Reduced sampling efficiency causes degraded Vernier hyperacuity with normal aging: Vernier acuity in position noise.

Vernier acuity, a form of visual hyperacuity, is amongst the most precise forms of spatial vision. Under optimal conditions Vernier thresholds are much finer than the inter-photoreceptor distance. Achievement of such high precision is based substantially on cortical computations, most likely in the primary visual cortex. Using stimuli with added positional noise, we show that Vernier processing is reduced with advancing age across a wide range of noise levels. Using an ideal observer model, we are able to characterize the mechanisms underlying age-related loss, and show that the reduction in Vernier acuity can be mainly attributed to the reduction in efficiency of sampling, with no significant change in the level of internal position noise, or spatial distortion, in the visual system.

Objective real-time measurement of instrument myopia in microscopists under different viewing conditions.

While instrument myopia is known to occur when microscopes are used, little is known about the accommodation response during microscopy, or about the factors which may alter the magnitude of instrument myopia. In addition, there has been no real-time objective measurement of instrument myopia during the microscopy task. Twenty inexperienced subjects and 10 experienced microscopists (average work experience of 4.8 years (SD 3.2 yr)) with mean age of 24.1 years (SD 2.9 yr) and 31.2 years (SD 2.9 yr) respectively were recruited to the study. Instrument myopia was measured using an infrared photorefractor (PowerRefractor) under different viewing conditions and microscope settings (with different forms of refractive error correction, changes in target quality, changes in eyepiece power settings, changes in magnification and changes in illumination of the target). Instrument myopia was greater in inexperienced (1.98 D (SD 0.91 D)) than in experienced (1.38 D (SD 0.75 D)) microscope users. There was no statistically significant change in the level of instrument myopia under the different viewing conditions or different microscope settings, and there were large individual variations. Other factors may play more of a role in determining the degree of instrument myopia during microscopy than the task variables altered here.

The effect of a beta-adrenoceptor antagonist on accommodative adaptation in Hong Kong children.

PURPOSE: Increased susceptibility to nearwork-induced accommodative adaptation has been suggested as a risk factor for myopia development. We investigated whether accommodative adaptation may explain in part the high prevalence of myopia in Hong Kong children and examined the effect of beta-antagonism with topical timolol maleate on accommodative adaptation. METHODS: Thirty children (10 emmetropes and 20 myopes) aged between 8 and 12 years were recruited. Tonic accommodation was measured before and after 5 min of video game-playing using an open-field Shin-Nippon autorefractor. Measurements were repeated 30 min after timolol instillation. RESULTS: Children with progressing myopia demonstrated accommodative adaptation following the near task, whereas stable myopes showed counter-adaptive, hyperopic accommodative changes. Timolol increased the magnitude of accommodative adaptation in the stable myopes but had little effect on responses of the progressing myopes or emmetropes. CONCLUSIONS: Neuropharmacological modulation of the accommodative system may have a possible etiological role in the progression of myopia.

Prevalence of myopia in local and international schools in Hong Kong.

PURPOSE: This study aims to investigate genetic and environmental influences on physiological myopia by studying the difference in myopia prevalence between local schools and international schools in Hong Kong. METHODS: Vision screening was carried out in local and international schools for students 13 to 15 years old. Types of refractive error were identified by visual acuity measurement, the presence of spectacles, a simple refraction, and the use of plus and minus ophthalmic lenses. RESULTS: Three local schools and six international schools participated in the study. Two hundred eighty-nine students were from the local schools, and 789 students were from the international schools. Prevalence of myopia at the local schools ranged from 85 to 88%, whereas it ranged from 60 to 66% in the international schools. Students in the international schools were subdivided into Chinese origin, white, mixed Chinese, and Asian. Prevalence of myopia was highest in the Chinese group (82.8%) and lowest in the white group (40.5%). There was no age or gender difference in the prevalence of myopia. CONCLUSIONS: Hong Kong Chinese students had a higher prevalence of myopia regardless of whether they studied in local or international schools when compared with other ethnic groups, such as whites. This further supports a genetic input into myopia development.

Prevalence of myopia in a group of Hong Kong microscopists.

