The correction of anisomyopia with contact lenses (author's transl)

Currently it is believed that correction of anisomyopia with contact lenses is contraindicated because most anisomyopias are axial. By determination of dioptric aniseiconia it has been shown that this is smaller than generally believed also with the correction by contact lenses. In childhood it is advisable to correct an anisomyopia fully as early as possible because the distortion of room perception by spectacles seems to play a much bigger role in higher anisomyopia than the functional aniseiconia. The results are shown in tables.     

Permalens hydrogel intracorneal lenses for spherical ametropia

PURPOSE: To assess the efficacy, stability, and safety of Permalens hydrogel intracorneal lenses for the correction of spherical ametropia 6 years after implantation. METHODS: Implantation of intracorneal hydrogel lenses was performed by the same surgeon (JIBM) in five aphakic and five high myopic eyes. The lens closet to corneal vertex refraction was used. Refractive outcomes, keratometry, keratography, endothelial cell count, and corneal topography were studied. RESULTS: Corneal tolerance to the hydrogel implants was maintained throughout for 6 years with no alteration in endothelial cell count. All myopic eyes showed regression of achieved correction. The aphakic eyes showed no statistically significant difference between the results at 1 month and those obtained at 1 and 6 years. CONCLUSIONS: Hyrdogel intracorneal lenses are well tolerated and the refractive results are stable in aphakic patients. They may be considered when intraocular lenses cannot be placed in aphakic patients, but are not now in clinical use.     

The utility of external performance measurement tools in program evaluation

We describe the use of unfrozen tissue lenses in 42 cases of epikeratophakia in children aged 2-14 years. Fourteen operations were performed in an aphakic eye, 28 in combination with congenital or traumatic cataract extraction. The tissue lenses, made from unfrozen donor cornea according to an original design, healed in 91.5% of cases. The tissue lens was removed when epithelial growth was inadequate on its surface. A five-year follow-up showed that correction within 3.0 D of emmetropia was achieved in 73.7% of the eyes. Preoperatively, mean keratometry readings were 43.5+/-0.2 D, increasing postoperatively to 53.6+/-0.8 D. Mean spherical equivalent at the spectacle plane increased by 9.6+/-0.9 D. Our investigations show the efficacy and safety of non-freeze epikeratophakia in the correction of pediatric aphakia.     

Correctional aspects of anisometropia in railway machine operators

The authors assessed occupationally significant visual functions in anisometropy varying in type and degree. Disorders of occupationally significant visual functions depend reliably on anisometropy degree. Correction of anisometropy with recovered vision and binocular functions restores all parameters of night and color vision. Optic and operative correction of anisometropy could be used for rehabilitation of railway machine operators with long length of service. The article provides recommendations to use intraocular lenses for artiphakia in railway machine operators.     

Nursing research activities in New York state are alive and well: a survey of selected acute care facilities and schools of nursing

The development of effective methods for preventing and correcting myopia in pilots is one of the most important problems of aeronautic ophthalmology. The majority of Russian and foreign aeronautic ophthalmologists agree that contact correction is the principal method for repair of occupational vision of myopic pilots. Experiments with soft contact lenses with 38 and 70% humor content were carried out. The methodology was based on comprehensive examinations of the vision status and status of the organ of vision under common conditions on the Earth and during simulation of unfavorable flight factors. The results indicate that contact lenses are a safe means for correcting myopia in pilots. This is confirmed by the absence of unfavorable changes in the main visual functions and in the status of the anterior segment of the eye, by a constant level of visual working capacity, and by the absence of negative subjective sensations.     

Baseline characteristics in the Myopia Progression Study, a clinical trial of bifocals to slow myopia progression

BACKGROUND: Retrospective studies have indicated that myopic children with nearpoint esophoria experienced slower myopia progression if they wore bifocal glasses rather than single-vision glasses. A small, 18-month clinical trial also supported that finding, but the results were not statistically significant. The Myopia Progression Study was funded by the National Eye Institute to test more rigorously the efficacy of bifocals, compared with single-vision glasses, in slowing myopia progression in children with nearpoint esophoria. A secondary objective of the study was to identify other variables that might influence the rate of myopia progression. This report describes the design and methods of the Myopia Progression Study and the baseline characteristics of the subjects. METHODS: A 3-year, randomized clinical trial was initiated. Subjects were children between 6 and 12 years of age who were myopic (at least -0.50 D in each eye) and who demonstrated nearpoint esophoria by the von Graefe technique. RESULTS: Eighty-two children were enrolled. After blocking by gender and clinical site (two sites), subjects were randomly assigned to one of the two treatments: correction with single-vision spectacle lenses or correction with bifocal lenses having a +1.50 D add in a flattop segment. The average degree of myopia at baseline was -2.31 D (SD = 1.31 D). CONCLUSION: This clinical trial can be expected to determine the effectiveness of bifocal glasses in slowing the progression of myopia in children with nearpoint esophoria.     

Corneal transplantation

Corneal transplantation is a highly successful procedure for restoring sight in patients with corneal disease. The most common indication for transplantation is corneal edema following cataract extraction. A common problem following corneal transplantation is astigmatism, which often requires thick lenses for correction. The excimer laser holds promise for correcting postoperative astigmatism but is not yet in wide use. Rejection is a life-long risk and is most likely to occur during the first year. Topical corticosteroids are commonly used to decrease this risk. Frank corneal rejection must be recognized early and treated with intensive topical therapy.     

Methods of screening for dementia: a meta-analysis of studies comparing an informant questionnaire with a brief cognitive test

OBJECTIVE: The Canadian Ophthalmological Society was asked by the Royal Canadian Mounted Police (RCMP) and the Canadian Human Rights Commission to render an opinion on the acceptability of contact lenses as a reasonable accommodation to the uncorrected visual acuity standard. DESIGN: Survey by mailed questionnaire. SETTING: Canada. SUBJECTS: All RCMP general duty constables with a visual acuity code of V3, V4, V5 or V6 (n = 348) and a random sample of approximately 25% of the constables with an acuity code of V2 (n = 809). Of the 1040 questionnaires returned, 1037 were usable (final response rate 89.6%). Of the 1037 respondents 316 were in the V3 to V6 group and 721 were in the V2 group. OUTCOME MEASURES: Reported frequency of problems with spectacles or contact lenses, weighted according to sampling fraction. RESULTS: A total of 934 respondents indicated that they used some form of visual acuity correction while on duty; of the 934, 360 reported that they wore contact lenses at least some of the time. Approximately 75% of the spectacle wearers reported having to remove their spectacles because of fogging or rain. Although contact lens dislogement or fogging (21.2%) was less frequent than spectacle dislogement (59.2%), 35.4% of the contact lens wearers reported that they were unable to wear their lenses because of irritation on at least one occasion in the previous 2 years; the median length of time was 3.14 days. When the additional amount of time due to other causes is factored in, it is clear that contact lens users wear spectacles for substantial periods while on duty. CONCLUSIONS: Not only are RCMP general duty constables who usually wear contact lenses likely to have to wear spectacles at some time, but it is also possible that they will have to remove their spectacles and function in an uncorrected state in critical situations. Thus, altering the current standard to allow the use of contact lenses as a reasonable accommodation would not ensure effective and safe job performance.     

The effects of depression and chronic pain on psychosocial and physical functioning

Ray tracing with a personal computer allows realistic simulation of optical properties of the human eye. Patterns of point sources are used as objects. The path of light rays is calculated between the point source and the retina for a Gullstrand eye model with improved parameters; the normal eye model has a resolution limit close to the natural resolution limit of the human eye. The image formed on the retina is projected back to a screen at the distance of the object so as to simulate image interpretation by the brain. Refractive errors are modeled by a change in eye parameters and corrected by eyeglasses or/and contact lenses or by an artificial intraocular lens. For optic correction the parameters of seeing aids can be fitted automatically by a least-squares routine. The effect of faulty eye correction on image quality is visualized by using a photograph of a realistic scene as an object.     

Effects of wearing the Bausch & Lomb SoflensTM while skydiving

The use of Soflenses as a method of ametropic correction and ocular protection while skydiving is explored. The use of the Soflens with and without the addition of protective goggles is compared. Vision is seen to be relatively stable and clear while jumping with the Soflens, yet stability and clarity improve significantly when protective goggles are worn over the Soflenses. Stability and clarity improve significantly when protective turbulence in the facial area increases due to more involved skydiving maneuvers. A definite short-term corneal epithelial disturbance is observed when lenses are blown off the eyes due to wind turbulence.     

Modeling human eye aberrations and their compensation for high-resolution retinal imaging

We introduced a mathematical eye model using Gullstrand's six-surface eye model modified by clinically measured aspherical data to study human eye aberrations and their compensation for high-resolution retinal imaging. Ray tracing was used to characterize aberrations and point spread functions (PSFs) of the eye model. By using the Zernike polynomial decomposition of the calculated pupil function, we quantified the wavefront aberrations. Based on calculated PSFs, we designed optical inverse filters to reduce the aberrations for a large pupil size and improve the resolution. Spherical aberration and oblique astigmatism were found to be in good agreement with published experimental measurements. Spherical aberration and defocus were the most significant aberrations for on-axis imaging, whereas oblique astigmatism and coma combined with spherical aberration and defocus were most significant for off-axis imaging. The best retinal image resolution occurred at 2- to 3-mm pupil diameter. After aberration correction for an 8-mm diameter pupil, the resolutions for on-axis or 9 degrees off-axis imaging points were very close to diffraction-limited resolutions. Over a limited field of view (FOV), retinal image resolution of the eye model can be greatly improved by aberration correction using aspheric and astigmatic lenses. For imaging large FOVs, space-variant compensation techniques will be required for aberration correction.     

Gas-permeable cellulose acetate butyrate (CAB) contact lenses

Gas-permeable cellulose acetate butyrate (CAB) contact lenses may often be worn succesfully by aphakic and other patients who are unable to wear hard contact lenses. The comfort characteristics of the CAB lenses are betweeen those of hard and soft contact lenses. They are much more permeable to O2 and CO2 than soft lenses and thus are less apt to cause edema. They are more flexible and more wettable than hard lenses. This study presents 50 patients who, having had to discontinue wearing hard contact lenses because of discomfort, diffuse central corneal edema, or visual problems, were fitted with CAB contact lenses. Thirty of the fifty were able to wear the CAB lenses successfully.     

Reversibility with sodium bicarbonate of styrene maleic anhydride, an intravasal injectable contraceptive, in male rats

PURPOSE: Patients who use topical ophthalmic medications and wear soft contact lenses must remove their lenses before drop instillation to prevent absorption of the medication into the lenses. No previous study has examined how long such a patient should wait before reinserting their lenses. This study was designed to test the hypothesis that waiting 5 minutes before reinsertion of lenses would be sufficient to reduce absorption to a level below what is needed to produce a physiological response. METHODS: Naphcon-A was used as the test solution and pupillary dilation was the physiological response measured. The amount of benzalkonium chloride (BAC) extracted from the lenses was also measured. Twenty-three subjects, none of whom had any significant ocular or systemic abnormalities nor showed pupillary dilation to directly applied Naphcon-A, completed this 3-week study. The study used a 2-period crossover design with a 1-week screening phase. Results were analyzed with a repeated-measure analysis of variance. RESULTS: The pupils averaged 0.316 mm larger when subjects instilled Naphcon-A with lenses in place as compared to when dosing with lenses removed for 5 minutes (P = 0.0008). Nine of 23 subjects showed pupillary dilation greater than 0.5 mm when dosing with lenses in place as compared to none when lenses were removed for 5 minutes. Significantly (P < 0.01) more BAC was extracted from lenses that had been worn during dosing than from lenses removed for 5 minutes (0.9 microgram/lens as compared to no detectible amount). CONCLUSION: Removing soft contact lenses for 5 minutes was sufficient to prevent absorption of clinically significant amounts of Naphcon-A into the lenses.     

Physiological investigations by image analysis

Cataract formation in diabetic lenses has been attributed to polyol-osmotic pressure-generated influx of water. The ensuing swelling in the form of pocket and lake accumulations cause light scattering. The authors tested whether clear lenses of diabetic patients show different hydration properties than age matched normal lenses. Normal and diabetic human lenses were investigated for their nonfreezable water content by differential scanning calorimetry. The total water content of the lens sections were studied by thermogravimetric analysis. Non-cataractous diabetic lenses in all three regions showed a higher total water content than normal lenses. The nonfreezable water content, seems to increase with age in diabetic lenses and decrease with age in normal human lenses. Thus, hydration changes in human diabetic lenses precede cataract formation. While syneresis, the release of bound water into the bulk, is part of the normal aging process, it appears to occur in the younger diabetics only. In older diabetics syneresis is halted or even reversed. This may be due to the glycation of lens proteins in diabetic patients which tends to immobilize water and therefore, reverse the syneresis due to aging.     

