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Biomedical subjects

O Braddick

Publications and source records attributed to O Braddick.

At least 55 records · Page 3Linked to original sources

Vision screening and photorefraction - the relation of refractive errors to strabismus and amblyopia.

Isotropic photorefraction is a technique well suited for screening infants and young children for refractive errors. The photorefractive measurements have been empirically calibrated against retinoscopic refractions, so errors exceeding selected criteria can be identified in screening and followed up. Such a screening programme is in progress for the population of 6-9 month infants in the City of Cambridge. In 1096 infants screened 5% have been found to have large hypermetropic errors, 1.3% to show a refractive difference between the eyes (anisometropia) and less than 1% to have significant myopia or manifest strabismus. These findings were generally confirmed on retinoscopic examinations. In subsequent follow up of the large hypermetropic errors, most decline with age but a few show little or no change up to age 2 years and some show more change in one eye than the other leading to anisometropia. A trial is underway to examine whether early correction with spectacles can reduce the later incidence of strabismus and amblyopia in hypermetropic infants. Significant astigmatism is found in a large fraction of the infant population; the predominant axis of this astigmatism shows marked and unexplained variations between different locations in England.

Amblyopia↗

Assessment of visual acuity in infancy and early childhood.

The forced-choice preferential looking method (FPL) shows the development of acuity during the first year of life, and is applicable to clinical assessment. A tracking test using a narrow strip of grating yields a more sensitive measure for the later part of this age range, however. The development of acuity is dominated by neural rather than optical or accommodative factors. By age 3 years resolution acuity is very close to adult performance, but at 5 years 'crowding' effects may still impair performance on practical acuity tasks more than for the adult.

Adult↗

The development of binocular function in infancy.

Binocular function in infancy can be assessed by means of the visual evoked potential (VEP) induced by a dynamic random dot pattern which alternates between a binocularly correlated and an anticorrelated state. A VEP time-locked to the alternation can only be produced by binocular interaction in the cortex. This interaction becomes detectable at around three months of age. Optokinetic nystagmus (OKN) in monocular viewing becomes symmetrical in nasal and temporal directions around the same age. Animal analogues and clinical cases suggest that this may also be an indicator of cortical binocularity. These techniques may be applicable to clinical assessment of binocular function in young infants.

Animals↗

The use of isotropic photorefraction for vision screening in infants.

Isotropic photorefraction is a technique which makes possible the rapid, economic, large scale screening of infants and young children for refractive errors. The relative size of blur circles reflected from the fundus in 3 flash photographs with different camera settings allows the size and direction of refractive errors to be estimated. The method has been validated against retinoscopic measures on a large group of infants. Findings of a high incidence of astigmatism in the first year are confirmed. Detection of hypermetropia in early infancy by this screening procedure may allow preventive treatment for accommodative strabismus.

Astigmatism↗

Optics of photorefraction: orthogonal and isotropic methods.

Analysis of the optics of photorefractively computed ray tracing shows that, for short camera-to-subject distances, the function relating image size to defocus of the eye is not symmetrical for errors of focus in front of and behind the camera. This asymmetry is exploited in the new method of isotropic photorefraction, in which the supplementary cylinder lenses of the original orthogonal photorefractors are replaced by defocusing of the camera lens itself. By comparing photographs taken with the camera focused in front of and behind the subject, the sign of the eyes' defocus (myopic or hyperopic relative to the camera) can be determined. The axis of any astigmatism is readily apparent as the direction in which the photorefractive images are elongated. The method is well adapted for the refractive screening of infants and young children.

Astigmatism↗

The onset of binocular function in human infants.

Visual evoked potentials (VEP) elicited by a dynamic random-dot correlogram were used to assess the development of cortical binocular function in infant subjects. In a group of newborn infants who showed a VEP for a comparable non-binocular stimulus, none showed evidence of binocular function. A further group of infants were tested longitudinally, starting between 35-50 days. The median age for the first evidence of binocular function in this group was 91 days, with individual variation from 54 to at least 105 days.

Aging↗

'Preferential looking' for monocular and binocular acuity testing of infants.

A method is described for obtaining rapid and reliable estimates of acuity in infants, for both monocular and binocular viewing. The method depends on 'preferential looking', where the infant prefers to look at a striped pattern rather than a blank screen of matched mean luminance. A staircase procedure for testing is followed, with observations being recorded by a 'blind' observer (who does not know on which of the 2 screens the striped pattern is displayed). Monocular acuity estimates have been obtained for a group of infants 3 to 4 months old with normal refractions. Many of these infants show similar acuity values in the 2 eyes, with a few showing reliable differences between the eyes. To check reliability of the method a comparison of 2 independent interleaved staircase estimates of the same eye have been made. In general this check shows highly consistent estimates for a given eye of a given infant. Nearly all infants show slightly higher acuity estimates for binocular viewing than for monocular. The possible reasons for this difference are discussed. The clinical use of such a method is reported for a number of cases. The method has been found to be useful in a variety of clinical conditions where other available tests are not possible on young infants.

Child, Preschool↗

Contrast sensitivity function of preschool children.

A procedure specifically adapted for children of preschool age has been used to measure contrast sensitivity in emmetropic children aged 3 to 5 years. Mothers of the children acted as adult observers using the same procedure. The results show that the contrast sensitivity function of adults and children is very similar, sensitivity for the children being slightly lower than that for adults at all spatial frequencies. The sensory and cognitive factors involved in these differences are discussed.

Adult↗

Does the Catford drum give an accurate assessment of acuity?

Adult emmetropes and myopes were tested with the Catford drum and the results compared with subjective (Landolt C) acuity. For he emmetropes the Catford drum was found to overestimate visual acuity by a factor of approximately 4. For myopes, and emmetropes viewing through plus lenses, the discrepancies were much larger. Since the Catford drum not only overestimates acuity but will do so by a factor which varies for different visual disorders, caution is needed in clinical interpretation of results obtained with it.

Adult↗

Cortical binocularity in infants.

The primate visual cortex, including that of man, receives separate input from each eye and these interact in binocular cortical neurones. This organization is known to be vulnerable to disruption in early life. To understand the development of human visual cortex, and to detect and assess disorders of binocular function at the earliest possible age, a robust method is needed for detecting binocular interactions in the infant's visual system. We have done this by recording cortical visual evoked responses (VERs) to the onset and offset of binocular correlation in a large-screen dynamic random dot display. We report here that, in general, the human infant has a functional binocular visual cortex by 3 months of age, with some individuals showing cortical binocularity at an earlier age.

Age Factors↗