PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from −6.00 to −12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.
Cross-Sectional Studies ; Emmetropia ; Female ; Humans ; Institute of Medicine (U.S.) ; Lions ; Male ; Myopia ; Ophthalmoscopy ; Optic Disk ; Optic Nerve ; Retinaldehyde

PURPOSE: To evaluate the clinical features of children with high hyperopia weaning with age. METHODS: The medical records of 203 children wearing spectacles due to hyperopia of +4.00 diopters (D) or greater in at least one eye based on the cycloplegic refraction and with follow-up for 3 years or more were reviewed. The patients were divided into those who showed a decrease in the spherical equivalent (SE) of 1.50 D or greater and those who maintained. The age of wearing spectacles, the magnitude of hyperopia, the angle of deviation, the ratio of accommodative-convergence to accommodation (AC/A), and the frequency of amblyopia and anisometropia were compared. RESULTS: Forty seven patients with decreased hyperopia and 156 patients with sustained hyperopia were included. The decreased-group started to wear spectacles later than the sustained-group (5.0 ± 2.3 years vs. 4.1 ± 2.4 years). The mean SE of the hyperopic eye in the decreased-group was significantly greater at the initial visit than in the sustained-group (6.29 ± 2.18 D vs. 5.47 ± 1.38 D); was identical at the 1 year follow-up (4.83 ± 1.72 D vs. 4.89 ± 1.55 D); and significantly lower at the last follow-up (3.15 ± 1.72 D vs. 4.65 ± 1.56 D). In the decreased-group, the mean hyperopia of 3.14 ± 2.02 D decreased during a mean period of 3.9 years, especially during the first year after spectacle correction. At baseline, the frequency and angle of esotropia at both distant and near with/without hyperopic correction was significantly larger in the sustained-group. The frequency of amblyopia and anisometropia and the AC/A were identical between the two groups, while the frequency of amblyopia at the last follow-up was significantly lower in the decreased-group. CONCLUSIONS: Some patients with hyperopia of +4.00 D or greater who had none or a small angle of esotropia and improved amblyopia showed a decrease in hyperopia with age.
Amblyopia ; Anisometropia ; Child ; Emmetropia ; Esotropia ; Eyeglasses ; Follow-Up Studies ; Humans ; Hyperopia ; Medical Records ; Weaning

PURPOSE: To evaluate the clinical features and treatment outcomes of smartphone overusers with acute acquired comitant esotropia. METHODS: We retrospectively reviewed the medical records of patients ≥ 15 years of age who used a smartphone for > 4 hours a day for > 1 year, and who were diagnosed with acute acquired comitant esotropia from May 2011 to January 2016. We analyzed sex, age at the time of manifestation and duration of esotropia, refractive error, deviated angle at the first and final visits, and the results of refraining from smartphone use, use of the Fresnel prism, and surgery for esotropia. RESULTS: A total of 13 patients were studied, including 8 males and 5 females. The mean age at development of esotropia was 22.7 ± 9.7 years. The mean duration of esotropia before the first visit was 28.0 ± 33.0 months, and the mean follow-up period was 16.4 ± 16.4 months. The mean angle of esotropia was 21.8 ± 7.0 prism diopters (PD) at distance and 22.2 ± 7.9 PD at near. There were eight myopic patients; the other patients were emmetropia. The esotropia of all patients did not improve after refraining from smartphone use. There was no improvement in five patients who were wearing the Fresnel prism for ≥ 4 months. A total of six patients were treated with bilateral medial rectus recession; only one patient remained orthotropic at postoperative 6 months, three patients were undercorrected, and two had a recurrence. CONCLUSIONS: Esotropia persisted after refraining from smartphone use or wearing a Fresnel prism in acute acquired comitant esotropia patients who were smartphone overusers, and the surgical prognosis of these patients was relatively poor.
Emmetropia ; Esotropia ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Prognosis ; Recurrence ; Refractive Errors ; Retrospective Studies ; Smartphone

