Precision and agreement of axial length in paediatric population measured with MYAH and AL-Scan biometers.

CLINICAL RELEVANCE: Measuring axial length is key in the field of myopia development and control. Hence, the precision and agreement of commercially available biometers is of vital interest to understand their variability and interchangeability in the paediatric population. BACKGROUND: Different biometers are available to measure axial length and monitor myopia progression in clinical practice. The purpose of this study was to assess the precision (repeatability and reproducibility) and agreement of the MYAH and AL-Scan biometers in a paediatric population. METHODS: Three consecutive measurements were performed using MYAH and AL-Scan biometers in each subject by the same operator to test for repeatability. To test for reproducibility, two measurements were performed for each subject by two different observers with a 5-min interval between measurements. To test the agreement, each subject was measured once with each instrument. RESULTS: A total of 187 subjects, with a mean age of 8.5 ± 0.3 years and mean spherical equivalent refractive error of +0.22 ± 0.77 D participated in the study. For the repeatability study, the within-subject standard deviation was 0.01 mm, and the repeatability limit was 0.04 mm for both instruments, with no statistically significant differences among repeated measures (p = 0.162 for MYAH and p = 0.774 for AL-Scan). For the reproducibility study, the within-subject standard deviation was 0.01 mm and the repeatability limit was 0.04 mm. There were statistically significant differences for the repeated measures for the AL-Scan (p = 0.002) but not for the MYAH (p = 0.643). Regarding the agreement between both instruments, the 95% limit of agreement ranged from -0.04 to 0.05 mm, and the differences were statistically significant (p = 0.021). CONCLUSIONS: The repeatability, reproducibility, and agreement of the MYAH and AL-Scan biometers seem optimal for following children with myopia.

Eye movements in patients with post-COVID condition.

Eye movement control is impaired in some neurological conditions, but the impact of COVID-19 on eye movements remains unknown. This study aims to investigate differences in oculomotor function and pupil response in individuals who suffer post-COVID-19 condition (PCC) with cognitive deficits. Saccades, smooth pursuit, fixation, vergence and pupillary response were recorded using an eye tracker. Eye movements and pupil response parameters were computed. Data from 16 controls, 38 COVID mild (home recovery) and 19 COVID severe (hospital admission) participants were analyzed. Saccadic latencies were shorter in controls (183 ± 54 ms) than in COVID mild (236 ± 83 ms) and COVID severe (227 ± 42 ms) participants (p = 0.017). Fixation stability was poorer in COVID mild participants (Bivariate Contour Ellipse Area of 0.80 ± 1.61°2 vs 0.36 ± 0.65 °2 for controls, p = 0.019), while percentage of pupil area reduction/enlargement was reduced in COVID severe participants (39.7 ± 12.7%/31.6 ± 12.7% compared to 51.7 ± 22.0%/49.1 ± 20.7% in controls, p < 0.015). The characteristics of oculomotor alterations found in PCC may be useful to understand different pathophysiologic mechanisms.

Influence of power and the time of application of fogging lenses on accommodation.

Fogging is a non-invasive technique based on the use of positive spherical power lenses to relax accommodation during refraction that is commonly used as an alternative to cycloplegic drugs. Although the mechanism of the fogging technique has been described, some aspects of its methodology remain unclear. The main purpose of this work was to determine which lens power and time of application are more suitable for achieving a successful relaxation of accommodation by analyzing the changes in accommodation when fogging lenses of different powers were placed in front of the participants' eye for a certain timespan. The results of this analysis showed, in general, that low-power lenses and timespans of less than half a minute provided the highest relaxation of accommodation. However, high inter-subject variability was found in the two variables (power and time).

System for Objective Assessment of the Accommodation Response During Subjective Refraction.

Purpose: To evaluate a system based on a Hartmann-Shack wavefront sensor attached to a phoropter that allows the user to obtain real-time information about the refractive state of the eye and the accommodation response (AR). Methods: The objective refractions (ME) and ARs of 73 subjects (50 women, 23 men; ages, 19-69 years) were assessed with the system developed while placing in the phoropter the subjective refraction (MS) plus a set of trial lenses with differences in spherical equivalent power (ΔM) between ±2 diopters (D). Results: The objective estimations (ME) showed a good correlation with the subjective values (MS) (r = 0.989; P < 0.001). The means of the ARs presented a region where the accommodation remained stable (ΔM from +2 D to about 0 D), followed by another in which the response increased progressively (ΔM from about 0 to -2 D) with the magnitude of the accommodation stimulus. The analysis of variance within subjects applied to ARs introducing age and MS as covariates showed an increasing effect size of age from medium to large between ΔM of -0.5 and -2 D. In contrast, MS had a medium effect size (between ΔM of +2 and 0 D). Conclusions: The implemented system permitted an objective estimation of the refraction of the eye and its AR. Because it is coupled to a phoropter, the system can be used to retrieve the AR during subjective refraction procedures. Translational Relevance: The developed system can be used as a supporting tool during subjective refraction to provide certainty about the true state of accommodation.

