Publications by authors named "Peter M Allen"

87 Publications

Nearwork-induced transient myopia and accommodation function before and after laser-assisted keratomileusis surgery.

Indian J Ophthalmol 2021 07;69(7):1707-1711

Vision and Hearing Sciences Research Group, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.

Purpose: To assess the change in Near Induced Transient Myopia (NITM) and other accommodation parameters, before and after undergoing LASIK surgery for myopia correction.

Methods: Twenty-nine myopic subjects were recruited from a tertiary eye hospital in India. Age range was 21 to 35 years with an average age of 26.1 ± 3.5 years. Mean spherical equivalent was -3.86 D ± 1.50 D presurgery. NITM, lag of accommodation, near point of convergence (NPC), accommodative amplitude (AA), and binocular near accommodative facility (AF) were measured. All data were collected 21 days prior to and 30 days after LASIK surgery.

Results: NITM, lag of accommodation and amplitude of accommodation were significantly lower (NITM -0.05 ± 0.15, Lag 0.38 ± 0.38, AA 10.27 ± 2.24) after surgery when compared to before (NITM 0.26 ± 0.12, Lag 0.77 ± 0.51, AA 12.18 ± 2.02; P < 0.001). Accommodative facility increased and near point of convergence was significantly more distal following surgery (AF 10.70 ± 2.29, NPC 7.96 ± 1.63) when compared to prior (AF 8.65 ± 2.74, NPC 5.62 ± 1.71; P < 0.001).

Conclusion: Significant changes in NITM and accommodation function should be expected in the short term following LASIK surgery. This study supports the importance of evaluating accommodative parameters and patient counselling prior to and following refractive surgery.
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http://dx.doi.org/10.4103/ijo.IJO_3224_20DOI Listing
July 2021

Nearwork-induced transient myopia and accommodation function before and after laser-assisted keratomileusis surgery.

Indian J Ophthalmol 2021 07;69(7):1707-1711

Vision and Hearing Sciences Research Group, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK.

Purpose: To assess the change in Near Induced Transient Myopia (NITM) and other accommodation parameters, before and after undergoing LASIK surgery for myopia correction.

Methods: Twenty-nine myopic subjects were recruited from a tertiary eye hospital in India. Age range was 21 to 35 years with an average age of 26.1 ± 3.5 years. Mean spherical equivalent was -3.86 D ± 1.50 D presurgery. NITM, lag of accommodation, near point of convergence (NPC), accommodative amplitude (AA), and binocular near accommodative facility (AF) were measured. All data were collected 21 days prior to and 30 days after LASIK surgery.

Results: NITM, lag of accommodation and amplitude of accommodation were significantly lower (NITM -0.05 ± 0.15, Lag 0.38 ± 0.38, AA 10.27 ± 2.24) after surgery when compared to before (NITM 0.26 ± 0.12, Lag 0.77 ± 0.51, AA 12.18 ± 2.02; P < 0.001). Accommodative facility increased and near point of convergence was significantly more distal following surgery (AF 10.70 ± 2.29, NPC 7.96 ± 1.63) when compared to prior (AF 8.65 ± 2.74, NPC 5.62 ± 1.71; P < 0.001).

Conclusion: Significant changes in NITM and accommodation function should be expected in the short term following LASIK surgery. This study supports the importance of evaluating accommodative parameters and patient counselling prior to and following refractive surgery.
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http://dx.doi.org/10.4103/ijo.IJO_3224_20DOI Listing
July 2021

Efficacy of low-dose atropine to reduce myopia progression among Indian children.

Indian J Ophthalmol 2021 05;69(5):1358-1359

Vision and Hearing Sciences Research Group, Anglia Ruskin University, East Road, Cambridge, UK.

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http://dx.doi.org/10.4103/ijo.IJO_3157_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186620PMC
May 2021

IMI Accommodation and Binocular Vision in Myopia Development and Progression.

Invest Ophthalmol Vis Sci 2021 Apr;62(5)

School of Optometry, Aston University, Birmingham, United Kingdom.

The role of accommodation in myopia development and progression has been debated for decades. More recently, the understanding of the mechanisms involved in accommodation and the consequent alterations in ocular parameters has expanded. This International Myopia Institute white paper reviews the variations in ocular parameters that occur with accommodation and the mechanisms involved in accommodation and myopia development and progression. Convergence is synergistically linked with accommodation and the impact of this on myopia has also been critiqued. Specific topics reviewed included accommodation and myopia, role of spatial frequency, and contrast of the task of objects in the near environment, color cues to accommodation, lag of accommodation, accommodative-convergence ratio, and near phoria status. Aspects of retinal blur from the lag of accommodation, the impact of spatial frequency at near and a short working distance may all be implicated in myopia development and progression. The response of the ciliary body and its links with changes in the choroid remain to be explored. Further research is critical to understanding the factors underlying accommodative and binocular mechanisms for myopia development and its progression and to guide recommendations for targeted interventions to slow myopia progression.
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http://dx.doi.org/10.1167/iovs.62.5.4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083074PMC
April 2021

Do visual fields need to be considered in classification criteria within visually impaired shooting?

