Talk:Refractive error

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 14 June 2021 and 11 July 2021. Further details are available on the course page. Student editor(s): Neuro1111. Peer reviewers: Monicro98.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 07:56, 17 January 2022 (UTC)

"Refractive error" vs. "Refraction error"

As of today, "Refraction error" receives 11,800 Google hits [1], where as "Refractive error" receives 325,000 [2]. I suggest that Refraction error redirect to Refractive error. -AED 04:07, 4 June 2006 (UTC)

(Note: this now occurs. Dragon Dave 00:16, 21 March 2007 (UTC))

The article should address the question of how a refractive error is different from nearsightedness or farsightedness. Or are nearsightedness & farsightedness simply common speech for the outcomes of refractive errors? It's unclear from the text. anon 96.60.13.125 (talk) 22:36, 6 October 2009 (UTC)

There are different cases of refractive errors, including myopia (nearsightedness) and hyperopia (farsightedness) - they are refractive errors, but different kinds. Other cases of refractive errors include presbyopia and astigmatism. This can probably be better clarified in the article. Bstephens393 (talk) 13:59, 10 March 2011 (UTC)

Image Caption

Also, the caption for the image of the eye examiner and patient used to say that the examiner was using a retinoscope along with a phoropter to measure the patient's refractive error, but upon a closer look, he is only using trial lenses, so I have edited the caption to better suit the image. Bstephens393 (talk) 13:59, 10 March 2011 (UTC)

Statistical number of people with refractive error in 2004

This must be wrong. I suppose it is more than, for example, 500 per 100 000 inhabitants. — Preceding unsigned comment added by 77.253.245.124 (talk) 22:08, 12 August 2011 (UTC)

Yes, the image caption was wrong: These are not number of people affected by refractive errors, but DALY rates. I changed the caption to reflect that. Iwesp (talk) 21:38, 14 February 2015 (UTC)

Planned rewrite of this article

Hello contributors. I have gotten lazy maintaining "dead" articles with my edits going unnoticed by the Wikipedia community, so I was surprised to see edits I made yesterday be reverted. I feel this article contains redundancies, poor and/or misleading wordings, and other areas that could generally be improved. I'd like to formally announce my intention to attempt to improve this article. Anyone that disagrees with any of my edits, please feel free to discuss them here or within another section of this talk page.

Thank you and I look forward to working with you.

Garvin ^Talk 14:44, 26 October 2017 (UTC)

Proposed reformatting

It seems to me that the descriptions of myopia/hyperopia/etc. could all be consolidated into the classification section. This would reduce redundancy and improve clarity. If anyone feels differently, please discuss your thoughts here.

Garvin ^Talk 14:49, 26 October 2017 (UTC)

Not sure what you mean? The descriptions are in the classification section. Doc James (talk · contribs · email) 17:37, 26 October 2017 (UTC)

Yes. I propose to move the descriptions that occur above the TOC to the classification section. "Near-sightedness results in far away objects [...] presbyopia aging of the lens of the eye such that it cannot change shape sufficiently." could all be incorporated into the classification section to improve readability and fluidity.Garvin ^Talk 15:26, 27 October 2017 (UTC)

The lead is supposed to be a summary of the condition in question. IMO this text " Near-sightedness results in far away objects being blurry, far-sightedness and presbyopia result in close objects being blurry, astigmatism causes objects to appear stretched out or blurry." is an important part of the summary.

Generally we keep these summarizes at 3 to 4 paragraphs as this one is. Doc James (talk · contribs · email) 20:36, 27 October 2017 (UTC)Doc James (talk · contribs · email) 20:36, 27 October 2017 (UTC)

Definition of distance object

The previous definition of an object beyond 8 meters seemed arbitrary and without citation. I have changed it, but I fail to find a citation confirming my edit. The articles at Visual acuity and Snellen Chart agree with my edit, but they also have no citation for this information. I believe the problem is that the fact is universally accepted in the eyecare and vision science communities. I will wipe the dust of some old textbooks to see if I can get a formal source/citation. Garvin ^Talk 15:23, 26 October 2017 (UTC)

Yes you are correct per [3]. Will add. Doc James (talk · contribs · email) 17:40, 26 October 2017 (UTC)

Why did you User:Garvin58 remove the reference I added?[4] Doc James (talk · contribs · email) 20:42, 26 October 2017 (UTC)

I wasn't aware that I did. Perhaps I had an edit window open that saved over top of your change. I apologize for the error. Garvin ^Talk 12:40, 27 October 2017 (UTC)

Okay no worries Doc James (talk · contribs · email) 20:35, 27 October 2017 (UTC)

First sentence

"is a problem with focusing light on the retina due to the shape of the eye"

versus

"is a problem focusing of light accurately on the retina due to the shape of the eye."

