Twenty Years of Acanthamoeba Keratitis

Purpose: We described the rate of Acanthamoeba keratitis (AK) in a referral eye center in Sao Paulo, Brazil, through a retrospective review of clinical and laboratorial records of patients over 2 decades. Methods: From 1987 to 2006, a total of 581 requests for amoebic laboratory workup in cases of infections keratitis were investigated. Statistical analyses were applied to analyze a tendency of AK cases. Results: Acanthamoeba species were cultured from corneal scrapings of 185 patients, 5 of them with bilateral infection. Eighty-three percent of those patients were related with contact lens wear. Conclusions: The results suggested that patients with AK have persisted and increased over time at our ophthalmology center. Contact lenses showed to be a potential risk factor. Amoebic corneal infection can be considered as a new but well-established disease ill Brazilian ophthalmology and visual sciences.

Perfil dos alunos usuários de lentes de contato do curso de Medicina da Universidade Estadual Paulista - UNESP - Botucatu

OBJETIVO: Analisar o perfil dos usuários de lentes de contato entre os estudantes de medicina da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista - UNESP - Botucatu (SP), quanto à ametropia, à aquisição, aos cuidados e às complicações. MÉTODOS: Foi aplicado um questionário aos alunos do 1º ao 6º ano de Medicina da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista - UNESP - Botucatu (SP), perfazendo um estudo analítico transversal. RESULTADOS: Foram 566 entrevistados. Destes, 155 (27,4%) usavam lente de contato. Das lentes de contato usadas, 94,8% eram gelatinosas, e em 98,7% o grau era negativo. O descarte dessas lentes era mensal em 46,9% dos entrevistados e 63,9% a utilizavam, em média, 14 horas/dia. Faziam aquisição da lente de contato em óptica ou farmácia 14,1% dos estudantes. Faziam a higiene ao colocá-las e ao retirá-las dos olhos, 46,5%. As complicações referentes aos olhos vermelhos eram 51,0%; 44,5%, embaçamento; e 42,6%, sensação de corpo estranho, além de 4 estudantes relatarem ceratite. CONCLUSÕES: A maioria dos alunos utilizava lentes hidrofílicas, descarte mensal e grau negativo. A adaptação inadequada, aquisição de lentes de contato em ópticas ou farmácias e complicações graves ocorreram, mesmo nos usuários socioculturalmente considerados diferenciados. em vista disso, demanda a extrema necessidade de maior atenção na abordagem do tema em questão, a fim de prevenir o comprometimento visual permanente.

Automedicação em oftalmologia

Purpose: To analyze the conditions, consequences and risks of self-medication in patients attended in ophthalmology emergency room at Hospital das Clínicas de Botucatu (UNESP). Methods: Sixty patients who had used any form of self-medication were studied according: age, sex, professional activity, mainly complain, visual acuity (best-corrected vision), who administrated the self-medication (friends/parents, pharmacy clerk, advertisement, or the person himself), sort of medication or product used (eyedrops/ointments/contact lenses), cost (R$), time expenditure to medical attention, ocular complications, risk of visual loss and final diagnose. Results: The majority of patients with self-medication were male (72%). The mean age was 40,9 years (7-77 years). Patients usually used eyedrops that they had at home and delayed 3 days to the first medical evaluation. The most frequently kind of topical eyedrop used was vasoconstrictor (17%). However, many patients even knew what kind of medication they had dropped in their eyes (21%). The great majority of the patients (68%) were exposed to the risk of visual loss. According to our results, self-medication may cause visual complications in 12% of patients, in which, 42% was related to the contact lenses fit without ophthalmologic assistance. Conclusion: The majory of the patients used medication that they had in home. The topical vasoconstrictor was the most frequently used drug, however, they did not know which medication were dropping in their eyes (21%).

Effect of weathering and thickness on roughness of acrylic resin and ocular button

Purpose: The aim of this study was to evaluate the roughness of colorless ocular button and four brands of colorless acrylic resins designed to fabricate ocular prosthesis as a function of weathering (1008 h) and different thickness (1 and 3.5 mm). Materials and methods: One-hundred-and-twenty specimens were fabricated and distributed in 12 groups. The analysis was carried out by means of digital roughness meter. Results: Data were analyzed statistically by ANOVA and Tukey test at 1% significance. The results showed that there was no statistically significant difference after the weathering period. Both the Vipi Cril acrylic resin with 3.5 mm in thickness and ocular button with 1 mm in thickness presented the lowest roughness values (0.12. Ra). Conclusion: The roughness of the acrylic resins and the ocular button was not affect by the weathering of 1008 h. However, the thickness of the specimens proved to have a major influence on roughness property. © 2010.

