Ocular dimensions in relation to auxological data in a sample of Swedish children aged 4-15 years

Measurements of oculo-palpebral landmarks and evaluation of patient's head position

PURPOSE

Keeping the head in a neutral position is requisite for glasses/lenses/head-up designs, the suitability of oculo-plastic surgery and for the grading the eye shift. Anatomically incompatible glasses are one of the common problems affecting accommodation, reducing comfort and disturbing by causing symptoms such as dizziness and nausea. The oculo-palpebral measurements act as a key determinant in symmetrical facial attractiveness. This study aims to investigate the most effective oculo-palpebral landmarks, head-neutral as the ideal position, taking into account of individual anatomical differences of these patients.

METHODS

100 females and 100 males aged between 18 and 20 years were photographed. Digital photogrammetric measurements were made with the ImageJ program. Interpupillary and interhelical distances, besides bilateral palpebral fissure length and height, and iris diameter were calculated on front-facing photographs.

RESULTS

Mean interpupillary distance was measured wider in males than in females. The mean length of palpebral fissure was 31 mm; palpebral fissure height was 10 mm. These figures were valid in both eyes and gender. The interhelical distance was calculated as the mean and was measured longer in men. Since the measurement values were the same in both sexes and on both sides, they were determined as important landmarks for controlling the head-neutral position, evaluating whether there was a deviation in the eye, and measuring the numerical value when detected.

CONCLUSION

It is essential to check the side-symmetry of the patient's palpebral fissure height, palpebral fissure length, diameter of iris and corneal depth during oculo-plastic invention and artificial design.

Refractive development I: Biometric changes during emmetropisation

PURPOSE

Although there are many reports on ocular growth, these data are often fragmented into separate parameters or for limited age ranges. This work intends to create an overview of normal eye growth (i.e., in absence of myopisation) for the period before birth until 18 years of age.

METHODS

The data for this analysis were taken from a search of six literature databases using keywords such as "[Parameter] & [age group]", with [Parameter] the ocular parameter under study and [age group] an indication of age. This yielded 34,409 references that, after screening of title, abstract and text, left 294 references with usable data. Where possible, additional parameters were calculated, such as the Bennett crystalline lens power, whole eye power and axial power.

RESULTS

There were 3422 average values for 17 parameters, calculated over a combined total of 679,398 individually measured or calculated values. The age-related change in refractive error was best fitted by a sum of four exponentials (r²  = 0.58), while all other biometric parameters could be fitted well by a sum of two exponentials and a linear term ('bi-exponential function'; r² range: 0.64-0.99). The first exponential of the bi-exponential fits typically reached 95% of its end value before 18 months, suggesting that these reached genetically pre-programmed passive growth. The second exponentials reached this point between 4 years of age for the anterior curvature and well past adulthood for most lenticular dimensions, suggesting that this part represents the active control underlying emmetropisation. The ocular components each have different growth rates, but growth rate changes occur simultaneously at first and then act independently after birth.

CONCLUSIONS

Most biometric parameters grow according to a bi-exponential pattern associated with passive and actively modulated eye growth. This may form an interesting reference to understand myopisation.

Association of birth weight with corneal aberrations in adulthood - Results from a population-based study

PURPOSE

Low birth weight (BW) is associated with increased corneal aberrations in childhood and alterations of corneal geometry in adulthood. Increased corneal aberrations may be a factor contributing to decreased visual function in former low BW newborns in later life. Hence, the aim of this study was to analyze the long-term effect of low BW on corneal aberrations in adulthood.

METHODS

In the German population-based Gutenberg Health Study (GHS) participants (age: 40-80 years) were examined with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany). The relationship between self-reported BW and the different types of corneal aberrations was analyzed using linear regression analysis as uni- and multivariable analysis with adjustment for potential confounders. The main outcome measures were corneal aberrations defined as astigmatism (Z₂^-2; Z₂²), coma (Z₃^-1; Z₃¹), trefoil (Z₃^-3; Z₃³), spherical aberration (Z₄⁰) and root-mean square of higher order aberrations (HOA; 3rd up to 8th order; aperture size: 6 mm).

RESULTS

Overall, 5,628 participants were included in this analysis (3,004 women, aged 56.0 +/- 10.3 years). In a multivariable analysis lower BW was associated with decreased horizontal trefoil (B = 0.004 [0.001; 0.006] µm/500 g; p=.008); higher spherical aberrations (B=-0.006 [-0.008;-0.003] µm/500 g; p<.001), higher RMS (B=-0.028 [-0.042;-0.014] µm/500 g; p<.001), increased HOA (B=-0.007 [-0.010;-0.003] µm/500 g; p<.001) and increased LOA (B=-0.027 [-0.041;-0.013] µm/500 g; p<.001). No association was observed between birth weight and the other types of corneal aberrations in multivariable model.

CONCLUSION

Our results indicate an association between BW and spherical aberration in adults aged 40 to 80 years. This indicates that low BW may have an association with an altered corneal shape development which may affect optical image quality and, hence, visual function.

Normal range of ocular biometry in healthy children: A systemic review and meta-analysis of 33,559 individuals under seven years of age

PURPOSE

To conduct a systemic review and meta-analysis on the normative range of ocular biometry in healthy children under seven years of age.

METHODS

A literature search was performed using the PubMed (MEDLINE) database. The main outcomes were normative values of axial length (AL), central corneal thickness (CCT), cornea curvature (CC), anterior chamber depth (ACD), lens thickness (LT) and vitreous chamber depth (VCD). Pooled estimates were obtained with a random-effects meta-analysis. Multivariate meta-regressions ascertained the moderator-related trends.

RESULTS

We included 47 studies for a total of 33,559 subjects. The pooled ALs for 0.0-1.9 years, 2.0-3.9 years and 4.0-6.9 years were 18.33 mm (95% confidence interval [CI] 17.57-19.09), 21.71 mm (21.49-21.93) and 22.37 mm (22.29-22.45), respectively. Children aged 0.0-1.9 years had a greater CCT (576.70 μm, 567.20-586.21), steeper cornea (7.41 mm, 7.16-7.65) and shallower ACD (2.46 mm, 2.23-2.69). LT ranged from 3.65 to 3.74 mm for 0-6 years, and VCD increased from 11.94 mm at birth to 15.36 mm at 4.0-6.9 years. Differences in AL between East Asian and non-East Asian children were found below two years of age (17.30 mm vs. 18.40 mm, p = 0.008) and for CC at 4.0-6.9 years of age (7.82 mm vs. 7.79 mm, p = 0.004). In a multivariate meta-regression, AL, CC, ACD and VCD increased with age (p < 0.05 for all), while CCT decreased with age (p = 0.0007).

CONCLUSIONS

This study reports normative data for ocular biometry in children. Few differences were found with ethnicity in the ocular biometry of infants and pre-schoolers.

Dry Eye Parameters and Lid Geometry in Adults Born Extremely, Very, and Moderately Preterm with and without ROP: Results from the Gutenberg Prematurity Eye Study

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (<20 s) was associated with ROP treatment (OR = 4.42; p = 0.025). Lower GA correlated with increased bulbar redness (B = −0.02; p = 0.011) and increased length of wetting in the Schirmer test (B = −0.69; p = 0.003). Furthermore, low GA was associated with narrowing of the nasal palpebral angle (B = 0.22; p = 0.011) adjusted for age and sex, but not when considering ROP in the multivariable model. Conclusion: Our analyses indicate that perinatal history affects ocular surface properties, tear production and lid geometry in adults born term and preterm. This might indicate that affected persons have a predisposition to diseases of the corneal surface such as the dry eye disease.

Validated establishment of anthropometric measurements of mid-face zone in Egyptian healthy preschool-age children: a cross-sectional study

Objectives

To provide normal reference data and identify growth patterns for craniofacial dimensions of a mid-face zone in healthy preschool Egyptian children.

Background

Anthropometry is the biological science that provides objective data to the craniofacial morphology evaluation, through a series of head and face measurements by using simple, noninvasive, low-risk, and inexpensive techniques.

Methods

The study was conducted on 3080 randomly selected healthy preschool boys and girls enrolled with criteria favoring good general health state and absence of any systemic disorders or long-term therapies. All children were subjected to detailed medical history, anthropometric measurements, head measurement (head circumference, head length, and width), and midface zone including eye measurements (inner canthal, outer canthal, inter-pupillary distance, and palpebral fissure length), nasal measurements (length, width, protrusion, columella length, and width), and ear measurements (length, width, projection, ear position, and rotation), with emphasis on the head should be erect (in the resting position) and both eyes facing forward.

Results

Upon plotting general measurements, head measurements, and specific measures of eye, nose, and ear on Z-score charts, it was shown that no significant difference was detected for the studied mid-face dimensions in both sexes with 0.6–1% low set ear setting which may be of a familial pattern. Egyptian facial morphology shows no similarities to Afro-Americans, but resembles those of Iranians with observed disagreeable ear features in comparison to Turkish children.

Conclusion

This study presents first referenced national Z-score curves that were accomplished to describe the growth pattern of mid-face proportions for Egyptian preschool healthy children.

Visual Acuity and the Risk of Cycling Injuries: Register-Based Cohort Study From Adolescence to Middle-age

BACKGROUND

Cycling is increasingly encouraged in many countries as an inexpensive and healthy choice of transportation. Operating any vehicle on the road requires high visual acuity, but few studies to our knowledge have examined the association between vision and cycling injuries.

METHODS

We examined whether poorer visual acuity is associated with increased risk of fatal and nonfatal cycling injuries. We used prospectively recorded register data for 691,402 men born between 1970 and 1992 in Sweden. We followed these men from an average age of 18 years, when visual acuity was assessed during the conscription assessment, to age 45 at the latest. We identified fatal and nonfatal cycling and car injuries using Patient and Cause of Death registers. Cox regression models were used to estimate hazard ratios and 95% confidence intervals.

RESULTS

Based on visual acuity for the eye with the best vision, moderately impaired acuity 0.9 to 0.6 when wearing refractive correction was associated with increased risk for cycling injuries (hazard ratio = 1.44 [95% confidence interval = 1.16, 1.79]) compared with unimpaired vision (uncorrected visual acuity 1.0) and after adjustment for a wide range of potential confounders. This association remained consistent across various sensitivity analyses. Visual acuity was not associated with car injury risk.

CONCLUSIONS

In this cohort study, poorer vision was specifically associated with a higher rate of cycling injuries.

Anthropometric Analysis on the Ocular Region Morphology of Children and Young Adults in Chinese Han Population

PURPOSE

The periocular features vary in different age groups and ethnic populations. In this study, the authors sought to determine whether age-related differences exist for certain periocular parameters between children and young adults of Chinese Han population.

METHODS

OU of 310 children (aged 7-10 years) and 301 young adults (aged 20-30 years) were evaluated by 2-dimensional photogrammetry. All the subjects were of Chinese Han population. The eyelid crease profiles were classified according to their morphology. Periocular measurements, including 11 linear and 3 angular parameters were acquired from standardized photographs, 3 indices were further derived. The presence of epicanthal fold was also recorded. Each of the parameters was compared between the age groups.

RESULTS

A statistical difference was found between the 2 age groups for the distribution of eyelid crease types. Statistical significances existed between the age groups for various parameters, these include palpebral fissure height and width, margin reflex distance, intercanthal and outercanthal width, distance from the medial end of the eyebrow to the medial canthus, distance from the lateral end of the brow to the lateral canthus, crease height and eyebrow height, angle of endocanthion and exocanthion, palpebral fissure inclination, palpebrae fissure index, canthal index, and angular index (p < 0.05). The incidence of epicanthal fold tended to decrease with increase of age.

CONCLUSIONS

Age differences exist in periocular features between children and young adults of Chinese Han population. Standards of periocular measurements based on age and race could provide reliable guidelines for clinical examination and planning periocular surgery.

Ocular findings in adult subjects with an inactivating mutation in GH releasing hormone receptor gene

OBJECTIVE

Ocular function is fundamental for environmental adaptation and survival capacity. Growth factors are necessary for a mature eyeball, needed for adequate vision. However, the consequences of the deficiency of circulating growth hormone (GH) and its effector insulin-like growth factor I (IGF-I) on the physical aspects of the human eye are still debated. A model of untreated isolated GH deficiency (IGHD), with low but measurable serum GH, may clarify this issue. The aim of this study was to assess the ocular aspects of adult IGHD individuals who have never received GH therapy.

