In infants, abnormally high intraocular pressure (IOP) results in excessive eye enlargement. In the study reported here, we investigated whether IOP might be a determinant of ocular elongation using the chick as an animal model. Specifically, we examined IOP changes in (I). normally developing eyes, and (II). eyes undergoing altered growth. In the first case (I). developmental changes in IOP, axial length and refractive error were assessed at approximately daily intervals during early development (days 2-11 post-hatch, n = 8), and at weekly intervals from weeks 1 to 6 (n = 8). In the second case (II). opposite ocular growth responses were elicited using -15 D and +15 D defocusing spectacle lenses fitted monocularly to 8-day-old chicks (n = 8 and 7, respectively). Treated eyes were measured 3 and 7 h after lens application (between 9 and 10 am), as well as 1, 2 and 4 days later, around the same time as the initial lens application. In normal development (I). IOP increased over the first post-hatch week, peaking at 18.0 +/- 5.1 mmHg, and declined slowly thereafter to be back to near 'hatching' values at 6 weeks (12.7 +/- 5.3 mmHg at day 2 cf. 13.4 +/- 1.9 mmHg). Eyes elongated at an approximately linear rate over the entire monitoring period. The -15 D and +15 D lenses (II). produced opposing effects on eye growth, as indicated by axial length changes of + 0.67 +/- 0.25 mm cf. -0.33 +/- 0.17 mm over the 4-day treatment period. Both groups showed decreases in IOP over the first 20 h of lens wear. The faster growing eyes of the -15 D group exhibited a later relative increase in IOP. The described changes in IOP are compatible with, but do not prove, a modulatory influence of IOP on early eye growth.

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Investigations evaluating the effectiveness of music-based interventions as a complementary approach to symptom management and health promotion for cognitively-impaired children with life-limiting conditions and their families are needed to minimize the physical and psychological burdens on individuals and their caregivers. Songwriting is one music-based strategy for a remote family-centered complementary approach to improve outcomes for cognitively-impaired children with life-limiting conditions, their parents, and families. The overall purpose of this study is to test the feasibility and preliminary efficacy of a songwriting intervention for cognitively-impaired children (ages 5–17 years) who are receiving palliative or complex care and their parents. Specific aims are to: (1) determine the feasibility of songwriting for cognitively-impaired children with life-limiting conditions and their parents, and (2) examine preliminary efficacy of songwriting for child psychological distress and physical symptoms, parent psychological distress, and family environment. The protocol for this 1-group pre-and post-intervention clinical trial ( N = 25) is described.

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