Hyperopic Refractive Error Research Articles

Hyperopic refractive errors as a prognostic factor in intermittent exotropia surgery.

Purpose: To evaluate and compare surgical outcomes with respect to refractive errors in strabismus surgery for the treatment of intermittent exotropia (IXT). The medical records of patients with IXT who were treated by one surgeon from January 2005 and June 2011 were reviewed. Three hundred and thirty-three IXT patients were included and divided into three groups according to preoperative refractive error: IXT with hyperopia (group I), IXT with emmetropia (group II), and IXT with myopia (group III). The surgical outcomes with respect to sensory and motor criteria were compared among the three groups. The surgical success rates according to motor criteria and sensory and motor criteria combined were higher in groups I (29 patients) and III (124 patients) than in group II (180 patients) at postoperative 3 and 6 months and at the last follow-up. Stereopsis was significantly better in groups II and III than in group I preoperatively (P=0.002 by one-way analysis of variance test); however, the difference was not significant postoperatively. Twenty patients in group I (69.0%) were prescribed undercorrected hyperopic spectacles postoperatively, while only 22 patients in group III (17.7%) were prescribed spectacles with more myopic power than their refractive errors. In the surgical treatment of IXT, hyperopia was not an indicator of poor prognosis. Taking into consideration the age effect, follow-up period after IXT surgery, and stereopsis improvement, hyperopic refractive error is rather a good prognostic factor.

The long-term outcome of the refractive error in children with hypermetropia.

The purpose of this study was to investigate the long-term outcome of high hypermetropic refractive errors in childhood. We retrospectively reviewed data from the clinical records of 164 children with spherical equivalent (SE) hypermetropic refractive errors in three medical centers collected over 29 years. Refractive errors between +1.00 and +3.00 diopter (D) on initial examination were classified as mild hypermetropia and those +5.00 D or greater were classified as high hypermetropia. The four variables studied were, age, refractive error, strabismus, and gender. The rate of reduction in hypermetropic refractive error was calculated over time in years. We identified subgroups according to age, gender, and initial refractive error. Seventy-eight children with high hypermetropia and 86 children with mild hypermetropia were studied. High hypermetropia was detected at a mean age of 3.3 years, while mild hypermetropia was detected at a mean 4 years of age. The mean follow-up was 6.6 years for high hypermetropia and 6.4 years for mild hypermetropia. Over the follow-up period, children in all subgroups tended to reduce their refractive errors. The reduction in refraction power was small for both mild and high hypermetropic refractive errors. Amblyopia in the high hypermetropia group was more common and more refractory to treatment. Most children with hypermetropia of less than +3.00 D experience a reduction in hyperopic refractive error over time and will outgrow any need for corrective lenses. Children with hyperopia greater than +5.00 D will not experience a significant reduction in the power of the refractive error.

Plasticity in the growth of the chick eye: Emmetropization achieved by alternate morphologies

Both refractive properties of the eyes and ambient light conditions affect emmetropization during growth. Exposure to constant light flattens the cornea making chicks hyperopic. To discover whether and how growing chick eyes restore emmetropia after exposure to constant light (CL) for 3, 7, or 11weeks, we returned chicks to normal (N) conditions with 12h. of light alternating with 12h. of darkness (designated the “R”, or recovery, condition) for total periods of 4, 7, 11, or 17weeks. The two control groups were raised in CL conditions or raised in N conditions for the same length of time. We measured anterior chamber depths and lens thicknesses with an A-scan ultrasound machine. We measured corneal curvatures with an eight-axis keratometer, and refractions with conventional retinoscopy. We estimated differences in optical powers of CL, R and N chicks of identical age by constructing ray-tracing models using the above measurements and age-adjusted normal lens curvatures. We also computed the sensitivity of focus for small perturbations of the above optical parameters. Full refractive recovery from CL effects always occurred. Hyperopic refractive errors were absent when R chicks were returned to N for as little as 1week after 3weeks CL treatment. In R chicks exposed to CL for 11weeks and returned to N, axial lengths, vitreous chamber depths and radii of corneal curvatures did not return to normal, although their refractions did. While R chicks can usually recover emmetropia, after long periods of exposure to CL, they cannot recover normal ocular morphology. Emmetropization following CL exposure is achieved primarily by adjusting the relationship between corneal curvature and axial length, resulting in normal refractions.

