Refractive Errors
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Refractive Error Changes in Cortical, Nuclear and Posterior Subcapsular Cataracts
1524 Refractive error changes in cortical, nuclear and posterior subcapsular cataracts. D.B. Elliott & K. Pesudovs . Department of Optometry, University of Bradford, Bradford, United Kingdom.. Purpose • To determine the effect of the three main morphological types of age-related cataract on refractive error. Background • The increase in myopia in some patients with age-related nuclear cataract is well known (Brown & Hill, 1987). This change accounts for the “second sight of the elderly” in which the myopic shift provides normal reading ability without the need for spectacles. Distance vision, however, worsens. • Planter (1981) suggested that cortical opacity can induce hyperopic shifts. However, this claim has not been repeated since and no firm evidence is available. • Review papers suggest that cortical opacity can induce astigmatic changes (Brown, 1993). However, these reports were based on clinical impression with no supporting data. • . The prevalence of uncorrected refractive error in the elderly population is high (Wormald et al., 1992). It is likely that a reasonable proportion of these patients have refractive error changes induced by cataract. • It has been suggested that a delay in operating on age-related cataract of 10 years could reduce the number of patients requiring cataract surgery (Kupfer, 1985). The possible role of correcting cataract-induced refractive error to delay the need for surgery should be explored. Subjects • 98 elderly subjects (mean age 67 ± 8 years) were recruited. • 77 subjects had one type of morphological cataract: 34 subjects had cortical cataract, 21 had nuclear cataract and 21 had posterior subcapsular cataract (PSC). • 22 subjects had normal, healthy eyes. • Ocular screening excluded amblyopia, strabismus, eye disease or surgery. -
Understanding Corneal Blindness
Understanding Corneal Blindness The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed. Corneal Diseases and Disorders that May Require a Transplant Corneal Infections. Sometimes the cornea is damaged after a foreign object has penetrated the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant. Fuchs' Dystrophy. Fuchs' Dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma (the middle layers of the cornea). This causes the cornea to swell and distort vision. Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment. Epithelial swelling damages vision by changing the cornea's normal curvature, and causing a sightimpairing haze to appear in the tissue. -
Fact Sheet: Refractive Errors
Fact Sheet: Refractive Errors More than 11 million Americans have common vision problems that can be corrected with the use of prescriptive eyewear such as glasses or contact lenses.1 These conditions are known as refractive errors and they occur when the eye doesn’t correctly bend, or ―refract,‖ light as it enters the eye. Common refractive errors include the following: o Nearsightedness (also called myopia)—A condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. o Farsightedness (also called hyperopia)—A common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. o Astigmatism—A condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. o Presbyopia—An age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Refractive errors are one of the most common—and correctable—causes of visual impairment in the United States. According to a recent study led by the National Eye Institute (NEI), approximately half of all American adults don’t have the 20/20 vision physicians consider optimal due to refractive errors.2 Women experience refractive error more frequently than men: Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older. -
Hyperopia Hyperopia
Hyperopia Hyperopia hyperopia hyperopia • Farsightedness, or hyperopia, • Farsightedness occurs if your eyeball is too as it is medically termed, is a short or the cornea has too little curvature, so vision condition in which distant objects are usually light entering your eye is not focused correctly. seen clearly, but close ones do • Its effect varies greatly, depending on the not come into proper focus. magnitude of hyperopia, the age of the individual, • Approximately 25% of the the status of the accommodative and general population is hyperopic (a person having hyperopia). convergence system, and the demands placed on the visual system. By Judith Lee and Gretchyn Bailey; reviewed by Dr. Vance Thompson; Flash illustration by Stephen Bagi 1. Cornea is too flap. hyperopia • In theory, hyperopia is the inability to focus and see the close objects clearly, but in practice many young hyperopics can compensate the weakness of their focusing ability by excessive use of the accommodation functions of their eyes. Hyperopia is a refractive error in • But older hyperopics are not as lucky as them. By which parallel rays of light aging, accommodation range diminishes and for 2. Axial is too short. entering the eye reach a focal older hyperopics seeing close objects becomes point behind the plane of the retina, while accommodation an impossible mission. is maintained in a state of relaxation. 