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A study of 25 long-term contact lens wearers, fitted so as to minimize changes in their refractive error, showed an inverse relationship between corneal curvature change and change in refractive components other than the cornea. When the cornea flattens, the other components change inversely so that the refractive error usually remains unchanged.
Optimal visual acuity is a requirement for piloting aircraft in military and civilian settings. While acuity can be corrected with glasses, spectacle wear can limit or even prohibit use of certain devices such as night vision goggles, helmet mounted displays, and/or chemical protective masks. Although current Army policy is directed toward selection of pilots who do not require spectacle correction for acceptable vision, refractive error can become manifest over time, making optical correction necessary. In such cases, contact lenses have been used quite successfully. Another approach is to neglect small amounts of refractive error, provided that vision is at least 20/20 without correction. This report describes visual findings in an aviator who was fitted with a contact lens to correct moderate astigmatism in one eye, while the other eye, with lesser refractive error, was left uncorrected. Advanced methods of testing visual resolution, including high and low contrast visual acuity and small letter contrast sensitivity, were used to compare vision achieved with full spectacle correction to that attained with the habitual, contact lens correction. Although the patient was pleased with his habitual correction, vision was significantly better with full spectacle correction, particularly on the small letter contrast test. Implications of these findings are considered.
PURPOSE: To appreciate the indications, complications and visual outcomes in the correction of refractive errors with contact lenses at children. MATERIAL AND METHOD: We studied 15 eyes from nine kids. The times prescription included: history (motivation of wearing contact lenses), ocular refraction (with cycloplegia), best corrected visual acuity, keratometry, the corneal diameter, slit lamp examination, the selection of contact lens and follow up. RESULTS: The age of patients varied between several months to twelve years. The refractive errors in which we used contact lenses were: aphakia--6 eyes, myopia--6 eyes, hyperopia--3 eyes. The types of contact lenses were for permanent use--8 eyes and discontinuity use--7 eyes. We didn't have any major complication. The best corrected visual acuity with contact lenses was: 0.1-0.3 at 4 eyes, 0.4-0.6 at 2 eyes and one at 7 eyes. CONCLUSIONS: (1) Contact lenses represent the optimal correction of anisometropia after congenital or traumatic cataract operation in children. (2) The quality of vision obtained with contact lenses represents an important factor in the prevention and treatment of amblyopia.
BACKGROUND: Traditional approaches to Javal's rule do not use data from subjects with oblique astigmatism and have not been used to make predictions about subjects with oblique astigmatism. Vector approaches to analyzing refractive error can circumvent these problems. METHODS: Subjects were 993 Singaporean schoolchildren. We performed linear regression of refractive error astigmatism on corneal astigmatism, using J0 vectors to describe with-the-rule and against-the-rule astigmatism and J45 vectors to describe oblique astigmatism. RESULTS: We obtained the following statistically significant regression relationships: RJ0 = 0.931 x CJ0 - 0.276 and RJ45 = 0.638 x CJ45 + 0.010, where R and C denote refractive error astigmatism and corneal astigmatism, respectively. CONCLUSION: Our vector-based Javal's rule gives closer predictions of refractive astigmatism than the original Javal's rule and the simplified Javal's rule and can be applied in cases of corneal oblique astigmatism.
PURPOSE: The PR2000 (Topcon, Tokyo, Japan) is a photorefractor that has been used in a population study comparing different methods of screening preschool children. The present study was conducted to determine the accuracy of the device in a largely clinical population. METHODS: Two hundred twenty-two children less than 8 years of age were included. All children were examined by an orthoptist using the PR2000 without inducing cycloplegia. All children then underwent retinoscopy with cycloplegia by an examiner who was unaware of the results from the PR2000 examination. RESULTS: The PR2000 gave a numerical reading for 90% of the children's right eyes and the message "Out of range" for a further 5%. The readings underestimated the amount of hypermetropic or astigmatic refractive error found on retinoscopy by an amount proportional to the magnitude of the refractive error. Agreement with retinoscopy for the axis of astigmatism more than 0.75 D was moderately good (intraclass correlation coefficient [ICC] = 0.63). The PR2000 was more useful as a screener, especially for anisometropia for which it was 91% sensitive and 92% specific. The repeatability was good for sphere (ICC = 0.74), less so for astigmatism (ICC = 0.59), and better than the optometrist for anisometropia (ICC = 0.38). The presence of nonrefractive diagnoses and the age of the children examined made little difference in the screening results. CONCLUSIONS: The PR2000 underestimated hypermetropic refractive errors when used without cycloplegia. However, it was at least as good a screening device as other similar instruments, especially when judged by its ability to detect anisometropia and the repeatability of the results.
