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Purpose: This study aimed to investigate the choroidal thickness (ChT) distribution in adult myopic eyes, focusing on the macular, nasal midperiphery, and temporal midperiphery regions, and to explore its relationship with axial length (AL) and refractive error., Study Design: A cross-sectional, observational study., Methods: Twenty-nine eyes of 29 adult volunteers were examined. ChT was measured using high-speed swept-source optical coherence tomography covering an area of 50 degrees in three different regions: centered at macular, nasal side at 33 degrees, and temporal side at 33 degrees. Statistical analyses were performed to assess differences in ChT between regions and correlations with AL and spherical equivalent (SE)., Results: ChT was found to be thickest in the macular region, followed by the nasal and temporal midperiphery regions. Significant correlations were observed between AL/SE and ChT in the macular and temporal regions, but not in the nasal region. The temporal midperiphery showed the strongest correlation with AL and SE., Conclusion: This study revealed a nasal-temporal asymmetry in ChT distribution in myopic eyes, with the temporal midperiphery showing the thinnest ChT. The strong correlations between ChT in the temporal midperiphery and AL/SE suggest a role for the temporal choroid in axial elongation and myopia progression. These findings highlight the importance of considering peripheral ChT in understanding ocular growth and myopia management., (© 2024. Japanese Ophthalmological Society.)

Purpose: This study aimed to investigate the changes in ocular refraction and pupillary diameter during fixation on augmented reality (AR) images using a Maxwellian display., Methods: Twenty-two healthy young volunteers (average age, 20.7 ± 0.5 years) wore a Maxwellian display device in front of their right eye and fixated on an asterisk displayed on both a liquid-crystal display (real target) and a Maxwellian display (AR target) for 29 seconds (real as a baseline for 3 seconds, AR for 13 seconds, and real for 13 seconds) at distances of 5.0, 0.5, 0.33, and 0.2 meters. A binocular open-view autorefractometer was used to measure the ocular refraction and pupillary diameter of the left eye., Results: Accommodative (5.0 meters, 0.28 ± 0.29 diopter [D]; 0.5 meter, -0.12 ± 0.35 D; 0.33 meter, -0.43 ± 0.57 D; 0.2 meter, -1.20 ± 0.82 D) and pupillary (5.0 meters, 0.07 ± 0.22 mm; 0.5 meter, -0.08 ± 0.17 mm; 0.33 meter, -0.16 ± 0.20 mm; 0.2 meter, -0.25 ± 0.24 mm) responses were negative when the real target distances were farther away. The accommodative response was significantly and positively correlated with the pupillary response during fixation on the AR target (R2 = 0.187, P < 0.001)., Conclusions: Fixating on AR images using a Maxwellian display induces accommodative and pupillary responses. Accommodative responses depend on the distance between real objects. Overall, the Maxwellian display does not completely eliminate accommodation in real space.

Objectives: To characterize higher-order aberrations (HOAs) in different severities of keratoconus (KC) from the anterior and posterior corneal surfaces and whole eye using an integrated Scheimpflug corneal tomographer/Hartmann-Shack wavefront aberrometer., Methods: This study included eyes with clinical KC, topographic KC (no clinical signs), fellow eyes with very asymmetric ectasia with normal topography and no clinical signs (VAE-NT), and control eyes. Corneal and ocular wavefront aberrations were obtained using an integrated Scheimpflug tomographer/Hartmann-Shack wavefront aberrometer. The diagnostic capability of distinguishing VAE-NT from the control was also tested., Results: This study included 68 eyes with clinical KC, 44 with topographic KC, 26 with VAE-NT, and 45 controls. Clinical KC had significantly greater total HOAs and coma from the anterior and posterior corneal surfaces and whole eye than the other groups ( P <0.05). Although topographic KC had significantly greater values in all wavefront parameters than the control ( P <0.05), ocular and corneal HOAs did not differ between the VAE-NT and control groups. The coma from the anterior cornea in topographic KC was significantly greater than that in VAE-NT ( P <0.05); the coma from the posterior cornea and whole eye did not differ. Total HOAs from the anterior corneal surface exhibited the highest area under the receiver operating characteristic curve value of 0.774 (sensitivity, 73%; specificity, 78%)., Conclusion: A comprehensive wavefront assessment can be used to quantitatively evaluate corneal and ocular HOAs across various severity of KC. Total HOAs from the anterior corneal surface exhibited the potential ability in distinguishing VAE-NT from the control eyes., (Copyright © 2023 Contact Lens Association of Ophthalmologists.)

