Clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM‐5500

Purpose: A clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM‐5500 (Japan) was performed to evaluate validity and repeatability compared with non‐cycloplegic subjective refraction and Javal–Schiotz keratometry. An investigation into the dynamic recording capabilities of the instrument was also conducted. Methods: Refractive error measurements were obtained from 150 eyes of 75 subjects (aged 25.12 ± 9.03 years), subjectively by a masked optometrist, and objectively with the WAM‐5500 at a second session. Keratometry measurements from the WAM‐5500 were compared to Javal–Schiotz readings. Intratest variability was examined on all subjects, whilst intertest variability was assessed on a subgroup of 44 eyes 7–14 days after the initial objective measures. The accuracy of the dynamic recording mode of the instrument and its tolerance to longitudinal movement was evaluated using a model eye. An additional evaluation of the dynamic mode was performed using a human eye in relaxed and accommodated states. Results: Refractive error determined by the WAM‐5500 was found to be very similar (p = 0.77) to subjective refraction (difference, ?0.01 ± 0.38 D). The instrument was accurate and reliable over a wide range of refractive errors (?6.38 to +4.88 D). WAM‐5500 keratometry values were steeper by approximately 0.05 mm in both the vertical and horizontal meridians. High intertest repeatability was demonstrated for all parameters measured: for sphere, cylinder power and MSE, over 90% of retest values fell within ±0.50 D of initial testing. In dynamic (high‐speed) mode, the root‐mean‐square of the fluctuations was 0.005 ± 0.0005 D and a high level of recording accuracy was maintained when the measurement ring was significantly blurred by longitudinal movement of the instrument head. Conclusion: The WAM‐5500 Auto Ref/Keratometer represents a reliable and valid objective refraction tool for general optometric practice, with important additional features allowing pupil size determination and easy conversion into high‐speed mode, increasing its usefulness post‐surgically following accommodating intra‐ocular lens implantation, and as a research tool in the study of accommodation.     

Evaluation of refractive error measurements of the Wavescan Wavefront system and the Tracey Wavefront aberrometer

PURPOSE: To evaluate the accuracy and repeatability of the WaveScan WavePrint system and the Tracey wavefront aberrometer in measuring refractive errors in phakic eyes. SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. METHODS: Using subjective manifest refraction (MR) as the standard, the spherical equivalent (SE), sphere, and cylinder were compared to values measured by WaveScan and Tracey devices in virgin eyes and eyes that had had corneal refractive surgery. Astigmatism was evaluated using vector analysis. The accuracy of the WaveScan and Tracey devices was assessed by 95% limits of agreement (95% LA), and repeatability was analyzed by 2 standard deviations (SDs) and intraclass correlation coefficients (ICCs). RESULTS: The mean differences in SE, sphere, and cylinder between MR and WaveScan were -0.26 diopter (D), -0.12 D, and -0.28 D, respectively, and between MR and Tracey, -0.21 D, -0.01 D, and -0.40 D, respectively. The 95% LA for SE, sphere, and cylinder were -1.09 to 0.57 D, -1.14 to 0.89 D, and -0.95 to 0.40 D, respectively, for WaveScan and -1.37 to 0.95 D, -1.27 to 1.26 D, and -1.16 to 0.35 D, respectively, for Tracey. Vector analysis revealed mean differences of -0.47 +0.07 x 9 degrees between MR and WaveScan and of -0.53 +0.27 x 12 between MR and Tracey. The 2 SDs for SE, sphere, and cylinder were 0.26 D, 0.29 D, and 0.16 D, respectively, for WaveScan and 0.31 D, 0.36 D, and 0.33 D, respectively, for Tracey. The ICCs for SE, sphere, and cylinder were 0.993, 0.992, and 0.902, respectively, for WaveScan and 0.994, 0.992, and 0.764, respectively, for Tracey. The Tracey device measured all eyes evaluated; the WaveScan could not measure 14% of normal eyes and 50% of post laser in situ keratomileusis eyes. CONCLUSIONS: Using MR as the standard, refractive errors measured by the WaveScan and Tracey devices were reliable and reproducible. However, the Tracey device was more robust in its ability to obtain measurements in normal and postoperative eyes.     

Clinical evaluation of the Topcon BV-1000 automated subjective refraction system.

