Master's Thesis Abstracts | Vision Science and Business (Optometry)

Author: Alja Al-Jouja Ramadani

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Oliver Buck, M.Sc. in Vision Science and Business (Optometry)

Author: Meryam Danhach

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Heinrich Aderneuer, M.Sc. Vision Science and Business (Optometry)

Author: Simone Fillip

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Oliver Buck, M.Sc. in Vision Science and Business (Optometry)

Author: Sabrina Gutherz

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Thomas Hofmann, M.Sc. Vision Science and Business (Optometry)

Author: Tibor Illés

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Damjan Žunić, M.Sc. Vision Science and Business (Optometry)

Author: Ian Legros

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Damjan Žunić, M.Sc. in Vision Science and Business (Optometry)

Author: Ana Majdak

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Dr. Matjaž Mihelčič, M.Sc. Vision Science and Business (Optometry)

Author: Katharina Manz

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Prof. Dr. Philipp Hessler

Author: Jonathan Riecker

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Prof. Dr. med. Amir Mobarez Parasta

Author: Anaswara Siby Moolayil

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisors: Prof. Dr. med. univ. Dr. med. Katrin Lorenz, FEBO (Fellow of the European Board of Ophthalmology); Thomas Hofmann, M.Sc. Vision Science and Business (Optometry) 

Author: Fabian Wegmann

Primary Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisor: Georg Scheuerer, M.Sc. Vision Science and Business (Optometry)

Author: Christine Adler

First Examiner (Aalen University): Prof. Dr. Anna Nagl

Second Examiner (Pacific University): Prof. Dr. Hannu Laukkanen

Submission Date: August 31, 2025

Purpose of the Master’s Thesis:

The paper version of the Brain Injury Vision Symptom Survey (BIVSS) was validated in the U.S. in 2016 and subsequently widely adopted for mild to moderate traumatic brain injury (mTBI). It was later modified into unvalidated electronic formats by various providers. A limited 2024 pilot study suggested few differences in results between the paper version and an online electronic format. The main aim of this master’s thesis is to expand upon the pilot study’s reliability investigation and extend it to different countries. Another objective is to investigate the impact of cultural and linguistic factors on results from BIVSS translations into other languages. Related aims include exploring scoring variability within the 8-BIVSS symptom subcategories across different countries and for different causes of acquired brain injury.

Methods:

Healthcare providers from North America, Europe, and Asia collaborated to help complete this international multicenter study. Subjects aged 18–70 with trauma-induced ABI and non-trauma-induced ABI were recruited. Prior to data collection, the BIVSS was translated into 8 different languages using the multistep “forward-backward translation” protocol. The BIVSS questionnaire was converted to an electronic online format on the Qualtrics platform. Participants completed the BIVSS twice, approximately one month apart—once on paper and once online, or vice versa.

The BIVSS questionnaire is a 28-item quality-of-life survey with 8 subcategories: visual acuity, visual comfort, double vision, light sensitivity, dry eyes, depth perception, peripheral vision, and reading. Visual symptoms are rated on a Likert scale from 0 = never to 4 = always. The cutoff score is ≥ 32. Patients whose symptoms exceed this cutoff score are at high risk for significant visual problems related to mTBI.

Study protocol methods differed slightly between Asia, North America, and Europe due to anonymization rules and data protection regulations. Responses to both questionnaires were summarized in an Excel table and analyzed using SPSS. A regression line and a Bland-Altmann plot were generated. The paired t-test (95% CI, p 0.05) was used to test the two formats for significant differences. The TOST test (with CI = 90%) was used to test the equivalence of the paper-based and online formats. This was performed twice: the first time with an equivalence margin of 0.2 SD, and the second time with 0.5 SD. The other targets could only be represented with diagrams due to the limited number of participants.

Results:

125 participants from the United States, Canada, Spain, the Philippines, and Luxembourg. Participants from Israel, China, and Poland also took part. Only 38 participants (~30%) completed the required protocol and were included in the data analysis. The mean difference between electronic and paper formats was M = 1.76 points (+/-8.67 SD). The Bland-Altmann scatter plot difference score was within the tolerance range [15.24; -18.76]. The paired t-test, p = 0.218 [95% CI; p > 0.05] showed no significant differences between the two formats, with an equivalence margin of 0.2 SD = 0 ± 1.74 points and a 90% CI [-4.1367; 0.6104]. In contrast, the TOST test failed (p-values [0.5081; 0.0088]). The TOST test indicated equivalence between the paper and online formats with an equivalence margin of 0.5X SD = ± 4.34 points. The two p-values [0.0377; 0.0001] fell within the 90% CI. Statistically meaningful conclusions could not be drawn regarding the other objectives due to the limited dataset.

Conclusions:

In clinical practice, the electronic and paper formats of the BIVSS can be considered equivalent in most cases. When readministering the BIVSS to a patient, it is recommended to use the same format for follow-up. When the patient’s total BIVSS score is close to 32 points, sticking with the same format reduces the risk of potential misdiagnosis. Due to the small dataset, no further extrapolative conclusions could be drawn. Further research is recommended to explore potential variables related to language, non-traumatic ABI, and BIVSS symptom subcategories.

Keywords: Traumatic Brain Injury (TBI); Acquired Brain Injury (ABI); Brain Injury Vision Symptom Survey (BIVSS); International; Translation

Author: Saša Ocerlič 

Advisors: 

Prof. Dr. Anna Nagl, Aalen University

Dr. Matjaž Mihelčič, M.Sc., Aalen University

31 August 2025

Purpose:

Diabetes mellitus (DM) is a significant public health issue that is reaching epidemic levels worldwide. The number of people with diabetes is expected to rise drastically in the coming years. Uncontrolled or untreated diabetes often leads to serious complications, including cardiovascular, kidney, and neurological diseases. Long-term metabolic changes primarily damage small blood vessels, with the retinal vessels being most frequently affected in the form of diabetic retinopathy (DR). Effective and appropriate care in the early stages of DR can significantly reduce vision loss and improve patients’ quality of life. The purpose of this thesis is to support optometrists in providing comprehensive care for patients with DR and to demonstrate how, as individuals and professionals, we can improve the treatment, monitoring, and overall management of this condition.

