346

    View details for PubMedID 38853693

  • Effects of vision therapy on near exodeviation in children with convergence insufficiency treated during the convergence insufficiency treatment trials. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Schulman, E., Scheiman, M., Kulp, M. T., Roberts, T. L., Cotter, S., Sinnott, L. T., Toole, A. 2024


    To report the change in the magnitude of near exodeviation in children with symptomatic convergence insufficiency successfully treated with office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial.A total of 131 children 9-14 years of age with symptomatic convergence insufficiency classified as successfully treated with office-based vergence/accommodative therapy at the 16-week outcome visit were included. Masked examiners measured the near ocular deviation by the prism and alternate cover test at baseline, primary outcome and 1-year post-treatment. The mean change in near deviation was calculated from baseline to primary outcome, from primary outcome to 1-year post-treatment and from baseline to 1-year post-treatment.Of the 131 participants successfully treated with vergence/accommodative therapy, 120 completed the 1-year post-treatment visit. A significant change in near exodeviation was observed at baseline to primary outcome (2.6Δ less exo, p < 0.001, moderate effect size d = 0.61) and at baseline to 1-year post-treatment (2.0Δ less exo; p < 0.001, small effect size d = 0.45). The change from primary outcome to 1-year post-treatment (0.6Δ more exo; p = 0.06, small effect size d = 0.11) was not significant. Forty per cent (48/120) of participants had a decrease in near exodeviation >3.5∆ (expected test/retest variability) between baseline and the primary outcome examination. Of the 120 participants, one (1.0%) was esophoric at the primary outcome and was subsequently exophoric at 1-year post-treatment. Four participants (3.3%) who were orthophoric or exophoric at the primary outcome were esophoric (all ≤3∆) at the 1-year post-treatment visit.On average, the near exodeviation was smaller in size immediately after the discontinuation of vergence/accommodative therapy (2.6∆, moderate effect size) and 1 year post vergence/accommodative therapy (2.0∆, small effect size) in children with convergence insufficiency who were successfully treated; 40% had a clinically meaningful decrease in exophoria. The development of near esophoria was rare.

    View details for DOI 10.1111/opo.13316

    View details for PubMedID 38619213

  • <i>Fcirc</i> statistic for steady-state evoked potentials; a generalized version of<i> T2circ</i> statistic BIOMEDICAL SIGNAL PROCESSING AND CONTROL Norouzpour, A., Roberts, T. L. 2024; 87
  • Ocular motor disorders in children and adults with mTBI: a scoping review protocol. BMJ open Theis, J., Chen, A. M., Burgher, A. P., Greenspan, L. D., Morgenstern, A., Salzano, A. D., Yap, T. P., Scheiman, M., Roberts, T. L. 2023; 13 (10): e073656


    Ocular motor function is susceptible to neurological injury because it requires a large portion of brain circuitry including every lobe of the brain, brainstem, thalamus, basal ganglia, cerebellum, cranial nerves and visual tracts. While reports of a high frequency of ocular motor dysfunctions after mild traumatic brain injury (mTBI) span multidisciplinary journals, there is no scoping review of the signs, diagnostic assessments and criteria, and appropriate management of ocular motor disorders post-mTBI. Post-mTBI ocular motor dysfunction has been reported to respond to active treatment. The objective of this scoping review is to map the available evidence on the diagnostic assessment and treatment modalities currently used in the management of mTBI-related ocular motor disorders in children and adults. This scoping review also aims to identify gaps in the current literature and provide suggestions for future research.This review will include populations with reported concussion and/or mTBI without restrictions on age, race, sex or time since injury. The review will evaluate the reported symptoms related to ocular motor dysfunction, types of assessments and diagnostic criteria used, reported treatments, and the level of evidence supporting the reported treatments. This review will exclude literature on brain injury of non-traumatic aetiology and moderate/severe traumatic brain injury. Ocular motor dysfunction after mTBI appears in journals across multiple disciplines. Thus, multiple databases will be evaluated including Pubmed, Embase, PEDro, OVID, Clinical Key, Google Scholar and REHABDATA. Literature will be searched from inception to present day. Evidence sources will include experimental study designs including randomised controlled trials, non-randomised controlled trials and interrupted time-series. Additionally, analytical observational studies including prospective and retrospective cohort studies, case series, cross-sectional studies and clinical practice guidelines will be considered for inclusion. Data will be extracted on clinical presentation, frequency, assessment, diagnostic criteria management strategies and outcomes of concussion and mTBI-related ocular motor disorders.This scoping review will use data from existing publications and does not require ethical approval by an institutional review board. Results will be disseminated through publication in a peer-reviewed scientific journal and presented at relevant conferences and as part of future workshops with professionals involved with diagnosis and management of patients with mTBI.

    View details for DOI 10.1136/bmjopen-2023-073656

    View details for PubMedID 37857540

  • Low-Dose 0.01% Atropine Eye Drops vs Placebo for Myopia Control: A Randomized Clinical Trial. JAMA ophthalmology Repka, M. X., Weise, K. K., Chandler, D. L., Wu, R., Melia, B. M., Manny, R. E., Kehler, L. A., Jordan, C. O., Raghuram, A., Summers, A. I., Lee, K. A., Petersen, D. B., Erzurum, S. A., Pang, Y., Lenhart, P. D., Ticho, B. H., Beck, R. W., Kraker, R. T., Holmes, J. M., Cotter, S. A., Pediatric Eye Disease Investigator Group, Alexopoulous, D. D., Allen, M., Anderson, H. A., Austin, D. S., Black, S. C., Boyle, N. M., Casey, G. A., Chandler, M. A., Chinn, R., Clausius, D. A., Colon, B. J., Conner, C. L., Curtis, L. T., Dinani, Z., Donahue, Q., Dubois, M., Evans, P. L., Fimbel, B. P., Fowler, M. K., Golden, R. P., Harper, B. G., Henderson, R. J., Ho, D., Hoepner, J. E., Hopkins, K. B., Jenks, A. S., Kaplon, J. D., Khan, S., Koutnik, C. A., Kuo, A. F., Lee, J., Martinez, M. M., Marusic, S. M., McGregor, M. L., McMurtrey, J. R., Miller, K. B., Mokka, P. L., Montejo, J., Morrell, B. A., Nylin, E., Odom, K. C., Ortiz, G., Parra, S. A., Perkins, K. J., Plum, L. W., Redenbo, E. F., Robinson, J. L., Stutz, K. M., Sutherland, D. R., Teodorescu, M. X., Torgensen, L. L., Toro, D. O., Turner, P. B., Weil, N. C., Wiecek, E. K., Wilkins, C. S., Woodard, V. C., Woodruff, K. M., Yin, H., Yumang, M. L., Yamada, T., Ekdawi, N. S., Leske, D. A., Wallace, D. K., Christian, M. L., Glaser, S. R., Birch, E. E., Chen, A. M., Christiansen, S. P., Enyedi, L. B., Everett, D. F., Freedman, S. F., Good, W. V., Jenewein, E. C., London, R., Manh, V. M., Morrison, D. G., Pineles, S. L., Ralay Ranaivo, H., Roberts, T. L., Ruark, S. T., Schweinler, B. R., Silver, J. L., Suh, D. W., Verderber, L. C., Diener-West, M., Baker, J. D., Davis, B., Higgins, R. D., Poff, S. W., Saunders, R. A., Tychsen, L. 2023


