Change In Refractive Power Research Articles

Chalazion and monocular refractive power changes

Purpose: A 60-year-old women consulted a local ophthalmologist (10.2016) because of blurry vision and chalazion (right eye). He prescribed medical treatment of the chalazion and new glasses, since there was a difference of sph. +1.50dpt. cyl. −0.50dpt. of the refraction (right eye only), compared to the wearing glasses (which were bought September 2016). The patient renewed her right lens, blurry vision was unchanged. Such she consulted a different ophthalmologist, who rejected any correlation between the chalazion and blurry vision and recommended further neurological evaluations, including MRI, since both eyes appeared to be healthy. The patient consulted the optometry department of the Horst Riede GmbH, Weinheim, Germany for further clarification in November 2016. Both eyes still appeared to be healthy, except of the known chalazion at the right upper eyelid. The difference to her new lens, as prescribed by the ophthalmologist (October 2016) was sph. −0.75dpt. Topography using a Scheimpflug Camera (Pentacam, Oculus, Wetzlar, Deutschland) showed superior, corneal irregularity (right eye). Diagnoses and Treatment: Cause of the variable refraction were assumed to be due to corneal moulding by the upper eyelid's chalazion. Warm compresses (MGDRx Eye Bag, The Eyebag Co. Ltd., UK) twice a day @45 °C for 10 min each time were recommended. By the scheduled follow-up in December 2016 the chalazion of the right eye had disappeared. Her refractive power of the right eye was now close to the initial one from September 2016. Corneal irregularity appeared to be normalized, refractive power changes were reflected in pre-warm compress topography.

Control-matched comparison of refractive and visual outcomes between small incision lenticule extraction and femtosecond laser-assisted LASIK.

PurposeThis retrospective case-matched study aimed to compare visual and refractive outcomes between small incision lenticule extraction (SMILE) and LASIK.Patients and methodsPatients who underwent SMILE (34 eyes of 23 patients) or LASIK (34 eyes of 24 patients) were enrolled and matched according to preoperative manifest refractive spherical equivalents. The mean preoperative manifest refractive spherical equivalent was −4.69±0.6 and −4.67±0.64 D in the SMILE and LASIK groups, respectively. The safety, efficacy, and predictability were compared 3 months after surgery. Changes in corneal refractive power from the center to peripheral points and their maintenance ratios were analyzed and compared between the two groups.ResultsIn the SMILE and LASIK groups, 82.4% and 85.3% of patients, respectively, achieved 20/13 or better uncorrected distance visual acuity (p=1.00). There were no eyes that lost two or more lines of corrected distance visual acuity in either group. The maintenance ratios of corneal refractive power changes at the peripheral points in the SMILE group were significantly higher than those in the LASIK group (p<0.05).ConclusionBoth groups achieved similar high efficacy and safety. SMILE surgery resulted in higher refractive power correction in the peripheral cornea than LASIK surgery.

Role of short-wavelength filtering lenses in delaying myopia progression and amelioration of asthenopia in juveniles.

To evaluate the positive effects of blue-violet light filtering lenses in delaying myopia and relieving asthenopia in juveniles. Sixty ametropia juveniles (aged range, 11-15y) were randomized into two groups: the test group (30 children, 60 eyes), wearing blue-violet light filtering lenses; and the control group (30 children, 60 eyes), wearing ordinary aspherical lenses. Baseline refractive power of the affected eyes and axial length of the two groups was recorded. After 1-year, the patients underwent contrast sensitivity (glare and non-glare under bright and dark conditions), accommodation-related testing, asthenopia questionnaire assessment, and adverse reaction questionnaire assessment. After 1y of wearing the filtering lenses, changes in refractive power and axial length were not significantly different between the two groups (P>0.05). Under bright conditions, the contrast sensitivities at low and medium-frequency grating (vision angles of 6.3°, 4.0°, and 2.5°) with glare in the test group were significantly higher than in the control group (P<0.05), while the contrast sensitivity at low-frequency grating (vision angles of 6.3° and 4.0°) in the absence of glare in the test group was higher than in the control group (P<0.05). Under glare and non-glare dark conditions, the contrast sensitivities of various frequencies in the test group did not show significant differences compared with those in the control group (P>0.05). In the test group, the amplitude of accommodation, accommodative lag, and accommodative sensitivity of patients wearing glasses for 6 and 12mo were significantly elevated (P<0.05), while the asthenopia gratings were significantly decreased (P<0.05). Nevertheless, in the control group, the amplitude of accommodation, accommodative lag, and accommodative sensitivity after 12mo were not significantly altered compared with baseline (P>0.05), and the asthenopia grating was not significantly decreased (P>0.05). In addition, after wearing glasses for 6 to 12mo, the asthenopia grating of patients in the test group decreased significantly compared with the control group (P<0.05). At 12mo, the constituent ratio of adverse reactions did not show significant difference between the two groups (P>0.05). A 1-year follow-up reveal that compare with ordinary glasses, short-wavelength filtering lenses (blue/violet-light filters) increase the low- and medium-frequency contrast sensitivity under bright conditions and improved accommodation. They effectively relieved asthenopia without severe adverse reactions, suggesting potential for clinical application. However, no significant advantages in terms of refractive power or axial length progression were found compared with ordinary aspheric lenses.

