Patients with Intacs for keratoconus may require a combination of soft and rigid contact lenses for the best possible VA. Contact lens fitting with a high-Dk piggyback contact lens system can provide optimal comfort, corneal health, and VA for patients with Intacs for keratoconus.

Purpose: To evaluate the ability of the PDI Check (PDI Check LLC, Anchorage, AK) near vision screening game to assess monocular acuity, stereopsis, suppression, and color. Methods: Children and adults consented to perform the PDI Check Quick Screening game following conventional near testing of patched Rosenbaum acuity, Titmus Fly stereo, Worth 4-dot, and Ishihara color. Time to complete each test and preferred method were recorded. Results: A total of 77 patients (5 to 63 years old) attempted all tests. There was a positive correlation between the PDI Check and conventional tests for all visual tasks. Using previously determined instrument referral criteria, sensitivity/specificity was determined for right acuity (67%/91%), left acuity (55%/94%), stereopsis (87%/95%), red-green color (80%/99%), and ocular suppression (58%/98%). Screening time was 202 ± 96 versus 99 ± 42 seconds for the PDI Check and the game was preferred by 87%. Conclusions: The PDI Check provided a valid assessment of near vision in less than half the time of conventional testing without patches or goggles. This Quick Screening version may help eye technicians and physicians with time efficiency in the frequent task of near visual assessment. [ J Pediatr Ophthalmol Strabismus . 2019;56(4):234–237.]

Background: A near vision game has been developed for the autostereoscopic screen of the Nintendo 3DS console. Ease of use and time for testing by non–English-speaking patients was not known. Methods: Adult and pediatric patients in a remote Burma clinic were compared with US military staff with each performing conventional near acuity, Stereo Fly, and Ishihara color in addition to PDI Check game, so results could be correlated and timed. Results: Seventeen Burma adults (aged 19–58), 20 Burma children (aged 7–15), and 14 US military staff (aged 21–36) completed the testing. Conventional testing correlated with PDI Check for stereo ( P < 0.001), acuity oculo dexter ( P < 0.01), acuity oculo sinister ( P < 0.01). For visual acuity and stereopsis, the intraclass coefficient was 0.55 [95% confidence interval (CI) 0.28–0.72] and 0.62 (95% CI 0.41–0.77) respectively, but with few color deficient cases color was 0.30 (95% CI –0.05 to 0.60). The time in seconds to complete near vision testing with PDI Check (172 ± 27, overall; 198 ± 34, Burma; 99 ± 20, military) was significantly (25% ± 18%) briefer than conventional testing (226 ± 31, overall; 270 ± 34, Burma; 126 ± 20, military). The Burma patients took significantly longer than the military staff (234 ± 25 vs 112 ± 14, P < 0.01). Time for Burma children did not differ from Burma adults for PDI (109 ± 47 vs 217 ± 54, P = 0.42) and for conventional testing (266 ± 51 vs 275 ± 52, P = 0.80). Conclusions: Non–English-speaking Burma children and adults were able to reliably perform 3 types of near vision testing with a Nintendo 3DS game 25% quicker than the 2 to 3 minutes for conventional methods. They were slower than experienced US military staff adults.

Background: Handheld devices can automatically give an estimate of refraction. The established method for refraction comparison using spherical equivalent (M) and J0, J45 vector transformations by Bland-Altman analysis is too complex for non-eye doctors involved with vision screening and remote vision clinics. Therefore, a simpler comparison technique was developed. Methods: Based on the spectacle limit to resolve grade A 1 logMAR, B 3 logMAR and C 6 logMAR blur, J0, J45, and M are combined into the Alaska Blind Child Discovery (ABCD) composite ellipsoid GRADE system. Pediatric eye patients had confirmatory examination after dry refraction with three portable autorefractors: Plusoptix, 2WIN and Retinomax. The refractions were then compared using both Bland-Altman and ABCD composite. Performance to detect AAPOS amblyopia risk factors was also assessed. Results: A total of 202 children, mean age seven years, 28% high spectacle need and 43% AAPOS 2013 amblyopia risk factors showed high correlation with cycloplegic refraction (intraclass correlation 0.49 to 0.90) for sphere, J0 and J45 spectacle components. Plusoptix had more (10%) inconclusives due to patients out-of-range. The Retinomax was unable to screen some younger children and was less reliable for sphere but gave more precise astigmatism estimates. The proportion of autorefractions expected to give GRADE A/B highneed patients acuity improvement to 20/40 would be 41% for Plusoptix, 39% for 2WIN and 65% for Retinomax. Sensitivity/specificity for amblyopia risk factor detection was 80%/83% for Plusoptix, 72%/88% for 2WIN and 84%/73% for Retinomax. Conclusion:The simplified spectacle comparison resembled Bland-Altman and could assist lay vision screeners and non-eye doctors attempting remote spectacle donation worldwide.

Significance: A Nintendo ® 3DS™ game can reliably test monocular near acuity, stereopsis and color without the need for occlusion patches or goggles. Purpose: We developed dynamic, forced-multiple choice games to measure monocular near acuity, color vision and stereopsis on the autostereoscopic barrier screen of the Nintendo 3DS gaming system. Methods: In an institutional review board-approved study, pediatric and adult patients and normal subjects performed routine patched near visual acuity, Ishahara’s color test and Stereo Fly tests. Then each subject performed a two-phase orientation and testing game, “PDI Check”, on a Nintendo 3DS. Results: Forty-five patients aged 5–60 years completed the routine and Nintendo near tests, resulting in positive, consistent, discriminatory correlation functions. From ROC curves, referral criteria were determined to separate poor from fair-to-normal monocular acuity with 98% sensitivity and 100% specificity, stereoacuity with 80% sensitivity and 97% specificity, and color with 83% sensitivity and 100% specificity. Conclusion: The Nintendo 3DS game PDI Check can provide consistent near vision testing via a dynamic, randomized method that does not require goggles for stereo, and does not require patching to assure monocular testing.