Tear film stability assessment by corneal reflex image degradation: publisher's note.

This publisher's note corrects the funding in J. Opt. Soc. Am. A36, B110 (2019).JOAOD60740-323210.1364/JOSAA.36.00B110.

Clinical evaluation of an automated subjective refraction method implemented in a computer-controlled motorized phoropter / Evaluación clínica de un método de refracción subjetiva automatizado implementado en un foróptero motorizado controlado por computadora

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

Objetivo: Investigar un nuevo algoritmo para llevar a cabo una refracción automatizada no ciclopéjica en adultos. Métodos: Se midió a cincuenta sujetos sanos dos veces (prueba-reprueba) con el nuevo método de refracción subjetiva automatizado y con al procedimiento de refracción subjetiva clínica convencional. También se midió la refracción objetiva con el autorrefractómetro Grand Seiko WAM-5500. El nuevo método automatizado está inspirado en el algoritmo de bisección de búsqueda de raíces y en las distancias Euclidianas entre los vectores de potencia. Se introdujo el algoritmo en un ordenador, sincronizado a un foróptero motorizado personalizado. La repetibilidad se valoró principalmente mediante la desviación estándar intrasujetos (Sw), evaluándose el acuerdo con los límites de concordancia. Resultados: Las desviaciones estándar intrasujetos de los componentes del vector de potencia (M, J0, J45) obtenidos para el ojo derecho fueron (±0,13, ±0,04, ±0,05) D y (±0,17, ±0,03, ±0,07) D para los métodos subjetivos de refracción clínica y automatizada, respectivamente. Los límites de concordancia (con el método clínico) para los métodos automatizado y objetivo fueron, respectivamente, (±0,56, ±0,18, ±0,31) D y (±0,77, ±0,15, ±0,18) D. Se obtuvieron resultados similares para el ojo izquierdo. Conclusiones: El método automatizado propuesto es repetible y más preciso que las técnicas objetivas en adultos sanos. Sin embargo, no es lo suficientemente preciso para sustituir aún a la refracción subjetiva clínica, y debería probarse en una población más amplia en términos de edad, refracción y situaciones oculares diferentes. A pesar de estas importantes limitaciones, este método podrá ser valioso a la hora de mejorar el acceso a los servicios de atención primaria ocular en países en desarrollo

Tear film stability assessment by corneal reflex image degradation.

Tear film stability assessment is one of the main tests in dry eye diagnosis. However, to date, no test methodology has been adopted as the gold standard due to several reasons, such as the methods being invasive, subjective, or unfeasible for the clinical environment. In this paper, a method that overcomes the above-mentioned limitations for tear film stability measurements is presented, and is based on the degradation of corneal reflex images caused by breakups. The experimental setup, which is based on recording the corneal reflex image or the first Purkinje image, is described, as well as the method used to determine tear film stability by means of the associated breakup time (BUT) using corneal reflex image degradation. Images obtained through simulations of the experimental setup are also shown. Moreover, BUT measurements performed using both the conventional fluorescein method and the proposed method in nine healthy adults are presented. Both the experimental and simulation images show corneal reflex image degradation due to the appearance of breakups in the tear film, highlighting the potential of the method to assess tear film stability. We have shown that the corneal reflex image degrades when the tear film breaks up and, thus, the proposed method can be used to assess tear film stability.

Method to reduce undesired multiple fundus scattering effects in double-pass systems.

Double-pass systems rely on backscattering of light by the human ocular fundus to assess the optical quality of the eye. In this work, we present a method to reduce double-pass image degradation caused by undesired multiple scattering effects in the eye fundus. The reduction is based on combined data processing of simultaneous measurements using two different configurations: one symmetric with equal entrance and exit pupils and another asymmetric with unequal entrance and exit pupils. Under certain conditions, such scattering effects may be effectively suppressed. Measurements of human eyes show that, although multiple fundus scattering imposes a shift on the estimations, double-pass systems can be used to predict the optical quality of the eye within a population.

