Biomedical subjects

K Zadnik

Publications and source records attributed to K Zadnik.

At least 37 records · Page 2Linked to original sources

PubMed2000

Daily disposable vs. disposable extended wear: a contact lens clinical trial.

BACKGROUND: The purpose of this work was to compare traditional standards of contact lens success and patient-reported preferences in the daily-disposable and disposable extended-wear contact lens modalities. METHODS: This study was a randomized, cross-over contact lens clinical trial involving 50 patients. After the baseline examination, two outcome examinations were performed including the self-administration of the Refractive Status and Vision Profile (RSVP) survey, an additional survey, and masked visual acuity and slit-lamp assessments. RESULTS: No differences were noted on the RSVP when comparing treatment modalities. Patients were considered equally successful in terms of wearing time, overall comfort, visual acuity, and ocular health criteria. In terms of patient preferences, a significant number of patients preferred the disposable extended-wear modality over the daily-disposable modality (chi2(1) = 4.08, p = 0.04). Patients preferred disposable extended-wear over daily-disposables due to convenience (odds ratio = 30.33). CONCLUSIONS: Disposable extended-wear represents a convenient contact lens option for contact lens patients.

Adolescent↗

PubMed2000

Vision-specific quality of life and modes of refractive error correction.

PURPOSE: Many studies currently use surveys to assess patients' reports of vision-specific quality of life to determine the impact of the disease or the most appropriate mode of treatment. One such instrument, the National Eye Institute Visual Function Questionnaire (NEI-VFQ), was developed to assess vision-related quality of life with respect to emotional well-being and social function as well as difficulty with tasks and symptoms. We administered the NEI-VFQ to 218 subjects free of eye disease to see if the survey was sensitive enough to detect differences in three modes of refractive error correction: spectacles, soft contact lenses, and rigid contact lenses. METHODS: Surveys were administered to 117 rigid contact lens wearers, 51 spectacle wearers, and 50 soft contact lens wearers. Kruskal-Wallis one-way analysis of variance was conducted to determine significant differences in each of the subscales. RESULTS: The Peripheral Vision subscale score (mean +/- SD) was 92.6 +/- 15.2 for the spectacle wearers, 100.0 +/- 0.0 for the soft contact lens wearers, and 98.3 +/- 7.1 for the rigid gas-permeable contact lens wearers; the spectacle wearers' Peripheral Vision score was significantly lower than the other two groups (Wilcoxon rank sum, p < 0.003 for both). The spectacle wearers (96.6 +/- 9.2) also had a significantly lower Dependency subscale score than the rigid contact lens group (99.7 +/- 1.5) (Wilcoxon rank sum, p = 0.001). There were no significant differences between the three groups detected in the mean of any of the other subscale scores. At least 50% of the subjects reported the maximum score for 6 of the 11 subscales. Given our sample size, we have 100% power to detect a difference of 10 points with a SD of 10 at the alpha = 0.05 level. CONCLUSION: The NEI-VFQ is not appropriate for detecting significant differences in vision-related quality of life among spectacle, soft contact lens, and rigid gas-permeable contact lens wearers, primarily due to maximum ratings by many of the subjects.

Adolescent↗

PubMed2000

Peripheral refraction and ocular shape in children.

PURPOSE: To evaluate the relation between ocular shape and refractive error in children. METHODS: Ocular shape was assessed by measuring relative peripheral refractive error (the difference between the spherical equivalent cycloplegic autorefraction 30 degrees in the nasal visual field and in primary gaze) for the right eye of 822 children aged 5 to 14 years participating in the Orinda Longitudinal Study of Myopia in 1995. Axial ocular dimensions were measured by A-scan ultrasonography, crystalline lens radii of curvature by videophakometry, and corneal power by videokeratography. RESULTS: Myopic children had greater relative hyperopia in the periphery (+0.80 +/- 1.29 D), indicating a prolate ocular shape (longer axial length than equatorial diameter), compared with relative peripheral myopia and an oblate shape (broader equatorial diameter than axial length) for emmetropes (-0.41 +/- 0.75 D) and hyperopes (-1.09 +/- 1.02 D). Relative peripheral hyperopia was associated with myopic ocular component characteristics: deeper anterior and vitreous chambers, flatter crystalline lenses that were smaller in volume, and steeper corneas. Lens thickness had a more complex association. Relative peripheral hyperopia was associated with thinner lenses between refractive error groups but changed in sign to become associated with thicker lenses when analyzed within each refractive error group. Receiver operator characteristics analysis of the ocular components indicated that vitreous chamber depth was the most important ocular component for characterizing the myopic eye, but that peripheral refraction made a significant independent contribution. CONCLUSIONS: The eyes of myopic children were both elongated and distorted into a prolate shape. Thinner crystalline lenses were associated with more hyperopic relative peripheral refractions across refractive error groups, but failure of the lens to thin may account for the association between thicker lenses and more hyperopic relative peripheral refractions within a given refractive group. Increased ciliary-choroidal tension is proposed as a potential cause of ocular distortion in myopic eyes.