Methods:

This thesis is based on a comprehensive review of current literature, including scientific journals available on Google Scholar and PubMed, books, and clinical guidelines.

Results:

In my review, I have sought to demonstrate how essential optometrists are in the multidisciplinary management of diabetic retinopathy. In addition to prescribing eyeglasses and managing refractive errors, optometrists play a vital role in the multidisciplinary management of diabetic retinopathy (DR). An optometrist can significantly enhance patient care and outcomes by performing thorough ocular evaluations using ancillary diagnostic tests such as visual acuity (VA) testing, refraction, biomicroscopy, tonometry, and comprehensive retinal examinations. Furthermore, providing appropriate follow-up care and educating patients, along with timely and appropriate referrals, further improve patient management and outcomes. Artificial intelligence can also serve as additional support for optometrists and ophthalmologists. One example is IDx-DR, the first medical device that uses artificial intelligence to detect diabetic retinopathy. The system is capable of identifying diabetic retinopathy beyond the mild stage, and it was approved by the FDA in 2018. AI holds significant promise for mass screening and unlocks new possibilities in detecting diabetic retinopathy, thereby improving the efficiency of disease management.

Conclusions:

The purpose of this guide is to support optometrists in providing comprehensive care for patients with diabetic retinopathy and to demonstrate how, as individuals and professionals, we can improve our approach to the treatment, monitoring, and overall management of this condition. This guide outlines the early signs of the disease and reviews its classification and stages of severity in order to determine appropriate treatment. Since effective and appropriate care in the early stages of diabetic retinopathy can significantly reduce vision loss and improve patients’ quality of life, early recognition, patient education, and timely intervention are highly recommended.

Keywords: diabetes mellitus, diabetic retinopathy, optometry, ocular evaluation, management and referral, patient education

Author: Hadil Hafez Abuzant

First Examiner: Prof. Dr. Anna Nagl, Aalen University

Second Examiner: Prof. Dr. JP Lowery, Pacific University

Delivery: 10. September 2024

Purpose:

This study aims to investigate the vision development of an infant from birth to 8

months of age, marking the major changes of vision affecting the infant vision functions and interacting with activities every single month included during the study period.

Methods:

1) Lea Gratings paddles, Cardiff Cards, Lang Stereo Test to study the development of vision in infant during the study period.

2) A videotaping is performed for the infant at every month in the study period to detect the visual development and depth perception.

Results:

Infant vision develops rapidly during the first year of life and continues until the best visual acuity is reached to let the infant experience daily activities. Saccades are present at birth and improve rapidly but pursuit eye movements take many more months to develop. Smooth tracking without any catch-up is not seen until 8-12 months. By the seven month of age infant, demonstrate stereoscopic vision, when everything is normal.

Conclusions:

It is vital to encourage parents to bring children for eye examination as early as possible, to ensure the prober development of their vision and to treat any problem that could cause loss of vision function. If not detected early, it may be late to save their vision or it takes more time to improve their visual acuity.

Keywords: Infant Vision, Vision Development, Visual Acuity.

Author: Melinda Letitia Parangath
Examiner: Prof. Dr. Anna Nagl
Delivery: September 2024

Purpose:

Scientific studies showed a high prevalence of myopia among Asian counties. As India is one of the Asian countries and became most populated country in world, this study aims to understand the visual need in India and determine the potential risk of myopia using refraction data.

Methods:

Data collected by Aloka Vision Program, called Vision for a Cause and Miracle of sight were used for the evaluation. More than 28000 individuals from the first dataset aged between 5- to 20-year-old were included for the evaluation of visual need in India, while over 4000 individuals aged between 4- to 20-year-old were included from the second dataset to evaluate of myopia risk in India. Both group of individuals were studying in government or government-aided schools, representing a subset of the total population. The visual need was evaluated using variables such as age, gender, location, visual acuity, spectacle users, objective refraction, and colour vision to determine spherical equivalent, colour vision deficiency and anisometropia. The myopia risk was evaluated using variables such as age, gender, objective refraction to determine the spherical equivalent to develop percentile curves for both genders. Additionally, the relationship between geographical areas and refractive errors along with school levels, was evaluated. 

Results:

A total of 28016 individual’s data were evaluated to find visual need in India. Among them, 57% were females and 43% were males. The mean age calculated for females was 12.76 ± 2.93 years, while for males it was 12.30 ± 2.99 years. This study found that 81% of individuals had visual acuity 6/9 or better. Additionally, 14% of Individuals had refractive error, with 10.20% being myopic. However, this study also found that only 0.96% of individual were using corrective glasses. Moreover, 0.60% had colour vision deficiency, and 0.34% had anisometropia among this study group. Percentile curves were developed to assess myopia risk. This group included 49% were females and 51% were males. The mean age calculated for females was 12.90 ± 2.18 years, while for males it was 12.92 ± 2.11 years. The curves showed that myopia is a predominant refractive error in India. However, risk of developing high myopia was not observed in both genders between 6- to 18-year-old. Only 0.37% of individuals had anisometropia in this group. Finally, in the evaluation of geographical separation, it was found that the median spherical equivalent was below zero diopters for all four regions. However, in the South and the West regions, there was a tendency for spherical equivalent to progress towards myopia as individuals aged. Additionally, the percentage of emmetropes was higher in low primary compared to high school.

Conclusions:

This study provides a valuable insight on visual need of Indian population. The data showed myopia is a predominant refractive error among this study population. The study found that only a small group of individuals had access to using corrective glasses while there is a large group in need. However, this group represents the subset of the total population. This indicates the importance of including more screening programs and incorporating basic vision screening with refraction assessment and colour vision tests can improve quality of life among individual across the country. In addition, the development of percentile curves using refraction data might provide insights to eye care professionals in managing myopia for this study population. Moreover, the findings on geographical influence, refractive values and school levels also provides an insight to the refractive errors among children and young adults. Considering the large population in India, these findings must be considered.

Keywords: myopia; visual health; percentile curve; colour vision; refractive error in children; geographical region

Author: Teresa Köberle
First Examiner (Aalen University): Prof. Dr. Anna Nagl
Second Examiner: Georg Scheurer (M. Sc.)
Delivery: September 27, 2024

Purpose of the Master Thesis:

This master thesis aims to develop a practice-oriented guideline for the calculation of myopia management products and services. The guideline combines theoretical principles of internal accounting with a special focus on optometric applications in the field of myopia management. The aim is to provide not only theoretical knowledge but also practical tools and methods that are important for precise costing.

Methods:

The guideline is divided into three main sections. The first is an introduction to the topic of myopia and the corresponding management options, supplemented by a SWOT analysis. In the second section, a survey was developed and evaluated to analyze current practice in the costing of myopia management products and services, focusing on the challenges of pricing. The results form the basis for the development of the practical guideline. This is followed by an introduction to internal accounting, in which cost control strategies are explained and costing approaches are illustrated using practical examples.

Results:

Of the participants (n=58) in the survey, 66% stated that they carry out their own calculations, while 34% base their pricing exclusively on external factors such as competitor prices or recommended retail prices (RRP). A comparison of these two groups shows a significant difference in the perceived difficulty of pricing. Those who create their own calculations find this process less challenging than those who use external factors as a guide. The biggest challenge identified by the participants was the low level of awareness and lack of understanding of myopia management among the general population.

Conclusion:

Myopia management has already gained importance in the daily practice of many opticians, while it is still largely unknown to the public. Economically successful pricing is influenced by various factors, whereby precise calculation of myopia management products and services will play a central role in the future. The guidelines developed offer a introduction to costing and provide practical examples to support pricing.

Keywords:

Myopia / Myopia management / Internal accounting / Cost and activity accounting / Cost accounting systems / Calculation / Offer calculation/ Product calculation

Author: Peter Steckbauer
First Examiner (Aalen University) : Prof. Dr. Anna Nagl
Second Examiner: Georg Scheuerer M.Sc. und Andreas Polzer Diplom Kaufmann (FH)
Delivery: September 27, 2024

Abstract

Purpose: 
The aim of this master's thesis is to survey the satisfaction with the myopia management programs currently used in the German-speaking region. This will highlight the strengths and weaknesses of the current programs, which can serve as a basis for new users to determine which program best meets their needs. The knowledge gained can be used as a basis for the design of an innovative myopia management program, which should include a growth-specific performance review.

Methods: 
In order to falsify the theses derived from the literature, an empirical survey (online survey) was carried out on the myopia management programs currently used. This survey was answered by 100 participants from German-speaking countries. In addition, a separate evaluation and presentation of the functions of the various programs was carried out.

 Results: 
The survey showed that the three hypotheses tested - the desire for better data entry and greater user-friendliness, satisfaction with the content and structure of the reports, and the desire for a more precise breakdown of ethnic groups - could not be confirmed. The majority of respondents did not express any significant problems with the programs used.

 Conclusions: 
The master's thesis and the survey it contained made it possible to demonstrate that users have a desire for innovative approaches with which existing programs can be further improved. These suggestions and bring important information for designing an innovative approach to a myopia management program. For a more precise evaluation of the annual growth curves, the PEGA (Pediatric Eye Growth Analysis) was designed, which specifically addresses the growth of the respective percentiles.

Keywords: Myopia, myopia management, axial length, software, innovative program

Author: Thomas Sebastian Götz
First Examiner: Prof. Dr. Anna Nagl, Aalen University
Second Examiner: Karl Amon, M.Sc. Vision Science and Business (Optometry)
Delivery: September 27, 2024

Abstract

Purpose of the Master Thesis:
This master's thesis refers to optometrists and business owners who are interested in offering and providing optometric services. These guidelines will help implement additional services into daily practice and serve as a foundational resource for further specialization in optometry.

Methods:
In addition to developing guidelines, the thesis includes empirical research aimed at assessing the ocular health of a specific group. Furthermore, a questionnaire was used to get an impression whether the participants liked the screening and would be willing to pay for the service.

Results:
During the testing period the screening was performed on a group of 71 customers (N=71), out of which 54 showed no abnormalities. A group of 13 individuals showed some potentially suspicious findings that should undergo further examination. During 4 screenings acute abnormalities were discovered that led to an immediate referral.

The questionnaire showed that a majority of 70.4 % were highly confident that any abnormalities were found during the exam. 90.1 % of the participants would have been willing to pay for the screening, with the median being € 45. The polled persons mentioned shorter waiting times as the main advantage compared to examinations by an ophthalmologist.

Conclusion:
These results demonstrate the high level of acceptance and added value that optometric services provide to customers and businesses, serving as additional motivation to implement these services.

Keywords:
Optometric Screening; Eye Health; Early Detection of Eye Diseases; Optometry in Germany; Fundus Examination; Cost Acceptance of Optometric Services

Author: Ema Logar
First Examiner: Prof. Dr. Anna Nagl, Aalen University
Second Examiner : Dr. Matjaž Mihelčič, M.Sc., Aalen University
Delivery: September 27, 2024

Abstract

Purpose: 
The purpose of this master thesis is to make a comprehensive review on pediatric cataract and their management. Cataracts in pediatric patients present a unique set of challenges due to the critical period of visual development during early childhood. Prompt diagnosis, appropriate surgical intervention, and comprehensive optometric management are essential to optimize visual outcomes and prevent irreversible consequences such as amblyopia. Through early intervention and ongoing management, optometrists can significantly contribute to the prevention of long-term visual impairment and the promotion of normal visual development in pediatric cataract patients.

Methods:
Secondary quantitative research that includes randomized controlled trials, studies, and case-controlled studies from public records, journals available on Google Scholar, PubMed and books.

 Results: 
The result is a comprehensive literature review containing information about development of the eye and visual development in early childhood. It contains information about morphology and etiology of pediatric cataract and their surgical management. The review also provides guidelines for various options of optical correction for aphakic and pseudophakic children.

Conclusions: 
Cataracts in pediatric patients present a unique set of challenges due to the critical period of visual development during early childhood. Prompt diagnosis, appropriate surgical intervention, IOL insertion and comprehensive optometric management are essential to optimize visual outcomes and prevent complications such as amblyopia. Optometric management of children with cataract is a critical component of their overall care, aimed at maximizing visual outcomes and supporting normal visual development by prescribing spectacles or contact lenses and manage amblyopia, strabismus and nystagmus if present. Early intervention, consistent follow-up visits with frequent adjustments to refractive prescription as the child grows, and caregiver education are essential to the success of the postoperative treatment plan. By ensuring that children with cataracts receive comprehensive and individualized care, optometrists play a pivotal role in improving their quality of life and long-term visual prognosis.

Keywords: congenital cataract; aphakia; pseudophakia; contact lenses; bifocal spectacles

Author: Dora Bilić
First Examiner: Prof. Dr. Anna Nagl, Aalen University
Second Examiner : Damjan Žunić, M.Sc., Aalen University
Delivery: Dezember 12, 2024

Abstract

Purpose:
The main goal is to understand a comprehensive approach to myopia, integrating preventive measures, early detection, and effective treatment to curb further spread of myopia among the younger population

Methods:
In this work, secondary research will be carried out, encompassing pertinent sources such as controlled studies, cases extracted from public records, European and global journals, books, as well as private cases.

Conclusion:
Myopia prevention and management in childhood are key to eye health and public well-being, especially as its prevalence rises globally. Understanding the factors that contribute to myopia is crucial for reducing its long-term impact. Preventive measures such as outdoor activities, limiting screen time, and promoting healthy visual habits can help lower the risk. Parents, educators, and healthcare providers can collaborate to reduce myopia rates in children. Once diagnosed, managing myopia involves corrective measures like eyeglasses and contact lenses, along with treatments like atropine drops and myopia control lenses. Alternative treatments, like orthokeratology, offer options without daily corrective lenses. Educating families about early signs and good visual hygiene is vital for effective management. Continued research will guide improved prevention and treatment strategies, ultimately enhancing children’s eye health and quality of life.

Keywords: myopia, prevention of myopia, management of myopia, myopia in childhood, progression of myopia

Author: Kai Jaeger
First Examiner (Aalen University): Prof. Dr. Anna Nagl
Second Examiner: Dr. Stefan Bandlitz
Delivery: September 30, 2020
The Master Thesis was written in German    

Purpose of the Master Thesis:
The aim of this master thesis is to analyze whether it is possible to predict the scleral sagittal heights of the anterior eye via other ocular parameters with sufficient accuracy without measuring them directly. The parameters used for the calculation should be as easy as possible to determine with equipment usually available in the establishments, such as topographers and biometers. The method of multiple linear regression analysis should be used to calculate a corresponding model.
If this would be possible, it would make the fitting of scleral lenses easier for the contact lens fitter, the definition of the required lens geometry more target-oriented and the fitting more comfortable for the patient.

Methods:
22 right eyes of 22 study participants (mean age = 46.45 ± 19.38 years, 11 men, 11 women) will be measured on the premises at the Collogne School of Optics and Optometry (Höhere Fachschule für Augenoptik und Optometrie Köln - HFAK).
During the measurements, various parameters will be recorded at the anterior segment of the eye and  measured with 3 devices. The devices are: Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany), Wave Analyzer medical 700 (Essilor, Braunschweig, Germany), Nidek AL-Scan (Oculus Optikgeräte GmbH, Wetzlar, Germany).
The data obtained will be statistically processed via SPSS version 29 (IBM; Armonk, NY, USA) and various multiple linear regression models will be generated to analyze a relationship between the parameters and the scleral sagittal height in different orientations and tendons.

Results:
Within the calculated models, the use of the following target variable presents itself as the most meaningful and for practical use to support the selection of an initial scleral measurement lens:
Determination of sagittal height in a subject-specific chordal width of HWTW + 3.5mm in the orientation of the flat as well as steep central corneal meridian of the anterior cornea.
This model generates a valid coefficient of determination of R2 = 0.722 (p<0.001) when calculating the sagittal height as the mean of the arrow heights between the flat and steep corneal meridian of the anterior cornea,     R2 = 0.583 (p<0, 001) when calculating sagittal height in the direction of the flat central corneal meridian of the anterior cornea and R2 = 0.644 (p<0.001) when calculating sagittal height in the direction of the steep central corneal meridian of the anterior cornea.
Predictors for calculation included: HWTW, averaged radius of the anterior corneal surface, the axis of photopic refraction, and in one model, the radius of the steep meridian of the posterior corneal surface.
No influence of the axial length of the eye on the scleral sagittal heights or the bulbous slope could be detected.

Conclusion:
The regression model allows the prediction of the average sagittal height with a coefficient of determination of 0.722 (72.2%) and can therefore be used as an aid in the selection of the first scleral measurement lens if the fitter has no possibility to measure the relevant sagittal heights.  

Keywords:
Corneo-Scleral Profile; Scleral lens; Pentacam ©; Biometer; axial length of the eye; Limbus

Author: Katarina Šarac

First Examiner (Aalen University): Prof. Dr. Anna Nagl

Co-Supervisors: MD, PhD Maja Pauk Gulić, ophthalmologist, Damjan Žunić, M.Sc. Vision Science and Business (Optometry)

Purpose of the Master Thesis:
There are many beautiful words and quotes that describe the eyes, and one of them is "eyes are the mirror of the soul" or rather "eyes are the windows of the soul". And we can imagine why that is said because the eyes are beautiful, colorful balls that convey emotions and messages without words or body language! One look into someone's eyes can reveal happiness, pride, pain, anxiety, excitement, joy, boredom and many other feelings. Eyes are fascinating, powerful and amazing parts of our body. And they are also extremely difficult to describe in words. But I would add to that proverb: "Eyes are also a window to one's body - a window to systemic health". Understanding the relationship between ocular clinical signs and systemic disease can help identify underlying diseases and ensure that eye problems are resolved when known disease that may involve the eyes is treated.

Methods:
Secondary quantitative research including randomized control studies, controlled studies, cases from public records, European and global journals, books and private cases.

Results:
The result is a handbook containing specific systemic diseases discussed in terms of epidemiology, pathophysiology, clinical picture, signs/symptoms, and when referral to ophthalmology or other specialist is necessary. It has also been described how to help the patient in the form of glasses, contact lenses, vision therapy and other methods of treatment depending on the country where the optometrist works.

Conclusion:
Optometrists often encounter patients with eye symptoms and signs of systemic disease. In some cases, some patients are not educated about the disease, so the ophthalmologist and optometrist are the first to suspect a certain caution. Part of the patients are familiar with the disease they have, but they still need care. This is why it is important to be educated and familiar with the diseases, signs, symptoms and treatment.

Keywords:
Systemic disease/ Down syndrome/ Hypertension / Thyroid eye disease / Shaking baby syndrome / Metastatic carcinoma / AIDS / Diabetes /

Author: Torsten Dautzenberg

First Examiner (Aalen University): Prof. Dr. Anna Nagl

Second Examiner: Stefan Tüß M. Sc.

Delivery: October 1, 2023

Restriction notice: Thesis is subject to a confidentiality agreement

 

Purpose of the Master Thesis:
The successful repair of a diseased surface of the cornea constitutes a formidable challenge. In most cases, the use of a substrate that supports cell proliferation and differentiation is required.
Today, the clinically used material in this respect is amniotic membrane (AM), despite its many limitations and disadvantages.
Currently, the possibility to replace AM by a thin transparent silk fibroin (SF) film from the Bombyx mori (B. mori) mulberry spinner is being studied by several research groups and offers to be an auspicious alternative. The silk scaffolds made from the cocoons of B. mori provide good elastic properties and resistance for easy handling by the surgeon. Furthermore, the scaffolds mediate the adhesion and growth of epithelial, stromal, and endothelial cells.
Regenerated SF solution serves as the starting material for generating novel silk formats, including thin films. For corneal regeneration, the silk films are cultured ex vivo with healthy corneal cells and then transplanted into the patient.
This thesis gives a review of the advances, applicability, and performance of SF for cornea repair.
Measurement results from SF samples that were produced at the company Fibrothelium including measurements of the fibroin solution, material properties and optical properties of the fibroin foils are presented and compared to results that are available in the literature.
The cell growth behavior and biocompatibility of SF as an ocular graft material are discussed by a review of today’s available in vivo and in vitro studies in the literature.
Finally, the chances and profitability of introducing fibroin-based products for corneal regeneration onto the German market and worldwide are discussed.

Methods:
The study summarizes the state of the art of SF as a substrate material for corneal repair. To that purpose the broader context of corneal regeneration is furnished, and the most important scientific articles from a wide range of research groups have been collected and are presented. The thesis includes data on production processes and measurements performed in the context of the cooperation with the company Fibrothelium, which has specialized in producing fibroin-based products for medical applications.
Production methods and properties of self-produced SF foils are presented.
Measurements of wettability/hydrophilicity and of mechanical properties including elasticity (Young’s) modulus and stress at break were obtained at the company Fibrothelium, measurements of viscosity were performed at Aachen University of Applied Sciences and optical measurements at HFAK Cologne (Höhere Fachschule für Augenoptik und Optometrie Köln).
Cell culturing and biocompatibility with own samples could not be directly assessed in the framework of this thesis. Therefore, results from in vitro and in vivo studies of outstanding groups in the field are presented.
A cost-volume-price analysis is performed to gain an estimate of the profitability if a company introduces SF graft substrates into the market as a replacement for current AM.

Results:
A fibroin solution was produced, and its viscosity measured as a function of the fibroin concentration. It could be shown that using a fibroin concentration of a defined percentage fibroin foils with a thickness of between 30-40 μm could be produced using a Foil Applicator Device. The foils were tested for wettability and had hydrophilic behavior. The hydrophilicity of fibroin can be further increased by EtOH treatment. Foils with a thickness of between 300-500 μm were used for tensile tests to measure the Young’s elasticity modulus and stress and strain at break.
Optical measurements with a spectrophotometer showed that values of visual light transmission of up to 90.9% could be obtained for SF foils with a thickness of 30 μm.
In vitro cell proliferation and in vivo studies of rabbits undertaken by different research groups show that SF-based grafts provide an excellent cell morphology, cell proliferation and biocompatibility behavior.
A market study revealed that if AM can be replaced by SF foils, the incentive to develop SF foils for corneal applications to enter the market is high both from a medical and economical point of view.

Conclusion:
It could be shown that the production of SF foils for the use as cellular grafts for corneal cells is possible. SF foils have some decisive advantages over currently used AM. Measurements at the company Fibrothelium as well as a literature review showed that SF foils have better mechanical properties in terms of Young’s modulus, stretchability, handleability and biocompatibility. The results from the performed optical measurements were in line with measurements from other research groups and prove the superior transparency of SF foils over AM.
It is known that AM have relatively poor mechanical strength, limited transparency, difficulty of handling, and the potential risk of disease transmission. Furthermore, the AM can lead to an immunologic reaction which results in rejection of the graft. As discussed in this thesis, these problems can be avoided or at least improved by the use of SF grafts.
It can be concluded that it is worthwhile to pursue the development of SF grafts as a future replacement for currently used AM grafts both from an economical point of view and from a point of view of the patient’s well-being.

Keywords:
cornea regeneration; silk fibroin; amniotic membrane, fibroin graft, tissue engineering; epithelial repair, stromal repair, endothelial repair, regraft, cost-volume-price analysis

Purpose of the Master Thesis:
The purpose of this study was to examine the performance of male football athletes on a multiple-object tracking (MOT) test to determine possible differences in tracking abilities at different skill levels.

Methods:
A sample of 15 football athletes, categorized into 7 semi pro and 8 professional football players, underwent a standardized multiple object tracking test on Senaptec Sensory Station. Performance measures such as tracking accuracy while athlete is static and objects moving, number of objects successfully tracked, and errors made were recorded and evaluated. The results are presented in on a graph and the results are compared to other athletes depending on their competition level, age and position in team.

Results:
Preliminary results indicate that there is a significant difference in MOT (multiple object tracking) assessment between semi pro and professional football athletes, particularly when the task involves tracking five or more objects.
Our investigation has yielded compelling results, demonstrating a clear and statistically significant disparity in MOT performance favoring professional athletes.

Conclusion:
The ability to efficiently track multiple objects is a distinguishable skill among footballers. This ability depends heavily on the communication between the eyes and the brain, especially how effectively we can use both the central and peripheral areas of our visual field simultaneously.

Keywords:
multiple object tracking, senaptec, sport vision, eyes, brain, central and peripheral vision.

 Blocking notice

Purpose of the Master Thesis:

To assess changes in intraocular pressure (IOP) and other corneal structure during and after short term scleral contact lens wear.

Methods:

Twenty-five healthy adults, 28,4 ± 6,43 years old (mean ± SD) without history of eye diseases or scleral contact lens wear were included in this study. Each person was fitted with a 16mm Menicon mini scleral lens on one random eye (study eye). Before fitting central IOP was measured in both eyes by Huvitz tonometer and corneal pachymetry and corneal angle were measured by Solix OCT. The lens was then placed on a randomly chosen eye and was worn for 3 hours. IOP and corneal parameters were then immediately measured after lens removal in both eyes. IOP was then compared to pre-wear measurements in both eyes.

Results:

Corneal IOP measurement showed no significant difference compared with the baseline measurements (pre 15,31 ± 2,78 mmHg vs post 15,43 ± 2,48 mmHg, P=0,2). The total average difference between pre-CCT and post-CCT was 11.58 µm (546,73 ± 31,56 µm vs. 558,32 ± 31,57 µm; 2,1% thicker cornea; P<0,001).

Conclusion:

Short term wear of scleral corneal contact lenses does not increase IOP in healthy adults eyes. On the other hand, pachymetry is slightly increased, probably due to hypoxic conditions created by the lens.

Keywords:

Scleral contact lens; IOP; Corneal angle; Pachymetry

Year: 2023

Category: Master Thesis

Author: Angelina Di Benedetto

First Examiner: Prof. Dr. Anna Nagl

Second Examiner: Michael Wyss M.Sc. Vision Science and Business (Optometry)

Purpose of the Master Thesis: The purpose of this master's thesis is to demonstrate the establishment of an optometric practice in Switzerland. In our Western societies, the age structure of the population is changing. People are getting older than ever before, while at the same time, birth rates are decreasing. Against the background of this demographic change, the number of people with visual impairments is increasing rapidly. At the same time, societal changes are contributing to an increasing number of people suffering from myopia. Statistics and forecasts indicate that by 2050 an estimated 54.1% of the population in Central Europe will be affected by myopia. Thanks to recent studies, it is now known that myopia and the associated health risks can be reduced by providing targeted vision care to children's eyes as they grow. Based on these facts, the use of optometrists is essential to ensure comprehensive vision care for the population. Therefore, this master's thesis is dedicated to the fascinating topic of establishing an optometric practice as an entrepreneurial venture, presented in the form of a practice-based case report.

Methods: A carefully prepared business plan was prepared as the basis for the economic decisions regarding the establishment of an optometric practice. The business plan comprehensively considered factors such as profitability calculation, risk management, strategic planning, and self-reflection. To gain even deeper insights, eight expert interviews were conducted. Self-employed optometrists served as experts. Of these eight optometrists, five work in Switzerland, two in Germany, and one in Slovenia. The responses from these qualitative interviews were analyzed in detail and examined for key elements of self-employment in the optometry field. Topics of interest included organizational structure, strategic focus, efficient time management, cost recovery, pricing strategies, and continuing education.

Results: The findings illustrate the multi-faceted challenges faced by self-employed optometrists. Individual approaches and solutions to these challenges are presented.

Conclusion: This work suggests that it is possible to practice optometry economically. This work can serve as a motivation and tool for starting an optometric practice.

Keywords: Optometry; optometrist; optometric practice; contact lens fitting; health care; myopia control

Blocking Notice

Year: 2023

Category:  Master Thesis

Author: Matthias Maget

First Examiner: Prof. Dr. Anna Nagl

Second Examiner: Priv.-Doz Dr. Bernd Semsch

Purpose of the Master Thesis: EMDR (Eye Movement Desensitization and Reprocessing) is a neurobiologically oriented psychotherapeutic approach to treating post-traumatic stress disorder (PTSD) and other stressful life events. It involves the use of eye movements to facilitate the processing and integration of traumatic memories. This noninterventional application observation examines the importance of eye movements in EMDR and potential benefits of incorporating auditory and tactile stimuli into therapy.

Methods: A literature review describes the possible contribution of visual, auditory, and tactile stimuli. Consequently, in a non-interventional application observation, the results of EMDR treatments, are contrasted with the results of EMDR supplemented with auditory and tactile stimulation.

The use of eye movements in EMDR is based on the theory that traumatic memories are inadequately processed and stored in the brain. Eye movements to the right and left while the head is static, such as following the therapist's finger or a moving point of light, induce eye movements that allow traumatic memories to be processed. This bilateral stimulation is thought to activate the brain's information processing system and allow the integration of the traumatic experience into more adaptive memory networks.

The addition of auditory and tactile stimuli synchronous with eye movement in EMDR, is based on the concept of multisensory stimulation. By activating multiple sensory modalities simultaneously, the therapy aims to stimulate different areas of the brain and improve the processing of traumatic memories. This multisensory approach can lead to a more comprehensive and effective treatment outcome.

Results: While research on the specific effects of incorporating auditory and tactile stimuli into EMDR is still limited, these studies suggest promising results.  The addition of auditory and tactile stimuli may enhance the therapeutic benefits of EMDR, resulting in improved symptom reduction and increased treatment efficacy.

Conclusion: In summary, the use of eye movements in EMDR, for the treatment of traumatic disorders has been shown to be effective. The extension of EMDR with auditory and tactile stimuli has potential benefits by incorporating other sensory modalities, and thereby enhancing processing of traumatic memories.

Keywords: Stress disorders, traumatic memories, EMDR treatments, auditory and tactile stimulation, multisensory integration, working memory.

Year: 2023

Category:  Master Thesis

Author: Patrick Petzold

First Examiner: Prof. Dr. Anna Nagl

Second Examiner: Markus Hofmann

Purpose of the Master Thesis: Digitization has increased sharply in recent years and permeates almost all private and professional areas of life and has become indispensable for many. What objectively often brings us relief in everyday life and work is, however, contrasted with a subjective feeling of acceleration, excessive demands and an increased sense of stress. Whether and how this subjective impression can be concretized scientifically and objectively is to be examined in this work.

The aim is to shed light on the current state of digitalization in connection with its possible consequences, in particular its possible effects on the perception of stress as well as the health of the German population over the last two decades. Three physical and three mental diseases, which are suspected to correlate with stress, will be examined for their prevalence rates. In the field of ophthalmology, chorioretinopathy centralis serosa (CCS), the fourth most common cause of irreversible retinal damage, and retinal vascular occlusions in general were analyzed. In addition, the development of arterial hypertension as a third physical disease is considered. At the psychological level, depression, anxiety, and Internet Gaming Disorder (IGD) will be included in the research based on their prevalence. An analysis of prevalence rates over the last two decades will provide information on whether the stress caused by digitalization has contributed to an increase in these clinical pictures. In addition, multiple interactions of the above-mentioned diseases in the physical and psychological spheres will be addressed. This is because these phenomena must not only be considered in isolation, but also affect the human being as a physical and mental being in its entire complexity.

Methods: Specific studies, books, technical papers, reviews and generally accessible websites were selected on the basis of a systematic literature search. The search engines Google and Google Scholar were used for this purpose. Almost all reports originated from the online databases Pubmed, ScienceDirect, Thieme-connect, and SpringerLink.

Results: Digitization has increased dramatically in recent years, and daily use of digital media averages 8.5 hours. At the same time, the prevalence of stress sensations, especially chronic stress, has also increased continuously and reached a value of 26% in 2021. Little can be said about the incidence trend of CCS because sufficiently valid data were lacking at the time of the research. Arterial hypertension has increased since 2000 and decreased again slightly compared with 2016, but remains high at 31.6%. For retinal vascular occlusion, the described prevalence varies, making it difficult to draw a clear conclusion. Moreover, only estimated values were given here by the authors. The number of cases of depression has increased almost continuously since 2000 with one exception in the year of the first lockdown 2020. In 2022, 17% of the German population was affected by depression. Anxiety disorders increased until 2012, after which the prevalence decreased to 11%. The scientifically recorded number related to online gambling addiction has increased since 2010, affecting 3.5% of adolescents aged 12 to 17 in 2020.

Conclusion: The results of the present literature review suggest that progressive digitization has a negative impact on human health. Both unilateral consequences on the physical constitution can be identified as well as differentiated interactions between stress-induced diseases. A deeper investigation of these reciprocal mechanisms could improve treatment and prophylaxis in optometry, among other fields.

Keywords: Prevalence, stress, digitalization, arterial hypertension, depression, internet gaming disorder

Year: 2023

Category:  Master Thesis

Author: Silu Bhitrikoti

First Examiner: Prof. Dr. Anna Nagl

Second Examiner: Dr. Katharina Breher

Purpose of the Master Thesis:
The term “Job satisfaction” refers to how satisfied employees are with their jobs. Job satisfaction is an important factor in healthcare, including optometry, as the provision of essential health services is impacted significantly by the retention of healthcare employees. This current study surveyed optometrists in Germany and Nepal to assess job satisfaction and the associated factors among optometrists. The study aims to find relevant variations among job satisfaction and associated factors. 

Methods:
A cross-sectional survey of optometrists in Nepal and Germany was carried out between January 2023 and March 2023 to investigate the factors influencing job satisfaction. Information on sociodemographic data, the nature of the optometric workforce, and the level of job satisfaction were collected using a verified, well-structured questionnaire. A Likert scale was used to evaluate job satisfaction, with a higher score indicating a higher degree of satisfaction. Data was analyzed using SPSS, and the chi-square test was used to check for statistical differences between the distribution from Nepal and Germany for socio-demographics, nature of the workforce and factors of evaluating the correlation between overall job satisfaction and factors that influence it.

Results:
A total of 60 registered and licensed optometrists, 30 from Nepal and 30 from Germany, have participated in the study. It was found that most optometrists from Nepal (60.0%) and Germany (86.7%) were satisfied. The factors like salary (p=0.65), supervisor (p=0.06), encouragement (p=0.06), recognition (p=0.08), the responsibility of work (p=0.39), and support from co-workers (p=0.09) showed no significant differences between countries. However, factors like job security (p=0.003), workplace equipment and facilities (p=0.04), task variety (p=0.004), workload (p=0.00), level of control over work (p=0.007) and continuing the education (p=0.003) as well as career opportunities (p=0.002) revealed a significant difference.

Conclusion:
Most optometrists from Nepal and Germany are satisfied with the current study. However, Nepalese optometrists tend to show lower levels of satisfaction. The findings of this study could assist in the growth of effective healthcare systems and the accessibility of outstanding eye care services in Nepal and Germany. The data gathered in the current study could be used as an initial basis for developing statistical tools for a more comprehensive assent of job satisfaction and associated factors in the optometric profession.

Keywords: Job satisfaction, optometry, Nepal, Germany

Blocking Notice

Year: 2023

Category:  Master Thesis

Author: Barbara Waltisberg

First Examiner (Aalen University): Prof. Dr. Anna Nagl

Second Examiner: Dr. med. Jessica Graziano

 

Purpose of the Master Thesis: 
The purpose of this study is to find out whether a longer treatment interval is possible when switching from aflibercept to faricimab.

Methods: 
This is a retrospective study using data from the “Augenzentrum Burgdorf” collected between 01.09.2021 and 31.07.2023. The study included patients with age-related macular degeneration (nAMD) or diabetic macular edema (DME) who were switched from aflibercept to faricimab as part of the treatment and extension (T&E) regimen. Among the nAMD patients, 37 patients aged 64-96 years (mean 80.46) received at least 6 injections of aflibercept before switching to faricimab and followed by at least 6 injections of faricimab and were treated after T&E. For the DME patients, 14 patients aged 58-84 years (mean 73.286) were evaluated. These had received at least 5 injections of aflibercept and, after switching, also at least 5 injections of faricimab (treatment according to T&E).

Results:
The Friedman nonparametric test and repeated measures ANOVA were executed. Both tests yielded a significant result with p < 0.001 (where p < 0.05 is considered statistically significant). The subsequent post-hoc repeated-measures ANOVA indicated significant differences in the treatment interval from the 1st (p = 0.000), 2nd (p = 0.010), 3rd (p = 0.023), and 4th (p = 0.013) measurement time points (1st to 4th aflibercept injections) to the 12th measurement time point (6th faricimab injection). This difference was already seen at the 11th measurement time point (5th faricimab injection).
Central retinal thickness (CRT) showed statistical significance with a value of p < 0.001. The mean value was 310.586 μm under aflibercept and 277.495 μm under faricimab. However, post-hoc ANOVA with repeated measures showed no significant difference between the different groups.
Only the BCVA was not significant at p = 0.176. The means here were 0.635 under aflibercept and 0.649 under faricimab.
Among the DME patients, both Friedman's test (p = 0.740) and the repeated measures ANOVA (p = 0.38) indicated no significant difference within the treatment interval.
The same was true for central retinal thickness (CRT). Mean values were 319.943 μm with aflibercept and 304.471 μm with faricimab, also no significant difference was shown by the nonparametric Friedman test (p = 0.093).
Regarding BCVA, the mean values were 0.718 with aflibercept and 0.735 with faricimab. As observed in nAMD patients, there was no significant difference (p = 0.494).

Conclusion:
The results presented in this study indicate that a longer treatment interval after the 3rd faricimab injection is possible in nAMD patients.
Conversely, an extended treatment interval was not achievable in DME patients. No significant differences were observed in the best corrected visual acuity (BCVA) and central retinal thickness (CRT) within either patient group.

Keywords:
Aflibercept, Eylea, Faricimab, Vabysmo, Anti-VEGF, treat and extend (T&E), age-related macular degeneration (nAMD), diabetic macular edema (DME)

Blocking Notice

Year: 2023

Category: Masterthesis

Writer: Sinje Nordhausen

Supervisor: Prof. Dr. Anna Nagl

Co-Supervisor: Lukas Zurbuchen, M.Sc. Vision Science and Business (Optometry)



Abstract

Purpose:
The aim of this study is to find out whether an optometric practice can support itself solely through the services offered or whether cross-financing via the product glasses is absolutely necessary.

Method:
For data collection, real numbers for the location Verden (Aller) were determined and real offers for the equipment were obtained. The company could be opened at this location as described in this thesis.

Result:
Evaluation showed that there is theoretically a realistic possibility of getting by without cross-financing the glasses. At the same time, it makes sense to include contact lenses in the program, at least in the context of myopia management. A practical implementation is associated with risks, but it can be successful.

Year: 2023

Category: Masterthesis

Writer: Stefanie Berger

Supervisor: Prof. Dr. Anna Nagl

Co-Supervisor: Dr. Frederik Sündermann, Mister Spex SE

Thesis with a blocking notice

Purpose
The purpose of this masterthesis is to develop a conversion factor to recommend a frame width based on a head width measurement.

Methods
A cross-sectional study is conducted to determine the appropriate frame width for 45 eyeglass wearers. In addition, the actual head width is measured manually with a craniometer and digitally with the new Mister Spex app.

Results
Through this study, a conversion factor is developed that allows Mister Spex customers to select eyewear based on head width measurements. Thus, customers can be sure that the selection of glasses fits the head width.

Conclusions
This thesis is the basis for the new way of recommending glasses on misterspex.de. This way, customers get a size-based recommendation - similar to what they would get in a local store.

Keywords
Mister Spex; eyewear width matching face width; curated shopping experience