The effects of spectacle wear in infancy on eye growth and refractive error in the marmoset (Callithrix jacchus).

We made a comprehensive study, involving observations on 45 marmosets, of the effects on ocular growth and refraction of wearing spectacles from the ages of 4-8 weeks. This period was within the period early in life when the eye grows rapidly and refraction changes from hyperopia to its adult value of modest myopia. In one series of experiments we studied the effect of lenses of powers -8, -4, +4 and +8D fitted monocularly. In another series of experiments we studied the effect of lenses of equal and opposite powers fitted binocularly, with the two eyes alternately occluded, so as to give an incentive to use both eyes, and in particular to accommodate, for at least part of each day, through the negative lens. The vitreous chamber of eyes that wore negative lenses of -4D or -8D, combined with alternate occlusion, elongated more rapidly than that of the fellow eye (negative lens eye-positive lens eye, 0.21 +/- 0.03 mm (S.E.M.), P < 0.01 and 0.25 +/- 0.06 mm, P < 0.05, respectively) and became relatively more myopic (2.8 +/- 0.26D, P < 0.01 and 2.4 +/- 0.61D, P < 0.05 respectively). Eyes that wore -4D lenses monocularly elongated more rapidly and became myopic than fellow eyes. Eyes that wore +4D or +8D lenses were less strongly affected: animals that wore +8D lenses monocularly (without alternate occlusion) developed a slight relative hyperopia (0.99 +/- 0.21D, P < 0.01), with the more hyperopic eyes also slightly shorter (0.09 +/- 0.05 mm) than their fellow eyes, but eyes wearing +4D lenses were not significantly different from their fellow eyes. Animals that wore -8D lenses monocularly (without alternate occlusion) developed a slight relative hyperopia after three weeks of lens-wear (0.85 +/- 0.26D, P < 0.05). These were the only eyes that responded in a non-compensatory direction to the optical challenge of spectacle wear, and we interpret this effect as one due to visual deprivation. After the removal of lenses, the degree of anisometropia slowly diminished in those groups of animals in which it had been induced, but in the three groups in which the largest effects had been produced by lens-wear the overall mean anisometropia (0.68 +/- 0.24D, P < 0.01) and vitreous chamber depth (VCD) discrepancy (0.09 +/- 0.03 mm, P < 0.01) were still significant at the end of the experiments, when the animals were 273 days old. The reduction of anisometropia in these groups was associated with an increase in the rate of elongation of the vitreous chamber in the eyes that had previously grown normally i.e. the less myopic eyes grew more rapidly than their fellow eyes: in the seven weeks following lens-wear these eyes became more myopic and longer than normal eyes (refraction P < 0.001; VCD P < 0.001). Control experiments showed that occlusion of one eye for 50% of the day had no effect on eye growth and refraction, and therefore that alternate occlusion itself had no effect.     

Spectacle lens compensation in the pigmented guinea pig

When a young growing eye wears a negative or positive spectacle lens, the eye compensates for the imposed defocus by accelerating or slowing its elongation rate so that the eye becomes emmetropic with the lens in place. Such spectacle lens compensation has been shown in chicks, tree-shrews, marmosets and rhesus monkeys. We have developed a model of emmetropisation using the guinea pig in order to establish a rapid and easy mammalian model. Guinea pigs were raised with a +4D, +2D, 0D (plano), −2D or −4D lens worn in front of one eye for 10 days or a +4D on one eye and a 0D on the fellow eye for 5 days or no lens on either eye (littermate controls). Refractive error and ocular distances were measured at the end of these periods. The difference in refractive error between the eyes was linearly related to the lens-power worn. A significant compensatory response to a +4D lens occurred after only 5 days and near full compensation occurred after 10 days when the effective imposed refractive error was between 0D and 8D of hyperopia. Eyes wearing plano lenses were slightly more myopic than their fellow eyes (−1.7D) but showed no difference in ocular length. Relative to the plano group, plus and minus lenses induced relative hyperopic or myopic differences between the two eyes, inhibited or accelerated their ocular growth, and expanded or decreased the relative thickness of the choroid, respectively. In individual animals, the difference between the eyes in vitreous chamber depth and choroid thickness reached ±100 and ±40 μm, respectively, and was significantly correlated with the induced refractive differences. Although eyes responded differentially to plus and minus lenses, the plus lenses generally corrected the hyperopia present in these young animals. The effective refractive error induced by the lenses ranged between −2D of myopic defocus to +10D of hyperopic defocus with the lens in place, and compensation was highly linear between 0D and 8D of effective hyperopic defocus, beyond which the compensation was reduced. We conclude that in the guinea pig, ocular growth and refractive error are visually regulated in a bidirectional manner to plus and minus lenses, but that the eye responds in a graded manner to imposed effective hyperopic defocus.     