Accurately is not needed IMO as if it is not accurate it is not focusing. There is no such thing as inaccurate focusing. Doc James (talk · contribs · email) 17:43, 26 October 2017 (UTC)

In common English, I identify with what you are saying. However, in terms of optics, "focus", when defined as a verb, is a system causing light to converge or diverge relative to a focal point. An eye with a refractive error is focusing light at the wrong location: anterior to the retina for myopia, and posterior to the retina for hyperopia. I double checked my definitions at Focal length and Focus (optics). Sorry to be so nit-picky, but it stems from this minor linguistic difference causing me to have to re-educate several patients each day about what's happening with their eyes and why they need correction.

Garvin ^Talk 19:36, 26 October 2017 (UTC)

Our goal is to write in common English rather than technical English. Thus I have restored again. Doc James (talk · contribs · email) 20:40, 26 October 2017 (UTC)

Rather than continue the back and forth revisions, is there a simple way to request an arbitration? I haven't been very active with Wikipedia in the past few years and am not aware of the current protocol for an issue such as this. Thanks in advance for your expertise in this matter. Garvin ^Talk 21:04, 26 October 2017 (UTC)

Sure we could have a WP:RfC and request further peoples opinions. Many people with refractive errors are either not properly focusing light or focusing it not onto the retina.

Not sure what you feel is incorrect with "a problem with focusing light onto the retina due to the shape of the eye."? Doc James (talk · contribs · email) 21:20, 26 October 2017 (UTC)

One of my daily frustrations is when a patient says "I don't think my glasses are strong enough." This statement implies that increasing the power of the lens will always improve the person's vision. This is obviously not the case as many times a reduction in power is what actually improves things. This is an example of how word choice that is acceptable in casual conversation prevents progress in an educational setting. I have to start my education by first breaking down the patient's misunderstanding of how glasses work before I can explain the concept that builds off that point. In a casual conversation, I do not take issue with the above sentence. But in a Wikipedia article where people will only be reading if they are attempting to understand their eyes better, I feel the emphasis should be placed on the accuracy (or inaccuracy) of how the eye is bending light. When starting from this premise, my patient education has been more complete, fluid and efficient, without having to explain the wave theory of light or what a refractive index is. There is no question that the sentence in question already implies a problem with accuracy, however, the sentence could also be true for cataracts, corneal disorders, vitreous hemorrhages, and other conditions. In all of those cases, a focused image does not arrive on the retina. But what makes refractive error different from the above conditions is the focal point existing at another location other than the plane of the retina. By adding the word "accurately", it sets a strong foundation for how refractive error stands out from other visual limitations. I do not find the word "accurately" to be beyond the comprehension of the average reader, and while in a scientific, statistical, or industrial setting, hours could be devoted to the studies of accuracy and precision, I feel the word is common enough in the English language that I disagree with your above sentiment that it makes the sentence "too technical".

TL;DR: I think the addition of the word "accurately" improves the definition of refractive error without negatively impacting the readability of the sentence. I do not think the existing sentence structure is inaccurate, just incomplete. Garvin ^Talk 12:36, 27 October 2017 (UTC)

Okay agree it is a minor difference. Have changed to "is a problem with focusing light accurately onto the retina due to the shape of the eye" Doc James (talk · contribs · email) 20:34, 27 October 2017 (UTC)

Not a great source

This source about special contact lenses is not particularly good.[5] Doc James (talk · contribs · email) 17:44, 26 October 2017 (UTC)

I can look for a better one. Hopefully find one of the five studies the article references.Garvin ^Talk 17:57, 26 October 2017 (UTC)

Or a review on the topic per WP:MEDRS Doc James (talk · contribs · email) 18:11, 26 October 2017 (UTC)

I may have a PDF (if not, I may still have access to it) from CE at the academy meeting. I would need to cite the original study and not the CE lecture that referenced it, correct? Garvin ^Talk 19:40, 26 October 2017 (UTC)

I will look for a proper reference. Doc James (talk · contribs · email) 20:42, 26 October 2017 (UTC)

Okay found a couple of recent review articles that support the content in question[6] Doc James (talk · contribs · email) 21:07, 26 October 2017 (UTC)

Discussion on blur

Proposed Section

Blur is the subjective experience or perception of a defocus aberration within the eye. Blur may appear differently depending on the amount and type of refractive error. The following are some examples of blurred images that may result from refractive errors: Blur is corrected by focusing light on the retina. This may be done with eyeglasses or contact lenses, or by altering the shape of various eye structures via refractive surgery or special contact lenses. Eyeglasses sometimes have unwanted effects including magnification or reduction, distortion, color fringes, altered depth perception, etc. Although many people think of lenses as magnifiers, the lenses within eyeglasses improve vision primarily by reducing blur. Depending on the optical setup, they may also produce magnification or reduction of images which may or may not be intentional or desirable. Often, magnifiers are part of a regimen prescribed by low vision optometrists to help people with reduced vision. The visual acuity is measured with an eye chart. The eye chart is the background used by eye doctors to compare the patient's visual acuity with that of other individuals who have viewed the chart. Although there are many variations in type of eye chart, the standard one is the Snellen eye chart, which was developed by Dutch eye doctor Hermann Snellen in the 1860s. Usually, these charts show 11 rows of capital letters and it is common that the first row contains one letter (the "big E") and the other rows contain letters that are progressively smaller. Other types of eye charts are the Landolt C and the pediatric Lea test. With individuals who are unable to read letters for various reasons, including being too young to know the alphabet or having a handicap, eye doctors may use what is called the tumbling E chart. This type of chart is a variation of the Snellen chart and shows the capital letter E at different sizes and rotated in increments of 90 degrees. The scale of the tumbling E chart is the same as with the standard Snellen chart. The eye doctor, in this case, will ask the person being tested to use either hand (with fingers extended) to show in which direction the "fingers" of the E are pointing: right, left, up or down. In the United States, a 20/20 visual acuity is considered normal. This means that the chart is normally placed at 20 feet distance from the person who is being tested. 20/20 visual acuity is considered normal vision for individuals, but not perfect, as some individuals, although rare, can see at 20 feet what others can see at 10. While vision can be poorer than 20/200, a person with the best-corrected vision (once wearing corrective lenses) of 20/200 is normally considered legally blind. Individuals with 20/200 vision are normally able to read only the first letter on the chart. Usually the 20/20 line of letters is fourth from the bottom, with 20/15, 20/10 and 20/5 below that. Not many people have 20/10 or better visual acuity, but many animals do, especially birds of prey, which have been estimated to have an acuity of 20/5 or even better. In the United States, individuals who want to get their driver's licenses without corrective lens restrictions must have at least 20/40 visual acuity. Eye charts do not provide information on peripheral vision, depth perception, color perception, or contrast sensitivity and therefore do not sufficiently characterize the quality of vision, nor assess the health of the eyes. A complete eye examination will include other tests. However, eye charts are useful in deciding whether the patients need eyeglasses or contact lenses to correct their distance visions, and assessing how effective their refractive corrections are.

The above is a copy/paste from the Eyeglass prescription article. It seems like the information fits this article as blur is a symptom of refractive error. If it were to exist in a complete form here, the section at Eyeglass prescription could be condensed and a "see also: Refractive error" could be added. I welcome input as to where this section would fit best into the existing article. Garvin ^Talk 17:19, 30 October 2017 (UTC)

The source "allaboutcision.com" is not very good. This IMO is overly details for here. Doc James (talk · contribs · email) 20:04, 30 October 2017 (UTC)

Perhaps not as a direct copy/paste, but a summary of the above would be helpful for emmetropes to understand what the symptoms are for a refractive error. Perhaps incorporating the info into blur and linking it in this article would keep this article on the rails while still making the information available. Thanks always for your contributions.Garvin ^Talk 15:04, 31 October 2017 (UTC)

Recent changes

This

is a primary source https://www.ncbi.nlm.nih.gov/pubmed/?term=14638728

is from 1982 "Eva, Paul Riordan. "Refractive change in hyperglycaemia: hyperopia, not myopia." British Journal of Ophthalmology (1982)"

Primary source from 1992 https://www.ncbi.nlm.nih.gov/pubmed/?term=1537826

Primary source https://www.ncbi.nlm.nih.gov/pubmed/21539801

Doc James (talk · contribs · email) 20:10, 23 November 2017 (UTC)

Types

What ref says that these are types?

