Distribution and correlation of refractive parameters in children with different corneal curvatures in southeast China

AIM

To analyze the distribution of refractive status in school-age children with different corneal curvatures (CC) and the correlation between CC and refractive status.

METHODS

A total of 2214 school-aged children of grade 4 in Hangzhou who were screened for school myopia were included. Uncorrected distance visual acuity (UCDVA), non-cycloplegic refraction, axial length (AL), horizontal and vertical corneal curvature (K1, K2) were measured and spherical equivalent (SE), corneal curvature radius (CCR) and axial length/corneal radius of curvature ratio (AL/CR) were calculated. UCDVA<5.0 and SE≤-0.50 D were classified as school-screening myopia. According to the different CCRs, the patients were divided into the lower corneal curvature (LCC) group (CCR≥7.92) and the higher corneal curvature (HCC) group (CCR<7.92). Each group was further divided into the normal AL subgroup and the long AL subgroup. The refractive parameters were compared to identify any differences between the two groups.

RESULTS

Both SE and AL were greater in the LCC group (P=0.013, P<0.001). The prevalence of myopia was 38% in the LCC group and 44% in the HCC group (P<0.001). The proportion of children without screening myopia was higher in the LCC group (62%) than in the HCC group (56%). Among these children without screening myopia, the proportion of long AL in the LCC group (24%) was significantly higher than that in the HCC group (0.012%; P<0.001). The change of SE in the LCC group was less affected by the increase of AL than that in the HCC group.

CONCLUSION

School-aged children in the LCC group have a lower incidence of screening myopia and longer AL. Low CC can mask SE reduction and AL growth to some extent, and the change of AL growth change more in children with low CC than high CC. Before the onset of myopia, its growth rate is even faster than that after the onset of myopia.

Changes in Ocular Biometry Following PreserFlo MicroShunt Implantation and Trabeculectomy: A Prospective Observational Study

Background This study aimed to evaluate postoperative changes in ocular biometry following initial PreserFlo MicroShunt implantation and trabeculectomy. Methodology This prospective, observational study analyzed 27 cases of PreserFlo MicroShunt implantation and 29 cases of trabeculectomy performed by a single surgeon. Visual acuity, intraocular pressure, corneal curvature, central corneal thickness, anterior chamber depth, and axial length were assessed at baseline and postoperatively at one day, one week, two weeks, one month, two months, three months, and six months. Patients requiring additional surgery and those with missing data were excluded. Consecutive data were compared with the baseline values using multiple comparisons. Results In both groups, intraocular pressure was significantly decreased from baseline at all postoperative time points (all p < 0.01). Visual acuity decreased in both groups at one day and one week postoperatively. Corneal curvature remained unchanged in both groups throughout the six-month follow-up. Central corneal thickness increased at one day and one week postoperatively in the PreserFlo group, but not in the trabeculectomy group. Anterior chamber depth exhibited a significant decrease at one week postoperatively in both groups. Axial length significantly decreased postoperatively until three months in the PreserFlo group and at all postoperative time points in the trabeculectomy group. Conclusions Ocular biometry following PreserFlo and trabeculectomy had a similar tendency postoperatively.

Comparison of Automated Keratometer and Scheimpflug Tomography for Predicting Refractive Astigmatism in Pseudophakic Eyes

PURPOSE

To analyse the correspondence between refractive astigmatism and corneal astigmatism in pseudophakic eyes with non-toric intraocular lenses.

SETTING

Yeouido St. Mary hospital, Seoul, Republic of Korea.

DESIGN

Evaluation of a diagnostic test instrument.

METHODS

This retrospective study included 95 eyes of 95 patients. Corneal astigmatism was measured with an automated keratometer (RK-5, Canon) and Scheimpflug tomography (Pentacam HR, Oculus). Refractive astigmatism was compared to keratometric astigmatism (based on anterior corneal measurements only), equivalent K-reading, and total corneal astigmatism (both based on anterior and posterior corneal measurements). Vector analysis was carried out by Næser's polar value method. The accuracy was defined as the average magnitude of the vectorial difference in astigmatism (DA). Each corneal measurement was optimized in retrospect by a multiple linear regression equation between refractive and corneal astigmatism.

RESULTS

Keratometric astigmatism overestimated with-the-rule (WTR) refractive astigmatism and underestimated against-the-rule (ATR) refractive astigmatism. Several measurements based on both corneal surfaces' values did not show any statistically significant difference with respect to refractive astigmatism. The mean corneal astigmatism by total corneal refractive power (TCRP) at 4.0 mm (zone/pupil) produced the lowest mean arithmetic DA and the highest percentage of eyes with a DA ≤ 0.50 dioptre. After optimization, the accuracies of automated KA and TCRP 4.0 mm (zone/pupil) were similar.

CONCLUSIONS

Total corneal astigmatism measured by Scheimpflug tomography at a 4.0 mm zone centered on the pupil accurately reflects the refractive astigmatism in pseudophakic eyes. However, the accuracy of total corneal astigmatism is not different from automated KA after optimization.

Anterior, Posterior, and Thickness Cornea Differences after Scleral Lens Wear in Post-LASIK Subjects for One Year

The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.

Effect of central corneal curvature on corneal material stiffness parameter acquired by dynamic corneal responses

The stress-strain index (SSI) is a measure of corneal material stiffness, which is obtained using the Corvis ST algorithm based on dynamic corneal response parameters. The reduced SSI corresponds to the longer axial length (AL). In a previous study, we found SSI increases as the corneal curvature flattens, whereas a flatter corneal curvature indicates a longer AL (emmetropia or myopia). Therefore, in this cross-sectional study, we aimed to address these contradictory findings. First, we characterized the features of SSI, curvature radius of the anterior corneal surface (CR), and AL and analyzed their correlation with advanced myopia. Next, we compared the relationship between AL and SSI after adjusting for the effect of CR. We found a significant positive correlation between SSI and CR, which contradicts the developmental law of axial myopia. Furthermore, after accounting for the effect of CR, we observed a stronger correlation between SSI and AL than that in the unadjusted model. In conclusion, CR is an independent influencing factor for SSI in addition to AL, which masked the decrease in SSI caused by prolonged AL in axial myopia.

Refractive Status and Biometric Characteristics of Children With Familial Exudative Vitreoretinopathy

Purpose

To compare biometric characteristics between patients with early-stage familial exudative vitreoretinopathy (FEVR) and healthy controls.

Methods

This case-control study included 50 FEVR eyes in stage 1-2 and 50 control eyes matched by age, gender and spherical equivalent (SE). Biometric parameters including axial length (AL), white-to-white diameter (WTW), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), pupil diameter, vitreous chamber depth, anterior and posterior corneal surface curvature radius (ACR and PCR), anterior lens surface curvature radius (ALR) and posterior lens surface curvature radius were measured using IOLMaster 700 and compared between cases and controls using paired t-test. Correlations between SE and biometric measures were assessed using Pearson correlation coefficient (r) in cases and controls.

Results

Both FEVR cases and matched controls had a mean age of 7.6 years, 48% female and mean SE of -5.3 D (80% myopia). Compared to controls, FEVR eyes had smaller AL (P = 0.009), WTW (P = 0.001), ACD (P < 0.001), and ALR (P = 0.03), but larger CCT (P = 0.02) and LT (P = 0.01). In FEVR eyes, SE was negatively correlated with AL (r = -0.79, P < 0.001), positively correlated with ACR (r = 0.29, P = 0.04) and PCR (r = 0.33, P = 0.02), whereas in controls, SE was negatively correlated with AL (r = -0.82, P < 0.001) and LT (r = -0.34, P = 0.02), positively correlated with ALR (r = 0.29, P = 0.04).

Conclusions

Patients at early stage of FEVR exhibited a unique eye morphology resembling ocular development arrest, which may help to develop screening and early detection tools for FEVR. In FEVR patients, myopia is very prevalent and significantly associated with corneal curvature increase.

Ocular biometric parameters of mild hyperopia to mild myopia children aged 6-14 years from Wenzhou optometry center: A cross-sectional study

Introduction

Myopia is the most common visual disorder in school-aged children and adolescents worldwide. This study aimed to explore the ocular biometric characteristics of children aged 6–14 years from the Wenzhou optometry center and to determine the relationship between spherical equivalent refraction (SER) and macular pigment optical density (MPOD).

Subjects and methods

Participants underwent a full-scale ophthalmic examination anteriorly and posteriorly. Relevant parameters were documented, such as axial length (AL), anterior chamber depth (ACD), SER and lens thickness (LT), corneal curvature radius (CCR), and MPOD. Lens power (LP) was calculated using Bennett’s formula. Shapiro–Wilk tests and histograms were used to check the normality of the distribution of refractive and ocular biometric parameters. Scatter diagrams were adopted to analyze the relationships between refraction and parameters of ocular biometry. Multiple linear regression models were employed to fit the associated factors of AL, AL/CCR, and LP.

Results

A total of 902 mild hyperopia to mild myopia (+3.00 D ≤ SE ≤ −3.00 D) children aged 6–14 years were included. The mean age of participants was 10.03 ± 2.47 years, and the prevalence of mild hyperopia, emmetropia, and myopia was 5.65, 27.05, and 67.30%, respectively. The prevalence of mild myopia increased from 30.53% at 6 years of age to 93.62% at 14 years of age. Overall, AL, ACD, and AL/CCR increased, but LP declined from 6 to 14 years of age, whereas CCR and MPOD remained stable. An increase of 1 mm in AL was associated with −0.69 D of myopic change. A unit increase in AL/CCR was associated with −7.87 D in SER. As for the SER variance, AL explained 30.5% and AL/CCR explained 51.1%, whereas AL/CCR and LP accounted for 59.2%.

