Significant Hyperopia Research Articles

Analysis of the peripheral refraction in myopic adults using a novel multispectral refraction topography

PurposeTo determine the distribution and characteristics of peripheral refraction in adults with myopia using the novel multispectral refraction topography. MethodA total of 187 adults with myopia were recruited for this study. This study was conducted in two stages. Part I: participants were divided into 6 groups based on the central refraction of the right eyes, Part II: according to the interocular differences in refractive error (IOD) of the central refraction, we divided the participants into isomyopia group (IOD<1.00 D) and anisomyopia group (IOD≥1.0 D). We surveyed the characteristics of peripheral refraction and relative peripheral refraction (RPR), as well as the correlation between RPR and central refraction, age, sex, and axial length. ResultPart I: With an increase in the degree of myopia, relative peripheral hyperopia developed from the center to the periphery. A statistically significant hyperopia shift compared to the center (P < 0.05) was first observed on the temporal side within a 40° field of view at the posterior pole of the retina. The RPR of the temporal, superior, and inferior retinas positively correlated only with age. Part II: In the isomyopic participants, there was no difference in peripheral refraction between the eyes (P < 0.05). In the anisomyopic participants, the RPR of the more myopic eyes was more hyperopic than that of the less myopic eyes in NRDV40-50, SRDV10-20, SRDV30-50, TRDV20-30, TRDV40-50, and IRDV10-40. ConclusionWith an increase in the degree of myopia, relative peripheral hyperopia developed from the center to the periphery, and peripheral refraction progressed at different rates in various retinal zones.

Combined DSAEK With Cataract Surgery in a Patient With Fuchs Endothelial Corneal Dystrophy and Keratoconus After Corneal Crosslinking

Purpose: To report a combined Descemet stripping automated endothelial keratoplasty (DSAEK) with cataract surgery in a case of Fuchs endothelial corneal dystrophy (FECD) and keratoconus after corneal crosslinking combined with photorefractive keratectomy. Methods: We report a case of a 56-year-old woman with a history of subclinical keratoconus who underwent corneal crosslinking (CXL) plus 7 years ago. At presentation, the patient complained of blurry vision, which was more prominent in the morning over the past few years, and frequent changes of spectacle prescription ever since the initial treatment with CXL plus. Post-CXL plus corneal tomographies revealed progressive corneal flattening of 6.20 diopters (D) and 6.50 D in the right (OD) and left (OS) eye, respectively, in terms of mean keratometry values over a period of 7 years, which resulted in significant hyperopia. Corrected distance visual acuity (CDVA) at presentation was 20/50 in the OD and 20/200 in the OS. Slit-lamp examination revealed guttae (diagnosis of FECD) with associated posterior corneal edema and advanced nuclear sclerotic cataracts in both eyes. Combined DSAEK with cataract surgery was performed on the left eye. Results: One year after the combined procedure, CDVA improved to 20/25, with the correction of (−0.25, −4.25 × 25). Slit-lamp examination revealed a clear cornea without evidence of corneal edema or scarring. Corneal tomography indicated discontinuation of the corneal flattening in the left eye while the fellow eye continued to flatten. Conclusions: Combined DSAEK with cataract surgery provides an effective surgical option for patients with FECD after CXL plus procedures for keratoconus, offering fast visual rehabilitation and functional visual outcomes.

Artificial intelligence enhanced ophthalmological screening in children: insights from a cohort study in Lubelskie Voivodeship

This study aims to investigate the prevalence of visual impairments, such as myopia, hyperopia, and astigmatism, among school-age children (7–9 years) in Lubelskie Voivodeship (Republic of Poland) and apply artificial intelligence (AI) in the detection of severe ocular diseases. A total of 1049 participants (1.7% of the total child population in the region) were examined through a combination of standardized visual acuity tests, autorefraction, and assessment of fundus images by a convolutional neural network (CNN) model. The results from this artificial intelligence (AI) model were juxtaposed with assessments conducted by two experienced ophthalmologists to gauge the model's accuracy. The results demonstrated myopia, hyperopia, and astigmatism prevalences of 3.7%, 16.9%, and 7.8%, respectively, with myopia showing a significant age-related increase and hyperopia decreasing with age. The AI model performance was evaluated using the Dice coefficient, reaching 93.3%, indicating that the CNN model was highly accurate. The study underscores the utility of AI in the early detection and diagnosis of severe ocular diseases, providing a foundation for future research to improve paediatric ophthalmic screening and treatment outcomes.