Human eye ocular component analysis for refractive state and refractive surgery.

To analyze the clinical factors influencing the human vision corrections via the changing of ocular components of human eye in various applications; and to analyze refractive state via a new effective axial length. An effective eye model was introduced by the ocular components of human eye including refractive indexes, surface radius (r1, r2, R1, R2) and thickness (t, T) of the cornea and lens, the anterior chamber depth (S1) and the vitreous length (S2). Gaussian optics was used to calculate the change rate of refractive error per unit amount of ocular components of a human eye (the rate function M). A new criterion of myopia was presented via an effective axial length. For typical corneal and lens power of 42 and 21.9 diopters, the rate function Mj (j=1 to 6) were calculated for a 1% change of r1, r2, R1, R2, t, T (in diopters) M1=+0.485, M2=-0.063, M3=+0.053, M4=+0.091, M5=+0.012, and M6=-0.021 diopters. For 1.0 mm increase of S1 and S2, the rate functions were M7=+1.35, and M8=-2.67 diopter/mm, respectively. These rate functions were used to analyze the clinical outcomes in various applications including laser in situ keratomileusis surgery, corneal cross linking procedure, femtosecond laser surgery and scleral ablation for accommodation. Using Gaussian optics, analytic formulas are presented for the change of refractive power due to various ocular parameter changes. These formulas provide useful clinical guidance in refractive surgery and other related procedures.

Tomographic Analysis of Anterior and Posterior and Total Corneal Refractive Power Changes After Femtosecond Laser–Assisted Keratotomy

To analyze the effect of penetrating femtosecond laser-assisted keratotomy (pFLAK) during laser lens surgery on anterior and posterior corneal astigmatism and total corneal refractive power (TCRP) astigmatism (CAant, CApost, CATCRP) measured with Scheimpflug tomography. Prospective, interventional case series. This institutional study included 27 eyes of 23 patients (aged 65 ± 8 years) with low-to-moderate CATCRP determined with Scheimpflug tomography (Pentacam HR; Oculus, Wetzlar, Germany) after penetrating femtosecond laser-assisted keratotomy (pFLAK) and laser lens surgery. The CAant, CApost, and CATCRP were determined before and 1 and 3months after surgery. Vector analysis according to the Alpins method was used to calculate surgically induced astigmatism (SIA). The mean preoperative CAant (0.97 ± 0.30 diopter [D]) was significantly reduced to 0.63 ± 0.34 D (P < .001). SIAant was 0.71 ± 0.37 D. The CApost showed no significant change, from preoperative 0.26 ± 0.12 D to 0.26 ± 0.10 D postoperatively (P= .625). In line with this finding, SIApost was low (0.12 ± 0.07 D). The CATCRP showed similar results as CAant. pFLAKs planned according to Scheimpflug-based CATCRP result in a significant reduction of the CAant and CATCRP, but do not affect the posterior corneal curvature significantly, as measured by Scheimpflug tomography. Further research is required to develop a new valid nomogram for laser-assisted lens surgery.

Extending the Alvarez-Lens Concept to Arbitrary Optical Devices: Tunable Gratings, Lenses, and Spiral Phase Plates

The Alvarez lenses consist of two parts with surface geometry designed to produce a change in refractive power with transversal translation between the upper and lower parts of the device. In this study, we present a new and straightforward approach to calculating the geometry of such devices and show that an Alvarez configuration can be found not only for lenses, but also for virtually any refractive device. Surface profiles required to realize an optical wedge, a blazed grating, a lens, and a spiral phase plate are presented. The performance of the devices is verified by numerical simulations and experimentally.

