[Principles of construction of intelligent devices for early cataract diagnosis on the basis of incoherent fiber-optic converters]

Currently used methods for cataract diagnosis are considered and compared. Principles of construction of novel devices on the basis of incoherent fiber-optic converters are described. These devices can be used for rapid cataract diagnosis during mass-scale prophylactic examination in remote areas. The principle of operation of the device and the procedure for simulating the device operation are described.

Comparison of the Scanning Peripheral Anterior Chamber Depth Analyzer and the Modified van Herick Grading System in the Assessment of Angle Closure

PURPOSE

To compare the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and the modified van Herick grading system in the assessment of angle closure, using gonioscopy as the reference standard.

DESIGN

Prospective comparative study.

PARTICIPANTS

One hundred twenty phakic subjects (53 with primary angle closure and 67 with open angles) with no history of laser or intraocular surgery.

METHODS

The modified van Herick grading system was used to grade the peripheral anterior chamber depth (ACD) clinically. The SPAC was used to assess ACD, and this was graded categorically as S (suspect angle closure), P (potential angle closure), or N (normal) and numerically from 1 to 12. One randomly selected eye of each subject underwent examination with the modified van Herick grading, SPAC, Goldmann applanation tonometry, optic disc examination, and gonioscopy. The SPAC measurements, modified van Herick grades (0%, 5%, 15%, 25%, 40%, 75%, and > or =100% of corneal thickness), and gonioscopy (graded as narrow or open) were correlated using the Spearman correlation coefficient. The receiver operating characteristics of the 2 methods to detect angle closure also were compared.

MAIN OUTCOME MEASURES

Grading of ACD by the SPAC, the modified van Herick system, and gonioscopic grading of the angle.

RESULTS

The SPAC results correlated well with the modified van Herick grading system (categorical grade, r = 0.527; numerical grade, r = 0.542; P<0.0001). For eyes graded as having narrow angles by gonioscopy, the area under the curve (AUC) for SPAC categorical grade S or P was 0.790; sensitivity and specificity were 84.9% and 73.1%, respectively. For the modified van Herick grading system, using a cutoff of peripheral ACD < or = 25% corneal thickness, the AUC was 0.872 and sensitivity and specificity were 84.9% and 89.6%. Compared with gonioscopy that found 53 of 120 cases of narrow angles, the SPAC graded more eyes as having narrow angles (63/120) than the modified van Herick system (52/120).

CONCLUSIONS

The SPAC correlated well with the modified van Herick system in grading peripheral ACD. However, the SPAC appeared to overestimate the proportion of eyes with narrow angles relative to gonioscopy and the modified van Herick grading system.

[Refraction and accommodation]

The main purpose of ophthalmology is to improve the quality of vision by the recovery of visual function. Visual acuity, among the visual functions, is the most important factor. Decreased far vision is caused mainly by refractive errors, while decreased near vision is caused by accommodative insufficiency, especially presbyopia. REFRACTIVE ERRORS: The development of myopia may be influenced by both polygenic and environmental factors. Investigation of the mechanism of myopia has progressed based on the experimental animal models of myopia. The conventional treatments for refractive errors is spectacles or contact lenses, and new treatment includes phakic IOL, orthokeratology, and refractive surgery. There are also newly designed types of equipment to assess refraction and refractive elements. ACCOMMODATIVE INSUFFICIENCY: Presbyopia is mainly corrected using multifocal or progressive power spectacle lenses. Nowadays, bifocal and multifocal contact lenses and sometimes surgical treatment are used for presbyopia. Equipment for asthenopia has also been developed.

Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis

AIM

To investigate the coefficient of repeatability (CR) for corneal parameters evaluated with Pentacam after laser in situ keratomileusis (LASIK) in myopic eyes.

DESIGN AND SETTING

Prospective, non-interventional, non-comparative study in an institutional setup.

MATERIALS AND METHODS

Forty eyes of 40 consecutive subjects who had undergone LASIK for myopia were assessed with the Scheimpflug system (Pentacam 70700: Oculus, Wetzlar Germany). The mean of five consecutive measurements of all the corneal parameters was recorded and CR was calculated as standard deviation of the difference from the mean of these repeat measurements divided by the mean response. The statistical significance of the CR was calculated for these parameters at 5% significance level.

