Lente de contacto híbrida de geometría inversa en córnea irregular con presencia de isla central tras cirugía LASIK

La lente híbrida de geometría inversa PS ofrece una mejoría de la calidad visual en pacientes con córneas irregulares tras cirugía refractiva miópica, mostrándose como una excelente opción en aquellos casos en que el insuficiente lecho corneal imposibilita retratamientos posteriores.

Trabajo de coordinación para la implantación del Máster en Optometría Avanzada y Salud Visual

Durante el curso 2013-2014 la Universidad de Alicante ha propuesto la implantación del Master en Optometría Avanzada y Salud Visual, dicha solicitud está siendo actualmente evaluada por la ANECA. Con el fin de coordinar la docencia de este Máster y dentro del Proyecto de Redes de Investigación en Docencia Universitaria 2013-2014, se ha creado una red formada por todos los profesores que han participado en la elaboración del plan de estudios. En esta red esta red se pretende la coordinación entre las distintas asignaturas para elaborar las guías docentes a partir de los datos de las fichas enviadas a la ANECA. Por otra parte también se ha modificado la memoria atendiendo a las alegaciones realizadas por la ANECA. Y se han desarrollado los contenidos, la metodología de las distintas actividades propuestas con el fin de asegurar la consecución de las competencias previstas.

Correlation of Anterior and Posterior Corneal Shape in Keratoconus

Purpose: To evaluate the correlation of the mean curvature and shape factors of both corneal surfaces for different corneal diameters measured with the Scheimpflug photography–based system in keratoconus eyes. Methods: A total of 61 keratoconus eyes of 61 subjects, aged 14 to 64 years, were included in this study. All eyes received a comprehensive ophthalmologic examination including anterior segment and corneal analysis with the Sirius system (CSO): anterior and posterior mean corneal radius for 3, 5, and 7 mm (aKM, pKM), anterior and posterior mean shape factor for 4.5 and 8 mm (ap, pp), central and minimal corneal thickness, and anterior chamber depth. Results: Mean aKM/pKM ratio around 1.20 (range, 0.95–1.48) was found for all corneal diameters (P = 0.24). Weak but significant correlations of this ratio with pachymetric parameters were found (r between −0.28 and −0.34, P < 0.04). The correlation coefficient between aKM and pKM was ≥0.92 for all corneal diameters. A strong and significant correlation was also found between ap and pp (r ≥ 0.86, P < 0.01). The multiple regression analysis revealed that central pKM was significantly correlated with aKM, central corneal thickness, anterior chamber depth, and spherical equivalent (R2 ≥ 0.88, P < 0.01) and that 8 mm pp was significantly correlated with 8 mm ap and age (R2 = 0.89, P < 0.01). Conclusions: Central posterior corneal curvature and shape factor in the keratoconus eye can be consistently predicted from the anterior corneal curvature and shape factor, respectively, in combination with other anatomical and ocular parameters.

Coordinación docente del cuarto curso del Grado de Óptica y Optometría y el Máster en Optometría Clínica y Visión

El Máster en Optometría Clínica y Visión comenzó a impartirse en la Universidad de Alicante en el curso 2010-2011. Durante estos tres años los alumnos que han accedido a él, han sido, en su mayoría, Diplomados en Óptica y Optometría. Actualmente se está impartiendo el Grado de Óptica y Optometría, por lo que a partir del curso 2013-2014 los alumnos que accedan al Máster serán mayoritariamente graduados. Teniendo en cuenta que en el Grado de Óptica y Optometría se han añadido asignaturas (respecto a la Diplomatura), que incluyen temas coincidentes con asignaturas del Máster, es necesario modificar y reorientar algunas de las guías docentes de las asignaturas del Máster. En este sentido el objetivo principal de esta red ha sido la coordinación entre los profesores de las diferentes asignaturas para actualizar y/o reorientar las guías docentes de las asignaturas del Máster en Optometría Clínica y Visión, evitando solapamientos con las asignaturas de 4º curso del Grado de Óptica y Optometría.