Intravitreal vascular endothelial growth factor concentration and axial length.

To examine the intravitreal concentration of vascular endothelial growth factor (VEGF) in dependence of the axial length in eyes without intraocular neovascularization. The concentrations of VEGF in vitreous samples and blood samples of patients undergoing pars plana vitrectomy for treatment of idiopathic macular holes or epiretinal membranes were examined using enzyme-linked immunosorbent assay. Axial length was determined by biometry. The study included 34 patients with macular holes (n = 21) or epiretinal membranes (n = 13) with a mean age of 62.4 ± 10.5 years (range: 35-76 years) and a mean axial length of 24.1 ± 1.8 mm (range: 21.0-29.1 mm). The intravitreal VEGF concentration (mean: 71.0 ± 63.2 pg/mL) was significantly (P < 0.001) lower than the VEGF concentration in the blood (830 ± 585 pg/mL). Both parameters were significantly associated with each other (P = 0.04; correlation coefficient r = 0.35). The intravitreal VEGF concentration was not significantly associated with gender (P = 0.25) or age (P = 0.48). A higher intravitreal VEGF concentration was significantly associated with a shorter axial length (P = 0.025; r = -0.39) or a higher hyperopic refractive error (P = 0.04; r = 0.35). Neither plasma concentration of VEGF nor the ratio of plasma VEGF concentrations to intravitreal VEGF concentration was significantly associated with axial length (P = 0.89 and P = 0.22, respectively) or with refractive error (P = 0.89 and P = 0.26, respectively). Intravitreal VEGF concentration decreased with increasing axial length. It suggests a diluting effect in eyes with larger intraocular volume and/or a faster turnover rate of VEGF in axially myopic eyes with vitreous liquefaction.

Effect of cycloplegia on the refractive status of children: the Shandong children eye study.

PurposeTo determine the effect of 1% cyclopentolate on the refractive status of children aged 4 to 18 years.MethodsUsing a random cluster sampling in a cross-sectional school-based study design, children with an age of 4–18 years were selected from kindergardens, primary schools, junior and senior high schools in a rural county and a city. Auto-refractometry was performed before and after inducing cycloplegia which was achieved by 1% cyclopentolate eye drops.ResultsOut of 6364 eligible children, data of 5999 (94.3%) children were included in the statistical analysis. Mean age was 10.0±3.3 years (range: 4–18 years). Mean difference between cycloplegic and non-cycloplegic refractive error (DIFF) was 0.78±0.79D (median: 0.50D; range: -1.00D to +10.75D). In univariate analysis, DIFF decreased significantly with older age (P<0.001;correlation coefficient r:-0.24), more hyperopic non-cycloplegic refractive error (P<0.001;r = 0.13) and more hyperopic cycloplegic refractive error (P<0.001;r = 0.49). In multivariate analysis, higher DIFF was associated with higher cycloplegic refractive error (P<0.001; standardized regression coefficient beta:0.50; regression coefficient B: 0.19; 95% confidence interval (CI): 0.18, 0.20), followed by lower intraocular pressure (P<0.001; beta: -0.06; B: -0.02; 95%CI: -0.03, -0.01), rural region of habitation (P = 0.001; beta: -0.04; B: -0.07; 95%CI: -0.11, -0.03), and, to a minor degree, with age (P = 0.006; beta: 0.04; B: 0.009; 95%CI: 0.003, 0.016). 66.4% of all eyes with non-cycloplegic myopia (≤-0.50D) remained myopic after cycloplegia while the remaining 33.6% of eyes became emmetropic (18.0%) or hyperopic (15.7%) under cycloplegia. Prevalence of emmetropia decreased from 37.5% before cycloplegia to 19.8% after cycloplegia while the remaining eyes became hyperopic under cycloplegia.ConclusionsThe error committed by using non-cycloplegic versus cycloplegic refractometry in children with mid to dark-brown iris color decreased with older age, and in parallel manner, with more myopic cycloplegic refractive error. Non-cycloplegic refractometric measures lead to a misclassification of refractive error in a significant proportion of children.

