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Biomedical subjects

J T Holladay

Publications and source records attributed to J T Holladay.

At least 19 recordsLinked to original sources
PubMed1992

Intraocular lens power calculations for multifocal intraocular lenses.

We performed calculations for anterior and posterior chamber intraocular lenses, determining the necessary power for emmetropia and 3 diopters of myopia for various axial lengths and corneal powers. Our results demonstrate that to achieve an effective add of 3.00 diopters at the spectacle plane (reading distance of 33 cm), the fabricated add (labeled add) on an intraocular lens must vary from 3.3 diopters for an anterior chamber lens in a patient with a flat cornea, to 5.1 diopters for a posterior chamber lens in a patient with a steep cornea. For most patients, targeting for an effective add of 3 diopters is appropriate, but factors such as availability of fabricated adds from the manufacturer and unusual patient requirements for near vision, may alter this target. We reviewed alternatives with monofocal lenses, such as monovision and compound myopic astigmatism.

Anterior Chamber↗
PubMed1992

Calculating the surgically induced refractive change following ocular surgery.

Calculating the surgically induced refractive change following ocular surgery is important for evaluating the results of keratore-fractive procedures, smaller incisions and various wound closures for cataract surgery, and the effect of suturing techniques and suture removal following corneal transplant surgery. We present a ten-step method of calculating the spherical- and cylindrical-induced refractive change in a manner suitable for a programmable calculator or personal computer. Several applications are given including (1) adding the overrefraction to the spectacle correction, (2) determining the surgically induced refractive change from the preoperative and postoperative refractions, (3) determining the surgically induced refractive change from the K-readings, (4) rotating axes, (5) determining the power at meridians oblique to the principal meridians of a spherocylinder, (6) determining the coupling ratio, and (7) averaging axes. Standard methods for calculating and reporting aggregate results are also given.

Astigmatism↗
PubMed1991

The relationship of visual acuity, refractive error, and pupil size after radial keratotomy.

To better define the relationship between residual refractive error, uncorrected visual acuity, and pupil diameter, we compared 42 eyes that had an eight-incision radial keratotomy according to the Prospective Evaluation of Radial Keratotomy Study protocol with 42 matched control eyes. The parameters measured were best corrected visual acuity, uncorrected visual acuity, and the change in cycloplegic refraction with enlarging pupil diameter. The best corrected visual acuity was 20/16 in both the radial keratotomy and control groups, but the variability (SD) was higher in the radial keratotomy group. The average uncorrected visual acuity was 0.35 (35%) better in the radial keratotomy group, but the variability was 1.77 times higher. Change in refraction with dilation occurred in 9% of the controls and 36% of the radial keratotomy patients, indicating a significant difference (P = .002). The change in refraction with dilation in the eyes with radial keratotomy was almost equally split between a hyperopic change (17%) and a myopic change (18%), which was much different than in the control eyes, only 2% of which changed in a hyperopic direction and 7% in a myopic direction. The radial keratotomy patients with a myopic change had the best uncorrected visual acuity, indicating that positive spherical aberration yielded the best aspherical surface for uncorrected visual acuity.

Adult↗
PubMed1990

Optical performance of multifocal intraocular lenses.

The optical performance of one monofocal and five multifocal lenses was evaluated in the laboratory and photographically. The laboratory testing included determination of the modulation transfer function (MTF), through focus response (TFR), resolution efficiency, and Strehl ratio of each lens. The photographic testing included photographs of the Regan high contrast acuity chart at ten feet with clearest focus and 18 additional photographs in which the image was defocused using minus trial lenses in 0.25 diopter increments. A color photograph of the Kodak color chart was also taken using each lens. All testing was conducted using a 3 mm artificial pupil under ideal implant conditions with no decentration or tilt. The laboratory and photographic results demonstrate that all the multifocal lenses had a two- to three-fold increase in the depth of field with at least a 50% lower contrast in the retinal image. The photographic testing revealed a one to two line better resolution limit with the monofocal lens, which corresponded to the 12% to 41% better MTF cut-off value with the monofocal lens by laboratory testing. The measured resolution efficiencies of all six lenses were comparable. The color photographs revealed color mixing of adjacent colors with the multifocal lenses, whereas the colors appeared unchanged from the original with the monofocal lens.

Equipment Design↗
PubMed1989

Glare testing in cataract patients: instrument evaluation and identification of sources of methodological error.

