Specialist contact lens fitting

What is meant by the term ‘specialist contact lens fitting’? Or put another way, what would be considered non-specialist contact lens fitting? Is there such a thing as routine contact lens fitting? Soft or silicone hydrogel fitting for daily wear would probably be considered as routine contact lens fitting, but would extended or flexible wear remain in the same category or would they be considered a specialist fit? Different eras will classify different products as being ‘specialist’. Certainly twenty years ago soft toric contact lenses were considered as being speciality lenses but today would be thought of as routine lenses. Conversely, gas permeable lenses were thought of as mainstream twenty years ago but now are considered as speciality lenses. Although this would not be the same globally, as in some countries (such as Netherlands, France and Japan) gas permeable lens fitting remains popular and is not on the decline as in other countries (Canada, Australia and Sweden) [1]. Bandage soft lenses applied after surface laser refractive procedures would be considered as therapeutic lenses but in reality they are just plano thin hydrogel lenses worn constantly for 3–4 days to allow the underlying epithelium to convalesce and are then removed [2]. Some patients find that wearing hydrogel lenses during periods when they suffer from seasonal allergies actually improves their ocular comfort as the contact lens acts as a barrier to the allergen [3] and [4]. Scleral lenses have long been considered speciality lenses, apart from a time when they were the only lenses available but at that time all contact lens work would have been considered speciality practice! Nowadays we see the advent of mini-scleral designs and we see large diameter gas permeable lenses too. It is possible that these lenses increase the popularity of gas permeable lenses again and they become more main stream. So it would seem that the lines between routine and speciality contact lens fitting are not clear. Whether a lens is classed a specialist fit or not would depend on the lens type, why it was fitted, where in the world the fitting was being done and even the era in which it was fitted. This begs the question as to what would be considered entry level knowledge in contact lens fitting. This may not be an issue for most BCLA members or CLAE readers but certainly would be for bodies such as the College of Optometrists (UK) or the Association of British Dispensing Opticians when they are planning the final registration examinations for budding practitioners or when planning the level of higher level qualifications such as College Certificates or Diplomas. Similarly for training institutions when they are planning their course content. This becomes even trickier when trying to devise a qualification that spans across many countries, like the European Diploma in Optometry and Optics. How do we know if the training and examination level is correct? One way would be to analyse things when they go wrong and if patterns of malpractice are seen then maybe that could be used as an indicator to more training being needed. There were 162 Fitness to Practice Hearing at the General Optical Council between 2001 and 2010. Forty-seven of these were clinically related case, 39 fraud related, and 76 others. Of the clinical ones only 3 were contact lens related. So it would appear that as whole, in the profession, contact lens clinical skills are not being questioned too often (although it seems a few of us can’t keep our hands out the cookie jar!).

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.

History and symptom taking in contact lens fitting and aftercare

Aim: To appraise history and symptom taking for contact lens consultations, to determine current practice and to make recommendations for best practice. Method: The peer reviewed academic literature was reviewed and the results informed a survey completed by 256 eye care practitioners (ECPs) on their current practice and influences. Results: The last eye-test date, last contact lens aftercare (for existing wearers) and reason for visit are key questions for most ECPs. Detailed use of contact lens questions are more commonly applied in aftercares than when refitting patients who have previously discontinued wear (87% vs 56% use), whereas questions on ocular and general history, medication and lifestyle were generally more commonly utilised for new patients than in aftercares (72% vs 50%). 75% of ECPs requested patients bring a list of their medication to appointments. Differential diagnosis questioning was thorough in most ECPs (87% of relevant questions asked). Attempts to optimise compliance included oral instruction (95% always) and written patient instructions (95% at least sometimes). Abbreviations were used by 39% of respondents (26% used ones provided by a professional body). Conclusion: There is scope for more consistency in history and symptom taking for contact lens consultations and recommendations are made.

Penalized Least Squares Fitting

* Supported by the Army Research Office under grant DAAD-19-02-10059.

Multi-model fitting based on minimum spanning tree

This paper presents a novel approach to the computation of primitive geometrical structures, where no prior knowledge about the visual scene is available and a high level of noise is expected. We based our work on the grouping principles of proximity and similarity, of points and preliminary models. The former was realized using Minimum Spanning Trees (MST), on which we apply a stable alignment and goodness of fit criteria. As for the latter, we used spectral clustering of preliminary models. The algorithm can be generalized to various model fitting settings, without tuning of run parameters. Experiments demonstrate the significant improvement in the localization accuracy of models in plane, homography and motion segmentation examples. The efficiency of the algorithm is not dependent on fine tuning of run parameters like most others in the field.

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.

Fitting model-based psychometric functions to simultaneity and temporal-order judgment data: MATLAB and R routines

Research on temporal-order perception uses temporal-order judgment (TOJ) tasks or synchrony judgment (SJ) tasks in their binary SJ2 or ternary SJ3 variants. In all cases, two stimuli are presented with some temporal delay, and observers judge the order of presentation. Arbitrary psychometric functions are typically fitted to obtain performance measures such as sensitivity or the point of subjective simultaneity, but the parameters of these functions are uninterpretable. We describe routines in MATLAB and R that fit model-based functions whose parameters are interpretable in terms of the processes underlying temporal-order and simultaneity judgments and responses. These functions arise from an independent-channels model assuming arrival latencies with exponential distributions and a trichotomous decision space. Different routines fit data separately for SJ2, SJ3, and TOJ tasks, jointly for any two tasks, or also jointly for the three tasks (for common cases in which two or even the three tasks were used with the same stimuli and participants). Additional routines provide bootstrap p-values and confidence intervals for estimated parameters. A further routine is included that obtains performance measures from the fitted functions. An R package for Windows and source code of the MATLAB and R routines are available as Supplementary Files.

Mathematical analysis of maximum power generated by photovoltaic systems and fitting curves for standard test conditions

The rural electrification is characterized by geographical dispersion of the population, low consumption, high investment by consumers and high cost. Moreover, solar radiation constitutes an inexhaustible source of energy and in its conversion into electricity photovoltaic panels are used. In this study, equations were adjusted to field conditions presented by the manufacturer for current and power of small photovoltaic systems. The mathematical analysis was performed on the photovoltaic rural system I- 100 from ISOFOTON, with power 300 Wp, located at the Experimental Farm Lageado of FCA/UNESP. For the development of such equations, the circuitry of photovoltaic cells has been studied to apply iterative numerical methods for the determination of electrical parameters and possible errors in the appropriate equations in the literature to reality. Therefore, a simulation of a photovoltaic panel was proposed through mathematical equations that were adjusted according to the data of local radiation. The results have presented equations that provide real answers to the user and may assist in the design of these systems, once calculated that the maximum power limit ensures a supply of energy generated. This real sizing helps establishing the possible applications of solar energy to the rural producer and informing the real possibilities of generating electricity from the sun.

Sensitivity analysis in optimized parametric curve fitting

Purpose – Curve fitting from unordered noisy point samples is needed for surface reconstruction in many applications -- In the literature, several approaches have been proposed to solve this problem -- However, previous works lack formal characterization of the curve fitting problem and assessment on the effect of several parameters (i.e. scalars that remain constant in the optimization problem), such as control points number (m), curve degree (b), knot vector composition (U), norm degree (k), and point sample size (r) on the optimized curve reconstruction measured by a penalty function (f) -- The paper aims to discuss these issues -- Design/methodology/approach - A numerical sensitivity analysis of the effect of m, b, k and r on f and a characterization of the fitting procedure from the mathematical viewpoint are performed -- Also, the spectral (frequency) analysis of the derivative of the angle of the fitted curve with respect to u as a means to detect spurious curls and peaks is explored -- Findings - It is more effective to find optimum values for m than k or b in order to obtain good results because the topological faithfulness of the resulting curve strongly depends on m -- Furthermore, when an exaggerate number of control points is used the resulting curve presents spurious curls and peaks -- The authors were able to detect the presence of such spurious features with spectral analysis -- Also, the authors found that the method for curve fitting is robust to significant decimation of the point sample -- Research limitations/implications - The authors have addressed important voids of previous works in this field -- The authors determined, among the curve fitting parameters m, b and k, which of them influenced the most the results and how -- Also, the authors performed a characterization of the curve fitting problem from the optimization perspective -- And finally, the authors devised a method to detect spurious features in the fitting curve -- Practical implications – This paper provides a methodology to select the important tuning parameters in a formal manner -- Originality/value - Up to the best of the knowledge, no previous work has been conducted in the formal mathematical evaluation of the sensitivity of the goodness of the curve fit with respect to different possible tuning parameters (curve degree, number of control points, norm degree, etc.)

Fitting phase type distribution to service process with sequential phases

The work of this thesis is concerned with fitting Hypo-exponential and Erlang phase type distributions for modeling real life processes with non-exponential service time. There exist situations where exponential distributions cannot explain the distribution of service time properly. This thesis presents the application of two traditional statistical estimation techniques to approximate the service distributions of processes with coefficient of variation less than one. It also presents an algorithm to fit Hypo-exponential distribution for complex situations which can’t be handled properly with traditional estimation techniques. The result shows the effect of variation of sample size and other parameters on the efficiency of the estimation techniques by comparing their respective outputs. Furthermore it checks how accurately the proposed algorithm approximates a given distribution.

