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Accommodative lag, peripheral aberrations, and myopia in children

Berntsen, David A.
http://rave.ohiolink.edu/etdc/view?acc_num=osu1243829481

Abstract Details

2009, Doctor of Philosophy, Ohio State University, Vision Science.
A two-year, double-masked, randomized clinical trial of myopic children 6 to 11 years old is being conducted using progressive addition lenses (PALs) to evaluate two theories of juvenile-onset myopia progression. Eligible children had a high accommodative lag and either: (1) low myopia (less myopic than –2.25 D spherical equivalent) or (2) high myopia (more myopic that –2.25 D spherical equivalent) with esophoria at near. The accommodative lag theory hypothesizes that hyperopic retinal blur drives myopia progression. The mechanical tension theory hypothesizes that ciliary-choroidal tension created by the ocular components restricts equatorial expansion and causes axial elongation in people with factors that produce a large globe. To test between these theories, children were randomly assigned to wear either PALs with a +2.00-D add or single vision lenses (SVLs) for one year to achieve a reduction in myopia progression in the PAL group relative to the SVL group. All children then wear SVLs for the second year to evaluate the permanence of the treatment effect; a maintained treatment effect supports the lag theory, while a rebound supports mechanical tension. The primary outcome is central cycloplegic autorefraction. Complete ocular biometric data are being collected at six-month intervals. Over 17 months, 192 children were screened, and 85 (44%) were eligible and enrolled. The mean age (± SD) was 9.3 ± 1.4 years. The mean accommodative lag was 1.71 ± 0.37 D, and 54 children (64%) were esophoric at near. The mean cycloplegic spherical equivalent refractive error and axial length were –1.95 ± 0.78 D and 24.17 ± 0.80 mm, respectively. Baseline characteristics of the children enrolled are described. Because the clinical trial is ongoing, all findings are confidential. Aberrometry-based relative peripheral refraction measurements were validated against measurements made with an autorefractor. A method of analyzing peripheral aberration data collected from a dilated pupil was validated. A single-value metric of image quality was calculated to describe retinal image quality centrally and in four peripheral locations. When including only higher-order aberrations, image quality was best centrally and decreased in the periphery. When relative peripheral refractive error was included with higher-order aberrations, more significant reductions in peripheral retinal image quality were present, and the greatest reductions were in the temporal and superior retina where astigmatism was highest. Baseline and six-month accommodative lag data from children in the study were analyzed. Children still had a significant lag of accommodation for a 4-D stimulus when tested wearing a +2.00 D bifocal add. No evidence of an effect of bifocal adaptation on accommodative lag was found. Children with greater myopia progression over the previous six months exhibited higher accommodative lags when tested with their full manifest correction. Myopia progression had no effect on accommodative lag when testing was performed with the child’s habitual correction. These data suggest that a child’s accommodative lag should be measured with both the full manifest and habitual corrections if attempting to relate the retinal blur experienced by the child to his or her myopia progression.
Karla Zadnik, OD, PhD (Advisor)
Donald O. Mutti, OD, PhD (Advisor)
Nicklaus Fogt, OD, PhD (Committee Member)
287 p.
Optics
juvenile-onset myopia; relative peripheral refraction; peripheral aberrations; accommodative lag; bifocal; progressive addition lens; image quality

Recommended Citations

Citations

  • Berntsen, D. A. (2009). Accommodative lag, peripheral aberrations, and myopia in children [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1243829481

    APA Style (7th edition)

  • Berntsen, David. Accommodative lag, peripheral aberrations, and myopia in children. 2009. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1243829481.

    MLA Style (8th edition)

  • Berntsen, David. "Accommodative lag, peripheral aberrations, and myopia in children." Doctoral dissertation, Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1243829481

    Chicago Manual of Style (17th edition)

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© 2009, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.