Hyperopia in schoolchildren: Investigating the impact on vision and determining appropriate methods for screening.

Hyperopia is associated with reduced vision and educational outcomes in schoolchildren. This study explored the impact of clinically significant hyperopia (≥+2.00 D) on visual function in schoolchildren and compared the ability of different screening tests (alone and in combination) to detect this level of hyperopia. Vision testing including monocular logMAR visual acuity (VA) measured to threshold (distance [DVA], near [NVA] and DVA through a plus lens [+2.50 D]), stereoacuity and cycloplegic autorefraction (tropicamide 1%) were undertaken on 263 schoolchildren (mean age: 11.76 years ± 3.38) in Queensland, Australia. Vision measures were compared between children with clinically significant hyperopia in at least one meridian (≥+2.00 D) and emmetropia/low hyperopia (>0.00 and <+2.00 D). Receiver operating curve (ROC) analysis was performed to identify optimal pass/fail criteria for each test and the diagnostic accuracy of individual and combinations of tests. Thirty-two children had clinically significant hyperopia and 225 had emmetropia/low hyperopia. DVA and NVA were worse (p < 0.01), while the difference in DVA through a plus lens was less in children with clinically significant hyperopia (p < 0.01). ROC analysis for individual tests resulted in areas under the curve (AUCs) ranging from 0.65 to 0.85. Combining screening tests revealed that failing one or more of the following tests was most effective for detecting hyperopia: DVA, NVA and difference in DVA through a plus lens, resulting in a sensitivity and specificity of 72% and 81%, respectively. Significant differences in visual function existed between schoolchildren with clinically significant hyperopia and emmetropia/low hyperopia. Combining measures of DVA and NVA and the difference in DVA through a plus lens demonstrated good discriminative ability for detecting clinically significant hyperopia in this population.

Chorio-Retinal Folds Associated With Orbital Cavernous Venous Malformations.

To determine the incidence of clinically detectable chorio-retinal folds (CRFs) with orbital cavernous venous malformations (OCVMs) and their recovery. Retrospective case-note and imaging review, with estimation of odds ratios in relation to the position and volume of the mass. Records for 402 patients were reviewed, 83 (21%) having CRFs. The mean logarithm of minimum angle of resolution acuity was similar with or without CRFs (0.37 and 0.31, respectively; p = 0.46), but induced hyperopia was commoner with CRFs (76% vs. 12%; p < 0.001), exophthalmos greater (4.52 mm vs. 2.97 mm; p < 0.001), eye movement restriction commoner (37% vs. 21%; p = 0.004), and disc swelling more prevalent (42%, vs. 17%; p < 0.001). Orbital cavernous venous malformations with CRFs were almost all intraconal (98%; odds ratio 9.96; p = 0.002), and 93% (77/83) midorbital (odds ratio 6.02; p < 0.001). The median size with CRFs was twice that of those without (3.85 ml vs. 1.92 ml; p < 0.001), and two-thirds OCVMs with folds had volumes >2.5 ml ( p < 0.001). The OCVM was excised in 76 of 83 (92%) of CRF group and 213 of 319 (67%) of those without ( p < 0.001). The postoperative acuity was improved or unchanged in 67 of 76 (88%) eyes with folds, and 184 of 213 (83%) without CRFs ( p = 0.84). The proportion recovering an acuity within 1 Snellen line (or better than) the unaffected side was 80% with CRFs and 77% in their absence ( p = 0.63). Induced hyperopia persisted in 39% of all patients, with the mean being higher with CRFs (2.22D vs. 1.02D; p = 0.017). CRFs occur in ~25% of mid-intraconal OCVMs. Despite OCVM excision, 39% of operated patients retain significant residual hyperopia (54% if CRFs present before surgery), and 41% of such CRFs remain clinically detectable after surgery (with variable visual impairment). Earlier surgery might, therefore, be advisable in patients with CRFs and/or induced hyperopia.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia.

This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA-assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal Ⅱ and Hill-RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Sixty-five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal Ⅱ (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill-RBF > Haigis > SRK/T > Barrett Universal Ⅱ). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill-RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal Ⅱ (53.84%). IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal Ⅱ although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift.

Comparison of Accuracy in Keratometries Measured by Different Camera Devices for Predicting the Intraocular Lens Power in Lens-Dislocated Patients

Introduction: This is a cross-sectional cohort study focused on assessing the influence of ocular biometric parameters of different camera devices for accurately predicting the intraocular lens (IOL) power in congenital ectopia lentis (EL) patients. Methods: This study includes a total of 91 eyes of 60 patients with congenital EL from June 2018 to April 2021. All patients underwent lens subluxation surgery with Cionni modified capsular tension rings implantation. Ocular parameters measured by partial coherence interferometry (IOLMaster 700; Carl Zeiss Meditec AG, Jena, Germany) and rotating Scheimpflug camera (Pentacam HR system; Oculus Optikgeräte GmbH, Wetzlar, Germany) were acquired from the database. The authenticity of the different keratometries (Ks) was analyzed by comparing the prediction error in spherical equivalent under controlled formula SRK/T, Haigis, and after Wang-Koch (WK) adjustment. Results: We observed significant greater K values were obtained in IOLMaster than Pentacam, resulting in more significant hyperopia error while calculating SRK/T. The IOL power calculated with the total corneal refractive power (TCRP) from Pentacam revealed the highest prediction accuracy, indicating that TCRP is the closest to the actual refractive power of the cornea. However, in an exceptional case for long eye patients, total K from IOLMaster was better recommended when using formula Haigis with WK adjustment. Conclusions: For most instances, TCRP is the best-recommended source of K value while calculating IOL power for EL patients. However, the total K from IOLMaster preferably fits for long eye patients, who require WK adjustment for Haigis formula.

Detection of Significant Hyperopia in Preschool Children Using Two Automated Vision Screeners.

Moderate to high uncorrected hyperopia in preschool children is associated with amblyopia, strabismus, reduced visual function, and reduced literacy. Detecting significant hyperopia during screening is important to allow children to be followed for development of amblyopia or strabismus and implementation of any needed ophthalmic or educational interventions. This study aimed to compare the sensitivity and specificity of two automated screening devices to identify preschool children with moderate to high hyperopia. Children in the Vision in Preschoolers (VIP) study were screened with the Retinomax Autorefractor (Nikon, Inc., Melville, NY) and Plusoptix Power Refractor II (Plusoptix, Nuremberg, Germany) and examined by masked eye care professionals to detect the targeted conditions of amblyopia, strabismus, or significant refractive error, and reduced visual acuity. Significant hyperopia (American Association for Pediatric Ophthalmology and Strabismus definition of hyperopia as an amblyopia risk factor), based on cycloplegic retinoscopy, was >4.00 D for age 36 to 48 months and >3.50 D for age older than 48 months. Referral criteria from VIP for each device and from a distributor (PediaVision) for the Power Refractor II were applied to screening results. Among 1430 children, 132 children had significant hyperopia in at least one eye. Using the VIP referral criteria, sensitivities for significant hyperopia were 80.3% for the Retinomax and 69.7% for the Power Refractor II (difference, 10.6%; 95% confidence interval, 7.0 to 20.5%; P = .04); specificities relative to any targeted condition were 89.9 and 89.1%, respectively. Using the PediaVision referral criteria for the Power Refractor, sensitivity for significant hyperopia was 84.9%; however, specificity relative to any targeted condition was 78.3%, 11.6% lower than the specificity for the Retinomax. Analyses using the VIP definition of significant hyperopia yielded results similar to when the American Association for Pediatric Ophthalmology and Strabismus definition was used. When implementing vision screening programs for preschool children, the potential for automated devices that use eccentric photorefraction to either miss detecting significant hyperopia or increase false-positive referrals must be taken into consideration.