Stimulus Unpredictability in Time, Magnitude, and Direction on Accommodation.

SIGNIFICANCE: The effect of predictability in changes of time, magnitude, and direction of the accommodation demand on the accommodation response latency and its magnitude are insignificant, which suggests that repetitive accommodative tasks such as the clinical accommodative facility test may not be influenced by potential anticipation effects. PURPOSE: The purpose of this study was to investigate the effect of stimulus' time, magnitude, and direction predictability, as well as their interactions, on accommodation latency and response magnitude. METHODS: Monocular accommodative response and latency were measured in 12 young subjects for nine different conditions where the stimulus accommodative demand changed several times in a steplike fashion for a period of 120 seconds. Each change in accommodative demand could have different time duration (i.e., 1, 2, or 3 seconds), magnitude (1, 2, or 3 diopters), and/or direction (i.e., accommodation or disaccommodation). All conditions were created permuting the factors of time, magnitude, and direction with two levels each: random and not random. The baseline condition was a step signal from 0 to 2 diopters persisting for 2 seconds in both accommodative demands. After each condition, subjects were asked to provide a score from 1 to 5 in their perceived predictability. RESULTS: Friedman test conducted on the perceived predictability of each condition resulted in statistically significant differences between the nine conditions (χ = 56.57, P < .01). However, repeated-measures analysis of variance applied to latency and accommodative response magnitude did not show significant differences (P > .05). In addition, no correlation was found between the perceived predictability scores and both latency and accommodative response magnitudes between the most predictable and the most unpredictable conditions. CONCLUSIONS: Subjects were able to perceptually notice whether the stimulus was predictable or not, although our results indicate no significant effect of stimuli predictability on either the accommodation latency or its magnitude.

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

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

Random Changes of Accommodation Stimuli: An Automated Extension of the Flippers Accommodative Facility Test.

PURPOSE: To study the accommodative dynamics for predictable and unpredictable stimuli using manual and automated accommodative facility tests Materials and Methods: Seventeen young healthy subjects were tested monocularly in two consecutive sessions, using five different conditions. Two conditions replicated the conventional monocular accommodative facility tests for far and near distances, performed with manually held flippers. The other three conditions were automated and conducted using an electro-optical system and open-field autorefractor. Two of the three automated conditions replicated the predictable manual accommodative facility tests. The last automated condition was a hybrid approach using a novel method whereby far and near-accommodative-facility tests were randomly integrated into a single test of four unpredictable accommodative demands. RESULTS: The within-subject standard deviations for far- and near-distance-accommodative reversals were (±1,±1) cycles per minute (cpm) for the manual flipper accommodative facility conditions and (±3, ±4) cpm for the automated conditions. The 95% limits of agreement between the manual and the automated conditions for far and near distances were poor: (-18, 12) and (-15, 3). During the hybrid unpredictable condition, the response time and accommodative response parameters were significantly (p < 0.05) larger for accommodation than disaccommodation responses for high accommodative demands only. The response times during the transitions 0.17/2.17 D and 0.50/4.50 D appeared to be indistinguishable between the hybrid unpredictable and the conventional predictable automated tests. CONCLUSIONS: The automated accommodative facility test does not agree with the manual flipper test results. Operator delays in flipping the lens may account for these differences. This novel test, using unpredictable stimuli, provides a more comprehensive examination of accommodative dynamics than conventional manual accommodative facility tests. Unexpectedly, the unpredictability of the stimulus did not to affect accommodation dynamics. Further studies are needed to evaluate the sensitivity of this novel hybrid technique on individuals with accommodative anomalies.

Effect of Experimental Conditions in the Accommodation Response in Myopia.