J Sports Sci 2021 Apr 16:1-9. Epub 2021 Apr 16.

Vision and Hearing Sciences Research Group, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.

Classification within the sport of vision impairment (VI) shooting is based upon the athlete's visual function. This study aimed to determine whether more than one class of competition is needed within VI shooting on the basis of visual field loss. Qualification scores of 23 elite athletes were obtained at World Championship events in prone and standing shooting disciplines. Visual field data were obtained from classification data and from assessment at events. A standardized scoring protocol determined whether athletes had function (≥10 dB) or no function (<10 dB) at locations between 0-60 degrees eccentricity along 10 meridia. Visual field function was not associated with shooting performance in prone or standing disciplines (p > 0.05). Having measurable visual field function beyond 30 degrees made no difference to athletes' ability to shoot competitively in prone (p = 0.65) or standing disciplines (p = 0.47), although a potential impact on qualification was observed in the standing discipline. There was no evidence that loss of visual field function at any specific location adversely affected ability to shoot competitively. There is currently no evidence to consider visual fields in classification within prone or standing VI shooting, although further research is needed as the sport grows.
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http://dx.doi.org/10.1080/02640414.2021.1911425DOI Listing
April 2021

Is the pink ball still under review? Cricket umpires' perceptions of the pink ball for day/night matches.

J Sci Med Sport 2021 Mar 27. Epub 2021 Mar 27.

Vision and Hearing Sciences Research Centre, School of Psychology and Sport Science, Anglia Ruskin University, United Kingdom; Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, United Kingdom. Electronic address:

Objectives: The visibility of the pink ball used in day/night Test cricket has been under scrutiny, with recent research suggesting cricketers find the pink ball less visible at dusk under floodlights. With increasing interest in this match format, this study sought to investigate elite umpires' opinions pertaining to the visibility of the pink cricket ball during day/night matches.

Design: Purposeful sampling of a cross-section of elite umpires with experience adjudicating matches played using a pink cricket ball.

Methods: Twenty-seven international/first-class umpires completed a questionnaire consisting of Likert scale and free text responses covering perceptions of the pink cricket ball, with a particular emphasis on visibility.

Results: The pink ball when viewed at night under floodlights was rated as being significantly more visible than the red ball during natural lighting (ps<0.050). Umpires who actively participated in training reported a significantly higher rating of the visibility of the pink ball (mean -3.14) at night under floodlights compared to those who didn't (mean p=0.010). No significant difference was reported in visibility in natural light or dusk under floodlights. Free text responses (n=10) revealed the following themes: use of eyewear (coverage 0.30), and adjustment to positioning (coverage 0.20) to improve visibility of the pink ball.

Conclusions: Umpires report the visibility of the pink ball is equal to the red in natural light and at dusk but is significantly better at night. Preference for the pink ball is likely due to the predominantly perceptual nature of visual tasks performed by umpires.
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http://dx.doi.org/10.1016/j.jsams.2021.03.011DOI Listing
March 2021

Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.

Eur J Ophthalmol 2021 Mar 5:1120672121998960. Epub 2021 Mar 5.

School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.

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 myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
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http://dx.doi.org/10.1177/1120672121998960DOI Listing
March 2021

Social representation of hearing aids among people with hearing loss: an exploratory study.

Int J Audiol 2021 Mar 2:1-15. Epub 2021 Mar 2.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Objective: The aim of the current study was to examine the social representation (SR) of hearing aids in people with hearing loss (PHL) in India, the Republic of Korea (ROK), the United Kingdom (UK), and the United States of America (US).

Design: The study used a cross-sectional survey design. The data collected by using a free association task were analysed qualitatively (i.e. content analysis) and quantitatively (i.e. chi-square analysis, similarities analysis, prototypical analysis).

Study Sample: 424 participants with hearing loss.

Results: The most commonly reported categories across all countries were "beneficial," "cost and time," and "appearance and design." Approximately 50% of the associations reported were negative. There were variations in terms of the categories that were predominant in the SR of each country. "Others actions and attitude" category was predominantly reported by PHL in India. "Disturbance" and "dissatisfaction" of hearing aids and the "repairs and maintenance of hearing aids" categories were mainly reported from the ROK and the US, respectively.

Conclusions: The current results highlight the main aspects that PHL report spontaneously when they think about hearing aids. The findings will help to further inform public health campaigns and will contribute to develop culturally appropriate media materials regarding hearing aids.
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http://dx.doi.org/10.1080/14992027.2021.1886349DOI Listing
March 2021

Exploring tinnitus heterogeneity.

Prog Brain Res 2021 24;260:79-99. Epub 2020 Jul 24.

National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, United Kingdom.

Introduction: Tinnitus experiences differ widely. A greater understanding of the core processes underlying these variations is needed. Moreover, meaningful definitions for different subgroups are required to better manage this heterogeneous population. The objective of the present research was to contribute toward the understanding of tinnitus heterogeneity by identifying factors that can predict tinnitus severity and to ascertain if distinct subgroups of tinnitus presentation can be identified.

Methods: This cross-sectional study consisted of 326 adults subdivided into subgroups of those with mild tinnitus (n=32; 10%), significant tinnitus (n=99; 30%) and severe tinnitus (n=195; 60%) according to their scores from the Tinnitus Functional Index. Multiple regression was used to identify factors associated with tinnitus severity. These factors included personal traits, tinnitus-related traits, treatment modalities and clinical comorbidities.

Results: Insomnia, hearing distress, and anxiety were the best predictors of tinnitus severity (explaining 53% of the variability). These comorbidities were stronger predictors than any demographical factors (that explained 11% of the variability). Distinct subgroups based on tinnitus severity (mild, significant, and severe) and anxiety levels were evident. Those with severe tinnitus had significantly more severe comorbidities compared with the mild and significant groups.

Conclusions: This study highlights that people with tinnitus could initially be grouped according to tinnitus severity to direct further management. Those with higher tinnitus severity should receive more immediate and intensive care. Due to the strong associations between tinnitus severity and tinnitus-related comorbidities (e.g., insomnia, hearing disability, and anxiety), tinnitus assessment and interventions should focus on these comorbidities.
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http://dx.doi.org/10.1016/bs.pbr.2020.05.022DOI Listing
July 2020

Expert opinion on classification for footballers with vision impairment: Towards evidence-based minimum impairment criteria.

J Sports Sci 2021 Feb 7:1-10. Epub 2021 Feb 7.

Department of Human Movement Sciences, IPC Research and Development Centre for the Classification of Athletes with Vision Impairment, Vrije Universitteit Amsterdam, Netherlands.

In Para sport, the aim of classification is to minimize the impact of impairment on the outcome of competition. Despite requirements of the International Paralympic Committee Athlete Classification Code for classification to be evidence-based and sport-specific, sports for athletes with VI, including football, use the same generic classes across almost all sports. The aim of this study was to consult with experts to establish the needs and challenges for developing a code-compliant system of classification for VI football. A panel of 18 experts with international experience in VI football (16.8 ± 10.2 years) took part in a three-round Delphi study using online surveys. Results showed that the panel did not think that the current system completely fulfils the aim of classification. The panel identified measures of visual function they considered to be relevant but are not currently measured during classification including dynamic acuity, depth and motion perception, and contrast and light sensitivity. Moreover, they identified technical skills such as ball control, dribbling and passing, as well as perceptual-cognitive skills, as most likely to be affected by vision impairment. Findings outline the need for change and offer a framework for future research to develop an evidence-based classification for VI football.
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http://dx.doi.org/10.1080/02640414.2021.1881301DOI Listing
February 2021

The effect of the COVID-19 pandemic on working practices of UK primary care optometrists.

Ophthalmic Physiol Opt 2021 03 2;41(2):378-392. Epub 2021 Feb 2.

Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK.

Purpose: In late 2019, a new coronavirus capable of infecting humans, SARS-CoV-2, was identified in Wuhan, China. The resultant respiratory disease was subsequently named COVID-19. In March 2020, in response to the COVID-19 pandemic, primary care optometry practices only remained open to deliver essential or emergency eye care. This study aimed to characterise the experiences of United Kingdom (UK)-based primary care optometrists during the COVID-19 pandemic.

Methods: An email invitation to participate in an online cross-sectional survey was sent to 3000 UK-based, currently practicing members of The College of Optometrists (UK). Responses to the structured questionnaire were analysed using descriptive statistics, including frequencies, means and standard deviations. Frequency analyses were used to evaluate items with multiple responses. Free-text responses were examined using thematic analyses.

Results: After data cleaning, a total of 1250 responses remained. Sixty-three percent were female, 70% self-identified as being of white ethnicity and 78% were based in England. During the first national lockdown, over half of all respondents were involved with the provision of remote consultations for emergency/urgent care. The majority felt 'very'/'moderately' comfortable conducting remote consultations, but 66% felt professional liability was increased. Forty percent were involved in the provision of face-to-face consultations. Eye-health and vision-related problems were the most commonly reported patient issues during both remote and face-to-face consultations, while contact-lens related problems were the least. Thematic analysis of the responses showed several challenges adjusting to the pandemic (e.g., working safely), but also some potential benefits (e.g., increased skills).

Conclusions: The findings provide an overview of changes to optometric practice in the UK during the COVID-19 pandemic. The results may be used to inform the development of professional guidance and facilitate resource allocation for safe and effective eye care during this and any future pandemics.
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http://dx.doi.org/10.1111/opo.12786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013371PMC
March 2021

In vivo screens using a selective CRISPR antigen removal lentiviral vector system reveal immune dependencies in renal cell carcinoma.

Immunity 2021 Mar 25;54(3):571-585.e6. Epub 2021 Jan 25.

Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA. Electronic address:

CRISPR-Cas9 genome engineering has increased the pace of discovery for immunology and cancer biology, revealing potential therapeutic targets and providing insight into mechanisms underlying resistance to immunotherapy. However, endogenous immune recognition of Cas9 has limited the applicability of CRISPR technologies in vivo. Here, we characterized immune responses against Cas9 and other expressed CRISPR vector components that cause antigen-specific tumor rejection in several mouse cancer models. To avoid unwanted immune recognition, we designed a lentiviral vector system that allowed selective CRISPR antigen removal (SCAR) from tumor cells. The SCAR system reversed immune-mediated rejection of CRISPR-modified tumor cells in vivo and enabled high-throughput genetic screens in previously intractable models. A pooled in vivo screen using SCAR in a CRISPR-antigen-sensitive renal cell carcinoma revealed resistance pathways associated with autophagy and major histocompatibility complex class I (MHC class I) expression. Thus, SCAR presents a resource that enables CRISPR-based studies of tumor-immune interactions and prevents unwanted immune recognition of genetically engineered cells, with implications for clinical applications.
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http://dx.doi.org/10.1016/j.immuni.2021.01.001DOI Listing
March 2021

Social Representation of "Hearing Loss" Among People with Hearing Loss: An Exploratory Cross-Cultural Study.

J Am Acad Audiol 2020 11 15;31(10):725-739. Epub 2020 Dec 15.

Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, United Kingdom.

Background: Hearing loss can have an effect on the physical, psychosocial, and cognitive wellbeing of an individual. Despite the research on attitudes and stigma associated with hearing loss, people with hearing loss (PHL) continue to delay seeking help. Thus, it is vital to look at alternative theories which have been successfully used in disability research to better understand how PHL perceive hearing loss.

Purpose: The aim of the current exploratory study was to examine the social representation (SR) of "hearing loss" in PHL in India, Republic of Korea (ROK), United Kingdom (UK), and the United States (US).

Research Design: The study used a cross-sectional survey design.

Study Sample: In this study, 424 participants were recruited using a consecutive sampling method in four countries (India, Republic of Korea, United Kingdom, and United States).

Data Collection And Analysis: Data collection was conducted using a questionnaire. Data were analyzed using content analysis, similarities analysis, prototypical analysis, and chi-square analysis.

Results: The free associations of the PHL were grouped into 37 categories. The most commonly reported categories were and . Similarities analysis and prototypical analysis highlighted two main negative categories () which form the central elements of SR of hearing loss. PHL associated hearing loss mainly as a negative phenomenon, but with some positive and neutral aspects. Respondents from ROK reported a greater number of neutral associations compared with other countries. There were cross-cultural similarities and differences in terms of PHL's SR of hearing loss, but there were more similarities than differences.

Conclusion: The study provides an insight into how PHL collectively view their "hearing loss" and helps to develop our understanding of the influence of culture on the SR of "hearing loss." The results will aid the development of culturally appropriate public education campaigns, marketing material, and appropriate rehabilitation for PHL.
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http://dx.doi.org/10.1055/s-0040-1719127DOI Listing
November 2020

Perspectives of a new sport-specific Para Shooting classification system for athletes with vision impairment.

J Sports Sci 2020 Dec 15:1-11. Epub 2020 Dec 15.

School of Pyschology and Sports Science, Anglia Ruskin University, Cambridge, UK.

The International Paralympic Committee (IPC) and individual sports federations have established the need to develop evidence-based systems of classification for athletes with vision impairment (VI) that may differ depending on the visual demands of each sport. As a consequence, research has been conducted that led to a new classification system for athletes competing in VI shooting. The purpose of this study was to canvas the experiences of key stakeholders (athletes, coaches and classifiers) when the new system of classification was implemented. Twenty-eight participants (17 athletes, 7 coaches and 4 classifiers) completed a questionnaire to rate their experiences of the previous and new classification systems and were interviewed to gain richer insights into their opinions. It was apparent that the changes to the classification system were not adequately communicated to the athletes in particular, and that the classifiers may require a better understanding of the principles of evidence-based classification. The new system was perceived to be significantly more specific for VI shooting and intentional misrepresentation was observed to be significantly less likely than when using the old system. This research provides valuable insights into both the positive and negative experiences of key stakeholders experiencing change in a classification system.
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http://dx.doi.org/10.1080/02640414.2020.1851923DOI Listing
December 2020

Changes in Tinnitus Experiences During the COVID-19 Pandemic.

Front Public Health 2020 5;8:592878. Epub 2020 Nov 5.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, United States.

The COVID-19 pandemic has disrupted delivery of healthcare, economic activity, and affected social interactions. Identifying and supporting those most affected by the pandemic is required. The purpose of this study was to determine the impact of the pandemic on individuals with tinnitus and to identify mediating factors. This is a mixed-methods exploratory cross-sectional study, using data collected via an online survey from 3,103 individuals with tinnitus from 48 countries. The greatest representation was from North America (49%) and Europe (47%) and other countries were only marginally represented. Although the study was aimed at those with pre-existing tinnitus, 7 individuals reported having COVID-19 initiated tinnitus. Having COVID-19 symptoms exacerbated tinnitus in 40% of respondents, made no change in 54%, and improved tinnitus in 6%. Other mediating factors such as the social and emotional consequences of the pandemic made pre-existing tinnitus more bothersome for 32% of the respondents, particularly for females and younger adults, better for 1%, and caused no change to tinnitus for 67%. Pre-existing tinnitus was significantly exacerbated for those self-isolating, experiencing loneliness, sleeping poorly, and with reduced levels of exercise. Increased depression, anxiety, irritability, and financial worries further significantly contributed to tinnitus being more bothersome during the pandemic period. These findings have implications for tinnitus management, because they highlight the diverse response both internal and external factors have on tinnitus levels. Clinical services should be mindful that tinnitus may be caused by contracting COVID-19 and pre-existing tinnitus may be exacerbated, although in the majority of respondents there was no change. Additional support should be offered where tinnitus severity has increased due to the health, social, and/or emotional effects of the COVID-19 pandemic. Tinnitus may be more bothersome for those experiencing loneliness, having fewer social interactions, and who are more anxious or worried.
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http://dx.doi.org/10.3389/fpubh.2020.592878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676491PMC
May 2021

Contact lens wear and care in Spain during the COVID-19 pandemic.

Cont Lens Anterior Eye 2020 Nov 11:101381. Epub 2020 Nov 11.

Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK. Electronic address:

Aim: To establish contact lens wear and care practices during the COVID-19 pandemic in Spain.

Method: A 58-item anonymous online survey was distributed during the period 30th April to 10th May via Qualtrics. The survey explored: a) demographic characteristics (age, sex, general health and where they were living during lockdown), b) changes in their contact lens use during lockdown, c) hygiene and contact lens compliance and d) concerns associated with contact lens wear and ways to support wearers during the pandemic.

Results: Two hundred and sixty responses were analysed (38.8 ± 11.4 years old, 75% female). Three-quarters of participants reported that they were self-isolating or rigorously following social distancing advice. Sixty-seven percent of participants reported using their contact lenses less during the pandemic. Respondents were found to be compliant with handwashing prior to inserting and removing contact lenses (in both cases 97% doing this 'most times' or 'every time'). However, only 44 % complied with the '20 s rule' and 48 % used a shared towel to dry their hands. A higher proportion of hydrogen peroxide users replaced the lens case monthly compared to multi-purpose users (64% vs.49%; p < 0.001). Twenty-four percent admitted wearing lenses whilst showering and 16% did not consider ceasing lens wear if feeling unwell with flu/cold symptoms.

Conclusion: Eye care practitioners should continue to educate contact lens wearers to ensure safe contact lens wear to minimise the chance of developing contact lens related complications during the pandemic. Modifiable factors that need particular attention in Spain include: handwashing for at least 20s before lens handling, drying hands with single use paper towels, including a rub-and-rinse step for reusable lenses, lens case cleaning and renewal, avoidance of water exposure and when to cease lens wear during the pandemic.
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http://dx.doi.org/10.1016/j.clae.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657612PMC
November 2020

Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE).

Clin Ophthalmol 2020 6;14:3039-3047. Epub 2020 Oct 6.

Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK.

Purpose: Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked.

Patients And Methods: A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl).

Results: There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p<0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl.

Conclusion: The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.
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http://dx.doi.org/10.2147/OPTH.S273524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547802PMC
October 2020

Evidence-based Classification in Track Athletics for Athletes with a Vision Impairment: A Delphi Study.

Optom Vis Sci 2020 Nov;97(11):984-994

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences and Institute Brain and Behavior, Amsterdam, the Netherlands.

Significance: The Delphi analysis presented here highlights the need for a sport-specific evidence-based classification system for track athletics for athletes with a vision impairment (VI). This system may differ for different race distances. Further research is required to develop a useful test battery of vision tests for classification. The issue of intentional misrepresentation during classification needs particular attention.