Discussion

In this work, we have studied the distributions of ocular biometric characteristics of mild hyperopia to mild myopia children from the perspective of an optometry center rather than a sampling survey. In addition, we found that children from the optometry center had a slower progression toward myopia than those from previous sampling surveys, which was an informative finding for future myopia prevention. In addition, we have made a correlation analysis between the macular pigment optical density and spherical equivalent refraction. Though, no correlation was found.

A Study Linking Axial Length, Corneal Curvature, and Eye Axis With Demographic Characteristics in the Emmetropic Eyes of Bangladeshi People

Background Axial length (AL) and corneal curvature (CC) are one of the furthest critical parameters for optometry and oculoplastic surgery. These two variables are crucial in biometry for accurately measuring the power of the intraocular lens in cataract surgery. This research aimed to determine the association linking axial length and corneal curvature with demographic characteristics in emmetropic eyes of Bangladeshi people. Methods This descriptive cross-sectional research was carried out among 200 emmetropic eyes of Bangladeshi people attending the Department of Ophthalmology at Rajshahi Medical College, Bangladesh, with different eye conditions, between July 2017 and June 2018. Data was gathered by conducting person-to-person interviews, checking visual activity using the Snellen chart, and measuring corneal curvature using an auto-keratometer and axial eyeball length using A-scan ultrasonography. Results A total of 200 attendances were studied, 90 males and 110 females. All were emmetropic. The age range was 21-52 years, and the highest contributors were in the 21-30-year age group. The association between right axial length and right corneal curvature shows a negative relation among both sexes. It was -0.61 (β-coefficient (β-coff)), and highly significant in females at -0.89 (β-coff). Additionally, the association between left axial length and left corneal curvature shows a negative relation of -0.65 (β-coff), which was again highly significant in females at -0.87 (β-coff). Both were not significant in males. There was no significant association linking axial length and eye axis in both sexes. The multivariate regression model was used to assess the p-value, and the regression model was adjusted by age. Conclusion Optical parametric measurement is a noninvasive diagnostic and assessment tool that might help in the actual measurement of intraocular lens implantation in cataract surgery and may also provide supplementary information to the researcher domain.

Central Corneal Thickness of a Saudi Population in Relation to Age, Gender, Refractive Errors, and Corneal Curvature

Background In this study, we aimed to investigate the relationship between central corneal thickness (CCT) and age, gender, refractive errors, and corneal curvature in a Saudi population. Methodology In this randomized, hospital-based, retrospective study, data were collected from Dr. Sulaiman Al Habib Hospital and Imam Medical Center, Riyadh. A total of 1,005 eyes were included and recruited from patients referred to the refractive surgery clinic for Lasik assessment. The study included patients aged between 17 and 57 years with no history of any ocular pathology, eye surgeries, and systemic disease, as well as all groups with stable refractions. The identifying data were the age and gender of the patients, as well as their CCT, refraction, and corneal curvature. CCT and corneal curvature were measured by ultrasound pachymeter Pentacam. Results The distribution of CCT was 543.81 ± 34.47 μm. A significant difference in the mean CCT was observed across different refractive errors (p = 0.004). Patients with astigmatism had the lowest CCT, followed by myopic and hyperopic patients. An association between the spherical equivalent of patients with myopia and CCT (p = 0.001) was noted. Conclusions In the Saudi population, we found no significant association between mean corneal curvature and CCT in all three groups. Spherical equivalent in myopic patients was significantly associated with CCT. A significant difference in the mean CCT was observed across different refractive errors. There was a significant negative and weak correlation between age in myopic and astigmatism patients and CCT. Gender was significantly associated with CCT in patients with astigmatism.

Refractive Shifts and Changes in Corneal Curvature Associated With Antibody-Drug Conjugates

PURPOSE

Antibody-drug conjugates (ADCs) are a class of cancer drug wherein some are associated with corneal abnormalities, but there is a dearth of published information on refractive shifts in patients receiving ADCs. Here, we evaluated the dynamics of refractive error and keratometry readings in patients with ADC-related keratopathy and microcyst-like epithelial changes (MECs).

METHODS

This study is a retrospective case series including 58 eyes of 29 patients with ADC-related keratopathy from a single tertiary care cancer referral center (MSKCC). One eye (29 total) was randomly assigned for statistical analysis. In addition, a subset analysis of MEC location-refractive error correlation was performed on 20 eyes. Clinical records including slitlamp examination, indirect ophthalmoscopy, calculated spherical equivalence (SE), keratometry, and visual acuity were recorded at baseline, during, and off treatment.

RESULTS

A subset analysis of MEC location-refractive error correlation of 20 eyes revealed the following: Peripheral MECs were significantly associated with hyperopic shifts (P value < 0.001) and paracentral/central associated with myopic shifts (P value < 0.001). In the full cohort and on drug, the greatest change in SE from baseline was myopic (68%, as high as -4.75 D) and hyperopic (32%, as much as +3.75 D). Eighty-nine percent had a change in vision from baseline while on drug, but at the 3-month follow-up off drug, SE and vision returned to baseline in 33% and 82% of eyes.

CONCLUSIONS

Peripheral MECs were significantly associated with hyperopic shifts, and paracentral/central MECs were associated with myopic shifts. While on drug, most eyes had a myopic refractive shift, which corresponded with corneal steepening.

Corneal curvature-associated MTOR variant differentiates mild myopia from high myopia in Han Chinese population

BACKGROUND

Myopia is the most prevalent ocular disorder in the world, and corneal parameters have been regarded as key ocular biometric parameters determining the refractive status. Here, we aimed to determine the association of genome-wide association study-identified corneal curvature (CC)-related gene variants with different severity of myopia and ocular biometric parameters in Chinese population.

METHODS

Total 2,101 unrelated Han Chinese subjects were recruited, including 1,649 myopia and 452 control subjects. Five previously reported CC-associated gene variants (PDGFRA, MTOR, WNT7B, CMPK1 and RBP3) were genotyped by TaqMan assay, and their association with different myopia severity and ocular biometric parameters were evaluated.

RESULTS

Joint additive effect analysis showed that MTOR rs74225573 paired with PDGFRA rs2114039 (P = .009, odds ratio (OR) = 4.91) or CMPK1 rs17103186 (P = .002, OR = 13.03) were significantly associated with higher risk in mild myopia. Critically, mild myopia subjects had significantly higher frequency in MTOR rs74225573 C allele than high myopia subjects (P = .003), especially in male subjects (P = .001, OR = 0.49). High myopia subjects carrying MTOR rs74225573 C allele have significant flatter CC (P = .035) and longer corneal radius (P = .044) than those carrying TT genotype.

CONCLUSION

This study revealed that male high myopia subjects are more prone to carry CC-related MTOR rs74225573 T allele, whereas mild myopia subjects are prone to carry the C allele. MTOR rs7422573 variant could be a genetic marker to differentiate mild from high myopia in risk assessment.

ABBREVIATIONS

ACD: anterior chamber depth; AL: axial length; AL/CR: axial length/corneal radius ratio; ANOVA: analysis of variance; CC: corneal curvature; CCT: central corneal thickness; C.I.: confidence interval; CMPK1: cytidine/uridine monophosphate kinase 1; CR: corneal radius; D: diopter; GWAS: genome-wide association studies; HWE: Hardy-Weinberg equilibrium; LT: lens thickness; MIPEP: mitochondrial intermediate peptidase; MTOR: mechanistic target of rapamycin kinase; OR: odds ratio; PDGFRA: platelet-derived growth factor receptor-α; RBP3: retinol-binding protein 3; SD: standard deviation; SE: spherical equivalence; SNTB1: syntrophin beta 1; VCD: vitreous chamber depth; VIPR2: vasoactive intestinal peptide receptor 2; WNT7B: wingless/integrated family member 7B.

Correlating Kane formula with existing intraocular lens formulae for corneal curvatures and axial lengths

BACKGROUND:

To evaluate the predictability of the Kane formula in estimating postoperative refractive outcome with various corneal curvatures and axial lengths (ALs) besides comparing with existing intraocular lens (IOL) formulae.

MATERIALS AND METHODS:

A prospective cross-sectional study was carried out among patients having uneventful cataract surgery at an eye hospital. A total of 50 eyes were considered for the study. The corresponding A-constant for the model of IOL implanted into the patient's eye was taken along with the actual power of IOL implanted and corresponding predicted power for the IOL power inserted were taken for all the chosen formulae and was termed as "Adjusted Predicted Refractive Power." This was compared with the actual refractive outcome and the absolute error (AE) was measured. The eyes were separated into groups in terms of corneal curvature as flat (<42D), medium (42D–46D), and steep (>46D) corneas. In terms of AL, it was grouped as short (≤22 mm), medium (>22.0–<24.0 mm), and long (>24.0 mm) eyes.

RESULTS:

The study included 50 eyes and the mean AE for all the selected formulae were calculated for each group. Over the entire corneal curvature range, none of the formulae showed any significance when compared with the Kane formula (P > 0.05). In short AL, SRK-T formula had a statistical significance over the Kane formula (P = 0.043), whereas no other group had any significance over the Kane formula in AL groups.

CONCLUSION:

The study shows, all formulae (SRK-T, Holladay1, Hoffer Q, Hill RBF, Barrett Universal II, Kane) are interchangeable to predict the IOL power for any of the corneal curvature and ALs.

Keratometry in normal cats: a cross-sectional study in Japan using an automated handheld keratometer

Keratometry was performed in 73 domestic cats of varied signalment in Japan using an automated handheld keratometer. The mean corneal curvature radius was significantly lower for cats younger than 1 year than for those older than 2 years (8.04 mm vs. 8.80-8.99 mm, P<0.01). The radius was significantly greater in males than in females among the cats older than 11 years (9.22 mm vs. 8.84 mm, P=0.01), while the age distributions of the males and females were similar. Corneal astigmatism did not significantly differ across the gender and age groups. The predictability of the corneal curvature and astigmatism was approximately 41-43% and less than 3%, respectively, as a function of age and bodyweight. The results highlighted some age- and sex-related keratometric variations in domestic cats in Japan.

Corneal curvature, asphericity, and aberrations after transepithelial photorefractive keratectomy and femtosecond laser-assisted in situ keratomileusis for myopia: A prospective comparative study

Purpose:

We aimed to compare transepithelial photorefractive keratectomy (TPRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia treatment by analyzing corneal curvature, asphericity (Q-value), and corneal aberration.

Methods:

Corneal topography was measured before and 6 months after the TPRK or FS-LASIK surgery. We measured and compared corneal curvature (sagittal curvature in the 1- to 7-mm zones), change in keratometric measurements (Kmpost – Kmpre, ΔK), Q-values (from the vertex of the 6-, 7-, 8-, and 9-mm zones), higher-order aberration (HOA), vertical and horizontal trefoil (Z3^-3 and Z3³), vertical and horizontal coma (Z3^-1 and Z3¹), and spherical aberration (Z4⁰) between the two surgery groups.

Results:

The sagittal curvature Δ K in the 1-mm zone after TPRK was significantly higher than after FS-LASIK. The Δ K/ΔSE (ΔSE [spherical equivalent] = SEpre – SEpost) ratio in the 1- to 4-mm diameter zones was significantly higher after TPRK than after FS-LASIK. The preoperative Q-values of the 6- and 7-mm zones did not differ between the treatment groups, but postoperative values were significantly higher following FS-LASIK than following TPRK. HOA, Z4⁰, and Z3^-1 were all significantly higher after surgery in both groups. Postoperative Z3^-3 was significantly higher following TPRK but not following FS-LASIK. There were no postoperative differences in aberrations in either group; however, the change in HOA and Z3^-1 was significantly greater following FS-LASIK.

Conclusion:

TPRK changes the corneal curvature to a greater extent and the visual quality (Q-value, aberrations) to a lesser extent than FS-LASIK.

Correlating Kane formula with existing intraocular lens formulae for corneal curvatures and axial lengths

BACKGROUND

To evaluate the predictability of the Kane formula in estimating postoperative refractive outcome with various corneal curvatures and axial lengths (ALs) besides comparing with existing intraocular lens (IOL) formulae.

MATERIALS AND METHODS

A prospective cross-sectional study was carried out among patients having uneventful cataract surgery at an eye hospital. A total of 50 eyes were considered for the study. The corresponding A-constant for the model of IOL implanted into the patient's eye was taken along with the actual power of IOL implanted and corresponding predicted power for the IOL power inserted were taken for all the chosen formulae and was termed as "Adjusted Predicted Refractive Power." This was compared with the actual refractive outcome and the absolute error (AE) was measured. The eyes were separated into groups in terms of corneal curvature as flat (<42D), medium (42D-46D), and steep (>46D) corneas. In terms of AL, it was grouped as short (≤22 mm), medium (>22.0-<24.0 mm), and long (>24.0 mm) eyes.

RESULTS

The study included 50 eyes and the mean AE for all the selected formulae were calculated for each group. Over the entire corneal curvature range, none of the formulae showed any significance when compared with the Kane formula (P > 0.05). In short AL, SRK-T formula had a statistical significance over the Kane formula (P = 0.043), whereas no other group had any significance over the Kane formula in AL groups.

CONCLUSION

The study shows, all formulae (SRK-T, Holladay1, Hoffer Q, Hill RBF, Barrett Universal II, Kane) are interchangeable to predict the IOL power for any of the corneal curvature and ALs.

Time to Keratometric Stability After Pterygium Excision and the Associated Factors: A Clinical Perspective

Purpose

To determine the percentage of eyes with corneal astigmatic power stability and mean corneal keratometric power at 6-month post-pterygium excision, and to identify the time, and the associated factors, required to achieve stability.

Methods

This prospective observational study enrolled patients undergoing pterygium excision. Patients were evaluated for baseline characteristics and keratometric data before and every month after pterygium excision for six months using IOL Master 500^® (Carl Zeiss, Meditec). Clinically stable corneal astigmatic power and keratometric power were, respectively, defined as changes in these parameters of less than 0.25 and 0.27 diopters after two consecutive visits. Time to corneal astigmatic and keratometric power stability, as well as factors associated with the stability, were analyzed.

Results

Forty percent and 73.3% of eyes, respectively, demonstrated corneal astigmatic and corneal keratometric stability at six months post-operation. Within three months of reaching initial stability, the corneal astigmatic power and the mean keratometric power showed instability in 46.7% and 27.3% of patients, respectively. No patients with keratometric stability for more than three months became unstable during the study period. The extension of pterygium exceeding 3.0 mm was associated with a delay in time to corneal astigmatic stability (HRadjusted 0.41; 95% CI 0.19-0.89; P= 0.02).

Conclusion

According to the clinical relevance, 40% and 73% of patients, respectively, presented corneal astigmatic and keratometric stability within six months post-operation. Patients with a pterygium extension of more than 3 mm required a longer time for corneal astigmatic stability. It is recommended that keratometric stability be achieved for at least three months before commencing with additional procedures.

Changes of angle Kappa and corneal morphology changes in myopic patients after SubBowmanKeratomileusis

OBJECTIVES

To investigate angle Kappa and diopter distribution in myopic patients and the changes of angle Kappa and corneal morphology after Sub-Bowman-Keratomileusis (SBK), and to analyze the effects of the surgery on corneal morphologic changes and the patients' near fixation characteristics.

METHODS

The clinical data of 134 myopic patients (268 eyes) undergoing SBK from August 2015 to August 2016 were retrospectively analyzed. Angle Kappa, corneal curvature in the central corneal region of 3 mm, and post-corneal Diff value were measured by Orbscan IIz Corneal Topography System before operation, 1 month and 6 months after operation. According to the values of angle Kappa before SBK, the patients were divided into 2 groups: the large K group (angle Kappa≥5°, 71 eyes) and the small K group (angle Kappa<5°, 197 eyes). Correlation analysis of the factors influencing angle Kappa at 6 months after operation was performed.

RESULTS

In the large K group, angle Kappa was (5.67±0.65)°, spherical equivalent was (-4.84±2.32) D, and angle Kappa was decreased after operation (both P<0.05) with the increased decreasing range over time. In the small K group, angle Kappa was (3.51±1.08)°, spherical equivalent was (-5.78±2.63) D, angle Kappa was increased after operation with decreased increasing range over time, and the difference was statistically significant between 6 months after operation and before operation (P<0.05).The post-corneal Diff value of the 2 groups was increased after operation (all P<0.001), and was decreased from 1 month to 6 months after surgery. The corneal curvature in the central corneal region of 3 mm of the 2 groups 1 month after operation was decreased significantly (both P<0.001). From 1 month to 6 months after operation, the corneal curvature of the large K group tended to be stable, while the corneal curvature of the small K group tended to increase. There was no significant correlation between the changes of angle Kappa 6 months after operation and the changes of the corneal central curvature or the post-corneal Diff value (both P>0.05), but the changes of angle Kappa 6 months after operation was positively correlated with corneal cutting thickness (rlarge K group=0.398, rsmall K group=0.218, both P<0.05) and it was negatively correlated with preoperative diopter (rlarge K group=-0.283, rsmall K group=-0.233, both P<0.05).

CONCLUSIONS

The angle Kappa is decreased in low-moderate myopia patients with large angle Kappa, while is increased in high myopia patients with small angle Kappa after SBK. Myopia patients after SBK will look for the new balance of the binocular accommodation and vergence function for improving the comfort in the near-work situations.

Evaluation and comparison of a novel Scheimpflug-based optical biometer with standard partial coherence interferometry for biometry and intraocular lens power calculation

In the present study, the axial length (AL), corneal curvature, anterior chamber depth (ACD) and white-to-white (WTW) distance were assessed using the Pentacam AXL (Oculus Optikgeraete GmbH), a novel Scheimpflug-based optical biometer with standard partial coherence interferometry (PCI). The Pentacam AXL and PCI biometer (IOLMaster 500; Carl Zeiss AG) were compared in terms of their intraocular lens (IOL) power calculations. The medical records of patients (eyes, n=190) who underwent cataract surgery were retrospectively reviewed. Biometry measurements involved the eyes of patients with cataract and were performed by the same examiner with the Pentacam AXL biometer and the IOLMaster 500 device. Following determination of the AL, mean keratometry (Km), ACD and WTW distance, the IOL power calculation was compared between the two devices using the Sanders, Retzlaff and Kraff theoretical (SRK/T) and Haigis formulas. The AL, Km and WTW values for the Pentacam AXL group were significantly lower compared with those of the IOLMaster 500 group. The difference was -0.02±0.04 mm, -0.20±0.28 D and -0.10±0.20 mm, respectively (P<0.001). The ACD for the Pentacam AXL group was higher compared with that of the IOLMaster 500 group with a difference of 0.02±0.13 mm (P=0.13). The IOL power calculated using the SRK/T and Haigis formulas exhibited significant differences between the two devices (t=11.48 and 10.97, respectively; P<0.001). In conclusion, the AL, ACD, WTW measurement and IOL power indicated optimal agreement and strong correlations between the two devices. However, constant optimization may be necessary for the novel biometer Pentacam AXL.

Scleral lens wear following penetrating keratoplasty: changes in corneal curvature and optics

PURPOSE

Visual rehabilitation following penetrating keratoplasty is the primary indication for approximately 15% of all scleral lens fittings. Since corneal biomechanics are altered following penetrating keratoplasty, the aim of this study was to quantify changes in anterior corneal optics following short-term scleral lens wear in eyes with corneal grafts.

METHODS

Scheimpflug images were obtained before and after a period of scleral lens wear (mean 6.3 ± 1.4 h), from eyes that had previously undergone penetrating keratoplasty (10 eyes of nine participants, mean age 31 ± 9 years). Corneal power and thickness data were examined over the central 6 mm, including regional analyses of the central (0-3 mm) and the mid-peripheral cornea (3-6 mm annulus) using customised software to deterime corneal power vectors M (best fit sphere), J₀ (90/180 astigmatism) and J₄₅ (45/135 astigmatism). Anterior corneal aberrations were extracted using corneal elevation data.

RESULTS

Corneal power vector J₄₅ increased following lens wear (by 0.22 ± 0.05 D, p = 0.003) across the central 6 mm, while M displayed regional variations following lens wear indicating larger changes further from the corneal centre (p = 0.004). The change in corneal power vector M was also correlated with the magnitude of central corneal swelling (r = 0.65, p = 0.04). The anterior corneal aberration terms of oblique astigmatism, hoirzontal coma, and spherical aberration also varied following lens wear (all p ≤ 0.01). The mean change in the corneal spherocylinder derived from the elevation data following lens wear was +0.14/-0.54 × 44 for a 6 mm corneal diameter.

CONCLUSIONS

Clinically significant alterations in anterior corneal topography and higher order aberrations were observed following short-term scleral lens wear in eyes that had undergone penetrating keratoplasty. Spherocylindrical changes were approximately double the magnitude and more oblique in orientation compared to previous reports of healthy eyes. Changes in corneal power vector M may be related to epithelial corneal oedema.

Genome-Wide Association of Genetic Variants With Refraction, Axial Length, and Corneal Curvature: A Longitudinal Study of Chinese Schoolchildren

Background

Myopia is a common eye disorder that is approaching epidemic proportions worldwide. A genome-wide association study identified AREG (rs12511037), GABRR1 (rs13215566), and PDE10A (rs12206610) as being associated with refractive error in Asian populations. The present study investigated the associations between these three genetic variants and the occurrence and development of myopia, spherical equivalent refraction (SER), axial length (AL), and corneal curvature (CC) in a cohort of southeastern Chinese schoolchildren.

Methods

We examined and followed 550 children in grade 1 enrolled in the Wenzhou Epidemiology of Refractive Error (WERE) project. During the 4-year follow-up, non-cycloplegic refraction was evaluated twice each year, and the AL and CC were measured once every year. Age, sex, and the amounts of time spent on near work and outdoors were documented with a questionnaire. Sanger DNA sequencing was used to genotype single nucleotide polymorphisms (SNPs). SNPtest software was used to identify potential genetic variants associated with myopia, SER, AL, and CC. Ten thousand permutations were used to correct for multiple testing.

Results

In total, 469 children, including 249 (53.1%) boys and 220 (46.9%) girls, were included in analyses. The mean age of all the children was 6.33 ± 0.48 years. After adjusting for age, sex, time spent on near work and time spent outdoors, neither the genotypes nor the allele frequencies of the three SNPs were significantly associated with myopic shift, incident myopia or the change in SER. After adjusting for age, sex, near-work time and outdoor time with 10,000 permutations, the genotype AREG (rs12511037) was associated with an increase in AL (P′-values for the dominant, recessive, additive and general models were 0.0032, 0.0275, 0.0045, and 0.0099, respectively); the genotype PDE10A (rs12206610) was associated with a change in CC in the additive (P′ = 0.0096), dominant (P′ = 0.0096), and heterozygous models (P′ = 0.0096).

Conclusion

These findings preliminarily indicate that AREG SNP rs12511037 and PDE10A SNP rs12206610 are etiologically relevant for ocular traits, providing a basis for further exploration of the development of myopia and its molecular mechanism. However, elucidating the role of AREG and PDE10A in the pathogenesis of myopia requires further animal model and human genetic epidemiology studies. This trial is registered as ChiCTR1900020584 at www.Chictr.org.cn.

Pattern of corneal astigmatism induced by primary pterygium in patients with cataract in a secondary hospital in Southern China: a cross-sectional study

OBJECTIVES

To review the pattern of primary pterygium-induced corneal astigmatism in patients with cataract in a southern Chinese population.

DESIGN

Clinic-based cross-sectional retrospective study.

SETTING

A secondary hospital at southern China.

PARTICIPANTS

A group of 1689 eyes with primary pterygium (PT group) and the other group of 4062 eyes without pterygium (NPT group) were included.

MAIN OUTCOME MEASURES

Corneal power was measured by an autokeratorefractometer. Corneal astigmatism was calculated as the difference in corneal power between the steepest and flattest meridians. Distribution of corneal astigmatism was compared between eyes with pterygium and eyes without pterygium.

RESULTS

Distribution of corneal astigmatism was different between PT group (skewness=2.548, kurtosis=8.237) and NPT group (skewness=2.778, kurtosis=15.52). Mean corneal astigmatism was significantly higher in the PT group (1.62±1.49D) compared with the NPT group (1.17±0.89D, p<0.0001). The prevalence of corneal astigmatism >1D (PT 52.3%, NPT 40.9%, p<0.0001), >2D (PT 22.4%, NPT 10.6%, p<0.0001) or >3D (PT 10.5%, NPT 3.2%, p<0.0001) was significantly higher in the PT group compared with the NPT group. Eyes in the PT group had significantly higher corneal astigmatism than the NPT group in almost every age group (all p<0.05), with the exception of patients ≥90 years. Moreover, eyes in the PT group had significantly higher with-the-rule (PT 1.72±1.59D, NPT 1.19±0.88D, p<0.0001) and against-the-rule (PT 1.63±1.46D, NPT 1.18±0.88D, p<0.0001) but similar oblique astigmatism (PT 1.11±1.00D, NPT 0.99±0.89D, p=0.065) corneal astigmatism compared with the NPT group. Power vector analysis indicated that the axis of corneal astigmatism was not significantly different between the two groups (J₀, PT -0.01±0.74D, NPT 0.01±0.52D, p=0.48; J₄₅, PT -0.03±0.82D, NPT 0.00±0.52D, p=0.54).

CONCLUSIONS

Pattern of corneal astigmatism in eyes with cataract and coexisting primary pterygium was different from eyes without pterygium. Pterygium is associated with higher magnitude but not different axis of corneal astigmatism.

Characterising keratometry in different dog breeds using an automatic handheld keratometer

Background

Keratometry is clinically important and is routinely performed as part of human ophthalmic examination. In veterinary ophthalmology, little is known about keratometry in dogs, and its practical application has been limited. The present study aimed to describe keratometry in some dog breeds popular in Japan using a handheld keratometer.

Methods

Client-owned dogs of various signalment were enrolled prospectively in the keratometry examination. Interbreed variations in mean corneal curvatures (R1R2avg) and corneal astigmatism (Δ(R1−R2)) were evaluated statistically with respect to their bodyweight based on the data which fulfilled the predetermined inclusion criteria. P<0.05 was considered statistically significant.

Results

On examination of 237 dogs from 16 different breeds, R1R2avg (mean±sd) ranged from 7.54±0.30 mm in Pomeranians to 9.28±0.19 mm in golden retrievers. Δ(R1−R2) (mean±sd) ranged from 0.22±0.11 mm in miniature schnauzers to 0.57±0.30 mm in French bulldogs.

Conclusion

The present study successfully described keratometry in 16 dog breeds. The study revealed considerable interbreed variations in both R1R2avg and Δ(R1−R2), which did not necessarily correlate with bodyweight. These results are useful both clinically in fitting contact lenses in the management of corneal diseases and non-clinically in optometric studies in dogs.

Impact of corneal parameters on intraocular pressure measurements in different tonometry methods

AIM

To evaluate the impact of central corneal thickness (CCT) and corneal curvature on intraocular pressure (IOP) measurements performed by three different tonometers.

METHODS

IOP in 132 healthy eyes of 66 participants was measured using three different tonometry techniques: Goldmann applanation tonometer (GAT), Pascal dynamic contour tonometer (DCT), and ICare rebound tonometer (RT). CCT and corneal curvature were assessed.

RESULTS

In healthy eyes, DCT presents significantly higher values of IOP than GAT (17.34±3.69 and 15.27±4.06 mm Hg, P<0.0001). RT measurements are significantly lower than GAT (13.56±4.33 mm Hg, P<0.0001). Compared with GAT, DCT presented on average 2.51 mm Hg higher values in eyes with CCT<600 µm and 0.99 mm Hg higher results in eyes with CCT≥600 µm. The RT results were lower on average by 1.61 and 1.95 mm Hg than those obtained by GAT, respectively. Positive correlations between CCT in eyes with CCT<600 µm were detected for all IOP measurement techniques, whereas a similar relationship was not observed in eyes with thicker corneas. A correlation between IOP values and keratometry in the group with CCT<600 µm was not detected with any of the tonometry methods. In thicker corneas, a positive correlation was found for GAT and mean keratometry values (R=0.369, P=0.005).

CONCLUSION

The same method should always be chosen for routine IOP control, and measurements obtained by different methods cannot be compared. All analysed tonometry methods are dependent on CCT; thus, CCT should be taken into consideration for both diagnostics and monitoring.

Comparison of corneal curvature parameters obtained from two different instruments-Pentacam and VX120

AIM

To explore whether the same corneal curvature parameters and anterior chamber depth measured by Pentacam and VX120 have a good consistency and can replace each other.

METHODS

This study enrolled 140 eyes of 70 patients ranging in age from 19 to 53y. All eyes underwent a comprehensive ophthalmologic examination including an anterior segment analysis with the VX120 system (Visionix-Luneau Technologies, Chartres, France) and Pentacam (Oculus Optikgerate GmbH) respectively. The comparison on corneal curvature parameters was done between Pentacam and VX120 using clustered signed rank test; the interclass correlation coefficients (ICC) with 95% confidence intervals (CI) was calculated for each parameter between Pentacam and VX120; the Bland-Altman plot of each parameter was supplemented.

RESULTS

The anterior corneal curvature measured by VX120 was Ks: 44.00±1.78 D, KsAt: 89.45±22.18, Kf: 42.84±1.58 D, KfAt: 93.91±79.34; which measured by Pentacam was Ks: 43.80±1.82 D, KsAt: 91.17±21.40, Kf: 42.61±1.64 D, KfAt: 91.16±78.69. There was statistical difference between Pentacam and VX120 for anterior corneal curvature parameter (P<0.001). The posterior corneal curvature measured by VX120 was Ks: -6.42±1.23 D, KsAt: 91.00±23.45, Kf: -5.85±1.24 D, KfAt: 95.93±79.11; which measured by Pentacam was Ks: -6.44±0.32 D, KsAt: 92.24±11.75, Kf: -6.01±1.05 D, KfAt: 74.43±80.64. There was statistical difference between Pentacam and VX120 for posterior corneal curvature parameters (P<0.001). Anterior chamber depth (ACD) measured by Pentacam and VX120 was statistically different. Pentacam and VX120 achieved high consistency only on corneal anterior surface, including Ks and Kf. The ICCs were 0.96 (95%CI: 0.95, 0.97) and 0.95 (95%CI: 0.94, 0.97) respectively. For other corneal surface curvature parameters, all ICCs of between Pentacam and VX120 were below 0.87. Bland-Altman plots indicated of low consistency of corneal surface curvature parameters measured by Pentacam and VX120.

CONCLUSION

The corneal curvature parameters and anterior chamber depth measured by Pentacam and VX120 were statistically different. Data measured by Pentacam and VX120 is not suggested to replace each other, mixing data measured by Pentacam and VX120 together is not suggested either.

Relationship between early structural changes at cornea incision sites and surgical outcomes after phacoemulsification

AIM

To assess the early structural changes at clear corneal cataract incision sites and surgical outcomes using anterior segment optical coherence tomography (AS-OCT).

METHODS

We evaluated 80 eyes of 59 patients who underwent phacoemulsification with a clear corneal incision. All incisions were evaluated 1wk, 1, and 3mo postoperatively using AS-OCT and analyzed regarding angle, length of the incision, maximal corneal thickness at the incision, and if present, corneal endothelial gap length and incision gap area. The patients were divided into two groups according to whether or not an endothelial gap was present at 1wk postoperatively (endothelial gap, group 1; no endothelial gap, group 2). We analyzed the difference in patient and surgical factors between the two groups, and compared the surgical outcome and the refractive outcome.

RESULTS

An endothelial gap was observed in 56 (70.0%) of 80 eyes at 1wk postoperatively but not at 3mo postoperatively. The mean patient age was significantly higher in group 1 than in group 2. The longer the length of the corneal incision and the steeper the incision angle, the greater the length and area of the endothelial gap. In group 1, the mean change in mean keratometry of the anterior cornea was significantly greater than in group 2, and the spherical equivalent (SE) and mean numerical error indicated significant myopic changes at 1wk postoperatively.

CONCLUSION

The risk of an endothelial gap increases with patient age and a long corneal incision and steep incision angle. The presence of an endothelial gap after surgery may affect the early postoperative corneal curvature and SE.

Visual acuity and amblyopia prevalence in 11- to 12-year-old Danish children from the Copenhagen Child Cohort 2000

PURPOSE

To evaluate the prevalence of amblyopia and associated biometric factors in Danish children.

METHODS

Determination of best-corrected visual acuity (BCVA) using ETDRS charts, non-cycloplegic subjective refractioning guided by automated refractometry, axial length and corneal curvature, fundus photography and optical coherence tomography (OCT) in 1335 children from the population-based Copenhagen Child Cohort 2000 (CCC2000) Eye Study. Birth data were obtained from the Danish Medical Birth Registry.

RESULTS

The mean (±SD) age of children was 11.7 (±0.4) years, and 47% were boys. Amblyopia prevalence was 1.5 (95% CL 0.8-2.2) %. Unilateral amblyopic eyes [BCVA < 80 ETDRS letters (0.8 snellen) and ≥2 lines difference between the eyes] was 0.6 (95% CL 0.3-1.0) mm shorter, 1.34 (95% CL 0.30-2.37) D more hyperopic and had 0.79 (95% CL 0.14-1.44) D more astigmatism compared with fellow eyes. Compared with the right eyes of the non-amblyopic children, unilateral amblyopic eyes were 1.0 (95% CL 0.5-1.6) mm shorter, 2.48 (95% CL 1.11-3.86) D more hyperopic, 1.09 (95% CL 0.43-1.75) D more astigmatic and had a 47 (95% CL 13-81) μm thicker subfoveal choroid.

CONCLUSION

Amblyopia was found in 1.5% of Danish children born 22 years after the inception of the nationwide preschool visual screening programme. Amblyopia was associated with anisometropia, astigmatism, a thicker subfoveal choroid and a history of childhood strabismus.

Correlation of Central Corneal Thickness and Keratometry with Refraction and Axial Length: A Prospective Analytic Study

Introduction  The correlation between corneal curvature and central corneal thickness (CCT), with ocular parameters like axial length and refraction, remains elusive. The various ocular biometric parameters are interdependent and their correlation varies with the population studied. A comprehensive study is required for a better understanding of the ocular biometric properties of Indian eyes. Methodology This is a prospective study done in 156 subjects. Subjects with clear lens and clear cornea were included in the study. Those with corneal opacity, cataract, pregnancy, and diabetes were excluded. Cycloplegic refraction, autokeratometry (Potex, ultrasonic auto keratometer), central corneal thickness (ultrasonic pachymeter), and axial length (Sonomed) were done in all subjects. Subjects were divided into two groups based on refraction, for an analysis of parameters. Group one included subjects with refraction of +3 diopters (D) to -2.99D and group two with subjects with > -3D refraction. Results With an increasing axial length and myopic refraction, the corneal curvature tends to be steeper. The average CCT of subjects in group one and group two were 530.34 microns and 542.63 microns, respectively. Subjects with refraction more than 10 diopters or axial length more than 25 mm had a mean CCT of 525.25 microns. Subjects with myopic refraction between 3 diopters and 10 diopters had a mean CCT of 551.32 microns. Conclusion Increase in corneal power is associated with increasing myopic refraction. Steeper corneal curvature is correlated with increasing axial length and thinner corneas. The mean CCT was 533.87 microns with a standard deviation (SD) of 40.02. Axial myopia is associated with an increase in corneal thickness. These ocular biometric findings have crucial implications in refractive surgeries.

Ten-year reinvestigation of ocular manifestations in Marfan syndrome

IMPORTANCE

Long-term follow-up of Marfan syndrome (MFS) patients.

BACKGROUND

Investigate changes in ocular features in MFS patients fulfilling the Ghent-2 criteria following a period of 10 years.

DESIGN

Repeated cross-sectional study with two observations.

PARTICIPANTS

Eighty-four MFS patients were investigated in 2003-2004 (baseline). Forty-four of these patients (52%) were examined after 10 years.

METHODS

A comprehensive ocular examination performed at baseline and follow-up.

MAIN OUTCOME MEASURES

Development or progression of ectopia lentis (EL).

RESULTS

At follow-up, mean age was 50.1 ± 11.9 years (range: 30-80 years), 74% were female and 70% of the patients were diagnosed with EL compared to 66% at baseline. Two patients (3 eyes) had developed EL over the decade, representing a 13% risk. Furthermore, one eye had progressed from a subtle tilt of the lens to dislocation. We found no significant change in the axial length (P = 0.96), the corneal curvature (P = 0.64) or the spherical equivalent (P = 0.23). Best corrected visual acuity was improved at follow-up (P = 0.02). There were 7% and 33% risks for development of retinal detachment and cataract between baseline and follow-up, respectively.

CONCLUSIONS AND RELEVANCE

Our study indicates that even though EL typically occurs at an early stage in most MFS patients, there is still a risk of developing EL in adulthood. The risk of developing vision-threatening complications such as retinal detachment and cataract was much higher than in the normal population, but even so, the visual potential of the MFS patients was relatively good.