Anisometropic amblyopia is decreased visual acuity in one eye, and treatment consists of wearing complete corrective spectacles. Aniseikonia occurs with complete correction of anisometropia using spectacles. Aniseikonia has been ignored when treating pediatric anisometropic amblyopia because of the prevailing belief that anisometropic symptoms are suppressed by adaptation. However, the conventional direct comparison method for evaluating aniseikonia significantly underestimates the degree of aniseikonia. This study investigated whether the adaptation occurs due to long-term anisometropic amblyopia treatment in patients who have had successful amblyopia treatment using a spatial aniseikonia test with high accuracy and repeatability compared with the conventional direct comparison method. The amount of aniseikonia was not significantly different between the patients with successful amblyopia treatment and individuals with anisometropia without a history of amblyopia. In both groups, the aniseikonia per 1.00 D of anisometropia and the aniseikonia per 1.00 mm of aniso-axial length were comparable. The repeatability of the amount of aniseikonia using the spatial aniseikonia test did not differ significantly between the two groups, indicating a high degree of agreement. These findings suggest that aniseikonia is not adapted to amblyopia treatment and that aniseikonia increases as the difference between spherical equivalent and axial length increases.

Objectives: To assess agreement between measurements of ocular wavefront aberrations obtained using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) (Aberrometer A) and KR-1W (Topcon Corp) (Aberrometer B), both of which are based on the Hartmann-Shack principle., Methods: In this prospective case-control study, ocular wavefront aberrations measurements were obtained using both aberrometers in patients with keratoconus (KC) and control participants. Ocular wavefront aberrations were measured through the natural pupil without dilation using both devices in a dark room. For both aberrometers, accommodation was inhibited by automatically adding fogging. The individual Zernike coefficients from the second to fourth order were compared between the two aberrometers for a 4-mm pupil diameter., Results: Twenty-six KC and 29 control eyes were assessed. Statistically significant correlations ( P <0.05) were observed for all Zernike coefficients, except for Z 4-2 in the control group. Bland-Altman analysis indicated good agreement between aberrometers and no statistically significant differences in the control group. However, in the KC group, patterns of proportional error were observed in vertical coma Z 3-1 (r=0.338, P =0.008), trefoil Z 4-4 (r=0.701, P =0.003), secondary astigmatism Z 4-2 (r=0.348, P =0.025), and spherical aberrations Z 40 (r=0.407, P =0.012)., Conclusions: The Zernike coefficient values measured by the two aberrometers were well correlated in the control and KC groups. However, in eyes with KC, Aberrometer B tended to present greater values in several Zernike coefficients than Aberrometer A, suggesting that wavefront measurements obtained using the two aberrometers are not interchangeable in patients with KC., (Copyright © 2022 Contact Lens Association of Ophthalmologists.)

