Microwave decontamination of eyelid warming devices for the treatment of meibomian gland dysfunction

PURPOSE: The role of bacteria in meibomian gland dysfunction is unclear, yet contamination of compresses used as treatment may exacerbate this condition. This study therefore determined the effect of heating on bacteria on two forms of compress. METHODS: Cotton flannels and MGDRx EyeBags (eyebags) were inoculated by adding experimental inoculum (Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa; one species for each set of 3 eyebags and flannels). One of each were then randomised in to 3 groups: no heating (control); therapeutic (47.4±0.7°C); or sanitisation (68±1.1°C). After treatment, bacteria cell numbers were calculated. The experiment was repeated in triplicate. RESULTS: There was a statistically significant difference between each treatment with the eyebag for S. aureus (control=7.15±0.11logC/ml, therapeutic heating=5.24±0.59logC/ml, sanitisation heating=3.48±1.43logC/ml; P<0.001) and S. pyogenes (7.36±0.13, 5.73±0.26, 4.75±0.54; P<0.001). P. aeruginosa also showed a significant reduction (P<0.001) from control (6.39±0.34) to therapeutic (0.33±0.26) and sanitisation (0.33±0.21), but the latter were similar (P=1.000). For the flannels, there was significant difference between each treatment for S. aureus (6.89±0.46, 3.96±1.76, 0.42±0.90; P<0.001). For S. pyogenes, there was a significant reduction (P<0.001) from control (7.51±0.10) to therapeutic (5.91±0.62) and sanitisation (5.18±0.8), but the latter were similar (P=0.07). For P. aeruginosa, there was a significant difference (P<0.001) from control (7.15±0.36) to sanitisation (5.83±0.44); but not to therapeutic (6.84±0.31) temperatures (P=0.07). CONCLUSIONS: Therapeutic heating produces a significant reduction in bacteria on the eyebags, but only sanitisation heating appears effective for flannels. However, patients should be advised to heat the eyebag to sanitisation temperatures on initial use.

Drug-induced bilateral transient myopia with the sulphonamide sulphasalazine

Whereas there are numerous reported ocular side effects from systemic sulpha medication, most are rare and reversible, with myopia being the most common reaction observed. A case report is presented of sudden bilateral onset of -1.0 DS of myopia (from -3.0 to -4.0 DS) in a young adult female following the addition of a sulphonamide (sulphasalazine) to oral non-steroidal anti-inflammatory treatment (meloxicam) for rheumatoid arthritis. The myopia regressed to -3.50 DS after 2 weeks when all medication was withdrawn and stabilised at this level when subsequent treatment was resumed after 8 weeks with the non-steroidal anti-inflammatory drug celecoxib. The case indicates that account needs to be taken of the possibility that relatively modest myopic shifts encountered in young adult contact lens wearers may be associated with concomitant systemic medication. © 2003 The College of Optometrists.

Clinical monitoring of ocular physiology using digital image analysis

Aim: To examine the use of image analysis to quantify changes in ocular physiology. Method: A purpose designed computer program was written to objectively quantify bulbar hyperaemia, tarsal redness, corneal staining and tarsal staining. Thresholding, colour extraction and edge detection paradigms were investigated. The repeatability (stability) of each technique to changes in image luminance was assessed. A clinical pictorial grading scale was analysed to examine the repeatability and validity of the chosen image analysis technique. Results: Edge detection using a 3 × 3 kernel was found to be the most stable to changes in image luminance (2.6% over a +60 to -90% luminance range) and correlated well with the CCLRU scale images of bulbar hyperaemia (r = 0.96), corneal staining (r = 0.85) and the staining of palpebral roughness (r = 0.96). Extraction of the red colour plane demonstrated the best correlation-sensitivity combination for palpebral hyperaemia (r = 0.96). Repeatability variability was <0.5%. Conclusions: Digital imaging, in conjunction with computerised image analysis, allows objective, clinically valid and repeatable quantification of ocular features. It offers the possibility of improved diagnosis and monitoring of changes in ocular physiology in clinical practice. © 2003 British Contact Lens Association. Published by Elsevier Science Ltd. All rights reserved.

