Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation.

PURPOSE: To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS: PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS: Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS: Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].

Optics of spectacle lenses intended to treat myopia progression.

SIGNIFICANCE: This is a review of the optics of various spectacle lenses that have been used in myopia control over the last 60 years, with emphasis on approximately the last 15 years.Myopia has become an increasing health problem worldwide, particularly in some East Asian countries. This has led to many attempts to slow its progression in children and reduce its endpoint value. This review is concerned with the optics of spectacle lenses for use in myopia control, from bifocal lenses to multisegment and diffusion optics lenses. Treatments are based on theories of the onset or progression of myopia. These include the hypotheses that eye growth and myopia in susceptible children may be stimulated by (1) poor accommodation response and the consequent hyperopic defocus with near vision tasks, (2) relative hyperopic peripheral refraction, and (3) high retinal image contrast as occurs in urban environments. Using spectacle lenses to slow myopia progression has a history of about 60 years. The review is laid out in approximately the order in which different types of lenses have been introduced: bifocals, conventional progressive addition lenses, undercorrection with single-vision lenses, specialized progressive addition lenses, defocus-incorporated multiple segments, diffusion optics, and concentric bifocals. In the review, some of the lenses are combined with an eye model to determine refractive errors for peripheral vision for the stationary eye and for foveal vision for the rotating eye. Numbers are provided for the reported success of particular designs in retarding myopia progression, but this is not an epidemiological paper, and there is no critical review of the findings. Some of the recent treatments, such as multiple segments, appear to reduce the eye growth and myopia progression by better than 50% over periods of up to 2 years.

Measurement of in vivo lens shapes using IOLMaster 700 B-scan images: Comparison with phakometry.

PURPOSE: This study compared in vivo crystalline lens shape measurements using B-scan images from the IOLMaster 700 with phakometry. METHODS: Twenty-four young adult participants underwent IOLMaster 700 and phakometry measurements under cycloplegia (1% cyclopentolate). The IOLMaster 700 generated B-scan images along six meridians in 30° increments, which were analysed using custom MATLAB software to determine lens surface radii of curvature. Phakometry measurements were obtained using Purkinje images reflected from the lens surfaces. RESULTS: The IOLMaster 700 image analysis method yielded a lower mean anterior lens surface spherical equivalent power (+6.20 D) than phakometry (+7.55 D); however, the two measurements were strongly correlated (R(21) = 0.97, p < 0.0001). The astigmatic power vectors (J0 and J45) for the anterior lens surface were significantly higher for the IOLMaster 700 measurements, with only J0 showing a significant moderate positive correlation (R(21) = 0.57, p = 0.005). For the posterior lens surface, the IOLMaster 700 measurements had a higher mean spherical power (+14.28 D) compared to phakometry (+13.70 D); however, a strong positive correlation (R(21) = 0.90, p < 0.0001) was observed. No significant correlations were noted for posterior lens surface astigmatic vectors (J0 and J45). The IOLMaster 700 estimates for the equivalent lens mean spherical power were slightly lower than those for phakometry, with a mean difference of -0.72 D, and both methods were positively correlated (R(21) = 0.94, p < 0.0001). CONCLUSIONS: The findings demonstrate that IOLMaster 700 B-scan image analysis technique provides similar estimates of lens surface powers to phakometry. These results highlight the potential of the IOLMaster 700 to provide measurements of lens shape, informing future research and clinical use.

Change in refractive errors with changes in IOL parameters.