    Importance: Controlling myopia progression is of interest worldwide. Low-dose atropine eye drops have slowed progression in children in East Asia.Objective: To compare atropine, 0.01%, eye drops with placebo for slowing myopia progression in US children.Design, Setting, and Participants: This was a randomized placebo-controlled, double-masked, clinical trial conducted from June 2018 to September 2022. Children aged 5 to 12 years were recruited from 12 community- and institution-based practices in the US. Participating children had low to moderate bilateral myopia (-1.00 diopters [D] to -6.00 D spherical equivalent refractive error [SER]).Intervention: Eligible children were randomly assigned 2:1 to 1 eye drop of atropine, 0.01%, nightly or 1 drop of placebo. Treatment was for 24 months followed by 6 months of observation.Main Outcome Measures: Automated cycloplegic refraction was performed by masked examiners. The primary outcome was change in SER (mean of both eyes) from baseline to 24 months (receiving treatment); other outcomes included change in SER from baseline to 30 months (not receiving treatment) and change in axial length at both time points. Differences were calculated as atropine minus placebo.Results: A total of 187 children (mean [SD] age, 10.1 [1.8] years; age range, 5.1-12.9 years; 101 female [54%]; 34 Black [18%], 20 East Asian [11%], 30 Hispanic or Latino [16%], 11 multiracial [6%], 6 West/South Asian [3%], 86 White [46%]) were included in the study. A total of 125 children (67%) received atropine, 0.01%, and 62 children (33%) received placebo. Follow-up was completed at 24 months by 119 of 125 children (95%) in the atropine group and 58 of 62 children (94%) in the placebo group. At 30 months, follow-up was completed by 118 of 125 children (94%) in the atropine group and 57 of 62 children (92%) in the placebo group. At the 24-month primary outcome visit, the adjusted mean (95% CI) change in SER from baseline was -0.82 (-0.96 to -0.68) D and -0.80 (-0.98 to -0.62) D in the atropine and placebo groups, respectively (adjusted difference=-0.02 D; 95% CI, -0.19 to +0.15 D; P=.83). At 30 months (6 months not receiving treatment), the adjusted difference in mean SER change from baseline was -0.04 D (95% CI, -0.25 to +0.17 D). Adjusted mean (95% CI) changes in axial length from baseline to 24 months were 0.44 (0.39-0.50) mm and 0.45 (0.37-0.52) mm in the atropine and placebo groups, respectively (adjusted difference = -0.002 mm; 95% CI, -0.106 to 0.102 mm). Adjusted difference in mean axial elongation from baseline to 30 months was +0.009 mm (95% CI, -0.115 to 0.134 mm).Conclusions and Relevance: In this randomized clinical trial of school-aged children in the US with low to moderate myopia, atropine, 0.01%, eye drops administered nightly when compared with placebo did not slow myopia progression or axial elongation. These results do not support use of atropine, 0.01%, eye drops to slow myopia progression or axial elongation in US children.Trial Registration: Identifier: NCT03334253.

    View details for DOI 10.1001/jamaophthalmol.2023.2855

    View details for PubMedID 37440213

  • Prescribing patterns for paediatric hyperopia among paediatric eye care providers. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Morrison, A. M., Kulp, M. T., Ciner, E. B., Mitchell, G. L., McDaniel, C. E., Hertle, R. W., Candy, T. R., Roberts, T. L., Peterseim, M. M., Granet, D. B., Robbins, S. L., Srinivasan, G., Allison, C. L., Ying, G. S., Orel-Bixler, D., Block, S. S., Moore, B. R. 2023


    To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia.Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test.Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years.Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

    View details for DOI 10.1111/opo.13184

    View details for PubMedID 37334937

  • Effect of Co-existing Clinical Signs on Prescribing Patterns for Pediatric Hyperopia Morrison, A., Kulp, M. T., Ciner, E. B., McDaniel, C., Mitchell, G., Allison, C. L., Block, S. S., Granet, D., Hertle, R. W., Moore, B., Orel-Bixler, D., Roberts, T. L., Robbins, S. L., Peterseim, M., Srinivasan, G., Ying, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Accommodative Response in Astigmatic Children Aged 3 to <10 Years Haensel, J. X., Chen, A., Cotter, S. A., Lorenzana, I., Han, S., Lytle, A. A., Raghuram, A., Huang, K., Manh, V., Patel, R., Retnasothie, D., Jordan, L., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Comparison of Push-Up versus Push-Out Accommodative Amplitude Measurement Methods in a Pediatric Population Marusic, S., Oke, I., Vyas, N., Haensel, J., Slinger, K., Jenewein, E., Meiyeppen, S., Scheiman, M., Roberts, T., Raghuram, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Stability of Astigmatism following Lensectomy for Pediatric Cataract Bothun, E., Repka, M., Freedman, S., Sutherland, D., Hatt, S., Leske, D., Kraker, R., Melia, B., Roberts, T., Holmes, J., Cotter, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • A complementary note for the analytical method to estimate individual attention fluctuation using steady-state evoked potentials Biomedical Signal Processing and Control Norouzpour, A., Roberts, T. L., Klein, S. A. 2023
  • Strabismus and Nystagmus in Patients with Pediatric Cataracts: Study using Insurance Claims Data. American journal of ophthalmology Kim, S. J., Slinger, K., Lambert, S. R., Koo, E., Shue, A., Roberts, T. L. 2022


    To describe the characteristics and prevalence of strabismus and nystagmus in children diagnosed with cataracts using a national insurance claims database.Population-based retrospective cohort study METHODS: Patients <13 years diagnosed with cataracts (traumatic cataracts excluded) and enrolled continuously in their healthcare program for ≥5 years after their first cataract diagnosis were identified in a retrospective review of 66 million charts in Optum's de-identified Clinformatics Data Mart Database between 2003 and 2015. Patients were categorized based on age of their first diagnosed cataract, and if cataract surgery was performed. Clinical and demographic factors associated with the occurrence of strabismus and nystagmus were evaluated.Of 1,636 children diagnosed with cataract, 434 (26.5%) and 109 (6.7%) were diagnosed with strabismus and nystagmus, respectively. Both strabismus and nystagmus were more common in those who underwent cataract surgery (P <0.001) and in patients diagnosed with cataract ≤ 12 months of age (P <0.001). Survival analysis demonstrated that strabismus and nystagmus may be diagnosed 8 years following the initial cataract diagnosis. Cox proportional hazard regression analyses revealed strabismus was associated with cataract surgery, nystagmus, and the diagnosis with cataract ≤ 12 months and cataract surgery > 12 months.As strabismus and nystagmus occur more frequently in children diagnosed with cataracts necessitating cataract surgery, regular long-term follow-up is crucial for these children to monitor for the development of strabismus and nystagmus.

