Refractive outcomes of laser-assisted subepithelial keratectomy for myopia, hyperopia, and astigmatism using a 213 nm wavelength solid-state laser

To study the visual and refractive outcomes after laser-assisted subepithelial keratectomy (LASEK) performed with a 213 nm solid-state laser for a broad range of refractive errors.

Sympathetic inhibition of accommodation after sustained nearwork in subjects with myopia and emmetropia

PURPOSE. The purposes of the present study were to assess the effect of a sympathetic inhibitory pharmacologic agent, timolol maleate, on the magnitude of nearwork-induced transient myopia (NITM) and its decay in different refractive groups for an extended near task duration and to determine the proportion of the young adult population manifesting effective sympathetic access under naturalistic closed-loop viewing conditions. METHODS. Ten subjects with emmetropia and 10 with myopia were tested. They read binocularly for 1 hour at a distance of 35 to 40 cm. NITM was calculated as the difference in distance refractive state after task as compared with before task immediately after reading. All subjects received timolol maleate to block the sympathetic nervous system and betaxolol as a control agent in independent test sessions separated by at least 3 days. Forty minutes after drug instillation, the NITM measurement procedure was repeated. RESULTS. Initial NITM magnitude was larger in subjects with myopia than in subjects with emmetropia before and after timolol instillation. Furthermore, NITM magnitude in subjects with sympathetic access was increased after timolol instillation. In contrast, with the control agent betaxolol, there was no increase. NITM decay duration to baseline was increased after timolol instillation in the subjects with myopia only. Only 15% of the subjects (n = 3 subjects with myopia) demonstrated effective and significant access to sympathetic facility. CONCLUSIONS. Subjects with myopia demonstrated an increase in decay duration with timolol, thus suggesting impaired sympathetic inhibition of accommodation. This may be a precursor for myopia progression in some persons.

Wavefront analyzers induce instrument myopia

PURPOSE: To assess the accuracy of three wavefront analyzers versus a validated binocular open-view autorefractor in determining refractive error in non-cycloplegic eyes. METHODS: Eighty eyes were examined using the SRW-5000 open-view infrared autorefractor and, in randomized sequence, three wavefront analyzers: 1) OPD-Scan (NIDEK, Gamagori, Japan), 2) WASCA (Zeiss/Meditec, Jena, Germany), and 3) Allegretto (WaveLight Laser Technologies AG, Erlangen, Germany). Subjects were healthy adults (19 men and 21 women; mean age: 20.8 +/- 2.5 years). Refractive errors ranged from +1.5 to -9.75 diopters (D) (mean: +1.83 +/- 2.74 D) with up to 1.75 D cylinder (mean: 0.58 +/- 0.53 D). Three readings were collected per instrument by one examiner without anticholinergic agents. Refraction values were decomposed into vector components for analysis, resulting in mean spherical equivalent refraction (M) and J0 and J45 being vectors of cylindrical power at 0 degrees and 45 degrees, respectively. RESULTS: Positive correlation was observed between wavefront analyzers and the SRW-5000 for spherical equivalent refraction (OPD-Scan, r=0.959, P<.001; WASCA, r=0.981, P<.001; Allegretto, r=0.942, P<.001). Mean differences and limits of agreement showed more negative spherical equivalent refraction with wavefront analyzers (OPD-Scan, 0.406 +/- 0.768 D [range: 0.235 to 0.580 D] [P<.001]; WASCA, 0.511 +/- 0.550 D [range: 0.390 to 0.634 D] [P<.001]; and Allegretto, 0.434 +/- 0.904 D [range: 0.233 to 0.635 D] [P<.001]). A second analysis eliminating outliers showed the same trend but lower differences: OPD-Scan (n=75), 0.24 +/- 0.41 D (range: 0.15 to 0.34 D) (P<.001); WASCA (n=78), 0.46 +/- 0.47 D (range: 0.36 to 0.57 D) (P<.001); and Allegretto (n=77), 0.30 +/- 0.62 D (range: 0.16 to 0.44 D) (P<.001). No statistically significant differences were noted for J0 and J45. CONCLUSIONS: Wavefront analyzer refraction resulted in 0.30 D more myopia compared to SRW-5000 refraction in eyes without cycloplegia. This is the result of the accommodation excess attributable to instrument myopia. For the relatively low degrees of astigmatism in this study (<2.0 D), good agreement was noted between wavefront analyzers and the SRW-5000. Copyright (C) 2006 SLACK Incorporated

Myopia:precedents for research in the twenty-first century

The myopic eye is generally considered to be a vulnerable eye and, at levels greater than 6 D, one that is especially susceptible to a range of ocular pathologies. There is concern therefore that the prevalence of myopia in young adolescent eyes has increased substantially over recent decades and is now approaching 10-25% and 60-80%, respectively, in industrialized societies of the West and East. Whereas it is clear that the major structural correlate of myopia is longitudinal elongation of the posterior vitreous chamber, other potential correlates include profiles of lenticular and corneal power, the relationship between longitudinal and transverse vitreous chamber dimensions and ocular volume. The most potent predictors for juvenile-onset myopia continue to be a refractive error ≤+0.50 D at 5 years of age and family history. Significant and continuing progress is being made on the genetic characteristics of high myopia with at least four chromosomes currently identified. Twin studies and genetic modelling have computed a heritability index of at least 80% across the whole ametropic continuum. The high index does not, however, preclude an environmental precursor, sustained near work with high cognitive demand being the most likely. The significance of associations between accommodation, oculomotor dysfunction and human myopia is equivocal despite animal models that have demonstrated that sustained hyperopic defocus can induce vitreous chamber growth. Recent optical and pharmaceutical approaches to the reduction of myopia progression in children are likely precedents for future research, for example progressive addition spectacle lens trials and the use of the topical MI muscarinic antagonist pirenzepine.

Myopia: pathways to therapy

Editorial

Do organizational climate and competitive strategy moderate the relationship between human resource management and productivity?

This study examined whether the effectiveness of human resource management (HRM) practices is contingent on organizational climate and competitive strategy. The concepts of internal and external fit suggest that the positive relationship between HRM and subsequent productivity will be stronger for firms with a positive organizational climate and for firms using differentiation strategies. Resource allocation theories of motivation, on the other hand, predict that the relationship between HRM and productivity will be stronger for firms with a poor climate because employees working in these firms should have the greatest amount of spare capacity. The results supported the resource allocation argument. © 2005 Southern Management Association. All rights reserved.