Reformed Church University

OBJECTIVE: To examine whether cognitive-emotional hyperarousal is a premorbid characteristic of middle-aged and young good sleepers vulnerable to stress-related insomnia. METHODS: Self-reported information was collected from two samples of 305 middle-aged and 196 young adults. From those adults, 149 middle-aged (50.34 +/- 4.47 years) and 85 young (20.19 +/- 1.31 years) good sleepers were selected for the present study. The Ford Insomnia Response to Stress Test (FIRST) was used to measure vulnerability to stress-related insomnia. Trait measures of personality, arousability, rumination, presleep arousal, and coping skills were entered as predictors in the linear regression models, at the same time controlling for gender, depression, and anxiety. RESULTS: The regression models showed that arousability (beta = 0.546), neuroticism (beta = 0.413), perceived stress (beta = 0.375), and rumination (beta = 0.214) were associated with FIRST scores in middle-aged adults. Among young adults, the regression models revealed that presleep cognitive arousal (beta = 0.448), arousability (beta = 0.426), neuroticism (beta = 0.320), presleep somatic arousal (beta = 0.290), emotion-oriented coping (beta = 0.220), and rumination (beta = 0.212) were associated with FIRST scores. Finally, individuals with high FIRST scores did not show lower scores in measures of cognitive-emotional hyperarousal compared with chronic insomniacs. CONCLUSIONS: These data suggest that cognitive-emotional hyperarousal may be a premorbid characteristic of subjects vulnerable to insomnia. It seems that maladaptive coping stress strategies and cognitive-emotional hyperarousal predispose to the development of insomnia and that interventions targeting these characteristics may be important in the prevention and treatment of chronic insomnia.

PURPOSE: To determine in a longitudinal study whether there is correlation between videokeratography and clinical signs of keratoconus that might be useful to practicing clinicians. SETTING: Cornea-Genetic Eye Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. METHODS: Eyes grouped as keratoconus, early keratoconus, keratoconus suspect, or normal based on clinical signs and videokeratography were examined at baseline and followed for 1 to 8 years. Differences in quantitative videokeratography indices and the progression rate were evaluated. The quantitative indices were central keratometry (K), the inferior-superior (I-S) value, and the keratoconus percentage index (KISA). Discriminant analysis was used to estimate the classification rate using the indices. RESULTS: There were significant differences at baseline between the normal, keratoconus-suspect, and early keratoconus groups in all indices; the respective means were central K: 44.17 D, 45.13 D, and 45.97 D; I-S: 0.57, 1.20, and 4.44; log(KISA): 2.49, 2.94, and 5.71 (all P<.001 after adjusting for covariates). Over a median follow-up of 4.1 years, approximately 28% in the keratoconus-suspect group progressed to early keratoconus or keratoconus and 75% in the early keratoconus group progressed to keratoconus. Using all 3 indices and age, 86.9% in the normal group, 75.3% in the early keratoconus group, and 44.6% in the keratoconus-suspect group could be classified, yielding a total classification rate of 68.9%. CONCLUSIONS: Cross-sectional and longitudinal data showed significant differences between groups in the 3 indices. Use of this classification scheme might form a basis for detecting subclinical keratoconus.

Flap creation is a critical step in laser in situ keratomileusis (LASIK). Efforts to improve the safety and predictability of the lamellar incision have fostered the development of femtosecond lasers. Several advantages of the femtosecond laser over mechanical microkeratomes have been reported in LASIK surgery. In this article, we review common considerations in management and complications of this step in femtosecond laser–LASIK and concentrate primarily on the IntraLase laser because most published studies relate to this instrument. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Although gammadelta T cells express clonally distributed T-cell receptors (TCRs), a hallmark of adaptive immunity, they are classically considered as innate-like effectors, owing to the high frequency of preactivated gammadelta T cells, with restricted antigen recognition repertoire in particular tissue locations. Actually, such features are shared only by a fraction of gammadelta T-cell subsets located in the skin and reproductive organ mucosa in rodents or in peripheral blood in humans. By contrast, other gammadelta subsets, e.g. those found in rodent and human spleen, show diverse antigenic reactivity patterns and mixed naive/memory phenotypes. Thus, gammadelta T cells are made of both 'primitive' subsets endowed with innate-like properties and 'evolved' subsets able to mount anamnestic responses like conventional major histocompatibility complex-restricted alphabeta T cells. In this article, we show that human gammadelta T cells, although heterogeneous, do share recurrent innate features that distinguish them from mainstream alphabeta T cells. In particular, most of them are activated on TCR- or natural killer receptor-mediated recognition of a restricted set of conserved yet poorly defined endogenous stress determinants. This rather simple recognition mechanism allows human gammadelta T cells to discriminate healthy cells from altered cells and to exert a variety of immunostimulatory or regulatory functions. The recent availability of synthetic gammadelta T-cell agonists mimicking these natural stress-induced ligands have fostered development of immunotherapeutic strategies, with broad indications against infectious and tumor diseases, which are briefly reviewed here.

