Eye Surgery. LASIK: buyer beware.
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This study presents the results of the prescription of small prisms in ametropic patients whose glasses increase the associated heterophoria (which we have called heterophoria "against the rule"). It concerns the myopic eso (group I), the hyperopic exo (group II) and the presbyopic exo (group III) as a particular subgroup of the former. In a population of 211 patients wearing prisms, we have selected 53 in the first group, 34 in the second group and 20 in the third group. The 3 groups were compared according to the age and the fusional complaints of the patients. In 70 to 80% of the cases the associated ametropia was very small. In more than 60% of the cases the total prismatic prescription never exceeded 2 PD. A decrease or a suppression of the prisms was possible in 50% of the cases in groups I and II and in 15% in group III. Respectively 87%, 89% and 86% of the cases became asymptomatic in each category after a mean follow-up of 6.8--4.7--5.8 years (range: 2-12). No complaint was increasing during this period and no prismatic prescription exceeded a total amount of 5 PD. A familial factor was present in 18% of the cases. This study underlines the fact that the limit of tolerance of a latent phoric unbalance is more important that the amount of heterophoria itself. This observation is fundamental for understanding the apparent paradoxal behaviour of these patients and the efficacy of an apparent "homeopathic" prescription of prisms.
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Twenty-nine presbyopic subjects who spent at least 20 hours a week at a video display terminal compared a progressive addition lens designed for this function, with another commonly prescribed task-specific lens. Each of the paired lens types was worn for 4 weeks and then compared directly for 1 week. A statistically significant (P < .05) portion of the subjects (76%) preferred the task-specific lenses overall. It also was preferred more frequently for each feature compared, although the difference was statistically significant (P < .05) only for utility of distance vision. Both of the task-specific designs contributed to symptomatic relief. The presence of a distance-clear zone and the absence of lens discontinuities most likely account for user preference for the task-specific lenses. That preference suggests improved performance for presbyopic computer users wearing task-specific progressive addition lenses.
We fit two multifocal soft contact lenses, Bausch & Lomb's Bi-Tech and the Unilens contact lens from Unilens Corporation, in two separate populations of presbyopes. Most patients (24/42, 57%) had no prior contact lens experience. Patients were evaluated at 6 and 12 months for comfort, visual acuity, lens fit, and corneal findings. Both distance and near vision were found to be slightly decreased with each contact lens when compared to best corrected visual acuity with spectacles. Seventy-seven percent (14/18) of the Unilens wearers and 67% (16/24) of the Bi-Tech wearers continued to wear their lenses for at least 1 year. Those who discontinued lens wear did so because they were dissatisfied with their vision. Presbyopes who seek correction with soft contact lenses appear to be more tolerant of a decrease in distance vision than a decrease in near vision. Both lenses were comfortable and no corneal pathology was induced. Our results suggest that the Unilens (simultaneous vision design) provides more predictable correction of presbyopic symptoms than the Bi-Tech (alternating vision design) because it is independent of lower lid position and translation. Both of these lenses are viable options for the correction of presbyopic symptoms.
BACKGROUND: Video display terminals (VDTs) have Gaussian display characteristics. Research suggests that patients accommodate differently to Gaussian images. In the present study, we asked if the accommodative response to the PRIO Computer Vision Tester (a Gaussian image) is different than the accommodative response to a Monocular Estimation Method (MEM) printed text target. METHOD: A normally sighted prepresbyopic group of subjects (N = 60) was recruited from the student body of Nova Southeastern University. Low neutral retinoscopy was performed on each subject at a distance of 50 cm. using both the PRIO vision tester and an MEM target. RESULTS: The PRIO vision tester and the printed text provided essentially the same measures of accommodative response. In addition, the luminance of the PRIO dropped by nearly 40% over the course of 1 hour of intermittent use. CONCLUSION: The PRIO vision tester and traditional nearpoint retinoscopy provided essentially the same measures of accommodative response in prepresbyopic subjects. Further studies should be considered to evaluate whether the change in luminance of the PRIO system has any effect on the measurement of accommodative response.
We examined the contrast sensitivity function of presbyopic subjects wearing the Hydron Echelon diffractive bifocal contact lens. Contrast sensitivity with the Echelon lens was compared to contrast sensitivity with bifocal spectacle correction. Each eye was tested for near and distance vision with the Echelon contact lens and with spectacle correction. Most subjects achieved a visual acuity of 20/20 with the Echelon lens; however, on average, contrast sensitivity was found to be significantly decreased with the contact lens as compared to spectacles for both distance and near vision. The largest decrease in contrast sensitivity was seen for mid-range spatial frequencies (4 to 16 cycles/degree). Although most subjects experienced a significant decrease in contrast sensitivity, two experienced only small decreases with the Echelon lens. Only one subject who met entry criteria reported that vision was as good with the Echelon lens as with spectacles. The decreased contrast sensitivity may result from contact lens decentration as well as inherent optical characteristics of the Echelon lens.
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