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The grazing activity of predators on photosynthetic organisms is a major mechanism of mortality and population restructuring in natural environments. Grazing is also one of the primary difficulties in growing cyanobacteria and other microalgae in large, open ponds for the production of biofuels, as contaminants destroy valuable biomass and prevent stable, continuous production of biofuel crops. To address this problem, we have isolated a heterolobosean amoeba, HGG1, that grazes upon unicellular and filamentous freshwater cyanobacterial species. We have established a model predator-prey system using this amoeba and Synechococcus elongatus PCC 7942. Application of amoebae to a library of mutants of S. elongatus led to the identification of a grazer-resistant knockout mutant of the wzm ABC O-antigen transporter gene, SynPCC7942_1126. Mutations in three other genes involved in O-antigen synthesis and transport also prevented the expression of O-antigen and conferred resistance to HGG1. Complementation of these rough mutants returned O-antigen expression and susceptibility to amoebae. Rough mutants are easily identifiable by appearance, are capable of autoflocculation, and do not display growth defects under standard laboratory growth conditions, all of which are desired traits for a biofuel production strain. Thus, preventing the production of O-antigen is a pathway for producing resistance to grazing by certain amoebae.

Purpose: To compare macular and peripapillary retinal nerve fiber layer (RNFL) thickness in children from diabetic compared with nondiabetic pregnancy., Design: Cross-sectional study., Methods: As part of the Sydney Myopia Study, 2367 children from grade 7 (age range 11.1 to 14.4 years) completed detailed ocular examinations during 2004-2005. Examination included determination of best-corrected visual acuity (logarithm of minimal angle of resolution) and autorefraction after cycloplegia. Axial length was measured using noncontact interferometry. Optical coherence tomography (OCT) was performed using Stratus OCT through dilated pupils. Participants and parents completed comprehensive questionnaires including questions on birth parameters and medical history., Results: There were 1741 and 1687 children with adequate-quality RNFL and macular scans respectively, who had complete examination and questionnaire data. There were 57 children from diabetic pregnancies who had both RNFL and macular scans. Children from diabetic pregnancies had significantly thinner inner (264.9 μm vs 270.2 μm, P = .007) and outer (231.9 μm vs 238.6 μm, P = .0001) macular thickness and macular volume (6.75 mm(3) vs 6.92 mm(3), P = .0003) compared with children from nondiabetic pregnancies. However, central macular thickness, foveal minimum thickness, and RNFL parameters were not significantly different between the 2 groups., Conclusion: Diabetes during pregnancy is associated with changes in retinal morphology in the offspring. Thinning of the pericentral macular parameters was evident in Stratus OCT scans of children from diabetic pregnancies. These findings suggest the possibility that maternal diabetes impacts on the development of the retina., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: To examine the influence of different signal strengths on measurements made with optical coherence tomography (OCT) of macular, optic nerve head, and retinal nerve fiber layer (RNFL) parameters., Methods: From 2003 to 2005, 2092 children, mostly aged 12 years, were examined, and macular, optic nerve head, and RNFL parameters were measured by OCT. Multiple fast scans were acquired, and only right eyes were included in the analyses. Signal strength category was determined after averaging individual signal strengths from each scan and classifying scans as providing moderate (average signal strength, 5-7.49), good (average signal strength, 7.5-9.49), and excellent (average signal strength, >or=9.5) image quality. General linear models were used after adjustment for covariates., Results: Significant differences were observed between measurements obtained at excellent signal strengths compared with those obtained at moderate and good signal strengths for both macular and optic nerve parameters. However, although statistically significant, the magnitude of the differences in macular parameters was very small (approximately 5 microm, or a 2% difference). Differences in optic nerve head parameters were much greater (up to a 32% difference), with larger measurements recorded for most parameters with increasing signal strength category. Significant differences in RNFL parameters with increasing signal strength were not demonstrated., Conclusions: Significantly larger macular and optic nerve head OCT measurements were obtained with increasing signal strength measurements, although absolute differences in macular measurements were small and are of questionable clinical importance. The results support the robustness of OCT in providing precise macular imaging.

Aim: To examine ethnic differences in optic nerve head and retinal nerve fibre layer (RNFL) parameters between European Caucasian and East Asian children aged 6-12 years., Methods: Of 4118 children examined in the Sydney Childhood Eye Study (incorporating the Sydney Myopia Study) from 34 randomly selected primary and 21 secondary schools during 2003-5, 3382 (82.1%) had optical coherence tomography (OCT; Zeiss Stratus) data suitable for analysis. 'Fast' optic disc and RNFL scans were used. Ethnicity was defined only when both parents were of the same ethnicity., Results: East Asian children tended to have a lower birth weight, were shorter with a smaller body mass index and were less hyperopic than European Caucasian children of the same age. After adjusting for age, gender, axial length, birth weight and optic-disc area, East Asian children had similar mean vertical disc diameters to European Caucasians (p=0.38, p=0.64 for 6-12 years, respectively) but 30-43% larger mean vertical cup diameters (p<0.0001 for both), resulting in larger mean cup/disc ratios (p<0.0001 for both). Compared with European Caucasians (101.95 microm and 104.57 microm, respectively), East Asian children had thicker mean average RNFL (105.45 microm and 107.92 microm, respectively; p=0.0006 and 0.0001) and thicker non-nasal RNFL quadrants in both ages., Conclusions: Compared with European Caucasian children, East Asian children generally had thicker RNFL and larger mean cup/disc ratios. Given the relatively lower prevalence of open angle glaucoma in Asians, these anatomical variations could contribute to better understanding of apparent racial differences in glaucoma susceptibility.

