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Off-axis refraction and aberrations following conventional laser in situ keratomileusis.

PURPOSE: To investigate off-axis refraction and aberrations following conventional laser in situ keratomileusis (LASIK) for myopia and hypermetropia. SETTING: School of Optometry, Queensland University of Technology, Australia. METHODS: Using an autorefractor, off-axis refractions were analyzed along the horizontal visual field between 35 degrees nasally and 35 degrees temporally in 1 eye each of 15 emmetropic subjects (-0.50 to +0.50 diopters [D]), 6 myopic subjects (-2.25 to -6.50 D), 6 hyperopic subjects (+1.50 to +3.00 D), 6 myopic LASIK patients (presurgical refraction -2.75 to -9.00 D), and 6 hyperopic LASIK patients (presurgical refraction +0.75 to +2.00 D). Wavefront sensing measured off-axis higher-order aberrations in 2 myopic LASIK patients. RESULTS: In myopic LASIK, the mean spherical components of refraction M became highly myopic away from the center of the visual field; in emmetropic and untreated myopic eyes, there were relatively small myopic shifts and hyperopic shifts, respectively. Off-axis 90-degree to 180-degree astigmatisms J180 in myopic LASIK subjects were greater than in untreated subjects. In hyperopic LASIK, there were mainly hyperopic shifts in M, opposite the direction in emmetropic and untreated hyperopic subjects. Off-axis J180 was less than in emmetropic and untreated hyperopic subjects. Some hyperopic LASIK patients had greater off-axis 45-degree to 135-degree astigmatisms J45 than patients in the other groups. In 2 myopic LASIK patients, Zernike root-mean-square 4th-order aberrations were higher than in the near-emmetropia group because of higher levels of positive spherical aberration. CONCLUSIONS: Off-axis aberrations can be dramatically affected by conventional myopic and hyperopic LASIK. In myopic LASIK, the increased off-axis refractive errors may have adverse effects on peripheral visual tasks that are dependent on off-axis refractive errors. The relatively low off-axis refractive errors in hyperopic LASIK patients may improve peripheral visual tasks.

Adult↗

Effect of cataract surgery incision location and intraocular lens type on ocular aberrations.

PURPOSE: To determine whether Hartmann-Shack wavefront sensing detects differences in optical performance in vivo between poly(methyl methacrylate) (PMMA) and foldable acrylic intraocular lenses (IOLs) and between clear corneal and scleral tunnel incisions and whether optical differences are manifested as differences in visual performance. SETTING: Department of Optometry, University of Bradford, West Yorkshire, United Kingdom. METHODS: This study comprised 74 subjects; 17 were phakic with no ocular pathology, 20 had implantation of a Pharmacia 722C PMMA IOL through a scleral tunnel, 21 had implantation of an Alcon AcrySof IOL through a scleral tunnel, and 16 had implantation of an AcrySof IOL through a corneal incision. Visual acuity and contrast sensitivity testing, ocular optical quality measurement using Hartmann-Shack wavefront sensing, and corneal surface measurement with a videokeratoscope were performed in all cases. RESULTS: There were significant differences between groups in the total root-mean-square (RMS) wavefront aberration over a 6.0 mm pupil (F=3.91; degrees of freedom=3,70; P<.05) mediated at the 4th-order RMS, specifically spherical and tetrafoil aberrations. The PMMA-scleral group had the least aberrations and the AcrySof-corneal group the most. For a 3.5 mm diameter pupil, the total higher-order RMS wavefront aberration was not significantly different between the groups (P>.05). There were no differences between groups in corneal shape, visual acuity, or contrast sensitivity. CONCLUSIONS: Implantation of the spherical PMMA IOL led to a slight reduction in total wavefront aberration compared to phakic eyes. AcrySof IOLs induced more aberrations, especially spherical aberration. Corneal-based incisions for IOL implantation compounded this increase. Studies of the optical performance of IOLs in vivo should use wavefront sensing as the main outcome measure rather than visual measures, which are readily confounded by multiple factors.

