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Huang SY, Su HR, Hu YS, Lee CH, Tsai MS, Yeh SM, Chen YY, Tsai TH. Immediate Effects of Vergence Exercises Using Automatic Dual Rotational Risley Prisms on Accommodative Lag and Facility. Ophthalmol Ther 2023; 12:3361-3372. [PMID: 37853298 PMCID: PMC10640441 DOI: 10.1007/s40123-023-00832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION This study evaluated novel automatic dual rotational Risley prisms (ADRRPs) as a vergence exercise tool for patients with myopia to improve accommodative lag and accommodative facility. METHODS Participants with myopia aged 20-24 years were recruited. After vergence exercises with prisms (treatment group) or plano lenses (control group) using ADRRPs for 10 min, measurements were taken using an open-field autorefractor (Grand Seiko WAM-5500) at viewing distances of 0.4 m and 6.0 m. We measured accommodative facility using a ± 2.00 D accommodative flipper. RESULTS A total of 56 participants (treatment group, 39; control group, 17) performed vergence exercises using ADRRPs. Participants in the treatment group showed improvements in accommodative lag at a 0.4 m viewing distance, with measurements of 0.57 D (right eye; OD) and 0.53 D (left eye; OS) and 0.21 D (OD) and 0.27 D (OS) before and after the exercises, respectively (p < 0.001). Over-refractions using an open-field autorefractor with spherical equivalent contact lenses at a 6.0 m viewing distance were - 0.01 ± 0.30 D (OD) and 0.03 ± 0.34 D (OS) and 0.15 ± 0.32 D (OD) and 0.19 ± 0.28 D (OS) before and after the exercises, respectively (difference + 0.16 D; p < 0.001). Accommodative facility values before and after exercises were 14.88 ± 3.36 and 15.59 ± 3.60 cpm, respectively (p < 0.01). No significant differences in accommodative lag, relaxation, and accommodative facility before and after exercise were observed in the control group. CONCLUSIONS Using ADRRPs in vergence exercises can improve accommodative lag, accommodative facility, and accommodative relaxation in adults with myopia. Further research to evaluate persistent and long-term effects is needed.
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Affiliation(s)
- Shuan-Yu Huang
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung, 402, Taiwan
| | - Hui-Rong Su
- Ph.D. Program of Electrical and Communications Engineering, Feng Chia University, Taichung, 407, Taiwan
| | - Yun-Shao Hu
- Department of Optometry, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Chi-Hung Lee
- Department of Electrical Engineering, Feng Chia University, Taichung, 407, Taiwan
| | - Ming-Shan Tsai
- Department of Electrophysics, National Chiayi University, Chiayi, 600, Taiwan
| | - Shang-Min Yeh
- Department of Optometry, Da-Yeh University, Changhua, 515, Taiwan
| | - Ya-Yu Chen
- Department of Optometry, Da-Yeh University, Changhua, 515, Taiwan
| | - Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
- Department of Ophthalmology, National Taiwan University Hospital, Taipei City, 100225, Taiwan.
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Wagner S, Süer E, Sigdel B, Zrenner E, Strasser T. Monocular transcorneal electrical stimulation induces ciliary muscle thickening in contralateral eye. Exp Eye Res 2023; 231:109475. [PMID: 37061116 DOI: 10.1016/j.exer.2023.109475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
Transcorneal electrical stimulation (TES) is used as therapy for retinal diseases such as retinitis pigmentosa (RP) and was suggested for assessing retinal sensitivity by determining phosphene thresholds, subjective luminance impressions caused by retinal stimulation. Further applications concerned the accommodation process, revealing an improved accommodative amplitude in presbyopic eyes after TES treatment. The respective changes of the ciliary muscle (CM), the structure most important for near vision, during TES are yet unknown. In a pilot study, we aimed to assess whether monocular TES leads to morphological and functional CM changes and whether central accommodation control is affected. Ten healthy, near-emmetropic adults participated in the trial (4 females, age 26.3 ± 3.6 years). Using a wavefront and a stimulus generator, a biphasic square-wave stimulus (2 s positive and 6 s negative amplitude) of 0 μA average current was produced and transferred to the eye by means of a Dawson-Trick & Litzkow electrode. Prior to the stimulation, an individual determination of phosphene thresholds served to define individual TES current amplitudes, which ranged between 60 and 100 μA. Optical coherence tomography (OCT) imaging of the right eye's temporal ciliary muscle was performed before and during ipsi-as well as contralateral monocular TES in randomized order in the morning and afternoon of the same day. During imaging, subjects fixated a target at 4 m distance and refraction was simultaneously recorded via eccentric infrared photorefraction. OCT images were assessed using previously published custom-developed software, allowing the definition of selective CM thickness (CMT) readings, and plotting of continuous CMT profiles along the muscle border. CMT profiles revealed that both stimulations, on the ipsi- and contralateral eye, induced a thickening of the CM compared to the non-stimulated state. The selective CMT readings confirmed a significant increase with ipsi- (31 ± 30 μm; p = 0.010) and contralateral (25 ± 16 μm; p = 0.001) TES. However, refraction during far vision was not significantly affected by either stimulation (ipsilateral [n = 5]: median Δw/-w/o = 0 D; contralateral [n = 7]: Δw/-w/o = 0.13 D). Pupil size on average increased during TES, but without reaching significance (ipsilateral [n = 5] median Δw/-w/o = 0.23 mm, contralateral [n = 7] Δw/-w/o = 0.39 mm). Ipsilateral CM thickening could be explained by local changes within the stimulated ciliary muscle, such as increased blood flow or interstitial fluid rise induced by TES. However, the CMT increase in the right eye when TES was performed contralaterally, on the left eye, indicates an involvement of the central control circuit of accommodation. Further possible explanations for this finding are a synchronization of neuronal activities in the visual pathway, the release of vasoactive neuropeptides, or effects on the central blood pressure regulation. Given a neuromodulation effect on the CM function, TES might have implications for children with accommodation insufficiencies and as additional therapy in myopia control management, e.g. in combination with multifocal contact lens treatment. Our study is important for the clinical application of TES, and the outcome might add crucial knowledge to the current understanding of the accommodation process and inform research and treatment of both myopia and presbyopia.
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Affiliation(s)
- Sandra Wagner
- Institute for Ophthalmic Research, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany.
| | - Esra Süer
- Institute for Ophthalmic Research, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany.
| | - Bishesh Sigdel
- Institute for Ophthalmic Research, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany.
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany; University Eye Hospital Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany; Werner Reichardt Centre for Integrative Neuroscience (CIN), Otfried-Mueller-Str. 25, 72076, Tuebingen, Germany.
| | - Torsten Strasser
- Institute for Ophthalmic Research, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany; University Eye Hospital Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany.
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Vedhakrishnan S, de Castro A, Vinas M, Aissati S, Marcos S. Accommodation through simulated multifocal optics. BIOMEDICAL OPTICS EXPRESS 2022; 13:6695-6710. [PMID: 36589586 PMCID: PMC9774842 DOI: 10.1364/boe.473595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 05/02/2023]
Abstract
We evaluated the interaction of multifocal patterns with eye's accommodation. Seven patterns were mapped on the spatial light modulator and the deformable mirror of an adaptive optics visual simulator, and projected onto the subjects' eyes, representing different contact lens designs: NoLens, Bifocal Center Distance (+2.50D), Bifocal Center Near (+2.50D) and Multifocal Center Near-MediumAdd (+1.75D) and Center Near HighAdd (+2.50D), positive and negative spherical aberration (±1µm). The change in spherical aberration and the accommodative response to accommodative demands were obtained from Hartmann-Shack measurements. Positive spherical aberration and Center Distance designs are consistent with a higher accommodative response (p=0.001 & p=0.003): steeper shift of SA towards negative values and lower accommodative lag.
