Este trabalho apresenta um sistema computacional que utiliza técnicas de Aprendizado de Máquina (AM) para auxiliar o diagnóstico oftalmológico. Trata-se de um sistema de medidas objetivas e automáticas dos principais vícios de refração ocular, astigmatismo, hipermetropia e miopia. O sistema funcional desenvolvido aplica técnicas convencionais de processamento a imagens do olho humano fornecidas por uma técnica de aquisição chamada Hartmann-Shack (HS), ou Shack-Hartmann (SH), com o objetivo de extrair e enquadrar a região de interesse e remover ruídos. Em seguida, vetores de características são extraídos dessas imagens pela técnica de transformada wavelet de Gabor e, posteriormente, analisados por técnicas de AM para diagnosticar os possíveis vícios refrativos presentes no globo ocular representado. Os resultados obtidos indicam a potencialidade dessa abordagem para a interpretação de imagens de HS de forma que, futuramente, outros problemas oculares possam ser detectados e medidos a partir dessas imagens. Além da implementação de uma nova abordagem para a medição dos vícios refrativos e da introdução de técnicas de AM na análise de imagens oftalmológicas, o trabalho contribui para a investigação da utilização de Máquinas de Vetores Suporte e Redes Neurais Artificiais em sistemas de Entendimento/Interpretação de Imagens (Image Understanding). O desenvolvimento deste sistema permite verificar criticamente a adequação e limitações dessas técnicas para a execução de tarefas no campo do Entendimento/Interpretação de Imagens em problemas reais. / This work presents a computational system that uses Machine Learning (ML) techniques to assist in ophthalmological diagnosis. The system developed produces objective and automatic measures of ocular refraction errors, namely astigmatism, hypermetropia and myopia from functional images of the human eye acquired with a technique known as Hartmann-Shack (HS), or Shack-Hartmann (SH). Image processing techniques are applied to these images in order to remove noise and extract the regions of interest. The Gabor wavelet transform technique is applied to extract feature vectors from the images, which are then input to ML techniques that output a diagnosis of the refractive errors in the imaged eye globe. Results indicate that the proposed approach creates interesting possibilities for the interpretation of HS images, so that in the future other types of ocular diseases may be detected and measured from the same images. In addition to implementing a novel approach for measuring ocular refraction errors and introducing ML techniques for analyzing ophthalmological images, this work investigates the use of Artificial Neural Networks and Support Vector Machines (SVMs) for tasks in Image Understanding. The description of the process adopted for developing this system can help in critically verifying the suitability and limitations of such techniques for solving Image Understanding tasks in \"real world\" problems.

This is a study on the prevalence of refractive errors and patients requiring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and OR Tambo District Municipalities of the Eastern Cape. This is an area characterised by extreme poverty where the cost of an eye examination and prescription spectacles remains financially unobtainable for most. Optometry services are provided mainly by private optometrists who service the small proportion of the population that can afford them. Adults and children remain house bound or are labelled as dull and unproductive simply because they don’t have access to an eye examination and a pair of spectacles. Purpose The purpose of the study is to identify patients with refractive errors and those requiring refractive services at the 15 eye clinics in the Eastern Cape. Another purpose is to describe the refractive services that are available to patients attending health facilities, where the eye clinics are conducted. Lastly, the purpose is to explore the possibility of nurses providing refractive services independently or under the supervision of optometrists to supplement the lack to refracting and dispensing services. Study Method A quantitative and qualitative non-experimental descriptive design was used. Research involved the analysis of Vision Care’s eye clinic records collected from 15 eye clinics from January 2010-June 2010. Semi-structured interviews were conducted with 30 nurses working at the 15 health facilities where the eye clinics were conducted using purposive sampling. The quantitative data was analysed using excel spreadsheets and graphs and qualitative data was analysed using coding and categorizing methods. Conclusion According to Vision Care’s data of the patients assessed, 19.2 percent had a refractive error and 54 percent of the patients required refractive services. It is estimated that 71.41 percent of the patients had a refractive error according to the optometrist. Although there were some organisations active in the eradication of cataracts, there was little healthcare available in the form of refraction services. xiv Patients needed to travel an average of 63.8kms to access refraction services against the backdrop of poor roads, poverty and unemployment. 28 out of 30 nurses either ‘strongly agreed’ or ‘agreed’ that nurses could be trained to perform refractions and dispense spectacles. 29 out of 30 nurses thought that this would have a positive impact on eye care. Further research is necessary to assess the feasibility of implementing a nurse operated refractive program and whether it should be within their scope of practice to refract and dispense spectacles.

