Evaluation of modern intraocular lenses

Accommodating Intraocular Lenses (IOLs), multifocal IOLs (MIOLs) and toric IOLs are designed to provide a greater level of spectacle independency post cataract surgery. All of these IOLs are reliant on the accurate calculation of intraocular lens power determined through reliable ocular biometry. A standardised defocus area metric and reading performance index metric were devised for the evaluation of the range of focus and the reading ability of subjects implanted with presbyopic correcting IOLs. The range of clear vision after implantation of an MIOL is extended by a second focal point; however, this results in the prevalence of dysphotopsia. A bespoke halometer was designed and validated to assess this photopic phenomenon. There is a lack of standardisation in the methods used for determining IOL orientation and thus rotation. A repeatable, objective method was developed to allow the accurate assessment of IOL rotation, which was used to determine the rotational and positional stability of a closed loop haptic IOL. A new commercially available biometry device was validated for use with subjects prior to cataract surgery. The optical low coherence reflectometry instrument proved to be a valid method for assessing ocular biometry and covered a wider range of ocular parameters in comparison with previous instruments. The advantages of MIOLs were shown to include an extended range of clear vision translating into greater reading ability. However, an increased prevalence of dysphotopsia was shown with a bespoke halometer, which was dependent on the MIOL optic design. Implantation of a single optic accommodating IOL did not improve reading ability but achieved high subjective ratings of near vision. The closed-loop haptic IOL displayed excellent rotational stability in the late period but relatively poor rotational stability in the early period post implantation. The orientation error was compounded by the high frequency of positional misalignment leading to an extensive overall misalignment of the IOL. This thesis demonstrates the functionality of new IOL lens designs and the importance of standardised testing methods, thus providing a greater understanding of the consequences of implanting these IOLs. Consequently, the findings of the thesis will influence future designs of IOLs and testing methods.

The local dimension of employment-related welfare policy in Germany, England and Sweden

The link between work and welfare is a key pathway of modern welfare state development in Western Europe. National governments face a constant balancing act between the welfare expectations of the labour forces and the labour market liberalisation demands of the business communities. Facilitating the transit from welfare into employment has therefore become an important tool for the British, German and Swedish governments, providing labour as and when needed while keeping welfare expenditure in check. However, the approaches to organising active labour market policies are quite different, notably with regard to the territorial dimension. Although labour markets are quite diverse in all three cases, the role of local authorities, local agencies and local labour market actors from the private and voluntary sector are generally under-developed and apparently under-appreciated, but in different ways and for different reasons. The article compares current employment-related welfare provisions and approaches to develop active labour market policies in the three countries, and concludes that while certain structural and procedural similarities exist, the basic political priorities and actual support and services provided remain very far apart.