Purpose: To describe the normal physiological relationship between retinal arteriolar and venular caliber and retinal nerve fiber layer (RNFL), macular, and optic nerve head parameters., Methods: The Sydney Childhood Eye Study assessed 2038 adolescents aged 12 years. Retinal vessel calibers were measured from digital fundus photographs using standardized protocols. Optical coherence tomography measurements of RNFL, macular, and optic nerve head parameters were obtained with the Fast-scan protocol of the Stratus OCT (Carl Zeiss Meditec, Inc., Dublin, CA). Mixed model analyses were performed., Results: After adjustment for covariates, each micrometer increase in RNFL thickness was associated with a 0.22-microm (0.15%, P < 0.0001) and 0.49-microm (0.23%, P < 0.0001) increase in mean arteriolar and venular caliber, respectively. This positive association existed across all RNFL quadrants (0.07%-0.24%, P

Purpose: To compare the measurements of optic nerve head parameters from digital photographic images and optical coherence tomography (OCT) in normal children., Methods: The Sydney Childhood Eye Study assessed 1765 children aged 6 years from 34 randomly selected primary schools during 2003 to 2005. Optic nerve head parameters were measured from digital photographs captured using a Canon fundus camera (CF-60Uvi)/EOS 10D and OCT3 (Zeiss Stratus) using the "fast" optic disc protocol. Retinal images of 333 sequential child participants were graded using both methods and are included in analyses. Optic disc and cup area, vertical and horizontal disc and cup diameters, vertical and horizontal cup/disc diameter ratios, and cup/disc area ratios were calculated using both modalities. Magnification of the planimetric images was corrected using the Bengtsson formula., Results: Mean vertical and horizontal disc and cup diameter and mean disc and cup area, as measured using OCT (1.76, 1.50, 0.71, and 0.68 mm and 2.15 and 0.47 mm, respectively) were significantly (P<0.0001; cup area P=0.0014) smaller than when measured using digital photography (1.85, 1.66, 0.76, and 0.74 mm and 2.40 and 0.51 mm, respectively). All 3 cup/disc ratio measures did not vary significantly (P>0.05) between the 2 methods (0.41, 0.45, and 0.22 vs. 0.41, 0.44, and 0.21, respectively)., Conclusions: Linear and area measures by Stratus-OCT, compared with digital planimetry measurements, are around 10% smaller; however, all 3 cup/disc ratios were preserved. Where OCT produces unexpectedly small cup/disc ratios, manual viewing is advisable. However, OCT can be considered moderately reliable in measuring and monitoring cup/disc ratio in clinical settings.

Purpose: To examine macular and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopia., Design: Population-based cross-sectional study., Participants: Of 4118 children examined in the Sydney Childhood Eye Study (incorporating the Sydney Myopia Study) from 34 randomly selected primary schools and 21 secondary schools from 2003 to 2005, 3529 (85.7%) were included in this analysis. The median age of the 2 samples was 6 years (n = 1395) and 12 years (n = 2134), respectively., Methods: A detailed eye examination was conducted on all children, including determination of best-corrected visual acuity (logarithm of the minimum angle of resolution [logMAR]), autorefraction (RK-F1 autorefractor, Canon, Tokyo, Japan) after cyclopentolate (1%), cover testing to identify strabismus, and optical coherence tomography (StratusOCT, Carl Zeiss Meditec, Dublin, CA) through dilated pupils to obtain macula and peripapillary RNFL thickness. Amblyopia was defined as best visual acuity <0.3 logMAR units not explained by any obvious underlying eye or visual pathway abnormalities. Anisometropia was defined as an interocular difference of at least 1.0 diopter of the spherical equivalent refraction., Main Outcome Measures: Macular and peripapillary RNFL thickness., Results: Amblyopic eyes had slightly greater foveal minimum thickness than the normal fellow eye (by 5.0 microm; 95% confidence interval 0.1-9.9) and right eyes of non-amblyopic children (by approximately 10 microm), both P<0.05. This was more pronounced in 6-year-old children (6.9 microm) than 12-year-old children (4.2 microm). Amblyopic eyes also had slightly thicker central macula (1 mm diameter region) in both comparisons, although these differences were not statistically significant. The inner macular ring (outer radius 1.5 mm) was thinner in amblyopic than normal fellow eyes. Peripapillary RNFL thickness was not significantly different between amblyopic and normal fellow eyes or normal eyes of non-amblyopic children., Conclusions: In children aged predominantly 6 and 12 years, central macular thickness may be increased in eyes with amblyopia, although it is uncertain if this precedes or follows the development of amblyopia. No differences in peripapillary RNFL thickness were found when compared with normal eyes., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To assess the relationship of birth weight, birth length, and head circumference as proxy markers of intrauterine growth, cup/disc ratio, and other optic disc parameters measured using optical coherence tomography (OCT)., Design: Population-based cross sectional analysis., Participants: The Sydney Childhood Eye Study examined 2353 primarily 12-year-old children from 21 randomly selected secondary schools during 2003 to 2005., Methods: Of 2353 children examined, 2134 (90.7%) had OCT scans (Zeiss Stratus OCT, Carl Zeiss Meditec, Dublin, CA) and are included in this study. The "fast" optic disc scan protocol was used. Birth weight, birth length, and head circumference were ascertained from health records. Height and weight were measured using standardized protocols, body mass index (BMI) was defined as weight (kilograms)/ height squared (meters), and sociodemographic information was collected in a questionnaire completed by parents. Low birth weight was defined as birth weight