Editorial

This time of year we look back at the year that has passed and make plans for the next year. I like to reflect on things that I have learnt and people that I have met, especially those who facilitated that learning. In 2009 I went to various conferences, The BCLA conference in Manchester, The Romanian Optical Society meeting in Brasov, Transylvania (where the university is actually on Vlad Tepes Street), The European Council for Optometry and Optics (ECOO) in Brno, Czech Republic, The American Academy of Optometry (AAO) in Orlando USA, The International Association of Contact Lens Educators (IACLE) meeting in Tianjin China and finally The Vereinigung Deutscher Contactlinsen-Spezialisten (VDCO) meeting in Jena. All were interesting places and thoroughly all were enjoyable conferences with their own highlights but I wanted to focus on Jena and one person I met there and his inspirational search for knowledge and the contributions he made in the field of contact lenses. Jena itself is a fascinating place and should be on the ‘must visit’ list of anyone involved in eye care. It is the birth place of Carl Zeiss of course and where he started his company. It is also the birth place of Ernst Abbe (physicist and optometrist and expert lens maker), and Otto Schott (chemist and technologist who made high quality glass. There are many road signs bearing witness to these famous pioneers. The optical museum is worth spending a few hours looking around too. I was invited to speak at the VDCO at the kind invitation from colleagues at the Jena School of Optometry, Professor Wolfgang Sickenberger and Professor Sebastian Marx. At this meeting I met 87-year-old Willi KAUE who was being awarded the Adolf Wilhelm Müller-Welt prize by the VDCO for contribution to contact lenses over his 60-year career. At the age of 15 Willi Kaue took up an apprenticeship to become an Optician in Germany in 1937. At this time he first heard about the scleral glass lenses made by the Carl Zeiss Company in Jena. This started his lifelong fascination which was to become his passion but not yet his career. During the war he was enlisted into military service but immediately after was back to his former career. In 1950 Willi corrected his own 3.5 dioptres of myopia with a plastic scleral lens. His fascination strengthened as for the first time he himself could experience a wider field of view than his spectacles gave him, less aberrations and less retinal minification. He also appreciated the fact that contact lenses did not cause pressure on the nose or ears and did not slide down his nose plus remained optically centred with his eye movements. He decided that form now on he would make fitting contact lenses his career. He travelled to London to learn more about contact lenses and how to fit them but initially did not find many willing teachers and to start with became largely self-taught. He wanted to know how to make scleral lenses. So far he only knew that pulverized polymethyl methacrylate (PMMA) was pressed and moulded. In 1951 he met Berlin optician Otto Marzock. He made his only scleral lenses from using military PMMA windshields. His process involved lathe cutting the lenses and resulted in lenses that were thinner than moulded ones. Willi developed a manufacturing method, using a rotary diamond drill, starting form the outer edge and towards the centre at a constant cut speed. This enabled him to make more reproducible lenses and in less time. His enthusiasm in the field was clear from the travels he made in the pursuit of advancement - travelling around Europe, South America, North America and Asia. In 1963 he visited George Nissel in Hemel Hempstead, England. Constantly thriving towards innovations Willi came across the new Naturalens from the USA made from HEMA at a congress in Marseille in 1969. Amongst his contributions to the field, was his own technique of fitting ocular prosthetics, using an alginate impression of the orbit. I was fortunate enough to have dinner with Willi Kaue and learnt more about his fascinating career through the patient interpreting skills of Hilmar Bussacker (the 2008 winner of the same award and the 2007 winner of the European Federation of the Contact Lens and IOL Industries Award). I look forward to 2010 with eager anticipation as to what I may learn and who I might meet!!! Copyright © 2009 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Changes at the BCLA

