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Refractive error in cataract surgery after previous refractive surgery.

Bilateral cataract extraction with posterior chamber intraocular lens (IOL) implantation was performed in a patient after previous photorefractive keratectomy, radial keratotomy (RK) combined with astigmatic keratotomy, and retreatment of RK. Significant hyperopic error was observed after cataract surgery, and the IOLs were eventually exchanged in both eyes. A review of this case found that the refractive error was smaller when a refraction-derived keratometric value was selected for IOL power calculation. Nevertheless, hyperopic error still occurred.

Adult↗

Refractive error and preferential looking visual acuity in human infants: a pilot study.

A clinical pilot study comparing refractive error and preferential looking (PL) visual acuity in infants 2 to 12 months of age is described. The PL visual acuity of 30 normal infants without significant visual disorders was assessed using the Acuity Card Procedure. Near retinoscopy was used to determine refractive error. Infants of this sample had monocular PL visual acuities similar to those established by McDonald et al. in a laboratory setting. Statistical analysis of the data for this sample of infants showed that refractive error did not change systematically from 2 to 12 months of age. We have found that results obtained with the Acuity Card Procedure in a clinical setting agree with infant visual acuity as described in the research literature. Refractive error did not correlate with changes in PL visual acuity in infants 2 to 12 months of age.

Humans↗

Axial length and refractive error in X-linked retinoschisis.

PURPOSE: To examine the relationship between axial length and refractive error in patients with X-linked retinoschisis. DESIGN: To determine whether the hypermetropia frequently found in patients with X-linked retinoschisis is axial hypermetropia. METHODS: The axial length and refractive error were measured in 29 right eyes of 29 patients. The patients were divided into two groups: a juvenile group with ages <13 years (12 eyes) and an adult group with ages > or =13 years (17 eyes). The axial length of the right eye of 30 adult men without eye diseases whose refractive error ranged from +/- 1.0 diopter served as controls. RESULTS: In the adult patient group, the refractive error was significantly more hypermetropic and the axial length was significantly shorter than was the normal adult group (P <.001). CONCLUSION: These results strongly suggest that the hypermetropia in patients with X-linked retinoschisis is axial hypermetropia.

Adolescent↗

Refractive errors in children born before 32 weeks gestation.

PURPOSE: To document the refractive errors in a cohort of children born before 32 weeks gestation. METHODS: All children born before 32 weeks gestation between 1 January 1990 and 31 December 1991 to mothers resident in the Northern Region of the National Health Service were examined at 2 years old (n = 558). RESULTS: Stage 3 or worse retinopathy of prematurity (ROP) was associated with myopia. In those not developing stage 3 or worse ROP, the refractive errors were myopia in 1.5%, hypermetropia > 4 dioptres (D) in 5.4%, anisometropia > 1 D in 1.1% and astigmatism > 1.25 D in 5.7%. CONCLUSION: The incidence of refractive errors in those not developing stage 3 or worse ROP was similar to that in the general population.

Acute Disease↗

Effect of uncorrected refractive errors upon central visual field testing.

An investigation of the effects of uncorrected refractive errors upon a central visual field examination has been made with a view to establishing what the likely effects would be of omitting a refractive correction when screening the visual field with a threshold related, supra-threshold strategy on the Henson CFA3000. The results indicate that, while a linear relationship exists between the extent of threshold elevation and the product of residual refractive error and pupil size, the scatter in the results means that accurate predictions cannot be made in individual cases. The threshold elevation was found to be independent of eccentricity (within the central 21 degrees from fixation) and did not increase the variability of results. These last two findings indicate that uncorrected refractive errors are unlikely to affect the sensitivity of the threshold related, supra-threshold strategy to localized visual field defects.

Adult↗

Stereopsis angle in relation to proximity and induced refractive errors.

Dependence of stereoacuity (SA) angle on the reciprocal of the test distance with positive, negative, and zero values of induced refractive errors is demonstrated with the three-rod test and the mean errors statistical method. Two male emmetropes and one hyperope showed linearly increasing dependence of SA angle on the reciprocal of the test distance within the subject's range of clear vision extended at both ends by 1 D. Linear regression coefficients were not influenced by the value of induced refractive error within +/- 2 D. Correlation coefficients in the case of corrected refractive error were about 0.90, but their mean value in the case of induced refractive errors was 0.83.

Adult↗

The biological basis of myopic refractive error.

Myopia is among the most common refractive errors and is associated with the greatest risk of pathological outcomes. Most animals, including humans, are born with hyperopic errors. During development, axial elongation of the eye occurs and is regulated through a vision-dependent process, known as emmetropisation The extremely rapid changes in the prevalence of myopia and the dependence of myopia on the level of education indicate that there are very strong environmental impacts on the development of myopia. This conflicts with the common occurrence of familial patterns of inheritance of myopia, which suggests a role for genetic determination. There are more than 150 defined genetic syndromes in which familial high myopia is one of the features, including some that are not associated with other syndromes. The evidence for the roles of both nature and nurture in the aetiology of myopia is discussed. This review also examines the experimentally induced refractive errors associated with form-deprivation, recovery from form deprivation and the effects of both negative and positive lenses. In addition, it looks at the local and optical control of eye growth. Finally, the various control pathways for growth are considered. These include dopamine, ZENK-glucagon, retinoic acid and retinoic acid receptors, crystallin, seratonin and melatonin, vasoactive intestinal peptide and enkephalins, nitric oxide and various growth factors.

Accommodation, Ocular↗

Refractive errors and visual impairment in 900 adults with intellectual disabilities in the Netherlands.

PURPOSE: To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. PATIENTS: A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. METHODS: All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. RESULTS: Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). CONCLUSIONS: With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Adult↗

Studies on the role of the retinal dopamine/melatonin system in experimental refractive errors in chickens.

We have found that development of both deprivation-induced and lens-induced refractive errors in chickens implicates changes of the diurnal growth rhythms in the eye (Fig. 1). Because the major diurnal oscillator in the eye is expressed by the retinal dopamine/melatonin system, effects of drugs were studied that change retinal dopamine and/or serotonin levels. Vehicle-injected and drug-injected eyes treated with either translucent occluders or lenses were compared to focus on visual growth mechanisms. Retinal biogenic amine levels were measured at the end of each experiment by HPLC with electrochemical detection. For reserpine (which was most extensively studied) electroretinograms were recorded to test retinal function [Fig. 3 (C)] and catecholaminergic and serotonergic retinal neurons were observed by immunohistochemical labelling [Fig. 3(D)]. Deprivation myopia was readily altered by a single intravitreal injection of drugs that affected retinal dopamine or serotonin levels; reserpine which depleted both serotonin and dopamine stores blocked deprivation myopia very efficiently [Fig. 3(A)], whereas 5,7-dihydroxy-tryptamine (5,7-DHT), sulpiride, melatonin and Sch23390 could enhance deprivation myopia (Table 1, Fig. 5). In contrast to other procedures that were previously employed to block deprivation myopia (6-OHDA injections or continuous light) and which had no significant effect on lens-induced refractive errors, reserpine also affected lens-induced changes in eye growth. At lower doses, the effect was selective for negative lenses (Fig. 4). We found that the individual retinal dopamine levels were very variable among individuals but were correlated in both eyes of an animal; a similar variability was previously found with regard to deprivation myopia. To test a hypothesis raised by Li, Schaeffel, Kohler and Zrenner [(1992) Visual Neuroscience, 9, 483-492] that individual dopamine levels might determine the susceptibility to deprivation myopia, refractive errors were correlated with dopamine levels in occluded and untreated eyes of monocularly deprived chickens (Fig. 6). The hypothesis was rejected. Although it has been previously found that the static retinal tissue levels of dopamine are not altered by lens treatment, subtle changes in the ratio of DOPAC to dopamine were detected in the present study. The result indicates that retinal dopamine might be implicated also in lens-induced growth changes. Surprisingly, the changes were in the opposite direction for deprivation and negative lenses although both produce myopia. Currently, there is evidence that deprivation-induced and lens-induced refractive errors in chicks are produced by different mechanisms. However, findings (1), (3) and (5) suggest that there may also be common features. Although it has not yet been resolved how both mechanisms merge to produce the appropriate axial eye growth rates, we propose a scheme (Fig. 7).

5,7-Dihydroxytryptamine↗

The effect of refractive error on automated global analysis program G-1.

We determined the effect of induced refractive errors on the visual field indices of the Octopus global analysis program G-1. After cycloplegia, refractive errors were introduced randomly in ten nonglaucomatous eyes of ten patients. Mean defect values (+/- S.D.) were lowest (2.4 +/- 0.8 dB) with full cycloplegic correction. With increasing ametropia, the mean defect increased significantly; it was 3.6 +/- 0.8 dB (P less than .0001) with the addition of +1.00 diopter and 5.3 +/- 0.9 dB (P less than .0001) with +2.00 diopters of sphere over the full cycloplegic correction. No significant differences in corrected loss variance, skew, short-term fluctuation, or reliability factor could be determined with changes in refractive error.

Adult↗

[Relation between postoperative refraction errors and decentration of the intraocular lens].

In a group of 51 patients the authors measured the position of the intraocular lens (the method was based on mathematical analysis of the Purkinje images position) and calculated the postoperative refractive error. The dependence of the postoperative refractive error on IOL position was analyzed and the results of the analysis were compared with the presumptions based on theoretical calculations. The results obtained from the measurement are very close to that assessed by the theoretical calculations. The IOL decentration in the eye causes the the shift of the postoperative refractive error towards myopia and it is probably the cause of the part of the postoperative refractive error.

Humans↗

[The role of light in pathogenesis of refractive errors].

PURPOSE: To present and account the results of newest experimental and clinical investigations on the subject of the light effect on the creation of refractive errors. MATERIAL AND METHODS: A review of literature concerning the role of the light in the refractive errors' pathogenesis has been performed. RESULTS: The influence of continuous light and night adaptation on the eyeball development as well as on the creation of refractive errors in experimental conditions are discussed. The anatomical and biochemical changes taking place in the course of experimental myopia are described. The entities of diseases predisposing to the creation of myopia are characterized. The results of the newest clinical investigations in which was shown that myopia and hyperopia might be associated with sleeping in lighted rooms up to the age of two are presented as well as accounted. CONCLUSIONS: Light and darkness play an important role in the proper eye development. Disturbance of the diurnal cycle over the time during which refraction forms may create refractive errors.

Adaptation, Physiological↗

Corneal asphericity and refractive error.

The relationship between corneal curvature measured by classical keratometry and refractive error raises the question of a possible systematic relationship between refractive error and the degree of corneal asphericity. A recomputation and analysis of previously published data leads to the conclusion that the different refractive groups have similar values of the parameter 'p' and differ only in the apical radius of the cornea.

Cornea↗

Intraocular pressure associations with refractive error and axial length in children.

AIM: To assess whether intraocular pressure (IOP) is associated with refractive error or axial length in children. METHODS: Of subjects from the Singapore Cohort Study of the Risk Factors for Myopia (SCORM), 636 Chinese children aged 9-11 years from two elementary schools underwent non-contact tonometry, cycloplegic autorefraction, and A-scan biometry during 2001. For analyses, refractive error was categorised into four groups; hypermetropia (spherical equivalent refraction (SE) > or = +1.0D), emmetropia (-0.5D<SE< +1.0D), low myopia (-3.0D<SE< or = -0.5D) and high myopia (SE< or = -3.0D). RESULTS: Of the 636 children examined, 50.6% were male. The mean IOP was 16.6 (SD 2.7) mm Hg. There were no significant IOP differences between low (mean IOP = 16.4 (2.8) mm Hg) or high myopes (16.7 (2.5) mm Hg) and emmetropes (16.7 (2.9) mm Hg), p = 0.57. IOP was not correlated with spherical equivalent refraction (Spearman correlation, r = 0.009) or axial length (r = 0.030). In regression analyses adjusting for diastolic blood pressure, neither spherical equivalent (regression coefficient = 0.014) nor axial length (regression coefficient = 0.027) were significantly associated with IOP. CONCLUSION: These findings do not support an association between IOP and refractive error or axial length in children. This questions postulated roles of IOP in the pathogenesis of myopia.

Biometry↗

Genes and environment in refractive error: the twin eye study.

PURPOSE: A classical twin study was performed to examine the relative importance of genes and environment in refractive error. METHODS: Refractive error was examined in 226 monozygotic (MZ) and 280 dizygotic (DZ) twin pairs aged 49 to 79 years (mean age, 62.4 years). Using a Humphrey-670 automatic refractor, continuous measures of spherical equivalent, total astigmatism, and corneal astigmatism were recorded. Univariate and bivariate maximum likelihood model fitting was used to estimate genetic and environmental variance components using information from both eyes. RESULTS: For the continuous spectrum of myopia/hyperopia, a model specifying additive genetic and unique environmental factors showed the best fit to the data, yielding a heritability of 84% to 86% (95% confidence interval [CI], 81%-89%). If myopia and hyperopia (< or = -0.5 D and > or = 0.5 D, respectively) were treated as binary traits, the heritability was 90% (95% CI, 81%-95%) for myopia and 89% (95% CI, 81%-94%) for hyperopia. For total and corneal astigmatism, modeling showed dominant genetic effects are important; dominant genetic effects accounted for 47% to 49% of the variance of total astigmatism (95% CI, 37%-55%) and 42% to 61% of corneal astigmatism variance (95% CI, 8%-71%), with additive genetic factors accounting for 1% to 4% and 4% to 18%, respectively (95% CIs, 0%-13% and 0%-60%, respectively). CONCLUSIONS: Genetic effects are of major importance in myopia/hyperopia; astigmatism appears to be dominantly inherited.