1 Amplitude of Accommodation hyperopia Maximum Amplitude= 25-0.4(age) • An emmetropic eye for reading and other near Probable Amplitude= 18.5-.3(age) work, at distance of 16 in (40cm), the required amount of acc. -
Orthoptic Department Information Sheet
Are there any complications? Keratoconus is a rare condition where the cornea becomes thinner and cone shaped. This results in increasingly large amounts of astigmatism resulting in poor vision which is not fully corrected by glasses. Contact numbers Keratoconus usually requires contact lenses Orthoptist: for clear vision, and may eventually result in needing surgery on the cornea. St Richard’s A Keratometer is an instrument sometimes 01243 831499 used to measure the curvature of the cornea. By focusing a circle of light on the Southlands cornea and measuring its reflection, it is 01273 446077 possible to tell the exact curvature of the cornea’s surface. A more sophisticated procedure called corneal topography may be done in some cases to get an even more detailed idea of Orthoptic Department the shape of the cornea. Information Sheet We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than Astigmatism English, please contact the Communications Office by email: [email protected] St Richard’s Hospital or speak to a member of the department. Spitalfield Lane Chichester West Sussex PO19 6SE www.westernsussexhospitals.nhs.uk Southlands Hospital Department: Orthoptics Upper Shoreham Road Issue date: March 2018 Shoreham-by-Sea Review date: March 2020 West Sussex BN43 6TQ Leaflet Ref: ORT03 This leaflet is intended to answer some of What are the signs and symptoms? These eye drops stop the eyes from the questions of patients or carers of Children are good at adapting to blurred focussing for a few hours so that the patients diagnosed with astigmatism under vision and will often not show any signs of Optometrist can get an accurate reading. -
Myopia: More Than a Refractive Error − Lasik and Retinal Dystrophies
MYOPIA: MORE THAN A REFRACTIVE ERROR − LASIK AND RETINAL DYSTROPHIES WALRAEDT S.1*, LEROY B.P.1,2*, KESTELYN P.H.1, DE LAEY J.J.1 SUMMARY SAMENVATTING Three patients who had undergone laser in situ Drie patiënten die een correctie van myopie hadden keratomileusis (LASIK) correction for myopia were ondergaan met laser in situ keratomileusis (LASIK) first seen because of suboptimal visual acuity (VA) werden onderzocht omwille van postoperatieve sub- and night blindness and/or photophobia. After a com- optimale visus en nachtblindheid en/of fotofobie. Na prehensive examination including psychophysical uitgebreid onderzoek met inbegrip van psychofysi- and electrophysiological tests, two of the three pa- sche en electrofysiologische testen werd een dia- tients were shown to suffer from a progressive cone- gnose van progressieve kegeltjes-staafjesdystrofie ge- rod dystrophy. The third patient had retinitis pig- steld bij twee patiënten. De derde patiënt leed aan mentosa. These cases illustrate the need for in depth retinitis pigmentosa. Deze gevallen illustreren de preoperative evaluation in myopic patients about to noodzaak van een doorgedreven preoperatief onder- undergo LASIK when signs or problems of night blind- zoek bij myope patiënten die LASIK zullen onder- ness and/or photophobia are present. gaan met klachten van nachtblindheid en fotofobie. KEY WORDS RÉSUMÉ Retinal dystrophy, cone-rod dystrophy, Trois patients sont présentés ayant été examinés pour retinitis pigmentosa, photophobia, night une acuité visuelle sous-optimale et une héméralo- blindness, laser in situ keratomileusis, pie et/ou photophobie, après correction d’une myo- preoperative evaluation pie suivant la technique du laser in situ keratomi- leusis (LASIK). Sur base d’une évaluation élaborée, MOTS-CLÉS y inclus des tests psychophysiques et éléctrophysio- logiques, un diagnostic de dystrophie des cônes et Dystrophie rétinienne, dystrophie de type bâtonnets a été établi chez deux patients. -
Management Modalities for Keratoconus an Overview of Noninterventional and Interventional Treatments
