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Ogino M, Salmerón-Campillo RM, Hunter S, Hussey V, Suh D, Gore R, López-Gil N, Jaskulski M, Piña-Miguelsanz D. Clinical validation of a novel smartphone application for measuring best corrected visual acuity. JOURNAL OF OPTOMETRY 2023:S1888-4296(23)00001-8. [PMID: 36964070 DOI: 10.1016/j.optom.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/28/2022] [Accepted: 01/01/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Personal mobile devices such as smartphones are proving their usefulness in ever more applications in tele-eyecare. An inconvenience and potential source of error in these past approaches stemmed from the requirement for the subjects to situate their devices at a distance. The present study aims to clinically validate best corrected visual acuity (BCVA) measures carried out by a novel smartphone application "vision.app" (VisionApp Solutions S.L.) using comparative statistics against clinical measurements. MATERIALS AND METHODS BCVA was measured in both eyes of 40 subjects using vision.app which displayed a black Landolt-C optotype with crowding on a white background, and utilized a 4 forced-choice procedure for the subjects to find (by means of swiping in either of four directions) the smallest optotype size they could resolve. Results were compared to BCVA measurements taken using a standard Snellen chart placed at 20 feet (6 m). RESULTS The t-test revealed no significant differences between the app- and clinically-measured VA (p = 0.478 (OD) and 0.608 (OS)), with a mean difference between clinical and app measurements of less than one line of the eye chart (-0.009 logMAR (OD) and -0.005 logMAR (OS)). A limit of agreement for a 95% confidence interval of ± 0.08 logMAR for OD and OS was found. CONCLUSIONS The results show the potential use of a smartphone to measure BCVA at a handheld distance. The newly validated study results can hold major future advancements in tele-eyecare and provide eye care professionals with a reliable and accessible method to measure BCVA.
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Affiliation(s)
- Mari Ogino
- Creighton University School of Medicine, Omaha, NE, United States
| | | | - Stephen Hunter
- University of California Riverside School of Medicine, Riverside, CA, United States
| | - Vincent Hussey
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Donny Suh
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Rujuta Gore
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Norberto López-Gil
- Grupo de Ciencias de La Visión (CiViUM), Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain; Clínica Universitaria de Visión Integral (CUVI), Universidad de Murcia, Murcia, Spain
| | - Matt Jaskulski
- Grupo de Ciencias de La Visión (CiViUM), Facultad de Óptica y Optometría, Universidad de Murcia, Murcia, Spain; Clinical Optics Research Lab (CORL), Indiana University, Bloomington, IN, United States
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Koh S, Inoue R, Iwamoto Y, Mihashi T, Soma T, Maeda N, Nishida K. Comparison of Ocular Wavefront Aberration Measurements Obtained Using Two Hartmann-Shack Wavefront Aberrometers. Eye Contact Lens 2023; 49:98-103. [PMID: 36729105 DOI: 10.1097/icl.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess agreement between measurements of ocular wavefront aberrations obtained using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) (Aberrometer A) and KR-1W (Topcon Corp) (Aberrometer B), both of which are based on the Hartmann-Shack principle. METHODS In this prospective case-control study, ocular wavefront aberrations measurements were obtained using both aberrometers in patients with keratoconus (KC) and control participants. Ocular wavefront aberrations were measured through the natural pupil without dilation using both devices in a dark room. For both aberrometers, accommodation was inhibited by automatically adding fogging. The individual Zernike coefficients from the second to fourth order were compared between the two aberrometers for a 4-mm pupil diameter. RESULTS Twenty-six KC and 29 control eyes were assessed. Statistically significant correlations ( P <0.05) were observed for all Zernike coefficients, except for Z 4-2 in the control group. Bland-Altman analysis indicated good agreement between aberrometers and no statistically significant differences in the control group. However, in the KC group, patterns of proportional error were observed in vertical coma Z 3-1 (r=0.338, P =0.008), trefoil Z 4-4 (r=0.701, P =0.003), secondary astigmatism Z 4-2 (r=0.348, P =0.025), and spherical aberrations Z 40 (r=0.407, P =0.012). CONCLUSIONS The Zernike coefficient values measured by the two aberrometers were well correlated in the control and KC groups. However, in eyes with KC, Aberrometer B tended to present greater values in several Zernike coefficients than Aberrometer A, suggesting that wavefront measurements obtained using the two aberrometers are not interchangeable in patients with KC.
