Childhood ethnic differences in ametropia and ocular biometry:the Aston Eye Study

Purpose: To describe the methodology, sampling strategy and preliminary results for the Aston Eye Study (AES), a cross-sectional study to determine the prevalence of refractive error and its associated ocular biometry in a large multi-racial sample of school children from the metropolitan area of Birmingham, England. Methods: A target sample of 1700 children aged 6–7 years and 1200 aged 12–13 years is being selected from Birmingham schools selected randomly with stratification by area deprivation index (a measure of socio-economic status). Schools with pupils predominantly (>70%) from a single race are excluded. Sample size calculations account for the likely participation rate and the clustering of individuals within schools. Procedures involve standardised protocols to allow for comparison with international population-based data. Visual acuity, non-contact ocular biometry (axial length, corneal radius of curvature and anterior chamber depth) and cycloplegic autorefraction are measured in both eyes. Distance and near oculomotor balance, height and weight are also assessed. Questionnaires for parents and older children will allow the influence of environmental factors on refractive error to be examined. Results: Recruitment and data collection are ongoing (currently N = 655). Preliminary cross-sectional data on 213 South Asian, 44 black African Caribbean and 70 white European children aged 6–7 years and 114 South Asian, 40 black African Caribbean and 115 white European children aged 12–13 years found myopia prevalence of 9.4% and 29.4% for the two age groups respectively. A more negative mean spherical equivalent refraction (SER) was observed in older children (-0.21 D vs +0.87 D). Ethnic differences in myopia prevalence are emerging with South Asian children having higher levels than white European children 36.8% vs 18.6% (for the older children). Axial length, corneal radius of curvature and anterior chamber depth were normally distributed, while SER was leptokurtic (p < 0.001) with a slight negative skew. Conclusions: The AES will allow ethnic differences in the ocular characteristics of children from a large metropolitan area of the UK to be examined. The findings to date indicate the emergence of higher levels of myopia by early adolescence in second and third generation British South Asians, compared to white European children. The continuation of the AES will allow the early determinants of these ethnic differences to be studied.

A novel, dynamic, in vivo, non-contact method of measuring oxygen depletion rate of the anterior eye

Despite the importance of oxygen measurements, techniques have been limited by their invasive nature and small corneal area of assessment. The aim of this study was to assess a non-contact way of measuring oxygen uptake of the whole anterior eye.

Neuronal convergence in early contrast vision: binocular summation is followed by response nonlinearity and area summation

We assessed summation of contrast across eyes and area at detection threshold ( C t). Stimuli were sine-wave gratings (2.5 c/deg) spatially modulated by cosine- and anticosine-phase raised plaids (0.5 c/deg components oriented at ±45°). When presented dichoptically the signal regions were interdigitated across eyes but produced a smooth continuous grating following their linear binocular sum. The average summation ratio ( C t1/([ C t1+2]) for this stimulus pair was 1.64 (4.3 dB). This was only slightly less than the binocular summation found for the same patch type presented to both eyes, and the area summation found for the two different patch types presented to the same eye. We considered 192 model architectures containing each of the following four elements in all possible orders: (i) linear summation or a MAX operator across eyes, (ii) linear summation or a MAX operator across area, (iii) linear or accelerating contrast transduction, and (iv) additive Gaussian, stochastic noise. Formal equivalences reduced this to 62 different models. The most successful four-element model was: linear summation across eyes followed by nonlinear contrast transduction, linear summation across area, and late noise. Model performance was enhanced when additional nonlinearities were placed before binocular summation and after area summation. The implications for models of probability summation and uncertainty are discussed.

In-Motes EYE:a real time application for automobiles in wireless sensor networks

Wireless sensor networks have been identified as one of the key technologies for the 21st century. In order to overcome their limitations such as fault tolerance and conservation of energy, we propose a middleware solution, In-Motes. In-Motes stands as a fault tolerant platform for deploying and monitoring applications in real time offers a number of possibilities for the end user giving him in parallel the freedom to experiment with various parameters, in an effort the deployed applications to run in an energy efficient manner inside the network. The proposed scheme is evaluated through the In-Motes EYE application, aiming to test its merits under real time conditions. In-Motes EYE application which is an agent based real time In-Motes application developed for sensing acceleration variations in an environment. The application was tested in a prototype area, road alike, for a period of four months.

