Higher-order Aberrations and their Visual Impact in Paediatric Blepharokeratoconjunctivitis.

doi:10.21203/rs.3.rs-1959011/v1

Download PDF

Article

Higher-order Aberrations and their Visual Impact in Paediatric Blepharokeratoconjunctivitis.

https://doi.org/10.21203/rs.3.rs-1959011/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background/Objectives:

To analyse the higher-order aberrations (HOAs) and their visual impact on a paediatric blepharokeratoconjunctivitis (PBKC) cohort compared with healthy controls.

Subjects/Methods:

A prospective observational, case-control study of paediatric patients (≤ 16 years old) was designed. Subjects underwent a visual system wavefront aberrometry analysis to compare HOAs and their impact on visual quality.

Results

150 eyes from 76 patients were included for analysis. The PBKC group consisted of 50 eyes, and the control group included 100 healthy eyes. Mean age was 10.39 ± 3.81 years for the PBKC group and 10.80 ± 3.61 years for the controls. Mean corrected-distance visual acuity (CDVA) was 0.24 ± 0.21 LogMAR in the PBKC group and 0.07 ± 0.1 in the controls (p = < 0.001). Mean astigmatism was 1.6 ± 1.98 in the PBKC group vs. 0.67 ± 0.76 in the controls (p = 0.01). Mean RMS of HOAs was 1.05 ± 1.7 in the PBKC group and 0.41 ± 0.18 in the controls (p = < 0.001). The mean modulation transfer function (MTF) in the PBKC group was significantly lower (16.37 ± 16.32) than in the controls (30.3 ± 23.57) (p = < 0.001). Corneal leucoma, neovascularization, phlyctenula, and pannus formation were associated with a greater risk of increased HOAs.

Conclusions

There was a significant increase in the total HOAs of PBKC eyes compared to healthy controls. The PBKC eyes aberrations profile, particularly coma, secondary astigmatism, quadrafoil, and pentafoil, had a significant visual impact. Leukoma, corneal neovascularization, pannus, and phlyctenula were strongly associated with increased HOAs.

chronic blepharitis

blepharokeratoconjunctivitis

childhood rosacea

higher-order aberrations

staphylococcal blepharoconjunctivitis

wavefront aberrometry

Paediatric blepharokeratoconjunctivitis (PBKC), also known as chronic or staphylococcal blepharoconjunctivitis or childhood rosacea, is an underdiagnosed and underestimated chronic and recurrent inflammatory process of the eyelid margins that can produce significant structural and functional alterations on the ocular surface. [1–3] The pathogenesis of PBKC is not yet fully elucidated. However, it is probably multifactorial, involving host immunogenetic susceptibility factors, characterised by early bacterial antigen presentation, a delayed-type cellular hypersensitivity reaction against proteins from eyelid bacteria wall, and direct toxicity of bacterial-produced lipases and exotoxins. [4, 5] The interaction of these immunopathogenic mechanisms, among other host and environmental factors, can produce a deleterious persistent inflammation on the ocular surface, resulting in corneal damage. [1–5]

The prevalence of corneal involvement in PBKC ranges from 39.5–81%, depending on the series. [1, 6–8] The spectrum of PBKC corneal manifestations is diverse and includes punctiform epithelial erosions, nummular stromal inflammatory infiltrates, phlyctenula and pannus formation, stromal neovascularization, marginal infiltration and ulceration, peripheral ulcerative keratitis, leukoma formation, stromal melting, and perforation. [9–11]

PBKC may induce amblyopia, irregular astigmatism, contrast sensitivity alterations, and higher-order aberrations (HOAs) that may significantly affect the visual quality. [12, 13]