PURPOSE: To study the prevalence and magnitude of myopia in a group of Hong Kong Chinese microscopists and compare it with that observed in microscopists working in the United Kingdom. METHODS: Forty-seven microscopists (36 women and 11 men) with a median age of 31 years and working in hospital laboratories throughout Hong Kong were recruited to the study. Information about past refractive corrections, microscopy work, and visual symptoms associated with microscope use were collected. All subjects had a comprehensive eye examination at The Hong Kong Polytechnic University Optometry Clinic, including measures of refractive error (both noncycloplegic and cycloplegic), binocular vision functions, and axial length. RESULTS: The prevalence of myopia in this group of microscopists was 87%, the mean (+/- SD) refractive error was -4.45 +/- 3.03 D and mean axial length was 25.13 +/- 1.52 mm. No correlation was found between refractive error and years spent working as a microscopist or number of hours per day spent performing microscopy. Subjects reporting myopia progression (N = 22) did not differ from the refractively stable group (N = 19) in terms of their microscopy working history, working hours, tonic accommodation level, or near phoria. However, the AC/A ratio of the progressing group was significantly greater than that of the stable group (4.59 delta/D cf. 3.34 delta/D). CONCLUSION: The myopia prevalence of Hong Kong Chinese microscopists was higher than that of microscopists in the United Kingdom (87% cf. 71%), as well as the Hong Kong general population (87% cf. 70%). The average amount of myopia was also higher in the Hong Kong Chinese microscopists than the Hong Kong general population (-4.45 D cf. -3.00 D). We have confirmed that the microscopy task may slightly exacerbate myopia development in Chinese people.

An assessment of consecutively presenting orthokeratology patients in a Hong Kong based private practice.

PURPOSE: The aim of this study was to collect objective, subjective and demographic data on consecutively presenting orthokeratology (ortho-k) patients who attended for routine follow-up examination in a Hong Kong based private practice in May 2001. METHOD: Sixty-nine patients who returned to the surveyed practice for follow-up visits during the study period (May 2001) were interviewed and relevant data extracted from their files. Data collected included identification and estimation of the extent of complications encountered by ortho-k patients and their satisfaction with the treatment. RESULTS: Among the 61 patients who had been wearing ortho-k lenses for at least one month, 50 patients were younger than 16 years old. Twelve children (24 per cent) had been reluctant to wear ortho-k lenses before undergoing the treatment but, after commencement of lens wear, only one child was not very willing to wear the ortho-k lenses. The mean pre-ortho-k spherical refractive error of these patients was -3.93 +/- 2.30 D (OS only). Of the 59 patients who wore ortho-k lenses for at least one month and who were on night therapy, 10 patients had to wear spectacles or contact lenses in the daytime due to significant residual myopia. There was no statistically significant correlation between post-ortho-k unaided visual acuity and pre-ortho-k refractive error (spherical, cylindrical or the equivalent sphere) in the 49 patients who did not need to wear any vision correction in the daytime. Of the 61 patients, four reported eye inflammation/infection during the treatment. All recovered their ocular health without any effect on their vision or corneal health. The incidence of corneal staining that required lens wear to be stopped appeared to increase with the duration of ortho-k lens treatment. The incidence of staining was not related to refractive error, unaided visual acuity or the age of the subjects. The most common problem reported by the patients was lens binding and there were also reports of increased redness, itching, light sensitivity and secretion of mucus in the morning after opening their eyes. More than 50 per cent of the patients experienced some distance vision blur, which was worse towards the end of the day. For most patients, these problems occurred only occasionally. Higher pre-ortho-k spherical refractive error was related to poor near and distance vision and worse distance vision towards the end of the day. CONCLUSION: The majority of the patients interviewed were children who reported being 'happy with the results of the treatment'. Night wear is the main wearing modality and in view of the increased risk of complications in overnight wear and the fact that a large number of the patients are children, the need for strict compliance with the practitioner's instructions for lens use and care cannot be overemphasised. With careful monitoring and good compliance, complications with overnight ortho-k wear can be minimised. In view of the high incidence of lens binding, it is essential that patients and parents of young patients know the correct method to free a bound lens.

AC/A ratios in myopic and emmetropic Hong Kong children and the effect of timolol.