Acrylic Resins↗

Repeatability of autorefraction and axial length measurements after laser in situ keratomileusis.

PURPOSE: To assess the repeatability and agreement of refractive error measurements and the repeatability of axial length (AL) measurements in patients after laser in situ keratomileusis (LASIK). SETTING: The Ohio State University College of Optometry, Columbus, Ohio, USA. METHODS: Subjective refraction, autorefraction measurements with the Grand Seiko and Humphrey autorefractors, and AL measurements with the IOLMaster were completed for 40 previously myopic LASIK patients under noncycloplegic and cycloplegic conditions on 2 separate occasions. RESULTS: The mean difference between visits for axial length measurements was 0.008 mm +/- 0.04 (SD). The between visits repeatability for all refractive error measurements were <0.75 diopter (D). The mean difference between the subjective refraction and the Humphrey autorefractor for spherical equivalent was statistically significant under noncycloplegic conditions (-0.90 D, P<.0001) and cycloplegic conditions (-2.05 D, P<.0001). The mean difference between subjective refraction and Grand Seiko autorefraction measurements was not significant under noncycloplegic conditions (+0.05 D, 95% limits of agreement [LoA]=-0.99, 1.09; P=.52) conditions but was statistically significant, but not clinically relevant, under cycloplegic conditions (+0.17 D, 95% LoA=-0.73, 1.07; P=.03). CONCLUSIONS: Refractive error measurements after LASIK using the Grand Seiko autorefractor are reliable and agree well with subjective refraction measurements.

Adult↗

Changes in quality of life after laser in situ keratomileusis for myopia.

PURPOSE: To measure quality of life (QoL) outcome in prepresbyopic myopic patients having laser in situ keratomileusis (LASIK) refractive surgery using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire and to compare the QoL of preoperative patients with a sample of spectacle and contact lens wearers not considering refractive surgery. SETTING: Department of Optometry, University of Bradford, Bradford, and Ultralase, Leeds, West Yorkshire, United Kingdom. METHODS: The validated QIRC questionnaire was prospectively completed by 66 patients before and 3 months after LASIK. Patients had myopia greater than 0.50 diopters (D) (range --0.75 to --10.50 D) and were aged 16 to 39 years. Patients were also directly asked to evaluate their QoL after surgery. RESULTS: Overall QIRC scores improved after LASIK from a mean of 40.07+/- 4.30 (SD) to 53.09+/- 5.25 (F(1,130)=172.65, P<.001). Greater improvements occurred in women (53.83+/- 5.46) than in men (49.39+/- 5.94; F(1,64)=9.37, P<.005). Overall, 15 of the 20 questions (especially convenience, health concerns, and well-being questions) showed significantly improved scores (P<.05). Patients who "strongly agreed" (53.96+/- 4.91, n=33) or "agreed" (51.78+/- 6.19, n=23) had improved QoL and had significantly higher QIRC scores than those who "neither agreed nor disagreed" (44.36+/- 4.97, n=5) or "strongly disagreed" (42.82, n=1) (F(1,60)=11.24, P<.001). The matched group not contemplating LASIK scored 42.41 +/- 3.89 on QIRC overall. CONCLUSIONS: Large improvements in QIRC QoL scores were found after LASIK for myopia in the majority of patients, with greater improvements in women. A small number of patients (4.5%) had decreased QIRC QoL scores, and these were associated with complications. People presenting for LASIK scored measurably poorer than matched patients not contemplating refractive surgery.

Adult↗

Lens epithelial cell ongrowth: comparison of 6 types of hydrophilic intraocular lens models.

