Kathryn J Saunders

• Professor at University of Ulster

Purpose The Predicting Myopia Onset and progression (PreMO) risk indicator, developed using data generated from white children in the UK, incorporates age, spherical equivalent refraction (SER), axial length (AL) and parental myopia to stratify the likelihood of developing myopia. This study evaluated the PreMO's predictive accuracy using prospecti...

Aim To determine the regional and ethnic differences in ocular axial elongation and refractive error progression in myopic and non‐myopic children. Methods A retrospective analysis of 15 longitudinal clinical and population‐based studies was conducted in the UK, Sweden, Australia (classified as European), China, and Vietnam (classified as East Asi...

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,...

While there has been a long-term commitment to inclusion in mainstream schools for pupils with special educational needs, including vision impairment (VI), the position of these pupils in an inclusive school environment, and the extent to which their educational, social, and emotional needs are met, continues to be problematic. This study investiga...

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...

Myopia is becoming increasingly common in young generations all over the world, and it is predicted to become the most common cause of blindness and visual impairment in later life in the near future. Because myopia can cause serious complications and vision loss, it is critical to create and prescribe effective myopia treatment solutions that can...

Purpose Previous studies have demonstrated an association between melatonin status and both refractive error and axial length in young adult myopes. This study aimed to determine if this relationship extends to a younger adolescent cohort. Methods Healthy children aged 12–15 years provided morning saliva samples before attending Ulster University...

The prevalence of myopia is increasing across the world. Controlling myopia progression would be beneficial to reduce adverse outcomes such as retinal detachment and myopic maculopathy which are associated with increased axial length. Pharmacological control of myopia progression with atropine has been investigated since the 19th century and the be...

This study investigated the accuracy and stability of accommodative and vergence functions in children with and without hyperopia while engaged in two sustained near tasks. The sustained accommodative and vergence characteristics of participants without refractive correction (n = 92, aged 5–10 years) with and without hyperopia (defined as cyclopleg...

Purpose: Controversy exists regarding the influence of peripheral visual experience on the onset and progression of childhood myopia. This longitudinal, observational study evaluated the relationship between relative peripheral refraction (RPR) and changes in refractive error and axial length (AL) over 12 months in White children aged 6–7 and 12–13...

Purpose: We have previously demonstrated the upper limit of complete spatial summation (Ricco's area) to increase in non-pathological axial myopia compared to non-myopic controls. This study sought to investigate whether temporal summation is also altered in axial myopia to determine if this aspect of visual function, like in glaucoma, is influenc...

Cerebral Visual Impairment (CVI) is a common condition in the UK. Patients with conditions associated with CVI are frequently seen in paediatric ophthalmology clinics offering eye care professionals an opportunity to identify children proactively. In most cases CVI occurs as part of a neurodevelopmental condition or as a feature of multiple and com...

Introduction Hypoaccommodation is common in children born prematurely and those with hypoxic ischaemic encephalopathy (HIE), with the potential to affect wider learning. These children are also at risk of longer-term cerebral visual impairment. It is also well recognised that early intervention for childhood visual pathology is essential, because n...

The Babies in Glasses (BiG ) Study: Feasibility and acceptability of early spectacle intervention to babies and parents to improve visual outcomes in infants at risk of perinatal brain insult.

Purpose: There are several indirect methods used to estimate retinal ganglion cell (RGC) count in an individual eye, but there is limited information as to the agreement between these methods. In this work, RGC receptive field (RGC-RF) count underlying a spot stimulus (0.43°, Goldmann III) was calculated and compared using three different methods....

Purpose To evaluate the repeatability and reproducibility of the swept-source optical coherence tomographer Zeiss IOLMaster 700 and compare its outputs with those obtained using partial coherence interferometry (Zeiss IOLMaster v3) in a healthy, paediatric population. Methods This is a cross-sectional, observational study. Examiner 1 took two sets...