This study considered two questions associated with intraocular lens (IOL) power and refraction: (1) Given a refraction with a particular IOL in the eye, what will be the refraction for the IOL or another IOL if located differently with regard to tilt or anterior-posterior position? (2) For a target refraction, what is the power of another IOL if located differently with regard to tilt or position? A thin lens technique was developed to address these questions. For the first question, light was traced through the initial correcting spectacle lens to the cornea, refracted at the cornea, transferred to the position of the initial IOL, refracted at this IOL, transferred to the position of a new IOL (which may be the same IOL but with a different position and/or tilt), refracted backwards through the new IOL, transferred to the cornea and refracted out of the eye to give a new correcting spectacle lens power. For the second question, light was traced through the initial correcting spectacle lens to the cornea, refracted at the cornea, transferred to the position of the initial IOL, refracted at the initial IOL and transferred to the position of a new IOL. Light was also traced through the second correcting spectacle lens, refracted at the cornea and transferred to the position of the second IOL. The difference between the reduced image vergence for the first raytrace and the reduced object vergence for the second raytrace gave the effective power of the second IOL, and from this, the power of the second IOL was determined. Examples are presented for different situations, including a case report.

Vision screening using the Acuidrive device.

CLINICAL RELEVANCE: Understanding devices used for vision screening, including their potential utilisation and validity, will facilitate proper utilisation of this technology. BACKGROUND: The Acuidrive is a self-illuminated, hand-held, visual acuity screening device intended for use in policing, with visual acuity assessed roadside to identify drivers who may not meet vision standards for driving. The target is presented binocularly at 24 cm, and +4.00 D lenses eliminate the accommodation requirement. This study investigates its validity and applicability relative to the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. METHODS: There were 36 participants, half younger adults aged 18-30 years and half older adults aged 50-70 years. The subjects underwent binocular visual acuity testing using the Acuidrive device and an ETDRS chart displayed on a monitor. Eyes were corrected for distance using lenses in a trial frame, and additional trial lenses provided four blur levels: zero, +0.50 DS, +1.00 DS and +1.50 DS. Luminances for the devices were similar at approximately 100 cd/m2. ETDRS chart measurements were conducted both with room lighting on and off. RESULTS: The Acuidrive device underestimated the ETDRS visual acuity across all blur levels, with mean differences of 0.24 ± 0.07 logMAR and 0.18 ± 0.10 logMAR for room lights on and off, respectively. To predict ETDRS visual acuity of poorer than 0.34 logMAR (6/12=), a screening level of 0.50 logMAR (6/19) with the Acuidrive device provided high sensitivity and specificity (86% and 79% with lights-on, and 85% and 78% with lights-off). Visual acuity was better for the older group than the younger group by approximately 0.10 logMAR. CONCLUSION: There was an offset of 0.2 logMAR (two lines) between visual acuity measures for the Acuidrive device and an ETDRS chart. The Acuidrive device has the potential to be a viable screening tool with refinement to its construction.

Effects of induced aniseikonia on binocular visual acuity.

CLINICAL RELEVANCE: Binocular visual acuity is an important index of functional performance. Optometrists need to know how binocular visual acuity is affected by aniseikonia, and whether reduced binocular visual acuity is a marker for aniseikonia. BACKGROUND: Aniseikonia, the perception of unequal image sizes between the eyes, can occur spontaneously or can be induced after different types of eye surgery, or trauma. It is known to affect binocular vision, but there are no prior studies about how it affects visual acuity. METHODS: Visual acuity was measured for 10 healthy well-corrected participants aged 18-21 years of age. Aniseikonia of up to 20% was induced in one of two ways: (1) size lenses, which provided minification of field of view in one eye of each participant and (2) polaroid filters, which allowed vectographic viewing of optotypes on a 3D computer monitor. The best corrected acuity was measured on conventional logarithmic progression format vision charts and isolated optotypes, under both induced aniseikonia conditions. RESULTS: Induced aniseikonia caused binocular visual acuity thresholds to increase by small but statistically significant amounts, with the largest deficit being 0.06 logMAR for 20% size differences between the eyes. Binocular visual acuity was worse than monocular visual acuity for aniseikonia of 9% and greater. Acuity measured with the vectographic presentation gave slightly higher thresholds (by 0.01 logMAR) than for those viewed with size lenses. Acuity measured with charts gave slightly higher thresholds (by 0.02 logMAR) than with isolated letters. CONCLUSION: An acuity change of 0.06 logMAR is small and may be missed in a clinical examination. Therefore, visual acuity cannot be used as a marker of aniseikonia in clinical settings. Even with very marked induced aniseikonia, binocular visual acuity remained well within standards for licen*c*sing of drivers.

