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D I Flitcroft

Publications and source records attributed to D I Flitcroft.

15 recordsLinked to original sources
PubMed2005

Retinal dysfunction and refractive errors: an electrophysiological study of children.

AIMS: To evaluate the relation between refractive error and electrophysiological retinal abnormalities in children referred for investigation of reduced vision. METHODS: The study group comprised 123 consecutive patients referred over a 14 month period from the paediatric service of Moorfields Eye Hospital for electrophysiological investigation of reduced vision. Subjects were divided into five refractive categories according to their spectacle correction: high myopia (< or = -6D), low myopia (>-6D and < or = -0.75D), emmetropia (>-0.75 and <1.5D), low hyperopia (> or = 1.5 and <6D), and high hyperopia (> or = 6D). Patients with a specific diagnosis at the time of electrophysiological testing were excluded. Only the first member of any one family was included if more than one sibling had been tested. All tests were performed to incorporate ISCEV standards, using gold foil corneal electrodes where possible. In younger patients skin electrodes and an abbreviated protocol were employed. RESULTS: The mean age of patients was 7.1 years with an overall incidence of abnormal electrophysiological findings of 29.3%. The incidence of abnormality was higher in high ametropes (13/25, 52%) compared to the other groups (23/98, 23.5%). This difference was statistically significant (chi2 test, p = 0.005). There was also a significant association between high astigmatism (>1.5D) and ERG abnormalities (18/35 with high astigmatism v 20/88 without, chi2 test, p = 0.002). There was no significant variation in frequency of abnormalities between low myopes, emmetropes, and low hyperopes. The rate of abnormalities was very similar in both high myopes (8/15) and high hyperopes (5/10). CONCLUSIONS: High ametropia and astigmatism in children being investigated for poor vision are associated with a higher rate of retinal electrophysiological abnormalities. An increased rate of refractive errors in the presence of retinal pathology is consistent with the hypothesis that the retina is involved in the process of emmetropisation. Electrophysiological testing should be considered in cases of high ametropia in childhood to rule out associated retinal pathology.

Adolescent↗
PubMed2004

Ocular shape and myopia.

INTRODUCTION: To learn if eye shape might be a useful parameter in refractive research. MATERIALS AND METHODS: Laboratory research on eye growth mechanisms is summarised. The available clinical literature relating refraction to eye shape and peripheral refraction is critically assessed in the context of the laboratory research on refractive development. RESULTS: Almost all refraction research assesses optical and length parameters exclusively along the visual axis. Contemporary laboratory research demonstrates a remarkable phylogenic conservation of the neural mechanisms regulating refractive development. On-axis image quality regulates central refractive development in animals and probably, to some extent, in humans. Off-axis image quality at the retina depends on anterior segment geometry and optics, and on the 3-dimensional conformation of the retina. In chicks, eye shape is a predictable parameter linked to the underlying neural mechanisms modulating eye development. Based on the sparse clinical literature in human adults and children, the eye shapes induced in chicks are also seen in human subjects in patterns suggesting that eye shape may be a useful parameter in clinical studies. CONCLUSION: The diverse findings suggest that incorporating the 3-dimensional conformation of the eye into future clinical studies may help resolve many of the ambiguities in contemporary refractive research.

Animals↗
PubMed1999

The lens paradigm in experimental myopia: oculomotor, optical and neurophysiological considerations.

The lens-rearing paradigm has developed great importance in the field of experimental myopia. Although an apparently simple paradigm, the results of any experiment can be influenced by a variety of factors including habitual viewing distance, ocular refraction, oculomotor performance and the spatial sensitivity of the retinal elements involved in retinal image assessment. Computer modelling has been used to evaluate the expected impact when lenses are placed in front of a primate eye as a function of the above parameters. Spatial band-pass responses of the mechanisms responsible for emmetropization are predicted to lead to a limited range of retinal defocus over which compensation to lenses could occur. Even assuming an equal ability to detect hyperopic and myopic defocus, it is predicted that primate eyes should be able to compensate for a much larger range of minus lenses than plus lenses. This derives from the ability of the accommodation system to keep retinal defocus within this operating range over a wider range of minus lenses than plus lenses. The range over which compensation can occur will depend on the spatial tuning of the elements responsible for detecting retinal defocus and capabilities of the accommodation system. The observed asymmetry in responses of the primate eye to rearing with plus and minus lenses and observed differences between primates and chickens in lens rearing studies may therefore be partly attributable to optical and neurophysiological considerations.

