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J Opt om. 2011;4(1):30-34
Journal
of
Optometry
P e e r- r e v i e w e d J o u r n a l o f t h e
Spanish General Council of Optometry
ISSN: 1888-4296
Journal
of
Optometry
January-March 2011
| Vo l . 4 | n . 1
Editorial
1
Two-year retrospective analysis of the international impact of Journal of Optometry: part II
José Manuel González-Méijome, Robert Montés-Micó, César Villa-Collar
Case report
4
Contact lens intolerance: reitting with dual axis lens for corneal refractive therapy
9
Comparison between the preferential hyperacuity perimeter and the Amsler grid to detect
age-related macular degeneration and Stargardt’s disease
María López-López, José Miguel Pelegrín-Sánchez, Paloma Sobrado-Calvo, Diego García-Ayuso
Original Articles
Eva Chamorro, Juan Cedrún, Isabel Portero
14
Peripheral myopization using a dominant design multifocal contact lens
Daniela Lopes-Ferreira, Cláudia Ribeiro, Raquel Maia, Nery García-Porta, António Queirós,
César Villa-Collar, José Manuel González-Méijome
22
Efect of lens diameter on lens performance and initial comfort of two types of GP lenses
for keratoconus: a pilot study
30
A simple clinical test for perception of progressive addition lens peripheral image blur.
A pilot study
Luigiana Sorbara, Katrin Mueller
Technical report
Alan Kwok-Hei, Cindy Sin-Ting Chung, Terence Wai-Keung Kwok
www.elsevier.es/ opt omet ry
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TECHNICAL REPORT
A simple clinical test for perception of progressive addition lens
peripheral image blur. A pilot study
Alan Kwok-Hei Moka,b, *, Cindy Sin-Ting Chunga, Terence Wai-Keung Kwoka
a
Eye’ ni, Hong Kong SAR, China
Depart ment of Anat omy, Facult y of LKS Medicine, The Universit y of Hong Kong, Hong Kong, China
b
Received June 5, 2010; accept ed July 5, 2010
KEYWORDS
Progressive addit ion
lens;
Image blur;
Trial lens;
Ast igmat ism;
Polat est
Abstract
Purpose: To int roduce a simple met hod for subj ect ive percept ion of progressive addit ion lens (PAL)
peripheral image blur (PIB). The amount s of PIB induced by t radit ional PAL t rial lenses (plano
dist ant PAL, TPAL) and prescript ion PAL (FPAL) were also evaluat ed.
Met hods: Subj ect s wearing t he PALs adj ust ed t heir heads lat erally t o view t he fi xat ion t arget for
PIB percept ion. 38 subj ect s were randomized and recruit ed from t he Eye’ ni opt ical shop. Out comes
were assessed by t he high-cont rast visual acuit y chart (LogMAR scal e), and by subj ect ivel y
indicat ing t he magnit ude of PIB on a scale of 0 t o 10 (10 is ext remely blur) using ast igmat ism-sensit ive
opt ot ype (Polat est ®, Carl Zeiss Vision, Germany).
Resul t s: Visual acuit ies (mean ± SD) at t he cent ral and t emporal f ixat ions were measured at
0 ± 0.03 and 0.2 ± 0.04 wit h FPAL, and 0 ± 0.03 and 0.1 ± 0.03 wit h TPAL respect ively. Signifi cant ly
lower visual acuit ies were found wit h t he t emporal fi xat ion t han wit h t he cent ral fi xat ion in bot h
PALs (p < 0.001). And signifi cant even reduct ion at t he t emporal fi xat ion wit h FPAL t han wit h TPAL
was observed (p < 0.001). For subj ect ive measures of PIB using ast igmat ism-sensit ive opt ot ype,
t he average score of FPAL (7.4 ± 0.8, ranged 5-9) was found st at ist ically higher t han t hat of TPAL
(6.7 ± 0.8, ranged 4-8) (p < 0.01).