Evaluation of Binocular Vision Therapy Efficacy by 3D Video-Oculography Measurement of Binocular Alignment and Motility

Objective: To evaluate two cases of intermittent exotropia (IX(T)) treated by vision therapy the efficacy of the treatment by complementing the clinical examination with a 3-D video-oculography to register and to evidence the potential applicability of this technology for such purpose. Methods: We report the binocular alignment changes occurring after vision therapy in a woman of 36 years with an IX(T) of 25 prism diopters (Δ) at far and 18 Δ at near and a child of 10 years with 8 Δ of IX(T) in primary position associated to 6 Δ of left eye hypotropia. Both patients presented good visual acuity with correction in both eyes. Instability of ocular deviation was evident by VOG analysis, revealing also the presence of vertical and torsional components. Binocular vision therapy was prescribed and performed including different types of vergence, accommodation, and consciousness of diplopia training. Results: After therapy, excellent ranges of fusional vergence and a “to-the-nose” near point of convergence were obtained. The 3-D VOG examination (Sensoro Motoric Instruments, Teltow, Germany) confirmed the compensation of the deviation with a high level of stability of binocular alignment. Significant improvement could be observed after therapy in the vertical and torsional components that were found to become more stable. Patients were very satisfied with the outcome obtained by vision therapy. Conclusion: 3D-VOG is a useful technique for providing an objective register of the compensation of the ocular deviation and the stability of the binocular alignment achieved after vision therapy in cases of IX(T), providing a detailed analysis of vertical and torsional improvements.

Análisis de la eficacia de la terapia visual en el tratamiento de la exotropía intermitente mediante videooculografía 3D

Objetivo: Evaluar la eficacia del tratamiento en 3 casos de exotropia intermitente (XT(i)) mediante ejercicios de terapia visual, completando la exploración clínica con Videooculografia-30 y evidenciar la potencial aplicabilidad de esta tecnología para dicho propósito. Métodos: Exponemos los cambios ocurridos tras ejercicios de terapia visual en una mujer de 36 años con XT(i) de -25 dioptrías prismáticas (dp) de lejos y 18 dp de cerca; Un niño de 10 años de edad con 8 dp de XT(i) en posición primaria, asociados a +6 dp de hipotropia izquierda; y un hombre de 63 años con XT(i) de 6 dp en posición primaria asociada a +7 dp de hipertropia derecha. Todos los pacientes presentaron buena agudeza visual corregida en ambos ojos. La inestabilidad de la desviación ocular se evidenció mediante análisis de VOG-30, revelando la presencia de components verticales y torsionales. Se realizaron ejercicios de terapia visual, incluyendo diferentes tipos de ejercicios de vergencias, acomodación y percepción de la diplopía. Resultados: Tras la terapia visual se obtuvieron excelentes rangos de vergencias fusionales y de punto próximo de convergencia («hasta la nariz»). El examen mediante VOG-3D (Sensoro Motoric lnstruments, Teltow, Germany) confirmó la compensación de la desviación con estabilidad del alineamiento ocular. Se observó una significativa mejora después de la terapia en los components verticals y torsionales, lo cuales se hicieron más estables. Los pacientes se mostraron muy satisfechos de los resultados obtenidos. Conclusión: La VOG-3D es una técnica útil para dotamos de un método objetivo de registro de la compensación y estabilidad de la desviación ocular después de realizar ejercicios de terapia visual en casos de XT(i), ofreciéndonos un detallado análisis de la mejoría de los components verticales y torsionales.

Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies

Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectraldomain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups (P = 0.18). However, mean MP overall sensitivity was significantly higher in group A (29.05 ± 0.57 dB versus group B, 26.05 ± 2.75 dB; P < 0.001). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated (P < 0.001). Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine.

Coupled Biomechanical Response of the Cornea Assessed by Non-Contact Tonometry. A Simulation Study

The mechanical response of the cornea subjected to a non-contact air-jet tonometry diagnostic test represents an interplay between its geometry, the corneal material behavior and the loading. The objective is to study this interplay to better understand and interpret the results obtained with a non-contact tonometry test. A patient-specific finite element model of a healthy eye, accounting for the load free configuration, was used. The corneal tissue was modeled as an anisotropic hyperelastic material with two preferential directions. Three different sets of parameters within the human experimental range obtained from inflation tests were considered. The influence of the IOP was studied by considering four pressure levels (10–28 mmHg) whereas the influence of corneal thickness was studied by inducing a uniform variation (300–600 microns). A Computer Fluid Dynamics (CFD) air-jet simulation determined pressure loading exerted on the anterior corneal surface. The maximum apex displacement showed a linear variation with IOP for all materials examined. On the contrary, the maximum apex displacement followed a cubic relation with corneal thickness. In addition, a significant sensitivity of the apical displacement to the corneal stiffness was also obtained. Explanation to this behavior was found in the fact that the cornea experiences bending when subjected to an air-puff loading, causing the anterior surface to work in compression whereas the posterior surface works in tension. Hence, collagen fibers located at the anterior surface do not contribute to load bearing. Non-contact tonometry devices give useful information that could be misleading since the corneal deformation is the result of the interaction between the mechanical properties, IOP, and geometry. Therefore, a non-contact tonometry test is not sufficient to evaluate their individual contribution and a complete in-vivo characterization would require more than one test to independently determine the membrane and bending corneal behavior.

La disparidad de fijación: concepto y manejo clínico

La diferencia de alineación de los ejes visuales en la Disparidad de Fijación en la gran mayoría de situaciones se produce como un efecto fisiológico no produciendo sintomatología al paciente. Sin embargo, existen ciertas situaciones en las que la Disparidad de Fijación sí que produce sintomatología al paciente, produciéndose como consecuencia del estrés de los sistemas de vergencia y acomodativo con el objetivo de mantener la visión binocular. Existen además evidencias científicas de que determinados hábitos de lectura, patologías como las migrañas y pacientes disléxicos con problemas de lectura y de aprendizaje pueden observar un incremento significativo de la Disparidad de Fijación, estando asociados a Disparidades de Fijación anormales. Debido a la información que proporciona la medida de la Disparidad de Fijación resulta de especial interés la cuantificación de la misma en la práctica clínica, existiendo en la actualidad diferentes tests y dispositivos clínicos que se utilizan comúnmente para la medida de la Disparidad de Fijación, como la Curva de Vergencias Forzadas, el Disparómetro de Sheedy, la Unidad de Mallet y la Carta de Wesson entre otros.

Optic neuritis in pediatric population: A review in current tendencies of diagnosis and management

Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.

Orbscan Topography in Primary Open-Angle Glaucoma

Purpose: To compare anterior and posterior corneal curvatures between eyes with primary open-angle glaucoma (POAG) and healthy eyes. Methods: This is a prospective, cross-sectional, observer-masked study. A total of 138 white subjects (one eye per patient) were consecutively recruited; 69 eyes had POAG (study group), and the other 69 comprised a group of healthy control eyes matched for age and central corneal pachymetry with the study ones. Exclusion criteria included any corneal or ocular inflammatory disease, previous ocular surgery, or treatment with carbonic anhydrase inhibitors. The same masked observer performed Goldmann applanation tonometry, ultrasound pachymetry, and Orbscan II topography in all cases. Central corneal thickness, intraocular pressure, and anterior and posterior topographic elevation maps were analyzed and compared between both groups. Results: Patients with POAG had greater forward shifting of the posterior corneal surface than that in healthy control eyes (p < 0.01). Significant differences in anterior corneal elevation between controls and POAG eyes were also found (p < 0.01). Conclusions: Primary open-angle glaucoma eyes have a higher elevation of the posterior corneal surface than that in central corneal thickness–matched nonglaucomatous eyes.

Corneal biomechanics: a review

Biomechanics is often defined as ‘mechanics applied to biology’. Due to the variety and complexity of the behaviour of biological structures and materials, biomechanics is better defined as the development, extension and application of mechanics for a better understanding of physiology and physiopathology and consequently for a better diagnosis and treatment of disease and injury. Different methods for the characterisation of corneal biomechanics are reviewed in detail, including those that are currently commercially available (Ocular Response Analyzer and CorVis ST). The clinical applicability of the parameters provided by these devices are discussed, especially in the fields of glaucoma, detection of ectatic disorders and orthokeratology. Likewise, other methods are also reviewed, such as Brillouin microscopy or dynamic optical coherence tomography and others with potential application to clinical practice but not validated for in vivo measurements, such as ultrasonic elastography. Advantages and disadvantages of all these techniques are described. Finally, the concept of biomechanical modelling is revised as well as the requirements for developing biomechanical models, with special emphasis on finite element modelling.

Corneal Biomechanics, Retinal Nerve Fiber Layer, and Optic Disc in Children

Purpose: To evaluate the possible associations between corneal biomechanical parameters, optic disc morphology, and retinal nerve fiber layer (RNFL) thickness in healthy white Spanish children. Methods: This cross-sectional study included 100 myopic children and 99 emmetropic children as a control group, ranging in age from 6 to 17 years. The Ocular Response Analyzer was used to measure corneal hysteresis (CH) and corneal resistance factor. The optic disc morphology and RNFL thickness were assessed using posterior segment optical coherence tomography (Cirrus HD-OCT). The axial length was measured using an IOLMaster, whereas the central corneal thickness was measured by anterior segment optical coherence tomography (Visante OCT). Results: The mean (±SD) age and spherical equivalent were 12.11 (±2.76) years and −3.32 (±2.32) diopters for the myopic group and 11.88 (±2.97) years and +0.34 (±0.41) diopters for the emmetropic group. In a multivariable mixed-model analysis in myopic children, the average RNFL thickness and rim area correlated positively with CH (p = 0.007 and p = 0.001, respectively), whereas the average cup-to-disc area ratio correlated negatively with CH (p = 0.01). We did not observe correlation between RNFL thickness and axial length (p = 0.05). Corneal resistance factor was only positively correlated with the rim area (p = 0.001). The central corneal thickness did not correlate with the optic nerve parameters or with RNFL thickness. These associations were not found in the emmetropic group (p > 0.05 for all). Conclusions: The corneal biomechanics characterized with the Ocular Response Analyzer system are correlated with the optic disc profile and RNFL thickness in myopic children. Low CH values may indicate a reduction in the viscous dampening properties of the cornea and the sclera, especially in myopic children.

Relationship among Corneal Biomechanics, Refractive Error, and Axial Length

Purpose: To evaluate the relationship between different ocular and corneal biomechanical parameters in emmetropic and ametropic healthy white children. Methods: This study included 293 eyes of 293 healthy Spanish children (135 boys and 158 girls), ranging in age from 6 to 17 years. Subjects were divided according to the refractive error: control (emmetropia, 99 children), myopia (100 children), and hyperopia (94 children) groups. In all cases, corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated with the Ocular Response Analyzer system. Axial length (AL) and mean corneal power were also measured by partial coherence interferometry (IOLMaster), and central corneal thickness (CCT) and anterior chamber depth were measured by anterior segment optical coherence tomography (Visante). Results: Mean (±SD) CH and CRF were 12.12 (±1.71) and 12.30 (±1.89) mm Hg, respectively. Mean (±SD) CCT was 542.68 (±37.20) μm and mean (±SD) spherical equivalent was +0.14 (±3.41) diopters. A positive correlation was found between CH and CRF (p < 0.001), and both correlated as well with CCT (p < 0.0001). Corneal resistance factor was found to decrease with increasing age (p = 0.01). Lower levels of CH were associated with longer AL and more myopia (p < 0.001 and p = 0.001, respectively). Higher values of CH were associated with increasing hyperopia. Significant differences in CH were found between emmetropic and myopic groups (p < 0.001) and between myopic and hyperopic groups (p = 0.011). There were also significant differences in CRF between emmetropic and myopic groups (p = 0.02). Multiple linear regression analysis showed that lower CH and CRF significantly associated with thinner CCT, longer AL, and flatter corneal curvature. Conclusions: The Ocular Response Analyzer corneal biomechanical properties seem to be compromised in myopia from an early age, especially in high myopia.

Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex

We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox®) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex.