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Purpose Microperimetry (MP) allows for measurement of retinal sensitivity at precise locations and is now commonly employed as a clinical trial endpoint. Test–retest reliability is important when evaluating treatment effects in patients with geographic atrophy (GA). This study aimed to determine the test–retest variability of MP in patients with moderate to severe GA using the MAIA MP device. Methods In this prospective study, patients with a confirmed diagnosis of foveal-involving GA were enrolled. Participants performed three MP assessments of a selected eye over two visits with the Macular Integrity Assessment (MAIA) 2 instrument (Centervue, Padova, Italy) utilizing a wide 30° grid, consisting of 93 stimuli (Goldmann III) using a 4-2 representation strategy, encompassing the entire area of GA and beyond. Mean retinal sensitivity (MS) was expressed as an average threshold value (dB) for the entire field tested. Coefficients of Repeatability at a 95% level (CoR 95 ) were calculated for Point Wise Sensitivity (PWS). Fixation stability (FS) was assessed by evaluating the area of an elliptical representation encompassing 95% of the cloud of fixation points (CFP) dataset generated by the MAIA MP, known as the bivariate contour ellipse area (BCEA). Results A total of 8 subjects were enrolled (21 tests), with six subjects completing 3 MP assessments. BCVA in these patients ranged from 20/100 to 20/800. The mean area of GA was 18.7 ± 12.3 mm 2 . The average time to complete one MP assessment was 13 min 9 s and mean BCEA@95% was 38.5 ± 19.3°2. The MS was 14.3 ± 4.5 dB. No significant increase in MS was noted between testing pairs 1&2 and 2&3. The preferred retinal locus was maintained in the same quadrant on successive tests. The mean CoR95 for PWS were similar for testing pairs 1&2 (± 3.50 dB) and 2&3 (± 3.40). Conclusion Microperimetry using a wide grid can be reliably performed in a reasonable amount of time in patients with moderate and severe vision loss secondary to GA. There was no learning effect seen between sequential assessments when analyzing MS or PWS. A change of approximately 4 dB in PWS provides a threshold for considering a true change in this patient cohort.

ObjectivesTo evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA).MethodsFor Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA), individual participant data (IPD) were sought from all published randomised controlled trials (RCTs) comparing therapeutic exercise to non-exercise controls in people with knee/hip OA. Using the Counterfactual framework, the effect of the exercise intervention and the percentage mediated through each potential mediator (muscle strength, proprioception and range of motion (ROM)) for knee OA and muscle strength for hip OA were determined.ResultsData from 12 of 31 RCTs of STEER OA (1407 participants) were available. Within the IPD data sets, there were generally statistically significant effects from therapeutic exercise for pain and physical function in comparison to non-exercise controls. Of all potential mediators, only the change in knee extension strength was statistically and significantly associated with the change in pain in knee OA (β −0.03 (95% CI −0.05 to −0.01), 2.3% mediated) and with physical function in knee OA (β −0.02 (95% CI −0.04 to −0.00), 2.0% mediated) and hip OA (β −0.03 (95% CI −0.07 to −0.00), no mediation).ConclusionsThis first IPD mediation analysis of this scale revealed that in people with knee OA, knee extension strength only mediated ±2% of the effect of therapeutic exercise on pain and physical function. ROM and proprioception did not mediate changes in outcomes, nor did knee extension strength in people with hip OA. As 98% of the effectiveness of therapeutic exercise compared with non-exercise controls remains unexplained, more needs to be done to understand the underlying mechanisms of actions.

IntroductionKnee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions.Methods and analysis Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI.Ethics and disseminationResearch ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians.PROSPERO registration numberCRD42017054049.

There were also differences between the two lenses in subject ratings of EoD comfort. This measure was significantly higher with the senofilcon A lenses than with the lotrafilcon B lenses (p = 0.0005). In addition, subjects rated the senofilcon A lenses as having significantly higher EoD comfort compared to the lotrafilcon B lenses at one week (p = 0.0010) and two weeks (p = 0.0002).

[Brian Tompkins], an advocate of ON wear, says: 'For those whose eyes are suitable, ON wear reduces the number of procedures that patients need to conduct with their lens wear and care' The number of care steps involved in various modalities has previously been compared,46 highlighting that DD lenses need 120 steps per month, reusable lenses 210 (when using a multipurpose solution) compared to extended wear with only four steps per month.

A survey of more than 1,000 soft lens wearers found fewer dryness symptoms and end-of-day discomfort with two-weekly replacement lenses than with monthly lenses.6 Comfort at replacement was the same with daily disposable and two-weekly lenses and both were significantly more comfortable at replacement than monthly lenses.

The new Acuvue Advance for Astigmatism lens combines a new design concept in soft toric lenses with the material benefits of its spherical counterpart, Acuvue Advance with Hydraclear. Clinical studies have shown that the lens orientates quickly and accurately, is rotationally stable and performs well for vision and comfort against other commonly prescribed soft tories. The lens can be fitted successfully to a high proportion of astigmats and has the potential to grow the astigmatic contact lens market.

Mean visual acuity was nearly one line (0.07 logMAR) poorer than spectacle visual acuity and only 70 per cent of patients rated overall quality of vision as 'excellent' or 'very good'. Only 54 per cent said that the statement 'They were comfortable to wear all day long' described the lenses 'completely' or 'very well' and only 68 per cent of patients rated overall comfort as 'excellent' or 'very good'.

In addition to patient comfort, minimal impact on corneal physiology is a primary concern when fitting any contact lens. Moezzi et al16 compared open-eye corneal swelling between eyes wearing 1-Day Acuvue Moist and no lens wear. Central and peripheral corneal swelling with the spherical hydrogel lens was <1.5 per cent and comparable to no lens wear during daily wear. Limbal and bulbar hyperaemia, and corneal staining were also unremarkable.