As we welcome 2014 we say goodbye to 2013 and I must start with an apology to authors who have submitted papers to CLAE and seen a delay in either the review process or the hard copy publication of their proofed article. The delays were caused by a major hike in the number of submissions to the journal in 2012 that increased further in 2013. In the 12 months leading to the end of October 2011 we had 94 new paper submissions, and for the same period to the end of 2012 the journal had 116 new papers. In 2012 we were awarded an impact factor for the first time and following that the next 12 month period to the end of October 2013 saw a massive increase in submissions with 171 new manuscripts being submitted. This is nearly twice as many papers as 2 years ago and 3 times as many as when I took over as Editor-in-Chief. In addition to this the UK academics will know that 2014 is a REF year (Research Excellence Framework) where universities are judged on their research and one of the major components of this measure remains to be published papers so there is a push to publishing before the REF deadline for counting. The rejection rate at CLAE has gone up too and currently is around 50% (more than double the rejection rate when I took over as Editor-in-Chief). At CLAE the number of pages that we publish each year has remained the same since 2007. When compiling issue 1 for 2014 I chose the papers to be included from the papers that were proofed and ready to go and there were around 200 proofed pages ready, which is enough to fill 3½ issues! At present Elsevier and the BCLA are preparing to increase the number the pages published per issue so that we can clear some of this backlog and remain up to date with the papers published in CLAE. I should add that on line publishing of papers is still available and there may have been review delays but there are no publishing online so authors can still get an epub on line final version of their paper with a DOI (digital object identifier) number enabling the paper to be cited. There are two awards that were made in 2013 that I would like to make special mention of. One was for my good friend Jan Bergmanson, who was awarded an honorary life fellowship of the College of Optometrists. Jan has served on the editorial board of CLAE for many years and in 2013 also celebrated 30 years of his annual ‘Texan Corneal and contact lens meeting’. The other award I wish to mention is Judith Morris, who was the BCLA Gold Medal Award winner in 2013. Judith has had many roles in her career and worked at Moorfields Eye Hospital, the Institute of Optometry and currently at City University. She has been the Europe Middle East and Africa President of IACLE (International Association of Contact Lens Educators) for many years and I think I am correct in saying that Judith is the only person who was President of both the BCLA (1983) and a few years later she was the President College of Optometrists (1989). Judith was also instrumental in introducing Vivien Freeman to the BCLA as they had been friends and Judith suggested that Vivien apply for an administrative job at the BCLA. Fast forward 29 years and in December 2013 Vivien stepped down as Secretary General of the BCLA. I would like to offer my own personal thanks to Vivien for her support of CLAE and of me over the years. The BCLA will not be the same and I wish you well in your future plans. But 2014 brings in a new position to the BCLA – Cheryl Donnelly has been given the new role of Chief Executive Officer. Cheryl was President of the BCLA in 2000 and has previously served on council. I look forward to working with Cheryl and envisage a bright future for the BCLA and CLAE. In this issue we have some great papers including some from authors who have not published with CLAE before. There is a nice paper on contact lens compliance in Nepal which brings home some familiar messages from an emerging market. A paper on how corneal curvature is affected by the use of hydrogel lenses is useful when advising patients how long they should leave their contact lenses out for to avoid seeing changes in refraction or curvature. This is useful information when refracting these patients or pre-laser surgery. There is a useful paper offering tips on fitting bitoric gas permeable lenses post corneal graft and a paper detailing surgery to implant piggyback multifocal intraocular lenses. One fact that I noted from the selection of papers in the current issue is where they were from. In this issue none of the corresponding authors are from the United Kingdom. There are two papers each from the United States, Spain and Iran, and one each from the Netherlands, Ireland, Republic of Korea, Australia and Hong Kong. This is an obvious reflection of the widening interest in CLAE and the BCLA and indicates the new research groups emerging in the field.

