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At least 1,027 records · Page 57Linked to original sources
PubMed2002

Development of refractive errors into old age.

PURPOSE: To evaluate refractive errors in older adults. METHODS: The distribution of refractive error components was evaluated in a sample of 569 older adults including 171 participants over the age of 80 years. The mean age was 75.2 years with a range from 59 to 106 years. Emphasis was placed on modern methods of analyzing astigmatic refractive errors, which convert cylindrical refractive errors into primary and oblique components. RESULTS: The known increase in hyperopia after maturity continues into old age. The primary negative astigmatic component increases dramatically in prevalence and amount after age 70 years, whereas the oblique component remains unchanged. Significant anisometropia is common in the oldest old, suggesting failure of emmetropization mechanisms with age. Substantial gender differences exist in refractive changes with age. CONCLUSIONS: The continuing changes in all components of refractive error into old age and the surprisingly high prevalence of large amounts of astigmatism and anisometropia emphasize the importance of regular refractive evaluations among the oldest old.

Aged↗
PubMed2002

Sensitivity and specificity of visual acuity screening for refractive errors in school children.

PURPOSE: To examine the optimal cutoff point for the use of the visual acuity test to screen for refractive errors in schoolchildren. METHODS: In a sample of schoolchildren between 7 and 9 years old, visual acuity testing was performed using modified ETDRS charts monocularly without optical aids by trained personnel. Cycloplegic autorefraction was performed in each eye. The screening efficacy of using various cutoff points for referring children for further optometric/ ophthalmic assessment was studied. Myopia was defined as a spherical equivalent of at least -0.5 D, hyperopia a spherical equivalent of at least +2.0 D, and astigmatism a cylinder of at least -1.0 D in at least one eye. The sensitivity, specificity, and predictive values were calculated using each patient as a case; a receiver operator curve was plotted. RESULTS: A total of 1,028 children were tested. A satisfactory sensitivity/specificity profile was obtained using a referral criterion of visual acuity worse than or equal to 0.28 logarithm of the minimum angle of resolution in at least one eye. In this scenario, the sensitivity and specificity of this screening test were 72% (95% confidence interval [CI], 68 to 76) and 97% (95%CI, 95 to 98), respectively. The positive and negative predictive values were 96% (95%CI, 93 to 98) and 78% (95%CI, 75 to 82), respectively. CONCLUSIONS: The modified ETDRS visual acuity chart can be used to predict refractive errors in schoolchildren in Singapore in a sensitive and specific manner using a referral criterion of worse than or equal to 0.28 logarithm of the minimum angle of resolution.

Child↗
PubMed2003

Ocular component data in schoolchildren as a function of age and gender.

PURPOSE: To describe the refractive error and ocular components of a large group of school-aged children as a function of age and gender. METHODS: In this report, we describe the refractive error and ocular components of 2583 school-aged children (49.3% girls, overall mean [+/-SD] age 10.0 +/- 2.3). Measurement methods included cycloplegic autorefraction, autokeratometry, videophakometry, and A-scan ultrasonography. For statistical comparisons across gender and age, a critical point of alpha = 0.005 was used to assess significance because of the large sample size and the large number of comparisons made. RESULTS: Of these 2583 children, 10.1% were myopic (-0.75 D or more myopia in both meridians), and 8.6% were hyperopic (+1.25 D or more hyperopia in both meridians). As would be expected, there was a significant effect of age on refractive error (spherical equivalent, p < 0.0001), toward less hyperopia/more myopia. There was no significant difference in the average refractive error between girls and boys (p = 0.0192). Girls had steeper corneas than boys (0.74 D steeper in the vertical meridian and 0.63 D steeper in the horizontal meridian, p < 0.0001). There were no significant differences in corneal power with age (p = 0.16). Both older age and male gender were significantly associated with deeper anterior chambers (p < 0.0001 for both). The crystalline lens showed significant thinning with age (p < 0.0001), however, there was no significant difference in the lens thickness between girls and boys (p = 0.66). Both Gullstrand lens power and calculated lens power showed significant effects of age and gender (p < 0.0001 for both). Girls, on average, had Gullstrand lens powers that were 0.28 D steeper and calculated lens powers that were 0.80 D more powerful than boys. Axial length also showed significant effects of age and gender (p < 0.0001 for both). Girls' eyes were, on average, 0.32 mm shorter than those of boys. CONCLUSIONS: These cross-sectional data show a general pattern of ocular growth, no change in corneal power, and crystalline lens thinning and flattening between the ages of 6 and 14 years. Girls tended to have steeper corneas, stronger crystalline lenses, and shorter eyes compared with boys.

Adolescent↗
PubMed2003

Prevalence of myopia among 12- to 13-year-old schoolchildren in northern Mexico.

PURPOSE: The aim of this article was to report the prevalence of refractive errors, mainly myopia, among 12- to 13-year-old children in a metropolitan setting in Mexico. METHODS: A total of 1035 schoolchildren were examined in a field study in Monterrey, Mexico. The examination included best-corrected visual acuity and refraction during cycloplegia. A sample of the children was sent to a pediatric eye clinic and underwent cycloplegic refraction with an autorefractor. RESULTS: We found a prevalence of myopia (>/=-0.5 D SE) of 44%, whereas bilateral myopia was present in 37% of the children. In the total sample, high myopia (>/=-5D) was found in 1.4%. The prevalence of myopia was significantly higher in girls. Only 20% of children with bilateral myopia used prescription glasses; 8% had prescribed glasses, but did not use them. Hyperopia (>/=+1 D) was present in 6.0% of the total population, and astigmatism (>/=-1.5 D) was present in 9.5%. CONCLUSIONS: The prevalence of myopia among 12- to 13-year-old children in Mexico is high. The majority of cases are low grade, and a large number of the myopic children do not have, or do not use, prescription glasses.

Adolescent↗
PubMed2004

Accuracy of noncycloplegic autorefraction in school-age children in China.

PURPOSE: To evaluate the accuracy of noncycloplegic autorefraction in a representative sample of school-age children in China. METHODS: Refractive error was measured with an autorefractor, both before and after cycloplegia induced with cyclopentolate, in a population-based sample of 4973 children between the ages of 7 and 18 years. Spherical equivalent refractive error and astigmatism as represented by Jackson crossed-cylinders (J0 and J45) were the main outcome measures. RESULTS: Noncycloplegic measurements of equivalent spheres were consistently more negative or less positive than those after cycloplegia, with mean +/- SD differences of -1.23 +/- 0.97 D. The differences were particularly large for hyperopic eyes (mean difference of -2.98 +/- 1.65 D for hyperopia of at least +2.00 D) while becoming progressively smaller for emmetropic eyes, and smaller yet for myopic eyes (mean difference of -0.41 +/- 0.46 D for myopia of -2.00 D or more). Increasing age was associated with increased, but clinically insignificant, differences. Little difference was found between noncycloplegic and cycloplegic measurements of astigmatism: mean J0 and J45 differences were -0.08 +/- 0.13 D and -0.01 +/- 0.09 D, respectively. CONCLUSIONS: Noncycloplegic autorefraction was found to be highly inaccurate in school-age children and, thus, not suitable for studies of refractive error or for prescription of glasses in this population.

Adolescent↗
PubMed1994

Congenital hypertrophy of the retinal pigment epithelium associated with familial adenomatous polyposis.

PURPOSE: Multiple, bilateral areas of congenital hypertrophy of the retinal pigment epithelium (CHRPE) have been described in association with familial adenomatous polyposis (FAP). Histopathologic findings have suggested a generalized effect of the FAP gene on the RPE, which could impair the functional integrity of the RPE. The clinical, psychophysical, electrophysiologic, and fluorescein angiographic findings in CHRPE in subjects with FAP were assessed. METHODS: RPE function was assessed in 7 subjects with CHRPE and a family history of FAP. Four had documented FAP (mean age = 22.25 years) and the other three were siblings of affected subjects, with a 50% risk of developing FAP (mean age = 6.33 years). All subjects underwent comprehensive ophthalmologic examination. RESULTS: All subjects showed mild hyperopia (mean, +1.13 D; best corrected visual acuity, 20/20 or better). On perimetry, there were scotomas corresponding to some lesions. ERG showed normal rod, maximal, single-flash cone, and flicker responses. Light-dark ratio was within the normal range on EOG. Fluorescein angiography demonstrated normal retinal vasculature overlying the CHRPE lesions, which blocked background choroidal fluorescence. A normal choriocapillaris was observed through some hypopigmented lacuna. CONCLUSION: CHRPE has been related to generalized expression of an abnormal gene in RPE, but its functional abnormalities tend to be localized.

Adenomatous Polyposis Coli↗
PubMed2001

Variations of Weiss's ring.

BACKGROUND: Weiss's ring is an important index for diagnosing a posterior vitreous detachment (PVD). The authors studied the configurations of Weiss's ring because the ring has several variations. METHODS: Weiss's ring was examined biomicroscopically in 223 eyes with PVD and documented videographically using a scanning laser ophthalmoscope. The configurations of Weiss's ring were classified into four groups: a complete ring, a partial ring, a ball-like opacity, and a hole without a ring. RESULTS: In the 223 eyes with PVD, Weiss's ring was categorized as a complete ring in 63 eyes (28.3%), a partial ring in 128 eyes (57.4%), a ball-like opacity in 17 eyes (7.6%), and a hole without a ring in 15 eyes (6.7%). A complete ring was observed in 8 (57.1%) of 14 eyes with hyperopia (+3 diopters or more), in 25 (28.7%) of 87 eyes with emmetropia (between -1 and +1 diopter), and in 10 (16.1%) of 62 eyes with myopia (-3 diopters or more). Six months after the initial examinations, the contour of Weiss's ring remained unchanged in 86 (96.6%) of 89 eyes with fresh PVD. CONCLUSIONS: Scanning laser ophthalmoscope is a useful tool for observing Weiss's ring. A "classic" annular opacity around a hole in the prepapillary posterior vitreous cortex represents less than one third of the configurations of Weiss's ring, indicating that the term "ring" is erroneous.

Aged↗
PubMed1995

Indications, results, and complications of refractive corneal surgery with mechanical methods.

Radial keratotomy (RK) incisions permanently weaken the cornea. This structural weakening can cause several complications and side effects, including diurnal fluctuation, progressive hyperopic shift, and the potential for traumatic rupture of the keratotomy scars. Minimally invasive-RK may be a useful alternative to reduce the invasiveness of RK while retaining its efficacy. Mild myopia can be treated by either RK or photorefractive keratectomy. Patients treated by RK in the first eye and photorefractive keratectomy in the second eye preferred the speed of recovery and the clarity of vision with RK. Combining the microkeratome and the excimer laser appears to be an ideal technique to correct high myopia. Laser ablation of the corneal lenticule while securely fixed by the suction ring in the Berlin microkeratome offers the advantage of perfect centration and fixation. Hexagonal keratotomy, used to treat hyperopia, appears to be an unpredictable, unsafe surgical procedure.

Cornea↗
PubMed1996

Refractive aspects of cataract surgery.

The emphasis in cataract surgery has shifted to perfecting the refractive outcome. More accurate lens power calculations and refinement in techniques to reduce or eliminate surgically induced and preexisting astigmatism have moved us closer to the ultimate surgical result-emmetropia. Multifocal lenses and surgically induced multifocal corneas have the potential to eliminate not only myopia and hyperopia but also the loss of accommodation resulting from the pseudophakic state.

Cataract Extraction↗
PubMed1996

Mechanical methods in refractive corneal surgery.

The past year has seen considerable advances and debate with regard to several new and some established mechanical means of refractive surgery. Lamellar in situ keratomileusis is gaining increased interest, especially for the treatment of moderate and high myopia, although considerable questions still exist with regard to its safety, predictability, and the possibility of loss of lines of best corrected visual acuity. Mini-radial keratotomy may be of benefit in reducing the risk of traumatic rupture of radial keratotomy incisions, and a refinement of the nomograms for astigmatic keratotomy in the treatment of congenital astigmatism has been proposed. Another report on the use of hexagonal keratotomy for the treatment of hyperopia again raised concerns of its predictability. A blind eye study of intrastromal corneal rings has provided some reassurance with regard to its safety but has also raised doubts over its predictability. Meanwhile, several more reports of the use of both anterior and posterior chamber phakic intraocular lenses for the treatment of myopia have been presented.

Cornea↗
PubMed1998

Indications, results, and complications of LASIK.

The technique of laser in situ keratomileusis (LASIK) has been used with very encouraging results in the treatment of all degrees of myopia and also shows considerable promise in the treatment of hyperopia. Compared with photorefractive keratectomy, LASIK is advantageous in causing minimal postoperative discomfort, in its rapid recovery of clear vision and stabilization of refractive change, in the infrequent occurrence of haze, and in its greater facility in correcting high degrees of myopia. However, LASIK is the more surgically demanding technique. We discuss our own experience with LASIK as well as published data from other centers. We anticipate that LASIK will continue to increase in importance in the surgical correction of refractive error.

Cornea↗
PubMed2000

Postoperative complications in laser in situ keratomileusis.

Laser in situ keratomileusis (LASIK) has become the most common procedure to correct refractive errors in North America. Increasing numbers of patients and surgeons are choosing LASIK in the management of low and moderate myopia, astigmatism, and hyperopia. LASIK presents a unique group of postoperative challenges and complications. It is important to be able to identify these complications in the early and late postoperative periods and to provide effective management. In this article, we review the most commonly encountered early and late postoperative complications after LASIK and the most current methods in prevention and treatment.

Humans↗
PubMed2002

Incisional refractive surgery.

The use of incisional refractive surgery has become limited due to the widespread use of the excimer laser to correct myopia, hyperopia and astigmatism. Laser in situ keratomileusis and photorefractive keratectomy have proven to be much more accurate and predictable in correcting refractive error. This has made some forms of incisional refractive surgery practically obsolete. Radial keratotomy should not be considered a primary refractive procedure in the modern world, as RK has become "RKhaic". There are still indications for incisional refractive surgery in cataract and post-surgical patients for the treatment of astigmatism. However, with the advent of the toric intraocular lens and the use of LASIK in such aforementioned patients, these indications for incisional surgery will likely become more limited. In this review, we go over the past history of incisional refractive surgery and also report the current uses and advancements of this technique in today's practice environment.

Astigmatism↗
PubMed2004

Advances in phakic intraocular lenses: indications, efficacy, safety, and new designs.

PURPOSE OF REVIEW: The recent evolution of phakic intraocular lenses (PIOLs) has made this refractive surgical technique safer, very predictable, and effective. Due to these reasons, PIOLs have been expanding the horizon of their indications. The aim of this review is to update the reader in the recent advances reported on the topic during the year 2003. RECENT FINDINGS: The most recent progress has been made towards decreasing the incision size down to 3 mm or less for all PIOLs models to avoid pupil ovalling in angle-supported designs with new biomaterials or exchangeable haptics, and to decrease the incidence of cataract induction in posterior chamber models with modified designs and better sizing. High-order aberrations and the quality of vision are improved with PIOLs. The main limitation for the further development of PIOLs is the lack of adequate diagnostic imaging techniques to perform a precise preoperative study of the anterior segment anatomy. Emerging diagnostic technologies based on the use of very high frequency (100 MHz) ultrasound and optical coherence tomography seem to have a most important role in the future development of PIOLs defining preoperatively the most adequate anatomic conditions for each design. PIOLs offer today an excellent alternative for the correction of high and moderate myopia, hyperopia, and astigmatism. Emerging indications, still under investigation, include presbyopia and pediatric anisometropic amblyopia. SUMMARY: Due to their advantages for quality of vision and the increased knowledge on their safety, as well as the evidence of their predictability, PIOLs are expected to largely increase their clinical use as a refractive surgical technique in the coming years.

Anterior Chamber↗
PubMed2004

Surgical treatment of presbyopia: scleral, corneal, and lenticular.

PURPOSE OF REVIEW: Having solved most of the problems concerning myopia, hyperopia, and astigmatism, it is perfectly understandable that the surgical treatment of presbyopia should be next on the agenda. It is a new challenge where every possible aspect is explored. RECENT FINDINGS: The past five years have been troubled by the debate over von Helmholtz theory on accommodation. Numerous investigations have been carried out on the primate and humans using various procedures. The more we learn about this mechanism, the nearer we will be to finding a solution to presbyopia. It appears essential to refer to recent works confirming von Helmholtz theory. Therefore, understanding presbyopia requires a great deal of optical ingenuity such as monovision, scleral modifications, which still remain controversial, or clear lens exchange or refilling. SUMMARY: In 2003, with all the different techniques available, the surgeon has a wide choice to offer patients that are satisfactory from a practical, theoretical, and ethical point of view. However, these techniques must only be proposed once the patients have been carefully informed.

Cornea↗
PubMed2003

Characterization of a stapes ankylosis family with a NOG mutation.