REFRACTIVE SURGERY FEATURE STORY EXCLUSIVE ONLINE CONTENT AVAILABLE Management Modalities for Keratoconus An overview of noninterventional and interventional treatments. BY MAZEN M. SINJAB, MD, PHD anagement of keratoconus has advanced TAKE-HOME MESSAGE during the past few years, and surgeons can • When evaluating patients with keratoconus, ask now choose among numerous traditional and them to stop using RGP contact lenses at least 2 modern treatments. Traditional modalities weeks before evaluation to achieve correct Msuch as spectacle correction, contact lenses, penetrating measurement of the corneal shape. keratoplasty (PKP), and conductive keratoplasty (CK) • Interventional management modalities include CK, are still effective; however, demand for the last two has PKP, DALK, ICRSs, CXL, phakic IOLs, or some decreased with the advent of modern alternatives, specifi- combination of these treatments. cally intrastromal corneal ring segments (ICRSs) and cor- • Making the right management decision depends neal collagen crosslinking (CXL). Caution should be used on the patient’s corneal transparency and stress when considering these newer treatment modalities, and lines, age, progression, contact lens tolerance, surgeons should be aware of their indications, contraindi- refractive error, UCVA and BCVA, K-max, corneal cations, conditions, and complications before proceeding thickness, and sex. with treatment. Keratoconus treatments can be divided into two cate- Some patients achieve good vision correction and comfort gories, interventional and noninterventional. In this article, with this strategy. particular attention is given to ICRSs and CXL, as they are Advances in lens designs and materials have increased the the most popular emerging interventional management proportion of keratoconus patients who can be fitted with modalities for keratoconus. -
Astigmatism Astigmatism Is One of the Most Common Vision Problems, But
Astigmatism Astigmatism is one of the most common vision problems, but most people don't know what it is. Many people are relieved to learn that astigmatism is not an eye disease. Like nearsightedness and farsightedness, astigmatism is a type of refractive error – a condition related to the shape and size of the eye that causes blurred vision. In addition to blurred vision, uncorrected astigmatism can cause headaches, eyestrain and make objects at all distances appear distorted. Astigmatism signs and symptoms If you have only a small amount of astigmatism, you may not notice it at all, or you may have only mildly blurred or distorted vision. But even small amounts of uncorrected astigmatism can cause headaches, fatigue and eyestrain over time. Astigmatism usually develops in childhood. A study at the Ohio State University School of Optometry found that more than 28% of schoolchildren have astigmatism. Children may be even more unaware of the condition than adults, and they may also be less likely to complain of blurred or distorted vision. But astigmatism can cause problems that interfere with learning, so it's important to have your child’s eyes examined at regular intervals during their school years. What causes astigmatism? Usually, astigmatism is caused by an irregularshaped cornea, the clear front surface of the eye. In astigmatism, the cornea isn’t perfectly round, but instead is more football or eggshaped. In some cases, astigmatism may be caused by an irregularshaped lens inside the eye. In most astigmatic eyes, the irregular shape of the cornea or lens causes light rays to form two distorted images in the back of the eye, rather than a single clear one. -
Cone Contributions to Signals for Accommodation and the Relationship to Refractive Error
Vision Research 46 (2006) 3079–3089 www.elsevier.com/locate/visres Cone contributions to signals for accommodation and the relationship to refractive error Frances J. Rucker ¤, Philip B. Kruger Schnurmacher Institute for Vision Research, State University of New York, State College of Optometry, 33 West 42nd Street, New York, NY 10036, USA Received 18 February 2005; received in revised form 7 April 2006 Abstract The accommodation response is sensitive to the chromatic properties of the stimulus, a sensitivity presumed to be related to making use of the longitudinal chromatic aberration of the eye to decode the sign of the defocus. Thus, the relative sensitivity to the long- (L) and middle-wavelength (M) cones may inXuence accommodation and may also be related to an individual’s refractive error. Accommodation was measured continuously while subjects viewed a sine wave grating (2.2 