A new algorithm for the relationship between vision and ametropia

Refraction simulators used for undergraduate training at Aston University did not realistically reflect variations in the relationship between vision and ametropia. This was because they used an algorithm, taken from the research literature, that strictly only applied to myopes or older hyperopes and did not factor in age and pupil diameter. The aim of this study was to generate new algorithms that overcame these limitations. Clinical data were collected from the healthy right eyes of 873 white subjects aged between 20 and 70 years. Vision and refractive error were recorded along with age and pupil diameter. Re-examination of 34 subjects enabled the calculation of coefficients of repeatability. The study population was slightly biased towards females and included many contact lens wearers. Sex and contact lens wear were, therefore, recorded in order to determine whether these might influence the findings. In addition, iris colour and cylinder axis orientation were recorded as these might also be influential. A novel Blur Sensitivity Ratio (BSR) was derived by dividing vision (expressed as minimum angle of resolution) by refractive error (expressed as a scalar vector, U). Alteration of the scalar vector, to account for additional vision reduction due to oblique cylinder axes, was not found to be useful. Decision tree analysis showed that sex, contact lens wear, iris colour and cylinder axis orientation did not influence the BSR. The following algorithms arose from two stepwise multiple linear regressions: BSR (myopes) = 1.13 + (0.24 x pupil diameter) + (0.14 x U) BSR (hyperopes) = (0.11 x pupil diameter) + (0.03 x age) - 0.22 These algorithms together accounted for 84% of the observed variance. They showed that pupil diameter influenced vision in both forms of ametropia. They also showed the age-related decline in the ability to accommodate in order to overcome reduced vision in hyperopia.

Anterior eye health recording

Aims: To survey eye care practitioners from around the world regarding their current practice for anterior eye health recording to inform guidelines on best practice. Methods: The on-line survey examined the reported use of: word descriptions, sketching, grading scales or photographs; paper or computerised record cards and whether these were guided by proforma headings; grading scale choice, signs graded, level of precision, regional grading; and how much time eye care practitioners spent on average on anterior eye health recording. Results: Eight hundred and nine eye care practitioners from across the world completed the survey. Word description (p <. 0.001), sketches (p = 0.002) and grading scales (p <. 0.001) were used more for recording the anterior eye health of contact lens patients than other patients, but photography was used similarly (p = 0.132). Of the respondents, 84.5% used a grading scale, 13.5% using two, with the original Efron (51.6%) and CCLRU/Brien-Holden-Vision-Institute (48.5%) being the most popular. The median features graded was 11 (range 1-23), frequency from 91.6% (bulbar hyperaemia) to 19.6% (endothelial blebs), with most practitioners grading to the nearest unit (47.4%) and just 14.7% to one decimal place. The average time taken to report anterior eye health was reported to be 6.8. ±. 5.7. min, with the maximum time available 14.0. ±. 11. min. Conclusions: Developed practice and research evidence allows best practice guidelines for anterior eye health recording to be recommended. It is recommended to: record which grading scale is used; always grade to one decimal place, record what you see live rather than based on how you intend to manage a condition; grade bulbar and limbal hyperaemia, limbal neovascularisation, conjunctival papillary redness and roughness (in white light to assess colouration with fluorescein instilled to aid visualisation of papillae/follicles), blepharitis, meibomian gland dysfunction and sketch staining (both corneal and conjunctival) at every visit. Record other anterior eye features only if they are remarkable, but indicate that the key tissue which have been examined.

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.

Do educators need educating?

Actual text: I was recently at the Spanish College of Optometry biennial conference and attended a meeting of contact lens lecturers from around Spain and Portugal. We discussed various ideas, mainly about how to share good practice and improve standards. What came to my mind was ‘is there a blueprint for training trainers?’ Well probably not but there are many things that we need to acknowledge such as the way students learn for example. Many educators themselves were taught by lecturers who would write on a blackboard or use acetate on an overhead projector, then came the 35 mm slide era followed by the Powerpoint era. More recently there is a move towards a much more integrated approach of various teaching methods. At my university our contact lens and anterior eye lectures generally follow a format where a narrated Powerpoint lecture is uploaded onto our internal virtual learning environment. This narrated version of the slides is designed to give the didactic element of the topic. The students listen to that before attending an interactive seminar on that topic. The seminar is also recorded so that students can listen to that afterwards. The seminar is designed to give additional information, such as case reports, or to clarify key points or for live demonstrations. It is a good way of doubling the contact time with the students without imposing further on an already packed formal timetable as the students can work in their own time. One problem that we noticed with this approach was that attendance can vary. If the students feel that they will gain something from the interactive seminar then they are more likely to attend – exam tips usually win them over! At the Spanish meeting the educators decided that they wanted to have regular meetings. The industry colleagues in attendance said that they were happy to help but could not necessarily give money, but they could offer meeting rooms, pay for lunch and evening meals. They even said that that they were happy to host meetings and invite other companies too (except to manufacturing plants). In the UK the British Committee of Contact Lens Educators (BUCCLE) meets for one day on three occasions in the year. The American Optometric Contact Lens Educators (AOCLE) meets annually at a three day event. Both these organisations get some help from industry. BUCCLE usually has one of its meetings at a university, one at a company training centre/manufacturing plant/national headquarters and one meeting the day before the BCLA annual conference. BUCCLE usually has its pre-BCLA meeting in conjunction with the International Association of Contact Lens Educators (IACLE). So when educators meet what would they discuss; well probably the focus should be on education rather than actual contact lens knowledge. For example sharing ideas on how to teach toric lens fitting would be better than discussing the actual topic of toric lenses itself. Most universities will have an education department with an expert who could share ideas on how to use the internet in teaching or how to structure lectures or assessments etc. In the past I have helped with similar training programmes in other countries and sharing good practice in pedagogy is always a popular topic. Anyone who is involved in education in the field of contact lenses should look at the IACLE web page and look out for the IACLE World Congress in 2015 in the days preceding the BCLA. Finally, IACLE, AOCLE and BUCCLE all exist as a result of generous educational grants from contact lens companies and anyone interested in finding out more about should refer to their respective web pages.

Biomaterial interactions with compromised tissue surfaces

This thesis is concerned with the nature of biomaterial interactions with compromised host tissue sites. Both ocular and dermal tissues can be wounded, following injury, disease or surgery, and consequently require the use of a biomaterial. Clear analogies exist between the cornea/tear film/contact lens and the dermal wound bed/wound fluid/skin adhesive wound dressing. The work described in this thesis builds upon established biochemistry to examine specific aspects of the interaction of biomaterials with compromised ocular and dermal tissue sites, with a particular focus on the role of vitronectin. Vitronectin is a prominent cell adhesion glycoprotein present in both tear fluid and wound fluid, and has a role in the regulation and upregulation of plasmin. The interaction of contact lenses with the cornea was assessed by a novel on-lens cell-based vitronectin assay technique. Vitronectin mapping showed that vitronectin-mediated cell adhesion to contact lens surfaces was due to the contact lens-corneal mechanical interaction rather than deposition out of the tear film. This deposition is associated predominantly with the peripheral region of the posterior contact lens surface. The locus of vitronectin deposition on the contact lens surface, which is affected by material modulus, is potentially an important factor in the generation of plasmin in the posterior tear film. Use of the vitronectin mapping technique on ex vivo bandage contact lenses revealed greater vitronectin-mediated cell adhesion to the contact lens surfaces in comparison to lenses worn in the healthy eye. The results suggest that vitronectin is more readily deposited from the impaired corneal tissue bed than the intact healthy tissue bed. Significantly, subjects with a deficient tear film were found to deposit high vitronectin-mediated cell adhesion levels to the BCL surface, thus highlighting the influence of the contact lens-tissue interaction upon deposition. Biomimetic principles imply that adhesive materials for wound applications, including hydrogels and hydrocolloids, should closely match the surface energy parameters of skin. The surface properties of hydrocolloid adhesives were found to be easily modified by contact with siliconised plastic release liners. In contrast, paper release liners did not significantly affect the adhesive surface properties. In order to characterise such materials in the actual wound environment, which is an extremely challenging task, preliminary considerations for the design of an artificial wound fluid model from an animal serum base were addressed.

International session at the BCLA conference

Full text: It seems a long time ago now since we were at the BCLA conference. The excellent FIFA World Cup in Brazil kept us occupied over the summer as well as Formula 1, Wimbledon, Tour de France, Commonwealth Games and of course exam paper marking! The BCLA conference this year was held in Birmingham at the International Convention Centre which again proved to be a great venue. The number of attendees overall was up on previous years, and at a record high of 1500 people. Amongst the highlights at this year's annual conference was the live surgery link where Professor Sunil Shah demonstrated the differences in technique between traditional phacoemulsification cataract surgery and femtosecond assisted phacoemulsification cataract surgery. Dr. Raquel Gil Cazorla, a research optometrist at Aston University, assisted in the procedure including calibrating the femtosecond laser. Another highlight for me was the session that I chaired, which was the international session organised by IACLE (International Association of CL Educators). There was a talk by Mirjam van Tilborg about dry eye prevalence in the Netherlands and how it was managed by medical general practitioners (GPs) or optometrists. It was interesting to know that there are only 2 schools of optometry there and currently under 1000 registered optometrists there. It also seems that GPs were more likely to blame CL as the cause for dry eye whereas optometrists who had a fuller range of tests were better at solving the issue. The next part of the session included the presentation of 5 selected posters from around the world. The posters were also displayed in the main poster area but were selected to be presented here as they had international relevance. The posters were: 1. Motivators and Barriers for Contact Lens Recommendation and Wear by Nilesh Thite (India) 2. Contact lens hygiene among Saudi wearers by Dr. Ali Masmaly (Saudi) 3. Trends of contact lens prescribing and patterns of contact lens practice in Jordan by Dr. Mera Haddad (Jordan) 4. Contact Lens Behaviour in Greece by Dr. Dimitra Makrynioti (Greece) 5. How practitioners inform ametropes about the benefits of contact lenses and overcome the potential barriers: an Italian survey, by Dr. Fabrizio Zeri (Italy) It was interesting to learn about CL practice in different parts, for example the CL wearing population ration in Saudi Arabia is around 1:2 Male:Female (similar to other parts of the world) and although the sale of CL is restricted to registered practitioners there are many unregistered outlets, like clothing stores, that flout the rules. In Jordan some older practitioners will still advise patients to use tap water or even saliva! But thankfully the newer generation of practitioners have been educated not to advise this. In Greece one of the concerns was that some practitioners may advise patients to use disposable lenses for longer than they should and again it seems to be the practitioners with inadequate education that would do this. In India it was found that cost was one barrier to using contact lenses but also some practitioners felt that they shouldn’t offer CLs due to cost too. In Italy sensitive eyes and CL care and maintenance were the barriers to CL wear but the motivators were vision and comfort and aesthetics. Finally the international session ended with the IACLE travel award and educator awards presented by IACLE president Shehzad Naroo and BCLA President Andrew Yorke. The travel award went to Wang Ling, Jinling Institute of Technology, Nanjing, China. There were 3 regional Contact Lens Educator of the Year Awards sponsored by Coopervision and presented by Dr. J.C. Aragorn of Coopervision. 1. Asia Pacific Region – Dr. Rajeswari Mahadevan of Sankara Nethralaya Medical Research Foundation, Chennai, India 2. Americas Region – Dr. Sergio Garcia of University of La Salle, Bogotá and the University Santo Tomás, Bucaramanga, Colombia 3. Europe/Africa – Middle East Region: Dr. Eef van der Worp, affiliated with the University of Maastricht, the Netherlands The posters above were just a small selection of those displayed at this year's BCLA conference. If you missed the BCLA conference then you can see the abstracts for all posters and talks in a virtual issue of CLAE very soon. The poster competition was kindly sponsored by Elsevier. The poster winner this year was: Joan Gispets – Corneal and Anterior Chamber Parameters in Keratoconus The 3 runners up were: Debby Yeung – Scleral Lens Central Corneal Clearance Assessment with Biomicroscopy Sarah L. Smith – Subjective Grading of Lid Margin Staining Heiko Pult – Impact of Soft Contact Lenses on Lid Parallel Conjunctival Folds My final two highlights are a little more personal. Firstly, I was awarded Honorary Life Fellowship of the BCLA for my work with the Journal, and I would like to thank the BCLA, Elsevier, the editorial board of CLAE, the reviewers and the authors for their support of my role. My final highlight from the BCLA conference this year was the final presentation of the conference – the BCLA Gold Medal award. The recipient this year was Professor Philip Morgan with his talk ‘Changing the world with contact lenses’. Phil was the person who advised me to go to my first BCLA conference in 1994 (funnily he didn’t attend himself as he was busy getting married!) and now 20 years later he was being honoured with the accolade of being the BCLA Gold Medallist. The date of his BCLA medal addressed was shared with his father's birthday so a double celebration for Phil. Well done to outgoing BCLA President Andy Yorke and his team at the BCLA (including Nick Rumney, Cheryl Donnelly, Sarah Greenwood and Amir Khan) on an excellent conference. And finally welcome to new President Susan Bowers. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

The influence on unaided vision of age, pupil diameter and spherocylindrical refractive error

Background - The aim was to derive equations for the relationship between unaided vision and age, pupil diameter, iris colour and sphero-cylindrical refractive error. Methods - Data were collected from 663 healthy right eyes of white subjects aged 20 to 70 years. Subjective sphero-cylindrical refractive errors ranged from -6.8 to +9.4 D (mean spherical equivalent), -1.5 to +1.9 D (orthogonal component, J0) and -0.8 to 1.0 D (oblique component, J45). Cylinder axis orientation was orthogonal in 46 per cent of the eyes and oblique in 18 per cent. Unaided vision (-0.3 to +1.3 logMAR), pupil diameter (2.3 to 7.5 mm) and iris colour (67 per cent light/blue irides) was recorded. The sample included mostly females (60 per cent) and many contact lens wearers (42 per cent) and so the influences of these parameters were also investigated. Results - Decision tree analysis showed that sex, iris colour, contact lens wear and cylinder axis orientation did not influence the relationship between unaided vision and refractive error. New equations for the dependence of the minimum angle of resolution on age and pupil diameter arose from step backwards multiple linear regressions carried out separately on the myopes (2.91.scalar vector +0.51.pupil diameter -3.14 ) and hyperopes (1.55.scalar vector + 0.06.age – 3.45 ). Conclusion - The new equations may be useful in simulators designed for teaching purposes as they accounted for 81 per cent (for myopes) and 53 per cent (for hyperopes) of the variance in measured data. In comparison, previously published equations accounted for not more than 76 per cent (for myopes) and 24 per cent (for hyperopes) of the variance depending on whether they included pupil size. The new equations are, as far as is known to the authors, the first to include age. The age-related decline in accommodation is reflected in the equation for hyperopes.

CLAE to move to online format

Editorial: The 2015 BCLA annual conference was another fantastic affair. It was the first time the conference was held in the beautiful city of Liverpool. The venue was great and the programme was excellent. The venue overlooked the River Mersey and many of the hotels were local boutique hotels. I stayed in one which was formerly the offices of White Star Liners—where the RMS Titanic was originally registered. The hotel decor was consistent with its historic significance. The BCLA gala dinner was held in the hugely impressive Anglican Cathedral with entertainment from a Beatles tribute band. That will certainly be a hard act to follow at the next conference in 2017. Brian Tompkins took the reigns as the new BCLA president. Professor Fiona Stapleton was the recipient of the BCLA Gold Medal Award. The winner of the poster competition was Dorota Szczesna-Iskander with a poster entitled ‘Dry Contact lens poor wettability and visual performance’. Second place was Renee Reeder with her poster entitled ‘Abnormal Rosacea as a differential diagnosis in corneal scarring’. And third place was Maria Jesus Gonzalez-Garcia with her poster entitled ‘Dry Effect of the Environmental Conditions on Tear Inflammatory Mediators Concentration in Contact Lens Wearers’. The photographic competition winner was Professor Wolfgang Sickenberger from Jena in Germany. The Editorial Panel of CLAE met at the BCLA conference for their first biannual meeting. The journal metrics were discussed. In terms of number of submissions of new papers CLAE seems to have plateaued after seeing a rapid growth in the number of submissions over the last few years. The increase over the last few years could be attributed to the fact that CLAE was awarded an impact factor for the first time in 2012. This year it seems that impact factors across nearly all ophthalmic related journals has dropped. This could in part be due to the fact that last year was a ‘Research Exercise Framework (REF) year for UK universities, where they are judged on quality of their research output. The next REF is in 2020 so we may see changes nearing that time. Looking at article downloads, there seems to be a continued rise in figures. Currently CLAE attracts around 85,000 downloads per year (this is an increase of around 10,000 per year for the last few years) and the 2015 prediction is 120,000! With this in mind and with other contributing factors too, the BCLA has decided to move to online delivery of CLAE to its members starting from issue 5 of 2015. Some members do like to flick through the pages of a hard copy of the journal so members will still have the option of receiving a hard copy through the post but the default journal delivery method will now be online. The BCLA office will send various alerts and content details to members email addresses. To access CLAE online you will need to log in via the BCLA web page, currently you then click on ‘Resources’ and then under ‘Free and Discounted Publications’ you will see CLAE. This actually takes you to CLAE’s own webpage (www.contactlensjournal.com) but you need to log in via the BCLA web page. The BCLA plans to change these weblinks so that from the BCLA web page you can link to the journal website much more easily and you have the choice of going directly into the general website for CLAE or straight to the current issue. In 2016 you will see an even easier way of accessing CLAE online as the BCLA will launch a CLAE application for mobile devices where the journal can be downloaded as a ‘flick-book’. This is a great way of bringing CLAE into the modern era where people access their information in newer ways. For many the BCLA conference was part of a very busy conference week as it was preceded by the International Association of Contact Lens Educators’ (IACLE) Third World Congress, held in Manchester on the 4 days before the BCLA conference. The first and second IACE World Congresses were held in Waterloo, Canada in 1994 and 2000 respectively and hosted by Professor Des Fonn. Professor Fonn was the recipient of the first ever IACLE lifetime achievement award. The Third IACLE World Congress saw more than 100 contact lens educators and industry representatives from around 30 countries gather in the UK for the four-day event, hosted by The University of Manchester. Delegates gained hands-on experience of innovations in teaching, such as learning delivery systems, the use of iPads in the classroom and for creating ePub content, and augmented and virtual reality technologies. IACLE members around the world also took part via a live online broadcast. The Third IACLE World Congress was made possible by the generous support of Sponsors Alcon, CooperVision and Johnson & Johnson Vision Care., for more information look at the IACLE web page (www.iacle.org).

A program to analyse optical coherence tomography images of the ciliary muscle

Purpose: To describe and validate bespoke software designed to extract morphometric data from ciliary muscle Visante Anterior Segment Optical Coherence Tomography (AS-OCT) images. Method: Initially, to ensure the software was capable of appropriately applying tiered refractive index corrections and accurately measuring orthogonal and oblique parameters, 5 sets of custom-made rigid gas-permeable lenses aligned to simulate the sclera and ciliary muscle were imaged by the Visante AS-OCT and were analysed by the software. Human temporal ciliary muscle data from 50 participants extracted via the internal Visante AS-OCT caliper method and the software were compared. The repeatability of the software was also investigated by imaging the temporal ciliary muscle of 10 participants on 2 occasions. Results: The mean difference between the software and the absolute thickness measurements of the rigid gas-permeable lenses were not statistically significantly different from 0 (t = -1.458, p = 0.151). Good correspondence was observed between human ciliary muscle measurements obtained by the software and the internal Visante AS-OCT calipers (maximum thickness t = -0.864, p = 0.392, total length t = 0.860, p = 0.394). The software extracted highly repeatable ciliary muscle measurements (variability ≤6% of mean value). Conclusion: The bespoke software is capable of extracting accurate and repeatable ciliary muscle measurements and is suitable for analysing large data sets.