James Loughman

• PhD
• Professor (Full) at Technological University Dublin

Supplementing glaucoma patients with macular pigment carotenoids improved ocular health, as confirmed by Serum Raman spectroscopy correlating with MPOD and ocular parameters. This highlights vast potential benefits of the method for healthcare.

Objective Data regarding the progression of myopia and new-onset myopia in young adults are lacking. This study aims to describe the natural history of myopia development and progression in adults using anonymized electronic medical records from Irish optometric practices. Design Longitudinal study. Subjects Electronic medical record data were ex...

Importance Additional data are required regarding atropine treatment regimens for control of myopia progression. Objective To investigate the efficacy and safety of different atropine regimens for myopia in children. Design, Setting, and Participants This was a secondary analysis of the 3-year results of the 24-Month Myopia Outcome Study of Atrop...

Purpose To investigate 2‐year changes in macular choroidal thickness (ChT) in children receiving 0.01% atropine eyedrops and its relationship with spherical equivalent refraction (SER) progression and axial length (AL) elongation. Methods A total of 250 myopic children aged 6–16 years (167%–0.01% atropine, 83‐placebo) were enrolled in the MOSAIC (...

Introduction This work aimed to establish the largest UK and Ireland consensus on myopia management in children and young people (CYP). Methods A modified Delphi consensus was conducted with a panel of 34 optometrists and ophthalmologists with expertise in myopia management. Results Two rounds of voting took place and 131 statements were agreed,...

As all major dietary carotenoids are contained in blood, it is a suitable substrate to evaluate their content, in vivo. Following 18-month supplementation of open-angle glaucoma patients with macula-pigment carotenoids (Lutein, Zeaxanthin and Meso-Zeaxanthin) in the European Nutrition in Glaucoma Management trial, Raman spectroscopic analysis of th...

Aims/Purpose: To investigate the association between red/green colour vision deficiency (CVD) and myopia in Irish and Australian participants. Methods: Data from the Ireland Eye Study (IES; age 12–13 years), Raine Study Gen2 cohort (Australia; age 18–22 years) and Kidskin Study (Australia; age 25–30 years) were used. Colour vision was assessed with...

Aims/Purpose: Assessing axial eye growth is a key component in myopia management; however, access to biometry is limited in primary eye care settings. This study evaluated choroidal thickness, compared to spherical equivalent refraction, as a potential biomarker of axial elongation. Methods: The Myopia Outcome Study of Atropine in Children (MOSAIC)...

Background/objectives: Axial length, a key measurement in myopia management, is not accessible in many settings. We aimed to develop and assess machine learning models to estimate the axial length of young myopic eyes. Subjects/methods: Linear regression, symbolic regression, gradient boosting and multilayer perceptron models were developed usin...

Purpose This retrospective analysis of electronic medical record (EMR) data investigated the natural history of myopic progression in children from optometric practices in Ireland. Methods The analysis was of myopic patients aged 7–17 with multiple visits and not prescribed myopia control treatment. Sex‐ and age‐specific population centiles for an...

Background To investigate the short‐term effects of cyclopentolate and tropicamide eyedrops on choroidal thickness (ChT) in myopic children using placebo or low‐dose atropine eyedrops. Methods The analysis included 242 myopic individuals (7–19 years) enrolled in two randomised placebo‐controlled clinical trials of low‐dose atropine eyedrops. Cyclo...

Précis Patients with glaucoma demonstrated deficiencies in their ability to process multi-sensory information when compared to controls, with those deficiencies being related to glaucoma severity. Impaired multi-sensory integration may affect the quality of life in individuals with glaucoma, and may contribute to the increased prevalence of falls a...

Purpose: The Myopia Outcome Study of Atropine in Children (MOSAIC) is an investigator-led, double-masked, randomized controlled trial investigating the efficacy and safety of 0.01% atropine eye drops for managing myopia progression in a predominantly White, European population. Methods: Children aged 6-16 years with myopia were randomly allocate...

Purpose: This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017. Methods: Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practic...

Significance: This study addresses the lack of choroidal thickness (ChT) profile information available in European children and provides a baseline for further evaluation of longitudinal changes in ChT profiles in myopic children as a potential biomarker for myopia treatment and identifying children at risk of myopic progression. Purpose: This s...

Carotenoid compounds are ubiquitous in nature, providing the characteristic colouring of many algae, bacteria, fruits and vegetables. They are a critical component of the human diet and play a key role in human nutrition, health and disease. Therefore, the clinical importance of qualitative and quantitative carotene content analysis is increasingly...