BACKGROUND: The BV-1000 is a new instrument that performs binocular autorefraction and subjective refraction. The aim of the study was to evaluate the accuracy of the BV-1000 compared with subjective refraction without cycloplegia and the repeatability of the BV-1000 in subjects without cycloplegia. METHODS: BV-1000 binocular autorefraction (mean of three measures) and automated subjective refraction was performed on 100 eyes and compared with practitioner subjective refraction. After BV-1000 assessment, the result was modified by the investigator in the form of a binocular addition; the practitioner was masked as to the result of the BV-1000. Repeatability was evaluated by comparing the test-retest data on 40 eyes. Refraction data were converted into Fourier component terms: mean spherical equivalent (MSE), J0, J45, and vector dioptric difference (VDD). RESULTS: Mean difference of MSE (BV-1000 subjective vs. practitioner) was 0.05 +/- 0.35 D (p = 0.13), whereas after binocular addition, the mean difference in MSE was -0.01 +/- 0.21 D (p = 0.67). The mean difference of MSE (BV-1000 objective vs. practitioner) was +0.10 +/- 0.37 D (p < 0.05). Mean difference in J0 and J45 was -0.03 +/- 0.12 D (p = 0.09) and -0.02 +/- 0.10 D (p = 0.06), respectively. More than 95% of cylinder powers were within +/- 0.50 D. The median VDD was 0.35 D (range, 1.38 D; interquartile range, 0.31) for comparisons of BV-1000 subjective refraction and the practitioner. A median VDD of 0.25 D (range, 1.06 D; interquartile range, 0.16) was found after binocular addition correction. There was no statistically significant difference (p = 0.73) in spherical intereye difference between BV-1000 subjective and subjective refraction. Mean spherical intereye difference (spherical balancing error) between the BV-1000 and practitioner subjective refraction was -0.02 +/- 0.24 D. Repeatability as described by the mean difference between occasions for MSE was found to be -0.06 +/- 0.19 D, -0.02 +/- 0.08 D for J0, and -0.03 +/- 0.07 D for J45. CONCLUSIONS: The subjective refraction routine within the BV-1000 improves the results of simultaneous binocular autorefraction data. The BV-1000 provides an accurate and repeatable measure of subjective refraction after binocular addition.     

Height, weight, body mass index and ocular biometry in patients with sickle cell disease

Purpose:  To investigate the effects of physical size on refractive error and the dimensions of optical components in sickle cell disease (SCD).
Methods:  The design was cross sectional. Height and weight of adult patients suffering from SCD were measured, and body mass index (BMI) was calculated. Anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and axial length (AL) were measured using A-scan ultrasonography. Corneal radius of curvature (CR) was measured using a keratometer. Non-cycloplegic refractive error was determined subjectively.
Results:  Subjects with SC genotype were significantly taller than those with SS genotype. In the unadjusted data, height was correlated with VCD [ p  = 0.02, 0.44 mm deeper per 10 cm increase in height, 95% CI (0.65, 8.25)] and AL [ p  = 0.03, 0.42 mm longer for every 10 cm increase in height, 95%CI (0.49, 7.99)]. The relationship between height, VCD and AL was absent after adjustment for age, gender, genotype and weight. BMI (kg m⁻²) was correlated with AL/CR ratio in both unadjusted ( p  = 0.04, −0.10 decrease per 1 kg m⁻², 95% CI (−0.018, −0.001) and adjusted data ( p  = 0.05, −0.10 decrease per 10 kg m⁻², 95% CI (−0.0189, 0.0001). Refractive error was not related to height, weight or BMI.
Conclusions:  Physical size does not affect refractive error or optical components in adult patients with SCD.     

Hyper-response of OP3 to systemic hyperoxia in the dark-adapted retina

Purpose:  We have demonstrated that the third wavelet (OP3) of the scotopic flash oscillatory potential (OP) complex shows a hyper-response during experimentally-induced systemic hyperoxia. The objective of the present study was to further evaluate and detail the time course of this enhanced retinal response.
Methods:  Twenty healthy adults volunteered for this study. The OPs were recorded with a DTL-type electrode following pupillary dilation and retinal dark adaptation. Stimuli consisted of white flashes. The OPs were recorded at 8 points in time before, during and after breathing pure oxygen (O₂). The arterial blood O₂ saturation (SaO₂), end-tidal CO₂ (EtCO₂), respiratory rate (RR), pulse rate (PR) and blood pressure (BP) were monitored throughout the experiment.
Results:  The amplitude of the OPs did not vary significantly across test conditions except for OP3, which increased with systemic hyperoxia and was still elevated by the end of the experiment. The SaO₂ and RR increased, the EtCO₂ and PR decreased, whereas the BP was not altered during O₂ breathing.
Conclusions:  This study provides further evidence indicating that the neural generators of OP3 display a unique hyper-reactivity to increased systemic O₂ levels in the young healthy adult. Further studies looking at OP3 are still needed to determine if this unique behavior could serve as an index of altered oxygen level and retinal function in health or disease.     

