Aldo Martinez

Spectacle lenses designed to reduce progression of myopia: 12-month results.

Purpose. To report the results of 12-month wear of three novel spectacle lens designs intended to reduce peripheral hyperopic defocus and one standard design control lens and their effect on the progression of myopia in Chinese children aged 6 to 16 years. Methods. Chinese children (n = 210) with myopia (−0.75 D to −3.50 D sphere, cylinder ≤−1.50 D) were randomized to one of four groups wearing either one of three novel spectacle lens designs (types I, II, or III) or conventional, single-vision spectacle lenses. Data were collected at 6 and 12 months. Primary and secondary outcome measures were the changes in central cycloplegic auto-refraction and eye axial length, respectively. Peripheral refraction along the horizontal meridian (nasal and temporal) was taken at baseline with and without spectacle lenses. Multivariate linear regression was used to adjust analyses for important covariates. Results. Progression in eyes wearing control spectacle lenses at 6 and 12 months was −0.55 D ± 0.35 D and −0.78 ± 0.50 D, respectively. For the entire group, no statistically significant differences were observed in the rates of progression with the novel designs in comparison to control spectacle lenses. However, in younger children (6 to 12 years) with parental history of myopia (n = 100), there was significantly less progression (−0.68 D ± 0.47 D vs. −0.97 D ± 0.48 D) with lens type III compared with control spectacles (mean difference, 0.29 D, std error, 0.11, p = 0.038). Conclusions. There were no statistically significant differences in the rate of progression of myopia between the control and novel lens wearing eyes for the age group 6 to 16 years. The finding of reduced progression of myopia with type III lens design in younger children with parental myopia needs to be validated in a more targeted study.

Peripheral defocus with single-vision spectacle lenses in myopic children.

Purpose. To determine the impact of wearing single-vision spectacle lenses (SVLs) on the refractive errors at the periphery of the retina in myopic eyes of Chinese children. Methods. Twenty-eight children (8 to 15 years) were divided into two groups: one (n = 17) comprising children with low myopia (spherical equivalent between −0.75 D and −3.00 D inclusive) and the other (n = 11), with moderate myopia (spherical equivalent between −3.25 D and −6.00 D inclusive). Cycloplegic autorefraction from right eyes was measured at the fovea and at 20, 30, and 40° in the temporal and nasal visual fields. Measurements were taken on each subject both while uncorrected and while wearing SVLs. Results. Hyperopic peripheral defocus was found with SVLs in both the low and moderate myopia groups. However, the increase in relative peripheral hyperopic defocus when wearing spectacle correction, when compared with the uncorrected state was statistically significant for the moderate myopia group only. In the moderate myopia group, relative peripheral hyperopic defocus when wearing spectacle correction was statistically significantly greater vs. the low myopia group at 40° in the nasal field and at both 30 and 40° in the temporal field (p < 0.038). An increase in astigmatism with correction was observed for J45 (p < 0.05) was also seen in eyes with moderate myopia, but this was limited to the nasal field. Conclusions. Previous investigators have suggested that peripheral hyperopic defocus may play a role in the development and progression of myopia. We have shown that SVLs used to correct myopia can result in increased hyperopic defocus at the peripheral retina in the eyes of Chinese children. The magnitude of this increase tends to escalate with increasing refractive error and eccentricity, especially in cases with moderate levels of myopia.

Influence of accommodation on off-axis refractive errors in myopic eyes

INTRODUCTION This study aims to understand off-axis refraction during accommodation and to identify whether the relative hyperopia generally observed in myopic eyes changes with accommodation. METHOD Twenty bilateral myopes (18 to 33 years) between -0.50 D and -4.25 D (spherical equivalent) and astigmatism less than 1.25 D participated in this study. A soft contact lens was used to correct refractive error for all measurements. Non-cycloplegic autorefraction was measured at the fovea and 20 degrees, 30 degrees, and 40 degrees eccentricities in the nasal and temporal retina at distances of 2 m, 40 cm, and 30 cm. RESULTS Peripheral refractive error, relative to central refraction, became less hyperopic with increasing eccentricity and with increasing accommodation. Lag of accommodation increased with accommodation (p < 0.001) shifting the image-shell backward relative to the retina. In the farther periphery, there was either no change in refractive error or increased myopic shifts with accommodation. Astigmatism increased with eccentricity and significantly increased in the farther eccentricities with accommodation (p < 0.001). CONCLUSION Myopes display hyperopic shifts in the center and near peripheral field during near-viewing, while the farther periphery either remains unshifted or demonstrates a myopic shift. These results are due to the combined effect of lag of accommodation and an increased curvature of field during accommodation.

Monochromatic aberrations in hyperopic and emmetropic children

We investigated differences in higher order monochromatic aberrations between hyperopic and emmetropic eyes from two large cohorts (mostly 6 and 12 year old) of Caucasian children. Additionally, we investigated the differences of higher order monochromatic aberrations between age groups. In both cohorts, hyperopic eyes had significantly higher levels of positive spherical aberration (SA) and higher orders (HO) RMS than emmetropic eyes. Higher levels of positive SA were also found in the older cohort (irrespectively of the refractive error) although this difference was statistically significant only for emmetropic, low hyperopic and moderate hyperopic eyes. The observed higher levels of positive SA found in hyperopic eyes could explain for the previously reported differences in accommodative responses between hyperopic and non-hyperopic eyes. Our results provide some evidence of a relationship between ocular changes that typically occur during eye growth and the observed levels of higher order aberrations in children eyes.

Total ocular, anterior corneal and lenticular higher order aberrations in hyperopic, myopic and emmetropic eyes

Total ocular higher order aberrations and corneal topography of myopic, emmetropic and hyperopic eyes of 675 adolescents (16.9 ± 0.7 years) were measured after cycloplegia using COAS aberrometer and Medmont videokeratoscope. Corneal higher order aberrations were computed from the corneal topography maps and lenticular (internal) higher order aberrations derived by subtraction of corneal aberrations from total ocular aberrations. Aberrations were measured for a pupil diameter of 5mm. Multivariate analysis of variance followed by multiple regression analysis found significant difference in the fourth order aberrations (SA RMS, primary spherical aberration coefficient) between the refractive error groups. Hyperopic eyes (+0.083 ± 0.05 μm) had more positive total ocular primary spherical aberration compared to emmetropic (+0.036 ± 0.04 μm) and myopic eyes (low myopia=+0.038 ± 0.05 μm, moderate myopia=+0.026 ± 0.06 μm) (p<0.05). No difference was observed for the anterior corneal spherical aberration. Significantly less negative lenticular spherical aberration was observed for the hyperopic eyes (-0.038 ± 0.05 μm) than myopic (low myopia=-0.088 ± 0.04 μm, moderate myopia=-0.095 ± 0.05 μm) and emmetropic eyes (-0.081 ± 0.04 μm) (p<0.05). These findings suggest the existence of differences in the characteristics of the crystalline lens (asphericity, curvature and gradient refractive index) of hyperopic eyes versus other eyes.

Comparison of Aberrometer and Autorefractor Measures of Refractive Error in Children

Purpose. The purpose of this study was to evaluate and compare the Complete Ophthalmic Analysis System (COAS) G200 Aberrometer (Wavefront Sciences Inc., Albuquerque, NM) and Canon RK-F1 Autorefractor (Canon Inc., Tokyo, Japan) for measuring refractive errors in young children. Methods. The Sydney Myopia Study is a population-based study of refractive error and eye health in young Australian children. Cycloplegic refractions were performed on 1504 school year 1 students (mostly 6 years old) and 890 school year 7 (mostly 12 years old) students using both the COAS G200 Aberrometer and Canon RK-F1 autorefractor. Refractive data were analyzed using power vectors. Mean differences and 95% limits of agreement were determined for refractive components between the two instruments. Results. The mean age ± standard deviation was 6.7 ± 0.4 years (range, 5.5–9.1 years) and 12.6 ± 0.5 years (range, 11.1–14.4 years) for the year 1 and year 7 students, respectively. Mean paired differences for the M component (spherical equivalent) between the COAS G200 and Canon RK-F1 were <0.25 D in both age groups and were statistically significant in the year 1 group only (p < 0.001). Small significant differences were found in the astigmatic components (J0 and J45) in both groups. A smaller coefficient of agreement for the M component was found in the older group (0.54 D), whereas the coefficients of agreement of the astigmatic components (J0 and J45) were similar for both groups. Conclusions. The COAS G200 aberrometer was an easy-to-use instrument for the measurement of refractive error in children. In addition to being able to measure higher and lower order aberrations, the COAS G200 provides refractive error measurements comparable to those of an autorefractor.

Change in peripheral refraction and curvature of field of the human eye with accommodation

Recent research showed that the peripheral refractive state is a sufficient stimulus for myopia progression. This finding led to the suggestion that devices that control peripheral refraction may be efficacious in controlling myopia progression. This study aims to understand whether the optical effect of such devices may be affected by near focus. In particular, we seek to understand the influence of accommodation on peripheral refraction and curvature of field of the eye. Refraction was measured in twenty young subjects using an autorefractor at 0° (i.e. along visual axis), and 20°, 30° and 40° field angles both nasal and temporal to the visual axis. All measurements were conducted at 2.5 m, 40 cm and 30 cm viewing distances. Refractive errors were corrected using a soft contact lens during all measurements. As field angle increased, refraction became less hyperopic. Peripheral refraction also became less hyperopic at nearer viewing distances (i.e. with increasing accommodation). Astigmatism (J180) increased with field angle as well as with accommodation. Adopting a third-order aberration theory approach, the position of the Petzval surface relative to the retinal surface was estimated by considering the relative peripheral refractive error (RPRE) and J180 terms of peripheral refraction. Results for the estimated dioptric position of the Petzval surface relative to the retina showed substantial asymmetry. While temporal field tended to agree with theoretical predictions, nasal response departed dramatically from the model eye predictions. With increasing accommodation, peripheral refraction becomes less hyperopic while the Petzval surface showed asymmetry in its change in position. The change in the optical components (i.e. cornea and/or lens as opposed to retinal shape or position) is implicated as at least one of the contributors of this shift in peripheral refraction during accommodation.