Impact of soft contact lens edge design and mid-peripheral lens shape on the epithelium and its indentation with lens mobility

Purpose. To evaluate the influence of soft contact lens midperipheral shape profile and edge design on the apparent epithelial thickness and indentation of the ocular surface with lens movement. Methods. Four soft contact lens designs comprising of two different plano midperipheral shape profiles and two edge designs (chiseled and knife edge) of silicone-hydrogel material were examined in 26 subjects aged 24.7 ± 4.6 years, each worn bilaterally in randomized order. Lens movement was imaged enface on insertion, at 2 and 4 hours with a high-speed, high-resolution camera simultaneous to the cross-section of the edge of the contact lens interaction with the ocular surface captured using optical coherence tomography (OCT) nasally, temporally, and inferiorly. Optical imaging distortions were individually corrected for by imaging the apparent distortion of a glass slide surface by the removed lens. Results. Apparent epithelial thickness varied with edge position (P < 0.001). When distortion was corrected for, epithelial indentation decreased with time after insertion (P = 0.010), changed after a blink (P < 0.001), and varied with position on the lens edge (P < 0.001), with the latter being affected by midperipheral lens shape profile and edge design. Horizontal and vertical lens movement did not change with time postinsertion. Vertical motion was affected by midperipheral lens shape profile (P < 0.001) and edge design (P < 0.001). Lens movement was associated with physiologic epithelium thickness for lens midperipheral shape profile and edge designs. Conclusions. Dynamic OCT coupled with high-resolution video demonstrated that soft contact lens movement and image-corrected ocular surface indentation were influenced by both lens edge design and midperipheral lens shape profiles. © 2013 The Association for Research in Vision and Ophthalmology, Inc.

End-to-end versus hop-by-hop soft state refresh for multi-hop signalling systems

To ensure state synchronization of signalling operations, many signaling protocol designs choose to establish “soft” state that expires if it is not refreshed. The approaches of refreshing state in multi-hop signaling system can be classified as either end-to-end (E2E) or hop-by-hop (HbH). Although both state refresh approaches have been widely used in practical signaling protocols, the design tradeoffs between state synchronization and signaling cost have not yet been fully investigated. In this paper, we investigate this issue from the perspectives of state refresh and state removal. We propose simple but effective Markov chain models for both approaches and obtain closed-form solutions which depict the state refresh performance in terms of state consistency and refresh message rate, as well as the state removal performance in terms of state removal delay. Simulations verify the analytical models. It is observed that the HbH approach yields much better state synchronization at the cost of higher signaling cost than the E2E approach. While the state refresh performance can be improved by increasing the values of state refresh and timeout timers, the state removal delay increases largely for both E2E and HbH approaches. The analysis here shed lights on the design of signaling protocols and the configuration of the timers to adapt to changing network conditions.

End-to-end versus hop-by-hop state refresh in soft state signaling protocols

The concept of soft state (i.e., the state that will expire unless been refreshed) has been widely used in the design of network signaling protocols. The approaches of refreshing state in multi-hop networks can be classified to end-to-end (E2E) and hop-by-hop (HbH) refreshes. In this article we propose an effective Markov chain based analytical model for both E2E and HbH refresh approaches. Simulations verify the analytical models, which can be used to study the impacts of link characteristics on the performance (e.g., state synchronization and message overhead), as a guide on configuration and optimization of soft state signaling protocols. © 2009 IEEE.

An analysis of the role of soft systems methodology in the change process and the contribution of the facilitator within this process

This research aims to examine the effectiveness of Soft Systems Methodology (SSM) to enable systemic change within local goverment and local NHS environments and to examine the role of the facilitator within this process. Checkland's Mode 2 variant of Soft Systems Methodology was applied on an experimental basis in two environments, Herefordshire Health Authority and Sand well Health Authority. The Herefordshire application used SSM in the design of an Integrated Care Pathway for stroke patients. In Sandwell, SSM was deployed to assist in the design of an Infonnation Management and Technology (IM&T) Strategy for the boundary-spanning Sandwell Partnership. Both of these environments were experiencing significant organisational change as the experiments unfurled. The explicit objectives of the research were: To examine the evolution and development of SSM and to contribute to its further development. To apply the Soft Systems Methodology to change processes within the NHS. To evaluate the potential role of SSM in this wider process of change. To assess the role of the researcher as a facilitator within this process. To develop a critical framework through which the impact of SSM on change might be understood and assessed. In developing these objectives, it became apparent that there was a gap in knowledge relating to SSM. This gap concerns the evaluation of the role of the approach in the change process. The case studies highlighted issues in stakeholder selection and management; the communicative assumptions in SSM; the ambiguous role of the facilitator; and the impact of highly politicised problem environments on the effectiveness of the methodology in the process of change. An augmented variant on SSM that integrates an appropriate (social constructivist) evaluation method is outlined, together with a series of hypotheses about the operationalisation of this proposed method.

Comparison of fitting stability of the different soft toric contact lenses

Purpose: To compare lens orientation and rotational recovery of five currently available soft toric lenses. Methods: Twenty subjects were recruited and trialed with each of the study lenses in a random order. Study lenses were PureVision® Toric (B&L), Air Optix® for Astigmatism (Alcon), Biofinity® Toric (CooperVision), Acuvue® Advance for Astigmatism (Vistakon), and Proclear® Toric (CooperVision). Lens orientation in primary position to determine the lens rotation form the vertical position and rotational recovery to primary gaze orientation following a 45° manual misorientation for the different lenses was compared. Results: The Biofinity Toric showed the lowest rotation from the vertical position and the Proclear Toric the highest. Also, the highest and the lowest reorientation speed were related to the Biofinity Toric and the Acuvue Advance for Astigmatism, respectively. The Repeated Measures ANOVA showed a significant difference in the lens rotation (P=. 0.004) and rotational recovery (P<. 0.001) among different contact lenses and the performed multiple comparisons indicated differences in rotation and also in reorientation speed were only seen between the Biofinity Toric when compared to four other lenses (P<. 0.05). Conclusion: Although there was appropriate fitting, based upon lens orientation and reorientation speed, with each of the study lenses it would appear that the optimized ballast technique used in the design of the Biofinity Toric helps reduce lens rotation and improve rotational recovery compared to others.

Fitting an MSD (Mini Scleral Design) rigid contact lens in advanced keratoconus with INTACS

Keratoconus is a bilateral degenerative disease characterized by a non-inflammatory, progressive central corneal ectasia (typically asymmetric) and decreased vision. In its early stages it may be managed with spectacles and soft contact lenses but more commonly it is managed with rigid contact lenses. In advanced stages, when contact lenses can no longer be fit, have become intolerable, or corneal damage is severe, a penetrating keratoplasty is commonly performed. Alternative surgical techniques, such as the use of intra-stromal corneal ring segments (INTACS) have been developed to try and improve the fit of rigid contact lenses in keratoconic patients and avoid penetrating keratoplasties. This case report follows through the fitting of rigid contact lenses in an advanced keratoconic cornea after an INTACS procedure and discusses clinical findings, treatment options, and the use of mini-scleral and scleral lens designs as they relate to the challenges encountered in managing such a patient. Mini-scleral and scleral lenses are relatively easy to fit, and can be of benefit to many patients, including advanced keratoconic patients, post-INTAC patients and post-penetrating keratoplasty patients. © 2011 British Contact Lens Association.

Accommodation in young adults wearing multifocal soft contact lenses under long- and short- wavelength lighting

Purpose: Several studies have suggested accommodative lags may serve as a stimulus for myopic growth, and while a blurred foveal image is believed to the main stimulus for accommodation, spectral composition of the retinal image is also believed to influence accommodative accuracy. Of particular interest is how altering spectral lighting conditions influences accommodation in the presence of soft multifocal contact lenses, which are currently being used off-label for myopia control. Methods: Accommodative responses were assessed using a Grand Seiko WAM-5500 autorefractor for four target distances: 25, 33, 50, and 100cm for 30 young adult subjects (14 myopic, 16 emmetropic; mean refractive errors (±SD, D) -4.22±2.04 and -0.15±0.67 respectively). Measurements were obtained with four different soft contact lenses, Single vision distance (SVD), Single vision near (SVN), Centre-Near (CN) and Centre-Distance (CD) (+1.50 add), and three different lighting conditions: red (peak λ 632nm), blue (peak λ 460nm), and white (peak λ 560nm). Corrections for chromatic differences in refraction were made prior to calculating accommodative errors. Results: The size of accommodative errors was significantly affected by lens design (p<0.001), lighting (p=0.027), and target distance (p=0.009). Mean accommodative errors were significantly larger with the SV lenses compared to the CD and CN designs (p<0.001). Errors were also significantly larger under blue light compared to white (p=0.004) and a significant interaction noted between lens design and lighting (p<0.001). Blue light generally decreased accommodative lags and increased accommodative leads relative to white and red light, the opposite was true of red light (p≤0.001). Lens design also significantly influenced direction of accommodative error (i.e. lag or lead) (p<0.001). Interactions with or between refractive groups were not found to be statistically significant for either the magnitude or direction of accommodative error (p>0.05 for all). Conclusions: Accuracy of accommodation is affected by both lens design and by wavelength of lighting. These accommodative lag data lend some support to recent speculation about the potential therapeutic value of lighting with a spectral bias towards blue during near work for myopia, although such treatment effects are likely to be more subtle under broad compared to the narrow spectrum lighting conditions used here.

Design of an information system for metrology contents

Dimensional and form inspections are key to the manufacturing and assembly of products. Product verification can involve a number of different measuring instruments operated using their dedicated software. Typically, each of these instruments with their associated software is more suitable for the verification of a pre-specified quality characteristic of the product than others. The number of different systems and software applications to perform a complete measurement of products and assemblies within a manufacturing organisation is therefore expected to be large. This number becomes even larger as advances in measurement technologies are made. The idea of a universal software application for any instrument still appears to be only a theoretical possibility. A need for information integration is apparent. In this paper, a design of an information system to consistently manage (store, search, retrieve, search, secure) measurement results from various instruments and software applications is introduced. Two of the main ideas underlying the proposed system include abstracting structures and formats of measurement files from the data so that complexity and compatibility between different approaches to measurement data modelling is avoided. Secondly, the information within a file is enriched with meta-information to facilitate its consistent storage and retrieval. To demonstrate the designed information system, a web application is implemented. © Springer-Verlag Berlin Heidelberg 2010.