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  • 1.
    Baptista, Antonio M. G.
    et al.
    University of Minho, Portugal.
    Joel, Monteiro
    Centro Hospitalar do Alto Ave, Portugal.
    Vieira, Marco
    Centro Hospitalar do Alto Ave, Portugal.
    Reimão, Pedro
    Centro Hospitalar do Alto Ave, Portugal.
    Rocha, Paulo
    University of Porto, Portugal.
    Rocha-Sousa, Amandio A.
    University of Porto, Portugal.
    Freitas, Cristina
    Hospital de Braga, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Marques, Ana Patricia
    Nova University of Lisbon, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Causes of Vision Impairment in Portugal: A hospital based study2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, article id 2118Article in journal (Refereed)
    Abstract [en]

    Purpose 

    Causes of vision impairment (VI) are influenced by factors such as race or socio-economic circumstances. Because of this collecting national information is important for planning reduction of vision loss. The aim of this study was to determine causes of vision impairment in a population visiting ophthalmology departments in public hospitals in Portugal.

    Methods 

    This study was designed according with the guidelines of the Vancouver Economic Burden of Vision Loss Group (IOVS, 2010, V51/4/1801). Recommendations are to collect hospital data during 1 year to determine causes of VI. We selected four public hospitals that are expected to have over 120-140K appointments per year. Files are analysed weekly to detect patients with vision impairment. Inclusion criteria are: visual acuity with the current refractive correction equal or less than 0.5 (20/40) in the better-seeing eye and/or a visual field of less than 20 degrees. Patients were selected by trained hospital staff (medics and orthoptists) and inserted in a database. Diagnoses were classified according the ICD9. Data collected included fundamental demographic information, main diagnosis, secondary diagnosis and comorbidities.

    Results 

    We have now 2462 patients selected that correspond to 4 to 33 weeks of data collection. The number of weeks is variable because we did not start all hospitals simultaneously. From the current number of cases detected, 58% are female, 1.9% are under 20, 8.2% are between 20 and 50 and 89.9% are 50 years or older. The leading causes of vision impairment among these patients are diabetic retinopathy (DR), cataract (C), glaucoma (GC) and age-related macular degeneration (AMD). Using the North American definition of VI the proportions are 26.8% for DR, 25.5% for C, 10.4% for GC and 8.2% for AMD. The remaining causes of VI have percentages below 5% and in total they correspond to approximately 29% of the cases detected.

    Conclusions 

    Our results show that the most common causes of vision impairment are eye diseases related with systemic conditions and aging of the population. Vision impairment was relatively low under the age of 20 and the causes were mostly inherited diseases. Numbers reported now will be more accurate at the end of the study but they already highlight the importance of targeting conditions such as diabetes.

  • 2.
    Baptista, António M. G.
    et al.
    University of Minho, Portugal.
    Sousa, Raul A. R. C.
    Rocha, Filomena A. S. Q.
    Sepúlveda Fernandes, Paula
    Macedo, António Filipe
    University of Minho, Portugal.
    The macular photostress test in diabetes, glaucoma, and cataract2013In: 8th Iberoamerican Optics Meeting and 11th Latin American Meeting on Optics, Lasers, and Applications, SPIE - International Society for Optical Engineering, 2013Conference paper (Refereed)
    Abstract [en]

    Purpose. The photostress recovery time test (PSRT) has been widely reported as a helpful screening clinical tool. However, the poor standardization of its measurement technique remains to be a limitation among clinicians. The purpose of this study is to apply a recommended clinical technique to measure the PSRT in some of the most commons eye diseases to ascertain whether these diseases affect the PSRT values. Methods. One hundred and one controls and 105 patients, with diagnosed diabetes (without visible signs of diabetic retinopathy), primary open angle glaucoma (POAG) or cataracts underwent photostress testing. The test was performed with a direct ophthalmoscope for illuminating the macula for 30 seconds. Participants belonged to three age classes: A, B and C; and were divided into four groups: control, diabetic, POAG and cataract. The age range for A, B and C classes were respectively 43-54, 55-64 and 65-74 years. The groups were also further compared within each age class. In addition, the influence of age on PSRT was evaluated using the control group. Results. Results demonstrate that PSRT changes with age (p<0.02). In class A, diabetic group had a faster PSRT than control group, (mean ± standard deviation) 20.22±7.51 and 26.14±8.34 seconds. The difference between these groups was statistical significant (t-test, p=0.012). Cataract and POAG groups did not affect the PSRT significantly. Conclusions. The technique used for the Photostress showed that diabetics, younger than 54 years, may have faster PSRT and that, aging delays PSRT

  • 3.
    Baskaran, Karthikeyan
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Calabrèse, Aurélie
    Castet, Eric
    Moreno, Laura
    Silva, Marta
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Scoring reading parameters: an inter-rater reliability study using the MNREAD test2017Conference paper (Refereed)
    Abstract [en]

    Aim: Estimating MNREAD parameters such as Critical Print Size (CPS) and Maximum Reading Speed (MRS) - using the time taken to read blocks of text - often requires subjective analysis of the reading profile. Depending on the rater, parameters may be over- or under-estimated, resulting in difficult or even impossible between-study comparisons. The aim of this project was to evaluate the inter-rater reliability of MNREAD parameters in subjects with visual impairment. Methods: Reading times for the Portuguese version of the MNREAD chart from 32 subjects, reading binocularly were analyzed. Reading speed was computed by a single experimenter (AFM) using reading time and number of errors. Based on reading speeds, three experimented raters (AFM, AC and KB) computed MRS and CPS using the following method. CPS was defined as the print size at which subsequent smaller print sizes were read at 1.96 x standard deviation slower than the mean of the preceding print sizes; MRS was estimated as the mean reading speed for sentences in print larger than the CPS. Inter-rater reliability was assessed using intra-class correlation (ICC) coefficient for both MRS and CPS for all three raters. Results: Near acuity range was 0.14-1.9 logMAR. The average measure ICC for CPS was 0.896 with a 95% CI from 0.814 to 0.946 (p< 0.001). The average measure ICC for MRS was 0.984 with a 95% CI from 0.970 to 0.992 (p< 0.001). Conclusion: A high degree of reliability was found between the three raters for both CPS and MRS. Even though some small variability exists this may be due to raters’ high-level experience with MNREAD data. Future directions will involve: 1) including more raters with various level of experience in MNREAD rating; 2) investigating the degree of inter-rater reliability for raters using different estimation methods.

  • 4.
    Baskaran, Karthikeyan
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Calabrèse, Aurélie
    Aix-Marseille University, France.
    Rater and algorithm data of maximum reading speed (MRS) and critical print size (CPS) of 101 low vision participants.2019Data set
  • 5.
    Baskaran, Karthikeyan
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    He, Yingchen
    University of Minnesota, USA.
    Hernandez-Moreno, Laura
    University of Minho Braga, Portugal.
    Queirós, Tatiana
    Hospital de Braga, Portugal.
    Mansfield, J. Stephen
    SUNY College at Plattsburgh, USA.
    Calabrèse, Aurélie
    Aix-Marseille University, France;CNRS, France.
    Scoring reading parameters: An inter-rater reliability study using the MNREAD chart2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, p. 1-14, article id e0216775Article in journal (Refereed)
    Abstract [en]

    Purpose First, to evaluate inter-rater reliability when human raters estimate the reading performance of visually impaired individuals using the MNREAD acuity chart. Second, to evaluate the agreement between computer-based scoring algorithms and compare them with human rating. Methods Reading performance was measured for 101 individuals with low vision, using the Portuguese version of the MNREAD test. Seven raters estimated the maximum reading speed (MRS) and critical print size (CPS) of each individual MNREAD curve. MRS and CPS were also calculated automatically for each curve using two different algorithms: the original standard deviation method (SDev) and a non-linear mixed effects (NLME) modeling. Intra-class correlation coefficients (ICC) were used to estimate absolute agreement between raters and/or algorithms. Results Absolute agreement between raters was ‘excellent’ for MRS (ICC = 0.97; 95%CI [0.96, 0.98]) and ‘moderate’ to ‘good’ for CPS (ICC = 0.77; 95%CI [0.69, 0.83]). For CPS, inter-rater reliability was poorer among less experienced raters (ICC = 0.70; 95%CI [0.57, 0.80]) when compared to experienced ones (ICC = 0.82; 95%CI [0.76, 0.88]). Absolute agreement between the two algorithms was ‘excellent’ for MRS (ICC = 0.96; 95%CI [0.91, 0.98]). For CPS, the best possible agreement was found for CPS defined as the print size sustaining 80% of MRS (ICC = 0.77; 95%CI [0.68, 0.84]). Absolute agreement between raters and automated methods was ‘excellent’ for MRS (ICC = 0.96; 95% CI [0.88, 0.98] for SDev; ICC = 0.97; 95% CI [0.95, 0.98] for NLME). For CPS, absolute agreement between raters and SDev ranged from ‘poor’ to ‘good’ (ICC = 0.66; 95% CI [0.3, 0.80]), while agreement between raters and NLME was ‘good’ (ICC = 0.83; 95% CI [0.76, 0.88]). Conclusion For MRS, inter-rater reliability is excellent, even considering the possibility of noisy and/or incomplete data collected in low-vision individuals. For CPS, inter-rater reliability is lower. This may be problematic, for instance in the context of multisite investigations or follow-up examinations. The NLME method showed better agreement with the raters than the SDev method for both reading parameters. Setting up consensual guidelines to deal with ambiguous curves may help improve reliability. While the exact definition of CPS should be chosen on a case-by-case basis depending on the clinician or researcher’s motivations, evidence suggests that estimating CPS as the smallest print size sustaining about 80% of MRS would increase inter-rater reliability.