Phakic refractive lens experience in Spain

PURPOSE: To evaluate the efficacy, predictability, and safety of a phakic refractive lens (PRL) for high myopia and hyperopia. SETTING: Instituto Oftalmológico Hoyos, Barcelona, Spain. METHODS: A PRL was implanted in 31 eyes (17 myopic, 14 hyperopic) with a mean preoperative spherical equivalent (SE) of -18.46 diopters (D) (range -11.85 to -26.00 D) for myopia and +7.77 D (range +5.25 to +11.00 D) for hyperopia. All eyes had a thorough ophthalmologic examination before and after surgery. The follow-up was at least 12 months. RESULTS: At 1 year, the mean postoperative SE in the myopic group was -0.22 D +/- 0.87 (SD) and 82% were within +/-1.00 D of the desired refraction. The mean postoperative SE in the hyperopic group was -0.38 +/- 0.82 D, and 79% were within +/-1.00 D. Snellen lines of visual acuity were gained in 65% of the myopic eyes (8 eyes gained 1 line, 3 eyes gained 2 lines), and no eye lost lines. In the hyperopic group, 1 eye gained 1 line of acuity and 1 eye lost 1 line. In the hyperopic group, complications included pupillary block in 2 eyes and pigment dispersion signs without intraocular hypertension in 1 eye. In the myopic group, 1 eye had a corticosteroid-induced intraocular pressure rise, 1 eye had a spot of anterior cortical lens opacity immediately after surgery that did not progress, and 3 eyes with the PRL model 100 had decentration that required replacement of the lens. Four patients (2 myopic, 2 hyperopic) reported night halos in both eyes. CONCLUSIONS: Results indicate that PRL implantation to correct high myopia and hyperopia is a relatively rapid, safe, predictable, and stable method that in many cases also improves the best corrected visual acuity. Complications such as visually significant progressive cataract and pigmentary glaucoma were not observed.     

Overnight lens removal avoids changes in refraction and eye growth produced by plano soft contact lenses in infant marmosets

Infant marmosets were fitted with zero-powered (plano) soft contact lenses from 4 to 8 weeks of age worn either continuously (24 h per day) (n = 4), for 12 h (n = 4), or for 8 h (n = 3) per day to determine whether limiting the daily duration of lens-wear could significantly reduce or eliminate the effects of continuous lens-wear on ocular growth and refractive state. As in macaques (Hung, L. F., & Smith, E. L. (1996). Extended-wear, soft, contact lenses produce hyperopia in young monkeys. Optometry and Vision Science, 73, 579-584), eyes fitted with contact lenses worn continuously developed more hyperopic refractions (mean +3.22 +/- 1.49 D SE) compared to their fellow untreated eyes, inconsistent changes in vitreous chamber depth (-0.02 +/- 0.09 mm SE) and flatter corneas (mean decrease in corneal power 4.22 +/- 0.39 D SE). Eyes wearing lenses for only 12 h per day showed similar but reduced effects compared to the 24-h group. Most importantly, ocular growth, corneal power and refraction were unaffected in the 8-h group. Future studies using contact lenses in infant primates should employ a reduced daily duration of lens-wear to eliminate the undesirable effect of contact lens-wear per se on ocular development.     

Constant light rearing disrupts compensation to imposed- but not induced-hyperopia and facilitates compensation to imposed myopia in chicks

PURPOSE: While rearing chicks in constant light (CL) inhibits anterior segment growth, these conditions also induce excessive enlargement of the vitreous chamber. The mechanisms underlying these effects are poorly understood although it has been speculated that the enlarged vitreous chambers are a product of emmetropization, a compensatory response to the altered anterior segments. We examined the ability of eyes to compensate to defocusing lenses in CL as a direct test of their ability to emmetropize. We also studied recovery responses, i.e. from lens-induced changes in CL as well as CL-induced changes alone or combined with lens-induced changes in eyes returned to normal diurnal lighting (NL). METHODS: Hatchling White-Leghorn chicks were reared in either CL or NL (control) lighting conditions (n=36) for 2 weeks, with lenses of either +10 or -10D power fitted to one eye of all chicks at the beginning of the second week. The lenses were removed at the end of the same week, at which time some CL chicks (n=14) were shifted to NL, the rest of the chicks remaining in their respective original lighting conditions. Retinoscopy, IR photo-keratometry and high-frequency A-scan ultrasonography were used to track refractions, corneal radii of curvature and ocular axial dimensions, respectively; data were collected on experimental days 0, 7, 9, 14 and 21. RESULTS: Under CL, eyes showed near normal, albeit slightly exaggerated responses to +10D lenses while the response to -10D lenses was disrupted. With +10D lenses, lens-wearing eyes became more hyperopic (RE), and had shorter vitreous chambers (VC) and optical axial lengths (OL) relative to their fellows by the end of the lens period [RE: +10.5+/-1.5D, CL, +8.25+/-2.5D, NL; VC: -0.363+/-0.129mm, CL; -0.306+/-0.110mm, NL; OL: -0.493+/-0.115mm, CL, -0.379+/-0.106mm, NL (mean interocular difference+/-SD)]. With -10D lenses, the NL group showed a myopic shift in RE and increased elongation of both VC depth and OL (RE: -10.75+/-2.0D; VC depth: 0.554+/-0.097mm; OL: 0.746+/-0.166mm), while the CL group showed a small hyperopic shift in RE (+4.0+/-6.0D). Nonetheless, CL eyes were able to recover from lens-induced hyperopia, whether they were left in CL or returned to NL. One week of exposure to NL was sufficient to reverse the effects of 2 weeks of CL on anterior and vitreous chamber dimensions. CONCLUSION: CL impairs emmetropization. Specifically, it disrupts compensation to lens-imposed hyperopia but not imposed myopia. However, CL eyes are able to recover from lens-induced hyperopia, suggesting that the mechanisms underlying the compensatory responses to defocusing lenses are different from those involved in recovery responses. The ocular growth effects of CL on young eyes are reversible under NL.     

