Biomedical subjects

R A Applegate

Publications and source records attributed to R A Applegate.

At least 19 recordsLinked to original sources

PubMed1999

Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis.

PURPOSE: To compare changes in the corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. METHODS: In a prospective randomized study, 22 patients with bilateral myopia received photorefractive keratectomy on one eye and laser in situ keratomileusis on the other eye. The procedure assigned to each eye and the sequence of surgery for each patient were randomized. Corneal topography measurements were performed preoperatively, 2 and 6 weeks, 3, 6, and 12 months after surgery. The data were used to calculate the wavefront aberrations of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: Both photorefractive keratectomy and laser in situ keratomileusis significantly increased the total wavefront aberrations for 3- and 7-mm pupils, and values did not return to the preoperative level throughout the 12-month follow-up period. For a 3-mm pupil, there was no statistically significant difference between photorefractive keratectomy and laser in situ keratomileusis at any postoperative point. For a 7-mm pupil, the post-laser in situ keratomileusis eyes exhibited significantly larger total aberrations than the post-photorefractive keratectomy eyes, where a significant intergroup difference was observed for spherical-like aberration, but not for coma-like aberration. This discrepancy seemed to be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure. Before surgery, simulated pupillary dilation from 3 to 7 mm caused a five- to six-fold increase in the total aberrations. After surgery, the same dilation resulted in a 25- to 32-fold increase in the photorefractive keratectomy group and a 28- to 46-fold increase in the laser in situ keratomileusis group. For a 3-mm pupil, the proportion of coma-like aberration increased after both photorefractive keratectomy and laser in situ keratomileusis. For a 7-mm pupil, coma-like aberration was dominant before surgery, but spherical-like aberration became dominant postoperatively. CONCLUSIONS: Both photorefractive keratectomy and laser in situ keratomileusis increase the wavefront aberrations of the cornea and change the relative contribution of coma- and spherical-like aberrations. For a large pupil, laser in situ keratomileusis induces more spherical aberrations than photorefractive keratectomy. This finding could be attributable to the smaller transition zone of the laser ablation in the laser in situ keratomileusis procedure.

Adult↗

PubMed1999

Accuracy of the tomey topographic modeling system in measuring surface elevations of asymmetric objects.

BACKGROUND: Most studies have assessed the accuracy of videokeratographic systems using spheres, ellipsoids, or toric surfaces. Most human corneas are asymmetric to some degree and many pathological corneas are markedly asymmetric. To date, little work has been done to ascertain the accuracy of videokeratographic systems for measuring the shape of asymmetric objects. PURPOSE: The purpose of this study is to determine the accuracy with which the Tomey Topographic Modeling System can evaluate the topography of asymmetric surfaces. METHODS: Calibrated ellipsoidal test objects were tilted with respect to the videokeratometric axis to create asymmetric test surfaces with known characteristics. RESULTS: Root mean squared error of all the measured surface elevations varied from 0.7 microm to 11.3 microm. Although there was a trend for greater error with the more asymmetric surfaces, the trend was not statistically significant. Accuracy was not dependent on apical radius. Measurement error increased toward the periphery. CONCLUSIONS: For the Tomey Topographic Modeling System, the accuracy in measurement of smooth, asymmetric surfaces is comparable the accuracy in measurement of symmetric surfaces.

Cornea↗

PubMed1999

Entoptic foveal avascular zone measurement and diabetic retinopathy.

BACKGROUND: Entoptic visualization of the foveal avascular zone (FAZ) provides a noninvasive method for measurement of the FAZ. To determine if repeatability of measurement with this technique is good enough to monitor changes in diabetic retinopathy, we quantify (1) the repeatability of entoptic FAZ measurement in healthy subjects and (2) the relationship between measured FAZ diameter and the severity of retinopathy. METHODS: (1) To determine FAZ measurement repeatability, 10 healthy adults entoptically measured their FAZ diameters in 11 separate testing sessions. (2) In a separate experiment, 53 patients with varying levels of diabetic retinopathy and 21 control subjects used a vascular entoptoscope to measure their FAZ diameters. RESULTS: The disease-related increase in FAZ diameter is large (approximately 400 microm) compared to the repeatability of the entoptic measurement within a subject (SD approximately 35 microm). CONCLUSION: Entoptic measurements have the repeatability necessary to reliably monitor increases in FAZ diameter of the magnitude of those induced by diabetes.

