Reliability of the Snellen chart.
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Biomedical subjects
Publications and source records attributed to B Winn.
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Although many colour-depth phenomena are predictable from the interocular difference in monocular chromatic diplopia caused by the eye's transverse chromatic aberration (TCA), several reports in the literature suggest that other factors may also be involved. To test the adequacy of the optical model under a variety of conditions, we have determined experimentally the effects of background colour on perceived monocular chromatic diplopia and perceived depth (chromostereopsis). A Macintosh colour monitor was used to present red, blue, and green test stimuli which were viewed monocularly or binocularly (haploscopically) through 1.78 mm artificial pupils. These apertures were displaced nasally and temporally from the visual axis under controlled conditions to induce a variable degree of TCA. Monocular chromatic diplopia and binocular chromostereopsis were measured for red and blue targets, and also for red and green targets, presented on either a black background or on a background which was composed of the sum of the targets' spectral composition (e.g. red and blue presented on magenta; red and green presented on yellow). In all cases, chromatic diplopia and chromostereopsis were found experimentally to reverse in sign with this change in background. Furthermore, we found that a given coloured target could be located in different depth planes within the same display when located on different background colours. These seemingly paradoxical results could nevertheless be explained by a simple model of optical TCA without the need to postulate additional factors or mechanisms.
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The study of ocular mechanisms is often concerned with the possible interaction of two systems. Spectral analysis has been used previously by many investigators as a tool to investigate the interrelationships in the behaviour of two or more systems. This note demonstrates the value of computing coherence functions following spectral analysis to obtain a more rigorous tool for the investigation of synergy between two systems.
PURPOSE: The aim of this study was to evaluate a clinical test of hyperacuity in the assessment of retinal-neural function in patients with posterior capsular opacification. METHODS: Neodymium (Nd):YAG laser capsulotomy was performed on 39 subjects (mean age, 76.72 years +/- 10.41 years). Measurements of refractive error, logMAR acuity, and displacement threshold hyperacuity (DTH) were made before and 3 weeks after Nd:YAG therapy. The DTH task involved measurement of the smallest detectable displacement of an object relative to two stationary references. In addition, an independent fundus examination was performed before and after therapy to determine the presence of retinal disease. By ophthalmoscopic examination, a blind protocol was adopted for the classification of subjects as normal or as having retinal disease. RESULTS: Preoperative measures of logMAR visual acuity were of no value in distinguishing between patients with retinal disease and normals (P > 0.1) and were a poor indicator of postoperative logMAR acuity (r2 = 0.2). Preoperative DTH could be used to distinguish patients with retinal disease from normals (P < 0.005) and were found to be correlated with measures of postoperative logMAR acuity (r2 = 0.4). Preoperative DTH correlated well with postoperative DTH (r2 = 0.7), which is consistent with its resistance to optical image degradation. CONCLUSION: The results of this study indicate that DTH is of value in the presurgical assessment of visual function in patients with media opacification if adequate fundus examination is not possible.
PURPOSE: The characteristics of prism adaptation have been evaluated by many previous studies but most have been performed on young subjects (typically 18 to 35 years of age). Because little information is available regarding the effect of age on vergence adaptation, we assessed prism adaptation on 25 visually normal subjects across a wide age range (19 to 85 years) for both convergent and divergent induced disparities. METHODS: A "flashed" (125 ms) Maddox rod procedure was used for distance fixation (5 m) over a 3.5 min adaptation period and a 2.5 min recovery period. Stimulus presentation and occlusion time were controlled with an Apple lle microcomputer through a ClL Microsystems interface. RESULTS: Prism adaptation was shown to be present in all age groups, with convergence showing a greater amplitude than divergence. However, the magnitude of adaptation declined significantly as a function of increasing age at a rate of approximately 0.6% per year. CONCLUSION: An adaptation mechanism is present in all subjects but it operates with reduced gain in older subjects. The finding may explain the clinical observation that older patients readily accept prismatic correction to control oculomotor imbalance.
