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Purpose: The purpose of this thesis is to provide a comprehensive literature review about albinism as an inherited metabolic disorder of melanin synthesis along with those related conditions impacting the visual system. As such, it addresses eye care emphasizing the visual consequences of albinism along with diagnostic and treatment options.
Methods: Background knowledge about ocular development is given as well as information about etiological biochemical and genetic processes. The current classification, clinical findings and their assessment and management options are presented based on recent results of research. In conclusion, two case reports are described as examples of visual care options.
Results: Melanin plays a big role in the retinal and chiasmal development. Melanin biosynthesis can be disrupted by different genes in various ways which leads to the current classification of albinism. Clinical findings include fundus hypopigmenta-tion, nystagmus, iris transillumination, photophobia, foveal hypoplasia, excessive chiasmal decussation, reduced visual acuity, high astigmatism (with-the-rule), strabismus and decreased stereopsis. Treatment options to improve visual acuity, fixation and binocularity are (tinted) prescription lenses and contact lenses, low vision aids, surgical procedures and vision therapy. Medication and supplementa-tion for increased pigmentation are currently being tested on mice.
Conclusions: Albinism is caused by genetic mutations resulting in ocular and cutaneous hypopigmentation. It establishes various phenotypes that require different therapy approaches in order to improve vision and therefore quality of life.
Ophthalmic lenses are ideally measured in accordance with the center of rotation of the eye. Therefore a measuring device was constructed due to this principle to measure lenses with a focimeter. In this work that measuring device was validated. Lenses of ± 4 dpt in spherical and aspherical design were measured across a field of 9x9 measuring points being at 5° distance from each other. This corresponds to a field of view of 40°. The measurement points in x- and y- direction were theoretically calculated to validate the measurement results. Regarding angles of incidence up to 20° it was supposed that the main optical aberration depends on a change in the sagittal and tangential sphere powers which is also defined as astigmatism. Therefore the calculation presents the tangential and sagittal oblique sphere powers depending on the different angles of the line of vision. On average the measurement results and the calculated data of the spherical designed lenses coincide quite good (correlation at 0,98), the systematic deviation of both values on average is 0.01 dpt and the random error (standard deviation) amounts 0.03 dpt on average. The minimum deviation is -0.06 dpt and the maximum is 0.09 dpt. Common focimeters have a measuring inaccuracy of up to 0.06 dpt (Diepes, Blendowske 2002). Therefore the quality of the measured data should be reliable. The aspherical designed lenses were compared to the spherical designed lenses. With increased angles of incidence the astigmatism of the aspherical lenses leads to lower values than the astigmatism of the spherical lenses
Purpose
The purpose of this study was to evaluate the validity of the iPad Aniseikonia Test for
measurement size lens-induced aniseikonia. The iPad Aniseikonia Test is a new
computer-based test designed for measuring aniseikonia in vertical direction. The iPad
Test uses red-green anaglyphs.
Methods
Aniseikonia was induced in 21 subjects by means of afocal size lenses. Resulting
aniseikonia was measured in vertical direction by the iPad Aniseikonia Test. The
measurement was performed in dark condition with appropriate correction of refractive
error. All subject were patients with normal vision with no anisometropia or other
ocular problem.
Results:
Afocal size lenses of known magnification were used to induce aniseikonia. 5
measurements were taken in each subject, ranging from zero to 7 % magnification.
When using the regression analysis, the slope of the fitted line significantly differs from
1. The average slope of regression line is 0,58.
Conclusions:
Only moderate accuracy was found for tested target size and orientation. In all cases the
iPad Aniseikonia Test underestimates the level of aniseikonia. However for gross
assessment of anisometropia in clinical practice it could be successfully used. Further
study with different target size should be addressed.
Purpose: Recent studies found a reduction of myopia progression with multifocal contact lenses, however, with yet unclear mechanism. This raises the hypothesis that the addition zones of the multifocal contact lenses induce myopic defocus on the retina, which consequentially leads to choroidal thickening and therefore inhibited eye growth. We tested the effect of the optical design of multifocal contact lenses on choroidal thickness.
Methods: 18 myopic students wore four different contact lenses ((1) single-vision lens corrected for distance, (2) single-vision lens with +2.50 D full-field defocus, (3) “Multifocal center-distance” design, addition +2.50 D, (4) “Multifocal center-near” design, addition +2.50 D) for each 30 minutes on their right eye. Automated analysis of the macular choroidal thickness, vitreous chamber depth and eccentric photorefraction were performed before and after each contact lens.
Results: Choroidal thickness and vitreous chamber depth showed no significant differences to baseline with none of the contact lenses. Choroidal thickness increased the most with the “Multifocal center-distance” and the full-field defocus lens, followed by the “Multifocal center-near” and the single-vision contact lens (+2.1 ± 11.1 μm, +2.0 ± 11.1 μm, +1.6 ± 11.3 μm, +0.9 ± 11.2 μm, respectively). The “Multifocal center-distance” design showed an overall more myopic refractive profile than the other lenses. Changes of vitreous chamber depth occurred in anti-phase to these of choroidal thickness.
Conclusion: Multifocal contact lenses have no significant influence on choroidal thickness and after short-term wear. Therefore, it is assumed that it is not the main contributor to the protective effect of multifocal contact lenses in myopia control.
Aim Patrick J. Caroline and Mark P. Andre first reported about soft lens orthokeratology in 2005. In a number of articles in the past five years, they reported about their research on this topic and their new findings. The aim of this study was to continue the research of Patrick J. Caroline and Mark P. Andre and to collect more information about the outcome of the technique. Methods Ten subjects with low myopia from -0.25 D to -1.25 D and a refractive astigmatism from plano to -0.75 D were fitted with a -10.00 D CIBA VISION AIR OPTIX® NIGHT&DAY® silicone hydrogel contact lens and were told to wear the lenses over night and everted. Corneal topography and refraction measurements were taken after one night, one week and one month of contact lens wear. Results Eight out of ten subjects finished the study, six female and two male. The mean age of the subjects was 23.9 years. With the eight subjects who finished the study, the mean change in subjective refraction was about +1.00 D in the sphere and +0.22 D in the cylinder, with maximum changes of +1.75 D sphere and +0.75 D cylinder. The mean apical power change, measured with the topographer, was 1.11 D. Changes in K - readings ranged from slight corneal steepening in both of the meridians to 0.23 mm of corneal flattening in the horizontal meridian and 0.27 mm of corneal flattening in the vertical meridian. Corneal eccentricity decreased about 0.65 on average. The main complaints and problems were the high minus power and the decentration of the contact lens and the occurrence of ghosting at night. Conclusion The results of this study show that everted wear of a high minus silicone hydrogel contact lens can lead to orthokeratology - such as changes in corneal topography and subjective refraction. These changes range from plano to +1.75 D sphere and +0.25 D to +0.75 D cylinder but are unpredictable and vary from subject to subject. Additional studies regarding the contact lens decentration and the unpredictability of the outcome need to be done to optimize the process.