Evaluation of factors affecting the food consumption levels of inpatients in a Turkish armed forces training hospital

The aims of this study are to determine how patients hospitalized in a Turkish Armed Forces Training Hospital perceive different attributes of food and food services and to determine factors affecting the level of food consumption.This study was conducted in Gulhane Military Medical Academy Training Hospital, with 1000 beds. A questionnaire was used to determine the patients’ perception of the food quality and levels of food consumption.It was found that 44.4% of the patients consumed all of the food provided, 28.9% of patients consumed the half, 23.5% of patients consumed some and 3.2% of patients did not consume any of their meals. Logistic regression analysis was used to identify patients who did not consume 50% or more of their food. It was found that non-surgical patients (OR = 0.498; p = 0.022), and those dissatisfied with the taste and smell of food (OR = 4.272; p = 0.000) and the appearance of food (OR = 3.161; p = 0.003) were more likely to be in the patient group who reported not consuming at least 50% of the food provided.     

Changes in tear film,corneal topography,and refractive status in premenopausal women during menstrual cycle

PurposeTo investigate the changes in a questionnaire based subjective symptomatology, tear film break-up time, tear volume, corneal topography, and refractive status in premenopausal women during menstrual cycle.MethodsSeventeen premenopausal females and 15 healthy males were enrolled in this prospective study. After routine ophthalmologic examination, an ocular surface disease index questionnaire was administered, tear film break-up time (TBUT), and Schirmer I tests were performed. Keratometry readings and refractive status were also obtained. All examinations were repeated at day 21, day 12 and day 2.ResultsOSDI score in day 21 was significantly lower than that in day 12 (p = 0.004) and day 2 (p = 0.01) in the female patients; however, no significant change was found in the male subjects (p > 0.05). No statistically significant difference was found in TBUT and Schirmer I tests, keratometry, and refraction results in both of the female and male subjects at all of the test points (p > 0.05). There was a significant correlation between OSDI score and TBUT (p = 0.02, p = 0.03, respectively), and Schirmer I test at day 12 (p = 0.004, p = 0.008, respectively). A significant negative correlation was found between oestrogen level and horizontal keratometry values at day 21 (r = −0.5, p = 0.03; r = −0.4, p = 0.04, respectively) for the right and left eyes in the female subjects.ConclusionOur study confirms that fluctuations in the blood levels of oestrogen produce alterations in ocular surface equilibrium during the menstrual cycle and consequently affect the subjective dry eye symptoms in female patients. However, no ocular surface parameter changes were observed.     

Microbial contamination of contact lens care accessories and compliance with care regimens in Nepal

PurposeTo determine the rates of microbial contamination and identify contaminants associated with contact lens (CL) care accessories. To investigate self-reported compliance levels with care of CL accessories and its association with contamination level.MethodsA total of 46 CL cases and care solutions from asymptomatic soft contact lens wearers were collected. Samples from the CL cases and care solutions were cultured for microbiological identification and enumeration. A questionnaire regarding compliance to care and hygiene procedures were administered to each subject on their visit.ResultsThe percentage of microbial contamination for CL cases and care solutions was 50% and 10.9%, respectively. All the contaminants were bacterial. Staphylococcus aureus (37.0%, 17 of 46 cases) and Escherichia coli (8.7%, 4 of 46 cases) were the most common microorganisms detected in CL cases. In care solutions, S. aureus (8.7%, 4 of 46 samples), Pseudomonas aeruginosa (2.2%, 1 of 46 samples) were common contaminants. CL cases and care solutions that were used for <3 months were significantly less contaminated than those used for >3 months (10.9% versus 39.1%, p < 0.05). Polyquad and Aldox based MPS solution showed no contamination. Subjects with medium or low compliance had highly significant rates of contaminations both in CL cases and solutions than for subjects with high compliance (p < 0.05).ConclusionsNepalese Soft CL wearers are at high risk of developing ocular complications due to high CL case and solution contamination. Frequent replacement of CL cases and solutions, as well as good compliance is recommended to reduce risk of contamination.     

Conjunctival UV autofluorescence – Prevalence and risk factors

PurposeAutofluorescence of ultraviolet (UV) light has been shown to occur in localised areas of the bulbar conjunctiva, which map to active cellular changes due to UV and environmental exposure. This study examined the presence of conjunctival UV autofluorescence in eye care practitioners (ECPs) across Europe and the Middle East and its associated risk factors.MethodImages were captured of 307 ECPs right eyes in the Czech Republic, Germany, Greece, Kuwait, Netherlands, Sweden, Switzerland, United Arab Emirates and the United Kingdom using a Nikon D100 camera and dual flash units through UV filters. UV autofluorescence was outlined using ImageJ software and the nasal and temporal area quantified. Subjects were required to complete a questionnaire on their demographics and lifestyle including general exposure to UV and refractive correction.ResultsAverage age of the subjects was 38.5 ± 12.2 years (range 19–68) and 39.7% were male. Sixty-two percent of eyes had some conjunctival damage as indicated by UV autofluorescence. The average area of damage was higher (p = 0.005) nasally (2.95 ± 4.52 mm²) than temporally (2.19 ± 4.17 mm²). The area of UV damage was not related to age (r = 0.03, p = 0.674), gender (p = 0.194), self-reported sun exposure lifestyle (p > 0.05), geographical location (p = 0174), sunglasses use (p > 0.05) or UV-blocking contact lens use (p > 0.05), although it was higher in those wearing contact lenses with minimal UV-blocking and no spectacles (p = 0.015). The area of UV damage was also less nasally in those who wore contact lenses and spectacles compared to those with no refractive correction use (p = 0.011 nasal; p = 0.958 temporal).ConclusionUV conjunctival damage is common even in Europe, Kuwait and UAE, and among ECPs. The area of damage appears to be linked with the use of refractive correction, with greater damage nasally than temporally which may be explained by the peripheral light focusing effect.     

Trans epithelial corneal collagen crosslinking for progressive keratoconus: 6 months follow up

PurposeTo evaluate keratoconus biomechanical changes after transepithelial corneal collagen cross linking (TE CXL) using riboflavin and ultraviolet A (UVA).SettingSecond University of Naples, Naples, Italy.DesignProspective non comparative case series study.MethodsPatients with progressive keratoconus were examined, before and during a 6 months follow up after TE CXL, with a Pentacam, an Ocular Response Analyzer and an IOLMaster.Best corrected visual acuity (BCVA), refraction, corneal thinnest point (CTP), keratometry readings at the keratoconus apex (K_max), axial eye length (AL), corneal volume (CV) anterior chamber volume (ACV), anterior chamber depth (ACD), corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated.ResultsThirty-six eyes of 36 patients with progressive keratoconus were analyzed. Six months after treatment there was a significant improvement in BCVA (p < 0.01), no significant changes in refraction (p = 0.57), CTP (p = 0.07), K_max (p = 0.88), AL (p = 0.07), CV (p = 0.38), ACV (p = 0.07), ACD (p = 0.7), CH (p = 0.1) and CRF (p = 0.3).ConclusionsAccording to our results TE CXL stabilizes most of the patients with progressive keratoconus, without affecting in negative way the corneal elasticity.     

Small optical zones with aspheric profiles in laser refractive surgery for myopia: A surgical outcome and patient satisfaction study

PurposeTo assess the outcomes of small optical zone (OZ) ablations used in conjunction with large transition zones (TZ) and a highly aspheric treatment profile.MethodsInterventional case series of 39 consecutive patients with myopia or myopic astigmatism. Patient data included pre and postoperative refraction and visual acuities, laser treatment settings and pre and postoperative corneal topography as well as questionnaire responses about the use of glasses and the quality of vision postoperatively.ResultsThe mean preoperative spherical equivalent was −4.50 ± 2.11 dioptres (D) and the mean OZ and TZ diameters were 4.5 ± 0.5 mm and 8.1 ± 0.4 mm, respectively. The mean patient age was 40.7 ± 10.4 years. Manifest spherical refraction was within ±0.5 D in 87% of patients (±1.0 D in 99%) and cylindrical refraction within 0.5 D in 79% (≤1.0 D in 95%). The need to wear distance glasses postoperatively was associated with dissatisfaction with the quality of daytime vision (p = 0.05) and unhappiness with night vision was associated with symptoms of halos (p = 0.03) and starbursts (p = 0.02). The proportion of patients reporting symptoms of dysphotopsias included: ghosting 0%; glare 2%; halos 10%; and starbursts 15%. There was a significant difference in the measured mean effective OZ diameter (4.8 ± 0.3 mm) compared to the mean programmed OZ (4.5 ± 0.5 mm, p = 0.00).ConclusionsSmall ablation zones, when used in conjunction with a large diameter TZ, do not lead to a greater incidence of unwanted visual phenomena over that reported by many studies with larger OZs.     

Comparison of subjective grading and objective assessment in meibography

AimTo analyse repeatability of subjective grading and objective assessment in non-contact infra-red meibography.MethodsMeibography photographs of 24 subjects (female 14; mean age = 46; range = 19–69 years, upper-lid images = 12, lower-lid images = 12) were classified in two sessions by three experienced observers (OI, OII, OIII). Relative area or portion affected by meibomian glands (MG) loss was classified applying three different grading scales in randomized order: a four-grade scale (4S) (degree 0 = no partial glands; 1 = <25% partial glands; 3 = 25–75% partial glands; 3 = >75% partial glands), a pictorial five-grade scale (5S) (degree 0 = no meibomian gland loss (MGL); 1 = <25% MGL; 3 = 26–50% MGL; 3 = 51–75%; 4 = >75% MGL) and objectively by a 100-grade scale (DA) applying ImageJ software.ResultsObserved MG loss ranged from 0% to 69%. Intra-observer agreement of the 5S (OI: κ = 0.80, p < 0.001; OII: κ = 0.40, p = 0.009; OIII κ = 0.81, p < 0.001) was better than of the 4S (OI: κ = 0.79, p < 0.001; OII: κ = 0.15, p = 0.342; OIII κ = 0.50, p = 0.0071). Intra-observer agreement of OI and OIII (±0.88 (95% confidence interval), ±1.305) was better than of OII (±2.21) in 4S and 5S (±0.99, ±2.00 and ±0.91; OI, OII and OIII, respectively) while it was relatively similar in DA (±18, ±17 and ±17). Inter-observer agreement was better in DA (OI–OII: ±13, OI–OII: ±19, OII–OIII: ±26) than in 4S (OI–OII: ±1.76; OI–OIII: ±1.29 and OII–OIII: ±1.31) or 5S (OI–OII: ±1.49; OI–OIII: ±0.91 and OII–OIII: ±1.20).ConclusionIntra-observer and inter-observer agreement was better in computerized grading followed by the subjective five-grade scale and four-grade scale.     

Predicting success with silicone-hydrogel contact lenses in new wearers

Purposeto evaluate changes in tear metrics and ocular signs induced by six months of silicone-hydrogel contact lens wear and the difference in baseline characteristics between those who successfully continued in contact lens wear compared to those that did not.MethodsNon-invasive Keratograph, Tearscope and fluorescein tear break-up times (TBUTs), tear meniscus height, bulbar and limbal hyperaemia, lid-parallel conjunctival folds (LIPCOF), phenol red thread, fluorescein and lissamine-green staining, and lid wiper epitheliopathy were measured on 60 new contact lens wearers fitted with monthly silicone-hydrogels (average age 36 ± 14 years, 40 females). Symptoms were evaluated by the Ocular Surface Disease Index (OSDI). After six months full time contact lens wear the above metrics were re-measured on those patients still in contact lens wear (n = 33). The initial measurements were also compared between the group still wearing lenses after six months and those who had ceased lens wear (n = 27).ResultsThere were significant changes in tear meniscus height (p = 0.031), bulbar hyperaemia (p = 0.011), fluorescein TBUT (p = 0.027), corneal (p = 0.007) and conjunctival (p = 0.009) staining, LIPCOF (p = 0.011) and lid wiper epitheliopathy (p = 0.002) after six months of silicone-hydrogel wear. Successful wearers had a higher non-invasive (17.0 ± 8.2 s vs 12.0 ± 5.6 s; p = 0.001) and fluorescein (10.7 ± 6.4 s vs 7.5 ± 4.7 s; p = 0.001) TBUT than drop-outs, although OSDI (cut-off 4.2) was also a strong predictor of success.ConclusionSilicone-hydrogel lenses induced significant changes in the tear film and ocular surface as well as lid margin staining. Wettability of the ocular surface is the main factor affecting contact lens drop-out.     

The relationship between measurement method and corneal structure on apparent intraocular pressure in glaucoma and ocular hypertension

PurposeTo analyse the relationship between measured intraocular pressure (IOP) and central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) in ocular hypertension (OHT), primary open-angle (POAG) and normal tension glaucoma (NTG) eyes using multiple tonometry devices.MethodsRight eyes of patients diagnosed with OHT (n = 47), normal tension glaucoma (n = 17) and POAG (n = 50) were assessed. IOP was measured in random order with four devices: Goldmann applanation tonometry (GAT); Pascal^® dynamic contour tonometer (DCT); Reichert^® ocular response analyser (ORA); and Tono-Pen^® XL. CCT was then measured using a hand-held ultrasonic pachymeter. CH and CRF were derived from the air pressure to corneal reflectance relationship of the ORA data.ResultsCompared to the GAT, the Tonopen and ORA Goldmann equivalent (IOPg) and corneal compensated (IOPcc) measured higher IOP readings (F = 19.351, p < 0.001), particularly in NTG (F = 12.604, p < 0.001). DCT was closest to Goldmann IOP and had the lowest variance. CCT was significantly different (F = 8.305, p < 0.001) between the 3 conditions as was CH (F = 6.854, p = 0.002) and CRF (F = 19.653, p < 0.001). IOPcc measures were not affected by CCT. The DCT was generally not affected by corneal biomechanical factors.ConclusionThis study suggests that as the true pressure of the eye cannot be determined non-invasively, measurements from any tonometer should be interpreted with care, particularly when alterations in the corneal tissue are suspected.     

Long-term changes in straylight induced by corneal refractive therapy: A pilot study

PurposeTo assess long-term intraocular straylight changes induced by corneal refractive therapy (CRT) and to determine whether these changes persist after cessation of CRT lens wear.MethodsA single-center, prospective, longitudinal study was performed in 22 subjects (group 1) undergoing overnight corneal refractive therapy for 1 year. Ten right eyes of 10 subjects (group 2) with emmetropia served as controls. In each subject, high contrast visual acuity (HCVA), manifest refraction and intraocular straylight were determined at several time points during treatment and 1 month after discontinuing treatment. Straylight was measured using the van den Berg straylight meter (third generation). EDTRS charts (logMAR units) were used to assess HCVA. For both groups, only data for the right eyes were analyzed.ResultsStraylight (mean ± standard deviation) significantly fell from baseline (0.98 ± 0.13) to values recorded after 1 month (0.88 ± 0.13, p = 0.011), 3 months (0.88 ± 0.13, p = 0.004), 6 months (0.88 ± 0.13, p = 0.000) and 12 months (0.76 ± 0.12, p = 0.003) of treatment. One month after discontinuing CRT lens wear, straylight was still significantly lower than baseline (0.89 ± 0.13, p = 0.003). No correlations were observed between intraocular straylight and HCVA.ConclusionsGood refractive outcomes and reductions in straylight were observed in response to corneal refractive therapy for myopia. The reduction in straylight observed after discontinuing CRT warrents further investigation.     

Motivating instructions increases children’s sensory sensitivity

AimTo determine the impact of competitive and cooperative instructions on children’s motivation and performance of sensory tests.Subjects and methodsGerman children (n = 202; 101 girls, 101 boys, 6–9 year-olds) participated in liking and similarity tests after giving either (1) competitive: “I want to see if you can do it better than others”, (2) cooperative: “Would you like to help me”, (3) competitive–cooperative: “Would you like to help me to be better than the other group”, or (4) neutral instructions: “Could you perform this test”. Furthermore, they were asked questions about their motivation.ResultsCompetitive–cooperative instructions were associated high intrinsic motivation (p < 0.05) and better ability to discriminate between different samples in terms of liking, than when other instructions were given. Competitive instructions were associated with a lower performance of the similarity test (p < 0.05). The more children enjoyed the task the better they were able to perform the similarity test (p < 0.05).ConclusionGerman children’s sensory sensitivity can be increase by giving competitive–cooperative instructions. This is likely to be associated with a high intrinsic motivation.     

Efficacy of two silicone-hydrogel contact lenses for bandage use after photorefractive keratectomy

PurposeTo evaluate the efficacy of two silicone hydrogel (SiH) contact lenses, approved for continuous wear for one week, following photorefractive keratectomy (PRK).MethodsForty seven myopic patients (94 eyes) undergone bilateral PRK were enrolled in this prospective, double-masked, comparative study. One eye of each patient was fitted with a Lotrafilcon B lens (Ciba Vision, Duluth, US; 30-day recommended replacement) whereas the fellow eye was fitted with an Asmofilcon A lens (Menicon, Nagoya, Japan; 14-day recommended replacement). Epithelial defect size was assessed using slit lamp biomicroscopy on the day of surgery and at days 1–4 post-operatively. Uncorrected and best-corrected visual acuity and retinal straylight (C-Quant, Oculus Optigerate, Germany) were evaluated pre-operatively and one month post-operatively.ResultsAverage epithelial defect size for Asmofilcon A and Lotrafilcon B was 25.5 ± 11.0 mm² vs. 27.1 ± 9.9 mm² at day 1 (p = 0.007) and 6.3 ± 7.0 mm² vs. 9.2 ± 9.5 mm² at day 2 (p = 0.012) post-operatively. Re-epithelialization at day 3 was completed in 87.2% of the eyes fitted with Asmofilcon A lenses, compared to 74.5% with Lotrafilcon B lenses (p = 0.012). At the 3rd post-operative day 29.8% of re-epithelialized eyes showed irregular suture with Lotrafilcon B, compared to 12.8% eyes with Asmofilcon A lenses (p < 0.001). Finally, no statistically significant differences were found post-operatively between the two lenses retinal straylight (p = 0.98) and best-corrected visual acuity (p = 0.68).ConclusionsSiH lenses can be used as an effective bandage after PRK due to the limited time requested for achieving complete corneal re-epithelialization. Faster and smoother epithelial healing is provided with Asmofilcon A over Lotrafilcon B lenses.     

Progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses

PurposeTo investigate the rate of progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses (pancorneal RGP-CL) compared to non-pancorneal RGP-CL. We also evaluated alterations in anterior chamber parameters with the progression of keratoconus and investigated the location of the cone in eyes with keratoconus.MethodsThe current study was a retrospective study including patients with clinically evident keratoconus from the outpatient clinic from the Department of Ophthalmology of the Erasmus Medical Center, Rotterdam, the Netherlands. Medical history and contact lens characteristics were documented. All participants underwent ophthalmic examination including corneal topography. Corneal topography was repeated at one of the consecutive visits of the patient. Patients were divided into two groups: those wearing pancorneal RGP-CL and those wearing other contact lens types. As a measure of progression of keratoconus differences in corneal topography parameters between both groups were compared.ResultsA total of 82 patients were included of which 42 had follow-up (mean 17.8 months) data. We found a significant difference in progression between eyes fitted with and without pancorneal RGP-CL (K-flat: p = 0.09, K-steep: p = 0.02, K-mean: p = 0.02, and K-minimum: p = 0.04). Compared with eyes fitted without pancorneal RGP-CL no significant difference in K-values was found for eyes fitted with pancorneal RGP-CL during follow-up. Furthermore, a significant decrease in anterior chamber volume (p < 0.001) and corneal volume (p = 0.008) was found during follow-up. In 86.6% the location of the cone was located infero-temporal.ConclusionsPancorneal RGP-CL have a better effect on stabilizing progression of keratoconus than non-pancorneal RGP-CL. The finding of an infero-temporal location of the cone in keratoconic corneas may improve results of contact lens fitting and surgical management.     

Evaluation of central corneal thickness after cataract surgery,penetrating keratoplasty and long-term soft contact lens wear

PurposeThe aim of this study was to compare central corneal thickness (CCT) between corneas of normal healthy eyes (cNHE), corneas of eyes that had undergone cataract surgery by clear corneal phacoemulsification with implantation of an intracapsular intraocular lens (cIOL), corneal grafts after penetrating keratoplasty (gPK) and corneas of long-term soft contact lens wearers (cCL).MethodsThe study design was a consecutive cross-sectional trial. CCT was measured using rotating Scheimpflug camera (Pentacam, software version 1.16r04) in 80 cNHE, 79 cIOL, 46 gPK and 78 cCL. Analysis of variance (one-way ANOVA) was performed to compare differences of mean values between these four groups. Pearson's or Spearman's correlation coefficient (r) was determined between CCT value and age, follow up time after penetrating keratoplasty (timePK) or contact lens wearing time (timeCL).ResultsMeans of CCT measurements were comparable between cNHE (mean CCT ± standard deviation, 554 ± 36 μm), cIOL (551 ± 40 μm) and gPK (534 ± 52 μm) as determined by one-way ANOVA. Mean CCT values in cCL (537 ± 37 μm) were statistically significantly lower in comparison to cNHE (p = 0.026, 95% CI = 1.43–31.44). There was no linear correlation between age and CCT values of cNHE and cIOL (p = 0.841, r = −0.031 and p = 0.931, r = 0.011, respectively). No linear relationship was determined between CCT values of cCL and timeCL (p = 0.315, r = −0.125). CCT values of gPK did not correlate with timePK (p = 0.738, r = 0.054).ConclusionsThe data reported here indicate that in the same statistical model among CCT values of cNHE, cIOL and gPK only long-term soft contact lenses (CL) wearer have significantly lower CCT measurements.     

Evaluating the effect of splitting cylindrical power on improving patient tolerance to toric lens misalignment

PurposeEvaluating the impact of splitting toric power on patient tolerance to misorientation such as with intraocular lens rotation.SettingUniversity vision clinic.MethodsHealthy, non astigmats had +1.50D astigmatism induced with spectacle lenses at 90°, 135°, 180° and +3.00D at 90°. Two correcting cylindrical lenses of the opposite sign and half the power each were subsequently added to the trial frame misaligned by 0°, 5° or 10° in a random order and misorientated from the initial axis in a clockwise direction by up to 15° in 5° steps. A second group of adapted astigmats with between 1.00 and 3.00DC had their astigmatism corrected with two toric spectacle lenses of half the power separated by 0°, 5° or 10° and misorientated from the initial axis in both directions by up to 15° in 5° steps. Distance, high contrast visual acuity was measured using a computerised test chart at each lens misalignment and misorientation.ResultsMisorientation of the split toric lenses caused a statistically significant drop in visual acuity (F = 70.341; p < 0.001). Comparatively better acuities were observed around 180°, as anticipated (F = 3.775; p = 0.035). Misaligning the split toric power produced no benefit in visual acuity retention with axis misorientation when subjects had astigmatism induced with a low (F = 2.190, p = 0.129) or high cylinder (F = 0.491, p = 0.617) or in the adapted astigmats (F = 0.120, p = 0.887).ConclusionMisalignment of toric lens power split across the front and back lens surfaces had no beneficial effect on distance visual acuity, but also no negative effect.     

Comparison of corneal hysteresis and corneal resistance factor after small incision lenticule extraction and femtosecond laser-assisted LASIK: A prospective fellow eye study

PurposeTo compare corneal hysteresis (CH) and corneal resistance factor (CRF) between eyes treated with small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK).SettingBeyoğlu Eye Training and Research Hospital.DesignProspective comparative case series.MethodsSixty eyes from 30 patients with bilateral myopia or myopic astigmatism were studied. Inclusion criteria were spherical equivalent of subjective manifest refraction (SE) <10 diopters (D) and a difference ≤0.50 D between the SEs of both eyes. One eye of each patient was treated with SMILE, and the fellow eye underwent femto-LASIK. Randomization was performed using a sealed envelope system. The main outcome measures were CH and CRF measured preoperatively and postoperatively (1 and 6 months).ResultsPreoperative SE was similar in both groups (p = 0.852). CH and CRF values were reduced postoperatively in both groups compared to their corresponding preoperative values (p < 0.001). At the 6-month follow-up visit, the mean CH values in the SMILE and femto-LASIK groups were 8.95 ± 1.47 and 9.02 ± 1.27, respectively (p = 0.852), and the mean CRF values were 7.77 ± 1.37 and 8.07 ± 1.26, respectively (p = 0.380).ConclusionCH and CRF decreased after SMILE. There were no differences between SMILE and femto-LASIK treatments in postoperative CH or CRF values.     

A preliminary investigation into the effects of ocular lubricants on higher order aberrations in normal and dry eye subjects

PurposeTo study the effects of ocular lubricants on higher order aberrations in normal and self-diagnosed dry eyes.MethodsUnpreserved hypromellose drops, Tears Again™ liposome spray and a combination of both were administered to the right eye of 24 normal and 24 dry eye subjects following classification according to a 5 point questionnaire. Total ocular higher order aberrations, coma, spherical aberration and Strehl ratios for higher order aberrations were measured using the Nidek OPD-Scan III (Nidek Technologies, Gamagori, Japan) at baseline, immediately after application and after 60 min. The aberration data were analyzed over a 5 mm natural pupil using Zernike polynomials. Each intervention was assessed on a separate day and comfort levels were recorded before and after application. Corneal staining was assessed and product preference recorded after the final measurement for each intervention.ResultsHypromellose drops caused an increase in total higher order aberrations (p = <0.01 in normal and dry eyes) and a reduction in Strehl ratio (normal eyes: p = <0.01, dry eyes p = 0.01) immediately after instillation. There were no significant differences between normal and self-diagnosed dry eyes for response to intervention and no improvement in visual quality or reduction in higher order aberrations after 60 min. Differences in comfort levels failed to reach statistical significance.ConclusionCombining treatments does not offer any benefit over individual treatments in self-diagnosed dry eyes and no individual intervention reached statistical significance. Symptomatic subjects with dry eye and no corneal staining reported an improvement in comfort after using lubricants.     

Evaluation of the ocular tolerance of a novel eyelid-warming device used for meibomian gland dysfunction

PurposeObstructive meibomian gland dysfunction (MGD) frequently induces a chronic complaint with various symptoms related to dry eye and discomfort. Previous research indicates a pivotal role for heat therapy for melting the meibum as part of any successful management plan, but delivery of constant temperature during treatment is vital. This study evaluated the performance of a novel device designed to deliver controlled, latent, moist heat to the eyelids and surrounding area.MethodsThe signs, symptoms and ocular temperature of 25 normal subjects (M8, F17; age 29.2 ± 5.7 years) were recorded before and after a 10 min application of the Blephasteam^® device. Ocular temperature (non-invasive ocular thermography; A40 Flir, UK), tear film stability (NIBUT), intra-ocular pressure (IOP), and ocular surface staining and hyperaemia were recorded. Results were checked for normality and compared using paired t-tests.ResultsTemperatures in both eyelids were significantly greater after device application (upper +1.7 ± 0.9 °C; lower +2.1 ± 0.7 °C, p < 0.0005). Bulbar conjunctival hyperaemia significantly decreased after treatment (p < 0.005), but limbal and palpebral hyperaemia remained similar (p = 0.33 and p = 0.11, respectively). Ocular surface staining (p = 0.74) and tear film stability (p = 0.12) were unchanged in this normal cohort, and there was no significant change in IOP (13.8 ± 2.0 mmHg vs 12.9 ± 2.2 mmHg; p = 0.092).ConclusionsThe Blephasteam^® device provides effective levels of warming that would be sufficient to melt meibum, and no adverse ocular responses were recorded in this cohort, indicating that this is a safe device. Interestingly, even in this normal cohort, ocular surface redness appears less after treatment.     

Long term results of Epi-LASIK and LASEK for myopia

PurposeTo evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia.SettingGazi University Medical School, Department of Ophthalmology, Ankara, Turkey.DesignRetrospective study.MethodsTwenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25 s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes.ResultsPreoperative myopic spherical equivalent refraction was −4.65 ± 1.74 D in the LASEK and −3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p = 0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p = 0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p = 0.42).ConclusionsBoth LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term.