Visual Psychophysics and Physiological Optics Longitudinal Change and Stability of Refractive, Keratometric, and Internal Astigmatism in Childhood

PURPOSE. To assess longitudinal change in refractive, keratometric, and internal astigmatism in a sample of students from a population with a high prevalence of with-the-rule (WTR) astigmatism and to determine the optical origins of changes in refractive astigmatism. METHODS. A retrospective analysis of longitudinal measurements of right eye refractive and keratometric astigmatism in Tohono O'odham Native American children was conducted. Changes in refractive and keratometric astigmatism per year were compared in a younger cohort (n ¼ 1594, 3 to <11 years old) and an older cohort (n ¼ 648, 11 to <19 years old). Data were analyzed in clinical notation (Cyl) and vector notation (J0, J45). RESULTS. On average, refractive astigmatism (means: 1.19 diopters [D] Cyl, þ0.54 J0, þ0.03 J45) resulted primarily from WTR corneal astigmatism (means: þ0.85 J0, À0.02 J45) and against-the-rule (ATR) internal astigmatism (means: À0.31 J0, þ0.05 J45). Mean longitudinal changes in astigmatism were statistically significant (younger cohort À0.02 D/y Cyl; older cohort þ0.06 D/y Cyl). In the younger cohort, astigmatism decreased with age in low and moderate astigmats (<3.00 D) and increased with age in high astigmats ( ‡3.00 D). In the older cohort, astigmatism increased with age across all levels of astigmatism. Longitudinal changes in keratometric and internal astigmatism were negatively correlated in both cohorts. CONCLUSIONS. Cross-sectional data suggest the presence of a constant ATR contribution from internal astigmatism (0.60 D Cyl) that is close to the 0.50 D ATR constant reported by Javal and others. Highly astigmatic 3-to <11-year-old children and children older than age 11 years show a small (not clinically significant) increase in astigmatism with age. A negative correlation between changes in keratometric astigmatism and internal astigmatism suggests an active compensation that may contribute to the stability of astigmatism in Tohono O'odham children. Keywords: astigmatism, refractive error development, children, Native American R esearch conducted over the past 15 years has yielded a large longitudinal database on refractive development in Tohono O'odham children. There is a high prevalence of astigmatism among elementary school children who are members of this Native American tribe. 1-4 The high prevalence of refractive astigmatism in Tohono O'odham children is present in infancy and persists at least through elementary school. 1,2,4-7 A longitudinal study of corneal astigmatism in 960 Tohono O'odham children aged 6 months through 7 years showed that in early development (6 months to <3 years), astigmatism decreased in children with high astigmatism (À0.37 diopters [D]/y) and remained stable in children with little or no astigmatism (þ0.05 D/y). 7 From age 3 through 7 years, astigmatism decreased in children with both high astigmatism (À0.11 D/y) and low/no astigmatism (À0.03 D/y). 7 A detailed account of changes in astigmatism beyond age 7 years in this population has not yet been reported. However, a recent report on change in spherical equivalent (M) in a longitudinal sample of Tohono O'odham students ages 3 to 18 years showed that rate of change in M with age was significantly greater for children who were hyperopic (M ‡ þ2.00) prior to age 5.5 years, consistent with continued emmetropization into the school years. In addition, higher levels of refractive astigmatism were associated with predicted myopia onset (M À0.75 D) by age 18 years. 9 This relation, specifically the relation between keratometric and refractive (total) astigmatism, was originally described by Javal in 1890 10,11 : Refractive Astigmatism ¼ 1.25(Keratometric Astigmatism) À 0.50 D 3 90. A more recent empirically based modification of Javal's rule suggests that WTR and ATR refractive astigmatism can be predicted by subtracting an ATR constant (0.50 D) from the magnitude of keratometric astigmatism, with little or no adjustment based on magnitude of keratometric astigmatism. 10 Little is known about how the relation between keratometric and internal astigmatism changes with development in childhood. For example, it is not known if magnitude of AT

Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O’odham Students

Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd–8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: <1.00 D, moderate: 1.00 D to <3.00 D, and high: ≥3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 ± 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only (p=0.02) and with CI and AI (p=0.001) had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI

Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O&apos;odham Students

. Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd-8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: &lt;1.00 D, moderate: 1.00 D to &lt;3.00 D, and high: ≥3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 ± 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only ( = 0.02) and with CI and AI ( = 0.001) had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI

Visual Motor and Perceptual Task Performance in Astigmatic Students

. Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism &lt; 1.00 D, myopia &lt; 0.75 D, hyperopia &lt; 2.50 D, and anisometropia &lt; 1.50 D) or bilateral astigmatism group (right and left eye ≥ 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group ( = 0.829). Uncorrected astigmats had lower VMI scores than the control group ( = 0.038) and corrected astigmats ( = 0.007). Mean VMIp scores for uncorrected ( = 0.209) and corrected astigmats ( = 0.124) did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats ( = 0.003). Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction

Visual Motor and Perceptual Task Performance in Astigmatic Students

Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism = 1.00 D) based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) and Visual Perception (VMIp). Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88). Mean VMI score in corrected astigmats did not differ from the control group (p = 0.829). Uncorrected astigmats had lower VMI scores than the control group (p = 0.038) and corrected astigmats (p = 0.007). Mean VMIp scores for uncorrected (p = 0.209) and corrected astigmats (p = 0.124) did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats (p = 0.003). Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction.National Eye Institute/National Institutes of Health [U10-EY13153]; Research to Prevent BlindnessThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study

SIGNIFICANCE: Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States. PURPOSE: This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children. METHODS: Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics. RESULTS: The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years. CONCLUSIONS: The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.12 month embargo; first published April 2024This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Early Childhood Refractive Error and Parental History of Myopia as Predictors of Myopia

A child's refractive error in the first grade and the number of myopic parents can provide an indication of the child's risk for development of myopia; however, because the sensitivity of these predictive factors is low, they may not be sufficient at this young age in situations in which making a more accurate prediction of future onset is needed

Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia,” Invest

PURPOSE. To evaluate refractive error, axial length, and relative peripheral refractive error before, during the year of, and after the onset of myopia in children who became myopic compared with emmetropes. METHODS. Subjects were 605 children 6 to 14 years of age who became myopic (at least Ϫ0.75 D in each meridian) and 374 emmetropic (between Ϫ0.25 D and ϩ1.00 D in each meridian at all visits) children participating between 1995 and 2003 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Axial length was measured annually by A-scan ultrasonography. Relative peripheral refractive error (the difference between the spherical equivalent cycloplegic autorefraction 30°in the nasal visual field and in primary gaze) was measured using either of two autorefractors (R-1; Canon, Lake Success, NY [no longer manufactured] or WR 5100-K; Grand Seiko, Hiroshima, Japan). Refractive error was measured with the same autorefractor with the subjects under cycloplegia. Each variable in children who became myopic was compared to age-, gender-, and ethnicity-matched model estimates of emmetrope values for each annual visit from 5 years before through 5 years after the onset of myopia. RESULTS. In the sample as a whole, children who became myopic had less hyperopia and longer axial lengths than did emmetropes before and after the onset of myopia (4 years before through 5 years after for refractive error and 3 years before through 5 years after for axial length; P Ͻ 0.0001 for each year). Children who became myopic had more hyperopic relative peripheral refractive errors than did emmetropes from 2 years before onset through 5 years after onset of myopia (P Ͻ 0.002 for each year). The fastest rate of change in refractive error, axial length, and relative peripheral refractive error occurred during the year before onset rather than in any year after onset. Relative peripheral refractive error remained at a consistent level of hyperopia each year after onset, whereas axial length and myopic refractive error continued to elongate and to progress, respectively, although at slower rates compared with the rate at onset. CONCLUSIONS. A more negative refractive error, longer axial length, and more hyperopic relative peripheral refractive error in addition to faster rates of change in these variables may be useful for predicting the onset of myopia, but only within a span of 2 to 4 years before onset. Becoming myopic does not appear to be characterized by a consistent rate of increase in refractive error and expansion of the globe. Acceleration in myopia progression, axial elongation, and peripheral hyperopia in the year prior to onset followed by relatively slower, more stable rates of change after onset suggests that more than one factor may influence ocular expansion during myopia onset and progression. (Invest Ophthalmol Vis Sci

Visual Activity before and after the Onset of Juvenile Myopia

Before the onset of myopia, children's near work activities did not differ from those of emmetropes. Those who became myopic had fewer sports and outdoor activity hours than emmetropes had, before, at, and after myopia onset