Long-Term Changes of Hyperopic Refractive Error in Refractive Accommodative Esotropia

Purpose: To analyze the long-term changes of hyperopic refractive error in patients with refractive accommodative esotropia. Methods: We retrospectively reviewed the medical records of 54 patients with accommodative esotropia who underwent at least 36 months of follow-up and had hyperopia more than +1.50 diopter (D). The patients were divided into groups according to the degree of hyperopia: +1.50~ 400 sec. The divided groups were than retrospectively reviewed if they influenced the refractive error at the third year of follow-up using Fisher’s exact test, paired t-test, Wilcoxon’s signed-ranks test, Mann-Whitney U test, Kruskal-Wallis H test, and ANOVA (p < 0.05). Results: The mean follow-up period was 103.72 ± 41.82 months for refractive accommodative esotropia. Patients with a greater initial hyperopic refractive error showed a significant tendency towards emmetropization with a higher rate of hyperopic decrease (p < 0.001), regardless of the hyperopic refractive error. Statistical differences were not observed in patients who started wearing glasses after four-years old, patients with amblyopia, patients with a large degree of astigmatism, and patients with poor stereoacuity. Conclusions: Long-term changes of hyperopic refractive error in accommodative esotropia showed a significant decrease when initial hyperopic refractive error was high. Wearing hyperopic glasses at an older age and visual functions such as amblyopia, large degree of astigmatism, and poor stereoacuity may influence emmetropization. J Korean Ophthalmol Soc 2015;56(4):580-585

Correlation between the use of the accommodation and symptoms of asthenopia in hyperopic patients

Purpose: The objective of this paper was to compare the symptoms of asthenopia in patients at different levels of hyperopia and corrected for different accommodative efforts. Methods: This study is an experimental design and quantitative approach. Sixty-nine hyperopic patients aged between 15 and 40 were selected. Individuals with a diagnosis of accommodative insufficiency and paralysis, accommodative spasm or any type of ocular deviation were excluded. Subjects were randomly divided into four groups. Each one performed a nearvision task with different corrective lenses, varying the value of the accommodative effort. Results: There is significant reduction in the asthenopia score during the near-vision task when leaving 35% or more of the amplitude of accommodation in reserve. The linear regression showed that the variables total hyperopia (r = 0.109) and the difference between static and dynamic refraction (r = 0.135) did not obtain significant linear relationship to the asthenopia score. Conclusions: There is significant reduction in the asthenopia score when leaving 35% or more of the amplitude of accommodation in reserve. The symptoms of asthenopia are not associated to the severity of the hyperopic refractive error. The search for symptoms before the near vision task, using a questionnaire, related to the symptoms during the accommodative effort task, revealing the importance of searching for complaints about asthenopia during anamnesis, which can help ophthalmologists with prescriptions of glasses for hyperopic patients with asthenopia.