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Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science (S.K., R.I.), Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology (S.K., Y.I., T.S., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan; SEED CO. (R.I.), LTD., Tokyo, Japan; and Department of Orthoptics (T.M.), Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Comparison of Corneal Higher-order Aberrations between Miniscleral and Hybrid Lenses in Keratoconus. Optom Vis Sci 2020; 97:749-753. [PMID: 32941341 DOI: 10.1097/opx.0000000000001560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Fitting specialty contact lenses (hybrid and miniscleral) can be a useful option in keratoconus patients to decrease higher-order aberrations (HOAs) and increase the quality of vision. PURPOSE The aim of the present study was to compare corneal HOAs between miniscleral and hybrid lenses in keratoconus patients. METHODS The target population of this study was 37 patients with bilateral keratoconus aged 20 to 35 years who were referred to a specialized contact lens clinic by a corneal specialist. Pre-fitting examinations included objective and subjective refraction, measurement of uncorrected and best spectacle-corrected visual acuity, and measurement of corneal HOAs. Lens fitting was performed in the next step. Finally, post-fitting measurements including contact lens-corrected visual acuity and corneal HOAs were performed. RESULTS The root mean square of the total HOAs significantly decreased after fitting both miniscleral and hybrid lens designs. There was a significant change in the third-order vertical coma and spherical aberration after fitting the miniscleral lens. In the hybrid lens group, a significant change was found only in vertical coma after fitting. There was no significant difference in the post-fitting HOA change between the two groups. CONCLUSIONS The results of this study showed the effectiveness of both miniscleral and hybrid lenses in decreasing HOAs in keratoconus patients. No significant difference was observed between these two lenses in this regard.
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Jinabhai AN. Customised aberration-controlling corrections for keratoconic patients using contact lenses. Clin Exp Optom 2019; 103:31-43. [PMID: 31264266 DOI: 10.1111/cxo.12937] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
Technological advancements in the design of soft and scleral contact lenses have led to the development of customised, aberration-controlling corrections for patients with keratoconus. As the number of contact lens manufacturers producing wavefront-guided corrections continues to expand, clinical interest in this customisable technology is also increasing among both patients and practitioners. This review outlines key issues surrounding the measurement of ocular aberrations for patients with keratoconus, with a particular focus on the possible factors affecting the repeatability of Hartmann-Shack aberrometry measurements. This review also discusses and compares the relative successes of studies investigating the design and fitting of soft and scleral customised contact lenses for patients with keratoconus. A series of key limitations that should be considered before designing customised contact lens corrections is also described. Despite the challenges of producing and fitting customised lenses, improvements in visual performance and comfortable wearing times, as provided by these lenses, could help to reduce the rate of keratoplasty in keratoconic patients, thereby significantly reducing clinical issues related to corneal graft surgery. Furthermore, enhancements in optical correction, provided by customised lenses, could lead to increased independence, particularly among young adult keratoconic patients, therefore leading to improvements in quality of life.
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Affiliation(s)
- Amit Navin Jinabhai
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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Soeters N, Muijzer MB, Molenaar J, Godefrooij DA, Wisse RPL. Autorefraction Versus Manifest Refraction in Patients With Keratoconus. J Refract Surg 2018; 34:30-34. [PMID: 29315439 DOI: 10.3928/1081597x-20171130-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare visual performance using autorefraction and manifest refraction assessments in patients with keratoconus and investigate whether autorefraction measurements lead to suboptimal visual performance. METHODS Corrected distance visual acuity (CDVA) was measured in 90 eyes of 61 patients with keratoconus with both autorefraction and manifest refraction, in a random order. Maximum keratometry (Kmax), cone location, and wavefront aberration were determined with Scheimpflug tomography. The difference between the autorefraction and manifest refraction outcomes was converted to vectors and a multivariable analysis was performed to identify potential underlying causes of this difference. RESULTS A significantly better CDVA was achieved with manifest refraction (0.06 vs 0.29 logMAR [20/23 vs 20/38 Snellen], P < .001). After vector analysis, a mean difference of 4.83 diopters was found between autorefraction and manifest refraction. Increased Kmax was strongly and significantly associated with better visual performance of manifest refraction compared to autorefraction (B = 0.496, P = .002). CONCLUSIONS This study showed that a superior CDVA is achieved with manifest refraction compared to autorefraction in patients with keratoconus. Furthermore, the difference between the two refraction methods increases as the cornea steepens. According to this study, autorefraction is unreliable in patients with keratoconus and should be avoided. [J Refract Surg. 2018;34(1):30-34.].
