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.

Impact in contact lenses and the anterior eye:challenges prevailing in 2015

As we settle into a new year, this second issue of Contact Lens and Anterior Eye allows us to reflect on how new research in this field impacts our understanding, but more importantly, how we use this evidence basis to enhance our day to day practice, to educate the next generation of students and to construct the research studies to deepen our knowledge still further. The end of 2014 saw the publication of the UK governments Research Exercise Framework (REF) which ranks Universities in terms of their outputs (which includes their paper, publications and research income), environment (infrastructure and staff support) and for the first time impact (defined as “any effect on, change or benefit to the economy, society, culture, public policy or services, health, the environment or quality of life, beyond academia” [8]). The REF is a process of expert review, carried out in 36 subject-based units of assessment, of which our field is typically submitted to the Allied Health, Dentistry, Nursing and Pharmacy panel. Universities that offer Optometry did very well with Cardiff, Manchester and Aston in the top 10% out of the 94 Universities that submitted to this panel (Grade point Average ranked order). While the format of the new exercise (probably in 2010) to allocate the more than £2 billion of UK government research funds is yet to be determined, it is already rumoured that impact will contribute an even larger proportion to the weighting. Hence it is even more important to reflect on the impact of our research. In this issue, Elisseef and colleagues [5] examine the intriguing potential of modifying a lens surface to allow it to bind to known wetting agents (in this case hyaluronic acid) to enhance water retention. Such a technique has the capacity to reduced friction between the lens surface and the eyelids/ocular surface, presumably leading to higher comfort and less reason for patients to discontinue with lens wear. Several papers in this issue report on the validity of new high precision, fast scanning imaging and quantification equipment, utilising techniques such as Scheimpflug, partial coherence interferometry, aberrometry and video allowing detailed assessment of anterior chamber biometry, corneal topography, corneal biomechanics, peripheral refraction, ocular aberrations and lens fit. The challenge is how to use this advanced instrumentation which is becoming increasingly available to create real impact. Many challenges in contact lenses and the anterior eye still prevail in 2015 such as: -While contact lens and refractive surgery complications are relatively rare, they are still too often devastating to the individual and their quality of life (such as the impact and prognosis of patients with Acanthmoeba Keratitis reported by Jhanji and colleagues in this issue [7]). How can we detect those patients who are going to be affected and what modifications do we need to make to contact lenses and patient management prevent this occurring? -Drop out from contact lenses still occurs at a rapid rate and symptoms of dry eye seem to be the leading cause driving this discontinuation of wear [1] and [2]. What design, coating, material and lubricant release mechanism will make a step change in end of day comfort in particular? -Presbyopia is a major challenge to hassle free quality vision and is one of the first signs of ageing noticed by many people. As an emmetrope approaching presbyopia, I have a vested interest in new medical devices that will give me high quality vision at all distances when my arms won’t stretch any further. Perhaps a new definition of presbyopia could be when you start to orientate your smartphone in the landscape direction to gain the small increase in print size needed to read! Effective accommodating intraocular lenses that truly mimic the pre-presbyopic crystalline lenses are still a way off [3] and hence simultaneous images achieved through contact lenses, intraocular lenses or refractive surgery still have a secure future. However, splitting light reaching the retina and requiring the brain to supress blurred images will always be a compromise on contrast sensitivity and is liable to cause dysphotopsia; so how will new designs account for differences in a patient's task demands and own optical aberrations to allow focused patient selection, optimising satisfaction? -Drug delivery from contact lenses offers much in terms of compliance and quality of life for patients with chronic ocular conditions such as glaucoma, dry eye and perhaps in the future, dry age-related macular degeneration; but scientific proof-of-concept publications (see EIShaer et al. [6]) have not yet led to commercial products. Part of this is presumably the regulatory complexity of combining a medical device (the contact lens) and a pharmaceutical agent. Will 2015 be the year when this innovation finally becomes a reality for patients, bringing them an enhanced quality of life through their eye care practitioners and allowing researchers to further validate the use of pharmaceutical contact lenses and propose enhancements as the technology matures? -Last, but no means least is the field of myopia control, the topic of the first day of the BCLA's Conference in Liverpool, June 6–9th 2015. The epidemic of myopia is a blight, particularly in Asia, with significant concerns over sight threatening pathology resulting from the elongated eye. This is a field where real impact is already being realised through new soft contact lens optics, orthokeratology and low dose pharmaceuticals [4], but we still need to be able to better predict which technique will work best for an individual and to develop new techniques to retard myopia progression in those who don’t respond to current treatments, without increasing their risk of complications or the treatment impacting their quality of life So what will your New Year's resolution be to make 2015 a year of real impact, whether by advancing science or applying the findings published in journals such as Contact Lens and Anterior Eye to make a real difference to your patients’ lives?

