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PubMed1995

Non-arteritic anterior ischemic optic neuropathy and refraction.

A small cup-disk ratio has been reported as a risk factor in non-arteritic anterior ischemic optic neuropathy. Hyperopia is possibly related with a small cup-disk ratio. The purpose of the present study is to compare the refraction of 37 eyes with non-arteritic anterior ischemic optic neuropathy with a sex and age matched control group of 74 eyes. In our study, mild hyperopia was more frequently observed in the anterior ischemic optic neuropathy group than in the control group.

Adult↗

PubMedDate not supplied

Refractive results after photorefractive excimer laser treatment in mild myopic and in mild hyperopic eyes.

Evaluation of 12-month results of photorefractive keratectomies (PRK) performed in low myopic (0 to -6.0 D) and low hyperopic (0 to +6.0 D) eyes. Myopic and hyperopic PRK treatments with the Aesculap Meditec MEL 60 ArF excimer laser. Prospective study, 30 eyes per group. The change in best corrected visual acuity (VA), refraction required, uncorrected VA and the postoperative haze were compared at the 12th postoperative month. The average preoperative correction in the low myopic eyes (Group I) was -4.65 +/- 1.24 D, which decreased to -0.17 +/- 0.56 D during the follow-up. In mild hyperopic eyes (Group II) the preoperative refraction was +3.9 +/- 0.93 D and decreased to +1.23 +/- 1.59 D post-PRK. Comparing the pre- and postoperative average best corrected VA values, there was no statistical change in either group. In the low myopic group all eyes had a 20/40 or better uncorrected VA, in hyperopic eyes 11 had a VA of 20/40 or better, four had a worse uncorrected VA. In Group I, 86.6% of the eyes were within +/-1.0 D of the intended refraction at 12 months postoperatively. In Group II, 46.7% of the eyes were within +/-1.0 D of final refraction. There were no intergroup differences in subjective complaints, reepithelization and average postoperative haze. Both methods are able to alter the refractive power of the cornea toward emmetropia. The predictability of the method was to be found higher in cases of mild myopia than in mild hyperopia. The upper limit of myopia is above -6.0 D, but in hyperopia, with the present technical facilities, good postoperative results can be obtained only as far as +4.25 D of preoperative refractive error.

Adult↗

PubMed1997

[Why and how to correct hypermetropia?].

How and why to prescribe an optical correction in hyperopia is described. The reasons for prescribing are closely related to the visual risk of not doing so (amblyopia, lack of stereopsy, strabismus), to the patient's complains and history as well as to his ophthalmological examination. How to correct hyperopia depends on the presence or absence of squint and on the amount of ametropia.

Adult↗

PubMed1999

Emmetropization in the rhesus monkey (Macaca mulatta): birth to young adulthood.

PURPOSE: To provide baseline measurements on the postnatal changes in refractive error, corneal curvature, and axial elongation of the eyes of normal monkeys. Little is known about the course of normal eye growth from birth to adolescence, particularly how refractive parameters co-vary during development. In animal models of ametropia, usually one eye is manipulated and the fellow eye serves as a control. However, given individual differences, and without baseline data, it is impossible to determine whether either eye develops normally. METHODS: Measurements were obtained on 237 rhesus monkeys, whose ages ranged from birth to 5 years. Examinations included cycloplegic refraction by retinoscopy, keratometry measurements, and A-scan ultrasound measurements of axial length. The time course of development was evaluated using a growth curve analysis appropriate for a mixture of cross-sectional and longitudinal data. RESULTS: At birth, all three parameters were normally distributed and only weakly correlated. Monkeys had +7 D (SD=2.3 D) of hyperopia, corneal power of 58 D (SD=1 D), and axial length of 13.2 mm (SD=0.4 mm). Refractive error ranged from +0.5 D to +14.5 D, with a mean difference between the two eyes of 0.5 D. Corneal curvature ranged from 61 D to 54 D, with a mean difference between the two eyes of 0.8 D. Axial length ranged from 12.0 mm to 14.2 mm, with a mean difference between the two eyes of 0.1 mm. Although the degree of hyperopia achieved asymptote, of + 2 D, shortly after 1 year of age, corneal curvature and axial length did not achieve asymptote until nearly 5 years of age. By this time, refractive error had declined by 5 D, corneal curvature had declined by 7 D, and axial length had increased by 6 mm. CONCLUSIONS: The magnitude of the individual differences that can occur in a small sample of experimental subjects is large enough to necessitate reference to age norms derived from a large population. Our results provide a baseline for studies of normal and abnormal eye growth and ametropia in primates. Our results also led to the confirmation of a set of "rules" that have been offered as an explanation of how these three parameters interact during emmetropization.