PURPOSE: Caucasian children with myopia have elevated response accommodative vergence to accommodation (AC/A) ratios. The purpose of this study was twofold: to determine if response AC/A ratios vary with refractive error and with myopic progression rate in Hong Kong Chinese children, and to determine the effect of beta-adrenergic antagonism with topical timolol application on AC/A ratios. METHODS: Thirty children aged eight to 12 years participated in the study. All refractive errors were corrected with spectacle lenses. Accommodative responses were measured using a Shin-Nippon autorefractor and concurrent changes in vergence were assessed using a vertical prism and a Howell-Dwyer card at three metres and 0.33 metre. Accommodative demand was altered using plus or minus two dioptre lenses and lens- and distance-induced response AC/A ratios were calculated. Measurements were repeated 30 minutes after the instillation of topical timolol maleate (0.5 per cent). RESULTS: AC/A ratios appeared higher in progressing myopic children but the difference was not statistically significant. Timolol application reduced accommodative convergence (AC) in the stable myopes (reduction = -3 +/- 1.14 prism dioptres) but not in the emmetropes (0.69 +/- 0.96 prism dioptres) or progressing myopes (0.16 +/- 0.43 prism dioptres) and this difference between refractive groups was statistically significant (F(2, 27) = 3.766; P = 0.036). However, timolol did not produce a significant change in the accommodative response to positive or negative lenses or response AC/A ratios. CONCLUSIONS: We did not find that AC/A ratios in myopic Chinese children were elevated and therefore, it is unlikely that elevated AC/A ratios are responsible for the high levels of myopia that occur in Hong Kong. The finding that timolol reduced AC in the stable myopes suggests that the autonomic control of accommodative convergence in these children may be different from that in emmetropic children and those with progressing myopia.

The expandability of the eye in childhood myopia.

PURPOSE: While intraocular pressure has been shown to have some influence on eye growth, the stress exerted on the outer wall of the eye and the rigidity of the outer coats of the eye may be of greater importance. No studies have assessed the significance of both of these variables in terms of childhood myopia and its progression. METHODS: Twenty myopic and twenty non-myopic children aged 8 to 12 years participated in the study. Refractive error (including refractive error shift over the past year), ocular dimensions (anterior chamber, lens thickness, vitreous chamber, axial length), intraocular pressure, equatorial scleral rigidity, and outer wall thickness were measured for right eyes. Outer wall stress was calculated using the approximation, p = IOP*r/2t. RESULTS: The myopic group was 3.43 D more myopic and had 1.43 mm longer eyes on average than the non-myopic group. The myopic children had experienced a mean refractive shift of -0.30 D/yr over the past year. Equatorial wall thickness was significantly less in myopes than non-myopes (difference of 0.09 mm, p = 0.02) and in the combined sample was correlated to refractive error (r = 0.312, p = 0.05), but not refractive error shift. Ocular rigidity and eye wall stress values were similar in the two groups. The refractive shift increased as wall stress increased both in the combined sample (r = -0.386, n = 35, p = 0.022) and the myopic group (r = -0.600, n = 16, p = 0.014). CONCLUSION: We did not find large differences in wall thickness, ocular rigidity, or wall stress in myopic and non-myopic children. While reduced ocular rigidity, increased wall stress and scleral thinning may have a role in myopia progression in childhood we were not able to clearly show this in our study of 40 children.

Practice of orthokeratology by a group of contact lens practitioners in Hong Kong. Part 2: orthokeratology lenses.

PURPOSE: The aim of the study was to provide information about the characteristics of three main types of orthokeratology (ortho-k) lenses used in Hong Kong and to report on their performance based on the clinical impressions of a group of ortho-k practitioners. METHOD: Twelve ortho-k practitioners were interviewed between 1 March and 30 June 2001. RESULTS: Most ortho-k lenses were ordered from three manufacturers: DreimLens, Fargo and Contex. The median maximum myopia reduction reported for DreimLens, Contex and Fargo lenses were 6.25 D, 6.00 D and 4.50 D respectively. The time to reduce myopia by up to 4.00 D could be up to three weeks for Contex and DreimLens and up to four weeks for Fargo. For reduction of myopia by up to 4.00 D, the treatment usually required only one or two lenses per eye for all three types of lenses. The incidence of lens binding and lens tightening after achieving the optimal reduction was reported to be higher with the DreimLens design. Good centration, less lens binding, relatively lower incidence of complications and lens tightening after achieving the optimal reduction were reported with the Fargo lenses. CONCLUSIONS: DreimLens tended to be more effective for myopia reduction. However, some practitioners were concerned with the aggressiveness of myopia reduction using this lens design and the higher potential for ocular complications. Selection of the lens design is dependent on various factors, in particular, practitioners need to be comfortable with the design they choose and to consider the needs of their patients and the final goal of the treatment.

Objective method to measure corneal clarity before and after laser in situ keratomileusis.