This prospective observational study aimed to evaluate the ocular biometry of Japanese people through a multicenter approach. The uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) in the log minimum angle of resolution (logMAR), subjective and objective spherical equivalent values (SE) of ocular refraction, anterior and posterior corneal curvature (ACC and PCC, respectively), anterior and posterior corneal asphericity (ACA and PCA, respectively), central corneal thickness (CCT), anterior chamber depth (ACD), and ocular axial length (AL) were measured in the eyes of 250 participants (mean age = 46.5 ± 18.0 years, range: 20-90 years) across five institutions in Japan. The mean UDVA, CDVA, subjective SE, objective SE, ACC, PCC, ACA, PCA, CCT, ACD, and AL were 0.68, -0.08, -2.42 D, -2.66 D, 7.77 mm, 6.33 mm, -0.31, -0.39, 0.55 mm, 2.92 mm, and 24.78 mm, respectively. Age-related changes and sex-based differences were noted in the visual acuity, refraction, corneal shape, ACD, and AL. Our results serve as basis for future studies aiming to develop refractive correction methods and various vision-related fields., Competing Interests: The authors declare no conflict of interest.

Objectives: To characterize higher-order aberrations (HOAs) in clinical and subclinical keratoconus (KC)., Methods: The study included 33, 36, and 26 patients with clinical, topographic (no clinical signs), and pretopographic (normal topography and no clinical signs) KC and 30 controls. Ocular and corneal HOAs for the 4-mm pupils were measured using a wavefront sensor and expanded up to the sixth order of Zernike polynomials. The magnitudes of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were calculated via Zernike vector analysis and used as HOA parameters along with total HOAs. Area under the receiver operating characteristic curve (AUROC) values for each wavefront parameter for pretopographic KC were compared., Results: Control eyes and eyes with pretopographic KC had significantly lower ocular or corneal total HOAs and Zernike vector terms than those with clinical KC and topographic KC, except for ocular tetrafoil between topographic KC and pretopographic KC and spherical aberration among all groups. The AUROCs for corneal total HOAs and corneal coma for pretopographic KC and control eyes were 0.781 (100% sensitivity and 47% specificity) and 0.735 (73% sensitivity and 73% specificity), respectively., Conclusion: Corneal total HOAs and corneal coma exhibited a potential ability to discriminate pretopographic KC from normal control eyes., (Copyright © 2022 Contact Lens Association of Ophthalmologists.)

The current method of controlling the focus of an accommodating intraocular lens is based on ciliary muscle contraction and cannot be used in older patients with presbyopia. We aimed to develop a dynamically accommodating intraocular lens powered by a membrane-shaped ion polymer metal composite actuator that is thin enough to be inserted in the eye. This study addresses two key problems identified in our previous accommodating intraocular lens prototype: the lack of repeatability due to the use of swine lenses instead of artificial lenses and the occurrence of a sixth order aberration. Thus, we present a new accommodating intraocular lens design and a method to transfer energy to actuators. To accommodate lens deformation and depth of focus, we used a membrane-shaped ion polymer metal composite actuator, thin enough to be inserted in the eye, and used an artificial silicone lens. To prevent the sixth order aberration, we included a ring between the ion polymer metal composite actuator and the lens. Different voltage patterns were applied to the IPMC actuator and changes in focus were observed. We were able to obtain repeatability and prevent the sixth order aberration. The dioptric power changed to ±0.23 D when ±1.5 V was used; however, at >1.5 V, a large accommodating range occurred, in addition to astigmatic vision. Thus, we have developed a novel prototype that is completely artificial, allowing reproducible and repeatable results. Visual accommodative demands were successfully met; however, although astigmatic vision was lessened, it was not completely eradicated., Competing Interests: The authors have declared that no competing interests exist.