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Change in Accommodation and Ocular Aberrations in Keratoconus Patients Fitted With Scleral Lenses. Eye Contact Lens 2016; 44 Suppl 1:S50-S53. [PMID: 27607148 DOI: 10.1097/icl.0000000000000317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the accommodative response to different accommodative stimulus and to determine the changes in ocular higher-order aberrations with accommodation in keratoconus patients fitted with mini scleral lenses. MATERIAL AND METHODS The study included 15 keratoconus patients wearing mini scleral lenses (Misa Scleral Lens-Microlens, Arnhem, the Netherlands) and 15 keratoconus patients wearing rigid gas permeable lenses. Hartmannn Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) was used for the evaluation of accommodation. Accommodative responses to the accommodative stimulus ranging from 0.5 to 5.0 diopters (D) with intervals of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total higher-order aberrations (HOAs, third to sixth orders) at baseline, at 2.5 D stimulus, and at 5 D stimulus were also recorded. RESULTS Although accommodative response to accommodative stimulus of 0.5 to 2.5 D (with 0.5 D intervals) was similar in both groups, accommodative response to accommodative stimulus of 3.0 to 5.0 D was significantly lower in keratoconus group wearing mini scleral lenses. The coma, spherical, trefoil aberrations, and the RMS of total HOAs at baseline, at 2.5 D stimulus, and at 5 D stimulus were not significantly different between the groups. However, changes in the coma and trefoil aberrations and RMS of total HOA with 2.5 D and 5.0 D stimulus were significant only in the RGP group. CONCLUSIONS Accommodative response to increasing accommodative stimulus was found to be impaired in keratoconus patients wearing mini scleral lenses.
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Use of Wavefront Imaging Technology to Demonstrate Improvement in Corneal Aberrations Using Piggyback Contact Lens in a Keratoconus Eye With Intrastromal Corneal Ring Segment Implantation. Eye Contact Lens 2016; 42:e12-6. [DOI: 10.1097/icl.0000000000000159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agreement Between Autorefraction and Subjective Refraction in Keraring-Implanted Keratoconic Eyes. Eye Contact Lens 2016; 43:116-122. [PMID: 26825280 DOI: 10.1097/icl.0000000000000244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the agreement between subjective refraction and autorefraction and to explore the relationship between the magnitude of higher order aberration, and visual acuity and refraction, before and after keraring implantation. METHODS This prospective, randomized, interventional study enrolled 27 subjects (mean age 28.1±6.5 years) with keratoconus. Noncycloplegic refraction was performed subjectively by one clinician and with an autorefractor by another clinician, before and 6 months after surgery. The limit of agreement (LoA) between methods was assessed, and the relationships between the corrected distance visual acuity, logMAR on the one hand and refraction measurements and higher-order aberrations on the other, were examined. RESULTS The agreement in mean spherical equivalent refraction (MSER) between methods was good postoperatively but poor preoperatively. The autorefractor gave a more myopic refraction than subjective refraction preoperatively (-3.28±3.06 D; LoA -9.27 to +2.71 D, P<0.0001) and postoperatively (-0.63±1.64 D; LoA -3.85 to +2.58 D, P=0.055), and returned higher negative cylinders preoperatively (-1.10±1.17 D; LoA -3.40 to +1.19 D, P<0.0001) and postoperatively (-1.08±1.27 D; LoA -3.60 to +1.41 D, P<0.0001) in keratoconic eyes. The difference in MSER between methods was significantly related to the refractive error at both visits (P<0.05) and to the magnitude of higher-order aberrations in keratoconic eyes preoperatively (P<0.05). The logMAR visual acuity achieved subjectively worsened as the magnitude of higher-order aberrations increased preoperatively (P<0.001). CONCLUSIONS The autorefractor returns values that are significantly more myopic in MSER and higher negative cylinders than subjective refraction, preoperatively, but the MSER was similar between devices postoperatively. The autorefactor seems a valid starting point for subjective refraction in keratoconic eyes treated with keraring, but the cylinder should be corrected by about +1 D. The instruments agree more in less myopic than high myopic eyes.
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Jinabhai A, O'Donnell C, Tromans C, Radhakrishnan H. Optical quality and visual performance with customised soft contact lenses for keratoconus. Ophthalmic Physiol Opt 2014; 34:528-39. [DOI: 10.1111/opo.12133] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Amit Jinabhai
- Faculty of Life Sciences; The University of Manchester; Manchester UK
| | - Clare O'Donnell
- Faculty of Life Sciences; The University of Manchester; Manchester UK
- Optegra Eye Sciences; Optegra Eye Hospital; Manchester UK
- School of Life and Health Sciences; Aston University; Birmingham UK
| | - Cindy Tromans
- Faculty of Life Sciences; The University of Manchester; Manchester UK
- Manchester Academic Health Science Centre; Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
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Meek KM, Hayes S. Corneal cross-linking - a review. Ophthalmic Physiol Opt 2013; 33:78-93. [DOI: 10.1111/opo.12032] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Keith M Meek
- Structural Biophysics Group; School of Optometry and Vision Sciences; Cardiff University; Cardiff; UK
| | - Sally Hayes
- Structural Biophysics Group; School of Optometry and Vision Sciences; Cardiff University; Cardiff; UK
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Jinabhai A, O'Donnell C, Radhakrishnan H. Changes in refraction, ocular aberrations, and corneal structure after suspending rigid gas-permeable contact lens wear in keratoconus. Cornea 2012; 31:500-8. [PMID: 22314817 DOI: 10.1097/ico.0b013e31820f777b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study reports on changes in visual acuity, ocular higher-order aberrations, and refraction after suspending rigid gas-permeable lens wear for 1 week in 15 patients with moderate to severe keratoconus. Alterations in the anterior surface, central corneal powers and axes, and central corneal thickness were also explored. METHODS Scheimpflug photography and Hartmann-Shack aberrometry were performed at 2 visits, 7 days apart, after the patients had removed their habitual contact lenses. Subjective refraction and both high- and low-contrast logarithm of the minimum angle of resolution visual acuities were also recorded at both visits. RESULTS Reductions in both high-contrast visual acuity (P = 0.001) and low-contrast visual acuity (P = 0.002), along with an increase in third-order root mean square aberrations (P = 0.008), occurred after rigid gas-permeable lens wear was suspended in these patients with keratoconus. However, no significant changes in subjective refraction were found over the 1-week period (P ≥ 0.10). Significant correlations were observed between third-order coma root mean square aberrations and the measured high-contrast (r(p) ≥ 0.59; P ≤ 0.02) and low-contrast visual acuities (r(P) ≥ 0.61; P ≤ 0.015). In addition to increases in the anterior surface central corneal powers (P ≤ 0.02), a reduction in central corneal thickness also was found between the 2 visits (P = 0.00016). CONCLUSIONS Changes in the optical and structural parameters of the keratoconic cornea occur after suspending rigid gas-permeable contact lens wear. This information may be of interest to practitioners concerned with prescribing aberration-controlling soft contact lenses for such patients.
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Affiliation(s)
- Amit Jinabhai
- Faculty of Life Sciences, University of Manchester, England, United Kingdom
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Jinabhai A, Neil Charman W, O’Donnell C, Radhakrishnan H. Optical quality for keratoconic eyes with conventional RGP lens and simulated, customised contact lens corrections: a comparison. Ophthalmic Physiol Opt 2012; 32:200-12. [DOI: 10.1111/j.1475-1313.2012.00904.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jinabhai A, Radhakrishnan H, Tromans C, O’Donnell C. Visual performance and optical quality with soft lenses in keratoconus patients. Ophthalmic Physiol Opt 2012; 32:100-16. [DOI: 10.1111/j.1475-1313.2011.00889.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jinabhai A, Radhakrishnan H, O’Donnell C. Repeatability of ocular aberration measurements in patients with keratoconus. Ophthalmic Physiol Opt 2011; 31:588-94. [DOI: 10.1111/j.1475-1313.2011.00868.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jinabhai A, O’Donnell C, Radhakrishnan H. A Comparison between Subjective Refraction and Aberrometry-Derived Refraction in Keratoconus Patients and Control Subjects. Curr Eye Res 2010; 35:703-14. [DOI: 10.3109/02713681003797921] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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