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K J Ciuffreda

Publications and source records attributed to K J Ciuffreda.

At least 19 recordsLinked to original sources
PubMed2005

Elevated dark adaptation thresholds in traumatic brain injury.

PRIMARY OBJECTIVE: To expand upon earlier findings of elevated dark adaptation (scotopic) thresholds in photosensitive individuals with traumatic brain injury (TBI). METHODS AND PROCEDURES: To assess scotopic thresholds in individuals with TBI (n = 17) manifesting varying degrees of photosensitivity (mild, moderate or marked), but without retinal dysfunction, to those of non-photosensitive, visually-normal individuals (n = 21) using a hand-held dark adaptometer. MAIN OUTCOMES AND RESULTS: The group mean scotopic threshold for the TBI group was significantly higher than that of the visually-normal group. Over 50% (nine out of 17) of the TBI group exhibited elevated thresholds. There was no correlation between the threshold value and degree of photosensitivity. CONCLUSION: The elevated scotopic thresholds suggest an abnormality in cortical gain control. An anomalous adaptive response may develop due to cortical damage, thereby attenuating subjective light sensation.

Adult↗
PubMed2000

A unifying theory of refractive error development.

While retinal defocus is believed to be myopigenic in nature, the underlying mechanism has remained elusive. We recently constructed a theory of refractive error development to investigate its fundamental properties. Our Incremental Retinal-Defocus Theory is based on the principle that the change in retinal-defocus magnitude during an increment of genetically-programmed ocular growth provides the requisite sign for the appropriate alteration in subsequent environmentally-induced ocular growth. This theory was tested under five experimental conditions: lenses, diffusers, occlusion, crystalline lens removal, and prolonged nearwork. Predictions of the theory were consistent with previous animal and human experimental findings. In addition, simulations using a MATLAB/SIMULINK model supported our theory by demonstrating quantitatively the appropriate directional changes in ocular growth rate. Thus, our Incremental Retinal-Defocus Theory provides a simple and logical unifying concept underlying the mechanism for the development of refractive error.

Computer Simulation↗
PubMed2000

Accommodative and vergence findings in ocular myasthenia: a case analysis.

Myasthenia gravis (MG) is a neuromuscular disorder that affects skeletal muscles, in particular, the extraocular muscles. Response variability is a hallmark sign. Detailed findings are described in a patient with MG in which the presenting sign was accommodative insufficiency. Objective accommodative findings were recorded 3 years before the onset of myasthenia, soon after the initial diagnosis was made, and then after the treatment commenced with pyridostigmine. In addition, clinical measurements were obtained periodically at different times of the day for various binocular motor functions, including near point of convergence, phoria, fusional and accommodative amplitudes, and relative accommodation. The disease adversely affected all accommodative and vergence findings, with fatigue being the primary disturbance. The therapeutic administration of pyridostigmine improved static measurements of accommodation and vergence and reduced asthenopia. The objective dynamic measurements of accommodation, vergence, and versions were less affected. These findings provide a clear demonstration that both intrinsic and extrinsic ocular muscles may be affected in the prepresbyopic myasthenic patient.

Accommodation, Ocular↗
PubMed2000

Quantitative analysis of the effect of near lens addition on accommodation and myopigenesis.

PURPOSE: To develop a quantitative, objective, and scientific basis for understanding the effects of applying near bifocal additions (ADDs) on oculomotor control and myopia development. This is important because myopia is a major public health problem that affects 25% of the U.S. population and 75% or more in Asian countries. It is also associated with an increased risk for vision-threatening conditions, such as retinal breaks and detachments, as well as glaucoma. METHODS: A comprehensive model of refractive error development was constructed based on a dual-interactive feedback model of accommodation and vergence, which represented the short-term dynamics pathway, with the addition of both genetic and environmental (defocus-induced axial growth) components in a long-term pathway. An alternating near- and far-viewing paradigm was simulated, with varying amounts of ADDs, to obtain a parametric relationship between the root mean square of accommodative error (AE) and the induced refractive error (IRE). The parametric relationship provided the crucial linkage between the long-term growth pathway and the conventional short-term dynamics pathway. ADD is the simulated lens placed before the eyes only during near viewing, whereas IRE is the simulated lens fixed before the eyes that represents the optical effect of slowly progressive refractive development caused by near work. RESULTS: A V-shaped functional relationship was found between AE and IRE. The left half of the curve is associated with hyperopic defocus and myopigenesis, whereas the right half is associated with myopic defocus and hyperogenesis. Introduction of an ADD shifts the V-shaped curve horizontally. Thus, an "optimal" ADD can be used to shift the minimum of the accommodative error curve to the zero IRE point, and thereby reduce or eliminate retinal defocus and its potential towards myopigenesis. On the other hand, sensitivity analysis of model parameters shows that increasing the accommodative convergence crosslink gain (AC) shifts the curve to the right and results in a tendency towards myopigenesis, which is consistent with clinical findings in progressive myopia. CONCLUSIONS: The model can be used to specify the precise ADD needed for an individual to retard or eliminate retinal defocus-induced myopic progression. If future experiments show that using the "optimal" ADD results in the greatest benefit (i.e., least myopia progression), there will be considerable worldwide public health benefit.

