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

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

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.

Measurement of scleral thickness in humans using anterior segment optical coherent tomography

Anterior segment optical coherent tomography (AS-OCT, Visante; Zeiss) is used to examine meridional variation in anterior scleral thickness (AST) and its association with refractive error, ethnicity and gender. Scleral cross-sections of 74 individuals (28 males; 46 females; aged between 18-40 years (27.7±5.3)) were sampled twice in random order in 8 meridians: [superior (S), inferior (I), nasal (N), temporal (T), superior-temporal (ST), superior-nasal (SN), inferior-temporal (IT) and inferior-nasal (IN)]. AST was measured in 1mm anterior-toposterior increments (designated the A-P distance) from the scleral spur (SS) over a 6mm distance. Axial length and refractive error were measured with a Zeiss IOLMaster biometer and an open-view binocular Shin-Nippon autorefractor. Intra- And inter-observer variability of AST was assessed for each of the 8 meridians. Mixed repeated measures ANOVAs tested meridional and A-P distance differences in AST with refractive error, gender and ethnicity. Only right eye data were analysed. AST (mean±SD) across all meridians and A-P distances was 725±46μm. Meridian SN was the thinnest (662±57μm) and I the thickest (806 ±60μm). Significant differences were found between all meridians (p<0.001), except S:ST, IT:IN, IT:N and IN:N. Significant differences between A-P distances were found except between SS and 6 mm and between 2 and 4mm. AST measurements at 1mm (682±48 μm) were the thinnest and at 6mm (818±49 μm) the thickest (p<0.001); a significant interaction occurred between meridians and A-P distances (p<0.001). AST was significantly greater (p<0.001) in male subjects but no significant differences were found between refractive error or ethnicity. Significant variations in AST occur with regard to meridian and distance from the SS and may have utility in selecting optimum sites for pharmaceutical or surgical intervention.

Displaced Comminuted Patellar Fracture Associated with Post Anterior Cruciate Ligament Reconstruction in a Male Collegiate Basketball Player

We present a unique case of a collegiate athlete who suffered an anterior cruciate ligament (ACL) injury leading to a displaced patellar stress fracture. We identified an unusual potential association between ACL reconstruction and patellar fractures in order to avoid potential complications in the rehabilitation and return to activity process.

Recurrent Tibial Tunnel Cyst Formation Following Anterior Cruciate Ligament Reconstruction and Interference Screw Removal

A unique case of a collegiate athlete who suffered an anterior cruciate ligament injury leading to the formation of a synovial cyst is described. The cyst, localized over the tibial tunnel, resulted from irritation caused by the removal of interference screws.

Efeito do kinesio taping® no desempenho neuromuscular do quadríceps e no equilíbrio em sujeitos submetidos à reconstrução do ligamento cruzado anterior: ensaio clínico e randomizado

Objetivo: Investigar os efeitos imediatos do Kinesio Taping® no desempenho neuromuscular do Quadríceps Femoral (QF) de indivíduos submetidos à reconstrução do Ligamento Cruzado Anterior (LCA). Metodologia: trata-se de um ensaio clínico e randomizado composto por 45 indivíduos do sexo masculino que se encontravam entre 12ª e 17ª semanas após reconstrução do LCA. Todos foram submetidos a uma avaliação inicial composta pela análise do equilíbrio postural, através da baropodometria; determinação do Senso de Posição Articular (SPA), seguidas das avaliações isocinéticas excêntricas e concêntricas a 600/s, concomitante com a captação do sinal eletromiográfico do músculo Vasto Lateral (VL). Posteriormente foram alocados de forma aleatória em Grupo Controle (GC), Grupo Placebo (GP) e Grupo Experimental (GE). Os indivíduos do GE foram submetidos ao protocolo sugerido (aplicação do Kinesio Taping® no QF do membro acometido), enquanto os do GP utilizaram a aplicação do Kinesio Taping® sem as recomendações propostas pelo método. Já os indivíduos do GC permaneceram em repouso por dez minutos, sendo todos os indivíduos submetidos a uma reavaliação de forma idêntica à primeira. Foram analisadas as seguintes variáveis: pico de torque médio, pico de torque/peso corporal, potência muscular e erro absoluto do SPA para a dinamometria; amplitude ântero-posterior e médio-lateral para a baropodometria; e a amplitude de ativação muscular (Root Means Square - RMS) por meio da eletromiografia de superfície. Resultados: Nenhuma das variáveis analisadas apresentou diferenças intergrupo ou intragrupo. Conclusão: O Kinesio Taping® não altera o desempenho neuromuscular do quadríceps femoral de indivíduos submetidos à reconstrução do LCA para nenhuma das variáveis analisadas.