PURPOSE: To develop, evaluate, and use an objective method to determine the effect of laser in situ keratomileusis (LASIK) on corneal clarity. SETTING: Centre for Myopia Research, The Hong Kong Polytechnic University, and the Hong Kong Laser Eye Center, Hong Kong, China. METHODS: Color photographs of corneal sections were taken using a digital camera and converted to 8-bit gray-scale images. The desired area of the photograph was isolated using a preset mask, and a gray-scale or corneal clarity index of the desired area was obtained by averaging the "intensity" indices of individual pixels within the area. The reliability of the clarity index measures was determined by comparing test and retest measures. The sensitivity of the method was quantified by its ability to identify a small (clinically undetectable) decrease in corneal clarity produced by tight-fitting soft contact lenses worn for 30 minutes. Finally, corneal clarity was measured and compared in 24 patients before and 1 day, 1 week, and 1 month after LASIK. RESULTS: The reliability value was 4.11 corneal clarity units, and the change in corneal clarity due to soft contact lens use was 16.24 units. In the LASIK patients, there were statistically significant decreases in corneal clarity from preoperatively to 1 day and 1 week but not to 1 month. CONCLUSIONS: The method measured changes in corneal clarity that were undetectable clinically and were 4 times greater than 95% of the differences between test and retest measures. The method is therefore reliable and sensitive. Corneal clarity decreased after LASIK and recovered within approximately 1 month.

Contact lens practice in Hong Kong in the new millennium.

PURPOSE: We evaluated the contact lens services provided by practitioners in Hong Kong, the fitting habits of the contact lens practitioners and their attitudes regarding the use of orthokeratology (ortho-k) and silicone hydrogel (SH) lenses for overnight wear. METHODS: Questionnaires were sent to all Hong Kong optometrists licensed to prescribe contact lenses. RESULTS: Two hundred and seventy-five questionnaires (21 per cent) were returned. Most of the respondents (96 per cent) were employed in optical shops and worked in practices that provided contact lens services. The number of new/refit cases per practice per month was about 55, with the percentages of new and refit cases being 48 per cent and 52 per cent respectively. Eighty-eight per cent of the patients were fitted with soft lenses and 10 per cent were fitted with rigid gas permeable (RGP) lenses. Fifty-nine per cent of soft lens patients were fitted with planned replacement (frequent replacement and disposable) soft lenses. Fifty per cent of soft lenses were low water content lenses and 85 per cent of RGP lenses were in low DK (< or = 40) material. Multipurpose solutions and soaking solutions with separate cleaner were the most commonly prescribed care regimens for soft and rigid lenses, respectively. Thirteen per cent of the practitioners provided ortho-k services and the mean number of ortho-k cases per month per ortho-k practitioner was six, the majority of patients being children. DreimLens was the lens design most commonly used and Boston XO the most used material. However, 96 per cent of the responding practitioners had reservations about the practice of ortho-k and the use of SH lenses for overnight wear. CONCLUSIONS: The contact lens market in HK is still dominated by soft lenses, particularly planned replacement lenses, whereas the percentage of RGP fits has changed little in the past decade. Few respondents used overnight ortho-k and SH lenses in view of concerns about their efficacy and long-term safety.

Practice of orthokeratology by a group of contact lens practitioners in Hong Kong--Part 1. General overview.

PURPOSE: To describe orthokeratology (ortho-k) as practised by a number of practitioners in Hong Kong. METHODS: Twelve optometrists who had been practising ortho-k for between 2.5 and four years were interviewed in the period 1 March to 30 June 2001. RESULTS: The number of ortho-k cases seen by each practitioner ranged from 50 to 800, and the main reason for fitting was myopia control in children. All practitioners were using advanced ortho-k lens designs and most recommended night therapy. In general, patients were accepted if they had less than five dioptres of myopia; one or two lenses were required for a myopia reduction of four dioptres or less, whereas two to four lenses were required to achieve reduction of more than four dioptres. Success, defined as the percentage of the target reduction agreed with patients that was actually achieved, was reported as better than 80 per cent for most practitioners. The time for trial lens wear was from 15 minutes to four hours and was 30 minutes in most cases. Suction holders were generally used for lens removal. Foggy vision was the most frequently reported adverse symptom and mild corneal staining the most frequent sign. CONCLUSIONS: It is clear that there is considerable variation in the practice of ortho-k in Hong Kong even among the relatively experienced practitioners interviewed here. The skills of contact lens practitioners in Hong Kong vary considerably because of the nature of the registration arrangements. We suggest that a statement of best clinical practice for ortho-k should be developed to assist practitioners to carry out this procedure effectively and safely.