Effect of soft contact lenses on the measurements of intraocular pressure with non-contact pneumotonometry

PURPOSE: To evaluate the effect of soft contact lenses with different lens power on the measured value of the intraocular pressure with non-contact pneumotonometry. METHODS: 120 eyes (80 healthy volunteers: 50 women, 30 men, aged 22 to 61 years) were included in this study. Intraocular pressure was measured with a pneumotonometer Canon X-10 before and after insertion of the Ciba Vision Focus Night&Day soft contact lens. We used contact lenses with different lens power of + 0.25 D, + 1.00 D, + 4.00 D, - 1.00 D, and - 4.00 D. The averages of three measurements were taken as representative IOP values that were statistically evaluated. RESULTS: IOP measured over myopic lenses of - 1.00 and - 4.00 D showed lower values within the mean range of 1 mm Hg. The difference between the measurements over the myopic lenses was mostly smaller than +/- 2 mm Hg (78% when using - 1.00 D and 90% when using - 4.00 D contact lens). All the differences using + 0.25 D contact lens were smaller than +/- 2 mm Hg. The difference was considerably higher in measurements over + 1.00 and + 4.00 hyperopic contact lenses and showed strong increase with the lens power. CONCLUSIONS: In our study we showed that intraocular pressure can be reliably measured with non-contact pneumotonometry over myopic lenses or hypermetropic lenses with small lens power. This suggests that non-contact pneumotonometry is a useful method in patients wearing therapeutic contact lenses and contact lens wearers who, when measuring the eye pressure, would not need to remove the contact lenses before the examination.     

Effects of continuous light on experimental refractive errors in chicks

It is possible to induce ametropias in young chicks either by depriving the developing eye of clear form vision with a translucent goggle or by defocusing the retinal image with convex or concave lenses. The refractive properties of the developing chick eye are also altered by raising young birds in a continuous light environment. The effects of superimposing form deprivation or defocus treatments on chicks raised in continuous light are unclear. Newly hatched (n = 31) chicks were raised for 2 weeks under continuous light while wearing either translucent goggles or + 10 or ? 10 diopter (D) lenses over one eye. Refractive states, corneal curvature and intraocular dimensions were measured periodically by retinoscopy, keratometry and A-scan ultrasound. The birds were sacrificed after 2 weeks and the eyes removed and measured with calipers. Under continuous light, all eyes treated with translucent goggle and ? 10D lens developed moderate myopia (? 2.6 ± 0.5 D and ? 1.4 ± 0.3 D, respectively) by day 4. The eyes treated with a + 10 D lens developed moderate hyperopia (+ 4.8 ± 0.5 D) at day 4. Corneal curvatures of all treated eyes were slightly, but significantly, larger than contralateral control eyes by day 4. After 2 weeks of goggle or lens application, all the treated eyes were hyperopic due to corneal flattening. But the eyes treated with a goggle or a ? 10 D lens still showed relative myopia compared to the fellow eyes (treated minus untreated = ? 3.8 ± 0.4 D and ? 2.8 ± 0.4 D, respectively), and the eyes treated with a + 10 D lens showed more hyperopia than fellow eyes (treated minus untreated = + 5.1 ± 0.6 D). Compared with the control eyes, the axial length (mainly vitreous chamber depth) was slightly, but significantly, increased in the eyes treated with a goggle or a ? 10 D lens, and the axial length decreased slightly in the eyes treated with + 10 D lens. The results suggest that form deprivation and retinal defocus (induced by ± 10 D lenses) could still induce experimental refractive errors (myopia and hyperopia) in chicks kept under continuous light, but the effects of form deprivation and retinal defocus were partially suppressed by continuous light.     

Time to resolution of contact lens-induced corneal warpage prior to refractive surgery.

PURPOSE: To evaluate the resolution of contact lens-induced corneal warpage before keratorefractive surgery. METHODS: We prospectively studied the eyes of 165 consecutive contact lens-wearing patients evaluated for keratorefractive surgery. Significant contact lens-induced corneal warpage was detected by comeal topography in 20 eyes of 11 patients. Manifested refraction, keratometry, and cornea topography were subsequently recorded during weekly or biweekly reevaluations and were compared with previous measurements for stability. Effects of age, sex, type, and duration of contact-lens wear and the recovery time period to stabilization were analyzed. RESULTS: Overall, a 12% incidence of significant contact lens-induced corneal warpage was found. In patients demonstrating lens-associated warpage, the mean duration of prior contact lens wear was 21.2 years (range 10 to 30 years); lens use included daily wear soft (n=2), extended-wear soft (n=6), toric (n=4), and rigid gas-permeable contact lenses (n=8). Up to 3.0 diopter (D) refractive and 2.5D keratometric shifts accompanied by significant topography pattern differences were observed. The average recovery time for stabilization of refraction, keratometry (change within +/- 0.5D), and topography pattern was 7.8+/-6.7 weeks (range 1 to 20 weeks). Recovery rates differed between the lens types: soft extended-wear 11.6+/-8.5 weeks, soft toric lens 5.5+/-4.9 weeks, soft daily wear 2.5+/-2.1 weeks, and rigid gas-permeable 8.8+/-6.8 weeks. CONCLUSION: We observed a 12% incidence of significant contact lens-induced corneal warpage in patients undergoing evaluation for keratorefractive surgery. Warpage occurred with all types of contact lens wear but resolved at different rates. To optimize the quality and predictability of keratorefractive procedures, an appropriate waiting period is necessary for contact lens-induced corneal warpage to stabilize. We suggest that resolution of corneal warpage be documented by stable serial manifested refractions, keratometry, and corneal topographic patterns before scheduling patients for keratorefractive surgery.     

Effectiveness of hyperopic defocus, minimal defocus, or myopic defocus in competition with a myopiagenic stimulus in tree shrew eyes

PURPOSE: To examine the ability of hyperopic defocus, minimal defocus, and myopic defocus to compete against a myopiagenic -5-D lens in juvenile tree shrew eyes. METHODS: Juvenile tree shrews (n > or = 5 per group), on a 14-hour lights-on/10-hour lights-off schedule, wore a monocular -5-D lens (a myopiagenic stimulus) over the right eye in their home cages for more than 23 hours per day for 11 days. For 45 minutes each day, the animals were restrained so that all visual stimuli were >1 m away. While viewing distance was controlled, the -5-D lens was removed and another lens was substituted with one of the following spherical powers: -5 D, -3 D (hyperopic defocus); plano (minimal defocus); or +3, +4, +5, +6, or +10 D (myopic defocus). Daily noncycloplegic autorefractor measures were made on most animals. After 11 days of treatment, cycloplegic refractive state and axial component dimensions were measured. RESULTS: Eyes with the substituted -5- or -3-D-lens developed significant myopia (mean +/- SEM, -4.7 +/- 0.3 and -3.1 +/- 0.1 D, respectively) and appropriate vitreous chamber elongation. All animals with the substituted plano lens (minimal defocus) during the 45-minute period showed no axial elongation or myopia (the plano lens competed effectively against the -5-D lens). Variable results were found among animals that wore a plus lens (myopic defocus). In 11 of 20 eyes, a +3-, +4-, or +5-D lens competed effectively against the -5-D lens (treated eye <1.5 D myopic relative to its fellow control eye). In the other eyes (9/20) myopic defocus was ineffective in blocking compensation; the treated eye became more than 2.5 D myopic relative to the control eye. The +6- and +10-D substituted lenses were ineffective in blocking compensation in all cases. CONCLUSIONS: When viewing distance was limited to objects >1 m away, viewing through a plano lens for 45 minutes (minimal defocus) consistently prevented the development of axial elongation and myopia in response to a myopiagenic -5-D lens. Myopic defocus prevented compensation in some but not all animals. Thus, myopic defocus is encoded by at least some tree shrew retinas as being different from hyperopic defocus, and myopic defocus can sometimes counteract the myopiagenic effect of the -5-D lens (hyperopic defocus). However, it appears that minimal defocus is a more consistent, strong antidote to a myopiagenic stimulus in this mammal closely related to primates.     

Potency of myopic defocus in spectacle lens compensation

PURPOSE: Previous studies have shown that chick eyes compensate for positive or negative lenses worn for brief periods if the chicks are in darkness the remainder of the time. This study was undertaken to determine whether chicks can compensate for brief periods of lens wear if given unrestricted vision the remainder of the time. Previous studies have also shown that chick eyes alternately wearing positive and negative lenses for brief periods compensate for the positive lenses. The current study sought to determine whether brief periods of positive lens wear can outweigh daylong wearing of negative lenses. METHODS: Chicks wore +6 D or +10 D lenses for between 8 and 60 min/d, in two to six periods and wore either no lenses or negative lenses for the remainder of the 12-hour daylight period. Refraction and ultrasound biometry were performed before and after the 3-day-long experiments. RESULTS: Wearing positive lenses for as little as 12 min/d (six periods of 2 minutes) with unrestricted vision the remainder of the time caused eyes to become hyperopic and reduced the rate of ocular elongation. These effects also occurred when the scene viewed was beyond the far point of the lens-wearing eye and thus was myopically blurred. Even when chicks wore negative lenses for the entire day except for 8 minutes of wearing positive lenses, the eyes compensated for the positive lenses, as though the negative lenses had not been worn. When chicks wore binocular negative lenses for the entire day except for 8 minutes of wearing a positive lens on one eye and a plano lens on the other, the eye wearing the positive lens became less myopic than the eye wearing the plano lens. CONCLUSIONS: Brief periods of myopic defocus imposed by positive lenses prevent myopia caused by daylong wearing of negative lenses. This implies that periods of myopic and hyperopic defocus do not add linearly. If children are like chicks and if the hyperopic defocus of long daily periods of reading predisposes a child to myopia, regular, brief interruptions of reading might have use as a prophylaxis against progression of myopia.     

Inducing myopia, hyperopia, and astigmatism in chicks

Myopia and hyperopia have been produced in chicks by applying specially designed convex and concave soft contact lenses to the eyes of newly hatched birds. After 2 weeks of wear, the eyes develop refractive states equivalent in sign and amount (+8 and -10 D) to the lens used. However, the lenses produce an artificial hyperopic shift during the first week of wear due to corneal flattening. We have developed a new approach involving the use of goggles with hard convex and concave contact lens inserts placed between the frontal and lateral visual fields. Myopia and hyperopia (+10 and -10 D) can be produced within days (4 days for hyperopia and 7 days for myopia) if the defocus is applied from the day of hatching. We can also produce significant amounts of astigmatism (1 to 5 D) axis at 90 degrees and 180 degrees by using cylindrical contact lens inserts. Although these last results are preliminary, they suggest that accommodation is not likely involved at this stage of refractive development because we do not believe that the accommodative mechanism can cope with cylindrical defocus. All spherical refractive errors produced using the goggle system appear to result from alterations in vitreous chamber depth.     

Eyes of a lower vertebrate are susceptible to the visual environment

PURPOSE: Recently, it has been found that form deprivation myopia can be induced in fish (tilapia). This study examined the sensitivity of the tilapia eye to positive and negative lenses. It further investigated the sensitivity of the fish eye to form deprivation by examining the effect of fish weight. METHODS: Twenty-five Nile tilapia (Oreochromis niloticus; group 1) were weighed (range, 26-101 g) and killed, and their eyes were measured to provide normative data regarding fish eye size, body weight, and refractive state. Goggles with lenses of refractive powers in water of either +15 D (group 2, n = 7) or -12 D (group 3, n = 7) were sutured over the right eye of for 2 weeks to induce hyperopia or myopia. The untreated contralateral eye served as a control. An additional six fish (group 4), each wearing a goggle with an open central area, were used to evaluate the effect of the goggle itself. Refractive measurements for these 20 fish were made before and after treatment, after which the fish were killed, the eyes were removed, and axial lengths were measured from frozen sections. Another 21 fish were treated with goggles with lenses for 2 weeks, after which the goggle was removed and the refractive states of both eyes were measured every day for 6 days (day 19) and then after 28 days. These fish were placed in one group (group 5) wearing negative (-12 D) lenses (n = 8; average weight, 25.5 g) and two groups (groups 6, 7) of different size (average weights, 13.9 g [n = 5] and 26.9 g [n = 8], respectively) wearing positive (+15 D) lenses during the treatment period. In addition, translucent goggles were applied for 2 weeks to induce form deprivation myopia in three groups of fish (groups 8, 9, 10) of different weights, averaging 16.0 g (n = 7), 57.4 g, (n = 8), and 98.4 g, (n = 7), to provide an evaluation of the effect of weight on the development of form deprivation myopia. RESULTS: In untreated fish (group 1), the axial length of the eye, ranging from 5.86 mm to 7.16 mm, was proportional to weight (26.5-101 g), whereas refractive state shifted from hyperopia (+15D for 10-g fish) toward emmetropia. The +15D lens-treated fish (group 2) became hyperopic relative to the contralateral eye (+7.7 +/- 1.6 D; mean +/- SD), whereas the -12 D lenses (group 3) induced myopia relative to the control eye (-8.4 +/- 0.8 D) within 2 weeks. Hyperopic eyes were shorter (4.16 +/- 0.11 mm vs. 4.28 +/- 0.06 mm) and myopic were eyes longer (3.96 +/- 0.36 mm vs. 3.84 +/- 0.27 mm) than their contralateral control eyes. There were no significant differences in eye size or refractive state between treated and untreated eyes of fish wearing open goggles. In the groups that were allowed to recover (groups 5, 6, 7), the fish treated with minus lenses developed an average of -9.8 +/- 1.9 D myopia, whereas +15 D lenses induced average hyperopia amounts of +8.1 +/- 1.4 D (group 6) and +6.2 5 +/- 2.87 D (group 7). All these fish recovered completely within 2 weeks once the goggles with lenses were removed. Pretreatment and posttreatment refractive results indicated that the contralateral control eyes were affected by the positive and negative lens treatments, though to a lesser extent. Form deprivation myopia was induced in all three different weight groups, averaging -11.9 +/- 2.9 D for group 8, 6.3 +/- 2.5 D for group 9, and -2.3 +/- 1.0 D for group 10. All form-deprived eyes and those treated with positive and negative lenses recovered-i.e., little or no difference resulted in refractive state or dimensions between the treated and untreated eyes-to pretreatment levels within 1 week of goggle removal. CONCLUSIONS: Tilapia, a lower vertebrate species, exhibits positive and negative lens-induced refractive change, as is the case for higher vertebrates. In addition, the level of sensitivity to form deprivation is weight dependent.     

