Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.143
Filtrar
1.
Invest Ophthalmol Vis Sci ; 61(2): 13, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32049342

RESUMO

Purpose: Exposure to short-wavelength light influences refractive development and inhibits myopic development in many animal models. Retinal mechanisms underlying this response remain unknown. This study used a mouse model of lens-induced myopia to evaluate the effect of different wavelength light on refractive development and dopamine levels in the retina. A possible retinal pathway is tested using a mutant mouse with dysfunctional cones. Methods: Wild-type C57BL/6J (WT) and ALS/LtJ/Gnat2cpfl3 (Gnat2-/-) mice were exposed to one of three different light conditions beginning at postnatal day 28: broad-spectrum "white" (420-680 nm), medium wavelength "green" (525 ± 40 nm), and short wavelength "violet" (400 ± 20 nm). One-half of the mice received hyperopic lens defocus. All mice were exposed to the light for 4 weeks; animals were measured weekly for refractive error and axial parameters. Retinal dopamine and the dopamine metabolite 3,4-dihydroxyphenylacetic acid were measured by HPLC. Results: In WT mice, short-wavelength violet light induced hyperopia and violet light inhibited lens-induced myopia when compared with mice exposed to white light. Hyperopia could be attributed to shallower vitreous chambers in WT animals. There were no changes in the levels of dopamine or its metabolite. In Gnat2-/- mice, violet light did not induce hyperopia or inhibit lens-induced myopia. Conclusions: These findings show that short-wavelength light slows refractive eye growth, producing hyperopic responses in mice and inhibiting lens-induced myopia. The lack of inhibition in mice with dysfunctional cones suggests that cone signaling plays a role in the hyperopic response to short-wavelength (violet) light.


Assuntos
Luz , Miopia/prevenção & controle , Fototerapia , Células Fotorreceptoras Retinianas Cones/fisiologia , Transdução de Sinais/fisiologia , Animais , Dopamina/metabolismo , Feminino , Proteínas Heterotriméricas de Ligação ao GTP/deficiência , Doenças do Cristalino/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos , Refração Ocular/fisiologia , Retina/metabolismo
2.
PLoS One ; 15(1): e0224733, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31986151

RESUMO

SIGNIFICANCE: This is the first study to validate the repeatability of objective measurements of amplitude of accommodation (AA) using the TONOREF III (NIDEK Co., Ltd., Japan), which can measure the AA in 30 seconds. PURPOSE: To evaluate the repeatability of objective measurements of AA using the TONOREF III and explored the association between objectively measured AA and factors, including age, sex, spherical equivalent, baseline pupil size and pupil size change during accommodation. METHODS: This cross-sectional study recruited 35 healthy subjects aged 26 to 52 years. The Bland-Altman method and intraclass correlation coefficients (ICCs) were used to assess the repeatability of TONOREF III measurements. The relationships between AA and age, sex, baseline pupil size, changes in pupil size (ΔPS) during accommodation were analyzed using linear regression for univariate and multivariate analysis. RESULTS: The mean difference in AA (ΔAA) between two sessions of TONOREF III measurements was 0.23 D (95% CI: -1.07 to +1.53 D), while no significant correlation was found between the mean and ΔAA (p = .14). The ICCs of the TONOREF III was 0.96. Age, sex, and ΔPS during accommodation were significant factors affecting the AA in multivariate analysis. CONCLUSIONS: The repeatability of objective AA measurements using the TONOREF III was good. Measuring AA using the TONOREFTM III in clinical practice is feasible.


Assuntos
Acomodação Ocular/fisiologia , Optometria , Pupila/fisiologia , Refração Ocular/fisiologia , Adulto , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
3.
PLoS One ; 15(1): e0227638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935241

RESUMO

PURPOSE: To compare the accuracy of the five commonly used intraocular lens (IOL) calculation formulas integrated to a swept-source optical biometer, the IOLMaster 700, and evaluate the extent of bias within each formula for different ocular biometric measurements. METHODS: The study included patients undergoing cataract surgery with a ZCB00 IOL implant, using IOLMaster 700 optical biometry. A single eye per patient was included in the final analysis for a total of 324 cases. The SRK/T, Hoffer Q, Haigis, Holladay 2, and Barrett Universal II formulas were evaluated. The correlations between the refractive prediction errors calculated using the five formulas and ocular dimensions such as axial length (AL), anterior chamber depth (ACD), corneal power, and lens thickness (LT) were analyzed. RESULTS: There were significant differences in the median absolute error predicted by the five formulas after the adjustment for mean refractive prediction errors to zero (P = 0.038). The Barrett Universal II formula had the lowest median absolute error (0.263) and resulted in a higher percentage of eyes with prediction errors within ±0.50 D, ±0.75 D, and ±1.00 D (all P < 0.050). The refractive errors predicted by only the Barrett formula showed no significant correlation with the ocular dimensions: AL, ACD, corneal power, and LT. CONCLUSIONS: Overall, the Barrett Universal II formula, integrated to a swept-source optical biometer had the lowest prediction error and appeared to have the least bias for different ocular biometric measurements for the ZCB00 IOL.


