Anterior segment anomalies and effects on visual quality

The tear film, cornea and lens dictate the refractive power of the eye and the retinal image quality is principally defined by diffraction, whole eye wavefront error, scatter, and chromatic aberration. Diffraction and wave aberration are fundamentally pupil diameter dependent; however scatter can be induced by refractive surgery and in the normal ageing eye becomes an increasingly important factor defining retinal image quality. The component of visual quality most affected by the tear film, refractive surgery and multifocal contact and intraocular lenses is the wave aberration of the eye. This body of work demonstrates the effects of each of these anomalies on the visual quality of the eye. When assessing normal or borderline self-diagnosed dry eye subjects using aberrometry, combining lubricating eye drops and spray does not offer any benefit over individual products. However, subjects perceive a difference in comfort for all interventions after one hour. Total higher order aberrations increase after laser assisted sub-epithelial keratectomy performed using a solid-state laser on myopes, but this causes no significant decrease in contrast sensitivity or increase in glare disability. Mean sensitivity and reliability indices for perimetry were comparable to pre-surgery results. Multifocal contact lenses and intraocular lenses are designed to maximise vision when the patient is binocular, so any evaluation of the eyes individually is confounded by reduced individual visual acuity and visual quality. Different designs of aspheric multifocal contact lenses do not provide the same level of visual quality. Multifocal contact lenses adversely affect mean deviation values for perimetry and this should be considered when screening individuals with multifocal contact or intraocular lenses. Photographic image quality obtained through a multifocal contact or intraocular lens appears to be unchanged. Future work should evaluate the effect of these anomalies in combination; with the aim of providing the best visual quality possible and supplying normative data for screening purposes.

A randomised controlled trial investigating the effect of nutritional supplementation on visual function in normal, and age-related macular disease affected eyes:design and methodology [ISRCTN78467674]

Background: Age-related macular disease is the leading cause of blind registration in the developed world. One aetiological hypothesis involves oxidation, and the intrinsic vulnerability of the retina to damage via this process. This has prompted interest in the role of antioxidants, particularly the carotenoids lutein and zeaxanthin, in the prevention and treatment of this eye disease. Methods: The aim of this randomised controlled trial is to determine the effect of a nutritional supplement containing lutein, vitamins A, C and E, zinc, and copper on measures of visual function in people with and without age-related macular disease. Outcome measures are distance and near visual acuity, contrast sensitivity, colour vision, macular visual field, glare recovery, and fundus photography. Randomisation is achieved via a random number generator, and masking achieved by third party coding of the active and placebo containers. Data collection will take place at nine and 18 months, and statistical analysis will employ Student's t test. Discussion: A paucity of treatment modalities for age-related macular disease has prompted research into the development of prevention strategies. A positive effect on normals may be indicative of a role of nutritional supplementation in preventing or delaying onset of the condition. An observed benefit in the age-related macular disease group may indicate a potential role of supplementation in prevention of progression, or even a degree reversal of the visual effects caused by this condition.