Accommodation, Ocular↗
PubMed1999

Adaptation model of nearwork-induced transient myopia.

A nearwork model was developed to determine whether variation in accommodative adaptation gain, KA, can account for the differences in the dynamic decay timecourse following near work in hyperopes (HYP), emmetropes (EMM), early-onset myopes (EOM), and late-onset myopes (LOM). The model incorporated a proximal component into a previously-developed adaptation model of accommodation and vergence. It was used to simulate the nearwork-induced transient myopia (NITM) response following 10 min of congruent binocular near viewing (5 D, 5 MA). The accommodative adaptation gain, KA, value was varied from 1.0 to 6.0 in increments of 0.5. For the hyperopes, an additional constraint was imposed wherein the accommodative response was biased on the under-accommodated side of the deadspace operator (i.e., depth-of-focus). In addition, the effect of prolonged nearwork was simulated by alternating between 1 hr of congruent near viewing (3 D, 3 MA) and 5 min of congruent far viewing (0.25 D, 0.25 MA) over a 160 hr period representing one work-month with 40 hours of nearwork per week. The steady-state rms value of the accommodative error was measured as a function of KA. It was found that the NITM timecourses for HYP, EMM, EOM, and LOM could be simulated accurately using KA values of 2.0, 2.5, 4.0 and 5.5, respectively. The long-term final steady-state rms of the accommodative error was found to increase from 0.182 D to 0.188 D as KA increased from 1 to 6. This indicated a small and progressive increase in residual accommodative error for higher KA values, which was associated with EOM and LOM. Thus, NITM for the different refractive groups could be quantified by the accommodative adaptation gain element, with KA for the HYP, EMM, and EOM and LOM groups having lower, intermediate, and higher values, respectively. The larger rms for higher KA values suggests that a myopic individual may have a predisposition to exhibit a slightly larger long-term accommodative error, which may stimulate axial elongation and in turn promote the progression of axial myopia.

Accommodation, Ocular↗
PubMed1999

Model of human refractive error development.

PURPOSE: To construct a model of refractive error development that can account for the different interactive mechanisms and time courses of refractive error in the hyperope (HYP), emmetrope (EMM), early-onset myope (EOM), and late-onset myope (LOM) over the first 30 years of life. METHODS: First, a baseline short-term (1 mo.) simulation of a previously developed nearwork-induced transient myopia (NITM) model was performed under both far- and near-viewing paradigms to obtain the critical relationships between AErms and refractive error for the four refractive groups. Then, two control pathways were added to the NITM model. The genetically-controlled pathway was associated with the long-term growth of the cornea, lens, and the eyeball. The environmentally-controlled pathway was associated with retinal-defocus during nearwork, wherein the root mean square (rms) of the accommodative error (AE) above a threshold level resulted in an increase in axial length of the eyeball. The thresholds for defocus-induced axial length change were empirically determined to correspond to the differential susceptibility in the four refractive groups. The combination of effects from the two pathways produced the overall refractive error. The relationship between AErms and refractive error was combined with the two control pathways for the long-term simulations (30 yrs: the initial 15 yrs using a far-viewing paradigm followed by an additional 15 yrs using a near-viewing paradigm) to quantify refractive error development as related to daily nearwork activity in the four refractive groups. RESULTS: All refractive groups began early in life with a genetically-determined hyperopic refractive error. The HYP had the lowest susceptibility or highest threshold to retinal defocus effects, and remained at a hyperopic level. The EMM exhibited a relative myopic shift in the first 2 years to become and remain at emmetropia. In the myopic groups, the EOM exhibited both a genetically-controlled component (starting 2 years of age) and a defocus-induced component (starting at 15 years of age), whereas the LOM manifested only a defocus-induced factor (starting at 15 years of age) in the development of myopia. In addition, simulations indicated that emmetropization occurred only for "induced" refractive error that was less than 0.5 D, which was consistent with the non-monotonic relationship between AErms and refractive error, wherein the minimum AErms occurred at 0.5 D. CONCLUSIONS: The model showed that both genetic and defocus-induced environmental factors play important roles in the development of refractive error in the different refractive groups. The model also provides a framework for further detailed quantitative analysis of the processes of refractive error development and emmetropization.

Accommodation, Ocular↗
PubMed1998

Static aspects of accommodation: age and presbyopia.

Although the progressive reduction in accommodative amplitude with increased age is well documented, little is known about several other aspects of static or steady-state accommodation to provide a comprehensive assessment of changes related to age and presbyopia. Static components of accommodation (tonic accommodation, depth-of-focus, slope of the stimulus/response function, and accommodative controller gain) were assessed objectively using an infrared (IR) optometer in 30 human subjects aged 21-50 years; depth-of-focus was also determined psychophysically as was accommodative amplitude. Tonic accommodation and the amplitude of accommodation decreased with increased age, whereas the subjective depth-of-focus increased; the other parameters remained unchanged. The decrease in tonic accommodation and amplitude of accommodation was attributed to biomechanical factors, whereas the increase in subjective depth-of-focus was believed to result from increased tolerance to defocus related to the gradual onset of presbyopia. Constancy of the objective depth-of-focus suggested absence of age effects on the neurologic control of reflex accommodation, whereas the lack of systematic change in slope and controller gain provided support for the Hess-Gullstrand theory of accommodation and presbyopia.

Accommodation, Ocular↗
PubMed1998

Dynamic asymmetries in disparity convergence eye movements.

Vergence eye movements have traditionally been considered the product of a single neural control center and are usually studied by combining the movements of each eye into a single 'vergence' response. In the present experiment, disparity-driven eye movements were produced by symmetrical step stimuli, and the dynamic properties of each eye movement were analyzed separately. Although the final positions of the two eyes were symmetrical, large dynamic asymmetries often occurred. The timing between the two eyes showed fair synchrony as they attained maximum velocity at approximately the same time. Since the final static positions were symmetrical, asymmetries occurring during the initial dynamic component must necessarily be compensated by offsetting asymmetries in the latter portion of the response.

Adult↗
PubMed1998

Vision therapy to reduce abnormal nearwork-induced transient myopia.

After brief periods of nearwork, some younger patients complain of transient distance blur that is correlated with a transient pseudomyopic shift in their distance refraction. This phenomenon has recently been documented objectively. However, there is lack of objective documentation demonstrating the effects of conventional optometric vision therapy in symptomatic individuals manifesting this "abnormal nearwork-induced transient myopia" (ANITM). Five symptomatic subjects received 7 to 10 weeks (5 to 6 sessions) of accommodative facility vision therapy (i.e., lens flippers and Hart chart). Objective recording of their ANITM and its decay were taken before and after the vision therapy, using a Canon R-1 autorefractor. A daily log was maintained, describing qualitatively their nearwork-related symptomatology. After therapy, there was marked reduction of symptoms and considerable improvement in clinical accommodative facility measures, as well as improvement in the objective findings. These results demonstrate multi-faceted positive effects of optometric accommodative vision therapy in this diagnostic group of symptomatic individuals.

Accommodation, Ocular↗
PubMed1998

Initial component control in disparity vergence: a model-based study.

The dual-mode theory for the control of disparity-vergence eye movements states that two components control the response to a step change in disparity. The initial component uses a motor preprogram to drive the eyes to an approximate final position. This initial component is followed by activation of a late component operating under visual feedback control that reduces residual disparity to within fusional limits. A quantitative model based on a pulse-step controller, similar to that postulated for saccadic eye movements, has been developed to represent the initial component. This model, an adaptation of one developed by Zee et al. [1], provides accurate simulations of isolated initial component movements and is compatible with the known underlying neurophysiology and existing neurophysiological data. The model has been employed to investigate the difference in dynamics between convergent and divergent movements. Results indicate that the pulse-control component active in convergence is reduced or absent from the control signals of divergence movements. This suggests somewhat different control structures of convergence versus divergence, and is consistent with other directional asymmetries seen in horizontal vergence.

Adult↗
PubMed1998

Myopes show increased susceptibility to nearwork aftereffects.

PURPOSE: Some aspects of accommodation may be slightly abnormal (or different) in myopes, compared with accommodation in emmetropes and hyperopes. For example, the initial magnitude of accommodative adaptation in the dark after nearwork is greatest in myopes. However, the critical test is to assess this initial accommodative aftereffect and its subsequent decay in the light under more natural viewing conditions with blur-related visual feedback present, if a possible link between this phenomenon and clinical myopia is to be considered. METHODS: Subjects consisted of adult late- (n = 11) and early-onset (n = 13) myopes, emmetropes (n = 11), and hyperopes (n = 9). The distance-refractive state was assessed objectively using an autorefractor immediately before and after a 10-minute binocular near task at 20 cm (5 diopters [D]). RESULTS: Group results showed that myopes were most susceptible to the nearwork aftereffect. It averaged 0.35 D in initial magnitude, with considerably faster posttask decay to baseline in the early-onset (35 seconds) versus late-onset (63 seconds) myopes. There was no myopic aftereffect in the remaining two refractive groups. CONCLUSIONS: The myopes showed particularly striking accommodatively related nearwork aftereffect susceptibility. As has been speculated and found by many others, transient pseudomyopia may cause or be a precursor to permanent myopia or myopic progression. Time-integrated increased retinal defocus causing axial elongation is proposed as a possible mechanism.

Accommodation, Ocular↗
PubMed1997

Convergence and divergence exhibit different response characteristics to symmetric stimuli.

The dynamic characteristics of horizontal convergence and divergence eye movement responses to symmetric stimuli were examined. Binocular eye movements were recorded in five, visually normal adult subjects using the infrared reflection technique for symmetric convergent and divergent blur-free, disparity-only, step stimuli of 2, 4, 8, 12, and 16 deg. The main sequence as well as other temporal parameters including latency, time-to-peak velocity, time constant, and total duration were analyzed. A number of fundamental differences in the response characteristics were found between convergence and divergence. First, the slope of the peak velocity vs amplitude curve was approximately twice as high for convergence than divergence. The results are consistent with neurophysiological findings in monkeys and most findings in humans. Second, the initial fast component for convergence exhibited a larger amplitude than for divergence. This may reflect differences in central neural gain for convergence and divergence. And, third, all temporally related components were shorter for convergence than divergence. These findings provide an overall framework for vergence control and suggest fundamental differences in neural processing delays and neural controller pathways for convergence and divergence.

Adult↗
PubMed1997

Irlen lenses do not improve accommodative accuracy at near.

The purpose of the experiment was to determine the influence of Irlen lenses on steady-state accommodation in successful users, as there is speculation that near accommodative dysfunction may be a factor in these patients. Monocular steady-state accommodation in six successful Irlen patients was assessed for near blur stimuli (2, 3, and 4 D) either with nonfiltered spectacle refractive correction or their spectrally broad-band filtered spectacle refractive correction. Accommodation was measured subjectively using a Hartinger coincidence optometer. There was no significant difference in mean level of accommodation between the two conditions. Additionally, there was a small but significant increase in accommodative variability with the filtered prescription. The use of Irlen correction did not have any positive effect on monocular steady-state accommodation at near.

Accommodation, Ocular↗
PubMed1997

The AC/A ratio, age and presbyopia.

Previous reports concerning the effect of age on the AC/A ratio have been equivocal. Therefore, the present study investigated both the stimulus (AC/As) and response (AC/Ar) ratios using a subjective haploscope-optometer in a relatively large sample of subjects (n = 42) over a wide range of ages (22-65 years). The AC/As showed a small but significant decrease with age (approximately 0.04 delta/D/year). When the older subjects (> 45 years of age) were excluded, however, there was no systematic age effect. The AC/Ar exhibited a small but significant increase with age (approximately 0.08 delta/D/year) for subjects under 45 years of age. However, when the older pre-presbyopes and younger presbyopes (35-44 years of age) were excluded, there was no systematic age effect. In subjects 45 years of age and older, the AC/Ar could not be reliably assessed. This was attributed to physiological and instrumentation noise as a result of the minimal change in accommodative response. In the mid-aged subjects (35-44 years of age), the apparent increase in AC/Ar with age was speculated to be due to neural adaptation of the crosslink gain from the accommodative to the vergence system and/or slight intrusion into the upper non-linear response region of accommodation with the measurements. The finding of AC/Ar constancy with age when mid-aged pre-presbyopes and early presbyopes were excluded supports the non-linearity hypothesis, and thus there appears to be no real change in AC/Ar with increased age. The results support the Hess-Gullstrand theory of presbyopia.

Accommodation, Ocular↗
PubMed1996

Proximal contribution to a linear static model of accommodation and vergence.

To determine the influence of target proximity on accommodation and vergence under both open- (OL) and closed-loop (CL) viewing conditions, a static interactive feedback model, which included proximal accommodation (PA) and proximal vergence (PV) inputs, was developed and analysed quantitatively. It was based on an earlier static dual-interactive feedback model of accommodation and vergence. The proximal inputs were added to both the accommodative and vergence loops at the output of the respective controllers. The values of the PA and PV gains were obtained from experimental dual-OL data. The model equations were analysed over a stimulus range of 1 to 6 D (or MA). It was found that under the dual-OL condition, the contribution of PA to the overall accommodative output ranged from 42.5 to 81.6%, whereas the contribution of PV to the overall vergence output ranged from 56.1 to 88.5%. In contrast, under all other stimulus conditions, with the exception of the PA contribution to the accommodative output under the Aol, Vcl condition (26.5-41.0%), the relative contributions were much smaller, ranging from 0.04 to approximately 7.0%. In particular, under the dual-CL condition, representing the normal binocular visual feedback condition, the relative contributions were only 4.0 and 0.04% for PA and PV, respectively. Thus, although the relative contributions of PA and PV were large under the dual-OL condition, they were generally very small under the various CL conditions that simulated more naturalistic viewing situations. Nevertheless, proximity may still play an important role by providing cues for attaining coordinated and harmonious motor responses under specific viewing conditions.

Accommodation, Ocular↗
PubMed1995

Nearwork-induced transient myopia: a critical review.

The literature on nearwork-induced transient myopia (NITM) is reviewed, with NITM being defined as the short-term myopic far point shift immediately following a sustained near visual task. A majority of these investigations demonstrated the presence of NITM for a variety of test parameters, e.g., visual acuity, contrast sensitivity and far point. Overall, these studies reported relatively small myopic shifts, with a mean of approximately 0.40 D and a range from 0.12 to 1.30 D. The subsequent decay is characterized by an exponential function with a relatively short time course. While the precise etiology and implications of NITM remain unclear, speculations regarding its origin and relevance to clinical myopia are discussed. Studies that did not demonstrate NITM are also reviewed.

Accommodation, Ocular↗
PubMed1995

Vergence adaptation and the order of clinical vergence range testing.

When measuring horizontal relative vergence ranges, the conventional clinical procedure is to assess the base-in (or divergence) range before the base-out (or convergence) determination. The rationale for this order of testing is that the convergence responses stimulated during the base-out measurements may produce vergence adaptation (i.e., a fusional aftereffect), which may temporarily bias the subsequent base-in values in the base-out direction. However, the effect of reversing this order of testing (i.e, base-out before base-in) has not been directly evaluated. Accordingly, the present study compared distance base-in vergence ranges measured both before and after base-out testing at separate test sessions. Additionally, tonic vergence (TV) was assessed before and after each vergence range measurement. The results indicated that base-out vergence range testing stimulated vergence adaptation, and furthermore produced a statistically significant reduction in the subsequently measured base-in recovery value. However, the magnitude of this shift was less than the estimated degree of repeatability of the vergence range measurement. Therefore, a more appropriate order of testing would be to assess the heterophoria compensating range first in order to obtain accurate results during this more critical measurement.

Adaptation, Ocular↗