Adolescent↗

PubMed2000

Age-related decreases in the prevalence of myopia: longitudinal change or cohort effect?

PURPOSE: The prevalence of myopia shows a decline with age in cross-sectional studies. This pattern may represent an increase in the prevalence of myopia in younger generations, possibly through increased exposure to near work, or an intrinsic age-related decline in myopia prevalence. Data were analyzed from published studies to determine which of these two alternatives better explains the data: a cohort effect of changing prevalence by decade or a longitudinal effect of changing prevalence as a function of age. METHODS: Prevalence data were taken from three studies conducted in the late 1980s and compared with those obtained indirectly from a national survey conducted in the early 1970s. The prevalence of myopia was then plotted as a function of age and year of birth. RESULTS: The pattern of change in the prevalence of myopia as a function of age was consistent across all studies when data were scaled relative to the prevalence of myopia at age-range midpoints from 44.5 to 49.5 years. The pattern of change was not consistent as a function of year of birth. When the data were scaled relative to the prevalence of myopia among those with years of birth from 1940 to 1942 and plotted by year of birth, results from the early 1970s were offset from those of later studies by approximately 18 years. CONCLUSIONS: The decline in the prevalence of myopia in older adults between the early 1970s and the late 1980s can be better explained by age than by year of birth. The prevalence of myopia appears to decrease because of an intrinsic age-related decrease in the amount of an individual's myopia rather than because of a cohort effect of increasing prevalence over time. The hypothesis that increasing environmental exposures to near work in recent decades have changed the prevalence of myopia is not supported by this analysis.

Adolescent↗

PubMed2000

AC/A ratio, age, and refractive error in children.

PURPOSE: To examine how the response AC/A ratio (the amount of accommodative convergence per unit of accommodative response) varies as a function of refractive error and age, to determine whether it is a risk factor for the onset of myopia, and to examine the relation between ocular structural features and the AC/A ratio. METHODS: Accommodation was stimulated by a letter target presented in a Badal system at 0.00, 2.25, and 4.37 D to 828 children aged 6 through 14 years in 1996. Of these, 726 had no myopia in 1996 and were available for examination the following year. Accommodative response and cycloplegic refractive error were measured by autorefraction and convergence by monitoring the relative movement of Purkinje images I and IV. Lens radii of curvature were measured by video phakometry, corneal radius of curvature by topography, and ocular axial dimensions by A-scan ultrasonography. RESULTS: Adjusted for age, the response AC/A ratio was highest in myopes (6.39 delta/D), intermediate in emmetropes (3.94 delta/D), and lowest in hyperopes (3.40 delta/D; P < 0.0001; two-way analysis of variance [ANOVA]). The stimulus AC/A ratio did not vary with refractive error. Adjusted for refractive error, the response AC/A ratio did not change as a function of age. In non-myopic children, having a response AC/A ratio of 5.84 delta/D or more elevated the risk of development of myopia within 1 year by 22.5 times (95% CI = 7.12-71.1). In a subsample of children without myopia who had refractive errors less than +0.75 D, having a response AC/A ratio of 5.84 delta/D or more elevated the risk of development of myopia within 1 year by 3.21 times (95% CI = 1.14-9.07). The AC/A ratio was associated with all measured ocular features except lens spherical volume. Only the negative correlations with refractive error and the shape of the crystalline lens (Gullstrand lens power) were significant in a multiple regression model (adjusted R2 = 0.16). CONCLUSIONS: An elevated response AC/A ratio was associated with myopia and was an important risk factor for its rapid onset. The association between higher AC/A ratios and flatter crystalline lens shapes, as well as other reported features of accommodation in myopia, may be explained by "pseudocycloplegia," which the authors define as tension on the crystalline lens that increases the level of effort needed to accommodate. Accommodative deficits in myopia may be the functional consequences of the underlying anatomy of the enlarged eye.

