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Journal of Optometry 2020To determine the significance of changes and and inter-relationships between three markers of binocular function (aniseikonia, distance and near stereoacuity) following... (Comparative Study)
Comparative Study
PURPOSE
To determine the significance of changes and and inter-relationships between three markers of binocular function (aniseikonia, distance and near stereoacuity) following unremarkable LASIK at 3 and 6 months postoperatively.
METHODS
All patients underwent LASIK using the Schwind Amaris 750S and the flaps were created using Intralase 150 kHz. Patients were I, monocular myopes II, binocular myopes III, binocular hyperopes IV, binocular astigmats V, anisometropes and VI, matched age and gender control (n = 20 in each group except III where n = 18). Aniseikonia (Awaya test), distance and near stereoacuity (Randot tests) were measured before surgery, and at 3 and 6 months after surgery. At all times data were collected under constant conditions and analyzed using appropriate non-parametric statistical tests.
RESULTS
The following statistically significant changes were found after applying the Bonferroni correction (p ≤ 0.001); aniseikonia reduced (groups I, III, IV, V), stereoacuity improved at distance (groups I, III-V) and near (groups I, V). Inter-group differences in aniseikonia distance and near stereoacuity were significant preoperatively, but not postoperatively. In groups I, IV and V, the changes in aniseikonia and stereoacuity (near and distance) were significantly correlated with the preoperative value. Aniseikonia was significantly correlated with distance and near stereoacuity preoperatively but not postoperatively.
CONCLUSION
Binocular function improved in all groups after LASIK except in binocular myopes. In general, binocular function was still low compared with the control group at six months postoperatively. It is unclear why binocular function improved in the binocular astigmats.
Topics: Adult; Aniseikonia; Astigmatism; Depth Perception; Female; Humans; Hyperopia; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Middle Aged; Myopia; Prospective Studies; Vision, Binocular; Visual Acuity; Young Adult
PubMed: 31668775
DOI: 10.1016/j.optom.2019.06.004 -
Frontiers in Medicine 2021To evaluate the ocular biometric parameters in patients with constant and intermittent exotropia by the measurement of swept-source optical coherence tomography...
To evaluate the ocular biometric parameters in patients with constant and intermittent exotropia by the measurement of swept-source optical coherence tomography (SS-OCT) optical biometer OA-2000 and comparing it with the normal control subjects. Cross-sectional case-control study. Fifty-five constant and 24 intermittent patients with exotropia with central fixation and 77 orthotropic normal control participants aged 4-18 years old. Non-contact and high-resolution optical biometric OA-2000 measurements were conducted under uniform ambient light conditions. The statistical analysis included intraclass correlation coefficient (ICC), Bland-Altman plot, and independent -tests. Spherical equivalent (SE), ocular biological parameters such as pupil diameter (PD), anterior chamber depth (ACD), lens thickness (LT), and axial lengths (AL). The absolute values of inter-eye differences for SE, PD, ACD, LT, and AL were recorded as AnisoSE, AnisoPD, AnisoACD, AnisoLT, and AnisoAL, respectively. AnisoSE (0.878 vs. 0.577, = 0.019), AnisoAL (0.395 vs. 0.208, = 0.001), AnisoACD (0.060 vs. 0.032, < 0.001), AnisoLT (0.060 vs. 0.031, = 0.002), and AnisoPD (0.557 vs. 0.340, = 0.002) were significantly larger in concomitant patients with exotropia. The SE, AL, ACD, LT, and PD showed excellent binocular correlation with ICC values that ranged from 0.943 to 0.987 in control participants and from 0.767 to 0.955 in concomitant exotropia patients. Bland-Altman plots showed the wider range of agreement in patients with concomitant exotropia than the control participants (SE: 5.0288 vs. 3.3258; AL: 2.2146 vs. 1.3172; ACD:0.3243 vs. 0.1682; PD: 2.4691 vs. 1.9241; and LT:0.3723 vs 0.1858). Patients with concomitant exotropia showed larger inter-eye differences in SE, ACD, LT, PD, and AL. Advice should be given to suspicious children to avoid or delay the development of concomitant exotropia.
PubMed: 35059408
DOI: 10.3389/fmed.2021.724122 -
Clinical Ophthalmology (Auckland, N.Z.) 2022To evaluate long-term safety, effectiveness, and stability of unilateral LASIK in pediatric myopic anisometropic amblyopia.
PURPOSE
To evaluate long-term safety, effectiveness, and stability of unilateral LASIK in pediatric myopic anisometropic amblyopia.
METHODS
This retrospective study included children who received unilateral LASIK for myopic anisometropia of >6 D, after mandatory 6-month occlusion/penalization therapy. They were evaluated at 6 months, 1 year, 2 years and biannually until 10 years. Outcome measures included visual acuity, refraction, ocular alignment, stereopsis, corneal clarity, and corneal topography.
RESULTS
32 patients (16 girls) with mean age of 8.6 ± 2.3 years completed 10 years of follow up after unilateral LASIK. Mean preoperative spherical equivalent refraction (SER) was -10.3D ±2.0D in the affected eye, with anisometropic difference of -9.5D ±1.7D. Mean post-LASIK SER was -1.3D±0.8D (p<0.001). Anisometropia significantly decreased to 0.3D±0.8D, 0.4D±1.0D, and 1.0±2.5D at 6 months, 1 year and 10 years respectively (p<0.001). 11 patients (34%) who had preoperative intermittent exotropia (< 15°) regained orthophoria in all gazes, while 5 of 10 who had constant exotropia with large angle (>30°) required strabismus surgery for ocular alignment. BCVA improved from 0.04±0.6 Decimal at baseline to 0.6 ±0.2 after LASIK and occlusion therapy (p< 0.001). Despite insignificant refractive regression in both eyes, patients have maintained orthophoria, improved stereopsis, clear cornea, and the topography showed no evidence of post-LASIK ectasia.
CONCLUSION
LASIK appears safe, effective, and stable for correcting refractory pediatric myopic anisometropia, in which conventional measures fail or endanger normal visual development. Eliminating anisometropic aniseikonia consequently restores binocular vision and stereopsis which, along with amblyopia therapy, would reverse amblyopia and prevent recurrence.
PubMed: 36578667
DOI: 10.2147/OPTH.S387302 -
Investigative Ophthalmology & Visual... Oct 2019We measure neural responses associated with form and motion processing in children with anisometropia before and after treatment with spectacles and occlusion.
PURPOSE
We measure neural responses associated with form and motion processing in children with anisometropia before and after treatment with spectacles and occlusion.
METHODS
In this prospective, case-control treatment study, 10 children with anisometropia and amblyopia and 16 age-matched visually normal children participated. Steady-state visual evoked potentials (VEP) were recorded from electrodes over the occipital cortex. The visual stimulus comprised a horizontal bar grating into which Vernier offsets were introduced and withdrawn periodically at 3.75 Hz. The VEP amplitude at 3.75 Hz (first harmonic [1F]) and 7.5 Hz (second harmonic [2F]) were recorded to index the sensitivity of form/position-sensitive versus motion/transient-sensitive neural populations, respectively. Response amplitude at 1F and 2F were recorded over a series of 10 logarithmically spaced offset sizes before and after treatment. Main outcome measures are VEP amplitude versus displacement functions, interocular response amplitude differences.
RESULTS
After relaxing into spectacles (minimally-treated state), form/position-sensitive responses in the dominant/less ametropic eye of the children with anisometropia were larger and responses in the more ametropic eye were smaller than those of controls. Motion-transient responses were equal to those of controls in the less ametropic eye, but were smaller than controls in the more ametropic eye. After treatment, responses did not differ from those of controls.
CONCLUSIONS
Form and motion responses are differentially susceptible to neural deprivation via optical blur. Form responses are more plastic than motion responses in minimally-treated children with anisometropic amblyopia. Most treatment effects occurred above threshold range, suggesting some treatment effects are not detected clinically.
Topics: Amblyopia; Anisometropia; Case-Control Studies; Child; Child, Preschool; Evoked Potentials, Visual; Eyeglasses; Female; Form Perception; Humans; Male; Motion Perception; Prospective Studies; Visual Acuity; Visual Cortex
PubMed: 31574139
DOI: 10.1167/iovs.19-27005 -
American Journal of Ophthalmology Feb 2024To examine the genetic and clinical features and the natural history of RBP3-associated retinopathy.
PURPOSE
To examine the genetic and clinical features and the natural history of RBP3-associated retinopathy.
DESIGN
Multi-center international, retrospective, case series of adults and children, with moleculraly confirmed RBP3-asociated retinopathy.
METHODS
The genetic, clinical, and retinal imaging findings, including optical coherence tomography (OCT) and fundus autofluorescence (FAF), were investigated both cross-sectionally and longitudinally. The results of international standard full-field electroretinography (ERG) and pattern electroretinography (PERG) were reviewed.
