Small targets in cross-cylinder astigmatic testing.
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Validation of surveys is an important step in establishing the usefulness of questionnaires for gathering information in clinical studies. Often in large studies of refractive error, it is not possible to examine and refract all subjects and their relatives. Therefore, we used 3 methods to evaluate 112 consecutive clinic patients' abilities to report myopia through a survey: (1) The Lay Terms Method asks: "are you nearsighted?"; (2) The Direct Method asks: "are you myopic?"; and (3) The Indirect Method uses a series of questions about the use of eyeglasses and age at first dispensing. Patient responses to the survey before examination were compared to subjective refraction findings at the completion of the eye examination. The Lay Terms Method had the highest sensitivity (0.98) but poor specificity (0.48), and the Direct Method yielded the highest specificity (0.83) but poor sensitivity (0.54). The rate of nonresponse ("don't know") was high (25.9 and 46.4% for the Lay Term and Direct Methods, respectively). The Indirect Method gave both high sensitivity and specificity (0.76 and 0.74, respectively), and only an 8.9% don't know response rate. The survey method that reports the presence or absence of myopia with the best balance of sensitivity and specificity and fewest don't know responses is the Indirect Method, suggesting it is the most suitable of our three approaches for use in clinical studies.
BACKGROUND: There are basically two possibilities to measure cylindrical refractive errors by eccentric photorefraction. The first is to determine the size and the tilt of the light crescent in the subject's pupil. Sphere, cylinder, and axis can be obtained from two pictures with the knife edge at two different orientations by using equations derived by Wesemann et al. In natural eyes, the procedure has limitations because undetermined factors (not considered in the theory) affect size, shape, and intensity of the light crescent. A second possibility is to perform eccentric photorefraction separately in at least three different meridians. METHODS: We have tested the power of the second possibility. The three critical parameters (sphere, cylinder, and axis) were calculated from Euler's law, which describes curvatures (or refractions) at any given angle. The procedure relied only on empirical calibration and not on a theoretical treatment of the optics. Therefore, it was not necessary to identify all factors that determine the path of light. RESULTS: The procedure compared favorably with subjective refractive (first population: students, age 26-30 years, N = 7 (14 eyes); correlations: sphere, r = 0.983; cylinder, r = 0.867; axis, r = 0.935) and with a Canon R-1 Autorefractor (second population: children, age 4-14 years, N = 48 (96 eyes); correlations: sphere, r = 0.955; cylinder, r = 0.600; axis, r = 0.846). CONCLUSIONS: Because it is fast, the technique may be suitable for screening in children. The refractions in the different meridians are performed in real time (25 to 30 Hz) and a single reading (the average from 4-6 refractions in each of the 6 meridians) is obtained in 1-2 s. It constitutes a major improvement to commercially available videorefractors which use measurements only in two meridians in conjunction with the formula by Wesemann et al., although it is still not precise enough to permit spectacle prescription.
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A new variable power cross-cylinder lens set is described. It differs from the well known Stokes variable power cross-cylinder lens set, which is made of cylinder lenses of equal but opposite power, in that in the new variable power cross-cylinder lens set both lens elements are identical. These elements can be sphero cylindrical of any type and can be designed to give the same effect as a Stokes lens set or create a spherical bias or offset of a desired amount. The action of this lens set is analyzed using 3-dimensional refractive space.