Power spectrum analysis of accommodative microfluctuations has identified two dominant frequency components: a low frequency component (LFC < 0.6 Hz) and a high frequency component (1.3 Hz < HFC < 2.5 Hz). Computer-driven models of accommodation and experimental manipulation of accommodative feedback loops indicate that LFCs are likely to have a functional role in monitoring retinal image contrast during sustained accommodation. In contrast HFCs have been shown to be correlated with arterial pulse frequency and consequently their characteristics can be modified by the extra- and intra-ocular vascular (and possibly CNS) effects. For example, topical instillation of the non-selective beta-antagonist timolol maleate has shown previously the ability to modify the HFC. In an attempt to clarify proposed differences between beta-adrenoceptor antagonist agents with regard to their effects on systemic and ocular vasculature, we extend the potential offered by HFCs as a non-invasive method of assessing the ocular response to beta-antagonists to the cardioselective beta-antagonist betaxolol HCl. Accommodative microfluctuations were measured using a continuously recording infrared optometer on 10 emmetropic subjects (mean age 23.9 +/- 2.3 years) who viewed a high contrast target located at a vergence of -4 D. A double-blind protocol was employed between saline and betaxolol (0.5%, 2 x 30 microliters) following corneal anaesthesia. Local and systemic effects were separated by examining the treated and untreated eyes of three subjects. Power spectrum analysis indicated that the root mean square (r.m.s.) value and power of LFCs and HFCs were equivalent for the saline and betaxolol trials.(ABSTRACT TRUNCATED AT 250 WORDS)
The characteristics of post-task regression of accommodation to pre-task tonic accommodation (TA) levels have been examined in a number of studies to clarify the nature of the within-task facility for accommodative adaptation. Of special interest is the recent observation that significant attenuation of post-task regression occurs in late-onset myopes (LOMs) when compared with emmetropes (EMMs). These findings have led to speculation that such attenuation may reflect a deficit in inhibitory sympathetic innervation to ciliary smooth muscle in late-onset myopia and hence a predisposition to sustained accommodative adaptation which then acts as a precursor to the induced myopia. A consequence of this study was that post-task regression may have some value in predicting those individuals who may be susceptible to post-task accommodative hysteresis. A pre-requisite for such a predictive value is that for a given individual the variation in inter-trial regression patterns is not significant. The aim of this study is principally to investigate the inter-trial variability of post-task regression for individual subjects following a sustained near vision task, and to confirm further differences that have been reported between EMMs and LOMs with respect to the time course of post-task regressions. A modified Canon R1 infrared optometer was used to measure accommodation objectively throughout a near task and for 2 min post-task. Accommodative level was measured following 3 min fixation of a high contrast photopic Maltese cross target placed 3 D above the subject's baseline TA. Repeatability of post-task regression in 10 EMMs and 10 LOMs was assessed by taking measurements on three separate occasions.(ABSTRACT TRUNCATED AT 250 WORDS)
PURPOSE: To investigate the effect of age, gender, refractive error, and iris color on light-adapted pupil size in humans. METHODS: Pupil diameters of 91 subjects (age range, 17 to 83 years) with normal, healthy eyes were measured using an objective infrared-based continuous recording technique. Five photopic ocular illuminance levels were used (2.15 to 1050 lumens m-2), and the accommodative status of each subject was precisely controlled at a constant level. RESULTS: Pupil size decreased linearly as a function of age at all illuminance levels. Even at the highest illuminance level, there was still a significant effect of age upon pupil size. The rate of change of pupil diameter with age decreased from 0.043 mm per year at the lowest illuminance level to 0.015 mm per year at the highest. In addition, the variability between pupil sizes of subjects of the same age decreased by a factor of approximately two as luminance was increased over the range investigated. Pupil size was found to be independent of gender, refractive error, or iris color (P > 0.1). CONCLUSIONS: Of the factors investigated, only chronologic age had a significant effect on the size of the pupil. The phenomenon of senile miosis is present over a wide range of ocular illuminance levels.
The nominally steady-state accommodation response exhibits temporal variations which can be characterized by two dominant regions of activity; a low frequency component (LFC < 0.6 Hz) and a high frequency component (1.0 < or = HFC < or = 2.1 Hz). There is no consensus as to the relative contribution made by each of the frequency components of the microfluctuations to the control of steady-state accommodation. We investigate the effect of variations in artificial pupil diameter (0.5, 1, 2, 3, 4 and 5 mm pupils) on the microfluctuations of accommodation, while three young emmetropic subjects view, monocularly, a photopic high contrast Maltese cross target placed at a dioptric distance equal to their open-loop accommodation level. Average power spectra were calculated for five accommodation signals, each of 10 sec duration, collected for each viewing condition at a sampling rate of 102.4 Hz using a continuously recording infrared objective optometer. For artificial pupil diameters < or = 2 mm the power of the LFC was found to increase as a function of reducing pupil diameter, while for artificial pupil diameters > 2 mm the LFC was found to be relatively constant. No systematic change in the HFC with varying artificial pupil diameter was observed. Changes in the root-mean-square (r.m.s.) value of the fluctuations with varying pupil diameter were significant (one-way ANOVA, F = 8.507, P = 0.0001, d.f. = 89) and showed a similar form to the changes in the LFC.(ABSTRACT TRUNCATED AT 250 WORDS)