"Other terminology include anisometropia, when the two eyes have unequal refractive power, and aniseikonia which is when the magnification power between the eyes differ."

Doc James (talk · contribs · email) 20:00, 11 February 2020 (UTC)

References

Article chosen

I decided on choosing this topic because it is immensely common and important and if not treated , though it looks simple can have dire consequences too . The article is rated a C grade article with top priority. This is interesting to me because I very well know that many people will google up this symptom and other than my specific interests , I thought augmenting the article of public concern , will be a way to contribute the most

Initial analysis of the article

The article looks poorly updated and poorly informed with random sentences and lacking an organizational structure . The article hasn't been updated with the latest version of developments .

Overall organization, what changes

The article will be organized as follows on the subheadings :

Classification

Have a tabulated format or a picture added to it .

Refractive error

Get its individual subsection .

Causes of refractive error

Updated list of causes will be listed and explained

Genetic causes

Tabulated the causes of refractive error

Diagnosis

All of the diagnostic procedure in the dark room will be added in subsections

Management

Each form of management will be given subsections

Epidemiology section

This section will be moved between the introduction and classification and also there will be addition of the country or regional variation of refractive errors.

Pictures

Causes of refractive errors , preventive measures etc will be added .

What will I be adding

Ill be adding an account on the snellen chart Signs and symptoms of refractive error section Add subsections in the diagnosis

I'll be removing

Quantification of refractive error

The augmentation will be done in the following sections

Genetic factors

Add the genetic factors in a tabulated form Add the description in a detailed way for the types of the refractive errors and maybe keep a subsection of each

Classification :

Keep a figure of the classification table

In the management section of the article

Describe each management technique like refractive surgery , contact lenses , glasses in a simplified way .

In the epidemiology section of the article :

Add the recent global burden disease study Country level burden of Refractive errors Highlight the variation of the global burden of the disease around the world Neuro1111 (talk) 12:51, 17 June 2021 (UTC)

Workplan for Article Edits

I plan to add a section about the normal anatomy/physiology of the eye and refraction prior to the description of refractive error. Potentially could give very brief description then link to pages on eye or lens. I also would like to remove the section that in "classification" that goes too deep into the physics of refraction, using terminology that I feel is out of reach for lay people.

I want to edit the overview section to have a header and to be more clear, giving an overview rather than specifics. I also think that a lot of the language and descriptions need to be simplified or removed to facilitate understanding by the intended audience.

In the section about risk factors for refractive error, I want to clarify that looking at things close up stimulates the lengthening of the eyeball, promoting near-sightedness.'

Discuss refractive error in children, including natural myopic shift and risk of ambylopia if left untreated

Discuss what cylcoplegics are, how long they last, and why they are used.

Peer Review

Hello, I have read your work plan and the article. Refractive errors are very common and thus should have more information for people to understand it better. Here are some points I would like to make on the article in general as it is now after changes been made.

• The introduction is a little all over the place. It starts off strong but then makes it difficult to understand the organization.
• Epidemiology could be higher because it is lost at the end of the article, and the introduction has some information that could be integrated into the epidemiology section.
• The quantitive calculations of a refractive error could be explained in a much more visual manner or eliminated all together, because this is information for specialists, not as easy to understand for the general public.
• You could mention which cycloplegic agents are used and their duration, and also what they do.
• You could add images to improve the understanding of the types of glasses, and also explain divergent and convergent lenses.
• The cost is not that important, and could be eliminated.
• Some of the bibliography is not open access.

See you around. Monicro98 (talk) 17:57, 10 July 2021 (UTC)

Wiki Education assignment: WikiMed Fall 2023

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 October 2023 and 17 November 2023. Further details are available on the course page. Student editor(s): Japown (article contribs).