Adult↗

PubMed1999

Changes in corneal wavefront aberrations with aging.

PURPOSE: To investigate whether corneal wavefront aberrations vary with aging. METHODS: One hundred two eyes of 102 normal subjects were evaluated with videokeratography. The data were decomposed using Taylor and Zernike polynomials to calculate the monochromatic aberrations of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: For a 3-mm pupil, the amount of total aberrations (Spearman rank correlation coefficient r(s) = 0.145; P = 0.103) and spherical-like aberrations (r(s) = -0.068; P = 0.448) did not change with aging, whereas comalike aberrations exhibited a weak but statistically significant correlation with age (r(s) = 0.256; P = 0.004). For a 7-mm pupil, total aberrations (r(s) = 0.552; P < 0.001) and comalike aberrations (r(s) = 0.561; P < 0.001) significantly increased with aging, but spherical-like aberrations showed no age-related changes (r(s) = 0.124; P = 0.166). Simulated pupillary dilation from 3 mm to 7 mm caused a 38.0+/-28.5-fold increase in the total aberrations, and the extent of increases significantly correlated with age (r(s) = 0.354; P < 0.001). Pupillary dilation influenced the comalike aberrations more in the older subjects than in the younger subjects (r(s) = 0.243; P = 0.006), but such age dependence was not found for spherical-like aberrations (r(s) = 0.141; P = 0.115). CONCLUSIONS: Comalike aberrations of the cornea correlate with age, implying that the corneas become less symmetrical along with aging. Spherical-like aberrations do not vary significantly with aging. Pupillary dilation markedly increases wavefront aberrations, and those effects are more prominent in older subjects than in younger subjects.

Adolescent↗

PubMed1998

Effect of pupillary dilation on corneal optical aberrations after photorefractive keratectomy.

BACKGROUND: Complaints of glare, halos, and disturbances of night vision after photorefractive keratectomy (PRK) probably result from changes in the corneal aberration structure induced by the laser ablation procedure. The purpose of this article is to characterize changes in the corneal aberration structure after PRK and to demonstrate the effect of pupil dilation on these changes. METHODS: Videokeratographs obtained preoperatively (n = 112) and at 1 (n = 94), 3 (n = 103), 6 (n = 91), 12 (n = 60), 18 (n = 53), and 24 (n = 44) months postoperatively from 112 eyes of 89 patients who had undergone PRK for myopia were analyzed. The data were used to calculate the wavefront variance of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS: For both the 3- and 7-mm pupil, coma-like aberrations increased significantly from preoperative values to 1-month postoperative values (P < .05 and P < .001, respectively); for 7-mm pupils, the postoperative values never returned to preoperative values (P < .001, 24 months). For the 3-mm pupil, spherical-like aberrations decreased significantly 1 month after surgery (P < .001), and never returned to preoperative values. For the 7-mm pupil, spherical-like aberrations increased significantly 1 month after surgery (P < .001) and did not return to preoperative values. Opening the pupil from 3 to 7 mm increased spherical-like aberrations only 7-fold before PRK. After PRK, however, pupillary dilation caused a 300-fold increase in this type of aberration. For both pupil sizes at all times after PRK, the magnitude of the surgically induced aberration correlated with the amount of the attempted correction (P < .001, r2 = 0.6 at 1 month for a 7-mm pupil). CONCLUSIONS: Photorefractive keratectomy increases the wavefront variance of the cornea; PRK changes the relative contribution of coma-like and spherical-like aberrations; after PRK, the diameter of the entrance pupil greatly affects the amount and character of the aberrations; and the magnitude of the aberration increases with the attempted correction. CLINICAL RELEVANCE: Quantitative characterization of irregular astigmatism with the measurement of aberration structures following corneal surgery and the correlation of these data with visual performance in clinical trials provide the basis for understanding patient complaints and for improving surgical approaches. Our analysis shows that, whereas induced aberrations are minimal for simulated day-time vision (3-mm pupil), the increase in aberrations measured for simulated night vision (7-mm pupil) supports the use of large treatment zones to reduce visual disturbances such as glare and halos.

Adult↗

PubMed1998

Assessment of the accuracy of the crossed-cylinder aberroscope technique.

Simulations of the optics of the Howland crossed-cylinder aberroscope technique show that errors in alignment, data collection, and analysis can lead to unexpected asymmetries of the determined aberrations in a rotationally symmetric system. In particular, coma can be incorrectly indicated. The magnitude of the error in aberration measurement depends on the magnitude of the alignment, data collection, and alignment errors. These findings indicate that the tolerances for setting up the technique and data collection should be analyzed thoroughly before quantitative significance is given to the determined aberration coefficients.

Computer Simulation↗

PubMed1997

Mathematical model of a Placido disk keratometer and its implications for recovery of corneal topography.

The purpose of this paper is to illustrate the importance of radial contours in the target pattern of a Placido disk keratometer. We do so by presenting an example of a corneal surface which cannot be determined solely by the use of Placido ring images, but rather which requires radial contours for its determination. In order to prove our assertions, we derive partial differential equations (called the corneal transform), which relate the ring targets to their images.

Cornea↗

PubMed1997

Entoptic evaluation of diabetic retinopathy.

PURPOSE: Studies using optimized entoptic viewing of the parafoveal retinal vasculature have shown that normal subjects see their own capillaries with greater detail in the fovea than seen typically in fluorescein angiography. The authors have extended these investigations to persons with diabetes to evaluate the sensitivity, specificity, and accuracy with which they can detect and locate their own parafoveal retinal defects untrained. METHODS: A vascular entoptoscope using Maxwellian view optics creates a high-contrast entoptic view of retinal vasculature abnormalities in the parafoveal area. Using a double-masked protocol, 70 patients with diabetes and 29 control subjects described, drew, and quantified their entoptic image. These entoptic records were compared to angiograms and color photographs obtained immediately after the entoptic evaluation. RESULTS: Angiograms or color photographs or both showed that 61 of 70 patients with diabetes had retinal defects (e.g., microaneurysms or exudates or both) within the field of view of the Vascular Entoptoscope (8.1 degrees or 11.6 degrees circular field depending on the Vascular Entoptoscope used: parafoveal area subtends approximately 9.7 degrees). Of these 61 patients with diabetes, 51% (31) observed dark "spots" or "blobs" in the entoptic field corresponding to retinal defects in the angiograms or photographs or both. Seven (18%) of the 38 patients (9 patients with diabetes and 29 control subjects without defects in the entoptic field) said they saw something when angiograms or photographs or both showed nothing (false-positive). Thus, the sensitivity and specificity (using angiograms or photographs or both as the gold standard) with which untrained patients with diabetes detect their own parafoveal area defects are 51% and 82%, respectively. Superimposition of the entoptic image (as drawn by the patient) and the angiograms or color photography or both often showed excellent correspondence. Most (22 of 29) of the control subjects and more than half (40 of 70) the patients with diabetes were able to quantify the size of their foveal avascular zone (FAZ) from the entoptic view, whereas only 22 of 70 of the capillary loops defining the FAZ were visible in the optimal frame of the capillary phase of the fluorescein angiogram. As reported previously in a smaller sample, large FAZs often were associated with poor visual acuity. CONCLUSIONS: More than half the untrained patients with diabetes were able to visualize their own parafoveal retinopathy entoptically, and most untrained patients with diabetes and control subjects where able to quantify the size of their FAZ. Patients and control subjects without parafoveal defects rarely report defects not visible photographically. Patients can be trained to detect their defects. Clinical entoptic monitoring will require verification that patients can detect changes in their retinopathy. Entoptic testing is low cost, noninvasive, and can be performed as often as needed at no risk to the patient. It is, therefore, a promising research technique for subjective monitoring of the early natural history of parafoveal area disease processes.

Adolescent↗

PubMed1996

Corneal aberrations increase with the magnitude of radial keratotomy refractive correction.

BACKGROUND: Refractive surgery induces optically abrupt changes in shape in the midperiphery of the cornea. The abruptness of this change is in part dependent on the magnitude of the surgically induced refractive change. Therefore, the optical aberrations of the cornea, as quantified by wavefront variance (WFV), may be expected to increase as the surgically induced change in the refraction increases. PURPOSE: It is the purpose of this study to test the hypothesis that as the surgery-induced change in refraction increases, so does the WFV of the cornea. METHODS: Fourteen radial keratotomy (RK) patients and seven normal patients served as subjects. Measurements were made before and 2 years after RK surgery. To quantify the WFV of the cornea, we used corneal topography measurements to calculate the surgically induced change in corneal WFV with respect to two different reference surfaces, a sphere and the presurgical cornea. To quantify the surgically induced change in the equivalent spherical correction (ESC), cycloplegic refractions were performed. The measurements were summarized by regressing the surgically induced change in the WFV against the surgically induced change in the ESC. RESULTS: For large pupils (7 mm diameter), the correlation between the change in the WFV referenced to a sphere and the change in the ESC was significant (p < 0.0001, r2 = 0.745) and dominated by fourth order aberrations. Similar results were found for the surgical lens. For small pupils (3 mm diameter), the effects were markedly reduced. CONCLUSIONS: (1) As the magnitude of the surgically induced refractive change increases so does the WFV of the cornea, particularly for large pupils. (2) The increase in corneal WFV for large pupils is dominated by fourth order aberrations. (3) The increase in corneal WFV is consistent with reported decreases in visual function (contrast sensitivity and low contrast visual acuity), particularly for large pupil diameters in combination with large surgically induced changes in refractive error.

Cornea↗

PubMed1996

The crossed-cylinder aberroscope: an alternative method of calculation of the aberrations.

The distorted retinal grid image in the cross-cylinder aberroscope is conventionally analysed using a method based upon orthogonal polynomials. This method restricts the amount of data that can be extracted from the grid image and requires the real grid that is placed between the cross-cylinders to be pre-distorted, with the amount of pre-distortion depending upon the vertex distance. We present an alternative method based upon the minimization of least squares that does not have these restrictions and show that it gives essentially the same results as the original orthogonal polynomial method. Furthermore, the minimization of least squares method also provides a measure of 'goodness' of fit (e.g. the minimum of the sum of the squares of the deviations.

Humans↗

PubMed1995

Experimental verification of computational methods to calculate magnification in refractive surgery.

OBJECTIVE: To determine the correlation between measured and computed magnification caused by a change in the plane of correction from the spectacle plane to the corneal plane in myopic refractive surgery. METHODS: Fourteen patients who underwent radial keratotomy and five normal volunteers served as subjects. Anticipated relative magnification was computed and measured by means of a direct-comparison eikonometer. Measured values were correlated to the anticipated magnification effects determined by computation. RESULTS: Measured and computed magnifications were highly correlated (r = .891). CONCLUSIONS: Magnification induced by refractive surgery can increase visual acuity in excess of 1 line for myopic corrections or similarly decrease visual acuity for hyperopic corrections. Magnification effects can be modeled accurately by means of computational methods. When clinical studies are designed to evaluate refractive surgery, ignoring the effects of magnification is similar to saying that visual acuity can be measured with and without the aid of a magnifier and the results directly compared.

Computers↗

PubMed1995

How accurately can videokeratographic systems measure surface elevation?

INTRODUCTION: Surface topography, as opposed to dioptric topography, defines the corneal surface in simple terms without assumptions. Accordingly, it is important to know how well surface topography can be measured with current videokeratometric machines. PURPOSE: The purpose of this paper is to quantify the accuracy with which the TMS-1 Corneal Modeling System can measure the surface topography of calibrated spherical, elliptical, and bicurve surfaces. METHODS: The Computed Anatomy TMS-1 videokeratometer was used to measure three spherical, three elliptical, and two bicurve surfaces with known characteristics. Surface characteristics were either back-calculated from the dioptric files or directly obtained from the TMS-1 elevation file for each of 6400 points (256 points in each of 25 rings). The accuracy with which each method determined the true surface was quantified by calculating the root mean squared error (RMSE) of the 6400 measured surface elevations from the known surface elevation at each sampling point. RESULTS: (1) For spherical and elliptical surfaces, back-calculation of surface elevation from the dioptric file can be made with RMSE of 5 mu or less. (2) For spheres but not elliptical surfaces the TMS-1 elevation file defines the surface with RMSE 5 mu or less. (3) The surface area measured by placido-based videokeratometers varies with surface curvature. (4) RMSE in measured surface elevation increase as the distance from the videokeratometric axis increases. (5) For bicurves, the dioptric maps are smoothed by the TMS-1 over abrupt transitions and for large transitions never recover. Additionally, our back-calculation methods further smooth abrupt transitions, making the RMSE of the bicurve surface that is back-calculated from the dioptric file larger than the RMSE of the surface generated from the TMS-1 elevation file. CONCLUSIONS: Surface elevations can be back-calculated from dioptric files with RMSE of 5 microns or less for spheres and elliptical surfaces as long as there are no areas of abrupt transition. If areas of abrupt transition exist, the TMS-1 elevation file provides more accurate surface profile data.

Cornea↗

PubMed1993

Magnification and visual acuity in refractive surgery.

In comparisons of retinal image size within the same eye before and after refractive surgery, a change in the plane of correction from the spectacle to the cornea induces a change in retinal magnification. Comparing retinal image size between eyes of different individuals, a change in the plane of correction as well as the type of ametropia (axial or refractive) interacts to change the retinal magnification. Consequently, comparing acuity before and after refractive surgery without considering the effects of retinal magnification can be misleading. Magnification effects can be large, accounting for a visual acuity increase of 1 line or more. Here we model the magnification induced by refractive surgery in various reference eyes and discuss implications in the context of current clinical trials.

Humans↗

PubMed1993

Parametric representation of Stiles-Crawford functions: normal variation of peak location and directionality.

Evidence suggests that the psychophysically determined Stiles-Crawford effect of the first kind (SCE) reflects waveguide properties of human photoreceptors. The peak of the SCE data set is assumed to reflect the principal alignment tendencies, and the spread (e.g., rho value, the curvature or width at half-height) is assumed to reflect the directionality (i.e., interreceptor differences in alignment) of the population of photoreceptors being tested. As such, disruption of the normal SCE can be used and/or has been used (1) to document early natural history of retinal pathology involving the photoreceptors, (2) to provide a firm rationale for therapeutic intervention, and (3) to provide a method for monitoring therapies designed to alter the natural course of retinal-disease processes. We report large-sample norms for foveal SCE peak location and spread (horizontal peak location, nasal 0.51 +/- 0.72, horizontal rho value 0.047 +/- 0.013, vertical peak location, superior 0.20 +/- 0.64, vertical rho value 0.053 +/- 0.012), compare these norms with values determined in other laboratories, and discuss the various mathematical forms used for the empirical description of SCE data sets.

Adult↗

PubMed1993

Contrast sensitivity and disability glare in the middle years.

Spatial contrast sensitivity and disability glare were measured in a large sample (n = 90, 30 per decade) of middle-aged subjects, aged 21-50 years, who had clear media and were ophthalmologically normal. We found no significant differences in the contrast sensitivities as a function of age in the middle years for (1) gratings generated on a monitor; (2) interference gratings generated in the retinal plane; (3) gratings in the presence of glare; and (4) mesopic increment thresholds with and without glare. The large sample size provides sufficient statistical power (0.8) for one to conclude that contrast sensitivity, optical quality, and foveal neural sensitivity are unlikely to vary more than 0.1 log unit between the ages of 21 and 50 in ophthalmologically normal subjects with clear media.

Adult↗

PubMed1992

Set shot shooting performance and visual acuity in basketball.

Common sense suggests that decreasing visual acuity will have a negative effect on basketball shooting performance. To test the hypothesis that basketball shooting performance monotonically decreases with decreasing acuity, 19 subjects attempted 25 set shots from a fixed location at each of 5 different acuity levels: 6/6 or better and vision blurred (by optical defocus) to visual acuities of 6/12, 6/24, 6/48, and 6/75. Our results revealed a small but statistically nonsignificant decrease in shooting performance between the 6/6+ and 6/12 conditions. For visual acuities between 6/12 and 6/75, the number of baskets made remained constant. We conclude that decreases in visual acuity over the range of 6/6+ to 6/75 resulting from defocus do not significantly reduce set shot shooting performance.

Adolescent↗

PubMed1992

Psychophysical measurement of the size and shape of the human foveal avascular zone.

We have examined two psychophysical procedures for assessing the size and shape of the human foveal avascular zone (FAZ). Both procedures used a Maxwellian view system with a rotating beam to create a high contrast entoptic view of the retinal vasculature. Most subjects readily report a clear avascular zone surrounding their fixation point. The size of this FAZ was measured by (a) reducing the circular Maxwellian view field stop until it appeared to coincide with the edge of the FAZ, and (b) by tracing the boundary of the FAZ with a point source. Consistent with earlier angiographic and anatomical studies, the first method (N = 34 eyes) showed a mean FAZ diameter of 0.736 mm (area 0.42 mm2). FAZ diameter ranged from 0.46 to 1.13 mm (area 0.166-1.00 mm2) and the FAZ from the right and left eyes of each individual subject were very similar (r2 = 0.863). The tracing technique (n = 24 eyes) showed that FAZ's were generally not spherical but well fit by ellipses with, on average, a major axis 17% longer than the minor axis. The maximum diameters of the FAZ tracings were very similar and significantly correlated with the circle diameters matched to the FAZ in experiment 1.

Adult↗

PubMed1991

Acuities through annular and central pupils after radial keratotomy.

The corneal radius of curvature after radial keratotomy (RK) increases centrally in the surgery-free area while remaining relatively unchanged paracentrally and peripherally in the surgical areas. These corneal topography changes suggest that the imaging properties of the cornea should vary with the area of the cornea allowed to participate in image formation. To test this hypothesis visual acuities were measured both through a central and an annular pupil for normals and RK patients as a function of time after surgery. Annular acuities were decreased significantly after RK and remained decreased over time. Best corrected central acuity increased as a function of time after surgery, becoming significantly better than presurgery acuities but not as good as normals with similar low refractive corrections. Clinical implications include: (1) variations in visual performance (e.g., acuity, contrast sensitivity, glare) and optical quality measures (e.g., refraction, higher-order aberrations) as a function of pupil size; (2) use of a large a surgery-free area as possible; (3) careful centering of the surgery-free area on the natural pupil; (4) new contact lens designs for correcting RK patients' residual refractive error; and (5) counseling patients in general, and patients with naturally large pupils in particular, concerning possible variation in visual function with pupil size. In summary, this study indicates that postsurgery RK paracentral/peripheral corneal optics experience a loss in optical quality as compared to either normal eyes with a low refractive correction or the same eye before surgery.

Adult↗