Is esophoria a factor in slowing of myopia by progressive lenses?

PURPOSE: Our previous findings suggest that myopia can be slowed by wearing progressive lenses, and one possible mechanism for this is through the oculomotor system. We reanalyzed our findings to investigate the relationship between baseline oculomotor parameters and change in refraction, and between the change in these values and change in refraction. METHODS: Children who wore progressive lenses (N = 38; 26 with +1.50 D addition, and 16 with +2.00 D addition) or single-vision lenses (N = 32) had refraction, distance heterophoria, near heterophoria, and stimulus AC/A ratio measured prospectively over a 2-year period. RESULTS: There were no statistically significant correlations between baseline heterophoria or AC/A values and change in refractive error. Distance and near heterophoria did not change significantly over the 2 years of the experiment; AC/A ratio decreased significantly, but in an equivalent manner for both groups. In the combined progressive lens group, change toward more exophoria at near was associated with less myopia progression. However three-way analysis of variance (visit x lens type x esophoria/nonesophoria) showed significant main effects in refraction over all five visits. There was a significant interaction between lens type and visits; there was no significant interaction between lens type and esophoria/ nonesophoria grouping. Three-way analysis of variance showed a statistically significant decrease of AC/A ratio over all five visits; there was no interaction of visit by lens or visit by phoria grouping. CONCLUSIONS: Although there were no statistically significant differences between esophoric and nonesophoric subjects, there was only 46% as much myopia progression in the progressive lenses-esophoric group as in the progressive lenses-nonesophoric group. In addition, there were no differences in AC/A ratio between esophoric and nonesophoric subjects. However these findings are not definitive. This experiment was not designed to discriminate between refraction and oculomotor changes in esophoric and nonesophoric subjects and lacked the necessary statistical power to do so.

Contrast sensitivity after laser in situ keratomileusis. one-year follow-up.

PURPOSE: To determine whether contrast sensitivity measurement, a more sensitive test of visual function than visual acuity, better characterizes visual outcomes after laser in situ keratomileusis (LASIK). SETTING: Hong Kong Laser Eye Centre, Hong Kong, China. METHODS: Contrast sensitivity was monitored in 41 LASIK patients for 1 year. Seven spatial frequencies (0.3, 0.8, 1.5, 3.4, 6.9, 10.3, and 20.5 cpd) were tested with 15 sequences per spatial frequency, and a staircase technique was used for target presentation. RESULTS: There was a general depression in the contrast sensitivity function after LASIK; 1.5 cpd and 3.4 cpd were the most affected frequencies. Recovery took at least 6 months. The reduction in contrast sensitivity was greater for higher amounts of myopia. CONCLUSION: The post-LASIK nonpermanent depression in contrast sensitivity was probably due to optical factors.

Blur detection thresholds in childhood myopia: single and dual target presentation.

There is some suggestion that the ability to detect blur may be altered in adults with myopia. Here, we address the question of whether children with myopia have worse blur detection than other children, and whether blur detection in myopic children is related to the rate of myopia progression. We recruited 20 myopes and 20 non-myopes aged between 8 and 12 years. Refractive errors, visual acuity, and contrast sensitivity were measured and the change in refractive error over the past year calculated from clinic records. Blur detection thresholds for two different types of black and white targets (text and scenes), two illumination conditions and two testing protocols were determined using a computer-based forced-choice testing procedure. The two testing protocols used were: (i) dual image presentation where subjects were asked to choose the clearer of the two images, one image always having zero blur, and (ii) single image presentation in which the subject reported whether the image was clear or blurred. Blur discrimination ability under all tested conditions was similar for both refractive error groups. Blur detection thresholds were 0.27+/-0.15 D (myopes) and 0.24+/-0.07 D (non-myopes) for text images. Thresholds were similar when measured with a one log unit reduction in lighting: 0.27+/-0.31 D compared to 0.23+/-0.14 D. Blur detection thresholds were greater for photographic scenes (myopes 0.41+/-0.36 D, non-myopes 0.44+/-0.36 D) and when only a single text image (myopes 0.51+/-0.21 D, non-myopes 0.59+/-0.01 D) was presented, but this increase was measured in both refractive error groups. There was no correlation between blur thresholds and refractive error magnitude, refractive error progression over the past year, or contrast sensitivity. We found that the blur detection ability showed greater individual variation in myopic children. Further work is required to determine whether blur detection ability is of relevance to myopia development.