Glossary - Aniseikonia through Aphakia

GLOSSARY - Aniseikonia through Aphakia

Aniseikonia - is a condition that causes each eye to perceive the size of objects differently. Aniseikonia is considered clinically significant when the difference of the images between the eyes is greater than 0.75%. Around 20-30% of the general spectacle wearing population may have a measurable amount of aniseikonia, however only 5-6% are clinically significant. There is no prevalence for gender, ethnicity or age.

Symptoms can include headaches, double vision, disorientation or dizziness, tearing, eye pain or fatigue, sensitivity to light, visual acuity issues and trouble reading, as well as nausea.

Aniseikonia can occur naturally or as an unintended consequence of ocular surgery. Retinal Aniseikonia can occur when retinal damage causes distortion in size perception,(e.g. macular degeneration). Neurological Issues such as a lesion on the occipital lobe of the brain can also cause aniseikonia. Different visual tests, which focus on the perception of binocular space, and the direct comparison of image size perceived by each eye, are administered to diagnose aniseikonia. 

Spectacle and medical contact lenses are the current treatment for aniseikonia.

 

Anisometropia -  is a condition in which each eye has a significant difference in refractive power, meaning that each eye has different ability to focus on objects at a distance.  Most people have some difference in the focusing ability of each eye, but it is rarely noticeable in small amounts. Anisometropia occurs when the difference between eyes is intolerable.

Types of Anisometropia, include: Simple anisometropia, which occurs when only one eye has a refractive error, and the other eye can focus normally; Iso anisometropia (Compound anisometropia), which occurs when there is a significant focusing strength difference  between two eyes  in which both are myopic (nearsighted); and antimetropia (Mixed anisometropia), which occurs when one eye is hyperopic (far-sighted) and the other is myopic (nearsighted).

Common symptoms include diplopia, or “double vision,” headaches, light sensitivity, nausea, disorientation, fatigue or blurred vision.

Because each eye has a different focusing strength, both eyes are not able to focus on the same point in space together, resulting in problems with binocular vision. Because of this, there is a tendency to automatically favor one eye over the other. As a result, the less-favored eye will become weaker can result in Amblyopia (“lazy eye”). This can be especially problematic in younger patients and why pediatric eye exams are recommended.

Anisometropia affects approximately 6% of children between the 6 and 18 years-of-age, and there is a greater than 6% prevalence in older adults. Anisometropia can result from ocular trauma, is more prevalent in myopic patients and often results from the eyes being different in shape or curvature.

Test to diagnose anisometropia, include a visual acuity test of the eyes’ ability to see various objects of different sizes clearly and retinoscopic measures of reflected light projected on the retina to determine the refractive error of each eye.

Immediate treatment is recommended when anisometropia is diagnosed, and can include: corrective contact lenses or spectacles with different prescription strengths for each eye; “patching” or covering one eye to strengthen the less-favored eye which may have become weakened by nonuse; or laser surgery to correct refractive error, making the eyes more similar in focusing power.

 

Aphakia - is a condition where the eye is missing an important focusing structure called the crystalline lens (often shortened to “lens”).  The lens accounts for approximately one-third of the eye's focusing power, and when it is missing, vision is drastically affected. The lens is located directly behind the iris. The Iris is the colored part of the eye that relaxes and constricts to control pupil size, therefore, controlling the amount of light that enters the eye. 

There are surgical, congenital and traumatic causes and risk factors for aphakia. Surgically, aphakia is caused by the removal of the lens when it has become clouded by cataracts. Congenital factors also can cause some people to be born without a functioning lens. Injury to the eye which displaces the lens is another cause for aphakia.

The most common symptom of aphakia is hypermetropia, or what is commonly known as “far-sightedness,” in which people are able to see distant objects better than near objects.  When the lense is missing in aphakia, the eye becomes unable to focus on objects at different distances. Iridodonesis, or an iris instability, is another symptom of aphakia. 

Contact lenses are the preferred treatment, over spectacles, with different prescription strengths for each eye.