Accommodation, Ocular↗
PubMed1999

Intraocular lenses in children: changes in axial length, corneal curvature, and refraction.

AIM: To assess changes in axial length, corneal curvature, and refraction in paediatric pseudophakia. METHODS: 35 eyes of 24 patients with congenital or developmental lens opacities underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. Serial measurements were made of axial length, corneal curvature, objective refraction, and visual acuity. RESULTS: For patients with congenital cataracts (onset < 1 year age) the mean age at surgery was 24 weeks. Over the mean follow up period of 2.7 years, the mean increase in axial length of 3.41 mm was not significantly different from the value of an expected mean growth of 3.44 mm (paired t test, p = 0.97) after correction for gestational age. In the developmental cataract group (onset > 1 year of age) the mean age at surgery was 6.4 years with a mean follow up of 2.86 years. This group showed a mean growth in axial length of 0.36 mm that was not significantly different from an expected value of 0.47 mm (paired t test, p = 0.63). The mean preoperative keratometry was 47.78 D in the congenital group and 44.35 D in the developmental group. At final follow up the mean keratometry in the congenital group was 46.15 D and in the developmental group it was 43.63 D. In eyes followed for at least 2 years, there was an observed myopic shift by 24 months postoperatively of 3.26 D in the congenital cases (n = 10) and 0.96 D in the developmental cases (n = 18). CONCLUSION: The pattern of axial elongation and corneal flattening was similar in the congenital and developmental groups to that observed in normal eyes. No significant retardation or acceleration of axial growth was found in the eyes implanted with IOLs compared with normal eyes. A myopic shift was seen particularly in eyes operated on at 4-8 weeks of age and it is recommended that these eyes are made 6 D hypermetropic initially with the residual refractive error being corrected with spectacles.

Cataract↗
PubMed1998

A model of the contribution of oculomotor and optical factors to emmetropization and myopia.

The purpose of this work was to investigate quantitatively the interactions between accommodation, vergence and a mechanism of emmetropization driven by optical blur within the retinal image with a view to developing a model that provides an explanation of both normal emmetropization and near-work associated myopia. The simulations of the change in the refractive state of the eye over time that derive from this model indicate that optical regulation of eye growth can result in emmetropization, i.e. a progressive reduction in refractive errors over time leading towards emmetropia. This occurs when viewing conditions involve a preponderance of distance work. With increasing near work, the model predicts that the refraction of the eyes will converge towards myopia. In keeping with the previously reported associations of myopia with esophoria, poor accommodation function and high AC/A ratios, these conditions increase the amount of myopia produced under intensive near viewing conditions but do not lead to myopia during mainly distance viewing. This model provides quantitative validation of the hypothesis that the epidemiological association between myopia and increased nearwork may be caused by a disturbance of normal emmetropization by steady state errors of accommodation. The same model can explain normal emmetropization, increasing myopia with increasing nearwork demands and the currently recognised oculomotor associations that have been reported to precede the development of myopia.

Accommodation, Ocular↗
PubMed1997

Accommodation in binocular contour rivalry.

