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- W1994459611 abstract "A 3-year-old boy with Marfan’s syndrome presented with poor vision. The cycloplegic refraction was +0.25 cyl −3.0 ax 180° right eye (RE) and −0.25 cyl −2.5 ax 10° left eye (LE) using skiascopy and atropine. Visual acuity (VA) was 0.3 bilaterally. Lenses were subluxated superonasally, slightly more so in the LE (Fig. 1A,B). Media were clear and fundi were normal. Autorefractometry was unrecordable in the LE; thus, the refraction was measured subjectively and by skiascopy. VA at age 3 years 6 months was 0.5 x +0.25 cyl −3.0 ax 180° RE and 0.4 x −0.25 cyl −2.5 ax 10° LE. Spectacles were prescribed based on the full correction; these were represcribed at age 5. At age 6 years 6 months, VA was 0.9 x −5.5 cyl −2.5 ax 160° RE but 0.5 x −2.75 cyl −4.0 ax 45° LE. (A,B) Subluxation of both lenses superonasally, slightly more so in the left eye. (A) Right eye. (B) Left eye. (C,D) Point spread function (PSF) images. (C) Left eye. The astigmatism is −9.0 D, as estimated from the refractive positions between the focal lines. A single-pass image after refractive correction reveals a high-contrast image. (D) Right eye. No evident focal lines are observed in the double-pass images. A single-pass image reveals asymmetric components of aberration. (E,F) Simulated retinal images of Landolt’s rings and contrast after refractive correction. Visual acuity (VA) is predicted from the simulated retinal images and from the point of intersection of the contrast of the simulated retinal images and the threshold of perception. (E) Left eye. The predicted VA is 1.0. (F) Right eye. Simulated retinal images show lower contrast compared to the left eye. The predicted VA is slightly below 1.0. Parental consent was obtained for further optical evaluation, and point spread function (PSF) analysis was performed at age 7 years 5 months using a PSF analyser (PSFA) (prototype model; Topcon, Tokyo, Japan) (Kobayashi et al. 2004; Shibutani et al. 2004) under cycloplegia induced with cyclopentolate. By adjusting the position of the collimating lens and the focusing lens, double-pass images were recorded at 0.25- D increments bilaterally using equal-sized apertures of 4 mm and unequal apertures of 1.5 mm and 4 mm (Fig. 1C,D). The spherical power is obtained from the moving range of these lenses. The cylindrical power is obtained from the disparity of the refractive positions between the anterior and posterior focal lines. The single-pass image is calculated mathematically from the double-pass images (Artal et al. 1995). By a convolution process of the single-pass image with images of the original Landolt’s rings, the retinal images of the Landolt’s rings after full refractive correction – namely the simulated retinal images – are obtained. VA can then be predicted from the simulated retinal images or further by plotting the contrast of the simulated retinal images horizontally and vertically and calculating the point of intersection with the threshold of perception (Fig. 1E,F) – a method that we have described previously (Kobayashi et al. 2004), as based on the original design by Campbell & Green (1965). In the LE, the spherical power was approximately −6.0 D. Focal lines were apparent, and the astigmatism was estimated to be −9.0 D. The single-pass image and the simulated retinal images after correction of −9.0 D showed high contrast, indicating only symmetrical components of aberration (Fig. 1C,E). The predicted VA was 1.0 (Fig. 1E). After wearing spectacles (−6.0 D cyl −7.0 ax 30°) based on PSF analysis, with the maximum cylindrical power commercially possible along with 3 hr of daily occlusion of the fellow eye, the VA of 1.0 was achieved in 9 months – as predicted using the PSFA. In the RE, the spherical power was approximately −9.0 D. No evident focal lines were observed, indicating less astigmatism, but the single-pass image and the simulated retinal images disclosed asymmetric components of aberration apparently uncorrectable by spectacles (Fig. 1D,F). The predicted VA was slightly below 1.0 (Fig. 1F), which was in agreement with the recent VA of 0.9 x −9.5 cyl −2.0 ax 160°. PSF analysis is advantageous over other conventional refractive measurements. Firstly, astigmatism over 6 D is unmeasurable by autorefractometry or wavefront aberrometry. Skiascopy facilitates refractive measurement in infants and can measure astigmatism exceeding 6 D; however, with distorted ocular optics, for example, large variability in the refractive error may result according to the optical area measured, necessitating extra skills. However, refractive measurements using the PSFA can be performed objectively without special skills. Secondly, asymmetric aberrations cannot be measured by autorefractometry or skiascopy. In contrast, the PSFA can simulate the retinal images including the effect of asymmetric aberrations (Kobayashi et al. 2004; Shibutani et al. 2004). Thirdly, the PSFA can predict retinal image quality even in an eye with intermediate opacity such as cataract (Negishi et al. 2006) (although the present case was not such an example). This information is not obtainable with either wavefront aberrometry or autorefractometry. We report the first clinical application of the PSFA in a child with ectopia lentis. Detailed estimation of optical function and refractive error using the PSFA can preserve vision in children with complicated aberrations caused by distorted lenses and may prevent unnecessary surgery. Practical application of the PSFA for paediatric eyes in general can be considered, especially when subjective examinations are difficult to perform. This study was presented in part at the annual meeting of The Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, USA on 28 April 2004. This work was supported in part by a grant (H12Kankakuki011) for Research on Sensory and Communicative Disorders from the Ministry of Health, Labour and Welfare of Japan. The authors M.S., K.K. and G.T. are employees of Topcon." @default.
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- W1994459611 title "Point spread function analysis in a child with ectopia lentis: objective optical function evaluation and correction of refractive errors" @default.
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- W1994459611 doi "https://doi.org/10.1111/j.1755-3768.2008.01296.x" @default.
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