  • 6.
    Carneiro de Freitas, Rui
    et al.
    Hospital de Braga, Portugal.
    Freitas, Cristina
    Hospital de Braga, Portugal.
    Leite, Ricardo
    Hospital de Braga, Portugal.
    Sousa, Keissy
    Hospital de Braga, Portugal.
    Mendes-Ferreira, José
    Hospital de Braga, Portugal.
    Soares, Andreia
    Hospital de Braga, Portugal.
    Rubin, Gary S.
    UCL-Institute of Ophthalmology, UK.
    Rocha-Sousa, Amandio A.
    University of Porto, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Prevalence of Visual Impairment in Portugal: study design and initial results2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, article id 2119Article in journal (Refereed)
    Abstract [en]

    Purpose 

    Information about the prevalence of visual impairment is fundamental to define policies that deal with vision loss. The aim of this study is to determine the prevalence of visual impairment (VI) in the population looking for eye care in public hospitals in Portugal.

    Methods 

    We designed an observation, cross-sectional prospective study (Prevalence and Costs of Visual Impairment in Portugal: PC-VIP study) to investigate the prevalence of VI in patients attending outpatient appointments in four public hospitals in Portugal. Hospital selected provide from general eye care (3-6 ophthalmologists) to high-specialized eye care (40+ ophthalmologists) that in total have between 120-140K hospital appointments per year. Files of patients are analysed weekly to detect patients with VI. Inclusion criteria were: visual acuity equal or worse than 0.5 (USA definition 20/40) in the better eye and/or a visual field of less than 20deg. Cases are selected by trained hospital staff and inserted in a database. Data collected included demographic information, acuity from both eyes, qualitative information about visual field (good, reduced, requires investigation), main diagnosis, secondary diagnosis and comorbidities. Diagnoses were classified according with ICD9.

    Results 

    We have now detected 2462 cases of VI that correspond to 4 to 33 weeks of data collection. The number of weeks is variable because collection did not start simultaneously in all sites. From the number of cases detected, 58% were female, 1.9% were under 20y, 8.2% were between 20y and 50y and 89.9% were ≥50y. The mean prevalence of visual impairment was 13.6% (SD=5.6) using the USA definition and it was 7.0%(SD=4.1) using the WHO definition (acuity equal or worse than 0.3 or ~20/63). With a methodology that controls for demographics the lowest and highest estimates were calculated. Considering the USA definition, the prevalence in the general population would be in the range 0.4 -0.4% (age<40y) and 0.8-2.4% (age>=40y). Considering WHO definition, it would be 0.2-0.5% (age<40y) and 0.4-1.0% (age>=40y).

    Conclusions 

    A hospital-based study can provide effective estimates of the prevalence of visual impairment in a population. Estimates for the country are in agreement with the expected results that can be deducted from neighbour countries and self-reported visual impairment in census 2001.

  • 7.
    Cima, Joana
    et al.
    Nova University of Lisbon, Portugal ; University of Porto, Portugal.
    Santana, R.
    Nova University of Lisbon, Portugal.
    Massof, Robert
    Johns Hopkins Wilmer Eye Institute, USA.
    Hernandez-Moreno, Laura
    University of Minho, Portugal.
    Baptista, António
    University of Minho, Portugal.
    Marques, Ana Patricia
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    EQ-5D and Activity Inventory: Measures of Visual Health Outcome2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no Suppl 3Article in journal (Refereed)
    Abstract [en]

    The aim of the study is to test if EQ-5D, a more generic instrument, and Activity Inventory, a more specific instrument to the visual condition, produce consistent results when considering the different levels of visual impairment. By assessing how these instruments reflect visual status in a sample of patients with visual impairment, we will help to understand how they can work in cultural context and population in which they were never tested before.Method is based on Multivariate Analysis of Variance, in which the levels of visual impairment (slightly, moderate, severe/blindness) are defined through the visual acuity values, and the utility values derived from EQ-5D and the Activity Inventory.Participants were recruited in 3 public hospitals as a part of an ongoing study of prevalence and costs of visual impairment in Portugal. Patients attending outpatient appointments in these hospitals with acuity in the better eye of 0,30logMAR or worse and/or visual field in the better eye <20 degrees were invited to take part in face-to-face interviews. Additional visual measures, as acuity was collected using standardize methods. Visual acuity was assessed using an internally illuminated ETDRS chart at 4 m with room lights extinguished.The results show that both instruments have a good explanatory power. However when considering different clinical conditions, the AI presents better results. The EQ-5D due its low sensitivity/adaptability does not capture differences in health status in patients with slightly and moderate visual impairment.Since EQ-5D is the instrument most used in the evaluation of public health programs performance, the results suggest that its use should be more cautious in a situation of different difficulty levels. The results indicate that in these cases the EQ-5D should be used with a complementary instrument more specific to the clinical condition.

    Key messages

    • The results suggest that with different difficulty levels the EQ-5D should be used with a complementary instrument more specific to the clinical condition to be produced more reliable results
    • This study is supported by the Portuguese Foundation for Science and Technology (FCT) -POCTI & FSE GRANT: PTDC/DPT-EPI/0412/2012
  • 8.
    Crossland, Michael D.
    et al.
    Anglia Ruskin University, UK ; Moorfields Eye Hospital NHS Foundation Trust, UK.
    Silva, Rui S.
    University of Minho, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Smartphone, tablet computer and e-reader use by people with vision impairment2014In: Ophthalmic & physiological optics, ISSN 0275-5408, E-ISSN 1475-1313, Vol. 34, no 5, p. 552-557Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Consumer electronic devices such as smartphones, tablet computers, and e-book readers have become far more widely used in recent years. Many of these devices contain accessibility features such as large print and speech. Anecdotal experience suggests people with vision impairment frequently make use of these systems. Here we survey people with self-identified vision impairment to determine their use of this equipment.

    METHOD:

    An internet-based survey was advertised to people with vision impairment by word of mouth, social media, and online. Respondents were asked demographic information, what devices they owned, what they used these devices for, and what accessibility features they used.

    RESULTS:

    One hundred and thirty-two complete responses were received. Twenty-six percent of the sample reported that they had no vision and the remainder reported they had low vision. One hundred and seven people (81%) reported using a smartphone. Those with no vision were as likely to use a smartphone or tablet as those with low vision. Speech was found useful by 59% of smartphone users. Fifty-one percent of smartphone owners used the camera and screen as a magnifier. Forty-eight percent of the sample used a tablet computer, and 17% used an e-book reader. The most frequently cited reason for not using these devices included cost and lack of interest.

    CONCLUSIONS:

    Smartphones, tablet computers, and e-book readers can be used by people with vision impairment. Speech is used by people with low vision as well as those with no vision. Many of our (self-selected) group used their smartphone camera and screen as a magnifier, and others used the camera flash as a spotlight.

  • 9.
    Crossland, Michael
    et al.
    Moorfields Eye Hospital NHS Foundation Trust, UK ; Anglia Ruskin University, UK.
    Macedo, António Filipe
    University of Minho, Portugal.
    Use of tablet computers and e-readers by people with visual impairment2014In: Clinical and experimental optometry, ISSN 0816-4622, E-ISSN 1444-0938, Vol. 97, p. e19-e19, article id 53Article in journal (Refereed)
    Abstract [en]

    Background: We have observed many people with visual impairment using tablet computers and electronic books and have previously shown that these devices can be used by people with relatively low visual acuity and contrast sensitivity.

    Method: An online survey was advertised to people with visual impairment using personal contacts, social media and online discussion groups. Participants were asked to specify whether they used tablet computers and/or electronic books and if so, which device they used, what they used the device for and which accessibility functions they used.

    Results: Forty-four of 75 (59 per cent) respondents used a tablet computer. Of these, 30 (65 per cent) used an Apple iPad. All tablet users accessed the internet on their device and more than half read electronic books, took photographs and used apps. The ability to enlarge print was seen as the most useful accessibility option, cited by 76 per cent. Forty-nine per cent used contrast adjustment and 58 per cent used speech. Only 16 of the 75 respondents (22 per cent) used an electronic reader. Enlarged print was the most popular accessibility option on ereaders.

    Conclusions: Tablet computers are widely used by people with visual impairment. Large print is the most commonly used accessibility option, although speech and contrast reversal are also frequently used.