약시 치료에 의한 시감각 개선이 안기능 향상에 미치는 효과

································································································································································································································ Purpose: This study is to investigate if the improvement of visual sensory (VS) by amblyopia treatment affects the ocular functions in refractive errors, accommodative errors and phoria at distance and near. Methods: 10 subjects (17 eyes, mean age of 10.7± 2.9 years) who treated amblyopia completely, were participated for this study. Refractive errors, accommodative errors, and distance and near phoria were compared between before and after treatments of amblyopia. Refractive errors and accommodative errors at 40 cm were measured using openfield auto-refractor (NVision-5001, Shin Nippon, Japan) and using monocular estimated method (MEM) respectively. Phoria was determined at 3 m for distance and at 40 cm for near using Howell phoria card, cover test or Maddox rod. Results: Mean corrected visual acuity (CVA) significantly increased from 0.46± 0.11 (decimal notation) for before amblyopia treatment to a level of 1.03± 0.13 for after amblyopia treatment (p 0.05). Accommodative error significantly decreased from accommodative lag of +1.1± 0.75D to a level of +0.5± 0.59D (accommodative lag) (p < 0.05). Distance phoria significantly changed from eso 2.9± 6.17PD (prism diopters) to a level of eso 0.2± 3.49 PD (p < 0.05), and near phoria also significantly changed from eso 0.4± 2.32PD to level of exo 2± 4.9 PD (p < 0.05). There was a high correlation (r = 0.88, p < 0.001) between improvement of visual acuity and decrease of accommodative lag. Conclusions: Hyperopic refractive error decreased with improvement of CVA or VS by amblyopia treatment. And the improvement of VS by amblyopia treatment also improved accommodative error, and changed phoria coupled with accommodation.

Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children.

BackgroundStudies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability.MethodsThis systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model.ResultsThe review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling.ConclusionFuture studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

Changes in refractive errors related to spectacle correction of hyperopia.

BackgroundHyperopic undercorrection is a common clinical practice. However, less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood.ObjectivesTo evaluate the effect of spectacle correction on the change in refractive errors in hyperopic children less than 12 years of age with or without strabismus.Data ExtractionA retrospective cohort study was performed by a computer based search of the hospital database of patients with hyperopia, accommodative esotropia or exotropia. A total of 150 hyperopic children under 12 years of age were included. Patients were classified into four groups: 1) accommodative esotropia with full correction of hyperopia, 2) exotropia with undercorrection of hyperopia, 3) orthotropia with full correction of hyperopia, 4) orthotropia with undercorrection of hyperopia. The 4 groups were matched by initial age on examination and spherical equivalent refractive errors (SER). The main outcome measure was the change in SER (Diopter/year) in both eyes after two years of follow-up.ResultsAn overall negative shift in SER was noted during the follow-up period in all groups, except for the group with esotropia and full correction. The mean negative shift of hyperopia was more rapid in groups receiving undercorrection of hyperopia with or without strabismus. The amount of undercorrection of hyperopia was positively correlated to the magnitude of decrease in hyperopia in all patients (r = 0.289, P<0.001) and in the subgroup of patients with orthotropia (r = 0.304, P = 0.011). The amount of undercorrection of hyperopia was the only factor associated with a more negative shift in SER (OR, 2.414; 95% CI, 1.202–4.849; P = 0.013).ConclusionsThe amount of undercorrection is significantly correlated to the change in hyperopic refractive errors. Full correction of hyperopia may inhibit emmetropization during early and late childhood.

Prospective Comparison of One-Piece and Three-Piece Tecnis Aspheric Intraocular Lenses: 1-year Stability and its Effect on Visual Function

Purpose: To compare the stability and visual function of one-piece hydrophobic intraocular lens (IOL) (ZCB00, Abbot Medical Optics) and a three-piece hydrophobic IOL (ZA9003, Abbot Medical Optics) after cataract surgery. Materials and methods: Eighteen eyes of 18 patients with the one-piece IOL and 20 eyes of 20 patients with the three-piece IOL who underwent cataract surgery were evaluated prospectively on best corrected distance visual acuity, postoperative refractive error, IOL decentration and tilt, anterior chamber depth (ACD), spherical aberration and contrast sensitivity. Measurements were performed 1 week and 1, 3, 6 and 12 months postoperatively. The postoperative outcomes were compared between the two groups. Results: In the one-piece group, a hyperopic refractive error (p < 0.002) and deeper ACDs during 1-year post-operatively were observed compared with the three-piece group. There were no significant differences in BCVA, IOL tilt, spherical aberration or contrast sensitivity. Conclusions: The stability of the one-piece IOL was greater than that of the three-piece IOL. The postoperative ACD and refractive error demonstrated that an anteriorly offset haptic in the one-piece IOL allowed incremental fixation to the posterior capsule.

Color perception levels in patients with hyperopia

AbstractPurpose Evaluation of color perception levels in different types of hyperopia.Methods 4 groups of patients: 1 (n=35) – low hyperopia; 2 (n=29) – moderate hyperopia; 3 (n=26) – high hyperopia; 4 (control, n=39) –emmetropia. The supplement ‐ Farnsworth‐Munsell 100 Hue Test (FM 100). Measures of assessing were: total error score (TES), the level of recognition of colors (LRC), color vision deficiency (CVD), the type of color deficiency (TCD). Color vision defects were studied using a special computer program for FM 100.Results Group 1: TES=67±25 (р˂0,05), LRC 16‐100 TES, CVD 41‐100 TES, TCD individual abnormalities in blue color. Group 2: TES=93±25 (р˂0,05), LRC 16 and more TES, CVD 41‐200 TES, TCD cian, blue. Group 3: TES=180±25 (р˂0,05), LRC 101 and more TES, CVD 101 and more TES, TCD cian, blue, violet. Group 4: TES=53±25 (р˂0,05), LRC 16‐100 TES, CVD no more 100 TES, TCD individual abnormalities in blue color.Conclusion We revealed correlation between stages of hyperopia and color level perception: in the 1st group LRC average, CVD slight; 2nd group: LRC average/low, CVD slight/moderate; 3rd group: LRC low, CVD moderate/severe; 4th group: LRC average, CVD none/slight. Also, hyperopic refractive errors are associated with defects of blue color. Quantitative analysis of color vision defects with FM100 provides the possibility for detecting condition of cone photoreceptor cells, which mostly damaged in the 3rd group.

Outcomes of photorefractive keratectomy enhancement after LASIK.

To report the outcomes of photorefractive keratectomy (PRK) enhancement after LASIK for patients diagnosed as having hyperopic and myopic refractive errors. In this retrospective case series at a single private practice in the United States, all patients undergoing PRK enhancement after LASIK were identified. Patients with visually significant cataract, non-plano targets, and follow-up of fewer than 226 days were excluded. The primary outcome measure was uncorrected distance visual acuity (UDVA) with secondary measures of corrected distance visual acuity (CDVA) and postoperative refractive error. Linear regression analysis was performed for actual versus targeted change in spherical equivalent. Mean UDVA improved from 20/39 to 20/24 for hyperopes (n = 14; P < .002) and from 20/45 to 20/22 for myopes (n = 29; P < .0000001) after enhancement. All patients had a UDVA of 20/40 or better at their most recent follow-up visit. Fifty percent of hyperopes and 65.5% of myopes were 20/20 or better. The mean refractive error for hyperopes changed from +1.10 ± 0.71 (range: +0.13 to +2.25 diopters [D]) to +0.38 ± 0.66 D (range: -0.75 to +1.38 D) and from -1.21 ± 0.61 (range: -3.25 to -0.38 D) to +0.34 ± 0.45 D (range: -0.25 to +1.75 D) for myopes. The manifest refraction cylinder decreased from 0.84 to 0.46 D in hyperopes (P = .02) and from 0.64 to 0.26 D in myopes (P < .002). CDVA was maintained in both groups, with only one patient in each worse than 20/20. There was a nonsignificant trend toward less haze in the patients receiving mitomycin C (5.1% vs 25%, P = .14). Linear regression showed a tendency toward overtreatment in the myopic group. PRK is safe and highly effective for patients who previously underwent LASIK and in whom the surgeon would prefer not to perform a flap-lift enhancement.

