Arne Ohlendorf

The effect of ambient illuminance on the development of deprivation myopia in chicks.

PURPOSE Recent epidemiologic studies have shown that children who spend a higher proportion of time outdoors are less likely to develop myopia. This study was undertaken to investigate whether light levels may be a relevant factor in the development of myopia. METHODS; Paradigm 1: Chicks were fitted with translucent diffusers for 5 days, with the diffusers removed daily for 15 minutes under one of three lighting conditions: (1) normal laboratory lighting (500 lux), (2) intense laboratory lighting (15,000 lux), or (3) daylight (30,000 lux). A control group, which continuously wore diffusers, was also kept under an illumination of 500 lux. Paradigm 2: Chicks fitted with translucent diffusers were raised for 4 days under one of three lighting conditions: (1) low laboratory lighting (50 lux, n = 9), (2) normal laboratory lighting (500 lux, n = 18), or (3) intense laboratory lights (15,000 lux, n = 9). In groups 1 and 3, the chicks were exposed to either low or high ambient illuminances for a period of 6 hours per day (10 AM-4 PM), but were kept under 500 lux for the remaining time of the light phase. Axial length and refraction were measured at the commencement and cessation of all treatments, with corneal curvature measured additionally in paradigm 2. RESULTS Paradigm 1: The chicks exposed daily to sunlight for 15 minutes had significantly shorter eyes (8.81 +/- 0.05 mm; P < 0.01) and less myopic refractions (-1.1 +/- 0.45 D; P < 0.01) than did the chicks that had their diffusers removed under normal laboratory light levels (8.98 +/- 0.03 mm, -5.3 +/- 0.5 D). If the diffusers were removed under intense laboratory lights, the chicks also developed shorter eyes (8.88 +/- 0.04 mm; P < 0.01) and less myopic refractions (-3.4 +/- 0.6D; P < 0.01). Paradigm 2: The chicks that wore diffusers continuously under high illuminance had shorter eyes (8.54 +/- 0.02 mm; P < 0.01) and less myopic refractions (+0.04 +/- 0.7D; P < 0.001) compared with those chicks reared under normal light levels (8.64 +/- 0.06 mm, -5.3 +/- 0.9 D). Low illuminance (50 lux) did not further increase deprivation myopia. CONCLUSIONS Exposing chicks to high illuminances, either sunlight or intense laboratory lights, retards the development of experimental myopia. These results, in conjunction with recent epidemiologic findings, suggest that daily exposure to high light levels may have a protective effect against the development of school-age myopia in children.

Visual Acuity with Simulated and Real Astigmatic Defocus

Purpose. To compare the effects of “simulated” and “real” spherical and astigmatic defocus on visual acuity (VA). Methods. VA was determined with letter charts that were blurred by calculated spherical or astigmatic defocus (simulated defocus) or were seen through spherical or astigmatic trial lenses (real defocus). Defocus was simulated using ZEMAX and the Liou-Brennan eye model. Nine subjects participated [mean age, 27.2 ± 1.8 years; logarithm of the minimum angle of resolution (logMAR), −0.1]. Three different experiments were conducted in which VA was reduced by 20% (logMAR 0.0), 50% (logMAR 0.2), or 75% (logMAR 0.5) by either (1) imposing positive spherical defocus, (2) imposing positive and negative astigmatic defocus in three axes (0, 45, and 90°), and (3) imposing cross-cylinder defocus in the same three axes as in (2). Results. Experiment (1): there were only minor differences in VA with simulated and real positive spherical defocus. Experiment (2): simulated astigmatic defocus reduced VA twice as much as real astigmatic defocus in all tested axes (p < 0.01 in all cases). Experiment (3): simulated cross-cylinder defocus reduced VA much more than real cross-cylinder defocus (p < 0.01 in all cases), similarly for all three tested axes. Conclusions. The visual system appears more tolerant against “real” spherical, astigmatic, and cross-cylinder defocus than against “simulated” blur. Possible reasons could be (1) limitations in the modeling procedures to simulate defocus, (2) higher ocular aberrations, and (3) fluctuations of accommodation. However, the two optical explanations (2) and (3) cannot account for the magnitude of the effect, and (1) was carefully analyzed. It is proposed that something may be special about the visual processing of real astigmatic and cross-cylinder defocus—because they have less effect on VA than simulations predict.

Peripheral refraction profiles in subjects with low foveal refractive errors.

Purpose. To study the variability of peripheral refraction in a population of 43 subjects with low foveal refractive errors. Methods. A scan of the refractive error in the vertical pupil meridian of the right eye of 43 subjects (age range, 18 to 80 years, foveal spherical equivalent, <±2.5 diopter) over the central ±45° of the visual field was performed using a recently developed angular scanning photorefractor. Refraction profiles across the visual field were fitted with four different models: (1) “flat model” (refractions about constant across the visual field), (2) “parabolic model” (refractions follow about a parabolic function), (3) “bi-linear model” (linear change of refractions with eccentricity from the fovea to the periphery), and (4) “box model” (“flat” central area with a linear change in refraction from a certain peripheral angle). Based on the minimal residuals of each fit, the subjects were classified into one of the four models. Results. The “box model” accurately described the peripheral refractions in about 50% of the subjects. Peripheral refractions in six subjects were better characterized by a “linear model,” in eight subjects by a “flat model,” and in eight by the “parabolic model.” Even after assignment to one of the models, the variability remained strikingly large, ranging from −0.75 to 6 diopter in the temporal retina at 45° eccentricity. Conclusions. The most common peripheral refraction profile (observed in nearly 50% of our population) was best described by the “box model.” The high variability among subjects may limit attempts to reduce myopia progression with a uniform lens design and may rather call for a customized approach.

Contrast adaptation induced by defocus - a possible error signal for emmetropization?

PURPOSE To describe some features of contrast adaptation as induced by imposed positive or negative defocus. To study its time course and selectivity for the sign of the imposed defocus. METHODS Contrast adaptation, CA (here referred to as any change in supra-threshold contrast sensitivity) was induced by presenting a movie to the subjects on a computer screen at 1m distance for 10min, while the right eye was defocused by a trial lens (+4D (n=25); -4D (n=10); -2D (n=11 subjects). The PowerRefractor was used to track accommodation binocularly. Contrast sensitivity at threshold was measured by a method of adjustment with a Gabor patch of 1deg angular subtense, filled with 3.22cyc/deg sine wave grating presented on a computer screen at 1m distance on gray background (33cd/m(2)). Supra-threshold contrast sensitivity was quantified by an interocular contrast matching task, in which the subject had to match the contrast of the sine wave grating seen with the right eye with the contrast of a grating with fixed contrast of 0.1. RESULTS (1) Contrast sensitivity thresholds were not lowered by previous viewing of defocused movies. (2) By wearing positive lenses, the supra-threshold contrast sensitivity in the right eye was raised by about 30% and remained elevated for at least 2min until baseline was reached after about 5min. (3) CA was induced only by positive, but not by negative lenses, even after the distance of the computer screen was taken into account (1m, equivalent to +1D). In five subjects, binocular accommodation was tracked over the full adaptation period. Accommodation appeared to focus the eye not wearing a lens, but short transient switches in focus to the lens wearing eye could not be entirely excluded. CONCLUSIONS Transient contrast adaptation was found at 3.22cyc/deg when positive lenses were worn but not with negative lenses. This asymmetry is intriguing. While it may represent an epiphenomenon of physiological optics, further experiments are necessary to determine whether it could also trace back to differences in CA with defocus of different sign.

The Influence of Induced Astigmatism on the Depth of Focus.

Purpose To evaluate whether an induced astigmatism influences the subjective depth of focus. Methods Fifty-one participants aged 18 to 35 years and with a mean spherical equivalent refractive error of −0.51 ± 2.35 DS participated in the study. The accommodation was blocked with three drops of 1% cyclopentolate. Refractive errors were corrected after subjective refraction with a 4-mm artificial pupil. To evaluate the depth of focus (DoF), defocus curves with a spherical range of ±1.5 DS were assessed. The DoF was calculated as the horizontal distance at a threshold level of +0.1 logMAR from the maximum visual acuity (VA). Defocus curves were estimated binocularly during distance (500 cm) and a near vision (40 cm) for two induced axis (ATR in 0° and WTR in 90°) and for a fixed amount of astigmatic defocus of −0.5 DC. Results The mean natural DoF was 0.885 ± 0.316 D for far vision and 0.940 ± 0.400 D for near vision. With induced astigmatism, the DoF for far vision was significantly increased to 1.095 ± 0.421 D (p = 0.006, ANOVA) for the WTR astigmatism but not for the ATR astigmatism (1.030 ± 0.395 D; p = 0.164, ANOVA). The induced WTR astigmatism enhanced the DoF for near vision significantly to 1.144 ± 0.338 D (p = 0.04, ANOVA), and DoF with induced ATR astigmatism (0.953 ± 0.318 D) was not significantly different (p = 1.00, ANOVA). ATR-astigmatism reduced VA by +0.08 ± 0.08 logMAR (p < 0.01, t-test). Conclusions With an induced WTR astigmatism of −0.5 DC, the DoF can be enhanced in the near viewing distance with a marginal loss in binocular VA. The approach of using induced WTR astigmatism can lead to novel optical treatments for presbyopia.

Peripheral refraction in pseudophakic eyes measured by infrared scanning photoretinoscopy.