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Affiliation(s)
- Shrilekha Vedhakrishnan
- Instituto de Optica ”Daza de Valdes”, Consejo Superior de Investigaciones Cientificas, IO-CSIC, Serrano, 121, Madrid 28006, Spain
| | - Alberto de Castro
- Instituto de Optica ”Daza de Valdes”, Consejo Superior de Investigaciones Cientificas, IO-CSIC, Serrano, 121, Madrid 28006, Spain
| | - Maria Vinas
- Wellman Center for Photomedicine and Harvard Medical school, Massachusetts General Hospital, 50 Blossom St, Boston, MA, USA
| | - Sara Aissati
- Center for Visual Science; The Institute of Optics; Flaum Eye Institute, University of Rochester, Rochester, New York, USA
| | - Susana Marcos
- Instituto de Optica ”Daza de Valdes”, Consejo Superior de Investigaciones Cientificas, IO-CSIC, Serrano, 121, Madrid 28006, Spain
- Center for Visual Science; The Institute of Optics; Flaum Eye Institute, University of Rochester, Rochester, New York, USA
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Sarkar S, Devi P, Vaddavalli PK, Reddy JC, Bharadwaj SR. Differences in Image Quality after Three Laser Keratorefractive Procedures for Myopia. Optom Vis Sci 2022; 99:137-149. [PMID: 34974458 DOI: 10.1097/opx.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Psychophysical estimates of spatial and depth vision have been shown to be better after bilateral ReLEx small-incision lenticule extraction (SMILE) refractive surgery for myopia, relative to photorefractive keratectomy (PRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis. PURPOSE This study aimed to compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia. METHODS Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-month, and 6-month post-operative intervals using computational through-focus analysis for a 6-mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus), and the depth of focus. RESULTS The increase in root mean squared deviations of higher-order aberrations post-operatively was lesser after SMILE (1-month visit median [25th to 75th interquartile range], 0.34 μm (0.28 to 0.39 μm]) than after PRK (0.80 μm [0.74 to 0.87 μm]) and FS-LASIK (0.74 μm [0.59 to 0.83 μm]; P ≤ .001), all relative to pre-operative values (0.20 μm [0.15 to 0.30 μm]). The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 to 0.75 D, and depth of focus widened significantly after PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significant in a minority of instances after SMILE surgery (P ≥ .01). CONCLUSIONS Although all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values after SMILE, compared with FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye post-operatively.
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Affiliation(s)
| | | | | | - Jagadesh C Reddy
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Németh J, Tapasztó B, Aclimandos WA, Kestelyn P, Jonas JB, De Faber JTHN, Januleviciene I, Grzybowski A, Nagy ZZ, Pärssinen O, Guggenheim JA, Allen PM, Baraas RC, Saunders KJ, Flitcroft DI, Gray LS, Polling JR, Haarman AEG, Tideman JWL, Wolffsohn JS, Wahl S, Mulder JA, Smirnova IY, Formenti M, Radhakrishnan H, Resnikoff S. Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute. Eur J Ophthalmol 2021; 31:853-883. [PMID: 33673740 PMCID: PMC8369912 DOI: 10.1177/1120672121998960] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
The prevalence of myopia is increasing extensively worldwide. The number of people with myopia in 2020 is predicted to be 2.6 billion globally, which is expected to rise up to 4.9 billion by 2050, unless preventive actions and interventions are taken. The number of individuals with high myopia is also increasing substantially and pathological myopia is predicted to become the most common cause of irreversible vision impairment and blindness worldwide and also in Europe. These prevalence estimates indicate the importance of reducing the burden of myopia by means of myopia control interventions to prevent myopia onset and to slow down myopia progression. Due to the urgency of the situation, the European Society of Ophthalmology decided to publish this update of the current information and guidance on management of myopia. The pathogenesis and genetics of myopia are also summarized and epidemiology, risk factors, preventive and treatment options are discussed in details.
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Affiliation(s)
- János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Beáta Tapasztó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | | | | | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | | | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Olavi Pärssinen
- Gerontology Research Centre and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, University of South-Eastern Norway, Kongsberg, Norway
| | - Kathryn J Saunders
- Centre for Optometry and Vision Science research, Ulster University, Coleraine, UK
| | - Daniel Ian Flitcroft
- Temple Street Children’s Hospital, Dublin, Ireland
- Centre for Eye Research Ireland (CERI) Technological University Dublin, Ireland
| | | | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | - Annechien EG Haarman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Willem L Tideman
- Department of Ophthalmology and Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - James Stuart Wolffsohn
- Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Siegfried Wahl
- Institute for Ophthalmic Research, University Tübingen, Tübingen, Germany
- Carl Zeiss Vision International GmbH, Tübingen, Germany
| | - Jeroen A Mulder
- Department of Optometry and Orthoptics, Hogeschool Utrecht, University of Applied Science, Utrecht, The Netherlands
| | | | - Marino Formenti
- Department of Physics, School of Science, University of Padova, Padova, Italy
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, Australia
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