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Background: Refractive error (RE) represents a common cause of treatable visual impairment, and studying its epidemiology has been a research interest worldwide. Objectives: To investigate the refractive status of Iraqi patients visiting the eye clinic at Fallujah Teaching Hospital and report the results compared to local and global records. Methods: A hospital-based cross-sectional study analyzed the saved patients' records from the Fallujah eye clinic. The prevalence of myopia, hyperopia, and astigmatism was estimated and analyzed according to gender and age groups in children, adolescents, and adult patients. Results: In children and adolescents under the age of 18 years, the prevalence of emmetropia, myopia, hyperopia, and astigmatism was 34.95%, 19.7%, 20.9%, and 24.6%, respectively. In adult subjects, 29.6% were emmetropic, 16.9% were myopic, 20.7% were hyperopic, and 32.8% were astigmatic. A significant association between RE and age was detected (P = 0.001) but not with gender (P = 0.061). Conclusion: This study found a high prevalence of RE among all age groups, with astigmatism being the most prevalent RE, followed by hyperopia and myopia. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes in patients undergoing small-incision lenticule extraction (SMILE) for correction of myopic astigmatism (≥-1.50 D) with or without manual cyclotorsion compensation. Methods: A prospective, double-blinded, randomized, contralateral study was conducted in the refractive services of a tertiary eye care center. Eligible patients with bilateral high myopic astigmatism (≥1.5 D) and intraoperative cyclotorsion (≥5°) undergoing SMILE between June 2018 and May 2019 were included. Cyclotorsion compensation was performed using triple centration method before femtosecond laser delivery. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) measurement, manifest refraction, slit-lamp biomicroscopy, and corneal tomography were performed preoperatively and at 1 and 3 months' postoperative visit. Astigmatic outcomes were analyzed using Alpins criteria. Results: A total of 30 patients (60 eyes) were included in this study. The patients underwent bilateral SMILE surgery, with manual cyclotorsion compensation in one eye (CC group, n = 30 eyes) and no cyclotorsion compensation in the other eye (NCC group, n = 30 eyes). Preoperative astigmatism and intraoperative cyclotorsion were -2.0 D and 7.03° ± 1.06° (CC) and -1.75 D and 7.24° ± 0.98° (NCC) (P = 0.472 and 0.240, respectively). No significant differences were noted in mean refractive spherical equivalent (MRSE), UDVA, CDVA, and refractive error between the two groups at 3 months' postoperative visit. Astigmatic outcomes measured using Alpins criteria demonstrated no significant difference between the two cohorts. Conclusion: The cyclotorsion compensation technique provided no additional advantage in terms of astigmatic outcomes or postoperative visual quality, in eyes with high preoperative astigmatism and intraoperative cyclotorsion. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2012, Chicago Public Schools and the Chicago Department of Public Health partnered together to create the Chicago School‐Based Vision Program (CSBVP). This ongoing, city‐wide program provides school‐based vision services (eye examinations, eyeglasses provision, and eye care referrals) to students with limited access. METHODS: Descriptive analysis of the program operations from 2012 to 2020, including number of students served and exam findings during 2017‐2020, as well as lessons learned and recommendations for reproducing the successes of the CSBVP in other contexts. RESULTS: During its first 8 years, the CSBVP provided eye examinations to over 350,000 students. During the years 2017‐2020, this included 126,238 eye exams and provision of eyeglasses to 73,751 students. CONCLUSIONS: The CSBVP is built upon strong community and school relationships. The program offers vision services, equitably, to all students across the district. The lessons learned through the implementation of the CSBVP may provide guidance for future district‐wide vision programs. [ABSTRACT FROM AUTHOR]

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the "India of Tomorrow". Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre-COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID-19 (2022–23) for further analysis to depict the impact of COVID-19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country. [ABSTRACT FROM AUTHOR]

There have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive. An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting. Overall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019–2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel – 51 %; daily disposable silicone hydrogel – 27 %; daily disposable hydrogel – 12 %; and reusable hydrogel – 10 %. There has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses. [ABSTRACT FROM AUTHOR]

Purpose: Owing to the paucity of literature on Indian children with periventricular leukomalacia (PVL), this retrospective study aimed to describe the visual and associated developmental abnormalities in a series of affected children attending a tertiary level eye care facility.Methods: Children with radiologically confirmed PVL who attended the Pediatric Department of a tertiary eye hospital were included and underwent a detailed ocular and general developmental assessment.Results: Of the 75 children, the mean age was 2.3 years, the mean follow-up was 3.1 years, 68% were males and 43% were born preterm. Grade I PVL was identified in 13 children (17%), Grade 2 PVL in 39 (52%), and Grade 3 PVL in 23 (31%). Premies with ≤2 kg (72.5%) and term babies with >2 kg (75%) had a greater association of PVL occurrence with a preponderance to severe PVL; 46% of the children were visually impaired which was significantly higher in the children with Grade 3 PVL (74%) than those with Grade 2 PVL (15%). Strabismus was common (80%) with a change in deviation over time. Seventy-one percent of the children had a refractive error, frequently myopic astigmatism. All the children except two had a delay in one or more general developmental milestones.Conclusion: PVL occurrence is observed both in the babies born at term and premies, resulting in significant ocular and systemic morbidities. We recommend a system in place for early identification and referral to initiate an early intervention program which goes a long way toward improving the quality of life in these children. [ABSTRACT FROM AUTHOR]

