The Associations among Metamorphopsia, Orientation Discrimination Threshold, and Retinal Layer Thickness in Patients with Idiopathic Epiretinal Membrane

Time Course of Perceived Visual Distortion and Axial Length Growth in Myopic Children Undergoing Orthokeratology

Purpose: To establish the time course of the subjective visual function changes during the first month of orthokeratology treatment in myopic children, and to investigate how the time course variations are associated with the objective optical quality changes and the axial length growth (ALG) after 1 year of treatment.

Methods: A total of 58 myopic children aged from 8 to 16 years participated in this self-controlled prospective study. All subjects were fitted with designed spherical four-zone orthokeratology lenses. Subjective visual function was evaluated with orientation discrimination threshold (ODT), and objective optical quality was quantified with the high-order aberration root-mean-square (HOA-RMS) and the changing speed of HOA. The measurements were done before the lens fitting and 1 day, 1-, 2-, and 4-weeks after lens wear. Axial length was obtained at baseline and 1-year follow-up, and ALG was defined as the difference. One-way ANOVA was conducted to compare the difference for statistical analysis.

Results: After lens fitting, the ODT time courses peaked on day 1 in 28 children, 1 week in 15 children, 2 weeks in 11 children, and 4 weeks in 4 children. In contrast, the HOA-RMS steadily rose during the first month, and the changing speed of HOA was only transiently elevated on day 1 after the initial lens wear. The ALG was 0.12 ± 0.20 mm in subjects whose ODT peaked at day 1, 0.08 ± 0.09 mm in subjects whose ODT peaked on 1-week, and 0.12 ± 0.15 mm in subjects whose ODT peaked on 2-week or later. There was no difference in axial growth among the subjects whose ODT peaked at different days (P = 0.734).

Conclusion: While half ODT time course resembled the changing speed of HOA with a transient elevation on day 1, about a quarter of the ODT time course resemble the steadily rising of HOA-RMS, and the rest was located in the middle. The ALGs in children with different types of ODT time courses were similar.

Clinical Update on Metamorphopsia: Epidemiology, Diagnosis and Imaging

Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function.Methods: A literature search of electronic databases was performedResults: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula. Alteration of alignment of inner and outer retinal layers at various retinal loci has been identified using multimodal imaging in patients with metamorphopsia in a range of conditions. Although the Amsler Grid assessment of metamorphopsia is a useful clinical indicator, new emerging methods of metamorphopsia assessment with psychophysical tests such as M-CHARTS and preferential hyperacuity perimetry, have been developed.Conclusions: It appears that there is a complex relationship between visual acuity and metamorphopsia symptoms that vary between retinal conditions. Although metamorphopsia has traditionally been challenging to measure in the clinic, advances in technology promise more robust, easy-to-use tests. It is possible that home assessment of metamorphopsia, particularly in conditions such as age-related macular degeneration, may help to guide the need for further clinic evaluation and consideration of treatment.

Good Visual Performance Despite Reduced Optical Quality during the First Month of Orthokeratology Lens Wear

Purpose: To measure changes in visual performances and optical quality in myopic children during the first month of wearing orthokeratology lens, and to reveal the association between those two.Methods: Thirty-five myopic children participated in this study. Visual performances were evaluated with visual acuity and shape discrimination threshold (SDT) for radial frequency patterns. Placido disc-based corneal topography for central 4 mm and 6 mm zones was collected and decomposed by Fourier analysis into the spherical, asymmetric, and regular astigmatic components. Root-mean-square of third-order, fourth-order, and total higher-order aberrations (HOA) were extracted for the 4 mm and 6 mm zones. All examinations were conducted at baseline, 1-week, and 1-month after lens dispensing. The changing trends over time and association between SDT and optical quality were analysed with linear-mixed model.Results: All subjects' uncorrected visual acuity improved to 0.1 logMAR or better at 1-week and 1-month lens wear (P < .01). SDT did not change significantly from the baseline at 1-week and 1-month after lens wear (P > .05). For the two zones with diameters of 4 mm and 6 mm, the spherical component decreased significantly at 1-week (P < .01) and remained stable thereafter (P < .01); the asymmetric component increased significantly at 1-week (P < .01) and remained high at 1-month (P < .01); and the regular astigmatism did not show any significant change throughout (P > .05). At the two zones with diameters of 4 mm and 6 mm, the third-order, fourth-order, and total HOA increased significantly over time (P < .05). Change of SDT did not correlate with impairments in optical quality (P > .05 for all parameters).Conclusions: While corneal optical quality decreased steadily during the first month following lens wearing, the visual acuity and shape discrimination sensitivity assessed by SDT remained very satisfactory.