    View details for DOI 10.1016/j.ajo.2022.11.014

    View details for PubMedID 36410473

  • Vergence/accommodative therapy for symptomatic convergence insufficiency in children: Time course of improvements in convergence function. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Jenewein, E. C., Cotter, S., Roberts, T., Kulp, M., Mitchell, G. L., Jones-Jordan, L. A., Chen, A. M., Hopkins, K., Huang, K., Amster, D., Fecho, G., Tyler, J., Meiyeppen, S., Scheiman, M., Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART) Investigator Group, Cooper, J., Schulman, E., Hamian, K., Iacono, D., Larson, S., Leung, V., Meeder, S., Ramos, E., Ritter, S., Steiner, A., Stormann, A., Vricella, M., Zhu, X., Tamkins, S., Aguilera, N., Brafman, E., Capo, H., Cavuoto, K., Crespo, I., Dowling, M., Draskovic, K., Farag, M., Fischer, V., Grace, S., Gutierrez, A., Manchola-Orozco, C., Martinez, M., McKeown, C., Osigian, C., Pham, T., Small, L., Townsend, N., Gallaway, M., Boas, M., Calvert, C., Franz, T., Gerrouge, A., Hayden, D., Margolies, Z., Myung, J., Pollack, K., Shoge, R., Tang, A., Tannen, N., Trieu, L., Trujillo, L., Buckland, M., Ellis, A., Fogt, J., McDaniel, C., McGann, T., Morrison, A., Mulvihill, S., Peiffer, A., Plaumann, M., Pierce, G., Preston, J., Reuter, K., Stevens, N., Teeny, J., Toole, A., Widmer, D., Zimmerman, A., Barnhardt, C., Borsting, E., Chu, R., Parker, S., Retnasothie, D., Wu, J., Hertle, R., Clark, P., Culp, K., Fraley, K., Grant, D., Hanna, N., Knox, S., Lawhon, W., Li, L., Mitcheff, S., Ricker, I., Solis, C., Wall, P., Zaczyk, S., Marsh-Tootle, W., Bowen, M., Call, T., Domnanovich, K., Frazier, M., Guyette, N., Hayes, O., Houser, J., Lee, S., Montejo, J., Oechslin, T., Turner, C., Weise, K., Coulter, R., Bade, A., Bansal, S., Falco, L., Green, K., Irizarry, G., Jhajj, J., Patterson, N., Rodena, J., Tea, Y., Weiss, D., Zakaib, L., Lorenzana, I., Meza, Y., Mann, R., Quezada, M., Rein, S., Rudaitis, I., Stepleton, S., Wajs, B., Redford, M., Hertle, R., Redford, M., Denton, C., Arnold, E., Borsting, E., Chase, C., Denton, C., Wee, S., Dahl-Leonard, K., Powers, K., Alaniz, A., Diener-West, M., Good, W. V., Grisham, D., Kratochvil, C. J., Revicki, D., Wanzek, J., Pollack, K., Abraham, M., Dangelo, J., Hegedus, J., Jones, I., Junglas, A., Lee, J., Nettles, J., Mitchell, C., Osman, M., Scott-Tibbs, G., Sinnott, L., Teasley, C., Vang, V., Varghese, R. 2022


    PURPOSE: To evaluate the time course of improvements in clinical convergence measures for children with symptomatic convergence insufficiency treated with office-based vergence/accommodative therapy.METHODS: We evaluated convergence measures from 205, 9- to 14-year-old children with symptomatic convergence insufficiency randomised to office-based vergence/accommodative therapy in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial (CITT-ART). Near-point of convergence (NPC) and near-positive fusional vergence (PFV) were measured at baseline and after 4, 8, 12 and 16weeks of therapy; mean change in NPC and PFV between these time points were compared using repeated measures analysis of variance. Rates of change in NPC and PFV from: (1) baseline to 4weeks and (2) 4-16weeks were calculated. For each time point, the proportion of participants to first meet the normal criterion for NPC (<6cm), PFV blur (break if no blur; >15Delta and >2 times the exodeviation) and convergence composite (NPC and PFV both normal) were calculated.RESULTS: The greatest change in NPC and PFV (7.6cm and 12.7 Delta) and the fastest rate of improvement in NPC and PFV (1.9cm/week and 3.2 Delta/week, respectively) were both found during the first 4weeks of therapy, with both slowing over the subsequent 12weeks. After 12weeks of therapy, the NPC, PFV and convergence composite were normal in 93.2%, 91.7% and 87.8% of participants, respectively, and normalised with another 4weeks of therapy in 4.4%, 2.0% and 4.4% of participants, respectively.CONCLUSION: Although the greatest improvements in NPC and PFV occurred in the first 4weeks of therapy, most participants had weekly improvements over the subsequent 12weeks of treatment. While most children with convergence insufficiency obtained normal convergence following 12weeks of therapy, an additional 4weeks of vergence/accommodative therapy may be beneficial for some participants.

    View details for DOI 10.1111/opo.13062

    View details for PubMedID 36271753

  • Validation of the PowerRef 3 for Measuring Accommodation: Comparison With the Grand Seiko WAM-5500A Autorefractor. Translational vision science & technology Gehring, A. M., Haensel, J. X., Curtiss, M. K., Roberts, T. L. 2022; 11 (10): 25


    This validation study examines the PowerRef 3 as a method for measuring accommodation objectively. We assess agreement with refractive measurements obtained simultaneously by the Grand Seiko WAM-5500A autorefractor.Refractive measurements were recorded simultaneously using the PowerRef 3 and WAM-5500A in 32 noncyclopleged participants aged 15 to 46 years. Accommodative states were recorded for 10 seconds at six accommodative demands (5 diopters [D], 4 D, 3 D, 2.5 D, 2 D, and 0 D) while participants fixated a high-contrast Maltese cross. WAM-5500A measurements were converted to power in the vertical meridian for comparison with PowerRef 3 data. Dioptric difference values were computed, and agreement was assessed using Bland-Altman plots with 95% limits of agreement (LOA) and intraclass correlation coefficient analyses.The mean absolute dioptric differences measured 0.14 D or less across accommodative demands. Analyses showed an excellent intraclass correlation coefficient across the tested demands (0.93). Bland-Altman plots indicated a bias of -0.02 D with 95% LOA of -1.03 D to 0.99 D. The 95% LOA was smallest for the 3 D demand (-0.71 D to 0.64 D), and largest at 5 D demand (-1.51 D to 1.30 D).The mean dioptric differences between the PowerRef 3 and WAM-5500A autorefractor were small and not clinically significant. While some variability in agreement was observed depending on the tested demand, the PowerRef 3 demonstrated good agreement with the WAM-5500A.The PowerRef 3 may be used to obtain objective measures of accommodation both monocularly and binocularly and provides a more flexible method, especially in pediatric populations.