Retinal shadows produced by myopia control spectacles.

PURPOSE: To analyse ocular coherence tomography (OCT) images of the retinal shadows caused by defocus and diffusion optics spectacles. METHODS: One eye was fitted successively with the Hoya Defocus Incorporated Multiple Segments (DIMS) spectacle lens, two variations of the +3.50 D peripheral add spectacle (DEFOCUS) and the low-contrast dot lens (Diffusion Optics Multiple Segments, DOMS); each at a vertex distance of 12 mm. Simultaneously, a retinal image of the macular region with central fixation was obtained using infrared OCT. The corneal power and intraocular distances were determined using an optical biometer. RESULTS: The retinal images for the DIMS and DOMS lenses showed patterns of obvious retinal shadows in the periphery, while the central 10-11° remained clear. The DEFOCUS lens produced a darkened peripheral area. Dividing the size of the retinal pattern, measured with the calliper of the OCT software, by the actual size on the spectacle lens gave a magnification of -0.57 times. This is consistent with the incoming OCT beam being imaged to a position approximately 31 mm beyond the front of the eye. [Correction added on 26 October 2023 after first online publication: The preceding paragraph was corrected.] CONCLUSION: With device-specific correction, retinal OCT images can help visualise the regions affected by the defocus or lowered contrast induced by myopia control spectacles. This is of potential value for improving myopia therapies.

Refractive errors occurring with tilt of intraocular lenses.

A thin lens technique was developed to determine how the effective powers of toric monofocal intraocular lenses (IOLs) are influenced by tilt and the refractive errors associated with the tilt. A series of steps determined the effective power of the cornea at the IOL, the IOL power, the effective power of the tilted IOL, the correction required at the front of the eye and the power of an IOL that would compensate for the tilt. The correction was determined by starting at the ideal reduced image vergence at the IOL, backwards raytracing to obtain a reduced image vergence at the cornea, and subtracting the cornea power from this reduced image vergence. Examples are presented for different situations where the IOL is either tilted about the vertical or an oblique axis. Raytracing with a thick lens verified the accuracy of the technique.

Determining specified intraocular lens powers when silicone oil is to be used in the vitreous chamber.

PURPOSE: To apply a theoretical approach to determining how specified intraocular lens (IOL) powers should change when vitreous oil substitution is combined with IOL implantation. SETTING: University laboratory, private Ophthalmological practice. DESIGN: Theoretical raytracing. METHODS: Raytracing was done backwards from the retina with equi-convex 20 diopters (D) and 25 D IOLs, of refractive index 1.5332, to the object side of the anterior IOL surface. The 1.336 vitreous index was replaced with a high index 1.405 silicone oil. Raytracing was repeated with increase in specified power, that power as if 1.336 index was still surrounding the IOL, so that the object reduced vergence on the anterior side of the lens matched that of the original IOL power. This was done for a range of lens shapes from plano-convex (front surface flat), through equi-convex, to plano-convex (back surface flat), and for a range of axial lengths. The true power, the power with 1.336 index on the object side and silicone oil on the image side, was also determined. RESULTS: Replacing vitreous by silicone oil increases the necessary specified IOL power. This increase varies from approximately 14% for flat back surfaces, to 40% for equi-convex lenses, to 80% for flat front surface IOLs. True powers increase by about 15% across the range of IOL shapes. In terms of percentages, effects of changing the original IOL power and the axial length are small. CONCLUSIONS: When silicone oil is to remain in an eye after cataract surgery, biconvex IOLs require much higher specified powers than convex-plano IOLs.

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

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

Central and peripheral choroidal thickness and eye length changes during accommodation.

PURPOSE: Eye length increases during accommodation, both on-axis and in the periphery. The aim of this study was to determine whether the peripheral choroid thins with accommodation and to determine the relationship with eye length changes measured at the same location. METHODS: Subjects included 53 young adults in good ocular and general health, with 19 emmetropes and 34 myopes. Measurements from the right eye were made for 0 D and 6 D accommodation stimuli for ±30° horizontal visual field/retinal locations in 10° steps. Valid eye length and choroidal thickness measurements were obtained for 37 and 47 participants, respectively, and both measures were taken for 31 participants. 2.5% phenylephrine was instilled to dilate the pupils. Participants turned their eyes, without head movement, to fixate targets and to make the target 'as clear as possible' during measurements. Correction was made for the influence of lens thickness changing at different peripheral angles. Choroidal thickness was measured with a spectral-domain-Optical Coherence Tomographer. For peripheral images, the internal cross target on the capture screen was moved from the centre to 17.25° nasal/temporal positions. RESULTS: In accordance with previous literature, eye length increased with accommodation. The greatest change (mean ± SD) of 41 ± 17 µm occurred at the centre, with a mean change across the locations of 33 µm. There were no significant differences between emmetropes and myopes. Choroidal thickness decreased with accommodation, with changes being about two-thirds of those occurring for eye length. The greatest change of -30 ± 1 µm occurred at the centre, with a mean change of -21 µm. Greater choroidal thinning occurred for myopes than for emmetropes (23 ± 11 vs. 17 ± 8 µm, p = 0.02). CONCLUSIONS: With accommodation, eye length increased and the choroid thinned, at both central and peripheral positions. Choroidal thinning accounted for approximately 60% of the eye length increase across the horizontal ±30°.

Technical notes on peripheral refraction, peripheral eye length and retinal shape determination.

PURPOSE: To give an overview of the misconceptions and potential artefacts associated with measuring peripheral refractive error and eye length, the use of these measures to determine the retinal shape and their links to myopia development. Several issues were identified: the relationship between peripheral refractive error and myopia development, inferring the retinal shape from peripheral refraction or eye length patterns, artefacts and accuracy when measuring peripheral eye length using an optical biometer. METHODS: A theory was developed to investigate the influence of artefacts in measuring peripheral eye length and on using peripheral eye length to make inferences about retinal shape. RESULTS: When determining peripheral axial length, disregarding the need to realign instruments with mounted targets can lead to incorrect field angles and positions of mounted targets by more than 10% for targets placed close to the eye. Peripheral eye length is not a good indicator of the effects of myopia or of treatment for myopia development because eyes of different lengths but with the same retinal shape would be interpreted as having different retinal shapes; the measurement leads to overestimates of changes in retinal curvature as myopia increases. Determining peripheral eye length as a function of estimated retinal height rather than field angle will halve the magnitude of the artefact. The artefact resulting from the peripheral use of biometers with an on-axis calibration is modest and can be ignored. CONCLUSION: There are significant issues with peripheral measurements of the refractive error and eye length that must be considered when interpreting these data for myopia research. Some of these issues can be mitigated, while others require further investigation.

Do Anisometropic Eyes Have Steeper Retinas Than Their Isometropic Counterparts?