RESULTS

The best CR was observed for the periphery of the anterior corneal curvature (0.18%) and the least for the horizontal meridian of the posterior corneal curvature (1.29%). Despite being significantly different ( P < 0.001), both the measurements were highly repeatable in post-LASIK eyes. The central, apical and minimal corneal thickness had a CR of 1%, 0.78% and 0.77% respectively. These were equally repeatable ( P> 0.323). The CR of the mean radius of curvature of the anterior cornea (0.29%) was significantly better ( P < 0.001) than the posterior corneal curvature (0.57%).

CONCLUSION

The CR for the post-LASIK cornea with Pentacam was the best for the anterior corneal curvature. Significantly, Pentacam has a high degree of repeatability for the posterior corneal curvature, which has a potential for early detection of keratectasia in these eyes. Post-LASIK pachymetry with Pentacam also showed excellent repeatability.

Screen tests used to map out ocular deviations

A century ago Hess described how to map out ocular deviations on two pieces of paper in cases of diplopia. This paper discusses how to obtain useful information regarding ocular deviations from a chart that has been obtained from screen tests (Hess, Lancaster, Lees, Weiss).

Corneal Radii and Anterior Chamber Depth Measurements Using the IOLMaster Versus the Pentacam

PURPOSE

Corneal radii (R1, R2) and anterior chamber depth are important parameters for biometry and refractive surgery. This study aimed to investigate whether the IOLMaster, a biometric device, and the Pentacam, a rotating Scheimpflug camera, provide comparable results.

METHODS

In this prospective study, corneal radii and anterior chamber depth were analyzed in 82 eyes of 41 phakic patients (median age 72 years) using the IOLMaster and Pentacam. Normal distribution was confirmed using the Kolmogorov-Smirnov test. A paired t test was used for statistical analysis.

RESULTS

No statistically significant difference was noted for R2 using the Pentacam versus the IOLMaster (P = .40). There was a small statistical difference of 0.03 mm (P < .01) for R1 (corresponding to 0.08 diopters [D]). The IOLMaster measured a mean R1 of 7.87 mm and R2 of 7.67 mm. The Pentacam measured mean R1 of 7.90 mm and R2 of 7.69 mm. For anterior chamber depth values, a small statistically significant difference of 0.05 mm (P < .001) was found (corresponding to 0.01 D). Mean anterior chamber depth measured from the epithelium was 3.20 mm for the IOLMaster and 3.25 mm for the Pentacam. The Bland-Altman plot showed no distorting trends for either variable.

CONCLUSIONS

Keratometry and anterior chamber depth were comparable for the two devices. If the axial length is known, the Pentacam can be used as a biometric device.

A Study of Pupillary Assessment in Outpatient Neurosurgical Clinics

This study compared the accuracy of three methods of assessing pupil diameter Measurements from the ForSite pupillometer and visual assessments were compared with measurements obtained using a pupil gauge (the standard method). Two sets of measurements were obtained from 65 out-patients at four neurosurgical clinics. The correlation between the three methods showed significance; however, the pupil gauge measurements showed a more significant correlation with measurements from the pupillometer than with visual assessments. Pupil diameter measurements from the pupillometer were larger than those from either the pupil gauge or clinical observation. We conclude that the ForSite pupillometer is an easy-to-use and accurate measure of pupil diameter in a clinic setting. It may be more accurate than the pupil gauge.

Assessment of change of optic nerve head cupping in pediatric glaucoma using the RetCam 120

PURPOSE

To ascertain the interobserver agreement among various specialists when analyzing images of the optic nerve head taken with the RetCam 120 (Clarity Medical Systems, Inc., Pleasanton, CA) for assessing the progression of optic disk cupping in pediatric glaucoma.

METHODS

Five observers compared pairs of RetCam 120 two-dimensional photographs from 64 eyes to identify whether or not changes in the optic disk had occurred. Observers included a pediatric glaucoma specialist, pediatric neurophthalmologist, strabismologist, pediatric ophthalmic imaging specialist, and pediatric ophthalmology fellow. Each was masked to the patient identity and clinical course. For each patient, the observers reviewed the photographs taken prior to therapy and at a minimum of 6 months following initiation of therapy. Interobserver variability was calculated and analysis conducted to identify influential variables.

RESULTS

Poor agreement was noted between the observers. No significant association was obtained between agreement level and variables affecting photographic quality: variability of contrast and illumination, exposure and magnification, image clarity, presence of fluorescein on the cornea, and pixelation of the image with poor resolution. Raters noted problems with these image variables in 75.6% of the observations. The Kappa statistic obtained was kappa = 0.29 with overall proportion of agreement of p = 0.69, suggesting a fair agreement but not a moderate agreement.

CONCLUSIONS

Comparison of RetCam 120 pediatric optic nerve head photographs, when performed subjectively by observers with different perspectives, and in isolation from clinical information, may not be a reliable indicator of cupping change. In addition, variations in image contrast, luminance, color, and pixelation pose significant challenges to agreement between observers. Comparison of RetCam 120 images should not be considered the sole criterion for monitoring pediatric glaucoma.

Burst-shot infrared digital photography to determine scotopic pupil diameter

PURPOSE

To evaluate the usefulness of infrared digital photography for determining scotopic pupil size by comparing infrared digital photography with a Colvard pupillometer (Oasis Medical).

SETTING

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea.

METHODS

Scotopic pupil size in 50 eyes of 25 healthy individuals was measured with a Colvard pupillometer and a digital camera (DSC-F828) using infrared burst shots after 5 minutes of dark adaptation. Measurements were performed by 2 independent examiners (E1 and E2). The digital photograph images were read using the ruler function of Adobe Photoshop 7.0 by 2 independent readers (R1 and R2). Agreement and repeatability were analyzed using the comparison method described by Bland and Altman.

RESULTS

The mean scotopic pupil diameter measured using the Colvard pupillometer was 6.69 mm +/- 0.78 (SD) (E1) and 6.70 +/- 0.71 mm (E2). The mean scotopic pupil diameter measured from the digital photograph images was 6.67 +/- 0.75 mm (E1) and 6.66 +/- 0.78 mm (E2). The mean difference between E1 and E2 with both devices was small; however, the result with the infrared digital camera was marginally smaller than with the Colvard pupillometer. The limits of agreement were -0.01 +/- 0.70 mm with the Colvard pupillometer and 0.01 +/- 0.20 mm with the digital photograph image. The digital photograph image showed better agreement. The coefficient of interrater repeatability was smaller for the digital photograph image (0.39) than for the Colvard pupillometer (0.70).

CONCLUSIONS

Scotopic pupil measurement using an infrared digital camera with a burst shot had good agreement with the Colvard pupillometer and better repeatability. The infrared digital camera is less expensive, and pupil unrest can be overcome by taking serial images.

Comparison of Digital and Film Stereo Photography of the Optic Nerve in the Evaluation of Patients with Glaucoma

The aim of this study was to validate a digital simultaneous stereo photography system against film in the assessment of optic nerve head features in patients with glaucoma. Fifteen digital and 15 corresponding film simultaneous stereo photographs (SSP) of the optic nerve from patients with glaucoma were graded by two glaucoma specialists. Assessed parameters included the vertical and horizontal cup-to-disc ratios (VCD and HCD, respectively), and the image quality score (1 = worse, 5 = best) for each image. Digital and film SSP were presented in random order, two times to each grader. A total of 60 evaluations (30 digital and 30 film) per grader were collected. A Nidek 3-Dx simultaneous stereo disc camera (Gamagori, Japan) was used with both a standard 35-mm-film camera back, and with a 6.1 mega pixel camera (Nikon D1x, Tokyo, Japan) for capture of digital images. All digital images were stored on a computer and reviewed using the Navis Screener software (proprietary software from Nidek). Digital image pairs were evaluated directly on an ADVAN 27-inch Liquid Crystal Display computer monitor (Taipei, Taiwan) with resolution comparable to that of the digital camera, using the screen-vu stereo viewer held at a fixed angle to the monitor. Film image pairs were evaluated using a Pentax stereo slide viewer (Asahi Optical Co., Tokyo, Japan) illuminated by a light box over a neutral density filter to match the luminance between the computer screen and the light box. The mean difference between digital and film was near zero for all three evaluated outcomes (VCD, HCD, and quality score), and there was no significant grader effect for any of the outcomes. Digital images correlated well with film for SSP of the optic nerve in glaucoma.

Measurement of pupil reactivity using fast pupillometry

Analysis of human eye pupil reactivity is a very valuable diagnostic method used mainly for evaluation of the condition of the autonomic nervous system and the visual system. The paper presents an experimental pupillometer built in the Institute of Physics of the Wroclaw University of Technology. The apparatus makes it possible to record and analyze pupillary light reflex and spontaneous changes in the pupil diameter during a session in the dark. The detector system used in the pupillometer allows us to record the pupil diameter at a rate of 90 Hz with a linear accuracy of 0.008 mm. In this paper, the proposed detection method, the principle of operation and calibration of the apparatus and the possibilities of the measurement system are presented.

A pilot study on slit lamp-adapted optical coherence tomography imaging of trabeculectomy filtering blebs

BACKGROUND

Our study aims to identify anatomical characteristics of glaucoma filtering blebs by means of slit lamp-adapted optical coherence tomography (SL-OCT) and to identify new parameters for the functional prognosis of the filter in the early post-operative period.

METHODS

Patients with primary open-angle glaucoma, aged 18 years and older, scheduled for primary trabeculectomy at the Department of Ophthalmology, Radboud University Nijmegen Medical Centre, were considered for our study. All patients underwent standardized trabeculectomy with intra-operative application of mitomycin C. The filtering blebs were evaluated clinically and with SL-OCT on day 1 and 1, 2, 4 and 12 weeks following surgery. The resulting data were analysed and weighed against surgical success. To better understand the SL-OCT data a small comparative histologic study was performed.

RESULTS

The study included 20 eyes of 20 patients. After completion of our study, 15 eyes of 15 patients (mean age+/-SD 67 +/- 16 years) were eligible for data analysis and 5 eyes missed at least one follow-up visit. Filtering surgery was considered successful (intraocular pressure < or = 21 mmHg without antiglaucomatous medication) in 11 of 15 eyes. SL-OCT frequently demonstrated multiple hypo-reflective layers within Tenon's capsule ("striping" phenomenon) in the first post-operative week. Presumably, these layers corresponded with drainage channels in the histological specimen. These channels were present in functional filters but not in the failures. In addition, the visualisation of the sclera below the filtering zone was better defined in failures compared with successful filtering blebs ("shading" phenomenon). We observed no differences in the volume and clinical aspect of the blebs in the successful group compared with the unsuccessful group.

CONCLUSIONS

Successful filtering blebs show characteristic optical properties on SL-OCT. These phenomena suggest a diffusely enhanced fluid content and the presence of intra-bleb drainage channels in functional filtering blebs.

A New Wavefront Sensor With Polar Symmetry: Quantitative Comparisons With a Shack-Hartmann Wavefront Sensor

PURPOSE

A novel wavefront sensor has been developed. It follows the same principle of the Shack-Hartmann wavefront sensor in that it is based on slope information. However, it has a different symmetry, which may offer benefits in terms of application.

METHODS

The new wavefront sensor consists of a set of donut-shaped acrylic lenses with a charge coupled device located at the focal plane. From detection of shift in the radial direction, radial slopes are computed for 2880 points. Theoretical computations for higher order aberrations and lower order aberrations were implemented for the Shack-Hartmann wavefront sensor and the new wavefront sensor, and practical measurements were conducted on several sphere-cylinder trial lenses.

RESULTS

The overall mean value of root mean square error (RMSE) (in microns) for theoretical computations was 0.03 for the Shack-Hartmann wavefront sensor and 0.02 for the new wavefront sensor. The mean value of RMSE for lower order aberrations (1-5) was 0.01 and 0.00003, and for higher order aberrations was 0.02 and 0.02, for the Shack-Hartmann and new wavefront sensors, respectively. For practical measurements (sphere, cylinder, axis), the standard deviation was 0.04 diopters (D), 0.04 D, and 4 degrees for the new wavefront sensor and 0.02 D, 0.02 D, and 5 degrees for the Shack-Hartmann wavefront sensor.

CONCLUSIONS

Precision of the new wavefront sensor when measuring astigmatic and spherical surfaces is compatible with the Shack-Hartmann wavefront sensor. Centration with this new sensor is an absolute process using the center of the entrance pupil, which is where the line of site passes. This wavefront sensor, similar to the Shack-Hartmann sensor, does not eliminate the possibility of tilt. For more conclusive and statistically valid data, in vivo measurements are needed.

Optical Quality Analysis After Surface Excimer Laser Ablation: The Relationship Between Wavefront Aberration and Subepithelial Haze

PURPOSE

To investigate the relationship between mild and moderate corneal haze and the distribution of higher order wavefront aberrations after photorefractive keratectomy (PRK).

METHODS

Thirty-six eyes from 18 patients who underwent PRK were divided into two groups: 10 eyes with corneal haze and 26 eyes without corneal haze (control). All eyes were evaluated up to 6 months after PRK. Wavefront aberrations were measured using a psychophysical wavefront sensor and the NIDEK OPD-Scan. Topography, point spread function, and modulation transfer function maps were obtained from the OPD-Scan.

RESULTS

The mean total higher order aberration was slightly higher in the corneal haze group than in the control group. This difference was not statistically significant. The mean third order coma aberrations were higher and mean fourth order spherical aberrations were lower in the haze group compared with the control group, although neither difference attained statistical significance. The t test values were 1.05, -0.38, -1.10, -0.08, and -0.23, when comparing the mean third, fourth, fifth, sixth, and seventh order aberrations, respectively. None of these differences attained statistical significance. In terms of Zernike coefficients, Z-1 and Z1 showed greater mean root-mean-square (RMS) in the haze group (0.33 and 0.35 microm, respectively) than those for the control group (0.26 and 0.23 microm, respectively) (t=0.71 and P=.49; t=0.84 and P=.43, respectively). However, ZO had lower RMS in the haze group (0.18 microm) than in the control group (0.28 microm). This difference also was not statistically significant.

CONCLUSIONS

In this study comparing the optical aberrations of eyes with and without corneal haze after PRK, corneal haze did not affect the magnitude and distribution of higher order aberrations in a predictable manner.

Shack-Hartmann-Based Wavefront Analyzer for Calibrating Excimer Lasers

PURPOSE

Currently, refractive surgical excimer laser systems are calibrated by ablating plastic lenses, which are measured by lensometer and analyzed by a technician. The accuracy of this method is approximately 0.25 diopters (D) in sphere and cylinder power. Theoretically, objective calibration using wavefront technology would be significantly more accurate, thereby improving surgical outcomes. This study describes a Shack-Hartmann-based instrument, which has been developed to measure ablated plastic lenses for calibration and quality control of the excimer laser.

METHODS

A calibration instrument comprising an LED source at 640 nm, a lenslet array, beam-guiding optics, and a CCD camera was designed to perform full wavefront analysis. The measurement plane is conjugate to the lenslet array plane, and the diameter of the pupil is 5 mm. Accuracy was determined by measuring a set of well-calibrated spherical and cylindrical glass lenses. Plastic lenses were ablated, and high-precision measurements were performed by surface profile scanner.

RESULTS

In the power range of -6.00 to +4.00 D, repeatability exceeded 0.01 D, accuracy of measurement exceeded 0.04 D, and 10 for the axis of cylinder lenses. The measurement of excimer-ablated plastic lenses agreed with high-precision surface profile scanner measurements within 0.10 D, and repeatability exceeded 0.01 D.

CONCLUSIONS

Wavefront technology-based, high-precision measurement of calibration lenses can more accurately set the energy of the excimer laser, which enhances the accuracy of refractive laser correction. In automating calibration, the new instrument removes operator subjectivity and decreases the time needed for calibration.

Comparison of 2 multiple-measurement infrared pupillometers to determine scotopic pupil diameter

PURPOSE

To compare a monocular and a binocular multiple-measurement digital infrared pupillometers for measuring scotopic pupil diameter.

SETTING

Department of Ophthalmology, Loma Linda University, Loma Linda, California, USA.

METHODS

Scotopic pupil size was measured after 1 minute of dark adaptation in 42 eyes of 21 volunteers. Measurements were taken twice each with 2 multiple-measurement digital infrared pupillometers, the monocular pupillometer (Neuroptics, Inc.), and the binocular pupillometer (P2000D, Procyon, Ltd.) Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were used to measure repeatability and agreement of measures with each instrument and between instruments. The Wilcoxon signed rank test was used to compare variability of measurements within each instrument.

RESULTS

The mean scotopic pupil size was 4.79 mm +/- 0.95 (SD) with the Procyon and 4.86 +/- 0.93 mm with the Neuroptics. Repeatability and agreement tests for the Procyon measures showed the following: ICC, 0.954; 95% confidence interval (CI), 0.916-0.975; LOA, -0.60 to 0.56; range, 1.16. The Wilcoxon signed rank test of variability gave a Z score of -2.53 (P = .01, 2 tailed). The repeated measures testing with the Neuroptics pupillometer showed the following: ICC, 0.985; 95% CI, 0.972-0.992; LOA, -0.39 to 0.26; range, 0.64; Z score, -1.15 (P = .25, 2-tailed). Repeatability and agreement tests for measures between instruments showed the following: ICC, 0.954; 95% CI, 0.916-0.975; LOA, -0.60 to 0.50; range 1.11.

CONCLUSIONS

There was a high repeatability and agreement in scotopic pupil diameter for repeated measures within each device and measurements between the devices. Differences in variability in scotopic pupil diameter evaluated by the Wilcoxon signed rank test were significant only with the Procyon pupillometer.

A Shack-Hartmann-Based Autorefractor

PURPOSE

Autorefractors are typically based on either the optometer or the Scheiner principles, or a combination of the two techniques. These devices have dominated the market for objective assessment of refractive error for >30 years. The purpose of this investigation is to test a Shack-Hartmann-based system as an alternative to these systems.

METHODS

Fourteen subjects with varying levels of refractive error were measured with a Topcon autorefractor and a Shack-Hartmann-based autorefractor. Fourier transform techniques were used to extract sphere, cylinder, and axis information from the Shack-Hartmann images, avoiding the need for image processing. The deviation of the refractive error from a subjective refraction was used as a means of comparing the two devices.

RESULTS

The two devices performed similarly on this group of subjects. The mean difference in refraction between the two devices was nearly zero, suggesting that the likelihood and magnitude of errors for the two devices are equivalent.

CONCLUSIONS

The Shack-Hartmann-based autorefractor shows promise as an alternative to conventional optometer or Scheiner-based technologies. However, issues with extending the myopic range of the device still need to be resolved.

Comparison between central corneal thickness measurements by ultrasound pachymetry and optical coherence tomography

PURPOSE

Measurement of central corneal thickness (CCT) plays an important role in both diagnostic and therapeutic assessment of ocular diseases. Although ultrasound pachymetry (U-PACH) is regarded as the golden standard for measurement of CCT, optical coherence tomography (OCT) may offer advantages as it can locate the central cornea with precision with no corneal touch. Nevertheless, the agreement of OCT with U-PACH has not yet been gauged by Bland-Altman analysis. This study compares CCT measurement by OCT with that by U-PACH.

METHODS

Healthy subjects without ocular abnormality (except refractive errors less than or equal to -6.0 D), contact lens wear or ocular surgery were recruited. CCT was measured in one eye of normal subjects using OCT and U-PACH. Results were compared using correlation and Bland-Altman plots.

RESULTS

Fifty subjects were recruited. Mean +/- SD CCT measured by OCT was 565 +/- 33 microm. This was highly correlated (Pearson's coefficient = 0.934) with the mean thickness measured by U-PACH (543 +/- 33 microm). The coefficients of variation were good and comparable at 7.9% for U-PACH and 3.5% for OCT. Compared with U-PACH, OCT consistently overestimated the CCT by a mean of 23 microm as shown on Bland-Altman plot.

CONCLUSION

CCT measured by OCT and U-PACH is highly correlated. With appropriate adjustment factor, OCT agrees well with U-PACH and is a reliable alternative for CCT measurement.

Comparison of Aberrometer and Autorefractor Measures of Refractive Error in Children

PURPOSE

The purpose of this study was to evaluate and compare the Complete Ophthalmic Analysis System (COAS) G200 Aberrometer (Wavefront Sciences Inc., Albuquerque, NM) and Canon RK-F1 Autorefractor (Canon Inc., Tokyo, Japan) for measuring refractive errors in young children.

METHODS

The Sydney Myopia Study is a population-based study of refractive error and eye health in young Australian children. Cycloplegic refractions were performed on 1504 school year 1 students (mostly 6 years old) and 890 school year 7 (mostly 12 years old) students using both the COAS G200 Aberrometer and Canon RK-F1 autorefractor. Refractive data were analyzed using power vectors. Mean differences and 95% limits of agreement were determined for refractive components between the two instruments.

RESULTS

The mean age +/- standard deviation was 6.7 +/- 0.4 years (range, 5.5-9.1 years) and 12.6 +/- 0.5 years (range, 11.1-14.4 years) for the year 1 and year 7 students, respectively. Mean paired differences for the M component (spherical equivalent) between the COAS G200 and Canon RK-F1 were <0.25 D in both age groups and were statistically significant in the year 1 group only (p < 0.001). Small significant differences were found in the astigmatic components (J0 and J45) in both groups. A smaller coefficient of agreement for the M component was found in the older group (0.54 D), whereas the coefficients of agreement of the astigmatic components (J0 and J45) were similar for both groups.

CONCLUSIONS

The COAS G200 aberrometer was an easy-to-use instrument for the measurement of refractive error in children. In addition to being able to measure higher and lower order aberrations, the COAS G200 provides refractive error measurements comparable to those of an autorefractor.

Fast assessment of the central macular pigment density with natural pupil using the macular pigment reflectometer

We built a new macular pigment reflectometer (MPR) for fast and objective measuring of the optical density of macular pigment in the human eye, using the undilated eye. The design is based on the spectral reflectance from a spot of white light at the fovea. To evaluate its performance, we measured the macular pigment of 20 healthy subjects, ages 18 to 79 years, under four conditions: (1) natural pupil in the dark, (2) natural pupil with dim room light, (3) dilated pupil in the dark, and for comparison with a different technique, (4) heterochromatic flicker photometry (HFP) in dim room light with natural pupil. Condition 1 was repeated in a subset of 10 subjects after an interval of at least 3 days. Data analysis with a model of reflectors and absorbers in the eye provided the density of the macular pigment in conditions 1 to 3. Dim room light and pupil dilatation had no influence on measured density. Mean within subjects variation was typically 7%. Mean difference between test and retest after at least 3 days was 1%. Correlation between MPR and HFP was r=0.56 (p=0.012). Mean within subjects variation with HFP was 19%. The new instrument holds promise for specific applications such as epidemiological research.

[I have tested for you. Pachymetry devices]

Different techniques are currently available to measure central corneal thickness: optical pachymetry, ultrasound pachymetry, optical coherence pachymetry, slit-scanning pachymetry, specular microscopy, and confocal microscopy. Ultrasound pachymetry is the gold standard. It is a noncontact and rapid technique with high precision, approximately 1%. The correlation between optical coherence pachymetry and ultrasound pachymetry is high, with a 0.99 correlation coefficient. Nevertheless, optical coherence pachymetry measurements seem underestimated compared to ultrasound pachymetry measurements. Correlation of ultrasound pachymetry with the other techniques is less satisfying. If the ultrasound probe can be decontaminated for each patient, ultrasound pachymetry seems to be the best technique for measuring central corneal thickness. Otherwise, optical coherence pachymetry seems to be the most advantageous technique.

Comparison of two pupillometers in determining pupil size for refractive surgery

PURPOSE

To compare a handheld and a digital pupillometer in determining pupil size in a population of refractive surgery candidates (group 1) and after implantation of an Artisan phakic intraocular lens (PIOL) for correction of myopia (group 2).

METHODS

Pupil size was measured with the Colvard and Procyon pupillometers in 121 eyes in group 1 and 83 eyes in group 2. Pupil sizes measured with the Colvard device were compared with the scotopic, mesopic-low and mesopic-high measurements taken with the Procyon pupillometer in both groups. Analysis of comparison between pupil measurements was performed according to methods described by Bland and Altman.

RESULTS

The mean Colvard scotopic pupil diameter, scotopic, mesopic-low and mesopic-high Procyon pupil diameters were 5.86 +/- 0.81 mm, 6.42 +/- 0.88 mm, 5.55 +/- 0.95 mm and 4.21 +/- 0.73 mm in group 1 and 5.32 +/- 0.67 mm, 6.14 +/- 0.81 mm, 5.33 +/- 0.78 mm and 4.02 +/- 0.55 mm in group 2, respectively. The Colvard diameter compared most favourably with the Procyon mesopic-low diameter (group 2; p = 0.78).

CONCLUSIONS

Measurements of pupil diameter with the Colvard pupillometer correlated best with measurements taken by the Procyon pupillometer under standardized mesopic-low light conditions. We believe that digital binocular infrared pupillometry is advantageous for obtaining standardized measurements of pupil size.