    View details for DOI 10.1167/tvst.11.10.25

    View details for PubMedID 36255360

  • Low- and Very Low-Dose Bevacizumab for Retinopathy of Prematurity Reactivations, Additional Treatments, and 12-Month Outcomes OPHTHALMOLOGY Freedman, S. F., Hercinovic, A., Wallace, D. K., Kraker, R. T., Li, Z., Bhatt, A. R., Boente, C. S., Crouch, E. R., Hubbard, G., Rogers, D. L., VanderVeen, D., Yang, M. B., Cheung, N. L., Cotter, S. A., Holmes, J. M., Pediat Eye Dis Investigator Grp 2022; 129 (10): 1120-1128


    Low-dose and very low-dose intravitreal bevacizumab (IVB) have been reported to be successful in short-term treatment of type 1 retinopathy of prematurity (ROP), down to an initial dose of 0.004 mg. We now report 12-month outcomes for these infants.Masked, multicenter, dose de-escalation study.One hundred twenty prematurely born infants with type 1 ROP.A cohort of 120 infants with type 1 ROP in at least 1 eye from 2 sequential dose de-escalation studies of low-dose IVB (0.25 mg, 0.125 mg, 0.063 mg, and 0.031 mg) or very low-dose IVB (0.016 mg, 0.008 mg, 0.004 mg, and 0.002 mg) to the study eye; the fellow eye (if also type 1) received 1 dose level higher of IVB. After primary success or failure at 4 weeks, clinical management was at investigator discretion, including all additional treatment.Reactivation of severe ROP by 6 months corrected age, additional treatments, retinal and other ocular structural outcomes, and refractive error at 12 months corrected age.Sixty-two of 113 study eyes (55%) and 55 of 98 fellow eyes (56%) received additional treatment. Of the study eyes, 31 (27%) received additional ROP treatment, and 31 (27%) received prophylactic laser therapy for persistent avascular retina. No trend toward a higher risk of additional ROP treatment related to initial IVB doses was found. However, time to reactivation among study eyes was shorter in eyes that received very low-dose IVB (mean, 76.4 days) than in those that received low-dose IVB (mean, 85.7 days). At 12 months, poor retinal outcomes and anterior segment abnormalities both were uncommon (3% and 5%, respectively), optic atrophy was noted in 10%, median refraction was mildly myopic (-0.31 diopter), and strabismus was present in 29% of infants.Retinal structural outcomes were very good after low- and very low-dose IVB as initial treatment for type 1 ROP, although many eyes received additional treatment. The rate of reactivation of severe ROP was not associated with dose; however, a post hoc data-driven analysis suggested that reactivation was sooner with very low doses.

    View details for DOI 10.1016/j.ophtha.2022.05.019

    View details for Web of Science ID 000877338600020

    View details for PubMedID 35660415

    View details for PubMedCentralID PMC9509410

  • Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review. Brain injury Xiang, L., Bansal, S., Wu, A. Y., Roberts, T. L. 2022: 1-10


    To review the pathway to care for treatment and management of patients receiving visual and vestibular rehabilitation after mild traumatic brain injury (mTBI).English scientific peer-reviewed articles from PubMed, CINAHL, Embase, and PsycINFO between 2000 and 2020 were first screened by title and abstract, then those selected underwent full-text review and analysis.The database search yielded 1640 results and after title and abstract review, 75 articles were selected for full-text screening, from which 8 were included in the qualitative synthesis. Current evidence includes a limited number of retrospective cohort studies and case studies.Many patients with visual and vestibular deficits following mTBI do not receive rehabilitation services until months following their injury as there is no standardized pathway to care for patients for visual and vestibular rehabilitation. Barriers to establishing a standardized pathway are the lack of natural history data for visual and vestibular function following mTBI and the lack of randomized clinical trials establishing the efficacy of rehabilitation in patients following mTBI.

    View details for DOI 10.1080/02699052.2022.2105399

    View details for PubMedID 35918848

  • Associations Between Distance Visual Acuity and Cycloplegic Refractive Error in Children Aged 5 to 9 Years Haensel, J. X., Jordan, L., Chen, A., Cotter, S. A., Lorenzana, I., Han, S., Aldrich, A. E., Raghuram, A., Huang, K., Manh, V., Patel, R., Retnasothie, D. V., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Associations Between Stereoacuity and Vision Characteristics in Children with Uncorrected Refractive Error Han, S., Chen, A., Cotter, S. A., Jordan, L., Lorenzana, I., Aldrich, A. E., Raghuram, A., Huang, K., Manh, V., Patel, R., Retnasothie, D. V., Roberts, T. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Repeatability of the Accommodative Response Measured by the Grand Seiko Autorefractor in Children with and without Amblyopia and Adults. American journal of ophthalmology Chinn, R. N., Raghuram, A., Curtiss, M., Gehring, A., De Paula, A. J., Roberts, T. L. 2021


    PURPOSE: To assess test-retest repeatability of the accommodative response (AR) in children with and without amblyopia and adults using the Grand Seiko autorefractor.DESIGN: Prospective Reliability Assessment METHODS: Test-retest of accommodation was obtained while participants viewed 20/150 sized letters at 33 cm using the Grand Seiko autorefractor of children 5 to < 11 years with amblyopia (n=24) and without amblyopia (n=36), and adults 18 to < 35 years (n=34). Bland-Altman 95% limits of agreement (LOA) and intraclass correlation coefficients (ICC) were used to assess repeatability and reliability. The AR between the fellow and amblyopic eyes of children with amblyopia and Eye 1 and Eye 2 of the visually normal participants was assessed using group comparisons.RESULTS: The 95% LOA of the AR was greatest in the amblyopic eyes (-1.25 D, 1.62 D) of children with amblyopia. The 95% LOA were similar between the fellow eyes (-0.88 D, 0.74 D) of children with amblyopia and both eyes of the children without amblyopia (Eye 1: -0.68 D, 0.71 D; Eye 2: -0.59 D, 0.70 D) and the adults (Eye 1: 95% LOA = -0.49 D to 0.45 D; Eye 2: LOA = -0.66 D to 0.67 D). ICC revealed the Grand Seiko autorefractor as a reliable instrument for measuring AR.CONCLUSIONS: The Grand Seiko autorefractor was more repeatable and reliable when measuring the AR in children and adults without amblyopia than in the amblyopic eye in children with amblyopia. It is recommended that multiple measures of the AR is obtained in amblyopic eyes to improve the precision of measures.

    View details for DOI 10.1016/j.ajo.2021.10.019

    View details for PubMedID 34699740

  • Endophthalmitis after pediatric cataract surgery in the United States: report using an insurance claims database. Journal of cataract and refractive surgery Nguyen, A. M., Roberts, T. L., Ryu, W. Y., Lambert, S. R. 2021; 47 (9): 1161-1166


    PURPOSE: To describe the characteristics and incidence of children developing endophthalmitis within the first 90 days following pediatric cataract surgery.SETTING: Deidentified commercial and Medicare Advantage health claims across the United States.DESIGN: Population-based retrospective cohort study.METHODS: In a retrospective review of approximately 58 million charts in Optum's deidentified Clinformatics Data Mart Database, patients aged <13 years who underwent cataract surgery in one or both eyes with or without primary intraocular lens (IOL) implantation between 2003 and 2017 were identified. Excluded were patients with traumatic cataract, <90 days of continuous insurance coverage, a prior diagnosis of endophthalmitis, and a diagnosis of endophthalmitis occurring after 90 days of cataract surgery. The main outcome measure was the incidence of endophthalmitis occurring within the first 90 days of cataract surgery and the odds ratio for developing endophthalmitis according to demographic and intraoperative factors.RESULTS: Cataract surgery was performed on 789 eyes (52.6% male), with a median age of 4 (interquartile range 1-8) years. The rate of IOL implantation at the time of cataract surgery was 66.8%. Endophthalmitis was diagnosed in 4 of 789 eyes (0.51%). The median time to diagnosis of endophthalmitis was 6.5 days (range: 5-44 days). There was no significant association between endophthalmitis and age, sex, or primary IOL implantation.CONCLUSIONS: In this large insurance claims database, the incidence of endophthalmitis following pediatric cataract surgery reported was more than the rate previously reported by any study with patients of a similar age.

