Grand Seiko WAM-5500 Autorefractor Research Articles

Effect of multifocal spectacle lenses on accommodative errors over time: Possible implications for myopia control.

The study purpose was to improve understanding of how multifocal spectacle lenses affect accommodative errors and whether this changes over time. Fifty-two myopes aged 18 to 27 years were allocated randomly to one of two progressive addition lens (PAL) types with 1.50 D additions and different horizontal power gradients across the near-periphery boundary. Lags of accommodation were determined with a Grand Seiko WAM-5500 autorefractor and a COAS-HD aberrometer for several near distances with the distance correction and the near PAL correction. For the COAS-HD the neural sharpness (NS) metric was used. Measures were repeated at three-month intervals over 12 months. At the final visit, lags to booster addition powers of 0.25, 0.50, and 0.75 D were measured. Except at baseline, both PALs' data were combined for analysis. For the Grand Seiko autorefractor, both PALs reduced accommodative lag at baseline compared with SVLs (p < 0.05 and p < 0.01 at all distances for PAL 1 and PAL 2, respectively). For the COAS-HD, at baseline PAL 1 reduced accommodative lag at all near distances (p < 0.02), but PAL 2 only at 40 cm (p < 0.02). Lags measured with COAS-HD were greater for shorter target distances with PALs. After 12 months' wear, the PALs no longer reduced accommodative lags significantly, except at 40 cm distance, but 0.50 D and 0.75 D booster adds decreased the lags to those measured at baseline or less. In conclusion, for PALs to reduce accommodative lag effectively, addition power should be tailored to typical working distances and after the first year of wear should be boosted by at least 0.50 D to maintain efficacy.

Less is more: optimal recording time for measuring the steady-state accommodative response

ABSTRACT Clinical Relevance Background: Steady-state accommodation is frequently evaluated with open-field autorefractors; however there is no consensus regarding the optimal test duration. Our results allow us to standardise the procedure followed for the assessment of the steady-state accommodative response in clinical and laboratory settings and may be of great relevance in time-constrained situations. Background: The present study aims to determine the optimal recording time to assess the magnitude and variability of the accommodative response with a binocular open-field autorefractor. Methods: The steady-state accommodative response of 84 healthy undergraduate students was dynamically measured using the Grand Seiko WAM-5500 autorefractor at 500 cm, 40 cm and 20 cm for 90 s while participants maintained focus on a stationary target. We examined the reliability and level of agreement between four time intervals (the first 10-s, 30-s, 60-s and 90-s) at three accommodative demands (0.2D, 2.5D and 5D). Results: The magnitude of accommodation showed an excellent level of reliability (intraclass correlation coefficient [ICC]> 0.90) for the comparisons between the 90-s, 60-s and 30-s time intervals at the three viewing distances tested. However, when including the 10-s interval, there was a moderate reduction of the reliability indices and an increase of the mean difference between two time intervals (intra-class correlation [ICC] ranging from 0.89 to 0.97; and ESs ranging from 0.16 to 0.42). For the variability of accommodation, we observed an excellent reliability for the comparisons of the 90-s and 60-s measures at the three accommodative demands (ICC: 0.95–0.96), whereas for the rest of comparisons we observed from moderate to good levels of reliability. Conclusion: Our data indicate that of 30-s and 60-s are enough to accurately assess the magnitude and variability of the accommodative response with the WAM-5500 autorefractor, respectively.

Changes in accommodation dynamics after alcohol consumption, for two different doses.