Aging↗

PubMed2001

Cycloplegic refractions in healthy children aged 1 through 48 months.

OBJECTIVES: To provide a description of refractive errors in healthy, term-born children, aged 1 through 48 months, and to test the hypotheses that spherical equivalent becomes significantly less hyperopic and less variable with increasing age. METHODS: Following a prospective, cross-sectional design, cycloplegic retinoscopy was used to measure the refractive error in both eyes of 514 healthy, term-born children in 12 age groups. Three hundred were aged 12 months or younger. Spherical equivalent and cylindrical power and axis were analyzed as a function of age. Prediction limits for spherical equivalent were calculated. RESULTS: Spherical equivalents of right and left eyes did not differ at any age. Hyperopia declined significantly with increasing age. The variability in spherical equivalent also decreased significantly with age. Cylindrical error of 1 diopter or more was found in 25% of the children; the proportion with astigmatism was highest in infancy and then waned. Myopia and anisometropia were rare, occurring in 3% and 1% of the sample, respectively. CONCLUSIONS: Significant declines in hyperopia and variability of spherical equivalent appear to be features of emmetropization. The normal prediction limits provide guidelines against which data from individual patients can be compared.

Age Distribution↗

PubMed2002

Clinical and theoretical results of intraocular lens power calculation for cataract surgery after photorefractive keratectomy for myopia.

OBJECTIVES: To describe the refractive results of cataract surgery after photorefractive keratectomy (PRK) for patients with myopia, and to find a more accurate method to predict intraocular lens (IOL) power in these cases. DESIGN: Nonrandomized, retrospective clinical study. PATIENTS AND METHODS: Nine patients (15 eyes) who underwent cataract surgery after prior PRK to correct myopia were identified. The medical records of both the laser and cataract surgery centers were reviewed. MAIN OUTCOME MEASURES: Eight different keratometric values (K values; measured or calculated) were entered into 3 different IOL calculation formulas: SRK/T, Holladay 1, and Hoffer Q. The actual biometry and IOL parameters were used to predict postoperative refraction, which was compared with the actual refractive outcome. Also, the relative underestimation of the refractive change in corneal dioptric power by keratometry after PRK was calculated. RESULTS: In 7 of 15 eyes, IOL exchange or piggybacking was performed because of hyperopia. Retrospectively, the most accurate K value for IOL calculation was found to be the pre-PRK K value corrected by the spectacle plane change in refraction. Use of the Hoffer Q formula would have avoided postoperative hyperopia in more cases than the other formulas. The mean underestimation of the change in corneal power after PRK varied from 42% to 74%, depending on the method of calculation. CONCLUSION: The predictability of IOL calculation for cataract surgery after PRK can be improved by using a corrected, refraction-derived K value instead of the measured, preoperative K value.

Adult↗

PubMed2005

Clinical and molecular characterization of a family with autosomal recessive cornea plana.

BACKGROUND: Autosomal recessive cornea plana is characterized by a flattened corneal surface associated with hyperopia and various anterior segment abnormalities. Mutations have been detected in the keratocan gene (KERA), a member of the small leucine-rich proteoglycan family. OBJECTIVE: To clinically and molecularly characterize a consanguineous family of Hispanic origin in which 3 individuals are affected with cornea plana. METHODS: Clinical ophthalmic examination, including corneal topography and axial eye length measurement, was performed on 7 family members. Molecular analysis of KERA was performed on DNA from each family member who had been examined. RESULTS: All 3 affected individuals showed extreme flattening of the cornea (< 36 diopters [D]), normal axial eye lengths, and hyperopia greater than 6.25 D (spherical equivalent). Anterior segment abnormalities included scleralization of the cornea and central iris strands to the corneal endothelium. Affected individuals were homozygous for a novel mutation in KERA. The sequence change was found in exon 2, which results in an asparagine to aspartic acid change at codon 131. This amino acid change occurs within a highly conserved leucine-rich repeat of keratocan. CONCLUSIONS: The cause of disease in this family is likely to be a mutation in exon 2 of KERA. Other mutations in KERA known to cause cornea plana also fall within the region encoding the leucine-rich repeat motifs and are predicted to affect the tertiary structure of the protein. CLINICAL RELEVANCE: This is the first report of the identification of a mutation within KERA in a family of Hispanic origin with autosomal recessive cornea plana. Although the vast majority of cases of cornea plana are in individuals of Finnish descent, this report demonstrates the occurrence of the disease in other populations.

Amino Acid Sequence↗

PubMed1985

Classification of congenital and early onset retinitis pigmentosa.

We retrospectively studied 36 patients with congenital (Leber's amaurosis) and early onset retinitis pigmentosa (RP) to develop a new schematic classification system based on the age at onset of symptoms, severity of visual loss, and associated nonocular abnormalities. Our four groups were designated as complicated and uncomplicated Leber's congenital amaurosis and juvenile and early onset RP. Criteria for patient selection included an extinguished or barely recordable electroretinogram, well-documented age of onset, and comprehensive ocular and medical examinations before the age of 10 years. Among the congenitally blind, the distinguishing features were the degree of hyperopia and the presence or absence of neurologic abnormalities. Among patients with infantile or juvenile onset of retinal degeneration, the distinguishing features were the severity of visual loss and the age at onset of symptoms. The presence of nystagmus and hyperopia and the severity of central visual loss differentiated congenital from early onset RP.

Child↗

PubMed1994

One-year results of excimer laser photorefractive keratectomy for low to moderate myopia.

OBJECTIVE: Excimer photorefractive keratectomy is a promising method to reduce myopia. We evaluated the effectiveness, predictability, stability, and safety of photorefractive keratectomy performed by two surgeons at a single site with a 1-year follow-up. METHODS: An excimer laser (Summit Excimed UV200, Summit Technology, Waltham, Mass) was used to treat 47 eyes. Preoperative uncorrected visual acuity averaged 20/277 and ranged from 20/60 to 20/500. Spherical equivalent averaged -3.9 diopters and ranged from -1.5 to -6.1 D. RESULTS: One year postoperatively, best corrected visual acuity averaged 20/13 and ranged from 20/10 to 20/20. No patients lost any of best corrected visual acuity. The uncorrected visual acuity at 1 year averaged 20/20 and ranged from 20/10 to 20/200. Ninety-four percent of eyes had an uncorrected visual acuity of 20/40 or better; 83%, 20/25 or better; and 74%, 20/20 or better. An initial hyperopic overcorrection is followed by gradual regression to emmetropia during a 12-month period. Refractive spherical equivalent averaged 0.44 D and ranged from -3 to +2.6 D at 1 year. The proportion of eyes within 1 D of emmetropia was 80% at 1 year. The most significant shifts in refraction occurred between the first and second months, but small shifts occurred up to 12 months. Subgrouping the results according to age revealed a significantly greater effect with larger residual hyperopia in those older than 40 years. Patient satisfaction with the procedure was high. CONCLUSION: During a 1-year period, excimer photorefractive keratectomy appears to be an effective, predictable, stable, and safe method to reduce myopia. Age may play a role in the effectiveness of the procedure, with greater hyperopia resulting in those older than 40 years.