Steady‐state VEP and behavioural measures of visual acuity in infants and children with Down syndrome

Purpose:  Children with Down syndrome (DS) have reduced behavioural visual acuity (VA). This may reflect sensory deficits, or alternatively, a loss of performance in later mechanisms responsible for behavioural responses. This study compared acuity measured using visual-evoked potentials (VEP), with behavioural tests, in children with DS. The goal was to determine whether reduced VA could be detected in VEP recordings from the first stages of the response pathway.
Methods:  The subject group contained 34 children with DS and 35 controls, aged 3 months to 14 years. VA was measured using steady-state, swept VEP (Norcia and Tyler, 1985). VA was also measured using behavioural techniques.
Results:  Visual acuity was analysed using a subject group (DS vs controls) × test type (behavioural vs VEP) anova with age as a covariate. A significant effect of subject group was observed ( F _1,59 = 8.632, p  < 0.001) and a significant interaction between subject group and test type ( F _1,59 = 5.169, p  = 0.027). The DS group showed reduced VA compared with the controls in both VEP and behavioural tests, but the deficit was more pronounced with behavioural testing. Reduced VA in the DS group was still seen when analysis was restricted to children who accommodate accurately ( F _1,26 = 8.047, p  = 0.009).
Conclusions:  Reduced VEP acuity in the DS group supports the idea of an underlying sensory deficit in the DS visual system. Increased reduction with behavioural techniques implies additional losses at later stages of processing. Accommodative inaccuracy does not fully explain reduced VA in DS. Children with DS who do not have significant levels of defocus still exhibit reduced VA when compared with controls.     

Comparison of refractive outcomes using immersion ultrasound biometry and IOLMaster biometry

Background:  The IOLMaster determines axial length using partial coherence interferometry. This study was designed to compare the refractive outcomes of patients who had been measured preoperatively by both immersion ultrasound and IOLMaster biometry.
Methods:  Patients were recruited from those who had undergone cataract surgery during the preceding 12 months by one surgeon at The Queen Elizabeth Hospital (55 eyes from 55 patients). Each patient underwent measurement of axial length by immersion ultrasound and the IOLMaster. Target refraction was determined using an SRK-T formula and the amount that this differed postoperative refraction was calculated for immersion ultrasound and the IOLMaster. These results were then compared.
Results:  Eyes measured longer by the IOLMaster method compared with immersion ultrasound (23.37 ± 0.87 vs. 23.25 ± 0.90 mm, t  = 4.83; P  < 0.0001). However anterior chamber depth was the similar. Postoperatively, final refractive outcome was 0.01 ± 0.63 dioptres (D) more hypermetropic than the target refraction when using the IOLMaster compared with 0.25 ± 0.73 D more myopic when using immersion ultrasound ( t  = 3.83; P  < 0.0001). Seventy-five per cent of patients were within 0.5 D of target refraction and 93% were within 1.0 D when the IOLMaster was used, compared with 49% and 85% within 0.5 and 1.0 D respectively when using immersion ultrasound (χ² = 8.34; P  = 0.04).
Conclusions:  Biometry performed using the IOLMaster produces a more predictable refractive outcome than immersion ultrasound, with patients' spherical equivalent more likely to be closer to their target refraction.     

Accommodation, pupil diameter and myopia

Concurrent measurements of steady-state accommodation response/stimulus curves and of pupil diameter were made in groups ( n  = 20) of young, adult myopes [age (mean ± SD) 23.1 ± 4.5 years, mean-sphere error (MSE) −3.06 ± 2.35 D, range −0.60 to −8.54 D] and emmetropes (mean age 25.3 ± 5.7 years, mean MSE −0.07 ± 0.26 D, range −0.50 to +0.50 D). The aim of this study was to explore the possibilities that pupil diameters with relaxed accommodation were larger, and that accommodative miosis was weaker, in the myopic group. Such behaviour would lead to relatively greater degradation of the retinal images in the myopic group, even though aberrations at constant pupil diameter and dioptric accommodative lags in the two groups were the same: this might result in excessive axial growth and further myopia development. No evidence for any systematic refractive dependence of pupillary characteristics or accommodative responses was found. Interestingly, those subjects whose response/stimulus curves had a higher slope tended to display greater accommodative miosis, irrespective of their refractive error.     