The purpose of this work was to evaluate possible changes in accommodation dynamics caused by the intake of different doses of alcohol. A total of 20 emmetropic subjects took part in the study. This involved a baseline session, a session after consuming 300 ml of red wine, and another after consuming 450 ml of the same wine. The accommodation dynamics were characterized for two target vergences (2.5D and 5.0D) using the Grand Seiko WAM-5500 autorefractor, which provided the accommodation and disaccommodation variables. The accommodative facility was measured using flippers of ± 2.00 D. The mean accommodation velocities and velocity peaks were significantly lower after consuming alcohol for the higher intake, particularly for 5.0D (p < 0.05). The response time was significantly higher only for the high-intake condition for 5.0D (p < 0.05). The accommodative microfluctuations were significantly higher for both target vergences for the high-intake condition (p < 0.05). The accommodative facility was significantly impaired in both intake conditions (p < 0.05). The breath alcohol content (BrAC) was correlated with the deterioration of some variables: the accommodative facility (ρ = 0.490), and the velocity peak for 2.5D (ρ = 0.349) and 5.0D (ρ = 0.387). Alcohol intake affects accommodation dynamics, causing deterioration in the mean velocity, velocity peak, response time, accommodative microfluctuations, and accommodative facility, especially for the target vergence of 5.0D and high alcohol dosages.

Accommodative dynamics and attention: the influence of manipulating attentional capacity on accommodative lag and variability.

There is evidence that attention can modulate ocular dynamics, but its effects on accommodative dynamics have yet to be fully determined. We investigated the effects of manipulating the capacity to focus on task-relevant stimuli, using two levels of dual-tasking (arithmetic task) and auditory feedback, on the accommodative dynamics at three different target distances (500, 40 and 20cm). The magnitude and variability of the accommodative response were objectively measured in 20 healthy young adults using the Grand Seiko WAM-5500 autorefractor. In randomised order, participants fixated on a Maltese cross while 1) performing an arithmetic task with two levels of complexity (low and high mental load); 2) being provided with two levels of auditory feedback (low and high feedback); and 3) without performing any mental task or receiving feedback (control). Accommodative and pupil dynamics were monitored for 90seconds during each of the 15 trials (5 experimental conditions x 3 target distances). The lag of accommodation was sensitive to the attentional state (p=0.001), where a lower lag of accommodation was observed for the high feedback condition compared to the control (corrected p-value=0.009). The imposition of mental load while fixating on a distant target led to a greater accommodative response (corrected p-value=0.010), but no effects were found for the near targets. There was a main effect of the experimental manipulation on the accommodative variability (p<0.001), with the use of auditory feedback improving the accuracy of the accommodative system. Our data show that accommodative dynamics is affected by varying the capacity to focus on task-relevant stimuli, observing an improvement in accommodative stability and response with auditory feedback. These results highlight an association between attention and ocular dynamics and provide new insight into the control of accommodation.

Characterisation of internal, refractive, and corneal astigmatism in a UK university student population

PurposeThere is a clear benefit in defining internal (IA) and corneal astigmatic error (CA) prior to surgical and other refractive interventions, such as orthokeratology, to minimise risk of unsatisfactory refractive outcomes. Such data would also be of relevance to broader areas of ophthalmic care such as spectacle dispensing and other types of rigid lens fitting. This study offers a detailed characterisation of astigmatic error in a group of university students and specifically investigates compensation of corneal astigmatism by the eye’s internal optics. MethodsFor 176 young-adult participants, objective measurements of refractive error were obtained using the open-view Grand Seiko WAM-5500 autorefractor; corneal curvature and axial length were measured using the Aladdin biometer. Clinical measurements of corneal and refractive astigmatism were converted into vector components J0 and J45; followed by an assessment of corneal astigmatism compensation. ResultsMean total refractive astigmatism (RA), CA, and IA were 0.24 ± 0.32D, 0.46 ± 0.27D and -0.21 ± 0.25D respectively for J0 and -0.05 ± 0.20D, 0.01 ± 0.16D, and -0.06 ± 0.18D for J45. Significant linear correlations were noted between RA, CA, and IA for both J0 and J45 (P < 0.01). A significant linear regression was also noted between axial length and J45 RA and IA, but not CA. Levels of full compensation were low, 7% and 9% for J0 and J45 respectively, however, a complete absence of compensation was also uncommon particularly for J45 (2%). ConclusionsIn general, partial compensation for corneal astigmatism by the eye’s internal optics is noted, but it is unclear whether this is an active compensatory mechanism. Further, larger scale, studies would be required to characterise differences in corneal astigmatic compensation with respect to ethnicity.