Purpose: To determine whether differences exist in morphological structures of dominant and nondominant eyes in children ages 6 or 12 years. The following structural features were assessed: axial length, refraction, corneal radius of curvature, and retinal features-measured with the use of optical coherence tomography (OCT)-including macular and retinal nerve fiber layer thickness and optic disk parameters., Methods: Of 4,118 children examined from 2003 to 2005 in the Sydney Myopia Study, 3,382 (82.1%) had OCT data for analysis. Comprehensive standardized eye examinations were performed, including best-corrected visual acuity. Ocular dominance was determined using the hole-in-card test, repeated on 3 occasions. Dominance was assigned only if the 3 measurements were identical. "Fast" scans of the optic disk and retina were performed using OCT., Results: Dominance was observed in 85% of subjects, with boys having a tendency toward right eye dominance. The dominant eye was longer (p = 0.001 and p = 0.0003 for 6- and 12-year-old patients, respectively) and more myopic (p = 0.002 and p = 0.0001, respectively) than its counterpart. No retinal features consistently identified dominant from nondominant eyes in both age groups., Conclusions: Although dominant eyes tended to be longer and slightly more myopic than nondominant eyes, we found no consistent ocular structural differences between dominant and nondominant eyes with the use of OCT.

Purpose: To examine the distribution of macular and peripapillary nerve fiber layer (NFL) thickness and optic disc parameters in early-adolescence Australian children and to compare these with previously reported findings in younger children., Methods: The Sydney Childhood Eye Study is a population-based cross-sectional survey of children's eye health. During 2004 and 2005, 2367 (75.3%) of 3144 eligible year 7 students from a random cluster sample of 21 secondary schools in Sydney, Australia, were examined. The comprehensive eye examination included measurement of macular and NFL thickness and optic disc parameters by optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, CA)., Results: Macular, NFL thickness, and optic disc parameters were normally distributed in early-adolescence children. Mean (+/-SD) thicknesses of the central 1 mm, and inner and outer macular rings were 197.4 +/- 18.7, 271.9 +/- 15.0, and 239.5 +/- 13.5 microm, respectively. The foveal minimum thickness was 161.6 +/- 19.9 microm. The mean (+/-SD) of average NFL thickness was 103.6 +/- 10.6 microm. Mean (+/-SD) vertical and horizontal disc diameters were 1.88 +/- 0.25 and 1.61 +/- 0.20 mm; corresponding cup-to-disc ratios were 0.39 +/- 0.14 and 0.44 +/- 0.16. There were minimal sex differences in these parameters after adjustment for multiple ocular and demographic variables. Compared with parameters in the childhood group, the macula was generally slightly thicker and the optic disc slightly larger in the early-adolescence group, although differences between these two age groups were small. The foveal minimum and NFL thickness were similar between the two age groups., Conclusions: This study describes the normative distribution of macular, NFL, and optic disc parameters in early-adolescence children and also demonstrates minimal differences between the sexes. These parameters were also largely unchanged between early childhood and early adolescence, although the comparisons were made in two cross-sectional samples, rather than from longitudinal measures.

Porphyromonas species are frequently isolated from the oral cavity and are associated with periodontal disease in both animals and humans. Black, pigmented Porphyromonas spp. isolated from the gingival margins of selected wild and captive Australian marsupials with varying degrees of periodontal disease (brushtail possums, koalas and macropods) were compared phylogenetically to Porphyromonas strains from non-marsupials (bear, wolf, coyote, cats and dogs) and Porphyromonas gingivalis strains from humans using 16S rRNA gene sequence analysis. The results of the phylogenetic analysis identified three distinct groups of strains. A monophyletic P. gingivalis group (Group 1) contained only strains isolated from humans and a Porphyromonas gulae group (Group 2) was divided into three distinct subclades, each containing both marsupial and non-marsupial strains. Group 3, which contained only marsupial strains, including all six strains isolated from captive koalas, was genetically distinct from P. gulae and may constitute a new Porphyromonas species.

Purpose: To compare the distribution of spherical equivalent refraction (SER) and other ocular parameters and to assess the contribution from oculometric parameters to SER in two age-specific, cross-sectional samples of children, and in two ethnic groups (European Caucasian and East Asian)., Methods: A random-cluster design was used to recruit predominantly 6-year-old (1765 participants, 78.9% response) and 12-year-old children (2353 participants, 75.3% response) from schools across Sydney, Australia. Data collection included questionnaires and eye examination (keratometry, biometry, and cycloplegic autorefraction). Results of three analytical methods (Pearson correlation, partial correlation coefficient, and linear regression analyses) are reported for 6- and 12-year-old children., Results: Kurtosis for SER and axial length (AL) in the 12-year-old children (14.3 and 2.1, respectively) was similar to that previously reported for the 6-year-old children (11.3 and 0.5). AL showed high correlation (r) with SER in the 6- (r = -0.44) and 12-year-old (r = -0.61) children. Lower correlations for SER with corneal radius (r