Análise do comportamento da cor de restaurações cerâmicas sem metal avaliadas por diferentes métodos: estudo clínico prospectivo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reduced foveal vision enhances peripheral monitoring and peripheral event detection

Introduction: Although it seems plausible that sports performance relies on high-acuity foveal vision, it could be empirically shown that myoptic blur (up to +2 diopters) does not harm performance in sport tasks that require foveal information pick-up like golf putting (Bulson, Ciuffreda, & Hung, 2008). How myoptic blur affects peripheral performance is yet unknown. Attention might be less needed for processing visual cues foveally and lead to better performance because peripheral cues are better processed as a function of reduced foveal vision, which will be tested in the current experiment. Methods: 18 sport science students with self-reported myopia volunteered as participants, all of them regularly wearing contact lenses. Exclusion criteria comprised visual correction other than myopic, correction of astigmatism and use of contact lenses out of Swiss delivery area. For each of the participants, three pairs of additional contact lenses (besides their regular lenses; used in the “plano” condition) were manufactured with an individual overcorrection to a retinal defocus of +1 to +3 diopters (referred to as “+1.00 D”, “+2.00 D”, and “+3.00 D” condition, respectively). Gaze data were acquired while participants had to perform a multiple object tracking (MOT) task that required to track 4 out of 10 moving stimuli. In addition, in 66.7 % of all trials, one of the 4 targets suddenly stopped during the motion phase for a period of 0.5 s. Stimuli moved in front of a picture of a sports hall to allow for foveal processing. Due to the directional hypotheses, the level of significance for one-tailed tests on differences was set at α = .05 and posteriori effect sizes were computed as partial eta squares (ηρ2). Results: Due to problems with the gaze-data collection, 3 participants had to be excluded from further analyses. The expectation of a centroid strategy was confirmed because gaze was closer to the centroid than the target (all p < .01). In comparison to the plano baseline, participants more often recalled all 4 targets under defocus conditions, F(1,14) = 26.13, p < .01, ηρ2 = .65. The three defocus conditions differed significantly, F(2,28) = 2.56, p = .05, ηρ2 = .16, with a higher accuracy as a function of a defocus increase and significant contrasts between conditions +1.00 D and +2.00 D (p = .03) and +1.00 D and +3.00 D (p = .03). For stop trials, significant differences could neither be found between plano baseline and defocus conditions, F(1,14) = .19, p = .67, ηρ2 = .01, nor between the three defocus conditions, F(2,28) = 1.09, p = .18, ηρ2 = .07. Participants reacted faster in “4 correct+button” trials under defocus than under plano-baseline conditions, F(1,14) = 10.77, p < .01, ηρ2 = .44. The defocus conditions differed significantly, F(2,28) = 6.16, p < .01, ηρ2 = .31, with shorter response times as a function of a defocus increase and significant contrasts between +1.00 D and +2.00 D (p = .01) and +1.00 D and +3.00 D (p < .01). Discussion: The results show that gaze behaviour in MOT is not affected to a relevant degree by a visual overcorrection up to +3 diopters. Hence, it can be taken for granted that peripheral event detection was investigated in the present study. This overcorrection, however, does not harm the capability to peripherally track objects. Moreover, if an event has to be detected peripherally, neither response accuracy nor response time is negatively affected. Findings could claim considerable relevance for all sport situations in which peripheral vision is required which now needs applied studies on this topic. References: Bulson, R. C., Ciuffreda, K. J., & Hung, G. K. (2008). The effect of retinal defocus on golf putting. Ophthalmic and Physiological Optics, 28, 334-344.

9-fold Fresnel-Kohler concentrator with Fresnel lens of variable focal point

Non-uniform irradiance patterns over Multi-Junction Cells gives rise to power losses, especially when considering spectral irradiance distributions over different junctions. Thermal effects on Silicone-on-Glass lenses affect spectral irradiance distributions. A new Photovoltaic Concentrator (CPV), formed by nine optical channels, each one with a Köhler configuration, has been designed to overcome these effects at high concentrations for a large acceptance angle. A Fresnel Lens with a Variable Focal Point is proposed to prevent optical crosstalk in multichannel systems. When integrated into the concentrator, improves the acceptance angle. These designs are designed to fulfill the expected requirements of four junction CPV systems.

The extraordinarily rapid disappearance of entoptic images.