Incremental nature of anterior eye grading scales determined by objective image analysis

Aim: To use previously validated image analysis techniques to determine the incremental nature of printed subjective anterior eye grading scales. Methods: A purpose designed computer program was written to detect edges using a 3 × 3 kernal and to extract colour planes in the selected area of an image. Annunziato and Efron pictorial, and CCLRU and Vistakon-Synoptik photographic grades of bulbar hyperaemia, palpebral hyperaemia roughness, and corneal staining were analysed. Results: The increments of the grading scales were best described by a quadratic rather than a linear function. Edge detection and colour extraction image analysis for bulbar hyperaemia (r2 = 0.35-0.99), palpebral hyperaemia (r2 = 0.71-0.99), palpebral roughness (r2 = 0.30-0.94), and corneal staining (r2 = 0.57-0.99) correlated well with scale grades, although the increments varied in magnitude and direction between different scales. Repeated image analysis measures had a 95% confidence interval of between 0.02 (colour extraction) and 0.10 (edge detection) scale units (on a 0-4 scale). Conclusion: The printed grading scales were more sensitive for grading features of low severity, but grades were not comparable between grading scales. Palpebral hyperaemia and staining grading is complicated by the variable presentations possible. Image analysis techniques are 6-35 times more repeatable than subjective grading, with a sensitivity of 1.2-2.8% of the scale.

Eye alignment:a novel approach

This thesis describes the design and development of an eye alignment/tracking system which allows self alignment of the eye’s optical axis with a measurement axis. Eye alignment is an area of research largely over-looked, yet it is a fundamental requirement in the acquisition of clinical data from the eye. New trends in the ophthalmic market, desiring portable hand-held apparatus, and the application of ophthalmic measurements in areas other than vision care have brought eye alignment under new scrutiny. Ophthalmic measurements taken in hand-held devices with out an clinician present requires alignment in an entirely new set of circumstances, requiring a novel solution. In order to solve this problem, the research has drawn upon eye tracking technology to monitor the eye, and a principle of self alignment to perform alignment correction. A handheld device naturally lends itself to the patient performing alignment, thus a technique has been designed to communicate raw eye tracking data to the user in a manner which allows the user to make the necessary corrections. The proposed technique is a novel methodology in which misalignment to the eye’s optical axis can be quantified, corrected and evaluated. The technique uses Purkinje Image tracking to monitor the eye’s movement as well as the orientation of the optical axis. The use of two sets of Purkinje Images allows quantification of the eye’s physical parameters needed for accurate Purkinje Image tracking, negating the need for prior anatomical data. An instrument employing the methodology was subsequently prototyped and validated, allowing a sample group to achieve self alignment of their optical axis with an imaging axis within 16.5-40.8 s, and with a rotational precision of 0.03-0.043°(95% confidence intervals). By encompassing all these factors the technique facilitates self alignment from an unaligned position on the visual axis to an aligned position on the optical axis. The consequence of this is that ophthalmic measurements, specifically pachymetric measurements, can be made in the absence of an optician, allowing the use of ophthalmic instrumentation and measurements in health professions other than vision care.

What is the optimum artificial treament for dry eye?

Dry eye disease is a common clinical condition whose aetiology and management challenges clinicians and researchers alike. Practitioners have a number of dry eye tests available to clinically assess dry eye disease, in order to treat their patients effectively and successfully. This thesis set out to determine the most relevant and successful key tests for dry eye disease diagnosis/ management. There has been very little research on determining the most effective treatment options for these patients; therefore a randomised controlled study was conducted in order to see how different artificial treatments perform compared to each other, whether the preferred treatment could have been predicted from their ocular clinical assessment, and if the preferred treatment subjectively related to the greatest improvement in ocular physiology and tear film stability. This research has found: 1. From the plethora of ocular the tear tests available to utilise in clinical practice, the tear stability tests as measured by the non-invasive tear break (NITBUT) up time and invasive tear break up time (NaFL TBUT) are strongly correlated. The tear volume tests are also related as measured by the phenol red thread (PRT) and tear meniscus height (TMH). Lid Parallel Conjunctival Folds (LIPCOF) and conjunctival staining are significantly correlated to one another. Symptomology and osmolarity were also found to be important tests in order to assess for dry eye. 2. Artificial tear supplements do work for ocular comfort, as well as the ocular surface as observed by conjunctival staining and the reduction LIPCOF. There is no strong evidence of one type of artificial tear supplement being more effective than others, and the data suggest that these improvements are more due to the time than the specific drops. 3. When trying to predict patient preference for artificial tears from baseline measurements, the individual category of artificial tear supplements appeared to have an improvement in at least 1 tear metric. Undoubtedly, from the study the patients preferred artificial tear supplements’ were rated much higher than the other three drops used in the study and their subjective responses were statistically significant than the signs. 4. Patients are also willing to pay for a community dry eye service in their area of £17. In conclusion, the dry eye tests conducted in the study correlate with one another and with the symptoms reported by the patient. Artificial tears do make a difference objectively as well as subjectively. There is no optimum artificial treatment for dry eye, however regular consistent use of artificial eye drops will improve the ocular surface.