Purpose: To assess the effects of refraction and axial length on optical coherence tomography (OCT) measures of childhood optic disk parameters., Design: Population-based cross-sectional study., Methods: Of 4,118 children examined in the Sydney Myopia Study (Sydney Childhood Eye Study) from 34 randomly selected primary schools and 21 secondary schools from 2003 through 2005, 3,529 (85.7%) were included in the analysis (1,395 6-year-old children [year 1 students] and 2,134 12-year-old children [year 7 students]). Comprehensive standardized eye examinations included best-corrected visual acuity, cycloplegic autorefraction, biometry measurements, and fast optic disk scans using OCT., Results: After adjusting for magnification, the mean optic disk area was positively associated with axial length (P(trend) < .0001, both age groups) but was not associated consistently with spherical equivalent refraction (SER)., Conclusions: Optic disk parameters in childhood are influenced by axial length, but not by refractive error itself.

Purpose: To report the distribution of stereoacuity thresholds and ocular characteristics associated with reduced stereoacuity in a representative sample of 12-year-old Australian children., Methods: Stereoacuity thresholds were determined using the three quantitative plates of the TNO test in 2343 children, either unaided or with spectacles, if worn. Logarithm of minimum angle of resolution (logMAR) visual acuity was measured. Cycloplegic autorefraction (using cyclopentolate), cover testing, and dilated fundus examination were performed. Reduced stereoacuity was defined as > 120 arcsec. Myopia was defined as spherical equivalent refraction (SER) < or = -0.50 D hyperopia as spherical equivalent refraction > or = +2.0 D, anisometropia as spherical equivalent refraction difference between eyes > or =1.00 D, and astigmatism as cylinder > or = 1.0 D., Results: Stereoacuity was based on unaided visual acuity in 1975 children (84.3%) and on spectacle-corrected visual acuity in 368 children (15.7%); 87 children (3.7%) had reduced stereoacuity. Amblyopia was the most common identifiable cause, accounting for 32%, followed by strabismus (15%) and anisometropia (14%). Presence of anisometropia was significantly associated with reduced stereoacuity; 78.6% of anisometropic children achieved normal stereoacuity versus 98.9% without anisometropia (p < 0.0001)., Conclusions: Reduced stereoacuity was relatively uncommon in a population of 12-year-old Australian children. Its functional and psychosocial impact on individuals and on the whole population remains uncertain.

Purpose: To examine the influences of ethnicity, parental myopia, and near work on spherical equivalent refraction (SER) and axial length (AL) in a population-based sample of 12-year-old Australian children., Methods: Year-7 children in the Sydney Myopia Study (n = 2353, 75.3% response) underwent an ophthalmic examination including cycloplegic autorefraction (1% cyclopentolate) and ocular biometry (IOLMaster; Carl Zeiss Meditec GmbH, Jena, Germany). Data for parental myopia, ethnicity, near work, and outdoor activities were derived from questionnaires and were available for 1781 children. Optical prescriptions of parents were sought if the spectacles were used., Results: The prevalence of myopia in the children increased with the number of myopic parents (7.6%, 14.9%, and 43.6% for no, one, or two myopic parents). In parallel, the mean SER (+/-SE of the mean) was more negative (0.70 +/- 0.08, 0.34 +/- 0.09, and -0.55 +/- 0.34 D), and the mean AL was longer (23.32 +/- 0.05, 23.44 +/- 0.06, and 23.62 +/- 0.16 mm) after adjustment for demographic and environmental factors. In multivariate analyses, odds of childhood myopia did not change with higher levels of near work (odds ratio [OR] = 1.01; 95% confidence interval [CI] = 0.99-1.03). Interactions between parental myopia and ethnicity were significant for SER and AL (both P < 0.0001), reflecting greater decreases in SER and greater increases in AL with the number of myopic parents in the children of East Asian ethnicity than in the children of European Caucasian ethnicity. In the nonmyopic children, there was no association between parental myopia and AL., Conclusions: In this sample, parental myopia was associated with more myopic SER and longer AL, with significant ethnic interactions.

Purpose: To examine symmetry of macular, peripapillary nerve fiber layer (NFL), and optic disk measurements in healthy children., Design: Cross-sectional study., Methods: We examined a population-based sample of six-year-old children (n = 1,765) in the Sydney Childhood Eye Study. Optical coherence tomography (OCT) scan data for right and left eyes were compared., Results: High interocular correlations (>0.8) were found for foveal minimum thickness and cup-to-disk ratios. Average NFL thickness was moderately correlated (0.7). Other macular, NFL, and optic disk parameters showed negligible or small mean interocular differences. In 95% of children, interocular difference in macular thickness was <22 microm for foveal minimum and <40 microm for other areas, and 16 to 17 microm for average NFL thickness. Cup-to-disk ratio was highly symmetric, varying by <0.25 in 95% of children., Conclusions: Interocular asymmetry of retinal/optic disk parameters should be interpreted in the context of other clinical measures because of the potential for large degrees of asymmetry among individuals.

Purpose: To determine the reproducibility of optical coherence tomography (OCT) measurements of macular thickness, peripapillary nerve fiber layer (NFL) thickness, and optic disk parameters and to investigate the effect of axial length and refractive error on these measurements in children with healthy eyes., Design: Cross-sectional study., Methods: The Sydney Childhood Eye Study examined 2,353 year 7 students (75.3% response) from a random cluster sample of 21 secondary schools across Sydney. A consecutive subsample of 120 children had OCT (StratusOCT, Carl Zeiss, Dublin, California, USA) performed by a single operator, which was repeated with a brief rest between the two sessions. Scans of the NFL, macula, and optic disk were performed., Results: Intersubject variability of measurements of macular thickness, NFL thickness, and optic disk parameters assessed using intraclass correlation coefficients accounted for >85%, >62%, and >38% of total variability of measurements, respectively. Corresponding coefficients of variability were <5%, <8%, and <13%. Magnification effects attributable to axial length and refractive error on the measurement of these parameters were statistically not significant., Conclusion: The StratusOCT demonstrated reproducible measurements of macular and NFL thickness. Measurement of most optic disk parameters were also reproducible. Magnification attributable to axial length and refractive error had minimal impact on measurements of macular and NFL thickness.

Purpose: To study the distributions of refractive (RA), corneal (CA), and internal astigmatism (IA) in 12-year-old Australian children and to explore differences from previous findings in 6-year-old children., Methods: Eligible year 7 students (2353/3144 [75.3%], median age, 12 years) from a random cluster sample of 21 high schools in Sydney, Australia, were examined by keratometry, cycloplegic autorefraction, and review of questionnaire data., Results: Prevalence rates of RA, CA, and IA > or =1.0 D in right eyes were 6.7% (95% confidence interval [CI], 5.0-8.4), 26.6% (CI, 22.1-31.1), and 26.5% (CI, 22.9-30.0), respectively. RA was predominantly with-the-rule (WTR; 40.4%, CI, 32.6 to 48.2) and against-the-rule (ATR; 43.6%, CI, 35.7-51.5), CA was WTR (88.8%, CI, 86.3-91.3), and IA was ATR (90.2%, CI, 87.8-92.6). The girls had significantly greater CA and IA prevalence, with greater ATR astigmatism and lower oblique IA than did the boys. The European white-Australian children had lower CA prevalence than did the East Asian-Australian children and higher IA prevalence than did the South Asian-Australian children. Ethnic differences in RA prevalence were not significant, when adjusted for confounders. RA was more frequently ATR in European white than in other ethnic groups. Compensation between CA and IA reduced the magnitude of RA. Comparison with the data on 6-year-old children revealed minimal differences for all astigmatic components., Conclusions: There was a relatively low prevalence of RA, due to compensation between CA and IA. The minimal differences in all components of astigmatism between the two age cohorts suggest that astigmatism is stable between ages 6 and 12 years, although this conclusion needs to be confirmed in longitudinal studies.

Purpose: The purpose of this study was to evaluate and compare the Complete Ophthalmic Analysis System (COAS) G200 Aberrometer (Wavefront Sciences Inc., Albuquerque, NM) and Canon RK-F1 Autorefractor (Canon Inc., Tokyo, Japan) for measuring refractive errors in young children., Methods: The Sydney Myopia Study is a population-based study of refractive error and eye health in young Australian children. Cycloplegic refractions were performed on 1504 school year 1 students (mostly 6 years old) and 890 school year 7 (mostly 12 years old) students using both the COAS G200 Aberrometer and Canon RK-F1 autorefractor. Refractive data were analyzed using power vectors. Mean differences and 95% limits of agreement were determined for refractive components between the two instruments., Results: The mean age +/- standard deviation was 6.7 +/- 0.4 years (range, 5.5-9.1 years) and 12.6 +/- 0.5 years (range, 11.1-14.4 years) for the year 1 and year 7 students, respectively. Mean paired differences for the M component (spherical equivalent) between the COAS G200 and Canon RK-F1 were <0.25 D in both age groups and were statistically significant in the year 1 group only (p < 0.001). Small significant differences were found in the astigmatic components (J0 and J45) in both groups. A smaller coefficient of agreement for the M component was found in the older group (0.54 D), whereas the coefficients of agreement of the astigmatic components (J0 and J45) were similar for both groups., Conclusions: The COAS G200 aberrometer was an easy-to-use instrument for the measurement of refractive error in children. In addition to being able to measure higher and lower order aberrations, the COAS G200 provides refractive error measurements comparable to those of an autorefractor.

Purpose: To study the distribution of retinal nerve fiber layer (RNFL) thickness by ocular and demographic variables in a population-based study of young children., Design: Population-based cross-sectional study., Participants: One thousand seven hundred sixty-five of 2238 (78.9%) eligible 6-year-old children participated in the Sydney Childhood Eye Study between 2003 and 2004. Mean age was 6.7 years (50.9% boys)., Methods: Detailed examination included cycloplegic autorefraction and measurement of axial length. Retinal nerve fiber layer scans using an optical coherence tomographer were performed with a circular scan pattern of 3.4-mm diameter. Multivariate analyses were performed to examine the distribution of RNFL parameters with gender, ethnicity, axial length, and refraction., Main Outcome Measures: Peripapillary RNFL thickness and RNFL(estimated integral) (RNFL(EI)), which measures the total cross-sectional area of ganglion cell axons converging onto the optic nerve head., Results: Peripapillary RNFL thickness and RNFL(EI) were normally distributed. The mean+/-standard deviation RNFL average thickness was 103.7+/-11.4 microm and RNFL(EI) was 1.05+/-0.12 mm2. Retinal nerve fiber layer thickness was least for the temporal quadrant (75.7+/-14.7 microm), followed by the nasal (81.7+/-19.6 microm), inferior (127.8+/-20.5 microm), and superior (129.5+/-20.6 microm) quadrants. Multivariate adjusted RNFL average thickness was marginally greater in boys than in girls (104.7 microm vs. 103.2 microm; P = 0.007) and in East Asian than in white children (107.7 microm vs. 102.7 microm; P<0.0001). The RNFL was thinner with greater axial length (P(trend)<0.0001) and less positive spherical equivalent refractions (P(trend) = 0.004)., Conclusions: Retinal nerve fiber layer average thickness and RNFL(EI) followed a normal distribution. Retinal nerve fiber layer thickness varied marginally with gender, but differences were more marked between white and East Asian children. Retinal nerve fiber layer thinning was associated with increasing axial length and less positive refractions.

Purpose: To examine influences of gestational age and birth parameters on peripapillary nerve fiber layer (NFL) and macular thickness at age six., Design: Cross-sectional study., Methods: The Sydney Childhood Eye Study examined a random-cluster sample of 1765 six-year-old Sydney school children. Peripapillary NFL and macular thickness were measured (StratusOCT, Zeiss, Dublin, California, USA). Birth parameters were extracted from health records. Multivariate analyses were performed., Results: Higher birth weight children had greater peripapillary NFL, inner and outer (all P(trend) < 0.03), but not central or average macular thickness (both P(trend) > 0.1). Peripapillary NFL (P(trend) = 0.001), inner (P(trend) = 0.01), outer (P(trend) = 0.002), and average macular thickness (P(trend) = 0.02), but not central macular thickness (P(trend) = 0.5) was greater in children with larger head circumference at birth. The central macula was thicker in prematurely (<37 weeks) born children (195.0 microm) than those born at term (191.2 microm), P = 0.04., Conclusion: Birth weight and head circumference predicted peripapillary NFL and macular thickness. Prematurity was weakly associated with central macular thickness.

Purpose: To study the distribution of optic disc, cup, and neural rim size by ocular and demographic variables in a population-based sample of 6-year-old children., Methods: The Sydney Childhood Eye Study examined 1765 of 2238 eligible 6-year-old children (78.9%) from 34 randomly selected Sydney schools during 2003 to 2004. Comprehensive standardized eye examination included cycloplegic autorefraction, optical biometry and "fast optic disc" scans performed using optical coherence tomography., Results: Scans of adequate quality were available for 1309 children (75% of participants), with 70% aged 6 years; 50.9% were boys. Mean (+/- SD) horizontal and vertical disc diameter and disc area was 1.53 +/- 0.21 mm, 1.79 +/- 0.28 mm, and 2.20 +/- 0.39 mm(2), respectively. Corresponding cup dimensions were 0.70 +/- 0.28 mm, 0.73 +/- 0.27 mm, and 0.48 +/- 0.32 mm(2). A definable optic cup was absent in 7.4%, 87% of whom were European white. Cup-to-disc diameter ratios were 0.46 +/- 0.16 horizontally and 0.42 +/- 0.15 vertically, whereas cup-to-disc area ratio was 0.22 +/- 0.13. Mean +/- SD neural rim area was 1.76 +/- 0.44 mm(2) and increased with disc size (Pearson correlation = 0.68, P < 0.0001). Horizontal and vertical average nerve widths were 0.36 +/- 0.05 and 0.28 +/- 0.05 mm, respectively. In analyses adjusting for potential confounders, disc area increased significantly with axial length (P(trend) < 0.0001) and refraction (P(trend) = 0.02). Rim area increased only with axial length (P(trend) = 0.01). There were no gender differences, except for average nerve width, marginally greater in boys. Most disc and cup dimensions were significantly larger in East-Asian than European white and Middle Eastern children., Conclusions: Disc, cup, and neural rim parameters were generally normally distributed in this young population. Axial length appeared to be a stronger determinant of disc and rim size than refraction. Some ethnic but not gender differences were demonstrated for most parameters.

Purpose: To document the prevalence of correctable and non-correctable visual impairment in a representative sample of Australian children, predominantly age 12 years., Design: Population-based cross-sectional study., Methods: Logarithm of the minimum angle of resolution (logMAR) visual acuity was measured in both eyes unaided, with spectacles if worn, and after subjective refraction if required, in 2353 children, examined during 2004 to 2005. Cycloplegic autorefraction (using cyclopentolate) and dilated fundus examination were performed. Using a cut-off of 0.3 logMAR units (<20/40), presenting visual impairment was defined using unaided visual acuity if spectacles were not worn or with usual correction if spectacles were worn. Impairment not eliminated by refraction was considered non-correctable; any difference between this and presenting impairment was defined as correctable impairment. Myopia was defined as spherical equivalent refraction (SER) < or =-0.50 diopters (D), hyperopia as SER > or =+2.0 diopters, anisometropia as SER difference > or =1.00 diopters, and astigmatism as cylinder > or =1.0 diopters. Amblyopia was defined as corrected visual acuity <0.3 logMAR not attributable to an underlying structural eye or visual pathway abnormality., Results: Visual impairment was found in the worse eye of 117 children (5.0%) and comprised correctable (82%) and non-correctable impairment (18%). Correctable impairment was due to myopia in 67 (69.8%), hyperopia in 11 (11.5%) and astigmatism in 32 subjects (33.3%). Causes of non-correctable impairment were: amblyopia 66.7%, congenital glaucoma 9.5%, optic nerve hypoplasia 9.5%, congenital nystagmus 4.8%, and cortical blindness 4.8%., Conclusions: Visual impairment had a relatively low prevalence in this older childhood population, a large proportion of which was correctable by refraction alone.

Purpose: To study the distribution of macular thickness by ocular and demographic variables in a population-based study of young children., Methods: The Sydney Childhood Eye Study examined 1765 6-year-old children from 34 randomly selected Sydney schools during 2003 and 2004 (78.9% response). A comprehensive eye examination included cycloplegic autorefraction and optical biometry. Fast macular thickness scans were performed over a 6-mm diameter central retinal region with optical coherence tomography. Multivariate analyses were performed. Macular thickness is presented on a modified Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid, with outer radii for the central, inner, and outer macular regions being 0.5, 1.5, and 3 mm, respectively., Results: In the study, 1543 children (88.7% of participants; 51.1% boys) had high-quality scan data (mean age, 6.7 years). The mean (SD) minimum foveal thickness was 161.1 (19.4) microm. The thickness of the central, inner, and outer macula was normally distributed, with means (SD) of 193.6 (17.9), 264.3 (15.2), and 236.9 (13.6) microm, respectively. Total macular volume was also normally distributed, with a mean (SD) of 6.9 (0.4) mm(3). The temporal quadrant was thinner than other quadrants for both inner and outer macular regions. The foveal minimum, central, and inner macula was generally significantly thicker in boys than in girls, and in white than in East Asian children. Outer macular thickness showed no significant gender-ethnic differences. Sectoral macular thickness variations were preserved in both gender and ethnic groups. The inner and outer macula, but not the central macula, showed significant thinning with increasing axial length. These corresponding areas were significantly thicker with more hyperopic spherical equivalent refractions., Conclusions: Macular thickness and volume were normally distributed in this young childhood population. Significant gender and ethnic differences were demonstrated. Axial length and refraction were important ocular biometric determinants of macular thickness.

Purpose: To evaluate the repeatability and comparability of keratometry measured by both the IOLMaster and RK-F1 AutoRef-Keratometer in children., Methods: Keratometry results from a sample (n = 447) of 6-year-old children who were examined in the Sydney Myopia Study were analyzed. Corneal power was analyzed along the flattest and steepest meridians to determine if there were any systematic differences between repeat measurements or between the two instruments. The 95% limits of repeatability (LR) and 95% limits of agreement (LA) (mean difference +/- 1.96 x standard deviation of differences) were calculated., Results: There were no systematic differences in repeat measurements for each instrument. For the IOLMaster, mean difference of the flattest corneal meridian was -0.01 (D) (P = 0.3, 95% LR, -0.22, 0.21 D) and of the steepest corneal meridian, 0.01 D (P = 0.3, 95% LR, -0.35, 0.38 D). For the RK-F1, mean difference of the flattest corneal meridian was -0.02 D (P = 0.3, 95% LR, -0.25, 0.21 D); and of the steepest corneal meridian, 0.00 D (P = 0.9, 95% LR, -0.39, 0.39 D). Systematic differences, however, were found between the two instruments. The IOLMaster gave significantly (P < 0.0001) steeper readings than the RK-F1 for both the flattest corneal meridian, 0.29 D (95% LA, -0.08, 0.66 D), and the steepest corneal meridian, 0.18 D (95% LA, -0.29, 0.65 D)., Conclusions: Keratometry was highly repeatable for both the IOLMaster and RK-F1 instruments when used in young children. These instruments would be suitable for use in monitoring changes of corneal curvature over time. Small significant systematic differences in keratometry between the two instruments were also found.

Aim: To study the distribution of anisometropia and aniso-astigmatism in young Australian children, together with clinical and ocular biometry relations., Method: The Sydney Myopia Study examined 1765 predominantly 6 year old children from 34 randomly selected Sydney schools during 2003-4. Keratometry, cycloplegic autorefraction, and questionnaire data were collected., Results: Spherical equivalent (SE) anisometropia (> or =1 dioptre) prevalence was 1.6% (95% confidence interval (CI) 1.1% to 2.4%). Aniso-astigmatism (>or =1D) prevalence was 1.0% (CI: 0.6% to 1.6%). Both conditions were significantly more prevalent among moderately hyperopic (SE > or =2.0D) than mildly hyperopic (SE 0.5-1.9D) children. Myopic children (SE < or =-0.5D) had higher anisometropia prevalence. Neither condition varied by age, sex, or ethnicity. In multivariate analyses, anisometropia was significantly associated with amblyopia, odds ratio (OR) 29, (CI: 8.7 to 99), exotropia (OR 7.7, CI: 1.2 to 50), and neonatal intensive care unit (NICU) admission (OR 3.6, CI: 1.1 to 12.6). Aniso-astigmatism was significantly associated with amblyopia (OR 8.2, CI: 1.4 to 47), maternal age >35 years (OR 4.0, CI: 1.3 to 11.9), and NICU admission (OR 4.6, CI: 1.2 to 17.2). Anisometropia resulted from relatively large interocular differences in axial length (p<0.0001) and anterior chamber depth (p = 0.0009). Aniso-astigmatism resulted from differences in corneal astigmatism (p<0.0001)., Conclusion: In this predominantly 6 year old population, anisometropia and aniso-astigmatism were uncommon, had important birth and biometry associations, and were strongly related to amblyopia and strabismus.

Purpose: The purpose of the present study was to report the prevalence of refractive (RA), corneal (CA), and internal astigmatism (IA) in a population of 6-year-old children; examine their variation with gender, ethnicity, and refraction; and examine the effects of gender, ethnicity, and spherical equivalent refraction on the relationship between CA and RA in this population., Methods: The Sydney Myopia Study is a population-based survey of refraction and eye health in 6-year-old children. A random cluster design was used to recruit children from schools across Sydney, Australia, during 2003 to 2004. Data collection used a detailed questionnaire and comprehensive eye examination. Keratometric and cycloplegic autorefraction data from right eyes were analyzed., Results: Of 2238 eligible children, 1765 (78.9%; 50.7% boys) had parental consent to participate. Overall prevalence of RA (> or =1.0 diopter [D]) was 4.8% (95% confidence interval [CI] 3.8%-6.1%), CA (> or =1.0 D) 27.7% (CI 23.8%-32.3%), and IA (> or =1.0 D) 21.1% (CI 19.0%-23.5%). The RA axis was fairly evenly distributed, with predominance of oblique axis (39.1%; CI 35.9%-42.6%). CA axis was mainly with the rule (75.1%; CI 72.6%-77.8%), while IA axis was mainly against the rule (76.7%; CI 74.2%-79.3%). After adjustment for multiple variables, girls had significant, marginally greater mean CA and IA than boys. East Asian and South Asian children had significantly greater prevalence and mean RA and CA than European Caucasian children. There were no significant ethnic differences of mean IA. Compared to reference (spherical equivalent [SEq] 1.01-1.50 D), mean RA and CA increased significantly with more hyperopic and more myopic refractions. Mean IA was significantly greater only for hyperopic refractions (SEq > 2.00 D)., Conclusions: The prevalence of astigmatism found in this population of 6-year-old children was relatively low, and showed significant variation with ethnicity. The data suggest that emmetropization for RA occurs by a compensatory process between CA and IA.

Purpose: To assess the accuracy of the Lang II stereotest in screening for strabismus, amblyopia, and anisometropia in 6-year-old children., Design: Cross-sectional population-based study., Methods: The Sydney Myopia Study examined 1765 6-year-old children (78.9% of eligible) who were identified by random cluster sampling of 34 schools in Sydney, Australia. Sensitivity and specificity of the Lang II stereotest was determined by best stereoacuity. Cycloplegic autorefraction, assessment of visual acuity, and ocular motility were conducted., Results: Test sensitivity ranged from 21.4% for anisometropia (> or =1.0 diopter) to 31.3% for amblyopia. The detection rate for new cases of amblyopia ranged from 20% to 40%; the detection rate for new cases of strabismus was 30%. Specificity was >98% in all three conditions. Children with false-negative results included newly diagnosed cases of strabismus (14 of 25 children) or amblyopia (5 of 12 children)., Conclusion: The Lang II stereotest, when used alone, has very limited value as a screening test of binocular dysfunction.

Purpose: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and 5-year incidence of cataract and cataract surgery., Design: Population-based cohort study., Participants: Of the 3654 participants (aged 49 years or older) of the Blue Mountains Eye Study (BMES I) baseline examination (during 1992 to 1994), 2334 (75%) were reexamined after 5 years from 1997 to 1999 (BMES II)., Method: Risk factor data were collected for all participants at baseline (BMES I). Assessment of renal function was based on estimated creatinine clearance (C(Cr)) calculated with the Cockcroft-Gault formula, adjusted for body surface area, and expressed in ml/minute/1.73 m2. Cataract incidence was determined from graded photographs. The association between renal function and incidence of cataract and cataract surgery was analyzed by logistic regression., Main Outcome Measures: Incidence of nuclear, cortical, and posterior subcapsular cataract, and cataract surgery., Results: Mean C(Cr) +/- standard deviation was 60+/-13 ml/minute/1.73 m2. The overall 5-year incidence of nuclear, cortical, and posterior subcapsular cataract was 35.7% (417 of 1167 participants at risk), 16.7% (274 of 1641), and 4.3% (77 of 1790), respectively. Cataract surgery was performed in 6.8% (144 of 2123) of participants. There were no significant associations of renal function with incident nuclear (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.99-1.02), cortical (OR, 1.0; CI, 0.98-1.01), and posterior subcapsular cataract (OR, 1.0; CI, 0.99-1.04) after adjusting for multiple risk factors. After adjusting for age, gender, and dark brown iris color, moderate or worse renal impairment (C(Cr) <60 ml/minute/1.73 m2) compared with normal or mildly impaired function (C(Cr) > or =60 ml/minute/1.73 m2) was significantly associated with incident cataract surgery (P<0.05), but the effect depended on age. Participants younger than 60 years of age with moderate to severe renal impairment had increased odds of incident cataract surgery (OR, 2.75; CI, 1.06-7.14), but this OR decreased with age. In participants 80 years old or older, the OR was 0.34 (CI, 0.11-1.10)., Conclusions: There were no significant effects of renal function on the incidence of cataract of any type. The effect of moderate or worse renal impairment on incident cataract surgery depended on age. However, the interpretation of this effect is uncertain because of additional factors that may be involved in patients having surgery.