An analysis of progressive addition spectacles lens design by the use of interferometry

Progressive addition spectacle lenses (PALs) have now become the method of choice for many presbyopic individuals to alleviate the visual problems of middle-age. Such lenses are difficult to assess and characterise because of their lack of discrete geographical locators of their key features. A review of the literature (mostly patents) describing the different designs of these lenses indicates the range of approaches to solving the visual problem of presbyopia. However, very little is published about the comparative optical performance of these lenses. A method is described here based on interferometry for the assessment of PALs, with a comparison of measurements made on an automatic focimeter. The relative merits of these techniques are discussed. Although the measurements are comparable, it is considered that the interferometry method is more readily automated, and would be ultimately capable of producing a more rapid result.

Some clinical aspects of the eye in extended contact lens wear

The limbal vascular response to extended contact lens wear was examined in a group comparative study initially intended to last eighteen months. After six months all patients wearing contact lenses had presented with micro-epithelial cysts. This unanticipated occurrence of the micro-epithelial-cysts necessitated termination of the study, and limited the quantity of data collected. However, sufficient results were available to allow a limited description of •the vascular response to this form of contact lens wear. Interpretations of the date collected ore discussed in relation to suggested vasostimulating factors in the cornea. The micro-epithelial cysts observed after extended wear were classified and their rate of recovery recorded. A further clinical study was undertaken to observe cysts in both contact lens - and non contact lens-wearing eyes. Cysts were observed in every category of patient, although the characteristic patterns varied. These observations of micro-epithelial cysts are discussed with respect to the aetiopathogeneses of corneal epithelial cystic disorders. Subsequently, attempts were made to induce cysts in rabbit corneae by extended contact lens wear. Clinical observations revealed cyst-like appearances. Histological sections did not contain cysts but did exhibit signs characteristic •of cystic disorders of the corneal epithelium. In general, the results from the study indicate that extended wear is subjectively acceptable to contact lens wearers. However, the objective findings of significant vascular changes, micro-epithelial cysts and cases of acute red eye response cast considerable doubt on the recommendation of extended wear contact lenses for purely cosmetic applications.

An optical study of human ocular dimensions

Many workers have studied the ocular components which occur in eyes exhibiting differing amounts of central refractive error but few have ever considered the additional information that could be derived from a study of peripheral refraction. Before now, peripheral refraction has either been measured in real eyes or has otherwise been modelled in schematic eyes of varying levels of sophistication. Several differences occur between measured and modelled results which, if accounted for, could give rise to more information regarding the nature of the optical and retinal surfaces and their asymmetries. Measurements of ocular components and peripheral refraction, however, have never been made in the same sample of eyes. In this study, ocular component and peripheral refractive measurements were made in a sample of young near-emmetropic, myopic and hyperopic eyes. The data for each refractive group was averaged. A computer program was written to construct spherical surfaced schematic eyes from this data. More sophisticated eye models were developed making use of linear algebraic ray tracing program. This method allowed rays to be traced through toroidal aspheric surfaces which were translated or rotated with respect to each other. For simplicity, the gradient index optical nature of the crystalline lens was neglected. Various alterations were made in these eye models to reproduce the measured peripheral refractive patterns. Excellent agreement was found between the modelled and measured peripheral refractive values over the central 70o of the visual field. This implied that the additional biometric features incorporated in each eye model were representative of those which were present in the measured eyes. As some of these features are not otherwise obtainable using in vivo techniques, it is proposed that the variation of refraction in the periphery offers a very useful optical method for studying human ocular component dimensions.

Physical and psychophysical analysis of progressive addition lens embodiments

The extent to which the surface parameters of Progressive Addition Lenses (PALs) affect successful patient tolerance was investigated. Several optico-physical evaluation techniques were employed, including a newly constructed surface reflection device which was shown to be of value for assessing semi-finished PAL blanks. Detailed physical analysis was undertaken using a computer-controlled focimeter and from these data, iso-cylindrical and mean spherical plots were produced for each PAL studied. Base curve power was shown to have little impact upon the distribution of PAL astigmatism. A power increase in reading addition primarily caused a lengthening and narrowing of the lens progression channel. Empirical measurements also indicated a marginal steepening of the progression power gradient with an increase in reading addition power. A sample of the PAL wearing population were studied using patient records and questionnaire analysis (90% were returned). This subjective analysis revealed the reading portion to be the most troublesome lens zone and showed that patients with high astigmatism (> 2.00D) adapt more readily to PALs than those with spherical or low cylindrical (2.00D) corrections. The psychophysical features of PALs were then investigated. Both grafting visual acuity (VA) and contrast sensitivity (CS) were shown to be reduced with an increase in eccentricity from the central umbilical line. Two sample populations (N= 20) of successful and unsuccessful PAL wearers were assessed for differences in their visual performance and their adaptation to optically induced distortion. The possibility of dispensing errors being the cause of poor patient tolerance amongst the unsuccessful wearer group was investigated and discounted. The contrast sensitivity of the successful group was significantly greater than that of the unsuccessful group. No differences in adaptation to or detection of curvature distortion were evinced between these presbyopic groups.

Another angle on contact lens surface analysis

Purpose: Dynamic contact angle (DCA) methods have advantages over other contact angle methodologies, not least that they can provide more than single contact angle values. Here we illustrate the use of DCA analysis to provide “fingerprint” characterisation of contact lens surfaces, and the way that different materials change in the early stages of wear. Method: The DCA method involves attaching to a microbalance weighted strips cut from a lens. The strips are then cyclically inserted into and removed from an aqueous solution. Conventionally, readings of force taken from linear portions of the resultant dipping curves are translated into advancing (CAa) and receding contact (CAr) angles. Additionally, analysis of the force versus immersion profile provides a “fingerprint” characterisation of the state of the lens surface. Results: CAa and CAr values from DCA traces provide a useful means of differentiating gross differences in hydrophilicity and molecular mobility of surfaces under particular immersion and emersion conditions, such as dipping rate and dwell times. Typical values for etafilcon A (CAa:63.1; CAr:37) and balafilcon B (CAa:118.4; CAr:36.4) illustrate this. Surface modifications induced in lens manufacture are observed to produce not only changes in these value, which may be small, but also changes in the DCA “fingerprint” (slope, undulations, length of plateau). Interestingly, similar changes are induced in the first few hours of lens wear with some lens-patient combinations. Conclusions: Although single parameter contact angles are useful for material characterisation, information of potential clinical interest can be obtained from more detailed analysis of DCA traces.

Tear analysis and lens-tear interactions:part II. Ocular lipids-nature and fate of meibomian gland phospholipids

Purpose: Published data indicate that the polar lipid content of human meibomian gland secretions (MGS) could be anything between 0.5% and 13% of the total lipid. The tear film phospholipid composition has not been studied in great detail and it has been understood that the relative proportions of lipids in MGS would be maintained in the tear film. The purpose of this work was to determine the concentration of phospholipids in the human tear film. Methods: Liquid chromatography mass spectrometry (LCMS) and thin layer chromatography (TLC) were used to determine the concentration of phospholipid in the tear film. Additionally, an Amplex Red phosphatidylcholine-specific phospholipase C (PLC) assay kit was used for determination of the activity of PLC in the tear film. Results: Phospholipids were not detected in any of the tested human tear samples with the low limit of detection being 1.3 µg/mL for TLC and 4 µg/mL for liquid chromatography mass spectrometry. TLC indicated that diacylglycerol (DAG) may be present in the tear film. PLC was in the tear film with an activity determined at approximately 15 mU/mL, equivalent to the removal of head groups from phosphatidylcholine at a rate of approximately 15 µM/min. Conclusions: This work shows that phospholipid was not detected in any of the tested human tear samples (above the lower limits of detection as described) and suggests the presence of DAG in the tear film. DAG is known to be at low concentrations in MGS. These observations indicate that PLC may play a role in modulating the tear film phospholipid concentration.

May the contact lens force be with you

FULL TEXT: Like many people one of my favourite pastimes over the holiday season is to watch the great movies that are offered on the television channels and new releases in the movie theatres or catching up on those DVDs that you have been wanting to watch all year. Recently we had the new ‘Star Wars’ movie, ‘The Force Awakens’, which is reckoned to become the highest grossing movie of all time, and the latest offering from James Bond, ‘Spectre’ (which included, for the car aficionados amongst you, the gorgeous new Aston Martin DB10). It is always amusing to see how vision correction or eye injury is dealt with by movie makers. Spy movies and science fiction movies have a freehand to design aliens with multiples eyes on stalks or retina scanning door locks or goggles that can see through walls. Eye surgery is usually shown in some kind of day case simplified laser treatment that gives instant results, apart from the great scene in the original ‘Terminator’ movie where Arnold Schwarzenegger's android character encounters an injury to one eye and then proceeds to remove the humanoid covering to this mechanical eye over a bathroom sink. I suppose it is much more difficult to try and include contact lenses in such movies. Although you may recall the film ‘Charlie's Angels’, which did have a scene where one of the Angels wore a contact lens that had a retinal image imprinted on it so she could by-pass a retinal scan door lock and an Eddy Murphy spy movie ‘I-Spy’, where he wore contact lenses that had electronic gadgetry that allowed whatever he was looking at to be beamed back to someone else, a kind of remote video camera device. Maybe we aren’t quite there in terms of devices available but these things are probably not the behest of science fiction anymore as the technology does exist to put these things together. The technology to incorporate electronics into contact lenses is being developed and I am sure we will be reporting on it in the near future. In the meantime we can continue to enjoy the unrealistic scenes of eye swapping as in the film ‘Minority Report’ (with Tom Cruise). Much more closely to home, than in a galaxy far far away, in this issue you can find articles on topics much nearer to the closer future. More and more optometrists in the UK are becoming registered for therapeutic work as independent prescribers and the number is likely to rise in the near future. These practitioners will be interested in the review paper by Michael Doughty, who is a member of the CLAE editorial panel (soon to be renamed the Jedi Council!), on prescribing drugs as part of the management of chronic meibomian gland dysfunction. Contact lenses play an active role in myopia control and orthokeratology has been used not only to help provide refractive correction but also in the retardation of myopia. In this issue there are three articles related to this topic. Firstly, an excellent paper looking at the link between higher spherical equivalent refractive errors and the association with slower axial elongation. Secondly, a paper that discusses the effectiveness and safety of overnight orthokeratology with high-permeability lens material. Finally, a paper that looks at the stabilisation of early adult-onset myopia. Whilst we are always eager for new and exciting developments in contact lenses and related instrumentation in this issue of CLAE there is a demonstration of a novel and practical use of a smartphone to assisted anterior segment imaging and suggestions of this may be used in telemedicine. It is not hard to imagine someone taking an image remotely and transmitting that back to a central diagnostic centre with the relevant expertise housed in one place where the information can be interpreted and instruction given back to the remote site. Back to ‘Star Wars’ and you will recall in the film ‘The Phantom Menace’ when Qui-Gon Jinn first meets Anakin Skywalker on Tatooine he takes a sample of his blood and sends a scan of it back to Obi-Wan Kenobi to send for analysis and they find that the boy has the highest midichlorian count ever seen. On behalf of the CLAE Editorial board (or Jedi Council) and the BCLA Council (the Senate of the Republic) we wish for you a great 2016 and ‘may the contact lens force be with you’. Or let me put that another way ‘the CLAE Editorial Board and BCLA Council, on behalf of, a great 2016, we wish for you!’