This study aimed to investigate the influence of refractive status and age of patients on corneal higher-order aberrations (HOAs). Four hundred and twenty-six right eyes of 426 patients were enrolled in this study. The mean and standard deviation of patient age was 47.7 ± 22.1 years. Total HOAs, spherical-like aberration, coma-like aberration, Z -1 3 , Z 1 3 , Z -3 3 , Z -3 3 and spherical aberration (Z 0 4 ) for 6-mm pupil were measured using anterior segment optical coherence tomography (AS-OCT). Subjects were classified into three groups according to the amount of spherical equivalent refractive error (SE): myopia (<-0.5 D), emmetropia (-0.5 to 0.5 D), and hyperopia (>0.5 D). The amount of corneal astigmatism was recorded. Relationship between corneal aberrations, refractive status, astigmatism, and age was analyzed. In total, total HOAs, spherical-like aberration and amount of Z -3 3 and Z 0 4 were significantly larger in the hyperopia group than in the myopia group. After adjustment for age, however, aberration components did not differ among the three refractive groups. In multiple regression analysis, age and corneal astigmatism showed significant correlation with aberrations, whereas amount of SE and refractive status did not. The current study indicated that age and amount of corneal astigmatism have significant influence on corneal HOAs, but refractive status (myopia, emmetropia, or hyperopia) is not associated with corneal HOAs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The key determinants of the range of clear focus in pre-presbyopes and their relative contributions to the difference between subjective range of focus and objective accommodation assessments have not been previously quantified. Fifty participants (aged 33.0 ± 6.4 years) underwent simultaneous monocular subjective (visual acuity measured with an electronic test-chart) and objective (dynamic accommodation measured with an Aston open-field aberrometer) defocus curve testing for lenses between +2.00 to -10.00 DS in +0.50 DS steps in a randomized order. Pupil diameter and ocular aberrations (converted to visual metrics normalized for pupil size) at each level of blur were measured. The difference between objective range over which the power of the crystalline lens changes and the subjective range of clear focus was quantified and the results modelled using pupil size, refractive error, tolerance to blur, and ocular aberrations. The subjective range of clear focus was principally accounted for by age (46.4%) and pupil size (19.3%). The objectively assessed accommodative range was also principally accounted for by age (27.6%) and pupil size (15.4%). Over one-quarter (26.0%) of the difference between objective accommodation and subjective range of clear focus was accounted for by age (14.0%) and spherical aberration at maximum accommodation (12.0%). There was no significant change in the objective accommodative response (F = 1.426, p = 0.229) or pupil size (F = 0.799, p = 0.554) of participants for levels of defocus above their amplitude of accommodation. Pre-presbyopes benefit from an increased subjective range of clear vision beyond their objective accommodation due in part to neural factors, resulting in a measured depth-of-focus of, on average, 1.0 D.

Purpose: To compare rates of myopia progression and adverse events between orthokeratology (OK) and soft contact lens (SCL) wearers over a 10-year period in schoolchildren., Methods: Medical records of consecutive patients (≤16 years of age at baseline) who started OK for myopia correction and continued the treatment for 10 years were retrospectively reviewed. For the control group, patients who started using soft contact lenses (SCLs) for myopia correction and continued to use them for 10 years were also reviewed. Clinical data, including sex, age, manifest refraction, visual acuity, prescription lens power, and adverse events during the 10-year period, were recorded. Estimated myopia progression was calculated as the sum of 'changes in prescription lens power during 10 years' and 'residual refractive errors at the 10-year visit,' and was compared between groups. We also compared the incidence of adverse events between groups over the 10-year study period., Results: A total of 104 eyes of 53 patients who underwent OK treatment and 78 eyes of 39 patients who wore SCLs fulfilled the criteria. The estimated myopia progression over the 10-year period found in the OK and SCL groups were -1.26 ± 0.98 and -1.79 ± 1.24 days, respectively; this difference was statistically significant (p = 0.001). Additionally, lower myopia progression was found in the OK in comparison to the SCL group at all baseline ages (p = 0.003 to p = 0.049) except at 16 years old (p = 0.41). No significant difference was found in the number of adverse events found between the OK (119) and SCL (103) groups (p = 0.72)., Conclusions: The results of this study supports the long-term efficacy and safety of OK lens wear in reducing myopia progression in schoolchildren., (© 2018 The Authors Ophthalmic & Physiological Optics © 2018 The College of Optometrists.)