Avaliação dos efeitos da retirada do etanol em curto e longo prazo sobre respostas comportamentais relacionadas à ansiedade e sobre células imunorreativas para a serotonina no núcleo dorsal da Rafe em ratas

Ethanol withdrawn individuals present a wealth of signs and symptoms, some of them related with anxiety. To better understand brain areas involved in anxiety caused by ethanol abstinence, preclinical studies have been employing models of ethanol consumption followed by withdrawal in rodents submitted to behavioral tests of anxiety, such as the elevated plus-maze. The aim of this study was to investigate if short- or long-term ethanol withdrawal could alter both anxiety-related behaviors in the elevated plus-maze (EPM) and open field tests and the number of serotonin immunorreactive cels in the dorsal raphe nucleus, a midbrain area associated with anxiety. Female Wistar rats (90 days old) were submitted to increasing concentrations of ethanol (2% for 3 days, 4% for 3 days and 6% for 15 days) as the only source of liquid diet and the control group received water ad libitum. Both groups received food ad libitum. In the behavioral experiments, on 21st day of consumption, ethanol was substituted by water (withdrawal) and 72 h or 21 days after withdrawal animals were submitted to the EPM, where it was evaluated the percentage of time and entries in the open arms and the entries in the enclosed arms during 5 minutes. Twenty and four hours after testing in the EPM, animals were submitted to the open field test for 15 minutes, where the distance traveled by the animals was observed along this period. During the first 5 minutes, the distance traveled, entries and time spent in the center of the test were analyzed. In the immunohistochemistry study, animals were submitted to 21 days of consumption of ethanol followed or not by 72 hours and 21 days of withdrawal previously perfusion, brain tissue preparation and quantification of serotonin dyed cells in the dorsal and caudal portions in the dorsal raphe nucleus. Behavioral data showed that both short- and long-term ethanol withdrawals reduced the open arms exploration in the EPM. In the open field test there were no locomotor activity changes during the total 15 minutes; however, longterm ethanol withdrawal reduced the exploration in the center of the open field during the first 5 minutes. In the immunohistochemistry step, there were no differences, when short- and long-term withdrawn groups were compared with control group; nevertheless, the chronic consumption of ethanol decreased the number of serotonergic immunorreactive cells in the dorsal part of dorsal raphe nucleus. Taken together, results here obtained suggest that both short- and long-term ethanol withdrawals promoted an anxiogenic-like effect that was not related with changes in the serotonin immunorreactivity in the dorsal and caudal parts of the dorsal raphe nucleus.

Influência dos odores de gato e de cobra no comportamento defensivo e expressão de fos do sistema hipotalâmico de defesa de camundongo

Studies using neuronal tract-tracer in rat have shown that the anterior hypothalamic nucleus, dorsomedial division of the ventromedial nucleus of the hypothalamus and dorsal premammillary nucleus are highly connected. When the rat is exposed to predator or its odor these nuclei have shown a expression of Fos and their lesion reduces defensive behavior against predator. This set of nuclei was named the Hypothalamic Defense System. However, little is known about the response of this system to the odor of different predators or its role in mice. In this work, we exposed Swiss mice to two different predators odor (cat and snake) to verify the Fos expression in the Hypothalamic Defense System, as well as the defensive behaviors displayed. The analysis showed that the mice exposure to cat odor had an increased expression of Fos protein compared to control, while those exposed to snake odor showed no rise in Fos expression, which was corroborated by the behavioral data. Our results indicate that this distinct circuit in mice seems to act differentially to odorous stimuli of different predators, causing distinct behavioral responses of mice and that the odor of snake seems not to be perceived by Swiss mice as a threatening stimulus.

Mapeamento das projeções retinianas para o sistema óptico acessório, colículo superior e complexo pré-tectal do sagui (callithrix jacchus)

