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Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M, Jones D, Logan NS, Lundström L, Torii H, Read SA, Naidoo K. IMI - Clinical Myopia Control Trials and Instrumentation Report. Invest Ophthalmol Vis Sci 2019; 60:M132-M160. [PMID: 30817830 DOI: 10.1167/iovs.18-25955] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Pete S Kollbaum
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - David A Berntsen
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, Texas, United States
| | - David A Atchison
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | | | - Arthur Bradley
- Indiana University, School of Optometry, Bloomington, Indiana, United States
| | - Hetal Buckhurst
- School of Health Professions, Peninsula Allied Health Centre, Plymouth University, Plymouth, United Kingdom
| | - Michael Collins
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Takashi Fujikado
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masakazu Hirota
- Department of Applied Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Debbie Jones
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nicola S Logan
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | | | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Scott A Read
- School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Kovin Naidoo
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Del Águila-Carrasco AJ, Lara F, Bernal-Molina P, Riquelme-Nicolás R, Marín-Franch I, Esteve-Taboada JJ, Montés-Micó R, Kruger PB, López-Gil N. Effect of phenylephrine on static and dynamic accommodation. JOURNAL OF OPTOMETRY 2019; 12:30-37. [PMID: 29602687 PMCID: PMC6318542 DOI: 10.1016/j.optom.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE We tested the hypothesis that changes in accommodation after instillation of Phenylephrine Hydrochloride (PHCl) observed in some studies could be caused by changes in optics. METHODS We performed two experiments to test the effects of PHCl on static and on dynamic accommodation in 8 and 6 subjects, respectively. Objective wavefront measurements were recorded of the static accommodation response to a stimulus at different distances or dynamic accommodation response to a sinusoidally moving stimulus (between 1 and 3 D of accommodative demand at 0.2Hz). The responses were characterized using two methods: one that takes into account the mydriatic optical effects on the accommodation produced by higher-order aberrations of the eye and another that takes into account only power changes paraxially due to the action of the ciliary muscle and regardless of the pupil size. RESULTS When mydriatic optical effects were taken into account, differences in responses before and after PHCl instillation were 0.51±0.53 D, and 0.12±0.15, for static and dynamic accommodation, respectively, and were statistically significant (p<0.039). When mydriatic optical effects were not taken into account, the differences in responses before and after PHCl instillation were -0.20±0.51 D, and -0.05±0.14, for static and dynamic accommodation, respectively, and were not statistically significant (p>0.313). CONCLUSIONS The mydriatic effect of the PHCl causes optical changes in the eye that can reduce the objective and subjective measurement of accommodation.
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Affiliation(s)
- Antonio J Del Águila-Carrasco
- Department of Optics, and Optometry, and Vision Sciences. University of Valencia, 46100 Burjassot, Spain; Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain.
| | - Francisco Lara
- Facultad de Óptica y Optometría, Universidad de Murcia, 30100 Murcia, Spain
| | - Paula Bernal-Molina
- Department of Optics, and Optometry, and Vision Sciences. University of Valencia, 46100 Burjassot, Spain; Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain
| | | | - Iván Marín-Franch
- Department of Optics, and Optometry, and Vision Sciences. University of Valencia, 46100 Burjassot, Spain; Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain; Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - José J Esteve-Taboada
- Department of Optics, and Optometry, and Vision Sciences. University of Valencia, 46100 Burjassot, Spain; Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain
| | - Robert Montés-Micó
- Department of Optics, and Optometry, and Vision Sciences. University of Valencia, 46100 Burjassot, Spain; Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain
| | - Philip B Kruger
- State College of Optometry. State University of New York, USA
| | - Norberto López-Gil
- Interuniversity laboratory for research in Vision and Optometry. Mixed group UVEG-UMU, Spain; Facultad de Óptica y Optometría, Universidad de Murcia, 30100 Murcia, Spain
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Hunter JJ, Campbell MCW. Potential Effect on the Retinoscopic Reflex of Scleral Expansion Surgery for Presbyopia. Optom Vis Sci 2006; 83:649-56. [PMID: 16971843 DOI: 10.1097/01.opx.0000232813.73127.db] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE In this initial study, we model the impact of crystalline lens movement and tilt, which we postulate are a potential consequence of scleral expansion surgery (SES). We demonstrate the possibility that these lead to an improvement in near vision with no concurrent restoration of lens accommodative function. With the implantation of scleral expansion bands (SEB), Schachar predicts an increase in the amplitude of accommodation not observed objectively. We postulate that the SEB implants cause the crystalline lens to be shifted forward and become misaligned. Using mathematical models of the optics of the human eye, we assess the effects of our postulate on the power of the eye, the depth of field, optical aberrations, and the appearance of the horizontal retinoscopic reflex. METHODS Using anatomically based models of the human eye, the postulated effects of SES are theoretically modeled and optically analyzed in Code V for unintentional lens anterior movement, tilts, and decentrations of up to 1 mm, +/- 3 degrees , and +/- 0.3mm, respectively. The transverse aberrations are calculated before and after SES. Because it has been reported that the appearance of the retinoscopic reflex is consistent with the presence of excess aberrations, we also predict the appearance of the one-dimensional retinoscopic reflex for our models. The change in refractive error is also determined. RESULTS.: Unintentional lens shift, tilt, and decentration, as might occur as a result of SES surgery, would result in an increase in the total power of the eye along with an increase in asymmetric aberrations and little change in symmetric aberrations. The calculated appearances of the retinoscopic reflexes pre- and postsurgery are consistent with observations in the literature. CONCLUSIONS Scleral expansion surgery could produce an improvement in near vision through an unintentional anterior displacement of the crystalline lens in combination with excess tilts and decentrations rather than as a result of a restoration of lens accommodation. There is a need for measurements and further analysis of the optical and visual properties of SES patients postsurgery.
