Novel Approach to Ocular Photoscreening

Photoscreening is a technique that is typically applied in mass pediatric vision screening due to advantage of its objective, binocular, and cost-effective nature. Through the retinal reflex image, ocular alignment and refractive status are evaluated. In the USA, this method has screened millions of preschool children in the past years. Nevertheless, the efficiency of the screening has been contentious. In this dissertation, the technique is reviewed and reexamined. Revisions of photoscreening technique are developed to detect and quantify strabismus, refractive errors, and high-order ocular aberrations. These new optical designs overcome traditional design deficiencies in three areas: First, a Dynamic Hirschberg Test is conducted to detect strabismus. The test begins with both eyes following a moving fixation target under binocular viewing, and during the test each eye is designed to be unconscientiously occluded which forces refixation in strabismus subjects and reveals latent strabismus. Photoscreening images taken under monocular viewing are used to calculate deviations from the expected binocular eye movement path. A significant eye movement deviation from binocular to monocular viewing indicates the presence of strabismus. Second, a novel binocular adaptive photorefraction (APR) approach is developed to characterize the retinal reflex intensity profile according to the eye\u27s refractive state. This approach calculates the retinal reflex profile by integrating the retinal reflex intensity from a coaxial and several eccentric photorefraction images. Theoretical simulations evaluate the influence from several human factors. An experimental APR device is constructed with 21 light sources to increase the spherical refraction detection range. The additional light source angular meridians detect astigmatism. The experimentally measured distribution is characterized into relevant parameters to describe the ocular refraction state. Last, the APR design is further applied to detect vision problems that suffer from high-order aberrations (e.g. cataracts, dry eye, keratoconus). A monocular prototype APR device is constructed with coaxial and eccentric light sources to acquire 13 monocular photorefraction images. Light sources projected inside and along the camera aperture improve the detection sensitivity. The acquired reflex images are then decomposed into Zernike polynomials, and the complex reflex patterns are analyzed using the Zernike coefficient magnitudes

The use of cues to convergence and accommodation in naive, uninstructed participants

A remote haploscopic video refractor was used to assess vergence and accommodation responses in a group of 32 emmetropic, orthophoric, symptom free, young adults naïve to vision experiments in a minimally instructed setting. Picture targets were presented at four positions between 2 m and 33 cm. Blur, disparity and looming cues were presented in combination or separately to asses their contributions to the total near response in a within-subjects design. Response gain for both vergence and accommodation reduced markedly whenever disparity was excluded, with much smaller effects when blur and proximity were excluded. Despite the clinical homogeneity of the participant group there were also some individual differences

Axial length changes during accommodation in myopes and emmetropes

Purpose: To investigate the influence of accommodation upon axial length (and a comprehensive range of ocular biometric parameters), in populations of young adult myopic and emmetropic subjects. Methods: Forty young adult subjects had ocular biometry measured utilizing a non-contact optical biometer (Lenstar LS 900) based upon the principle of optical low coherence reflectometry, under three different accommodation demands (0 D, 3 D and 6 D). Subjects were classified as emmetropes (n=19) or myopes (n=21) based upon their spherical equivalent refraction (mean emmetropic refraction -0.05 ± 0.27DS and mean myopic refraction -1.82 ± 0.84 DS). Results: Axial length changed significantly with accommodation, with a mean increase of 11.9 ± 12.3 µm and 24.1 ± 22.7 µm for the 3 D and 6 D accommodation stimuli respectively. A significant axial elongation associated with accommodation was still evident even following correction of the axial length data for potential error due to lens thickness change. The mean ‘corrected’ increase in axial length was 5.2 ± 11.2 µm, and 7.4 ± 18.9 µm for the 3 D and 6 D stimuli respectively. There was no significant difference between the myopic and emmetropic populations in terms of the magnitude of change in axial length with accommodation, regardless of whether the data were corrected or not. A number of other ocular biometric parameters, such as anterior chamber depth, lens thickness and vitreous chamber depth also exhibited significant change with accommodation. The myopic and emmetropic populations also exhibited no significant difference in the magnitude of change in these parameters with accommodation. Conclusions: The eye undergoes a significant axial elongation associated with a brief period of accommodation, and the magnitude of this change in eye length increases for larger accommodation demands, however there is no significant difference in the magnitude of eye elongation in myopic and emmetropic subjects