It has been known for more than 40 years that images fade from perception when they are kept at the same position on the retina by abrogating eye movements. Although aspects of this phenomenon were described earlier, the use of close-fitting contact lenses in the 1950s made possible a series of detailed observations on eye movements and visual continuity. In the intervening decades, many investigators have studied the role of image motion on visual perception. Although several controversies remain, it is clear that images deteriorate and in some cases disappear following stabilization; eye movements are, therefore, essential to sustained exoptic vision. The time course of image degradation has generally been reported to be a few seconds to a minute or more, depending upon the conditions. Here we show that images of entoptic vascular shadows can disappear in less than 80 msec. The rapid vanishing of these images implies an active mechanism of image erasure and creation as the basis of normal visual processing.

Clinical Characterization of Asymptomatic or Minimally Symptomatic Young Patients Showing Signs Compatible With Dry Eye: A Pilot Study

Purpose: To evaluate and characterize the clinical profile of young asymptomatic or minimally symptomatic patients without diagnosis of dry eye but showing signs compatible with dry eye syndrome (DES). Methods: Prospective study including a total of 50 consecutive subjects with ages ranging from 18 to 40 years that were identified as asymptomatic or minimally symptomatic by means of the Ocular Surface Disease Index (OSDI) (score of <22). In all patients, a complete battery of tests for the diagnosis of DES was performed including the evaluation of the tear film break-up time (TFBUT), the level of corneal and conjunctival staining, and the eyelid and Meibomian morphology. Results: The OSDI score was significantly higher in women than in men (median: 12.5 vs. 5.3, P=0.01). Low grades of ocular surface staining, dysfunction of Meibomian gland expression, and alteration of quality of Meibomian secretions were observed in 56%, 58%, and 84% of eyes, respectively. More eyes with some dysfunction of Meibomian gland expressibility had a TFBUT less than 5 sec (P=0.033). A statistically significant difference in the OSDI score was found between patients with and without systemic allergies (P=0.036) and between male and female (P=0.01). Likewise, the OSDI score was significantly higher in those women wearing contact lenses compared with those not wearing them (P=0.012). Conclusions: Asymptomatic or minimally symptomatic young subjects may present low grades of clinical signs compatible with DES, with a trend to more symptomatology in women and allergic patients. These outcomes should be confirmed in future studies with larger samples.

Visual signs and symptoms of Creutzfeldt-Jakob disease

A number of neurodegenerative diseases caused by prions have been described recently. These include Creutzfeldt-Jakob disease (CJD) in humans, scrapie in sheep and BSE in cows. Patients with CJD may suffer a range of visual problems including eye movement deficits and visual hallucinations. In addition, it is possible that CJD may be acquired via corneal transplant and that prions may be transmitted by reusable contact lenses.

A method for profiling biometric changes during disaccommodation

PURPOSE: To demonstrate the application of low-coherence reflectometry to the study of biometric changes during disaccommodation responses in human eyes after cessation of a near task and to evaluate the effect of contact lenses on low-coherence reflectometry biometric measurements. METHODS: Ocular biometric parameters of crystalline lens thickness (LT) and anterior chamber depth (ACD) were measured with the LenStar device during and immediately after a 5 D accommodative task in 10 participants. In a separate trial, accommodation responses were recorded with a Shin-Nippon WAM-5500 optometer in a subset of two participants. Biometric data were interleaved to form a profile of post-task anterior segment changes. In a further experiment, the effect of soft contact lenses on LenStar measurements was evaluated in 15 participants. RESULTS: In 10 adult participants, increased LT and reduced ACD was seen during the 5 D task. Post-task, during fixation of a 0 D target, a profile of the change in LT and ACD against time was observed. In the two participants with accommodation data (one a sufferer of nearwork-induced transient myopia and other a non-sufferer), the post-task changes in refraction compared favorably with the interleaved LenStar biometry data. The insertion of soft contact lenses did not have a significant effect on LenStar measures of ACD or LT (mean change: -0.007 mm, p = 0.265 and + 0.001 mm, p = 0.875, respectively). CONCLUSIONS: With the addition of a relatively simple stimulus modification, the LenStar instrument can be used to produce a profile of post-task changes in LT and ACD. The spatial and temporal resolution of the system is sufficient for the investigation of nearwork-induced transient myopia from a biometric viewpoint. LenStar measurements of ACD and LT remain valid after the fitting of soft contact lenses.

