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PubMed1997

Efficacy of a mydriatic spray in the pediatric population.

BACKGROUND: Children often resist instillation of mydriatic drops for dilated fundus evaluation. As cycloplegic sprays have proven useful, this study's aim was to demonstrate efficacy of a mydriatic spray. METHODS: Twenty-two healthy subjects, ages 2 to 8 years, participated in the study. All but two had dark brown irides. Subjects were given either one drop each of 1% tropicamide and 2.5% phenylephrine in each eye or one application of mydriatic spray (containing concentrations of 0.5% tropicamide and 2.5% phenylephrine) to each closed eyelid. Pupils were measured with a pupil gauge before drug delivery and every 10 min thereafter, for 40 min. RESULTS: Repeated measures analysis of variance for the five time intervals demonstrated no significant difference between the two application methods nor in the method/time interaction, but a statistically significant increase in pupil size over time (p < 0.0005) for each method. A t-test revealed no statistically significant difference in pupil size (p > 0.05) between the two methods of drug administration at 40 min after application. CONCLUSIONS: This study suggests that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes for children.

Administration, Topical↗
PubMed1997

The artifact of retinoscopy revisited: comparison of refractive error measured by retinoscopy and visual evoked potential in the rat.

PURPOSE: The validity of retinoscopy in small eyes has not been clearly established due to uncertainty regarding the source of the ocular reflections assessed during this procedure. A widely cited model which proposes that their origin is the inner limiting membrane of the retina was evaluated in the rat by comparing refractive errors measured by retinoscopy to those measured by visual evoked potentials (VEPs). METHODS: Ten rats were refracted both by cycloplegic streak retinoscopy and by VEP while viewing 0.05 to 0.15 cpd square-wave gratings-reversed at 1.875 Hz. Spherical aberration of the rat eye was assessed as a potentially confounding variable in VEP refraction by sequential retinoscopic refractions across the rat's natural pupil through a 1.5-mm pinhole. RESULTS: All animals were moderately to highly hyperopic by both methods (range = +4.5 to +18.5 D). Spherical aberration was minimal (median = 3.5 D of overcorrected aberration). The median difference between retinoscopic refractions and those by VEP was not significant (+1.94 D more hyperopia by retinoscopy; p = 0.062, Wilcoxon signed rank) but was significantly less than the +9.64 D difference predicted by an inner limiting membrane model (upper 95% limit = +3.76 D). CONCLUSION: This suggests that the origin of the retinoscopic reflex is located in the outer retina rather than at the inner limiting membrane. Correction factors for retinoscopy in small eyes may be smaller than previously assumed.

Animals↗
PubMed1997

Infant emmetropization: longitudinal changes in refraction components from nine to twenty months of age.

Rapid emmetropization is described in pediatrically normal infants from 9 months of age during the following year. The infants, obtained from various categories of the Cambridge population screening program, provided a broad range of refractive errors. The large group of 254 nonanisometropic infants studied allowed the mean rate of change and dependence on the initial refraction value to be determined. Refraction was measured by cycloplegic retinoscopy. Rapid emmetropization changes occurred in the following refractive components: mean spherical equivalent (MSE), astigmatism magnitude, the horizontal astigmatism component, the infant's most positive meridian, and the infant's most negative meridian. The MSE and astigmatism rates of change (diopters/year), were highly dependent on their respective initial powers (r = -0.61 and r = -0.76). The percentage weighted mean proportional rate of change for MSE was -30% (SE 4%) and for astigmatism magnitude it was -59% (SE 14%). There was much individual variation, with some exhibiting fast emmetropization and others not. The MSE and astigmatism changes, however, were almost independent of each other. The refractive errors of the most positive and most negative meridians emmetropize because they are both derived from the MSE and half the astigmatism. With-the-rule astigmatism was more prevalent than against-the-rule astigmatism at 9 months of age, and with-the-rule astigmatism exhibited a significantly greater proportional rate of change. The relationship of emmetropization and refractive screening is considered. A new component "MOMS" is introduced, the maximum ocular meridional separation, when both eyes are considered. Thus incorporating astigmatism and anisometropia may be a good single indicator of conditions associated with later amblyopia. The almost independent emmetropization of the MSE and astigmatism components is an important result to consider in theories of emmetropization, refractive screening, clinical prescribing, and the evaluation of infants in treatment trials.