Purpose To compare real-world measures of illumination obtained with the Actiwatch-2 and Clouclip-M2 with ‘gold standard’ photometry measures and to evaluate the ability of Actiwatch-2 to correctly identify photometer-defined conditions: scotopic (≤0.01 lux), mesopic (0.02–3 lux), indoor photopic (>3–1,000 lux) and outdoor photopic (>1,000 lux); an...

Controversy exists regarding the influence of peripheral visual experience on axial ocular growth in humans. This longitudinal, observational study evaluates the relations between baseline relative peripheral refraction, change in central refraction and ocular biometry in Caucasian children.

Purpose: This study investigated whether refractive correction improved accommodative function of hyperopic children while engaged in two sustained near activities. Methods: Sustained accommodative function of 63 participants (aged 5-10 years) with varying levels of uncorrected hyperopia (>/= +1.00 D and < + 5.00 D spherical equivalent in the le...

The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopi...

Purpose Cerebral visual impairment (CVI) is the leading cause of childhood visual impairment in the developed world. Despite this, there are no agreed clinical guidelines for the investigation and diagnosis of the condition. Before development of such guidelines can commence, it is important to recognise which approaches are currently employed. Thi...

Background Changes of choroidal vasculature in the eye have been reported in Alzheimer’s disease (AD) and this is positively correlated with declining cognitive status. Patients with Down’s syndrome (DS) are at a high risk of developing AD and also show signs of premature ageing. Both AD and ageing have been associated with thinner choroid, measure...

This report describes development of spherical equivalent refraction (SER) and axial length (AL) in two population-based cohorts of white, European children. Predictive factors for myopic growth were explored. Participants were aged 6-7- (n = 390) and 12-13-years (n = 657) at baseline. SER and AL were assessed at baseline and 3, 6 and 9 years prosp...

Objectives To evaluate parent and teacher opinion of the provision of in-school eyecare and jargon-free written reporting of visual status for children in special educational settings. Participants and methods A nationally-agreed, in-school eyecare framework for children attending special schools which recommends a full eye examination, dispensing...

Background/Aims Both eyes of one individual share the same environment and genes. We examined interocular differences in biometry to determine the potential role of other factors in refractive development. Methods 362 subjects (6–7 years) from the Northern Ireland Childhood Errors of Refraction study were studied. Cycloplegic autorefraction was me...

Purpose: To evaluate the relationship between refractive error, circadian phase, and melatonin with consideration of prior light exposure, physical activity, and sleep. Methods: Healthy young myopic (spherical equivalent refraction [SER] ≤-0.50DS) and emmetropic adults underwent noncycloplegic autorefraction and axial length (AL) measures. Objec...

This study demonstrates significant differences between the area of complete spatial summation (Ricco’s area, RA) in eyes with and without non-pathological, axial myopia. Contrast thresholds were measured for six stimuli (0.01–2.07 deg2) presented at 10º eccentricity in 24 myopic subjects and 20 age-similar non-myopic controls, with RA estimated us...

Down syndrome (DS) is frequently associated with cataract, but there remains scant information about DS cataract morphology. Supra-nuclear cataracts in DS have been proposed as indicative of beta-amyloid (Aβ) aggregation and thus potential biomarkers for Alzheimer’s (AD). This study employed anterior segment OCT (AS-OCT) and slit-lamp (SL) photogra...

Significance: Pupillometry protocols evaluating rod/cone- and melanopsin-driven responses often use mydriatics to ensure maximal stimulus exposure; however, retinal effects of mydriatics are not fully understood. We demonstrate that dilation with either atropine or phenylephrine results in similar enhancements of rod/cone- and melanopsin-driven pu...

Accessible summary Children with learning disabilities often have problems with their eyesight. We tested the eyes of nine children and checked whether they needed glasses or bigger print. We found that when they got what they needed to see better, their behaviour improved. This is important because children with learning disabilities need to be ab...

To evaluate the intra-examiner repeatability of the swept-source optical coherence tomographer (Zeiss IOLMaster 700) in a clinically normal, young adult population, and compare its outputs with those of the IOLMaster v3.