Expression and role of specificity protein 1 in the sclera remodeling of experimental myopia in guinea pigs.

To study the expression of collagen I and transcription factor specificity protein 1 (Sp1), a transforming growth factor-β1 (TGF-β1) downstream target, and reveal the impact of the TGF-β1-Sp1 signaling pathway on collagen remodeling in myopic sclera. Seventy-five 1-week-old guinea pigs were randomly divided into normal control, form deprivation myopia (FDM), and self-control groups. FDM was induced for different times using coverage with translucent latex balloons and FDM recovery was performed for 1wk after 4wk treatment; then, changes in refractive power and axial length were measured. Immunohistochemistry and reverse transcription-polymerase chain reaction were used to evaluate dynamic changes in collagen I and Sp1 expression in the sclera of guinea pigs with emmetropia and experimental myopia, and the relationship between collagen I and Sp1 levels was analyzed. In the FDM group, the refractive power was gradually changed (from 2.09±0.30 D at week 0 to -1.23±0.69 D, -4.17±0.59 D, -7.07±0.56 D, and -4.30±0.58 D at weeks 2, 4, 6, and 1wk after 4wk, respectively; P<0.05), indicating deepening of myopia. The axial length was increased (from 5.92±0.39 mm at week 0 to 6.62±0.36 mm, 7.30±0.34 mm, 7.99±0.32 mm, and 7.41±0.36 mm at weeks 2, 4, 6, and 1wk after 4wk; P<0.05). The mRNA and protein expression of Sp1 and collagen I in the sclera of the FDM group was lower than that of the control groups (P<0.05), and the reduction was eye-coverage time-dependent. Furthermore, correlation between Sp1 and collagen I down-regulation in the myopic sclera was observed. Our data indicate that transcription factor Sp1 may be involved in the regulation of type I collagen synthesis/degradation during myopic sclera remodeling, suggesting that TGF-β1 signaling plays a role in the development and progression of myopia.

Early wound healing and refractive response of different pocket configurations following presbyopic inlay implantation.

BackgroundPresbyopic inlays have mostly been implanted under a corneal flap. Implantation in a pocket has advantages including less postoperative dry eye and neurotrophic effect, and better biomechanical corneal stability. This study investigated the effect of different pocket and flocket dimensions on corneal stability and refractive power after Raindrop™ implantation, and the associated wound healing response.MethodologyTen New Zealand White rabbits had bilateral pocket Raindrop™ implantation. Eyes were allocated to 4 groups: pockets with 4mm, 6mm, and 8mm diameters, and 8mm flocket. They were examined pre-operatively, at day 1, weeks 1, 2, 3 and 4 post-surgery with anterior segment optical coherence tomography, corneal topography and in-vivo confocal microscopy. After euthanasia (week 4), CD11b, heat shock protein (HSP) 47 and fibronectin corneal immunohistochemistry was performed.ResultsCorneal thickness (mean±SD) increased from 360.0±16.2μm pre-operatively to 383.9±32.5, 409.4±79.3, 393.6±35.2, 396.4±50.7 and 405±20.3μm on day 1, weeks 1,2,3 and 4 respectively (p<0.008, all time-points). Corneal refractive power increased by 11.1±5.5, 7.5±2.5, 7.5±3.1, 7.0±3.6 and 6.3±2.9D (p<0.001). Corneal astigmatism increased from 1.1±0.3D to 2.3±1.6, 1.7±0.7, 1.8±1.0, 1.6±0.9 and 1.6±0.9D respectively (p = 0.033). CT, refractive power change and astigmatism were not different between groups. The 8mm pocket and 8mm flocket groups had the least stromal keratocyte reflectivity. CD11b, fibronectin or HSP47 weren’t detected.ConclusionsAnatomical and refractive stability was achieved by 1 week; the outcomes were not affected by pocket or flocket configuration. No scarring or inflammation was identified. The 8mm pocket and flocket showed the least keratocyte activation, suggesting they might be the preferred configuration.