SIGNIFICANCE: The accommodative response is more affected by the type of refractive error than the method of stimulation, field of view (FOV), or stimulus depth. PURPOSE: This study aims to analyze the effect of stimulation method, stimulus depth, and FOV on the accommodation response (AR) for emmetropes (EMM), late-onset myopes (LOM), and early-onset myopes (EOM). METHODS: Monocular AR was measured in 26 young observers (n = 9 EMM, n = 8 LOM, n = 9 EOM) under 60 different viewing conditions that were the result of permuting the following factors: (1) stimulation method (free space or Badal lens viewing), (2) stimulus depth (flat or volumetric), (3) FOV (2.5, 4, 8, 10, and 30°), and (4) accommodative stimulus (AS: 0.17, 2.50, and 5.00 diopters [D]). RESULTS: Mixed analysis of variance for 2.50 D of AS resulted in a significant effect of refractive group (F = 6.77, P < .01) and FOV (F = 1.26, P = .04). There was also a significant interaction between stimulus depth and FOV (F = 2.73, P = .03) and among stimulation method, FOV, and refractive group (F = 2.42, P = .02). For AS of 5.00 D, there was a significant effect of refractive group (F = 13.88, P < .01) and stimulation method (F = 5.16, P = .03). There was also a significant interaction of stimulation method, stimulus depth, and refractive group (F = 4.08, P = .03). When controlling for all interactions, LOM showed larger lags than EMM and EOM; the AR did not significantly change for fields of 8, 10, and 30°, and it did not significantly differ for different stimulation methods or stimulus depth. CONCLUSIONS: Previously reported differences in AR when using lens-based methods compared with free space viewing may be explained by the effect of other factors such as the FOV or the depth of the stimulus. Targets with an FOV of 8 or 10° may be optimal for accurate ARs.

Suitability of open-field autorefractors as pupillometers and instrument design effects.

AIM: To determine the agreement and repeatability of the pupil measurement obtained with VIP-200 (Neuroptics), PowerRef II (Plusoptix), WAM-5500 (Grand Seiko) and study the effects of instrument design on pupillometry. METHODS: Forty patients were measured twice in low, mid and high mesopic. Repeatability was analyzed with the within-subject standard deviation (Sw) and paired t-tests. Agreement was studied with Bland-Altman plots and repeated measures ANOVA. Instrument design analysis consisted on measuring pupil size with PowerRef II simulating monocular and binocular conditions as well as with proximity cues and without proximity cues. RESULTS: The mean difference (±standard deviation) between test-retest for low, mid and high mesopic conditions were, respectively: -0.09 (±0.16), -0.05 (±0.18) and -0.08 (±0.23) mm for Neuroptics, -0.05 (±0.17), -0.12 (±0.23) and -0.17 (±0.34) mm for WAM-5500, -0.04 (±0.27), -0.13 (±0.37) and -0.11 (±0.28) mm for PowerRef II. Regarding agreement with Neuroptics, the mean difference for low, mid and high mesopic conditions were, respectively: -0.48 (±0.35), -0.83 (±0.52) and -0.38 (±0.56) mm for WAM-5500, -0.28 (±0.56), -0.70 (±0.55) and -0.61 (±0.54) mm for PowerRef II. The mean difference of binocular minus monocular pupil measurements was: -0.83 (±0.87) mm; and with proximity cues minus without proximity cues was: -0.30 (±0.77) mm. CONCLUSION: All the instruments show similar repeat-ability. In all illumination conditions, agreement of Neuroptics with WAM-5500 and PowerRef II is not good enough, which can be partially induced due to their open field design.

Effect of apparent depth cues on accommodation in a Badal optometer.

BACKGROUND: The aim was to analyse the effect of peripheral depth cues on accommodation in Badal optometers. METHODS: Monocular refractions at 0.17 and 5.00 D of accommodative stimulus were measured with the PowerRef II autorefractor (Plusoptix Inc., Atlanta, Georgia, USA). Subjects looked (randomly) at four different scenes, one real scene comprising familiar objects at different depth planes (Real) and three virtual scenes comprising different two-dimensional pictures seen through a Badal lens. The first image consisted of a photograph of the real scene taken in conditions that closely mimic a healthy standard human eye performance (out-of-focus [OoF] blur); the second image was the same photograph rendered with a depth of focus to infinity (OoF sharpness); and finally the third image consisted of a fixation target and a even white surrounding (White). In all cases the field of view was 25.0° and the fixation target was a Maltese cross subtending to two degrees. RESULTS: Twenty-eight right eyes from healthy young subjects were measured. The achieved statistical power was 0.9. At 5.00 D of accommodative stimulus, the repeated measures analysis of variance was statistically significant (p < 0.05) and the corresponding Bonferroni post hoc tests showed the following mean accommodative response differences and standard deviation (p-value) between the real and the virtual scenes: real-white =-0.66 ± 0.92 D (p < 0.01); real-OoF sharpness = -0.43 ± 0.88 D (p = 0.07); real-OoF blur =-0.25 ± 0.93 D (p = 0.89). CONCLUSIONS: A stimulus poor in depth cues inaccurately stimulates accommodation in Badal optometers; however, accommodation can be significantly improved in the same Badal optometer, when displaying a realistic image rich in peripheral depth cues, even though these peripheral cues (also referred to as retinal blur cues) are shown in the same plane as the fixation target. These results have important implications in stereoscopic virtual reality systems that fail to represent appropriately retinal blur.

Spherical subjective refraction with a novel 3D virtual reality based system / Refracción subjetiva esférica utilizando un nuevo sistema 3D basado en realidad virtual

Purpose: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. Methods: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. Results: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was −0.034 D (±0.454 D). The corresponding 95% Limits of Agreement (LoA) were (−0.856 D, 0.924 D). In relation to precision, intra-observer mean difference for the M component was 0.034 ± 0.195 D for the Subj.C, 0.015 ± 0.177 D for the WAM and 0.072 ± 0.197 D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25 D) in all instruments. Conclusions: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way (AU)

Objetivo: Realizar una validación clínica de un sistema experimental basado en realidad virtual, capaz de evaluar la refracción subjetiva esférica simplificando la metodología de la refracción ocular. Métodos: Para evaluar la concordancia, se obtuvieron mediciones de la refracción esférica de 104 ojos pertenecientes a 52 sujetos, utilizando tres métodos diferentes: subjetivamente con el prototipo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C); y objetivamente con el autorrefractómetro WAM-5500 (WAM). Para evaluar la precisión (variabilidad intra e inter-observador) de cada herramienta refractiva, de forma independiente, se midieron 26 ojos en cuatro ocasiones. Resultados: Con respecto a la concordancia, la diferencia media (±DE) para el equivalente esférico (M) entre el nuevo método subjetivo experimental (Subj.E) y la refracción subjetiva clásica (Subj.C) fue de −0,034 D (±0,454 D). El 95% correspondiente a los Límites de la Concordancia (LoA) fue de (−0,856 D, 0,924 D). En relación a la precisión, la diferencia media intra observador para el componente M fue de 0,034 ± 0,195 D para Subj.C, 0,015 ± 0,177 D para WAM y 0,072 ± 0,197 D para Subj.E. La variabilidad inter observador reflejó peores valores de precisión, aunque fueron clínicamente válidos (inferiores a 0,25 D) en todos los instrumentos. Conclusiones: El equivalente esférico obtenido con el nuevo sistema experimental fue preciso y guardó consonancia con la rutina subjetiva clásica. El algoritmo introducido en este nuevo sistema, y su configuración óptica, han demostrado ser un avance válido para la corrección del error esférico de modo semi-automático (AU)

Spherical subjective refraction with a novel 3D virtual reality based system.

PURPOSE: To conduct a clinical validation of a virtual reality-based experimental system that is able to assess the spherical subjective refraction simplifying the methodology of ocular refraction. METHODS: For the agreement assessment, spherical refraction measurements were obtained from 104 eyes of 52 subjects using three different methods: subjectively with the experimental prototype (Subj.E) and the classical subjective refraction (Subj.C); and objectively with the WAM-5500 autorefractor (WAM). To evaluate precision (intra- and inter-observer variability) of each refractive tool independently, 26 eyes were measured in four occasions. RESULTS: With regard to agreement, the mean difference (±SD) for the spherical equivalent (M) between the new experimental subjective method (Subj.E) and the classical subjective refraction (Subj.C) was -0.034D (±0.454D). The corresponding 95% Limits of Agreement (LoA) were (-0.856D, 0.924D). In relation to precision, intra-observer mean difference for the M component was 0.034±0.195D for the Subj.C, 0.015±0.177D for the WAM and 0.072±0.197D for the Subj.E. Inter-observer variability showed worse precision values, although still clinically valid (below 0.25D) in all instruments. CONCLUSIONS: The spherical equivalent obtained with the new experimental system was precise and in good agreement with the classical subjective routine. The algorithm implemented in this new system and its optical configuration has been shown to be a first valid step for spherical error correction in a semiautomated way.

Does the Badal optometer stimulate accommodation accurately?

PURPOSE: To study whether the accommodation response to Badal optometer is equivalent to the response for real space targets. METHODS: Accommodative responses were measured for 28 young eyes with the WAM-5500 autorefractometer in eight configurations for 0.17 D, 2.0 D and 5.0 D accommodation stimuli. Parameters that might contribute to differences in response were systematically isolated: stimulation method (real space vs Badal targets), field of view, instrument's cover proximity, the looming effect, and the peripheral interposition of objects in depth. RESULTS: Mean accommodative response differences between a natural view configuration and a configuration with a Badal Optometer were 0.50 ± 0.43 D and 0.58 ± 0.53 D for 2.0 D and 5.0 D stimulation, respectively (p < 0.001), with accommodation lags for the latter condition. Of the isolated parameters that might contribute to these differences, varying the interposition of objects in depth affected accommodation response more markedly. CONCLUSIONS: It is likely that Badal optometers affect accommodation through a combination of some or all of the studied parameters. We conclude that accommodation response to closed-view Badal optometers is not equivalent to real space target response.