Objective To establish the baseline distribution of refractive errors and associated factors amongst a population that attended primary care optometry clinics. Design Retrospective cross sectional cohort study of electronic medical records (EMR). Methods Electronic medical record data was extracted from forty optometry clinics, representing a mix...

Purpose: To provide contemporary and future estimates of childhood myopia prevalence in Africa. Methods: A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ -0.50D; high myopia: SE ≤ -6.00D) in Africa. Population- or school-based cross-sectional studies published from 1 Ja...

Background: To test the hypothesis that 0.01% atropine eyedrops are a safe and effective myopia-control approach in Australian children. Methods: Children (6-16 years; 49% Europeans, 18% East Asian, 22% South Asian, and 12% other/mixed ancestry) with documented myopia progression were enrolled into this single-centre randomised, parallel, double...

Carotenoids are naturally abundant, fat-soluble pigmented compounds with dietary, antioxidant and vision protection advantages. The dietary carotenoids, Beta Carotene, Lutein, and Zeaxanthin, complexed with in bovine serum albumin (BSA) in aqueous solution, were explored using Raman spectroscopy to differentiate and quantify their spectral signatur...

Purpose: Treatments for myopia progression are now available, but implementing these into clinical practice will place a burden on the eye care workforce. This study estimated the full-time equivalent (FTE) workforce required to implement myopia control treatments in the UK and Ireland. Methods: To estimate the number of 6- to 21-year-olds with...

Purpose: Visual acuity assessment is the most commonly performed vision screening method for drivers. The standards and repeat assessment intervals used, however, are arbitrary, lack an evidence base and are highly variable across different countries. This study utilises the power of Big Data to provide evidence-based recommendations for standardi...

Objective To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error amongst ametropes and hence estimate the current and future risk of vision impairment. Design Cross Sectional Study Subjects A total 141,547,436 spectacle lens sales records from an international European lens manufac...

Choroidal thickness (CT) variations are significant contributory mechanisms to the development of chorioretinal pathologies in myopic patients. Baseline CT profiles may provide important information on the longitudinal choroidal changes associated with myopic progression in children. The purpose of this study was to investigate CT profiles in myopi...

Myopia has been associated with structural changes such as axial elongation and thinning of the retina and choroid. The relationship between choroidal thickness (CT), axial length (AL) and myopia has been studied in adult populations, yet there is little evidence available in children. Baseline data of 248 myopic children aged 6-16 years and enroll...

Purpose To evaluate the macular pigment response to carotenoid supplementation in glaucomatous eyes. Design A double masked, randomized and placebo-controlled clinical trial, the European Nutrition In Glaucoma Management (ENIGMA) study (ClinicalTrials.gov Identifier: NCT04460365). Participants Sixty-two participants (38 male, 24 female) with a di...

Objective: To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error amongst ametropes and hence estimate the current and future risk of vision impairment. Design: Cross Sectional Study Subjects: A total 141,547,436 spectacle lens sales records from an international European lens manufa...

Purpose To examine whether data sourced from electronic medical records (EMR) and a large industrial spectacle lens manufacturing database can estimate refractive error distribution within large populations as an alternative to typical population surveys of refractive error. Subjects A total of 555,528 patient visits from 28 Irish primary care opt...

In this paper we propose a convolution estimator for estimating the density of a response variable that employs an underlying multiple regression framework to enhance the accuracy of the estimates through the incorporation of auxiliary information. Suppose we have a sample of $N$ observations of a response variable and an associated set of covariat...

Shortsightedness is caused by the eye growing too long, which results in faraway objects, such as the board in school, appearing blurry. People who are shortsighted wear glasses or contact lenses to see better. But would not it be incredible to figure out and avoid whatever causes shortsightedness, so we could wave goodbye to our never-clean, alway...

Significance: Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. Purpose: This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP...

The burden of vision impairment due to uncorrected refractive error (needing spectacles) in Mozambique is known to be significant. To improve the planning and provision of eye health services, a better understanding of how vision is valued by patients is needed. The willingness to pay (WTP) for improved vision through correcting refractive error wa...

Myopia is caused by an eye which has grown too long. The prevalence of myopia has increased drastically in recent years and half of the world's population is expected to be myopic by 2050.(Reference Holden, Fricke and Wilson1) Consequently, a significant increase in sight threatening diseases will follow.(Reference Holden, Fricke and Wilson1) Myopi...