Association analysis of exome variants and refraction, axial length, and corneal curvature in a European-American population

Refractive errors, myopia, and hyperopia are common visual disorders greatly affecting older individuals. Refraction is determined by genetic factors but only a small percentage of its variation has been explained. We performed a genetic association analysis with three ocular phenotypes: spherical equivalent (a continous measure of refraction), axial length, and corneal curvature in 1,871 European-Americans from the Beaver Dam Eye Study. Individuals were genotyped on the Illumina exome array and imputed to the Haplotype Reference Consortium reference panel. After increasing the number of analyzed variants in targeted protein-coding regions 10-fold via imputation, we confirmed associations for two previously known loci with corneal curvature (chr4q12, rs2114039; g.55092626T > C, β = -0.03 (95% confidence interval [CI]): -0.06, -0.01, P value = 0.01) and spherical equivalent (chr15q14, rs634990; g.35006073T > C, β = -0.27, 95% CI: -0.45, -0.09, P value = 3.79 × 10^-3 ). Despite increased single nucleotide polymorphism (SNP) density, we did not detect any novel significant variants after correction for multiple comparisons. In summary, we confirmed two previous loci associated with corneal curvature and spherical equivalent in a European-American population highlighting the potential biological role of those regions in these traits.

Validation of keratometric measurements obtained with an intraoperative image-guided system: intra-session repeatability and interchangeability with an optical biometer

PURPOSE

To evaluate the intra-session repeatability of keratometric measurements obtained in healthy eyes with the Verion image-guided system (Alcon Laboratories Inc, Fort Worth, Texas, USA) as well as the interchangeability of such measurements with those obtained with an optical biometer (Aladdin, Topcon, Tokyo, Japan).

METHODS

A total of 53 eyes of 53 patients (age 31-67 years) were enrolled in the study. All eyes received a comprehensive ophthalmologic examination including an analysis with the Verion image-guided and Aladdin systems. Three consecutive measurements of keratometry were obtained with the Verion system to assess the intra-session repeatability. Within-subject standard deviation (S_w ) and intraobserver precision (± 1.96 × S_w ) were calculated. Bland-Altman analysis was used for the interchangeability analysis.

RESULTS

Mean S_w was 0.26, 0.24 and 0.10 D for the keratometric power in the flattest meridian (K1), keratometric power in the steepest meridian (K2) and astigmatism, respectively. Mean S_w was 4.29° for the axis of the flattest corneal meridian (AX1). Statistically significant but clinically acceptable differences were found in K1, K2 and keratometric astigmatism among systems (p < 0.01). In contrast, differences among systems in AX1 were not statistically significant (p = 0.385) but clinically relevant (mean difference: 15.74°; limits of agreement: -30.93 to 62.41°).

CONCLUSIONS

The Verion system provides consistent measurements of keratometric parameters, with measurements of AX1 that are not interchangeable with that provided by the optical biometer Aladdin, especially in cases of low and oblique astigmatism.

The relationship between corneal biomechanics and anterior segment parameters in the early stage of orthokeratology: A pilot study

To investigate the relationship between corneal biomechanics and anterior segment parameters in the early stage of overnight orthokeratology.Twenty-three eyes from 23 subjects were involved in the study. Corneal biomechanics, including corneal hysteresis (CH) and corneal resistance factor (CRF), and parameters of the anterior segment, including corneal curvature, central corneal thickness (CCT), and corneal sublayers' thickness, were measured at baseline and day 1 and 7 after wearing orthokeratology lens. One-way analysis of variance with repeated measures was used to compare the longitudinal changes and partial least squares linear regression was used to explore the relationship between corneal biomechanics and anterior segment parameters.At baseline, CH and CRF were positively correlated with CCT (r = 0.244, P = .008 for CH; r = 0.249, P < .001 for CRF), central stroma thickness (CST) (r = 0.241, P = .008 for CH; r = 0.244, P = .002 for CRF) and central Bowman layer thickness (CBT) (r = 0.138, P = .039 for CH; r = 0.171, P = .006 for CRF). Both CH and CRF significantly decreased from day 1 after orthokeratology. The corneal curvature and the epithelium thickness also significantly decreased, while the stromal layer thickened significantly from day 1 after orthokeratology. There was no correlation between the changes of corneal biomechanics and anterior segment parameters at day 1 and 7 after orthokeratology.While corneal biomechanics were positively correlated with CCT, CST, and CBT, the changes of CH and CRF were not correlated with the changes of corneal curvature, CCT, and corneal sublayers' thickness in the early stage of orthokeratology in our study.

Central corneal thickness of Iraqi population in relation to age, gender, refractive errors, and corneal curvature: a hospital-based cross-sectional study

BACKGROUND

Central corneal thickness (CCT) is an important indicator of corneal status. Its measurement provides valid information about corneal physiological condition and possible changes associated with diseases, traumas, and hypoxia. It is an integral part for interpretation of intraocular pressure and glaucoma patient management and in prerefractive procedure assessment.

OBJECTIVE

The aim of this study is to determine the mean CCT among a normal Iraqi population and to correlate between CCT and age, gender, refraction, and corneal curvature.

PATIENTS AND METHODS

This cross-sectional study was carried out at Ibn Al-Haitham Teaching Eye Hospital. A total of 418 eyes from 209 healthy individuals with an age range from 20 to 75 years were studied. CCT was measured by ultrasound pachymeter. Refraction was measured using an auto-refractor and confirmed by trial lenses and retinoscopy to calculate the spherical equivalent. Corneal curvature was measured using an auto-refracto-keratometer to calculate the average corneal curvature (AVK).

RESULTS

The mean CCT was 543.95±32.58 μm with a range from 422 to 636 μm. CCT was not affected by gender. CCT significantly negatively correlated with age and AVK. CCT significantly positively correlated with the spherical equivalence.

CONCLUSION AND RECOMMENDATION

Among an Iraqi population, CCT significantly decreased with age. Myopics had significantly thinner corneas. There was weak but significant negative correlation between CCT and corneal curvature. We recommend further studies about the relationship between central corneal thickness and other ocular parameters in Iraqi population such as the axial length.

Comparative study of changes of corneal curvatures and uncorrected distance visual acuity prior to and after corneal collagen crosslinking: 1-year results

Background/Purpose:

Keratoconus is the most common primary corneal ectatic disease and has considerable importance in public health. Corneal collagen crosslinking (CXL) is a procedure to mitigate progression of keratoconus and reduce demand for corneal transplantation. The aim of this study was to evaluate the effect of CXL on corneal topographic and uncorrected distance visual acuity (UDVA) by Oculus Pentacam in the 15–30-year-old population.

Methods:

In this descriptive–analytic study, we enrolled 38 eyes of 27 patients suffering from progressive keratoconus who were candidates for CXL. UDVA and the anterior and posterior corneal curvatures assessed prior to and 12 months after CXL. Data were analyzed by the paired t test and p < 0.05 was considered significant.

Results:

One year after the CXL, mean UDVA significantly improved 0.1 ± 0.25 logarithm of the minimal angle of resolution (p = 0.012). Changes for steep keratometry values, flat keratometry, and mean keratometry on the anterior corneal surface were statistically significant (all p < 0.005). However, the difference observed in maximum keratometry and astigmatism was not significant (p = 0.421 and p = 0.745, respectively). After 12 months, all four keratometry values on the posterior corneal surface had increased significantly (p < 0.005), while no significant change observed in astigmatism (p = 0.303).

Conclusion:

Corneal collagen crosslinking has been revealed as an effective and minimally invasive intervention for the treatment of progressive keratoconus that can improve UDVA.

Numerical analysis of corneal curvature dynamics based on Corvis tonometer images

The paper presents numerical analysis of corneal curvature distribution, based on Corvis ST images. It was shown that a new approach to analysis of corneal curvature from tonometer images enables a better description and understanding of processes during fast corneal deformation. Ten healthy volunteers participated in nine repeated measurements on one eye. 90 sequences of images were processed with software written in Matlab, with the use of the Image Processing Toolbox. Time-spatial distribution of the local curvature distribution of the corneal profile was obtained for each and every measurement. Some new curvature parameters were proposed and analyzed. A high repeatability for individual subjects was obtained for the proposed parameters. For four of these new parameters, the ICC coefficients were higher than 0.85. The ICC value for the calculated curvature of the cornea before deformation reaches 0.989. Such high repeatability of the proposed new parameters can be useful in examination and differentiation of corneas due to their geometrical and biomechanical properties.

Assessment of corneal curvature using verion optical imaging system: a comparative study

BACKGROUND

Keratometry is a critical determinant of the postoperative refractive outcome. This study evaluates the comparability of keratometry measurements obtained using the Verion Optical Imaging System with devices used in current clinical practice. Further, it determines the interobserver reliability of the Verion Optical Imaging System.

DESIGN

Retrospective analysis of patient data

PARTICIPANTS

Keratometric data was obtained from 100 patients presenting for pre-operative evaluation. Furthermore, repeatability and reproducibility were assessed using 15 healthy volunteers.

METHODS

Corneal curvature values acquired by the Verion Optical Imaging System were compared with existing keratometry devices including autokeratometry, partial coherence interferometry (IOLMaster) and Scheimpflug corneal topography (Pentacam).

MAIN OUTCOME MEASURES

Direct comparison of corneal power, cylinder, axis of astigmatism and vector analysis were performed using correlation and Bland-Altman analyses. Reproducibility and reliability of the device were assessed using within-subject standard deviation and intraclass correlation coefficients for experienced and inexperienced technicians.

RESULTS

There was no statistically significant difference between Verion values and those obtained by other methods in relation to mean keratometry, corneal astigmatism, steep meridian and vector analyses (P > 0.05). Bland-Altman plots showed narrow limits of agreement for keratometry and astigmatism and wider agreement for steep meridian. Intraoperator reliability for both experienced and inexperienced operators and interoperator reproducibility showed no statistically significant differences between values.

CONCLUSION

Measurements show no significant difference from those obtained by the other devices. This suggests the Verion system is en par with instruments used in current clinical practice. The Verion Optical Imaging System produces repeatable data with no difference related to operator experience.

Refractive error, visual acuity, and corneal-curvature changes in high and low myopes with orthokeratology treatment: A Malaysian study

Background/Purpose:

The effect of orthokeratology (OK) on low myopia is well known, but there are a few reports on its effect on high myopia. In this study, the parametric changes in high and low myopia as results of wearing OK lenses for a period of 6 months have been analyzed.

Methods:

Records of schoolchildren (age 7–17 years) undergoing OK treatment from an optometry clinic were retrospectively reviewed. Data involving refractive errors, uncorrected visual acuity, and corneal curvatures at baseline and after 1 day, 1 week, 1 month, 3 months, and 6 months of OK treatment from 25 patients who fulfilled the inclusion criteria were examined. For the analysis, the participants were arbitrarily divided into two groups comprising high myopia (< −6.00 D) and low to moderate myopia (from −1.00 D to −6.00 D).

Results:

Significant reductions of refractive error, improvement in visual acuity, and corneal-curvature flattening were found in all participants after 6 months of OK lens wear compared to the baseline. No significant changes were found in corneal toricity in both high and low to moderate myopic groups. Almost all of these occurred after one night of lens wear in both the high- and low-myopia groups.

Conclusion:

The OK lens wear significantly reduced the refractive error and corneal curvature that results in the improvement in visual acuity in both high- and low-myopia groups, and the reduction seemed to occur nearly at the same time despite the difference in initial myopic power. High myopes with refractive power up to −8.25 D would benefit significantly from OK lenses.

Comparative analysis of corneal measurements obtained from a Scheimpflug camera and an integrated Placido-optical coherence tomography device in normal and keratoconic eyes

PURPOSE

To assess the agreement between a Scheimpflug camera (Pentacam) and a combined Placido-optical coherence tomography device (Visante OMNI) in measuring corneal curvature, thickness and elevation values in normal and keratoconic eyes.

METHODS

Corneal measurements of 110 normal eyes (one eye per subject) and 70 keratoconic eyes were obtained from both devices and compared. Agreement was determined using the Bland-Altman analysis 95% limits of agreement (LoA).

RESULTS

The Pentacam measured significantly greater keratometry readings in the flattest (K1) and steepest meridians (K2) in normal and keratoconic eyes. The 95% LoA in normal eyes were -0.32 to 0.59 dioptres (D) (K1) and -0.41 to 0.74 D (K2). In keratoconic eyes, the 95% LoA were -1.35 to 1.92 D (K1) and -1.38 to 1.99 D (K2). The Pentacam recorded significantly higher central corneal thickness (CCT) values in both groups of eyes. The 95% LoA were -4.31 to 39.89 microns (μ) and -12.92 to 41.35 μ in normal and keratoconic eyes, respectively. Pentacam anterior and posterior corneal elevations were significantly greater in both groups of eyes. The devices demonstrated excellent repeatability and reproducibility for corneal curvature and thickness but not elevation measurements.

CONCLUSIONS

The Pentacam measured significantly greater corneal curvature, thickness and elevation values compared to the Visante OMNI in normal and keratoconic eyes. The devices agree moderately for anterior corneal elevations in normal eyes and do not appear to be interchangeable for corneal measurements in clinical practice.

Correlation of axial length and corneal curvature with diopter in eyes of adults with anisometropia

PURPOSE

To analyze the causes of anisometropia.

METHODS

Between June 2011 and November 2012 101 participants were divided into three groups. The refraction comprising the degree of refractive errors in the presence of astigmatism which was converted into the degree of spherical equivalent as well as ocular axial length (AL), corneal curvature (CR), average corneal power (ave K) and diopters were measured.

RESULTS

The differences of ocular AL/CR and CR between two eyes were statistically significant among the three groups (P < 0.05). Standardized regression coefficients obtained by a multiple linear regression analysis indicated that AL/CR, AL and ave K differences correlated with anisometropia in descending order.

CONCLUSION

The difference of AL/CR ratios between the eyes was the main cause for anisometropia, followed by AL and ave K values.

Comparison of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in normal and glaucomatous eyes

AIM

To compare the intraocular pressure (IOP) measurements obtained with the rebound tonometry (RT), dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in normal and glaucomatous eyes and investigate the effects of central corneal thickness (CCT) and corneal curvature (CC) on IOP measurements.

METHODS

One hundred and twenty-four eyes of 124 subjects were enrolled in this cross-sectional study. Fifty-six of participants were healthy individuals and 68 of them were glaucomatous patients. IOP was measured on each subject always in the same order, ICare RT-Pascal DCT-GAT, after a minimum interval of 10min between measurements. CCT and CC were measured using a rotating Scheimpflug camera before the IOP measurements in all subjects. One way repeated measures ANOVA, Pearson correlation coefficient and regression analysis, and Bland-Altman analysis was used for the statistical assessment.

RESULTS

Mean IOP for all enrolled eyes was 16.00±3.80 mm Hg for GAT, 16.99±4.91 mm Hg for RT, and 20.40±4.44 mm Hg for DCT. Mean differences between GAT and RT was -1.75±3.41 mm Hg in normal (P<0.001) and -0.37±3.00 mm Hg in glaucomatous eyes (P=0.563). Mean differences between GAT and DCT was -4.06±3.42 mm Hg in normal (P<0.001) and -4.67±3.12 mm Hg in glaucomatous eyes (P<0.001). GAT and RT were significantly positive correlated with CCT in normal (r=0.317, P=0.017 and r=0.576, P<0.001, respectively) and glaucomatous eyes (r=0.290, P=0.016 and r=0.351, P=0.003, respectively). DCT was also significantly positive correlated with CCT in normal eyes (r=0.424, P=0.001) but not in glaucomatous eyes (r=0.170, P=0.165). All tonometers were unaffected by CC.

CONCLUSION

IOP measurements by RT and DCT were significantly higher than GAT. DCT has highest IOP measurements among these tonometers. RT was most influenced tonometer from CCT although all tonometers were significantly positive correlated with CCT except DCT in glaucomatous eyes. CC did not influence IOP measurements.

Ocular findings in 87 adults with Ghent-1 verified Marfan syndrome

PURPOSE

To study ocular characteristics in 87 patients with verified Marfan syndrome (MFS) based on the Ghent criteria from 1996 (Ghent-1).

METHODS

The position of the lens was noted by observing the eye in different gaze directions in maximal mydriasis during slit lamp examination. Ectopia lentis (EL) was classified as subluxated (dislocation slightly backwards) or luxated (vertical or horizontal displacement). Corneal curvature, axial length (AL), corneal diameter, central corneal thickness, anterior chamber depth, lens thickness, condition of the iris, intraocular pressure, spherical equivalent and visual acuity were also investigated.

RESULTS

EL was found in 108 eyes (62.1%). Of the 68 phakic eyes with EL, 43 (63.2%) had subluxation. Mean AL was 24.80 ± 2.57 mm, and the AL was above 23.5 mm in 65.3%. Mean keratometry (K) in phakic eyes was 41.79 ± 1.70 diopters (D), and the K value was <41.5D in 46.8%. Iris hypoplasia was found in 3.4%. Myopia above 3D occurred in 38.4% of the phakic eyes. Mean binocular logMAR was 0.10 ± 0.32. Only five patients (5.7%) had a logMAR more than 0.5. These 5 patients had EL, and 4 of them were amblyopic.

CONCLUSION

In this strictly defined MFS group fulfilling the Ghent-1 criteria, the prevalence of EL was 62.1%. In many cases, the dislocation of the lens was subtle. On average, the corneas were flattened and the globe length was increased. Only a few patients were visually impaired. Children with MFS should have a thorough follow up to avoid amblyopia.

High heritability of posterior corneal tomography, as measured by Scheimpflug imaging, in a twin study

PURPOSE

Anterior corneal curvature shows significant heritability. Scheimpflug imaging also permits assessment of posterior tomography. We estimated heritability of posterior and anterior tomographic parameters.

METHODS

Oculus Pentacam images were obtained in twins from the TwinsUK cohort. Mean anterior and posterior radii of curvature (right cornea) were compared within twin pairs, and heritability calculated (maximum likelihood structural equation modeling, using OpenMx package). Heritability estimates also were calculated for other parameters (anterior and posterior elevation at apex and thinnest point; pachymetry at apex and thinnest point; average pachymetry progression index).

RESULTS

Images from 138 twins were included (32 monozygotic [MZ] and 37 dizygotic [DZ] twin pairs). Mean (SD) age was 61 (11) years; 91% were female. Coefficients for intrapair correlation for MZ and DZ twins were, respectively, 0.89 and 0.42 for anterior curvature, and 0.93 and 0.46 for posterior curvature (P ≤ 0.0001 for differences between MZ and DZ correlations; Fisher r-to-z transformation). Heritability estimates (95% confidence interval [CI]) for anterior and posterior curvature were 89% (79%-93%) and 90% (83%-94%), respectively. Estimates for all other parameters were 75% or higher, except anterior apical elevation (61%). Point estimates for posterior parameters were consistently higher than anterior parameters, although CIs overlapped. Age-matching yielded similar estimates. Intereye correlations were high; correlations with age were weak (r < 0.30).

CONCLUSIONS

This is the first study to explore heritability of a number of different parameters of corneal tomography, including posterior curvature. Almost all parameters appeared highly heritable, with a trend toward higher heritability estimates for posterior (versus anterior) parameters.

Relationship Between Corneal Hysteresis and Corneal Resistance Factor with Other Ocular Parameters

PURPOSE

To evaluate the relationship between corneal hysteresis (CH) and corneal resistance factor (CRF) with age, central corneal thickness (CCT), corneal curvature (KM), corneal volume (CV), and refractive error in naïve eyes.

METHODS

105 healthy subjects (58 male and 47 female) were included in this study. The ages ranged from 19 to 82 years (mean 43.1 ± 15.4 years) and refraction between -11 D and +6 D (mean -0.79 ± 2.95 D). CH and CRF obtained with the Ocular Response Analyzer (ORA) were correlated with age, refractive error, Goldmann Applanation Tonometry (GAT), and with CCT, KM, CV obtained with the Pentacam, and with Corneal-Compensated Intraocular Pressure (IOPcc) and Goldmann-correlated intraocular pressure measurement (IOPg) obtained with ORA. A multivariable mixed effect model was used to evaluate associations among these parameters.

RESULTS

CH ranged from 6.9 to 14.6 mmHg (mean 10.26 ± 1.49 mmHg); CRF ranged from 5.8 to 17 mmHg (mean 10.38 ± 1.64 mmHg). Multivariate analysis showed a statistically significant correlation between CH with CCT (p < 0.001), and KM (p < 0.001), and between CRF with CCT (p < 0.001) and GAT (p < 0.001).

CONCLUSIONS

Our findings support the hypothesis that CH and CRF are related to the corneal shape and thickness, and show a decrease of CH with age.

Use of the Visante™ OCT to measure the sagittal depth and scleral shape of keratoconus compared to normal corneae: Pilot study

Purpose

The purpose of this study is to demonstrate and compare the use of optical coherence tomography (OCT) in measuring sagittal depth (SD) and in describing the corneo–scleral junctions with the use of scleral angles, in a population of keratoconics (KC) and of normals (normal).

Methods

Fourteen participants (one eye randomly selected) in the normal group and fourteen eyes of nine participants in the keratoconus group were enrolled in the study. Orbscan II (B&L, Rochester) topography was performed to establish eligibility, steep and flat K readings (axes) and HVID. Measurements of the sagittal depth of the cornea and the scleral angles along a particular chord diameter (their HVID and 15 mm) both flat and steep were taken with the use of the on screen measurement tools from the profile view of the cornea of the Visante™ OCT (Carl Zeiss, Dublin, CA).

Results

Data were taken from 14 eyes (11 Females; 3 Males) in the normal group and 14 eyes (5 females; 9 males) in the KC group where either or both eyes were measured. The study participants had a mean age of 33 ± 7yrs (normal) and 40 ± 14yrs (KC). The groups were matched according to HVID: 11.77 ± 0.41 mm (normal) and 11.75 ± 0.35 mm (KC), (p = 0.880). The steep K readings were 53.74 ± 5.98D for the keratoconus eyes as compared to 43.77 ± 1.35D for the control (p < 0.0001). The sagittal depths (±SD) of the keratoconic cornea were significantly different than the normal corneae at their HVID and at 15 mm in the steep meridian only (3.41 ± 0.88 mm versus 2.42 ± 0.09 mm, p = 0.001 and 3.93 ± 0.25 mm versus 3.70 ± 0.16 mm, p = 0.009, respectively). In addition, when the two groups were compared there was no difference in the scleral angles at the HVID's overall (p = 0.490), but there were differences by location (inferior and temporal, p = 0.003). At the 15 mm chord, there was a significant difference between the groups (p = 0.012) overall, but not by location (p = 0.130).

Conclusions

Measurement of the sagittal depth and the corneal-scleral junction angle in the steepest meridian at either the HVID or at 15 mm are two metrics that significantly differentiate normals from keratoconics.

Age, gender, corneal diameter, corneal curvature and central corneal thickness in Nigerians with normal intra ocular pressure

Purpose

To investigate the relationship between age, gender, corneal diameter, central corneal curvature, central corneal thickness (CCT) and intraocular pressure in Nigerians with normal intraocular pressure.

Methods

One hundred and thirty eyes from 130 subjects (mean age = 47.8 ± 16.8 years) including 77 males and 53 females were recruited. CCT was measured by ultrasound pachymetry, intraocular pressure was determined by non-contact tonometry, horizontal and vertical corneal diameters were measured with a ruler and central corneal curvature was measured by keratometry.

Results

The mean values obtained were as follows: CCT = 548.97 ± 34.28 μm, IOP = 15.61 ± 2.69 mmHg, average corneal curvature (AVK) = 42.98 ± 1.19 D, horizontal corneal diameter (HVID) = 11.39 ± 0.69 mm and vertical corneal diameter (VVID) = 10.51 ± 0.50 mm. There was a significant effect of age on CCT (r = −0.35, p < 0.001). A 10-year-increase in age was associated with a 7.0 μm decrease in CCT. Males had significantly wider HVID than females (p = 0.03). Subjects in older age groups have narrower HVID and VVID. Corneal curvature, corneal diameter and gender did not significantly affect CCT.

Conclusion

CCT of normotensive Nigerian adults decreases with increasing age. There was no correlation between CCT and IOP in normotensive subjects. CCT was not significantly influenced by gender, corneal curvature and corneal diameter.

Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis

AIM

To investigate the coefficient of repeatability (CR) for corneal parameters evaluated with Pentacam after laser in situ keratomileusis (LASIK) in myopic eyes.

DESIGN AND SETTING

Prospective, non-interventional, non-comparative study in an institutional setup.

MATERIALS AND METHODS

Forty eyes of 40 consecutive subjects who had undergone LASIK for myopia were assessed with the Scheimpflug system (Pentacam 70700: Oculus, Wetzlar Germany). The mean of five consecutive measurements of all the corneal parameters was recorded and CR was calculated as standard deviation of the difference from the mean of these repeat measurements divided by the mean response. The statistical significance of the CR was calculated for these parameters at 5% significance level.

RESULTS

The best CR was observed for the periphery of the anterior corneal curvature (0.18%) and the least for the horizontal meridian of the posterior corneal curvature (1.29%). Despite being significantly different ( P < 0.001), both the measurements were highly repeatable in post-LASIK eyes. The central, apical and minimal corneal thickness had a CR of 1%, 0.78% and 0.77% respectively. These were equally repeatable ( P> 0.323). The CR of the mean radius of curvature of the anterior cornea (0.29%) was significantly better ( P < 0.001) than the posterior corneal curvature (0.57%).

CONCLUSION

The CR for the post-LASIK cornea with Pentacam was the best for the anterior corneal curvature. Significantly, Pentacam has a high degree of repeatability for the posterior corneal curvature, which has a potential for early detection of keratectasia in these eyes. Post-LASIK pachymetry with Pentacam also showed excellent repeatability.

The effects of corneal parameters on the assessment of endothelial cell density in the elderly eye

BACKGROUND

The possible impact of corneal thickness, curvature, and size on the measurement of endothelial cell density (ECD) has largely been ignored in the normal eye. The aim of this study was to investigate the possible impact of the main corneal parameters on the analysis of ECD values at the central, superior, and temporal parts of the corneal surface.

METHODS

All 75 participants (52 females, 23 males) were assessed as part of a pre-cataract surgery investigation. The mean age was 75.7 (SD 10.9) years. Confocal microscopy was used to measure ECD and the percentage of six sided cells at the central, superior, and temporal parts of the cornea. The Orbscan II topography system was used to measure corneal thickness, topography, and horizontal corneal diameter.

RESULTS

The mean central ECD measured was 2488 (SD 301) cells/mm(2), compared with 2525 (SD 505) cells/mm(2) in the temporal cornea and 2639 (SD 398) cells/mm(2) in the superior cornea. The regional differences in ECD were not significant (p>0.14). The central ECD was significantly correlated to the central (mean 0.593 (SD 0.039) mm, p = 0.021) as well as the temporal (0.628 (SD 0.039) mm, p<0.001) and the superior corneal thickness (SD 0.644 (SD 0.048) mm, p = 0.018). The mean corneal curvature at the centre (7.7 (SD 0.34) mm, p = 0.002) as well as 3 and 5 mm from the apex was significantly related to ECD (p = 0.008 and p = 0.009, respectively).

CONCLUSIONS

The study suggests that in an older population, lower ECD values would be expected in thinner and/or steeper corneas.

A new non-contact optical device for ocular biometry

BACKGROUND

A new commercially available device (IOLMaster, Zeiss Instruments) provides high resolution non-contact measurements of axial length (using partial coherent interferometry), anterior chamber depth, and corneal radius (using image analysis). The study evaluates the validity and repeatability of these measurements and compares the findings with those obtained from instrumentation currently used in clinical practice.

METHOD

Measurements were taken on 52 subjects (104 eyes) aged 18-40 years with a range of mean spherical refractive error from +7.0 D to -9.50 D. IOLMaster measurements of anterior chamber depth and axial length were compared with A-scan applanation ultrasonography (Storz Omega) and those for corneal radius with a Javal-Schiötz keratometer (Topcon) and an EyeSys corneal videokeratoscope.

RESULTS

Axial length: the difference between IOLMaster and ultrasound measures was insignificant (0.02 (SD 0.32) mm, p = 0.47) with no bias across the range sampled (22.40-27.99 mm). Anterior chamber depth: significantly shorter depths than ultrasound were found with the IOLMaster (-0.06 (0.25) mm, p <0.02) with no bias across the range sampled (2.85-4.40 mm). Corneal radius: IOLMaster measurements matched more closely those of the keratometer than those of the videokeratoscope (mean difference -0.03 v -0.06 mm respectively), but were more variable (95% confidence 0.13 v 0.07 mm). The repeatability of all the above IOLMaster biometric measures was found to be of a high order with no significant bias across the measurement ranges sampled.

CONCLUSIONS

The validity and repeatability of measurements provided by the IOLMaster will augment future studies in ocular biometry.