Yes / Purpose. A recent study suggested that updated spectacles could increase falls rate in older people. We hypothesized that this may be due to changes in spectacle magnification and this study assessed the effects of spectacle magnification on adaptive gait. Methods. Adaptive gait and visual function was measured in 10 older adults (mean age 77.1 ¿ 4.3 years) with the participants¿ optimal refractive correction and when blurred with +1.00DS, +2.00DS, -1.00DS and -2.00DS lenses. Adaptive gait measurements for the lead and trail foot included foot position before the step, toe clearance of the step edge and foot position on the step. Vision measurements included visual acuity, contrast sensitivity and stereoacuity. Results. The blur lenses led to equal decrements in visual acuity and stereoacuity for the +1.00DS and -1.00DS and the +2.00DS and -2.00DS lenses. However, they had very different effects on adaptive gait compared to the optimal correction: Positive blur lenses led to an increased distance of the feet from the step, increased vertical toe clearance and reduced distance of the lead heel position on the step. Negative lenses led to the opposite of these changes. Conclusion. The adaptive gait changes did not mirror the effects of blur on vision, but were driven by the magnification changes of the lenses. Steps appear closer and larger with positive lenses and further away and smaller with negative ones. Magnification likely explains the mobility problems some older adults have with updated spectacles and after cataract surgery. / Federation of Ophthalmic and Dispensing Opticians

Purpose. To determine whether gait alterations due to monocular spherical lens blur were a safety strategy or driven by lens magnification. Methods. Adaptive gait and visual function were measured in 10 older adults (mean age, 74.9 4.8 years) with the participants¿ optimal refractive correction and when monocularly blurred with 1.00 DS and 2.00 DS lens over the dominant eye. Adaptive gait measurements for the lead and trail foot included foot position before the raised surface, toe clearance of the raised surface edge, and foot position on the raised surface. Vision measurements included binocular visual acuity, contrast sensitivity, and stereoacuity. Results. Equal levels of monocular positive and negative spherical lens blur led to very different stepping strategies when negotiating a raised surface. Positive blur lenses led to an increased vertical toe clearance and reduced distance of the lead foot position on the raised surface. Negative lenses led to the opposite of these changes. Conclusions. Findings suggest that step negotiation strategies were driven by the magnification effect provided by the spherical lenses. Steps appeared closer and larger with magnification from positive lenses and further away and smaller with minification from negative lenses and gait was adjusted accordingly. These results suggest that previously reported adaptive gait changes to monocular spherical lens blur were not safety strategies as previously suggested but driven by lens magnification. The significance of these findings in terms of prescribing large refractive changes in frail older patients is discussed.

Clinicians are becoming increasingly aware of the effect of various pathologieso n the characteristicso f saccadice ye movements.A s such, an efficient and non-invasivem eano f measuringe ye-movementisn a clinical environmenti s of interest to many. The aim of this thesis is to investigate the clinical application of a non-invasive eye movement recording technique as a part of a clinical examination. Eye movements were measured using an IRIS 6500 infrared limbal eye tracker, which we customized for the direct recording of oblique eye movements as well as horizontal and vertical. Firstly, the eye-tracker itself was assessed. Visually normal observers made saccadic eye movements to a 10' stimulus in eight directions of gaze. Primary (ANOVA) and secondary analyses (mean error less than 5%) resulted in acceptance that averaging four measurements would give a representative measurement of saccadic latency, peak velocity, amplitude and duration. Test-retest results indicated that this technique gives statistically (± 1.96*STDEVDifference) repeatable responses. Severalf actors that could potentially influence clinically basedm easureso f eye-movementsw ere examined. These included, the effect of ageing, viewing distances, dioptric blur and cataract. The results showed that saccadic latency and durationa re significantly (p< 0.05) longer in older (60-89 years)o bserversc ompared to younger (20-39 years). Peak velocity and amplitude were not significantly affectedb y the age of the observer.A ll saccadicp arameters( SP) were significantly affected by direction (Chapter 5). The compact nature of this eye movement methodology is obtainable since there is no significant effect on viewing distance (300 cm vs. 49 cm) (Chapter 6). There is also no significant effect of dioptric blur (up to +LOODS) on any of the four SP. In contrast, a higher level of defocus (+3.O ODS)h as a larger probability of interfering with the measurementso f peak velocity and duration (Chapter 7). Saccadice ye-movementsw ere also recorded whilst normally sighted subjects wore cataract simulation goggles. The results suggested that the presence of dense cataract introduces significant increases in saccadic latencies and durations. No effect was found on the peak velocities and amplitudes.T he effect of amblyopiao n SP was also investigatedin order to examine if this methodologyi s able to detectn ormal from abnormalr esponses(i . e. increased saccadicla tencies).T his set of data (Chapter9 ) showedt hat using IRIS 6500, longer than normal latencies may be recorded from the amblyopic eye but no consistent effect was found for the other SP (peak velocity, amplitude, duration). overall, the results of this thesis demonstrateth at the IRIS 6500 eye-tracker has many desirable elements (it is non-invasive; comfortable for the observers and gives repeatable and precise results in an acceptable time) that would potentially make it a useful clinical tool as a part of a routine examination.

Clinicians are becoming increasingly aware of the effect of various pathologies on the characteristics of saccadic eye movements. As such, an efficient and non-invasive means of measuring eye-movement in a clinical environment is of interest to many. The aim of this thesis is to investigate the clinical application of a non-invasive eye movement recording technique as a part of a clinical examination. Eye movements were measured using an IRIS 6500 infrared limbal eye tracker, which we customized for the direct recording of oblique eye movements as well as horizontal and vertical. Firstly, the eye-tracker itself was assessed. Visually normal observers made saccadic eye movements to a 10' stimulus in eight directions of gaze. Primary (ANOVA) and secondary analyses (mean error less than 5%) resulted in acceptance that averaging four measurements would give a representative measurement of saccadic latency, peak velocity, amplitude and duration. Test-retest results indicated that this technique gives statistically (± 1.96*STDEVDifference) repeatable responses. Several factors that could potentially influence clinically based measures of eye-movements were examined. These included, the effect of ageing, viewing distances, dioptric blur and cataract. The results showed that saccadic latency and duration are significantly (p < 0.05) longer in older (60-89 years) observers compared to younger (20-39 years). Peak velocity and amplitude were not significantly affected by the age of the observer. All saccadic parameters (SP) were significantly affected by direction (Chapter 5). The compact nature of this eye movement methodology is obtainable since there is no significant effect on viewing distance (300 cm vs. 49 cm) (Chapter 6). There is also no significant effect of dioptric blur (up to +LOODS) on any of the four SP. In contrast, a higher level of defocus (+3.O ODS) has a larger probability of interfering with the measurements of peak velocity and duration (Chapter 7). Saccadic eye-movements were also recorded whilst normally sighted subjects wore cataract simulation goggles. The results suggested that the presence of dense cataract introduces significant increases in saccadic latencies and durations. No effect was found on the peak velocities and amplitudes. The effect of amblyopia on SP was also investigated in order to examine if this methodology is able to detect normal from abnormal responses (i.e. increased saccadic latencies). This set of data (Chapter9 ) showed that using IRIS 6500, longer than normal latencies may be recorded from the amblyopic eye but no consistent effect was found for the other SP (peak velocity, amplitude, duration). Overall, the results of this thesis demonstrate that the IRIS 6500 eye-tracker has many desirable elements (it is non-invasive; comfortable for the observers and gives repeatable and precise results in an acceptable time) that would potentially make it a useful clinical tool as a part of a routine examination.