The accessory optical system, the pretectal complex, and superior colliculus are important control centers in a variety of eye movement, being extremely necessary for image formation, consequently to visual perception. The accessory optical system is constituted by the nuclei: dorsal terminal nucleus, lateral terminal nucleus, medial terminal nucleus and interstitial nucleus of the posterior superior fasciculus. From a functional point of view they contribute to the image stabilization, participating in the visuomotor activity where all system cells respond to slow eye movements and visual stimuli, which is important for the proper functioning of other visual systems. The pretectal complex comprises a group of nuclei situated in mesodiencephalic transition, they are: anterior pretectal nucleus, posterior pretectal nucleus, medial pretectal nucleus, olivary pretectal nucleus and the nucleus of the optic tract, all retinal projection recipients and functionally are related to the route of the pupillary light reflex and the optokinetic nystagmus. The superior colliculus is an important subcortical visual station formed by layers and has an important functional role in the control of eye movements and head in response to multisensory stimuli. Our aim was to make a mapping of retinal projections that focus on accessory optical system, the nuclei of pretectal complex and the superior colliculus, searching mainly for pretectal complex, better delineation of these structures through the anterograde tracing with the B subunit of cholera toxin (CTb) followed by immunohistochemistry and characterized (measured diameter) synaptic buttons present on the fibers / terminals of the nucleus complex pré-tectal. In our results accessory optical system, including a region which appears to be medial terminal nucleus and superior colliculus, were strongly marked by fibers / terminals immunoreactive CTb as well as pretectal complex in the nucleus: optic tract, olivary pretectal nucleus, anterior pretectal nucleus and posterior pretectal nucleus. According to the characterization of the buttons it was possible to make a better definition of these nucleus.

Dual path: a concept to improve the esthetic replacemente of missing anterior teeth with removable partial denture

The dual path of insertion concept for removable partial denture (RPD) design may be used in esthetically demanding situations. When compared to conventional RPDs, the main advantage of this design is the minimal use of clasps. This clinical report describes the treatment of a patient with an anterior maxillary edentulous area using a dual path RPD. The diagnostic cast was surveyed to ensure the adequacy of the undercuts on the mesial surfaces of the anterior abutments, where rigid minor connectors were placed. Inverted V-shaped canine cingulum rest seats were prepared to provide resistance to tooth movement during function. The dual path RPD concept allows excellent esthetic results, minimizes tooth preparation, and reduces the tendency toward plaque accumulation in a Kennedy class IV partially edentulous arch.

Influência da interação dipolar nas fases magnéticas de nanopartículas esféricas com estrutura núcleo@camada

Bi-magnetic core@shell nanoparticle has attracted attention several researchers because great applicability that they offer. The possibility of combining different functionalities of magnetic materials make them a key piece in many areas as in data processing permanent magnets and biomagnetics sistems. These nanoparticles are controlled by intrinsic properties of the core and shell materials as well as the interactions between them, besides size and geometry effects. Thus, it was developed in this thesis a theoretical study about dipolar interaction contribution between materials different magnetic properties in bi-magnetic core@shell nanoparticles conventional spherical geometry. The materials were analyzed CoFe2O4, MnFe2O4 e CoFe2 in various combinations and sizes. The results show that the impact of the core dipole field in the shell cause reverse magnetization early its, before of the core, in nanoparticle of CoFe2O4(22nm)@CoFe2(2nm), thereby causing a decrease coercivity field of 65% in comparection with simple nanoparticle of CoFe2O4 (HC=13.6 KOe) of same diameter. The large core anisotropy in conventional nanoparticle makes it the a stable dipolar field source in the shell, that varies length scale of the order of the core radius. Furthermore, the impact of dipolar field is greatly enhanced by the geometrical constraints and by magnetics properties of both core@shell materials. In systems with core coated with a thin shell of thickness less than the exchange length, the interaction interface can hold reversal the shell occurring an uniform magnetization reversal, however this effect only is relevant on systems where the dipole field effects is weak compared with the exchange interaction.

Influência da interação dipolar nas fases magnéticas de nanopartículas esféricas com estrutura núcleo@camada

Bi-magnetic core@shell nanoparticle has attracted attention several researchers because great applicability that they offer. The possibility of combining different functionalities of magnetic materials make them a key piece in many areas as in data processing permanent magnets and biomagnetics sistems. These nanoparticles are controlled by intrinsic properties of the core and shell materials as well as the interactions between them, besides size and geometry effects. Thus, it was developed in this thesis a theoretical study about dipolar interaction contribution between materials different magnetic properties in bi-magnetic core@shell nanoparticles conventional spherical geometry. The materials were analyzed CoFe2O4, MnFe2O4 e CoFe2 in various combinations and sizes. The results show that the impact of the core dipole field in the shell cause reverse magnetization early its, before of the core, in nanoparticle of CoFe2O4(22nm)@CoFe2(2nm), thereby causing a decrease coercivity field of 65% in comparection with simple nanoparticle of CoFe2O4 (HC=13.6 KOe) of same diameter. The large core anisotropy in conventional nanoparticle makes it the a stable dipolar field source in the shell, that varies length scale of the order of the core radius. Furthermore, the impact of dipolar field is greatly enhanced by the geometrical constraints and by magnetics properties of both core@shell materials. In systems with core coated with a thin shell of thickness less than the exchange length, the interaction interface can hold reversal the shell occurring an uniform magnetization reversal, however this effect only is relevant on systems where the dipole field effects is weak compared with the exchange interaction.

The role of supraspinal excitability in the development of healthy-limb deficits following anterior cruciate ligament injury

In the current study, we examined how supraspinal and spinal excitability were altered bilaterally after unilateral anterior cruciate ligament reconstruction (ACLr). 7 participants with ACLr and 7 healthy controls underwent transcranial magnetic stimulation (TMS) and electrical stimulation. To evaluate supraspinal excitability, resting motor thresholds (RMT) and motor evoked potential (MEP) stimulus response curves (SRC) were used. To measure spinal excitability, H-reflex SRC gain was assessed. Mixed factorial ANOVAs were used to compare measures between limbs and between groups. Cohen’s d was used to assess effect sizes between groups. Data indicated no significant differences between subject groups or between limbs. However, large effect sizes were found between limbs for H-reflex gain and RMTs suggesting that ACLr can have an effect on some of the variables examined. This study identified decreases in strength in the injured limbs and that subjects with an ACL injury exhibited decreases in spinal and supraspinal excitability of the quadriceps compared to Healthy controls.

Cambios en el polo anterior tras la ortoqueratología nocturna

La Ortoqueratología nocturna (OKN) es una técnica que utiliza lentes de contacto especialmente diseñadas y adaptadas al ojo con el fin de modificar el contorno corneal induciendo un aplanamiento en la región central de la córnea, cambiando así el estado refractivo del mismo. El efecto buscado es similar al de la cirugía refractiva salvo que con este sistema, el efecto inducido es reversible. La aparición de lentes capaces de inducir de forma efectiva los cambios deseados en la córnea, en tan sólo siete días de manera rápida, eficaz y reversible, ha propiciado que esta técnica haya comenzado a utilizarse con resultados muy satisfactorios permitiendo que el paciente pueda estar libre de gafas o lentes de contacto durante el día. Esta terapia ha despertado un gran interés en la comunidad científica, convirtiéndose en una alternativa real a la Cirugía Refractiva. Además, se ha reportado en diversos estudios que el uso de lentes de OKN en niños, reduce el crecimiento axial entre un 30% y un 50%, en comparación con los niños que usan gafas o lentes de contacto 1-6 . El auge de la OKN y la creciente utilización de esta técnica en niños para el control de la miopía implica la necesidad de una mayor comprensión del mecanismo por el cual las LC de geometría inversa inducen la corrección del error refractivo en el ojo...

GESTÃO DA CULTURA NA UNIVERSIDADE: O NÚCLEO DE ARTE E CULTURA DA UNIVERSIDADE METODISTA DE SÃO PAULO

Essa dissertação resulta de um processo de reflexão autobiográfica, com base no resgate de memórias e vivências do percurso de vida-trabalho da pesquisadora, a partir da experiência na gestão do Núcleo de Arte e Cultura (NAC) da Universidade Metodista de São Paulo (UMESP), desde a sua criação, em 2005. Compreender o processo de criação, constituição e inserção do NAC na UMESP, como também o exercício da gestão cultural nesse espaço universitário, foram objetivos dessa pesquisa, que destaca o diálogo entre Educação e Cultura, mediado pela Arte, a partir da inserção de ações artístico-culturais focadas no respeito às diferenças e na valorização da diversidade humana e cultural. Qual o papel da ação cultural dentro de uma universidade? Como essas ações podem somar com o processo de formação educacional? Que desafios envolveram a construção e constituição do Núcleo de Arte e Cultura da UMESP? Essas são questões geradoras do desenvolvimento desse trabalho, no qual é utilizada a abordagem (auto)biográfica como metodologia de pesquisa. Na narrativa propiciada por essa abordagem, a pesquisadora procurou revisitar e ressignificar, numa perspectiva de produção de conhecimento, memórias e histórias que contribuíram para a construção da sua própria identidade e que alavancaram sua inserção na gestão da Cultura na UMESP, legitimando e firmando a atuação do Núcleo de Arte e Cultura, ao longo dos seus 10 anos de existência. Ao refletir sobre essa práxis, evidenciou-se que trabalhar com as subjetividades é o grande desafio da gestão da Cultura, como também a construção de processos colaborativos, na perspectiva do “fazer com” e não do “fazer para” é o caminho para o fortalecimento e enraizamento das ações.