ESCRS Homepage

April 2003
Eye to Eye Supplement Compliance : The Hidden Challenge of Glaucoma Management
IN THIS ISSUE

Safer refractive IOLs to boost vision options for ametropes


EGS to publish updated guidelines for diagnosis and management of glaucoma

Topical beta-blockers cause respiratory obstruction for one in every 55 patients

Immediate treatment halves risk of open-angle glaucoma progression, EMGT report reveals

Nothing between them as randomised Canadian SLT/ALT study releases preliminary results

Latanoprost does not cause ocular pathology by inducing ultrastructural iris changes, says study

One-piece ‘floating’ refractive implant could prove a secure new option for the correction of myopia

Battlelines clearly marked out as trabeculectomy and drainage implant surgery go head to head

New visual field testing strategies to banish patient boredom and facilitate earlier detection

Latanoprost remains leader of the drops but proponents of competing drugs line up to bid for alternative

Data drought ends as surge of clinical results explains effects of treatments on the development of glaucoma

Zyoptix system produces encouraging results in US for the correction of myopia

Refractive IOL and laser bioptics broaden possibilities for highly ametropic patients, says specialists

How the eye’s natural adaptive mechanism
can compensate for corneal aberrations

Handheld GPS device helps blind steer safely through the metropolitan jungle

New classification system to assist in diagnosis and treatment of limbal stem cell disease

Lasik on top in ultimate test as daredevil climbers reach Mount Everest’s summit in 29,000ft hike

PHMB-containing antiseptics ‘may offer alternative’ to iodine
perioperative agents, say researchers

High intensity headlights could cause road
accidents by dazzling oncoming drivers

Oral sildenafil causes inconsistent changes in
choroidal vascular congestion, study shows

HALTK’s alternative to PK could be gateway to restoring corneal clarity

Doctors warn against ditching specs Superman-style as fears remain on safety of paediatric Lasik

Povidone-iodine offers inexpensive alternative for paediatric conjunctivitis

Getting to grips with ocular tissue is crucial to PK success in children

New device brings virtual vision to the blind

Toric IOLs improve on previous designs with less rotation and more patient satisfaction

FEATURES
From The Editor
Guest Editor
Reflections on Refractive Surgery
In Your Good Books
Bio-ophthalmology
Prime Site
An Eye On Travel
Regulatory Matters



How the eye’s natural adaptive mechanism can compensate for corneal aberrations

Daniel Keller PhD
in San Francisco

THE natural adaptive mechanism of the human visual system can compensate for deficiencies in its own optics, including some common types of corneal aberrations, researchers say.

Neurobiologist Howard C Howland PhD and colleagues used wavefront analysis to study ocular aberrations in volunteers. Presenting his results at the fourth International Congress of Wavefront Sensing and Aberration-free Refraction Correction, he reported that the visual system could compensate for three of the 12 kinds of corneal aberrations.

The researchers used a Topcon KR 9000PW Wavefront Analyser to study the eyes of 20 young, healthy undergraduate students whose refractions were within +1.0 D to – 2.0 D of emmetropia.

They used the Topcon instrument to measure refraction, corneal topography using 11 rings and the optical wavefront of the total eye. The topographical and wavefront measurements were made along the same axis, which was at the centre of the pupil, and measurements referred to aberrations in the line of vision.

The degree of compensation was computed by comparing the wavefront of the total eye to the corneal topography. The 11 infrared illuminated rings are at a distance of about 30cm from the eye and reflected off the cornea to measure its topography.
“We did find some evidence for developmental compensation for corneal astigmatism. We see a good correlation between the amount of astigmatism you have in the cornea and the amount of compensation you have in the lens. The internal optics of the eye could compensate for both corneal with and against-the-rule astigmatism,” Dr Howland reported.

There was no correlation between the individual amount of spherical aberration and the individual compensation. This suggests that it wasn't an individual developmental feedback loop.

Rather, it looked like it was genetically determined. The feedback loop was present by dint of natural selection in lens structure, with higher power operating in the centre. Similarly, it appears that compensation for lateral coma is genetic rather than developmental, he said.

The Cornell investigators' work built upon research by Pablo Artal and colleagues in Spain (Artal, P et al: Compensation of corneal aberrations by the internal optics of the human eye. Journal of Vision 2001;1:1-18), who had examined the total and corneal aberrations of the eye.

The Spanish researchers found that the cornea had both spherical aberration and coma and somehow the eye's internal optics could compensate for corneal irregularities.
Such compensation may wane with age since aberrations appeared to worsen, according to findings from McLellan et al (Age-related changes in monochromatic wave aberrations of the human eye. Investig Ophthal and Vis Sci 2001;42 (6):1390-1395) and Artal et al (Contribution of the cornea and internal surfaces to the change of ocular aberrations of the eye. J Opt Soc Am A 2002;19(1):137-143).

Dr Howland explained that in a system as complex as vision, it appears that visual acuity is a result of various component parts 'wanting' to see better. The parts seem to be able to sense aberrations and then change shape and function.
Some compensation occurred across the evolution of the species, but others are more individualised, occurring early in life and even throughout life.
The underlying neurobiology of the developmental compensatory effects is not yet known with any degrees of certainty. Experiments have shown a feedback mechanism in lower animals as well as primates which compensates for defocus. The eye grows in length so that the image falls on the retina.

Dr Howland gave an example of a weak cornea and lens system, where the image falls behind the retina and the eye elongates so that the location of the retina will correspond to the point of focus of the image.
In the case of astigmatism, the compensation probably comes from the lens and not by asymmetrical elongation of the eye.

“The lens grows continuously throughout life. A curve of the weight of the lens with age would be a straight ascending line. It's continuously laying on new lens fibres. However, the question is how would it know where to put them and how would the growth signal get there?,” Dr Howland asked.
He proposed that the ciliary muscle may have a role, but no one has determined a mechanism. In addition, the inner surface of the cornea may make slight changes. But since the rear surface of the cornea is in contact with the vitreous and has a similar refractive index, it probably does not have much focusing power.

“We know there's compensation. We know it's probably in the lens. But we don't know how developmental compensatory effects take place,” he said.
In the case of spherical aberration, Dr Howland explained that the mechanism is a long-term genetic effect. The immediate clinical significance of this work may relate to children with irregular astigmatism which is not correctable with lenses. Clinicians may be less likely to intervene during childhood since these eyes may internally compensate over time.

“When the eyes cannot compensate internally, that's when we look to those astronauts of the medical world, the ophthalmic surgeons, to fix what nature could not,” Dr Howland said.

Howard C Howland PhD
Cornell University in Ithaca, New York, US
Email: hch2@cornell.edu


Top