Conclusions: Our proposed simple clinical met hod appears t o facilit at e PAL peripheral image blur
demonst rat ion, which may help pot ent ial PAL wearers t o effect ively experience t he peripheral PAL
image blur. Opt icians may caut ion t he pot ent ial PAL wearers t hat prescript ion PAL may induce
more peripheral image blur t han t hat wit h t he t radit ional dist ant plano PAL t rial lenses.
© 2010 Spanish General Council of Opt omet ry. Published by Elsevier España, S.L. All right s reserved.
*Corresponding aut hor. A.K. Mok. Eye'ni, G/ F 63 Lee Garden road, Causeway Bay, Hong Kong, China
E-mail address: [email protected] (A.K. Mok).
1888-4296/ $ - see front mat t er © 2010 Spanish General Council of Opt omet ry. Published by Elsevier España, S.L. All right s reserved.
A simple clinical t est for percept ion of progressive addit ion lens peripheral image blur. A pilot st udy
PALABRAS CLAVE
Lent e de adición
progresiva;
Desenfoque de
imagen;
Lent e de prueba;
Ast igmat ismo;
Polat est
31
Prueba clínica simple para percibir el desenfoque de la imagen periférica de las lentes
de adición progresiva. Estudio preliminar
Resumen
Obj et ivo: Present ar un mét odo simple para la percepción subj et iva del desenfoque periférico de
la imagen (DPI) de las lent es de adición progresiva (LAP). También se evaluó la cant idad de DPI
inducido por las lent es de prueba LAP t radicionales (LAP planas dist ant es, TPAL) y las LAP graduadas (FPAL).
Mét odos: Suj et os con LAP aj ust aron la cabeza lat eralment e para mirar el obj et o de fi j ación con el
fi n de percibir el DPI. Se incluyeron y aleat orizaron 38 suj et os de la ópt ica Eye’ ni. Los result ados
se evaluaron mediant e el gráfi co de agudeza visual de alt o cont rast e (escala LogMAR) e indicando
de manera subj et iva la magnit ud del DPI sobre una escala de 0 a 10 (10 equivalía a desenfoque
ext remo) ut ilizando un opt ot ipo apt o para det erminar el ast igmat ismo (Polat est ®, Carl Zeiss Vision, Alemania).
Result ados: Las agudezas visuales (media ± DE) en las fi j aciones cent ral y t emporal se midieron a
0,00 ± 0,03 y 0,20 ± 0,04 con FPAL, y a 0,00 ± 0,03 y 0,10 ± 0,03 con TPAL, respect ivament e. En
ambas LAP se observaron agudezas visuales signifi cat ivament e inferiores con la fi j ación t emporal
que con la fi j ación cent ral (p < 0,001). Asimismo, se observó una reducción signifi cat iva const ant e
en la fi j ación t emporal con FPAL en comparación con TPAL (p < 0,001). Para las mediciones subj et ivas del DPI ut ilizando un opt ot ipo apt o para det erminar el ast igmat ismo, la punt uación media de
la FPAL (7,4 ± 0,8; int ervalo, 5-9) fue est adíst icament e mayor que la de la TPAL (6,7 ± 0,8; int ervalo, 4-8) (p < 0,01).
Concl usiones: Aparent ement e, nuest ra propuest a de mét odo clínico simple facilit a la demost ración del desenfoque periférico de la imagen de las LAP, lo que podría ayudar a posibles candidat os
para LAP a experiment ar de manera efi caz el desenfoque periférico de la imagen de LAP. Los ópt icos pueden advert ir a los posibles usuarios de LAP que las LAP graduadas pueden inducir más
desenfoque periférico de la imagen que las lent es de prueba LAP planas dist ant es t radicionales.
© 2010 Spanish General Council of Opt omet ry. Publicado por Elsevier España, S.L. Todos los derechos
reservados.
