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Utility of an open field Shack-Hartmann aberrometer for measurement of refractive error in infants and young children.

ABSTRACT: To assess the utility of an open-field Shack-Hartmann aberrometer for measurement of refractive error without cycloplegia in infants and young children.Data included 2698 subject encounters with Native American infants and children aged 6 months to <8 years. We attempted right eye measurements without cycloplegia using the pediatric wavefront evaluator (PeWE) on all participants while they viewed near (50 cm) and distant (2 m) fixation targets. Cycloplegic autorefraction (Rmax [Nikon Retinomax K-plus2]) measurements were obtained for children aged ? 3 years.The success rates of noncycloplegic PeWE measurement for near (70%) and distant targets (56%) significantly improved with age. Significant differences in mean spherical equivalent (M) across near versus distant fixation target conditions were consistent with the difference in accommodative demand. Differences in astigmatism measurements for near versus distant target conditions were not clinically significant. Noncycloplegic PeWE and cycloplegic Rmax measurements of M and astigmatism were strongly correlated. Mean noncycloplegic PeWE M was significantly more myopic or less hyperopic and astigmatism measurements tended to be greater in magnitude compared with cycloplegic Rmax.The PeWE tended to overestimate myopia and underestimate hyperopia when cycloplegia was not used. The PeWE is useful for measuring accommodation and astigmatism.

SUBMITTER: Harvey EM

PROVIDER: S-EPMC3881277 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Utility of an open field Shack-Hartmann aberrometer for measurement of refractive error in infants and young children.

Harvey Erin M EM Miller Joseph M JM Schwiegerling Jim J

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 20131001 5

<h4>Purpose</h4>To assess the utility of an open-field Shack-Hartmann aberrometer for measurement of refractive error without cycloplegia in infants and young children.<h4>Method</h4>Data included 2698 subject encounters with Native American infants and children aged 6 months to <8 years. We attempted right eye measurements without cycloplegia using the pediatric wavefront evaluator (PeWE) on all participants while they viewed near (50 cm) and distant (2 m) fixation targets. Cycloplegic autorefr ...[more]

PMID: 24160970

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Project description:PURPOSE:The intrinsically photosensitive retinal ganglion cells (ipRGCs) signal environmental light, control pupil size and entrain circadian rhythm. There is speculation that ipRGCs may be involved in the protective effects of light exposure in myopia. Here, the ipRGC-driven pupil response was evaluated in children and examined with light exposure and refractive error. METHODS:Children ages 5-15 years participated. Subjects wore an actigraph device prior to the lab visit for objective measures of light exposure and sleep. For pupillometry, the left eye was dilated and presented with stimuli, and the consensual pupil response was measured in the right eye. Pupil measurements were preceded by 5 min dark adaptation. In Experiment 1 (n = 14), 1 s long wavelength light ('red,' 651 nm, 167 cd m-2 ) and 10 increasing intensities of 1 s short wavelength light ('blue,' 456 nm, 0.167-167 cd m-2 ) were presented with a 60 s interstimulus interval. A piecewise two-segment regression was fit to the stimulus response function to determine the functional melanopsin threshold. Pupil responses were analysed with light exposure over the previous 24 h. For Experiment 2 (n = 42), three 1 s red and three 1 s blue alternating stimuli were presented with a 60 s interstimulus interval. Following an additional 5-min dark adaption, the experiment was repeated. Pupil metrics included peak constriction, the 6 s and 30 s post-illumination response (PIPR), early and late area under the curve (AUC). Following pupil measurements, cycloplegic refractive error and axial length were measured. RESULTS:For Experiment 1, PIPR metrics demonstrated a graded response to increasing intensity blue stimuli, with a mean functional melanopsin threshold of 6.2 ± 4.5 cd m-2 (range: 0.84-16.7 cd m-2 ). The 6 s PIPR and early AUC were associated with 24-h light exposure for high intensity stimuli (33.3 and 83.3 cd m-2 , p < 0.005 for both). For Experiment 2, there were no associations between pupil metrics and refractive error. The 6 s PIPR and early AUC to blue stimuli were significantly increased for Trial 2 compared to Trial 1. CONCLUSIONS:The ipRGC-driven pupil responses in children were robust and similar to responses previously measured in an adult population. The 6 s PIPR and early AUC to high intensity blue stimuli were associated with previous light exposure. There were no associations between the ipRGC-driven pupil response and refractive status in this cohort.

