PURPOSE. The present study investigated retinal integrity in high myopia using spatial psychophysical tasks. METHODS. Ten axial high myopes (Ϫ8.5 to Ϫ11.5 D) and 10 age-matched control subjects (Ϯ1.0 D) were recruited. All participants underwent clinical examination and ocular biometry and demonstrated no visible macular disease with visual acuities better than 6/12. Foveal summation thresholds were determined for white and S-cone-isolating spots of various diameters up to 5.4°and spatial contrast sensitivity to luminance sine wave gratings (0.5-9.7 cyc/deg). Data were analyzed after correction for the magnification induced by eye size and correcting lens power. RESULTS. Spatial summation for both white and S-cone-isolating spots showed a generalized loss of sensitivity at all spot sizes in myopes relative to control subjects (P ϭ 0.01). Critical areas at maximum summation were significantly larger in myopes, for S-cone isolating spots only, after image size correction (P ϭ 0.048). Sensitivity at maximum summation correlated negatively with vitreous chamber depth for both targets (P ϭ 0.005). Sensitivities for S-cone and luminance spots also correlated (P Ͻ 0.001), indicating widespread dysfunction. Myopes displayed contrast sensitivity losses at high spatial frequencies (P Յ 0.006) with a normal peak contrast sensitivity. CONCLUSIONS. These data can be interpreted to indicate that highly myopic eyes have either (1) a reduction in the number of receptors and/or a reduction in their sensitivity or, (2) a reduction in the sensitivity of postreceptoral processes. The presence of normal contrast sensitivity at low spatial frequencies indicates dysfunction at a postreceptoral level in high myopes. (Invest Ophthalmol Vis Sci. 2006;47:3695-3702) M yopia is a common refractive condition, which occurs due to an excessive axial enlargement of the eye that is not coordinated with the power of the eye's optical surfaces. The resultant visual image of distant objects is formed in front of the photoreceptor plane. This excessive axial enlargement is largely accounted for by increased vitreous chamber depth, as little abnormal change is found in anterior chamber depth or lens thickness in high myopia. 1High myopia is usually defined as myopia in excess of 6 D, equating to an eye length of between 25 and 26 mm. The prevalence of high myopia in the general population is approximately 3% 2 ; however, the prevalence is as high as 16% in certain Southeast Asian populations. 3 One of the most important manifestations of high degrees of myopia is the increased prevalence of retinal degenerative disease, which is largely attributable to the increased stresses placed on the retina of the enlarging eye. 4 The cause of these mechanical demands on the retina are probably twofold. First, the retina thins as it is stretched across the enlarging globe and, second, vitreous motion during eye movement places significant shear forces on the retina. 5,6 There is increasing evidence to confirm that, in enlarging eyes, the retinal elements are str...

Ocular ischaemic syndrome is a rare condition. It often results in blindness and is linked to serious systemic morbidity. Its presentation is usually subtle and it can be misdiagnosed due to its diverse signs and symptoms. A case of ocular ischaemic syndrome is presented and current diagnostic procedures and treatment described. Recognition by the clinician is important because of the severe ocular and potential systemic sequelae. Keywords: carotid artery, ocular ischaemic syndrome, vascular disease Ocular ischaemic syndrome (01s) is an uncommonly reported, serious blinding condition, first described by Knox in 1965.' It is often misdiagnosed because of its diverse and sometimes subtle presentation.' Sturrock and Miller3 estimated the incidence to be 7.5 cases per million persons per year, based on only six cases over a two-year period in a large hospital setting. However, the exact frequency is unknown and previous reports may underestimate the incidence, when o n e considers the various ocular disorders that have similar presentations. CASE REPORTA 71-year-old Caucasian male presented for optometric examination, complaining of sore, dry eyes and a gradual reduction in distance and near acuity. He had no other presenting complaints. His previous eye examination had been two years earlier. He had a history of head trauma 30 years earlier, which is believed to have resulted in static right optic atrophy. He suffered from severe occlusive carotid artery disease ( O W ) with previous endarterectorny of the right internal carotid artery (ICA) two months before the present examination. The left ICA was reported to be completely blocked and inoperable. There was no history of diabetes.Visual acuities were R 6/24 with +1.25/ -0.75~75 and L 6/ 12 with +1.25/0.25~110. There was no improvement with pinhole (NIPH). A +3.00 D near addition enabled N5 print to be read at 33 cm. At optometric examinations two and four years previously, visual acuities were recorded as R 6/15 = (NIPH) and L 6/4.8. Previous automated visual fields demonstrated a dense temporal defect of the right eye (Figure 1). There was also a right relative afferent pupillary defect. Slitlamp examination revealed moderate signs of dry eye with a reduced tear break-up time and inferior and diffuse sodium-fluorescein and Rose Bengal staining. Non-preserved tear supplements were suggested. The ocular media were clear, but trace left iris neovascularisation was noted. Dilated ocular fundus examination revealed a pale and atrophic right optic disc. In the left posterior pole, focal and general arteriole attenuation was noted. Scattered small blot retinal haemorrhages were also noted in all four quadrants (Figure 2). Intraocular pressures (IOP) were R 9 mmHg and L 9 mmHg measured with Perkins

SIGNIFICANCE: Optometric educators are constantly looking for learning and teaching approaches to improve clinical skills training. In addition, the COVID-19 pandemic has made educators scrutinize the time allocated to face-to-face teaching and practice. Simulation learning is an option, but its use must first be evaluated against traditional learning methods. PURPOSE:The purpose of this study was to compare the training of binocular indirect ophthalmoscopy skills achieved by students and optometrists through deliberate practice on the Eyesi Indirect Ophthalmoscope simulator with deliberate practice using a peer.METHODS: Students and optometrists were randomly allocated to practice on either the simulator or a peer. Binocular indirect ophthalmoscopy performance was assessed using a peer and the simulator as the patients at different time points. Knowledge and confidence were examined before and following all practice sessions using a quiz and survey.RESULTS: Significant improvements in binocular indirect ophthalmoscopy performance using either a peer or the simulator as the patient for assessment were seen after 8 hours of student practice ( P < .001) and after a half-hour practice time for optometrists ( P < .001). There was no significant difference in performance overall between those practicing on a simulator and those practicing on a peer ( P > .05). Confidence in ability to perform the technique was lower for students who had practiced on the simulator. CONCLUSIONS:The simulator has similar efficacy to peer practice for teaching binocular indirect ophthalmoscopy to students and maintenance of this clinical skill for optometrists. Simulation does not replace the need for peer practice but may be a useful adjunct reducing the face-to-face hours required. These findings present a need for further research regarding diverse applications of the Eyesi Indirect Ophthalmoscope simulator in the curriculum for training optometry students and as a continuing professional development offering for optometrists, given the short exposure duration required to observe a significant improvement in skill.