Introduction
Pr ogr essi ve addi t i on l ens (PAL) ar guabl y i s one of t he
ef f ect i ve management s of pr esbyopi a nowadays. The
primary complicat ions of PAL is t he presence of peripheral
undesirable ast igmat ism, which is induced by t he cont inuous
change i n power t hr ough t he l ens. 1, 2 Cont our pl ot s of
ast igmat ism and mean add power are t he most common
measures of t he peripheral undesirabl e ast igmat ism. 3-5
Subj ect ive assessment 6-8 is a crit ical t est since wearers
woul d j udge di r ect l y t he vi si on qual i t y of t he PAL i n
combi nat i on wi t h t hei r eyes. Per i pher al undesi r abl e
ast igmat ism wil l adversel y degrade t he vision, and PAL
wearers may be aware of t he lat eral blur which may affect
t he success of t he adapt at ion process. Most pot ent ial PAL
wearers, especi al l y t he f i rst t i me PAL wearers, sel dom
experience of such peripheral image blur. Thus we propose
a simple clinical met hod t o f acilit at e t he PAL peripheral
i mage bl ur demonst r at i on f or t hese peopl e. The mai n
advant age of t his clinical met hod is t o aid pot ent ial PAL
wearers t o acquire t he PAL peripheral image blur in order t o
advance t he success of adapt at ion. To best of my knowledge,
no similar clinical met hod has been proposed. Under our
proposed met hod, subj ect t urns his head lat erally and looks
at t he f ixat ion t arget such as t he ast igmat ism sensit ive
opt ot ype or visual acuit y chart t hrough t he PAL periphery t o
perceive t he peripheral PAL image blur. On t he ot her hand,
some opht halmic lens companies may provide some PAL t rial
lenses, normally are plano-dist ance wit h various addit ion
PALs, for pot ent ial PAL wearers t o experience t he PAL opt ical
char act er i zat i on. However, t hese PAL t r i al l enses ar e
considered incapable of simulat ing comprehensively t he
opt i cs of a PAL desi gn across t he spect rum of di st ance
prescri pt i ons. In t hi s pi l ot st udy, we al so eval uat e t he
degrees of peripheral image blur bet ween t radit ional plano
dist ance PAL t rial lenses (TPAL) and prescript ion PAL (FPAL)
using our proposed clinical met hod.
Methods
Subjects
This is a single cent re randomized cont rolled pilot st udy.
Thirt y-eight subj ect s, t went y men and eight een women,
were recruit ed from t he Eye’ i opt ical shop. Subj ect s were
select ed by t hree opt omet rist s, who commit t ed t o inf orm
pat ient s, check select ion crit eria, obt ain informed consent
and col l ect i nf or mat i on. Al l subj ect s wer e pr esbyopi c
(46 ± 2 years old) and all were not PAL wearers. Refract ive
error ranged from —3.00 t o —6.00 D sphere wit h lower t han
—0.50 D cylindrical power (mean ± SD, SE —3.90 ± 0.36 D).
Only right eye was assessed. All subj ect s were screened and
enrolled from March t o May 2009.
32
A.K. Mok et al
PAL trial lenses
We have our own set of 36 mm di amet er f ul l apert ure
mult i-coat ing crown glass (n = 1. 52) general-purpose PAL
t ri al l enses (Gradaul Top ®, Carl Zei ss Vi si on, Germany,
spherical power: plano, —3.00 t o —6.00 wit h —0.25 per st ep
wit h addit ions of +2. 00 D) (Figure 1). Since t he amount
per i pher al i mage bl ur i s di r ect l y pr opor t i onal t o t he
addit ion, higher addit ion (+2. 00 D) is adopt ed f or bet t er
t r ends i n i mage bl ur per cept i on. Two PAL t r i al f r ames
(Fi gure 2) were prepared wi t h t wo di f f erent t ri al l ens
syst ems (combinat ion of plano dist ance PAL and spherical
power si ngl e vi si on l ens f or TPAL, and combi nat i on of
spherical power dist ance PAL and plano power single vision
lens f or FPAL). The sequence of t he dual lenses mount ed
was t hat PAL (plano-dist ance or spherical power dist ance)
was pl aced cl ose t o t he eye, and singl e vision l ens was
mount ed in front of t he PAL lens. Pant oscopic t ilt angle and
back ver t ex di st ance of t r i al f r ame wer e adj ust ed t o
10 degrees and 12 mm respect ively. Subj ect ’s pupil cent er
was mat ched exact ly wit h t he PAL fi t t ing point .
Fixation targets
Figure 1
PAL t rial lens.