Eccentric photorefraction (EPR) is a simple photographic technique for detecting amblyopiogenic conditions. Previous EPR studies to detect refractive errors (RE) have demonstrated high sensitivity but poor predictive value. We have established new criteria for detecting RE involving quantifying retinoscopic reflex crescent widths, thereby achieving 67% predictive value with 100% sensitivity for detecting RE greater than or equal to +3.5 D in a clinical study of 69 children. Optical analysis of EPR shows that anticrescent width (light crescent-free portion of the pupil) is independent of pupil diameter. Quantifying anticrescent widths in the above clinical trial increased the predictive value to 85%. Schematic eye and human eye EPR studies verify the theoretical prediction that similar ability to detect refractive errors is maintained when the working distance and eccentricity (distance of light source from lens edge) are reduced. These improvements in EPR reduce its cost and improve its yield; both are essential for its introduction as an acceptable community screening tool.
OBJECTIVE: To assess efficacy, safety, predictability, stability, and changes in higher-order aberrations (HOAs) and contrast sensitivity (CS) after wavefront-guided and standard LASIK enhancement for the correction of residual refractive errors. DESIGN: Prospective, randomized, comparative clinical study. PARTICIPANTS: Twenty eyes of 20 consecutive patients (spherical equivalent [SE], -2.01+/-1.36 diopters [D]) treated with wavefront-guided Zyoptix Ablation Refinement software (ZAR) LASIK and 20 eyes of 20 consecutive patients (SE, -1.81+/-1.21 D) treated with standard Planoscan LASIK, both for residual refractive error enhancement. MAIN OUTCOME MEASURES: Efficacy, safety, predictability, stability, HOAs, and CS were evaluated before and after enhancement at 6 months' follow-up. METHODS: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, CS by means of the Functional Acuity Contrast Test, and HOAs by means of Zywave aberrometry were evaluated preoperatively and 6 months after retreatment. RESULTS: At 6 months postoperatively, UCVA was 20/25 or better in 100% of the eyes. Efficacy indexes were 1.09 for ZAR patients and 0.95 for Planoscan patients. No eyes lost > or =1 line of BCVA; in the ZAR group, 2 eyes gained 1 line and 6 eyes gained > or =2 lines; in the Planoscan group, 3 eyes gained 1 line. The ZAR group showed a percentage of eyes (94.4%) within the 0.5-D range in SE higher than that shown by the Planoscan group (88.8%). After 6 months, the HOA root mean square (RMS) increased on average by a factor of 1.44 for the Planoscan group (P = 0.003). No change or reduction in HOA RMS was found in the ZAR group (factor of 0.96; P>0.01). Contrast sensitivity was reduced in the Planoscan group only at the highest spatial frequency (18 cycles per degree; P<0.01). There was a significant reduction of CS as a function of HOA increase for the Planoscan group (P<0.0001). No changes were observed for the ZAR group at any spatial frequency (1.5-18 cycles per degree; P>0.01). CONCLUSIONS: Wavefront-guided LASIK using the ZAR algorithm is an effective and safe procedure for treatment of residual refractive errors. Wavefront-guided LASIK does not increase HOAs and does not modify CS compared with preoperative values. Wavefront-guided LASIK seems to be better than standard LASIK for retreatments.