Visual performance of a new bi-aspheric, segmented, asymmetric multifocal IOL

PURPOSE: To assess the visual performance and subjective experience of eyes implanted with a new bi-aspheric, segmented, multifocal intraocular lens: the Mplus X (Topcon Europe Medical, Capelle aan den IJssel, Netherlands). METHODS: Seventeen patients (mean age: 64.0 ± 12.8 years) had binocular implantation (34 eyes) with the Mplus X. Three months after the implantation, assessment was made of: manifest refraction; uncorrected and corrected distance visual acuity; uncorrected and distance corrected near visual acuity; defocus curves in photopic conditions; contrast sensitivity; halometry as an objective measure of glare; and patient satisfaction with unaided near vision using the Near Acuity Visual Questionnaire. RESULTS: Mean residual manifest refraction was -0.13 ± 0.51 diopters (D). Twenty-five eyes (74%) were within a mean spherical equivalent of ±0.50 D. Mean uncorrected distance visual acuity was +0.10 ± 0.12 logMAR monocularly and 0.02 ± 0.09 logMAR binocularly. Thirty-two eyes (94%) could read 0.3 or better without any reading correction and all patients could read 0.3 or better with a reading correction. Mean monocular uncorrected near visual acuity was 0.18 ± 0.16 logMAR, improving to 0.15 ± 0.15 logMAR with distance correction. Mean binocular uncorrected near visual acuity was 0.11 ± 0.11 logMAR, improving to 0.09 ± 0.12 logMAR with distance correction. Mean binocular contrast sensitivity was 1.75 ± 0.14 log units at 3 cycles per degree, 1.88 ± 0.20 log units at 6 cycles per degree, 1.66 ± 0.19 log units at 12 cycles per degree, and 1.11 ± 0.20 log units at 18 cycles per degree. Mean binocular and monocular halometry showed a glare profile of less than 1° of debilitating light scatter. Mean Near Acuity Visual Questionnaire Rasch score (0 = no difficulty, 100 = extreme difficulty) for satisfaction for near vision was 20.43 ± 14.64 log-odd units. CONCLUSIONS: The Mplus X provides a good visual outcome at distance and near with minimal dysphotopsia. Patients were very satisfied with their uncorrected near vision. © SLACK Incorporated.

Benefit of coloured lenses for age-related macular degeneration

Purpose: To evaluate and compare the functional and perceived benefits of wearing coloured lenses by patients with age-related macular degeneration (ARMD). Method: Ten subjects with early ARMD and five elderly controls wore a selection of NoIR wrap-around coloured lenses (yellow 29.7% light transmission, orange 22.9%, red 16.8% and grey 10.3%), each for a duration of 7 days. Contrast sensitivity, colour vision, visual acuity, the effect of glare and peripheral sensitivity were measured for each lens and compared with a control (no lens) condition. Subjective ratings of visual performance were also scored. Results: Compared with the no filter condition, red and grey lenses reduced contrast sensitivity whereas yellow and orange lenses increased contrast sensitivity. These objective changes were supported by subjective ratings in subjects with ARMD. Grey lenses reduced the loss of contrast sensitivity usually suffered in the presence of glare, whereas visual acuity and peripheral sensitivity decreased with red lenses. Colour vision became distorted with red lenses in control subjects, but was relatively unaffected by the use of coloured lenses in subjects with ARMD. Conclusions: The subjective benefit of coloured lenses appears to be due to a minor enhancement of contrast sensitivity. © 2002 The College of Optometrists.

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.

Determining which factors influence the optimum multifocal contact lens correction for presbyopia

