Measuring aniseikonia tolerance range for stereoacuity - a tool for the refractive surgeon

Effects of induced aniseikonia on binocular visual acuity

CLINICAL RELEVANCE

Binocular visual acuity is an important index of functional performance. Optometrists need to know how binocular visual acuity is affected by aniseikonia, and whether reduced binocular visual acuity is a marker for aniseikonia.

BACKGROUND

Aniseikonia, the perception of unequal image sizes between the eyes, can occur spontaneously or can be induced after different types of eye surgery, or trauma. It is known to affect binocular vision, but there are no prior studies about how it affects visual acuity.

METHODS

Visual acuity was measured for 10 healthy well-corrected participants aged 18-21 years of age. Aniseikonia of up to 20% was induced in one of two ways: (1) size lenses, which provided minification of field of view in one eye of each participant and (2) polaroid filters, which allowed vectographic viewing of optotypes on a 3D computer monitor. The best corrected acuity was measured on conventional logarithmic progression format vision charts and isolated optotypes, under both induced aniseikonia conditions.

RESULTS

Induced aniseikonia caused binocular visual acuity thresholds to increase by small but statistically significant amounts, with the largest deficit being 0.06 logMAR for 20% size differences between the eyes. Binocular visual acuity was worse than monocular visual acuity for aniseikonia of 9% and greater. Acuity measured with the vectographic presentation gave slightly higher thresholds (by 0.01 logMAR) than for those viewed with size lenses. Acuity measured with charts gave slightly higher thresholds (by 0.02 logMAR) than with isolated letters.

CONCLUSION

An acuity change of 0.06 logMAR is small and may be missed in a clinical examination. Therefore, visual acuity cannot be used as a marker of aniseikonia in clinical settings. Even with very marked induced aniseikonia, binocular visual acuity remained well within standards for licen*c*sing of drivers.

Evaluating the relationship between induced aniseikonia and distance stereopsis

Background

The impact of aniseikonia on stereopsis has been studied for decades, however, inconsistency which may be partly attributed to the method of inducing aniseikonia exists among these findings. This study aimed to induce overall and meridional aniseikonia using a three-dimensional (3D) computer and then evaluate the effect of induced aniseikonia on distance stereopsis using contour-based and random-dot-based patterns.

Methods

A 3D laptop was used to produce all of the test symbols. Unlike the usual method of creating aniseikonia with size lenses, which would change not only the size but also the relative position of the test symbols in the two images as seen by the two eyes, a new test system was designed to evaluate the aniseikonia, which only modified the size while maintaining the relative position of the test symbols. This new method reduced the disparities induced by location changing of the paired test targets when inducing aniseikonia. Aniseikonia was induced overall or in one of the meridians. The induced meridional aniseikonia included 180°, 30°, 45°, 60°, and 90°, respectively. The range of induced aniseikonia was 0-30% with an increment of 5%.

Results

Overall magnification affected stereopsis more than magnification in any one of the meridians. The stereoacuity differences between oblique meridians (30°, 45°, and 60°) were not significant until the aniseikonia increased up to 20%. The difference between 180°, 45°, and 90° was significant when the aniseikonia increased up to 10% in the contour-based test and over 20% in the random-dot-based test. The stereoacuity trend was improved gradually, coupled with the angle changing from 180º to 90º in the contour-based pattern, and deteriorated gradually in the random-dot-based pattern.

Conclusions

Overall aniseikonia affected stereopsis more than meridional aniseikonia. The stereoacuity of the contour-based pattern was superior to that of the random-dot-based pattern in the 90° meridian, while the opposite result was obtained in the 180° meridian.

Meridional ocular magnification after cataract surgery with toric and non-toric intraocular lenses

Background

Overall ocular magnification (OOM) and meridional ocular magnification (MOM) with consequent image distortions have been widely ignored in modern cataract surgery. The purpose of this study was to investigate OOM and MOM in a general situation with an astigmatic refracting surface.

Methods

From a large dataset containing biometric measurements (IOLMaster 700) of both eyes of 9734 patients prior to cataract surgery, the equivalent (P_IOLeq) and cylindric power (P_IOLcyl) were derived for the HofferQ, Haigis, and Castrop formulae for emmetropia. Based on the pseudophakic eye model, OOM and MOM were extracted using 4 × 4 matrix algebra for the corrected eye (with P_IOLeq/P_IOLcyl (scenario 1) or with P_IOLeq and spectacle correction of the residual refractive cylinder (scenario 2) or with P_IOLeq remaining the residual uncorrected refractive cylinder (blurry image) (scenario 3)). In each case, the relative image distortion of MOM/OOM was calculated in %.

Results

On average, P_IOLeq/P_IOLcyl was 20.73 ± 4.50 dpt/1.39 ± 1.09 dpt for HofferQ, 20.75 ± 4.23 dpt/1.29 ± 1.01 dpt for Haigis, and 20.63 ± 4.31 dpt/1.26 ± 0.98 dpt for Castrop formulae. Cylindric refraction for scenario 2 was 0.91 ± 0.70 dpt, 0.89 ± 0.69 dpt, and 0.89 ± 0.69 dpt, respectively. OOM/MOM (× 1000) was 16.56 ± 1.20/0.08 ± 0.07, 16.56 ± 1.20/0.18 ± 0.14, and 16.56 ± 1.20/0.08 ± 0.07 mm/mrad with HofferQ; 16.64 ± 1.16/0.07 ± 0.06, 16.64 ± 1.16/0.18 ± 0.14, and 16.64 ± 1.16/0.07 ± 0.06 mm/mrad with Haigis; and 16.72 ± 1.18/0.07 ± 0.05, 16.72 ± 1.18/0.18 ± 0.14, and 16.72 ± 1.18/0.07 ± 0.05 mm/mrad with Castrop formulae. Mean/95% quantile relative image distortion was 0.49/1.23%, 0.41/1.05%, and 0.40/0.98% for scenarios 1 and 3 and 1.09/2.71%, 1.07/2.66%, and 1.06/2.64% for scenario 2 with HofferQ, Haigis, and Castrop formulae.

Conclusion

Matrix representation of the pseudophakic eye allows for a simple and straightforward prediction of OOM and MOM of the pseudophakic eye after cataract surgery. OOM and MOM could be used for estimating monocular image distortions, or differences in overall or meridional magnifications between eyes.

Prediction of ocular magnification and aniseikonia after cataract surgery

BACKGROUND

Ocular magnification and aniseikonia after cataract surgery has been widely ignored in modern cataract surgery. The purpose of this study was to analyse ocular magnification and inter-individual differences in a normal cataract population with a focus on monovision.

METHODS

From a large dataset containing biometric measurements (IOLMaster 700) of both eyes of 9734 patients prior to cataract surgery, eyes were indexed randomly as primary (P) and secondary (S). Intraocular lens power (IOLP) was derived for the HofferQ, Haigis and Castrop formulae for emmetropia for P and emmetropia or myopia (-0.5 to -2 dpt) for S to simulate monovision. Based on the pseudophakic eye model in addition to these formulae, ocular magnification was extracted using matrix algebra (refraction and translation matrices and a system matrix describing the optical property of the entire spectacle corrected or uncorrected eye).

RESULTS

With emmetropia for P and S the IOLP differences (S-P) showed a standard deviation of 0.162/0.156/0.157 dpt and ocular magnification differences yielded a standard deviation of 0.0414/0.0405/0.0408 mm/mrad for the HofferQ/Haigis/Castrop setting. Simulating monovision, the myopic eye (S) showed a systematically smaller mean absolute spectacle corrected ocular magnification than the emmetropic eye (-0.0351/-0.0340/-0.0336, respectively, relative magnification around 2%). If myopia in the S eye remains uncorrected, the reduction of ocular magnification is much smaller (around 0.2-0.3%).

CONCLUSION

Vergence formulae for IOLP calculation sometimes implicitly define a pseudophakic eye model which can be directly used to predict ocular magnification after cataract surgery. Despite a strong similarity of both eyes, ocular magnification does not fully match between eyes and the prediction of ocular magnification and aniseikonia might be relevant to avoid eikonic problems in the pseudophakic eye.

Evaluation of the Relationship Between Aniseikonia and Stereopsis Using a New Method

Purpose

To investigate the influence of induced aniseikonia on stereopsis measured by contour-based and random-dot-based stereograms using a new method.

Methods

Unlike previous studies in which aniseikonia was induced using magnifiers, which potentially influenced the position of the test symbols in the half-view, here the image was magnified while maintaining each test symbol’s central position within the half-view. A phoropter and two 4K smartphones were used to measure stereopsis in seventeen young adults aged 20–28 years old. Stereopsis was tested using both contour-based and random-dot-based stereograms under overall or meridional aniseikonia with magnifications ranging from 2.5 to 30%. Repeated measures ANOVA was used to evaluate the effect of aniseikonia on stereopsis.

Results

Stereopsis decreased with an increase in aniseikonia magnification in the overall, horizontal, and vertical directions. Stereopsis values (log arcsec) increased from 1.29 ± 0.14 at baseline to 2.38 ± 0.16 with 30% overall aniseikonia of contour-based stereograms. In random-dot based stereograms, stereopsis values increased from 1.29 ± 0.16 at baseline to 2.24 ± 0.23 with 22.5% overall aniseikonia. Overall aniseikonia caused a significantly greater impairment on stereopsis as compared with the changes in meridional directions. In contour-based stereograms, vertical aniseikonia had significantly less impact on stereopsis than horizontal aniseikonia of identical magnification. The opposite phenomenon was found in random-dot-based stereograms.

Conclusion

Stereopsis decreased with an increase of magnification of induced aniseikonia. Magnifying patterns (overall, horizontal, or vertical) also significantly affected stereopsis. The conflicting impact of meridional aniseikonia on stereopsis measured by contour-based and random-dot-based stereograms may be associated with the uniqueness of the two test systems.