Biometric and refractive changes following the monocular application of peripheral myopic defocus using a novel augmented-reality optical system in adults.

The prevalence of myopia is growing at an alarming rate and is associated with axial elongation of the eye. The cause of this undesirable physiological change involves multiple factors. When the magnitude of myopia approaches high levels, this accompanying mechanical effect increases the risk of developing other clinical conditions associated with permanent vision loss. Prior work has investigated how we may halt or reverse this process of axial elongation associated with myopic progression when we expose the eye to a peripheral myopic defocus stimulus. Specifically, the known, short-term response to myopic defocus stimulation is promising and demonstrates the possibility of establishing more permanent effects by regulating the axial length of the eye with specific defocus stimulation. However, how to directly convert these known, short-term effects into more long-term, permanent changes to effectively prevent these unfavourable physiological and refractive changes over time is yet to be understood. Here, we show for the first time that we can produce sustained, long-term reductions in axial length and refractive endpoints with cumulative short-term exposure to specific myopic defocus stimuli using a novel optical design that incorporates an augmented reality optical system. We believe that this technology will have the potential to improve the quality of vision in mankind.

Effect of short-term peripheral myopic defocus on ocular biometrics using Fresnel "press-on" lenses in humans.

This study assessed axial length and choroidal thickness changes following short-term peripheral myopic defocus in normal adult subjects. Twenty subjects underwent defocus sessions by viewing a full-field projected movie 4 m away for 4 h in the morning, while wearing spectacle lenses, corrected for distance vision in both eyes. The right eye, serving as the test eye, was peripherally defocused using a Fresnel lens overlay of + 3.50 D with a central clear aperture of 11.5 mm (correlating to a clear central visual field of approximately 23°), while the left eye served as the control (with no Fresnel lens overlay). A subset of 10 subjects from the same cohort also underwent additional defocus sessions with + 5.00 D of peripheral defocus. Axial length was measured and radial sub-foveal choroidal scans were obtained before and after the defocus sessions. The increase in axial length of the test eyes were significantly less than the control eyes under both peripheral defocus conditions (p < 0.05). The difference in mean change for choroidal thickness between test and control eyes was not significant for either dioptric condition. Our results demonstrated that short-term peripheral myopic defocus significantly inhibited axial elongation in adult humans, without significant changes in choroidal thickness.

Visual Performance as a Function of Clear Central Aperture Diameter with a Defocused Myopic Periphery.

SIGNIFICANCE: Visual performance is affected least by a 15° radial aperture surrounded by peripheral myopic defocus. This finding has important applications for spectacle and contact lens designs and myopia control optimization. PURPOSE: The purpose of this study was to assess the effect of clear central apertures of different diameters with a defocused retinal periphery, using a range of visual performance tasks. METHODS: Thirty visually normal subjects (mean age, 24.4 ± 3.3 years; 20 females; mean spherical equivalent of -1.28 D) were enrolled. Subjects wore five different spectacles during testing, all corrected for distance refraction, in random order: three single-vision spectacles with clear central apertures of 10, 12.5, and 15° radii with the periphery defocused using Fresnel "press-on" lenses (+3.5 D sphere), progressive addition lens (PAL) spectacles with a +3.5 D addition, and single-vision lens (SVL) spectacles with no peripheral defocus. Static and kinetic visual field sensitivities, reading rate and comprehension, head movements, global saccadic tracking, and saccadic visual search were evaluated. RESULTS: Reading rate and comprehension did not differ across the five test conditions; however, increased head movement was found with the smallest aperture compared with the PAL condition with adjusted P < .05. Static visual field sensitivity was reduced for all three apertures in eccentric regions when compared with the SVL and PAL conditions with adjusted P < .05, whereas kinetic sensitivity did not differ for any lens condition. The 15° aperture was superior to the 10 and 12.5° apertures based on its similarity to the SVL and PAL spectacle conditions in head movement during reading, the Michigan Tracking Test, and the vertical results of the Developmental Eye Movement Test. CONCLUSIONS: Visual performance is least affected adversely by a 15° aperture surrounded by a peripheral myopic defocus. This finding has important applications for spectacle and contact lens designs to optimize myopia treatment with minimal impact on visual performance.

Rotational stability of toric soft contact lenses during natural viewing conditions.

PURPOSE: To compare objectively the rotational stability of two differently designed toric soft contact lenses over a range of natural viewing conditions using a novel infrared, video-based technique. METHODS: Two contact lenses using different methods of stabilization were assessed: Accelerated Stabilization Design (ACUVUE ADVANCE for ASTIGMATISM) and Lo-Torque Design (B&L SofLens Toric). Four tasks involving saccades were performed: settling time with free viewing, reading, visual search, and execution of large versional tasks. Lens position (degrees of rotation) was continuously recorded with a head mounted, infrared, video-based system and a digital photo slit-lamp in 20 adult subjects. All measurements were obtained from the left eye under binocular viewing conditions with contact lenses on both eyes. RESULTS: The ACUVUE lens was significantly more stable during the settling time and large saccadic versional tasks than the SofLens. For the two other tasks (reading, visual search), performance was similar. CONCLUSION: The ACUVUE design was superior in stability for two of the four conditions tested. This resulted in a more stable lens immediately after insertion as well as during some visual tasks involving either naturally occurring or programmed large versional eye movements. Both lens designs provided acceptable performance in terms of induced astigmatism produced by off-axis rotation.

"Bothersome blur": a functional unit of blur perception.

Knowledge regarding the amount of blur perceived to be "bothersome" to an individual, namely that which is assumed to be annoying and to adversely affect task performance, remains limited. A Badal optical system was used to measure the blur detection, bothersome blur, and non-resolvable blur dioptric thresholds monocularly either to an isolated 20/50 or 20/200 Snellen E, or to three 20/50 lines of text. Subjects were comprised of 13 visually normal young adults and 3 absolute presbyopes. Cycloplegia was used to paralyze accommodation in the young adults. Within each target type for the young adults, the mean bothersome blur threshold was always significantly larger than that found for blur detection and significantly smaller than that found for non-resolvable blur. Across target types and blur criteria, the bothersome blur thresholds for the isolated 20/50 E (1.02 D) and the 20/50 text (1.34 D) were not significantly different, although in 12 of the 13 subjects the latter were larger (p<0.002, sign test). However, both were significantly smaller than for the isolated 20/200 E (1.80 D). In a subset of young adult subjects, bothersome blur was found to be repeatable over time. The results were similar in the absolute presbyopes. The bothersome blur threshold was primarily influenced by target detail and secondarily by target extent. These findings have important implications with respect to tolerances for optical lens design and refractive surgery outcomes, as well as provide insight into basic aspects of human blur perception.

Dynamic interactions of eye and head movements when reading with single-vision and progressive lenses in a simulated computer-based environment.

PURPOSE: To assess dynamic interactions of eye and head movements during return-sweep saccades (RSS) when reading with single-vision (SVL) versus progressive-addition (PAL) lenses in a simulated computer-based business environment. METHODS: Horizontal eye and head movements were recorded objectively and simultaneously at a rate of 60 Hz during reading of single-page (SP; 14 degrees horizontal [H]) and double-page (DP; 37 degrees H) formats at 60 cm with binocular viewing. Subjects included 11 individuals with normal presbyopic vision aged 45 to 71 years selected by convenience sampling from a clinic population. Reading was performed with three types of spectacle lenses with a different clear near field of view (FOV): a SVL (60 degrees H clear FOV), a PAL-I with a relatively wide intermediate zone (7.85 mm; 18 degrees H clear FOV), and a PAL-II with a relatively narrow intermediate zone (5.60 mm; 13 degrees H clear FOV). RESULTS: Eye movements were initiated before head movements in the SP condition, and the reverse was found in the DP condition, with all three lens types. Duration of eye movements increased as the zone of clear vision decreased in the SP condition, and they were longer with the PALs than with the SVL in the DP condition. Gaze stabilization occurred later with the PALs than with the SVL in both the SP and DP conditions. The duration of head movements was longer with the PAL-II than with the SVL in both the SP and DP conditions. Eye movement peak velocity was greater with the SVL than the PALs in the DP condition. CONCLUSIONS: Eye movement and head movement strategies and timing were contingent on viewing conditions. The longer eye movement duration and gaze-stabilization times suggested that additional eye movements were needed to locate the clear-vision zone and commence reading after the RSS. Head movements with PALs for the SP condition were similarly optically induced. These eye movement and head movement results may contribute to the reduced reading rate and related symptoms reported by some PAL wearers. The dynamic interactions of eye movements and head movements during reading with the PALs appear to be a sensitive indicator of the effect of lens optical design parameters on overall reading performance, because the movements can discriminate between SVL and PAL designs and at times even between PALs.

Static aspects of eye and head movements during reading in a simulated computer-based environment with single-vision and progressive lenses.

PURPOSE: Reading with two different intermediate progressive lens designs was investigated regarding eye and head movement patterns and compared with movement patterns with a conventional single vision lens in a computer-based work environment. METHODS: Two-dimensional eye (horizontal, vertical) and three-dimensional head (horizontal, vertical, and torsional) movements were recorded objectively and simultaneously at a rate of 60 Hz during reading of moderate contrast (40%) single- and double-page text formats at 60 cm with binocular viewing. In addition, global reading ability was rated subjectively for each lens. Subjects were 11 visually normal, presbyopic individuals aged 45 to 71 years selected by convenience sampling from a clinic population. Reading was performed with three types of spectacle lenses: a single-vision lens (SVL; 60 degrees horizontal [H] clear field-of-view [FOV]); a progressive addition lens (PAL) with a relatively wide intermediate zone (PAL-I; 7.85 mm, 18 degrees H clear FOV); and a PAL with a relatively narrow intermediate zone (PAL-II; 5.60 mm, 13 degrees H clear FOV). RESULTS: Many reading-related parameters, as well as eye- and head-movement parameters, were adversely affected by the PALs compared with the SVL. One reading-related parameter (i.e., number of regressions) differentiated between PALs. Subjective rating of global reading ability was highest with the SVL and lowest with the PAL-II. CONCLUSIONS: The optical design of a spectacle lens had significant impact on reading performance and on the combined eye-head movements initiated during reading. Both horizontal eye and head movements discriminated well between PALs and the SVL, but not between PALs, despite subjective preferences. This suggests that nonoculomotor factors contribute to patients' nonacceptance of PALs. Vertical eye and head movements and torsional head movements were not as discriminatory as were their horizontal counterparts.

Assessing visual performance with progressive addition lenses.

PURPOSE: As a result of lens design limitations, progressive addition lenses (PAL's) present a limited field of view for tasks at intermediate distances, such as with computers. To assess whether this limitation results in diminished visual performance, PAL's were compared with single-vision lenses in four different types of reading tasks in a computer workplace environment. METHODS: Adult subjects performed four computer-based reading tasks using both single-vision lenses and PAL's at an intermediate distance of 64 cm. RESULTS: Single-vision lenses performed significantly better than PAL's in one task, with a trend for better performance in another task. There was no difference in performance for the remaining two tasks. CONCLUSIONS: Visual performance tests that involved stimuli subtending the widest visual angles and demanded more fixational shifts were more sensitive in discerning performance differences between the lens designs. In general, PAL's showed marginally diminished performance compared with single-vision lenses, presumably due to their restricted intermediate channel.