Accommodating intraocular lenses:a review of design concepts, usage and assessment methods

The correction of presbyopia and restoration of true accommodative function to the ageing eye is the focus of much ongoing research and clinical work. A range of accommodating intraocular lenses (AIOLs) implanted during cataract surgery has been developed and they are designed to change either their position or shape in response to ciliary muscle contraction to generate an increase in dioptric power. Two main design concepts exist. First, axial shift concepts rely on anterior axial movement of one or two optics creating accommodative ability. Second, curvature change designs are designed to provide significant amplitudes of accommodation with little physical displacement. Single-optic devices have been used most widely, although the true accommodative ability provided by forward shift of the optic appears limited and recent findings indicate that alternative factors such as flexing of the optic to alter ocular aberrations may be responsible for the enhanced near vision reported in published studies. Techniques for analysing the performance of AIOLs have not been standardised and clinical studies have reported findings using a wide range of both subjective and objective methods, making it difficult to gauge the success of these implants. There is a need for longitudinal studies using objective methods to assess long-term performance of AIOLs and to determine if true accommodation is restored by the designs available. While dual-optic and curvature change IOLs are designed to provide greater amplitudes of accommodation than is possible with single-optic devices, several of these implants are in the early stages of development and require significant further work before human use is possible. A number of challenges remain and must be addressed before the ultimate goal of restoring youthful levels of accommodation to the presbyopic eye can be achieved.

Exploratory database visualisation: the application and assessment of data and dimensionality reduction

This thesis describes the development of a complete data visualisation system for large tabular databases, such as those commonly found in a business environment. A state-of-the-art 'cyberspace cell' data visualisation technique was investigated and a powerful visualisation system using it was implemented. Although allowing databases to be explored and conclusions drawn, it had several drawbacks, the majority of which were due to the three-dimensional nature of the visualisation. A novel two-dimensional generic visualisation system, known as MADEN, was then developed and implemented, based upon a 2-D matrix of 'density plots'. MADEN allows an entire high-dimensional database to be visualised in one window, while permitting close analysis in 'enlargement' windows. Selections of records can be made and examined, and dependencies between fields can be investigated in detail. MADEN was used as a tool for investigating and assessing many data processing algorithms, firstly data-reducing (clustering) methods, then dimensionality-reducing techniques. These included a new 'directed' form of principal components analysis, several novel applications of artificial neural networks, and discriminant analysis techniques which illustrated how groups within a database can be separated. To illustrate the power of the system, MADEN was used to explore customer databases from two financial institutions, resulting in a number of discoveries which would be of interest to a marketing manager. Finally, the database of results from the 1992 UK Research Assessment Exercise was analysed. Using MADEN allowed both universities and disciplines to be graphically compared, and supplied some startling revelations, including empirical evidence of the 'Oxbridge factor'.

New lecturers' beliefs about learning, teaching and assessment in higher education:the role of the PGCLTHE programme

This study was carried out with new lecturers on a two year Post Graduate Certificate in Learning and Teaching in Higher Education programme in a UK university. The aim was to establish their beliefs about how studying on the programme aligned with their teaching and learning philosophy and what, if anything, had changed or constrained those beliefs. Ten lecturers took part in an in-depth semi-structured interview. Content analysis of the transcripts suggested positive reactions to the programme but lecturers’ new insights were sometimes constrained by departments and university bureaucracy, particularly in the area of assessment. The conflicting roles of research and teaching were also a major issue facing these new professionals.

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.

Collaborative Learning and Assessment in e-Learning

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2016

The development and analysis of a field project model curriculum and its impact on achievement and attitude toward science and the environment with at-risk eleventh and twelfth grade students

This study was an evaluation of a Field Project Model Curriculum and its impact on achievement, attitude toward science, attitude toward the environment, self-concept, and academic self-concept with at-risk eleventh and twelfth grade students. One hundred eight students were pretested and posttested on the Piers-Harris Children's Self-Concept Scale, PHCSC (1985); the Self-Concept as a Learner Scale, SCAL (1978); the Marine Science Test, MST (1987); the Science Attitude Inventory, SAI (1970); and the Environmental Attitude Scale, EAS (1972). Using a stratified random design, three groups of students were randomly assigned according to sex and stanine level, to three treatment groups. Group one received the field project method, group two received the field study method, and group three received the field trip method. All three groups followed the marine biology course content as specified by Florida Student Performance Objectives and Frameworks. The intervention occurred for ten months with each group participating in outside-of-classroom activities on a trimonthly basis. Analysis of covariance procedures were used to determine treatment effects. F-ratios, p-levels and t-tests at p $<$.0062 (.05/8) indicated that a significant difference existed among the three treatment groups. Findings indicated that groups one and two were significantly different from group three with group one displaying significantly higher results than group two. There were no significant differences between males and females in performance on the five dependent variables. The tenets underlying environmental education are congruent with the recommendations toward the reform of science education. These include a value analysis approach, inquiry methods, and critical thinking strategies that are applied to environmental issues. ^

Effect of the Florida A+ Plan on curriculum and instruction in Title I public elementary schools

The purpose of this research was to study the effect of the Florida A+ Plan accountability program on curriculum and instruction in four Title I public elementary schools in the Miami-Dade County Public Schools system. It focused on the experiences of the school principals and the classroom teachers of the four schools as they related to curriculum and instruction. The study included an analysis of the school improvement plans in curriculum and instruction for each school during the school years 1998-2004. ^ The study was conducted in the format of interviews with the school principals and principal selected classroom teachers who taught third, fourth, or fifth grade during the first six years of the Florida A+ Plan. The analysis of the school improvement plans focused on the implementation of curriculum and instruction for each of the four schools. It focused on the goals and measurable objectives selected by each school to improve its instructional program in the academic subjects of reading, mathematics, writing, and science. ^ The findings indicated that under the pressure to improve their school grade on the Florida A+ Plan, each of the target schools, based on individual needs assessments, and restructured their instructional program each school year as documented in their school improvement plans. They altered their programs by analyzing student performance data to realign curriculum and instruction. The analysis of the interviews with the principals and the teachers showed that each school year they restructured their program to align it with the FCAT content. This realigning was a collaborative effort on the part of the administration and the instructional staff. ^