Malonaldehyde, superoxide dismutase and human cataract

UV-spectrophotometry and fluorometry were used to study Malonaldehyde (MDA) and Superoxide Dismutase (SOD) in normal, cataractous human lenses and red blood cells of the patients with cataract. MDA content of senile and complicated cataractous lenses was significantly higher than that of normal human lenses, while that of complicated cataract was significantly higher than that of senile cataract. SOD activity of senile and complicated cataractous lenses was significantly lower than that of normal human lenses, while there was no marked difference between senile and complicated cataractous lenses. Significant correlation between cataractous lenses and red blood cells was not found in MDA content and SOD activity. There was a negative correlation between SOD and MDA in normal human lenses, but no correlation between SOD and MDA in cataractous lenses. The study shows that lipid peroxidation may be one of the possible mechanisms of cataractogenesis in human, and emphasizes the role of SOD in prevention of photoperoxidative damages to the tissues.     

Gene organization, primary structure and RNA processing analysis of a ribosomal RNA operon in Lactococcus lactis

The introduction and development of soft lenses and rigid gas-permeable lenses has ushered in a new era in fitting athletes with contact lenses. Many of the well-known disadvantages associated with polymethylmethacrylate (PMMA)-type lenses have been either eliminated or minimized. Fitting athletes with contact lenses must still be viewed with caution, however, since athletes' visual needs are usually much more demanding than those of the general public. An indiscriminate choice of lens design can adversely affect athletic performance and may even create a hazardous situation. An intelligent choice of lens can provide some subtle advantages that may improve athletic performance and provide the margin for victory.     

The oxidative stress in the cataract formation

The lens of the eye is an avascular tissue surrounded by fluids such as the aqueous humor and vitreous body, with one side facing toward the outside of the body. We investigated peroxidative reactions occurring in cataractous lenses, examining changes within the lens tissues as well as in the surrounding environment. 1. Peroxidative reactions in lenses. 1) Aging and peroxidative reactions. The activity of superoxide dismutase (SOD) began to decrease in the lenses of rats at six months of age. Moreover, the level of lipid peroxide increased significantly in the lenses of rats at 24 months of age. Lipoproteins became increasingly oxidized with age. The levels of Na+, K+, and Ca++, ions that are important to the maintenance of membrane function, also varied significantly with age. In the lenses of six-month-old Senescence Accelerated Mice (SAM), there was a marked decrease in the ability of scavenge active oxygen and a marked increase in the amount of lipid peroxide. In human lenses, the level of autofluorescence increased as the lens fiber structure changed with age. 2) Generation of free radicals inside the lens. We verified that HO. and ascorbic acid radicals were being generated inside cataractous lenses using electron spin resonance (ESR). 3) Changes in oxidation-related substances in cataractous lenses. Senile cataractous lenses and diabetic cataractous lenses were classified as four types, cortical, nuclear, posterior subcapsular, and mature. In cataractous lenses from all types of diabetic patients, the levels of glucose, glycated protein, and lipid peroxide were higher than in senile cataractous lenses. Among the four types of cataracts, the accumulation of peroxides was the greatest in the nuclear type both diabetic and senile cataractous lenses. 4) Transitional metals. Iron ions and copper ions existed in lens tissue. In particular, the subepithelial region of the lens stained strongly for copper ions. The increased level of copper ions in cataractous lenses is likely to be related to the increased peroxidation in this tissue. 5) Changes in membrane. Lowered levels of phospholipids and a higher degree of saturation of fatty acids were observed in senile cataractous lenses as compared with normal lenses. The increased saturation of fatty acids indicated that there was a damage to the membrane structure due to peroxidative reactions. The receptors for low density lipoprotein (LDL) were shown to exist on the epithelium of normal lenses. Acetyl-LDL, a denatured lipoprotein was incorporated into senile cataractous lenses but not into normal lenses, suggesting that the barrier function of the membrane deteriorates in cataractous lenses. Moreover, in diabetic cataractous lenses, the levels of very low density lipoprotein (VLDL) and LDL significantly increased. 2. Change in the environment surrounding the lens and peroxidative reactions. 1) Changes in the levels of oxidation-related substances in blood, aqueous humor, and vitreous body from diabetic patients: all had decreased levels of reduced glutathione and superoxide scavenging activity, and increased levels of lipid peroxide and glycated protein. This may have been due to a reduction in the anti-oxidative potential in the environment surrounding the lens due to the enhanced glycation. Changes in the level of oxidation related substances in the vitreous body in particular, will likely have a significant impact on the lens. 2) Changes in lenses as the surrounding environment deteriorates. Human lenses were cultured for three weeks under conditions similar to those found in vivo utilizing the culture system that we had originally designed and constructed. When protective activity against peroxidation was reduced, the amount of lipid peroxide increased significantly. In the presence of high levels of glucose, the levels of lipid peroxide increased and the amount and activity of SOD decreased. 3. Effects of changes in the external environment on peroxidative reactions.     

