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The incidence of strabismus and refractive error in patients with blepharophimosis, ptosis and epicanthus inversus syndrome (BPES).

A retrospective review was carried out of 204 patients with blepharophimosis, (blepharo) ptosis and epicanthus inversus syndrome (BPES). Of these, 94 (46%) had an autosomal dominant family history of BPES. Forty (20%) had manifest strabismus. Of these, 28 (70%) had esotropia, 10 (25%) had exotropia and 2 (5%) had hypertropia. Twelve (6%) patients had nystagmus. Seventy (34%) patients had a significant refractive error requiring spectacles. Twenty-one (30%) of these patients had anisometropic hypermetropia and 24 (34%) had anisometropic myopia. Forty-three patients had bilateral amblyopia and 40 had unilateral amblyopia, with 26 (65%) of these undergoing occlusion treatment. Of these, 14 had strabismus and refractive error, 7 refractive error only, 2 strabismus only and 3 neither refractive error nor strabismus. We conclude that there is a higher incidence of strabismus and refractive error in patients with BPES than in the normal population.

Blepharophimosis↗

AC/A ratio, age, and refractive error in children.

PURPOSE: To examine how the response AC/A ratio (the amount of accommodative convergence per unit of accommodative response) varies as a function of refractive error and age, to determine whether it is a risk factor for the onset of myopia, and to examine the relation between ocular structural features and the AC/A ratio. METHODS: Accommodation was stimulated by a letter target presented in a Badal system at 0.00, 2.25, and 4.37 D to 828 children aged 6 through 14 years in 1996. Of these, 726 had no myopia in 1996 and were available for examination the following year. Accommodative response and cycloplegic refractive error were measured by autorefraction and convergence by monitoring the relative movement of Purkinje images I and IV. Lens radii of curvature were measured by video phakometry, corneal radius of curvature by topography, and ocular axial dimensions by A-scan ultrasonography. RESULTS: Adjusted for age, the response AC/A ratio was highest in myopes (6.39 delta/D), intermediate in emmetropes (3.94 delta/D), and lowest in hyperopes (3.40 delta/D; P < 0.0001; two-way analysis of variance [ANOVA]). The stimulus AC/A ratio did not vary with refractive error. Adjusted for refractive error, the response AC/A ratio did not change as a function of age. In non-myopic children, having a response AC/A ratio of 5.84 delta/D or more elevated the risk of development of myopia within 1 year by 22.5 times (95% CI = 7.12-71.1). In a subsample of children without myopia who had refractive errors less than +0.75 D, having a response AC/A ratio of 5.84 delta/D or more elevated the risk of development of myopia within 1 year by 3.21 times (95% CI = 1.14-9.07). The AC/A ratio was associated with all measured ocular features except lens spherical volume. Only the negative correlations with refractive error and the shape of the crystalline lens (Gullstrand lens power) were significant in a multiple regression model (adjusted R2 = 0.16). CONCLUSIONS: An elevated response AC/A ratio was associated with myopia and was an important risk factor for its rapid onset. The association between higher AC/A ratios and flatter crystalline lens shapes, as well as other reported features of accommodation in myopia, may be explained by "pseudocycloplegia," which the authors define as tension on the crystalline lens that increases the level of effort needed to accommodate. Accommodative deficits in myopia may be the functional consequences of the underlying anatomy of the enlarged eye.

Accommodation, Ocular↗

Refractive Error Study in Children: sampling and measurement methods for a multi-country survey.

PURPOSE: The Refractive Error Study in Children was designed to assess the prevalence of refractive error and vision impairment in children of different ethnic origins and cultural settings. METHODS: Population-based cross-sectional samples of children 5 to 15 years of age were obtained through cluster sampling. Presenting, uncorrected, and best-corrected visual acuity, along with refractive error under cycloplegia, were the main outcome measures. Amblyopia and other causes of uncorrectable vision impairment were determined. RESULTS: Study design and sample size calculations, survey enumeration and ophthalmic examination methods, quality assurance monitoring, and da ta analyses and statistical methods are described. CONCLUSIONS: The study design, sample size, and measurement methods ensure that the prevalence of age-specific and sex-specific refractive error can be estimated with reasonable accuracy in the target populations. With commonality of methods, a comparison of findings between studies in different ethnic origins and cultural settings is possible.

Adolescent↗

Repeatability (test-retest variability) of refractive error measurement in clinical settings.

PURPOSE: To estimate the repeatability of refractive error measurement (REM) in a clinical environment in cataractous, pseudophakic and healthy eyes. METHODS: The refractive error of patients referred for cataract surgery or consultation measured by ophthalmic professionals was re-examined and the measurement results were compared. A total of 99 eyes from 99 persons (41 cataractous, 36 pseudophakic and 22 healthy eyes) with visual acuity (VA) of 0.3-1.3 (logMAR 0.52 to - 0.11) were included. The differences between measurements 1 and 2 were calculated as 3-dimensional vector values and spherical equivalents (SEs) and expressed as the coefficient of repeatability (CR). The mean time interval between the first and second examinations was 45 days. RESULTS: The CRs for all eyes for vertical (V), torsional (T) and horizontal (H) vectors were 0.74 D, 0.34 D and 0.93 D, respectively. The CR of SE for all eyes was 0.74 D. Eyes with lower VA (0.3-0.45) had larger variability in vector and SE values but the differences between VA groups were not statistically significant. The difference in the mean defocus equivalent (DE) between measurements 1 and 2 was, however, significantly greater in the group with lower VA. In all VA groups the mean difference vector was very close to the zero vector, which means that there was no systematic difference. CONCLUSIONS: Repeatability of refractive error measurements in clinical settings has a certain degree of variability. In this series, the variability in eyes with better VA was not great and was in accordance with earlier findings in healthy eyes. Eyes with lower VA had greater variability due to greater tolerance to defocus. Thus, conclusions concerning changes in the refractive state and the need to make changes in the refractive correction of eyes with poorer vision should be made with caution.

Adult↗

Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study.

AIMS: To identify characteristics of people with clinically relevant undercorrected refractive errors. METHODS: The Blue Mountains Eye Study was a population based survey of 3654 Australians aged 49-97 years. Examinations included a standardised refraction and measurement of presenting and best corrected visual acuity. Clinically relevant undercorrected refractive error was defined as improvement of >/=10 letters (2+ lines on the logMAR chart) in subjects with presenting acuity 6/9 or worse. Associations with a range of demographic and ocular variables were explored, adjusting for age and sex, presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Undercorrected refractive error was present in 814/3654 subjects (10.2%). Older age (p <0.001), hyperopia (OR 1.45, CI 1.15 to 1.83), longer interval from last eye examination (p <0.001), past occupation as tradesperson (OR 1.64, 1.13 to 3.29) or labourer (OR 2.00, CI 1.39 to 2.89), receipt of government pension (OR 1.47, CI 1.12 to 1.94), and living alone (OR 1.34, CI 1.05 to 1.72) were all associated with undercorrected refractive error. Past or current use of distance glasses (OR 0.25, CI 0.20 to 0.32) and driving (OR 0.67, CI 0.52 to 0.86) were associated with a lower prevalence. CONCLUSIONS: Increasing age and measures of socioeconomic disadvantage and isolation were found to predict undercorrected refractive error. Given the documented impacts from correctable visual impairment, these findings suggest a need to target education and eye care services.

Age Factors↗

Relationship between refractive error and visual acuity in the Prospective Evaluation of Radial Keratotomy (PERK) Study.

As part of the Prospective Evaluation of Radial Keratotomy (PERK) study, we examined the relationship between post-operative refractive error and visual acuity without correction. We included 394 eyes (one eye per patient) with refractive errors ranging from -3.00 to +3.00 diopters one year after radial keratotomy. Within each 1-D range of the spherical equivalent of the refractive error, the visual acuity spanned five to ten Snellen lines. For visual acuities of 20/16 to 20/50, the refractive error spanned 3 to 5 D. Additionally, operated eyes had a better average uncorrected visual acuity than unoperated eyes with a similar refractive error. Within the narrow range of refraction between -2.00 and -2.50 D, the mean uncorrected visual acuity was 20/125 for 56 unoperated eyes and 20/63 for 29 operated eyes, a difference of three Snellen lines.

Adult↗

Does cryotherapy affect refractive error? Results from treated versus control eyes in the cryotherapy for retinopathy of prematurity trial.

PURPOSE: To evaluate the effect of cryotherapy on refractive error status between ages 3 months and 10 years in children with birth weights of less than 1251 g in whom severe retinopathy of prematurity (ROP) developed in one or both eyes during the neonatal period. DESIGN: Randomized clinical trial. PARTICIPANTS: Two hundred ninety-one children in whom severe ROP developed during the neonatal period. INTERVENTION: Cryotherapy for ROP. MAIN OUTCOME MEASURES: Cycloplegic Refraction METHODS: The children underwent repeated follow-up eye examinations, including cycloplegic retinoscopy, between 3 months and 10 years after term due date. Refractive error data from all eyes that were randomized to cryotherapy were compared with data from all eyes that were randomized to serve as controls. Refractive error data were also compared for a subset of children who had both a treated and a control eye that could be refracted. RESULTS: At all ages, the proportion of treated eyes that were unable to be refracted because of retinal detachment, media opacity, or pupillary miosis was approximately half the proportion of the control eyes that were unable to be refracted. When data from all eyes that could be refracted were considered, the distribution of refractive errors between fewer than 8 diopters (D) of myopia and more than 8 D of hyperopia was similar for treated and control eyes at all ages. The proportion of eyes with 8 D or more of myopia was much higher in treated than in control eyes at all ages after 3 months. In the subset of children who had a treated eye and a control eye that could be refracted, distributions of refractive errors in treated versus control eyes were similar at most ages. CONCLUSIONS: In both treated and control eyes, there was an increase in the prevalence of high myopia between 3 and 12 months of age. Between 12 months and 10 years of age, there was little change in distribution of refractive error in treated or control eyes. The higher prevalence of myopia of 8 D or more in treated eyes, as compared with control eyes, may be the result of cryotherapy's preservation of retinal structure in eyes that, in the absence of cryotherapy, would have progressed to retinal detachment.

Astigmatism↗

Refractive errors associated with hemangiomas of the eyelids and orbit in infancy.

Asymmetrical refractive errors, both astigmatic and myopic, were associated with infantile hemangiomas of the eyelids and orbit in 46% of 37 patients who had large lesions and upper eyelid involvement predisposing to the ammetropia. The axis of the astigmatic error related to the location of the eyelid hemangioma and correlated closely with keratometric measurements of corneal astigmatism. The refractive errors tended to be stable despite eventual resolution of the hemangiomas. Efforts to combat strabismic and refractive amblyopia were rewarding in many patients. A history of complete eyelid occlusion during part of the first year of life was associated with dense amblyopia and eccentric fixation in some patients, but in other patients this history was compatible with the eventual development of useful vision. Absence of an asymmetrical refractive error in patients with eyelid and orbital hemangiomas rendered the prognosis for vision good in involved eyes.

Astigmatism↗

Screening of infants for significant refractive error using videorefraction.

Isotropic photorefraction has been suggested as a suitable method for screening infants for refractive error. Recently published data suggested that reasonable consistency with retinoscopy results might be achieved using cycloplegic videophotorefraction (VPR) for spherical refractive error but that results might be unreliable for astigmatic errors. Non-cycloplegic VPR did not appear to produce results consistent with retinoscopy. A practical idea of how many children might be identified using this technique and how many missed was needed by personnel designing screening projects. Hence the VPR was tested by screening a population of 247 infants for significant refractive error, and comparing the results with cycloplegic retinoscopy. Sensitivity and specificity scores were calculated for a range of test levels of ametropia. Without cycloplegia, sensitivity of VPR was poor. With cycloplegia the situation was much improved, with sensitivity for hyperopia +4.00 D or over of 83.3% and specificity of 90.6%. Sensitivity for astigmatism of 1 D or greater (84.6%) was high but specificity was poor (45.6%). Acceptable sensitivity was achieved for identifying children in this age group at risk of developing squint and amblyopia due to refractive error, providing cycloplegia was used.

Amblyopia↗

Frequency of under-corrected refractive errors in elderly Chinese in Beijing.

PURPOSE: The aim of the study was to evaluate the prevalence of under-corrected refractive error among elderly Chinese in the Beijing area. METHODS: The population-based, cross-sectional, cohort study comprised 4,439 subjects out of 5,324 subjects asked to participate (response rate 83.4%) with an age of 40+ years. It was divided into a rural part [1,973 (44.4%) subjects] and an urban part [2,466 (55.6%) subjects]. Habitual and best-corrected visual acuity was measured. Under-corrected refractive error was defined as an improvement in visual acuity of the better eye of at least two lines with best possible refractive correction. RESULTS: The rate of under-corrected refractive error was 19.4% (95% confidence interval, 18.2, 20.6). In a multiple regression analysis, prevalence and size of under-corrected refractive error in the better eye was significantly associated with lower level of education (P<0.001), female gender (P<0.001), and age (P=0.001). CONCLUSIONS: Under-correction of refractive error is relatively common among elderly Chinese in the Beijing area when compared with data from other populations.

Adult↗

The distribution of refractive errors in Nigeria.

A clinical study of the refractive errors of 349 females aged between 5 and 69 years and 473 males aged between 3 and 62 years was undertaken. This report describes the prevalence of the different types of refractive errors with regard to sex and age.

Adolescent↗

Refractive error, ocular biometry, and lens opalescence in an adult population: the Los Angeles Latino Eye Study.

PURPOSE: To characterize age- and gender-related differences in refractive error, ocular biometry, and lens opalescence (NOP) in a population-based sample of adult Latinos. Also assessed were the determinants of age-related refractive differences. METHODS: Participants in the Los Angeles Latino Eye Study (LALES), a population-based study of Latinos aged 40 years and more, underwent an ophthalmic examination, including ultrasonic measurements of axial length (AL), vitreous chamber depth (VCD), anterior chamber depth (ACD), lens thickness (LT), and noncycloplegic automated and subjective refraction. Corneal curvature/power (CP) was measured using an autorefractor. NOP was graded at the slit lamp by an ophthalmologist using the Lens Opacity Classification System II. Age- and gender-related differences were calculated. Multiple regression models were used to identify the determinants of age-related refractive differences. RESULTS: Of the 6357 LALES participants, 5588 phakic individuals with biometric data were included in this analysis. Older individuals had shallower ACDs, thicker lenses, more NOP, and more hyperopia compared to younger individuals (P < 0.001). There was no age-related difference in AL (P > or = 0.05). Women had significantly shorter AL, shallower ACD and VCD, than did men (P < or = 0.01). The strongest determinants of refractive error were AL (primarily VCD) and CP. NOP was a small but significant determinant of refractive error in older individuals. CONCLUSIONS: Age- and gender-related differences in ocular biometric, refractive error, and NOP measurements are present in adult Latinos. While the relative contribution of NOP in determining refractive error is small, it is greater in older persons compared to younger individuals.

Adult↗

Refractive error profile--a clinical study.

AIM: To study the distribution of refractive error in different ethnic groups of Nepal. METHODS: A total of 1276 new eye patients between 5-35 years of age were included in this study after a thorough eye examination consisting of vision test, anterior and posterior segment eye examination including the investigative procedures whenever needed to rule out any systemic and ocular diseases. Thereafter, the patients were subjected to rigorous streak retinoscopic refraction. RESULTS: Out of 1276 eye patients examined 51.33 % patients are males and 48.66 % are females. The ethnic distribution of refractive error shows that there are 32.44% Newars; 27.50% Brahmins; 21.63% Chhetriyas; 12.14% Gurungs, Magars, Rais, Limbus, Tamangs, Sunuwars; and 6.26% Madhesias. Out of 414 Newar patients, 14.00% patients are myopic; 29.71% hyperopic; and 56.28% astigmatic. In 351 Brahmin patients, 14.81% patients are myopic; 49.85% hyperopic; and 35.32% astigmatic. In 276 Chhetry patients, 13.40% patients are myopic; 48.18% hyperopic; and 38.40% astigmatic. Out of 155 Gurungs, Magars, Rais patients, 11.61% are myopic; 52.90% hyperopic; and 35.48% astigmatism. Out of 80 Madhesias patients, 11.25% are myopic; 37.50% hyperopic; and 51.25 % astigmatic. CONCLUSION: Thus, a refractive error profile is drawn up in Nepalese population.

Adolescent↗

[Assortative mating among individuals with refractive errors of the eye].

Negative assortative mating for refractive errors of the eyes of 1241 married couples was discovered in the urban region of the South Moravian region. 46 married couples were myopic, 55 hyperopic, 73 astigmatic, 175 had combinations of refractive errors, 261 were emetropic and 631 were mixed. Negative assortative mating is highly significant (chi-square P < or = 0.001). It is more significant for urban population. Positive selection for emetropic married couples plays more important role in urban peoples than in citizens.

Family Health↗

The prevalence of refractive errors among adults in the United States, Western Europe, and Australia.

OBJECTIVE: To estimate the prevalence of refractive errors in persons 40 years and older. METHODS: Counts of persons with phakic eyes with and without spherical equivalent refractive error in the worse eye of +3 diopters (D) or greater, -1 D or less, and -5 D or less were obtained from population-based eye surveys in strata of gender, race/ethnicity, and 5-year age intervals. Pooled age-, gender-, and race/ethnicity-specific rates for each refractive error were applied to the corresponding stratum-specific US, Western European, and Australian populations (years 2000 and projected 2020). RESULTS: Six studies provided data from 29 281 persons. In the US, Western European, and Australian year 2000 populations 40 years or older, the estimated crude prevalence for hyperopia of +3 D or greater was 9.9%, 11.6%, and 5.8%, respectively (11.8 million, 21.6 million, and 0.47 million persons). For myopia of -1 D or less, the estimated crude prevalence was 25.4%, 26.6%, and 16.4% (30.4 million, 49.6 million, and 1.3 million persons), respectively, of whom 4.5%, 4.6%, and 2.8% (5.3 million, 8.5 million, and 0.23 million persons), respectively, had myopia of -5 D or less. Projected prevalence rates in 2020 were similar. CONCLUSIONS: Refractive errors affect approximately one third of persons 40 years or older in the United States and Western Europe, and one fifth of Australians in this age group.

Adult↗

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↗