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PubMed2006

The accommodative element in accommodative esotropia.

PURPOSE: To evaluate the effect of reducing the hyperopic correction on the state of binocular accommodative response in fully accommodative esotropia and to determine the "comfortable" amount of reduction in hyperopic correction. DESIGN: A cohort study. METHODS: Hyperopic corrections of children with a baseline refractive error of +1.50 to +5.0 diopters were gradually reduced in 0.50-diopter increments. Binocular accommodative ability was assessed by dynamic retinoscopy (monocular estimate method). Similar binocular accommodative responses were ascertained among patients with a baseline hyperopic correction of < or =3.0 of hyperopia and >3.0 of hyperopia, and patients were divided into two groups, group 1 (13 patients) and group 2 (18 patients), accordingly. RESULTS: After a reduction of 2.0 diopters in group 1 and 1.0 diopter in group 2, there was a decrease in accommodative response initially in the nondominant eye, accompanied by the dominant eye with a further reduction of 0.50 diopter. To overcome the bilateral accommodative lag, a reinstatement of a 0.50-diopter stronger hyperopic correction was required. Patients in group 1 tolerated a mean undercorrection of 2.37 diopters, and 77% were weaned from their spectacles. All of the children in group 2 were dependent upon spectacles at the completion of the study period. The final spectacle worn was a median of -1.67 diopters less than their full cycloplegic refraction. CONCLUSIONS: A complete binocular accommodative ability seems to be a prerequisite for the establishment of "comfortable" hyperopic undercorrections. It does not seem to be a reasonable approach to consider further reductions in hyperopic correction in the presence of a bilateral decreased accommodative performance.

Accommodation, Ocular↗
PubMed2006

Escitalopram-induced uveal effusions and bilateral angle closure glaucoma.

PURPOSE: To report the onset of bilateral angle closure glaucoma resulting from ciliochoroidal effusions noted after taking escitalopram. DESIGN: Case report. METHODS: A 41-year-old woman with a medical history of depression was placed on escitalopram and presented with acute bilateral angle closure glaucoma. A medical history and ophthalmic examination (including slit-lamp photography and high-frequency ultrasonography) were performed at the time of diagnosis and at resolution of her symptoms. RESULTS: High-frequency ultrasonography revealed bilateral choroidal effusions with ciliary body detachments and angle closure. Attempts to reduce intraocular pressure with topical ocular antihypertensive drugs and subsequent laser peripheral iridotomy were unsuccessful. Over the course of four days, the use of topical cycloplegics, corticosteroids, and discontinuation of escitalopram resulted in normalization of intraocular pressures, deepening of anterior chamber depths, and resolution of her uveal effusions. CONCLUSIONS: The use of escitalopram resulted in uveal effusions, angle rotation, and acute bilateral angle closure glaucoma. Discontinuation of escitalopram and corticosteroid therapy resulted in normalization of the patient's eyes.

Acute Disease↗
PubMed2006

A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children.

PURPOSE: To evaluate the accuracy of autorefraction using three autorefractors comparing to subjective refraction in diagnosing refractive error in children. DESIGN: A cross-sectional study. METHODS: setting: Community based study. study population: 117 children sampled from primary schools. procedures: All subjects underwent autorefraction using three auto refractors and subjective refraction with and without cycloplegia. main outcome measures: Spherical power, cylindrical power, and spherical equivalence (SE). RESULTS: Without cycloplegia, the mean SE were significantly different for Retinomax K plus 2 (-1.55 diopters, SD 2.37 diopters; 95% CI -1.98 to -1.12; P < .0001) and Canon RF10 (-1.11 diopters; SD 2.61 diopters; 95% CI -1.59 to -0.64; P = .0023) compared with monocular subjective refraction (-0.80 diopters; SD 2.25 diopters; 95% CI -1.21 to -0.35). Mean SE was significantly different for Grand Seiko WR5100K (-0.79 diopters; SD 2.40 diopters; 95% CI -1.23 to -0.35; P = .0002) compared with binocular subjective refraction (-0.62 diopters; SD 2.51 diopters; 95% CI -1.07 to -0.16). With cycloplegia, there was no significant difference in mean SE between refraction methods. Sensitivity and specificity results for the diagnosis of myopia: Without cycloplegia: Retinomax K plus 2 (sensitivity 1.0, specificity 0.51); Canon RF10 (sensitivity 0.92, specificity 0.81); and Grand Seiko WR5100K (sensitivity 0.91, specificity 0.98). With cycloplegia: Retinomax K plus 2 (sensitivity 0.97, specificity 0.99); Canon RF10 (sensitivity 0.97, specificity 0.96); and Grand Seiko WR5100K (sensitivity 1.0, specificity 0.97). CONCLUSIONS: Under noncycloplegic conditions, all three autorefractors have a tendency towards minus over correction in children resulting in over diagnosis of myopia. However autorefractors were accurate under cycloplegic conditions.

Child↗
PubMed2006

Correctable and non-correctable visual impairment in a population-based sample of 12-year-old Australian children.

PURPOSE: To document the prevalence of correctable and non-correctable visual impairment in a representative sample of Australian children, predominantly age 12 years. DESIGN: Population-based cross-sectional study. METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes unaided, with spectacles if worn, and after subjective refraction if required, in 2353 children, examined during 2004 to 2005. Cycloplegic autorefraction (using cyclopentolate) and dilated fundus examination were performed. Using a cut-off of 0.3 logMAR units (<20/40), presenting visual impairment was defined using unaided visual acuity if spectacles were not worn or with usual correction if spectacles were worn. Impairment not eliminated by refraction was considered non-correctable; any difference between this and presenting impairment was defined as correctable impairment. Myopia was defined as spherical equivalent refraction (SER) < or =-0.50 diopters (D), hyperopia as SER > or =+2.0 diopters, anisometropia as SER difference > or =1.00 diopters, and astigmatism as cylinder > or =1.0 diopters. Amblyopia was defined as corrected visual acuity <0.3 logMAR not attributable to an underlying structural eye or visual pathway abnormality. RESULTS: Visual impairment was found in the worse eye of 117 children (5.0%) and comprised correctable (82%) and non-correctable impairment (18%). Correctable impairment was due to myopia in 67 (69.8%), hyperopia in 11 (11.5%) and astigmatism in 32 subjects (33.3%). Causes of non-correctable impairment were: amblyopia 66.7%, congenital glaucoma 9.5%, optic nerve hypoplasia 9.5%, congenital nystagmus 4.8%, and cortical blindness 4.8%. CONCLUSIONS: Visual impairment had a relatively low prevalence in this older childhood population, a large proportion of which was correctable by refraction alone.

Adolescent↗
PubMed2006

Prevalence of eye disorders in young children with eyestrain complaints.

PURPOSE: To determine whether eyestrain symptoms predict eye conditions in 6-year-old children. DESIGN: Cross-sectional population-based study. METHODS: Reports of eyestrain symptoms were sought in parental questionnaires; 1740 children (79% response) underwent eye examinations (visual acuity, cover testing, cycloplegic autorefraction, and fundus examination). RESULTS: Eyestrain information was available for 1448 children; 220 (15.2%) reported eyestrain symptoms, including 60 (3.4%) who reported near work-associated headaches. Most children (82.3%) had a normal eye examination, while refractive errors, amblyopia, and strabismus were found in 15.0%, 3.6%, and 7.3%, respectively. Corresponding rates for children without eyestrain were 9.9%, 1.4%, and 1.8%, respectively. Moreover, 78.7% of children with refractive errors, 68% with amblyopia, and 58% with strabismus reported no eyestrain. CONCLUSIONS: Most children complaining of eyestrain had a normal eye examination; whereas most children with refractive error, amblyopia, or strabismus were free of eyestrain, making this complaint a poor marker of eye conditions in young children.

Asthenopia↗
PubMed2006

Factors associated with a previous diagnosis of strabismus in a population-based sample of 12-year-old Australian children.

PURPOSE: To describe the prevalence of strabismus and factors associated with its diagnosis in a representative sample of older Australian children. DESIGN: Cross-sectional, population-based study. METHODS: A representative stratified random cluster sample of 2353 children (aged 12 years) attending 21 secondary schools in Sydney, Australia was examined in 2004 to 2005 (response 75.3%). Cover testing was performed at near (30 cm) and distance (6 m); cycloplegic autorefraction, visual acuity, and stereoacuity were assessed. Previous strabismus diagnosis was obtained from parental questionnaires. RESULTS: Strabismus was evident in 64 children (2.7%); 21 (33%) had esotropia, 27 (42%) had exotropia, and 16 (25%) had microstrabismus. There were no gender (P = .2) or ethnicity (P = .6) associations. Previous diagnosis by an eye practitioner was noted in 27 (42%). This was related to hyperopia (P = .04), esotropia (P = .001), and amblyopia (P = .001). CONCLUSIONS: Strabismus was relatively infrequent in this Australian childhood sample. Its diagnosis was strongly related to presence of esotropia, hyperopia, and amblyopia.

Child↗
PubMed2005

Predictive value of photoscreening and traditional screening of preschool children.

PURPOSE: To compare the usefulness of traditional vision screening and photoscreening of 3- and 4-year-old children in the pediatrician's office. METHODS: Following training of pediatricians and office staff, six pediatric clinics used both the MTI PhotoScreener (Medical Technology Industries, LLC, Riviera Beach, FL) and traditional acuity and stereopsis screening materials (HOTV charts/Random Dot E tests as recommended by established AAP-MCHB-PUPVS guidelines) during well-child exams. Clinics used one testing method for a 6-month period and switched to the other for the following 6 months, in a randomized manner. Referred children received a complete eye examination with cycloplegic refraction by local ophthalmologists or optometrists who forwarded the results to Vanderbilt Ophthalmology Outreach Center. Amblyogenic factors were defined using standardized published criteria. RESULTS: Six hundred five children were screened with the photoscreener and 447 were screened with traditional techniques. Mean time for screening was less with the photoscreener: 2.5 versus 5.9 minutes ( P < 0.01). Untestable rates were similar (18% vs 10%, respectively P = NS), but higher with the photoscreener due to one clinic's 70% unreadable rate. Referral rates were also similar: 3.8% versus 4.5%. The positive predictive value (PPV) rate differed greatly. With follow-up results obtained from 56% of referred children, 73% of photoscreening referred children (8/11 examined) had amblyogenic factors confirmed on formal eye exams, whereas all children referred using traditional screening methods (10/10 examined) were normal. CONCLUSION: Photoscreening is more time efficient than traditional screening and has a significantly higher PPV in 3- and 4-year-old children. This study was unable to validate traditional screening techniques in this preschool age group. If these results can be replicated, support for traditional vision screening must undergo intense scrutiny, and attention should be turned toward making photoscreening feasible for widespread implementation.

Amblyopia↗
PubMed2004

Refractive error in premature infants.

PURPOSE: To determine the incidence and the degree of refractive error between the ages of 2 weeks and 6 months in premature infants without retinopathy of prematurity and to seek a correlation between refractive error and age at examination, birth weight, or gestational age. SUBJECTS AND METHODS: In this observational cross-sectional study, eye refraction in 390 premature infants, with no ocular pathology, was measured by cycloplegic retinoscopy at the age of 2 weeks to 6 months. A correlation was sought between refractive error and perinatal variables. RESULTS: Of the 390 infants reviewed, 347 (89%) had a refractive error and 43 (11%) were emmetropic in both eyes. Most of the infants were hyperopic (76.8%). Myopia was observed in only 11.9%. Astigmatism was found in 24.4% of the infants. The mean age at examination was 2.1 +/- 1 months; the mean birth weight was 1639 +/- 444 g, and the mean gestational age at birth was 32.2 +/- 2.4 weeks. The mean spherical equivalent of refraction was +1.56 +/- 1.82 diopters (D) in the right eye and +1.55 +/- 1.78 D in the left eye. Refractive error was positively correlated with age at examination ( R = 0.16, P = 0.001). The mean refractive error was +1.24 D in infants aged 1 month or less and reached +2.50 D at the age of 4 to 6 months. Refractive error was not correlated with birth weight or gestational age. CONCLUSIONS: The incidence of refractive error in premature infants without retinopathy of prematurity in the first 6 months of life may be as high as 89%. Most of these infants are hyperopic. Eye refraction is correlated with age at examination, but not with birth weight or gestational age.

Birth Weight↗
PubMed2005

Patterns of spectacle use in young Australian school children: findings from a population-based study.

PURPOSE: To describe the patterns of spectacle use in a population-based sample of Australian Year 1 school children (mostly aged 6 years). METHODS: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes before and after pinhole correction, and using spectacles if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. Visual impairment was defined as visual acuity <40 logMAR letters (ie, <20/40 Snellen equivalent). Myopia was defined as spherical equivalent (SE) refraction < or = -0.50 diopters (D), and hyperopia as SE refraction > or = +2.0D, deemed significant when > or = +3.0D. Astigmatism was defined as cylinder > or =1.0D and anisometropia as SE refraction difference between the two eyes at least 1.0D. RESULTS: One thousand seven hundred forty predominantly 6-year-old school children were examined during 2003 to 2004. Spectacle use was documented in 77 children (4.4% of sample). Uncorrected visual impairment was found in the worse eye of 71 children (4.1%) and refractive error accounted for the majority (69.0%). Astigmatism was the most common refractive error causing visual impairment, accounting for 46.5%. Hyperopia, with or without astigmatism, was the most frequent reason for spectacle use, documented in 40.3%. Spectacle use in the absence of significant refractive error, amblyogenic risk factors, or visual impairment was noted in 26 children (33.8% of spectacle wearers). The prescription of spectacles could have benefited a further 26 children (1.5% of sample), mostly for correction of astigmatism. CONCLUSION: This study documents a significant disparity between spectacle use and need. Astigmatism was the most common cause of visual impairment due to refractive error.

Child↗
PubMed2006

Factors affecting sensory functions after successful postoperative ocular alignment of acquired esotropia.

PURPOSE: We sought to evaluate the sensory status of patients with acquired esotropia who were able to re-establish stable alignment by optical correction and surgery and to determine the possible predictors of the different sensory outcomes. METHODS: Thirty-four successfully aligned esotropic patients were included in the study. Preoperative evaluation comprised history taking, measurement of visual acuity, evaluation of the sensory status (using the Worth 4-Dot test, and the Titmus Stereo test), measurement of ocular deviation, cycloplegic refraction, and fundus examination. All patients underwent successful surgical alignment to within 10 prism diopters (Delta) of orthotropia. At each postoperative follow-up visit, the sensory functions and ocular alignment were assessed. Statistical analysis of the results was performed. RESULTS: Among the 34 patients included in the study, 62% achieved fusion, 17% had diplopia, 15% had suppression, and 6% had a variable response to the Worth 4-Dot test at 6 months after surgery. Stereopsis was achieved in 32% as determined by the Titmus Stereo test. Statistical analysis revealed a significant relationship between the sensory status and the duration of strabismus (P=.00002), the age at surgery (P=.00289), and postoperative ocular alignment (P=.02211). CONCLUSION: Early surgical and optical ocular alignment of strabismic patients is advisable to achieve fusion and stereopsis.

Accommodation, Ocular↗
PubMed2006

Ocular phenotype correlations in patients with TWIST versus FGFR3 genetic mutations.

BACKGROUND/PURPOSE: Despite the similar clinical phenotype of the Saethre-Chotzen and Muenke craniosynostoses, the 2 syndromes are now genotypically distinct. Patients with Saethre-Chotzen and Muenke syndromes carry mutations in the TWIST and fibroblast growth factor receptor (FGFR) 3 genes, respectively. We sought to assess possible ocular phenotypic differences in patients with mutations of either gene previously grouped according to phenotype only. METHODS: A retrospective chart review was performed for 21 children with known mutations of the TWIST (n=10) or the FGFR3 (n=11) genes. Data gathered included patient sex, age, family craniofacial history, craniofacial and ophthalmic surgeries, type of strabismus, ptosis, cycloplegic refraction, visual acuity, the presence of amblyopia, nasolacrimal duct obstruction (NLDO), nystagmus, hypertelorism, epicanthal fold anomalies, and any ocular structural abnormalities. RESULTS: In the TWIST group, ptosis was present in 90%, amblyopia in 70%, horizontal strabismus in 70%, vertical strabismus in 60%, NLDO in 60%, astigmatism in 50%, inferior oblique overaction (IOOA) in 40%, hyperopia in 40%, myopia in 30%, nystagmus in 30%, and optic nerve findings in 30%. In the FGFR3 group, ptosis was present in 36%, amblyopia in 18%, horizontal strabismus in 55%, vertical strabismus in 36%, NLDO in 0%, astigmatism in 9%, IOOA in 45%, hyperopia in 27%, myopia in 18%, nystagmus in 18%, and optic nerve findings in 27%. CONCLUSIONS: Patients with TWIST gene mutations may have more ophthalmic abnormalities, including more strabismus, ptosis, NLDO, astigmatism, vertical deviations, and amblyopia compared with patients with FGFR3 gene mutations.

Abnormalities, Multiple↗
PubMed2006

Field evaluation of the Welch Allyn SureSight vision screener: incorporating the vision in preschoolers study recommendations.

INTRODUCTION: The prospective Vision in Preschoolers (VIP) study evaluated 11 methods of screening and proposed referral criteria for the Welch Allyn SureSight(trade mark) Vision Screener with 90% and 94% specificity. The SureSight had a higher sensitivity than most other screening techniques when these criteria were applied. We evaluated the usefulness of these criteria in a field study of healthy preschool children. METHODS: The SureSight software was altered to recommend referral using the VIP referral criteria with 90% specificity. Lions Club volunteers screened preschool children throughout Tennessee. Referred children underwent comprehensive eye examinations with cycloplegic refraction. Examination failure criteria were based upon published standards. Reanalysis using the 94% specificity criteria was then performed. Outcomes included referral rate and positive predictive value. RESULTS: The SureSight was used to screen 4,733 children, and screening was successful in 99.7% of children. The referral rate using the 90% specificity criteria was 12.2%. Most children (73%) were referred for suspected astigmatism. The positive predictive value was 30%. Using the 94% specificity criteria from the VIP study decreased the referral rate to 7.9% and substantially decreased over referral for suspected astigmatism; however, several anisometropes went undetected. Higher specificity was achieved by raising astigmatism referral criteria to 2.2 diopters while leaving the anisometropia criteria unchanged. CONCLUSIONS: The SureSight can be used successfully for preschool screening in the field provided that criteria with high specificity are incorporated into the instrument's software program. Higher rates of positive predictive value can be achieved without jeopardizing sensitivity by raising astigmatism referral criteria to 2.2 diopters.

Amblyopia↗
PubMed2004

Clear lens extraction for the treatment of persistent accommodative spasm after head trauma.

We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.

Accidents, Traffic↗
PubMed2005

Photorefractive keratectomy and laser in situ keratomileusis in refractive accommodative esotropia.

PURPOSE: To evaluate the efficacy of excimer laser refractive surgery as an alternative for optical correction in patients affected by fully refractive accommodative strabismus. SETTING: Eye Clinic, University of L'Aquila, L'Aquila, Italy. METHODS: After a simulation of the cycloplegic correction with contact lenses over a 30-day period, 18 patients (6 men, 12 women, mean age 32.4 years +/- 9.4 [SD]) affected by fully refractive accommodative esotropia had refractive surgery using an excimer laser; 8 patients had photorefractive keratectomy (PRK), and 10 patients had laser in situ keratomileusis (LASIK). RESULTS: The correction of the refractive error with excimer laser allowed a reduction of the angle of deviation in all but 1 patient, who presented with a regression of refractive error and of the angle of deviation 2 years posttreatment. The 2-year follow-up showed that the mean angle of deviation in PRK was 2(Delta) esophoria at near and 0.4(Delta) esophoria at distance (P<.06); in LASIK, it was 1.7(Delta) esophoria at near and 0.2(Delta) esophoria at distance (P<.06). The difference between the 2 groups was not statistically significant at near (P = .56), at distance (P = .74), or for spherical equivalent (P = .16). CONCLUSION: Excimer laser refractive surgery seems to be useful in the correction of fully refractive accommodative esotropia.

Accommodation, Ocular↗
PubMed2005

Comparison of higher-order wavefront aberrations with 3 aberrometers.

PURPOSE: To evaluate the agreement of higher-order aberrations (HOAs) between aberrometers based on the Hartmann-Shack wavefront technology. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan. METHODS: Three clinical aberrometers WaveScan (Visx Inc.), LADARWave (Alcon Inc.), and Zywave (Bausch & Lomb Inc.) were used to measure HOAs in 34 cycloplegic eyes in 17 subjects. All the measurements in each subject were performed in 1 visit to reduce the impact of biologic fluctuation of HOAs. Each device was operated by an independent experienced operator, and the operators were blind to the data obtained from the other aberrometers. Root mean square (RMS) of coma, spherical aberration, and total 3rd- and 4th-order HOAs were compared between any 2 devices by a paired t test. RESULTS: WaveScan had the lowest mean RMS, whereas Zywave reported the highest mean RMS for any HOAs. The coefficients of variation were similar between any 2 devices. Paired t tests of RMS yielded a P value <.01 in 9 of 12 comparisons. In general, the largest discrepancies of HOA measures were between WaveScan and Zywave, and similar data were found between LADARWave and WaveScan. More than 80% of the absolute difference of HOA RMS between LADARWave and WaveScan, 50% to 78% between LADARWave and Zywave, and 38% to 59% between WaveScan and Zywave were within +/-0.1 microm. CONCLUSIONS: Significant discrepancies in HOA measurements were found among the 3 popular aberrometers. The HOA RMS data were closer between LADARWave and WaveScan, and HOA RMS by Zywave was generally higher than the other 2 devices. The 3 devices had comparable measurement variation.

Adult↗
PubMed2005

Contact lens overrefraction variability in corneal power estimation after refractive surgery.

PURPOSE: To evaluate the accuracy and precision of the contact lens overrefraction (CLO) method in determining corneal refractive power in post-refractive-surgery eyes. SETTING: Refractive Surgery Service and Contact Lens Service, University of Illinois, Chicago, Illinois, USA. METHODS: Fourteen eyes of 7 subjects who had a single myopic laser in situ keratomileusis procedure within 12 months with refractive stability were included in this prospective case series. The CLO method was compared with the historical method of predicting the corneal power using 4 different lens fitting strategies and 3 refractive pupil scan sizes (3 mm, 5 mm, and total pupil). Rigid lenses included 3 9.0 mm overall diameter lenses fit flat, steep, and an average of the 2, and a 15.0 mm diameter lens steep fit. Cycloplegic CLO was performed using the autorefractor function of the Nidek OPD-Scan ARK-10000. Results with each strategy were compared with the corneal power estimated with the historical method. The bias (mean of the difference), 95% limits of agreement, and difference versus mean plots for each strategy are presented. RESULTS: In each subject, the CLO-estimated corneal power varied based on lens fit. On average, the bias between CLO and historical methods ranged from -0.38 to +2.42 diopters (D) and was significantly different from 0 in all but 3 strategies. Substantial variability in precision existed between fitting strategies, with the range of the 95% limits of agreement approximating 0.50 D in 2 strategies and 2.59 D in the worst-case scenario. The least precise fitting strategy was use of flat-fitting 9.0 mm diameter lenses. CONCLUSIONS: The accuracy and precision of the CLO method of estimating corneal power in post-refractive-surgery eyes was highly variable on the basis of how rigid lense were fit. One of the most commonly used fitting strategies in clinical practice--flat-fitting a 9.0 diameter lens-resulted in the poorest accuracy and precision. Results also suggest use of large-diameter lenses may improve outcomes.

Adult↗
PubMed2006

Analysis of crystalline lens position.

PURPOSE: To study normal crystalline lens position to provide a comparative baseline for future studies of crystalline lens or intraocular lens shift. SETTING: Taipei Municipal Yang-Ming Hospital, Taipei, Taiwan. METHODS: A Scheimpflug anterior segment analyzer (EAS-1000, Nidek) was prospectively applied to measure the cycloplegic crystalline lens position in subjects who had not had previous ocular surgeries or who had been diagnosed previously with major ocular diseases such as glaucoma, retinal detachment, or cataract. Measurements included anterior chamber depth (ACD), magnitudes, direction of lens decentration, and lens tilt. Refractive error was measured with an autorefractometer, and multiple linear regression was used to verify revealed relationships. The aging effect was determined with the Pearson correlation test. RESULTS: Thirty-nine eyes of 30 subjects (15 men, median age 13 years, range 4 to 53 years) were included. The center of the anterior lens surface was decentered 0.25 mm superotemporally. The lens tilted 2.85 degrees with the anterior lens surface facing the inferotemporal quadrant. The mean ACD was 3.26 mm; it tended to increase before subjects reached 20 years of age and to decrease thereafter. With age, the lens tended to exhibit less tilt. Lens position did not affect the spherical equivalent or the magnitude of astigmatism. CONCLUSION: The crystalline lens was not aligned perfectly along the visual axis, but its effect on refraction was limited.

Adolescent↗
PubMed2004

Anterior ischemia after posterior segment surgery.

Anterior segment ischemia is a rare complication of posterior segment surgery with a broad spectrum of presentations. Most frequently, it follows a mild self-limited course. Cases that are more prominent usually result from a co-incidence of precipitating factors. Recognition of precipitating factors and appropriate action can avoid anterior segment ischemia. Management includes nonspecific steps, such as topical medications (ie, corticosteroids and cycloplegics) and face-mask and eye-mask oxygen delivery, as well as specific steps related to the underlying cause (eg, removal of an encircling scleral buckle).

Anterior Eye Segment↗