Accommodation, Ocular↗

PubMed1999

Discordance for keratoconus in two pairs of monozygotic twins.

PURPOSE: We present two pairs of monozygotic twins discordant for keratoconus. METHODS: Two pairs of twins, each with one twin with keratoconus, and available family members were examined clinically and with computer-assisted videokeratography. Polymerase chain reaction-based zygosity assays using between nine and 11 unique, anonymous DNA markers were performed on blood obtained from the twins and surviving parents to assess the probability of genetic monozygosity. RESULTS: DNA probes showed a >99% probability that each of the two sets of twins was monozygotic. One twin from each pair had clinically diagnosed keratoconus. The remaining twins were normal by clinical examination and corneal topography. Clinical results for all family members examined were normal except that five of 13 from one family and one of six from the other family demonstrated "suspicious" corneal topography. CONCLUSION: Recent advances in knowledge and understanding of the twinning process suggest that monozygotic twins discordant for keratoconus does not preclude the possibility of a significant genetic component.

Adult↗

PubMed1999

Cycloplegia in African-American children.

PURPOSE: The selection of a cycloplegic agent depends on the desired outcome, the characteristics of the patient receiving the drug, and the associated risks. The Orinda Longitudinal Study of Myopia (OLSM) has used 1% tropicamide to assess the ocular components and cycloplegic refractions in a large cohort of predominantly Caucasian children. Although tropicamide has provided adequate cycloplegia and mydriasis for the OLSM cohort, conventional clinical wisdom and scientific investigations have suggested that tropicamide might not produce adequate cycloplegia and mydriasis for subjects with darker iris pigmentation. In this study one drop of 1% tropicamide followed by one drop of 1% cyclopentolate was used to determine their effectiveness in producing adequate cycloplegia and mydriasis for cycloplegic refraction and ocular component measurements in a group of African-American children. METHODS: Nineteen children [age range 5.5 to 15.6 years, mean 8.4 years +/- (SD) 2.5 years] were tested at Family HealthCare of Alabama, Eutaw, AL. Their accommodative responses were measured using a Canon R-1 autorefractor prior to and at 30, 45, and 60 min after instillation of one drop of 0.5% proparacaine, 1% tropicamide (Mydriacyl), and 1% cyclopentolate (Cyclogyl) in both eyes. A target of 20/155 letters in a 4x4 grid positioned behind a +6.50 diopter (D) Badal lens provided accommodative stimuli of 1.00 D, 2.00 D, and 4.00 D. RESULTS: All results are presented as mean +/-1 SD. Pupils, measured from video frames, dilated rapidly and maximally at 30 min after instillation of eye drops (7.3+/-0.5 mm) Predilation, the mean accommodative responses were 0.17+/-0.29 D for the 1.00 D stimulus, 1.01+/-0.40 D for the 2.00 D stimulus, and 2.77+/-0.74 for the 4.00 D stimulus. At 30 min after drop instillation, the responses were 0.07+/-0.14 D for the 1.00 D stimulus, 0.36+/-0.35 D for the 2.00 D stimulus, and 0.77+/-0.61 for the 4.00 D stimulus. Results were very similar at 45 and 60 min after drop instillation. CONCLUSIONS: Combining 1% tropicamide and 1% cyclopentolate was very effective in providing both cycloplegia and mydriasis adequate for ocular biometry and cycloplegic refractions 30 min after drop instillation in African-American children.

Accommodation, Ocular↗

PubMed1999

Short-term repeatability of hand-held keratometry measurements.

PURPOSE: The Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study is a multi-center, observational investigation of ocular component and refractive error development in schoolchildren. Anterior corneal curvature is one of several ocular components which influence refractive status of the eye, and the CLEERE Study uses the Alcon Auto-Keratometer to measure corneal curvature. This report assesses the repeatability of this hand-held instrument. Previous studies have demonstrated the validity of the Alcon Auto-Keratometer; however, none have assessed its repeatability. METHODS: Sixty children were recruited from clinics affiliated with the Southern California College of Optometry and the University of Houston College of Optometry. Two sets of five hand-held keratometry measurements were obtained on the right eye of each child by one investigator at each site using the Alcon Auto-Keratometer. The two sets of measurements were performed at least 10 minutes apart. RESULTS: The mean differences between the two occasions were not significantly different from zero for either the flat or steep corneal curvature measurements regardless of the number of readings taken. The largest improvement in repeatability, primarily for the steep meridian, occurred when the first two readings were averaged. The addition of readings 3, 4, and 5 to the average did not substantially improve repeatability for either meridian. The 95% limits of agreement between the average of two readings on two occasions for the flat and steep meridians were +/-0.28 and +/-0.39 D, respectively. The 95% limits of agreement after two readings were +/-0.28, +/-0.20, and +/-0.24 D for the M, J0, and J45 vectors, respectively. CONCLUSION: The Alcon hand-held keratometer provides a repeatable measure of corneal curvature as demonstrated by short-term repeat agreement within +/-0.50 D. This level of repeatability can be achieved only by manually averaging two consecutive measurements.

Adolescent↗

PubMed1999

Contact lens management of patients who have had unsuccessful refractive surgery.

The advent of corneal refractive surgery has, inevitably, resulted in the occasional need for contact lens fitting after surgery. For each new, developing procedure, new contact lens fitting challenges arise. The literature on contact lens use after radial keratotomy is rich and well known, but reports on the use of contact lenses after photorefractive keratectomy or laser-assisted in situ keratomileusis are few and far between. This review summarizes the prevailing clinical opinions on the contact lenses and contact lens fitting methods that are most effective after refractive surgery that results in high refractive error, irregular astigmatism, or anisometropia.

Anisometropia↗

PubMed1999

Tonic accommodation, age, and refractive error in children.

PURPOSE: An association between tonic accommodation, the resting accommodative position of the eye in the absence of a visually compelling stimulus, and refractive error has been reported in adults and children. In general, myopes have the lowest (or least myopic) levels of tonic accommodation. The purpose in assessing tonic accommodation was to evaluate it as a predictor of onset of myopia. METHODS: Tonic accommodation was measured in children enrolled in the Orinda Longitudinal Study of Myopia using an infrared autorefractor (model R-1; Canon, Lake Success, NY) while children viewed an empty lit field or a dark field with a fixation spot projected in Maxwellian view. Children aged 6 to 15 years were measured from 1991 through 1994 (n = 714, 766, 771, and 790 during the 4 years, successively). Autorefraction provided refractive error and tonic accommodation data, and videophakometry measured crystalline lens curvatures. RESULTS: Comparison of the two methods for measuring tonic accommodation shows a significant effect of age across all years of testing, with the lit empty-field test condition yielding higher levels of tonic accommodation compared with the dark-field test condition in children aged 6 through 11 years. For data collected in 1994, mean (+/-SD) tonic accommodation values for the lit empty-field condition were significantly lower in myopes, intermediate in emmetropes, and highest in hyperopes (1.02 +/- 1.18 D, 1.92 +/- 1.59 D, and 2.25 +/- 1.78 D, respectively; Kruskal-Wallis test, P < 0.001; between-group testing shows each group is different from the other two). Age, refractive error, and Gullstrand lens power were significant terms in a multiple regression model of tonic accommodation (R2 = 0.18 for 1994 data). Lower levels of tonic accommodation for children entering the study in the first or third grades were not associated with an increased risk of the onset of myopia, whether measured in the lit empty-field test condition (relative risk = 0.90; 95% confidence interval = 0.75, 1.08), or the dark-field test condition (relative risk = 0.83; 95% confidence interval = 0.60, 1.14). CONCLUSIONS: This is the first study to document an association between age and tonic accommodation. The known association between tonic accommodation and refractive error was confirmed and it was shown that an ocular component, Gullstrand lens power, also contributed to the tonic accommodation level. There does not seem to be an increased risk of onset of juvenile myopia associated with tonic accommodation.