Purpose: : To assess the repeatability of ocular measurements, particularly astigmatism, taken using the latest version of an swept-source optical coherence tomography (SS-OCT) device, IOLMaster 700.Methods: This prospective observational study done in a private eye care centre. Study included 213 eyes of 152 patients diagnosed with cataract. Axial length (AL), Anterior corneal astigmatism (ΔK), Total corneal astigmatism (ΔTK), Aqueous depth (AD), Lens thickness (LT), Iris barycentre distance (IBD) and White to white distance (WTW) were analysed; three measurements were taken for each patient in the same sitting by the same examiner in an undilated state using the SS-OCT device. Repeatability was analysed using intraclass coefficient (ICC) and coefficient of variation (CV) measures, and astigmatism values were transformed into vector components (J0/J45) and categorised based on magnitude.Results: Astigmatism vector components (J0/J45) showed poor repeatability (ICC < 0.5 and CV > 0), while iris coordinates (IBD) and astigmatism magnitude had good correlation (ICC > 0.9) but more variations between the readings which was least for magnitude ≥ 1.5D; however, rest of the parameters demonstrated excellent repeatability (ICC > 0.9 with P value < 0.05).Conclusion: IOLMaster 700 demonstrated good reliability for the parameters measured, although, for astigmatism and iris barycentre distance, more number of readings and cross reference with other devices may be required to get clinically accurate results. [ABSTRACT FROM AUTHOR]

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed. [ABSTRACT FROM AUTHOR]

Backgrounds: Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children.Methods: In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model.Results: Of 1131 children (66.90 ± 3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI) = 1.14-2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR) = 6.42, 95%CI = 2.63-15.69, P < 0.001; non-vectorial aniso-TA: OR = 4.99, 95%CI = 1.41-17.68, P = 0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR = 2.43, 95%CI = 1.05-5.60, P = 0.04). Pre-term delivery (OR = 2.60, 95%CI = 1.09-6.15, P = 0.03) and post-term delivery (OR = 3.61, 95%CI = 1.31-9.96, P = 0.01) were significantly associated with higher risk of vectorial aniso-CA.Conclusions: Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score < 7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA. [ABSTRACT FROM AUTHOR]

Aim: To assess the demography, magnitude, and type of corneal astigmatism in patients undergoing cataract surgery in North India. Methods: It is a clinic-based, cross-sectional, observational study. Keratometric values and demographic data were collected for eligible patients who had undergone phacoemulsification at a tertiary eye care center between January 2010 and December 2017, using a non contact, optical low coherence reflectometry (OLCR). Results: A total of 3597 eyes were recruited for the study. There were 1810 (50.3%) females and 1787 (49.7%) males. The mean age was 59.121± 15.19 (range 5– 100 years). A total of 3559 eyes were qualified for astigmatism analysis. The mean corneal astigmatism among all patients was 1.17± 1.15 D (range 0– 12.5 D). There was no astigmatism in 99 eyes (2.78%), with-the-rule (WTR) in 1062 eyes (29.83%), against-the-rule (ATR) in 1843 eyes (51.72%) and oblique astigmatism (OA) in 555 eyes (15.59%). The tendency of a gradual change from with the rule (WTR) to against the rule (ATR) astigmatism was noted as the age advanced. Conclusion: In the present study around 56.69% of eyes had corneal astigmatism of < 1.0 D that can be managed by simple cost-effective keratorefractive procedures especially in developing countries. However, our 40.49% patients had > 1.0 D of corneal astigmatism, which may benefit by toric intraocular lenses. [ABSTRACT FROM AUTHOR]

Background: Visual impairment is disproportionately distributed between rural and urban dwellers. Rural dwellers have limited access to the eye care services that are available in urban cities. Aim: The aim of this study was to determine the prevalence and causes of visual impairment in Dariyah, a rural community in the Qassim region, Saudi Arabia. Setting: This research comprised a population-based assessment of the vision and visual status of the inhabitants of Dariyah community. Methods: A cross-sectional descriptive study was conducted amongst the inhabitants of the community of Dariyah. A comprehensive eye examination consisting of visual acuity, ocular health examination, objective and subjective refraction was performed. The examinations were conducted by registered ophthalmologists and optometrists from the Qassim University. Vision impairments were categorised according to the International Classification of Diseases (ICD), Section 9D90, 'Vision impairment including blindness' (2018). Results: In all, 68 (24.5%) participants had vision impairment (using the better-seeing eye), with refractive errors being the main cause of vision impairment. Other causes of vision impairment included cataract (20, 7.2%), trichiasis (5, 1.8%) and glaucoma (2, 0.7%). Refractive errors were present in 193 (69.7%), with astigmatism being the commonest refractive error. About 60% of those with refractive errors presented without spectacles for correction, and 20% reported that they had never had an eye examination. Refractive errors could not be determined in 19 (6.9%) of the subjects because of conditions such as matured cataract and other ocular abnormalities. Conclusion: Uncorrected refractive error was found to be the leading cause of vision impairment in this rural community in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Objective: To find out the association of seeking ophthalmic assessment in children with parental history of refractive errors. Methods: After the approval of ethical review board, an analytical cross-sectional study was conducted in eight high schools of public and private sector at Lahore during the period of seven months from August 2017 to March 2018. Multistage random sampling technique was opted and 2000 study subjects were recruited including 50% boys and 50% girls. Informed consent was obtained and data was collected on a structured questionnaire. The data was organized, entered in version 23 of IBM SPSS and analyzed by the use of statistical tools. Results: Age of the respondents ranged between nine to 18 years with a mean of 13.40±1.82 SD. Parental history of wearing spectacles was present in 21.3% of the fathers and 28.6% of the mothers. Moreover, 72.4% of the participants never visited eye care professional. Among private schools, an association was found between the visit of boys to eye care professional and maternal positive history of wearing spectacles (p-value 0.019). A significant association was found between the positive paternal history of wearing spectacles and visit of the female strudy subjects to an eye care professional (p-value 0.001). In public schools, there was an association between visit of children to eye care services and positive history of mothers about the use of spectacles (p-value 0.018). Conclusions: This study concludes that positive maternal history of wearing spectacles is associated with the ophthalmic examination of children in both public and private school. [ABSTRACT FROM AUTHOR]

Background: Amongst refractive errors, myopia was found to be the leading cause of vision impairment, followed by astigmatism and hypermetropia in females age group 11 to 16 years. Methodology: This study was carried out in eye O.P.D, where after verbal consent; presenting visual acuity of all individuals of selected age group was recorded and underwent ocular examination. Distance visual acuity was measured both monocularly and binocularly by using Snellens E Chart at a distance of 6 m. After refraction, best corrected visual acuity was then assessed and recorded. Retinoscopy with fogging was used for objective refraction and then its verification was made through subjective refraction. Cycloplegic refraction was carried out for subjects with hyper active accommodation, i.e. when dry retinoscopy gave fluctuating results. Results: A total of 225 female patients were part of my study, out of which 105 patients had refractive error while 120 had no refractive error, i.e. 47% were ametropic while 53% were emmetropic, among these, 25 had hypermetropia, 50 had myopia and 30 had astigmatism. Conclusion: Amongst refractive errors, Myopia was found to be the leading cause of vision impairment, followed by Astigmatism and Hypermetropia in females age group 11 to 16 years. Visual Impairment due to refractive error in any population suggests that eye care services in general in that population are inadequate, as treatment of refractive error is perhaps the simplest and most effective form of eye care .i.e. a pair of spectacles. [ABSTRACT FROM AUTHOR]

Importance Provision of refractive changes is important to predict eye care needs for aging population. Background: To provide 5‐year refractive changes in a rural Chinese adult population. Design Population‐based longitudinal study. Participants: At baseline, 6830 subjects aged 30+ years took part in the Handan Eye Study. A total of 5394 of the 6323 survivors (85.3%) participated in the 5‐year follow‐up. Methods: Ocular examinations including standardized refraction were performed according to the same protocol at both baseline and follow‐up. Main Outcome Measures: Change in spherical equivalent (SE; sphere + 1/2 cylinder) and astigmatism. Results: A total of 3970 right eyes were available for refraction analysis. The 5‐year change in SE for all subjects was +0.17 diopters (D), and was −0.21D, +0.14D, +0.40D and +0.08D for subjects aged 30–39, 40–49, 50–59, and 60–69 years, respectively. By binary regression analysis, myopic shift was associated with severe nuclear opacity, longer axil length, diabetes and large change of lens power, while hyperopic shift was associated with older age and ocular hypertension at baseline. There was a mean change of 0.18D in the against‐the‐rule astigmatism. Conclusions and Relevance: There was a myopic shift for those 30–39 years old and a hyperopic shift from 40 to 69 years old in a rural Chinese adult population. Those with severe nuclear opacity, longer axil length, diabetes and large change of lens power tended to have a myopic shift, while those being older and having ocular hypertension at baseline were prone to have a hyperopic shift. There was also an increase in against‐the‐rule astigmatism in this population. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes and higher order aberrations (HOAs) following wavefront optimized (WFO) laser in situ keratomileusis (LASIK) versus topography-guided customized ablation (TCAT) LASIK for myopia and myopic astigmatism.Methods: Patients who underwent femtosecond-assisted LASIK for myopic correction between August 2016 and October 2017 were included in this interventional prospective case series. The following parameters were evaluated preoperatively and at 3 months' postoperative visit: uncorrected distance vision acuity (UDVA) and corrected distance vision acuity (CDVA), manifest refraction, and HOAs.Results: Two hundred eyes of 100 patients were included in the study. At 3 months' postoperative visit, 92% and 90% eyes in the TCAT and WFO groups, respectively, demonstrated a UDVA of 20/20 or better (P = 0.90). A residual manifest spherical equivalent within 0.5 D was achieved in 100% and 95% of the eyes in the TCAT and WFO groups, respectively (P = 0.10). No significant difference was observed in the HOAs induced in both the groups, with slightly lower induction of trefoil and horizontal coma in the TCAT group.Conclusion: Both groups demonstrated similar refractive efficacy and predictability, with greater gain of CDVA following TCAT ablation. HOAs induced were not significantly different between the two groups. Further studies are needed to validate the superiority of one procedure over the other. [ABSTRACT FROM AUTHOR]

Purpose: To compare the surgical outcomes of glued intraocular lens (GIOL) and sutured scleral fixated intraocular lens (SFIOL) implantation.Methods: A retrospective, interventional case series of 60 patients (68 eyes) who underwent GIOL (28 eyes: 11 primary; 17 secondary) and SFIOL (40 eyes: 24 primary; 16 secondary) in a tertiary eye care institute was done. The main outcome measures were complications, time taken for surgery, postoperative refractive outcomes, and final best-corrected visual acuity (BCVA).Results: The mean final BCVA was 0.42 (20/40) (+/- SD 0.29) in the GIOL group and 0.57 (20/50) (+/- SD 0.48) in the SFIOL group (p=0.08). The time taken for primary GIOL (mean+/- SD: 66+/-19 minutes) was significantly lower than primary SFIOL (means+/-SD: 94+/-34 minutes) (p=0.006). The complications were comparable between the GIOL (25%) and SFIOL (15%) groups (p=0.30). The most common complication noted was transient vitreous hemorrhage (GIOL 17%, SFIOL 5%). The only sight-threatening complication seen was retinal detachment, with one eye in each group. The mean follow-up was 20 (GIOL) and 20.4 weeks (SFIOL).Conclusion: Both glued intraocular lens and sutured scleral fixated intraocular lens are safe and effective procedures in cases of insufficient capsular support. In view of the shorter surgical time with similar outcomes, primary GIOL can be considered as a preferred surgical option over primary SFIOL. [ABSTRACT FROM AUTHOR]