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...

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Objectives To determine whether implementation of comprehensive in-school eyecare results in measurable benefits for children and young people in terms of visual status, classroom behaviours and how well their visual needs are met. Design School-based observational study. Participants & Methods 200 pupils [mean age 10 years 9 months, 70% male, ma...

Objectives This study reports the prevalence of persistent amblyopia (post-traditional treatment age) in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems. Design This is a population-based observational study...

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 study highlights potential differences that can arise in gaze-position estimates from first Purkinje image–based eye trackers based on how individual Hirschberg ratios (HRs) are calculated. PURPOSE The purpose of this study was to evaluate the accuracy and repeatability of eccentric-viewing, prism-based, and theoretical technique...

Purpose: This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic a...

Significance: This study highlights potential differences that can arise in gaze-position estimates from first Purkinje image-based eye trackers based on how individual Hirschberg ratios (HRs) are calculated. Purpose: The purpose of this study was to evaluate the accuracy and repeatability of eccentric-viewing, prism-based, and theoretical techn...

Purpose To survey a large number of UK‐based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. Methods One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The que...

Background: We applied the National Screening Committee vision screening protocol [pass criterion monocular acuity ≤ 0.2 LogMAR in both eyes(BE)] to children four to five years old to investigate the visual profile of children who passed/failed. Previous studies have only evaluated those failing. The aim was to derive false positive and negative v...

Best practice clinical guidelines for myopia control involve an understanding of the epidemiology of myopia, risk factors, visual environment interventions, and optical and pharmacologic treatments, as well as skills to translate the risks and benefits of a given myopia control treatment into lay language for both the patient and their parent or ca...

Aim To report refractive error prevalence and visual impairment in Republic of Ireland (henceforth 'Ireland') schoolchildren. Methods The Ireland Eye Study examined 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), in Ireland between June 2016 and January 2018. Participating schools were selected by...

Significance: Accommodative responses were significantly poorer in individuals with autism spectrum disorder (ASD) compared with age-matched typically developing control subjects, and hypoaccommodation was associated with reduced near visual acuity (NVA) and convergence. Purpose: Autism spectrum disorder is a neurodevelopmental disorder with a r...

Background A 2015 SeeAbility report1 estimates that children with special educational needs are 28x more likely to have a serious vision problem compared to typically developing children, yet over 40% of these children had never had their eyes tested. Little and Saunders2 found that even when eye care is accessed, there is often a failure to share...

Purpose: Experimental animal models of myopia demonstrate that higher melatonin (Mel) and lower dopamine (DA) concentrations actively promote axial elongation. This study explored the association between myopia and serum concentrations of DA and Mel in humans. Methods: Morning serum concentrations of DA and Mel were measured by solid phase extra...

Individuals with Down syndrome (DS) often exhibit hypoaccommodation alongside accurate vergence. This study investigates the sensitivity of the two systems to retinal disparity and blur cues, establishing the relationship between the two in terms of accommodative-convergence to accommodation (AC/A) and convergence-accommodation to convergence (CA/C...

The accuracy of an eccentric infrared (IR) photorefraction device for defocus estimates and gaze position measurement depends largely on the calibration of the built-in propriety values for both parameters. This study explored the accuracy and repeatability of PlusOptix PowerRefractor III using lens and prism calibration techniques.Refractive and g...

Purpose: Conjunctival ultraviolet autofluorescence (CUVAF) has been used in previous Southern Hemisphere myopia research as a marker for time spent outdoors. The validity of CUVAF as an indicator of time spent outdoors is yet to be explored in the Northern Hemisphere. It is unclear if CUVAF represents damage attributed to UV exposure or dry eye. T...

The majority of individuals with Down syndrome (DS) do not exhibit accurate accommodation, with the aetiology of this deficit unknown. This study examines the mechanism underlying hypoaccommodation in DS by simultaneously investigating the ‘near triad’ – accommodation, vergence and pupillary response. An objective photorefraction system measured ac...

Purpose: Autistic Spectrum Disorder (ASD) is a common neurodevelopmental disorder characterised by impairment of communication, social interaction and repetitive behaviours. Only a small number of studies have investigated fundamental clinical measures of vision including refractive error. The aim of this study was to describe the refractive profi...

OBJECTIVE:To determine six-year spherical refractive error change among white children and young adults in the UK and evaluate differences in refractive profiles between contemporary Australian children and historical UK data. DESIGN:Population-based prospective study. PARTICIPANTS:The Northern Ireland Childhood Errors of Refraction (NICER) study P...

Raw data set for the change in ocular biometrics (AL = axial length, corneal power & ACD = anterior chamber depth) and SER (spherical equivalent refraction) between Phase 1 and Phase 3 (6–7 years to 12–13 years) for participants classified as myopic within the younger cohort. Participants shown in bold were classified as myopic at both Phase 1 and...

Raw data set for the change in ocular biometrics (AL = axial length, corneal power & ACD = anterior chamber depth) and SER (spherical equivalent refraction) between Phase 1 and Phase 3 (12–13 years to 18–20 years) for participants classified as myopic within the older cohort. Participants shown in bold were classified as myopic at both Phase 1 and...

Raw data set for the change in ocular biometrics (AL = axial length, corneal power & ACD = anterior chamber depth) and SER (spherical equivalent refraction) between Phase 1 and Phase 3 (12–13 years to 18–20 years) for participants classified as hyperopic at Phase 1 within the older cohort. Outlined below are the Spearman correlations between the ch...

Raw data set for the change in ocular biometrics (AL = axial length, corneal power & ACD = anterior chamber depth) and SER (spherical equivalent refraction) between Phase 1 and Phase 3 (6–7 years to 12–13 years) for participants classified as hyperopic at Phase 1 within the younger cohort. Outlined below are the Spearman correlations between the ch...

We performed a prospective study of the changing profile of astigmatism in white school children in Northern Ireland. Of the 399 6- to 7-year-old and 669 12- to 13-year-old participants in Phase 1 of the Northern Ireland Childhood Errors of Refraction (NICER) study, 302 (76%) of the younger and 436 (65%) of the older cohort were re-examined three y...

Anomalous visual processing has been described in individuals with autism spectrum disorder (ASD) but relatively few studies have profiled visual acuity (VA) in this population. The present study describes presenting VA in children with ASD (n = 113) compared to typically developing controls (n = 206) and best corrected visual acuity (BCVA) in a su...

Visual dysfunction is more common in children with neurological impairments and previous studies have recommended such children receive visual and refractive assessment. In the UK, children with neurological impairment often have educational statementing for Special Educational Needs (SEN) and the statement should detail all health care and support...

Purpose: To explore risk factors for myopia in 12-13-year-old children in Northern Ireland (NI). Methods: Stratified random sampling was performed to obtain representation of schools and children. Cycloplegia was achieved using cyclopentolate hydrochloride 1%. Distance autorefraction was measured using the Shin-Nippon SRW-5000. Height and weight we...

Purpose: To compare the aberrometry-derived refractive error measurements from the IRX3 aberrometer (Imagine Eyes, Orsay, France) with a standardized measure of refractive error from the Shin-Nippon SRW-5000 (Japan) autorefractor in a large sample of school-aged children. Methods: Participants were a subgroup of children from the Northern Irelan...

Purpose: The interaction between higher order ocular aberrations (HOA) and refractive error is not yet fully understood. This study investigated HOA in relation to refractive error and ocular biometric parameters in a population with a high prevalence of ametropia. Methods: The HOA were investigated in two cohorts of Caucasian children aged 9 to...

To explore the onset and progression of spherical refractive error in a population with infantile nystagmus syndrome. Retrospective refractive error data were obtained from 147 medical records of children with infantile nystagmus syndrome (albinism n = 98; idiopathic infantile nystagmus n = 49), attending a low vision clinic in Northern Ireland, ov...

