Candice E. Clifford-Donaldson

Amblyopia in Astigmatic Children: Patterns of Deficits

Neural changes that result from disruption of normal visual experience during development are termed amblyopia. To characterize visual deficits specific to astigmatism-related amblyopia, we compared best-corrected visual performance in 330 astigmatic and 475 non-astigmatic kindergarten through 6th grade children. Astigmatism was associated with deficits in letter, grating and vernier acuity, high and middle spatial frequency contrast sensitivity, and stereoacuity. Although grating acuity, vernier acuity, and contrast sensitivity were reduced across stimulus orientation, astigmats demonstrated orientation-dependent deficits (meridional amblyopia) only for grating acuity. Astigmatic children are at risk for deficits across a range of visual functions.

Changes in visual function following optical treatment of astigmatism-related amblyopia

Effects of optical correction on best-corrected grating acuity (vertical (V), horizontal (H), oblique (O)), vernier acuity (V, H, O), contrast sensitivity (1.5, 6.0, and 18.0 cy/deg spatial frequency, V and H), and stereoacuity were evaluated prospectively in 4- to 13-year-old astigmats and a non-astigmatic age-matched control group. Measurements made at baseline (eyeglasses dispensed for astigmats), 6 weeks, and 1 year showed greater improvement in astigmatic than non-astigmatic children for all measures. Treatment effects occurred by 6 weeks, and did not differ by cohort (<8 vs. >or= 8 years), but astigmatic children did not attain normal levels of visual function.

Anisometropia Prevalence in a Highly Astigmatic School-Aged Population

Purpose. To describe prevalence of anisometropia, defined in terms of both sphere and cylinder, examined cross-sectionally, in school-aged members of a Native American tribe with a high prevalence of astigmatism. Methods. Cycloplegic autorefraction measurements, confirmed by retinoscopy and, when possible, by subjective refraction were obtained from 1041 Tohono O’odham children, 4 to 13 years of age. Results. Astigmatism ≥1.00 diopter (D) was present in one or both eyes of 462 children (44.4%). Anisometropia ≥1.00 D spherical equivalent (SE) was found in 70 children (6.7%), and anisometropia ≥1.00 D cylinder was found in 156 children (15.0%). Prevalence of anisometropia did not vary significantly with age or gender. Overall prevalence of significant anisometropia was 18.1% for a difference between eyes ≥1.00 D SE or cylinder. Vector analysis of between-eye differences showed a prevalence of significant anisometropia of 25.3% for one type of vector notation (difference between eyes ≥1.00 D for M and/or ≥0.50 D for J0 or J45), and 16.2% for a second type of vector notation (between-eye vector dioptric difference ≥1.41). Conclusions. Prevalence of SE anisometropia is similar to that reported for other school-aged populations. However, prevalence of astigmatic anisometropia is higher than that reported for other school-aged populations.

Accuracy of the Welch Allyn SureSight for measurement of magnitude of astigmatism in 3- to 7-year-old children

PURPOSE To evaluate the accuracy of the Welch Allyn SureSight in noncycloplegic measurements of astigmatism as compared to cycloplegic Retinomax K+ autorefractor measurements of astigmatism in children from a Native American population with a high prevalence of high astigmatism. METHODS Data are reported for 825 3- to 7-year-old children with no ocular abnormalities. Each child had a Retinomax K+ cycloplegic measurement of right eye astigmatism with a confidence rating > or =8 and 3 attempts to obtain a SureSight measurement on the right eye. RESULTS SureSight measurement success rates did not differ significantly across age or measurement confidence rating (<6 vs > or =6). Ninety-six percent of children had at least 1 measurement (any confidence), and 89% had at least 1 measurement with confidence at the manufacturers recommended value (> or =6). Overall, the SureSight tended to overestimate astigmatism. If the SureSight measurement had any dioptric value (0.00 D to 3.00 D), astigmatism of 2.00 D or less was likely to be present. If the SureSight showed astigmatism beyond the instruments dioptric range (>3.00 D), Retinomax K+ measurements indicated that >2.00 D of astigmatism was present in 136 of 157 (86.6%). In cooperative children for whom the SureSight would not give a reading, 32 of 34 (94%) had >3.00 D of astigmatism. CONCLUSIONS The SureSight does not provide an accurate, quantitative measure of amount of astigmatism. However, it does allow accurate categorization of amount of astigmatism as < or =2.00 D, >2.00 D, or >3.00 D, and it has high measurement success rate in young children.

Accuracy and validity of IK4 handheld video keratometer measurements in children.

The infant keratometer (IK4) is a custom handheld instrument that was designed specifically to allow measurement of corneal astigmatism in infants as young as 6 months of age. In this study, accuracy of IK4 measurements with the use of standard toric surfaces was within 0.25 D. Validity measurements obtained in 860 children aged 3-7 years demonstrated slightly greater astigmatism measurements in the IK4 than in the Retinomax K+. Measurement success was 98% when the IK4 was used. The IK4 may prove to be clinically useful for screening children as young as 3 years of age at high risk for corneal astigmatism.