Effects of eye rotation and contact lens decentration on horizontal peripheral refraction.

Peripheral refraction is important in design of myopia control therapies. The aim was to investigate the influence of contact lens decentration associated with eye rotation on peripheral refraction in the horizontal visual field. Participants were 10 emmetropes and 10 myopes in good general and ocular health. Right eyes underwent cycloplegic peripheral refraction, using a Grand-Seiko WAM-5500 Autorefractor, in 5° steps to ±35° eccentricities along the horizontal visual field. Targets were fixated using eye rotation only or head rotation only. Refractions were measured without correction and with three types of contact lenses: single vision, a multifocal centre-distance aspheric with +2.50D add and NaturalVue aspheric. Photographs of eyes during lens wear were taken for each eye rotation. Effects of visual field angle, lens type and test method (head or eye rotation) on vector components of relative peripheral refraction were evaluated using repeated measures anovas. Test method for each visual field angle/lens combination were compared via paired t-tests. Horizontal decentration ranges across the visual field were 1.2±0.6mm for single vision and 1.2±0.4mm for multifocal lenses but smaller at 0.7±0.4mm for NaturalVue lenses. There were only two significant effects of test method across the visual field angle/lens type combinations (single vision: for emmetropes horizontal/vertical astigmatism component at 35° nasal with mean difference -0.38D and for myopes spherical equivalent refraction at 20° temporal with mean difference +0.24D). Upon eye rotation the contact lenses decentred on the eye, but not enough to affect peripheral refraction. For the types assessed and for the horizontal visual field out to ±35° when measurements were performed with the Grand-Seiko WAM-5500 autorefractor, it is valid to use eye rotations to investigate peripheral refraction.

Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter

PurposeTo investigate a new algorithm to perform an automated non-cycloplegic refraction in adults. MethodsFifty healthy subjects were measured twice (test–retest) with the new automated subjective refraction method and with the conventional clinician subjective refraction procedure. Objective refraction was also measured with the Grand Seiko WAM-5500 autorefractor. The new automated method was inspired on the root finding bisection algorithm and on the Euclidean distances in the power vector domain. The algorithm was implemented in a computer that was synchronized with a customized motorized phoropter. Repeatability was mainly assessed with the within-subject standard deviation (Sw) and accuracy was mainly assessed with the limits of agreement. ResultsThe within-subject standard deviations of the power vector components (M, J0, J45) obtained for the right eye are (±0.13, ±0.04, ±0.05)D and (±0.17, ±0.03, ±0.07)D, respectively, for the clinical and the automated subjective refraction methods. The limits of agreement (with the clinical method) for the automated and the objective methods are, respectively (±0.56, ±0.18, ±0.31)D and (±0.77, ±0.15, ±0.18)D. Similar results are obtained for the left eye. ConclusionsThe proposed automated method is repeatable and more accurate than objective techniques in healthy adults. However, it is not accurate enough to replace the clinical subjective refraction yet and it should be tested in a wider population in terms of age, refraction and different ocular conditions. Despite these important limitations, this method has been shown to be a potentially valuable method to improve the access to primary eye care services in developing countries.

Effect of simplified and traditional Chinese character on accommodative microfluctuation in young adult myopes and emmetropes