OBJECTIVE: We administered an acute psychological stressor to multiple sclerosis (MS) patients and normal controls to determine whether differences in subjective and physiological responses to stress may underlie the susceptibility of MS patients to stress-related exacerbations. METHOD: Twenty-five MS patients (18 female, 7 male) and 25 age- and gender-matched controls participated in the study. They were asked to give a 5-minute videotaped speech defending themselves in a hypothetical scenario in which they were wrongly accused of stealing. Subjective and autonomic responses were monitored, and blood was sampled at baseline, 5, 20, and 60 minutes after the stressor to assess mitogen-stimulated production of interleukin-1beta(IL-1beta), interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma). RESULTS: MS patients and controls demonstrated similar subjective and physiological responses to the stressor that were independent of gender, mood, and disability status. The macrophage-derived cytokines IL-1beta and TNF-alpha were increased during the stressor, and remained elevated through 60 minutes. Th1 lymphocyte-derived IFN-gamma production also was increased at 5 and 60 minutes relative to baseline; however, there was no change in the Th2 lymphocyte-derived cytokine IL-4. CONCLUSIONS: These results favor the hypothesis that MS patients do not differ in stress response from normal controls; however, psychological stress may enhance cellular immune responses that would be potentially harmful to MS patients.

PURPOSE: To report the clinical results of refractive lenticule extraction using a femtosecond laser and describe the effect of scanning patterns on the results. SETTING: Private laser center, Vadodara, India. DESIGN: Prospective clinical study. METHODS: The Visumax femtosecond laser system was used to perform lenticule extraction to treat refractive errors using 2 scanning trajectories. The laser was used to cut a refractive lenticule intrastromally to correct myopia or myopic astigmatism. The lenticule was then physically extracted from the stroma. In scanning pattern A, the laser scanned from the center out and the periphery in while the 2 surfaces of the lenticule were cut. In scan pattern B, the laser scanned from the periphery in and the center out. Outcome measures were corrected and uncorrected distance visual acuities and manifest refraction during a 6-month follow-up. Differences between the 2 scanning patterns were also analyzed. RESULTS: The study comprised 329 eyes of 173 patients. One week postoperatively, there were statistically significant differences in refractive outcomes (P=.03), safety (P<.01), and efficacy (P<.01), between the 2 scanning-pattern groups. At 6 months, there were no significant differences. CONCLUSIONS: Early visual recovery and refractive outcomes after femtosecond lenticule extraction were affected by the scanning trajectory of the laser. A trajectory that scanned from the periphery to the center and the center to the periphery to cut the 2 lenticule surfaces had a positive effect on visual recovery.

PURPOSE: Over the past 30 years, the number and type of academic faculty tracks have increased, and researchers have found differences in promotion rates between track types. The authors studied the gender distribution of medical school faculty on the traditional tenure track (TTT) and clinician-educator track (CET) types. METHOD: The authors analyzed gender and academic track type distribution data from the March 31, 2011, snapshot of the Association of American Medical Colleges' Faculty Roster. Their final analysis included data from the 123 medical schools offering the TTT type and the 106 offering the CET type, which excluded any schools with 10 or fewer faculty on each track type. RESULTS: The original dataset included 134 medical schools representing 138,508 full-time faculty members, 50,376 (36%) of whom were women. Of the 134 medical schools, 128 reported at least one of four track types: TTT, CET, research track, and other. Of the 83 medical schools offering the CET type, 64 (77%) had a higher proportion of female than male faculty on that track type. Of the 102 medical schools offering the TTT type, only 20 (20%) had a higher proportion of female than male faculty on that track type. CONCLUSIONS: Medical schools offering the CET type reported higher proportions of female faculty on that track type. Given that faculty on the CET type lag behind their TTT colleagues in academic promotion, these findings may contribute to continued challenges in gaining academic and leadership parity for women in academic medicine.

