Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema

Purpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting. Patients and methods: Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test. Results: In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99). Conclusion: These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off. © 2014 Mushtaq et al.

The influence on unaided vision of age, pupil diameter and spherocylindrical refractive error

Background - The aim was to derive equations for the relationship between unaided vision and age, pupil diameter, iris colour and sphero-cylindrical refractive error. Methods - Data were collected from 663 healthy right eyes of white subjects aged 20 to 70 years. Subjective sphero-cylindrical refractive errors ranged from -6.8 to +9.4 D (mean spherical equivalent), -1.5 to +1.9 D (orthogonal component, J0) and -0.8 to 1.0 D (oblique component, J45). Cylinder axis orientation was orthogonal in 46 per cent of the eyes and oblique in 18 per cent. Unaided vision (-0.3 to +1.3 logMAR), pupil diameter (2.3 to 7.5 mm) and iris colour (67 per cent light/blue irides) was recorded. The sample included mostly females (60 per cent) and many contact lens wearers (42 per cent) and so the influences of these parameters were also investigated. Results - Decision tree analysis showed that sex, iris colour, contact lens wear and cylinder axis orientation did not influence the relationship between unaided vision and refractive error. New equations for the dependence of the minimum angle of resolution on age and pupil diameter arose from step backwards multiple linear regressions carried out separately on the myopes (2.91.scalar vector +0.51.pupil diameter -3.14 ) and hyperopes (1.55.scalar vector + 0.06.age – 3.45 ). Conclusion - The new equations may be useful in simulators designed for teaching purposes as they accounted for 81 per cent (for myopes) and 53 per cent (for hyperopes) of the variance in measured data. In comparison, previously published equations accounted for not more than 76 per cent (for myopes) and 24 per cent (for hyperopes) of the variance depending on whether they included pupil size. The new equations are, as far as is known to the authors, the first to include age. The age-related decline in accommodation is reflected in the equation for hyperopes.

Superfocusing of high-M2 semiconductor laser beams:experimental demonstration

The focusing of multimode laser diode beams is probably the most significant problem that hinders the expansion of the high-power semiconductor lasers in many spatially-demanding applications. Generally, the 'quality' of laser beams is characterized by so-called 'beam propagation parameter' M2, which is defined as the ratio of the divergence of the laser beam to that of a diffraction-limited counterpart. Therefore, M2 determines the ratio of the beam focal-spot size to that of the 'ideal' Gaussian beam focused by the same optical system. Typically, M2 takes the value of 20-50 for high-power broad-stripe laser diodes thus making the focal-spot 1-2 orders of magnitude larger than the diffraction limit. The idea of 'superfocusing' for high-M2 beams relies on a technique developed for the generation of Bessel beams from laser diodes using a cone-shaped lens (axicon). With traditional focusing of multimode radiation, different curvatures of the wavefronts of the various constituent modes lead to a shift of their focal points along the optical axis that in turn implies larger focal-spot sizes with correspondingly increased values of M2. In contrast, the generation of a Bessel-type beam with an axicon relies on 'self-interference' of each mode thus eliminating the underlying reason for an increase in the focal-spot size. For an experimental demonstration of the proposed technique, we used a fiber-coupled laser diode with M2 below 20 and an emission wavelength in ~1μm range. Utilization of the axicons with apex angle of 140deg, made by direct laser writing on a fiber tip, enabled the demonstration of an order of magnitude decrease of the focal-spot size compared to that achievable using an 'ideal' lens of unity numerical aperture. © 2014 SPIE.

One-year outcome of bevacizumab therapy for chronic macular edema in central and branch retinal vein occlusions in real-world clinical practice in the UK

Background: The purpose of this study was to investigate the 12-month outcome of macular edema secondary to both chronic and new central and branch retinal vein occlusions treated with intravitreal bevacizumab in the real-life clinical setting in the UK. Methods: Retrospective case notes analysis of consecutive patients with retinal vein occlusions treated with bevacizumab in 2010 to 2012. Outcome measures were visual acuity (measured with Snellen, converted into logMAR [logarithm of the minimum angle of resolution] for statistical calculation) and central retinal thickness at baseline, 4 weeks post-loading phase, and at 1 year. Results: There were 56 and 100 patients with central and branch retinal vein occlusions, respectively, of whom 62% had chronic edema and received prior therapies and another 32% required additional laser treatments post-baseline bevacizumab. Baseline median visual acuity was 0.78 (interquartile range [IQR] 0.48–1.22) in the central group and 0.6 (IQR 0.3–0.78) in the branch group. In both groups, visual improvement was statistically significant from baseline compared to post-loading (P,0.001 and P=0.03, respectively), but was not significant by month 12 (P=0.058 and P=0.166, respectively); 30% improved by at least three lines and 44% improved by at least one line by month 12. Baseline median central retinal thickness was 449 μm (IQR 388–553) in the central group and 441 µm (IQR 357–501) in the branch group. However, the mean reduction in thickness was statistically significant at post-loading (P,0.001) and at the 12-month time point (P,0.001) for both groups. The average number of injections in 1 year was 4.2 in the central group and 3.3 in the branch group. Conclusion: Our large real-world cohort results indicate that bevacizumab introduced to patients with either new or chronic edema due to retinal vein occlusion can result in resolution of edema and stabilization of vision in the first year.

Crossover evaluation of silicone hydrogel daily disposable contact lenses

PURPOSE: To assess the surface tear breakup time and clinical performance of three daily disposable silicone hydrogel contact lenses over 16 hours of wear. METHODS: Thirty-nine patients (mean [±SD] age, 22.1 [±3.5] years) bilaterally wore (narafilcon A, filcon II-3, and delefilcon A) contact lenses in a prospective, randomized, masked, 1-week crossover clinical trial. Tear film was assessed by the tear meniscus height (TMH), ocular/contact lens surface temperature dynamics, and lens surface noninvasive breakup time at 8, 12, and 16 hours of wear. Clinical performance and ocular physiology were assessed by subjective questionnaire, by high-/low-contrast logMAR (logarithm of the minimum angle of resolution) acuity, and through bulbar and limbal hyperemia grading. Corneal and conjunctival staining were assessed after lens removal. RESULTS: Delefilcon A demonstrated a longer noninvasive breakup time (13.4 [±4.4] seconds) than filcon II-3 (11.6 [±3.7] seconds; p < 0.001) and narafilcon A (12.3 [±3.7] seconds; p < 0.001). A greater TMH (0.35 [±0.11] mm) was shown by delefilcon A than filcon II-3 (0.32 [±0.10] seconds; p = 0.016). Delefilcon A showed less corneal staining after 16 hours of lens wear (0.7 [±0.6] Efron grade) than filcon II-3 (1.1 [±0.7]; p < 0.001) and narafilcon A (0.9 [±0.7]; p = 0.031). Time was not a significant factor for prelens tear film stability (F = 0.594, p = 0.555) or TMH (F = 0.632, p = 0.534). Lens brand did not affect temperature (F = 1.220, p = 0.308), but it decreased toward the end of the day (F = 19.497, p < 0.001). Comfort, quality of vision, visual acuity and contrast acuity, and limbal grading were similar between the lens brands but decreased with time during the day (p < 0.05). CONCLUSIONS: The tear breakup time over the contact lens surface differed between lens types and may have a role in protecting the ocular surface.

Transition in homogeneously heated inclined plane parallel shear flows

The transition of internally heated inclined plane parallel shear flows is examined numerically for the case of finite values of the Prandtl number Pr. We show that as the strength of the homogeneously distributed heat source is increased the basic flow loses stability to two-dimensional perturbations of the transverse roll type in a Hopf bifurcation for the vertical orientation of the fluid layer, whereas perturbations of the longitudinal roll type are most dangerous for a wide range of the value of the angle of inclination. In the case of the horizontal inclination transverse roll and longitudinal roll perturbations share the responsibility for the prime instability. Following the linear stability analysis for the general inclination of the fluid layer our attention is focused on a numerical study of the finite amplitude secondary travelling-wave solutions (TW) that develop from the perturbations of the transverse roll type for the vertical inclination of the fluid layer. The stability of the secondary TW against three-dimensional perturbations is also examined and our study shows that for Pr=0.71 the secondary instability sets in as a quasi-periodic mode, while for Pr=7 it is phase-locked to the secondary TW. The present study complements and extends the recent study by Nagata and Generalis (2002) in the case of vertical inclination for Pr=0.

Two way power flow using GTO thyristors

Two-way power flow is nothing new and has been in practical use using line commutated converters for at least 50 years. With these types of converters, reversal of power flow can be achieved by increasing the firing angle of the devices beyond 90 degrees thus producing a negative DC voltage. Line commutated converters have several known disadvantages including: the direct current cannot be reversed, the power factor decreases when the firing angle increases and the harmonics are high on the line current. To tackle the above problems a forced commutated converter can be used. The power factor can be unity and the harmonics can be reduced. Many researchers have used PWM with different control techniques to serve the above purposes. In each converter arm, they used a forced commutated device with an antiparallel diode. Under the rectification mode of operation the current path is preponderantly through the diodes and under the inverter operation the current flows preponderantly through the forced commutated devices. Although their results were encouraging and gave a unity power factor with nearly sinusoidal current, the main disadvantage was that there were difficulties in controlling the power factor when the system is needed to operate at lagging or leading power factor. In this work, a new idea was introduced by connecting two GTOs antiparallel instead of a diode and a GTO. A single phase system using two GTO converters which are connected in series was built. One converter operates as a rectifier and the other converter operates as an inverter. In the case of the inversion mode and in each inverter arm one GTO is operated as a diode simply by switching it always on and the other antiparallel GTO is operated as a normal device to carry the inverter current. In case of the rectification mode, in each arm one GTO is always off and the other GTP is operated as a controlled device. The main advantage is that the system can be operated at lagging or leading power factor.

Controlling soliton refraction in optical lattices

We show in the framework of the 1D nonlinear Schrödinger equation that the value of the refraction angle of a fundamental soliton beam passing through an optical lattice can be controlled by adjusting either the shape of an individual waveguide or the relative positions of the waveguides. In the case of the shallow refractive index modulation, we develop a general approach for the calculation of the refraction angle change. The shape of a single waveguide crucially affects the refraction direction due to the appearance of a structural form factor in the expression for the density of emitted waves. For a lattice of scatterers, wave-soliton interference inside the lattice leads to the appearance of an additional geometric form factor. As a result, the soliton refraction is more pronounced for the disordered lattices than for the periodic ones.

Transfer coefficients over inclined tube banks

The thesis presents experimental results for shell-side transfer coefficients and pressure drops across four different tube banks, using small-scale models, with yawed tubes, as found in many types of heat exchangers, boilers and nuclear reactors. The tube banks investigated have a staggered tube layout on a rotated square pitch, with a 1.25 pitch-to-diameter ratio. The angle of attack was varied between 45o and 90o. An extensive range of Reynolds number, i.e. 0.5. to 12,600, covering so-called laminar, transition and turbulent flows, was investigated. A diffusion-controlled electrochemical mass transfer technique has been employed to measure mass transfer coefficients. The heat transfer coefficients may be then readily obtained from the mass transfer values by applying the well-established Chilton-Colburn analogy. The results for the normal tube bank, which forms the base case for the study on inclined tube banks, show close agreement with previous work. The transfer coefficients and pressure drops of the inclined tube banks are compared with results from the ideal normal tube bank to examine the effect of inclination angle on heat transfer and pressure drop variations. The variation of the transfer coefficients row-by-row and the entrance and exit effects have also been investigated. An auxilary investigation has been carried out on the role of natural convection. A preliminary correlation of transfer coefficients and pressure drops against the variation in the yaw angle has been attempted. The results are discussed in the light of the few existing theoretical treatments and experimental data for these situations, and recommendations made for future work.

Laterality differences in memory and attention

A critical review of the auditory selective attention literature is presented, particular reference is made to methodological issues arising from the asymmetrical hemispheric representation of language in the context of the dominant research technique dichotic shadowing. Subsequently the concept of cerebral localization is introduced, and the experimental literature with reference to models of laterality effects in speech and audition discussed. The review indicated the importance of hemispheric asymmetries insofar as they might influence the results of dichotic shadowing tasks. It is suggested that there is a potential overlap between models of selective attention and hemispheric differences. In Experiment I, ~ a key experiment in auditory selective attention is replicated and by exercising control over possible laterality effects some of the conflicting results of earlier studies were reconciled. The three subsequent experiments, II, III and IV, are concerned with the recall of verbally shadowed inputs. A highly significant and consistent effect of ear of arrival upon the serial position of items recalled is reported. Experiment V is directed towards an analysis of the effect that the processing of unattended inputs has upon the serial position of attended items that are recalled. A significant effect of the type of unattended material upon the recall of attended items was found to be influenced by the ear of arrival of inputs. In Experiment VI, differences between the two ears as attended and unattended input channels were clarified. Two main conclusions were drawn from this work. First, that the dichotic shadowing technique cannot control attention. Instead the task aprocessing both channels of dichotic inputs is unevenly shared bet\'reen the hemispheres as a function of the ear shadowed. Consequently, evidence for the processing of unattended information is considered in terms of constraints imposed by asymmetries in the functional organization of language, not in terms of a limited processing capacity model. The second conclusion to be drawn is that laterality differences can be effectively examined using the dichotic shadowing technique, a new model of laterality differences is proposed and discussed.

Transition in plane parallel shear flows heated internally

The stability of internally heated inclined plane parallel shear flows is examined numerically for the case of finite value of the Prandtl number, Pr. The transition in a vertical channel has already been studied for 0≤Pr≤100 with or without the application of an external pressure gradient, where the secondary flow takes the form of travelling waves (TWs) that are spanwise-independent (see works of Nagata and Generalis). In this work, in contrast to work already reported (J. Heat Trans. T. ASME 124 (2002) 635-642), we examine transition where the secondary flow takes the form of longitudinal rolls (LRs), which are independent of the steamwise direction, for Pr=7 and for a specific value of the angle of inclination of the fluid layer without the application of an external pressure gradient. We find possible bifurcation points of the secondary flow by performing a linear stability analysis that determines the neutral curve, where the basic flow, which can have two inflection points, loses stability. The linear stability of the secondary flow against three-dimensional perturbations is also examined numerically for the same value of the angle of inclination by employing Floquet theory. We identify possible bifurcation points for the tertiary flow and show that the bifurcation can be either monotone or oscillatory. © 2003 Académie des sciences. Published by Elsevier SAS. All rights reserved.

Functional near vision assessment in presbyopia

The aim of this thesis was to develop standards of best practice for the subjective assessment of near visual function in presbyopia. Near visual acuity (VA) is a quick and simple measure but an assessment of the maximum reading speed and the smallest print size that can maintain this are equally important, to gain a better reflection of real world visual function. These metrics are dependent on the amplitude of accommodation (AoA) and often this must be evaluated using subjective techniques. Defocus curves are less susceptible than the push-up/push-down test to the influence of blur tolerance but their implementation must be standardised such that letter sequences and the order of lens presentation are randomised, to avoid memory effects, whilst the AoA should be quantified as the range of defocus for which only the best VA is maintained. In addition to such clinical assessments, subjective questionnaire evaluations are also important, to determine whether at least an individual’s needs are met. The Near Activity Visual Questionnaire (NAVQ) developed in this thesis can be used for this. Using these standardised near vision metrics it is shown that visual performance with monovision and multifocal contact lenses is comparable whilst initial outcomes of single optic ‘accommodating’ intraocular lens implantation are unlikely to be sustained in the long-term.

Ultraviolet damage to the eye revisited:eye-sun protection factor (E-SPF®), a new ultraviolet protection label for eyewear

Ultraviolet (UV) radiation potentially damages the skin, the immune system, and structures of the eye. A useful UV sun protection for the skin has been established. Since a remarkable body of evidence shows an association between UV radiation and damage to structures of the eye, eye protection is important, but a reliable and practical tool to assess and compare the UV-protective properties of lenses has been lacking. Among the general lay public, misconceptions on eye-sun protection have been identified. For example, sun protection is mainly ascribed to sunglasses, but less so to clear lenses. Skin malignancies in the periorbital region are frequent, but usual topical skin protection does not include the lids. Recent research utilized exact dosimetry and demonstrated relevant differences in UV burden to the eye and skin at a given ambient irradiation. Chronic UV effects on the cornea and lens are cumulative, so effective UV protection of the eyes is important for all age groups and should be used systematically. Protection of children's eyes is especially important, because UV transmittance is higher at a very young age, allowing higher levels of UV radiation to reach the crystalline lens and even the retina. Sunglasses as well as clear lenses (plano and prescription) effectively reduce transmittance of UV radiation. However, an important share of the UV burden to the eye is explained by back reflection of radiation from lenses to the eye. UV radiation incident from an angle of 135°-150° behind a lens wearer is reflected from the back side of lenses. The usual antireflective coatings considerably increase reflection of UV radiation. To provide reliable labeling of the protective potential of lenses, an eye-sun protection factor (E-SPF®) has been developed. It integrates UV transmission as well as UV reflectance of lenses. The E-SPF® compares well with established skin-sun protection factors and provides clear messages to eye health care providers and to lay consumers. © 2014 Behar-Cohen et al, This work is published by Dove Medical Press Ltd.

InAs/AlSb widely tunable external cavity quantum cascade laser around 3.2 μm

Room temperature, tunable, external-cavity short-wavelength InAs/AlSb quantum cascade laser (QCL) is reported. Wavelength tuning of 85 nm for the spectral range between 3190 nm and 3275 nm has been achieved by rotating the diffraction grating forming the external cavity. To suppress lasing inside the QCL cavity, its ridge was tilted by 7° at the external cavity end. The optimal tilting angle of the laser ridge was chosen by careful consideration of the return losses of the TM-polarized waveguide mode from the diffraction grating in a quasi-Littrow configuration and the Fabry-Pérot feedback from the tilted laser facet. No antireflection coating was used. © 2013 American Institute of Physics.

Objective accommodative amplitude and dynamics with the 1CU accommodative intraocular lens

PURPOSE. To compare the objective accommodative amplitude and dynamics of eyes implanted with the one-compartment-unit (1CU; HumanOptics AG, Erlangen, Germany) accommodative intraocular lenses (IOLs) with that measured subjectively. METHODS. Twenty eyes with a 1CU accommodative IOL implanted were refracted and distance and near acuity measured with a logMAR (logarithm of the minimum angle of resolution) chart. The objective accommodative stimulus-response curve for static targets between 0.17 and 4.00 D accommodative demand was measured with the SRW-5000 (Shin-Nippon Commerce Inc., Tokyo, Japan) and PowerRefractor (PlusOptiX, Nürnberg, Germany) autorefractors. Continuous objective recording of dynamic accommodation was measured with the SRW-5000, with the subject viewing a target moving from 0 to 2.50 D at 0.3 Hz through a Badal lens system. Wavefront aberrometry measures (Zywave; Bausch & Lomb, Rochester, NY) were made through undilated pupils. Subjective amplitude of accommodation was measured with the RAF (Royal Air Force accommodation and vergence measurement) rule. RESULTS. Four months after implantation best-corrected acuity was -0.01 ± 0.16 logMAR at distance and 0.60 ± 0.09 logMAR at near. Objectively, the static amplitude of accommodation was 0.72 ± 0.38 D. The average dynamic amplitude of accommodation was 0.71 ± 0.47 D, with a lag behind the target of 0.50 ± 0.48 seconds. Aberrometry showed a decrease in power of the lens-eye combination from the center to the periphery in all subjects (on average, -0.38 ± 0.28 D/mm). Subjective amplitude of accommodation was 2.24 ± 0.42 D. Two years after 1CU implantation, refractive error and distance visual acuity remained relatively stable, but near visual acuity, and the subjective and objective amplitudes of accommodation decreased. CONCLUSIONS. The objective accommodating effects of the 1CU lens appear to be limited, although patients are able to track a moving target. Subjective and objective accommodation was reduced at the 2-year follow-up. The greater subjective amplitude of accommodation is likely to result from the eye's depth of focus of and the aspheric nature of the IOL. Copyright © Association for Research in Vision and Ophthalmology.