En 2017, il n'est plus nécessaire de se rappeler un numéro de téléphone par cœur, de patienter gentiment pour goûter les fruits et légumes de saison ou d'attendre quelqu’un à la gare avec impatience sans avoir eu de ses nouvelles : les émotions sont d'avantage liées à des moyens de communication bien plus immédiats. Le rythme naturel du temps qui passe dans nos vies semble s’apparenter pour l'homme (et pour la femme) du nouveau millénaire, davantage à une accélération effrénée et constante, une course contre le temps, dans l'illusion d'un monde instantané, hyper-rapide, super efficace : un monde « smart ». De cette manière, plutôt que d'écouter et de respecter le rythme naturel de notre respiration, de notre corps, nous choisissons à chaque instant de courir toujours plus vite, dans l'illusion omnipotente de gagner la course contre le temps, l'infaillible gardien de notre existence. Nous exprimons le désir d'être constamment connecté, créant l'illusion de l'hyper-présence. L'évolution technologique a radicalement transformé notre style de vie, notre manière de communiquer, notre propre expérience humaine et émotive. Si d'un côté la révolution technologique à laquelle nous appartenons, et dont nous continuons à en être les acteurs a permis la transformation globale des processus de communication de masse, celle-ci a en même temps permis l'émergence de nouvelles fragilités et la manifestation évidente de psychopathologies en relation à Internet. C’est à partir de la consultation de plus de 240 articles scientifiques internationaux et avec les données fournies sur la prévalence de ces nouvelles formes d’addiction en Asie (le continent technologiquement plus avancé et concerné à ce sujet), que le comité scientifique APA (American Psychiatric Association – Société Américaine de Psychiatrie) a décidé d’introduire l’Internet Gaming Disorder dans la dernière version du DSM, en Mai 2013. Le domaine de l’addiction à Internet est une frontière extrêmement emmêlée et complexe qui représente un nœud névralgique des discussions d'une partie de la communauté scientifique internationale. Voraces et habiles consommatrices des nouvelles technologies, les nouvelles générations sont particulièrement exposées au risque de développer ces nouvelles formes de dépendance. Il est nécessaire que la communauté scientifique internationale s'interroge sur de nouvelles stratégies d'intervention pour pouvoir intercepter et accueillir ces formes de malaise juvénile, qu’elle sache les définir pour les identifier et les soigner grâce à des protocoles d'intervention pour répondre de manière toujours plus efficace aux besoins réels des ces jeunes consommateurs. D'où l’intérêt de développer des projets de recherche portant sur ce sujet. Cette thèse, décrit donc un problème en émergence et la proposition d’une approche thérapeutique possible face à ces nouvelles formes d’addiction avec les arts thérapies, plus précisément avec la dramathérapie. Le cadre expérimental de cette thèse s’articule en deux parties : la première partie correspond à l’étude des répercussions physiologiques notamment sur la variation des compétences visuelles par rapport à un usage abusif ou addictif des écrans. Cette étude, qui constitue la principale expérience psychopédagogique de prévention de cette thèse, a été adressée à 250 adolescents italiens sains. La deuxième partie est une expérience clinique de prise en charge des addictions à Internet, auprès d’un public de 13 adolescents et jeunes adultes atteints du syndrome d’Asperger, addictifs aux jeux vidéo. Un dernier projet de dramathérapie adressé à des adolescents et des jeunes adultes, souffrant d’addiction aux substances constitue l’ouverture du regard clinique face aux comorbidités possibles qui caractérisent la pratique clinique de notre champ d’étude. (...) / In 2017, there is no longer a need to remember a phone number by heart, wait for the right time to taste seasonal fruit or vegetables, or wait for someone at the station without having news briefly before hugging him on the train quay Emotions are more closely related to much more immediate communication flows. The natural rhythm of time flowing in our lives seems to be synonymous for the man (and the woman) of the new millennium of a frantic and constant acceleration against time, in the illusion of a flashy world, super-fast, super-efficient: a smart world. In this way, instead of listening to and respecting the natural rhythm of our breath, our body, we choose at any time to run faster and faster, in the omnipotent illusion of winning the race against time, the unreliable guardian of our existence. We express the desire to be constantly connected, creating the illusion of hyper-presence. Technological development has radically changed our lifestyle, our way of communicating, our human and emotional, individual and collective experience. On the one hand, the technological revolution has allowed the global transformation of the mass communication process and is an inexhaustible source of knowledge and discovery; not to be demonized but to be explored with intelligence and curiosity; it has at the same time led to the emergence of new vulnerabilities and manifestations of Internet-related psychopathological discomfort. It is through the consultation of over 240 international scientific articles and data on the prevalence of these new forms of dependence in Asia (the continent most technologically advanced and involved in this regard), that the American Psychiatric Association (APA) decided to introduce the Internet Gaming Disorder in its latest version of the DSM (Diagnostic and Statistical Manual of Mental Disorders) in May 2013. The field of Internet addiction is an extremely tangled and complex border that represents a nerve node discussion in part of the international scientific community. Voracious consumers and clever users of new technologies, that is the new generations, seem to be particularly at risk of developing these dependencies. This is why it is important to develop research projects and it is urgent to propose psycho-educational prevention projects for the adolescent population. This thesis describes an emergency problem and the proposal of a possible approach facing these new addiction forms through arts therapies, more precisely through dramatherapy. The experimental part of this thesis is articulated in two parts: the first one corresponds to the study of physiological repercussion on variations of visual skills related to the use or abuse of screen use.This study, that represents the psycho pedagogical and prevention experience of this thesis, was addressed to 250 Italian sound teenagers. The second part consists of a clinical experience of cure of Internet addiction addressed to 13 video games addicted adolescents and young adults with Asperger syndrome. A further project of dramatherapy addressed to drugs addicted adolescents and young adults represents a clinical perspective in front of possible comorbidities that characterize the clinical practice in our field of study. The dramatherapy approach in the field of prevention and cure of web related addictions is considered regarding two important aspects: the recovery and reclamation of the body and sensory experience (size altered in the virtual experience facing the monitors) and the possibility to expose the person to a gaming experience through a shared transitional space. The body dimension, completely abandoned or altered in the virtual experience, is recovered and exalted through dramatherapy. The therapeutical approach is born, grows and develops in the body. In our view the stage represents the appropriate mediation between the virtual space of the abuse and real space of existence. (...)

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Syfte: Syftet med denna studie var att undersöka aktuell praxis bland optikeri Sverige vad gäller evidensbaserat arbete för att främja god compliance hoskontaktlinspatienter, samt att belysa de eventuella områden där optiker iSverige kan förbättra sitt arbete i ovan nämnda avseende. Metod: En online-baserad enkät med 28 frågor togs fram och delades medOptikerförbundets medlemmar samt via Facebookgruppen Optikforum. Svaren sammanställdes och analyserades. Utvalda frågor poängsattes därmaxpoäng innebar “godkänt”, alltså att deltagaren alltid gör det somefterfrågas i enkäten, i enlighet med Kvalitetsnorm i synvården. Resultat: Antal svarande var 196, varav 190 inkluderades. 108 av dessaarbetade självständigt, alltså utan delegation till annan personal, vidnytillpassning, återbesök samt årskontroll vid kontaktlinstillpassning, ochpoängsattes därför. 24% av de 108 erhöll full poäng och ansågs arbetaevidensbaserat för att främja god kontaktlinsrelaterad compliance. Områdendär dessa 108 optiker fick lägst poäng, och således skulle kunna förbättra sittarbete för att främja kontaktlinsrelaterad compliance, var informerande av:vikten av egenkontroll av ögonen, vikten av rätt skötselrutin om patientenanvänder smink, hur länge kontaktlinserna bör gnuggas samt vikten avlinsvila. Hos de samtliga 190 inkluderades svar framkom att 4 av 5 optiker isamband med årskontroll aldrig eller sällan ber sina patienter att visa hur derengör sina kontaktlinser, eller ber sina patienter visa hur de sätter i- och tarur sina kontaktlinser. Slutsats: Alla optiker i denna studie arbetade inte helt och hålletevidensbaserat. Denna studie visade att optiker i Sveriges arbete med attfrämja kontaktlinsrelaterad compliance kan förbättras, bland annat vad gällertillhandahållande av patientinformation. Detta kan bidra till ökad compliancehos denna patientgrupp, vilket i sin tur kan minska risken förkontaktlinsrelaterade komplikationer. Ökad tillgång till extra utbildning omkontaktlinser för optikerna skulle också kunna förbättra detta arbete. / Purpose: The purpose of this study was to investigate current practiceamongst optometrists in Sweden regarding evidence-based work toencourage compliance in their contact lens patients. Moreover, to highlightthe potential areas where the optometrists possibly could improve their workwithin the field of encouraging contact lens-related compliance. Method: An online based survey was developed and shared with membersof the Swedish Optometrists’s Association, Optikerförbundet, and theFacebook-group ‘Optikforum’. The responses were compiled and analysed.Selected questions were scored, where the maximum score amounted to a“passing grade”, meaning that the participant always does what is requestedin the questionnaire, in accordance with the Quality Norm of vision care. Result: The number of respondents was 196, of which 190 were included.108 of these worked independently, i.e. without delegation to other staff,during new fitting, return visits and annual control during contact lens fitting,and were therefore scored. 24% of the 108 received full points and wereconsidered to be working evidence-based to encourage contact lens-relatedcompliance. Areas where these 108 opticians scored the lowest, and thuscould improve their work to encourage contact lens-related compliance, wereinformative of: the importance of self-examination of the eyes, theimportance of the correct care routine if the patient wears make-up, how longthe contact lenses should be rubbed and the importance of contact lens rest.In the responses of all 190 included, it emerged that 4 out of 5 opticians inconnection with the annual check-up never or rarely ask their patients toshow how they clean their contact lenses, nor ask their patients to show howthey put in and take out their contact lenses. Conclusion: All optometrists in this study were not always working in anevidence-based manner. This study showed that optometrists in Sweden’swork to encourage contact lens-related compliance can be improved, one ofthem being in terms of providing patient information. This can contribute toincreased compliance in this patient group, which in turn can reduce the riskof contact lens-related complications. Increasing the amount of extraeducation for the optometrists regarding contact lenses, could also improvetheir work in this regard.