DESIGN

Cross sectional study.

METHODS

Setting: University Hospital, Federal University of Sergipe, Brazil.

PATIENTS

Twenty-five adult (13 males, mean age 50.1years, range 26 to 70years old) IGHD subjects homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene, and 28 (15 males, mean age 51.1years, range 26 to 67years old) controls were submitted to an endocrine and ophthalmological assessment. Forty-six IGHD and 50 control eyes were studied.

MAIN OUTCOME MEASURES

Visual acuity, intraocular pressure, refraction (spherical equivalent), ocular axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous depth (VD), mean corneal curvature (CC) and central corneal thickness (CCT).

RESULTS

IGHD subjects exhibited unmeasurable serum IGF-I levels, similar visual acuity, intraocular pressure and LT, higher values of spherical equivalent and CC, and lower measures of AL, ACD, VD and CCT in comparison to controls, but within their respective normal ranges. While mean stature in IGHD group was 78% of the control group, mean head circumference was 92% and axial AL was 96%.

CONCLUSIONS

These observations suggest mild ocular effects in adult subjects with severe IGF-I deficiency due to non-treated IGHD.

Ophthalmological findings in relation to auxological data in moderate-to-late preterm preschool children

PURPOSE

To evaluate ophthalmological findings in preschool children born moderate-to- late preterm (MLP) and relate the findings to auxological data at birth and at 5.5 years of age.

METHODS

Seventy-eight MLP children [gestational age (GA) 32-36 weeks; 34 girls; mean age 5.7 years] were investigated. Gestational age, weight, length and head circumference at birth and at the time of assessment were registered. Visual acuity (VA), refraction, orthoptic evaluation, slit-lamp examination and ophthalmoscopy were conducted, and a history of visuoperceptual problems was recorded. The data were compared with age- and sex-matched controls born full term (n = 35).

RESULTS

Ophthalmological abnormalities were noted in 82% of MLP children and 47% of controls (p = 0.0004). There was a significant difference with regard to impaired motility (p = 0.03), heterophoria at distance (p = 0.006) and refraction expressed as spherical equivalent dioptre (p = 0.01). Amongst auxological data at birth, birthweight (BW) was the strongest predictor to ophthalmological abnormalities (p = 0.0003). In a stepwise logistic regression, GA was the strongest predictor of VA outcome at time of assessment (p = 0.0036). Moderate-to-late preterm birth showed a 2.4-fold increased risk of refractive errors compared with full-term children (RR 2.39: 95% CI 1.10-5.20; p = 0.02).

CONCLUSION

Based on our findings, MLP birth may be associated with increased ocular morbidity compared with their full-term counterparts. Auxological data at birth, especially BW, seems to be an important factor when conducting an ophthalmological diagnosis in preschool MLP children, and an increased VA was correlated to a higher GA.

Association of birth parameters with refractive status in a sample of caucasian children aged 4-17 years

Purpose. To investigate the association of birth parameters with refractive status in different age groups of Caucasian children. Materials and Methods. This cross-sectional study included 564 eyes of 282 children aged 4 to 17 years. All children underwent complete ophthalmologic examination. The children were divided into three groups according to their refractive status (emmetropia,myopia, and hyperopia), ages (4-7, 8-9, 10-12, and 13-17), and appropriateness for gestational age, respectively. Results. The mean age of the children was 9.2 ± 2.8 (age range 4-17 years). The mean spheric equivalent was +0.3 ± 1.7 (range: (-10.0)-(+10.0) diopters). The mean birth weight and gestational age were 2681.1 ± 930.8 grams (750-5000 grams) and 37.2 ± 3.7 weeks (25-42 weeks). According to multinominal logistic regression analysis, children with myopia were more likely to have higher birth weights than emmetropic children (OR: 1.0, 95% CI: 1.000-1.001, and P = 0.028). The hypermetropes were found to be significantly small for gestational age between 13 and 17 years of age. Conclusion. Birth weight and appropriateness for gestational age as birth parameters may have an impact on development of all types of refractive errors. The hypermetropic children tended to be small for gestational age.