Presbyopia is a consequence of ageing and is therefore increasing inprevalence due to an increase in the ageing population. Of the many methods available to manage presbyopia, the use of contact lenses is indeed a tried and tested reversible option for those wishing to be spectacle free. Contact lens options to correct presbyopia include multifocal contact lenses and monovision.Several options have been available for many years with available guides to help choose multifocal contact lenses. However there is no comprehensive way to help the practitioner selecting the best option for an individual. An examination of the simplest way of predicting the most suitable multifocal lens for a patient will only enhance and add to the current evidence available. The purpose of the study was to determine the current use of presbyopic correction modalities in an optometric practice population in the UK and to evaluate and compare the optical performance of four silicone hydrogel soft multifocal contact lenses and to compare multifocal performance with contact lens monovision. The presbyopic practice cohort principal forms of refractive correction were distance spectacles (with near and intermediate vision providedby a variety of other forms of correction), varifocal spectacles and unaided distance with reading spectacles, with few patients wearing contact lenses as their primary correction modality. The results of the multifocal contact lens randomised controlled trial showed that there were only minor differences in corneal physiology between the lens options. Visual acuity differences were observed for distance targets, but only for low contrast letters and under mesopic lighting conditions. At closer distances between 20cm and 67cm, the defocus curves demonstrated that there were significant differences in acuity between lens designs (p < 0.001) and there was an interaction between the lens design and the level of defocus (p < 0.001). None of the lenses showed a clear near addition, perhaps due to their more aspheric rather than zoned design. As expected, stereoacuity was reduced with monovision compared with the multifocal contact lens designs, although there were some differences between the multifocal lens designs (p < 0.05). Reading speed did not differ between lens designs (F = 1.082, p = 0.368), whereas there was a significant difference in critical print size (F = 7.543, p < 0.001). Glare was quantified with a novel halometer and halo size was found to significantly differ between lenses(F = 4.101, p = 0.004). The rating of iPhone image clarity was significantly different between presbyopic corrections (p = 0.002) as was the Near Acuity Visual Questionnaire (NAVQ) rating of near performance (F = 3.730, p = 0.007).The pupil size did not alter with contact lens design (F = 1.614, p = 0.175), but was larger in the dominant eye (F = 5.489, p = 0.025). Pupil decentration relative to the optical axis did not alter with contact lens design (F = 0.777, p =0.542), but was also greater in the dominant eye (F = 9.917, p = 0.003). It was interesting to note that there was no difference in spherical aberrations induced between the contact lens designs (p > 0.05), with eye dominance (p > 0.05) oroptical component (ocular, corneal or internal: p > 0.05). In terms of subjective patient lens preference, 10 patients preferred monovision,12 Biofinity multifocal lens, 7 Purevision 2 for Presbyopia, 4 AirOptix multifocal and 2 Oasys multifocal contact lenses. However, there were no differences in demographic factors relating to lifestyle or personality, or physiological characteristics such as pupil size or ocular aberrations as measured at baseline,which would allow a practitioner to identify which lens modality the patient would prefer. In terms of the performance of patients with their preferred lens, it emerged that Biofinity multifocal lens preferring patients had a better high contrast acuity under photopic conditions, maintained their reading speed at smaller print sizes and subjectively rated iPhone clarity as better with this lens compared with the other lens designs trialled. Patients who preferred monovision had a lower acuity across a range of distances and a larger area of glare than those patients preferring other lens designs that was unexplained by the clinical metrics measured. However, it seemed that a complex interaction of aberrations may drive lens preference. New clinical tests or more diverse lens designs which may allow practitioners to prescribe patients the presbyopic contact lens option that will work best for them first time remains a hope for the future.

Visual and quality outcomes following bilateral implantation of a trifocal intraocular lens

Purpose: To examine visual outcomes following bilateral implantation of the FineVision trifocal intraocular lens (IOL; PhysIOL, Liège, Belgium). Methods: 26 patients undergoing routine cataract surgery were implanted bilaterally with the FineVision Trifocal IOL and followed up post-operatively for 3 months. The FineVision optic features a combination of 2 diffractive structures, resulting in distance, intermediate (+1.75 D add) and near vision (+3.50 D add) zones. Apodization of the optic surface increases far vision dominance with pupil aperture. Data collected at the 3 month visit included uncorrected and corrected distance (CDVA) and near vision; subjective refraction; defocus curve testing (photopic and mesopic); contrast sensitivity (CSV-1000); halometry glare testing and a questionnaire (NAVQ) to gauge near vision function and patient satisfaction. Results: The cohort comprised 15 males and 11 females, aged 52.5–82.4 years (mean 70.6 ± 8.2 years). Mean post-operative UDVA was 0.22 ± 0.14 logMAR, with a mean spherical equivalent refraction of +0.02 ± 0.35 D. Mean CDVA was 0.13 ± 0.10 logMAR monocularly, and 0.09 ± 0.07 logMAR binocularly. Defocus curve testing showed an extensive range of clear vision in both photopic and mesopic conditions. Patients showed high levels of satisfaction with their near vision (mean ± 0.9 ± 0.6, where 0 = completely satisfied, and 4 = completely unsatisfied) and demonstrated good spectacle independence. Conclusion: The FineVision IOL can be considered in patients seeking spectacle dependence following cataract surgery, and provide good patient satisfaction with uncorrected vision.