The wavefront HOAs are visual distortions acquired by irregularities of the eye´s refractive system that cannot be corrected with spectacle glasses and are usually calculated using the mean root square deviation (RMS). A wavefront error can be decomposed into the Zernike polynomials coefficients, with the value of each specific coefficient expressed in microns. [14, 15] Moreover, the eye optical quality visual system and performance can be analysed using different methods, like the modulation transfer function (MTF) and the point spread function (PSF). The MTF is a Fourier transform of the PSF and displays the contrast sensitivity that is objectively simulated based on wavefront aberrations. It shows the contrast needed for the patient to identify optotypes in a visual acuity chart. [16, 17] On the other hand, the PSF simulates how a point source light appears to the patient when looking at it, based on the eye´s optical aberration. [15, 17]

The refractive power corneal analyser OPD-Scan-III (Nidek Technologies, Gamagori, Japan) uses time-based retinoscopy (dynamic skiascopy), wavefront aberrometry, and a Placido disc-based topography to measure objective refraction, corneal curvature, pupillary size, and optical aberrations. [18, 19]

This study aims to analyse the HOAs produced in the eyes of PBKC patients using the OPD-Scan-III and compare them with healthy controls to evaluate the resultant impact that such aberrations have on the visual quality.

Study design and setting.

A prospective observational, case-control study was designed to compare the wavefront HOAs and their visual impact between PBKC patients and healthy controls. The study was conducted at the Tecnologico de Monterrey Institute of Ophthalmology and Visual Sciences between 2016 and 2019. All patients' parents read and signed informed consent to allow their children to participate in the study voluntarily. The investigation was previously approved by our institution´s Ethics and Research Committees and conducted according to the tenets of the Declaration of Helsinki.

Study population and inclusion/exclusion criteria.

The PBKC group inclusion criteria consisted of children of any sex between 6 and 16 years of age and clinically diagnosed with PBKC based on the criteria previously described.[6] Only patients with no signs of active inflammation at the time of analysis were included in the study. The control group inclusion criteria consisted of children with matched sex and age range with no systemic or ocular morbidities and a corrected distance visual acuity (CDVA) of 20/20 with a regular ametropia in the following ranges: ≤2.00D of myopia, ≤ 4.00D of hyperopia, and ≤ 1.75D of regular astigmatism. Only patients who were willing to participate and cooperate with the OPD-Scan analysis, achieving a centred capture and a minimum of 22 out of 31 Placido disc rings readings, were included for analysis.

The PBKC group exclusion criteria consisted of patients unwilling to participate or not cooperating with the OPD-Scan analysis (decentered capture or < 22/31 Placido rings readings) and those with active or uncontrolled inflammation using anti-inflammatory medications. Also, patients within the control group were excluded from the study if they did not meet the ametropia criteria shown above and if they had other causes of ocular surface disease, including allergy and infectious conjunctivitis, as well as strabismus, amblyopia, nystagmus, optic nerve, and macular disorders, previous ocular surgery, systemic disease, and contact lens wearers.

Data acquisition and methodology.

The same examiner (CMZ) performed all the corneal analyses in a dark room, using the OPD-Scan-III, a double pass aberrometer where an infrared light-slit and photodetectors are placed on a rotating wheel along with the same rotational position across the pupil. The moving of the incident beam along with a specific pupillary meridian result in a reflected beam that will go in the same or opposite direction. As the wheel rotates, the instrument compares the time for light to peak at each photodiode after passing a beam splitter. The equipment calculates the optical pathway difference and derives the wavefront error by comparing the results with the theoretical reference time and generates a refractive map and wave-front profile. This procedure yields 1,440 points of data within 0.4 seconds. (Fig. 1). [18, 19]

Data collection.

Variables considered for statistical analysis included age, sex, CDVA, astigmatism, keratometry, corneal manifestations of PBKC, HOA-RMS, Zernike polynomials, MTF, and PSF. The RMS of total HOA, corneal HOA, and internal HOA were obtained. Zernike polynomials up to the sixth order were reported in microns at pupil diameters under mesopic conditions. MTF and PSF were obtained under mesopic pupil conditions to measure optical quality and contrast sensitivity. Patients with PBKC were also divided into symmetric and asymmetric diseases based on significant differences in the severity of clinical manifestations between eyes. This further classification allowed us to perform an interocular comparison of the HOA and optical quality parameters in PBKC patients with asymmetrical disease.

Statistical analysis.

The primary outcome was comparing total HOA-RMS induced by PBKC with healthy eyes. The secondary outcome was to evaluate the risk of increased HOAs due to corneal involvement in PBKC eyes. The sample size was calculated considering the highest prevalence of the reported PBKC incidence and the exactitude in the comparisons with an outcome variance probability in the sample of 3% between the groups (α 95% / β 80%). Patients were grouped into those with PBKC (experimental group) and healthy controls.

All data were compiled in Microsoft Excel (versión 365 Proplus, Windows®) spreadsheets and then processed with RStudio statistical package (version 3.6.1 for Windows, by CRAN, Boston, MA. USA). Quantitative variables were analysed with the two-tailed student t-test, adjusted to normality, and nonparametric variables with the U Man-Whitney or the Kruskal-Wallis tests. Categorical variable analyses included the two-tailed Fisher's exact test or two-sided χ². The odds ratio and Cohen’s d were used to evaluate the effect size of HOA and corneal manifestations. P values < 0.05 were considered significant.

Sociodemographic and baseline refractive characteristics.

A total of 150 eyes from 76 patients were included in the present study. Fifty eyes from 26 patients were included in the PBKC group. Of these, 16 (61.6%) were females and 10 (38.4%) males, with a male-to-female ratio of 1:1.6. The mean age was 10.39 ± 3.81 years. The control group consisted of 100 eyes from 50 healthy patients, 26 (52.0%) females and 24 (48.0%) males. The characteristics of both groups are shown in Table 1. Visual acuity and astigmatism were statistically different; however, keratometric values were not.

Table 1

Demographic characteristics and baseline refractive data of PBKC and control groups.
Variable	PBKC group Mean ± SD	Control group Mean ± SD	P-value
No. of eyes	50	100
Age	10.39 ± 3.81	10.80 ± 3.61	0.1632
Gender Female Male	16, 61.60% 10, 38.40%	26, 52.00% 24, 48.00%	0.461
CDVA (LogMAR)	0.24 ± 0.21	0.07 ± 0.1	< 0.001
Pupillometry*	5.78 ± 0.99 mm	6.16 ± 0.96 mm	0.522
Spherical equivalent	-0.11 ± 2.23 D	0.23 ± 1.61 D	0.8489
Astigmatism (D)	1.6 ± 1.98	0.67 ± 0.76	0.017
K1	42.27 ± 2.96	42.4 ± 1.87	0.7594
K2	44.1 ± 3.6	44.11 ± 1.97	0.9849
*Pupil size under mesopic conditions. CDVA: Corrected-distance visual acuity, PKBC: Pediatric blepharokeratoconjunctivitis.

Zernike HOA polynomial analysis.

RMS values of total HOAs (1.05 ± 1.7µm), corneal HOA (11.96 ± 11.89 µm), and internal HOAs (11.78 ± 12.25 µm) from PBKC eyes were significantly higher (p < 0.001) than the controls (total HOAs = 0.41 ± 0.18 µm, corneal HOAs = 0.82 ± 0.91 µm, and internal HOAs = 0.9 ± 0.94 µm).

Individual aberration profile analysis showed that PBKC eyes had higher vertical coma, vertical secondary astigmatism, vertical quadrafoil, and oblique pentafoil than controls. (Fig. 2 and Table 2). Zernike coefficients profile of PBKC group versus healthy control group showed 4th -degree aberrations. Changes were detected in the vertical secondary astigmatism zones (4, 2) with very negative topographic values (M -0.05, ± 0.15, P = 0.0156, d = -0.38), as well as with decreased figures (M -0.04, ± 0.22, P = 0.0214, d = -0.35) for the foil square vertical zone (4, 4). In the 5th order aberrations only oblique pentafoil (5, 5) showed more alterations (M 0.07, ± 0.2, P = 0.0139, d = 0.372).

