Peter M. Allen

Repeatability and validity of the PowerRefractor and the Nidek AR600-A in an adult population with healthy eyes.

We assessed the repeatability and validity of the PowerRefractor and the Nidek AR-600A autorefractor. This is the first independent study conducted on adults to evaluate the performance of these instruments in a laboratory setting. Fifty subjects (23 males and 27 females) aged 16 to 61 years (mean, 37 ± 12) participated in the study. The validity of the PowerRefractor and the Nidek autorefractor readings were determined by comparing them to subjective refraction. Measurements of refractive error were obtained from the two instruments on two separate occasions to assess their repeatability. The measured refractive error was converted into a dioptric power matrix for data analysis. No significant difference was found between the measurements obtained with the two instruments and the subjective refraction. The estimate of refractive error given by the two instruments was also found to be repeatable. In addition to measuring the refractive error, the PowerRefractor also offers the facility to measure eye position, pupil size, and dynamics of accommodation. We suggest some improvements to the PowerRefractor measurement technique to standardize its clinical use and to improve accuracy.

Accommodation functions: Co-dependency and relationship to refractive error

We assessed the extent to which different accommodative functions are correlated and whether accommodative functions predict the refractive error or the progression of myopia over a 12 month period in 64 young adults (30 myopes and 34 non-myopes). The functions were: amplitude of accommodation; monocular and binocular accommodative facility (6 m and 40 cm); monocular and binocular accommodative response to target distance; AC/A and CA/C ratios, tonic accommodation (dark focus and pinhole), accommodative hysteresis, and nearwork-induced transient myopia. Within groups of related accommodative functions (such as facility measures or open-loop measures) measurements on individuals were generally significantly correlated, however correlations between functions from different groups were generally not significant. Although accommodative amplitude and pinhole (open loop) accommodation were significantly different in myopes than in non-myopes, these functions were unrelated to myopia progression. Facility of accommodation and accommodative lag was independent predictors of myopia progression.

Screening for Meares-Irlen sensitivity in adults : can assessment methods predict changes in reading speed?

Two methods of assessing candidates for coloured overlays were compared with the aim of determining which method had the most practical utility. A total of 58 adults were assessed as potential candidates for coloured overlays, using two methods; a questionnaire, which identified self‐reported previous symptoms, and a measure of perceptual distortions immediately prior to testing. Participants were classified as normal, Meares–Irlen sensitive, and borderline sensitive. Reading speed was measured with and without coloured overlays, using the Wilkins Rate of Reading Test and the change in speed was calculated. Participants classified as normal did not show any significant benefit from reading with an overlay. In contrast, a significant reading advantage was found for the borderline and Meares–Irlen participants. Current symptom rating was found to be a significant predictor of the change in reading speed, however the previous symptom rating was not found to be a reliable predictor. These data indicate that the assessment of perceptual distortions immediately prior to measuring colour preference and reading speed is the most meaningful method of assessing pattern glare and determining the utility of coloured overlays.

Facility of accommodation in myopia.

Purpose: Myopes have been shown to have abnormal accommodative characteristics. This study investigated the characteristics of accommodation facility in myopic and emmetropic students.

The effect of altering spherical aberration on the static accommodative response

Purpose:  To investigate the effect of altering the spherical aberration (SA) of the eye on the static accommodative response.

Peripheral refractive changes associated with myopia progression

PURPOSE To evaluate the changes in peripheral refraction profiles associated with myopia progression and treatment modalities used in the Cambridge Anti-Myopia Study. METHODS one hundred and seventy-seven myopes in the age range of 14 to 22 years were enrolled in the study. The mean spherical equivalent refractive error was 3.12 1.87 diopters (D) and the refractive error of each participant was corrected with contact lenses. The participants were randomly assigned to one of four treatment groups, which included: altered spherical aberration and vision training, altered spherical aberration only, vision training only, and control. Peripheral refractive error was measured using an open field autorefractor in the central 60° of the retina in 10° steps. The refractive error was measured using cycloplegic autorefraction. Two-year refractive progression data and initial peripheral refraction measurements were available in 113 participants. Measurements of peripheral refraction and cycloplegic refraction were obtained at three visits over 2 years in 12-month intervals for 92 participants. RESULTS All subjects showed a relative peripheral hyperopia, especially in the nasal retina. A limited magnitude of myopia progression of -0.34 ± 0.36 D over 2 years was found in each of the four groups on average. There were no significant differences in the rate of progression between any of the treatment groups (P > 0.05). Initial peripheral J45 astigmatic refractive error at 20° and 30° in the nasal retina was weakly correlated with progression of myopia over 2 years (r = -0.27, P = 0.004 and r = -0.20, P = 0.040, respectively; n = 113). The change in spherical equivalent peripheral refractive error at 30° nasal retina over time was also significantly correlated with progression of myopia especially at 24 months (r = -0.24, P = 0.017, n = 92). CONCLUSIONS Relative peripheral hyperopia is associated with myopia. Myopia progression may be weakly linked to changes in the peripheral refraction profiles in the nasal retina. However, a causative link between peripheral refractive error and myopia progression could not be established.