PURPOSE: To evaluate the results of combining phakic posterior chamber intraocular lens (IOL) implantation and excimer corneal surgery to treat high myopia or myopia with astigmatism. SETTING: Service d'Ophtalmologie, Hôpital Purpan, University of Toulouse, Toulouse, France. METHODS: Thirty-two eyes of 28 patients with extreme myopia or myopia combined with astigmatism were treated by implantation of a phakic posterior chamber IOL. Residual refractive errors were treated no earlier than 6 weeks after IOL implantation by photorefractive keratectomy (PRK) in eyes with low refractive errors or by laser in situ keratomileusis (LASIK) in eyes with higher residual refractive errors. RESULTS: The mean preoperative spherical equivalent (SE) refraction was -18.7 diopters (D). The refractive astigmatism ranged from 0 to 3.5 D. After excimer laser treatment, the SE refraction ranged from -0.5 to -2.5 D and the refractive astigmatism, from 0 to 1.5 D in the PRK group. In the LASIK group, spherical ametropia ranged from -1.5 to +1.5 D and astigmatism, from 0 to 1.0 D. After excimer laser treatment, the uncorrected visual acuity improved in all eyes but a loss of 1 line of the corrected vision after IOL implantation occurred in 22.2% of PRK-treated eyes and in 13.6% of LASIK-treated eyes. CONCLUSIONS: Bioptic treatment of extreme myopia and myopia associated with astigmatism appears to be safer and more predictable than other methods of treatment.
A retinitis pigmentosa (RP) population (268 eyes) had predominantly myopic refractive errors. Whereas 12% of a normal population have myopic refractions, myopia was found in 75% of 268 eyes of RP patients and in 95% of 41 eyes of X-linked RP patients. The spherical errors describe a single-peaked, skewed distribution, with a mean of -1.86 dioptres that is significantly (P less than 0.001) more myopic, by -2.93 D, than that of a normal population. The X-linked genetic group has a spherical mean of -5.51 D that is significantly (P less than 0.01) more myopic than the non-X-linked RP population. This X-linked spherical error distribution may be composed of two separate subdistributions. Astigmatic refractive errors greater than 0.5 D are found in 47% of this RP population, considerably in excess of the 19% of a normal population with such astigmatic errors.
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The accommodation response is sensitive to the chromatic properties of the stimulus, a sensitivity presumed to be related to making use of the longitudinal chromatic aberration of the eye to decode the sign of the defocus. Thus, the relative sensitivity to the long- (L) and middle-wavelength (M) cones may influence accommodation and may also be related to an individual's refractive error. Accommodation was measured continuously while subjects viewed a sine wave grating (2.2c/d) that had different cone contrast ratios. Seven conditions tested loci that form a circle with equal vector length (0.27) at 0, 22.5, 45, 67.5, 90, 120, 145 deg. An eighth condition produced an empty field stimulus (CIE (x,y) co-ordinates (0.4554, 0.3835)). Each of the gratings moved at 0.2 Hz sinusoidally between 1.00 D and 3.00 D for 40s, while the effects of longitudinal chromatic aberration were neutralized with an achromatizing lens. Both the mean level of accommodation and the gain of the accommodative response, to sinusoidal movements of the stimulus, depended on the relative L and M cone sensitivity: Individuals more sensitive to L-cone stimulation showed a higher level of accommodation (p=0.01; F=12.05; ANOVA) and dynamic gain was higher for gratings with relatively more L-cone contrast. Refractive error showed a similar correlation: More myopic individuals showed a higher mean level of accommodation (p<0.01; F=11.42; ANOVA) and showed higher gain for gratings with relatively more L-cone than M-cone contrast (p=0.01; F=10.83 ANOVA). If luminance contrast is maximized by accommodation, long wavelengths will be imaged behind the photoreceptors. Individuals in whom luminance is dominated by L-cones may maximize luminance contrast both by accommodating more, as shown here, and by increased ocular elongation, resulting in myopia, possibly explaining the correlations reported here among relative L/M-cone sensitivity, refractive error and accommodation.
PURPOSE: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city. DESIGN: Population-based, cross-sectional survey. PARTICIPANTS: Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households. METHODS: Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus. MAIN OUTCOME MEASURES: Distance visual acuity and cycloplegic refraction. RESULTS: The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction. CONCLUSIONS: Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.
The visual evoked cortical potential (VECP) is widely used to verify complaints of reduced visual performance and to identify the site of the disorder. In this study, we investigated the correlation between reduced visual acuity and VECP in volunteers with normal corrected visual acuity and in patients suffering from inherited macular degeneration or from age related macular degeneration (ARMD). Flash evoked VECP was not affected by the visual acuity in the cases of refractive error and in ARMD patients but was reduced in amplitude and delayed in implicit time in the patients suffering from inherited macular degeneration. The VECP elicited by pattern reversal checkerboard (PVECP) was not affected by the quality of the visual image in volunteers with uncorrected refractive error when checks of 60' or larger were used but were considerably reduced in size and prolonged in implicit time for checks smaller than 15'. In both groups of patients suffering from macular dysfunction, pattern reversal VECP was very subnormal and was characterized by prolonged implicit time compared to values expected from their visual acuity. These findings indicate that the PVECP does not directly correlate with visual acuity but rather with foveal function. Therefore, we suggest that recordings of PVECP can be used to differentiate between refractive error and macular disorders as causing reduction in visual acuity when other clinical signs are missing or not available.
When using a videorefractor (VPR-1) the margins of the defocused blur circles are sometimes poorly defined and difficult to locate. To investigate the effect this may have on the apparent refractive error, the relationship between blur circle diameter and refractive error was found by videoing circles of known size and inputting these data as pupil and blur circle diameters. The results indicate that for accuracy of 0.50 D blur circles need to be defined to approximately equal to 1 mm.
PURPOSE: To determine the prevalence of refractive errors in the young and middle-aged adult population in Norway. METHODS: Refractive errors were measured in a population-based sample of young (20-25 years) and middle-aged (40-45 years) adults participating in the Helseundersøkelse i Nord Trøndelag (HUNT) Health Study, conducted in the County of Nord-Trøndelag in Norway. RESULTS: A total of 3137 persons (1248 young and 1889 middle-aged adults) with corrected visual acuity > or = 0.5 (in either eye) were included in the study. The prevalence of myopia was 35.0% in the young adult group and 30.3% in the middle-aged group. Myopia was significantly higher in women aged 20-25 years (36.4%) than in men aged 40-45 years (28.1%). Prevalence of hyperopia increased with age from 13.2% (20-25 years) to 17.4% (40-45 years). The highest rate of hyperopia (20.1%) was encountered in middle-aged women. CONCLUSION: The results show a slightly higher prevalence of myopia in the general population of Norway than previously estimated.
Values of refractive error (RE) observed for subjects and groups depend on the degree to which the measurement method used relaxes accommodation. This affects statistics calculated on RE measurements in predictable ways. Comparing noncycloplegic (NC) with cycloplegic (C) methods, myopia is expected to be more frequent, differences between group means should be less, and correlations and regressions relating RE to other variables may be reduced slightly. Tests based on the categorization of RE will show weaker associations with putative influencing variables. The implications of this are discussed for comparing published studies and choosing measurement methods in epidemiological and genetic studies.
This study investigated the relationship between retinal dopamine and lens induced refractive errors in chicks by high performance liquid chromatography with ultraviolet detection (HPLC-UV). After two weeks of lens wear, the chick eyes treated with +10D lenses were hyperopic (+8.29 +/- 0.43D), while the eyes treated with -10D lenses were myopic (-11.69 +/- 0.74D). At the same time, in myopic eyes the level of retinal dopamine and its metabolite 3,4-dihydroxy-phenylacetic acid (DOPAC) were reduced compared to control eyes, while in hyperopic eyes the level of retinal dopamine and DOPAC were increased as compared with control eyes. Therefore, retinal dopamine may participate in the development of lens induced refractive errors in chicks.
Postoperative refractive errors after intraocular lens (IOL) implantation can be caused by different reasons. The most likely is incorrect IOL calculation resulting from incorrect measurements of the eye. However, other explanations must also be taken into account. The surgeon in the operating theater should make sure that the correct IOL was chosen. The IOL package should also contain the correct IOL cartridge. When unsealed IOL packages are used, an IOL cartridge from 1 package can be mistakenly placed in another package. Finally, incorrect IOL labeling by the manufacturer can occur. In this case, the optical power of an explanted IOL was not identical to the IOL power printed on the company's label. Even with the highest quality control throughout the IOL manufacturing process, the surgeon should keep in mind the possibility of a mislabeled IOL.