The impact of eliminating extraneous sound and light on students' achievement: An empirical study

The impact of eliminating extraneous sound and light on students’ achievement was investigated under four conditions: Light and Sound controlled, Sound Only controlled, Light Only controlled and neither Light nor Sound controlled. Group, age and gender were the control variables. Four randomly selected groups of high school freshmen students with different backgrounds were the participants in this study. Academic achievement was the dependent variable measured on a pretest, a posttest and a post-posttest, each separated by an interval of 15 days. ANOVA was used to test the various hypotheses related to the impact of eliminating sound and light on student learning. Independent sample T tests on the effect of gender indicated a significant effect while age was non- significant. Follow up analysis indicated that sound and light are not potential sources of extraneous load when tested individually. However, the combined effect of sound and light seems to be a potential source of extrinsic load. The findings revealed that the performance of the Sound and Light controlled group was greater during the posttest and post-posttest. The overall performance of boys was greater than that of girls. Results indicated a significant interaction effect between group and gender on treatment subjects. However gender alone was non-significant. Performance of group by age had no significant interaction and age alone was non-significant in the posttest and post-posttest. Based on the results obtained sound and light combined seemed to be the potential sources of extraneous load in this type of learning environment. This finding supports previous research on the effect of sound and light on learning. The findings of this study show that extraneous sound and light have an impact on learning. These findings can be used to design better learning environments. Such environments can be achieved with different electric lighting and sound systems that provide optimal color rendering, low glare, low flicker, low noise and reverberation. These environments will help people avoid unwanted distraction, drowsiness, and photosensitive behavior.

Simulação de desempenho luminoso para salas de aula em Natal-RN

The city of Natal has a significant daylight availability, although it use isn’t systematically explored in schools architecture. In this context, this research aims to determine procedures for the analysis of the daylight performance in school design in Natal-RN. The method of analysis is divided in Visible Sky Factor (VSF), simulating and analyzing the results. The annual variation of the daylight behavior requires the adoption of dynamic simulation as data procedure. The classrooms were modelled in SketchUp, simulated in Daysim program and the results were assessed by means of spreadsheets in Microsoft Excel. The classrooms dimensions are 7.20mx 7.20m, with windows-to-wall-ratio (WWR) of 20%, 40% and 50%, and with different shading devices, such as standard horizontal overhang, sloped overhang, standard horizontal overhang with side view protection, standard horizontal overhang with a dropped edge, standard horizontal overhang with three horizontal louvers, double standard horizontal overhang, double standard horizontal overhang with three horizontal louvers, plus the use of shelf light in half the models with WWR of 40% and 50%. The data was organized in spreadsheets, with two intervals of UDI: between 300lux and 2000 lux and between 300lux and 3000lux. The simulation was performed with the weather file of 2009 to the city of NatalRN. The graphical outputs are illuminance curves, isolines of UDI among 300lux and 2000 lux and tables with index of occurrences of glare and to an UDI among 300lux 3000lux. The best UDI300-2000lux performance was evidenced to: Phase 1 (models with WWR of 20%), Phase 2 (models with WWR of 40% and 50% with light shelf). The best UDI300-3000lux performance was evidenced to: Phase 1 (models with WWR of 20% and 40% with light shelf) and Phase 2 (models with WWR of 40% and 50% with light shelf). The outputs prove that the daylight quality mainly depends on the shading system efficacy to avoid the glare occurrence, which determines the daylight discomfort. The bioclimatic recommendations of big openings with partial shading (with an opening with direct sunlight) resulted in illuminances level higher than the acceptable upper threshold. The improvement of the shading system percentage (from 73% to 91%) in medium-size of openings (WWR 40% and 50%) reduced or eliminate the glare occurrence without compromising the daylight zone depth (7.20m). The passive zone was determined for classrooms with satisfactory daylight performance, it was calculated the daylight zone depth rule-of-thumb with the ratio between daylight zone depth and the height of the window for different size of openings. The ratio ranged from 1.54 to 2.57 for WWR of 20%, 40% and 50% respectively. There was a reduction or elimination of glare in the passive area with light shelf, or with awning window shading.