Purpose of the study Macular pigment (MP), comprising the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, is believed to benefit eye health and vision. Numerous clinical and research devices and techniques are currently available to facilitate MP optical density (MPOD) measurement. One of those techniques, dual-wavelength fundus autoflu...

Myopia is one of the leading causes of preventable blindness in the world. Its prevalence has risen drastically over recent decades, and it is estimated that close to half the world population will be myopic by 2050.The rise in myopia is lifestyle related. Myopia occurs as a consequence of excessive eye growth, which may be related to general growt...

Clinical relevance This study demonstrates an association between myopia and smartphone data usage. Youths now spend more time participating in near tasks as a result of smartphone usage. This poses an additional risk factor for myopia development/progression and is an important research question in relation to potential myopia management strategie...

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the...

Clinical significance Nutritional status influences growth and development, including that of the eye. However, little attention has been given to possible dietary influences in myopia. This study demonstrates that serum zinc has no relationship with myopia development. Background Myopia is inherently associated with eye growth and thereby possibl...

Importance: Atropine eyedrops are a promising treatment for slowing myopia progression in East Asian children. However, its effects on children in Australia, including those of non-Asian background, have not been well-studied. Background: The Western Australia Atropine for the Treatment of Myopia (WA-ATOM) study aims to determine the efficacy an...

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the...

Background/aims To report the protocol of a trial designed to evaluate the efficacy, safety and mechanism of action of low-dose atropine (0.01%) eye-drops for reducing progression of myopia in UK children. Methods Multicentre, double-masked, superiority, placebo-controlled, randomised trial. We will enrol children aged 6–12 years with myopia of −0...

Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the eff...

Significance: This present study advances our knowledge on the role of lifestyle factors in myopia (short-sightedness), specifically dietary factors. It has been suggested in previous studies that lower zinc status is associated with myopia; however, this article shows no relationship between dietary zinc intake and myopia in U.S. adolescents. Pu...

Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula, and may therefore protect retinal tissue from the oxidative stress and inflammation associated with ocular disease and ageing. There is a body of evidence implicating oxidative damage and inflammation as underlying pathological processes in diabetic retinop...

The Relationship between Serum Zinc Levels and Myopia (short-sightedness) in Korean Adolescents - Volume 78 Issue OCE2 - Niamh Burke, John S Butler, Ian Flitcroft, James Loughman

Background: The Myopia Outcome Study of Atropine in Children (MOSAIC) aims to explore the efficacy, safety, acceptability and mechanisms of action of 0.01% unpreserved atropine for myopia control in a European population. Methods: MOSAIC is an investigator-led, double-masked, placebo-controlled, randomised clinical trial (RCT) investigating the eff...

BACKGROUND: The global burden of vision impairment has been acknowledged by the World Health Organisation as a public health challenge. In order to scale up the production of eye health personnel in developing countries, a tiered model of optometry training was explored in Mozambique. OBJECTIVES: The Mozambique case study was evaluated to assess th...

Purpose: This cross-sectional study compared macular pigment (MP) levels among persons with Type 2 diabetes relative to healthy controls. Additionally, a range of behavioral, anthropometric, clinical and serum measures were explored as possible predictors of low MP optical density (MPOD) in diabetes. Methods: Two health status groups; Group 1: Type...

Background: Studies suggest that lutein and zeaxanthin may be important for cognitive development in children, but a comprehensive evidence synthesis is lacking. The purpose of this evidence synthesis was to analyse the available data regarding the role of lutein and zeaxanthin for cognition in children and propose a theoretical basis for future st...

Significance: Autorefractors are commonly used by eye care practitioners worldwide as a starting point for clinical prescribing and by researchers as an instrument to study development of refractive errors and accommodation. This study demonstrates that the Nidek ARK-1 provides a reasonable and repeatable estimate of refractive error. Purpose: T...

Background Myopia is becoming increasingly prevalent throughout the world. It is an overlooked but leading cause of blindness, particularly among the working aged population. Myopia is often considered benign because it is easily corrected with glasses, contact lenses or refractive surgery. Traditionally myopia has been classified into physiologica...

Current treatment strategies for glaucoma are limited to halting disease progression and do not restore lost visual function. Intraocular pressure is the main risk factor for glaucoma, and intraocular pressure–lowering treatment remains the mainstay of glaucoma treatment, but even successful intraocular pressure reduction does not stop the progress...

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and...