OBJECTIVE: To characterize the otologic phenotype in a family with autosomal dominant stapes ankylosis, hyperopia, and skeletal abnormalities caused by a mutation in the noggin gene (NOG). STUDY DESIGN: Case series. SETTING: Academic tertiary care center. PATIENTS: Eight affected and 3 unaffected family members. MAIN OUTCOME MEASURES: History, physical and radiologic examination, and surgical outcomes. RESULTS: Although affected members were initially presumed to have typical nonsyndromic otosclerosis, the clinical data were most consistent with an autosomal dominant congenital stapes ankylosis syndrome. Eight of eight affected family members had bilateral low-frequency conductive hearing loss. Six of eight underwent fenestration procedures and/or stapedectomies. All members with initial postoperative closure of the air-bone gap returned to their baseline conductive loss within 2 years. Two affected family members had documented maximal conductive hearing loss by age 4, and two members without previous otologic surgery have not experienced sensorineural hearing loss. High-resolution temporal bone computed tomography showed stapes ankylosis and indistinction of the incudomalleal junction bilaterally and bony regrowth over the stapedotomy for those with stapedectomies. Detailed physical and radiologic examination identified multiple other skeletal abnormalities. CONCLUSIONS: Although this phenotype may present as classic otosclerosis to the otolaryngologist, detailed investigation revealed a congenital stapes ankylosis syndrome. Because is essential in regulating normal bone development and maturation, mutations in this gene may be associated with excessive bony overgrowth and refixation of the stapes footplate after initial successful surgery. Patients with hereditary conductive hearing loss should be assessed to rule out subtle features of a skeletal syndrome.

Ankylosis↗
PubMed2003

Kersley lecture: eye believe in contact lenses: contact lenses and/or refractive surgery.

PURPOSE: Media publicity has made patients increasingly aware that surgical vision correction is available. This article gives an overview on refractive surgery and contact lenses. METHODS: Contact lens and refractive surgery possibilities are highlighted for patients with myopia, hyperopia, astigmatism, presbyopia, aphakia, and keratoconus. Therapeutic, pediatric, and cosmetic indications are discussed. RESULTS: Refractive surgery is beneficial for low refractive errors. The use of contact lenses is mandatory in cases of monovision and strabismus before refractive surgery and beneficial for therapeutic use postoperatively. CONCLUSION: Although many patients are always best corrected with contact lenses, only the right synergism of contact lenses and refractive surgery will benefit patients.

Contact Lenses↗
PubMedDate not supplied

Review of patients with basal cell nevus syndrome.

PURPOSE: To review patients with basal cell nevus syndrome (BCNS), documenting presentation, referrals, treatment patterns, and associated morbidity. METHODS: Cross-sectional review and retrospective data collection of 39 patients with BCNS. Patients from the BCNS support group were invited to be examined. Demographics, presenting features, associated pathologies, and treatment modalities were recorded. Demographic data, age at presentation, age at diagnosis, spectrum of ophthalmic and periocular disease, treatment modalities used, and periocular deformities developed were reviewed. RESULTS: Thirty-nine patients were included with age range of 5 to 72 years. Presenting clinical features included odontogenic keratocyst in 17 patients and basal cell carcinoma in 13 patients; less common presentations were with congenital malformations (n = 2), with ophthalmic associations (n = 3), and at genetic counseling (n = 4). Seventeen of the 39 patients confirmed a parental diagnosis of BCNS. Basal cell carcinoma developed in 18 of the 28 patients before the age of 30, confirming the reported early age of onset. Periocular basal cell carcinoma was reported in 24 of 39 patients (61%), with recurrent disease reported in 17 of these 24 (71%), despite a variety of treatment modalities used. Associated ophthalmic features were multiple eyelid cysts (15 patients), strabismus (9 patients), myopia (5 patients), hyperopia (7 patients), cataracts (5 patients), myelinated nerve fibers (3 patients), amblyopia (3 patients), and nystagmus and iris transillumination defects (2 patients each). All patients were involved in multidisciplinary medical care. CONCLUSIONS: Patients with BCNS frequently have ophthalmic manifestations, particularly periocular basal cell carcinoma. Multidisciplinary care is essential in the care of the patient with BCNS. Early diagnosis of BCNS may allow for skin protection and surveillance at an earlier age.

Adolescent↗