Adult↗

PubMed1996

Vision in Leber congenital amaurosis.

OBJECTIVE: To determine if vision changed with age in infants and children with Leber congenital amaurosis. PATIENTS: Grating acuity and dark-adapted visual thresholds were tested in 36 patients with Leber congenital amaurosis. Longitudinal assessments were obtained for 24 patients and analyzed for significant changes over time. Visual acuity and threshold and the courses of visual acuity and threshold were examined for significant associations with hyperopia, fundus appearance, and complicated vs uncomplicated status. RESULTS: Measurable grating acuities ranged from 0.16 to 6 cycles per degree (median, 1.27 cycles per degree or about 20/500), and dark-adapted visual thresholds were elevated 1.0 to 5.6 log units (median, 2.33 log units). Eighteen patients never had demonstrable grating acuity, and 12 had no light perception. Among those with serial tests, visual acuity improved or remained stable in 10 patients and declined in 4. Dark-adapted visual thresholds were stable in those with improving or stable visual acuities but worsened in 5 patients, including the 4 whose visual acuity worsened. No significant associations of visual acuity, dark-adapted visual threshold, the course of visual acuity, or the course of dark-adapted visual threshold with hyperopia, fundus appearance, or complicated vs uncomplicated status were found. CONCLUSIONS: Visual capabilities varied widely. Vision was stable in the majority by longitudinal measures but increased in a few and deteriorated in others. Neither ocular characteristics nor complicated vs uncomplicated status predicted visual function. Thus, if vision and its course are to be known in a patient with Leber congenital amaurosis, it must be tested.

Aging↗

PubMed2002

Ocular findings in children with congenital sensorineural hearing loss.

OBJECTIVE: To examine the yield of ophthalmologic examination in the diagnostic workup of unexplained sensorineural hearing loss (SNHL) in children. DESIGN: Retrospective analysis of ophthalmologic findings in children with unilateral or bilateral SNHL between January 1998 and May 2000. SETTING: Tertiary care university hospital. PARTICIPANTS: Children 18 years or younger presenting with unilateral or bilateral SNHL. OUTCOME MEASURES: Ophthalmologic findings. RESULTS: Of the 49 patients with SNHL for whom ophthalmologic examination results were available, 15 (31%) had ocular abnormalities. Hyperopia was the most common abnormality, present in 7 patients (46%). Myopia was found in 2 patients (13%) and astigmatism in 1 (2%). Two other patients had multiple abnormalities: one with hyperopia and astigmatism and the other with myopia and astigmatism. The remaining 4 patients had the following abnormalities: Lisch nodules, esotropia, ptosis, and allergic conjunctivitis. As a result of ophthalmologic examination, 5 interventions were performed in 4 children: 2 children received prescription lenses; 2 children underwent surgery; and 1 child was treated with eyedrops. Ophthalmologic examination in 2 children contributed to the diagnosis of a hearing loss syndrome. CONCLUSION: In children with SNHL, ophthalmologic examination is useful in evaluating visual acuity and determining or confirming the cause of hearing impairment.

Adolescent↗

PubMed1990

Experimental studies of emmetropization in the chick.

The eyes of neonates grow from ametropia (refractive error) toward emmetropia. Whether or not this 'emmetropization' is visually guided is controversial. I describe experiments which demonstrate that in the chick refractive state is used to regulate the growth of the eye's vitreous chamber in order to achieve emmetropia from hyperopia or myopia that is induced by different visual deprivations. I discuss several studies that begin to examine the neural pathways that might be involved in the control of eye growth. Optic nerve section was used to examine the level of visual processing necessary for the control of eye growth. Eyes in which the optic nerve has been cut can still grow in the appropriate direction to correct induced hyperopia or myopia. Nevertheless, an intact optic nerve is necessary for normal refractions to be achieved; eyes with optic nerve section overshoot control levels and reverse the sign of the initial refractive error. These findings suggest that eye growth in chicks is controlled by an intraocular mechanism and possibly by a brain-mediated mechanism as well. The hypothesis that ocular accommodation is integral to the control of eye growth was also tested. Complete recovery from induced refractive errors was achieved even when accommodation had been abolished by lesions of the Edinger-Westphal nucleus. The elimination of accommodation did not prevent the ability of chick eyes to compensate for the defocus of spectacle lenses. These results suggest that accommodation is not necessary for the control of eye growth.

Accommodation, Ocular↗

PubMed1992

Apparent cleavage of the retinal nerve fiber layer in asymptomatic eyes with high myopia.

The appearance of the retinal nerve fiber layer was studied in one eye of 203 normal Asians (59 with high myopia greater than or equal to -5 D, and 144 with emmetropia or hyperopia). "Cleavage" of the retinal nerve fiber layer was observed in 3 of these 59 highly myopic eyes, but there was no significant damage to either the retinal pigment epithelium or the choroid. In contrast, no cleavage was observed in the other 144 emmetropic or hyperopic eyes. High myopia (P = 0.0237, Fisher's exact test) was a significant risk factor for "cleavage" development in the retinal nerve fiber layer. The occurrence of a defect (nerve fiber loss) in the retinal nerve fiber layer in severe myopia (5/59, 8%) was also greater than that in either emmetropia or hyperopia (2/144, 1%; P = 0.0229). These results indicate that subtle changes can occur in the appearance of the retinal nerve fiber layer of the eye in some patients with asymptomatic myopia.

Adult↗

PubMed1992

The refractive development of the eye of the American kestrel (Falco sparverius): a new avian model.

Most measures of avian visual performance are carried out on commonly available domestic species such as the chicken, and most of the data on avian induced refractive error deals with chickens. Raptors are predatory birds in which good visual resolving ability is particularly important. Behavioral studies indicate that the eyes of raptors have two to three times the resolving ability of the human eye. The domestic chicken is precocial at hatching whereas most raptors are semi-altricial. This study was an effort to determine if the effect of early visual deprivation on the refractive development of the chicken eye can be reproduced in the American kestrel, a species which is not domesticated and in which the need for acute vision is particularly important. Visual deprivation was achieved by unilaterally applying translucent plastic goggles over the eyes of kestrels two days after hatching. Refractive error was measured using a retinoscope and trial lenses. Ocular growth was monitored by A-scan ultrasonography, and frozen ocular sections of sacrificed birds. The effect of the experimental manipulation on the contralateral control eye and body weight was evaluated each day over a 42-day period. The goggles did not significantly affect the normal changes in body weight or the normal pattern of ocular growth and refractive development in the untreated eyes. An analysis of the refractive state changes as a result of form deprivation was made each week for 6 weeks after hatching on both the treated and untreated eyes in a separate group of experimental birds. Visual form deprivation caused a significant myopic shift in refractive error and a significant increase in the vitreous chamber depth in the treated eyes at 3 and 6 weeks of age. However, the amount of myopia produced is much less than that induced in chicks, and in certain cases hyperopia is produced. The kestrels recover from myopia and hyperopia within 10 days of goggle removal, after 3 to 4 weeks of deprivation. This study is the first indication that chickens may not be a representative bird model for studying form-deprivation myopia. First, myopia is not always produced in kestrels in response to form deprivation. Second, kestrels are severely myopic at hatching and therefore, the direction of emmetropization is opposite to that found in hatchling chicks.

Animals↗

PubMed1993

Ocular findings in prematurely born children at 5 years of age.

