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Refractive variation during autorefraction: multivariate distribution of refractive status.

The refractive variation of a sample of 106 university students (63 females and 43 males) studying optometry was examined by means of autorefraction. Stereo-pair scatter plots in Euclidean three-dimensional h-space are used to illustrate the nature of the spread or distribution of data measurements found in particular subjects. A wide variety of different distributions were observed ranging from tightly to loosely clustered arrangements of measurements. Some aspects of departure from multivariate normality, including outliers (atypical measurements in a sample) and polymodal or multimodal distributions, are demonstrated. Outliers appear to be possible anywhere in the space of the scatter plots, although outliers may be more common in the region of h-space corresponding to transitory increases in accommodation. Multimodal distributions may be indicative of changes in ocular fixation during autorefraction or may reflect accommodative or other anomalies. Other departures from multivariate normality such as kurtosis and skewness are also of importance when attempting to form an understanding of variation of refractive state. Measurements made on an artificial or test eye showed very tight clusters in h-space. This suggests that the autorefractor itself contributes little to the variation observed during autorefraction of an eye.

Accommodation, Ocular↗

Multifaceted treatment of congenital nystagmus: a report of 6 cases.

Patients with congenital nystagmus (CN) often have associated conditions (e.g., strabismus, high astigmatism, and binocular inefficiency) that also impair visual acuity. Unfortunately, individually used techniques directed at reducing nystagmus have generally produced only slight increases in Snellen acuity. We present case reports of six patients with nystagmus seen in our clinic (University of Houston, College of Optometry) to illustrate the use of problem-specific management to improve visual acuity and/or binocular function. The results suggest that a comprehensive management strategy should include treatment of all associated conditions as well as therapy to improve the characteristics of the nystagmus wave form.

Adolescent↗

Effect of oculomotor and other visual skills on reading performance: a literature review.

The diagnosis and management of many oculomotor anomalies is within the domain of optometry. Thus, a thorough understanding of these systems and their relation to reading performance is vital. Efficient reading requires accurate eye movements and continuous integration of the information obtained from each fixation by the brain. A relation between oculomotor efficiency and reading skill has been shown in the literature. Frequently, these visual difficulties can be treated successfully with vision therapy.

Aptitude↗

A case-comparison of intermittent exotropia and quality of life measurements.

A Vision Quality of Life Questionnaire that combines the SF-20 and a Vision Quality Scale developed by the authors was pilot tested in a case-comparison of extreme groups, patients with intermittent exotropia (IXT) and those with no vision problems (Non-IXT), at the University of Houston (UH) Optometry Clinic. The purposes of the study were to measure the internal consistency reliability and examine the validity-related evidence of vision function associated with the instrument. The pilot study involved mailing the instrument to 52 patients in each group (IXT and Non-IXT patients). IXT patients were then frequency-matched by age and separately by sex, to control for confounding variables, to Non-IXT group patients. The Cronbach's Alpha internal consistency reliability of both scales was acceptable at > 0.70 for both the IXT and Non-IXT groups. The Wilcoxon signed ranks test was used to determine validity-related evidence. The differences between groups on the SF-20 (p = 0.0276) and Vision Function Scale (VFS) (p = 0.0385) confirm that the scales discriminate between IXT and Non-IXT populations. Two conclusions can be drawn from the pretesting and pilot testing of the SF-20 and the VFS: (1) both have acceptable internal consistency reliability scores, and (2) both show validity-related evidence that they can discriminate vision function between IXT and Non-IXT patient populations.

Adolescent↗

Comparison of repeat videokeratography: repeatability and accuracy.

