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Gal E, Gispets J, Wilkins A, Zyroff M, Netanya E, Gantz L. Assessment of a Clinical Test for Detection of Alteration in Visual Perception Due to Astigmatism. Clin Ophthalmol 2024; 18:723-733. [PMID: 38468915 PMCID: PMC10926918 DOI: 10.2147/opth.s447627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 03/13/2024] Open
Abstract
Purpose Astigmatism blurs the retinal image of a circular spot along a particular orientation rendering it an elliptical shape. Astigmatic patients demonstrate adaptation to residual astigmatic blur that may affect their discrimination between oval and circular targets. The Wilkins Egg and Ball Test (WEBT) was created to detect altered visual perception due to residual astigmatic blur by discriminating a circle within a row of oval elements. This prospective, cross-sectional study examined the utility of WEBT in detecting uncorrected residual astigmatism on the perception of form symmetry in astigmatic and keratoconic participants as well as normal participants with induced astigmatism at four primary meridians. Methods The mean search time (sT) and number of errors (noE) of 33 non-astigmatic controls (mean age: 24±5, range: 18-43, 6 males), 23 astigmatic participants (mean age: 36±12, range: 18-43, 6 males) and 13 keratoconic participants (N=22 eyes, mean age: 36±12, range: 18-58, 6 males) were measured under baseline, and 2.00 DC induced cylinder at four primary meridians, and for uncorrected, spherical-correction only, and fully corrected conditions, respectively. Mean sT and noE were converted to Z-scores, combined for each condition, and compared using repeated measures ANOVA with post-hoc analysis. Results Combined Z-scores for the controls were significantly worse (p<0.001) for all induced cylinder conditions. The induced 180° condition was significantly better than 45° and 90° conditions (p=0.04), but not the 135° condition. For both astigmatic and keratoconic cohorts, Z-scores of the uncorrected condition were significantly worse than the fully corrected condition (both p<0.01), but the fully corrected and spherical-only conditions did not differ significantly (p=0.06 and p=0.05, respectively). Conclusion In accommodating young adults, WEBT detected altered visual perception due to overall blur, and moderate-high amounts of uncorrected induced astigmatism and keratoconus, but is not useful as a tool for detection of altered visual perception due to small residual astigmatic blur.
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Affiliation(s)
- Eyal Gal
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
- University Vision Centre, Universitat Politècnica de Catalunya, Terrassa, Barcelona, Spain
| | - Joan Gispets
- University Vision Centre, Universitat Politècnica de Catalunya, Terrassa, Barcelona, Spain
| | - Arnold Wilkins
- Department of Psychology, University of Essex, Colchester, UK
| | - Meira Zyroff
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Efrat Netanya
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - Liat Gantz
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
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Ozhan FO, Aygun U, Sahin A, Urey H. Dynamic accommodation measurement using Purkinje reflections and machine learning. Sci Rep 2023; 13:21625. [PMID: 38062067 PMCID: PMC10703819 DOI: 10.1038/s41598-023-47572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Quantifying eye movement is important for diagnosing various neurological and ocular diseases as well as AR/VR displays. We developed a simple setup for real-time dynamic gaze tracking and accommodation measurements based on Purkinje reflections, which are the reflections from front and back surfaces of the cornea and the eye lens. We used an accurate eye model in ZEMAX to simulate the Purkinje reflection positions at different focus distances of the eye, which matched the experimental data. A neural network was trained to simultaneously predict vergence and accommodation using data collected from 9 subjects. We demonstrated that the use of Purkinje reflection coordinates in machine learning resulted in precise estimation. The proposed system accurately predicted the accommodation with an accuracy better than 0.22 D using subject's own data and 0.40 D using other subjects' data with two-point calibration in tests performed with 9 subjects in our setup.
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Affiliation(s)
- Faik Ozan Ozhan
- Department of Electrical and Electronics Engineering, Koç University, 34450, Istanbul, Turkey
| | - Ugur Aygun
- Department of Electrical and Electronics Engineering, Koç University, 34450, Istanbul, Turkey
| | - Afsun Sahin
- Koç University Translational Medicine Research Center (KUTTAM), 34450, Istanbul, Turkey
- School of Medicine, Koç University, 34450, Istanbul, Turkey
| | - Hakan Urey
- Department of Electrical and Electronics Engineering, Koç University, 34450, Istanbul, Turkey.
- Koç University Translational Medicine Research Center (KUTTAM), 34450, Istanbul, Turkey.
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Carracedo G, Carpena-Torres C, Pastrana C, Rodríguez-Lafora M, Serramito M, Privado-Aroco A, Espinosa-Vidal TM. Accuracy and precision of automated subjective refraction in young hyperopes under cycloplegia. JOURNAL OF OPTOMETRY 2023; 16:252-260. [PMID: 37019707 PMCID: PMC10518767 DOI: 10.1016/j.optom.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To assess the agreement between the Eye Refract, an instrument to perform subjective automated refraction, and the traditional subjective refraction, as the gold standard, in young hyperopes under noncycloplegic and cycloplegic conditions. METHODS A cross-section and randomized study was carried out, involving 42 participants (18.2 ± 7.7 years, range 6 to 31 years). Only one eye was chosen for the analysis, randomly. An optometrist conducted the refraction with the Eye Refract, while another different optometrist conducted the traditional subjective refraction. Spherical equivalent (M), cylindrical components (J0 and J45), and corrected distance visual acuity (CDVA) were compared between both refraction methods under noncycloplegic and cycloplegic conditions. A Bland-Altman analysis was performed to assess the agreement (accuracy and precision) between both refraction methods. RESULTS Without cycloplegia, the Eye Refract showed significantly lower values of hyperopia than the traditional subjective refraction (p < 0.009), the mean difference (accuracy) and its 95% limits of agreement (precision) being -0.31 (+0.85, -1.47) D. Conversely, there were no statistical differences between both refraction methods under cycloplegic conditions (p ≥ 0.05). Regarding J0 and J45, both refraction methods manifested no significant differences between them under noncycloplegic and cycloplegic conditions (p ≥ 0.05). Finally, the Eye Refract significantly improved CDVA (0.04 ± 0.01 logMAR) compared with the traditional subjective refraction without cycloplegia (p = 0.01). CONCLUSIONS The Eye Refract is presented as a useful instrument to determine the refractive error in young hyperopes, the use of cycloplegia being necessary to obtain accurate and precise spherical refraction.
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Affiliation(s)
- Gonzalo Carracedo
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain.
| | - Carlos Carpena-Torres
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Cristina Pastrana
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - María Rodríguez-Lafora
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - María Serramito
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Ana Privado-Aroco
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Teresa María Espinosa-Vidal
- Ocupharm Research Group, Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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Gehring AM, Haensel JX, Curtiss MK, Roberts TL. Validation of the PowerRef 3 for Measuring Accommodation: Comparison With the Grand Seiko WAM-5500A Autorefractor. Transl Vis Sci Technol 2022; 11:25. [PMID: 36255360 PMCID: PMC9587467 DOI: 10.1167/tvst.11.10.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This validation study examines the PowerRef 3 as a method for measuring accommodation objectively. We assess agreement with refractive measurements obtained simultaneously by the Grand Seiko WAM-5500A autorefractor. Methods Refractive measurements were recorded simultaneously using the PowerRef 3 and WAM-5500A in 32 noncyclopleged participants aged 15 to 46 years. Accommodative states were recorded for 10 seconds at six accommodative demands (5 diopters [D], 4 D, 3 D, 2.5 D, 2 D, and 0 D) while participants fixated a high-contrast Maltese cross. WAM-5500A measurements were converted to power in the vertical meridian for comparison with PowerRef 3 data. Dioptric difference values were computed, and agreement was assessed using Bland-Altman plots with 95% limits of agreement (LOA) and intraclass correlation coefficient analyses. Results The mean absolute dioptric differences measured 0.14 D or less across accommodative demands. Analyses showed an excellent intraclass correlation coefficient across the tested demands (0.93). Bland-Altman plots indicated a bias of -0.02 D with 95% LOA of -1.03 D to 0.99 D. The 95% LOA was smallest for the 3 D demand (-0.71 D to 0.64 D), and largest at 5 D demand (-1.51 D to 1.30 D). Conclusions The mean dioptric differences between the PowerRef 3 and WAM-5500A autorefractor were small and not clinically significant. While some variability in agreement was observed depending on the tested demand, the PowerRef 3 demonstrated good agreement with the WAM-5500A. Translational Relevance The PowerRef 3 may be used to obtain objective measures of accommodation both monocularly and binocularly and provides a more flexible method, especially in pediatric populations.
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Affiliation(s)
| | - Jennifer X. Haensel
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Molly K. Curtiss
- Children's Vision Center, Akron Children's Hospital, Akron, OH, USA
| | - Tawna L. Roberts
- Children's Vision Center, Akron Children's Hospital, Akron, OH, USA
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
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Margines JB, Yu F, Mehravaran S, Coleman AL. Non-Cycloplegic and Cycloplegic Autorefraction with Retinomax: An Agreement Study in Preschoolers in Los Angeles, California. Ophthalmic Epidemiol 2022:1-7. [PMID: 36168672 DOI: 10.1080/09286586.2022.2127786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the agreement between non-cycloplegic autorefraction (NCAR) and cycloplegic autorefraction (CAR) in an ethnically diverse population of preschool-aged children and the validity of the screening criteria used to refer for further evaluation. METHODS This study included data from 7,073 preschoolers who underwent NCAR and CAR, which enabled refractive error classification based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 criteria. Right eye data of sphere and cylinder were used to compare NCAR to CAR via paired t-testing and vector analyses, and left eye data for an analysis on anisometropia. The sensitivity and specificity of screening referral criteria for refractive error were calculated. RESULTS Mean values of sphere differed between NCAR and CAR by 1.95 ± 1.45 D (p < .05) with 95% limits of agreement (LoA) of -0.94 to 4.85 D, with less discrepancy found in myopic eyes. The mean values of cylinder differed by -0.08 ± 0.43 D (p < .05) with 95% LoA of -0.93 to 0.77 D. Power vector results reflected a similar lack of agreement. The sensitivity and specificity of our screening referral criteria were, respectively, 66% and 84% for myopia, 66% and 98% for hyperopia, and 98% and 58% for astigmatism. CONCLUSION NCAR is insufficient in preschoolers for spherical refractive error referrals. Level of agreements was lower for spherical (15.5% within 0.5D) and higher for cylindrical refractive errors (89.6%) compared to CAR. In the absence of cycloplegic examination, screening programs using NCAR should utilize low referral thresholds for spherical refractive error.
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Affiliation(s)
- Jack Benjamin Margines
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.,Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Shiva Mehravaran
- School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA
| | - Anne Louise Coleman
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.,Fielding School of Public Health, University of California, Los Angeles, California, USA
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Wu F, Zhao Y, Zhang H. Ocular Autonomic Nervous System: An Update from Anatomy to Physiological Functions. Vision (Basel) 2022; 6:vision6010006. [PMID: 35076641 PMCID: PMC8788436 DOI: 10.3390/vision6010006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
The autonomic nervous system (ANS) confers neural control of the entire body, mainly through the sympathetic and parasympathetic nerves. Several studies have observed that the physiological functions of the eye (pupil size, lens accommodation, ocular circulation, and intraocular pressure regulation) are precisely regulated by the ANS. Almost all parts of the eye have autonomic innervation for the regulation of local homeostasis through synergy and antagonism. With the advent of new research methods, novel anatomical characteristics and numerous physiological processes have been elucidated. Herein, we summarize the anatomical and physiological functions of the ANS in the eye within the context of its intrinsic connections. This review provides novel insights into ocular studies.
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