자동포롭터 내부렌즈의 합성굴절력에 대한 신뢰도 평가

목적: 자동포롭터의 표기 도수와 구면굴절력 및 원주굴절력 실측값을 비교하여 굴절력의 신뢰도를 평가하였다. 방법: 자동포롭터의 마이너스 구면렌즈 및 원주렌즈의 굴절력을 수동렌즈미터로 측정하여 표기도수와의 정확도를 비교하였으며 두 렌즈가 중첩되었을 때의 합성굴절력과 등가구면굴절력을 시험렌즈와 비교 평가하였다. 결과: 포롭터에 내장되어 있는 구면렌즈의 구면굴절력은 70.6%가 표기도수와 0.125 D 이상의 오차가 발생하였으며, 굴절력이 높아질수록 오차값도 증가하였다. 원주렌즈의 단일 원주굴절력은 표기도수와 거의 일치하였다. 포롭터에서 구면렌즈와 원주렌즈가 중첩되었을 때의 합성 구면굴절력은 단일렌즈 구면굴절력과 동일하여 중첩에 의한 구면굴절력의 변화가 없음을 알 수 있었다. 그러나 구면렌즈와 원주렌즈가 중첩되었을 때의 원주굴절력은 표기도수와 큰 차이가 있어 중첩에 의해 영향을 받는다는 것을 알 수 있었다. 포롭터를 이용하여 실측된 등가구면굴절력은 표기도수 및 시험테를 이용한 등가구면굴절력에 비해 낮았으며 고도수일수록 더 낮았다. 결론: 고도의 근시안 또는 근시성 난시 안에서 자동포롭터를 사용하여 시력검사를 하는 경우 표기도수와 차이가 발생하며 과교정이 될 것으로 보여 이에대한 개선이 필요할 것으로 보인다. Purpose: To evaluate the reliability of refractive power by comparing the marked refractive power in an automatic phoropter and actually measured spherical/cylindrical refractive power. Methods: Actual refractive power of minus spherical lens and cylindrical lens in an automatic phoropter was measured by a manual lensmeter and compared with the accuracy of marked refractive power. Furthermore, combined refractive power and spherical equivalent refractive power of two overlapped lenses were compared and evaluated with the refractive power of trial lens. Results: An error of 0.125 D and more against the marked degree was observed in 70.6% of spherical refractive power of spherical lens which is built in phoropter, and the higher error was shown with increasing refractive power. Single cylindrical refractive power of cylindrical lens is almost equivalent to the marked degree. Combined spherical refractive power was equivalent to spherical refractive power of single lens when spherical lens and cylindrical lens were overlapped in a phoropter. Thus, there was no change in spherical refractive power by lens overlapping. However, there was a great difference, which suggest the effect induced by overlapping between cylindrical refractive power and the marked degree when spherical lens and cylindrical lens were overlapped. Spherical equivalent refractive power measured by using a phoropter was lower than that estimated by trial glasses frame and marked degree. The difference was bigger with higher refractive power. Conclusions: When assessment of visual acuity is made by using an automatic phoropter for high myopes or myopic astigmatism, some difference against the marked degree may be produced and they may be overcorrected which suggests that improvement is required.

Central and Peripheral Corneal Power Change in Myopic Orthokeratology and Its Relationship With 2-Year Axial Length Change

We assessed the relationship between axial length (AL) change and corneal refractive power change induced by orthokeratology (ortho-k) contact lens wear. A total of 88 myopic children aged 7 to 12 years were fitted with ortho-k lenses for overnight wear. Axial length was measured before enrollment and every 6 months after initiation of lens wear up to 24 months. Corneal apical refractive power and the mean power of each concentric ring from 0.5 to 7.2 mm in diameter at 0.1-mm intervals were measured using the Pentacam HR, and compared before and after 3 months of ortho-k lens wear. Summed corneal power change (SCPC) was defined as the sum of relative corneal power change within the central 7.2-mm diameter corneal region. Age, baseline spherical equivalent refractive error (SERE), and SCPC were tested against 2-year AL growth in a stepwise multiple linear regression model. Of the 88 myopic children who were successfully fitted with ortho-k lenses, 64 completed the 2-year follow-up period. These completed test subjects experienced a mean axial growth of 0.37 ± 0.27 mm. Spherical equivalent refractive error and corneal apical refractive power decreased from baseline values of -2.88 ± 0.96 diopters (D) and 43.47 ± 1.03 D to -0.20 ± 0.85 D and 40.61 ± 1.23 D, respectively, after 3 months of lens wear. The mean SCPC was 10.84 ± 5.28 D · mm after 3 months. Axial elongation was significantly correlated with SCPC (standardized β = -0.573, P < 0.001) and baseline age (standardized β = -0.403, P < 0.001), but not with baseline SERE (β = 0.081, P = 0.396). The regression model using SCPC and baseline age to predict axial elongation was acceptable (adjusted R2 = 0.56) and statistically significant (F2,61 = 41.09, P < 0.001). Axial elongation in children undergoing ortho-k therapy is negatively correlated with the age of the wearer and summed corneal power change from the central to the mid-peripheral cornea. We speculate that axial elongation is influenced by the extent to which the retinal defocus profile is altered with ortho-k lens wear. (http://www.chictr.org number, ChiCTR-TNRC-11001210.).