Accommodation, Ocular↗
PubMed1997

Sterility of ophthalmic drugs dispensed from spray bottles.

BACKGROUND: Spray application of cycloplegics and mydriatics is efficacious and frequently easier to use than a standard dropper bottle in the pediatric population. However, no documentation regarding the sterility of drugs dispensed from spray bottles is available. This study was conducted to determine whether contamination of ophthalmic drugs occurs with spray bottle use. METHODS: Fifteen milliliters of 1% cyclopentolate hydrochloride or 0.5% tetracaine hydrochloride were transferred to each of 15 disinfected spray bottles, stored at room temperature or refrigerated, and sprayed three times weekly for 12 weeks. Cultures were obtained from the spray bottles and drugs before transfer of the drug and from spray bottle contents at 0, 2, 4, and 6 to 12 weeks of storage. RESULTS: No cultures showed significant bacterial growth. The bactericidal action of the preservative and sterility of the drugs were maintained. CONCLUSIONS: Despite the transfer to and use of a spray bottle there appears to be minimal risk of instilling contaminated diagnostic drugs using the spray method when a single drug is stored in a spray bottle.

Anesthetics, Local↗
PubMed1998

Effects of lid suturing and trans-scleral cryotherapy on ocular growth in a piglet model.

PURPOSE: To study whether lid suturing can induce axial myopia and explore whether trans-scleral cryotherapy can affect ocular growth in piglets or not. METHODS: A total of fourteen 2- to 3-week-old piglets were studied. Three groups were included: lid suture, cryotherapy, and both lid suture/cryotherapy groups. The lid suturing group (N = 6) was given lid suturing to produce visual deprivation. The cryotherapy group (N = 4) received trans-scleral cryotherapy 360 degrees to encircle anterior to the equator. Both treatment groups (N = 4) received both cryotherapy and lid suturing. The cycloplegic refraction, corneal power, biometric axial length, and intraocular pressure (IOP) were measured before the experiments and 4 months later. RESULTS: Mild axial myopia was induced in five lid-sutured eyes of the lid suturing group. The ocular refraction and eye size of cryotherapy eyes were not different from the control eyes in the cryotherapy group. More myopia was found in all four piglets that received both cryotherapy and lid suturing. CONCLUSIONS: Lid suturing can induce axial myopia; however, cryotherapy did not affect normal eye growth and did not prevent the development of lid suturing myopia in piglets.

Animals↗
PubMed1999

Blur sensitivity in myopes.

PURPOSE: This study compared the ability of myopes and emmetropes to detect subjectively the presence of retinal defocus. METHODS: Subjects (12 myopes, 12 emmetropes) were cyclopleged and monocularly viewed a bipartite target through an appropriate near addition lens via a 2-mm artificial pupil. One-half of the target remained fixed while the other half was alternatively moved forward or backward until subjects first reported a difference in clarity between the two halves of the target. RESULTS: The mean blur threshold for the emmetropes and myopes was +/-0.11 and +/-0.19 D, respectively (p = 0.0001). CONCLUSIONS: These results demonstrate that myopes are less sensitive to the presence of blur, and may at least partially explain why previous reports have demonstrated a larger lag of accommodation in this refractive group. Additionally, the hyperopic retinal defocus resulting from the increased accommodative error may play a significant role in myopia development and progression.

Accommodation, Ocular↗
PubMed1999

Effect of interrupted lens wear on compensation for a minus lens in tree shrews.

BACKGROUND: When a young animal wears a monocular minus (concave) lens that shifts the focal plane away from the cornea, the vitreous chamber elongates over a period of days, shifting the retinal location to compensate for the altered focal plane. We examined the effect of removing the lens for a portion of each day on the amount of compensation in tree shrews. METHODS: Starting 24 days after natural eye opening, juvenile tree shrews wore a goggle frame that held a -5 D lens in front of one eye, with an open frame around the fellow control eye. The goggle was removed for 0, 0.5, 1, 2, or 7 h each day (N = 5, 5, 5, 5, and 3 animals per group, respectively), starting 0.5 h after the start of each 14 h light-on period. After 21 days of treatment, measures were made of the cycloplegic refractive state (streak retinoscopy) and the ocular component dimensions (A-scan ultrasound). Normal animals that experienced 14 h each day with no lens (N = 3) were also examined. RESULTS: The treated eyes of the 0 h group developed full refractive compensation for the lens (treated eye - control eye, mean +/- SEM = -5.8+/-1.1 D) and had increased vitreous chamber depth (0.13+/-0.02 mm) and axial length (0.12+/-0.02 mm) relative to the untreated control eye. The groups in which the lens was removed for 0.5 and 1 h each day showed partial compensation for the -5 D lens, both in refractive state (-4.2+/-0.4 D; -2.9+/-1.6 D) and in vitreous chamber depth (0.12+/-0.02 mm; 0.09+/-0.02 mm). The 2, 7, and 14 h (normal) groups showed no significant refractive or axial compensation. In the 0.5 and 1 h groups, A-scan ultrasound showed a thinning of the region between the front of the retina and back of the sclera. CONCLUSIONS: The eyes of tree shrews can tolerate altered monocular visual stimulation produced by a minus lens worn for 12 h of a 14-h light cycle without developing an induced myopia. However, when the lens is worn more than 12 of 14 h each day, compensation appears to increase linearly with decreased lens-off time. If the eyes of human children respond similarly to defocus from near work or other sources, it would seem that the defocus must be present almost all the time to induce myopia. If defocus contributes to human myopia through a compensation mechanism, then an increase in the amount of time that focused images are present should reduce myopic progression.

Adaptation, Ocular↗
PubMed1999

Form deprivation myopia in adolescent monkeys.

BACKGROUND: Early in life, at ages corresponding to the rapid infantile phase of ocular growth in humans, visual feedback can modulate refractive development in monkeys and many other species. To determine if vision-dependent mechanisms can still influence refractive development in primates during the slow juvenile phase of ocular growth, the time period when myopia typically develops in human children, we examined the effects of form deprivation on adolescent monkeys. METHODS: Unilateral, form deprivation was produced in four rhesus monkeys by surgically fusing the eyelids of one eye. The onset of deprivation was between 3.7 and 5 years of age, which corresponds to onset ages between approximately 15 and 20 human years. The ocular effects of form deprivation were assessed by cycloplegic retinoscopy and A-scan ultrasonography. RESULTS: At the onset of form deprivation all four monkeys were isometropic and the axial dimensions in the two eyes were well matched. After 71 to 80 weeks of form deprivation, all of the deprived eyes had become relatively more myopic than their fellow non-treated eyes (mean anisometropia = -2.03 +/- 0.78 D) and they exhibited relative increases in vitreous chamber depth (mean = 0.55 +/- 0.31 mm) and axial length (mean = 0.49 +/- 0.35 mm). DISCUSSION: Our results demonstrate that vision-dependent mechanisms can influence ocular growth and refractive development in "teenage" monkeys. These results raise the possibility that visual experience may be involved in the genesis of school-age myopia in children.

Aging↗
PubMed2000

Refractive errors in Singapore and Xiamen, China--a comparative study in school children aged 6 to 7 years.

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.

Anisometropia↗
PubMed2000

Temporal variations in myopia progression in Singaporean children within an academic year.

PURPOSE: Excessive nearwork is believed to be associated with myopia development and progression. To investigate this further, we studied refractive error changes and their correlation with nearwork in a cohort of grade school children in Singapore. METHODS: Cycloplegic autorefraction was performed 5 times over 10 months on 168 children aged 7, 9, and 12 years who were further divided into myopic and nonmyopic subgroups based in their initial refractive errors. Information about nearwork was obtained through diaries filled out over 24 h at the commencement of the study. RESULTS: Myopia progression was high (overall mean: -0.87 D per year) and largely linear throughout the year, but significantly higher rates were seen after the final school examinations in 7-year-old myopes and nonmyopes. Overall, myopic groups exhibited higher progression rates than nonmyopic groups, although 33.6% of subjects from the latter groups had become myopic by the end of the study. Nearwork scores derived from the diaries were generally not well correlated with overall myopia progression. CONCLUSIONS: The tendency for myopia progression rates to increase after the final school examinations in 7-year-olds is interpreted as a delayed effect of the intense nearwork associated with preparing for them. The timing of nearwork-diary data collection at the beginning of the study could be responsible for the poor correlation between these data and overall myopia progression rates.

Child↗
PubMed2000

Factors related to the progression of myopia in Singaporean children.

PURPOSE: To examine the possible factors related to the progression of myopia in Singapore children. METHODS: One hundred fifty-three Singapore children aged 6 to 12 years were recruited to participate in a concurrent cohort study of the risk factors for the progression of myopia. Socioeconomic status, outdoor activity, and near-work activity were documented in a face-to-face clinic interview. The changes in cycloplegic subjective refraction and autorefraction were ascertained with the use of a Nidek ARK 900 over a 2-year period. RESULTS: The average rate of progression of myopia as measured by subjective refraction was -0.59 D per year (95% confidence interval -0.52, -0.66). Younger children and children who were more myopic at the beginning (refractive error worse than -2.0 D) of the study had higher myopia progression rates. CONCLUSIONS: Myopia progression was faster for younger children and for children who had more severe myopia at baseline. Socioeconomic status and near-work activity were not related to myopia progression.

Child↗
PubMed2001

The contact lens and myopia progression (CLAMP) study: design and baseline data.

BACKGROUND: Although previous contact lens myopia control studies indicate that rigid contact lenses slow the progression of myopia in children, they have all suffered from limitations that challenge the significance of their results. The Contact Lens and Myopia Progression (CLAMP) Study addresses the limitations of previous studies and attempts to correct them by implementing alternative Study designs. The CLAMP study also measures all the ocular components to examine the potential mechanism of treatment effect. METHODS: Eligible children were fitted with rigid gas-permeable contact lenses and enrolled in a run-in period to determine whether they were able to adapt to rigid contact lens wear. Subjects who successfully completed the run-in period were randomly assigned to wear rigid contact lenses or soft contact lenses for the remainder of the 3-year study. The primary outcome measure will be the 3-year change in cycloplegic autorefraction; the secondary outcome measures will include the 3-year change in axial length, peripheral autorefraction, crystalline lens curvatures, corneal curvature and thickness, accommodation, and intraocular pressure, which are being measured annually. RESULTS: We examined 148 eligible subjects who participated in the run-in period. Of the 148 eligible subjects, 116 (78.4%) were able to adapt to rigid contact lens wear and were enrolled in the CLAMP Study. The mean age of the participants at the baseline visit was 10.5 years, and 59.5% were girls. At the randomization visit, the mean (+/-SD) spherical equivalent refractive error in the right eye was -2.09 +/- 0.89 D, the mean central curvature of the right cornea by videokeratography was 44.5 +/- 1.3 D, and the mean axial length of the right eye was 24.13 +/- 0.71 mm. CONCLUSIONS: Four of five children aged 8- to 11-years-old were able to adapt to rigid gas-permeable contact lens wear. The CLAMP Study aims to further clarify the effect of rigid gas-permeable contact lenses on myopia progression in children.

Astigmatism↗
PubMed2001

Ultrasound biomicroscopy of the aging rhesus monkey ciliary region.

Ultrasound biomicroscopy of the living rhesus monkey ocular ciliary region was undertaken to identify age-dependent changes that might relate to the progression of presbyopia. Monkeys were anesthetized and pharmacologically cyclopleged, the eyelids were held open with a lid speculum, and sutures were placed beneath the medial and lateral rectus muscles. Ultrasound biomicroscopy imaging of the nasal and temporal quadrants of the eye were performed, and the live images were recorded to videotape. Subsequent image analysis was performed to obtain objective morphometric measurements of the ciliary body region. The ciliary body inner radius of curvature, outer radius of curvature, inner arc length, area, thickness, perimeter, zonular fiber length, and circumlental space were measured. Zonular space was calculated. The circumlental space decreased with increasing age in the temporal quadrant. The other morphologic measurements were not significantly correlated with age or body weight. Most morphologic measurements were significantly different comparing temporal vs. nasal quadrants. Bifurcation of the posterior zonular fibers was frequently observed. Although temporal circumlental space was the only measurement found to change with age, ultrasound biomicroscopy of the living rhesus ciliary region did identify distinct nasal vs. temporal asymmetries, which may reflect anatomical requirements for convergence-associated accommodation.

Accommodation, Ocular↗
PubMed2002

Prevalence rates and epidemiological risk factors for astigmatism in Singapore school children.

PURPOSE: This study examined the prevalence rate of astigmatism and its epidemiological risk factors in Singapore school children. METHODS: In a study of school children aged 7 to 9 years old in two schools in Singapore in 1999, a detailed questionnaire was administered to parents regarding reading or close-work habits, past history of close-work, family history, and socioeconomic factors. Cycloplegic refraction was performed five times in each eye. Defining astigmatism as worse than or equal to 0.5, 0.75, and 1 D cylinder in the right eye, the prevalence of astigmatism was calculated. RESULTS: The study population consisted of 1028 children. The prevalence rate of astigmatism (worse than or equal to 1 D cylinder) was 19.2% (95% confidence interval, 16.8 to 21.6). This was not different between genders, ethnic groups, or age (p > 0.05). With-the-rule astigmatism was more common than against-the-rule astigmatism. The prevalence of astigmatism and myopia was 9.8% (95% confidence interval, 8.0 to 11.6). A high AC/A ratio was associated (p = 0.003) with astigmatism, even after exclusion of myopic children. On vectorial analysis, J0 and J45 were associated with the number of hours of playing video games, whereas J45 was also associated with computer use. Only J45 was associated to male gender, a high AC/A ratio, and a family history of myopia. CONCLUSIONS: The prevalence rate of astigmatism (> or = 1 D) was 19%. Playing video games and computer use may be associated with astigmatism severity, although the presence of astigmatism (> or = 1 D) was not associated with any nearwork factors. A family history of myopia was associated with oblique astigmatism severity. A high AC/A ratio is associated with astigmatism, and this requires further investigation.

Astigmatism↗
PubMed2002

Sensitivity and specificity of visual acuity screening for refractive errors in school children.

PURPOSE: To examine the optimal cutoff point for the use of the visual acuity test to screen for refractive errors in schoolchildren. METHODS: In a sample of schoolchildren between 7 and 9 years old, visual acuity testing was performed using modified ETDRS charts monocularly without optical aids by trained personnel. Cycloplegic autorefraction was performed in each eye. The screening efficacy of using various cutoff points for referring children for further optometric/ ophthalmic assessment was studied. Myopia was defined as a spherical equivalent of at least -0.5 D, hyperopia a spherical equivalent of at least +2.0 D, and astigmatism a cylinder of at least -1.0 D in at least one eye. The sensitivity, specificity, and predictive values were calculated using each patient as a case; a receiver operator curve was plotted. RESULTS: A total of 1,028 children were tested. A satisfactory sensitivity/specificity profile was obtained using a referral criterion of visual acuity worse than or equal to 0.28 logarithm of the minimum angle of resolution in at least one eye. In this scenario, the sensitivity and specificity of this screening test were 72% (95% confidence interval [CI], 68 to 76) and 97% (95%CI, 95 to 98), respectively. The positive and negative predictive values were 96% (95%CI, 93 to 98) and 78% (95%CI, 75 to 82), respectively. CONCLUSIONS: The modified ETDRS visual acuity chart can be used to predict refractive errors in schoolchildren in Singapore in a sensitive and specific manner using a referral criterion of worse than or equal to 0.28 logarithm of the minimum angle of resolution.

Child↗
PubMed2003

Measurement of refractive errors in young myopes using the COAS Shack-Hartmann aberrometer.

PURPOSE: To evaluate the Complete Ophthalmic Analysis System (COAS; WaveFront Science) for accuracy, repeatability, and instrument myopia when measuring myopic refractive errors. METHODS: We measured the refractive errors of 20 myopic subjects (+0.25 to -10 D sphere; 0 to -1.75 D cylinder) with a COAS, a phoropter, and a Nidek ARK-2000 autorefractor. Measurements were made for right and left eyes, with and without cycloplegia, and data were analyzed for large and small pupils. We used the phoropter refraction as our estimate of the true refractive error, so accuracy was defined as the difference between phoropter refraction and that of the COAS and autorefractor. Differences and means were computed using power vectors, and accuracy was summarized in terms of mean vector and mean spherocylindrical power errors. To assess repeatability, we computed the mean vector deviation for each of five measurements from the mean power vector and computed a coefficient of repeatability. Instrument myopia was defined as the difference between cycloplegic and noncycloplegic refractions for the same eyes. RESULTS: Without cycloplegia, both the COAS and autorefractor had mean power vector errors of 0.3 to 0.4 D. Cycloplegia improved autorefractor accuracy by 0.1 D, but COAS accuracy remained the same. For large pupils, COAS accuracy was best when Zernike mode Z4(0) (primary spherical aberration) was included in the computation of sphere power. COAS repeatability was slightly better than autorefraction repeatability. Mean instrument myopia for the COAS was not significantly different from zero. CONCLUSIONS: When measuring myopes, COAS accuracy, repeatability, and instrument myopia were similar to those of the autorefractor. Error margins for both were better than the accuracy of subjective refraction. We conclude that in addition to its capability to measure higher-order aberrations, the COAS can be used as a reliable, accurate autorefractor.

Adolescent↗
PubMed2003

Relationship between refractive error and monochromatic aberrations of the eye.

PURPOSE: To examine the relationship between ametropia and optical aberrations in a population of 200 normal human eyes with refractive errors spanning the range from +5.00 to -10.00 D. METHODS: Using a reduced-eye model of ametropia, we tested the hypothesis that the optical system of the eye is uncorrelated with the degree of ametropia. These predictions were evaluated experimentally with a Shack-Hartmann aberrometer that measured the monochromatic aberrations across the central 6 mm of the dilated pupil in well-corrected, cyclopleged eyes. RESULTS: Optical theory predicted, and control experiments on a model eye verified, that Shack-Hartmann measurements of spherical aberration will vary with axial elongation of the eye even if the dioptric components of the eye are fixed. Contrary to these predictions, spherical aberration was not significantly different from emmetropic eyes. Root mean square of third-order aberrations, fourth-order aberrations, and total higher aberrations (third to 10th) in myopic and hyperopic eyes were also uncorrelated with refractive error. Astigmatic eyes tended to have larger total higher-order aberrations than nonastigmatic eyes. CONCLUSIONS: We conclude that a reduced-eye model of myopia assuming fixed optical parameters and variable axial length is not tenable.

Accommodation, Ocular↗
PubMed2003

Visual acuity as a function of Zernike mode and level of root mean square error.

BACKGROUND: The coefficients of normalized Zernike expansion are orthogonal and reflect the relative contribution of each mode to the total root mean square (RMS) wavefront error. The relationship between the level of RMS wavefront error within a mode and its effect on visual performance is unknown. PURPOSE: To determine for various levels of RMS wavefront error how each mode of the normalized Zernike expansion for the second, third, and fourth orders affect high- and low-contrast acuity. METHODS: Three healthy optimally corrected cyclopleged subjects read aberrated and unaberrated high- and low-contrast logarithm of the minimum angle of resolution acuity charts monocularly through a 3-mm artificial pupil. Acuity was defined by the total number of letters read correctly up to the fifth miss. Aberrated and unaberrated charts were generated using a program called CTView. Six levels of RMS wavefront error were used (0.00, 0.05, 0.10, 0.15, 0.20, and 0.25 microm). Each level of RMS error was loaded into each mode of the second, third, and fourth radial orders individually for a total of 72 charts. Data were normalized by subject, and the normalized data were averaged across subjects. RESULTS: Across modes and within each mode as the level of RMS wavefront error increased above 0.05 microm of RMS wavefront error, visual acuity decreased in a linear fashion. Slopes of the linear fits varied depending on the mode. Modes near the center of the Zernike pyramid had steeper slopes than those near the edge. CONCLUSIONS: Increasing the RMS error within any single mode of the normalized Zernike expansion decreases visual acuity in a linear fashion. The slope of the best fitting linear equation varies with Zernike mode. Slopes near the center of the Zernike pyramid are steeper than those near the edge. Although the normalized Zernike expansion parcels RMS error orthogonally, the resulting effects on visual performance as measured by visual acuity are not orthogonal. New metrics of the combined effects of the optical and the neural transfer functions that are predictive of visual performance need to be developed.

Adult↗