The purpose of this study was to determine why childbirth pain and the childbirth experience are reported to vary so vastly. The correlation and relative contribution of eleven psychological and background variables to six childbirth outcome measures were investigated. Predictor variables included natural childbirth training, age, gravida, education, menstrual pain, first menstrual experience, sexual desire, wanting husband to be present, medication expectation, and general overt reaction to pain. The six criteria variables are labor length, behavior, medication amount, self-report of pain, childbirth description, and testimony. Findings indicated that the most important factors contributing to childbirth outcome were: training, attitudes toward childbirth, reaction to pain in general, medication expectation, and desire for husband's presence. Childbirth training did not contribute to the variance of labor length, self-report of pain, or childbirth description. None of the predictors influenced self-report of pain. The underlying factor involved in contributing to a positive childbirth experience appears to be the woman's desire to be an active participant in her labor and delivery.

BACKGROUND: Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE). METHODS: We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program. RESULTS: In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001). CONCLUSIONS: These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.

PURPOSE: To determine the accuracy of intraocular lens (IOL) power calculations in eyes with high myopia and to suggest adjusted constants for these cases. SETTING: Centre for Ophthalmology, Eberhard-Karls-University, Tuebingen, Germany. METHODS: Patients with high myopia having phacoemulsification with implantation of an AcrySof MA60MA IOL (power range +5.00 to -5.00 diopters [D]) were evaluated. Optical biometry (IOLMaster) and IOL calculations were performed before and after IOL implantation. Because of different optic principal planes of negative-diopter and positive-diopter IOLs, separate constants were calculated for these groups. RESULTS: Fifty eyes (32 patients) were evaluated. Thirty eyes (mean AL 31.15 mm +/- 1.69 [SD]) had implantation of a positive-diopter IOL (mean power +3.10 +/- 1.50 D) and 18 eyes (mean AL 33.20 +/- 2.25 mm), a negative-diopter IOL (mean power -3.20 +/- 1.70 D). Postoperatively, the mean spherical equivalent was -1.42 +/- 1.33 D and -0.41 +/- 1.81 D, respectively. The difference in optimized constants between positive- and negative-diopter IOLs was significant for all formulas. Power calculation with the SRK II formula showed a wide range of deviation of postoperative refraction from target refraction. Calculation with the Haigis, SRK/T, Holladay 1, and Hoffer Q formulas showed a mean deviation of 0.00 D with an SD of 0.88, 0.92, 1.03, and 1.15, respectively. CONCLUSIONS: Results indicate that the SRK II formula cannot be recommended for IOL power calculation in highly myopic patients. With optimized constants, the SRK/T, Haigis, Hoffer Q, and Holladay 1 formulas produced small deviation of postoperative refraction from target refraction.

To assess the repeatability and validity of lens densitometry derived from the Pentacam Scheimpflug imaging system.Eye Clinic, Queensland University of Technology, Brisbane, Australia.This prospective cross-sectional study evaluated 1 eye of subjects with or without cataract. Scheimpflug measurements and slitlamp and retroillumination photographs were taken through a dilated pupil. Lenses were graded with the Lens Opacities Classification System III. Intraobserver and interobserver reliability of 3 observers performing 3 repeated Scheimpflug lens densitometry measurements each was assessed. Three lens densitometry metrics were evaluated: linear, for which a line was drawn through the visual axis and a mean lens densitometry value given; peak, which is the point at which lens densitometry is greatest on the densitogram; 3-dimensional (3D), in which a fixed, circular 3.0 mm area of the lens is selected and a mean lens densitometry value given. Bland and Altman analysis of repeatability for multiple measures was applied; results were reported as the repeatability coefficient and relative repeatability (RR).Twenty eyes were evaluated. Repeatability was high. Overall, interobserver repeatability was marginally lower than intraobserver repeatability. The peak was the least reliable metric (RR 37.31%) and 3D, the most reliable (RR 5.88%). Intraobserver and interobserver lens densitometry values in the cataract group were slightly less repeatable than in the noncataract group.The intraobserver and interobserver repeatability of Scheimpflug lens densitometry was high in eyes with cataract and eyes without cataract, which supports the use of automated lens density scoring using the Scheimpflug system evaluated in the study.

Hypothalamo-pituitary-adrenal [HPA] activation and abnormal HPA regulatory mechanisms have been observed in depressed patients. Depressed and schizophrenic patients were studied to determine whether the HPA disturbances in depression are specific to this psychiatric illness or are mediated by nonspecific breakdown of psychological defense mechanisms. Despite the presence of severe ego defense breakdown and considerable secondary depressive symptomatology, the schizophrenic patients had normal HPA function. The depressed patients had elevated urine free cortisol excretion, high CSF cortisol levels, and did not show normal HPA suppression in response to dexamethasone. Within the depressed group significant correlations of HPA parameters were obtained with somatic features but not with ego breakdown features. After recovery depressed patients had more normal HPA function. The results indicate that HPA dysfunction can occur in association with primary depressive illness, that a psychoendocrine distinction can be made between primary depressive illness and secondary depressive symptomatology, and that psychological defense breakdown is not related to these neuroendocrine observations. Attention is drawn to the utility of urinary free cortisol measurement as a valuable index of HPA activation in psychoendocrine studies.

OBJECTIVE: To clarify the prevalence and predictors of Type 2 diabetes mellitus (T2DM) in people with posttraumatic stress disorder (PTSD) and where possible compare this to healthy controls. METHODS: We searched major electronic databases until May 2015 for studies reporting T2DM prevalence in people with PTSD. Two independent authors extracted data and completed methodological quality appraisal. A random-effects meta-analysis was used. RESULTS: From 1171 candidate publications after exclusions, nine publications were included (n = 23,396; 28.6% male; mean age = 35-60 years). The overall prevalence of T2DM was 10.0% (95% confidence interval [CI] = 8.1%-12.0%). Subgroup analysis demonstrated that war veterans experience higher prevalence of T2DM (16.3%; 95% CI = 5.2%-31.8%; n studies = 3, n = 473) compared with mixed samples (11.8%; 95% CI = 6.34-18.7, p < .001; n studies = 4, n = 2753). Increasing age (β = 0.0593, 95% CI = 0.010-0.109, z = 2.34, p = .019), median year of publication (β = -0.08, 95% CI = -0.14 to -0.03, z = -3.09, p = .002), and a lower percentage of white participants (β = -3.21, 95% CI = -5.12 to -1.29, z = -2.28, p = .001) predicted prevalence of T2DM. A relative risk meta-analysis comparing controls (n = 125,723) against those with PTSD (n = 23,203) demonstrated a significantly increased risk of T2DM (n studies = 5, relative risk = 1.49, 95% CI = 1.17-1.89, p = .001). CONCLUSIONS: People with PTSD are at a high risk for developing T2DM. The current findings should, however, be interpreted with caution because most studies were based on self-report data.

PURPOSE: To compare anterior segment measurements and morphology of 2 optical coherence tomography (OCT) systems. SETTING: Department of Ophthalmology, District Railway Hospital, and the Nursing Department and Social Medical Issues, Health Care Division, Silesian Medical University, Katowice, Poland. METHODS: In normal eyes and in eyes with corneal and trabecular-iris angle disorders, the central corneal thickness (CCT), trabecular-iris angle, and angle-opening distance at the nasal and temporal angles were measured 3 times during 1 visit using the Visante time-domain OCT system and the RTVue-100 Fourier-domain corneal anterior module OCT system. Anterior segment morphology was assessed and compared. RESULTS: Fifty-four eyes were evaluated. The mean values (+/-SD) by time-domain OCT and Fourier-domain OCT were, respectively, automatic CCT, 535 +/- 33.07 microm and 538 +/- 31.82 microm; manual CCT, 545 +/- 30.91 microm and 542 +/- 30.57 microm; nasal trabecular-iris angle, 34.7 +/- 9.5 degrees and 35.2 +/- 8.9 degrees; temporal trabecular-iris angle, 35.3 +/- 8.5 degrees and 35.5 +/- 9 degrees; nasal angle-opening distance, 435 +/- 95 microm and 444 +/- 98 microm; and temporal angle-opening distance, 443 +/- 103 microm and 452 +/- 99 microm. There was no significant difference between mean values, and they were highly correlated. On morphologic analysis, time-domain OCT had lower resolution; however, all anterior chamber structures were visible on 1 image. Fourier-domain OCT provided precise information about small areas of the anterior chamber. CONCLUSION: Fourier-domain OCT provided accurate anterior eye segment measurements that agreed with those obtained with time-domain OCT.