Risk factors for astigmatism in the Vision in Preschoolers Study.

To determine demographic and refractive risk factors for astigmatism in the Vision in Preschoolers Study. Three- to 5-year-old Head Start preschoolers (N = 4040) from five clinical centers underwent comprehensive eye examinations by study-certified optometrists and ophthalmologists, including monocular visual acuity testing, cover testing, and cycloplegic retinoscopy. Astigmatism was defined as the presence of greater than or equal to +1.5 diopters (D) cylinder in either eye, measured with cycloplegic refraction. The associations of risk factors with astigmatism were evaluated using the odds ratio (OR) and its 95% confidence interval (CI) from logistic regression models. Among 4040 Vision in Preschoolers Study participants overrepresenting children with vision disorders, 687 (17%) had astigmatism, and most (83.8%) had with-the-rule astigmatism. In multivariate analyses, African American (OR, 1.65; 95% CI, 1.22 to 2.24), Hispanic (OR, 2.25; 95% CI, 1.62 to 3.12), and Asian (OR, 1.76; 95% CI, 1.06 to 2.93) children were more likely to have astigmatism than non-Hispanic white children, whereas American Indian children were less likely to have astigmatism than Hispanic, African American, and Asian children (p < 0.0001). Refractive error was associated with astigmatism in a nonlinear manner, with an OR of 4.50 (95% CI, 3.00 to 6.76) for myopia (≤-1.0 D in spherical equivalent) and 1.55 (95% CI, 1.29 to 1.86) for hyperopia (≥+2.0 D) when compared with children without refractive error (>-1.0 D, <+2.0 D). There was a trend of an increasing percentage of astigmatism among older children (linear trend p = 0.06). The analysis for risk factors of with-the-rule astigmatism provided similar results. Among Head Start preschoolers, Hispanic, African American, and Asian race as well as myopic and hyperopic refractive error were associated with an increased risk of astigmatism, consistent with findings from the population-based Multi-ethnic Pediatric Eye Disease Study and the Baltimore Pediatric Eye Disease Study. American Indian children had lower risk of astigmatism.

Acute Adult Onset Comitant Esotropia Associated with Accommodative Spasm

Acute onset comitant esotropia associated with spasm of accommodation in children and adults is a rare clinical condition. When occurring with pupillary miosis and restricted ocular motility, it is referred to as "spasm of near reflex" (SNR) and may require neurological investigation. The natural history of SNR depends on its etiology. There is little information in the literature regarding the long-term follow-up of SNR and the stability of visual signs and symptoms following cessation of treatment. We report a case of SNR in an otherwise healthy young male, and discuss the presentation, clinical investigations, management, response to treatment, and 1-year follow-up. A 23-year-old male patient reported to the clinic with sudden onset of blurred vision, inward deviation of the eyes, and binocular diplopia. On examination, he was diagnosed to have acute onset esotropia resulting from SNR. He was treated with cycloplegic medications and vision therapy. The condition resolved following 1 year and there has been no recurrence. Acute adult onset esotropia occurring with accommodative spasm responds favorably to cycloplegic medications but may need a longer course of treatment for successful resolution and stability.

Visual Impairment and Spectacle Use in Schoolchildren in Rural and Urban Regions in Beijing