Background: Aniseikonia is a condition in which there are different image sizes in the two eyes. Post-surgical anisometropia from corneal transplant, cataract surgery, or epiretinal membrane peel continues to be the primary cause and sometimes is large enough to remain symptomatic even after contact lens (CL) correction. Clinical measurement of aniseikonia is rare and uses obsolete instrumentation long out of production. This case report details the diagnosis and treatment of a symptomatic patient with significant anisometropia, pseudophakia OS, and post-penetrating keratoplasty OU secondary to keratoconus. Treatment included using size lenses and common clinical equipment. Case Report: A 62-year-old female presented with diplopia and blurry vision. Due to her irregular astigmatism, the manifest refraction was unreliable. The patient was fit with a large-diameter corneal gas-permeable CL OD (-11.50 DS) and a scleral CL OS (-2.50 DS) to correct her irregular astigmatism OU. Best-corrected acuities were 20/20 OD and 20/30 OS. After contact lens correction, the patient noted poor depth perception, clumsiness, and non-specific asthenopia. Using the Brecher test, aniseikonia was diagnosed. Aniseikonia was measured at 6% larger retinal image OS using plano magnifiers (size lenses). A 6% size lens was prescribed for the OD with a 2 prism diopter base-in correction. A 10 D base curve (BC) spectacle lens in CR-39 (n=1.498) and standard 1.5 mm center thickness was prescribed OD, matching the BC of the plano magnifier accepted on trial framing over the patient's contact lens correction for residual post-surgical aniseikonia. The following year, the aniseikonia measured at 7%, but the patient preferred the thinner 6% magnifier since it still allowed fusion. Horizontal prism correction was changed to 4 prism diopters base out. Conclusions: The Brecher test combined with a size lens set, lens clock, and specialty CL can be used to diminish or to eliminate aniseikonia without requiring additional mathematical calculation of spectacle base curve or center thickness. [ABSTRACT FROM AUTHOR]

Background. The purpose of our study was to assess the distribution and patterns of refractive errors in children for the proper planning of paediatric eye care at the centre. Material and methods. The study was conducted in the hospital of the Lithuanian University of Health Sciences in Kaunas, from 1 January 2012 to 31 December 2012. During this period, a total of 11,406 children, aged 0-18 years, were evaluated at the outpatient department of paediatric ophthalmology, Kauno klinikos, the Lithuanian University of Health Sciences. All the children underwent a complete ophthalmic examination with cycloplegic refraction. Results. Myopia increased from 1.5% (95% CI:1.2, 1.8) in the age group of 0-1 to 44.7% (95% CI:43.46, 45.94) in the age group of 14-18 (p < 0.001). Myopia was associated with older age, female gender (20.3%; 95% CI:19.3, 21.3; p < 0.001). Hypermetropia decreased from 84.6% (95% CI:83.7, 85.5) in the cohort of 0-1 to 11.4% (95% CI: 10.61, 12.19) in the 14-18 age group (p < 0.001). Hypermetropia was associated with younger age, male gender (43.4%; 95% CI:42.16, 44.64;p < 0.001), preterm birth (56.1%; 95% CI:54.86, 57.34; 43.4%; p < 0.001), low birth weight (61.8%; 95% CI:60.59, 63.01;p < 0.001), and birth by Caesarean section (57.1%; 95% CI: 55.87; 58.33) (p < 0.001). The prevalence of astigmatism was 25.5% (95% CI: 24.41; 26.59) (p < 0.001). Astigmatism was associated with female gender (20.1%; 95%. CI: 19.1; 21.1) and too big pregnancy weight (22.1%.; 95%. CI: 21.06; 23.14) (p < 0.001). Conclusions. Of the 14-18 age group, 44.7% of the patients were myopic. Of the 0-1 age group, 84.6% were hypermetropic. Astigmatism was detected in about 25.5% of children. The prevalence of refractive errors was associated with age, gender, gestation age, gestation weight, and parental refractive error. [ABSTRACT FROM AUTHOR]

The article offers guides to protecting young eyes from accidental damage. Topics discussed include signs of normally and abnormally developing eyes, and the role of health visitors in recognizing warning signs of eye diseases such as myopia, hyperopia, astigmatism, colour blindness, ambliyopia, and strabismus. Also mentioned are guides to recognizing retinoblastoma, a rare and aggressive form of eye cancer.

Purpose To compare 1.8 mm micro-incision and 2.75 mm standard incision in coaxial cataract surgery combined with 23-Gauge (23G) vitrectomy with respect to intraoperative and postoperative complications and outcomes. Methods In this prospective study 30 eyes of 30 patients planned for combined phacoemulsification and 23G vitrectomy were enrolled, and randomized to undergo either Standard 2.75 mm Incision Cataract Surgery ( SICS, 15 eyes) or Coaxial 1.8 mm Micro-Incision Cataract Surgery (C- MICS, 15 eyes) followed by vitrectomy. Inclusion criteria were cataract and macular disorders including macular hole, epiretinal membrane and vitreomacular traction. Data were collected at preoperative evaluation and 1 and 12 months or more after surgery. Results Incision leakage occurred in two eyes (7%: one per group), retinal break in nine (30%: four in C- MICS, five in SICS). Fibrin in anterior chamber ( AC) occurred day 1 in three eyes (10%: two C- and one SICS). Posterior capsule opacification developed in 22 eyes (78%: 13 MICS, nine SICS, p = 0.1). A myopic shift of −0.63 ± 0.7 was noted (−0.59 ± 0.8 MICS, −0.68 ± 0.6 SICS, p = 0.74). Surgically induced astigmatism ( SIA) was significantly smaller in C- MICS group (Δ KP, −0.019 ± 0.095 versus −0.141 ± 0.219, p = 0.0038) at 1 month but not at final follow-up (Δ KP, 0.0005 ± 0.16 in C- MICS versus −0.057 ± 0.12, p = 0.3 Conclusions Both techniques were equally safe with respect to intraoperative and postoperative findings. Coaxial micro-incision cataract surgery (C-MICS) was associated with less surgically-induced astigmatism ( SIA) 1 month after surgery but differences were not statistically significant at final follow-up indicating a faster refractive recovery with C- MICS than with SICS. [ABSTRACT FROM AUTHOR]

Purpose Astigmatism is a common cause of refractive error and is known to vary in prevalence with age. Although the search for genes associated with spherical refractive errors (especially myopia) has met with limited success, current efforts to identify genetic variants implicated in astigmatism development have been less rewarding. We aimed to assess the association between astigmatism and age to identify appropriate age cut-offs for maximizing power in genetic studies of astigmatism. Methods We performed a cross-sectional analysis of right eye astigmatism data from four Australian-based eye studies comprising 3841 participants aged 5-90 years. Measurements were performed under cycloplegia using an autorefractor, and individuals with a history of cataract, refractive surgery or corneal pathology were excluded from the analysis. In addition to the magnitude and type (against-the-rule, with-the-rule, and oblique) of astigmatism, we calculated the vector components (J0, J45) and evaluated the association of these outcome measures with age. Results The magnitude of refractive astigmatism ( RA) remained relatively stable [mean ± SD (−0.44 D ± 0.50)] until individuals reached the age of 50, thereafter increasing in average magnitude by approximately 1.00 D for those subjects aged 90. In contrast, corneal astigmatism ( CA) remained relatively stable from childhood until the age of 80 (−0.76 D ± 0.61). The prevalence of clinically significant RA (≥1.00 D) increased with age and was highest in those aged >70 years [55.1% (47.2-62.7%)]. Age was significantly associated with RA in adults [odds ratio ( OR) = 1.04 per 1 year, p < 0.001]. A weaker relationship was observed between CA and age ( OR = 1.007 per 1 year, p = 0.02). Conclusions We have confirmed the previously documented association between RA and age. Our results indicate that most of the observed change occurs after the age of 50, providing a recommended cut-off for participants in genetic studies of this refractive condition. [ABSTRACT FROM AUTHOR]