— Assignment last updated by Japown (talk) 19:29, 23 October 2023 (UTC)

Lead

• For the lead section, very minimal editing was done so far. A few more grammatical changes could be made (the first sentence of the second paragraph seems like it could be reworded), but otherwise, his suggested workplan and the changes he has made seem appropriate to leave it mostly as is.

Content

• Is the content added relevant to the topic? - Yes. You showed a very focused and well-reasoned work-plan that involved making some sections more coherent while adding a few sections (such as normal refraction) in plain English.
• Is the content added up-to-date? - Recent sources were used throughout, including comprehensive review articles from reliable and up-to-date sources.
• Is there content that is missing or content that does not belong? - All the content added seems appropriate for this article. Normal refraction was discussed in brief to help better understand the classifications of errors. Error types were better grouped and explained. Screening was covered succinctly and objectively. Everything added seems to fit within the confines of your workplan.

Tone and Balance

• Is the content added neutral? - Everything that I have read that Japown added is in neutral voice. There are no personal suggestions or implied connections. The few places that discuss recommendations are not focused on convincing but just detailing what the standardized bodies focused on this subject current recommend, along with a brief explanation why (that typically children do not recognize or bring up their blurry vision).
• Are there viewpoints that are overrepresented, or underrepresented?: No, I would say nothing in this article that he wrote is written in an attempt to convince or lead to a specific viewpoint, only to simplify existing knowledge and condense it into Wikipedia format.

Sources and References

• Is all new content backed up by a reliable secondary source of information? - Everything is cited to a reliable source. Checking through the sources, they are all reliable and recent.
• Are the sources thorough - i.e. Do they reflect the available literature on the topic? Yes, including multiple reviews and a Cochrane review.
• Are the sources current? - All dates are 2016 or after as far as I can find. This seems appropriately recent and updated.
• Are the sources written by a diverse spectrum of authors? These come from different journals with different focuses, and I do not see any authors repeated in my review.
• Are there better sources available, such as peer-reviewed articles in place of news coverage or random websites? (You may need to do some digging to answer this.) - I do not see any less valuable source cited in any of the sections he edited. All come from academic sources and are focused on guidelines and review of knowledge, not primary research.

Organization

• Is the content added well-written - i.e. Is it concise, clear, and easy to read? Yes it easy to read, with varied sentence structure and good grammar, as well as explanations for jargon whenever appropriate.
• Does the content added have any grammatical or spelling errors? The opening part of each description of refractory error categories is punctuated with a period, but each are phrases, not sentences. This could be reworded to not have the colon there, and instead write "Presbyopia occurs when the flexibility of the lens declines, typically due to age." This could still be done as a bulleted list but written as sentences, instead of phrases.
• Is the content added well-organized - i.e. broken down into sections that reflect the major points of the topic? - Organization is one of the strengths of the article. The updated organization of the refraction error categories is very clear and concise, and the sections added are in their appropriate place, with good headings, and of reasonable lengths.

Overall impressions

• Has the content added improved the overall quality of the article - i.e. Is the article more complete?/How can the content added be improved? - Overall, I think the improvements help quite improve the article quite a bit. You've added high value citations and reorganized an important section well. The added sections provide valuable context to refraction errors. I think you could make a few grammatical improvements, but what you have done so far is high quality work and improves the article. Beyond that, if you come up with any further improvements to the section on contact lenses as your work-plan and bibliography, those could be welcome additions. But your work so far is well-sourced, well-organized, appropriately neutral and written to an appropriate education level.

Additional Questions

• Does your peer have 5-7 reliable sources? You have added at least that many high quality, recent sources.
• Does the topic link in some way to our course material? This topic fits very well into the overall goal of the MedicalWiki course - finding a important page relevant to medicine and the student's area of interest that needs further improvement.

Hopper1828 (talk) 13:37, 13 November 2023 (UTC)

Peer Review

Lead

• For the lead section, very minimal editing was done so far. A few more grammatical changes could be made (the first sentence of the second paragraph seems like it could be reworded), but otherwise, his suggested workplan and the changes he has made seem appropriate to leave it mostly as is.