PURPOSE: To evaluate the anterior segment biometric parameters of non-accommodative and accommodative refractive accommodative esotropia (RAE). METHODS: Eighty-one eyes of 81 patients were included in this prospective, case-control study. The patients were divided into three groups as follows: the RAE group (n = 31), the hypermetropia group (n = 25), and the emmetropia group (n = 25). Measurements were obtained in the non-accommodative (0.0 diopters) and accommodative status (-5.0 diopters) using a Pentacam HR. The anterior chamber depth (ACD), anterior chamber volume (ACV), pupil diameter (PD), and anterior chamber angle (ACA) were evaluated at all four quadrants. RESULTS: The ACD, ACV and PD values in the RAE group were lower than those of the other groups in both states (p < 0.05). The ACD values were lower in the hypermetropia group than in the emmetropia group for the non-accommodative status (p = 0.024) but were similar for the accommodative status (p = 0.225). PD and ACV values were lower in the hypermetropia group than in the emmetropia group in both states (non-accommodative status, p = 0.011 and p = 0.022; accommodative status, p = 0.026 and p = 0.034, respectively). Changes in ACD, ACV and PD during accommodation (Δ) were not significant in the RAE group but were significant for the other groups (hypermetropia: ΔACD, p = 0.001; ΔACV, p = 0.001; ΔPD, p = 0.002; emmetropia: ΔACD, p < 0.001; ΔACV, p = 0.001; ΔPD, p < 0.001). These changes were significantly lower in the hypermetropia group than in the emmetropia group (ΔACD, p = 0.012; ΔACV, p = 0.031; ΔPD, p = 0.034). CONCLUSIONS: The anterior chamber in RAE patients was shallower and the increase in convexity of the anterior surface or forward movement of the crystalline lens was more limited during accommodation in RAE.
Anterior Chamber ; Case-Control Studies ; Emmetropia ; Esotropia ; Humans ; Hyperopia ; Lens, Crystalline ; Prospective Studies ; Pupil

PURPOSE: To assess choroidal thickness (CT) variation according to refractive errors using enhanced-depth imaging optical coherence tomography. METHODS: Eighty-nine eyes (in 89 children) <±6 diopter were categorized into three groups: hyperopia, emmetropia, and myopia, according to refractive error, and underwent choroidal scans using enhanced-depth imaging-optical coherence tomography. CT was measured at the fovea and at 1 mm and 3 mm nasal (N1 and N3), temporal (T1 and T3), superior (S1 and S3), and inferior (I1 and I3) from the fovea. RESULTS: Mean foveal CTs were 346.86 µm, 301.97 µm, and 267.46 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). CTs at N3 and T3 were 214.59 µm and 318.68 µm, 163.92 µm and 320.79 µm, and 153.93 µm and 295.61 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). All CTs in the hyperopia group were thicker than those of other groups (p < 0.05). Fovea was thickest and was significantly thicker than at N3 and I3 in hyperopia (p < 0.05). T3 thickness in the emmetropia and myopia groups was greater than thickness at other areas, particularly the nasal and inferior choroids (p < 0.05). CT was positively correlated with spherical equivalent (p = 0.029). CONCLUSIONS: In Korean children, CTs were greater in the hyperopia group than in the emmetropia and myopia groups. The temporal choroid was thicker than the nasal choroid, regardless of the refractive error. The thickest location in the hyperopia group was the fovea; however, the temporal choroid was thickest in the emmetropia and myopia groups.
Child* ; Choroid* ; Emmetropia ; Humans ; Hyperopia ; Korea ; Myopia ; Refractive Errors* ; Tomography, Optical Coherence

PURPOSE: To investigate the degree, distribution, and change in refractive error in the pediatric population 5 to 20 years of age. METHODS: We collected data from 7,695 subjects aged 5 to 20 years who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2012. Non-cycloplegic refractive error was measured using an autorefractor. Mean spherical equivalent calculated from the measured refractive error data in both eyes was used. The subjects were categorized into mild, moderate, or high refractive abnormality or emmetropia according to the degree of refractive error. The degree and distribution of refractive error in all subjects and age-matched subjects were analyzed. The change in refractive error was analyzed according to age. RESULTS: Mean refractive error of the study subjects was -1.82 diopters. As subject age increased, myopia increased from +0.04 diopters at 5 years of age to -2.88 diopters at 20 years of age. Myopia was observed in 66.2% of subjects and accounted for only 18.5% of the 5-year-old subjects, but increased to 84.3% in the 20-year-old subjects. The rate among all study subjects was -0.19 diopters per year. The greatest myopic progression rate (-0.46 diopters per year) among all age groups was in subjects 7 to 9 years of age. Myopic progression continued until 16 years of age. CONCLUSIONS: The ratio of pediatric myopia subjects between 5 and 20 years of age was high in Korea. The rate of myopic progression was the fastest in subjects 7 to 9 years of age. After 16 years of age, myopic change paused.
Child, Preschool ; Emmetropia ; Humans ; Korea* ; Myopia ; Nutrition Surveys* ; Refractive Errors ; Young Adult

PURPOSE: In this study, the visual performance and patient satisfaction one year after monovision cataract surgery and the results after 2 months. METHODS: Thirty patients who had bilateral cataract surgery between February 2010 and January 2014 treated with monovision therapy and received postoperative examinations for at least one year after surgery were enrolled in the present study. The eye with the more severe cataract had the surgery first and was corrected for distance vision targeted at emmetropia. The fellow eye was operated for near vision targeted to -1.50~-2.50 diopter (D) range considering the patient's need for near task and preoperative refractive errors 2-4 weeks after the first operation. Binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), spherical equivalent, anisometropia, stereopsis, patient satisfaction for far and near distance, and spectacle dependence were evaluated preoperatively and two months and one year postoperatively. RESULTS: The mean age of patients was 71.9 years. Two months and one year after the surgery, the binocular UCDVA (log MAR) were 0.03 ± 0.10 and 0.08 ± 0.14, UCNVA were 0.21 ± 0.15 and 0.25 ± 0.14, anisometropia were 1.28 ± 0.68 and 1.29 ± 0.76 D, and stereopsis were 301.67 ± 251.28 and 251.67 ± 269.28 arcsec, respectively. One year after the surgery, the number of patients answering ‘Better’ or ‘Much better’ for distant vision was 27 (90%) and for near vision 22 (73.3%); 11 patients (36.7%) answered ‘Not dependent on spectacles at all’. CONCLUSIONS: Monovision is an effective method to correct presbyopia after bilateral cataract surgery. Visual performances and patient satisfaction at one year after cataract surgery were not different compared with those at two months.
Anisometropia ; Cataract* ; Depth Perception ; Emmetropia ; Eyeglasses ; Humans ; Methods ; Patient Satisfaction ; Presbyopia ; Refractive Errors ; Telescopes ; Visual Acuity

PURPOSE: To investigate the shape of normal fovea in Korean subjects in their 20's using spectral domain optical coherence tomography (SD-OCT). METHODS: One hundred-twelve emmetropic eyes of 60 subjects and 100 myopic eyes of 58 subjects between 20 and 29 years of age were included in this study. Central foveal thickness (CFT), regional maximal retinal thickness (MRT), pit diameter, pit depth, and slope were obtained using Spectralis OCT and analyzed according to spherical equivalent and gender. RESULTS: In emmetropic and myopic eyes, MRT was significantly thinner temporally (p < 0.001) than in other regions and pit diameter was wider horizontally than vertically (p < 0.001). The CFT was significantly thicker and all regional MRT was thinner in myopic eyes than in emmetropic eyes (p < 0.001). Foveal pits were narrower and shallower in myopic eyes (p < 0.001). In both groups, CFT and all regional MRT in males were significantly thicker than in females (p < 0.05); however, no difference between the genders in horizontal pit diameter, pit depth, and slope were found. CONCLUSIONS: In normal subjects, statistically significant differences were found in foveal shapes between subjects with different spherical equivalent and gender. These differences should be considered when interpreting a foveal shape. Knowledge of the normal foveal morphology is important when conducting further macular studies.
Emmetropia* ; Female ; Humans ; Male ; Myopia* ; Retinaldehyde ; Tomography, Optical Coherence*

PURPOSE: To investigate the epidemiology of contact lens (CL)-related complications in Korea. METHODS: A questionnaire regarding CL-related complications including patient's gender, age, causative factors, and signs and symptoms was distributed to members of the Korean Ophthalmological Society by The Korean Contact Lens Study Society and the results of the questionnaire analyzed. RESULTS: Responses to the questionnaire written by ophthalmologists from 22 institutes and clinics were collected from 499 subjects over a 20-month period starting in October 2008 and analyzed. The mean age of respondents was 22.9 years and the male-to-female ratio was 1:8.1. The soft CL and cosmetic colored lens comprised the majority (46.6% and 42.1%, respectively) of the reported cases, followed by the rigid gas permeable lens (RGP lens; 10.6%) and orthokeratology lens (0.8%). In subjects using a cosmetic colored lens, 62.2% showed emmetropia and 89.1% of the lenses were prescribed by opticians. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, conjunctival injection, corneal ulcer, and dry eye syndrome. The most common causative factor of complications was excessive lens wear. Comparing main causative factors according to the RGP lens prescriber, the most common factor was poor lens fit. CONCLUSIONS: The number of cosmetic colored lens-related complications in the emmetropic eyes of young patients is increasing rapidly. Considering opticians are the main CL prescribers in CL-related complications, Korean ophthalmologists need to pay more attention to CL fitting and constant education of patients regarding proper CL wear and care.
Academies and Institutes ; Conjunctival Diseases ; Corneal Ulcer ; Surveys and Questionnaires ; Dry Eye Syndromes ; Emmetropia ; Epidemiology ; Humans ; Korea* ; Patient Education as Topic

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.
Emmetropia ; Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Lenses, Intraocular ; Patient Satisfaction ; Photorefractive Keratectomy ; Pupil ; Surveys and Questionnaires ; Refractive Surgical Procedures* ; Visual Acuity