Objective: This study investigates the effect of simplified and traditional Chinese character on accommodative microfluctuation in young adult myopes and emmetropes. Methods: Prospective cohort study. Based on refractive errors, Young adult candidates (18-28 years) were classified into two groups based on their spherical equivalent degrees: emmetropes (n=18), myopes (n=18). Four different reading targets (12pt size simplified and traditional Chinese characters, and 8pt size simplified and traditional Chinese characters) were displayed on computer screen collectively for 135s. The accommodative microfluctuation of the candidates were measured using the free space Grand-Seiko WAM-5500 autorefractor. Results: The results indicated that the type of character (simplified and traditional) had significant influence on accommodative microfluctuation. For myopic candidates, the accommodative microfluctuation for traditional Chinese character was greater than that for simplified Chinese character [traditional Chinese character: (0.35±0.17) D, vs. simplified Chinese character: (0.29±0.11) D, t=2.556, P=0.017], however as for emmetropic candidates, the difference between the accommodative microflucuation for the two types of characters was of no statistical significance [traditional Chinese character: (0.24±0.11) D, vs. simplified Chinese character: (0.24±0.12) D, t=0.004, P=0.996]. There was a difference between emmetropic and myopic candidates in terms of accommodative microfluctuation for traditional Chinese character, myopes had greater accommodative microfluctuation than emmetropes (t=3.140, P=0.02). However the difference between emmetropic and myopic candidates in terms of accommodative microfluctuation for simplified Chinese character was of no statistical significance (t=1.866, P=0.066). Conclusions: The results of the study indicated that myopes were more susceptible than emmetropic in accommodative microfluctuation when reading traditional Chinese character of high spatial frequency. (Chin J Ophthalmol, 2018, 54: 288-293).

Experimental investigation of accommodation in eyes fit with multifocal contact lenses using a clinical auto-refractor.

Multifocal or multi-zone contact lenses are increasingly being fit to young eyes in an attempt to control myopia progression. However, success in achieving this aim may depend on how much the eye accommodates. The purpose of the current work was to evaluate the ability of an open-field clinical autorefractor to measure on-axis refractive state and accommodation in eyes fit with multifocal contact lenses (CLs). Refractive state was measured with a Grand Seiko WAM-5500 autorefractor (www.grandseiko.com) and a clinical Shack-Hartmann Complete Ophthalmic Analysis System (COAS) aberrometer (www.wfsci.com) in subjects fit bilaterally with single vision aspheric contact lenses, centre distance, and centre near zonal multifocal CLs, and an experimental myopia control multi-zone bifocal CLs (MiSight). Autorefractor measurements were obtained when aligned with the pupil centre, pupil margin, and mid-periphery. Accuracy of refractive state measurements was evaluated using a fully presbyopic (62-year-old) dilated (pupil diameter = 7.1 mm) eye measured through known added spherical powers (trial lenses) of +1.00 D to +6.00 D. Refractive state and accommodation were measured for seven young myopic eyes (23.71 ± 2.87 years) with six target vergences ranging from -0.33 D to -5.00 D. Irrespective of the CL fitted, measured changes in refractive state of the calibration eye were within ≤0.25 D of the added sphere power and the slope (measured refractive state/trial lens power) was approximately -1.0 D/D for both Shack-Hartmann (COAS) aberrometer and Grand Seiko instruments. Also, the Grand Seiko data were highly repeatable (mean measurement standard deviation = 0.04 D) as long as measurements occurred at the same pupil location, but exhibited a hyperopic bias that increased to +1.00 D when eyes were fit with CLs containing significant negative spherical aberration. Centre and marginal refractive states could differ by >3.00 D due to the combined spherical aberration contained in the eye plus the different CL designs. Measured refractive states of young accommodating eyes also varied with measurement location in the pupil. The accommodation gains were similar at each pupil location, irrespective of contact lens design. With consistent sampling at the same pupil location, the open field Grand Seiko clinical autorefractor proved an effective tool for assessing the on-axis refractive state and accommodative responses of eyes fit with multi-zone bifocal and multifocal CLs.

Effects of Near Addition Lenses and Prisms on Accommodative Microfluctuations in Chinese Children.