It is feasible that small temporal variations in steady-state accommodation may provide feedback to the accommodation control system through changes in retinal image contrast and that this feedback may be used to maintain an optimal accommodation response. The complex waveform of microfluctuations is dominated by two distinct regions of activity; a low frequency component (LFC < 0.6 Hz) and a high frequency component (1.0 < or = HFC < or = 2.3 Hz). Whereas the HFCs appear to be correlated with some intraocular manifestation of arterial pulse the contribution of the LFCs to the control of steady-state accommodation is unclear. The present study investigates the effect of target luminance on the waveform of accommodative microfluctuations. Three young emmetropic observers viewed monocularly a high contrast (90%) Maltese cross target placed at a vergence equal to their dark-focus level of accommodation in a Badal stimulus system. The luminance of the target was varied from 0.002 to 11.63 cd m-2 in nine equal logarithmic steps. Five continuous accommodation signals were collected for each viewing condition at a sampling rate of 102.4 Hz, and average power spectra subsequently calculated with a frequency resolution of 0.1 Hz. One-way ANOVA revealed a significant variation in the root-mean-square (r.m.s.) value of the microfluctuations (F = 19.795, d.f. 124, P = 0.0001) which could be attributed mainly to increases in the r.m.s. value for the two lowest luminances (0.002 and 0.004 cd m-2). Power spectrum analysis revealed that these changes in the microfluctuations could be attributed to increases of power in the LFC.(ABSTRACT TRUNCATED AT 250 WORDS)
Problems with design and format of the traditional Snellen chart have led to the development of alternative charts for the measurement of visual acuity in adults. However, advances in chart design for the measurement of visual acuity in pre-school children have not paralleled those used in adult test charts. Visual acuity can be measured in infants and very young children using behavioural and electrophysiological techniques but clinical measurement of letter acuity tends to commence when the child is old enough to interact and co-operate with the examiner. Charts which are commercially available in the UK for measuring letter acuity in pre-school children (3-5 years old) either use single optotypes or are derivatives of the Snellen format. There is a need for a test of letter acuity for use with this young age group which is accurate, reliable and based upon sound and established design principles. Glasgow Acuity Cards have been designed to include features that should allow change in letter acuity to be detected in pre-school children, especially those undergoing vision therapy training. The test is performed at 3 m and incorporates several design features which have been used previously in adult charts but are new to childrens' test charts. These include: linear progression of letter sizes using a log scale; letters of approximately equal legibility; equal number of letters per line; control of contour interaction; screening cards to determine initial level of acuity. The test is quick and easy to perform and should provide a means of detecting change in letter acuity, with increased confidence.
PURPOSE: To investigate the relationship between photopic open-loop accommodation and vergence and the effect of mental effort on these positions. METHODS: Twenty subjects (11 men and 9 women) viewed monocularly a photopic (25 cdm-2), high-contrast (90%) Maltese cross-target for 3 minutes, through a 0.5-mm pinhole drilled into an infrared filter. Accommodation was measured objectively at 1-second intervals using a Canon Autoref R-1 infrared optometer, and vergence was recorded continuously and objectively using a differential infrared eye tracking system. RESULTS: Under passive viewing conditions there was a significant correlation between photopic open-loop accommodation and vergence (R = 0.671, P = 0.0012); for the majority of subjects the imposition of mental effort shifted the passive levels of both open-loop accommodation and vergence, but these shifts were unsystematic and uncorrelated (R = 0.259, P = 0.270). The active open-loop positions of accommodation and vergence were also found to be correlated (R = 0.692, P = 0.0007). CONCLUSIONS: The influence of proximal stimuli can explain the correlations identified between photopic open-loop positions of accommodation and vergence. The uncorrelated responses of the accommodation and vergence systems to mental effort are likely to reflect interactions between various spatiotopic stimuli including mental effort and perceived proximity.
The drive to the pupil constriction associated with near fixation has generally been attributed to accommodation with convergence and fusional convergence having secondary roles. However, our previous investigations have shown that significant changes in accommodation can take place without concomitant pupil response. To investigate further, the present study recorded pupil and accommodation responses to a blur-only accommodative stimulus using a target moved sinusoidally at a range of temporal frequencies. Care was taken to minimise target size change and apparent lateral or vertical target displacement. Results show that pupil response could be very much reduced or absent irrespective of stimulus temporal frequency and despite maintained accommodation response. The results suggest that blur-driven accommodation alone is not sufficient to drive pupil near response and that the presence of cues such as size change and lateral or vertical displacement of an approaching object may be necessary to elicit a response.
We review the research which has attempted to determine whether the characteristics of autonomic innervation of ciliary smooth muscle are relevant to the process of accommodative adaptation. The effect of various topical autonomic drugs on the three phases of adaptation were analyzed: pre-task tonic accommodation (open-loop); within-task accommodative response (closed-loop); and post-task regression of accommodation to pre-task tonic levels. Although it is clear that parasympathetic innervation predominates, there is evidence that some individuals utilize supplementary inhibitory sympathetic innervation. When sympathetic innervation is augmented by substantial levels of concurrent parasympathetic accommodative activity, it may serve to attenuate the magnitude and duration of post-task shifts in tonic accommodation. It is proposed that individuals with a deficit in sympathetic inhibition may therefore be predisposed to anomalies of accommodative adaptation. However, the mechanism by which the oculomotor system responds to such predisposition is at present obscure.