RESULTS
We ascertained 12 patients (5 female and 7 male) from 10 families (4 patients previously reported). Ten novel disease-causing RBP3 variants were identified. Ten patients were homozygous. The mean age (±SD, range) of the group was 21.4 years (±19.1, 2.9-60.5 years) at baseline evaluation. All 12 patients were highly myopic, with a mean spherical equivalent of -16.0D (range, -7.0D to -33.0D). Visual acuity was not significantly different between eyes, and no significant anisometropia was observed. Mean best-corrected visual acuity (BCVA) was 0.48 logMAR (SD, ±0.29; range, 0.2-1.35 logMAR); at baseline. Eleven patients had longitudinal BCVA assessment, with a mean BCVA of 0.46 logMAR after a mean follow-up of 12.6 years. All patients were symptomatic with reduced VA and myopia by the age of 7 years old. All patients had myopic fundi and features in keeping with high myopia on OCT, including choroidal thinning. The 4 youngest patients had no fundus pigmentary changes, with the rest of the patients presenting with a variable degree of mid-peripheral pigmentation and macular changes. FAF showed variable phenotypes, ranging from areas of increased signal to advanced atrophy in older patients. OCT showed cystoid macular edema at presentation in 3 patients, which persisted during follow-up in 2 patients and resolved to atrophy in the third patient. The ERGs were abnormal in 9 of 9 cases, revealing variable relative involvement of rod and cone photoreceptors with additional milder dysfunction post-phototransduction in some. All but 1 patient had PERG evidence of macular dysfunction, which was severe in most cases.
CONCLUSIONS
This study details the clinical and functional phenotype of RBP3-retinopathy in the largest cohort reported to date. RBP3-retinopathy is a disease characterized by early onset, slow progression over decades, and high myopia. The phenotypic spectrum and natural history as described herein has prognostic and counseling implications. RBP3-related disease should be considered in children with high myopia and retinal dystrophy.
Topics: Adult; Aged; Child; Female; Humans; Male; Young Adult; Atrophy; Electroretinography; Myopia; Retina; Retinal Dystrophies; Retrospective Studies; Tomography, Optical Coherence; Retinol-Binding Proteins
PubMed: 37806543
DOI: 10.1016/j.ajo.2023.09.025 -
Frontiers in Physiology 2022This study aimed to explore the macular structures and vascular characteristics of more myopic (MM) and contralateral eyes with highly myopic anisometropia....
This study aimed to explore the macular structures and vascular characteristics of more myopic (MM) and contralateral eyes with highly myopic anisometropia. Comprehensive ophthalmic examinations were performed for 33 patients with highly myopic anisometropia. Macular structures (total retinal layer [TRL], ganglion cell and inner plexiform layer [GCIPL], inner nuclear layer [INL], outer retinal layer [ORL], nerve fiber layer [NFL], choroidal layer [CHL]) and vascular characteristics (superficial vascular complex density [SVD], deep vascular complex density [DVD], choriocapillaris perfusion area [CCPA]) were assessed using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). Macular structures and vascular characteristics of each subregion were compared to those of the Early Treatment of Diabetic Retinopathy Study (ETDRS). With highly myopic anisometropia, the thicknesses of the TRL, GCIPL, INL, and ORL in MM eyes were smaller than those in contralateral eyes in at least one quadrant of the perifoveal and parafoveal circles (all < 0.05), with no changes in the foveal and temporal quadrants of perifoveal regions (all > 0.05). A thicker NFL ( = 0.018) was found in MM eyes than in contralateral eyes in the superior perifoveal quadrant. The CHL (all < 0.05) in MM eyes was thinner in all regions than in the contralateral eyes according to the ETDRS. There were no statistical differences in the SVD, DVD, and CCPA of MM and contralateral eyes (all > 0.05). All retinal layers, except the NFL, tended to be thinner in all subregions, except the temporal perifoveal and foveal quadrants in MM eyes, and choroidal thickness was thinned in all areas.
PubMed: 36045745
DOI: 10.3389/fphys.2022.918393 -
Indian Journal of Ophthalmology Aug 2022To study the profile, risk factors, and management outcomes of infantile strabismus at a tertiary eye care center.
PURPOSE
To study the profile, risk factors, and management outcomes of infantile strabismus at a tertiary eye care center.
METHODS
We prospectively analyzed the data of infants (children less than 1 year of age) who presented at our institute from August 2018 to December 2019. We excluded infants who did not complete a minimum follow-up of 6 months. Detailed meticulous history based on a set of standardized questionnaires was obtained and a comprehensive ophthalmological examination of the child was performed. Data were collected regarding refractive error (astigmatism; myopia; hyperopia; anisometropia [<1.0 DS or >1.0 DS]; astigmatism [<1.0 DS or >1.0 DS]) and the type of strabismus.
RESULTS
During this period, we saw 4,773 infants, out of which 123 infants were diagnosed to have infantile-onset strabismus (hospital prevalence of 2.6%). Boys and girls were equally affected. Sixty-two patients had esotropia, 37 had exotropia, 2 had hypotropia, and 22 had pseudo strabismus. Prematurity, hypermetropia, and anisometropia had increased odds of developing esotropia, whereas delivery by cesarean section, delayed cry at birth, infantile seizures, parental consanguinity, delayed development of milestones, and myopia had increased odds of developing exotropia. Twenty-nine patients underwent a surgical correction. The mean deviation at the first visit was 42.59 ± 15.40 PD and 8.25 ± 12.70 PD at the last visit. For all patients who underwent a squint surgery, the change in ocular deviation was clinically and statistically significant (P-value <0.0001, paired t-test).
CONCLUSION
The hospital prevalence of infantile strabismus in our cohort was found to be 2.6%. Our study suggests that esotropia is two-fold more common in our cohort as compared to exotropia. Further, our study highlights risk factors for the development of strabismus in infancy, which must be kept in mind and awareness must be created among pediatricians. Surgical correction should be considered early during the infantile period, because it may lead to promote the development of good binocular vision.
Topics: Anisometropia; Astigmatism; Cesarean Section; Child; Esotropia; Exotropia; Female; Humans; Hyperopia; Infant, Newborn; Male; Myopia; Pregnancy; Retrospective Studies; Strabismus
PubMed: 35918972
DOI: 10.4103/ijo.IJO_543_22 -
Investigative Ophthalmology & Visual... Jun 2023To identify gene variants associated with anisometropia development in children.
PURPOSE
To identify gene variants associated with anisometropia development in children.
METHODS
This is a population-based, cross-sectional, and longitudinal genetic association study involving 1057 children aged 6 to 10 years with both baseline and 3-year follow-up data. Six single nucleotide polymorphisms (SNPs), ZC3H11B rs4373767, ZFHX1B rs13382811, KCNQ5 rs7744813, SNTB1 rs7839488, PAX6 rs644242, and GJD2 rs524952 were analyzed in all children. Anisometropia was defined by an interocular difference in SE of ≥1 diopter (D) (Aniso-SE) and an interocular difference in axial length (AL) of ≥0.3 mm (Aniso-AL), respectively. Genetic associations of individual SNPs and joint SNP effects were analyzed.
RESULTS
ZFHX1B rs13382811 was associated nominally with Aniso-AL (odds ratio [OR], 1.66; P = 0.003) at baseline. At 3 years, rs13382811 was significantly associated with Aniso-AL (OR, 1.49; P = 0.001) and became nominally associated with Aniso-SE (OR, 1.40; P = 0.01). In addition, PAX6 rs644242 was significantly associated with Aniso-AL at 3 years (OR, 1.45; P = 0.002). At the 3-year follow-up, PAX6 rs644242 was associated significantly with Aniso-AL development (OR, 1.61; P = 0.0003) and nominally with Aniso-SE development (P = 0.03) in children who were not anisometropic at baseline, whereas ZFHX1B rs13382811 was associated nominally with Aniso-AL development (P = 0.02). An additive SNP analysis indicated children carrying the risk allele T of ZFHX1B rs13382811 and allele A of PAX6 rs644242 might have a 4.33- and 6.90-fold of increased risk of Aniso-SE and Aniso-AL development by 3 years, respectively.
CONCLUSIONS
This study identified two susceptible gene variants, ZFHX1B rs13382811 and PAX6 rs644242, for anisometropia development in Hong Kong Chinese children, implicating their role in imbalanced refractive change and axial elongation between both eyes.
Topics: Child; Humans; Anisometropia; Axial Length, Eye; Cross-Sectional Studies; East Asian People; Eye; Hong Kong; PAX6 Transcription Factor; Zinc Finger E-box Binding Homeobox 2
PubMed: 37266952
DOI: 10.1167/iovs.64.7.6 -
Frontiers in Medicine 2023There is a particular anisometropia occurring in one eye with myopia, while the other eye has very low myopia, emmetropia, or very low hyperopia. It is unclear how the...