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Affiliation(s)
- Jennifer J Hunter
- Guelph-Waterloo Physics Institute, Department of Physics and Astronomy and School of Optometry, University of Waterloo, Waterloo, Ontario, Canada
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Malkki PE, Kröger RHH. Visualization of chromatic correction of fish lenses by multiple focal lengths. ACTA ACUST UNITED AC 2005. [DOI: 10.1088/1464-4258/7/11/012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
PURPOSE Besides the classic "with," "against," and "neutral" absence of motion, retinoscopic reflexes can display anomalous "with" motion in myopia. A model is presented that explains the source of this anomalous motion, as well as quantifies the appearance of retinoscopic motion in myopia and hyperopia. METHODS Various 2 x 2 matrices were created to describe schematic eyes for a +20 D trial lens, a Gullstrand #1 schematic eye, and an infant schematic eye. Rays from the retinoscope were traced paraxially through these matrices over a full transit of the retinoscope beam across the pupil. Retinal position of the edge of the reflex visible to the observer was plotted as a function of pupil sizes from 2 mm to 16 mm for -5.00 D and +2.00 D refractive errors for the +20 D trial lens. RESULTS The edge of the retinoscopic reflex could be formed by one of two sources: the edge of the retinoscope beam itself, or the shadow cast by the beam against the edge of the pupil. Anomalous "with" motion arose in myopia when the edge of the reflex was formed by the edge of the beam. The edge of the beam was also visible in hyperopia but did not create anomalous motion. The retinoscope peephole was not involved in the formation of the edge of the reflex. The degree of anomalous motion increased with greater myopia and pupil size. Measured pupil sizes needed to completely eliminate anomalous motion agreed well with those predicted by the model, except at the largest pupil sizes. The limit for anomalous motion depended only on pupil size, refractive error, and working distance but not on whether the system matrix represented the trial lens, a Gullstrand #1 eye, or an infant eye. CONCLUSIONS Seeing the edge of the beam at large pupil sizes during retinoscopy creates anomalous "with" motion in myopia but may make the reflex easier to see in hyperopia. Anomalous "with" motion in myopia can be managed by adjustment of pupil size, working distance, or net corrected refractive error. Aside from possible effects of aberrations, retinoscopic motion appears to be consistent across various paraxial optical systems for a given refractive error and pupil size.
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Affiliation(s)
- Donald O Mutti
- Ohio State University College of Optometry, Columbus, Ohio, USA.
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Abstract
Computer simulation is being increasingly used as a teaching tool. Having developed a computer-generated virtual focimeter, we are now in the process of developing a computer-generated virtual streak retinoscope to teach the principles of retinoscopy and the effect of residual refractive error and mirror movement on the pupil reflex. One of the important requirements was to provide as accurate a simulation as possible for the completely general case of an astigmatic patient and a streak in any orientation being moved also in any orientation. This required a thorough understanding of the optical theory of the retinoscope and equations that describe the behaviour of the pupil reflex. We have taken this opportunity to review the optics of the streak retinoscope and derive equations for the behaviour of the pupil streak reflex.
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Affiliation(s)
- G Smith
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia.
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Abstract
We explored the impact of the eye's higher-order aberrations on subjective refraction comparing two classes of methods for estimating refractive state, one based directly on the wave aberration defined in the pupil plane and another based on the retinal image plane. The method defined in the pupil plane chose the sphere and cylinder that either minimized the wave aberration root mean square or minimized the sum of all the spherical and cylindrical components in the wave aberration. The method defined in the image plane chose the sphere and cylinder that optimized an image-quality metric such as the Strehl intensity ratio, the entropy and the intensity variance of the point-spread function, the volume under the modulation transfer function, or the volume under the contrast-sensitivity function. All these methods were compared in a population of six eyes for which we measured both the wave aberration with a Shack-Hartmann wavefront sensor and the subjective refraction under identical conditions. Pupil plane methods predicted subjective refraction poorly. The mean absolute error of the prediction, in spherical equivalent, was about 0.5 D (range, 0.1 to 0.8 D) and increased with increases in higher-order aberrations. However, for all the retinal image plane methods, the mean error between predicted and subjective refraction was about 0.1 D (range, 0 to 0.25 D). The reliability of the method based on the image-quality optimization was further confirmed in a large population of 146 eyes. In conclusion, higher-order aberrations influence the amount of sphere and cylinder required to correct vision. The results indicate that subjective refraction can be predicted from the eye's optics alone by optimizing computed retinal image quality.
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Affiliation(s)
- Antonio Guirao
- Laboratorio de Optica, Departamento de Física, Universidad de Murcia, Campus de Espinardo Murcia, Spain.
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