J Korean Med Sci.  2009 Aug;24(4):708-714. 10.3346/jkms.2009.24.4.708.

Changes of Ocular Version with Aging in Normal Korean Population

• Kang NY

• KMID: 1779208
• DOI: http://doi.org/10.3346/jkms.2009.24.4.708

Abstract

The purpose of this study is to estimate normative values of maximum versions in healthy Koreans and investigate age-associated changes in eye movement, using lateral and vertical version light-reflex (LVR) test. Two hundred forty normal healthy subjects whose corrected visual acuity was better than 20/50 in both eyes, from 4 to 79 yr old (30 subjects in each decade) were studied. Maximum sustained values of dextroversion, levoversion, supraversion, and infraversion in each eye were measured using LVR test. Changes of versions according to age were analyzed. Mean normal value of dextroversion, levoversion, supraversion, and infraversion in normal Koreans was 7.7 mm, 41.6degrees, 33.9degrees, and 7.7 mm respectively. Contrary to values of Caucasians, levoversion (adductive movement) was more excessive and infraversion (depression) was smaller in Koreans. All versions were decreased with aging (P<0.001 for all). Levoversion had the largest decrease with aging compared with other versions (P<0.001, respectively) and infraversion had the least decrease with age than levoversion (P<0.001), supraversion (P<0.001). All maximal sustained versions were decreased with aging but the ranges of ocular movements in Koreans were different with Caucasians as version least affected and most affected by age was infraversion and levoversion in Koreans. The study standardized normal maximal versions and aging changes of versions in Koreans.

Keyword

Ocular Version; Lateral and Vertical Version Light-reflex (LVR) Test; Aging

MeSH Terms

Adolescent
Adult
Aged
Aging/*physiology
Asian Continental Ancestry Group
Child
Child, Preschool
Eye Movements/*physiology
Female
Humans
Korea
Male
Middle Aged
Reference Values

Figure

• 

  Fig. 1 Photographs of LVR (lateral and vertical version light-reflex) test measurements in dextroversion (A), levoversion (B), supraversion (C) and infraversion (D) of the right eye. Note corneal light reflex and scleral light reflex (arrow point indicates the exact position) in each eye.

• 

  Fig. 2 Mean values of LVR (lateral and vertical version light-reflex) test in dextroversion and infraversion of right eye. Subjects were grouped according to decade of life. All values are scleral light reflex on the right eye. The values are mean±SEM.

• 

  Fig. 3 Mean values of LVR (lateral and vertical version light-reflex) test in levoversion and supraversion of right eye. Subjects were grouped according to decade of life. Values of scleral light reflex on the right eye were converted into degrees. The values are mean±SEM.

• 

  Fig. 4 Mean values of horizontal palpebral fissure length (FW), fissure height (FH) of right eye and inner intercanthal distance (ICD) and interpupillary distance (PD). Subjects were grouped according to decade of life. The values are mean±SEM.

• 

  Fig. 5 Calculated mean lateral and vertical version light-reflex (LVR) test measurements in each decade as a percentage relative to the mean values of the 3rd decade group of the right eye. Subjects were grouped according to decade of life. All four versions are decreased with aging (P<0.001, respectively by regression analysis). Levoversion is the most decreased with aging (P<0.001 for each version type) and infraversion is least affected compared to levoversion (P<0.001) and supraversion (P<0.001), but not significantly different from dextroversion (P=0.3036 by multiple comparison test). The values are mean±SEM.

Reference

1. Von Noorden GK. Von Noorden GK, Campos EC, editors. Examination of the patient-II. Binocular vision and ocular motility: Theory and management of Strabismus. 2002. 6th ed. St Louis: Mosby;199–200.

2. Guibor GP. Squint and allied conditions. 1959. New York: Grune & Stratton;28.

3. Kestenbaum A. The clinical methods of neuro-ophthalmologic examination. 1961. 2nd ed. New York: Grune & Stratton;237.

4. Urist MJ. A lateral version light-reflex test. Am J Ophthalmol. 1967. 63:808–815.

5. Urist MJ. Midline vertical versions in paretic deviations measured by a vertical version light-reflex test. Am J Ophthalmol. 1967. 64:253–260.

6. Urist MJ. A lateral version light-reflex test. II. Value in the study of lateral rectus muscle palsy. Am J Ophthalmol. 1967. 64:70–77.

7. Ziffer AJ, Isenberg SJ, Elliott RL, Apt L. The effect of anterior transposition of the inferior oblique muscle. Am J Ophthalmol. 1993. 116:224–227.

8. Hanada AL, De Souza EN Jr, Moribe I, Curze AA. Comparison of palpebral fissure obliquity in three different racial groups. Ophthal Plast Reconstr Surg. 2001. 17:423–426.

9. Kang JS. Plastic surgery. 2004. 3rd ed. Seoul: Koonja;865–866.

10. Kono R, Poukens V, Demer JL. Quantitative analysis of the structure of the human extraocular muscle pulley system. Invest Ophthalmol Vis Sci. 2002. 43:2923–2932.

11. Sharpe JA, Sylvester TO. Effect of aging on horizontal smooth pursuit. Invest Ophthalmol Vis Sci. 1978. 17:465–468.

12. Spooner JW, Sakala SM, Baloh RW. Effect of aging on eye tracking. Arch Neurol. 1980. 37:575–576.

13. Chamberlain W. Restriction in upward gaze with advancing age. Am J Ophthalmol. 1971. 1:341–346.

14. Yamashiro M. Objective measurement of the limit of uniocular movement. Jpn J Ophthalmol. 1957. 1:130–135.

15. Oguro H, Okada K, Suyama N, Yamashita K, Yamaguchi S, Kobayashi S. Decline of vertical gaze and convergence with aging. Gerontology. 2004. 50:177–181.

16. Clark RA, Isenberg SJ. The range of ocular movements decreases with aging. J AAPOS. 2001. 5:26–30.

17. Koh HJ, Yoo JM. The amounts of horizontal ocular movement in Korean people and comparison according to methods of measurement. J Korean Ophthalmol Soc. 2003. 44:1370–1375.

18. Clark RA, Demer JL. Effect of aging on human rectus extraocular muscle paths demonstrated by magnetic resonance imaging. Am J Ophthalmol. 2002. 134:872–878.

19. Del Monte MA, Richard JM, Mets MB, Wilson ME, Wight KW. Denny M, editor. Section 6: Pediatric ophthalmology and strabismus. Basic and Clinical Science Course. 1994. Vol 6. San Fransisco: American Academy of Ophthalmology;237–277.

20. Park DM, Song JW, Han KH, Kang JS. Anthropometry of normal Korean eyelids. J Korean Soc Plast Reconstr Surg. 1990. 17:822–834.

21. Kim CJ, Han KS, Kim Y, Cho YJ. A facial anthropometric study on the Korean youths. J Korean Soc Plast Reconstr Surg. 1988. 15:427–436.

22. Oh SJ, Koh IC, Lee YH, Lew JD. Somatometric study on the face of the Korean. J Korean Soc Plast Reconstr Surg. 1975. 2:15–22.

23. Cho JH, Han KH, Kang JS. Normal anthropometric values and standardized templates of Korean face and head. J Korean Soc Plast Reconstr Surg. 1993. 20:995–1004.