Acta Ophthalmologica 2014

Table 1. Refraction and ocular components according to refractive error groups at baseline.
Letter to the Editor Baseline Initially myopic Initially emmetropic Initially hyperopic

Spherical equivalent (dioptres) 2.29 0.12 1.08

Axial length (mm) 24.37 23.54 23.1
Lens power loss in early Anterior chamber depth (mm) 3.6 3.6 3.39
Lens thickness (mm) 3.5 3.56 3.62
adulthood Corneal radius (mm) 7.78 7.83 7.9
Lens power (dioptres) 23.29 23.72 24.34
Rafael Iribarren,1 Anna Midelfart2 and Follow-up at 3 years
Bettina Kinge3 Spherical equivalent (dioptres) 2.96 0.38 0.84
Axial length (mm) 24.75 23.93 23.32
1
Department of Ophthalmology, Centro Anterior chamber depth (mm) 3.59 3.61 3.43
Medico San Luis, Buenos Aires, Lens thickness (mm) 3.58 3.63 3.66
Argentina Corneal radius (mm) 7.79 7.83 7.88
2
Institute of Neuroscience, Faculty of Lens power (dioptres) 22.92 22.95 23.75
Medicine, Norwegian University of Change after 3-year follow-up
Science and Technology, Trondheim, Spherical equivalent (dioptres) 0.67 0.5 0.24
Norway Axial length (mm) 0.38 0.39 0.22
3
Blikk Øyeklinikk, Oslo, Norway Anterior chamber depth (mm) 0.01 0.01 0.04
Lens thickness (mm) 0.08 0.07 0.04
doi: 10.1111/aos.12552 Corneal radius (mm) 0.01 0 0.02
Lens power (dioptres) 0.37 0.77 0.60
Editor,

S ince the time of Sorsby, the lens

has been shown to lose power
while the eye grows during school
years. This loss of power compensates
for axial elongation in eyes that remain
nearly emmetropic during infancy and
adolescence. But during school myopia
development, the lens has been shown
to alter its rate of lens power loss
(Iribarren et al. 2012; Mutti et al.
2012). Three studies in selected groups
developing myopia during early adult-
hood have reported prospectively on
myopic shifts and biometry. These
studies have been performed in micros-
copists and medical or engineering
students, who have been shown to
develop adult onset myopia (Lin et al.
1996; McBrien & Adams 1997; Kinge
et al. 1999), but authors did not report
on lens power change with age,
although those studies showed that
the myopic shifts found were smaller
than expected for the increase in axial
length, thus pointing to possible loss of
lens power during those adult years.
Full prospective data of refractive
change and biometry, including anterior
chamber depth and lens thickness, were
available in one of these studies (Kinge
et al. 1999), so the lens power could be
calculated with Bennett’s equation (Ben-
nett 1988). As can be seen in the Table 1,
the 3-year growth of approximately
0.4 mm in axial length that would rep-
resent a myopic shift in spherical equiv-
alent of about 1.2 dioptres did not
match the actual myopic shift found of
0.50 dioptres because the lens lost
about 0.40–0.80 dioptres of power. It
can then be seen that the lens continues
to compensate for axial elongation in
early adult years. Interestingly, the com-
pensation is less evident in progressing
myopes, as emmetropes or hyperopes
show greater loss of lens power than
progressing myopes in the same period.
The lens thins and flattens curva-
tures in children up to age 10, and from
then on, the lens increases in axial
thickness, steepens front and back
curvatures and loses internal effective
refractive index (Brown’s lens para-
dox). The increase in axial thickness
can be seen in the follow-up of the
current study, and interestingly,
although curvatures may be steepening
slightly with age in these engineering
students, the lens is losing power
probably because of changes in its
internal structure, as has been dis-
cussed before (Iribarren et al. 2012).
The fact that the lens seems to be losing
more power in baseline emmetropes or
hyperopes than in myopic subjects is
possibly related to the changes seen in
lens power loss during myopia devel-
opment in previous studies (Iribarren
et al. 2012; Mutti et al. 2012).
A 0.77 dioptres change in 3 years
represents a rate of lens power loss
of 0.26 dioptres per year, which
compares well with the rate of lens
power loss in SCORM emmetropic
schoolchildren of 0.29 dioptres per
year (Iribarren et al. 2012). It could
then be that the rate of lens power loss
does not slow up much after age 10 and
is still present during early adult life in
subjects prone to develop myopic
shifts, like these engineering students
in Norway. It would be interesting to
analyse lens power loss prospectively in
population-based studies in younger
and older adults according to refractive
groups as has been done in CLEERE
and SCORM studies in schoolchildren.
References
Bennett AG (1988): A method of determining the equiv-
alent powers of the eye and its crystalline lens without
resort to phakometry. Ophthalmic Physiol Opt 8: 53–
59.
Iribarren R, Morgan IG, Chan YH et al. (2012): Changes
in lens power in Singapore Chinese children during
refractive development. Invest Ophthalmol Vis Sci 53:
5124–5130.
Kinge B, Midelfart A, Jacobsen G & Rystad J (1999):
Biometric changes in the eyes of Norwegian university
students–a three-year longitudinal study. Acta Oph-
thalmol Scand 77: 648–652.
Lin LL, Shih YF, Lee YC et al. (1996): Changes in
ocular refraction and its components among medical
students–a 5-year longitudinal study. Optom Vis Sci
73: 495–498.
McBrien NA & Adams DW (1997): A longitudinal
investigation of adult-onset and adult-progression of
myopia in an occupational group. Refractive and
biometric findings. Invest Ophthalmol Vis Sci 38: 321–
333.
Mutti DO, Mitchell GL, Sinnott LT et al. (2012): Cor-
neal and crystalline lens dimensions before and after
myopia onset. Optom Vis Sci 89: 251–262.
Correspondence:
Rafael Iribarren
Department of Ophthalmology
Centro Medico San Luis
San Martın de Tours 2980
1425 Buenos Aires, Argentina
Tel/Fax: +54 11 4393 1844
Email: rafairibarren@gmail.com