Aged↗

Laser in situ keratomileusis and photorefractive keratectomy for residual refractive error after phakic intraocular lens implantation.

PURPOSE: To determine the visual and refractive outcome of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in eyes with prior posterior chamber phakic intraocular lens implantation for high myopia. METHODS: We studied a series of 37 consecutive eyes of 31 patients who underwent LASIK or PRK for residual refractive error following collamer posterior chamber intraocular lens (IOL) (Staar Surgical Implantable Contact Lens) implantation into a phakic eye. Twenty-eight eyes had LASIK and nine eyes had PRK. Mean follow-up was 8.1 +/- 4.7 months after laser ablation (range, 3 to 18 mo). RESULTS: The preoperative mean spherical equivalent refraction prior to phakic posterior chamber IOL implantation was -17.74 +/- 4.89 D (range, -9.75 to -28.00 D). Following phakic IOL implantation and prior to LASIK or PRK, mean spherical equivalent refraction was -2.56 +/- 2.34 D (range, -0.25 to -8.75 D). One month following LASIK or PRK, mean spherical equivalent refraction was -0.24 +/- 0.52 D (range, -1.50 to +1.50 D), 3 months following LASIK or PRK, mean spherical equivalent refraction was -0.19 +/- 0.50 D (range, -1.50 to +1.00 D). The refraction was within +/-1.00 D of emmetropia in 36 eyes (97.2%) and within +/-0.50 D in 31 eyes (83.7%). Three eyes developed anterior subcapsular opacities several weeks after laser ablation, one eye developed macular hemorrhage 4 weeks after laser ablation, and one eye had corticosteroid induced ocular hypertension. CONCLUSIONS: LASIK or PRK can be used to treat the residual refractive error following posterior chamber phakic IOL implantation.

Adult↗

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER.

PURPOSE: To report the prevalence of blindness and visual impairment and the contribution of uncorrected refractive error to visual loss, in a population-based sample of Mexican Americans aged 40 and older. METHODS: Proyecto VER is a population-based study of blindness and visual impairment in Mexican Americans in Arizona. Block groups in Tucson and Nogales were randomly selected with probability proportional to the size of the Mexican-American population aged 40 and older. Participants had a complete ophthalmic evaluation, including assessment of presenting and best corrected visual acuity using standardized procedures. Those with presenting visual acuity worse than 20/30 had refraction to determine best corrected vision. A home questionnaire and a clinic examination provided data on education, perception of visual impairment, income, and acculturation. RESULTS: The prevalence of presenting visual acuity worse than 20/40 was 8.2%, with uncorrected refractive error accounting for 73% of the impaired acuity. In multivariate models comparing those who improved two or more lines on the acuity chart with proper refraction with those who had adequate optical correction, uncorrected refractive error showed a strong association with age, less than 13 years of education (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.5-2.0), low acculturation index (OR 1.3, CI 1.1-1.3), lack of insurance coverage (OR 1.4, CI 1.1-1.7), and not having seen an eye-care provider in the past 2 years (OR 2.5, CI 2.1-3.0). Prevalence of best corrected acuity worse than 20/40 increased from 0.3% in those aged 40 to 49 years to 18% in those aged 80 years or more. CONCLUSIONS: Visual loss in this Mexican-American population is higher than has been reported in whites and is comparable to that in African Americans. Almost three quarters of those with visual acuity impairment would improve with optical correction. Socioeconomic factors that are probable markers of limited access to health care services were associated with uncorrected refractive error. These data suggest that education programs and interventions to improve access to eye care could significantly decrease the burden of visual loss among Mexican Americans.

Adult↗

Geometrical optics and the statistical analysis of refractive error.

Relationships among statistical quantities used in the analysis of refractive error are derived from geometrical optics principles. The accuracy of these results are verified using the data of Sorsby et al. As an application of these results, it is shown that there is difficulty in accounting for leptokurtosis of refractive error in terms of correlation among the optical parameters of the eye. Also, it is shown that the distribution of the optical parameters of the eye cannot be a joint-normal distribution.

Humans↗