Refracting the pseudophakic patient

Pseudophakic patients are frequently encountered in optometric practice, often the result of cataract extraction but also presbyopia correction. Given advances in technology and surgery, the demand for intraocular lenses for correcting a variety of refractive requirements has increased owing to an ageing population. Based on the patient’s needs, either fixed focus, toric, accommodating or multifocal intraocular lenses (IOLs) may be implanted. During optometric examination, attention should be drawn to a history of IOLs and the potential complications they may cause in order to manage them effectively, particularly where sight is threatened. Although objective and subjective refraction does not differ greatly between phakic and pseudophakic patients, care should be taken to set the patient up correctly and the reflex during retinoscopy observed for posterior sub-capsular opacification. Additional tests such as reading speed, and glare and contrast sensitivity are necessary to determine the outcome of IOL surgery and detect potential problems associated with multifocal and accommodating IOLs. Based upon the results of these tests, refraction, and type of IOL, contact lens or spectacle correction may be required to meet the visual demands of the patient.

Unifractality and multifractality in the Italian stock market

Tests for random walk behaviour in the Italian stock market are presented, based on an investigation of the fractal properties of the log return series for the Mibtel index. The random walk hypothesis is evaluated against alternatives accommodating either unifractality or multifractality. Critical values for the test statistics are generated using Monte Carlo simulations of random Gaussian innovations. Evidence is reported of multifractality, and the departure from random walk behaviour is statistically significant on standard criteria. The observed pattern is attributed primarily to fat tails in the return probability distribution, associated with volatility clustering in returns measured over various time scales. © 2009 Elsevier Inc. All rights reserved.

Evaluating techniques to improve visual performance with and assessment of premium intraocular lenses

Premium Intraocular Lenses (IOLs) such as toric IOLs, multifocal IOLs (MIOLs) and accommodating IOLs (AIOLs) can provide better refractive and visual outcomes compared to standard monofocal designs, leading to greater levels of post-operative spectacle independence. The principal theme of this thesis relates to the development of new assessment techniques that can help to improve future premium IOL design. IOLs designed to correct astigmatism form the focus of the first part of the thesis. A novel toric IOL design was devised to decrease the effect of toric rotation on patient visual acuity, but found to have neither a beneficial or detrimental impact on visual acuity retention. IOL tilt, like rotation, may curtail visual performance; however current IOL tilt measurement techniques require the use of specialist equipment not readily available in most ophthalmological clinics. Thus a new idea that applied Pythagoras’s theory to digital images of IOL optic symmetricality in order to calculate tilt was proposed, and shown to be both accurate and highly repeatable. A literature review revealed little information on the relationship between IOL tilt, decentration and rotation and so this was examined. A poor correlation between these factors was found, indicating they occur independently of each other. Next, presbyopia correcting IOLs were investigated. The light distribution of different MIOLs and an AIOL was assessed using perimetry, to establish whether this could be used to inform optimal IOL design. Anticipated differences in threshold sensitivity between IOLs were not however found, thus perimetry was concluded to be ineffective in mapping retinal projection of blur. The observed difference between subjective and objective measures of accommodation, arising from the influence of pseudoaccommodative factors, was explored next to establish how much additional objective power would be required to restore the eye’s focus with AIOLs. Blur tolerance was found to be the key contributor to the ocular depth of focus, with an approximate dioptric influence of 0.60D. Our understanding of MIOLs may be limited by the need for subjective defocus curves, which are lengthy and do not permit important additional measures to be undertaken. The use of aberrometry to provide faster objective defocus curves was examined. Although subjective and objective measures related well, the peaks of the MIOL defocus curve profile were not evident with objective prediction of acuity, indicating a need for further refinement of visual quality metrics based on ocular aberrations. The experiments detailed in the thesis evaluate methods to improve visual performance with toric IOLs. They also investigate new techniques to allow more rapid post-operative assessment of premium IOLs, which could allow greater insights to be obtained into several aspects of visual quality, in order to optimise future IOL design and ultimately enhance patient satisfaction.

The importance of institutions in expansionary fiscal consolidations. A critical assessment of non-Keynesian effects

The short-term effects of fiscal consolidation have attracted an increasing attention from both the academia and policy makers in the recent years. Authors in the literature on non- Keynesian effects usually put the emphasis on the need for the devaluation of the national currency, the accommodating reaction of the monetary authority and the favourable international economic conditions as the necessary accompanying tools of fiscal consolidation, in order to realise short-term expansionary effects. Some also add the necessity of large-scale adjustment; while others support the view that a high and increasing debt ratio or increasing government spending, by triggering an unavoidable adjustment, is the key to experiencing short-term expansionary effects. The composition of adjustment also became a crucial explanation for non-Keynesian effects. However, as the following critical assessment of the literature on expansionary fiscal consolidations will reveal, institutional conditions, such as the importance of the depth of financial intermediation and the influencing role of labour market structure, can prove to be crucial in the occurrence of the desired expansionary short-term effects.

Effects of academic integration on the persistence and achievement of under-prepared college students

The purpose of this dissertation was to examine the effect of academic integration, defined in terms of instructor/student contact, on the persistence of under-prepared college students and the achievement of those who persist. The overall design of this study compared instructor-initiated contact with conventional contact. The dependent variables were persistence, achievement, motivation and anxiety. Information was collected by administering the College-Level Mathematics Test (CLM), the Perceived Affective Contact Questionnaire (PAC), the expectancy and anxiety components of the Motivated Strategies for Learning Questionnaire (MSLQ), a departmental final examination, and by accessing university records. The sample consisted of 130 college algebra students at a large, public university with a Hispanic majority. The main analyses consisted of a 2 x 2 x 2 ANOVA (treatment by ethnicity by gender) to test for differences in achievement, t-tests to compare motivation, anxiety and perceived affective contact scores for the two groups, Chi-square tests to assess differences in persistence, and Pearson Product-Moment Correlation to determine the relationship between pretest scores and achievement variables. Results indicated that neither instructor-initiated contact, gender nor ethnicity is related to persistence, motivation or anxiety. A significant disordinal interaction of treatment and ethnicity was observed, with Hispanic experimental students scoring significantly higher on a test of algebra achievement than Hispanic control students. ^ Academic integration, defined in terms of instructor/student contact, has a positive influence on the achievement of Hispanic students. This may imply their positive responsiveness to the relational aspect of contact due to traditional cultural values of interdependence, acquiescence to authority and physical closeness. Such interactive feedback is a means by which students with these values are recognized as members of the university academic community, prompting increased academic effort. Training in contact initiation to promote academic integration is implied, by the results of this study, for instructors dealing with first year students, especially instructors at institutions accommodating instructional methods to the needs of diverse groups. ^

*Postsecondary access for individuals with psychological disabilities: An analysis of federal rulings and institutional philosophies, *policies, and practices

This study was a qualitative investigation, with demographic quantitative features, of post-secondary educational access and legal guidelines for individuals with psychological disabilities. Although disability laws have positively influenced post-secondary educational attitudes and practices relative to accommodating many individuals with disabilities, prevailing stigmas regarding mental illness have discouraged the equal access to higher education for individuals with psychological disabilities. Little research concentrating on this area was found.^ Thirty-six relevant legal case decisions, focusing on a variety of realms of higher education, were scrutinized. The policies, procedures, and practices of six Southeastern United States universities were analyzed through official documents and participant responses from disability service providers and other university employees. Comparisons were made between legal cases, and within and between universities. Case findings also provided standards through which participating university practices could be studied.^ The legal analysis revealed that most institutions did not discriminate against individuals with psychological disabilities. Practices of a few of these institutions, however, suggested non-compliance despite favorable decisions on their behalf. Institutions found to have discriminatory practices were cited for inadequate procedures, or for presumptive assessments of the educational functioning levels of individuals with psychological disabilities.^ Participant university practices generally suggested disability law compliance; however, certain campus interventions were determined to be ineffective in identifying, addressing, and communicating about the educational needs of individuals with psychological disabilities. The most effective services for these individuals, who were described as rapidly increasing in number but lagging in self-advocacy and acceptance by others, went beyond legal requirements.^ Recommendations were made for institutional practices concerning disability-related documentation, written standards and operations, and student identification and referral. Directions for future research focused on study skills training for students; exposure of mental health professionals to client educational needs; and expansion of the current research, on a nationwide collegiate level, and a parallel analysis focusing on business and industry. ^

Effects of academic integration on the persistence and achievement of under-prepared college students

The purpose of this dissertation was to examine the effect of academic integration, defined in terms of instructor/student contact, on the persistence of under-prepared college students and the achievement of those who persist. The overall design of this study compared instructor-initiated contact with conventional contact. The dependent variables were persistence, achievement, motivation and anxiety. Information was collected by administering the College-Level Mathematics Test (CLM), the Perceived Affective Contact Questionnaire (PAC), the expectancy and anxiety components of the Motivated Strategies for Learning Questionnaire (MSLQ), a departmental final examination, and by accessing university records. The sample consisted of 130 college algebra students at a large, public university with a Hispanic majority. The main analyses consisted of a 2x2x2 ANOVA (treatment by ethnicity by gender) to test for differences in achievement, t-tests to compare motivation, anxiety and perceived affective contact scores for the two groups, Chi-square tests to assess differences in persistence, and Pearson Product-Moment Correlation to determine the relationship between pretest scores and achievement variables. Results indicated that neither instructor-initiated contact, gender nor ethnicity is related to persistence, motivation or anxiety. A significant disordinal interaction of treatment and ethnicity was observed, with Hispanic experimental students scoring significantly higher on a test of algebra achievement than Hispanic control students. Academic integration, defined in terms of instructor/student contact, has a positive influence on the achievement of Hispanic students. This may imply their positive responsiveness to the relational aspect of contact due to traditional cultural values of interdependence, acquiescence to authority and physical closeness. Such interactive feedback is a means by which students with these values are recognized as members of the university academic community, prompting increased academic effort. Training in contact initiation to promote academic integration is implied, by the results of this study, for instructors dealing with first year students, especially instructors at institutions accommodating instructional methods to the needs of diverse groups.

Can aberrometry provide rapid and reliable measures of subjective depth of focus following multifocal intraocular lens implantation?

Purpose: To determine whether the ‘through-focus’ aberrations of a multifocal and accommodative intraocular lens (IOL) implanted patient can be used to provide rapid and reliable measures of their subjective range of clear vision. Methods: Eyes that had been implanted with a concentric (n = 8), segmented (n = 10) or accommodating (n = 6) intraocular lenses (mean age 62.9 ± 8.9 years; range 46-79 years) for over a year underwent simultaneous monocular subjective (electronic logMAR test chart at 4m with letters randomised between presentations) and objective (Aston open-field aberrometer) defocus curve testing for levels of defocus between +1.50 to -5.00DS in -0.50DS steps, in a randomised order. Pupil size and ocular aberration (a combination of the patient’s and the defocus inducing lens aberrations) at each level of blur was measured by the aberrometer. Visual acuity was measured subjectively at each level of defocus to determine the traditional defocus curve. Objective acuity was predicted using image quality metrics. Results: The range of clear focus differed between the three IOL types (F=15.506, P=0.001) as well as between subjective and objective defocus curves (F=6.685, p=0.049). There was no statistically significant difference between subjective and objective defocus curves in the segmented or concentric ring MIOL group (P>0.05). However a difference was found between the two measures and the accommodating IOL group (P<0.001). Mean Delta logMAR (predicted minus measured logMAR) across all target vergences was -0.06 ± 0.19 logMAR. Predicted logMAR defocus curves for the multifocal IOLs did not show a near vision addition peak, unlike the subjective measurement of visual acuity. However, there was a strong positive correlation between measured and predicted logMAR for all three IOLs (Pearson’s correlation: P<0.001). Conclusions: Current subjective procedures are lengthy and do not enable important additional measures such as defocus curves under differently luminance or contrast levels to be assessed, which may limit our understanding of MIOL performance in real-world conditions. In general objective aberrometry measures correlated well with the subjective assessment indicating the relative robustness of this technique in evaluating post-operative success with segmented and concentric ring MIOL.

Multi-View Weighted Network

Extensive investigation has been conducted on network data, especially weighted network in the form of symmetric matrices with discrete count entries. Motivated by statistical inference on multi-view weighted network structure, this paper proposes a Poisson-Gamma latent factor model, not only separating view-shared and view-specific spaces but also achieving reduced dimensionality. A multiplicative gamma process shrinkage prior is implemented to avoid over parameterization and efficient full conditional conjugate posterior for Gibbs sampling is accomplished. By the accommodating of view-shared and view-specific parameters, flexible adaptability is provided according to the extents of similarity across view-specific space. Accuracy and efficiency are tested by simulated experiment. An application on real soccer network data is also proposed to illustrate the model.

Wave energy conversion of oscillating water column devices including air compressibility

This paper presents an investigation on air compressibility in the air chamber and its effects on the power conversion of oscillating water column (OWC) devices. As it is well known that for practical OWC plants, their air chambers may be large enough for accommodating significant air compressibility, the “spring effect,” an effect that is frequently and simply regarded to store and release energy during the reciprocating process of a wave cycle. Its insight effects on the device’s performance and power conversion, however, have not been studied in detail. This research will investigate the phenomena with a special focus on the effects of air compressibility on wave energy conversion. Air compressibility itself is a complicated nonlinear process in nature, but it can be linearised for numerical simulations under certain assumptions for frequency domain analysis. In this research work, air compressibility in the OWC devices is first linearised and further coupled with the hydrodynamics of the OWC. It is able to show mathematically that in frequency-domain, air compressibility can increase the spring coefficients of both the water body motion and the device motion (if it is a floating device), and enhance the coupling effects between the water body and the structure. Corresponding to these changes, the OWC performance, the capture power, and the optimised Power Take-off (PTO) damping coefficient in the wave energy conversion can be all modified due to air compressibility. To validate the frequency-domain results and understand the problems better, the more accurate time-domain simulations with fewer assumptions have been used for comparison. It is shown that air compressibility may significantly change the dynamic responses and the capacity of converting wave energy of the OWC devices if the air chamber is very large.

Do Multiculturalism Policies Erode the Welfare State (Working Paper 33)

The past 30 years have witnessed a dramatic change in the way Western democracies deal with ethnic minorities. In the past, ethnic diversity was often seen as a threat to political stability, and minorities were subject to a range of policies intended to assimilate or marginalize them. Today, many Western democracies have adopted a more accommodating approach. This is reflected in the widespread adoption of multiculturalism policies for immigrant groups, the acceptance of territorial autonomy and language rights for national minorities, and the recognition of land claims and selfgovernment rights for indigenous peoples. We refer to these policies as “multiculturalism policies” or MCPs. The adoption of MCPs has been controversial, for two reasons. The first is a philosophical critique, which argues that MCPs are inherently inconsistent with basic liberal-democratic principles. Since the mid-1990s, however, this philosophical debate has been supplemented by a second argument: namely, that MCPs make it more difficult to sustain a robust Welfare State (hereafter WS). Critics worry that such policies erode the interpersonal trust, social solidarity and political coalitions that sustain a strongly redistributive WS. This paper reviews the reasons why critics believe that MCPs weaken political support for redistribution, and then examines empirically whether the adoption of MCPs has, in fact, been associated with erosion of the WS. This examination involves two steps: we develop a taxonomy of MCPs and classify Western democracies as “strong”, “modest” or “weak” in their level of MCPs. We then examine whether the strength of MCPs is associated with the erosion of the WS during the 1980s and 1990s. The evolution of the WS is measured through change in four indicators: social spending as a percentage of GDP; the redistributive impact of taxes and transfers; levels of child poverty; and the level of income inequality. We find no evidence of a consistent relationship between the adoption of MCPs and the erosion of the WS. Our analysis has limits, and we hope it stimulates further research. Nevertheless, the preliminary evidence presented here is clear: the case advanced by critics of MCPs is not supported. The growing ethnic diversity of Western societies has generated pressures for the construction of new and more inclusive forms of citizenship and national identity. The evidence in this paper suggests that debates over the appropriateness of multiculturalism policies as one response to this diversity should not be pre-empted by unsupported fears about their impact on the WS.

Local Storage Meets Local Demand: A Technical Solution to Future Power Distribution System

Future power systems are expected to integrate large-scale stochastic and intermittent generation and load due to reduced use of fossil fuel resources, including renewable energy sources (RES) and electric vehicles (EV). Inclusion of such resources poses challenges for the dynamic stability of synchronous transmission and distribution networks, not least in terms of generation where system inertia may not be wholly governed by large-scale generation but displaced by small-scale and localised generation. Energy storage systems (ESS) can limit the impact of dispersed and distributed generation by offering supporting reserve while accommodating large-scale EV connection; the latter (load) also participating in storage provision. In this paper, a local energy storage system (LESS) is proposed. The structure, requirement and optimal sizing of the LESS are discussed. Three operating modes are detailed, including: 1) storage pack management; 2) normal operation; and 3) contingency operation. The proposed LESS scheme is evaluated using simulation studies based on data obtained from the Northern Ireland regional and residential network.

Integrated Housing Approach for Riyadh’s hot arid Climate: solutions from the desert vernacular

Thesis (Master's)--University of Washington, 2016-06