A. Queirós

Comparison of the ICare® rebound tonometer with the Goldmann tonometer in a normal population

The aim of this study was to evaluate the accuracy of measurement of intraocular pressure (IOP) using a new induction/impact rebound tonometer (ICare®) in comparison with the Goldmann applanation tonometer (AT).

Peripheral refraction in myopic patients after Orthokeratology

Purpose. The purpose of this study was to characterize the central and peripheral refraction across the horizontal meridian of the visual field before and after myopic corneal refractive therapy (CRT) with contact lenses. Methods. Twenty-eight right eyes from 28 subjects (mean age ± SD = 24.6 ± 6.3 years) were fitted with Paragon CRT contact lenses to treat myopia between −0.88 and −5.25 D of spherical equivalent. Along with a complete set of examination procedures to assess suitability for treatment, the central and peripheral refractions were measured along the horizontal meridian up to 35° of eccentricity in the nasal and temporal retinal area in 5° steps. Results. Baseline central average spherical equivalent (M) measured by subjective refraction changed from −1.95 ± 1.27 D to −0.38 ± 0.67 D. Changes in M component ranged between 1.42 ± 0.89 D at center and 0.43 ± 0.88 D at 20° in the temporal retina (p < 0.002). At 25° to both sides of the central refraction measurement, peripheral refraction after treatment was not statistically different from baseline values (p > 0.351). Beyond the 25° limit, M component changed in the myopic direction up to −1.11 ± 0.88 D at 35° in temporal retina (p < 0.001). Treatment induced was symmetric between nasal and temporal visual field along the horizontal meridian (p > 0.05 for all eccentricities). Furthermore, the degree of myopic increase in spherical equivalent for 30° (r2 = 0.573, p < 0.001) and 35° (r2 = 0.645, p < 0.001) eccentric refraction was highly correlated with axial spherical equivalent at baseline. Conclusions. CRT inverts the pattern of peripheral refraction in spherical equivalent refraction, creating a treatment area of myopic reduction within the central 25° of visual field, and a myopic shift beyond the 25°. In peripheral refraction for 30° and 35°, the amount of myopia induced in terms of spherical equivalent has an almost 1:1 relationship with the amount of baseline spherical equivalent refraction to be corrected.

Short-Term Changes in Light Distortion in Orthokeratology Subjects

Purpose. Quantifying adaptation to light distortion of subjects undergoing orthokeratology (OK) for myopia during the first month of treatment. Methods. Twenty-nine healthy volunteers (age: 22.34 ± 8.08 years) with mean spherical equivalent refractive error −2.10 ± 0.93D were evaluated at baseline and days 1, 7, 15, and 30 of OK treatment. Light distortion was determined using an experimental prototype. Corneal aberrations were derived from corneal topography for different pupil sizes. Contrast sensitivity function (CSF) was analyzed for frequencies of 1.50, 2.12, 3.00, 4.24, 6.00, 8.49, 12.00, 16.97, and 24.00 cpd under photopic conditions. Results. Average monocular values of all light distortion parameters measured increased significantly on day 1, returning to baseline after 1 week (P < 0.05 in all cases). Spherical-like aberration stabilized on day 7 for all pupil diameters, while coma-like for smaller pupils only. CSF was significantly reduced on day 1 for all spatial frequencies except for 1.5 cpd, returning to baseline afterwards. Significant correlation was found between light distortion and contrast sensitivity for middle and high frequencies (P < 0.05) after 15 days. Conclusion. Despite consistently increased levels of corneal aberrations, light distortion tends to return to baseline after one week of treatment, suggesting that neural adaptation is capable of overcoming optical quality degradation.

Correlations between corneal biomechanical properties measured with the ocular response analyzer and ICare rebound tonometry.

PurposeTo investigate the biomechanical properties of the normal cornea, and correlate them with central and peripheral corneal thickness and age. MethodsSeventy-six right eyes of volunteers were measured with Ocular Response Analyzer (ORA), ICare rebound tonometry and an ultrasound pachymeter at corneal center and at 4 mm from corneal center in the nasal and temporal directions. ResultsICare readings were significantly correlated with central and peripheral corneal thickness and corneal biomechanical properties. Corneal resistance factor was the biomechanical parameter with the higher correlation with ICare intraocular pressure (IOP) values. ICare tonometry at center and Goldmann equivalent IOP obtained with ORA were significantly higher for thicker than thinner corneas (P<0.05). IOP compensated for corneal properties with the ORA was lower than the remaining IOP values measured in the study. Higher correlation was found between Goldmann equivalent IOP with ORA and ICare IOP values. ConclusionsIOP values obtained with the rebound tonometer are higher in thicker corneas and are positively correlated with biomechanical corneal parameters, namely corneal resistance factor. Although corneal thickness plays a significant role in rebound tonometry, elastic and viscous properties of the cornea seem to play a significant role in the interaction of the tonometer probe with the ocular surface. However, the mechanism behind this process is presently unknown.