To assess the validity of questionnaire use in the self-identification of refractive status. Two hundred and forty adults (21-60 years of age) presenting for a routine eye examination at various optometric practices in Northern Ireland were asked to complete one of two questionnaires. Both questionnaires used identical questions to ascertain age, g...

The Frisby stereotest and the TNO test for stereoscopic vision are popular clinical tests for assessing stereoacuity: however, reference data for school-age children for the Frisby stereotest are limited. This study compared stereoacuity results of both tests in a large sample of typically developing school-age children. Primary (elementary school...

To investigate crystalline lens thickness (LT) across a range of ages and accommodative demands and to evaluate the repeatability of LT measurements using the Visante Anterior Segment Optical Coherence Tomographer (AS-OCT) (Zeiss Meditec, Germany) under non-cycloplegic conditions. Participants were 98 visually normal adults aged 18-75 years, strati...

Purpose: To explore 3-year change in spherical refractive error and ocular components among white Northern Irish schoolchildren. Methods: Baseline data were collected among 6- to 7-year-old and 12- to 13-year-old children. Three years after baseline, follow-up data were collected. Cycloplegic refractive error and ocular components measurements (...

Purpose: We explored associations between refractive error and foveal hypoplasia in infantile nystagmus syndrome (INS). Methods: We recruited 50 participants with INS (albinism n = 33, nonalbinism infantile nystagmus [NAIN] n = 17) aged 4 to 48 years. Cycloplegic refractive error and logMAR acuity were obtained. Spherical equivalent (SER), most...

Purpose: Down syndrome (DS) is associated with ocular abnormalities and reduced visual function. Studies report atypical optical structures in the DS eye such as thinner, steeper corneae and thinner crystalline lenses and, functionally, a degrading influence of the optics on acuity. This study further investigates optical quality in DS by comparin...

PURPOSE. We describe the profile and associations of anisometropia and aniso-astigmatism in a population-based sample of children. METHODS. The Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit a representative sample of children from schools in Northern Ireland. Examinations included c...

Purpose: Children with Down syndrome (DS) and cerebral palsy (CP) often have reduced visual acuity (VA). This study assessed VA and low-contrast acuity (LCA) with Lea symbols in DS and CP populations to explore whether LCA measures provide useful additional information about visual performance. VA and LCA were also measured in a large group of typ...

Vision screening programs often rely on acuity measures to detect significant refractive error and clinicians use measures of acuity to monitor refractive treatment. This study investigated the effects of induced astigmatism on visual acuity (VA) using several paediatric acuity tests: the Keeler LogMAR crowded and single letter acuity tests, the si...

To compare refraction and ocular biometry in European Caucasian children aged 6 to 7 years and 12 to 13 years, living in Sydney, Australia, and Northern Ireland. All children had a comprehensive eye examination, including cycloplegic (cyclopentolate 1%) autorefraction and ocular biometry. Hyperopia was defined as a right spherical equivalent refrac...

To investigate the utility of uncorrected visual acuity measures in screening for refractive error in white school children aged 6-7-years and 12-13-years. The Northern Ireland Childhood Errors of Refraction (NICER) study used a stratified random cluster design to recruit children from schools in Northern Ireland. Detailed eye examinations included...

Little data exist detailing the normal cup-to-disc (CD) ratios and arteriole-to-venule (A/V) ratios of school age children. In addition, controversy exists in the literature regarding associations between CD and A/V ratios and visual and biometric parameters. The present study investigates the success rates of obtaining useable optic disc images fr...

To study the prevalence of and relation between refractive and corneal astigmatism in white school children in Northern Ireland and to describe the association between refractive astigmatism and refractive error. Stratified random clustering was used to recruit 1053 white children, 392 aged 6-7 years and 661 aged 12-13 years. Eye examinations inclu...

There is no consensus as to the best method of assessing vision in children with neurological disability. There are a variety of tests and approaches that can be used. It is important to look at models of assessment that identify the visual diagnosis and provide appropriate feedback and explanation to parents, carers and educational professionals....