Pattern-Related Visual Stress, Chromaticity, and Accommodation

PURPOSE To investigate the impact of colored overlays on the accommodative response of individuals, with and without pattern-related visual stress (PRVS), a condition in which individuals manifest symptoms of perceptual distortion and discomfort when viewing a 3-cyc/deg square-wave grating. METHODS Under double-masked conditions, 11 individuals who reported PRVS selected an overlay with a color individually chosen to reduce perceptual distortion of text and maximize comfort (PRVS group). Two groups of control subjects individually matched for age, sex, and refractive error were recruited. Control group 1 similarly chose an overlay to maximize comfort. Control group 2 used the same overlays as the paired PRVS participant. The overlay improved reading speed by 10% (P < 0.001), but only in the PRVS group. A remote eccentric photorefractor was used to record accommodative lag while participants viewed a cross on a background. The background was uniform or contained a grating and was either gray or had a chromaticity identical with that of the chosen overlay. There were therefore four backgrounds in all. RESULTS Overall, the accommodative lag was 0.44 D greater in the participants with PRVS. When the background had the chosen chromaticity, the accommodative lag was reduced by an average of 0.16 D (P = 0.03) in the PRVS group, but not in the symptom-free groups: in control group 2 the colored background slightly increased the accommodative lag. CONCLUSIONS Accommodative lag was greater in individuals susceptible to pattern-related visual stress and was reduced by a colored background.

Aberration Control and Vision Training as an Effective Means of Improving Accommodation in Individuals with Myopia

PURPOSE To test the efficacy of a novel dual treatment for improving accommodative accuracy and dynamics in young persons with myopia. METHODS Ninety-three young persons with myopia (mean spherical equivalent, -3.0 +/- 1.8 D; age 16.8 +/- 2.1 years; spherical aberration +0.06 +/- 0.04 microm) participated in the study. Custom-designed soft contact lenses were used to alter ocular SA to -0.10 microm to improve accommodative accuracy and reduce any lag of accommodation. A vision training regimen was performed for 18 minutes per day for up to 6 weeks to improve speed of dynamic accommodation. Control groups had contact lenses with no added SA and/or no exercises. To avoid any effects of natural levels of negative aberration on the results of the study, all participants who had negative SA were excluded. RESULTS The treatment contact lenses produced a significant reduction in lag of accommodation (P < 0.05) at all proximal viewing distances measured. The vision training measurement and treatment resulted in a significant increase in distance facility rate for all groups compared with their own baselines (P < 0.05). Near facility rate improved in the vision training treatment group only compared with its baseline (P < 0.05). Both positive and negative response times for distant viewing were significantly shorter in all groups after training compared with their baseline values (P < 0.05). At near, the positive response times were decreased significantly (P < 0.05) in both groups, whereas the negative response times decreased significantly only in the vision training treatment group. CONCLUSIONS After 3 months, the dual treatments (altering SA and vision training) used in the study were effective in modifying accommodation. The static accommodative response to targets at proximal distances was increased by the altered SA contact lenses and rates of dynamic accommodation improved with vision training.

Increasing negative spherical aberration with soft contact lenses improves high and low contrast visual acuity in young adults

Purpose:  To evaluate the effects of a customised manipulation of spherical aberration (SA) on the high and low contrast visual acuities and contrast sensitivity of young adult myopes.

A systematic review of controlled trials on visual stress using Intuitive Overlays or the Intuitive Colorimeter

Claims that coloured filters aid reading date back 200 years and remain controversial. Some claims, for example, that more than 10% of the general population and 50% of people with dyslexia would benefit from coloured filters lack sound evidence and face validity. Publications with such claims typically cite research using methods that have not been described in the scientific literature and lack a sound aetiological framework. Notwithstanding these criticisms, some researchers have used more rigorous selection criteria and methods of prescribing coloured filters that were developed at a UK Medical Research Council unit and which have been fully described in the scientific literature. We review this research and disconfirm many of the more extreme claims surrounding this topic. This literature indicates that a minority subset of dyslexics (circa 20%) may have a condition described as visual stress which most likely results from a hyperexcitability of the visual cortex. Visual stress is characterised by symptoms of visual perceptual distortions, headaches, and eyestrain when viewing repetitive patterns, including lines of text. This review indicates that visual stress is distinct from, although sometimes co-occurs with, dyslexia. Individually prescribed coloured filters have been shown to improve reading performance in people with visual stress, but are unlikely to influence the phonological and memory deficits associated with dyslexia and therefore are not a treatment for dyslexia. This review concludes that larger and rigorous randomised controlled trials of interventions for visual stress are required. Improvements in the diagnosis of the condition are also a priority.