A new algorithm for the relationship between vision and ametropia

Abstract

Refraction simulators used for undergraduate training at Aston University did not realistically reflect variations in the relationship between vision and ametropia. This was because they used an algorithm, taken from the research literature, that strictly only applied to myopes or older hyperopes and did not factor in age and pupil diameter. The aim of this study was to generate new algorithms that overcame these limitations. Clinical data were collected from the healthy right eyes of 873 white subjects aged between 20 and 70 years. Vision and refractive error were recorded along with age and pupil diameter. Re-examination of 34 subjects enabled the calculation of coefficients of repeatability. The study population was slightly biased towards females and included many contact lens wearers. Sex and contact lens wear were, therefore, recorded in order to determine whether these might influence the findings. In addition, iris colour and cylinder axis orientation were recorded as these might also be influential. A novel Blur Sensitivity Ratio (BSR) was derived by dividing vision (expressed as minimum angle of resolution) by refractive error (expressed as a scalar vector, U). Alteration of the scalar vector, to account for additional vision reduction due to oblique cylinder axes, was not found to be useful. Decision tree analysis showed that sex, contact lens wear, iris colour and cylinder axis orientation did not influence the BSR. The following algorithms arose from two stepwise multiple linear regressions: BSR (myopes) = 1.13 + (0.24 x pupil diameter) + (0.14 x U) BSR (hyperopes) = (0.11 x pupil diameter) + (0.03 x age) - 0.22 These algorithms together accounted for 84% of the observed variance. They showed that pupil diameter influenced vision in both forms of ametropia. They also showed the age-related decline in the ability to accommodate in order to overcome reduced vision in hyperopia.