No / To determine whether Hartmann-Shack wavefront sensing detects differences in optical performance in vivo between poly(methyl methacrylate) (PMMA) and foldable acrylic intraocular lenses (IOLs) and between clear corneal and scleral tunnel incisions and whether optical differences are manifested as differences in visual performance. SETTING: Department of Optometry, University of Bradford, West Yorkshire, United Kingdom. METHODS: This study comprised 74 subjects; 17 were phakic with no ocular pathology, 20 had implantation of a Pharmacia 722C PMMA IOL through a scleral tunnel, 21 had implantation of an Alcon AcrySof IOL through a scleral tunnel, and 16 had implantation of an AcrySof IOL through a corneal incision. Visual acuity and contrast sensitivity testing, ocular optical quality measurement using Hartmann-Shack wavefront sensing, and corneal surface measurement with a videokeratoscope were performed in all cases. RESULTS: There were significant differences between groups in the total root-mean-square (RMS) wavefront aberration over a 6.0 mm pupil (F=3.91; degrees of freedom=3,70; P<.05) mediated at the 4th-order RMS, specifically spherical and tetrafoil aberrations. The PMMA-scleral group had the least aberrations and the AcrySof-corneal group the most. For a 3.5 mm diameter pupil, the total higher-order RMS wavefront aberration was not significantly different between the groups (P>.05). There were no differences between groups in corneal shape, visual acuity, or contrast sensitivity. CONCLUSIONS: Implantation of the spherical PMMA IOL led to a slight reduction in total wavefront aberration compared to phakic eyes. AcrySof IOLs induced more aberrations, especially spherical aberration. Corneal-based incisions for IOL implantation compounded this increase. Studies of the optical performance of IOLs in vivo should use wavefront sensing as the main outcome measure rather than visual measures, which are readily confounded by multiple factors.

No / This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child's first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after the emergence of amblyopia secondary to either deprivation or strabismus, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of 'pure' anisometropic amblyopia. Although indirect, the therapeutic impact of refractive correction on anisometropic amblyopia provides strong support for the hypothesis that the anisometropia caused the amblyopia. Direct evidence for the aetiology of anisometropic amblyopia will require longitudinal tracking of at-risk infants, which poses numerous methodological and ethical challenges. However, if we are to prevent this condition, we must understand the factors that cause it to develop.

The loss of central vision subsequent to macular disease is often extremely debilitating. People with central field loss (CFL) must use other peripheral areas of the retina in order to see; areas with inferior resolution capacity, which are also affected by off-axis optical errors. The overall aim of the work encompassed by this thesis was to identify and evaluate methods of improving vision for people with CFL; with focus on the effects of off-axis optical correction and stimulus motion on resolution acuity and contrast sensitivity. Off-axis optical errors were measured using a commercially-available COAS-HD VR open-view aberrometer. We used adaptive psychophysical methods to evaluate grating resolution acuity and contrast sensitivity in the peripheral visual field; drifting gratings were employed to   measure the effect of motion on these two measures of visual performance. The effect of sphero-cylindrical correction and stimulus motion on visual performance in healthy eyes and in subjects with CFL was also studied; in addition, the effect of adaptive optics aberration correction was examined in one subject with CFL. The COAS-HD aberrometer provided rapid and reliable measurements of off-axis refractive errors. Correction of these errors gave improvements in low-contrast resolution acuity in subjects with higher amounts of oblique astigmatism. Optical correction also improved high-contrast resolution acuity in most subjects with CFL, but not for healthy subjects. Adaptive optics correction improved both high and low contrast resolution acuity in the preferred retinal locus of a subject with CFL. The effect of stimulus motion depended on spatial frequency; motion of 7.5 Hz improved contrast sensitivity for stimuli of low spatial frequency in healthy and CFL subjects. Motion of 15 Hz had little effect on contrast sensitivity for low spatial frequency but resulted in reduced contrast sensitivity for higher spatial frequencies in healthy subjects. Finally, high-contrast resolution acuity was relatively insensitive to stimulus motion in the periphery. This thesis has served to broaden the knowledge regarding peripheral optical errors, stimulus motion and their effects on visual function, both in healthy subjects and in people with CFL. Overall it has shown that correction of off-axis refractive errors is important for optimizing peripheral vision in subjects with CFL; the use of an open-view aberrometer simplifies the determination of these errors. In addition, moderate stimulus motion can have a beneficial effect on contrast sensitivity for objects of predominantly low spatial frequency.

Este trabalho apresenta um sistema computacional que utiliza técnicas de Aprendizado de Máquina (AM) para auxiliar o diagnóstico oftalmológico. Trata-se de um sistema de medidas objetivas e automáticas dos principais vícios de refração ocular, astigmatismo, hipermetropia e miopia. O sistema funcional desenvolvido aplica técnicas convencionais de processamento a imagens do olho humano fornecidas por uma técnica de aquisição chamada Hartmann-Shack (HS), ou Shack-Hartmann (SH), com o objetivo de extrair e enquadrar a região de interesse e remover ruídos. Em seguida, vetores de características são extraídos dessas imagens pela técnica de transformada wavelet de Gabor e, posteriormente, analisados por técnicas de AM para diagnosticar os possíveis vícios refrativos presentes no globo ocular representado. Os resultados obtidos indicam a potencialidade dessa abordagem para a interpretação de imagens de HS de forma que, futuramente, outros problemas oculares possam ser detectados e medidos a partir dessas imagens. Além da implementação de uma nova abordagem para a medição dos vícios refrativos e da introdução de técnicas de AM na análise de imagens oftalmológicas, o trabalho contribui para a investigação da utilização de Máquinas de Vetores Suporte e Redes Neurais Artificiais em sistemas de Entendimento/Interpretação de Imagens (Image Understanding). O desenvolvimento deste sistema permite verificar criticamente a adequação e limitações dessas técnicas para a execução de tarefas no campo do Entendimento/Interpretação de Imagens em problemas reais. / This work presents a computational system that uses Machine Learning (ML) techniques to assist in ophthalmological diagnosis. The system developed produces objective and automatic measures of ocular refraction errors, namely astigmatism, hypermetropia and myopia from functional images of the human eye acquired with a technique known as Hartmann-Shack (HS), or Shack-Hartmann (SH). Image processing techniques are applied to these images in order to remove noise and extract the regions of interest. The Gabor wavelet transform technique is applied to extract feature vectors from the images, which are then input to ML techniques that output a diagnosis of the refractive errors in the imaged eye globe. Results indicate that the proposed approach creates interesting possibilities for the interpretation of HS images, so that in the future other types of ocular diseases may be detected and measured from the same images. In addition to implementing a novel approach for measuring ocular refraction errors and introducing ML techniques for analyzing ophthalmological images, this work investigates the use of Artificial Neural Networks and Support Vector Machines (SVMs) for tasks in Image Understanding. The description of the process adopted for developing this system can help in critically verifying the suitability and limitations of such techniques for solving Image Understanding tasks in \"real world\" problems.

Este trabalho apresenta um sistema computacional que utiliza técnicas de Aprendizado de Máquina (AM) para auxiliar o diagnóstico oftalmológico. Trata-se de um sistema de medidas objetivas e automáticas dos principais vícios de refração ocular, astigmatismo, hipermetropia e miopia. O sistema funcional desenvolvido aplica técnicas convencionais de processamento a imagens do olho humano fornecidas por uma técnica de aquisição chamada Hartmann-Shack (HS), ou Shack-Hartmann (SH), com o objetivo de extrair e enquadrar a região de interesse e remover ruídos. Em seguida, vetores de características são extraídos dessas imagens pela técnica de transformada wavelet de Gabor e, posteriormente, analisados por técnicas de AM para diagnosticar os possíveis vícios refrativos presentes no globo ocular representado. Os resultados obtidos indicam a potencialidade dessa abordagem para a interpretação de imagens de HS de forma que, futuramente, outros problemas oculares possam ser detectados e medidos a partir dessas imagens. Além da implementação de uma nova abordagem para a medição dos vícios refrativos e da introdução de técnicas de AM na análise de imagens oftalmológicas, o trabalho contribui para a investigação da utilização de Máquinas de Vetores Suporte e Redes Neurais Artificiais em sistemas de Entendimento/Interpretação de Imagens (Image Understanding). O desenvolvimento deste sistema permite verificar criticamente a adequação e limitações dessas técnicas para a execução de tarefas no campo do Entendimento/Interpretação de Imagens em problemas reais. / This work presents a computational system that uses Machine Learning (ML) techniques to assist in ophthalmological diagnosis. The system developed produces objective and automatic measures of ocular refraction errors, namely astigmatism, hypermetropia and myopia from functional images of the human eye acquired with a technique known as Hartmann-Shack (HS), or Shack-Hartmann (SH). Image processing techniques are applied to these images in order to remove noise and extract the regions of interest. The Gabor wavelet transform technique is applied to extract feature vectors from the images, which are then input to ML techniques that output a diagnosis of the refractive errors in the imaged eye globe. Results indicate that the proposed approach creates interesting possibilities for the interpretation of HS images, so that in the future other types of ocular diseases may be detected and measured from the same images. In addition to implementing a novel approach for measuring ocular refraction errors and introducing ML techniques for analyzing ophthalmological images, this work investigates the use of Artificial Neural Networks and Support Vector Machines (SVMs) for tasks in Image Understanding. The description of the process adopted for developing this system can help in critically verifying the suitability and limitations of such techniques for solving Image Understanding tasks in \"real world\" problems.

This is a study on the prevalence of refractive errors and patients requiring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and OR Tambo District Municipalities of the Eastern Cape. This is an area characterised by extreme poverty where the cost of an eye examination and prescription spectacles remains financially unobtainable for most. Optometry services are provided mainly by private optometrists who service the small proportion of the population that can afford them. Adults and children remain house bound or are labelled as dull and unproductive simply because they don’t have access to an eye examination and a pair of spectacles. Purpose The purpose of the study is to identify patients with refractive errors and those requiring refractive services at the 15 eye clinics in the Eastern Cape. Another purpose is to describe the refractive services that are available to patients attending health facilities, where the eye clinics are conducted. Lastly, the purpose is to explore the possibility of nurses providing refractive services independently or under the supervision of optometrists to supplement the lack to refracting and dispensing services. Study Method A quantitative and qualitative non-experimental descriptive design was used. Research involved the analysis of Vision Care’s eye clinic records collected from 15 eye clinics from January 2010-June 2010. Semi-structured interviews were conducted with 30 nurses working at the 15 health facilities where the eye clinics were conducted using purposive sampling. The quantitative data was analysed using excel spreadsheets and graphs and qualitative data was analysed using coding and categorizing methods. Conclusion According to Vision Care’s data of the patients assessed, 19.2 percent had a refractive error and 54 percent of the patients required refractive services. It is estimated that 71.41 percent of the patients had a refractive error according to the optometrist. Although there were some organisations active in the eradication of cataracts, there was little healthcare available in the form of refraction services. xiv Patients needed to travel an average of 63.8kms to access refraction services against the backdrop of poor roads, poverty and unemployment. 28 out of 30 nurses either ‘strongly agreed’ or ‘agreed’ that nurses could be trained to perform refractions and dispense spectacles. 29 out of 30 nurses thought that this would have a positive impact on eye care. Further research is necessary to assess the feasibility of implementing a nurse operated refractive program and whether it should be within their scope of practice to refract and dispense spectacles.

MPH / Department of Public Health / See the attached abstract below