An alternative methodology for fitting selectivity curves to pre-defined distributions

A non-linear least-squares methodology for simultaneously estimating parameters of selectivity curves with a pre-defined functional form, across size classes and mesh sizes, using catch size frequency distributions, was developed based on the model of Kirkwood and Walker [Kirkwood, G.P., Walker, T.L, 1986. Gill net selectivities for gummy shark, Mustelus antarcticus Gunther, taken in south-eastern Australian waters. Aust. J. Mar. Freshw. Res. 37, 689-697] and [Wulff, A., 1986. Mathematical model for selectivity of gill nets. Arch. Fish Wiss. 37, 101-106]. Observed catches of fish of size class I in mesh m are modeled as a function of the estimated numbers of fish of that size class in the population and the corresponding selectivities. A comparison was made with the maximum likelihood methodology of [Kirkwood, G.P., Walker, T.I., 1986. Gill net selectivities for gummy shark, Mustelus antarcticus Gunther, taken in south-eastern Australian waters. Aust. J. Mar. Freshw. Res. 37, 689-697] and [Wulff, A., 1986. Mathematical model for selectivity of gill nets. Arch. Fish Wiss; 37, 101-106], using simulated catch data with known selectivity curve parameters, and two published data sets. The estimated parameters and selectivity curves were generally consistent for both methods, with smaller standard errors for parameters estimated by non-linear least-squares. The proposed methodology is a useful and accessible alternative which can be used to model selectivity in situations where the parameters of a pre-defined model can be assumed to be functions of gear size; facilitating statistical evaluation of different models and of goodness of fit. (C) 1998 Elsevier Science B.V.

Vector Fitting based Automatic Circuit Identification

This paper describes a method to automatically obtain, from a set of impedance measurements at different frequencies, an equivalent circuit composed of lumped elements based on the vector fitting algorithm. The method starts from the impedance measurement of the circuit and then, through the recursive use of vector fitting, identifies the circuit topology and the component values of lumped elements. The method can be expanded to include other components usually used in impedance spectroscopy. The method is firstly described and then two examples highlight the robustness of the method and showcase its applicability.

Tracking people in 3D using position, size and shape

This paper presents a prototype tracking system for tracking people in enclosed indoor environments where there is a high rate of occlusions. The system uses a stereo camera for acquisition, and is capable of disambiguating occlusions using a combination of depth map analysis, a two step ellipse fitting people detection process, the use of motion models and Kalman filters and a novel fit metric, based on computationally simple object statistics. Testing shows that our fit metric outperforms commonly used position based metrics and histogram based metrics, resulting in more accurate tracking of people.

The future of office property

The following paper considers the question, where to office property? In doing so, it focuses, in the first instance, on identifying and describing a selection of key forces for change present within the contemporary operating environment in which office property functions. Given the increasingly complex, dynamic and multi-faceted character of this environment, the paper seeks to identify only the primary forces for change, within the context of the future of office property. These core drivers of change have, for the purposes of this discussion, been characterised as including a range of economic, demographic and socio-cultural factors, together with developments in information and communication technology. Having established this foundation, the paper proceeds to consider the manner in which these forces may, in the future, be manifested within the office property market. Comment is offered regarding the potential future implications of these forces for change together with their likely influence on the nature and management of the physical asset itself. Whilst no explicit time horizon has been envisioned in the preparation of this paper particular attention has been accorded short to medium term trends, that is, those likely to emerge in the office property marketplace over the coming two decades. Further, the paper considers the question posed, in respect of the future of office property, in the context of developed western nations. The degree of commonality seen in these mature markets is such that generalisations may more appropriately and robustly be applied. Whilst some of the comments offered with respect to the target market may find application in other arenas, it is beyond the scope of this paper to explicitly consider highly heterogeneous markets. Given also the wide scope of this paper key drivers for change and their likely implications for the commercial office property market are identified at a global level (within the above established parameters). Accordingly, the focus is necessarily such that it serves to reflect overarching directions at a universal level (with the effect being that direct applicability to individual markets - when viewed in isolation on a geographic or property type specific basis – may not be fitting in all instances)

“I woke up and realised the ground had shifted”: the shifting terrain of English curriculum

The theme of this conference comes from the epitaph on the Lewis Carroll’s gravesite. “Is All our Life then But A Dream?” This seems fitting for a time when so much change in the terrain of English makes us feel as if we are somnambulating through a surrealist landscape. Like Lewis Carroll’s Alice, (Carroll, 2003) we might find ourselves at strange tea parties with bureaucratic mad hatters, and just when we think we have a grasp of applying new theory in our teaching, we fall down another rabbit hole, to swim in confusion as some queen calls out, ‘off with their heads!’. The shifting ground in English inevitably moves in response to waves of theory influencing classroom practice. Each new paradigm has claimed to liberate language learners from the flaws of the previous model. Each linguist or literary theorist who shaped the new paradigm no doubt dreamt of a new population emerging from school as more powerfully literate citizens than the previous generation.