OBJECTIVE: This study aimed to examine associations among race, the accumulation of multiple forms of discriminatory experiences (i.e., "pervasive discrimination"), and allostatic load (AL) in African Americans and whites in midlife. METHODS: Using data collected in 2004 to 2006 from 226 African American and 978 white adults (57% female; mean [SD] age = 54.7 [0.11] years) in the Midlife in the United States II Biomarker Project, a pervasive discrimination score was created by combining three discrimination scales, and an AL score was created based on 24 biomarkers representing seven physiological systems. Linear regression models were conducted to examine the association between pervasive discrimination and AL, adjusting for demographics and medical, behavioral, and personality covariates. A race by pervasive discrimination interaction was also examined to determine whether associations varied by race. RESULTS: African Americans had higher pervasive discrimination and AL scores than did whites. In models adjusted for demographics, socioeconomic status, medications, health behaviors, neuroticism, and negative affect, a pervasive discrimination score of 2 versus 0 was associated with a greater AL score (b = 0.30, SE = 0.07, p < .001). Although associations seemed to be stronger among African Americans as compared with whites, associations did not statistically differ by race. CONCLUSIONS: More pervasive discrimination was related to greater multisystemic physiological dysregulation in a cohort of African American and white adults. Measuring discrimination by combining multiple forms of discriminatory experiences may be important for studying the health effects of discrimination.

OBJECTIVE: Mobile phones are increasingly becoming a part of the social environment, and when individuals feels excluded during a socially stressful situation, they often retreat to the comfort of their phone to ameliorate the negativity. This study tests whether smartphone presence does, in fact, alter psychological and physiological responses to social stress. METHODS: Participants (N = 148, 84% female, mean age = 20.4) were subjected to a peer, social-exclusion stressor. Before exclusion, participants were randomized to one of the following three conditions: (1) phone-present with use encouraged, (2) phone-present with use restricted, or (3) no phone access. Saliva samples and self-report data were collected throughout the study to assess salivary alpha amylase (sAA), cortisol, and feelings of exclusion. RESULTS: Participants in both phone-present conditions reported lower feelings of exclusion compared with individuals who had no access to their phone (F(2,143) = 5.49, p = .005). Multilevel modeling of sAA responses revealed that the individuals in the restricted-phone condition had a significantly different quadratic trajectory after the stressor compared with the phone use (υ = -0.12, z = -2.15, p = .032), and no-phone conditions (υ = -0.14, z = -2.64, p = .008). Specifically, those in the restricted-phone condition showed a decrease in sAA after exclusion, those in the no-phone condition showed a gradual increase, and phone users exhibited little change. Cortisol responses to the stressor did not vary by condition. CONCLUSIONS: Taken together, these results suggest that the mere presence of a phone (and not necessarily phone use) can buffer against the negative experience and effects of social exclusion.