Accuracy of Intraocular Lens Calculation Formulas in Patients Undergoing Combined Phakic Intraocular Lens Removal and Cataract Surgery

To investigate the prediction accuracy of intraocular lens (IOL) calculation formulas, and the impact of anterior chamber depth (ACD) and lens thickness (LT) measurement errors on IOL power calculation in patients undergoing combined phakic IOL (PIOL) removal and cataract surgery. Retrospective, consecutive case series study. Thirty-six PIOL implanted eyes (12 anterior chamber PIOLs and 24 posterior chamber PIOLs [PC-PIOL]) undergoing cataract surgery were included. The prediction accuracy of new formulas (Barrett universal II, Emmetropia verifying optical, Kane, and Ladas super formula) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) with or without Wang-Koch (WK) axial length (AL) adjustment was evaluated. The influence of ACD and LT measurement errors of IOLMaster 700 on refractive outcomes was also investigated. The Kane and traditional formulas with WK AL adjustment had no significant systematic prediction error and displayed a smaller median absolute error, whereas the other formulas showed significant hyperopia shift (P < .05) and relatively lower prediction accuracy. The accuracy rate of IOLMaster 700 in measuring the ACD and LT was 100% in eyes with anterior chamber PIOL implantation, and 37.50% in the PC-PIOL subgroup. No significant difference was observed in refractive outcomes of formulas using correct and wrong parameters in the PC-PIOL subgroup (P > .05). The Kane and traditional formulas with WK AL adjustment exhibited relatively higher prediction accuracy in patients who underwent combined PIOL removal and cataract surgery. The IOLMaster 700 displayed low accuracy in ACD and LT measurements for PC-PIOL implanted eyes, but showed negligible impact on IOL prediction accuracy.

Detection of treatment-requiring hyperopia using a photo vision screening device in a preschool population

Hyperopia is common in childhood, but can cause refractive or strabismic amblyopia if significant hyperopia remains untreated. While current guidelines recommend treatment of hyperopia with esotropia starting at 1.50-2.00 D, there is no definitive cut off for hyperopia without strabismus. The plusoptiX S12 (POS12) using Option 4, refers for hyperopia at 2.50 D or greater. This study seeks to determine the accuracy of detecting significant hyperopia in preschool children for referral at 2.50 D.

Consistency of autorefraction by two autorefractors in 1138 Chinese children and adolescents

AIM: To assess the consistency of refractive errors measured by two autorefractors in myopia screening of school-age Chinese children. METHODS: Topcon RM-8900 and Tianle RM-9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16y who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed. RESULTS: A total of 2276 eyes of 1138 subjects with a mean age of 10.49±2.66y were finally enrolled. Spearman correlation analysis showed that sphere (r=0.958, P&lt;0.0001), cylinder (r=0.769, P&lt;0.0001), and spherical equivalent (r=0.962, P&lt;0.0001) measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic (P&lt;0.0001) with a mean difference of 0.44 D (SD: 0.37; 95%CI: -0.27, 1.16) while the maximum absolute value (1.13 D) of the difference within the 95%CI was above the clinically acceptable range; however, no significant difference (P=0.83) was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D (SD: 0.31; 95%CI= -0.62, 0.61) while the maximum absolute value (0.62 D) of the difference within the 95%CI was clinically acceptable. The proportion of the axial deviation within ±20° was 84.6% (1503/1777) in eyes with cylinder ≤ -0.25 D while that rose to 96.4% (853/885) in eyes with cylinder ≤ -0.75 D. CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.

Refractive errors and visual impairment among children and adolescents in southernmost China

BackgroundRefractive errors and visual impairment in southernmost China have not been reported previously. We aim to investigate and determine the age-specific prevalence of myopia, hyperopia, astigmatism, and visual impairment based on a large population cross-sectional study in Hainan area of southernmost tropical province in China.MethodsA population-based sample of 31,524 children aged 6–15 years from Hainan was assessed. Non-cycloplegic autorefraction and visual acuity (VA) analyses were performed on all participants and a subgroup of participants undergoing cycloplegia.ResultsOf all participants, 23.0% presented uncorrected VA (UCVA) was worse than 20/40 in worse eye, 6.0% presented mild presenting visual acuity impairment (PVAI), 7.0% presented moderate PVAI, 0.2% presented severe PVAI in the better eye, and 46.9% presented abnormal UCVA [worse than 20/25 (≥ 6, < 8 years old) and worse than 20/20 (≥ 8 years and older)] at least in one eye. The overall prevalence of myopia [spherical equivalent (SE) ≤ − 0.50 D] and high myopia (SE ≤ − 6.00 D) were 46.0%, 1.0% respectively. Hyperopia [SE ≥ + 1.00 D (≥ 7 years old) and SE ≥ + 2.00 D (≥ 6, < 7 years old)] and significant hyperopia (SE ≥ + 3.00 D) were 4.2 and 0.6%, respectively. Astigmatism [cylinder ≥ 1.00 D (≥ 7 years old) and ≥ 1.75 D (≥ 6, < 7 years old)] was found in 31.9%.ConclusionsMyopia was the most common refractive error in southernmost province in China (Hainan). Its prevalence increased with age, while hyperopia prevalence showed a decreasing trend. However, myopia, especially high myopia prevalence was much lower than in other urban regions across China.

Hyperopic peripapillary retinal nerve fiber layer thickness and foveal thickness using optical coherence tomography

Purpose Studying the peripapillary retinal nerve fiber layer (RNFL) thickness and foveal thickness in hyperopia using optical coherence tomography. Background Significant hyperopia is defined to be any degree of hyperopia sufficient to cause symptoms requiring remediation. Peripapillary RNFL thickness was approved to be conversely correlated with axial length (AL) and the spherical equivalent in hyperopic populations. Optical coherence tomography is a modern noncontact and noninvasive imaging technique designed to produce high-resolution images and accurate measurements of the different retinal components. Patients and methods The presented study included ninety eyes: 45 of them were simple hyperopic eyes, and the other 45 eyes were emmetropic. The emmetropic eyes were age and sex matched to the case group. The participants were included in the study after obtaining informed consent and a detailed history. Ophthalmological examination including visual acuity assessment, cycloplegic refraction, best-corrected visual acuity, cover–uncover test and extraocular muscle movement examination, anterior segment examination, intraocular pressure measurement, fundus examination, AL measurement, and peripapillary RNFL thickness and foveal thickness measurements (all methods of assessment are mentioned in detail in the patients and methods section) was carried out. Results There was no statistically significant difference between the hyperopic and the emmetropic groups with regard to age and sex. There was a statistically significant increase in the thickness of the RNFL in the hyperopic group that was more than that of the emmetropic group, and there was a statistically significant increase in the thickness of the superior, inferior, and nasal quadrants in the hyperopic group more than that of the emmetropic group. There was no statistically significant difference in the temporal quadrant between both groups. Conclusion The AL is statistically significantly short, and the mean foveal thickness is statistically significantly high in the hyperopic eyes. The RNFL thickness is statistically significantly thick, and the superior, inferior, and nasal quadrants were thicker in the hyperopic eyes than in the emmetropic ones.

Adequacy of the Fogging Test in the Detection of Clinically Significant Hyperopia in School-Aged Children

Purpose To evaluate the efficacy of the “fogging test,” performed with a +2 diopters (D) lens, in the exclusion of clinically significant hyperopia in school-aged children. Methods We studied 54 children between 5 and 11 years of age, with 10/10 best-corrected bilateral visual acuity (VA) without significant degree of correction. VA was assessed in each eye with a “bilateral” +2 D sphere over-refraction followed by cycloplegic retinoscopy. The capacity of the test to detect hyperopia of ≥+2 D and ≥+1.5 D was evaluated by examining the respective receiver operating characteristic (ROC) curves and sensitivity and specificity values for different cutoff values of VA. Results For the detection of hyperopia ≥+2 D, the area under the ROC curve (AUC) was 0.955 (p ≤ 0.001). The VA cutoff with best discriminative capacity was ≥5/10, with a sensitivity of 100%, specificity of 79%, positive predictive value (PPV) of 57%, and negative predictive value (NPV) of 100%. In respect of ≥+1.5 D hyperopia, the test capacity was lower (AUC = 0.832; p ≤ 0.001). The best VA cutoff was also of ≥5/10, with a PPV of 81% and a NPV of 85%. Conclusion The accuracy of the test was high for the evaluation of ≥+2 D hyperopia but lower for ≥+1.5 D hyperopia. For the detection of ≥+2 D hyperopia, the VA cutoff of <5/10 may permit the exclusion of clinically significant hyperopia in selected children, without the need for cycloplegia. For the same cutoff, the PPV was low, meaning that in children with ≥5/10 VA cycloplegic refraction remains obligatory.

Comparison of retinoscopy results with and without 1% cyclopentolate in school-aged children.

This study was designed with the aim of providing practitioners with an evidence base to inform their clinical decision making as to when cycloplegic retinoscopy is necessary and when it might be appropriate to forgo. The study aimed to determine the age at which there ceases to be a clinically significant difference between cycloplegic and non-cycloplegic retinoscopy and whether age, refractive error, habitual spectacle wear and accommodation influence the relationship. A single examiner carried out cycloplegic and non-cycloplegic retinoscopy on 128 children stratified into four age groups (6-7, 8-9, 10-12 and 12-13years). Cycloplegia was achieved using 1% cyclopentolate and retinoscopy carried out after 30min. The examiner was masked to the lenses used and to habitual spectacle wear. Accommodation was assessed using dynamic retinoscopy prior to cycloplegia. Cycloplegic and non-cycloplegic sphere differed significantly (z=-9.18, p<0.0001). Although the difference decreased significantly as age increased (χ2 =16.57, p=0.0009), cycloplegic retinoscopy revealed more hyperopia than non-cycloplegic retinoscopy in all age groups (p<0.0001). The difference between cycloplegic and non-cycloplegic results was greater where 'high' hyperopia (≥+2.50DS) was present (F1,6 =12.86, p=0.0005), and as hyperopia increased the difference increased (Spearman's ρ=0.55, p<0.0001). Neither spectacle wear (p=0.74) nor accommodation (p=0.08) influenced the difference between spherical measures. Measures of astigmatic error did not differ significantly (z=-1.59, p=0.11). A non-cycloplegic sphere ≥+1.50DS was relatively sensitive (87%) and specific (96%) at indicating clinically significant hyperopia (≥+2.50D) as revealed by cycloplegic retinoscopy. Cyclopentolate 1% does not impact the cylindrical component of the retinoscopy result, but reveals significantly more hyperopia in the spherical component, both statistically and clinically in children aged 6-13years. Differences between cycloplegic and non-cycloplegic sphere increase significantly with increasing hyperopia, independent of spectacle wear and accommodation. A non-cycloplegic retinoscopy result of ≥+1.50DS may be used by practitioners wishing to identify children aged 6-13years at risk of clinically significant hyperopia (≥+2.50DS), but cycloplegia is required to accurately ascertain the full spherical error.

Ophthalmological data on 4.5- to 7-year-old Danish children.

To report normative data on visual acuity (VA) for near and distance, refraction, ocular alignment, ocular motility and stereo acuity in a cohort of children aged 4.5-7years. A total of 950 children with normal development from the municipality of Roskilde, Denmark, were invited to participate in an ophthalmic cross-sectional population-based survey, of which 445 children in the age of 54-87months participated with a complete ocular examination including cycloplegia. Visual acuity (VA) was tested using Kay Picturecharts and notified in logMAR units. Mean distance VA was 0.010 logMAR [standard deviation (SD): 0.048] in right eye, and near VA in right eye was 0.012 logMAR (SD: 0.054), with a nonsignificant difference between right and left eye in both parameters (paired t-test, p=0.15 and p=0.08, respectively). Amblyopia was found in 12 children (2.7%), mainly related to refractive errors. The mean refractive error of right eye was +1.75D, and significant hyperopia (greater than +3.0D) was found in 7.9%. No myopia (greater than or equal to -0.5D) was found, astigmatism (>1D) was seen in 4.3%. Manifest strabismus was present in 1.6%, and heterophoria in 4.0%. Reduced or absent stereo acuity was present in 35 children (7.9%) and was related to a reduced VA, refractive error and strabismus. Ophthalmic data of 445 normally developed children are presented, supplementing previous reported normative data in children. We found a relatively high prevalence of amblyopia and of hyperopia, while myopia was not found, confirming previous studies that myopia is not developing at early age in Danish children.

Esotropia and Exotropia Preferred Practice Pattern®

Esotropia and Exotropia Preferred Practice Pattern®

Refractive Status in Nepalese Pre-Term and Full-Term Infants Early in Life.

This study suggests that pre-term infants, even without retinopathy of prematurity, are at risk for abnormal refractive development and informs the need for close monitoring of refractive error in such infants, regardless of their retinopathy of prematurity status. The present study aims to investigate the refractive error trend in Nepalese pre-term infants without retinopathy of prematurity (ROP) in the first 6 months of life and explore the association of refractive error with birth weight (BW) and gestational age (GA). Thirty-six pre-term infants without ROP and 40 full-term infants underwent cycloplegic retinoscopy at birth, term (for pre-term only), 3 months, and 6 months chronologically. Refractive status was classified into emmetropia (mean spherical equivalent refraction [SER] 0 to +3.00D), myopia (SER < 0.00D), and significant hyperopia (SER > +3.00D). Refractive parameters at various age points were compared between the pre-term and full-term infants using general linear model repeated measures ANOVA. At birth, the SER in the pre-term infants was +0.84 ± 1.72D; however, there was a shift toward myopia at 6 months of age (SER = -0.33 ± 1.95D). There was a significant difference in SER, astigmatism, and anisometropia between pre-term and full-term infants by 6 months of age (P < .01). Astigmatism and anisometropia showed an increasing trend with age in pre-term infants (P < .05 at 6 months) in contrast to a decreasing trend in full-term infants (P < 0.05 at 3 and 6 months). In pre-term infants, there was a statistically significant positive relationship between GA and SER (β = 0.32, R = 17.6%, P < .05) but a negative relationship between BW and astigmatism (β = -1.25, R = 20.6%, P < .01). Pre-term infants who do not develop ROP show a trend toward increasing myopia and demonstrate greater astigmatism and anisometropia than full-term infants in their first 6 months of life.

Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial—study protocol

IntroductionOptic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of...

Disruption of the Centrifugal Visual System Inhibits Early Eye Growth in Chicks

Emmetropization, the process by which neonatal refractive errors are reduced toward zero, is partially dependent on brain-retina connectivity. Here, we investigated the role of the centrifugal visual system, a visually driven retinal feedback projection, as one potential influence on this complex mechanism. Lesions of the isthmo-optic nucleus/tract or sham surgeries were performed in fifty-four 4- to 5-day-old chicks to disrupt centrifugal efferents to the contralateral retina. Prior to surgery, baseline refractive error measurements were made using streak retinoscopy. Postoperative ocular phenotyping, which (in addition to retinoscopy) comprised A-scan ultrasonography and infrared keratometry, was performed 7 days and 21 days postsurgery. A pathway-tracing paradigm was used to determine lesion success, whereby an injection of wheat-germ agglutinin was made into the vitreous chamber contralateral to the lesion. Postmortem, tissue processing, immunohistochemistry, and stereological analysis of intact centrifugal neurons were performed. Subsequently, chicks were divided into quartile groups based on percentage lesion success. Seven days postsurgery, chicks in the quartile of highest percentage lesion success exhibited significant axial hyperopia in the "treated eye" (contralateral to the lesion) relative to the "control eye" (ipsilateral to the lesion) eye, when compared with subjects within quartile groups of lower percentage lesion success (P = 0.004). However, by 21 days postsurgery, the induced hyperopia was no longer evident. Unilateral disruption of centrifugal efferents to the retina of the contralateral eye induces an initial axial hyperopia, which is subsequently reversed through increased vitreous elongation in the affected eyes.