Assuntos
Biometria/métodos , Lentes Intraoculares/normas , Testes Visuais/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comprimento Axial do Olho , Extração de Catarata/métodos , Córnea/fisiologia , Feminino , Humanos , Implante de Lente Intraocular/métodos , Cristalino/fisiologia , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Facoemulsificação/métodos , Registros , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , Procedimentos Cirúrgicos Refrativos/métodos , Reprodutibilidade dos Testes , República da Coreia , Estudos Retrospectivos , Acuidade Visual/fisiologia
4.
Eur J Ophthalmol ; 30(1): 201-208, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30556416

RESUMO

PURPOSE: To evaluate the long-term objective and subjective results of a trifocal intraocular lens. METHODS: Prospective observational study enrolling 24 eyes that underwent uneventful microincisional cataract surgery with bilateral implantation of a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL, Belgium). After a mean follow-up period of 60 ± 2 months, patients answered the 10-item Near Activity Vision Questionnaire (NAVQ-10) and were assessed for uncorrected and corrected distance, intermediate and near visual acuity, defocus curve, light-distortion analysis, and total ocular aberrometry with a pyramidal wavefront sensor (Osiris, CSO, Italy). RESULTS: There was significant improvement of uncorrected visual acuity at all distances in all eyes (p < 0.01). The distorsion index and best-fit circle radius were significantly lower in binocular conditions (p = 0.02). Mean Rasch score at NAVQ-10 was 16.29 ± 11.57. Patients reported to be completely, very, and moderately satisfied with their uncorrected near vision in 67%, 25%, and 8% of cases, respectively. We found no significant correlation between patient satisfaction scores at near vision satisfaction questionnaire and other variables such as light-distortion analysis or wavefront aberrometry parameters. CONCLUSION: The studied diffractive trifocal intraocular lens provides good and stable long-term results for distance, intermediate, and near vision, with high levels of patient satisfaction at long-term follow-up. The intraocular lens' light-distortion effect is less disturbing in binocular conditions and may have its perception down-modulated by neuroadaptation over time.


Assuntos
Aberrações de Frente de Onda da Córnea/fisiopatologia , Implante de Lente Intraocular , Lentes Intraoculares Multifocais , Satisfação do Paciente/estatística & dados numéricos , Facoemulsificação , Acuidade Visual/fisiologia , Aberrometria , Idoso , Sensibilidades de Contraste/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Inquéritos e Questionários , Resultado do Tratamento
5.
Eur J Ophthalmol ; 30(1): 139-146, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30541357

RESUMO

IMPORTANCE: This study shows that a newer long-arc length intrastromal corneal ring segment is efficient and safe for keratoconus treatment. BACKGROUND: To evaluate visual, tomographic results and complications of a 320-degree intrastromal corneal ring segment implantation with the femtosecond laser for keratoconus treatment. DESIGN: A prospective, nonrandomized, and interventional study. PARTICIPANTS: A total of 34 eyes of 31 patients diagnosed with keratoconus were enrolled. METHODS: Patients were divided into two groups based on the strategy used for 320-degree intrastromal corneal ring segment thickness selection. In one group, this selection was based on spherical equivalent (SE group) and in the other on the mean asphericity (Q group). The uncorrected and corrected distance visual acuities, spherical equivalent, K1, K2, Km, Kmax, and mean asphericity (Q) on corneal tomography were evaluated preoperatively and at 3 and 6 months postoperatively. For astigmatism improvement, we analyzed the corneal tomographic vectorial astigmatism change preoperatively and at 6 months postoperatively. The mean follow-up period was 6.63 ± 0.96 months. RESULTS: The mean uncorrected distance visual acuity and corrected distance visual acuity improved with a significant spherical equivalent improvement (p < 0.05), with no differences between the 320-degree intrastromal corneal ring segment groups. All corneal tomographic parameters improved significantly (p < 0.05) between the preoperative and postoperative intervals, with a significant better performance when we used spherical equivalent for the 320-degree intrastromal corneal ring segment thickness selection. Finally, the mean vectorial corneal tomographic astigmatism significantly improved after 6 months, again with no differences between groups. CONCLUSION: This study suggests that implanting a 320-degree intrastromal corneal ring segment is a safe and effective procedure for treating patients with keratoconus. It also suggests that for thickness selection spherical equivalent is the better strategy.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Implante de Lente Intraocular/métodos , Refração Ocular/fisiologia , Acuidade Visual , Adolescente , Adulto , Criança , Substância Própria/patologia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese , Fatores de Tempo , Adulto Jovem
6.
Eur J Ophthalmol ; 30(1): 125-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30384777

RESUMO

PURPOSE: To evaluate the visual, refractive, topographic, pachymetric, and biomechanical outcomes after intracorneal ring segment implantation in corneas with post-LASIK ectasia. METHODS: Retrospective longitudinal study enrolling 26 eyes of 22 patients with post-LASIK ectasia and undergoing intracorneal ring segment implantation (KeraRing®, Mediphacos) using a 60-kHz femtosecond laser (IntraLase®, IntraLase Corp.) for corneal tunnelization. Visual, refractive, anterior, and posterior corneal topographic (Pentacam HR, Oculus), pachymetric, and corneal biomechanical changes (Ocular response Analyzer, Reichert) were evaluated during a 12-month follow-up. Vector analysis of astigmatic changes was performed. RESULTS: A statistically significant reduction of sphere (p = 0.043) was observed at 1 month after surgery, with a significant improvement of uncorrected distance visual acuity associated (p = 0.019). Likewise, a significant reduction of anterior corneal power measurements (p ⩽ 0.014) and steepest posterior keratometric reading (p = 0.006) were observed at 1 month postoperatively, with no significant changes afterwards (p ⩾ 0.133). No significant changes were observed in manifest cylinder (p ⩾ 0.175), corrected distance visual acuity (p ⩾ 0.174), flattest posterior keratometric measurement (p ⩾ 0.282), volumetric measurements (p ⩾ 0.051), and corneal biomechanical parameters (p ⩾ 0.068). Vector analysis revealed an initial trend to overcorrection of astigmatism, with a trend to undercorrection at the end of follow-up and a significant variability in the outcome achieved in each patient. CONCLUSION: The implantation of KeraRing segments in post-LASIK corneal ectasia generates a significant modification of spherical refraction and a visual improvement due to a central corneal flattening generated. More refined nomograms of implantation in these cases should be developed to achieve a more predictable correction of astigmatism.


Assuntos
Córnea/cirurgia , Doenças da Córnea/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Implante de Lente Intraocular/métodos , Complicações Pós-Operatórias/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Adulto , Córnea/patologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Desenho de Prótese , Reoperação , Estudos Retrospectivos
7.
Am J Ophthalmol ; 209: 45-54, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31526796

RESUMO

PURPOSE: To characterize age- and sex-related changes in corneal refractive parameters in myopic and hyperopic patients undergoing refractive surgery. DESIGN: A retrospective cross-sectional study. METHODS: Analysis of demographic and refractive parameters of myopic and hyperopic patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2000 and December 2014 at the Care-Vision Laser Centers, Tel-Aviv, Israel. RESULTS: A total of 62,422 eyes of 31,211 patients were included. With advancing age, refractive surgery was performed for lower magnitudes of myopia and hyperopia. The magnitude of cylinder was higher in men than in women in both myopic and hyperopic patients. In comparison, women were significantly more myopic than men (spherical equivalent of -3.73 diopter [D] versus -4.07 D; P < 0.01). The myopic group sphere (r = 0.044; P < 0.001) had a positive correlation with age, whereas other parameters had a negative correlation with age: astigmatism (r = -0.09; P < 0.001), best-correct visual acuity (BCVA) (r = -0.04; P < 0.001), flat K (r = -0.09; P < 0.001), steep K (r = -0.06; P < 0.001), average K (r = -0.07; P < 0.001), and J0 (r = -0.05; P < 0.001). For hyperopic patients, astigmatism (r = 0.35; P < 0.001), BCVA (r = 0.11; P < 0.001), flat K (r = 0.30; P < 0.001), average K (0.14; P < 0.001), and central corneal thickness (r = 0.10; P < 0.001) correlated positively with age, whereas sphere (r = -0.23; P < 0.001), J0 (r = -0.31; P < 0.001), and overall blurring strength (r = -0.31; P < 0.001) had negative correlations with age. CONCLUSIONS: This large cohort study shows age- and sex-related refractive parameters among myopic and hyperopic patients seeking refractive surgery. These parameters can explain and predict trends in patients attending refractive surgery.


Assuntos
Córnea/fisiologia , Hiperopia/fisiopatologia , Miopia/fisiopatologia , Refração Ocular/fisiologia , Adulto , Fatores Etários , Paquimetria Corneana , Estudos Transversais , Feminino , Humanos , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Estudos Retrospectivos , Fatores Sexuais , Testes Visuais , Acuidade Visual , Adulto Jovem
8.
J. optom. (Internet) ; 12(4): 240-247, oct.-dic. 2019. graf
Artigo em Inglês | IBECS | ID: ibc-188253

