Accommodation and pupil behaviour of binocularly viewing early presbyopes

Almutairi, Meznah S; Altoaimi, Basal H.; Bradley, Arthur

doi:10.1111/opo.12356

Cited by 15 publications

(21 citation statements)

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“…Studies assessing the effect of pupil size in pseudophakic visual performance tend to use a single measure of the pupil size performed monocularly with a pupillometer [22]. There are some important limitations in this approach with respect to visual assessment conditions since it accounts for neither binocularity nor object distance [23,24]. Recently, Almutairi et al [24] reported an average pupil decrease of 0.24 mm/D of stimulus vergence, in different age groups, including full presbyopes.…”

Section: Introductionmentioning

confidence: 99%

Pupil Function in Pseudophakia: Proximal Miosis Behavior and Optical Influence

et al. 2019

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The pseudophakic eye lacks the ability to produce a refractive change in response to object proximity. Thus, individual anatomical features such as the pupil size play an important role in achieving functional vision levels. In this work, the range of pupil sizes at varying object distance was measured in pseudophakic participants. Furthermore, the impact of the measured values on eye optical quality was investigated using a computer simulation model. A binocular eye-tracker was used to measure the participants’ pupil sizes at six object distances, ranging from 0.33 m (i.e., vergence of 3.00 D) to 3.00 m (i.e., vergence of 0.33 D), while observing a Maltese cross with a constant angular size of 1 ∘ . In total, 58 pseudophakic participants were enrolled in this study (age mean ± standard deviation: 70.5 ± 11.3 years). The effects of object distance and age on pupil size variation were investigated using linear mixed effects regression models. Age was found to have a small contribution to individual variability. The mean infinite distance pupil size (intercept) was 4.45 ( 95 % CI: 2.74, 6.17) mm and the mean proximal miosis (slope) was − 0.23 ( 95 % CI: −0.53, 0.08) mm/D. The visual acuity (VA) estimation for a distant object ranged from − 0.1 logMAR (smallest pupil) to 0.04 logMAR (largest pupil) and the near VA ( 0.33 m) when mean proximal miosis was considered ranged from 0.28 logMAR (smallest pupil) to 0.42 logMAR (largest pupil). When mean distance pupil was considered, proximal miosis individual variability produced a variation of 0.04 logMAR for the near object and negligible variation for the distant object. These results support the importance of distance pupil size measurement for the prediction of visual performance in pseudophakia, while suggesting that proximal miosis has a negligible impact in VA variability.

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Section: Introductionmentioning

confidence: 99%

Pupil Function in Pseudophakia: Proximal Miosis Behavior and Optical Influence

et al. 2019

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“…Also, the between subject accommodative response SDs with bilateral distance correction increased from 0.24 D before the response to 0.48 D after the 2.00 D far‐to‐near response. This increase is primarily due to between subject differences in accommodative response amplitudes (ranging from 0.40 D to 1.90 D, as anticipated in this age group …”

Section: Resultsmentioning

confidence: 96%

“…Both measures of refractive state were employed because estimates of accommodative response amplitude depend on the pupil weight used to determine refractive state . Measured refractive state at the spectacle plane was converted to the eye's entrance pupil plane using standard paraxial transfer equations and normalised to the refractive state required to focus the distant 2 m stimulus . Image quality was quantified using the AreaMTF metric, which unlike Strehl ratio based metrics, provides meaningful estimates of image quality in the presence of up to 2.00 D of defocus .…”

Section: Methodsmentioning

confidence: 99%

“…51 Measured refractive state at the spectacle plane was converted to the eye's entrance pupil plane using standard paraxial transfer equations and normalised to the refractive state required to focus the distant 2 m stimulus. 38 Image quality was quantified using the AreaMTF metric, which unlike Strehl ratio based metrics, provides meaningful estimates of image quality in the presence of up to 2.00 D of defocus. 50 Response latency was defined as the time at which changes in refractive state and pupil diameter reached two standard deviations above the mean of the pre-step responses.…”

Section: Aberrometry and Accommodation Measuresmentioning

confidence: 99%

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Impact of monovision on dynamic accommodation of early presbyopes

Almutairi

Altoaimi

Bradley

2019

Ophthalmic Physiologic Optic

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Purpose To examine the impact of monovision on dynamic changes in accommodation, pupil responses, spherical aberration and resultant image quality in early presbyopes. Methods Refractive state, pupil size and spherical aberration levels were monitored in nine early presbyopes who exhibited some accommodation (40–50 years, mean = 42 ± 2.37 years) using a Shack‐Hartmann aberrometer as a binocularly viewed stimulus stepped closer (from 2 m to 40 cm), or farther (from 40 cm to 2 m). Comparison data from two fully presbyopic (i.e. non‐accommodating) subjects (ages 46 and 61 years) and two young adults (ages 26 and 29 years) were also collected. Each subject was fit with four different refractive strategies: (1) both eyes corrected for 2 m, (2) both eyes corrected for 40 cm, (3) monovision with the measured right eye corrected for 2 m and, (4) monovision with the right eye corrected for 40 cm. Monochromatic image quality was quantified using the AreaMTF metric. Results When fit with monovision, the largest number of early presbyopes produce an accommodative response dominated by the right eye correction (distance or near) as the stimulus is abruptly changed from the retinal conjugate plane of one eye to that of the other eye. However, the accommodative responses in some early presbyopes were always dominated by the distance corrected eye, the near corrected eye, or by convergence. When the stimulus approached, the near corrected eye experienced high image quality only if there was no accommodative response. However, reduced image quality was observed if an accommodative response was initiated. Neither accommodation nor pupil response latencies were longer with monovision corrections compared with bilateral distance corrections (p > 0.05). In the early presbyopes, spherical aberration was reduced during near viewing, but primarily due to pupil miosis and not lens shape changes. Conclusion As the stimulus was abruptly changed from the retinal conjugate plane of the distance corrected eye to that of the near corrected eye, most early presbyopes fit with monovision accommodated, which resulted in a decline, not an increase in image quality in the near corrected eye. These results reveal a non‐optimal accommodative strategy in early presbyopes fit with monovision.

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“…measure these changes in slope using an objective double‐pass system and find that in younger adults the slope remains almost constant up to the age of 35 and declines steadily thereafter. Almutairi et al . also measure the response/stimulus curve, together with the pupil diameter, of subjects between the ages 27 and 60 years.…”

Section: Changes In Refraction and Accommodation Performance With Agementioning

confidence: 99%

Virtual Issue Editorial: Presbyopia – grappling with an age‐old problem

Charman

2017

Ophthalmic Physiologic Optic

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Accommodation and pupil behaviour of binocularly viewing early presbyopes

Cited by 15 publications

References 50 publications

Pupil Function in Pseudophakia: Proximal Miosis Behavior and Optical Influence

Pupil Function in Pseudophakia: Proximal Miosis Behavior and Optical Influence

Impact of monovision on dynamic accommodation of early presbyopes

Virtual Issue Editorial: Presbyopia – grappling with an age‐old problem

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