To determine prevalence and associations of visual impairment and frequency of spectacle use among grade 1 and grade 4 students in Beijing. This school-based, cross-sectional study included 382 grade 1 children (age 6.3 ± 0.5 years) and 299 grade 4 children (age 9.4 ± 0.7 years) who underwent a comprehensive eye examination including visual acuity, noncycloplegic refractometry, and ocular biometry. Presenting visual acuity (mean 0.04 ± 0.17 logMAR) was associated with younger age (p = 0.002), hyperopic refractive error (p<0.001), and male sex (p = 0.03). Presenting visual impairment (presenting visual acuity ≤20/40 in the better eye) was found in 44 children (prevalence 6.64 ± 1.0% [95% confidence interval (CI) 4.74, 8.54]). Mean best-corrected visual acuity (right eyes -0.02 ± 0.04 logMAR) was associated with more hyperopic refractive error (p = 0.03) and rural region of habitation (p<0.001). The prevalence of best-corrected visual impairment (best-corrected visual acuity ≤20/40 in the better eye) was 2/652 (0.30 ± 0.21% [95% CI 0.00, 0.72]). Undercorrection of refractive error was present in 53 children (7.99 ± 1.05%) and was associated with older age (p = 0.003; B 0.53; OR 1.71 [95% CI 1.20, 2.42]), myopic refractive error (p = 0.001; B -0.72; OR 0.49 [95% CI 0.35, 0.68]), and longer axial length (p = 0.002; B 0.74; OR 2.10 [95% CI 1.32, 3.32]). Spectacle use was reported for 54 children (8.14 ± 1.06%). Mean refractive error of the worse eyes of these children was -2.09 ± 2.88 D (range -7.38 to +7.25 D). Factors associated with presenting visual impairment were older age, myopic refractive error, and higher maternal education level. Despite a prevalence of myopia of 33% in young schoolchildren in Greater Beijing, prevalence of best-corrected visual impairment (0.30% ± 0.21%), presenting visual impairment (6.64% ± 1.0%), and undercorrection of refractive error (7.99% ± 1.05%) were relatively low.

Accommodative esotropia decompensated to cyclic esotropia in a 6-year-old boy

Cyclic esotropia, characterized by alternating intervals of esotropia and orthotropia, is associated with decreased vision, trauma, strabismus surgery, or central nervous system disease. We report a 6-year-old boy who developed cyclic esotropia after 3 years of successful control of accommodative esotropia with full hyperopic correction. After bilateral medial rectus recession, he remained esophoric with good binocular function and stereoacuity. To our knowledge, this is the first report of accommodative esotropia decompensating into a cyclic esotropia.

Characterization of the Choroid-Scleral Junction and Suprachoroidal Layer in Healthy Individuals on Enhanced-Depth Imaging Optical Coherence Tomography

Accurate measurements of choroidal thickness (CT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) require a well-defined choroid-scleral junction (CSJ), which may appear in some eyes as a hyporeflective band corresponding to the suprachoroidal layer (SCL). To identify factors associated with the presence and thickness of the SCL in healthy participants and determine how different CSJ boundary definitions impact CT measurements. Secondary analysis of EDI-OCT images obtained prospectively from 74 eyes of 74 controls (mean age, 68.6 years) from the Age-Related Eye Disease Study 2 Ancillary SDOCT Study. The CSJ appearances were categorized as either having no visible SCL or a hyporeflective band corresponding to the SCL. Ocular parameters associated with the presence and thickness of the SCL were identified. Subfoveal CT was measured using 3 different posterior boundaries: (1) the posterior vessel border (vascular CT [VCT]), (2) inner border of the SCL (stromal CT [StCT]), and (3) inner border of the sclera (total CT [TCT]). Manual segmentation using custom software was used to compare VCT, StCT, and TCT across the macula. RESULTS The SCL was visible in 33 eyes (44.6%). Factors associated with SCL presence and thickness included hyperopic refractive error (R2 = 0.123; P = .045) and increased TCT (R2 = 0.215; P = .004), but not age, visual acuity, intraocular pressure, retinal foveal thickness, VCT, or StCT. In eyes where the SCL was not visible, mean [SD] subfoveal VCT was 222.3 [101.5] μm and StCT and TCT were 240.0 [99.0] μm, with a difference of 17.7 [16.0] μm (P < .001). In eyes where the SCL was visible, mean [SD] subfoveal VCT, StCT, and TCT were 221.9 [83.1] μm, 257.7 [97.3] μm, and 294.1 [104.8] μm, respectively, with the greatest difference of 72.2 [30.4] μm between VCT and TCT (P < .001). All 3 CT measurements were significantly different along all points up to 3.0 mm nasal and temporal to the fovea. A hyporeflective SCL is visible at the CSJ on EDI-OCT in nearly half of healthy individuals, and its presence correlates with hyperopia. Different posterior boundary definitions may result in significant differences in CT measurements and should be explicitly identified in future choroidal studies and segmentation algorithms.

The Initial Factors Influencing Successful Final Stereoacuity in Refractive Accommodative Esotropia

Purpose: To evaluate the initial factors influencing successful final stereoacuity in patients with refractive accommodative esotropia. Methods: The charts of 48 refractive accommodative esotropia patients 2 years of age or older andassessed using the Titmus stereoacuity test were retrospectively reviewed. Hyperopic refractive error on post-cycloplegic refraction, age at first glasses, stereoacuity after refractive correction and amblyopia were categorized and evaluated as the factors influencing final stereoacuity. Results: The mean follow-up period was 43.51 ± 30.02 months. The mean hypermetropia at the initial examination was 4.67 ± 2.18 diopters (D), the mean age at first glasses was 48.09 ± 20.22 months and the mean stereoacuity after refractive correction was 1243.75 ± 1378.24 seconds of arc. The rates of successful stereoacuity at the final visit were 83.3% without amblyopia, 75.0% with mild amblyopia and 42.9% with moderate amblyopia which were statistically significant (p = 0.039). Hyperopic refractive error and age at first glasses were categorized as +1.0 to <3.0 D, +3.0 to <5.0 D, ≥+5.0 D and 2 to <4 years, 4 to <6 years and ≥6 years, respectively, and the rates of successful stereoacuity at the final visit were 83.3%, 66.7%, 61.9% (p = 0.362) and 71.4%, 75.0% and 54.5% (p = 0.334), respectively. Conclusions: The amblyopia at the initial examination was significantly associated with the outcome of stereoacuity at the final visit in patients with refractive accommodative esotropia. J Korean Ophthalmol Soc 2014;55(6):877-881

Target Refraction for Best Uncorrected Distance and near Vision in Cataract Surgery

To assess the target refractive error after cataract surgery to achieve best uncorrected visual acuity for both distance vision and reading vision. The study included patients consecutively undergoing routine phacoemulsification with clear corneal incisions and implantation of a foldable monofocal intraocular lens (IOL). Uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), uncorrected near visual acuity (UCNVA,) and best-corrected near visual acuity were measured at 93 ± 47 days (minimum 4 weeks) after surgery. Inclusion criteria were a postoperative cylindrical refractive error ≤1.5 D and an unremarkable postoperative status. The study included 493 eyes of 493 patients with a mean age of 74.2 ± 8.7 years and mean axial length 23.4 ± 1.1 mm. The UCDVA significantly (p<0.001) increased with decreasing myopic refractive error (spherical equivalent) towards emmetropia and then significantly (p<0.001) decreased with increasing hyperopic refractive error. The UCNVA significantly (p<0.001) decreased with decreasing myopic and increasing hyperopic refractive error. The ascending UCDVA line and the descending UCNVA line intersected in the refractive error range (spherical equivalent) of -1.00 D to -1.50 D. For patients with a BCDVA of ≥20/25, the lines of UCDVA and UCNVA intersected at a UCDVA range between 20/40 (logMAR 0.30; -1.5 D) and 20/32 (logMAR 0.26; -1.0 D) and at a UCNVA range between Jaeger 3 (logMAR 0.26) and Jaeger 4 (logMAR 0.32). For routine unilateral cataract surgery with implantation of monofocal IOLs, target refractive error to achieve best uncorrected distance and near vision was in the range of -1.00 D to -1.50 D (spherical equivalent).