This study sought to determine the relative sensitivity of two commercially available glare testers in predicting outdoor acuity in a population of patients with minimal cataracts. Two target optotypes were evaluated: high contrast letters and varying contrast sinusoidal gratings. Although both instruments demonstrated a significant correlation between indoor and outdoor acuity, they showed a significant difference between predicted outdoor acuity and obtained visual acuity. The brightness acuity tester on high intensity was inaccurate in predicting outdoor vision regardless of test optotype, overpredicting glare disability in 76% (average) of the study population. Glare disability overpredictions fell to 8% on the medium setting with +/- 2 lines of vision classified as "no change." Using the same criterion, the Miller-Nadler glare tester overpredicted glare disability in 2% of the cataract population but underpredicted glare disability in 62%. In this study, letter optotypes resulted in less variability than sinusoidal grating stimuli. In addition, we identify several methodological factors to consider before designing a glare experiment. These potential sources of error can influence the outcome of any glare study that compares indoor and outdoor acuity and include the study population, visual stimuli (optotypes), and elements of the outdoor testing situation.

Adolescent↗
PubMed1988

Silicone intraocular lens resolution in air and in water.

The resolution efficiencies of 31 biconvex silicone intraocular lenses, ranging in power from 16.0 to 23.5 diopters, were tested in air and in water to see if a predictable relationship existed as previously reported with polymethylmethacrylate lenses. Resolution efficiency is defined as the percentage ratio of the actual resolving power of a lens to that of a perfect lens of the same focal length which is only limited in resolution by diffraction. The lenses ranged from 29% to 58% resolution efficiency in air. No lenses exhibiting multiple images were included. All 31 lenses achieved at least 73% resolution efficiency in water, and one lens achieved 82%. Based on these findings, a biconvex silicone lens that exceeds 30% resolution efficiency in air and does not produce multiple images can perform near its diffraction limit when implanted in the eye.

Air↗
PubMed1988

A three-part system for refining intraocular lens power calculations.

A three-part system that determines the correct power for an intraocular lens (IOL) to achieve a desired postoperative refraction is presented. The three components are (1) data screening criteria to identify improbable axial length and keratometry measurements, (2) a new IOL calculation formula that exceeds the current accuracy of other formulas for short, medium, and long eyes, and (3) a personalized "surgeon factor" that adjusts for any consistent bias in the surgeon's results, from any source, based on a reverse solution of the new formula; the reverse solution uses the postoperative stabilized refraction, the dioptric power of the implanted IOL, and the preoperative corneal and axial length measurements to calculate the personalized surgeon factor. The improved accuracy of the new formula was proven by performing IOL power calculations on 2,000 eyes from 12 surgeons and comparing the results to seven other currently used formulas.

Evaluation Studies as Topic↗
PubMed1988

Pulmonary edema following retrobulbar block.

We report a patient requiring keratoplasty who developed acute pulmonary edema following the administration of a retrobulbar block for anesthesia. A variety of factors that may have been implicated in the genesis of this complication are discussed.

Anesthesia, Local↗
PubMed1987

Relationship between refractive error and visual acuity in the Prospective Evaluation of Radial Keratotomy (PERK) Study.

As part of the Prospective Evaluation of Radial Keratotomy (PERK) study, we examined the relationship between post-operative refractive error and visual acuity without correction. We included 394 eyes (one eye per patient) with refractive errors ranging from -3.00 to +3.00 diopters one year after radial keratotomy. Within each 1-D range of the spherical equivalent of the refractive error, the visual acuity spanned five to ten Snellen lines. For visual acuities of 20/16 to 20/50, the refractive error spanned 3 to 5 D. Additionally, operated eyes had a better average uncorrected visual acuity than unoperated eyes with a similar refractive error. Within the narrow range of refraction between -2.00 and -2.50 D, the mean uncorrected visual acuity was 20/125 for 56 unoperated eyes and 20/63 for 29 operated eyes, a difference of three Snellen lines.

Adult↗
PubMed1987

Brightness acuity test and outdoor visual acuity in cataract patients.

The disparity between functional outdoor vision and the acuity measured in the standard refracting lane is well known among clinicians. A simple device, the brightness acuity tester (B.A.T.), was developed to predict a patient's functional outdoor acuity. The B.A.T. has an illuminated hemispheric bowl, 60 mm in diameter, with a 12-mm aperture. Fourteen normals and 50 patients with cataracts were tested using the B.A.T. and then tested outside in bright sunlight. The B.A.T. correlated extremely well (r = +0.84, P less than .0001) with the acuities measured outside. There was no decrease in visual acuity in the 14 normal patients, but there was a one to ten line decrease in vision among the cataract patients. Upon retesting, the B.A.T. scores did not vary, while outside testing scores did change due to variable outdoor ambient light levels on sunny days. The B.A.T. is a simple, repeatable, useful test for predicting functional outdoor acuity.

Cataract↗