Two f i xat i on t ar get s, ast i gmat i sm-sensi t i ve opt ot ype
(Figure 3) and high-cont rast visual acuit y were employed in
t his st udy. The fi xat ion t arget was proj ect ed by Carl Zeiss
vision Polat est ® visual t est ing equipment at a dist ance of
f our met ers. The ast igmat ism-sensit ive opt opt ype, which
was a pat t ern of high cont rast dark 9 mm diamet er dot s
against t he whit e background, was designed specifi cally for
cylindrical power and axis assessment s. For visual acuit y
assessment , hi gh cont rast numeral s were present ed i n
LogMAR scale.
Clinical procedure for perception of PAL peripheral
image blurs
Figure 2
PAL t rial frames.
To perceive t he peripheral image blur, subj ect wearing t he
PAL t rial frame was inst ruct ed t o t urn t he head lat erally t o
l ef t t o view t he f ixat ion t arget t hrough l ens periphery.
Test ed region was locat ed at 15 mm t emporally along t he
line of t he PAL fi xat ion cross, equivalent t o about 30 degrees
t empor al l y. The t est ed zone was mar ked of f as 4 mm
diamet er circle. To ensure adequat e blinding t he equipment
provided t o t he pat ient s was st rict l y simil ar, same t rial
f rame and t ri al l enses. Two i dent i cal t ri al f rames wi t h
dif f erent t rial lens combinat ions were prepared f or swif t
int erchange. Subj ect s were masked wit h t he t ype of PAL
t rial l enses since al l PALs were mount ed on same met al
rings. Part icular at t ent ion was paid t o ensure t he subj ect s
viewed t he t arget t hrough t he exact same point on each
PAL t r i al f r ame. The ci r cl e was car ef ul l y mar ked f or
each PAL t rial l ens. When t hese t rial l enses are packed
t oget her, t he circles were shown well concent ric. Examiner
woul d moni t or t he subj ect t o f i xat e wel l t hr ough t he
marked circle during each measurement . The order of t rial
frames was randomized.
Outcomes
Figure 3 Ast igmat ism-sensit ive opt ot ype.
Two out comes were assessed in t his pilot st udy. For t he fi rst
out come, hi gh-cont r ast numer al at LogMAR scal e was
employed. The inst ruct ion and procedure were same as t he
regular visual acuit y assessment . For t he second out come,
subj ect s wer e i nf or med t o compar e t he cl ar i t y of t he
ast igmat ism-sensit ive opt ot ype (Polat est ®, Carl Zeiss Vision,
Germany) in t erm of darkness, sharpness, cont rast and
shape of t he dot s. The i nst r uct i on was based on t he
cross-cylindrical t est f or assessing cylindrical power and
A simple clinical t est for percept ion of progressive addit ion lens peripheral image blur. A pilot st udy
axis. They were asked t o indicat e t he magnit udes of image
blur on a scale of 0 t o 10 (10 is ext remely blur). Subj ect s
were allowed t o pract ice several t imes if needed.
Data analysis
Pair-t t est was carried out t o det ect dif f erences bet ween
pairs of measures. The level of st at ist ical signifi cance was
t aken as 0.01. Approval for t he st udy was obt ained from t he
Eye’ ni cl i ni cal t r i al et hi cs commi t t ee. Al l cl i ni cal
invest igat ions were conduct ed according t o t he principles of
t he Decl arat ion of Hel sinki. Inf ormed consent had been
obt ained for all part icipat ing subj ect s.
Results
33
usual l y t he di st ant pl ano PALs t ri al l enses wi t h vari ous
addit ions. To our knowl edge, no st udy has assessed t he
opt ical perf ormances bet ween PAL t rial l enses and f inal
prescript ion PALs. Under our proposed cl inical met hod,
prescri pt i on PAL was shown t o i nduce more amount of
peripheral image blur t han t hat wit h t he t radit ional PAL t rial
l ens. The f i ndi ngs ar e expect ed, and suggest t hat t he
t radit ional PAL t rial l enses probabl y underest imat e t he
amount of PAL induced peripheral image blur. Opt icians are
advised t o not if y pot ent ial PAL wearers t hat t he fi nal PAL
possibly generat es more amount of peripheral image blur
t han do t he PAL t rial lens. In t his pilot st udy, we measured
only a part icular dist ant peripheral zone, but ot her zones
would perhaps be assessed by pat ient looking t hrough such
as on and beside t he corridor of power progression where
t he aberrat ions of unwant ed ast igmat ism, defocus error and
higher aberrat ion are higher.
