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In this article, a small series of cases is presented in which large refractive errors inadvertently result from a change in the brands of trephine used for corneal transplantations. From these experiences, it is evident that the corneal surgeon should be very cautious if he chooses to interchange various brands and types of trephines.
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AIMS: To determine the effect of the three main morphological types of cataract on refractive error. METHODS: Data were prospectively collected from 77 subjects (age 67 (SD 8) years) with one morphological type of cataract. 34 had cortical, 21 had nuclear, and 21 had posterior subcapsular cataract. 22 subjects with clear lenses (60 (7) years) were recruited as controls. The spherical equivalent and astigmatic vector change between spectacle correction and optimal refraction were calculated. RESULTS: The cortical cataract group showed a significant astigmatic change of 0.71 (0.67) D (mean (1 SD)) compared to the control group (0.24 (0.20) D), with 24% outside the 95% confidence limit (0.63 D). The nuclear cataract group showed a significant myopic shift of -0.38 (0.60) D compared to the control group (+0.02 (0.21) D), with 52% beyond the minus 95% confidence limit (-0.39 D). CONCLUSION: A quarter of subjects with cortical cataract showed larger changes in astigmatism than subjects with clear lenses. This is probably because of the localised refractive index changes along cortical spoke opacities within the pupillary area. The well known myopic shift of nuclear cataract was also demonstrated.
The population-based Finnish Twin Cohort study was used to establish a heritability estimate for refractive errors especially for myopia. The twin cohort was derived from adult same-sexed twins in Finland. The total number of twins with both members alive in 1984 was 23,570. Of these, 3,676 twin pairs were monozygotic, and 8,109 pairs dizygotic. The sample for the present study was linked from the Finnish Police Force data base in 1984, where information of a person's possession of a driver's license and the obligation to wear glasses for far correction when driving a motor vehicle is recorded. Correlations in liability were estimated according to a multifactorial method of Smith. Falconer's heritability was 0.62 among males and 0.98 among females in the age group 28-29 years. When compared to previous twin studies of myopia, the proband concordance rates were higher for both MZ and DZ twin pairs.
The refractive state and Snellen acuity of 532 and 640 eyes respectively were determined and correlated with the visibility of the flying corpuscle phenomenon of Scheerer used in evaluating macular integrity. A model BFE 100 Blue Field Entoptoscope (BFE) was used to elicit the Scheerer phenomenon. This study shows that Snellen visual acuity and refractive state are associated with the type of flying corpuscle movement seen (pulsatile or uniform) when using the BFE to evaluate macular integrity.
The refractive status of 3,099 children was analyzed. The result showed that the incidence and degree of hyperopia decreased gradually and those of myopia increased along with the growing up of children in ametropia. In binocular refractive amblyopia, high and medium hyperopia and myopia in severe and medium amblyopia were significantly more than those in mild amblyopia. In monocular refractive amblyopia, high and medium hyperopia and high myopia in the amblyopic eyes were more than those in the nonamblyopic eyes. The refractive status of binocular esotropic amblyopia had no significant difference in various ages and degrees of amblyopia. There was also no significant difference between the refractive status of the amblyopic and nonamblyopic eyes in monocular esotropic amblyopia. It was considered that refractive amblyopia was closely related to high ametropia and the deviation of the eye might be the main cause of strabismic amblyopia.
This report consists of a retrospective clinical study of the effect of retinal detachment repair, specifically the encircling procedure, on induced spherical refractive error. The analyze the findings we include optical and supplementary clinical and in vitro studies of corneal curvature, axial length, and anteiror chamber depth. The results of each of these help confirm and are sufficient to explain the discoveries of the original clinical study.
Eight subjects who wore hydroxy-ethylmethacrylate (HEMA) contact lenses showed a steepening in corneal curvature and an increase of minus in their post-wear refraction after three months of wear. After one year or more of wear, with the previously noted changes still present, these patients were fitted with a flatter series lenses which they wore for three months. Significant results are noted in corneal curvature and post-wear refractive error.
The objective of the practice guideline 'Refraction errors' from the Dutch College of General Practitioners is to help the general practitioner to deal with patients presenting with gradual loss of vision. The number of ophthalmologists in the Netherlands is small and general practitioners need to differentiate between acute and non-acute ocular conditions. For the first time diagnostic refraction is included as a means of differentiating between a refraction disorder and other ocular pathology. The anamnesis section in the guideline is meagre and the use of a stenopeic opening and the subject of presbyopia are insufficiently emphasised. The underlying assumption that general practitioners are insufficiently capable of carrying out an ophthalmological investigation such as ophthalmoscopy needs to be revised.
Aside from hereditary juvenile macular dystrophy (Stargardt's disease), the author observed a significant increase in the incidence of spheric and astigmatic refractive errors in a further six hereditary or congenital deformities with poor vision. A shift toward myopia was seen in cases of coloboma, both of the optic nerve head as well as of the macular region, and in cases of macular aplasia and hypoplasia. A shift toward hyperopia was found in complete and ocular albinism, in retinitis pigmentosa and congenital achromatopsia. This hyperopic shift is in contradiction to the hypothesis that myopia can be deprivation-induced. It is assumed that a disturbance of visual stimulation early in life can disrupt emmetropization and thus induce the eye to become either myopic or hyperopic, in combination with a high incidence of astigmatism. This disturbance of visual stimulation may be due to clouding of the dioptric media, though equally to congenital or hereditary defects in the retina or the visual pathways of visual cortex.
Three different components contribute to the modulation transfer function of the visual system: (1) formation of the optical image (refractive media, pupil); (2) scattering of light in the prereceptoral layers of the retina; (3) neuronal processing in the retina und superior visual centers. In the presence of media opacities or non-correctable refractive errors, the clinical question often arises as to which macular function can be expected under the assumption of normal optical image formation (e.g. prior to cataract extraction, corneal transplantation, or vitrectomy). Simple tests such as light projection, color discrimination, and two-point discrimination cannot provide adequate information about macular function. The same holds true for the global luminance ERG. The X-ray phosphene is obsolete. The Maddox rod (with limitations), transilluminated Amsler grid, and various entoptic phenomena (Purkinje vascular phenomenon, foveal chagrin, Haidinger's brushes, blue field phenomenon) are available as qualitative subjective tests. Maxwellian view systems with pinhole aperture (potential acuity meter PAM) and the interferometers (retinometer, visometer, SITE-IRAS interferometer) provide quantitative subjective methods. The flash VECP is primarily a qualitative objective test that allows semiquantitative acuity prediction under special conditions (unilateral opacities). Psychophysical criteria that are less affected by the quality of the retinal image show promising developments in future subjective tests, e.g. optotypes in positive contrast, optotypes or targets superimposed on a background of optical noise, or hyperacuity. Future objective test developments are pattern VECP or even pattern ERG elicited by interferometric stimulation, speckle VECP and focal ERG.
There were 3,375 children between the ages of 6 months and 3 years screened for refractive errors and strabismus. In 363 children (10.7%) some kind of pathology was detected. We suggest that continued efforts should be made to lower the age of detection of defects in vision.
Simple formulas based on reduced eyes have been developed to predict the variation in longitudinal chromatic aberration with variation in ametropia or accommodation. Two formulas were developed, one for axial ametropia and one for refractive ametropia. The latter also served as a model for accommodation. The results using the formulas are in close agreement with results obtained using raytracing through more sophisticated models. Combining the results of different methods gives the following predictions of change in chromatic difference of focus, between wavelengths of 400 and 700 nm, with change in each diopter of refractive error or accommodation: axial ametropia 0.012 to 0.017 D (0.6 to 0.9%), refractive ametropia 0.05 D (2.2 to 2.4%), and accommodation 0.04 to 0.05 D (2.1 to 2.6%). The chromatic aberration effects of correcting lenses with low dispersion are intermediate in effect and opposite in sign to the effects of corresponding degrees of axial ametropia and refractive ametropia.
PURPOSE: To compare and contrast the prevalence of myopia and other refractive errors in Xiamen city, Xiamen countryside (Southern China), and Singapore. METHODS: One hundred thirty-two schoolchildren aged 6 to 7 years from Xiamen city, 104 from Xiamen countryside, and 146 from Singapore city were recruited to join the study. Cycloplegic autorefraction, keratometry, and biometry measurements were performed on all children. RESULTS: The prevalence of myopia was 12.3% in Singapore city, 9.1% in Xiamen city, and 3.9% in Xiamen countryside. The prevalence of astigmatism was higher in Singapore compared with Xiamen. The rates of hyperopia and anisometropia were similar in all three locations. CONCLUSIONS: The myopia rate in Singapore city was higher than in Xiamen city; the lowest rates were found in Xiamen countryside. As the Chinese population from all three sites is of similar genetic stock (predominantly from Southern China), it is postulated that the differences in myopia rates in these three localities may be related to environmental factors.
We examined the spherical equivalent refractions of 237 subjects who had been seen four or more times in a longitudinal study of refractive development in normal children. We employed both photorefraction and autorefraction using a Canon R1 autorefractor. We performed an analysis of variance (F-test for Lack of Fit) to determine the significance of a linear regression in fitting these refractions against three different measures of familial refractive status. One measure included only the number of myopic parents, a second took into account the number of hyperopic parents, and a third included the refractive states of extended genetic relatives. We found no significant correlation between photorefractive data and familial refractions; however, we did find significant, albeit weak, correlations between all measures of familial refractive status and infrared autorefractions of their children. A linear relationship between autorefractive data and overall familial refractive state was found to be most significant. Linear regression of children's autorefractions against a measure of parental myopia and hyperopia was less significant, while a linear model fitting only a measure of parental myopia was least significant, in addition to showing other non-linear trends. We attribute the failure to find a significant correlation between parent and offspring refractions using children's photorefractive data to vignetting by the apparatus and to the short distance of the fixation target. We believe the significant correlation patterns found with the autorefractor reflect the inheritance patterns of parental and familial refractive states.
PURPOSE: The second Cambridge Infant Vision Screening Program examined whether screening for accommodative errors by using videorefraction without cycloplegia could effectively serve as a first stage of screening for refractive errors, measured by standard cycloplegic retinoscopy. The screening also included an orthoptic examination for detection of strabismus. METHODS: All infants born in the Cambridge (UK) Health District, over a 2-year period, were invited for screening. Of those 5142 (76%) with mean age 8.1 +/- 0.8 months (SD) attended and received noncycloplegic videorefraction and an orthoptic examination. All those with a focusing error or orthoptic problem, as well as a randomly selected sample of visually normal control subjects, were invited to follow-up a month later for cycloplegic retinoscopy, repeat noncycloplegic videorefraction and orthoptic examination. RESULTS: Of the 5142 screened, 514 had a focusing error or orthoptic problem (positives). Four hundred thirty-nine of these and 284 visually normal control subjects (negatives) attended follow-up. A refractive or orthoptic condition was confirmed in 59.0% of the positive cases, whereas infants in 96.8% of the negative cases were confirmed normal. Adjusting for the proportions of the population represented by those infants seen at follow-up, sensitivity for the screening procedure was calculated at 0.67 and specificity at 0.96. Detailed results are presented in terms of the different conditions detected at screening (far, near, and anisometropic focus and orthoptic error), distribution of greatest axes at screening, and a comparison of initial videorefraction with repeat videorefraction and cycloplegic retinoscopy. CONCLUSIONS: A noncycloplegic screening procedure, simpler to perform than cycloplegic screening, succeeded in detecting a large proportion of infants with significant ametropia, particularly those with significant hyperopia, which is considered to be a strabismogenic and amblyogenic risk factor.
Several uncontrolled, retrospective studies have suggested that permanent changes in refractive error can be seen following strabismus surgery. We prospectively enrolled 68 patients undergoing strabismus surgery for evaluation of pre- and postoperative cycloplegic refraction. In addition, the adult patients had computerized corneal topography recorded using the Corneal Modeling System, (Computed Anatomy, Inc, New York, NY). Pre- and postoperative refractions were compared using spherical equivalent and meridional equivalent (90- and 180-degree meridian). We found no significant change in the spherical equivalent between the pre- and postoperative measurements. However, a significant increase in the astigmatic power at 180 degrees (meridional equivalent at 180 degrees) was detected in both pediatric and adult patients. We did not observe any qualitative change in the corneal topography pre- and postoperatively. The change in astigmatic power at 180 degrees is equivalent to additional plus-cylinder correction at 90 degrees and was persistent throughout the 4-month postoperative period.
The case is made that there must be a feedback mechanism operating during the development of the human eye which means that over a population most people have relatively small refractive errors. The possible feedback mechanisms are examined and the conclusion is drawn that chromatic aberration of the human eye may produce visual cues which could be utilized in such a feedback system.