Fifty-eight prematurely born children (gestational age < or = 32 weeks) were studied at the age of 5 years. The ophthalmological examination was part of an extensive neurodevelopmental evaluation. The eye study revealed significant hyperopia (> or = + 2.0) in 22.4%, myopia (> or = -1.0 D) in 8.6%, astigmatism (> or = 1.0 D) in 12.1%, and anisometropia (> or = 1.0 D) in 12.1%. The myopic refractive error was high in all of the cases: from -6.0 to -14.0 D. Manifest strabismus was found in 24.2% and significant visual impairment or blindness in 6.9%. Optic atrophy and cicatricial retinopathy of prematurity were the main causes for severe visual defects. In the randomly selected full-term children of the same age, significant hyperopia was seen in 14.3%, astigmatism in 5.4% and strabismus in 1.8%. The pattern of the eye findings was different in the preterm children compared with those born at term.

Child, Preschool↗

PubMed2002

Efficiency of a video-autorefractometer used as a screening device for amblyogenic factors.

BACKGROUND: High ametropia is known as a risk factor in developing amblyopia. The aim of the study was to evaluate the efficiency of a commercially available infrared videorefractometer (PowerRefractor) in examining children, and to evaluate its effectiveness in detecting amblyogenic factors of the refraction. The influence of cycloplegia was of interest. METHODS: A total of 255 eyes (-28.25 D to +7.88 D spherical equivalent) of 128 patients (1-81 years) were examined by cycloplegic retinoscopy. All of them were measured with the PowerRefractor under cycloplegia. Fifty-four of these patients (108 eyes) were additionally measured without cycloplegia. The technique of the device is based on the eccentric photorefraction method. Both eyes can be measured simultaneously from a distance of 1 m. A video-analysis of each eye is computed in three meridians. The subject can be observed in real time on a screen, and the refraction is immediately available. RESULTS: Measurement of refraction was possible at all ages. More effort was required with young children who could not cooperate well with the procedure of conventional table-top autorefractometers. The mean sensitivity in detection of any amblyogenic ametropia was 80% with and without cycloplegia. The specificity was 61% with cycloplegia and 84% without. The rate of false-negative results in the detection of anisometropia, hyperopia and astigmatism ranged from 10% to 24%. In particular, high astigmatism and hyperopia remained undiscovered. CONCLUSIONS: The reliability of the photorefractor which was the subject of the evaluation in detecting amblyogenic ametropia was comparable to that of other devices described previously in the literature. The method is suitable for use in children, but anisometropia, high astigmatic and hyperopic ametropia remained undiscovered in several cases. Commercial interest: none.

Adolescent↗

PubMed1988

Enlargement of the blind spot caused by papilledema.

Blind spot enlargement in papilledema has been attributed to either mechanical disruption of the integrity of the peripapillary percipient elements by the swollen optic disk or to the Stiles-Crawford effect. We investigated the possibility that blind spot enlargement in papilledema is caused, at least in part, by a refractive scotoma due to peripapillary hyperopia. We reduced the enlarged blind spot in a patient with focal peripapillary hyperopia, without papilledema, to near normal size by using progressively stronger plus lenses. Similarly, with the addition of plus sphere, we reduced the size of the blind spot in five of six patients with papilledema, but in none of our normal subjects.

Adult↗

PubMed1991

Refractive-error changes in kitten eyes produced by chronic on-channel blockade.

The dependence of the emmetropization process on retinal ON-channel activity was examined in developing kittens by making regular intravitreal injections of D,L-2-amino-4-phosphonobutyric acid (APB). In comparison to sham-injected control eyes, the APB-treated eyes had shorter axial lengths and were more hyperopic. Since chronic atropinization did not alter the development of the APB-induced hyperopia, these anomalous refractive errors are not the result of altered accommodative function. The axial hyperopia observed in the APB-treated eyes indicates that the mechanisms responsible for normal axial elongation are dependent to some extent on ON-channel activity and that, even in the presence of a clear retinal image, OFF-channel activity, by itself, is not sufficient to regulate the normal emmetropization process.

Aminobutyrates↗