Response for light scattered in the ocular fundus from double-pass and Hartmann-Shack estimations.

Double-pass (DP) and Hartmann-Shack (HS) are complementary techniques based on reflections of light in the ocular fundus that may be used to estimate the optical properties of the human eye. Under conventional data processing, both of these assessment modes provide information on aberrations. In addition, DP data contain the effects of scattering. In the ocular fundus, this phenomenon may arise from the interaction of light with not only the retina, but also deeper layers up to which certain wavelengths may penetrate. In this work, we estimate the response of the ocular fundus to incident light by fitting the deviations between DP and HS estimations using an exponential model. In measurements with negligible intraocular scattering, such differences may be related to the lateral spreading of light that occurs in the ocular fundus due to the diffusive properties of the media at the working wavelength. The proposed model was applied in young healthy eyes to evaluate the performance of scattering in such a population. Besides giving a parameter with information on the ocular fundus, the model contributes to the understanding of the differences between DP and HS estimations.

Binocular open-view system to perform estimations of aberrations and scattering in the human eye.

We present a system that integrates a double-pass (DP) instrument and a Hartmann-Shack (HS) wavefront sensor to provide information not only on aberrations, but also on the scattering that occurs in the human eye. A binocular open-view design permits evaluations to be made under normal viewing conditions. Furthermore, the system is able to compensate for both the spherical and astigmatic refractive errors that occur during measurements by using devices with configurable optical power. The DP and HS techniques provide comparable data after estimating wavefront slopes with respect to the intersections of an ideal grid and compensating for residual errors caused by the optical defects of the measuring system. Once comparable data is obtained, it is possible to use this combined manner of assessment to provide information on scattering. Measurements in an artificial eye suggest that the characteristics of the ocular fundus may induce deviations of DP with respect to the HS data. These differences were quantified in terms of the modulation transfer function in young, healthy eyes measured in infrared light to demonstrate the potential use of the system in visual optics studies.

Comparing Autorefractors for Measurement of Accommodation.

PURPOSE: To compare the static and dynamic accommodative responses measured with the WAM-5500 and the PowerRef-II autorefractors. METHODS: The dynamic and static monocular accommodative responses were measured with the WAM-5500 and the PowerRef-II instruments in 30 pre-presbyopic patients (23.66 [±3.19] years). The spherical equivalent was measured at 0.00, 2.50, and 5.00 diopters (D) of accommodative stimulation for the static measurements. The subjective refraction was also determined. Dynamic accommodation was measured for abrupt changes of stimulus vergence of 2.00 D. Mean and peak velocities of accommodation and disaccommodation were evaluated. For the PowerRef-II, dynamic measurements were calculated for sampling frequencies of 5 and 25 Hz. RESULTS: For far distance static results, the differences between subjective and WAM-5500 measurements were 0.07 (±0.21) D (p = 0.093) and those between subjective and PowerRef-II measurements were 0.70 (±0.47) D (p = 0.001). The difference in the response measured with both instruments was 0.08 (±0.32) D (p = 0.194) for 2.50 D and -0.32 (±0.48) D (p = 0.001) for 5.00 D of stimulation. For the dynamic mode, the PowerRef-II at 25 Hz measured faster mean and peak velocities of accommodation and disaccommodation than the WAM-5500, with statistically significant (p < 0.05) differences of 0.68 (±1.01), 0.67 (±0.98), 1.26 (±1.19), and 1.42 (±1.53) D/s, respectively. With a sampling frequency of 5 Hz for the PowerRef-II, these differences, which were statistically significant (p < 0.05), were reduced to 0.52 (±0.90), 0.49 (±0.91), 0.83 (±1.07), and 0.83 (±1.31) D/s, respectively. CONCLUSIONS: There is good agreement between subjective refraction and WAM-5500 measurements. In contrast, the PowerRef-II produced more hyperopic results. There were no differences among instruments at 2.50 D of static stimulation; however, differences were found at 5.00 D. In the dynamic measurements, the PowerRef-II measured faster velocities, partly attributed to the difference in the sampling frequency.