PURPOSE: We compared the repeatability and accuracy of four commercially available videokeratography instruments and a manual keratometer. METHODS: Ten optometry students and two university employees who had no history of rigid contact lens wear and no soft contact lens wear within 6 months of the study were measured. Two independent measurements were taken on the right eyes only using the Alcon EyeMap EH-290 topography system (both manual and automatic focus), the EyeSys System 2000 corneal topography system, the Humphrey Mastervue topography system, the Humphrey Atlas topography system, and a Marco manual keratometer. A three-factor repeated measures analysis of variance with all factors repeated was performed using SAS and BMDP statistical software. Separate analyses were conducted for paracentral and peripheral data. To test accuracy, measurements were taken with the Alcon EyeMap automatic focus system, the EyeSys System 2000, the Humphrey Atlas system, and the Humphrey Mastervue system using four calibration spheres. RESULTS: There were no statistically significant differences in the repeatability of the instruments. The EyeSys corneal topography system had the most narrow 95% limits of agreement around the mean difference. The two Humphrey instruments performed similarly to the EyeSys. Although the Alcon EyeMap EH-290 had the widest 95% limits of agreement around the mean difference, it showed better repeatability when the manual focus was used compared with the automatic focus. The instruments varied in their level of accuracy, but the highest percentage of data points within +/- 0.37 D of the known values of the calibration spheres was found with the Humphrey Atlas. CONCLUSIONS: Although there were no statistically significant differences in repeatability, the EyeSys System 2000 had the highest repeatability, which may have clinical relevance. The accuracy measured in this study varied tremendously; however, the Humphrey Atlas was found to be the most accurate of the instruments tested.

Cornea↗

A unified paraxial approach to astigmatic optics.

In Gaussian optics properties such as dioptric power, lateral and angular magnification and thickness are simple scalar concepts. In linear optics, the optics of thick astigmatic systems, however, these concepts generalize to three-dimensional concepts in some cases (the dioptric power of thin systems, for example) and to four-dimensional concepts in general. As a result, the quantitative treatment of these properties in astigmatic systems presents challenges to the researcher in optometry, ophthalmology, and vision science. Considerable progress has been made only in the case of dioptric power. This paper presents a generalized approach to astigmatic optics which allows different physical properties to be treated in the same way: the theory is unified and, in a sense, complete. Mathematical and statistical methods developed for treating one concept become directly applicable to others. The paraxial optical properties of any optical system are completely defined by the 4 x 4 ray transfer matrix, called here the (ray) transference. The transference defines four fundamental properties of an optical system, tentatively called here positional magnification, optical thickness, divergence, and directional magnification. They are the four 2 x 2 submatrices A, B, C, and D of the transference. Each fundamental property is a modification of a familiar concept. Divergence is the negative of dioptric power expressed as the dioptric power matrix F. The four fundamental optical properties A, B, C, and D, and the derived property F, despite being different physically, all have the same underlying mathematical structure. This fact is exploited in developing a unified theory. The theory is complete in the sense that the fundamental properties fully characterize the paraxial optics of any system. The paper presents a general treatment that applies to any of the five properties. The implications are far reaching and extend beyond what can be described in the paper. Dioptric power of thin systems is treated as a particular application of the general theory. The result is the resolution of a number of issues of current interest to the researcher. It is shown, for example, that root-mean-squared (curvital) power, root-mean-squared torsional power, and length of the power vector (or dioptric strength) have a Pythagorean relationship, the power vector being the hypotenuse. Mean-squared curvital and torsional powers are in effect the area enclosed by polar profiles of curvital and torsional power, respectively. The full character of dioptric power cannot be represented by a single vector in the usual sense of the term. Two vectors are required: they are the meridional (vector) power and the orthogonal (vector) power, both of which are associated with the reference meridian. The power along a meridian (often thought of as a scalar or as two scalars) is a vector, the meridional power. This meridional power has components along (the meridional component of the meridional power) and perpendicular to (the orthogonal component of the meridional power) the meridian. In the literature, these components are the curvital power and the negative of the torsional power, respectively. The paper also examines the generalization of these results to the dioptric power of thick systems. Dioptric power is not a fundamental optical property but a derived property. Divergence, the negative of dioptric power, is the corresponding fundamental property. The theory described here is ray-based. The concept of the wavefront is unnecessary. The many formulas and concepts that apply in the context of dioptric power apply directly to the fundamental properties as well. The theory has the potential to provide a complete framework for future studies of astigmatic systems and could systematize the approach to and enhance the knowledge of astigmatism.

Astigmatism↗

The presumed influence of attention on accuracy in the developmental eye movement (DEM) test.

BACKGROUND: The developmental eye movement (DEM) test is a clinical test used widely to evaluate ocular motility function (accuracy and speed) in school-age children. PURPOSE: The purpose of this study was to investigate, retrospectively, the change in accuracy over time while performing the DEM horizontal reading task in children. METHODS: The charts from children who had performed the DEM test during a routine eye examination in a pediatric optometry service were reviewed. The study included 22 patients (6 to 11 years old, 12 boys, 10 girls) who had a routine eye examination that was precepted by one of the authors (R.C.) during the period of 1995 to 1999. Patients were divided into two categories: 1) those with abnormal DEM test results and 2) a control group consisting of those with normal DEM test results. Chart review was done consecutively within each category. Collected data included patient age, gender, refractive error, and DEM test results. For analysis, the horizontal task of the DEM was divided into two halves (I and II), Part I always preceded part II, and data was sorted as the number of errors per part. RESULTS: More errors in accuracy occurred in part II than in part I (Wilcoxon signed rank test, p < or = 0.01) of the horizontal DEM test in the group of subjects with an abnormal DEM test. No differences in the number of errors in parts I and II of the horizontal task of the DEM were found in the control group. CONCLUSIONS: Findings showed that when excessive errors in accuracy occurred, the number of errors increased over time. If the errors were caused by an oculomotor dysfunction found in the DEM, errors should be equally distributed throughout the text. If errors were caused by fatigue, a difference in parts I and II should have occurred in both the test and the control group. These findings suggest that attention may influence accuracy over time in those patients that do poorly on the DEM test.

Aging↗

The interoccasion repeatability of intraocular pressure measurement using the Tono-Pen in a sample of school-aged children.

PURPOSE: The purpose of this study was to assess the interoccasion repeatability of the Tono-Pen XL portable applanation tonometer in school-aged children. METHODS: Thirty-one normal children were recruited from The Ohio State College of Optometry Pediatric Clinic. They ranged in age from 6 to 14 years. Intraocular pressure was measured using the Tono-Pen XL in both eyes of all subjects on two different occasions within a median of 9 days. Refractive error was measured by noncycloplegic autorefraction. Data from right eyes only are presented. RESULTS: There was no average difference in the intraocular pressure between occasions. The 95% limits of agreement between occasions were -5.58 to 4.87 mm Hg. CONCLUSIONS: The Tono-Pen XL gives reasonably repeatable readings between occasions in school-aged children.

Adolescent↗

Objective measurement of optical aberrations in myopic eyes.

PURPOSE: To determine whether the degree of myopia affects the optical quality of the retinal image after appropriate correction, monochromatic aberrations of the human eye were measured as a function of the degree of myopia. METHODS: Using a modified Hartmann-Shack method, a population of 27 myopic (up to -9.25 D) and 7 emmetropic optometry students (18-32 years) were objectively evaluated before and after pupil dilation. We then identified for each subject the most influential aberration types, and we calculated the profile of wavefront aberration. To study the behavior of aberration as a function of the degree of myopia, we determined the maximum value of aberration as well as the root mean square (rms) value. RESULTS: It turned out that aberration increases with the refractive error in a quasi-linear relationship for pupil diameters of 5 and 9 mm. This result is valid for both rms and maximum values. CONCLUSIONS: We objectively showed that optical quality decreases as myopia increases and as the pupil gets larger. Coma is more frequent in high myopia, and spherical aberration occurs more frequently for dilated pupils.

Adult↗

Visual acuity results in school-aged children and adults: Lea Symbols chart versus Bailey-Lovie chart.

PURPOSE: To compare visual acuity results obtained using the Lea Symbols chart with visual acuity results obtained with the Bailey-Lovie chart in school-aged children and adults using a within-subjects comparison of monocular acuity results. METHODS: Subjects were 62 individuals between 4.5 and 60 years of age, recruited from patients seen in five optometry clinics. Each subject had acuity of the right eye and the left eye tested with the Lea Symbols chart and the Bailey-Lovie chart, with order of testing varied across subjects. Outcome measures were monocular logarithm of the minimum angle of resolution (logMAR) visual acuity and inter-eye acuity difference in logMAR units for each test. RESULTS: Correlation between acuity results obtained with the two charts was high. There was no difference in absolute inter-eye acuity difference measured with the two acuity charts. However, on average, Lea Symbols acuity scores were one logMAR line better than Bailey-Lovie acuity scores, and this difference increased with worse visual acuity. CONCLUSIONS: The Lea Symbols chart provides a measure of inter-eye difference that is similar to that obtained with the Bailey-Lovie chart. However, the monocular acuity results obtained with the Lea Symbols chart differ from those obtained with the Bailey-Lovie chart, and the difference is dependent on the individual's absolute level of visual acuity.

Adolescent↗

Prevalence of myopia in a group of Hong Kong microscopists.

PURPOSE: To study the prevalence and magnitude of myopia in a group of Hong Kong Chinese microscopists and compare it with that observed in microscopists working in the United Kingdom. METHODS: Forty-seven microscopists (36 women and 11 men) with a median age of 31 years and working in hospital laboratories throughout Hong Kong were recruited to the study. Information about past refractive corrections, microscopy work, and visual symptoms associated with microscope use were collected. All subjects had a comprehensive eye examination at The Hong Kong Polytechnic University Optometry Clinic, including measures of refractive error (both noncycloplegic and cycloplegic), binocular vision functions, and axial length. RESULTS: The prevalence of myopia in this group of microscopists was 87%, the mean (+/- SD) refractive error was -4.45 +/- 3.03 D and mean axial length was 25.13 +/- 1.52 mm. No correlation was found between refractive error and years spent working as a microscopist or number of hours per day spent performing microscopy. Subjects reporting myopia progression (N = 22) did not differ from the refractively stable group (N = 19) in terms of their microscopy working history, working hours, tonic accommodation level, or near phoria. However, the AC/A ratio of the progressing group was significantly greater than that of the stable group (4.59 delta/D cf. 3.34 delta/D). CONCLUSION: The myopia prevalence of Hong Kong Chinese microscopists was higher than that of microscopists in the United Kingdom (87% cf. 71%), as well as the Hong Kong general population (87% cf. 70%). The average amount of myopia was also higher in the Hong Kong Chinese microscopists than the Hong Kong general population (-4.45 D cf. -3.00 D). We have confirmed that the microscopy task may slightly exacerbate myopia development in Chinese people.

Adult↗

Accommodative and vergence difficulties interfering with image clarity through a binocular indirect ophthalmoscope.

PURPOSE: This study sought to identify accommodative and vergence deficiencies that could explain why some students have difficulty seeing clearly when using a binocular indirect ophthalmoscope (BIO) containing its standard +2.00 D lenses. METHODS: A survey was distributed to Illinois College of Optometry 3rd- and 4th-year students. Based on the information supplied by the survey, students were divided into two groups: those who are unable ("BIO plano") and those who are able ("BIO plus") to obtain a clear image with the +2.00 D lenses in their BIO's. Forty-seven subjects participated: 22 in the BIO plano group and 25 in BIO plus group. Two of the authors, masked to subject group, measured all subjects' accommodative amplitudes and facilities, monocular estimation method (MEM) retinoscopy, negative relative accommodation and positive relative accommodation (NRA/PRA), distance and near vergence ranges, distance and near phorias, Worth 4-dot test, and near point of convergence (five times). RESULTS: The Mann-Whitney U analysis of numerical data for the two groups showed a statistically significant difference for accommodative facility in the right eye (p = 0.004). The difference between the two groups approached significance for accommodative facility with both eyes (p = 0.02), facility in the left eye (p = 0.03), distance base-out blur (p = 0.02), near base-out break (p = 0.02), and near base-out recovery (p = 0.04). For all findings in which the difference between the two groups was significant or approached significance, the BIO plus group had higher median values. When subjects were classified by difficulty with the plus side of the flippers during accommodative facility testing, there was a statistically significant difference with both eyes (Fisher exact test, p = 0.003) and with the right eye (p = 0.008) between the BIO plus and BIO plano groups. When subjects were classified by the presence or absence of an accommodative or binocular vision syndrome, categorical data analysis showed the difference between the two groups approached significance, with more BIO plano subjects having syndromes (p = 0.03). CONCLUSION: No one test absolutely defined who would have difficulty with the +2.00 D lenses in the BIO. There are several skills required; less developed plus acceptance and convergence may cause difficulties.

Accommodation, Ocular↗

Visual field defects and vision-specific health-related quality of life in African Americans and whites with glaucoma.

PURPOSE: To examine the relationship of visual field impairment to vision-specific health-related quality of life and symptoms in a large cohort (N=345) of African Americans and Whites of non-Hispanic origin diagnosed with glaucoma. MATERIALS AND METHODS: Participants consisted of persons > or =55 years of age recruited from university-affiliated ophthalmology and optometry practices in Birmingham, AL who had been diagnosed with glaucoma. Medical records were abstracted to collect information on demographics, visual acuity, and visual fields. A telephone survey was conducted to obtain information on vision-specific health-related quality of life [National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)], glaucoma symptoms [Glaucoma Symptom Scale (GSS)], and cognitive status (Short Portable Mental Status Questionnaire). Visual fields were used to compute a visual field defect score for each eye based on the Advanced Glaucoma Intervention Study (AGIS) scoring system. RESULTS: Mean NEI VFQ-25 subscale scores ranged from the 50s to 80s. Scores for African Americans and Whites did not differ except for the general health and ocular pain subscales for which African Americans had slightly higher scores. For both African Americans and Whites, as the AGIS score became worse in the better and/or worse eye, there was a decrease in VFQ subscale score for most VFQ subscales including general vision, distance vision, near vision, social functioning, color vision, and peripheral vision (P<0.05). AGIS scores were unrelated to the GSS subscales in African Americans; for Whites, the visual but not the nonvisual subscale was related to AGIS score. CONCLUSIONS: Scores on most subscales of the NEI VFQ-25 and the 2 subscales of the GSS are highly similar in African Americans and Whites of non-Hispanic origin who have been diagnosed with glaucoma. In addition, for both African Americans and Whites, the VFQ subscales for the most part demonstrated good construct validity with respect to the extent of visual field impairment. Results imply that the NEI VFQ-25 and the GSS are appropriate instruments for studying the personal burden of glaucoma in studies whose samples involve both African American and White adults.

Black or African American↗

Survey of contact lens-wearing habits and attitudes toward methods of refractive correction: 2002 versus 2004.

PURPOSE: The purpose of this study is to measure patient attitudes toward methods of refractive correction among cross-sectional populations of contact lens wearers in 2002 and 2004 at the School of Optometry contact lens clinic at Indiana University. We also assessed the role of age and gender on these attitudes. METHODS: Attitudes toward methods of refractive correction were surveyed among 349 consecutive contact lens wearers in the spring of 2002 and compared with surveyed attitudes among 99 contact lens wearers in the winter of 2004. The 23 questions in the survey queried attitudes on the health and safety, cost, and interest in methods of refractive correction in addition to questions about the wearing schedule for the subjects' current contact lenses (CL). Refractive methods that were compared included glasses, daily wear CL (DW), 7-day extended wear (EW) CL, 30-day continuous wear (CW) CL, LASIK, and orthokeratology (OK). The proportion of answers citing "agree" or "strongly agree" were combined and analyzed by chi-squared tests comparing the results for stratified groups in the previous and the current survey. The groups were stratified by gender and age over of under 30 years. Significance level was set at p < or = 0.05. RESULTS: In the 2004 survey, the age of the subjects was significantly younger. Subjects' interest in EW increased significantly in 2004 (59% vs. 45% with high level of interest 2004 vs. 2002, respectively; p = 0.015) and the proportion of subjects reporting overnight wear increased significantly (DW = 58% vs. 69% 2004 vs. 2002, p = 0.0017, controlling for age and gender). In 2004, glasses and EW CL were rated as more healthy compared with 2002 (glasses 95% vs. 88%, p = 0.05; EW CL 48% vs. 34%, p = 0.005). Males are now less likely in 2004 to rate EW as healthy compared with females (38% vs. 53%, p = 0.01). In the 2004 survey, subjects over age 30 were significantly less interested in LASIK compared with those under age 30 (59% vs. 33%, p = 0.02) and less interested than they were in 2002. CONCLUSIONS: In the 2004 survey, significantly more subjects reported overnight lens wear, an increased interest in, and opinion of overnight wear as a healthy method of refractive correction compared with the 2002 survey. There was some dampening of enthusiasm for LASIK among subjects over 30 years of age in the 2004 survey. Age and gender can influence attitudes toward refractive correction, with females in this sample showing the most change over time, most probably as a result of different health information sources used by various demographic groups.

Adult↗

A clinical evaluation of proview pressure phosphene tonometry in children.

PURPOSE: The Proview tonometer measures intraocular pressure by inducing a pressure phosphene through the eyelid and, if reliable and valid, may offer a quick, nonthreatening and noninvasive alternative method of obtaining intraocular pressures (IOPs) without the use of eye drops. This study compares the IOP measurements obtained in children using Proview pressure phosphene tonometry (PPPT) and Goldmann tonometry (GT). METHODS: One hundred four 5- to 12-year-old patients of the University Optometric Center/SUNY College of Optometry participated in the study. Subjects were randomized to receive, by different investigators, either PPPT or GT first. Two measurements with each instrument were attempted on each eye of all subjects. A subgroup of 41 subjects was asked which of the two methods was preferred. RESULTS: Seven percent of the subjects did not report a pressure phosphene response compared with 12% of the subjects on whom the investigators were unable to perform GT. The remaining 85 subjects completed the subject protocol. Of the 41 subjects asked, 56% preferred PPPT, 24% had no preference, and 20% preferred GT. The coefficient of repeatability between the two readings was higher for PPPT (3-4 mm Hg) than for GT (1 mm Hg). Mean IOP was 4 mm Hg higher for PPPT than GT with the difference in readings between the two instruments increasing with higher IOPs (r >19%, p < 0.005). CONCLUSIONS: In our study of healthy young subjects, PPPT measurements of IOP appear to be repeatable within a few millimeters of mercury in most children, but for some children, variability in repeat measurements can be substantial. Our data showed a mean difference in readings of 4 mm Hg with a 95% confidence interval that the PPPT reading was between 12 mm Hg above GT and 4 mm Hg below GT. This wide range of values indicates that PPPT is not comparable to GT. However, because our study found that children can appreciate pressure phosphenes and most prefer PPPT over GT, the Proview monitor may have value as a noninvasive, portable screener in pediatric patients. To fully evaluate this potential, further studies are needed that include patients with high IOPs.

Child↗

Automatic pupillometry from digital images.

Determination of two-dimensional characteristics of the anterior surface of the eye is becoming increasingly important in modern optometry and ophthalmology practice. In particular, accurate estimation of the pupil size and centration is crucial in customized refractive surgery, corneal transplantation, and advanced contact lens fitting. The pupil parameters change under different lighting conditions so they often need to be related to some fixed reference such as the limbus outline. However, current commercial pupillometers do not estimate limbus position. We present a novel algorithm for automatic extraction of pupil parameters from digital images that takes the relative limbus information into account. The algorithm utilizes several customized image processing techniques that form a robust procedure which performs well for a wide range of clinical images. We apply the developed algorithm to images obtained by a standard digital camera, and specialized ophthalmic instruments such as a wavefront sensor and a high-speed imaging system.

Algorithms↗

Analysis of New Zealand's research productivity in ophthalmology and vision science: 1993-2002.

AIM: To assess New Zealand's research productivity in the area of ophthalmology and vision science over the decade 1993-2002. METHODS: New Zealand-based researchers involved in ophthalmology or vision science research, including ophthalmologists, optometrists and vision scientists were identified via professional colleges, universities and electronic databases. Peer-reviewed publications by these authors were identified by both searching electronic databases (MEDLINE/Pubmed) and personal communication with individual researchers. RESULTS: Eighty-five New Zealand-based researchers involved in ophthalmology or vision science research published 446 articles in 84 scientific journals during the 10-year period. The cohort consisted of 59 ophthalmologists and 26 other researchers based in a diverse range of ophthalmology, optometry and university departments. Significant collaboration was observed between groups within New Zealand and with international institutions. Comparing ophthalmologists and 'other' researchers, ophthalmologists produced 69% of all ophthalmology and vision science research publications and those classified as 'active ophthalmologist researchers' published an average of 11 (range 5-55) papers each during this decade, compared to eight (range 5-25) for the group 'other active researchers'. This was also reflected in the high productivity rate by ophthalmologists of 277 publications per 1000. Publications were identified in a wide range of journals with the majority in top 20-ranked ophthalmology journals. The trend over the decade highlighted an increase in number of scientific publications, from 43 per annum in 1993, to 68 per annum in 2002. CONCLUSIONS: Despite a relatively small and geographically isolated population, New Zealand ophthalmology and vision science research is highly active and collaborative, with significantly increased research productivity during the period 1993-2002. The present study is the first to document these trends and provides strong evidence to justify continued support for ophthalmology and vision science research in New Zealand.

Bibliometrics↗

Viewing distance with minimum heterophoria.

BACKGROUND: The purposes of this study are to determine the viewing distance with minimum heterophoria and its relationship with refractive error and the resting position of accommodation. METHODS: The heterophoria and the accommodation responses of 36 optometry students (25 emmetropes and 11 myopes) were tested. Heterophoria was measured with the Free-Space Heterophoria Card at five different viewing distances (25 cm, 33 cm, 50 cm, 100 cm and 300 cm). The dioptric viewing distance with minimum heterophoria for each individual was estimated from the graph, where heterophoria in prism dioptres was plotted against viewing distance in centimetres. The Canon R-1 autore-fractor was used to determine the accommodation response at six different viewing distances (25 cm, 33 cm, 50 cm, 100 cm, 300 cm and 600 cm). The resting position of accommodation for each individual was estimated from the graph where the accommodative stimulus in dioptres was plotted against the accommodative response in dioptres. RESULTS: The dioptric viewing distance with minimum heterophoria ranges from 0.003 D to 0.65 D in emmetropes and ranges from 0.03 D to 2.36 D in myopes. There is no difference in the dioptric viewing distance with minimum heterophoria between myopes and emmetropes. Our results show a possible but not significant correlation between the dioptric viewing distance with minimum heterophoria and the resting position of accommodation. CONCLUSIONS: The viewing distance with minimum heterophoria is not affected by refractive error (stable early-onset myopia) and is poorly correlated with the resting position of accommodation.

Journal Article↗