SIGNIFICANCE: Our findings suggest that retinal shapes of the eyes of anisometropes are not different from that of the eyes of isometropes with the same refractions. PURPOSE: We investigated ( a ) intereye differences in relative peripheral eye lengths between isometropes and anisometropes and ( b ) if the retinal shape is different between isometropic and anisometropic eyes with the same central refraction. METHODS: Central and peripheral eye lengths were determined along the horizontal meridian in 10° intervals out to ±30° using a noncontact biometer in 28 isometropes and 16 anisometropes. Retinal coordinates were estimated using these eye lengths and ray tracing. Retinal shape was determined in terms of vertex radius of curvature ( Rv ), asphericity ( Q ), and equivalent radius of curvature ( REq ). Linear regression was determined for the REq as functions of central refraction in a subset of isometropic and anisometropic eyes having the same refraction. RESULTS: The differences in relative peripheral eye lengths between the two eyes of anisometropes were significantly greater than for isometropes at ±30° eccentricities. Higher myopic eyes of anisometropes had smaller Rv , more negative Q , and smaller REq than the lower myopic eyes for both isometropes and anisometropes (mean ± standard error of the mean: Rv , 9.8 ± 0.5 vs. 11.7 ± 0.4 mm [ P = .002]; Q , -1.1 ± 0.2 vs. -0.5 ± 0.2 [ P = .03]; REq , 11.5 ± 0.3 vs. 12.4 ± 0.2 mm [ P = .01]). Intercepts and slopes of the linear regressions of REq in anisometropes and their isometropic counterparts with the same refraction were not significantly different from each other ( P > .05). CONCLUSIONS: Higher myopic eyes of anisometropes had similar retina shapes along the horizontal meridian to those of isometropic eyes with the same refraction.

The effect of concentric and aspheric multifocal soft contact lenses on binocular vision in young adult myopes.

PURPOSE: Multifocal soft contact lenses (MFCLs) are prescribed to inhibit myopia progression; these include aspheric and concentric designs. The effects of MFCLs on visual quality, accommodation and vergence in young-adult myopes were evaluated. METHODS: Participants were twenty-six myopes (19-25 years, spherical equivalent -0.50 to -5.75D), with normal binocular vision and no past myopia control. Pupil sizes were 4.4 ± 0.9 mm during distance viewing and 3.7 ± 0.8 mm at near. In random order, participants wore four MFCLs: Proclear single vision distance, MiSight concentric dual focus (+2.00D), distance center aspheric (Biofinity, +2.50D) (CooperVision lenses), and NaturalVue aspheric (Visioneering Technologies). Testing included visual acuity, contrast sensitivity (Pelli-Robson), stereoacuity, accommodation response, negative and positive relative accommodation, horizontal phorias, horizontal fusional vergence and AC/A ratio, and a visual quality questionnaire. RESULTS: The four lenses differed in distance (p = 0.001) and near visual acuity (p = 0.011), and contrast sensitivity (p = 0.001). Compared with the single vision lens, the Biofinity aspheric had the greatest visual impact: 0.19 ± 0.14 logMAR distance acuity reduction, 0.22 ± 0.15 log contrast sensitivity reduction. Near acuity was affected less than distance acuity; the reduction was greatest with the NaturalVue (0.05 ± 0.07 logMAR reduction). The MFCLs altered the autorefraction measure at distance and near (p = 0.001); the accommodation response was less with aspheric lenses. Negative relative accommodation reduced with the aspheric lenses (p = 0.001): by 0.9 ± 0.5D with Biofinity and 0.5 ± 0.7D with NaturalVue. Exophoric shifts were greater with aspheric lenses (1.8 ± 2.4Δ Biofinity, 1.7 ± 1.7Δ NaturalVue) than with the concentric MiSight (0.5 ± 1.3Δ). CONCLUSIONS: MFCLs alter visual performance, refraction and vergence; two aspheric lenses had greater effect than a concentric lens.

Effect of Text Messaging Parents of School-Aged Children on Outdoor Time to Control Myopia: A Randomized Clinical Trial.

Importance: Myopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required. Objective: To investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control. Design, Setting, and Participants: This randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school-aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021. Interventions: Parents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention. Main Outcomes and Measures: The co-primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence. Results: Of 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17; P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34]; P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50]; P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37]; P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (-0.69 diopters [D] [95% CI, -0.78 to -0.60] vs -0.82 D [95% CI, -0.91 to -0.73]; P = .04) and year 3 (-0.47 D [95% CI, -0.54 to -0.39] vs -0.60 D [95% CI, -0.67 to -0.53]; P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]). Conclusions and Relevance: In this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525.

Accommodation lags are higher in myopia than in emmetropia: Measurement methods and metrics matter.

PURPOSE: To determine whether accommodative errors in emmetropes and myopes are systematically different, and the effect of using different instruments and metrics. METHODS: Seventy-six adults aged 18-27 years comprising 24 emmetropes (spherical equivalent refraction of the dominant eye +0.04 ± 0.03 D) and 52 myopes (-2.73 ± 0.22 D) were included. Accommodation responses were measured with a Grand Seiko WAM-5500 and a Hartmann-Shack Complete Ophthalmic Analysis System aberrometer, using pupil plane (Zernike and Seidel refraction) and retinal image plane (neural sharpness-NS; and visual Strehl ratio for modulation transfer function-VSMTF) metrics at 40, 33 and 25 cm. Accommodation stimuli were presented to the corrected dominant eye, and responses, referenced to the corneal plane, were determined in the fellow eye. Linear mixed-effects models were used to determine influence of the refractive group, the measurement method, accommodation stimulus, age, race, parental myopia, gender and binocular measures of heterophoria, accommodative convergence/accommodation and convergence accommodation/convergence ratios. RESULTS: Lags of accommodation were affected significantly by the measurement method (p < 0.001), the refractive group (p = 0.003), near heterophoria (p = 0.002) and accommodative stimulus (p < 0.05), with significant interactions between some of these variables. Overall, emmetropes had smaller lags of accommodation than myopes with respective means ± standard errors of 0.31 ± 0.08 D and 0.61 ± 0.06 D (p = 0.003). Lags were largest for the Grand Seiko and Zernike defocus, intermediate for NS and VSMTF, and least for Seidel defocus. CONCLUSIONS: The mean lag of accommodation in emmetropes is approximately equal to the previously reported depth of focus. Myopes had larger (double) lags than emmetropes. Differences between methods and instruments could be as great as 0.50 D, and this must be considered when comparing studies and outcomes. Accommodative lag increased with the accommodation stimulus, but only for methods using a fixed small pupil diameter.

Ciliary Muscle Dimension Changes With Accommodation Vary in Myopia and Emmetropia.

Purpose: The purpose of this study was to determine whether accommodation-induced changes in ciliary muscle dimensions vary between emmetropes and myopes, and the effect of the image analysis method. Methods: Seventy adults aged 18 to 27 years consisted of 25 people with emmetropia (spherical equivalent refraction [SER] +0.21 ± 0.36 diopters [D]) and 45 people with myopia (-2.84 ± 1.72 D). There were 23 people with low myopia (>-3 D) and 22 people with moderate myopia (-3 to -6 D). Right eye ciliary muscles were imaged (Visante OCT; Carl Zeiss Meditec) at 0 D and 6 D demands. Measures included ciliary muscle length (CML), ciliary muscle curved length (CMLarc), maximum ciliary muscle thickness (CMTmax), CMT1, CMT2, and CMT3 (fixed distances 1-3 mm from the scleral spur), CM25, CM50, and CM75 (proportional distances 25%-75%). Linear mixed model analysis determined effects of refractive groups, race, and demand on dimensions. Significance was set at P < 0.05. Results: Myopic eyes had greater CML and CMLarc nasally than emmetropic eyes. Myopic eyes had thicker muscles than emmetropic eyes at nasal positions, except CM25 and CMT3, and at CM75 temporally. During accommodation and only nasally, CML reduced in emmetropic and myopic eyes, and CMLarc reduced in myopic eyes only. During accommodation, both nasally and temporally, muscles thickened anteriorly (CMT1 and CM25) and thinned posteriorly (CMT3 and CM75) except for temporal CM75. Moderate myopic eyes had greater temporal CMLarc than low myopic eyes, and the moderate myopes had thicker muscles both nasally and temporally using fixed and proportional distances. Conclusions: People with myopia had longer and thicker ciliary muscles than people with emmetropia. During accommodation, the anterior muscle thickened and the curved nasal muscle length shortened, more in myopic than in emmetropic eyes. The fixed distance method is recommended for repeat measures in the same individual. The proportional distance method is recommended for comparisons between refractive groups.

Low levels of refractive blur increase the risk of colour misperception of red train signals.

PURPOSE: Red signals signify danger in a range of situations, including train operations. Importantly, misperception of a red signal as yellow can have serious safety implications. This study investigated the effects of lens blur on incorrect colour perception of red signals, which has been implicated in previous train crashes. METHODS: Participants included 15 young (26.6 ± 4.6 years) and 15 older (55.8 ± 3.1 years) visually normal adults. Red and yellow wayside train signals were simulated for two brightness levels (dim, bright) using a custom-built projection system. The effect of blur (best-corrected refraction [No Blur], +0.25 DS, +0.50 DS, +0.75 DS, +1.00 DS, +1.25 DS) on the number of incorrect colour perception responses of the signals was recorded. The order of conditions was randomised between participants. RESULTS: For incorrect responses to the red signal, there were significant main effects of blur (p < 0.001) and signal brightness (p < 0.001) and a significant interaction between blur and brightness (p < 0.001). The effects of blur were greater for the dim compared to the bright signals, with significantly higher colour misperceptions for the dim signal for +0.50 DS blur and higher, compared with No Blur. Colour misperceptions of the yellow signals were low compared with that of the red signals, with only +1.25 DS blur resulting in a significantly higher number of incorrect responses than No Blur (p < 0.001). There were no effects of age for the red or yellow colour misperceptions (p > 0.19). CONCLUSIONS: Low levels of blur (+0.50 DS to +1.25 DS) resulted in a significant misperception of the red signals as orange-yellow, particularly for dim signals. The findings have implications for vision testing and refractive correction of train drivers to minimise the possibility of colour misperception of red train signals.

The effects of optically and digitally simulated aniseikonia on stereopsis.

PURPOSE: To simulate both lens-induced and screen-induced aniseikonia, and to assess its influence on stereopsis. Additionally, to determine if screen-based size differences could neutralise the effects of lens-induced aniseikonia. METHOD: A four-circle (4-C) paradigm was developed, where one circle appears in front or behind the others because of crossed or uncrossed disparity. This stereotest was used for three investigations: (1) Comparison with the McGill modified random dot stereogram (RDS), with anisometropia introduced with +2 D spheres and cylinders, and with aniseikonia introduced with 6% overall and 6% meridional (×180, ×90) magnifiers before the right eye; (2) Comparison of lens-induced and screen-induced 6% overall and meridional magnifications and (3) Determining if lens and screen effects neutralised, by opposing 6% lens-induced magnification to the right eye with screen-inducements of either 6% left eye magnification or 6% right eye minification. A pilot study of the effect of masking versus not masking the surround was also conducted. RESULTS: The 4-C test gave higher stereo-thresholds than the RDS test by 0.5 ± 0.2 log units across both anisometropic and aniseikonic conditions. However, variations in power, meridian and magnification affected the two tests similarly. The pilot study indicated that surround masking improved neutralisation of screen and lens effects. With masking, lens-induced and screen-induced magnifications increased stereo-thresholds similarly. With lens and screen effects opposed, for most participants stereo-thresholds returned to baseline for overall and ×180 magnifications, but not for ×90 magnification. Only three of seven participants showed good compensation for ×90 magnification. CONCLUSIONS: Effects of lens-induced aniseikonia on stereopsis cannot always be successfully simulated with a screen-based method. The ability to neutralise refractive aniseikonia using a computer-based method, which is the basis of digital clinical measurement, was reasonably successful for overall and ×180 meridional aniseikonia, but not very successful for ×90 aniseikonia.