To investigate the effects of different near addition lenses and prisms on accommodative microfluctuations (AMFs) in Chinese early-onset myopic (EOM) and emmetropic (EMM) children. Twenty-one EMM and 27 EOM children aged between 9 and 14years participated in the study. At near, 23 children were exophoric (exo, <0 Δ), and 25 were esophoric (eso, ≥0 Δ). The AMFs and phoria through multiple addition lenses (-1.00, 0, +1.00, +2.00, and +3.00D on each eye) and prisms (base-in prism power: 3 Δ, 2 Δ, 1 Δ; and base-out prism power: 1 Δ and 2 Δ on each eye) were measured at 25cm under binocular viewing conditions with a Grand Seiko WAM-5500 auto-refractor and a modified Thorington card. Higher AMFs were found in EOM than in EMM (EOM, 0.19±0.06D; EMM, 0.16±0.03D; p=0.035). Plus additions from +1.00 to +3.00D reduced the AMFs in both EMM and EOM, except +3.00D for EMM. In both refractive groups, -1.00D additions increased AMFs. Esophores showed greater AMFs compared with exophores (esophores, 0.20±0.01D; exophores, 0.16±0.01D; p=0.012). Prisms increased the AMFs in EMM and did not alter the AMFs in EOM. Microfluctuations of accommodation decreased with plus addition lenses and increased with negative addition lenses. Plus addition lenses of +2.00 to +3.00D for EOM and +2.00D for EMM decreased AMFs the least at a 25-cm working distance. Esophores had higher AMFs than exophores, indicating that phoria status influences AMFs.

Weak Accommodation in Asymptomatic Young Adults

Weak accommodative function does not always predict visual discomfort symptoms during near work (Chase C, Tosha C, Borsting E, Ridder WH. Visual discomfort and objective measures of static accommodation, Optom Vis Sci 2009;86:883-89). This study examined the possibility that individuals with weak accommodation may remain asymptomatic through a compensatory vergence response. Both binocular and monocular continuous autorefraction data was collected using a Grand-Seiko WAM-5500 autorefractor while young adults read a passage from a children’s story for 10 minutes. Participants’ scores on the Conlon survey (Conlon EG, Lovegrove WJ, Chekaluk E, Pattison PE. Measuring visual discomfort. Vis Cogn 1999;6:637-63) provided a measure of their visual discomfort. For some of the participants with low near work visual discomfort, accommodation lags in the monocular and binocular conditions were comparable and well within depth of focus. However, there was a subset of asymptomatic participants who exhibited a large lag outside the depth of focus in the monocular condition that decreased in the binocular condition. This may be due to a strong vergence system that compensated for weak accommodation. When they perform a binocular task such as reading in a natural setting, their vergence system affords them the ability to perform near work with relatively little discomfort even though they do not have a strong accommodative response. Objective measures of accommodation, such as autorefraction, can identify asymptomatic individuals who have weak accommodative function by comparing the accommodation lag during binocular and monocular tasks. Meeting abstract presented at VSS 2012

Accommodative response and cortical activity during sustained attention

Greater accommodative lag and vergence deficits have been linked to attentional deficits similar to those observed in Attention Deficit Hyperactivity Disorder (ADHD). The purpose of the present study was to assess the effect of accommodative–vergence stress on a measure of sustained attention (Conners CPT) used in the diagnosis of ADHD. Twenty-seven normal non-ADHD adults completed the Conners CPT twice: wearing −2.00 D lenses and normally (without the −2.00 D lenses) in a counterbalanced order with at least 24h between the sessions. Simultaneous recording of participants’ dynamic accommodative responses was performed from the right eye using the Grand Seiko WAM-5500 auto-refractor and electroencephalographic activity (EEG) in the left prefrontal region using the Neurosky Mindset headset. The results demonstrated a significantly greater accommodative lag in the −2.00 D stress condition and a significantly poorer performance on the Conners CPT as indexed by slower reaction time, greater standard error of hit reaction time, grater response variability, poorer stimulus detectability and a greater number of perseverations. No differences were observed on measures of EEG in the theta (4–7Hz), alpha (8–12Hz), and beta (12–20Hz) bands. Moreover, when directly juxtaposed with each EEG band in multiple linear regression analyses, greater accommodative lag in the stress condition was significantly associated with a greater probability of clinical classification on the Conners CPT, and was also marginally predictive of the number of omissions recorded in the stress condition. The results demonstrated that sustained attention can be influenced by such factors as accommodative–vergence stress and suggest that bottom-up processes can contribute to and potentially exacerbate attentional problems in individuals with ADHD. The study also showed that cortical dysfunction (while sufficient) may not be a necessary condition for attentional deficits.