Purpose With the increasing prevalence in myopia there is growing interest in active myopia prevention. This study aims to increase our understanding of parental attitudes to myopia development and control, as a means to inform future health planning and policy. It evaluates, for the first time, the attitude of parents to myopia and its associated...

Purpose: To investigate current diagnostic equipment availability and usage for glaucoma case-finding within community optometric practice, and to explore optometrists' attitudes towards an enhanced scope of clinical practice. Methods: An anonymous survey was developed, validated, and distributed to all optometrists in Ireland. Results: 199 op...

Purpose: Glaucoma referral refinement (GRR) has proven a successful demand management strategy for glaucoma suspect cases in the United Kingdom (UK). A GRR clinic was established in Dublin, Ireland to investigate the clinical viability of this pathway outside the UK's National Health Service (NHS) structures, and away from the influence of Nationa...

Purpose: To test the hypothesis that genes known to cause clinical syndromes featuring myopia also harbor polymorphisms contributing to nonsyndromic refractive errors. Methods: Clinical phenotypes and syndromes that have refractive errors as a recognized feature were identified using the Online Mendelian Inheritance in Man (OMIM) database. One h...

Aim To evaluate the relationship between macular pigment optical density (MPOD) and glare disability in open-angle glaucoma. Methods A cross-sectional analysis of baseline data (88 subjects; median age, 67 (range 36–84) years) collected during the Macular Pigment and Glaucoma Trial (ISRCTN registry number: 56985060). MPOD at 0.25°, 0.5° and 1° of...

Background: This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system. Methods: A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included...

research has focused on evaluation of competence and developing competency frameworks for optometrists and mid-level eye care personnel in Mozambique. Professor Loughman is a Professor of optometry at Dublin Institute of Technology. He has a specific academic and research interest in preventive eye health interventions for the most common causes of...

Background The relationship between measures of visual function and gait related risk factors for falls is unclear. In this study, we examine the relationship between visual function (visual acuity [VA] and contrast sensitivity [CS] at multiple spatial frequencies) and quantitative spatiotemporal gait, using a large, nationally representative sampl...

Optometry globally has undergone major developments yet poor eye health statistics remain. The World Health Organization (WHO) cites social accountability as key to addressing health challenges, urging the education sector to be more socially accountable and train according to the needs of society. A qualitative, descriptive study was used to deter...

Background Optometry has, over the past ten years, emerged as a profession strategically positioned to address the burden of uncorrected refractive error in developing countries. Estimates suggest that 285 million people in the world are needlessly visually impaired, mainly due to the lack of trained eye health professionals in the developing world...

Background: Myopia is a condition of enormous public health concern, affecting up to 2.5 billion people worldwide. The most effective treatment to prevent myopia progression is atropine but at the cost of accommodative paresis and mydriasis, necessitating the use of bifocal glasses. Low-dose atropine (0.01%) has been found to be almost as effectiv...

Background: There is an extreme paucity of eye-care personnel and training facilities in developing countries. This study was designed to develop a comprehensive framework of competency standards for ophthalmic technicians and optometrists, in Mozambique. This could then inform the evolution of socially responsive curricula for both cadres. Metho...

Introduction. The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors. Materials & Methods. Community dwelling adults (aged...

Overview of literature Overview of studies comparing self-reports of vision and objective measures, in particular those taking into account cognitive and socio-demographic variables.

Measures utilised in the study Variables from the TILDA study utilised in the present study.

Purpose To investigate the relationship between visual function and severity of early age-related macular degeneration (AMD) and activity of neovascular (nv-) AMD. Methods The following data was collected from 66 eyes of 66 subjects with early AMD and 47 eyes of 47 subjects with active nv-AMD: corrected distance visual acuity (CDVA); contrast sens...

To evaluate the relationship between macular pigment optical density (MPOD) and structural parameters of the macula and optic nerve head in glaucomatous eyes. A cross-sectional analysis of the baseline data collected during the Macular Pigment and Glaucoma Trial (ISRCTN registry number: 56985060). Eighty-eight subjects (48 male, 40 female) with a d...

Introduction: The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors. Materials & Methods: Community dwelling adults (aged...

Introduction: The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors. Materials & Methods: Community dwelling adults (aged...

The dire need for eye care services and a dearth of human resources (HR) in sub-Saharan Africa motivated the setting up of new optometry programmes. However, to make a meaningful impact, geographical, gender, economic and educational disparities must additionally be addressed.Aqualitative study utilizing purposive sampling to select academic leader...

