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EYE ADVICE: Professional Papers


Paper One: Meridional (Astigmatic) Accommodation

by Kon Zagoritis BscOptom FVCO


Based on my clinical experience, I believe that an understanding of Meridional Accommodation (MA) is essential for refractionists, as it appears to provide a scientific explanation for a large part of what is often referred to as the "art" of refraction.

Part I of this paper reviews the significant contributions in the literature in support of asymmetric ciliary  muscle contraction effecting MA and corneal toricity changes. This is followed by a proposed basis for afferent and efferent mechanisms subserving MA.

Even though MA is operative in most people, it usually does not manifest itself clinically. Part II emphasizes certain principles underlying those cases that depart from normality. These principles can be used by the practitioner as a guide to more successful refracting. Several case examples are used in which the effects of MA are more easily demonstrated and which rely on knowledge of the subject for appropriate prescribing. The implications of MA on various subjects of clinical interest are discussed, including correction of astigmatism with laser refractive surgery.






Paper 1 - Meridional (Astigmatic) Accommodation  Abstract

Physiology of Meridional Accommodation (A) Ciliary Muscle Action and Innervations
(B) Corneal Changes due to Ciliary Muscle Action
(C) Theory of Initiation of Meridional Accommodation

Clinical Implications of Meridional Accommodation


(A) Astigmatic Changes Related to WTR Corneal Toricity (i) Latent Astigmatism
(ii) Primary Accommodative Astigmatism (PAA)       (B) Reflex or 2°PMA and Induced ATR Astigmatic Changes
(C) Eye Preference and Meridional Accommodation (i) 1° PMA and Eye Preference
(ii) 2° PMA and Eye Preference (D) Proactive Prescribing for Presbyopia (i) Phakic Presbyopes
(ii) Pseudophakes and ATR Corneal Changes (E) Refractive Techniques and MA (i) Balancing Meridional Accommodation
(ii) Binocular Test of Cylinder Power (F) Further Clinical Subject Areas and Meridional Accommodation (i) Preventing Induced Oblique Astigmatism in Children
(ii) Low Vision
(iii) Keratoconus
(iv) Hard Contact Lenses
(v) PRK and PARK (Photorefractive Astigmatic Keratectomy)



Paper 2 - Common Chronic (Infective) Conjunctivitis and Nasal Rinsing

Paper 3 - Primary Open-Angle Glaucoma

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