We present an opto-mechanical artificial eye that can be used for examining multi-wavelength ophthalmic instruments. Standard off-the-shelf lenses and a refractive-index-matching fluid were used in the creation of the artificial eye. In addition to dispersive properties, the artificial eye can be used to simulate refractive error. To analyze the artificial eye, a multi-wavelength Hartmann-Shack aberrometer was used to measure the longitudinal chromatic aberration and the possibility of inducing refractive error. Off-axis chromatic aberrations were also analyzed by imaging through the artificial eye at two discrete wavelengths. Possible extensions to the dispersive artificial eye are also discussed.

Purpose: To evaluate the influence of increases in light scattering on intraocular lens (IOL) surfaces on paraxial forward scattering using goniophotometry and Hartmann-Shack wavefront aberrometry., Methods: Surface light scattering was reproduced experimentally by acceleratedly aging 4 intraocular lenses by 0, 3, 5, and 10 years each. Light scattering from both IOL surfaces was measured using Scheimpflug photography. The paraxial forward scattering from the aged IOLs was measured using a goniophotometer with a halogen light source (wavelength: 350-850 nm) and telecentric optics, and changes in the maximum intensity and full width at 10% of maximum intensity (FW10%) were evaluated. The influences on the retina image were examined using a Hartmann-Shack aberrometer (wavelength: 840 nm). The contrast and difference from the point spread function of the central centroids were evaluated., Results: The mean surface light scattering from both IOL surfaces ranged from 30.0 to 118.3 computer compatible tape (CCT) and increased with each aging year. Evaluations using the goniophotometer and the Hartmann-Shack aberrometer showed no significant change in the paraxial forward scattering with the aging year (P > .45, Kruskal-Wallis test), and no association with the surface light scattering intensity was found (P > .75, Spearman rank correlation)., Conclusion: This experimental study using aged IOLs demonstrated that surface light scattering does not influence paraxial forward scattering.

Surgeons treat cataracts by replacing the clouded lens with an intraocular lens (IOL), but patients are required to wear reading glasses for tasks requiring near vision. We suggest a new voltage-controlled accommodating IOL made of an ionic polymer metal composite (IPMC) actuator to change focus. An in vitro experiment was conducted where an actuator was placed inside the eye and moved with applied voltage. The lens attached to the actuator was deformed by its movement to change the patient's focus. The results showed that this system can accommodate a change of approximately 0.8 diopters under an applied voltage of ± 1.3 V.

Several researchers have studied the longitudinal chromatic aberration (LCA) of eyes implanted with an intraocular lens (IOL). We investigated the LCA of eyes implanted with yellow-colored IOLs from three different manufacturers: Alcon Inc., HOYA Corp., and AMO Inc. The number of subjects was 11, 16, and 16, respectively. The LCA of eyes implanted with SN60WF and SN60AT (Alcon Inc.), and with XY-1 (HOYA Corp.), was the same as that of phakic eyes. The LCA of eyes with ZCB00V (AMO Inc.) was smaller than that of phakic eyes. The LCA of eyes implanted with Alcon's and HOYA's IOLs, but not the LCA of eyes implanted with AMO's IOLs, was positively correlated with the powers of the IOLs. We also performed simulations to verify the impacts of LCA on visual performance for 4-mm pupil diameter; the simulations were a polychromatic modulation transfer function (MTF) and a visual Strehl ratio computed on the basis of an optical transfer function (VSOTF). We concluded that the differences between the LCA of different manufacturers do not affect visual performances when some extent of higher-order aberration (HOA) exists. The smaller HOA of AMO IOLs may enhance visual performance.

Several researchers studied the longitudinal chromatic aberration (LCA) of the human eye and observed that it does not change due to age. We measured the LCA of 45 subjects' normal right eyes at three distinct wavelengths (561, 690, and 840 nm) using a Hartmann-Shack wavefront aberrometer (HSWA) while consecutively switching between three light sources for wavefront sensing. We confirmed that the LCA of the human eye does not change due to age between 22 and 57 years.