PURPOSE: To compare the ongrowth of lens epithelial cells (LECs) on the anterior surface of 6 different hydrophilic intraocular lenses (IOLs). SETTING: Medical University of Vienna, Department of Ophthalmology and Optometry, Vienna, Austria. METHODS: Six models of hydrophilic IOLs were compared in this prospective study: Visionflex A-100 (Distra Softcryl), Rayner Centerflex 570H (Rayner), Collamer CC4204BF-IOL (Staar), Injectacryl F 3000 (Distra), Hydroview H60M (Bausch & Lomb), and MemoryLens (ORC). Postoperative biomicroscopic examinations were performed 1, 3, 7, 30, 90, 180, and 365 days after surgery. Lens epithelial cells in each quadrant of the anterior capsule-free lens surface were graded. The product with the highest density and the number of quadrants with this density were used to measure LEC ongrowth. RESULTS: The Hydroview and Visionflex IOLs showed significantly more LECs than the other IOLs starting on day 7 after surgery (P < .028). There was a statistically significant difference in LEC ongrowth on the Memory IOL compared with all other IOLs from day 30 onward (P < .001). The Rayner, Collamer and Injectacryl IOLs had the fewest LECs on the anterior surface compared with all other IOLs from day 7 until the final examination. CONCLUSIONS: The findings show that LEC ongrowth on the IOL surface is material dependent. The findings suggest that the material of the recently developed hydrophilic IOLs induces less LEC ongrowth than older models.

Cataract↗

Ophthalmology and vision science research. Part 1: Understanding and using journal impact factors and citation indices.

In an increasingly "publish or perish" clinical and academic environment, all clinicians and clinician-scientists involved in research must have a firm understanding of the measures commonly used to assess the quality of scientific journals and, by default, those extended to grade individual articles and authors. The publication of research is a vital part of clinical and experimental research, and citation analyses of research publications have increasingly been adopted as a means of assessing the apparent quality of journals and the research published therein. In the first of a series of articles for those embarking on ophthalmic and vision science research, this paper discusses the key features of citation analysis, concentrating on the 2004 Journal Citation Report figures for the field of ophthalmology that include 42 ophthalmology, vision science, physiological optics, and optometry journals. The Institute for Scientific Information (ISI) calculates a number of parameters including citation counts, Journal Impact Factor (JIF), Immediacy Index, and cited/citing half-life. This article discusses the methods of calculation and possible uses along with current controversies and potential abuses. The JIF and its relevance, potential bias, and limitations are discussed in depth as it has become the most widely used analysis of journal quality. The possible alternatives to ISI citation analysis are presented, and we conclude that citation analysis can be considered a reasonable measure of journal research quality only if used correctly.

Bibliometrics↗

Computer simulation of visual outcomes of wavefront-only corneal ablation.

PURPOSE: To evaluate the effectiveness, predicted visual outcome, and limitations of a corneal ablation algorithm that uses wavefront aberration measurement alone without the need for corneal shape information. SETTING: Contact Lens and Visual Optical Laboratory, School of Optometry, Queensland University of Technology, Brisbane, Australia. METHODS: Corneal topography and wavefront error data from 22 eyes of 11 potential refractive surgery candidates were used. A computer simulation of the corneal ablation was performed, and the predicted postoperative visual outcome was assessed by calculating the resulting wavefront root-mean-square (RMS) values and visual Strehl ratios. Additionally, the effect of ablation alignment error was examined. Finally, the visual outcomes of the wavefront-only corneal ablations were compared to those in an age-matched group of 20 emmetropic patients. RESULTS: Significant improvement in total and higher-order wavefront RMS was achieved postoperatively in both an ideal setting and in the case of ablation alignment errors. The predicted improvement in visual Strehl ratio in the potential refractive surgery candidates was significantly better than that in the untreated emmetropes. After additional simulated decentration of the pupil center by 150 microm, the result was slightly worse, but the change was found to not be significant when compared to the retinal image quality of emmetropes. CONCLUSIONS: Wavefront-only corneal ablation algorithms could potentially lead to significantly better visual outcomes than those normally encountered in untreated emmetropes, provided that the alignment error is not large. The presented methodology may be used as a screening tool to predict patients' visual outcomes before the surgery.