c/d) that had diVerent cone contrast ratios. Seven conditions tested loci that form a circle with equal vector length (0.27) at 0, 22.5, 45, 67.5, 90, 120, 145 deg. An eighth condition produced an empty Weld stimulus (CIE (x,y) co-ordinates (0.4554, 0.3835)). Each of the gratings moved at 0.2 Hz sinusoidally between 1.00 D and 3.00 D for 40 s, while the eVects of longitudinal chromatic aberration were neutralized with an achromatizing lens. Both the mean level of accommo- dation and the gain of the accommodative response, to sinusoidal movements of the stimulus, depended on the relative L and M cone sen- sitivity: Individuals more sensitive to L-cone stimulation showed a higher level of accommodation (p D 0.01; F D 12.05; ANOVA) and dynamic gain was higher for gratings with relatively more L-cone contrast. -
Orthoptic Department Information Sheet
Are there any complications? Keratoconus is a rare condition where the cornea becomes thinner and cone shaped. This results in increasingly large amounts of Contact numbers astigmatism resulting in poor vision which is not fully corrected by glasses. Keratoconus usually requires contact lenses for clear Orthoptist: vision, and may eventually result in needing surgery on the cornea. St Richard’s 01243 788122 ext 3514 Worthing 01903 205111 ext 85430 Orthoptic Department Information Sheet We are committed to making our publications as accessible as possible. If Astigmatism you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact St Richard’s Hospital the Communications Office by: Spitalfield Lane email: [email protected] Chichester or by calling 01903 205 111 ext 84038. West Sussex PO19 6SE www.westernsussexhospitals.nhs.uk Worthing Hospital Lyndhurst Road Department: Orthoptics Worthing Issue date: Nov 2013 West Sussex Review date: Nov 2015 BN11 2DH Leaflet Ref: ORT03 This leaflet is intended to answer some of What are the signs and symptoms? These eye drops fix the child’s focus at a the questions of patients or carers of Children are good at adapting to blurred distance focus for a few hours so that the patients diagnosed with astigmatism under vision and will often not show any signs of Optometrist can get an accurate reading. the care of Western Sussex Hospitals NHS having astigmatism. Sometimes a child can The eye drops also widen the pupils to give Trust. want to sit closer to the tv than normal, or the Optometrist a good view of the back of complain of headaches, light sensitivity, the eye – this large pupil effect can last tiredness and blurred vision. -
Clinical Findings and Management of Posterior Vitreous Detachment
American Academy of Optometry: Case Report 5 Clinical Findings and Management of Posterior Vitreous Detachment Candidate’s Name, O.D. Candidate’s Address Candidate’s Phone number Candidate’s email Abstract: A posterior vitreous detachment is a degenerative process associated with aging that affects the vitreous when the posterior vitreous cortex separates from the internal limiting membrane of the retina. The composition of the vitreous gel can degenerate two collective ways, including synchysis or liquefaction, and syneresis or shrinking. Commonly, this process of separation occurs with the posterior hyaloid resulting in a Weiss ring overlying the optic nerve. Complications of a posterior vitreous detachment may include retinal breaks or detachments, retinal or vitreous hemorrhages, or vitreomacular traction. This case presentation summarizes the etiology of this ocular condition as well as treatment and management approaches. Key Words: Posterior Vitreous Detachment, Weiss Ring, Vitreous Degeneration, Scleral Depression, Nd:YAG Laser 1 Introduction The vitreous humor encompasses the posterior segment of the eye and fills approximately three quarters of the ocular space.1 The vitreous is a transparent, hydrophilic, “gel-like” substance that is described as a dilute solution of collagen, and hyaluronic acid.2,3,4 It is composed of 98% to 99.7% water.4 As the eye matures, changes may occur regarding the structure and composition of the vitreous. The vitreous functions to provide support to the retina against the choroid, to store nutrients and metabolites for the retina and lens, to protect the retinal tissue by acting as a “shock absorber,” to transmit and refract light, and to help regulate eye growth during fetal development.3,4 Case Report Initial Visit (03/23/2018) A 59-year-old Asian female presented as a new patient for examination with a complaint of a new onset of floaters and flashes of light in her right eye. -
Refractive Errors a Closer Look
2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep.