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Prevalences of astigmatism and anisometropia in adult danes. With reference to presbyopes' possible use of supermarket standard glasses.

A report is given of astigmatism and anisometropia prevalences in an adult hospital sample considered refractively unselected. Astigmatism of at least 0.75 cyl value (by subjective trial) appeared in 20% (n = 600), or in 16% of all eyes (some cases being unilateral). Twenty per cent of astigmatic eyes had an oblique axis. Inverse astigmatism (against rule) showed increasing frequency with age. In a sample analysed for anisometropia (n = 1.200) 9% had a side difference of 1 D or more, while 75% had strict isometropia. Eyes with astigmatism and anisometropia are grouped mainly towards the ametropic ends of the refractive distribution curve, away from emmetropia. The data are used for assessing to what extent the presbyopic population can expect benefit from some newly introduced supermarket standard reading-glasses (+1 to +4 D). Probably, about two thirds can use them. Having had a tradition of individual prescription in our country, the offer of standard glasses without professional trial may eventually result in fewer ophthalmic disorders being diagnosed 'by chance'.

Adolescent↗

Refraction and interpupillary distance measurements of adult Icelanders with special reference to presbyopes possible use of supermarket standard spectacles.

In Iceland refraction is exclusively performed by ophthalmologists who at the same time provide a comprehensive screening for ocular disease. One of the authors travelled three times a year during 1980 through 1984 providing ophthalmic services for rural area in the Eastern Region of Iceland. By the 1st of December 1982 the population 43 years of age and older was 925 persons. This age group is likely to require reading glasses. 751 persons, i.e. 81.2%, had eye examination including visual acuity tests. 730 persons were refracted i.e. 71.9%, and interpupillary distance for near was measured for 555 persons, i.e. 60% of the population. The results were used to estimate the suitability and usefulness of standard supermarket glasses. In 32.1% of the cases, standard reading glasses were found to be unsuitable because of refraction and in 14.2% of the cases, glasses with appropriate interpupillary distance were unavailable in the store. Thus almost half of the examined persons would not have found suitable glasses even if they had been correct in their selection in all instances, which is impossible.

Adult↗

Interocular blur suppression and monovision.

The ability of the binocular system to suppress blur from the defocused eye is an important mechanism underlying the success of monovision correction. With a group of 60 new monovision wearers, we found that blur suppression ability varied substantially between subjects and that crossed dominance influenced blur suppression ability. Symptoms of ghosting amongst the monovision wearers appeared to be influenced by the strength of rivalry dominance. An understanding of the suppression processes underlying monovision may assist in patient selection and management.

Anisometropia↗

Diffractive multifocal intraocular lens implants for unilateral cataracts in prepresbyopic patients.

Multifocal intraocular lenses allow pseudophakic patients to obtain good near and distance visual acuities without an additional near correction. We report our experiences in implanting diffractive multifocal intraocular lenses in prepresbyopic patients with acquired unilateral cataracts and assess their postoperative visual acuities and stereoscopic vision. Accommodative function in patients following cataract surgery is discussed.

Accommodation, Ocular↗

Presbyopic phacovitrectomy.

AIM: To review the results and complications of combined phacoemulsification and vitrectomy in presbyopic patients. METHODS: Retrospective review of 90 consecutive presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment (RRD) (21), redo-RRD (seven), stages 2 and 3 full thickness macular holes (FTMH) (38), stage 4 FTMH (six), idiopathic epiretinal membrane (ERM) (11), proliferative diabetic retinopathy (PDR) (three) and vitreous haemorrhage secondary to branch retinal vein occlusion (BVO) (four). RESULTS: Lens opacity was absent or mild in 84.5% of patients. Reattachment rates for primary RRD and redo-RRD after one procedure were 90.5% and 71.4% and final reattachment rates were 95.2% and 100%, respectively. Macular hole closure rate was 89.5% for stage 2 and 3 FTMH and 83.3% for stage 4 FTMH. There was significant improvement in the median logMAR visual acuity from 1.00 preoperatively to 0.48 postoperatively for the whole cohort (p<0.001, Wilcoxon test). Postoperative complications included fibrinous uveitis (13.3%), iris bombe (2.2%), IOL/iris capture secondary to gas overfill (1.1%), and posterior capsule opacification (51.1%). CONCLUSION: Combined phacoemulsification and vitrectomy is a safe and desirable option in the management of phakic, presbyopic patients with vitreoretinal pathologies that warrant vitreous surgery, even in the absence of significant lens opacity.

Aged↗

Contact lenses.

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Aged↗

The accommodation of lens implants.

Efforts devoted to the production of accommodative lens implants may be premature as there is conflicting information about the functional performance of the aged ciliary muscle which may determine their performance. Additional doubts exist on the performance of the ageing lenticular capsule in connection with some types of implant. Not only do these matters need resolving, but the change in the optical power of the eye needs also to be large enough for reading glasses to become unnecessary. However, not all these strictures apply to the development of accommodative lens implants for children who may be aphakic following operations, e.g. for congenital cataracts.

Accommodation, Ocular↗

[Binocular functions in unilateral aphakia with intraocular lens, contact lens, and spectacle correction (author's transl)].

The quality of binocular vision in unilateral aphakia was tested in presbyopic patients. 10 of them were corrected by a contact lens, 10 by an intraocular implant. Unilateral aphakic young patients were submitted to the same tests. In the young patients the unilateral accommodation proves to be the main obstacle to binocularity. In the presbyopics there is no difference between intraocular and contact lens correction as to the quality of binocular functions. Which one of these two alternatives for the correction of unilateral aphakia should be preferred in the individual case must, therefore, be decided upon by other criteria than binocular vision. The results with unilateral spectacle correction demonstrate that binocular vision cannot be achieved by compensation of aniseikonia alone.

Age Factors↗

One fixates accurately in order to see clearly not because one sees clearly.

Binocular gaze was measured accurately under natural conditions with the Maryland Revolving Field Monitor to determine how visual-clarity affects gaze-accuracy. The gaze of 3 unrestrained, seated subjects (2 presbyopes and 1 myope) was recorded as they tapped 4 LEDs with a long, narrow rod cemented to a thimble worn on their index fingers. They wore positive contact lenses, permitting very clear vision only nearby, within 35 cm. This task was hard. It took more than 7 seconds to complete. Gaze-accuracy varied inversely with target-distance. Gaze was less accurate when targets were nearby, and seen clearly, than when targets were farther away and harder to see. This result was not anticipated. It implies that gaze is accurate in order to see clearly and not because targets can be seen clearly.

Adult↗

Myopic versus hyperopic eyes: axial length, corneal shape and optical aberrations.

This study investigated differences in geometrical properties and optical aberrations between a group of hyperopes and myopes (age-matched 30.3+/-5.2 and 30.5+/-3.8 years old, respectively, and with similar absolute refractive error 3.0+/-2.0 and -3.3+/-2.0, respectively). Axial length (AL) was measured by means of optical biometry, and corneal apical radius of curvature (CR) and asphericity (Q) were measured by fitting corneal topography data to biconic surfaces. Corneal aberrations were estimated from corneal topography by means of virtual ray tracing, and total aberrations were measured using a laser ray tracing technique. Internal aberrations were estimated by subtracting corneal from total aberrations. AL was significantly higher in myopes than in hyperopes and AL/CR was highly correlated with spherical equivalent. Hyperopic eyes tended to have higher (less negative) Q and higher total and corneal spherical aberration than myopic eyes. RMS for third-order aberrations was also significantly higher for the hyperopic eyes. Internal aberrations were not significantly different between the myopic and hyperopic groups, although internal spherical aberration showed a significant age-related shift toward less negative values in the hyperopic group. For these age and refraction ranges, our cross-sectional results do not support evidence of relationships between emmetropization and ocular aberrations. Our results may be indicative of presbyopic changes occurring earlier in hyperopes than in myopes.

Adult↗

Self-reported visual problems of older drivers.

We conducted a survey in order to gain insights into the reasons older persons decide to give up driving. Our survey focused on vision. We probed the relationship between visual deficiencies and driving status by asking older people about the problems they encountered while performing routine visual tasks. The results showed that older persons who had recently given up driving reported more visual problems than did their driving counterparts. These problems related to difficulties in dynamic vision, visual processing speed, visual search, light sensitivity, and near vision. The results suggested that older persons are sensitive to their own visual deficits and that this awareness influences decisions about driving.

Activities of Daily Living↗

Social skills training for depressed, visually impaired older adults. A treatment manual.

Late-onset visual impairment due to cataracts, glaucoma, macular degeneration, or diabetic retinopathy afflicts approximately 10% of people older than 65, and often results in depression and social dysfunction. Whereas the majority of sighted older adults are active participants in their community, individuals suffering from progressively worsening vision experience heightened levels of isolation and reduced social support, and participate in fewer reinforcing recreational activities. This article describes our social skills training package for the treatment of depressed, visually impaired, older adults. Our treatment focuses on increasing the frequency and level of assertiveness with which visually impaired older adults interact with each other. In addition to specified treatment methods, our empirically derived program employs standardized assessment measures to evaluate therapeutic progress. Sessions are implemented to reinforce efforts to apply social skills in the environment and reestablish skills that have begun to fade.

Aged↗

Visual impairment among older people.

Visual impairment is the most age-related disability, with older people forming the majority of the visually disabled population. This article re-examines the nature of visual impairment among older people and points to a key role for nurses in identification and intervention.

Adult↗