The effect of altering spherical aberration on the static accommodative response

Purpose:  To investigate the effect of altering the spherical aberration (SA) of the eye on the static accommodative response.
Methods:  Participants were fitted with nominally afocal contact lenses with controlled amounts of SA of either −0.2, −0.1, 0.0, +0.1 or +0.2 μm for a 5-mm pupil. Measurements of SA and root mean square (RMS) total aberration for the eye plus lens for each participant were determined with a Complete Ophthalmic Analysis System aberrometer. Accommodation was stimulated either by placing targets at different dioptric distances from the eye, or by using a fixed distance target and placing negative-powered lenses in front of the eye. Accommodation responses were determined with a Shin-Nippon autorefractor.
Results:  For both stimuli situations, the slope of the accommodation stimulus-response function was lowest for the lenses with +0.2 μm SA, and increased as the amount of SA was reduced. There was a significant negative correlation between SA and slope. Lag of accommodation at 33 cm correlated well with added SA, but did not correlate with total RMS error. There was no significant difference between the responses at 30 min after lens wear started and the responses after 1 h.
Conclusions:  Adding negative SA to the eye generally improves the slope of the accommodation stimulus-response curve and decreases lag of accommodation, and positive added SA depresses the slope of the stimulus-response curve and increases lag. The effect seems to be specific to SA, as there was no relationship between lag and RMS error. Altering SA may be a viable way of changing accommodative functions in clinical situations.     

Pulsatile ocular blood flow measurements in healthy Asian eyes: reference values for an Indian population

Purpose:  To investigate pulsatile ocular blood flow (POBF) in a healthy Indian population and use the data derived as reference values.
Methods:  Two hundred and fifty-two healthy subjects (121 males, 131 females) underwent intraocular pressure and POBF measurement with the Ocular Blood Flow Analyzer (Paradigm Medical Industries, Salt Lake City, UT, USA and formerly the POBF Tonograph). Before POBF measurement, subjects underwent a complete ophthalmic examination including refraction, slitlamp examination and biomicroscopic fundoscopy and Goldmann applanation tonometry (GAT). Subjects with ocular pathology were excluded from the study. Median age was 29 years (male median 32 years, female median 27 years).
Results:  Average POBF in males was found to be 1052 µL min⁻¹ (95% CI: 988–1116 µL min⁻¹) and in females to be 1293 µL min⁻¹ (95% CI: 1222–1364 µL min⁻¹). Median age was significantly different between males and females (Mann–Whitney U  = 6685; p  = 0.0311) but POBF was found to be independent of age in both sexes. As a group, mean refractive error influenced POBF (Kendall's τ = 0.24; p  = 0.0017).
Conclusions:  Pulsatile ocular blood flow values in Indians appear to be higher than reported in studies conducted on other racial groups. The reasons for this difference could be instrumental or anatomical (i.e axial length, ocular rigidity). Care should be taken in deriving normative data using the Ocular Blood Flow Analyzer in mixed race groups.     

Customized hydrogel contact lenses for keratoconus incorporating correction for vertical coma aberration

Purpose:  To study the effects on visual performance of a novel custom hydrogel contact lens, which employs a correction for vertical coma aberration, in keratoconic eyes.
Methods:  Six subjects (8 eyes) with mild or moderate keratoconus were recruited for the study. Preliminary measurements included corneal topography, wavefront aberrometry, subjective refraction, visual acuity (VA) and 50% contrast VA. Based on the aberrometry data, customized lenses were made and fitted to the subjects. Evaluation of the on-eye performance of the lenses was carried out, including wavefront aberrometry, over-refraction, VA and 50% contrast VA. In two of the subjects, both eyes were fitted with the customized lenses, and binocular performance was evaluated.
Results:  Monocular visual performance with a 4 mm pupil, with the lenses worn, was improved, and reached the mean values of −0.003 (LogMar units) of 100% high contrast VA, and 0.049 (in LogMar units) of 50% contrast VA. Vertical coma aberration and total higher-order aberrations (HOAs) were reduced (naked eyes: −0.64 ± 0.21 root mean square (rms) of vertical coma and 0.86 ± 0.15 rms of total HOAs; with the lenses worn: −0.29 ± 0.23 rms of vertical coma and 0.57 ± 0.17 rms of total HOAs, all for a 4 mm pupil). Binocular VA results from two of the subjects were on average −0.040 (LogMar units) 100% high contrast acuity and −0.060 (LogMar units) 50% contrast visual acuity.
Conclusions:  Customized hydrogel contact lenses implementing correction of vertical coma, have been found to improve both monocular and binocular visual performance of eyes affected with mild or moderate keratoconus.     

Relative roles of resolution and spatial interference in foveal and peripheral vision

The rate of change of visual performance with increasing eccentricity of fixation is known to be task dependent. In order to examine eccentricity-related changes in visual performance when a combination of two different factors influence thresholds, visual acuity in the presence of flanking elements was investigated across the visual field. Interference zones increased in extent with eccentricity at a much faster rate than did resolution thresholds. E ₂ values, quantifying the eccentricity-related magnification required, were 1–2° for resolution and 0.1–0.2° for spatial interference. E ₂ values for resolution in the presence of flanks depended on the proximity of the flanks and their 'weighting' in the task. From the results, the magnitude and extent of spatial interference across the visual field can be described quantitatively. Further, the results serve as an example of how observed variations in peripheral threshold gradients might be achieved as a combination of underlying factors with different E ₂ values.     

Variability components of standard automated perimetry and frequency-doubling technology perimetry

PURPOSE. To evaluate and compare intra- and intertest variability components for both standard automated perimetry (SAP) and frequency-doubling technology (FDT) perimetry in a small group of normal individuals and patients with glaucoma. METHODS. The method of constant stimuli (MOCS) was used to examine matched test locations with both SAP and FDT perimetry stimuli in a group of eight normal individuals and seven patients with glaucoma. Subjects were tested weekly at three predetermined visual field loci for 5 consecutive weeks. Frequency-of-seeing (FOS) curves were generated and used to quantify threshold sensitivity (50% seen on FOS, in decibels), intratest variability (FOS interquartile range, in decibels), and intertest variability (interquartile range of weekly repeated threshold determinations, in decibels). RESULTS. In patients with glaucoma, SAP intra- and intertest variabilities were found to increase with sensitivity reductions, as previously reported. FDT perimetry revealed that both intra- and intertest variability components did not appreciably change with reductions in sensitivity. With the measurement scales used in this investigation, both intra- and intertest variability components were significantly greater for SAP than for FDT perimetry (P < 0.001 and P = 0.003, respectively). Intratest variability exceeded intertest variability for both SAP (P = 0.001) and FDT perimetry (P < 0.001). CONCLUSIONS. For both SAP and FDT perimetry, variability occurring within a single test session contributed more to total variability than between-session variability. When the measurement scales available on commercial instrumentation were used, FDT perimetry exhibited significantly less variability than SAP, especially within regions of visual field sensitivity loss. FDT perimetry therefore shows promise as an effective test for detecting progressive glaucomatous visual field loss, although prospective longitudinal validation is still required to determine sensitivity to change.     

Ametropia in Down''s syndrome

Non-cycloplegic video-refraction and cycloplegic retinoscopy refraction results are reported for a Cambridge population of binocular, non-strabismic infants aged 7–9 months.
Method: The Cambridge vision screening programme detected high refractive errors by measuring the accommodative response to a 75 cm distance toy using the VPR-1 video-refractor. Of 4452 infants screened, the binocular mean refraction was −0.7 D, i.e. +0.62 D accommodative 'lag' or focus error (SD = ± 0.92 D). Seven percent had + 1.5 D refraction, i.e. + 2.8 D focus error or accommodative 'lag' in any one meridian. Of those followed up, refraction was also measured by cycloplegic retinoscopy (cycloRet) and VPR-1 (cyclo VPR) after 1 drop 1% cyclopentolate.
Results: Of the 223 infants who had large lags of accommodation + 2.8 D: (a) High hyperopia of + 3.5 D in any one meridian, by cyclo-Ret, was found in 173/223 (78%) of these infants. The mean cyclo-Ret spherical equivalent was + 3.8 ± 1.8 DS and unsigned astigmatism 0.8 ± 0.7 DC. The magnitude of the largest accommodative lag was significantly related to the cyclo-Ret most-positive-meridional power ( r = 0.4, P < 0.0001, n = 223). The majority orientation of the largest (non-cyclo-VPR) lag power was horizontal (WTR astigmatism). (b) The latest longitudinal refractive changes in this highly hyperopic group and also a control group will be described in terms of mean spherical equivalent, astigmatism and anisometropia.
Conclusion: The large lags of accommodation can reveal infants with highly hyperopic meridians. These infants may require early partial spectacle correction.
Acknowledgement: Supported by the Medical Research Council (Grant G7908507).     

Repeatability and agreement of ARK-30 autorefraction after cataract surgery

Background: To evaluate the intra‐test variability of ARK‐30 handheld autorefractor and the agreement with subjective refraction and retinoscopy after uneventful cataract surgery. Design: Prospective and non‐randomized study that included 6 visits by patients undergoing uneventful cataract surgery at IOBA (Instituto de Oftalmobiología Aplicada) Eye Institute (University of Valladolid). Participants: The mean age of the 79 patients was 66.5 years (range 23–90 years). For the 124 eyes, the mean spherical equivalent of the sample at baseline visit was ?3.59 ± 6.28 D (range ?21.00 D to +4.44 D). Methods: Automated refraction was performed on follow‐up visits 1 day and weekly for 4 weeks. Retinoscopy and subjective refraction were conducted at the Week 4 follow up. Main Outcome Measures: Automated refraction. Results: Sphere, cylinder and mean spherical equivalent, J₀ and J₄₅ coefficient variabilities were low in all visits. Standard deviations and the limits of agreement were smallest for the last visit. Subjective refraction sphere and cylinder values were more positive than autorefraction by 0.12 ± 0.53 D (P = 0.031) and 0.23 ± 0.42 D (P < 0.001), respectively. Comparison between autorefraction and retinoscopy showed a similar trend with the sphere and cylinder differences, 0.32 ± 0.77 D and 0.38 ± 0.43 D (P < 0.05), respectively. Conclusions: The ARK‐30 is sufficiently accurate and repeatable for automated refraction after uneventful cataract surgery. This instrument may be useful for monitoring refractive outcome in these patients.     

Determination of the total attenuation coefficient for six contact lens materials using the Beer–Lambert law

The Beer–Lambert law has been used to determine the total attenuation coefficient, μ _t , of three hard and three soft contact lens materials. The three hard contact lens materials were PMMA, Polycon II and Boston IV whereas the 3 soft materials were chosen with differing water contents of 38, 55 and 70%, respectively. The total attenuation coefficients of all six materials were obtained from measurements of the axial transmission at 632.8 nm of a series of plano powered lenses varying in axial thickness from 0.5 to 3.5 mm. The value of the total attenuation coefficient depends on both scattering and absorption and hence PMMA and Boston IV, which both incorporated a handling tint, showed significantly higher values ( P < 0.0001) of μ _t (0.562 ± 0.010 mm⁻¹ and 0.820 ± 0.008 mm⁻¹, respectively) than Polycon II (μ _t = 0.025 ± 0.005 mm⁻¹). A comparison between Polycon II and the three hydrated soft contact lens materials showed a significant increase ( P < 0.02) in the total attenuation coefficients for the 38% and 55% water content materials, and a weakly significant increase for the 70% water content soft lens material ( P < 0.1). On the assumption that the absorption coefficients of these four materials are approximately constant, then this change would be due to an increase in the scattering coefficient of the material and could contribute to an increase in intraocular scatter. No significant difference ( P > 0.5) was found between any of the hydrated soft contact lens materials tested.     

Reversible ophthalmoplegia in CPEO

Purpose: To present a case of improvement of ocular motility in a patient with chronic progressive external ophthalmoplegia (CPEO) with Coenzyme Q₁₀.
Methods: Coenzyme Q₁₀ 300 mg daily was given for three years with a three-day trial period of 200 mg daily after one year. Ocular ductions were measured by synoptophore.
Results: Ocular ductions improved with treatment with Coenzyme Q₁₀.
Conclusion: Coenzyme Q₁₀, is effective in limiting the severity of ophthalmoplegia in this case.