In concl usi on, our pr oposed si mpl e cl i ni cal met hod
ap p ear s t o f ac i l i t at e PAL p er i p h er al i m age b l u r
demonst rat ion, which may help pot ent ial PAL wearers t o
ef f ect ivel y experience t he peripheral PAL image bl ur in
order t o advance t he process of adapt at ion. Opt icians may
caut ion t he PAL wearers t hat prescript ion PAL may induce
more peripheral image blur t han t hat do t he t radit ional
dist ant plano PAL t rial lens.
LogMAR scale visual acuit ies (mean ± SD) at t he cent ral and
t empor al f i xat i ons w er e measur ed at 0 ± 0. 03 and
0.2 ± 0.04 wit h FPAL, and 0 ± 0.03 and 0.1 ± 0.03 wit h TPAL
respect ivel y. No st at ist ical l y signif icant dif f erence was
not ed at t he cent r al f i xat i on bet ween TPAL and FPAL
(p = 0. 71). Signif icant ly lower visual acuit ies were f ound
wit h t he t emporal fi xat ion t han wit h t he cent ral fi xat ion in
bot h TPAL and FPAL (p < 0. 001). And si gni f i cant even
reduct ion at t he t emporal fi xat ion wit h FPAL t han wit h TPAL
was obser ved (p < 0. 001). For subj ect i ve measur e of
peripheral image blur using ast igmat ism-sensit ive opt ot ype,
t he average score of FPAL (7.4 ± 0.8, ranged 5-9) was found
st at ist ically higher t han t hat of TPAL (6.7 ± 0.8, ranged 4-8)
(p < 0.01).
Aut hor s decl ar e t hat t hey don’ t have any conf l i ct of
int erest .
Discussion
Acknowledgments
PAL ar guabl y i s one of t he ef f ect i ve management s of
presbyopia. Peripheral PAL opt ics is complicat ed and induces
bot h lower (defocus and ast igmat ism) and higher (coma and
t ref oil) aberrat ions. 9, 10 PAL wearers may be aware of t he
lat eral image blur which may adversely affect t he success of
t he adapt at ion process. Since most pot ent ial PAL wearers
who are used t o t he single vision lenses seldom experience
such peripheral opt ical rest rict ion, we int roduce a simple
clinical met hod t o facilit at e t he PAL peripheral image blur
demonst rat ion. The advant age of t his simple clinical met hod
may assist t he pot ent ial PAL wearers t o advance t he success
of adapt at ion by acquiring t he PAL peripheral image blur.
Under our simple clinical met hod, subj ect t urns his head
l at er al l y and l ooks at t he f i xat i on t ar get such as t he
ast igmat ism sensit ive opt ot ype or highest cont rast visual
acuit y chart t hrough t he PAL periphery. Al l our non-PAL
wearers appeared t o pract ically det ect peripheral image
bl ur wit h t he evidence of visual acuit y reduct ion when
f i xat i ng t hr ough t he per i pher y of t he PAL. Si nce t he
procedure is simple and an opt ot ype is already in exist ence,
t his clinical met hod can be applied effect ively at t he general
opt omet ric clinic.
Secondl y, we compared t he peri pheral i mage bl ur of
t radit ional plano dist ance PAL t rial lenses and prescript ion
PALs. Wi t h obj ect i ve t o ai d pot ent i al PAL wear er s t o
experience t he unique PAL opt ical feat ures, PAL t rail lenses
may be provided by t he opht halmic lens company which are
The aut hors woul d l i ke t o t hank Mr Frank Tang and Mr
Kar-ning Chu for t heir guidance, which st imulat ed t his st udy,
and for t heir support t hroughout t he research.
Conflict of interests
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