PURPOSE
There is a particular anisometropia occurring in one eye with myopia, while the other eye has very low myopia, emmetropia, or very low hyperopia. It is unclear how the binocular axial length changes when these children wear unilateral OK lenses only in the more myopic eyes. This study investigates the changes in the axial elongation of both eyes.
METHODS
This is a 1-year retrospective study. In total, 148 children with myopic anisometropia were included. The more myopic eyes were wearing orthokeratology lenses (treated eyes), whereas the contralateral eyes were not indicated for visual correction (untreated eyes). The untreated eyes were classified into three subgroups based on the spherical equivalent refraction (SER): low myopia (≤ -0.50 D, = 37), emmetropia (+0.49 to -0.49 D, = 76), and low hyperopia (≥0.50 D, = 35). Changes in the axial length (AL) were compared between the untreated and treated eyes and among the three subgroups.
RESULTS
The axial elongation was 0.14 ± 0.18 mm and 0.39 ± 0.27 mm in all treated and untreated eyes, respectively ( < 0.001). The interocular AL difference decreased significantly from 1.09 ± 0.45 mm at the baseline to 0.84 ± 0.52 mm at 1 year ( < 0.001). The baseline median (Q1, Q3) SER of the untreated eyes were -0.75 D (-0.56, -0.88 D), 0.00 D (0.00, -0.25 D), and +0.75 D (+1.00, +0.62 D) in low myopia, emmetropia, and low hyperopia subgroups, respectively. The axial elongation was 0.14 ± 0.18 mm, 0.15 ± 0.17 mm, and 0.13 ± 0.21 mm ( = 0.92) in the treated eyes and 0.44 ± 0.25 mm, 0.35 ± 0.24 mm, and 0.41 ± 0.33 mm in the untreated eyes ( = 0.11) after 1 year. Multivariate linear regression analyses only showed significant differences in axial elongation between the emmetropia and low myopia subgroups of untreated eyes ( = 0.04; > 0.05 between other subgroups).
CONCLUSION
Unilateral orthokeratology lenses effectively reduced axial elongation in the more myopic eyes and reduced interocular AL differences in children with myopic anisometropia. The refractive state of the untreated eyes did not affect the axial elongation of the more myopic eye wearing the orthokeratology lens. In the untreated eyes, AL increased faster in the low myopia subgroup than in the emmetropia subgroup.
PubMed: 38020088
DOI: 10.3389/fmed.2023.1266354 -
Taiwan Journal of Ophthalmology 2022To compare and evaluate improvement in corrected distant visual acuity (CDVA) between myopia and hyperopia after laser keratomileusis (LASIK) in adult patients with...
PURPOSE
To compare and evaluate improvement in corrected distant visual acuity (CDVA) between myopia and hyperopia after laser keratomileusis (LASIK) in adult patients with anisometropic amblyopia.
MATERIALS AND METHODS
This prospective clinical study included 103 amblyopic eyes (103 patients), which underwent LASIK correction of refractive error from January 2013 to January 2018. Uncorrected distance visual acuity (UDVA), CDVA, spherical equivalent (SE), postoperative astigmatism, and intraocular pressure were evaluated at time points of 1, 6, and 12 months.
RESULTS
Patients were divided into two groups according to refractive error. Group 1: Forty-six patients with myopia and Group 2: Fifty-seven patients with hyperopia. Mean CDVA (logarithm of the minimum angle of resolution [logMAR]) preoperatively was 0.23 ± 0.16 in Group 1 and 0.40 ± 0.19 in Group 2. Postoperative CDVA (logMAR) was 0.17 ± 0.13 in Group 1 and 0.32 ± 0.17 in Group 2. There was statistically significant increase in UDVA ( < 0.0001) postoperatively and no change during the follow-up period of 12 months in both groups. Group 1 showed more expectable results, 95% of variability SE achieved was dependent on SE intended ( 0.95), while in Group 2, the percentage was slightly lower of expected 87% ( 0.87). There was statistical significance in respect of CDVA change postoperatively and preoperatively in both groups. Correlation factors are low, in Group 1 = -0.53 and in Group 2 = -0.39.
CONCLUSION
LASIK can improve CDVA in a considerable portion of amblyopic eyes, both myopic and hyperopic. Eyes with better initial CDVA and those with myopia were associated with greater improvement in postoperative CDVA.
PubMed: 36660114
DOI: 10.4103/tjo.tjo_22_21