Outcome after treatment of ametropia with implantable contact lenses

OBJECTIVE: To evaluate long-term results after insertion of implantable contact lenses (ICLs) in phakic eyes. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Seventy-five phakic eyes (65 myopic, 10 hyperopic eyes) of 45 patients aged 21.7 to 60.6 years were included. INTERVENTION: STAAR Collamer Implantable Contact Lenses (STAAR Surgical Inc., Nidau, Switzerland) were implanted for correction of high myopia and hyperopia. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were determined. Presence of lens opacification and the distance between the ICL and the crystalline lens were assessed by slit-lamp examination before surgery and at 1, 3, 6 months, and yearly after lens implantation. RESULTS: Preoperative mean spherical equivalent was -16.23+/-5.29 diopters (D) for myopic eyes and +7.88 +/-1.46 D for hyperopic eyes. After ICL implantation, mean residual refractive error was -1.77+/-2.17 D in myopic patients and +0.44+/-0.69 D in hyperopic patients. Preoperative mean UCVA was Snellen 0.03+/-0.03 for myopic patients and Snellen 0.12+/-0.16 for hyperopic patients. Preoperative mean BCVA was Snellen 0.49+/-0.23 for myopic patients and Snellen 0.82+/-0.23 for hyperopic patients. After ICL implantation, mean UCVA up to the end of individual observation time was Snellen 0.36+/-0.36 for myopic patients and Snellen 0.58+/-0.28 for hyperopic patients. Mean BCVA was Snellen 0.73+/-0.26 for myopic and Snellen 0.80+/-0.24 for hyperopic patients. Mean preoperative IOP was 14.2+/-2.7 mmHg, and mean postoperative IOP was 13.46+/-2.1 mmHg over all follow-up investigations. The main complication was the development of subcapsular anterior opacifications of the crystalline lens in 25 eyes (33.3%), 2 of which showed direct contact to the ICL. Eleven eyes (14.7%) were stable in opacification and 14 eyes (18.7%) had progressive opacifications. The median time to opacification was 27.1 months. In 8 patients (10.7%), the subjective visual impairment mandated cataract surgery. CONCLUSIONS: The most significant long-term complication after ICL implantation is the formation of opacifications of the crystalline lens with the risk of the necessity of subsequent cataract surgery (10.7%). Old age, female gender, and contralateral opacification are independent significant risk factors for early formation of opacifications in this patient group.     

Continuous ambient lighting and lens compensation in infant monkeys.

PURPOSE: Protracted daily lighting cycles do not promote abnormal ocular enlargement in infant monkeys as they do in a variety of avian species. However, observations in humans suggest that ambient lighting at night may reduce the efficiency of the emmetropization process in primates. To test this idea, we investigated the ability of infant monkeys reared with continuous light to compensate for optically imposed changes in refractive error. METHODS: Beginning at about 3 weeks of age, a hyperopic or myopic anisometropia was imposed on 12 infant rhesus monkeys by securing either a -3 D or +3 D lenses in front of one eye and a zero-powered lens in front of the fellow eye. Six of these monkeys were reared with the normal vivarium lights on continuously, whereas the other six lens-reared monkeys were maintained on a 12-h-light/12-h-dark lighting cycle. The ocular effects of the lens-rearing procedures were assessed periodically during the treatment period by cycloplegic retinoscopy, keratometry, and A-scan ultrasonography. RESULTS: Five of six animals in each of the lighting groups demonstrated clear evidence for compensating anisometropic growth. In both lighting groups, eyes that experienced optically imposed hyperopic defocus (-3 D lenses) exhibited faster axial growth rates and became more myopic than their fellow eyes. In contrast, eyes treated with +3 D lenses showed relatively slower axial growth rates and developed more hyperopic refractive errors. The average amount of compensating anisometropia (continuous light, 1.6 +/- 0.5 D vs. control, 2.3 +/- 0.5 D), the structural basis for the refractive errors, and the ability to recover from the induced refractive errors were also not altered by continuous light exposure. CONCLUSION: Ambient lighting at night does not appear to overtly compromise the functional integrity of the vision-dependent mechanisms that regulate emmetropization in higher primates.     

Temporal integration characteristics of the axial and choroidal responses to myopic defocus induced by prior form deprivation versus positive spectacle lens wear in chickens.

PURPOSE: In chicks, the temporal response characteristics to form deprivation and to spectacle lens wear (myopic and hyperopic defocus) show essential differences, suggesting that the emmetropization system "weights" the visual signals differently. To further explore how the eye integrates opposing visual signals, we examined the responses to myopic defocus induced by prior form deprivation vs. that induced by positive spectacle lenses, in both cases alternating with form deprivation. METHODS: Three experimental paradigms were used: 1) Form deprivation was induced by monocular occluders for 7 days. Over the subsequent 7 days, the occluders were removed daily for 12 hours (n = 13), 4 hours (n = 7), 2 hours (n = 7), or 0 hours (n = 6). 2) Birds were form-deprived on day 12. Over the subsequent 7 days, occluders were replaced with a +10 D lens for 2 hours per day (n = 13). 3) Starting at day 11, a +10 D lens was placed over one eye for 2 hours (n = 13), 3 hours (n = 5), or 6 hours (n = 10) per day and were otherwise untreated. Ocular dimensions were measured with high-frequency A-scan ultrasonography; refractive errors were measured by streak retinoscopy at various intervals. RESULTS: In recovering eyes, 2 hours per day of myopic defocus was as effective as 12 hours at inducing refractive and axial recovery (change in refractive error: +10 D vs. +13 D, respectively). By contrast, 2 hours of lens-induced defocus (alternating with form deprivation) was not sufficient to induce refractive or axial compensation (change in refractive error: -1.7 D). When myopic defocus alternated with unrestricted vision, 6 hours per day were sufficient to induce nearly full compensation (2 hours vs. 6 hours: 4.4 D vs. 8.2 D; p < 0.0005). Choroids showed rapid increases in thickness to the daily episodes of myopic defocus; these resulted in "long-term" thickness changes in recovering eyes and eyes wearing lenses for 3 or 6 hours per day. CONCLUSIONS: The response to myopic defocus induced by prior form deprivation is more robust than the response induced by positive lenses, suggesting that the underlying mechanisms differ. Presumably, this difference is related to the size of the eye at the onset. Compensatory decreases in growth rate occur without full compensatory choroidal thickening.     

Contact lens wear enhances adherence of Pseudomonas aeruginosa and binding of lectins to the cornea

Extended wear soft contact lenses are associated with an increased incidence of Pseudomonas aeruginosa keratitis. Because the first step in the pathogenesis of this disease is adherence of the microorganism to the corneal surface, we studied the effect of soft contact lens wear on the adherence of P. aeruginosa to the cornea. Rabbits were fitted for extended wear soft contact lenses in the left eye, and the right eye served as a control. Both eyes were then closed with a partial tarsorrhaphy. After 1-5 days of wear, the lenses were removed and the corneas of the left and right eye were removed. Differences in the number of adherent Pseudomonas and in lectin binding to lens-wearing corneas and non-lens-wearing corneas were determined. After 1, 3, and 5 days of soft contact lens wear, there was a significant increase in the number of P. aeruginosa adherent to the lens-wearing cornea. Three to eight times as many bacteria adhered to the lens-wearing eye as compared with the control eye (p less than 0.05). In addition, a soft contact lens placed in the eye followed by the immediate application of P. aeruginosa resulted in an eightfold increase in adherence of bacteria to the lens-wearing cornea (p less than 0.05). Lens wear also led to an increase in binding of concanavalin A (Con A), wheat germ agglutinin (WGA), and Maclura pomifera agglutinin (MPA) to surface epithelium covered by the lens. These corneal epithelial changes induced by extended wear soft contact lenses may provide some insight as to why soft contact lens wearers are predisposed to Pseudomonas keratitis.     

Effects of contact lenses on scanning laser polarimetry of the peripapillary retinal nerve fiber layer

PURPOSE: To determine the effects of contact lenses on scanning laser polarimetry of the peripapillary nerve fiber layer. METHODS: In a prospective study using the Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, California), retinal nerve fiber layer thickness in 22 subjects (51 eyes) was imaged with and without contact lenses (disposable and nondisposable daily wear soft and rigid gas permeable). Measurements of the circumference and of each quadrant were compared using paired Student t test. RESULTS: Nerve Fiber Analyzer measurements with and without contact lenses were not significantly different for any of the contact lens types tested (P > or = .11), using either hyperopic (to +4 diopters) or myopic (to -8.5 diopters) lenses. CONCLUSION: Contact lens wear and refractive power of the eye within the range tested do not significantly affect scanning laser polarimetry of the peripapillary nerve fiber layer.     

Laser in situ keratomileusis versus lens-based surgery for correcting residual refractive error after cataract surgery

PURPOSE: To evaluate and compare the efficacy and safety of laser in situ keratomileusis (LASIK) versus lens-based surgery (intraocular lens [IOL] exchange or piggyback IOL) for correcting residual refractive error after cataract surgery. SETTING: Private eye center, Salt Lake City, Utah, USA. METHODS: This retrospective study included 57 eyes of 48 patients who had LASIK (28 eyes) or lens-based correction (29 eyes) for residual refractive error after cataract surgery. The visual and refractive outcomes were evaluated at a mean follow-up of 20 to 24 months. RESULTS: In the LASIK group, the mean spherical equivalent (SE) was reduced from -1.62 +/- 0.80 diopters (D) preoperatively to +0.05 +/- 0.38 D postoperatively in myopic eyes and from +0.51 +/- 1.25 D to +0.19 +/- 0.35 D in hyperopic eyes. Ninety-two percent of eyes were within +/-0.50 D of intended correction. In the lens group, the mean SE was reduced from -3.55 +/- 2.69 D preoperatively to -0.20 +/- 0.50 D postoperatively in myopic eyes and from +2.07 +/- 2.38 D to +0.07 +/- 0.85 D in hyperopic eyes. Eighty-one percent of eyes had postoperative SE within +/-0.50 D of the intended correction. The UCVA improved significantly in both groups. No eye lost more than 1 line of BSCVA. With a similar length of follow-up, no significant difference in postoperative SE was found between the 2 groups (P = .453). CONCLUSIONS: The results showed efficacy, safety, predictability, and merits of LASIK and lens-based approaches for correcting different types of residual refractive error after cataract surgery.     

Colchicine attenuates compensation to negative but not to positive lenses in young chicks

Optic nerve-sectioned (ONS) chick eyes are capable of emmetropisation, but these eyes also exhibit increased hyperopia without any visual manipulations, which suggests altered eye growth regulation. These altered growth changes may be related to the loss of retinal ganglion cells that follows nerve lesioning. Colchicine, which also destroys retinal ganglion cells in chicks, was used to further examine the effects of retinal ganglion cell loss on emmetropisation. Growth responses of +10D and -10D lens-wearing colchicine-injected eyes were compared to those of +10D and -10D lens-wearing saline-injected eyes, respectively. Changes after removal of lenses were also analysed. Prior to lens-wear, colchicine-injected eyes exhibited longer optical axial lengths (OL; distance from cornea to retina; p=0.0185) but no differences in refractive error (RE; p=0.6588). Although myopic shifts were not significant for -10D lens-wearing colchicine-injected eyes (p=0.5913), but were for the saline-injected eyes (p=0.0034), these changes were not different (p=0.1646). However, -10D lens-induced OL changes in colchicine-injected eyes showed insignificant (p=0.2214) and reduced (p=0.0102) changes compared to those of saline-injected eyes. +10D lens-treated colchicine-injected eyes showed significant hyperopic shifts (p<0.0001) and significant reductions in OL (p<0.0001) that were similar to those of saline-injected eyes (p=0.7990 and p=0.1495, respectively). Growth responses in eyes recovering from -10D lenses were minimal, with REs unaffected (p=0.3325), but OL reductions affected (p=0.0199) by colchicine. Colchicine-injected eyes recovering from +10D lenses showed significant myopic shifts (p=0.0003) and OL elongations (p<0.0001) that were similar to those of saline-injected eyes (p=0.3999 and p=0.4731, respectively). The results showing that colchicine suppresses the ability to respond to negative lenses but leaves compensation to positive lenses relatively unchanged, are opposite to those of optic nerve sectioned eyes. We speculate that the differences are probably related to the way retinal cells are lost.     

Refractive plasticity of the developing chick eye

We have developed a lightweight plastic goggle with rigid contact lens inserts that can be applied to the eyes of newly hatched chicks to explore the range and accuracy of the developmental mechanism that responds to retinal defocus. Convex and concave lenses of 5, 10, 15, 20 and +30 D were applied to one eye on the day of hatching. The chick eye responds accurately to defocus between -10 and +15 D, although hyperopia develops more rapidly than myopia. Beyond this range there is first a levelling off of the response and then a decrease. The resulting refractive errors are caused mainly by increases and decreases in axial length, although high levels of hyperopia are associated with corneal flattening. If +/- 10 D defocusing lenses are applied nine days after hatching the resulting myopia and hyperopia are equal to about 80% of the inducing power. After one week of inducing myopia and hyperopia with +/- 10 D lenses, the inducing lenses were reversed. In this case, the refractive error did not reach the power of the second lens after another week of wear. Instead, astigmatism in varying amounts (0-12 D) was produced, being greater when reversal was from plus to minus. Finally, astigmatism can also be produced by applying 9 D toric inducing lenses on the day of hatching. The astigmatism produced varies from 2 to 6 D, and the most myopic meridian coincides with the power meridian of the inducing lens. This astigmatism appears to be primarily due to corneal toricity.(ABSTRACT TRUNCATED AT 250 WORDS)