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Anderson HA. Sources of reduced visual acuity and spectacle treatment options for individuals with Down syndrome: Review of current literature. Ophthalmic Physiol Opt 2024. [PMID: 39092592 DOI: 10.1111/opo.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
Individuals with Down syndrome are known to have a greater prevalence of ocular conditions such as strabismus, nystagmus, elevated refractive error, poor accommodative function, elevated higher-order optical aberrations and corneal abnormalities. Related to these conditions, individuals with Down syndrome commonly have reduced best-corrected visual acuity at both far and near viewing distances across their lifespan. This review summarises the various optical sources of visual acuity reduction in this population and describes clinical trials that have evaluated alternative spectacle prescribing strategies to minimise these optical deficits. Although refractive corrections may still have limitations in their ability to normalise visual acuity for individuals with Down syndrome, the current literature provides evidence for eye care practitioners to consider in their prescribing practices for this population to maximise visual acuity. These considerations include accounting for the presence of elevated higher-order aberrations when determining refractive corrections and considering bifocal lens prescriptions, even for young children with Down syndrome.
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Jo E, Kim SM, Kim JM, Han SY. Changes in ocular biometrics following cycloplegic refraction in strabismic and amblyopic children. Medicine (Baltimore) 2024; 103:e38143. [PMID: 38758890 PMCID: PMC11098244 DOI: 10.1097/md.0000000000038143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to measure refractive error accurately by paralyzing accommodation. However, effects on axial length (AL), anterior chamber depth (ACD), keratometry (Km), and white-to-white distance (WTW) are not well studied in this population. This retrospective study examined 797 patients (1566 eyes) undergoing cycloplegic refraction at a Samsung Kangbuk hospital pediatric ophthalmology clinic from 2010 to 2023. Ocular biometry was measured before and after instilling 1% cyclopentolate and 0.5% phenylephrine/0.5% tropicamide. Patients were categorized by strabismus diagnosis, age, refractive error and amblyopia status. Differences in AL, ACD, Km, WTW, and refractive error pre- and post-cycloplegia were analyzed using paired t tests. ACD (3.44 ± 0.33 vs 3.58 ± 0.29 mm, P < .05) and WTW (12.09 ± 0.42 vs 12.30 ± 0.60 mm, P < .05) increased significantly after cycloplegia in all groups except other strabismus subgroup (Cs) in both parameters and youngest subgroup (G1) in ACD. Refractive error demonstrated a hyperopic shift from -0.48 ± 3.00 D to -0.06 ± 3.32 D (P < .05) in overall and a myopic shift from -6.97 ± 4.27 to -8.10 ± 2.26 in high myopia (HM). Also, AL and Km did not change significantly. In conclusion, cycloplegia impacts ocular biometrics in children with strabismus and amblyopia, significantly increasing ACD and WTW. Refractive error shifts hyperopically in esotropia subgroup (ET) and myopically in high myopia subgroup (HM), eldest subgroup (G3) relating more to anterior segment changes than AL/Km. Understanding cycloplegic effects on biometry is important for optimizing refractive correction in these patients.
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Affiliation(s)
- Eunhui Jo
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kwok HY, Kwok HY, Ng TN, Leung TW, Kang BS, Kee CS. Characteristics of ciliary muscle profile in high myopes measured by swept-source anterior segment optical coherence tomography. PLoS One 2023; 18:e0289135. [PMID: 38033137 PMCID: PMC10688841 DOI: 10.1371/journal.pone.0289135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/11/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To characterize and compare the ciliary muscle thickness (CMT) between low and high myopes using swept-source anterior segment optical coherence tomography (AS-OCT). METHODS Forty visually healthy young Chinese adults aged 18-25 years were divided into two groups based on refractive errors: low myopia (n = 20, spherical-equivalent refractive error (SER) between -0.50 D to -3.00 D) and high myopia (n = 20, SER ≤ -6.00 D). Cycloplegic refractions were performed before axial length (AL) and CMT were measured using a partial coherence laser interferometer and an AS-OCT respectively. CMT was measured perpendicularly to the sclera-ciliary muscle interface at 1 mm (CMT_1), 2 mm (CMT_2), and 3 mm (CMT_3) posterior to the scleral spur, and at the location with maximal thickness (CMT_MAX). RESULTS High myopes demonstrated thicker CMT at 2 mm (CMT_2, p = 0.035) and 3 mm (CMT_3, p = 0.003) posterior to the scleral spur, but thinner maximal CMT (CMT_MAX, p = 0.005) than low myopes. The apical CMT_1 and CMT_MAX were also thinner in high myopes than in low myopes (both p< 0.001). CMT_MAX, apical CMT_1, and apical CMT_MAX correlated directly with SER and inversely with AL; in contrast, CMT_2 and CMT_3 showed inverse correlations with SER but direct correlations with AL. CONCLUSION Our findings revealed significant differences in CMT between low and high myopes, with high myopes showing thicker CMT at 2 mm and 3 mm posterior to the scleral spur, but thinner maximal CMT. These results provide new evidence of the potential structural differences in ciliary muscles during myopia development and progression.
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Affiliation(s)
- Hiu Yin Kwok
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
| | - Hoi Yee Kwok
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
| | - Tsz Nok Ng
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
| | - Tsz-wing Leung
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
- Research Centre for Sharp Vision, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
- Centre for Eye and Vision Research Limited, Hong Kong, SAR, China
| | - Byung Soo Kang
- Centre for Eye and Vision Research Limited, Hong Kong, SAR, China
| | - Chea-su Kee
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
- Research Centre for Sharp Vision, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR, China
- Centre for Eye and Vision Research Limited, Hong Kong, SAR, China
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Owusu E, Shasteen NM, Mitchell GL, Bailey MD, Kao CY, Toole AJ, Richdale K, Kulp MT. Impact of accommodative insufficiency and accommodative/vergence therapy on ciliary muscle thickness in the eye. Ophthalmic Physiol Opt 2023; 43:947-953. [PMID: 37184092 DOI: 10.1111/opo.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload. METHODS Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75 mm (CMT0.75) to 3 mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative/vergence therapy. RESULTS Sixteen subjects with AI (mean age = 17.4 years, SD = 8.0) were matched with 48 controls (mean age = 17.8 years, SD = 8.2). On average, the controls had 52-72 μm thicker ciliary muscles in the apical region at 0D than those with AI (p = 0.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8 weeks of accommodative/vergence therapy, the CMT increased by an average of 22-42 μm (p ≤ 0.04 for all), while AA increased by 7D (p < 0.001). CONCLUSIONS This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative/vergence therapy.
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Affiliation(s)
- Emmanuel Owusu
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | | | - G Lynn Mitchell
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Melissa D Bailey
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Chiu-Yen Kao
- Department of Mathematical Sciences, Claremont McKenna College, Claremont, California, USA
| | - Andrew J Toole
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn Richdale
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Marjean T Kulp
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
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Chen W, Yu X, Ye Y, Gao H, Cao X, Lin G, Zhang R, Li Z, Wang X, Zhou Y, Shen M, Shao Y. CMS-NET: deep learning algorithm to segment and quantify the ciliary muscle in swept-source optical coherence tomography images. Ther Adv Chronic Dis 2023; 14:20406223231159616. [PMID: 36938499 PMCID: PMC10017933 DOI: 10.1177/20406223231159616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
Background The ciliary muscle plays a role in changing the shape of the crystalline lens to maintain the clear retinal image during near work. Studying the dynamic changes of the ciliary muscle during accommodation is necessary for understanding the mechanism of presbyopia. Optical coherence tomography (OCT) has been frequently used to image the ciliary muscle and its changes during accommodation in vivo. However, the segmentation process is cumbersome and time-consuming due to the large image data sets and the impact of low imaging quality. Objectives This study aimed to establish a fully automatic method for segmenting and quantifying the ciliary muscle on the basis of optical coherence tomography (OCT) images. Design A perspective cross-sectional study. Methods In this study, 3500 signed images were used to develop a deep learning system. A novel deep learning algorithm was created from the widely used U-net and a full-resolution residual network to realize automatic segmentation and quantification of the ciliary muscle. Finally, the algorithm-predicted results and manual annotation were compared. Results For segmentation performed by the system, the total mean pixel value difference (PVD) was 1.12, and the Dice coefficient, intersection over union (IoU), and sensitivity values were 93.8%, 88.7%, and 93.9%, respectively. The performance of the system was comparable with that of experienced specialists. The system could also successfully segment ciliary muscle images and quantify ciliary muscle thickness changes during accommodation. Conclusion We developed an automatic segmentation framework for the ciliary muscle that can be used to analyze the morphological parameters of the ciliary muscle and its dynamic changes during accommodation.
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Affiliation(s)
| | | | | | - Hebei Gao
- Division of Health Sciences, Hangzhou Normal University, Hangzhou, China
| | - Xinyuan Cao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Guangqing Lin
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Riyan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Zixuan Li
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xinmin Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Yuheng Zhou
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, China
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Straßer T, Wagner S. Performance of the Deep Neural Network Ciloctunet, Integrated with Open-Source Software for Ciliary Muscle Segmentation in Anterior Segment OCT Images, Is on Par with Experienced Examiners. Diagnostics (Basel) 2022; 12:diagnostics12123055. [PMID: 36553062 PMCID: PMC9777151 DOI: 10.3390/diagnostics12123055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT), being non-invasive and well-tolerated, is the method of choice for an in vivo investigation of ciliary muscle morphology and function. The analysis requires the segmentation of the ciliary muscle, which is, when performed manually, both time-consuming and prone to examiner bias. Here, we present a convolutional neural network trained for the automatic segmentation of the ciliary muscle in AS-OCT images. Ciloctunet is based on the Freiburg U-net and was trained and validated using 1244 manually segmented OCT images from two previous studies. An accuracy of 97.5% for the validation dataset was achieved. Ciloctunet's performance was evaluated by replicating the findings of a third study with 180 images as the test data. The replication demonstrated that Ciloctunet performed on par with two experienced examiners. The intersection-over-union index (0.84) of the ciliary muscle thickness profiles between Ciloctunet and an experienced examiner was the same as between the two examiners. The mean absolute error between the ciliary muscle thickness profiles of Ciloctunet and the two examiners (35.16 µm and 45.86 µm) was comparable to the one between the examiners (34.99 µm). A statistically significant effect of the segmentation type on the derived biometric parameters was found for the ciliary muscle area but not for the selective thickness reading ("perpendicular axis"). Both the inter-rater and the intra-rater reliability of Ciloctunet were good to excellent. Ciloctunet avoids time-consuming manual segmentation, thus enabling the analysis of large numbers of images of ample study cohorts while avoiding possible examiner biases. Ciloctunet is available as open-source.
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Affiliation(s)
- Torsten Straßer
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany
- University Eye Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence:
| | - Sandra Wagner
- Institute for Ophthalmic Research, University of Tuebingen, 72076 Tuebingen, Germany
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7
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Kaphle D, Schmid KL, Davies LN, Suheimat M, Atchison DA. Ciliary Muscle Dimension Changes With Accommodation Vary in Myopia and Emmetropia. Invest Ophthalmol Vis Sci 2022; 63:24. [PMID: 35749128 PMCID: PMC9234357 DOI: 10.1167/iovs.63.6.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to determine whether accommodation-induced changes in ciliary muscle dimensions vary between emmetropes and myopes, and the effect of the image analysis method. Methods Seventy adults aged 18 to 27 years consisted of 25 people with emmetropia (spherical equivalent refraction [SER] +0.21 ± 0.36 diopters [D]) and 45 people with myopia (−2.84 ± 1.72 D). There were 23 people with low myopia (>−3 D) and 22 people with moderate myopia (−3 to −6 D). Right eye ciliary muscles were imaged (Visante OCT; Carl Zeiss Meditec) at 0 D and 6 D demands. Measures included ciliary muscle length (CML), ciliary muscle curved length (CMLarc), maximum ciliary muscle thickness (CMTmax), CMT1, CMT2, and CMT3 (fixed distances 1–3 mm from the scleral spur), CM25, CM50, and CM75 (proportional distances 25%–75%). Linear mixed model analysis determined effects of refractive groups, race, and demand on dimensions. Significance was set at P < 0.05. Results Myopic eyes had greater CML and CMLarc nasally than emmetropic eyes. Myopic eyes had thicker muscles than emmetropic eyes at nasal positions, except CM25 and CMT3, and at CM75 temporally. During accommodation and only nasally, CML reduced in emmetropic and myopic eyes, and CMLarc reduced in myopic eyes only. During accommodation, both nasally and temporally, muscles thickened anteriorly (CMT1 and CM25) and thinned posteriorly (CMT3 and CM75) except for temporal CM75. Moderate myopic eyes had greater temporal CMLarc than low myopic eyes, and the moderate myopes had thicker muscles both nasally and temporally using fixed and proportional distances. Conclusions People with myopia had longer and thicker ciliary muscles than people with emmetropia. During accommodation, the anterior muscle thickened and the curved nasal muscle length shortened, more in myopic than in emmetropic eyes. The fixed distance method is recommended for repeat measures in the same individual. The proportional distance method is recommended for comparisons between refractive groups.
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Affiliation(s)
- Dinesh Kaphle
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Discipline of Optometry, Faculty of Health, University of Canberra, Bruce ACT 2617, Australia
| | - Katrina L Schmid
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Leon N Davies
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marwan Suheimat
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - David A Atchison
- Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Chang X, Li M, Lv L, Yan X, Liu Y, Zhu M, Wang J, Wang P, Xiang Y. Assessment of Choroidal Vascularity and Choriocapillaris Blood Perfusion After Accommodation in Myopia, Emmetropia, and Hyperopia Groups Among Children. Front Physiol 2022; 13:854240. [PMID: 35370764 PMCID: PMC8968861 DOI: 10.3389/fphys.2022.854240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/24/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To investigate choroidal vascularity (CV) and choriocapillaris blood perfusion before and after accommodation in myopia, emmetropia, and hyperopia groups among children. Methods This study included 39 myopic eyes from 22 subjects, 17 emmetropic eyes from 11 subjects, and 18 hyperopic eyes from 10 subjects. All subjects were children. Choroidal thickness (CT) and CV, including total choroidal area (TCA), luminal area (LA), and stromal area (SA) were measured using swept-source optical coherence tomography (SS-OCT). Choriocapillaris luminal area (CLA) was measured using SS-OCT-angiography before and after accommodation (near reading with an additional −3 diopter lens). Results For baseline results, except horizontal CV (showing no significant differences between myopia and emmetropia groups), both horizontal and vertical CT and CV were significantly smaller in the myopia group than in the emmetropia or hyperopia groups. In terms of CLA, no significant differences were observed among the myopia, emmetropia, and hyperopia groups. In addition, only myopic eyes showed significant decreases in CT and CV, whereas most CT and CV of emmetropic and hyperopic eyes showed non-significant decreases after accommodation. Furthermore, accommodation induced no significant changes in CLA in the myopia, emmetropia, or hyperopia groups. Conclusion Myopia had thinner baseline choroid and lower baseline choroidal blood perfusion. Furthermore, myopic eyes were more prone to choroidal thinning and blood perfusion decreases after accommodation.
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Affiliation(s)
- Xuejiao Chang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mu Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Lv
- Department of Ophthalmology, Hankou Aier Eye Hospital, Wuhan, China
| | - Xiaoqin Yan
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengxia Zhu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ping Wang,
| | - Yan Xiang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Yan Xiang,
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Anderson HA, Bailey MD, Manny RE, Kao CY. Ciliary muscle thickness in adults with Down syndrome. Ophthalmic Physiol Opt 2022; 42:897-903. [PMID: 35292999 DOI: 10.1111/opo.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Melissa D Bailey
- College of Optometry, The Ohio State University, Columbus, Ohio, USA
| | - Ruth E Manny
- College of Optometry, The University of Houston, Houston, Texas, USA
| | - Chiu-Yen Kao
- Department of Mathematical Sciences, Claremont McKenna College, California, USA
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10
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Zhang X, Wu Q, Wen T, Zhao H, Tian Q, Xu J, Tang G, Li R, Guo X, Song J, Bi H. In vivo analysis of ciliary muscle in myopic Chinese young adults using ArcScan Insight ® 100. Ophthalmic Physiol Opt 2022; 42:559-570. [PMID: 35261043 DOI: 10.1111/opo.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the morphological characteristics of the ciliary muscle (CM) and to explore its relationship with different ocular biometric parameters in myopic young Chinese adults. METHODS This observational, cross-sectional study included 50 right eyes from 50 myopic adults. The CM area (CMA), CM thickness (CMT) and CM length (CML) were measured using the ArcScan Insight® 100. CMT was determined at three points: 1.0 mm (CMT-1), 2.0 mm (CMT-2) and 3.0 mm (CMT-3) posterior to the scleral spur. CML was measured on the scleral (CMLs) and vitreous (CMLv) aspects. The spherical equivalent refraction (SER), axial length (AL) and subfoveal choroidal thickness (SFCT) were examined to determine their associations with CM parameters (CMA, CML and CMT). RESULTS The mean SER and AL were -4.39 ± 2.29 D and 25.61 ± 1.15 mm, respectively. Compared with the nasal CMA, CML and CMT (CMT-1, CMT-2 and CMT-3) findings, the temporal CM parameters (CMA, CMLs, CMLv, CMT-1, CMT-2 and CMT-3) were found to be significantly thicker (all p < 0.001, except CMLv and CMT-1; p < 0.01). The nasal CMA was associated with the average corneal curvature (r = 0.30, p = 0.03) and SER (r = -0.30, p = 0.04). Nasal and temporal CMT-2 were negatively correlated with SER (r = -0.33 and -0.32, respectively, both p < 0.05). There was no correlation between CM parameters (except nasal CMLs, r = 0.31, p = 0.03) and SFCT, or between CM parameters and either the AL or anterior chamber depth (all p > 0.05). CONCLUSION These results suggest that there is temporal versus nasal asymmetry of the CM. CMA, CMT or CML did not vary with axial growth of the eye. The CM is not simply stretched as the eye elongates in myopic young adults.
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Affiliation(s)
- Xiuyan Zhang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qiuxin Wu
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tiancai Wen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haiqiang Zhao
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingmei Tian
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing Xu
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guodong Tang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Runkuan Li
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxiao Guo
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jike Song
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongsheng Bi
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
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11
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Xie X, Sultan W, Corradetti G, Lee JY, Song A, Pardeshi A, Yu F, Chopra V, Sadda SR, Xu BY, Huang AS. Assessing accommodative presbyopic biometric changes of the entire anterior segment using single swept-source OCT image acquisitions. Eye (Lond) 2022; 36:119-128. [PMID: 33633350 PMCID: PMC8727625 DOI: 10.1038/s41433-020-01363-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVES To evaluate biometric changes throughout the anterior chamber during accommodation and presbyopia using single image acquisition swept-source anterior-segment optical coherence tomography (AS-OCT). SUBJECT/METHODS Anterior-segment images were obtained using a new swept-source AS-OCT device (ANTERION, Heidelberg Engineering) from healthy volunteers (n = 71) across two centers in this prospective observational case series. In one image acquisition, cornea through posterior lens, including the ciliary muscle on both sides of the right eye, was imaged. Subjects undertook no accommodative effort and -1, -3, and -5 D of target vergence. Two-way repeated measures ANOVA modeling was performed for ciliary muscle measurements, lens parameters, aqueous depth (AD), and pupil diameter (PD). The first ANOVA factor was accommodative stimuli, and the second factor included age and refractive status. RESULTS Maximum ciliary muscle thickness increased with accommodative stimuli (p < 0.001), while the distance from the scleral spur to the maximal point on the ciliary muscle and posterior ciliary muscle thickness (CMT2) decreased (p < 0.001-0.002). Older individuals showed no accommodative changes for ciliary muscle parameters, lens thickness, lens vault, PD, and AD (p = 0.07-0.32). Younger- and middle-aged eyes showed statistically significant accommodative structural alterations for these endpoints (p < 0.001-0.002), but with different patterns, including early loss of CMT2 contraction in middle-aged eyes. Within the middle-aged group, myopic eyes maintained better capacity for accommodative structural change. CONCLUSIONS Swept-source AS-OCT demonstrated multiple simultaneous anterior-segment biometric alterations in single acquisition images, including early loss of posterior ciliary muscle function and better maintained capacity for anterior-segment structural change in myopia.
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Affiliation(s)
- Xiaobin Xie
- grid.410318.f0000 0004 0632 3409Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China ,grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - William Sultan
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Giulia Corradetti
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Jong Yeon Lee
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA ,grid.256155.00000 0004 0647 2973Department of Ophthalmology, College of Medicine, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Abe Song
- grid.42505.360000 0001 2156 6853Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, CA USA
| | - Anmol Pardeshi
- grid.42505.360000 0001 2156 6853Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, CA USA
| | - Fei Yu
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Vikas Chopra
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Srinivas R. Sadda
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Benjamin Y. Xu
- grid.42505.360000 0001 2156 6853Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, CA USA
| | - Alex S. Huang
- grid.19006.3e0000 0000 9632 6718Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA USA
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12
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Fernández-Vigo JI, Kudsieh B, Shi H, De-Pablo-Gómez-de-Liaño L, Fernández-Vigo JÁ, García-Feijóo J. Diagnostic imaging of the ciliary body: Technologies, outcomes, and future perspectives. Eur J Ophthalmol 2021; 32:75-88. [PMID: 34233517 DOI: 10.1177/11206721211031409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The ciliary body (CB) is part of the uvea and is a complex, highly specialized structure with multiple functions and significant relationships with nearby structures. Its functions include the aqueous humor (AH) production in the ciliary processes, the regulation of the AH output through the uveoscleral pathway, and accommodation, which depends on the ciliary muscle. Also, the CB is an important determinant of angle width as it forms part of the ciliary sulcus. Until recently, knowledge of the CB was based on histological studies. However, this structure can currently be assessed in vivo using imaging techniques such as ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both techniques have shown good reproducibility of their measurements allowing for quantification of CB dimensions and their localization. In effect, studies have shown a larger CB in myopia and its diminishing size with age. Swept-source OCT devices offer fast, non-invasive high-resolution imaging allowing the identification of multiple structures. UBM requires contact and is uncomfortable for the patient. However, this technique offers deeper imaging and therefore remains the gold standard for assessing the posterior chamber, ciliary processes, or zonula. The clinical utility of CB imaging includes its assessment in different types of glaucoma such as angle-closure, malignant or plateau iris. Diagnostic CB imaging is also invaluable for the assessment of ciliochoroidal detachment when suspected, the position after the implantation of a pre-crystalline or sulcus-sutured lenses, diagnosis or monitoring of cysts or tumors, sclerotomies after retinal surgery, intermediate uveitis, or accommodation.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Bachar Kudsieh
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Hang Shi
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Lucía De-Pablo-Gómez-de-Liaño
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain
| | - José Ángel Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Badajoz, Spain.,Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain
| | - Julián García-Feijóo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
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13
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Logan NS, Radhakrishnan H, Cruickshank FE, Allen PM, Bandela PK, Davies LN, Hasebe S, Khanal S, Schmid KL, Vera-Diaz FA, Wolffsohn JS. IMI Accommodation and Binocular Vision in Myopia Development and Progression. Invest Ophthalmol Vis Sci 2021; 62:4. [PMID: 33909034 PMCID: PMC8083074 DOI: 10.1167/iovs.62.5.4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The role of accommodation in myopia development and progression has been debated for decades. More recently, the understanding of the mechanisms involved in accommodation and the consequent alterations in ocular parameters has expanded. This International Myopia Institute white paper reviews the variations in ocular parameters that occur with accommodation and the mechanisms involved in accommodation and myopia development and progression. Convergence is synergistically linked with accommodation and the impact of this on myopia has also been critiqued. Specific topics reviewed included accommodation and myopia, role of spatial frequency, and contrast of the task of objects in the near environment, color cues to accommodation, lag of accommodation, accommodative-convergence ratio, and near phoria status. Aspects of retinal blur from the lag of accommodation, the impact of spatial frequency at near and a short working distance may all be implicated in myopia development and progression. The response of the ciliary body and its links with changes in the choroid remain to be explored. Further research is critical to understanding the factors underlying accommodative and binocular mechanisms for myopia development and its progression and to guide recommendations for targeted interventions to slow myopia progression.
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Affiliation(s)
- Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Hema Radhakrishnan
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Fiona E Cruickshank
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Praveen K Bandela
- Brien Holden Vision Institute, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Leon N Davies
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Satoshi Hasebe
- Department of Ophthalmology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Safal Khanal
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Katrina L Schmid
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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14
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Xie X, Corradetti G, Song A, Pardeshi A, Sultan W, Lee JY, Yu F, Zhang L, Chen S, Chopra V, Sadda SR, Xu B, Huang AS. Age- and refraction-related changes in anterior segment anatomical structures measured by swept-source anterior segment OCT. PLoS One 2020; 15:e0240110. [PMID: 33095821 PMCID: PMC7584205 DOI: 10.1371/journal.pone.0240110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the effects of age and refractive status on anterior segment anatomical structures, including the ciliary body, using a new swept-source anterior segment optical coherence tomography (AS-OCT) device. METHODS This prospective observational study included 63 healthy volunteers (mean age: 44.2 years). Images of the anterior segment were obtained using a new swept-source AS-OCT (ANTERION, Heidelberg Engineering GmbH, Heidelberg, Germany) with tracking and image averaging from the right eye of all participants. Repeatability as well as inter- and intra-observer reliability of biometric measurements were evaluated. The impact of image tracking and averaging on ciliary muscle measurements was tested. Univariate and multivariable statistical models were developed to evaluate the relationship of age and refractive status on anterior segment biometric measurements. RESULTS For all test-retest repeatability and inter- and intra-observer reproducibility of swept-source AS-OCT measurements, high intraclass correlation (ICC) was noted (0.88-1.00). The nasal maximum ciliary muscle thickness (CMTMAX) and distance between scleral spur to the thickest point of the ciliary muscle (SSMAX) were larger than those on the temporal side (p<0.001 and p = 0.006, respectively). Nasal and temporal CMTMAX (p = 0.004 and p<0.001, respectively) and lens thickness (p<0.01) increased with age. Nasal and temporal SSMAX decreased with older age and increasing hyperopia (p = 0.01 and p<0.001, respectively). Image averaging resulted in improved ciliary muscle measurements (p = 0.008 to 0.02). Lens vault increased with older age and increased hyperopia (p<0.01). OCT measurements of the angle decreased with older age and increased hyperopia (p<0.001 to 0.03). Aqueous depth decreased with older age and increased hyperopia (p<0.01). Pupil diameter decreased with older age (p<0.01). CONCLUSIONS Repeatability and reproducibility of biometric measurements using the ANTERION AS-OCT were excellent. Image averaging improved the accuracy of ciliary muscle measurements. The device produced measurements of biometric parameters that described superficial and deep structures including the ciliary body and full lens thickness from a single image.
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Affiliation(s)
- Xiaobin Xie
- Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- * E-mail:
| | - Giulia Corradetti
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Abe Song
- Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California, United States of America
| | - Anmol Pardeshi
- Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California, United States of America
| | - William Sultan
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Jong Yeon Lee
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Department of Ophthalmology, College of Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Fei Yu
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Lixia Zhang
- Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuang Chen
- Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Vikas Chopra
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Srinivas R. Sadda
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Benjamin Xu
- Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California, United States of America
| | - Alex S. Huang
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
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15
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Does anisometropia affect the ciliary muscle thickness? An ultrasound biomicroscopy study. Int Ophthalmol 2020; 40:3393-3402. [PMID: 33083933 DOI: 10.1007/s10792-020-01625-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the ciliary muscle thickness (CMT) of the normal fellow eye to that of the amblyopic eye using ultrasound biomicroscopy (UBM) in patients with unilateral anisometropic amblyopia. METHODS Thirty patients with unilateral anisometropic amblyopia were involved. The patients were divided into two groups: 19 hyperopic and 11 myopic. Axial length (AL) was measured with optic biometry and anterior chamber depth (ACD), iris area, and CMT were measured with UBM. RESULTS The mean age was 34.10 ± 6.61 years. The mean spherical difference between two eyes was 2.59 diopter (D) in hyperopic patients and 3.77D in myopic patients. In the hyperopic patients, nasal CMT1(nCMT), temporal CMT1(tCMT), tCMT2, and tCMT3 values were statistically thinner in amblyopic eyes than healthy eyes (p = 0.036, p = 0.003, p = 0.023, p = 0.005, respectively). ACD values were statistically lower in amblyopic eyes (2.78 ± 0.26 mm) than healthy eyes (2.90 ± 0.21 mm) (p < 0.001). In the myopic patients, nCMT1, nCMT2, nCMT3, tCMT1, tCMT2, and tCMT3 values were statistically thicker in amblyopic eyes than healthy eyes (p = 0.003, p = 0.003, p = 0.005, p = 0.003, p = 0.003, p = 0.019, respectively). ACD values were statistically higher in amblyopic eyes (3.20 ± 0.30 mm) than healthy eyes (3.06 ± 0.29 mm) (p = 0.004). Also, there was no significant difference in the iris area between the amblyopic and normal eyes of the myopic and hyperopic patients (p > 0.05). CONCLUSIONS Amblyopic eyes in patients with unilateral myopic anisometropia have thicker CMT and deeper ACD than healthy eyes. Conversely, amblyopic eyes in patients with unilateral hyperopic anisometropia have thinner CMT and shorter ACD than healthy eyes. There is a positive correlation between AL and CMT.
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16
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Fernández‐Vigo JI, Shi H, Kudsieh B, Arriola‐Villalobos P, De‐Pablo Gómez‐de‐Liaño L, García‐Feijóo J, Fernández‐Vigo JÁ. Ciliary muscle dimensions by swept-source optical coherence tomography and correlation study in a large population. Acta Ophthalmol 2020; 98:e487-e494. [PMID: 31773907 DOI: 10.1111/aos.14304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine ciliary muscle (CM) dimensions in vivo by swept-source optical coherence tomography (SS-OCT) in a large healthy population. To assess the reproducibility of CM measurements and correlations with different parameters. METHODS In this cross-sectional study, the following CM measurements were made in 495 eyes of 495 subjects in the temporal and nasal quadrants: length (CML), area (CMA) and thickness at distances of 1000 μm (CMT1), 2000 μm (CMT2) and 3000 μm (CMT3) from the scleral spur using the SS-OCT DRI-Triton® (Topcon, Tokyo, Japan). These dimensions were then assessed for correlations with the factors age, gender, refractive error, anterior chamber angle (ACA) and intraocular pressure (IOP). The reproducibility of CM measurements was determined in 85 of the participants. RESULTS Mean age was 41.4 ± 17.5 years (range 5-83). The following means were recorded as follows: CML = 4.57 ± 0.73 mm (range 2.16-6.97), CMA = 1.35 ± 0.31 mm2 (2.04-5.45), CMT1 = 558 ± 98 μm (299-891), CMT2 = 366 ± 100 μm (89-629) and CMT3 = 210 ± 75 μm (36-655). Negative correlation was detected between CML/CMA and age (R = -0.516/R = -0.404; p < 0.001) and refractive error (R = -0.519/R = -0.538; p < 0.001). No gender differences were observed (p ≥ 0.150). Both CML and CMA were correlated with ACA (R = 0.498 and 0.546; p < 0.001) and slightly with IOP (R = -0.175; p < 0.001). The reproducibility of the CM measurements was excellent (intraclass correlation coefficient ≥0.878). CONCLUSIONS Swept-source optical coherence tomography is a valid tool for in vivo CM measurements. Our data indicate a larger CM in myopes and its diminishing size with age.
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Affiliation(s)
- José Ignacio Fernández‐Vigo
- Department of Ophthalmology Hospital Clínico San Carlos Instituto de Investigación Sanitaria (IdISSC) Madrid Spain
- Centro Internacional de Oftalmología Avanzada Madrid Spain
| | - Hang Shi
- Department of Ophthalmology Hospital Clínico San Carlos Instituto de Investigación Sanitaria (IdISSC) Madrid Spain
- Centro Internacional de Oftalmología Avanzada Madrid Spain
| | - Bachar Kudsieh
- Centro Internacional de Oftalmología Avanzada Madrid Spain
- Department of Ophthalmology Hospital Puerta de Hierro Majadahonda Madrid Spain
| | - Pedro Arriola‐Villalobos
- Department of Ophthalmology Hospital Clínico San Carlos Instituto de Investigación Sanitaria (IdISSC) Madrid Spain
- Centro Internacional de Oftalmología Avanzada Madrid Spain
| | - Lucía De‐Pablo Gómez‐de‐Liaño
- Centro Internacional de Oftalmología Avanzada Madrid Spain
- Department of Ophthalmology Hospital 12 de Octubre Madrid Spain
| | - Julián García‐Feijóo
- Department of Ophthalmology Hospital Clínico San Carlos Instituto de Investigación Sanitaria (IdISSC) Madrid Spain
| | - José Ángel Fernández‐Vigo
- Centro Internacional de Oftalmología Avanzada Madrid Spain
- Department of Ophthalmology Universidad de Extremadura Badajoz Spain
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17
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Kudsieh B, Fernández-Vigo JI, Shi H, De Pablo Gómez de Liaño L, Ruiz-Moreno JM, García-Feijóo J, Fernández-Vigo JÁ. Ciliary muscle dimensions measured by swept-source optical coherence tomography in eyes with primary open-angle glaucoma and healthy eyes. Int Ophthalmol 2020; 40:2247-2255. [DOI: 10.1007/s10792-020-01405-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/27/2020] [Indexed: 12/17/2022]
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18
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Pucker AD, Jackson AR, McHugh KM, Mutti DO. Morphological ciliary muscle changes associated with form deprivation-induced myopia. Exp Eye Res 2020; 193:107963. [PMID: 32045599 DOI: 10.1016/j.exer.2020.107963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022]
Abstract
Myopic children have larger ciliary muscles than non-myopic children, suggesting that the ciliary muscle may have an impact on or be affected by refractive error development. The guinea pig represents an attractive model organism for myopia development research. The purpose of the study was to investigate whether form deprivation-induced myopia in one or more strains of guinea pig causes thickening of the ciliary muscle as seen in human myopia. Thirty-nine guinea pigs were bred from in-house progenitors obtained from Cincinnati Children's Hospital (Cincinnati) and the United States Army (Strain 13). At 2-4 days of age the right eyes of animals were exposed to form deprivation for 7 days while the fellow eyes served as controls. Refractive error was determined with retinoscopy while vitreous chamber depth (VCD) and axial length (AL) were determined with A-scan ultrasound. Ciliary muscle characteristics (ciliary muscle length, cross-sectional area, volume, cell number, cell size, and smooth muscle actin concentration) were determined histologically with antibody labeling and analyzed according to whether the animal developed axial myopia (anisometropia > -2.00 D with VCD and/or AL differences > 0.1 mm) or was unresponsive. This analysis method yielded four groups with Group 1 having no induced myopia but with axial elongation (n = 11), Group 2 having myopia without vitreous or axial elongation (n = 8), Group 3 having myopia with either vitreous or axial elongation (n = 11), and Group 4 having myopia with both vitreous and axial elongation (n = 8). There were no post-treatment inter-ocular differences between strains or for the overall group of animals for any ciliary muscle variable; however, a higher response group number in multivariate ordinal regression was related to having a treated compared to fellow eye that had a lower smooth muscle actin concentration (p = 0.006), with a shorter ciliary muscle length (p = 0.042), and a less oblate eye shape (p = 0.010). Guinea pig ciliary muscle length and smooth muscle actin concentration were significantly less in the treated eyes of axially myopic animals suggesting that 7 days of form deprivation induced ciliary muscle cellular atrophy or inhibited ciliary muscle growth. Form deprivation myopia in the guinea pig does not result in the increase in ciliary muscle thickness associated with human juvenile and adult myopia.
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Affiliation(s)
- Andrew D Pucker
- University of Alabama at Birmingham, School of Optometry, 1716 University Blvd, Birmingham, AL, USA.
| | - Ashley R Jackson
- Nationwide Children's Hospital, Center for Clinical and Translational Research, 700 Childrens Drive, Columbus, OH, USA.
| | - Kirk M McHugh
- Nationwide Children's Hospital, Center for Clinical and Translational Research, 700 Childrens Drive, Columbus, OH, USA.
| | - Donald O Mutti
- The Ohio State University, College of Optometry, 338 W 10th Ave, Columbus, OH, USA.
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19
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Shi J, Zhao J, Zhao F, Naidu R, Zhou X. Ciliary muscle morphology and accommodative lag in hyperopic anisometropic children. Int Ophthalmol 2020; 40:917-924. [PMID: 31916057 DOI: 10.1007/s10792-019-01264-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the cross-sectional area (CSA) and thickness of the ciliary muscle and their correlation with accommodative lag in hyperopic anisometropic children. METHODS Forty children aged between 6 and 10 years with hyperopic anisometropia were recruited. The more hyperopic eye (mean refractive power of 3.51 ± 1.70 D) was compared with the less hyperopic eye (mean refractive power of 0.78 ± 1.41 D). The thickness and CSA of the ciliary muscle were measured with anterior segment optical coherence tomography (OCT) images at four meridians. The differences between the eyes and the correlations between CSA, thickness, axial length and accommodative lag were accessed. RESULTS There was no statistically significant difference in CSA between the two groups at any meridian, except at the inferior meridian (P < 0.05). There was no statistically significant difference in ciliary muscle thickness between eyes at any meridian, except on the temporal and the nasal meridians (P < 0.05). There was a significant difference in the ratio of CSA to axial length at all meridians between the two groups (all P < 0.05). Accommodative lag was 1.65 ± 0.55 D and 0.93 ± 0.45 D in the more and less hyperopic eyes, respectively, which was a statistically significant difference (P < 0.05). There was no significant correlation between the CSA with the axial length and the accommodative lag. CONCLUSIONS This study demonstrated a greater degree of accommodative lag in the more hyperopic eye of anisometropic children. There was no correlation among accommodative lag, axial length and CSA of the ciliary muscle with the degree of hyperopia.
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Affiliation(s)
- Jinglin Shi
- Department of Ophthalmology, Shuguang Hospital, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Zhao
- Key NHC Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Chinese Academy of Medical Sciences, Fudan University, 83 FenYang Road, Shanghai, 200031, China
| | - Feng Zhao
- Key NHC Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Chinese Academy of Medical Sciences, Fudan University, 83 FenYang Road, Shanghai, 200031, China.,Department of Ophthalmology, Shuguang Hospital, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rajeev Naidu
- School of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Xingtao Zhou
- Key NHC Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Chinese Academy of Medical Sciences, Fudan University, 83 FenYang Road, Shanghai, 200031, China.
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20
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Wagner S, Zrenner E, Strasser T. Emmetropes and myopes differ little in their accommodation dynamics but strongly in their ciliary muscle morphology. Vision Res 2019; 163:42-51. [PMID: 31401218 DOI: 10.1016/j.visres.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
Previous work suggested an association between near vision and myopia. We therefore investigated the accommodation process in emmetropes and myopes regarding morphologic changes of the ciliary muscle (CM) and power changes of the lens for different accommodation demands. The temporal CM of 18 emmetropic and 20 myopic students was imaged via anterior segment optical coherence tomography during far and near accommodation (2.5D, 3D, 4D). Additionally, accommodation dynamics to the stimuli pattern far-near-far (15 s each; 2.5D, 3D, 4D) were recorded with eccentric infrared photorefraction. OCT images were processed using custom-developed software facilitating the analysis of selective CM thickness (CMT) readings and CMT profiles. Anterior CMT readings were significantly smaller in myopes. Starting at 1.4 mm posterior to the scleral spur (SP), myopic CM became thicker than emmetropic. Anterior CMT changes (ΔCMT) continuously increased with accommodation demand in myopes while emmetropic ΔCMT only increased from 2.5D to 3D. Compared to emmetropes, myopes showed smaller ΔCMT but increased CM movement relative to SP. There were no significant differences between the groups for accommodation changes from far to near vision and vice versa, velocity, microfluctuations, power spectra or lag of accommodation. At 4 D, larger ΔCMT were associated with lower lens changes for disaccommodation. While CM shape, movement, and thickness showed distinct differences depending on refractive error, emmetropes and myopes did not differ in their dynamic accommodation. Further analysis is necessary to evaluate whether the CM's anatomical shape or predispositions in its intramuscular constituents are causative factors in myopigenesis.
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Affiliation(s)
- Sandra Wagner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany.
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience (CIN) Tuebingen, Otfried-Mueller-Str. 25, 72076 Tuebingen, Germany
| | - Torsten Strasser
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
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Assessment of Changes in Cyliary Muscle in Patients with Hypermetropy Using Mathematical Modeling Methods. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.4.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Age-related decline in accommodation in patients with emmetropia, myopia and hyperopia is characterized by multidirectional changes in the thickness of the ciliary muscle and the configuration of the inner apex of the ciliary body. The structural and functional state of the ciliary muscle and its individual components and the patterns of their change with age in patients with hyperopia remain little studied.Aim: to study the structural and functional state of the ciliary muscle and its components in patients with hyperopia using mathematical modeling methods.Methods. 110 patients (220 eyes) with axial hyperopia were examined. The first group consisted of patients aged 18–30 years – 20 people. The second group consisted of 80 patients aged 45–65 years. The control group consisted of 30 healthy volunteers aged from 18 to 30 years. All patients underwent ultrasound biomicroscopy, on the basis of which a spatial-mathematical model was created using the ImageJ software package.Results and conclusion. In patients with hyperopia, in the aging process there is a transformation of the ciliary body and the restructuring of its muscular components. Structural irido-ciliary relationships in young patients with emmetropia and hyperopia significantly differ in the location and configuration of the inner apex of the ciliary body, the degree of emphasis on the circular portion of the ciliary muscle.
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Wagner S, Schaeffel F, Zrenner E, Straßer T. Prolonged nearwork affects the ciliary muscle morphology. Exp Eye Res 2019; 186:107741. [PMID: 31336108 DOI: 10.1016/j.exer.2019.107741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
There is evidence for a possible link between myopia development and near vision. We investigated the effect of prolonged nearwork on ciliary muscle (CM) morphology and accommodation in 18 myopic and 17 emmetropic subjects (age 19 to 25). The CM was imaged during far (0.25 D) and near vision (4 D) using optical coherence tomography (OCT), and accommodation to a step pulse (0.25 D - 4 D - 0.25 D, 15 s each) was assessed by eccentric infrared photorefraction before and after a 30-min reading task at 25 cm. OCT images were analyzed using a custom-developed semi-automatic segmentation algorithm to determine CM thickness (CMT) profiles and selective CMT readings. Accommodation was assessed using a non-linear model. On average, the CM got thinner after nearwork, predominantly at 0.0-1.4 mm posterior to the scleral spur in emmetropes, and at 1.0-1.9 mm in myopes. Selective CMT readings confirmed a significant thinning after nearwork (univariate ANOVA F1,66 = 26.313, p < 0.001), without any influence of the subjects' refractive state (F1,66 = 1.887, p = 0.174) or the target distance (F1,66 = 0.014, p = 0.907). The mean accommodation response for targets at infinity was significantly increased after nearwork (F1,32 = 7.775, p = 0.009), with a larger myopic shift in myopes (F1,32 = 11.310, p = 0.002). No change in velocity of accommodation was found. Sharing properties of striated muscles, the CM was expected to increase its thickness, but the opposite was found. Previous studies suggesting sustained nearwork to result in a CM spasm cannot be confirmed by the data presented here. Further research exploring the possible impact of sympathetic innervation is necessary as it is activated during intense nearwork.
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Affiliation(s)
- Sandra Wagner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Frank Schaeffel
- Section Neurobiology of the Eye, Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience (CIN), Otfried-Mueller-Str. 25, 72076, Tuebingen, Germany.
| | - Torsten Straßer
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
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Determination of iris thickness development in children using swept-source anterior-segment optical coherence tomography. PLoS One 2019; 14:e0217656. [PMID: 31136628 PMCID: PMC6538171 DOI: 10.1371/journal.pone.0217656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/15/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose The uvea comprises the iris, ciliary body, and choroid. However, the development of the anterior part (iris and ciliary body) in children is not yet fully elucidated. We investigated the iris thickness (IT) in children using swept-source anterior-segment optical coherence tomography (ASOCT). Methods In this retrospective, clinic-based study, we enrolled 41 children (mean ± standard deviation: 6.8 ± 3.3 years; range: 3–16; 17 males) with normal or mild refractive error. Horizontal scanning images of swept-source ASOCT were analyzed in temporal and nasal angle areas. The ITs at 1 and 2 mm from the pupil edge were measured using swept-source ASOCT. The association between IT and age, sex, and ocular morphological parameters (i.e., axial length, average corneal curvature, central corneal thickness, inter-scleral spur distance, and anterior chamber depth) was assessed using Pearson’s correlation coefficient (r) and linear regression analysis. Results The average IT (temporal and nasal) at 1 and 2 mm were 0.432 ± 0.060 (0.302−0.569 mm) and 0.337 ± 0.045 (0.229−0.414 mm), respectively. There was a significant correlation between age and average IT (r = 0.45, P = 0.002 at 1 mm and r = 0.31, P = 0.042 at 2 mm). Multiple linear regression analysis revealed that age (coefficient: 0.01), axial length (−0.02), average corneal curvature (0.01), and anterior chamber depth (0.01) at 1 mm as well as age (0.00), average corneal curvature (0.09), anterior chamber depth (0.06), and male (–0.02) at 2 mm were identified as predictors of IT. Conclusions IT in children increases with age. Additionally, IT was thinner with longer axial length and in males, thicker in eyes with deeper anterior chamber and flatter corneal curvature. Our study may partly explain the development of eyeball structures in children.
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Troilo D, Smith EL, Nickla DL, Ashby R, Tkatchenko AV, Ostrin LA, Gawne TJ, Pardue MT, Summers JA, Kee CS, Schroedl F, Wahl S, Jones L. IMI - Report on Experimental Models of Emmetropization and Myopia. Invest Ophthalmol Vis Sci 2019; 60:M31-M88. [PMID: 30817827 PMCID: PMC6738517 DOI: 10.1167/iovs.18-25967] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/20/2018] [Indexed: 11/24/2022] Open
Abstract
The results of many studies in a variety of species have significantly advanced our understanding of the role of visual experience and the mechanisms of postnatal eye growth, and the development of myopia. This paper surveys and reviews the major contributions that experimental studies using animal models have made to our thinking about emmetropization and development of myopia. These studies established important concepts informing our knowledge of the visual regulation of eye growth and refractive development and have transformed treatment strategies for myopia. Several major findings have come from studies of experimental animal models. These include the eye's ability to detect the sign of retinal defocus and undergo compensatory growth, the local retinal control of eye growth, regulatory changes in choroidal thickness, and the identification of components in the biochemistry of eye growth leading to the characterization of signal cascades regulating eye growth and refractive state. Several of these findings provided the proofs of concepts that form the scientific basis of new and effective clinical treatments for controlling myopia progression in humans. Experimental animal models continue to provide new insights into the cellular and molecular mechanisms of eye growth control, including the identification of potential new targets for drug development and future treatments needed to stem the increasing prevalence of myopia and the vision-threatening conditions associated with this disease.
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Affiliation(s)
- David Troilo
- SUNY College of Optometry, State University of New York, New York, New York, United States
| | - Earl L. Smith
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Debora L. Nickla
- Biomedical Sciences and Disease, New England College of Optometry, Boston, Massachusetts, United States
| | - Regan Ashby
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Andrei V. Tkatchenko
- Department of Ophthalmology, Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Lisa A. Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Timothy J. Gawne
- School of Optometry, University of Alabama Birmingham, Birmingham, Alabama, United States
| | - Machelle T. Pardue
- Biomedical Engineering, Georgia Tech College of Engineering, Atlanta, Georgia, United States31
| | - Jody A. Summers
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Chea-su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Falk Schroedl
- Departments of Ophthalmology and Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University of Tuebingen, Zeiss Vision Science Laboratory, Tuebingen, Germany
| | - Lyndon Jones
- CORE, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
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Woodman-Pieterse EC, Read SA, Collins MJ, Alonso-Caneiro D. Anterior scleral thickness changes with accommodation in myopes and emmetropes. Exp Eye Res 2018; 177:96-103. [DOI: 10.1016/j.exer.2018.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/07/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022]
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Wagner S, Zrenner E, Strasser T. Ciliary muscle thickness profiles derived from optical coherence tomography images. BIOMEDICAL OPTICS EXPRESS 2018; 9:5100-5114. [PMID: 30319924 PMCID: PMC6179398 DOI: 10.1364/boe.9.005100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 05/09/2023]
Abstract
The purpose of this study was to provide an in-depth analysis of the ciliary muscle's (CM) morphological changes during accommodation by evaluating CM thickness (CMT) profiles. The CM of 15 near-emmetropic subjects (age 20-39) was imaged via optical coherence tomography (OCT) during far (0 D) and near vision (3 D). A custom-made Java-based program was used for semi-automatic CM segmentation and thickness measurements. CMT profiles were generated to determine regions of the largest shape changes. The results revealed on average a thinning within the first 0.25 mm and a thickening from 0.36 to 1.48 mm posterior to scleral spur when accommodating from 0 to 3 D. In contrast to previous analyses, this method offers pixel-wise reconstruction of CM shapes and quantification of accommodative change across the entire muscle boundary.
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Affiliation(s)
- Sandra Wagner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
- Werner Reichardt Centre for Integrative Neuroscience (CIN), Otfried-Mueller-Str. 25, 72076 Tuebingen, Germany
| | - Torsten Strasser
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Elfriede-Aulhorn-Str. 7, 72076 Tuebingen, Germany
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Dimensions of the ciliary muscles of Brücke, Müller and Iwanoff and their associations with axial length and glaucoma. Graefes Arch Clin Exp Ophthalmol 2018; 256:2165-2171. [DOI: 10.1007/s00417-018-4085-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022] Open
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Aldossari H, Suheimat M, Atchison DA, Schmid KL. Effect of Accommodation on Peripheral Eye Lengths of Emmetropes and Myopes. Optom Vis Sci 2017; 94:361-369. [PMID: 28027274 DOI: 10.1097/opx.0000000000001037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the effect of accommodation on central and peripheral axial lengths in young adult emmetropes and myopes. METHODS On-axis and peripheral axial lengths were measured with the Haag-Streit Lenstar in 83 young adult participants for 0D and 6D accommodation demands. A Badal system was used to both correct refractive errors and induce accommodation. Participants were emmetropes (n = 29, mean spherical equivalent refraction +0.35 ± 0.35D), low myopes (32, -1.38 ± 0.73D), and higher myopes (22, -4.30 ± 0.73D). Ages were similar for all groups (22 ± 2 years). Pupils were dilated with 2.5% phenylephrine to allow a large field of measurement while maintaining active accommodation. Axial lengths were measured in 5° steps to ±30° across the horizontal visual field. RESULTS With accommodation, axial length increased for all refractive groups at all positions, but with lessening effect away from fixation. Axial length changes were greater for higher myopes than for emmetropes on-axis (higher myopes 41 ± 14 μm, emmetropes 30 ± 12 μm, P = .005), for higher myopes than for low myopes at 30° nasal (P = .03), and for the higher myopes than for the other groups at 20° nasal (P < .05). There were significant correlations between myopia and changes in axial length at all positions, with the highest correlation on-axis (R = 0.30, P < .001). CONCLUSIONS During accommodation, eye length increased out to at least ±30° visual angle in young adult myopes and emmetropes. The increase was significantly greater for higher myopes than for the other groups at some positions. At all positions, there were significant correlations between myopia and accommodation-induced changes in axial length.
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Affiliation(s)
- Hussain Aldossari
- *PhD †DSc, FAAO School of Optometry and Vision Science and Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia (all authors)
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Are high lags of accommodation in myopic children due to motor deficits? Vision Res 2016; 130:9-21. [PMID: 27876513 DOI: 10.1016/j.visres.2016.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 11/09/2016] [Accepted: 11/14/2016] [Indexed: 11/21/2022]
Abstract
Children with a progressing myopia exhibit an abnormal pattern of high accommodative lags coupled with high accommodative convergence (AC/A) and high accommodative adaptation. This is not predicted by the current models of accommodation and vergence. Reduced accommodative plant gain and reduced sensitivity to blur have been suggested as potential causes for this abnormal behavior. These etiologies were tested by altering parameters (sensory, controller and plant gains) in the Simulink model of accommodation. Predictions were then compared to the static and dynamic blur accommodation (BA) measures taken using a Badal optical system on 12 children (6 emmetropes and 6 myopes, 8-13years) and 6 adults (20-35years). Other critical parameters such as CA/C, AC/A, and accommodative adaptation were also measured. Usable BA responses were classified as either typical or atypical. Typical accommodation data confirmed the abnormal pattern of myopia along with an unchanged CA/C. Main sequence relationship remained invariant between myopic and nonmyopic children. An overall reduction was noted in the response dynamics such as peak velocity and acceleration with age. Neither a reduced plant gain nor reduced blur sensitivity could predict the abnormal accommodative behavior. A model adjustment reflecting a reduced accommodative sensory gain (ASG) coupled with an increased AC cross-link gain and reduced vergence adaptive gain does predict the empirical findings. Empirical measures also showed a greater frequency of errors in accommodative response generation (atypical responses) in both myopic and control children compared to adults.
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Pucker AD, Jackson AR, Morris HJ, Fischer AJ, McHugh KM, Mutti DO. Ciliary Muscle Cell Changes During Guinea Pig Development. Invest Ophthalmol Vis Sci 2016; 56:7691-6. [PMID: 26641547 DOI: 10.1167/iovs.15-17927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Guinea pig ciliary muscle (CM) increases robustly in volume, length, and thickness with age. We wanted to characterize CM cells during development to determine the contributions of hypertrophy (cell size increase) and hyperplasia (cell number increase) during development. METHODS Six pigmented guinea pig eyes were collected at each of five ages: 1, 10, 20, 30, and 90 days. Refractive errors and axial lengths were determined. Eyes were temporally marked, enucleated, hemisected, and fixed. Nasal and temporal eye segments were embedded and 30-μm serial sections were collected; the two most central slides from each hemisection were analyzed with an epifluorescence microscope and Stereo Investigator software to determine normal morphologic parameters. RESULTS Refractive errors became less hyperopic (P = 0.0001) while axial lengths and CM lengths, cross-sectional areas, volumes, and cell sizes all increased linearly with log age (all P < 0.00001). Ciliary muscle cell numbers increased only during the first 20 days of life (P = 0.02). Nasal and temporal CM lengths (P = 0.07), cross-sectional areas (P = 0.18), and cell numbers (P = 0.70) were not different, but CM cell sizes were initially larger temporally and became larger nasally after age 30 days. CONCLUSIONS The mechanism of guinea pig CM cell growth during the first 90 days of life was characterized by early hyperplasia combined with hypertrophic cell growth throughout development that results in larger CM lengths, cross-sectional areas, and volumes. Nasal-temporal CM development was generally symmetric, but there was more CM hypertrophy nasally at older ages.
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Affiliation(s)
- Andrew D Pucker
- College of Optometry The Ohio State University, Columbus, Ohio, United States
| | - Ashley R Jackson
- Center for Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Hugh J Morris
- College of Optometry The Ohio State University, Columbus, Ohio, United States
| | - Andrew J Fischer
- Department of Neuroscience, The Ohio State University, Columbus, Ohio, United States
| | - Kirk M McHugh
- Center for Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Donald O Mutti
- College of Optometry The Ohio State University, Columbus, Ohio, United States
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Li SM, Iribarren R, Kang MT, Li H, Li SY, Liu LR, Sun YY, Meng B, Zhan SY, Rozema JJ, Wang N. Corneal Power, Anterior Segment Length and Lens Power in 14-year-old Chinese Children: the Anyang Childhood Eye Study. Sci Rep 2016; 6:20243. [PMID: 26832228 PMCID: PMC4735284 DOI: 10.1038/srep20243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022] Open
Abstract
To analyze the components of young Chinese eyes with special attention to differences in corneal power, anterior segment length and lens power. Cycloplegic refractions and ocular biometry with LENSTAR were used to calculate lens power with Bennett’s method. Mean refraction and mean values for the ocular components of five different refractive groups were studied with ANOVA and post-hoc Scheffé tests. There were 1889 subjects included with full data of refraction and ocular components. As expected, mean axial length was significantly longer in myopic eyes compared to emmetropes. Girls had steeper corneas, more powerful lenses and shorter eyes than boys. Lens power was lower in boys and also lower in myopic eyes. Lens thickness was the same for both genders but was lower in myopic eyes. Although cornea was steeper in myopic eyes in the whole sample, this was a gender effect (more girls in the myopic group) as this difference disappeared when the analysis was split by gender. Anterior segment length was longer in myopic eyes. In conclusion, myopic eyes have lower lens power and longer anterior segment length, that partially compensate their longer axial length. When analyzed by gender, the corneal power is not greater in low and moderate myopic eyes.
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Affiliation(s)
- Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rafael Iribarren
- Department of Ophthalmology, San Luis Medical Center, Buenos Aires, Argentina
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - He Li
- Anyang Eye Hospital, Henan Province, China
| | - Si-Yuan Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo-Ru Liu
- Anyang Eye Hospital, Henan Province, China
| | - Yun-Yun Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Bo Meng
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
| | - Si-Yan Zhan
- Department of Epidemiology and Health Statistics, Peking University School of Public Health, Beijing, China
| | - Jos J Rozema
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Department of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Laughton DS, Coldrick BJ, Sheppard AL, Davies LN. A program to analyse optical coherence tomography images of the ciliary muscle. Cont Lens Anterior Eye 2015; 38:402-8. [DOI: 10.1016/j.clae.2015.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
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Abstract
PURPOSE The purpose of this study was to develop a method for quantifying guinea pig ciliary muscle volume (CMV) and to determine its relationship to age and ocular biometric measurements. METHODS Six albino guinea pigs' eyes were collected at each of five ages (n = 30 eyes). Retinoscopy and photography were used to document refractive error, eye size, and eye shape. Serial sections through the excised eyes were made and then labeled with an α-smooth muscle actin antibody. The ciliary muscle was then visualized with an Olympus BX51 microscope, reconstructed with Stereo Investigator (MBF Bioscience), and analyzed using Neurolucida Explorer (MBF Bioscience). Full (using all sections) and partial (using a subset of sections) reconstruction methods were used to determine CMV. RESULTS There was no significant difference between the full and partial volume determination methods (p = 0.86). The mean (±SD) CMV of the 1-, 10-, 20-, 30-, and 90-day-old eyes was 0.40 (±0.16) mm, 0.48 (±0.13) mm, 0.67 (±0.15) mm, 0.86 (±0.35) mm, and 1.09 (±0.63) mm, respectively. Ciliary muscle volume was significantly correlated with log age (p = 0.001), ocular length (p = 0.003), limbal circumference (p = 0.01), and equatorial diameter (p = 0.003). It was not correlated with refractive error (p = 0.73) or eye shape (p = 0.60). Multivariate regression determined that biometric variables were not significantly associated with CMV after adjustment for age. CONCLUSIONS Three-dimensional reconstruction was an effective means of determining CMV. These data provide evidence that ciliary muscle growth occurs with age in tandem with eye size in normal albino guinea pigs. Additional work is needed to determine the relationship between CMV and abnormal ocular growth.
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Sreenivasan V, Irving EL, Bobier WR. Can current models of accommodation and vergence predict accommodative behavior in myopic children? Vision Res 2014; 101:51-61. [DOI: 10.1016/j.visres.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/23/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
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Abstract
PURPOSE To investigate the changes occurring in the axial length, choroidal thickness, and anterior biometrics of the eye during a 10-minute near task performed in downward gaze. METHODS Twenty young adult subjects (10 emmetropes and 10 myopes) participated in this study. To measure ocular biometrics in downward gaze, an optical biometer was inclined on a custom-built height- and tilt-adjustable table. Baseline measures were collected after each subject performed a distance primary gaze control task for 10 minutes to provide washout period for previous visual tasks before each of three different accommodation/gaze conditions. These other three conditions included a near task (2.5 diopters [D]) in primary gaze and a near (2.5 D) and a far (0 D) accommodative task in downward gaze (25 degrees), all for 10 minutes' duration. Immediately after and then 5 and 10 minutes from the commencement of each trial, measurements of ocular biometrics (e.g., anterior biometrics, axial length, choroidal thickness, and retinal thickness) were obtained. RESULTS Axial length increased with accommodation and was significantly greater for downward gaze with accommodation (mean ± SD change, 23 ± 13 μm at 10 minutes) compared with primary gaze with accommodation (8 ± 15 μm at 10 minutes) (p < 0.05). A small amount of choroidal thinning was also found during accommodation that was statistically significant in downward gaze (13 ± 14 μm at 10 minutes; p < 0.05). Accommodation in downward gaze also caused greater changes in anterior chamber depth and lens thickness compared with accommodation in primary gaze. CONCLUSIONS Axial length, choroidal thickness, and anterior eye biometrics change significantly during accommodation in downward gaze as a function of time. These changes seem to be caused by the combined influence of biomechanical factors (i.e., extraocular muscle forces, ciliary muscle contraction) associated with near tasks in downward gaze.
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Abstract
PURPOSE The purpose of this study was to investigate the relationships between ciliary muscle thickness (CMT), refractive error, and axial length both across subjects and between the more and less myopic eyes of adults with anisometropia. METHODS Both eyes of 29 adult subjects with at least 1.00 D of anisometropia were measured. Ciliary muscle thickness was measured at the maximum thickness (CMTMAX) and at 1.0 (CMT1), 2.0 (CMT2), and 3.0 mm (CMT3) posterior to the scleral spur, and also at the apical region (Apical CMTMAX = CMTMAX - CMT2, and Apical CMT1 = CMT1 - CMT2). Multilevel regression models were used to determine the relationship between the various CMT measures and cycloplegic refractive error or axial length, and to assess whether there are CMT differences between the more and less myopic eyes of an anisometropic adult. RESULTS CMTMAX, CMT1, CMT2, and CMT3 were negatively associated with mean refractive error (all p ≤ 0.03), and the strongest association was in the posterior region (CMT2 and CMT3). Apical CMTMAX and Apical CMT1, however, were positively associated with mean refractive error (both p < 0.0001) across subjects. Within a subject, i.e., comparing the two anisometropic eyes, there was no statistically significant difference in CMT in any region. CONCLUSIONS Similar to previous studies, across anisometropic subjects, a thicker posterior region of the ciliary muscle (CMT2 and CMT3) was associated with increased myopic refractive error. Conversely, shorter, more hyperopic eyes tended to have thicker anterior, apical fiber portions of their ciliary muscle (Apical CMTMAX and Apical CMT1). There was no difference between the two eyes for any CMT measurement, indicating that in anisometropia, an eye can grow longer and more myopic than its fellow eye without resulting in an increase in CMT.
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