    View details for DOI 10.1097/j.jcrs.0000000000000602

    View details for PubMedID 34468453

  • Vergence and accommodation deficits subacutely and chronically in concussion recovery Raghuram, A., Chinn, R., Wiecek, E. K., Marshall, C., Roberts, T. L., Stevens, R., Hawash, K. K., O'Brien, M., Shah, A. S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Vergence and accommodation deficits subacutely and chronically in concussion recovery Raghuram, A., Chinn, R., Wiecek, E. K., Marshall, C., Roberts, T. L., Stevens, R., Hawash, K. K., O'Brien, M., Shah, A. S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Prescribing Patterns for Hyperopia Kulp, M., Ciner, E., Mitchell, G., Ying, G., Peterseim, M., Alex, A., Allison, C., Block, S., Candy, T., Granet, D., Hertle, R., Moore, B., Orel-Bixler, D., Roberts, T., Robbins, S., Srinivasan, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Diagnosis of vergence and accommodation deficits in children and adolescent with concussion using established clinical criteria versus normative data Chinn, R., Marshall, C., Wiecek, E. K., Roberts, T. L., O'Brien, M., Hawash, K. K., Stevens, R., Shah, A. S., Raghuram, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Vergence, accommodation, and visual tracking in children and adolescents evaluated in a multidisciplinary concussion clinic. Vision research Wiecek, E. K., Roberts, T. L., Shah, A. S., Raghuram, A. 2021; 184: 30–36


    Many patients with concussion experience visual symptoms following injury that lead to a diagnosis of convergence insufficiency, accommodative insufficiency, or saccadic dysfunction. However, these diagnostic categories are based on aggregates of clinical tests developed from a non-concussed population and therefore may not accurately describe visual deficits in the concussed population. Thus, we sought to understand individual metrics of visual dysfunction in chronically symptomatic post-concussion patients. This retrospective cross-sectional study included patients examined at the multidisciplinary concussion clinic (MDCC) at Boston Children's Hospital over four years. Patients aged 5-21years who had a complete assessment of eye alignment, vergence, accommodation, and visual tracking, and had visual acuity better than or equal to 20/30 in each eye were included. Patients with history of amblyopia, strabismus, or ocular pathology were excluded. Chart review yielded 116 patients who met inclusion criteria (median age 15years, 64% female). The majority of patients (52%) experienced a single concussion and most were sports-related (50%). Clinical data show vergence, accommodation, or visual tracking deficits in 95% of patients. A receded near point of convergence (NPC, 70/116) and reduced accommodative amplitude (63/116) were the most common deficits. Both NPC and accommodative amplitude were significantly correlated with one another (r=-0.5) and with measures of visual tracking (r=-0.34). Patients with chronic post-concussion symptoms show deficits in individual metrics of vergence, accommodation and visual tracking. The high incidence of these deficits, specifically NPC and accommodative amplitude, highlights the need for a detailed sensorimotor evaluation to guide personalized treatment following concussion.

    View details for DOI 10.1016/j.visres.2021.03.002

    View details for PubMedID 33838503

  • Association between post-concussion symptoms and oculomotor deficits among adolescents. Brain injury Gowrisankaran, S., Shah, A. S., Roberts, T. L., Wiecek, E., Chinn, R. N., Hawash, K. K., O'Brien, M. J., Howell, D. R., Meehan, W. P., Raghuram, A. 2021: 1-11


    To examine the association between Post-Concussion Symptom Scale (PCSS) scores, Convergence Insufficiency Symptom Survey (CISS) scores, and oculomotor deficits post-concussion.Records of adolescent patients examined in a multidisciplinary concussion clinic between July 2014 and May 2019 were reviewed. PCSS and CISS scores, results of eye examination and oculomotor assessment, concussion history, and demographics were abstracted.One hundred and forty patient records (median age, 15.3 years; 52 males, presented 109 days (median) from their most recent concussion) met inclusion criteria. Mean total scores on PCSS and CISS were 46.67 ± 25.89 and 27.13 ± 13.22, respectively, and were moderately correlated with each other (r = 0.53, p < .001). Oculomotor deficits were observed in 123 (88%) patients. Step-wise linear regression identified increased PCSS total score to be significantly associated with decreased amplitude of accommodation (p < .001). Increased CISS total score was significantly associated with receded near point of convergence, developmental eye movement test error scores, and cause of concussion.High PCSS scores may indicate an accommodation deficit and thus prompt an oculomotor assessment in patients following a concussion. Using the CISS and a detailed oculomotor assessment may reveal underlying oculomotor deficits, which may benefit from treatment.

    View details for DOI 10.1080/02699052.2021.1959065

    View details for PubMedID 34383619

  • yy Repeatability of Accommodation in Children with and without Amblyopia using the Grand Seiko Autorefractor Roberts, T. L., Chinn, R., Curtiss, M., Gehring, A., De Paula, A., Raghuram, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Effectiveness of vergence/accommodative therapy for accommodative dysfunction in children with convergence insufficiency. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) Chen, A. M., Roberts, T. L., Cotter, S. A., Kulp, M. T., Sinnott, L. T., Borsting, E. J., Tea, Y. C., Jones-Jordan, L. A., Hertle, R. n., Mitchell, G. L., Eugene Arnold, L. n., Chase, C. n., Scheiman, M. M. 2020


    To determine the effectiveness of office-based vergence/accommodative therapy for improving accommodative amplitude and accommodative facility in children with symptomatic convergence insufficiency and accommodative dysfunction.We report changes in accommodative function following therapy among participants in the Convergence Insufficiency Treatment Trial - Attention and Reading Trial with decreased accommodative amplitude (115 participants in vergence/accommodative therapy; 65 in placebo therapy) or decreased accommodative facility (71 participants in vergence/accommodative therapy; 37 in placebo therapy) at baseline. The primary analysis compared mean change in amplitude and facility between the vergence/accommodative and placebo therapy groups using analyses of variance models after 4, 8, 12 and 16 weeks of treatment. The proportions of participants with normal amplitude and facility at each time point were calculated. The average rate of change in amplitude and facility from baseline to week 4, and from weeks 4 to 16, were determined in the vergence/accommodative therapy group.From baseline to 16 weeks, the mean improvement in amplitude was 8.6 dioptres (D) and 5.2 D in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 3.5 D, 95% confidence interval (CI): 1.5 to 5.5 D; p = 0.01). The mean improvement in facility was 13.5 cycles per minute (cpm) and 7.6 cpm in the vergence/accommodative and placebo therapy groups, respectively (mean difference = 5.8 cpm, 95% CI: 3.8 to 7.9 cpm; p < 0.0001). Significantly greater proportions of participants treated with vergence/accommodative therapy achieved a normal amplitude (69% vs. 32%, difference = 37%, 95% CI: 22 to 51%; p < 0.0001) and facility (85% vs. 49%, difference = 36%, 95% CI: 18 to 55%; p < 0.0001) than those who received placebo therapy. In the vergence/accommodative therapy group, amplitude increased at an average rate of 1.5 D per week during the first 4 weeks (p < 0.0001), then slowed to 0.2 D per week (p = 0.002) from weeks 4 to 16. Similarly, facility increased at an average rate of 1.5 cpm per week during the first 4 weeks (p < 0.0001), then slowed to 0.6 cpm per week from weeks 4 to 16 (p < 0.0001).Office-based vergence/accommodative therapy is effective for improving accommodative function in children with symptomatic convergence insufficiency and coexisting accommodative dysfunction.

    View details for DOI 10.1111/opo.12747

    View details for PubMedID 33119180

  • Impact of Visual Cues on the Magnitude and Variability of the Accommodative Response in Children With Emmetropia and Uncorrected Hyperopia and Adults. Investigative ophthalmology & visual science Roberts, T. L., Manny, R. E., Anderson, H. A. 2019; 60 (5): 1527–37


    We investigated the effect of blur and disparity cues on accommodative accuracy (lag) and variability (time [RMS] and frequency domain [LFC]) in the developing visual system.A total of 59 children (3-9 years, spherical equivalent refractive error [RE] = -0.3- +4.91 diopters [D]) and 10 adults (23-31 years, RE = -0.37-+1.15D) participated. Accommodation was measured in the right eye for 1 minute at 100 and 33 cm using photorefraction (25 Hz) for three conditions: blur + disparity (binocular, 20/50 optotypes), blur-only (monocular, 20/50 optotypes), disparity-only (binocular, difference-of-Gaussian stimulus). The effect blur and disparity cues have on accommodative accuracy, RMS, and LFC was assessed.Lag, RMS, and LFC increased (P < 0.001) from 100 to 33 cm for each condition in children and adults. In children, accommodation was most accurate and stable when blur and disparity cues remained in the stimulus and became significantly less accurate and more variable (P < 0.001) when blur or disparity cues were removed at 33 cm. In adults, accommodation was significantly less accurate and more variable only when blur was removed from the stimulus (P < 0.022). Children with RE matched to adults had less accurate and more variable accommodative responses at near than adults when cues were removed (P ≤ 0.02).In children and adults, an increase in RMS and LFC is related to an increase in accommodative lag. Children's accommodative systems do not compensate as efficiently as adults when blur and disparity cues are removed, suggesting children <10 years old do not have a mature afferent visual pathway.

    View details for PubMedID 30994863

  • A Randomized Clinical Trial of Immediate versus Delayed Glasses for Moderate Hyperopia in 1- and 2-Year-Olds. Ophthalmology Kulp, M. T., Holmes, J. M., Dean, T. W., Suh, D. W., Kraker, R. T., Wallace, D. K., Petersen, D. B., Cotter, S. A., Manny, R. E., Superstein, R. n., Roberts, T. L., Avallone, J. M., Fishman, D. R., Erzurum, S. A., Leske, D. A., Christoff, A. n. 2019


    Two strategies were compared for managing moderate hyperopia without manifest strabismus among 1- and 2-year-old children: (1) immediate prescription of glasses versus (2) observation without glasses unless reduced distance visual acuity (VA), reduced stereoacuity, or manifest strabismus.Prospective randomized clinical trial.A total of 130 children aged 1 to 2 years with hyperopia between +3.00 diopters (D) and +6.00 D spherical equivalent (SE) in at least 1 eye, anisometropia ≤1.50 D SE, and astigmatism ≤1.50 D based on cycloplegic refraction and no manifest strabismus.Participants were randomly assigned to glasses (1.00 D less than full cycloplegic hyperopia) versus observation and followed every 6 months for 3 years. Glasses were prescribed to those assigned to observation if they met prespecified deterioration criteria of distance VA or near stereoacuity below age norms, or development of manifest strabismus.At the 3-year primary outcome examination, participants were classified as failing the randomized management regimen if distance VA or stereoacuity was below age norms or manifest strabismus was observed (each with and without correction in trial frames, confirmed by masked retest, irrespective of whether deterioration had occurred previously), or if strabismus surgery had been performed.Of the 106 participants (82%) completing the 3-year primary outcome examination, failure occurred in 11 (21%) of 53 in the glasses group and 18 (34%) of 53 in the observation group (difference = -13%; 95% confidence interval [CI], -31 to 4; P = 0.14). Sixty-two percent (95% CI, 49-74) in the observation group and 34% (95% CI, 23-48) in the glasses group met deterioration criteria (requiring glasses if not wearing).For 1- and 2-year-olds with uncorrected moderate hyperopia (+3.00 D to +6.00 D SE), our estimates of failure, after 3 years of 6-month follow-ups, are inconclusive and consistent with a small to moderate benefit or no benefit of immediate prescription of glasses compared with careful observation (with glasses only if deteriorated).

    View details for PubMedID 30615896

  • The Impact of Visual Cues on Accommodative Variability in Children with Emmetropia and Uncorrected Hyperopia Roberts, T. L., Manny, R. E., Anderson, H. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Reliabilityand Validity of Gaze-Dependent Functional Vision Space: A Novel Metric Quantifying Visual Function in Infantile Nystagmus Syndrome INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Roberts, T. L., Kester, K. N., Hertle, R. W. 2018; 59 (5): 1760–68


    This study presents test-retest reliability of optotype visual acuity (OVA) across 60° of horizontal gaze position in patients with infantile nystagmus syndrome (INS). Also, the validity of the metric gaze-dependent functional vision space (GDFVS) is shown in patients with INS.In experiment 1, OVA was measured twice in seven horizontal gaze positions from 30° left to right in 10° steps in 20 subjects with INS and 14 without INS. Test-retest reliability was assessed using intraclass correlation coefficient (ICC) in each gaze. OVA area under the curve (AUC) was calculated with horizontal eye position on the x-axis, and logMAR visual acuity on the y-axis and then converted to GDFVS. In experiment 2, validity of GDFVS was determined over 40° horizontal gaze by applying the 95% limits of agreement from experiment 1 to pre- and post-treatment GDFVS values from 85 patients with INS.In experiment 1, test-retest reliability for OVA was high (ICC ≥ 0.88) as the difference in test-retest was on average less than 0.1 logMAR in each gaze position. In experiment 2, as a group, INS subjects had a significant increase (P < 0.001) in the size of their GDFVS that exceeded the 95% limits of agreement found during test-retest.OVA is a reliable measure in INS patients across 60° of horizontal gaze position. GDFVS is a valid clinical method to be used to quantify OVA as a function of eye position in INS patients. This method captures the dynamic nature of OVA in INS patients and may be a valuable measure to quantify visual function patients with INS, particularly in quantifying change as part of clinical studies.

    View details for DOI 10.1167/iovs.17-23229

    View details for Web of Science ID 000429088400009

    View details for PubMedID 29610862

    View details for PubMedCentralID PMC5886028

  • Blur Detection, Depth of Field, and Accommodation in Emmetropic and Hyperopic Children OPTOMETRY AND VISION SCIENCE Roberts, T. L., Stevenson, S. B., Benoit, J. S., Manny, R. E., Anderson, H. A. 2018; 95 (3): 212–22


    Our results demonstrate that blur detection thresholds are elevated in young children compared with adults, and poorer blur detection thresholds are significantly correlated with the magnitude of accommodative microfluctuations. Given that accommodative microfluctuations are greater with greater accommodative responses, these findings may have implications for young uncorrected hyperopes.This study investigated the association between subjective blur detection thresholds and accommodative microfluctuations in children 3 years to younger than 10 years old and adults.Blur detection thresholds were determined in 49 children with habitually uncorrected refractive error (+0.06 to +4.91 diopters [D] spherical equivalent) and 10 habitually uncorrected adults (+0.08 to +1.51 D spherical equivalent) using a custom blur chart with 1° sized optotypes at 33 cm. Letters were blurred by convolution using a Gaussian kernel (SDs of 0.71 to 11.31 arc minutes in √2 steps). Subjective depth of field was determined in subjects 6 years or older and adults. Accommodative microfluctuations, pupils, and lag were measured using infrared photorefraction (25 Hz).Children had greater blur detection thresholds (P < .001), accommodative microfluctuations (P = .001), and depth of field (P < .001) than adults. In children, increased blur detection thresholds were associated with increased accommodative microfluctuations (P < .001), increased uncorrected hyperopia (P = .01), decreased age (P < .001), and decreased pupil size (P = .01). In a multiple linear regression analysis, blur detection thresholds were associated with accommodative microfluctuations (P < .001) and age (P < .001). Increased accommodative microfluctuations were associated with increased uncorrected hyperopia (P = .004) and decreased pupil size (P = .003) and independently associated with uncorrected hyperopia (P = .001) and pupil size (P = .003) when controlling for age and lag.Children did not have adult-like blur detection thresholds or depth of field. Increased accommodative microfluctuations and decreased age were independently associated with greater blur detection thresholds in children 3 years to younger than 10 years. Larger amounts of uncorrected hyperopia in children appear to increase blur detection thresholds because the greater accommodative demand and resulting response increase accommodative microfluctuations.

    View details for DOI 10.1097/OPX.0000000000001177

    View details for Web of Science ID 000426554100007

    View details for PubMedID 29401180

    View details for PubMedCentralID PMC5821572

  • Impact of Cognitive Demand during Sustained Near Tasks in Children and Adults OPTOMETRY AND VISION SCIENCE Roberts, T. L., Manny, R. E., Benoit, J. S., Anderson, H. A. 2018; 95 (3): 223–33


    These results demonstrate that accommodation in children is more accurate and less variable when performing a sustained near task with increased cognitive demand. In addition, children with increased uncorrected hyperopia have less stable accommodative responses, which may have visual implications during sustained near tasks.This study investigated accommodative accuracy (lag) and variability during sustained viewing for passive and active tasks in children and adults with emmetropia and uncorrected hyperopia.Lag and variability (root mean square [RMS] and low-frequency component) were measured in 54 children aged 3 to younger than 10 years with mean spherical equivalent of +1.31 ± 1.05 diopters (D) (range, -0.37 to +4.58 D) and 8 adults aged 22 to 32 years with mean spherical equivalent +0.65 ± 0.62 D (range, -0.13 to +1.15 D). Subjects viewed 20/50 stimuli at 33 cm during both a 10-minute passive and active task. Group 1 (<6 years or nonreaders) viewed shapes; group 2 (≥6 years and reading) and adults read passages.Groups 1 and 2 had larger lags, RMS, and low-frequency component for passive versus active tasks (P < .001). Lag and RMS did not differ between tasks in adults (P > .05), but low-frequency component was larger during passive viewing (P = .04). Group 1 had significantly higher RMS and low-frequency component than group 2 and the adults in the passive condition had greater low-frequency component in the active condition. In children, hyperopia was independently associated with RMS and low-frequency component under passive (RMS 95% confidence interval [CI], 0.04 to 0.15; low-frequency component 95% CI, 0.00011 to 0.00065) and active (RMS 95% CI, 0.001 to 0.06; 95% CI, 0.000014 to 0.00023) viewing.Accommodation is more accurate and less variable when children are engaged in the task. Children also have more variable accommodation than adults. In addition, children with greater hyperopia have more variable accommodation during sustained near tasks.

    View details for DOI 10.1097/OPX.0000000000001186

    View details for Web of Science ID 000426554100008

    View details for PubMedID 29461410

    View details for PubMedCentralID PMC5875985

  • Accommodative Accuracy and Stability In Passive and Active Viewing Tasks in Children with Uncorrected Hyperopia Roberts, T. L., Benoit, J. S., Manny, R. E., Stevenson, S. B., Anderson, H. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016
  • Accommodative Gain in Relation to Perceived Target Clarity OPTOMETRY AND VISION SCIENCE Roberts, T. L., Anderson, H. A., Stuebing, K. K. 2015; 92 (11): 1092–1102


    The purpose of this study is to determine the relationship between target clarity and the magnitude of accommodative lag using the metric accommodative gain (AG).Monocular accommodative responses were measured with Grand Seiko autorefraction using both proximal and minus lens techniques in 139 subjects aged 5 to 35 years. Subjects viewed a 1.5-mm letter at 13 discrete distances (range, 40 to 3.33 cm) for the proximal technique and fixed at 33 cm through minus lenses of increasing power for the lens technique. Subjects were instructed to keep the target clear and report when it blurred. The AG was calculated (accommodative response/accommodative demand) for the four greatest consecutive demands perceived clear (termed conditions 1 to 4) and the first demand perceived blurry (termed condition 5).Multivariate planned contrast, including age as a predictor, revealed that mean AG was significantly larger when the target was clear (range, 0.71 to 0.77 for conditions 1 to 4 across techniques) versus blurry (0.59 and 0.68 for condition 5 across techniques) (p < 0.001 for proximal and p < 0.036 for lens). Age was only a contributing factor for the proximal technique, with the youngest subjects having the largest decrease in AG when the target changed from clear to blurry (p = 0.017).These data suggest that across age and technique, the AG is relatively constant when the target is perceived clear but drops below approximately 70%, on average, once the target is perceived as blurry for subjects aged 5 to 35 years. The AG may be a useful metric to compare accommodative responses across a range of demands and to identify accommodative responses that may not be sufficient to perceive a clear target.