RESUMO

PURPOSE: To investigate immediate and short-term visual recovery in a large cohort of 2093 myopic eyes (with or without astigmatism) treated with SmartSurfACE procedure, a combination of Transepithelial Photo Refractive Keratectomy (PRK) and Smart Pulse Technology (SPT, SCHWIND eye-tech-solutions GmbH, Kleinostheim, Germany). METHODS: In this retrospective case series, post-operative outcomes were evaluated immediately after the surgery (Day 0), at day 1 and 3 months postoperatively, after myopic SmartSurfACE treatment with mean pre-operative spherical equivalent -4.65 ± 2.53 D and range from -16.13D to- 0.13D. In all cases, pre and postoperative standard examinations were performed. The analysis evaluated preoperative Corrected and Uncorrected Distance Visual Acuity (CDVA and UDVA, respectively), and postoperative UDVA, monocularly and binocularly, immediately after the surgery, at day 1 and 3 month follow up. RESULTS: Sixty-two percent eyes achieved monocular UDVA 20/40 or better immediately after the surgery, while 82% patients achieved binocular UDVA 20/32 or better immediately after the surgery. At 3-month postoperatively, monocular UDVA 20/25 or better was achieved in 94% eyes. Treated eyes achieved immediately after the surgery or by the next day mean UDVA 20/41 ± 8. UDVA improved significantly from Day 1 to 3-months follow up (p < 0.0001 for both OS and OD) to mean UDVA 20/21 ± 5 (equal to preoperative CDVA 20/21 ± 8). CONCLUSION: Immediate and short-term visual recovery after SmartSurfACE PRK in our large cohort was rapid, providing functional binocular UDVA immediately after the surgery


OBJETIVO: Investigar la recuperación visual inmediata y a corto plazo en una amplia cohorte de 2.093 ojos miópicos (con o sin astigmatismo) tratados con el procedimiento SmartSurfACE, una combinación de Queratectomía Fotorrefractiva Transepitelial (PRK) y SPT (Smart Pulse Technology, SCHWIND eye-tech-solutions GmbH, Kleinostheim, Alemania). MÉTODOS: En esta serie de casos retrospectivos, se evaluaron los resultados post-operatorios inmediatamente tras la cirugía (Día 0), al día siguiente a la misma, y a los tres meses de la intervención, tras el tratamiento de la miopía con SmartSurfACE, con un equivalente esférico preoperatorio medio -4,65 ± 2,53D y rango desde -16,13D a -0,13D. En todos los casos se realizaron exámenes estándar preoperatorios y postoperatorios. El análisis evaluó preoperatoriamente la agudeza visual de lejos corregida y no corregida (CDVA y UDVA), y postoperatoriamente UDVA, monocular y binocular, inmediatamente tras la cirugía, al día siguiente, y a los tres meses de seguimiento. RESULTADOS: El 62% de los ojos logró UDVA monocular 20/40 o un valor mejor inmediatamente tras la cirugía, y el 82% de los pacientes logró UDVA binocular 20/32 o un mejor valor inmediatamente tras la cirugía. A los tres meses de la intervención, se logró UDVA monocular 20/25 o un valor mejor en el 94% de los ojos. Los ojos tratados lograron inmediatamente tras la cirugía o al día siguiente UDVA 20/41 ± 8. UDVA mejoró significativamente entre el día siguiente y los tres meses de seguimiento (p < 0,0001 para ambos ojos) a un valor medio de 20/21 ± 5 (igual a CDVA preoperatoria de 20/21 ± 8). CONCLUSIÓN: La recuperación visual inmediata y a corto plazo tras PRK con SmartSurfACE en nuestra amplia cohorte fue rápida, logrando una UDVA binocular funcional inmediatamente tras la cirugía


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Recuperação de Função Fisiológica/fisiologia , Topografia da Córnea , Miopia/fisiopatologia , Refração Ocular/fisiologia , Estudos Retrospectivos , Visão Binocular/fisiologia
9.
Cochrane Database Syst Rev ; 12: CD012801, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31845757