Accommodation, Ocular↗

PubMed1999

Naturally occurring vitreous chamber-based myopia in the Labrador retriever.

PURPOSE: To investigate whether myopia is present in a breed of domestic dog, the Labrador retriever, and how the ocular components are related to refractive error in this breed. METHODS: Cycloplegic refractive error was measured in 75 Labrador retrievers by retinoscopy. Corneal and crystalline lens radii of curvature were measured in the right eyes of 57 of these dogs using a video-based keratophakometer, with axial ocular dimensions measured using A-scan ultrasonography. RESULTS: Of the 75 dogs tested, 11 (14.7%) were myopic by at least -0.50 D in one eye, and 6 (8.0%) were myopic in both eyes (full range of refractive errors, +3.50 D to -5.00 D). Of the 57 dogs with ocular component measurements, seven (12.3%) were myopic by at least -0.50 D in the right eye. There was a significant negative correlation between refractive error and vitreous chamber depth (Spearman r = -0.42; P < 0.001). Myopic eyes had an elongated vitreous chamber depth (10.87+/-0.34 mm for myopic dogs, 10.02+/-0.40 mm for nonmyopic dogs; P < 0.0001, Kruskal-Wallis test). There was also a significant quadratic association between lens thickness and vitreous chamber depth (P < 0.005; R2 = 0. 11), indicating that thinner lenses occurred at both shorter and longer vitreous chamber depths. CONCLUSIONS: Myopia in the Labrador retriever is analogous to human myopia in that it is caused by an elongated vitreous chamber. Thinner crystalline lenses found at longer vitreous chamber depths may be analogous to lens thinning documented in human ocular development. The Labrador retriever warrants investigation as a potential model of myopia that is naturally occurring rather than experimentally induced.

Animals↗

PubMed1999

Ocular predictors of the onset of juvenile myopia.

PURPOSE: The purpose of this study was to identify reliable predictors of the onset of juvenile myopia. METHODS: The data from 554 children enrolled in the Orinda Longitudinal Study of Myopia (OLSM) as nonmyopes with baseline data from the third grade were evaluated to develop a predictive profile for later onset of juvenile myopia. Myopia was defined as at least -0.75 D of myopia in the vertical and horizontal meridians of the right eye as measured by cycloplegic autorefraction (n = 45 children). Chosen predictors were refractive error and the ocular components: corneal power, Gullstrand crystalline lens power, and axial length. Sensitivity and specificity were calculated. Receiver operating characteristic (ROC) curves were generated to evaluate and compare these predictors singly and combined. RESULTS: Refractive error, axial length, Gullstrand lens and pod corneal power were all significant predictive factors for the onset of juvenile myopia. The best single predictor of future myopia onset in the right eye was the right eye's cycloplegic autorefraction spherical refractive error value (mean sphere across 10 readings) at baseline. For a cut point of less than +0.75 D hyperopia in the third grade, sensitivity was 86.7% and specificity was 73.3%. The area under the ROC curve for this mean sphere was 0.880. Producing a logistic model combining mean sphere, corneal power, Gullstrand lens power, and axial length results in a slight improvement in predictive ability (area under the ROC curve = 0.893). CONCLUSIONS: Onset of juvenile myopia can be predicted with moderate accuracy using the mean cycloplegic, spherical refractive error in the third grade. Measurement of other ocular components at this age improves predictive ability, albeit incrementally. Further improvements in the prediction of myopia onset will require the use of longitudinal data in addition to one-time measurement of refractive error and the ocular components.

Adolescent↗

PubMed1999

Rigid contact lens fitting relationships in keratoconus. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group.

PURPOSE: Although the influence of flat-fitting contact lenses on corneal scarring in keratoconus is frequently debated, the current standard of care with regard to the apical fitting relationship in keratoconus remains undocumented. METHODS: Patients were examined at baseline in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study (N = 1209). Patients wearing a rigid contact lens in one or both eyes (N = 808) had their habitual rigid contact lenses analyzed, and the fluorescein patterns and base curves were compared to the first definite apical clearance lens (FDACL). The FDACL is the flattest lens in the CLEK Study trial lens set that exhibits an apical clearance fluorescein pattern. For patients wearing a rigid contact lens in both eyes, one eye was selected randomly for analysis. RESULTS: Twelve percent of the rigid contact lens-wearing eyes were wearing lenses fitted with apical clearance based upon the clinician's fluorescein pattern interpretation. The remainder (88%) was wearing lenses fitted with apical touch. For mild (steep keratometric reading <45 D) keratoconus corneas, the mean estimate of the base curve to cornea-fitting relationship was 1.18 D flat (SD +/- 1.84 D); moderate (steep keratometric reading: 45 to 52 D) corneas were fitted on average 2.38 D flat (SD +/- 2.56 D); and severe (steep keratometric reading > 52 D) corneas were fitted an average of 4.01 D flat (SD +/- 4.11 D). CONCLUSIONS: Despite the potential risk for corneal scarring imposed by flat-fitting rigid contact lenses, most CLEK Study patients wear flat-fitting lenses. Overall, rigid lenses were fitted an average of 2.86 D (SD +/- 3.31 D) flatter than the FDACL.

Contact Lenses↗

PubMed1999

Corneal scarring in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: baseline prevalence and repeatability of detection.

PURPOSE: The multicenter Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a prospective, observational study of 1,209 keratoconus patients. We report on the prevalence of corneal scarring in these patients. We also report on the test-retest repeatability of corneal scar documentation at the slit-lamp biomicroscope by trained clinicians and by masked photograph readers and on the scarring-status agreement at baseline between clinicians and photograph readers. METHODS: Clinicians and masked photograph readers graded each cornea as to scarring status. Patients were examined by clinicians, and their corneas were photographed at baseline (2,297 nongrafted eyes of 1,209 patients) and at a repeated visit (258 nongrafted eyes of 138 patients). These photographs were evaluated by the masked readers at the CLEK Photography Reading Center (CPRC). Clinicians reported corneal scars in right eyes at baseline as "definitely not present" in 53.9%, "probably not present" in 8.4%, "probably present" in 8.2%, and "definitely present" in 29.4% of patients. A weighted kappa statistic of 0.83 (95% confidence interval from 0.78 to 0.88) indicates that agreement is excellent between baseline and repeated assessments for the presence of a corneal scar by clinicians. RESULTS: Agreement is very good between baseline and repeated photograph-reader assessments for the presence of a scar, with a weighted kappa of 0.77 (95% confidence interval, 0.72-0.82). The kappa statistic comparing photograph-reader scarring assessments with clinician results was 0.69 (95% confidence interval, 0.66-0.71). CONCLUSION: The data also suggest better agreement between clinicians and readers when Vogt's striae and corneal nerves were observed. The data also suggest better agreement when corneal staining was not observed by the photograph readers. The CLEK Study protocol for determining the presence of scars is highly repeatable.

Cicatrix↗

PubMed1998

The effect of continuous light on refractive error and the ocular components of the rat.

Phototoxic induced degeneration of the rat retina is a well-documented phenomenon resulting in losses of photoreceptors and their cell bodies, and an overall retinal thinning. This process may serve as a test of the hypothesis that the retinoscopic reflex originates from the inner limiting membrane of the retina. Retinal thinning should produce myopia in the absence of any other ocular component changes in a stable, mature eye if the inner limiting membrane model is correct. Phototoxic retinal degeneration was induced in 10 albino rats by exposure to 19 days of continuous light (1,800 cd m-2). Another 10 albino rats exposed to 12-hr on/12-hr off cycled light served as controls. Before and after the exposure to constant light, measures were made of refractive state by cycloplegic retinoscopy, corneal curvature and lens curvature by Purkinje image photography, and axial length of the globe by A-scan ultrasonography. Comparing pre- to post-exposure values, phototoxic degeneration resulted in a mean (+/- S.D.) myopic shift of -5.10 +/- 2.12 D (P < 0.002). The corneal curvature also steepened significantly (0.17 +/- 0.11 mm, equivalent to -6.0 D; P < 0.004), while the posterior curvature of the crystalline lens flattened by 0.21 +/- 0.22 equivalent mm (P < 0.027), and the axial length shortened by 0.11 +/- 0.11 equivalent mm (all tests Wilcoxon signed-rank; P < 0.025). Phototoxic rats underwent a mean retinal thinning of 49.6 mu compared to controls (Kruskal-Wallis test; P < 0.0008). No refractive or ocular parameters changed significantly in the controls. Phototoxic degeneration in the rat has optical consequences beyond simple retinal thinning. The size of the eye and the curvature of refractive surfaces can be altered in a mature eye well after the completion of development. The multiple changes which occur prevent phototoxic retinal thinning from serving as a test of the inner limiting membrane model for retinoscopic reflections.