Adolescent↗

Capabilities of potential vision test measurements: clinical evaluation in the presence of cataract or macular disease.

PURPOSE: To determine the usefulness of a battery of potential vision tests (PVTs) including potential acuity meter (PAM), laser interferometer (LI), critical flicker/fusion frequency (CFF), superilluminated pinhole at distance (SPH(d)) and near (SPH(n)), and optimal reading speed (ORS) by their independence of the effects of cataracts and sensitivity to macular disease (MD). SETTING: Department of Optometry, University of Bradford, Bradford and Leeds General Infirmary, Leeds, United Kingdom. METHODS: Potential vision test measurements were determined in 76 patients with age-related cataract and no other eye disease, 52 patients with MD and clear ocular media, and 28 patients with normal, healthy eyes. RESULTS: Potential vision tests were independent of the degrading effects of cataract up to a visual acuity (VA) level of 20/200 or worse (CFF), 20/125 (ORS and SPH), and 20/40 (PAM and LI). A high degree of association was found between PVT scores and distance VA in the MD group for SPH(d) (r2 = 0.93), SPH(n) (r2 = 0.89), and PAM (r2 = 0.71). A moderate correlation was found for LI (r2 = 0.55), CFF (r2 = 0.50), and ORS (r2 = 0.45). CONCLUSIONS: Potential acuity meter and LI showed very limited independence to moderate/dense cataracts and inaccurate predictions in patients with MD. Superilluminated pinhole was relatively unaffected by moderate/dense cataract and yet provided accurate predictions in the presence of MD and clear ocular media. Critical flicker/fusion frequency showed the greatest ability to bypass cataracts, although its ability to predict VA in patients with early MD was limited. The ORS was relatively unaffected by moderate/dense cataract, but its poor ability to predict VA in MD may limit its clinical suitability as a PVT.

Aged↗

Developmental Eye Movement Test: reliability and symptomatology.

BACKGROUND: The Developmental Eye Movement Test (DEM) is a widely used visual skill test, especially in the context of a vision therapy evaluation. It is intended to diagnose oculomotor dysfunction (OMD) and can also identify deficient rapid automatized naming. As such, its reliability and associated symptomatology are important. METHODS: The DEM test-retest reliability was investigated within two populations: a group of 53 office patients who were participating in vision therapy evaluation in a private optometry practice, and a smaller group of 13 subjects at their school. One to four weeks separated the test and retest for both groups. We also studied the relationship between results on a questionnaire of symptoms associated with OMD and DEM test performance in these two populations. RESULTS: The first administration of the DEM significantly correlated with the second for all four of its scores for both groups. The office group had higher intra-class correlation coefficients than the school group. There was good agreement between test and re-test in terms of pass-fail classification for the office group. Symptomatic subjects performed poorer than asymptomatic subjects on the DEM. Failing the DEM Ratio, the score used to diagnose OMD, identified 90% of the subjects who were symptomatic. CONCLUSIONS: The DEM has good intra-subject test-retest reliability for all four of its scores when it is administered in an office setting to patients participating in a vision therapy evaluation. It also has good consistency in classifying patients as pass or fail. Performance on the DEM relates to certain symptoms that are associated with OMD.

Adolescent↗

Complications of intravitreal steroid injections.