Content

• Is the content added relevant to the topic? - Yes. You showed a very focused and well-reasoned work-plan that involved making some sections more coherent while adding a few sections (such as normal refraction) in plain English.
• Is the content added up-to-date? - Recent sources were used throughout, including comprehensive review articles from reliable and up-to-date sources.
• Is there content that is missing or content that does not belong? - All the content added seems appropriate for this article. Normal refraction was discussed in brief to help better understand the classifications of errors. Error types were better grouped and explained. Screening was covered succinctly and objectively. Everything added seems to fit within the confines of your workplan.

Tone and Balance

• Is the content added neutral? - Everything that I have read that Japown added is in neutral voice. There are no personal suggestions or implied connections. The few places that discuss recommendations are not focused on convincing but just detailing what the standardized bodies focused on this subject current recommend, along with a brief explanation why (that typically children do not recognize or bring up their blurry vision).
• Are there viewpoints that are overrepresented, or underrepresented?: No, I would say nothing in this article that he wrote is written in an attempt to convince or lead to a specific viewpoint, only to simplify existing knowledge and condense it into Wikipedia format.

Sources and References

• Is all new content backed up by a reliable secondary source of information? - Everything is cited to a reliable source. Checking through the sources, they are all reliable and recent.

• Are the sources thorough - i.e. Do they reflect the available literature on the topic? Yes, including multiple reviews and a Cochrane review.
• Are the sources current? - All dates are 2016 or after as far as I can find. This seems appropriately recent and updated.
• Are the sources written by a diverse spectrum of authors? These come from different journals with different focuses, and I do not see any authors repeated in my review.
• Are there better sources available, such as peer-reviewed articles in place of news coverage or random websites? (You may need to do some digging to answer this.) - I do not see any less valuable source cited in any of the sections he edited. All come from academic sources and are focused on guidelines and review of knowledge, not primary research.

Organization

• Is the content added well-written - i.e. Is it concise, clear, and easy to read? Yes it easy to read, with varied sentence structure and good grammar, as well as explanations for jargon whenever appropriate.
• Does the content added have any grammatical or spelling errors? The opening part of each description of refractory error categories is punctuated with a period, but each are phrases, not sentences. This could be reworded to not have the colon there, and instead write "Presbyopia occurs when the flexibility of the lens declines, typically due to age." This could still be done as a bulleted list but written as sentences, instead of phrases.

• Is the content added well-organized - i.e. broken down into sections that reflect the major points of the topic? - Organization is one of the strengths of the article. The updated organization of the refraction error categories is very clear and concise, and the sections added are in their appropriate place, with good headings, and of reasonable lengths.

Overall impressions

• Has the content added improved the overall quality of the article - i.e. Is the article more complete?/How can the content added be improved? - Overall, I think the improvements help quite improve the article quite a bit. You've added high value citations and reorganized an important section well. The added sections provide valuable context to refraction errors. I think you could make a few grammatical improvements, but what you have done so far is high quality work and improves the article. Beyond that, if you come up with any further improvements to the section on contact lenses as your work-plan and bibliography, those could be welcome additions. But your work so far is well-sourced, well-organized, appropriately neutral and written to an appropriate education level.

Additional Questions

• Does your peer have 5-7 reliable sources? You have added at least that many high quality, recent sources.
• Does the topic link in some way to our course material? This topic fits very well into the overall goal of the MedicalWiki course - finding a important page relevant to medicine and the student's area of interest that needs further improvement.

Hopper1828 (talk) 13:39, 13 November 2023 (UTC)

Thank you for the feedback! I will try and respond to each section.

Lead: Definitely will go and reword

Content: I am glad that the content is more readable, clear, and succinct now.

Tone/Balance: I really tried to make neutral statements. Glad to see that come through.

Sources: Yay!

Organization: I understand what you mean about the colons/bulleted lists. I will give it some thought.

Overall: I will peruse the article again for grammatical errors and see what I can fix/reword. Japown (talk) 23:01, 15 November 2023 (UTC)

Add a section on animals

There should be a section on animal refractive errors as considering we have an article on myopia in animals and it is generally known that many animals suffer from refractive errors that aren't just myopia too. 2001:FB1:97:82A5:18BB:2C9:745A:714C (talk) 12:18, 24 April 2024 (UTC)