Estratégias para obtenção de adequada iluminação natural em escolas: uma análise de sistemas de aberturas para Natal/RN

The purpose of this research is to analyze different daylighting systems in schools in the city of Natal/RN. Although with the abundantly daylight available locally, there are a scarce and diffuse architectural recommendations relating sky conditions, dimensions of daylight systems, shading, fraction of sky visibility, required illuminance, glare, period of occupation and depth of the lit area. This research explores different selected apertures systems to explore the potential of natural light for each system. The method has divided into three phases: The first phase is the modeling which involves the construction of three-dimensional model of a classroom in Sketchup software 2014, which is featured in follow recommendations presented in the literature to obtain a good quality of environmental comfort in school settings. The second phase is the dynamic performance computer simulation of the light through the Daysim software. The input data are the climate file of 2009 the city of Natal / RN, the classroom volumetry in 3ds format with the assignment of optical properties of each surface, the sensor mapping file and the user load file . The results produced in the simulation are organized in a spreadsheet prepared by Carvalho (2014) to determine the occurrence of useful daylight illuminance (UDI) in the range of 300 to 3000lux and build graphics illuminance curves and contours of UDI to identify the uniformity of distribution light, the need of the minimum level of illuminance and the occurrence of glare.

Distribution, density and abundance of Antarctic ice seals off Queen Maud Land and the eastern Weddell Sea

The Antarctic Pack Ice Seal (APIS) Program was initiated in 1994 to estimate the abundance of four species of Antarctic phocids: the crabeater seal Lobodon carcinophaga, Weddell seal Leptonychotes weddellii, Ross seal Ommatophoca rossii and leopard seal Hydrurga leptonyx and to identify ecological relationships and habitat use patterns. The Atlantic sector of the Southern Ocean (the eastern sector of the Weddell Sea) was surveyed by research teams from Germany, Norway and South Africa using a range of aerial methods over five austral summers between 1996-1997 and 2000-2001. We used these observations to model densities of seals in the area, taking into account haul-out probabilities, survey-specific sighting probabilities and covariates derived from satellite-based ice concentrations and bathymetry. These models predicted the total abundance over the area bounded by the surveys (30°W and 10°E). In this sector of the coast, we estimated seal abundances of: 514 (95 % CI 337-886) x 10**3 crabeater seals, 60.0 (43.2-94.4) x 10**3 Weddell seals and 13.2 (5.50-39.7) x 10**3 leopard seals. The crabeater seal densities, approximately 14,000 seals per degree longitude, are similar to estimates obtained by surveys in the Pacific and Indian sectors by other APIS researchers. Very few Ross seals were observed (24 total), leading to a conservative estimate of 830 (119-2894) individuals over the study area. These results provide an important baseline against which to compare future changes in seal distribution and abundance.

Notas críticas y exegéticas sobre el capítulo 166 (Antonio Diógenes, Las maravillas de más allá de Tule) de la "Biblioteca" de Focio.

Notas críticas y exegéticas sobre el capítulo 166 (Antonio Diógenes, Las maravillas de más allá de Tule) de la Biblioteca de Focio.

Ausonius’ Caesares

Ausonio de Burdigala (Burdeos) escribe entre los años 379-383 su obra poética titulada Caesares. Esta colección es una biografía de la vida de los emperadores en verso (hexámetro y dístico elegíaco). Caesares no está completa; la obra acaba de repente en el cuarteto dedicado a Heliogábalo. En este trabajo abordamos el género de la colección, examinamos el estilo de Ausonio en varias partes (monósticos y tetrásticos) y destacamos las fuentes (Suetonio, Tácito, Kaisergeschichte, Mario Máximo). Asimismo valoramos las diferentes opiniones que los estudiosos de Ausonio han expresado sobre la parte perdida de esta colección.

A prosodic mistake in the Latin of the Diccionario de la Lengua Española: Astur, -uris

In this paper we point out a prosodic mistake in the Latin etymology Astur, -uris, which is found in the two last editions of the Diccionario de la Lengua Española (twenty-second and twentythird – Edición del Tricentenario) and put forward its correction. We also analyse the entry astur in the prior editions of the Diccionario in order to recognise the changes undergone by the Latin term.

Quantitative evaluation of visual function 12 months after bilateral implantation of a diffractive trifocal IOL

PURPOSE: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month. METHODS: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively. RESULTS: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 logMAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05). CONCLUSIONS: The Physiol FineVision® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit.