Studies examining impaired emotion recognition and perceptual processing in autism spectrum disorders (ASD) show inconsistent results (Harms, Martin, & Wallace, 2010; Jemel, Mottron, & Dawson, 2006), and many of these studies include eye tracking data. The current study utilizes a novel task, emotion recognition of a dynamic talking face with sound, to compare children with ASD (n=8; aged 6-10, 7 male) with mental age (MA) and gender matched controls (n=8; aged 4-10, 7 male) on an emotion identification and eye tracking task. Children were asked to watch several short video clips (2.5-5 seconds) portraying the emotions of happy, sad, excited, scared, and angry and identify the emotion portrayed in the video. A mixed factorial ANOVA analysis was conducted to examine group differences in attention when viewing the stimuli. Differences in emotion identification ability were examined using a t-test and Fisher's exact tests of independence. Findings indicated that children with ASD spent less time looking at faces and the mouth region than controls. Additionally, the amount of time children with ASD spent looking at the mouth region predicted better performance on the emotion identification task. The study was underpowered; however, so these results were preliminary and require replication. Results are discussed in relation to natural processing of emotion and social stimuli. <i>[revised ETD per Dean DePauw 10/25/12 GMc]</i> / Master of Science

Yes / Background: Small-area analysis of National Health Service (NHS)-funded sight test uptake in Leeds showed significant inequalities in access among people aged <16 or ≥60. Methods: Data were extracted from 604 126 valid General Ophthalmic Services (GOS)1 claim forms for eye examinations for Essex residents between October 2013 and July 2015. Expected GOS1 uptake for each lower super output area was based on England annual uptake. Poisson regression modelling explored associations in GOS1 uptake ratio with deprivation. Results: People aged ≥60 or <16 living in the least deprived quintile were 15% and 26%, respectively, more likely to have an NHS funded eye examination than the most deprived quintile, although all are equally entitled. GOS1 uptake is higher in the more deprived quintiles among 16-59-year old, as means tested social benefits are the main eligibility criteria in this age-group. Inequalities were also observed at local authority level. Conclusions: Inequalities in access among people ≥60 years were not as large as those reported in Leeds, although inequalities in <16-year old were similar. However, demonstrable inequalities in this data set over a longer time period and a larger and more diverse area than Leeds, reinforce the argument that interventions are needed to address eye examination uptake inequalities. / The College of Optometrists.

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)

Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p&lt0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p &lt 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (&gt -10.00 D) can be over 1.00 D.

Die Kombination von Eyetracking und fMRI in den Neurowissenschaften ist eine relativ neue Methode, die einerseits eine technische Herauforderung darstellt, andererseits neue Möglichkeiten des Zugangs zu neuronalen Prozessen darbietet. In der vorliegenden Arbeit wurden durch Kombination beider Methoden Prozesse der neuronalen und visuellen Verarbeitung von Emotionen untersucht. Zunächst wurde die Rolle von verschiedenen Gehirnregionen innerhalb des emotionalen Netzwerks sowie die Frage nach der Lateralität der emotionalen Verarbeitung untersucht. Die Ergebnisse zeigten, dass die neuronale Antwort in den unterschiedlichen Regionen in erster Linie die Anforderungen an die jeweilige funktionelle Einheit spiegelt. Im Rahmen der Untersuchungen von visueller Verarbeitung wurden die einzelnen spezifischen Blickbewegungsmuster für Emotionen Angst, Ekel und Freude erstmals charakterisiert. Es wurden auch Habituationseffekte auf die beschriebenen Blickbewegungsmuster untersucht. Die gemeinsame Analyse beider Datensätze zeigte, dass zwischen visuellen und neuronalen Prozessen eine enge qualitative Interaktion besteht. Es wurde ein Zusammenhang zwischen der Betrachtungsdauer und der tiefe der Verarbeitung nachgewiesen.

Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p&lt0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p &lt 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (&gt -10.00 D) can be over 1.00 D.

Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p&lt0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p &lt 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (&gt -10.00 D) can be over 1.00 D.

Purpose: To improve the predictability, accuracy and stability of laser in-situ keratomileusis (LASIK), by evaluating the clinical, procedural and tissue response factors that affect refractive outcomes. Methods: Myopic LASIK surgeries (n=5,978) were carried out using the Technolas planoscan and Nidek EC-5000 excimer lasers. Clinical variables associated with a refractive outcome of within ??0.50 D of the target were identified using regression analysis. Possible procedural variations such as the timing of the procedure and accuracy of both the chosen keratome and excimer laser were evaluated. The predictability and accuracy of the ablation was assessed by measuring changes in corneal thickness during and after the procedure. Factors influencing the stability of refractive outcome were assessed. Results: Clinical factors associated with a refractive outcome of within ??0.50 D of the target included; corrections less than 5.00 DS (OR 0.21x, 95% CI 0.11-0.40x compared with corrections over -5.00 DS[referent]), patients younger than 40 years (patients over 50 OR 8.27x, 95% CI 3.41-20.03x, patients 40 to 50 years OR 1.93x, 95% CI 0.96-3.90x, compared with patients under 40[referent]) and average pre-operative curvatures between 43.50 and 45.50D (OR 0.39x, 95% CI 0.18-0.83 compared with curvatures of less than 43.50D [referent]). Refractive stability was improved using optic zone sizes between 5.5-6.0 mm, reduced myopic corrections, flatter pre-operative corneal curvatures and thicker corneal flaps (R??=25%, p&lt0.001). Procedural factors associated with poorer outcomes included: thinner measured flap thickness, deeper ablations and the use of the automated corneal shaper (ACS) microkeratome with a novice surgical team (R??=34%, p &lt 0.001). Delaying the ablation from 20 to 90 seconds (s) after flap lift was associated with a more stable refractive outcome at three months (p=0.017). In the 90 s following flap lift, the cornea thinned by 5??3%. The ablation rate per scan varied between procedures, however, the effect on refractive outcome was small (r=0.15, p=0.267). Changes in central corneal thickness indicated refractive stability (p=0.039). Conclusions: Applying the optimal clinical and procedural factors as described afforded a refractive outcome in a further 8% of cases, resulting in 94% to 96% of cases within ??0.50 DS of target. Refractive predictability was limited due to the inability of the keratome to produce a consistent corneal flap thickness and unexpected changes in corneal thickness. The accuracy of refractive outcome will decrease with larger ablations. The degree of refractive inaccuracy with high refractive corrections (&gt -10.00 D) can be over 1.00 D.

Assessment and diagnosis of dry eye disease (DED) is a challenging task. The conventional ways of diagnosing DED are problematic due to their invasiveness, poor test reliability and significant test duration. Previously, ocular surface thermography has been shown to be able to detect early inflammation and dry eye. However, its diagnostic ability and ocular temperature metrics that can best diagnose DED are not clear. The objectives of this thesis were manyfold. First, the prevalence of dry eye in Singapore population was investigated as a helpful basis for the rest of the project. A cross-sectional dry eye survey was carried out using McMonnies dry eye questionnaire. Members of the public were interviewed at 46 (out of 62) selected mass rapid transit stations in Singapore and its vicinity. 1004 questionnaires were collected from participants aged 15 - 83 years and various ethnicity. Prevalence of symptomatic dry eye (SDE) was found to be 12.3% (about 0.5 million Singaporeans). Risk factors associated with SDE were found to be age, gender, ethnicity, hypertension and contact lens wear. Smoking was not associated with SDE.The main part of this thesis sought to evaluate the efficacy of ocular thermography in diagnosing DED. A new infrared detector (NEC Thermo Tracer TH 9260) with relatively high resolution was used. Inter-image, inter-occasion and inter-examiner repeatability was first studied on 21 healthy and 15 DED subjects. Ocular surface marking and ocular surface temperature (OST) acquisition was performed with a novel 'diamond' method using a custom-designed OST analysis V2 software. Ten out of the twelve tested OST indices were shown to be highly repeatable for three studied time points: 0 s, 5 s and 10 s. They were temperatures of the geometric center of the cornea (GCC), mean temperature (MOST) of the region of interest (ROI), maximum (MaxT) and minimum (MinT) temperatures of the ROI, extreme temporal (T1) and nasal conjunctiva (T4), mid temporal (CT) and nasal conjunctiva (CN) and temporal (LT) and nasal limbal (LN). Another 62 DED and 63 age- and sex-matched controls were then recruited and the ten static and dynamic OST indices were evaluated. Static measures were study of absolute OST at t = 0 s, 5 s and 10 s after eye opening. Dynamic measures were study of mean change and net change in OST over 10 s of sustained eye opening. Static measures on eight OST indices (GCC, MOST, MinT, MaxT, T4, CT, LT and LN) at t = 0 s, 5 s and 10 s and dynamic measures on two OST indices (T4 at 3 s onward and MaxT at 5 s onward) were found to be valuable in detecting DED. The temperature metrics (static and dynamic) were identified for further investigation. Thereafter, the diagnostic ability of the temperature metrics were evaluated singly and as combinations in terms of their area under the curve (AUC), Youden index and discrimination power. Receiver operating characteristic curves were plotted for each metric. Best detectors for DED were found to be the T4 temperature metrics: particularly T4-5 and T4-10 (i.e. absolute temperature of the extreme nasal conjunctiva at 5 s and 10 s). Values of T4-5 of < 34.8 °C were found to give sensitivity and specificity of 87.1% and 50.8% respectively and values of T4-10 of < 34.6 °C were found to give sensitivity and specificity of 77.6% and 61.9% respectively. The two temperature metrics had highest Youden index as compared to other metrics and were shown to be useful in view of AUC > 70% but of limited performance in view of their discrimination power. Nevertheless, measuring T4-5 and T4-10 was found to be comparable to other conventional methods for DED. T4-10 was better than T4-5 in view of higher AUC and Youden index. None of the tested dynamic metrics was good detector for DED and combining metrics were not able to increase the diagnostic ability. The last part of this thesis was to validate the effectiveness of some common conventional dry eye tests, to study their correlation with T4 temperature metrics and derive the best composite/combined tests for DED. Sixty two DED patients and 82 controls were studied. The conventional clinical tests examined were: symptom evaluation using McMonnies dry eye questionnaire (Mscore) and symptom count (Scount), fluorescein break-up time (FBUT) and corneal epithelial staining (CES), non-invasive break-up time (NIBUT) and tear meniscus height (TMH). Mscore and Scount was the best detectors for DED, followed by FBUT and CES. Discordance between signs and symptoms for DED was further confirmed. Combining CES with T4-10 (series) can be future objective tests for DED. Further research is warranted, particularly to (1) validate the ability of T4-10 as a stand-alone test for DED and (2) work out an algorithm and validate the diagnostic ability of the recommended combined test (CES and T4-10) using newly recruited subjects.

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)