Table 2

Higher-order aberrations profiles of the PBKC versus healthy control groups.
Zernike coefficient (mode)	PBKC group (Mean ± SD)	Control group (Mean ± SD)	P-value
Total HOAs	1.05 ± 1.7	0.41 ± 0.18	< 0.001
V. coma Z (3, -1)	-0.21 ± 0.58	-0.04 ± 0.17	0.0071
H. coma Z (3,1)	-0.18 ± 0.58	-0.07 ± 0.14	0.0957
O. trefoil Z (3,3)	-0.12 ± 0.86	0.01 ± 0.17	0.128
O. Quadrafoil Z (4, -4)	0.02 ± 0.35	0.01 ± 0.11	0.7135
S. astigmatism Z (4, -2)	0.04 ± 0.2	0 ± 0.07	0.077
Spherical Z (4,0)	-0.03 ± 0.23	-0.09 ± 0.15	0.0679
V. S. astigmatism Z (4,2)	-0.05 ± 0.15	0 ± 0.09	0.0156
V. quadrafoil Z (4,4)	-0.04 ± 0.22	0.02 ± 0.1	0.0214
O. Pentafoil Z (5,5)	0.07 ± 0.2	0.01 ± 0.08	0.0139
H: Horizontal, O: Oblique, PBKC: Pediatric blepharokeratoconjunctivitis, S: Secondary, V: Vertical.

Increased HOAs and PBKC.

The OR and logistic regression analysis for developing HOAs according to corneal manifestations of PBKC are summarised in Table 3. The corneal manifestations with a stronger HOAs association were leucoma (OR = 32.01, p < 0.001), corneal vascularization (OR = 22.83, p < 0.001), phlyctenula formation (OR = 22.83, p < 0.001), and pannus (OR = 9.19, p < 0.001). Other corneal manifestations such as peripheral stromal infiltrate, focal corneal thinning, peripheral ulcerative keratitis (PUK), and corneal perforation were not associated with increased HOAs.

Table 3

The association of most common PBKC corneal manifestations with increased Higher-order aberrations.
Variable	No. eyes (%)	Odds ratio	95% CI	P-value
Age	50 (100%)	0.95	0.89–1.02	0.1836
Gender Female Male	16 (61.60%) 10 (38.40)%	1.3639 0.7332	-	0.461
Corneal pannus	37 (84%)	9.19	4.78–19.59	< 0.001
Marginal infiltrates	22 (44%)	3263.99	0.00 – NA	0.993
Corneal thinning	8 (16%)	804.29	0.00 – NA	0.977
Perforation	1 (2%)	457.3	0.00 – NA	0.979
Leucoma	22 (44%)	32.01	13.56–87.25	< 0.001
Corneal neovascularization	21 (42%)	22.83	8.95–76.07	< 0.001
Ulcer	2 (4%)	569.61	0.00 – NA	0.981
Phlyctenula	15 (30%)	22.83	8.95–76.07	< 0.001
PUK	1 (2%)	457.3	0.00 – NA	0.979
HOA: Higher-order Aberrations; PBKC: Pediatric Blepharokeratoconjunctivitis.

Optical quality measurements.

The MTF of PBKC eyes was significantly lower than the control group in mesopic conditions (16.37 ± 16.32 vs. 30.3 ± 23.57, p = < 0.001, r = .944). The mean values of the Strehl ratio from the PSF analysis were not significantly different between PBKC (0.01 ± 0.02) and the control group (0.02 ± 0.02, p = 0.611). Furthermore, amblyopia was present in 30 (60.0%) PBKC eyes, showing a positive correlation with total HOAs (p = < 0.001).

Disease asymmetry comparative analysis.

A total of 17 patients (65.3%) presented with bilateral asymmetric PBKC, while 9 (34.7%) had a symmetric disease. An analysis was performed on the PBKC group to compare the RMS value of HOAs between both eyes in cases of symmetric disease and the most affected eye in asymmetric disease. There was no significant difference in RMS values of total HOAs between both subgroups (p = 0.7197). However, corneal RMS HOAs were statistically higher (p = 0.0111) in the asymmetric subgroup (18.23 ± 76.2 µm vs. 0.85 ± 1 µm).

PBKC is an underdiagnosed chronic and recurrent inflammatory disorder with significant ocular surface morbidity during childhood. [1, 2, 8, 11, 20–22] PBKC usually presents in children aged 6.2 ± 2.4 years [2, 6, 8, 20], and self-limits between 9.5 to 13 years. [2, 21] This reported age of self-limitation is like the mean age reported in our study, which excluded patients with active disease (10.39 ± 3.81 years). Although some series do not report a significant predisposition to the disease by gender [2, 23], others have reported a female predominance. [6, 9, 22] No clear gender predisposition was found in these series (p = 0.461).

Corneal involvement has been reported in up to 55 to 81% of PBKC eyes [1, 8, 22]; hence, severe visual impairment is potentially related to corneal inflammation and scarring-induced refractive alterations and opacity. Therefore, considering that this sight-threatening disorder affects childhood and taking advantage of the ease and speed of acquiring a complete visual system analysis with the OPD Scan-III device, we decided to assess the eyes of PBKC children with corneal involvement and compare them with a healthy control group. Furthermore, although the eye's optical aberration analysis has recently become an important issue in ocular surface diseases, we still lack normative values in children. [24, 25]

Limited evidence exists regarding ocular surface disorders and the impact of optical aberrations on visual outcomes. [26, 27] In this study, PBKC patients had a significantly lower (0.24 LogMAR) CDVA than the control group (0.07 LogMAR). Teo et al. [22] reported that up to one-third of PBKC eyes might have poor vision (< 0.3 LogMAR) at presentation. Likewise, Jones et al. [8] reported a median monocular CDVA of 0.28 LogMAR in affected eyes at presentation. They demonstrated that a 2-year lag between disease onset and presentation could result in a 0.06 LogMAR-unit reduction in visual acuity, emphasising the disease can result in significant visual loss. [8] Further evidence has shown that the diagnosis of PBKC is usually delayed up to more than three years, correlating with worse visual outcomes. [1, 6]

The PBKC group had significantly higher astigmatism than the control group. In contrast, Doan et al. [21] found a mean astigmatism of 0.80 ± 0.89D in PBKC patients; 52% had astigmatism of at least 0.75D attributable to corneal scarring. Also, a significant increase in cornea astigmatism and ectasia pattern with no changes in average K values has been reported in adult patients with phlyctenular keratitis.[28] However, the average keratometry values did not differ between our study's PBKC and control groups.

Zhang et al. [24] studied 1,634 healthy children's eyes between 5 and 17 years old, finding a considerable variability in the presence of total HOAs. The mean total HOAs in the preschool age (5–7 years) was 0.338 ± 0.125, during the scholar age (8–12 years) was 0.353 ± 0.224, and during adolescence (13–17 years) was 0.400 ± 0.250. [24] In our healthy control population, including children between 6 to 16 years of age, the mean HOAs value was 0.41 ± 0.18, like previous studies on Asian and Oceanic healthy children. [24, 25, 29].

Chan et al. [30] reported the effect of corneal involvement in children with vernal keratoconjunctivitis, concluding that chronic inflammation on the ocular surface produced by this chronic allergic disease induces wavefront optical aberrations consisting of higher levels of HOAs RMS values and coma. We also found a significantly higher value of total HOAs in PBKC eyes than in healthy controls (Fig. 2).

The presence of leucoma, corneal vascularization, phlyctenula, and pannus formation demonstrated a higher risk of presenting elevated HOAs (Table 3). The association between these corneal manifestations and the increased likelihood of developing HOAs might be explained because these lesions may affect the visual axis and, therefore, often involve the physiologic pupil size studied by OPD-Scan. We could not relate peripheral stromal infiltrates, focal corneal thinning, peripheral ulcerative keratitis (PUK), and corneal perforation to increased HOAs because a limited number of eyes were suffering from these clinical manifestations. In addition to the peripheral location of corneal lesions that were not included in the OPD-Scan analysis.

Finally, OPD-Scan includes simulated analyses of the eye's optical quality and visual performance. [31] The MTF is an optical bench measurement used to evaluate the performance of an optical system, and aberrations contribute to a poor MTF value. [32] However, while RMS error and MTF are strongly correlated, it is not perfect, and in aberrated eyes, the interrelation of RMS and MTF is strongly dependent on the relative magnitudes of all Zernike coefficients. [33] Nevertheless, there was a significant relationship between reduced MTF and prominent HOAs in the PBKC group in this study (Fig. 1). On the other hand, there was no difference in the distortion level of a simulated point source of light measured by the Strehl ratio from the PSF analysis between groups, which is probably related to the localization of the peripherical corneal lesions in the PBKC and the presence of lower-order aberration in the control group.

Limitations encountered during the planning and execution of this study were the difficulty in evaluating visual acuity by contrast sensitivity and glare test in younger children, which would have improved our knowledge of the effect of PBKC corneal lesions on visual performance. Also, the frequency of recurrence or persistent inflammation hinders the availability of OPD-Scan analysis in PBKC patients. Moreover, although the device possesses an excellent eye visual fixation system and a quick data acquisition, it is always challenging to achieve children´s cooperation to perform a reliable OPD-Scan analysis. Also, longer follow-up periods and a larger series would be ideal for establishing the long-term effect of the HOAs on these children´s visual acuity.

In conclusion, this study addresses for the first time the visual impact of optical aberrations caused by PBKC, describing the corneal findings leading to increased HOAs. It demonstrates that astigmatism and HOAs are frequently observed in PBKC, with a higher impact on asymmetric disease, reducing visual acuity and quality. Wavefront aberrometry is a valuable tool to evaluate the eye´s optical system, allowing a fast and accurate analysis in chronic BKC children and a comprehensive assessment of the affected eye's optical quality by clinicians. Such information is crucial for making therapeutic decisions in the visual rehabilitation stage of these patients.

Acknowledgments: Salomon Alvarado-Ramos M.D. for his contribution to statistical assistance.

Conflict of Interest: The authors declare that they have no competing financial interests.

Funding: This research project received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Contributors: Conceptualization (SGG, ARG), Methodology (SGG, CMZ, GOM), Validation (SGG, JHPG, ARG), Formal Analysis (CMZ, SGG, GOM), Investigation (CMZ, SGG, GOM, JHPG, ARG), Resources (JHPG, ARG), Data Curation (CMZ, GOM, SGG), Writing – Original Draft (CMZ, SGG, GOM, ARG), Writing – Review & Editing (CMZ, SGG, ARG), Visualisation (SSG, JHPG, ARG), Supervision (SGG, JHPG, ARG), Project Administration (ARG).

Ethics approval: The study was approved by the Ethics (License No. P000172-BLE-STAFF-CEIC-CR001) and Research (License No. P000172-BLE-STAF-CI-CR001) Committees of our institution (License No. CONBIOETICA 19 CEI 011-2016-10-17 and COFEPRIS 20 CI 19 039 002, respectively), following the tenets of the Declaration of Helsinki.

Informed Consent: Informed consent from all patients´ parents was obtained.

ORCID IDs:

Carolina Mendoza-Zamora: http://orcid.org/0000-0002-5356-741X

Sara Gonzalez-Godinez: http://orcid.org/0000-0002-2387-8196

Gustavo Ortiz-Morales: http://orcid.org/0000-0003-4217-8985

Juan Homar Paez-Garza: http://orcid.org/0000-0001-7786-0189

Alejandro Rodriguez-Garcia: http://orcid.org/0000-0002-1419-2109

Data Availability Statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Rodriguez-Garcia A, Gonzalez-Godinez S, Lopez-Rubio S. Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome. Eye 30, 438–446 (2016). doi:10.1038/eye.2015.249
Viswalingam M, Rauz S, Morlet N, Dart JKG. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol 89, 400–403 (2005). doi:10.1136/bjo.2004.052134
McCulley JP. Blepharoconjunctivitis. Int Ophthalmol Clin 24, 65–77 (1984). doi:10.1097/00004397-198424020-00009
Seal D, Ficker L, Ramakrishnan M, Wright P. Role of staphylococcal toxin production in blepharitis. Ophthalmology <background-color:#FFCC66;bu>97</background-color:#FFCC66;bu>, 1684–1688 (1990). https://doi.org/10.1016/S0161-6420(90)32361-8
Ficker L, Ramakrishnan M, Seal D, Wright P. Role of cell-mediated immunity to staphylococci in blepharitis. Am J Ophthalmol 111, 473–479 (1991). https://doi.org/10.1016/S0002-9394(14)72383-9
Gonzalez-Godinez S, Lopez-Rubio S, Rodriguez-Garcia A. Staphylococcal blepharokeratoconjunctivitis at pediatric age. Rev Mex Oftalmol 89, 71–77 (2015). doi:10.1016/j.mexoft.2014.09.002
Shoaib KK. Severity of pediatric blepharokeratoconjunctivitis in Asian eyes. Am. J. Ophthalmol 154, 210 (2012). https://doi.org/10.1016/j.ajo.2012.03.002
Jones SM, Weinstein JM, Cumberland P, Klein N, Nischal KK. Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis. Ophthalmology 114, 2271–2280 (2007). https://doi.org/10.1016/j.ophtha.2007.01.021
Hammersmith KM, Cohen EJ, Blake TD, Laibson PR, Rapuano CJ. Blepharokeratoconjunctivitis in children. Arch Ophthalmol 123, 1667–1670 (2005). https://doi.org/10.1001/archopht.123.12.1667
Farpour B, McClellan KA. Diagnosis and management of chronic blepharokeratoconjunctivitis in children. JAAPOS <background-color:#FFCC66;bu>38</background-color:#FFCC66;bu>, 207–212 (2001). https://doi.org/10.3928/0191-3913-20010701-06
Palioura S, Kymionis G. Corneal neovascularization in childhood keratitis. Exp Rev Ophthalmol 12, 387–394 (2017). https://doi.org/10.1080/17469899.2017.1379900
Rohatgi J, Dhaliwal U. Phlyctenular eye disease: a reappraisal. Jpn J Ophthalmol 44, 146–150 (2000). https://doi.org/10.1016/S0021-5155(99)00185-9
Bernauer W, Langenauer UM. [Chronic (kerato-) conjunctivitis refractory to therapy in children]. Klin Monbl Augenheilkd 223, 353–356 (2006). https://doi.org/10.1055/s-2006-926557
Lapid-Gortzak R, Rosen S, Weitzman S, Lifshitz T. Videokeratography findings in children with vernal keratoconjunctivitis versus those of healthy children. Ophthalmology 109, 2018–2023 (2002). https://doi.org/10.1016/S0161-6420(02)01218-6
Cerviño A, Hosking SL, Montes-Mico R, et al. Clinical ocular wavefront analyzers. J Refract Surg 2007;23:603–616. https://doi.org/10.3928/1081-597X-20070601-12
Maeda N. Clinical applications of wavefront aberrometry - a review. Clin Exp Ophthalmol 37, 118–129 (2009). https://doi.org/10.1111/j.1442-9071.2009.02005.x
Tomás-Juan J. Aberrometría ocular: aplicaciones clínicas y limitaciones de los sensores de frente de onda. Ciencia & Tecnología para la Salud Visual y Ocular 1, 93–105 (2014). https://doi.org/10.19052/sv.2497
Buscemi P. Clinical applications of the OPD-Scan wavefront aberrometer/corneal topographer. J Refract Surg 18, S385-388 (2002). https://doi.org/10.3928/1081-597X-20020502-23
MacRae S, Fujieda M. Slit skiascopic-guided ablation using the Nidek laser. J Refract Surg 16, S576-580 (2000). https://doi.org/10.3928/1081-597X-20000901-18
Gupta N, Dhawan A, Beri S, D'souza P. Clinical spectrum of pediatric blepharokeratoconjunctivitis. JAAPOS 14, 527–529 (2010). https://doi.org/10.1016/j.jaapos.2010.09.013
Doan S, Gabison EE, Nghiem-Buffet S, Abitbol O, Gatinel D, Hoang-Xuan T. Long-term visual outcome of childhood blepharokeratoconjunctivitis. Am J Ophthalmol 143, 528–529 (2007). https://doi.org/10.1016/j.ajo.2006.09.058
Teo L, Mehta JS, Htoon HM, Tan DTH. Severity of pediatric blepharokeratoconjunctivitis in Asian eyes. Am J Ophthalmol 153, 564–570. (2012). https://doi.org/10.1016/j.ajo.2011.08.037
O’Gallagher M, Banteka M, Bunce C, Larkin F, Tuft S, Dahlmann-Noor A. Systemic treatment for blepharokeratoconjunctivitis in children. Cochrane Database Syst Rev CD011750 (2016). https://doi.org/10.1002/14651858.CD011750.pub2
Zhang N, Liu L, Yang B, Wei M, Xue W, Wu Y, et al. Higher-Order Aberrations in Children and Adolescents of Southwest China. Optom Vis Sci 95, 53–59 (2018). https//doi:10.1097/OPX.0000000000001160
Philip K, Sankaridurg PR, Ale JB, Naduvilathab TJ, Mitchell P. Profile of off-axis higher order aberrations and its variation with time among various refractive error groups. Vision Res 153, 111–123 (2018). https://doi.org/10.1016/j.visres.2018.07.005
Hu Y, Fang L, Guo X, Yang, X, Chen W, Ding X, et al. Corneal Configurations and High-order Aberrations in Primary Congenital Glaucoma. J Glaucoma 27, 1112–1118 (2018). https://doi.org/10.1097/IJG.0000000000001049
Awwad ST, El-Kateb M, McCulley JP. Comparative higher-order aberration measurement of the LADARWave and Visx WaveScan aberrometers at varying pupil sizes and after pharmacologic dilation and cycloplegia. J Cataract Refract Surg 32, 203–214 (2006). https://doi.org/10.1016/j.jcrs.2005.08.058
Katayama T, Yagi-Yaguchi Y, Ibrahim O, Shimazaki J, Yamaguchi T. Corneal higher-order aberrations in phlyctenular keratitis. Jpn J Ophthalmol 64, 478–484 (2020). https://doi.org/10.1007/s10384-020-00759-8
Gao J, Wang X-X, Wang L, Liu R, Zhao Q. The Effect of the Degree of Astigmatism on Optical Quality in Children. J Ophthalmol 2017:5786265 (2017). https://doi.org/10.1155/2017/5786265
Chan TCY, Wong ES, Chan JCK, Wang Y, Yu M, Maedaet N, et al. Corneal backward scattering and higher-order aberrations in children with vernal keratoconjunctivitis and normal topography. Acta Ophthalmol 96, e327-333 (2018). https://doi.org/10.1111/aos.13566
Scialdone A, Raimondi G, Monaco G. In vivo assessment of higher-order aberrations after AcrySof toric intraocular lens implantation: a comparative study. Eur J Ophthalmol 22, 531–540. (2012) https://doi.org/10.5301/ejo.5000090
Boreman GD. Modulation Transfer Function in Optical and Electro-Optical Systems, Second Edition. 2021. doi:10.1117/3.2581373
McLellan JS, Prieto PM, Marcos S, Burns SA. Effects of interactions among wave aberrations on optical image quality. Vision Res 46, 3009–3016 (2006). https://doi.org/10.1016/j.visres.2006.03.005

(Not answered)

Download PDF

Version 1

posted

You are reading this latest preprint version

Higher-order Aberrations and their Visual Impact in Paediatric Blepharokeratoconjunctivitis.

Status:

Version 1

Abstract

Background/Objectives:

Subjects/Methods:

Results

Conclusions

Figures

Introduction

Materials/subjects And Methods

Statistical analysis.

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1