RESUMO

BACKGROUND: Cataract is the leading cause of blindness in the world, and clinically significant astigmatism may affect up to approximately 20% of people undergoing cataract surgery. Pre-existing astigmatism in people undergoing cataract surgery may be treated, among other techniques, by placing corneal incisions near the limbus (limbal relaxing incisions or LRIs) or by toric intraocular lens (IOLs) specially designed to reduce or treat the effect of corneal astigmatism on unaided visual acuity. OBJECTIVES: To assess the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 9); Ovid MEDLINE; Ovid Embase and four other databases. The date of the search was 27 September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing toric IOLs with LRIs during phacoemulsification cataract surgery.  DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. We graded the certainty of the evidence using GRADE. Our primary outcome was the proportion of participants with postoperative residual refractive astigmatism of less than 0.50 dioptres (D) six months or more after surgery. We also collected data on mean residual refractive astigmatism. Secondary outcomes included: uncorrected distance visual acuity, vision-related quality of life, spectacle independence and adverse effects including postoperative lens rotation requiring re-alignment. To supplement the main systematic review assessing the effects of toric IOLs compared with LRIs in the management of astigmatism during phacoemulsification cataract surgery, we sought to identify economic evaluations on the subject. MAIN RESULTS: We identified 10 relevant studies including 517 people (626 eyes). These studies took place in China (three studies), UK (three), Brazil (one), India (one), Italy (one) and Spain (one). The median age of participants was 71 years. The level of corneal astigmatism specified in the inclusion criteria of these studies ranged from 0.75 D to 3 D. A variety of toric IOLs were used in these studies, in all but one study, these were monofocal. Studies used three different nomograms to determine the size and placement of the LRI. Two studies did not specify this. None of the studies were at low risk of bias in all domains, but two studies were at low risk of bias in all domains except selective outcome reporting, which was unclear. The remaining studies were at a mixture of low, unclear or high risk of bias. People receiving toric IOLs were probably more likely to achieve a postoperative residual refractive astigmatism of less than 0.5 D six months or more after surgery (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.10 to 1.78; 5 RCTs, 262 eyes). We judged this to be moderate-certainty evidence, downgrading for risk of bias. In the included studies, approximately 500 eyes per 1000 achieved postoperative astigmatism less than 0.5 D in the LRI group compared with 700 per 1000 in the toric IOLs group. There was a small difference in residual astigmatism between the two groups, favouring toric IOLs (mean difference (MD) -0.32 D, 95% CI -0.48 to -0.15 D; 10 RCTs, 620 eyes). Although all studies favoured toric IOLs, the results of individual studies were inconsistent (range of effects -0.02 D to -0.71 D; I² = 89%). We considered this to be low-certainty evidence, downgrading for risk of bias and inconsistency. People receiving a toric IOL probably have a small improvement in visual acuity at six months or more after surgery compared to people receiving LRI, but the difference is small and probably clinically insignificant (MD -0.04 logMAR, 95% CI -0.07 to -0.02; 8 RCTs, 474 eyes; moderate-certainty evidence). Low-certainty evidence from one study of 40 people suggested little difference in vision-related quality of life measured using the Visual Function Index (VF-14) (MD -3.01, 95% CI -8.56 to 2.54). Two studies reported spectacle independence and suggested that people receiving toric IOLs may be more likely to be spectacle independent (RR 1.56, 95% CI 1.14 to 2.15; 100 people; low-certainty evidence). There were no cases of lens rotation requiring surgery (very low-certainty evidence). Five studies (320 eyes) commented on a range of other adverse effects including corneal oedema, endophthalmitis and corneal ectasia. All these studies reported that there were no adverse events with the exception of one study (40 eyes) where one participant in the LRI group had a central de-epithelisation which recovered over 10 days. We found no economic studies that compared toric IOLs with LRIs. AUTHORS' CONCLUSIONS: Toric IOLs probably provide a higher chance of achieving astigmatism within 0.5 D after cataract surgery compared with LRIs. There may be a small mean difference in postoperative astigmatism, favouring toric IOLs, but this difference is likely to be clinically unimportant. There was no evidence of an important difference in postoperative visual acuity or quality of life between the techniques. Evidence on adverse effects was uncertain. The apparent shortage of relevant economic evaluations indicates that economic evidence regarding the costs and consequence of these two procedures is currently lacking.


Assuntos
Ceratoplastia Penetrante/métodos , Implante de Lente Intraocular/métodos , Facoemulsificação/métodos , Acuidade Visual , Astigmatismo/etiologia , Astigmatismo/cirurgia , Humanos , Lentes Intraoculares , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
10.
Ophthalmic Physiol Opt ; 39(6): 451-458, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31696541

RESUMO

PURPOSE: To determine the differences in mean ocular dimensions between urban and rural children and identify possible influencing factors. METHODS: This work uses previously published data from the Shandong Children Eye Study, which was based on a random cluster sampling applied to a cross-sectional school-based study design in the rural Guanxian County and Weihai city. All children underwent auto-refractometry and biometry under cycloplegia. RESULTS: The study included 3290 children (aged 9.35 ± 2.93 years), consisting of 888 pairs of boys and 757 pairs of girls matched by sex, age and refractive error (each pair matching one child from urban cohort with one from the rural cohort). Overall urban children were significantly taller and heavier than rural children (t-test; p < 0.001), which was confirmed for all age groups for weight. Urban ocular axial lengths were significantly longer by 0.23 mm compared to the rural population (t-test; p < 0.001), mostly in younger children and boys. Meanwhile, corneal curvatures were flatter in the urban cohort by 0.08 mm (p < 0.001). This association of axial length with urban vs rural region was reduced in magnitude by 69.7% after accounting for height. CONCLUSIONS: For the same, matched refractive error, children from urban regions had significantly longer eyes and flatter corneal curvature than rural children. Since corneal curvature is defined during the first 2 years of life, early environmental factors may be the source of these differences in ocular dimensions.


Assuntos
Biometria/métodos , Córnea/fisiopatologia , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , População Rural , População Urbana , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Córnea/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Erros de Refração/epidemiologia , Erros de Refração/fisiopatologia
11.
BMC Ophthalmol ; 19(1): 213, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684898

RESUMO

BACKGROUND: To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. METHODS: This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). RESULTS: Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from - 0.5 to - 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). CONCLUSIONS: The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.


Assuntos
/diagnóstico , Corpo Ciliar/diagnóstico por imagem , Glaucoma de Ângulo Fechado/diagnóstico , Pressão Intraocular/fisiologia , Miopia/diagnóstico , Refração Ocular/fisiologia , Acuidade Visual , Adulto , Criança , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Glaucoma de Ângulo Fechado/induzido quimicamente , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Miopia/induzido quimicamente , Miopia/fisiopatologia , Estudos Retrospectivos
12.
Optom Vis Sci ; 96(10): 726-732, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31592955

RESUMO

SIGNIFICANCE: There is a critical need for tools that increase the accessibility of eye care to address the most common cause of vision impairment: uncorrected refractive errors. This work assesses the performance of an affordable autorefractor, which could help reduce the burden of this health care problem in low-resource communities. PURPOSE: The purpose of this study was to validate the commercial version of a portable wavefront autorefractor for measuring refractive errors. METHODS: Refraction was performed without cycloplegia using (1) a standard clinical procedure consisting of an objective measurement with a desktop autorefractor followed by subjective refraction (SR) and (2) with the handheld autorefractor. Agreement between both methods was evaluated using Bland-Altman analysis and by comparing the visual acuity (VA) with trial frames set to the resulting measurements. RESULTS: The study was conducted on 54 patients (33.9 ± 14.1 years of age) with a spherical equivalent (M) refraction determined by SR ranging from -7.25 to 4.25 D (mean ± SD, -0.93 ± 1.95 D). Mean differences between the portable autorefractor and SR were 0.09 ± 0.39, -0.06 ± 0.13, and 0.02 ± 0.12 D for M, J0, and J45, respectively. The device agreed within 0.5 D of SR in 87% of the eyes for spherical equivalent power. The average VAs achieved from trial lenses set to the wavefront autorefractor and SR results were 0.02 ± 0.015 and 0.015 ± 0.042 logMAR units, respectively. Visual acuity resulting from correction based on the device was the same as or better than that achieved by SR in 87% of the eyes. CONCLUSIONS: This study found excellent agreement between the measurements obtained with the portable autorefractor and the prescriptions based on SR and only small differences between the VA achieved by either method.


Assuntos
Aberrometria/instrumentação , Erros de Refração/diagnóstico , Aberrometria/economia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Presbiopia/fisiopatologia , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Acuidade Visual/fisiologia , Adulto Jovem
13.
Optom Vis Sci ; 96(10): 733-744, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31592956

RESUMO

SIGNIFICANCE: Measurement of ocular aberrations is a critical component of many optical corrections. PURPOSE: This study examines the accuracy and repeatability of a newly available high-resolution pyramidal wavefront sensor-based aberrometer (Osiris by Costruzione Strumenti Oftalmici, Firenze, Italy). METHODS: An engineered model eye and a dilated presbyopic eye were used to assess accuracy and repeatability of aberration measurements after systematic introduction of lower- and higher-order aberrations with calibrated trial lenses (sphere +10.00 to -10.00 D, and astigmatic -4.00 and -2.00 D with axis 180, 90, and 45°) and phase plates (-0.57 to 0.60 µm of Seidel spherical aberration defined over a 6-mm pupil diameter). Osiris aberration measurements were compared with those acquired on a previously calibrated COAS-HD aberrometer for foveal and peripheral optics both with and without multizone dual-focus contact lenses. The impact of simulated axial and lateral misalignment was evaluated. RESULTS: Root-mean-square errors for paraxial sphere (corneal plane), cylinder, and axis were, respectively, 0.07, 0.11 D, and 1.8° for the engineered model and 0.15, 0.26 D, and 2.7° for the presbyopic eye. Repeatability estimates (i.e., standard deviation of 10 repeat measures) for the model and presbyopic eyes were 0.026 and 0.039 D for spherical error. Root-mean-square errors of 0.01 and 0.02 µm, respectively, were observed for primary spherical aberration and horizontal coma (model eye). Foveal and peripheral measures of higher- and lower-order aberrations measured with the Osiris closely matched parallel data collected with the COAS-HD aberrometer both with and without dual-focus zonal bifocal contact lenses. Operator errors of focus and alignment introduced changes of 0.018 and 0.02 D/mm in sphere estimates. CONCLUSIONS: The newly available clinical pyramidal aberrometer provided accurate and repeatable measures of lower- and higher-order aberrations, even in the challenging but clinically important cases of peripheral retina and multifocal optics.


Assuntos
Aberrometria/instrumentação , Aberrações de Frente de Onda da Córnea/diagnóstico , Erros de Refração/diagnóstico , Acomodação Ocular/fisiologia , Adulto , Aberrações de Frente de Onda da Córnea/fisiopatologia , Humanos , Hiperopia/diagnóstico , Hiperopia/fisiopatologia , Pessoa de Meia-Idade , Miopia/diagnóstico , Miopia/fisiopatologia , Presbiopia/diagnóstico , Presbiopia/fisiopatologia , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Acuidade Visual/fisiologia , Adulto Jovem
14.
Optom Vis Sci ; 96(10): 780-789, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31592961

RESUMO

SIGNIFICANCE: We review retinally induced aniseikonia, an underrecognized condition resulting from common retinal conditions that has a significant effect on quality of life. Optometrists can influence the timing of surgical intervention to mitigate the damage from delaying surgical intervention in patients whose other findings do not meet a surgeon's treatment threshold.Aniseikonia due to optical differences between the eyes occurs in 1 to 3.5% of the population and can hinder the quality of binocular vision. The less noted retinally induced aniseikonia is due to mechanical distortion and displacement of the retinal photoreceptors and occurs with disorders such as epiretinal membrane, reattached retinal detachment, macular hole, and macular edema. Despite that it was first reported in 1950 and its incidence continues to rise in the aging population, many eye care practitioners are unaware of this condition, which can persist or even be exacerbated after treatment as a contributing cause of binocular vision symptoms. The purpose of this report is to allow more eye care practitioners to become familiar with retinally induced aniseikonia. The review of the literature includes demographics and epidemiology, etiology, pathogenesis, diagnosis, results of treatment, prognosis, and case examples.


Assuntos
Aniseiconia/etiologia , Doenças Retinianas/complicações , Aniseiconia/fisiopatologia , Aniseiconia/psicologia , Humanos , Qualidade de Vida/psicologia , Refração Ocular/fisiologia , Doenças Retinianas/fisiopatologia , Doenças Retinianas/psicologia , Visão Binocular/fisiologia , Acuidade Visual/fisiologia
15.
Korean J Ophthalmol ; 33(5): 458-466, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612657

RESUMO

PURPOSE: To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. METHODS: This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). RESULTS: The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was -0.32 ± 0.3 diopters (D, -1.25 to 0.00 D) in group 1, -0.47 ± 0.2 D (-2.00 to 0.00 D) in group 2, -0.62 ± 0.2 D (-1.00 to -0.25 D) in group 3, and -0.91 ± 0.2 D (-1.50 to -0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). CONCLUSIONS: Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.


Assuntos
Astigmatismo/cirurgia , Córnea/cirurgia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Refração Ocular/fisiologia , Acuidade Visual , Adolescente , Adulto , Astigmatismo/complicações , Astigmatismo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/complicações , Miopia/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Asia Pac J Ophthalmol (Phila) ; 8(5): 371-376, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567264

RESUMO

Small incision lenticule extraction (SMILE) is a new paradigm for refractive surgery, and was first performed by Sekundo and Blum in 2008. It uses only a femtosecond laser to carve out a lenticule within the corneal stroma, and then achieves refractive correction by extracting the lenticule through a small incision. A number of studies have shown that SMILE leads to stable and efficacious outcomes, combined with high safety. Long-term studies also indicate that SMILE has excellent outcomes combined with high safety. Although relatively safe, SMILE can have some intraoperative and postoperative complications, including suction loss during the procedure, lenticule tears, incision tears, epithelial ingrowth, diffuse lamellar keratitis, and residual refractive error. Studies indicate that SMILE leads to less postoperative dry eyes. It is thus preferred over laser-assisted in-situ keratomileusis (LASIK) in cases wherein there is mild dry eye preoperatively. It is also preferred over LASIK in cases wherein the patient is likely to engage in contact sports. LASIK may be preferred over SMILE for the treatment of hyperopia, and in cases of significant higher order wavefront aberrations or topographic irregularities.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Humanos , Miopia/fisiopatologia
17.
Asia Pac J Ophthalmol (Phila) ; 8(5): 385-390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567265

RESUMO

The advent of "flapless" small-incision lenticule extraction (SMILE), employing all-in-one technology, has resulted in a revolutionary breakthrough in refractive surgeries. SMILE has been gaining popularity due to fewer potential complications, such as postoperative dry eyes and greater biomechanical stability, etc. However, attention must be given to 1) the centration on the corneal vertex, 2) the proper alignment of the astigmatic axis, and 3) the relationship between pupil size and treatment diameter, to achieve good SMILE results. There is no pupil-tracking system to ascertain the accuracy of centration during the SMILE surgery. To improve the centration accuracy, our center uses two corneal topographers (Pentacam and Sirius) to measure and determine corneal vertex. Proper predicted optical zone diameter is not clearly defined yet in SMILE. Some scholars insist that mesopic pupil size should be taken into consideration when setting the predicted optical zone. Meanwhile, the issue of "functional optical zone" still has many unresolved issues and warrants further studies.


Assuntos
Substância Própria/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular/fisiologia , Acuidade Visual , Substância Própria/diagnóstico por imagem , Topografia da Córnea , Humanos , Miopia/diagnóstico , Miopia/fisiopatologia
19.
Invest Ophthalmol Vis Sci ; 60(13): 4319-4327, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31622468

RESUMO

Purpose: To investigate the effects of high ambient lighting on refraction and ocular biometry in guinea pig models of form-deprivation myopia (FDM). Methods: Forty 3-week-old guinea pigs were randomly assigned to groups exposed to either high light (HL, 10,000 lux) or normal light (NL, 500 lux) with normal vision or form deprivation. Throughout the 10-week rearing period, animals were exposed to high light or normal light for 12 hours with a 12-hour light/dark cycle. Refraction, axial length (AL), and radius of corneal curvature (CCR) were measured by cycloplegic retinoscopy, A-scan ultrasonography, and keratometer, respectively. Results: At the end of treatment, form-deprived eyes under high ambient lighting exhibited more hyperopic refraction and shorter AL than those under normal ambient lighting (2.06 ± 1.68 diopters [D; mean ± SD] vs. -0.59 ± 1.56 D, P < 0.001; 8.36 ± 0.13 mm vs. 8.56 ± 0.16 mm, P < 0.001). Deprived eyes under high ambient lighting were relatively more myopic than their contralateral control eyes at the end of treatment (2.06 ± 1.68 D vs. 5.44 ± 0.66 D, P < 0.001). High lighting induced a significant hyperopic shift in normal eyes after 4 weeks of exposure. There were no significant differences in CCR between eyes exposed to high and normal light, nor between deprived eyes and contralateral eyes. Conclusions: High ambient lighting could retard, but not fully inhibit, the development of FDM. High light levels contributed to a greater hyperopic shift in normal eyes during the first 4 weeks of treatment. Corneal curvature was unaffected by either high ambient lighting or form deprivation.


Assuntos
Luz/efeitos adversos , Miopia/etiologia , Privação Sensorial , Animais , Comprimento Axial do Olho/patologia , Biometria , Córnea/anatomia & histologia , Modelos Animais de Doenças , Cobaias , Hiperopia/etiologia , Refração Ocular/fisiologia , Retinoscopia
20.
Exp Eye Res ; 189: 107850, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31639338

RESUMO

Evidence from animal studies suggests that the eye's natural diurnal rhythms can be disrupted by altering the light/dark cycle or during refractive error development. Although diurnal variations in axial length (AL) and choroidal thickness are well documented in human eyes, the relationship between ambient light exposure, refractive error progression and diurnal AL and choroidal thickness variations is not well understood. Therefore we examined the association between objective ambient light exposure and daily variations in AL and subfoveal choroidal thickness (SFCT), along with longer-term changes in AL and SFCT over 12 months. Thirty-four young adult emmetropes and myopes had their daily variations (measurements ~ every 3 h from 9 a.m. to 9 p.m.) in AL and SFCT assessed on a weekday and weekend in winter and then six months later in summer. Participants then returned six months later for a single measurement session to determine the longer-term change in AL and SFCT. Personal ambient light exposure was captured in winter and summer using wrist-worn light sensors (Actiwatch-2) worn for 14 days over the same period of time when the diurnal measurements were collected. Linear mixed model analyses revealed significant daily variations in AL and SFCT (each p < 0.05). The mean daily peak to trough difference (amplitude) in AL was significantly greater in myopes (0.020 mm; 95% CI: 0.014-0.026 mm) compared to emmetropes (0.010 mm; 95% CI: 0.005-0.015 mm) (p < 0.01), but the SFCT variations were not significantly different between the refractive groups (p = 0.45). Daily variations in AL were negatively associated with the daily SFCT variations (r = -0.603, p < 0.001). Correlation analyses indicated that the amplitude of daily AL variations was negatively associated with the daily time exposed to bright light (r = -0.511, p = 0.002) and positively associated with the longitudinal AL changes over 12 months (r = 0.381, p = 0.04). There was an inverse association between the longer-term changes in AL and SFCT (r = -0.352, p = 0.002). The daily ocular diurnal variations were not significantly different between weekdays and weekends, or between summer and winter (each p > 0.05). In summary, diurnal variations in AL were higher in amplitude in myopes compared to emmetropes and were also associated with longitudinal changes in AL. These findings suggest that diurnal variations may be associated with longer-term axial eye growth. Time spent in bright light also significantly influenced the amplitude of daily AL variations, with more time exposed to bright light associated with a smaller amplitude of diurnal AL change. Choroidal thickness exhibited an inverse association with the AL changes, implying a potential role for the choroid in eye growth.


Assuntos
Comprimento Axial do Olho/patologia , Corioide/patologia , Ritmo Circadiano/fisiologia , Miopia/diagnóstico , Refração Ocular/fisiologia , Estações do Ano , Tomografia de Coerência Óptica/métodos , Adolescente , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Luz , Masculino , Miopia/fisiopatologia , Estudos Prospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA