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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics 120 Accommodation and Presbyopia Sunday, May 05, 2013 10:30 AM-12:15 PM TCC LL 4/5 Paper Session Program #/Board # Range: 381-387 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 381 Presentation Time: 10:30 AM - 10:45 AM Three-Dimensional Biometric Measurements of Accommodation Using Full-Eye-Length Swept-Source OCT Ireneusz Grulkowski1, Jonathan J. Liu1, Benjamin Potsaid1, 2, Vijaysekhar Jayaraman3, Alex E. Cable2, Martin F. Kraus1, 4, Joachim M. Hornegger4, Jay S. Duker5, David Huang6, James G. Fujimoto1. 1Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA; 2Advanced Imaging Group, Thorlabs Inc., Newton, NJ; 3Praevium Research Inc., Santa Barbara, CA; 4Pattern Recognition Lab and Graduate School in Advanced Optical Technologies (SAOT), University Erlangen-Nuremburg, Erlangen, Germany; 5New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA; 6Casey Eye Institute, Oregon Health & Science University, Portland, OR. Purpose: To demonstrate high speed, long-range swept source OCT utilizing vertical cavity surface emitting laser (VCSEL) technology for in vivo dynamic three-dimensional (3-D) imaging of eyes during accommodation. To measure changes in biometric parameters of the cornea and crystalline lens and determine changes in intraocular distances during accommodation. Methods: A high speed swept-source OCT instrument for long-range imaging was developed and integrated with Badal optometer for investigating accommodation. Full-eye-length imaging at 1050 nm with 100 kHz axial scan rate and 39 mm depth range was performed on five eyes (5 subjects, age 28.4±5.6 yrs, mean spherical equivalent -3.2±2.7 D) at 4 different vergence levels (0 D, 2 D, 4 D and 6 D). OCT volumetric data sets scanned with orthogonal rasters were registered and refraction corrected to remove both motion artifacts and distortion from light refraction. Measurements of parameters in the eye were calculated including central corneal thickness, anterior chamber depth, lens thickness, vitreous depth, axial length, as well as corneal curvature and crystalline lens curvature. Results: Volumetric OCT data spanning the depth of the entire eye for 3-D visualization and measurement of anterior chamber morphometry and axial eye length during accommodation were obtained. No significant change of the central corneal thickness or axial eye length was observed during accommodation. Increased accommodation demand caused movement of the crystalline lens toward the cornea, which resulted in decreased anterior chamber depth. The crystalline lens became thicker during accommodation, and its anterior and posterior curvatures change significantly compared with the unaccommodated eye. The iris also became more constricted at higher accommodation demand levels. Conclusions: 3-D Full eye length swept source OCT enables the measurement of comprehensive quantitative biometric information on the anterior segment of the eye as well as eye length during accommodation. This technology and method promises to be a useful tool for studying the mechanisms of accommodation and presbyopia as well as for developing next generation accommodating or multifocal IOLs in the future. Commercial Relationships: Ireneusz Grulkowski, None; Jonathan J. Liu, None; Benjamin Potsaid, Thorlabs, Inc. (E), Optovue, Inc. (P); Vijaysekhar Jayaraman, Praevium Research, Inc. (E), Thorlabs, Inc. (F); Alex E. Cable, None; Martin F. Kraus, Optovue Inc. (P); Joachim M. Hornegger, Optovue Inc. (P) (P); Jay S. Duker, Carl Zeiss Meditech (F), OptoVue (F), Optos (C); David Huang, Optovue (F), Optovue (I), Optovue (P), Optovue (R), Carl Zeiss Meditec (P); James G. Fujimoto, Carl Zeiss Meditec (P), Optovue (P), Optovue (I) Support: NIH (R01-EY011289-27, R01-EY013178-12, R01EY018184-05, R44EY022864-01, R01-CA075289-16, R01NS057476-05, R44-CA101067-05, R44-EY022864-01), AFOSR (FA9550-10-1-0551 and FA9550-10-1-0063), Research to Prevent Blindness, Massachusetts Lions Club, Thorlabs matching funds to Praevium, DFG (DFG-GSC80-SAOT). Program Number: 382 Presentation Time: 10:45 AM - 11:00 AM Three-dimensional biometry and alignment in eyes implanted with Accommodative IOLs as a function of accommodative demand Susana Marcos1, Sergio Ortiz1, Pablo Perez-Merino1, Miriam Velasco1, Mengchan Sun1, Judith Birkenfeld1, Sonia Duran2, Ignacio Jimenez-Alfaro2. 1Instituto de Optica, Consejo Superior de Investigaciones Cientificas, Madrid, Spain; 2Fundacion Jimenez Diaz, Madrid, Spain. Purpose: Accommodative intraocular lenses (A-IOLs) appear as a promising solution for the correction of presbyopia. We used custom spectral Optical Coherence Tomography (sOCT) to fully image and quantify in 3D the anterior segment of the eye in patients implanted with A-IOLs designed to move axially inside the eye. Methods: Custom sOCT provided with quantification tools (automatic image analysis and fan an optical distortion correction algorithms) was used to fully image in 3D the ocular anterior segment in 20 eyes from 10 patients (73-82 years old) implanted with single-optic A-IOLs (Crystalens AO, B&L). Measurements were performed pre-operatively, and post-operatively for 0, 1.25 and 2.5 D accommodative demands, under phenilephrine. The following parameters were extracted from the images: anterior and posterior ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics corneal and lens (natural and A-IOL) surface 3D geometry, pre-and post- anterior chamber depth (ACD), and lens and A-IOL tilt. ACD and lens alignment were estimated from 3D data, from the distances between surface apices, and from the vectors normal to the pupil and lens planes, respectively. Results: Data were obtained from fully registered pre/post-operative images, and from images corresponding to different accommodative demands (see Figure). The average ACD pre-op was 2.67±0.25 mm, and post-op (relaxed accommodation) was 3.84±0.39 mm, with high left/right eye symmetry. Most lenses moved axially backward upon an accommodative demand (up to 0.4 mm), opposite from the expected shift by design. Only five lenses moved forward (up to 0.11 mm). Natural lens tilt ranged from -2.14 to 1.84 (superior). The absolute tilt of the implanted A-IOLs was on average higher than the natural lens’ tilt; in 5 eyes the A-IOL tilt exceeded by more than x2.5 the pre-op tilt, and changed orientation. A-IOLs tilts generally occurred in the superior/nasal orientation. Most lenses changed tilt with accommodative demand (from 0 to 9 deg/D, on average across eyes). Conclusions: Quantitative sOCT imaging of the pre- and postoperative anterior segment of the eye appear essential to understand the mechanisms by which current A-IOLs operate and advance towards new developments. The tested A-IOL did not work as expected in most eyes, indicating that potential improvements in near vision are unlikely resulting from effective change in paraxial power, but may be associated to induced lens tilt. Program Number: 383 Presentation Time: 11:00 AM - 11:15 AM Synchronized Real Time Imaging of Ocular Anterior Segment Biometry and Ciliary Muscle during Accommodation Aizhu Tao1, 2, Yilei Shao1, 2, Meixiao Shen2, Hong Jiang1, Jianguang Zhong1, 3, Dexi Zhu2, Jianhua Wang1. 1University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL; 2 Wenzhou Medical College, School of Ophthalmology and Optometry, Wenzhou, China; 3Hangzhou First People’s Hospital, Hangzhou, China. Purpose: To test the feasibility and repeatability of synchronized real-time imaging of ocular anterior segment biometry and ciliary muscle during accommodation using optical coherence tomography (OCT). Methods: An improved OCT system using CMOS camera for scan speed improvement based on our previously reported ultra-long scan depth OCT was used (Du et al., Ophthalmology, 2012). The scan depth was 12.6 mm in air. A switchable reference arm was used to sequentially acquire a set of two frames with the placement of the zero delay lines on the top and the bottom of the anterior segment. Semi-automatic software was used to register and overlap the two frames and optical correction was performed before yielding biometric measurements. Another OCT was used to image the ciliary muscle and had a light source with the central wavelength of 1310 nm and the bandwidth of 75 nm. The two devices were combined and synchronized. The full range of the anterior segment at horizontal meridians with a frame rate of 8 fps, while the ciliary muscle at the temporal side of 7 fps, were imaged for a total time of approximately 3.7 second. The 6.00 D accommodative stimulus was given 1 second after the onset of acquisition. Four healthy subjects (age: 24.3 ± 2.1 yrs, refractive error: 4.4 ± 2.0 D) were enrolled and imaged in two separate sessions. Results: Dynamic alternation of both the anterior segment biometry and ciliary muscle were successfully recorded and measurements matched well between two imaging sessions (Fig. 1). During accommodation, the ciliary muscle contracts as shown in the increase of the maximal ciliary muscle thickness and the forward movement of the ciliary apex. As expected, the crystalline lens became thicker and steeper in the front surface. These changes appeared to be as a function of time and the biometric alternation was almost parallel to the ciliary muscle constriction. However, hysteresis (0.5 s) of the lens reshaping (time to reach the maximal changes) compared to maximal ciliary muscle contraction occurred in two cases. Conclusions: This pilot study demonstrated for the first time that combined OCT system is feasible to determine the dynamic alternation of the anterior segment during accommodation. The realtime relationship between anterior segment biometry and ciliary muscle contraction can be quantified reliably, which sets the stage for studying the mechanism of accommodation. Commercial Relationships: Susana Marcos, Essilor (F), PCT/ES2012/070185 (P); Sergio Ortiz, PCT/ES2012/070185 (P); Pablo Perez-Merino, None; Miriam Velasco, None; Mengchan Sun, None; Judith Birkenfeld, None; Sonia Duran, None; Ignacio Jimenez-Alfaro, None Support: Spanish Government Grant FIS2011-25637; European Research Council ERC-2011 AdG-294099; EU Marie Curie FP7PEOPLE-2010-ITN 264605; CSIC JAE-Program; Unidad Asociada IO-CSIC/FJD ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics accommodate less, and thus presents a real accommodative lag for near targets. Commercial Relationships: Norberto Lopez-Gil, None; Paula Bernal-Molina, None; Richard Legras, None; Teresa FerrerBlasco, None; Robert Montés-Micó, None Support: European grant ERC-2012-StG 309416-SACCO and Fundacion Seneca Grant 15312/PI/10 Commercial Relationships: Aizhu Tao, None; Yilei Shao, None; Meixiao Shen, None; Hong Jiang, NIH (F); Jianguang Zhong, None; Dexi Zhu, None; Jianhua Wang, NIH (F), RPB (F) Support: Supported by research grants in part from the NIH EY021012, EY021336 and R01EY020607S, NIH Center Grant P30 EY014801, Research to Prevent Blindness (RPB), Department of Defense (DOD- Grant#W81XWH-09-1-0675). Program Number: 384 Presentation Time: 11:15 AM - 11:30 AM Depth-of-focus of the accommodating eye Norberto Lopez-Gil1, Paula Bernal-Molina1, Richard Legras2, Teresa Ferrer-Blasco3, Robert Montés-Micó3. 1Grupo de Investigación de Ciencias de la Visión, Universidad de Murcia, Murcia, Spain; 2 Laboratoire Aimé Cotton, CNRS. University Paris-Sud, Orsay, France; 3Optica, Universidad de Valencia, Burjassot, Spain. Purpose: To obtain experimental values of the depth-of-focus (DoF) of the human eye for different accommodative states. Methods: In a first part of the experiment we measured the aberrations of 7 young eyes (29.7 ± 7.7 years) during accommodation at 8 different accommodative steps (from -1 to 6 D). Then, in a second part, accommodation was paralyzed (cyclopentolate) and we used an adaptive optics system with a deformable mirror (Imagine Eyes, France) to correct the aberrations of the paralyzed eye and to simulate the aberrations of the accommodated eye for each accommodative state measured in the first part of the experiment. A Badal system was used to modify the vergence of the stimulus in order to obtain three-repeated measurements of the subjective DoF. Equally in the second part of the experiment, an artificial pupil with a similar diameter to the natural pupil measured in the first part was used. The object stimulus used consisted on microdisplay showing three lines of high contrast black letters of 0.4, 0.5 and 0.6 VA on a white background. The criteria used for DoF was the objectionable blur. Results: All subjects presented a similar result of DoF (maximum intra-subject SD = 0.23 D) with a mean value of DoF which increased from 0.85 to 1.07 D during accommodation (0 to 6 D). This increase can be explained in terms of pupil accommodative myosis (mean pupil diameter decreased from 5.70 to 4.63 mm during the accommodation range). Accommodative lag increased with accommodation, and for large accommodation demands (4-6 D) the refractive state of the eye was close to the extreme of the DoF, so, in fact, accommodation was minimum. Results of DoF correlate with the few measurements previously obtained using other methodologies by other authors. Conclusions: Under experimental conditions, DoF is close to 1 D. Our results clearly indicate that, if the deterioration of the retinal image quality is acceptable, the visual system uses DoF to Program Number: 385 Presentation Time: 11:30 AM - 11:45 AM Anatomical and accommodative changes in patients undergoing cataract surgery with presbyopia accommodative lens placement Diego Chavez. echography, Hospital Nuestra Señora de la Luz, Mexico, Mexico. Purpose: Document with UBM study the anatomical and accommodative intraocular changes that occur with pharmacological accommodative stimulus using 2% pilocarpine in eyes with accommodative IOLs implantation. Methods: METHODS patients undergoing cataract surgery with intraocular accommodative lens placement during 2012. Measurements in millimeters of the lens-corneal endothelium distance (LCED) , irido-corneal angle (ICA) and trabecular ciliary body distance (TCBD) were taken using UBM study, all of them with superior and nasal orientation. Then we apply one drop of pilocarpine 2% every 15 minutes and measure the same variables. Results: patients undergoing cataract surgery with accommodative lens placement from January to September 2012. Three patients attended the study, all with placement of accommodative IOLs in both eyes, six eyes were analyzed. The average age was 60 years, the average IOLs power was 22.9 diopters. To analyze the data we search a significant difference between the measurements obtained at baseline and after application of pilocarpine. We calculate the mean, median and standard deviation. Finally data was analyzed using F Fisher statistic method with 5 degrees of freedom and 95% interval confidence looking for a P value less than 0.05. Conclusions: Pilocarpine induced no significant changes in the anterior displacement of the IOLs. Assuming the anterior displacement of the IOLs provides accommodative capacity, endothelium lens distance should decrease, however, in this study we found no correlation between them. Also found no significant difference between the distance trabecular ciliary body and iridocorneal angle. We conclude that pilocarpine does not induce any change in position of the lens in spite of several studies that reported a change in lens position using this method, the present study found no significant difference in the measurement of anterior chamber depth, iridocorneal angle and trabecular ciliary body distance. More studies with a larger number of patients and long-term followup is needed to document the loss of motility of the lens over time, whereas capsular fibrosis is an expected consequence of cataract surgery, we assume that the accommodative IOLs analyzed in this study have already presented some type of capsular fibrosis impeding the proper functioning of the accommodative IOLs. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics eyes, respectively, and in the older eyes the posterior pole of the lens moved forward during accommodation by -0.08 ± 0.04 mm (n=4). Over the entire age range for the human subjects, the posterior lens movement declined by 0.0049 ± 0.0008 mm/year (p=0.001, r=0.86). Similar results were seen in the phakic monkey eyes. Following ECLE the capsule bowed backward in all 6 monkeys during accommodation. In the three monkey eyes in which measurements were taken, the posterior capsule bowed backward during accommodation by 0.70 ± 0.03 mm, 0.45 ± 0.02 mm, and 0.26 ± 0.03 mm in the 8-, 17-, and 22-year-old monkeys, respectively. Conclusions: During accommodation, the vitreous allows a small amount of posterior movement of the posterior pole of the lens and allows pronounced backward movement of the capsule following ECLE, but this posterior accommodative movement declines with age. These findings may have implications for the mechanism of accommodation and presbyopia and the function of accommodating IOLs. Commercial Relationships: Mary Ann Croft, Seros Medical (R), Z-Lens LLC (R); Gregg A. Heatley, None; T Michael Nork, None; Jared P. McDonald, None; Alex Katz, None; Julie Kiland, None; Paul L. Kaufman, Alcon (C), Allergan (C), Altheos, Inc (C), Bausch & Lomb (C), Amakem Therapeutics (C), Johnson & Johnson (C), Lens AR, Inc (F), Merck (C), Pfizer (C), Santen (C), WARF (F), Z Lens, LLC (F), Alcon (R), Allergan (R), Altheos, Inc (R), Bausch & Lomb (R), Amakam Therapeutics (R), Merck (R), Pfizer (R), Santen (F), Santen (R) Support: Support: NEI (RO1 EY10213 & R21 EY018370 to PLK), RPB, Grant # 5P51 RR 000167 to WNPRC, OPREF Core Grant for Vision Research Grant # P30 EY016665. Commercial Relationships: Diego Chavez, None Program Number: 386 Presentation Time: 11:45 AM - 12:00 PM Accommodative Movements of the Lens/Capsule in Relation to the Vitreous Face and Aging Mary Ann Croft, Gregg A. Heatley, T Michael Nork, Jared P. McDonald, Alex Katz, Julie Kiland, Paul L. Kaufman. Ophthalmology, Univ of Wisconsin-Madison, Madison, WI. Purpose: To elucidate the accommodative movements of the posterior lens/capsule in the human eye at various ages in comparison to the monkey eye before and after extracapsular lens extraction (ECLE). Methods: The eyes of 6 rhesus monkeys (aged 8-22 yrs) and 12 human subjects (aged 19-65 yrs) were studied. Maximum accommodative responses were induced in the human eyes by pharmacological stimulation (2 drops 4% pilocarpine) and in the monkey eyes by central electrical stimulation of the EdingerWestphal (E-W) nucleus. Ultrasound biomicroscopy (UBM; 50 MHz, 35 MHz) images were collected in the region of the lens/capsule, ciliary body, and zonular attachments in both species. Results: During accommodation in the human eyes, the posterior pole of the lens moved posteriorly by 0.08 ± 0.01 [mean ± s.e.m.] mm (n=4) and 0.01 ± 0.03 mm (n=4) in the young and middle-aged Program Number: 387 Presentation Time: 12:00 PM - 12:15 PM Accommodative-Disaccommodative IOL with Zonular Capture Haptics Paul M. Beer1, 2, Paul L. Kaufman3, Mary Ann Croft3, Gregg A. Heatley3, Jared P. McDonald3, Alex Katz3. 1Ophthalmology, Z Lens LLC, Slingerlands, NY; 2Ophthalmology, Albany Medical College, Albany, NY; 3Ophthalmology, Univ of Wisconsin, Madison, WI. Purpose: To determine if a single optic accommodativedisaccommodative IOL with Zonular Capture Haptics will exhibit desirable axial shift and accommodation. Methods: Single optic, accommodative IOL’s with Zonular Capture Haptics were manufactured using a 5mm silicone optic from a commercially available IOL and haptics made from Prolene® suture material. Two such IOL’s were implanted into two Rhesus monkeys. The capsular bag was sectioned three weeks post implantation. Two weeks later UBM and plano perfusion lens imaging was performed in each animal. One week later the experiments were repeated with Visante OCT imaging. Accommodation was induced by pharmacological stimulation with corneal iontophoresis of 40% carbachol (CARB) in agar; a supramaximal dose for inducing accommodation. Results: Pharmacologically stimulated accommodation yielded a maximum accommodation of 2 and 6 diopters in respectively. In both animals maximum accommodation was reached 10 minutes after CARB administration with a rapid return to near baseline refractions at only 20 minutes. Both animals had accommodative anterior chamber shallowing as measured using UBM: 0.33mm(0.39-0.27) at two weeks post sectioning and OCT 0.54mm(0.65-0.43mm) at three weeks post sectioning. Plano perfusion lens imaging revealed a decrease in capsule diameter during accommodation in both animals of 0.59mm (0.52-0.65mm). ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Conclusions: Zonular Capture Haptic based accommodativedisaccommodative IOL’s demonstrate a useful range of accommodation and significant axial shift in a first prototype, proof of concept IOL model. Conclusions: A significant difference in the number of patients with high scattered light measurements were observed in the patients with floaters and no PVD. The exact nature of this difference needs to be further evaluated. It is possible that only floaters close to the retinal surface are able to induce a measureable light scattering and be responsible for the clinical manifestations. Axial Shift Commercial Relationships: Paul M. Beer, Z Lens LLC (I), Z Lens LLC (P); Paul L. Kaufman, Alcon (C), Allergan (C), Altheos, Inc (C), Bausch & Lomb (C), Amakem Therapeutics (C), Johnson & Johnson (C), Lens AR, Inc (F), Merck (C), Pfizer (C), Santen (C), WARF (F), Z Lens, LLC (F), Alcon (R), Allergan (R), Altheos, Inc (R), Bausch & Lomb (R), Amakam Therapeutics (R), Merck (R), Pfizer (R), Santen (F), Santen (R); Mary Ann Croft, Seros Medical (R), Z-Lens LLC (R); Gregg A. Heatley, None; Jared P. McDonald, None; Alex Katz, None 128 Spatial Vision, Visual Psychophysics and Aging I Sunday, May 05, 2013 10:30 AM-12:15 PM Exhibit Hall Poster Session Program #/Board # Range: 568-586/C0179-C0197 Organizing Section: Visual Psychophysics / Physiological Optics Contributing Section(s): Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology Program Number: 568 Poster Board Number: C0179 Presentation Time: 10:30 AM - 12:15 PM The effect of posterior vitreous detachment or vitreous opacities (floaters) on straylight measurements Miguel Castilla, Marc D. de Smet. MIOS, Lausanne, Switzerland. Purpose: To evaluate if straylight measures taken in patients with complaints of floaters (and no posterior vitreous detachment [PVD]) are different from patients presenting with a PVD. Methods: A retrospective review of patients having undergone a straylight measurement with a C-Quant (Oculus, Germany) who presented with a complaint of floaters or observed to have a PVD when examined but who did not complain of floaters. Data was collected on age, status of the lens, and only the initial C-Quant measurement was analyzed if several were taken. Only patients with intact vitreous were considered in the study. Straylight measurements were considered significant if they were above 2 standard deviations [SD] from a normative database, controlled for age. Results: The mean age for both groups was 58.58 years with an SD of 12.75 years. Thrity one eyes from 29 patients were included, 11 eyes with a diagnosis of PVD, and 20 eyes with floaters. In the PVD group, only 5 eyes had measures above the 2 SD cutoff, while 14 of 20 eyes in the floaters group met this criterion. The mean straylight value for the floaters group was 1.88 with an SD of 1.42 and for the PVD group of 1.24 with an SD of 0.25. The differences between both groups did not reach statistical significance (p=0.087). Commercial Relationships: Miguel Castilla, None; Marc D. de Smet, Thrombogenics (P), Thrombogenics (C), Sanofi (C), Bayer (C), Regeneron (C), Preceyes (R), Allergan (C), Janssens (R), GSK (C), CRL (C) Program Number: 569 Poster Board Number: C0180 Presentation Time: 10:30 AM - 12:15 PM Visual findings in children with Autistic Spectrum Disorder Pamela M. Anketell1, Kathryn J. Saunders1, Stephen M. Gallagher2, Clare Bailey3, Julie-Anne Little1. 1School of Biomedical Sciences, University Of Ulster, Coleraine, United Kingdom; 2School of Psychology, University of Ulster, Coleraine, United Kingdom; 3 Community Child Health, Northern Health & Social Care Trust, Newtownabbey, United Kingdom. Purpose: Anomalous visual findings have been described in Autistic Spectrum Disorder (ASD) including both superior and reduced visual acuity (VA) (Ashwin et al. 2009, Milne et al. 2009), an increased prevalence of strabismus (Denis et al. 1997) and reduced near point of convergence (NPC) (Milne et al. 2009). The aim of this study was to investigate visual findings in a large population of children with ASD. Methods: Children with ASD (n=88, mean age 10.7 years ±3.1 years, range 5-16 years) were recruited from a regional populationbased register (n=67) and special education schools (n=21). ASD diagnosis was available from the register and classified as; Autism (AU) n=50, Asperger’s syndrome (AS) n=33, unspecified n=5. Agematched controls were recruited from mainstream schools (n=204, mean age 11.5 years ±3.1 years). Monocular recognition crowded VA, presence of strabismus, NPC, fusional reserves (FR) and Frisby stereoacuity scores were assessed. Results: Table 1 presents success rates and summary statistics for all data. Controls demonstrated slightly but significantly better VA than the ASD group (Mann Whitney z=-2.49, p<0.05). A statistically significant higher prevalence of strabismus was noted ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics for the ASD group (6.8%) [AU; 4%, AS; 12.1%] compared with the control group (1.4%) (Chi-squared χ2(2, 287)=10.76, p<0.01). NPC was significantly poorer for AU subgroup compared to controls (Mann Whitney z=3.6, p<0.0005). There was no significant difference between ASD and control groups in magnitude of FR (Base out; Kruskal-Wallis=0.02, p=0.99, Base-in; KruskalWallis=1.83, p=0.40). Analyses of stereoacuity scores identified that control and AS subgroups achieved significantly better stereoacuity compared to the AU group (Mann Whitney control; z=2.85 p<0.005, AS; z=3.22 p<0.005). Conclusions: Children with ASD in the current study have a different visual profile when compared to controls; including increased prevalence of strabismus and reduced VA, NPC and stereoacuity. Whilst statistically significant, these differences in VA, NPC and stereoacuity may lack clinical relevance. However, clinicians should be aware of the increased prevalence of strabismus in this population. Table 1; success rates and summary statistics for all data Commercial Relationships: Pamela M. Anketell, None; Kathryn J. Saunders, None; Stephen M. Gallagher, None; Clare Bailey, None; Julie-Anne Little, None Support: NHS R&D Fellowship Grant number EAT/4197/09 Program Number: 570 Poster Board Number: C0181 Presentation Time: 10:30 AM - 12:15 PM Videogame Experience Enhances Temporal Visual Attention in Adult Amblyopia: The Attentional Blink in Amblyopia Charlie V. Ngo1, 2, Truyet Tran2, Calvin Nguyen2, Dennis M. Levi2, Roger W. Li2. 1Optometry, Baltimore VA Medical Center, Baltimore, MD; 2School of Optometry, University of California, Berkeley, Berkeley, CA. Purpose: Amblyopia causes deficits in spatial and temporal vision. Our recent findings have shown that videogame training induces a generalized recovery of spatial visual functions in amblyopic patients. Here we investigated whether playing videogames enhances temporal visual attention in adult amblyopia. When visual targets are presented in rapid succession, correct identification of the first target can interfere with identification of the second. This second-target deficit is known as the attentional blink. This phenomenon has often been explained on the basis of an “attentional bottleneck” (i.e., a processing stage that can handle only one item at a time). Amblyopes show an abnormal attentional blink with their amblyopic eye. Methods: We measured the attentional blink in each eye of 11 adults with amblyopia, before and after 40 hours of videogame play, using a rapid serial visual presentation (RSVP) technique. The observer had two tasks: (1) To identify a white letter (T1) randomly positioned in a temporal sequence of black letters and (2) to detect the presence of a black letter “X” (T2), which was presented in half of the trials at a random temporal position after T1 (lag=1-8; lag 1: “X” was the first letter to appear after T1; each letter frame was 100 ms). Additional random letters were added to the end of the sequence. Results: Prior to videogame play the shape of the mean baseline attentional blink curve (probability of correct T2 report vs time after T1) of the amblyopic eyes was slightly shallower than that of the fellow preferred eyes, as reported by Popple & Levi, 2008). After 40 hours of videogame play, we observed a 22% improvement (reduction) in the attentional blink (identifying T2 200 ms after T1) seen through the amblyopic eye. Conclusions: Our findings suggest that videogame play improves temporal visual attention in adult amblyopia. Importantly, this videogame training technique might be useful in combination with other vision therapy regimens and induce visual plasticity in cortical visual disorders. Commercial Relationships: Charlie V. Ngo, None; Truyet Tran, None; Calvin Nguyen, None; Dennis M. Levi, None; Roger W. Li, None Support: NIH Grant R01EY01728 Program Number: 571 Poster Board Number: C0182 Presentation Time: 10:30 AM - 12:15 PM Suppression of the Implicit Surface Susan Kelly, Yi Pang. Basic Science, Illinois College of Optometry, Chicago, IL. Purpose: A number of authors have reported that human observers can accurately judge the physical distance of visual targets if they are located on a flat ground surface. The correlation between distance judgments measured with the blind-walking technique correlate highly with a target’s physical distance in lighted conditions. However distance judgments of self-illuminated targets in darkness are very inaccurate. Ooi and colleagues have proposed that in both darkness and light, observers judge an object’s distance as the intersection between its angle of declination and the perceived slant of the ground surface. They report that in darkness the human visual system relies on a default ground surface called the implicit surface that tilts upwards towards the horizon with a slant of around 12 deg. Our experiments have revealed another aspect of this implicit surface; it is triggered by the absence of light in the visual field and suppressed by the presence of light in the visual field. Methods: Forty-five visually normal young adults observed a small self-illuminated target in darkness. Subjects were instructed to blindwalk to the remembered location of the target under one of the following conditions: 1) blind-walk in darkness (n=28); 2) blind-walk in presence of white light (n=10) and 3) blind-walk in presence of red light (n=7). Results: The blind-walking estimates of a target’s distance are much more accurate if the blind-walking takes place in a lighted room versus a dark room (F=18.85, p<0.001) even though in both cases subjects are blind-folded when walking; the only difference between these conditions is the presence or absence of light in the visual field. Pair-wise comparison showed no difference in estimates made in white versus red room illumination (p=0.21) but both differed significantly from the dark condition (p<0.01). Conclusions: The distance perception of targets viewed in darkness is dramatically affected by the presence or absence of room lighting; when subjects blind-walk to the remembered target location in darkness they rely on the implicit surface and their distance estimates are inaccurate. However, if they blind-walk to the remembered target location with room illumination present then there is no default to the implicit surface and distance perceptions are accurate. Neither the ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics photoreceptors nor the neural pathway responsible for suppressing the implicit surface are known. Commercial Relationships: Susan Kelly, None; Yi Pang, None Program Number: 572 Poster Board Number: C0183 Presentation Time: 10:30 AM - 12:15 PM Postural adaptation to large optic flow fields Guillaume L. Giraudet1, 2, Clementine Faron1, Jocelyn Faubert1. 1 Psychophysics & Visual Perception Lab, Universite de Montreal, Montreal, QC, Canada; 2ESSILOR Canada, Montreal, QC, Canada. Purpose: The aim of the current study was to determine the effect of visual adaptation for contracting and expanding optic flow on postural stability. Methods: Twelve subjects participated in the experiment. They stood in a fully immersive virtual reality environment. The stimulus was a 3D textured tunnel, either static or moving forward (expansion) or backward (contraction) at 3 different speeds: 0.275, 1.1 and 4.4 m/s. Each trial was composed of 3 stages. The first one was called “Baseline”, during which the tunnel was static. It lasted 2 seconds. Then the stimulus started to move forward or backward for 10, 20 or 40 seconds; “Adaptation” stage. For the third, “post-adaptation” stage the stimulus suddenly halted and remained static for 15s. Optical motion sensors, located on the stereoscopic goggles, were used to track and register body movements. Behavioral reactions to the various visual conditions were described by comparing postural stability between the 3 different stages described above. Results: Results showed that subjects get adapted to the expansion optic flows by increasing their postural stability. The longer the adaptation stage lasted, the more body movements were reduced. A similar stabilization effect was observed when movement speed increased. However, we did not measure any adaptation for the contraction optic flow. In this direction, postural behavior remained constant during the whole sequence, that is, during all 3 different stages of presentation and for all moving scene speeds. Conclusions: The current study confirms that expansion and contraction optic flows are processed differently and have different impacts on visuomotor systems. Several neurophysiological and imaging studies reported an expanding motion bias represented as greater activation in motion sensitive cortical areas than for contraction optic flow (Ptito, Kupers, Faubert, Gjedde, 2001). Our results highlight that, in the context of visually guided actions, the control of body posture changes when the properties of the expanding optic flow are modified but it does not respond to properties of moving scenes in contraction. Commercial Relationships: Guillaume L. Giraudet, ESSILOR Canada (E); Clementine Faron, None; Jocelyn Faubert, Université de Montréal (P) Support: CRSNG-ESSILOR Industrial Chair Program Number: 573 Poster Board Number: C0184 Presentation Time: 10:30 AM - 12:15 PM Measurement of stimulus contrast and fading under natural and manipulated motion trajectories Nicole M. Putnam1, 2, Pavan Tiruveedhula2, Austin Roorda2. 1Arizona College of Optometry, Midwestern University, Glendale, AZ; 2 School of Optometry, University of California, Berkeley, Berkeley, CA. Purpose: High-resolution imaging with Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) combined with real-time image stabilization and targeted stimulus delivery allows simultaneous imaging and psychophysical testing. We utilize this capability to investigate the role of small fixational eye movements, or the lack thereof, on stimulus contrast and fading. Methods: Image stabilization and targeted stimulus delivery with AOSLO facilitates the presentation of any stimulus motion including natural, stabilized, amplified, rotated, or independent trajectories. We first investigated the threshold for detection of a small grating that increased in contrast over the course of a 6 second trial at the fovea and 1 degree eccentricity. Subjects performed a 2 AFC judgment of grating orientation as soon as they were able to make a judgment. We recorded the contrast level at the time the decision was made under natural, stabilized and manipulated eye motion conditions. We then looked at the time-course of image fading for small stimuli near the fovea. Subjects fixated the corner of the imaging raster and a small 100% contrast grating appeared at a random location within the field. Subjects pressed one button when the stimulus was no longer visible and pressed another if the 9 second trial concluded with no image fading. We measured the time the stimulus was visible and the percentage of trials where the stimulus was visible for the entire trial for natural, stabilized, and manipulated eye motion conditions. Results: We find that the contrast required to detect a stimulus that was ramping up in contrast over a 6 second trial was the highest under stabilized conditions at both locations tested. The conditions under which thresholds were smallest, however, depended on the retinal location. At the fovea, the thresholds were at a minimum for natural stimulus motion whereas at 1 deg, the minimum threshold occurred with amplified motion (double the retinal slip). For the fading experiments, we found that the time required for an image to fade was shortest under stabilized conditions and that there were no instances where the stimulus did not fade in the 9-second trials for three subjects. Conclusions: Our results suggest that the sensitivity of foveal cones is optimal for natural image motion caused by fixation. However, as close as 1 degree, contrast sensitivity is improved when the retinal image motion is amplified. Commercial Relationships: Nicole M. Putnam, None; Pavan Tiruveedhula, None; Austin Roorda, US Patent #6890076 (P), US Patent #7118216 (P), UC Berkeley (P) Support: EY014375 and AOF William C. Ezell Fellowship Program Number: 574 Poster Board Number: C0185 Presentation Time: 10:30 AM - 12:15 PM Dynamic stimulus presentation facilitates peripheral resolution acuity Peter R. Lewis, Victoria Holm, Karthikeyan Baskaran, Jorgen Gustafsson. Section of Optometry and Vision Science, Linnaeus University, Kalmar, Sweden. Purpose: Peripheral high-contrast resolution is sampling limited; the center to center spacing between ganglion cells ultimately limiting visual performance (Thibos et al., 1987). Although retinal image motion in the fovea has a detrimental effect on visual acuity, previous studies have suggested that retinal image motion may be advantageous in the peripheral visual field (Bex et al., 2003; Brown, 1972; Macedo et al., 2010). The aim of this study was to evaluate the effect of drift motion on peripheral resolution acuity. Methods: Peripheral high-contrast resolution acuity in a group of 26 subjects (age 23.5 ± 3.2 years) was initially determined using a 2alternative forced-choice Bayesian algorithm; the threshold value defined as the spatial frequency resulting in a 75% correct response rate. The stimuli used to measure static visual acuity were stationary Gabor-patches with a visible diameter of 2° and were presented at 20° in the nasal visual field. We determined the percentage correct response rate for varying velocities using drifting Gabor patches of the same spatial frequency as determined during measurement of static visual acuity. The sine-wave gratings drifted within the Gaussian envelope at one of 10 angular velocities, varying from 0.2 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics to 2.0 degrees/second in 0.2 degrees/second steps. Results: Results showed an overall improvement in the subjects’ performance for all velocities. There was a significant difference in the percentage of correct responses between static stimulus presentation and for velocities of between 0.4 to 1.2 degrees/second (p < 0.05, One-way repeated measures ANOVA with Bonferroni post hoc tests). The average “correct response” for static stimulus presentation was 76 ± 2 %, improving to at least 85 % for velocities between 0.4 to 1.2 degrees/second. At velocities greater than 1.2 degrees/second performance was still better than for static stimulus presentation, but showed a gradual decline with increasing speed. Conclusions: In line with previous studies stimulus motion has a positive effect on peripheral high-contrast resolution acuity. Presenting moving stimuli may benefit patients who rely on peripheral visual function, such as those with central visual field loss subsequent to AMD. Commercial Relationships: Peter R. Lewis, None; Victoria Holm, None; Karthikeyan Baskaran, None; Jorgen Gustafsson, None Program Number: 575 Poster Board Number: C0186 Presentation Time: 10:30 AM - 12:15 PM Distance Visual Acuity Screening of Preschoolers with Hyperopia Marjean T. Kulp1, Gui-Shuang Ying2, Jiayan Huang2, Maureen G. Maguire2, Graham E. Quinn3, Elise Ciner4, Deborah A. Orel-Bixler5, Lynn A. Cyert6, Bruce Moore7. 1College of Optometry, Ohio State University, Columbus, OH; 2University of Pennsylvania, Philadelphia, PA; 3Children’s Hospital of Philadelphia, Philadelphia, PA; 4Pennsylvania College of Optometry, Salus University, Elkins Park, PA; 5School of Optometry, University of California, Berkeley, CA; 6College of Optometry, Northeastern State University, Tahlequah, OK; 7New England College of Optometry, Boston, MA. Purpose: Hyperopia has been shown to be associated with an increased risk of amblyopia and strabismus among preschoolers. The purpose of this study is to compare uncorrected distance visual acuity (VA) measured with the VIP Crowded Single LEA Symbols® VA Test at 5 feet (VIP 5ft Lea) in 3- to 5-year-old Head Start children with versus without hyperopia. Methods: In VIP (Phase II), 1452 preschoolers were screened with the VIP 5ft Lea test by lay screeners. All children underwent comprehensive vision examination including threshold VA using the ATS single-surround HOTV letter protocol, cover testing, and cycloplegic retinoscopy by masked examiners. Hyperopia was defined as >+3.25D in the most positive meridian in one or both eyes. Uncorrected distance VA in the worse eye as measured by the VIP 5 ft Lea was compared for 1) children with hyperopia and those without and 2) children with hyperopia plus other visual conditions (amblyopia, strabismus, astigmatism, and/or anisometropia), those with hyperopia alone, and those without hyperopia. Results: Uncorrected distance VA measured with the VIP 5ft Lea test was significantly different between children with hyperopia (n=182, median VA 20/50) as compared to those without hyperopia (n= 1270, median VA 20/40)(p<0.0001). Uncorrected distance VA was also significantly different when compared among children with hyperopia plus other visual conditions (n=111, median VA 20/200), those with hyperopia alone (n=71, median VA 20/50), and those without hyperopia (p<0.0001 for comparison among the 3 groups, p=0.02 for comparison between children with hyperopia alone versus no hyperopia). Conclusions: Uncorrected distance visual acuity, measured with the VIP 5ft Lea test, is significantly lower in children with versus without hyperopia, even when not associated with other visual conditions. Commercial Relationships: Marjean T. Kulp, None; Gui-Shuang Ying, None; Jiayan Huang, None; Maureen G. Maguire, Inspire Pharmaceuticals (F), Amakem (F), IDx LLC (F), Merck (C); Graham E. Quinn, None; Elise Ciner, None; Deborah A. OrelBixler, None; Lynn A. Cyert, None; Bruce Moore, EyeNetra Inc. (I) Support: NEI/NIH, DHHS grants: U10EY12644; U10EY12547; U10EY12545; U10EY12550; U10EY12534; U10EY12647; U10EY12648 and R21EY018908 Program Number: 576 Poster Board Number: C0187 Presentation Time: 10:30 AM - 12:15 PM Comparison of foveal and perifoveal acuity in myopia Stephanie X. Shao, Nancy J. Coletta. New England College of Optometry, Boston, MA. Purpose: Visual acuity and cone density both decrease at parallel rates with increasing myopia (Coletta and Watson, Vis. Res., 2006; Chui et al., IOVS, 2008). Young adult eyes with refractions less than 3D are reported to have relatively lower perifoveal cone density when the foveal cone density is high, implying that foveal specialization involves greater migration of perifoveal cones to the foveal area (Elsner et al., ARVO 2012). We compared perifoveal and foveal acuity in a group of young adult subjects with the aim of determining whether higher foveal acuity was associated with relatively lower perifoveal acuity and if this relationship was affected by the degree of myopia. Methods: The subjects (n=33) had a mean age of 24.4 years +/- 1.8 s.d. Refractive errors ranged from +0.25 D to -8.88 D with a mean of -3.04 D and axial lengths, measured with a Zeiss IOL Master, ranged from 22.5 to 26.7 mm with a mean of 24.3 mm. Acuity was measured with 543nm laser interference fringes displayed in a 2 deg patch at the fovea and at 7° eccentricity in the temporal, nasal, superior and inferior retinal meridians. Acuity was expressed in cycles per mm on the retina, adjusted by the axial lengths. Results: Foveal and perifoveal acuity both decreased with increasing myopia, significantly at the fovea (p=0.0004). The perifoveal to foveal acuity ratio was on average 0.40 on the horizontal meridian and 0.28 on the vertical meridian. Perifoveal acuity in each retinal meridian increased with foveal acuity when all subjects were included. On the nasal retinal meridian, however, there was a negative correlation between perifoveal acuity and foveal acuity that was evident only for refractions in the range of -1.00 to -6.00 D. Conclusions: A comparison of perifoveal and foveal acuity in young adults over a range of refractive errors indicates that acuity in the fovea and perifovea are generally positively correlated. However, in subjects with low to moderate myopia, perifoveal acuity on the nasal meridian decreased with increasing foveal acuity, implying that myopia may affect the relative cone density distribution on the nasal side of the fovea. Commercial Relationships: Stephanie X. Shao, None; Nancy J. Coletta, None Support: NIH grants R24 EY014817 and T35 EY007149 Program Number: 577 Poster Board Number: C0188 Presentation Time: 10:30 AM - 12:15 PM iPad-Based Quick CSF Implementation to Assess Effects of Dioptric Blur on Contrast Sensitivity Michael Dorr1, Luis A. Lesmes1, Zhong-Lin Lu2, Peter Bex1. 1 Schepens Eye Research Institute, Harvard Medical School, Boston, MA; 2Department of Psychology, Ohio State University, Columbus, OH. Purpose: The quick CSF method is a novel adaptive method developed to rapidly estimate features of the contrast sensitivity function, including i) peak contrast sensitivity; and ii) CSF acuity, the high-frequency cutoff that corresponds to a contrast threshold of 50% ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (sensitivity=2). It has been demonstrated that CSF acuity estimates correlate well with logMAR acuity (Lesmes LA, et al. IOVS 2012;52:ARVO E-Abstract 4358). Because acuity is an important criterion for choosing optical correction, we investigated how dioptric blur affects CSF acuity estimates obtained with the quick CSF, implemented on an iPad for convenience. Methods: Six observers (21-46 yrs old; mean 27.5) were tested at a viewing distance of 40cm. Tests were run at self-reported correction and additional blur conditions (+1,+2,+3,+4D). Gratings of different frequencies (.29-18.5cpd) and contrasts (.2-100%) were presented for 250ms at 3.4deg either left or right of fixation (spatial 2AFC) and subjects used the touch screen to respond. Each test (120 trials) lasted 3-4 min. To estimate repeatability, all conditions were run again the following day. Results: As expected, dioptric blur primarily affected the CSF's highfrequency region, and not its peak height (Fig 1). When normalized to the lens condition with maximum acuity, CSF acuities exhibited a sharp decrease across lens conditions that was not demonstrated by peak sensitivity (Fig 2). Although contrast thresholds measured on digital displays often exhibit ceiling effects, we reliably obtained peak thresholds <1% for 5 subjects. Test reliability was calculated from the coefficient of variation for difference scores between first and second tests; for peak sensitivity, this was <12% after 30 trials, <6.2% after 60, and <3.8% after 90 and 120 trials. These values for CSF acuity are <16%, <14.4%, <10%, and <7%, respectively. Conclusions: These results confirm that dioptric blur affects high frequencies more than the peak and lower frequency regions of the CSF. The main contribution of the current study is the use of a portable tablet device, and algorithms to extend contrast resolution (>8bits), to rapidly and reliably measure features of the contrast sensitivity function. Example CSFs obtained from one subject; each curve describes the average of two runs at a fixed dioptric blur. Average relative CSF acuity and peak sensitivity, normalized to the maximum acuity condition. Commercial Relationships: Michael Dorr, Adaptive Sensory Technology, LLC (S), Rapid Measurement of Visual Sensitivity (P); Luis A. Lesmes, Adaptive Sensory Technology (S), 7938538 (P); Zhong-Lin Lu, US Patent 7,938,538 (P); Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: Supported by NIH EY018664, EY019281 (MD, LAL, and PB), and EY017491 (ZLL) Program Number: 578 Poster Board Number: C0189 Presentation Time: 10:30 AM - 12:15 PM Repeatability of Visual Acuity with a Chart Having Lines of Equivalent Legibility Lawrence R. Stark, Scot A. Class. Southern California College of Optometry, Fullerton, CA. Purpose: To determine if differences in legibility between the ten letters of the British standard (BS) set contribute to variability in visual acuity (VA). Methods: Intra-session test-retest repeatability of best-corrected VA was assessed in 68 visually-normal young adults under bright photopic conditions. Threshold VA was determined with custom Bailey-Lovie charts (five letters per line) in two conditions in random order: (1) Non-Paired Condition. Presentation of two letter charts having non-matched letter legibility across lines. The five letters on each line in a single chart were chosen randomly without replacement from the BS set; and (2) Paired Condition. Presentation of paired letter charts having matched letter legibility across lines. In these chart pairs, each of the ten BS letters appeared exactly once for a given line size across the two charts of a pair. Results: The 95% limits of agreement for test-retest repeatability were ±0.053 log MAR for the Non-Paired condition, and ±0.075 log MAR for the Paired condition. Repeatability was not significantly better in the Paired condition (Brown-Forsythe test, one-tailed, p = .97). When three outlying points were removed (> ±3 s.d.), the finding did not change substantially (n = 65, p = .82). Conclusions: When visual acuity is based on the average of two chart presentations (each with five letters per line), differences in letter legibility in the British Standard set do not have a significant effect on the repeatability of visual acuity. Commercial Relationships: Lawrence R. Stark, None; Scot A. Class, Nationwide Vision Center (E) Program Number: 579 Poster Board Number: C0190 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Presentation Time: 10:30 AM - 12:15 PM The Effect of Exposure Duration on Visual Acuity for Letter Optotypes Depends On How Visual Acuity is Defined J Jason McAnany, Philip R. Nolan, Aimee Beluch. Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL. Purpose: Increasing exposure duration improves visual acuity (VA) for letter optotypes, as defined by the standard logarithm of the minimum angle of resolution (log MAR) scale. This study determined the extent to which VA, expressed in terms of retinal frequency (cycles per degree; cpd), improves with increasing duration after accounting for the object frequency information mediating performance (cycles per letter; cpl). Methods: Log MAR VA of four visually-normal individuals (ages 25 to 35) was measured for a set of tumbling E optotypes presented on a CRT display for presentation durations ranging from 0.02 to 1.0 s. The Es were either unblurred or blurred through convolution with Gaussian functions of different widths (σstim), which permitted object frequency to be derived. Log MAR values were plotted as a function of log σstim and fit with the function: MAR = MAR0[1 + (σstim/ σint)2]0.5, where MAR0 and σint set the vertical and horizontal positions of the function, respectively. The object frequencies mediating VA were derived from MAR0 and σint as: cpl = 5*MAR0*1/(2π*σint). The retinal frequencies mediating VA were derived from MAR0 and cpl as: cpd = 12*cpl/ MAR0. Results: Log MAR for the unblurred E decreased (VA improved) significantly (p < 0.05) by a factor of 1.6 as duration was increased from 0.02 to 0.50 s, but log MAR was constant for durations longer than approximately 0.50 s. These findings are consistent with previous reports. Increasing the exposure duration had similar effects on log cpl, a relationship that has not been reported previously. That is, from 0.02 to 0.50 s, cpl decreased significantly (p < 0.05) by a factor of approximately 1.6, and was constant for longer durations. However, VA expressed in cpd was independent of exposure duration. This constancy is due to the offsetting effects of the decrease in letter size (increase in cpd) and the decrease in cpl (decrease in cpd), as indicated in the definition of retinal frequency. Conclusions: The extent to which VA for broadband optotypes improves with increasing exposure duration depends on how VA is defined. If it is assumed that object frequency is independent of duration (i.e. the log MAR scale), then VA improves as duration is increased up to approximately 0.50 s. However, if both size and object frequency are included in the definition of VA (i.e. cpd), then VA is approximately independent of duration. Commercial Relationships: J Jason McAnany, None; Philip R. Nolan, None; Aimee Beluch, None Support: NIH research grant R00EY019510 (JM), NIH core grant P30EY001792, and an unrestricted departmental grant from Research to Prevent Blindness. Program Number: 580 Poster Board Number: C0191 Presentation Time: 10:30 AM - 12:15 PM Assessing the Quality of Functional Vision through AdSpecs Nadine Solaka1, Hilary Gaiser1, Joshua Silver2, Bruce Moore1. 1New England College of Optometry, Boston, MA; 2Center for Vision in the Developing World, Oxford University, Oxford, United Kingdom. Purpose: According to the RESC Studies, at least 10% of children in the developing world could benefit from refractive correction. Lack of professional eyecare limits access to refractive correction. Adjustable glasses (AdSpecs) both measure and correct refractive error. A previously published study showed that AdSpecs provide clear vision when adjusted by myopic children. However, it remained uncertain whether this complex lens system may adversely effect visual function, especially at near. The purpose of this study was to assess near visual function through AdSpecs. Methods: 30 myopic adults 21-41 years of age were recruited from New England College of Optometry. Near VA was measured in Munits using a Good-Lite (#251000) near card at 40 cm. Contrast sensitivity (CS) was measured using a Mars Test (mars perceptrix) at 50 cm. Lateral and vertical phoria were measured with Modified Thorington at 40 cm. All tests were done in down gaze (45° from primary gaze) with both AdSpecs and habitual correction (HC). Inclusion criteria were: Hyperopia +1.50 to +4.50 D, Myopia -0.75 to -6.00 D, Astigmatism <2.00 D, Anisometropia <1.00 D and VAcc ≥20/25 in each eye. Results: Near VA mean for OD was 1.08M ± 0.16M with HC and 0.99M ± 0.20M with AdSpecs (mean diff.: 0.09M, p-value: 0.02). CS mean for OD was 1.76 ±0.07 with HC and 1.77 ±0.05 with AdSpecs (mean diff.: -0.01, p-value: 0.62). Lateral phoria mean was -3.57PD (Exo) ±4.74PD with HC and -3.48PD (Exo) ±5.15PD with AdSpecs (mean diff.: -0.09PD (Exo), p-value: 0.79). Vertical phoria mean was 0.02PD (RHyper) ±0.43PD with HC and -0.08PD (RHypo) ±0.47PD with AdSpecs (mean diff.: 0.1PD (RHyper), p-value: 0.25). Conclusions: Near VA was slightly reduced through AdSpecs. This may be due to the AdSpec's complex lens design. Multiple lens surfaces result in reflection and reduced light transmission. CS and phoria were similar between AdSpecs and HC . The small difference in phoria is likely due to the preset pupillary distance on the AdSpecs, resulting in some subjects with induced prismatic effect exacerbated by the complex lens system. Future designs with reduced lens thickness are underway. Despite small statistical differences, the overall results of each of the variables (near VA, contrast sensitivity and phoria) were not clinically significantly different between the AdSpecs and HC. These results help answer the question about the quality of functional vision through these adjustable glasses. Commercial Relationships: Nadine Solaka, None; Hilary Gaiser, None; Joshua Silver, Centre for Vision in the Developing World (E), Adaptive Eyecare Ltd (I), Adlens Ltd (I); Bruce Moore, EyeNetra Inc. (I) Program Number: 581 Poster Board Number: C0192 Presentation Time: 10:30 AM - 12:15 PM Neural substrates of perceptual integration during bistable object perception Anastasia V. Flevaris1, 2, Antigona Martinez2, 3, Steven Hillyard2. 1 Department of Psychology, University of Washington, Seattle, WA; 2 Department of Neurosciences, University of California, San Diego, San Diego, CA; 3Nathan Kline Institute, New York, NY. Purpose: Object perception depends not only on physical stimulus properties but also on endogenous, top-down factors that affect the observer’s perceptual state. In this study we equated physical properties to investigate the neural mechanisms of top-down contributions in object perception. Methods: We recorded EEG and compared neural activity elicited by varying perceptions of the same physical image - a bistable moving image in which perception spontaneously alternates between dissociated fragments and a single, unified object. Results: A time-frequency analysis of EEG changes associated with the perceptual switch from object to fragment and vice versa revealed a greater decrease in alpha band (8-12Hz) power accompanying the switch to object-percept than to fragment-percept. Recordings of event-related potentials elicited by irrelevant probe flashes superimposed on the image revealed an enhanced positivity in the latency range of the P2 component (~184-212ms) when the probes were contained within the perceived unitary object. The topography of this positivity elicited by probes during object- relative to ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics fragment-perception was distinct from the topography of the P2 elicited by probes during fragment perception, suggesting that neural processing of probes differed as a function of perceptual state. Two source localization algorithms estimated the neural generator of the difference positivity to lie in the lateral occipital cortex (LOC), a region associated with object perception. Conclusions: These data suggest that objects attract attention and modulate the processing of individual elements occurring within their boundaries, perhaps reflecting the perceptual binding of the elements into a unified object. Importantly, these effects were observed when the perceived "object" in this case emerged as a function of the fluctuating perceptual state of the viewer. Commercial Relationships: Anastasia V. Flevaris, None; Antigona Martinez, None; Steven Hillyard, None Support: T32 MH 020002-11A1 Program Number: 582 Poster Board Number: C0193 Presentation Time: 10:30 AM - 12:15 PM Digital precise remote near visual acuity evaluation using mobile devices Oren Yehezkel, Anna Sterkin, Maria Lev, Uri Polat. Ucansi Inc., New York, NY. Purpose: Our aim was to develop a tool for precise remote selfassessment of near visual acuity in order to accurately and remotely estimate the functional reading acuity. Methods: We used an application by Ucansi Inc., developed for iOSbased mobile devices (iPhone, iPad, iPod), based on the technology tested both on mobile devices and PCs (electronic visual acuity, eVA). Here we present part of the data, collected on 73 volunteers that were tested on iPhone 4, operating the application by themselves. The minimal measurable acuity is -0.18 logMAR, as determined by the pixel size of 0.078 mm. The stimuli were matrices composed of 25 letters "E" (5×5), each with a randomly chosen orientation out of 4 possibilities (left, right, up or down). Two variations of inter-letter spacing within the matrix were used (0.4 and 1 letter size). The task was to report the orientation of the central letter. The evaluation was performed using a staircase measuring the minimal detectable target size. For each staircase, the duration of target presentation (ranging between 240 to 30 msec) and the inter-letter spacing were changed. The results were compared to the standard clinical near visual acuity chart (ETDRS chart-based visual acuity, cVA) and to the required reading addition (measured using the fused cross-cylinder test, FCC). Results: There was a significant correlation between the eVA and the cVA. Best correlation was found between monocular eVA and cVA (R=0.85, p<0.01; eVA: mean of 0.34±0.02 logMar, ranging between -0.09 and 0.73; mean of 0.32±0.02; cVA: ranging between -0.04 and 0.72). There was also a significant correlation with the FCC measurement (R=0.73, p<0.01; mean of 1.58±0.07, ranging between 0 and 2.75). Conclusions: The remote self-assessment of near visual acuity using the iOS-based application is very accurate and may better predict the functional visual acuity due to the brief stimuli presentation similar in duration to a single fixation between saccades during reading. Moreover, measurements under the conditions of letter crowding induced by the letter matrix used by the application better estimate the functional reading acuity as opposed to single letter detection used in reading chart measurements. The assessment may be performed both monocularly and binocularly. Finally, VA improvement measured with eVA was highly correlated to the improvement measured by cVA. Commercial Relationships: Oren Yehezkel, Ucansi Inc. (E); Anna Sterkin, Ucansi Inc. (E); Maria Lev, Ucansi Inc. (E); Uri Polat, Ucansi Inc. (I) Program Number: 583 Poster Board Number: C0194 Presentation Time: 10:30 AM - 12:15 PM The Handy Eye CheckTM: A Mobile Medical Application for Testing Vision in Children Amy K. Hutchinson1, Keri Stalun1, Michael J. Lynn2, T R. Candy3. 1 Ophthalmology, Emory University School of Medicine, Atlanta, GA; 2Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA; 3Indiana University School of Optometry, Atlanta, GA. Purpose: The Handy Eye ChartTM uses hand gesture symbols as optotypes and is a valid test of visual acuity in children age 6 to 18 years.1 Modifications are needed to improve testability in younger children. The goal of this study was to develop an electronic version of the chart. Methods: We developed an iPad application (the Handy Eye CheckTM) to test visual acuity by presenting isolated Handy Eye ChartTM optotypes with crowding bars according to the Amblyopia Treatment Study (ATS) protocol. Validity and reliability of the Handy Eye CheckTM were determined by comparing results with the previously validated chart and assessing test-retest results. Results: The poorest seeing eye of 61 children aged 6-18 years was tested. Visual acuity ranged from -0.1 to 1.0 logarithm of the minimal angle of resolution (logMAR). There was a strong linear correlation (r = .92) and a mean difference in acuity of -0.005 (less than one letter) (95% CI -0.03 to 0.02) logMAR, between the two tests. The 95% limits of agreement were ± 2 lines. Test-retest reliability was high, with 81% of retest scores within 0.1 logMAR (5 letters) and 100% within 0.2 logMAR (10 letters), an intraclass correlation coefficient of 0.93, and a standard error of measurement of 0.08. Conclusions: : Validity and reliability testing of the Handy Eye CheckTM compares favorably to other pediatric acuity tests2 and to other studies of electronic testing protocols in children3The Handy Eye CheckTM is a valid and reliable test of visual acuity in children age 6-18 years. References: 1. Cromelin CH, Candy RT, Lynn MJ, Harrington CL, Hutchinson AK. The Handy Eye ChartTM: A New Visual Acuity Test for Use in Children. Ophthalmology 2012;119(10):2009-2013. 2. Vision in Preschoolers (VIP) Study Group. Visual acuity results in school-aged children and adults: Lea Symbols chart versus BaileyLovie chart. Optom Vis Sci 2003;80:650 - 4 3. Cotter S, Chu RH, Chandler DL et al. Reliability of the electronic early treatment diabetic retinopathy study testing protocol in children 7 to < 13 years old. AJO 2003;134(4);655-661. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Isolated optotypes presented with crowding bars The Handy Eye ChartTM Commercial Relationships: Amy K. Hutchinson, Emory University (P); Keri Stalun, None; Michael J. Lynn, None; T R. Candy, None Support: Atlanta Pediatric Device Consortium Program Number: 584 Poster Board Number: C0195 Presentation Time: 10:30 AM - 12:15 PM Influence of glare light on contrast sensitivity through absorptive lenses Hiroshi Uozato1, 2, Masatsugu Kanazawa1. 1Ophthalmology/Visual Science, Kitasato Univ Grad Sch of Med Sci, Sagamihara, Japan; 2 Orthoptics and Visual Science, Kitasato University School of Allied Health Sciences, Sagamihara, Japan. Purpose: To investigate the influence of glare light in peripheral visual field on the contrast sensitivity (CS) through absorptive lenses under photopic and mesopic vision. Methods: The subjects were 13 healthy volunteers and accepted CS measurement. Its measurement was performed to use a contrast glare tester, CGT-2000 (TAKAGI SEIKO), under photopic (background brightness: 100 cd/m2) and mesopic vision (background brightness: 10 cd/m2). Intensities of glare light which was indicated on 12° were glare M (brightness: 40,000 cd/m2) or glare H (brightness: 100,000 cd/m2). Binocular CS without glare light was compared with glare M and glare H. The effect of absorptive lenses was analyzed for wavelength component: cone’s peak wavelength value through absorptive lenses. We defined S-, M- and L- cone’s peak wavelength value as S-, M- and L- wavelength components and calculated correlation coefficients between contrast sensitivity and wavelength components. Absorptive lenses were RETINEX (HOYA, CO., JAPAN) with 5 colors: Orange - Brown (OB: luminous transmittance (LT), 12%), Orange (OR: LT, 49%), Red (RE: LT, 33%), Yellow (YE: LT, 77%), Yellow - Brown (YB: LT, 29%). Results: Compared with CS without glare light, there was no change between CS with glare light under photopic vision. CS, however, decreased with glare H under mesopic vision (ANOVA, Scheffé, p < 0.05). In the analysis of a correlation coefficient, L and M wavelength components effectively contribute to contrast sensitivity under photopic vision. Correlation coefficients of each wavelength component showed almost the same values under mesopic. Conclusions: We suggest that binocular CS decreases in the case of the highest intensity of glare light in peripheral visual field under mesopic vision. Absorptive lenses are especially useful in daylight because color lenses which absorb short-wavelength hardly affect CS under photopic vision. Commercial Relationships: Hiroshi Uozato, None; Masatsugu Kanazawa, None Support: Grant from Kitasato Univ. School of Allied Health Sciences No.2012-1013 Program Number: 585 Poster Board Number: C0196 Presentation Time: 10:30 AM - 12:15 PM Novel method to objectively evaluate visual comfort during sunglass use George A. Zikos, Samantha Slotnick, Rocco Robilotto, Arkady Selenow, Steven R. Ali. Institute for Vision Research, Manhattan Vision Associates, New York, NY. Purpose: Several studies connect visual comfort with squinting, and muscle tension (Nahar et al. 2007, Sheedy et al. 2005, Aaras et al. 2005). In a previous study we demonstrated that polarized lenses improve CSF and reaction times in a simulated driving environment (Zikos et al. 2009) We have further developed this method by adding simultaneous evaluation of pupil size and squint amount during either distance or a near task in the presence of glare, in order to further evaluate objectively different sunglass types. Methods: Four subjects were tested during simulated outdoor distance and near activities: The distance task was similar to the 2009 investigation’s simulated driving environment (CSF and response times tested with Cambridge Research Systems Ltd. ViSaGe system). The near task included a reading task and FACT Near CSF in the presence of glare. A modified ISCAN eye movement system with IR cameras was used to track pupil and aperture size (squinting level) during testing. Three types of lenses were tested: polarized, tinted and clear. Results: Both distance and near CSF results show increased contrast sensitivity when using polarized lenses vs. tinted or clear lenses. (mean increase 124% distance and 134% near). Pupil measurements were similar between the two sunglasses (Mean pupil size 4.2mm) Good correlation between measuring squint levels with ISCAN and photographically was found. Mean squint levels were 0.8mm less on average with the sunglasses. Conclusions: The addition of measuring pupil size and squint levels may prove useful in objectively measuring comfort levels with different spectacle lenses. Commercial Relationships: George A. Zikos, Essilor USA (F); Samantha Slotnick, Optos, Inc. (F); Rocco Robilotto, Essilor (F); Arkady Selenow, None; Steven R. Ali, None Support: Essilor USA Program Number: 586 Poster Board Number: C0197 Presentation Time: 10:30 AM - 12:15 PM Influence of Thermal Lensing on Human Visual Function ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Erica L. Towle1, 2, Michelle T. Aaron1, Leon N. McLin1, Benjamin A. Rockwell1. 1711 HPW/RHDO, Air Force Research Laboratory, Fort Sam Houston, TX; 2Research Apprenticeship Program, National Research Council, Washington, DC. Purpose: It has been hypothesized that slight heating (1 - 3°C) of ocular tissue with a near-infrared (NIR) laser could induce temporary changes in visual function through an effect known as thermal lensing. If these visual distortions could be safely induced and controlled, this technology would have potential as a new form of device that can temporarily alter the visual field of the observer. A previously completed study concluded that it was possible to safely and temporarily interrupt visual function using the thermal lensing effect; however, little effort was made to measure the extent of the blurring in terms of changes to a subject’s visual acuity and contrast threshold. Methods: Ten subjects were asked to identify the orientation of a 50% contrast Landolt ring while being exposed to various laser sources co-aligned with the stimulus. Each exposure lasted 0.5 seconds and was within the safety limits set by the American Conference of Government Industrial Hygienists. With each exposure, the size of the target was increased (from 0 logMAR) until the subject was able to correctly identify the location direction of the Landolt ring. Once the target was correctly identified, the current and previous acuity levels were repeated three times to refine the threshold of acuity. This threshold under each laser condition (none, visible only, NIR only, combined visible and NIR) was then averaged across three sessions (days) to account for any subject variability. Results: Results show that effects of a visible only exposures significantly alter the subject’s ability to see targets smaller than 0.25 logMAR. NIR only exposures did not significantly change the subject’s acuity. By combining two sources, the influence of the NIR on the visible obscuration was also observed to be negligible. Several subjects, however, were able to correctly identify when the NIR light was included in the exposure by a distinct “graying” or “loss of contrast” of the target. Conclusions: While the blurring effect of the thermal lens was not able to obscure the target on its own, evidence suggests that a distinct loss of contrast was induced during the experiments as a result of the thermal lens introduced in the eye. This loss of contrast has the potential to reduce visual acuity of much finer targets (high resolution Gabors), and therefore, future experiments are planned to investigate the change in an individual’s contrast acuity in the presence of a thermal lens. Commercial Relationships: Erica L. Towle, None; Michelle T. Aaron, None; Leon N. McLin, None; Benjamin A. Rockwell, None 136 IOL and Crystalline lens Sunday, May 05, 2013 1:00 PM-2:45 PM Exhibit Hall Poster Session Program #/Board # Range: 826-856/B0050-B0080 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 826 Poster Board Number: B0050 Presentation Time: 1:00 PM - 2:45 PM Straylight in Pseudophakes for Different Intraocular Lens Types Luuk Franssen1, Marrie Van der Mooren1, Burkhard H. Dick2, Ulrich Mester3, Patricia A. Piers1. 1R&D, AMO Groningen BV, Groningen, Netherlands; 2Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany; 3Augenzentrum im Medizeum, Saarbrücken, Germany. Purpose: To investigate the influence of intraocular lens (IOL) design and material on straylight in pseudophakes, and to investigate straylight in cataract patients and pseudophakes at different scatter angles. Methods: Seventy-one eyes diagnosed for cataract were implanted with either a monofocal (spherical acrylic (N=16), aspheric acrylic (N=17), aspheric silicone (N=13)) or multifocal (silicone diffractive (N=13), acrylic diffractive (N=12)) IOL. Intraocular straylight was measured preoperatively and 1 week and 3 months postoperatively with the C-Quant (Oculus), which measures at an average straylight angle of 7 degrees. In 29 eyes, straylight was also measured with an adapted C-Quant, which measures at an average angle of 3.5 degrees. Results: The average 3-month postoperative straylight values for the 3 monofocal groups were not statistically significantly different (log(s) between 1.26 and 1.37 for 7 degrees, log(s) between 1.41 and 1.45 for 3.5 degrees). For 7 degrees, the average value for the multifocal group (log(s)=1.32) was almost the same as for the monofocal group (log(s)=1.31). Also for 7 degrees, 80% of the patients had a lower straylight value at 3 months postoperatively compared to preoperatively. The 3.5 degree average results were higher than the 7 degree results postoperatively (pseudophakes), but not preoperatively (cataract patients). Conclusions: For the patients implanted with monofocal IOLs, design and material did not influence the average straylight value postoperatively. There was also no difference found between the multifocal and monofocal groups. Cataract patients tend to have a different angular straylight dependence than pseudophakes. Commercial Relationships: Luuk Franssen, AMO Groningen BV (E); Marrie Van der Mooren, AMO Groningen BV (E); Burkhard H. Dick, None; Ulrich Mester, None; Patricia A. Piers, Abbott Medical Optics (E) Program Number: 827 Poster Board Number: B0051 Presentation Time: 1:00 PM - 2:45 PM Binocular through-focus image quality with various combinations of modified monovision Guillaume Van Der Meer1, Pierre-Jean Pisella1, Richard Legras2. 1 Univ Hospital of Tours, France, Tours, France; 2CNRS, Orsay, France. Purpose: To evaluate the binocular through-focus (TF) subjective vision with various combinations of modified monovision (ie different profile of spherical (SA4) and secondary spherical (SA6) aberration on each eye). Methods: We used a numerical eye model to calculate the appearance of an image (ie three 0.4 logMAR size high contrast letters) viewed thought an eye taking into account of the variation of pupil size as a function of proximity (ie 4.7mm at distance vision to 3.3mm at near vision). Images were calculated for various combinations of SA4 and SA6 (ie SA4-0.4μm, SA4+0.4μm, SA40.4μm and SA6+0.2μm, SA4+0.4μm and SA6-0.2μm) and for all proximities from -5-D to 5-D with a 0.125-D step. A 3D-NVIDIA video device was used to simulated binocular vision by projecting a different image on each eye with a 120Hz frequency. TF subjective vision was evaluated by using a grading scale (ITU-R 500 recommendation) by three subjects under monocular and binocular condition for each tested conditions (ie various combination of the five multifocal profiles). Results: Binocular TF curves followed the best monocular curve but there was no binocular summation of quality of vision. Binocular inhibition was greater when the difference in subjective vision between each eye was important. Ocular dominance affected the level of inhibition. We calculated area under the binocular curve (AUC) to evaluate subjective quality of vision and depth-of-focus. AUC increased when adding spherical aberrations and can even be doubled, compared to naked eye, with reverse profile of SA4 and ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics SA6 between each eye (ie SA4-0.4μm and SA6+0.2μm on one eye and SA4+0.4μm and SA6-0.2μm on the other eye). Pupil diameter variations had to be taken into account when using simulated images. The decrease of pupil size in near vision led to a better TF subjective vision especially with combination of SA4 and SA6. Although we distinguished two different optical performance profiles (ie (i) good distance vision/acceptable intermediate vision/poor near vision, and (ii) good distance vision/poor intermediate vision/good near vision) there was a good correlation (r2=0.89) between AUC and mean quality of vision at distance/intermediate and near vision. Conclusions: There is no binocular summation of quality of vision. However the use of different SA profiles on each eye especially reverse profile of SA4 and SA6 profile involved a better binocular TF subjective vision. Commercial Relationships: Guillaume Van Der Meer, None; Pierre-Jean Pisella, None; Richard Legras, None Program Number: 828 Poster Board Number: B0052 Presentation Time: 1:00 PM - 2:45 PM Influence of Pupil Diameter on Intraocular Scattering Measurements Based on Double Pass Images in Patients with Different Types of Cataracts Jaume Pujol1, Juan Carlos Ondategui Parra2, Joan A. MartinezRoda2, Meritxell Vilaseca1, Mouafk Asaad Ammaar3. 1Centre for Sensors, Instruments and Systems Development (CD6),, Universitat Politecnica Catalunya, Terrassa, Spain; 2University Vision Center (CUV), Universitat Politècnica Catalunya (UPC), Terrassa, Spain; 3 Ophthalmology, Hospital de Terrassa, Terrassa, Spain. Purpose: To assess the influence of pupil diameter size on intraocular scattering measurements obtained from double pass images in patients with different type of cataracts. Methods: Intraocular scattering was measured using a comercial double-pass system (Optical Quality Analysis System, OQAS, Visiometrics, Spain) (Güell et al. J Cataract Refr Surg 2004) and quantified using Objective Scattering Index (OSI)(Artal et al. Plos one 2011; Vilaseca et al Br. J. Ophthalmol. 2012) in four groups of patients with cataracts (nuclear (NC), cortical (CC), posterior subcapsular (PSC) and cortical-nuclear mixed (CNMC)). Cataracts were classified using a LOCS III system. Measurements were performed using two different pupil diameters: 4mm (with and without cycloplegic drops) and 7mm (with cycloplegic drops), which were obtained using the artificial pupil of OQAS system. Results: 56,5% of the subjects were female where 48 eyes (of 55 patients with cataracts). Cataract classification showed: 29 NC, 12 PSC; 18 SPC and 26 CNMC). Mean ages (± SD [range]) were of 68.3±8.20 (47 to 85 yr.) There are not differences in OSI values obtained for a pupil diameter of 4 mm either with or without cyclopegia. The correlations between OSI (4mm) and OSI (7mm) using cyclopegia were: NC r=0.804 (p=0.00); PSC r=0.608 (p=0.07); CC r=0.957 (p=0.00) and CNMC r=0.769 (p=0.00). OSI parameter showed a high correlation between both pupil diameters. Mean± SD OSI results for 4mm and 7mm pupil were: NC 3.7±2.2 / 6.0±3.4; PSC 3.1±1.7 / 4.8±2.0; CC 3.5±2.3 / 6.3±3.8 and CNMC 5.0±3.4 / 7.4±3.5. All OSI values presented a proportional increase for each type of cataracts. Similar changes were obtained considering the classification according LOCSIII system. The increase in OSI values (lower in PSC and higher in CC) probably can be due to the peripherical distribution of cataract in CC and to the central lens opacity on PSC. Conclusions: OSI results increase when pupil diameter is higher, but we have not found difference to classify different types of cataracts. We can conclude that OSI parameter provides useful information to classify cataracts regardless of pupil diameter. Future work will be focused on a larger number of patients with cortical and subcapsular cataracts. Commercial Relationships: Jaume Pujol, Visiometrics (P); Juan Carlos Ondategui Parra, None; Joan A. Martinez-Roda, None; Meritxell Vilaseca, None; Mouafk Asaad Ammaar, None Support: “Ministerio de Educación y Ciencia”, Spain (grant n0 DPI2011-30090-C02-01 and European Union Program Number: 829 Poster Board Number: B0053 Presentation Time: 1:00 PM - 2:45 PM Capsular Adhesion to Intraocular Lens Evaluated In Vivo Using Ultralong-scan-depth Optical Coherence Tomography Yinying Zhao, Jin Li, Weilin Lu, Xiaoying Xing, Fan Lu, Yune Zhao. wenzhou medical college, Wenzhou, China. Purpose: A firm capsular apposition to the intraocular lens (IOL) could inhibit lens epithelial cell proliferation and migration. Many researchers have focused on the design and material of the IOL. However, we found few studies evaluating the capsule-IOL interaction in highly myopic eyes. This study was to evaluate the in vivo capsular apposition to IOL in patients by ultralong-scan-depth optical coherence tomography (OCT). Methods: It is an observational case series research. Thirty eyes from 30 cataract patients were recruited at the Affiliated Eye Hospital, Wenzhou Medical College, of which 15 eyes were highly myopic (axial length >26 mm) and 15 eyes were emmetropic (22 mm<axial length <24.5 mm). All eyes were examined with a custom-built ultralong-scan-depth OCT at 4hours, 1 month, 3 month, 1 year after surgery, as well as slit lamp examination. Results: Most of posterior capsule started to adhere with the IOL sectionally at 1 month after surgery. Complete apposition of the posterior capsule with the IOL was significantly less among highly myopic eyes than in emmetropic eyes at 1 year after surgery ( 10 vs 15 eyes; P<0.01). At 1-year follow-up, there are still 5 high myopia eyes with uncompleted apposition of the posterior capsule with the IOL. Posterior capsule adhesion to the IOL was inversely correlated with axial length (r=0.491, P<0.001, nonparametric Spearman test). The 6 types of adhesive capsular bend configurations observed were classified as anterior adhesion, middle adhesion, and posterior adhesion, funnel adhesion, parallel adhesion, and furcated adhesion during the follow-up. Seven highly myopic eyes had PCO at the 1year follow-up, as did one emmetropic eye. Four of the eyes with PCO presented opened capsular bends and uncompleted apposition of the posterior capsule with the IOL, accompanied with proliferative lens epithelial cells observed by ultralong-scan-depth OCT. While the other three are presented closed capsular bends. Conclusions: Ultralong-scan-depth OCT could be used to evaluate capsular adhesion and different types of capsular bend of eyes. Postoperatively, we found weak posterior capsule adhesion to the IOL in myopic eyes, as well as various types of capsular bending. These 2 weaknesses in the defense of highly myopic eyes could increase the incidence of PCO. These features presumably increase the likelihood of PCO during the early postoperative period. Commercial Relationships: Yinying Zhao, None; Jin Li, None; Weilin Lu, None; Xiaoying Xing, None; Fan Lu, None; Yune Zhao, None Support: the National Nature Science Foundation of China(Grant No. 81170869) Clinical Trial: NCT01605812 Program Number: 830 Poster Board Number: B0054 Presentation Time: 1:00 PM - 2:45 PM Restoration of acrylic intraocular lens injected through cartridge ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Makoto Inoue1, Jiro Hidaka2, Akito Hirakata1. 1Ophthalmology, Kyorin Eye Center, Mitaka, Japan; 2HOYA Corp., Tokyo, Japan. Purpose: To evaluate the effect of temperature in restoration of acrylic intraocular lenses (IOLs) after injection through a cartridge. Methods: Acrylic IOLs (SA60AT; Alcon, 251; HOYA, YA-65BB; HOYA, W-60, Santen, NX-70; Santen) were loaded or preloaded in a cartridge with viscoelastic material and injected into a water chamber under temperature control at 24 or 34 C°. Wavefront analyzer (LAMBDA-X, NIMO TR0815) was used to measure the form of IOLs. Time to restore the form of the IOLs was defined as Δcylinder power (difference from the baseline) < 0.2 diopter. Results: All IOLs restored within 2 minutes at 34 C°. At 24 C°, SA60AT and 251 restored within 3 minutes but YA-65BB and W-60 (single-piece) required 3.5 minutes and NX-70 (three piece IOL with same material of W-60) up to 6 minutes. The central optical thickness of NX-70 (7.0 mm diameter) was 0.865 mm and was thicker than that of W-60 (6.0 mm diameter) at 0.640 mm. The cross section of the cartridge for NX-70 was round shape with mean diameter of 2.17 mm and that for W-60 was oval shape with 1.65 mm of mean diameter. Conclusions: Restoration of IOL was dependent on temperature. However it may depend on the thickness of IOL and inner shape of the cartridge. Commercial Relationships: Makoto Inoue, None; Jiro Hidaka, HOYA Corporation Medical Division (E); Akito Hirakata, None Program Number: 831 Poster Board Number: B0055 Presentation Time: 1:00 PM - 2:45 PM Stability of the human crystalline lens measured with a high temporal resolution dynamic Purkinje-meter system Juan Tabernero, Antonio Fernández, Pablo Artal. Laboratorio de Optica, Universidad de Murcia, Murcia, Spain. Purpose: To measure the dynamic stability of the human crystalline lens by using a custom-made new instrument that tracks the lens oscillations following a controlled saccadic eye movement (lens wobbling effect) Methods: We developed a modified prototype of a Purkinje-meter that uses a high temporal resolution CMOS camera attached to a telecentric lens and a semicircular ring of IR LEDs placed on the lens aperture‘s rim. Saccadic eye movements of 9‘ amplitude were induced by two flickering visible LEDs (1 Hz) placed in a central and a peripheral position with respect to the objective-camera axis. Four flickering orientations were possible (nasal, temporal, inferior and superior). The wobbling effect is a quick oscillation of Purkinje image PIV (posterior lens surface reflection) with respect to PI (corneal reflection) that follows immediately after a change in the direction of gaze and is captured at high speed (400 frames per second).Stability is assessed by fitting the relative movement of PIV with respect to PI to the solutions of a damped harmonic oscillator. Four parameters are used to characterize the wobbling effect, i) the amplitude (i.e., the overshooting effect with respect to the stable position of PIV), ii) the oscillation frequency, iii) the damping ratio and iv) the stationary time (the time constant of the wobbling effect). Videos were recorded in eight subjects during a series of 15 saccadic movements performed horizontally (center-temporal) and vertically (center-up). Results: The mean value of the oscillation frequency after a saccadic was 19 Hz (standard deviation 6 Hz) and the mean damping ratio was 0.45 (SD 0.10). The average stationary time was 57 msec (SD 20 msec). Given that the mean post-saccadic suppression time is around 50 msec (Diamond et al, Journal of Neuroscience, 2000) the visual effect of the lens wobbling in normal subjects will not be noticeable. Comparing vertical and horizontal movement, we only observed differences in the amplitude, larger in the case of the horizontal movement (252 microns) than in the vertical upwards movement (194 microns), which perhaps reveals some gravity effects or an asymmetric distribution of tension on the lens zonule. Conclusions: A new instrument to measure crystalline lens stability has been developed and successfully tested in normal subjects. It may be useful for a wide range of future studies involving lens stability. Commercial Relationships: Juan Tabernero, None; Antonio Fernández, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013) and Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06 Program Number: 832 Poster Board Number: B0056 Presentation Time: 1:00 PM - 2:45 PM Rotational stability of two single-piece toric acrylic intraocular lenses Gernot Steinwender, Navid Ardjomand. Dept of Ophthalmology, Medical University Graz, Graz, Austria. Purpose: To assess the rotational stability of two single-piece toric acrylic intraocular lenses (IOL) during the first postoperative month. Methods: This retrospective case series included 15 eyes (14 patients) with age-related cataract and corneal astigmatism ≥1.50 diopters [D]. Corneal astigmatism was measured using the Pentacam Scheimpflug system (Oculus) and IOL biometry was performed with laser interferometry (IOL Master). All eyes were analyzed after uncomplicated phacoemulsification with in-the-bag implantation of toric IOL (Hoya iSert 351; Rayner T-flex). Rotational stability of the IOL was assessed by comparison of images taken by the microscope video camera intraoperatively with retroillumination photographs at 1 month postoperatively. Results: The overall mean absolute IOL rotation was 7.67 degrees ± 5.54 (SD). The mean absolute IOL rotation was 5.60 degrees ± 3.21 (SD) for Rayner T-flex IOL and 6.11 degrees ± 4.53 (SD) for Hoya iSert 351 respectively. Conclusions: Both investigated acrylic toric IOL seem to be rotationally stable with just mild IOL rotation in the first postoperative month and can be recommended for the correction of astigmatism during cataract surgery. Commercial Relationships: Gernot Steinwender, None; Navid Ardjomand, None Program Number: 833 Poster Board Number: B0057 Presentation Time: 1:00 PM - 2:45 PM Multicenter clinical evaluation of an aspheric diffractive multifocal one-piece IOL ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Daniel H. Chang1, Elizabeth A. Davis2. 1Empire Eye and Laser Center, Bakersfield, CA; 2Minnesota Eye Consultants, Bloomington, MN. Purpose: To evaluate clinical outcomes, patient satisfaction, and surgeon satisfaction following bilateral implantation of the TECNIS® Multifocal 1-Piece IOL (ZMB00). Methods: On-going, prospective, open-label observational trial from surgeons performing cataract surgery and bilateral TECNIS® Multifocal (TMF) 1-Piece IOL implantation in qualified subjects aged 21 years or older. All eyes had preoperative corneal astigmatism of < 1.0 D. Visual acuity (distance, intermediate, near) and patient satisfaction questionnaires were collected at the 3-4 month postoperative visit. Surgeon assessment questionnaires were taken at 3 months and at one year. Results: Interim data were collected on 106 subjects with a mean age of 66.0 ± 8.1 years. Mean postoperative sphere was 0.07 ± 0.47 D with 0.40 ± 0.39 D of cylinder and a spherical equivalent of +0.05 ± 0.47 D. Mean binocular UCVA was 20/23 at distance, 20/30 at intermediate and 20/22 at near. Mean binocular DCVA was 20/20 at distance, 20/28 at intermediate, and 20/21 at near. The percentage of subjects with UCVAs of 20/32 or better was 91.8% for distance, 67.7% for intermediate, and 93.8% for near. The percentage of subjects with DCVAs of 20/32 or better was 98.8% for distance, 70.9% for intermediate, and 96.6% for near. At 3-4 months postoperative, 86.9% of subjects never or hardly ever use glasses, 87.9% of subjects were either satisfied or very satisfied with their overall vision without glasses, and 81.3% of subjects would most likely choose this lens again. At the 3 months, 78.5% of surgeons felt comfortable with the TMF after implanting ≤ 6 lenses, and 92.9% of surgeons would recommend the TMF to family, friends, and colleagues. At one year, 86% of top enrollers were still using the TMF. Conclusions: Subjects receiving the TECNIS® Multifocal 1-Piece IOL showed high levels of satisfaction with good visual outcomes at all distances and minimal postoperative refractive error. Surgeonreported experience and perception of the TMF were highly positive. This experiential data further corroborates the U.S. FDA clinical study results. Commercial Relationships: Daniel H. Chang, Abbott Medical Optics, Inc. (F), Abbott Medical Optics, Inc. (C), Abbott Medical Optics, Inc. (R); Elizabeth A. Davis, None Support: Abbott Medical Optics, Inc. Program Number: 834 Poster Board Number: B0058 Presentation Time: 1:00 PM - 2:45 PM Light Transmittance of Explanted Hydrophobic Acrylic Intraocular Lenses with Surface Light Scattering Liliana Werner1, Caleb Morris1, Shannon Stallings1, Erica Liu1, Anne M. Floyd1, Andrew Ollerton1, Lisa Leishman1, Zachary Bodnar1, Marcia Ong2, Ali Akinay2. 1Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, UT; 2Alcon Laboratories, Fort Worth, TX. Purpose: Surface light scattering on hydrophobic intraocular lenses (IOLs) is caused by hydration-related subsurface nanoglistenings within the acrylic IOL material. The aim of this study was to investigate the potential effect of surface light scattering on the light transmittance of single-piece hydrophobic acrylic IOLs made of AcrySof material (Alcon) with or without blue light filter (BLF). Methods: IOLs were obtained from human cadavers (49 lenses total; 36 with BLF), and from finished-goods inventory (controls). The IOLs were explanted from the cadaver eyes and power/model matched to unused control IOLs. After removing proteins, the IOLs were allowed to hydrate for 24 hours at room temperature. Surface light scattering was then measured with a Scheimpflug camera (EAS1000 Anterior Segment Analysis System, Nidek Ltd). Light transmittance was measured with a Perkin Elmer Lambda 35 UV/Vis spectrophotometer (single-beam configuration with RSA-PE-20 integrating sphere). Results: Hydrated scatter values ranged from 4.8 to 202.5 CCT for explanted IOLs with BLF and 1.5 to 11.8 CCT for controls; values ranged from 6.0 to 137.5 CCT for explanted IOLs without BLF and 3.5 to 9.7 CCT for controls. In both groups, there was a tendency for increasing scatter values with increasing postoperative time. No differences in light transmittance were observed between explanted IOLs and controls for both groups of lenses (BLF IOLs: P=0.407, Paired T-Test; Non BLF IOLs: P=0.216, Wilcoxon Signed Rank Test for Paired Data). Conclusions: Although surface light scattering of explanted lenses was significantly higher than that of controls and appeared to increase with time, no effect was observed on the light transmittance of singlepiece hydrophobic acrylic lenses with or without blue light filter. Commercial Relationships: Liliana Werner, Aaren Scientific (F), Abbott Medical Optics (F), Advanced Vision Science (F), Alcon Laboratories (F), Anew Optics (F), Bausch & Lomb Surgical (F), Calhoun Vision (F), Innovia (F), MRI Research (C), Powervision (C), Rayner Intraocular Lenses (F), Visiogen (C); Caleb Morris, None; Shannon Stallings, None; Erica Liu, None; Anne M. Floyd, None; Andrew Ollerton, None; Lisa Leishman, None; Zachary Bodnar, None; Marcia Ong, Alcon Research (E); Ali Akinay, Alcon Researh, Ltd (E) Program Number: 835 Poster Board Number: B0059 Presentation Time: 1:00 PM - 2:45 PM Visual Simulation of Retinal Images through a New Asymmetric Refractive Multifocal Intraocular Lens with Two Spherical Surfaces Yuki Hidaka1, Kazuno Negishi1, Kazuhiko Ohnuma2, Kazuhiro Watanabe1, Hidemasa Torii1, Megumi Saiki1, Kazuo Tsubota1. 1 Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Japan; 2Graduate School of Engineering, Chiba University, Chiba, Japan. Purpose: To evaluate optical performance of an asymmetric refractive multifocal intraocular lens (MIOL) using a visual simulation system. Methods: The system consists of a lens that corresponds to a cornea, an IOL in a water cell, and a charge-coupled device (CCD) camera. The images formed by the lens can be detected by the CCD camera and observed on the monitor of a personal computer. The aperture diameter is exchangeable in the water cell. Using this system, visual simulations of Landolt visual acuity (VA) charts at various distances were performed using the MIOL (LENTIS® Mplus, Oculentis) through a 3.5-mm aperture corresponding to photopic conditions or a 4.5-mm aperture corresponding to mesopic conditions. The contrasts of the gaps of large (logarithm of the minimum angle of resolution [logMAR] 0.7), medium (logMAR 0.4), and small (logMAR 0.0) Landolt VA charts in the simulated images were analyzed using Photoshop graphics editing software (Adobe). Results: Using the 3.5-mm aperture, the contrasts of the gaps of the large, medium, and small charts were 0.22, 0.1, and 0.08 at 5 meters (m) and 0.08, 0.04, and 0.02 at 0.34 m, which was the best near focus, respectively. Using the 4.5-mm aperture, the contrasts of the gaps of the large, medium, and small charts were 0.14, 0.07, and 0.03 at 5 m and 0.07, 0.04, and 0.01 at 0.34 m, respectively. The large charts maintained good contrast at all distances through the 3.5-mm aperture. The contrast decreased with decreasing sizes of the Landolt rings, especially at the intermediate distance (from 1-0.5 m). Through ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics the 4.5-mm aperture, the results showed a similar trend with degraded contrasts compared to the 3.5-mm aperture. The typical simulated image had an asymmetric blur probably due to the asymmetric MIOL design. Conclusions: The asymmetric refractive MIOL provides good optical performance at all distances for large charts under photopic conditions, although the optical performance degrades especially at intermediate distance with medium and small charts or under mesopic conditions. Commercial Relationships: Yuki Hidaka, None; Kazuno Negishi, Oculentis (F); Kazuhiko Ohnuma, None; Kazuhiro Watanabe, None; Hidemasa Torii, None; Megumi Saiki, None; Kazuo Tsubota, AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical (C), Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa (F), Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki (P), Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company (P) Program Number: 836 Poster Board Number: B0060 Presentation Time: 1:00 PM - 2:45 PM A novel hydrophilic intraocular lens with lateral walls to prevent posterior capsular bag opacification Hiroyuki Matsushima1, Koichiro Mukai1, Satoshi Watabiki1, Yoko Katsuki1, Jiro Hidaka2, Senoo Tadashi1. 1Ophthalmology, Dokkyo Medical University, Shimotsuga-Gun, Japan; 2Hoya Surgical Optics, Tokyo, Japan. Purpose: Previous studies show that equator ring and peripheral ring prevented capsular bag opacification. And another study shows the aqueous humor inhibit lens epithelial cells development. In this study, we made a novel hydrophilic intraocular lense (IOL) with lateral walls. And we evaluated the prevention of posterior capsular bag opacification (PCO) by circulating aqueous humor in experimental rabbit studies. Methods: NY-60 (HOYA) was remodeled that having 4 lateral walls (2.8mm height, Fig. 1) to expand posterior capsule after implanting into the lens capsule. And 8 holes around the peripheral of intraocular lens (IOL) optic and 1 each hole in center of the walls were made for role of aqueous humor circulate into a capsular bag (aqueous humor circulate IOL; AHC IOL). Eight weeks 6 albino rabbits weighting 2 kg were prepared and phacoemulsification in 2.65mm corneal insertion were performed. Control IOL (NY-60, HOYA) was implanted one eye and the AHC IOL was implanted another eye. After 1, 2 and 4 weeks, the IOL and PCO were observed using slit lump and tissue section was stained with hematoxylin-eosin and observed under light microscope. The PCO was quantified on the basis of the thickness of the lens epithelial cell layer on the central subcapsular area and compared among two groups. Results: After 2 weeks, partial PCO was observed using slit lump in control group; however, no significant PCO was observed in AHC group. The thickness of developed lens epithelial cells in center of IOL was 59.4±67.9μm in control group and 8.3±3.2μm in AHC group at 4 weeks postoperatively. There is statistically significance (unpaired t-test). Conclusions: Novel AHC IOL prevents PCO in experimental rabbit study. A device of IOL shape without well known sharp edge may prevent PCO. Commercial Relationships: Hiroyuki Matsushima, HOYA (C); Koichiro Mukai, None; Satoshi Watabiki, None; Yoko Katsuki, None; Jiro Hidaka, HOYA Corporation Medical Division (E); Senoo Tadashi, None Program Number: 837 Poster Board Number: B0061 Presentation Time: 1:00 PM - 2:45 PM Curvature Changing Accommodating IOL Jim Schwiegerling, Sean J. McCafferty, William Duncan. Optical Sciences, University of Arizona, Tucson, AZ. Purpose: To demonstrate the accommodative capabilities of a curvature changing intraocular lens. Methods: We previous demonstrated a concept for an accommodating IOL in which an elastic material is sandwiched between two rigid plates. One of the plates has a small aperture through which the soft material can be partially extruded when the plates are compressed. The extruded material takes on a roughly parabolic shape and consequently imparts optical power to the system. Here, we have fabricated a prototype lens consisting of a silicone gel with refractive index of 1.38 and a durometer value of 12 units on the “00” scale. The rigid portion of the IOL is fabricated from PMMA. To make the IOL increase in power in response to constriction of the ciliary muscle, the soft material needs to extrude into a higher index fluid. We evaluate a series of liquids, indexed matched to the PMMA, as well as lower index fluids in the index range of 1.44 to 1.48. Results: Compression of 100 microns of the silicone gel over a 3 mm aperture leads to a potential accommodative amplitude of 5.3 to 9.7 D for the fluids examined. There is concern of the fluid diffusing into the silicone gel and a membrane may be needed at this interface. Conclusions: he feasibility of an accommodating IOL based on curvature change of interface between a low index silicone gel and a high index fluid is demonstrated. The power change of the lens model works with the accommodation mechanism of the eye. Commercial Relationships: Jim Schwiegerling, Alcon Research (F), Wavetec (F), Visioneering (C); Sean J. McCafferty, None; William Duncan, None Support: NIH Grant EY021847 Program Number: 838 Poster Board Number: B0062 Presentation Time: 1:00 PM - 2:45 PM A triplet optical design for a wide range accommodative IOL Enrique-Josua Fernandez, Pablo Artal. Laboratorio de Optica, Instituto Universitario de investigación en Óptica y Nanofísica (IUiOyN), Universidad de Murcia, Murcia, Spain. Purpose: Standard intraocular lenses (IOLs) are mostly designed for far distance vision. Although accommodative IOLs have been ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics proposed, the current designs only provide a modest range of accommodation in the best-case scenario. We describe here a new optical design providing a wide-range of potential accommodation change that could be incorporated in an IOL. Methods: The mechanical properties of the capsule and the zonula are known to solely slightly change as the eye ages. The ciliary muscle essentially maintains its function during the life span. Consequently, there is a possibility to use the accommodation apparatus to eventually transmit the subtle mechanical changes into an IOL able for modulating its optical power. A family of optical designs with a variable power, sensitive to small compression forces has been devised. If incorporated within an IOL, power would change in response to small variations in their equatorial diameter. Regular materials available for standard IOL have been employed, as acrylics and silicones. Results: The proposed design is a triplet-like optical structure that produces unprecedented gains between the equatorial compression and the subsequent change in lens power. Some of the generated IOL models exhibit an increase in their power of up to 10 D once implanted in the eye. The gain is approximately 1 D/µm of equatorial compression. The proposed IOL also permits the incorporation of aspheric or toric surfaces for optimizing ocular spherical aberration or correcting astigmatism. Chromatic aberration and ghost images analysis have been also accomplished showing a similar performance to monofocal standard IOLs currently available. The typical central thickness of the triplet is 1 mm, showing an optical zone of 6 mm of diameter. These dimensions and the structure of the proposed haptics might allow the implantation of the IOL through a corneal incision of 2-3 mm of diameter. The accurate control of the equatorial diameter of the accommodative IOL and its changes during accommodative efforts can be solved by using a special intracapsular ring. The distribution of radial forces of the implanted IOL combined with the ring showed an efficient mechanism to transmit the changes from the ciliary muscle to the lens. Conclusions: A new triplet-type optical design in combination with a capsular ring for the precise control of its equatorial diameter may have the potential to restore accommodation after cataract surgery. Commercial Relationships: Enrique-Josua Fernandez, EP-101193 (P), VOPTICA SL (P), VOPTICA SL (P), VOPTICAL SL (I), VOPTICAL SL (I); Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013) and Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06 Program Number: 839 Poster Board Number: B0063 Presentation Time: 1:00 PM - 2:45 PM Optical Ensemble Analysis of the Potential Optical Performance of Aspheric Multifocal Toric IOLs Huawei Zhao. R & D, Abbott Medical Optics, Santa Ana, CA. Purpose: Contrast transfer is an important link between pseudophakic visual performance and intraocular lens (IOL) optical performance. This study uses previously validated optical ensemble analysis (OEA, Zhao, Optics Letters) to compute pseudophakic optical performance for acrylic aspheric IOLs with diffractive multifocal anterior or posterior and toric on the accordingly opposite surfaces. Methods: OEA is a Monte Carlo simulation using ZEMAX (ZEMAX Corporation, Bellevue, WA, USA) and a clinically-oriented eye model. MTF values are computed with different astigmatism, asphericity, pupil size, and IOL decentration, tilt and astigmatic orientation error. 600 eyes were simulated for two groups of aspheric multifocal toric IOLs: Group1 [aspheric-toric anterior and 4D-add diffractive multifocal posterior surface; low refractive index (1.47) and chromatic dispersion (Abbe# = 55); full aspheric correction] and Group 2 [aspheric apodized diffractive 3D-add anterior and toric posterior surface; high refractive index (1.55) and chromatic dispersion (Abbe# = 37); partial aspheric correction]. Three cylinder powers were studied for each group (1.5, 2.25 and 3.0 D). Results: Ocular parameters in Groups1 and 2 agreed well with published clinical data and there were no statistically significant differences between groups (p>0.05). Ocular spherical aberration for Group1 was statistically significantly lower than Group2. Pseudophakic optical performance declined consistently with increasing astigmatic power in each of the two groups. Both IOLs significantly reduced the ocular astigmatism (p<0.05) with no statistically significant difference between the two groups in the astigmatism (p>0.05) and MTFs of far vision (p>0.05). MTFs of near vision for Group1 were statistically significantly better than Group2 (p<0.05). Conclusions: Acrylic aspheric IOLs with diffractive multifocal anterior and toric posterior or multifocal posterior and toric anterior surfaces reduce refractive astigmatism effectively. Optical performance is better at lower astigmatic corrections. Optical performance of near vision is also better under all light conditions for pseudophakic eyes with low chromatic dispersion IOLs that fully correct ocular spherical aberration. Commercial Relationships: Huawei Zhao, Abbott Medical Optics inc. (E) Program Number: 840 Poster Board Number: B0064 Presentation Time: 1:00 PM - 2:45 PM Visual outcomes after implantation of a new trifocal intraocular lens Luis Izquierdo, Maria A. Henriquez, Mauricio Rodriguez. Ophthalmology, Instituto Oftalmo Salud, Lima, Peru. Purpose: To analyze the visual outcomes after cataract surgery with a new trifocal intraocular lens (IOL) implantation Methods: 30 eyes of 15 patients (age range 55-80 years) were included in this prospective study. All subjects underwent a bilateral cataract surgery with implantation of the new trifocal FineVision (Physiol, Belgium) IOL. Distance (4m), intermediate (70cm) and near (40cm) visual acuities (decimal scale, logMar and defocus ), refractive outcomes, corneal topography, were evaluated 3 months after surgery. Results: the distance corrected visual acuity (DCVA) improvement was observed after surgery (from 0.58 +/- 0.10 to 0.80 +/- 0.20; p < 0.01). 97% of eyes have a spherical equivalent within +/- 0.50D. Postoperatively, the uncorrected near visual acuity was 0.76 +/- 0.15 and the uncorrected intermediate visual acuity was 0.69 +/- 0.28. The efficacy and safety indexes incremented Conclusions: The new trifocal intraocular lens FineVision IOL is able to restore successfully the distance, intermadiate and near visual acuity after cataract surgery. Commercial Relationships: Luis Izquierdo, None; Maria A. Henriquez, None; Mauricio Rodriguez, None Program Number: 841 Poster Board Number: B0065 Presentation Time: 1:00 PM - 2:45 PM Visual outcomes and patient satisfaction after cataract surgery with a diffractive trifocal intraocular lens Javier García Bella1, Jose Vazquez-Molinin2, Laura Valcarce1, Jesus Carballo2, Juan Velez1, Juan Carlos Sanz2, Vicente Polo3, Jose M. Martinez de la Casa1. 1HOSPITAL CLINICO SAN CARLOS, ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Madrid, Spain; 2Facultad de Óptica y Optometría, Madrid, Spain; 3 Hospital Universitario Miguel Servet, Zaragoza, Spain. Purpose: To assess the visual and refractive outcomes after implantation of the FineVision trifocal IOL (PhysIOL, Belgium). Methods: Fifty eyes of twenty five patients were implanted consecutively with the FineVision trifocal IOL. This IOL combine 2 diffractive profiles to achieve far, intermediate, and near correction. Outcome measures recorded 3 months postoperatively were uncorrected and distance-corrected (far, near, intermediate) visual acuities, defocus curve, contrast sensitivity, reading speed (radner vissum reading chart) and patients' quality of life (visual function questionnaire VFQ-25, halos and glare presence, overall satisfaction). Results: At the 3-month postoperative visit, the mean sphere was 0.16 ± 0.45 D and the mean cylinder -0.50 ± 0.55. Binocular uncorrected and best corrected distance acuity were 0,10 ± 0.11 and 0.03 ± 0.07 logMAR respectively. The mean binocular uncorrected best distance-corrected near acuity 0.11 ± 0.12 logMAR. The photopic defocus curve showed similar performance in intermediate and near distance with visual acuity around 0.1 logMAR. The speed reading improved from 69,7 ± 13.8 words per minute preoperatively to 94,7 ± 43,9 in the postoperative period. The photopic contrast sensitivity was within the standard normal range. The rate of spectacle independence for all the distances was higher than 85%. A low percentage of patients referred significative halos or ghost images. Conclusions: The FineVision trifocal IOL provided a satisfactory full range of vision with high optical quality and patient satisfaction. Commercial Relationships: Javier García Bella, None; Jose Vazquez-Molinin, None; Laura Valcarce, None; Jesus Carballo, None; Juan Velez, None; Juan Carlos Sanz, None; Vicente Polo, None; Jose M. Martinez de la Casa, None Support: None in the Support field below Program Number: 842 Poster Board Number: B0066 Presentation Time: 1:00 PM - 2:45 PM Monochromatic Higher Order Aberrations in Patients Undergoing Cataract Surgery with an Aspheric Intraocular Lens Douglas A. Lyall1, 2, Sathish Srinivasan2, Lyle Gray1. 1Glasgow Caledonian University, Glasgow, United Kingdom; 2Ophthalmology, University Hospital Ayr, Ayr, United Kingdom. Purpose: To evaluate the effectiveness of an aspheric intraocular lens (IOL) in reducing monochromatic higher order aberrations (MHOA) following routine phacoemulsification and IOL implantation. Methods: Prospective, observational study of 50 patients with visually significant cataract who underwent uncomplicated cataract extraction and aspheric IOL implantation. Whole eye, corneal and internal MHOA were measured before, and four weeks after, surgery. Pre and post-operative data was compared to 300 eyes of 167 agematched patients with no visually significant cataract. MHOAs were measured over a 5 mm dilated pupil diameter using the iTrace aberrometer (Tracey Technologies, Houston, TX). Zernike coefficients were obtained to the 6th order. Results: There was a significant reduction in total root mean square (RMS) MHOA following cataract surgery (p<0.001). Whole eye mean MHOA reduced from 0.729 µm to 0.484 µm (p<0.001) and mean internal MHOA reduced from 0.681 µm to 0.475 µm (p<0.001). The RMS of total internal 3rd (p<0.001), 4th (p<0.001), 5th (p=0.033) and 6th (p=0.006) orders also showed a significant reduction post-operatively. Internal spherical aberration (SA; Z(4,0)) also showed a significant reduction from 0.172 µm to 0.071 µm (p=0.004). Post-operative whole eye MHOAs (mean 0.484 µm) were found to be significantly less (p<0.001) than age match controls (mean 0.648 µm). Post-operative whole eye (mean 0.133 µm) and internal SA (mean 0.071 µm) was found to be significantly less than control cases (mean 0.223 µm; p<0.001 and mean 0.133; p=0.022 respectively). Conclusions: Implantation of an aspheric IOL during cataract surgery significantly reduces both internal and whole eye MHOA. Post-operative MHOAs in patients with an aspheric IOL are significantly less than age matched controls with clear optical media and no visually significant cataract. These changes may contribute to greater patient satisfaction and improved visual function following cataract surgery. Commercial Relationships: Douglas A. Lyall, None; Sathish Srinivasan, Rayner (R); Lyle Gray, None Clinical Trial: 11/AL/0067 Program Number: 843 Poster Board Number: B0067 Presentation Time: 1:00 PM - 2:45 PM Non-invasive Evaluation of Intraocular Lens Performance Patricia A. Piers1, Sanjeev Kasthurirangan2, Basilios Sideris1, 3. 1 Applied Research, Abbott Medical Optics Groningen, Groningen, Netherlands; 2Clinical Research, Abbott Medical Optics, Milpitas, CA; 3Biomedical Engineering, Delft Technical University, Delft, Netherlands. Purpose: Visual performance with intraocular lenses (IOLs) such as multifocals is usually evaluated through human clinical trials with surgical implantation. Development of a new type of IOL may need multiple design iterations requiring multiple clinical trials, which may prove costly and time consuming. A method is proposed to noninvasively evaluate IOLs in lieu of human clinical trials. Methods: Photographic images of a miniature ETDRS chart in a bench-top eye model (ACE) model) that has a cornea lens with the same spherical aberration as the average human cornea were obtained for a multifocal IOL (ZM900, Abbott Medical Optics, USA) and a monofocal control lens (CeeOn, Abbott Medical Optics, USA). Images were obtained in 12-bit grayscale at different defocus levels from +0.75 to -3.50D, in 0.25D steps, by adjusting the camera position, and for two different entrance pupil diameters of the ACE model (3mm and 5mm). A central ‘S’ letter from the ETDRS chart was cropped and scaled to different sizes for visual acuity testing using Matlab (The Mathworks, USA), psychophysics toolbox and the QUEST procedure with 4-alternative forced choice. The letter was presented on a CRT monitor (NEC MultiSync FP2141SB, Mitsubishi Electronics, Illinois) through a BITS# device (Cambridge Research Systems, UK). Visual acuity testing was performed from 0D to 3D defocus (in 0.50D steps) binocularly in two observers with no prior ocular surgery and 20/20 visual acuity. The results were compared to the data from a FDA clinical trial on the two IOLs. Results: Visual acuity for different defocus levels of the ‘S’ letter was 20/20 at 0D for both IOLs (mean ± SD; 911A: -0.03 ± 0.0 logMAR, ZM900: 0.01 ± 0.01 logMAR) and declined with defocus for both IOLs, but returned to 20/20 at 3D with the multifocal IOL (ZM900: 0.0 ± 0.02 logMAR). The through focus visual acuities with the multifocal IOL were similar for 3mm and 5mm apertures (all differences were within 1-line or 0.1 logMAR). When compared to clinical trial data, visual acuities with the multifocal IOL were within 1-line (or 0.1 logMAR) for all defocus levels. Data on more subjects is being collected and will be presented at the meeting. Conclusions: A non-invasive method for evaluating IOLs was developed that provided visual outcomes similar to a previous human clinical trial. The proposed methodology will be useful in quickly and efficiently evaluating novel IOL designs prior to large-scale clinical trials. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Patricia A. Piers, Abbott Medical Optics (E); Sanjeev Kasthurirangan, Abbott Medical Optics (E); Basilios Sideris, AMO Groningen BV (R) Support: SNN Eoropean fund for Regional Development and the Ministry of Economic Affairs, Peaks in the Delta grants 086 and 087 Program Number: 844 Poster Board Number: B0068 Presentation Time: 1:00 PM - 2:45 PM Predicted changes in the cut surface and weight of colored acrylic intraocular lenses in 20 years Kenji Kawai. Ophthalmology, Tokai Univ School of Medicine, Isehara, Japan. Purpose: We previously reported that long-term immersion of intraocular lenses (IOLs) in water at high temperature leads to their opacification and deterioration, depending on differences in materials. This study aimed to examine predicted changes in the cut surface and weight of colored acrylic IOLs (colored IOLs) in 20 years. Methods: Colored IOLs manufactured by various companies were immersed in 50-mL screw-tube bottles containing ultrapure water at 100 degrees for 115 days (equivalent to 20 years). External appearance and cut surfaces were observed before and after drying of the IOLs, and then percent changes in weight before and after treatment were determined. IOLs used: We used 3 colored IOLs of each of the following 5 types manufactured by different companies - SN60WF (Alcon) and AN6K (KOWA) by the cast-molding method and NY-60 (HOYA), NX-60 (Santen), and NS-60YG (NIDEK) by the lathe-cut method. Results: External appearance: Opacification was observed to a varying degree in all IOLs except AN6K and NX-60. After drying at a room temperature of 25 degrees for 48 hours, opacification disappeared in all IOLs except SN60WF. Cut surfaces: Opacification was observed to a varying degree for all IOLs. After drying, opacification was observed in all except NS60YG. Percent changes in weight: Percent changes in weight before drying were unmeasurable for SN60WF, -3% for AN6K, -0.9% for NY-60, +2.3% for NX-60, and +0.6% for NS-60YG. The changes after drying were -1.5% for SN60WF, -9.8% for AN6K, -2.7% for NY-60, -3.7% for NX-60, and -1.5% for NS-60YG. Conclusions: There were differences in opacification among cut surfaces of IOLs. Percent changes in weight before and after drying differed by approximately 6% for AN6K and NX-60. These differences may be attributable to different methods of manufacturing acrylic resin. Commercial Relationships: Kenji Kawai, Alcon (F), KOWA (F), HOYA (F), Santen (F), NIDEK (F) Program Number: 845 Poster Board Number: B0069 Presentation Time: 1:00 PM - 2:45 PM Safety and clinical results of posterior chamber phakic intraocular lens implantation in low anterior chamber depth Min gyu Lee, Dong Hui Lim, Eui Sang Chung, Tae-Young Chung. Ophthalmology, Samsung medical center, Seoul, Republic of Korea. Purpose: To investigate the safety and present clinical experiences of the Visian implantable Collamer lens (ICL) implantation in patients with shallow anterior chamber. Methods: This retrospective study included patients with anterior chamber depth (ACD) lower than 2.8 mm who underwent ICL implantation. Implanted ICL size, pre- and postoperative visual acuity, refractive errors, postoperative central vault, intra- and postoperative complications were recorded through a medical chart review. The implanted ICL size and vault at 6 months follow-up were compared with a calculated ICL size and expected vault using a regression formula reported by the same author previously. Pneumatic tonometer, specular microscopy, and ultrasound biomicroscopy (UBM) were performed before and after surgery to evaluate the safety by measuring intraocular pressure (IOP), endothelial cell count (ECC), ICL vault, angle opening distance at 500 μm from the scleral spur (AOD 500) and trabecular-iris angle (TIA). Results: The mean follow-up period of 16 eyes of 9 patients was 28.00 ± 15.03 months and preoperative ACD was 2.70 ± 0.08 mm. Preoperative and postoperative spherical equivalent (SE) were -10.27 ± 2.38 and -0.11 ± 0.51 diopters, respectively. Postoperative uncorrected and best corrected visual acuity were 0.89 ± 0.24 and 0.98 ± 0.19, respectively. The implanted ICL size revealed no significant difference with calculated ICL size (independent t-test, p=.356). However, postoperative vault was 0.346 ± 0.179 mm, which was lower than expected vault of 0.531 ± 0.173 mm calculated by a regression formula (independent t-test, p=.000). The pre- and postoperative mean AOD 500 were 0.379 ± 0.088 and 0.267 ± 0.111 mm, and mean TIA were 33.68 ± 5.37 and 23.67 ± 8.33 degrees, respectively. There were significant differences between preoperative and postoperative AOD500 and TIA (independent t-test, p=.000). However, there was no severe complication such as elevated IOP, ECC reduction, cataract formation or angle closure glaucoma. Conclusions: ICL implantation performed in the eyes with shallow ACD showed good visual outcomes without severe complication during relatively long follow-up period. The size of ICL which was calculated to get ideal vault of 500 to 750 μm, but it resulted in lower vault than expected. It suggests the necessity for modulation of ICL sizing method in patients with low anterior chamber depth. Commercial Relationships: Min gyu Lee, None; Dong Hui Lim, None; Eui Sang Chung, None; Tae-Young Chung, None Program Number: 846 Poster Board Number: B0070 Presentation Time: 1:00 PM - 2:45 PM Comparative study of visual performance of two multifocal intraocular lens : two-year follow-up Balmitgère Thomas1, 2, Burillon Carole2, 1. 1Ophthalmology, Hôpital Lyon Sud, Pierre-Bénite, France; 2Ophthalmology, Hôpital Edouard Herriot, Lyon, France. Purpose: To compare visual performance and functional tolerance of two multifocal diffractive intraocular lens, AcrySof ReSTOR ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics SN60D3 (Alcon, Inc.) and Acri.LISA 376D (Carl Zeiss Meditec), two years after cataract surgery. Methods: This monocentric, prospective, comparative study was conducted between March 2009 and September 2011. Inclusion criteria were patients between 50 and 80 years, no longer willing to wear glasses or contact lenses for distance and near vision, and wanting a cataract surgery with bilateral implantation. Cataract surgery was performed by the same surgeon using the same phacoemulsification technique . The parameters analyzed were biomicroscopic examination; monocular and binocular visual acuity with and without spectacle correction using ETDRS charts, at a distance of 4 meters for far vision, 66 centimeters for intermediate vision, 33 centimeters for near vision; monocular contrast sensitivity in photopic conditions ; glare sensitivity ; a quality of life questionnaire, assessing visual disturbances and dependence on glasses ; a macular OCT (Optical Coherence Tomography) analysis to exclude a maculopathy. Results: 20 eyes (10 patients) received the ReSTOR intraocular lens (IOL) and 24 eyes (12 patients) received the Acri.LISA IOL in the Edouard Herriot Hospital, Lyon. There was no statistically significant difference (α=5%) between the two lens in terms of visual acuity for far and near vision, for monocular and binocular vision, for contrast sensitivity and glare test . There was a statistically significant difference in favor of Acri.LISA group for intermediate visual acuity specially for monocular uncorrected visual acuity (p = 0.03), binocular uncorrected visual acuity(p = 0.041) and binocular corrected visual acuity (p = 0.004) . The analysis of quality of life questionnaire did not find any statistically significant difference between the two groups and any correlation between visual discomfort during night driving and glare test. Conclusions: This study shows that both IOL have similar visual performance (good level of satisfaction without eye glasses). Intermediate vision is better in the Acri. LISA group. It could be explained by the asphericity of the lens increasing the depth of field. This study (2 years of follow-up) confirms the results of previous studies reported in the literature (6 months and 1 year follow-up). Commercial Relationships: Balmitgère Thomas, None; Burillon Carole, None images taken by the camera could be in focus with the target. In this schematic eye, the target can be lowered, elevated or in a fixed position, in the latter the images stay in focus while opening and closing the diaphragm simulating a pupil, like that, the differences from the same image taken with different diaphragm diameters can be analyzed. Also at the lens position any kind of IOL can be placed. For this study parallel or concentric line targets were used, and a refractive - diffractive - apodized IOL was placed in the schematic eye and images were recorded. Results: ubjectively with 2 and 3 mm diaphragm diameters, the images were clear in the central and peripheral areas of the image. When the diaphragm was opened wider, the central image lost quality and the peripheral image increased its sharpness. When elevating or lowering the target a similar effect was found, with the peripheral and central image changing in sharpness. Conclusions: This novel schematic eye is an alternative to study the images produced by different IOLs at variable diaphragm diameters. Images can be analyzed qualitatively and in the future with the appropriate software quantitatively. This schematic eye will help clinicians and researchers to make better analysis of the behavior and performance of optics systems related to cataract surgery, intraocular lenses either focal or multifocal and it variations with pupil size. Figure 1. Schematic eye and its components. Program Number: 847 Poster Board Number: B0071 Presentation Time: 1:00 PM - 2:45 PM Proposed novel schematic eye model for testing intraocular lens performance Cristina Mendoza1, 3, Anabel S. Sanchez-Sanchez2, Omar TeranJimenez2, David Rivera4, Claudia Palacio1, Laura Leticia ArroyoMuñoz1, Oscar Guerrero-Berger1, Ernesto Suaste Gomez2. 1 Fundacion Hospital Nuestra Senora de la Luz, Mexico, Mexico; 2 Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico, Mexico; 3Hospital General Manuel Gea González, Mexico, Mexico; 4IDISA Instituto para el Desarrollo Integral de la Salud, Mexico City, Mexico. Purpose: How does a patient actually sees once he has been placed an intraocular lens (IOL) is a subjective evaluation sometimes difficult to understand by the clinicians. An objective way to know how an IOL is performing would be to create a schematic eye that could show us with real images how the patient is perceiving those images. Here we present a proposed novel schematic eye where different IOLs can be placed, and images of different targets can be taken in order to objectively analyze them. Methods: A schematic eye consisting of a optical microscope with a camera, a platform holding the IOL, a diaphragm that simulates the pupil with a range of aperture of 2-5mm, a pattern target (simulating an optotype) and a light source (See figure 1) were arranged so the Figure 2. Same image taken with different diaphragm diameters. Commercial Relationships: Cristina Mendoza, None; Anabel S. Sanchez-Sanchez, None; Omar Teran-Jimenez, None; David Rivera, None; Claudia Palacio, None; Laura Leticia ArroyoMuñoz, None; Oscar Guerrero-Berger, None; Ernesto Suaste Gomez, None Program Number: 848 Poster Board Number: B0072 Presentation Time: 1:00 PM - 2:45 PM ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Schematic eye model based on the regression of age-dependent changes of the crystalline lens Takushi Kawamorita1, 2, Hiroshi Uozato1, 2, Hiroshi Sasaki3, Yuko Shibata2, Masatsugu Kanazawa2, Masakazu Hirota2, yoona jang2, Shinji Arai2, Kimiya Shimizu4, 2. 1Orthoptics and Visual Science, Kitasato University School, Sagamihara-shi, Japan; 2Ophthalmology and Visual Science, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3Ophthalmology, Kanazawa Medical University, Kahokugun, Japan; 4Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan. Purpose: To construct a schematic eye model based on the regression of age-dependent changes of the crystalline lens and determine the effects on retinal image quality of refractive index, transmittance, scattering, and lens shape. Methods: Optical simulation was performed using the optical design software CodeV. Three-dimensional eye models based on a modified Navarro model eye were used for the simulation. We used a number of published regression models in relation to the shape and optical characteristics of crystalline lens used. Refractive error and modulation transfer function (MTF) were calculated. Results: With increasing refractive index of the lens nucleus (from 0 to +0.02), refractive errors showed a myopic shift (from 0 to -8.50 D). The amount of change increased in as the lens nucleus became steeper. However, with increasing refractive index of the lens cortex, refractive errors showed a hyperopic shift (from 0 to +2.33 D). As scattering angle increased (from 0 to 30 min arc), MTF decreased overall and the lens nucleus was affected the most. As transmittance at the center of the lens decreased (from 100 to 10%), MTF was increased at 250 c/mm and decreased at 100 c/mm, indicating the effect of apodization. Conclusions: This schematic eye model based on regression of agedependent changes of the crystalline lens should prove useful for the comparative evaluation of refractive correction methods and the development of new ophthalmic instruments. Commercial Relationships: Takushi Kawamorita, None; Hiroshi Uozato, None; Hiroshi Sasaki, None; Yuko Shibata, None; Masatsugu Kanazawa, None; Masakazu Hirota, None; yoona jang, None; Shinji Arai, None; Kimiya Shimizu, None Support: JSPS KAKENHI Grant Number 24791872; Kitasato University Research Grant for Young Researchers 2012 Program Number: 849 Poster Board Number: B0073 Presentation Time: 1:00 PM - 2:45 PM Comparative Analysis of Residual Astigmatism Induced by a Single-piece or Three-piece Intraocular Lens after Cataract Surgery Jin Kwon Chung1, Mee Kum Kim2, Won Ryang Wee2. 1Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; 2Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea. Purpose: To analyze comparatively lenticular astigmatism of singleand three-piece intraocular lenses (IOLs) after cataract surgery. Methods: The medical records of the 397 patients who underwent cataract surgery with IOL implantation were retrospectively reviewed. Patients were divided into 4 groups depending on the implanted IOLs (SN60WF, SN60AT, MA60BM, or AR40e). IOL induced lenticular astigmatism was measured by differences between refractive astigmatism and total corneal astigmatism as determined by Fourier transformation. Vertical and horizontal astigmatic vectors (J0), oblique astigmatic vectors (J45), and overall IOL induced astigmatic strengths were compared. Coefficients of determination of IOL J0 and J45 values were assessed using linear regression models. Results: Mean (J0, J45) vectors were -0.19 diopters (D) and 0.06 D, - 0.20 D and 0.06 D, -0.17 D and 0.09D, and -0.22D and 0.06 D in the SN60WF, SN60AT, MA60BM, and AR40e groups, respectively. No significant intergroup differences were found for J0 or J45. Overall IOL induced astigmatic strengths were 0.35 D, 0.37 D, 0.42 D, and 0.39 D in the SN60WF, SN60AT, MA60BM, and AR40e groups, respectively, which were without statistical significance. Linear regression analysis showed a highest R2 value for SN60AT and a lowest R2 value for AR40e for the determination of refractive astigmatism. The residual astigmatism induced by IOLs contributed to refractive astigmatism by an average of 23.8%. Conclusions: Single-piece IOLs with an aspheric optic seemed to be comparable in terms of functional stability with three-piece IOLs in terms of inducible residual astigmatism. Commercial Relationships: Jin Kwon Chung, None; Mee Kum Kim, None; Won Ryang Wee, None Program Number: 850 Poster Board Number: B0074 Presentation Time: 1:00 PM - 2:45 PM Impact of Ultrasound Biomicroscopy (UBM) versus White-toWhite (WTW) measurement on sizing of Visian Implantable Collamer Lens (ICL) and Residual Postoperative Refraction Puneet Panda1, Ann Ostrovsky2, Scott E. Brodie1, Mark Speaker2. 1 Ophthalmology, Mount Sinai Medical Center, New York, NY; 2 Laser and Corneal Surgery Associates, PC, New York, NY. Purpose: The aim of this work is to compare residual postoperative refractive error after implantation of Visian Implantable Collamer Lens (ICL) in patients having the lenses sized with either Ultrasound Biomicroscopy (UBM) or white-to-white (WTW) measurements, and to determine if the residual refraction correlates with amount of postoperative lens vault. Methods: This cohort study included 33 eyes that underwent Visian ICL implantation. Sulcus-to-sulcus (STS) distances were determined using Ultrasound UBM in 23 eyes and with caliper assisted white-towhite (WTW) measurements in 10 eyes. Manifest refractions (spherical equivalents) and central lens vaults were compared between the two groups at the postoperative month 1 visit, using twosample t-tests. Results: The pre-operative mean spherical equivalent (MSE) for all 33 patients was -10.97 diopters (D) (range: -5.37 D to -17.13 D). The pre-operative MSE was -10.18D for the UBM group, and -12.78D for the WTW group, respectively. The postoperative MSE was -0.43+/0.43D for the UBM group and -0.85 +/-0.53D for the WTW group (p=0.02). Postoperative mean central vault height was 495 +/- 167um in the UBM group and 710 +/- 250um in the WTW group (p>0.05). Conclusions: This study suggests that UBM valuation of STS distance results in more precise sizing of the ICL implant and consequently in more accurate refractive outcomes. Effective lens position, reflected by postoperative lens vault may be a factor in postoperative refractive outcome. Residual refractive error was often the result of astigmatism in some patients. Commercial Relationships: Puneet Panda, None; Ann Ostrovsky, None; Scott E. Brodie, None; Mark Speaker, None Program Number: 851 Poster Board Number: B0075 Presentation Time: 1:00 PM - 2:45 PM Measurement of the intraocular scattering in cataractous patients, using different instruments and parameters. Comparative study Juan Carlos Ondategui Parra1, 2, Lorena Mateos-Pena1, 3, Joan A. Martinez-Roda1, 2, Montserrat Arjona1, 3. 1Optics and Optometry, Politechnical Univ of Catalonia, Terrassa, Spain; 2University Vision Center (CUV), Terrassa, Spain; 3Center for Sensors, Instruments and Systems Development (CD6), Terrassa, Spain. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Purpose: To perform clinical measurements of intraocular scattering in cataractous patients by means of different available commercial instruments that have become common in clinical practice Methods: Intraocular scattered light was measured by means of two different available commercial instruments: the CQuant system (Oculus), which provides an absolute intraocular scattering value (log(s)) (Van der Berg et al Ophthal. Physiol Opt. 2009), and the OQAS (Visiometrics), which uses the Objective Scatter Index (OSI) parameter (Artal el al. Plos One 2011) obtained from the double-pass retinal image. 78 cataractous eyes of 52 patients were included in the study (37 right eyes, and 41 left eyes), 41 female and 37 male with a mean ± SD in age of 68.24 ± 8.3 years (range: 47 to 85 years), spherical manifest refraction ranged from -8.00 to +5.75D and the cylinder from 0.00 to 3.00D, best spectacle-corrected visual acuity in the logMAR scale of 0.17±0.27 (1.25 to -0.20). The grade and type of cataract was: 24 eyes of nuclear cataract (30.4%), 27 of mixed nuclear (34.2%), 9 eyes of cortical (11.4%) and 18 of posterior subcapsular (24.1%). CSF was also measured using CSV-1000 (Vector Vision Results: Considering all types of cataract, the Pearson correlation between log(s) and OSI is statistically significant (r=0.339 and p=0.002). For high degree of cataract and high OSI values (OSI>8) inconsistencies appear (normally low values of log(s)). Removing this values a better correlation (r=0.559 and p<0.001) is obtained. The correlation between log(s) and OSI values separate in nuclear cataract group(r=0.654 and p=0.001) and mixed nuclear cataract group (r=0.707 p<0.001), is statistically significant. There is no statistically significant Pearson correlation for both cortical cataracts group (r=0.524 and p=0.286), and for posterior subcapsular cataract group (r=0.359 and p=0.144). Pearson correlation r between CS (3, 6, 12, and 18 c/deg), LogMAR log(s) and OSI is statistically significant in more cases with OSI than with log (s) Conclusions: C-Quant and OQAS are good predicting methods of the gradation of different types of cataracts in the clinical practice, although the OSI parameter has shown more statistically significant results. Future work will be focused on a larger number of patients with cortical and subcapsular cataracts. Commercial Relationships: Juan Carlos Ondategui Parra, None; Lorena Mateos-Pena, None; Joan A. Martinez-Roda, None; Montserrat Arjona, None Support: “Ministerio de Educación y Ciencia”, Spain (grant n0 DPI2011-30090-C02-01 and European Union Program Number: 852 Poster Board Number: B0076 Presentation Time: 1:00 PM - 2:45 PM Square-Edge IOLs and Epithelial Lens Cell Proliferation: Implication on Posterior Capsule Opacification in an in Vitro Model Eleonora Favuzza, Iacopo Paladini, Ugo Menchini, Rita Mencucci. Eye Clinic-University of Florence, Florence, Italy. Purpose: To evaluate human Lens Epithelial Cell (hLEC) proliferation comparing a 360-degree square-edge one-piece Intraocular Lens (IOL) (TECNIS ONE Abbott Medical Optics) to a square-edge three-piece IOL (AR40E, AMO) using an in vitro culture model Methods: An in vitro Posterior Capsule Opacification (PCO) model was established: hLECs (104 from ATCC, USA) were seeded on transwell cell culture inserts coated with a type I collagen membrane on which an IOL (TECNIS ONE or AR40E) had been previously placed. As control, cells were plated on the insert membrane without an IOL and cultured at the same conditions. At day six (cells confluent in controls) IOLs were removed and cell counting, viability and cell density under and outside the IOLs were evaluated Results: At day six the cell number in inserts containing IOLs was significantly (P<0.05) lower than in controls. The inserts with TECNIS ONE contained a similar number of cells to AR40e (P>0.05 ); all the cells in each insert were viable. Cell density in the area under each IOL was significantly lower either than the cell density outside the IOL or in the control insert. Cell density under TECNIS ONE was lower but not significantly different from that under AR40E (P>0.05). Conclusions: A 360-degree square edge is a key factor in PCO formation. Probably also an haptic design able to increase IOL capsular bag fixation is important in preventing PCO. Long term clinical evaluation is necessary to estimate functional results. Commercial Relationships: Eleonora Favuzza, None; Iacopo Paladini, None; Ugo Menchini, None; Rita Mencucci, None Program Number: 853 Poster Board Number: B0077 Presentation Time: 1:00 PM - 2:45 PM visual impact of micro-vacuole defect in intraocular lenses Marrie Van der Mooren1, Michelle Langeslag1, George Beiko2, Patricia A. Piers1. 1Applied Research, AMO Groningen BV, Groningen, Netherlands; 2McMaster, Univ of toronto, St. Catherines, ON, Canada. Purpose: The impact of micro vacuole defects in intraocular lenses (IOL) on quality of vision is subject to scientific debate. The purpose of this study is to estimate the visual effect of the micro vacuole defect in IOLs based on in-vitro straylight measurements. Methods: The straylight induced by the micro vacuole defect was calculated by subtracting the straylight measurement results of an IOL with and without inclusions. The micro vacuole defects were induced by immersing IOLs in a saline solution and changing from room to eye temperature overnight. The visual effect is estimated by using the concept of equivalent veiling luminance introduced by Stiles-Holladay. The additional induced luminance could be calculated as function of visual angle and illuminance of the eye. Confocal microscopy, dark field imaging and straylight measurements were performed before and after the temperature change on the IOLs. Four different hydrophobic acrylic lenses made by respectively ALCON, B&L, AMO and HOYA were tested including IOLs recently manufactured with an improved process. Results: All lenses had straylight scatter less than a 20 yr old human crystalline lens before temperature change. After change of temperature in a water bath, micro vacuole formation was evident in dark field imaging in ALCON and HOYA hydrophobic acrylic lenses. The IOLs made with an improved process by the same manufacturer had similar levels of micro vacuole formation as previous IOLs. The straylight measurements results showed that IOLs susceptible to micro vacuole formation produced two optical fields arriving at different eccentric (retinal) locations. One field is diffracted by the surfaces of the micro vacuoles creating a white halo and the other field exists of colored fringes produced by the field propagating through the micro vacuole. An average micro vacuole size of 6 micrometer was obtained by confocal microscopy. For a typical micro vacuole density the scatter level increased 5 deg2/sr at 10 degrees of visual angle. In this condition and for 20 lux of ocular illuminance, a veiling retinal luminance of 1 cd/m2 is induced. Conclusions: The angular straylight distribution induced by the micro vacuole defect consists of two optical fields: white halo and colored fringes. The visual effect was calculated in terms of veiling retinal luminance predicting a potentially debilitating contrast loss. Commercial Relationships: Marrie Van der Mooren, AMO Groningen BV (E); Michelle Langeslag, AMO Groningen B.V. (E); ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics George Beiko, AMO (C); Patricia A. Piers, Abbott Medical Optics (E) Program Number: 854 Poster Board Number: B0078 Presentation Time: 1:00 PM - 2:45 PM Evaluation of the Impact of Scatter in Pseudophakic Eyes with Glistenings Anand Doraiswamy1, Edward DeHoog2. 1Research and Development, Advanced Vision Science Inc, Santa Barbara, CA; 2 Optical Engineering & Analysis LLC, Grants Pass, OR. Purpose: To evaluate the impact of light scatter from glistenings in pseudophakic eye models Methods: A pseudophakic eye model is constructed in ZEMAX using established eye models. The lens is optimized for a polychromatic MTF for field angles 0, 1.4 and 2 Degrees corresponding with Foveal vision. The modeling and evaluation of scatter and image resolution (MTF) are performed for various materials (hydrophobic acrylic, PMMA) for various size and grades (density) of glistenings, all under scotopic and photopic conditions. Results: Results from the evaluation demonstrate that light scatter increases and MTF decreases with increase in glistening density for both materials. The difference in index of refraction between the cavitations filled with water and the IOL material causes the scatter. As predicted by Mie theory as the relative difference between the scatterer and media increases the amount of scatter will increase. Size of glistenings/cavitations also plays a crucial role in the extent of light scatter and loss of MTF. 2 micron sized glistenings were found to more significant than 200 micron sized glistenings in influencing resolution of image. Conclusions: Incorporation of scatter metrics into a model eye allows us to learn more about the impact of various phenomena on quality of vision. Mathematical modeling demonstrated that glistening can have a significant effect on scatter and resolution of image. Smaller cavitations and larger density have a more pronounced effect on the MTF than larger cavitations and smaller density. The effect is more pronounce in higher index materials with glistenings. Further evaluation will focus on the effect of surface haze, and more importantly the role of neuroadaptation that may depress the predicted outcomes in-vivo. Commercial Relationships: Anand Doraiswamy, Advanced Vision Science Inc. (E); Edward DeHoog, Advanced Vision Science (C) Program Number: 855 Poster Board Number: B0079 Presentation Time: 1:00 PM - 2:45 PM In vitro straylight levels for IOLs across forward scatter positions up to 30 degrees Michelle Langeslag, Marrie Van der Mooren, Patricia A. Piers, Luuk Franssen. Research, AMO Groningen BV, Groningen, Netherlands. Purpose: The purpose of the study is to combine the straylight levels of IOLs measured with a method for small and a method for large forward scatter position angles. The straylight levels were determined for intraocular lenses (IOLs) with different designs and materials. Methods: IOLs were measured on two different lab-based set-ups: 1) for forward scatter positions between 0.6 and 2 degrees 2) for forward scatter positions up to 30 degrees. In both cases the IOL was placed in a saline filled cuvette on an optical bench set-up. A CCD camera was used to measure the line spread functions from which the angular dependent straylight parameters were then calculated. The straylight measured using the two methods were then combined in order to determine the magnitude over the entire angular range. Using this method IOLs made from 4 different materials (2 hydrophobic and 2 hydrophilic acrylics) and 3 different designs (spherical monofocal, aspheric monofocal and diffractive multifocal) were measured and compared. Additionally, the measured straylight levels were compared to the levels published for a 20 and 70 year old human crystalline lens. Results: All monofocal IOLs with the same type of optical design show comparable straylight parameters, both for small and large forward scatter angles. At a forward scatter angle of 2° the average value for the straylight parameter of diffractive multifocal lenses is 4.5. For an angle of 7.5° the average value for the same type of lenses is 1.2. Irrespective of material or design, the amount of straylight is reduced for larger forward scatter angles. All IOLs have a straylight parameter of approximately 1.0 for angles of 10° and larger. For an angle larger than 7.5° all IOLs have a straylight level below that of a 20-year old human crystalline lens. Conclusions: Straylight parameter results from both set-ups can be combined to determine the straylight profile of an IOL over an angular range from 0.6 to 30 degrees. IOL design has more influence on the height of the straylight parameter than the IOL material does. IOL straylight parameters get smaller as the measurement angles increase. The straylight parameter of all IOLs measured is independent of design parameters for angles larger than 10°. Commercial Relationships: Michelle Langeslag, AMO Groningen B.V. (E); Marrie Van der Mooren, AMO Groningen BV (E); Patricia A. Piers, Abbott Medical Optics (E); Luuk Franssen, AMO Groningen BV (E) Program Number: 856 Poster Board Number: B0080 Presentation Time: 1:00 PM - 2:45 PM Optical simulation for sub-surface nano glistening Yoriko Takahashi1, Takushi Kawamorita2, Norihiro Mita1, Natsuko Hatsusaka1, Eri Shibuya1, Eri Kubo1, Hiroshi Sasaki1. 1 ophthalmology, Kanazawa Medical University, Ishikawa, Japan; 2 Orthoptics and Visual Science, University School of Allied Health Sciences, Sagamihara, Japan. Purpose: To investigate the effect of sub-surface nano glistening(SSNG)in hydrophobic acrylic intraocular lens (IOL) on irradiance, forward light scattering and imaging characteristics of retina by optical simulation. Methods: To simulate the effect of SSNG we used optical design software LightTools and CODE V (Synopsis) to evaluate the peak value of irradiance on retina, forward light scattering, and the modulation transfer function (MTF) with Liou-Brenann model eye (JOSA, 1997). The physicality and shape of IOL was set as acrylic IOL (SN60AT, Alcon). Ong et al (JCRS, 2012) found in explanted acrylic IOLs with severe SSNG, particles of diameter 150 nm located up to 60μm from the surface of the anterior and posterior side of the IOL at a volume ratio of SSNG particle, which corresponds to the density, of 0.05%. In the present optical simulation, particle diameter ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics and volume ratios were set at 100 nm, 150 nm and 200 nm and 0%, 0.05%, 0.1%, 0.2%, 0.5%,1.0%, 2.0%, 5.0% and 10.0%. Results: Peak value irradiance reduced with increased volume ratio and particle size of SSNG. At volume ratio 0.05%, peak values of irradiance for SSNG particle diameters 100nm, 150nm and 200nm reduced by 0.7%, 1.8% and 2.9%, respectively, compared with those at volume ratio 0% (no SSNG). At volume ratio 0.1%, peak values of irradiance for SSNG particle diameters 100nm, 150nm and 200nm reduced by 1.5%, 3.6% and 5.7%, respectively. Forward light scattering increased with increased size of SSNG particle and volume ratio. MTF did not change with increased size of SSNG particle and volume ratio. Conclusions: Although SSNG in this condition setting slightly increased forward scattering and reduced irradiance, there was no effect on the characteristics of retinal imaging. These results suggest that the effect of SSNG on visual function is very slight in eyes without severe retinal diseases. Commercial Relationships: Yoriko Takahashi, None; Takushi Kawamorita, None; Norihiro Mita, None; Natsuko Hatsusaka, None; Eri Shibuya, None; Eri Kubo, None; Hiroshi Sasaki, None predicted vs. measured change of acuity did not differ significantly from 1 (α=0.05) for 2 of the 3 metrics: logNS (p=0.28, Fig.2) and logVSX (p=0.13, Fig.3). Conclusions: One can confidently use logNS or logVSX to design wavefront guided corrections that minimize the impact of registration uncertainty on visual acuity. 218 Aberrations, Image Quality and Visual Performance Monday, May 06, 2013 8:30 AM-10:15 AM TCC LL 4/5 Paper Session Program #/Board # Range: 1279-1285 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 1279 Presentation Time: 8:30 AM - 8:45 AM Optical quality metrics predictive of visual acuity for the design of wavefront guided corrections in the presence of dynamic registration uncertainty Yue Shi, Raymond A. Applegate, Ayeswarya Ravikumar, Harold E. Bedell. College of Optometry, University of Houston, Houston, TX. Purpose: When building a wavefront guided contact lens correction for highly aberrated eyes we would like to achieve the best visual acuity given dynamic registration uncertainty. To optimize the design of such a lens correction, it is useful to have optical quality metrics that are highly correlated with and predictive of visual acuity. The purpose here is to find optical quality metrics that are highly correlated with and predictive of acuity given the unusual aberration structures generated by misalignment of wavefront guided corrections. Methods: Residual aberrations were generated by allowing 4 correction designs (3 wavefront guided and 1 sphero-cylinder for each eye) to undergo horizontal, vertical and rotary motion with respect to 3 keratoconic eyes (KC) for 2 pupil sizes (4 and 5mm). Then 77 aberrations were selected based on their log visual Strehl with the expectation that they would induce up to at least 5 lines loss of acuity [JOV, 12:1-13, 2012]. The point spread functions of the selected aberrations were convolved with unaberrated logMAR acuity charts to generate blurred charts, which were presented monocularly to 3 normal chart-readers with 20/15 best corrected acuity. For each chart, visual acuity was measured up to 5th letter missed through a 3 mm pupil placed conjugate and centered with the chart-reader’s dilated pupil. The measured change of acuity with respect to the unaberrated chart was regressed against the changes of acuity predicted by 29 optical quality metrics [JOV, 12:1-13, 2012]. Results: Regression analysis revealed that only 3 of the 29 metrics (Fig.1) predicted change of measured logMAR acuity with a coefficient of determination (R2) of at least 0.9: logNS (R2=0.96), logVSX (R2 =0.96), and logVSMTF (R2=0.90). The slopes of Fig. 1: R2 values of 29 metrics in the regressions. Fig. 2&3: Regressions of measured and predicted change of acuity by logNS or logVSX. 3 data symbols: aberrations generated in 3 KC eyes. Error bars: 1 standard deviaiton of measeured change of acuity by 3 chart-readers. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Yue Shi, None; Raymond A. Applegate, University of Houston (P); Ayeswarya Ravikumar, None; Harold E. Bedell, None Support: NEI 5R01EY008520; NIH/NEI 5R01EY019105; NIH/NEI P30 EY 07551 Program Number: 1280 Presentation Time: 8:45 AM - 9:00 AM Influence of aberration-induced blur on contrast sensitivity: comparison of different optotype sizes Jens Buehren1, Hendrik Jungnickel2, 3, Wolfgang Raab1, Daniel Weigel3, Michael Gebhardt2, Richard Kowarschik3, Thomas Kohnen1. 1 Dept of Ophthalmology, Goethe University Frankfurt, Frankfurt am Main, Germany; 2SciTec Department, Ernst Abbe University of Applied Sciences, Jena, Germany; 3Institute for Apllied Optics, Schiller University Jena, Jena, Germany. Purpose: To compare the decrease of contrast sensitivity (CS) due to defocus and higher-order aberration (HOA) blur measured with optotypes of different size. Methods: Thirty-three emmetropic healty volunteers were included. In a first experiment (defocus blur), CS was measured in 31 eyes. Experimental fogging was performed with spherical trial lenses of 0, +0.25, +0.5 and +0.75 diopters (D). In a second experiment (HOA blur), CS was measured in 3 eyes at an adaptive optics (AO) visual simulator. Besides the correction of lower-order aberrations (LOA) and full correction, subjects were presented 6 wavefront errors of different blur strength and characteristics (3 keratoconus eyes, 3 postLASIK eyes). In total, 8 different wavefront errors with a VSOTF (visual Strehl ratio based on the optical transfer function) range of 0.05 to -1.70 log units were presented. In both experiments, CS was measured with Landolt rings of 1.3 and 0.3 logMAR using FrACT software. The impact of defocus blur (D) or HOA blur (VSOTF) on CS was assessed using linear regression analysis. The regression coefficient b and the coefficient of determination R2 reflect the sensitivity of the CS contrast test to aberration-induced blur. Results: Experiment 1: Unfogged photopic CS was 1.93±0.06 logCS (1.3 logMAR) and 1.56±0.05 logCS (0.3 logMAR). Regression coefficients were higher for the 0.3 logMAR (b=-0.88, R2=0.70) than for the 1.3 logMAR Landolt ring (b=-0.39, R2=0.28). Experiment 2: CS was 1.98±0.17 (0.3 logMAR optotype: 0.95±0.14) log units with full AO correction. Also in this experiment, CS was more sensitive to optical blur if measured Landolt rings of 0.3 logMAR (b=0.63, R2=0.74) compared to those of 1.3 logMAR (b=0.34, R2=0.34). Conclusions: CS tests with large optotypes such as the Pelli-Robson test may not pick up subtle, yet notable aberration-induced changes in retinal image quality. Therefore, for the assessment of effects of optical aberrations, CS testing should be performed at higher spatial frequencies (e.g., 0.3 logMAR Landolt ring). Commercial Relationships: Jens Buehren, None; Hendrik Jungnickel, None; Wolfgang Raab, None; Daniel Weigel, None; Michael Gebhardt, None; Richard Kowarschik, None; Thomas Kohnen, None Support: Federal Ministry for Education and Research (BMBF) 01EZ0608 Program Number: 1281 Presentation Time: 9:00 AM - 9:15 AM Visual performance under natural, corrected and Adaptive Optics induced astigmatism: meridional and adaptational effects Maria Vinas1, Pablo De Gracia1, Carlos Dorronsoro1, Lucie Sawides1, Gildas Marin2, Martha Hernandez2, Susana Marcos1. 1 Visual Optics & Biophotonics Lab, Instituto de Optica, CSIC, Madrid, Spain; 2R&D, Vision Science Department, Essilor International, Saint-Maur, France. Purpose: To study the extent to what prior adaptation to astigmatism affects visual performance, whether this effect is axis-dependent, and the time-scale effect of potential changes in visual performance in the presence of astigmatism following its correction. To study whether the effect of possible positive interactions of aberrations (astigmatism & coma) on visual performance might be altered after long-term adaptation to correction of astigmatism. Methods: Measurements of visual acuity (VA) were performed under induction of astigmatism and a combination of astigmatism and coma, while controlling the low and high order aberrations (HOA) of the subject with an Adaptive Optics (AO) system, in 25 subjects classified in 3 groups: non-astigmats, habitually-corrected and uncorrected astigmats. Astigmatism (1.00D) was induced at 3 different orientations: at the natural axis, at the perpendicular orientation, and at 45deg for astigmats, and at 0, 90 and 45deg for non-astigmats. Experiments were also performed with coma (0.41µm at a relative angle of 45deg) combined with the mentioned amount/orientations of astigmatism. VA was measured in a total of 14 different conditions, using an 8-Alternative Forced Choice (8AFC) procedure with tumbling E letters and a QUEST algorithm. Uncorrected astigmats were provided with proper astigmatic correction immediately after the first session. Measurements were performed during 6 months following correction. Results: In non-astigmats, inducing astigmatism at 90deg, under full AO correction, produced a statistically (p<0.01) lower reduction in VA (29%) than at 0 (40%) or 45deg (41%). In astigmats, the lower decrease was for astigmatism induced at the natural axis (24% for corrected astigmats, 28% for non-corrected astigmats). 6-months of astigmatic correction wear did not reduce the insensitivity to astigmatism induction along the natural axis. Visual benefit of adding coma to astigmatism over astigmatism alone improved significantly only in non-astigmats, and only for some orientations of astigmatism. Conclusions: The impact of astigmatism on VA is greatly dependent on the orientation of the induced astigmatism, even in non-astigmats. Prior experience to astigmatism plays a significant role on visual performance in the presence of both astigmatism and combinations of astigmatism and coma, with a strong bias towards the axis of natural astigmatism. Commercial Relationships: Maria Vinas, Essilor International (F); Pablo De Gracia, None; Carlos Dorronsoro, Essilor International (F); Lucie Sawides, None; Gildas Marin, Essilor international (E); Martha Hernandez, Essilor International (E); Susana Marcos, Essilor (F), PCT/ES2012/070185 (P) Support: Spanish Goverment FIS2008-02065, FIS2011-25637, and FPU Programs; European Research Council ERC-2011-AdG294099; CSIC JAE Predoctoral Program ; Essilor International Colaborative agreement Program Number: 1282 Presentation Time: 9:15 AM - 9:30 AM Perceptual learning after correcting the eye’s aberration with adaptive optics Ramkumar Sabesan1, 2, Geunyoung Yoon1, 2. 1Flaum Eye Institute, University of Rochester, Rochester, NY; 2The Institute of Optics, University of Rochester, Rochester, NY. Purpose: Highly aberrated keratoconic (KC) eyes do not elicit the maximum visual advantage immediately after a customized correction. This is attributed to the neural insensitivity arising from chronic visual experience with poor retinal image quality, dominated by low spatial frequencies. The goal of this study was to investigate if targeted perceptual learning with adaptive optics (AO) can stimulate ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics neural plasticity in these eyes, improving their visual benefit. Methods: A large-stroke AO vision simulator was employed to train the worse eye of 2 KC subjects in a contrast detection test under complete aberration correction with AO. Prior to training, visual acuity (VA) and contrast sensitivity (CS) at 4, 8, 12, 16, 20, 24 and 28 c/deg were measured in both eyes of subjects with AO correction for a 6mm pupil. The spatial frequency requiring 50% contrast for detection with AO correction was picked as the training frequency. Subjects were required to train on a contrast threshold task with AO correction for 1 hour each for 5 consecutive days. During each training session, 800 trials of threshold CS measurement at the training frequency with AO were conducted. The same pre-training measurements were repeated after the 5 training sessions. Results: Optical quality with AO was confirmed to be similar pre and post-training and across training sessions. After training, CS with AO improved by a factor of 1.91 (range: 1.77-2.04) and 1.75 (range: 1.22-2.34) on average over spatial frequencies in the two subjects. In both subjects, the benefit in CS was measured across a broad range of spatial frequencies, i.e. at frequencies lower and higher than the one employed during training. In both subjects, this perceptual learning effect with gratings transferred to letter VA, improving it by 1.5 lines (0.04 to -0.1 logMAR) and 1.3 lines (-0.02 to -0.15 logMAR) respectively. Inter-ocular transfer of training was also observed. The untrained eye’s CS was improved by a factor of 1.57 on average across spatial frequencies and VA by 0.8 lines (-0.01 to -0.09 logMAR) in one of the two subjects with AO. Conclusions: The improvements in visual performance after training with AO denote an improvement in neural sensitivity. Perceptual learning with AO thus has the potential to enhance neural function in abnormal corneal patients leading to improved visual benefit after a customized correction. Commercial Relationships: Ramkumar Sabesan, None; Geunyoung Yoon, Bausch & Lomb (F), Johnson & Johnson (F), Allergan (C), Staar Surgical (C), CIBA Vision (F), Acufocus (C) Support: NIH/NEI grant RO1EY 014999, Research to Prevent Blindness Program Number: 1283 Presentation Time: 9:30 AM - 9:45 AM What is the smallest change in visual acuity that is correlated with a change in image quality? Ayeswarya Ravikumar, Jason D. Marsack, Yue Shi, Raymond A. Applegate. College of Optometry, University of Houston, Houston, TX. Purpose: The 95% confidence interval for logMAR acuity testing is ~ ±5 letters (±1 line)[ Optom Vis Sci, 1998. 75(5): 342]. Metrics of image quality (IQ) can quantify 6 just noticeable differences in blur before 1 line of acuity is lost [J Cataract Refract Surg, 2011. 37(8): 1523] and visual acuity (VA) is highly correlated (R2> 0.8) to change in metrics of image quality when inducing several lines of change in acuity. However, the correlation between acuity and metric values is not known as the change in acuity approaches the test re-test reliability of acuity. The purpose here is to determine how the coefficient of determination (R2 ) between change in VA and change in IQ metric/s value changes as the range is decreased from 8 lines to the test re-test reliability of acuity measurement (1 line). Methods: The Thibos virtual eye generator [Opththalmic Physiol opt, 2009;29(3):288-291] was used to generate 60 WFEs whose log visual Strehl ratio varied between 0.0 and -1.8 in approximately equal steps. For each of the 60 WFEs, three unique logMAR acuity charts were generated (0.8 to -0.3 logMAR). For each chart, VA was measured up to the 5th letter missed for each of 3 normal subjects. Change in visual acuity was linearly regressed against change in 29 IQ metrics to determine the coefficient of determination when the change in visual acuity was decreased in 1 line steps from 8 lines to 1 line. Results: See Figure. Extrapolation from the fitted line shows that R2 goes to zero at ~3 letters (0.6 of a line), which is below the test retest reliability for acuity measurement (1 line). With a 2 line loss (or one line above the 95% confidence level for the measurement of acuity), 42% of the variance in acuity is accounted for by the metrics. The function begins to asymptote between 4 and 5 lines, and little improvement in correlation is seen with additional lines of acuity change. Conclusions: Image quality metrics can detect blur prior to an acuity loss (prior work), begin to be correlated with acuity below the re-test reliability for acuity testing and reach a maximum R 2 > 0.8. These two experimental observations suggest that IQ metrics can serve as an objective tool for evaluating and designing therapy intended to improve visual performance, and that correlations are primarily limited by the acuity task and not by the IQ metrics. Commercial Relationships: Ayeswarya Ravikumar, None; Jason D. Marsack, University of Houston (P); Yue Shi, None; Raymond A. Applegate, University of Houston (P) Support: R01 EY08520 (RAA), R01 EY019105 (RAA), P30 EY 07551 (Core Grant), N0025910 P1354 (RAA) Program Number: 1284 Presentation Time: 9:45 AM - 10:00 AM Determination of Customized Aberration Thresholds Carmen Canovas1, 2, Patricia A. Piers1, Silvestre Manzanera2, Christina Schwarz2, Pedro M. Prieto2, Henk A. Weeber1, Pablo Artal2. 1R&D, AMO Groningen B.V., Groningen, Netherlands; 2 Laboratorio de Optica, Unversidad de Murcia, Murcia, Spain. Purpose: Different aberration terms may have lower or higher impact on vision. This could be used to optimize correction strategies. We studied the customized level of spherical aberration (SA) and vertical coma (VC) that can be induced while maintaining acceptable high contrast visual acuity (VA) and to then determine whether these levels of aberration affect subjects’ through focus vision. Methods: An adaptive optics visual simulator (Fernández, et al. Opt. Lett. 2001) was used to correct individual aberrations up to the fifth order and to induce a common higher order aberration baseline (0.15 µm RMS for a 5mm pupil) corresponding to that of an average pseudophakic eye, in five normal subjects. High contrast VA was measured with SLOAN letters at the best focus position with a 4mm physical pupil. Letter size was then increased to correspond to a decrease in VA by 0.1LogMAR. Thresholds for SA (positive and negative) and positive VC were then subjectively determined by ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics increasing its value in steps of 0.02 µm until the letter could not be read. Results: The threshold value for negative SA was the smallest (0.16±0.04 µm at 5mm pupil), followed by positive SA (0.25±0.05 µm). The custom threshold for VC was consistently the highest (0.78±0.12 µms), ranging from 0.70 to 0.98 µms. Monocular through focus VA was measured, both for the baseline aberration level and after inducing the individual threshold for coma. In this case, VA for the best focus position decreased by 0.16LogMAR with respect to the baseline, reaching an average absolute VA of 0.04± 0.04LogMAR. VA decreased linearly as a function of defocus in both cases, but has a flatter slope when the individual threshold for VC was induced (0.17LogMAR per diopter of defocus versus 0.40LogMAR, respectively). Conclusions: Customized aberration thresholds for individual Zernike modes were similar for the aberrations studied for all subjects. The high contrast VA threshold for positive VC was consistently higher than that for SA demonstrating the robustness of our visual system to this aberration and indicating that disturbances resulting in VC, such as decentration of optical surfaces that correct spherical aberration, may play a less impact on vision than originally believed. The induction of VC may be advantageous for extending depth of focus. Commercial Relationships: Carmen Canovas, AMO Groningen B.V. (E); Patricia A. Piers, Abbott Medical Optics (E); Silvestre Manzanera, AMO (F), CIBA Vision (F), CALHOUN (F), VOPTICA (I); Christina Schwarz, AMO (F); Pedro M. Prieto, AMO (F), AcuFocus (F), Voptica SL (I), Voptica SL (P); Henk A. Weeber, AMO Groningen b.v. (E); Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013) and Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06 and AMO. Program Number: 1285 Presentation Time: 10:00 AM - 10:15 AM Impact of the Retinal Reflection on the Wide-Angle Point Spread Function of the Human Eye Harilaos S. Ginis1, 2, Guillermo M. Perez3, Alexandros Pennos1, Juan M. Bueno1, Pablo Artal1. 1Laboratorio de Optica, UNIVERSIDAD DE MURCIA, Murcia, Spain; 2Institute of Vision & Optics, University of Crete, Heraklion, Greece; 3Voptica SL, Murcia, Spain. Purpose: Objective measurements of scattered light in the living human eye require the analysis of double-pass (DP) retinal images. The inherent wavelength-dependent properties of the retinal reflection may influence these measurements. The aim of this work was to measure the wide-angle Point Spread Function (PSF) at different wavelengths to better understand the role of the fundus optical properties and to identify the optimal conditions for visually relevant scattering measurements. Methods: The instrument, based on the DP principle, used an extended-source, and allowed the recording of the wide-angle PSF for different wavelengths. A liquid-crystal wavelength tunable filter was used to select six different wavelengths ranging from 500 to 650 nm. Series of uniformly illuminated disks with angular size up to 8.1 degrees in radius were sequentially projected onto the ocular fundus. A technique previously reported (Ginis et al., J. Vision (2012)) was employed to analyze the DP images and reconstruct the wide-angle PSF for each wavelength. The complete series of measurements were performed in 10 healthy Caucasian subjects with different pigmentation. As an indication of the amount of measured scatter, we obtained the value of the PSF for small (0.5 degrees) and large (7 degrees) angles. Results: For small angles, there was a wavelength dependence that matches the transmittance spectrum of oxy-hemoglobin, what suggests that diffuse light from the fundus was part of the reconstructed PSF at longer wavelengths. This contribution of the fundus is more important for wavelengths longer than 600nm.There was a different behavior depending on subjects’ pigmentation with light-colored eyes exhibiting higher intensities of scattered light and without dependence on wavelength. For larger angles, scatter was nearly independent of wavelength and subjects’ pigmentation. Conclusions: The central part of the wide-angle PSF in the eye is affected by the wavelength dependent properties of the retinal reflection, which are closely related to subject’s pigmentation. At those small angles, measurements using wavelengths shorter than 600nm might be better correlated with scatter affecting vision. However, the impact of the retinal reflection in the values of the PSF at larger angles did not depend on the measuring wavelength. Commercial Relationships: Harilaos S. Ginis, Universidad de Murcia (P); Guillermo M. Perez, VOPTICA (E); Alexandros Pennos, None; Juan M. Bueno, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Supported by the Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013), Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06 and EU ITN OpAL (PITN-GA-2010-264605). 233 Binocular Vision and Age Effects on Vision Monday, May 06, 2013 8:30 AM-10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 1517-1529/B0303-B0315 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 1517 Poster Board Number: B0303 Presentation Time: 8:30 AM - 10:15 AM Oblique effects in V2 neurons of infant macaque monkeys Xiaofeng Tao1, Bin Zhang1, 2, Guofu Shen1, Earl L. Smith1, Yuzo M. Chino1. 1College of Optometry, Unitersity of Houston, Houston, TX; 2 College of Optometry, NOVA Southeastern University, Fort Lauderdale, FL. Purpose: The neural basis of oblique effects is elusive. We previously reported that the spatial matrix of facilitatory subfields (subunits) in the receptive fields of individual V2 neurons in adult monkeys exhibits an orientation anisotropy; the homogeneity of the subfields is greater if a neuron preferred the cardinal orientations compared to oblique orientations (Tao et al, 2012). In this study, we asked whether a similar orientation anisotropy (an oblique effect) exists in V2 of infant monkeys shortly after birth. In addition we asked whether or not we find an oblique effect if we analyze the responses of a large number of adult V2 neurons (> 600 units) using sine-wave grating stimuli. Methods: Extracellular recording was made in individual V2 neurons of anesthetized and paralyzed 4-, 8-, and 16-week-old macaque monkeys. The results from infants were compared to those obtained in adults. Standard sine-wave grating stimuli were initially used to determine the preferred orientation, spatial frequency and size of neuron’s receptive fields. Neurons were classified into vertically, horizontally, or obliquely oriented units after we determined the preferred orientation of each neuron. This was followed by the use of dynamic two dimensional noise stimuli and a reverse correlation (LSRC) method to obtain the spatial matrix of subfields with facilitatory profiles. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Results: 1) Using grating stimuli, we found that V2 neurons in adult monkeys show an oblique effect. 2) The oblique effect in the spatial matrix of subfields was absent in V2 at 4 and 8 weeks of age but emerged sometime between 8 and 16 weeks; the average maximal orientation differences between adjacent subfields were smaller for those neurons preferring the cardinal orientations. Conclusions: 1) Our results with grating stimuli represent the first demonstration of oblique effects in monkey extrastriate cortex. 2) The oblique effect in the spatial matrix of facilitatory subfields may not be present at birth, but appears to result from experiencedependent maturation of the connections between V1 and V2. However, the effects of optical factors including higher-order aberrations have not been ruled out. Commercial Relationships: Xiaofeng Tao, None; Bin Zhang, None; Guofu Shen, None; Earl L. Smith, Ziess (P); Yuzo M. Chino, None Support: NIH Grant R01-EY008128 (YMC), R01-EY003611 (ELS), Core Grant P-30-EY007751 Program Number: 1518 Poster Board Number: B0304 Presentation Time: 8:30 AM - 10:15 AM Interocular acuity differences alter the spatial frequency tuning of stereopsis Ashley Craven1, Truyet Tran1, Kevin Gustafson1, Thomas H. Wu1, Kayee So1, Dennis M. Levi1, 2, Roger W. Li1, 2. 1School of Optometry, University of California-Berkeley, Berkeley, CA; 2Helen Wills Neuroscience Institute, University of California-Berkeley, Berkeley, CA. Purpose: It is well known that interocular acuity differences result in reduced stereo acuity. However, previous studies have used tests that are broadband in their spatial frequency content. The purpose of the present study was to investigate the effects of interocular differences in acuity on the spatial frequency tuning of stereoscopic depth perception. Methods: The visual stimulus consisted of two horizontally separated square blocks, one presented to each eye. Each block contained a Gabor target patch surrounded by four Gabor reference patches. Binocular disparity was introduced by shifting the two Gabor targets in opposite directions (controlled by 2 interleaved staircases), and a haploscope was used to enable binocular fusion. Stimulus spatial frequency ranged from 1-20 cyc/deg. The visual task was to determine the stereoscopic depth of the Gabor target (crossed disparity: in front of / uncrossed disparity: behind) relative to the four references. Five adult observers with corrected-to-normal vision were tested. Bangerter foils were used to reduce visual acuity in the dominant eye. Stereothresholds were measured for a range of acuity difference: from 1 to 8 letter-lines on a standard LogMAR letter chart. Results: The stereoacuity versus spatial frequency function is basically the inverse of a typical contrast sensitivity function, with the optimum spatial frequency at 5- 10 cyc/deg. Increasing the interocular acuity difference degrades stereo thresholds selectively at high spatial frequencies, gradually shifting the optimum frequency to lower spatial frequencies. Interestingly, stereopsis for low frequency targets was only mildly affected even with an acuity difference of as much as eight letter-lines (0.8 LogMAR). Conclusions: The current study shows that interocular acuity differences result in spatial frequency specific losses of stereopsis. These findings have important clinical implications for understanding both the sparing of coarse stereopsis and the deficits in fine stereopsis in anisometropic amblyopia. Commercial Relationships: Ashley Craven, None; Truyet Tran, None; Kevin Gustafson, None; Thomas H. Wu, None; Kayee So, None; Dennis M. Levi, None; Roger W. Li, None Support: NIH Grant R01EY01728 Program Number: 1519 Poster Board Number: B0305 Presentation Time: 8:30 AM - 10:15 AM Enhancing stereoacuity through perceptual learning in normal vision: Specificity for spatial frequency and orientation Truyet Tran1, Kayee So1, Calvin Nguyen1, Tszwing Leung3, Sandy Chat1, Dennis M. Levi1, 2, Roger W. Li1, 2. 1School of Optometry, University of California-Berkeley, Berkeley, CA; 2Helen Wills Neuroscience Institute, University of California-Berkeley, Berkeley, CA; 3School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Purpose: To investigate whether practicing a stereoscopic depth detection task enhances stereoacuity in adults with normal vision and whether the learning effects, if any, transfer across target spatial frequencies and carrier orientations. Methods: The visual stimulus consisted of two horizontally separated square blocks, one presented to each eye. Each block contained a Gabor target patch surrounded by four Gabor reference patches. A haploscope was used to enable binocular fusion. The visual task was to determine the stereoscopic depth of the Gabor target (in front / behind) relative to the four references. Ten adult observers with corrected-to-normal vision participated. The training protocol consisted of three training phases (each of 13 sessions). In Phase 1 observers were trained with targets with a vertical carrier of 5 cyc/deg (V5, vertical). In Phase 2 they continued to train with the same spatial frequency, but with an orthogonal carrier orientation (H5, horizontal). They were subsequently required to practice with targets with a vertical carrier at a higher spatial frequency (V10, 10 cyc/deg) in phase 3. Thresholds for each of the three stimulus configurations were measured before and after each training phase. Trial-by-trial feedback was provided. Results: Our observers showed a substantial mean improvement of 64% in stereo thresholds after practicing with V5 stimuli in phase 1, and the improvement transferred substantially to the other two untrained stimulus configurations (H5: 46% and V10: 56%). Additional significant improvements obtained with subsequent directtraining in phases 2 (H5: 29%) and 3 (V10: 19%) indicate that the transfers observed in phase 1 were not complete. Conclusions: Perceptual learning can induce functional plasticity for enhancing stereovision in the mature visual system. Our findings characterize the magnitude, time course and specificity of visual learning. This technique might have important applications in restoring impaired binocular vision in cortical visual disorders. Commercial Relationships: Truyet Tran, None; Kayee So, None; Calvin Nguyen, None; Tszwing Leung, None; Sandy Chat, None; Dennis M. Levi, None; Roger W. Li, None Support: NIH Grant R01EY01728 Program Number: 1520 Poster Board Number: B0306 Presentation Time: 8:30 AM - 10:15 AM Factors influencing stereoacuity levels after surgery to correct unilateral developmental cataracts in children Soo Jung Lee1, Nam Eok Kim2, Jung Min Park2. 1Haeundae Paik Hospital, Busan, Republic of Korea; 2Ophthalmology, Maryknoll Medical Center, Busan, Republic of Korea. Purpose: To evaluate factors influencing stereoacuity after surgery to correct unilateral developmental pediatric cataracts. Methods: We retrospectively surveyed 110 patients who had undergone removal of unilateral acquired developmental cataracts ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics and primary posterior chamber intraocular lens implantation between February 1992 and December 2009. In all patients, stereoacuity was assessed using the Titmus test at the last follow-up period of minimum 2 years after surgery. Patients were divided into two groups according to the extent of stereoacuity: Group 1 (n=42) had stereoacuity values ≤100 sec/arc and Group 2 (n=68) values >100 sec/arc. The values of ten parameters associated with stereoacuity were measured in each group: Cataract types, preoperative best corrected visual acuity (BCVA) of the affected eyes, between-eye difference in BCVA, age at cataract surgery, operative method, aftercataracts, postoperative strabismus, postoperative BCVA of the affected eyes, between-eye difference in BCVA, and anisometropia. Results: The extent of stereoacuity was significantly associated with both operative method and after-cataract (P=0.000 and P=0.016, respectively). All patients in whom the posterior capsule was preserved, had poor stereoacuity >100 sec/arc. Significant correlations with the extent of stereoacuity were found with postoperative strabismus (P=0.048), postoperative BCVA of the affected eyes (P=0.002), anisometropia (P=0.034). Conclusions: Postoperative stereoacuity was better in patients who underwent either optic capture or anterior vitrectomy after posterior continuous curvilinear capsulorhexis, and who didn’t develop aftercataracts or strabismus postoperatively. Furthermore, postoperative BCVA of the affected eyes, and anisometropia influenced the stereoacuity of the patients surgically treated for unilateral developmental pediatric cataracts. Commercial Relationships: Soo Jung Lee, None; Nam Eok Kim, None; Jung Min Park, None Program Number: 1521 Poster Board Number: B0307 Presentation Time: 8:30 AM - 10:15 AM Do Bangerter filters promote binocular function in amblyopes? Daming Deng1, Jinrong LI1, 2, Benjamin Thompson3, Minbin Yu1, 2, Robert F. Hess4. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; 2Department of Optometry and Vision Science, Sun Yat-sen University, Guangzhou, China; 3Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; 4 Department of Ophthalmology, McGill University, Montreal, QC, Canada. Purpose: Bangerter foils have become an alternative treatment regimen for amblyopia penalization. We have previously found that while Bangerter foils can penalize the normal eye, they do so in a manner that is not graded. In this study, we investigated whether Bangerter foils promote binocular function within the amblyopic visual system. Methods: Suppression thresholds were measured for 17 amblyopes using our previously established “balance point” protocol combined with a Gabor direction discrimination task. We compared normal binocular viewing with viewing conditions where the fellow fixing eye was penalized with 0.8, 0.6, 0.4 and 0.2 strenght Bangerter foils. In addition, the effect of Bangerter filters on suppression thresholds for patients was compared to results from 10 control observers. Results: The 0.8, 0.6 and 0.4 labeled foils did not influence suppression in the amblyopic observers. The 0.2 Bangerter foil reduced suppression thresholds and a binocular balance point was obtained in 14 out of the 17 subjects. Conclusions: Bangerter foils do not gradually induce binocular facilitation. The 0.8 to 0.4 strength Bangerter foils did not predictably shift the binocular status of amblyopes. Only the most extreme foil tested, labeled 0.2, reduced suppression among the amblyopic subjects. Care should be taken when prescribing Bangerter foils in clinical practice. Commercial Relationships: Daming Deng, None; Jinrong LI, None; Benjamin Thompson, US12528934 (P), US8006372B2 (P); Minbin Yu, None; Robert F. Hess, None Support: JRL was supported by The Thrasher Research Fund for Early Career Award, the Fundamental Research Funds of State Key Laboratory of Ophthalmology, Sun Yat-sen University and the Guangdong Province Medical Science Research Grant (B2011105). DDM was supported by the Guangdong Province International Collaboration Project Grant (2010B050100014). Program Number: 1522 Poster Board Number: B0308 Presentation Time: 8:30 AM - 10:15 AM Optimizing binocular vision of pseudophakes with uncorrected astigmatism Veerendranath Pesala1, Prashant Garg2, Shrikant R. Bharadwaj1. 1 Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; 2Cornea and anterior segment services, L V Prasad Eye Institute, Hyderabad, India. Purpose: Uncorrected astigmatism improves monocular near acuity of pseudophakes, but with an associated loss in distance vision. The impact of uncorrected astigmatism on binocularity of these eyes however remains unknown. This study determined combinations of astigmatism in the two eyes that simultaneously optimize binocular distance and near resolution acuity and stereoacuity of bilateral pseudophakes with monofocal IOL implants. Methods: Binocular distance (3m) and near (40cm) logMAR acuity and random-dot stereoacuity (40cm) was measured in 13 emmetropic pseudophakes with 10 different combinations of astigmatism induced in random order before the two eyes. Three strategies were chosen such that one eye had I) no astigmatism or II) 1D simple myopic or III) 1D simple hyperopic astigmatism at 90° while the fellow eye had a) the same error or that with b) orthogonal axis (180°) or c) different magnitude (2.5D) or d) opposite polarity (-1D). Results: For all combinations of induced astigmatism, the mean (±1SEM) distance logMAR acuity (0.03±0.03) did not deteriorate significantly from the best-corrected condition (-0.08±0.02) (p=0.32). Near logMAR acuity and stereoacuity were in-between the uncorrected (NVA: 0.59±0.05; Stereo: 232.9±33.9arc sec) and bestcorrected (NVA: 0.18±0.02; Stereo: 60.9±10.2arc sec) conditions for all myopic astigmatic combinations (Ib & c and IIa - c) and same or worse than the uncorrected condition for hyperopic astigmatic combinations (Id, IId & IIIa - c) (p=0.003 to 0.36 for all). All outcomes variables were closest to their respective best-corrected values for combination IIc (OD: ±/+1.0x90°; OS: ±/+2.5x90°; DVA: 0.12±0.02; NVA: 0.38±0.03; Stereo: 82.6±8.05arc sec), followed by IIa (OU: ±/+1.0x90; DVA: 0.04±0.02; NVA: 0.43±0.05; Stereo: 104.5±13.5arc sec) and Ib. Stereoacuity was worse with orthogonal axes (IIb) than with parallel axes of myopic astigmatism (IIa) in the two eyes (p=0.002). Conclusions: Binocular near logMAR and stereo acuity of bilateral pseudophakes can be simultaneously optimized without hindering distance vision using combinations of myopic astigmatism in the two eyes. Leaving such combinations uncorrected after cataract surgery may be a viable alternative to sphero-cylindrical bifocals in optimizing the overall binocular visual experience of the patient. Combinations with astigmatism with orthogonal axes in the two eyes or with hyperopia deteriorate near vision of pseudophakes. Commercial Relationships: Veerendranath Pesala, None; Prashant Garg, None; Shrikant R. Bharadwaj, None Support: Department of BioTechnology Ramalingaswami Fellowship, Govt. of India. Program Number: 1523 Poster Board Number: B0309 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Presentation Time: 8:30 AM - 10:15 AM Effects of refractive blur and clothing on night-time pedestrian visibility Joanne M. Wood, Ralph Marszalek, Trent Carberry, Philippe Lacherez, Sumanth Virupaksha, Michael J. Collins. School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia. Purpose: To investigate the effects of refractive blur on night-time pedestrian recognition and whether clothing that has been shown to improve pedestrian conspicuity is robust to the effects of blur. Methods: Twenty-four visually normal participants (12 younger M=25.6 ± 5.2 years and 12 older adults M= 77.6 ± 5.5 years) drove an instrumented vehicle around a 1.8 km closed road circuit at night with 3 levels of binocular blur (+0.50 D, +1.00 D, +2.00 D) compared to a baseline condition (optimal correction). A pedestrian walked in place on the course and wore either normal clothing (gray pants and top), black pants and top with a retroreflective vest, or the same top and vest with retroreflective tape positioned on the extremities in a configuration that conveyed biological motion (known as “biomotion”). Participants pressed a vehicle-mounted response pad when they were first confident that a pedestrian was present; each participant drove around the track 13 times (4 vision conditions x 3 pedestrian clothing conditions randomized + 1 practice trial). Results: Refractive blur and pedestrian clothing had a significant effect on pedestrian recognition distances (p<0.05) and there was a significant two-way interaction between these factors. Overall, recognition distances were significantly reduced by all levels of blur compared to the baseline. In all blur conditions, a pedestrian wearing the “biomotion” clothing was more recognizable than either the pedestrian wearing the retroreflective vest or normal clothing, and the pedestrian wearing the retroreflective vest was more recognizable than when wearing normal clothing, although the magnitude of the difference became smaller with increasing levels of blur. These effects were greater for younger adults, older adults showing generally shorter recognition distances and therefore smaller effects of either clothing or blur. In the absence of blur, the pedestrian wearing biomotion clothing was recognized at an average distance of 173 m compared to 18 m in the normal-wear condition (almost 10X the distance). Conclusions: Even small amounts of blur have a significant detrimental effect on night-time pedestrian recognition. Biomotion configurations of retroreflective clothing represent a highly beneficial visibility aid which are effective even under moderately degraded visibility conditions, and improve the recognizability of pedestrians for both older and younger drivers. Commercial Relationships: Joanne M. Wood, None; Ralph Marszalek, None; Trent Carberry, None; Philippe Lacherez, None; Sumanth Virupaksha, None; Michael J. Collins, None Support: ARC Linkage LP0990292 Program Number: 1524 Poster Board Number: B0310 Presentation Time: 8:30 AM - 10:15 AM Pupil Changes under Scotopic and Photopic illumination Li Chen, Dimitri Chernyak. AMO Development, LLC, Milpitas, CA. Purpose: To investigate changes in pupil and iris diameter, location of pupil center and non-circularity of pupil under scotopic and photopic illumination. Methods: Scotopic and photopic eye images of 98 eyes from 49 subjects (age range, 26 to 75 years) with normal eyes were captured using the pupillometer of iDesign Wavefront Studio (AMO Development, LLC). The pupillometer operated by capturing a pair of images of the eye illuminated by a combination of IR and NIR LEDs for scotopic illumination and a pair of green LEDs for scotopic illumination. The scotopic image was captured first, then the green LEDs were turned on and the photopic image was captured. The scotopic and photopic eye images were then analyzed to locate pupil and iris limbus boundary. Pupil boundary and iris boundary were fitted with a best-fitting circle to locate the center and diameter. The shift in pupil position relative to the cornea was calculated from the pupil center and iris center from scotopic and photopic images. Pupil boundary was also fitted with a best-fitting ellipse and the noncircularity of pupil was calculated from the major diameter and minor diameter of the best-fitting ellipse. Results: Under photopic illumination, the mean pupil diameter was 4.26 mm ± 0.95 (SD) (range 2.08 to 7.13 mm), and the mean iris diameter was 12.03 mm ± 0.31 (SD) (range 11.22 to 12.67 mm); Under scotopic illumination, the mean pupil diameter was 6.09mm ± 1.00 (SD) (range 3.43 to 8.13 mm), and the mean iris diameter was 12.03 mm ± 0.32 (SD) (range 11.45 to 12.69 mm). Pupil diameter decreased as a function of age was observed both in photopic and scotopic conditions. Iris diameter also showed a 0.24 mm average decrease in aged eyes of the over 60s (unpaired t-test, p=0.002) both under photopic and scotopic illumination. With changes of pupil diameter from photopic and scotopic illumination, the mean pupil center shifting toward temporal to cornea center was 0.064 mm ± 0.045 (SD) (range 0.004 to 0.293 mm). On average, the pupil noncircularity was 0.037 from the 98 photopic eyes and 0.046 from the 98 scotopic eyes. Conclusions: This study not only confirmed pupil diameter decrease with aged eyes, but also observed decreased iris diameter in aged eyes. Pupil center shifted temporally from the cornea center with changes of pupil diameter under scotopic illumination. Noncircularity of pupil increased on average with the increased pupil diameters under scotopic illumination. Commercial Relationships: Li Chen, Abbott Medical Optics Inc (E); Dimitri Chernyak, Abbott Medical Optics (E) Program Number: 1525 Poster Board Number: B0311 Presentation Time: 8:30 AM - 10:15 AM The Correlation between Visual Acuity, Refraction and Cognitive Function in the Elderly Oriel Spierer1, Naomi Fischer1, Adiel Barak1, Michael Belkin2. 1 Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Ophthalmic Technologies Laboratory, Goldschleger Eye Research Institute, Tel Aviv University, Tel Hashomer, Israel. Purpose: To study the correlation between visual acuity, refraction and cognitive state in an elderly population, with no known dementia or Alzheimer's disease. Methods: A cross sectional study was conducted, comprising of 200 subjects age 75 and older from adult day care centers. Near visual acuity was tested using the Jaeger chart and refraction was examined by a portable auto-refractometer. Cognitive function was evaluated with the mini-mental state examination (MMSE). The eye with better visual acuity and no cataract or refractive surgery was used for analysis. Patients that underwent cataract or refractive surgery in both eyes were excluded. Correlation tests were used to find association between visual acuity, refraction, wearing eyeglasses for near or far vision and cognitive functions. Results: One hundred and ninety five subjects (mean age 81.6 ± 5.1 years, 70.3% females) fulfilled the inclusion criteria and comprised the study population. The mean period of education was 9.2 ± 4.6 years (range 0-25). Mean Jaeger near visual acuity was J3.3 ± 3.1 (range J1-J16). Mean refractive error was 0.52 ± 2.33 (range +4.625 to -5.625). Eyeglasses for near vision were used by 124 (63.6%) participants and 128 (65.6%) participants used eyeglasses for ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics distance vision. Mean MMSE was 24.9 ± 4.0 points (range 15-30). Good near visual acuity (J3 or lower) was found to be associated with high MMSE score (>24) (OR=3.74, 95% CI=1.86-7.52, p<0.001) and remained significant after adjustment for sex, age and years of education. Wearing eyeglasses for near or far vision were found to be correlated with high MMSE score after adjustment for sex and age (OR=1.95, 95% CI=1.06-3.57, p=0.03, OR=1.94, 95% CI=1.05-3.59, p=0.04, respectively) but did not after adjustment for years of education. A trend was found toward correlation between myopia and better MMSE score (r=-0.12, p=0.09, Pearson's correlation) although it did not remain so after adjusting for sex, age or education. Conclusions: Good near visual acuity and wearing eyeglasses for far or near vision seem to be correlated with better cognitive function. The nature of the relationship between visual and cognitive functions and possible causality needs to be further investigated. Commercial Relationships: Oriel Spierer, None; Naomi Fischer, None; Adiel Barak, None; Michael Belkin, Alcon (C), Ellex (C), PCT: IL2011/000373 Filed 9/5/2011 Published (P) Program Number: 1526 Poster Board Number: B0312 Presentation Time: 8:30 AM - 10:15 AM Relationship between dynamic vision and balance in older adults Allen M. Cheong1, Kar Ho Siong1, William Tsang2, 3, Ho Lung Henry Chan1, 3. 1School of Optometry, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; 2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 3Institute of Active Ageing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong. Purpose: Deteriorated visual function is one important risk factor for the detrimental balance control in older adults. Most studies examined the relationship between static visual and balance functions, largely ignoring that between dynamic vision and balance. In this study, we examined dynamic visual function and its interaction with balance in young and old people. Methods: Fifteen younger (aged 21-40 years) and twelve community-dwelling participants (60 years or above) with normal vision were recruited. Visual acuity (VA) and contrast sensitivity (CS) were measured by Psykinematix for stimuli of different optotypes or gratings moving at 5 different speeds (0, 15, 30, 60 and 90 deg/sec). Static balance was measured by a force platform when the participant stood on a firm or foam surface while fixating at different targets. Dynamic balance was measured by limits of stability test where the participants were asked to make a corresponding weight shift as maximal as possible within their base of support to 8 positions whenever individual stimulus representing the weight shift at a particular position showed in the monitor. Results: VA and CS significantly deteriorated for recognizing moving objects as the speed increased. However, such deterioration became plateau when the moving speed reached 30 deg/sec, where the young group performed better (p<0.05). Age-related decline was only found in CS (p<0.001), but not in VA. Standing on a compliant foam surface imposed significant impediment on postural control (p<0.05). Both static (in terms of total sway area) and dynamic balance (in terms of averaged maximum excursion at 8 orientations) were significantly impaired in the older group (p<0.05), however the extent of deterioration was much stronger in the dynamic (rs=-0.682) than static balance (rs=0.10). Multivariate analyses showed that dynamic vision could weakly correlate with static balance (rs= 0.01), but significantly correlate with dynamic balance (rs=-0.514). Conclusions: As a consequence of aging, both visual and balance functions were significantly deteriorated. However, stronger agerelated decline occurred when both vision and balance were measured in dynamic perspective. In addition to age, a much stronger relationship was established between dynamic vision and dynamic balance, implying that a person with poorer dynamic vision has weaker dynamic balance control. Commercial Relationships: Allen M. Cheong, None; Kar Ho Siong, None; William Tsang, None; Ho Lung Henry Chan, None Support: PolyU Internal Grant - A-PJ67 & A-PL43 Program Number: 1527 Poster Board Number: B0313 Presentation Time: 8:30 AM - 10:15 AM Effect of Visual Function on Giving and Receiving Help in an Older Adult Population Monique J. Leys1, Priyanka Jain1, Merideth Smith2, G. Jamie Miller1, Kenneth B. Mitchell1, J V. Odom1. 1WVU Eye Institute, Morgantown, WV; 2Psychology, WVU, Madison, WI. Purpose: To determine the relationship of measures of visual function and reported giving and receiving help in an older adult population. Methods: 100 persons participated in a telephone interview to determine the relationship of volunteering or giving help, and help received on depression and suicidal ideation in the elderly. The specific measures of giving help were responses to the questionnaires Volunteering (V) and Informal Support Provided (ISP); measures of help received were Perception of Support Received (PSR) and Informal Support Received (ISR). ISR had several subscales Tangible Support (ISR-T), Instrumental Support (ISR-I), Emotional Support (ISR-E) and Total (ISR-TOT). Patients were aged 60 years or more (mean: 73.48 years; range 60-94) and passed standard cognitive tests to rule out dementia. 55 were female and 45 were male. Participants were patients at the WVU Eye Institute whose vision ranged from normal to severe visual impairment. A chart review determined the visual acuities, ocular disease, duration of disease, and visual fields. Visual acuities of the better and worse seeing eyes (VA-B and VA-W) were converted to LogMAR values. The visual field (VF) information in the charts was converted to a 4point rating scale of binocular field loss severity. Disease duration (DD) was expressed in years. Using correlation analyses and stepwise regression, we determined which of the independent variables (IV) predicted reports of giving or receiving help. Results: Stepwise regression indicated a significant relationship of visual variables to V (p < 0.00126; Multiple R-squared = 0.15 with VA-B, VF, and DD as the significant IVs), to PSR (p<0.00052; Multiple R-squared = 0.17 with VA-B, VA-W and VF as the IVs), and ISR-T (p < 0.000697; Multiple R-squared = 0.14 with VA-B and DD as the IVs). Measured visual functions did not predict ISP, ISR-I, ISR-E and ISR-TOT significantly. Conclusions: Our data provide additional support for the importance of visual function as an influence on the prosocial behavior of older adults. Better visual function is associated with more volunteering, but influence the informal support that older adults provide others. Poorer visual function is associated with the receipt of tangible assistance, but does not influence receipt of other informal assistance. Commercial Relationships: Monique J. Leys, None; Priyanka Jain, None; Merideth Smith, None; G. Jamie Miller, None; Kenneth B. Mitchell, None; J V. Odom, None Support: Research to Prevent Blindness Challenge Grant Program Number: 1528 Poster Board Number: B0314 Presentation Time: 8:30 AM - 10:15 AM Online Assessment of Contrast Sensitivity and Hallucinations in Parkinson’s Disease ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Mary Lou Jackson1, Jennifer Wallis1, Paul Wicks2, Peter Bex1. 1 Harvard Dept of Ophthalmology, Massachusetts Eye & Ear Infirmary, Boston, MA; 2PatientsLikeMe Research, Boston, MA. Purpose: To assess contrast sensitivity (CS) and visual hallucinations (VH) in individuals with Parkinson’s disease. Patients with Parkinson’s disease who experience hallucinations may show impaired CS, a relationship previously reported in people with low vision who experience Charles Bonnet Syndrome. Methods: A total of 964 members of the online patient community ‘PatientsLikeMe’ were invited via email to participate in this study. 269 members completed the study; 153 of this group were patients with Parkinson's disease, 116 were controls (other disorders). Participants completed, online, a modified version of the University of Miami Parkinson’s Disease Hallucinations Questionnaire (UMPDHQ) and a test of CS similar to the Pelli Robson chart. Results: Results from the UM-PDHQ showed that 18% of people in the Parkinson’s group currently experienced VH versus 9% in the control group. Hallucinations reported by participants with Parkinson’s disease included mice, cats, people, distorted faces, furniture or complex patterns. Both groups, participants with Parkinson’s disease (M: 1.85, SD: .36) and the control group (M: 1.75, SD: .35) showed relatively good CS as measured with the online letter test (F(1, 269)= 1.49, p=.22). Individuals with current VH showed relatively low CS scores (M: 1.69, SD: .36) compared to individuals who had never had VH (M:1.81, SD: .35), or had previously (M: 1.80, SD: .37) experienced VH. This difference, however, did not reach statistical significance (F(2, 263)= 1.55, p= .22). CS differences in the Parkinson’s disease group between those with VH (M: 1.69, SD: .34) and those with no current VH (never VH - M: 1.77, SD: .34, VH but not in past month M: 1.74, SD: .40) were small. Conclusions: More patients with Parkinson’s disease reported visual hallucinations than the control group, however, both groups showed relatively good CS. Interestingly, participants who reported VH, irrespective of disease status, showed relatively low CS compared to participants who did not. This difference is of clinical interest. Contacting subjects via an online health social network is a novel method of conducting vision research that allows large numbers of individuals to be contacted quickly, including those in remote communities. Commercial Relationships: Mary Lou Jackson, None; Jennifer Wallis, None; Paul Wicks, PatientsLikeMe (E), Abbott (F), Acorda (F), Avanir (F), Biogen (F), Genzyme (F), Johnson & Johnson (F), Merck (F), Novartis (F), Sanofi (F), UCB (F), PatientsLikeMe (I); Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Program Number: 1529 Poster Board Number: B0315 Presentation Time: 8:30 AM - 10:15 AM Contrast acuity in Lewy Body Disease Helene Kergoat1, 2, Guillaume Carcenac1, Mireille Parent1. 1School of Optometry, University of Montreal, Montreal, QC, Canada; 2 Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada. Purpose: Lewy Body Disease (LBD) is a neurodegenerative disease affecting older individuals, that is characterized by visual hallucinations, fluctuations in cognition and parkinsonism. It is associated with deficits in both the dopaminergic and cholinergic systems. These neurotransmitters play a role in the processing of visual information. Therefore, the present study was undertaken to verify if contrast acuity was altered in LBD. Methods: Twelve participants with a confirmed diagnosis of LBD (Avg: 76.0 yrs ± SD 6.1) and 12 age-matched controls (Avg: 75.1 yrs ± SD 6.5) were recruited for the study. All subjects received a complete eye examination prior to testing to ensure that they had a visual acuity better than 20/30 and good ocular health. The eye with best corrected visual acuity was chosen for testing. Contrast sensitivity and contrast acuity were measured at an 8 foot distance with a retroilluminated CSV-1000 system (VectorVision) having a mean luminance of 85 cd/m2. Contrast sensitivity was measured with the CSV-1000E chart test face for 4 spatial frequencies: 3, 6, 12 and 18 cycles per degree (cpd). Contrast acuity was measured with the CSV-1000CVA20/30 chart test face for 3 contrast levels: 100%, 9% and 6%. Statistics consisted of ANOVAs for an alpha level of 0.05. Results: Our results indicated that the contrast sensitivity was significantly reduced in subjects with LBD for the 3, 12 and 18 cpd gratings (p< 0.01). Contrast acuity was also reduced in subjects with LBD, for all contrast levels tested (p< 0.01). Conclusions: These results show that LBD is associated with a reduction in contrast acuity for both gratings and letters. These findings may be related to dopaminergic/cholinergic deficits, or to structural anomalies known to occur in the retina of individuals with LBD. Commercial Relationships: Helene Kergoat, None; Guillaume Carcenac, None; Mireille Parent, None Support: Fondation Caroline-Durand, COETF 246 Cone Photoreceptors in Aging and Disease Monday, May 06, 2013 11:00 AM-12:45 PM TCC LL 4/5 Paper Session Program #/Board # Range: 1740-1746 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 1740 Presentation Time: 11:00 AM - 11:15 AM Cone Distribution Variations for Young Healthy Subjects vs. Older Subjects Ann E. Elsner1, Toco Y. Chui1, Lei Feng1, 2, Colleen M. McIntyre1, Hongxin Song1, 3, Thomas Gast1, Stephen A. Burns1. 1Optometry, Indiana University, Bloomington, IN; 2Second Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China; 3Center for Visual Science, University of Rochester, Rochester, NY. Purpose: To compare the individual differences in cone distribution with age, minimizing the effects of eye length and retinal disease. To distinguish between cone density variations related to foveal specialization, as opposed to more global factors or aging. Methods: Subjects who had a normal fundus and axial length < 26 mm were divided into 2 groups, with age = 18 - 35 yr for the 47 subjects in the younger group and 50 - 70 yr for the 17 subjects in the older group. Cone densities were quantified using a second generation Adaptive Optics Scanning Laser Ophthalmoscope. Cones were imaged using 820 to 840 nm +/- 20 nm at approximately 100 microwatts, illuminating 530 x 550 microns of the retina. Samples collected in a + shape around the fovea were montaged. Cones were counted at a nominal 270, 630, 1480, and 2070 microns from the foveal center using custom software (Matlab, Mathworks). To reduce shadowing from large retinal vessels, temporal meridian data were used. Axial length measurements were used to correct the cone sampling positions and retinal area in mm2 (IOL Master, Zeiss Meditec). A subset of data were refit to a 2 parameter exponential model. Results: Cone density was greater on average for the younger group, but had substantial variability and overlap with the older group. The refit data from 36 younger subjects matched the 2 parameter ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics exponential model sufficiently well that 97% had R2 > 0.9; but the parameters differed, and 92% of the data were slightly too steep. These cone densities averaged 43,200, 27,500, 15,000, and 12,200 microns per mm2, for the 270, 630, 1440, and 2070 micron locations, with a coefficient of variation of .14, .13, .10, and .10. Cone density at 630 microns was negatively correlated with the ratio of cones at 2070: cones at 630, p < .0001 and p = .0008 for the younger and older groups, respectively, and uncorrelated to the (unnormalized) density at 2070 microns, p = 0.71 and 0.37. The ratio of cones at 2070: cones at 630 averaged 0.45 vs. 0.39, for younger vs. older eyes. Conclusions: Cone density is not characterized by a scalar factor for either eccentricity or age, nor a model with fixed exponents. Instead, cones from outside the fovea migrate centrally to provide foveal specialization, and aging further alters the distribution. Commercial Relationships: Ann E. Elsner, Aeon Imaging, LLC (I), Aeon Imaging, LLC (F), Aeon Imaging, LLC (P); Toco Y. Chui, None; Lei Feng, None; Colleen M. McIntyre, None; Hongxin Song, Canon (F); Thomas Gast, None; Stephen A. Burns, None Support: NIH Grant EY007624, EY004395, P30EY019008 Program Number: 1741 Presentation Time: 11:15 AM - 11:30 AM Longitudinal Cone Density Measurements using a Commercially Available Flood-Illuminated Adaptive Optics Camera in Japanese Macaque Monkeys with Dominantly Inherited Drusen Mark E. Pennesi1, Keith V. Michaels1, Shu Feng1, Travis B. Smith1, Anupam K. Garg1, Trevor J. McGill2, Laurie Renner2, Marvin Sperling3, Kay D. Rittenhouse3, Martha Neuringer2. 1Ophthalmology, Casey Eye Institute - OHSU, Portland, OR; 2Division of Neuroscience, Oregon National Primate Center, Beaverton, OR; 3 External R&D Innovations, Pfizer Inc., San Diego, CA. Purpose: To study the longitudinal changes in cone density in a line of adult Japanese Macaque monkeys with dominantly inherited drusen using a commercially available flood illuminated adaptive optics camera. Methods: Twenty male and female Japanese Macaques were sedated and imaged on the RTx1 Adaptive Optics Camera (Imagine Eyes, Orsay, France) at baseline and six months later. In each animal, a series of overlapping AO images were obtained starting at the optic nerve and extending temporally through the fovea. Individual images were montaged using I2k Align (DualAlignTM). Cone profiles were counted using a Matlab algorithm (generously provided by Dr. Joseph Carroll) and axial lengths were measured to correct for magnification. Macular drusen were identified with advanced Weka segmentation (University of Waikato). Results: Cone density plots revealed an anatomic distribution of cone photoreceptors in the macula, but cones within 1.6° of the foveal center could not be individually identified. The mean cone density across 1.6-3.1° eccentricity was 28843 ± 5284 cones/mm2 after six months. When broken into parafoveal quadrants, cone density was highest in the nasal quadrant and lowest in the superior quadrant for both time points. The mean baseline age for the animals was 10.8 ± 5.5 years. Age was not significantly associated with cone density (p = 0.46), nor was it associated with the change in cone density between the time points (p = 0.75). The fraction of area occupied by drusen was 8.8 ± 12.8 percent. Drusen area also was not significantly associated with cone density (p = 0.55), nor was it associated with the change in cone density between the time points (p = 0.70). Conclusions: Commercially available flood illuminated adaptive optics allows for longitudinal measurement of cone density in macaques with drusen. Preliminary results indicate that age and drusen load are not associated with a significant change in cone density over the period studied. Further collections are planned every six months to assess long-term changes in cone density. Commercial Relationships: Mark E. Pennesi, Pfizer (F); Keith V. Michaels, Pfizer, Inc. (F); Shu Feng, None; Travis B. Smith, Pfizer, Inc. (F); Anupam K. Garg, None; Trevor J. McGill, StemCells, Inc. (C), Pfizer (F), AGTC (F); Laurie Renner, Pfizer (F), Applied Genetic Technologies Corporation (F); Marvin Sperling, Pfizer Inc. (E); Kay D. Rittenhouse, Pfizer Inc. (E); Martha Neuringer, Pfizer (F), Applied Genetic Technologies Corporation (F) Support: Pfizer Ophthalmology External Research Unit, FFB CDCL-0808-0469-OHSU, RPB CDA (MEP), RPB Unrestricted - CEI, NIH grant P51OD011092 Program Number: 1742 Presentation Time: 11:30 AM - 11:45 AM Assessing the Mosaic of Cone Photoreceptors Overlying Subretinal Drusenoid Deposits in vivo Using Adaptive Optics Sarah Mrejen1, 2, Taku Sato1, 2, Richard F. Spaide1, 2. 1vitreous retina macula consultants of New York, New York, NY; 2LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY. Purpose: To investigate the cone photoreceptor mosaic in eyes with pseudodrusen as evidenced by the presence of subretinal drusenoid deposits (SDD) using adaptive optics (AO) imaging integrated into a multimodal approach. Methods: Consecutive patients with pseudodrusen were examined using near-infra-red reflectance (IR) confocal scanning laser ophthalmoscopy (SLO) and eye-tracked spectral-domain optical coherence tomography (SD-OCT) and a flood-illuminated retinal AO camera prototype (rtx-1, Imagine Eyes, Orsay, France). The AO images were acquired between 1 and 5 degrees of retinal eccentricity from the foveal center in the areas of SDD. Correlations were made between the IR SLO, SD-OCT and the AO images. Cone packing density analysis was performed on AO images within 50 x 50 µm windows in 5 regions of interest overlying and in 5 located between SDD. Five patients with soft drusen were evaluated as a comparison group. Results: The mean age of 5 patients, all female, with SDD was 71.8 years. The SDD identified by combined IR and eye-tracked SD-OCT corresponded to well-defined areas darker than the surrounding uninvolved areas in the AO images. The mean (±SD) cone packing density was 1254 (± 673) cones/mm2 on SDD and 10818 (±1860) cones/mm2 between SDD. Cone density on SDD was approximately 11% of cone density between SDD, whereas cone density on soft drusen varied from 60 to 90% of cone density between soft drusen. The cone density between SDD was not significantly different from the cone density between soft drusen at the same degree of retinal eccentricity. The lack of visualization of cones on SDD was correlated with the disruption of the ellipsoid zone on corresponding SD-OCT. The cone mosaic was well preserved on soft drusen when the ellipsoid zone was preserved on corresponding SD-OCT. Conclusions: The lack of visualization of cones on SDD in the AO images can be due to several possible causes: a change in their orientation, absence or shortening of their outer segments, or absence of the cones. Whether the lack of detection of cones on SDD is due to absent or shortened outer segment or absence of cones, all of these explanations imply decreased cone function is possible. These findings suggest these patients with pseudodrusen may experience decreased retinal function independent of choroidal neovascularization or retinal pigment epithelium atrophy. Commercial Relationships: Sarah Mrejen, None; Taku Sato, Alcon Japan Ltd. (F); Richard F. Spaide, Topcon (P), Thrombogenics (C), Bausch and Lomb (C) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 1743 Presentation Time: 11:45 AM - 12:00 PM Adaptive Optics Scanning Laser Ophthalmoscopy in Stargardt Disease Reveals Decreased Cone and Rod Densities Hongxin Song1, Angela Pugliese2, Ethan A. Rossi1, Lisa R. Latchney2, Edwin M. Stone3, Alfredo Dubra4, Jennifer J. Hunter1, 2, Mina M. Chung1, 2. 1Center for Visual Science, University of Rochester, Rochester, NY; 2Flaum Eye Institute, University of Rochester, Rochester, NY; 3Ophthalmology and Visual Science, University of Iowa, Iowa City, IA; 4Ophthalmology, University of Wisconsin, Milwaukee, WI. Purpose: Stargardt disease (SD) is defined clinically by its ophthalmoscopic features including atrophy and lipofuscin deposition in the retinal pigment epithelium (RPE). The causative ABCA4 gene encodes a protein uniquely expressed in the cone and rod outer segments. The pathologic steps by which mutations in ABCA4 lead to the clinically detectable RPE changes remain unclear. We investigated whether photoreceptor changes precede RPE loss in SD using adaptive optics scanning laser ophthalmoscopy (AOSLO). Methods: Two brothers with SD, aged 8 and 17 years, underwent a comprehensive eye examination and conventional imaging including fundus photography and optical coherence tomography (OCT). Genetic testing was performed using a combination of allele-specific testing and sequencing of the ABCA4 gene. AOSLO images were obtained at the central fovea and along the inferior and temporal meridians to generate 10x1.5 degree montages. The center of the foveal avascular zone was used as the foveal center. Cones were counted using custom semi-automated cone marking software. Peripheral cones and rods were counted at 100 µm intervals in 100x100 µm and 50x50 µm windows respectively. At the foveal center, cones were counted in a 50x50 µm window. Results: Genetic testing showed the presence of three likely diseasecausing mutations: Gly863Ala, Gly1961Glu, and Arg2030Stop. The older brother had visual acuity 20/150 with a central scotoma and macular RPE atrophy with no peripheral flecks. His brother had visual acuity 20/30 with subtle RPE stippling in the macula. In both brothers, OCT confirmed central retinal thinning. AOSLO revealed that rod density was decreased to ~30% of normal in the peripheral macula; these areas appeared normal by ophthalmoscopy and OCT. Cones in the peripheral macula showed a dark, low reflective appearance with density 30% of normal. No cones were detectable in the foveal center of the older brother. In the younger brother, foveal cones were enlarged with low density. Conclusions: This study provides the first in vivo images of both rods and cones in SD. Although the primary clinical features of SD are changes in the RPE, AOSLO reveals decreased density of both cones and rods in areas that appear normal by conventional imaging methods. These findings suggest that loss of cone and rod photoreceptors precedes clinically detectable RPE disease in SD. Commercial Relationships: Hongxin Song, Canon (F); Angela Pugliese, None; Ethan A. Rossi, Canon Inc. (F); Lisa R. Latchney, None; Edwin M. Stone, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Jennifer J. Hunter, Polgenix, Inc. (F); Mina M. Chung, Canon (F) Support: NEI EY021786, EY014375, EY001319, Edward N. & Della L. Thome Memorial Foundation to Mina Chung, Research to Prevent Blindness Unrestricted/Challenge Grant, Burroughs Wellcome Fund to Alfredo Dubra-Suarez Program Number: 1744 Presentation Time: 12:00 PM - 12:15 PM Cone structure imaged with Adaptive Optics Scanning Laser Ophthalmoscopy in eyes with Non-Neovascular Age-related Macular Degeneration Shiri Zayit-Soudry1, Reema Syed1, Kavitha Ratnam1, Moreno Menghini1, Austin Roorda2, Jacque L. Duncan1. 1 Ophthalmology/Retina Division, University of California, San Francisco, San Francisco, CA; 2School of Optometry, University of California, Berkeley, Berkeley, CA. Purpose: To evaluate cone structure using Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) in eyes with non-neovascular age related macular degeneration (AMD), and to correlate progression of AOSLO-derived cone measures with standard measures of macular structure. High resolution imaging of cone photoreceptor morphology and quantitative measures of cone structure may enhance understanding of the pathophysiology of vision loss in AMD and provide a sensitive biomarker for disease progression. Methods: AOSLO macular images were obtained over 12 to 21 months from 7 patients with non-neovascular AMD including 4 eyes with geographic atrophy (GA) and 6 eyes with drusen. AOSLO images were precisely superimposed onto color, infrared and autofluorescence fundus photographs and spectral domain optical coherence tomography (SD-OCT) images to allow direct correlation of cone parameters with macular structure. Cone spacing was measured for each visit in selected regions including areas over drusen (n=29), at the margin of GA (n=14), and regions without evidence of drusen or GA on fundus photos or SD-OCT (n=13) and compared to normal, age-related values. Results: AOSLO imaging revealed intact cones up to the GA edge and overlying drusen, although subtle mosaic irregularity and reduced reflectivity often resulted in a dark signal surrounding GA margins and drusen. At baseline, cone spacing measures were normal at all study locations but 2 GA margin locations and 4 drusen locations. Although progression of GA was observed in most study eyes with standard clinical measures, AOSLO longitudinal tracking showed mild increases in cone spacing in 3 drusen locations, but stable cone spacing measures in all other drusen and GA margin locations. Conclusions: AOSLO provides adequate resolution for quantitative measurement of cone structure at the margin of GA and over drusen in eyes with non-neovascular AMD, providing insight into the pathophysiology of GA progression. Despite reflectivity changes noted over drusen and at GA margins, cone spacing was often preserved at these locations and remained stable over time, suggesting changes in cone spacing may not represent a primary structural change in AMD progression. Commercial Relationships: Shiri Zayit-Soudry, None; Reema Syed, None; Kavitha Ratnam, None; Moreno Menghini, None; Austin Roorda, US Patent #6890076 (P), US Patent #7118216 (P), UC Berkeley (P); Jacque L. Duncan, None Support: NIH EY014375, Novartis Institutes for Biomedical Research, NEI Core grant EY002162, American Health Assistance Foundation (AHAF) Macular Degeneration Research Grant (MDR), Foundation Fighting Blindness, Research To Prevent Blindness, That Man May See Program Number: 1745 Presentation Time: 12:15 PM - 12:30 PM Adaptive Optics Imaging of Photoreceptors following Repair of Rhegmatogenous Retinal Detachments Meenakashi Gupta1, Michael Dubow1, 2, Alexander Pinhas1, 2, Nishit Shah1, Patricia Garcia1, Gennady Landa1, Yusufu N. Sulai3, Alfredo Dubra4, Richard B. Rosen1. 1New York Eye and Ear Infirmary, New York, NY; 2Mount Sinai School of Medicine, Mount Sinai Hospital, ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics New York, NY; 3University of Rochester, Rochester, NY; 4Medical College of Wisconsin, Madison, WI. Purpose: Patients with macula-off rhegmatogenous retinal detachments can have poor visual recovery or metamorphopsia despite successful retinal reattachment. Subtle changes in the foveal structure, causing such visual disturbances, can be difficult to identify with standard examination and imaging tools. Adaptive Optics (AO) allows in vivo imaging of individual photoreceptors. Using an AO scanning laser ophthalmoscope, we evaluated the foveal photoreceptor appearance following repair of macula-off retinal detachments. AO images were compared with infrared and OCT imaging. Visual acuity and microperimetry were obtained for functional correlation. Methods: Three patients who had previously undergone anatomically successful repair of rhegmatogenous macula-off retinal detachments were evaluated with AO following reattachment surgery. AO videos were recorded using a 790 nm light source and 1 degree field of view. Motion contrast images from several videos were used to create montages yielding a 2.5 degree field of view centered around the foveal depression. Montages from the affected eye were compared with corresponding montages from the unaffected eye. Spectralis infrared imaging (870 nm), Spectralis OCT, visual acuity and OCT/SLO microperimetry (Opko/OTI) were also obtained. Results: In reattached retina, the appearance of mottling of the macula with infrared imaging (Fig 1A) and hyporeflectivity of the foveal IS/OS junction using OCT (Fig 1B) corresponded to patchy disruption of the foveal photoreceptor mosaic with AO imaging (Fig 1C). These findings were associated with reduced visual acuities and threshold sensitivities on microperimetry (Fig 2). Conclusions: AO imaging of repaired macula-off retinal detachments demonstrated disruptions of the photoreceptor mosaic in regions of abnormal fundus infrared signal, irregular IS/OS junction and reduced visual function. Further AO studies will help us better understand microstructural and pathophysiological changes following retinal detachment repair. Figure 1: A) Infrared imaging of a 43-year-old woman 6 weeks following macula-off retinal detachment repair shows mottling of the macula. B) OCT of the fovea with hyporeflective regions in the IS/OS junction (Red). C) AO of foveal photoreceptors showing dark patches interrupting the photoreceptor mosaic. Figure 2: Microperimetry corresponding to Figure 1 showing depressed sensitivity within the macula. Commercial Relationships: Meenakashi Gupta, None; Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Patricia Garcia, None; Gennady Landa, None; Yusufu N. Sulai, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C) Support: Marrus Family Foundation, Bendheim-Lowenstein Family Foundation, Wise Family Foundation, Chairman's Research Fund of the New York Eye and Ear Infirmary Program Number: 1746 Presentation Time: 12:30 PM - 12:45 PM Changes in Cone Reflectivity and Regularity Assessed by Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) Correlate with Presence of Diabetic Retinopathy Jan Lammer1, 2, Amel Ahmed5, Sonja G. Prager1, 2, Michael C. Cheney1, Stephen A. Burns4, Paolo S. Silva1, 3, Lloyd P. Aiello1, 3, Jennifer K. Sun1, 3. 1Beetham Eye Institute, Joslin Diabetes Center, Boston, MA; 2Department of Opthalmology and Optometry, Medical University of Vienna, Vienna, Austria; 3Department of Ophthalmology, Harvard Medical School, Boston, MA; 4School of Optometry, Indiana University, Bloomington, IN; 5Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt. Purpose: To utilize high resolution AOSLO to evaluate differences in cone density, reflectivity and regularity in eyes with and without diabetes (DM) and across a range of diabetic retinopathy (DR) severity. Methods: Cone mosaics at the fovea and 4 macular quadrants (1x1.2° area, mean+SD eccentricity = 4.2±0.4°) were imaged using AOSLO (2.5µm resolution). Contrast of aligned and averaged images was automatically standardized based on the 8-bit histogram. Cone counting was performed semi-automatically using ImageJ and manual correction by 2 independent graders masked to clinical data. Count differences >20% were adjudicated. Parameters including density, nearest neighbor (NN) and Voronoi tile measurements were calculated as well as mean reflectivity of each Voronoi tile. Results: Forty eyes of 40 subjects were assessed. For subjects, mean±SD age was 44±12yrs, 57% (N=12) were male, 78% (31) had DM, DM duration was 22±14yrs and 32% (10) had no DR, 19% (6) mild nonproliferative DR (NPDR), 29% (9) moderate NPDR, 10% ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (3) severe NPDR and 10% (3) PDR. No consistent relationship for DM or DR was seen with absolute cone density, NN measurements, or reflectivity. However, the reflectivity regularity index (RI) (Voronoi tile reflectivity mean/SD) decreased in all 5 macular regions with increasing DR severity and this decrease was statistically significant in the inferior regions of the macula (No DR: 4.6±0.9, mild NPDR: 4.5±0.8, moderate NPDR: 4.5±0.7, severe NPDR: 4.2±0.9, PDR: 3.8±0.9, p<0.05). A significantly lower NN RI (NN mean/SD) was seen in macular quadrants in eyes with DM as compared with no DM (4.7±1.0 vs. 5.4±1.5, p<0.04). Increasing age correlated with a decrease in mean cone density (<35y: 11,567±2,848, 35-50y: 10,933±2,403, 50+y: 10,023±2,219 cones/mm2, p<0.05) as well as an increase in reflectivity RI (4.1±0.9, 4.3±0.8, 4.8±0.8, respectively, p=0.002) in all regions. Conclusions: Although absolute cone density does not appear to change substantially in diabetes, decreases in regularity of cone spacing and reflectivity regularity are associated with presence of DM and increasing DR severity, respectively. If future studies demonstrate that these properties correlate with functional or metabolic alterations of the retinal photoreceptors, these assessments may provide novel predictors of visual or anatomic outcomes in the diabetic eye. Commercial Relationships: Jan Lammer, None; Amel Ahmed, None; Sonja G. Prager, None; Michael C. Cheney, None; Stephen A. Burns, None; Paolo S. Silva, Optos plc (F); Lloyd P. Aiello, Genentech (C), Genzyme (C), Thrombogenetics (C), Ophthotech (C), Kalvista (C), Pfizer (C), Proteostasis (C), Abbott (C), Vantia (C), Optos, plc (F); Jennifer K. Sun, Boston Micromachines (F), Abbott Laboratories (C), Novartis (C), Genentech (F) Support: Eleanor Chesterman Beatson Childcare Ambassador Program Foundation Grant, JDRF 17-2011-359, NIDDK 5 P30 DK036836-24 P&F Grant, Massachusetts Lions Eye Research Fund 281 Low Vision: Central Vision Loss Monday, May 06, 2013 2:45 PM-4:30 PM TCC LL 4/5 Paper Session Program #/Board # Range: 2182-2188 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 2182 Presentation Time: 2:45 PM - 3:00 PM Optical attachment for binocular imaging with the Scanning Laser Ophthalmoscope (SLO) George T. Timberlake1, Warren Ward2. 1Research, Kansas City VA Medical Center, Kansas City, MO; 2Ward Electro-Optics, Inc., Gallatin, MO. Purpose: Our objective was to develop a binocular optical system that attaches to the SLO for imaging the retinas of both eyes. Such a system may help answer questions as to how (or if) individuals with bilateral macular scotomas use Preferred Retinal Loci (PRLs) in both eyes when viewing an object. Methods: We designed and constructed an electro-optical system that alternately images the left and right retinas at 15 Hz. A linear motor moves two small, offset orthogonal mirrors up and down, reflecting the SLO light path left or right. The optical system is adjusted in position so that the focal point of the converging laserbeam scan from the SLO is imaged at the intersection of the two moving orthogonal mirrors. Additional mirrors reflect the left and right beams toward the subject. Relay lens pairs mounted in rotating eyepieces allow for inter-pupillary distance adjustment. Electronic circuits synchronize the mirror movement with the SLO 30 Hz video output. The retina is imaged in infrared (780 nm) and visual stimuli are presented in the SLO’s HeNe (632 nm) laser-beam raster. Video output can be recorded continuously and later separated into left and right eye frames using standard software, or left and right retinas can be presented on separate monitors. Results: Initial tests with model eyes produced alternating video images of the model eye “retinas” at 15 Hz. Analysis of recorded SLO video showed the “retina” of each model eye imaged on every other 30 Hz video frame. Retinas of two visually-normal subjects were imaged in the same way. When following a moving disk in the SLO raster, the image of the disk was placed on the fovea of both eyes. The present binocular system has some loss of field due to optical constraints. In addition, magnification is somewhat greater than the SLO alone. The 15 Hz alternating rate produces noticeable flicker for the observer, but it does not seriously interfere with binocular viewing and tracking. Conclusions: Presently, only eye-tracking techniques are available for investigating how both eyes are used together by those with macular scotomas. Such techniques cannot determine what retinal area(s) are used to inspect visual stimuli. We believe that the binocular SLO attachment will be useful for investigating how individuals with bilateral macular scotomas use PRLs in both eyes to look at objects. Commercial Relationships: George T. Timberlake, None; Warren Ward, None Support: Department of Veterans Affairs Rehabilitation Research and Development Service Grant C1000R Program Number: 2183 Presentation Time: 3:00 PM - 3:15 PM Does the location of the PRL correspond to the retinal location with the best acuity? Susana T. Chung, Jean-Baptiste Bernard. School of Optometry, University of California, Berkeley, CA. Purpose: Following the onset of central vision loss, most patients develop a retinal location outside the central scotoma, the preferred retinal locus (PRL), as the new reference for visual tasks. Little is known as to how the PRL locations are selected. In this study, we tested the hypothesis that the selection of the location for a PRL is based on optimizing visual acuity, which predicts that acuity is the best at the PRL, compared with other retinal locations. Methods: Using a Rodenstock scanning laser ophthalmoscope (SLO) as a gaze-contingent display, we first mapped out the absolute scotoma for four observers with long-standing central vision loss (age: 56-84, logMAR acuity: 0.52-1.04). We then measured acuity using a 4-orientation Tumbling-E task presented using the SLO at the PRL and at multiple locations around the scotoma. These locations were positioned along 12 meridians (2-3 positions per meridian) originating from the anatomical fovea (30° apart), straddling 1-5° from the edge of the scotoma. The order of testing these 24-36 locations was random. A staircase procedure was used to track the letter size threshold that corresponded to 71% correct. The thresholds averaged across three staircases represented the acuity at each testing location. Results: Across observers, the acuity at the PRL was never the best among all testing locations. Instead, acuities were better (up to 47%) at 10-46% of the testing locations than at the PRL. These locations with better acuities did not cluster around the PRL, and did not necessarily lie at the same distance from the fovea or the edge of the scotoma as the PRL. Except for the only observer who had foveal sparing, acuities did not correlate with the eccentricities of the testing locations. However, when acuities at different eccentricities along the same meridian were averaged, the meridian with the best averaged acuity was consistent with the meridian on which the PRL was ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics located. Conclusions: The worse acuity found at the PRL than at other locations around the scotoma implies that the selection of the PRL location was unlikely to be based on optimizing acuity. Although our measurements were made years after the development of the PRL, perceptual learning suggests that with continuous usage, acuity at the PRL should only get better and not worse, further affirming that the initial selection of the PRL location was not based on optimizing acuity at a specific location. Commercial Relationships: Susana T. Chung, None; JeanBaptiste Bernard, None Support: NIH Grant R01-EY012810 Program Number: 2184 Presentation Time: 3:15 PM - 3:30 PM Retinal Fixation Locus in Patients with Bilateral Central Scotomas: Letter Targets are Better Suited for Visual Testing than Targets that Fill in Joshua Pratt, Harold E. Bedell, Joy M. Ohara, Stanley Woo. University of Houston College of Optometry, Houston, TX. Purpose: Training eccentric viewing has been widely implemented as a regular part of low vision services for patients with central scotomas. In this experiment we investigated whether target type affects the retinal fixation location and stability, and specifically whether targets expected to perceptually fill in are imaged at the vestigial fovea. If targets expected to fill in are imaged at or near the vestigial fovea, then fixation on these targets would allow the projected location of the vestigial fovea and the pathological scotoma to be located accurately in visual space during eccentric viewing training, even without the use of a fundus imaging device. Methods: The retinal location and stability of fixation were measured using the Nidek MP-1 microperimter in twelve patients with bilateral central scotomas for six types of fixation target, three expected to fill in and three that included letters. The approximate position of the vestigial fovea was delineated either by using residual retinal landmarks or by locating the residual foveal pit in a dense macular scan, obtained with a Spectralis Optical Coherence Tomographer. Fixation location and stability were compared for the different target types and referenced to the position of the vestigial fovea. Results: All of the subjects except one fixated consistently on targets that included a letter using peripheral retinal locations outside of the central scotoma. Eleven of the twelve subjects used a retinal location closer to the vestigial fovea to fixate targets expected to fill in, compared to letters. Although four of the subjects imaged the fill-in targets at or within a half degree of the vestigial fovea, six other subjects imaged the fill-in targets at a retinal locus removed from the vestigial fovea. Target type produced no overall significant difference in fixation stability, specified in terms of bivariate contour ellipse area. However, in some individual subjects fixation tended to be more stable on letter targets than on fill-in targets. Conclusions: In patients with central field loss, letter targets generate more consistent fixation behavior than fill-in targets and should be used for eccentric viewing training and perimetry. Commercial Relationships: Joshua Pratt, None; Harold E. Bedell, None; Joy M. Ohara, None; Stanley Woo, None Support: NIH Core Grant P30 EY 07551, Beta Sigma Kappa Student Research Grant Program Number: 2185 Presentation Time: 3:30 PM - 3:45 PM Qualitative and Quantitative Assessment of Metamorphopsia in Retinopathy Patients Emily K. Wiecek1, 2, Kameran Lashkari2, 3, Steven C. Dakin1, 4, Peter Bex2, 3. 1Institute of Ophthalmology, University College London, London, United Kingdom; 2Opthalmology, Harvard Medical, Boston, MA; 3Opthalmology, Massachusetts Eye and Ear, Boston, MA; 4 NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, United Kingdom. Purpose: Metamorphopsia (perceived distortion of visual space) is commonly experienced by patients with retinal pathology. Although this distortion is typically measured with Amsler charts, more objective and quantitative assessments are desirable for effective monitoring of the presence, progression, and remediation of visual impairment. We compare qualitative assessments with novel quantitative methods across a range of retinal pathologies. Methods: An eleven-item questionnaire assessed metamorphopsia symptoms in 80 patients with monocular distortion from maculopathy. All patients completed an Amsler assessment (presented on a computer screen with fixation compliance monitored by an eye tracker), and 35 patients additionally completed two novel objective measures of metamorphopsia in the central five degrees of visual field. One task required participants to arrange dots in a square (combining spatial bisection and Vernier hyperacuities), and the other used spatial alignment of dichoptically-presented targets. A dichoptic task was also used as a binary measure of inter-ocular suppression. Results: Monocular distortions were suppressed by undistorted vision in the better eye in 45% of patients. Questionnaire scores from non-suppressing patients positively correlated with distortion measures; however there was no relationship between subjective and quantitative assessments for patients who experienced suppression (p =.03). There was significant negative correlation in the overall vertical direction of distortion between the two novel quantitative distortion assessments (p = .05), as well as a positive correlation between the directional displacement measured in the dichoptic task and the gaze-contingent Amsler grid quantification (p = .01). There were no significant correlations between localized measures of visual distortion across all three measures. Conclusions: The onset and progression of visual impairment may be underreported in maculopathy due to the suppression of distorted visual input from the more impaired eye. It is critical to assess metamorphopsia monocularly, and we have introduced novel metrics to quantify such visual distortion in central vision. Commercial Relationships: Emily K. Wiecek, None; Kameran Lashkari, Circadian Technologies (F), Regeneron (R); Steven C. Dakin, None; Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: R01EY019281, SCD is supported by NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital Program Number: 2186 Presentation Time: 3:45 PM - 4:00 PM The effects of central and peripheral visual losses on reaching and grasping Aachal Kotecha1, 2, Rachel T. Fahy2, Gary S. Rubin2, 1. 1NIHR BRC for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, United Kingdom; 2Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom. Purpose: This study aims to evaluate the relative contributions of central and peripheral vision to prehension in visually impaired adults. Methods: Reaching and grasping was quantified using motion detection cameras (ProReflex, Qualisys AB, Sweden). Subjects reached and grasped one of two cylindrical objects placed at 20cm or 40cm from the hand. Measures were repeated 8 times under each test condition and the median used in subsequent analysis. Indices of ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics prehension planning [movement onset (MO ms); peak speed (V mm/s), time to peak speed (ttV ms)], execution [movement duration (MD ms); path deviation ratio (PD)] grasping [peak grip aperture (PGA, angle), grip application time (GAT, ms)] and control [deceleration time (DT ms)] were quantified. Analyses were performed using repeated measures ANOVA. Results: The results of 9 control (C), 11 age related macular degeneration (AMD) and 12 glaucoma (G) patients during binocular viewing are presented. There were significant group differences in movement planning [MO: p < 0.01, V: p = 0.03, ttV: p < 0.01] and grasping [GAT:p < 0.01] with aspects of execution and online control approaching significance [MD: p = 0.06; PD, p = 0.1]. AMD and G patients had longer MO ('far,large' condition mean [standard error]: C = 274 [46] ms; G = 378 [87] ms; AMD = 439 [104] ms), ttV (C = 594 [79] ms; G = 719 [103] ms; AMD = 766 [100] ms) and GAT (C = 411 [74] ms; G = 544 [126] ms; AMD = 644 [163] ms); however AMD reaching speed V was slower, suggesting a deficiency in some aspects of movement planning (C = 1032 [122] mm/s; G = 918 [150] mm/s; AMD = 854 [94] mm/s). In contrast, glaucoma patients displayed longer DT (C = 510 [109] ms; G = 552 [79] ms; AMD = 528 [74] ms) , MD (C = 935 [113] ms; G = 1078 [192] ms; AMD = 1060 [156] ms) and higher PD (C = 1.14 [0.04]; G = 1.16 [0.05]; AMD = 1.12 [0.04]) suggesting difficulties with online control. Conclusions: This preliminary analysis suggests that whilst glaucoma and AMD patients have deficits in reach to grasp movements compared with controls, they display distinct differences in movement planning and online control. Further work will explore how these relate to their specific visual deficiency. Commercial Relationships: Aachal Kotecha, None; Rachel T. Fahy, None; Gary S. Rubin, None Support: Special Trustees of Moorfields Eye Hospital Program Number: 2187 Presentation Time: 4:00 PM - 4:15 PM Effect of central vision loss on mutual gaze perception Alexandra R. Bowers1, Sarah S. Sheldon1, Jessilin Quint2, Heiko Hecht3. 1Schepens Eye Res Inst, Mass Eye and Ear, Ophthalmology, Harvard Med School, Boston, MA; 2Indiana University School of Optometry, Bloomington, IN; 3Psychologisches Institut, Johannes Gutenberg-Universitat, Mainz, Germany. Purpose: The ability to perceive mutual gaze (knowing whether somebody else is looking at you) is an important nonverbal visual cue that directs conversations and social interactions. Individuals with central vision loss (CVL) have limited access to such cues, which may cause difficulties in social situations. We evaluated perceived difficulties with gaze perception and examined the relationship with functional abilities quantified using a performance-based measure. Methods: 18 persons with CVL (visual acuity 20/60 to 20/250) and 18 age-similar controls completed a battery of vision tests, a short questionnaire rating perceived difficulties with gaze perception, face recognition and social interactions, and a gaze perception task. They adjusted the positions of the eyes of a life-size virtual head on a monitor at a 1-m distance until the eyes appeared either to be looking straight at them or were at the extreme lateral left or right position at which they still appeared to be looking toward them. For each trial (n = 48), the angular deviation of the final position of the virtual eyes from the straight ahead gaze position was computed. The gaze cone width was the difference between the extreme left and right positions. Results: CVL participants reported moderate difficulty with knowing when somebody was looking at them; moderate difficulty with seeing how other people reacted in social situations; and a variety of coping strategies. Controls reported no difficulties. The median gaze cone widths were not significantly different for the two groups (CVL 11.5°, controls 13.2°; p = 0.9) neither were the mean judgments of the straight ahead gaze direction (CVL 0.1 ± 0.9°, controls 0.2 ± 1.7°; p = 0.82). However, CVL participants had significantly more variability in their judgments (6.9 ± 2.4° and 4.6 ± 1.8°; p < 0.01). Greater judgment variability correlated with higher levels of perceived difficulties (r = 0.78, p < 0.001) but not with visual acuity (r = 0.44, p = 0.07) or contrast sensitivity (r = -0.37, p = 0.13). Conclusions: CVL increased the variability of mutual gaze judgments suggesting that CVL participants had more difficulty with the task than controls; however, the average estimate of gaze direction was similar in the two groups. While traditional vision measures did not predict the extent to which CVL affected the more complex gaze judgment task, perceived difficulties were predictive of increased judgment variability. Commercial Relationships: Alexandra R. Bowers, None; Sarah S. Sheldon, None; Jessilin Quint, None; Heiko Hecht, None Support: NIH grant T35EY007149 Program Number: 2188 Presentation Time: 4:15 PM - 4:30 PM Association of Self-Reported Task Difficulty with Binocular Central Scotoma Locations Nicole C. Ross, Judith E. Goldstein, Robert W. Massof. Ophthalmology, Johns Hopkins Univeristy, School of Medicine, Baltimore, MD. Purpose: To determine if the location of binocular central scotomas relative to fixation, predicts the difficulty that low vision patients are likely to have with driving, reading, and mobility tasks. Methods: This study was conducted in accordance with the tenets of the Declaration of Helsinki and Johns Hopkins Institutional Review Board. Perimetry: Central scotomas were mapped with a video haploscope tangent screen in 284 patients. The haploscope consisted of 2 flat panel displays, one per eye, imaged at infinity through 9mm diameter exit pupils centered on the patient’s pupils. The patient’s refractive error corrections were incorporated into the optical paths. Infrared video cameras where used to monitor ocular alignment and fixation stability. The patient fused the two 50o h x 40o v displays and the fixation cross was imaged at the center of both displays, thereby providing binocular fixation, while test stimuli were presented monocularly at 43 locations in a 25o square grid around fixation. Self Reported Difficulty Ratings: Patients rated difficulty of a subset of 120 reading, 50 mobility and 22 driving tasks in the Activity Inventory on a five point scale. Rasch analysis was used to estimate self-perceived ability for driving, reading and mobility for each patient. Analysis: Unpaired, two tailed t-tests were performed on distributions of each ability measure for each test location in the central field comparing patients who detected the stimulus to those who did not. Results: Driving: Scotomas below and to the lower right of fixation and a single point 10o above and to the right of fixation were associated with significant decreases in self-perceived driving ability. Reading: Scotomas from 7.5o left of fixation to 12.5o right of fixation and scotomas below and to the lower right of fixation were associated with significant decreases in self-perceived reading ability. Mobility: Scotomas below and to the upper right of fixation were most strongly associated with decreases in self-perceived mobility function. Conclusions: Driving difficulty is associated with scotomas that fall on the instrument panel and rear view mirror when gazing straight ahead. Reading difficulty is associated with scotomas that could ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics interfere with text preview and navigating to the next line. Mobility difficulty is associated with scotomas that could interfere with identifying information below the line of sight. Commercial Relationships: Nicole C. Ross, None; Judith E. Goldstein, None; Robert W. Massof, None Support: NEI grant EY012045 and MD 22 Lions Vision Research Foundation Postdoctoral Fellowship 288 Refractive Errors, Myopia I Monday, May 06, 2013 2:45 PM-4:30 PM Exhibit Hall Poster Session Program #/Board # Range: 2327-2343/B0286-B0302 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 2327 Poster Board Number: B0286 Presentation Time: 2:45 PM - 4:30 PM Daily interruptions to hyperopic defocus can reduce induced eye growth in marmosets Alexandra Benavente-Perez, Ann Nour, Luying Yan, Keisha Roden, Kathleen Abarr, David Troilo. Biological Sciences, SUNY College of Optometry, New York, NY. Purpose: To assess the effect that short daily interruptions to imposed hyperopic defocus have on the eye growth of marmosets, and to measure the effective refractive state during the interruption period. Methods: A total of 20 marmosets were treated with -5D contact lenses on their right eyes for 12 weeks from the age of 10 weeks of age (left eyes wore plano controls). On-axis vitreous chamber depth (VC) was measured after four (T4), eight (T8) and twelve weeks of treatment (T12). Fifteen marmosets wore contact lenses continuously for 9hrs/day and five had both contact lenses removed for 30mins twice/day (mid morning and mid afternoon) during the first four and last four weeks of treatment. Vision during the interruptions was controlled by placing the marmoset in a primate chair at the center of a 1m radius cylinder with videos of animal scenes projected on the wall. Noncyloplegic Rx was measured at 5min intervals using an infrared video photorefractor (Power Refractor, MultiChannel System) while the marmosets were in the chair. Untreated marmosets (N=25) were used as controls. Results: At T4 the interocular difference in ocular growth rates in the interrupted lens-reared group was smaller than in the continuous lens reared group (mean±SE exp-con: -0.3±1.3 vs +3.6±1.0 µm/day, p<0.05) and similar to the untreated group (-0.2±0.4 µm/day, p=0.97). At T8, after both treatment groups worn -5D contact lenses continuously for 4weeks, their growth rates were the same (+2.8±0.7 vs +1.8±1.2 µm/day, p=0.47). At T12, after the second period of lens interruption, the growth rate in the interrupted lens-reared group was again smaller than in the continuous lens reared group growth, but did not reach significance (-0.07±0.8 vs +0.85±1.5 µm/day, p>0.05). While inside the cylinder, the marmosets experienced an overall relative myopic defocus of -2.07±0.63D during T4 that increased to 4.08±1.63 D during T12. Conclusions: Daily brief interruptions to imposed hyperopic defocus prevent the increased rate of ocular growth triggered by -5D contact lenses in marmosets. The effects were stronger when the interruptions happened early during treatment than when the interruptions were applied to eyes that were already growing faster to compensate for imposed hyperopia. Commercial Relationships: Alexandra Benavente-Perez, None; Ann Nour, None; Luying Yan, None; Keisha Roden, None; Kathleen Abarr, None; David Troilo, None Support: NIH R01 EY11228 Program Number: 2328 Poster Board Number: B0287 Presentation Time: 2:45 PM - 4:30 PM Luminance and Color Changes with Defocus Provide Differential Cues For Emmetropization Molly Fellows1, Gagan Kaur2, Ashley Tang1, Frances J. Rucker1. 1 Biomedical Science & Disease, New England College of Optometry, Boston, MA; 2Southern California College of Optometry, Fullerton, CA. Purpose: Factors that interfere with lens compensation are considered to interfere with emmetropization. We examine the effects of color and luminance changes on lens compensation. Methods: Exp. 1: 5-7 day old chicks were exposed daily (9am-5pm) for three days, on consecutive weeks, to 2Hz sinusoidal, in-phase (LUM), modulated white light (619 nm + 515 nm + 460 nm; Mean 680 lux) or to counterphase-modulated red/green light (R/G). Chicks wore either a negative or a positive 7 D lens on alternate weeks. Exp. 2: 14 day old chicks were exposed daily (9am-5pm) for three days to 2Hz sinusoidal, in-phase, modulated white light (619 nm + 515 nm + 460 nm; Mean 850 lux) either with (+B) or without blue light (-B). Chicks wore either a negative or positive 7 D lens on one eye. Chicks wore no lenses in a control, no flicker condition. Chicks were kept in the dark overnight after exposures and otherwise in a brooder on a 12/12 hr light cycle between experiments. Relative changes in the ocular components were measured with ultrasound (Exp.1) or with Lenstar (Exp. 2) and with a Hartinger refractometer. Results: Exp. 1: LUM flicker, but not R/G flicker, interfered with positive lens compensation. There was a change in refraction in R/G (wk1: 4.93 ± 2.116 D; p=0.02) but not in LUM (wk1: 2.43 ± 2.68 D), despite a reduction in eye growth in all conditions (R/G: -196 ± 30 μm; LUM: - 139 ± 24 μm; p<0.006) with choroidal thickening in R/G but not in LUM (RG: 53 ± 18 μm; LUM: 14 ± 16 μm; p<0.01). LUM flicker and R/G flicker both interfered with negative lens compensation. There was no refractive (wk1: R/G: -1.76 ± 1.13 D; LUM: -1.64 D), eye growth (RG: 24 ± 48 μm; LUM: -4 ± 23 μm), or choroidal thickness change (-1 to -6 μm). Exp. 2: There was no refractive change with or without blue light to positive (+B: -0.47 ± 2.7 D: -B: 0.32 ± 3.03 D) or negative defocus (+B: -0.77 ± 2.4 D; -B: -1.65 ± 1.19 D), compared to steady light/no lens condition (+B: -0.25 D; -B: 0.51 D). However, with positive lenses there were changes in eye length (+B: -219 ± 36 μm; -B: -228 ± -28 μm; both p<0.001) and choroidal thickening (+B: 124 ± 14 μm; -B: 132 ± 20 μm;both p<0.001) compared to the steady light/no lens condition (+B: -50 µm; -B: -20 µm). Conclusions: Luminance cues are important for lens compensation with both signs of defocus, while color cues are only important with negative defocus. Commercial Relationships: Molly Fellows, None; Gagan Kaur, None; Ashley Tang, None; Frances J. Rucker, None Program Number: 2329 Poster Board Number: B0288 Presentation Time: 2:45 PM - 4:30 PM Myelinated Retinal Nerve Fibers associated Local Scleral Excavation and Induced Axial Myopia: Investigation using Spectral-domain Optical Coherence Tomography Baek-Lok Oh, Jeong-Min Hwang, Se Joon Woo. Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seognam, Republic of Korea. Purpose: To report findings of spectral domain optical coherent tomography (SD-OCT) of myelinated nerve fibers (MNF) and propose a mechanism for axial myopia associated with MNF. Methods: In this retrospective observational case series, 12 eyes from 12 patients (6 children and 6 adults) with MNF over 2 disc ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics diameters underwent a full ophthalmologic examination including SD-OCT. The distribution of MNF in the fundus photography was compared with the regional excavation of the scleral excavation in vertical or horizontal scan and circular scan centered on the optic disc of SD-OCT. Results: In all cases, SD-OCT visualized MNF as hyperreflective thickening of retinal nerve fibers and there were no morphologic abnormalities in the photoreceptor layers in the fovea. In eyes with temporally extended MNF, the tilting of Bruch’s membrane in vertical scans of SD-OCT was significantly associated with the major distribution of myelination (P < 0.001). The slope of Bruch’s membrane was much smaller in the adult group than in the child group (P = 0.008). The area of MNF in fundus photography and focal scleral excavation in the peripapillary circular SD-OCT scan images were significantly correlated (P <0.001). Conclusions: Localized scleral excavation inducing axial myopia was strongly associated with the distribution of MNF especially in children, which indicates MNF itself or confined retinal areas with visual deprivation by MNF may directly induce axial myopia via local trophic effects on the underlying sclera in early life. Fundus photography and reconstructed 3-dimensional images of spectral domain optical coherence tomography of fundus with myelinated nerve fibers. Sectioning planes are indicated with black lines. Examples of quantitative analysis of the association of the area of myelinated nerve fibers measured by fundus photography (A, F) and the depth of the internal limiting membrane or Bruch’s membrane near the optic disc (B, G; white arrows) measured in circular 3.4 mm- diameter scans centered on the optic disc of spectral domain optical coherence tomography along clock-hours. E, J. The correlation between the modified area of the myelinated nerve fibers (MNF length) and the depth of the internal limiting membrane or Bruch’s membrane (the scleral excavation) was statistically significant (P < 0.001). Commercial Relationships: Baek-Lok Oh, None; Jeong-Min Hwang, None; Se Joon Woo, None Support: A grant from the Korea Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant No. A111161). Program Number: 2330 Poster Board Number: B0289 Presentation Time: 2:45 PM - 4:30 PM Comparing the Historical and Contemporary Ocular Biometry of Emmetropes Jos J. Rozema1, 2, David A. Atchison3, Marie-José B. Tassignon1, 2. 1 Dept of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; 2Dept of Medicine and Healthy Science, University of Antwerp, Wilrijk, Belgium; 3School of Optometry & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia. Purpose: To compare the historical emmetropic ocular biometry data reported by Zeeman (Graefes Arch. Ophthal. 1911;78:93-128) and Sorsby (Spec Rep Ser Med Res Counc 1957: 293) with data from contemporary emmetropes published by Atchison et al. (J Vis. 2008;8:29, 1-20). Methods: Zeeman and Sorsby published the ocular biometry for Caucasian subjects using similar methods: retinoscopy for ocular refraction, Javal keratometry for the corneal radius of curvature, a slit lamp method for the anterior chamber depth and lens thickness, and phakometry for the lens radii of curvature. In order to make sure that the contemporary data are comparable with the historical data, it is important that compatible biometry methods are used. Hence Placido topography and ultrasound biometry were used (both of which have been validated against the historical methods in the literature), as well as autorefraction and phakometry. For all three datasets the axial length was derived using a method proposed by Sorsby. As this method does not take the aging of the crystalline lens into account, only subjects aged between 18 and 38 were considered. This left 25 emmetropes from Zeeman (refraction within ±1 D), 38 from Sorsby and 20 from Atchison et al. for analysis. Comparisons were done by ANOVA, a t test after Fisher r-to-z transformation to compare correlations, and Flury Hierarchy and random skewers to compare covariance matrices. Results: After Šidák correction to account for alpha inflation in case of multiple comparisons, the posterior lens radius was found to be significantly flatter for Atchison et al. (-6.88 ± 0.96 mm) than for Zeeman (-6.02 ± 0.53 mm; P = 0.001), and the anterior chamber depth was significantly shallower for Sorsby (3.55 ± 0.24 mm) than for Zeeman (3.76 ± 0.29 mm; P = 0.004). No significant differences were seen in the correlations between the parameters of the three datasets. For the covariance matrices, considerable and significant differences were seen between the Atchison et al. data on the one side and the Zeeman and Sorsby data on the other side. Conclusions: The average biometry and correlation between biometric parameters of emmetropic subjects has remained similar throughout the last hundred years. The significant differences between the studies for the biometry and the covariance matrices may reflect differences in methods or instrument calibration. Commercial Relationships: Jos J. Rozema, None; David A. Atchison, None; Marie-José B. Tassignon, None ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 2331 Poster Board Number: B0290 Presentation Time: 2:45 PM - 4:30 PM Effects of Eyeglass Correction on Oral Reading Fluency in Elementary and Middle School Children Irene Campus1, Mabel Crescioni1, Tina K. Green1, John D. Twelker1, 2 , Joseph M. Miller1, 2, Erin M. Harvey1, 2. 1Ophthalmology and Vision Science, University of Arizona, Tucson, AZ; 2College of Public Health, University of Arizona, Tucson, AZ. Purpose: To examine the influence of eyeglass correction on oral reading fluency. Methods: Eye examinations were conducted on students in grades 28 who failed a vision screening test. Exams included cycloplegic refraction and subjective refinement. Glasses were prescribed for children who met the following criteria: Astigmatism ≥ 1.00 D, Myopia ≥ 1.00 D on any meridian, or Hyperopia ≥ 2.50 D spherical equivalent (SE) in either eye, or anisometropia ≥ 1.50 D SE. Eyeglasses were dispensed at a second testing session several weeks after the exam for students meeting the criteria for eyeglass correction (N=21). DIBELS Oral Reading Fluency (ORF) (a standardized test of accuracy and fluency with connected text) was measured at the eyeglass dispensing session, and children were tested without correction (3 passages read). Several weeks later (average 6.31 weeks, SD 4.44), after students had adjusted to their eyeglasses, DIBELS ORF was repeated while children were wearing their best correction. Students in 7th and 8th grade completed DIBELS ORF for the 6th grade level, the highest grade level available. DIBELS ORF median raw score was determined for tests conducted while uncorrected and corrected, and scores were converted to percentiles Results: Most students were prescribed eyeglasses for astigmatism (18) and/or myopia (14), with one meeting the criteria for hyperopia. DIBELS ORF percentile scores increased significantly an average of 7.14 (SD 11.49, p < 0.02) with eyeglass correction. Amount of improvement was not significantly correlated with time between tests (duration of new eyeglass wear). Conclusions: Students who meet common criteria for eyeglass prescription show rapid improvement in reading fluency through eyeglass wear. Due to the short follow-up interval and the fact that improvement was not correlated with time from first to second test, it is likely that this effect is a result of improved visual clarity, as opposed to advances in reading skills resulting from instruction (learning). There may be additional long-term effects on reading as a result of improved visual clarity, but this study did not measure these effects. These results indicate the importance of vision screening in schools with follow-up to eye care professionals as needed. Commercial Relationships: Irene Campus, None; Mabel Crescioni, None; Tina K. Green, None; John D. Twelker, None; Joseph M. Miller, None; Erin M. Harvey, None Support: NIH/NEI 13153, Research to Prevent Blindness Program Number: 2332 Poster Board Number: B0291 Presentation Time: 2:45 PM - 4:30 PM Peripheral photoreceptor activity during accommodation and emmetropization Brian P. Schmidt1, Maureen Neitz2, Jay Neitz2. 1Graduate Program in Neurobiology and Behavior, University of Washington, Seattle, WA; 2 Ophthalmology, University of Washington, Seattle, WA. Purpose: Myopia results when the eye grows too long for its optics. The importance of the peripheral retina in emmetropization has recently been appreciated and our group has argued that the relative activity of cone photoreceptors contributes as well. However, there has not been a systematic analysis of how peripheral photoreceptor activity might be stimulated by natural images during near accommodation over the period of life which emmetropization occurs. The present work uses mathematical modeling to develop a theoretical framework of emmetropization based on the observation that the peripheral retina is often exposed to distant scenes when the fovea is accommodated to near objects. Methods: The OSLO ray tracing software (Lambda Research) was used to derive modulation transfer functions of a schematic eye (Escudero-Sanz & Navarro 1999 J. Opt. Soc. Am. A. 16:1881-91) for several eccentricities and accommodation states. The amplitude spectrum of calibrated natural images (Tkačik et al. 2011 PLoS One 6:e20409) were computed with a fast Fourier transform and fit with a 1 / f power law. The activity of photoreceptors was modeled as a difference of Gaussians. Finally, the transfer functions, amplitude spectrum and photoreceptor model were combined to obtain the response from the peripheral cone photoreceptor mosaic to the average natural scene. Results: Accommodation to near objects results in a significant loss of medium and high spatial frequencies for images of distant objects in the peripheral retina relative to the fovea reducing the relative activity of photoreceptors there. This loss of frequency content is partially ameliorated by accommodative lag that has been observed in young children but decreases during emmetropization. Conclusions: Considering the statistical environment and the optical transfer functions characteristic of common accommodation states we compute that the amount of information the peripheral retina receives about the visual environment during near accommodation to small centrally fixated targets changes systematically during emmetropization. This change may regulate the signals that control eye growth. The reason near work contributes to myopia may be because the spatial frequency content of the images produced in the periphery during such activity simulates the normal signals produced by natural scenes in peripheral retina of a young hyperopic eye. Commercial Relationships: Brian P. Schmidt, None; Maureen Neitz, Genzyme (F), Alcon (F), Alcon (P); Jay Neitz, Alcon (F), Alcon (P) Program Number: 2333 Poster Board Number: B0292 Presentation Time: 2:45 PM - 4:30 PM Relation between refractive astigmatism and change in spherical equivalent with age in a sample of Native American children age 3 to 18 years of age Erin M. Harvey1, 2, John D. Twelker1, 2, Joseph M. Miller1, 2. 1 Ophthalmology and Vision Science, University of Arizona, Tucson, AZ; 2College of Public Health, University of Arizona, Tucson, AZ. Purpose: To determine if presence of refractive astigmatism is associated with change in spherical equivalent (SE) refractive error in children age 3 to 18 years of age. Methods: Subjects were participants one or more NIH/NEI funded studies of visual development in Tohono O’odham children (“Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error” (CLEERE, Tucson Site), “Astigmatism and Amblyopia Among Native American Children”, “Amblyopia in Astigmatic Children: Development and Treatment”). Previous research has documented a high prevalence of with-the-rule astigmatism in this population. A baseline exam was conducted and follow-up exams were attempted at least yearly for each study. Data was combined across studies. Cycloplegic autorefraction (Retinomax Autorefractor (KPlus or KPlus2, Nikon Inc., Tokyo Japan)) was conducted at each study exam. Subject exams that met the following criteria were included in analyses: age 3 to < 19 years, right eye autorefraction confidence ≥ 8. Only subjects with at least two study exams and a minimum interval of 1 year between first and last exam were included in analyses. Analyses included only right eye data, and only data from each child’s baseline and final study exams. Linear ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics regression analysis was conducted to determine the relation between baseline refractive astigmatism and change per year in SE refractive error with age (change is SE/fu interval). The following variables were also included: sex, baseline age, follow-up interval, baseline SE. Results: For the 2,043 subjects who met inclusion criteria, mean age was 6.13 years (SD 2.90) at baseline and 10.70 years (SD 3.56) at follow-up, with a mean follow-up interval of 4.57 years (SD 3.28). SE tended to shift towards less hyperopia/more myopia with age in most children (Table 1). On average, there was a shift towards less hyperopia/more myopia of 0.16 D/year (Table 2). Neither of these trends varied significantly with amount of baseline astigmatism. Regression analysis yielded significant effects of age, sex, length of follow-up interval, and baseline SE on change per year in SE, but no significant effect of baseline astigmatism magnitude. Conclusions: The results of the present study indicate that highly astigmatic children in this population are not at increased risk for development or progression of myopia. Sensor, the Pediatric Wavefront Evaluator (PeWE). Children ranged in age from 6 mos to 9 yrs. Images were recorded while children watched a cartoon at 50 cm (near, n) and 2 m (distant, d) viewing distance. At least 7 focused and centered images were obtained at both fixation distances, with undilated pupil diameters ranging from 3 to 5 mm. Zernike decomposition to 4th order was performed. Lower order aberrations were converted to m, j0 and j45. Signed Zernike terms Z(3,1) (y coma, yc), Z(3,-1) (x coma, xc) and Z(4, 0) (spherical aberration, sa) were derived for the observed mm pupil diameter (mmpd). Three different pupil scaling methods were used: (1) all terms were scaled down to 3mmpd, (2) those greater than 4 mmpd scaled down to 4 mmpd (data with pupil < 4 mm excluded), and (3) all were scaled up to 5 mmpd. Within each subject, at least 3 observations were required at 4mmpd to be averaged, while 7 were always averaged at 5 mmpd and 3 mmpd. Paired sample (d and n) ttests on the signed coefficients (micron) were compared at 3, 4, and 5 mmpd. Results: As expected, accommodation produced a change in m from n to d of -1.33 to -0.25D (p=0.000). A small (<0.1mm) but significant decrease in d to n pd was also observed (p=0.000). J0 and J45 had small but significant differences d to n (<0.1D, p=0.000. Coma (xc and yc) did not change with accommodation (p>0.20). Spherical Aberration became increasingly negative with accommodative effort (p<0.05). Table summarizes d and n yc, xc and sa at 3 (n=545) , 4 (n=233), and 5 (n=545) mmpd. Conclusions: In this population of Native American children, the observed coma did not change with accommodation, suggesting a non-lenticular or corneal origin. The increased negative spherical aberration with accommodation enhances near vision, and suggests a lenticular origin. Future work will compare these refractive aberrations to corneal aberrations measured with surface topography. Commercial Relationships: Joseph M. Miller, None; Erin M. Harvey, None; Jim Schwiegerling, Alcon Research (F), Wavetec (F), Visioneering (C) Support: NIH/NEI 13153(EMH); RBP (JMM) Commercial Relationships: Erin M. Harvey, None; John D. Twelker, None; Joseph M. Miller, None Support: NIH Grant EY13153, NIH/NEI EY08893, and Research to Prevent Blindness Program Number: 2334 Poster Board Number: B0293 Presentation Time: 2:45 PM - 4:30 PM Change in coma and spherical aberration with accommodation in Native American children of a tribe having elevated levels of Corneal Astigmatism Joseph M. Miller1, 2, Erin M. Harvey1, Jim Schwiegerling2, 1. 1Ophthal & Vision Science, University of Arizona, Tucson, AZ; 2College of Optical Sciences, University of Arizona, Tucson, AZ. Purpose: Children from some Native American tribes are known to have elevated levels of corneal astigmatism. We report accommodation-induced changes in higher order refractive aberrations (coma and spherical aberration) among children of one such tribe, whose children participated in the tribally sponsored Tohono O’odham Vision Screening Program (TOVSP). Methods: Children were imaged with a hand-held Shack-Hartmann Program Number: 2335 Poster Board Number: B0294 Presentation Time: 2:45 PM - 4:30 PM Monochromatic Aberrations, Vision and Refractive Error in Healthy Young Adults David A. Mackey1, Seyhan Yazar1, Alex W. Hewitt1, Hannah Forward1, Charlotte M. McKnight1, Alexander X. Tan1, Jenny A. Mountain2. 1Centre for Ophthalmology and Visual Science, University of Western Australia, Lions Eye Institute, Perth, WA, Australia; 2Centre for Child Health Research, University of Western Australia, Telethon Institute for Child Health Research, Perth, WA, Australia. Purpose: Understanding of monochromatic aberrations and their associations with visual acuity and refractive error in a normal population is crucial for applying customized intraocular lenses and laser refractive surgery. In this study, we established the distribution of monochromatic aberrations from a large cohort of healthy young adults and investigated association of monochromatic aberrations with visual acuity and refractive error. Methods: Ophthalmic examination was conducted on the Western Australian Pregnancy Cohort (Raine) Study at 20 years of age. Monochromatic aberrations were measured in 2039 eyes of 1040 participants using Zywave II Wavefront Aberrometer (Bausch & ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Lomb, Inc., Rochester, NY) on natural pupils in a dark room. Bestcorrected logMAR visual acuity (BCVA) was measured monocularly in normal room illumination. Cycloplegic autorefraction was performed. Results: Data from 1007 right eyes were analysed. Median (IQR) BCVA and spherical equivalent were -0.06 (-0.10, 0) and +0.25 (0.38, 0.63) diopters (D), respectively. The median (IQR) 6mm higher order aberrations (HOA) was 0.58 (0.44, 0.79) μm. Coma-like aberrations, third, fourth and fifth HOAs were significantly different between individuals with BCVA equal to or better than 6/4.8 and worse than 6/4.8 Snellen score. Fourth order aberrations (Z4-4 p=0.024, Z4-2 p=0.029) and second order aberrations (Z20<0.001) differed significantly between myopic, emmetropic and hypermetropic eyes. Individuals with higher myopia had slightly higher total HOAs. Conclusions: HOAs in this population were marginally higher than previously reported values. Our findings confirm that there is a difference in monochromatic aberrations among different vision and refractive groups. Results of this study will benefit decision-making processes in the clinical setting. Commercial Relationships: David A. Mackey, None; Seyhan Yazar, None; Alex W. Hewitt, None; Hannah Forward, None; Charlotte M. McKnight, None; Alexander X. Tan, None; Jenny A. Mountain, None Support: Lions Eye Institute, Australian Foundation for the Prevention of Blindness, Alcon Research Institute Program Number: 2336 Poster Board Number: B0295 Presentation Time: 2:45 PM - 4:30 PM Refractive Astigmatism and the components of Astigmatism in preschool children of China Jia Huang, Xingtao Zhou, Xiaomei Qu. Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China. Purpose: To report the prevalence of refractive (RA), corneal (CA), and internal astigmatism (IA) in a population of preschool children in China, we also examine the contribution of corneal and internal astigmatism components to total refractive astigmatism by power vectors. Methods: We examined refraction and eye health in 14116 cases of 3-6 years old children (7310 boys, 51.8%) in Yangpu District, Shanghai, China. Cycloplegic refractive and keratometri measures using autorefractor (Canon RK-F1,Japan) and IOL master( Carl Zeiss, Germany). Of 13080 eligible children, all the data from right eyes were analyzed. Measures of total and corneal cylinder were transposed into J0 and J45 components, where positive and negative J0 values quantified with-the-rule (WTR) and against-the-rule(ATR) astigmatisms, respectively, and J45 quantified oblique astigmatism. The difference of RA and CA is IA. We divided the sample into high RA group (total cylinder≥1 D; mean, 1.56±0.73 D; n =2899) and normal RA group (0.25D≤total cylinder≤0.75 D; mean, 0.54±0.20 D; n= 4264). Results: Overall prevalence of RA (≥1.0 diopter [D]) was 22.16%, CA (≥1.0 D) 64.21%, IA (≥1.0 D) 40.28%. In high RA group, RA axis was mainly WTR(81.54%), followed by oblique axis(17.00%), then ATR(1.46%); in normal RA group, RA axis was also mainly WTR(61.92%), then oblique axis(31.06%), ATR(7.02%). CA axis was mainly with the rule (85.69%), while IA axis was mainly against the rule (76.54%). Regression analysis showed J0 component of CA was positively correlated with RA only in high WTR astigmats’ group(R2=0.684; P<0.001 ). In all groups, the mean J0 component of CA were always positive; the mean J0 component of IA are always negative. Conclusions: In 3-6 years old preschool children of China, astigmatism axis is mainly with the rule, especially in the high astigmatism group, followed by the oblique axis astigmatism and against the rule astigmatism. Corneal astigmatism is mainly with the rule, while internal astigmatism is mainly against the rule. J0 components of CA and IA counteract each other in all groups, J45 components of CA and IA also counteract each other in high RA group, however, J45 components of CA and IA are superimposed on each other in normal RA group. Commercial Relationships: Jia Huang, None; Xingtao Zhou, None; Xiaomei Qu, None Program Number: 2337 Poster Board Number: B0296 Presentation Time: 2:45 PM - 4:30 PM Refractive and Corneal Astigmatism in Autistic Spectrum Disorder Julie-Anne Little1, Pamela M. anketell1, Stephen M. Gallagher2, Kathryn J. Saunders1. 1Biomedical Sciences, University of Ulster, Coleraine, United Kingdom; 2School of Psychology, University of Ulster, Coleraine, United Kingdom. Purpose: An increased prevalence of refractive error and increased astigmatism has been reported in Autistic Spectrum Disorder (ASD) (Haider et al. 2012). The present study investigated refractive error and corneal keratometry in children with ASD. Methods: 89 ASD participants (73 males) aged between 5-16 years, (mean age 10.7+/-3.2 years) were recruited through a populationbased register and special educational schools. Age-matched controls were recruited from mainstream schools (n=204). Refractive error and corneal keratometry were measured using the Shin Nippon NVision-K 5001 auto-refractor 30 minutes after instillation of cyclopentolate HCl 1%. Where participants were not able to cooperate for auto-refraction (AR), retinoscopy was performed. Refractive errors and corneal powers were transformed into their M, J0 and J45 vector components for analysis (Thibos et al. 1997). Results: ASD Success rates: Cycloplegic AR was measured in n=74 children (83%), n=9 non-cycloplegic AR (10%) and n=5 cycloplegic retinoscopy (6%). One participant did not cooperate for refractive error measurement. Corneal keratometry was successful for n=63 (71%). Control success rates: Cycloplegic AR n=203 (99.5%). Corneal keratometry was successful on 186 controls (92%). Table 1 includes summary statistics of the ASD and control data. No significant difference in J0 data was found for right and left eyes, so right eye data is presented. Mean refractive and corneal astigmatism was significantly higher in the ASD group than controls (one-way ANOVAs F(1,288)=22.6 and 24.1, p<0.00001). Refractive J0 indicated that 54% of the ASD group had with-the-rule astigmatism (44% controls), 29% against-the-rule (34% controls) and 18% no astigmatism (22% controls). In ASD, of those with refractive astigmatism >/=1.50D (n=9), 44% did not wear glasses. Refractive J0 was significantly greater in ASD than controls (one way ANOVA F(1,288)=3.99, p<0.05). No significant difference between ASD and controls was found for corneal J0 (one way ANOVA F(1,288)=0.55, p=0.46). The J45 component was small for both groups and no significant difference was found between ASD and controls. Conclusions: This study confirms that refractive astigmatism is greater in ASD, and tends to be along the primary meridians; however this is not fully accounted for by the profile of corneal astigmatism. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics necessary to drive and can improve legally blind vision to a highly functional level. Commercial Relationships: Lloyd M. Cuzzo, None; Jesse L. Berry, None; Peter A. Quiros, None Table 1 Commercial Relationships: Julie-Anne Little, None; Pamela M. anketell, None; Stephen M. Gallagher, None; Kathryn J. Saunders, None Support: HSC R&D Office Northern Ireland Program Number: 2338 Poster Board Number: B0297 Presentation Time: 2:45 PM - 4:30 PM Unmet Need for Corrective Eyeglasses: Follow-up Results from a Los Angeles County Hospital Survey Lloyd M. Cuzzo1, 2, Jesse L. Berry1, 2, Peter A. Quiros1, 2. 1 Ophthalmology, Doheny Eye Institute, Los Angeles, CA; 2Keck School of Medicine, University of Southern California, Los Angeles, CA. Purpose: To demonstrate that donated eyeglasses can be used for vision correction in settings where patients cannot afford to purchase prescription glasses. Methods: Patients at the Los Angeles County (LAC) Ophthalmology clinic who were identified as having refractive error were manifest refracted and prescribed glasses over a one-month period. Those who could not afford glasses were given glasses from a donated glasses collection in the clinic. Donated glasses with closest prescription to their manifest refraction were given to the patients. Visual acuity (VA) was recorded without glasses, with manifest refraction (MRx), and with donated glasses. VA before and after glasses were converted to logMAR. This study was approved by the University of Southern California iSTAR Internal Review Board and the methods were in accordance with the guidelines of Declaration of Helsinki. Results: The results presented in this study come from the first month of dispensing glasses from a donated eyeglasses program. During the month, 7 patients (14 eyes) were refracted and then provided recycled glasses. Two of the eyes had a VA of no light perception and thus were excluded from the study. Of the 12 eyes included in the study, the average logmar VA before glasses was 0.93 which correlates to a snellen VA of 20/170 (range 20/30-20/400). The average best corrected logmar VA after MRx was 0.32, correlating to snellen VA of 20/42 (range 20/25-20/100). With donated glasses the average logmar was 0.41 correlating to a snellen VA of 20/50 (range 20/30-20/100). Five of the 7 patients (71%) had a VA less than the level required for driving (20/40 or better in at least one eye) without glasses but were able to attain ‘driving’ vision with donated glasses. Three of the 7 (43%) patients were previously legally blind without corrective refractive lenses (20/200 or worse in both eyes) but with donated lenses improved on average to 20/70. Conclusions: Previously the authors have demonstrated that cost is a major factor in preventing low-income, un- or under-insured patients at LAC Hospital from obtaining prescription eyeglasses. Donated eyeglasses are a functional, cost effective means for significantly correcting refractive error. In many patients they can restore vision Program Number: 2339 Poster Board Number: B0298 Presentation Time: 2:45 PM - 4:30 PM Epidemiological profile of ophthalmological care in the Public Service in Brazil Marisa N. Figueiredo1, Larissa Rossana S. Stival1, Marcia L. Machado1, Joao J. Nassaralla2. 1Cornea and Refractive Surgery, Instituto de Olhos de Goiânia, Goiania, Brazil; 2Retina and Vitreous, IOG, Goiania, Brazil. Purpose: To improve health services it is necessary to know the demand profile. This study was carried out with the 2 objectives: to identify the main reasons to seek an ophthalmologic public care service in Brazil (SUS - Brazilian National Health Care System) and to analyze the frequency of the principal diagnoses, aiming to achieve goals of loss in eyesight prevention. Methods: This is an observational, retrospective, cross study conducted from March to August 2012, at the Instituto de Olhos de Goiânia (Goiânia Eye Institute), analyzing 1670 patients, therefore representing a good share of the Goiás State and Mid-Western Brazilian region. The data were obtained through the analysis of the medical records with the ICD-10 registration. The studied variables were age and sex of patient, origin, eye discomfort complaints, comorbidities and diagnosis (ICD-10). Results: The ages ranged from 0 to 99 years and the mean age was 56.9 years. There was a predominance of females (58.1%) and the main origin of patients was Goiânia (61.5%) against 38.5% from interior. It was detected a prevalence of 45.9% of patients with a history of Systemic Arterial Hypertension, 16.8% of Diabetes Mellitus and 5% of glaucoma. The main reason for the consultation was low visual acuity (70%), followed by burning (26%) and itchiness (24.4%), as shown in Figure 1. Among the abnormal tests there was a high prevalence of refractive errors (73.4%) and presbyopia (59.6%). The cause of refractive errors was astigmatism (70.5%), hypertrophy (58.6%) and myopia (15.1%). Table 2 shows other main diagnosis results. Conclusions: The consequences of blindness are becoming an important issue in public health. Primary care professionals play a relevant role in prevention and control of ocular disabilities in their communities. Understanding the main complaints and common eyesight health problems in a particular region can help better manage the public resources and make a better planning for strategic action aiming to reduce and control visual impairment and blindness. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Marisa N. Figueiredo, None; Larissa Rossana S. Stival, None; Marcia L. Machado, None; Joao J. Nassaralla, None Clinical Trial: NCT01740466 Program Number: 2340 Poster Board Number: B0299 Presentation Time: 2:45 PM - 4:30 PM Comparison of a Novel Cell Phone-Based Refraction Technique (Netra-G) with Subjective Refraction Hilary Gaiser1, Bruce Moore1, Vitor Pamplona2, Nadine Solaka1, David Schafran1, Dennis Merrill2, Nathaniel Sharpe2, Joe R. Geringer2, Ramesh Raskar2. 1New England College of Optometry, Boston, MA; 2EyeNetra Inc, Somerville, MA. Purpose: To assess the performance of a cell phone based refracting device (NETRA-G). This study determines the accuracy of this prototype in determining refractive error in comparison to subjective refraction (SR). Methods: NETRA-G (NET) retrofits a high-resolution mobile phone (Sony Xperia U) by adding a pinhole mask, a film and a lens onto the display. The device is bi-ocular with the fellow eye viewing an object at infinity. The subject aligns red and green lines with the translation on screen proportional to refractive error. 27 subjects (mean + SD age 24.79 +/- 1.60) underwent SR, and NET refraction. Subjects refractive error ranged from plano to -6.0D (mean + SD refraction 3.34 +/- 1.46D). Exclusion criteria included amblyopia, floaters, divergent vertical deviation and any ocular pathology. The NET result was used as a starting point for SR. Results: For all 27 subjects (54 eyes), the average absolute difference between NET and SR is 0.31 +/- 0.37D. The refraction determined by NET is well correlated with that of SR r=0.96 and the two measures were not statistically significantly different from each other (p=0.36>0.05). Orthogonal linear regression fit presented a slope of 0.92 and a y-intercept of -0.36D. Average difference on visual acuity between SR and NET 0.089 +/- 0.13 logMar and 77% received 20/25 or better vision directly from NET. Conclusions: When compared to SR, NET slightly overestimated the myopic refractive errors and had a small myopic offset of -0.36D. On average, the visual acuity difference between SR and NET is less then a line on the logMar chart. The results show that NET has potential to be a used as an effective tool for rapidly estimating refractive errors by non-eyecare professionals. Accuracy of this novel technique is expected to increase as technology evolves. Commercial Relationships: Hilary Gaiser, None; Bruce Moore, EyeNetra Inc. (I); Vitor Pamplona, EyeNetra (E); Nadine Solaka, None; David Schafran, EyeNetra Inc (R); Dennis Merrill, None; Nathaniel Sharpe, Eyenetra (E); Joe R. Geringer, Impact Product Development., LLC (C); Ramesh Raskar, EyeNetra Inc (I) Program Number: 2341 Poster Board Number: B0300 Presentation Time: 2:45 PM - 4:30 PM Comparison of Cycloplegic Handheld Autorefraction with Conventional Cycloplegic Retinoscopy in a Pediatric Population Smitha Inaganti1, Nisha Krishan-Dave2. 1Ophthalmology, New York Medical College, New York, NY; 2Ophthalmology, Metropolitan Hospital, New York, NY. Purpose: Several studies have found that autorefraction under cycloplegic conditions is accurate enough to substitute for cycloplegic retinoscopy in children. The purpose of this study is to analyze whether cycloplegic handheld autorefraction is accurate and consistent with cycloplegic retinoscopy performed by ophthalmology residents in a pediatric population. Methods: A retrospective chart review was performed of pediatric patients in an inner-city, resident eye clinic between November 2011 and November 2012. We identified 200 eyes of 100 patients between the ages of 3 and 17 who underwent post cycloplegic handheld autorefraction with the Righton Retinomax 3, followed by streak retinoscopy and subjective manifest refraction, all performed by second year ophthalmology residents. Spherical equivalence, spherical power, cylindrical power and axis measurements were compared. Results: Spherical equivalence measured by autorefractor was significantly different from both retinoscopy (p<0.0001) and final subjective manifest refraction (p<0.0001). There was no significant difference in spherical equivalence between retinoscopy and manifest refraction (p= 0.41). Similar differences were found in spherical power, with autorefractor measurements significantly different from retinoscopy (p<0.0001) and manifest (p<0.0001) and no significant difference between retinoscopy and manifest refraction (p=0.98). The spherical power measured by autorefractor was within +/- 0.5 diopter range of the manifest refraction in 26% of eyes compared to 84% by retinoscopy. No significant difference was found between the autorefractor and retinoscopy for cylindrical power (p=0.79) with 78% of autorefraction cylindrical power measurements within +/- 0.5 D of manifest. Measurement of axis, in 99 of 200 eyes, was significantly different (p<0.0001), with retinoscopy measuring more consistent with manifest. Only 63% of autorefractor measurements were within ten degrees of manifest axis, compared with 98% of retinoscopy measurements. Conclusions: Under cycloplegic conditions, there remained a significant difference between handheld autorefraction and standard flash retinoscopy. The autorefractor had a tendency toward overcorrecting spherical power for minus by a mean of 1.1 diopters. The autorefractor was more consistent with retinoscopy when measuring cylindrical power, although measurement of axis was inconsistent. Commercial Relationships: Smitha Inaganti, None; Nisha Krishan-Dave, None Program Number: 2342 Poster Board Number: B0301 Presentation Time: 2:45 PM - 4:30 PM Evaluating Calibrated Retinoscopy Clinton N. Sims. Self Employed, Self employed, Fort Myers, FL. Purpose: To evaluate the accuracy of a 6-8° off axis mathematically based retinoscopic technique using calibrated converging light to produce a +0.50D retinoscopic endpoint, the retinoscopic measurements were compared to those of a subjective refraction. The ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics optical clarity of the +0.50D retinoscopic endpoint was also compared to an infinity endpoint using diverging light. Methods: A Copeland Optec 360 Streak Retinoscope (Fig. 1) was calibrated for a 65cm retinoscopic working distance (RWD) and marked for a +0.50D retinoscopic endpoint using +1.00D converging light (CCR+050D) and a infinity retinoscopic endpoint (∞) using 1.50D diverging light. Slide locks maintained the alignment of the calibration line with the marked positions. The CCR+050D retinoscopic technique uses the principles of conventional retinoscopy and doesn’t require a fogging lens. With a phoropter, twenty-six normal and abnormal eyes of patients aged 11-77 with undilated pupils were retinoscoped using the CCR+050D technique as they read the Snellen chart. The +0.50D endpoint was compared to the infinity endpoint by adding a +1.50D sphere and elevating the calibration line from the +0.50D position to the ∞ position with the thumb slide. A subjective refraction was performed and the results compared to the CCR+050D measurements. Results: The mean differences and 95% confidence intervals between the spherical equivalents (SE) and crossed cylinders (X/Cyl) of the CCR+050D endpoints and subjective refractions were: 0.03(-0.21 to +0.21)DSE and 0.00(-0.21 to +0.21)DX/Cyl. The +0.50D pupillary reflexes were brighter, sharper and easier to evaluate than the dull infinity pupillary reflexes. Conclusions: The results indicate a high degree of accuracy for the CCR+050D technique in contrast to the accuracy/repeatability studies of conventional retinoscopy. This is due to the calibrated visible retinoscopic endpoint plus eliminating the fogging lens, the 0.50D zone of doubt, the dull undetectable infinity endpoint, cycloplegics and other disadvantages of conventional retinoscopy. Since retinoscopes are the only uncalibrated instruments used to measure a refractive error, they can produce different spherical measurements and many cannot be calibrated. The clear CCR+050D endpoint should improve the efficiency of the office and make retinoscopy easier to perform and teach. Ocular Refractive State In Fighting Bulls Juan I Seva1, Manuel Sanes1, Francisco Martinez-Gomariz1, Matteo Lo Sapio2, Juan M. Bueno2. 1Facultad de Veterinaria, Universidad de Murcia, Murcia, Spain; 2Laboratorio de Optica, Universidad de Murcia, Murcia, Spain. Purpose: Fighting bulls are bred free range on extensive farms under similar experimental conditions, well-defined manipulation procedures and hardly human contact. Although they are genetically selected for a certain combination physical energy and aggressiveness, their behavior usually differs among animals during bullfighting. It is believed that bulls present some lateral preferences and sometimes they do not have a correct (near or far) vision. We investigate whether differences in the ocular refractive state (RS) might be part of this lateralized visual processing. Methods: One-hundred and fifty eyes from 75 fighting bulls were involved in the study. Animals were obtained from a local bullfighting arena. They were raised in different farms distributed all across the country and ages ranged from 48 to 70 months. Enrolment was preceded by a veterinarian examination to rule out the presence of any physical factor likely to interfere with the usual fighting. The RS of each eye was assessed via streak retinoscopy with trial lenses in the horizontal meridian immediately after the regular bullfighting took place. Before assessment we ensured the eyes kept their optical properties intact. Results: RS values varied between -1.25 and 2.5 D, with a mean of +0.65 D (SD=+/-0.80 D). Although both eyes were highly correlated (R=0.79), left eyes tend to be less ametropic. 8% of eyes (12/150) were myopic (refraction < -0.5 D). Anisometropia (difference in RS in a pair of eyes > 0.5 D) was detected in 35 animals (23%). RS was not correlated with either age or weight. No significant differences in RS among the animals coming from different farms were found. Conclusions: RS values of fighting bulls varied widely, although they tend to be slightly hyperopic. This RS could explain their behavior when stimuli are presented at different locations, especially at short distances. Moreover, the existence of a certain degree of anisometropy between pairs of eyes might be a factor contributing to a possible visual lateralization, and might help to understand differences in the behavior when the stimulus is presented in front of an eye or the other. Commercial Relationships: Juan I Seva, None; Manuel Sanes, None; Francisco Martinez-Gomariz, None; Matteo Lo Sapio, None; Juan M. Bueno, None Support: Ministerio de Edicación y Ciencia, Spain (grants FIS200906234-E) 308 Binocular Vision and Stereopsis Tuesday, May 07, 2013 8:30 AM-10:15 AM TCC LL 4/5 Paper Session Program #/Board # Range: 2658-2664 Organizing Section: Visual Psychophysics / Physiological Optics Fig. 1 Retinoscope calibrated for CCR+050D and infinity pupillary reflexes and the RWD. Commercial Relationships: Clinton N. Sims, US 8,272,739 B2 (P), US 8,272,740 B2 (P) Program Number: 2343 Poster Board Number: B0302 Presentation Time: 2:45 PM - 4:30 PM Program Number: 2658 Presentation Time: 8:30 AM - 8:45 AM Mechanisms underlying global stereopsis in fovea and periphery Robert F. Hess, Nirel Witz. Ophthalmology, McGill University, Montreal, QC, Canada. Purpose: To better understand the mechanisms underlying global stereopsis we examined the relationship between carrier luminance spatial frequency and modulator disparity spatial frequency. Methods: Thresholds for detecting global sinusoidal disparity corrugations of equi-detectable spatially band-pass noise were measured as a function of modulator disparity spatial frequency for ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics both centrally and peripherally located stimuli using a standard 2-IFC task. Results: We found a characteristic relationship that depended on modulator disparity spatial frequency. At high modulator disparity spatial frequencies (>1 c/d), there is an optimal ratio of around 2.6, whereas at low modulator disparity spatial frequencies, there is an optimal absolute carrier luminance spatial frequency (i.e., 3 c/d). In the periphery, vision is restricted to modulator disparity spatial frequencies below 1 c/d and, as a consequence, follows the above rule, there is an optimum absolute carrier luminance spatial frequency that reduces in spatial frequency with increasing eccentricity. Conclusions: This finding is consistent with there being more than one channel processing global stereo. This is subsequently confirmed using a 2x2 AFC detection/discrimination paradigm. Furthermore, because of the different carrier/modulator relationships in central and peripheral vision, peripheral global stereo cannot be simply related to central global stereo by a scaling factor and thus cannot be simply due to cortical magnification as previously proposed. Commercial Relationships: Robert F. Hess, None; Nirel Witz, None Support: NSERC (#46528-11) Program Number: 2659 Presentation Time: 8:45 AM - 9:00 AM Effect of inter-ocular differences in blur on spatial and stereoresolution Sowmya Ravikumar1, Bjorn Vlaskamp2, Martin S. Banks1. 1Vision Science, University of California Berkeley, Berkeley, CA; 2Philips Research, Eindhoven, Netherlands. Purpose: Monovision—setting the refraction of one eye to a different value than the other—is a procedure for dealing with presbyopia. The difference in refractions for the two eyes should be the appropriate value for maximizing visual performance, but there is little research on what the appropriate value is. We know that both visual acuity and stereoacuity worsen as blur increases. However, visual-acuity tasks can in principle be performed when one eye is suppressed, but stereo tasks cannot. Thus, visual acuity might be limited by image quality in the better eye while stereoacuity might be limited by the poorer eye. Some previous observations are consistent with these expectations. Indeed, blur in one eye can be more detrimental to stereoacuity than the same blur in both eyes (blur paradox). Methods: We compared visual acuity and stereoacuity in the same observers with the same blur manipulations. Stimuli were displayed binocularly using a custom stereoscope. Accommodation was paralyzed with cyclopentolate. An artificial pupil set the effective aperture to 4mm. Blur was introduced with ophthalmic lenses. We measured visual acuity with a letter-identification task. We measured stereoacuity using a random-dot stereogram that created sinusoidal corrugations in depth oriented +/- 20 degrees about the horizontal; subjects indicated which of two corrugation orientations was presented. Results: The results were consistent with our expectations. For varying amounts of blur in the two eyes, visual acuity closely conformed to the better eye’s performance while stereoacuity was largely limited by the worse eye’s blur. Monocular blur had almost no effect on visual acuity, with binocular visual acuity remaining close to 20/20 with up to 1.5D blur in one eye. For the same amount of blur, stereoacuity decreased by a factor of almost two. When the blur was equal in the two eyes, stereoacuity was slightly better than when the same blur was present in one eye only (e.g., In comparing 1.5D in both eyes to 1.5D of blur in one eye only, in one subject, stereo-acuity was 1.98 cpd compared to 1.13 cpd and in another subject, stereoacuity was 1.54 cpd compared to 1.37 cpd). Conclusions: The results will help us design monovision protocols in a way that is the best compromise between visual acuity and stereoacuity for various viewing distances. Commercial Relationships: Sowmya Ravikumar, None; Bjorn Vlaskamp, Philips (E); Martin S. Banks, None Support: RO1-EY 12851 to MSB Program Number: 2660 Presentation Time: 9:00 AM - 9:15 AM Binocular combination of optically-induced asymmetric interocular blur Aixa Alarcon1, Len Zheleznyak2, 1, Martin S. Banks3, Geunyoung Yoon1, 2. 1Flaum Eye Institute, University of Rochester, Rochester, NY; 2Institute of Optics, University of Rochester, Rochester, NY; 3 Vision Science Program, University of California Berkeley, Berkeley, CA. Purpose: It has been reported that interocular mirror symmetry in the aberrations (or optical blur) is present in the normal population. The goal of this study was to investigate the effects of interocular differences of monocular blur orientation on binocular blur perception. Methods: Eight cyclopleged subjects were asked to binocularly view a stimulus under 3 aberration conditions and to match the subjective blur by inducing defocus to an unaberrated stimulus in 0.05D increments. A binocular adaptive optics vision simulator was used to correct subjects’ native aberrations, induce the 3 aberration conditions and to induce defocus for the blur matching task for a 6mm pupil. A monochromatic (550nm) binary noise image with random edge orientation served as the stimulus. The aberration conditions consisted of 0.5 and 1D astigmatism and 1μm coma. The aberration orientation of the right eye was rotated 0 and 90 degrees (i.e. equivalent and orthogonal, respectively) in the case of astigmatism and 0, 90 and 180 degrees in the case of coma while the left eye’s aberration was held fixed at 0 degrees for all conditions. In the coma condition, right eye orientations of 0 and 180 degrees correspond to a binocular mirror asymmetry and symmetry of blur orientation, respectively. Two subjects participated in the blur matching experiment in the 0.5D astigmatism condition, and 8 subjects participated in the remaining conditions. Results: Bilateral equivalent and orthogonal astigmatism of 0.5D resulted in significantly different blur matches of 0.53±0.05 and 0.36±0.09D, respectively (p<0.01, Student’s t-test). However, the blur matches for equivalent and orthogonal astigmatism of 1.0D did not differ significantly (0.81±0.24 and 0.79±0.21D, respectively). In the case of coma, as the right eye aberration rotated 0, 90 and 180 degrees with respect to the left eye with 0 degree, the blur match decreased (0.93±0.42, 0.80±0.29 and 0.83±0.37D, respectively). The perceived blur of coma with bilateral mirror symmetry (180-0 degree) was significantly less than the case of mirror asymmetry (0-0 degree) (p<0.01, Student’s t-test). Conclusions: Binocular blur perception is reduced when interocular blur orientations differ. This finding suggests a compensatory mechanism of the binocular visual system to cope with different interocular blur orientation, however its capacity likely depends on the magnitude and relative orientation of blur between the eyes. Commercial Relationships: Aixa Alarcon, None; Len Zheleznyak, None; Martin S. Banks, None; Geunyoung Yoon, Bausch & Lomb (F), Johnson & Johnson (F), Allergan (C), Staar Surgical (C), CIBA Vision (F), Acufocus (C) Support: NIH Grant EY014999, Unrestricted Grant from Research to Prevent Blindness ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 2661 Presentation Time: 9:15 AM - 9:30 AM The Effect of Unilateral Mean Luminance on Binocular Combination in normal and amblyopic vision Chang-Bing Huang1, Jiawei Zhou2, Robert F. Hess2. 1Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; 2Department of Ophthalmology, McGill Vision Research, McGill University, Montreal, QC, Canada. Purpose: We investigated the role of interocular luminance difference on supra-threshold binocular phase combination, from which we wanted to derive the functional balance index between the two eyes, for both normals and amblyopes. We also attempted to determine whether we can artificially simulate “amblyopic” behaviour in normal subjects and recover “normal” response pattern in amblyopic subjects by inducing luminance difference in the two eyes, and to understand the theoretical basis of such effects. Methods: Using a binocular combination paradigm developed by J. Ding and G. Sperling (2006) and neutral density (ND) filters of varied intensities, the effect of unilateral mean luminance on binocular combination in 3 normal and 4 amblyopic observers were quantified. Results: In normal observers, attenuation of one eye’s stimulus luminance with ND filters produces binocular combination similar to those of amblyopic subjects. Correspondingly, in amblyopic observers, reduction of the fellow eye’s stimulus luminance produces binocular combination similar to those of normal subjects. These results can be well explained by a modified contrast gain-control model, which suggests that decreasing the mean luminance in one eye reduces the efficiency of gain-control from that eye to the other eye, thus lower its contribution in binocular combination. Conclusions: Our manipulation of interocular luminance difference provides a simple and effective way to modulate interocular imbalances in amblyopia by reducing the effectiveness of the signal originating from the fellow fixing eye, which might bear upon any future binocular treatment of amblyopia. Commercial Relationships: Chang-Bing Huang, None; Jiawei Zhou, None; Robert F. Hess, None Support: CIHR (# MOP53346) to RFH, and the Knowledge Innovation Program of the Chinese Academy of Sciences, Institute of Psychology (Grant No. Y1CX201006 to CBH) Program Number: 2662 Presentation Time: 9:30 AM - 9:45 AM The Contribution of Perspective, Blur and Disparity to Depth Perception in Natural Vision Guido Maiello1, 2, Manuela Chessa2, Fabio Solari2, Peter Bex1. 1 Department of Ophthalmology, Harvard Medical School, Boston, MA; 2Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy. Purpose: Natural scenes contain multiple sources of depth information. However, the relative contribution of these alternative cues is not well understood under natural conditions. When these cues are not accurately simulated in computer generated 3 dimensional scenes, observers can experience visual fatigue, nausea and diplopia. We examine depth perception in real images with natural variation in perspective, blur and binocular disparity. Methods: Image patches subtending 8 degrees of visual angle were extracted from light field photographs of natural scenes taken with a Lytro camera that simultaneously captures up to 12 focal planes. When accommodation at any given plane was simulated, the correct defocus blur and stereoscopic disparity at other depth planes was extracted from the stack of focal plane images. Depth information from geometric cues, relative blur and stereoscopic disparity were independently introduced into depth images. In a 2AFC paradigm with feedback, four observers identified the closer of two stimuli presented concurrently. Results: Depth discrimination thresholds were lowest when geometric and stereoscopic disparity cues were both present. Depth order discrimination was not possible with defocus blur alone and the addition of blur cues impaired geometric thresholds by reducing the contrast of geometric information at high spatial frequencies. When blur cues were introduced along with geometric and disparity cues, they did not noticeably impair thresholds, and appeared to compensate the perceptual bias towards the far plane previously induced by disparity. Conclusions: Light field photographs are a useful tool to quantify how naturally-occurring cues contribute to depth perception. Correct defocus blur diminishes visual fatigue while viewing stereoscopic stimuli (Hoffman, et al (2008) JoV 8(3), 33,1-33,30) and should therefore not be discarded in 3D images. Here we show that defocus cues alone impair fine depth perception near the plane of fixation, but might be beneficial if used in conjunction with stereoscopic disparity. Commercial Relationships: Guido Maiello, None; Manuela Chessa, None; Fabio Solari, None; Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: NIH Grant R01EY019281 Program Number: 2663 Presentation Time: 9:45 AM - 10:00 AM Rapid assessment of core visual deficits in amblyopia MiYoung Kwon1, Luis A. Lesmes1, Alexandra Miller1, Melanie Kazlas2, Michael Dorr1, David G. Hunter2, 1, Zhong-Lin Lu3, Peter Bex1. 1Ophthalmology, Harvard Medical School, Boston, MA; 2 Ophthalmology, Boston Children’s Hospital, Boston, MA; 3 Psychology, Ohio State University, Columbus, OH. Purpose: Amblyopia is the most common cause of monocular visual loss in children, affecting approximately 3-5% of the population. Although amblyopia is associated with a wide range of visual deficits that include reduced visual acuity, loss of contrast sensitivity, spatial distortion, and abnormal binocular interaction, outcomes for amblyopia treatment currently monitor only visual acuity. A major obstacle to broad characterization of the deficits has been inefficiency of psychophysical assessments such as long testing time. The present study aims to develop novel methods for rapidly assessing correlation among these core deficits in amblyopic vision. Methods: Contrast sensitivity, spatial distortion and binocular interaction were assessed in subjects with strabismic amblyopia (546-yr-old; mean age =14.38 yrs; n=8), strabismus without amblyopia (6-84-yr-old; mean age =34.4 yrs; n=15) and normal vision (5-32-yrold; mean age =18.71 yrs; n=24). The contrast sensitivity function (CSF) was estimated in less than 30 trials with the quick CSF method (Lesmes et al., 2010) on a handheld device (iPad). Local and global spatial distortion was measured with a dichoptic pointing task (Mcilreavy et al., 2010) in which subjects aligned a target dot presented to their amblyopic eye with a cross-hair presented to their fellow eye. Binocular interaction was measured with a dichoptic matching task (Ding & Sperling, 2006) in which subjects matched the phase of a binocular probe to the cyclopean percept of a dichoptic pair of gratings whose ratios were systematically varied. Testing was performed in an ophthalmology clinic with a total testing time of approximately 20 minutes. Results: Compared to subjects with normal vision or strabismus without amblyopia, subjects with amblyopia had significantly reduced contrast sensitivity (F(2,35) = 4.7, p = 0.015), significantly larger spatial distortion (F(2,37) = 4.8, p = 0.014) and decreased interocular contrast summation. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Conclusions: Amblyopia can be characterized by pronounced deficits in contrast sensitivity, spatial distortion, and binocular interaction suggesting a higher contrast requirement for the amblyopic compared to the fellow eye. Despite the short testing time, our novel methods are as effective as conventional laboratory assessments for quantifying the core deficits in amblyopia. Commercial Relationships: MiYoung Kwon, None; Luis A. Lesmes, Adaptive Sensory Technology (S), 7938538 (P); Alexandra Miller, None; Melanie Kazlas, None; Michael Dorr, Adaptive Sensory Technology, LLC (S), Rapid Measurement of Visual Sensitivity (P); David G. Hunter, REBIScan, Inc (I), Boston Children's Hospital (P), Johns Hopkins University (P); Zhong-Lin Lu, US Patent 7,938,538 (P); Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: NIH Grant R01 EY021553 Program Number: 2664 Presentation Time: 10:00 AM - 10:15 AM Binocular Visual Acuity with Combined Correction of Spherical and Longitudinal Chromatic Aberrations Christina Schwarz, Silvestre Manzanera, Pedro M. Prieto, Pablo Artal. Laboratorio de Optica, Universidad de Murcia, Murcia, Spain. Purpose: A previous study (Artal et al., Optics Express 2010) showed that monocular visual acuity (VA) improved by correcting spherical aberration (SA) and longitudinal chromatic aberration (LCA). However, the effect of their combined correction on binocular visual performance has not been investigated yet. Here, we measured both monocular and binocular VA when correcting SA and LCA separately or in combination. Methods: We used a binocular adaptive optics visual analyzer to measure binocular and monocular VA at an intermediate contrast of letters (30%). The instrument (Schwarz et al., Optics Letters, 2011) allows for modifying the magnitude and phase of the eye’s complex pupil function. It incorporates two liquid-crystal spatial light modulators for both wavefront shaping and to create the artificial pupil. A micro-display presents letters through the controlled eye’s optics to measure monocular and binocular VA for 4 different cases: 1) natural conditions (LCA and SA present), 2) LCA removed, 3) SA corrected, 4) LCA removed and SA corrected. In the cases where SA is present, the average SA value found in pseudophakic patients was induced (0.149µm for a 4.8mm pupil). LCA was removed by using monochromatic (532nm) instead of polychromatic light. The three subjects that took part in this study had also participated in the previous. Results: The main tendencies of the previous monocular study were reproduced, although a different instrument was used and the technique to correct for LCA was different. Average monocular VA increased gradually form condition 1) 0.68±0.05; 2) 0.75±0.05; 3) 0.82±0.06 and 4) 1.2±0.2. Average binocular VA for the three subjects increased from 0.80±0.04 for the case when LCA and SA were present to 1.2±0.1 for the case when LCA and SA were corrected. The average binocular summation ratio ranged between 1.0±0.2 and 1.4±0.2, being the smallest in the all-corrected case. Conclusions: We studied how binocular VA is affected by correcting longitudinal chromatic aberration and spherical aberration in combination. The best performance was attained binocularly when both aberrations were removed. This result may indicates that bilateral implantation of IOLs correcting both SA and LCA could further improve binocular spatial vision. Commercial Relationships: Christina Schwarz, AMO (F); Silvestre Manzanera, AMO (F), CIBA Vision (F), CALHOUN (F), VOPTICA (I); Pedro M. Prieto, AMO (F), AcuFocus (F), Voptica SL (I), Voptica SL (P); Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Inovación, Spain, FIS2010-14926 and CSD2007-00013; Fundación Seneca, Región de Murcia, Spain 4524/GERM/06; AMO 313 Low Vision Rehabilitation Tuesday, May 07, 2013 8:30 AM-10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 2747-2784/B0001-B0038 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 2747 Poster Board Number: B0001 Presentation Time: 8:30 AM - 10:15 AM Measuring reading speed: a comparison of reading paragraphs and single sentences Susanne Trauzettel-Klosinski, Elke K. Altpeter, Tobias Marx, Nhung Nguyen. Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany. Purpose: For measuring reading speed, the use of standardized texts is crucial 2. Single sentences (MN-Read, Radner) are well suited for assessing critical print size. We developed paragraphs (International Reading Speed Texts IReST 2) for measuring reading speed, which showed a high agreement within and between languages (17 languages, linguistically adapted). We hypothesize that paragraphs are preferable to single sentences for more precise speed measurement by stopwatch. Methods: Reading speeds during reading standardized paragraphs of text ( IReST, German version, texts 3,6,10; 132 words, SD 3.2) were compared with standardized single sentences (Radner, German version, texts 1-3; 14 words each). 30 normally sighted elderly native German speakers (mean age = 64 years, SD 7 years) read the texts aloud in random order. Reading time was measured by stop watch and reading speed was calculated in correctly read words/minute (wpm). Results: Mean reading speed did not show a relevant difference between IReST (167 wpm, SD 30.3) and Radner (170 wpm, SD 30.2), (highest mean difference: 7 WPM), when reading speeds of the total cohort were compared. However, individual variation during reading 3 texts of each type showed markedly higher standard deviations for the Radner texts (SD 18.9) than for the IReST texts (SD 5.2). A clinically relevant difference was defined as > 10 wpm 2. Conclusions: For group comparisons, the kind and length of text (IReST or Radner) did not have a relevant influence on reading speed. For intra-individual measurement of reading speed, IReST texts showed lower variation between the texts. For higher accuracy we recommend to use them for repeated measurements, especially for monitoring the course of a reading disorder and for assessing effects of interventions. References 1 Radner W et al (2002) Graefe`s Arch Clin Exp Ophthalmol 240: 461-46 2 Trauzettel-Klosinski S, Dietz K and the IReST Study Group (2012) IOVS 53:5452-5461 Commercial Relationships: Susanne Trauzettel-Klosinski, None; Elke K. Altpeter, None; Tobias Marx, None; Nhung Nguyen, None Program Number: 2748 Poster Board Number: B0002 Presentation Time: 8:30 AM - 10:15 AM Properties of the Dutch Reading Charts ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Ger V. Van Rens, Tamara Verkerk Brussee, Edwin Klerkx, Ruth V. Nispen. Ophthalmology, Free Univ Amsterdam Medical Ctr, Amsterdam, Netherlands. Purpose: To investigate some measurement properties of Dutch reading charts. Methods: 71 participants (mean age: 55 +/- 19.7 years) with normal vision read 5 reading charts available in the Dutch language (“Nederlanders”; LEO; IReST, Radner and Colenbrander). All sentences and texts were printed at the same size and characters and were read out loud and timed with a stopwatch. In order to compare charts, the main outcomes were reading speed in syllables and characters per minute (corrected for reading mistakes) and the mean number of mistakes per character. Results: The corrected reading speed in syllables per minute were in ascending order of charts Nederlanders 237/min, Colenbrander 246/min, Leo 269/min, IReST 278/min and Radner 299/min. The corrected reading speed in characters per minute gave the same order of charts Nederlanders 713/min, Colenbrander 814/min, Leo 823/min, IReST 823/min and Radner 923/min. The number of mistakes made in the reading charts per character were in descending order Nederlanders, Colenbrander, IReST, Leo and Radner. A one tailed Pearson correlation of the number of mistakes per character and reading speed per character revealed a significant correlation for the reading charts that are based on longer texts, 0.013 in Nederlanders and 0.008 in IReST. No significant correlation was found in the other three reading charts that are based on separate sentences. The range of mistakes for the three reading charts with the highest reading speeds was significantly lower than that of the Colenbrander and Nederlanders. The reading speeds decreased from younger to older age categories, aged 18-35 years (n=19) , 36-59 years (n=18) and 60-86 years (n=34). This was also true for the number of mistakes that were made. Conclusions: Archaic language may have led to more mistakes in the Nederlanders chart. The 5 Dutch reading charts revealed clear differences in reading speed and difficulty (number of mistakes). These findings have consequences for daily practice and for the possibility to compare scientific outcomes. In the near future, we will also study the charts with logarithmic progression of character size in a population of visually impaired participants. Commercial Relationships: Ger V. Van Rens, None; Tamara Verkerk Brussee, None; Edwin Klerkx, None; Ruth V. Nispen, None Program Number: 2749 Poster Board Number: B0003 Presentation Time: 8:30 AM - 10:15 AM iPad vs Closed Circuit Television Low Vision Reading Rates and Preferences Alex Zemke1, 2, Danielle Irvine1, 2, John Coalter1, Walter M. Jay3. 1 Spectrios Institute for Low Vision, Wheaton, IL; 2The Chicago Lighthouse for People Who are Blind or Visually Impaired, Chicago, IL; 3Loyola University Chicago, Maywood, IL. Purpose: Accessibility features of tablets such as the Apple iPad have revolutionized reading rehabilitation for low vision patients. These features include system wide zoom and high reversible contrast. We compared subjective preference as well as reading rates on the Apple iPad and a closed circuit television (CCTV). Methods: After IRB approval, fourteen low vision patients, 18 years and older, were recruited with visual acuity ranging from 20/50 to 20/200 and minimal prior experience with an iPad or CCTV. Objective data collection involved calculating reading rates from a newspaper article and a book. Patients read both media for two minutes on each device at their preferred zoom, and a third time on the CCTV with the zoom matched to the iPad’s angle of resolution. Physical copies were provided to be used on the 24 inch Optelec Clearview CCTV and electronic copies were acquired for the third generation iPad. Upon conclusion of the reading assignments, patients were surveyed with a questionnaire concerning subjective comfort, performance and preference. Paired t-test with Bonferroni adjustment was used to compare reading rates. A chi squared analysis was used for preference responses. Results: The mean age of the subjects was 62.7 (Std Dev = 13.4) years and the range was 35 to 91. There were 9 different diagnoses, with proliferative diabetic retinopathy (5) and glaucoma (2) being the most common. The mean acuity was 20/108 and the range was 20/50 to 20/200. Twelve of 14 subjects (85.7%) chose the iPad for overall reading preference (mean age 59.3, mean acuity 20/110). The other two subjects preferred the CCTV (mean age 83.5, mean acuity 20/100). Faster reading rates of the newspaper with the CCTV at both the patient's preferred zoom and constant angle of resolution to the iPad were statistically significant (p = 0.0047 and 0.0080 respectively), while there was no statistical significance between the CCTV and iPad reading rates with the book. Conclusions: Despite equal or slower reading rates with the iPad, patients' subjective preference was in favor of the iPad. Patients' primary reasons for preference of the iPad were portability, ease of navigation, and added versatility. Considering these reasons in addition to lower cost and improved social acceptance, tablets, such as the iPad, should be considered in the reading rehabilitation of visually impaired patients. Commercial Relationships: Alex Zemke, None; Danielle Irvine, None; John Coalter, None; Walter M. Jay, None Support: 2012 Illinois Society for the Prevention of Blindness Research Grant Program Number: 2750 Poster Board Number: B0004 Presentation Time: 8:30 AM - 10:15 AM Reading performance in low-vision patients using a low-cost portable reading system prototype Adriana Berezovsky, Vagner R. dos Santos, Nívea N. Cavascan, Solange R. Salomao. Departamento de Oftalmologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. Purpose: Reading performance is an important tool to evaluate patients with impaired vision. Reading speed, reading acuity and critical print size are factors that mainly influence reading performance in normal and low-vision subjects. The aim of this study was to investigate the impact of a recently developed low-cost electronic portable magnifier reading system (PRS) in the reading performance of low-vision subjects. Methods: Ten adult subjects (ages ranging from 20 to 92 years) with low vision and without any training for low vision devices were included. Reading performance was assessed binocularly with best optical correction with the Minnesota Reading Speed Chart version for the Portuguese language (MNREAD Portuguese). PRS apparatus is composed of a system of image capturing coupled with a 5.6 inch monochromatic monitor, providing up to 15 x standard magnification. Parameters of reading speed (words per minute), reading acuity (logMAR), and critical print size (logMAR) were determined without and with the PRS prototype. Paired t-test was used to compare results with and without PRS prototype for reading performance parameters. When normality test failed, Wilcoxon signed rank test was used. Statistical significance was set at p≤0.05. Results: Mean reading speed was 48.4 ± 30.5 words per minute without PRS, decreasing to 45.0 ± 19.6 words per minute with PRS utilization without any significance. All subjects showed ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics improvement in both reading acuity and critical print size with PRS prototype. Mean reading acuity without PRS prototype (1.00 ± 0.23 logMAR) was statistically poorer (t=13.054, p≤0.001) than that measured with it (-0.08 logMAR ± 0.25). The same trend was found in mean critical print size, with 1.15 ± 0.18 logMAR without the PRS prototype and for values significantly better (t=16.694, p≤0.001) with prototype (0.13 ± 0.25 logMAR). Conclusions: Considerable improvement in both reading acuity and critical print size was provided by PRS prototype use. However, reading speed results had no statistical differences with and without PRS prototype in this small cohort of patients. Further studies with large numbers of patients are recommendable to corroborate and extend the findings with this new promising technology. Commercial Relationships: Adriana Berezovsky, None; Vagner R. dos Santos, None; Nívea N. Cavascan, None; Solange R. Salomao, None Program Number: 2751 Poster Board Number: B0005 Presentation Time: 8:30 AM - 10:15 AM Improving reading speed in peripheral vision through a nontask-based training Deyue Yu. College of Optometry, The Ohio State University, Columbus, OH. Purpose: People with central vision loss rely on their peripheral vision for reading. Previous studies have shown that peripheral reading can be improved with practice on character-based tasks. An optimal training paradigm should require little effort from patients to allow self-administration while providing efficient learning and prominent improvements. Heretofore, such a paradigm has been lacking. Here, we introduce a practical and effective training method that utilizes priming of stimulus identity to facilitate learning in the absence of a task. Methods: Seven normally-sighted young adults were trained at 10° in the lower visual field in a pre/post design. In the pre-test, we measured reading speeds using Rapid Serial Visual Presentation, visual-span profile (letter-recognition accuracy as a function of letter position) with trigrams (strings of three random letters), the spatial extent of crowding (letter separations yielding 80% recognition accuracy for the middle letters of trigrams), and isolated-letter recognition performance. To assess transfer of learning across print sizes, reading speed was measured at two print sizes (2.5° (trained), 1°). Training consisted of five sessions of viewing trigrams presented at various letter positions, a total of 7150 trials. Each training session had 26 blocks. Within each block, the middle letter of the trigram was always the same. The left and right letters were randomly selected resulting in differences, across trials, in the perceived appearance of the middle letter. The observer had no task, but rather was asked to attend to each trial and learn the known target letter with the option of repeating the same trigram stimulus for as many times as needed (averaged 0.4 times). The post-test was identical to the pre-test but in reversed order. Results: Averaged across observers, the five-day training reduced the spatial extent of crowding by 29% and enlarged the visual span by 1.6 characters. The improvements transferred to the untrained reading task for both the trained print size (reading speed increased from 132 to 298wpm) and the untrained print size (from 68 to 171wpm), which is beyond what is typically observed in traditional task-based training. Conclusions: Our findings demonstrate the effectiveness of utilizing priming and stimulus exposure in training to improve peripheral reading. Moreover, this non-task-based training is simple enough to allow self-training at home. Commercial Relationships: Deyue Yu, None Program Number: 2752 Poster Board Number: B0006 Presentation Time: 8:30 AM - 10:15 AM Effect of Decreased Lighting on Visual Acuity in Normal Subjects Donald C. Fletcher MD; California Pacific Medical Center Dept. of Ophthalmology and Smith-Kettlewell Eye Research Institute. Laura Walker Renninger; Smith-Kettlewell Eye Research Institute David T. Hamilton. 1Low Vision Research, CPMC, San Francisco, CA; 2Low Vision Research, Smith-Kettlewell Eye Research Institute, San Francisco, CA. Purpose: Central field loss patients anecdotally report that more light improves their vision. In a recent study (Fletcher, Renninger, and Schuchard, 2012), it was reported that indeed acuity declines with lower light levels. The purpose of this study is to determine the extent to which light conditions affect visual acuity in normally sighted subjects. Methods: Binocular Visual acuity was assessed on 20 normally sighted volunteers using their habitual correction. Initially a Snellen letter chart was viewed at one meter under ambient room light. Participants were tested a second time while wearing 4% transmission gray filter glasses (NOIR U23) over their spectacles or contact lenses. The acuity difference is reported as lines difference with decreased light. Results: Participants ranged in age from 22-70 (with a mean of 44.85 years). All patients displayed diminished visual acuity when 4% transmission glasses were worn. Lines difference ranged from 1 (31, F) to 7 (60, F) with the majority of patients falling in the 2-5 line range (mean: 2.95 lines, median: 2.5 lines). In Dr. Fletcher's patients, he observes a mean drop of about two lines (ambient room light vs. 4% transmission gray filter glasses.) My results are slightly more exaggerated, with almost a full additional mean line drop (2 vs. 2.95 lines.) Conclusions: A significant reduction in visual acuity was noted with reduced lighting in this population of normally sighted healthy individuals. Providing adequate lighting conditions optimizes visual acuity for tasks such as reading. This is an inexpensive and easily administered test to evaluate visual performance under dim light conditions. Pathological conditions are often felt to decrease functional performance in subdued lighting. This data can serve as a baseline for comparisons. Commercial Relationships: David T. Hamilton, None Program Number: 2753 Poster Board Number: B0007 Presentation Time: 8:30 AM - 10:15 AM Luminance in Acuity and Reading Performance of Low Vision Patients Donald C. Fletcher1, 2, Laura Renninger2, Ronald A. Schuchard3. 1 Ophthalmology, California Pacific Medical Center, San Francisco, CA; 2Smith-Kettlewell Eye Research Institute, San Francisco, CA; 3 VAPAHCS, Stanford University, Palo Alto, CA. Purpose: To assess the role of luminance in low vision patients for visual function tests. Methods: 152 consecutive low vision patients had assessment of visual acuity (VA) with habitual correction and with a 4% transmission gray filter on the ETDRS chart at 1 meter. Reading acuity on the MN Read was performed in room light and then with 125 (low) and 2070 Lux (high) additional lighting. Central visual field (CCVFT) was also performed. All tests were done binocularly. Results: Patient age median (range) was 82 (13 - 101) years with 63% female. All patients were referred for low vision rehabilitation with 89% having the diagnosis of a maculopathy. Visual acuity with habitual correction median (range) was 20/100 (20/20 - 20/1000). ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Visual acuity with a 4% transmission gray filter over habitual correction median (range) was 20/220 (20/20 - 20/2000). Change in visual acuity with the decreased luminance was median (range) 2 lines decrease (plus 2 - minus 10 lines). On the MN Read test the low additional light gave no performance increase in 44% of patients, a one block increase in 50% and a 2 block increase in 6%; the high additional light gave no performance increase in 12% of patients, a one block increase in 29% and a 2 block increase in 32% and a greater than 2 block increase in 27% with up to an 8 block increase in one patient. Ring scotoma patients (25) improved 1 block (range 0 2) on the MN Read with low additional light and 4 blocks (range 1 8) with high additional light. Non ring-scotoma patients (107) improved 0 blocks (range 0 - 2) on the MN Read with low light and 2 blocks (range 0 - 5) with high light. There is a significant moderate correlation between the lines lost with the filters and improvement with additional lighting - 125 Lux (r = 0.30) and 2070 Lux (r = .49). Of particular interest, patients with ring scotomas had the largest improvements in reading with extra light. Conclusions: There is a significant tendency for acuity to drop with decreased luminance and this had some tendency to predict response to extra light. There was a consistent positive improvement in reading acuity with extra light and especially with very bright light. All patients and particularly those with ring scotomas should have trials with very bright illumination in their rehabilitation program. Commercial Relationships: Donald C. Fletcher, Precision Vision (R); Laura Renninger, None; Ronald A. Schuchard, QLT Inc. (C) Program Number: 2754 Poster Board Number: B0008 Presentation Time: 8:30 AM - 10:15 AM SK-Read performance as a predictor of handwriting difficulty in low vision patients Ken Downes1, 2, Donald C. Fletcher1, 2, Laura Renninger2. 1 Ophthalmology, California Pacific Medical Center, San Francisco, CA; 2Smith-Kettlewell Eye Research Institute, San Francisco, CA. Purpose: To assess whether performance on the Smith-Kettlewell Reading (SK-Read) Test is a reliable predictor of handwriting in low vision patients. Methods: We performed a prospective cohort study of 31 low vision patients at their initial low vision rehabilitation evaluation. The patients completed all components of a routine low vision appointment including logMAR acuity measurement, performed the SK-Read Test (a non-conextual reading test), and performed a handwriting task. Patients were timed while performing each task and their accuracy was recorded. The handwriting task was performed by having patients write five five-letter words into sets of boxes where each letter is separated by a box. The boxes were 15mm x 15mm and accuracy was scored with 50 points possible from 25 letters - one point for each letter within the confines of a box and 1 point if the letter was legible. The variables reported on are SK-Read errors per block, SK-Read time per block, logMAR acuity, and handwriting task time-to-accuracy ratio. Correlation analysis was performed to examine the association between each pair of variables. Results: 31 low vision patients participated in the study. Median age was 81.5 years (range: 54-97). 27/31 patients (87%) had ARMD or some other maculopathy while 3/31 patients (13%) had visual impairment from media opacity or neurological impairment. Median Snellen Acuity was 20/152 (range: 20/22-20/1000) and median logMAR acuity was 0.88 (range: 0.04-1.70). SK-Read errors per block correlated with logMAR acuity (r= 0.55, p<< 0.01) and SKRead time per block correlated with logMAR acuity (r=0.38, p=0.03). SK-Read errors per block correlated with handwriting task time-toaccuracy ratio (r=0.68, p<< 0.01). SK-Read time per block correlated with handwriting task time-to-accuracy ratio (r=0.84, p<<0.01). LogMAR acuity score correlated with handwriting task time-toaccuracy ratio (r=0.35, p=0.053). Conclusions: SK-Read may be a more reliable predictor of handwriting performance than logMAR acuity in low vision patients. SK Read difficulty has been associated with presence of central scotomas which may also be associated with difficulty in visually guided motor activity. Further study is warranted to examine the implications of SK-Read performance on vision-related disability in low vision patients. Commercial Relationships: Ken Downes, None; Donald C. Fletcher, Precision Vision (R); Laura Renninger, None Program Number: 2755 Poster Board Number: B0009 Presentation Time: 8:30 AM - 10:15 AM Using Mirametrix Eye Tracking Technology to Evaluate Eccentric Reading Joseph J. Zinkovich1, Erika Anderson2, Erin Doxtader2, Michelle Nguyen2. 1School of Optometry, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA; 2Arizona College of Optometry, Midwestern University, Glendale, AZ. Purpose: The aims of the present study were two-fold: 1. To develop and evaluate methods of utilizing a Mirametrix eye tracker to evaluate eccentric reading. 2. To compare eccentric viewing results with published anatomical descriptions of the fovea. Methods: Using binocular point of gaze (POG) data captured on Cartesian coordinates, eccentric viewing (EV) distances (by step approach in four directions), and eccentric reading (ER; by dynamically presenting and hiding words in the four directions), were evaluated in 3 subjects. Results: The average distances and standard deviations for EV were: inferior: 27.3mm ±2.92; superior: 28.0 ±2.67; right: 43.25 ±2.55; left: 43.92 ±2.76. ANOVA analysis provides sufficient evidence to suggest that the EV distances between three subjects are the same for inferior (p=0.99), superior (p=0.40), right (p=0.98), however, for left, it was the same for two of the three subjects (p=0.46). Analysis suggests that ER difficulty is the same for inferior versus superior (p=0.34), right versus left (p=0.65), but different for vertical versus horizontal meridian (p<0.001). Conclusions: EV was similar among subjects except when using left retina for one subject, which we believe shows the identification of the subject’s history of a binocular vision problem. The vertical to horizontal ratio (0.634) of our findings is similar to the anatomical ratio (0.667) of the fovea. The use of vertical directions during ER is similar in terms of distance and difficulty, as is the horizontal directions, but markedly differing between the two. Preliminary use of the Mirametrix eye tracker along with our methodology proves to be a useful research or clinical tool. Commercial Relationships: Joseph J. Zinkovich, None; Erika Anderson, None; Erin Doxtader, None; Michelle Nguyen, None Program Number: 2756 Poster Board Number: B0010 Presentation Time: 8:30 AM - 10:15 AM Search during Word Recognition in Visual Noise with the Laser Scanning Digital Camera Stimulator Elli J. Kollbaum1, Christopher A. Clark1, Bryan P. Haggerty1, Benno L. Petrig1, 2, Ann E. Elsner1, 2. 1School of Optometry, Indiana University, Bloomington, IN; 2Aeon Imaging, LLC, Bloomington, IN. Purpose: In this study we analyzed the visual search pattern of naive subjects during a novel word recognition task. Varied levels of contrast were presented by adding visual noise to word and background in the Laser Scanning Digital Camera Stimulator (LSDCS). The stimuli were designed to simulate widespread internal visual ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics noise found in ocular and neurological disease, as opposed to focal pathology. Methods: The 11 subjects included 4 male and 7 female, ages 22 - 50 yr with visual acuity of 20/20. The stimulus was a 20/200 optotype, 2 - 3 syllable word in Arial font presented centrally in the LSDC-S. A 16 word list was generated from the Low Vision Training Manual (Quillman). The LSDC-S is a slit scanning imager that provides a high contrast, 11 Hz and 36 deg retinal image, 860 nm at 2 mW at the cornea. The visual stimuli were projected by a digital light projector in Maxwellian view, with linked stimulus and retinal image focus. The background illuminance and the contrast for stimuli and background matched Goldmann perimetry, 1.5 log units. Levels of noise, at a fixed spatial frequency, were presented with the words, starting with 9% and then lowered by 3% over 4 levels until the word was recognized. The trial was stopped if recognition did not occur in 6 sec, and the time to recognition was recorded for the final trial. Fixation and sample scan patterns were evaluated from the x, y coordinates of a retinal image feature over time, plus the probability of accuracy. Results: Despite the large letter size, this task was difficult for all subjects, who recognized no words with noise > 6% contrast. The average jump in scanning on the x axis was 2.62X larger than for y (p<0.0001). However, the jump size varied, 3.31X to 2.10X for the highest vs. lowest contrasts. One prominent search pattern was to stay at a specific point on the x axis, scan along the y axis, then jump to the next x axis locus. In a subset of the data, the eye movements for two hard words differed from two easy words, (p= 0.006). Smaller jumps were typical for difficult words, “learned” than easier words, “morning.” Conclusions: The LSDC-S word recognition task is a novel visual assessment method with varied noise contrast levels. Analysis of fixation reveals both word difficulty and directional differences in search patterns. These data may assist in reading assessment and associated rehabilitation. Commercial Relationships: Elli J. Kollbaum, None; Christopher A. Clark, None; Bryan P. Haggerty, None; Benno L. Petrig, Aeon Imaging LLC (E), Aeon Imaging LLC (P); Ann E. Elsner, Aeon Imaging, LLC (I), Aeon Imaging, LLC (F), Aeon Imaging, LLC (P) Support: NIH/NEI EY018772 Program Number: 2757 Poster Board Number: B0011 Presentation Time: 8:30 AM - 10:15 AM Low-power Half Lens Prisms For The Rehabilitation Of Hemianopia Giovanni Sato1, Roberta Rizzo1, Gianfrancesco M. Villani2, 1. 1Centro di Riabilitazione Visiva, Ulss16, Ospedale S. Antonio, Padova, Italy; 2 Ophthalmology, Centro Riabilitazione Ipovedenti e Microperimetria - CRIM, Castel d'Azzano, Italy. Purpose: To evaluate the expansion of visual fields in hemianopia after binocular application of low-power prisms Methods: Retrospective study of 26 patients with different types of hemianopic defects secondary to cerebral lesions: 10 with right homonymous hemianopia, 11 with left homonymous hemianopia, 2 with upper-right homonymous quadrantopsia, 1 with lower-right homonymous quadrantopsia, 1 with bitemporal heteronymous hemianopia, 1 with a complex type of hemianopic defect combined with hemianopic macular scotoma. Evaluation included ETDRS BCVA at 4m, Greene Test, Humphrey visual field test 30-2, and Esterman binocular visual field test before and after application of binocular correction with low-power half lens prisms (≤10 prismatic diopters) with the base placed towards the blind site. Main outcome measures were tolerance to prisms and expansion of Esterman binocular grid. To measure personal satisfaction, a custom questionnaire for visual adaptation to prism lenses and the Environmental Social State test (ESS) were used Results: Age median (range) was 54 (19-83) years, and BCVA was 0 (0-2) logMAR. Prismatic correction ranged from 8 to 2 prismatic diopters (median 6 D). Esterman binocular visual field on the meridian of greater involvement measured 80° median (range 40100°) before treatment, and 100° (50-120°) after the application of prismatic lenses. The median of visual field expansion was 10° (range 5-35°). Tolerance as reported by patients about the use of prisms during the activities of daily living was high in all but 2 patients: so, 24 patients (92.3%) wore prisms all day. Among these, only one patient complained about image displacement. Orientation and mobility improvement was the most frequent achievement, and 7 patients regained their driving license. Patients also reported reading with more ease Conclusions: Low-power half lens prisms for the rehabilitation of hemianopia resulted in an expansion of binocular visual fields and were well tolerated by a great majority of patients, so that prisms were worn all day in 92.3%. The highest satisfaction was reported about the increase in orientation and mobility (7 patients had their driving license back!), and in reading endurance Commercial Relationships: Giovanni Sato, None; Roberta Rizzo, None; Gianfrancesco M. Villani, Letter Scotometry/Marte srl © TX0007576130 / 2012-04-25 (P) Program Number: 2758 Poster Board Number: B0012 Presentation Time: 8:30 AM - 10:15 AM Peripheral Prisms Increase Blindside Eye And Head Scanning Movements During Outdoor Walking In Hemianopes: Preliminary Results Matteo Tomasi, Jeffrey Churchill, Jean Paul Wiegand, Kevin Houston, Eli Peli, Alexandra R. Bowers, Gang Luo. Schepens Eye Research Institute, Boston, MA. Purpose: Peripheral prism glasses are used as a field expansion device for hemianopia. As the field expansion is always present at all lateral gaze positions (unlike other designs), it should provide a constant stimulus to initiate eye and/or head movements to the blind side. We tested the hypothesis that peripheral prisms would increase eye and head scanning movements toward the blind hemifield in an outdoor walking task (as gaze behaviors in lab-based tasks may not be representative of those in a natural environment). Methods: To date 7 people with homonymous hemianopia walked 0.8-mile routes on busy downtown streets, with and without prism glasses, on two occasions: immediately after receiving peripheral prism glasses and 1.5 months later. Between the two visits, each subject received 12 hours of in-lab perceptual-motor training with the prism glasses and wore the device at home on a daily basis. During the walks, their eye and head movements were recorded using a head mounted eye tracker and inertial motion sensors, respectively. We defined the neutral point as the most frequent sample of the distribution for eye movements, and the standard anatomical position for head movements. We analyzed the eye/head movements within the blind and seeing sides (with respect to the neutral point) as the sum of the amplitudes divided by the total number of samples. A 10° range around the neutral point was excluded to minimize the impact of random and less-meaningful fluctuations. A repeated-measures ANOVA was used to evaluate the effects of prism (with/without), side (seeing/blind) and training (pre/post). Results: Patients had a trend to bias their eye-in-head position towards the blind side when wearing the prisms but not when walking without them (prism-by-side interaction p = 0.081). After training, there was a trend for patients to increase their head turns towards the blind side when wearing the prisms (prism-by-training ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics interaction p=0.070). However, the overall distribution (standard deviation) of eye positions appeared to be narrower after training (from 12.7° to 11.2°, p=0.081) suggesting that there might be an environmental learning effect. Conclusions: Preliminary results from this study suggest that peripheral-prism glasses may increase scanning toward the blind side in patients with hemianopia; recruitment is ongoing to increase the sample size. Commercial Relationships: Matteo Tomasi, None; Jeffrey Churchill, None; Jean Paul Wiegand, None; Kevin Houston, None; Eli Peli, Alcon Research , Ltd, Tx (C), Chadwick Optical (P), Emerald Events (R), Google (C), Nintendo of America (C), ReVision Optics, CA (C), SuperFocus (C), Trivisio Prototyping Gmbh (C), VisionCare Inc (C), Butler Law Group (C), Dillon & Findley, P.C. (C); Alexandra R. Bowers, None; Gang Luo, None Support: NIH grant 2K12EY016335-06, DoD grant DM090420, Harvard Milton Award Program Number: 2759 Poster Board Number: B0013 Presentation Time: 8:30 AM - 10:15 AM Perceptual-motor adaptation in hemianopes wearing peripheral prisms is possible: Preliminary results Kevin Houston1, 2, Jeffrey Churchill2, Jean Paul Wiegand2, Eli Peli2, 3 , Gang Luo2, 3, Robert B. Goldstein2, 3, Russell L. Woods2, 3, Alexandra R. Bowers2, 3. 1Ophthalmology, Massachusetts Eye and Ear, Boston, MA; 2Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, MA; 3Ophthalmology, Harvard Medical School, Cambridge, MA. Purpose: For hemianopia, peripheral prism (p-prism) glasses are used to optically shift peripheral areas of the blind hemifield 20°-30° toward the seeing side. This improves detection immediately however perceived location of prism side obstacles is incorrect. With general wear, some hemianopes make cognitive corrections for the displacement, but perceptual adaptation does not occur (Giorgi et al 2009). We are conducting a pilot study to evaluate whether intensive perceptual-motor training improves adaptation and generalizes to improved collision judgments in a walking simulator. Methods: Seven hemianopes wearing 57Δ oblique p-prisms received 120 minutes of computerized training over 3 weeks consisting of reaching out to touch peripheral stimuli presented on a touch screen under fixed gaze conditions. Training included 5 levels of difficulty starting with slow but accurate reaching to blind side stimuli (level 1), reaching to stimuli in both hemifields (level 2), increasing speed (level 3), cognitive loading (level 4), and use of background visual cues (level 5). Collision judgment data under fixed gaze conditions were collected in a video walking simulator before and after training. Results: Touch accuracy error to targets presented in prism areas improved significantly (p=0.02) from median (x,y) (17°, 6°) to (1° , 0.5°) (equivalent to seeing-side accuracy). The median difference between seeing and prism side reaction times reduced significantly (p=0.04) from 880ms to 110ms. Preliminary analyses of collision judgment data suggest no or only modest improvements in performance post-training. Conclusions: These pilot data suggest that hemianopes wearing pprisms can be trained to perform similarly on the blind and seeing side during a perceptual-motor task. We suspect the mechanism of adaptation for most participants was realignment of the felt position of the arm (as opposed to retinotopic coordinates), and so did not generalize. We are developing pre- and post- test measures to investigating this hypothesis by looking for transfer to the untrained hand. Commercial Relationships: Kevin Houston, None; Jeffrey Churchill, None; Jean Paul Wiegand, None; Eli Peli, Alcon Research , Ltd, Tx (C), Chadwick Optical (P), Emerald Events (R), Google (C), Nintendo of America (C), ReVision Optics, CA (C), SuperFocus (C), Trivisio Prototyping Gmbh (C), VisionCare Inc (C), Butler Law Group (C), Dillon & Findley, P.C. (C); Gang Luo, None; Robert B. Goldstein, None; Russell L. Woods, None; Alexandra R. Bowers, None Support: NIH grant 2K12EY016335-06, EY12890 and DoD grant DM090420, W81WXH-07-2-0038 Program Number: 2760 Poster Board Number: B0014 Presentation Time: 8:30 AM - 10:15 AM Contrast Sensitivity (CS) test-retest reliability and consistency with Vector Vision CSV-1000LVand CSV-1000HGT in patients with Albinism Maria Cucuras1, Susan Kelly2, Faheemah Saeed3. 1Illinois College of Optometry, Chicago, IL; 2Illinois College of Optometry, Chicago, IL; 3 Illinois College of Optometry, Chicago, IL. Purpose: The ability to accurately monitor the disease status or improve the visual function of low vision patients requires reliable and repeatable vision tests. It is generally accepted that measures of visual function in the low vision patient population are more variable than normally sighted individuals. This may decrease the reliability of standard visual tests when applied to a population such as albinism. The purpose of our study is to determine whether one such test of visual function, contrast sensitivity, could reliably be measured in this population both in the presence of glare and without. Methods: CS was tested with Vector Vision CSV-1000 LV which is a low vision letter chart and the CSV-1000HGT (halogen glare test) which tests CS in the presence of glare. Thirteen subjects with albinism with best corrected logMAR visual acuity (VA) ranging from 0.4 to 0.9, participated in this study. LogMAR VA was tested using the EDTRS chart. Dependent variables including CS under normal test condition and CS with glare, were tested at two different visits, 3 months apart. The CSV1000LV chart was used to measure CS while the CSV1000HGT was utilized to measure the effect of glare on CS. Test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Results: A significant test-retest reliability was determined according to the ICC values calculated for both CS measured without and with glare (ICC=0.864, p<0.001; ICC=0.455, p= .048) respectively. Conclusions: CS in patients with albinism, as tested with Vector Vision CSV-1000LV and CSV-1000HG is repeatable and consistent, indicating that this test is a reliable tool for measuring visual function in this particular low vision population. Commercial Relationships: Maria Cucuras, None; Susan Kelly, None; Faheemah Saeed, None Program Number: 2761 Poster Board Number: B0015 Presentation Time: 8:30 AM - 10:15 AM Analyses of contrast sensitivity assessments over time: A pilot study Xi Chen, Luis A. Lesmes, Jennifer Wallis, Thomas S. Wallis, Mary Lou Jackson, Peter Bex. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: The contrast sensitivity function (CSF) provides a useful functional endpoint for development of ophthalmic drugs and devices. Evaluation of CSF assessment over time is critical for tracking the progression or remediation of CSF deficits. In this pilot study, we examined a series of repeated CSF assessments, to evaluate method reliability, and examine trends (such as learning) using a time-based analysis that may be useful for future evaluation of clinical therapies. Methods: In 5 subjects with corrected-to-normal vision (ages ranging ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics from 20 to 57), we tested contrast sensitivity weekly over a 4-8-week period with the novel quick CSF method (Lesmes et al, 2010) and established contrast sensitivity charts (Pelli-Robson and Vistech). To assess reliability, two runs of 20 quick CSF trials were collected at each session, and each run lasted approximately 3 minutes. We focused on the general contrast sensitivity assessment provided by the area under the log CSF (AULCSF). Results: The AULCSF values demonstrated excellent test-retest reliability (r = 0.91) between runs, averaged across weeks. The coefficient of variation (sd/mean) for within-session difference scores <12%. We applied a Bayesian hierarchical linear model to analyze the AULCSF values, with model terms that signified learning patterns: either changes across weeks or across runs in the same session. The significant differences observed between subjects were expected age-related effects, though Pelli-Robson and Vistech exhibited no difference across observers. The stability of CSF assessments between and within repeated testing sessions was confirmed by slope coefficient estimates that were not credibly different from zero at the population level. Conclusions: For clinical studies using contrast sensitivity endpoints, it is critical to evaluate trends over time. The current study demonstrated that the quick CSF method provides reliable contrast sensitivity assessments using a statistical framework based on a hierarchical analysis. Together, these tools demonstrate potential for future studies that identify the progression of visual impairment, or its remediation with therapeutic intervention. Commercial Relationships: Xi Chen, None; Luis A. Lesmes, Adaptive Sensory Technology (S), 7938538 (P); Jennifer Wallis, None; Thomas S. Wallis, None; Mary Lou Jackson, None; Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: RO1EY01928 Program Number: 2762 Poster Board Number: B0016 Presentation Time: 8:30 AM - 10:15 AM The Reliability of the quick CSF Method for Contrast Sensitivity Assessment in Low Vision Luis A. Lesmes, Jennifer Wallis, Mary Lou Jackson, Peter Bex. Dept of Ophthalmology, Mass Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Purpose: The contrast sensitivity function (CSF) presents a better characteristic of functional vision than visual acuity. The quick CSF is a novel adaptive method that greatly reduces CSF testing times, using Bayesian adaptive inference and a trial-to-trial information gain strategy. In an application of the quick CSF to assess low vision (Lesmes et al, ARVO 2012), we reported that only 2-3 minutes (15 trials) were needed to obtain estimates of the area under the log CSF (AULCSF), which were correlated with Pelli-Robson contrast sensitivity. The current study was designed to complement the previous demonstration of method accuracy, and assess method reliability using repeated measurements in patients with normal and impaired vision. Methods: CSF assessments were obtained from people with normal and impaired vision. Each observer completed two CSF tests (~3 minutes each). Reliability was assessed via the AULCSF difference scores, calculated between estimates obtained from repeated CSF assessments. Results: Two important results were: (1) AULCSF estimates obtained in normal vision were slightly more reliable than those in impaired vision and (2) in both groups, AULCSF estimates demonstrated greater reliability with increasing test length. For normal vision, differences between repeated AULCSF estimates exhibited a coefficient of variation (CV) of ~15% after 15 trials and <10% after 20 trials. For impaired vision, CV values were ~20% after 15 trials and <15% after 20 trials. This level of variability, considered between repeated measurements, is small when compared to the individual differences (population variability) in sensitivity exhibited in either the normal or impaired vision groups. Conclusions: These results suggest that the quick CSF provides a rapid and reliable contrast sensitivity assessment in normal and impaired vision. The broad contrast sensitivity measure provided by the AULCSF, which can be assessed in a short, clinically practical testing time, demonstrates potential value as a functional endpoint for clinical practice and clinical trials. Commercial Relationships: Luis A. Lesmes, Adaptive Sensory Technology (S), 7938538 (P); Jennifer Wallis, None; Mary Lou Jackson, None; Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Support: EY019281 Program Number: 2763 Poster Board Number: B0017 Presentation Time: 8:30 AM - 10:15 AM Contrast Sensitivity Measurement in the Pediatric Low Vision Setting Gregory R. Hopkins, Angela M. Brown. College of Optometry, The Ohio State University, Columbus, OH. Purpose: A new test of contrast sensitivity (CS), the Stripe Cards of Contrast Sensitivity (SCCS) test, can serve as a simple and efficient means for estimating the maximum contrast sensitivity value of a given patient without having to use multiple spatial frequency gratings, and without knowing the spatial frequency at which maximum sensitivity occurs. This test could be useful for a wide range of patients with various levels of visual acuity (VA), ages, and diagnoses. Methods: We measured VA [Bailey-Lovie (BL), Teller Acuity Cards (TAC)] and CS [Pelli-Robson (PR), SCCS] in counterbalanced order of 26 subjects at the Ohio State School for the Blind. Thus, we tested VA and CS using letter charts (BL, PR) and grating cards (TAC, SCCS). Testing distance was 58 cm for the grating cards, and was adjusted based upon nominal visual acuity for letter charts. Subjects used the dominant or better eye only. Letter chart scoring was letterby-letter with no substitutions. Time of testing was recorded for each test. Results: Measurements were obtained on 24 (92%) subjects using all four tests. Two additional subjects could not read letter charts, but were able to complete the TAC and SCCS. Median acuity values were: 1.09 [interquartile range (IQR)=0.71-1.41] for B-L, 0.59 [IQR=0.34-0.82] for TAC. Median log CS was 1.38 [IQR=0.81-1.75] for P-R. The SCCS test showed a ceiling effect, with 65% of subjects scoring the maximum CS (1.65); the upper quartile value was 1.35. The subjects with impaired CS on the PR (according the WHO standards, PR<1.65) showed reliably better sensitivity on the SCCS test than the PR test (sign test, p= 0.002, 2-tailed; nonparametric test required because of the ceiling effect on the SCCS). All subjects had impaired VA, and they showed reliably better TAC acuity than logMAR acuity (Paired t-test, p=0.001, 2-tailed, no ceiling effect). Testing times averaged 54 ± 33 sec (B-L) and 96 ± 65 sec for TAC, averaged 61 ± 42 sec for P-R and 58 ± 46 sec for SCCS. Conclusions: Both of the grating tests (SCCS and TAC) gave better sensitivity than the corresponding letter charts for subjects with reduced vision. For measuring contrast sensitivity in those with reduced vision, the simpler task and bolder patterns of the SCCS may make it more likely to reveal the maximum performance that a given patient can achieve. Commercial Relationships: Gregory R. Hopkins, None; Angela M. Brown, Precision-Vision (P) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Support: NEI Grant: R41EY022545-01 Program Number: 2764 Poster Board Number: B0018 Presentation Time: 8:30 AM - 10:15 AM Feedback measures for a wearable visual aid designed for the visually impaired Aminat Adebiyi1, James D. Weiland1, 2, Carey Zhang1, 3, Kaveri Thakoor4. 1Biomedical Engineering, University of Southern California, Los Angeles, CA; 2Ophthalmology, University of Southern California, Los Angeles, CA; 3Electrical Engineering, University of Southern California, Los Angeles, CA; 4Neuroscience Graduate Program, University of Southern California, Los Angeles, CA. Purpose: To test the viability of a voice-driven feedback system to assist low-vision subjects with mobility. Methods: The audible feedback system consists of audio boneconduction headphones worn by the user behind the ear and a custom Android application, which delivers commands to the user when a researcher presses a button corresponding to that command on the program. Two low-vision subjects were recruited from the Braille Institute, Los Angeles. Wearing the audible feedback system, subjects were steered around a three minute randomized course five times by a researcher, who gave commands that were randomized by trial. Commands included ‘forward’, ‘veer left’, ‘turn left’, ‘veer right’, turn right’ and ‘stop’. The course measured 17ft X17ft and was interspersed with one foot cones every five feet. Appropriate response to commands, angle of turns and reaction time were measured. Subjects were also given an exit survey that measured the usability of the feedback system. The Android application recorded a time stamp for each command and video footage was recorded for each trial. Results: Subject one had an average of 71.80% responses consistent with commands, whereas subject two had an average of 53.18% responses consistent with commands; although subject two showed a higher range in improvement over the course of the trials. Both subjects had an average of 95% positive compliance to the ‘forward’ and ‘stop’ commands, and less than 5% compliance to the ‘veer left’ and ‘veer right’ commands. Subject one had an average reaction time of 1.5 seconds, whereas subject two had an average reaction time of 2.5 seconds. Both subjects had an average turning radius of approximately 70 degrees for the ‘turn right and ‘turn left’ commands. Based on the system usability scale, the system was determined to be 90% useable in its current condition. Conclusions: Judging by the reactions times and the system usability scale, the audible feedback system seems to be an intuitive solution that will create a balanced connection between the user and the feedback controller. However, significant training is needed to maximize appropriate responses by its users to the commands provided Commercial Relationships: Aminat Adebiyi, None; James D. Weiland, Second Sight Medical Products, Inc. (F); Carey Zhang, None; Kaveri Thakoor, None Support: Research to Prevent Blindness, W.M. Keck Foundation, USAMRMC-W81XWH-10-2-0076 Program Number: 2765 Poster Board Number: B0019 Presentation Time: 8:30 AM - 10:15 AM LOCOMOTION IN LOW LUMINANCE WITH NON IMMERSIVE HEAD MOUNTED DEVICE FOR PATIENTS WITH NIGHT BLINDNESS Coen Cecilia1, Caroline Chauvire1, Guillaume Le Gall2, Arnaud Koustanai1, Marion Swital2, Laurence Bernardini1, Philippe Chaumet-Riffaud1, 3, Saddek Mohand-Said1, Jose A. Sahel1, Avinoam B. Safran1. 1INSERM, U968; UPMC Univ Paris 06, UMR_S 968, Institut de la Vision; CNRS, UMR_7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France; 2Essilor R&D Internationnal, Paris, France; 3Univ Paris Sud, AP-HP, CHU Bicêtre, EA 4046, Paris, France. Purpose: Retinitis pigmentosa (RP) is characteristically associated with reduced dark adaptation, which may lead to difficulties for locomotion in dim light specially when lighting abruptly decreases. We tested a non immersive Head Mounted Display (HMD) providing a luminance-enhanced video image to determine its value for affected individuals in dim light condition. Methods: Nine RP patients were enrolled (age from 23 to 81 years, mean 43). All patients complained of altered dark adaptation. We evaluted visual acuity (VA), horizontal binocular visual field (VF) and dark adaptometry (Goldmann-Weekers - GW). We tested a nonimmersive HMD (Essilor Int., Institut de la Vision, Paris, France; Lumus, Rehovot, Israel), which provides a processed video image displayed on transparent lenses. Image was a luminance-enhanced view of the surrounding environment. Patients were asked to walk along a straight corridor (white walls and floor, 30 meters long). Five conditions were explored as follows: (1) in a clear corridor in photopic condition (700 lux), and (2) in dim light (5 lux); (3) in a corridor with 6 obstacles (white boxes 30x35x55cm) laid out on the floor in photopic, (4) and dim light. The last condition (5) in a corridor with 6 obstacles, in dim light, was tested using the HMD. The walking speed was measured 3 times in each condition. Spatial disposition of obstacles was modified between consecutive trials. Patients were exposed to photopic lighting during 5 min before each trial to prevent dark adaptation. Results: Four of nine patients performed better using the HMD than without: between-groups comparison showed that these four patients increased their walking speed when obstacles were laid out in dim light (mean walking speed without HMD = 0.35 m/s; SD = 0.07, mean walking speed with HMD = 0.47 m/s; SD = 0.06) ;( F (4,152) =12.1; p<.01). For these four subjects, alteration in dark adaptation reduction in VA and VF were more pronounced than for the remaining patients. Conclusions: Significant HMD benefits were observed in patients demonstrating severe handicap in dim light. However, in patients suffering to a lesser degree from night-blindness, the device did not prove to be invaluable. Commercial Relationships: Coen Cecilia, None; Caroline Chauvire, None; Guillaume Le Gall, Essilor International (E); Arnaud Koustanai, None; Marion Swital, Essilor International (E); Laurence Bernardini, None; Philippe Chaumet-Riffaud, None; Saddek Mohand-Said, None; Jose A. Sahel, UPMC/Essilor (P), Second Sight (F); Avinoam B. Safran, essilor (F) Program Number: 2766 Poster Board Number: B0020 Presentation Time: 8:30 AM - 10:15 AM Object identification by retinitis pigmentosa patients in dim light, using a Head Mounted Display Marion Swital2, Coen Cecilia1, Caroline Chauvire1, Arnaud Koustanai1, Guillaume Le Gall2, Sihem Kime1, Philippe ChaumetRiffaud1, 3, Saddek Mohand-Said1, Jose A. Sahel1, Avinoam B. Safran1. 1INSERM, U968; UPMC Univ Paris 06, UMR_S 968, Institut de la Vision; CNRS, UMR_7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France; 2R&D, Essilor International, Paris, France; 3Univ Paris Sud, AP-HP, CHU Bicêtre, EA 4046, Paris, France. Purpose: Retinitis pigmentosa (RP) results in peripheral vision loss and reduced, delayed dark-adaptation. In this study we assessed with affected individuals in dim light, the value of enhanced luminance ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics image processing using a Head Mounted Display (HMD), to locate and identify objects. Methods: We enrolled 12 patients with RP, complaining of night blindness to various degrees, (23 to 81 years old, mean = 43; visual acuity (VA) = -0.1 to +0.5 logMAR, mean = +0.15; horizontal visual field = 20° to 180°, mean = 52°). Dark-adaptation threshold was assessed with Goldmann-Weekers adaptometer. We used a non-immersive HMD (Lumus, Israel; Essilor Int. and Institut de la Vision, Paris) which provides a luminance-enhanced video image, displayed through transparent lenses. The experiment took place in a living room, including regular furniture. Before starting the evaluation, the tested subject viewed the furniture setting in photopic lighting condition (700 lux). Then, the subject turned his back on the scene, and the experimenter placed nine objects on various locations. Eventually lighting was abruptly reduced to 3 lux, and the, subject was asked to identify all added objects as quickly as possible. Trials were repeated three times, with and without the HMD. Between two consecutive trials, object locations were changed, and the subject was exposed to photopic condition during 5 minutes to prevent dark adaptation. The number of objects and the detection time were recorded. Results: To identify the presented objects, four of 12 patients performed better using the HMD than without it (F(1,54) = 8.05; p < .01). In this group, three subjects had time-savings of mean 45.6 s with the HMD and two subjects were able to recognize more objects with the HMD (mean= 4.7). For these four subjects, alteration in dark adaptation and reduction in VA were more pronounced than for the remaining patients. Conclusions: The luminance-enhanced image provided by the HMD improved object identification, following sudden reduction in lighting for patients with advanced RP. It may prove valuable in daily life, in such lighting conditions. Less affected Individual might also benefit from the HMD in dark environments if a more light-sensitive camera is used. Commercial Relationships: Marion Swital, Essilor International (E); Coen Cecilia, None; Caroline Chauvire, None; Arnaud Koustanai, None; Guillaume Le Gall, Essilor International (E); Sihem Kime, ALTEN SA (E); Philippe Chaumet-Riffaud, None; Saddek Mohand-Said, None; Jose A. Sahel, UPMC/Essilor (P), Second Sight (F); Avinoam B. Safran, essilor (F) Program Number: 2767 Poster Board Number: B0021 Presentation Time: 8:30 AM - 10:15 AM Sensitivity recovery following a bleach; a dual “smiley” arc stimulus technique for studying abnormal dark adaptation Humza J. Tahir1, Ian J. Murray1, David Carden1, Neil R. Parry2. 1 Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom; 2University of Manchester Health Science Research Centre and Vision Science Centre, Manchester Royal Eye Hospital, Manchester, United Kingdom. Purpose: There is much interest in sensitivity recovery under low luminance conditions. The rate of recovery of rod-vision following a bleach is important as it is slowed in the older eye and in many clinical conditions, notably Age-Related Macular Degeneration. It is not known for certain whether this is a pan-retinal effect or if there are localised regions of impaired rod function. To address this a dual arc stimulus was developed that simultaneously samples sensitivity recovery in two retinal locations. Preliminary findings on normal observers are presented. Methods: Arc-shaped white “smiley” stimuli were presented on a black CRT screen at two locations in the inferior visual field. They were 75° segments of annuli with internal and external diameters 5° and 7° (stim 1) or 10° and 12° deg (stim 2). The dynamic range of the CRT was expanded by covering the left half of the screen with a 1.2 log unit neutral density (ND) filter, and the right half with 3.6 log ND. The fixation/stimulus ensemble initially appeared in the left window but shifted rightwards when screen stimulus intensity fell below -1.5 log cd/m2, giving a total filtered luminance range of about 6.5 log units (0.8 to -5.7 log cd/m2). Recovery of sensitivity to the two stimuli was measured simultaneously using method of adjustment by alternately presenting them following a localised bleach of at least 30% using a calibrated photographic flash. Results: In normal observers the dark adaption process is composed of a cone and a rod stage. When the stimuli are approximately matched for photometric sensitivity their dark adaptation curves coincide for the cone branch of the curve and remain separate for the duration of the ‘S2’ stage which, due to the bleach intensity, can be thought of as rate limited (Lamb and Pugh, IOVS, 2006;47;51385152). In some subjects the curves coalesce again for ‘S3’, the third stage of the dark adaptation curve, but not in others indicating a possible dissociation between S2 and S3. Conclusions: This technique allows the measurement of dark adaptation in multiple retinal locations simultaneously using a new PC-based method. Preliminary results show differences in the tested regions. As this new method places little additional demands on subjects it allows for the easy investigation of potential regional differences in impaired rod function in older and diseased eyes. Commercial Relationships: Humza J. Tahir, None; Ian J. Murray, None; David Carden, None; Neil R. Parry, None Support: Nutricious R&D BV Program Number: 2768 Poster Board Number: B0022 Presentation Time: 8:30 AM - 10:15 AM Darks are detected faster and more accurately than lights in normal subjects and patients with moderate glaucoma Linxi Zhao, Mitchell W. Dul, Jose M. Alonso, Stanley J. Komban, Qasim Zaidi. SUNY College of Optometry, New York, NY. Purpose: Previous studies have shown that darks are detected faster and more accurately than lights, when presented in noisy backgrounds (Komban et al., 2011). We investigated how these differences in detection time and accuracy are affected by age and ganglion cell pathology caused by moderate glaucoma. Methods: One eye of 8 glaucoma patients, 11 age-matched controls (50-83 y/o) and 3 young control subjects (23-25 y/o) were tested. Subjects were asked to count the number of light or dark targets superimposed on a white noise background as fast as possible. Each presentation contained 1-3 squared targets of 1° / side, located at random positions within the central 30° of the visual field. A total of 600-800 measures were collected for per subject. Results: We replicate previous findings (Komban et al., 2011) that darks are detected more accurately and faster than lights. We extend these findings by demonstrating that differences in detection time are reliably found across different ages and are also present in subjects with moderate glaucoma. In controls, we demonstrate that detection times increase with age, both for lights (r=0.83, p<0.0001) and darks (r=0.85, p<0.0001) but detection accuracy remains unchanged (lights: r=0.37, p=0.18; darks: r=0.12, p=0.68). The difference in detection time between lights and darks also increases with age (r=0.66, p=0.99). When compared with controls, glaucoma patients showed a significant reduction of 11-15% in detection accuracy (normal/glaucoma, lights: 87.29% / 72.27%, p=0.008, darks: 94.42% / 83.02%, p=0.009, Wilcoxon tests) but not detection time (normal/glaucoma, lights: 2.06 sec / 2.59 sec, p=0.13, darks: 1.47 sec / 1.87 sec, p=0.1, Wilcoxon tests). Differences in accuracy between darks and lights were larger in glaucoma patients but the difference was not large enough to reach significance (normal/glaucoma, 7.14% ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics / 10.75%, p=0.06, Wilcoxon test). Conclusions: Differences in the detection of darks and light are robust, can be demonstrated over a wide range of ages and in patients with retinal ganglion cell disease caused by glaucoma. The finding that patients with glaucoma show a 15% reduction in detection accuracy raises the question of whether a simple detection test could be used to monitor disease progression. Commercial Relationships: Linxi Zhao, None; Mitchell W. Dul, None; Jose M. Alonso, None; Stanley J. Komban, None; Qasim Zaidi, None Support: EY007556, EY007716, EY013312, EY005253, T35EY020481 Program Number: 2769 Poster Board Number: B0023 Presentation Time: 8:30 AM - 10:15 AM Is visual exploration training beneficial in tunnel vision? Iliya V. Ivanov, Annika F. Vollmer, Nhung Nguyen, Susanne Trauzettel-Klosinski. University of Tuebingen, Tuebingen, Germany. Purpose: Tunnel vision is a severe peripheral visual field loss impairing mobility. It has been previously shown that normally sighted subjects exhibit larger horizontal than vertical component of eye position dispersions (standard deviations) while walking and avoiding obstacles in daily life. However, for patients with tunnel vision caused by retinitis pigmentosa (RP), horizontal and vertical components were not found to be significantly different 1. In this study we wanted to test whether visual exploration training is beneficial for RP patients, as in patients with homonymous hemianopia 2. Any efficient eye movement training in RP patients, would result in change of eye-movement pattern- larger horizontal than vertical dispersions. Methods: Patients (n=33) were randomly assigned into three training groups: saccadic (experimental), reading (placebo) or crossover (placebo+experimental). In saccadic training condition, computerbased training extended eye-movement exploration outside of the concentric constriction of the visual field (VF). In reading training condition patients had to read a text that was presented at the center of the screen, one word at time. To assess any effect of training, mobile eye tracker was used to record eye positions while walking in standardized environment (parkour), before and after training. We compared horizontal and vertical eye dispersions of patients in the different experimental groups with a control group of normals (n = 10). Results: Comparable with previous findings, patients who had residual VF < 15° (from fixation) showed equal horizontal and vertical dispersions before training. After training however, patients who received saccadic training showed significantly larger horizontal dispersion (p<0.05). Patients with VF > 15° remained the same. Regardless of their residual VF, patients in placebo group did not show an effect of training: horizontal and vertical dispersions remained unchanged after training. Conclusions: These findings suggest that visual exploration training is highly specific and resulted in significantly increased dynamic VF for the RP patients with VF < 15°. Commercial Relationships: Iliya V. Ivanov, None; Annika F. Vollmer, None; Nhung Nguyen, None; Susanne TrauzettelKlosinski, None Support: Kniese Foundation; Funke Foundation; Stiftung Auge Program Number: 2770 Poster Board Number: B0024 Presentation Time: 8:30 AM - 10:15 AM Is Vernier Acuity more Sensitive than Grating Acuity to Visual Impairment in Adolescents? Huizi Kelly Yin1, Barry S. Kran2, Darick Wright3, Donna D. Bent3, Li Deng2, Dale L. Mayer2. 1Illinois College of Optometry, Chicago, IL; 2 New England College of Optometry, Boston, MA; 3Perkins School, Watertown, MA. Purpose: Vernier acuity, often referred to as a “hyperacuity”, may be more sensitive than grating acuity in detecting visual deficits such as amblyopia in young children. Thus, we compared vernier acuity (VeA) and grating acuity (GA) tests to recognition acuity (RA) in adolescents with visual impairment, hearing loss, and cognitive disabilities. Methods: 24 optometry students from the New England College of Optometry and 10 adolescents (16 eyes) attending Perkins School for the Blind were tested in each eye for RA (crowded letters), VeA (Drover et al OVS 2010) and GA (Teller Acuity Cards) in 2 sessions. Acuities were analyzed in logMAR. Test-retest reliabilities were examined with Bland-Altman method (bias, 95% Limits of agreement, LOA). To directly compare VeA and GA to RA in adolescents, their raw data were normalized taking the difference from the normal value for age (Delta-Normal, ΔN). ΔNs were analyzed with correlations and means. Results: Adult mean (SD) logMAR acuities (RE, session 1) were: RA -0.11 (0.05) (20/16); VeA: -0.24 (0.15); GA: -0.09 (0.05). Testretest analyses of the adolescent data (in logMAR) showed minimal bias and similar 95% LOA (0.66 for RA; 0.69 for VeA; 0.56 for GA). For adults, test-retest 95% LOA for RA was 0.28 logMAR. Correlations of adolescents’ ΔN for VeA and GA with RA (session1) were significant and similar (VeA with RA, r=0.78; GA with RA, r=0.83). Mean ΔNs were also similar and not significantly different (RA: -0.79±0.34; VeA: -0.89 ± 0.44; GA: -0.76±0.31). Conclusions: Test retest reliabilities are similar for RA, VeA and GA tests in a small sample of adolescents with visual impairment and other disabilities. Normalized VeA and GA acuities have a similar relationship to normalized RA and are not significantly different on average. Thus, vernier acuity may not have an advantage over grating acuity in adolescents with visual impairments due to ocular and neurological causes, who have other disabilities. However, for other causes of visual deficits, for example, amblyopia, vernier acuity may be more sensitive than grating acuity. Vernier acuity cards with stimuli, forming a second-order shape of a six-pointed star or a flower (Drover et al 2010). Acknowledgments: Eileen E. Birch, PhD. and Yi-Zhong Wang, PhD. who provided the stimuli. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics II is responsive to changes in VF resulting from LVR and has the potential to be used as a measure of LVR outcomes in future studies. Commercial Relationships: Vijaya K. Gothwal, None; Rebecca Sumalini, None; Seelam Bharani, None Photograph of examiner testing an adolescent participant with vernier acuity cards. Commercial Relationships: Huizi Kelly Yin, None; Barry S. Kran, None; Darick Wright, None; Donna D. Bent, None; Li Deng, None; Dale L. Mayer, None Support: New England College of Optometry internal research grant Program Number: 2771 Poster Board Number: B0025 Presentation Time: 8:30 AM - 10:15 AM Evaluating the Effectiveness of Low Vision Rehabilitation in Children Vijaya K. Gothwal, Rebecca Sumalini, Seelam Bharani. Meera and L B Deshpande Centre for Sight Enhancement, L V Prasad Eye Institute, Hyderabad, India. Purpose: Approximately 90% of patients with visual impairment (VI) have adequate residual vision to benefit from low vision rehabilitation (LVR). However, good evidence on LVR outcomes is required to guide service development and improve the lives of people with VI. Studies in adults with VI have demonstrated an improvement in the overall visual functioning (VF) and quality of life after LVR. Nonetheless, such effects are yet to be demonstrated in children with VI. The aim of this study was to evaluate the effectiveness of a multidisciplinary LVR program on VF using the LV Prasad-Functional Vision Questionnaire II (LVP-FVQ II). Methods: First-time referrals to the Centre for Sight Enhancement were assessed before and after LVR (3-4 months). Children were administered the LVP-FVQ II before low vision assessment and at 34 months follow-up to assess the outcomes of LVR. Recently, a second version of the LVP-FVQ (LVP-FVQ II) was developed and was demonstrated to be a reliable and valid measure of VF using Rasch analysis. Rasch analysis was used to estimate the LVP-FVQ II scores on an interval scale. Cohen d values were used to estimate the magnitude of the change and the standardized response mean (SRM) was selected to determine the clinical change of the LVR induced changes. Results: Sixty-three participants completed the rehabilitation (mean age, 11.9 years; male, 62%). Approximately one-half had retinal disorders (48%, 30) and most were moderately visually impaired (<20/60-20/200, 74.6%, 47). Using the LVP-FVQ II, significant improvement in VF was recorded (p<0.0001) after rehabilitation and the increase in VF (SD) was 2.03 (1.68) logits (equivalent to an 8-line improvement in visual acuity on an Early Treatment of Diabetic Retinopathy Study chart). The magnitude of the improvement in LVR intervention at follow-up was found to be relatively large (Cohen’s d = 1.27, SRM = 1.21) indicating large treatment effects both statistically and clinically. By comparison, there was no significant change in VF for the control group (n=41). Conclusions: This is the first study to provide strong evidence that LVR services are effective in children with VI. Significant (both statistically and clinically) improvements in the overall VF in children with VI were found using the LVP-FVQ II. The LVP-FVQ Program Number: 2772 Poster Board Number: B0026 Presentation Time: 8:30 AM - 10:15 AM Quantification and evaluation of bivariate contour ellipse area (BCEA) in different diseases after rehabilitation Francesca Verboschi, Vittoria De Rosa, Chiara Di Crescenzo, Gianmarco Rea, Marco Mafrici, Daniela Domanico, Enzo M. Vingolo. University of Rome "La Sapienza", Latina (LT), Italy. Purpose: To quantify BCEA in different diseases and to evaluate its change after rehabilitation with microperimetric biofeedback. Methods: 64 patients (38 female and 26 male, mean age 75.87 years) were enrolled and 96 eyes were divided into different groups: 16 eyes with dry age-related macular degeneration (group 1), 12 eyes with advanced glaucoma (group 2), 11 eyes with central retinal vein occlusion (group 3), 11 eyes after surgery for macula-off retinal detachment (group 4), 11 eyes with amblyopia (group 5), 13 eyes with myopic maculopathy (group 6), 12 eyes with diabetic maculopathy (group 7), 10 eyes with retinitis pigmentosa (group 8). All the patients underwent the same rehabilitative protocol: microperimetry MP-1 (Nidek technologies, Padova, Italia), threshold strategy 4-2, Goldmann III stimolus, with fixation study that was quantified by calculating the BCEA; 10 training sessions, once a week, 10 minutes for each eye, with microperimetric biofeedback, repeated after 3 months. Statistical analysis was performed using ttest paired, p values less than 0.05 were considered statistically significant. For statistical analysis, BCEA values (deg ) were converted into their logarithms. Results: After the training mean BCEA became from 7.51±2.48 deg to 3.85±2.93 deg in group 1 (p=0.02); mean BCEA became from 4.02±2.83 deg to 0.84±0.48 deg in group 2 (p=0.14); mean BCEA became from 3.72±4.85 deg to 2.18±2.22 deg in group 3 (p=0.42); mean BCEA became from 3.31±2.53 deg to 2.15±1.59 deg in group 4 (p=0.03); mean BCEA became from 3.18±2.55 deg to 2.15±1.32 deg in group 5 (p=0.06); mean BCEA became from 2.22±2.65 deg to 0.45±0.13 deg in group 6 (p=0.05); mean BCEA became from 3.38±3.42 deg to 1.72±1.72 deg in group 7 (p=0.02); mean BCEA became from 1.89±1.40 deg to 0.77±0.26 deg in group 8 (p=0.14). Conclusions: The largest BCEA reduction after the training indicates a greater efficacy of microperimetric biofeedback especially in dry age-related macular degeneration, after surgery for macula-off retinal detachment, myopic maculopathy and diabetic maculopathy compared to glaucoma, central retinal vein occlusion, amblyopia and retinitis pigmentosa. The study of BCEA is useful and more sensitive instrument than Fujii classification to evaluate the stability of fixation especially in diseases with macular involvement. Commercial Relationships: Francesca Verboschi, None; Vittoria De Rosa, None; Chiara Di Crescenzo, None; Gianmarco Rea, None; Marco Mafrici, None; Daniela Domanico, None; Enzo M. Vingolo, None Program Number: 2773 Poster Board Number: B0027 Presentation Time: 8:30 AM - 10:15 AM Comparison of Fixation Stability Measured by Laser Scanning Digital Camera and DLP-Cam Benno L. Petrig1, 2, Jeff Clendenon2, Lisa Ensman1, Matthew S. Muller2, Ann E. Elsner1, Glen Y. Ozawa3, Taras V. Litvin3, Jorge A. Cuadros3, Tuhin Roy3, Danny Li3. 1School of Optometry, Indiana University, Bloomington, IN; 2Aeon Imaging LLC, Bloomington, IN; 3 School of Optometry, UC Berkeley, Berkeley, CA. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Purpose: To compare fixation stability in diabetic patients measured by the laser scanning digital camera (LSDC) and the digital light projector camera (DLP-Cam), using standard deviation of Euclidean distance (ED) and bivariate contour ellipse area (BCEA) as metrics. Methods: Eight diabetic patients (5 male, 3 females, age 48±12 yr) were imaged at the Eastmont Wellness Center, a diabetic retinopathy screening site within the EyePACS telemedicine network, with both the LSDC and the DLP-Cam. LSDC and DLP-Cam have 36 and 33 deg fields, respectively. Light levels at the cornea were 2 mW @ 850 nm, which appeared quite dim, for the LSDC and 42 uW from the green LED, which was bright, for the DLP-Cam. Image buffers of 20 @ 11 fps (LSDC) and 16 @ 17 fps (DLPC) frames were acquired on the same day by the same camera operator. One eye was chosen at random for this analysis. Fixation stability was assessed using the coordinates determined for image registration by the same alignment algorithm. The measurements in pixels were converted to minArc before comparing the LSDC and DLPC results by paired t-tests. Results: The standard deviation of ED for this group of patients was 5.09±3.42 and 5.69±3.25 minArc for LSDC and DLP-Cam, respectively. The BCEA, which typically decreases the effect of outliers, was 2.43±0.41 and 2.43±0.44 log(minArc^2), for LSDC and DLP-Cam, respectively. The differences in fixation stability were not statistically significant by either metric. Conclusions: Both imaging systems provide comparable fixation stability measures, suggesting that the brighter fundus illumination of the DLP-Cam compared to the LSDC does not affect fixation ability. Our alignment algorithms are able to process images taken with either visible or near infrared fundus illumination which are known to emphasize different retinal structures. Commercial Relationships: Benno L. Petrig, Aeon Imaging LLC (E), Aeon Imaging LLC (P); Jeff Clendenon, Aeon Imaging, LLC (E); Lisa Ensman, None; Matthew S. Muller, Aeon Imaging, LLC (I), Aeon Imaging, LLC (P), Aeon Imaging, LLC (R), Aeon Imaging, LLC (S), Indiana University Research and Technology Corporation (P); Ann E. Elsner, Aeon Imaging, LLC (I), Aeon Imaging, LLC (F), Aeon Imaging, LLC (P); Glen Y. Ozawa, None; Taras V. Litvin, None; Jorge A. Cuadros, EyePACS LLC (I); Tuhin Roy, None; Danny Li, None Support: R44EY018772(BLP), R44EY020017(MSM) Program Number: 2774 Poster Board Number: B0028 Presentation Time: 8:30 AM - 10:15 AM Do visually impaired participants hear better? An evaluation of self report using a modified version of Speech, Spatial and Qualities of Hearing Scale Shahina Pardhan1, Silvia Cirstea1, Andrew Kolarik2, 1, Brian Moore2. 1 Vision and Eye Research Unit (VERU), Anglia Ruskin University, Cambridge, United Kingdom; 2Department of Psychology, University of Cambridge, Cambridge, United Kingdom. Purpose: Literature suggests that visually impaired participants may perform better than sighted participants on auditory tasks. This is more apparent in participants with severe visual impairment. However, it is not known whether these participants perceive their hearing to be better than normally sighted participants. We modified the Speech, Spatial and Qualities of Hearing questionnaire for use by visually impaired participants. Visual aspects were removed from ten items, but modifications were kept minimal, so as to maintain the meaning of the original items. The modified questionnaire addresses a large variety of auditory scenarios and assesses situations which visually-impaired participants find most demanding, and those which present little difficulty. Methods: The modified SSQ was administered to 8 participants with severe visual impairment but who had normal hearing. Age-matched sighted participants with normal hearing acted as controls. Items assessed self report for speech comprehension in the presence or absence of competing speech or noise, and spatial aspects of hearing including judgements of direction and distance. Qualities of the listening experience such as perceived effort and sound identification were also assessed. Results: In the speech domain, Mann-Whitney U tests showed that participants with severe visual impairment reported significantly more difficulties (p<0.05) than sighted participants in scenarios where multiple sound sources were present, and the scenario required noise or competing sound sources to be ignored. Significant differences were not observed in the spatial or qualities domains. Conclusions: Although there have been many reports of enhanced auditory abilities of participants with severe visual impairment, especially within the spatial domain, the present findings suggest that sensory compensation is not perceived to confer benefit in their daily lives. The self-reported increased difficulty for a subset of the speech items is a consequence of the lack of visual cues, which, apart from precluding lip-reading, may lead to increased difficulties in separating objects in complex auditory scenes and to higher susceptibility to informational masking. Commercial Relationships: Shahina Pardhan, None; Silvia Cirstea, None; Andrew Kolarik, None; Brian Moore, None Support: Postdoctoral Fellowship, Postgraduate Medical Institute, Anglia Ruskin University. MRC grant G0701870 to BCJM Program Number: 2775 Poster Board Number: B0029 Presentation Time: 8:30 AM - 10:15 AM An Object Localization and Feedback System Nii Tete Mante1, 2, Gerard Medioni2, Armand R. Tanguay1, 4, Thang Dinh2, Furkan E. Sahin4, Patrick J. Nasiatka4, James D. Weiland1, 3. 1 Department of Biomedical Engineering, University of Southern California, Los Angeles, CA; 2Department of Computer Science, University of Southern California, Los Angeles, CA; 3Department of Opthamology, University of Southern California, Los Angeles, CA; 4 Department of Electrical Engineering, University of Southern California, Los Angeles, CA. Purpose: The goal of the project was to create a system which assists blind/low vision subjects with reaching and grasping for objects. This system is referred to as the 'Object Localization and Feedback System' (OLFS). The OLFS aims to enhance the autonomy of blind patients, by utilizing advanced algorithms and feedback mechanisms for daily tasks. Methods: The OLFS utilized a 100° wide-angle camera (Tanguay, Sahin, Nasiatka), central processing unit (CPU) and bone conduction headphones. Computer Vision algorithms (Context Tracker, Medioni and Dinh) on the CPU parsed, and processed the camera input to determine object(s) position. Bone conduction headphones produced auditory feedback for the blind user based on object position. For example, if the object is positioned left to the camera's center of vision (COV), the computer would say “Left” to the test subject. Once the object was centralized within the users/cameras center of vision, test subjects were asked to reach out and touch the object. Two blind test subjects evaluated the device. Subjects were trained to use the system initially. Afterwards, autonomous testing was carried out. In both stages, subjects were asked to reach and grasp for an object with the aid of the OLF system. If test subjects were not able to grasp the object within 45 seconds, the trial was stopped and considered unsuccessful. Results: In ten object localization trials, patient RS-2 was able to grasp the desired object 6/10 times. The average time to grasp the object for the 6 successful trials was 15.43 seconds. Patient NM was able to grasp the object 10/10 times, and average the time to grasp the ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics object was 13.95 seconds. Both patients were given a System Usability Scale (SUS) test. Patients RS-2 and NM gave the OLFS system a score of 87.5% and 67.5%, respectively. A 100% score symbolizes a perfectly usable system (as judged by the subject). Object tracking path data within the FOV was also recorded for each test and each test subject. Conclusions: An initial system for assisting the blind in reaching and grasping for objects was successfully designed, implemented and tested. Test subjects were able to successfully grasp the object. Future improvements to the system will include enhanced robustness of vision algorithms, and new implementations of physical feedback. These two improvements will act to make the use of the system more intuitive for the patient. Commercial Relationships: Nii Tete Mante, None; Gerard Medioni, None; Armand R. Tanguay, University of Southern California (P); Thang Dinh, None; Furkan E. Sahin, None; Patrick J. Nasiatka, None; James D. Weiland, Second Sight Medical Products, Inc. (F) Support: Research to Prevent Blindness, W.M. Keck Foundation; USAMRMC-W81XWH-10-2-0076 Program Number: 2776 Poster Board Number: B0030 Presentation Time: 8:30 AM - 10:15 AM Magnification, Field of View and Depth of Field in Low Vision Aids and Optical Instruments Ian L. Bailey. School of Optometry, University of California, Berkeley, Berkeley, CA. Purpose: Clinicians prescribing low vision aids or using visual instruments to examine eyes often need to understand what fine details can be seen, how much of the object can be seen, and how visual access depends of the viewing system. Some new simple concepts can allow clinicians to estimate the magnitude of magnification effects, fields of view and depths of field. Methods: There are several different methods used to quantify magnification effects at near and this often leads to erroneous predictions of optical performance. As an alternative, we use Equivalent Viewing Distance (EVD) which is the distance at which the object would subtend the same angle that is being subtended by the image. The size of just-resolvable detail is simply proportional to the EVD. For collimating systems, the EVD is equal to the equivalent focal length. For images at finite distances, the EVD is calculated by dividing the eye-to-image distance by the enlargement ratio (ER) . To understand such systems, the clinician needs to know the image location and ER. The Field of View (FoV) is determined by a “field cone’ whose angle is determined by the field limiting aperture and its distance from the eye. The Image Field Aspect Ratio (IFAR) is a diameter-to-distance ratio defining this angle. The width of the FoV is equal to the product of EVD and IFAR. Slit lamps, and most other microscope systems are analogous to Kelperian telescopes and then, IFAR = approx. 1.0, and the EVD and the FoV will be about equal. A practical estimate of the Depth of Field is given by the square of the EVD. Results: These methods can provide an immediate and accurate estimate of EVD, FoV and DoF in hand held magnifiers, stand magnifiers, telescopes for distance or near. It is easy for clinician observing a patient to mentally visualize the field cone and EVD plane, and immediately estimate the FoV. The same approach can easily be applied to the slit lamp and most other visual inspection instruments. Once the geometric concepts are grasped, only minimal calculation skills are required. Conclusions: The concept of Equivalent Viewing Distance simplifies the quantification of magnification effects and prediction of resolvable detail. The image field cone concept when combined with the EVD, directly and intuitively predicts the width of the FoV. Once the EVD is known, the depth of field can be estimated by squaring the EVD. Commercial Relationships: Ian L. Bailey, None Program Number: 2777 Poster Board Number: B0031 Presentation Time: 8:30 AM - 10:15 AM Preference pattern of low vision aids in glaucoma-redefining guidelines Aparna Rao, Sirajum Monira, Mahasweta Chowdhury. Glaucoma Services, LV Prasad Eye Institute, Patia, India, Bhubaneswar, India. Purpose: To evaluate preference pattern of low vision devices (LVD) in patients with glaucoma to arrive at specific guidelines for prescribing these devices with regards to specific visual disabilities. Methods: Retrospective review of records of glaucoma patients attending low vision services. Criteria for low vision was defined as best corrected distance visual acuity <20/80 in the better eye with Log mar chart and/or near visual acuity <N10 binocularly with Bailey Lovie word reading chart and/or visual field 20degrees or <20 degrees from the point of fixation. The data collected for each patient included the age, gender, diagnosis, extent of visual field loss (mean deviation and central residual field of vision), type of visual disability and the type of low vision aid (optical vs electronic) preferred by the patients for daily routine use. Results: The mean age of the 51 patients was 51±23.4 (9-83 years) which included 14 females (27.5%) and 37(72.5%) males, 14 developmental (27.5%), 8 PACG (15.7%) and 29 POAG (56.8%). While 34 (77%) opted for optical devices, 17 opted for electronic devices. There was no statistical difference in preference of LVD among the two sexes or between patients with different level of education (undergraduate or postgraduate or different distance or low contrast visual acuity. On univariate analysis, younger age, magnification>5x, color matching disabilities and glare were found to significantly influence preference for electronic devices while on multivariate regression, age <30 years (β=-0.04, p=0.005), color matching disability (β=3.08, p=0.002), glare (β=2.04, p<0.001) were significant influences for preference for electronic LVD. There was no specific preference pattern for preference of optical magnifiers in this study. Conclusions: Younger patients <30 years with glare and color contrast impairment may be prescribed electronic low vision devices for optimal visual function as compared to optical devices. Glare measurement and color matching disability may be added as parameters for assessing visual functions routinely in patients with advanced glaucoma. Commercial Relationships: Aparna Rao, None; Sirajum Monira, None; Mahasweta Chowdhury, None Program Number: 2778 Poster Board Number: B0032 Presentation Time: 8:30 AM - 10:15 AM ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Sustained benefits of Therapeutic Tinted Contact Lenses (CL) in patients with Albinism Faheemah Saeed1, Darrell G. Schlange2, Tina Najafi3. 1Illinois College of Optometry, Chicago, IL; 2Illinois College of Optometry, Chicago, IL; 3Illinois College of Optometry, Chicago, IL. Purpose: To determine whether the improvement in visual function and nystagmus eye movements observed in patients with Albinism using tinted CL correction is sustained after 6 months following the initial dispense. Improved visual function and nystagmus eye movements in 20 patients with Albinism resulting from tinted CL use were reported last year. Results collected 6 months after the initial CL dispense are now being reported on 13 returning patients. Methods: 20 subjects were fitted with soft toric CL’s that were then custom tinted to create an artificial iris. Dependent variables including visual acuity (VA), contrast sensitivity (CS) with and without glare, and nystagmus eye movement recordings were tested again while wearing tinted CLs, 6 months following the initial dispense of tinted CL. The EDTRS chart was used to measure visual acuity. The CSV-1000HGT (halogen glare test) and 1000E (Contrast Sensitivity chart) were used to measure the contrast sensitivity function and effect of glare. Nystagmus eye movement characteristics of intensity and foveation were recorded and analyzed with an ISCAN system (RK 826PCI) that uses a video based dark pupil-tocornea reflection method. Results: The improved logMar VA observed with tinted CLs was still present at the 6 month follow up visit, as the difference obtained at the two visits did not differ significantly (t= 1.72, p=0.11). Mean CS under normal testing conditions was further improved at the 6 month follow up visit (t= 2.49, p=0.028) while the mean CS with glare did not differ between the two visits (t= 1.17, P=0.266). ISCAN recordings with 3 runs in each of 5 gaze positions showed that the reduced intensity of nystagmus was also maintained with tinted CL wear after 6 months (t= 0.61, p=0.557). Conclusions: We previously reported that VA, Nystagmus intensity and CS with and without glare were significantly improved with tinted CL wear in patients with albinism. The current study indicates that these significant improvements are maintained or even increased for at least six months following initial dispensing of tinted CL’s. Commercial Relationships: Faheemah Saeed, None; Darrell G. Schlange, None; Tina Najafi, None Program Number: 2779 Poster Board Number: B0033 Presentation Time: 8:30 AM - 10:15 AM Evaluating center of pressure (CoP) measures of postural stability in low and normal vision using the Nintendo Wii Balance BoardTM (WBB) Pamela E. Jeter1, Jialiang Gu2, Judith E. Goldstein1, Ava K. Bittner1, Gislin Dagnelie1. 1Ophthalmology, Johns Hopkins University, Baltimore, MD; 2Electrical & Computer Engineering, Carnegie Mellon University, Pittsburgh, PA. Purpose: To evaluate Center of Pressure measures obtained on a commercially available Nintendo Wii Balance BoardTM (WBB) in a group of low vision (LV) and normal participants. Methods: Subjects with low vision (visual acuity worse than 20/70 and/or visual field less than 40°, in the better eye, N=7) and subjects with corrected-to-normal vision (N=5), completed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) which includes four sensory conditions: double-leg standing on a firm surface with eyes open (EO-firm); standing on a firm surface with eyes closed (EC-firm); standing on an unstable (3” thick) surface with EO (EO-foam); and standing on an unstable surface with EC (EC-foam). Subjects performed each condition for 4 successive trials for up to 30 seconds with a one-minute rest period in between. The conditions were randomly ordered. Center of Pressure (COP) outcomes were derived from data sent by the 4 force plate sensors in the WBB to a laptop via Bluetooth. The COP measures include root mean square (RMS) of the COP excursion (mm), RMS of velocity (mm/s), mean total velocity (MTV, mm/s), and area (mm2). Results: In the LV group, all COP measures differed significantly between firm and foam conditions with EC and EO (all p<0.05) with the exception of SD of velocity in the M-L direction. In both groups, no significant differences across COP measures were found in an independent samples t-test between the EO-firm and EC-firm conditions (all p>0.05) and between the EO-foam and EC-foam condition. No significant differences were found across all variables when comparing LV participant COP measures to normal participants with the exception of MTV and area in the EO-firm condition (p=0.01 and p = 0.03, respectively). Conclusions: This pilot study uses the WBB for determining postural stability in a LV and normal group. As expected, differences were found between the firm and foam conditions both with EO and EC in the LV group suggesting that visual and sensorimotor challenges exist. In comparison, the normal group performed well across all conditions suggesting more stability. MTV and area measures differed between the LV and normal group in the EO-firm condition suggesting that these variables might by predictors of balance impairment. A larger sample size is needed to determine test-retest reliability of each COP measure. Commercial Relationships: Pamela E. Jeter, None; Jialiang Gu, None; Judith E. Goldstein, None; Ava K. Bittner, None; Gislin Dagnelie, None Support: Louise L. Sloan Research Grant Award, Lions Vision Research Foundation, Wilmer Eye Institute Program Number: 2780 Poster Board Number: B0034 Presentation Time: 8:30 AM - 10:15 AM Low vision and work opportunities Jørn Kalleberg1, Irene Langeggen2. 1NAV Buskerud, Drammen, Norway; 2Buskerud University College, Kongsberg, Norway. Purpose: The aim is to enhance routines around any working low vision patients enrolled at The Norwegian Labour and Welfare Association, Low vision clinic (NLW-LWC) and Kongberg community, Buskerud, Norway. Data published by the Norwegian Blind Association reports 25-40 % of visual impaired are working. There is no literature referring to the role of NLW-LWC and community cooperation to enhance low vision rehabilitation for these patients. Methods: Patients were recruited from a list of candidates given by either the Kongsberg Community optometrist or the NLW-LWC optometrist. The patients included were all eligible to low vision aids according to Norwegian guidelines. All participants were asked and signed the consent form.The interview of the subjects was based on a questionnaire concerning general health, mobility, work situation, use of visual aids and their experience with visual rehabilitation. Results: Age ranged from 32 - 59 years. Of 13 participants, six males and four females were interviewed. One of the subjects had a congenital low vision condition. All subjects have completed education at a high school level. One has a master degree. There is no one working in health care profession. Eight of ten works daily on a computer, but only one uses Zoomtext. Visual acuity ranged from 0,15 - 1,2 (Snellen). Visual field was reduced in nine of ten subjects. Six of ten used filter spectacles. Magnifier (4), near and reading magnifying spectacles (7) and the computer (7) were the prefered low vision aids. Seven subjects have a full time position. Neither had experienced a systematic approach to their low vision ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics situation. Follow ups where through the local optometrist (7/10). They thought highly of the questionnaire and emphasized the need for regular follow up of optometrists with low vision advices as a health speciality. Conclusions: To enhance better low vison rehabilitation and to provide better work situationsis it necessary to look at the work and the home situation together. There is a need for a systematic approach towards this patient group. The optometrist is essential in optical low vision follow up, the NLW-LWC needs to focus on technical support, illumination, legal rights and the dialog with the work place. Our questionnaire can be a tool of care. To improve the rehabilitation at work you improve selfesteem and paricipation in the society. Commercial Relationships: Jørn Kalleberg, None; Irene Langeggen, None Program Number: 2781 Poster Board Number: B0035 Presentation Time: 8:30 AM - 10:15 AM The effect of an Adapted Day Centre on Physical and Psychological Well-Being in Older Adults with Low Vision Walter Wittich1, 2, Caitlin Murphy3, 2, Daphne Mulrooney1, 2. 1 Research, MAB-Mackay Rehabilitation Centre, Montreal, QC, Canada; 2CRIR, Montreal, QC, Canada; 3School of Optometry, University of Montreal, Montreal, QC, Canada. Purpose: Older adults with visual impairment are vulnerable to social isolation and associated health risks. The MAB-Mackay Rehabilitation Centre runs a Day Centre program whose objectives are to maintain or improve the seniors’ biological, psychological, and social health, and foster a better quality of life, while delaying or avoiding institutionalization. Activities include walking groups, language courses, memory games, crafts and theme parties, supervised by an interdisciplinary team, including a nurse, social worker and occupational therapist. Services include medical and rehabilitation follow-up and referrals to additional community resources. The present study evaluates the impact the Day Centre has on the holistic health of older adults with visual impairment. Methods: Between September 2011 and October 2012, 16 newly referred clients in the Day Centre (age 71 to 98, M = 85, VA 20/50 to NLP, M = 20/126) were evaluated at intake, and after 6 months, using the Visual Function Questionnaire-14, Hearing Handicap Inventory for the Elderly, Geriatric Depression Scale (GDS), Friendship Scale, Life-Space Questionnaire, Activity-specific Balance Confidence scale, Timed-Up-and- Go Test, and the adapted Montreal Cognitive Assessment (MoCA). Acuity, visual field, and average decibel hearing loss were recorded. Results: All participants continued to live independently in the community 6 months after entering the Day Centre. Comorbid conditions included high blood pressure, asthma, cardiac problems, diabetes, stroke, arthritis, osteoporosis, and anxiety. Participants reported statistically unchanged scores on all the measures, except for increased GDS scores (p < .05) and a trend towards improvement on the MoCA (p = .06). Conclusions: Considering the fragility, vulnerability and age of this population, the data indicate that the Day Centre fulfills its mandate to prevent decline in its clients’ biological, psychological, and social health. We speculate that the increase in depression scores is linked to serious life events during the follow-up period for some of the participants, such as loss of a spouse. Participation in adapted Day Centre activities, as an integrated part of rehabilitation services, seems to support independent living in older adults with vision loss. Commercial Relationships: Walter Wittich, None; Caitlin Murphy, None; Daphne Mulrooney, None Program Number: 2782 Poster Board Number: B0036 Presentation Time: 8:30 AM - 10:15 AM Vision, Demographic Factors, and Motor Vehicle Collisions in Bioptic Drivers Bradley E. Dougherty1, Roanne E. Flom1, Mark A. Bullimore2, Thomas W. Raasch1. 1Optometry, Ohio State University, Columbus, OH; 2Optometry, The University of Houston, Houston, TX. Purpose: In approximately 40 US states, drivers who cannot meet vision standards with conventional optical correction are permitted to use bioptic telescopic spectacles to obtain licensure. Very few studies of safety of bioptic driving have been conducted. This study examined the relationships among visual and demographic factors and motor vehicle collisions (MVC) in bioptic drivers in Ohio. Methods: A retrospective study of patients identified as having received an initial daylight bioptic examination at the College of Optometry at the Ohio State University was conducted. Data were collected on vision, including visual acuity (logMAR charts), contrast sensitivity (Pelli Robson or Mars charts) and visual field (arc or Goldmann perimeter). Driving records from the Ohio BMV were obtained and demographics, ocular diagnoses, and licensure history were also recorded. Relationships among vision, demography, and BMV data including MVC were investigated using survival analysis and the Cox proportional hazards regression model. Results: 238 drivers (65% male) were identified. Age at initial exam ranged from 16 to 81 years (mean = 39±15 years). Time since bioptic licensure ranged from 1 to 22 years (mean = 10±5 years). Mean logMAR visual acuity OU was 0.76±0.12 (approximately 20/115) and mean log contrast sensitivity was 1.53±0.23. A total of 292 MVC were documented in the BMV records for these drivers. The number of MVC per driver ranged from 0 to 11, with 124 (52%) drivers having had at least one MVC and 72 (30%) having had two or more. Visual acuity, contrast sensitivity, and horizontal visual field were not significant predictors of MVC (p = 0.81, 0.18, and 0.76, respectively). Gender was not associated with MVC (p=0.28), but age was associated with fewer MVC (p < 0.001). Previous (withoutbioptic) licensure status was associated with fewer MVC (p < 0.001), with 41% of drivers with previous licensure involved in an MVC versus 67% of drivers without previous licensure. Conclusions: Age and previous non-bioptic licensure were inversely associated with fewer MVC in this group of bioptic drivers. VA, CS, horizontal VF, and gender did not predict MVC involvement. Commercial Relationships: Bradley E. Dougherty, None; Roanne E. Flom, None; Mark A. Bullimore, Alcon (C), Carl Zeiss Meditec (C), DigitalVision Systems (C), Ridgevue (I); Thomas W. Raasch, None Support: NIH Grant 8TL1TR000091-05, Ohio Lions Eye Research Foundation Grant Program Number: 2783 Poster Board Number: B0037 Presentation Time: 8:30 AM - 10:15 AM Effects of patient traits on physician-predicted low vision outcomes Tiffany L. Chan, Robert W. Massof, Judith E. Goldstein. Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD. Purpose: We reported that physicians’ ability to predict the success of low vision rehabilitation (LVR), relative to patient-reported outcomes, is no better than chance. This study determines if patients’ traits influence ratings physicians provide and if those traits affect patient-reported outcomes. Methods: The Activity Inventory (AI), a self-report visual function questionnaire, was administered pre and post-LVR to 270 low vision patients served by 28 LVR centers that participated in a collaborative study. The physical component of the SF-36, GDS, and TICS also ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics were administered pre-LVR to measure physical capability, depression and cognitive status. Following patient evaluation, 38 LVR physicians estimated the probability of outcome success (POS) on a scale of 0 to 100% for each of their patients, using their own criteria for success.The POS ratings and change in functional ability, based on Rasch analysis of AI responses, were used to assess the effects of patients’ baseline traits on predicted and patient-reported outcomes. The distributions of SF-36 physical functioning, GDS, and TICS measures were divided into quartiles and visual acuity (VA) was categorized by severity. Analysis of variance was performed with POS and change in functional ability as the dependent variables and the quartiles for each trait serving as factors. Results: Baseline traits with significant effects on POS are: physical functioning (p=0.003), cognitive state (p=0.001), visual acuity (p<0.001), and baseline functional ability (p= 0.005). Depressed mood, age, gender, and number of symptomatic co-morbidities have no significant effect on the POS. Only pre-LVR functional ability (p=0.001) has a significant effect on changes in functional ability, none of the other traits has a significant effect. Conclusions: Physicians’ predictions of LVR outcomes appear to be driven by patient’s physical ability, cognitive functioning, VA, and baseline visual function - information physicians acquire from the patient’s history and examination. However, none of these traits, except baseline functional ability, is predictive of changes in functional ability. Although physicians appear to be using reasonable information about the patient’s state to estimate rehabilitation potential, the baseline traits selected are not reliable predictors of patient outcomes, therefore LVR physician predictions of successful outcomes are no better than chance. Commercial Relationships: Tiffany L. Chan, None; Robert W. Massof, None; Judith E. Goldstein, None Support: NIH Grant EY018696 Program Number: 2784 Poster Board Number: B0038 Presentation Time: 8:30 AM - 10:15 AM An Inventory of Visually Guided Activities Self-reported by Individuals with Profound Visual Impairment Gislin Dagnelie1, Pamela E. Jeter1, Lauren Dalvin2, Ellen R. Arnold1. 1 Ophthal-Lions Vision Cntr, Johns Hopkins Univ, Baltimore, MD; 2 NE Ohio Medical Univ, Rootstown, OH. Purpose: Visual functioning questionnaires (VFQs) can assess functional vision in individuals with mild to severe impairment, but are uninformative if remaining vision is minimal. We performed a systematic inventory of daily activities that require some, albeit minimal, visual guidance or support. These activities can then be assigned item difficulty scores through rating by profoundly impaired individuals, with the eventual purpose of extending the range of currently used VFQs. Methods: Nine focus groups of 4-6 members with profound vision loss met in person or conference call to discuss the role of vision in their daily activities. The Massof Activity Inventory (Optom vis Sci 84:763-74;2007) was used as a template. Each group held 4-7 sessions of 60-90 min; audio recordings of the sessions were abstracted and analyzed for content. Reported activities were categorized into 4 domains - reading (R), mobility (M), visual motor (V), and visual information (I) -- and into 10 aspects -- brightness, contrast, lighting, movement, size, distance, depth, eccentricity, familiarity, and other. Results: Focus groups reported 760 activities, with 10%, 17%, 24%, and 49% categorized in the R, M, V, and I domains, respectively. On average, 1.58 aspects of visual function were involved in each activity. Contrast (68%), brightness (27%), lighting (14%), size (14%), and distance (12%) were the most prevalent aspects that were critical in performing these activities, with eccentricity (8%), movement (7%), familiarity (5%), depth (1%), and other (2%) critical in smaller subsets of activities. A representative subset of these activities spanning all domains and visual aspects was used to create a set of 144 survey questions for a draft VFQ for ultra-low vision. Conclusions: Even at these ultra-low vision levels visual activities in all 4 domains, and spanning all 10 aspects, of vision continue to be of critical importance. Following administration to a population of 100 profoundly impaired individuals and Rasch analysis, the resulting survey questions will be reduced to a set of ~50 questions spanning the lower end of the item difficulty scale largely untested by current VFQs. The selected activities also form the basis for training and assessment test in controlled environments, now being developed as part of the prosthetic low vision rehabilitation (PLoVR) curriculum. PLoVR: Prosthetic Low Vision Rehabilitation Commercial Relationships: Gislin Dagnelie, None; Pamela E. Jeter, None; Lauren Dalvin, None; Ellen R. Arnold, None Support: R01EY021220(+-S1) 320 Color Vision, Photoreceptor Function, Adaptation Tuesday, May 07, 2013 8:30 AM-10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 3014-3030/C0177-C0193 Organizing Section: Visual Psychophysics / Physiological Optics Contributing Section(s): Visual Neuroscience Program Number: 3014 Poster Board Number: C0177 Presentation Time: 8:30 AM - 10:15 AM Is dark-adapted cone detection optimized given noise and uncertainty? Darren E. Koenig, Heidi J. Hofer. College of Optometry, University of Houston, Houston, TX. Purpose: Spatial summation is important for understanding and modeling the early stages of vision. Optimal summation is stimulusmatched; however our previous work in the dark-adapted fovea suggests independent combination across multiple units of different sizes within a zone of spatial uncertainty. By developing detection models with different summation strategies and comparing predicted behavior with experimental data we investigate the number of different size units and whether detection is nearly optimal given both uncertainty and noise. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Methods: Detection thresholds were previously measured in the dark-adapted fovea for spots from 0.3' to 25' in diameter (550nm, 1030ms), viewed through either a 2 mm (conventional optics, 4 subjects) or 6 mm pupil (adaptive optics aberration correction, 5 subjects). Thresholds and psychometric function slopes were compared with predictions from analytic and Monte-Carlo models with different summation strategies given detection uncertainty, Poisson noise, and cone mosaic granularity. Results: Average change in log threshold with log stimulus area was 0.12±0.03 for stimuli up to 4-10' diameter, precluding both a single unit size and the optimal stimulus-matched strategy. Data were consistent with spatial uncertainty of at least 25'. Model comparison suggests suboptimal combination across multiple-sized units, where smaller units exhibit relatively more post-receptoral noise, with the smallest unit no larger than the smallest stimulus (~0.5' retinal fullwidth half maximum), and the largest unit 4-10' in diameter. At least two different unit sizes are required to describe the data. Although many different unit sizes are required for performance approaching optimal stimulus-matched summation, independent combination across two sizes reduces efficiency by only ~0.1 log unit. With a 10' largest unit (roughly parasol receptive field center size) and quantum efficiency of 0.11-0.35, dark noise is estimated at 9-435 events/cone/s. Conclusions: Dark-adapted foveal detection as a function of stimulus size is consistent with independent combination across at least two different sized units, the largest and smallest of which are consistent with midget and parasol ganglion cell receptive field sizes. An independent detection strategy across midget and parasol ganglion cells is expected to perform only slightly worse than the optimal stimulus-matched strategy, given noise and uncertainty constraints. Commercial Relationships: Darren E. Koenig, None; Heidi J. Hofer, None Support: NIH ROI EY019069, P30 EY07551 Program Number: 3015 Poster Board Number: C0178 Presentation Time: 8:30 AM - 10:15 AM Quick and easy light sensitivity assessment of the dark adapted eye: The Tuebingen Scotopic Threshold Test (TSTT) Torsten Strasser, Hana Langrová, Anne Kurtenbach, Ditta Zobor, Dominic Hillerkuss, Eberhart Zrenner. Institute for Ophthalmic Research, Centre for Ophthalmology, Tuebingen, Germany. Purpose: Light sensitivity of the dark-adapted eye is a valuable indicator of retinal function. Changes in light sensitivity are observed in many retinal disorders like Retinitis pigmentosa, CSNB, or in vitamin A deficiency. Light sensitivity is usually tested using dark adaptometry: after transient exposition to bright light the darkadaptation curve and the final threshold are measured. This procedure is time-consuming and uncomfortable, especially for children. Within the EU-project TREATRUSH, we developed a test for assessing the scotopic threshold for early detection of Usher's syndrome. Methods: The TSTT has 2 panels for scotopic and photopic stimulation. Each panel has a size of 7×10cm, consisting of 35 individually addressable LED bars, thus allowing to use various stimulus shapes. The centerpiece of the TTST is a microcontroller (ATmega8515, Atmel Corp.), running a self-developed software. Stimulus luminance is tuned by pulse-width modulation and adjustable in 100 steps between -3 to -1 log cd/m2. Using filters, this can be extended from -8 to -1 log cd/m2. The luminance gradually increases until a perception is indicated. The patient names the shape and the examiner confirms or discards the response, thus discriminating correct answers from false-positives. If confirmed, the luminance is decreased and the procedure is repeated. Feasibility and repeatability were tested in 11 subjects (10-68yrs). Monocular and binocular presentation were compared, as well as results obtained with natural or dilated pupil. Results: All subjects completed the test successfully. Binocular presentation reduced threshold by ~0.15 log units. Intra-subject repeatability was >90%. We found no difference in the results obtained with natural or dilated pupils. A flickering stimulus did not show advantages over a constant presentation. Conclusions: The Tuebingen Scotopic Threshold Test allows for quick and easy assessment of the sensitivity of the dark-adapted eye. The recording takes only 5 minutes (w/o dark adaptation), can be done with natural pupils and is comfortable for the patient. Results obtained with the TSTT show a high correlation to similar tests. This makes the TSTT to a well suited tool for testing children. This project and study is supported through TREATRUSH (HEALTH-F2-2010-242013), a European Collaborative project supported by the European Commission under the 7th Framework Program. Commercial Relationships: Torsten Strasser, None; Hana Langrová, None; Anne Kurtenbach, None; Ditta Zobor, None; Dominic Hillerkuss, None; Eberhart Zrenner, Retina Implant AG (F), Retina Implant AG (I), Retina Implant AG (C), Retina Implant AG (P), QLT Inc (C), Servier, Paris (C), Steinbeis GmbH&CoKG, Stuttgart (I), Steinbeis GmbH&CoKG, Stuttgart (C), Neurotech, USA (C), Pfizer, USA (C) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 3016 Poster Board Number: C0179 Presentation Time: 8:30 AM - 10:15 AM Dark Adaptation and the effect of Oxygen Inhalation in Cystic Fibrosis Rachel Hiscox1, Christine Purslow2, Rachel V. North1, Ian Ketchell3, Katharine Evans1. 1School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom; 2School of Health Professions, Plymouth University, Plymouth, United Kingdom; 3All Wales Adult Cystic Fibrosis Centre, University Hospital Wales, Cardiff, United Kingdom. Purpose: Previous research has shown impaired measures of dark adaptation in cystic fibrosis (CF), with the cause generally attributed to concomitant vitamin A deficiency. However, other factors including CF-related diabetes (CFRD) may influence these results. Impaired dark adaptation in Type 1 and 2 diabetics improves upon oxygen inhalation and has therefore been attributed to retinal hypoxia. The purpose of this preliminary study was to evaluate the effect of oxygen inhalation on dark adaptation in CF, to determine the underlying cause of impairment. Methods: Dark adaptation was assessed in 9 CF (5 CFRD, 4 nonCFRD) and 9 age, gender and ethnicity-matched controls using a custom made computerised dark adaptometer to present an 11° achromatic stimulus centred on the fovea. All CF subjects were vitamin A sufficient. Following pupil dilation, a Maxwellian view optical system was used to administer an 82% cone and 75% rod photopigment bleach. Subsequently, threshold was monitored for 25 minutes whilst the patient inhaled either medical air or 100% oxygen (selected at random) through a 60% venti mask. This procedure was repeated for the second gas following a 15 minute wash out period. Threshold recovery parameters were modelled and the cone time constant of recovery (τ), final cone and final rod thresholds determined. Relationships were evaluated using paired and unpaired T-tests as appropriate. Results: Final rod threshold was significantly elevated in CF subjects compared to controls when inhaling medical air, -4.54 and -4.64 log cd/m2 respectively (p=0.03). Oxygen inhalation had no significant effect on any parameter for controls. Oxygen inhalation in CF subjects caused a significant decrease in final rod threshold compared to medical air, -4.66 and -4.54 log cd/m2 respectively (p=0.04). When analysed according to CFRD status, the CFRD group was found to have a significantly elevated final rod threshold compared to the nonCFRD group when inhaling medical air, -4.47 and -4.64 log cd/m2 respectively (p=0.03). This difference was not present when inhaling oxygen. Conclusions: This study has shown final rod threshold to be significantly elevated in CF, particularly in those with CFRD, with recovery to normal levels upon inhalation of oxygen. For the first time, this observation suggests that CFRD subjects experience impaired dark adaptation secondary to retinal hypoxia, indicating similarities to Type 1 and 2 diabetics. Commercial Relationships: Rachel Hiscox, None; Christine Purslow, None; Rachel V. North, None; Ian Ketchell, None; Katharine Evans, None Support: School of Optometry and Vision Sciences, Cardiff University Program Number: 3017 Poster Board Number: C0180 Presentation Time: 8:30 AM - 10:15 AM Characteristics of Color Visual Acuity by Step Changes of Background Luminance in Young Subjects of Normal Eyes Yoshiki Tanaka1, Kiyoshi Tanaka1, Sho Yokoyama2, Hideki Nakamura2, Kazuo Ichikawa2, Shoko Tanabe3. 1Faculty of Engineering, Shinshu University, Nagano, Japan; 2Ophthalmology, Social Insurance Chukyo Hosp., Nagoya, Japan; 3Chukyo Eye Clinic, Nagoya, Japan. Purpose: Color Visual Acuity (CVA) is the visual acuity that measures from colored Landolt ring on the background of achromatic color and that is the measure for evaluation of visual function for colors in daily life. In our previous research, we measured CVA of young normal subjects in the case of the background luminance of the color 30 [cd/m2] (same luminance with Landolt ring’s color) and 100 [cd/m2]. In the result, for the background luminance of 100 [cd/m2], CVAs of all colors were almost the same value; and for the background luminance of 30 [cd/m2], the CVAs of Blue-Yellow axis of color were higher than the other colors. Then, we further examined the changes of CVA for gradual changes of background luminance. Methods: Four normal eyes of 4 subjects (4 males) were enrolled in this study. The mean age was 21.8 years old (range 21-22 years). They had no history of ocular disease (including color anomaly) or surgery. All of them had best corrected visual acuity of 20/13. We set the background color as white point of the standard light D65, and Ladnolt ring was colored with four colors (“Red” and “Green” for the Red-Green axis of color, “Green-Yellow” and “Blue-Purple” for the Green-Yellow axis of color) used in New Color Test (Luneau Ophtalmologie).The luminance value of Landolt ring was 30 [cd/m2] as a fixed value, and background was from 50 to 30 [cd/m2] and from 15 to 30 [cd/m2]. Results: There was significant difference for the colors of G (between 50 and 30 [cd/m2]), GY (between 50 and 30, 15 and 30 [cd/m2]), BP (between 50 and 30, 15 and 30, 15 and 28 [cd/m2]) (p<0.05, p<0.01, Friedman/Dunn test, shown in Figure) Conclusions: In young subjects of normal eyes, it was confirmed that the influence of luminance difference between background and Landolt ring for the CVA of Blue-Yellow axis of color was significant that in comparison with the CVA of Red-Green axis of color. In addition, it was confirmed that there was a range of the background luminance that could measure the CVA without the influence of luminance difference between background and Landolt ring in the area of 30 plus or minus 2 [cd/m2]. Measurement results of CVA by step changes of background luminance in young subjects of normal eyes (CVA: Decimal Visual Acuity). Commercial Relationships: Yoshiki Tanaka, None; Kiyoshi Tanaka, None; Sho Yokoyama, None; Hideki Nakamura, None; Kazuo Ichikawa, None; Shoko Tanabe, None Program Number: 3018 Poster Board Number: C0181 Presentation Time: 8:30 AM - 10:15 AM ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics A Color Visual Function Test to Evaluate the Age-Related Changes in Good Visual Acuity of Normal Eyes Sho Yokoyama1, Kazuo Ichikawa1, Hideki Nakamura1, Shoko Tanabe2, Yoshiki Tanaka3, Kiyoshi Tanaka3, Rie Horai2. 1 Ophthalmology, Social Insurance Chukyo Hosp, Nagoya, Japan; 2 Chukyo Eye Clinic, nagoya, Japan; 3Faculty of Engineering, Shinshu University, Matsumoto, Japan. Purpose: Color Visual Acuity (CVA) is the visual acuity that measured from colored Landolt ring on the background of achromatic color and that is the measure for evaluation of visual function for colors in daily life. From ARVO of 2012, we measured the subjects of best corrected visual acuity (BCVA) 20/20 or better of normal eyes in each generation to examine the CVA and we noticed particularly in Red-Green axis color of CVA had negative correlation with age. However, target group of BCVA has already accepted the negative correlation with age, so that in comparison with the conventional Landolt ring, we were not able to fully grasp the significance correlation with CVA and age. Therefore, this time we intended for only BCVA 20/13 of normal eyes and again to examine the correlation of CVA and age-related changes. Methods: One hundred thirteen normal eyes of 131 subjects were enrolled in this study. The mean age was 39 years old (range 16-80 years). They had no history of ocular disease (including color anomaly) or surgery. All of them had the BCVA 20/13. We set the background color as white point of the standard light D65 and Landolt ring colors with fifteen colors using the New Color Test (Luneau Ophtalmologie, Paris). The luminance of background and Landolt Ring is both set approximately at the same value of 30[cd/m2]).We measured all CVA of fifteen different colors for each subjects (Figure). Results: The results of the negative correlation with age are shown in the descending orders GB, G, R, YR, YG, RY, BG, B, PR, P and RP. In contrast the results of no correlation were Y, GY, PB and BP (linear regression analysis: significance level P<0.05). Conclusions: The subject group of the BCVA 20/13, even in the normal subjects with good visual acuity, depending on colors, the CVA decreased with increasing age. Commercial Relationships: Sho Yokoyama, None; Kazuo Ichikawa, None; Hideki Nakamura, None; Shoko Tanabe, None; Yoshiki Tanaka, None; Kiyoshi Tanaka, None; Rie Horai, None Program Number: 3019 Poster Board Number: C0182 Presentation Time: 8:30 AM - 10:15 AM Training for Identification of Colors Altered by Colored Filters Thomas Kuyk1, Alastair Smith1, Semih Kumru2. 1TASC, Inc, Ft Sam Houston, TX; 2Air Force Research Laboratory, Ft Sam Houston, TX. Purpose: Colored filters (CF) can alter the appearance of colored stimuli because they selectively absorb visible light. Last year we reported subjects can learn to rename narrow band (NB) hues (generated on a CRT) that were altered in appearance by a CF. We repeated last year’s experiment but with broad band (BB) reflective hues and also determined if learning to identify altered BB hues had any effect on identifying NB hues. Methods: Six subjects were tested on a color naming (CN) task wearing a CF that blocked short wavelengths. The CN stimulus set consisted of 8 circular BB hues printed on a white background. One hue was presented at a time using a color wheel (CW) format. Each CW had 8 hues that differed in the set and order. One CW set had colors labeled by name and another set had no labels. After familiarization with the color set using labeled CWs, CN without a CF was tested with the unlabeled CWs. Each color was presented 8 times in random order and subjects had a choice of 8 CNs. The test was repeated with the CF. Then the CN test with NB hues was given without and with the CF. Next a block of training trials with the CF on was given using the labeled CWs. Subjects examined 64 colors (8 for each color in the set) at their own pace and were instructed to learn to associate the CN with hues as they appeared through the CF. No training with the NB hues was given. Immediately after the training block, the BB CN test was re-administered. Subjects were instructed to use what they had learned in training to name the colors. Re-testing without further training occurred again 2 and 7 days later. Also on day 7, the CN test with the NB hues was re-done. A control group of 5 completed a similar sequence of CN testing with BB hues but were never given any CN training. Data were CN error rates. Results: CN without a CF was near 100% correct. With the CF, but before training, errors increased to 33% incorrect. After training errors decreased to 14% and stayed there at 2 days post training. At 7 days the error rate rose slightly to 20%. The initial error rate for the NB colors with the CF was 71% and was unchanged at day 7. CN performance for the control group showed little improvement with repeated testing. Conclusions: Subjects were able to learn to rename a set of BB hues altered in appearance by a CF and retain that ability over a few days. There was no evidence what was learned for BB hues transferred to CN of NB hues. Commercial Relationships: Thomas Kuyk, None; Alastair Smith, None; Semih Kumru, None Program Number: 3020 Poster Board Number: C0183 Presentation Time: 8:30 AM - 10:15 AM Investigation of color vision defect among dental practitioners Hani Alarify, Nasser Aldossari, Ahmed Alharbi, Ali Masmali, Turki Almubrad. Cornea Research Chair, Optometry Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. Purpose: Most of dental practitioners use the traditional method for selecting shade which is based on the experience and the judgment of the trained human eye of the operator. Dentists having defective color vision may be unaware of their defect or may have problems in perceiving color vision as normal dentists do. This study was aimed to investigate color vision defect in adult dental practitioners. Methods: 57 subjects (41 male, 16 Female) were recruited for the study from Dentistry College at KSU & Dental Technology Department at CAMS. The subjects were aged between 20 and 40 years (mean= 24.38), they were dentists, dental students and dental technologist. Ishihara Color Test and Farnsworth dichotomous test D15 were used in this study. The Ishihara test was taken 1minute in ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics range. The Farnsworth dichotomous test D-15 was taken twice for each subject with 6 minutes in range. Results: 12.79% of subjects have color vision defect, 5 Males (8.7%) have Protan and 2 Females (3.5%) have Protan during the first test of Farnsworth D-15; but only 2 Males (3.5%) have Protan during the retest of Farnsworth D-15. Conclusions: The prevalence of color vision defect among dental practitioners in this study is higher than the prevalence in a previous study (12.3% of 160 subjects). Color vision test should be applied to dental practitioners in order to avoid any defect for shade matching of teeth. Commercial Relationships: Hani Alarify, None; Nasser Aldossari, None; Ahmed Alharbi, None; Ali Masmali, None; Turki Almubrad, None Program Number: 3021 Poster Board Number: C0184 Presentation Time: 8:30 AM - 10:15 AM Dependence of the color brown on the spatial configuration of high luminance surrounds Tanner DeLawyer, Ariel Frederick, Simon Kaplan, Tracy Lin, Sophie Shonka, Steven L. Buck. Psychology, University of Washington, Seattle, WA. Purpose: The same long-wavelength stimuli look brown when dim and yellow-orange when bright, relative to surrounding stimuli. Earlier research showed that the stimuli directly surrounding a brown stimulus were most important in the perception of brown. We confirmed these earlier results quantitatively and then tested the dependence of brown on brighter surrounding stimuli by varying their spatial configuration, to assess necessary and sufficient conditions for perceiving brown. Methods: Observers, under room-light adaptation, adjusted the luminance of a constant-chromaticity 4°-diameter foveal test stimulus to set both upper and lower luminance thresholds for perceiving brown under the four possible combinations of white and black near (4°x6° annulus) and far (6° and beyond) surrounds. The test stimulus appeared yellow-orange when at a high luminance and brown at a low luminance. Observers also completed a set of trials with an otherwise identical 1°, 2°, 3°, 4°, 5°, 6°, or 7°-diameter foveal test stimulus with a 2°, 4°, 6°, and 8° white near surround and black far surround. Results: Our results for the different combinations of near and far surrounds indicated that the perception of brown occurred at significantly higher luminance thresholds in the presence of a white near surround regardless of far surround luminance. Subjects could not perceive brown with a black near and far surround. In our spatial configuration conditions we found a general trend that as the size of the test stimulus increased, subjects had to adjust to lower luminance values in order to perceive brown. The size of the annulus did not have a significant effect on the subjects’ perception of brown. Conclusions: Our replication of earlier results established quantitative light levels that are necessary for the perception of brown under normal lighting conditions both with and without the presence of a high luminance near surround. Spatial results appear to indicate that as an object covers areas of the retina outside of the fovea the perception of brownness begins to fade, requiring a higher luminance contrast in order to perceive the object as being brown. This agrees with observation that it is difficult to perceive a stimulus as brown when it is viewed extra-foveally even in the presence of a high luminance surround. This suggests the neural mechanisms for perceiving a brown object are highly dependent on foveal input. Commercial Relationships: Tanner DeLawyer, None; Ariel Frederick, None; Simon Kaplan, None; Tracy Lin, None; Sophie Shonka, None; Steven L. Buck, None Program Number: 3022 Poster Board Number: C0185 Presentation Time: 8:30 AM - 10:15 AM Frequency of atypical genotypes associated with normal and defective color vision Candice Davidoff, Jay Neitz, Maureen Neitz. Ophthalmology, University of Washington, Seattle, WA. Purpose: The majority of red-green color vision deficiencies result from gene rearrangements that cause the loss of normal L or M opsin expression. This can be due to deletion of an L or M gene or insertion of an extra L gene between the normal L and M genes, displacing the M gene to a non-expressed position. Thus, characterizing the number of L and M genes is a good predictor of the presence and type of congenital red-green color vision defects. However, two atypical types of mutations, missense mutations and extra L opsin genes downstream of the expressed positions, would result in misdiagnoses based on L and M gene stoichiometry. This study aims to estimate the frequency of these types of mutations in the population. Methods: For 803 males unselected for color vision deficiencies, PCR was performed to selectively amplify L or M opsin genes. From these products exons 3 and 4 were sequenced. The number and type of opsin genes on the X-chromosome were determined by SNP analysis using Sequenom's MassARRAY system. For samples found to have extra L genes, long range PCR was performed to amplify the most downstream gene and verify whether it encoded an L or M opsin. For samples with missense mutations, parts of the last gene were sequenced to determine if the mutation was in a gene in an expressed position. Results: 3 missense mutations were identified in L opsin genes: R151T, V171L and V232L. 8 mutations were found in M opsin genes: six C203R, one R163I and one synonymous mutation. No C203R mutation was observed in any L opsin gene. 74 samples were found to have extra L genes. Of these 25 were confirmed to have the extra L in an expressed position, 20 were confirmed to have L genes at the end of the array and thus are likely to have normal color vision, and 29 had arrays too long to determine the position of the extra L gene. Conclusions: C203R mutations are unlikely to cause protan defects. Missense mutations that may cause protan defects were present in 0.37% of the sample and those that may cause deutan defects were detected in 1%. 9% of men in this sample have more than one L gene. Of those, at least a quarter had the genetic basis for normal color vision despite the presence of an extra L gene. 3.1% of men could be confirmed to have an L gene in the second position and are presumed to have deuteranomaly and another 3.6% may be deuteranomalous depending on the location of the extra L gene(s) in arrays with > 3 genes. Commercial Relationships: Candice Davidoff, None; Jay Neitz, Alcon (F), Alcon (P); Maureen Neitz, Genzyme (F), Alcon (F), Alcon (P) Program Number: 3023 Poster Board Number: C0186 Presentation Time: 8:30 AM - 10:15 AM Rod Hue Biases for Foveal Stimuli on CRT Displays Katharina G. Foote, Steven L. Buck. Psychology, University of Washington, Seattle, WA. Purpose: Signals from rod photoreceptors bias (shift) the hues determined by cone photoreceptors for extrafoveal mesopic stimuli creating green, blue, and red rod hue biases at long, middle, and short wavelengths, respectively. The fovea contains far fewer rods and S ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics cones but may not be immune to rod hue biases. Here, we determine which biases are found for foveal stimuli presented on a CRT display. Methods: On a CRT display, a 1-s duration test disk of 0.5°, 1.0°, or 2.0° diameter alternated with a 3-s duration array of 0.25° fixation dots placed 4° from fixation, all on a black background. Seven observers adjusted the hue of the test disk around the RGB phosphor mixture triangle, to yield each of the 4 unique hues, Ured, Ugreen, Ublue, and Uyellow. Light levels ranged from 0.05 - 0.17 (CIE2°) or 0.08 - 0.03 (CIE10°) cd/m2. Results: 1°-2°-diameter foveal test disks (a) produced rod green bias at Uyellow for most observers, (b) favored rod green bias at Ublue over the rod red biases shown in prior extrafoveal studies, and (c) produced less consistent rod hue biases at Ured and Ugreen. 0.5°diameter foveal test disks produced no consistent rod hue biases across observers. Remaining rod hue biases tended to be small but some observers showed larger idiosyncratic effects for a specific unique hue. Conclusions: 1°-2°-diameter foveal disks on a CRT display produced relatively strong rod green bias, mediated by rod interaction with L & M cones, presumably in midget/parvo pathways. In contrast, these foveal stimuli disadvantaged rod influence mediated by S cones, presumably in small-bistratified/konio pathways, producing only weak/inconsistent rod red bias at Ublue and rod blue bias at Ured and Ugreen. 0.5°diameter disks disadvantaged all rod hue biases, but with individually idiosyncratic exceptions for some observers. Commercial Relationships: Katharina G. Foote, None; Steven L. Buck, None Program Number: 3024 Poster Board Number: C0187 Presentation Time: 8:30 AM - 10:15 AM Fundus-controlled two-color adaptometry with the Microperimeter MP1 Wadim Bowl, Birgit Lorenz. Department of Ophthalmology, JustusLiebig-University, Giessen, Germany. Purpose: To provide fundus-controlled two-color adaptometry of mesopic vision with an existing device without modifying the CEmarked Microperimeter MP1 itself. Rod and cone sensitivity can be measured and differentiated on defined retinal positions the examiner is most interested in. Methods: An external filter holder was imposed on the objective lens of the MP1 (Nidek, Padova, Italy) and fitted with filters to modify background and stimulus intensity. Light output of the MP1 was reduced by Schott RG780 and BG3 filters outside the instrument to create the stimulus colors red and blue, which were used alternating in this examination. Absorption of infrared light by these filters is low thereby minimizing problems with fundus observation by the built-in infrared camera system. After bleaching with a Ganzfeld ColorDome (Espion E2, Diagnosys LLC, Lowell, MA, USA) with a luminous intensity of 3000 cd/m2 for 5 minutes, twenty normal subjects were investigated with a pattern covering 3 spots at the posterior pole of the retina (3 blue spots at 12° nasal; 3 red spots at 0° and 1°). The test was repeated every 3 minutes during the first 15 minutes and every 5 minutes until 45 minutes of dark-adaptation. Thresholds were determined using a 200 ms red Goldmann IV stimulus and a blue Goldmann III stimulus employing the built-in 4-2 strategy in a dark room. Results: In the first 5 minutes a slight increase of median light increment sensitivity (LIS) was measured for the red stimulus. With further dark-adaptation, LIS to red stimuli remained at about 7 dB. For blue stimuli LIS increased considerably during the first ten minutes. With processing time sensitivity to blue stimuli reached a plateau at 15 dB. Both measurements showed typical characteristics of dark-adaptation-curves. Conclusions: Two-color fundus-controlled adaptometry with a commercial MP1 without internal changes to the device provides a quick and easy examination of rod and cone function during dark adaptation at defined retinal loci. Under the mesopic lighting conditions chosen, LIS for blue stimuli is determined by the rod pathway. LIS for red stimuli is mediated by the cone pathway. The method should be helpful to identify rod vs. cone function in the posterior pole in early stages of retinal degenerations. Commercial Relationships: Wadim Bowl, None; Birgit Lorenz, Optos (F) Support: German Research Counsil (DFG LO457/10-1) Program Number: 3025 Poster Board Number: C0188 Presentation Time: 8:30 AM - 10:15 AM Color Discrimination and Visual Perimetry Evaluation in Multiple Sclerosis and Neuromyelitis Optica Phelipe A. Paixao1, 2, Lorena B. Botelho Vergara1, 2, Lucas Daniel A. Almeida Fernandes1, 2, Eliza Maria C. Lacerda1, 3, Givago S. Souza1, 3 , Hideraldo Luis Souza Cabeça5, Alexandre A. Rosa2, 4, Luiz Carlos L. Silveira1, 3. 1Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Brazil; 2Instituto de Ciencias da Saude, Universidade Federal do Para, Belem, Brazil; 3Instituto de Ciencias da Biologicas, Universidade Federal do Para, Belem, Brazil; 4Hospital Universitario Bettina Ferro de Souza, Universidade Federal do Para, Belem, Brazil; 5 Neurologia, Hospital Ophir Loyola, Belem, Brazil. Purpose: To compare visual performance in color discrimination and visual perimetry of patients with multiple sclerosis (MS) and neuromyelitis optica (NMO) with or without optic neuritis (ON). Methods: Patients with MS (9 subjects, 17 eyes, 37±9.7 years old) and with NMO (10 subjects, 18 eyes, 36.1±11.8 years old) were studied with biomicroscopy, fundoscopy, and visual acuity measurements. Color vision was evaluated with the full test protocol of Colour Assesment and Diagnosis (CAD) Test. The diameter of the circle with equivalent area of the color discrimination ellipses was measured. Visual perimetry was evaluated by Central 30-2 Threshold Test of the Humphrey Visual Field Analyzer. The two patient groups were compared to each other and to an age- and gender-matched control group. Statistical analyses used: tolerance intervals, binomial test, two-way ANOVA, α=0.05. Results: After the ophthalmologic evaluation, it was observed that 4 eyes from patients with MS and 6 eyes from patients with NMO had ON. Color discrimination. 2/4 eyes from patients with MS and ON and 4/10 eyes from patients with MS without ON had color discrimination above the upper tolerance limit for controls. 1/6 eyes from patients with NMO and ON and 1/9 eyes from patients with NMO without ON had color discrimination above the upper tolerance limit for controls. Regardless of ON presence, MS had significantly more eyes with altered color discrimination results than NMO (p<0.05). The MS group had statistically lower color discrimination than the control group (p<0.05). Visual perimetry. There were no statistical differences between the number of altered results across the visual field between patients with MS with and without ON. The group with MS and ON had significantly more altered results than NMO with ON and, despite of the disease, there were more altered results in patients with ON than without ON (p<0.05). There were no altered results in the group of NMO without ON across the visual field. The group of NMO with ON had significant lower sensitivity than the control group at all eccentricities and had lower sensitivity than the group of NMO without ON at eccentricity of 20° (p<0.05). Conclusions: MS was more harmful to color discrimination than NMO, while NMO patients had worse performance in visual ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics perimetry than MS patients. The ON presence impaired the visual function mainly for visual perimetry and NMO patients. Commercial Relationships: Phelipe A. Paixao, None; Lorena B. Botelho Vergara, None; Lucas Daniel A. Almeida Fernandes, None; Eliza Maria C. Lacerda, None; Givago S. Souza, None; Hideraldo Luis Souza Cabeça, None; Alexandre A. Rosa, None; Luiz Carlos L. Silveira, None Support: CNPq, CAPES, FINEP, FAPESPA, UFPA Program Number: 3026 Poster Board Number: C0189 Presentation Time: 8:30 AM - 10:15 AM Psychophysical and electrophysiological evaluation of visual function in type 1 diabetics Valéria D. Garcia1, 3, Mirella Gualtieri3, 1, Mirella T. Barboni3, 1, Daniela M. Bonci3, 1, Thiago L. Costa3, 1, Balázs V. Nagy1, 3, Sérgio T. Rodrigues4, Ana L. Moura1, 3, Francisco Max Damico1, 2, Dora F. Ventura1, 3. 1Neuroscience and bahavior, University of São Paulo, São Paulo, Brazil; 2Ophthalmology, University of São Paulo, São Paulo, Brazil; 3Experimental Psychology, University of São Paulo, São Paulo, Brazil; 4Physical Education, Universidade Estadual Paulista, Bauru, Brazil. Purpose: Diabetes mellitus (DM) is a chronic disease that impairs different aspects of health at different times during its progression. One of the most prevalent complications associated with DM is diabetic retinopathy (DR), which causes losses in visual functions and can ultimately result in blindness. Visual loss can be detected prior to the development of DR, potentially leading to improvement in the blood sugar control, prevention, and treatment of DR. The present work investigated color discrimination, contrast sensitivity and the multifocal electroretinogram (mfERG) of type 1 DM patients without DR. Methods: Twenty patients with type 1 DM without DR (mean age = 28 ± 7 years old) were compared to 20 control subjects without diabetes or ocular diseases (mean age = 28 ± 5). Color discrimination was evaluated with the Cambridge Colour Test (CCT) and contrast sensitivity with the Metropsis software (Cambridge Research System, Ltd) using vertical sine wave gratings at seven spatial frequencies (0.2; 0.5; 1; 2; 5; 10; 20 cpd). The Visual Evoked Response Imagining System (VERIS) was used to record the mfERGs . Groups were compared using ANOVA. Results: Type 1 diabetic patients presented significantly elevated values for all CCT parameters compared to control subjects. Protan, deutan and tritan thresholds in u’v’ units were respectively 51.95 ± 23.81 (F1,40 = 5.384, p = 0.026); 53.45 ± 25.66 (F1,40 = 6.90, p = 0,012) and 93,90 ± 41,94 (F1,40 = 14.30, p = 0.001); elipse area was 1672 ± 1102 (F1,40 = 11.665, p = 0.002). Contrast sensitivity was reduced in the diabetics at 0. 2 cpd (F1,40 = 4.67, p = 0.037) and 5 cpd (F1,40 = 6.08, p = 0.004). mfERGs of DM patients showed increased implicit time for N1 at 0° (F1,40 = 5.18, p = 0.03) and N2 at 5°(F1,40 = 4.15, p = 0.04) eccentricities. In addition, there was reduced amplitude of N2 at the 20° (F1,40 = 4.40, p = 0.04) and 25° (F1,40 = 5.42, p = 0.02) eccentricities. Conclusions: Non retinopathic type 1 diabetes mellitus patients present significant visual loss detectable by psychophysical and electrophysiological tests. Retinal hypoxia caused by chronic hyperglycemia has been identified as the main reason for reduced visual functions detected in the early DM, including color vision loss and contrast sensitivity. These findings suggest that psychophysical and electrophysiological tests should be routinely performed in diabetic patients Commercial Relationships: Valéria D. Garcia, FAPESP (F); Mirella Gualtieri, None; Mirella T. Barboni, None; Daniela M. Bonci, None; Thiago L. Costa, None; Balázs V. Nagy, None; Sérgio T. Rodrigues, None; Ana L. Moura, None; Francisco Max Damico, None; Dora F. Ventura, None Program Number: 3027 Poster Board Number: C0190 Presentation Time: 8:30 AM - 10:15 AM Psychophysical Measurement of Rod and Cone Thresholds in Stargardt Disease with Full-Field Stimuli Frederick T. Collison1, Gerald A. Fishman1, 2, J Jason McAnany2, Jana Zernant3, Rando Allikmets3, 4. 1The Pangere Center for Hereditary Retinal Diseases, The Chicago Lighthouse for People Who Are Blind or Visually Impaired, Chicago, IL; 2Department of Ophthalmology, University of Illinois Chicago, Chicago, IL; 3 Department of Ophthalmology, Columbia University, New York, NY; 4Department of Pathology and Cell Biology, Columbia University, New York, NY. Purpose: To investigate rod and cone psychophysical thresholds in Stargardt disease with the Diagnosys Full-Field Stimulus Test (DFST) using chromatic stimuli and a dark adaptation protocol. Methods: Twenty-two patients with Stargardt disease (age range 2152) were categorized by fundus appearance as Stage 1 (flecks confined to the macula, n=7), Stage 2 (flecks also outside the macula, n=6), or Stage 3 (resorbed flecks, n=9). The better-seeing eye was tested with ETDRS acuity charts, SD-OCT, and full-field ERG. Using the D-FST, dark-adapted rod thresholds were measured with short-wavelength stimuli and cone thresholds were obtained from the cone plateau phase of dark adaptation using long-wavelength stimuli. Four visually normal subjects (age range 28-38) also underwent the D-FST with the same protocol. For D-FST results zero dB = 0.1 photopic cd/m2. Correlation coefficients were calculated for comparisons of D-FST thresholds to other tests. Results: Stargardt patient D-FST cone thresholds correlated with ETDRS acuity (r=+0.56, p<0.01), ERG light-adapted single flash bwave (r=-0.78, p<0.001), and SD-OCT macular thickness (r=-0.62, p<0.01). For normal subjects D-FST mean rod threshold was -70.1 dB (SD 3.4), and mean cone threshold was -29.1 dB (SD 1.2). Stage 1 D-FST cone and rod thresholds were all within 3 dB of normal (mean rod and cone thresholds were -69.7 dB, SD 1.2 and 28.4 dB, SD 1.5, respectively). Stage 2 rod and cone thresholds ranged from normal to well above normal by 7 dB for rods and 9 dB for cones (rod mean -69.2 dB, SD 4.2; cone mean -25.6 dB, SD 4.5). Stage 3 rod thresholds ranged from 1.3 to 13.8 dB above normal (rod mean -63.8 dB, SD 4.9), whereas Stage 3 cone thresholds were all elevated at least 6 dB above normal (cone mean -21.3 dB, SD 1.5). Conclusions: D-FST may be useful as an efficient measure of visual function in patients with macular dystrophies who have difficulty fixating during visual field tests. Various levels of threshold elevation were identified among three stages of Stargardt disease by measuring thresholds with the D-FST both fully dark adapted (for rods) and during dark-adaptation (for cones). Of particular importance, cone thresholds in Stage 3 were consistently elevated, suggesting that fullfield cone thresholds may be a parameter that warrants monitoring in this subset of Stargardt disease patients in treatment trials. Commercial Relationships: Frederick T. Collison, None; Gerald A. Fishman, None; J Jason McAnany, None; Jana Zernant, None; Rando Allikmets, None Support: Pangere Corporation, Grant Healthcare Foundation, Cless Foundation, NIH #R00EY019510 (JM), NEI/NIH R01 EY021163 and NEI/NIH R24 EY019861 (RA) Program Number: 3028 Poster Board Number: C0191 Presentation Time: 8:30 AM - 10:15 AM ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Laser Eye Protection and Visibility of Multi-Function Displays Martin LaFrance1, Craig A. Williamson2, Leedjia Svec3, Thomas Kuyk1. 1Air Force Research Laboratory, Fort Sam Houston, TX; 2 Defence Science and Technology Laboratory, Salisbury, United Kingdom; 3Defense Equal Opportunity Management Institute, Patrick AFB, FL. Purpose: Handheld lasers have become commonplace, examples include laser games and hobbyist targeting devices. Unfortunately these lasers are at times used maliciously against commercial aircraft. Misuse has risen at an alarming pace with the Federal Aviation Administration reporting 3500+ events in 2011 alone; thus, laser eye protection (LEP) for aircrew is a growing concern. Aircrew LEP requires careful consideration for integration with avionics and multifunction displays (MFD) which are heavily dependent upon the accurate perception of color. The perception of color, mediated by cone photoreceptors, is altered by conventional LEP due to incongruent impact upon short, medium and longwavelength sensitive cones. The objective of this study is to compare a color-balanced LEP design, one which preserves the weighting of spectral transmission to cone subtypes, with conventional LEP on tests of color discrimination used as predictors of MFD integration and user acceptance. Methods: 15 color-normal subjects completed color identification tasks with the Farnsworth Munsell-100 and an 8-hue simulated MFD color identification test without and with a color-balanced LEP and a luminance matched neutral density (ND) filter. Results were compared to predictive models of color identification errors (E94, Color-Zone Border Analysis and ΔEu’v’) and like data collected previously for two conventional LEP. Results: FM-100 total error scores exceeded 80 for conventional and color-balanced LEP designs, the threshold for impaired discrimination, and were significantly higher than null and ND filter conditions. Color identification was markedly improved on the 8-hue MFD test for the color-balanced design vs. conventional LEP, statistically outperforming on five hues and producing a minor decrement for one. Global error rate across 8 hues was ~40% for conventional designs and 7% for cone-balanced. E94 calculations were ~10 for conventional vs. 8 for the cone balanced LEP design also predicting improved hue discrimination. Conclusions: A color-balanced LEP design demonstrates better integration for key multi-function display hues when compare with conventional LEP. Both conventional and color-balanced LEP, by virtue of selectively blocked wavelengths, produce higher total error scores with the Farnsworth Munsell-100; however, this test may not be the best predictor of user acceptance for LEP in cockpit integration. Commercial Relationships: Martin LaFrance, None; Craig A. Williamson, None; Leedjia Svec, None; Thomas Kuyk, None Program Number: 3029 Poster Board Number: C0192 Presentation Time: 8:30 AM - 10:15 AM Chromatic components in underwater targets do not affect Great cormorants’ (Phalacrocorax carbo) visual resolution Gadi Katzir1, 2, Ruth Almon1, Ido Izhaki1. 1Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel; 2Marine Biology, University of Haifa, Haifa, Israel. Purpose: The negative effects of scatter and absorption of light on image formation impair vision underwater. Because scatter and absorption are wavelength dependent, it is expected that visual resolution for targets with different chromatic components, will differ. Great cormorants pursue prey (fish) underwater, facing visual constraints in their frequent transitions between air and water. Visual resolution of cormorants for achromatic targets has been previously established yet the effects of chromatic components have remained open. We aimed here to determine the underwater visual resolution of cormorants for square wave gratings comprising chromatic and achromatic components. Methods: Hand-reared Great cormorants (N=6) were trained and tested for their resolution, in an underwater Y-maze. The visual targets comprised square-wave gratings that were achromatic (black & white) or chromatic (black & color). Colors ranged from “reds” through “yellow greens” to “blues”. Targets with vertically oriented bars were “positive” and targets with horizontally oriented bars were “negative”. Gratings ranged from 1.4 to 12 cpd. Illumination was diffuse daylight and water turbidity ranged 0.3-5.6 NTU. The cormorants’ choice was made at 1.4m from the targets. Each individual provided results from ca. 30 tests on chromatic and ca. 7 tests on achromatic gratings. The proportion of correct choices was used to determine resolution (at p=0.75 level). Results: Over all cormorants (grouped) the mean maximal underwater visual resolution for achromatic and chromatic gratings was ca. 8cpd. Resolution for achromatic gratings was consistently higher than for chromatic gratings yet the difference was not significant. Chromatic components did not have a significant effect while the effects of gratings frequency and of individual differences on resolution were significant. Individuals showing high resolution reached 6.1-12.2 cpd while individuals showing low resolution reached 3.0 - 4.0 cpd. Conclusions: Under the experimental conditions here, the chromatic components in the targets did not affect visual resolution. It may well indicate that color patterns of fishes, such as alternating black and chromatic bars, may not significantly affect their detection by foraging cormorants. Marked and consistent individual differences in visual resolution must play a role in prey detection and capture success. Commercial Relationships: Gadi Katzir, None; Ruth Almon, None; Ido Izhaki, None Support: Israel Science Foundation - ISF Program Number: 3030 Poster Board Number: C0193 Presentation Time: 8:30 AM - 10:15 AM High Throughput Behavioral Estimates of Visual Thresholds in Mice in a Watermaze with Cued Escape Platform Arkady Lyubarsky, Muhammad Sheheryar Khan, Meera Sivalingam, Jean Bennett. F.M. Kirby Center for Molecular Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, PA. Purpose: To develop a quantitative, sensitive, cost-effective, noninvasive behavioral technique for evaluation of vision in mice with emphasis on its suitability for the end point characterization in gene therapy of retinal diseases. Methods: The apparatus was a round (1.2 m diameter and 0.7 m high) tub made of a dark blue plastic, and filled with water to a 20 cm depth with a single submerged escape platform (8 cm diameter). A plastic 20 cm high pole covered with a disposable aluminum foil sleeve and standing at the platform center served as a visual cue assisting animals in finding the platform. Four infrared sources provided a uniform, invisible for mice, illumination of the tub, and a video camera with an infrared filter was recording animal’s moves. Four regulated visible light sources provided uniform illumination inside the apparatus in a 1E-5 to 1E+2 scot cd m-2 range. Wild-type (WT) and neural retina leucine zipper (NRL) knock-out (KO) mice lacking rod photoreceptors were trained to escape to the platform at the brightest level of illumination, and then were tested at 0.5 - 0.8 log-unit decrements of the illumination intensity. To determine the threshold, we first evaluated the probability of reaching the platform ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics by chance per second of swimming time; to do this we measured the frequency of platform encounter by mice swimming in dark with only IR illumination on. In test runs an animal was considered as “seeing” the pole if it reached the platform in 3 out of 3 consecutive trials, and the probability of achieving this result by way of 3 random hits was <1%. Results: The thresholds for seeing the platform were ~1E-5 and ~5 scot cd m-2 for the WT and NRL KO mice, respectively; the value of the threshold for the WT mice was somewhat lower than the one determined by Hayes and Balkema (5E-5 scot cd m-2, Behavior Genetics, VoI. 23, No. 4, 1993) in 6-way water maze experiments. In contrast with their paradigm which required over 10 days of training plus a comparable time for testing, our method needs only 6-8 hours for training , 1-3 days for testing, and it does not require specialized tracking software. Conclusions: We suggest a quantitative behavioral test for evaluating vision in mice which, as compared to analogous existing techniques, offers 5-10 fold higher throughput at comparable or better sensitivity. Commercial Relationships: Arkady Lyubarsky, None; Muhammad Sheheryar Khan, None; Meera Sivalingam, Canon Inc (F); Jean Bennett, Gensight Biologics (S) Support: NIH P30EY001583, 8 DP1 EY023177, 1R24 EY019861, Foundation Fighting Blindness, Research to Prevent Blindness, Foundation for Retinal Research, EuroUsher Consortium, the Grousbeck Family Foundation, The Mackall Foundation Trust. 334 Clinical Aspects of Motion Perception - Minisymposium Tuesday, May 07, 2013 11:00 AM-12:45 PM TCC LL 4/5 Minisymposium Program #/Board # Range: 3210-3216 Organizing Section: Visual Psychophysics / Physiological Optics Contributing Section(s): Eye Movements / Strabismus / Amblyopia / Neuro-Ophthalmology, Glaucoma Program Number: 3210 Presentation Time: 11:00 AM - 11:15 AM Motion perception in ocular disease and visual dysfunction Peter Bex. Harvard Medical School, Boston, MA. Commercial Relationships: Peter Bex, Adaptive Sensory Technology, LLC (S), Rapid Assessment of Visual Sensitivity (P) Program Number: 3211 Presentation Time: 11:15 AM - 11:30 AM Motion perception in migraine Allison M. McKendrick. Optometry & Vision Sciences, The University of Melbourne, Parkville, VIC, Australia. Commercial Relationships: Allison M. McKendrick, Heidelberg Engineering GmbH (F) Program Number: 3212 Presentation Time: 11:30 AM - 11:45 AM Motion Perimetry Michael Wall. Neurology & Ophthalmology, Univ of Iowa, Carver Coll of Med, Iowa City, IA. Commercial Relationships: Michael Wall, None Program Number: 3213 Presentation Time: 11:45 AM - 12:00 PM Moorfields Motion Displacement Test for Glaucoma David F. Garway-Heath. Institute of Ophthalmology, University College London, London, United Kingdom. Commercial Relationships: David F. Garway-Heath, Moorfields MDT (P), Carl Zeiss Meditec (F), Heidelberg Engineering (F), Reichert Technoloies (F), Ziemer Ophthalmic Systems AG (F), Pfizer Inc (F), Allergan (F), Allergan (C), Allergan (R), Alcon (C), Alcon (R), Bausch & Lomb (R), Merck (R), Santen (R), Quark (C), Teva (C), Topcon (F), OptoVue (F) Program Number: 3214 Presentation Time: 12:00 PM - 12:15 PM Global motion, suppression and amblyopia Robert F. Hess. Ophthalmology, McGill University, Montreal, QC, Canada. Commercial Relationships: Robert F. Hess, None Program Number: 3215 Presentation Time: 12:15 PM - 12:30 PM Peripheral Motion Perception in Low Vision: Characterization of Deficits and the Effects of Training Duje Tadin. Brain & Cognitive Science, University of Rochester, Rochester, NY. Commercial Relationships: Duje Tadin, None Program Number: 3216 Presentation Time: 12:30 PM - 12:45 PM Motion Perception in Nystagmus Magella M. Neveu. Electrophysiology, Moorfields Eye Hospital, London, United Kingdom. Commercial Relationships: Magella M. Neveu, None 344 Cones and Outer Retina Tuesday, May 07, 2013 11:00 AM-12:45 PM Exhibit Hall Poster Session Program #/Board # Range: 3428-3455/C0149-C0176 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 3428 Poster Board Number: C0149 Presentation Time: 11:00 AM - 12:45 PM Photoreceptor Pointing as a Function of Retinal Eccentricity in Normal Human Eyes Nathan Doble1, Rebecca Kivlin1, Johanan L. Codona2, Simone Li3, Stacey S. Choi1. 1Vision Science, New England College of Optometry, Boston, MA; 2Steward Observatory, University of Arizona College of Optical Sciences, Tuscon, AZ; 3Retina Foundation of the Southwest, Dallas, TX. Purpose: The optical alignment of the cone photoreceptors with respect to the pupil center is a potential metric to assess retinal health. Roorda and Williams (JOV, 2002) first made measurements of the directionality of single cone photoreceptors in normal human eyes. Choi et al, (IOVS 2008) subsequently performed measurements on a subject with retinal disease. We present work on a larger number of normal subjects at several retinal eccentricities. Methods: The adaptive optics (AO) fundus camera at the New England College of Optometry was used to acquire retinal images on three normal human subjects, N1, N2 and N3 (ages 23 to 26) at 2 and 4 degrees in the nasal retina. 2 degrees temporal eccentricity was also measured in two of the subjects. At each location, a series of 1° diameter retinal images (680nm light) were acquired for 9 different entrance pupil positions. Images were then registered and a centroiding algorithm applied to determine the alignment property of individual cones at the pupil plane of the eye. Results: After processing, the pointing of approximately 600 cones at ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics each retinal location could be measured. As an example, for subject N1, the projection of the cone pointing at the pupil plane from all retinal locations fell within an area of 0.25mm in diameter, located slightly nasally (0.15mm) from the pupil center along the horizontal meridian. The other subjects showed similar nasal bias in alignment with respect to the pupil center. Our disarray is smaller than that reported by previous studies (Roorda, JOV, 2002) possibly due to choosing areas that did not include retinal blood vessels. Conclusions: For normal subjects, our results are in agreement with previous reports (both psychophysical and imaging studies) that the disarray of the photoreceptors is very small; which is to optimize the efficiency of light capture within the photoreceptors. In diseased eyes, larger variations in cone disarray were reported (Choi et al, IOVS 2008). Commercial Relationships: Nathan Doble, Iris AO Inc (I); Rebecca Kivlin, None; Johanan L. Codona, None; Simone Li, None; Stacey S. Choi, None Support: EY020901 Program Number: 3429 Poster Board Number: C0150 Presentation Time: 11:00 AM - 12:45 PM The role of defocus on photoreceptor light coupling analyzed with a waveguide-based retinal simulator Brian Vohnsen1, Diego Rativa Millan2, Carmen Vela1, Benjamin Lochocki1, Philip B. Kruger3. 1School of Physics, University College Dublin, Dublin, Ireland; 2Pós-Graduação em Engenharia de Sistemas (PPGES), Universidade de Pernambuco, Recife, Brazil; 3College of Optometry, State University of New York, New York, NY. Purpose: Obliqueness of light at the retina diminishes the visual response as a consequence of the Stiles-Crawford effect caused by photoreceptor waveguiding. The aim of this study is to analyze the sensitivity to defocus under waveguide conditions that resemble those of the human eye retina using a retinal simulator consisting of an array of photonic-crystal waveguides. Methods: A liquid-filled photonic crystal fibre array has been used to simulate waveguiding by retinal photoreceptors and the total fraction of coupled light has been measured. Defocus is generated with a Badal-system and monitored simultaneously with a Hartmann-Shack wavefront sensor. Measurements are performed both at 633 nm and at 543 nm wavelength to study a possible chromatic impact. The results are compared with those of an analytical waveguide model and Zemax-based eye models. Results: Measurements show that the fraction of coupled light power is sensitive to defocus as expected due to the wavefront curvature at the entrance facet of the waveguides. This is in agreement with the numerical models suggesting a possible role of light power for accommodation and emmetropization of the eye. Conclusions: We found that a photonic crystal fibre array is a suitable experimental tool to analyze the role of defocus and more generally aberrations and their possible role on vision and effective retinal images. The fraction of light that couples to waveguide modes may provide a clue for accommodation and emmetropization of the eye. The sign of defocus is not determined but may relate to the chromatic difference for a finite bandwidth or to photoreceptor disarray though also other aberrations and other factors can provide accommodative clues. Commercial Relationships: Brian Vohnsen, None; Diego Rativa Millan, None; Carmen Vela, None; Benjamin Lochocki, None; Philip B. Kruger, None Support: Science Foundation Ireland grants 07/SK/B1239a and 08/IN.1/B2053 Program Number: 3430 Poster Board Number: C0151 Presentation Time: 11:00 AM - 12:45 PM Measurement of the Photoreceptor Pointing in the Living Chick Eye Maria Walker, Rebecca Kivlin, Nathan Doble. Vision Science, New England College of Optometry, Boston, MA. Purpose: The chick retina is a widely used animal model in the study of eye growth, in particular for the study of emmetropization and myopia. Like most eyes, the ability to image the fine retinal structure is degraded by the aberrations in the lens and cornea. In previous work, we showed in-vivo images of individual chick photoreceptors taken with an adaptive optics (AO) fundus camera (Headington et al. Current Eye Research, 2011). Here we utilize this imaging capability to examine the individual cone directionality of the chick photoreceptors. Methods: Two White Leghorn chickens (Gallus gallus domesticus) (age 30d, approx. 650g) were anesthetized with a combination of Ketamine/Xylazine and dilated with Vecuronium Bromide suspension prior to imaging. The AO fundus camera at the New England College of Optometry was modified in order to image the smaller 3mm pupil of the chick. Translating the entrance pupil position of the imaging beam (650nm) allowed for the measurement of the individual cone pointing. Thirteen entrance pupil positions were tested to obtain 1-degree FOV retinal images; four retinal images were registered for each position. Upon compensating for the variation in incident light intensity due to light delivery optics, a centroiding algorithm was used to determine the directionality of individual cones. Results: Upon projection of the cone pointing toward the pupil plane, the degree of disarray was found to be slightly larger than that found in the human eye. Interestingly, our initial results show an elliptical pointing pattern in the pupil plane with major and minor axes of 0.5 and 0.2 mm respectively. The major axis was horizontal and the center of the pattern lay on average 0.5 mm from the pupil center. Conclusions: Similar to the human eye, the chick photoreceptor disarray is small, implying that the receptors are aligned to maximize the signal coming through the center of the pupil aperture. Commercial Relationships: Maria Walker, None; Rebecca Kivlin, None; Nathan Doble, Iris AO Inc (I) Support: NH Grant EY020901 Program Number: 3431 Poster Board Number: C0152 Presentation Time: 11:00 AM - 12:45 PM Reproducibility of the rtx1 adaptive optics retinal camera ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Dirk-Uwe G. Bartsch, Cheryl Arcinue, Feiyan Ma, Lingyun Cheng, William Freeman. Ophthalmology-Shiley Eye Ctr, Univ of California-San Diego, La Jolla, CA. Purpose: To study the reproducibility of the flash-illumination commercially available adaptive optics retinal camera rtx1 (ImagineEyes, Orsay, France) in a group of normal volunteers. Methods: The rtx1 is an adaptive optical fundus camera using flashed, non-coherent flood illumination centered at 850 nm to record a series of 40 images. Each image covers an area of 4° x 4°. The instrument is claimed to have a pixel resolution of 1.6 µm and resolve 250 line pairs per millimeter. The instrument uses a yellow fixation cross to help the subject fixate. The location of the center of fixation cross is stored by the instrument allowing the subject to fixate to the same stimulus location. After approval by the Institutional Review Board we recruited 6 subjects and imaged each subject in two different sessions. We selected 5 regions of interest. One was at the center of the fovea, and the other four regions were centered at 2 degrees from the foveal center in the four principal directions (superior, inferior, nasal and temporal). We selected a measurement area for each image pair that was matching according to vessel landmarks. We used the adaptive optics analysis software from ImagineEyes to measure density and spacing for each image. For statistical analysis we used concordance correlation coefficient (Lin, 1989) with a 95.0% asymptotic confidence interval, and a 95% BCa bootstrap confidence interval using SAS (Cary, NC). Results: We found that the rtx1 was able to resolve the photoreceptor cone mosaic in the parafoveal area. The instrument was not able to resolve the cone mosaic in the center of the macula. The central 2.5° of the fovea could not be resolved. For density means we found a CCC of 0.767. For spacing means we found a CCC of 0.786. Conclusions: The rtx1 adaptive optical camera allows reproducible acquisition of the photoreceptor cone mosaic. The resolution limit of the instrument does not allow imaging at the center of the fovea due to the very dense spacing of the photoreceptors. The current software does not allow to exclude blood vessels from the analysis. These two areas might influence overall accuracy and should be excluded in future versions of the software. Commercial Relationships: Dirk-Uwe G. Bartsch, None; Cheryl Arcinue, None; Feiyan Ma, None; Lingyun Cheng, Spinnaker Biosciences (C); William Freeman, OD-OS, Inc. (C) Support: NEI Grants R01EY016323, R01EY007366, R01EY018589, P30EY022589 Program Number: 3432 Poster Board Number: C0153 Presentation Time: 11:00 AM - 12:45 PM Test-Retest Reliability of Microperimetry Using the Optos OCT SLO in Eyes With and Without Known Retinal Diseases Hyun Soo Jang, Yasir J. Sepah, Millena G. Bittencourt, Mohammad A. Sadiq, Owhofasa O. Agbedia, Hongting Liu, Mehreen Ansari, Zubir S. Rentiya, Daniel A. Ferraz, Quan Dong Nguyen. Retinal Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD. Purpose: To evaluate the test-retest reliability of Optos (Optos, Inc, Scotland, UK) OCT SLO microperimetry (MP) device in eyes with and without known retinal diseases. Methods: Thirty six eyes of 19 subjects (ages 20-53, mean 29) with no known retinal diseases and 10 eyes of 5 subjects (ages 29-76, mean 52) with known retinal diseases were scanned. All tests were performed using the Optos OCT SLO. For each eye, a fixation test and spectral domain optical coherence tomography were obtained before the MP. Three consecutive fundus-aligned MP sessions for each eye with a maximum of 2-minute interval between the sessions were performed using the following settings: a customized 9-point pattern, 200 ms stimulus duration, Goldmann III size, 4-2-1 dB staircase strategy, 10 dB initial brightness, and red cross as the fixation target. The 9 points consisted of a 3x3 upright square lattice centered at the fovea, having a 1.5° angle between the center and every corner point (Figure). The point sensitivities were recorded. Results: Sensitivities and variances are recorded in the Table. Friedman Test showed no significant differences in the mean sensitivities across the 3 sessions in both groups (p>0.7 for both). The overall inter-session variances in normal (1.03 ± 0.07) and diseased (2.43 ± 0.51) groups were significantly different (p=0.05, MannWhitney Test). The variances of 9 points were significantly different in both groups (p<0.05, Friedman Test). The points with greatest variances are highlighted in the Table. Conclusions: The Optos OCT SLO microperimeter produces reliable test results with no significant differences in mean sensitivities among sessions. Eyes with retinopathies were found to have greater inter-session variance than those without. Therefore, interpretation of the changes in retinal sensitivities among eyes with pathologies must take into consideration the differences in test variances between normal and diseased eyes. Additional studies on the MP variances in different and larger diseased groups are indicated. Figure Table Commercial Relationships: Hyun Soo Jang, None; Yasir J. Sepah, None; Millena G. Bittencourt, None; Mohammad A. Sadiq, None; Owhofasa O. Agbedia, None; Hongting Liu, None; Mehreen Ansari, None; Zubir S. Rentiya, None; Daniel A. Ferraz, None; Quan Dong Nguyen, Genentech (F), Regeneron (F), Lux Biosciences (F), Abbott (F), GSK (F), Santen (F), Santen (C), Bausch and Lomb (C), Optos (F), Heidelberg Engineering (F) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Support: Retinal Imaging Research and Reading Center Fund Program Number: 3433 Poster Board Number: C0154 Presentation Time: 11:00 AM - 12:45 PM Assessing retinal detailed structure in pathological myopia with adaptive optics scanning laser ophthalmoscope na liao, Chaohong Li, Yiyu Li, Hao Chen, Qinmei Wang. wenzhou medical college, WenZhou, China. Purpose: To examine the retinal detailed structure in pathological myopia with adaptive optics scanning laser ophthalmoscope (AOSLO). Methods: The 20 eyes (10 emmetropias and 10 pathological myopias) of 20 subjects, whose ages ranged from 18 to 30, were enrolled. An AOSLO was used to obtain high resolution images of the macular photoreceptor mosaic, the surface-level pores of the lamina cribrosa and parafoveal capillary network of all participants. Results: AOSLO can compensate living human eye’s optical aberrations and get the retinal detailed histological image. Compared with the emmetropic eyes, the pathological myopia subjects showed an average lower cone packing densities in macular, greater lamina cribrosa pore areas, bigger foveal avascular zone (FAZ) and lower leukocyte speed. Conclusions: AOSLO as a non-invasive technique is able to visualize detail images in vivo retina which can assist in detecting pathologic features and illuminating the reasons of the increased glaucoma susceptibility in highly myopic eyes. This novel technique provides opportunities to enhance the understanding of retinal pathogenesis. Commercial Relationships: na liao, None; Chaohong Li, None; Yiyu Li, None; Hao Chen, None; Qinmei Wang, None Program Number: 3434 Poster Board Number: C0155 Presentation Time: 11:00 AM - 12:45 PM Variation of cone density assessed by Adaptive Optics Retinal Camera with axial length meillat mathieu, Perle TUMAHAI, Mélanie Bidaut-Garnier, Guillaume Debellemaniere, Mathieu Flores, Michel Montard, Bernard Y. Delbosc, Maher Saleh. ophthalmology, besancon hospital jean minjoz, Besancon, France. Purpose: To assess macular cone densities changes with axial length (AL) and spherical equivalent (SE) using Adaptive Optics (AO). Methods: Fifty-two eyes of 28 healthy adults under 50 years, with a visual acuity of 20/20, were imaged. Group 1 included myopic and group 2 non myopic eyes. All patients underwent a complete ophthalmologic examination, spectral-domain optical coherence tomography (SD OCT), and imaging with the RTX-1 Adaptive Optics (AO) device from Imagine eyes™ (Orsay, France). Mean cone density (cells/mm2) at a fixed distance from the fovea (1° nasally and temporally), spacing between cells (µ) and percentage of hexagonal cells calculated on Voronoi diagrams, were obtained by two masked graders using AODetect v. 0.1, the proprietary software of the device. Axial length was measured by using IOL Master® (Carl Zeiss. Meditec. USA). Results: In group 1 (n=22), AL was 25.17+-1.15 mm and SE -5+2.73 D. In group 2 (n=30), AL was 23.09+-0.87mm (p<0.05) and SE 1.23+-2.05 D (p<0.05). The mean age was 30.55 with no difference between groups (p<0.05). Cone density was lower in group 1 (23251+-1845 cells/mm2 vs 25419 +-2443 cells mm2 in group 2, t test, p=0.001). Spacing between photoreceptors was also higher in myopic eyes (7.47 +-0.52 µ vs 7.06 +-0.36 µ,t test, p=0.001). There was no difference in percentage of hexagonal cells between both groups. The cone density was inversely proportional to the axial length and the spherical equivalent (r2= 0.22,p=0.002 and r2=0.17 p=0.002, respectively). The multiple regression analysis showed that AL but not age contributed to the change in cone density (p=0.001). Conclusions: Myopic subjects with a good visual acuity showed a lower cone density in the macular area and a higher spacing between cells, correlated to the axial length. Adaptive Optics could help understanding the pathological changes induced in the retina by the myopia. Commercial Relationships: meillat mathieu, None; Perle TUMAHAI, None; Mélanie Bidaut-Garnier, None; Guillaume Debellemaniere, None; Mathieu Flores, None; Michel Montard, None; Bernard Y. Delbosc, None; Maher Saleh, None Program Number: 3435 Poster Board Number: C0156 Presentation Time: 11:00 AM - 12:45 PM Quantification and Comparison of Cone density, Outer Nuclear Layer and Henle’s Fiber Layer Thickness Using High-Resolution Imaging Grace K. Han1, Jan Kristine T. Bayabo2, Brandon J. Lujan2, 3, Jessica I. Morgan1. 1Scheie Eye Institute of Opthalmology, University of Pennsylvania, Philadelphia, PA; 2Vision Science, University of California, Berkeley, CA; 3West Coast Retina Medical Group, San Francisco, CA. Purpose: To quantify and compare cone photoreceptor density as measured with adaptive optics scanning laser ophthalmoscopy (AOSLO) to the thicknesses of the outer nuclear layer (ONL) and Henle’s fiber layer (HFL) as measured by directional optical coherence tomography (D-OCT). Methods: Retinal images from 8 normal sighted subjects (age 15-22) with no known retinal pathology were acquired along the nasaltemporal meridian with an AOSLO developed by Canon Inc. Horizontal D-OCTs through the fovea were acquired using the Heidelberg Spectralis OCT. During D-OCT imaging the entry position of the beam was modified horizontally through the pupil to reveal HFL. AOSLO cone images were registered using custom software from Canon, and manually montaged for precise alignment to the Spectralis fundus images and D-OCT sets. Cone density was measured at precise locations along the horizontal meridian using a semi-automated, custom Matlab program. D-OCTs were registered and the ONL and HFL were manually segmented. The thicknesses of these layers were measured at locations where cone density was measured. Results: Cone density was highest in the central most measured location and decreased with increasing eccentricity. The cone densities measured in this study agreed with previously reported densities for normal controls. From ~0.75-1.5mm cone density positively correlated with HFL thickness (R2=0.46). ONL thickness was highest in the fovea and decreased with eccentricity until reaching a local minimum at ~0.8mm. From ~ 0.8-1.3mm there was a slight increase in ONL thickness, beyond which ONL thickness leveled off. Cone density did not correlate with ONL thickness from 0.75-1.5mm (R2=0.02). The variability in cone density between subjects was less than the variability of ONL and the variability of HFL thickness at all locations measured between 0.75-1.5mm eccentricities. Conclusions: HFL can be imaged and quantified separate from the ONL by using directional OCT. ONL thickness did not correlate with cone density in the imaged regions, likely due to the increasing rod contribution at these eccentricities. Cone density measurements show less variability between subjects than ONL measurements, which may be a reflection of variability in the contribution of rods. Further studies will examine total photoreceptor densities in comparison with ONL and HFL thicknesses. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Grace K. Han, Canon Inc. (F), Optos PLC (F); Jan Kristine T. Bayabo, None; Brandon J. Lujan, Genentech (C), Genentech (R), Genentech (F), Carl Zeiss Meditec, Inc (C), Avalanche Biotech (C), Regeneron (R), UC Berkeley (P); Jessica I. Morgan, Canon (F), Optos (F) Support: Earl and Brenda Shapiro Leber's Congenital Amaurosis Research Initiative, Foundation Fighting Blindness, NIH K12 EY017269, NIH EY019861, F.M. Kirby Foundation, Research to Prevent Blindness, Mackall Trust, Canon Inc. Berkeley (P); Shiri Zayit-Soudry, None; Reema Syed, None; Travis Porco, NIH NEI (F); Jan Kristine T. Bayabo, None; Joseph Carroll, Imagine Eyes, Inc. (S); Austin Roorda, US Patent #6890076 (P), US Patent #7118216 (P), UC Berkeley (P); Jacque L. Duncan, None Support: Foundation Fighting Blindness, Research to Prevent Blindess, That Man May See, NEI Core Grant EY002162, NIH K12 EY017269 Clinical Trial: NCT00254605 Program Number: 3436 Poster Board Number: C0157 Presentation Time: 11:00 AM - 12:45 PM Correlation of outer nuclear layer thickness with cone density values in patients with retinitis pigmentosa and healthy subjects Moreno Menghini1, Brandon J. Lujan2, Shiri Zayit-Soudry1, Reema Syed1, Travis Porco1, Jan Kristine T. Bayabo2, Joseph Carroll3, Austin Roorda2, Jacque L. Duncan1. 1Ophthalmology, University of California San Francisco, San Francisco, CA; 2School of Optometry, University of California Berkeley, Berkeley, CA; 3Ophthalmology, Medical College of Wisconsin, Milwaukee, MI. Purpose: Outer nuclear layer thickness (ONL) has been widely used as a marker for photoreceptor numbers. However, some studies have not shown a consistent correlation between ONL thickness and cone density. Variability in ONL thickness measurements may be attributed to the inclusion of Henle’s fiber layer (HFL) when using standard optical coherence tomography (OCT) imaging techniques. The aim of our study is to compare ONL thickness using directional OCT (D-OCT) with cone density values at identical retinal locations in normals and retinitis pigmentosa (RP) patients. Methods: Cross-sectional analysis of images acquired with D-OCT and adaptive optics scanning laser ophthalmoscopy (AOSLO) from normals and RP patients. The D-OCT data sets were obtained using a previously described method of varying the pupil entry position of the beam to reveal the HFL. Five retinal layers (ILM, OPL/HFL junction, HFL/ONL junction, ELM and outer RPE border) were segmented using Image J and MatLab® software. Multiple locations along the central horizontal meridian were selected on the AOSLO images and compared with ONL thicknesses at identical eccentricities. Cone density was analyzed in areas where cone mosaics could unambiguously be identified and expressed as cones/degree2. Results: Mean age in our population was 40.5 in patients and 42.0 years in normals. Average central retinal thickness was 240±25.0um and 234±12.8um, with an average ONL thickness at 1° eccentricity of 47.2±8.8um and 46.0±3.7um in patients and in normals. Mean ONL thickness at 2° eccentricity was also comparable with 33.7±6.7um in RP patients and 33.7±7.1um in normals. Average cone densities measured at 1° eccentricity were 3718±1287 and 4313±541 for patients and normals, respectively. At more eccentric locations (2° eccentricity) the values were 2646±531 and 2646±245. Combining the normal and patient images, ONL thickness was significantly correlated with cone density (Pearson’s correlation coefficient 0.74, 95% CI 0.67, 0.82). The correlation between ONL+HFL values and cone density on the other hand was weaker (coefficient 0.59, 95% CI 0.46, 0.78). Conclusions: ONL thickness measures correlated with cone density measures in normals and RP patients, as measured using D-OCT. ONL thickness could be an easily obtainable indirect parameter to represent cone density values both in diseased and healthy individuals. Commercial Relationships: Moreno Menghini, None; Brandon J. Lujan, Genentech (C), Genentech (R), Genentech (F), Carl Zeiss Meditec, Inc (C), Avalanche Biotech (C), Regeneron (R), UC Program Number: 3437 Poster Board Number: C0158 Presentation Time: 11:00 AM - 12:45 PM Repeatability of Cone Density Measurements in Healthy Subjects Using Commercially Available Flood-Illuminated Adaptive Optics Shu Feng, Anupam K. Garg, Ambar Faridi, Jonathan D. Fay, Hope E. Titus, Travis B. Smith, Keith V. Michaels, Mark E. Pennesi. Casey Eye Institute, Oregon Health & Sciences University, Portland, OR. Purpose: To evaluate a commercially available flood-illuminated adaptive optics camera for its repeatability in measuring the cone mosaic and to determine average cone density among healthy subjects Methods: We used the RTX1 flood-illuminated adaptive optics camera (Imagine Eyes: Orsay, France) to image the cone mosaic in 54 healthy subjects, ages 14 to 69 years. For each subject, a series of 25 4°x4° retinal images were obtained. Using MosaicJ, these images were combined to create a retinal montage spanning a 12°x12° field of the central macula. Retinal montages were analyzed for regional differences in cone density. Images were post processed in ImageJ and cone counting was performed with a MATLAB algorithm. To determine repeatability of the device and montaging process, a subset of 7 subjects ranging in age from 19 to 36 years were imaged on 3 separate occasions. To assess the validity of automated cone counting for each montage, automated cone counts were compared to manual counts in sample retinal areas 2° and 4° temporal to the foveal center. Results: Image quality was excellent in most young subjects, but increasingly variable in older subjects. Cones within 1.5° of the foveal center could not be resolved with this camera. Angular density of cones averaged 1587 ± 91 cones/degree2 at 1.6° - 4.3° eccentricity and 1428 ± 64 cones/degree2 between 4.3° and 5.4° eccentricity. When adjusted for axial length, cone density averaged 18,688 ± 2081 cones/mm2 between 1.6° and 4.3° and 16,763 ± 1669 cones/mm2 between 4.3° and 5.4°. Angular cone density between 1.6° and 4.3° decreased with age, but between 4.3° and 5.4° increased. Repeated measurements of cone density in the same subject from separate imaging sessions resulted in an intraclass correlation coefficient of 0.98 (p < 0.001, 95% CI: 0.93-1.00) between 1.6° and 4.3° and 0.95 (p < 0.001, 95% CI: 0.83-0.99) between 4.3° and 5.4°. However, validity of the automated cone counting algorithm depended on image quality, with poor quality images producing higher variability. Conclusions: Flood-illuminated adaptive optics provides measurements of cone density that are consistent with anatomical studies. Repeated measurements in a subset of younger subjects resulted in very strong intraclass correction coefficients, which indicate the system produced consistent measurements. However, challenges remain with older subjects. Commercial Relationships: Shu Feng, None; Anupam K. Garg, None; Ambar Faridi, None; Jonathan D. Fay, None; Hope E. Titus, None; Travis B. Smith, Pfizer, Inc. (F); Keith V. Michaels, Pfizer, Inc. (F); Mark E. Pennesi, Pfizer (F) Support: Research to Prevent Blindness (Unrestricted, CEI), Foundation Fighting Blindness (Pennesi CDA, CD-CL-0808-0469- ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics OHSU), Foundation Fighting Blindness (Weleber, C-CL-0711-0534OHSU01) Program Number: 3438 Poster Board Number: C0159 Presentation Time: 11:00 AM - 12:45 PM High resolution imaging of photoreceptors in healthy humans of different ages eyes using RTX-1 ™ Adaptive Optics Retinal camera Perle TUMAHAI, meillat mathieu, Melanie Bidaut-garnier, Guillaume Debellemaniere, Mathieu Flores, Michel Montard, Bernard Y. Delbosc, Maher Saleh. Ophthalmology, University Hospital of Besançon, Besançon, France. Purpose: To determine age-related macular photoreceptor density changes in healthy patients of various ages. Methods: Observational case series. Healthy subjects with no retinal pathology or systemic affection were included. High myopic patients were excluded. All patients underwent a full ophthalmologic examination, SD-OCT imaging, and imaging with the RTX-1 ™ Adaptive Optics (AO) retinal camera from Imagine eyes® (Orsay, France). Mean cone density (cells/mm2) at a fixed distance from the fovea (1° nasally and temporally), spacing between cells (µm) and % of hexagonal cells calculated on Voronoi diagrams, were obtained using AODetect v. 0.1, the proprietary software of the device. Results: 58 normal eyes of 35 patients were studied. Mean age was 34.45±2.5 y (min-max: 10-78y). The mean cone density reached 24039±2914.5 cells/mm2. It decreased with age (R2=0.21, p<0.001). Patients above 50 y lost 17.5% of the cone density compared to patients under 15 y (t-test, p=0.003). Spacing between cells (mean±SD: 7.31±0.56µm) increased with age (R2 =0.15, p=0.002), while the percentage of hexagonal cells (mean±SD: 43.93±3.8 %) moderately decreased (R2 =0.07, p=0.04). Cone density was slightly correlated to the thickness of the photoreceptor layer on OCT (distance between IS/OS and ELM hyperreflective lines) (R2= 0.08, p=0.04) but neither with central macular thickness nor choroidal thickness. Conclusions: Macular cone density decreased with age. The consequences of this finding on visual acuity as well as the meaning of spacing between cells and rate of hexagonal cells in the macula are not known yet. Commercial Relationships: Perle TUMAHAI, None; meillat mathieu, None; Melanie Bidaut-garnier, None; Guillaume Debellemaniere, None; Mathieu Flores, None; Michel Montard, None; Bernard Y. Delbosc, None; Maher Saleh, None Program Number: 3439 Poster Board Number: C0160 Presentation Time: 11:00 AM - 12:45 PM Quantitative analysis of cone photoreceptor distribution in aged patients using an adaptive optics fundus camera Ryo Obata1, Xue Tan1, Kayo Kure1, Frida Rosander2, Yasuo Yanagi1. 1 Department of Ophthalmology, The University of Tokyo, Tokyo, Japan; 2Department of Biomedical Engineering, Medical Informatics, Linköping University, Linköping, Sweden. Purpose: Relationship between cone photoreceptor distribution and aging is unclear. We used adaptive optics fundus camera to examine cone photoreceptor distribution in the macular area of aged patients and quantitatively analyzed its relationship with age, axial length, and age-related maculopathy for the first time to our knowledge. Methods: Sixty-three cases aged 50 or older with unilaterally affected macular diseases were included. Thirty-five cases (54%) were affected by neovascular age-related macular degeneration (AMD). The unaffected eye was examined with adaptive optics fundus camera (rtx1TM, Imagine Eyes, France) and high-resolution retinal images with cone photoreceptor mosaic were obtained. After excluding the eyes with any pathological findings within the area of interest, averaged cone packing density and spacing at 2° superior and 5° temporal to the fovea were calculated. Relationships between these values and age, axial length, AMD or non-AMD in the affected eye, drusen or pigment abnormality in the measured eye were analyzed. Amongst 24 eyes were repeatedly examined for testing repeatability. Results: Patient age ranged 50 to 77, and axial length 21.7 to 27.5 mm. At 2° superior (n=51) and 5° temporal (n=53) to the fovea average cone packing density were 19,200 ± 591 and 13,700 ± 386 (cells/mm2), and average cone spacing were 8.10 ± 0.14 and 9.56 ± 0.16 (μm), respectively. Axial length was significantly correlated with the density and the spacing (-1,360 and -1,080 cells/mm2/mm, 0.32 and 0.42 μm/mm at 2° superior and 5° temporal, respectively). Age was significantly correlated with the density at 5° temporal (-130 cells/ mm2/year), and this correlation was also observed when the density was calculated as angular density (-9.4 cells/deg2/year). AMD or non-AMD in the contralateral eye and degrees of drusen or pigment abnormality in the measured eye was not significantly associated with the density or the spacing. Intraclass correlation coefficients (%) for the density and the spacing were 95 and 94 at 2° superior, 90 and 91 at 5° temporal, respectively. Conclusions: Axial length and age were significantly correlated with cone photoreceptor distribution in aged patients. Patient’s background disease or degrees of drusen or pigment abnormality might not affect them. Influence of axial length and age should be considered when analyzing cone distribution in aged patients. Commercial Relationships: Ryo Obata, None; Xue Tan, None; Kayo Kure, None; Frida Rosander, Imagine Eyes (R); Yasuo Yanagi, None Support: Grant-in-Aid for Young Scientists (B) 24791837 from Ministry of Education,Culture,Sports,Science and Technology-Japan Program Number: 3440 Poster Board Number: C0161 Presentation Time: 11:00 AM - 12:45 PM Reproducibility of photoreceptor imaging by Adaptive Optics Retinal Camera Mélanie Bidaut-Garnier1, Mathieu Flores1, Perle TUMAHAI1, meillat mathieu1, Guillaume Debellemaniere1, Marc Puyraveau2, Bernard Y. Delbosc1, Michel Montard1, Maher Saleh1. 1Department of Ophthalmology, University Hospital of Besançon, Besançon, France; 2Methodology center, Besançon, France. Purpose: To report the reproducibility and the repeatability of photoreceptor imaging in healthy human eyes, using the RTx-1™ Adaptive Optics (AO) Retinal Camera, (Imagine Eyes, Orsay, France) and AOdetect v0.1 cone counting software. Methods: Three healthy emmetropic adults of 30, 42 and 42 years old, were imaged. Mean cone density (cells/mm2) at a fixed distance from the fovea (0.3 x 0.3 degree square located at 1° temporally), spacing between cells (µ) and percentage of hexagonal cells calculated on Voronoi diagrams, were also measured using the proprietary software of the device. Intersession repeatability was assessed by imaging both eyes of each subject, 5 consecutive days, by the same operator. Intrassession repeatability was assessed by comparing 10 consecutive acquisitions, obtained by the same operator from the right eye of each subject. Inter-operator variability was evaluated by comparing the images acquired by three different operators. The cone counts were blind measured by 2 graders using AOdetect v0.1. Pearson Coefficient (r) and coefficients of variation (COVs) were calculated. Results: The mean cone counts were 25475 ± 2983/mm2 and 26396 ±3174 cells/mm2 for the first and the second grader, respectively (t ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics test, p <0.05). All the parameters evaluated were highly reproducible: Pearson's r reached 0.90 (CI 95%: 0.84; 0.94) between both graders and 0.96 (CI 95%:0.57 ; 0.96) for the inter-operator variability. The intra-session and intersession COVs were 6% and 4%, respectively. The measurements of percentage of hexagonal cells and spacing between cells also varied in the same proportion (COV range from 3 to 9 %). Conclusions: Photoreceptor counts using the RTx-1™ Adaptive Optics Retinal Camera showed good reproducibility and repeatability in normal human eyes. Further studies on the use of AO in the normal clinical setting are needed. Commercial Relationships: Mélanie Bidaut-Garnier, None; Mathieu Flores, None; Perle TUMAHAI, None; meillat mathieu, None; Guillaume Debellemaniere, None; Marc Puyraveau, None; Bernard Y. Delbosc, None; Michel Montard, None; Maher Saleh, None Program Number: 3441 Poster Board Number: C0162 Presentation Time: 11:00 AM - 12:45 PM Analysis of the Photoreceptor Mosaic in Patients with Each Stage of Dry Age-Related Macular Degeneration (AMD): Cone Density and Spacing as Image-Based Biomarkers Adam Boretsky1, Faraz Khan1, Frederik J. van Kuijk2, Massoud Motamedi1. 1Center for Biomedical Engineering, Univ of Texas Medical Branch, Galveston, TX; 2Ophthalmology and Visual Neuroscience, University of Minnesota, Minneapolis, MN. Purpose: To use high resolution imaging to objectively measure photoreceptor density and spacing in patients with dry age-related macular degeneration (AMD). Methods: A custom built adaptive optics confocal scanning laser ophthalmoscope (AO-SLO) was used to acquire high resolution reflectance images of the macular cone photoreceptor mosaic in 20 patients comprising each category of dry AMD. An 830 nm Superluminescent diode (SLD) was used for both image acquisition and wavefront sensing. Photoreceptor mosaics were generated by automated registration and averaging of multiple images from video sequences. Particular emphasis was placed on macular disruption associated with the formation of drusen observed using fundus photography and spectral domain optical coherence tomography (SDOCT). We used an automated algorithm to identify individual photoreceptors and calculate local density values. Additionally, we performed Delaunay triangulation to characterize the mean spacing (center-to-center) of the cone photoreceptors within 0.25° x 0.25° subsets of each mosaic. Results: Photoreceptor density measurements varied greatly depending on the retinal eccentricity and were heavily influenced by the presence of vasculature and pathology. Segmenting the image into small regions of interest (ROIs) enabled us to differentiate between decreased photoreceptor density due to vasculature versus a reduction in cones due to drusen or geographic atrophy. This data was used to generate heatmaps of the local photoreceptor density. Mean cone spacing was also measured for each ROI to identify areas with increased spacing above one standard deviation from the mean. Conclusions: Cone photoreceptor density and spacing have the potential to be used as image-based biomarkers of AMD. Objective analysis of the photoreceptor mosaic in patients with dry AMD may provide an additional metric to assess disease progression and establish a correlation between photoreceptor loss and a decline in visual function. Additionally, AO-SLO may offer insight into the efficacy of emerging dry AMD therapies. Analysis of the local variations in the photoreceptor mosiac was performed to help identify areas of decreased cone density and an increase in photoreceptor spacing in patients with dry age-related macular degeneration. Commercial Relationships: Adam Boretsky, None; Faraz Khan, None; Frederik J. van Kuijk, None; Massoud Motamedi, None Support: The Wagner AMD Fund, Research to Prevent Blindness (RPB), Beckman Initiative for Macular Research (BIMR) Program Number: 3442 Poster Board Number: C0163 Presentation Time: 11:00 AM - 12:45 PM High Resolution Imaging with Adaptive Optics in Patients with Vogt-Koyanagi Harada Disease Kiyoko Gocho, Sachiko Kikuchi, Takenori Kabuto, Hisatomo Takahashi, Shuhei Kameya, Kunihiko Yamaki, Hiroshi Takahashi. Ophthalmology, Nippon Med Univ, Chiba Hokusoh Hosp, Inzai, Japan. Purpose: To report the findings of en face adaptive optics (AO) fundus imaging in eyes with Vogt-Koyanagi-Harada disease (VKH) patients. Methods: The macular region of five eyes from different stage of four VKH patients with a mean age of 39 (range 21-60) were imaged using both an infrared AO camera (rtx1™, Imagine Eyes, France) and spectral-domain optical coherence tomography (SD-OCT Cirrus™, Carl Zeiss Meditec, Germany). AO images were analyzed for cone density at 600μm and 1200μm nasal from the foveola. The data acquired from the VKH patients was then compared to that acquired from the eyes of 21 healthy volunteers with a mean age of 36 years (range 20-57) at the same eccentricities. Results: The mean cone densities in healthy retinas were 2.11±0.37 x104 and 1.70±0.31 x104 cones/mm2 at eccentricities 600μm and 1200μm respectively. One acute phase VHK patient was presented after 2 weeks from the onset, diagnosed with serous retinal detachment (SRD) and treated using steroid pulse treatment, underwent AO and SD-OCT at followup visits over 16th weeks. Analysis of the AO images enabled us to determine that the cone density at the 4th, 5th, 13th and 16th week from onset was 1.17x104, 0.78x104, 1.16x104 and 2.21x104 cones/mm2 at 600μm respectively, and 0.95 x104, 1.02 x104, 1.54 x104 and 1.61 x104 cones/mm2 at 1200μm respectively. At 16th week, even the cone density of the patient was within the range of the standard deviation of healthy volunteers, patchy dark areas with decreased cone were observed. OCT showed recovery from SRD, but hypo-reflectance in the cone outer segment tip (COST) line. Another patient who was treated with steroid pulse treatment just after the onset cured SRD, the COST line showed normal reflectance and AO cone counting was within normal range of healthy volunteers at both ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics 600μm and 1200μm. In two very late stage patients with sunset-glow fundus at more than 2 years after the onset, analysis of AO showed an irregularity in cone density at both 600μm and 1200μm eccentricities, even though patients’ visual acuity were better than 20/20. Conclusions: We have found that the photoreceptor damage remain longer even after serous retinal detachment was resolved with OCT in the convalescent and chronic stage VKH patients. Combined examinations using AO and SD-OCT may be useful in better understanding and managing the ophthalmic consequences of VHK disease. Commercial Relationships: Kiyoko Gocho, None; Sachiko Kikuchi, None; Takenori Kabuto, None; Hisatomo Takahashi, None; Shuhei Kameya, None; Kunihiko Yamaki, None; Hiroshi Takahashi, None Program Number: 3443 Poster Board Number: C0164 Presentation Time: 11:00 AM - 12:45 PM Spectral-Domain Optical Coherence Tomographic Findings in Acute Zonal Occult Outer Retinopathy (AZOOR)-complex at Initial Visit to the Hospital Yoshitsugu Matsui1, Mai Miyata1, Hisashi Matsubara1, Shinji Ueno2, Shu Kachi2, Yasuki Ito2, Hiroko Terasaki2, Mineo Kondo1. 1 Opthalmology, Mie University Graduate School of Medicine, Tsu, Japan; 2Opthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Purpose: To study outer retinal structural changes in acute zonal occult outer retinopathy (AZOOR)-complex by using spectraldomain optical coherence tomography (SD-OCT) at the initial visit to the hospital. Methods: Twenty-two eyes of 22 patients (four male and 18 female; age, 19-69) with AZOOR-complex, whose periods from symptom onset to initial visit to the hospital were within six months, were included in this study. The continuity of the external limiting membrane (ELM), photoreceptor inner/outer segment (IS/OS) junction, and cone outer segment tip (COST) were evaluated using SD-OCT at their initial visit to the hospital. These three lines were divided into three categories of “continuous”, “discontinuous” and “absent”. Results: At the retinal area of visual field defects, the ELM was continuous in eight eyes, discontinuous in five eyes, and absent in nine eyes. The IS/OS junction was continuous in one eye, discontinuous in nine eyes, and absent in 12 eyes. The COST line was absent in all 22 eyes. In thee of 22 eyes, well-demarcated hyperrefractive materials were present between the retinal pigment epithelium (RPE) and ERM, and these materials gradually disappeared within three months after the initial visit. Conclusions: The SD-OCT findings in AZOOR-complex at the initial visit were variable. The structure of ELM was most likely to be preserved, and COST line most severely affected. Our findings supported the idea that outer retinal structure was more vulnerable at the early stages of AZOOR-complex. Commercial Relationships: Yoshitsugu Matsui, None; Mai Miyata, None; Hisashi Matsubara, None; Shinji Ueno, None; Shu Kachi, None; Yasuki Ito, None; Hiroko Terasaki, None; Mineo Kondo, None SongEun Lee1, Sung Pyo Park1, 2, Eun Jin Bae2, Stephen H. Tsang1, Stanley Chang1. 1Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY; 2Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea. Purpose: To evaluate structural damage of photoreceptors in a patient with chloroquine/hydroxychloroquine maculopathy and the role of adaptive optics scanning laser ophthalmoscopy in screening of chloroquine/hydroxychloroquine maculopathy Methods: A 53-year-old Asian woman who had been treated with hydroxychloroquine and chloroquine for lupus erythematosus, developed bull's eye retinopathy. Humphrey visual field, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy were performed. The area with disrupted cone in AO-SLO images were matched with visual field test results. Results: Adaptive optics scanning laser ophthalmoscopy (AO-SLO) showed patch cone mosaic lesions, where cones were missing or lost. Additionally, cones that were present were asymmetrical in size and shape and varied in brightness. Disrupted cone AO-SLO images were matched with visual field test results, and functional deficits were given a precise location on the montage. This allowed functional changes (on HVF) to be correlated with histological findings. Conclusions: In the present study, bull’s eye maculopathy developed as a result of chronic use of antimalarial agents. The patient was studied with various imaging techniques, including AO-SLO. We demonstrated not only the disrupted microarchitecture of the photoreceptors but also a correlation between functional and structural defects associated with chloroquine retinopathy. The adaptive optics scanning laser ophthalmoscopy will provide better understanding of retinal damages in antimalarial agent-associated retinopathy. Program Number: 3444 Poster Board Number: C0165 Presentation Time: 11:00 AM - 12:45 PM Evidence of Retinal Damage in Chloroquine/Hydroxychloroquine Maculopathy as Revealed by High Resolution Imaging: A Case Report Utilizing Adaptive Optics Scanning Laser Ophthalmoscopy ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: SongEun Lee, None; Sung Pyo Park, None; Eun Jin Bae, None; Stephen H. Tsang, None; Stanley Chang, Alcon Laboratories (C), Alimera Sciences (C) Program Number: 3445 Poster Board Number: C0166 Presentation Time: 11:00 AM - 12:45 PM Adaptive Optics Scanning Laser Ophthalmoscopy and High Resolution Imaging in Autosomal Dominant Retinitis Pigmentosa Caused by a Novel PRPF31 Nonsense Mutation Jessica I. Morgan1, 2, Meera Sivalingam1, Grace K. Han1, Albert M. Maguire1, 2, Brian J. Forbes1, 2, Xiaowu Gai3, Eric A. Pierce4, Jean Bennett1, 2, Daniel C. Chung1, 2. 1Ophthalmology, University of Pennsylvania, Philadelphia, PA; 2Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA; 3Molecular Pharmacology and Therapeutics, Loyola University Chicago, Chicago, IL; 4Ocular Genomics Institute, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA. Purpose: To study cone photoreceptor density and retinal ultrastructure in autosomal dominant retinitis pigmentosa (adRP) using adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral domain optical coherence tomography (OCT) and to compare the results with clinical findings and genetic characterization. Methods: Exome sequencing was carried out in individuals negative for previously known mutations causing adRP. The DNA variants were confirmed in CLIA labs. Patients underwent ophthalmic examination, visual acuity (VA), Humphrey and Goldman visual field testing. Retinal images at several locations within 1.5mm of fixation were obtained using an AOSLO developed by Canon, Inc. Infrared and color fundus photos, OCT and autofluorescence (AF) images were also obtained. Results: For all patients, peripheral pigmentary clumping and bone spicule retinopathy were observed on ophthalmic examination. One individual was followed in the clinic for over 35 years. His VA went from 20/200 at age 36 to 20/500 OD and hand motion OS at age 73. VA was reduced: 20/60, 20/40, 20/25 for patients aged 44, 16 and 11 respectively in the second family. Goldman visual fields showed restricted peripheral fields with remaining central vision. Humphrey visual field showed no reduction of visual threshold in the central retina for the 16 and 11 y.o., but reduced sensitivity in the 44 y.o. OCT for the 11 y.o. revealed central intact photoreceptors with peripheral thinning. The 16 y.o. had macular edema OU. AF revealed a hyper-AF ring within the macula region. As well, the 44 y.o. exhibited clumps of hypo-AF in the periphery corresponding to regions of degenerated retinal pigment epithelium. AOSLO imaging of the central macula revealed intact cone photoreceptor mosaics, and cone density fell within normal limits. Results of genetic testing (in both families) revealed a PRPF31 c.1060 C>T mutation (p.Arg354Stop) which segregated with the phenotype and was consistent with the diagnosis of adRP. Conclusions: Here we report a novel PRPF31 mutation causing adRP in two apparently unrelated families. AOSLO imaging allows visualization of the cone mosaic within the remaining central retina in patients with adRP. AOSLO in combination with other imaging modalities will be useful for studying the mechanisms of disease progression for degenerations including adRP. Commercial Relationships: Jessica I. Morgan, Canon (F), Optos (F); Meera Sivalingam, Canon Inc (F); Grace K. Han, Canon Inc. (F), Optos PLC (F); Albert M. Maguire, None; Brian J. Forbes, None; Xiaowu Gai, None; Eric A. Pierce, None; Jean Bennett, Gensight Biologics (S); Daniel C. Chung, None Support: Earl and Brenda Shapiro Leber's Congenital Amaurosis Research Initiative, Foundation Fighting Blindness, Penn Genome Frontiers Institute, National Institute of Health EY019861,NIH EY012910, F.M. Kirby Foundation, Mackall Trust, Reserach to Prevent Blindness, Canon, Inc. Kathleen Marshall and Sarah McCague. Program Number: 3446 Poster Board Number: C0167 Presentation Time: 11:00 AM - 12:45 PM Cone Abnormalities in Fundus Albipunctatus Associated with RDH5 Mutation Using Adaptive Optics Scanning Laser Ophthalmoscopy Sotaro Ooto, Yukiko Makiyama, Masanori Hangai, Ken Ogino, Norimoto Gotoh, Akio Oishi, Nagahisa Yoshimura. Ophthalmology & Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. Purpose: To asses macular photoreceptor abnormalities in eyes with fundus albipunctatus associated with RDH5 mutation using adaptive optics scanning laser ophthalmoscopy (AO-SLO). Methods: Ten eyes of 5 patients with fundus ablipunctatus associated with RDH5 mutation (4 men and 1 woman from 4 families; mean age, 29.6 y; range, 15-64y) and 11 eyes of 11 volunteers underwent a full ophthalmologic examination, color fundus photography, microperimetry, spectral-domain optical coherence tomography (SD-OCT), and imaging with a prototype AOSLO system. Cone density and spatial organization of the cone mosaic were assessed using AO-SLO images. Results: Four patients from 3 families had the same mutation in RDH5, (c.928delC/ insGAAG). One patient had another mutation in RDH5 (c.718delG), which was the novel mutation of RDH5 gene. AO-SLO revealed the presence of small patchy dark areas representing cone loss in the macula of all eyes with fundus albipunctatus, which was true even in eyes for which SD-OCT did not reveal any visible defects in the photoreceptor layer. AO-SLO and SD-OCT showed microhole-like photoreceptor defect in the fovea in 1 eye. In eyes with fundus albipunctatus, cone density was significantly lower in each area at 0.5 mm and 1.0 mm from the center of the fovea compared to normal eyes (P = 0.014 for both). At 0.5 mm and 1.0 mm from the center of the fovea, a decreased number of cones had 6 neighbors in eyes with fundus albipunctatus (P = 0.022 and 0.002). The ratio of observed mean nearest neighbor distance (NND) for each subject divided by expected NND (computed assuming a perfectly hexagonal lattice of cones with a density equal to that observed for a given subject) was significantly lower for eyes with fundus albipunctatus than for normal eyes at 0.5 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics mm and 1.0 mm from the center of the fovea (P=0.007 and 0.001). Mean retinal sensitivity was significantly lower in the area with white dots, compared with area without them (11.2 ± 2.6 dB and 13.9 ± 3.1 dB, P<0.001). Conclusions: Macular cone density is decreased and the regularity of the macular cone mosaic spatial arrangement is disrupted in eyes with fundus albipunctatus, even when SD-OCT shows normal photoreceptor layer. AO-SLO imaging is a sensitive quantitative tool for detecting photoreceptor abnormalities in eyes with fundus albipunctatus. Commercial Relationships: Sotaro Ooto, None; Yukiko Makiyama, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon (C); Ken Ogino, None; Norimoto Gotoh, None; Akio Oishi, None; Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: Innovative Techno-Hub for Integrated Medical Bioimaging of the Project for Developing Innovation Systems, from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan, and Canon Inc. Program Number: 3447 Poster Board Number: C0168 Presentation Time: 11:00 AM - 12:45 PM Adaptive Optics Scanning Laser Ophthalmoscopy and MultiModality Clinical Imaging in a Patient with Gyrate Atrophy Eva S. Klinman1, Albert M. Maguire2, Grace K. Han2, Jessica I. Morgan2. 1Neuroscience, University of Pennsylvania School of Medicine, Philadelphia, PA; 2Scheie Eye Institute Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA. Purpose: Characterize retinal structure and function in a patient with gyrate atrophy using high resolution clinical imaging and adaptive optics scanning laser ophthalmoscopy (AOSLO). Methods: A patient with gyrate atrophy was imaged at several retinal locations within 1.5mm of fixation using an AOSLO developed by Canon Inc. Infrared (IR) fundus photography, spectral domain optical coherence tomography (OCT), and autofluorescence (AF) images were also obtained. Wide field SLO reflectance and AF images were acquired using the Optos P200C SLO. Retinal sensitivity was assessed by microperimetry at the locations corresponding to AOSLO images. Results: The patient had a peripheral ring of degenerated retina, with central preservation of both retinal pigment epithelium (RPE) and photoreceptors. Wide field SLO imaging also revealed retinal preservation in the far periphery. Within the ring of degeneration, the retina displayed hypo-AF with RPE disruption. Microperimetry displayed vision loss in this region. Choroidal vessels were visible on AOSLO in the region of degeneration; no cones were observed in these areas. In contrast, the spared central retinal on fundus photography corresponded to regions with preserved AF. AOSLO imaging confirmed cones in this region, including near the border of healthy and degenerated retina. Cone density was normal throughout most of the preserved retina, with slightly lower density at regions bordering degenerated retina. Photoreceptor and RPE cell layers appeared intact on OCT in the region of the central macula, although there were disruptions of the retinal architecture including cysts. Abnormal hyper-reflective patches were observed at multiple levels of retinal depth anterior to the photoreceptors, in multiple locations including the fovea. At these locations, the patient had slightly reduced light perception, as assessed by microperimetry. Conclusions: This patient with gyrate atrophy maintained photoreceptors and RPE cells centrally, although both are lost in a ring pattern in the periphery. Cones are visible with AOSLO until the point of RPE loss, as seen with AF. Gyrate atrophy is associated with findings in multiple levels of the retina, visible by both AOSLO and OCT. AOSLO imaging in combination with other imaging modalities will be useful to monitor disease progression, and provide a measure of cone loss over time in patients with gyrate atrophy. Commercial Relationships: Eva S. Klinman, Canon Inc (F), Optos, PLC (F); Albert M. Maguire, None; Grace K. Han, Canon Inc. (F), Optos PLC (F); Jessica I. Morgan, Canon (F), Optos (F) Support: Earl and Brenda Shapiro Leber's Congenital Amaurosis Research Initiative, Foundation Fighting Blindness, Choroideremia Research Foundation, NIH Grant EY019861, F.M. Kirby Foundation, Research to Prevent Blindness, Mackall Trust, Canon Inc. Program Number: 3448 Poster Board Number: C0169 Presentation Time: 11:00 AM - 12:45 PM Cellular Imaging Demonstrates Genetic Mosaicism in Heterozygous Carriers of an X-Linked Ciliopathy Gene Sung Pyo Park1, 2, In Hwan Hong2, Winston Lee1, Marcela Marsiglia1, Takeshi Kitamura4, Stephen H. Tsang1, 3, Stanley Chang1. 1 Ophthalmology, Columbia University Medical Center, New York, NY; 2Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea; 3Pathology & Cell Biology, Columbia University Medical Center, New York, NY; 4 Canon Inc., Tokyo, Japan. Purpose: The purpose of this study was to evaluate structural characteristics in 5 female obligate carriers of XLRP by using multimodal non-invasive imaging methods, including AO-SLO. Methods: Five patients and 18 controls having similar age and refractive error with patients were investigated. The XLRP carrier state was diagnosed by clinical and genetic analyses. All participants underwent a complete ophthalmic examination that included fundus color photography, IR and FAF imaing, SD-OCT and ERG. High resolution image of cone cells and direct measurement of the number of cones were investigated by AO-SLO equipped with a dual liquid crystal on silicon modulator. For the number of cones, we acquired 2 kinds of parameters: cone count by manual estimation and cone density by automated estimation. Results: 3 patients were confirmed with mutations in RPGR gene and the rest of the patients were diagnosed as carriers by clinical investigation and pedigree analysis. Regarding AO-SLO examination, compared to normal eyes, some images of each XLRP patient showed normal appearance of cone cell with a compact arrangement. However, cone cells in several areas showed irregular pattern and were of variable asymmetrical sizes and shapes. There were some dark areas where the cone cells were damaged or lost so that less compact distribution of cone cells than controls was noted. Statistical analysis between 5 carriers and controls revealed that the number of cone cells in these images was significantly decreased. When we compared the average number of cone cells counted using either method, among total 60 areas obtained from 5 carriers, overall 29 areas showed cone counts or densities lower than 1 standard deviation from the controls and the agreement between the 2 different methods was up to 82.8%. Conclusions: In all carriers, qualitative and quantitative analyses by AO-SLO imaging revealed a mosaic pattern of cone disruption, even in the absence of visual symptoms, normal visual acuity, normal macular thickness and mildly subnormal full-field cone ERG findings. Since the technique is sensitive to the level of a single cone, the ability to visualize the cone cells in vivo should be especially useful in other retinal diseases. Further investigation of XLRP carriers may yield insight into how cone structures change over time and ultimately enable understanding of the role of RPGR and RP2 in live human patients. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Sung Pyo Park, None; In Hwan Hong, None; Winston Lee, None; Marcela Marsiglia, None; Takeshi Kitamura, Canon U.S.A., Inc. (E); Stephen H. Tsang, None; Stanley Chang, Alcon Laboratories (C), Alimera Sciences (C) Program Number: 3449 Poster Board Number: C0170 Presentation Time: 11:00 AM - 12:45 PM Disruption of the Human Cone Photoreceptor Mosaic from a Defect in NR2E3 Transcription Factor Function Frank S. Siringo1, Sung Pyo Park1, 2, In Hwan Hong2, Stephen H. Tsang1, 3, Winston Lee1, Jason Horowitz1, Rando Allikmets1, Stanley Chang1, Suzanne Yzer4, 1. 1Ophthalmology, Columbia University Medical Center, Fort Lee, NJ; 2Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea; 3Pathology & Cell Biology, Columbia University Medical Center, New York, NY; 4Ophthalmology, Rotterdam Eye Hospital, Rotterdam, Netherlands. Purpose: Enhanced S-cone syndrome is an orphan disease caused by mutations in the NR2E3 gene, which results in an increased number of S-cones overpopulating the retina. Although the characteristic onset of enhanced S-cone syndrome can be well documented by current ophthalmic imaging modalities, techniques such as spectral domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscopy (SLO) fail to provide sufficient details regarding the microstructure of photoreceptors in retinal diseases. Adaptive optics (AO) provides a unique opportunity to analyze the effects of genetic mutations on photoreceptors by compensating for aberrations in the human eye. Methods: 3 eyes of 3 patients with enhanced S-cone syndrome were studied by clinical examination, genetic screening, fundus autofluorescence (FAF) imaging, SD-OCT, and electroretinography (ERG). Cone mosaic imaging was accomplished by an AO-SLO equipped with a dual crystal on silicon spatial light modulator. Qualitative image analyses and genetic findings were investigated in each patient. Results: The diagnosis was confirmed by ERG and genetic analysis. Two disease-causing mutations in the NR2E3 gene were identified on 2 study patients, as well as a novel mutation (202 A>G, S68G) in the third. Fundus photograph, FAF and SD-OCT found a rosette-like lesion within the mid-periphery along the vascular arcades of the retina. In all AO-SLO images, sparse distribution and asymmetric size of cone mosaic pattern were found within central retina. There were regions of dark space between groups of photoreceptors, distinguishable from shadowing and artifacts. Conclusions: AO-SLO provided an in-depth window into the retina of enhanced S-cone syndrome patients beyond the ability of other current imaging modalities. Dark lesions within the central retina contain structurally dysfunctional cones, which account for retinal mosaic disorganization and may predispose affected areas to other abnormalities such as rosettes. AO-SLO can be an efficient diagnostic tool in clinics for examining cellular-level pathologies in various retinal dystrophies. Commercial Relationships: Frank S. Siringo, None; Sung Pyo Park, None; In Hwan Hong, None; Stephen H. Tsang, None; Winston Lee, None; Jason Horowitz, None; Rando Allikmets, None; Stanley Chang, Alcon Laboratories (C), Alimera Sciences (C); Suzanne Yzer, None Program Number: 3450 Poster Board Number: C0171 Presentation Time: 11:00 AM - 12:45 PM Cellular Imaging after Remission from Diabetic Macular Edema Ching-Lung Chen1, 2, Sung Pyo Park1, 3, Takeshi Kitamura4, Stanley Chang1. 1OPhthalmology, Columbia university medical center, New york, NY; 2Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan; 3Department of Ophthalmology, Hallym University Medical Center, Seoul, Republic of Korea; 4Healthcare Solutions Division, Canon, New york, NY. Purpose: To evaluate structural differences in the patient recovered from diabetic macular edema by using multimodal non-invasive imaging methods, including adaptive optics scanning laser ophthalmoscopy (AO-SLO). Methods: An eighty-one year old Indian male suffered from diabetic retinopathy with macular edema. Following resolution of the macular edema in one eye, the visual acuity did not recover fully. The patient underwent a complete ophthalmic examination that included fundus color photography, IR imaging, OCT. High-resolution image of cone structure and measurement of the number and shape of cones was investigated by AO-SLO. After 14 months, the patient received the same examination. For the accurate analysis of condition of cone cells, we focused on the same portions of macula by manual estimation. Results: OCT revealed no macular edema with a central thickness of 231um in his right eye and central thickness of 289 um with inferior 0.5mm local edema of 352um in his left eye. 14 months later, OCT showed no specific difference on the right eye with central thickness of 229 um, but the central and inferior 0.5mm thickness had declined to 275 um and 339 um. Central vision metamorphopsia had almost ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics subsided and the visual acuity had improved. At the 14-month follow up visit, the density of cone photoreceptors, as measured by AO-SLO examination, had only decreased slightly, but the cellular hexagon rate declined remarkably in both eyes on average. Compared to the initial inferior local edema of 0.5 mm in the left eye, the cellular hexagon rate decreased from 36.4% to 22.8% at the 14-month followup exam. Conclusions: The analyses by AO-SLO imaging revealed only a slightly lower density of cone cells, but the cellular hexagon rate decreased in both eyes as compared to the examination 14 months prior. The cellular hexagon rate of previous edema area of left eye showed marked decline. The macular edema from long-term diabetic macular edema had subsided, based on the OCT image which showed flatter retina. The visual acuity had also improved, but the detail density and morphology still remained and even worsened. Longterm edema, diabetic retinopathy, or aging might be the risk factors. However, AO-SLO is more sensitive to the level of a single cone cell, and the ability to visualize the cone cells in vivo should be used in a larger diabetic retinopathy survey and may also be useful for studying other retinal diseases as well. Commercial Relationships: Ching-Lung Chen, None; Sung Pyo Park, None; Takeshi Kitamura, Canon U.S.A., Inc. (E); Stanley Chang, Alcon Laboratories (C), Alimera Sciences (C) Support: None in the Support field Program Number: 3451 Poster Board Number: C0172 Presentation Time: 11:00 AM - 12:45 PM Photoreceptor Structure in Presumed Non-Neoplastic Autoimmune Retinopathy David B. Kay1, Robert F. Cooper2, Drew H. Scoles3, Fouad R. Zakka1, Vesper Williams1, Alfredo Dubra1, 4, Joseph Carroll1, 4, Kimberly E. Stepien1. 1Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 2Department of Biomedical Engineering, Marquette University, Milwaukee, WI; 3Department of Biomedical Engineering, University of Rochester, Rochester, NY; 4 Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI. Purpose: Autoimmune retinopathies (AIR) are rare diseases, sometimes associated with systemic neoplasms, in which anti-retinal antibodies lead to cone and rod dysfunction. Patients present with progressive, bilateral, painless vision loss despite normal clinical fundus appearance, making diagnosis difficult. SD-OCT has shown outer retinal abnormalities and decreased macular thickness in AIR patients. Adaptive optics scanning light ophthalmoscopy (AOSLO) enables high-resolution imaging of the photoreceptor mosaic. This study incorporates AOSLO into the comprehensive investigation of individuals with AIR to evaluate its utility in improving the characterization and management of AIR. Methods: Three individuals with presumed non-neoplastic AIR who presented with vision loss, normal fundus appearance and known anti-retinal antibodies underwent a comprehensive ophthalmic evaluation and multiple retinal imaging sessions over a 5 - 14 month interval. Retinal appearance and lamination were assessed using fundus photography and SD-OCT. The photoreceptor mosaic was assessed using AOSLO. Results: All three individuals had different anti-retinal antibody combinations in serum, and presenting vision ranged from 20/40 to 20/100. Clinical and fundus photography evaluation confirmed normal appearing fundus. SD-OCT revealed decreased central macular thickness in two of the three patients, and focal disruption of outer retinal lamination was seen at the fovea in all patients. This disruption was also visible in the AOSLO images as a large hyporeflective area at the fovea. In addition, AOSLO images revealed significant reduction in parafoveal cone density in all three subjects, with variable numbers of non-waveguiding cones interspersed throughout the mosaic. This disruption was not visualized on SD-OCT. Conclusions: Both SD-OCT and AOSLO show outer retinal structure changes associated with AIR not apparent on clinical examination. However, AOSLO allows for assessment of photoreceptor structure at a resolution not resolvable on SD-OCT. AOSLO may prove to be a useful, noninvasive, highly accurate tool to aid in diagnosis of AIR as well as monitoring progression and treatment responses. Further study is needed to determine whether AOSLO can be used to accurately track progression of photoreceptor disruption in AIR over time. Commercial Relationships: David B. Kay, None; Robert F. Cooper, None; Drew H. Scoles, None; Fouad R. Zakka, VitreoRetinal Surgery Foundation (F); Vesper Williams, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Joseph Carroll, Imagine Eyes, Inc. (S); Kimberly E. Stepien, None Support: VitreoRetinal Surgery Foundation, Research to Prevent Blindness, NIH (UL1RR031973, EY017607, EY001931), Alcon Research Institute, Burroughs Wellcome Fund Program Number: 3452 Poster Board Number: C0173 Presentation Time: 11:00 AM - 12:45 PM Cone photoreceptors at the fovea after serous retinal detachment observed with adaptive optics fundus camera (rtx1) Atsushi Hayashi, Tomoko Nakamura, Naoki Tojo, Tomoko Ueda, Toshihiko Oiwake, Akio Miyakoshi, Hironori Ozaki. Ophthalmology, University of Toyama, Toyama, Japan. Purpose: Purpose: To examine recovery of cone photoreceptors in the fovea after serous retinal detachment (SRD) in patients with central serous chorioretinopathy (CSC) and Vogt-Koyanagi-Harada disease (VKH) with an adaptive optics (AO) fundus camera and to examine correlations between cone analyses and visual acuity. Methods: Methods: Ten eyes of CSC and 4 eyes of VKH were examined. After the SRD at the fovea was resolved with photodynamic therapy or steroid therapy, photographs of cone photoreceptors including the fovea were taken with an AO fundus camera (rtx1, Imagine eyes, France). The area of 200µm X 200µm at the fovea was chosen in the photograph of each eye and analyzed with the manufacturer’s software. Analyses of cone density, cone spacing, and voronoi domains were obtained and correlations between visual acuity and cone analyses were examined. OCT was obtained at the same time and length of the IS/OS line in the OCT image was measured in the area of 200µm at the fovea. Results: Results: Cone analyses showed that average cone density at the fovea was 15363±4239, average cone spacing was 8.96±1.21μm, and average voronoi domains was 36.9±4.1%. Average visual acuity (logMAR) was 0.155±0.391. Average length of the IS/OS line in the area of 200µm was 77.7±31.5%. Visual acuity and cone analyses showed significant correlations. Cone density; rs= -0.698 (Spearman’s rank Correlation Coefficient), cone spacing; rs=0.663, and voronoi domains; rs=-0.749. The length of IS/OS line and cone density showed a significant correlation; rs=0.770. Conclusions: Conclusions: Analyses of cone photoreceptors at the fovea after SRD was resolved were significantly correlated with visual acuity. Commercial Relationships: Atsushi Hayashi, None; Tomoko Nakamura, None; Naoki Tojo, None; Tomoko Ueda, None; Toshihiko Oiwake, None; Akio Miyakoshi, None; Hironori Ozaki, None Program Number: 3453 Poster Board Number: C0174 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Presentation Time: 11:00 AM - 12:45 PM Evaluation of cone density after retinal detachment surgery using an Adaptive Optics camera Maher Saleh, meillat mathieu, Mélanie Bidaut-Garnier, Perle TUMAHAI, Guillaume Debellemaniere, Mathieu Flores, Michel Montard, Bernard Y. Delbosc. Ophthalmology, University Hospital of Besançon, Besançon, France. Purpose: To assess macular cone photoreceptors density in human eyes operated for retinal detachment (RD) and in contralateral healthy eyes. Methods: Patients operated for RD with macular involvement were imaged using the RTX-1 Adaptive Optics (AO) device from Imagine eyes™ (Orsay, France), 6 weeks after the surgery. Cone density (cells/mm2) at a fixed distance from the fovea (1 °), spacing between cells (µ) and percentage of hexagonal cells calculated on Voronoï diagrams, were obtained using AO Detect v.0.1, the proprietary software of the device. Group 1 represented the eyes with history of RD and group 2 the contralateral eyes. Visual acuity (logMAR), refraction, axial length (mm) and the thickness of the different choroid and retinal layers (RPE, IS/OS, LME lines) imaged by SDOCT (Spectralis®, Heidelberg), were also compared to the cone densities. Results: Thirty eyes from 15 patients were studied. Visual acuities decreased in group 1 (0.34 vs 0.1 in group 2, paired t test, p<0.05). There was a reduction in cone density in group 1 (14368±4761/mm2) compared to group 2 (19240±3894/mm2) (p=0.002). In group 1, spacing between cones was increased (11.16±3.34 µ vs 8.65±1.95µ, p=0.01), while the proportion of hexagonal cells was reduced (36.11±5.29% vs. 42.08± 5.16 %, p=0.01). There was also a negative correlation between overall cone densities and visual acuities (R2=0.45). Cone density was also correlated to the thickness of the RPE hyperreflective layer on OCT (R2= 0.21, p=0.02) but neither with central macular thickness nor choroidal thickness. Conclusions: Adaptive Optics allowed in vivo imaging of the macular phoreceptors in eyes operated for RD. The cone density was correlated to the visual acuity. OA could represent a valuable prognostic tool after RD surgery. Commercial Relationships: Maher Saleh, None; meillat mathieu, None; Mélanie Bidaut-Garnier, None; Perle TUMAHAI, None; Guillaume Debellemaniere, None; Mathieu Flores, None; Michel Montard, None; Bernard Y. Delbosc, None Program Number: 3454 Poster Board Number: C0175 Presentation Time: 11:00 AM - 12:45 PM Recovery of photoreceptors in the macula of idiopathic choroidal neovascularization observed with adaptive optics fundus camera Tomoko Nakamura, Toshihiko Oiwake, Tomoko Ueda, Akio Miyakoshi, Atsushi Hayashi. University of Toyama, Toyama, Japan. Purpose: To observe recovery of photoreceptors in the macula of idiopathic choroidal neovascularization (ICNV) patients and to assess correlations between cone analyses and OCT images. Methods: Three eyes of 3 patients with ICNV were studied. All patient received intravitreal injections of 1.25mg bevacizumab (IVB). After subretinal fluid was resolved, adaptive optics (AO) images were obtained with rtx1TM (Imagine Eyes ,France) and cone analyses were performed. Changes in OCT and visual acuity were examined during the follow up. Results: After subretinal fluid was resolved by IVB, decimal visual acuity of all patients improved to 1.0. In AO images, cone photoreceptors were not observed in the area with absent or disrupted photoreceptor inner segment / outer segment (IS/OS) junction and cone outer segment tips (COST) line in OCT images. In the area with intact IS/OS junction and absent or disrupted COST line, cone photoreceptors returned to be observed after IVB. Cone density, cone spacing, and voronoi domains were improved with the recovery of the COST line in OCT. Conclusions: Recovery of cone photoreceptors in the macula of ICNV patients after IVB was associated with changes in OCT images. Commercial Relationships: Tomoko Nakamura, None; Toshihiko Oiwake, None; Tomoko Ueda, None; Akio Miyakoshi, None; Atsushi Hayashi, None Program Number: 3455 Poster Board Number: C0176 Presentation Time: 11:00 AM - 12:45 PM High resolution cone photoreceptor imaging analysis of an occult macular dystrophy patient with RP1L1 mutation Shuhei Kameya1, Takenori Kabuto1, Sachiko Kikuchi1, Hisatomo Takahashi1, Kiyoko Gocho1, Kunihiko Yamaki1, Hiroshi Takahashi2. 1 Ophthalmology, Chiba Hokusoh Hosp Nippon Med Sch, Inzai, Japan; 2Ophthalmology, Nippon Medical School, Tokyo, Japan. Purpose: To analyze cone photoreceptor degeneration by adaptive optics (AO) fundus camera in a Japanese occult macular dystrophy (OMD) patient with mutation in the RP1-like protein 1 (RP1L1) gene. Methods: An OMD patient with RP1L1 mutation (S1199C) and 20 normal volunteer underwent high resolution imaging analysis. Highresolution en face images were obtained using a flood-illumination AO fundus camera (Imagine Eyes, Orsay, France). We have statistically analyzed biomarker metrics (cone density, inter-cell spacing) computed from the images. These metrics are analyzed from the images obtained at 600 μm and 1200 μm from the fovea. Results: The mean age of volunteers is 36.0±10.5 (range 20-57 years). The mean cone density of volunteers was 2.11±0.37 x 10 4 cones/mm2 at 600 μm from the fovea and 1.70±0.31 x 10 4 cones/mm2 at 1200 μm from the fovea. The mean inter-cell spacing of volunteers was 7.73±0.81 μm at 600 μm from the fovea and 8.56±0.93 μm at 1200 μm from the fovea. The cone density of the right eye of the patient was 4.72 x 103 cones/mm2 at 600 μm from the fovea and 3.04 x 103 cones/mm2 at 1200 μm from the fovea. The inter-cell spacing of the right eye of the patient was 13.0 μm at 600 μm from the fovea and 16.9 μm at 1200 μm from the fovea. The cone density and intercell spacing of the patient were outside the range of the both standard deviation and 95% confidence intervals of normal volunteer. Conclusions: We have analyzed high resolution images of a Japanese OMD patient with RP1L1 mutation. An OMD patient showed decreased cone density and increased inter-cell spacing at both 600 μm and 1200 μm from the fovea. AO fundus camera and its computed metrics analysis were useful to detect the changes in the cone photoreceptors in OMD. Commercial Relationships: Shuhei Kameya, None; Takenori Kabuto, None; Sachiko Kikuchi, None; Hisatomo Takahashi, None; Kiyoko Gocho, None; Kunihiko Yamaki, None; Hiroshi Takahashi, None 370 Color Vision Tuesday, May 07, 2013 2:45 PM-4:30 PM TCC LL 4/5 Paper Session Program #/Board # Range: 3705-3710 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 3705 Presentation Time: 2:45 PM - 3:00 PM A psychophysical approach to spectral classification of single cones in vivo ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics William S. Tuten1, Wolf M. Harmening2, Lawrence C. Sincich3, Austin Roorda2. 1Vision Science, University of California, Berkeley, Berkeley, CA; 2School of Optometry, University of California, Berkeley, Berkeley, CA; 3Vision Sciences, University of Alabama at Birmingham, Birmingham, AL. Purpose: To distinguish L-cones from M- and S-cones psychophysically in humans using an adaptive optics scanning laser ophthalmoscope (AOSLO). Methods: We used a multi-wavelength AOSLO to measure visual sensitivity to cone-sized stimuli under L-cone isolating conditions in two subjects with normal color vision. Increment thresholds were measured at 1.5° eccentricity, and stimulus delivery to targeted cones was achieved using high-speed retinal eye tracking. An image-based measure of transverse chromatic aberration (TCA) was obtained and used to ensure repeated stimulation of the cone of interest. The test stimulus (λ = 711 nm) was a square which subtended 27 seconds of arc (= 2.2 microns) on the retina. The background was comprised of dim infrared light from the imaging beam, light leaking through the acousto-optic modulator in the red stimulus channel, and an external 488 nm LED source viewed through a beam splitter. The luminances of the red and blue backgrounds were 2.5 and 50 cd/m2, respectively. Converting these luminances to cone contrasts, an L- versus M-cone sensitivity ratio of 24-to-1 was expected. Stimulus intensity of the red beam was controlled via 10-bit modulation and expressed as arbitrary units (au) ranging from zero to 1. Thus, for L-cone thresholds greater than 0.042 au, M- and S-cone thresholds would be predicted to lie beyond the upper modulation limit of the stimulus beam (i.e., >1.0 au). Results: Thresholds were measured for 88 cones in the two subjects. The stimulus was readily visible in one group of cones (n = 59; threshold = 0.55 ± 0.14SD au), and these were classified as candidate L-cones. A second group of cones (n = 18) had thresholds above 1.0 au, with even the brightest stimulus being not visible. In these cones, threshold values were normal when tested under achromatic conditions, ruling out underlying dysfunction. In the remaining cones, classification was ambiguous (n = 11). Finally, there were multiple sites in each subject where thresholds from neighboring cones yielded different spectral identities, supporting the notion that the spatial accuracy of our psychophysical apparatus is on the order of a single cone. Conclusions: With combined retinal eye tracking, high-order aberration correction, and TCA compensation, AOSLO can be used to identify the spectral class of single cones in vivo with a psychophysical approach. Commercial Relationships: William S. Tuten, None; Wolf M. Harmening, None; Lawrence C. Sincich, None; Austin Roorda, US Patent #6890076 (P), US Patent #7118216 (P), UC Berkeley (P) Support: EY007043; Irvin M. Borish-Essilor Ezell Fellowship; DFG Ha 5323/2-1; EY021642; EY019566; Eyesight Foundation of Alabama; EY014375 Program Number: 3706 Presentation Time: 3:00 PM - 3:15 PM S-cone Electroretinograms in Old and New World Primates Recorded Using Two Methods James A. Kuchenbecker, Scott H. Greenwald, Maureen Neitz, Jay Neitz. Ophthalmology, University of Washington, Seattle, WA. Purpose: Using the exchange of two lights that lie along a tritan line makes it possible to isolate pure S-cone electroretinogram (ERG) signals. Here, we compare the pure S-cone ERG using silent substitution with a method in which “S-cone ERGs” are obtained to short wavelength flashes in the presence of intense long wavelength adaptation. Results were compared in an Old World (OW) primate (baboon) and a New World (NW) primate (squirrel monkey) to evaluate the possibility of differences in S-cone circuitry between the two primate groups that have been proposed to explain reported neuroanatomical differences. Methods: An LED Ganzfeld system was used (Q450; Roland Consult, modified by replacing 450 with a 420 nm LED). A tritan pair of lights was alternated at 1 Hz with a 50% duty cycle. A tritan pair that completely isolated S-cone responses for each individual animal was found by making small adjustments to the relative intensities of the two lights while taking advantage of the striking differences in the temporal characters of L/M vs. S-cone ERG signals. For comparison, “S-cone ERGS” were recorded in response to the 420 nm LED in the presence of steady adaption from an amber LED (~590 nm peak). Results: Compared to L/M, S-cone ERGs have very distinct temporal characteristics. The component waves also have strikingly different relative amplitudes including a much smaller a-wave and absent dwave which can be explained by the absence of S-cone specific offbipolar cells in primates. In comparison to the pure S-cone ERGs obtained with silent substitution, long wavelength adaptation can reduce but does not eliminate L/M contamination. Conclusions: Using silent substitution we recorded pure S-cone ERGs to investigate differences between S-cone and L/M cone mediated signals very early in the visual pathway. The temporal peak of both the S-cone a- and b-wave is slower indicating the sluggishness of S-cone temporal responses observed in human psychophysics has its origins in the outer retina and, at least, partly in the cones themselves. The robust off-bipolar cells signals in both the a- and d-waves elicited by L/M cone stimulation are absent in the pure S-cone ERG with no evidence for the species differences predicted from the anatomy in which off-midget bipolars have been proposed to contact S-cones in OW but not NW primates. Commercial Relationships: James A. Kuchenbecker, None; Scott H. Greenwald, None; Maureen Neitz, Genzyme (F), Alcon (F), Alcon (P); Jay Neitz, Alcon (F), Alcon (P) Program Number: 3707 Presentation Time: 3:15 PM - 3:30 PM Age-related decline in chromatic-spatial sensitivity Elise W. Dees1, 2, Stuart J. Gilson1, Rigmor C. Baraas1. 1Optometry & Visual Science, Buskerud University College, Kongsberg, Norway; 2Mathematical Sciences & Technology, Norwegian University of Life Sciences, Ås, Norway. Purpose: The aim was to investigate the variation in chromatic contrast sensitivity to low spatial frequencies for observers with varying degrees of color discrimination at different age decades. Methods: Twenty six normal trichromatic subjects (17 females and 9 males, aged 20-71 years), 2 female carriers of protan color vision deficiencies (aged 20-39) and 6 female carriers of deutan color vision deficiencies (aged 20-59) were included in the study. All observers were healthy with no known ocular abnormalities. They were tested with a battery of color vision tests and their statuses of either a normal trichromat or a carrier were confirmed with genetic analysis of the genes encoding L- and M-pigments. The observers were corrected to best logMar visual acuity and viewed the stimulus monocularly at a distance of either 114.6 cm (0.3-3.0 c/deg) or 229.2 cm (4.0-6.0 c/deg). The stimulus was a Gabor patch with a pseudoisochromatic design. The chromatic contrast was varied along either the L- or M-cone axis in the CIE 1931 chromaticity diagram. The observers were tested with 9-16 different spatial frequencies from 0.3-3.0 c/deg in all observers, and up to 6.0 c/deg in some. Results: The sensitivity to chromatic spatial patterns declined with age. Subjects aged 50 years and older had significantly lower ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics sensitivity [area under curve (ANOVA: f = 13.27, d.f. = 1, p = 0.01)] and cut-off values (ANOVA: f = 6.33 , d.f. = 1, p = 0.038) than the younger subjects. The protan carriers had similar sensitivity curves as the age matched normal trichromatic subjects. The deutan carriers, however, had on average lower chromatic sensitivity than both the normal trichromatic subjects and the protan carriers (for all age groups). The cut-off spatial frequencies were lower for the deutan carriers than for the normal trichromatic subjects at all age groups. Conclusions: The results show a decline in sensitivity to chromatic spatial patterns with age, and that deutan carriers have lower sensitivity to chromatic spatial patterns compared with age-matched normal trichromatic subjects. Commercial Relationships: Elise W. Dees, None; Stuart J. Gilson, None; Rigmor C. Baraas, None Support: Research Council of Norway Grant 176541/V10 and 182768/V10 (RCB) Program Number: 3708 Presentation Time: 3:30 PM - 3:45 PM Contrast Sensitivity (CS): Color CS is Decreased More than Luminance CS at Low Light Levels Jeff C. Rabin1, Michael Castro1, Daniel Ewing1, Hayley George1, Paul Lau1, Shannon Leon1, Andrew Yoder1, John Gooch2, Steve Wright2. 1Optometry, UIW Rosenberg School of Optometry, San Antonio, TX; 2Ophthalmology, USAF School Aerospace Medicine, Dayton, OH. Purpose: It is well-known that spatial & temporal vision decrease with decreasing luminance but less is known about the impact of luminance on color vision. Our purpose was to compare the effect of luminance on chromatic (color) & achromatic (luminance) CS. Methods: Luminance CS was measured with the Pelli-Robson (PR) chart which has large letters which decrease in contrast in 0.15 log steps (0.05/letter). Color CS was measured with the cone contrast test (CCT; Innova Systems, Inc.) which uses a Netbook computer & rapid staircase to present colored letters on a grey background which decrease in cone contrast to measure red (L), green (M) and blue (S) cone contrast thresholds. PR & CCT were measured at photopic (85 cd/m2), low photopic (5.4 cd/m2) & mesopic (0.7 cd/m2) levels by having subjects view monocularly through neutral density filters. 16 color vision normals (CVN) & 14 hereditary color vision deficients (CVD) were tested. Results: In CVN color (L & M cone) and luminance log CS were equal at high luminance (1.95 log CS) but decreased linearly with log luminance with color CS decreasing more rapidly (3.5X) vs. luminance CS (2.5X) such that color CS was 0.2 log units (1.6X) lower than luminance CS at the mesopic level (p<0.001). A linear decrease with luminance also prevailed for L & M cone CVD but both luminance & color CS decreased more rapidly in CVD for both affected & unaffected cones (L for protans, M for deutans). Suprisingly at the lowest light level achromatic luminance CS was 0.2 log units lower for CVD than for CVN (p<0.01). L & M CVD also showed a more rapid decrease in S cone CS with luminance (3.1X) vs. CVN (1.7X; p<0.01). Conclusions: Foveal color CS deceases more rapidly than luminance CS with decreasing light level in CVN & CVD. It is plausible that color-sensitive parvo cells mediate both color & luminance CS. The more rapid decline in color CS with decreasing luminance may reflect the selective nature of cone CS (e.g., red on grey) which stimulates fewer neurons at threshold (in this example mainly R+/Gopponent cells). The lack of redundant stimulation at low luminance yields decreased CS, more pronounced in CVD. These results indicate that cone CS may be more sensitive for detection of acquired CVD early in eye disease. The finding that low luminance achromatic CS can be decreased in hereditary CVD may have occupational significance. Commercial Relationships: Jeff C. Rabin, None; Michael Castro, None; Daniel Ewing, None; Hayley George, None; Paul Lau, None; Shannon Leon, None; Andrew Yoder, None; John Gooch, None; Steve Wright, None Program Number: 3709 Presentation Time: 3:45 PM - 4:00 PM Rod and cone inputs differ to bright and dark colors Steven L. Buck, Vina Hadyanto, Walker Short, Miaolu Tang, Joris Vincent, Lauren Wilson. Dept of Psychology, University of Washington, Seattle, WA. Purpose: Long-wavelength light that looks yellow in a black surround looks brown in a white surround. No other unique hue (blue, green, red) shows such distinct hue change when seen on white surrounds: they simply appear darker. We determined whether cone and rod weights differ for yellow vs. brown, and what differences occur for bright vs. dark versions of other hues. Methods: Observers saw a 1-s duration 2°-diameter foveal disk presented in a full-field surround that was either white (141 cd/m2, CIE 10° x,y .29,.29) or black, and adjusted the disk hue around the RGB-phosphor-mixture triangle of the CRT display at 21 cd/m2 in both surrounds. To assess cone balances, observers adjusted the hue to (a) red-green (RG) null for yellow, brown, and blue disks and (b) blue-yellow (BY) null for red and green disks. To assess rod hue bias, we reduced light levels by 2 log units to mesopic level, and compared hue balances under dark adapted and bleached conditions. Results: Cone balances. Yellow/brown: All 5 observers showed different RG balances for yellow and brown, with balanced-brown chromaticity shifted toward red compared to unique yellow at both photopic and mesopic levels. Blue: 3 of 5 observers showed the same direction of shift for bright/dark blue as for yellow/brown. Red and green: Shifts in BY hue balances between bright/dark versions were small or inconsistent across observers. Rod hue biases. Yellow/brown: Rods exerted a green bias on yellow for all 4 observers but a red bias on brown for 3 of 4 observers. Blue: Rods also exerted a green bias on bright blue for 3 of 4 observers. 2 observers showed a red bias for both dark blue and brown. Red and green: Rod effects were inconsistent across observers. Conclusions: Both RG balance and rod hue biases differ when the same test light appears yellow vs. brown. The different RG balances suggest M cones have stronger weighting relative to L cones in the portions of midget pathways mediating RG balance for brown compared to those for yellow. The opposite rod hue biases can be explained by rod and cone signals mixing with same sign in ON and OFF midget pathways. While some observers showed similar effects for light vs. dark blue, results were inconsistent for light vs. dark green and red. Thus cone and rod input differences were not apparent in S-cone pathways for light vs. dark colors, and may be exclusive to midget pathways. Commercial Relationships: Steven L. Buck, None; Vina Hadyanto, None; Walker Short, None; Miaolu Tang, None; Joris Vincent, None; Lauren Wilson, None Program Number: 3710 Presentation Time: 4:00 PM - 4:15 PM Cone signals feeding into luminance can exhibit large phase delays and sign reversals: the effect of an inhibitory surround network? Andrew Stockman. Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Purpose: The luminance flicker pathway is typically conceived of as a simple additive combination of M- and L-cone signals. As we reported before (ARVO, 2001), this simple picture is complicated by the existence of multiple cone signals with different delays and signs, which can be revealed by most conditions of chromatic adaptation. Here, we extend these measurements and model the results in terms of an inhibitory surround network. Methods: Cone delays were measured by a flicker photometric cancellation technique. Human subjects varied the relative delay between two superimposed flickering lights (and their relative modulation) in order to minimize or null the perception of flicker. One flickering light was either an M-cone or an L-cone isolating stimulus, and the other was a “standard” light that was of the same wavelength as the background. Measurements were made as a function of temporal frequency from 2.5 to about 25 Hz on a series of adapting backgrounds with wavelengths between 410 and 658 nm and at several background intensities. Results: Under most conditions, sizeable delays or advances by as much as 33 ms have to be introduced between the M- or L-cone flickering light and the standard in order to null the perception of flicker, particularly when M-cone flicker is used. In general, the results are consistent with the L- and M-cone signals being made up of faster components combined with delayed ones of the same or opposite sign. For M-cone signals, the delayed components can be larger than the fast, so that they predominate. Conclusions: These results challenge the idea that the luminance channel is made up of only additive M- and L-cone inputs. However, these complexities may simply reflect the fact that the inhibitory surround of each cone has both L- and M-cone inputs, and that there are typically more L-cone inputs than M. We model the surround as a network of direct and indirect inhibitory lateral connections across which each step in the network inverts and delays the signal. Thus, the effective sign and overall delay of the slow signal depend upon the relative strengths of the inhibitory feedback at each step and upon the number of steps. Commercial Relationships: Andrew Stockman, None Support: BBSRC 410 Spatial Vision, Visual Psychophysics and Aging II Wednesday, May 08, 2013 8:30 AM-10:15 AM TCC LL 4/5 Paper Session Program #/Board # Range: 4063-4068 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 4063 Presentation Time: 8:30 AM - 8:45 AM Two-point detection and appearance in the absence of higher order aberrations Heidi J. Hofer, Darren E. Koenig. College of Optometry, University of Houston, Houston, TX. Purpose: We investigated the impact of the cone mosaic on spatiochromatic reconstruction of two-point stimuli by measuring detection and appearance with stimuli made smaller than retinal cones with adaptive optics. We sought to determine whether detection and perception of these points are independent near the fovea, as has been previously hypothesized, and if not the extent of summation for detection and color. We also investigated whether two-point resolution is consistent with a photoreceptor limit under these conditions. Methods: We performed two experiments in which subjects viewed 550nm two-point stimuli through a 6mm pupil with adaptive optics aberration correction. Stimuli were viewed at ~1 degree eccentricity under a rod bleaching protocol to isolate cone responses. In one experiment two subjects were shown either one or two spots (25 ms, 0.5 arcmin estimated retinal full-width at half maximum (fwhm)) of different intensities and reported the number seen and color appearance. Separation was varied from 1.5 to 15 arcmin. In the second experiment two subjects were shown either one or two dim, yet suprathrehsold, spots (15 ms, 0.5 and 1.1 arcmin estimated fwhm) and reported whether they believed one or two spots were present. Separation was varied from 0.5 to 12 arcmin. Results: Detection thresholds in the first experiment were consistent with complete spatial summation up to 3-4 arcmin. Detection, but not color appearance, was independent for separations of 8 arcmin or more and consistent with at least 15 arcmin of spatial uncertainty. For two-point stimuli color appearance was highly variable, as for single points, but also highly coupled. Both points were reported to have the same color appearance on over 97% of trials, regardless of separation. Resolution thresholds were similar in both experiments, 2.5-5 arcmin, with a slight tendency towards lower thresholds with the larger spots. Conclusions: Cone detection at 1 degree is consistent with complete spatial summation over an extent including at least a cone and its nearest neighbors, creating challenges in recovering ‘single cone’ sensations from the responses to tiny stimuli. Despite this extent, two-point resolution is roughly consistent with expectations based on a photoreceptor limit. The large variation, but lack of independence, in the color appearance of the two-point stimuli, implies nonlocality in the color reconstruction mechanisms. Commercial Relationships: Heidi J. Hofer, None; Darren E. Koenig, None Support: ROI EY019069, P30 EY07551 Program Number: 4064 Presentation Time: 8:45 AM - 9:00 AM A Comparison of Acuity and Cone Density in the Temporal Retina Nancy J. Coletta1, Toco Y. Chui2, Ann E. Elsner2. 1Vision Science, New England College of Optometry, Boston, MA; 2School of Optometry, Indiana University, Bloomington, IN. Purpose: Cone spacing has long been thought to set a limit on visual acuity. While parafoveal acuity and cone density decrease at parallel rates with increasing myopia (Coletta and Watson, Vis Res, 2006; Chui et al., IOVS, 2008), parafoveal acuity has been reported to exceed the limit estimated from histological measures of cone spacing (Williams and Coletta, JOSA A, 1987). Recent advances in retinal imaging allow a comparison of acuity and cone spacing in the same eyes. We compared parafoveal acuity to cone density in several young adult individuals to determine whether acuity is matched to the limit estimated from cone density. Methods: Measurements were made on five subjects with an average age of 28 years +/- 4.30 s.d., average spherical equivalent refractive error of -1.93 D +/- 3.32 s.d. and average axial length of 24.48 mm +/- 1.38 s.d. (IOL Master, Zeiss Meditec). Acuity was measured on the temporal retinal meridian using 543 nm laser interference fringes at a retinal illumination of 100 td; fringes were displayed in a 1 deg patch at 2 deg and a 2 deg patch at 7 deg eccentricity. Acuity was estimated at the 75% correct level for a 2AFC vertical/horizontal discrimination task. Cone densities in the temporal retinal meridian were assessed using a second generation Adaptive Optics Scanning Laser Ophthalmoscope. Densities were measured at a nominal 630 and 2070 microns from the foveal center with custom software (Matlab, Mathworks). Axial lengths were used to correct the cone sampling positions and retinal area, as well as to convert cone densities to Nyquist frequencies (NF) in units of c/deg. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Results: The average acuity at 2 deg and 7 deg locations was 34.4 c/deg +/- 3.54 s.e.m. and 17.62 c/deg +/- 2.33 s.e.m., respectively, while the average cone NFs at 2 deg and 7 deg locations were 26.97 c/deg +/- 1.02 s.e.m. and 18.79 c/deg +/- 0.73 s.e.m., respectively. Individual ratios of acuity: cone NF ranged from 1.03 to 1.47 with a mean of 1.26 at 2 deg and 0.75 to 1.18 with a mean of 0.93 at 7 deg. A paired t-test of acuity and cone NF values at 7 deg was not statistically significant. Conclusions: Visual acuity exceeded the cone NF at 2 deg eccentricity, confirming earlier studies that compared parafoveal acuity and histological measures from different eyes. However our results at 7 deg eccentricity suggest that interferometric acuity may provide a good estimate of cone density in the perifoveal region. Commercial Relationships: Nancy J. Coletta, None; Toco Y. Chui, None; Ann E. Elsner, Aeon Imaging, LLC (I), Aeon Imaging, LLC (F), Aeon Imaging, LLC (P) Support: NIH Grants NEI EY007624 (AE Elsner), NEI EY004395 (SA Burns), NEI P30EY019008 at IU and NEI R24 EY014817 at NECO Program Number: 4065 Presentation Time: 9:00 AM - 9:15 AM Age-related variation in foveal, parafoveal and peripheral spatial suppression Rigmor C. Baraas, Craig Aaen-Stockdale, Stuart J. Gilson. Optometry & Visual Science, Buskerud University College, Kongsberg, Norway. Purpose: The study investigated motion-related spatial suppression across different age groups and across different eccentricities, with the stimuli scaled according to the size of MT receptive fields. The aim was to test three alternative hypotheses: If spatial suppression (1) is a perceptual correlate of center-surround antagonism in cortical visual area V5 then the levels of spatial suppression should be constant at all eccentricities; (2) reduces with increasing age, as a result of a generalized weakening of inhibition then suppression should be lower for older observers, but constant at all eccentricities; (3) is related to contrast-related changes in receptive field size at a retinal level then suppression should vary with eccentricity and possibly vary with cone density. Methods: Eleven normal, healthy subjects (7 females) with no known ocular abnormalities, aged 21-71 yrs participated in the study. Their left eye was patched and they fixated a fixation cross presented on the screen at eccentricities of 0, 2, 5 or 10 deg, or a back-lit fixation point at 25 or 40 deg. The stimulus was a 2 Hz drifting sinusoidal grating with a peak contrast of 92%. Spatial frequency was varied with eccentricity to keep it close to peak contrast sensitivity. Stimulus duration was varied to derive a duration threshold. Highresolution images of the cone mosaic were obtained with the Kongsberg Adaptive Optics Ophthalmoscope II. Results: Older observers showed zero suppression for foveal vision (0-2 deg), gradual increase in suppression in the parafovea (5-10 deg eccentricity) and weaker suppression in the periphery (25-40 deg). Contrary to this, young observers showed strong suppression for foveal and parafoveal vision (0-5 deg) with a gradual decline in suppression from 10 deg. There was between-individual variation in both spatial suppression and cone density. Initial analyses indicate that lower levels of suppression correlate with lower cone count. Conclusions: The strength of suppression, in both young and old observers, varied with eccentricity, despite the scaling of the stimulus with average MT receptive field size. The results for older observers imply that weaker suppression is not a generalizable result. The results suggest that spatial suppression may be the result of low-level stimulus characteristics and structural variation in the retina rather than a direct result of center-surround antagonism in MT. Commercial Relationships: Rigmor C. Baraas, None; Craig Aaen-Stockdale, None; Stuart J. Gilson, None Support: The Research Council of Norway Yggdrasil international mobility grant #211313 (CAa-S); Research Council of Norway Grant 176541/V10 and 182768/V10 (RCB) Program Number: 4066 Presentation Time: 9:15 AM - 9:30 AM Heterochromatic Modulation Photometry can be used to measure Macular Pigment Optical Density Cord R. Huchzermeyer1, Juliane Schlomberg1, Ulrich Welge-Lüssen1, Tos TJM Berendschot2, Jan J. Kremers1. 1Department of Ophthalmology, University Erlangen-Nuremberg, Erlangen, Germany; 2University Eye Clinic, Maastricht, Netherlands. Purpose: Macular pigment optical density (MPOD) can be measured psychophysically by comparing the luminance ratio between a shortwavelength and a long-wavelength light at a central and a peripheral retinal locus using heterochromatic flicker photometry (HFP). Heterochromatic modulation photometry (HMP) is a psychophysical test that uses, in contrast to HFP, test fields with constant mean luminance and chromaticity. To study whether HMP is suitable for measuring MPOD, we compared a custom made HMP protocol with measurements using HFP and macular pigment reflectometry (MPR). Methods: We developed a protocol for the measurement of MPOD using a Maxwellian view LED stimulator. Two lights (B: 460nm and R:660nm, retinal illuminance of 21 phot Td each) were modulated in counterphase in a 2° center-field surrounded by a 12° white background (587 phot Td). Flicker detection threshold contrasts were determined for 9 different contrast ratios (B/R) of the two lights, varying between 10-1 and 101. Thresholds were determined using two randomly interleaved staircases and a 2AFC (flicker/no flicker) procedure. The measurements were repeated with central and with 6° nasal fixation. For comparison, MPOD was also measured using an HFP-based Macular Densitometer (Macular Metrics, USA) and the Macular Pigment Reflectometer (Maastricht Instruments bv, The Netherlands). The right eyes of 14 normal subjects were measured. Results: Log sensitivity (1/threshold) vs log B/R can be described by a V-shaped curve with a minimum at log B/R = 0 for the standard observer with Vλ-like spectral luminosity. A horizontal shift (along the log B/R axis) of the minimum represents a deviation from the V λ. The difference of the positions of the minima measured at central and 6°nasal fixation were used to estimate the MPOD. MPOD measurements using HMP correlated with HFP (n=12, r=0.79, p<0.01) and MPR (n=13, r=0.69, p<0.05). Bland-Altman plots showed a marked systematic difference: HMP yielded 0.27±0.19 lower values than MPR. Agreement with HFP was much better (difference 0.02±0.13). HFP measured higher values in eyes with low MPOD and lower values in eyes with high MPOD. Conclusions: HMP measurements agree well with HFP, but HMP has the advantage of using constant mean luminances and chromaticities. HMP also correlates with MPR, but there are systematic differences. This pilot study showed that the HMP method can be used to measure MPOD. Commercial Relationships: Cord R. Huchzermeyer, None; Juliane Schlomberg, None; Ulrich Welge-Lüssen, None; Tos TJM Berendschot, None; Jan J. Kremers, None Support: ELAN Erlangen, IZKF Erlangen ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 4067 Presentation Time: 9:30 AM - 9:45 AM Comparability of Visual Performance of Individuals with Low Vision in Real and Virtual Street Intersections Lei Liu, Ellen L. Bowman. School of Optometry, University of Alabama at Birmingham, Birmingham, AL. Purpose: Low Vision Orientation & Mobility (O&M) evaluation and training are typically performed in streets and street intersections. While effective, the efficiency of the practice can be greatly improved by employing computer-generated virtual street scenarios. To evaluate the feasibility of virtual O&M training, we compared visual performance of low vision patients in real and virtual street intersections. Methods: A semi-CAVE virtual reality simulator was built. It consisted of a game computer, 3 digital projectors, three 2.4x1.9 m screens (>180o deg horizontal) and surrounding sound. Four virtual street intersections were built based on 4 real intersections in an urban environment. Google Street, Geographic Information System and on-site photos/videos were used to match the physical layout and surrounding, traffic controls, and vehicle and pedestrian traffic of the real and virtual intersections. Multiple crossing scenarios were set at each intersection. Ten legally blind subjects with adequate prior O&M training performed 10 visual tasks in both real and virtual intersections. These tasks included identifying traffic elements, determining intersection layout and choosing the safest time to cross. The performance was rated pass or fail by two certified O&M specialists. Agreement between performance in corresponding real and virtual intersections was compared. Results: Data from corresponding real and virtual intersections was organized into a 2x2 contingency table. The overall, positive and negative agreements were 83.3%, 89.4% and 68.6%, respectively, indicating that if a subject could perform a task in a real intersection, it was highly likely that she could also perform the same task in a virtual version of the intersection, and vice versa. The kappa coefficient was 0.59, bordering moderate and substantial agreement. A McNemar analysis of paired binary data showed an exact significance of 0.824, indicating no difference in performance between real and virtual intersections. Conclusions: Persons with low vision exhibited similar abilities while performing visual tasks in real and virtual street intersections. The agreement suggested that computer-generated traffic scenes provided sufficient visual and auditory information for low vision patients to perform O&M tasks. Virtual reality has the potential to become a useful supplement to tradition low vision rehabilitation training. Commercial Relationships: Lei Liu, None; Ellen L. Bowman, None Support: NIH Grant 1R21EY019549 Program Number: 4068 Presentation Time: 9:45 AM - 10:00 AM Optical quality and subjective judgments of blur under pure simultaneous vision Carlos Dorronsoro, Aiswaryah Radhakrishnan, Lucie Sawides, Susana Marcos. Instituto de Optica, CSIC, Madrid, Spain. Purpose: To compare retinal image quality and subjective image sharpness under pure bifocal simultaneous vision (PSV) across a wide range of addition values. Methods: Four subjects performed a weighted rank psychophysical experiment to grade (from totally blurred to totally sharp, 0 to 5) the perceptual quality of PSV images. As a control condition, the perceptual quality of purely defocused (PD) images was also assessed. Computer generated images of a face were observed, for 1.5s in random order, through adaptive optics to correct the aberrations of the eye. The PSV images (50/50 energy content) were obtained from the combination of a focused image superimposed to a defocused version of the same image. At least 18 defocus conditions (0-3D) were subjectively ranked (10 repetitions). In addition, optical quality was evaluated as a function of defocus, from the PSV and PD Point Spread Functions (PSF), using the Modulation Transfer Function (MTF) at different frequencies as a metric. Results: As expected, images without defocus were perceived as sharp (score s=5) in all subjects and conditions. The perceptual weighted rank systematically dropped for PD at a rate of 9.0±4.0 s/D, with the images perceived as completely blurred (s=0) from 0.6 D onwards. PSV images provided a similar decrease as their defocus component increased, in the 0-0.3D range. However, in 3 subjects the score reached a minimum at 0.5D (s=2.1±0.4) and then it was partially recovered back towards sharpness (s=3.5 at 1.2D), remaining stable afterwards. The 4th subject showed a similar trend judging PSV images but without a minimum. The objective simulations predicted the perceptual judgment trends, as well as the differences between judgments of PD and PSV images. MTF@20 c/deg decreased sharply with defocus in PD, but reached a minimum (0.42 at 0.5 D) and recovered a stable level (0.50 from 1.5D) in PSV. Averaged MTFs (15-25 c/deg) provided the most accurate predictions. Conclusions: As opposed to the common idea that simultaneous vision retinal images (as those found in multifocal contact or intraocular lenses) are severely optically degraded, but later restored in neural processes, we have found a good correspondence between pure subjective perception experiments and pure optical simulations. Although our findings do not preclude for possible effects of neural adaptation, neural effects seem to be secondary in the perceptual judgment of sharpness in PSV. Commercial Relationships: Carlos Dorronsoro, Essilor International (F); Aiswaryah Radhakrishnan, None; Lucie Sawides, None; Susana Marcos, Essilor (F), PCT/ES2012/070185 (P) Support: FIS2011-25637; ERC-2011-AdG-294099; EU Marie Curie FP7-PEOPLE-2010-ITN #26405 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics 417 Accommodation and Presbyopia Correction Wednesday, May 08, 2013 8:30 AM-10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 4250-4283/B0287-B0320 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 4250 Poster Board Number: B0287 Presentation Time: 8:30 AM - 10:15 AM The Influence of Multifocal Lenses on Fine Motor Tasks Rupal Lovell-Patel1, 2, Matthew A. Timmis2, Shahina Pardhan2, Paul McCarthy1, 2. 1Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom; 2Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom. Purpose: Literature suggests that multifocal lenses are associated with a decreased performance for a variety of tasks including negotiating steps, obstacles, driving and reading at certain distances, when compared to single vision lenses. In daily life we regularly perform other motor tasks, such as reaching and grasping an object. Currently, there is no evidence based data on how multifocal lenses affect the performance of such fine motor tasks when compared to single vision lenses. Methods: 12 presbyopic subjects who were habitual multifocal spectacle wearers took part in the study. Performance was compared for multifocal lenses and single vision lenses which were prescribed following a comprehensive vision assessment and an analysis of the distances at which the tasks were carried out. Subjects had a minimum visual acuity of 0.00 LogMAR. Participants completed 3 different fine motor tasks wearing both types of correction; object width estimation, reach-and-grasp and transport-and-placement. Hand and head movements were captured by a 3-D motion capture system. Results: Data were analysed using ANOVA. Peak grip aperture was significantly larger when grasping the large compared to small object (p < .001). Participants also showed greater error when positioning the large compared to small object (p < .001). For the reach-andgrasp task: onset time, overall movement time, peak velocity, peak grip aperture, deceleration time and velocity corrections were not significantly affected by spectacle type (p>0.05). Interestingly, head flexion was also not affected by the spectacle type (p > .05). For the object width estimation task: no significant difference was obtained in the perceived aperture width between the spectacle types. For transport-and-placement: movement time, peak velocity, deceleration time, velocity corrections, head rotation and error in object placement were unaffected by spectacle type (p > .05). Conclusions: The type of spectacle lens did not affect the fine motor tasks which encompassed a range of visual angles that would lie outside the multifocal lenses’ intermediate corridor. Data demonstrates that habitual multifocal spectacle wearers can carry out fine motor tasks such as reaching and grasping just as competently as they can with single-vision lenses. Commercial Relationships: Rupal Lovell-Patel, None; Matthew A. Timmis, None; Shahina Pardhan, None; Paul McCarthy, None Program Number: 4251 Poster Board Number: B0288 Presentation Time: 8:30 AM - 10:15 AM Accommodative Lag, Facility and Phoria with Multifocal Contact Lenses Jiyoon Chung1, Ravi C. Bakaraju1, Cathleen Fedtke1, Jerome Ozkan1, Klaus Ehrmann1, 2, Darrin Falk1, Arthur Ho1, 2, Brien A. Holden1, 2. 1 Brien Holden Vision Institute, Sydney, NSW, Australia; 2School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia. Purpose: To compare the accommodative lag, facility and phoria measurements of myopic participants fitted with various commercial contact lens designs. Methods: Forty myopic, non-presbyopic, subjects were randomized to be fitted bilaterally, with a single vision control lens (Air Optix Aqua) and two of four multifocal (MF) lenses (Proclear Distance and Near MF, Air Optix Aqua MF and PureVision MF) on a daily wear basis. Subjects wore each lens type for a minimum of 8 days over 4 scheduled (baseline and 3 follow-up) visits with a 1-week wash-out between lens types. Static accommodative responses were assessed with the EyeMapper at all visits. Five repeats were performed in a fogged state (+1D) and at four object vergences from -2 to -5D (1D steps). Paraxial curvature matching of the wavefront aberration map yielded the spherical equivalent. Accommodative facility and phoria (at distance and near) were evaluated using ± 2D flippers and Howell card, respectively. To reduce the effect of between-visit variability, the data was averaged over the four visits. Results: At +1D fogging, all lens types produced a myopic shift. With the control lens, the accommodative response function was relatively linear (slope = 0.82). Three centre-near MFs (Air Optix, PureVision and Proclear Near) all demonstrated accommodative lead at -2D, optimal response at -3D, and lag at -4 and -5D object vergences. Proclear Distance produced lag over all test vergences. All MFs produced lower accommodative facility compared to control lens (19.2 cycles / min, p<0.05). The facility measures for Air Optix, PureVision, Proclear Near and Proclear Distance were 15.8, 15.7, 14.4, and 16.5 cycles / min, respectively. There were no differences for distance phoria between all lens types. Significant differences were observed for near phoria with Proclear Near MF (5.6 exo, p< 0.05). Conclusions: There were significant differences between measured accommodative lag for different lens types with Proclear Distance producing greater lag than the rest. This observation was more pronounced at -3D, -4D and -5D accommodative states. Commercial Relationships: Jiyoon Chung, None; Ravi C. Bakaraju, None; Cathleen Fedtke, None; Jerome Ozkan, None; Klaus Ehrmann, None; Darrin Falk, None; Arthur Ho, None; Brien A. Holden, Allergan (F), AMO (I) Clinical Trial: ACTRN12611001004954 Program Number: 4252 Poster Board Number: B0289 Presentation Time: 8:30 AM - 10:15 AM The role of eye dominance on through-focus visual performance in modified monovision presbyopic corrections Len Zheleznyak1, 2, Aixa Alarcon2, Kevin C. Dieter3, Duje Tadin3, 2, Geunyoung Yoon2, 1. 1The Institute of Optics, University of Rochester, Rochester, NY; 2Flaum Eye Institute, University of Rochester, Rochester, NY; 3Brain and Cognitive Sciences, University of Rochester, Rochester, NY. Purpose: To investigate the impact of the degree of sensory eye dominance on through-focus visual performance in presbyopic corrections with modified and traditional monovision. Methods: The degree of sensory eye dominance was measured using a binocular rivalry technique in which orthogonal sinusoidal gratings (4cyc/deg) were presented to each eye. The proportion of exclusive visibility of each grating was recorded as the right eye’s contrast varied from 10-90% while the left eye remained fixed at 50%. The degree of ocular dominance (DOD) was defined as the difference in interocular contrast which resulted in perceiving the two gratings for equal portions of time. A binocular adaptive optics vision simulator was used to correct 9 cyclopleged subjects’ native aberrations and induce modified monovision (1.5D anisometropia, spherical aberration of +0.1 and -0.4μm in distance and near eyes, ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics respectively). To assess the impact of dominance on visual performance, through-focus visual acuity (VA) from 0.0 to 3.0D at 0.5D step with a 4mm artificial pupil was measured under two conditions by assigning dominant and non-dominant eye to distance and near, respectively, and vice versa. Traditional monovision of 1.5D anisometropia was measured for comparison. Results: Sensory eye dominance spanned from weak (DOD=4%) to strong (DOD=23%) dominance with average DOD=9±8%. The average difference in through-focus VA between switching eye assignment for distance in modified and traditional monovision was 0.01±0.04 and 0.00±0.03 logMAR, respectively. The subject with the strongest dominance experienced a loss in intermediate (0.5-1.5D) VA of 0.16±0.09 and 0.05±0.01 logMAR with modified and traditional monovision, respectively, when the non-dominant eye was assigned to distance compared to assigning the non-dominant eye to near. Conclusions: For subjects with typical low and moderate levels of sensory eye dominance, the degree of dominance did not have a significant effect on through-focus VA in monovision regardless of which eye was assigned to distance and near. However, it is important for subjects with strong eye dominance to assign the dominant eye to distance vision for optimal through-focus VA, especially in modified monovision correction. Commercial Relationships: Len Zheleznyak, None; Aixa Alarcon, None; Kevin C. Dieter, None; Duje Tadin, None; Geunyoung Yoon, Bausch & Lomb (F), Johnson & Johnson (F), Allergan (C), Staar Surgical (C), CIBA Vision (F), Acufocus (C) Support: NIH Grant EY014999, Research to Prevent Blindness Unrestricted/Challenge Grant, NIH Training Grant T32 EY007125 Program Number: 4253 Poster Board Number: B0290 Presentation Time: 8:30 AM - 10:15 AM Customizing depth of focus outcomes in Hyperopic Lasik using an Adaptive Optics Vision Analyzer Guillermo M. Perez1, Eloy A. Villegas2, Benjamin Leray3, Francois J. Malecaze3, Pablo Artal2. 1Voptica S.L., Murcia, Spain; 2Laboratorio de Optica, Universidad de Murcia, Murcia, Spain; 3Service d'Ophtalmologie, CHU Toulouse-Purpan, Toulouse, France. Purpose: LASIK allows not only to correct for the refractive error but also to extend depth of focus by inducing controlled amounts of spherical aberration (SA). However the success of the procedure may depend on the particular SA values required by each patient. We evaluate a customization procedure where the optimum values of SA were determined for each patient using an adaptive optics vision analyzer before the surgery. Methods: A group of 38 hyperopic/presbyopic patients were evaluated before and after surgery using the Adaptive Optics Vision Analyzer (AOVA, Voptica SL, Murcia, Spain). This is a clinical instrument to perform vision testing with full control of the optical aberrations induced in the patient’s eye non-invasively. The AOVA includes a wave-front sensor, a liquid crystal on silicon spatial light modulator to induce any desired aberration profile on the patient’s eye, and a micro-display to present the visual stimuli. Visual acuity was measured for defined combinations of residual defocus and SA at infinity, 60 cm and 40 cm. In each patient, the sets of optimized values of defocus and SA required to maintain adequate near and far VA were determined. Then, and taking into account the patient’s corneal asphericity (Q-value), the LASIK procedure (WaveLight Allegretto Wave Eye-Q Laser, Alcon) was settled to induce the desired range of negative SA in one eye. The fellow dominant eye was treated only to reach emmetropia without inducing SA. After the surgery, through focus VA, residual refraction, and SA was measured using the AOVA in each patient. Results: The average Q-value changed from -0.1 to -0.6 in the dominant eyes, and from -0.05 to -0.8 in the eyes treated for inducing extra asphericity. The average value of SA providing an extended depth of focus was around -0.2 microns for 4.5-mm pupil. In these eyes, the required positive addition for intermediate and near vision changed from +1.00D and +1.70D to +0.40D and +1.00D respectively. In those eyes with no SA induced, the positive addition required hardly changed. Conclusions: Hyperopic presbyopic patients are ideal candidates for customized LASIK to induce an extended depth of focus. This procedure can be optimized when mediated with adaptive to predict the right amount of SA to be induced. These results suggest that the LASIK guided with and AOVA can provide improved visual outcomes at all distances. Commercial Relationships: Guillermo M. Perez, VOPTICA (E); Eloy A. Villegas, Voptica, S.L. (I), Calhoun Vision (F); Benjamin Leray, None; Francois J. Malecaze, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013), Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06. Program Number: 4254 Poster Board Number: B0291 Presentation Time: 8:30 AM - 10:15 AM Effect of Age on Amplitude of Accommodation in Bolivia Magnus Andersson, Baskar Theagarayan. Section of Optometry and Vision Science, Linnaeus University, Kalmar, Sweden. Purpose: The purpose of this study was to investigate the impact of age on Amplitude of Accommodation (AA) in a Bolivian population and compare it with previously published data. We were also interested in finding out the age of onset of Presbyopia in this population. Methods: A sample of 197 Bolivian subjects aged between 8 to 60 years, attending three different field clinics provided by Vision For All (non-profit organization, Sweden) was used in the study. All the subjects were refracted binocularly and had at least best correction Visual acuity of 20/25. None of the subjects had any visible strabismus or ocular pathology. The AA was measured using the push-up and push-down method with a Royal Air Force (RAF) ruler. The ruler has both a metric scale in centimeters and a dioptric scale. The subjects were asked to read letters of N5 print size and report first sustained blur in push-up method and first sustained clear in the push-down method. The subjects had their correction in place during the measurements. Among the presbyopic subjects a +2.00D lens was placed as an addition to bring the target within measurable limits. The average of push-up and push-down readings was used as the subjective AA. Results: Independent samples t-test showed no statistically significant difference between the present and the previous AA studies (p > 0.05). The AA of the Bolivian population was generally lower compared to previous investigations. Regression analysis showed a significant correlation between age and the AA (r = 0.80, p < 0.05). The onset of presbyopia among the Bolivian population was found to be 38 years. Conclusions: This result supports the theory that there is a lower AA among people in tropical zones compared to those from temperate zones. The onset of presbyopia for this Bolivian population was seven years earlier than the Hofstetter formula would predict and five years earlier compared to Duane’s (Duane A, Trans Am Ophthalmol Soc, 1922; 20:132-157) values. Commercial Relationships: Magnus Andersson, None; Baskar Theagarayan, None ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 4255 Poster Board Number: B0292 Presentation Time: 8:30 AM - 10:15 AM Influences of cycloplegia with topical cyclopentolate on higherorder aberrations in myopic children Takahiro Hiraoka1, Kazunori Miyata2, Fumiki Okamoto1, Tetsuro Oshika1. 1Dept of Ophthalmology, University of Tsukuba, Tsukuba, Japan; 2Miyata Eye Hospital, Miyakonojo, Japan. Purpose: It is little known about the effect of cycloplegia with topical cyclopentolate on optical quality of the eye in myopic children. We conducted this prospective study to investigate the influence of topical cyclopentolate on higher-order aberrations (HOAs) in myopic children. Methods: Twenty-eight eyes of 28 myopic children (17 boys and 11 girls), ranging in age from 4 to 12 years (7.25 ± 2.55, mean ± standard deviation), were enrolled in this study. We evaluated refraction and wavefront aberrations before and after cycloplegia with topical instillation of 1% cyclopentolate hydrochloride. Ocular and corneal aberrations were simultaneously measured and compared with each other. Individual Zernike components were also analyzed for a 6-mm pupil up to the sixth order. All these parameters were compared before and after cycloplegia. In addition, the obtained data were compared with other 23 subjects with hyperopia. Results: Cycloplegia with topical cyclopentolate induced significant hyperopic changes from -3.07 ± 2.23 to -2.57 ± 2.15 D (P < 0.001, paired t-test). Ocular higher-order aberrations (HOAs) increased significantly from 0.243 ± 0.111 to 0.263 ± 0.105 μm for coma-like aberrations (P = 0.042), from 0.124 ± 0.041 to 0.138 ± 0.037 μm for spherical-like aberrations (P = 0.012), and from 0.279 ± 0.105 to 0.304 ± 0.096 μm for total HOAs (P = 0.015). Corneal HOAs did not change by cycloplegia. When corneal and ocular HOAs were compared, the ocular HOAs were significantly smaller than the corneal HOAs in spherical-like aberrations (P < 0.001) and total HOAs (P = 0.006). When compared between myopic and hyperopic children, spherical-like aberrations and total HOAs were significantly larger in hyperopia than in myopia (P = 0.001 and P = 0.042, unpaired t-test). However, each Zernike component showed a large standard deviation in both groups. Conclusions: Internal optics compensate for corneal HOAs also in myopic children, and paralysis of tonic accommodation with cyclopentolate considerably affects ocular HOAs. It may be that physiological tonic accommodation is done to improve retinal image quality by reducing HOAs. In addition, HOAs tend to be smaller in myopia than in hyperopia, but inter-individual variation in each Zernike component is quite large in both myopic and hyperopic children. Commercial Relationships: Takahiro Hiraoka, None; Kazunori Miyata, None; Fumiki Okamoto, None; Tetsuro Oshika, None Program Number: 4256 Poster Board Number: B0293 Presentation Time: 8:30 AM - 10:15 AM Five-year Incidence of Loss of Accommodative Ability in the Beaver Dam Offspring Study Dayna S. Dalton, Karen J. Cruickshanks, Mary E. Fischer, Barbara E. Klein, Ronald Klein, Aaron A. Pinto. Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI. Purpose: To determine the 5-year incidence of loss of accommodative ability in a large cohort of adults. Methods: Subjects (n=2256, age 21-84 years at baseline) participated in both the baseline (2005-2008) and 5-yr follow-up exam (2010 2012) of Beaver Dam Offspring Study. At each visit a Grand Seiko Autorefractor was used to obtain three measures of refractive error; distance correction and with correction focusing on two near targets; one requiring 2 diopters (D) and the other 4.5D. Readings were converted to spherical equivalent (sphere + ½ cylinder) (SE). Participants were classified as myopic (SE ≤ -1.00), hyperopic (SE ≥ +1.00) or emmetropic (SE > -1.00 and < +1.00). At each of the two near targets, the participant was considered to have lost accommodative ability if the spherical equivalent was ≥ -0.50. Subjects with cataract surgery were excluded. Results: In preliminary analyses of right eyes, there were 741 participants in the baseline exam who were able to accommodate at both targets. Of those, 333 (45%) were not accommodating at the 2D target and 241 (33%) were not accommodating at the 4.5D target at the 5-yr follow-up exam. Age was highly associated with the incidence of loss of accommodative ability (mean age of accommodating at 2D = 38.2 years; 4.5D = 38.7 years, not accommodating at 2D = 44.7 years; 4.5D = 46.1 years) and risk of losing accommodative ability increased with increasing age (OR 3.18, 95% CI 2.59-3.90 for each 5 years of age). Participants with hyperopia were less likely to lose accommodative ability (OR 0.01, 95% CI 0.00 - 0.04) compared to those with emmetropia. There was no association between myopia or sex with loss of accommodative ability. Eight participants over the age of 55 years at the baseline examination had accommodative ability at both distances at both examinations. Conclusions: Loss of accommodative ability is very common in middle-age. These data show that adjusting for age, hyperopia was associated with decreased risk. In spite of the strong age effect, a small number of people retain accommodative ability beyond midlife. Further investigation is necessary to identify factors that are associated with retention of accommodative ability. To the best of our knowledge, this is the first longitudinal study using an objective measure to investigate the loss of accommodative ability. Commercial Relationships: Dayna S. Dalton, None; Karen J. Cruickshanks, None; Mary E. Fischer, None; Barbara E. Klein, None; Ronald Klein, None; Aaron A. Pinto, None Support: NIH Grant AG021917 Program Number: 4257 Poster Board Number: B0294 Presentation Time: 8:30 AM - 10:15 AM Effect of Unclean Display on Accommodative Response Masakazu Hirota1, Hiroshi Uozato1, 2, Shinji Arai1, Yuko Shibata1. 1 Ophthalmology & Visual Sciences, Kitasato Univ Graduate School, Minami-ku, Sagamihara-shi, Japan; 2Orthoptics & Visual Sciences, Kitasato University School of Allied Health Science, Minami-ku, Sagamihara-shi, Japan. Purpose: To assess change of accommodative response when we watched an unclean display. Methods: Twenty volunteers (5 men and 15 women; mean ± standard deviation age, 22.2 ± 3.4 years; range, 19 to 33 years) participated in our study. All subjects had a visual acuity of 20/20 or better. In addition, we confirmed that all subjects had enough accommodation more than 7.00 D (mean ± standard deviation, 12.31 ± 0.54 D) and their near reflex was normal. Each subject’s accommodative response was measured by a target moving system WMT-1 (Grand Seiko Co., Ltd, Hiroshima, Japan). WMT-1 can move a target optionally from 0.2 to 1.0 m and it include a binocular Autorefractor WAM-5500 (Grand Seiko Co., Ltd, Hiroshima, Japan) that can measure refraction every 0.2 second in open field. We adopted iPad (Apple Inc., Cupertino, CA) on WMT-1 as a target. As an unclean display model, we covered closely to 3 pieces of tracing paper upon the iPad’s display. We compared accommodative response of a clean display and an unclean display in target distance of 1 m, 0.5 m, and 0.2 m. Results: The accommodative response of unclean display increased ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics larger than that of clean display (1.0 m: clean was -0.80 ± 0.24 D, unclean was -1.03 ± 0.25 D.). When the target came near, the difference of accommodative response between control and unclean display increased (0.5 m: clean was -1.56 ± 0.25 D, unclean was 1.82 ± 0.24 D, 0.2 m: clean was -4.22 ± 0.38 D, unclean was -4.73 ± 0.74 D.). Statistical significant differences were found between the accommodative response of unclean display and of clean display in all target distances (Wilcoxon signed rank test, p < 0.001) Conclusions: The accommodative response of unclean display was larger than that of clean display. The increase in necessary accommodative response may lead to asthenopia. We should keep a display clean to prevent eye fatigue. Commercial Relationships: Masakazu Hirota, None; Hiroshi Uozato, None; Shinji Arai, None; Yuko Shibata, None Program Number: 4258 Poster Board Number: B0295 Presentation Time: 8:30 AM - 10:15 AM The effect of near addition lenses on the accuracy of the accommodative response in myopic children during reading Jinhua Bao, Zhili Zheng, Hao Chen. School of Optometry and Ophthalmology, Wenzhou Medical College, Wenzhou, China. Purpose: Addition lenses may play a role in the retardation of the progression of myopia. The purpose of this study was to evaluate the changes to accommodation and phoria when myopic children perform near work with different near addition lenses. Methods: We measured accommodative response and phoria in 18 children (14 myopic and 4 emmetropic) at 33cm through their distance refractive correction alone or this correction combined with multiple addition lenses (+0.50D, +1.00D, +1.50D, +2.00D, +2.50D, and +3.00D). Accommodative response was measured using the infrared optometer (WAM-5500) and near phoria was measured using the modified Thorington technique. Results: Myopic children had larger lags (1.35D) than emmetropic children (0.86D) for a 33 cm reading target through the distance correction, and significantly decreasing lags of accommodation with larger addition lenses (P<0.01). A small lead of accommodation (0.22D) was found with the addition of +3.0D lens . There were obvious differences in the mean responses between the two refractive groups across the multiple addition lenses (F=28.74, P<0.01). The near phoria showed significant increases towards exophoria in both groups with larger addition lenses during reading (P<0.01). Conclusions: Near addition lenses may actually decrease the degree of retinal defocus for myopic children who have large lag. Accommodative lead to a +3.0D lens defocus to a near target (33cm) may be associated with proximal accommodation. Commercial Relationships: Jinhua Bao, None; Zhili Zheng, None; Hao Chen, None Program Number: 4259 Poster Board Number: B0296 Presentation Time: 8:30 AM - 10:15 AM Tonic Accommodation Correlates with Accommodative Amplitude-Scaled Facility Test for Symptomatic Graduate Students Chunming Liu1, Chris Chase1, Stefanie A. Drew3, Efrain Castellanos1, Amy Escobar1, Eric Borsting2, Lawrence R. Stark2. 1 Optometry, Western University of Health Sciences College of Optometry, Pomona, CA; 2Southern California College of Optometry, Fullerton, CA; 3California State University, Northridge, Northridge, CA. Purpose: Among standard clinical measures of binocular function, the accommodative amplitude-scaled facility (AsFac) test is the most sensitive for predicting visual discomfort symptoms. The AsFac test may be a better correlate due to its individual adjustment of the accommodative stimulus (AS) based on amplitude. Another factor that could affect stimulus demand is tonic accommodation (TA). Higher TA could put the accommodation resting state closer to the target demand, effectively reducing the AS. This study examined the relationship between AsFac test and TA in symptomatic and asymptomatic graduate students. Methods: Visual symptoms were assessed by the Convergence Insufficiency Symptom Survey (CISS). Based on the CISS adult cutoff score of 21, the sample was divided into High (N=22) and Low (N=17) symptom groups. Assessment of binocular function was made using standard clinical procedures. TA was recorded for 2 min after 5 min of dark adaptation. From the AsFac test with the plus lens, a TA-corrected AS was calculated based on testing distance, lens power, and TA with the formula: [(100/distance in cm) - lens power - TA]. Results: Among all clinical measures, including accommodative amplitude/facility, and vergence facility (3BI/12BO), only the binocular AsFac test showed a statistically significant correlation with TA (r=0.48, p=0.004). A positive correlation was found in the high symptom group (Y=6.989+2.812*X; R2=0.435; p=0.001), but not in the low symptom group (Y=13.948+0.961*X; R2=0.169; p=0.145) (Fig 1). A similar group effect was also found in the relationship between TA-corrected AS and AsFac. A statistically significant negative correlation only existed in the high symptom group (Y=14.330-1.184*X; R2=0.336; p=0.006), not in the low symptom group (Y=16.496-0.697*X; R2=0.064; p=0.406) (Fig 2). Conclusions: Our results suggest a possible link between AsFac test and the tonic accommodative adaptation state in graduate students with significant visual discomfort. The sensitivity of the test for predicting symptom might rely, at least partly, on this correlation. TA might be utilized as compensatory mechanism for reducing AS demand at near for this population. With lowered demand, subjects would be more efficient at performing a facility test. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Fig 1. Regression plot for TA and AsFac test were assessed by the Convergence Insufficiency Symptom Survey (CISS). The sample was divided into High (N=22) and Low (N=17) symptom groups based on the CISS adult cut-off score of 21. The average AR for each stimulus was compared between groups and correlated with the average TA. Results: Figure 1 shows the High and Low symptom groups had similar AR for targets (F(4,132)=.54, p=.71). Groups also had the same AR while reading (t(32)=.51, p=.61). TA values were the same for both groups (t(37)=.11, p=.91), but the sample averaged a significantly larger TA value (1.89 ± 1.09 D) than previously reported for college students (t(38)=2.14, p=.04). TA was significantly correlated with all AR measures for the High symptom group but not for the Low Symptom group (see Table 1). A linear regression between TA and accommodative error during reading showed that error increased 0.4 D for every 1 D decrease in TA below the text viewing distance of 3 D (Y = 1.5 - 0.4*X, R2 = 0.54, p=.0002). Conclusions: These results suggest TA plays a significant role in the AR of symptomatic graduate students. Those with more TA have better accommodative focus at near work distances. Possible weaknesses in the accommodation system of the symptomatic students may be compensated for by tonic accommodation. Fig 2. Regression plot for TA-corrected AS and AsFac test Commercial Relationships: Chunming Liu, None; Chris Chase, None; Stefanie A. Drew, None; Efrain Castellanos, None; Amy Escobar, None; Eric Borsting, None; Lawrence R. Stark, None Support: NIH Grant EY021021 Program Number: 4260 Poster Board Number: B0297 Presentation Time: 8:30 AM - 10:15 AM Larger Tonic Accommodation Correlates with Better Focus at Near for Symptomatic Graduate School Students Chris Chase1, Stefanie A. Drew3, Amy Escobar1, Chunming Liu1, Efrain Castellanos1, Lawrence R. Stark2, Eric Borsting2. 1College of Optometry, Western University of Health Sciences, Pomona, CA; 2 Southern California College of Optometry, Fullerton, CA; 3 California State University, Northridge, Northridge, CA. Purpose: Under stimulus-free conditions, tonic accommodation (TA) adopts a resting posture of about 1.5 D, although studies have shown considerable individual variability. Models developed in the 1980’s suggested that TA contributes little to the closed-loop accommodation response (AR), but empirical research on this issue has been sparse. This study examines the relationship between TA and AR in symptomatic and asymptomatic graduate students. Methods: Students from Western University of Health Sciences completed three tasks using an open-field WAM-5500 infrared autorefractor under monocular viewing conditions. First, continuous 2-min recordings were made to assess AR at 0, 2, 3, 4, and 5 D. Second, after 5-min of dark adaptation, TA was recorded for 2-min. Third, continuous recordings were made while reading 20/50 text for 10-min at 3 D. Participants were screened for normal visual acuity, no significant ocular pathology, no strabismus, normal stereopsis, and no significant uncorrected refractive error. Near-work symptoms Figure 1. Accommodation S-R Functions for High and Low symptomatic groups. Commercial Relationships: Chris Chase, None; Stefanie A. Drew, None; Amy Escobar, None; Chunming Liu, None; Efrain Castellanos, None; Lawrence R. Stark, None; Eric Borsting, None Support: EY021021 Clinical Trial: NCT01329848 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Program Number: 4261 Poster Board Number: B0298 Presentation Time: 8:30 AM - 10:15 AM The Dynamic Accommodative Response with the Binocular openfield autorefractor and a Movable Real Target Shinji Arai1, Hiroshi Uozato1, 2, Masakazu Hirota1. 1Department of Visual Science, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; 2Department Orthoptics and Visual Sciences, Kitasato University School of Allied Health Science, Kanagawa, Japan. Purpose: To evaluate the dynamic characteristic of accommodation in the open field and real target using new device WMT-1 Methods: Fourteen volunteers (6 men and 8 women; mean ± standard deviation age, 23.9 ± 4.0 years; range, 19 to 33 years) participated in our study. All subject had a visual acuity 20/20 or better and normal ocular health. Each subject’s accommodative response was measured by target moving system WMT-1 (Grand Seiko Co., Ltd, Hiroshima, Japan) dynamically. The WMT-1 is a new device that is connected to the WAM-5500 open-field autorefractor. It can move a target optionally from 0.2 to 1.0 meter and measure refraction every 0.2 second. We made shape of the cross as a visual target, displayed it in iPad (Apple Inc., Cupertino, CA). We evaluated three difference movements that had been programmed on the WMT-1. First, the constant diopter triangle drive. Second, constant velocity triangle drive. Third, diopter sin drive. We measured dynamically accommodative response in visual target distance from 1.0 meter to 0.2 meter. We compared maximum quantity of accommodative response and among three movements. Results: The maximum quantity of accommodative response of Diopter Sin Drive became larger than Constant Velocity Triangle Drive (p < 0.05, Scheffe test). However, statistical significantly difference was not found to other comparison. Accommodative response related to movement of visual target. Conclusions: We could measure dynamic characteristic of accommodation in the open field and real target using the WMT-1. The accommodation is evaluated at a definite point conventionally. The WMT-1 is useful to evaluate the dynamic characteristic of accommodation, because it can measure not only maximum quantity of accommodative response but also process of accommodative response. Commercial Relationships: Shinji Arai, None; Hiroshi Uozato, None; Masakazu Hirota, None Program Number: 4262 Poster Board Number: B0299 Presentation Time: 8:30 AM - 10:15 AM Suppression in the accommodative response to short-duration changes in dioptric stimulus Alistair P. Curd, Karen M. Hampson, Edward Mallen. Bradford School of Optometry and Vision Science, University of Bradford, Bradford, United Kingdom. Purpose: To investigate whether suppression of the accommodation response (AR) would be observed when a dioptric stimulus performed a step-change, followed by an inverted step-change within the latency time for AR. Results would be relevant to models of accommodation and nearwork. Methods: A monocular adaptive optics apparatus displayed a target to participants, and accommodation was recorded using a ShackHartmann wavefront sensor. A deformable mirror rapidly changed the dioptric stimulus provided by the target. The baseline vergence of the target was −2D at the eye. An initial step-change in the stimulus was followed by a second, inverted step, before the stimulus returned to the baseline. Initial steps were of 1D or 2D in either direction; intervals between the steps ranged from 0.05s to 0.5s. The stimulus settings were randomised in order. The six participants (aged 21-26) observed every stimulus condition five times, through their dominant eye. A Badal optometer arrangement was used to eliminate a size cue and audible cues from the system were masked with auditory input through headphones. Timings of the first change in the stimulus were randomised. Results: Whether accommodation was responding to the first or second change in the stimulus affected the peak AR (p<0.05 with ttests, correcting for multiple comparisons). For 0.2s intervals between the changes in stimulus, accommodation and disaccommodation responses were suppressed when responding to the first step change, relative to the second (p<0.05). These mean decreases in the peak AR were 0.13D, 0.18D and 0.10D for 2D disaccommodative (DS) and 1D and 2D accommodative stimuli (AS), relative to the baseline (from peaks of 0.31D, 0.45D and 0.37D, respectively). 1D DS from the baseline required a longer interval between steps (0.25s) to elicit a response than did 2D DS, 1D AS and 2D AS. Changes in stimulus with intervals between 0.4s and 0.5s also significantly affected AR (p<0.05). Conclusions: The accommodation system responds to changes that occur and are subsequently inverted well within its latency period.The response to the initial change in stimulus can be suppressed by a second change well within the latency. Changes in stimulus during onset may also affect the AR. During the latency, information from 200ms from the first change in stimulus, onwards, is used to determine the AR. Information prior to this is used, but less influential. Commercial Relationships: Alistair P. Curd, None; Karen M. Hampson, None; Edward Mallen, None Support: EPSRC grants EP/D036550/1 and EP/G015473/1 Program Number: 4263 Poster Board Number: B0300 Presentation Time: 8:30 AM - 10:15 AM Accommodation induced variations of ocular axial length and retinal thickness measured with SD-OCT Chuanqing Zhou, Shanhui Fan, Zhe Chen, Xinyu Chai. Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. Purpose: To measure and analyze the variations of the ocular axial length and retinal thickness during ocular accommodation by spectral domain optical coherence tomography (SD-OCT). Methods: A custom-built dual channel SD-OCT was developed for measurement of the ocular axial length and retinal imaging. The scans were performed by the same experienced operator. All eyes were studied in the relaxed and 5D accommodated states. During the imaging, the subjects were asked to fixate on a Maltsecross visual target and to see it clearly. The thickness between ILM and RPE and ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics its change caused by accommodation was calculated based on the acquired image. Results: Repeated measurements were taken in each accommodative state. Compared with relaxed state (0D), the mean thickness variation around the central fovea was 7.4957±8.3616 μm at 5D accommodation. In further study, we will collect more data to analyze the variations of axial length and retinal thickness. Conclusions: Preliminary result showed that the thickness between ILM and RPE in macular has a slight change during accommodation. Commercial Relationships: Chuanqing Zhou, None; Shanhui Fan, None; Zhe Chen, None; Xinyu Chai, None Support: the National Basic Research Program of China (2011CB707504), National Natural Science Foundation of China (81171377) Program Number: 4264 Poster Board Number: B0301 Presentation Time: 8:30 AM - 10:15 AM The Effect Of Age On The Lens Ultrastructure During Accommodation As Measured Using Slit Lamp Photos And Wave Front Analysis Rebecca K. Zoltoski1, Elizabeth Wyles1, Jennifer S. Harthan1, Jer R. Kuszak2. 1Illinois College of Optometry, Chicago, IL; 2LensAR, Orlando, FL. Purpose: During dynamic focusing, the shape, as well as the ultrastructure of the lens is changed. We have hypothesized that unique structural features and organization of fiber cells enables them to interface at the sutures resulting in a change in surface curvature of the lens, as well as an increase in thickness, allowing near focus to occur. We are reporting extended data on lens slit lamp photos, OCT of lens thickness changes, and sequential ray tracing analysis of the patterns associated with the lens sutures to provide additional insight into the importance of the ultra-structure of the lens in the accommodative process. Methods: OCT (Visante™), wavefront analysis (iTrace™), and slit lamp photos (Haag Streit, 16X magnification, dilated eye) were collected on the right eye of normal subjects, between the ages of 7 63 (n=30). Accommodation was stimulated using minus lenses in front of the viewing eye in 2.5 D increments until the subject could no longer clearly view the target. For the photos a prism system was used to keep the eye appropriately oriented. The objective accommodative response was calculated as the change from a distance measurement refractive value. ImageJ (NIH) was used to analyze the area of the sutural components. Data were analyzed using Systat v11 to correlate accommodative response (AR) with total HOA, SA and the foil patterns, as well as changes in slit lamp suture areas. Spearman Rank Correlation coefficients and p values are presented. Results: Lens thickness increases by 0.13 ± 0.05 μm/D during accommodation. The total foil aberration pattern was correlated with AR (r2=0.5, p=0.04). There was a decrease in suture band thickness that correlated with the AR (r2=-0.5, p<0.001). Conclusions: Regardless of age, increase in accommodative response results in changes in the ultra-structure of the lens, as evidenced by the decrease in area of the dark central region of the suture and in the total foil patterns. Further analysis of these changes will provide further insight into the anatomical basis of accommodation. Commercial Relationships: Rebecca K. Zoltoski, None; Elizabeth Wyles, None; Jennifer S. Harthan, None; Jer R. Kuszak, LensAR, Inc. (C) Support: NIH Grant EY021015-01 and ICO RRC Program Number: 4265 Poster Board Number: B0302 Presentation Time: 8:30 AM - 10:15 AM Do Higher Order Aberrations Affect the Magnitude of Odd-error Temporal Stimuli to Accommodation? Sangeetha Metlapally1, Jianliang Tong2, Humza J. Tahir3, 1, Clifton M. Schor1. 1School of Optometry, University of California at Berkeley, Berkeley, CA; 2Brain Trauma Foundation, New York, NY; 3 University of Manchester, Manchester, United Kingdom. Purpose: Fincham proposed that microfluctuations of accommodation produced a temporal hunting cycle for detecting the direction to accommodation (odd-error signal) for steps upto 2.5 D (upper defocus limit). This notion assumes that accommodation is performing contrast discrimination that is affected by spatial frequency (SF), the magnitude of defocus (Green & Campbell, 1965) and higher order aberrations (HOAs), which influence retinal image quality. This study computes the impact of HOAs on signal strength produced by microfluctuations (Weber fraction) for responding to accommodative stimuli within the upper defocus limit. Methods: We presented step-stimuli (1-3 D) for accommodation and disaccommodation, at baseline accommodation of 3 D. The stimulus was a maltese spoke. Wavefront aberrations were measured using a Shack-Hartmann wavefront sensor using a 4 mm artificial pupil. The direction of initial responses was noted and d-prime (d’) analysis used to evaluate the detectability of the correct direction to accommodate. We defined the upper defocus limit for each subject where d’ was 1. The Modulation Transfer Function was derived from Point Spread Functions computed from the wavefronts for 1 D and 2.5 D step-stimuli, at 2 and 4 cycles per degree (cpd), with and without HOAs. Microfluctuations were estimated from the standard deviation of the wavefronts at baseline. Weber fractions were derived from retinal image contrast changes due to microfluctuations. Results: As step defocus increased, accommodation only had medium (4 cpd) and low (2 cpd) SF available to discriminate contrast changes produced by microfluctuations. At 4 cpd, the Weber fraction is higher but the overall contrast is low, and vice versa at 2 cpd. HOAs generally reduced contrast changes from microfluctuations, and to a greater extent at higher SF or defocus. Conclusions: Empirical measures demonstrated that microfluctuations of accommodation are potentially useful for defocus values less than 2.5 D, where Weber fractions at 2 cpd and 4 cpd exceed detection thresholds. HOAs perhaps serve to marginally diminish the effectiveness of microfluctuations in odd-error signal detection under these conditions. Commercial Relationships: Sangeetha Metlapally, None; Jianliang Tong, None; Humza J. Tahir, None; Clifton M. Schor, None Support: NIH EY017678 to CMS and NEI K12EY017269 to SM (BCSDP) Program Number: 4266 Poster Board Number: B0303 Presentation Time: 8:30 AM - 10:15 AM Impact of pupil amplitude apodization on through-focus image quality with spherical aberration Hae Won Jung1, 2, Len Zheleznyak1, 2, Geunyoung Yoon2, 1. 1The Institute of Optics, University of Rochester, Rochester, NY; 2Flaum Eye Institute, University of Rochester, Rochester, NY. Purpose: It has long been known that the Stiles-Crawford effect, the intrinsic pupil amplitude apodization of the eye, is effective for enhancing retinal image quality. The goal of this study was to investigate the impact on through-focus image quality (TFIQ) of manipulating the pupil amplitude apodization function in combination with multifocal presbyopic corrections with spherical aberration (SA). Methods: TFIQ with SA was evaluated by optical bench testing and visual performance measurements in monochromatic light (550nm). ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics The optical bench system consisted of a model eye with phase-plate induced SA, a liquid crystal spatial light modulator to control pupil apodization, and a camera for imaging a tumbling E letter chart. TFIQ was quantified by calculating the correlation coefficient between a reference image (without SA and apodization) and captured through-focus images (0 to 2.5D with 0.1D step). Pupil apodization was modeled as a Gaussian function with various sigma values (0.5 to 2.0mm). Through-focus visual acuity was measured in 2 cyclopleged subjects at distance, intermediate and near object distances (0, 1 and 2D). Both optical bench testing and visual performance were carried out with ±0.2µm SA over a 4mm artificial pupil. Results: Introducing Gaussian apodization improved distance image quality, regardless of sign of SA, by 7-12% for sigma ranging from 0.5 to 2.0mm. At intermediate (1D) image quality, the negative SA case had a larger improvement (9-18%) than the positive SA case (711%) for sigma ranging 0.5 to 2.0mm. For near (2D), the improvement with negative SA was even larger (14-33%) while positive SA showed no improvement. Visual benefits with apodization were also found. Pupil apodization with sigma=0.5 led to a 1.0, 2.6 and 4.5 line improvement in visual acuity at 0, 1 and 2D, respectively, in the presence of negative SA. For positive SA, visual acuity improved by 1.0, 1.8 and 0.1 lines, respectively. Conclusions: Pupil amplitude apodization led to a significant improvement in through-focus image quality, especially with negative SA. This finding suggests that halos and glare induced by multifocal presbyopic corrections can be reduced with appropriate pupil amplitude apodization. Commercial Relationships: Hae Won Jung, None; Len Zheleznyak, None; Geunyoung Yoon, Bausch & Lomb (F), Johnson & Johnson (F), Allergan (C), Staar Surgical (C), CIBA Vision (F), Acufocus (C) Support: NIH Grant EY014999, Unrestricted Grant from Research to Prevent Blindness, NYSTAR/CEIS, Bausch & Lomb Program Number: 4267 Poster Board Number: B0304 Presentation Time: 8:30 AM - 10:15 AM Contribution of shape and gradient index to the spherical aberration of donor human lenses Judith Birkenfeld, Alberto de Castro, Susana Marcos. CSIC-Instituto de Optica, Madrid, Spain. Purpose: The relative contribution of crystalline lens geometry and gradient index (GRIN) to its spherical aberration (SA) and its agerelated changes is unknown. We investigated these relationship using Optical Coherence Tomography (OCT) and Laser Ray Tracing (LRT). Methods: 11 ex vivo human lenses (22-71 years) from an eye bank were imaged in 3D with a custom OCT to obtain optical path differences. The shape of the lens surfaces was extracted from the images using surface segmentation and Zernike polynomial fitting. The lens power was measured using LRT for 2 and 4-mm pupil diameters. The 3D GRIN was estimated by means of an optimization method based on genetic algorithms (de Castro et al. OE 2010), which searched for the parameters of a 4-variable GRIN model that best fits the distorted posterior lens surface of the lens in 18 different meridians. The SA of the lenses was estimated by computational ray tracing, assuming both a homogeneous index and the estimated GRIN. Results: Geometrical data of all lenses were reconstructed using 3D OCT images. Anterior radius of curvature and asphericity varied widely across lenses (6.1 to 11.3 mm, and -9.9 to 5.6, respectively), and were rather constant for the posterior surface (mean: 5 mm and 0.3, respectively). Lens power ranged from 34D (younger lens) to 24D (older lens). In 10/11 lens power decreased with pupil diameter, revealing a negative spherical aberration. Lens thickness (ranging from 3.8 to 5.2 mm) increased and mean group refractive index (ranging from 1.392 to 1.407) decreased slightly with age. The reconstructed GRIN showed surface refractive index values between 1.368 and 1.376, nucleus refractive index values between 1.403 and 1.415, and an exponential decay value ranging from 1.8 to 3.4 (axial) and from 1.9 to 5.8 (meridional). The estimated SA (from lens geometry and index) ranged from -0.8 to 0.3 µm for the equivalent refractive index, and from -2.1 to -0.3 µm for the estimated GRIN. SA shifted with age towards less negative values (slope=0.028 µm/yr and 0.022 µm/yr assuming equivalent index or GRIN, respectively). Conclusions: 3D OCT data and experimental power data of human donor lenses of different ages allowed reconstruction of the lens GRIN and evaluation of external geometry and GRIN contribution to the lens spherical aberration. GRIN shifted the SA towards negative values in all cases and played a role in the age-related shift of SA. Commercial Relationships: Judith Birkenfeld, None; Alberto de Castro, None; Susana Marcos, Essilor (F), PCT/ES2012/070185 (P) Support: FIS2008-02065, FIS2011-25637 (Spanish Government) and ERC 2011 Advanced Grant 294099 (European Research Council) to SM, CSIC JAE Program Fellowship to JB. Program Number: 4268 Poster Board Number: B0305 Presentation Time: 8:30 AM - 10:15 AM Crystalline lens thickness determines transverse chromatic aberration Yun Chen, Frank Schaeffel. Section of neurobiology of the Eye, Institute for Ophthalmic Research, Tuebingen, Germany. Purpose: To describe the magnitude and variability of transverse chromatic aberration (TCA) in the human eye, and to identify the ocular parameters that might determine its magnitude. Methods: Two different psychophysical procedures were used to quantify TCA. First, a red and a blue square, presented on a black screen, had to be matched in size by the subjects with their right eyes, using the arrow keys on keyboard. Second, two filled red or blue squares, flickering on top of each other at 2 Hz, had to be adjusted in brightness and in size to minimize the perceived flicker by subjects. Biometric ocular parameters in the right eyes were measured with a commercially available low coherence interferometer, the Lenstar LS 900 (Haag Streit, Switzerland). Corneal power, thickness, anterior chamber depth, lens thickness, vitreous chamber depth and axial length were correlated to psychophysical date. Sixteen subjects with no ocular pathologies other than refractive errors, with ages ranging from 22 to 58 years, participated in the study. Results: TCA varied widely among subjects, as was evident from the perceived differences between the red and the blue square which ranged from 0 to 3.2%. The two different psychophysical procedures to measure TCA provided highly correlated results, suggesting that no major confounders existed. The measurements of TCA were affected neither by changes in brightness of the blue or red nor by individual refractive errors. Comparing to optical parameters in the subjects’ eyes, only lens thickness was significantly correlated to TCA (p<0.01). However, since lens thickness and the gradient index structure in the lens both change with age, inter-individual differences in TCA could just be due to differences in age. Conclusions: The high inter-individual variability in TCA is largely determined by lens thickness. Since age is the major factor determining lens thickness, TCA increases inevitably with age. Commercial Relationships: Yun Chen, None; Frank Schaeffel, None Program Number: 4269 Poster Board Number: B0306 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Presentation Time: 8:30 AM - 10:15 AM Prediction of human crystalline lens power and spherical aberration using an anatomically-based discrete shell model Fabrice Manns1, 2, Arthur Ho3, 4, Jean-Marie A. Parel1, 5. 1 Ophthalmic Biophysics Center, Bascom Palmer Eye Inst, Univ of Miami, Miami, FL; 2Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL; 3 Brien Holden Vision Institute, Sydney, NSW, Australia; 4School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; 5Vision Cooperative Research Centre, Sydney, NSW, Australia. Purpose: To develop an anatomically-correct aspheric discrete model of the human crystalline lens that predicts power and spherical aberration and the contribution of the refractive index gradient. Methods: A continuous and a discrete model of a 30 year old relaxed human lens were developed. The shape was modeled using data from Dubbelman et al (Vis Res, 2001): Ant Radius=11.10mm; Ant Asphericity=-3.05; Post Radius = -5.82mm; Post Asphericity=-0.795; Thickness=3.69mm. In the continuous model, the refractive index gradient is represented as a set of aspheric iso-indicial surfaces with radius of curvature R(z) and asphericity Q(z) that vary linearly from the lens equator to the value at the surface. The axial refractive index follows a power-dependence in each half of the lens (Kasthurirangan et al, IOVS 2008): n(z)=1.41-0.032×(z/t)4, where t is the anterior or posterior half-thickness and z is the distance, both measured from the equator. The discrete shell model was created by sampling isoindicial surfaces of the continuous model at regularly spaced intervals. The ith shell of a model with K shells has thickness tK=tlens/K, is located at position zi = i*tK, radius Ri=R(zi), asphericity Qi=Q(zi), and is surrounded by refractive indices ni-1=n(zi-1) and ni=n(zi). The number of shells ranged from K=6 to K=3000. The contribution of each surface to lens power and Seidel primary spherical aberration was calculated from a paraxial ray trace. The contributions were plotted as a function of axial position and summed to provide the Seidel wavefront aberration coefficient W040, and total power contribution Psum. The power Psum was compared to the effective power Peff. Results: The spherical aberration coefficient and lens power converge as the number of shell increases. The asymptotic values were W040=0.053mm-3, Psum=22.2D, and Peff=22.3D. For lens power, the number of shells required to reach 90%, 95% and 99% of the asymptote are 20, 40, and 200. For spherical aberration the values are 160, 320, and approx. 1000. The contributions of the anterior and posterior halves of the lens were -0.015mm-3 and 0.068mm-3. Conclusions: The power and spherical aberration of the crystalline lens can be predicted using a discrete model with tightly packed shells.The discrete model allows calculation of contributions of specific regions of the lens to total spherical aberration from a paraxial ray trace. Commercial Relationships: Fabrice Manns, None; Arthur Ho, None; Jean-Marie A. Parel, CROMA (F), InnFocus (F), Abeamed (F), University of Miami (P) Support: NIH Grants R01EY14225, R01EY021834, and Center Grant P30EY14801; Australian Government CRC Scheme (Vision CRC); Florida Lions Eye Bank; an unrestricted grant from Research to Prevent Blindness; Henri and Flore Lesieur Foundation (JMP). Program Number: 4270 Poster Board Number: B0307 Presentation Time: 8:30 AM - 10:15 AM Age-related Stiffening of Human Lens Measured by In Vivo Brillouin Microscopy Sebastien Besner1, 2, Giuliano Scarcelli1, 2, Roberto Pineda3, Seok H. Yun1, 2. 1Department of Dermatology, Harvard Medical School, Boston, MA; 2Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA. Purpose: The loss of accommodation power with age is thought to be related to the increase of the stiffness of the crystalline lens. More recently, evidences have shown that the change in the stiffness gradient may also play a dominant role in accommodation amplitude. In order to investigate the contribution of lens sclerosis to loss of accommodation with age, we present a novel optical, non-contact and non-destructive method based on Brillouin scattering, which measures the local elastic modulus of the crystalline lens in vivo with micron size resolution. Methods: Brillouin confocal microscopy was performed on 5 dilated eyes (2.5% phenylephrine and 0.5% tropicamide) of 5 patients with an age range of 23 to 47 years. The Brillouin spectral shift, which is proportional to the longitudinal modulus of elasticity, was acquired along the optical axis of the crystalline lens with an axial resolution of about 60 microns and a lateral resolution of less than 10 microns. Ongoing study will include 10 eyes from 10 patients with age ranging between 20 and 60 years. Results: At all ages, the elastic modulus was found to increase from the lens cortex to the nucleus with a general steeper increase in the posterior part of the lens. The overall lens stiffness was found to increase with age (p<0.05). This is mainly due to the growth of the stiffer nucleus portion of the lens (R=0.91) and by the increase of the stiffness gradient from the cortex to the nucleus (R=0.65). Maximum elastic modulus (in the nucleus) and minimal elastic modulus (in the cortex) revealed no statistically significant age dependency. Conclusions: Elastic modulus of the human crystalline lens was measured for the first time in vivo by using confocal Brillouin microscopy. For the age range of 23 to 47 years old, we found that the lens nucleus was stiffer than the lens cortex. We also observed a statistically significant increase of the stiffness of the lens with age. However, the observed age-related stiffening was not due to an increase of peak modulus with age, but rather to a variation of the spatial distribution of the elastic modulus inside the aging lens, where both nucleus thickness and stiffness gradient might play a role. Total stiffness variation with age of the human crystalline lens along the optical axis. Error bars represent the sum of elastic modulus determination by Brillouin scattering and positioning errors. Commercial Relationships: Sebastien Besner, None; Giuliano Scarcelli, massachusetts general hospital (P); Roberto Pineda, Amgen (C), Angiotech (C); Seok H. Yun, Massachusetts General Hospital (P) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Support: NIH grant P41-EB015903, NSF grant CBET-0853773 , Harvard Clinical and Translational Science Center (NIH UL1RR025758), American Society for Laser Medicine and Surgery Program Number: 4271 Poster Board Number: B0308 Presentation Time: 8:30 AM - 10:15 AM Effect of Temperature on Lens Power, Anterior and Posterior Surface Lens Curvatures and Force during Simulated Accommodation in Cynomolgus Monkeys Jean-Marie A. Parel1, 3, Bianca M. Maceo1, 2, Cornelis J. Rowaan1, Fabrice Manns1, 2, Esdras Arrieta1. 1Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Univ. of Miami Miller School of Medicine, Miami, FL; 2Biomedical Optics and Laser Laboratory, Dept of Biomedical Engineering, College of Engineering, University of Miami, Miami, FL; 3Vision Cooperative Research Centre, Sydney, NSW, Australia. Purpose: To determine whether temperature has an effect on the accommodative response of primate lenses during simulated accommodation in a lens stretcher. Methods: Lens shape was measured during ex vivo simulated accommodation on 4 cynomolgus monkey (4.5-6.9 years) lenses from 4 donors (PMT 9.5+/-11 hours). Tissue samples were mounted in the EVASII lens stretching system (Ehrmann et al, Clin Exp Opt, 2008) and stretched in a step-wise fashion (0.25mm/step up to 2.5mm radially). In EVAS II, the tissue is immersed in preservation medium (DMEM) throughout the experiment. A temperature controller with thermocouple feedback was used to control the temperature of the medium. For each lens, a stretching experiment was first performed at 24°C (room temperature). At the end of the experiment, the temperature of the medium was increased to 35°C (ocular temperature). A second stretching experiment was then performed. The power, anterior and posterior curvatures, and thickness of the lens, and the force exerted to stretch the lens were measured at each step at both temperatures. The change in lens power, thickness, radius and the maximum force produced at the two temperatures were compared. Results: At 25°C, the average+/-SD of the change was 19.5+/-2.1D for lens power, 0.58+/-0.09mm for lens thickness, -2.54+/-0.74 for lens anterior radius; -0.94+/-0.12mm for lens posterior radius. The maximum force was 1.50+/-0.22g. At 35°C, the average+/-SD of the change was 18.1+/-2.7D for lens power, 0.57+/-0.09mm for lens thickness, -2.46+/-0.86mm for lens anterior radius; -0.91+/-0.29mm for lens posterior radius. The maximum force was 1.30+/-0.26g. Conclusions: Within the range of temperatures tested in this study (25-35°C), temperature does not have significant effect on the changes in lens shape, power and force during simulated accommodation in a lens stretcher. Commercial Relationships: Jean-Marie A. Parel, CROMA (F), InnFocus (F), Abeamed (F), University of Miami (P); Bianca M. Maceo, None; Cornelis J. Rowaan, None; Fabrice Manns, None; Esdras Arrieta, None Support: NIH Grant R01EY14225, R01EY021834, F31EY021444 (NRSA Individual Predoctoral Fellowship [BM]), and Center Grant P30EY14801; Australian Government CRC Scheme (Vision CRC); FloridaLions Eye Bank; an unrestricted grant from Research to Prevent Blindness; Henri and Flore LesieurFoundation (JMP) Program Number: 4272 Poster Board Number: B0309 Presentation Time: 8:30 AM - 10:15 AM Lens Spherical Aberration Changes in Cynomolgus Monkeys during Simulated Accommodation in a Lens Stretcher Bianca M. Maceo1, 2, Fabrice Manns1, 2, Alberto de Castro3, Stephen Uhlhorn1, Esdras Arrieta1, Susana Marcos3, Jean-Marie A. Parel1, 4. 1 Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Miami, FL; 2Biomedical Optics and Laser Laboratory, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL; 3Instituto de Óptica, Consejo Superior de Investigaciones Científicas, Madrid, Spain; 4Vision Cooperative Research Centre, Sydney, NSW, Australia. Purpose: To quantify the difference in spherical aberration (SA) of cynomolgus monkey lenses in the accommodated and unaccommodated state. Methods: A Laser Ray Tracing system (LRT) was used to obtain SA measurements on 2 cynomolgus monkey lenses from 2 donors (4.5 and 6.9 years, PMT= 4 and 26 hours). The tissue was mounted in a chamber filled with Dulbecco's Modified Eagle Medium inside a lens stretcher (Ehrmann et al, Clin Exp Opt, 2008). The lens spherical aberration was measured in the unstretched (accommodated) and stretched (relaxed) state. The LRT delivered 51 equally-spaced parallel rays along the vertical meridian of the lens over a total length of 6mm. A camera mounted on a vertical position stage was placed under the chamber containing the lens to sequentially record the spot corresponding to each individual ray. Spot images were measured at up 12 camera positions along the optical axis covering a range of up to 22mm. The images were processed to determine the centroid of each spot and calculate the corresponding ray height at each camera position. For each camera position, the measured ray heights were plotted as a function of entrance ray height and fit with a 3rd order polynomial: y = A*x + B*x3. The A and B coefficients were then plotted as a function of camera position and a linear fit was performed. The effective focal length and Seidel spherical aberration coefficient were extracted from the fits. A ray-trace analysis showed that the posterior window of the chamber contributes less than 1% error to the SA coefficient. Therefore the contribution of the window to spherical aberration was not corrected for. Results: The results for the two lenses are summarized in the table below: Conclusions: Spherical aberration in cynomolgus monkey lenses increases in absolute value with accommodation, as found in human and rhesus monkeys. Commercial Relationships: Bianca M. Maceo, None; Fabrice Manns, None; Alberto de Castro, None; Stephen Uhlhorn, None; Esdras Arrieta, None; Susana Marcos, Essilor (F), PCT/ES2012/070185 (P); Jean-Marie A. Parel, CROMA (F), InnFocus (F), Abeamed (F), University of Miami (P) Support: NIH Grant R01EY14225, R01EY021834, F31EY021444 (NRSA Individual Predoctoral Fellowship [BM]), and Center Grant P30EY14801; Australian Government CRC Scheme (Vision CRC); Florida Lions Eye Bank; an unrestricted grant from Research to Prevent Blindness; Henri and Flore Lesieur Foundation (JMP), Spanish Government FIS2011-25637, European Research Council ERC-2011-AdG-294099; CSIC I3P Program. Program Number: 4273 Poster Board Number: B0310 Presentation Time: 8:30 AM - 10:15 AM Comparison between in vivo and in vitro age-related loss of accommodation in rhesus monkeys Mark Wendt, Adrian Glasser. College of Optometry, University of Houston, Houston, TX. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Purpose: The progressive age related loss of accommodation in rhesus monkeys has been studied in vivo or with in vitro mechanical stretching to simulate disaccommodative changes in enucleated eyes (in vitro accommodation). No prior study had directly compared the two approaches with the same eyes. Here a direct comparison is made between the age-related in vivo loss of accommodation in rhesus monkeys and in vitro mechanical stretching induced disaccommodative changes in the same eyes after enucleation. Methods: Experiments were performed on 10 iridectomized monkeys aged between 10 and 25 years. Accommodation was stimulated with intravenous (i.v.) pilocarpine and refraction measured statically with a Hartinger coincidence refractometer and dynamically with infrared photorefraction. In one subsequent i.v. pilocarpine experiment with each monkey, accommodative changes in lens diameter were measured dynamically. Following euthanasia one eye each from nine of the monkeys was dissected and stretched radially step-wise while measuring changes in lens focal length and diameter to attempt to achieve the largest changes possible. Results: In vivo accommodative amplitudes decreased linearly with age from 12.38 D to 3.38 D (n = 10; r2 = 0.9097; p < 0.0001) and accommodative decrease in lens diameter decreased linearly with age from 0.703 mm to 0.327 mm (n = 9; r2 = 0.8097; p = 0.0009). In vitro accommodative change in lens power decreased linearly with age from 16.9 D to 6.16 D (n = 9; r2 = 0.8805; p = 0.0001) and in vitro accommodative change in lens diameter decreased linearly with age from 1.43 mm to 0.73 mm (n = 9; r2 = 0.62; p < 0.0009). In vitro accommodation with the maximum radial stretch overestimated in vivo accommodation on average by 2.94 ±1.604 D without optical compensation for ocular optical effects. In vitro accommodative changes in lens diameter with the maximum radial stretch overestimated the in vivo accommodative changes in lens diameter by 0.65 ± 0.083 mm. Conclusions: Maximum change in power and diameter that lenses undergo with stretching overestimates the in vivo accommodative changes in optical power and lens diameter. Both in vivo and in vitro accommodation in the same eyes of rhesus monkeys show a similar progressive age-related loss of accommodation. Since in vitro accommodation does not rely on ciliary muscle function, this supports a lenticular basis for presbyopia in rhesus monkeys. Commercial Relationships: Mark Wendt, None; Adrian Glasser, None Support: NEI Core Grant P30 EY007551 to UHCO Program Number: 4274 Poster Board Number: B0311 Presentation Time: 8:30 AM - 10:15 AM Age-related loss of accommodation in rhesus monkeys is associated with an age-related increase in lens stiffness Adrian Glasser, Mark Wendt. College of Optometry, University of Houston, Houston, TX. Purpose: It is generally agreed that presbyopia in humans is caused by an age-related increase in lens stiffness. Rhesus monkeys develop presbyopia with a similar relative age-course as humans and are used as an animal model for human presbyopia, although prior studies have suggested differences in the aetiology of presbyopia between humans and monkeys. Here, the age-related loss of accommodation from in vivo and in vitro experiments is correlated with the stiffness of the same lenses to ascertain the relationship between presbyopia and lens stiffness in rhesus monkeys. Methods: Experiments were performed on 10 iridectomized rhesus monkeys aged between 10 and 25 years. Accommodation was stimulated with intravenous pilocarpine and refraction measured with a Hartinger and infrared photorefraction and accommodative changes in lens diameter measured with slit-lamp videography. After euthanasia, one eye each from nine monkeys was used for mechanical stretching experiments in which changes in lens focal length and lens diameter were measured as a function of the applied radial stretch. Lenses were then isolated and squeezed in six 100 µm steps while measuring the applied force. Results: In vivo accommodative amplitudes decreased linearly with age (r2 = 0.9097; p < 0.001) and accommodative change in lens diameter decreased linearly with age (r2 = 0.8097; p < 0.001). With mechanical stretching the lens power and lens diameter curves for each lens plateaued and the maximum changes in lens power and diameter from all lenses decreased linearly with age (r2 = 0.8805; p < 0.001 and r2 = 0.62; p < 0.001, respectively). Maximum gram force from squeezing lenses increased exponentially with age (f = 0.0408 * 1.1658age p < 0.001). In vivo accommodation, in vivo accommodative change in lens diameter and in vitro change in lens focal length were significantly exponentially related (p < 0.001) to the maximum gram force from squeezing the lenses. Conclusions: In rhesus monkeys accommodation is lost with increasing age, lens stiffness increases exponentially with age, in vitro accommodation is not limited by ciliary muscle function and the magnitudes of in vivo ocular and in vitro lenticular accommodative changes are related to lens stiffness. These results demonstrate that in rhesus monkeys, as in humans, presbyopia is caused by a progressive age-related increase in lens stiffness. Commercial Relationships: Adrian Glasser, None; Mark Wendt, None Support: NEI Core Grant P30 EY007551 to UHCO Program Number: 4275 Poster Board Number: B0312 Presentation Time: 8:30 AM - 10:15 AM Dynamic wavefront measurement of accommodation and pupil area in response to electric stimulation of ciliary nerve in cats Suguru Miyagawa1, 2, Toshifumi Mihashi2, 4, Yoko Hirohara1, 2, Akira Takada1, Takao Endo2, Hiroyuki Kanda2, Tomomitsu Miyoshi3, Takashi Fujikado2. 1Optical Engineering Laboratory, Topcon Corporation, Itabashi-Ku, Japan; 2Dept of Applied Visual Science, Osaka University Graduate School of Medicine, Suita, Japan; 3 Integrative Physiology, Osaka University Graduate School of Medicine, Suita, Japan; 4Innovative Research Initiatives, Tokyo Institute of Technology, Yokohama, Japan. Purpose: To investigate the changes of accommodation and pupil area elicited by electrical stimulation of the ciliary nerve, we analyzed the wavefront aberrations (WAs) and the pupil size with a Shack-Hartmann wavefront aberrometer (SHWA) before, during, and after the stimulation. Methods: Six eyes of six cats were studied under general anesthesia. Trains of monophasic pulse (current, 0.1 to 2.0 mA; duration, 0.5 ms/phase; frequency, 5 to 40 Hz) were applied to either the lateral or medial branch of the short ciliary nerve (Kuchiiwa, 1990). Hookshaped bipolar stimulating electrodes were made of stainless steel with a diameter of 0.3 mm and were hooked onto the short ciliary nerve about 5 mm from the scleral surface. We measured the wavefront aberration for 2 seconds before, 8 seconds during, and for 20 seconds after the electrical stimulation with a compact wavefront aberrometer (Aston University and Topcon Co). The pupillary images were simultaneously photographed during the wavefront measurements. The wavefront aberrations and the pupil images were recorded at 10 Hz. Results: The pupil dilated asymmetrically when one side of the ciliary nerve was stimulated and dilated symmetrically when both sides of the ciliary nerves were stimulated. The pupil was never constricted by any stimulating parameters. Although asymmetrical pupil dilation occurred by unilateral ciliary nerve stimulation, no ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics asymmetrical terms of the WAs were found. The accommodative responses had an implicit time of 2 to 6 sec and an amplitude of 1 to 2 diopters. The implicit times were slower than that in humans (0.4 second, F. W. Campbell, 1960) and the cat’s response to electrical stimulation of the LS area (1.0 second, K. Ohtsuka, 1996). After the stimulation, accommodation decreased slowly to the original state taking >10 sec. The latencies of the accommodative responses were always shorter than the detection limit (<100 ms). Conclusions: The pupillary dilation was asymmetrical to the optical axis following unilateral ciliary nerve stimulation but no asymmetrical aberration change was found. The discrepancy may stem from the fact that the crystalline lens has a viscoelastic property and the asymmetric contraction of ciliary muscle might not cause the optical asymmetry. Commercial Relationships: Suguru Miyagawa, Topcon Corporation (E); Toshifumi Mihashi, Topcon Corp. (F); Yoko Hirohara, Topcon corp. (E); Akira Takada, None; Takao Endo, None; Hiroyuki Kanda, Nidek Co., Ltd. (P); Tomomitsu Miyoshi, None; Takashi Fujikado, Nidek (P) Program Number: 4276 Poster Board Number: B0313 Presentation Time: 8:30 AM - 10:15 AM Macular function contributes to the near vision performance in the patients with monofocal intraocular lens: a functional Multifocal ERG study Xialin Liu, Yao Ni, Chang He, Li Wang, Yizhi Liu. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Purpose: To investigate the relationship between macular function and individual near vision performance in normal pseudophakic eyes with monofocal intraocular lens (IOLs). Methods: In this study, 36 eyes after standard phacoemulsification with foldable monofocal IOLs implantation, and a postoperative uncorrected distance visual acuity of 0.8 or better were enrolled. Best corrected distance of visual acuity (BCVA), uncorrected near visual acuity (UNVA) and distance corrected near visual acuity (DCNA) were assessed. Macular function was measured by the multifocal ERG system (VERIS; Electro-Diagnostic Imaging, Inc., Redwood City, CA), with 103 scaled hexagons. The latencies and amplitude densities were analyzed according to 6 concentric ring averages. Results: All the pseudophakic eyes had a BCVA (logMAR) of 0.00 or better. Typical normal multifocal ERGs were obtained from these eyes. There was a positive correlation between DCNA (logMAR) and latencies of N1 in ring1(r=0.431, p=0.008). Except ring1, the other measures of latencies and average amplitude densities (ring 2-6) from multifocal ERG components were not correlation with DCNA. Additionally, there were no correlations between UNVA (logMAR) and all of the latencies and average amplitude densities. Conclusions: Ring 1 (ranged from 0-1.5°) represented the fovea which was responsible for sharp central vision.The data from the bipolar cell-dominated multifocal ERG revealed slightly functional differences between the enrolled individuals. A positive correlation between DCNA and latencies of N1 in ring1 implied that the more robust status of macular fovea may contribute to better DCNA. Our finding may offer a new perspective to understand the phenomenon of pseudo-accommodation. Commercial Relationships: Xialin Liu, None; Yao Ni, None; Chang He, None; Li Wang, None; Yizhi Liu, None Program Number: 4277 Poster Board Number: B0314 Presentation Time: 8:30 AM - 10:15 AM Changes in Add Power for Near Vision after Laser in Situ Keratomileusis for Presbyopic High Myopia Yukari Tsuneyoshi1, 3, Kazuno Negishi1, Miyuki Yoshida1, Megumi Saiki1, Naoko Kato1, Ikuko Toda2, Kazuo Tsubota1. 1Ophthalmology, Keio University School of medicine, Tokyo, Japan; 2Ophthalmology, Minamiaoyama Eye Clinic, Tokyo, Japan; 3Ophthalmology, Tachikawa Hospital, Tachikawa, Japan. Purpose: To evaluate the changes in the minimal add power to attain the best-corrected near visual acuity (add power) after laser in situ keratomileusis (LASIK) for presbyopic high myopia. Methods: We retrospectively analyzed 53 eyes of 41 patients who were 45 years of age and older and had undergone LASIK for high myopia (-6 diopters [D] and over). The add powers at 30 cm were measured preoperatively and postoperatively. Results: The mean patient age was 50.0 ± 4.1 years (standard deviation [SD]); the mean power corrected by LASIK was -7.69 ± 1.10 D. The preoperative and postoperative add powers were 1.80 ± 0.60 D and 2.18 ± 0.69 D, respectively, which was a significant (P < 0.01) increase of 0.38 ± 0.60 D. In patients under 50 years (n=30), the mean add power increased to 0.51±0.61 D, which is significantly (P < 0.01) greater than in patients 50 years and older (0.21±0.57 D), although the powers corrected by LASIK did not differ significantly between the groups. Conclusions: The add power increases after LASIK performed to treat presbyopic high myopia, especially in patients who are newly presbyopic, probably due to the effect of the vertex distance. Our results confirmed the importance of obtaining informed consent regarding the apparent progression of presbyopia in such patients. Commercial Relationships: Yukari Tsuneyoshi, None; Kazuno Negishi, Oculentis (F); Miyuki Yoshida, None; Megumi Saiki, None; Naoko Kato, None; Ikuko Toda, None; Kazuo Tsubota, AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical (C), Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa (F), Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki (P), Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company (P) Program Number: 4278 Poster Board Number: B0315 Presentation Time: 8:30 AM - 10:15 AM Subsurface Femto-Laser Photodisruption in the Sclera for the Creation of Presbyopic Implant Tunnels Aghapi mordovanakis1, 2, Larry Baitch3. 1Biomedical Engineering, University of Michigan, Ann Arbor, MI; 2Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, MI; 3Research, Refocus Group, Dallas, TX. Purpose: The PresVIEWTM procedure (Refocus Group, Dallas, TX) is a surgical ophthalmic procedure for the improvement of near visual acuity in presbyopes. In that procedure, a precision bladed device, scleratome, dissects the scleral tissue at a plane 400μm below the surface of the perilimbal sclera, resulting in a tunnel into which each of four PresVIEWTM Scleral Implants (PSI) are implanted per eye. Our studies seek to determine the feasibility of using laser sources similar to those used in currently-approved refractive femtolaser platforms, for development of a laser-based method for the creation of precise and predictable PSI tunnels. Methods: Scleral tissue is highly scattering for the near-infrared (NIR) wavelengths (1030-1065nm) employed by femtosecond refractive lasers. Our approach was to focus femtosecond laser pulses below the surface of porcine scleral sections to induce precise disruption about the laser focal plane. We created tunnels by rasterscanning the focused laser beam while translating the tissue along the tunnel length. We investigated the ablation efficacy at various depths (down to 400μm) under different laser parameters (shot pattern, pulse energy and repetition rate, lens numerical aperture). After laser exposure, scleral tissue samples were subjected to: 1) histological assessment to quantify uniformity of tunnel depth and collateral ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics damage to cells; 2) optical microscopy of the scleral tissue, cleared with a 40% glucose solution after laser irradiation; and 3) mechanical instrument probing to simulate the insertion of PSI implants. Results: Optical microscopy of cleared sclera showed explicit subsurface disruption when irradiated with microjoule-energy pulses at 1030nm wavelength. The efficacy of tissue separation was demonstrated by inserting a 1mm-wide blunt probe along tunnels of 3-4mm length. Histological assessment continued to show improvement in accuracy and consistency of the ablated tissue plane as the irradiation parameters were refined. Conclusions: Given the challenges that scleral tissue presents as an optical medium, our preliminary parametric trials of scleral subsurface femtosecond laser ablation on ex-vivo porcine are encouraging. These early results suggest that currently available refractive femtolaser platforms might be adapted for the creation of PSI tunnels. In-vivo animal experiments are necessary to assess the clinical viability of the procedure. Commercial Relationships: Aghapi mordovanakis, Refocus Group (F); Larry Baitch, Refocus Group (E) Support: Support from Refocus Group (Dallas, TX) Program Number: 4279 Poster Board Number: B0316 Presentation Time: 8:30 AM - 10:15 AM Electro-optic lens for correction of presbyopia Guoqiang Li, Thomas F. Mauger. Depts of Ophthal and Vis Sci and ECE, Ohio State University, Columbus, OH. Purpose: A large population on the planet needs correction of near vision with aging. To overcome the disadvantages of the existing eyeglasses for correction of presbyopia based on area division, it is very attractive to develop tunable electro-optic lens with high imaging quality and large aperture. In this technique, the power can be continuously adjusted by a small voltage across the whole aperture. Methods: By incorporating nanotechnology and cost-effective microfabrication technology, we have designed and fabricated tunable liquid crystal lenses with large aperture and large tunable range needed for correction of presbyopia. To our knowledge, this is the first demonstration of such a powerful device. The nanoparticles doped in the liquid crystals provide excellent alignment of the liquid crystals and this property eliminates the alignment layer on the surface of the microsturctured element. Results: We have designed and fabricated a tunable liquid crystal lens with large aperture (over 20 mm), large tunable range (over 3 diopters) and low driving voltage. The lens shows high optical quality. These lenses have been used to build the prototypes of adaptive spectacles and visual simulator. Vision test results will be shown. Conclusions: The electro-optic tunable lenses with large aperture and large tunable range are promising for vision correction and vision assessment. Model eye imaging. Left, adaptive lens off; right, adaptive lens on. Commercial Relationships: Guoqiang Li, The Ohio State University (E); Thomas F. Mauger, None Support: NIH/NEI grant R01 EY020641 Program Number: 4280 Poster Board Number: B0317 Presentation Time: 8:30 AM - 10:15 AM Tolerance to astigmatism with a small aperture corneal inlay Abhiram S. Vilupuru1, Juan Tabernero2, Pablo Artal2. 1R&D, AcuFocus, Inc, Irvine, CA; 2Universidad de Murcia, Murcia, Spain. Purpose: Small aperture corneal inlays are used to extend depth of focus in presbyopic patients. Visual outcomes depend on residual refractive error. While the impact of defocus was already studied (Tabernero & Artal, JCRS, 2011), we expanded their study to investigate how much uncorrected astigmatism can be tolerated with a small aperture corneal inlay. Methods: We developed 20 computational eye models using data from corneal topography, ocular axial lengths and wavefront aberrations taken in 20 healthy presbyopic subjects (mean age 59 years, standard deviation 7 years). The axial length was adjusted to render all eyes to be at best focus (emmetropia). A small aperture of 1.6 mm of diameter was placed at the corneal plane. The pupil of the eye was set to 3 mm of diameter. Astigmatism was induced in steps of 0.25 D (axis 90°) by placing a cylindrical lens at 15 mm from the corneal axis and then the eye’s modulation transfer function (for monochromatic light of 550 nm) was obtained for every eye from 0 D up to 3 D of induced astigmatism. The spatial frequency that corresponded to a modulation value of 0.2 (along the orthogonal direction to the axis of the astigmatism) was used as an image quality metric and calculated in every eye with and without the small aperture. Results: With the small aperture implanted in the cornea, the cut-off frequencies increased significantly for all values of induced astigmatism. On average for the 20 eyes, if 1 D of astigmatism remained uncorrected for a pupil diameter of 3 mm (which corresponds to a 0.2 cut-off frequency of 0.22 decimal visual acuity units) then the equivalent value with the small aperture inlay implanted is obtained at 1.9 D (i.e. an increasing of 0.9 D of tolerance to astigmatism). For a different uncorrected threshold value of astigmatism, for instance to 0.5 D, then the tolerance with the small aperture would double up to 1 D. Since the inlay is actually an annulus (external diameter of 3.8 mm), this tolerance would be lower in those subjects with pupil diameters significantly larger than 4 mm. Conclusions: The retinal image quality in eyes implanted with a small aperture corneal inlay to extend depth of focus is affected by the remaining uncorrected astigmatism. Although there is an individual variability due to the particular eye’s aberrations, the presence of the small aperture approximately doubles the typical tolerance to astigmatism. Commercial Relationships: Abhiram S. Vilupuru, AcuFocus (E); Juan Tabernero, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: FIS2010-14926 CSD2007-00013 4524/GERM/06 Program Number: 4281 Poster Board Number: B0318 Presentation Time: 8:30 AM - 10:15 AM Distribution of Achromatizing Pupil Positions and First Purkinje Reflections in a Normal Population Silvestre Manzanera1, Juan Tabernero1, Antonio Benito1, Abhiram S. Vilupuru2, Pedro M. Prieto1, Pablo Artal1. 1Laboratorio de Optica, University of Murcia, Murcia, Spain; 2R&D, AcuFocus, Irvine, CA. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Purpose: Quality of vision in patients with small aperture corneal inlays to correct for presbyopia depends on its proper centration. In practice, the inlay is positioned on the 1st Purkinje image but if this location is far from the foveal achromatic axis, a significant transverse chromatic aberration could degrade retinal images. We developed a new instrument to simultaneously measure both the 1 st Purkinje image and the intersection of the achromatic axis with the pupil plane. Methods: The apparatus records images of the eye’s pupil and the 1 st Purkinje reflection when illuminated with a semicircle of infrared LEDs. In addition, a liquid crystal spatial light modulator produces a small aperture conjugated to the subject’s pupil plane with a location that can be controlled by the subject. Subjects perform a Vernier-type alignment task by moving a 1-mm aperture over the eye’s natural pupil to align a red target to a blue grid. Both the positions of the 1 st Purkinje reflection and the achromatic axis intersection are determined simultaneously. Series of data in 33 eyes with a range of +/- 4 D refractive errors were obtained. Results: For each subject the procedure was repeated 10 times. The standard deviation in the measurements was below 0.18 and 0.04 mm for the achromatic axis and 1st Purkinje positions respectively. The average location of the achromatizing pupil, relative to the subject’s natural pupil, was: x = 0.29 ± 0.19 mm (nasal); y = 0.09 ± 0.19 mm (superior). These values should be compared to the average location of the 1st Purkinje image: x = 0.34 ± 0.19 mm; y = 0.07 ± 0.07 mm. Considered individually, the two positions were statistically different in 8 and 16 eyes for the horizontal (x) and vertical (y) directions respectively. The differences in the two locations were smaller than 0.4 mm for both directions in all the measured eyes. Conclusions: We have designed and built a new instrument that allows to measure simultaneously both the locations of the 1 st Purkinje image and the achromatic axis intersection with the pupil plane. On average, both locations coincide within the measurement errors. Although there is individual variability, the maximum differences in location did not exceed 0.4 mm in any eye. This value should induce a modest amount of transverse chromatic aberration, indicating that centration of the inlay on the 1st Purkinje image should be adequate for most patients. Commercial Relationships: Silvestre Manzanera, AMO (F), CIBA Vision (F), CALHOUN (F), VOPTICA (I); Juan Tabernero, None; Antonio Benito, None; Abhiram S. Vilupuru, AcuFocus (E); Pedro M. Prieto, AMO (F), AcuFocus (F), Voptica SL (I), Voptica SL (P); Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Supported by the Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013) and Fundación Séneca (Región de Murcia, Spain), grant 4524/GERM/06 & AcuFocus. Program Number: 4282 Poster Board Number: B0319 Presentation Time: 8:30 AM - 10:15 AM Visual Simulation of Retinal Images with Various Designs of Pinhole Contact Lenses using Ray Tracing Software Kazuno Negishi1, Yasuyo Nishi1, Kazuhiko Ohnuma2, Kazuo Tsubota1. 1Department of Ophthalmology, Keio Univ School of Medicine, Shinjuku-Ku, Japan; 2Graduate School of Engineering, Chiba Univesity, Chiba, Japan. Purpose: To determine the optimal design of pinhole contact lenses (PCLs) without refractive power to obtain a full range of vision from far to near using ray tracing software. Methods: We used five PCL designs in this study: design 1, a 2-mm central clear zone with a 6-mm opaque zone; design 2, five randomly positioned clear zones 2 mm in diameter in the 8-mm opaque zone; design 3, eight randomly positioned clear zones 2 mm in diameter in the 8-mm opaque zone. Simulated retinal images with the PCLs at 5 and 0.3 meter were obtained using an optical design software and a Liou & Brennan eye model with an 8-mm corneal diameter, a 3-mm pupil diameter, a -1.0-diopter refraction, and a 555-nm wavelength. The modulation transfer functions (MTFs) also were calculated in each condition. Results: Among the three designs, design 3 performed the best. Conclusions: Our results suggested that a PCL without refractive power might be useful to obtain a full range of vision from far to near if designed optimally, and the central clear zone may not always be necessary for a PCL. Commercial Relationships: Kazuno Negishi, Oculentis (F); Yasuyo Nishi, None; Kazuhiko Ohnuma, None; Kazuo Tsubota, AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical (C), Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa (F), Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki (P), Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company (P) Support: 2011FY NEDO Innovation Promotion Program 0822001 Program Number: 4283 Poster Board Number: B0320 Presentation Time: 8:30 AM - 10:15 AM Visual Simulation of Retinal Images with Various Designs of Pinhole Contact Lenses Yasuyo Nishi, Kazuno Negishi, Kazuhiro Watanabe, Yuki Hidaka, Hidemasa Torii, Megumi Saiki, Kazuo Tsubota. Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Purpose: To determine the optimal design of pinhole contact lenses (PCL) without refractive power to obtain a full range of vision from far to near using a visual simulation system and to evaluate the optical performance. Methods: The PCL has a central clear zone in a 6.0-mm diameter opaque zone with many minute clear zones. The total diameter and the base curve of the PCL were 14.0 mm and 8.5 mm, respectively. The visual simulation system consists of a model eye and a chargecoupled device camera. The different PCLs can be placed in front of the model eye and evaluated. Visual simulations were performed using this system at 5, 1, and 0.3 meters through a 3-mm aperture using Landolt visual acuity (VA) charts with different PCLs (different sized central clear zone, 2.0, 1.8, 1.6, 1.4, and 1.2 mm; different sized minute clear zones in the opaque zone, 0.14, 0.17, 0.20, and 0.23 mm). The contrast levels of the gaps of the Landolt VA charts in the simulated images were analyzed using Photoshop software to determine the optimal PCL design. Results: The PCL with a 1.4-mm central clear zone and 0.17-mm clear zones in the opaque zone maintained the contrast of the simulated images over 10% at all distances and had the best performance among the tested designs. Conclusions: Our results suggested that the PCL without refractive power might be useful to obtain a full range of vision from far to near if designed optimally. Commercial Relationships: Yasuyo Nishi, None; Kazuno Negishi, Oculentis (F); Kazuhiro Watanabe, None; Yuki Hidaka, None; Hidemasa Torii, None; Megumi Saiki, None; Kazuo Tsubota, AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical (C), Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa (F), Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki (P), Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company (P) Support: 2011FY NEDO Innovation Promotion Program．0822001,Dated August 22nd,2011． 432 Refractive Errors, Myopia II ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Wednesday, May 08, 2013 11:00 AM-12:45 PM TCC LL 4/5 Paper Session Program #/Board # Range: 4549-4554 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 4549 Presentation Time: 11:00 AM - 11:15 AM The impact of Spherical Aberration, Stiles Crawford Apodization and Spatial Frequency on wavefront-based and subjective refractions Renfeng Xu1, Arthur Bradley1, Larry N. Thibos1, Gildas Marin2, Martha Hernandez2. 1School of Optometry, Indiana University, Bloomington, IN; 2Essilor International, Paris, France. Purpose: Subjective refraction is independent of pupil size even for eyes with spherical aberration (SA). We tested the popular explanation that Stiles-Crawford apodization (SCA) biases subjective refraction towards the pupil center by attenuating marginal rays. Methods: Aberrometry data were used for objective wavefront refractions that indentify the target vergence required to maximize metrics of image quality for varying levels and signs of SA and apodization, and a range of spatial frequencies (SFs). Subjective refractions for a variety of test stimuli were measured with phase plates that controlled SA levels, and apodization filters that controlled the Stiles-Crawford effect. Results: In the presence of SA, high SF image quality and subjective appearance of best focus are both achieved with a near paraxial focus irrespective of the presence or absence of pupil apodization. Optimum low SF image quality is achieved by focusing more marginal pupil regions, and thus best focus for low SFs changes with SA levels and apodization. For letter charts used in clinical refraction, optimum retinal image quality is achieved with a sphere lens that focuses rays entering the eye 1- 1.5 mm from the pupil center. Conclusions: Clinical subjective refractions are independent of pupil size because retinal image quality is maximized when rays near the pupil center are preferentially focused, independent of SCA. Removing high spatial frequencies from the visual stimulus makes subjective refractions more dependent on pupil size in the presence of SA. Commercial Relationships: Renfeng Xu, None; Arthur Bradley, Essilor International (F); Larry N. Thibos, Essilor International (F), Vistakon Inc. (F), Vistakon, Inc. (C), Self (P); Gildas Marin, Essilor international (E); Martha Hernandez, Essilor International (E) Support: NIH P30EY019008, Essilor International Program Number: 4550 Presentation Time: 11:15 AM - 11:30 AM Impact of Primary and Secondary Spherical Aberration on Predicted Peripheral Image Quality Amanda C. Kingston1, 2, Geunyoung Yoon2. 1BME, University of Rochester, Rochester, NY; 2Flaum Eye Institute, University of Rochester, Rochester, NY. Purpose: To determine the impact of sign and magnitude of primary and secondary spherical aberration (SA) on predicted image quality at retinal eccentricities up to 20°. Methods: An Arizona eye model was implemented in commercially available optical design software (Zemax Bellevue, WA). Radii of curvature, index and thicknesses were used from the model while axial length and crystalline lens asphericity were varied to produce an eye with zero defocus and SA. Zernike SA up to ±1.00μm over a 6mm diameter was added to the anterior cornea to induce different signs and magnitudes of primary and secondary SA. Foveal retinal image quality with each SA condition was optimized at distance by adjusting defocus. Wavefronts were calculated for an elliptical pupil with a 6mm long axis, at each retinal eccentricity, using Zemax. Through-focus peripheral image quality, using an image-convolution based image quality metric was done with a custom Matlab program. Measured outcomes were retinal image quality, refractive error and depth of focus (DOF) as a function of retinal eccentricity. Results: For all eccentricities, negative primary SA induced hyperopic defocus whereas positive primary SA and zero SA induced myopic defocus. Peak image quality with zero SA was higher than all eyes with SA, and maintained the same magnitude of myopic shift as primary SA (0.25D and 1.50D at 10 and 20°, respectively). DOF was extended with increasing magnitude of primary SA for all eccentricities compared to the zero SA case. Positive secondary SA induced hyperopic defocus at all eccentricities, whereas negative secondary SA induced myopic defocus. Secondary SA gives a secondary peak image quality instead of single focus found with primary SA. This secondary peak is in the hyperopic direction for positive SA and myopic direction for negative SA. Increasing the magnitude of secondary SA degraded image quality by 26-35% for all eccentricities. Decreasing the magnitude of secondary SA to 0.10μm increased image quality while still maintaining myopic defocus. Conclusions: Positive primary and negative secondary SA yield acceptable foveal image quality while maintaining myopic defocus at all eccentricities. Inducing optimal primary and secondary SA of the eye with an advanced ophthalmic lens manipulates the amount of refractive defocus and depth of focus in the peripheral retina, potentially providing the ability to control myopia progression. Commercial Relationships: Amanda C. Kingston, Bausch & Lomb (E); Geunyoung Yoon, Bausch & Lomb (F), Johnson & Johnson (F), Allergan (C), Staar Surgical (C), CIBA Vision (F), Acufocus (C) Support: Research to Prevent Blindness (RPB) Program Number: 4551 Presentation Time: 11:30 AM - 11:45 AM Peripheral Wavefront Aberrations of Accommodating Human Eye Tao Liu, Larry N. Thibos. School of Optometry, Indiana University, Bloomington, Bloomington, IN. Purpose: Retinal image quality in the peripheral visual field is thought to contribute to visual control of eye growth and myopia progression. The contribution of spherical aberration is of particular interest because accommodation typically causes a sign reversal that can have a large impact on accommodative lag and image quality. Thus we aimed to measure spherical aberration in central and peripheral visual field as a function of accommodative demand. Methods: A scanning Shack-Hartmann wavefront aberrometer (Wei & Thibos, 2010 Opt Express 18: 1134) was employed to measure ocular aberrations along 37 different lines-of-sight over the central 26 degree visual field in 30 seconds. Aberrations were measured sequentially using light reflected from a small spot produced on the fundus by an incident probe beam that pivoted around the center of the eye’s entrance pupil. Scanning mirrors that steered the incident probe beam also de-scanned the reflected light into a fixed wavefront sensor. Accommodation was stimulated over the range 0-6D by an acuity target in a Badal configuration. Target and room illumination was reduced to promote pupil dilation. Spherical aberration coefficients C40 (primary) and C60 (secondary) for elliptically foreshortened pupils (Wei & Thibos, 2010, Optom Vis Sci 87, E767777) describe ocular wavefront error over a fixed, 6mm circle concentric with the eye’s pupil. Results: Primary spherical aberration varied significantly in sign and magnitude over the visual field but always changed in the negative ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics direction during accommodation. For 6D of accommodation, changes in C40 ranged from 0.1 to 0.4 microns RMS, with larger values occurring for larger eccentricities. These changes are much larger than the population mean values reported previously (Mathur, Atchison, & Charman, 2009. J Vis 9, 20 21-11). This discrepancy may be due to several factors, including individual variation, duration of measurement sequences, and the problematic interpretation of aberration coefficients obtained over elliptical pupils. Unlike C40, secondary spherical aberration C60 was typically positive and did not vary significantly with accommodation Conclusions: Spherical aberration in peripheral vision changes significantly during accommodation, which may provide a potential clue for visual control of eye growth. Commercial Relationships: Tao Liu, None; Larry N. Thibos, Essilor International (F), Vistakon Inc. (F), Vistakon, Inc. (C), Self (P) Support: NIH grant R01-EY05109 Program Number: 4552 Presentation Time: 11:45 AM - 12:00 PM 1 Changes in Ocular Biometrics and Refraction during Near Work in Downward Gaze over Time Atanu Ghosh, Michael J. Collins, Brett A. Davis, Scott A. Read, Fan Yi, Payel Chatterjee. School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia. Purpose: To investigate changes in the characteristics of the corneal optics, total optics, anterior biometrics and axial length of the eye during a near task, in downward gaze, over 10 min. Methods: Ten emmetropes (mean - 0.14 ± 0.24 DS) and 10 myopes (mean - 2.26 ± 1.42 DS) aged from 18 to 30 years were recruited. To measure ocular biometrics and corneal topography in downward gaze, an optical biometer (Lenstar LS900) and a rotating Scheimpflug camera (Pentacam HR) were inclined on a custom built, height and tilt adjustable table. The total optics of the eye were measured in downward gaze with binocular fixation using a modified ShackHartmann wavefront sensor. Initially, subjects performed a distance viewing task at primary gaze for 10 min to provide a “wash-out” period for prior visual tasks. A distance task (watching video at 6 m) in downward gaze (25°) and a near task (watching video on a portable LCD screen with 2.5 D accommodation demand) in primary gaze and 25°downward gaze were then carried out, each for 10 min in a randomized order. During measurements, in dichoptic view, a Maltese cross was fixated with the right (untested) eye and the instrument’s fixation target was fixated with the subject’s tested left eye. Immediately after (0 min), 5 and 10 min from the commencement of each trial, measurements of ocular parameters were acquired in downward gaze. Results: Axial length exhibited a significant increase with downward gaze and accommodation over time (p<0.05). The greatest axial elongation was observed in downward gaze with 2.5 D accommodation after 10 min (mean change from baseline 23±3 µm). Downward gaze also caused greater changes in anterior chamber depth (ACD) and lens thickness (LT) with accommodation (ACD mean change -163±12µm at 10 min; LT mean change 173±17 µm at 10 min) compared to primary gaze with accommodation (ACD mean change -138±12µm at 10 min; LT mean change 131±15 µm at 10 min). Both corneal power and total ocular power changed by a small but significant amount with downward gaze (p<0.05), resulting in a myopic shift (~0.10 D) in the spherical power of the eye compared with primary gaze. Conclusions: The axial length, anterior biometrics and ocular refraction change significantly with accommodation in downward gaze as a function of time. These findings provide new insights into the optical and bio-mechanical changes of the eye during typical near tasks. Commercial Relationships: Atanu Ghosh, None; Michael J. Collins, None; Brett A. Davis, None; Scott A. Read, None; Fan Yi, None; Payel Chatterjee, None Program Number: 4553 Presentation Time: 12:00 PM - 12:15 PM Effect of Accommodation on Peripheral Refraction Jason Shen, Frank Spors. College of Optometry, Western Univ of Hlth Sciences, Pomona, CA. Purpose: Both animal and human studies show that peripheral refraction has an impact on the development of central refractive error. Furthermore, there is evidence indicating the link between near work and myopia progression. The purpose of this study is to investigate the effect of accommodation during near work on peripheral refraction. Methods: Twenty six eyes (thirteen young subjects, 8 females and 5 males) with a narrow range of uncorrected refractive errors ranging from -0.50 to +1.00 diopters, and astigmatism less than -1.00 diopters were measured by a Grand Seiko WAM 5500 open field autorefractor. The refractive error was measured in 10° steps up to 30° across both the temporal and the nasal horizontal visual fields. The measurements were repeated with Maltese cross visual targets displayed at 20 ft distance, 40 cm and 25 cm. The near targets were arranged in an arc which allowed maintaining the same accommodative demand throughout the different directions of gaze. Central and peripheral refraction data were converted to power vectors M, J0, and J45. Results: Emmetropic eyes did have about 1.0 D myopic shift in 30° periphery. Increasing Against-The-Rule astigmatism was presented in the horizontal periphery. These results are in alignment with previous literature. With stimulated accommodation, there were no statistically significant differences of the peripheral spherical equivalents M and J0 astigmatism. Right eyes showed a positive linear slope of J45 profile across the horizontal visual field which was negative for left eyes. But with increasing accommodative demands, the slope of J 45 profiles changed signs. J45 values varied within a range of 0.6 D. Conclusions: Near accommodation to 25 cm and 40 cm did not show significant effects on M and J0 components of peripheral refraction in emmetropic subjects. However, near accommodation had major effects on the J45 component. It remains unclear why J45 changed significantly. Further studies are needed to investigate the relationships between J45 and the states of accommodation. Commercial Relationships: Jason Shen, None; Frank Spors, None Program Number: 4554 Presentation Time: 12:15 PM - 12:30 PM School-Age Myopic Shift in Hyperopic Children with Infantile Esotropia and Peripheral Myopia Eileen E. Birch1, 2, Simone Li1, Sarah E. Morale1, Reed M. Jost1, Vidhya Subramanian1, Donald O. Mutti3. 1Retina Foundation of the Southwest, Dallas, TX; 2Ophthalmology, UT Southwestern Medical Center, Dallas, TX; 3College of Optometry, The Ohio State University, Columbus, OH. Purpose: Children with infantile esotropia (IET) often fail to emmetropize during the first year of life (Birch et al. Eye, 2010). Nonetheless, after 5-6 years of persistent moderate hyperopia, many children with IET experience a myopic shift of -0.50D/yr when they are 7-12 years old (Birch et al Eye, 2010). Because eye shape and peripheral retinal defocus are thought to play an important role in controlling myopic progression, we examined foveal and peripheral biometric and refractive data associated with the early hyperopia and ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics later myopic shift in 3- to 14-year-old children with IET. Methods: Eye length (right eye) was measured with a Haag-Streit Lenstar in 40 children with infantile ET. Five measurements were obtained at the fovea and at 10° and 20° on the temporal retina. For off-axis measurements, children fixated a dim mini-LED affixed to the instrument. Distance refraction (right eye) was obtained for the same 3 locations with a Grand Seiko binocular autorefractor with the child fixating letter targets. Results: At 3-4 and 5-6 years old, children with IET had mean±se refractive error of +3.63±0.61D and +3.81±0.43D, respectively, and axial length of 21.4±0.3mm and 21.2±0.2mm, respectively. Peripheral eye length was 0.2-0.4 mm longer than axial length, consistent with oblate ocular shape. Peripheral refraction was -0.84 to -0.91D more myopic relative to foveal refraction. At 7-8 years, mean hyperopia was lower (+2.66±0.67D) and axial length longer (22.1±0.2mm). In this age group, peripheral eye length was shorter than axial length by 0.1-0.3 mm; i.e., eyes were less oblate in shape. By 9-14 years, mean hyperopia was again lower at +1.54±0.76D and axial length longer at 23.1±0.5mm; eyes were even less oblate (peripheral eye length was 0.2-0.4 mm shorter than axial length). In the older age groups peripheral refraction remained slightly myopic (0.1 to -0.2D) relative to foveal refraction. Conclusions: Hyperopia in IET is associated with oblate eye shape. While the putative “stop” signal of relative peripheral myopia is present in younger eyes, the older eyes are significantly longer and significantly less oblate at 7-14 years of age, just as the children experience a myopic shift. The possibility that some eyes can grow rapidly to become less hyperopic despite inhibitory peripheral defocus requires longitudinal confirmation. Commercial Relationships: Eileen E. Birch, None; Simone Li, None; Sarah E. Morale, None; Reed M. Jost, None; Vidhya Subramanian, None; Donald O. Mutti, None Support: NIH grant EY022313 467 Visual Functions in AMD Wednesday, May 08, 2013 2:45 PM-4:30 PM Exhibit Hall Poster Session Program #/Board # Range: 5017-5042/A0179-A0204 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 5017 Poster Board Number: A0179 Presentation Time: 2:45 PM - 4:30 PM Preliminary assessment of a new device to test potential visual acuity when compared to gold standard PAM Elizabeth R. Richter, Jan A. Kylstra. Storm Eye Institute, Medical University of South Carolina, Charleston, SC. Purpose: Assess a newly-developed potential visual acuity device compared with the gold standard Guyton-Minkowski Potential Acuity Meter (PAM) Methods: The rationale for potential acuity assessment is to determine if vision loss is due solely to cataract or due to other ocular pathology. The current gold standard is the Guyton-Minkowski PAM. This method has several problems, including high cost and difficulty in use. The physician cannot see the projected chart on the retina and has to rely on patient cooperation. When this method is unsuccessful, the cause of failure may result from true retinal pathology or difficulties with equipment use. We have developed a new device (the SCALE) which combines current indirect ophthalmoscopy with a 20 diopter lens and transparent ETDRS-style eye chart. The virtual image of the retina is formed 5cm in front of the lens, and in this same plane the eye chart is held. This allows the physician to directly project the eye chart onto the patient's retina while the practitioner also views the patient's retina to make sure the image is directed on the macula. This is the first comparison study to determine the ability of visual acuity measurement when compared to the current gold standard in 23 patients with preoperative cataracts. After conversion to logMAR acuity, paired t-test was used to compare differences amongst the data. The goal of this study was to determine ease of use and correlation with other accepted methods. Results: Of 23 eyes, only one patient was unable to see letters on either device. Another subject was unable to see anything on the PAM device (>20/800), but could see one line (20/252) with the SCALE. Analysis of the other patients yielded a significant difference between the visual acuities measured by these two potential acuity methods (t(20)=3.4916, p=0.00230). The mean PAM logMAR acuity was 0.551 (SD=0.384), while the SCALE showed a 0.335 acuity (SD=0.246); this is approximately 2-line increase on the ETDRS chart. Conclusions: The SCALE is another method to assess potential acuity. From preliminary study, it appears to overestimate visual acuity when compared to the gold standard PAM. However, this new device may be an excellent and inexpensive addition to the precataract toolkit to assess retinal function. Further studies are needed to assess post-surgical acuity to determine if this is a good estimator of prospective surgical outcome. Commercial Relationships: Elizabeth R. Richter, US Provisional Application No. 61/653,171 (P); Jan A. Kylstra, provisional 61/653,171 (P) Clinical Trial: 00016836 Program Number: 5018 Poster Board Number: A0180 Presentation Time: 2:45 PM - 4:30 PM Evaluation of vision auto-testing in patients with AMD using an iPad App Matthias G. Hartmann. Private Practice, Berlin, Germany. Purpose: Patients with age-related macular degeneration (AMD) need to undergo regular testing of their visual acuity. A tool for selfmeasurement to be run on an iPad was developed to enable patients to have regular testing by themselves. It is available in German, English, Spanish and Japanese. This project was designed to evaluate whether iPad-based vision auto-testing is a feasible method for patients with AMD compared to established instruments. Methods: The project was run in 4 ophthalmologist’s offices. Target sample size was 100 patients; only patients with an initial vision of at least 0.05 were included. Patients had to consent to a threepart vision test every 4 weeks for 6 months. Visual acuity was measured by a) distance vision testing by projection of Landolt rings (EN ISO 8596) b) near vision test charts (Oculus) with Landolt rings and c) automeasurement with Landolt rings using the iPad App “Eyetest Control your visual acuity”. Patients were initially advised how to use the iPad App. All tests were performed in the office. Test results were defined to be consistent when they differed to a maximum of one line. Results: 112 patients of 57 to 92 years of age (mean 77.2 yrs) were included. Nearly all patients had never used an iPad before (96% vs. 4%). Results for vision tests by projection and iPad were consistent in 76% (right eye) and 83% (left eye) of the measurements. Near vision test charts were used as a control. Results acquired by near vision test charts frequently differed from projection results by 2 or more lines. At the end of study, patients were asked for their preference. The majority of patients (81.25%) chose the iPad App as their preferred method to test visual acuity, only 12.5% chose the projection method, 6.25% preferred near distance test charts. Conclusions: The fact that over 80% of the patients prefer the iPad ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics App for vision testing illustrates the feasibility of the method. It is easy to use even for former iPad non-users and delivers results consistent with established vision testing instruments. This suggests that the iPad App is suitable to support patients and ophthalmologists in the routine care of AMD. Features like an adjustable reminder and a mail function contribute to its value. The Amsler grid will be included and an automated distance adjustment will be implemented to further improve feasibility and reliability of the tool. Home use of the auto-vision App will be evaluated. Commercial Relationships: Matthias G. Hartmann, Novartis (F) Program Number: 5019 Poster Board Number: A0181 Presentation Time: 2:45 PM - 4:30 PM A New Contour Integration Macular Perimetry (CIMP) on iPad for Visual Function Evaluation in Maculopathy Yi-Zhong Wang1, 2, Gina Mitzel1. 1Retina Foundation of the Southwest, Dallas, TX; 2Ophthalmology, UT Southwestern Medical Center, Dallas, TX. Purpose: Patients with maculopathy often show early abnormalities outside fovea. Such paracentral deficits may not be detected by visual function tests for foveal vision. In this study, a new macular perimetry based on contour integration was developed on iPad, and the feasibility of using CIMP to detect paracentral vision loss in maculopathy was assessed. Methods: Thirty normal subjects (mean age 51 years ± 22SD, mean visual acuity (VA) 0.04 logMAR ± 0.08SD) and 30 patients (mean age 62±21, mean VA 0.36±0.35) with maculopathy (12 with Stargardt disease, 7 diabetic maculopathy, and 11 age-related macular degeneration) participated in the study. CIMP stimuli were circular contour segments, and were generated on iPad screen that subtended 18x23.4 deg at a viewing distance of 18”. In each trial, 4 contour segments, each a 30 deg circular arc, were evenly placed along the center of the inner or outer ring of the ETDRS macular grid. Among 4 segments, one was distorted and others were smooth. The distortion was introduced by radial modulation. The stimulus duration was 0.25 sec. The subject’s task was to indicate by touch which one of 4 locations had distorted contour. A spatial 4-alternative, forced-choice (4AFC) staircase paradigm and a maximum likelihood fitting procedure were employed to estimate the threshold for detecting contour distortion in the inner or outer ring of the grid. Results: Thirty-four diseased eyes (mean VA 0.19±0.20) were able to perform the CIMP test. Their mean thresholds to detect distortion in the inner and outer rings were -0.36±0.36 and -0.54±0.35 logMAR, respectively, significantly worse than normal controls (0.73±0.16 and -0.81±0.16, respectively, p<0.008). Furthermore, for the diseased eyes with VA 0.20 or better (n=23, mean VA 0.08±0.11, not significantly different from the normal control, p>0.16), the inner and outer ring mean thresholds were -0.36±0.39 and -0.49±0.41, respectively, also significantly worse than the normal controls (p<0.0012). Twenty-six diseased eyes (mean VA 0.58±0.39) were unable to perform CIMP due to severe damage to the macula. Conclusions: These results suggest that the new CIMP test can detect paracentral loss of visual function in patients having normal visual acuity. CIMP implemented on iPad has the potential to be a new remote monitoring tool for early detection of treatable disease condition outside fovea in maculopathy. Commercial Relationships: Yi-Zhong Wang, Vital Art and Science, Inc. (I), Vital Art and Science, Inc. (C), Vital Art and Science, Inc. (P); Gina Mitzel, None Support: OneSight Research Foundation Program Number: 5020 Poster Board Number: A0182 Presentation Time: 2:45 PM - 4:30 PM myVisionTrack (mVT), a novel remote visual self-assessment, correlates with clinical course of macular function Yu-Guang He1, Johnathan D. Warminski1, Yi-Zhong Wang2. 1 Ophthalmology, Univ Texas Southwestern Med Ctr, Dallas, TX; 2 Retina Foundation of the Southwest, Dallas, TX. Purpose: Reliable self-assessment of a patients’ visual function can improve early detection of worsening macular function. mVT provides patients with a handheld, electronic platform to assess visual function based on shape discrimination. Methods: Case series comparing mVT self-assessments to patients’ snellen acuity, central macular thickness and clinical course during treatment for maculopathy. Results: 36 patients were monitored for 180-550 days during treatment of diabetic maculopathy (29) and age-related maculopathy (7). Self-monitoring correlated well with the patients’ snellen visual acuity and OCT measured central macular thickness. Conclusions: mVT provided a reliable self-measure of visual function in patients with macular edema. Commercial Relationships: Yu-Guang He, None; Johnathan D. Warminski, None; Yi-Zhong Wang, Vital Art and Science, Inc. (I), Vital Art and Science, Inc. (C), Vital Art and Science, Inc. (P) Program Number: 5021 Poster Board Number: A0183 Presentation Time: 2:45 PM - 4:30 PM Visual Acuity Loss In Patients With AMD, Measured Using A Vanishing Optotype Letter Chart Nilpa Shah1, Roger S. Anderson1, 2, Adnan Tufail1, Catherine A. Egan1, Steven Dakin1. 1NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, United Kingdom; 2Vision Science Research Group, School of Biomedical Sciences, University of Ulster at Coleraine, Northern Ireland, United Kingdom. Purpose: Vanishing Optotype (VO) letters have a pseudo high-pass design so that the mean luminance of the target is the same as the background and the letters thus ‘vanish’ once the resolution threshold is reached in the fovea. We wished to investigate how visual acuity measurements using charts constructed from these letters compared to charts of conventional letter design, in both normal subjects and patients with differing levels of AMD. Methods: 60 participants were recruited; 30 with no ocular abnormalities and 30 with AMD and no other significant ocular pathology. Following refractive error correction, each subject underwent monocular (single letter scored) visual acuity measurements using ETDRS charts 1 and 2, and charts of the same layout but constructed using VO letters (VO1 and VO2). All tests were performed in a random sequence. The methods of Bland and Altman were employed with test-retest variability (TRV) expressed as 95% confidence intervals for agreement. Results: Visual acuity measurements with the VO chart were, on average, approximately 3 logMAR lines ‘worse’ than those with conventional letter design in subjects with AMD compared to a difference of only 1.5 logMAR lines in normal subjects. This difference between the two groups was statistically significant (p<0.05, unpaired t-test). Similar TRV’s of approximately +/- 0.10 logMAR were found for both the ETDRS and VO charts in both groups. Conclusions: AMD patients display a measurably larger visual acuity deficit using VO letter charts compared to conventional ETDRS charts, with no significant difference in test-retest variability. Commercial Relationships: Nilpa Shah, None; Roger S. Anderson, None; Adnan Tufail, Allergan (C), Bayer (C), GSK (C), Oculogics (C), Pfizer (C), Thrombogenics (C), Amakem (C), Heidelberg Engineering (R), Novarits/Alcon (C), Sanofi/Genzyme ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (C); Catherine A. Egan, Bayer (S), Oculogics (S), Novartis (S), Allergan (S), Novartis (F); Steven Dakin, None Support: Supported by a Fight for Sight studentship, by Moorfields Special Trustees and by an award from the NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London Program Number: 5022 Poster Board Number: A0184 Presentation Time: 2:45 PM - 4:30 PM Screening for AMD Using Psychophysical Correlates of Macular Dysfunction Han Li1, Susan M. Culican2. 1Washington University School of Medicine, St. Louis, MO; 2Dept of Ophthalmology and Visual Science, Washington University School of Medicine, St. Louis, MO. Purpose: To assess the utility of our novel computerized vision task as a screening tool for AMD and other macular disorders. Methods: We developed a computerized task and administered it to 20 participants with AMD or other macular disorders, and 17 similarly aged control participants. The task was based on participant identification of interruptions in visual stimuli. Testing was conducted monocularly. Subject distance to the video display was determined by empirical adjustment, by positioning the physiological blind spot at the periphery of stimuli. Stimuli consisted of a central fixation point surrounded by rotating objects. Objective interruptions of some objects were programmed into the stimuli, which the participant was instructed to report by striking a key. We hypothesized that those with macular dysfunction would subjectively perceive more interruptions than were programmed, due to foveal and parafoveal scotomata. Results: Our results show significantly different task performance between those with and without macular disorders. Macular disorder participants reported a higher number of subjective interruptions (n=4.65 vs n=0.35, p<.001) as well as total errors, defined as sum of missed objective interruptions and subjective interruptions, compared to controls (n=6.3 vs n=1.24, p<.001). There was no significant difference in the number of missed objective interruptions alone (n=1.65 vs n=0.88, p=.158). Disease status correlates with test performance, while controlling for near distance visual acuity (p=.001). Furthermore, interocular test performance was the same in control participants, with no significant difference in subjective interruptions, missed objective interruptions, and total errors. Conclusions: Our visual task discriminates between macular disorder and control group participants, independent of visual acuity. Participant attention and instruction compliance were high, while fatigue and interocular learning curve effects were negligible. These results suggest that our novel computer task could be used as a rapid and effective screening tool in detecting macular disorder. In particular, the number of subjective interruptions could be used as a reliable screening parameter. However, further testing in demonstrating reliability and validity of our results must be done. Commercial Relationships: Han Li, None; Susan M. Culican, None Program Number: 5023 Poster Board Number: A0185 Presentation Time: 2:45 PM - 4:30 PM A New Method to Depict Central Scotomas: Automated Sterocampimetry Anthony P. Cappo1, Richard B. Rosen2, William H. Seiple3, Matthew D. Orr1, michele arthurs4, Trisha Emborgo5. 1Opticology, Inc., New York, NY; 2New York Eye & Ear Infirmary, New York, NY; 3 Lighthouse International, New York, NY; 4Universite de Montreal, Montreal, QC, Canada; 5Hunter College, City University of New York, New York, NY. Purpose: Despite high prevalence of central and para-central scotomas and the success of available treatments, no precise automated means to measure the size or shape of the scotoma exists. Such information would be useful for both early detection and following treatment. Standard automated perimetry and microperimetry present stimuli at various intensities to obtain thresholds. The stimuli are typically in a preset grid pattern which fails to give a detailed outline of scotomas. We describe a new technique, Automated Stereocampimetery, that precisely defines the size and shape of a scotoma, and compare the results to Microperimetry and to the underlying image of the damaged retina from SLO. Methods: We tested 30 patients on the Automated Stereocampimeter (AS) and an OCT SLO outfitted with a Microperimeter (MP) without screening for the type of retinal pathology. Both devices require a subjective response from the subject. The MP is part of an OCT SLO which also gives retinal thickness and image of the retina. It is a monocular test and ensures fixation by monitoring any movement of landmarks in the retinal image. The MP presents stimuli in a regular pattern over 30 degrees of visual field and the stimulus points are repeated at various light intensities (full threshold). The AS does not monitor fixation, but uses binocular fixation and animation of the target to improve fixation. To compare the locations and extents of loss, the AS results were superimposed on the MP results. Results: Of 30 subjects tested on the AS, 12 were found to have well-defined areas of scotomas. Eight of these 12 subjects were able to complete MP Testing. In 6 of these 8 cases the MP result confirmed the AS findings, with additional correspondence of the probable defects identified in the SLO image to the AS-determined scotoma outline. In 2 cases the relationship appeared weaker. Conclusions: More than half of patients have been able to complete an AS test successfully, and the comparison to the MP data suggests that the AS produced meaningful results that may be useful in following patients with centrally located pathology. Poor results were usually easy to identify, which reduces the chance of false positive tests. Further, the correspondence between discoloration in the retina image and the shape of discovered defect was greater than expected. MP results ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics AS superimposed on MP Commercial Relationships: Anthony P. Cappo, Opticology, Inc. (E), Centrofuse Technologies, LLC (I), LacriSciences, LLC (I); Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); William H. Seiple, None; Matthew D. Orr, Opticology, Inc. (C), Opticology, Inc. (P); michele arthurs, None; Trisha Emborgo, None Program Number: 5024 Poster Board Number: A0186 Presentation Time: 2:45 PM - 4:30 PM Spaeth/Richman Contrast Sensitivity Test in Macular Degeneration Bruno M. Faria, Fulya Duman, Mohsin Ali, Camila Zangalli, Sheryl S. Wizov, Lan Lu, Jesse Richman, Eric Spaeth, George L. Spaeth. Glaucoma, Bruno Faria, Philadelphia, PA. Purpose: To evaluate contrast sensitivity in age-related macular degeneration (AMD) patients using a new contrast sensitivity instrument. Methods: Age-related Macular Degeneration patients and controls were prospectively evaluated using the Spaeth-Richman Contrast Sensitivity (SPARCS) method and the Pelli-Robson test. Testing was performed monocularly in a standardized testing environment. Contrast thresholds for the central, superonasal, superotemporal, inferonasal and inferotemporal areas of vision were determined. The contrast sensitivity scores for each area of vision and the cumulative scores of AMD patients were compared with those of the controls. The results were analyzed with Spearman coefficients for continuous variables and the Kruskal-Wallis test for categorical variables. Results: Fifty-four eyes with AMD and one-hundred and eighty control eyes completed the study. The mean SPARCS scores were 54.6 for patients with AMD and 73.9 for controls (p<0.01). The SPARCS scores were significantly lower in all five quadrants for AMD patients (p<0.01). Conclusions: SPARCS was able to discriminate well between patients with AMD and controls. SPARCS may become a standard technique to assess visual function in AMD patients. Commercial Relationships: Bruno M. Faria, None; Fulya Duman, None; Mohsin Ali, None; Camila Zangalli, None; Sheryl S. Wizov, None; Lan Lu, None; Jesse Richman, none (P); Eric Spaeth, SPARCS (C), SPARCS (S); George L. Spaeth, Merck (F), U.S. Patent No. 8,042,946 (P), Pfizer (F) Support: Pfizer, inc. Clinical Trial: NCT01300949 Program Number: 5025 Poster Board Number: A0187 Presentation Time: 2:45 PM - 4:30 PM Central And Paracentral Single-Letter Recognition In Eyes With Macular Lesions Gianfrancesco M. Villani1, Lorenzo Bertelli1, Giovanni Sato2, Marco U. Morales3, August Colenbrander4. 1Ophthalmology, Centro Riabilitazione Ipovedenti e Microperimetria - CRIM, Castel d'Azzano, Verona, Italy; 2UO Oftalmologia, Centro Riabilitazione Visiva, Ospedale S. Antonio, Ulss16, Padova, Italy; 3Ophthalmology and Visual Sciences, School of Clinical Sciences, The University of Nottingham, Nottingham, United Kingdom; 4Smith-Kettlewell Eye Research Institute, San Francisco, CA. Purpose: To investigate the size, location, and number of single letters that can be recognized within 5° from fixation by patients with central vision loss Methods: 32 eyes (29 patients) with maculopathy (AMD, myopic maculopathy, macular edema, cone dystrophy, toxo scar) were enrolled. Lower-case single letters (TimesNewRoman) were randomly projected on a 19” LCD monitor at a viewing distance from 10 to 60 cm with black-on-white contrast polarity, >90% contrast, by custom software (“Letter Scotometry” [LS]). A two steps procedure was followed: 1- central size threshold (“CST”): central projection of a single letter at decreasing sizes from 0.63M to 25M in log steps until the answer was correct (≥3/5 letters per size); 2- paracentral span test (“PST”): random projection of single letters around a central small fixation dot into a grid of adjoining cells proportional to letter size. The letter size was set one log step bigger than CST, and not scaled by eccentricity (it could be increased if the patient read no letter, but then PST was restarted from the beginning). Stimuli stayed on screen until an answer was given, and the response-time was recorded. The only control of fixation was based on operator-patient interaction. The examination included ETDRS BCVA at 1m, MNREAD, SKREAD, and Microperimetry (MP) by Nidek MP1 or OPKO. Digital overlapping of letter-grids and microperimetry maps was done to compare scotoma borders in 8 directions from fixation and to understand if correct letters matched with the scotoma-free areas Results: BCVA median (range) was 0.75 (0.2-1.6) logMAR, CST was 0.84 (0.50-2.00) logMAR, MNREAD critical print size (CPS) was 0.9 (0.5-1.3) logMAR and SKREAD CPS was 0.9 (0.4-1.4) logMAR. Maximum Reading Speed (MRS) was 71.4 (2.4-162.2) wpm on MNREAD, and 25.5 (1.2-49.6) wpm on SKREAD. When the fixation dot was placed on the PRL the correspondence of scotoma borders between letter-grids and microperimetry was 74% (median 75%). CST on the LS test was strongly correlated with CPS (r 0.71) and minimum print size (r -0.77) on the SKREAD Conclusions: LS grids can be used clinically to display fixation/PRL behavior in recognizing single-letters of the magnification needed for the low-vision patient to read in the presence of central scotomas Commercial Relationships: Gianfrancesco M. Villani, Letter Scotometry/Marte srl © TX0007576130 / 2012-04-25 (P); Lorenzo Bertelli, Letter Scotometry/Marte srl © TX0007576130 / 2012-04-25 (P); Giovanni Sato, None; Marco U. Morales, None; August Colenbrander, None Program Number: 5026 Poster Board Number: A0188 Presentation Time: 2:45 PM - 4:30 PM Longitudinal Changes in Retinal Sensitivity among Patients with Maculopathy Hongting Liu, Millena G. Bittencourt, Owhofasa O. Agbedia, Ahmadreza Moradi, Yasir J. Sepah, Daniel A. Ferraz, Mohamed A. Ibrahim, Raafay Sophie, Mehreen Ansari, Quan Dong Nguyen. Retinal Imaging Research and Reading Center, Wilmer Eye Institute Johns Hopkins University, Baltimore, MD. Purpose: To investigate longitudinal changes in retinal sensitivity among patients with maculopathy with stable visual acuity (VA) and central retinal thickness (CRT). ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Methods: In this prospective study,16 patients with maculopathy and no change in VA (≤ 5 letters change in ETDRS score) and CRT (≤ 20 μm in spectral-domain optical coherence tomography (SD-OCT)) between 2 visits (interval: 2-6 months) were evaluated. Disease entities included diabetic macular edema, age related macular degeneration, central serous retinopathy, Stargardt's disease and idiopathic macular hole. Retinal sensitivity was assessed using the Spectral-OCT/SLO microperimetry (MP) (Optos Inc, Scotland, UK) at both visits. The test pattern was a standardized polar 3 grid which consists of 28 points within 11° from the fovea. The mean change and variance in retinal sensitivity for all patients was compared to the MP intersession variation of 10 patients with retinopathies. Results: A total of 700 points from 25 eyes (16 patients) with maculopathy were analyzed. The mean age of subjects was 53 years (SD ±16). The results are summarized in the table. The overall variance between the two visits (6.0dB) was significantly greater than the inter-session variance (2.4dB) (Mann Whitney Test, p=0.008). Conclusions: Microperimetry may capture subtle functional changes in maculopathy patients with stable visual acuity and no change in central retinal thickness. Further studies with larger sample size are indicated to validate the observed results. decibels) was measured with fundus-tracking microperimetry. A circular pattern of 28 test locations covering the central 11 degrees of the macula was used. Stimulus duration was 200ms, at an average interval of two seconds, and at a Goldmann III size. Fixation locations were recorded during 20 seconds of viewing an “X.” Fixation stability was calculated by fitting a Bivariate Contour Ellipse Area to these data. Results: Thickness remained stable post-treatment in half of the patients whereas the other half demonstrated an initial drop after the first injection and remained stable after subsequent visits. A qualitative assessment of OCT suggests that the integrity of the IS/OS layer did not improve if it appeared disrupted at baseline visit. Sensitivity increased across all visits for one patient(12.5%), increased for two patients in later visits(25%), remained stable in three patients(37.5%), decreased slightly in one patient(12.5%), and more importantly in the last patient(12.5%). While fixation location was variable for all subjects, fixation stability (BCEA area) slightly improved in one patient(12.5%), did not change in five patients(62.5%), and was quite variable for two patients(25%). Conclusions: Our data suggests that thickness and sensitivity were predictors in evaluating outcome of anti-VEGF treatment. Fixation did not show a significant improvement in stability post-treatment and fixation location tended to vary between visits indicating the possibility of more than one PRL. Commercial Relationships: michele arthurs, None; Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); Gennady Landa, None; Rishard Weitz, None; William H. Seiple, None Support: Genentech Clinical Trial: nct01255774 Commercial Relationships: Hongting Liu, None; Millena G. Bittencourt, None; Owhofasa O. Agbedia, None; Ahmadreza Moradi, None; Yasir J. Sepah, None; Daniel A. Ferraz, None; Mohamed A. Ibrahim, None; Raafay Sophie, None; Mehreen Ansari, None; Quan Dong Nguyen, Genentech (F), Regeneron (F), Lux Biosciences (F), Abbott (F), GSK (F), Santen (F), Santen (C), Bausch and Lomb (C), Optos (F), Heidelberg Engineering (F) Support: Wilmer Research Grant Program Number: 5028 Poster Board Number: A0190 Presentation Time: 2:45 PM - 4:30 PM Relationship between Visual Function and Optical Coherence Tomography features in Early Age-related macular degeneration (AMD)-Early Markers Observational Study Ruth E. Hogg1, George Murphy1, Giovanni Staurenghi2, Chiara Rosina2, Rufino Silva3, Ana Rita Santos3, Usha Chakravarthy1. 1 Center for Vision and Vascular Science, Queen's University Belfast, Belfast, United Kingdom; 2Eye Clinic - Department of Clinical Science, “Luigi Sacco”- Sacco Hospital, II School of Ophthalmology - University of Milan, Milan, Italy; 3Faculty of Medicine., University of Coimbra, Coimbra, Portugal. Purpose: To investigate the relationship between visual function parameters and tomographic metrics. Methods: Study sample: 105 patients (53 males, 52 females) with unilateral advanced AMD from 3 Centres (Milan, Coimbra and Belfast) aged 52-93 years. Study Eye=Fellow eye without advanced neovascular disease. Best corrected distance acuity (BCVA) and near acuity (NVA), reading speed adjusted for print size (reading index; RI) and low-luminance acuity (SKILL test) were measured. High density macular raster scans on the Heidelberg were obtained. Trained graders measured the neuroretinal thickness (NRT) and choroidal thickness (CT) at the foveal centre and evaluated the continuity of the following layers (ganglion cell layer GCL, inner segment/outer segment junction IS/OS, external limiting membrane ELM, photoreceptor layer PRL and retinal pigment epithelium RPE). Univariate and logistic regression analyses were employed to examine relationships between function and morphology. Results: NRT was associated with BCVA (r=0.24 p=0.024); CT with reduced (SKILL score) (r=-0.4 p<0.001). Retinal layer continuity showed relationships with functional tests. External Limiting Membrane continuity was associated with DVA (p=0.006), NVA Program Number: 5027 Poster Board Number: A0189 Presentation Time: 2:45 PM - 4:30 PM Monitoring the Progression of AMD post anti-VEGF treatment using the OPKO OCT/SLO michele arthurs1, Richard B. Rosen3, Gennady Landa3, Rishard Weitz3, William H. Seiple2, 3. 1Université de Montréal, Montréal, QC, Canada; 2New York Lighthouse, New York, NY; 3New York Eye & Ear Infirmary, New York, NY. Purpose: To evaluate the outcome of anti-VEGF treatment in patients with exudative age-related macular degeneration (AMD) using the optical coherence tomography-scanning light ophthalmoscope (OCT/SLO), and to determine if predictors of an individual patient’s responses to treatment can be identified. Methods: Patients diagnosed with exudative AMD and having received no prior AMD treatment were recruited. Eight subjects between 58 and 85 years of age with visual acuities ranging between 20/16 and 20/200 were enrolled. Monthly treatments of ranibizumab were given in the affected eye for up to 12 months. Three measures of local retinal function were obtained monthly using the OPKO OCT/SLO: retinal structure (OCT), psychophysical function (microperimetry), and fixation location and stability. Integrity of outer layers and retinal thickness were obtained with the OCT from line scans and from 3D topographies. Psychophysical sensitivity (in ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (p=0.021) and Reading index (p=0.020). IS/OS junction continuity was associated with DVA (p=0.007), NVA (p=0.03) and SKILL score (p=0.050). Photoreceptor layer continuity was associated with Reading index (p=0.039). RPE layer continuity was associated with SKILL score (p=0.003). Conclusions: Significant associations exist between stressors of macular visual function such as near acuity and low luminance acuity and tomographic markers of retinal and choroidal morphology. Commercial Relationships: Ruth E. Hogg, Novartis (F), Novartis (C); George Murphy, None; Giovanni Staurenghi, Ocular Instruments (P), GSK (C), Novartis (C), Alcon (C), Allergan (C), Bayer (C), Roche (C), Heidelberg Engineering (C), OD-OS (C), QLT (C), Optos (C); Chiara Rosina, None; Rufino Silva, Thea (C), Novartis (C), Bayer (C), Allergan (C), Alimera (C); Ana Rita Santos, None; Usha Chakravarthy, Bayer (C), Novartis (F), Neovista (C), Oraya (F) Program Number: 5029 Poster Board Number: A0191 Presentation Time: 2:45 PM - 4:30 PM Relationship between retinal sensitivity and retinal thickness in eyes with retinal disease Srinivas R. Sadda, Muneeswar Nittala. Ophthalmology, Doheny Eye Institute - USC, Los Angeles, CA. Purpose: To evaluate the point-to-point relationship between local retinal sensitivity as assessed by Optos SLO microperimetry and retinal thickness and volume as determined by optical coherence tomography (OCT). Methods: Twenty four eyes of twenty four subjects with various retinal diseases were enrolled in this IRB-approved prospective cross sectional study. Microperimetry and spectral domain optical coherence tomography (SD-OCT) were obtained on the study eye of all enrolled subjects using an Optos Spectral OCT/SLO (Optos plc, Dunfermline, UK). Microperimetry was performed with the using a standard 45 stimuli pattern spread over the central 12 degrees of the macula (foveal-centered), Goldmann III stimuli, and a 4-2-1 threshold strategy. The OCT-derived retinal thickness map was registered to the microperimetry data by the OCT instrument allowing point-to-point correlation between retinal sensitivity and OCT thickness. Correlation analysis was performed using a total of 1080 loci. Results: The mean age of the study cohort was 69 (SD; 13) years and 50 % were female. Retinal diseases in the study eyes included dry and wet age related macular degeneration, diabetic retinopathy, vein occlusions, macular telangiectasia and central serous chorioretinopathy. The mean baseline best-corrected (log MAR) visual acuity was 0.26 (Snellen ~ 20/30) and the mean (± SD) total retinal sensitivity was 13.70 (± 2.74, range: 6.0 - 16.90) dB. The log MAR visual acuity was significantly correlated with mean retinal sensitivity (r= -0.43, p=0.05), with an expected stronger correlation for foveal sensitivity (r= -0.74, p <0.001). Age was negatively correlated with mean retinal sensitivity (r= -0.42, p=0.05). The mean macular retinal thickness was 273.55 (± 32.31, range: 219 - 388) µm and the mean total retinal volume was 7.70 (± 0.92, range: 6.18 10.94) cubic mm. There was no significant correlation between the mean retinal sensitivity and mean retinal thickness (r=-0.06, p=0.79) or total retinal volume (r=-0.06, p=0.78). The point retinal sensitivity demonstrated a statistically significant, but weak correlation with corresponding point retinal thickness (r=-0.095, p=0.002). Conclusions: Local retinal sensitivity and retinal thickness are not strongly correlated, suggesting that microperimetry can provide independent, and potentially useful information regarding the effect disease on the status of the retina. Commercial Relationships: Srinivas R. Sadda, Regeneron (C), Genentech (C), Allergan (C), Carl Zeiss Meditec (C), Optos (C), Carl Zeiss Meditec (F), Optovue (F), Optos (F); Muneeswar Nittala, None Support: Research to Prevent Blindness Program Number: 5030 Poster Board Number: A0192 Presentation Time: 2:45 PM - 4:30 PM Multimodal Evaluation of Macular Function in Age-related Macular Degeneration Ken Ogino, Akitaka Tsujikawa, Kenji Yamashiro, Sotaro Ooto, Akio Oishi, Isao Nakata, Masahiro Miyake, Ayako Takahashi, Abdallah A. Ellabban, Nagahisa Yoshimura. Kyoto University Graduate School of Medicine, Kyoto, Japan. Purpose: To evaluate macular function using multimodality in eyes with age-related macular degeneration (AMD) at various stages. Methods: Macular function in 20 control eyes (20 subjects), 17 eyes (17 patients) with large drusen, 18 eyes (18 patients) with drusenoid pigment epithelial detachment (PED), and 19 eyes (19 patients) with neovascular AMD were examined by a Landolt chart for visual acuity; retinal sensitivity was measured by microperimetry, and focal macular electroretinography (fmERG) was performed. In all of these eyes, retinal morphology was examined using optical coherence tomography. Results: Eyes with neovascular AMD showed morphologic changes in the neurosensory retina as well as marked deterioration of macular function in all parameters measured with the Landolt chart, fmERG, and microperimetry. Eyes with large drusen showed only minimal morphologic changes in the neurosensory retina. In this large drusen group, although retinal sensitivity at the central point was significantly decreased (P = .0063), other parameters in macular function were well preserved. In eyes with drusenoid PED, structure of the neurosensory retina was well preserved while foveal thickness was significantly increased (P = .013). Macular function of these eyes was significantly deteriorated, with VA, amplitude of the a-wave and b-wave, and the retinal sensitivity being markedly decreased. In addition, the area of PED was correlated with amplitude of the photopic negative response, latency of the a- and b-waves, and retinal sensitivity within the central 4° or 8° region. Conclusions: Multimodal evaluation demonstrates a significant decrease in macular function in drusenoid PED and in neovascular AMD. Commercial Relationships: Ken Ogino, None; Akitaka Tsujikawa, Pfizer (F); Kenji Yamashiro, None; Sotaro Ooto, None; Akio Oishi, None; Isao Nakata, None; Masahiro Miyake, None; Ayako Takahashi, None; Abdallah A. Ellabban, None; Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: Grant-in-Aid for Scientific Research Japan 24791848 Program Number: 5031 Poster Board Number: A0193 Presentation Time: 2:45 PM - 4:30 PM The functional impact of subfoveal SD-OCT characteristic on reading acuity in neovascular age related macular degeneration Florian Sulzbacher1, Christopher G. Kiss1, Stefan Sacu1, Marion R. Munk1, Alexandra Kaider2, Tamara Mittermueller1, Philipp K. Roberts1, Ursula Schmidt-Erfurth1. 1Ophthalmology, Medical University Vienna, Vienna, Austria; 2Center for Medical Statistics, Informatics, and Intelligent Systems; Section for Clinical Biometrics;, Medical University of Vienna, Vienna, Austria. Purpose: To correlate reading acuity in patients with neovascular age-related macular degeneration (nAMD) to specific SD-OCT characteristics of the subfoveal area. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Methods: Fourty four eyes showing untreated nAMD were examined with the Heidelberg Spectralis-OCT. Pateints’ reading acuity (logRAD) was assessed using a German language reading test (Radner Lesetest), visual acuity (logMAR) was assessed using EDTRS charts. Reading- and visual performance was evaluated with respect to the following OCT-findings in the subfoveal area 500x500µm: neovascular complex (NVC), fibrovascular pigment epithelium detachment (fPED), serous pigment epithelium detachment (sPED), subretinal fluid (SRF), intraretinal fluid (IRF) and intraretinal cysts (IRC). Results: Of 44 eyes with nAMD mean reading acuity in logRAD was 0.72 ± 0.3 and mean visual acuity in logMAR was 0.59 ± 0.28 showing a strong correlation of r=0.821 spearmen (P=0,000). In general, in subfoveal NVC, the mean logRAD score was 0.84 ± 0.24, whereas in NVC with additional cysts the mean logRAD score was 1.0 ± 0.18. With SRF, the mean logRAD was 0.58 ± 0.32, whereas with IRF the mean logRAD was measured at 0.70 ± 0.35. A SPED was associated with a mean logRAD score of 0.37 ± 0.10, a FPED was associated with 0.83 ± 0.26 and FPED with additional cyst revealed a mean logRAD score of 0.92 ± 0.28. Conclusions: In nAMD, a severe deficiency in reading acuity was observed especially with subfoveal NVC associated with additional cysts and fibrovascular PED overlying cysts. Morphologic changes of the central retina have a direct impact on reading ability. Commercial Relationships: Florian Sulzbacher, None; Christopher G. Kiss, None; Stefan Sacu, None; Marion R. Munk, None; Alexandra Kaider, None; Tamara Mittermueller, None; Philipp K. Roberts, Canon Inc. (F); Ursula Schmidt-Erfurth, Alcon (C), Bayer Healthcare (C), Novartis (C) Program Number: 5032 Poster Board Number: A0194 Presentation Time: 2:45 PM - 4:30 PM Dark-adapted Microperimetry In Age-related Maculopathy And Geographic Atrophy Michael D. Crossland1, 2, Rola Ba-Abbad1, 2, Simona Degli Esposti2, Adnan Tufail2, 3, Gary S. Rubin1, 3. 1UCL Institute of Ophthalmology, London, United Kingdom; 2Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; 3NIHR Moorfields Biomedical Research Centre for Ophthalmology, London, United Kingdom. Purpose: In order to evaluate the effectiveness of emerging treatments for geographic atrophy, responsive metrics of visual function are required. Histological, psychophysical and questionnaire data indicate reduced rod function in age-related maculopathy (ARM) and geographic atrophy (GA). In this study we use the new test of dark-adapted microperimetry on a cohort of patients with ARM and GA to determine the effectiveness of this test on identifying areas of retinal abnormality. Methods: 20 patients with ARM or GA were recruited. Conventional and dark-adapted microperimetry were performed on a modified microperimeter (MP-1S, Nidek Technologies, Italy). Perimetry maps were registered with autofluorescence images (obtained using Spectralis, Heidelberg Engineering, Germany; superimposed using Navis software (Nidek Technologies, Italy)). Areas of abnormality on the autofluorescence image were identified by an ophthalmologist masked to microperimetry results. Results: On average, more points were not seen at the highest intensity on dark-adapted than conventional microperimetry (mean number of points missed: conventional: 4.45, dark-adapted: 12.2; matched pairs t-test, p<0.01). Dark-adapted sensitivity was poorer over areas of abnormality identified on autofluorescence imaging than over healthy retina (p<0.001). A significant relationship was identified between abnormal autofluorescence and missed points on dark-adapted microperimetry (Cochran-Mantel-Haenszel test, stratified by patient, p<0.0001). Conclusions: Performance on dark-adapted microperimetry was poorer than performance on conventional (mesopic) microperimetry testing in our patients with ARM and GA. Failure to detect a test point on dark-adapted microperimetry was significantly associated with the corresponding retinal location being identified as unhealthy on autofluorescence imaging. These results suggest that dark-adapted microperimetry may be a useful outcome measure in studies of geographic atrophy. Commercial Relationships: Michael D. Crossland, None; Rola Ba-Abbad, None; Simona Degli Esposti, None; Adnan Tufail, Allergan (C), Bayer (C), GSK (C), Oculogics (C), Pfizer (C), Thrombogenics (C), Amakem (C), Heidelberg Engineering (R), Novarits/Alcon (C), Sanofi/Genzyme (C); Gary S. Rubin, None Support: National Institute for Health Research grant PDF/01/2008/011 Program Number: 5033 Poster Board Number: A0195 Presentation Time: 2:45 PM - 4:30 PM Development of a Dark Adaptation Protocol for Use in AMD Clinical Trials Gregory R. Jackson1, John G. Edwards2. 1Ophthalmology, Penn State College of Medicine, Hershey, PA; 2MacuLogix, Hershey, PA. Purpose: About 20% of AMD patients exhibit significant worsening of dark adaptation (DA) over 12 months. This finding supports the potential use of DA as an endpoint in AMD clinical trials. To increase acceptance of DA, it is desirable to reduce the test duration for patients with AMD. The purpose of this project was to develop a new protocol that reduces test duration by 50% compared with our previous standard protocol. Methods: Eleven patients with AMD had their DA measured with three different dark protocols. Each measurement occurred on a different day. Protocol #1 was the previous standard. It utilized a 58,000 scotopic cd/m2 sec bleaching flash at a test location of 5o inferior visual field (VF). Protocol #2 used an 18,000 scotopic cd/m2 sec bleaching flash located at 12o inferior VF. Protocol #3 used a 4,500 scotopic cd/m2 sec bleaching flash located at 12o inferior VF. Results: Protocol #1 (previous standard) produced the slowest DA and longest test duration. Protocol #3 produced the fastest DA and shortest test duration. Protocol #2 produced an intermediate DA speed and test duration. On average, participants exhibited a ~55% reduction in test duration for protocol #2 compared with protocol #1. For a typical AMD patient, protocol #1 produced a rod intercept of 17.5 minutes which was reduced to 7.8 minutes by Protocol #2. Protocol #3 produced a very fast recovery of dark adaptation consistent with a rod intercept of 3.1 minutes. For Protocol #3, four of 11 participants had rod intercepts less than 3.1 minutes. It was concluded that Protocol #3’s DA functions were too fast to allow for the possibility of a significant improvement in DA performance in response to intervention. Thus, Protocol #2 was selected as the preferred new protocol. Conclusions: DA measurement in response to a moderate 18,000 scotopic cd/m2 sec bleaching flash located at 12o inferior to the fixation light produces a wide range of rod intercept values from about five minutes to 35 minutes across the range of AMD severity from early AMD to high-risk AMD. This protocol is under further evaluation in a natural history study and an intervention study. Further test duration reduction may be possible if the population of interest is restricted to high-risk AMD patients. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Gregory R. Jackson, MacuLogix (F), MacuLogix (I), MacuLogix (E), Genentech (R); John G. Edwards, MacuLogix, Inc (I), MacuLogix, Inc (E), MacuLogix, Inc (P), MacuLogix, Inc (S) Support: NIH Grant EY019593 Program Number: 5034 Poster Board Number: A0196 Presentation Time: 2:45 PM - 4:30 PM High Angular Resolution Peripheral Refraction in Patients with Age Related Macular Degeneration Bart Jaeken2, 1, Encarna Alcón1, 3, Jose María Marín3, Pablo Artal1. 1 Laboratorio de Optica, Universidad de Murcia, Murcia, Spain; 2 R&D, Voptica, Murcia, Spain; 3Oftalmología, Hospital Virgen de la Arrixaca, Murcia, Spain. Purpose: The Hartmann-Shack (HS) wavefront sensor was used to determine the peripheral refraction (PR) at specific angles in subjects with age related macular degeneration (AMD) (Lundström et al., Optom Vis Sci 2007). The correction of the PR in those subjects could improve their visual acuity at eccentric locations. However, instrumentation specifically designed for accurate and fast measuring PR was never tested in those patients. Easy determination of PR could provide those patients with customized corrections. Methods: We adapted a fast scanning peripheral HS wavefront sensor previously developed (Jaeken et al., Opt Exp 2011). Its design makes it possible to measure fast (order of seconds) and with a high angular resolution (1 measurement/°) a large part of a horizontal meridian of the visual field (50°). Two fixation methods were tested: placing the target in the patient’s preferred retinal location (PRL) and having the PRL aligned to the center of the measuring system. For both applications a red laser beacon was projected on a wall at 2 meter from the patient. The stability of fixation while scanning was determined looking at the position of the pupil in each frame of a scan. PR (sphere and cylinder) was determined from the series of recorded HS images. The repeatability of 4 consecutive scans was compared with that in normal elderly eyes. The light distribution within the HS spots was evaluated intra-patient between the different retinal areas. Results: No variation in the quality of the HS images was observed between the areas with and without retinal damage. Small displacements of the centre of the pupil were registered, although this did not affect the refraction results. The repeatability of the 4 scans in eyes with AMD was not different from that in normal elderly eyes. In some subjects anomalies were observed in the HS images which are presumed to come from a plane close to the pupil plane. Since some of the patients did not undergo cataract surgery, it probably comes from crystalline lens opacities. The measured PR of PRL varied among subjects. Conclusions: An adapted scanning peripheral wavefront sensor was found to be a functional tool for measuring fast and accurately the PR in AMD patients. This refractive information can be useful for customized corrections. For example, they could benefit from a custom designed intraocular lens adjusted to their exact PR at their PRL. Commercial Relationships: Bart Jaeken, PCT/ES2011/070640 (P); Encarna Alcón, None; Jose María Marín, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD2007-00013) and Fundación Séneca, Region de Murcia, Spain (grant 4524/GERM/06) Program Number: 5035 Poster Board Number: A0197 Presentation Time: 2:45 PM - 4:30 PM Compensation of fixational instability by the NIDEK MP-1 micro-perimeter Arunkumar Krishnan, Harold E. Bedell. University of Houston College of Optometry, Houston, TX. Purpose: Micro-perimeters are used increasingly to assess patients with central field loss, because of the reported capability of these instruments to compensate for fixational eye movements and present test stimuli repeatably at an intended retinal location. In this study we investigated the precision of eye-movement compensation by the NIDEK MP-1, when the fixation instability of normal subjects is increased by changing the size of the fixation target. Methods: Retinal sensitivity for horizontal (H) and vertical (V) traverses across one edge of the optic disc were assessed in one eye of 7 normal subjects, aged 25-35 years. Two fixation targets were chosen to promote ‘more’ and ‘less’ stable foveal fixation, respectively: a 1 deg cross and a 10 deg circle. A customized 15 x 2 element array of Goldmann size II test stimuli, each separated by 0.1 deg, was positioned horizontally across the temporal disc margin or vertically across the inferior or superior disc margin. An in-built 4-21 strategy determined the detection threshold for each stimulus element in the array. The MP-1 recorded the distribution of fixation positions during testing, from which the standard deviation (SD) of fixation was computed in both the H and V directions. Cumulative Gaussians were fit to the threshold profiles obtained during fixation on the cross and circle and the fitted SD for the circle fixation target was compared to the expected value based on an additive-variance model. Percent compensation during fixation on the circle target was defined as (expected SD - observed SD) / (expected SD). Results: Average fixational SDs increased from 0.20 to 0.65 deg (H) and 0.20 to 0.72 deg (V) for fixation on the cross and circle targets, respectively. Best-fit Gaussians to the perimetric profiles had SDs that were not significantly shallower during fixation on the circle compared to the cross (P = 0.11 [H]; P = 0.68 [V]). The average percent compensation for the increase in fixation instability on the circle target, was 91.7% (H) and 86.6% (V), corresponding to an increase in the SD of retinal image scatter of 2.2 (H) and 3.8 (V) min arc. Conclusions: The NIDEK MP-1 compensates well for an increase in fixational instability in the horizontal and vertical directions. This compensation ensures that, even in subjects with unstable fixation, perimetric test stimuli are presented close to the intended retinal locations. Commercial Relationships: Arunkumar Krishnan, None; Harold E. Bedell, None Support: Minnie flaura turner fund for impaired vision research, University of Houston sVGR. Program Number: 5036 Poster Board Number: A0198 Presentation Time: 2:45 PM - 4:30 PM BCEA evaluation after pattern stimulation in wet AMD patients Enzo M. Vingolo, Paolo G. Limoli, Serena Fragiotta, Vittoria De Rosa, Daniela Domanico. UOC Ophthal Hosp "SM Goretti" LT, University La Sapienza of Rome, Roma, Italy. Purpose: age related macular degeneration is one of the main cause of visual impairment in elderly people. We studied and compared the efficacy of rehabilitation by means of two different type of biofeedback techniques with MP-1 microperimeter in patients with evoluted AMD. Methods: We enrolled 30 patients, mean age 76,38yrs (8,77SD) bilaterally affected by wet AMD. Patients were randomly divided in two groups: A was treated with an acoustic biofeedback, group B was treated with a luminous biofeedback constituted by a black and white checkerboard flickering during the examination. All patients ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics underwent a complete ophthalmological examination including: best distance and near visual acuity assessment, reading speed test, MP-1 microperimetry evaluating BCEA. Low vision rehabilitation consisted in 12 training sessions of 10 minutes for each eye performed once a week with MP-1 for both groups. Statistical analysis was performed using Student’s t- test. Results: After training all patients displayed an improvement in visual acuity, fixation behaviuor, retinal sensitivity and reading speed. Group A: visual acuity was not statistically improved (p=0.054), reading speed showed statistically significant improvement (p=0.031), and a statistically significant reduction in average BCEA fixation (p=0.0023) was evidenced and a mean single point retinal sensitivity value was also improved (p=0.044). Group B: visual acuity was statistically higher (p=0.048), reading speed showed statistically significant improvement (p=0.024), a statistically significant high reduction in BCEA (p=0.0012) was evidenced and a mean single point retinal sensitivity value was also improved (p=0.027). Conclusions: Our results show that biofeedback techniques can improve fixation stability. Audio feedback and pattern stimulus facilites transmission between intraretinal neurons as well as between the retina and the brain, thereby probably facilitating a remapping phenomenon. Furthermore, highly informative and contrast rich pattern stimulus showed a statistically significant difference towards uninformative plain exercise limited to train the PRL as obtained with older software, thus indicating that it is possible with more informative tasks to reach a wider involvement of cell populations and recruit more and more efficient ganglion cell receptive fields so to better utilize the residual retinal function. Commercial Relationships: Enzo M. Vingolo, None; Paolo G. Limoli, None; Serena Fragiotta, None; Vittoria De Rosa, None; Daniela Domanico, None Support: Sapienza C26A10NRES/2010 Program Number: 5037 Poster Board Number: A0199 Presentation Time: 2:45 PM - 4:30 PM The Influence of Fixation Stability on Balance in Patients with a Central Scotoma Caitlin Murphy1, 4, Janette Chu2, Eoghan Landy2, Jean-Christophe Campbell2, Amy Phan2, Olga Overbury1, 3. 1School of Optometry, University of Montreal, Montreal, QC, Canada; 2Physiotherapy, McGill University, Montreal, QC, Canada; 3Ophthalmology, McGill University, Montreal, QC, Canada; 4Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada. Purpose: Vision is second only to the vestibular system in terms of its contribution to balance. Research has shown that visually impaired people (VIPs) often have problems in this domain. Some major visual disorders damage the central retina. To compensate for the loss of a functioning fovea, those affected use their remaining peripheral retina to accomplish daily tasks. This sometimes results in the formation of an unstable, non-central fixation point. The purpose of this study was to determine if reduced balance in VIPs is related to unstable fixation. Methods: Individuals with a visual acuity of 20/200 or better and a diagnosis of a retinal disorder, were recruited for this study. There were 44 participants (23 M and 21 F) ranging in age from 47 to 89 years. Fixation stability was determined using the Mirametrix Eye Tracker and participants were then divided into two groups: stable fixation and poor fixation. Functional balance was measured using the Timed Get-Up-and-Go (TUG) and the Berg Balance Scale (BBS). Balance confidence was assessed using the Activities-Specific Balance (ABC) Scale. The examiners conducting the balance tests were masked to the fixation status of the participants. Results: Performance on the TUG test was significantly different between the groups, with the poor-fixation group having a slower TUG time than the stable-fixation group, t (42) = 1.7263, p < .05. Clinically, taking more than 13.5 seconds to complete the task indicates an increased risk of falls. The poor fixation stability group had a mean score of 14.3 seconds. There was no significant difference in functional balance between the stable- and unstablefixation groups as determined by the BBS. Subjects with poor fixation stability scored lower on the ABC scale compared to the stable fixation group, t (42) = -1.856, p < .05. However, their scores were not low enough to have any clinical significance. Conclusions: Based on the TUG, VIPs with unstable fixation are at a higher risk of falls compared to those with stable fixation. Although there is a statistically significant difference between the two groups on the ABC scale, it is not great enough to conclude that those with poor fixation are at risk of falls. Commercial Relationships: Caitlin Murphy, None; Janette Chu, None; Eoghan Landy, None; Jean-Christophe Campbell, None; Amy Phan, None; Olga Overbury, None Program Number: 5038 Poster Board Number: A0200 Presentation Time: 2:45 PM - 4:30 PM Impact of Visual Motion Displayed in a Non-Immersive HeadMounted Device on the Balance of Patients with Age-Related Macular Degeneration Caroline Chauvire1, Coen Cecilia1, Arnaud Koustanai1, Johan Le Brun1, Samuel Pineau1, Thierry Villette2, Philippe Chaumet-Riffaud1, 3 , Saddek Mohand-Said1, Jose A. Sahel1, Avinoam B. Safran1. 1 INSERM, U968; UPMC Univ Paris 06, UMR_S 968, Institut de la Vision; CNRS, UMR_7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; 2Essilor R&D International, Paris, France; 3Univ Paris Sud, AP-HP, CHU Bicêtre, Paris, France. Purpose: Age-related Macular Degeneration (AMD) results in a reduced visual acuity (VA). Head-Mounted Displays (HMD) may be useful for affected individuals, by magnifying, freezing and dragging the view, vertically or horizontally, to relieve from reduced field of vision due to magnification. However, changes in image (size and movements) are susceptible to disturb visuomotor coordination and thus to disrupt postural control. The aim of this study was to evaluate the impact of changes in image on the balance of AMD patients, when using a non-immersive HMD. Methods: Three groups were included: 12 patients with atrophic AMD (AMDs: age between 62 and 81 years, mean 70; VA between +1.22 and +0.28 logMAR , mean +0.62), 6 older healthy subjects (OH: age between 65 and 75 years, mean 70; VA between 0 and -0.2 logMAR, mean -0.04), and 5 young healthy subjects (YH: age between 30 and 48 years, mean 37 ; VA between +0 and -0.1 logMAR, mean -0,01). Subjects stood in the dark on a stable force plate. A virtual street was projected onto a wall-screen. For comparison, subjects were tested without HMD eyes closed (EC) and eyes open (EO). When tested with HMD, subjects wore a non-immersive binocular opto-electronic device, displaying an image through transparent lenses. They viewed the scene moving successively in vertical and horizontal directions and from one size to another. In non-immersive mode, subjects viewed the scene both onto the wall-screen and in-motion through the HMD. In immersive mode, they only viewed the scene in-motion through HMD. Average velocity of center of pressure (V) was recorded. Each trial lasted 51.2 s and was repeated 3 consecutive times. Results: Difference between EO and EC was greater in OH than in AMDs and YH (p<.03). V was higher in immersive than in non- ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics immersive mode (p<.01). There was no significant difference between AMDs and OH (p=.7). The postural effects generated by the HMD image did not differ according to groups or modes of presentation. (p=.4). Conclusions: AMD patients demonstrated a smaller visual contribution to postural control than age-matched healthy subjects. Visual motion generated by the HMD did not induce stronger balance disruption in AMD patients than in healthy subjects, and never exceed sway in EC. Furthermore, immersive condition generated more instability than non-immersive condition for all subjects. Commercial Relationships: Caroline Chauvire, None; Coen Cecilia, None; Arnaud Koustanai, None; Johan Le Brun, None; Samuel Pineau, None; Thierry Villette, ESSILOR (E), ESSILOR (P); Philippe Chaumet-Riffaud, None; Saddek Mohand-Said, None; Jose A. Sahel, UPMC/Essilor (P), Second Sight (F); Avinoam B. Safran, essilor (F) Program Number: 5039 Poster Board Number: A0201 Presentation Time: 2:45 PM - 4:30 PM Comparing the fixational and functional preferred retinal locus Brian Sullivan, Laura Renninger. Smith-Kettlewell Eye Research Institute, San Francisco, CA. Purpose: Individuals with central vision loss (CVL) may adopt a preferred retinal locus (PRL) to eccentrically view stimuli in peripheral retina. PRLs are often defined by measuring the location and extent of peripheral retinal subtended by a small fixation stimulus viewed monocularly with the head stabilized. It is not known if this ‘fixational’ PRL is representative of situations where binocular vision and head movements are allowed, or when stimulus properties are varied. Methods: Monocular visual fields were recording by having subjects detect small suprathreshold stimuli using a scanning laser ophthalmoscope (SLO). Fixational PRLs were measured by having subjects fixate a stimulus for 10s and fitting a bivariate contour ellipse to this data. Using a similar methodology, a second setup using a binocular eye tracker, chin rest and monitor was used to record monocular and binocular visual fields and fixational PRLs. Subjects then participated in a reaching task where their functional PRLs could be evaluated and compared to the fixational PRLs described above. Subjects performed unspeeded reaches to targets presented on a LCD touch screen at a one of eight of positions presented at three eccentricities (5,10 and 15°). Trials were blocked so that subject made reaches with or without head movements, monocularly and binocularly. ‘Functional’ PRLs were measured by using the location of the reach target in the visual field at the reach endpoint. Results: We have established means to measure monocular visual fields in the SLO and on a computer monitor, with reasonable agreement. Additionally, binocular visual fields may be predicted from the monocular SLO data and compared to measured binocular fields assessed with the eye tracker setup. We present fixational and functional PRL data, including location and extent, using the bivariate contour ellipse area. Preliminary results give evidence that the fixational PRL is not always representative of the functional PRL. Subject reach duration and accuracy data are also presented. Conclusions: Although an ongoing study, our data thus far suggest that the PRL is flexible under task changing stimulus conditions during a reaching task. Further study is needed to better delineate the circumstances in which this flexibility occurs. Commercial Relationships: Brian Sullivan, None; Laura Renninger, None Program Number: 5040 Poster Board Number: A0202 Presentation Time: 2:45 PM - 4:30 PM Maximum Reading Speed and Binocular Summation in Patients with Central Vision Loss Luminita Tarita-Nistor1, 2, Esther G. Gonzalez1, 2, Michael H. Brent3, 4 , Samuel N. Markowitz3, 4, Martin J. Steinbach1, 2. 1Vision Science Research Program, Toronto Western Hospital, Toronto, ON, Canada; 2 Centre for Vision Research, York University, Toronto, ON, Canada; 3 Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 4Ophthalmology, Toronto Western Hospital, Toronto, ON, Canada. Purpose: Visual acuity is a poor predictor of the maximum reading speed of patients with central vision loss. We hypothesized that the maximum reading speed is a function of binocular summation of acuity for these patients. Methods: Maximum reading speed of 20 patients with central vision loss (mean age = 77 ± 13 years) was measured binocularly using the MNRead charts. Monocular and binocular acuities were measured with the ETDRS chart. Binocular summation was evaluated with a binocular ratio (BR) calculated as the ratio between the acuity of the better eye to binocular acuity. Fixation stability and PRL distance from the former fovea were evaluated with the MP-1 microperimeter. Results: Six patients experienced acuity summation (BR > 1.05), 5 experienced acuity inhibition (BR < 1.05), and 9 showed equality (BR = 1 ± .05). There were no differences in the mean acuity of the better eye, fixation stability, or PRL distance from the fovea of the three groups. Maximum reading speed was significantly slower (p < .05) for patients who experienced binocular inhibition (mean 42 ± 27 wpm, median 40 wpm) than for those who experienced binocular summation (mean 107 ± 39 wpm, median 108 wpm), or equality (mean 111 ± 62 wpm, median 90 wpm). BR correlated with the maximum reading speed for the overall sample (r(18) = .49, p = .03). BR together with PRL distance from the former fovea in the better eye explained 45% of the variance in maximum reading speed. Conclusions: Binocular summation of acuity rather than visual acuity alone predicts maximum reading speed of patients with central vision loss. Patients with binocular inhibition read significantly slower than those with binocular summation or equality. Assessment of binocular summation is important when devising reading rehabilitation techniques. Commercial Relationships: Luminita Tarita-Nistor, None; Esther G. Gonzalez, None; Michael H. Brent, None; Samuel N. Markowitz, None; Martin J. Steinbach, None Support: Milton Harris Fund for Adult Macular Degeneration (MHB); Natural Sciences and Engineering Research Council of Canada (NSERC) grant A7664 (MJS); Vision Science Research Program, Toronto Western Hospital; Sandra and David Smith postdoctoral fellowship; and an anonymous donor. Program Number: 5041 Poster Board Number: A0203 Presentation Time: 2:45 PM - 4:30 PM Predictive Factors of Reading Performance Post Reading Rehabilitation Program in Central Field Loss Patients Salvatore Di Lauro, Maria B. Coco, Alberto López-Miguel, Rubén Cuadrado, Agustin Mayo, José Alberto De Lázaro, Miguel J. Maldonado, Joaquín Herrera, Laura Mena, Jose-Carlos Pastor. Retina- Low Vision, IOBA Eye Institute, University of Valladolid, Valladolid, Spain. Purpose: Reading is the main complaint of central field loss (CFL) patients. Reading fluency might depend on visual and psychosocial factors, thus this study assesses whether visual and psychosocial variables can predict reading performance (RP) after a reading rehabilitation program (IOBA-RRP). Methods: Seventy-six CFL patients were recruited at IOBA-Eye ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Institute from the vision rehabilitation unit. Patients without previous experience of low vision optical aids use underwent a vision rehabilitation program (the IOBA-RRP). Visual (reading speed and duration, visual acuity and magnification) and psychosocial questionnaire outcomes were recorded before and after undergoing the 6-week training. Odds ratios (ORs) were calculated to assess the predictive value of these variables. Results: Contrast sensitivity (OR’s: 2.94, 95% confidence intervals (CI): 0.99-8.33), age (OR’s: 0.21, 95% CI: 0.06-0.74) and Geriatric Depression Scale (GDS) score (OR’s: -2.33, 95% CI: 1.16-4.76) were associated with improvement in reading speed. Conclusions: Better contrast sensitivity, older age and lower GDS scores can predict success on reading fluency in CFL patients after reading rehabilitation training. Commercial Relationships: Salvatore Di Lauro, None; Maria B. Coco, None; Alberto López-Miguel, VISIÓN I+D, SL (E); Rubén Cuadrado, None; Agustin Mayo, None; José Alberto De Lázaro, None; Miguel J. Maldonado, None; Joaquín Herrera, None; Laura Mena, None; Jose-Carlos Pastor, None Support: RD 12/0034/0001 Program Number: 5042 Poster Board Number: A0204 Presentation Time: 2:45 PM - 4:30 PM Do Pedestrians Make Safe Street-Crossing Decisions? Shirin E. Hassan. School of Optometry, Indiana University, Bloomington, IN. Purpose: The aim of this study was to determine whether the streetcrossing decisions of subjects with Age-related Macular Degeneration (AMD) are as safe as those made by young and older subjects with normal vision. Methods: Street-crossing decisions and crossing times in 12 AMD subjects, 20 young and 20 older control subjects with normal vision were measured along an unsignalized street for nine different gap time categories. Using their habitual vision and hearing, subjects observed an approaching vehicle for two seconds. At the end of the two second period, subjects were required to make a crossing decision of whether or not they thought it was safe to cross the street. Subjects’ crossing decisions were then objectively classified as being “safe” when the measured gap time was longer than the subject’s street-crossing time. The converse was true for objectively classifying crossing decisions as being “unsafe”. The proportion of safe crossing decisions (ie. subjects reporting it was safe to cross for objectively safe gap times) and unsafe crossing decisions (ie. subjects reporting it was safe to cross for objectively unsafe gap times) was determined for each subject group and gap time category. A hierarchical logistic regression, with repeated measures for subject, was used to determine if the proportion of safe and unsafe decisions changed as a function of subject group and gap time category. Results: We observed that the older normally-sighted subjects made more unsafe crossing decisions compared to the AMD subjects for gap times that were between four and one second shorter than the time they needed to cross the street. However, the differences between these two groups were only marginally significant (p=0.06, p=0.05, p=0.04 and p=0.05 for gap times that were four, three, two and one second shorter than subjects’ crossing times, respectively). No significant difference in the proportion of unsafe decisions were found between the young and older normally-sighted subjects (p>0.05) and between the young normally-sighted and AMD subjects (p>0.05). No significant differences in the proportion of safe crossing decisions were also found between the different subject groups for gap times that were longer than subjects’ crossing times (p>0.05). Conclusions: Our data suggests that older pedestrians with normal vision have a tendency to adopt a more risky crossing strategy than either the young normally-sighted or AMD pedestrians. Commercial Relationships: Shirin E. Hassan, None 508 Improving Imaging and Ophthalmic Instrumentation Thursday, May 09, 2013 8:30 AM-10:15 AM Exhibit Hall Poster Session Program #/Board # Range: 5543-5554/B0053-B0064 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 5543 Poster Board Number: B0053 Presentation Time: 8:30 AM - 10:15 AM Stabilized cone imaging with adaptive optics optical coherence tomography Omer P. Kocaoglu1, R. D. Ferguson2, Zhuolin Liu1, Ravi S. Jonnal1, Qiang Wang1, Daniel X. Hammer3, Donald T. Miller1. 1School of Optometry, Indiana University, Bloomington, IN; 2Physical Sciences Inc., Andover, MA; 3Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD. Purpose: Cone photoreceptors exhibit a complex optical signature that has become increasingly valuable in ophthalmologic examination. Adaptive optics optical coherence tomography (AOOCT) is a highly sensitive method that is particularly well suited for 3D imaging the cone signature. Like all in vivo retinal imaging methods, however, AO-OCT suffers from the effects of involuntary eye movements that blur and distort the image, especially at the cone level. Compensation of movement can be realized with registration algorithms in post processing or dynamic retinal tracking in hardware. Tracking is particularly attractive for AO-OCT as it can compensate for eye motion larger than the imaging field of view and permits repeated imaging of the same retinal patch. In light of these advantages, this study examines the efficacy of an active retinal tracker integrated into AO-OCT for cone imaging. Methods: The 2nd-generation Indiana AO-OCT system was integrated with a customized retina tracker module. Key AO-OCT components included a broadband light source (λc=800nm, Δλ=160nm, bandpassed to Δλ=80nm), an astigmatism-free sample arm, and a high-speed linescan camera operating at 100K Alines/s. The tracker module was designed to stabilize the location of the AOOCT beam relative to a specific retinal landmark tracked at 1060nm, and to provide a 35° field of view SLO image at 950 nm. Closed-loop tracking performance was assessed by comparing cone motion in 1.8°x1.8° volume videos acquired with and without dynamic retinal tracking. Videos were obtained at 4° nasal and 3° superior to the fovea of a normal subject (30 yrs). Five sessions of volume videos were collected, each consisting of five volumes (1 vol/s). En face projections of the AO-OCT volumes were assessed for lateral cone motion. To avoid masking tracker performance, no post-processing registration was applied to the videos. Results: The average maximum cone displacement was 18±5μm with tracking compared to 150±107μm without tracking, a factor of eight improvement. The corresponding contrast improvement in the averaged en face cone image was 38% (p=0.008). Tracking was sufficiently robust to find repeatedly the same cone patch across sessions. Conclusions: Dynamic tracking stabilized AO-OCT cone images, sufficiently so for monitoring the same cones over time. Commercial Relationships: Omer P. Kocaoglu, None; R. D. Ferguson, Physical Sciences Inc (E), Physical Sciences Inc (P); Zhuolin Liu, None; Ravi S. Jonnal, 7,364,296 (P); Qiang Wang, ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics None; Daniel X. Hammer, Physical Sciences Inc. (C), Physical Sciences Inc. (P); Donald T. Miller, n/a (P) Support: NEI Grants 5R01 EY014743, 1R01 EY018339, P30EY019008 Program Number: 5544 Poster Board Number: B0054 Presentation Time: 8:30 AM - 10:15 AM In vivo Imaging of the Human Retinal Pigment Epithelium Cell Mosaic using Short-wavelength Autofluorescence and achromatizing lenses Alfredo Dubra1, 2, Drew H. Scoles3, Yusufu N. Sulai4. 1 Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 2 Biophysics, Medical College of Wisconsin, Milwaukee, WI; 3 Biomedical Engineering, University of Rochester, Rochester, NY; 4 The Institute of Optics, University of Rochester, Rochester, NY. Purpose: Although adaptive optics (AO) imaging of the human retinal pigment epithelium (RPE) cell mosaic using intrinsic fluorescence has been recently demonstrated, it remains difficult to perform. This is mostly due to light safety limitations, the presence of longitudinal chromatic aberration (LCA) in the eye and more importantly, its variation across individuals. This last point complicates the focusing of the illumination (excitation) and the imaging (emission) channels, as they need to be adjusted for each individual. Here we explore the use of achromatizing lenses to mitigate this problem by compensating for the LCA that would be found in an average eye, thus bringing to closer focus the excitation and emission wavelength ranges. Methods: An AO scanning light ophthalmoscope (AOSLO) that allows simultaneous near-infrared (NIR) and visible imaging was modified with achromatizing lenses in the pupil planes of the illumination and imaging paths. Images were recorded in four subjects using a 2° field of view, 30 μW of 850 nm light for wavefront sensing, 92 μW of 790 nm light for reflectance imaging and 60 μW of 560-570 nm light for fluorescence excitation. At each retinal location, the excitation was first brought into focus onto the photoreceptor layer in reflectance, and then shifted towards the RPE. This was followed by simultaneous NIR reflectance and fluorescence imaging during 60-120 seconds using a 2.5 Airy disk confocal aperture and a 625 nm central wavelength (90 nm bandwidth) in the visible channel. Results: Imaging the photoreceptor mosaic using a broadband excitation light source (10 nm bandwidth) in reflectance greatly facilitates the focusing of the RPE imaging in fluorescence. The contiguous RPE cell mosaic can be visualized using safe light levels in human subjects after recording images at multiple foci. Conclusions: RPE imaging at the cellular scale is facilitated by the use of achromatizing lenses, although further improvement to this method requires accounting for inter-subject variations of LCA. The ability to visualize the RPE mosaic holds promise for studying and diagnosing retinal degenerations such as age related macular degeneration, as well as evaluating new therapies. RPE cell mosaic in two different human subjects, with the fluorescent signal originating from lipofuscin containing granules (scale bars are 50 μm across). Commercial Relationships: Alfredo Dubra, US Patent No: 8,226,236 (P); Drew H. Scoles, None; Yusufu N. Sulai, None Support: Glaucoma Research Foundation Grant Catalyst for a Cure grant, Research to Prevent Blindness Career Development Award and Burroughs Wellcome Fund CASI award. Program Number: 5545 Poster Board Number: B0055 Presentation Time: 8:30 AM - 10:15 AM A novel compact optical instrument for the clinical measurement of intraocular light scattering Onurcan Sahin1, Harilaos S. Ginis2, 1, Guillermo M. Perez3, Juan M. Bueno2, Pablo Artal2. 1Institute of Vision & Optics, University of Crete, Heraklion, Greece; 2Laboratorio de Optica, Universidad de Murcia, Murcia, Spain; 3Voptica SL, Murcia, Spain. Purpose: To develop a compact instrument to measure light scattering in the human eye for angles in the range between 3 and 9 degrees of visual angle. Methods: The instrument is based on a previous laboratory setup using extended light sources in a double-pass (DP) configuration (Ginis et al., J of Vision, 2012). The light source is an array of green (528±10 nm) light emitting diodes (LEDs) spatially homogenized by light shaping diffusers. The field is separated in 2 zones: a central area (corresponding to visual angles from 0 to 3 degrees (in radius) and an annular area (3 to 9 degrees). In both zones LEDs are squarewave temporally modulated at 483 Hz and 769 Hz for the central and peripheral areas respectively. Two annular diaphragms conjugated with the cornea and the lens allow the projection of the source on to the retina while leaving the central part of the pupil free of back scattered light and reflections. Light reflected from the fundus is sensed through a circular diaphragm conjugated with the center of the pupil with no overlapping of the illumination and measurement paths. A pupil camera controls the alignment. The light reflected from the central retinal area (15-arcmin) is selected through a circular diaphragm and a pinhole by a photodiode. The Fourier transform of the signal reveals the contribution of each annulus and therefore the average intensity of scattered light for the corresponding angles. The total measurement time is 200 msec. Results: Functionality, sensitivity and repeatability of the method were demonstrated with an artificial eye and two different previously characterized diffusers. The equivalent logarithm of the straylight parameter measured for the diffusers were 0.67 (SD=0.005) and 0.84 (SD=0.003), values not statistically significantly different than the anticipated. Pilot measurements in human eyes were also obtained. A careful analysis of the artifacts associated to alignment and refractive errors was also performed. Conclusions: A new compact instrument suitable for routine or clinical measurements of light scattering in the eye was developed. It ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics builds on previous experience with multi-wavelength, highsensitivity, imaging double-pass system for the measurement the wide-angle point-spread function of the eye. Commercial Relationships: Onurcan Sahin, None; Harilaos S. Ginis, Universidad de Murcia (P); Guillermo M. Perez, VOPTICA (E); Juan M. Bueno, None; Pablo Artal, AMO (C), Voptica SL (P), Voptica SL (I), AMO (F), Calhoun Vision (F), Calhoun Vision (C), AcuFocus (C) Support: ITN OpAL (PITN-GA-2010-264605), Ministerio de Ciencia e Innovación, Spain (grants FIS2010-14926 and CSD200700013), Fundación Séneca (Region de Murcia, Spain), grant 4524/GERM/06. Program Number: 5546 Poster Board Number: B0056 Presentation Time: 8:30 AM - 10:15 AM The Effect of AOSLO Image Distortion on Metrics of Mosaic Geometry Robert F. Cooper1, Zachary Harvey2, Michael Dubow3, 4, Yusufu N. Sulai5, Alexander Pinhas3, 4, Drew H. Scoles6, Nishit Shah3, Richard B. Rosen3, Alfredo Dubra2, 7, Joseph Carroll2, 8. 1Biomedical Engineering, Marquette University, Milwaukee, WI; 2 Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 3 New York Eye and Ear Infirmary, New York, NY; 4Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY; 5The Institute of Optics, University of Rochester, Rochester, NY; 6 Biomedical Engineering, University of Rochester, Rochester, NY; 7 Biophysics, Medical College of Wisconsin, Milwaukee, WI; 8Cell Biology, Medical College of Wisconsin, Milwaukee, WI. Purpose: Adaptive Optics Scanning Light Ophthalmoscopes (AOSLOs) permit near diffraction-limited imaging of the human photoreceptor mosaic, though intraframe eye movements lead to image distortion. Here, we explore the impact of these distortions on a number of metrics commonly used to characterize the photoreceptor mosaic. Methods: We acquired 9 image sequences of the parafoveal cone mosaic from 7 subjects on 3 similar AOSLOs. In another subject, we acquired an AOSLO and flood-illuminated AO image sequences of the same retinal location. To assess the effect of distortions within AOSLO images, ten averaged images were produced by registering against different reference frames using a previously described algorithm. The images were then registered with the same software while tracking the distortion applied to each image. The photoreceptor coordinates from the reference frame were transformed using this distortion. Voronoi geometry, cone density, nearestneighbor distance (NND), inter-cell spacing (ICS), and regularity index (RI) were calculated for each set of images. Repeatability was calculated to assess the effect of intraframe distortion on these metrics. Results: Across the AOSLO images, we analyzed 17,942 cones, 75% of which retained the number of sides in the corresponding Voronoi domains across the 10 images (range 56%-90%). Cone density was found to have a repeatability of 1.8% (i.e., the difference between any 2 measurements on the same subject would be less than 1.8% for 95% of observations). NND and ICS had even better repeatability, at 1.4% and 0.95%, respectively. In contrast, the NND RI and ICS RI had a repeatability of 11% and 31%, respectively. Comparing an AOSLO image set to a flood-illuminated AO image, we found similar repeatability (density: 2.7%, NND: 0.7%, ICS: 0.83%, NND RI: 8.9%, ICS RI: 20.3%) and 83% of cells had retained Voronoi geometry. Conclusions: Global metrics (density and cell spacing) are minimally affected by intraframe distortions, whereas local metrics (regularity index and Voronoi geometry) are more significantly affected. Intraframe distortion in AO scanning instruments limits the measurement accuracy of mosaic geometry, thus every effort should be made to choose minimally distorted reference frames. Commercial Relationships: Robert F. Cooper, None; Zachary Harvey, None; Michael Dubow, None; Yusufu N. Sulai, None; Alexander Pinhas, None; Drew H. Scoles, None; Nishit Shah, None; Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); Alfredo Dubra, US Patent No: 8,226,236 (P); Joseph Carroll, Imagine Eyes, Inc. (S) Support: RPB, NIH (UL1RR031973, EY017607, EY001931), Foundation Fighting Blindness, Alcon Research Institute, Burroughs Wellcome Fund Program Number: 5547 Poster Board Number: B0057 Presentation Time: 8:30 AM - 10:15 AM Photoreceptor imaging with in-the-plane adaptive optics optical coherence tomography using toroidal mirrors Zhuolin Liu, Omer P. Kocaoglu, Qiang Wang, Donald T. Miller. School of Optometry, Indiana University, Bloomington, IN. Purpose: Recent technological advances in adaptive optics (AO) and high-resolution ophthalmoscopy have resulted in sharper images of the cellular retina than previously possible. As part of these ongoing developments, we have re-engineered the Indiana AO-OCT system to improve imaging performance. In this study, we assessed system performance for imaging the 3D structure of photoreceptors. Methods: The 2nd generation Indiana AO-OCT system is based on a novel in-the-plane design of an off-axis ophthalmic AO system realized with toroidal mirrors. Unlike conventional designs that rely on all spherical mirrors, the inclusion of toroidal mirrors avoids accumulation of system astigmatism and unwanted beam displacement at pupil conjugate planes. As part of the new design, the AO system was upgraded with a 97-magnetic-actuator ALPAO wavefront corrector to improve stroke and fidelity, and a ShackHartmann wavefront sensor configured with an Andor Neo scientific CMOS camera to improve sensitivity and speed. To assess performance, volume images of the retina with focus at the photoreceptor layer were acquired at retinal eccentricities ranging from the fovea to 6 degrees in human subjects. Power spectra were computed of en face images at different depths in the photoreceptor layer. Each spectrum was radially averaged to increase signal to noise. Results: Ray trace analysis of the in-the-plane design predicts diffraction-limited imaging across the entire 3.6°x3.6° field of view of the AO-OCT system. Beam displacement of less than the pitch of the SHWS lenslet array is also predicted, thus enabling the full sensitivity of the SHWS to high spatial frequencies. Measured beam displacement and wavefront root-mean-square error of the system confirmed the theoretical predictions. Cone photoreceptors were routinely observed at retinal eccentricities as small as 0.2 degrees. This corresponds to cones narrower than that detected with the previous Indiana AO-OCT system. Analysis of power spectra at the inner segment / outer segment junction, and posterior tip of the outer segment revealed more energy at high spatial frequencies. Conclusions: The 2nd-generation Indiana AO-OCT system provides a more detailed view of the photoreceptor optical signature than the previous generation system. Commercial Relationships: Zhuolin Liu, None; Omer P. Kocaoglu, None; Qiang Wang, None; Donald T. Miller, n/a (P) Support: NIH R01EY018339, NIH R01EY014743, NIH P30EY019008 Program Number: 5548 Poster Board Number: B0058 ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Presentation Time: 8:30 AM - 10:15 AM Evaluation of a Dual-Conjugate Adaptive Optics Clinical Prototype for Retinal Imaging Zoran Popovic1, Jörgen Thaung1, Bengt Svensson2, Mette OwnerPetersen1. 1Department of Ophthalmology, University of Gothenburg, Mölndal, Sweden; 2Exomed AB, Sollentuna, Sweden. Purpose: To investigate the applicability of a new dual-conjugate adaptive optics clinical prototype for wide-field high-resolution adaptive optics retinal imaging in healthy volunteers and patients with early stages of retinal disease. Methods: A new design of a compact dual-conjugate adaptive optics clinical prototype has been built and used to image healthy volunteers and patients with early stages of retinal disease such as age-related macular degeneration (AMD) and diabetic retinopathy (DR). The clinical prototype, based on the concept of dual-conjugate adaptive optics, employs five spatially separated retinal probe beacons, two magnetic deformable mirrors (DM) (ALPAO, Grenoble, France), and a multi-channel Shack-Hartmann wavefront sensor. Monochromatic aberrations are measured and corrected over a 6 mm pupil. The five probe beacons are generated using light at a wavelength of 830±10 nm from a superluminescent diode (Superlum, Cork, Ireland). A 52 actuator DM positioned in a plane conjugate to the pupil of the eye will apply an identical correction for all fieldpoints in the field of view (FOV). A 97 actuator DM positioned in a plane conjugated to a plane inside the eye will contribute with partially individual corrections for the five angular directions and thus compensate for non-uniform (anisoplanatic) or field-dependent aberrations. Imaging is performed over a 7x7 deg FOV using a spectrally filtered Xenon flash at a wavelength of 575±10 nm. Results: The dual-conjugate adaptive optics clinical prototype features a 7x7 degree FOV and allows retinal features down to 2 μm to be resolved. A narrow depth of field of approximately 9 µm in the retina enables tomographic imaging of separate retinal layers, such as the cone photoreceptor layer deep within the retina in AMD patients, and superficial retinal capillary layers in DR patients. Conclusions: High resolution adaptive optics retinal imaging has enabled the vision research community to gain deeper insight into the development and progression of retinal diseases. We believe that the dual-conjugate adaptive optics clinical prototype has a future potential for clinical imaging with an impact particularly important for early diagnosis of retinal diseases, follow-up of treatment effects, and follow-up of disease progression. Commercial Relationships: Zoran Popovic, US7639369 (P), PCT/EP2012/069620 (P), EP12165365 (P); Jörgen Thaung, US7639369 (P), PCT/EP2012/069620 (P), EP12165365 (P); Bengt Svensson, Exomed AB (E), PCT/EP2012/069620 (P), EP12165365 (P); Mette Owner-Petersen, US7639369 (P), PCT/EP2012/069620 (P), EP12165365 (P) Support: Marcus and Amalia Wallenberg's Memorial Fund Grant MAW 2009.0053, Vinnova Grant 2010-00518 Program Number: 5549 Poster Board Number: B0059 Presentation Time: 8:30 AM - 10:15 AM AO-OCT Retinal Imaging with 163-Segment Deformable Mirror Susanna C. Finn1, Cherry Greiner1, Nathan Doble1, Robert J. Zawadzki2, John S. Werner2, Stacey S. Choi1. 1Vision Science, New England College of Optometry, Boston, MA; 2Ophthalmology & Vision Science, University of California Davis, Davis, CA. Purpose: Adaptive Optics (AO) has enabled vision scientists to directly image single retinal cells in vivo. We have constructed an AO Fourier-domain Optical Coherence Tomography (AO-FD-OCT) system utilizing a high segment count microelectromechanical systems (MEMS) deformable mirror (DM). This DM provides much higher spatial correction over a 7.5mm dilated pupil (Doble et al. Applied Optics 2007), providing diffraction-limited imaging. We describe retinal imaging results obtained on a range of human subjects. Methods: An AO-FD-OCT was designed and constructed at the New England College of Optometry. The AO-OCT system acquires Bscans made up of 600 A-scans at a frame rate of 60 Hz. A Superlum broadband superluminescent diode (SLD) light source is used with a central wavelength of 860nm and a full bandwidth of 135nm. Imaging data are post-processed and analyzed with custom Matlab software. The AO system consists of a Hartmann-Shack wavefront sensor and a 163-segment, 489-actuator Iris AO MEMS DM. The AO-OCT is designed for a 7.5mm pupil, with 13 discrete mirror segments across the pupil diameter. Retinal images were obtained on normal human subjects at 4 and 10 degrees in the nasal retina. The scan size for each B-scan was 0.5°, corresponding to approximately 150µm at the retina. Results: Distinct retinal layers were visible from the nerve fiber layer, to the inner and outer photoreceptor segments, through to the retinal pigment epithelium. Moreover, individual cone photoreceptors were clearly visible in images at 4 and 10 degrees eccentricity. The lateral spacing of the cones was measured to be 6.4±1.5 microns at 4° nasal, and 10.4±3.8 microns at 10°. The inner segment length of the cones was found to be 32.9±5.7 microns at 4°, and 24.5±3.0 microns at 10°. The outer segment length was correspondingly found to be 26.2±1.9 microns at 4°, and 27.8±1.4 microns at 10°. These results are in good agreement with histology. Conclusions: The combination of AO with the use of a higher segment MEMS DM with established OCT technology has enabled us to resolve fine retinal structure unseen with conventional OCT technologies and promises to be highly valuable in the study of retinal disease and injury. Commercial Relationships: Susanna C. Finn, None; Cherry Greiner, None; Nathan Doble, Iris AO Inc (I); Robert J. Zawadzki, None; John S. Werner, None; Stacey S. Choi, None Support: DoD Grant W81XWH-10-1-0738 Program Number: 5550 Poster Board Number: B0060 Presentation Time: 8:30 AM - 10:15 AM Use of multiple metrics to describe the parafoveal cone mosaic Marco Lombardo1, Sebastiano Serrao1, Pietro Ducoli1, Giuseppe Lombardo2, 3. 1Fondazione GB Bietti IRCCS, Rome, Italy; 2CNRIPCF Unit of Support Cosenza, Rende, Italy; 3Vision Engineering, Rome, Italy. Purpose: To investigate the distribution of cone density and spacing as well as the preferred packing arrangement of the cone mosaic as a function of retinal eccentricity. Methods: A flood-illumination adaptive optics retinal camera was used to obtain images of the parafoveal cone mosaic in nineteen healthy volunteers. Cone density and spacing were estimated for each subject using a sampling window of 80 x 80 pixels, at 250-, 450-, 650- and 1100-um eccentricities from the fovea along the nasal and temporal retina of both eyes. The inter-subject and intra-subject variation of cone density and spacing were calculated via Coefficient of Variation (CoV). Cone packing arrangement was assessed using Voronoi analysis; calculations were done over 1024x128 pixels image sections of the cone mosaic across the horizontal meridian from 200- to 1050-um eccentricities. Results: The inter-subject variation of parafoveal cone density ranged between 10% and 15% (P<0.001) and the intra-subject variation of cone density was lower than 8% in all subjects, except for two. The cone spacing values showed a moderate inter-subject ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (CoV<7%; P<0.001) and a low intra-subject variation (CoV<4% in all subjects, except for two cases). In the parafoveal region, 40% to 50% of cones were hexagonally arranged; the percentage of nonhexagonal Voronoi tiles increased at greater eccentricities. Conclusions: The use of multiple and complementary metric descriptors allows for a more detailed description of packing distribution and preferred arrangement of cone photoreceptors across the parafoveal retina. Commercial Relationships: Marco Lombardo, None; Sebastiano Serrao, None; Pietro Ducoli, None; Giuseppe Lombardo, None Program Number: 5551 Poster Board Number: B0061 Presentation Time: 8:30 AM - 10:15 AM Improved Sensitivity of Automated Cone Identification in Images of Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO) Keiko Yonezawa1, Hiraku Sonobe1, Akihito Uji2, Sotaro Ooto2, Masanori Hangai2, Nagahisa Yoshimura2. 1Medical Imaging Project, Canon Inc.,, Tokyo, Japan; 2Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Purpose: To provide an automated, highly sensitive cone detection algorithm even in the region where some cones are undetectable by the conventional local maximum detection algorithm previously proposed by Li and Roorda. Methods: In retinal images taken by our AOSLO, some cones were not detected by the conventional algorithm because those cones did not have local max intensity profile by the effect of high intensity neighboring cones. The undetected cones were precisely picked up with our newly developed technique which combined a filter to analyze local convex profile with the conventional local max filter. Retinal images of healthy subjects were acquired with our AOSLO, all with resolution of 400 x 400 pixels and 340μm x 340μm in size. Total six images at eccentricities of 0.5mm (3 images) and 1.0mm (3 images) were selected for analysis. Cones in the images were first detected by the conventional algorithm, and undetected cones were manually labeled by two engineers. A pair of cones labeled manually by the different engineer was considered the same when they were located within 1.2μm for 0.5mm and 1.7μm for 1.0mm of each other. Comparisons were made between the result of detection using our algorithm and manually labeled result combined with conventional algorithm. Results: Total cone counts manually labeled by at least one engineer were 3946±172 for 0.5mm and 2441±268 for 1.0mm. Agreement between two manual labeling was 96.0±1.8% for 0.5mm and 97.4±0.2% for 1.0mm. Among the manually labeled cones by at least one engineer, 97.5±0.9% for 0.5mm and 99.4±0.1% for 1.0mm of cones were detected by our method, whereas 90.9±3.0% for 0.5mm and 95.0±0.2% for 1.0mm of cones were detected by the conventional method. This means 261±87 for 0.5mm and 107±9 for 1.0mm additional cones were labeled correctly with our algorithm. Ratio of hexagon was also improved for all six images, in average 51.6±2.3 % to 54.4±2.2% for 0.5mm and 51.8±2.7 % to 53.4±2.4% for 1.0mm. Conclusions: Newly developed cone detection algorithm detected more cones correctly when some cones did not have local maximum intensity profile. As these effects were stronger in the region where the cone density was higher, improved capability of detecting cones of our algorithm was more evident at eccentricities of 0.5mm than 1.0mm. Commercial Relationships: Keiko Yonezawa, Canon Inc., (E); Hiraku Sonobe, Canon Inc (E); Akihito Uji, None; Sotaro Ooto, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon (C); Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: the Innovative Techno-Hub for Integrated Medical Bioimaging Project of the Special Coordination Funds for Promoting Science and Technology Program Number: 5552 Poster Board Number: B0062 Presentation Time: 8:30 AM - 10:15 AM Photoreceptors, Retinal Nerve Fibers and Retinal Blood Flow Observation by AOSLO Applied to Wide Diopter Range Takashi Yuasa1, Futoshi Hirose1, Kenichi Saito1, Kazuhiro Matsumoto1, Hiraku Sonobe1, Akihito Uji2, Sotaro Ooto2, Masanori Hangai2, Nagahisa Yoshimura2. 1Medical Imaging Project, Canon Inc., Ohta-ku, Japan; 2Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto City, Japan. Purpose: To construct a high contrast image of photoreceptors, retinal nerve fibers (RNF), and capillaries by using adaptive optics scanning laser ophthalmoscope (AOSLO) which is applied to wide diopter range. Methods: We have newly developed an AOSLO prototype equipped with two liquid-crystal-on-silicon spacial light modulators and optimized its optical system to cover a wide diopter range. The prototype covered spherical diopter range from -10D to +5D and cylindrical diopter range from -5D to 0D. Using the AOSLO prototype, we took images of healthy eyes and diseased eyes. Changing the position of in-line fixation target, we selected an imaging position in a 6 x 6mm square area on the retina. We also changed a focus position in the retina from retinal pigment epithelium (RPE) layer to RNF layer. Results: We took AOSLO images of 16 patients (27 eyes), whose spherical diopter ranged from -10.75D to +2.25D and whose cylindrical diopter ranged from -3.75D to 0D. We also took AOSLO images of two healthy eyes (spherical -3.50D, -4.25D; cylindrical 4.75D, -4.00D respectively) and selected imaging positions at eccentricities of 0.5, 1.0, 1.5, 2.0, 2.5, 3.0mm respectively, and acquired reliable images of good quality sufficient for analysis. When we selected a position nasal 2.0mm from the fovea, we changed focus positions and we observed photoreceptors, blood flow in capillaries, and retinal nerve fibers. Conclusions: We observed high contrast images of photoreceptors, RNF, and capillaries by using our AOSLO prototype. The instrument is useful to research on retinal diseases due to its capability of imaging the retina over a wide diopter range. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Commercial Relationships: Takashi Yuasa, Canon Inc. (E); Futoshi Hirose, Canon Inc. (E); Kenichi Saito, Canon Inc. (E); Kazuhiro Matsumoto, CANON INC. (E); Hiraku Sonobe, Canon Inc (E); Akihito Uji, None; Sotaro Ooto, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon (C); Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: the Innovative Techno-Hub for Integrated Medical Bioimaging Project of the Special Coordination Funds for Promoting Science and Technology Program Number: 5553 Poster Board Number: B0063 Presentation Time: 8:30 AM - 10:15 AM Compact multimodal adaptive optics imager (MAOI) R. D. Ferguson, Mircea Mujat, Ankit Patel, Nicusor Iftimia. Biomedical Imaging Group, Physical Sciences Inc, Andover, MA. Purpose: To demonstrate the imaging capabilities of a new multimodal version of the compact Adaptive Optics Line Scanning Ophthalmoscope (AOLSO). High-resolution AO imaging of the retina, capable of resolving photoreceptors and other cells and structures in the eye, is an important new window on ocular health and disease. A new design of the compact multi-modal AOLSO lineconfocal imager combines advantages of AOSLO with those of the AO fundus cameras for routine mapping of photoreceptor density.. Methods: The new multimodal adaptive optics imager (MAOI) incorporates a number of improvements in the optical design and the AO/focus control algorithms. The AOLSO uses <500μw of SLD illumination centered at 780nm (50nm FWHM) wih a cylindrical lens to generate line illumination, and AO-SDOCTuses SLD ~700 μW at 850nm (110nm FWHM). The system is currently configured for high-stroke DMs, a custom Shack-Hartman wavefront sensor, and an SDOCT spectrometer (Basler Sprint camera). MAOI has a compact footprint suitable for clinical application. The optical head measures ~30×45×20cm and is mounted to a standard slit lamp stand with chin/forehead rests. A field of up to ~3.5x5deg (1000x1500 pixels) is user-configurable with automated overlapping scan patterns in a 30deg field of regard for rapid montage. An integrated color LCD fixation display is included. LSO-based design allows video-rate (15 to 70 fps) high resolution retinal imaging with improved retinal navigation. Four normal adult volunteers ranging in age from 30 to 56 years, were imaged with a standard protocol (New England IRBapproved), and AOSLO image resolution was compared to that of prior designs. Results: New multimodal system design and AO control significantly enhanced the capabilities and resolution of the AOLSO portion of the MAOI imager. Based on images acquired in resolution targets, optical resolution in the MAOI was measured to be ~1.8μm (referenced to the retina); currently somewhat more in the eye (~2.5μm), due to sampling at ~1μm/pixel to preserve light collection-a more than 50% improvement over the previous system. A small region within a single, unprocessed image is shown below (512x 716μm with fovea ~100μm off the lower right corner of the image). Conclusions: The new compact MAOI resolves cones very near the fovea and can be used for automated AO montaging and photoreceptor density mapping in the macula. Portion of a MAOI image (AOLSO) of photoreceptors near the fovea. Commercial Relationships: R. D. Ferguson, Physical Sciences Inc (E), Physical Sciences Inc (P); Mircea Mujat, Physical Sciences, Inc. (E), Physical Sciences, Inc. (P); Ankit Patel, Physical Sciences Inc. (E); Nicusor Iftimia, None Support: NIH 5R44EY018509-03 Program Number: 5554 Poster Board Number: B0064 Presentation Time: 8:30 AM - 10:15 AM Use of variable Field Size in AOSLO retinal imaging to improve post-processing Ting Luo, Gang Huang, Toco Y. Chui, Stephen A. Burns. School of Optometry, Indiana University Blooomington, Bloomington, IN. Purpose: To test the use of variable scan sizes to generate variable field sizes giving low resolution images over a wider region of retina, which then provide references for image alignment even in the presence of modest sized saccades. Methods: Three normal subjects participated in this experiment. The Indiana AOSLO was used to generate both larger size (3.4 deg x3.3 deg) and standard size (typically either 1.9 deg x 1.8 deg or 1.3 deg x1.2 deg) fields. These smaller field sizes, which provide pixel sizes of approximately 1 micron per pixel or 0.66 microns per pixel, are desirable for capturing small features but in patients with poor fixation can be difficult to align and average due to eye movements. The steering capability of the AOSLO was used to make a rapid set of measurements on the eyes that covered 10x10 degrees. Subjects were also imaged using the normal fields sizes within the same session. In post-processing a montage of the large field size image was first generated and resized to the same number of pixels per degree as the small field images. Next each frame of the small field video sequences was cross-correlated with the large field montage and the location within the larger field identified. The location of the peak of the cross-correlation was used to determine the best template location within the larger field for each frame. Results: The larger field data acquisition required about 3 minutes additional time within a session. As expected the peak locations for the cross correlation were stable when fixation was stable. However, during eye movements between frames which cause problems for our standard alignment approach, the new approach was able to find a corresponding retinal location. Overall, the normalized crosscorrelation was lower, presumable due to a drop in image quality for the large field template, due to both decreased AO control over the wider field size, but also due to under sampling of the images. Conclusions: The Multi-resolution approach holds promise for increasing the yield of usable frames in subject with relatively poor fixation. It adds only a slight amount to the total imaging time required per patient. The major limitations are that improvements may not extend to subjects with very bad fixation because in those ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics cases acceptable frames of even the large field size may be difficult to obtain. Commercial Relationships: Ting Luo, None; Gang Huang, None; Toco Y. Chui, None; Stephen A. Burns, None 536 Inner Retina and Blood Vessels Thursday, May 09, 2013 10:30 AM-12:15 PM Exhibit Hall Poster Session Program #/Board # Range: 6054-6066/B0065-B0077 Organizing Section: Visual Psychophysics / Physiological Optics Program Number: 6054 Poster Board Number: B0065 Presentation Time: 10:30 AM - 12:15 PM Future Insights on an Ocular Hypertension Model in the White Leghorn Chicken Jennifer L. Choi1, Radouil T. Tzekov2, 3, Stacey S. Choi1. 1New England College of Optometry, Boston, MA; 2The Roskamp Institute, Sarasota, FL; 3Department of Ophthalmology, University of South Florida, Tampa, FL. Purpose: While White Leghorn chicken (Gallus gallus domesticus) have been used to study physiological optical properties of the eye and conditions such as myopia, there is a lack of in vivo studies that look at the potential of chicken as a model of ocular hypertension or glaucoma. When advanced imaging techniques are to be used in such models, chicken have an advantage over rodents, having bigger eyes with less optical aberrations. The induction of elevated IOP in chicken via anterior chamber injections of microbeads has thus been investigated. Methods: Animals of both genders and varying ages (n=15:12-124 days old) were subject to one of 12 combinations of anterior chamber injections of microbeads: magnetic (4.5 µm) or non-magnetic (12 µm) in one or both eyes with saline as a control. Intraocular pressure (IOP) was monitored frequently before and after injections with Tonopen. In 4 out of the 17 animals A-scan ultrasound was used to measure ocular parameters including anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), retinal thickness (RT) and choroidal thickness (ChT) pre and post all injections. All birds had isofluorane anesthesia prior to injections and ultrasound. Results: Elevation of IOP with maintenance of a clear visual axis was successful in 2 out of 17 animals after two 70µL injections of magnetic microbeads (concentration 20x108beads/mL). Animal #1943 was injected with 140x106 beads at age 51 days and with the same amount two weeks later; 5 days later IOP was elevated 5 mm Hg greater than the fellow eye for a period of 7 days. Animal #1975 received an injection of 140x106 beads at age 99 days and 160x106 beads at age of 110 days and an average elevation of 8mm Hg greater than the fellow eye was noted from day 4 to day 7 post second injection. In other animals injection of 98x106 magnetic beads at day 40 and again at day 51 blocked the visual axis. Non-magnetic microbeads (125x108 to 875x108 beads) did not elevate the IOP. One to 3 saline injections did not influence the growth rate of ocular parameters measured via ultrasound biometry. Conclusions: The White Leghorn chicken has potential for in vivo studies of ocular hypertension and/or glaucoma via magnetic microbead anterior chamber injections. Studying the effects of elevated IOP on the chicken retina over a longer time period is indicated. SD-OCT and Adaptive Optics imaging may shed further insights. Commercial Relationships: Jennifer L. Choi, None; Radouil T. Tzekov, None; Stacey S. Choi, None Support: NIH Grant EY007149 Program Number: 6055 Poster Board Number: B0066 Presentation Time: 10:30 AM - 12:15 PM Detection of flow velocity fluctuations associated with erythrocyte aggregation in diabetic retinopathy by using adaptive optics scanning laser ophthalmoscopy Akihito Uji, Masanori Hangai, Sotaro Ooto, Shigeta Arichika, Tomoaki Murakami, Nagahisa Yoshimura. Ophthalmology, Kyoto Univ Graduate Sch of Med, Kyoto City, Japan. Purpose: Adaptive Optics Scanning Laser Ophthalmoscopy (AOSLO) has enabled noninvasive and direct monitoring of erythrocyte aggregates in the retinal capillaries. In this study, we quantified the blood flow velocity in the parafoveal capillaries of patients with diabetic retinopathy (DR) by using the AO-SLO system prototype developed by Canon Inc. Methods: Ten patients (mean age ± standard deviation [SD], 45.8 ± 16.7 years) diagnosed with DR at Kyoto University Hospital (8 patients with mild nonproliferative DR [NPDR], 2 patients with moderate NPDR) and 8 control subjects without any history of ocular or systemic diseases (mean age, 34.6 ± 8.6 years) were recruited for this study. AO-SLO videos were acquired from the temporal and nasal areas located 0.5° from the foveal center. The scan area of the retina was 1.4 × 2.8°, and scans were recorded for 4 seconds per area at a frame rate of 64 Hz. Erythrocyte aggregates were detected as “dark tails” that were darker than the vessel shadows, and the velocities of all the dark tails observed in both temporal and nasal areas were measured. In subjects whose pulse was measured simultaneously during the AO-SLO video recording, a relative cardiac cycle was assigned to each dark tail velocity in order to investigate the effect of cardiac pulsation on the velocities. Results: Vessels showing rapid changes in dark tail flow velocity were noted in 6 DR patients, but these vessels were not detected in normal subjects. In these vessels, dark tail flow velocity was extremely low and deformation of the trajectory of the dark tail flow was depicted in the spatiotemporal image. Two such vessels were found in 3 patients and 1 vessel was found in each of the remaining 3 patients. The average velocity change in these vessels was 0.95 ± 0.53 mm/s. Pulse was measured in 6 DR patients and 8 normal subjects, and 220 dark tails were analyzed in total. The velocity of the dark tail in DR patients (1.45 ± 0.52 mm/s) was significantly higher than that in normal subjects (1.33 ± 0.40 mm/s) (P < 0.05). Conclusions: The velocity of the dark tail in NPDR patients was higher than that in normal subjects. However, at the same time, there were some vessels with extremely slow dark tail flow. Spatiotemporal images were useful in detecting rapid changes in dark tail flow. Commercial Relationships: Akihito Uji, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon (C); Sotaro Ooto, None; Shigeta Arichika, None; Tomoaki Murakami, None; Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: Innovative Techno-Hub for Integrated Medical Bioimaging Program Number: 6056 Poster Board Number: B0067 Presentation Time: 10:30 AM - 12:15 PM Adaptive contrast enhancement in capillary shadow region of AOSLO images using blood cell flow information Hiroshi Imamura1, Takashi Yuasa1, Hiraku Sonobe1, Akihito Uji2, Sotaro Ooto2, Masanori Hangai2, Nagahisa Yoshimura2. 1Canon Inc, Ohta-ku, Japan; 2Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto City, Japan. Purpose: To improve visibility of photoreceptors in capillary shadow region of AOSLO images using characteristics of temporal intensity ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics variation caused by blood cell flow. Methods: Our capillary shadow correction method consists of detecting abnormal frames in an AOSLO video, calculating statistical values of temporal intensity variation in each pixel except the abnormal frames, and allocating the pixel value based on the statistical values in each pixel position for producing the resultant contrast enhanced AOSLO image. In this study, we recorded AOSLO videos using Canon prototype AOSLO system with a high wavefront correction efficiency using dual liquid crystal phase modulators. The imaging light wavelength was 840 nm and the frame rate was 32 Hz. The scan area at the parafovea was 1.1 × 1.1° and was sampled at 400 × 400 pixels. The videos were recorded for 2-5 seconds. The proposed adaptive contrast enhancement method was applied to 15 AOSLO videos for 5 healthy subjects including parafoveal capillary regions (leukocyte preferred paths (LPPs) and plasma-gap capillaries (PGCs)) and macular arteriolovenous region. We calculated the spectral power ratio as a function of frequency between the adaptive contrast enhanced images and conventional frame averaged images particularly in LPPs, PGCs and macular arteriolovenous regions. Results: The spectral power ratio at a given frequency in LPPs and PGCs of the adaptive contrast enhanced AOSLO images were 1.62 and 1.09 on average respectively, because capillary shadows were corrected by using intensity values when leukocyte or plasma-gap passes. On the other hand, shadows in macular arteriolovenous regions were not corrected because pixel intensity was low in all frames of AOSLO video as the result of erythrocytes next to a leukocyte blocking the imaging light. Conclusions: Our method improved contrast of photoreceptors in retinal capillary shadow region of AOSLO images using blood cell flow information. Commercial Relationships: Hiroshi Imamura, Canon Inc. (E); Takashi Yuasa, Canon Inc. (E); Hiraku Sonobe, Canon Inc (E); Akihito Uji, None; Sotaro Ooto, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon (C); Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Support: the Innovative Techno-Hub for Integrated Medical Bioimaging Project of the Special Coordination Funds for Promoting Science and Technology Program Number: 6057 Poster Board Number: B0068 Presentation Time: 10:30 AM - 12:15 PM Study of epimacular membranes using adaptative optics high resolution imaging Hassiba Bouakkaz1, Sarah Ayello-Scheer1, Alexandre Leseigneur1, Celine Devisme1, Jose A. Sahel1, 2, Michel Paques1, 2. 1Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France; 2Institut de la Vision, Paris, France. Purpose: High resolution imaging using adaptative optics (AO) allows an improved viewing of retinal microstructures. Here, we analyzed the AO features of epimacular membranes (ERMs) before and after surgery. Methods: Seven eyes with ERM were included. For each patient, a complete ophthalmological examination including measurement of visual acuity, optical coherence tomography and AO infrared flood imaging (rtx1, ImagineEye, Orsay, France) was performed. In four patients these exams were repeated after surgical ablation of the membrane. Results: A very precise viewing of the ERMs and of the underlying retinal wrinkling was obtained. The ERM surface showed a myriad of highly reflective dots, whose reflectance varied with the light incidence. Around ERMs, radial retinal folds were seen. The peculiar aspect of ERMs at their very beginning, which seemed to develop around vessels, could be identified. By changing focus, it was possible in three cases to distinguish the ERM itself from the underlying retinal wrinkling. After surgery, retinal unfolding could be documented. Conclusions: Specific interests of AO imaging in ERM patients comprise the ability to identify the earliest stages of ERMs, which seem to develop primarily around vessels, and the characterization of the optical properties of the ERM surface. The strong dependence of reflectance to the angle of the incident light suggested that ERMs have a bumpy mosaic-like surface. Commercial Relationships: Hassiba Bouakkaz, None; Sarah Ayello-Scheer, None; Alexandre Leseigneur, None; Celine Devisme, None; Jose A. Sahel, UPMC/Essilor (P), Second Sight (F); Michel Paques, MerckSerono (C), Roche (C), Sanofi (C) Support: ANR_09_TECS_009_01_IPHOT Program Number: 6058 Poster Board Number: B0069 Presentation Time: 10:30 AM - 12:15 PM Parietal morphometry of retinal arterioles in health and hypertension using adaptive optics Edouard Koch1, 2, David Rosenbaumm3, Xavier Girerd3, Florence Rossant4, Michel Paques1. 1Clinial Investigation Center, QuinzeVingts Hospital-INSERM, Paris, France; 2Ophthalmology, Versailles Hospital, Versailles, France; 3Cardiology, Pitié Salpétrière Hospital, Paris, France; 4Institut Supérieur d'Electronique de Paris, ISEP, Paris, France. Purpose: Morphological changes affecting the wall of small retinal arteries are recognized surrogates of end-organ damage secondary to aging and/or arterial hypertension. However, direct observation of the microvascular wall is not feasible with routine imaging techniques. We report here the quantitative analysis of the structure of retinal arterioles (~ 50-150 µm diameter) using adaptive optics (AO) near infrared (NIR) imaging (rtx1 camera; ImagineEyes, France) in normo and hypertensive humans. Methods: From OA images, the wall-to-lumen ratio (WLR) was calculated using a dedicated software. We compared the WLR between a control group (n = 20; 30.2 ± 6 years) and a group of hypertensive subjects (n = 30, 48.1 ± 13 years). Focal lesions (arteriolar narrowing and arteriovenous nickings) were also analyzed. These data were compared to the carotid intima-media thickness (IMT). Results: The WLR was significantly higher in the hypertensive group than in controls (0.35 ± 0.071 vs 0.26 ± 0.035, respectively; p=0.017) after correcting for age. The WLR of retinal arterioles was also positively correlated to current arterial pressure (r=0.36; p=0.03) and to IMT (p=0.028). Arteriolar narrowing, but not arteriovenous nickings, showed locally increased WLR. Follow-up of patients under hypotensive treatment (n=7; mean follow-up 6 months) could document progressive vasodilation in two. Conclusions: Past history of arterial hypertension and current arterial pressure are both associated with increased WLR. Arteriovenous narrowing and arteriovenous nicking show distinct parietal abnormalities and hence are probably due to distinct pathological processes. Thickening of large and small arteries are correlated, suggesting some degree of parallelism of the evolution of macro and microcirculatory damage. We conclude that AO imaging enables to phenotype the microcirculation with an unprecedented precision and may improve the understanding and the management of arterial hypertension. Commercial Relationships: Edouard Koch, None; David Rosenbaumm, None; Xavier Girerd, None; Florence Rossant, None; Michel Paques, MerckSerono (C), Roche (C), Sanofi (C) Support: ANR_09_TECS_009_01_iPhot ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Clinical Trial: C10-03 Program Number: 6059 Poster Board Number: B0070 Presentation Time: 10:30 AM - 12:15 PM Investigation of the correlation among diameter of retinal vessel and arteriosclerosis risk factors including hypoadiponectinemia Kei Homma1, Ryo Kawasaki2, Yusuke Tanabe1, Koko Saito1, Akira Sugano1, Atsushi Hozawa3, Katou Takeo4, Isao Kubota5, Takamasa Kayama6, Hidetoshi Yamashita1. 1Ophthalmology, Yamagata Univ Sch of Medicine, Yamagata, Japan; 2Public Health, Yamagata Univ Sch of Medicine, Yamagata, Japan; 3Tohoku Univ Sch of Medicine, Sendai, Japan; 4Neurology,Hematology,Metabolism,Endocrinology and Diabetology, Yamagata Univ Sch of Medicine, Yamagata, Japan; 5 Cardiology,Pulmonology,and Nephrology, Yamagata Univ Sch of Medicine, Sendai, Japan; 6Neurosurgery, Yamagata Univ Sch of Medicine, Yamagata, Japan. Purpose: Hypoadiponectinemia caused by visceral fat accumulation is related to hypertension, diabetes, and hyperlipidemia, and is an independent risk factor for the arteriosclerosis. In this research, the correlation among diameter of retinal vessel and arteriosclerosis risk factors including hypoadiponectinemia was investigated in the population based epidemiological study. Methods: This research was approved by the Ethics committee of Yamgatata University School of Medicine. Fundus photographs were taken in the subjects who participated in the Takahata study and analyzed after securing written permission from the subjects. In total,1473 subjects were investigated. The estimated retinal artery(CRAE:centaral retinal artery equivalent, the estimated retinal vein(CRVE:central retinal vein equivalent),and AVR (arteliole to venule ratio) were measured from the fundus photographs used by the vessel diameter measurement dedicated software (Retinal Analysis,University of Wisconsin, Wisconsin).Characteristics to be inspected were divided into about 4 groups, and the vessel diameter of an each part was analyzed. Results: Multiple linear regression analysis showed that CRAE decreased along with systolic arterial pressure increased(0.067μm;p=0.039).CRAE increased along with adiponectin level increased(0.153μm;p=0.049).CRVE increase was also associated with HbA1c,smoking index,and body mass index(3.333μm;p=0.004,0.004μm;p=0.023,0.412μm;p=0.007 respectively). Conclusions: Hypoadiponectinemia was an independent risk factor for CRAE decrease.The results suggest that measurement of retinal blood vessels are a good clinical marker to detect macrovascular diseases. Commercial Relationships: Kei Homma, None; Ryo Kawasaki, None; Yusuke Tanabe, None; Koko Saito, None; Akira Sugano, None; Atsushi Hozawa, None; Katou Takeo, None; Isao Kubota, None; Takamasa Kayama, None; Hidetoshi Yamashita, Senju (C), Senju (P) Program Number: 6060 Poster Board Number: B0071 Presentation Time: 10:30 AM - 12:15 PM Noninvasive Imaging of Retinal Pericytes and Endothelial Cells in Living Human Eyes Toco Y. Chui, Thomas Gast, Stephen A. Burns. Optometry, Indiana University, Bloomington, IN. Purpose: To image the retinal vascular pericytes and endothelial cells in living human retina using an adaptive optics scanning laser ophthalmoscope (AOSLO). Methods: In vivo arteriolar wall imaging was performed on 8 healthy subjects using the Indiana AOSLO (Ferguson et al, 2010). Vessel wall imaging was performed using systematic control of the position of a large confocal aperture (Chui et al, 2012). Peripapillary arteries and arterioles were divided into 4 groups based on their lumen diameters (Gr 1: ≥100µm; Gr 2: 50-99µm; Gr 3: 10-49µm; Gr 4: retinal capillaries). Results: The retinal microvasculature and scattering behavior of erythrocytes were clearly visualized in all 8 subjects. On the smaller vessels the pericytes were visualized as distinct cells laying along the lumen of the blood vessel. The smaller vessel pericytes bulged outward from the vessel wall resulting in a wall of irregular thickness. For the larger Gr 1 vessels the pericytes were much flatter and formed the outer corrugated layer of a two (or more) layered vascular wall. While pericytes were readily seen in vessel groups 1, 2, and 3, endothelial cells were only visible in Gr 1 vessels - the largest retinal arteries. Fig 1A shows the fine structure of arteriolar wall in a Gr 1 and Gr 3 vessel. The ratio of pericytes to endothelial cells was approximately 1:1 in the Gr 1 arteries (Fig 1B). Vascular wall components were not identified in the smallest retinal capillaries (Gr 4). Conclusions: Our results show that retinal pericytes can be readily resolved in normal subjects for arterioles with a lumen diameter >10µm. Our noninvasive imaging approach allows direct assessment of the cellular structure of the vascular wall in vivo with potential applications in retinal vasculopathies such as diabetic retinopathy. Fig1 A) Fine structure of vessel wall in peripapillary arterioles. Asterisks indicate the vessel lumen of a 100µm diameter and 14µm diameter arteriole. The inner and outer vessel wall linings of the larger arteriole are indicated by the white arrows. Pericytes (black arrows) are observed in a precapillary arteriole with a lumen diameter of 14µm. B) Magnified region of the white box on A. Endothelial cells (white arrows) and pericytes (black arrows) are readily seen along the inner and outer vessel wall linings. Note the one to one ratio of endothelial cells and pericytes. Commercial Relationships: Toco Y. Chui, None; Thomas Gast, None; Stephen A. Burns, None Support: NIH grants R01-EY14375, R01-EY04395, and P30EY019008 Program Number: 6061 Poster Board Number: B0072 Presentation Time: 10:30 AM - 12:15 PM ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Adaptive Optics Measurements of Retinal Arterial Wall Thickness in both Normotensive and Hypertensive Subjects Jake Hillard1, Toco Y. Chui1, Dan A. Sapir2, Thomas Gast1, Stephen A. Burns1. 1School of Optometry, Indiana University, Bloomington, IN; 2Medical School, Indiana University, Bloomington, IN. Purpose: To make precise measurements of vascular wall thickness in the retinas of both systemically normotensive and hypertensive individuals using an adaptive optics scanning laser ophthalmoscope (AOSLO). Methods: We used the Indiana AOSLO, operated with a relatively large (10x the Airy disc) confocal aperture, displaced by more than the Airy disc radius. This imaging approach provides excellent imaging of the retinal vasculature, and gives a better visualization of the walls (Chui et al 2012). Images of retinal blood vessels ranging from capillaries to the largest retinal vessels were obtained in a group of 6 normal subjects and 16 subjects with a history of hypertension. Vessels ranging in size from an inner diameter of 9 to 171 microns were measured. Measurements were made using an image editing program and were repeated on each vessel 5 times. The lumens of the vessels were differentiated from the vessel walls by the motion of erythrocytes, within the lumens, readily seen on aligned video sequences. Results: Arterial walls and lumens were able to be measured in all subjects and in almost all of the vessels chosen for analysis. Venous walls were occasionally measurable in hypertensive but not in normal subjects. Some arteries could not be measured due to shadowing or focusing in a different plane although all tested individuals had at least some measurable arteries. For both small arteries and arterioles (lumen diameters < 50 microns) and larger ones, the hypertensive subjects had higher wall to lumen ratios (p< 0.02 , p<0.03 ) respectively. The highest ratios occurred for the smallest vessels in the hypertensive subjects (Figure 2). Conclusions: We have been able to measure arterial wall thickness in vessels with lumen diameters as small as 9 microns using an AOSLO. The imaging technique used allows clear visualization of the vessel walls which can be used to precisely measure arterial wall thickness non-invasively in subjects with a history of hypertension. Commercial Relationships: Jake Hillard, None; Toco Y. Chui, None; Dan A. Sapir, None; Thomas Gast, None; Stephen A. Burns, None Support: This work was supported by NIH grants R01-EY14375, R01-EY04395, and P30EY019008 to S.A.B. Program Number: 6062 Poster Board Number: B0073 Presentation Time: 10:30 AM - 12:15 PM Distribution of vessels with dark tails in the parafoveal capillary network monitored by adaptive optics scanning laser ophthalmoscopy Shigeta Arichika, Akihito Uji, Masanori Hangai, Sotaro Ooto, Nagahisa Yoshimura. Kyoto University, Kyoto, Japan. Purpose: Adaptive optics scanning laser ophthalmoscopy (AOSLO) provides a unique opportunity for objective and noninvasive study of vessels with dark tails, which correspond to erythrocyte aggregation. In this study, we investigated the distribution of vessels with dark tails in the parafoveal capillary network using our prototype AOSLO system developed by Canon Inc. Methods: The imaging light wavelength of AOSLO was 840 nm, and the frame rate was 32 or 64 Hz. The scan area at the retina was either 1.4 × 1.4° or 1.4 × 2.8°, and this was sampled at 200 × 200 pixels or 200 × 400 pixels, respectively. The AOSLO videos were recorded for 2-4 seconds per scan area, and 10-25 scan areas were obtained for each of 3 healthy subjects (aged 23-38 years) who had no ocular or systemic diseases to ensure total coverage of the parafoveal area. After the capillary images were constructed as projections of the sequential division images, those covering an area ranging from 0 to 0.15 mm peripheral to the edge of the foveal avascular zone (FAZ) and in which most of the capillary network appeared as a single layer were cropped and used for analyses. Vessels with and without dark tails were identified and their entire lengths were measured independently. Moreover, the boundary of the FAZ was divided into 2 categories based on the presence or absence of vessels with dark tails. Results: In all 3 subjects, the vessels could be divided into 2 categories based on the presence or absence of dark tails. No timedependent change was observed in distribution of vessels with dark tails. The total length of vessels with and without a dark tail was 3.01 mm and 5.44 mm, respectively. The lengths of vessels with and without a dark tail at the boundary of the FAZ were 0.70 mm and 1.42 mm, respectively. The average ratio of the length of a vessel with a dark tail relative to the length of a vessel without a dark tail was 0.55 in the parafoveal area and 0.54 on the boundary of the FAZ. Conclusions: AOSLO imaging revealed the existence of 2 pathways of dark tail flow in the parafoveal capillary network. Vessels with dark tails tended to be shorter than those without dark tails. Commercial Relationships: Shigeta Arichika, None; Akihito Uji, None; Masanori Hangai, Topcon (F), Canon (F), Nidek (C), Topcon ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics (C); Sotaro Ooto, None; Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160 (P) Program Number: 6063 Poster Board Number: B0074 Presentation Time: 10:30 AM - 12:15 PM In vivo imaging of Hypertensive Retinopathy using Fluorescence Adaptive Optics Scanning Light Ophthalmoscopy Michael Dubow1, 2, Alexander Pinhas1, 2, Nishit Shah1, Yusufu N. Sulai3, Patricia Garcia1, Nicole K. Scripsema4, Joseph Carroll5, Alfredo Dubra5, Richard B. Rosen1. 1New York Eye and Ear Infirmary, New York City, NY; 2Mount Sinai School of Medicine, Mount Sinai Hospital, New York City, NY; 3University of Rochester, Rochester, NY; 4New York Medical College, Valhalla, NY; 5Medical College of Wisconsin, Milwaukee, WI. Purpose: While hypertension affects 1 in 3 adults and 2 in 3 adults over age 60, hypertensive retinopathy is often overlooked as an important indicator of systemic disease. Previous studies have explored the relationship between hypertensive retinopathy and diabetes, nephropathy, heart disease and cerebrovascular events. Reflectance adaptive optics scanning light ophthalmoscopy (RAOSLO) is a powerful tool in our exploration of the retina, providing access to retinal microstructure previously unavailable in vivo. However, the technology has not yet been optimized to study the microvasculature. Our group has combined AOSLO with fluorescein angiography (FAOSLO) to image patients with hypertensive retinopathy. Methods: 12 adult patients with vascular disease were recruited. Baseline RAOSLO images were collected using a 790 nm light source and 1° FOV. Patients then ingested 1g of fluorescein sodium mixed with juice. Starting at 15 minutes post ingestion, reflectance and fluorescence (488nm excitation emission; emission filter centered at 525nm; 45nm bandwidth) 1° FOV image sequences were recorded simultaneously. Conventional fundus photography with and without intravenous fluorescein was performed. Results: FAOSLO revealed fine changes in the retinal microvasculature not seen with traditional imaging modalities and RAOSLO in all patients. We successfully imaged features of hypertensive retinopathy present in larger vessels on the microscopic scale, including microaneurysms, hemorrhages, intravascular lesions, focal arteriolar narrowing, and vessel tortuosity. Conclusions: FAOSLO represents a promising new technology to image features of hypertensive retinopathy with resolution previously attainable only through biopsy. New quantitative classification schemas will need to be developed to describe and categorize these abnormalities. Following patients over time will capture the evolution of the disease, giving invaluable insight into the onset and progression of hypertensive changes, both in the eye and throughout the body. Figure 1: A tortuous tertiary artery imaged on both fundus photo (A) and IV fluorescein (B). While the artery was visible on RAOSLO (C), FAOSLO revealed a focal filling defect (D, E), suggesting local constriction or intravascular lesion. Figure 2: Variable vessel tortuosity was seen in all levels in hypertensive retinopathy. Commercial Relationships: Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Yusufu N. Sulai, None; Patricia Garcia, None; Nicole K. Scripsema, None; Joseph Carroll, Imagine Eyes, Inc. (S); Alfredo Dubra, US Patent No: 8,226,236 (P); Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), ODOS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C) Support: Marrus Family Foundation, Bendheim-Lowenstein Family Foundation, Wise Family Foundation, Chairman's Research Fund of the NYEEI, Research to Prevent Blindness, Burroughs Wellcome Fund, Glaucoma Research Foundation Program Number: 6064 Poster Board Number: B0075 Presentation Time: 10:30 AM - 12:15 PM Normal retinal vasculature imaged using fluorescence adaptive optics scanning light ophthalmoscopy (FAOSLO) ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Nishit Shah1, Michael Dubow1, 2, Alexander Pinhas1, 2, Nicole K. Scripsema1, Alfredo Dubra3, 4, Yusufu N. Sulai6, 3, Drew H. Scoles5, 3, Richard B. Rosen1. 1Ophthalmology, New York Eye and Ear Infirmary, New York, NY; 2Mount Sinai Hospital, Mount Sinai School of Medicine, New York, NY; 3Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 4Biophysics, Medical College of Wisconsin, Milwaukee, WI; 5Biomedical Engineering, University of Rochester, Rochester, NY; 6The Institute of Optics, University of Rochester, Rochester, NY. Purpose: To report high resolution images of retinal vasculature using Fluorescein Angiography (FA) with the Adaptive Optics Scanning Light Ophthalmoscope (AOSLO). Methods: 5 subjects with no retinal pathology or evidence of eye disease were identified prior to imaging. Reflectance imaging with a 790nm super luminescent diode was used to identify the vascular structures of interest. One gram of fluorescein mixed with 4oz of orange juice was administered orally. Single-photon fluorescence images were then collected at the previously identified areas using a 488nm solid state laser for excitation and an emission filter centered at 525nm with a 45nm bandwidth over a 1° field of view. Imaging was repeated at 15 minute intervals until signal extinction. 3 subjects were also imaged after IV fluorescein administration. Results: Averaging 120 fluorescence images revealed the retinal microvasculature. Measurable fluorescence signal was observed as early as 8 minutes and as late as 2 hours after administering fluorescein orally. Although absolute fluorescence signal varied across patients, the best images were obtained between 15 and 45 minutes after administration. On the AOSLO, oral fluorescein provided comparable image quality to that of IV fluorescein. Time to signal extinction with IV fluorescein was shorter, probably due to quicker redistribution of the dye. No side effects from either oral or IV administration of fluorescein were observed. Conclusions: Fluorescein angiography is an invaluable tool in the management of ocular disease. Coupled with AOSLO, it permits a detailed examination of the capillary bed of the inner nuclear layer when compared to conventional IV FA. Furthermore, FAOSLO with oral fluorescein is a safer alternative to IV angiography and provides a longer imaging time window. High resolution imaging of the retinal microvasculature with FAOSLO will not only help to further understand vascular micropathology but will also guide early intervention in management of vascular diseases. Fig 1. Retinal vasculature as seen on: A.fundus photography B.with IV Fluorescein C.magnified view of a vessel (top arrow in B) D.FAOSLO image with IV fluorescein corresponding to frame C E.magnified view of a vessel (bottom arrow in B) F.FAOSLO image with oral fluorescein corresponding to frame E Fig 2. Comparison of mean intensity over time on averaged fluorescence images Commercial Relationships: Nishit Shah, None; Michael Dubow, None; Alexander Pinhas, None; Nicole K. Scripsema, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Yusufu N. Sulai, None; Drew H. Scoles, None; Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C) Support: Marrus Family Foundation, Bendheim-Lowenstein Family Foundation, Wise Family Foundation, Chairman's Research Fund of the NYEEI, Research to Prevent Blindness, The Burroughs Wellcome Fund and the Glaucoma Research Foundation Program Number: 6065 Poster Board Number: B0076 Presentation Time: 10:30 AM - 12:15 PM Histopathologic Features of Diabetic Microangiopathy Imaged Using an Adaptive Optics Scanning Laser Fluorescein Angiography Richard B. Rosen1, 2, Alfredo Dubra3, Rishard Weitz1, Joseph Carroll3, Michael Dubow1, 4, Alexander Pinhas1, 4, Nishit Shah1, Yusufu N. Sulai3, 5, Nicole K. Scripsema1, 2, Joseph B. Walsh1, 2. 1 Ophthalmology, New York Eye & Ear Infirmary, New York, NY; 2 Ophthalmology, New York Medical College, Valhalla, NY; 3 Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 4 Ophthalmology, Mount Sinai School of Medicine, New York, NY; 5 Ophthalmology, University of Rochester, Rochester, NY. Purpose: To describe the fluorescein angiographic features of diabetic microangiopathy lesions imaged with an adaptive optics scanning light ophthalmoscope (AOSLO) compared to their appearance on conventional fundus photography and spectral domain optical coherence tomography (SDOCT). Methods: AOSLO images (790nm; 1° degree field of view) without fluorescein dye were collected in 15 adult diabetic retinopathy patients to identify microvascular points of interest. Patients then ingested 1gm fluorescein dye mixed in 4oz of orange juice. Simultaneous reflectance (790 nm) and fluorescence (488 nm excitation, 503-548 nm emission) AOSLO images (1° field of view) were collected between 15 and 60 minutes post-ingestion. For comparison with conventional imaging techniques, fundus imaging with and without intravenous fluorescein were performed. Results: In the fluorescence AOSLO channel we were able to ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics visualize microangiopathic features of diabetic microangiopathy in vivo at the level of the retinal capillary bed. A number of lesions were clearly delineated, including a variety of microaneurysms, capillary loops, IRMA, and neovascularization, which could not be seen well in the 790nm channel. These lesions typically appeared as red dots on fundus photography or bright spots on clinical fluorescein angiography. OCT appearances were typically less distinct. Conclusions: Micro fluorescein angiography can by successfully and safely achieved using AOSLO in diabetic patients revealing anatomic features previously seen only on pathology slides. This level of clinical imaging may prove useful for evaluating the impact of treatment at a the microscopic scale. Figure 1. A:Segment of wide field fundus photograph demonstrating microaneurysms, tortuosity, and neovascularization. B:Standard wide field fluorescein angiogram with color coded frames corresponding to micro angiographic images in figure 2. C:Corresponding SD-OCT slice through the red frame revealing microaneurysms Figure 2. AOSLO FA images corresponding to frames in figure 1 revealing details of microangiopathy including vascular loops (A,B,C) microaneurysms(A,B,C), and capillary dropout( A, B,C). Commercial Relationships: Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C); Alfredo Dubra, US Patent No: 8,226,236 (P); Rishard Weitz, None; Joseph Carroll, Imagine Eyes, Inc. (S); Michael Dubow, None; Alexander Pinhas, None; Nishit Shah, None; Yusufu N. Sulai, None; Nicole K. Scripsema, None; Joseph B. Walsh, None Support: Marrus Family Foundation, Chairman's Research Fund of the New York Eye and Ear Infirmary, Bendheim-Lowenstein Family Foundation, Wise Family Foundation Program Number: 6066 Poster Board Number: B0077 Presentation Time: 10:30 AM - 12:15 PM Microangiopathic Features of Central Retinal Vein Occlusion Imaged Using Fluorescence Adaptive Optics Scanning Light Ophthalmoscopy Alexander Pinhas1, 2, Nishit Shah1, Michael Dubow1, 2, Mitul Mehta1, Patricia Garcia1, Nicole K. Scripsema1, 3, Joseph Carroll4, 5, Yusufu N. Sulai6, Alfredo Dubra4, 7, Richard B. Rosen1. 1Ophthalmology, New York Eye and Ear Infirmary, New York, NY; 2Mount Sinai School of Medicine, New York, NY; 3New York Medical College, Valhalla, NY; 4Ophthalmology, Medical College of Wisconsin, Milwaukee, WI; 5Cell Biology, Neurology and Anatomy, Medical College of Wisconsin, Milwaukee, WI; 6The Institute of Optics, University of Rochester, Rochester, NY; 7Biophysics, Medical College of Wisconsin, Milwaukee, WI. Purpose: Central retinal vein occlusion (CRVO) remains a common cause of vision loss in retinal vascular disease, second only to diabetic retinopathy. Fluorescein angiography (FA) has remained the gold standard for confirming its diagnosis and assessing the degree of retinal nonperfusion, macroangiopathic change and macroscopic response to treatment. The high transverse resolution of adaptive optics scanning light ophthalmoscopy (AOSLO) has allowed for in vivo study of retinal micropathology, but has been limited in its capability to image retinal microvasculature. Here, we demonstrate the use of fluorescence AOSLO (FAOSLO) for imaging microscopic angiopathic features of CRVO. Methods: Reflectance AOSLO (RAOSLO) images (790nm; 1° field of view) were collected in five adult CRVO patients to identify microvascular points of interest. Patients then ingested 1g fluorescein dye. Simultaneous RAOSLO and FAOSLO images were then collected between 15 and 60 minutes post-ingestion. The fluorescence channel used a 488nm light for excitation; and, an emission filter centered at 525nm with a 45nm bandwidth. For comparison with conventional imaging techniques, Topcon fundus imaging with and without IV fluorescein was performed. Results: The combination of RAOSLO and FAOSLO enabled us to visualize CRVO microangiopathic features in vivo in the finest capillaries of the retinal inner nuclear layer. Among the features visualized were vessel wall thickening, microaneurysms, neovascularization and hemorrhage. FAOSLO showed the full extent and detail of microangiopathy, as opposed to RAOSLO and conventional fundus photography. Conclusions: We believe that the clinical role of FAOSLO has significant potential. Comparison with motion contrast-based techniques remains to be evaluated. We believe that coupled with RAOSLO and a method to analyze microangiopathic features quantitatively, FAOSLO will lead to a better understanding of CRVO pathophysiology, disease progression and a more comprehensive method in monitoring tissue response to different treatment modalities. ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected]. ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group – Visual Psychophysics / Physiological Optics Fig 1. Fine capillary microaneurysms were seen (C, D) that were not appreciated on either conventional imaging (A, B) or RAOSLO. Fig 2. RAOSLO was better at visualizing hemorrhage (B) and vessel wall thickening (D), whereas FAOSLO was better at outlining the intravascular space and visualizing capillaries of finest caliber (C, E). Commercial Relationships: Alexander Pinhas, None; Nishit Shah, None; Michael Dubow, None; Mitul Mehta, None; Patricia Garcia, None; Nicole K. Scripsema, None; Joseph Carroll, Imagine Eyes, Inc. (S); Yusufu N. Sulai, None; Alfredo Dubra, US Patent No: 8,226,236 (P); Richard B. Rosen, Opko-OTI (C), Optos (C), Clarity (C), OD-OS (C), Topcon (R), Zeavision (F), Genetech (F), Optovue (C) Support: Marrus Family Foundation, Bendheim-Lowenstein Family Foundation, Wise Family Foundation, Chairman's Research Fund of the NYEEI, Research to Prevent Blindness, the Burroughs Wellcome Fund and the Glaucoma Research Foundation ©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