Purpose: At present, athletes with VI are placed into competition classes developed on the basis of legal definitions of VI. The International Paralympic Committee Athlete Classification Code states that all sports should have their own classification system designed to reflect the (visual) demands of that individual sport. This project gathered expert opinion on the specific requirements for an evidence-based sport-specific classification system for VI track athletics and to identify any particular issues within track athletics that require further research into their impact on sport performance.

Methods: A three-round Delphi review was conducted with a panel of 17 people with expertise in VI track athletics.

Results: The panel agreed that the current classification system in VI track athletics does not completely minimize the impact of impairment on competition outcome, highlighting the need for improvements. There was clear agreement that the existing measures of vision may fail to adequately reflect the type of vision loss that would impact running performance, with additional measures required. Intentional misrepresentation, where athletes "cheat" on classification tests, remains a serious concern.

Conclusions: The panel has identified measures of vision and performance that will inform the development of an evidence-based classification system by better understanding the relationship between VI and performance in track athletics. Issues such as the use of guides and whether the current class system was equitable gave rise to differing opinions within the panel, with these varying across the different running distances.
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http://dx.doi.org/10.1097/OPX.0000000000001600DOI Listing
November 2020

Cricketers are not tickled pink by the new coloured ball.

J Sci Med Sport 2021 Feb 20;24(2):183-188. Epub 2020 Aug 20.

Department of Vision and Hearing Sciences, Anglia Ruskin University, UK; Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, UK. Electronic address:

Objectives: Cricket administrators have started scheduling long-form matches which finish at night and are played with a pink as opposed to a red ball. However, there are reports that the pink ball may introduce new dangers and alter performance. The aim of this study was to investigate professional cricketers' opinions about the visibility of the pink ball whilst playing in different lighting conditions (afternoon, dusk and night).

Design: Purposeful sampling of a cross-section of elite cricketers with pink ball experiences playing in the United Kingdom.

Methods: Eighty-eight international or first-class professional cricketers completed a questionnaire consisting of Likert scale and free text responses to questions covering perceptions of the pink ball, with a particular emphasis on visibility.

Results: The pink ball was reported as less visible than the red ball when batting (p<0.001) and fielding (p<0.001). Within the three lighting conditions the pink ball was significantly less visible at dusk under floodlights compared to afternoon and night both when batting and fielding (ps<0.001). Free text comments confirmed that visibility of the pink cricket ball was most challenging at dusk (coverage 0.37), and that players sometimes experienced a blurring sensation with the pink ball leaving a visual 'trail' when viewed under floodlights (coverage 0.24).

Conclusions: Results advocate that governing bodies should consider the inclusion of a break in play during dusk to enhance player safety and performance. Empirical research is needed to quantify the risks to player safety in different lighting conditions.
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http://dx.doi.org/10.1016/j.jsams.2020.08.006DOI Listing
February 2021

Soft contact lens wearers' compliance during the COVID-19 pandemic.

Cont Lens Anterior Eye 2021 08 14;44(4):101359. Epub 2020 Aug 14.

Anglia Ruskin University, Vision and Hearing Sciences Research Centre, Cambridge, CB1 1PT, United Kingdom. Electronic address:

Aim: Contact lens wearers need to maintain optimal hygiene practices during the COVID-19 pandemic to minimise contact-lens complications including microbial keratitis and corneal infiltrative events. This online survey (UK and Ireland) explored contact lens wearers' compliance behaviours, attitudes and concerns during the pandemic.

Method: The 60-item anonymous online survey was distributed during a 1-month period via Qualtrics (starting on 14/04/20). The survey captured: a) demographic information, b) type of lenses worn and compliance with lens wear and care procedures, c) adherence to recommendations and d) concerns associated with contact lens wear during the pandemic.

Results: Two hundred and forty seven responses were received (34.3 ± 11.7 years old, 79% female). Seventy nine percent of participants reported that they were self-isolating or rigorously following social distance advice. Fifty-six percent of participants reported using their lenses less during the pandemic. Eighty-seven percent of respondents reported following the recommended 20-second rule most times/every time and 96% used soap and water during handwashing. Eleven percent of respondents admitted not following recommendations regarding disposal of lenses and 18% would not consider ceasing lens wear if unwell (with flu/cold) during the pandemic.

Conclusion: Respondents reported wearing their contact lenses less than usual. Good compliance with handwashing was observed but soft reusable lens wearers showed a statistically significant lower compliance with lens wear and care compared to daily disposable lens wearers (p=<0.001).
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http://dx.doi.org/10.1016/j.clae.2020.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427528PMC
August 2021

Optimal methodology for lid wiper epitheliopathy identification.

Cont Lens Anterior Eye 2021 Jun 14;44(3):101332. Epub 2020 May 14.

Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK.

Purpose: Lid wiper epitheliopathy (LWE) is a clinical sign that has been associated with dry eye disease. This study used a semi-automated method to identify the effect of drop instillation and post-dye viewing time on the absorption of lissamine green (LG) and sodium fluorescein (NaFl) on the upper eyelid in order to ascertain the optimal identification for LWE assessment.

Methods: In 37 participants with LWE, 1-drop of 1% LG (10 μL) was applied to the superior bulbar conjunctiva in the right eye, and photographs of the lid margin were taken 1, 3, and 5 min after instillation. Measurements were repeated in the same eye following instillations of 2-drops of 1% LG. The same procedures were followed for application of 2% NaFl (2 μL) to the left eye. Staining area was determined using software to detect and measure dye-stained images. Analysis used a linear mixed model with fixed effects of time, number of drops and their interaction.

Results: For LG, multivariate analysis showed that time of drop instillation was significant (p = 0.0091) as was the area of staining in the 2-drop versus 1-drop condition (p < 0.0001). For NaFl, there was a significant effect of time (p < 0.0001), drops (p < 0.0001), and a time/drops interaction (p < 0.0134), suggesting that both time and number of drops are important.

Conclusion: A single drop of dye is insufficient to reveal the full extent of LWE staining. A 2-drop instillation is recommended and observation is recommended between 1 and 5 min (LG) and between 3 and 5 min (NaFl).
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http://dx.doi.org/10.1016/j.clae.2020.04.016DOI Listing
June 2021

SARS-CoV-2 self-isolation: recommendations for people with a vision impairment.

Eye (Lond) 2020 Jul 29;34(7):1183-1184. Epub 2020 Apr 29.

School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK.

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http://dx.doi.org/10.1038/s41433-020-0917-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189829PMC
July 2020

Low-dose (0.01%) atropine eye-drops to reduce progression of myopia in children: a multicentre placebo-controlled randomised trial in the UK (CHAMP-UK)-study protocol.

Br J Ophthalmol 2020 07 25;104(7):950-955. Epub 2019 Oct 25.

Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK.

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 -0.50 dioptres or worse in both eyes.We will recruit 289 participants with an allocation ratio of 2:1 (193 atropine; 96 placebo) from five centres. Participants will instil one drop in each eye every day for 2 years and attend a research centre every 6 months. The vehicle and preservative will be the same in both study arms.The primary outcome is SER of both eyes measured by autorefractor under cycloplegia at 2 years (adjusted for baseline). Secondary outcomes include axial length, best corrected distance visual acuity, near visual acuity, reading speed, pupil diameter, accommodation, adverse event rates and allergic reactions, quality of life (EQ-5D-Y) and tolerability at 2 years. Mechanistic evaluations will include: peripheral axial length, peripheral retinal defocus, anterior chamber depth, iris colour, height and weight, activities questionnaire, ciliary body biometry and chorioretinal thickness. Endpoints from both eyes will be pooled in combined analysis using generalised estimating equations to allow for the correlation between eyes within participant. Three years after cessation of treatment, we will also evaluate refractive error and adverse events.

Conclusions: The Childhood Atropine for Myopia Progression in the UK study will be the first randomised trial reporting outcomes of low-dose atropine eye-drops for children with myopia in a UK population.

Trial Registration Number: ISRCTN99883695, NCT03690089.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314819DOI Listing
July 2020

Clinical Use of the Kannada and English Rate of Reading Tests.

Front Psychol 2019 20;10:2116. Epub 2019 Sep 20.

Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom.

The rate of reading test in which randomly ordered common words are read aloud has found use in optometric and educational practice as a means of assessing visual aspects of reading largely independently of comprehension. English and Kannada versions of the rate of reading test were administered to 761 children aged between 9 and 15 years. These children were recruited from four private and five state schools in Udupi Taluk that had English and Kannada, respectively, as the principal medium of instruction. The results showed that the reading rate increased with age, as expected, but depended on the language of the test and the medium of instruction. The study emphasizes the importance of using normative data based on age and the language of instruction used in school. It also suggests age-specific criteria to measure the efficacy of any visual intervention aimed at improving reading speed. The test can be used to assess (1) educational under-performance in reading and (2) the effects of optometric and educational intervention, and separate norms appropriate for each use are presented.
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http://dx.doi.org/10.3389/fpsyg.2019.02116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764215PMC
September 2019

Rifle Shooting for Athletes With Vision Impairment: Does One Class Fit All?

Front Psychol 2019 31;10:1727. Epub 2019 Jul 31.

Department of Human Movement Sciences, IPC Research and Development Centre for the Classification of Athletes with Vision Impairment, Amsterdam Movement Sciences, Institute of Brain and Behavior, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Revised evidence-based classification criteria introduced for shooting for athletes with vision impairment (VI shooting) suggest that athletes with impaired contrast sensitivity (CS) and visual acuity (VA) should be eligible for inclusion in the sport but should all eligible athletes compete against each other in the same "class" or is more than one class necessary? Twenty-five elite VI shooting athletes took part in the study. Two measures of visual function were assessed under standardized conditions: VA (using an ETDRS logMAR letter chart, and/or a BRVT chart) and CS (using both a Pelli-Robson chart and a Mars number chart). Shooting performance, in both prone and standing events, was measured during an international VI shooting competition. Fourteen of the 25 athletes had measurable VA, and for CS, 8 athletes had measurable function with the Pelli-Robson chart and 13 with the Mars chart. The remaining athletes had function not numerically measurable by the charts and were considered to have no residual vision. There was no indication that shooting performance varied with visual function, and individuals that had residual vision had no advantage over those without vision for either prone or standing shooting. The modifications made to VI shooting, including the use of auditory tones to guide the gun barrel, appear to have successfully rendered the sport equitable for all eligible athletes. Only one class is necessary for athletes. An improved method of measuring CS in athletes with profound VI would be advantageous.
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http://dx.doi.org/10.3389/fpsyg.2019.01727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684738PMC
July 2019

Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis.

Trends Hear 2019 Jan-Dec;23:2331216519851749

9 Department of Behavioral Sciences and Learning, Linköping University, Sweden.

Internet-based interventions have been developed to improve access to audiovestibular health care. This review aimed to identify outcomes of Internet interventions for adults with hearing loss, tinnitus, and vestibular disorders. Electronic databases and manual searches were performed to identify studies meeting eligibility for inclusion. Fifteen studies (1,811 participants) met the inclusion criteria, with nine studies targeting tinnitus distress, five considering hearing loss, and one for vestibular difficulties. Only the tinnitus and hearing loss Internet intervention studies were eligible for data synthesis. Internet-based interventions for hearing loss were diverse. Overall, they showed no significant effects, although a statistically significant moderate effect ( = 0.59) was found after removing the study with the highest risk of bias (as a result of high attrition). Most Internet-based interventions for tinnitus provided cognitive behavioural therapy. They yielded statistically significant mean effect sizes for reducing tinnitus distress compared with both inactive ( = 0.59) and active controls ( = 0.32). Significant effects were also present for the secondary outcomes of anxiety, depression, insomnia, and quality of life (combined effect  = 0.28). Only Internet-based interventions for tinnitus evaluated the 1-year postintervention effects indicated that results were maintained long term ( = 0.45). Scientific study quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach and found to vary from very low to moderate. This review indicates the potential of Internet interventions for tinnitus to provide evidence-based accessible care. There is a need for additional high-quality evidence before conclusive results can be established regarding the effects of audiovestibular Internet interventions.
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http://dx.doi.org/10.1177/2331216519851749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647231PMC
December 2019

Sources of error in clinical measurement of the amplitude of accommodation.

J Optom 2020 Jan - Mar;13(1):3-14. Epub 2019 Jul 11.

Institute of Optometry, 56-62 Newington Causeway, London SE1 6DS, UK; School of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK; Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.

Measurement of the amplitude of accommodation is established as a procedure in a routine optometric eye examination. However, clinical methods of measurement of this basic optical function have several sources of error. They are numerous and diverse, and include depth of focus, reaction time, instrument design, specification of the measurement end-point, specification of the reference point of measurement, measurement conditions, consideration of refractive error, and psychological factors. Several of these sources of inaccuracy are composed of multiple sub-sources, and many of the sub-sources influence the common methods of measurement of amplitude of accommodation. Consideration of these sources of measurement error casts doubt on the reliability of the results of measurement, on the validity of established normative values that have been produced using these methods, and on the value of reports of the results of surgery designed to restore accommodation. Clinicians can reduce the effects of some of the sources of error by modifying techniques of measurement with existing methods, but a new method may further improve accuracy.
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http://dx.doi.org/10.1016/j.optom.2019.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951837PMC
June 2020

Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

J Am Acad Audiol 2018 Nov/Dec;29(10):936-947

Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model.

Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective.

Research Design: A cross-sectional survey design was used.

Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.

Data Collection And Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions.

Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor.

Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.
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http://dx.doi.org/10.3766/jaaa.17094DOI Listing
October 2019

Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review.

Syst Rev 2018 11 23;7(1):205. Epub 2018 Nov 23.

Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders.

Method: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined.

Discussion: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders.

Systematic Review Registration: PROSPERO CRD42018094801.
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http://dx.doi.org/10.1186/s13643-018-0880-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260838PMC
November 2018

Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus.

Am J Audiol 2018 Nov;27(3S):431-447

Department of Behavioural Sciences and Learning, Linköping University, Sweden.

Purpose: The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus.

Method: Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year postintervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist.

Results: Undertaking iCBT for tinnitus led to significant improvements 1 year postintervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year postintervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment.

Conclusions: The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year postintervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials.
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http://dx.doi.org/10.1044/2018_AJA-IMIA3-18-0004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018448PMC
November 2018
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