Animals↗

PubMed1998

Visual acuity repeatability in keratoconus: impact on sample size. Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group.

PURPOSE: The purpose of this paper is to determine the repeatability of visual acuity measurement in keratoconus and to describe the impact of measurement repeatability on sample size. METHODS: Approximately 10% of a 1209 patient sample in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study were selected randomly for a Repeat CLEK Study Visit. Patients were tested at the 15 CLEK Participating Clinics. The test-retest sample consisted of 1 34 keratoconus patients who met the entry criteria of the CLEK Study. High and low contrast Bailey-Lovie visual acuity was measured with the patient's habitual visual correction (entrance visual acuity monocularly and binocularly), and with the best correction monocularly (either the patient's rigid contact lens and over-refraction, or with a CLEK Study trial lens and appropriate over-refraction) at two visits separated by a median of 90 days (range 22 to 268 days). RESULTS: The mean absolute differences between the number of letters correct at the two visits ranged from a low of 3.24 +/- 3.1 for entrance high contrast binocular acuity to a high of 5.48 +/- 5.1 for best corrected low contrast monocular acuity. Intraclass correlation coefficients ranged from 0.757 to 0.853. The visual acuity score was somewhat higher at the Repeat Visit than at the Baseline Visit when the examiners were different between visits. CONCLUSIONS: Given the variable vision reported by keratoconus patients, visual acuity in this sample was very repeatable. Repeatability was slightly poorer when different examiners tested visual acuity at the Baseline and Repeat Visits.

Adolescent↗

PubMed1998

Development of phoria in children.

BACKGROUND: Although the prevalence of phoria in adults is well documented, data are scarce on phoria in children. We present results using modified clinical technique vision screening and data from the Orinda Longitudinal Study of Myopia on a large, population-based sample of nonstrabismic children to document the prevalence of phoria with age. METHODS: We collected cross-sectional (N = 1495) and longitudinal (N = 469) data. Phoria data were collected by cover tests administered by one observer who subjectively classified phoria as orthophoria, esophoria, or exophoria in 2 delta steps. RESULTS: Ninety-seven percent of the children were orthophoric at distance, and there were no significant changes with age. Near phoria showed a more normal distribution, with a 10.8% decrease in the prevalence of exophoria (from 31.8 to 21.0%) and a 5.5% increase in the prevalence of esophoria (from 6.7 to 12.2%) between kindergarten and fifth grade. CONCLUSIONS: Children are typically orthophoric or exophoric at near, but convergent shifts occur with age.

Child↗

PubMed1998

Inter-clinician agreement on clinical data abstracted from patients' medical charts.

PURPOSE: The purpose of this study was to determine the inter-observer repeatability of retrospective chart reviews. METHODS: Retrospective abstraction of corneal transplant patients' medical records by two independent observers was performed at the University of California, Davis, Department of Ophthalmology, Sacramento, CA. The sample consisted of 100 consecutive patients who underwent penetrating keratoplasty, and the primary outcome measure was the degree of agreement between the 2 independent observers on clinical ocular data abstracted from patients' medical charts. RESULTS: Even when given specific criteria for abstraction of data from patients' medical charts, inexperienced but trained observers exhibited a small degree of disagreement (range 0 to 12%) on patient demographic variables (e.g., gender, age, and date of birth) to be used for data analysis. Larger amounts of disagreement (range 3 to 26%) were found on frequently occurring variables (e.g., predisposing ocular conditions, surgical complications, and classification of corneal staining). CONCLUSIONS: Based on these data, inter-observer repeatability for retrospective chart review studies is good, but investigators using this study methodology must be quite specific about the data to be collected and should be aware of standardization techniques to enhance observer repeatability.

Abstracting and Indexing↗