Purpose: A primary task of the eye care professional is determining the refraction, or optical correction, of a patient. The duochrome red-green test is a standard tool for verification of the final refraction. Traditionally, it is recommended for use both prior to and subsequent to determining the cylindrical or astigmatic component of the refraction. In order for it to be effective when used before correcting the cylinder it is necessary that the COLC (Circle of Least Confusion) be on the retina. This study examined whether it is necessarily true that the duochrome response in uncorrected astigmatism will be as trust-worthy as it is with corrected cylinders. Methods: The red-green examination was performed monocularly under the following three conditions: a. fully corrected refraction for the subgroup of eyes that had spherical refractions and for the subgroup of eyes with sphero-cylindrical refractions. b. best sphere-only correction without cylinder correction in sphero-cylindrical eyes c. an induced cylinder error in spherical eyes. The interval between the last “red” response and the first “green” response for the right eyes as a group and separately for the physiological cylinder and induced cylinder correction sub-groups was calculated and compared using a paired, two-tailed t-test. Results: The intervals between “red” and “green” responses were not significantly different in the population as a whole and in the uncorrected physiological cylinder and induced cylinder subgroups examined. Conclusion: Based on the finding that the interval of red-green equality with fully corrected cylinder and without the cylindrical correction are not significantly different, the red-green duochrome test can indeed be used both before and after cylindrical correction. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the refractive outcomes and rotational stability of a 4-haptic toric intraocular lens (IOL) in myopic eyes and the correlations between IOL rotation and refractive sphere, axial length (AL), and white-to-white (WTW) diameter. Setting Eye Clinic, Careggi Hospital, Florence, Italy. Design Prospective case series. Methods Phacoemulsification cataract extraction and implantation of an AT Torbi 709M IOL were performed. Corneal astigmatism was 1.50 diopters (D) or greater and the AL between 25.0 mm and 27.0 mm in all eyes. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and IOL axis were evaluated preoperatively and postoperatively up to 6 months. Results The study enrolled 20 eyes (20 patients). The UDVA and CDVA improved significantly postoperatively (P < .001). The mean refractive spherical equivalent decreased significantly from -7.10 D ± 1.78 (SD) preoperatively to -0.55 ± 0.25 D 1 day postoperatively (P < .001) and remained stable thereafter. Vector analysis showed that 90% and 85% of the eyes were within ±0.25 D for J0 and J45, respectively. At 3 months and 6 months, the mean IOL rotation was 2.66 ± 1.53 degrees and 3.00 ± 1.69 degrees, respectively (P < .001), with 95% of eyes and 90% of eyes, respectively, within ±5 degrees. A positive correlation was found between IOL rotation and preoperative sphere; none was found with AL and WTW. Conclusions Implantation of the 4-haptic toric IOL in myopic eyes was effective and safe. The IOL showed no significant rotation over the 6-month follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of astigmatism, and the astigmatic axis, and their determinants were evaluated in a rural population of Iran. Materials and Methods: In a cross-sectional study conducted from May to August 2011, 13 villages in the vicinity of the city of Khaf in northeast Iran were investigated in this study. All the examinations including visual acuity, refraction, slit-lamp biomicroscopy and fundoscopy were performed in a Mobile Eye Clinic. Written informed consent was obtained from all participants. Only phakic eye that could be reliably refracted without a previous history of ocular surgery were included. Results: Out of 2635 participants who were screened, 2124 were analysed for this study of whom 52% were female. The prevalence of astigmatism was 32.2% (95% confidence intervals (CI): 30.2-34.2). Astigmatism significantly increased from 14.3% in the under 15-year-old age group to 67.2% in the age group of over 65-years old (P < 0.001). The prevalence of With-The- Rule (WTR), Against-The-Rule (ATR), and oblique astigmatism was 11.7%, 18.1%, and 2.4 %, respectively. ATR significantly increased with age (P < 0.001). The mean corneal astigmatism was 0.73 D which linearly increased with age (P < 0.001). Conclusion: Attention must be paid to astigmatism in rural areas due to the high prevalence. Further studies are suggested to discover the role of the environmental and genetic factors. It seems that environmental and occupational factors in the villages cause a significant increase in the prevalence of astigmatism with age. A high percentage of participants had ATR astigmatism, which was more common at older ages. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To define a range of normality for the vectorial parameters Ocular Residual Astigmatism (ORA) and topography disparity (TD) and to evaluate their relationship with visual, refractive, anterior and posterior corneal curvature, pachymetric and corneal volume data in normal healthy eyes. Methods: This study comprised a total of 101 consecutive normal healthy eyes of 101 patients ranging in age from 15 to 64 years old. In all cases, a complete corneal analysis was performed using a Scheimpflug photography-based topography system (Pentacam system Oculus Optikgeräte GmbH). Anterior corneal topographic data were imported from the Pentacam system to the iASSORT software (ASSORT Pty. Ltd.), which allowed the calculation of the ocular residual astigmatism (ORA) and topography disparity (TD). Linear regression analysis was used for obtaining a linear expression relating ORA and posterior corneal astigmatism (PCA). Results: Mean magnitude of ORA was 0.79 D (SD: 0.43), with a normality range from 0 to 1.63D. 90 eyes (89.1%) showed against-the-rule ORA. A weak although statistically significant correlation was found between the magnitudes of posterior corneal astigmatism and ORA (r =0.34, p <0.01). Regression analysis showed the presence of a linear relationship between these two variables, although with a very limited predictability (R 2: 0.08). Mean magnitude of TD was 0.89D (SD: 0.50), with a normality range from 0 to 1.87D. Conclusion: The magnitude of the vector parameters ORA and TD is lower than 1.9D in the healthy human eye. [Copyright &y& Elsevier]

Background: The purpose of this study was to evaluate the safety and efficacy of topography-guided ablation using the WaveLight 400 Hz excimer laser in laser-assisted in situ keratomileusis (LASIK) for hyperopia and/or hyperopic astigmatism. Methods: We prospectively evaluated 208 consecutive LASIK cases for hyperopia with or without astigmatism using the topography-guided platform of the 400 Hz Eye-Q excimer system. The mean preoperative sphere value was +3.04 ± 1.75 (range 0.75-7.25) diopters (D) and the mean cylinder value was -1.24 ± 1.41 (-4.75-0) D. Flaps were created either with Intralase FS60 (AMO, Irvine, CA) or FS200 (Alcon, Fort Worth, TX) femtosecond lasers. Parameters evaluated included age, preoperative and postoperative refractive error, uncorrected distance visual acuity, corrected distance visual acuity, flap diameter and thickness, topographic changes, higher order aberration changes, and low contrast sensitivity. These measurements were repeated postoperatively at regular intervals for at least 24 months. Results: Two hundred and two eyes were available for follow-up at 24 months. Uncorrected distance visual acuity improved from 5.5/10 to 9.2/10. At 24 (8-37) months, 75.5% of the eyes were in the ±0.50 D range and 94.4% were in the ±1.00 D range of the refractive goal. Postoperatively, the mean sphere value was -0.39 ± 0.3 and the cylinder value was -0.35 ± 0.25. Topographic evidence showed that ablation was made in the visual axis and not in the center of the cornea, thus correlating with the angle kappa. No significant complications were encountered in this small group of patients. Conclusion: Hyperopic LASIK utilizing the topography-guided platform of the 400 Hz Eye-Q Allegretto excimer and a femtosecond laser flap appears to be safe and effective for correction of hyperopia and/or hyperopic astigmatism. The results are impressive for refractive error correction and stability and for improvement of both uncorrected and corrected distance visual acuity. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of toric and soft spherical contact lenses on the visual performance and wavefront aberrations in cases of low astigmatism. Material and Method: Twenty-four eyes of 14 contact lens users with cylindirical refractive error of -1.25 diopters or less were included in this prospective study. The subjects wore spherical (lotrafilcon B) and toric (galyfilcon A) lenses for eight hours with a one-week interval. The best-corrected visual acuity and contrast sensitivity were measured before and after 8 hours of contact lens wear. Corneal topography and wavefront analysis were also performed. Zernike coefficients were used to calculate the aberrations at a 6-mm pupil diameter. Total and higher-order root mean square (RMS) values as well as spherical and coma aberrations were measured. Result: The mean spherical refractive error of the cases was -2.52±1.25 (range: from -0.50 to -6.0) D. The mean best- corrected visual acuity was significantly higher with both types of contact lenses than with glasses (p=0.017), however, no statistical difference was observed between the two types of contact lenses (p=0.470). The mean high-frequency contrast sensitivity value was lower with toric lenses (p=0.038). The mean higher-order RMS value was higher with both types of contact lenses (p=0.021), but with no difference between them (p>0.05). The mean spherical aberration value did not differ among glasses, toric or soft spherical contact lenses (p>0.05). The mean coma aberrations were high with both types of contact lenses (p=0.041); no difference was observed between the two lens types (p>0.05). Discussion: In this study, it was demonstrated that in cases of low astigmatism, soft spherical and toric contact lenses increase visual acuity, total higher-order aberrations, and coma aberrations, but decrease high-frequency contrast sensitivity. There was no difference between the two types of contact lenses. [ABSTRACT FROM AUTHOR]

The typical stigmatic optical system has two nodal points: an incident nodal point and an emergent nodal point. A ray through the incident nodal point emerges from the system through the emergent nodal point with its direction unchanged. In the presence of astigmatism nodal points are not possible in most cases. Instead there are structures, called nodes in this paper, of which nodal points are special cases. Because of astigmatism most eyes do not have nodal points a fact with obvious implications for concepts, such as the visual axis, which are based on nodal points. In order to gain insight into the issues this paper develops a general theory of nodes which holds for optical systems in general, including eyes, and makes particular allowance for astigmatism and relative decentration of refracting elements in the system. Key concepts are the incident and emergent nodal characteristics of the optical system. They are represented by 2 × 2 matrices whose eigenstructures define the nature and longitudinal position of the nodes. If a system’s nodal characteristic is a scalar matrix then the node is a nodal point. Otherwise there are several possibilities: Firstly, a node may take the form of a single nodal line. Second, a node may consist of two separated nodal lines reminiscent of the familiar interval of Sturm although the nodal lines are not necessarily orthogonal. Third, a node may have no obvious nodal line or point. In the second and third of these classes one can define mid-nodal ellipses. Astigmatic systems exist with nodal points and stigmatic systems exist with no nodal points. The nodal centre may serve as an approximation for a nodal point if the node is not a point. Examples in the Appendix , including a model eye, illustrate the several possibilities. [ABSTRACT FROM AUTHOR]

Objective: There is shortage of knowledge about medical problems in adolescent skiers. This study aimed to determine frequency of medical signs and symptoms during or after ski among adolescents skiers. Methods: This cross sectional study was performed in 12 consecutive weekends in winter 2005 at Dizin ski resort in Iran. All adolescent skiers (<16years) who had entered the resort during this time period were enrolled in the study. A questionnaire including demographics, duration of transport to the resort, wearing glasses and contact lenses for medical and non medical applications, duration and frequency of skiing and development of signs and symptoms of ski sickness during or after skiing was filled for each participant. In addition, association of mentioned variables with medical problems was investigated. Findings: Of 162 skiers, 111 subjects (68.5%) were males. The mean age of the participants was 14.7±2.1 years. Of them, 1 2 7 skiers wore glasses or lens during skiing. Visual disorders including myopia, hyperopia and astigmatism were found in 24 (14.8%) skiers. Our study showed that the frequency of main ski-related signs and symptoms varies from 0 to 10.5%. There was significant association between occurrence of signs and symptoms and presence of visual disorder (P=0.015). Conclusion: Our results showed that development of ski-related signs and symptoms is relatively frequent. These signs and symptoms have association with minor ophthalmologic problems such as myopia or astigmatism. [ABSTRACT FROM AUTHOR]

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In addition to active duty military members and their dependents, retired military members and the members of their immediate families are eligible for eye care in military medical treatment facilities. We recorded refractive errors, age, sex, and race for 4,595 individual beneficiaries visiting optometry clinics at two U.S. Air Force medical treatment facilities during 2005 to 2006. Evaluation revealed most patients requiring optical correction were myopic, or near-sighted, and there was an increase in the degree of myopia between ages 4 and 23. That trend is reversed at age 30 and, by age 60, most patients are hyperopic, or far-sighted. Both trends were true for both sexes and all ethnicities studied. The degree of astigmatism was distributed similarly between races and age groups. Presbyopia occurred at similar ages and progressed at similar rates in all ethnicities and both sexes. [ABSTRACT FROM AUTHOR]

The changes in the patterns of refraction (skiagrams) over the central ±35 degrees of the horizontal field of 3 originally near-emmetropic eyes of 2 subjects were determined over a time interval of 26 years. The subjects were aged 32 and 40 years at the time of the first measurements. The central refractions shifted in the expected hyperopic direction, while the radial and tangential image fields in the periphery became more myopic. These longitudinal results agree with recent transverse studies, provided that allowance is made for the change in central refraction: the reported loss with age in peripheral visual performance does not seem to be attributable to markedly increased peripheral astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To assess topography-assisted corneal wavefront excimer laser surface ablation for the correction of ametropia and irregular astigmatism after keratoplasty. Setting: Department of Ophthalmology, St. Thomas'' Hospital, London, United Kingdom. Methods: In this pilot study, 15 patients (16 eyes) who were intolerant of spectacle and contact lens correction due to astigmatic anisometropia after keratoplasty (15 penetrating and 1 lamellar) had topography-assisted customized excimer laser treatments. Corneal topographic data using a Keratron Scout, Placido disk system allowed for preoperative analysis of wavefront anomalies of the anterior corneal surface from which a customized excimer laser correction of both lower-order aberrations (LOAs) and higher-order aberrations (HOAs) was prepared (ORK software) for treatment with a Schwind Esiris flying-spot laser. All eyes had laser-assisted subepithelial keratectomy (LASEK) using 15% alcohol with a 20-second to 30-second application. Four eyes received an application of mitomycin-C (MMC) 0.2 mg/mL for 1 minute after stromal ablation. Results: The mean preoperative spherical equivalent (SE) was −3.50 diopters (D) ± 3.97 (SD) (range +1.625 to −9.25 D). The preoperative cylindrical error was −7.2 D (range −2.75 to −13.5 D). The programmed laser correction was −3.14 D (range +1.62 to −9 D) with a maximum attempted cylindrical correction of −7 D. Adherent LASEK epithelial flaps along suture lines and the graft–host junction were noted in 9 eyes (56%), although it was possible to obtain and replace a partial flap. A follow-up of 18 months was achieved in all eyes. At the final follow-up visit, the mean postoperative SE was −1.08 ± 1.85 D (range +3 to −4.78 D) (P<.01, F<.01). Ten eyes (62.5%) were within ±1 D of the intended correction. The mean postoperative cylindrical error was −2.72 D (range −0.5 to −6.5 D) (P<.001), with vector analysis demonstrating a mean 6.23 D correction. Analysis of HOAs using a 6.0 mm pupil size demonstrated a significant reduction of higher-order root mean square (RMS) (P<.002), trefoil (P<.005), and 4th-order spherical aberration (P<.02) at 18 months compared with preoperative values. Uncorrected visual acuity improved in all eyes (P<.0001). Best spectacle-corrected visual acuity was unchanged or improved in 13 eyes (81%) and worse in 2 eyes by 1 line; 1 eye lost 3 lines due to an increase in preexisting cataract. In eyes that did not receive MMC, corneal haze (grade II to IV) was encountered in 3 eyes (27%). One eye required phototherapeutic keratectomy with MMC application at 12 months. Of the 4 eyes treated with MMC, 1 had trace haze and 3 had no detectable haze. There were no reported cases of epithelial instability, ectasia, or graft rejection. Conclusions: Topography-assisted customized LASEK was effective in the correction of postkeratoplasty astigmatism. A significant improvement of both LOAs and HOAs was obtained with good refractive stability for over 18 months. Iatrogenic haze typically occurred but appeared to be minimized with adjunctive use of intraoperative MMC. [Copyright &y& Elsevier]

PURPOSE: To compare a new ablation algorithm termed the optimized aspheric transition zone (OATz) with the conventional laser ablation profile for correction of myopic astigmatism. METHODS: LASIK using OATz profile #6 or using conventional ablation profile was performed on 98 eyes of 53 patients (OATz #6 group) and 111 eyes of 66 patients (control #6 group), respectively. Further, LASIK using OATz profile #5 or using the conventional ablation profile was performed on 109 eyes of 58 patients (OATz #5 group) and 109 eyes of 75 patients (control #5 group), respectively. The effective optical zone, uncorrected visual acuity, manifest refraction, aberrations, contrast sensitivity, and patient satisfaction at 3 months postoperatively were compared between the OATz #6 and control #6 groups and between the OATz #5 and control #5 groups. RESULTS: The effective optical zones in the OATz #6 group (6.45±0.29 mm) or OATz #5 group (6.40±0.21 mm) were significantly larger than those in the control #6 group (6.33±0.27 mm) or control #5 group (6.26±0.25 mm) (P<.01), respectively. Uncorrected visual acuity and manifest refraction were similar in all groups. The changes in contrast sensitivity were significant and favored the OATz #6 (P<.01) and OATz #5 groups (P<.05). The patient satisfaction survey found no statistical difference at 3 months postoperatively. CONCLUSIONS: Patients treated with the OATz profiles had better visual quality as measured by contrast sensitivity and also had larger effective optical zones as compared with those treated by the conventional ablation profile. [ABSTRACT FROM AUTHOR]

Aim: To quantify corneal irregularities, to describe the fitting with contact lenses, and to answer the question whether or not contact lenses with a special back surface design could improve visual acuity in patients with pellucid marginal corneal degeneration (PMCD). Methods: 13 eyes were fitted with contact lenses with a special back surface. Videokeratographic data were assessed. The patients were followed up for an average period of 22.2 months. Lens tolerance and corrected visual acuity were evaluated. Results: The mean eccentricity did not exceed 0.7 in all patients. Either the superior or the inferior eccentricity, or both, were negative in all patients. Using Fourier analysis all PMCD sublects showed an increased irregular astigmatism of the anterior cornea. Using Zernike coefficients seven eyes (53.8%) had a higher order aberration root mean square error (HOA RMS error) out of the normal range. The visual acuity with contact lenses improved in all eyes with an average increase of 2.7 lines (maximum eight lines). No serious complications were observed. Conclusions: Quantitative evaluation of videokeratographic data may help to diagnose PMCD and to distinguish PMCD from other ectatic corneal diseases. Contact lenses with a special back surface design can improve visual acuity and lens tolerance. [ABSTRACT FROM AUTHOR]