PURPOSE: To obtain quantitative data of peripheral refractive errors in pseudophakic eyes including measurements up to ±45 degrees on the retina. SETTING: University Eye Hospital, Tübingen, Germany. DESIGN: Population‐based cross‐sectional study. METHODS: Pseudophakic and phakic subjects were measured with a purpose‐built scanning photorefractor. The instrument was improved over previous versions. It permits measurement of semicontinuous peripheral profiles over the central 90‐degree field of the retina at a faster speed (4 s/scan). RESULTS: Twenty‐four pseudophakic and 43 phakic subjects were enrolled. The intraocular lenses (IOLs) induced a mean myopic shift of 2.00 diopters (D) at ±45 degrees of eccentricity in the vertical pupil meridian. Ray‐tracing simulations with phakic eye and pseudophakic eye models agreed well with the experimental data. They showed that changes induced by IOLs were a consequence of an increase in astigmatism with eccentricity and a myopic shift in the spherical equivalent. CONCLUSIONS: The peripheral refractions in pseudophakic eyes were more myopic than in phakic eyes as a consequence of the optical design of the IOLs. Whether a more myopic refraction of approximately 2.00 D at 45 degrees has significant effects on visual performance must be tested. Perhaps there is room for improvement in the peripheral optics of IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

TuebingenCSTest – a useful method to assess the contrast sensitivity function

Since contrast sensitivity (CS) relies on the accuracy of stimulus presentation, the reliability of the psychophysical procedure and observers attention, the measurement of the CS-function is critical and therefore, a useful threshold contrast measurement was developed. The Tuebingen Contrast Sensitivity Test (TueCST) includes an adaptive staircase procedure and a 16-bit gray-level resolution. In order to validate the CS measurements with the TueCST, measurements were compared with existing tests by inter-test repeatability, test-retest reliability and time. The novel design enables an accurate presentation of the spatial frequency and higher precision, inter-test repeatability and test-retest reliability compared to other existing tests.

Steps towards Smarter Solutions in Optometry and Ophthalmology-Inter-Device Agreement of Subjective Methods to Assess the Refractive Errors of the Eye.

Purpose: To investigate the inter-device agreement and mean differences between a newly developed digital phoropter and the two standard methods (trial frame and manual phoropter). Methods: Refractive errors of two groups of participants were measured by two examiners (examiner 1 (E1): 36 subjects; examiner 2 (E2): 38 subjects). Refractive errors were assessed using a trial frame, a manual phoropter and a digital phoropter. Inter-device agreement regarding the measurement of refractive errors was analyzed for differences in terms of the power vector components (spherical equivalent (SE) and the cylindrical power vector components J0 and J45) between the used methods. Intraclass correlation coefficients (ICC’s) were calculated to evaluate correlations between the used methods. Results: Analyzing the variances between the three methods for SE, J0 and J45 using a two-way ANOVA showed no significant differences between the methods (SE: p = 0.13, J0: p = 0.58 and J45: p = 0.96) for examiner 1 and for examiner 2 (SE: p = 0.88, J0: p = 0.95 and J45: p = 1). Mean differences and ±95% Limits of Agreement for each pair of inter-device agreement regarding the SE for both examiners were as follows: Trial frame vs. digital phoropter: +0.10 D ± 0.56 D (E1) and +0.19 D ± 0.60 D (E2), manual phoropter vs. trial frame: −0.04 D ± 0.59 D (E1) and −0.12 D ± 0.49 D (E2) and for manual vs. digital phoropter: +0.06 D ± 0.65 D (E1) and +0.08 D ± 0.45 D (E2). ICCs revealed high correlations between all methods for both examiner (p < 0.001). The time to assess the subjective refraction was significantly smaller with the digital phoropter (examiner 1: p < 0.001; examiner 2: p < 0.001). Conclusion: “All used subjective methods show a good agreement between each other terms of ICC (>0.9). Assessing refractive errors using different subjective methods, results in similar mean differences and 95% limits of agreement, when compared to those reported in studies comparing subjective refraction non-cylcoplegic retinoscopy or autorefraction”.

Individual neural transfer function affects the prediction of subjective depth of focus

Attempts to accurately predict the depth of focus (DoF) based on objective metrics have failed so far. We investigated the effect of the individual neural transfer function (iNTF) on the quality of the prediction of the subjective DoF from objective wavefront measures. Subjective DoF was assessed in 22 participants using subjective through focus curves of visual acuity (VA). Objective defocus curves were calculated for visual Strehl metrics of the optical (VSOTFa) and the modulation transfer function as well as the point spread function. DoF was computed for residual lower order aberrations (rLoA) and incorporation of iNTF. Correlations between subjective and objective DoF did not reach significance, when a) standard metrics were used and b) rLoA were considered (rmax = 0.33, pall > 0.05). By incorporating the iNTF of the individuals in the calculation of the objective DoF from the VSOTFa metric, a moderate statistically significant correlation was found (r = 0.43, p < 0.01, Pearson). The iNTF of the individual’s eye is fundamental for the prediction of subjective DoF using the VSOTFa metric. Individualized predictions could aid future application in the correction of refractive errors like presbyopia using intraocular lenses.