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Investigative Ophthalmology and Visual Science

Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach.

t hereportoftheepidemiologySubcommit - teeofthe � 2007� dryeyeWorkShopsummarizescurrent� knowledgeontheepidemiologyofdryeyedisease, �providing� prevalenceandincidencedatafromvariouspopulations.� It� stressestheneedtoexpandepidemiologicalstudiestoad- ditionalgeographicregions, � toincorporatemultipleraces� andethnicitiesinfuturestudies, �andtobuildaconsensus� ondryeyediagnosticcriteriaforepidemiologicalstudies.� recommendationsaremaderegardingseveralcharacteristics� ofdryeyequestionnairesthatmightbesuitableforusein� epidemiologicalstudiesandrandomizedcontrolledclinical� trials.�riskfactorsfordryeyeandmorbidityofthedisease� areidentified, �andtheimpactofdryeyediseaseonqualityof� lifeandvisualfunctionareoutlined. �Suggestionsaremadefor� furtherprospectiveresearchthatwouldleadtoimprovement� ofbotheyeandgeneralpublichealth.

The epidemiology of dry eye disease: Report of the epidemiology subcommittee of the international Dry Eye WorkShop (2007)

The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjogren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.

TFOS DEWS II pathophysiology report

Update on AUA Guideline on the Management of Benign Prostatic Hyperplasia

Purpose To determine the contribution of posterior corneal astigmatism to total corneal astigmatism and the error in estimating total corneal astigmatism from anterior corneal measurements only using a dual-Scheimpflug analyzer. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Case series. Methods Total corneal astigmatism was calculated using ray tracing, corneal astigmatism from simulated keratometry, anterior corneal astigmatism, and posterior corneal astigmatism, and the changes with age were analyzed. Vector analysis was used to assess the error produced by estimating total corneal astigmatism from anterior corneal measurements only. Results The study analyzed 715 corneas of 435 consecutive patients. The mean magnitude of posterior corneal astigmatism was −0.30 diopter (D). The steep corneal meridian was aligned vertically (60 to 120 degrees) in 51.9% of eyes for the anterior surface and in 86.6% for the posterior surface. With increasing age, the steep anterior corneal meridian tended to change from vertical to horizontal, while the steep posterior corneal meridian did not change. The magnitudes of anterior and posterior corneal astigmatism were correlated when the steeper anterior meridian was aligned vertically but not when it was aligned horizontally. Anterior corneal measurements underestimated total corneal astigmatism by 0.22 @ 180 and exceeded 0.50 D in 5% of eyes. Conclusions Ignoring posterior corneal astigmatism may yield incorrect estimation of total corneal astigmatism. Selecting toric intraocular lenses based on anterior corneal measurements could lead to overcorrection in eyes that have with-the-rule astigmatism and undercorrection in eyes that have against-the-rule astigmatism. Financial Disclosure The authors received research support from Ziemer Group. In addition, Dr. Koch has a financial interest with Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Calhoun Vision, Inc., NuLens, and Optimedica Corp.

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Contribution of posterior corneal astigmatism to total corneal astigmatism.

Laser in situ keratomileusis for myopia and astigmatism: Safety and efficacy: A report by the American Academy of Ophthalmology

Purpose (1) To investigate the distribution of anterior corneal higher-order aberrations (HOAs, 3rd to 6th orders) in the population; (2) to evaluate the symmetry of anterior corneal aberrations between right and left eyes of individuals; and (3) to study the variations in anterior corneal aberrations with aging. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Methods Using the CTView program (Sarver and Associates, Inc.), corneal HOAs were computed from the central 6.0 mm zone of the corneal topographic maps (Humphrey Atlas, Carl Zeiss, Inc.) of 228 eyes of 134 subjects (mean age 50 years ± 17 (SD); range 20 to 79 years; manifest spherical equivalent between –3.0 and +3.0 diopters [D]). Correlation analysis was performed to investigate the aberration symmetry between the right and left eyes and to assess the association between anterior corneal HOAs and age. Results There was wide individual variability in aberrations with ranges of individual Zernike terms from −0.579 to +0.572 μm. The mean coefficient of the 4th-order spherical aberration (SA) ( Z 4 0 ) was 0.280 ± 0.086 μm and was positive in all corneas. The mean root-mean-square (RMS) values were 0.479 ± 0.124 μm for HOA, 0.281 ± 0.086 μm for SA ( Z 4 0 and Z 6 0 ), and 0.248 ± 0.135 μm for coma ( Z 3 −1 , Z 3 1 , Z 5 −1 , and Z 5 1 ). Moderate to high correlations were found between right and left eyes for HOA, SA, and coma (Pearson r = 0.565, 0.751, and 0.565, respectively; all P P′ r = 0.434 and 0.290, respectively; both P r = 0.034). Conclusion Anterior corneal wavefront aberrations varied greatly among subjects and increased slightly with aging. All corneas had positive 4th-order SAs, and the values did not change with aging. A moderate to high degree of mirror symmetry existed between right and left eyes.