Although contour rivalry is known to suppress the contribution of the non-dominant eye to some visuomotor mechanisms such as the pupillary light reflex, there have been no reports of the impact of rivalry on accommodation control. In the situation where the accommodation demands in the two eyes are in dynamic conflict, it has been reported that the accommodation response can be modelled in terms of a vector average of the appropriate response in the two eyes. This study compared the binocular interactions in the accommodation system with rivalrous and non-rivalrous stimuli. Accommodation was continuously monitored with an infrared optometer, while the accommodation demand in the two eyes was dynamically modulated independently in the two eyes. When the visual target was perceptually rivalrous the previously described binocular interactions were abolished and the accommodation response closely followed the accommodation demand presented to the dominant eye.

Accommodation, Ocular↗
PubMed1995

Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a dedicated eye casualty.

Emergency care for eye complaints is provided both by accident and emergency (A&E) departments as well as by dedicated eye casualty departments. This study examines the role of each type of department and the quality of eye care provided. Significant differences were found between the accident and emergency department and the eye casualty department in the history, examination and management of eye patients. Most notably, there were significant differences in the quality of the assessment in the two institutions. Overall 19% (19/100) of A&E records had an inadequate history, compared with 2% (1/50) for eye casualty records. Fifty-nine per cent (59/100) of A&E records contained a significant examination omission, compared with only 8% (4/50) of eye casualty records. Most of the omissions related to a failure to perform an adequate, yet simple, ocular examination including failure to record visual acuity. In 44% (44-100) of A&E cases visual acuity was not recorded or recorded incorrectly. In comparison acuity omissions in eye casualty were present in only 4% (2/50) of cases.

Adult↗
PubMed1992

Binocular interactions in accommodation control: effects of anisometropic stimuli.

In binocular viewing of real targets, the accommodative demand in the two eyes is not in general identical, yet the accommodation response in the two eyes is equal. In order to investigate how the accommodative signals from the two eyes are combined, this study has examined the effects of several forms of dynamic anisometropic stimulation on the accommodation response in both man and the rhesus monkey (Macaca mulatta). All experiments were performed in a computer-controlled haploscopic apparatus to allow independent control of the accommodative stimuli to the two eyes and of the vergence stimulus. The vergence stimulus was held constant while the accommodation demand was modulated independently in each eye. Accommodation was monitored continuously with a dynamic infrared optometer. Four anisometropic conditions were used. In two of these conditions, accommodation demand was varied sinusoidally with time in both eyes, but with phases differing by 90 degrees or 180 degrees between the two eyes. In the two remaining conditions, accommodation demand in one eye varied sinusoidally, while the accommodation demand was constant in the other. In all cases, the form of the target pattern was identified in the two eyes. The accommodation responses observed with these stimulus conditions were similar in both man and the monkey. When presented with conflicting stimuli in the two eyes, the accommodation response appeared to be best described as a compromise between the inputs to the two eyes; there were no indications of a purely random alternation of eye dominance of the form seen in binocular contour rivalry. When the accommodation demand was modulated in only one eye, there was a modulated accommodation response of similar phase to the control condition (i.e., both eyes modulated in phase) but with a much smaller gain (mean, 39% of control gain). When the accommodation demand was modulated in both eyes with a phase difference of 180 degrees, no significant modulation was observed in the accommodation response at the stimulation frequency. When the interocular phase difference was 90 degrees, a modulated response was observed that showed a mean phase lag 41 degrees more than that observed in the control condition (both eyes modulated in phase) and an appreciably smaller gain (mean, 55% of control gain). The extent to which the results can be described by a linear vector average of the uniocular inputs is considered.

Accommodation, Ocular↗
PubMed1991

Accommodation and flicker: evidence of a role for temporal cues in accommodation control?

Static accommodation responses to sinusoidal grating stimuli that displayed temporal modulations in luminance contrast (i.e. contrast flicker) were measured with a laser speckle optometer. The effects of a variety of temporal waveforms were investigated including square-wave modulations, sinusoidal modulations, and band-pass filtered noise. The effects of altering both the amplitude and the temporal frequency (0.4-30 Hz) of the contrast flicker and the spatial frequency of the stimulus (0.77-9.2 c/deg) were also examined. All the flicker waveforms investigated (square wave, sinusoidal and band-pass noise) reduced accommodative accuracy, the effect being most apparent at lower spatial frequencies (0.77-1.15 c/deg). With band-pass filtered noise the effects of flicker were most apparent with frequencies in the range 1-4 Hz, at both lower (0.4 Hz) and higher flicker frequencies (8-32 Hz) accommodations was less affected. It was found that flicker impaired accommodation under conditions where the contrast was at all times suprathreshold. This is incompatible with the proposal that flicker reduces accommodation responses because for part of each flicker cycle the stimulus was below threshold. However, these results are compatible with the alternative hypothesis that flicker impairs the ability of the accommodation system to utilize temporal cues such as those derived from the higher frequency component (1-2 Hz) of accommodative oscillations.

Accommodation, Ocular↗
PubMed1990

A neural and computational model for the chromatic control of accommodation.

Accommodation is more accurate with polychromatic stimuli than with narrowband or monochromatic stimuli. The aim of this paper is to develop a computational model for how the visual system uses the extra information in polychromatic stimuli to increase the accuracy of accommodation responses. The proposed model is developed within the context of both trichromacy and also the organization of spatial and chromatic processing within the visual cortex. The refractive error present in the retinal image can be estimated by comparing image quality with and without small additional changes in refractive state. In polychromatic light, the chromatic aberration of the eye results in differences in ocular refractive power for light of different wavelengths. As a result, the refractive state of the eye can be estimated by comparing image quality in the three types of cone photoreceptor. The ability of cortical neurons to perform such comparisons on image quality with a crude form of spatial-frequency analysis is examined theoretically. It is found that spatially band-pass chromatically opponent neurons (that may correspond to double opponent neurons) can perform such calculations and that chromatic cues to accommodation are extracted most effectively by neurons responding to spatial frequencies of between 2 and 8 cycles/deg.

Accommodation, Ocular↗
PubMed1989

The interactions between chromatic aberration, defocus and stimulus chromaticity: implications for visual physiology and colorimetry.

It has long been recognised that chromatic aberration can introduce luminance artifacts into nominally isoluminant colour stimuli. In this study the effects of chromatic aberration (along with those of defocus and stimulus spatial frequency) on the chromaticity of the retinal image are considered. Such optical effects have important methodological and functional implications for visual physiology. The "Silent Substitution" principle is a fundamental feature of modern colorimetry, being employed in both psychophysical and electrophysiological approaches to the visual system. The theoretical colour spaces introduced by MacLeod and Boynton (1979) and Derrington et al. (1984) are also ultimately based on this principle. All such applications of the silent substitution principle are sensitive to the optical effects of chromatic aberration, defocus, spatial frequency and stimulus chromaticity. The spatial acuity of the mechanisms of colour vision are appreciably lower than those of the luminance system (Mullen, 1985). In addition chromatic aberration has been shown to be a cue to ocular accommodation (Fincham, 1951). The analysis presented in this study suggests a possible explanation for these findings in terms of the ecological and computational constraints placed on the visual system by chromatic aberration.

Color Perception↗
PubMed1988

Effects of temporal frequency on the contrast sensitivity of the human accommodation system.

Contrast thresholds were determined for the initiation of accommodative responses to drifting sine-wave stimuli (4.1 c/deg) over a range of temporal frequencies (0-14.0 Hz). Accommodation was monitored with a dynamic infrared optometer. Psychophysical detection thresholds were also determined for the same stimuli. A comparison of the contrast thresholds for detection with those for the initiation of accommodation indicates that these two tasks are mediated by mechanisms of comparable sensitivity. Examination of the effects of temporal frequency on the contrast sensitivity of these two visual tasks reveals modest differences in the tuning properties of the underlying sensory mechanisms. Transient mechanisms tuned to intermediate temporal frequencies appear to have a greater role in the initiation of accommodative responses to grating stimuli than in the detection of such stimuli.

Accommodation, Ocular↗