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At least 487 records · Page 27Linked to original sources
PubMed2003

Toric phakic intraocular lens: European multicenter study.

OBJECTIVE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN: Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS: Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS: Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES: The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS: Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS: Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.

Adult↗
PubMed2003

Bilateral choroidal folds and optic neuropathy: a variant of the crowded disk syndrome?

PURPOSE: To describe the clinical features of the syndrome that includes bilateral choroidal folds and optic neuropathy and to propose a novel etiology to explain this presentation. DESIGN: Observational small case series. PARTICIPANTS: Three patients. METHODS: Three patients received an extensive clinical work-up including complete ocular examination, A and B scan ultrasonography, Humphrey visual field analysis, and imaging of the brain and orbit. Neurological consultation was obtained in each patient two of whom underwent lumbar puncture. The findings of this detailed investigation are reported. RESULTS: Each patient demonstrated bilateral choroidal folds with optic disk congestion and leakage in one eye and optic atrophy in the fellow eye. Extensive ocular and extraocular investigation failed to uncover a specific etiology. Pseudotumor cerebri, a well-documented cause of papilledema and choroidal folds, was ruled out in each case. Each patient did demonstrate variable degrees of hyperopia and shortened axial lengths. CONCLUSIONS: The syndrome of bilateral choroidal folds and optic neuropathy may have various etiologies. Pseudotumor cerebri needs to be definitively ruled out. Normal neuro-ophthalmological investigation including lumbar puncture may indicate an alternative cause. Idiopathic acquired hyperopia in middle-aged patients who are hyperopic with shortened axial lengths may be associated with choroidal folds and a constricted scleral canal causing optic disk congestion and complicated by nonarteritic anterior ischemic optic neuropathy due to a crowded disk.

Aged↗
PubMed2003

Three-year follow-up of the Artisan phakic intraocular lens for hypermetropia.

PURPOSE: We report the postoperative results of the Artisan Hyperopia phakic intraocular lens (IOL; model 203W; Ophtec, Groningen, The Netherlands). DESIGN: Prospective, nonrandomized trial. PARTICIPANTS: Twenty-six eyes of 13 self-selected patients with refractive error ranging from +3.00 to +11.00 diopters (D). INTERVENTION: Patients with hypermetropia were implanted with the Artisan Hyperopia phakic IOL. Mean follow-up was 22.4 months (range, 3-36 months). MAIN OUTCOME MEASURES: Predictability, stability, efficacy, loss of best spectacle-corrected visual acuity, and complications. RESULTS: At six months, 90.9% (20 of 22 eyes) were +/-1.00 D of intended correction and 81.8% (18 eyes) were +/-1.00 D of emmetropia. The mean spherical equivalent was stable within 0.25 D during the entire 3-year follow-up period. Twenty-four eyes (92.3%) had a postoperative best spectacle-corrected visual acuity of 0.50 or better at all of their individual follow-up examinations. No patient lost 2 or more lines after the procedure. There was a significant negative correlation between anterior chamber depth and endothelial cell loss. Two patients experienced posterior synechiae with pigment deposits in both eyes. One of these patients had convex irides and underwent implant removal within 2 years with a consequent clear lens extraction and posterior chamber lens implantation. CONCLUSIONS: Implantation of the Artisan Hyperopic lens leads to accurate and stable refractive results with no significant loss of vision. More attention should be paid to convex irides and shallow anterior chambers during the preoperative screening to avoid unnecessary complications.

Adult↗
PubMed2003

Photorefractive keratectomy for the treatment of purely refractive accommodative esotropia.

PURPOSE: To evaluate the results of photorefractive keratectomy (PRK) for the treatment of young adult patients with purely refractive accommodative esotropia. SETTING: Private practice and university hospital, Milan, Italy. METHODS: The medical records of consecutive patients who had PRK for hyperopia associated with purely refractive esotropia were reviewed retrospectively. Preoperative and postoperative visual acuity, alignment, and sensory data were recorded and analyzed. Surgical methods and complications were reviewed. RESULTS: Sixteen eyes of 8 patients were treated. The mean patient age at the time of treatment was 24.6 years (range 17 to 38 years). All patients were followed for 1 year. At the 1-year follow-up evaluation, the uncorrected visual acuity was 20/40 or better in all eyes. No patient lost a line of best spectacle-corrected visual acuity. The mean spherical equivalent was -3.7 diopters (D) preoperatively and -0.7 D postoperatively. All patients were within +/-0.37 D of emmetropia at the 1-year evaluation. Preoperatively, the mean esotropic deviation was 10.75 prism diopters. Postoperatively, all patients were orthophoric without correction. Stereopsis was unaffected by PRK in all patients. There were no intraoperative or postoperative complications. CONCLUSION: Photorefractive keratectomy was an effective treatment for esotropia associated with mild to moderate hyperopia in young adults with purely refractive accommodative esotropia. These findings should not be widely applied to children with accommodative esotropia.

Accommodation, Ocular↗
PubMed1993

Management of radial keratotomy overcorrections by corneal sutures.

Refractive hyperopia is a significant complication after radial keratotomy (RK). In this study, we corrected it by suturing the radial incisions, using purse-string sutures, and using a combined technique. Thirteen patients (six original overcorrections, four overcorrections after reoperation, and three progressive hyperopes) were included, demonstrating that the techniques induced a wide range of central corneal steepness and therefore corrected variable amounts of hyperopia. However, only the combination of purse-string suture and radial incision suturing provided a stable result. One patient in the purse-string group and two in the radial group required a third combined surgery to achieve an acceptable result. In the combined group, all cases achieved an improvement in visual acuity. While all cases were within 1 diopter of emmetropia, in seven cases pre-RK visual acuity was equal to the best corrected visual acuity six months after surgery. Preoperative best corrected visual acuity was maintained in all cases. Suture removal at the sixth month postoperatively did not seem to influence the refractive result. Our results suggest that neither purse string nor radial suturing is enough to achieve the girdle effect to the cornea; they must be combined. A significant regression of the effect should be expected following the suture placement, mainly during the early postoperative period, until a stable result is achieved about six months later. A computer-assisted photokeratoscope image was taken preoperatively and postoperatively, showing that some irregular astigmatism should be expected as a result of the procedure.

Adult↗
PubMed1993

Phacoemulsification after T-hex keratotomy.

T-hex keratotomy surgically corrects manifest hyperopia. The typical patient presenting for this surgery is a presbyope who develops symptoms from latent hyperopia. These patients are older than typical radial keratotomy patients and are thus likely to develop senile cataracts sooner. The exact surgical approach to cataract surgery in such patients is unknown. We report a patient who had successful cataract extraction by phacoemulsification with implantation of a posterior chamber lens after a previous routine T-hex keratotomy. The preoperative workup and the surgical technique did not require modification.

Aged↗
PubMed1997

Excimer phototherapeutic keratectomy for corneal subepithelial cryoglobulin deposits.

A 64-year-old man with a history of cryoglobulinemia and repeated scraping of immunoglobulin deposits from both superficial corneas presented with gradual decrease in vision and progressive hyperopia caused by circumferential redeposition of the cryoglobulins in his corneas. He had debridment of the deposits combined with phototherapeutic keratectomy to smooth the corneal surface. Visual acuity and reading capacity markedly improved, and hyperopia regressed by 5.75 diopters (D) in the right eye and 5.25 D in the left. Follow-up was 3 years.

Corneal Diseases↗
PubMed1998

Evaluation of current techniques of corneal epithelial removal in hyperopic photorefractive keratectomy.

PURPOSE: To determine the efficacy of 3 current methods used to remove corneal epithelium prior to photorefractive correction of hyperopia and to compare clinical data in patients who had rotary brush or blunt scrape epithelial removal in the treatment of hyperopic photorefractive keratectomy (PRK). SETTING: University of Ottawa Eye Institute, Ottawa General Hospital, Ottawa, Ontario, Canada. METHODS: The epithelium from human eye-bank eyes was removed using a Paton spatula, 15% alcohol, and the Amoils rotating plastic brush. The effects were examined by scanning and transmission electron microscopy. Twelve month postoperative data were obtained on 25 eyes with refractions of +1.00 to +4.00 diopters (D) that had been treated for hyperopia with the VISX Star excimer laser, using blunt scrape or the rotary brush to remove the corneal epithelium. RESULTS: All 3 methods effectively removed corneal epithelium. The Paton spatula, however, left small nicks in Bowman's layer. Both the rotating brush and alcohol debridement left Bowman's layer intact. Alcohol treatment required follow-up epithelial debris removal, while brushing left minimal amounts of debris. There was a strong trend toward rapid epithelial healing in the brushed corneas compared with the scraped ones, but this was not statistically significant. Clinically, at 12 months postoperatively, brushed corneas showed a trend toward more superior outcomes than scraped corneas in actual refractive outcome, uncorrected visual acuity (UCVA), lines of UCVA gained, and predictability of the desired outcomes. However, only the outcome in UCVA of 20/40 or better and the decreased incidence of haze in the brushed corneas over scraped ones were statistically significant. CONCLUSIONS: Both alcohol and the rotating brush provide a quick, effective means of removing the corneal epithelium with minimal risk of damage to Bowman's layer. In our experience, the brush technique was as effective as and possibly superior to the blunt scrape for epithelial removal in hyperopic PRK.

Adult↗
PubMed1998

Secondary implantation of a double intraocular lens after penetrating keratoplasty.

Penetrating keratoplasty (PKP) patients often have severe, visually disabling refractive errors. Astigmatism can be addressed by refractive surgery; however, correcting hyperopia is more problematic. Although pseudophakic PKP patients can have a lens exchange, it can be traumatic in this population. In this pseudophakic PKP patient, I added a second posterior chamber intraocular lens, correcting the hyperopia and resolving visual complaints.

Astigmatism↗
PubMed2003

Distribution of refractive error in healthy infants.

PURPOSE: Few data exist regarding the upper limits of refractive error distributions in healthy infants; the data that do exist are biased because they were selected from the records of pediatric ophthalmology practices. We sought to obtain these data to validate examination failure criteria for vision screening. METHODS: We reviewed records from all children age birth to 5 years seen at the Tennessee Lions Eye Center at Vanderbilt Children's Hospital with a billing diagnosis of nasolacrimal duct obstruction and no comorbid ocular diagnoses except for refractive error. This was to avoid referral bias for any condition that could have influenced refractive error. All patients received a complete eye examination and cycloplegic refraction. Cumulative probability distribution (CPD) plots and means for spherical and cylindrical refractive error and anisometropia were prepared. RESULTS: One hundred thirty patients were studied; mean age was 15.5 +/- 9.9 months (range, 2 days to 66 months). The mean refractive error (spherical equivalent) was +1.4 D +/- 1.1 D. CPD plot analysis showed 95% of hyperopia to be < +3.25 D. Two children had myopia </=-1.00 D. The mean astigmatism was +0.2 D +/- 0.4 D, and 74% of patients had no astigmatism. Seven children had astigmatism > +1.00 D in one eye. CPD plot analysis showed 95% of astigmatism to be < +1.50 D and 95% of meridional anisometropia to be < 1.50 D. Six children had anisometropia >/=1.50 D, and 3 children had anisometropia > 3.00 D. CONCLUSIONS: At least 95% of children have hyperopia < +3.25 D, astigmatism < +1.50 D, and anisometropia < 1.50 D. This information will prove useful in identifying the natural history and prevalence of amblyogenic factors identified during preschool vision screening.

Age Distribution↗
PubMedDate not supplied

Evidence for a potential role of glucagon during eye growth regulation in chicks.

Eye growth and refraction are regulated by visual processing in the retina. Until now, the messengers released by the retina to induce these changes are largely unknown. Previously, it was found that glucagon amacrine cells respond to defocus in the retinal image and even to its sign. The expression of the immediate-early gene product ZENK increased in this cell population in eyes wearing plus lenses and decreased in minus lens-treated chicks. Moreover, it was shown that the amount of retinal glucagon mRNA increased during treatment with positive lenses. Therefore, it seems likely that these cells contribute to the visual regulation of ocular growth and that glucagon may act as a stop signal for eye growth. The purpose of the present study was to accumulate further evidence for a role of glucagon in the visual control of eye growth. Chicks were treated with plus and minus lenses after injection of different amounts of the glucagon antagonist des-His1-Glu1-glucagon-amide or the agonist Lys17,18,Glu21-glucagon, respectively. Refractive development and eye growth were recorded by automated infrared photorefraction and A-scan ultrasound, respectively. The glucagon antagonist inhibited hyperopia development, albeit only in a narrow concentration range, and at most by 50%, but not myopia development. In contrast, the agonist inhibited myopia development in a dose-dependent fashion. At high concentrations, it also prevented hyperopia development. The amount of glucagon peptide in the retinae and choroids of lens-treated chicks and its diurnal variation was measured by using a radio-immunoassay. Retinal glucagon content decreased after minus lens treatment and choroidal glucagon content increased after plus lens treatment. No diurnal variation in the retinal amount of glucagon was detected. In addition, using an optokinetic nystagmus paradigm, the effect of glucagon and the antagonist des-His1-Glu9-glucagon-amide on suprathreshold contrast sensitivity was studied. Glucagon reduced contrast sensitivity (which might be linked to a signal for growth inhibition) whereas the antagonist des-His1-Glu9-glucagon-amide increased contrast sensitivity. The results of the study are in line with the hypothesis that glucagon plays a role in the visual control of eye growth in the chick.