Optical aberrations of the human anterior cornea.

Calculating the surgically induced refractive change following ocular surgery is important for evaluating the results of keratore-fractive procedures, smaller incisions and various wound closures for cataract surgery, and the effect of suturing techniques and suture removal following corneal transplant surgery. We present a ten-step method of calculating the spherical- and cylindrical-induced refractive change in a manner suitable for a programmable calculator or personal computer. Several applications are given including (1) adding the overrefraction to the spectacle correction, (2) determining the surgically induced refractive change from the preoperative and postoperative refractions, (3) determining the surgically induced refractive change from the K-readings, (4) rotating axes, (5) determining the power at meridians oblique to the principal meridians of a spherocylinder, (6) determining the coupling ratio, and (7) averaging axes. Standard methods for calculating and reporting aggregate results are also given.

Calculating the surgically induced refractive change following ocular surgery

Purpose To evaluate the impact of posterior corneal astigmatism on outcomes with toric intraocular lenses (IOLs). Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Case series. Methods Corneal astigmatism was measured using 5 devices before and 3 weeks after cataract surgery. Toric IOL alignment was recorded at surgery and at the slitlamp 3 weeks postoperatively. The actual corneal astigmatism was calculated based on refractive astigmatism 3 weeks postoperatively and the effective toric power calculated with the Holladay 2 formula. The prediction error was calculated as the difference between the astigmatism measured by each device and the actual corneal astigmatism. Vector analysis was used in all calculations. Results With the IOLMaster, Lenstar, Atlas, manual keratometer, and Galilei (combined Placido–dual Scheimpflug analyzer), the mean prediction errors (D) were, respectively, 0.59 @ 89.7, 0.48 @ 91.2, 0.51 @ 78.7, 0.62 @ 97.2, and 0.57 @ 93.9 for with-the-rule (WTR) astigmatism (60 to 120 degrees), and 0.17 @ 86.2, 0.23 @ 77.7, 0.23 @ 91.4, 0.41 @ 58.4, and 0.12 @ 7.3 for against-the-rule (ATR) astigmatism (0 to 30 degrees and 150 to 180 degrees). In the WTR eyes, there were significant WTR prediction errors (0.5 to 0.6 diopters [D]) by all devices. In ATR eyes, WTR prediction errors were 0.2 to 0.3 D by all devices except the Placido–dual Scheimpflug analyzer (all P Conclusions Corneal astigmatism was overestimated in WTR by all devices and underestimated in ATR by all except the Placido–dual Scheimpflug analyzer. A new toric IOL nomogram is proposed. Financial Disclosure Drs. Koch, Weikert, and Wang received research support from Ziemer USA, Inc. Dr. Koch has a financial interest with Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Optimedica Corp., and Ziemer USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

http://www.surgivision.net/instantforum34/attachments/75555668Koch%20article%202.pdf

Douglas D. Koch

Papers

Contribution of posterior corneal astigmatism to total corneal astigmatism.

Laser in situ keratomileusis for myopia and astigmatism: Safety and efficacy: A report by the American Academy of Ophthalmology

Optical aberrations of the human anterior cornea.

Calculating the surgically induced refractive change following ocular surgery

Correcting astigmatism with toric intraocular lenses: Effect of posterior corneal astigmatism