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PubMed1994

Effects of optically induced blur on the refractive status of young monkeys.

In each of eight rhesus monkeys, one eye was defocused with a -9 D contact lens beginning before 1 month of age for periods of 2-3 months. At the end of the rearing period, interocular comparisons showed that one subject had developed a relative axial myopia (3.0 D), however, five monkeys had developed a relative axial hyperopia (2.0-3.5 D). After discontinuing the contact-lens rearing procedure, the induced refractive errors diminished over time in all subjects. These results indicate that the defocus threshold for form-deprivation myopia is relatively high and that substantial levels of optical defocus which do not exceed this threshold typically produce axial hyperopia. The recovery data suggests that monkeys have an emmetropization mechanism which is sensitive to optical defocus, but the failure of this mechanism to compensate for the refractive errors simulated during the lens-rearing procedures suggests that this mechanism has a limited operating range.

Animals↗
PubMed2004

Photorefractive keratectomy for pediatric anisometropia: safety and impact on refractive error, visual acuity, and stereopsis.

PURPOSE: To establish the safety and possible efficacy of excimer laser photorefractive keratectomy (PRK) for treatment of pediatric anisometropia. DESIGN: Interventional case series METHODS: This is a prospective, noncomparative interventional case series at an individual university practice of photorefractive keratectomy in 11 children aged 2 and 11 years with anisometropic amblyopia who were unable or unwilling to use contact lens, glasses, and occlusion therapy to treat the amblyopia. The eye with the higher refractive error was treated with PRK using a standard adult nomogram. The refractive treatment goal was to decrease the anisometropia to 3 diopters or less. Main outcome measures were cycloplegic refraction, refractive correction, degree of corneal haze, uncorrected and best spectacle-corrected visual acuity, and stereopsis over 12 months. RESULTS: All patients tolerated the procedure well. The mean refractive target reduction was -10.10 +/- 1.39 diopters for myopia and +4.75 +/- 0.50 diopters for hyperopia. The mean achieved refractive error reduction at 12 months for myopia was -10.56 +/- 3.00 diopters and for hyperopia was +4.08 +/- 0.8 diopters. Corneal haze at 12 months was minimal. Uncorrected visual acuity improved by 2 or more lines in 6 (75%) of the eight children able to perform psychophysical acuity tests. Best spectacle-corrected visual acuity improved by 2 lines in 3 (38%) of patients. Stereopsis improved in 3 (33%) of nine patients. CONCLUSIONS: Pediatric PRK can be safely performed for anisometropia. The refractive error response in children appears to be similar to that of adults with comparable refractive errors. Visual acuity and stereopsis improved despite several children being outside the standard age of visual plasticity. Photorefractive keratectomy may play a role in the management of anisometropia in selected pediatric patients.

Amblyopia↗
PubMed2005

Accommodative intraocular lens tilting.

PURPOSE: To report an unusual complication of accommodative intraocular lens (IOL) implantation after clear lens extraction for hyperopia correction. DESIGN: Observational case report. METHOD: A 48-year-old woman underwent clear lens exchange for the correction of moderate hyperopia. A Crystalens Model AT-45 Accommodating Posterior Chamber IOL (AT-45 IOL) was implanted to allow optimal distance and near vision. At the 3-week follow-up appointment, she complained of monocular diplopia. Ocular examination showed an increased astigmatism, causing decreased visual acuity. Scheimpflug Pentacam Image and Wave Front Analysis supported the diagnosis of IOL tilting. RESULTS: IOL repositioning was unsuccessful because of fibrosis of the haptics. It was necessary to replace AT 45 IOL with a monofocal acrylic sulcus-fixated IOL. CONCLUSION: Control of capsular fibrosis should be a major concern, especially in this type of IOL. Accommodating IOL exchange appears to be a safe alternative to manage this complication.

Accommodation, Ocular↗
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

Central toxic keratopathy: description of a syndrome in laser refractive surgery.

PURPOSE: To describe the clinical spectrum of a syndrome in laser refractive surgery, which we call central toxic keratopathy, and to present cases that illustrate the range of this syndrome. DESIGN: Retrospective observational case series. METHODS: Eyes with noninflammatory central corneal opacification in the immediate postoperative period after photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) were identified, and the charts abstracted. RESULTS: Twenty-three eyes of 14 patients were identified who developed central corneal opacification three to nine days after laser refractive surgery. Nineteen of these eyes had LASIK and four had PRK. All eyes had central corneal opacification in the area of laser treatment that extended posteriorly from the interface into the stromal bed (in the case of LASIK eyes). The opacification persisted a minimum of two months to a maximum of 18 months before clearing. Nine eyes developed postoperative hyperopia of greater than 2 diopters. Pre- and postoperative best-spectacle corrected acuity was available on 19 eyes; one of these eyes lost two lines of corrected acuity, and two other eyes lost one line. Eighteen of 19 LASIK eyes had diffuse lamellar keratitis preceding the onset of corneal opacification. CONCLUSIONS: Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The opacification gradually clears over a period of months, leaving the eye hyperopic. Enhancement is indicated to treat residual hyperopia and remove residual striae. Topical or oral corticosteroid treatment is not indicated. The cause of central toxic keratopathy is unknown.

Adult↗
PubMed2004

Treatment outcomes in refractive accommodative esotropia.

PURPOSE: To document and compare the clinical features and functional outcomes in patients with accommodative esotropia. To assess the efficacy of conventional management of accommodative esotropia, to determine functional outcomes of amblyopia and binocular vision, and to analyze possible risk factors involving the development of amblyopia. METHODS: We retrospectively reviewed the charts of 147 patients whose esotropia was corrected to within 10 prism diopters of orthotropia at both distance and near with use of full cycloplegic hyperopic correction. Multiple parameters were reviewed, including initial and final cycloplegic refraction, distance, and near deviation with and without glasses, stereoacuity, age of onset, and initiation of treatment, presence of anisometropia, and change in hyperopia. RESULTS: At presentation, 87 (59.2%) of the 147 patients were amblyopic, and anisometropia was found to be the only statistically significant risk factor for this (P = .001). Only 24.2% of these patients have stereo acuity between 40 and 100 sec/arc, 20.96% of patients have 200 to 800 sec/arc, and 22.58% of patients have 1980 to 3000 sec/arc; the remaining 32.26% had no stereo acuity. Fusion was achieved in 73.5% of the patients and later presentation (> 24 months) of esodeviation significantly determined their fusional ability (P = .031). Consecutive exotropia developed in 5.4 % of the patients an average of 5.5 years after institution of full optical correction. For clinical and functional outcomes we did not find any statistically significant difference between early onset (before 1 year old) and typical onset (2 to 3 years) age groups. The trend towards decreasing hyperopia was apparent, averaging -0.16 +/- 0.20 diopters annually in 80.5% of the patients with at least 5 years follow-up, although 23% of patients still had 20/40 or worse visual acuity in the amblyopic eye. CONCLUSIONS: Amblyopia is a commonly associated finding at presentation for patients with accommodative esotropia. Most of the patients developed good fusion but poor stereopsis at the end of treatment.

Accommodation, Ocular↗
PubMed2004

Photorefractive keratectomy followed by strabismus surgery for the treatment of partly accommodative esotropia.

PURPOSE: To evaluate photorefractive keratectomy (PRK) followed by bilateral medial rectus muscle recessions (BMR) to treat adults with partly accommodative esotropia. METHODS: We reviewed medical records of 10 consecutive patients with partly accommodative esotropia who underwent PRK to correct hyperopia followed 6 months later by BMR to treat the accommodative and nonaccommodative components of their esotropia, respectively. Visual acuity, spherical equivalent of refractive error, alignment, and sensory data were collected and analyzed. RESULTS: Twenty eyes of 10 patients were treated and followed for 1 year. PRK was successful in treating the hyperopia (mean post-PRK spherical equivalent was 0.14 D (SD = 0.22)) and the accommodative portion of the esotropia (the mean percentage of the distance accommodative component eliminated by PRK was 101.67% and the mean percentage of the near accommodative component eliminated by PRK was 115%). However, subsequent BMR using standard surgical tables based on the distance deviation to treat the post-PRK residual (nonaccommodative) esotropia resulted in uniform undercorrection. CONCLUSION: PRK may be useful to treat the accommodative portion of partly accommodative esotropia. Bilateral medial rectus muscle recession can be used to treat the residual, nonaccommodative component; however, it may be necessary to base the surgical dosage on the near deviation.

Accommodation, Ocular↗
PubMed2004

Anterior chamber angle biometry with ultrasound biomicroscopy after diode laser thermal keratoplasty.

PURPOSE: To evaluate the effect of diode laser thermal keratoplasty (DTK) on the geometry of the anterior chamber angle with ultrasound biomicroscopy (UBM). SETTING: Department of Ophthalmology and Optometry, Paracelsus Private Medical University, Salzburg, Austria. METHODS: In 9 eyes, a Rodenstock DTK (ProLaser Medical Systems) was used to correct hyperopia (n = 6) or hyperopic astigmatism (n = 3). Hyperopia was treated with a single- or double-ring pattern and hyperopic astigmatism, with additional spots in each of the flat half meridians. Ultrasound biomicroscopy measurements of the chamber angle were obtained preoperatively and 3 months postoperatively using a Humphrey UBM 840 system with a 50 MHz transducer. Quantitative measurements were performed at 3-, 6-, 9-, and 12-o'clock positions using a standardized method. RESULTS: No statistically significant differences between the preoperative and postoperative chamber angle measurements were detected. CONCLUSIONS: The results of the UMB measurements were surprising given the flattening of the corneal periphery found by computerized topography, a finding that suggests narrowing of the chamber angle. Shortening of the corneal tissue may result in centripetal traction that affects the trabecular meshwork and results in a relative opening of the chamber angle structures.

Adult↗
PubMed2005

Traumatic cataract and other adverse events with the implantable contact lens.

PURPOSE: To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia. SETTING: Helsinki University Eye Hospital, Helsinki, Finland. METHODS: In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens. RESULTS: In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months +/- 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within +/-1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 +/- 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant. CONCLUSIONS: Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.

Adult↗
PubMed2005

Topographic and biomechanical differences between hyperopic and myopic laser in situ keratomileusis.

PURPOSE: To evaluate the size, shape, and uniformity of the videokeratographic functional optical zone (FOZ) after laser in situ keratomileusis (LASIK) in 2 cohorts of patients with equivalent amounts of preoperative myopic or hyperopic astigmatism. SETTING: Pepose Vision Institute, St. Louis, Missouri, USA. METHODS: Eyes with myopic or hyperopic astigmatism (n=27 in each group) that had LASIK with the Visx Star S3 laser were retrospectively selected to match for level of preoperative refractive error. Slit-scanning videokeratography was performed preoperatively and 6 months postoperatively and analyzed using custom software. The FOZ was calculated by analyzing refractive power maps using a region-growing algorithm. Difference maps were generated from slit images and compared for interval change in corneal elevation, tangential curvature, and refractive power. The difference maps were also averaged (mean difference maps) for each target population. A Zernike decomposition of corneal first-surface elevation was performed to compare postoperative values with baseline parameters. RESULTS: The mean postoperative refractive sphere at 6 months was -0.17 diopter (D) +/- 0.66 (SD) and +0.25 +/- 0.85 D in the myopia group and hyperopia group, respectively, and the mean postoperative astigmatism, -0.49 +/- 0.32 D and -0.65 +/- 0.52 D, respectively (P=.11). Based on the refractive power maps, the mean preoperative and postoperative myopic FOZ was 33.09 +/- 7.30 mm(2) and 30.94 +/- 5.43 mm(2), respectively, and the mean hyperopic FOZ, 33.19 +/- 7.96 mm(2) and 37.99 +/- 6.88 mm(2), respectively. After LASIK, there was an increase in magnitude of negative anterior corneal surface spherical-like Zernike values in the myopia group (P<.0001) and an increase in magnitude of positive spherical-like Zernike values in the hyperopia group. Postoperatively, significant induction of corneal surface horizontal coma was noted in hyperopic eyes (P<.0001). Hyperopic eyes, on average, had larger topographic FOZs after LASIK, but with less uniformity of curvature and power change than myopic eyes. CONCLUSIONS: Hyperopic LASIK, which involves more transition points along the ablation diameter, produced a less uniform topographic FOZ than typical myopic treatments. Less predictable biomechanical changes from the circumferential release of tension on collagen bundles after midperipheral hyperopic ablation and greater variation in beam centration and the angle of incidence may contribute to the greater variability in corneal curvature and power in hyperopic LASIK than in myopic LASIK.

Astigmatism↗
PubMed2005

Hyperopic laser in situ keratomileusis in eyes with previous radial keratotomy.

PURPOSE: To assess the safety and efficacy of hyperopic laser in situ keratomileusis (LASIK) in eyes with previous radial keratotomy (RK). SETTING: Zale Lipshy University Hospital Laser Center for Vision, University of Texas Southwestern Medical Center, Dallas, Texas, USA. METHODS: Thirty-eight eyes of 25 patients were treated with LASIK for secondary hyperopia after RK using a Visx Star S2, S3, S4, or LADARVision excimer laser. Retreatment was done in 7 eyes. The main outcome measures were manifest refraction spherical equivalent (MRSE), uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), predictability of treatment, and complications. RESULTS: Preoperative mean MRSE was +2.39 diopters (D) +/- 1.28 (SD) (range +0.87 to +6.00 D). At the last visit (25 eyes with minimum follow-up of 12 months, including retreatments), the mean follow-up was 23.3 +/- 7.3 months (range 12 to 34 months), the mean MRSE was +0.11 +/- 0.71 D, and the UCVA was 20/40 or better in 24 eyes (96%). Although no significant change in the mean MRSE was observed, the postoperative mean refractive cylinder showed a gradual increase over the follow-up period. No eye lost more than 2 lines of BSCVA. CONCLUSIONS: Laser in situ keratomileusis was a safe and effective treatment with good predictability for the correction of consecutive hyperopia after RK. Cylindrical errors were difficult to correct, and astigmatic correction tended to regress over time. Retreatments are safe when old flaps were relifted.

Adult↗
PubMed2003

Corneal perforation during laser in situ keratomileusis after hyperopic electrothermal keratoplasty.

PURPOSE: To report a corneal perforation during laser in situ keratomileusis (LASIK) after previous electrothermokeratoplasty. DESIGN: Interventional case report. METHODS: A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was +4.00 in the right eye and +7.00 -3.00 x 135 degrees in the left eye, with a central pachymetry of 535 microm and 549 microm, respectively. Phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed. RESULTS: Postoperative refraction was -0.50 -0.50 x 150 degrees 20/20 in the right eye. Postphacoemulsification refraction was -4.75 -4.25 x 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed. CONCLUSIONS: Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.

Aqueous Humor↗
PubMed1990

Pigmentary glaucoma in the black population.

The pigment dispersion syndrome is associated with a secondary open-angle glaucoma most commonly found in young, myopic, white males. We studied 20 cases (38 eyes) of pigment dispersion syndrome in black individuals as defined by heavy deposition on the corneal endothelium and trabecular meshwork with increased intraocular pressure but no other ocular abnormalities. The 20 patients were a homogeneous group that was typified by older age distribution (average, 73 years), a preponderance of hyperopia (median refraction, +2.15 diopters spherical equivalent), female gender (19 women, one man), no iris transillumination defects (zero of 38 eyes), and flatter iris insertion into the ciliary body. We believe that this homogeneous group of black individuals with pigment dispersion and atypical features represents a pigment dispersion syndrome associated with older age, hyperopia, and female sex preponderance, in the black race.

Adult↗
PubMed2000

Modulation of constant light effects on the eye by ciliary ganglionectomy and optic nerve section.

Our previous studies have shown that an environment of constant light (CL) can lead to development of high degree of hyperopia in newborn chicks by inducing severe corneal flattening, and compensatory growth of the vitreous chamber. We wish to know whether the abnormal eye growth and progressive hyperopia under CL conditions is accomplished by a mechanism that uses the visual processing pathways of the central nervous system (CNS) or by a mechanism located in the eye. Thirty white leghorn chicks (Cornell K-strain) were raised under 12 h light/12 h dark (12L/12D) for either optic nerve section (ONS) or ciliary ganglion section (CGS). Another 30 chicks were raised under CL for ONS or CGS. Refractive states and corneal curvatures were measured by infrared (IR) photoretinoscopy and IR keratometry, respectively. The axial lengths of the ocular components were measured by A-scan ultrasonography. Both ONS and CGS surgery produced dilated pupils and accommodative paralysis. Four weeks after surgery, CGS eyes exhibited a hyperopic defocus, flatter cornea, and shorter vitreous chamber depth under both CL and normal conditions, whereas ONS eyes showed a smaller radius of corneal curvature and shallow vitreous chamber only in the normal light cycle group. CGS eyes of CL chicks showed significantly deeper vitreous chambers than did fellow control eyes. Our results indicate that optic nerve section does not seem to influence CL effects. Thus, local mechanisms may play a major role in the ocular development of chicks. The ciliary nerve is necessary for the normal corneal and anterior chamber growth, and prevents CL effects. The progressively increasing vitreous chamber depth under CL may be influenced by both local and central mechanisms.

Animals↗
PubMed2001

Compensatory changes in eye growth and refraction induced by daily wear of soft contact lenses in young marmosets.

Several studies have shown that growth of the primate eye responds in a compensatory direction to both positive and negative spectacle lenses--eyes grow more slowly and become hyperopic in response to positive lenses, and eyes grow more rapidly and become myopic in response to negative lenses. On the other hand, extended wear soft contact lenses, whether positively or negatively powered, induce hyperopia (Hung & Smith, 1996. Extended-wear, soft, contact lenses produce hyperopia in young monkeys. Optometry & Vision Science 73, 579-584.). We investigated whether responses in a compensatory direction occurred to soft contact lenses worn on a daily wear basis (8 h per day on an 8:16 h light:dark cycle). Ten infant marmosets (8-13 weeks of age) wore a soft contact lens, in one eye only, for 5-9 weeks. Lens powers used were zero (n = 2), +2 D (n = 1), +2 D followed after 5 weeks of lens wear by +4 D (n = 1) for 4 weeks, +4 D (n = 2), -2 D followed after 5 weeks of lens wear by -4 D (n = 2) for 4 weeks, -4 D (n = 2). At the end of the lens-wear period the positive lens-wearing eyes were more hyperopic relative to the fellow untreated eyes [mean +2.39 +/- 0.24 D (SE)] and the negative lens-wearing eyes were more myopic than the fellow untreated eyes [mean -2.48 +/- 0.91 D (SE)]. Fellow eyes were unaffected by lens wear [mean final refraction +0.45 +/- 0.09 D (SE)]. Plano lenses did not affect eye growth in either marmoset fitted with plano contact lenses.

Analysis of Variance↗
PubMed2000

Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3.

OBJECTIVE: To investigate possible risk factors for age-related macular degeneration (AMD) in participants in the Age-Related Eye Disease Study (AREDS). DESIGN: Case-control study. PARTICIPANTS: Of the 4757 persons enrolled in AREDS, 4519 persons aged 60 to 80 years were included in this study. The lesions associated with AMD ranged from absent in both eyes to advanced in one eye. MAIN OUTCOME MEASURES: Stereoscopic color fundus photographs of the macula were used to place participants into one of five groups, based on the frequency and severity of lesions associated with AMD. Participants with fewer than 15 small drusen served as the control group. RESULTS: Staged model building techniques were used to compare each of the four case groups with the control group. Increased age was a consistent finding of all four of the case groups compared with the control group, and all the following associations were age adjusted. Persons with either intermediate drusen, extensive small drusen, or the pigment abnormalities associated with AMD (group 2) were more likely to be female, more likely to have a history of arthritis, and less likely to have a history of angina. Persons with one or more large drusen or extensive intermediate drusen (group 3) were more likely to use hydrochlorothiazide diuretics and more likely to have arthritis. Hypertension, hyperopia, presence of lens opacities, and white race were also found more frequently in this group as well as in persons with neovascular AMD (group 5). Only persons in group 5 were more likely to have an increased body mass index, whereas persons with geographic atrophy (group 4) as well as those in groups 3 and 5 were more likely to have completed fewer years in school or to be smokers. Those with geographic atrophy were also more likely to use thyroid hormones and antacids. CONCLUSIONS: Our findings for smoking and hypertension, which have been noted in previous studies, suggest that two important public health recommendations, the avoidance of smoking and the prevention of hypertension, may reduce the risk of developing AMD. Other associations, such as those for hyperopia, lens opacities, less education, female gender, increased body mass index, and white race, which have been noted in other studies, are also seen in the AREDS population. The increased use of thyroid hormones and antacids in persons with geographic atrophy and the increased likelihood of arthritis or hydrochlorothiazide use in persons with one or more large drusen or extensive intermediate drusen have not been previously reported and need additional investigation.

Aged↗
PubMed2001

Clear lens extraction with intraocular lens followed by photorefractive keratectomy or laser in situ keratomileusis.

OBJECTIVE: To study photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) after clear lens extraction (CLE) with intraocular lens (IOL) implantation for hyperopia or astigmatism. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-five eyes (55 subjects) had CLE with posterior chamber IOL implants for hyperopia up to 12.25 diopters (D); 31 eyes were retreated with PRK, and 34 eyes were retreated with LASIK for residual ametropias. INTERVENTION: For PRK and LASIK, the refractive surgery was performed with the slit-scanning excimer laser Nidek EC-5000, Nidek Co., Tokyo, Japan. MAIN OUTCOME MEASURES: Manifest refraction, best-spectacle and uncorrected Snellen visual acuity, haze, and halos were evaluated before surgery and at 1, 3, 6, and 12 months postoperative. RESULTS: Forty-seven eyes were evaluated at the 12-month postoperative examination: 96% of these eyes had spherical equivalents (SE) within +/-2 D of emmetropia, 79% of eyes had SE within +/-1 D of emmetropia and 51% of eyes had SE within +/-0.50 D of emmetropia. Eighty-five percent of the eyes at 12 months postoperative had uncorrected visual acuity of 20/40 or better, and 46% of eyes had uncorrected visual acuity of 20/20 or better. Eighty-seven percent of the eyes at 12 months postoperative had uncorrected visual acuity within 1 Snellen line of their initial best spectacle-corrected visual acuity (BSCVA) before all treatment. No eye lost 2 Snellen lines of BSCVA at 3, 6, or 12 months after PRK or after LASIK. CONCLUSIONS: IOL implantation for CLE, although an invasive technique, resulted in better refractive outcomes without laser-related clinical complications after PRK or LASIK adjustment.

Adult↗
PubMed2002

Posterior segment changes associated with posterior microphthalmos.

PURPOSE: To characterize and analyze the posterior segment ocular involvement in patients with posterior microphthalmos. DESIGN: Retrospective observational case series. PARTICIPANTS: Eighteen patients (8 sporadic cases and 10 siblings from 5 different families) between the age of 4 and 36 years with posterior microphthalmos. METHODS: Records of patients with posterior microphthalmos over a 5-year-period were reviewed, including clinical, fundus photographic, fluorescein angiographic, and ultrasonographic findings, and management. RESULTS: All patients had bilateral foreshortening of the posterior ocular segment (range, 7--11.2 mm) with associated high hyperopia (range, +12.00--+19.00 diopters) and normal or slightly smaller than normal anterior segment dimensions. Visual acuity ranged from 20/200 to 20/40. Inheritance of this syndrome was compatible with an autosomal recessive pattern. Posterior segment changes included bilateral elevated papillomacular retinal fold (13 patients, 72.2%); fine retinal folds (6 patients, 33.3%); chorioretinal folds (11 patients, 61.1%); uveal effusion syndrome (3 patients, 16.7%); pigmentary retinopathy (4 patients, 22.2%), including retinitis punctata albescens in 1 patient; absence or marked reduction of the capillary-free zone (18 patients, 100%); crowded optic discs (18 patients, 100%); and sclerochoroidal thickening on ultrasonography (18 patients, 100%). Two patients with uveal effusion were successfully treated with scleral surgery. CONCLUSION: A wide variety of congenital or acquired posterior segment changes may be encountered in patients with posterior microphthalmos. Although high hyperopia and elevated papillomacular retinal fold are the main causes of visual impairment, other chorioretinal changes, such as pigmentary retinopathy, chorioretinal folds and uveal effusion syndrome, should be considered as causes of visual disturbance in patients with posterior microphthalmos. Early ultrasonographic diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain visual function in such patients.

Adolescent↗