Investigations into the loss of glutathione from lenses in organ culture

PURPOSE: To investigate possible causes and implications of the decrease in glutathione concentration in rat lenses during organ culture. METHODS: Freshly excised lenses were incubated in modified TC-199 medium. Ellman's Reagent or the GSH-400 assay were used to assay glutathione levels in lenses cultured for different times and under a variety of altered culture conditions. RESULTS: In lenses from young rats the glutathione decrease was not ameliorated by reduction of oxygen tension in the incubator, nor by supplementation of the culture medium with various antioxidants or sulfhydryl compounds, nor with the amino acid precursors of glutathione. Addition of 2-mercaptoethanol stimulated cysteine transport into the lens but had only a modest effect in maintaining the level of glutathione. The decrease in glutathione concentration was less in cultured lenses from older rats. Lenses from rhesus monkeys exhibited no decrease in glutathione levels when maintained in organ culture for up to 48 h. CONCLUSIONS: The basis for the decreased glutathione in cultured young rat lenses is still uncertain. The data from the present study indicate a definite relationship between glutathione loss and age for cultured rat lenses, with young lenses being much more susceptible. The resistance of cultured monkey lenses to loss of glutathione demonstrates species differences in this property which may be relevant to previously reported differences in susceptibility to oxidative damage.     

Evolution of C4 photosynthesis in response to changes in carbon and oxygen concentrations in the atmosphere through time

This work is a survey of 82 cases of keratoconus which have been followed up for 1 to 12 years. Among them only 66 were fitted with contact lenses. The contra-indications for them are: 1. a better visual acuity with spectacles than with contact lenses, 2. advanced cases (4th degree of Amsler) whose fitting is impossible, 3. unilateral keratoconus, 4. associated diseases such as trachomatous pannus, allergic kerato-conjunctivitis. Hard corneal lenses are now in use in most of the cases. Scleral lenses are much less used than they were 10 years ago, owing probably to the great improvement of the corneal lenses during this time. These hard corneal lenses have a short Ro (4 to 7 mm), an overall diameter between 8 and 11 mm, and an optic diameter of 5 mm. They are fitted under fluorescein control. The mobility must be good too. One case was fitted with soft lenses. The visual acuity is good and so is the tolerance: 80% of the patients wear their lenses 10 hours a day or more. Contact lenses do not affect the progression of keratoconus thus finally a keratoplasty must be performed in many cases. After the operation a contact lens is very often necessary, but its daily wearing time must be divided by two, to avoid corneal neo-vascularisation. Soft corneal lenses may be used in some cases of keratoconus. They are indicated when the hard lenses are no longer tolerated and before a keratoplasty. The base curves of these soft lenses are not related to the radii of the conic cornea. In most of the cases they are between 7.50 and 8.60 mm. The diameter is large: 14 or 15 mm. The lenses must not move too much: 1 mm up or down when the patient blinks. The edge of the lens must not depress the bulbar conjunctiva and there must be no air bubble under the lens. In many cases a cylindrical spectacle lens is necessary to obtain a good visual acuity. Some authors prefer to fit a hard corneal lens over the soft one: this is the "piggy back" method. Sometimes keratoconus has appeared in patients already fitted during several years to correct a myopic astigmatism. It is not clear whether these keratoconus have been produced or not be the contact lenses.