The collaboration of Fergus Campbell, Gerald Westheimer and John Robson in the 1950s produced insight into the nature of accommodation microfluctuations and instigated work which has led to the current view that the nominally steady-state accommodation response exhibits temporal variations which can be characterized by two dominant regions of activity: a low-frequency component (LFC less than 0.6 Hz) and a high-frequency component (HFC greater than or equal to 1.0 less than or equal to 2.3 Hz). A functional role has been attributed to these microfluctuations as they offer a means by which a directional cue could be derived from an even-error stimulus. However, there is no consensus regarding the respective contribution made by each of the dominant components in the accommodation control process. Using a newly-designed measurement and recording system we have conducted a series of experiments to investigate the nature and aetiology of the microfluctuations. The incidence and magnitude of microfluctuations in LFCs and HFCs for central and peripheral lens zones were investigated while five young emmetropic subjects viewed a near target. The form of the power spectra of the fluctuations was found to be similar for central and peripheral zones although an overall reduction in magnitude was observed in the periphery. The HFCs are thus a consistent feature of microfluctuations in central zones and not, as previously suggested, merely a spurious feature of peripheral zones. A significant between-subject variation in the location of HFCs was found and led us to consider the relationship between HFCs and other physiological systems which provide intraocular rhythmic variation.(ABSTRACT TRUNCATED AT 250 WORDS)
The ocular accommodation response to a stationary near target exhibits microfluctuations which are characterized by two dominant components of activity: a low-frequency component (LFC: less than 0.5 Hz) and a high-frequency component (HFC: 1.0-2.2 Hz). We have shown recently that there is a significant correlation between the frequency of arterial pulse (AP) and the peak frequency of the HFC. If the mechanisms by which AP induces the HFC are intraocular they are likely to involve both rhythmic variations in choroidal blood flow and intraocular pressure (IOP) pulse: the former inducing changes in ciliary ring diameter from pulsatile blood volume changes in the ciliary body, the latter producing changes in effective lens power following small shifts in lens position or, with each drop in IOP, reduced resistance to inherent lens substance and capsule elasticity. In addition to its well-known ocular hypotensive effect, topical instillation of the beta-adrenergic receptor antagonist timolol maleate has been shown to reduce significantly the magnitude of the IOP pulse, an effect that has been attributed to the vasoconstrictive action of the drug on the choroidal vasculature. Using a modified Canon IR optometer we report on the effect of 0.5% timolol maleate on the accommodative microfluctuations for a group of 10 emmetropic subjects viewing a target monocularly at a distance of 25 cm. Following a double-blind protocol against a saline control, timolol was shown to reduce the rms for both LFCs and HFCs. An experiment to separate local from systemic effects involved four subjects whose treated and untreated eyes were examined to determine the effects of the consensual reduction in IOP: the results on microfluctuations in the untreated eyes were equivocal but the correlation between arterial pulse frequency and location of the peak frequency of HFC was maintained. The results show that factors relating to IOP and vasculature will affect the magnitude of accommodative microfluctuations.
The purpose of this review is to give an account of the issues raised by reports that myopia can be treated by operant conditioning or biological feedback. Devices are available that provide auditory feedback of accommodative state such that variation in tone frequency provides a means by which the patient can monitor his or her ability to induce changes in accommodation response, the task thus being to change the pitch of the tone in a direction corresponding to a more distant far point. The aim of a training programme is to reinforce and establish control over the accommodative response by a process akin to operant conditioning and subsequently to transfer the skill to normal visual environments such that a manifest reduction in myopia becomes apparent. Although there are reports that the technique can induce a reduction in myopia by up to 3 D the findings are of limited value owing to the lack of objective data, for example pre- and post-training cycloplegic refraction. The pre- and post-training measures of subjective letter acuity used by many studies are, with repeated trials, particularly vulnerable to individual differences in the ability to learn how to discriminate and interpret blurred images. The review concludes that more comprehensive clinical trials are needed before accommodation biofeedback can qualify as an established method of clinical treatment of myopia. The trials should be designed to encompass the following issues: the characteristics of a feasible physiological model linking accommodation and myopia development; the rationale with regard to patient selection; the technical performance of the optometer employed; the characteristics of the control group used; the criteria for assessment of myopic change; the transfer of training to performance in normal visual environments; the economic viability of the programme of training and equipment; and the skill, training and knowledge of the clinician implementing the training programme.