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Correlation Between AC/A Ratio and Ciliary Muscle Morphology in School-Age Children

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Correlation Between AC/A Ratio and Ciliary Muscle Morphology in School-Age Children Correlation Between AC/A Ratio and Ciliary Muscle Morphology in School-Age Children THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Haind Fadel, M.D. Graduate Program in Vision Science The Ohio State University 2011 Master's Examination Committee: Melissa D. Bailey, OD PhD and Jeffrey J. Walline, OD PhD, Advisors Lisa A. Jones-Jordan, PhD Copyright by Haind Fadel, MD 2011 Abstract Purpose: To examine how the morphology of the ciliary muscle varies as a function of AC/A ratio and to investigate the difference between the thickness of the ciliary muscle during accommodation and during cycloplegia. Methods: Measurements were performed on the right eye only of thirty children aged 6 to 12 years. Height and weight were measured. Accommodative response was measured by autorefraction through habitual correction. Axial length was measured with the IOLMaster. Temporal ciliary muscle images from anterior segment Vistante OCT at 1mm (CMT1), 2mm (CMT2), and 3mm (CMT3) posterior to the scleral spur at 0D and 4D stimulus levels and under cycloplegia were measured four times each. Accommodative response and pupil size data were simultaneously recorded by the PowerRefractor during ciliary muscle measurements. Result: There were no significant correlations between AC/A ratio and the changes in ciliary muscle thicknesses, CMT1 (P= 0.8), CMT2 (P= 0.8), CMT3 (P=0.9), or CMT MAX (P=0.9). Axial length has an inverse correlation with the changes in ciliary muscle thicknesses at CMT1 (P=0.004), CMT2 (P=0.04), and CMT MAX (P= 0.03), but not with CMT3 (P= 0.07). However, when the extreme changes in CMT measures were removed, there was not a significant correlation with axial length at any location. Age was not ii significantly correlated with changes in CMT1 (P=0.18), CMT2 (P=0.4), CMT3 (P=0.5), or CMT MAX (P= 0.4). Conclusions: The AC/A ratio did not appear to be significantly correlated with the changes in ciliary muscle thicknesses with accommodation in this study. Increased axial length was correlated with thinning of the ciliary muscle, possibly due to the positive correlation between axial length and ciliary muscle thickness. Further investigation is necessary to determine whether the association truly exists and the potential reason for the relationship. iii Dedication “Dedicated to my family specially my beloved parents for encouraging and instilling the important of hard work and high education, to my sincere husband for his understanding and support, and to all Libyans who paid their lives for our beloved homeland” Haind Fadel iv Acknowledgments It is an honor for me to thank who made this thesis possible: Dr. Melissa Bailey and Dr. Jeffrey Walline who were abundantly helpful and offered invaluable assistance, support and guidance as my advisers. Deepest gratitude for Austen Tanner who teaches me how to read tapes and for his support. Special thanks for Dr. Karla Zadnik for guidance, support and for acceptance to be my first adviser. Dr. Lisa Jones-Jordan for serving on the thesis committee. Thank you! v Vita 1998................................................................Aligelat High School 2006................................................................M.D. Zawia Medical School 2010 to present ..............................................Graduate Student, Department of Vision Science, The Ohio State University Fields of Study Major Field: Vision Science vi Table of Contents Abstract............................................................................................................................... ii Dedication.......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita..................................................................................................................................... vi List of Tables ..................................................................................................................... ix List of Figures..................................................................................................................... x Chapter 1: Introduction....................................................................................................... 1 1.1 Accommodation ........................................................................................................ 1 1.2 AC/A Ratio ............................................................................................................... 5 1.3 Binocular Dysfunction and AC/A Ratio ................................................................... 6 1.4 Ciliary Muscle .......................................................................................................... 7 1.5 Ciliary Muscle Innervation ....................................................................................... 9 1.6 Accommodation, Ciliary Muscle, and Refractive Error ......................................... 10 1.7 AC/A Ratio and Myopia ......................................................................................... 12 vii Chapter 2: Methods .......................................................................................................... 14 2.1 Subjects ................................................................................................................... 14 2.2 Measurments ........................................................................................................... 14 2.3 Acoommdative Response........................................................................................ 16 2.4 Ciliary Muscle Image Analyses .............................................................................. 17 2.5 Data Analyses.......................................................................................................... 17 Chapter 3: Results............................................................................................................. 19 Chapter 4: Discussion ......................................................Error! Bookmark not defined.3 References......................................................................................................................... 46 viii List of Tables Table 1. Demographic characteristics of the study sample Error! Bookmark not defined.6 Table 1. Demographic characteristics of the study example. ........................................... 26 Table 2. Demographic characteristic of the changes of ciliary muscle thicknesses per unit of accommodation............................................................................................................. 27 Table 3. Multivariate linear regression models for changes in each of the ciliary muscle thickness locations. ........................................................................................................... 28 Table 4. Multivariate linear regression model for changes in ciliary muscle thickness at each location without the outliers. .................................................................................... 29 ix List of Figures Figure 1. Relationship between changes in CMT1 and axial length. ...................................... 30 Figure 2. Relationship between changes in CMT2 and axial length. ...................................... 31 Figure 3. Relationship between changes in CMT3 and axial length. ...................................... 32 Figure 4. Relationship between changes in CMTMAX and axial length. ............................... 33 Figure 5. Relationship between changes in CMT1 and age . ................................................. 34 Figure 6. Relationship between changes in CMT2 and age ............................................. ….35 Figure 7. Relationship between changes in CMT3 and age ............................................. ….36 Figure 8. Relationship between changes in CMTMAX and age ...................................... ….37 Figure 9. Relationship between changes in CMT1 and AC/A ratio .................................. ….38 Figure 10. Relationship between changes in CMT2 and AC/A ratio ................................ ….39 Figure 11. Relationship between changes in CMT3 and AC/A ratio ................................ ….40 Figure 12. Relationship between changes in CMTMAX and AC/A ratio ......................... ….41 Figure 13. Relationship between changes in CMT1(without outliers) and axial length ........... 42 Figure 14. Relationship between changes in CMT2(without outliers) and axial length ........... 43 Figure 15. Relationship between changes in CMT3(without outliers) and axial length ........... 44 Figure 16. Relationship between changes in CMTMAX(without outliers) and axial length......45 x Chapter 1: Introduction The mechanism and components of accommodation are fundamental to understanding the pathophysiology of the eye. As it is well known, the ciliary muscle is the most active component in accommodation. It is significant to know changes of morphology of the ciliary muscle with accommodation. In the other words, ciliary muscle thickness might be considered as a significant anatomical measurement for accommodation dysfunction in some ocular problems, such as refractive error. The data from this study provide ciliary muscle thickness and accommodation values for a variety of refractive errors in school-age children.
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