Age differences in central and peripheral intraocular pressure using a rebound tonometer.

Aim: To evaluate the influence of age on the measurements and relationships among central and peripheral intraocular pressure (IOP) readings taken with a rebound tonometer. Methods: The IOPs were measured using the ICare rebound tonometer on the right eyes of 217 patients (88 men and 129 women) aged 18–85 years (mean 45.9 (SD 19.8) years), at the centre and at 2 mm from the nasal and temporal limbus along the horizontal meridian. Three age groups were established: young (⩽30 years old; n = 75), middle aged (31–60 years old; n = 77) and old patients (>60 years old; n = 65). Results: A high correlation was found between the central and peripheral IOP readings, with the central readings being higher than the peripheral ones. Higher IOP values for the central location were found in the younger patients. Older patients had significantly lower temporal IOP readings than those for the remaining two groups (p<0.001), whereas no significant differences were found among groups when IOP was measured at the central and nasal locations. A significant decrease was observed in the nasal and temporal IOP readings as the age increased (p = 0.011 and 0.006, respectively). Conclusion: Older patients had lower IOP values than the middle-aged and younger patients in the temporal peripheral location. A negative correlation was found between age and IOP by rebound tonometry in the corneal periphery but not in its centre.

The influence of cycloplegia in objective refraction

The purpose of this study was to compare refractions measured with an autorefractor and by retinoscopy with and without cycloplegia. The objective refractions were performed in 199 right eyes from 199 healthy young adults with a mean age of 21.6 ± 2.66 years. The measurements were performed first without cycloplegia and repeated 30 min later with cycloplegia. Data were analysed using Fourier decomposition of the power profile. More negative values of component M and J0 were given by non‐cycloplegic autorefraction compared with cycloplegic autorefraction (p < 0.0001). However more positive values for the J45 vector were given by non‐cycloplegic autorefraction, although this difference was not statistically significant (p = 0.233). By retinoscopy, more negative values of component M were obtained with non‐cycloplegic retinoscopy (p < 0.0001); for the cylindrical vectors J0 and J45 the retinoscopy without cycloplegia yields more negative values (p = 0.234; p = 0.112, respectively). Accepting that differences between cycloplegic and non‐cycloplegic retinoscopy are only due to the accommodative response, the present results confirm that when performed by an experienced clinician, retinoscopy is a more reliable method to obtain the objective starting point for refraction under non‐cycloplegic conditions.

Peripheral refraction and retinal contour in stable and progressive myopia.

Purpose To compare the patterns of relative peripheral astigmatic refraction (tangential and sagittal power errors) and eccentric eye length between progressing and stable young-adult myopes. Methods Sixty-two right eyes of 62 white patients participated in the study, of which 30 were nonprogressing myopes (NP group) for the last 2 years and 32 were progressing myopes (P group). Groups were matched for mean spherical refraction, axial length, and age. Peripheral refraction and eye length were measured along the horizontal meridian up to 35 and 30 degrees of eccentricity, respectively. Results There were statistically significant differences between groups (p < 0.001) in the nasal retina for the astigmatic components of peripheral refraction. The P group presented a hyperopic relative sagittal focus at 35 degrees in the nasal retina of +1.00 ± 0.83 diopters, as per comparison with a myopic relative sagittal focus of −0.10 ± 0.98 diopters observed in the NP group (p < 0.001). Retinal contour in the P group had a steeper shape in the nasal region than that in the NP group (t test, p = 0.001). An inverse correlation was found (r = −0.775; p < 0.001) between retinal contour and peripheral refraction. Thus, steeper retinas presented a more hyperopic trend in the periphery. Conclusions Stable and progressing myopes of matched age, axial length, and central refraction showed significantly different characteristics in their peripheral retinal shape and astigmatic components of tangential and sagittal power errors. The present findings may help explain the mechanisms that regulate ocular growth in humans.

Effect of Pupil Size on Corneal Aberrations Before and After Standard Laser In Situ Keratomileusis, Custom Laser In Situ Keratomileusis, and Corneal Refractive Therapy

PURPOSE To evaluate the effect of changing the pupil size on the corneal first-surface higher-order aberrations induced by different refractive treatments: standard laser in situ keratomileusis (LASIK), custom LASIK, and corneal refractive therapy. DESIGN Observational study. METHODS Eighty-one right eyes from patients with a mean age of 29.94 +/- 7.5 years, of which 50 were female (61.7%), were analyzed retrospectively at the Clínica Oftalmológica NovoVision, Madrid, Spain. Corneal videokeratographic data were used to obtain corneal first-surface higher-order aberrations for aperture diameters from 3 to 8 mm using the Vol-CT software (Sarver & Associates, Inc). Total root mean square (RMS) and RMS for third- to sixth-order Zernike polynomials as well as spherical-like, coma-like, secondary astigmatism, and spherical plus coma-like variables were calculated. RESULTS We verified an increase in the higher-order aberration total RMS after treatments of 0.014 +/- 0.025 microm, 0.019 +/- 0.027 microm, and 0.018 +/- 0.031 microm for standard LASIK, custom LASIK, and corneal refractive therapy, respectively, for 3-mm pupil diameter. For the 8-mm aperture diameter, changes in total RMS increased by a factor of 50 compared with the variation for the 3-mm diameter up to 0.744 +/- 0.731 microm, 0.493 +/- 0.794 microm, and 0.973 +/- 1.055 microm for standard LASIK, custom LASIK, and corneal refractive therapy, respectively. CONCLUSIONS The 3 techniques increase the wavefront aberrations of the cornea and change the relative contribution of coma-like and spherical-like aberrations. For a large aperture (> 5 mm), corneal refractive therapy induces more spherical-like aberrations than standard and custom LASIK. However, no clinically or statistically significant differences existed for narrower apertures. Standard and custom LASIK did not display statistically significant differences regarding higher-order aberrations.

Pilot study on the influence of corneal biomechanical properties over the short term in response to corneal refractive therapy for myopia.

Purpose: To study the short-term corneal response to corneal refractive therapy for myopia and correlate it with corneal biomechanical properties as measured with the ocular response analyzer. Methods: Eight eyes from 8 young subjects were fitted with a reverse geometry contact lens, attempting a myopic correction of −4.00 D. Corneal resistance factor and corneal hysteresis (CH) were measured before contact lens fitting with the ocular response analyzer. These parameters were correlated with the degree of change in apical curvature, simulated keratometry, and central corneal thickness after 3 hours of contact lens wear (effect) and 3 hours after lens removal (recovery). Results: There was a trend toward a faster effect and faster recovery of the orthokeratologic effect for corneas with less resistance in terms of biomechanical properties. Corneal resistance factor did not correlate significantly, however, with any of the topographic and pachymetric parameters. Conversely, CH was significantly correlated with changes in steep keratometry (0.758; P = 0.029) and central corneal thickness (0.755; P = 0.030) during lens wear and with changes in steep keratometry (−0.835; P = 0.010) during recovery. Overall, higher values of CH meant slower effect and recovery of the orthokeratologic effect. Conclusions: Short-term response of human cornea to corneal refractive therapy is correlated with the biomechanical properties of the cornea. Of the different theories supporting such involvement of corneal response to reverse geometry contact lenses, the most likely one seems to be the one assuming a faster response and faster recovery for corneas with lower resistance. Larger sample studies would be needed to clarify the involvement of corneal biomechanical properties on corneal response to orthokeratology.

Local steepening in peripheral corneal curvature after corneal refractive therapy and LASIK.

Purpose. The purpose of this study was to assess the changes in curvature along the horizontal meridian of the anterior cornea occurring after refractive surgery and corneal refractive therapy (CRT). Methods. One hundred twenty-two eyes of 122 patients (70 female) with a mean (SD) age of 30.6 ± 7.5 years were retrospectively analyzed in this study. Forty-three of those underwent standard laser in situ keratomileusis (LASIK) ablation, 40 had customized LASIK and 39 had CRT with orthokeratology lenses. Patients in different groups were matched to be comparable in terms of pretreatment refractive error and corneal topographic profiles. Topographical data along the horizontal meridian were collected over a 10 mm corneal diameter in 1 mm steps using the tangential power map from the computer display. Results. A statistically significant increase in corneal power (p < 0.05) was observed at the nasal and temporal locations between 2 and 3 mm for CRT and 3 and 4 mm for LASIK procedures, from corneal keratometric center. This steepening was more pronounced after CRT treatment (p < 0.05 for all comparisons against LASIK groups) but not significantly different between LASIK groups (p > 0.124, Mann-Whitney Test). Conclusions. Both, surgical and non-surgical interventions show a mid-peripheral local corneal steepening. However, the narrower optic zone and higher midperipheral steepening with CRT seems to provide the potential to create a more relative peripheralmyopic increase in corneal power than LASIK, which may have implications in slowing down myopia progression.