A Multicenter Study of the Distribution Pattern of Posterior-To-Anterior Corneal Curvature Radii Ratio in Chinese Myopic Patients

Estimation of corneal refractive power (CRP) is of crucial importance to refractive and cataract surgery. The ratio of posterior to anterior curvature radii of the cornea (P/A ratio) is one of the key factors to determine the actual CRP (True-K). While the traditional method to calculate the CRP (Sim-K) is based on a constant P/A ratio (0.82), it is suggested that the P/A ratio varies in different people and exhibits a distribution pattern, which may have an impact on the accuracy of CRP estimation and postoperative refractive outcome. In this multicenter study, we aimed to investigate the distribution pattern of the P/A ratio in a large number of myopic patients, and further explore the relationship between P/A ratio and ΔK (the difference between True-K and Sim-K). We found that distribution of the P/A ratio ranged from 0.72 to 0.86 with an average value of 0.82 ± 0.01. The compensation effect of the refractive power of the posterior on the anterior surface of the cornea decreased with the increase of P/A ratio. There was a significant correlation between P/A ratio and ΔK in all eyes (r = 0.9764, P < 0.0001). A change of 0.1 in P/A ratio could cause a change of 0.75 D in ΔK. Our study suggests that the actual P/A ratio should be taken into consideration in refractive and cataract surgery when calculating the CRP and power of the intraocular lens in eyes with significantly deviated P/A ratios.

Clinical outcomes in post-epikeratophakic eyes after removal of epikeratoplasty lenticule

Background Assessment of the optical outcome and adverse events in post-epikeratopathic eyes after removal of the epikeratoplasty lenticule (EKPL). Methods This was a retrospective case-series study of patients who underwent EKPL removal between 2002 and 2020. Ten eyes were included in the analysis. We compared the clinical characteristics of the patients before surgery, 6 months after surgery, before lenticular removal, and after removal, and reported optical or ocular surface complications. Results We removed EKPL due to the lenticular opacity in five eyes (50%), intraocular lens (IOL) insertion (n = 4, 40%) after cataract surgery (n = 3) or in aphakic eyes (n = 1), and lenticule-induced irregular astigmatism in one eye (10%). After EKPL removal, the mean refractive power of the cornea (Km) revealed a tendency to increase. Out of nine cases, six cases showed corneal steepening and three cases revealed corneal flattening. When the keratometric readings of pre-epikeratoplasty and post-lenticular removal were compared within the same case, the average difference was 5.1 D ± 4.0 (n = 8). Complications were observed in 3 of 10 cases (excessive corneal flatness, ectatic change, and abnormal epithelial cell ingrowth) after removal. Conclusions The surgeon should expect the corneal refractive power to steepen or flatten in some cases with abnormal astigmatism and irregularity. Epikeratophakic eyes may exhibit serious ectatic changes, and abnormal epithelial cell ingrowth after removal of epikeratophakic lenticules.

Axial length and its associations in the Ural Very Old Study

To assess the distribution of axial length as surrogate for myopia and its determinants in an old population, we performed the Ural Very Old Study as a population-based cohort study. Out of 1882 eligible individuals aged 85 + years, the Ural Very Old Study performed in an urban and rural region in Bashkortostan/Russia included 1526 (81.1%) individuals undergoing ophthalmological and medical examinations with sonographic axial length measurement. Biometric data were available for 717 (47.0%) individuals with a mean age of 88.0 ± 2.6 years (range 85–98 years; 25%). Mean axial length was 23.1 ± 1.1 mm (range 19.37–28.89 mm). Prevalences of moderate myopia (axial length 24.5–< 26.5 mm) and high myopia (axial length ≥ 26.5 mm) were 47/717 (6.6%; 95% CI 4.7, 8.4) and 10/717 (1.4%; 95% CI 0.5, 2.3), respectively. In multivariable analysis, longer axial length was associated (coefficient of determination r2 0.25) with taller body height (standardized regression coefficient beta:0.16;non-standardized regression coefficient B: 0.02; 95% confidence interval (CI) 0.01, 0.03; P < 0.001), higher level of education (beta: 0.12; B: 0.07; 95% CI 0.02, 0.11; P = 0.002), and lower corneal refractive power (beta: − 0.35; B: − 0.23; 95% CI − 0.28, − 0.18; P < 0.001). Higher prevalence of moderate myopia, however not of high myopia, was associated with higher educational level (OR 1.39; 95% CI 1.09, 1.68; P = 0.007) and lower corneal refractive power (OR 0.77; 95% CI 0.63, 0.94; P = 0.01). In this old study population, prevalence of moderate axial myopia (6.6% versus 9.7%) was lower than, and prevalence of high axial myopia (1.4% versus 1.4%) was similar as, in a corresponding study on a younger population from the same Russian region. Both myopia prevalence rates were higher than in rural Central India (1.5% and 0.4%, respectively). As in other, younger, populations, axial length and moderate myopia prevalence increased with higher educational level, while high myopia prevalence was independent of the educational level.

Intraocular Lens Power Calculation According to the Difference between Anterior and Total Keratometry Using Scheimpflug Imaging

Purpose: We investigated the change in the absolute error according to the difference between anterior and total keratometry, to determine the criterion for the difference in keratometry, and to determine the indication for using total keratometry. Methods: Sagittal and total refractive power were measured with 2-, 3-, and 4-mm Pentacam® rings, and the absolute error of each was calculated in patients who underwent cataract surgery in our hospital. The correlation between the difference value the sagittal minus the total refractive power and each absolute error was analyzed by simple regression analysis. The analysis was performed by dividing the patients into two groups based on 0.6, which is the average of the difference between the sagittal and total refractive power for the 3-mm ring. Results: Sagittal power was larger than total refractive power for all rings and the absolute error obtained by applying the total refractive power was larger than the sagittal power for the 2- and 4-mm rings (p < 0.001). The simple regression analysis revealed that the absolute error using sagittal power was positively correlated with the difference between sagittal power and total refractive power. In the group with less than 0.6, the absolute error using the total refractive power of all rings was larger than the sagittal power (p < 0.001). In the group exceeding 0.6, the absolute error using the total refractive power was less than using the sagittal power for the 3 mm ring (p = 0.028). Conclusions: The greater the difference between sagittal and total refractive power, the greater the absolute error using sagittal power. Accuracy was higher in the group exceeding 0.6 after applying total refractive power measured at the 3 mm ring compared to sagittal power.

Anthropometric measures and their relationship to corneal refractive power in the United States population

Purpose: To determine the relationship between anthropometric measures and corneal refractive power (CRP). Methods: Participants from the 1999-2008 United States National Health and Nutrition Examination Survey (NHANES) visual exam with demographic, ocular, and anthropometric data (20,165 subjects) were included. Cases with steep cornea were defined by corneal power ≥ 48.0 diopters (n = 171) while controls had dioptric power < 48.0 D (n = 19,994). Multivariable analyses were performed for pooled and sex-stratified populations. Separate models assessed body mass index, height, and weight in relation to steep cornea. Results: A relationship between BMI and steep cornea in the pooled population was not detected (P for trend = 0.78). There was a strong inverse relationship between height and steep cornea in the pooled population (P for trend <0.0001) and women (P for trend <0.0001). For every 1-inch increase in height, there was a 16% reduced odds of steep cornea in the pooled population (OR, 0.84; 95% CI: 0.78-0.91). There was also a significant inverse relationship between weight and steep cornea in the pooled population (P for trend = 0.01) and in men (P for trend = 0.02). For each 10-pound increase in weight there was a 7% reduced odds of steep cornea (OR, 0.927; 95% CI: 0.882-0.975) in the pooled analysis. Conclusions: Greater height and greater weight were associated with a lower risk of steep cornea. These findings can contribute to an improved understanding of the pathogenesis of corneal ectasias.

Evaluation of axial length/total corneal refractive power ratio as a potential marker for ocular diagnosis of Marfan’s syndrome in children

AIM: To investigate whether the axial length (AL)/total corneal refractive power (TCRP) ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan’s syndrome (MFS) in children. METHODS: The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were evaluate. The biological characteristics, including age, sex, AL, and TCRP, were collected from medical records. Receiver operating characteristic (ROC) curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects. The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59. RESULTS: Of 96 subjects (mean age 7.46±3.28y) evaluated, 56 (110 eyes) had a definite diagnosis of MFS in childhood based on the revised Ghent criteria, 41 (82 eyes) with diagnosis of congenital ectopia lentis (EL) were included as a control group. AL was negatively correlated with TCRP, with a linear regression coefficient of -0.36 (R2=0.08). A significant correlation was found between age and the AL/TCRP ratio (P=0.023). ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other patients at a threshold of 0.59. MFS patients were present in 24/58 (41.38%) patients with an AL/TCRP ratio of ≤0.59 and in 34/39 (87.18%) patients with an AL/TCRP ratio of >0.59. CONCLUSION: An AL/TCRP ratio of >0.59 is significantly associated with the risk of MFS. The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS. Changes in the AL/TCRP ratio should be monitored over time.

Predicting corneal refractive power changes after orthokeratology

This study aimed to characterise corneal refractive power (CRP) changes along the principal corneal meridians during orthokeratology (OK). Nineteen myopes (mean age 28 ± 7 years) were fitted with OK lenses in both eyes. Corneal topography was captured before and after 14 nights of OK lens wear. CRP was calculated for the central 8 mm cornea along the horizontal and vertical meridians. The central-paracentral (CPC) power ratio was calculated as the ratio between maximum central and paracentral CRP change from individual data. There was a significant reduction in CRP at all locations in the central 4 mm of the cornea (all p < 0.001) except at 2 mm on the superior cornea (p = 0.071). A significant increase in CRP was evident in the paracentral zone at 2.5, 3 and 3.5 mm on the nasal and superior cornea and at 3.5 and 4 mm on the temporal cornea (all p < 0.05). No significant change in CRP was measured in the inferior cornea except decreased CRP at 2.5 mm (p < 0.001). CPC power ratio in the nasal and temporal paracentral regions was 2.49 and 2.23, respectively, and 2.09 for both the inferior and superior paracentral corneal regions. Our results demonstrates that OK induced significant changes in CRP along the horizontal and vertical corneal meridians. If peripheral defocus changes are inferred from corneal topography, this study suggests that the amount of myopia experienced on the peripheral retina was greater than twice the amount of central corneal power reduction achieved after OK. However, this relationship may be dependent on lens design and vary with pupil size. CPC power ratios may provide an alternative method to estimate peripheral defocus experienced after OK.

Early Age of the First Myopic Spectacle Prescription, as an Indicator of Early Onset of Myopia, Is a Risk Factor for High Myopia in Adulthood

Purpose. The present study investigated the risk factors for high myopia in adulthood, with a focus on the age at which children wore their first spectacles. Methods. Adults aged between 20 and 45 years were invited to complete a questionnaire about age, sex, current refractive error, high myopia in parents, early onset of myopia presented by the age of the first myopic spectacle prescription, refractive power of the first spectacles, and life habits at different educational stages. The associations between these factors and high myopia in adulthood were then evaluated and analyzed. Results. In total, 331 participants were enrolled. Their average refractive error was −4.03 diopters, and high myopia was noted in 27.5% of the study participants. Only 3.3% of participants had fathers with high myopia, while 6.0% had mothers with high myopia. The participants received their first myopic spectacle prescription at a mean age of 13.35 years, with a mean refractive error of −1.63 diopters. The significant risk factors for developing high myopia in adult life were earlier age of the first spectacles prescribed ( p < 0.001 ), higher refractive power of the first spectacles ( p < 0.001 ), mother with high myopia ( p = 0.015 ), and after-school class attendance in senior high school ( p = 0.018 ). Those who wore their first spectacles at <9 years of age were more predisposed to high myopia than those who did so at ≧13 years, with an odds ratio of 24.9. Conclusion. The present study shows that earlier onset of myopia, which is presented by the age of the first myopic spectacle prescription, higher myopic refraction of the first spectacles, mothers with high myopia, and after-school class attendance in senior high school are risk factors for high myopia in adulthood. It suggests that delaying the onset of myopia in children is important for the prevention of high myopia in later life.