The Mozambique Eyecare Project is a higher education partnership for the development, implementation, and evaluation of a model of optometry training at UniLúrio in Mozambique. There are many composite elements to the development of sustainable eye health structures, and appropriate education for eye health workers remains a key determinant of succ...

Introduction Uncorrected refractive error is the leading cause of visual impairment worldwide and leads to an impaired quality of life. This study was designed to determine the prevalence of uncorrected refractive error and presbyopia, to assess spectacle coverage, and to evaluate visual health-related quality of life among persons aged 15–50 years...

This study was designed to investigate the optical density of macular pigment in Type 1 and Type 2 diabetes subjects relative to normal controls. One hundred and fifty subjects were recruited to the study and divided into one of the three study groups on the basis of their health status, as follows: Group 1: Healthy controls; Group 2: Type 1 diabet...

Purpose: Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and con...

Background: The University of Lurio, School of Optometry in Mozambique is a new program in Africa. The school, the first to serve Portuguese-speaking Africa, can act as a template for such initiatives in other African countries and other limited-resource settings around the world. A major challenge facing such programs is the lack of knowledge abou...

Introduction: The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially determinant factors. Materials & Methods: Community dwelling adults (aged 50+) r...

Purpose Uncorrected refractive error remains a leading cause of visual impairment (VI) across the globe with Mozambique being no exception. The establishment of an optometry profession in Mozambique that is integrated into the public health system denotes significant progress with refractive services becoming available to the population. As the fou...

Background The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the bu...

Access to education was identified as a key international priority by UNESCO as far back as 1998 when it called for “equality of access”. The profession of optometry has been challenged to educate practitioners in increasing numbers in order to meet the eye care needs. The World Health Organization reported that globally, an estimated 285 million p...

Purpose: To investigate the impact of three different macular carotenoid formulations on macular pigment optical density and visual performance in subjects with early age-related macular degeneration. Methods: Fifty-two subjects were supplemented and followed for 12 months, 17 of them were in intervention Group 1 (20 mg/day lutein and 2 mg/day z...

The present study examined the association between vision, fear of falling and fear-related activity restriction, and assessed the effect of vision on the relationship between fear of falling and mobility, using data from a nationally representative sample of community-dwelling adults aged ≥50 years. Participants (n = 5003) completed an interview a...

Diabetic retinopathy can result in impaired photostress recovery time despite normal visual acuity and fundoscopic appearance. The Macular Degeneration Detector (MDD-2) is a novel flash photostress recovery time device. In this study, we examine the repeatability of the MDD-2 in normal and diabetic subjects. One hundred and ninety one (90 women, 10...

Background/aims: Macular pigment (MP) plays an important role in visual function and in the protection of the retina from oxidative damage. It is not known whether glaucoma, a progressive neurodegenerative disease of the optic nerve, is associated with alterations in MP. This study was designed to investigate the relationship, if any, between the...

Purpose. To assess visual function and its response to serial intravitreal ranibizumab (Lucentis, Genentech) in patients with neovascular age-related macular degeneration (nv-AMD). Methods. Forty-seven eyes of 47 patients with nv-AMD, and corrected distance visual acuity (CDVA) logMAR 0.7 or better, undergoing intravitreal injections of ranibizumab...

Background: The current study was designed to explore the effect of computer experience on the viability and testretest repeatability of the Moorfields Motion Displacement Test (MMDT), a novel computer-driven glaucoma screening device, in an African community setting. Methods: 164 healthy subjects were recruited from a semi-rural Mozambican environ...

Purpose: To investigate changes in macular pigment optical density (MPOD) and visual performance following supplementation with different macular carotenoid formulations. Methods: Thirty-six subjects (19 male, 17 female; mean SD, age 51 13 years) were recruited into this single-masked placebo-controlled study, and were randomly assigned to one o...

Purpose: The three carotenoids lutein, zeaxanthin, and meso-zeaxanthin, are found at the macula and referred to as macular pigment (MP). This study was undertaken to investigate determinants of MP in a large randomly selected sample from the Republic of Ireland (as part of The Irish Longitudinal Study on Ageing [TILDA]). Methods: MP optical dens...

Background: Diseases affecting the macula, such as age-related macular degeneration (AMD), diabetic retinopathy and central serous retinopathy can result in impaired photostress recovery time (PSRT) despite normal visual acuity and fundoscopic appearance. The MDD-2 Macular Degeneration Detection Device is a novel flash photostress recovery device....