PURPOSE: To evaluate visual quality after laser in situ keratomileusis (LASIK) performed to achieve monovision in presbyopic patients. SETTING: Laboratory of Vision Sciences and Applications, Department of Optics, University of Granada, Granada, and Clínica Novovisión, Madrid, Spain. DESIGN: Cohort study. METHODS: Laser in situ keratomileusis was performed with the Allegretto Wave Eye-Q 400 Hz laser. The dominant eye was corrected for far vision and the nondominant eye for near vision by targeting -1.25 diopters of myopia. The F-CAT algorithm was programmed targeting a postsurgical corneal asphericity of -0.80 in the dominant eye and -1.00 in the nondominant eye. Visual acuity, contrast sensitivity function, ocular aberrations, stereoacuity, the scattering index, and the visual-discrimination capacity were analyzed preoperatively and 3 months postoperatively. RESULTS: The study enrolled 25 patients (50 eyes) with a mean age of 49.3 years ± 4.5 (SD). Postoperatively, more than 90% of patients had a binocular uncorrected distance and near visual acuity of 0.0 logMAR or better, although the contrast sensitivity function diminished, especially in the nondominant eye and with binocular vision. Stereoacuity was significantly worse in all patients (P<.001). The visual discrimination capacity declined in nondominant eyes and under binocular conditions (P<.005); no significant changes occurred in dominant eyes (P=.614). In all eyes, the mean objective scatter index value increased postoperatively, but not significantly (P>.05). CONCLUSIONS: Monovision correction by LASIK improved functional near vision in presbyopic patients. Although visual acuity was good for far vision, contrast sensitivity and stereoacuity diminished significantly.

Ezra, Nehemiah und die Bildung einer frühjüdischen Identität

PURPOSE: To compare the clinical outcomes after cataract surgery with implantation of 2 models of a new rotationally asymmetric multifocal IOL to ascertain which provides better visual performance and patient satisfaction. SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: Consecutive eyes of cataract patients were divided into 2 groups. Group A received a Lentis Mplus LS-312 MF15 IOL (with a near addition [add] power of +1.50 diopters [D]) and Group B, a Lentis Mplus LS-312 MF30 IOL (with a near add power of +3.00 D). Distance, near, and intermediate visual acuity outcomes were evaluated preoperatively and postoperatively during a 6-month follow-up. Postoperative contrast sensitivity, patient satisfaction, ocular aberrations, ocular optical quality, and defocus curves were analyzed. RESULTS: Patients ranged in age from 55 to 83 years. Group A comprised 22 eyes and Group B, 21 eyes. Both groups had a statistically significant improvement in uncorrected and corrected distance and corrected near visual acuities postoperatively (P≤.01). Group B had statistically significantly better uncorrected and distance-corrected near visual acuity (P≤.01) and Group A, significantly better uncorrected intermediate visual acuity (P=.01) at 3 months. There were statistically significant differences between-group differences in several levels of defocus based on defocus curves. There were no significant differences in postoperative contrast sensitivity, patient satisfaction, optical quality, and ocular aberrometry between groups (P≥.07). CONCLUSIONS: Both IOL models restored distance visual function and improved intermediate vision. Near visual rehabilitation was complete with the +3.00 D add IOL.

PURPOSE: To provide a consistent standard for the evaluation of different types of presbyopic correction. SETTING: Eye Clinic, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. METHODS: Presbyopic corrections examined were accommodating intraocular lenses (IOLs), simultaneous multifocal and monovision contact lenses, and varifocal spectacles. Binocular near visual acuity measured with different optotypes (uppercase letters, lowercase letters, and words) and reading metrics assessed with the Minnesota Near Reading chart (reading acuity, critical print size [CPS], CPS reading speed) were intercorrelated (Pearson product moment correlations) and assessed for concordance (intraclass correlation coefficients [ICC]) and agreement (Bland-Altman analysis) for indication of clinical usefulness. RESULTS: Nineteen accommodating IOL cases, 40 simultaneous contact lens cases, and 38 varifocal spectacle cases were evaluated. Other than CPS reading speed, all near visual acuity and reading metrics correlated well with each other (r>0.70, P<.001). Near visual acuity measured with uppercase letters was highly concordant (ICC, 0.78) and in close agreement with lowercase letters (+/-0.17 logMAR). Near word acuity agreed well with reading acuity (+/-0.16 logMAR), which in turn agreed well with near visual acuity measured with uppercase letters (+/-0.16 logMAR). Concordance (ICC, 0.18 to 0.46) and agreement (+/-0.24 to 0.30 logMAR) of CPS with the other near metrics was moderate. CONCLUSION: Measurement of near visual ability in presbyopia should be standardized to include assessment of near visual acuity with logMAR uppercase-letter optotypes, smallest logMAR print size that maintains maximum reading speed (CPS), and reading speed.