  • 10.
    Crossland, Michael
    et al.
    UCL Institute of Ophthalmology, UK.
    Macedo, António Filipe
    UCL Institute of Ophthalmology, UK.
    Rubin, Gary
    UCL Institute of Ophthalmology, UK.
    Electronic books as low vision aids2010In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 94, no 8, p. 1109-Article in journal (Refereed)
    Abstract [en]

    Recently, several electronic book readers have become commercially available. These consist of a low glare electronic paper screen and internal memory, which can typically hold the full text of between 150 and 2000 full-length novels. Electronic paper has a wide viewing angle of almost 1808 but a slow refresh speed of about 250 ms. Amazon’s Kindle device has 300 000 books available in electronic format, and 11 000 are available through Waterstones in the UK for the Sony Reader. Table 1 shows the parameters of these and other popular electronic books. Here, we explore the utility of these two electronic books for use by the visually impaired.

  • 11.
    Ferreira, Marisa Borges
    et al.
    University of Minho, Portugal;Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Pereira, Paulo Alexandre
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal;University of Minho, Portugal.
    Parreira, Marta
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Sousa, Ines
    University of Minho, Portugal.
    Figueiredo, José
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Cerqueira, João José
    University of Minho, Portugal;Hospital de Braga, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Relationships between neuropsychological and antisaccade measures in multiple sclerosis patients2018In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 6, p. 1-18, article id e5737Article in journal (Refereed)
    Abstract [en]

    Background

    The Stroop test is frequently used to assess deficits in inhibitory control in people with multiple sclerosis (MS). This test has limitations and antisaccade eye movements, that also measure inhibitory control, may be an alternative to Stroop.

    Objectives

    The aim of this study was twofold: (i) to investigate if the performance in the antisaccade task is altered in patients with MS and (ii) to investigate the correlation between performances in neuropsychological tests, the Stroop test and the antisaccade task.

    Methods

    We measured antisaccades (AS) parameters with an infrared eye tracker (SMIRED 250 Hz) using a standard AS paradigm. A total of 38 subjects diagnosed with MS and 38 age and gender matched controls participated in this study. Neuropsychological measures were obtained from the MS group.

    Results

    Patients with MS have higher error rates and prolonged latency than controls in the antisaccade task. There was a consistent association between the Stroop performance and AS latency. Stroop performance but not AS latency was associated with other neuropsychological measures in which the MS group showed deficits.

    Conclusions

    Our findings suggest that AS may be a selective and independent measure to investigate inhibitory control in patients with MS. More studies are necessary to confirm our results and to describe brain correlates associated with impaired performance in the antisaccade task in people diagnosed with MS.

  • 12.
    Freitas, Cristina
    et al.
    University of Minho, Portugal ; Hospital de Braga, Portugal.
    Moreno-Perdomo, Natacha
    Hospital Santa Maria Maior de Barcelos, Portugal.
    Gentil, Rita
    Hospital de Braga, Portugal.
    Baptista, António M. G.
    University of Minho, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Functional impairment with minimal macular damage in femtosecond laser plasma injury : case report: [ Comprometimento funcional com dano macular mínimo em lesão com plasma de laser de femtosegundo: relato de caso ]2013In: Arquivos Brasileiros de Oftalmologia, ISSN 0004-2749, E-ISSN 1678-2925, Vol. 76, no 5, p. 317-319Article in journal (Refereed)
    Abstract [en]

    A 26 years old female patient was examined twenty-four hours after observing laser-induced plasma formation in a process of nanoparticle production complaining of bilateral central scotoma. The ophthalmologic evaluation included dilated fundus observation, fluorescein angiography, and optical coherence tomography (OCT). In the first assessment, visual acuity was 20/20 in the right eye and 20/25 in the left eye. Ophthalmologic evaluation revealed colour changes in the macular region of both eyes. Optical coherence tomography showed a central interruption of the photoreceptor layer in both eyes and fluorescein angiography was normal. In subsequent appointments acuity was always 20/20 in both eyes. Abnormal optical coherence tomography findings disappeared in less than 5 months, but subjective complaints of scotoma in the left eye remained. Extra care must be taken in this type of experiment by, for example, reducing the time that the retina is directly exposed to the plasma radiation. 

  • 13.
    Hernandez-Moreno, Laura
    et al.
    University of Minho Braga, Portugal.
    Moreno Perdomo, Natacha
    Hospital Santa Maria Maior E.P.E-Barcelos, Portugal.
    Aleman, Tomas S.
    University of Pennsylvania, USA.
    Baskaran, Karthikeyan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings2018In: Case Reports in Ophthalmological Medicine, ISSN 2090-6722, E-ISSN 2090-6730, p. 1-5, article id 2146826Article in journal (Refereed)
    Abstract [en]

    The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.

  • 14.
    Hernández-Moreno, Laura
    et al.
    University of Minho, Portugal.
    Massof, Robert W.
    Johns Hopkins Wilmer Eye Institute, USA.
    Sousa, Sofia
    University of Minho, Portugal.
    Cima, Joana
    Nova University of Lisbon, Portugal.
    Costa, J.P.M.
    University of Minho, Portugal.
    Monteiro, Joel
    Centro Hospitalar do Alto Ave, Portugal.
    Baptista, Antonio M. G.
    University of Minho, Portugal.
    Moreno, Natacha
    Hospital Santa Maria Maior de Barcelos, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    The Portuguese version of the activity inventory2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, article id 1368Article in journal (Refereed)
    Abstract [en]

    Purpose: To characterize interventions needed by the population with visual impairment or to assess interventions in vision rehabilitation validated and standardized instruments used in different cultural contexts are necessary. The aim of this work was to characterize the functional status of a sample of people with visual impairment with the Portuguese version of the activity inventory (AI)

    Methods: A group of participants in the study Prevalence and Costs of Visual Impairment in Portugal (PC-VIP) was recruit to face-to-face interviews and the activity inventory was administered. The AI examines 50 goals split between three objectives: social functioning, recreation and daily living. Goals rated ‘not important’ were skipped, but for all other goals the participant was asked to rate its difficulty on a five point scale ranging from ‘not difficult’ to ‘impossible without help’. The difficulty responses were Rasch analysed (Winsteps v3.81.0) to produce a continuous measure of visual ability (AI score). Additional information about distance and near visual acuity (ETDRS scale), contrast sensitivity (MARS test) and critical print size (MNREAD test) was collected.

    Results: A total of 94 persons participated in this study. Some participants were not able to read or recognize letters due to their poor vision or poor literacy and were excluded from further analysis. Data reported here are from 62 participants, median age 63y (range=12-85) and the most common cause of visual impairment were retinal diseases. Mean presenting acuity in the better eye was 0.93logMAR (SD=0.5). The mean difficulty (item measure) in the AI was -0.33 logits (SD=0.96). The most difficult items were "sew or do needlework", "read the newspaper", "drive" and the easiest items were "provide care for a pet", "eat your meals", "use the restroom in a public place". The mean ability score (person measures) was 1.11 logits (SD=2.04). The ability measures in the AI were correlated with distance visual acuity (r=-0.57, p<.001), near visual acuity (r=-0.66, p<0.001), contrast sensitivity (r=0.62, p<.001) and critical print size (r=-0.60, p<.001).

    Conclusions: Our results indicate that the AI scores in a sample of people Portuguese people with visual impairment were in line with what has been found in other cultural contexts. The visual ability measured by the AI was correlated with visual function assessed by different visual tests, which shows that this instrument can be used with confidence.

  • 15.
    Lima Ramos, Pedro
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Santana, Rui
    Univ Nova Lisboa, Portugal.
    Moreno, Laura Hernandez
    Univ Minho, Portugal.
    Marques, Ana Patricia
    Univ Nova Lisboa, Portugal.
    Freitas, Cristina
    Hosp Braga, Portugal.
    Rocha-Sousa, Amandio
    Univ Porto, Portugal;Ctr Hosp Sao Joao, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    ., The Portuguese visual impairment study group
    Predicting participation of people with impaired vision in epidemiological studies2018In: BMC Ophthalmology, ISSN 1471-2415, E-ISSN 1471-2415, Vol. 18, article id 236Article in journal (Refereed)
    Abstract [en]

    Background

    The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population.

    Methods

    Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher’s exact tests were applied to investigate the possible differences between subjects in our sample.

    Results

    Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation.

    Conclusion

    In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.

  • 16.
    Lima Ramos, Pedro
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Santana, Rui
    Univ Nova Lisboa, Portugal.
    Sousa, Ines
    Univ Minho, Portugal.
    Rocha-Sousa, Amandio A.
    Univ Porto, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Prevalence of Visual Impairment in the Municipality of Braga -Portugal using capture-recapture methods2018In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal (Other academic)
  • 17.
    Macedo, António Filipe
    et al.
    Universty of Minho, Portugal.
    Borges Ferreira, Marisa
    TEM-All with the Mutiple Sclerosis, Portugal ; Universty of Minho, Portugal.
    Parreira, Marta Gamito
    TEM-All with the Mutiple Sclerosis, Portugal.
    Sousa, Inês
    Universty of Minho, Portugal.
    Figueiredo, José
    Private Hospital of Braga, Portugal.
    Cerqueira, João José
    University of Minho, Portugal ; Hospital de Braga, Portugal.
    Silva Pereira, Paulo
    University of Minho, Portugal.
    Anti-saccades in early stages of multiple sclerosis2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, article id 2911Article in journal (Refereed)
    Abstract [en]

    Purpose: Eye movements disability is common finding in multiple sclerosis (MS) but the exact stage at which changes are visible is not clear. The aim of study was to assess if anti-saccade (AS) planning and execution are altered at early stages of the disease.

    Methods: A total of 48 participants with MS selected by a neurologist (JJC) at Hospital de Braga and 52 controls participated in this study. Inclusion criteria: relapsing-remitting course, EDSS≤3, 1 month or more without MS crisis, and normal or corrected visual acuity. Exclusion criteria (MS and Control): cognitive impairment, traumatic brain injury or stroke. The mean age in the MS group was 37y and 33y in the control group. Eye movements were monitored using a binocular infrared eyetracker running at 250Hz(RED250, SMI Gmb Germany), precision <0.4deg, stimuli were presented in a 22 monitor (Dell P2210). Code for running the experiment and data analysis was written using the Matlab (Mathworks Inc). Participants were seated in a room dim light at 74cm from the monitor and head movements were minimized by a headband. The task was to fixate, after a variable period between steady fixation and the stimulus of 1250ms or 1600ms, participants looked as quickly as possible for the opposite direction where the target (a 30x30mm cross) was presented (anti-saccade movement). Each subject performed 40 trails.

    Results: The main results were the proportion of the directional errors (wherein the participant voluntarily looked for the wrong side), and latencies for: i) anti-saccades, ii) pro-saccades (movement in the same direction of the stimulus) and iii) correction (reaction time that the participant takes from the error fixation until to start the movement). The mean number of errors was 28%(SD=19) in MS group and 16%(SD=11) in the control group, mean difference 12%, t(74)=3.83, p<.001. Anti-saccades latency was 330msec (SD=61) in the MS group and 294ms(SD=59) in the control group, mean difference 36ms, F(1,98)=10.99, p<.05. The mean of the correction latency value was 178ms(SD=111) in the MS group and 129ms(SD=107) in the control group with a mean difference of 49ms, F(1,98)=6, p<.05. No statistically significant differences were found in accuracy and pro-saccade latency between groups.

    Conclusions: This study shows that anti-saccades latency and errors are increased at early stages of multiple sclerosis. Anti-saccades might be a sensitive tool to assess functional status in people with this condition.

  • 18.
    Macedo, António Filipe
    et al.
    UCL Institute of Ophthalmology, UK ; University of Minho, Portugal.
    Crossland, M. D.
    UCL Institute of Ophthalmology, UK.
    Rubin, G. S.
    UCL Institute of Ophthalmology, UK ; NIHR Faculty, UK.
    The effect of retinal image slip on peripheral visual acuity2008In: Journal of Vision, ISSN 1534-7362, E-ISSN 1534-7362, Vol. 8, no 14, p. 1-11, article id 16Article in journal (Refereed)
    Abstract [en]

    Abstract Retinal image slip promoted by fixational eye movements prevents image fading in central vision. However, in the periphery a higher amount of movement is necessary to prevent this fading. We assessed the effect of different levels of retinal image slip in peripheral vision by measuring peripheral visual acuity (VA), with and without crowding, while modulating retinal image slip by using gaze-linked stimuli. Measurements were carried out at four isoeccentric positions at 5 and at 10 degrees eccentricity. Gaze position was monitored throughout using an infrared eyetracker. The target was presented for up to 500 msec, either with no retinal image slip, with reduced retinal slip, or with increased retinal image slip. Without crowding, peripheral visual acuity improved with increased retinal image slip compared with the other two conditions. In contrast to the previous result, under crowded conditions, peripheral visual acuity decreased markedly with increased retinal image slip. Therefore, the effects of increased retinal image slip are different for simple (noncrowded) and more complex (crowded) visual tasks. These results provide further evidence for the importance of fixation stability on complex visual tasks when using the peripheral retina.

  • 19.
    Macedo, António Filipe
    et al.
    UCL Institute of Ophthalmology, UK ; University of Minho, Portugal.
    Crossland, Michael D.
    UCL Institute of Ophthalmology, UK ; NIHR Biomedical Research Centre for Ophthalmology, UK.
    Rubin, Gary S.
    UCL Institute of Ophthalmology, UK ; NIHR Biomedical Research Centre for Ophthalmology, UK.
    Investigating unstable fixation in patients with macular disease2011In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 52, no 3, p. 1275-1280Article in journal (Refereed)
    Abstract [en]

    Purpose.: To assess the effect on visual acuity of compensating fixation instability by controlling retinal image motion in people with macular disease.

    Methods.: Ten patients with macular disease participated in this study. Crowded and noncrowded visual acuity were measured using an eye tracking system to compensate for fixation instability. Four conditions, corresponding to four levels of retinal image motion, were tested: no compensation (normal motion), partial compensation (reduced motion), total compensation (no motion), and overcompensation (increased motion). Fixation stability and the number of preferred retinal loci were also measured.

    Results.: Modulating retinal image motion had the same effect on crowded and noncrowded visual acuity (P = 0.601). When fixation instability was overcompensated, acuity worsened by 0.1 logMAR units (P < 0.001) compared with baseline (no compensation) and remained equal to baseline for all other conditions.

    Conclusions.: In people with macular disease, retinal image motion caused by fixation instability does not reduce either crowded or noncrowded visual acuity. Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion. The results provide evidence that fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control.

  • 20.
    Macedo, António Filipe
    et al.
    University of Minho, Portugal.
    Encarnacao, Tito J.
    University of Minho, Portugal.
    Baptista, Antonio M.
    University of Minho, Portugal.
    Temporal Processing in the Peripheral Retina2012In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 53, no 14, article id 4830Article in journal (Refereed)
    Abstract [en]

    Purpose: There is an increasing number of reports in the literature about the possible influence of the peripheral refraction in myopia development. The aim of this work was to determine whether the peripheral refractive differences lead to changes in visual performance. We used a forced choice procedure to assess the speed and accuracy (visual processing) of people with and without myopia at detecting the direction of a Gabor patch presented at different retinal locations.

    Methods: Visual processing was measured twice in random order at 6 retinal locations: 10, 20 and 30 degrees eccentricity at the temporal and at the nasal retina. We tested the dominant eye of 8 adults (aged 19 to 33 years) with moderate myopia (spherical equivalent ranging from -4.25 to -2.00 D) and 8 age-matched adults without myopia (spherical equivalent from -0.63 to 0.75 D). Participants’ task was to report via bottom press whether the Gabor patch, with suprathreshold contrast and spatial frequency, was tilted 30º to the right or to the left. The target was preceded by a 50 msec duration cue, exposed for variable periods of 10, 30, 60, 90 and 140 msec, selected in random order, and followed by a noise mask until response was given. For each block, processing time was determined using the method of constant stimuli based in 400 trials per retinal location (80 trials per exposure). Threshold was defined as the exposure time yielding 75% of correct responses; results were analysed using linear mixed models (SPSS, v18).

    Results: The mean processing time in the group with myopia was 73 msec and in the group without myopia was 66 msec; the difference between groups was not statistically significant (p = 0.087). There was a statistically significant difference between the nasal and temporal retina, mean difference was 13 msec (p = 0.002) with smaller processing time in the nasal retina.

    Conclusions: For the type of paradigm used in this study, there was no difference in processing time of the peripheral retina between people with and people without myopia. Despite extensive reports in the literature about different refraction patterns in this study we found evidences that this does not translate into functional changes.

  • 21.
    Macedo, António Filipe
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Encarnação, Tito J.
    Ctr. de Diagnóstico da Visão, Portugal.
    Vilarinho, Daniel
    University of Minho, Portugal.
    Baptista, António M. G.
    University of Minho, Portugal.
    An exploratory study of temporal integration in the peripheral retina of myopes2017In: Proceedings of SPIE 10453, SPIE - International Society for Optical Engineering, 2017, Vol. 10453, article id 104532GConference paper (Refereed)
    Abstract [en]

    The visual system takes time to respond to visual stimuli, neurons need to accumulate information over a time span in order to fire. Visual information perceived by the peripheral retina might be impaired by imperfect peripheral optics leading to myopia development. This study explored the effect of eccentricity, moderate myopia and peripheral refraction in temporal visual integration. Myopes and emmetropes showed similar performance at detecting briefly flashed stimuli in different retinal locations. Our results show evidence that moderate myopes have normal visual integration when refractive errors are corrected with contact lens; however, the tendency to increased temporal integration thresholds observed in myopes deserves further investigation.

  • 22.
    Macedo, António Filipe
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Lima Ramos, Pedro
    University of Minho, Portugal.
    Hernandez-Moreno, Laura
    University of Minho, Portugal.
    Cima, Joana
    Nova University of Lisbon, Portugal.
    Baptista, António M. G.
    University of Minho, Portugal.
    Marques, Ana Patricia
    Nova University of Lisbon, Portugal.
    Massof, Robert
    Johns Hopkins Wilmer Eye Institute, USA.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment2017In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 95, no 8, p. e783-e791Article in journal (Refereed)
    Abstract [en]

    Purpose

    Generic instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition-specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ-5D-3L and the Activity Inventory (AI).

    Methods

    Participants were recruited in different hospitals during the PCVIP-study. A total of 134 patients with acuity 0.30 logMAR or less in the better eye were interviewed. The AI includes 46 goals split between three objectives: social functioning, recreation and daily living, and was used to measure visual ability. The EQ-5D consists of five questions covering one domain each and was used to provide a measure of health states. Responses to each domain were combined to produce a single individual index.

    Results

    The AI and the EQ-5D-3L showed enough discriminatory power between VI levels (p < 0.001), and their results were strongly correlated r(134) = 0.825, (p < 0.001). Explanatory factors for visual ability were level of VI in better eye, age and gender, R2 = 0.43, (p < 0.001). Explanatory factors for the EQ-5D-3L were level of VI in the better eye, comorbidities and gender, R2 = 0.36, (p < 0.001).

    Conclusion

    Our results showed that the EQ-5D-3L is useful when characterizing the burden of VI and to compute, when necessary, quality-adjusted-life-years (QALY) changes due to VI. However, it is important to consider that the EQ-5D-3L uses a coarse response scale, assesses a limited spectrum of domains and is influenced by comorbidities. This might limit its responsiveness to small changes in visual ability.

  • 23.
    Macedo, António Filipe
    et al.
    University of Minho, Portugal.
    Moreno, Laura H.
    University of Minho, Portugal.
    Silva, Rui S.
    University of Minho, Portugal.
    Crossland, Michael D.
    Anglia Ruskin University, UK ; Moorfields Eye Hospital NHS Foundation Trust, UK.
    Smartphones in visual impairment2014In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 55, no 13, article id 4150Article in journal (Refereed)
    Abstract [en]

    Purpose 

    We have previously shown that electronic devices can be used by people with relatively low visual acuity and contrast sensitivity. The aim of this study was to determine if people with visual impairment use smartphones to compensate their visual deficits.

    Methods 

    An online survey was advertised to people with visual impairment using personal contacts, social media and online discussion groups. This survey was administered in two languages: English and Portuguese. The first author is fluent in both languages and ensured accurate translation. The questionnaire was designed to collect basic demographic information and self-reported cause of visual impairment. Participants were asked to specify whether they used smartphones, and if so which operating system they used, what they used the device for, and which accessibility functions they used.

    Results 

    In total 131 responses were obtained: 75 to the English and 56 to the Portuguese survey. 93% of the respondents were younger than 64 years and 25% had no perception of light. From the total number of 131 respondents, 101 used smartphone. Of these, 57% used an Apple OS, 22% used Android and 15% used Symbian. 98% of smartphone users made phone calls with their device and sending text messages was reported by 93%. Internet navigation was used by 84%, photo capabilities were used by 53% to help them to see and by 73% for other purposes. 80% also used apps on their device. Speech navigation was used by 67% of respondents, ability to enlarge print was used by 58% and a large screen was important to 40%. Font type and contrast changes were less commonly used. Only 14% received information about these devices from a vision care professional. Other sources included online search, recommendations from friends or blind associations.

    Conclusions 

    Smartphones are widely used by people with visual impairment. The current accessibility features such as speech navigation and large print allow people with visual impairment to use of these devices not only as phones but also as an electronic low vision aid.

  • 24.
    Macedo, António Filipe
    et al.
    University of Minho, Portugal.
    Nascimento, Sérgio Miguel Cardoso
    University of Minho, Portugal.
    Gomes, Augusto Oliveira Silva
    University of Porto, Portugal.
    Puga, André Texieira
    University of Porto, Portugal.
    Fixation in Patients with Juvenile Macular Disease2007In: Optometry and Vision Science, ISSN 1040-5488, E-ISSN 1538-9235, Vol. 84, no 9, p. 852-858Article in journal (Refereed)
    Abstract [en]

    Purpose. The instability of fixation with central scotoma has been mainly studied in patients with age-related macular diseases (MDs). However, early macular lesions can lead to different characteristics of fixation. The aim of this work was to study fixation in patients with juvenile MD.

    Methods. Eye movements of 10 patients and 10 controls were monitored during fixation. Visual fields were assessed by static perimetry to determine the extent of the field defects. Eye movements were separated into saccades and drifts, with fixation stability assessed by bivariate contour ellipse area (BCEA). To quantify the number and location of preferred retinal loci (PRL), the kernel density estimator and expectation maximization for mixtures of gaussians were used.

    Results. Patients have worse fixation stability than controls and large BCEAs resulted in more than one PRL. It was found that central field defects (10°) have negative correlation with the size of BCEA. In addition, the meridian of saccades during fixation was correlated with the meridian inter-PRL.

    Conclusions. Patients with juvenile MDs have large BCEAs, frequently associated with two PRL. Similar results had been found for patients with age-related MDs. Also, the meridian of involuntary saccades during fixation was found to be correlated with the location of PRLs, suggesting a useful role of these movements in alternating between them.

  • 25.
    Macedo, António Filipe
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Santos, Diana
    Univ Minho, Portugal.
    Hernandez-Moreno, Laura
    Univ Minho, Portugal.
    Leitao, Marta
    Univ Minho, Portugal.
    Latham, Keziah
    Anglia Ruskin Univ, UK.
    Linhares, Joao
    Univ Minho, Portugal.
    Exploring barriers to physical activity faced by people with vision loss2018In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal (Other academic)
  • 26.
    Marisa, Ferreira
    et al.
    University of Minho, Portugal ; Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Pereira, Paulo A.
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal ; University of Minho, Portugal.
    Parreira, Marta
    Association “Todos com a Esclerose Multipla (TEM)”, Portugal.
    Sousa, Inês
    University of Minho, Portugal.
    Cerqueira, João J.
    University of Minho, Portugal ; Hospital de Braga, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Using endogenous saccades to characterize fatigue in multiple sclerosis2017In: Multiple Sclerosis and Related Disorders, ISSN 2211-0348, E-ISSN 2211-0356, Vol. 14, p. 16-22Article in journal (Refereed)
    Abstract [en]

    Purpose

    Multiple Sclerosis (MS) is likely to cause dysfunction of neural circuits between brain regions increasing brain working load or a subjective overestimation of such working load leading to fatigue symptoms. The aim of this study was to investigate if saccades can reveal the effect of fatigue in patients with MS.

    Methods

    Patients diagnosed with MS (EDSS<=3) and age matched controls were recruited. Eye movements were monitored using an infrared eyetracker. Each participant performed 40 trials in an endogenous generated saccade paradigm (valid and invalid trials). The fatigue severity scale (FSS) was used to assess the severity of fatigue. FSS scores were used to define two subgroups, the MS fatigue group (score above normal range) and the MS non-fatigue. Differences between groups were tested using linear mixed models.

    Results

    Thirty-one MS patients and equal number of controls participated in this study. FSS scores were above the normal range in 11 patients. Differences in saccade latency were found according to group (p<0.001) and trial validity (p=0.023). Differences were 16.9 ms, between MS fatigue and MS non-fatigue, 15.5 ms between MS fatigue and control. The mean difference between valid and invalid trials was 7.5 ms. Differences in saccade peak velocity were found according to group (p<0.001), the difference between MS fatigue and control was 22.3°/s and between MS fatigue and non-fatigue was 12.3°/s. Group was a statistically significant predictor for amplitude (p<0.001). FSS scores were correlated with peak velocity (p=0.028) and amplitude (p=0.019).

    Conclusion

    Consistent with the initial hypothesis, our study revealed altered saccade latency, peak velocity and amplitude in patients with fatigue symptoms. Eye movement testing can complement the standard inventories when investigating fatigue because they do not share similar limitations. Our findings contribute to the understanding of functional changes induced by MS and might be useful for clinical trials and treatment decisions.

  • 27.
    Marques, Ana Patricia
    et al.
    NOVA University of Lisbon, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal .
    Hernandez-Moreno, Laura
    University of Minho Braga, Portugal .
    Lima Ramos, Pedro
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Butt, Thomas
    University College London, UK;Peking University, China .
    Rubin, Gary
    University College London, UK.
    Santana, Rui
    NOVA University of Lisbon, Portugal.
    The use of informal care by people with vision impairment2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0198631Article in journal (Refereed)
    Abstract [en]

    Purpose

    To estimate and characterize the use of informal care by people with vision impairment in Portugal.

    Methods

    A total of 546 visually impaired individuals were recruited from Portuguese hospitals. Clinical information was obtained from medical records, socio-demographic details and informal care use were collected during face-to-face interviews. In addition, participants responded to a functional vision questionnaire (activity inventory) to assess their visual ability. Logistic regression was used to determine independent factors associated with informal care use and linear regression was used to determine independent predictors of intensity of informal care use.

    Results

    Informal care was reported by 39.6% of the participants. The probability of reporting informal care was higher in non-married, those with comorbidities, with lower visual ability and worse visual acuity. The median number of caregivers’ hours per year was 390 (mean = 470; 95%CI = 488–407), which represent a median opportunity cost of €2,586. Visual ability was the only independent predictor of number of hours of informal care received.

    Conclusions

    Informal care was frequently used by individuals with impaired vision. Improving visual ability of people with impaired vision when performing valued activities may reduce the burden of visual loss at personal and societal level. This could be achieved with person-centred visual rehabilitation.

  • 28.
    Marques, Ana Patricia
    et al.
    NOVA University of Lisbon, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    Lima Ramos, Pedro
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    Moreno, Laura Hernandez
    University of Minho Braga, Portugal.
    Butt, Thomas
    Peking University, Peoples Republic of China;University College London, UK.
    Rubin, Gary
    University College London, UK.
    Santana, Rui Santana
    NOVA University of Lisbon, Portugal.
    Productivity Losses and Their Explanatory Factors Amongst People with Impaired Vision2019In: Ophthalmic Epidemiology, ISSN 0928-6586, E-ISSN 1744-5086, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Purpose: To estimate productivity losses amongst people with impaired vision in Portugal and to investigate explanatory factors associated with non-participation in the labour market.

    Methods: A total of 546 visually impaired individuals participated in face-to-face interviews. Participants were asked about their workforce participation to determine productivity (employment status questionnaire), their health-related quality of life – HRQoL (EQ-5D) and their visual acuity and visual ability (Activity Inventory). Productivity losses included absenteeism and reduction in workforce participation. Logistic regression was used to determine independent factors associated with participation in the labour market.

    Results: From the 546 participants, 50% were retired, 47% were of working age and 3% were students. The employment rate was 28%, and the unemployment rate was 21% for the working age sample. For those of working age, productivity losses were estimated at €1.51 million per year, mean of €5496 per participant. The largest contributor to productivity losses was reduced workforce participation, estimated from 159 early retired or unemployed participants. After controlling for visual acuity and ability, younger individuals, with more years of education, without comorbidities and high HRQoL had a higher probability of being employed.

    Conclusions: Our findings show a high unemployment rate and high productivity losses amongst people with impaired vision. The probability of being employed was associated with education, HRQoL and comorbidities. We speculate that promoting education and health through effective visual rehabilitation programs may help to increase participation in the labour market. These findings can inform decisions to intervene to reduce the burden of vision loss.

  • 29.
    Marques, Ana Patricia
    et al.
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Rocha-Sousa, Amandio A.
    Unversity of Porto, Portugal.
    Baptista, Antonio M. G.
    University of Minho, Portugal.
    Rubin, Gary S.
    UCL-Institute of Ophthalmology, UK.
    Monteiro, Joel
    Centro Hospitalar do Alto Ave, Portugal.
    Hernández-Moreno, Laura
    University of Minho, Portugal.
    Cima, Joana
    Nova University of Lisbon, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Estimating the cost of visual impairment: initial results2015In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 56, no 7, article id 2134Article in journal (Refereed)
    Abstract [en]

    Purpose: Vision loss can have a substantial human and economic impact on individuals and society that include disability, loss of productivity and reduction in quality of life. The purpose of this study was to estimate economic burden of visual impairment in Portugal.

    Methods: A prevalence-based cost of illness approach was adopted to estimate costs of vision impairment. We estimated direct medical costs and indirect economic costs. Direct medical hospital costs were determined using a bottom up approach. For those meeting the inclusion criteria (visual acuity of 20/40 or 0.5decimal or worse in the better eye and/or visual field of less than 20deg) we estimated direct costs by collecting information from administrative records that included: physician’s office visits, emergency and outpatient visits. We developed a survey based in parts of the annotated cost questionnaire-HERU Discussion Paper N.03/01 (UK Working Party on Patient Costs) and the Service Receipt Inventory-European Version. Using the questionnaire that we developed, in face-to-face interviews, we collect direct medical expenditures supported by patients that included: costs with medical prescriptions, low vision aids and devices. With the same questionnaire we collected information for indirect costs calculations. Indirect costs were calculated by estimating the value of productivity losses including employment participation, absenteeism and caregiver costs.

    Results: Results presented here correspond to 442 patients that met the inclusion criteria. The four main causes of visual impairment in this sample were Diabetic Retinopathy, Cataract, Glaucoma and Age-related macular degeneration. Direct medical hospital costs were accountable for 12% of total costs calculated. Patient expenditures represented 25% of expenses with visual impairment and indirect costs corresponded to 63% of the total. From this data we estimated that the average annual direct cost per patient with VI was 958 euro and average annual indirect cost was 1655 euro.

    Conclusions: With the instruments and methodology that was adopted we were able quantify direct medical hospital costs as well as indirect costs of visual impairment. Results of this study show that more than half of the costs with VI are indirect. This highlights that particular attention should be given to costs that arise for individuals with vision loss.

  • 30.
    Marques, Ana Patricia
    et al.
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Rocha-Sousa, Amandio A.
    University of Porto, Portugal.
    Perelman, Julian
    Nova University of Lisbon, Portugal.
    Baptista, António M.
    University of Minho, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Emergence of intravitreal injections in a National Health System: 2002-20122014In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 55, no 13, article id 6088Article in journal (Refereed)
    Abstract [en]

    Purpose 

    Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) are an innovative procedure with well-proven benefits to preserve vision in certain eye conditions. The aim of this study was to examine the diffusion of this treatment in the Portuguese National Health System.

    Methods 

    We used a database of all in-patient and day cases stays from all Portuguese public hospitals during period 2002-2012. We selected cases based on four procedures, ICD-9-CM codes: 1414, 1475, 1479, 149. Given that these procedures are not specific for intravitreal injections it is likely that our results captured cases that are not anti-VEGF injections. Because we were only interested in the diffusion of new anti-VEGF treatments we included years 2002-2005 as baseline because during that period drugs anti-VEGF were not licenced. We calculated absolute values, yearly rates of episodes and rates of patients treated per 100,000 habitants.

    Results 

    Our final sample included 98,408 episodes, 52% performed in men. The total number of episodes increased from 1,815 in 2002 to 25,106 in 2012 (mean annual increase of 32%). These values corresponded to an increase in ratios per 100,000 from 17.4 to 238.77. The highest increase was observed between 2007 and 2009 with an increase of 337%. The number of treated patients was six times higher in 2012 with 11,937 treated compared with 1,561 in 2002 (mean annual increase of 24%). The highest increase was also observed between 2006 and 2009. In 2012, 86.2% of the procedures were performed as day cases, representing an increase of 78.3% as compared to 2002. The percentage of patients older than 60 years increased from 60% in 2002 to 80% in 2012. Five diagnoses (See Figure: wet AMD, diabetic macular oedema, oedema of the retina, retinal neovascularization and non-specific AMD) were associated with 73% of these procedures in 2012, in contrast with only 16% in 2002.

    Conclusions 

    The number of procedures grew exponentially since anti-VGEF treatments were approved. The aging of the population and the expected growth in conditions such as diabetes and AMD are likely to increase the demand for these procedures in years to come. These factors are likely to impose tremendous challenges to health services. That will happen not only due to the price of the procedures but also for number of physicians and other staff needed in Ophthalmology departments.

     View

  • 31.
    Marques, Ana Patrícia
    et al.
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Perelman, Julian
    Nova University of Lisbon, Portugal.
    Aguiar, Pedro
    Nova University of Lisbon, Portugal.
    Rocha-Sousa, Amândio
    University of Porto, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Diffusion of anti-VEGF injections in the Portuguese National Health System2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, p. 11-Article in journal (Refereed)
    Abstract [en]

    Objectives

    To analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS).

    Setting

    NHS Portuguese hospitals.

    Participants

    All inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002–2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149.

    Primary and secondary outcome measures

    We measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling.

    Results

    We analysed all hospital discharges from all NHS hospitals in Portugal (98 408 hospital discharges corresponding to 57 984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km2 raised the rates by 11%.

    Conclusions

    Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated

  • 32.
    Marques, Dora Nazaré
    et al.
    University of Minho, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Perceptions of acceptable conducts by university students: [Percepciones sobre las conductas aceptables por los estudiantes universitarios]2016In: Journal of Optometry, ISSN 1888-4296, Vol. 9, no 3, p. 166-174Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: 

    To determine perceptions of acceptable conducts amongst under and postgraduate optometry students and to compare them with students from other disciplines.

    METHODS: 

    Students (under/postgraduate) of optometry (n=156) and other courses (n=54) from University of Minho participated in a voluntary online questionnaire about perception of conducts, classifying as acceptable or unacceptable 15 academic or professional scenarios.

    RESULTS: 

    210 questionnaires were analyzed. Differences in perceptions were found between optometry under and postgraduates in scenario 5, Chi-square(2,156)=4.3, p=0.038, and scenario 7, Chi-square(2,156)=7.0, p=0.008 (both with cheating more acceptable for postgrads). Differences between under and postgraduates from other courses were found in scenario 9 (taking supplies from classroom more acceptable for undergrads), Chi-square(1,54)=5.0, p=0.025, and scenario 14 (forging a signature more acceptable for postgrads), Chi-square(1,54)=3.9, p=0.046. Differences between optometry and other courses undergraduates were observed in scenario 2 (plagiarism more acceptable for optometry undergrads), Chi-square(1,154)=8.3, p=0.004 and scenario 9 (taking supplies from classroom more acceptable for other undergrads), chi-square(1,54)=7.8, p=0.005. Differences between optometry and other courses postgraduates were observed in scenario 7, Chi-square(1,56)=5.8, p=0.016, scenario 10 (both with cheating more acceptable for optometry postgrads), chi-square(1,54)=8.1, p=0.004 and scenario 14 (forging a signature more acceptable for other postgrads), Chi-square(1,54)=6.1, p=0.026.

    CONCLUSION: 

    Academic misconducts were mainly considered more acceptable than professional misconducts. Our results show that perceptions of acceptable conducts amongst optometry students are not very different from other students, and, against our initial prediction, do not show a general change in misconduct perception when students become more mature. Universities should pay more attention to this problem and take action.

  • 33.
    Miranda, Antonio Miguel
    et al.
    University of Minho Braga, Portugal.
    Nunes-Pereira, Eduardo J
    University of Minho Braga, Portugal.
    Baskaran, Karthikeyan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho Braga, Portugal.
    Eye movements, convergence distance and pupil-size when reading from smartphone, computer, print and tablet2018In: Scandinavian Journal of Optometry and Visual Science, ISSN 1891-0882, E-ISSN 1891-0890, Vol. 11, no 1, p. 1-5Article in journal (Refereed)
    Abstract [en]

    This study investigated the use of eye-tracking glasses to monitor visual behaviour when reading from electronic devices and paper in free-viewing conditions. The Tobii-Pro-Glasses were used to monitor 20 subjects with normal vision during reading tasks. Reading was performed in a smartphone, computer, paper and tablet. Texts from the IReST-test were read in devices in a random order. Participants read one text in each device and then repeated the same task 1 hour later; in total each participant read eight different texts. The sequence for the devices was randomized. We found differences between devices for saccade amplitude, fixation duration, convergence distance and pupil size. Reading speed between computer and tablet was slightly different (8 words-per-minute) and pupil size reduced up to 20% in electronic devices compared to print. Behavioural changes observed whilst reading from different devices may reflect an attempt from readers to optimize performance. The need to maintain visual performance under different visual condition may lead to increased visual symptoms. Eye-tracking glasses could be a valuable tool to investigate visual aspects of digital strain.

  • 34.
    Moreno, Laura Hernandez
    et al.
    Univ Minho, Portugal.
    Perdomo, Natacha Moreno
    Hosp Santa Maria Maior EPE, Portugal.
    Lima Ramos, Pedro
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portuga.
    Lewis, Peter
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Linhares, Joao
    Univ Minho, Portugal.
    Senra, Hugo
    Anglia Ruskin, UK.
    Santana, Rui
    Univ Nova Lisboa, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Univ Minho, Portugal.
    Visual and psychological outcomes in patients with and without low vision diagnosed with similar eye diseases - initial results.2018In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal (Other academic)
  • 35.
    Pazhoohi, Farid
    et al.
    University of Minho, Portugal.
    Doyle, James F.
    Stillwater, USA.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Arantes, Joana
    University of Minho, Portugal.
    Arching the Back (Lumbar Curvature) as a Female Sexual Proceptivity Signal: an Eye-Tracking Study2018In: Evolutionary Psychological Science, ISSN 2198-9885, Vol. 4, no 2, p. 158-165Article in journal (Refereed)
    Abstract [en]

    It is common in studies of human mate preference to have participants judge the attractiveness of photographs in which models adopt a neutral facial expression or a neutral body posture. However, it is unlikely that humans adopt neutral expressions and postures in normal social circumstances. One way in which posture can vary is in the curvature of the lower spine. In some non-human animals, a “lordotic” posture (in which the lower spine is curved towards the belly) is associated in females with readiness to mate. In humans, this posture may serve a similar function, attracting heterosexual men. In this study, participants were presented with computer-generated images of female bodies in which the back curvature was systematically manipulated. The result showed that small changes in lumbar curvature are associated with changes in the perception of attractiveness. Specifically, the result showed that there is a relationship between the range of the back curvatures used in this study and attractiveness, such that increasing the curvature increased the perception of attractiveness. Additionally, as the curvature increased, participants looked longer and fixated more on the hip region of the female bodies. This paper argues that the attractiveness of women in lordotic posture is due to a conserved mechanism across the taxa which signals proceptivity to men.

  • 36.
    Pazhoohi, Farid
    et al.
    University of Minho, Portugal.
    Garza, Ray
    Oklahoma State University, USA.
    Doyle, James F
    Stillwater, USA.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Arantes, Joana
    University of Minho, Portugal.
    Sex Differences for Preferences of Shoulder to Hip Ratio in Men and Women: an Eye Tracking Study2019In: Evolutionary Psychological Science, E-ISSN 2198-9885Article in journal (Refereed)
    Abstract [en]

    Shoulder to hip ratio (SHR) is a sexually dimorphic trait in humans, yet no previous study has investigated the gazing behavior and perceived physical attractiveness of men and women in relation to men and women’s SHRs. Men and women are attentive to men’s upper body and consider higher SHRs as cues to masculinity, strength, and formidability. Moreover, while women’s shoulder width varies from one individual to another, to our knowledge no previous study has investigated perceived attractiveness and eye movement in relation to women’s SHR. Therefore, in the current study, we investigated attractiveness ratings and eye movements of both men and women to front- and back-posed male and female stimuli varying in SHR. Our results showed that men prefer more masculine ratios for men and less masculine ratios for women. However, the results also showed that women preferred an intermediate SHR for both men and women in the back view while their preference in the front view is not influenced by SHR. Eye movements showed that men viewed the chest region of other men in the front and back views of stimuli, and they had longer dwell time on chests of male stimuli with higher SHRs, while no significant difference was found for dwell time on chests of female stimuli varying in SHR. Also, no differences were observed for female participants in dwell time, for either chest regions of SHRs of male stimuli or for the chests of female stimuli. Altogether, the results of this study suggest that men more than women are attentive to variations in SHRs.

  • 37.
    Pazhoohi, Farid
    et al.
    University of Minho, Portugal.
    Grammer, Karl
    University of Vienna, Austria.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Arantes, Joana
    University of Minho, Portugal.
    The effect of women’s leg posture on gazing behavior and perceived attractiveness2018In: Current Psychology, ISSN 1046-1310, E-ISSN 1936-4733, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Subtle nonverbal changes can influence perception, signal individual’s affective state and act as gateways in interpersonal communications. In this exploratory study, we investigated the effect of previously uninvestigated female leg posture (in-toeing vs. out-toeing) on gazing behavior and perceived attractiveness. Results showed a small effect: participants fixated more and spent more time looking at the legs and feet of the stimuli with in-toeing feet than parallel and out-toeing feet. Likewise, we found a small effect for the perception of the attractiveness. In line with the previous studies, we suggest in-toeing feet might signal femininity and submission and discussed our results accordingly.

  • 38.
    Pazhoohi, Farid
    et al.
    University of Minho, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Arantes, Joana
    University of Minho, Portugal.
    The Effect of Religious Clothing on Gaze Behavior: An Eye-Tracking Experiment2017In: Basic and Applied Social Psychology, ISSN 0197-3533, E-ISSN 1532-4834, Vol. 39, no 3, p. 176-182Article in journal (Refereed)
    Abstract [en]

    There are very few experimental studies regarding religious clothing. In the current study, we hypothesized that the function of conservative clothing hiding female curvaceous body features is to restrict visual access and consequently decreases female physical attractiveness. Using eyetracking, we quantified dwell times and number of fixations on religious clothing, ranging from conservative to liberal. Results showed that conservative religious clothing decreased visual access to female curvaceous body features and instead focused visual attention to the head/face region. Results were discussed in terms of the roles of conservative clothing in women’s clothing choice, men’s mate retention tactics, and parent-offspring conflict over mate choice. 

  • 39.
    Pazhoohi, Farid
    et al.
    University of Minho, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Doyle, James F.
    Stillwater, USA.
    Arantes, Joana
    University of Minho, Portugal.
    Waist-to-Hip Ratio as Supernormal Stimuli: Effect of Contrapposto Pose and Viewing Angle2019In: Archives of Sexual Behavior, ISSN 0004-0002, E-ISSN 1573-2800, p. 1-11Article in journal (Refereed)
    Abstract [en]

    In women, the waist-to-hip ratio (WHR) is an indicator of attractiveness, health, youthfulness, and reproductive potential. In the current study, we hypothesized that viewing angle and body postures influence the attractiveness of these forms based on the view dependency of WHR stimuli (vdWHR). Using eye tracking, we quantified the number of fixations and dwell time on 3D images of a female avatar in two different poses (standing and contrapposto) from eight viewing angles incrementing in 45 degrees of rotation. A total of 68 heterosexual individuals (25 men and 43 women) participated in the study. Results showed that the contrapposto pose was perceived as more attractive than the standing pose and that lower vdWHR sides of the stimuli attracted more first fixation, total fixations, and dwell time. Overall, the results supported that WHR is view-dependent and vdWHRs lower than optimal WHRs are supernormal stimuli that may generate peak shifts in responding. Results are discussed in terms of the attractiveness of women’s movements (gaits and dance) and augmented artistic presentations.

  • 40.
    Rocha De Sousa, Amandio
    et al.
    University of Porto, Portugal.
    Tavares-Ferreira, Joao
    Saint John Hospital, Portugal.
    Perestrelo, Sara P.
    Saint John Hospital, Portugal.
    Lima-Ramos, Pedro
    University of Minho, Portugal ; Laboratory of Vision Rehabilitation, Portugal.
    Baptista, António M.
    University of Minho, Portugal ; Laboratory of Vision Rehabilitation, Portugal.
    Santana, Rui
    Nova University of Lisbon, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal ; Laboratory of Vision Rehabilitation, Portugal.
    Hospital prevalence of visual of visual impairment caused by diabetic retinopathy2015In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 93, no S255Article in journal (Refereed)
    Abstract [en]

    Purpose

    To investigate cases of visual impairment caused by diabetic retinopathy (DR) in a hospital population.

    Methods

    As part of an observational study to estimate the prevalence and costs of visual impairment in Portugal (PCVIP study), clinical records of all patients attending the ophthalmology department of a tertiary hospital were analysed looking for patients meeting the inclusion criteria. Inclusion criteria were: (i) presenting visual acuity in the better eye <5/10 (20/40) and/or (ii) visual field <20°. Diagnosis of cases with VI were classified according with ICD9. Results reported here were selected from the total number of patients with VI by filtering ICD9 codes staring by 362.

    Results

    In 12 weeks, 1920 cases of VI were detected, 586 (31%) caused by any type of DR. From those: 54% were caused by non-proliferative-DR, 40% by proliferative-DR and 6% by diabetic macular oedema. The mean age of the patients with VI caused by DR was 69.4 (sd = 9.5) years and 57% were female. The estimated hospital prevalence (for 52 weeks) of VI caused by DR is 39% (95%CI = 38–41).

    Conclusions

    Our results show that DR remains the leading cause of VI in the population attending our hospital. Information about the number of patients reaching VI will be fundamental to assess the cost-benefits of treatments and public health campaigns to reduce the burden of diabetic retinopathy in Portugal.

  • 41.
    Rodrigues, Clarinda
    et al.
    Linnaeus University, School of Business and Economics, Department of Marketing.
    Rodrigues, Paula
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Baskaran, Karthikeyan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eye tracking the impact of in-store sensory and price messages on visual attention and intended purchase behavior2018In: Presented at the 13th Global Brand Conference, Newcastle upon Tyne, UK, May 2-4, 2018, 2018Conference paper (Refereed)
  • 42.
    Santos, Diana
    et al.
    University of Minho, Portugal.
    Abrantes, João
    Universidade Lusófona de Humanidades e Tecnologias, Portugal.
    Lewis, Peter
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Influence of the use of cane on the gait cycle of individuals who are blind2018In: The British Journal of Visual Impairment, ISSN 0264-6196, E-ISSN 1744-5809, Vol. 36, no 3, p. 251-261Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to perform a biomechanical characterization of the gait cycle in individuals who are blind. Five individuals with ages between 16 and 19 years participated in this study. The task consisted of walks of 12m measured in two conditions: (1) with cane and (2) wihtout cane; a total of 20 walks in each condition were performed. During walks, participants were monitored with a Vicon 3D-motion capture system. Spatialtemporal, kinematic, kinetic, and dynamic parameters were recorded and compared between the two conditions. We observed an interaction between the condition and ankle angular measures (p = .003); the interaction was due to differences induced by condition in instants ‘opposite toe off’ (p = .045) and ‘opposite initial contact’ (p = .019). We also obtained a significant difference in the negative ankle-joint-power measures between conditions (p = .044). This study showed that the use of cane changes the gait pattern in individuals who are blind. The subtle changes in ankle behaviour when walking with a cane, compared with no cane, suggest better application of the force during the initial stages of support leading to a more comfortable gait. This type of assessment of gait may be important to improve mobility training and rehabilitation strategies.

  • 43.
    Senra, Hugo
    et al.
    King's College London, UK.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Nunes, Nuno
    University of Porto, Portugal.
    Balaskas, Konstantinos
    Moorfields Eye Hospital, UK;University College London, UK.
    Aslam, Tariq
    University of Manchester, UK;Manchester Royal Eye Hospital, UK.
    Costa, Emilia
    University of Porto, Portugal.
    Psychological and Psychosocial Interventions for Depression and Anxiety in Patients with Age-Related Macular Degeneration: A Systematic Review2019In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 27, no 8, p. 755-773Article, review/survey (Refereed)
    Abstract [en]

    Purpose To review the current literature on psychosocial and psychological interventions to prevent and treat depression and anxiety in patients with age-related macular degeneration (AMD). Methods We conducted a systematic review of literature evaluating psychosocial and psychological interventions for depression and anxiety in AMD patients. Primary searches of PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were conducted to include all papers published until April 21st. 2018. Results Of a total of 398 citations retrieved, we selected 12 eligible studies published between 2002 and 2016. We found 9 randomized controlled trials (RCT), and 3 non-randomised intervention (NRI) studies. RCT studies suggested that interventions using group self-management techniques, and individual behavioural activation plus low vision rehabilitation can be effective to treat and prevent depression in AMD patients, and one study suggested that a stepped-care intervention using cognitive-behavioural techniques can be effective to manage anxiety and depression over time. NRI studies highlighted a positive effect of self-help and emotion-focused interventions to reduce depression. Conclusions Clinical practice with AMD patients can rely on some tailored cognitive-behavioural therapeutic protocols to improve patients’ mental health, but further clinical trials will generate the necessary evidence-based knowledge to improve those therapeutic techniques and offer additional tailored interventions for AMD patients.

  • 44.
    Silva, André
    et al.
    University of Minho, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Albuquerque, Pedro B.
    University of Minho, Portugal.
    Joana, Arantes
    University of Minho, Portugal.
    Always on My Mind? Recognition of Attractive Faces May Not Depend on Attention2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, p. 1-14, article id 53Article in journal (Refereed)
    Abstract [en]

    Little research has examined what happens to attention and memory as a whole when humans see someone attractive. Hence, we investigated whether attractive stimuli gather more attention and are better remembered than unattractive stimuli. Participants took part in an attention task – in which matrices containing attractive and unattractive male naturalistic photographs were presented to 54 females, and measures of eye-gaze location and fixation duration using an eye-tracker were taken – followed by a recognition task. Eye-gaze was higher for the attractive stimuli compared to unattractive stimuli. Also, attractive photographs produced more hits and false recognitions than unattractive photographs which may indicate that regardless of attention allocation, attractive photographs produce more correct but also more false recognitions. We present an evolutionary explanation for this, as attending to more attractive faces but not always remembering them accurately and differentially compared with unseen attractive faces, may help females secure mates with higher reproductive value.

  • 45.
    Soares, Ana Paula
    et al.
    University of Minho, Portugal.
    Oliveira, Helena
    University of Minho, Portugal.
    Ferreira, Marisa
    University of Minho, Portugal.
    Comesaña, Montserrat
    University of Minho, Portugal.
    Macedo, António Filipe
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. University of Minho, Portugal.
    Ferré, Pilar
    Univ Rovira & Virgili, Spain.
    Acuña-Fariña, Carlos
    Univ Santiago Compostela, Spain.
    Hernández-Cabrera, Juan
    Univ La Laguna, Spain.
    Fraga, Isabel
    Univ Santiago Compostela, Spain.
    Lexico-syntactic interactions during the processing of temporally ambiguous L2 relative clauses: An eye-tracking study with intermediate and advanced Portuguese-English bilinguals2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 5, p. 1-27, article id e0216779Article in journal (Refereed)
    Abstract [en]

    There is extensive evidence showing that bilinguals activate the lexical and the syntactic representations of both languages in a nonselective way. However, the extent to which the lexical and the syntactic levels of representations interact during second language (L2) sentence processing and how those interactions are modulated by L2 proficiency remain unclear. This paper aimed to directly address these issues by using an online technique (eye-tracking) that is highly sensitive to the lexical and syntactic processes involved in sentence reading. To that purpose, native-speakers of European Portuguese (EP) learning English as L2 at intermediate and advanced levels of proficiency were asked to silently read temporally ambiguous L2 relative clause (RC) sentences disambiguated with a High-Attachment (HA) or Low-Attachment (LA) strategy while their eye-movements were monitored. Since EP and English native speakers differ in the way they process and comprehend this syntactic structure (EP: HA, English: LA), HA preferences were used as a marker of L1 RC syntax interference. Additionally, the cognate status of the complex NP that preceded the RC was manipulated to further analyze how the lexical co-activation of both languages would also affect the syntactic representations of the non-target (L1) language. Results showed cognate facilitation in early and late reading time measures regardless of L2 proficiency, and also that the cognate status of the complex NP impacted L2 reading performance, particularly at lower levels of L2 proficiency. These findings provide compelling evidence for a bilingual reading system that seems to be highly dynamic and interactive not only within each level of processing, but, importantly, across levels of representation. They also suggested that, as the level of L2 proficiency increases, L1 RC syntax interference becomes stronger, in a syntactic parser that seems to operate in a more integrated and nonselective way, with both strategies being equally available to guide L2 reading comprehension. Results are discussed attending to the current models of bilingual syntactic processing.

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