    View details for DOI 10.1097/OPX.0000000000000711

    View details for Web of Science ID 000364200600009

    View details for PubMedID 26421684

    View details for PubMedCentralID PMC4812439

  • Comparison of Objective and Subjective Accommodative Response from Preschool to Pre-Presbyopia Roberts, T. L., Stuebing, K. K., Anderson, H. A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014
  • The Correlation Between a Dynamic Stimulus and Accommodation or Vergence Responses in Open-Loop Conditions During Infancy Candy, T., Roberts, T. L., Babinsky, E., Manh, V. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014
  • Intraobserver reliability of contact pachymetry in children JOURNAL OF AAPOS Weise, K. K., Kaminski, B., Melia, M., Repka, M. X., Bradfield, Y. S., Davitt, B. V., Johnson, D. A., Kraker, R. T., Manny, R. E., Matta, N. S., Schloff, S., Pediat Eye Dis Investigator Grp 2013; 17 (2): 144–48


    Central corneal thickness (CCT) is an important measurement in the treatment and management of pediatric glaucoma and potentially of refractive error, but data regarding reliability of CCT measurement in children are limited. The purpose of this study was to evaluate the reliability of CCT measurement with the use of handheld contact pachymetry in children.We conducted a multicenter intraobserver test-retest reliability study of more than 3,400 healthy eyes in children aged from newborn to 17 years by using a handheld contact pachymeter (Pachmate DGH55; DGH Technology Inc, Exton, PA) in 2 clinical settings--with the use of topical anesthesia in the office and with the patient under general anesthesia in a surgical facility.The overall standard error of measurement, including only measurements with standard deviation ≤5 μm, was 8 μm; the corresponding coefficient of repeatability, or limits within which 95% of test-retest differences fell, was ±22.3 μm. However, standard error of measurement increased as CCT increased, from 6.8 μm for CCT less than 525 μm, to 12.9 μm for CCT 625 μm and greater. The standard error of measurement including measurements with standard deviation >5 μm was 10.5 μm. Age, sex, race/ethnicity group, and examination setting did not influence the magnitude of test-retest differences.CCT measurement reliability in children via the Pachmate DGH55 handheld contact pachymeter is similar to that reported for adults. Because thicker CCT measurements are less reliable than thinner measurements, a second measure may be helpful when the first exceeds 575 μm. Reliability is also improved by disregarding measurements with instrument-reported standard deviations >5 μm.

    View details for DOI 10.1016/j.jaapos.2012.11.005

    View details for Web of Science ID 000319027700006

    View details for PubMedID 23622447

    View details for PubMedCentralID PMC3639436

  • Vision Specific Quality of Life of Pediatric Contact Lens Wearers OPTOMETRY AND VISION SCIENCE Rah, M. J., Walline, J. J., Jones-Jordan, L. A., Sinnott, L. T., Jackson, J., Manny, R. E., Coffey, B., Lyons, S., ACHIEVE Study Grp 2010; 87 (8): 560–66


    Several studies have shown that children are capable of wearing and caring for contact lenses, but it is not known whether the benefits outweigh the risks associated with contact lens wear. The purpose of this article is to compare the vision-related quality of life benefits of children randomized to wear spectacles or contact lenses for 3 years using the Pediatric Refractive Error Profile.The Pediatric Refractive Error Profile was administered to 484 children who wore glasses at baseline. The children were then randomly assigned to wear contact lenses (n = 247) or spectacles (n = 237) for 3 years. The survey was administered at the baseline examination, at 1 month, and every 6 months for 3 years.During 3 years, the overall quality of life improved 14.2 +/- 18.1 units for contact lens wearers and 2.1 +/- 14.6 units for spectacle wearers (p < 0.001). In all scales except the visual performance scales (Distance Vision, Near Vision, and Overall Vision), the quality of life improved more for older subjects than younger subjects. The three scales with the largest improvement in quality of life for contact lens wearers were Activities, Appearance, and Satisfaction with Correction.Myopic children younger than 12 years of age report better vision-related quality of life when they are fit with contact lenses than when they wear glasses. Older children, children who participate in recreational activities, children who are motivated to wear contact lenses, and children who do not like their appearance in glasses will benefit most.

    View details for DOI 10.1097/OPX.0b013e3181e6a1c8

    View details for Web of Science ID 000280551000006

    View details for PubMedID 20562669

  • Randomized Trial of the Effect of Contact Lens Wear on Self-Perception in Children OPTOMETRY AND VISION SCIENCE Walline, J. J., Jones, L. A., Sinnott, L., Chitkara, M., Coffey, B., Jackson, J., Manny, R. E., Rah, M. J., Prinstein, M. J., ACHIEVE Study Grp 2009; 86 (3): 222–32


    To determine whether contact lens wear affects children's self-perceptions.The Adolescent and Child Health Initiative to Encourage Vision Empowerment Study was a randomized, single-masked trial conducted at five clinical centers in the United States. Subjects were 8- to 11-year-old myopic children randomly assigned to wear spectacles (n = 237) or soft contact lenses (n = 247) for 3 years. The primary endpoint was the Self-Perception Profile for Children Global Self-Worth scale. Secondary outcomes included the Physical Appearance, Athletic Competence, Scholastic Competence, Behavioral Conduct, and Social Acceptance Self-Perception Profile for Children scales.Global self-worth was not affected by contact lens wear [analysis of variance (ANOVA), difference = 0.06; 95% CI, -0.004 to 0.117]. Physical appearance (ANOVA, difference = 0.15; 95% CI, 0.07 to 0.22), athletic competence (ANOVA, difference = 0.08; 95% CI, 0.01 to 0.15), and social acceptance (ANOVA, difference = 0.10; 95% CI, 0.03 to 0.17) were all greater for contact lens wearers.Although contact lens wear does not affect global self-perceptions of 8- to 11-year-old myopic children their physical appearance, athletic competence, and social acceptance self-perceptions are likely to improve with contact lens wear. Eye care practitioners should consider the social and visual benefits of contact lens wear when choosing the most appropriate vision correction modality for children as young as 8 years of age.

    View details for DOI 10.1097/OPX.0b013e3181971985

    View details for Web of Science ID 000264004400008

    View details for PubMedID 19214129

  • A Randomized Trial of the Effect of Soft Contact Lenses on Myopia Progression in Children INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Walline, J. J., Jones, L. A., Sinnott, L., Manny, R. E., Gaume, A., Rah, M. J., Chitkara, M., Lyons, S., ACHIEVE Study Grp 2008; 49 (11): 4702–6


    Soft contact lenses have been reported to increase the progression of myopia. The purpose of this study was to determine whether soft contact lenses affect the progression of myopia in children.Children between the ages of 8 and 11 years with -1.00 to -6.00 D myopia and less than 1.00 D astigmatism were randomly assigned to wear soft contact lenses (n = 247) or spectacles (n = 237) for 3 years. Refractive error and corneal curvatures were measured annually by cycloplegic autorefraction, and axial length was measured annually by A-scan ultrasound. Multilevel modeling was used to compare the rate of change of refractive error, corneal curvature, and axial length between spectacle and contact lens wearers.There was a statistically significant interaction between time and treatment for myopia progression (P = 0.002); the average rate of change was 0.06 D per year greater for contact lens wearers than spectacle wearers. After 3 years, the adjusted difference between contact lens wearers and spectacle wearers was not statistically significant (95% confidence interval [CI] = -0.46 to 0.02). There was no difference between the two treatment groups with respect to change in axial length (ANCOVA, P = 0.37) or change in the steepest corneal curvature (ANCOVA, P = 0.72).These data provide reassurance to eye care practitioners concerned with the phenomenon of "myopic creep." Soft contact lens wear by children does not cause a clinically relevant increase in axial length, corneal curvature, or myopia relative to spectacle lens wear. (, NCT00522288.).

    View details for DOI 10.1167/iovs.08-2067

    View details for Web of Science ID 000260502200002

    View details for PubMedID 18566461