Customized Finite Element Modelling of the Human Cornea.

AimTo construct patient-specific solid models of human cornea from ocular topographer data, to increase the accuracy of the biomechanical and optical estimate of the changes in refractive power and stress caused by photorefractive keratectomy (PRK).MethodCorneal elevation maps of five human eyes were taken with a rotating Scheimpflug camera combined with a Placido disk before and after refractive surgery. Patient-specific solid models were created and discretized in finite elements to estimate the corneal strain and stress fields in preoperative and postoperative configurations and derive the refractive parameters of the cornea.ResultsPatient-specific geometrical models of the cornea allow for the creation of personalized refractive maps at different levels of IOP. Thinned postoperative corneas show a higher stress gradient across the thickness and higher sensitivity of all geometrical and refractive parameters to the fluctuation of the IOP.ConclusionPatient-specific numerical models of the cornea can provide accurate quantitative information on the refractive properties of the cornea under different levels of IOP and describe the change of the stress state of the cornea due to refractive surgery (PRK). Patient-specific models can be used as indicators of feasibility before performing the surgery.

Evaluation of Refractive Power Changes after Soccer Ocular Trauma in a Child Eight Years Old

Evaluation of Refractive Power Changes after Soccer Ocular Trauma in a Child Eight Years Old

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

Optical Coherence Tomography Accurately Measures Corneal Power Change from Laser Refractive Surgery

To determine the ability of motion-corrected optical coherence tomography (OCT) to measure the corneal refractive power change due to LASIK. Evaluation of a diagnostic test or technology in a cohort. A total of 70 eyes from 37 subjects undergoing LASIK were measured preoperatively. A total of 39 eyes from 22 subjects were measured postoperatively and completed the study. Consecutive patients undergoing LASIK at the Duke Eye Center who consented to participate were imaged with Placido-ring topography, Scheimpflug photography, and OCT on the day of their surgery. Patients were then reimaged with the same imaging systems at the postoperative month 3 visit. Change in preoperative to postoperative corneal refractive power as measured by each of the imaging modalities was compared with the preoperative to postoperative change in manifest refraction (MRx) using the t test with generalized estimating equations. Corneal refractive power change due to LASIK as measured by Placido-ring topography, Scheimpflug photography, and OCT compared with the MRx change vertexed to the corneal plane. The change in MRx should correspond to the change in the corneal refractive power from LASIK and was considered the reference measurement. In 22 individuals (39 eyes) returning after LASIK, we found no significant difference between the clinically measured pre- to post-LASIK change in MRx and both Scheimpflug photography (P = 0.714) and OCT (P = 0.216). In contrast, keratometry values from Placido-ring topography were found to be significantly different from the measured refractive change (P < 0.001). In addition, of the 3 imaging modalities, OCT recorded the smallest mean absolute difference from the reference measurement with the least amount of variability. Motion-corrected OCT more accurately measures the change in corneal refractive power due to laser refractive surgery than other currently available clinical devices. By offering accurate corneal refractive power measurements in normal and surgically modified subjects, OCT offers a compelling alternative to current clinical devices for determining corneal refractive power.

RGP 콘택트렌즈의 진단적 피팅법에 의한 플랫한 피팅과 얼라인먼트 피팅 착용 전·후 각막 굴절력의 변화에 관한 연구

목적: 진단적 피팅법으로 우안에는 얼라인먼트 상태보다 1 D 플랫한 피팅의 RGP 콘택트렌즈를, 좌안에는 얼라인먼트 피팅의 RGP 콘택트렌즈를 착용시켜 2개월 후 착용 전 후의 각막 굴절력을 비교하고 선호도를 조사 하였다. 방법: 각막형상의 변화가 없는 경우를 대상으로 하기위해 콘택트렌즈를 처음 착용하면서 안질환이나 안과적 수술경험이 없으며 눈물양이 정상인 서울시내 중.고등학생 20명, 40안을 대상으로 RGP 콘택트렌즈 착용전의 각막 굴절력을 검사하고 10일 후 적응여부 검사와 각막 상태 검사를 통해 지속적인 착용여부를 확인한 뒤 하루 평균 8시간 이상을 착용시키고 2개월 후 각막 굴절력을 검사하여 비교 분석하였다. 결과: 얼라인먼트 상태보다 1 D 플랫한 피팅 렌즈를 착용한 우안의 2개월 후 각막중심 굴절력은 <TEX>$43.84{\pm}1.33D$</TEX>, 플랫 K 도수는 <TEX>$43.05{\pm}1.29D$</TEX>, 스티프 K 도수는 <TEX>$44.61{\pm}1.42D$</TEX>로 착용 전의 각막중심 굴절력보다 감소하여 변화량이 컸다(p<0.001, 0.001, 0.047). 양주경선의 편심률(e-value) 또한 변화량이 많았다(p = 0.037, 0.015). 얼라인먼트 피팅 렌즈를 착용한 좌안의 착용 2개월 후 각막 중심 굴절력은 <TEX>$44.40{\pm}1.26D$</TEX>, 플랫 K 도수는 <TEX>$43.57{\pm}1.23D$</TEX>, 플랫 K e-value는 <TEX>$0.58{\pm}0.05$</TEX>로 통계학적으로 유의한 차이가 없었다(p = 0.769, 0.614, 0.181). 그러나 스티프 K 굴절력은 <TEX>$45.25{\pm}1.36$</TEX>, 스티프 K e-value는 <TEX>$0.45{\pm}0.18$</TEX>로 통계학적으로 유의한 차이를 보였다(p = 0.018, 0.027). 결론: 렌즈 편안한 착용감, 선명한 시력, 눈의 건조감의 항목을 종합하여 선호 피팅법을 조사하였을 때 우안 얼라인먼트 상태보다 1 D 플랫한 피팅 렌즈를 선택한 사람이 6명(30%), 좌안 얼라인먼트 피팅 렌즈를 선택한 사람이 14명(70%)으로 좌안 얼라인먼트 피팅 렌즈를 선택한 착용자가 많았다. RGP 렌즈의 피팅은 정확한 검사를 요구하며 환자의 각막에 적합한 얼라인먼트 피팅을 처방하여야 한다. Purpose: This study is for compared the change of corneal refractive power before and after wearing of rigid gas permeable contact lense with diagnostic method which is 1 D flatter than alignment fitting on right eye and alignment fitting on left eye for 2 months and investigate the preference. Methods: Twenty middle school and high school students (40 eyes) who had never worn a contact lense before for no corneal topographical change, no ocular disease, no experience of ophthalmic surgery and have normal tear amount were selected for this study and corneal refractive power were examined before wearing rigid gas permeable contact lense and adaptation status and corneal examination were performed after 10 days of wearing and after cheking up the continuation of wearing, all candidate wear contact lens 8 hours per day for 2 month and corneal refractive power were compared. Results: After 2 months of wearing with 1 D flatter than the alignment fitting on right eyes, there was significant difference in the central corneal refractive power was <TEX>$43.84{\pm}1.33D$</TEX>, flat K power was <TEX>$43.05{\pm}1.29D$</TEX>, and steep K power was <TEX>$44.61{\pm}1.42D$</TEX> decreased than before wearing (p<0.001, 0.001, 0.047). The e-value of the principal meridians also shows statistically significant difference (p=0.037, 0.015). After 2 months of wearing with alignment fitting on left eyes, the central corneal refractive power was <TEX>$44.40{\pm}1.26D$</TEX>, flat K power was <TEX>$43.57{\pm}1.23D$</TEX>. and flat K e-value was <TEX>$0.58{\pm}0.05$</TEX> which showed no statistically significant difference (p = 0.769, 0.614, 0.181). But steep K power was <TEX>$45.25{\pm}1.36$</TEX>, and steep K e-value was <TEX>$0.45{\pm}0.18$</TEX> which shows statistically significant difference (p=0.018, 0.027). Conclusions: Consider the comfort, clear vision, dryness for preference fitting investment, 6 students (30%) prefer right eye which is 1 D flatter fitting, 14 students (70%) prefer left eye which is alignment fitting. For rigid gas permeable fitting needed for accurate examination and should prescribe the alignment fitting which is suitable for each cornea.

Corneal ray tracing versus simulated keratometry for estimating corneal power changes after excimer laser surgery

To evaluate whether the refractive changes induced by excimer laser surgery can be accurately measured by corneal ray tracing performed by a combined rotating Scheimpflug camera-Placido-disk corneal topographer (Sirius). Private practices. Evaluation of diagnostic test. This multicenter retrospective study comprised patients who had myopic or hyperopic excimer laser refractive surgery. Preoperatively and postoperatively, 2 corneal power measurements--simulated keratometry (K) and mean pupil power--were obtained. The mean pupil power was the corneal power calculated over the entrance pupil by ray tracing through the anterior and posterior corneal surfaces using Snell's law. Agreement between the refractive and corneal power change was analyzed according to Bland and Altman. Regression analysis and Bland-Altman plots were used to evaluate agreement between measurements. The study evaluated 72 eyes (54 patients). The difference between the postoperative and preoperative simulated K values underestimated the refractive change after myopic correction and overestimated it after hyperopic correction. Agreement between simulated K changes and refractive changes was poor, especially for higher amounts of correction. A proportional bias was detected (r = -0.77; P<.0001), and the 95% limits of agreement (LoA) were -0.15 -0.14 × ±0.62 diopters (D). The difference between the postoperative and preoperative mean pupil power showed an excellent correlation with the refractive change (r(2) = 0.98). The mean pupil power did not overestimate or underestimate the refractive change. The 95% LoA ranged between -0.97 D and +0.56 D. Corneal ray tracing accurately measured corneal power changes after excimer laser refractive surgery. Dr. Calossi is consultant to Costruzione Strumenti Oftalmici. Dr. Carones is consultant to Wavelight Laser Technologie AG. No other author has a financial or proprietary interest in any material or method mentioned.

Biomechanical and optical behavior of human corneas before and after photorefractive keratectomy

To evaluate numerically the biomechanical and optical behavior of human corneas and quantitatively estimate the changes in refractive power and stress caused by photorefractive keratectomy (PRK). Athineum Refractive Center, Athens, Greece, and Politecnico di Milano, Milan, Italy. Retrospective comparative interventional cohort study. Corneal topographies of 10 human eyes were taken with a scanning-slit corneal topographer (Orbscan II) before and after PRK. Ten patient-specific finite element models were created to estimate the strain and stress fields in the cornea in preoperative and postoperative configurations. The biomechanical response in postoperative eyes was computed by directly modeling the postoperative geometry from the topographer and by reproducing the corneal ablation planned for the PRK with a numerical reprofiling procedure. Postoperative corneas were more compliant than preoperative corneas. In the optical zone, corneal thinning decreased the mechanical stiffness, causing local resteepening and making the central refractive power more sensitive to variations in intraocular pressure (IOP). At physiologic IOP, the postoperative corneas had a mean 7% forward increase in apical displacement and a mean 20% increase in the stress components at the center of the anterior surface over the preoperative condition. Patient-specific numerical models of the cornea can provide quantitative information on the changes in refractive power and in the stress field caused by refractive surgery. No author has a financial or proprietary interest in any material or method mentioned.

Corneal refractive power and symmetry changes following normalization of ectasias treated with partial topography-guided PTK combined with higher-fluence CXL (the Athens Protocol).

To investigate preoperative and postoperative anterior and posterior keratometry and simulated corneal astigmatism in keratoconic eyes treated with collagen cross-linking combined with anterior surface normalization by partial topography-guided excimer ablation (the Athens Protocol). Anterior and posterior corneal keratometry were measured by Scheimpflug imaging for 267 untreated keratoconic eyes. Following treatment, they were assessed 1 year postoperatively. Before treatment, average anterior keratometric value was 47.06 ± 6.02 diopters (D) for flat and 51.24 ± 6.75 D for steep. The posterior keratometric values were -6.70 ± 0.99 D (flat) and -7.67 ± 1.15 D (steep). Anterior astigmatism was on average with-the-rule (-1.97 ± 6.21 D), whereas posterior astigmatism was against-the-rule (+0.53 ± 1.02 D). The posterior and anterior astigmatism were highly correlated (r(2) = 0.839). After treatment, anterior keratometric values were 43.97 ± 5.81 D (flat) and 46.55 ± 6.82 D (steep). Posterior keratometric values were -6.58 ± 1.05 D (flat) and -7.69 ± 1.22 D (steep). Anterior astigmatism was on average with-the-rule (-1.56 ± 3.80 D), whereas posterior astigmatism was against-the-rule (+0.45 ± 1.29 D). The statistically significant (P < .05) keratometric changes indicated anterior surface flattening -3.09 ± 2.67 D (flat) and -4.19 ± 2.96 D (steep). The posterior keratometric changes were not statistically significant (P > .05). Before treatment, there was a strong correlation between posterior and anterior corneal astigmatism. After treatment, statistically significant anterior keratometric values flattened. The posterior surface keratometric values did not demonstrate statistically significant postoperative change: there was minimal posterior change, despite the significant anterior surface normalization.

Corneal Power Change Is Predictive of Myopia Progression in Orthokeratology

This study aims to investigate the relationship between corneal refractive power change along three axes (nasal, temporal, and inferior) after orthokeratology (OK) treatment and 2-year axial growth in children. Thirty-two Chinese children aged from 9 to 14 were fitted with OK. When corneal reshaping process following OK treatment was completed and stabilized, the 3-month topographic outputs were taken as the post-OK data. Corneal refractive powers along the nasal, temporal, and inferior axes were collected over an 8-mm-diameter ring in 1-mm steps using the sagittal power map. The maximum power change along each axis was selected and divided into two subcategories, level 1 and level 2, depending on whether the value was below or above the average. Axial length (AL) was measured every 6 months during a 24-month period. The relationship between the maximum power changes and 2-year axial elongation were analyzed. Twenty-seven subjects completed the 24-month study. After OK treatment, statistically significant steepening (p < 0.05) was observed at the nasal 2 mm and 3 mm; temporal 3 mm; and inferior 2 mm, 3 mm, and 4 mm locations compared with the apical center. AL increased significantly throughout the 24-month observation period (p < 0.001). Changes in corneal refractive power significantly affected axial elongation (nasal, p = 0.001; temporal, p = 0.011; inferior, p = 0.001). Two-year axial elongation in patients with larger corneal power changes (level 2) was reduced by 54% to 69% compared with those with smaller corneal power changes (level 1). Maximum power changes along the three axes were negatively correlated (p < 0.05) with 2-year axial growth. Subjects with larger magnitude of corneal relative peripheral power change along specific axes after OK treatment experienced slower axial elongation by the end of 24 months. This effect might be mediated by the induction of greater amount of relative myopic defocus on the peripheral retina. Our study lends weight to potential OK lens designs for myopia control in children.

Effects of differenta mitomycin C concentrations on laser-assisted subepithelial keratectomy.

The aim of the present study was to determine the effect of different concentrations of mitomycin C (MMC) administered intraoperatively during laser-assisted subepithelial keratectomy (LASEK) surgery. A total of 261 patients (496 eyes) were randomly divided into two groups: 0.04% MMC treatment group consisting of 133 patients (245 eyes) and the 0.02% MMC treatment group consisting of 128 patients (251 eyes). The MMC solutions were dropped intraoperatively onto the ablation region and the duration was dependent on the preoperative refractive power of the patient’s cornea: ≤−3.00 diopters (D), 30 sec; between −3.25 D and −6.00 D, 60 sec; between −6.25 D and −9.00 D, 90 sec and ≥−9.25 D, 110 sec. Postoperative observations included haze formation, visual acuity, changes in refractive power, corneal endothelial cell density and incidence of complications. The one year postoperative incidence of haze differed significantly between the groups (P<0.05). The one week and one year comparisons of postoperative visual acuity also differed significantly between the groups (P<0.05). Postoperative changes in corneal refractive power at one, six and 12 months following surgery significantly differed between the groups (P<0.05). No statistically significant difference was identified between the density of corneal endothelial cells prior to surgery and the density at one, six and 12 months following surgery (P>0.05). Thus, the intraoperative application of 0.04% MMC solution effectively inhibited haze formation and markedly improved the efficacy of LASEK surgery, when compared with that of 0.02% MMC.