The Spatial Distribution of Relative Corneal Refractive Power Shift and Axial Growth in Myopic Children: Orthokeratology Versus Multifocal Contact Lens

PurposeTo determine if the spatial distribution of the relative corneal refractive power shift (RCRPS) explains the retardation of axial length (AL) elongation after treatment by either orthokeratology (OK) or multifocal soft contact lenses (MFCLs).MethodsChildren (8–14 years) were enrolled in the OK (n = 35) or MFCL (n = 36) groups. RCRPS maps were derived by computing the difference between baseline and 12-month corneal topography maps and then subtracting the apex values. Values at the same radius were averaged to obtain the RCRPS profile, from which four parameters were extracted: (1) Half_x and (2) Half_y, i.e., the x- and y-coordinates where each profile first reached the half peak; (3) Sum4 and (4) Sum7, i.e., the summation of powers within a corneal area of 4- and 7-mm diameters. Correlations between AL elongation and these parameters were analyzed by multiple linear regression.ResultsAL elongation in the OK group was significantly smaller than that in the MFCL group (p = 0.040). Half_x and Half_y were also smaller in the OK group than the MFCL group (p &lt; 0.001 each). Half_x was correlated with AL elongation in the OK group (p = 0.005), but not in the MFCL group (p = 0.600). In an analysis that combined eyes of both groups, Half_x was correlated with AL elongation (β = 0.161, p &lt; 0.001).ConclusionsThe OK-induced AL elongation and associated RCRPS Half_x were smaller than for the MFCL. Contact lenses that induce RCRPS closer to the corneal center may exert better myopia control.

OCT Application for Sterile Corneal Graft Screening in the Eye Bank

Background and Objective Sterile donor tomography enables the detection of corneal tissues with refractive anomalies. The aim of this study was to determine the curvature and thickness of donor corneas to support proper selection in the eye bank. Methods 704 donor corneas (Klaus Faber Center, LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, in Homburg/Saar) were measured using the anterior segment optical coherence tomograph (AS-OCT) CASIA 2 (Tomey Corp., Nagoya, Japan). The corneoscleral discs were measured in their cell culture flask, which was positioned in a holder on the chin rest of the AS-OCT, after conversion to medium II (with 6% dextran T-500). The measured raw data were analysed and processed in MATLAB (MathWorks Inc., Natick, Massachusetts, USA), after which the refractive power of the steep and flat meridian at the anterior and posterior surface and the central corneal thickness (CCT) of the donor corneas were determined. Results values are expressed as mean x̅ ± standard deviation SD. Results The mean refractive power of the steep/flat meridian at the anterior surface was 45.4 ± 1.8 D/44.0 ± 1.3 D, the corresponding values for the posterior surface were − 6.2 ± 0.3 D/− 5.9 ± 0.2 D, and the mean CCT was 616.3 ± 85.1 µm. Of the 704 (100%) measured donor tissues, 590 (83.8%)/670 (95.2%) donor corneas showed no anomaly beyond respectively x̅ ± 2 SD/x̅ ± 3 SD among the 5 examined parameters. 72 (10.3%)/23 (3.3%) donor corneas had only 1 anomaly, 26 (3.7%)/10 (1.4%) had 2 anomalies, 10 (1.4%)/1 (0.1%), 3 anomalies, 5 (0.7%)/0 (0.0%), 4 anomalies, and 1 (0.1%)/0 (0.0%), 5 anomalies. Conclusions AS-OCT provides an objective and sterile screening method to identify corneal tissues with curvature anomalies in order to further optimise donor selection in the eye bank. To avoid postoperative refractive surprises, donor corneas with a total refractive power that deviates > ± 3 SD from the mean should not be used for penetrating or anterior lamellar keratoplasty, but may be suitable for posterior lamellar keratoplasty (DMEK or DSAEK). In the future, sterile donor tomography could enable: (1) the harmonisation of donor and recipient tomography, which may minimise residual astigmatism for a particular donor-recipient pair; and (2) the improvement of IOL power calculation in a classical triple procedure by means of regression analysis between pre- and postoperative total refractive power of corneal grafts.