Development of a questionnaire to assess the relative subjective benefits of presbyopia correction

Purpose To develop a standardized questionnaire of near visual function and satisfaction to complement visual function evaluations of presbyopic corrections. Setting Eye Clinic, School of Life and Health Sciences, Aston University, Midland Eye Institute and Solihull Hospital, Birmingham, United Kingdom. Design Questionnaire development. Methods A preliminary 26-item questionnaire of previously used near visual function items was completed by patients with monofocal intraocular lenses (IOLs), multifocal IOLs, accommodating IOLs, multifocal contact lenses, or varifocal spectacles. Rasch analysis was used for item reduction, after which internal and test–retest reliabilities were determined. Construct validity was determined by correlating the resulting Near Activity Visual Questionnaire (NAVQ) scores with near visual acuity and critical print size (CPS), which was measured using the Minnesota Low Vision Reading Test chart. Discrimination ability was assessed through receiver-operating characteristic (ROC) curve analysis. Results One hundred fifty patients completed the questionnaire. Item reduction resulted in a 10-item NAVQ with excellent separation (2.92), internal consistency (Cronbach a = 0.95), and test–retest reliability (intraclass correlation coefficient = 0.72). Correlations of questionnaire scores with near visual acuity (r = 0.32) and CPS (r = 0.27) provided evidence of validity, and discrimination ability was excellent (area under ROC curve = 0.91). Conclusion Results show the NAVQ is a reliable, valid instrument that can be incorporated into the evaluation of presbyopic corrections.

Comparison of near visual acuity and reading metrics in presbyopia correction

PURPOSE: To provide a consistent standard for the evaluation of different types of presbyopic correction. SETTING: Eye Clinic, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. METHODS: Presbyopic corrections examined were accommodating intraocular lenses (IOLs), simultaneous multifocal and monovision contact lenses, and varifocal spectacles. Binocular near visual acuity measured with different optotypes (uppercase letters, lowercase letters, and words) and reading metrics assessed with the Minnesota Near Reading chart (reading acuity, critical print size [CPS], CPS reading speed) were intercorrelated (Pearson product moment correlations) and assessed for concordance (intraclass correlation coefficients [ICC]) and agreement (Bland-Altman analysis) for indication of clinical usefulness. RESULTS: Nineteen accommodating IOL cases, 40 simultaneous contact lens cases, and 38 varifocal spectacle cases were evaluated. Other than CPS reading speed, all near visual acuity and reading metrics correlated well with each other (r>0.70, P<.001). Near visual acuity measured with uppercase letters was highly concordant (ICC, 0.78) and in close agreement with lowercase letters (+/- 0.17 logMAR). Near word acuity agreed well with reading acuity (+/- 0.16 logMAR), which in turn agreed well with near visual acuity measured with uppercase letters 0.16 logMAR). Concordance (ICC, 0.18 to 0.46) and agreement (+/- 0.24 to 0.30 logMAR) of CPS with the other near metrics was moderate. CONCLUSION: Measurement of near visual ability in presbyopia should be standardized to include assessment of near visual acuity with logMAR uppercase-letter optotypes, smallest logMAR print size that maintains maximum reading speed (CPS), and reading speed. J Cataract Refract Surg 2009; 35:1401-1409 (C) 2009 ASCRS and ESCRS

New investigations into macular pigment optical density

Macular pigment (MP) is the collective name for three carotenoids, lutein, zeaxanthin and meso-zeaxanthin, which are found at high concentrations in the central macula. The macular carotenoids, like all carotenoids, are entirely of dietary origin. The term ‘macular pigment optical density’ (MPOD) refers to the peak concentration of MP in the retina, which varies from one individual to the next and is measurable in vivo. On account of its blue-light-filtering and antioxidant properties, MP has become a subject of interest with respect to age-related macular degeneration (AMD), the hypothesis being that MP helps to protect against AMD; the higher the MPOD, the lower the risk for AMD. Recently, a new MPOD-measuring device, the MPS 9000 (MPS), entered the ophthalmic market. Using this device, the research described here aimed to contribute new information to the MP literature. A second MPOD instrument, the Macular Pigment Reflectometer, was also used at times, but a reliability study (included in the thesis) demonstrated that it was unsuitable for use on its own. First, a series of exploratory investigations were undertaken to maximize the accuracy and consistency of MPOD measurements taken with the MPS; a protocol was established that substantially improved repeatability. Subsequently, a series of MPOD-based studies were conducted on anisometropia, South Asian race, blue-light-filtering contact lenses, and dietary modification with kale. The principle findings were as follows: interocular MPOD differences were not attributable to interocular refractive error differences; young adults of South Asian origin had significant gender-related MPOD differences (males>females, p<0.01), and they also had significantly higher MPOD than Caucasians (p<0.0005); wearing blue-light-filtering contact lenses for eight months did not affect MPOD; and dietary modification with kale for 16 weeks did not increase MPOD. This body of research adds new insights to MP knowledge, which in turn may contribute to MP knowledge in the context of AMD.