BACKGROUND: Intravitreal corticosteroid injections are a new therapeutic procedure used to treat various retinal edematous and neovascular conditions. They have been used in the treatment of diabetic macular edema, exudative macular degeneration, pseudophakic cystoid macular edema, macular edema associated with retinal vein occlusion, and chronic uveitis as well as other conditions. Because the use of this therapeutic technique is becoming increasingly more common, adverse effects are now being seen. The most common adverse effects associated with intravitreal steroid injection are elevation of intraocular pressure and progression of cataract. Endophthalmitis, pseudoendophthalmitis, and retinal detachment have also been reported. CASE REPORTS: This report describes 2 patients who were followed up at the VA Connecticut Healthcare System Newington Campus Optometry Clinic for steroid-induced elevation of intraocular pressure after intravitreal corticosteroid injection. One patient exhibited elevation of intraocular pressure after his first intravitreal steroid injection for treatment of clinically significant macular edema secondary to diabetes. The second patient did not exhibit a steroid response to the first intravitreal steroid injection utilized as treatment for choroidal neovascularization from age-related macular degeneration. However, he did show a rise in intraocular pressure after a second intravitreal corticosteroid injection. Intraocular pressures, treatment, and frequency of follow-up in both patients pre- and postinjection are discussed. CONCLUSION: Elevation of intraocular pressure after intravitreal steroid injection can commonly be controlled with topical glaucoma medications. Cataract progression is common in patients after intravitreal injection of corticosteroid; however, findings show these patients are at no additional risk for cataract surgery complications. Therefore, these do not appear to be major contraindications. However, because 30% to 50% of patients experience intraocular pressure rise up to a few months postinjection, and patients are at higher risk for complications such as endophthalmitis, optometrists should be aware of appropriate management after this increasingly utilized therapeutic procedure.

Aged↗

Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study.

BACKGROUND: Accommodative dysfunction and convergence insufficiency (CI) are common pediatric vision problems that have been associated with an increase in frequency and severity of vision-specific symptoms that affect children when doing schoolwork. However, the relationship between accommodative dysfunction and CI and other learning problems, such as attention deficit hyperactivity disorder (ADHD), are not well understood. The purpose of this study was to evaluate the frequency of ADHD behaviors in school-aged children with symptomatic accommodative dysfunction or CI. METHODS: Children 8 to 15 years of age with symptomatic accommodative dysfunction or CI were recruited from the teaching clinic at the Southern California College of Optometry. Children with learning disabilities or ADHD were excluded. One parent of each child completed the Conners Parent Rating Scale-Revised Short Form (CPRS-R:S). The children's scores on the CPRS-R:S were compared with the normative sample. RESULTS: Twenty-four children (9 boys and 15 girls) participated in the study with a mean age of 10.93 years (SD = 1.75). On the CPRS-R:S, cognitive problem/inattention, hyperactivity, and ADHD index were significantly different from normative values (p < or = .001 for all tests). CONCLUSIONS: The results from this preliminary study suggest that school-aged children with symptomatic accommodative dysfunction or CI have a higher frequency of behaviors related to school performance and attention as measured by the CPRS-R:S.

Accommodation, Ocular↗

Normative data for modified Thorington phorias and prism bar vergences from the Benton-IU study.

BACKGROUND: The use of a phoropter for measuring phorias and vergences in children is common in the optometric profession. For young children, the use of the phoropter can be confusing, making it difficult to obtain accurate measurements. Free space testing allows for direct observation of the eyes in a natural environment and is easier for children to understand the directions. The normal values for phorias and vergences used with children are derived from testing with a phoropter or free space measurements with mostly adult patients. METHODS: The Benton-IU Project was a large multidisciplinary study of factors affecting school performance conducted by the Indiana University School of Optometry and the Indiana University Department of Speech and Hearing with the cooperation of the Benton Community School Corporation (Benton County, Indiana). This project allowed the authors to obtain data on modified Thorington phorias and prism bar vergences from a nonselected group of first and fourth graders as part of an eye/vision examination. RESULTS: In this report, central tendency and variability statistics for modified Thorington and prism bar vergences are reported based on the data from the Benton-IU Study. CONCLUSION: The data presented in this report can be used by optometrists when deciding if the patient's phorias and vergences are within normal limits for children in the first through fourth grades.

Accommodation, Ocular↗

Blood pressure control in an African American sample with diabetes mellitus in an urban eye clinic.

BACKGROUND: The adequate control of blood pressure in patients with diabetes mellitus (DM) is important to limit the ocular and systemic complications of the disease. Hypertension in African Americans is among the highest in the world. This cross-sectional study reports the level of blood pressure control in a small sample of African American patients with DM at an urban eye care facility using the criteria defined by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII). METHODS: Five attending faculty members of the Illinois College of Optometry identified 234 African American patients with a diagnosis of DM over a period of 16 months. Blood pressure readings were recorded once at the time of their visit and were classified as controlled or uncontrolled based on the JNC VII cutoff of blood pressure less than 130/80 mmHg. RESULTS: Among the 234 African American patients in this study, 174 (74.4%) reported having DM and hypertension, and 60 (25.6%) reported having DM without hypertension. Of the patients with DM and a self-reported diagnosis of hypertension, 13.2% were controlled. Of the patients with diabetes without a self-reported diagnosis of hypertension, 26.7% were found to be adequately controlled. For the pooled data of 234 patients with diabetes, 16.7% met the JNC VII guidelines. CONCLUSION: The inadequate control of blood pressure in the African American population with DM is associated with increased disability and death from cardiovascular and renal disease. The results of this small cross-sectional study are consistent with those of other studies that show poor control of blood pressure in African American patients who have DM. Preventable blindness secondary to accelerated diabetic retinopathy from uncontrolled hypertension is a concern to all eye care practitioners.

Black or African American↗

Visual risk factors for driving difficulty among older drivers.

This study sought to evaluate associations between visual function and self-reported difficulty with driving tasks. Drivers (N = 384) between the ages of 55 and 85 were selected from ophthalmology practices and optometry clinics; three out of four of the sample had cataracts and the remaining were cataract-free. Information on driving exposure and difficulty was obtained via self-report. Visual functional status of all participants was measured with respect to acuity, contrast sensitivity, disability glare and useful field of view. Cognitive impairment was evaluated using the Mattis Organic Mental Syndrome Screening Examination. The results show a pattern of difficulty in high-risk driving situations among those with decreased visual acuity and contrast sensitivity, even after adjustments for age, gender, weekly mileage, and cognitive impairment.

Age Factors↗

Compensatory changes in eye growth and refraction induced by daily wear of soft contact lenses in young marmosets.

Several studies have shown that growth of the primate eye responds in a compensatory direction to both positive and negative spectacle lenses--eyes grow more slowly and become hyperopic in response to positive lenses, and eyes grow more rapidly and become myopic in response to negative lenses. On the other hand, extended wear soft contact lenses, whether positively or negatively powered, induce hyperopia (Hung & Smith, 1996. Extended-wear, soft, contact lenses produce hyperopia in young monkeys. Optometry & Vision Science 73, 579-584.). We investigated whether responses in a compensatory direction occurred to soft contact lenses worn on a daily wear basis (8 h per day on an 8:16 h light:dark cycle). Ten infant marmosets (8-13 weeks of age) wore a soft contact lens, in one eye only, for 5-9 weeks. Lens powers used were zero (n = 2), +2 D (n = 1), +2 D followed after 5 weeks of lens wear by +4 D (n = 1) for 4 weeks, +4 D (n = 2), -2 D followed after 5 weeks of lens wear by -4 D (n = 2) for 4 weeks, -4 D (n = 2). At the end of the lens-wear period the positive lens-wearing eyes were more hyperopic relative to the fellow untreated eyes [mean +2.39 +/- 0.24 D (SE)] and the negative lens-wearing eyes were more myopic than the fellow untreated eyes [mean -2.48 +/- 0.91 D (SE)]. Fellow eyes were unaffected by lens wear [mean final refraction +0.45 +/- 0.09 D (SE)]. Plano lenses did not affect eye growth in either marmoset fitted with plano contact lenses.

Analysis of Variance↗

Overnight lens removal avoids changes in refraction and eye growth produced by plano soft contact lenses in infant marmosets.

Infant marmosets were fitted with zero-powered (plano) soft contact lenses from 4 to 8 weeks of age worn either continuously (24 h per day) (n = 4), for 12 h (n = 4), or for 8 h (n = 3) per day to determine whether limiting the daily duration of lens-wear could significantly reduce or eliminate the effects of continuous lens-wear on ocular growth and refractive state. As in macaques (Hung, L. F., & Smith, E. L. (1996). Extended-wear, soft, contact lenses produce hyperopia in young monkeys. Optometry and Vision Science, 73, 579-584), eyes fitted with contact lenses worn continuously developed more hyperopic refractions (mean +3.22 +/- 1.49 D SE) compared to their fellow untreated eyes, inconsistent changes in vitreous chamber depth (-0.02 +/- 0.09 mm SE) and flatter corneas (mean decrease in corneal power 4.22 +/- 0.39 D SE). Eyes wearing lenses for only 12 h per day showed similar but reduced effects compared to the 24-h group. Most importantly, ocular growth, corneal power and refraction were unaffected in the 8-h group. Future studies using contact lenses in infant primates should employ a reduced daily duration of lens-wear to eliminate the undesirable effect of contact lens-wear per se on ocular development.

Analysis of Variance↗

Changes in posterior corneal curvature after photorefractive keratectomy.

PURPOSE: To determine whether myopic ablation by excimer laser photorefractive keratectomy (PRK) affects only the anterior curvature of the cornea or whether changes also occur in the posterior corneal curvature. SETTING: Department of Optometry and Neuroscience, UMIST, and Optimax Laser Eye Clinic, Manchester, United Kingdom. METHODS: Sixteen patients who presented for correction of myopia in 1 eye by excimer laser PRK were followed for 3 months. Only newly presenting patients were recruited, and the untreated eyes were used as controls. The patients were examined at the initial visit (0 week) and 6 and 12 weeks post-PRK. Measurements included Orbscan topography and pachymetry, autokeratometry, and ultrasound pachymetry. RESULTS: The mean patient age of the 8 men and 8 women was 29.6 years +/- 8.6 (SD) (range 20 to 47 years). The attempted mean spherical equivalent correction was between -1.73 and -6.43 diopters. Anterior corneal curvature and corneal thickness in the treated eyes changed systematically in relation to the amount of ablation. Posterior corneal curvature steepened in relation to the dioptric power treated. There were systematic differences between the pachymetry values obtained with the Orbscan and the ultrasound pachymeter. CONCLUSIONS: The results suggest that after myopic PRK, the thinner, ablated cornea may bulge forward slightly to steepen both anterior and posterior curvatures. This may account for the regression toward myopia that is typically found in the first few days posttreatment. The forward bulging is similar to the corneal relaxation effects observed after radial keratotomy.

Adult↗

Popperian falsification of methods of assessing surgically induced astigmatism.

To test several methods of assessing surgically induced astigmatism (SIA). Department of Ophthalmology, Arhus University Hospital, Arhus, Denmark. Assessment methods can be divided into 3 groups. Group 1 includes methods that consider only astigmatic magnitude and disregard astigmatic direction, such as the algebraic and simple subtraction methods. Group 2 can be termed "astigmatic magnitude not considering axis" and includes several almost identical techniques known as the methods of Naylor, Jaffe, Kaye, Holladay, and Olsen. Group 3 includes Naeser polar value analysis and the methods later described by Alpins and Holladay. The methods were tested in situations in which the expected result was known. When this result was not produced, the specific assessment method was considered falsified in a classical Popperian manner. The simple falsification experiments revealed that the methods in Groups 1 and 2 are erroneous. Mathematical analysis disclosed that the methods in Group 3 are similar, although derived from different concepts. The algebraic, simple subtraction, astigmatic magnitude not considering axis, and vector decomposition methods for assessment of SIA are erroneous and should not be used. The Naeser, Alpins, and Holladay methods are identical and in agreement with current research in optometry.

Astigmatism↗