Project description:ImportanceRefractive error (RE) is the most common form of visual impairment, and myopic RE is associated with an increased risk of primary open-angle glaucoma (POAG). Whether this association represents a causal role of RE in the etiology of POAG remains unknown.ObjectiveTo evaluate shared genetic influences and investigate the association of myopic RE with the risk for POAG.Design, setting, and participantsObservational analyses were used to evaluate the association between mean spherical equivalent (MSE) RE (continuous trait) or myopia (binary trait) and POAG risk in individuals from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. To quantify genetic overlap, genome-wide genetic correlation analyses were performed using genome-wide association studies (GWAS) of MSE RE or myopia and POAG from GERA. Potential causal effects were assessed between MSE RE and POAG using 2-sample Mendelian randomization. Genetic variants associated with MSE RE were derived using GWAS summary statistics from a GWAS of RE conducted in 102 117 UK Biobank participants. For POAG, we used GWAS summary statistics from our previous GWAS (3836 POAG cases and 48 065 controls from GERA). Data analyses occurred between July 2020 and October 2021.Main outcomes and measureOur main outcome was POAG risk as odds ratio (OR) caused by per-unit difference in MSE RE (in diopters).ResultsOur observational analyses included data for 54 755 non-Hispanic White individuals (31 926 [58%] females and 22 829 [42%] males). Among 4047 individuals with POAG, mean (SD) age was 73.64 (9.20) years; mean (SD) age of the 50 708 controls was 65.38 (12.24) years. Individuals with POAG had a lower refractive MSE and were more likely to have myopia or high myopia compared with the control participants (40.2% vs 34.1%, P = 1.31 × 10-11 for myopia; 8.5% vs 6.8%, P = .004 for high myopia). Our genetic correlation analyses demonstrated that POAG was genetically correlated with MSE RE (rg, -0.24; SE, 0.06; P = 3.90 × 10-5), myopia (rg, 0.21; SE, 0.07; P = .004), and high myopia (rg, 0.23; SE, 0.09; P = .01). Genetically assessed refractive MSE was negatively associated with POAG risk (inverse-variance weighted model: OR per diopter more hyperopic MSE = 0.94; 95% CI, 0.89-0.99; P = .01).Conclusions and relevanceThese findings demonstrate a shared genetic basis and an association between myopic RE and POAG risk. This may support population POAG risk stratification and screening strategies, based on RE information.

Project description:Accommodative esotropia (AE) is a convergent deviation due to an excess of the convergence linked to the innervational stimulus for accommodation and it is usually associated to the presence of hyperopia. The development of hyperopia over time has been widely described but the lack of comparative analysis among accommodative esotropia subtypes, does not allow to verify the existence of different developmental patterns. In this study we aimed to describe the long term changes of refractive error in patients affected by accommodative esotropia as a function of the strabismus type: refractive (RAE), non-refractive (NRAE) and partially accommodative esotropia (PAE). The medical records of 66 patients (24 RAE, 22 PAE, 20 NRAE), who wore the full correction of their cycloplegic refraction error during the entire follow up period, were retrospectively reviewed. Mean outcome was the analysis of the variations, among groups, of refractive error over time; differences between mild (≤3.00D) and high (≥5.00D) hyperopia, effects of amblyopia and relationship with AC/A ratio were also investigated. All patients were followed up from approximately 4 years of age to 20, with mean follow up of 16.06±0.29 years. Our results described similar non-linear trend of refractive error development among groups. The initial increase of hyperopia (up to 7-8 years) was followed by a decreasing trend persisting up to adulthood (approximately 20 years of age). During this period, spherical equivalent decreased at a lower mean annual rate in patients affected by RAE (-0.07D) compared to other groups (NRAE -0.11D, p = 0.003 and PAE 0.13D, p = 0.002). In all groups, however, significant amount of hyperopia was found at last examination; indeed the observed difference in SE values from baseline to the end of follow up, was not significant (RAE: +0.27D, 95% C.I. -0.49 to +1.04D, p = 0.472; PAE: -0.69D, 95% C.I. -1.67 to +0.28D, p = 0.154; NRAE: -0.39D, 95% C.I. -1.11 to +0.34D, p = 0.278). AC/A ratio, amblyopia and amount of initial hyperopia appeared to have no significant role in longitudinal change of the refractive error. In conclusion, this study provides a complete overview, from childhood to adulthood, of refractive error development in different form of accommodative esotropia.

Dataset Information

Utility of an open field Shack-Hartmann aberrometer for measurement of refractive error in infants and young children.

Publications

Utility of an open field Shack-Hartmann aberrometer for measurement of refractive error in infants and young children.

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