Analysis of Variance↗
PubMed1998

Refractive errors among young adults and university students in Norway.

PURPOSE: This study was initiated to compare the refractive state in a population sample to that among university students in Norway and to that among the general population in other Nordic countries. METHODS: A population sample of 112 individuals and 224 engineering students were randomly selected and examined using automated and clinical refraction in cycloplegia. RESULTS: Statistically significant differences were found in prevalences of myopia (population sample: 33%, students: 47%, p: 0.016) and prevalences of hyperopia (population sample: 47%, students: 30%, p: 0.001) between the two groups. The mean refractive error among the population sample was -0.1+/-2.0 D compared to -0.6+/-2.2 D among the students (p=0.0013). CONCLUSIONS: The population sample had a significantly lower prevalence of myopia and a higher prevalence of hyperopia than the student population. The state of refraction in the population sample was found to be in agreement with results reported from other Nordic countries.

Adult↗
PubMed2002

Prevalence of refractive errors in young and middle-aged adults in Norway.

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.

Adult↗
PubMed1994

[Video refraction measurement in the first year of life].

BACKGROUND: 426 children were examined, using the isotropic photorefraction method (Atkinson et al. 1981). The aim of this study was to analyze whether the frequency of convergent strabismus and/or amblyopia would increase, particularly in cases of high ametropia, and whether the early prescription of spectacles would be beneficial. The preliminary results of this study are presented here. MATERIALS AND METHODS: 426 children aged between 5 and 12 months were examined. Family history, particularly involving strabismus, ametropia and amblyopia, was ascertained and taken into consideration. RESULTS: Spherical refraction: 92% of the children were emmetropic or slightly hyperopic (< or = +2.5 D). 3.4% were hyperopic (> +2.5 D spherical equivalent) and 4.6% were myopic (0.9 > or = -2.0 D). Astigmatism: 85% had no or mild (< or = 1.5 D) astigmatism. Values greater than 3.5 D were rarely seen. Anisometropia: 67% of the children had no side-difference and only 2.4% had anisometropia with values greater than 1.5 D. Family history/orthoptic findings: 2.6% of the examined population had strabismus. In 12.2% of all the cases one or more first degree relatives had strabismus. Hyperopia and strabismus were found more frequently in this latter group, namely hyperopia (> +2.5 D spherical equivalent) in 13.6% and strabismus in 11.5%. CONCLUSIONS: Refractive errors greater than 2.5 D were seldom seen in this study, and yet were more frequently detected in families with a history of strabismus. In our opinion, isotropic photorefraction is a method most suitable to screening these especially high-risk groups.

Amblyopia↗
PubMed2002

Infant vision screening predicts failures on motor and cognitive tests up to school age.

In a population-based infant vision screening programme, 5295 infants were screened and those with significant refractive errors were followed up. To assess the relationship between the development of vision and other domains, we report a longitudinal study comparing infants with significant hyperopia, identified at age 9 months ('hyperopes') with infants with normal refractions ('controls'). Children are included who completed at each age a broad set of visual, cognitive, motor and language measures taken over a series of follow-up visits up to age 5.5 years. Hyperopes performed significantly worse than controls on the Atkinson Battery of Child Development for Examining Functional Vision at 14 months and 3.5 years and the Henderson Movement Assessment Battery for Children at 3.5 and 5.5 years. The Griffiths Child Development Scales, MacArthur Communicative Development Inventory and British Picture Vocabulary Scales showed no significant differences. Exclusion of those infants who became amblyopic and strabismic did not substantially alter these results, suggesting that the differences between groups were not a consequence of these disorders. These results indicate that early hyperopia is associated with a range of developmental deficits that persist at least to age 5.5 years. These effects are concentrated in visuocognitive and visuomotor domains rather than the linguistic domain.

Cognition Disorders↗
PubMed2004

Non-cycloplegic refractive screening can identify infants whose visual outcome at 4 years is improved by spectacle correction.

The Second Cambridge Population Infant Vision Screening Programme using the VPR-1 videorefractor without cycloplegia was undertaken in order to identify those infants with refractive errors who were potentially amblyogenic or strabismogenic. Infants identified at eight months were entered into a control trial of treatment with partial spectacle correction and underwent a long-term follow-up that monitored a wide range of visual, visuoperceptual, visuocognitive, visuomotor, linguistic and social development. In the present paper, the authors report on the outcome measures of visual acuity and strabismus. Poor acuity was defined as a best-corrected acuity of 6/12 or worse on crowded letters or 6/9 or worse on single letters, at age 4 years. Acuity was measured in 79 infants who were significantly hyperopic and/or anisometropic at 11-12 months of age, 23 who showed hyperopia of +3D but less than +3.5D, 196 control subjects, 14 controls with refractive errors, and 126 others who showed an accommodative lag on screening but were not significantly hyperopic on first retinoscopy. There was a poorer acuity outcome in the untreated group of hyperopes compared to controls (p < 0.0001) and to the children who were compliant in spectacle wear (p < 0.001) or who were prescribed spectacles (p < 0.05). Children who were significantly hyperopic at eight months were also more likely to be strabismic by 5.5 years compared to the emmetropic control group (p < 0.001). However, the present study did not find a significant difference in the incidence of strabismus between corrected and uncorrected hyperopic infants. Children who were not refractively corrected for significant hyperopia were four times more likely to have poor acuity at 5.5 years than infants who wore their hyperopic correction, supporting the findings of the First Cambridge Population Infant Vision Screening Programme.

Accommodation, Ocular↗
PubMed2003

Localized midperipheral corneal steepening after hyperopic LASIK following radial keratotomy.

PURPOSE: To describe a case of localized midperipheral corneal steepening after laser in situ keratomileusis (LASIK) to correct hyperopia induced by radial keratotomy (RK) overcorrection. METHODS: A retrospective case observation of an unusual case. RESULTS: Five years after bilateral RK (with eight incisions) performed out of the country, a 43-year-old woman underwent LASIK in her right eye. Preoperatively, manifest refraction was + 7.75 - 1.00 x 104. Four months after LASIK, the patient's UCVA was 20/70, manifest refraction was + 2.25 - 1.25 x 103, and LASIK enhancement with flap recutting was performed. One month later, the patient complained of a 1-day history of pain and photophobia. UCVA was 20/40, and a RK incision had opened. The eye was covered with a bandage contact lens (BCL) and TobraDex drops prescribed. The following day, the BCL was removed, and UCVA was 20/200. Four days later, the patient's UCVA was 20/25. Five and a half months after LASIK enhancement, the dehisced RK incision was closed, UCVA was 20/30, and manifest refraction was + 1.25 - 1.25 x 85. One year after enhancement, UCVA deteriorated to 20/70 with manifest refraction of - 1.00 - 1.25 x 40. Localized midperipheral corneal steepening on topography also seemed to be developing. CONCLUSION: In LASIK surgery after RK, there is an inherent weakness of the cornea. Although visual acuity after RK-induced hyperopia may be improved by LASIK, the long-term refractive stability of the procedure is uncertain. Patients who undergo such a procedure should be monitored for developing localized midperipheral corneal steepening and be informed that such a complication can occur.

Adult↗
PubMed1997

Branch retinal vein occlusion. Axial length and other risk factors.

OBJECTIVE: To determine the association between axial length, as a measurement of hyperopia, and branch retinal vein occlusion and to determine the clinical characteristics and other risk factors of patients with branch retinal vein occlusion. METHODS: A case-control study was performed using 36 patients with branch retinal vein occlusion and 36 age- and sex-matched control patients selected from a list of subjects who had undergone cataract extraction. RESULTS: There was essentially no difference in axial length between patients the disorder and control patients (23.55 mm versus 23.62 mm; P = 0.79). Although the intraocular pressure (IOP) among control eyes was somewhat higher than that in branch retinal vein occlusion eyes, the difference was not statistically significant (P = 0.32). Systemic hypertension was more common in patients with branch retinal vein occlusion (53%) than in control patients (42%) but the difference was not statistically significant (P = 0.35). Chronic open-angle glaucoma was present in 14% of patients with branch retinal vein occlusion and 22% of control patients (P = 0.37), but this difference was not statistically significant. Diabetes mellitus was two times more common in controls (28%) than in patients with branch retinal vein occlusion (14%). This difference, however, also did not reach statistical significance (P = 0.13). CONCLUSIONS: Hyperopia as measured by axial length is not a risk factor for branch retinal vein occlusion. This study provides evidence that hypertension is a risk factor for branch retinal vein occlusion and that chronic open-angle glaucoma and diabetes mellitus are not risk factors for branch retinal vein occlusion.

Adult↗